Universal Health Coverage: A burning need for developing countries

The term of universal health coverage (UHC) are getting popularity among the countries who have not yet attained it. Majority of the developing countries are planning to implement the UHC to protect the vulnerable citizen who cannot afford to buy the health services. Poor people living in developing countries, where there is no UHC, are bereft of getting equal health care. They have to bear a significant amount of health cost in buying different services which often causes catastrophic expenditures for an individual and a family. If a country can provide UHC, it will be possible to bring all the citizens under provision of equal and quality care. However, implementation of a UHC is not an easy phenomenon, rather it needs proper design of a good health insurance system by integrating both the public and private health care providers. The influence of good governance and a sustainable health financing system is fundamental to establish UHC in the developing countries

Impact of Improved Cooking Stove on Maternal Health in Rural Bangladesh: A Quasi-Experimental Study

Introduction: Two-thirds of all households in developing countries depend on unprocessed biomass fuel for cooking. Traditional stoves have poor combustion capacity which produce heavy smoke and numerous  harmful pollutants. Switching to Improved Cooking Stove (ICS), a well-designed earthen made stove equipped with a chimney could be beneficial for health. The aim of this study was to assess the efficacy of ICS on maternal health in rural areas of Bangladesh. Methods: A quasi-experimental design was adopted to conduct the study. This study selected 150 Households from 5 villages (intervention) and 150 Households from 2 villages (control) from the Manikgonj District of Bangladesh during January 1, 2012 to July 30, 2012. Differences between control and intervention group were examined by applying t-test or one-way analysis of variance (ANOVA). The conventional cut-off value of 0.05 was taken as statistical significance. Stata (version 13) was used to do the analysis. Results: Most of the respondents (62%) were less than 30 years of age. About 94% participants resided in tin-shaded houses, and 51% kitchens were small. After the intervention period, the measured mean concentrations of Particulate Matter (PM2.5) for the intervention and control group was 259 µg/m3 and 1285 µg/m3, respectively (p<0.05). However, lung function test (LFT) did not reveal significant differences between the two groups (p>0.05). Conclusion: ICS reduced the incidence of respiratory illness among the intervention group, however, did not demonstrate significant changes in LFT during the six months of the follow-up period. Therefore, this study found ICS might have the potential to be used to improve the maternal health in rural Bangladesh. However, more longitudinal investigations are expected to demonstrate the efficacy and impact of ICS on maternal health to support the statement

Contexts and Opportunities of e-Health Technology in Medical Care

Keeping up with a sound health is a fundamental right for the human beings. It also acts as an indicator of the socio-economic development of a country. However, nowadays keeping sound health is challenging because of rapidly increasing non-communicable diseases. Concurrently, we are on the edge of very fast technological advancement which includes usage of cellular technology, high-speed internet and wireless communications. These technologies and their unique applications are creating lots of new dimensions in health care system which is known as e-Health. The medical call centers, emergency toll-free telephone services are being used in all over the world. The newly developed electronic health system can play a vital role in the remote regions of emerging and developing countries although sometimes it seems difficult due to the lack of communication infrastructure. E-Health can be a promising aspect for providing public health benefits if it integrates with the conventional medical system. More strategic approaches are necessary for the planning, development, and evaluation of e-Health. This article is written to depict the existing and future opportunities of e-Health in health support system

Access to Water and Awareness about the Unsafe Water in Rural Bangladesh

Introduction: Access to drinking water is a fundamental concern for many countries, including Bangladesh. Drinking of unsafe water might result to cause diseases and illness which heightens the economic burden for every one by increasing the treatment costs and work days lost. In Bangladesh, rural households coupled with the lack of safe water, also faces water-contamination with arsenic and other pollutants. Objective: This study explores the status of the rural people in accessing the water for households. It also determines their knowledge regarding the contaminated water. Methodology: The current study used retrospective data from Bangladesh Rural Advancement Committee’s (BRAC) Research and Evaluation Division’s baseline survey which was initiated under the ‘water, sanitation and hygiene’ program. Data was taken from 16,052 households between November 2006 and June 2007. Descriptive statistics were used to report the study findings. Results: Approximately 67% of the households had a permanent water source and majority had their deep tube well. A major proportion of the household respondent (70%) identified the method properly to purify polluted water. About 41% households used tube well as a source of water for daily purposes, i.e., drinking, cooking, washing utensils, and bathing. Majority (85%) of the households were found to pay willingly for a good source of water. Households with the non-governmental organization (NGO) membership were willing to pay even more for the safe water as compared to households without NGO membership. Conclusion: Respondents had considerable knowledge and awareness concerning the contaminated water. The association of NGO membership and level of awareness presented in this study should be of particular interest to the policy makers. Keywords:  Health, Awareness, Knowledge, Rural Bangladesh

End Organ Damage in Hypertensive Geriatric Age Group: A Cross Sectional Study

Objective: Hypertension is one of the common risk factors for cardiovascular and cerebrovascular diseases/disorders A developing country like India faces the double burden of communicable and non-communicable diseases; of the which, hypertension is the most important treatable cause of mortality and morbidity with loss of functional capacity and decline in the quality of life. Aim: To study the prevalence of end organ damage in the hypertensive geriatric age group. Method: The present study was a cross sectional study, conducted in 150 elderly patients admitted in MGM Hospital, Navi Mumbai, India with the diagnosis of stage I or II hypertension from 2011 to 2013. Results: Data analysis of the present study showed that 68% of elderly population aged between 60 to 69 years were suffering from hypertension. Compared to males, females had a higher rate of target organ damage. This study found that out of all patients with total end organ damage, 54.6 % had CVS complications, 15.7 % had hypertensive retinopathy, 25.9 % and 18.51 had raised creatinine and proteinuria respectively. 19.4 % had cerebrovascular accident (CVA) complications. Among Cardiovascular related complications Coronary artery disease (CAD) was found in 21 patients, out of them 7 had Congestive cardiac Failure (CCF). Left Ventricular Hypertrophy (LVH) was the most common complication and seen in 38 patients. 13.8 % patients had Regional Wall Motion Abnormality (RWMA) Conclusion: The present study concluded that Isolated Systolic Hypertension (ISH) is the commonest type of hypertension in geriatric age group. This study concluded that the most common risk factors of HTN in the elderly are sedentary life style, dyslipidemia and extra salt intake while the most common end organ damage was observed to be Left Ventricular Hypertrophy followed by renal dysfunction

An Association of Total Health Expenditure with GDP and Life Expectancy

Introduction: Gradual  total health expenditure (THE) has become a major concern. It is not only the increased THE, but also its unequal growth in  overall economy, found among the developing countries. If increased life expectancy is considered as a leverage for an individual’s investment in health services, it can be  expected that as the life expectancy increases, tendency of health care investment will also experience a boost up. Objective: The aim of the present study was to explore and identify the association of healthcare expenditure with the life expectancy and Gross Domestic Product (GDP) in developing countries, especially that of Bangladesh. Methodology: Data were retrospectively collected from “Health Bulletin 2011” and “Sample Vital Registration System 2010” of Bangladesh considering the fiscal year 1996 to fiscal year 2006. Using STATA, multivariable logistic regression was performed to find out the association of total health expenditure with GDP and life expectancy. Results: A direct relationship between GDP and total health expenditure was found through analysing the data. At the individual level, income  had a direct influence on health spending. However, there was no significant relationship between total health expenditure with increased life expectancy. Conclusion: The present study did not find any association between life expectancy and total health expenditure. However, our analysis found out that total health expenditure is more sensitive to gross domestic product rather than life expectancy

ACE Alzheimer’s: The Role of Vitamin A, C and E (ACE) in Oxidative Stress induced Alzheimer’s Disease

Alzheimer's disease (AD), a chronic neurodegenerative disease which is known to progress gradually and has now become a substantial health concern through-out the world. Clinically, cognitive declination and progressive dementia are the main characteristics of AD while pathologically; Aß plaques and tau-neurofibrils are the hallmarks. The present literature search has suggested that oxidative stress is one of the most vital risk factor which can potentially lead to the development of AD. Oxidative stress is known to produce the Reactive Oxygen Species (ROS) which has a potential to increase in the structural and functional abnormalities in the glial cells of the brain and which could further lead to a cognitive decline and subsequently, dementia. Hence, in order to curb this oxidative stress in the glial cells, antioxidants have been proved to be of great help according to the literature search done in PubMed, Google Scholar and Scopus. We included Meta-Analysis, Systemic Reviews and Original studies. Vitamins A, C, and E are an example of antioxidants that can be used as adjuvants in the treatment of AD. This article focuses on the contemporary literature search and presents forward the evidence-based banes of using Vitamin A, C, and E as an adjuvant therapy for preventing and treating AD

Case Report: Unprovoked venous thromboembolism in a young adult male [version 2; peer review: 2 approved]

A 24-year-old male was presented to us with sudden onset of chest pain and dyspnea for the past one hour. There was no history of calf pain, trauma, surgery, prolonged immobilization, long-haul air travel, bleeding diathesis or any other co-morbidity. The patient denied any addiction history. The heart rate was 114 beats/min, and blood pressure was 106/90 mmHg. Electrocardiogram showed tachycardia with S 1Q 3T 3 pattern. The left arterio-venous Doppler study was suggestive of a thrombus in popliteal vein and sapheno-popliteal junction. The CT-Pulmonary Angiogram scan was suggestive of a massive pulmonary thromboembolism. The patient was thrombolysed with Intravenous Alteplase immediately and was put on tab Rivaroxaban for maintenance. He was later discharged after being stable. Unprovoked venous thromboembolism (VTE) is very rare and has the potential to lead to pulmonary embolism which could be disastrous, especially in young adults. We present such a case where unprovoked VTE was diagnosed and treated. This case suggests that high clinical suspicion is the key for the diagnosis of acute pulmonary embolism, especially in the absence of history suggestive of deep vein thrombosis

OUTCOME OF STAGE T1 RENAL CELL CARCINOMA TREATED WITH PARTIAL NEPHRECTOMY: INITIAL EXPERIENCES FROM A TEACHING HOSPITAL IN BANGLADESH

Background: Renal cell carcinoma accounts for 85% of all solid tumors of the kidney. For many years, radical nephrectomy was the stan¬dard treatment for RCC. Partial nephrectomy has gradual¬ly replaced radical nephrectomy over the past decade, es¬pecially for T1 stage renal cell carcinoma. However, the benefit of partial nephrectomy on oncolog¬ic outcomes is not well known. Objective: to investigate the clinical outcome of partial nephrectomy on T1 renal cell carcinoma. Methods: This prospective observational study was conducted in a single unit of urology department of Dhaka Medical College Hospital, Bangladesh from the period September 2014 to September 2017. Fourteen patients underwent partial nephrectomy during this period with renal mass based on eligibility criteria. Two follow up was done at three months and six months. Result: Mean age of the patients undergoing surgery was 52.0± 3.8 (46.0 to 57.0 years) years. For the majority of the patients, tumour size was in a range of 3-7 cm. Average operative time was 90 minutes and mean ischaemic time was 16.5 ± 4.6 minutes (14.5 to 21.0 minutes). Histopathological reports correlated with clinical diagnosis and showed adequate surgical clear margin in every case. There was no recurrence of tumour noticed during the two follow up periods. The different investigation did not reveal the impaired renal functional test during the follow-up period. Conclusion: The clinical outcome of partial nephrectomy was found better in this study. Partial nephrectomy has the potential to replace radical nephrectomy for managing T1 tumours. However, there are some controversies regarding the post-operative oncological outcome. More studies are recommended to investigate the effect of partial nephrectomy for T1 tumours