Health Sector of Bangladesh

he study report on the Gender Equity Analysis of Operational Plans (OPs) in the Health, Population, and Nutrition (HPN) sector of Bangladesh from 2017 to 2022 provides an in-depth exploration of the relationship between gender equity and health outcomes. It opens with a robust background that contextualizes the importance of health within Bangladesh's development goals, particularly in light of the country's aim to transition to a middle-income status. The National Health Policy 2011 emphasizes health as a human right, advocating for equitable access to healthcare, especially for disadvantaged and marginalized populations.

The introduction sets the stage by addressing the historical and ongoing efforts of the Government of Bangladesh (GOB) to implement sector-wide approaches to health, most notably through programs like the Health, Population, and Nutrition Sector Development Program (HPNSDP). This section outlines the core objectives of the operational plans, specifically aimed at ensuring quality healthcare delivery across diverse demographics.

The report details how gender equity is fundamentally recognized as a vital component of any healthcare framework. It discusses various dimensions of gender, including how social norms and roles can impact women's access to health services. The analysis reveals that although initiatives have been laid out to promote women's empowerment and reduce health risks, persistent gaps remain in the actual incorporation of gender-sensitive practices into OPs. There is an acknowledgment that gender norms, behaviors, and institutional barriers significantly influence these health behaviors, and these are not always effectively addressed in program planning or execution.

Throughout the report, various domains are discussed, including the context, objectives, and relevance of the OPs concerning gender inclusion. The analysis emphasizes the need for a gender-sensitive approach, particularly in areas concerning maternal and child health. It argues that the existing OPs often fail to adequately consider the specific barriers women face and do not sufficiently address the healthcare needs of transgender individuals or other marginalized genders.

Another notable aspect of the report is its examination of operational actions and activities, which are often not sufficiently detailed in terms of how gender equity is integrated. The report critiques the lack of gender-specific indicators within strategic objectives, highlighting the necessity for concrete actions to promote gender equity at all levels of health programming.

The narrative culminates in a call for a comprehensive reassessment of existing frameworks and strategies to better align with both national and international gender equity commitments, such as the Sustainable Development Goals (SDGs). Overall, the report presents a critical reflection on current practices and paves the way for future discussions on enhancing gender equity in health programs within the HPN sector.

Bangladesh has significantly improved health indicators during the last 20 years, notably lower infant mortality and fertility rates. The research titled "Assessing Community Clinic Utilisation in Health Service Development of Bangladesh" investigates the function of community clinics (CCs) in enhancing healthcare accessibility in rural Bangladesh. Community clinics, designed to deliver vital health services to rural people, are crucial in enhancing accessibility and fostering community engagement. This study seeks to determine socio-economic and demographic factors influencing service usage and examine the present state of community clinic use.  Notwithstanding considerable advancements in health metrics, rural healthcare encounters obstacles such as inadequate infrastructure, a shortage of medical personnel, and financial impediments. The research utilises a cross-sectional data analysis from 120 community clinic users across 12 districts by using structured questioners and analysis using SPSS. Research indicates that usage is affected by socio-economic and demographic variables, with women mostly utilising services. Financial constraints and educational obstacles also affect accessibility. Staffing challenges, training deficiencies, and resource constraints impede the quality of care, but Care Coordinators are vital in providing essential services. The study advocates for the resolution of infrastructural and quality concerns, the improvement of training, and the promotion of community engagement to maximize clinic efficacy and accessibility.  The findings point out the socio-cultural views and economic obstacles substantially influence clinic utilization rates. This research enhances the debate on health service development in Bangladesh, emphasizing the significance of community clinics in attaining equal healthcare access.

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Introduction: The COVID-19 has overwhelmed health systems across the countries globally. This pandemic has also impacted health related rehabilitation services worldwide which is particularly profound in low and middle-income countries including Bangladesh. Methods: Information used in the study gathered from World Health Organization (WHO) Bangladesh Director General of Health Services (DGHS), Institute of Epidemiology Disease Control and Research (IEDCR), online literature search using PubMed and PubMed Central research engines. Information also collected over personal telephone and email correspondence from the selected government, public, corporate, non-government institutes, and rehabilitation personals during the period of March-May 2020. Gathered data were analyzed; a set of challenges identified, and recommendations were made for a safe and standard working rehabilitation environment in the altered COVID-19 situation. Results: Rehabilitation doctors and therapists at most of...

SARS-CoV-2, commonly referred as COVID-19, has emerged as the most severe public health concern of the twenty-first century. Coronavirus usually is not very lethal to the persons who do not have any medical conditions, but it is fatal to people who have had past medical conditions that have often resulted in death. The objectives of this paper is to look at the effects of coronavirus on older diabetes patients, who are thought to be the ones who were affected the most by COVID-19. This research used a qualitative approach and was descriptive in nature. The researcher has purposefully chosen three areas in Dhaka city as the studies fixate: Shahbag, Khilgaon, and Rampura. Data was gathered using qualitative methods such as focus group discussion and key informant interviews. According to the study's findings, COVID-19 had a serious effect on older adults with diabetes. The number of patients at the hospital had significantly decreased. Despite the fact that hospitals were equipped to provide treatment and care, patients' mobility was limited. Many people preferred virtual consultation or telemedicine to face-to-face consultation and care. Doctors encouraged individuals to connect digitally, which is both safe and feasible in the face of the global pandemic. The expense of a diabetic patient rose, according to the majority of respondents. According to the findings, the pandemic is spurring new diabetes-care delivery methods. Many structural flaws were exposed as a result of Covid-19, paving the door for additional improvements in healthcare delivery in the study area.

Background Owing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatric patients is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness, and success. Objective The objective of this study is to compare postoperative patient comfort, length of hospital stay, and cost-effectiveness of pediatric laparoscopic appendectomies performed under spinal and general anesthesia with the usual standard-of-care procedures employed in the hospital. Methods This is a case series of 77 consecutive pediatric laparoscopic appendectomies (involving 5-8–year-old children) that took place in a hospital in Chittagong, Bangladesh, in 2019. A total of 40 patients underwent spinal anesthesia and 37 patients underwent general anesthesia. Variables such as surgery and operation theater times, pain score, incidence of postsurgery vomiting, analgesic usage, discharge times, and hospital costs were recorded. Statistical analysis ...

Background Surgery may be needed during pregnancy for nonobstetric reasons, most commonly appendicitis, and laparoscopy is considered as safe as the open method, for both mother and fetus. The aim of the present study was to emphasize the feasibility of laparoscopic appendectomy during pregnancy in a developing country, and also to report the first study of its kind from Bangladesh. Materials and methods From 7 October 2005 to 6 October 2010, 31 pregnant women were diagnosed with acute appendicitis. Diagnoses were based on clinical suspicion supported by ultrasonogram. Under general endotracheal anesthesia, laparoscopy was done in all 31 cases. One gynecologist was always present to monitor the conditions of the fetus preoperatively and postoperatively. Feeding was allowed 6 h after surgery, and the majority of the patients were discharged on the second postoperative day. Age, gestational period, operative time, hospital stay, maternal and fetal outcome, and complications were evaluated. Results Age ranged from 19 to 35 years and gestational period ranged from 6 to 31 weeks. Right lower quadrant pain was the presenting complaint in majority of cases. Average operative time was 34 ± 10.19 min, and there were no conversions to open surgery. There were no intraoperative or immediate postoperative hazards. Postoperative recovery was uneventful in all cases. Histopathology of 30 cases confirmed appendicitis. One patient, whose fetus was at 12 weeks gestation at the time of the appendectomy had a spontaneous abortion 1 month later. There were no adverse outcomes during the followup period. Conclusions Laparoscopy is a safe and effective technique for the treatment of appendicitis during pregnancy and can be performed in a developing country.

Introduction Bangladesh harbors many leeches in its vast wetlands. Leeches have a tendency to enter through body orifices with potentially life-threatening consequences. Literature search revealed inadequate description of clinical manifestations and treatment of leech infestations in children. We describe our experience with leech infestations in children. Methods Between January 1, 2004 and December 31, 2010, 17 cases of leech infestation through body orifices in children were managed. This is a retrospective study on age, sex, route of leech entry, investigation and treatment, and outcome. Results Age ranged from 4.5 to 11 years (mean 6.4 ± 1.8) and females accounted for more than 70 %. The orifices of leech entry include urethra, vagina, and rectum. Leeches could be found in eight cases. Two boys with leeches in the urinary bladder needed suprapubic removal. Leeches were retrieved from the vagina under general anesthesia in three cases, and on three occasions leeches came out from the vagina after normal saline instillation. In nine cases with different routes of entry where leech was not found, instillation of normal saline was sufficient to stop bleeding. Fifteen cases presented with bleeding and transfusion was required in five cases with Hb% \7 gm/dl. Conclusions Leech infestation through lower body orifices is common in children of rural Bangladesh. Prompt diagnosis is of paramount importance, and application of normal saline is effective in most cases. Sometimes surgical intervention is required.

Introduction Acute segmental enteritis is also known as acute segmental necrotizing enteritis, segmental obstructing acute jejunitis, and enteritis necroticans. Children presenting with high fever, P/R bleeding, prostration etc. along with features of intestinal obstruction are not uncommon. Many of these cases had to be operated upon revealing no definite obstructing lesion, except a segment of small gut with different magnitude of inflammation. The principal author encountered many of these cases in the same hospital and also in the previous working places. This study was thus undertaken and this is the first report from Bangladesh on segmental enteritis. Materials and methods From 1 January 2004 to 31 December 2009, 24 consecutive cases suffering from enteritis were managed. This prospective descriptive study evaluates the sex, age, presentations, physical findings, operative findings, hospital stay, outcome and complications. The inclusion criteria were an acute abdominal presentation, plain radiographic features of intestinal obstruction and intraoperative findings of segmental small intestinal involvement with ischemic lesions without definite obstruction. Results Fever and leucocytosis were present in all, abdominal tenderness in 17 and per-rectal bleeding in 15 cases. Jejunum alone was involved in 17, both jejunum and ileum in 5 and ileum alone in 2 cases. Scattered dark patches over the intestinal wall was found in 16, circumferential dusky lesions in 4, perforation in one and frank gangrene in 3 cases. Bacteriology of the peritoneal fluid in 17 cases revealed mixed flora. Histopathology of the mesenteric lymph nodes in 11 cases showed non-specific hyperplasic changes. Histopathology of four resected gut walls showed inflammatory infiltrates. In 17 cases recovery was uneventful. Seven cases suffered different complications including two (8.33%) deaths. One with ileal stricture and another with fecal fistula required reoperation. Mean hospital stay was 10.63 ± 3.00 days. The surviving patients were followed up for at least 6 months and faring well. Conclusions Segmental enteritis is occasionally encountered as a cause of acute abdomen in children of Bangladesh. Operative treatment is required and mechanical obstructing lesion was found in none of the cases. Majority of cases improve on intraoperative measures other than gut resections or creation of stoma.

Aim This survey reviewed the practice of laparoscopic appendectomy in pediatric surgical centers across Europe. Methods An online survey questionnaire was created and data obtained analyzed. Results There were 58 responders (52 Consultants and 6 trainees), of them n = 24 performed > 100 laparoscopic procedures per year. Procedures were performed by trainee with scrubbed consultant supervision n = 30, trainee with unscrubbed consultant n = 14, independent trainees n = 8 and consultants n = 6. Optic port preferences were 10 mm (n = 29), 5 mm (n = 24) and 12 mm (n = 3). Working port placement preference was sectorization n = 32, triangulation n = 16 and n = 10 decided based on intraoperative findings. Mesoappendix was dissected by monopolar hook n = 26, bipolar forceps n = 20, harmonic devices n = 8, and bipolar scissors n = 4. Appendix ligation was done with 3 vicryl endoloops (n = 36), 2 vicryl endoloops (n = 13), 3 polydioxanone (PDS) endoloops (n = 7) and endostaplers (n = 2). Appendix was removed through optic 10-12 mm port (n = 27), exchanging 5 mm for 10-12 mm port (n = 9), endobag (n = 8), sterile glove digit endobag (n = 7), through 5 mm ports (n = 5) and along 5 mm port (n = 2). In complicated appendicitis, n = 48/58 would proceed with laparoscopy on prior confirmed perforation and n = 53/58 would continue with laparoscopy when intraoperative findings showed complicated appendicitis. In the presence of pus, n = 52/58 would perform peritoneal lavage and n = 4/58 would only suction pus. Complicated appendices were removed via endobag n = 30, through 10-12 mm port n = 10, sterile glove digit n = 10, exchange 5 mm for 10-12 mm port n = 7 and along with work port n = 1. Conclusion Opinions were divided with regards to approach in performing various steps of pediatric laparoscopic appendectomy in institutions throughout Europe.

SARS-CoV-2, commonly referred as COVID-19, has emerged as the most severe public health concern of the twenty-first century. Coronavirus usually is not very lethal to the persons who do not have any medical conditions, but it is fatal to people who have had past medical conditions that have often resulted in death. The objectives of this paper is to look at the effects of coronavirus on older diabetes patients, who are thought to be the ones who were affected the most by COVID-19. This research used a qualitative approach and was descriptive in nature. The researcher has purposefully chosen three areas in Dhaka city as the studies fixate: Shahbag, Khilgaon, and Rampura. Data was gathered using qualitative methods such as focus group discussion and key informant interviews. According to the study's findings, COVID-19 had a serious effect on older adults with diabetes. The number of patients at the hospital had significantly decreased. Despite the fact that hospitals were equipped to provide treatment and care, patients' mobility was limited. Many people preferred virtual consultation or telemedicine to face-to-face consultation and care. Doctors encouraged individuals to connect digitally, which is both safe and feasible in the face of the global pandemic. The expense of a diabetic patient rose, according to the majority of respondents. According to the findings, the pandemic is spurring new diabetes-care delivery methods. Many structural flaws were exposed as a result of Covid-19, paving the door for additional improvements in healthcare delivery in the study area.

Introduction: The COVID-19 has overwhelmed health systems across the countries globally. This pandemic has also impacted health related rehabilitation services worldwide which is particularly profound in low and middle-income countries including Bangladesh. Methods: Information used in the study gathered from World Health Organization (WHO) Bangladesh Director General of Health Services (DGHS), Institute of Epidemiology Disease Control and Research (IEDCR), online literature search using PubMed and PubMed Central research engines. Information also collected over personal telephone and email correspondence from the selected government, public, corporate, non-government institutes, and rehabilitation personals during the period of March-May 2020. Gathered data were analyzed; a set of challenges identified, and recommendations were made for a safe and standard working rehabilitation environment in the altered COVID-19 situation. Results: Rehabilitation doctors and therapists at most of...

Background: Bangladesh with its large population is highly vulnerable to the devastating blows of coronavirus disease 2019 (COVID-19) and rural people are more at risks due to demographic characteristics and unequal health facilities. Currently, focuses are more on testing and clinical management of COVID-19 but initiatives or innovations on behavioural changes are almost unseen to prevent the spread of the disease which is more urgent until getting specific treatment or vaccine. Objective: The study was aimed to determine significant predictors in the preventive health practices during COVID-19 pandemic. Methods: The study was conducted among 810 rural adults of Bangladesh in 2020. Multistage sampling method was done and data were collected through face-to-face interview using a pretested questionnaire. Significant factors of COVID-19 prevention behaviour were determined through hierarchical regression and path relationships were explained through causal model. Results: Almost half...

Introduction: The COVID-19 has overwhelmed health systems across the countries globally. This pandemic has also impacted health related rehabilitation services worldwide which is particularly profound in low and middle-income countries including Bangladesh. Methods: Information used in the study gathered from World Health Organization (WHO) Bangladesh Director General of Health Services (DGHS), Institute of Epidemiology Disease Control and Research (IEDCR), online literature search using PubMed and PubMed Central research engines. Information also collected over personal telephone and email correspondence from the selected government, public, corporate, non-government institutes, and rehabilitation personals during the period of March-May 2020. Gathered data were analyzed; a set of challenges identified, and recommendations were made for a safe and standard working rehabilitation environment in the altered COVID-19 situation. Results: Rehabilitation doctors and therapists at most of...

Background The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence. Methods We conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, an...

The private retail drug shops market in Bangladesh is largely unregulated and unaccountable, giving rise to irrational use of drugs and high Out-of-pocket expenditure on health. These shops are served by salespersons with meagre or no formal training in dispensing. This facility-based cross-sectional study was undertaken to investigate how the drug shops currently operate vis-a-vis the regulatory regime including dispensing practices of the salespersons, for identifying key action points to develop an accredited model for Bangladesh. About 90 rural and 21 urban retail drug shops from seven divisions were included in the survey. The salespersons were interviewed for relevant information, supplemented by qualitative data on perceptions of the catchment community as well as structured observation of client-provider interactions from a sub-sample. In 76% of the shops, the owner and the salesperson was the same person, and >90% of these were located within 30 min walking distance from...

COVID-19 has affected 213 countries around the world, killing more than 484,000 and infecting more than 9.5 million by June 25, 2020 (worldometer.info). Bangladesh, a South Asian low-middle-income economy, has experienced a demographic and epidemiological transition with rapid urbanization and a gradual increase in life expectancy. It is the seventh most populous country in the world and population of the country is expected to be nearly double by 2050. The increasing burden of communicable diseases in Bangladesh can be attributable to rapid urbanization and nearly 50% of all slum dwellers of the country live in Dhaka division. In 2017, National Rapid Response Team of IEDCR investigated 26 incidents of disease outbreak. The joint survey of the Power and Participation Research Centre and BRAC Institute of Governance and Development reveals that per capita daily income of urban slum and rural poor drops by 80% due to present countrywide shutdown enforced by the government to halt the spread of COVID-19. 40%-50% of these population took loans to meet the daily expenses. However, the country has just 127,000 hospital beds, 91,000 of them in government-run hospitals. Researchers say, the country's economy is losing BDT 33 billion every day from its service and agriculture sectors during the nationwide shutdown.

COVID-19 has affected 213 countries around the soil, killing around 480,000 and infecting close to 9.4 million by June 24, 2020 (worldometer.info). Bangladesh, a low-middle-income South Asian economy, has experienced an epidemiological and demographic transition with rapid urbanization and a gradual increase in life expectancy. It is the world's seventh most populous country and the country's population is expected to almost double by 2050. The increasing burden of transmissible diseases in Bangladesh can be attributed to rapid urbanization and nearly 50% of the country's slum residents live in the Dhaka division. Institute of Epidemiology, Disease Control, and Research National Rapid Response Team investigated 26 diseaseoutbreak incidents in 2017. The joint survey conducted by the Power and Participation Research Center and the Bangladesh Rural Advancement Committee Institute for Governance and Development reveals that per capita daily income of urban slums and rural poor people drops by 80% due to the current national shutdown forced by the government to stop the increase of COVID-19. About 40-50% of these inhabitants took loans to get together the daily operating cost. The country has only 127,000 hospital beds, of which 91,000 are in government-run hospitals. Researchers say that the economy of the country loses 33 billion BDT per day from its repair in addition to agriculture sectors during the nationwide shutdown.

Background: Kamrangirchar and Hazaribagh are the largest slum areas in Dhaka, Bangladesh. In 2013, Médecins Sans Frontières initiated an urban healthcare programme in these areas providing services for factory workers and responding to the sexual and reproductive health needs of young women. Little in-depth information is available on perceptions of health and health seeking behaviour in this population. We aimed to provide a better understanding of community perceptions toward health and health care in order to inform programme strategies. Methods: In-depth interviews were conducted with women (n = 13); factory workers (n = 14); and key informants (n = 13). Participants were selected using purposive maximum variation sampling and voluntarily consented to take part. Topic guides steered participant-led interviews, which were audio-recorded, translated and transcribed from Bangla into English. By comparing cases, we identified emerging themes, patterns and relationships in the data. NVivo11© was used to sort and code the data. Results: Emerging themes indicated that in Kamrangirchar and Hazaribagh, health is seen as an asset necessary for work and, thus, for survival. Residents navigate a highly fragmented health system looking for 'quick fixes' to avoid time off work, with the local pharmacy deemed 'good enough' for 'common' health issues. Health care seeking for 'serious' conditions is characterised by uncertainty, confusion, and unsatisfactory results. Decisions are made communally and shaped by collective perceptions of quality care. People with limited socioeconomic capital have few options for care. 'Quality care' is perceived as comprehensive care 'under one roof,' including predictive biomedical diagnostics and effective medication, delivered through a trusting relationship with the care provider. Conclusions: Health seeking behaviour of slum dwellers of Kamrangirchar and Hazaribagh is based on competing priorities, where quick and effective care is key, focussed on the ability to work and generate income. This takes place in a fragmented healthcare system characterised by mistrust of providers, and where navigation is informed by word-of-mouth experiences of peers. Improving health in this context demands a comprehensive and integrated approach to health care delivery, with an emphasis on rapid diagnosis, effective treatment and referral, and improved trust in care providers. Health education must be developed in collaboration with the community to identify knowledge gaps, support decision-making, and be channelled through existing networks. Further research should consider the effectiveness of interventions aiming to improve the practice of pharmacists.

Introduction: The COVID-19 has overwhelmed health systems across the countries globally. This pandemic has also impacted health related rehabilitation services worldwide which is particularly profound in low and middle-income countries including Bangladesh. Methods: Information used in the study gathered from World Health Organization (WHO) Bangladesh Director General of Health Services (DGHS), Institute of Epidemiology Disease Control and Research (IEDCR), online literature search using PubMed and PubMed Central research engines. Information also collected over personal telephone and email correspondence from the selected government, public, corporate, non-government institutes, and rehabilitation personals during the period of March-May 2020. Gathered data were analyzed; a set of challenges identified, and recommendations were made for a safe and standard working rehabilitation environment in the altered COVID-19 situation. Results: Rehabilitation doctors and therapists at most of...

Introduction: The COVID-19 has overwhelmed health systems across the countries globally. This pandemic has also impacted health related rehabilitation services worldwide which is particularly profound in low and middle-income countries including Bangladesh. Methods: Information used in the study gathered from World Health Organization (WHO) Bangladesh Director General of Health Services (DGHS), Institute of Epidemiology Disease Control and Research (IEDCR), online literature search using PubMed and PubMed Central research engines. Information also collected over personal telephone and email correspondence from the selected government, public, corporate, non-government institutes, and rehabilitation personals during the period of March-May 2020. Gathered data were analyzed; a set of challenges identified, and recommendations were made for a safe and standard working rehabilitation environment in the altered COVID-19 situation. Results: Rehabilitation doctors and therapists at most of...

I, one of the fellows of the “Accountability Action Fellowship” powered by the Participatory Research Action Network (PRAN), visited several areas of Khetlal upazila, Joypurhat, for research on the topic of “A study on the Current Scenario of Community Clinic Service in the Area of Khetlal Upazila, Joypurhat.”
As part of my research on the current state of community clinic service, I went to six community clinics in the Khetlal upazila area. This study is a part of the “Accountability Action Fellowship” program of the Participatory Research Action Network (PRAN). The goal of the study is to find out what the problems are and how to fix them, as well as to make sure that the CC service is accountable to society. I conducted this research on community clinic service providers, service seekers, community leaders, and the upazila chairman to learn about their experiences and expectations. I met many classes of people like teachers, farmers, rickshaw poolers, etc. I interviewed them about the current ground scenario of community clinic service, the behavior of the staff, the availability of drugs, and their overall experience to date. I also interviewed the CHCP, HA, and FWA about the service they are providing, what is lacking, what they can do better, etc. I also wrote down the expectations and views of the community members towards the CC service.

I made this research with approximately over 50 people. Those 50 people represent the service providers and service seekers.

Introduction: The COVID-19 has overwhelmed health systems across the countries globally. This pandemic has also impacted health related rehabilitation services worldwide which is particularly profound in low and middle-income countries including Bangladesh. Methods: Information used in the study gathered from World Health Organization (WHO) Bangladesh Director General of Health Services (DGHS), Institute of Epidemiology Disease Control and Research (IEDCR), online literature search using PubMed and PubMed Central research engines. Information also collected over personal telephone and email correspondence from the selected government, public, corporate, non-government institutes, and rehabilitation personals during the period of March-May 2020. Gathered data were analyzed; a set of challenges identified, and recommendations were made for a safe and standard working rehabilitation environment in the altered COVID-19 situation. Results: Rehabilitation doctors and therapists at most of...

Objective: To evaluate the effectiveness of povidine-iodine swab versus electrocautery to disinfect appendicular stump. Methods: A randomized controlled trial was conducted in Services Institute of Medical Sciences, Lahore, with a sample size of 40 patients from 1st Dec 2012 to 31th August 2013. Random allocation was done into two equal groups. After cutting appendix, a culture swab was taken from the appendix stump. Electrocautery was used to disinfect appendicular stump in group A while, 10% povidone-iodine was used in group B. A second culture swab was taken from stump after five minutes. Absence of growth on the second culture was considered as effective therapy. Results: Out of total 40 patients, 27 (67%) were males and 13 (33%) were females. Mean age of the patients was 25.6 years. Electrocautery was effective in 100% while Povidone-Iodine was effective in 60% cases (p<0.05). Wound infections were reported in 15% of the cases in electrocautery group and 20% in povidone-iodi...

SARS-CoV-2, commonly referred as COVID-19, has emerged as the most severe public health concern of the twenty-first century. Coronavirus usually is not very lethal to the persons who do not have any medical conditions, but it is fatal to people who have had past medical conditions that have often resulted in death. The objectives of this paper is to look at the effects of coronavirus on older diabetes patients, who are thought to be the ones who were affected the most by COVID-19. This research used a qualitative approach and was descriptive in nature. The researcher has purposefully chosen three areas in Dhaka city as the studies fixate: Shahbag, Khilgaon, and Rampura. Data was gathered using qualitative methods such as focus group discussion and key informant interviews. According to the study's findings, COVID-19 had a serious effect on older adults with diabetes. The number of patients at the hospital had significantly decreased. Despite the fact that hospitals were equipped to provide treatment and care, patients' mobility was limited. Many people preferred virtual consultation or telemedicine to face-to-face consultation and care. Doctors encouraged individuals to connect digitally, which is both safe and feasible in the face of the global pandemic. The expense of a diabetic patient rose, according to the majority of respondents. According to the findings, the pandemic is spurring new diabetes-care delivery methods. Many structural flaws were exposed as a result of Covid-19, paving the door for additional improvements in healthcare delivery in the study area.

Background: Kamrangirchar and Hazaribagh are the largest slum areas in Dhaka, Bangladesh. In 2013, Médecins Sans Frontières initiated an urban healthcare programme in these areas providing services for factory workers and responding to the sexual and reproductive health needs of young women. Little in-depth information is available on perceptions of health and health seeking behaviour in this population. We aimed to provide a better understanding of community perceptions toward health and health care in order to inform programme strategies. Methods: In-depth interviews were conducted with women (n = 13); factory workers (n = 14); and key informants (n = 13). Participants were selected using purposive maximum variation sampling and voluntarily consented to take part. Topic guides steered participant-led interviews, which were audio-recorded, translated and transcribed from Bangla into English. By comparing cases, we identified emerging themes, patterns and relationships in the data. NVivo11© was used to sort and code the data. Results: Emerging themes indicated that in Kamrangirchar and Hazaribagh, health is seen as an asset necessary for work and, thus, for survival. Residents navigate a highly fragmented health system looking for 'quick fixes' to avoid time off work, with the local pharmacy deemed 'good enough' for 'common' health issues. Health care seeking for 'serious' conditions is characterised by uncertainty, confusion, and unsatisfactory results. Decisions are made communally and shaped by collective perceptions of quality care. People with limited socioeconomic capital have few options for care. 'Quality care' is perceived as comprehensive care 'under one roof,' including predictive biomedical diagnostics and effective medication, delivered through a trusting relationship with the care provider. Conclusions: Health seeking behaviour of slum dwellers of Kamrangirchar and Hazaribagh is based on competing priorities, where quick and effective care is key, focussed on the ability to work and generate income. This takes place in a fragmented healthcare system characterised by mistrust of providers, and where navigation is informed by word-of-mouth experiences of peers. Improving health in this context demands a comprehensive and integrated approach to health care delivery, with an emphasis on rapid diagnosis, effective treatment and referral, and improved trust in care providers. Health education must be developed in collaboration with the community to identify knowledge gaps, support decision-making, and be channelled through existing networks. Further research should consider the effectiveness of interventions aiming to improve the practice of pharmacists.

Communicable diseases (infectious diseases, contagious diseases); Non-communicable diseases (non-infectious diseases) Definitions Epidemiology: The term epidemiology has been used as the study of determinants, distribution, and occurrence of incidences related to diseases in a specific population group (Brachman 2011) which encompasses both infectious and non-infectious diseases. Epidemiological trends: This can refer to various aspects of epidemiology, but in this review this term will only be confined to secular trends of epidemiology which indicates the occurrence of diseases over a period of time, usually years; seasonal trends indicating disease incidence shift due to environmental changes and epidemic trends (Brachman 2011). Communicable or infectious diseases (CDs): These are diseases that are contagious, spreading via human contact (touch, fecal, oral, food, sexual activity, etc.), water, air, insect bites, animal contact, sexual activities, etc. Non-communicable diseases (NCDs): Also referred as chronic diseases, these are not contagious and are of long duration, caused by a combination of environmental, behavioral, psychological, and genetic factors. Risk factors: These are characteristics associated with lifestyle and living conditions that promote disease incidence. Diarrheal diseases: These are caused by various microorganisms and share the common symptom of diarrhea. Vaccine-preventable diseases (VPDs): These are diseases that can be prevented via immunization. Vector-borne diseases: These are diseases that spread through humans via blood-feeding arthropods. Immerging and re-emerging diseases: These are diseases that are newly discovered and/or were not observed before in the study area. Other diseases: These refer to diseases that spread via blood transfusion and/or venereal activity.

This study aimed to determine the change in anatomical location of appendix in full-term pregnancy. This was a descriptive cross-sectional study. Liaquat National University Hospital, Karachi, Pakistan, Department of General Surgery, January 01 to July 31, 2010. Full-term pregnant women undergoing caesarean section were enrolled. The anatomical position of the appendix was noted by visual inspection with reference to the transtubercular plane (TTP). SPSS-10 was used for analysis. Seventy-seven full-term pregnant female patients who underwent caesarean section were included in the study. Their mean age was 29 years, the mean height was 5.3 feet, and mean gestational age was 38 weeks. Appendix was found at the normal anatomical location in 63 out of 77 patients (81.8%), while it was located above the TTP in 14 patients (18.2%). Appendix does not migrate up with increasing gestational age in the majority of pregnant women. In most full-term pregnant female patients, appendix is located...

Bleeding as the result of a leech in the male urethra is very rare. We describe a 13-year-old boy who had a leech in his urethra. In the emergency department he persistently squeezed his penis in an attempt to prevent the leech from going deeper into his urethra. Manual removal by forcep failed and cystoscopic removal was recommended. Penile block with lidocaine 1% relieved the pain and enabled him to squeeze his penis harder until the leech was pushed out making forcep removal easier. Post-removal he had hematuria and penile pain for 2 days. A description of his presentation and management, along with a review of the literature is presented.

SARS-CoV-2, commonly referred as COVID-19, has emerged as the most severe public health concern of the twenty-first century. Coronavirus usually is not very lethal to the persons who do not have any medical conditions, but it is fatal to people who have had past medical conditions that have often resulted in death. The objectives of this paper is to look at the effects of coronavirus on older diabetes patients, who are thought to be the ones who were affected the most by COVID-19. This research used a qualitative approach and was descriptive in nature. The researcher has purposefully chosen three areas in Dhaka city as the studies fixate: Shahbag, Khilgaon, and Rampura. Data was gathered using qualitative methods such as focus group discussion and key informant interviews. According to the study's findings, COVID-19 had a serious effect on older adults with diabetes. The number of patients at the hospital had significantly decreased. Despite the fact that hospitals were equipped to provide treatment and care, patients' mobility was limited. Many people preferred virtual consultation or telemedicine to face-to-face consultation and care. Doctors encouraged individuals to connect digitally, which is both safe and feasible in the face of the global pandemic. The expense of a diabetic patient rose, according to the majority of respondents. According to the findings, the pandemic is spurring new diabetes-care delivery methods. Many structural flaws were exposed as a result of Covid-19, paving the door for additional improvements in healthcare delivery in the study area.

ABSTRACTLeech or Hirudinea is a major parasite in rural India. Normally, the leech attacks the skin and exposed areas. An 18‑year‑old child presented with bleeding per rectum for 1 day along with giddiness. A history revealed that while the boy was working in a field, had acrawling sensation in the perianal area. After admission, the patient was resuscitated with crystalloids and a limited colonoscopy revealed a rectal ulcer with a leech head attached to its base. The hooklets were removed using foreign body removal forceps and injection Adrenaline at 1:10,000 dilutions was injected in 1 ml aliquots into four quadrant to achieve hemostasis. There was no postprocedure complication. Leech infestation can present with exsanguinating acute severe lower gastrointestinal bleed.

Background: Kamrangirchar and Hazaribagh are the largest slum areas in Dhaka, Bangladesh. In 2013, Médecins Sans Frontières initiated an urban healthcare programme in these areas providing services for factory workers and responding to the sexual and reproductive health needs of young women. Little in-depth information is available on perceptions of health and health seeking behaviour in this population. We aimed to provide a better understanding of community perceptions toward health and health care in order to inform programme strategies. Methods: In-depth interviews were conducted with women (n = 13); factory workers (n = 14); and key informants (n = 13). Participants were selected using purposive maximum variation sampling and voluntarily consented to take part. Topic guides steered participant-led interviews, which were audio-recorded, translated and transcribed from Bangla into English. By comparing cases, we identified emerging themes, patterns and relationships in the data. NVivo11© was used to sort and code the data. Results: Emerging themes indicated that in Kamrangirchar and Hazaribagh, health is seen as an asset necessary for work and, thus, for survival. Residents navigate a highly fragmented health system looking for 'quick fixes' to avoid time off work, with the local pharmacy deemed 'good enough' for 'common' health issues. Health care seeking for 'serious' conditions is characterised by uncertainty, confusion, and unsatisfactory results. Decisions are made communally and shaped by collective perceptions of quality care. People with limited socioeconomic capital have few options for care. 'Quality care' is perceived as comprehensive care 'under one roof,' including predictive biomedical diagnostics and effective medication, delivered through a trusting relationship with the care provider. Conclusions: Health seeking behaviour of slum dwellers of Kamrangirchar and Hazaribagh is based on competing priorities, where quick and effective care is key, focussed on the ability to work and generate income. This takes place in a fragmented healthcare system characterised by mistrust of providers, and where navigation is informed by word-of-mouth experiences of peers. Improving health in this context demands a comprehensive and integrated approach to health care delivery, with an emphasis on rapid diagnosis, effective treatment and referral, and improved trust in care providers. Health education must be developed in collaboration with the community to identify knowledge gaps, support decision-making, and be channelled through existing networks. Further research should consider the effectiveness of interventions aiming to improve the practice of pharmacists.

Aim: To determine and define the advantages of the laparoscopic appendectomy in the treatment of complicated appendicitis by comparing it with the open appendectomy. Material and Methods: In this prospective interventional clinical study we compared the intraoperative data and the postoperative outcome of 77 patients presented with complicated appendicitis, operated with open and laparoscopic appendectomy within a period of 20 months. One surgeon performed all of the laparoscopic procedures and two other senior surgeons performed the open procedures. Results: Operative time was shorter in the laparoscopic group (p = 0.033). Conversion rate was 2.3%. Overall postoperative morbidity was 25.97%. There was one operative revision due to postoperative small bowel obstruction in the laparoscopic group. Appendicular stump leakage occurred in one patient in the open group. One intra-abdominal abscess occurred in the laparoscopic group (p = 0.38). Wound infection occurred only in the open gro...

The private retail drug shops market in Bangladesh is largely unregulated and unaccountable, giving rise to irrational use of drugs and high Out-of-pocket expenditure on health. These shops are served by salespersons with meagre or no formal training in dispensing. This facility-based cross-sectional study was undertaken to investigate how the drug shops currently operate vis-a-vis the regulatory regime including dispensing practices of the salespersons, for identifying key action points to develop an accredited model for Bangladesh. About 90 rural and 21 urban retail drug shops from seven divisions were included in the survey. The salespersons were interviewed for relevant information, supplemented by qualitative data on perceptions of the catchment community as well as structured observation of client-provider interactions from a sub-sample. In 76% of the shops, the owner and the salesperson was the same person, and >90% of these were located within 30 min walking distance from...

This study aimed to determine the change in anatomical location of appendix in full-term pregnancy. This was a descriptive cross-sectional study. Liaquat National University Hospital, Karachi, Pakistan, Department of General Surgery, January 01 to July 31, 2010. Full-term pregnant women undergoing caesarean section were enrolled. The anatomical position of the appendix was noted by visual inspection with reference to the transtubercular plane (TTP). SPSS-10 was used for analysis. Seventy-seven full-term pregnant female patients who underwent caesarean section were included in the study. Their mean age was 29 years, the mean height was 5.3 feet, and mean gestational age was 38 weeks. Appendix was found at the normal anatomical location in 63 out of 77 patients (81.8%), while it was located above the TTP in 14 patients (18.2%). Appendix does not migrate up with increasing gestational age in the majority of pregnant women. In most full-term pregnant female patients, appendix is located...

Bleeding as the result of a leech in the male urethra is very rare. We describe a 13-year-old boy who had a leech in his urethra. In the emergency department he persistently squeezed his penis in an attempt to prevent the leech from going deeper into his urethra. Manual removal by forcep failed and cystoscopic removal was recommended. Penile block with lidocaine 1% relieved the pain and enabled him to squeeze his penis harder until the leech was pushed out making forcep removal easier. Post-removal he had hematuria and penile pain for 2 days. A description of his presentation and management, along with a review of the literature is presented.

Objective: To evaluate the pregnancy outcomes of patients who underwent appendectomy during pregnancy. Materials and Methods: Patients who underwent appendectomy between years 2010 and 2014 were retrospectively evaluated. All patients' pregnancy outcomes were followed-up by using university registry system and telephone interview. Patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, mean time interval between emergency department and operation, mean operative time, pregnancy outcome and pathologic results of the appendix. Results: Thirty-nine patients were included in the study. Sixteen of 39 patients were in the first, 15 of them in the second and 8 of them were in the third trimester of the pregnancy. Three patients underwent laparoscopic appendectomy and the rest underwent laparotomy. In pathologic evaluation of the appendix, seven patients (17%) had normal appendix, 4 patients had perforated appendix, one patient had neuro-endocrine tumor and rest of the patients had appendicitis. Two missed abortion occurred after operation, rest of the patients had live birth. Six of them were preterm and 31 had term birth. Twelve patients delivered through vaginal birth and the rest via caesarean section. Twenty patients were in the first half of the pregnancy (group 1) and 19 patients were in the second half of the pregnancy (group 2). There were no significant differences between the groups in operation time and mean time interval between emergency administration and operation. Conclusion: Delayed operation and negative appendectomy can cause adverse pregnancy outcomes. Expectant management in suspected cases may decrease negative appendectomy rates but can also lead to perforation. Computed tomography and MRI ought to be considered if ultrasonography is inconclusive. Tocolytic regimens can be administered to prevent threatened preterm labor. Obstetric indications were valid for delivery mode. Amaç: Gebeliğinde apendektomi yapılan hastaların gebelik sonuçlarının değerlendirilmesi. Gereç ve Yöntemler: 2010-2014 yılları arasında apendektomi yapılan hastalar retrospektif olarak incelendi. Tüm hastaların gebelik sonuçları üniversite kayıt Ad dress for Cor res pon den ce/Ya zış ma Ad re si:

Background: Acute care surgery (ACS) and emergency general surgery (EGS) services must provide timely care and intervention for patients who have some of the most challenging needs. Patients treated by ACS services are often critically ill and have both substantial comorbidities and poor physiologic reserve. Despite the widespread implemention of ACS/EGS services across North America, the true postoperative morbidity rates remain largely unknown. Methods: In this prospective study, inpatients at 8 high-volume ACS/EGS centres in geographically diverse locations in Canada who underwent operative interventions were followed for 30 days or until they were discharged. Readmissions during the 30-day window were also captured. Preoperative, intraoperative and postoperative variables were tracked. Standard statistical methodology was employed. Results: A total of 601 ACS/EGS patients were followed for up to 30 inpatient or readmission days after their index emergent operation. Fifty-one percent of patients were female, and the median age was 51 years. They frequently had substantial medical comorbidities (42%) and morbid obesity (15%). The majority of procedures were minimally invasive (66% laparoscopic). Median length of stay was 3.3 days and the early readmission (< 30 d) rate was 6%. Six percent of patients were admitted to the critical care unit. The overall complication and mortality rates were 34% and 2%, respectively. Cholecystitis (31%), appendicitis (21%), bowel obstruction (18%), incarcerated hernia (12%), gastrointestinal hemorrhage (7%) and soft tissue infections (7%) were the most common diagnoses. The morbidity and mortality rates for open surgical procedures were 73% and 5%, respectively. Conclusion: Nontrauma ACS/EGS procedures are associated with a high postoperative morbidity rate. This study will serve as a prospective benchmark for postoperative complications among ACS/EGS patients and subsequent quality improvement across Canada. Contexte : Les services de chirurgie dans les unités de soins actifs (CSA) et de chirurgie générale dans les services d'urgence (CGSU) doivent fournir rapidement des soins et des interventions à des patients dont les besoins sont parmi les plus complexes. En effet, les patients pris en charge par les services de CSA sont souvent gravement malades et présentent des comorbidités sur fond de faible réserve physiologique. Même si les services de CSA/CGSU se sont répandus en Amérique du Nord, les taux réels de morbidité postopératoire demeurent pour une bonne part inconnus. Méthodes : Dans cette étude prospective, on a suivi pendant 30 jours ou jusqu'à leur congé, les patients hospitalisés pour des interventions chirurgicales dans 8 centres de CSA/CGSU achalandés de divers endroits au Canada. On a également tenu compte des réadmissions dans les 30 jours. Les paramètres pré-, per-et postopératoires ont été enregis trés. Une méthodologie statistique standard a été appliquée.

Patient satisfaction is a useful measure for providing quality indicators in health-care services. Concern over the quality of health-care services in Bangladesh has resulted in a loss of faith in health-care providers, low use of public health facilities, and increased outflows of patients from Bangladesh to hospitals abroad. The main barriers to accessing health services are inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached, very short consultation time, lack of empathy of the health professionals, their generally callous and casual attitude, aggressive pursuit of monetary gains, poor levels of competence and occasionally, disregard for the suffering that patients endure without being able to voice their concerns. All of these service failures are frequently reported in the print media. Such failures can pla...