Calculation of Costs of Pregnancy- and Puerperiumrelated Care: Experience from a Hospital in a Low-income Country.

Calculation of costs of different medical and surgical services has numerous uses, which include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services.

Correlates of perceived malarial episodes and treatment-seeking behavior in a malaria-endemic rural area in Bangladesh.

Malaria is one of the most serious diseases of developing countries. In Bangladesh the estimated population at risk of malaria was calculated to be 103.7 million. This study, carried out in 1995 in villages of the malaria-endemic south-eastern part of Bangladesh aimed to identify the correlates of perceived malarial episodes and healthcare-seeking behavior. Data were collected from villagers and healthcare providers by interviewing. Seventeen percent of the study population reported an episode of malaria during the two months prior to the survey. Males reported more malarial episodes than females; irregular visitors to the jungle and day laborers reported higher prevalence of illness than their regular counterparts. Ninety-nine percent of those who reported suffering from malaria consulted a village healthcare provider within 21 days of the onset of symptoms. Contact rate was higher for those living in highlands, the economically better-off and those aged 10-14 years. The education of the household head, location of the house, the age of the individual, the duration of treatment and the kind of medication suggested were significantly associated with treatment compliance. There is a need to raise awareness about prevention and appropriate management of malarial episodes.

Ordeal of women for induced abortion in a rural area of Bangladesh.

The study was carried out to document the context of induced abortion, nature of its management, and post-abortion complications in Matlab, Bangladesh. The study included all 91 cases of induced abortion that took place in the study area from July to October 1995. Information was collected from women within 60 days after the abortion. A physician carried out in-depth interviews and physical examinations of 20 randomly-selected cases. The findings depicted a complex context, within which the women had to go for an abortion. In most cases, the complete lack of use or lack of use-effectiveness of family-planning methods resulted in unwanted pregnancies. The women in desperation sought abortion services from traditional sources first. When their conditions worsened, they contacted the available modern service facilities. At times, it was too late and led to serious health consequences. Limited access to safe abortion services, together with an absence of social support, put women in a life-threatening situation. Prevention of unwanted pregnancies and access to safe abortion services are needed to improve the situation.

Family-planning services in a low-performing rural area of Bangladesh: insights from field observations.

This paper mainly reports the results of an observational study carried out during 1994-1995 in five rural unions of Bangladesh to identify the barriers to adoption of family-planning methods. At the time of the survey, one-fifth of 1,889 mothers with a living child, aged less than five years, were practising modern family-planning methods. Of the methods used, oral pill was the most common (50%), followed by injectables (20%), female sterilization (13%), IUD (11%), and condom (4%). Various factors that were responsible for the low performance of the family-planning programme included: inadequacy of motivational work by the field workers, poor counselling on the management of contraceptive-related side-effects, inadequate response to the needs of clients, irregular field visits, and poor supervision and monitoring. The efficiency of the programme needs to be improved to meet the demand for family-planning methods in Chakaria, Bangladesh.

Policy of universal salt iodization in Bangladesh: do coastal people benefit?

Iodine deficiency disorders (IDD) are a serious public-health problem in Bangladesh and in other countries. Use of iodized salt has been promoted to solve the problem. A study was conducted in eight unions of Chakaria upazila in the Cox's Bazar district of Bangladesh during 1997-1998 to determine the prevalence of use of iodized salt, explore the reasons behind nonuse, and identify the socioeconomic correlates of its use. A quantitative survey was conducted to collect information from 21,190 households on socioeconomic status, demographic characteristics, and the kind of salt used. In-depth interviews and focus-group discussions were also conducted to understand the situation further. The results revealed that only 1.9% of the households used iodized salt. Strong barriers that limit their use of iodized salt included the wide availability of coarse salt, lack of knowledge about the link between iodized salt and IDD, and the high cost of iodized salt. Households in the salt-producing localities and those that are economically disadvantaged tend to use iodized salt less than others. Understanding of the prevalent situation will allow the policy-makers to take measures to improve the situation in the salt-producing areas.

Gender inequality and severe malnutrition among children in a remote rural area of Bangladesh.

Bangladesh typifies many south-eastern countries where female children experience inferior health and uncertain survival, especially after the neonatal period. This paper attempts to study the gender inequality in nutritional status and the effects of various socioeconomic, demographic, and health-programme factors on gender inequality in a remote rural area of Bangladesh. Measurements of mid-upper arm circumference (MUAC) were taken from 2,016 children aged less than 5 years (50.8% male, 49.2% female) in 1994. Children were characterized as severely malnourished if MUAC was < 125 mm. Independent variables included various characteristics of children, households, and mothers. Average MUAC for all children was 130 mm; 33% were severely malnourished. Of the severely-malnourished children, 54.2% were female, and 45.8% were male. The gender gap persisted in the multivariate situation, with female 1.44 times more likely to be severely malnourished. Other variables with a statistically significant relationship included the age of children, acceptance of DPT1, and education of household heads. The persistence of such a gender discrimination now when the country has achieved a lot in terms of child survival is striking. The issue is important and demands appropriate corrective actions.