Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: Progress towards Sustainable Development Goal 3

Summary Background Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching$7·9 trillion (95% uncertainty interval 7·8–8·0) in 2017 and is expected to increase to $11·0 trillion (10·7–11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was$20·2 billion (17·0–25·0) and on tuberculosis it was $10·9 billion (10·3–11·8), and in malaria-endemic countries spending on malaria was$5·1 billion (4·9–5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019,$374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6–81·7) in 2015 to 83·1% (82·8–83·3) in 2030. Interpretation Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Funding The Bill & Melinda Gates Foundation

Setting HbA1c targets for patients with type 2 diabetes

Therapeutic strategies to optimize glycaemic control are an important part of clinical decision for management of patients with type 2 diabetes (T2DM). Several guidelines provide a target value of HbA1c for all T2DM patients. However, a "one-size-fits-all" goal might not be the best strategy for all T2DM patients

Childhood morbidity pattern and health seeking behaviors in Jumla district

Background: Jumla is a mountainous District that lies in Karnali Zone. Health status as well as health services in the district are very miserable. To provide preventive, promotive and curative health services for around 89,000 populations, 1 district hospital, 1 PHC, 8 health Posts and 20 Sub Health Posts have been established. This research aims to explore childhood morbidity pattern and practice of health seeking during illness in the district where virtually no research activities happen. Further, both childhood morbidity and health seeking behaviors are compared with various indigenous and social factors. Methods: Around 300 children were selected by WHO 30 cluster sampling for the study however only respondent of 278 children were available for the study. Sampling method was of probability type. Data were entered and analyzed in computer program SPSS and statistical inferences is drawn on the basis of percentage, mean and chi-square test. The study period was of around three months. It is a descriptive and cross sectional study and target population is under five children. Study was for the period of 1st Chaitra 2062 to 30th Falgun 2063. To get the inferences, statistical tools like chi-square test and mean are used. Results: In the period of last two weeks, 60.9 percent children were exposed to any type of illness. Cough and cold was the most leading cause of illness with 56 percent of children had its symptoms. Second leading is Diarrhoea and Dysentry with 21.8 percent third is Pneumonia with 9.2 percent. Two weeks incidence of disease is significantly associated with the house hold not using toilet (p = 0.017) and living away from one hour of distance from health institution (p = 0.036). Two weeks incidence is also higher among uneducated mothers, farmers, laborers and housewives. Similarly joint families and having traditional house hold are also more likely to be exposed to sickness. The proportion of mothers who sought modern health care for two weeks incidence is 46.1 percent, Home treatment 26.9 percent, traditional treatment 7.8 and doing nothing is 19.2 percent. Highest proportion of people sought the special care because it was easily available 38.1 percent where as 27.4 percent preferred it. More than two in three mothers take service from either Health Worker or Health Institution and more than one in four visited FCHV first among the people who sought for modern health care. On the other hand more than 50 percent felt lack of time or service unavailable to take service from health care providers. Treatment failure rate was highest among traditional healers 50% and lowest among modern health care seekers 3 percent (condition worsened and not changed). Treatment success rate is better in home treatment than that of doing traditional treatment or doing nothing. In an average, one child suffered 2.1 episodes of illness during last one year, and maximum episode was 12. They waited in an average 57.2 days in ear infection, 9.3 days in skin infection and 3.0 days for diarrhoea to seek health care. Diarrhoea and Pneumonia are felt most serious disease in Jumla. Feeding practices during diarrhoea is not satisfactory and just one in ten respondents know proper home care of cough and cold. Home treatment of fever and ear infection is horrible and harmful, unfortunately majority are pursuing it. Conclusions: It is necessary to develop, implement, and evaluate interventions to improve caretaker behaviors essential to child survival, including prevention, recognition of illness, home care of the sick child, and appropriate and timely care seeking. Also required are the development and testing of methods to motivate health personnel to adopt and sustain the new practices required by integrated case management of the sick child, including communication with caretakers

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019

Background: Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods: We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings: Globally in 2019, 1·14 billion (95% uncertainty interval 1·13–1·16) individuals were current smokers, who consumed 7·41 trillion (7·11–7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5–28·5] reduction) and females (37·7% [35·4–39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98–1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16–8·20) deaths and 200 million (185–214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3–21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation: In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Funding: Bloomberg Philanthropies and the Bill & Melinda Gates Foundation

Prevalence of depression and its associated factors in patients with type 2 diabetes: A cross-sectional study in Dhaka, Bangladesh

Depression is a common feature in patients with type 2 diabetes and often remains undetected and untreated, causing increased morbidity and mortality. We explored the prevalence of co-morbid depression and its associated factors, including major life-events among patients with type 2 diabetes in Bangladesh. We conducted a cross-sectional study among 515 patients with type 2 diabetes between September 2013 and July 2014 in a tertiary hospital in Dhaka city. We assessed depression using Patient Health Questionnaire-9 (PHQ-9) with predefined cut-off scores of 5, 10, 15 and 20 to indicate minimal, mild, moderate, moderately-severe, and severe depression. Associations between depression and its associated factors were explored using univariate and multivariate regression. Overall, 61.9% participants had depressive symptoms, and the prevalence was higher among females (70.9%) compared to males (50.6%). One-third (35.7%) of participants had mild depression and 36.2% had moderate to severe depression. In the multivariate analysis, factors significantly associated with depression were: age ≤ 60 years (OR: 2.1, 95% CI = 1.2–3.6; p ≤ 0.006), female gender (OR = 1.9, 95% CI = 1.3–3.0; p ≤ 0.002), those having 1–3 complications (OR = 2.3, 95% CI = 1.2–4.3; p = 0.010), experienced loss of business or crop failure (OR = 2.1, 95% CI = 1.2–3.6; p = 0.006), major family conflicts (OR = 2.2, 95% CI = 1.4–3.5; p ≤ 0.001), separation or deaths of family members or divorce (OR = 2.2, 95% CI = 1.4–3.5; p ≤ 0.001), and those who experienced unavailability of food or medicines (OR = 2.2, 95% CI = 1.0–4.5; p = 0.038). Patients with diabetes, especially females, those having other complications, and major life-events should routinely be screened for symptoms of depression with adequate management of these conditions

Socio-cultural factors influencing in care seeking practices during diarrhoea in Tharu community

Diarrhoea has been considered as the major cause of death in developing countries estimating about 5 million children under 5 death and 750 millions suffer per annum. In Nepal 90 percent of population suffer by water home diseases with diarrhoea as major health problem. Human and social factors are very predominant for diarrhoea and death due to diarrhoea. Taking community as a whole, there are many ideas, beliefs, prejudices, and practices those are helpful or obstructive for the health programme for prevention and control of diarrhoea at all levels of health care in Nepal

Mapping routine measles vaccination in low- and middle-income countries

The safe, highly effective measles vaccine has been recommended globally since 1974, yet in 2017 there were more than 17 million cases of measles and 83,400 deaths in children under 5 years old, and more than 99% of both occurred in low- and middle-income countries (LMICs)1–4. Globally comparable, annual, local estimates of routine first-dose measles-containing vaccine (MCV1) coverage are critical for understanding geographically precise immunity patterns, progress towards the targets of the Global Vaccine Action Plan (GVAP), and high-risk areas amid disruptions to vaccination programmes caused by coronavirus disease 2019 (COVID-19)5–8. Here we generated annual estimates of routine childhood MCV1 coverage at 5 × 5-km2 pixel and second administrative levels from 2000 to 2019 in 101 LMICs, quantified geographical inequality and assessed vaccination status by geographical remoteness. After widespread MCV1 gains from 2000 to 2010, coverage regressed in more than half of the districts between 2010 and 2019, leaving many LMICs far from the GVAP goal of 80% coverage in all districts by 2019. MCV1 coverage was lower in rural than in urban locations, although a larger proportion of unvaccinated children overall lived in urban locations; strategies to provide essential vaccination services should address both geographical contexts. These results provide a tool for decision-makers to strengthen routine MCV1 immunization programmes and provide equitable disease protection for all children

Epidemiology of non-communicable diseases (NCDs) in Bangladesh

This report on the Non-communicable Diseases (NCDs) is the sixth report presented by the Bangladesh Health Watch (BHW) on the state of health in Bangladesh. BHW, a civil society advocacy initiative since 2006 has been producing analytical reports on different issues that deserve priority attention of the government as well as non-government stakeholders who are committed to improve the health condition and health system of Bangladesh. So far five reports have been published. The first report focused on health equity (BHW, 2006); the second report on health workforce (BHW, 2007); the third report on governance of the health sector (BHW, 2009); the fourth report on universal health coverage (BHW, 2011); and the fifth report on urban health (BHW, 2014). All the BHW reports have attempted to present up-to-date data on the topic under discussion, analyze their policy and program implications and recommend long and short term actions. The reports were presented in public dialogues attended by policy makers program implementers, civil society advocacy groups, and development partners as well as media representatives. All BHW reports drew widespread media coverage, and generated discussion and debate about various policy and program options that need to be considered by all stakeholders

‘Connecting the dots’ for generating a momentum for Universal Health Coverage in Bangladesh: Findings from a cross-sectional descriptive study

Objective This study was conducted to explore how and whether, the strategic grants made by the Rockefeller Foundation (RF) in different sectors of health systems in the inception phase were able to ‘connect the dots’ for ‘generating a momentum for Universal Health Coverage (UHC)’ in the country. Design Cross-sectional descriptive study, using document review and qualitative methods. Setting Bangladesh, 17 UHC-related projects funded by the RF Transforming Health Systems (THS) initiative during 2010–2013. Data Available reports of the completed and on-going UHC projects, policy documents of the government relevant to UHC, key-informant interviews and feedback from grant recipients and relevant stakeholders in the policy and practice. Outcome measures Key policy initiatives undertaken for implementing UHC activities by the government post grants disbursement. Results The RF THS grants simultaneously targeted and connected the academia, the public and non-profit development sectors and news media for awareness-building and advocacy on UHC, develop relevant policies and capacity for implementation including evidence generation. This strategy helped relevant stakeholders to come together to discuss and debate the core concepts, scopes and modalities of UHC in an attempt to reach a consensus. Additionally, experiences gained from implementation of the pilot projects helped in identifying possible entry points for initiating UHC activities in a low resource setting like Bangladesh. Conclusions During early years of UHC-related activities in Bangladesh, strategic investments of the RF THS initiative played a catalytic role in sensitising and mobilising different constituencies for concerted activities and undertaking necessary first steps. Learnings from this strategy may be of help to countries under similar conditions of ‘low resource, apparent commitment, but poor governance,’ on their journey towards UH

Diabetes knowledge and utilization of healthcare services among patients with type 2 diabetes mellitus in Dhaka, Bangladesh

Diabetes is a significant global public health concern. Poor knowledge of disease and healthcare utilization is associated with worse health outcomes, leading to increasing burden of diabetes in many developing countries. This study aimed to determine diabetes related knowledge and factors affecting utilization of healthcare services among patients with type 2 diabetes mellitus in Bangladesh