Health system impact of COVID-19 on urban slum population of Bangladesh: a mixed-method rapid assessment study.

OBJECTIVE: We aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Bangladesh. DESIGN: Setting and participantsA cross-sectional survey among 476 households was conducted during October-December 2020 in five selected urban slums of Dhaka North, Dhaka South and Gazipur City Corporation. In-depth interviews with purposively selected 22 slum dwellers and key informant interviews with 16 local healthcare providers and four policymakers and technical experts were also conducted. OUTCOME MEASURES: Percentage of people suffering from general illness, percentage of people suffering from chronic illness, percentage of people seeking healthcare, percentage of people seeking maternal care, health system challenges resulting from COVID-19. RESULTS: About 12% of members suffered from general illness and 25% reported chronic illness. Over 80% sought healthcare and the majority sought care from informal healthcare providers. 39% of the recently delivered women sought healthcare in 3 months preceding the survey. An overall reduction in healthcare use was reported during the lockdown period compared with prepandemic time. Mismanagement and inefficient use of resources were reported as challenges of health financing during the pandemic. Health information sharing was inadequate at the urban slums, resulting from the lack of community and stakeholder engagement (51% received COVID-19-related information, 49% of respondents knew about the national hotline number for COVID-19 treatment). Shortage of human resources for health was reported to be acute during the pandemic, resulting from the shortage of specialist doctors and uneven distribution of health workforce. COVID-19 test was inadequate due to the lack of adequate test facilities and stigma associated with COVID-19. Lack of strong leadership and stakeholder engagement was seen as the barriers to effective pandemic management. CONCLUSION: The findings of the current study are expected to support the government in tailoring interventions and allocating resources more efficiently and timely during a pandemic.

Monitoring quantity and characteristics of municipal solid waste in Dhaka City.

A reliable estimate of the quantity of solid waste generation in the city is very important for proper solid waste planning and management. However, reported estimates of solid waste generation vary widely and lead to questionability. The reported values have been derived on the assumption of demography, standard rate of waste generation by households, density values, number of trucks engaged for waste transportation and monitoring of truck movement at dump sites, etc. This diverse nature of the available data and the question of accuracy necessitate a rigorous study that has tried to document the waste quantity in the recently formulated master plan of Dhaka City. The socio-economic parameters, behavioral characteristics, generation sources, seasonality, and per capita growth rate are considered in estimating the waste quantity along with its future projections. The findings from the estimation of waste quantities state that seasonal differences in the municipal solid waste stream are not substantial. The most seasonably variable material in the municipal solid waste stream is food waste. Residential waste is relatively homogeneous. Although there are some differences in waste generation depending on demographic and other local factors, most households dispose of essentially similar types of wastes. Variation occurs in waste composition dependent upon income levels and category of sources. Variation also occurs based upon the extent of source reduction and recycling opportunities. As opportunities exist to recycle wastes, the recycling facilities might have to grow at a similar pace to the generation of waste. Physical and chemical characteristics of solid waste are important to implement the waste disposal and management plan for the selection of resource and energy recovery potentials. A number of studies have been conducted to determine the composition of wastes including moisture content and calorific value. The data show that the moisture content in city waste is significantly higher and the calorific value is much lower, which determines the viability of composting or anaerobic digestions rather than waste combustion.