Health infrastructure:
To ensure equitable healthcare for every resident in Bangladesh, an extensive network of health services has been established. Infrastructure of healthcare facilities can be divided into three levels: medical universities, medical college hospitals, and specialty hospitals exist at the tertiary level. District hospitals, maternal and child welfare centers are considered to be on the secondary level. Upazila health complexes, union health & family welfare centers, and community clinics (lowest-level healthcare facilities) are the primary level healthcare providers. Various NGOs and private institutions also contribute to this intricate network.[2][3]
The total expenditure on healthcare as a percentage of Bangladesh's GDP was 2.37% in 2016.[4]
In the parliamentary budget of 2017–18, the budget that was set for the health sector was 16 thousand 203 crore 36 lakhs taka.[5]
There are 3 hospital beds per 10,000 people.[6] The general government expenditure on healthcare as a percentage of total government expenditure was 7.9% as of 2009. Citizens pay most of their health care bills as the out-of-pocket expenditures as a percentage of private expenditure on health: 96.5%.[4] The doctor to population ratio is 1:2,000[7] and the nurse to population ratio is 1:5,000[7]
Health status:
Demographics
Population – 168. million[8]
Rural population – 70%
Population density – (population/km2) 1,070/km2
People below poverty line – 60%
Population doubling rate – 25–30 years
GDP (current US$)(billions) – 300[9]
Health problems in Bangladesh:
Due to a large population, Bangladesh faces a large burden of disease:
*Non-communicable diseases: diabetes, cardiovascular disease, hypertension, stroke, chronic respiratory disease, cancer
*Communicable diseases: tuberculosis, HIV, tetanus, malaria, measles, rubella, leprosy
Malnutrition and environmental sanitation problems add to this burden.
Communicable disease
Historically, communicable diseases formed the bulk of total diseases in developing and tropical countries such as Bangladesh. By 2015 via Millennium development Goals, where communicable diseases were targeted, Bangladesh attained almost significant control on communicable diseases.[11] An expanded immunization program against nine major diseases (TB, tetanus, diphtheria, whooping cough, polio, hepatitis B, Haemophilus influenza type B, measles, rubella) was undertaken for implementation.
TB with HIV patient: Still now, HIV is considered as the most deadly infectious disease all over the world. It suppresses the immune system of the body. So any kind of infection can be incubated into the body, HIV infected person can be easily infected by mycobacterium tuberculosis, it is HIV-TB co infection. In 2017, the estimated number of the patient with HIV positive status tuberculosis was 540. Patient with HIV positive status (new and relapse case) notified was 89, out of 540 HIV positive patients. Among 89 patient 84 patients took anti-retroviral therapy.
Drug resistance: When micro-organism of TB causes resistance to isoniazid or/and rifampicin the most effective drugs of TB. If the organism causes resistance against both of the drugs then it is called multi-drug-resistant tuberculosis (MDR-TB). In 2017 the estimated number of MDR was 8400, among them 5800 cases was notified and 944 patients were confirmed by laboratory test and 920 patients started immediate treatment. If any patient develops resistance against isoniazid/rifampicin and one of the 2nd line antibiotic fluoroquinolones (i.e. amikacin, kanamycin, or capreomycin), it's called extreme drug resistance tuberculosis (XDR-TB). In 2017, 6 patients were confirmed XDR-TB by laboratory diagnosis and all of them started treatment instantly. As 31 December 2017, countrywide a total 6420 MDR-TB patients were enrolled for treatment including 920. Among 920 patients, 425 patients were in 24 month regimen and 495 patients were 9 months regimen.
Non-communicable diseases of Bangladesh
However, recent statistics shows that non-communicable disease burden has increased to 61% of the total disease burden due to epidemiological transition. According to National NCD Risk Factor Survey in 2010, 99% of the survey population revealed at least one NCD risk factor and ~29% showed >3 risk factors .Social transition, rapid urbanization and unhealthy dietary habit are the major stimulating reasons behind high prevalence of non-communicable diseases in Bangladesh remarkably in under-privileged communities such as rural inhabitants, urban slum dwellers.
Diabetes
Diabetes, one of four priority non-communicable diseases targeted by world leaders has become a major health problem globally (415 million adults with diabetes in 2015 and by 2040 that number will increase to 642 million). More than two-thirds of diabetic adults (75%) are from low and middle income countries due to demographic changes, cultural transition and population ageing. Among dominant identified risk factor of burden of diseases in South Asian countries, diabetes is placed in seventh position. Bangladesh is placed in top tenth position (7.1 million) among countries with highest number of diabetes adults in the world. Therefore, co-jointly with India and Sri Lanka, Bangladesh constitutes 99.0% of the adult with high blood sugar in the South Asian region. Previous studies show that prevalence of diabetes is increasing significantly in the rural population of Bangladesh. It is also observed that females have higher prevalence of diabetes than male both in rural and urban areas. Lacks of self-care, unhealthy dietary habit, and poor employment rate are the considerable factors behind that higher prevalence of diabetes among females. However, compared to Western nations, the pattern of diabetes begins with the onset at a younger age, and the major diabetic population is non-obese. Such clinical differences, limited access to health care, increase life expectancy, ongoing urbanization and poor awareness among population increase the prevalence and risk of diabetes in Bangladesh.
Eye disease related to diabetes:(diabetic retinopathy)
The prevalence of Diabetic retinopathy in Bangladesh is about one third of the total diabetic population (nearly 1.85 million) .These recent estimates are higher like western Countries and similar to Asian Malays living in Singapore. Sharp economic transition, urbanization, technology based modern life style, tight diabetes control guidelines and unwillingness to receive health care are thought to be the risk factors of diabetic retinopathy in Bangladesh. Unfortunately to attain that emerging health problem, the current capacity in the country to diagnose and treat diabetic retinopathy is very limited to a few centers. Till this year (2016), as per record of National Eye Care under HPNSDP (Health Population Nutrition Sector Development Program), 10,000 people with Diabetic Retinopathy have received services from Secondary and tertiary Hospitals where the screening programs have been established.
Environmental sanitation:
The most difficult problem to tackle in this country is perhaps the environmental sanitation problem which is multi-faceted and multi-factorial. The twin problems of environmental sanitation are lack of safe drinking water in many areas of the country and preventive methods of excreta disposal.
*Indiscriminate defecation resulting in filth and water born disease like diarrhea, dysentery, enteric fever, hepatitis, hook worm infestations.
*Poor rural housing with no arrangement for proper ventilation, lighting etc.
*Poor sanitation of public eating and market places.
*Inadequate drainage, disposal of refuse and animal waste.
*Absence of adequate MCH care services.
*Absence and/ or adequate health education to the rural areas.
*Absence and/or inadequate communications and transport facilities for workers of the public health.Communicable disease
Tuberculosis:
Background: Tuberculosis is one of the most dangerous chronic infectious diseases in Bangladesh. It is the major public health problem in this country. Mycobacterium tuberculosis is a commonly responsible organism of tuberculosis. It is an airborne disease that spreads through the coughing of an infected person. This disease is more prone to slum dwellers living in unhygienic conditions. Tuberculosis mainly infects the lungs (pulmonary tuberculosis) with the symptoms of persistent cough, evening fever with sweating, chest pain, weakness, weight loss, hemoptysis, etc. But it can also infect the other parts of the body (extrapulmonary tuberculosis) like the brain, kidneys and bones. In most cases patients infected with tuberculosis have other concomitant infections. HIV is more common to them.
Present TB status of Bangladesh: According to the WHO, 'Global TB Report 2017' total population was 165 million, Bangladesh is one of the world's 30 high TB burden countries and near about 59170 people died due to tuberculosis. The total estimated number of TB patients was 364000, among them male patients were recorded at 236000, and female patients was 128000. In 2017 the total case was notified 244201. The total new and relapse case was 242639. People are mainly suffering from pulmonary TB; it was 81% (197800 patients) of notified cases.[12] Still now, HIV is considered as the most deadly infectious disease all over the world. It suppresses the immune system of the body. So any kind of infection can be incubated into the body, HIV infected person can be easily infected by mycobacterium tuberculosis.
TB with HIV patient: Still now, HIV is considered as the most deadly infectious disease all over the world. It suppresses the immune system of the body. So any kind of infection can be incubated into the body, HIV infected person can be easily infected by mycobacterium tuberculosis, it is HIV-TB co infection. In 2017, the estimated number of the patient with HIV positive status tuberculosis was 540. Patient with HIV positive status (new and relapse case) notified was 89, out of 540 HIV positive patients. Among 89 patient 84 patients took anti-retroviral therapy.
Drug resistance: When micro-organism of TB causes resistance to isoniazid or/and rifampicin the most effective drugs of TB. If the organism causes resistance against both of the drugs then it is called multi-drug-resistant tuberculosis (MDR-TB). In 2017 the estimated number of MDR was 8400, among them 5800 cases was notified and 944 patients were confirmed by laboratory test and 920 patients started immediate treatment. If any patient develops resistance against isoniazid/rifampicin and one of the 2nd line antibiotic fluoroquinolones (i.e. amikacin, kanamycin, or capreomycin), it's called extreme drug resistance tuberculosis (XDR-TB). In 2017, 6 patients were confirmed XDR-TB by laboratory diagnosis and all of them started treatment instantly. As 31 December 2017, countrywide a total 6420 MDR-TB patients were enrolled for treatment including 920. Among 920 patients, 425 patients were in 24 month regimen and 495 patients were 9 months regimen.
Eye disease related to diabetes:(diabetic retinopathy)
The prevalence of Diabetic retinopathy in Bangladesh is about one third of the total diabetic population (nearly 1.85 million) .These recent estimates are higher like western Countries and similar to Asian Malays living in Singapore. Sharp economic transition, urbanization, technology based modern life style, tight diabetes control guidelines and unwillingness to receive health care are thought to be the risk factors of diabetic retinopathy in Bangladesh. Unfortunately to attain that emerging health problem, the current capacity in the country to diagnose and treat diabetic retinopathy is very limited to a few centers. Till this year (2016), as per record of National Eye Care under HPNSDP (Health Population Nutrition Sector Development Program), 10,000 people with Diabetic Retinopathy have received services from Secondary and tertiary Hospitals where the screening programs have been established.
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