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19 April, 2019 00:00 00 AM
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Public health issues in Bangladesh

The disease burden in Bangladesh is further exacerbated by unsanitary living conditions that underscore the poor economic conditions of both urban and rural people
Rayhan Ahmed Topader
Public health issues in Bangladesh

In South-East Asia the main public health issues are infectious diseases and communicable diseases. Public health has improved markedly in Bangladesh over the past three decades. Nevertheless, Bangladesh faces major health challenges. A scoping study was performed according to York methodology. The study was aimed to find out the major public health issues and challenges in Bangladesh. Bangladesh has one of the worst burdens of childhood malnutrition in the world. Communicable diseases are a major cause of death and disability in Bangladesh. Unsafe food remains a major threat to public health each year, citizens suffer from the acute effects of food contaminated by microbial pathogens, chemical substances and toxins. Bangladesh still ranks among the top ten countries in the world with the highest TB burden. Pneumonia and other infections are major causes of death among young children. In Bangladesh only one per cent of the population is reported to be HIV-positive, but rates are much higher among high-risk populations: injecting drug users, sex workers, and men who have sex with men. The toll of non-communicable diseases chronic diseases, cancer, diabetes, cardiovascular diseases, and chronic respiratory diseases is increasing in Bangladesh as the population becomes more urbanized. The converging pressures of global climate change and urbanisation have a devastating effect on Bangladesh’s most vulnerable populations.
The disease burden Bangladesh is further exacerbated by unsanitary living conditions that underscore the poor economic conditions of both urban and rural home dwellers. There are still several issues that Bangladesh health care system is yet to tackle, governance, accessibility and affordability are key issues that are preventing the implementation of solutions to the public health issues in Bangladesh. Unsafe food remains a major threat to public health each year; citizens suffer from the acute effects of food contaminated by microbial pathogens, chemical substances and toxins. There is a need to minimize the consumer's exposure to unhygienic, contaminated and adulterated food and drinks through strict laws to control marketing of such products. One such factor is violence against women. This is a widespread social problem that causes mental stress, physical suffering and even death, and is believed to be grossly underreported. One study reveals that in Bangladesh about 52 per cent of men in both urban and rural sites reported ever physically assaulting female intimate partners. However the disease burden in Bangladesh has shifted from communicable to non-communicable diseases (NCDs) like cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases. Over the past 45 years, Bangladesh's health and nutrition policies and programmes have focused largely on rural health services and outcomes.
The rural population, particularly the poor, can go to the community clinics at the village and ward levels for treatment of basic diseases and maternal health care. Unfortunately for the urban poor, especially those living in slums, these facilities are non-existent. Often the only option these residents have is to either visit expensive private facilities or oft-neglected public hospitals. Thus, unless you have money and a good amount at that, there aren't many places you can go to for treatment and relief. Equitable access to quality health and nutrition services for the urban poor has emerged as a major and pressing development issue. Hospitals and clinics are not necessarily physically distant, but they are socially and financially distant from poor urban populations. Government facilities that are meant to cater to the poor are functioning badly. A recent investigation from the Anti-Corruption Commission (ACC) revealed an astonishingly sad scenario. About 40 per cent of doctors in 11 public hospitals and health centres were found to be absent from their workplaces. Due to lack of supervision from the authorities, the doctors and nurses are often found to be very inefficient and this further weakens the prospect of poor people being unable to get access to proper health care services from public hospitals.  Bangladesh is being urbanised at a rapid pace, fuelled by rural poverty, climate change and the promise of a better economic future.
It is estimated that 300,000 to 400,000 new migrants leave their rural homesteads annually, heading for Dhaka.  Dhaka is overwhelmed by urban poverty and slums. Very high population densities and deteriorating city infrastructures worsen the already difficult living conditions of poor people living in Dhaka. Issues of urbanisation have been taking centre stage, as traditional focus of economic policymakers has been relegated to the rural front. Experts concur that the quality of life of the urban poor is also worse than that of the rural poor. The factors that differentiate the urban poor from the rural also include transient living, environmental hazards, social fragmentation, exposure to crimes, violence and accidents. Therefore, the transition from rural to urban life is far from linear and usually a complex process. Often, the urban poor living in slums bear the largest burden of such hazards and the evidence suggest that slum-dwellers are considerably worse off in almost every aspect of life. Within this framework of multidimensional poverty, health remains at the forefront of deprivations faced by the urban poor. While health shocks are a major source of vulnerability among low-income urban households, it is also important to recognise ill health as a chronic condition emerging from adverse living and working conditions that often require greater resources to manage over the medium- to long term.
Additionally, changing lifestyles, malnutrition, persistent social inequality, economic insecurity, and unstable social life have given rise to new health challenges non-communicable diseases, substance misuse, and mental health problems. Strengthening and reinforcing local-level involvement by urban governments to be responsible for their health services, with support from the two relevant central ministries Ministry of Local Government, Rural Development and Cooperatives, and the Ministry of Health and Family Welfare is required to resolve the health issues arising from rapid urbanisation. Also, aligning donor support from international organisations such as USAID and World Bank with the central government's urban health strategy is important to bring about viable change. Overall, unless a strong government institutional mechanism is established, it is difficult to envision the urban poor's equitable access to primary health care services any time soon. Failure to improve urban health could undermine and erode the gains that Bangladesh has achieved as the country continues to urbanise, not only in terms of health but in terms of the growth in consumption. NGOs and private providers such as NGO Health Service Delivery Project, the Urban Primary Health Care Services Delivery Project, Marie Stopes Clinics, and BRAC Manoshi project fill in some of the gap in urban primary health. Yet, their scope and coverage are limited.
In the first national survey to measure blood pressure and blood glucose, about one in three women and about one in five men age 35 and older has elevated blood pressure and roughly one in ten has elevated blood glucose, an indication of diabetes. Cancer is the sixth leading cause of death in Bangladesh, accounting for more than 150,000 deaths annually. Nevertheless, Bangladesh faces major health challenges. The national population is projected to grow to between 200 to 225 million over the next four decades. While fertility has declined, women have on average 2.3 children, and only about half use modern and effective contraceptive methods. Despite improvements in maternal health, Bangladesh still ranks in the bottom fourth of countries worldwide with approximately 240 deaths per 100,000 live births. Only one-in-four births takes place in a health care facility, putting both mothers and babies at risk. Although infant and child mortality is decreasing, poor nutrition is a critical health problem in Bangladesh. About half of children age 6-59 months suffers from anemia; four-in-ten are stunted; and one in three is underweight. Bangladesh has one of the worst burdens of childhood malnutrition in the world. In Bangladesh, close to 50 per cent of children under-five are stunted due to poor nutrition. It is reducing Bangladesh's chances of reaching its goal of achieving middle income country status by 2021 and is preventing millions of children from reaching their potential. According to UNICEF Bangladesh, malnutrition is caused by multiple factors.

 The writer is a contributor to
The Independent
 raihan567@yahoo.com

 

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Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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