- Assessing the effectiveness of using Public-Private Partnerships to improve family planning services in Bangladesh
Under this study, a public-private partnership (PPP) was developed to help private medical practitioners (PMPs) implement a referral strategy between themselves and family planning centres. We assessed whether the PPP model was effective in increasing the use of long-acting reversible contraceptive methods (LARCMs) and acceptable to both public and private healthcare providers.
Our findings revealed the PPP model is acceptable. The uptake of LARCMs increased with the use of a systematic referral system, as well as when the PMPs were in regular contact with and/or had their clinics either in or near the health centres that provided the family planning services. PMPs were more likely to refer patients to family planning centres if they were sure that their incentives would be properly disbursed. Additionally, it was apparent pharmacists and paramedics play an important role for motivating patients towards particular family planning methods. Communication between the PMPS and family planning centres is important to ensure continuous referral of patients for family planning services.
A policy brief was published based on the findings from the study which is available online.
- ASTRA – Addressing Smokeless Tobacco and Building Research Capacity in South Asia
ASTRA is a world-class, international and interdisciplinary group, aiming to reduce the substantial burden of disease caused by smokeless tobacco. Smokeless tobacco is responsible for thousands of deaths per year, but has so far been neglected in policy and research.
ASTRA’s international teams will carry out policy research and develop interventions to address the problems caused by smokeless tobacco use in South Asia. Our focus is on Bangladesh, India and Pakistan, where 80% of the world’s 300 million smokeless tobacco users live, and where the most harmful types of smokeless tobacco are favoured.
ASTRA is a three-year programme, with a budget of £2M, funded by the National Institute for Health Research, UK (NIHR).
- Children Learning About Second-hand Smoke (CLASS-II)
Children Learning About Second-hand Smoke (CLASS-II) was a two-arm pilot cluster randomised controlled trial funded by the Medical Research Council, UK. The project primarily aimed to establish the effectiveness of a school-based intervention, ‘Smoke Free Homes’ , in reducing exposure of school children to second hand smoke. Its effect on frequency and severity of respiratory illness, healthcare contacts, school absenteeism, smoking uptake and their lung function, quality of life and school performance were also studied.
CLASS II found that a school-based intervention has the potential to reduce children’s exposure to second-hand smoke. The trial provides key information to conduct a future definitive trial in this area of public health, which despite its importance has so far received little attention.
- Community Dialogues in Bangladesh
Community Dialogues in Bangladesh aims to develop and test a “community dialogue” approach for preventing and controlling antibiotic resistance in Bangladesh. It is funded by the Economic and Social Research Council, UK. The project has five objectives: to conduct research to inform the content of and processes for delivering community dialogues; to adapt the community dialogues approach to the setting; to pilot-test the approach in the catchment areas of five community clinics; to evaluate the feasibility of the pilot intervention in terms of the number of people it reaches, the extent to which it is delivered as intended, and whether or not is it acceptable to a range of stakeholders; and to engage with key stakeholders, such as policy makers, district health officials, community clinic staff and communities to ensure that the intervention is appropriate.
- Delivering a contextualized package of care for child development (0 - 12 months) and maternal mental health in the Rohingya refugee camps in Bangladesh
Background of the study:
The early childhood period is the basis for later success in life. It is the time when a child’s brain develops at a rapid rate creating plenty of opportunities for children’s learning and development. A child can have a good start in life when he/she grows up in a nurturing and stimulating environment that meets his/her essential needs such as nutrition, health, and safety, as well as the psychological, social, spiritual, and intellectual needs. This also means that the child has a greater chance of reaching his/her full potential later in life. Therefore, it is important to address children’s needs holistically because the absence of one or more essential needs can lead to negative developmental outcomes for children. Each and every child has a right to early
childhood development (ECD). The United Nations Convention on the Rights of the Child Article 6 (Article 6, UNICEF) highlights that the child has “a right to live…and develop healthy” and that every child has “the right to a standard of living that is good enough to meet their physical and mental needs” (Article 27, UNICEF).
Many of Bangladesh’s 61 million children suffer from malnutrition and lack appropriate
stimulation and early learning opportunities. About two fifths of the country’s children younger than five years old have stunted growth and about a fifth of newborns have low birth weights. In addition, about half the two-year-olds in Bangladesh are well below international height standards and about a third are severely underweight.
As of February 2018, the United Nations estimates that almost 1 million Rohingya refugees have fled Burma’s violent campaign of ethnic cleansing (4). Almost universally, they’ve moved into refugee settlements in Cox’s Bazar, Bangladesh.
This has caused a strain to Bangladesh, which has sheltered a remarkable number of people in just six months, leading to desperately cramped conditions in the camps. Air pollution in Ukhia and Teknaf has increased because of smoke from firewood burned by refugees and exhaust from thousands of trucks, jeeps, and cars bringing people and goods into the camps.
The refugees have changed the demographics of Bangladesh’s Ukhia and Teknaf areas, where Rohingya now outnumber locals 2 to 1.Of the approximately 900,000 Rohingya, 73 percent are living in new spontaneous settlements, 13 percent in makeshift settlements, 9 percent among host communities, and 5 percent in formal refugee camps.
More than 48,000 Rohingya infants are expected to be born in Bangladesh this year and would be exposed to different diseases and malnutrition since birth that might cause untimely death by five, warns Save the Children. According to the Needs and Population Monitoring Report, approximately 4.9 percent or 42,516 women of the total Rohingya population in Bangladesh (867,673) are pregnant. It is estimated that 15 percent of them will suffer miscarriage, meaning there will be an estimated 4,015 live births per month or 48,184 live births in 2018, Save the Children says. Children make up approximately 58 percent of the 655,000 Rohingyas, who fled violence in Rakhine of Myanmar to Bangladesh since late August last year. “We’re expecting about
130 live births per day in 2018. Most babies will likely be born at home in basic tents, in part because of the shortage of quality, 24-hour health facilities able to handle and manage basic emergency obstetrics, as well as challenges accessing healthcare,” said Rachael Cummings, the aid group’s health advisor in Cox’s Bazar.
Comprehensive early childhood care provides a strong foundation for good health, growth, and success in education, according to global evidence. Education is important for early learning and to prepare children for a better interactive youth years. It motivates and prepares children to attend primary school, provides parents with information about new approaches to education and prepares them to support their children’s growing experience.
The aim of the study is to develop an contextualize and evaluate an intervention for communitybased child development and maternal depression care in refugee camps.
Materials and Methods:
The intervention materials (i.e. provider training and mother counseling) will be contextualized and evaluated for delivering similar care in Bangladesh refugee setting. A cluster randomized trial, process evaluation and costing study will help knowing its effectiveness and feasibility in refugee setting. This adaptation, through a locally constituted technical working group, will take into account the technical, social, economic, and management support considerations for delivering child development and mental health care in a refugee camp setting.
We propose to evaluate the effectiveness (rather than efficacy) of a contextualized intervention, under potentially replicable circumstances in the refugee setting. A cluster randomized trial will have a total of 696 mother-child pairs in 22 clusters, randomly divided into equal number of intervention and control clusters. The mother-child pairs will get registered in the trial when the newborn child is less than 6 weeks old; and will be followed up, on quarterly basis, till the child gets one year old i.e. when the outcome measurements for child development and maternal mental health will be done.
We will also evaluate the feasibility of delivering child development and maternal mental health care, through community based care providers, in the refugee setting. The feasibility assessment will have a process-evaluation component to learn about the provider and consumer experiences of the intervention; and a costing study to assess the financial implications of replicating the intervention.
The clinic-based counseling intervention covering child stimulation, nutrition, and maternal mental health was delivered mainly by clinic assistant to mothers at ≤6 weeks, 3, 6, and 9 months of the child’s age. At 12 months of child age; each mother-child pair will be assessed for: the primary outcome, delays in the five development domains (ASQ-3 scores), and secondary outcomes, prevalence of stunting and maternal depression (PHQ-9 score). The outcome assessors will be blinded to the cluster-arm allocation. Outcome analyses will be calculated on cluster-level.
All children less than 6 weeks of age will be screened for eligibility, based on agreed
inclusion/exclusion criteria. The mother of each eligible child will be informed about the ECD care trial; and asked for consent to participate. Those who consent will get recruited in the trial, while those who refuse will receive the same care but their data will not be included in the trial. The ECD care will be delivered, at respective homes, by trained refugee women from the same camp. The care package will include mainly: a) child brain development and nutrition counseling; and b) mother depression assessment and care. At the end, home-based measurement of the outcomes will be arranged/ conducted for all registered children and their mothers. The outcome
measurement (when child gets 12 month old) will include: a) child brain development with ASQ-3; b) child physical growth i.e. weight and length; and c) mother depression with PHQ-9. These measurements will require 30-45 minutes for each mother-child pair. The quantitative data (ASQ-3 and PHQ-9) will be supplemented by semi-structured interviews with mothers, community care providers, and project staff. The quantitative and qualitative data collected on participating mothers and children will be kept confidential. This will include measures such as safe storage and restricted access to data; and using codes to identify mothers and children; and report statistics and
responses without identifying any individual. The intervention is expected to have beneficial health effect on children and mothers, without adding any potential risk to their health and wellbeing.
Potential benefit of the study:
This study will contextualize and potentially scale up implementation products available to deliver community-based child development and maternal mental health care in refugee camps. This will provide evidence of intervention effectiveness and feasibility for its possible scaling in refugee camps. This possibly may get considered for an integrated delivery of child development and mental health care at public primary health care facilities.
- Developing a psycho-social support (PSS) intervention for people with multi-drug resistant tuberculosis (MDR-TB) and com-morbid depression in Bangladesh: a feasibility study
This study aims to develop an acceptable and feasible psycho-social support (PSS) package that will be ready to embed within the existing National TB Control Programme (NTP) service delivery system in Bangladesh.
The existing service delivery system does not include any screening for mental health problems among MDR TB patients, or psycho-social counselling for the MDR TB patients.
We aim to develop an acceptable and feasible PSS package to embed within the existing NTP service delivery system. Our specific objectives are to assess the existing MDR-TB services, exploring the facilitators and barriers in the current service provision for mental health support; assess the prevalence of depression among MDR-TB patients using the depression module of the Public Health questionnaire (PHQ-9); validate PHQ-9 in the Bangladesh context; identify whether depression is associated with cure rate; and develop tools, materials and guideline for a PSS packagethat is applicable to the Bangladesh MDR-TB programme context.
- Evaluation of Tobacco Dependence Measures of Smokeless Tobacco (ST) Users in Bangladesh
Evaluation of Tobacco Dependence Measures of Smokeless Tobacco (ST) users in Bangladesh was a study supported by the University of York, UK. .
It was an 18-month project that aimed to evaluate psychometric properties of the Oklahoma Scale of Smokeless Tobacco Dependence among Bangladeshi smokeless tobacco users, and to identify underlying constructs and processes that explains dependence among smokeless tobacco users.
- Improving Outcomes in Mental and Physical Multimorbidity and Developing Research Capacity (IMPACT) in South Asia at the University of York
Comorbidity of physical and mental illness is a major cause of global disease burden, affecting some of the poorest and most vulnerable people in low and middle income countries.
The University of York’s expertise in epidemiological and intervention research combined with our partners’ knowledge of health systems in Bangladesh, India and Pakistan will be harnessed through the IMPACT group with the following aims:
i. To improve health and reduce deaths associated with diabetes, heart and lung diseases in people with severe mental ill health by addressing the most common health risk behaviours.
ii. To reduce depression and anxiety in people with chronic physical health conditions.
- Improving primary health care using community clinics in rural Bangladesh
Improving primary health care using community clinics in rural Bangladesh is a project that aimed to improve the quality of care of children in community clinics through an intervention and evaluation study.
The intervention contributed to a change in national policy and practice, with approximately 14,000 community health care providers nationwide given the job aid and trained.
Part of the findings from this project have been disseminated at a conference in Vancouver on November, 2016.
A research article and a policy brief on this study are published and available online.
- Improving the diagnosis and treatment of cardiovascular disease, diabetes and related conditions through primary health care in Bangladesh
This project aimed to develop and evaluate a service delivery model for the delivery of quality care to patients of cardiovascular diseases (CVDs) and diabetes at the Upazila Health Complexes and other primary health care (PHC) facilities.
Specific objectives included: establishing a systematic screening and care process to enhance early diagnosis of CVD and diabetes in selected PHC facilities; improving treatment and follow-up of CVD and diabetes through enabled primary care arrangements; developing and adapting case management guidelines, tools and training modules; building capacity of doctors, nurses and paramedics at the selected PHC facilities for early diagnosis and effective treatment of CVD and diabetes; and testing and evaluating guidelines and tools for further scale up.
- Intervention for Mothers in Pregnancy to Reduce Exposure to Second-hand Smoking (IMPRESS)
Intervention for Mothers in Pregnancy to Reduce Exposure to Secondhand Smoking (IMPRESS) is a study that aimed to culturally adapt, and then evaluate, the effectiveness of evidence-based strategies to reduce second-hand smoking within homes in the peri-urban area of Bangladesh. It also aimed to determine the costs versus benefits of implementing such an intervention.A paper has been published based on qualitative findings from the first phase of the study carried out in India and Bangladesh.
A pilot trial of a multi-component intervention is being conducted as part of the project.
- Muslim Communities Learning About Second-Hand Smoke (MCLASS-II)
Muslim Communities Learning About Second-hand Smoke (MCLASS-II) in Bangladesh is an effectiveness-implementation hybrid study funded by the Medical Research Council, UK. Its overall aim is to reduce the burden of disease due to second-hand smoke in low- and middle-income countries by discovering innovative community-based approaches to behaviour change. It will assess the feasibility and acceptability of introducing an intervention using imams as a change agent, thereby helping policy makers adapt tobacco cessation strategies to the local context. The findings will help researchers conduct a randomised controlled trial to assess the effectiveness of the intervention in reducing exposure to second-hand smoke at home.
Creating responsive health systems: improving the use of feedback from service users in quality assurance and human resource management in Bangladesh.
is a project that aims to assist policymakers in designing a comprehensive health-systems intervention to make Bangladesh’s health system more responsive. It will do so through assessing the current system of collecting, and responding to, feedback from health service users at sub-district (Upazila) level; and designing a comprehensive health systems intervention to improve utilisation of user feedback in health service quality assurance and human resource management processes at Upazila level. It is a multi-disciplinary and mixed-method health systems research study, using Realist Evaluation.
- Surveys for Urban Equity (SUE)
For public health services to respond to the growing burden of NCDs among the urban poor, the proper measurement of disease prevalence, risk factors and behaviours is a crucial first step. In low- and middle-income countries (LMICs), household surveys – such as the Demographic and Health Surveys (DHS) programme and the World Health Organization’s Stepwise Approach to Surveillance (STEPS) – provide vital data sources to inform national health sector planning in over 90 LMIC countries. However, the way these surveys are currently designed and presented undermines their use by decision-makers to monitor inter- and intra-urban health and plan interventions, and particularly to respond to the health needs of the poorest. The under-representation of the urban poor in these surveys means that health issues they experience are masked by the better health outcomes among the urban wealthy. This provides an overly rosy picture of urban health.
Our GCRF Foundation Award aims to address these problems by testing novel survey sampling and mapping approaches, piloting questionnaires on mental health and injuries, exploring the nature and definitions of urban poverty and households and working closely with urban-health decision-makers to find the best ways to present and use the data we collect.
- TB & Tobacco
The TB and Tobacco project aims to investigate ways in which interventions designed to encourage people to stop smoking can be integrated into tuberculosis (TB) control programmes. Its ultimate goal is to improve the health and longevity of patients suffering from TB, as well as decreasing the number of people who suffer from tobacco-related diseases.
- Tobacco Control Capacity Programme
The Tobacco Control Capacity Programme is a £3.4 million programme of training and research funded by Research Councils UK as part of the Global Challenges Research Fund. The overall aim of the programme is to improve research capacity in low- and middle-income countries (LMICs) to conduct high-quality studies that will generate evidence on how to reduce morbidity and mortality caused by tobacco use and to advance key development priorities. The programme has been funded until the end of 2021.
- Urban Anchal
Urban Anchal is a study looking at sustainable day-care for 1-4 year olds in disadvantaged urban communities in Dhaka, Bangladesh
It aims to address the lack of safe, stimulating and health-promoting environments for adequate early childhood development (ECD). Urban slums provide a challenging environment for child health. With slum-dwelling women working long hours and limited availability of extended family, slum communities face a childcare vacuum, undermining children’s healthy ECD. Adverse experiences and exposures increase the risk of poor health, social and cognitive outcomes during childhood and later in life.
Our study assesses the feasibility of providing day-care centres for young children in Dhaka. This present a holistic solution, allowing women to work whilst knowing their children are safe and provided with ECD opportunities. Our partners, Centre for Injury Prevention and Research, have extensive experience delivering and evaluating childcare in rural Bangladesh. Their model achieved significant impacts on all-cause mortality and injuries.
This project is funded from the UK Medical Research Council’s Public Health Intervention Development Fund and is of 1.5 years duration.
- Assessing the effectiveness of using Public-Private Partnerships to improve family planning services in Bangladesh