Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE; Child Health Epidemiology Reference Group of WHO and UNICEF, 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 2151–2161.
UNICEF, 2014. Levels & Trends in Child Mortality—Report 2014: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York, NY: UNICEF.
Dongre AR, Deshmukh PR, Garg BS, 2010. Health expenditure and care seeking on acute child morbidities in peri-urban Wardha: a prospective study. Indian J Pediatr 77: 503–507.
Sarker AR, Islam Z, Khan IA, Saha A, Chowdhury F, Khan AI, Qadri F, Khan JA, 2013. Cost of illness for cholera in a high risk urban area in Bangladesh: an analysis from household perspective. BMC Infect Dis 13: 518.
Roess AA, Winch PJ, Ali NA, Akhter A, Afroz D, El Arifeen S, Darmstadt GL, Baqui AH; Bangladesh PROJAHNMO Study Group, 2013. Animal husbandry practices in rural Bangladesh: potential risk factors for antimicrobial drug resistance and emerging diseases. Am J Trop Med Hyg 89: 965–970.
National Institute of Population Research and Training (NIPORT), 2013. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh: NIPORT.
Kumar S, 2004. Much health care in rural India comes from unqualified practitioners. BMJ 328: 975.
Piechulek H, Al-Sabbir A, Mendoza-Aldana J, 2003. Diarrhea and ARI in rural areas of Bangladesh. Southeast Asian J Trop Med Public Health 34: 337–342.
Huda TMN, Unicomb L, Johnston RB, Halder AK, Yushuf Sharker MA, Luby SP, 2012. Interim evaluation of a large scale sanitation, hygiene and water improvement programme on childhood diarrhea and respiratory disease in rural Bangladesh. Soc Sci Med 75: 604–611.
López-Alarcón M, Villalpando S, Fajardo A, 1997. Breast-feeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under six months of age. J Nutr 127: 436–443.
Kongsbak K, Wahed M, Friis H, Thilsted S, 2006. Acute-phase protein levels, diarrhoea, Trichuris trichiura and maternal education are predictors of serum retinol: a cross-sectional study of children in a Dhaka slum, Bangladesh. Br J Nutr 96: 725–734.
Burton DC, Flannery B, Onyango B, Larson C, Alaii J, Zhang X, Hamel MJ, Breiman RF, Feikin DR, 2011. Healthcare-seeking behaviour for common infectious disease-related illnesses in rural Kenya: a community-based house-to-house survey. J Health Popul Nutr 29: 61–70.
WHO, 2014. Diarrhoea. Available at: http://www.who.int/topics/diarrhoea/en/. Accessed October 15, 2016.
Luby SP, Halder AK, 2008. Associations among handwashing indicators, wealth, and symptoms of childhood respiratory illness in urban Bangladesh. Trop Med Int Health 13: 835–844.
Luby SP, Halder AK, Tarique NH, Unicomb L, Rohnston RB, 2011. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med 8: e1001052.
Vyas S, Kumaranayake L, 2006. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21: 459–468.
Hutchinson MK, Holtman MC, 2005. Analysis of count data using Poisson regression. Res Nurs Health 28: 408–418.
Hall DB, 2000. Zero-inflated Poisson and binomial regression with random effects: a case study. Biometrics 56: 1030–1039.
World Bank, 2011. Bangladesh—Household Income and Expenditure Survey: Key Findings and Results 2010. Available at: http://documents.worldbank.org/curated/en/2011/06/16494498/bangladesh-household-income-expenditure-survey-key-findings-results-2010. Accessed June 15, 2014.
Rahman MM, Gilmour S, Saito E, Sultana P, Shibuya K, 2013. Health-related financial catastrophe, inequality and chronic illness in Bangladesh. PLoS One 8: e56873.
Ahmed SM, Hossain MA, Rajachowdhury AM, Bhuiya AU, 2011. The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution. Hum Resour Health 9: 3.
Saksena P, Xu K, Elovainio R, Perrot J, 2010. Health Services Utilization and Out-of-Pocket Expenditure at Public and Private Facilities in Low-Income Countries. World Health Report (2010) Background Paper 20. Geneva, Switzerland: WHO.
Asenso-Okyere WK, Anum A, Osei-Akoto I, Adukonu A, 1998. Cost recovery in Ghana: are there any changes in health care seeking behaviour? Health Policy Plan 13: 181–188.
Ahmed SM, Hossain MA, 2007. Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: Implications for the HRH problem. Health Policy 84: 332–343.
Ahmed SM, Hossain MA, Chowdhury MR, 2009. Informal sector providers in Bangladesh: how equipped are they to provide rational health care? Health Policy Plan 24: 467–478.
Shahrawat R, Rao KD, 2012. Insured yet vulnerable: out-of-pocket payments and India's poor. Health Policy Plan 27: 213–221.
Tong N, 2013. Background Paper 6.22 Pneumonia. Update on 2004 Background Paper: Priority Medicines for Europe and the World “A Public Health Approach to Innovation.” Geneva, Switzerland: WHO.
Kelley L, Black R, 2001. Research to support household and community IMCI. Report of a meeting, 22–24 January 2001, Baltimore, Maryland, USA. J Health Popul Nutr 19: S111–S154.
Local Government Division, Government of Bangladesh, 1998. National Policy for Safe Water Supply & Sanitation 1998. Available at: http://www.dphe.gov.bd/pdf/National-Policy-for-Safe-Water-Supply-&-Sanitation-1998.pdf. Accessed October 15, 2016.
Bhuiyan MU, Luby SP, Alamgir NI, Homaira N, Mamun AA, Khan JA, Abedin J, Sturm-Ramirez K, Gurley ES, Zaman RU, Alamgir AS, Rahman M, Widdowson MA, Azziz-Baumgartner E, 2014. Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010. Influenza Other Respi Viruses 8: 406–413.
N-SSATS, 2011. Differences and Similarities between Urban and Rural Outpatient Substance Abuse Treatment Facilities. Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA. Available at: http://oas.samhsa.gov. Accessed October 15, 2016.
van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, Ibragimova S, Karan A, Ng CW, Pande BR, Racelis R, Tao S, Tin K, Tisayaticom K, Trisnantoro L, Vasavid C, Zhao Y, 2006. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet 368: 1357–1364.
Chaudhury N, Hammer JS, 2004. Ghost doctors: absenteeism in rural Bangladeshi health facilities. World Bank Econ Rev 18: 423–441.
Mahumud RA, Sultana M, Sarker AR, 2015. Trend of healthcare expenditures in Bangladesh over last decades. Am J Econ Financ Manag 1: 97–101.
Oxman AD, Thomson MA, Davis DA, Haynes B, 1995. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ 153: 1423–1431.
Kolstad JR, 2011. How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania. Health Econ 20: 196–211.
Darmstadt GL, Baqui AH, Choi Y, Bari S, Rahman SM, Mannan I, Ahmed AS, Saha SK, Seraji HR, Rahman R, Winch PJ, Chang S, Begum N, Black RE, Santosham M, Arifeen SE; Bangladesh Projahnmo-2 (Mirzapur) Study Group, 2011. Validation of a clinical algorithm to identify neonates with severe illness during routine household visits in rural Bangladesh. Arch Dis Child 96: 1140–1146.
Rahman MM, Huq M, Rahman MA, 2011. Study on the pattern of prescriptions available at rural households in Bangladesh. South East Asia J Public Health 1: 12–16.
Barua N, Pandav CS, 2011. The allure of the private practitioner: is this the only alternative for the urban poor in India? Indian J Public Health 55: 107–114.
Narayana K, 2006. The Unqualified Medical Practitioners: Methods of Practice and Nexus with the Qualified Doctors. Available at: http://www.eaber.org/node/22330. Accessed June 15, 2014.
Rahman AS, Islam MR, Koehlmoos TP, Raihan MJ, Hasan MM, Ahmed T, Larson CP, 2014. Impact of NGO training and support intervention on diarrhoea management practices in a rural community of Bangladesh: an uncontrolled, single-arm trial. PLoS One 9: e112308.
Lopes SC, Cabral AJ, de Sousa B, 2014. Community health workers: to train or to restrain? A longitudinal survey to assess the impact of training community health workers in the Bolama Region, Guinea-Bissau. Hum Resour Health 12: 8.
Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB, 2005. Lay health workers in primary and community health care. Cochrane Database Syst Rev CD004015.
Ande O, Oladepo O, Brieger WR, 2004. Comparison of knowledge on diarrheal disease management between two types of community-based distributors in Oyo State, Nigeria. Health Educ Res 19: 110–113.
Melek SP, Norris DT, Paulus J, 2014. Economic Impact of Integrated Medical-Behavioral Healthcare, Implications for Psychiatry. Milliman American Psychiatric Association Report. Denver, CO: Milliman Inc.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 478 | 422 | 31 |
Full Text Views | 595 | 11 | 1 |
PDF Downloads | 222 | 10 | 1 |
Understanding illness costs associated with diarrhea and acute respiratory infections (ARI) could guide prevention and treatment strategies. This study aimed to determine incidence of childhood diarrhea and ARI and costs of homecare, hospitalization, and outpatient treatment by practitioner type in rural Bangladesh. From each of 100 randomly selected population clusters we sampled 17 households with at least one child < 5 years of age. Childhood diarrhea incidence was 3,451 and ARI incidence was 5,849/1,000 child-years. For diarrhea and ARI outpatient care per 1,000 child-years, parents spent more on unqualified ($2,361 and $4,822) than qualified health-care practitioners ($113 and $947). For outpatient care, visits to unqualified health-care practitioners were at least five times more common than visits to qualified practitioners. Costs for outpatient care treatment by unqualified health-care practitioners per episode of illness were similar to those for qualified health-care practitioners. Homecare costs were similar for diarrhea and ARI ($0.16 and $0.24) as were similar hospitalization costs per episode of diarrhea and ARI ($35.40 and $37.76). On average, rural Bangladeshi households with children < 5 years of age spent 1.3% ($12 of $915) of their annual income managing diarrhea and ARI for those children. The majority of childhood illness management cost comprised visits to unqualified health-care practitioners. Policy makers should consider strategies to increase the skills of unqualified health-care practitioners, use community health workers to provide referral, and promote homecare for diarrhea and ARI. Incentives to motivate existing qualified physicians who are interested to work in rural Bangladesh could also be considered.
Authors' addresses: Amal K. Halder, Probir K. Ghosh, and Leanne Unicomb, Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh, E-mails: amalkrishna.halder@gmail.com, probir@icddrb.org, and leanne@icddrb.org. Stephen P. Luby, Department of Medicine, Stanford University, Stanford, CA, E-mail: sluby@stanford.edu. Shamima Akhter, Center for Equity and Health Systems, icddr,b, Dhaka, Bangladesh, E-mail: sakhter@icddrb.org. Richard B. Johnston, Joint Monitoring Programme for Water Supply and Sanitation, WHO, Geneva, Switzerland, E-mail: leanne@icddrb.org.
Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE; Child Health Epidemiology Reference Group of WHO and UNICEF, 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 2151–2161.
UNICEF, 2014. Levels & Trends in Child Mortality—Report 2014: Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation. New York, NY: UNICEF.
Dongre AR, Deshmukh PR, Garg BS, 2010. Health expenditure and care seeking on acute child morbidities in peri-urban Wardha: a prospective study. Indian J Pediatr 77: 503–507.
Sarker AR, Islam Z, Khan IA, Saha A, Chowdhury F, Khan AI, Qadri F, Khan JA, 2013. Cost of illness for cholera in a high risk urban area in Bangladesh: an analysis from household perspective. BMC Infect Dis 13: 518.
Roess AA, Winch PJ, Ali NA, Akhter A, Afroz D, El Arifeen S, Darmstadt GL, Baqui AH; Bangladesh PROJAHNMO Study Group, 2013. Animal husbandry practices in rural Bangladesh: potential risk factors for antimicrobial drug resistance and emerging diseases. Am J Trop Med Hyg 89: 965–970.
National Institute of Population Research and Training (NIPORT), 2013. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh: NIPORT.
Kumar S, 2004. Much health care in rural India comes from unqualified practitioners. BMJ 328: 975.
Piechulek H, Al-Sabbir A, Mendoza-Aldana J, 2003. Diarrhea and ARI in rural areas of Bangladesh. Southeast Asian J Trop Med Public Health 34: 337–342.
Huda TMN, Unicomb L, Johnston RB, Halder AK, Yushuf Sharker MA, Luby SP, 2012. Interim evaluation of a large scale sanitation, hygiene and water improvement programme on childhood diarrhea and respiratory disease in rural Bangladesh. Soc Sci Med 75: 604–611.
López-Alarcón M, Villalpando S, Fajardo A, 1997. Breast-feeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under six months of age. J Nutr 127: 436–443.
Kongsbak K, Wahed M, Friis H, Thilsted S, 2006. Acute-phase protein levels, diarrhoea, Trichuris trichiura and maternal education are predictors of serum retinol: a cross-sectional study of children in a Dhaka slum, Bangladesh. Br J Nutr 96: 725–734.
Burton DC, Flannery B, Onyango B, Larson C, Alaii J, Zhang X, Hamel MJ, Breiman RF, Feikin DR, 2011. Healthcare-seeking behaviour for common infectious disease-related illnesses in rural Kenya: a community-based house-to-house survey. J Health Popul Nutr 29: 61–70.
WHO, 2014. Diarrhoea. Available at: http://www.who.int/topics/diarrhoea/en/. Accessed October 15, 2016.
Luby SP, Halder AK, 2008. Associations among handwashing indicators, wealth, and symptoms of childhood respiratory illness in urban Bangladesh. Trop Med Int Health 13: 835–844.
Luby SP, Halder AK, Tarique NH, Unicomb L, Rohnston RB, 2011. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med 8: e1001052.
Vyas S, Kumaranayake L, 2006. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan 21: 459–468.
Hutchinson MK, Holtman MC, 2005. Analysis of count data using Poisson regression. Res Nurs Health 28: 408–418.
Hall DB, 2000. Zero-inflated Poisson and binomial regression with random effects: a case study. Biometrics 56: 1030–1039.
World Bank, 2011. Bangladesh—Household Income and Expenditure Survey: Key Findings and Results 2010. Available at: http://documents.worldbank.org/curated/en/2011/06/16494498/bangladesh-household-income-expenditure-survey-key-findings-results-2010. Accessed June 15, 2014.
Rahman MM, Gilmour S, Saito E, Sultana P, Shibuya K, 2013. Health-related financial catastrophe, inequality and chronic illness in Bangladesh. PLoS One 8: e56873.
Ahmed SM, Hossain MA, Rajachowdhury AM, Bhuiya AU, 2011. The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution. Hum Resour Health 9: 3.
Saksena P, Xu K, Elovainio R, Perrot J, 2010. Health Services Utilization and Out-of-Pocket Expenditure at Public and Private Facilities in Low-Income Countries. World Health Report (2010) Background Paper 20. Geneva, Switzerland: WHO.
Asenso-Okyere WK, Anum A, Osei-Akoto I, Adukonu A, 1998. Cost recovery in Ghana: are there any changes in health care seeking behaviour? Health Policy Plan 13: 181–188.
Ahmed SM, Hossain MA, 2007. Knowledge and practice of unqualified and semi-qualified allopathic providers in rural Bangladesh: Implications for the HRH problem. Health Policy 84: 332–343.
Ahmed SM, Hossain MA, Chowdhury MR, 2009. Informal sector providers in Bangladesh: how equipped are they to provide rational health care? Health Policy Plan 24: 467–478.
Shahrawat R, Rao KD, 2012. Insured yet vulnerable: out-of-pocket payments and India's poor. Health Policy Plan 27: 213–221.
Tong N, 2013. Background Paper 6.22 Pneumonia. Update on 2004 Background Paper: Priority Medicines for Europe and the World “A Public Health Approach to Innovation.” Geneva, Switzerland: WHO.
Kelley L, Black R, 2001. Research to support household and community IMCI. Report of a meeting, 22–24 January 2001, Baltimore, Maryland, USA. J Health Popul Nutr 19: S111–S154.
Local Government Division, Government of Bangladesh, 1998. National Policy for Safe Water Supply & Sanitation 1998. Available at: http://www.dphe.gov.bd/pdf/National-Policy-for-Safe-Water-Supply-&-Sanitation-1998.pdf. Accessed October 15, 2016.
Bhuiyan MU, Luby SP, Alamgir NI, Homaira N, Mamun AA, Khan JA, Abedin J, Sturm-Ramirez K, Gurley ES, Zaman RU, Alamgir AS, Rahman M, Widdowson MA, Azziz-Baumgartner E, 2014. Economic burden of influenza-associated hospitalizations and outpatient visits in Bangladesh during 2010. Influenza Other Respi Viruses 8: 406–413.
N-SSATS, 2011. Differences and Similarities between Urban and Rural Outpatient Substance Abuse Treatment Facilities. Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA. Available at: http://oas.samhsa.gov. Accessed October 15, 2016.
van Doorslaer E, O'Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, Ibragimova S, Karan A, Ng CW, Pande BR, Racelis R, Tao S, Tin K, Tisayaticom K, Trisnantoro L, Vasavid C, Zhao Y, 2006. Effect of payments for health care on poverty estimates in 11 countries in Asia: an analysis of household survey data. Lancet 368: 1357–1364.
Chaudhury N, Hammer JS, 2004. Ghost doctors: absenteeism in rural Bangladeshi health facilities. World Bank Econ Rev 18: 423–441.
Mahumud RA, Sultana M, Sarker AR, 2015. Trend of healthcare expenditures in Bangladesh over last decades. Am J Econ Financ Manag 1: 97–101.
Oxman AD, Thomson MA, Davis DA, Haynes B, 1995. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ 153: 1423–1431.
Kolstad JR, 2011. How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania. Health Econ 20: 196–211.
Darmstadt GL, Baqui AH, Choi Y, Bari S, Rahman SM, Mannan I, Ahmed AS, Saha SK, Seraji HR, Rahman R, Winch PJ, Chang S, Begum N, Black RE, Santosham M, Arifeen SE; Bangladesh Projahnmo-2 (Mirzapur) Study Group, 2011. Validation of a clinical algorithm to identify neonates with severe illness during routine household visits in rural Bangladesh. Arch Dis Child 96: 1140–1146.
Rahman MM, Huq M, Rahman MA, 2011. Study on the pattern of prescriptions available at rural households in Bangladesh. South East Asia J Public Health 1: 12–16.
Barua N, Pandav CS, 2011. The allure of the private practitioner: is this the only alternative for the urban poor in India? Indian J Public Health 55: 107–114.
Narayana K, 2006. The Unqualified Medical Practitioners: Methods of Practice and Nexus with the Qualified Doctors. Available at: http://www.eaber.org/node/22330. Accessed June 15, 2014.
Rahman AS, Islam MR, Koehlmoos TP, Raihan MJ, Hasan MM, Ahmed T, Larson CP, 2014. Impact of NGO training and support intervention on diarrhoea management practices in a rural community of Bangladesh: an uncontrolled, single-arm trial. PLoS One 9: e112308.
Lopes SC, Cabral AJ, de Sousa B, 2014. Community health workers: to train or to restrain? A longitudinal survey to assess the impact of training community health workers in the Bolama Region, Guinea-Bissau. Hum Resour Health 12: 8.
Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M, Scheel IB, 2005. Lay health workers in primary and community health care. Cochrane Database Syst Rev CD004015.
Ande O, Oladepo O, Brieger WR, 2004. Comparison of knowledge on diarrheal disease management between two types of community-based distributors in Oyo State, Nigeria. Health Educ Res 19: 110–113.
Melek SP, Norris DT, Paulus J, 2014. Economic Impact of Integrated Medical-Behavioral Healthcare, Implications for Psychiatry. Milliman American Psychiatric Association Report. Denver, CO: Milliman Inc.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 478 | 422 | 31 |
Full Text Views | 595 | 11 | 1 |
PDF Downloads | 222 | 10 | 1 |