Contents

Chapter 1 : Bangladesh - a Snapshot 1

Chapter 2 : Healthcare Network of Bangladesh under the Ministry of Health and Family Welfare 7
Chapter 3 : The Millennium Development Goals: Where Does Bangladesh Stand? 14
Chapter 4 : Primary Health Care 25
Chapter 5 : Secondary and Tertiary Health Care 48
Chapter 6 : Utilization of Health Facilities 53
Chapter 7 : Morbidity Profiles 62
Chapter 8 : Mortality Profiles 70
Chapter 9 : Communicable Diseases 81
Chapter 10 : Emergency Preparedness and Response 98
Chapter 11 : Non-communicable diseases 101
Chapter 12 : Safe Blood Transfusion 110
Chapter 13 : Nutrition 113
Chapter 14 : Public-health Interventions by Selected Institutions 119
Chapter 15 : Research and Development 127
Chapter 16 : Human Resource 144
Chapter 17 : Health Information System and eHealth 167
Chapter 18 : National Eye Care 185
Chapter 19 : Health Education and Promotion (HEP) 189
Chapter 20 : Alternative Medical Care 190
Chapter 21 : Financing Health Care 192
Annexures : 201
 Bangladesh-a snapshot

History
Bangladesh emerged in 1971 as an independent and sovereign country. Formerly, the land was
known as East Pakistan as one of the provinces of Pakistan. The citizens of Bangladesh fought a
nine-month War of Liberation against the Pakistan army under the leadership of Father of the
Nation Bangabandhu Sheikh Mujibur Rahman. Before the Pakistan era (1947-1971), the country
was ruled by the British (1757-1947) as a part of Bengal and Assam provinces of Indian sub-
continent. In 1947, the Sub-continent was divided into Pakistan and India. Before the British
rule, the present territory of Bangladesh was part of greater Bengal constituted by East and
West Bengal (the latter now being under India). The then Bengal, Bihar, and Orissa were
governed by a sovereign ruler Nawab Sirajuddowla who lost his emperor in a battle with the
British army in Plassey on 23 June 1757.

Geographical Location
Bangladesh territory is one of the largest deltas of the world. The total land area is 147,570
square kilometers (56,977 square miles). It is a low-lying country which stretches in latitude
between 20o34' and 26o38' north and in longitude between 88o01' and 92o41' east. The country
has borders with India on three sides adjoining West Bengal, Tripura, Assam, and Meghalaya.
Only a small strip in the southeast has border with Myanmar. The Bay of Bengal lies on the
south. The country is covered with a network of rivers and canals forming a maze of
interconnecting channels. Bangladesh mostly comprises floodplain areas, with scattered hills at
the eastern and the northern parts. The northern part is in the Himalayan valleys, and the
southern part in the coast of the Bay of Bengal. Bangladesh is recognized as the worst victim of
global climate change effect without being responsible for its underlying causes. The country
manifests all the direct and indirect effects of climate change, such as global warming, sea-level
rise, and melting of glaciers. The human health has to bear enormous costs as a result.

Climate
The climate of the country is tropical, with a hot and rainy summer and a dry winter. January is
the coolest month, with temperatures averaging nearly 26oC (78oF), and April is the warmest,
with temperatures ranging from 33oC to 36oC (91oF to 96oF). Most places receive more than
1,525 millimeters of rain a year, and areas near the hills receive 5,080 millimeters mostly during
the monsoon (June-September) and little in the winter (November-February). The humidity
varies from 73% to 86%, the highest in the monsoon and the lowest in the winter.

Religion and Culture

The majority (about 89.35%) of the people are Muslim, followed by Hindu (9.64%), Buddhist
(0.57%), Christian (0.27%), and others (0.17%). Over 98% of the people speak Bangla. English,
however, is widely spoken by people in the literate communities. Bangladesh is heir to a rich

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 Chapter 1: Bangladesh - a snap shot

cultural legacy of about two thousand or more years. The cultural traditions can be viewed in
innumerable tangible and intangible heritages in archaeological sites, in sculptures, in stones
and terracotta, in architectures, museums, archives, libraries, classical music, songs and dance,
paintings, dramas, folk arts, festivals, games, and ethnic cultural activities. The simplicity and
friendliness of the people of Bangladesh are examples of unprecedented communal harmony
among different religions years after years.

Population and Demography

The last census in Bangladesh was done in 2011. The preliminary counts show a population of
142,319 thousand which, after adjustment, can be as high as 152,111 thousand.

Bangladesh is a country with the highest population-density, with 964 living per square
kilometer as of 2011 census estimate. With the highest adjustment rate of 6.88% (as required in
the 1974 census), the figure can be as high as 1,031 per square kilometer. According to Sample
Vital Registration Survey 2009, three-fourths of the population (74.5%) live in rural area and the
rest in urban area (25.5%). The current national population growth rate is 1.35% as per
provisional estimate of the 2011 census; the rural to urban migration rate is 21.9%; the male to
female ratio is 100.3:100. The average household-size is 4.68. The 15-49 years age-group
constitutes the largest segment (53%) of the population, followed by 33.3% in <15 years age-
group. The age-groups of 50-59 years and 60+ years comprise 7.2% and 6.8% of people
respectively. Adult (15+ years) literacy rate is 58.4% (as of 2009). The life-expectancy is 67.2
years (66.1 years for males and 68.7 years for females).

Governance
Bangladesh has a unitary form of
government, with no state or
province. For purposes of smooth Divisions (7)
running of the government
Districts (64)
programs, the country is divided
into 7 administrative divisions. Upazilas (Sub-districts) (483)
There are several districts under a Unions (4,501)
division. There are 64 districts in
the country. Each district is again Wards (40,509)

divided into several upazilas (sub- Figure 1.1. For smooth governance, the country is divided into above
districts). There are 483 upazilas in geographic hierarchies

the country. The upazilas are

divided into unions, and each union is divided into 9 wards. There are 4,501 unions and 40,509
wards in the country. The urban areas have 9 city corporations and 306 municipalities. The
country is governed by the Parliamentary Democracy, and it has a unitary National Parliament,
named Bangladesh Jatiya Sangsad. There are 40 ministries and 13 functional divisions. The
Ministry of Health and Family Welfare is one of the largest ministries of the Government.

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 Chapter 1: Bangladesh - a snap shot

Economy
Bangladesh has an agrarian economy, although the contribution of agriculture to GDP has been
decreasing over the last few years. Yet, it dominates the economy, accommodating the major
rural labor-force. The principal industries of the country include readymade garments, textiles,
chemical fertilizers, pharmaceuticals, tea-processing, sugar, leather goods, etc. The principal
minerals include natural gas, coal, white clay, glass-sand, etc. From marketing point of view,
Bangladesh has been following a mixed system (public and private) that operates on the free-
market principles. The GDP growth rate is 6.66% (FY2010-11) (Bangladesh Bank 2011) and GDP
per-capita (current price as per 2009 estimate) is US$ 692 as per World Economic Outlook
October 2010 - International Monetary Fund (IMF).
________________________________
Source of information: National Census Preliminary Report 2011, BBS 2009 and Key Indicators on Report of Sample Vital
Registration System 2009 (published in 2011) by the Bangladesh Bureau of Statistics, World Economic Outlook October 2010-
International Monetary Fund (IMF) (HYPERLINK "http://www.imf.org/external/pubs/ft/weo/2010/02/index.htm" \t "_blank")

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 Chapter 1: Bangladesh - a snap shot

Bangladesh- Basic Information & Indicators

Name of indicator Source
A. GEOGRAPHY
Between 20°34' and 26°38' north latitude and
Location
Between 88°01' and 92°41' east longitude
North and West: India; South: Bay of Bengal;
Boundary
East: India & Myanmar
Area (sq.km.) 147,570 sq. km.(56,977 sq. miles)
Territorial water 12 nautical miles
Standard time GMT+ 6 hrs
Rainfall 203 mm/month
B. ADMINISTRATION Bangladesh data sheet, BBS
Division 7
City corporation 9
Metropolitan city 4
Municipality 308
District 64
Upazila 483
Union 4,501
Ward 40,509
Village (approximately) 87,310
Household 25,490,822
Average size of household 4.68 SVRS 2009, BBS
C. EDUCATION and ECONOMY
Per capita GDP (in US$) 2010-11 664 Bangladesh Economic Review
GDP growth rate (%) 2009-10 6 2010
Poverty rate National: 31.5%; Urban: 21.3%; Rural: 35.2%
Average monthly household income (Tk.) National: 11,480; Urban: 16,477; Rural: 9,648
Average monthly household expenditure
National: 11,200; Urban: 15,531; Rural: 9,612
(Tk.)
Average monthly household consumption
National: 11,003; Urban: 15,276; Rural: 9.436
expenditure (Tk.) HIES 2010, BBS
Per capita daily calorie intake (kcal) National: 2318.3; Urban: 2244.5; Rural: 2344.6
Households benefiting from social safety nets National: 24.6%; Urban: 9.4%; Rural: 30.1%
Households with access to electricity National: 24.6%; Urban: 9.4%; Rural: 30.1%
Households with mobile phones National: 63.7%; Urban: 82.7%; Rural: 56.7%
Literacy rate (7+ yrs) 57.9%
Adult literacy rate (Pop.15+), (Both sexes) 58.4 SVRS 2009, BBS
D. DEMOGRAPHY
Total 142.32
Population (in million)
Male 71.26 BBS 2011
(2011 Census)
Female 71.06
Total 158.96
Population projected July 2015 (in million) Male 81.96
Female 77.33
Projections as per BBS 2008
Total 167.39
Population projected July 2019 (in million) Male 85.86
Female 81.51

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 Chapter 1: Bangladesh - a snap shot

Bangladesh- Basic Information & Indicators (Continued...)

Name of indicator Source
Sex ratio (male per 100 female) 100.27 BBS 2011
Age 0-14 years population (in %) both sex 33.3
Female population (15-49 yrs in %) 54.1 SVRS 2009, BBS
Population (60 yrs + in %) both sex 6.4
Population density per sq.km. 964 BBS 2011
Crude birth rate (per 1,000 pop.) 19.4
SVRS 2009, BBS
Crude death rate (per 1,000 pop.) 5.8
Population growth rate (%) 1. 34 BBS 2011
Total fertility rate (birth per women 15-49 yrs) 2.15
Gross reproduction rate 1.07 SVRS 2009, BBS
Net reproduction rate (NRR) 1.06
Both sex 67.2
Life expectancy at birth (in years) Male 66.1
Female 68.7 SVRS 2009, BBS
Male 23.8
Mean age at first marriage (in years)
Female 18.5
E. HEALTH STATUS
Infant mortality rate (per 1000 livebirths) 39 SVRS 2009, BBS
Maternal mortality ratio (per 100,000 live births) 194 BMMS 2010
Neonatal mortality rate (per 1,000 live births) 28
Under-5 mortality rate (per 1,000 live births) 50
SVRS 2009, BBS
Percentage of population using safe drinking-water (tap and tubewell) 98.1
Percentage of population using sanitary latrine 62.7
Prevalence of night blindness among pre school children 0.04 IPHN, DGHS 2010
% of births attended by skilled personnel 26.54
% of women received at least one antenatal care 71.2 BMMS 2010
% of mother received PNC from a trained provider within 2 days of delivery 22.5
Malaria incidence rate per 1,000 population in endemic districts 5.13 CDC, DGHS 2011
TB incidence rate per 100,000 population 225.0 WHO 2010
TB case notification rate (%) 70.5
NTP 2010
TB cure rate (%) with DOTS 92.0
EPI (Valid vaccination among <23 months children)
DPT 3 89.4%
BCG 98.9%
Measles 89.2%
HAPB 3 89.4% Bangladesh EPI Coverage
Evaluation Survey 2010
OPV 3 94.7%
Fully immunized 83.4%
Vitamin A coverage 96%
F. HEALTH SERVICES PROVISION
Government hospitals at upazila and union level 463
Government hospitals of secondary and tertiary level 120
Total no. of government hospitals 583 DGHS 2011
No. of non-government hospitals (Regd. by DGHS) 2,501
No. of beds in MOHFW (functioning) 39,639
No. of beds in private sector (Regd. by DGHS) 42,237
No. of registered physicians 53,063 BMDC 2011
Estimated no. of doctors available in the country 43,537

Doctors working under MOHFW 38% HRD Data Sheet 2011

Doctors working under other ministries 3%

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 Chapter 1: Bangladesh - a snap shot

Bangladesh- Basic Information & Indicators (Continued...)

Name of indicator Source
Doctors working in private sector 58%

Doctors under DGFP 540

Registered diploma nurses 26,899

Estimated no. of nurses available in the country 15,023

No. of dental surgeons 4,165

No. of family planning officers 546

No. of assistant family planning officers 1,440

No. of registered sanitary inspectors 1,041

No. of dental technologists 1,886

No. of laboratory technologists 2,220

HRD Data Sheet 2011
No. of pharmacy technologists 7,622

No. radiographers 1,456

No. of physical therapists 581

No. of medical assistants 7,365

No. of health assistant (HA) 19,274

No. of assistant health inspectors 3,655

No. of family welfare visitors (Sanctioned) 5,705

No. of health inspectors (Existing) 1,125

No. of family planning inspectors (Existing) 4,500

No. of family welfare assistants (Existing) 23,500

No. of registered dental surgeons 3, 913 BMDC 2009

No. of government medical colleges 21 DGHS (ME) 2011
No. of private medical colleges 44 DGHS (ME) 2010
No. of private dental colleges 12 DGHS 2010
No. of private institute of health technology (IHT) 52 DGHS (MIS) 2009
No. of personnel under DGHS (Existing) 92,759 DGHS 2011 (June)
No. of doctors under DGHS (Existing) 16, 035 DGHS (MIS) 2011 (June)
No. of registered nurses (as on March 2010) 25,018 BNC 2010 (March)
No. of nurses in public sector (Existing) 13, 473 DNS 2010 (March)
No. registered mid -wives 23, 472 BNC 2010 (March)
No. of trained skilled birth attendants 5,159 UNFPA 2009 (Dec)
Population per physician
3,269 HRD Data Sheet 2011
(Current population / available registered physicians)
Population per bed
1,738 DGHS 2011
(Hospital beds: under MOHFW + Regd. private hospitals)

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 The Millennium Development Goals:
Where Does Bangladesh Stand?

The deadline for achieving the Millennium Development Goals (MDGs) is 2015−only 4 years
ahead. Assessment is ongoing throughout the world to find the answer whether or not the
countries made sufficient progress. Although much progress has been made, much more has
yet to be made. The same is true also for Bangladesh. A report has been published by the
Secretariat of the World Health Organization for the 64th World Health Assembly held in May
2011 (WHA document A64/11). The report summarizes the current global status of the health-
related MDGs.

MDG 4: Child survival

Child mortality continues to decline worldwide. The total number of deaths of children below
five years of age fell from 12.4 million in 1990 to 8.1 million in 2009. Mortality in children below
five years of age (under-five mortality) has fallen from 89 per 1000 livebirths in 1990 to 60 per
1000 livebirths in 2009, representing a reduction of about one-third, and the rate of decline has
accelerated over the period 2000-2009 compared to the 1990s. Despite these figures, much
more needs to be done to achieve Target 4.A−a two-thirds reduction in mortality from 1990
levels by the year 2015. Pneumonia and diarrheal diseases are the two biggest killers of children
below five years of age, with pneumonia accounting for 18% of all deaths and diarrheal diseases
for 15%. These rates include deaths that occur during the neonatal period. Deaths in that period
increasingly make up an important proportion of deaths among children below five years of age,
accounting for about 40% of all deaths. By 2009, measles immunization coverage was 82%
globally, up from 73% in 1990, among children aged 12-23 months,. However, the coverage of
crucial child health interventions against fatal diseases remains inadequate. These interventions
include oral rehydration therapy and zinc for diarrhea and case management with antibiotics for
pneumonia. Most child deaths due to pneumonia could be avoided if effective interventions
were implemented on a broad scale to reach the most vulnerable populations.

MDG 5: Maternal health

Estimates suggest that the number of women dying as a result of complications during
pregnancy and childbirth has decreased by 34%: from 546,000 in 1990 to 358,000 in 2008,
according to the new estimates of the United Nations in 2010. The progress is notable but the
annual rate of decline of 2.3% is less than half of the 5.5% needed to achieve Target 5.A−
reducing the maternal mortality ratio by three-quarters between 1990 and 2015. Almost all
(99%) maternal deaths in 2008 occurred in developing countries. There have been
improvements in the coverage of interventions to reduce maternal mortality, including family-
planning services and access of all pregnant women to skilled care during pregnancy, childbirth

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

and the postpartum period. The latest estimates show that 63% of women in developing
countries aged 15 to 49 years, who were married or in a union, were using some form of
contraception. Although 78% of pregnant women received antenatal care at least once during
the period 2000-2010, only 53% received the WHO-recommended minimum of four antenatal
visits. The proportion of deliveries attended by skilled health personnel rose from 58% in 1990
to 68% in 2008.

MDG 6: Combat HIV/AIDS, malaria, and tuberculosis

In 2009, estimated 33.3 million people were living with HIV; 2.6 million had new infections; and
1.8 million died of HIV/AIDS-related complications. The number of people living with HIV
worldwide continued to grow and was 23% higher in 2009 than in 1999. However, the overall
growth of the global epidemic appears to have stabilized, with the annual number of new HIV
infections steadily declining. In 2009, the estimated number of new HIV infections was nearly
20% lower than in 1999. The increasing number of HIV-positive people reflects, in part, the life-
prolonging effects of antiretroviral therapy, which, as in December 2009, was available to more
than five million people in low- and middle-income countries. Despite this progress globally,
treatment-coverage rates remain low: in 2009, only 36% of people needing treatment in low-
and middle-income countries received it. In 2009, estimated 1.4 million HIV-infected women
gave birth, and approximately 370,000 of their newborn children were infected during the
perinatal and breastfeeding period, with most of such cases occurring in sub-Saharan Africa.

A growing number of countries have recorded decreases in the number of confirmed cases of
malaria and/or reported admissions and deaths since 2000. Global control efforts have resulted
in a reduction in the estimated number of deaths from almost 1 million in 2000 to 781,000 in
2009. The estimated number of cases of malaria rose from 233 million in 2000 to 244 million in
2005 but decreased to 225 million in 2009. In total, 11 countries and one area in the African
region showed a reduction of more than 50% in either confirmed malaria cases or malaria-
related admissions and deaths between 2000 and 2009. In other WHO regions, the number of
reported cases of confirmed malaria decreased by more than 50% in 32 countries.

Globally, the annual number of new cases of tuberculosis continues to increase slightly as slow
reductions in the incidence rates per capita are offset by increases in population. In 2009, cases
were estimated to be in between 12 million and 16 million, with new cases estimated at 9.4
million. Estimated 1.3 million HIV-negative people died of tuberculosis in 2009. Mortality due to
this disease has fallen by more than a third since 1990. In 2009, 5.8 million cases were reported
by national tuberculosis programs. In 2008, the treatment success rate reached 86% worldwide,
and 87% in countries with a high burden of disease. This indicates that the target of 85% (first
requested by the World Health Assembly in 1991) has been exceeded. However, multidrug-
resistant tuberculosis continues to pose threats.

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

Neglected tropical diseases

The negleted diseases include leprosy, lymphatic filariasis, dracunculiasis, and dengue, which
affect more than 1,000 million people, primarily poor populations living in tropical and
subtropical climates. According to data received from 121 countries, the global prevalence of
leprosy at the beginning of 2009 stood at 213,036, and the number of new cases detected
during 2008 was 249,007. In 2009, lymphatic filariasis was endemic in 81 countries, 53 of which
were implementing mass treatment programs; the number of people treated increased from 10
million in 2000 to 546 million in 2007. Since 1989, the number of new cases of dracunculiasis
fell from 892,055 in 12 disease-endemic countries to 3,190 in four countries in 2009, a decrease
of more than 99%. Outbreaks of dengue, however, are increasing and spreading in wider
geographic regions; currently, dengue cases are reported in five of the six WHO regions.

Safe drinking-water
The proportion of the world's population with access to improved drinking-water sources
increased from 77% to 87% globally between 1990 and 2008. One component of Target 7.C of
Millennium Development Goal 7 is to halve the proportion of population without sustainable
access to safe drinking-water. Given the current rate, it is likely that this will be met.
Nevertheless, in 2008, some 884 million people still relied on unimproved water sources, 84% of
whom were living in rural areas. The other component of Target 7.C is to halve the proportion of
population without sustainable access to basic sanitation facilities. Current rates of progress
towards the sanitation target are insufficient. In 2008, 2600 million people were not using
improved sanitation facilities, of whom over 1100 million had no access to toilets or sanitation
facilities of any kind. If current trends continue, this component of Target 7.C will not be met.

Essential medicines
Developing countries continue to face low availability and high costs of essential medicines.
Surveys mainly in more than 40 low- and middle-income countries indicate that selected generic
medicines were available in only 42% of health facilities in the public sector and 64% in the
private sector. Lack of medicines in the public sector forces patients to purchase medicines
privately. In the private sector, generic medicines cost, on average, 630% more than their
international reference price, while recommended brands are generally even more expensive.

Pneumonia
Following the adoption of resolution WHA63.24 on prevention and treatment of pneumonia,
several countries have introduced integrated community case management as one of the
recognized strategies for increasing access to quality care. Countries such as Ethiopia and
Malawi have demonstrated that such strategies can contribute to the reduction in mortality of
children below five years of age. UNICEF/WHO joint statements for managing children with
diarrhea and pneumonia have been used by a number of countries as a basis for initiating policy
dialogue on increasing access to care. Such care can be provided by trained and supervised

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

community health workers. Out of 68 countries being monitored by the Countdown to 2015
initiative, 29 have changed policy to allow community-based management of pneumonia. Nepal
and Senegal have expanded community programs with positive results. In order to support and
facilitate the implementation of coordinated, expanded interventions for the control of
pneumonia and diarrhea among children below five years of age living in developing countries,
WHO is planning four regional workshops (three in the African region and one in the South-East
Asian region) for 2011-2012 in collaboration with health ministries, UNICEF, and other partners.
These regions carry the highest burden of mortality due to pneumonia and diarrhea and
comprise numerous countries that are not on track to achieving Millennium Development Goal
4 (Reduce child mortality). An unprecedented number of countries in the African region, the
regions of the Americas and the Eastern Mediterranean countries are set to introduce
pneumococcal conjugate vaccines during the coming year with support from the GAVI Alliance.
Clinical trials in developing countries, along with experience in industrialized countries that have
used the vaccine, indicate that these vaccines, together with Hib vaccine already in use in these
countries, will have a significant impact on morbidity and mortality caused by pneumonia. In
2010, Gambia and Rwanda, where the hepta-valent pneumococcal vaccine is in use, will switch
to the newly-available 13-valent vaccine that protects against 13 pneumococcal serotypes,
including those prevalent in developing countries. In early 2011, Kenya will introduce a deca-
valent vaccine, while Guyana, Honduras, and Nicaragua will introduce the 13-valent vaccine.
Rwanda has already introduced the pneumococcal conjugate vaccines to expand other
pneumonia-control strategies, and Kenya has plans to do the same. Likewise, other countries
that are introducing the vaccines will be supported to do this. In 2011, Cameroon, Central
African Republic, Congo, the Democratic Republic of the Congo, Mali, Sierra Leone, and Yemen
are preparing for the introduction of 13-valent pneumococcal vaccine while Benin, Burundi,
Ethiopia, Madagascar, Malawi, and Pakistan are scheduled to introduce the vaccine in 2012.

High-level Plenary Meeting of the General Assembly on the Millennium Development Goals
and Its Follow-up
The outcome document adopted by the United Nations General Assembly sets out a series of
actions, which, if sufficiently expanded and fitted into country-specific situations, would lead to
the achievement of the Millennium Development Goals. The High-level Plenary Meeting on the
Millennium Development Goals also identified important commitments from the international
community, including those represented in the outcome document, and advocated bold new
initiatives, such as the United Nations Secretary-General's Global Strategy for Women's and
Children's Health. That strategy, developed with the support and facilitation of the Partnership
for Maternal, Newborn and Child Health (of which WHO is a member), was initially discussed at
technical briefings during the Sixty-third World Health Assembly in May 2010.

The outcome document is based on a decade of effort and progress as well as on a series of
World Health Assembly and United Nations General Assembly's resolutions and reports
endorsing prioritized actions that reflect consensus for a number of health-related Millennium

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

Development Goals and underlying health system issues. Findings of the Commission on
Macroeconomics and Health and the Commission on Social Determinants of Health guide the
health efforts of WHO and its member countries that reinforce links with health, poverty
reduction, gender and human rights and that tackle health inequities. According to its
Constitution, WHO's objective is "the attainment by all peoples of the highest possible level of
health." The achievement of this involves a series of technical interventions. In contrast, the
implementation of health programs relies on interconnections with other sectors and the
resolution of issues familiar to foreign policy and national decision-makers: economic and social
development, humanitarian action, resource allocation, trade, technology transfer, intellectual
property, aid effectiveness, mutual accountability, quality of governance, national sovereignty
and concepts of human security. These actions help ensure that health remains high on the
political agenda. The 2009 and 2010 declarations of the Group of Eight nations confirmed
support for the Millennium Development Goals and adherence to past commitments.

Specific actions undertaken by WHO directly related to the Goals are further identified in other
documents submitted to the Health Assembly, including those on health system strengthening,
the future of financing for WHO, the global health-sector strategy for HIV/AIDS during 2011-
2015, malaria, global immunization vision and strategy, infant and young child nutrition and its
comprehensive implementation plan, the eradication of dracunculiasis, and the management of
safe drinking-water.

WHO is engaged extensively with other bodies in the United Nations system and the Secretary-
General's Office in the preparations for the High-level Plenary Meeting on the Millennium
Development Goals and actively participated in more than 20 side-events (a third of all that
Meeting's side-events were devoted to health), including several that set the stage for
preparations for the high-level meeting of the General Assembly on the prevention and control
of non-communicable diseases (scheduled to take place in September 2011). Statements made
in the General Assembly indicated that health issues remained high on national agenda.

Follow-up to the Secretary-General's Global Strategy for Women's and Children's Health
Before the High-level Plenary Meeting of the United Nations General Assembly on the
Millennium Development Goals, WHO, UNICEF, UNFPA, UNAIDS, and the World Bank (known as
the H4+ group), at the request of the Office of the UN Secretary-General, facilitated
consultations on the draft global strategy for women's and children's health in 25 lowest-
income countries with a heavy burden of mortality. The aim was to identify national
commitments to the prioritized action on the agenda of women's and children's health, within
the context of existing country-level processes and mechanisms for United Nations
coordination. The H4+ group led discussions with governments and national stakeholders. The
commitments identified were highlighted at that meeting and annexed to the Global Strategy.
Following the High-level Plenary Meeting on the Millennium Development Goals, country-

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

specific commitments for the 25 countries with a high burden of diseases were compiled and
analyzed to identify the required actions, activities, and support for their realization. The results
are being used in guiding WHO and other organizations in the United Nations system to
determine their priorities for providing technical and other support to the member countries.
The analytical framework will also serve to ensure accountability.

In the remaining 24 lowest-income countries, work has been initiated to identify specific
commitments required for critical areas where additional attention and resources could yield
significant results. An approach similar to that for the identification of commitments prior to the
High-level Plenary Meeting is being used.

Coherence and national health plans, policies, and strategies

Achieving the MDGs requires coherent global and national health policies. The Secretariat has
provided further support to countries in improving the coordination of their national health
strategies, policies, and plans in order that the health system delivers an integrated package of
services to combat all diseases and brings together the work of all stakeholders. Such an
approach needs high-level political leadership and sustained support from development
partners.

In anticipation of the Fourth High-level Forum on Aid Effectiveness (scheduled to be held in

Busan, Republic of Korea, during 26 November-1 December 2011), WHO will continue to
support implementation of the Paris Declaration on Aid Effectiveness (2005) and the Accra
Agenda for Action (2008). WHO's continued support for the international commitments to
health systems strengthening will promote the elaboration and use of national health strategies,
policies and plans as a means of increasing alignment with national priorities, and greater
consistency in advice on domestic financing policies. Similarly, WHO is working with the World
Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the GAVI Alliance, to develop
a common base for funding, in line with the recommendations of the High-level Taskforce on
Innovative International Financing for Health Systems.

Work towards increased alignment and coherence at the country level needs the collaboration
of a broad range of stakeholders as emphasized repeatedly in the outcome document.
Accordingly, WHO is increasing its efforts in this respect, for instance, through its work with the
International Health Partnership Plus (IHP+) group and through its renewed commitment to
primary healthcare.

Stronger health systems

Achieving the health-related MDGs will depend heavily on the degree to which health programs
can be integrated and underlying health systems strengthened (notably in terms of health
personnel, financing, and the organization of service delivery). The Sixty-third World Health
Assembly adopted the WHO Global Code of Practice on the International Recruitment of Health

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

Personnel, which now must be implemented. Health-financing strategies are summarized in the
World Health Report 2010.

Ensuring stronger national responses will require WHO country offices to have greater capacity
and be more effective, particularly in their roles of convener, facilitator, and provider of support
to the efforts of national authorities to place health higher up on the national agenda,
strengthen coordination among multiple stakeholders, improve measurable national plans, and
thereby increase policy coherence, coordination, and collaboration.

WHO is working with various partners to find ways of increasing multi-sectoral action for health,
including the use of indicators to monitor the impact of different strategies. The World
Conference on Social Determinants of Health (scheduled to be held in Rio de Janeiro, Brazil, on
19-21 October 2011) will provide a forum for identifying such strategies.

Securing required resources

Concerns remain with regard to raising the resources necessary for achieving the health-related
MDGs, meeting shortfalls in funding, and reinforcing the underlying health systems. Recent data
on trends in per-capita official development assistance for health in 46 countries of the African
region indicate that funding has increased significantly for Goal 6 (Combat HIV/AIDS, malaria
and other diseases) but has remained unchanged for the other goals. Moreover, one-third of
people living in absolute poverty reside in nations that receive up to 40% less aid per capita
than other low-income countries.

The High-level Plenary Meeting on the Millennium Development Goals has prompted several
commitments towards reaching the health-related goals. More than US$ 40,000 million has
been pledged over a five-year period to support implementation of the Global Strategy on
Women's and Children's Health. The High-level Plenary Meeting has also influenced the Global
Fund to Fight AIDS, Tuberculosis and Malaria, through its Third Voluntary Replenishment at the
Second Meeting (New York, 4-5 October 2010), at which donors pledged US$ 11,700 million for
2011-2013, the largest sum to date. The GAVI Alliance held a similar meeting. Initiatives such as
UNITAID (which raises some US$ 300 million annually) and the International Finance Facility for
Immunization also contribute significantly to funding the health-related goals.

Better accountability, information, and intelligence

Given the importance of ensuring accountability for commitments made at the High-level
Plenary Meeting on the Millennium Development Goals, the United Nations Secretary-General
has asked the Director-General to lead the development of an accountability framework to track
commitments and results for the Global Strategy on Women's and Children's Health. WHO is
establishing a time-limited Commission on Information and Accountability for Women's and
Children's Health composed of leaders and experts from member countries, the multilateral
system, academia, civil society, and the private sector, with information to be presented on

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

progress at the Sixty-fourth World Health Assembly. The Commission will identify the principles
of an effective global architecture for information and accountability for health. In addition, for
use by all countries, it will consider a framework that includes core indicators of health
resources and expected results. The aim is not to create an entirely new reporting infrastructure
and system but to harmonize and align existing arrangements. The Commission will also identify
opportunities for using innovative health information technologies in this context.

Health-information systems that function well are needed for monitoring progress towards the
health-related MDGs as well as progress towards the other national objectives and equity goals.
Reviews of system performance are also needed so as to inform national and international
decision-making processes. Health-information systems need data from multiple sources, such
as surveys, health facilities, and administrative bodies. Some progress has been made in
advancing health-information systems in many countries through civil registration systems as
well as the recording of births, deaths, and causes of deaths but wide gaps remain, most
notably in monitoring. WHO is working with partners and the Health Metrics Network to
support country efforts to enhance the availability and quality of data on the Millennium
Development Goals and on other indicators.

WHO will continue to report on the most recent estimates for health-related statistics in its
annual publication and world health statistics which include an assessment of progress towards
the health-related goals. The report provides comparative estimates for the main health
indicators. However, the quality of global estimates depends on the availability and quality of
country data which are still inadequate for many indicators.

Electronic information systems and e-health applications have the potential to provide wider
access to better-quality care through appropriate use of electronic health records and mobile
devices. Those technologies are also changing the model of health information, promoting local
ownership and allowing access to data-records at all levels of health systems. WHO will have a
pivotal role in ensuring application of appropriate standards and progressive national policies to
optimize the use of these technologies.

Health-related MDGs in Bangladesh

Table 3.1 summarizes the target, benchmark, and the latest information on the achievement of
health-related MDGs in Bangladesh.

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

Table 3.1. The health related MDGs targets and indicators

Global goal, target, and indicator Bangladesh target, benchmark, and current situation
Benchmark Achievement
Goal Target Indicator Target (Year)
(Year) (Reference)
Reduce by half the Prevalence of underweight 41.0 (BDHS 2007)
Goal 1: Eradicate - -
proportion of children <5 years of age 41.0 (UNICEF 2011)
extreme poverty
people who suffer Population below minimum level
and hunger - - -
from hunger of dietary energy consumption (%)
67.0 (MICS 2009)
Death rate among under-five
48.0 (2015) 144.0 (1990) 50.0 (SVRS 2009)
children /1,000 livebirths
Reduce by two- 65.0 (BDHS 2007)
Goal 4: Reduce thirds the mortality 45.0 (MICS 2009)
Infant mortality rate/1,000
child mortality rate among under- 31.3 (2015) 94.0 (1990) 39.0 (SVRS 2009)
livebirths
five children 52.0 (BDHS 2007)
1-year old children immunized 84.8 (BECES 2010)
- 52 (1991)
against measles (%) 83.1 (BDHS 2007)
Reduce by three- Maternal mortality ratio/100,000
143.5 (2015) 574.0 (1990) 194.0 (BMMS 2010)
quarters the livebirths
maternal mortality Births attended by skilled health
50.0 (2010) 7.0 (1990) 26.5 (BMMS 2010)
ratio personnel (%)
55.8 (BDHS 2007)
Contraceptive prevalence rate (%) - 39.9 (1991)
56.1 (SVRS 2009)
Goal 5: Improve Birth rate among adolescent
- - 33.0 (BDHS 2007)
maternal health Ensure, by 2015, mothers
universal access to Antenatal care coverage (at least
48.7 (2004) 52.0 (BDHS 2007)
reproductive one visit) (%)
healthcare Antenatal care coverage (at least
- - 20.4 (BDHS 2007)
four visits) (%)
Unmet need for family planning
- - 17.1 (BDHS 2007)
(%)
Halt and begin to
HIV prevalence among population 0.7% (HSS 2007) among
reverse the spread Halt (2015) -
aged 15-24 years (%) most-at-risk population
of HIV/AIDS
Ensure, by 2010,
universal access to Population with advanced HIV
treatment for infection with access to ARV drugs 100.0 (2015) - 49.0% (NASP 2010)
HIV/AIDS for all (%)
those who need
Malaria incidence rate in endemic < 3.0
- 5.13 (CDC, DGHS 2011)
districts/1,000 population (2015)
0.0034 (CDC, DGHS
Malarial death rate/1,000 0.0053 (2003)
2010)
Under-five children sleeping under
Goal 6: Combat 90% (2015) - 89% (CDC, DGHS 2011)
insecticide-treated bednets (%)
HIV/AIDS,
Under-five children with fever
malaria, and
treated with appropriate anti- - - 12.16 (CDC, DGHS 2011)
other diseases
Halt and begin to malarial drugs (%)
reverse the TB incidence rate/100,000
- - 225.0 (WHO 2010)
incidence of malaria population (new and old patients)
and other major TB prevalence rate/100,000
- - 426.0 (WHO 2010)
diseases population
TB death rate/100,000 population - - 51.0 (WHO 2010)
75.0 (2010)
TB case notification rate (%) >70.0 38.4 (2003) 70.5 (NTP 2010)
(MDG)
93.0 (2010)
TB cure rate (%) with DOTS >85.0 83.7 (2003) 92.0 (NTP 2010)
(MDG)
Treatment success rate - - 92% (NTP 2010)
Reduce by half the 97.8 (MICS 2009)
Population using improved 100.0
percentage of 97.6 (2006) 98.1 (SVRS 2009)
drinking-water source (%) (2015)
Goal 7: Ensure people without 97.0 (BDHS 2007)
environmental sustainable access
sustainability to safe drinking- Population using improved 100.0
39.2 (2006) 80.4 (MICS 2009)
water; % basic sanitation facility (%) (2015)
sanitation
Note: BDHS 2007 (Bangladesh Demographic and Health Survey 2007); MICS 2009 (Multiple Indicators Cluster Survey 2009 done by Bangladesh Bureau of Statistics;
SVRS 2009 (Sample Vital Registration Survey 2009 done by Bangladesh Bureau of Statistics; BECES 2010 (Bangladesh EPI Coverage Evaluation Survey 2010); BMMS
2010 (Bangladesh Maternal Mortality Survey 2010); HSS 2007 (HIV Sero-surveillance 2007); NASP 2010 (National AIDS Surveillance Program 2010); CDC 2011
(Communicable Disease Control 2011); DGHS 2010 (Directorate General of Health Service 2010); NTP 2010 (National Tuberculosis Control Program 2010)

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

The readers should consider that due to difference in time, place, method, and sampling, there
can be variation in the survey results, which we mentioned as reference. To help understand the
methodology used in the three major surveys referenced here, a brief description of each is
given below:

Bangladesh Demographic and Health Survey 2007 (BDHS 2007)

BDHS is undertaken under supervision of the National Institute of Population Research and
Training (NIPORT). BDHS 2007 used Enumeration Areas (EAs) followed in 2001 census. EAs from
the census were used as the Primary Sampling Units (PSUs) for the survey because they could
be easily located with correct geographical boundaries, and sketch-maps were available for each
one. An EA, which consists of about 100 households, on average, is equivalent to a mauza in
rural areas and to a mohallah in urban areas. The survey was based on a two-stage stratified
sample of households. The 361 PSUs selected in the first stage of sampling included 227 rural
PSUs and 134 urban PSUs. A household-listing operation was carried out in all selected PSUs
from January to March 2007. The resulting lists of households were used as the sampling frame
for the selection of households in the second stage of sampling. On average, 30 households
were selected from each PSU, using an equal probability systematic sampling technique. In this
way, 10,819 households were selected for the sample. However, some of the PSUs were large
and contained more than 300 households. Large PSUs were segmented, and only one segment
was selected for the survey, with probability proportional to segment-size. Households in the
selected segments were then listed prior to their selection. Thus, a 2007 BDHS sample cluster
was either an EA or a segment of an EA. The survey was designed to obtain 11,485 completed
interviews with ever-married women aged 15-49 years. According to the sample design, 4,360
interviews were allocated to urban areas and 7,125 to rural areas. All ever-married women aged
15-49 years in selected households were eligible respondents for the women's questionnaire. In
addition, ever-married men aged 15-54 years in every second household were eligible for
interviews.

Multiple Indicators Cluster Survey 2009 (MICS 2009)

MICS is done by the Bangladesh Bureau of Statistics (BBS). The sample for MICS 2009 was
designed to provide estimates of a few indicators on the situation of children and women for
urban and rural areas, at the national, district and upazila levels. Upazilas were identified as the
main sampling domains, and the sample was selected in two stages. Within each upazila, at
least 26 census Enumeration Areas (EAs) were selected with probability proportional to size. A
segment with 20 households was randomly drawn in each selected EA. The sample was
stratified by upazila and is not self-weighting. For reporting national and district level results,
sample-weights were used. Data-collection was done from 28 April to 31 May 2009. Number of
households selected was 300,000, of which 299,842 were successfully interviewed for a
household response rate of 99.9 percent. In the interviewed households, 336,286 women (aged
15-49 years) were identified. Of them, 333,195 were successfully interviewed, yielding a
response rate of 99.1 percent. In addition, 140,860 under-five children were listed in the

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 Chapter 3: The Millennium Development Goals: Where Does Bangladesh Stand?

household questionnaire. Sets of questionnaire were completed for 139,580 children,

corresponding to a response rate of 99.1 percent. An overall response rate of 99.0 percent was
obtained for both women and under-five children.

Sample Vital Registration Survey 2009 (SVRS 2009)

The SVRS is done by Bangladesh Bureau of Statistics (BBS). The decennial Population and
Housing Censuses produce benchmark data on the population, its composition, and spatial
distribution. However, census covers only basic information every ten years. The detailed
changes of vital events during the inter-census period are not known from census data. To have
a picture of the changes of vital events during inter-census period, BBS conducts a surveillance
system called 'Sample Vital Registration System' (SVRS) since 1980 to provide data on key life-
cycle or vital events. It covers 1,000 Primary Sampling Units (PSUs) each comprising about 250
compact households. The data are collected by the local registrars, and the quality of the data
are checked by supervisors. Filled-in schedules are then sent to headquarters on monthly basis.
Rechecking is done by Regional Statistical Officers and other officers and staff members.
Internal validation and close supervision of data-collection is done to improve the quality of
data. The surveys are conducted throughout the year. Dissemination is done every 2-3 years.

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 Primary Health Care
Community clinics
During 1996-2001, the Government of Bangladesh planned to extend Primary Health Care
services at the door-step of the rural people all over Bangladesh. To materialize this dream, the
Government decided to establish 18,000 community clinics (CCs). Following the decision, it was
planned to construct 13,500 community clinics (one for about 6,000 rural population). The
remaining 4,500 community clinics were planned to operate from within the existing health
facilities at upazila and union level. During 1998-2001 period, 10,723 community clinics were
constructed, of which 8,000 started functioning. However, due to change of Government in
2001, the community clinics were closed. The condition prevailed until 2008.

With the overwhelming mandate in the National Election held in December 2008, the current
Government took initiatives for revitalization of the community clinics as the topmost priority
project in health sector shortly after taking the oath on 6 January 2009. A project titled
"Revitalization of Community Health Care Initiatives in Bangladesh" was approved by the
Executive Committee of the National Economic Council (ECNEC) on 17 September 2009 for the
period commencing from 1 July 2009 and to the end of 30 June 2014.

The major activities of the project included:

• Making functional 10,624 existing community clinics
• Constructing 2,876 new community clinics (which included 99 previously constructed but
non-functional community clinics)
• Starting operation of community clinic units at 4,500 upazila and union health facilities
• Recruiting 13,500 Community Health Care Providers (CHCPs), one for each community clinic.

Table 4.1. Number of posts that have been sanctioned for the project
Name of the Post No. of posts
Project Director 1
Additional Project Director 2
Deputy Project Director 6
Communication Officer 1
Programmer 1
Accounts Officer 1
Training Officer 1
Data Entry Operator 8
PA-cum-Computer Operator 3
Accountant, Cashier 2
Store Keeper, Driver, MLSS 18
Community Health Care Provider 13,500
Total 13,544

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 Chapter 4: Primary Health Care

The project office is now fully functional with all the manpower and necessary logistics.
Recruitment of 13,500 community health care providers (CHCPs) has been completed. The
community clinic is a unique example of community participation as the clinics are constructed
on land donated by local people. At present, the domiciliary health staff, namely the health
assistants and family welfare assistants under the Ministry of Health and Family Welfare, are
providing health services alternatively, each for 3 days a week at the community clinics. The
responsibility will be taken by the CHCPs soon. The CHCPs are preferably females of the same
locality to make seeking care for females and children comfortable to the community members.

A package of health services, as listed below, has been set to be delivered from the community
clinic. The package includes the following:

1. Maternal and neonatal healthcare (MNH) services

2. Integrated Management of Childhood Illness (IMCI)
3. Reproductive health and family planning services (RH/FP)
4. Expanded Program on Immunization
5. Nutrition education and micronutrient supplements
6. Distribution of family-planning commodities
7. Health education and counseling
8. Identification of other severe illnesses, like tuberculosis, malaria, pneumonia, emergency
obstetric care (EmOC), life-threatening influenza, anthrax, etc.
9. Treatment for minor ailments and first-aid
10. Referral to union-level health facilities (health and family welfare centers, union sub-
centers, rural health centers, etc.), upazila health complexes (UHCs), and district hospitals.

The community clinics are managed by a body of local people, called community group (CG).
This is a 9 to 13-member management body, represented by different sectors of population
from within the catchment areas of respective clinics. Four of the community group members
are female. Community group plays a vital role in the management of a community clinic
through mobilizing community involvement, participation and ownership, ensuring the
sustainability of the community clinic activities. The common responsibilities include day-to-day
maintenance, cleanliness, security, local fund-generation and transparent use thereof,
monitoring, evaluation, and local planning for smooth functioning of the community clinic.
Besides the community group, there exist three other support groups in the catchment area of
each community clinic. Each support group comprises 10 to 15 members and works under the
leadership of community group members. Basically, the support groups work for raising
awareness of the community people about the health services available, service providers and
service timing, referral and means to promote own and familial health, healthful practices, and
behavior. The local government representatives are also involved with the community clinic.

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 Chapter 4: Primary Health Care

Local union parishad member is the chairperson of the community group. The union parishad
members are the community group members in their respective wards by dint of position.
Union parishad chairmen are the advisers of the community clinics of respective unions.

The community clinics will use information technology to store, process, and transmit health-
related data of the catchment areas. The CHCPs are IT literate. Each community clinic will be
provided with a mini-laptop computer with Internet connection. It is planned that the
community clinics will be developed as local health-related data-bank. Data related to
community clinic itself; community group; support group; general information; health,
nutrition, and family planning; etc. will be collected, stored, processed, interpreted, and acted
upon in the community clinic. The data will be used both locally and nationally for monitoring,
evaluation, and planning at the local and national level. The mini-laptops will also be used for
introducing telemedicine service in the community clinics.

Table 4.2. Progress of community clinics project as of April 2011

Description No.
Community clinics planned to be established 18,000
Independent community clinics planned to be built 13,500
Community clinic units planned to be operated in existing upazila
4,500
and union health facilities
Community clinics built during 1998-2001 period 10,723
Community clinics made non-functional during 2001-2008 period 99
2,876
Community clinics planned to be built in the current project period
(2,777 new
(2009-2014)
+ 99 non-functional)
Community clinics made functional (July 2009–April 2011) 10,323
Community clinics repaired by Health Engineering Department 10,638
FY 2008–2010 7,565
FY 2010–2011 3,073
Community clinics newly constructed by Health Engineering Department
FY 2009-2010 100
FY-2010-2011 (In process) 1,205
FY-2011-2012 (planned) 1,571

All the necessary medicines are being provided in adequate amount to the community clinics;
initially, the package consisted of 25 items of drugs. However, depending on the need and
reality, the package has been revised and extended to have 28 items.

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 Chapter 4: Primary Health Care

Table 4.3. Status of medicine supply to community clinics

Total Cost per community

Financial No. of
amount in clinic per year Remarks
year items
Taka (Taka)
In addition, medicines worth Tk.
15 crore were supplied from
2009-2010 25 43 crore 72,000
Director of Primary Health Care
of the DGHS
2010-2011 28 91 crore 88,000 Ongoing
Community clinics are gradually made functional in phases since 2009. At present, 10,323
community clinics are functioning. The number of clients is increasing day by day.

Table 4.4. Status of service-use from the community clinics

No. of clients Average number of clients per
Period No. of clients
referred community clinic per day
Apr 2009-Dec 2009 11,141,356 172,312 12
Jan 2010-Dec 2010 27,846,053 568,503 19
Total 38,987,409 740,815 -

Community clinic is an unprecedented instance of community participation and public-private

partnership. Being inspired by this community participation, some UN agencies and NGOs have
started working with the Community Clinics Project. Many other organizations are also coming
forward to work as the days are passing.

Table 4.5. Profile of GO-NGO collaboration for community clinics

Memorandum of
Organization Type of support
Understanding
Agreed and Rapid Assessment; Deployment of one full-time
supports consultant; Development of CHCP training manual;
WHO
provided and are Printing of all CHCP training-related manuals; Funds for
ongoing Training of Trainers (TOT) of CHCP training
PLAN Strengthening 200 CCs of 6 upazilas and capacity-
Signed
International building of 1,000 Core Groups (CGs) in 5 districts
Micronutrient Piloting in 3 upazilas to address neonatal health through
Signed
Initiative vitamin A syrup 50,000 IU within 48 hours of birth
Capacity development of CCs and Support Groups in 11
Eminence Signed
districts

Operational research on improvement of CC services

ICDDR,B In process
and healthcare-seeking behavior of the community

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 Chapter 4: Primary Health Care

Table 4.5. Profile of GO-NGO collaboration for community clinics (Continued...)

Memorandum of
Organization Type of support
Understanding
UNIDO In process Piloting on solar panels and income generation in 5 CCs

Piloting for the establishment of an IT network from CCs

EATL In process
to HQ

CARE On progress Capacity development of CGs and Support Groups

VSO On progress Capacity development of CGs and Support Groups

JICA On progress Capacity development of CGs and Support Groups

Community clinic is the flagship program of the present government. Undoubtedly, it is a pro-
people health initiative. If quality health services can be ensured near door-steps even at the
remotest corner of the country, people will spontaneously seek necessary service from the well-
trained care providers of the health facilities instead of the untrained traditional healers. It is
expected that community clinics will ensure provision of quality healthcare for the mass
population of rural Bangladesh, particularly the poor, vulnerable and the underprivileged and
will contribute to the achievement of the MDGs within 2015.

Upward referral linkage of primary healthcare: upazila hospitals and union facilities
The community clinics have upward referral linkages at the union and upazila level. Table 4.6
summarizes the health facilities available at the upazila level and below. There are 433
government hospitals at the upazila level, which altogether provide 16,104 hospital beds. Some
of the unions also have hospitals, with beds ranging from 10 to 20. There are 30 union-level
hospitals with total bed-capacity of 470. At the union level, there are 1,275 union sub-centers
and 87 union health and family welfare centers. This latter group of health facilities provides
only outdoor services. The Directorate General of Family Planning (DGFP) also has 3,719 union
health and family welfare centers (not mentioned in Table 4.6). Further below the union level,
there are 10,323 functional independent community clinics at the ward level. There is, on
average, one community clinic for every 6,000 population.
Table 4.6. Primary healthcare centers run by the DGHS at the upazila level and below (2010)
Upazila level Union level Ward level
Type of facility No. Type of facility No. Type of No.
facility
Upazila health complex (50-bed) 159 10-bed hospital 13 Community 10,323
Upazila health complex (31-bed) 244 20-bed hospital 17 clinics (OPD
Upazila health complex ( -bed) only)
Upazila health complex (10-bed) 13
Total upazila health complexes 418 Total hospitals 30
31-bed hospital 10 Union sub-center (OPD only) 1,275
30-bed hospital 1
Trauma center (20-bed) 4 Union health and family welfare center (OPD only) 87
Total 433 Total 1,362 Total 10323
Total beds 16,104 Total beds 470 Total beds 0

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 Chapter 4: Primary Health Care

Domiciliary service
At the ward or village level, there are domiciliary workers, one for every 5 to 6 thousand
population. There are 26,436 sanctioned posts of domiciliary workers under the DGHS, of which
20,841 are for health assistants (HA), 4,196 for assistant health inspectors (AHI), and 1,399 for
health inspectors (HI).

Urban health
The urban primary healthcare in Bangladesh is virtually provided by the Ministry of Local
Government, Rural Development and Cooperatives (MOLGRD) through the city corporations
and municipalities. These local bodies run a number of small to medium-sized hospitals and
outdoor facilities. Besides, two large-scale primary healthcare projects, viz. Urban Primary
Health Care Project (UPHCP) and Smiling Sun Franchise Program are run by the NGOs in
collaboration with the city corporations and with the financial assistance from donors. The
clients in these latter projects also share a part of the cost through service-charge. The Ministry
of Health and Family Welfare contributes to urban primary healthcare through the outpatient
services distributed through its secondary, tertiary and specialized hospitals located in the
urban settings. Besides, there are 35 urban dispensaries and 23 school health clinics in some of
the bigger cities and municipalities. Under Health, Nutrition and Population Sector Program
(HNPSP 2003-2011), there is a component for urban health to compliment the urban primary
healthcare services provided by the MOLGRD. The Urban Health Program of MOHFW will be
further improved in Health, Population and Nutrition Sector Development Program 2011-2016.

Emergency Obstetric Care (EOC) Program

To improve the maternal health situation targeting to achieve the Millennium Development
Goal 5, the Government of Bangladesh, in collaboration with UNICEF, is conducting facility-
based Emergency Obstetric Care (EOC) Program in all the districts of Bangladesh. All the
government medical college hospitals, district hospitals, upazila hospitals, and maternal and
child welfare centers take part in providing EOC. A number of private clinics or hospitals and
health-related NGOs also participate in the program. The service is provided in two forms, viz.
Comprehensive Emergency Obstetric Care (CEmOC) and Basic Emergency Obstetric Care (BEOC).
Currently, all medical college hospitals, 59 district hospitals, 3 general hospitals, 132 upazila
health complexes, and 63 MCWCs provide CEmOC, and rest of the upazila health complexes
provide BEOC. NGOs and private care providers from a number of districts also provide similar
services. Under a program jointly operated by the Management Information Systems (MIS) of
the DGHS and UNICEF, data are collected from the EOC facilities. For this publication, data from
690 health facilities, including 14 medical college hospitals, 62 district hospitals, 416 upazila
health complexes, 63 maternal and child welfare centers (MCWCs), NGOs, private hospitals
from 64 districts, and 7 other types of hospitals have been used for analysis. These data were
then translated into a format called United Nations Process Indicators. Table 4.7 summarizes the
sources of EOC data we received for 2010.

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 Chapter 4: Primary Health Care

Table 4.7. Number of hospitals and non-state care providers which sent emergency obstetric care data to MIS-
Health in 2010
Type of hospital No. Percentage
Medical college hospitals 14 2.03
District and general hospitals 62 8.99
Upazila health complexes 416 60.29
Districts from where NGO care providers sent data 64 9.28
Districts from where private care providers sent data 64 9.28
MCWC 63 9.13
Others 7 1.00
Total 690 100.00

Data show that there were 558,712 reported deliveries in the country's EOC facilities in 2010,
and there were 546,233 livebirths. The number of newborn deaths in these EOC facilities was
2,280 and that of maternal deaths was 1,700. Table 4.8 also shows the division-wise
distribution.

Table 4.8. No. of total deliveries, livebirths, newborn deaths, and maternal deaths in the emergency obstetric
care facilities of Bangladesh by division (2010)

UN Process
National Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet
Indicator
Total no. of
558712 27803 82880 184234 73605 86415 70397 33378
deliveries (N)
Livebirth (N) 546233 26980 80277 180823 72571 85128 69001 31453
Newborn death (N) 2280 505 501 399 147 165 257 306
Maternal death (N) 1700 143 257 537 119 212 255 177

Figure 4.1 shows the rates of newborn and maternal deaths as percentage of total livebirths and
number of total deliveries respectively in 2010. These death rates are obtained only from the
EOC facilities and should not be seen as reflections of the whole community. Nationally, the
newborn death rate as percentage of total livebirths was 0.4%, which was 1.8% and 0.9% in the
Barisal and Sylhet divisions respectively but varied between 0.2% and 0.6% in other five
divisions (Khulna, Dhaka, Rajshahi, Rangpur, and Chittagong) of Bangladesh. The maternal death
rate at facilities as percentage of total number of deliveries was 0.3% nationally. The rate was
0.5% in each of Barisal and Sylhet divisions. The rate varied between 0.2% and 0.4% in other
five divisions (Khulna, Dhaka, Rajshahi, Rangpur, and Chittagong).

Table 4.9 shows the detailed figures of the process indicators summarized for each division. The
reported institutional delivery rates varied between 13.9% and 21.7%, with average for the
whole country being 18.4%. The met need for emergency obstetric care varied between 36.1%
and 69.1% (average: 53.7%). Cesarean section rate was between 5.0% and 10.1% (average
7.6%). The case-fatality rate was between 0.4% and 1.4% (average 0.7%).

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 Chapter 4: Primary Health Care

Figure 4.1. Rates of newborn and maternal deaths in emergency obstetric care facilities
by division (year 2010)
1.82

Newborn death (% of total deliveries)

Maternal death (% of total deliveries)
0.92

0.60
0.36
0.41
0.51 0.29 0.24
0.20 0.37 0.53
0.31
0.22 0.19
0.30 0.16

National Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet

Table 4.9. Summary of data received from the emergency obstetric care facilities in 2010 and translated into
process indicators by division
Head Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh
Visit for ANC service (N) 63750 251178 561926 230181 165960 178045 65380 1516420
Admitted patients (N) 41135 105625 253992 102445 120809 94639 48328 766973
Complications treated (N) 15610 35470 98873 28612 28628 18228 18409 243830
Normal delivery (N) 13445 51275 86301 41465 61510 45541 20689 320226
Forceps/Vacuum/
34 938 949 336 376 753 621 4007
Destructive operation (N)
Vaginal breech/Face
72 927 1009 342 361 643 456 3810
presentation delivery (N)
Caesarean section (N) 14252 29740 95975 31462 24168 23460 11612 230669
Total deliveries (N) 27803 82880 184234 73605 86415 70397 33378 558712
Livebirth (N) 26980 80277 180823 72571 85128 69001 31453 546233
Stillbirth (N) 1071 3505 4887 1641 2159 2393 2206 17862
Other surgeries (N) 862 4887 10193 2319 3740 1987 3044 27032
Referred in (N) 1128 7349 5523 2076 1515 1606 1060 20257
Referred out (N) 2482 5045 10262 3602 5879 5662 3395 36327
Visit for PNC service (N) 18848 88611 255917 65387 70881 66582 30920 597146
Maternal death (N) 143 257 537 119 212 255 177 1700
Neonatal death (N) 505 501 399 147 165 257 306 2280
Proportion (%) of all births
13.9 141 19.3 20.6 21.7 20.9 17.3 18.4
in EmOC facilities
Met need (%) for EmOC 52.2 40.1 69.1 53.4 47.9 36.1 63.5 53.7
Cesarean section rate as %
7.15 5.0 10.1 8.8 6.1 7.0 6.0 7.6
of all births
Case-fatality rate (CFR) (%) 0.9 0.7 0.5 0.4 0.7 1.4 1.0 0.7

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 Chapter 4: Primary Health Care

Table 4.10 shows the distribution of EOC services provided by the medical college hospitals,
district hospitals, upazila health complexes, NGO facilities, and the private clinics/hospitals. Out
of the 558,712 reported deliveries, 80,615 took place in medical college hospitals, 78,555 in
district hospitals, 145,071 in upazila hospitals, 44,013 in maternal and child welfare centers,
35,814 in NGO facilities, and 171,943 in private clinics/hospitals. It stands at 348,254 (62.3%)
deliveries in major public facilities (upazilla health complexes, district hospitals and medical
college hospitals, and maternal and child welfare centers) and 210,458 (37.7%) deliveries in
NGO/private clinics and hospitals, and in other facilities. Of the number of total deliveries at the
major public facilities, 23.1% took place in medical college hospitals, 22.6% in district hospitals,
and the largest proportion (41.7%) took place in upazila health complexes. In maternal and child
health centers, 12.6% of deliveries took place. Of the total number of deliveries in NGO/private
clinics/hospitals and other facilities, 17.0% were done at NGO facilities and 81.7% at private
clinics/hospitals, and 1.3% at other facilities. Table 4.10 also reveals that there were 230,669
cesarean sections in 2010, of which public hospitals performed 99,264 (43.0%), and NGO and
private clinics/hospitals and other facilities performed 131,405 (57.0%). Of the total number of
cesarean sections at public facilities (n=99,264), 41.0% were done in medical college hospitals
(n=40,727), 28.8% in district hospitals (n=28,602), 20.1% in upazila health complexes
(n=19,999), and 10.0% in maternal and child welfare centers (n=9,936). Of the total cesarean
sections done by NGO and private facilities (n=131,405), 9.3% were done at NGO facilities
(n=12,256), 90.5% were done by private clinics/hospitals (n=118,938), and 0.2% at other
facilities (n=211).

Table 4.10. Summary of data received from the emergency obstetric care facilities in 2010 and translated into UN
Process Indicators
Maternal
Medical Upazila Private
District and child
Process Indicator college health NGO clinic/ Other Total
hospital welfare
hospital complex hospital
center
Visit for ANC service No. 121029 145994 492604 256954 191795 303722 4322 1516420
(N) % 7.98 9.63 32.48 16.94 12.65 20.03 0.29 100
No. 122983 142161 214852 50253 40531 192114 4079 766973
Admitted patients (N)
% 16.03 18.54 28.01 6.55 5.28 25.05 0.53 100
No. 51875 56812 56530 6696 4814 66314 789 243830
Complications (N)
% 21.28 23.30 23.18 2.75 1.97 27.20 0.32 100
No. 38047 49025 123005 33388 23028 51250 2483 320226
Normal delivery (N)
% 11.88 15.31 38.41 10.43 7.19 16.00 0.78 100
Forceps/Vacuum/Dest No. 973 252 1441 251 269 821 0 4007
ructive operation (N) % 24.28 6.29 35.96 6.26 6.71 20.49 0.00 100
Vaginal breech/Face No. 868 676 626 438 261 934 7 3810
delivery (N) % 22.78 17.74 16.43 11.50 6.85 24.51 0.18 100
No. 40727 28602 19999 9936 12256 118938 211 230669
Cesarean section (N)
% 17.66 12.40 8.67 4.31 5.31 51.56 0.09 100
No. 80615 78555 145071 44013 35814 171943 2701 558712
Total deliveries (N)
% 14.43 14.06 25.97 7.88 6.41 30.77 0.48 100
No. 76812 75388 141197 43758 35282 171150 2646 546233
Livebirth (N)
% 14.06 13.80 25.85 8.01 6.46 31.33 0.48 100
No. 5048 4526 4680 583 865 2060 100 17862
Stillbirth (N)
% 28.26 25.34 26.20 3.26 4.84 11.53 0.56 100

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 Chapter 4: Primary Health Care

Table 4.10. Summary of data received from the emergency obstetric care facilities in 2010 and translated into UN
Process Indicators (Continued...)
Maternal
Medical Upazila Private
District and child
Process Indicator college health NGO clinic/ Others Total
hospital welfare
hospital complex hospital
center
Surgery other than No. 8137 8857 6070 618 386 2719 245 27032
cesearian section % 30.10 32.76 22.45 2.29 1.43 10.06 0.91 100
No. 4350 6389 2265 1423 1141 4689 0 20257
Referred in (N)
% 21.47 31.54 11.18 7.02 5.63 23.15 0.00 100
No. 250 4821 23891 2106 1866 2875 518 36327
Referred out (N)
% 0.69 13.27 65.77 5.80 5.14 7.91 1.43 100
No. 62169 79581 197173 63497 39288 153003 2435 597146
PNC service (N)
% 10.41 13.33 33.02 10.63 6.58 25.62 0.41 100
No. 1059 389 164 7 26 55 0 1700
Maternal death (N)
% 62.29 22.88 9.65 0.41 1.53 3.24 0.00 100
No. 1338 281 259 15 132 252 3 2280
Neonatal death (N)
% 58.68 12.32 11.36 0.66 5.79 11.05 0.13 100

Demand-side financing (DSF) through maternal health voucher scheme

In line with the reform agenda of the Health Sector Programs (SWAp) of the Ministry of Health
and Family Welfare (MOHFW), WHO and MOHFW agreed in 2004 to pilot the innovative
Maternal Health Voucher Scheme, a demand-side financing initiative, to improve access to and
use of quality maternal health services. The scheme was formally inaugurated in 2007.
Currently, the program is being implemented in 502 unions of 46 upazilas of 38 districts. Under
the program, eligibility for getting vouchers is a defined poverty criterion, validated by the local
government representative. Half of the target population qualifies as poor. The total numbers of
annual beneficiaries in 46 upazilas are 182,000 pregnant women.

A voucher entitles its holder for specific free health services, such as ante- and postnatal care,
safe delivery, treatment of complications, including cesarean section, transportation cost, and
laboratory tests. Private and NGO care providers, once, certified under the scheme, are
reimbursed for vouchers. If delivery is attended by skilled staff, voucher-holders get
unconditional cash benefits for nutritious food and gift-box.

Performance data at the output level continue to increase. Safe delivery rate is now at
impressive 89% amongst the voucher recipients who constitute approximately 50% of the
pregnant women in the target upazilas. Participation of non-public healthcare providers (NGO
and private facilities) is also increasing. An Economic Evaluation Report was released in January
2011. It says that the scheme is very successful with an "unprecedented positive impact in
increasing utilization of maternal services from designated public and private providers in a
short period of time". In addition to increased rate of safe delivery at 89%, institutional delivery
rate also increased to 40%. Use-rate of antenatal care service continued to improve. However,
referral rates remained unchanged. The cesarean section rate contained at 9% against national
rate of 8%. Strikingly, the maternal mortality rate among the voucher-holder women is 12 per

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 Chapter 4: Primary Health Care

100,000 livebirths, in sharp contrast with the national rate of 194 per 100,000 livebirths. WHO is
providing technical assistance in field supervision through deployment of DSF organizers in 33
upazilas and in operating a national DSF cell located in the Directorate General of Health
Services.

Figure 4.2. Number of benificiary pregnant mothers who received maternal health vouchers in different
years (Total = 533590) under Demand-side Financing Programme

146,287 152,267
109,689 113,181

12,166

FY 2006 - 2007 FY 2007 - 2008 FY 2008 - 2009 FY 2009 - 2010 FY 2010 - 2011
(As of March 2011)

Maternal and Neonatal Health (MNH) Program

To accelerate progress towards achievement of MDG 4 and 5, with the assistance of UNFPA,
UNICEF, and WHO and funded by EC and DFID, the Director of Primary Health Care of the
Directorate General of Health Services is implementing a Maternal and Newborn Health
program is four districts of Bangladesh. The districts are: Thakurgaon, Jamalpur, Narail, and
Maulvibazar. All the upazilas under these four districts are included in the program. The
program focuses on saving maternal and newborn lives through creating need-based demand
and priority-based actions. The broad principle of this program is Local Level Planning (LLP) and
decentralization. The offices of the civil surgeons and the deputy directors of family planning
serve as the two principal locations for the project. The three UN agencies help ensure inclusion
of the three 'added values', viz. participation of civil society organizations, direct disbursement
of funds to agreed cost centers, and reaching the difficult-to-reach populations. National-level
authorities deal with major procurement, training, and partnership arrangements with NGOs
and national communication campaigns. The project plans to allocate a fixed ceiling of fund to
each district, based on needs, and defined by its poverty level, population and number of
upazilas. After successful review the interventions has been expanded to another seven
districts. The project has a number of "novel and innovative" approaches, based on global best
practices having the following elements: (i) a district-focused approach with direct resource
allocation to identified cost centers and the application of WHO's problem-solving techniques to
develop, monitor, and implement the plans; (ii) continuum of care that links the mothers and
newborns and addresses the three delays model; (iii) rights-based equitable approach in
planning, monitoring, implementation and supervision through involvement of consumer
groups and public-health watch groups to ensure accountability to women, families, and
communities; (iv) piloting initiatives, such as contracting private practitioners to provide
specialized services in an attempt to improve human resources for MNH at the district and
upazila levels; (v) pilot-testing of demand-side financing schemes (vouchers and other means)

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 Chapter 4: Primary Health Care

targeting the vulnerable and marginalized households to address equity; and (vi) pilot-testing of
ARH community-based and clinic-based 'youth-friendly' services and Voluntary Confidential
Counseling and Testing (VCCT) centres in selected districts with high risks of HIV and STIs.

Improving Maternal, Neonatal and Child Survival (IMNCS) Project

To accelerate the achievement of MDG 4 and 5, GOB, UNICEF, and BRAC are jointly
implementing an intervention named "Improving Maternal, Neonatal and Child Survival: A
Partnership Approach to Achieve the Millennium Development Goals (MDGs)". The intervention
is being funded by DFID, AusAID, and the Embassy of the Kingdom of the Netherlands (EKN) for
five years from 2008 to 2012. The intervention is implementing under the leadership of Director,
Primary Health Care and Line Director Hospital through Reproductive Health Services of
Director General of Health Services. Currently this intervention covers ten rural districts -
Nilphamari, Rangpur, Gaibandha, Mymensingh, Lalmonirhat, Kurigram, Rajbari, Faridpur,
Magura, and Madaripur.

Training of manpower for improving maternal health

One of the major barriers to improving the maternal health is the shortage of skilled manpower
in the remote areas to extend obstetric care. To tackle the problem, the Ministry of Health and
Family Welfare undertook a short-term measure to produce trained manpower to fulfill the gap
in the interim period. Young medical doctors were given 6 months' training on obstetrics and
anesthesiology. The number of doctors receiving training in the former discipline was 160 and,
in the latter discipline, this was 155. The Directorate General of Health Services is also
implementing Community-based Skilled Birth Attendant (CSBA) training program since 2003
with the goal to train and educate the female welfare assistants/female health assistants and
similar health workers working in the NGOs and private sector, with midwifery skills. The CSBAs
are trained to conduct the normal safe deliveries at home and to identify the risks and
complicated cases so that they can motivate and refer them to the nearby health facilities
where comprehensive EOC services are available. The CSBA training course is divided in three
major phases. First phase is the basic course for six months in a training center, and second
phase is a nine-month work experience as CSBA in own communities under supervision. The
third phase is the three-month additional course where trainees get opportunity to rectify their
shortcomings. Other initiatives also exist to improve maternal healthcare situation. The CSBA
training program is now organized in 342 upazilas of 60 districts. By the end of May 2011, a total
of 6,155 CSBAs completed basic training with support from UNFPA. There is a plan to create
positions of 13,500 CSBAs by 2015 for posting two CSBAs in each union across the country.

Table 4.11. Distribution of CSBAs across divisions

Division Dhaka Khulna Chittagong Rajshahi Rangpur Barisal Sylhet Total
No. 1,916 1,109 692 917 633 373 278 6,155
% 31% 18% 15% 15% 10% 6% 5% 100%

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 Chapter 4: Primary Health Care

Cervical and breast cancer screening program

In Bangladesh, there are around 13,000 cases, with about 6,600 deaths due to cervical cancer
each year. Cervical cancer constitutes 22-29% of cancers among females in Bangladesh. Cervical
cancer can be prevented if it is detected and treated in the precancerous condition. Breast
cancer screening is a method of detecting breast cancer at an early stage. Early detection of
breast cancer significantly reduces the morbidity and mortality related to breast cancer. The
Government of Bangladesh (GoB), with support from UNFPA, has taken initiatives to develop a
cervical and breast cancer screening program in Bangladesh. Since 2004, the Department of
Obstetrics and Gynecology of Bangabandhu Sheikh Mujib Medical University (BSMMU) is
helping the Government to implement the screening program on cervical and breast cancer
throughout the country. Visual inspection of the cervix after acetic acid (VIA) application is an
accepted method of cervical cancer screening at maternal and child welfare centers, district
hospitals, medical college hospitals, and Bangabandhu Sheikh Mujib Medical University. VIA is
administered by trained family welfare visitors (FWVs), senior staff nurses, and doctors. These
trained persons use VIA technique to detect the precancerous conditions or initial stages of
cervical cancer among women visiting the mentioned centers in various districts of Bangladesh.
Screen-positive women are referred to BSMMU and various government MCHs for colposcopic
evaluation and management. In Bangladesh, cervical cancer screening program is in an initial
stage of development. Colposcopy became an important part of this screening program in 2008
both for diagnosis and guiding the treatment. Women with precancerous lesions are managed
by loop electrosurgical excision procedure (LEEP) at the colposcopy clinic of BSMMU and several
medical college hospitals. The sensitivity and specificity of VIA to detect CIN 2-3 lesions were
93.6% and 58.3% respectively in a study performed at BSMMU and other medical college
hospitals.

This screening program has been implemented through capacity-building for service providers
of medical college hospitals, district hospitals, maternal and child welfare centers and selected
upazila hospitals, union health and family welfare centers, and various non-government
organizations, including Urban Primary Health Care Project (UPHCP). Doctors, senior staff
nurses, family welfare visitors, and paramedics from 214 centers of 64 districts have been
trained. They are performing VIA for cervical cancer screening and clinical breast examination
(CBE) for breast cancer screening at service centers and referring screen-positive women to
medical college hospitals and BSMMU for further evaluation and management. Table 4.12
shows the distribution of health personnel who have been given training on VIA by the project.

Table 4.12. Distribution of health personnel who have been given training from 2004 to 2010 on VIA (Visual
Inspection of Cervix with Acetic Acid)
MCH/ Grand
Year Designation MCWC UHFWC UPHCP Total
DH/UHC total
Pilot Doctors 31 17 - - 48
113
program Nurses/ FWVs 21 32 12 - 65

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 Chapter 4: Primary Health Care

Table 4.12. Distribution of health personnel who have been given training from 2004 to 2010 on VIA (Visual
Inspection of Cervix with Acetic Acid) (Continued...)
MCH/ Grand
Year Designation MCWC UHFWC UPHCP Total
DH/UHC total
Doctors 13 10 - 12 35
2006 100
Nurses/ FWVs 21 12 20 12 65
Doctors 20 13 - 7 40
2007 134
Nurses/ FWVs 47 30 - 17 94
Doctors 24 14 - 10 48
2008 154
Nurses/ FWVs 59 27 - 20 106
Doctors 11 8 - 10 29
2009 153
Nurses/ FWVs 66 38 - 20 124
Doctors 8 8 2 10 28
2010 88
Nurses/ FWVs 18 9 13 20 60
Total 339 218 47 138 742 742

At present, this program is continuing in all the 64 districts and screening-positive women are
being referred to the referral hospitals for colposcopic evaluation and management. To serve as
the referral hospitals, 79 postgraduate gynecologists from various medical colleges and
institutions have been given training on colposcopy. Table 4.13 shows the referral hospitals with
number of colposcopies done. In 2010 (January-December), 5,345 women with VIA-positive
results attended the colposcopy clinics of BSMMU and various medical college hospitals.

Table 4.13. Referral hospitals for colposcopy with number and percentage of colposcopies (2006-2010)

Name of institutions No. (%)

Bangabandhu Sheikh Mujib Medical University (BSMMU) 1,674 (31.32%)
Rajshahi Medical College Hospital (RjMCH) 850 (15.92%)
Chittagong Medical College Hospital (CMCH) 525 (9.82%)
Mymensingh Medical College Hospital (MMCH) 478 (8.94%)
Sylhet MAG Osmani Medical College Hospital (SMAGOMCH) 431 (8.06%)
Khulna Medical College Hospital (KMCH) 349 (6.52%)
Dhaka Medical College Hospital (DMCH) 285 (5.33%)
Shaheed Suhrawardi Medical College Hospital (SSMCH) 184 (3.44%)
Comilla Medical College Hospital (CoMCH) 170 (3.18%)
Barisal Sher-e-Bangla Medical College Hospital (SBMCH) 139 (2.62%)
Rangpur Medical College Hospital (RpMCH) 135 (2.52%)
Faridpur Medical College Hospital (FMCH) 125 (2.33%)
Total 5,345 (100%)

Figure 4.3 shows that 317,700 VIA tests were performed from January 2005 to December 2010
at various service centers. Among them, 15,109 (4.76%) women were found VIA-positive.

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 Chapter 4: Primary Health Care

Figure 4.3. Year-wise distribution of number of VIA tests done and VIA+ve
cases found
97,539
84,426

VIA done VIA+ve 61,648

40,785

21,609
11,693
926 1,918 3,181 3,652 4,885
548

Y2005 Y2006 Y2007 Y2008 Y2009 Y2010

The condition of the cervices of the referred VIA+ve cases examined by colposcopy at BSMMU is
shown in Figure 4.4.

Figure 4.4. Distribution of VIA+ve referred cases by colposcopic examination

Colposcopy
Ca-cervix
Moderate unsatisfactory
(n = 463)
dysplasia, CIN-II (n = 216)
7%
& Stage 0 3%
Cervical
Cancer, CIN-III
(n = 541)
9%
Normal
(n = 2993)
Mild 48%
dysplasia, CIN-I
(n= 2068)
33%

Table 4.14 shows that 240,795 clinical breast examinations (CBE) were performed from January
2007 to December 2010 at different centers. Among them, 6,315 (2.6%) women were CBE-
positive. During publication of this report, most of the districts of Bangladesh have at least two
centers for cervical and breast cancer screening. It is opined that awareness creation, use of
facilities, and further scaling-up will have noticeable impact on improvement of women's health
and prevention of cancer.

Table 4.14. Year-wise performance of clinical breast examination (CBE) in Bangladesh (January 2007 to December 2010)
No. Year 2007 Year 2008 Year 2009 Year 2010 Total
and CBE CBE CBE CBE CBE
CBE+ve CBE+ve CBE+ve CBE+ve CBE +ve
% done done done done done
No. 19,237 202 45,973 1,460 81,701 3,432 93,884 1,221 240,795 6,315

% +ve 1.1 3.2 4.2 1.3 2.6

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 Chapter 4: Primary Health Care

Universal Child Immunization

The Ministry of Health and Family Welfare continues to improve the child health through
various measures, the most notable of which is the high coverage of child immunization. Report
of the EPI Coverage Evaluation Survey 2010 is now available, which shows that percentage of
fully-vaccinated under-two children is 83.4% which was 79.0% in 2007. Hepatitis B and Hib
vaccines are also included now in the routine immunization. The picture of universal child
immunization program in Bangladesh has been shown in Figure 4.5 through 4.9.

Figure 4.5. Valid vaccination coverage (%) among < 12 months and < 23 months old children in
Bangladesh (EPI CES 2010)
23 months 12 months
98.9 98.7
98.7 98.7 97.6 97.5
97.5 94.7
89.4 89.4 89.2
98.6 98.4 83.4
98.4 98.4 97.1 93.6
97 97 88.7 88.7
84.4
79.4

Full
vaccination
BCG

Measles
OPV1

OPV2

OPV3
HB1

HB2

HB3
DPT1

DPT2

Figure 4.6. Valid vaccination coverage (%) among < 12 months and < 23 months DPT3
old children between rural and urban areas in Bangladesh (EPI CES 2010)

Figure 4.7. National coverage (%) of valid full vaccination between boys and
girls among < 12 months and < 23 months old children in Bangladesh (EPI
CES 2010)

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 Chapter 4: Primary Health Care

Figure 4.8. Division-wise valid vaccination coverage (%) in Bangladesh (EPI CES
2010)

Figure 4.9. Annual national trend of valid full vactination coverage (%) in Bangladesh (EPI CES 2010)

Bangladesh has requested for providing GAVI assistance to include pneumococcal and rotavirus
vaccines in the EPI. Discussions are ongoing to introduce also typhoid fever and oral cholera
vaccines. Bangladesh is fortunate to have no polio case virtually from 2001, except in a window
period in 2006. In 2006, 18 wild polio cases were imported in the country from the bordering
districts of India. To keep the country polio-free, Bangladesh conducts country-wide National
Immunization Day (NID). So far, 19 NIDs were conducted. Conduction of NID has to be
continued until India and Nepal become polio-free. Both the countries are trying to be polio-
free. There is a global vision for 90% reduction of measles-related child deaths by 2013.
Bangladesh already achieved this target. Overall, 88% of the eligible children in Bangladesh
were covered by measles vaccination under Measles Follow-up Campaign 2010. There was a
little variation in the coverage between urban and rural areas, i.e. 89% in urban areas vs. 88% in
rural areas. In the Measles Follow-up Campaign, oral polio vaccines and high-potency vitamin A
were also included (Table 4.15).

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 Chapter 4: Primary Health Care

Table 4.15. Coverage of oral polio vaccine and vitamin A capsules among children (EPI CES 2010)

Tetanus toxoid (TT) for women of childbearing age

Bangladesh is maintaining maternal and neonatal tetanus-free status since 2008. EPI
Bangladesh aims to immunize the number of women of childbearing age by administering
tetanus toxoid vaccine (TT) before the age of 18 years. A period of 2 years and 7 months is
required to complete all the 5 doses of TT vaccines. If a woman starts it at the age of 15 years
and maintains the exact interval, she would be able to complete all the doses before she
reaches the age of marriage, ensuring protection for her entire reproductive life. Figure 4.10
shows the valid TT vaccination status in the country. Although the crude TT vaccination
coverage (TT vaccination doses without maintaining exact interval) is relatively higher, it is
assumed that coverage of TT4 and TT5 doses goes down in the country. Attention is needed to
improve the situation in this regard.

Figure 4.10. Valid tetanus toxoid vaccination coverage (%)

among women aged 15 - 49 years by area (EPI CES 2010)

National Rural Urban

98
97
97

96
95
95

82
82
82

61
61
58

39
39
37

TT1 TT2 TT3 TT4 TT5

Integrated Management of Childhood Illness (IMCI)

The program "Integrated Management of Childhood Illness (IMCI)" was introduced in
Bangladesh in 2002 with assistance from UNICEF, WHO, and other development partners.
Before integration, there were separate vertical child health programs, viz. Control of Diarrheal
Diseases (CDD) and Acute Respiratory Infections (ARI). IMCI addresses morbidities which are
responsible for almost 75% of under-five deaths. To simplify case management in the primary
healthcare settings by the health workers and paramedics, the childhood diseases/problems
covered by IMCI program in Bangladesh have been classified into 13 broad categories, viz.
(i) very severe disease, (ii) pneumonia, (iii) cough and cold-not pneumonia, (iv) diarrhea, (v)
dysentery, (vi) fever-malaria, (vii) fever-not malaria, (viii) measles, (ix) ear problem, (x) PEM
(protein energy malnutrition), (xi) drowning, (xii) injury other than drowning, and (xiii) others.

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 Chapter 4: Primary Health Care

IMCI is provided through facility-based treatment as well as through home-care. The latter is
called Community IMCI Program. Currently, facility IMCI is running in 325 upazilas and
community IMCI in 15 upazilas. UNICEF and WHO provide technical and financial assistance to
the Ministry of Health and Family Welfare for implementing the IMCI program. Various other
development partners and NGOs also collaborate with the Government.

The Management Information System (MIS) of the DGHS tries to capture the data from IMCI
services provided in different IMCI facilities. Community IMCI Program is a newer intervention,
and a separate system for data-collection is being developed. Facility-based IMCI is delivered in
42 districts. Data on 1804577 patients from the IMCI facilities of the 42 districts have been
received by MIS-Health. The patients were aged 1 day to 5 years. The distribution of the
patients by division is shown in Figure 4.11.

Figure 4.11 Distribution of patients in the IMCI facilities by division

(N=18405677)
Barisal
Sylhet (n=122,046)
(n=282,346) 7%
13%
Chittagong
(n=255,028)
14%

Rangpur
(n=228,478)
15%

Rajshahi
(n=321,002)
18% Dhaka
Khulna (n=524,730)
(n=70,947) 29%
4%
Figure 4.12 shows the age distribution of the children. It is seen that children from 1 to 5 year(s)
of age constituted the largest IMCI service recipients (56%), followed by 2 to 12 months age-
group (34%). Of the total under-five children, 3% were at the neonatal age. Age-group 29 to 59
days comprised 7% of the total children receiving services from the IMCI facilities.

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 Chapter 4: Primary Health Care

Figure 4.12. Distribution of patients in the IMCI facilities by age-

group (n=1,844,658)
0-28 days 29-59 days
(n=52,412) (n=119,388)
3% 7%

1-5 years
(n=1,015,875)
56% 2-12 months
(n=616,902)
34%

Table 4.16 shows the distribution of the IMCI diseases among children aged 1 day to 5 years. It
is seen that the number and percentage of patients increased with age in case of each disease.
Caution is needed to interpret this situation. This trend should be related to more attendance of
the older children in the IMCI facilities than the younger ones.

Table 4.16. Distribution of IMCI diseases between age-groups (summary of data received from IMCI facilities in
42 districts in 2010)
Diseases/health 2-12
Unit 0-28 days 29-59 days 1-5 years Total
problems months
No. 20,447 40,464 16,166 19,195 95,134
Very Severe Disease
% 21 43 17 20 100
no. - - 79,623 115,087 194,755
Pneumonia
% - - 41 59 100
No Pneumonia no. - - 173,322 295,698 470,088
(Cough & Cold) % - - 37 63 100
no. 10,470 22,959 79,859 156,399 269,687
Diarrhoea
% 4 8 30 58 100
no. - - 5,425 11,017 16,442
Fever-Malaria
% - - 33 67 100
no. - - 97,841 188,322 286,188
Fever-No Malaria
% - - 34 66 100
no. 155 326 2,148 5,664 8,293
Measles
% 2 4 26 68 100
no. 1,967 6,011 22,912 44,676 75,566
Ear Problem
% 3 8 30 59 100
no. 5,044 13,684 30,685 57,517 106,930
Malnutrition
% 5 13 28 54 100
no. 19,619 39,683 119,432 252,577 431,311
Others
% 4 9 28 59 100
57,702 123,127 627,413 1,146,152 1,954,394
Total
3 6 32 59 100

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 Chapter 4: Primary Health Care

Table 4.17 presents the distribution of the IMCI diseases within each age-group. Among the
total children, respiratory tract infection was the leading cause of morbidity (cough and cold:
24%; pneumonia: 10%).

Table 4.17. Distribution of IMCI diseases within each age-group of children of both sexes (summary of data
received from IMCI facilities in 42 districts in 2010)
29-59 2-12
Diseases/health problems Unit 0-28 day(s) 1-5 year(s) Total
days months
Total cases (No.) 57,702 123,127 627,413 1,146,152 1,954,394
Very Severe Disease 35.4% 32.9% 2.6% 1.7% 4.9%
Pneumonia 0.0% 0.0% 12.7% 10.0% 10.0%
No Pneumonia (Cough and Cold) 0.0% 0.0% 27.6% 25.8% 24.1%
Diarrhoea 18.1% 18.6% 12.7% 13.6% 13.8%
Fever-Malaria 0.0% 0.0% 0.9% 1.0% 0.8%
%
Fever-No Malaria 0.0% 0.0% 15.6% 16.4% 14.6%
Measles 0.3% 0.3% 0.3% 0.5% 0.4%
Ear Problem 3.4% 4.9% 3.7% 3.9% 3.9%
Malnutrition 8.7% 11.1% 4.9% 5.0% 5.5%
Others 34.0% 32.2% 19.0% 22.0% 22.1%
Total 100.0% 100.0% 100.0% 100.0% 100.0%
Fever (malaria or no malaria) and diarrhea were the morbidities of 15% and 14% of the children
respectively. Similar pattern of morbidities was also observed among children of all age-groups.
However, very severe disease, diarrhea, and protein energy malnutrition were also prevalent
during the neonatal period [1-28 day(s)] affecting 35%, 18%, and 9% respectively.

Table 4.17 shows the burden of each of the IMCI diseases (based on the number and percentage
of children visiting IMCI facilities) shared by the IMCI facilities in various divisions. The estimates
are not representative of prevalence of these diseases. The variation in the number of patients
may also be due to variation in the number of IMCI facilities among the divisions. The
distribution of children according to IMCI diseases in each division is shown in Table 4.18.
Table 4.18. Distribution of children aged 1 day to 5 years according to IMCI diseases among divisions (summary
of data received from IMCI facilities in 42 districts in 2010)
Disease Unit Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Total

Very Severe No. 2,437 14,554 24,359 2,322 26,987 7,928 16,547 95,134
Disease % 2.6% 15.3% 25.6% 2.4% 28.4% 8.3% 17.4% 100.0%
No. 4,942 38,118 60,233 3,823 35,079 19,534 33,026 194,755
Pneumonia
% 2.5% 19.6% 30.9% 2.0% 18.0% 10.0% 17.0% 100.0%

No Pneumonia No. 35,097 62,085 158,845 19,511 85,730 61,231 47,589 470,088
Cough & Cold % 7.5% 13.2% 33.8% 4.2% 18.2% 13.0% 10.1% 100.0%
No. 16,588 46,019 67,829 10,060 46,878 39,171 43,142 269,687
Diarrhea
% 6.2% 17.1% 25.2% 3.7% 17.4% 14.5% 16.0% 100.0%
No. 168 1,802 2,411 367 3,443 3,789 4,462 16,442
Fever-Malaria
% 1.0% 11.0% 14.7% 2.2% 20.9% 23.0% 27.1% 100.0%
No. 24,483 36,320 110,064 14,327 49,715 29,779 21,500 286,188
Fever-No Malaria
% 8.6% 12.7% 38.5% 5.0% 17.4% 10.4% 7.5% 100.0%

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 Chapter 4: Primary Health Care

Table 4.18. Distribution of children aged 1 day to 5 years according to IMCI diseases among divisions (summary
of data received from IMCI facilities in 42 districts in year 2010) (Continued...)
Disease Unit Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Total
No. 1,596 286 992 22 954 2,923 1,520 8,293
Measles
% 19.2% 3.4% 12.0% 0.3% 11.5% 35.2% 18.3% 100.0%
No. 4,615 8,998 21,163 1,681 13,993 8,927 16,189 75,566
Ear Problem
% 6.1% 11.9% 28.0% 2.2% 18.5% 11.8% 21.4% 100.0%
No. 10,416 8,676 28,179 2,528 22,522 17,241 17,368 106,930
Malnutrition
% 9.7% 8.1% 26.4% 2.4% 21.1% 16.1% 16.2% 100.0%
No. 30,796 58,782 107,658 16,694 68,412 46,337 102,632 431,311
Others
% 7.1% 13.6% 25.0% 3.9% 15.9% 10.7% 23.8% 100.0%
No. 131,138 275,640 581,733 71,335 353,713 236,860 303,975 1,954,394
Total
% 6.7% 14.1% 29.8% 3.6% 18.1% 12.1% 15.6% 100.0%

Table 4.19. Distribution of children (%) aged 1 day to 5 years according to IMCI diseases within each division
(summary of data received from IMCI facilities in 42 districts in 2010)

Nutrition for the community

The Ministry of Health and Family Welfare has a National Nutrition Program (NNP) included
under Health, Nutrition and Population Sector Program (HNPSP 2003-2011). As of 2010, the
program was available in 172 upazilas. However, in Health, Population and Nutrition Sector
Development Program 2011-2016, the nutrition service has been planned to be mainstreamed
for delivery through the normal service-delivery chain of the DGHS and the DGFP. A new
operational plan called National Nutrition Service (NNS) has been included under the DGHS in
HPNSDP 2011-2016. As of June 2011, there was a community nutrition worker for every 1,200
population in NNP areas. She held nutrition clinic 6 days per week in her community. The NNP
provided nutrition care for the following: (i) children (birth registration plus services for
malnourished under-two children); (ii) mothers (pregnant and lactating mothers); (iii) newly-
married couples; (iv) adolescents; (v) father- and mother-in-law forum; (vi) husbands of
pregnant women forum; (vii) monitoring body-weights of children and pregnant women; (viii)

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 Chapter 4: Primary Health Care

supplementary nutrition (supply of specially-prepared local nutritious food); (ix) training;

(x) behavior change communication; (xi) food security (homestead gardens, poultry farming,
vulnerable group feeding, etc.). To implement the nutrition program at the field level, there
were 36,764 community nutrition workers, 3,732 community nutrition organizers, 960 field
supervisors, and 172 upazila managers under the NNP. The beneficiaries of the NNP included
9.1 million households covering 45 million people. The registered population for nutrition care
included 1.94 million under-two children, 0.5 million pregnant women, 0.42 million lactating
mothers, 2.1 million adolescent girls, and 0.24 million newly-married women.

Medical waste management at upazila level

Medical wastes are products of healthcare activities and, if not handled and disposed of
properly, these can transmit diseases by direct contact or by contaminating soil, air, and water.
In uncontrolled environment, service providers, other individuals, community and the
environment remain at risk. Under HNPSP 2003-2011 and HPNSDP 2011-2016, medical waste
management has been included as one of the important components of health facility
management. The waste management function for the health facilities at upazila level and
below has been entrusted with the operational plan of essential services delivery (ESD). The
components of the program are: (i) construction of pits (for infectious, general and recyclable
wastes, and sharps) in the upazila health complexes; (ii) procurement and regular supply of
logistics for collection and transportation of wastes and the safety materials for the waste-
handlers; (iii) training and orientation of the health personnel on proper waste management;
and (iv) community awareness of medical wastes, its management, and individual responsibility.

The medical waste management functions for hospitals at and the above district-level has been
entrusted with Line Director of Improved Hospital Services Management and Safe Blood
Transfusion.

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 Utilization of Health Facilities

The public hospitals and health centers are increasingly par
cipa
ng in sending pa
ents-related
data to the MIS-Health. For 2010 (January to December), we received data from quite a good
number of hospitals and health centers. In these health facili
es, reportedly 52,035,866 pa
ents
received healthcare from the outpa
ent departments. The number of children (both sexes) was
11,932,632. The number of male adult pa
ents was 17,209,849, and that of female adult pa
ents
was 22,279,861. The number of reported admissions was 3,470,963, which included 1,553,381
male pa
ents and 1,893,920 female pa
ents. The number of hospital-deaths was 69,620, of
which males were 46,025 and females were 37,434. The average hospital-death rate was 2.01%.
The detailed informa
on for each hospital is given in the annexure.

Table 6.1. Number of admissions, deaths, and out-pa
ent visits in different types of government health facili
es
(Jan-Dec 2010)

Type of No.of No. of admissions No. of hospital deaths No. of OPD visits
facility facili
es
Male Female Total Male Female Total Male Female Children Total
University 1 25,473 15,324 40,797 646 319 965 804,436 685,259 1,489,695
Hospital
Postgraduate
Teaching and 7 58,666 22,995 85,664 3,093 1,202 4,504 282,257 171,059 42,951 554,176
Specialized
Hospital
Medical
College 12 357,557 337,548 695,251 16,187 13,069 29,267 1,745,054 1,996,581 576,768 4,301,519
Hospital
District and
General 61 456,244 622,319 1,098,148 22,234 19,529 27,699 2,484,426 3,078,111 2,380,684 8,167,864
Hospital
Upazila Health 413 647,478 888,948 1,536,342 3,718 3,263 6,986 7,101,149 9,816,956 5,455,466 22,557,461
Complex

31-bed Health 3 2,070 2,411 4,486 1 2 3 32,996 48,642 43,309 124,947

Complex
Infec
ous
Disease 2 1,735 1,686 3,421 84 28 112 23,475 9,033 13,744 46,252
Hospital
Leprosy 2 229 27 256 0 0 0 4,554 5,926 640 11,120
Hospital
Drug Addic
on
Treatment 2 - - - - - - - - - -
Center
TB Hospital 9 1,085 429 1,521 38 17 55 4,770 2,195 253 7,218
Government
Employees’ 1 381 538 919 0 0 0 42,283 24,329 5,183 71,795
Hospital
Mental
Hospital 1 1,108 313 1,421 5 0 5 10,558 13,050 0 23,608
TB Center 1 - - - - - - - - - -
TB Clinic 33 - - - - - - 60,020 48,476 14,218 122,834
Union Sub- - - - - - - - 4,385,337 6,134,100 3,238,755 13,910,991
center
Urban 12 - - - - - - 27,388 53,453 45,703 126,850
Dispensary
RuralHealth 13 1,355 1,382 2,737 19 5 24 50,769 85,572 52,111 188,752
Center
School Health 16 - - - - - - 69,708 90,106 61,138 231,393
Clinic
Secretariat - - - - - - - 80,669 17,013 1,709 99,391
Clinic
Total 1,553,381 1,893,920 3,470,963 46,025 37,434 69,620 17,209,849 22,279,861 11,932,632 52,035,866

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 Chapter 6: Utilization of Health Facilities

Figure 6.1 shows the distribu
on of the OPD pa
ents among types of health facili
es. Of the total
52,035,866 pa
ents reported to be seen in the outpa
ent departments, 27% were seen in the
health facili
es having only outpa
ent services (union sub-center, health and family welfare
center, TB clinic, etc.). In the primary-care hospitals (upazila health complex, rural health centers,
10- or 20-bed hospitals), 44% of pa
ents were seen. In the secondary-care hospitals (district or
general hospitals), 16% of pa
ents were seen. The ter
ary-care hospitals (medical college
hospitals) and the postgraduate teaching hospitals served 8% and 1% of the outdoor pa
ents
respec
vely. There are some special-purpose hospitals, such as TB hospitals, leprosy hospitals,
infec
ous disease hospitals, labor hospitals, government emeployees’ hospitals, etc. These
special-purpose hospitals provided service to 1% of the total outdoor pa
ents. The Bangabadhu
Sheikh Mujib Medical University Hospital served 3% of the total reported outdoor pa
ents. A
profile of the pa
ent-visits to community clinics has been given in Chapter 4.

Figure 6.1. Distribu
on of the OPD pa
ents between Diffrent types of government-owned hospitals
(Year 2010) (n=absoulte number of pa
ents)

Special purpose
hospital
Primary care
(n=14,840,204),
hospital
28%
(n=22,682408),
44%

University Hospital
(n=1,489,695),
3%

Secondary care Ter
ary care Postgraduate

hospital hospital specialized hospital
(n=8,167864), (n=4,301,519), (n=554,176),
16% 8% 1%
MIS-Health had report on admissions for the primary-, secondary-, ter
ary-care, postgraduate
specialized teaching and special-purpose hospitals. We received report on 3,470,963 admissions
from these hospitals in 2010. Figure 6.2 shows the distribu
on of the admied pa
ents. Among
the total admied pa
ents, the primary-care hospitals had 44%; the secondary-care hospitals
had 32%; the ter
ary-care hospitals and the postgraduate teaching hospitals had 20% and 3%
admissions respec
vely. The special-purpose hospitals had 0.3% of the total admissions.
Bangabadhu Sheikh Mujib Medical University Hospital had 1% of the admissions during 2010.

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 Chapter 6: Utilization of Health Facilities
Figure 6.2. Distribu
on of admission between different type of health facili
es (n=3,470,963)

University hospital;
Special purpose 40,797;
hospital; 1%
10,275;
Ter
ary care
0%
hospital;
695,251;
20%

PG specialized
Primary care
hospital;
hospital;
85,664;
1,540,828;
3%
44%

Secondary care
hospital;
1,098,148;
32%

Table 6.2 shows the average length of stay, bed-occupancy rate, hospital-death rate, average
daily admission, and average daily OPD visits in different types of hospitals. Detailed informa
on
on services by the health facili
es is given in the annexure.

Table 6.2. Average length of stay, bed-occupancy rate, hospital-death rate, average daily admission, and average
daily OPD visits in different types of hospitals (2010)
Average length Bed-occupancy Hospital-death Average daily Average daily
Type of health facility
of stay (day) rate (%) rate (%) admission (N) OPD visits (N)
Specialized Postgraduate
7 71.96 5.48 34 217
Teaching Hospital
Medical College Hospital 3 78.88 3.98 287 918
District Hospital 3 106.64 2.83 54 404
Infec
ous Disease Hospital 1 4.99 3.76 3 42

Chest Clinics/Hospital 25 7.16 4.15 1 2

TB Segrega
on Hospital 42 63.04 4.59 0 2

Leprosy Hospital 44 38.45 0.00 0 19

Figure 6.3 shows the distribu
on of the upazila health complexes by bed-occupancy rates.
MIS-Health received data to calculate bed-occupancy rates for 413 upazila health complexes. It is
revealed that, in over 63% upazila health complexes, the bed-occupancy rate varies between 50%
and 100%. The bed-occupancy rates were seen to vary from below 40% to 140%. Table 6.3 shows
a
me-series from 2005 up to 2010 of the bed-occupancy rates.

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 Chapter 6: Utilization of Health Facilities

Figure 6.3. Distribu
on of the upazila health complexes by bed-occupancy rate (Year 2010; n=No. of
upazila health complexes)
18%

13% 12% 13%

10%
8% 7%
6% 6%
3% 3%
1%

Table 6.3. Distribu
on of the upazila health complexes by % of bed-occupancy rates in different years

No. and % of upazila health complexes

Bed-occupancy rate (%) 2005 2006 2007 2008 2009 2010

No. % No. % No. % No. % No. % No. %
Below 40.00 8 2.33 14 3.92 11 3.05 10 2.48 8 1.96 40 9.69
40.01– 50.00 9 2.62 20 5.6 14 3.88 42 10.4 23 5.64 23 5.57
50.01– 60.00 17 4.96 26 7.28 27 7.48 59 14.6 36 8.82 52 12.59
60.01– 70.00 45 13.12 36 10.08 48 13.3 74 18.32 75 18.38 48 11.62
70.01– 80.00 58 16.91 62 17.37 80 22.16 76 18.81 113 27.7 73 17.68
80.01– 90.00 97 28.28 75 21.01 69 19.11 61 15.1 60 14.71 56 13.56
90.01– 100.00 73 21.28 70 19.61 67 18.56 48 11.88 48 11.76 35 8.47
100.01– 110.00 27 7.87 36 10.08 37 10.25 16 3.96 20 4.9 30 7.26
110.01- 120.00 22 6.41 15 4.2 7 1.94 16 3.96 12 2.94 25 6.05
120.01- 130.00 3 0.87 2 0.56 1 0.28 0 0 9 2.21 14 3.39
130.01– 140.00 1 0.29 1 0.28 0 0 0 0 4 0.98 6 1.45
Above 140 0 0.0 0 0.0 0 0.0 2 0.5 0.0 0.0 11 2.66
Total 343 100.0 357 100.0 361 100.0 404 100.0 408 100.0 413 100.0

It is welcoming that MIS-Health received data on admissions, hospital-deaths, and outdoor visits
from some private hospitals. Table 6.4 summarizes the data.

Table 6.4. Number of admissions, hospital-deaths and outdoor visits in some private hospitals (during 2010)
(names of hospitals are shown in alphabe
cal order)
No. of Admission (N) Death (N) Outdoor visit (N)
Health facility
beds Male Female Total Male Female Total Male Female Children Total
ABC Complex Eye Clinic, Salna,
Sadar, Gazipur 10 649 853 1502 0 0 0 22942 18306 8150 49398
Ahsan Clinic,Dinajpur 10 153 316 469 0 0 0 0 0 0 0
Alam General Eye Hospital,
Kapasia, Gazipur 20 336 504 840 0 0 0 5110 6387 1277 12775
Al-Baraka General Hospital,
Gazipur 10 300 360 660 0 0 0 200 260 100 560

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 Chapter 6: Utilization of Health Facilities
Table 6.4. Number of admissions, hospital-deaths and outdoor visits in some private hospitals (during 2010)
(names of hospitals are shown in alphabe
cal order) (Con
nued...)
No. of Admission (N) Death (N) Outdoor visit (N)
Health facility
beds Male Female Total Male Female Total Male Female Children Total
Al-Fahim Hospital, Kapasia,
Gazipur 10 57 110 167 0 0 0 725 885 515 1825
Al-Hera Hospital, Sreepur
Gazipur 10 278 277 555 0 0 0 276 312 123 711
Al-Noor Islami Hospital,
Gazipur 10 94 477 571 0 0 0 425 2030 98 2553
Aloha Swasto Kandro Hoapital
Balubari, Dinajpur 5 11 100 111 0 0 0 127 166 0 293
Aurobindo Shishu Hospital,
Dinajpur 10 1578 1141 2719 17 10 27 4602 2606 7208 14416
Ayesha Memorial Hospital,
Dhaka 50 8760 5840 14600 263 175 438 9034 7391 5475 21900
BNSB Base Eye Hospital,
Sirajganj 45208 4978 9186 1 0 1 16635 19014 6673 42322
BRAC Shushastho, Dinajpur 10 663 673 4 0 0 0 325 2298 29 2652
BRAC Shushostho, Gazipur 5 3 903 906 0 0 0 3335 9322 2674 15331
Central
Hospital, Kaliganj, Gazipur 10 250 682 932 0 0 0 522 892 103 1517
Chandra Mallika Socity
Hospital, Gazipur 10 340 430 770 0 0 0 900 2100 61 3061
Chris
an Hospital,
Chadraghona, Kaptai, 100 2209 3273 5482 62 41 103 6756 17543 4465 28764
Rangama

Cosmos General Hospital,
Gopalpur, Lalpur, Natore 20 380 700 1080 0 0 0 1100 2500 500 4100
Desh Eye Hospital, Sadar,
Gazipur 10 140 133 273 0 0 0 650 600 50 1300
Dewan General Hos. &
Diagnos
c Centre, KaliaKair, 10 64 67 131 0 0 0 311 536 132 979
Gaipur
ENT KSG Hospi
al, Dinajpur 10 120 130 250 0 0 0 1000 1200 1000 3200
Green Hospital, Gazipur 10 264 352 616 0 0 0 1284 1648 329 3221
Holy Home Hospital &
Diagonos
c Centre, Kapasia, 8 168 371 539 0 0 0 229 397 101 727
Gazipur
ICDDRB, Dhaka 91300 65990 157290 122 86 208 17462 10920 25685 54067
Insaf Hospital, Joydebpur,
Gazipur 20 279 680 959 0 0 0 226 501 0 727
Jalalabad Ragib-Rabeya 17428
Hospital, Sylhet 890 17601 19607 37208 364 464 828 61001 69715 43572
8
Jalchatra Hospital, Madhupur,
Tangail 80 634 215 849 19 5 24 8741 8709 3138 20588
Jamil Eye & General Hospital,
Kaliganj, Gazipur 20 395 690 1085 0 0 0 14402 18001 3602 36005
Jobaida Memorial Hospital &
Diagonos
c Centre, Sadar, 10 405 555 960 0 0 0 2104 2893 263 5260
Gazipur
Kaliakair General Hospital &
Diagonos
c Center, Gazipur 20 152 530 682 0 0 0 1000 1400 785 3185
Kazi Hospital Complex, Gazipur 10 521 729 1250 0 0 0 898 1225 598 2721
Khaza Yunus Ali Medical
College & Hospital, Sirajganj 6175 3706 9881 170 109 279 38379 27828 66207 20
Konabari Clinic & Diagnos
c
Center, Gazipur 10 321 403 724 0 0 0 211 345 102 658
13449
Kumudini Hospital, Tangail 750 8358 11852 20210 155 154 309 49931 62811 21756
8
Lion Eye Ins
tute and Hospital,
Dhaka 3182 2320 5502 38743 36431 3020 78194
Lutheran Health Care,
Bangladesh (LHCB) Dumki, 40 392 962 1354 12 13 25 1259 7902 5726 14887
Patuakhali
M.A. Akbar Clinic, Sadar,
Gazipur 10 157 338 495 0 0 0 1146 1107 34 2287
Mathree Seba Clinic &
Diagnos
c Center, Konabari, 10 56 142 198 0 0 0 256 312 104 672
Gazipur
Mawna General Hospital,
Sreepur, Gazipur 10 37 148 185 0 0 0 840 1160 431 2431
Meher Hospital & Diagnos
c
Center, Gazipur 10 65 230 268 0 0 0 415 630 95 1140
Metropoliton Medical Center
Ltd., Dhaka 70 3872 265 0 0 0 0
Model Polly Hospital, Kapasia,
Gazipur 10 180 452 632 0 0 0 1244 3054 1836 6134
Modern Hospital & Diagnos
c
Center, Sreepur, Gazipur 10 230 332 562 0 0 0 1020 1400 300 2720
Nagaric Hospital, Barmi,
Sreepur, Gazipur 10 209 687 896 0 0 0 413 653 105 1171
New Turag General Hospital,
Tongi, Gazipur 20 319 527 891 0 0 0 521 815 218 1534
North Bengal Medical College
Hospital, Sirajganj 5800 5241 11041 55 16 71 29023 8811 7447 63251
Poly Cilnic, Dinajpur 12 73 115 188 0 0 0 0
Rajmuk
Nursing Home,
Dinajpur 10 314 1663 1977 0 0 0 0 0 0 0
Rawnak Jahan Eye Hospital
Pvt. Ltd., Mauna, Sreepur, 10 215 332 547 0 0 0 4210 4825 1842 10877
Gazipur

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 Chapter 6: Utilization of Health Facilities
Table 6.4. Number of admissions, hospital-deaths and outdoor visits in some private hospitals (during 2010)
(names of hospitals are shown in alphabe
cal order) (Con
nued...)

Rushmono Gen eral Hospital

Ltd., Dhaka 57 1077 995 2072 8 8 16 3 4 2 9
Safa Marwa General Hospital,
Kapasia, Gazipur 10 260 767 1027 0 0 0 1141 3890 1343 6374
Safe Way Medical Services,
Dinajpur 1 46 47 0 0 0 0 0 0 0
Seba General Hospital, Gazipur 20 202 414 616 0 0 0 1102 2570 648 4320
Sevenday Clinic & Nursing
Home, Dinajpur 10 162 244 406 0 0 0 0 0 0 0
Shafipur General Hospital,
Konabari, Gazipur 10 172 205 377 0 0 0 215 321 106 642
Shaheed Asadullah Ideal
Hospi
al, Dinajpur 10 368 181 549 0 0 0 0 0 0 0
Shapla Medicine & Diagnos
c
Center, Mauna, Sreepur, 10 478 982 1460 0 0 0 1735 1995 0 3730
Gazipur
Sharif General Hospital,
Konabari, Gazipur 20 720 900 1620 0 0 0 3650 5475 1825 10950
Shitalakhya G.H. & Diagnos
c
Center, Kapasia, Gazipur 10 230 610 840 0 0 0 7325 6128 1907 15360
St.Marys Catholic Mother &
Child Hospital, Kaliganj, 10 0 108 108 0 0 0 300 4000 2700 7000
Gazipur
St Vincent’s Hospital, Dinajpur 20 164 173 337 0 0 0 3745 5145 30 8920
Sufia Hospital & Diagnos
c
Center, Gazipur 10 266 932 1198 0 0 0 521 727 203 1451
Sultan General Hospital,
Gazipur 10 330 350 680 0 0 0 315 411 102 828
14261
Surjer Hashi Clinic, Dinajpur 20 8 2268 2276 0 0 0 26656 84767 31196
9
Syeam Clinic Housing
Roundabout, Dinajpur 10 61 182 243 0 0 0 0 0 0 0
The Modern Hospital, Sreepur,
Gazipur 10 212 645 857 0 0 0 398 723 189 1310
Tongi Adhunik Eye Hospital,
Gazipur 10 225 473 698 0 0 529 745 195 1469
United General Hospital,
Hossain Market, Tongi, Gazipur 10 312 525 837 0 0 0 442 581 203 1236
Upasom Hospital & Diagnos
c
Center, Gazipur 10 234 345 579 0 0 0 213 289 103 605
Zia Heart Founda
on &
Research ins
tute, Dinajpur 50 2456 1324 3780 260 112 372 6400 4317 316 11033
Islami Bank Central Hospital, 26728
Dhaka 160 8192 7554 15746 117 80 197 0 0 0
6
13251
Total 2927 215924 162299 339781 1625 1273 3163 408905 494882 268859
59

Table 6.4 summarizes the data on bed-occupancy rate, hospital-death rate, average daily
admission, and average daily outdoor visits in the private hospitals which provided data.

Table 6.5. Percentages of the average length of stay, bed-occupancy rate, hospital-death rate, average daily
admission, and average daily outpa
ent visits in some private hospitals (during 2010) (names of hospitals are
shown in alphabe
cal order)
Bed- Average
Hospital- Average daily
Facility No. of beds occupancy daily OPD
death rate (%) admission (N)
rate (%) visit (N)
ABC Complex Eye Clinic, Salna, Sadar, Gazipur 10 48.96 0.00 4 135
Alam General Eye Hospital, Kapasia, Gazipur 20 29.92 0.00 2 35
Al-Baraka General Hospital, Gazipur 10 41.75 0.00 1 2
Al-Fahim Hospital, Kapasia, Gazipur 10 12.68 0.00 0 5
Al-Hera Hospital, Sreepur, Gazipur 10 47.23 0.00 2 2
Al-Noor Islami Hospital, Gazipur 10 32.58 0.00 2 7
Aloha Swasto Kandro Hoapital, Balubari, 5 0.00 0.00 0 1
Dinajpur
Aurobindo Shishu Hospital, Dinajpur 10 0.00 1.00 7 39
Ayesha Memorial Hospital, Dhaka 50 0.00 3.09 39 60
Banesha Memorial Hospital, Tongi, Gazipur 10 28.77 0.00 1 1
BNSB Base Eye Hospital, Sirajgonj 0.00 0.01 25 116
BRAC Shushastho, Dinajpur 10 0.00 0.00 0 7
BRAC Shushostho, Gazipur 5 147.95 0.00 2 42

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 Chapter 6: Utilization of Health Facilities
Table 6.5. Percentages of the average length of stay, bed-occupancy rate, hospital-death rate, average daily
admission, and average daily outpa
ent visits in some private hospitals (during 2010) (names of hospitals are
shown in alphabe
cal order) (Con
nued...)
Bed- Average
Hospital- Average daily
Facility No. of beds occupancy daily OPD
death rate (%) admission (N)
rate (%) visit (N)
Central Hospital, Kaliganj, Gazipur 10 53.73 0.00 3 4
Chandra Mallika Society Hospital, Gazipur 10 84.38 0.00 2 8
Chris
an Hospital, Chadraghona, Kaptai, Rangama
100 73.31 1.93 15 79
Cosmos General Hospital, Gopalpur, Lalpur, Natore 20 44.38 0.00 3 11
Desh Eye Hospital, Sadar, Gazipur 10 19.37 0.00 1 4
Dewan General Hospital & Diagnos
c Center, 10 11.37 0.00 0 3
KaliaKair, Gaipur
Dianjpur Clinic, Dinajpur 10 0.00 0.00 0 0
ENT KSG Hospital, Dinajpur 10 6.85 0.00 1 9
G.C. Memorial Hospital, Dinajpur 10 0.00 0.00 0 0
Green Hospital, Gazipur 10 42.77 0.00 2 9
Holy Home Hospital & Diagnos
c Center, Kapasia, 8 49.62 0.00 1 2
Gazipur
ICDDRB, Dhaka - 0.00 0.13 432 148
Insaf Hospital, Joydebpur, Gazipur 20 71.18 0.00 3 2
Jalalabad Ragib-Rabeya Hospital, Sylhet 890 0.12 2.30 99 478
Jalchatra Hospital, Modhupur, Tangail 80 0.00 2.91 2 56
Jamil Eye & General Hospital, Kaligonj, Gazipur 20 31.85 0.00 3 99
Janata Clinic & Nursing Home, Dinajpur 10 0.00 0.00 1 0
Jobaida Memorial Hospital & Diagnos
c Center, Sadar, 10 52.60 0.00 3 14
Gazipur
Kaliakoir General Hospital & Diagos
c Center, Gazipur 20 26.19 0.00 2 9
Kazi Hospital Complex, Gazipur 10 92.74 0.00 3 7
Khaza Yunus Ali Medical College & Hospital, Sirajganj - 0.00 2.86 27 0
Konabari Clinic & Diagnos
c Center, Gazipur 10 53.84 0.00 2 2
Kumudini Hospital, Tangail 750 40.51 1.54 55 368
Lion Eye Ins
tute and Hospital, Dhaka - 0.00 0.00 15 214
Lutheran Health Care, Patuakhali 40 0.00 1.85 4 41
Bangladesh (LHCB) Dumki, Patuakhali
M. A. Akbar Clinic, Sadar, Gazipur 10 27.23 0.00 1 6
Mathree Seba Clinic & Diagnos
c Center, Konabari, 10 16.25 0.00 1 2
Gazipur
Mauna General Hospital, Sreepur, Gazipur 10 15.48 0.00 0 7
Meher Hospital & Diagnos
c Center, Gazipur 10 21.84 0.00 1 3
Metropolit an Medical Center Ltd., Dhaka 70 0.00 6.81 11 0
Model Polly Hospital, Kapasia, Gazipur 10 39.01 0.00 2 17
Modern Hospital & Diagnos
c Center, Sreepur, 10 34.52 0.00 2 7
Gazipur
Nagaric Hospital, Barmi, Sreepur, Gazipur 10 47.89 0.00 2 3
New Turag General Hospital, Tongi, Gazipur 20 31.84 0.00 2 4
North Bengal Medical College Hospital, Sirajganj - 0.00 0.65 30 173
Poly Cilnic, Dinajpur 12 4.29 0.00 0 0
Rajmuk
Nursing Home, Dinajpur 10 0.00 0.00 5 0
Rawnak Jahan Eye Hospital Pvt. Ltd., Mauna, Sreepur, 10 5.29 0.00 1 30
Gazipur
Rushmono General Hospital Ltd., Dhaka 57 0.03 0.78 6 0
Safa Marwa General Hospital, Kapasia, Gazipur 10 53.86 0.00 3 17
Safe Way Medical Sarvices, Dinajpur - 0.00 0.00 0 0
Seba General Hospital, Gazipur 20 41.37 0.00 2 12
Sevenday Clinic & Nursing Home, Dinajpur 10 0.00 0.00 1 0
Shafipur General Hospital, Khonabari, Gazipur 10 30.99 0.00 1 2
Shaheed Asadullah Ideal Hospi
al, Dinajpur 10 15.04 0.00 2 0
Shapla Medicine & Diagnos
c Centre, Mauna 10 120.00 0.00 4 10
Sreepur, Gazipur
Sharif General Hospital, Konabari, Gazipur 20 47.53 0.00 4 30
Shitalakhya G.H. & Diagnos
c Center, Kapasia, Gazipur 10 59.78 0.00 2 42
St. Marys Mother & Child Hospital, Kaligonj, Gazipur 10 9.10 0.00 0 19
St. Vincent’s Hospital, Dinajpur 20 125.71 0.00 1 24
Sufia Hospital & Diagnos
c Center, Gazipur 10 91.18 0.00 3 4
Sultan General Hospital, Gazipur 10 46.58 0.00 2 2
Surjer Hashi Clinic, Dinajpur 20 105.78 0.00 6 391

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 Chapter 6: Utilization of Health Facilities
Table 6.5. Percentages of the average length of stay, bed-occupancy rate, hospital-death rate, average daily
admission, and average daily outpa
ent visits in some private hospitals (during 2010) (names of hospitals are
shown in alphabe
cal order) (Con
nued...)
Syeam Clinic Housing Roundabout, Dinajpur 10 0.00 0.00 1 0
The Modern Hospital, Sreepur, Gazipur 10 40.41 0.00 1 4
Tongi Adhunik Eye Hospital, Gazipur 10 47.15 0.00 2 4
United General Hospital, Hossain Market, Tongi, 10 60.30 0.00 2 3
Gazipur
Upasom Hospital & Diagnos
c Center, Gazipur 10 20.36 0.00 2 2
Zia Heart Founda
on & Research ins
tute, Dinajpur 50 0.00 11.00 9 30
Islami Bank Central Hospital, Dhaka 160 0.00 1.29 42 732

Smiling Sun Franchise Program

The Smiling Sun Franchise Program (SSFP) is a project funded by the United States Agency for
Interna
onal Development (USAID). It is intended to complement the wide network of health and
family planning facili
es of the Government of Bangladesh, resor
ng to an innova
ve approach
to healthcare franchising. To achieve relevant health outcomes, the SSFP jointly works with
partnering NGOs to convert the exis
ng network into a viable social health franchise. The project
uses a build-operate-transfer (BOT) methodology to set a plan for developing the Franchise
Manager Organiza
on into an opera
onal en
ty so that it can fully assume franchise opera
ons
by the end of the project. Currently, 28 NGOs are providing healthcare services to women,
children, and youths through 320 sta
c and 8,500 satellite clinics in 61 districts of Bangladesh; 34
clinics of this network are providing Emergency Obstetric Care (EmOC) services. This network will
con
nue to expand the volume and types of quality healthcare under ESD provided to the
able-to-pay customers as well as underserved and poor clients. During the first and the second
year of the project, the SSFP worked with local implemen
ng partners and increased their ability
to cover opera
onal expenses from 25% to 31%, and currently, sustainability is approximately
41%. By the fourth year of this project, the SSFP aims to generate sufficient income to support
approximately 70% of the opera
onal cost while maintaining access to those who cannot afford
to pay for services. During 2010, three hundred twenty (320) smiling sun clinics treated
29,182,131 outdoor pa
ents while 17,145 pa
ents were admied and discharged in 34 EmOC
(ultra) clinics. As in previous years, no pa
ent died in smiling sun clinics during 2010. In 34 ultra
clinics, pa
ents stayed, on an average, for 3 days while their bed-occupancy rate was 52%, which
is 5 percent-point higher than the previous year. In 34 EmOC clinics, on an average, 47 pa
ents
were admied per day while the SSFP network treated, on an average, 99,418 outdoor pa
ents
per day. During 2010, twenty comprehensive EmOC clinics conducted 5,772 major surgeries
(c-sec
ons), which is 6% higher than that in the previous year.
Table 6.6. Number of pa
ents served in Smiling Sun Franchise Program (SSFP) partners in 2010
Average Average
Bed- Hospital Average
Admission Death length daily Cesarean
Month Total (N) occupancy -death daily OPD
(N) (N) of stay admission sec
on
rate (%) rate (%) visits (N)
(day) (N)
January 3651936 1549 0 3 56 0 49 140307 510
February 3486468 1347 0 3 53 0 48 156015 422
March 2044047 1505 0 3 54 0 48 79767 507
April 2024952 1260 0 3 47 0 42 83288 430
May 3453924 1279 0 3 46 0 41 138903 477

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 Chapter 6: Utilization of Health Facilities
Table 6.6. Number of pa
ents served in Smiling Sun Franchise Program (SSFP) partners in 2010 (Con
nued...)
Average Average
Bed- Hospital Average
Admission Death length daily Cesarean
Month Total (N) occupancy -death daily OPD
(N) (N) of stay admission sec
on
rate (%) rate (%) visits (N)
(day) (N)
June 2057732 1315 0 3 49 0 43 79305 441
July 2035454 1364 0 3 49 0 44 81063 471
August 2057864 1585 0 3 57 0 51 79926 544
September 2048843 1503 0 3 56 0 50 93537 509
October 2113913 1582 0 3 57 0 51 85338 534
November 2097036 1524 0 3 56 0 50 91880 495
December 2109962 1332 0 3 48 0 42 87734 432
Total 29182131 17145 - 3 52 0 47 99418 5772
Note: Only female pa
ents; the SSFP operates emergency obstetric care facili
es with 270 sanc
oned beds

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 Safe Blood Transfusion

Blood transfusion service in Bangladesh was started in 1950 in Dhaka Medical College Hospital.
To ensure supply of safe blood for humans through screening, the Safe Blood Transfusion
Program (SBTP) was launched in 2000 with the assistance of UNDP under the Health and
Population Sector Program (HPSP) 1998-2003. Under this program, blood-screening facilities
were developed in 99 blood transfusion centers. In 2004, the activities of the Safe Blood
Transfusion Program received financial support from the World Bank and DFID through IDA
credit. A Memorandum of Understanding (MoU) was signed between MOHFW and WHO under
HIV/AIDS Prevention Project (HAPP) with technical assistance from the latter. This continued till
2007. Since then, the activities are being implemented under the Health, Nutrition and
population Sector Program (HNPSP) 2003-2011. The activity will also continue under the Health,
Population and Nutrition Sector Development Program (HPNSDP) 2011-2016.

The Safe Blood Transfusion Program made a good progress over the past years through
reduction in the number of paid donors from 70% to 0%, capacity-building for blood-screening
in all blood transfusion centers for HIV, hepatitis B and C, syphilis and malaria, and expansion of
activities up to the upazila health complex level. Currently, 203 blood transfusion centers, with
89 in the upazila level, are functional under the program. Blood-component separation facilities
have been developed in 18 blood transfusion centers. Six centers have been equipped with
modern mobile vans for outdoor blood-collection. Following is a profile of the SBTP as of 2010:

No. of blood transfusion centers supported currently by SBTP .................. 203

No. of blood transfusion centers at the upazila level ................................... 89
No. of centers where blood-component separation facilities exist ............. 18
No. of centers with mobile vans for blood-collection .................................... 6

During 2001 to 2010, a total of 2,439,856 units of blood were tested, out of which 28,947 units
were rejected (1.5%) due to the evidence of transfusion-transmitted infections (TTIs). Of the
rejected units, 21,709 were for hepatitis B; 3,161 for hepatitis C; 2,799 for syphilis, 1,149 for
malarial parasites, and 126 for HIV (Figure 12.1). A total of 119,476 units of blood-components
were produced by 18 blood transfusion centers during 2008-2010.

Health Bulletin 2011 |Page-110

 Chapter 12: Safe Blood Transfusion

Fugure 12.1. Percentage of units of blood rejected due to various reasons from
2001 to 2010 (Total units rejected=28,947)

0.4%
4.0%

9.7% Hepatitis B (n=21,709)

Hepatitis C (n=3,161)
10.9% Syphilis (n=2,799)
Malarial Parasites (n=1,4149)
HIV (n=126)
75.0%

Table 12 shows the year-wise distribution of the number of units of rejected blood due to
various reasons based on the screening tests.

Table 12. Cumulative screening report for blood with TTIs 2001-2010
No. of units Malarial
Year HIV+ve Hepatitis B+ve Hepatitis C+ve Syphilis+ve
tested parasite+ve
2001 99,653 2 1,381 82 290 7
2002 170,948 4 2,433 246 655 53
2003 180,015 1 1,900 1,024 428 13
2004 121,993 36 1,284 251 257 8
2005 203,575 8 1,689 201 305 6
2006 228,127 20 1,814 242 209 1
2007 324,005 27 2,764 251 215 1,013
2008 369,026 13 2,996 309 143 4
2009 358,067 9 2,135 181 115 7
2010 384,447 6 3,313 374 182 37
Total 2,439,856 126 21,709 3,161 2,799 1,149

In 2010, a total of 40,242 units of blood-components were produced by the blood centers.
These included 21,254 units of red blood cell concentrate, 11,680 units of fresh frozen plasma,
7,269 units of plate concentrate, and 39 units of cryoprecipitate.

The Safe Blood Transfusion Act 2002 of Bangladesh was in place, the rules and regulations were
circulated in 2008. There is a reference laboratory for blood transfusion at the new annex
building of Dhaka Medical College Hospital. The functions of the reference laboratory are to
support various organizations for training and monitoring. The reference laboratory is also
testing the referred samples and validation of kits. The professionals engaged in the safe blood
transfusion program deeply feel that a National Blood Center should be established as soon as
possible to further streamline the stewardship role and coordination functions for the current
fragmented blood transfusion services operating throughout the country.

Health Bulletin 2011 |Page-111

 Chapter 12: Safe Blood Transfusion

Figure 12.2. Year-wise collection of number of units of blood by the blood centers
under SBTB

384,447
369,026

358,067
324,005
228,127
203,575
180,015
170,948

121,993
99,653

Y2001 Y2002 Y2003 Y2004 Y2005 Y2006 Y2007 Y2008 Y2009 Y2010

The blood centers under the Safe Blood Transfusion Program collectively gathered a total of
2,439,856 units of blood from 2001 to 2010. In 2010, the program personnel collected 384,447
units of blood. Figure 12.2 shows the year-wise collection of the number of units of blood by
the blood centers under SBTP.

Figure 12.3. Year-wise collection of number of units of blood by different voluntary blood donation
organizations
Y2001 Y2002 Y2003 Y2004 Y2005 Y2006 Y2007 Y2008 Y2009 Y2010
59,526

55,977
48,253
46,045
43,901
43,702

43,077

42,966
40,306
38,989
37,426

36,647
35,223

34,733
34,125

33,712
32,056
29,312

28,000
27,486

25,663
25,663
24,842
23,195
22,810

22,635
22,470

21,166
19,300

17,000
15,063
14,612

13,000
11,030
10,431

10,300
8,785
6,720
5,295
1,781

Sandhani Red Crecent Quantum Badhan

A number of voluntary or non-profit organizations also contribute to encourage healthy donors

for donating blood voluntarily. Some of these organizations have their own set-up for
collecting, testing, storing, and distributing blood or blood products. Figure 12.3 shows the
year-wise collection by the major voluntary blood-donation organizations.

Health Bulletin 2011 |Page-112

 Nutrition

The public-health nutrition program under the Ministry of Health and Family Welfare of
Bangladesh is operated through the Institute of Public Health Nutrition (IPHN) and two major
programs under the Health, Nutrition and Population Sector Program (HNPSP) 2003-2011.
These two programs are Micronutrient Supplementation (MS) and National Nutrition Program
(NNP). However, these two programs will be mainstreamed in the new name "National
Nutrition Services (NNS)" with the health and family-planning services under the Health,
Population and Nutrition Sector Development Program (HPNSDP) 2011-2016.

In the HNPSP 2003-2011, the IPHN and MS worked under the Directorate General of Health
Services (DGHS), and the NNP worked directly under the Ministry.

Conventionally, the director of IPHN works as the line director of MS and head of nutrition
programs of the IPHN. The programs include: (a) Control of micronutrient deficiencies focusing
on nutritional blindness due to vitamin A deficiency; (b) Control of protein-energy malnutrition
(PEM); (c) Control and prevention of iron-deficiency and other nutritional anemia; (d) Control of
iodine-deficiency disorders and other micronutrient problems; (e) School health nutrition
education program targeting school children; and (f) Revitalization of existing baby-friendly
hospitals. The programs of the IPHN and MS cover the entire country.

The NNP, on the other hand, covers 172 upazilas. In the NNP area, satellite community nutrition
centers are operated 6 days a week, one per 1,200 people. One lady community nutrition
worker runs the nutrition center. There are 36,764 community nutrition workers for 172
upazilas, 3,732 community nutrition organizers, 960 field supervisors, and 172 upazila
managers. The target populations of the NNP are: (a) under-2 children; (b) pregnant and
lactating mothers; (c) newly-married couples; (d) adolescent boys and girls; (e) in-laws; and (f)
husbands of pregnant women. The latter two target-groups are for advocacy services. The
services include nutrition supplementation to malnourished children and all pregnant and
lactating women; monitoring weight of under-2 children and pregnancy weight-gain; training;
behavior change communication; and food-security interventions through vulnerable group
feeding as well as through encouraging people for home-gardening and poultry-farming.

The nutrition activities carried out by the IPHN and MS have been summarized below:
Vitamin A program: Every year two rounds of vitamin A capsule supplementation to children
aged 12 to 59 months are done. On 8 January 2011, the first round of the 19th National
Immunization Day (NID) for 2011 took place, and the second round took place on 12 February
2011. Health workers and volunteers administered oral polio vaccine to 22 million children aged
0-59 months and vitamin A capsule to 20 million children aged 12-59 months at 140,000 sites
located in health facilities and health centers, schools as well as mobile sites (bus, boat, and

Health Bulletin 2011 |Page-113

 Chapter 13: Nutrition

railway-stations) throughout the country. Moreover, a four-day house-to-house immunization by

mobile teams followed in order to make sure that no child be missed. In the 18th NID held in
January 2010, the coverage of vitamin A capsule was 96%. Along with the vitamin A
supplementation, anti-helminthic tablet albendazole (400 mg) are also administered to children
aged 24 to 59 months. About 86% of the children who receive vitamin A fall under this age-
group, who received albendazole in the past rounds.

Protein-energy malnutrition (PEM): IPHN undertook efforts for creating awareness about the
improvement of protein-energy malnutrition situation in the country through using data and
resources, such as Child Nutrition Survey (CNU) 1995 and 2000, Child and Mother Nutrition
Survey (CMNS) 2005, and statistical databases of UNICEF and WHO. The organization also
worked with the National Nutrition Program (NNP) to improve nutritional status of pregnant
and lactating women, malnourished children, and adolescent girls to improve PEM situation.
Figure 13.1 shows the rate (%) of under-5 children with underweight in Bangladesh from 1980
to 2008 (UNICEF and WHO have data available only up to 2008).

Figure 13.1. Rate of underweight <5 year childrern fron 1980 to 2008 in
Bangladesh

Table 13.1 shows the trend in the prevalence of underweight, stunting, and wasting among the
under-5 children over the years. Data from Bangladesh show the urban and rural trends in the
prevalence.

Table 13.1. Prevalence of malnutrition among <5 children (2000 to 2008; no source provide data for period
beyond 2008)

Underweight (%) Stunted (%) Wasted (%)

Health Bulletin 2011 |Page-114

 Chapter 13: Nutrition

Table 13.1. Prevalence of malnutrition among <5 children (2000 to 2008; no source provide data for period
beyond 2008) (Continued...)

Source and year Location Underweight (%) Stunted (%) Wasted (%)
UNICEF 2000-2006 National 48.0 43.0 13.0
Urban 33.4 14.4 36.4
Bangladesh Demographic and Rural 43.0 18.2 45.0
Health Survey 2007 National 41.0 43.0 17.0
WHO 2008 National 41.0 43.0 17.0

It is estimated that about 59% of women in Bangladesh have normal BMI while 30% are
undernourished or thin (BMI less than 18.5), and 12% are overweight or obese (BMI 25 or
higher). Rural women are more likely to be undernourished than urban women (33% and 20%
respectively) while urban women are about three times more likely to be overweight or obese
than rural women (24% and 8% respectively).

Control and prevention of iron-deficiency and other nutritional anemia: No recent survey
report on iron-deficiency anemia in Bangladesh is available. A joint IPHN/HKI (Helen-Keller
International) survey carried out in 1999 showed 49.2% of pregnant women and 52.7% of the
preschool children of rural Bangladesh to suffer from iron-deficiency anemia. Control and
prevention of iron-deficiency and other nutritional anemia is broadly operated through
country's entire health service-delivery network and National Nutrition Program with key
components of distribution of iron-folate supplements to the target, vulnerable and anemic
groups. Control of intestinal parasites through distribution of albendazole tablets is done, along
with vitamin A capsules distribution program. The IPHN continued advocacy for food
fortification. The National Nutrition Program undertook dietary improvement interventions and
production of micronutrient-rich foods.

Control of iodine-deficiency disorders and other micronutrient problems: Table 13.2

summarizes the available data on iodine-deficiency disorders in the country. The IPHN provides
training to doctors and other health staff on control of iodine-deficiency disorders. Training is
also given to managers, chemists, and others in salt factories of three zones (Chittagong, Patia,
Cox's Bazar) in collaboration with Bangladesh Small and Cottage Industries Corporation (BSCIC).
The IPHN also tests the samples in its laboratory.

Table 13.2. Iodine nutritional status based on available national data

Health Bulletin 2011 |Page-115

 Chapter 13: Nutrition

Child nutrition program of IPHN: The IPHN has a school health nutrition education program
targeting school children. It also has an "Infant and Young Child Feeding (IYCF)" program. For the
latter program, the Institute developed a strategy paper. It trains doctors, senior staff nurses,
sanitary inspectors, health inspectors, and other officers on Breastmilk Substitutes Codes (BMS
codes) for baby-food (Sweet Baby II). The Institute also performs the regulatory function on
BMS codes, under which registration was denied to several marketing companies of breastmilk
substitutes due to lack of necessary papers. The Institute operates child nutrition units (CNUs),
one at the IPHN and 19 in upazila health hospitals of 19 districts.

Breastfeeding and complementary feeding: Practice of breastfeeding is universal in

Bangladesh, and exclusive breastfeeding practice has problems. Almost all Bangladeshi children
are breastfed for the first year of life. Even among children aged 20-23 months, 91% still receive
breastmilk. However, Only 43% children aged less than six months are exclusively breastfed.
Among infants of less than 2 months, only two-thirds (64%) are exclusively breastfed. On the
other hand, among children aged 6-9 months, only three in four children receive
complementary food. About 78% of the youngest children aged 6-35 months living with the
mothers consume foods rich in vitamin A. Breastfed children are less likely to consume vitamin
A-rich foods than non-breastfed children. About 58% of children aged 6-35 months living with
the mothers consume foods rich in iron.

Figure 13.2 to 13.5 show the coverage of services by the National Nutrition Program (NNP) in
the 109 upazilas from 2004 to 2009. Figure 13.2 summarizes the coverage for pregnancy-care
service. It reveals that pregnancy weight-gain was measured among 97% to 98% pregnant
women. Need for distribution of supplementary feeding reduced from 21% in 2005 to 8.3% in
2010. Antenatal care coverage was 53% in 2004 and 82% in 2010 whereas 43.4% of the
pregnant women received iron tablets in 2004; the figure was 97% in 2010.

Figure 13.2. Coverage (%) of pregnant mothers with service in 109 National Nutrition
Program upazilas (Year 2004 to 2010)

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 Chapter 13: Nutrition

Figure 13.3. Coverage (%) of lactating mothers with service in 109 National Nutrition
Program upazilas (Year 2004 to 2010)
NNP Baseline 2004 Sep-04 Jun-05 Jun-06 Jun-07 Jun-08 Jun-09 Jun-10 Dec-10

100.0

100.0

100.0

100.0
99.9
99.8

99.0

99.0

99.0
98.7
98.0

98.0

98.0

96.0
73.8
45.0

8.1

Lactating mothers received iron tablets Lactating mothers received Vit -A

Figure 13.3 shows the service given to lactating mothers in the 109 NNP upazilas. In 2004, 45%
of the lactating mothers were recorded to receive iron tablets. This figure rose to 100% in 2006,
and the same coverage was maintained also in 2007. By the end of 2010, it was 98%. In 2004,
only 8.1% of the lactating mothers received vitamin A capsules. In 2009, 99% of them were
receiving vitamin A capsules, although the coverage was 96% by the end of 2010.

Figure 13.4. Coverage (%) of newborn service in 109 National Nutrition Program
upazilas (Year 2004 to 2010)

Figure 13.4 shows the coverage of services provided to newborns and young children by the
NNP in 109 upazilas. In 2010, birthweights of 96% of the newborns were measured. In
December 2010, 10% of the newborns in the program area were found to have low brithweight,
which was 20.7% in 2004. In 2010, 99% of all newborns were reported to be fed colostrum,
which was 93.3% in 2004. Exclusive breastfeeding rate was markedly increased from 9.9% in
2004 to between 69% and 72% in 2010.

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 Chapter 13: Nutrition

Figure 13.5. Prevalence (%) of severely- and moderately-underweight <2 children with
supplemenary feeding in 109 National Nutrition Program upazilas (Year 2004 to 2010)

Figure 13.5 shows the prevalence of severely- and moderately-underweight children of less than
2 years of age in the NNP program area. Prevalence of severe underweight among under-2
children droped from 25.2% in 2004 to 8.6% in 2010. Prevalence of moderate underweight
among under-2 children dropped from 24.6% in 2004 to 21.0% in 2010. In 2004, 8.0% of the
under-2 children with underweight were given supplementary feeding from the program. This
figure was 9.9% by the end of 2010.

Figure 13.6. Percentage of households using iodized salt in 109 National Nutrition
Program Upazilas (Year 2004 to 2010)

Figure 13.6 shows the trend in the household iodized salt-use in 109 program upazilas of the
NNP. As of 2009, 92% of the households were consuming iodized salt, which was 61% in 2004. A
sharp increase (to 82%) in the household iodized salt consumption was noticed in later part of
2004 and, thereafter, a steady increasing rate was maintained.

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 Research and Development

For the year 2010, MIS-Health received information on research from several public, private and
autonomous institutions which include Bangladesh Medical Research Council (BMRC), National
Institute of Preventive and Social Medicine (NIPSOM), Institute of Mother and Child Health
(ICMH), ICDDR,B, and the James P. Grant School of Public Health of BRAC University. This
chapter provides a brief introduction of the Bangladesh Medical Research Council and the lists
of research activities done in different institutions.

Bangladesh Medical Research Council

Bangladesh Medical Research Council (BMRC) was established in 1972 by Father of the Nation
Bangabandhu Sheikh Mujibur Rahman. The BMRC is as an autonomous body under the Ministry
of Health and Family Welfare (MOHFW). As per resolution of the Government, the BMRC is the
only authorized body for giving clearance of health research in Bangladesh. The objectives of
the BMRC are to identify problems and issues relating to medical and health sciences and to
determine priority areas in research on the basis of healthcare needs, goals, policies, and
objectives. The mission of the Council is to create effective and quality healthcare facilities for
the whole population of the country by promoting health research through strengthening of
research facilities, training, and dissemination of research results. Honorable Prime Minister
Sheikh Hasina inaugurated the newly-built BMRC Bhaban on 14 October 2010.

The activities of the BMRC are mentioned below:

A. Research Funding: The BMRC organizes and promotes scientific research in various fields of
medicine, public health, reproductive health, and nutrition, with specific references to primary
healthcare needs for the application and utilization of the results of health research. The BMRC
provides research funds both from revenue budget and from grants received from development
partners.

B. Publication: The BMRC publishes the internationally-recognized quarterly journal 'BMRC

Bulletin' covered by various indexing agencies; RICH (Research Information and Communication
on Health) twice yearly, where abstracts of important research works are published; and CAS
(Current Awareness Service) annually containing the titles collected from different Journals
published in Bangladesh.

C. Training: The BMRC conducts training courses on research methodology, data-analysis,

project development and report writing, biostatistics, scientific writing, health systems research,
ethical issues in health research, use of statistical package in research (SPSS), with technical
support from WHO, Government, and NGOs.

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 Chapter 15: Research and Development

D. Ethical Clearance: The BMRC is the only government-approved organization for ethical
clearance and has a National Research Ethics Committee for this task.

BMRC activities in 2010-2011

A. Granting research funds to 28 research protocols in the following topics:
1. Serum zinc in vitiligo patients-a comparison with normal subject
2. Correlation of the outcome of transurethral resection of the prostate (TURP) with
preoperative degree of bladder outlet obstruction and detrusor function
3. Arsenic in human milk and assessment of human milk intake in children living in arsenic-
contaminated areas in Bangladesh
4. Prevalence of occupational asthma in sericulture workers
5. Evaluation of the role of end-range mobilization technique in the management of patients
with adhesive capsulitis of the shoulder-joint
6. Relationship between dental diseases and coronary heart disease in diabetic patients
7. Retinopathy in older persons without diabetes mellitus
8. Risk factors of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) among
urban population
9. Ocular injuries in patients with major trauma
10. Role of uric acid and dyslipidemia in ischemic stroke
11. Prevalence of NCD-related risk factors among population aged 35-60 years in Dhaka city
12. Epidemiological feature and economic burden of road-traffic accidents
13. Underlying factors of attempted suicides: experience from rural Bangladesh
14. Quality of healthcare services provided to the patients at the Medical Outpatient
Department of Dhaka Shishu Hospital
15. Efficacy of polymerase chain reaction for rapid diagnosis of pulmonary tuberculosis from
sputum
16. Plasma androgens levels in women with acne vulgaris
17. Prevalence of secretor and non-secretor among the random blood-donors
18. Non-communicable diseases among the shopkeepers in Dhaka city
19. A study on the effect of prolonged drinking of saline water on pregnancy outcome
20. Hepatitis B virus infection among the blood-donors in Dhaka city
21. Knowledge, attitude and practice on tobacco-related cancer among the general
population of Sharisahabari, a rural area of Bangladesh
22. Effect of targeted food supplementation through National Nutrition Program on
pregnancy weight-gain and birth-weight in different chronic energy-deficiency groups.
23. Study of risk factors of primary hemorrhagic and ischemic subtypes of acute stroke
among patients admitted in a tertiary-level hospital in Bangladesh
24. Association between smokeless tobacco consumption and adverse pregnancy outcome
among rural women in Bangladesh
25. Spectrum of clinical manifestation of post-kala-azar dermal leishmaniasis (PKDL) in kala-

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 Chapter 15: Research and Development

azar-endemic areas of Bangladesh

26. Early outcome of off-pump coronary artery bypass graft (OPCAB) surgery in women
27. Risk factors of suicide and para-suicide in rural Bangladesh
28. Studies of bioactive secondary metabolites of various indigenous plant materials for
natural food preservation.

B. Publishing 20 original articles and 3 letters-to-editor in BMRC Bulletin in August 2010,

December 2010, and April 2011 issues as shown below:
Issue 36 (2), August 2010: Original Articles
1. Topical tazarotene cream (0.1%) in the treatment of facial acne: An open clinical trial
2. Impaired fasting glucose and impaired glucose tolerance in rural population of Bangladesh
3. Recurrence of cancer cervix in patients treated by radical hysterectomy followed by
adjuvant external beam radiotherapy
4. Study on association of cutaneous tuberculosis with pulmonary tuberculosis
5. Oral health status of disabled children
6. Serum triglyceride level in type 2 diabetes mellitus patients with or without frozen
shoulder
7. Preoperative detection of ovarian cancer by color doppler ultrasonography and CA 125.
Issue 36 (3), December 2010: Original Articles
8. Effect of single-dose intravenous zoledronic acid on bone mineral density in post-
menopausal osteoporosis of Bangladeshi women
9. Feeding practice in acute stroke patients in a tertiary-care hospital
10. Protective effects of the dietary supplementation of turmeric (Curcuma longa L.) on
sodium arsenite-induced biochemical perturbation in mice
11. Role of computed tomography in the evaluation of pediatric brain tumor
12. Evaluation of myocardial protection in off-pump vs on-pump coronary bypass surgery by
troponin I estimation
13. Lipoprotein (a) level in pre-eclampsia patients.
Letter- to- Editor
1. Obesity in the north of Iran (south east of Caspian Sea)
2. Surgical management of ventricular septal defect with pulmonary stenosis with idiopathic
thrombocytopenic purpura.
Issue 37 (1), April 2011: Original Articles
1. Health-related quality of life among the people living with HIV
2. Usefulness of Light Emitting Diode (LED) fluorescent microscopy as a tool for rapid and
effective method for the diagnosis of pulmonary tuberculosis
3. Evaluation of management, control, complications and psychosocial aspects of diabetics in
Bangladesh: DiabCare Bangladesh 2008
4. Birthweight of the babies delivered by chronic energy-deficient mothers in National
Nutrition Program (NNP) intervention area

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 Chapter 15: Research and Development

5. Lipid profile in minor thalassemic patients: A historical cohort study

6. Higher prevalence of Cytomegalovirus pp65 antigenemia associated with lower CD4+ T
lymphocyte count
7. Safety and efficacy of the supracostal access for percutaneous nephrolithotomy: Our initial
experience.
Letter-to-Editor
1. Free Health Camps at 476 upazilas in Bangladesh.

C. Issuance of ethical clearance of the following research projects:

1. Nutrition impact on Monga
2. Study of the effectiveness of long-lasting insecticide-treated mosquito net (LN) against
visceral leishmaniasis vector Phlebotomus argentipes in highly-endemic area of Bangladesh
3. Chemoprevention of arsenic-induced skin cancer
4. Indoor air pollution: Extent, impact and prevention
5. Essential Health Hygiene and Nutrition Package by six contracted scale fund NGOs, 2009-
2010
6. Essential Health Hygiene and Nutrition Package for Innovation fund NGO (NDP) 2010-2011
7. A prospective, non-interventional, cohort survey on VTE risk patients receiving new
chemotherapy for cancer
8. Psychotic disorders among Yaba/methamphetamine (MA)-dependent subjects
9. Subcutaneous contraceptive injection Depo SubQ Provera 104 TM Depo SubQ/SAYANA
acceptability study
10. Assessing acceptability of Sino-implant (II) among Bangladeshi married women of
reproductive age
11. Effect of antioxidant vitamins intervention on oral Leukoplakia in selected population of
Bangladesh
12. Burden of diabetes mellitus: Experience from urban and rural communities of
Bangladesh
13. Phase-III randomized study of luteal phase versus follicular phase surgical oophorectomy
and Tamoxifen in premenopausal women with metastatic hormonal receptor-positive breast
cancer
14. The 2011 Bangladesh Demographic and Health Survey (BDHS)
15. Efficiency of fund-use in public and private hospitals: A comparative study in relation to
attaining MDGs
16. A comparison of costs associated with maternal health in connection with home-based
child births (delivery) with hospital-based child births
17. Usefulness and application of the monitoring and evaluation toolkit for indoor residual
spraying by the national vector control program
18. Treatment of early neuritis in leprosy
19. Evaluation of an educational intervention in arsenic-exposed school children in Araihazar,

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 Chapter 15: Research and Development

Bangladesh
20. Folic acid and creatine as therapeutic approaches for lowering blood arsenic
21. Community participation to lower arsenic exposure more effectively in Bangladesh
22. Comparative bioavailability study of 22.5% Omeprazole pellets preparation with 8.5%
pellets preparation in Bangladeshi population
23. A Phase III Open-label randomized study of three short-course combination regimens
(AmBiosme Miltefosine, Paromomycin) compared to AmBisome alone for the treatment of
visceral leishmaniasis (VL) in Bangladesh (amended version)
24. The role of Government, NGOs, and the private sector in Bangladesh's National
Tuberculosis Control Program
25. Effect of nutrition education on adolescent overweight girls to reduce excess weight in
urban area
26. Impact evaluation of behavior change communication and micronutrient
supplementation interventions on infant and young child feeding (IYCF) practices and on
childhood stunting and anemia
27. Design implementation and evaluation of a parent support/counseling program with a
focus on responsive stimulation for infants and young children in rural Bangladesh
28. Efficacy and safety of liposome amphoteriein B in Bangladeshi patents with visceral
leishmaniasis (amended version)
29. Dietary assessment and characteristics of health and nutritional impact of vegetable diet
among rural elderly vegetarian and non-vegetarian
30. Effects of nutritional education on people living with HIV/AIDS in Bangladesh
31. Enzyme-linked immunosorbent assay for the diagnosis of Wuchereria bancrofti infection
using urine samples and its application in Bangladesh
32. Intervention with dietary education for improving pregnancy outcome
33. Measuring the impact of lymphatic filariasis-related disability: The development of a
rapid assessment tool
34. A study on the impact of nutrition education of lactating mothers to improve nutritional
status of breastfed babies in selected hospitals in Dhaka city in Bangladesh
35. Evaluation of LED microscopes and staining techniques for acid fast smear fluorescence
microscopy
36. Study for cephalometric evaluation of craniofacial variation in normal Bangladeshi
population (age-group 21-27 years) according to Steiner analysis
37. Nutritional status and dietary pattern of adolescent girls between upper and lower
socioeconomic status in Dhaka city
38. Epidemiological surveillance of Burkholderia pseudomallei, Orientia tsutsugamushi, and
Rickettsia typhi based on serology in Bangladesh
39. The relationship of Maxillary Canines to the Facial Anatomical Landmarks in groups of
Thai and Bangladeshi people
40. Effect of nutrition education on LBW and pregnancy weight-gain at selected hospitals in

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 Chapter 15: Research and Development

Dhaka city
41. A descriptive study of the pharmacogenomics of Tamoxifen in Bangladeshi women with
breast cancer
42. Seroprotection against hepatitis B with and without birth-dose hepatitis B vaccine among
Bangladeshi children
43. Evaluation of mineral trioxide aggregate and calcium hydroxide cement as pulp-capping
agents in human teeth
44. Pharmacokinetic and bioequivalence study of Esomeprazole 20 mg capsule in healthy
Bangladeshi volunteers
45. Pharmacokinetic and bioequivalence study of Esomeprazole 35 mg capsule in healthy
Bangladeshi volunteers
46. The influence of maternal factors on birthweight in different socioeconomic levels
47. A study of the dietary intake and nutritional status in elderly people at urban area in
Bangladesh (Dhaka city)
48. Comparison of inappropriate infants and young child feeding (IYCF) practices and its
effect on nutritional status between lower and higher socioeconomic groups in Dhaka city
49. The impact of the quality and quantity of complementary food on nutritional status of
children (7-24 months) in families of lower socioeconomic status
50. Comparison of the nutritional status and diarrheal duration between breastfed and non-
breastfed infants
51. Comparison of risk factors, nutritional status, and morbidity rate between breastfed and
bottlefed infant in a selected area of Dhaka city
52. Comparison of nutritional status and dietary intake pattern between child laborers and
non-working children (5 to 14 years) in selected areas of Dhaka city
53. Consanguinity recessive genes and the risk of breast cancer
54. Consequences of arsenic and manganese exposure on childhood intelligence in
Bangladesh (amended version)
55. Validation study for diagnosis of smear-positive tuberculosis cases.

Research of NIPSOM students (2010)

Research by M. Phil. (Preventive and Social Medicine) students
• Health-related quality of life in patients with diabetes mellitus
• Factors affecting maternal mortality in a selected rural area of Bangladesh
• Factors associated with infant mortality in a selected rural area of Bangladesh
• Selected indoor air-pollutants and respiratory problems among Dhaka city-dwellers.
Research by MPH (Nutrition) students
• Lifestyle and food-habit of the overweight children attending a health center of Dhaka city
• Nutritional status of under-5 children in a rural community
• Nutritional status of the infertile patients attending the Infertility Outdoor of a tertiary-care
hospital

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• Assessment of nutritional status and related behavioral risk factors among government
high officials
• Maternal nutrition and nutritional status of breastfed children attending a selected health
center
• Nutritional status of street-adolescents in some selected shelter homes in Dhaka city.
Research by MPH (Maternal and Child Health) students
• Blood transfusion status among emergency obstetric patients in comprehensive EmOC
center
• Risk factors for bacterial vaginosis during first trimester of pregnancy in a selected union of
Bangladesh
• Tetanus-toxoid immunization status among unmarried female college students in rural area
of Bangladesh
• Knowledge about HIV/AIDS among female floating sex workers in Dhaka city
• Gender role on contraceptive-use among affluent and poor society
• Knowledge on NSB among the copies attending a selected MCH-HP center
• Reasons of relapse of drug-dependency among the drug-dependent individuals of
rehabilitation centers
• Teachers' and students' views regarding the reproductive and child health-related contents
in community medicine at undergraduate-level medical studies in Bangladesh
• Reasons for repeated menstrual regulation (MR) among the clients attending NGO clinics
• Patterns of climacteric symptoms and its severity among the rural menopausal women
• Awareness of the community stakeholders towards the barriers to access safe delivery care
in a selected rural area
• Maternal anemia and pregnancy outcome in a maternity hospital
• Cost of maternal care among the mothers attending a selected non-government MCH-FP
center
• Mothers' awareness of tuberculosis (TB) of under-5 children
• Reasons of drop-out of tetanus-toxoid vaccination in a selected urban area
• Pattern of accidents among the under-five children and working status of their mothers.
Research by MPH (Health Promotion and Health Education) students
• Educational intervention on dental caries among the primary school children
• Healthcare cost of patients attending out-patient departments of public hospitals and
private chambers
• Food-habit and dental caries among secondary school students
• Effects of community intervention program on HIV/AIDS prevention in Nigeria
• Knowledge about inhaler-use among the chronic asthma patients in a selected hospital
• Health education intervention on handwashing after defecation in a selected slum area
• Oral health status among 10 years old school children
• Status of anemia among under-five children in anemia reduction program in a Rohinga
refugee camp

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• Knowledge and practice of senior staff nurses about post-operative infection control
• Maternal characteristics and birthweight of the newborns
• Oral hygiene practice of school children exposed and non-exposed to Pepsodent oral
hygiene awareness program
• Periodontal status among gestational diabetic women
• Nutritional status and dietary pattern of non-primary school-going children
• Knowledge regarding human immunodeficiency virus infection among secondary school
students
• Nutritional status of pulmonary TB patients attending Shaymoli TB clinic, Dhaka
• Knowledge of senior staff nurses regarding bedsore and its preventions
• Pattern of tobacco consumption among household members in a selected upazilla
• Smoking-habit among secondary school students
• Oral health condition among tobacco-users and non-users
• Food-habit and oral hygiene status among under-5 children
• Knowledge and practice of physical exercise among diabetes mellitus patients
• Obesity status among the diabetes mellitus patients
• Nutritional knowledge among lactating mothers exposed and non-exposed to nutrition
education
• Educational intervention on sexually transmitted infections among secondary school
students
• Tetanus toxoid vaccine coverage among girls students in a rural college
• Educational intervention about importance of dental check-up during pregnancy
• Knowledge on oral cancer among medical internee doctors
• Oral health status and practice among pregnant women
• Knowledge on adverse effect of tobacco among the users in a community.
Research by MPH (Hospital Management) students
• Management of neuro-surgical emergencies in Bangabandhu Sheikh Mujib Medical University
• Factors of tooth-extraction among adult patients attending endodontics department of
Dhaka Dental College and Hospital
• Oral health status of the street-children of Dhaka metropolitan city
• Management of patients in Surgical in-Patient Department at Rangpur Medical College
Hospital
• Satisfactions of indoor patients in a selected secondary-level government hospital
• Hospital preparedness for emergency in a selected hospital in Dhaka city
• Infection control practices of dental surgeons in some selected dental clinics of Dhaka city
• Job-satisfaction of dental surgeons working in some selected upazila health complexes of
Bangladesh
• Practices of patients' safety care in Dhaka Dental College and Hospital
• Oral hygiene practices among the students of selected secondary school in Dhaka city
• Management status of radiological services in Combined Military Hospital (CMH), Dhaka

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 Chapter 15: Research and Development

• Level of satisfaction of patients attending some selected private dental clinics in Dhaka city
• Low back-pain (LBP)- its management and patients' satisfaction at the OPD of BSMMU.
Research by MPH (Occupation and Environmental Health) students
• Leptospirosis among sewage-cleaners in Dhaka City Corporation
• Effluents from selected industries and surface-water quality
• Occupational health problems among the brickfield workers
• Respiratory problems among the shoot-based cotton industry workers
• Awareness, practice, and toxicity symptoms associated with pesticide-use among farmers
in a selected area of Bangladesh
• Health problems of Jhum cultivators in a selected area of Chittagong Hill Tracts
• Work-related health problems and personal protective equipment-use among the workers
of a glass industry
• Occupational health problems among foundry workers
• Voice problems in primary school teachers of some selected schools in Bangladesh
• Occupational health problems among the workers in silk industries
• Clinico-histopathological characteristics of skin lesions among arsenicosis patients
• State of arsenicosis patients in an arsenic-endemic area
• Water-use and sanitation status among the tribal people in Chittagong Hill tracts
• Occupational health problems and salary measures among the poultry workers
• Health problems among the urea fertilizer factory workers
• Health problems among handloom workers.
Research by MPH (Public Health Administration) students
• Preference of contraceptive methods among women attending the family-planning services
in selected hospitals in Dhaka
• Occupational health problems and safety measures among female garment workers
• Body mass index and menopause-related quality of life among the menopausal women
• A study on clinical status and socio-demographic pattern of Beta-thalassemia in Bangladesh
• Nutritional status and lifestyle of old hypertensive patients ( 60 years and above)
• The role of public health in mental health promotion
• Barrier to adherence of tuberculosis treatment at selected DOTS center in Dhaka city
• Perceptions of adolescents on health and gender issues
• Lipid profile of gestational diabetic mellitus patients
• Key factors determining the motivation and retention of intern doctors in rural area
• Knowledge and attitude about maintenance of personal hygiene among the cleaners of
some clinics in Dhaka city
• Nutritional status of chronic arsenic-exposed women in a selected area of Bangladesh
• Gender discrimination and care-seeking behavior of tuberculosis patients attending the
selected DOTS centers
• Perception of university students regarding smoking in public places
• Tobacco-use and body mass index among rural population.

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List of research titles conducted on maternal health in Bangladesh (Compiled by ICDDR,B)

The Reproductive Health Unit of ICDDR,B has recently compiled a list of research protocols
conducted on reductive health in Bangladesh between 2000 and 2010. The list is given below:
1. Inequalities around childbirth and related maternal healthcare services in rural Bangladesh
(A proposal for "the reaching the poor" program of the World Bank)
2. Plateauing of the Bangladesh fertility decline
3. Incidence of HIV, hepatitis, and syphilis infections and risk behavior in injecting drug-users
in Dhaka, Bangladesh
4. Changes in use of health and family-planning services in two rural upazilas during the
transition to a new system of service delivery: 1998-2002
5. The socio-cultural and behavioral component for dysentery study
6. Evaluation of a six-month pilot to introduce depot holders in three types of urban areas
7. Monitoring the disparity in health status and access to and utilization of healthcare
services: Bangladesh health equity gauge (phase-1)
8. The effectiveness and utility of a green banana diet in the home-management of acute
and persistent childhood diarrhea
9. Unmet need for major obstetric interventions in Bangladesh
10. Operations research on strategies to improve reproductive health services for
adolescents by NGOs
11. Economic evaluation of shigellosis in an urban area of Dhaka, Bangladesh
12. Modeling the impact and incremental cost-effectiveness of introducing vaccines against
hepatitis B, hemophilus influenza type b, and rotravirus into routine infant immunization
programs in Bangladesh and Peru
13. The acceptability, effectiveness, and cost of strategies designed to improve access to
basic obstetric care in rural Bangladesh
14. Combined interventions to promote maternal and infant health
15. Population-based evaluation of Shigella infections in an urban area of Dhaka, Bangladesh
16. Scaling up zinc as a treatment for childhood diarrhea in Bangladesh: Monitoring the
impact of public, private and NGO delivery strategies
17. Sexuality and risky heterosexual behavior in rural Bangladesh
18. Time since pregnancy and mortality in women of reproductive age in Matlab, Bangladesh
19. Infertility: A lens to see women's situation in the context of Bangladesh
20. Evaluation of the effects of community-based interventions on maternal behaviors and
morbidity during labor, delivery, and the early postpartum period in rural Bangladesh
21. Effectiveness of large-scale supplementation activities for pregnant women: The role of
community nutrition promoters
22. Health needs and healthcare-seeking behaviors of street-dwellers in Dhaka city
23. Field evaluation of simple rapid tests in the diagnosis of syphilis
24. Studies on GUD in males: A hospital-based study in Dhaka, Bangladesh
25. Meeting additional family health needs of clients by addressing missed opportunities at

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the ESP clinics

26. Rapid assessment tool (RAT) for better health: Helping essential service package (ESP)
managers to be more effective
27. The identification of factors influencing and determining nurses' behavior in the delivery
of hands-on patient-care
28. Operations research on strategies to improve reproductive health services for
adolescents in the public sector
29. Use of ESP services and other factors associated with neonatal survival in rural areas of
Bangladesh served by a large NGO program (BPHC)
30. Management of tuberculosis by private practitioners and healthcare-seeking behavior of
symptomatic adults/TB suspects
31. Study to understand reproductive health practices and sexual network among men in
general population of Bangladesh
32. Reinitiating fertility decline in Bangladesh by meeting the needs of high-parity couples
33. Vulnerability to HIV/AIDS of migration-affected families
34. Perceptions, attitudes, and practices relating to gender and their linkages to low
birthweight
35. HIV/AIDS prevention project: Brothel-based sex workers in Bangladesh
36. A comparison of two methods (Enhanced Syndromic Management and Periodic
Presumptive Treatment) of systematic prevention and control of STIs among hotel-based
female sex workers in Dhaka, Bangladesh
37. Examining the associations between maternal blood, umbilical cord-blood arsenic and its
metabolites
38. Rapid assessment of youths' perspectives on health services: Modification of World
Health Organization guidelines for youth-friendly services in Bangladesh
39. Assessing unmet need for major obstetric interventions in different districts of
Bangladesh to improve coverage of maternal healthcare services
40. A baseline assessment of existing laboratory services in urban and rural primary health
care (PHC)/essential services package (ESP) delivery facilities of partner NGOs of the National
Service Delivery Program (NSDP) in Bangladesh
41. Baseline and endline HIV/AIDS surveys among youths in Bangladesh
42. The impact of violence against women on reproductive outcome and child survival: A
secondary data-analysis
43. Feasibility, acceptability, and program effectiveness of misoprostol in preventing
postpartum hemorrhage (PPH) in rural Bangladesh
44. Epidemiology of postnatal depression in rural Bangladesh
45. Case studies for safe motherhood: Learning from South Asian programs
46. Understanding the patterns of chronic obstetric morbidity and validation of the self-
report by women living in an urban slum district of Dhaka, Bangladesh
47. Demand-based reproductive health commodity project (DRHCP)

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48. Using management information system to improve quality of services through

strengthening supportive supervision in a community-based intervention in rural Bangladesh
49. An analysis of social, behavioral and biomedical risk factors of adolescents and young
clients of female sex workers: Implications for STI/HIV interventions in Bangladesh
50. Study to understand barriers to condom-use among female sex workers in Bangladesh
51. Better understanding of recognition and response to postpartum hemorrhage
52. Formative research on healthy fertility practices and postpartum care in Sylhet district,
Bangladesh
53. Evaluation of two home-based skilled birth attendant programs in rural Bangladesh
54. Cost-effectiveness of long-lasting insecticidal nets in the prevention of kala-azar project
acronym: KALANET
55. Determining the burden of maternal ill-health and death and its programmatic
implications in rural Bangladesh: Understanding the incidence of moderate/severe obstetric
complications and maternal death, their physical consequences; psychological, economic and
social impact; and determinants in rural Bangladesh
56. Causes of and healthcare-seeking in relation to neonatal deaths in rural Bangladesh: The
use of verbal autopsy
57. Evaluation of partner notification for sexually transmitted infections by service providers
in Bangladesh
58. Epidemiology of human papillomavirus (HPV) infection among females in Bangladesh
59. Does counseling of abused women using primary-level healthcare promoters help the
women?
60. Extent and consequence of catastrophic cost for caesarean section delivery among poor
households
61. Improving the utilization of healthcare services through community empowerment and
participatory monitoring in a rural area of Bangladesh
62. Future health systems−making health systems work for the poor, Phase I: Situation of
health services in Chakaria, Bangladesh
63. Situation analysis of unsafe abortion in Bangladesh: Magnitude, populations at risk,
resources, and consequences
64. Monitoring the impact of the SUZY project roll out of zinc as a treatment for childhood
diarrhea
65. Comprehensive maternal, neonatal and child healthcare (MNCH) to reduce mortality: A
programmatic approach through a continuum of care in a rural community in Matlab,
Bangladesh, with a package of known effective interventions
66. Private sector engagement: Feasibility of engaging unlicensed practitioners in STI
counseling and referral through guidelines dissemination
67. Reproductive health of religious minorities in India and Bangladesh
68. Strengthening service-delivery system of World Vision Bangladesh
69. Association between arsenic exposure and age at menarche and physical growth of

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adolescent girls: A cross sectional study in Matlab, Bangladesh

70. Role of nurses in maternal and neonatal healthcare programs in Bangladesh
71. Maternal and neonatal care configurations in Bangladesh: Availability and use
72. Evaluation of the ACCESS/Bangladesh Program: Population-based survey in the Sylhet
district of Bangladesh
73. Menstrual regulation and abortion in Bangladesh: Generating evidence and stimulating
action
74. Pilot study on caesarean section among urban women working at ICDDR,B
75. Improving low child immunization coverage in rural hard-to-reach areas of Bangladesh
76. Making health systems work for the poor, phase II: Interventions to prevent harmful
practices by the healthcare providers and enhance accountability through local-level health
watch
77. Exploring acceptable and appropriate interventions to promote correct and consistent
condom-use among young male clients of hotel-based female sex workers in Dhaka,
Bangladesh
78. Improving recognition of and initial response to prolonged/obstructed labor and birth
asphyxia in settings characterized by homebirth with unskilled attendants: A multi-site study
and academic partnership development project
79. Impact of an NGO training and support intervention on private sector providers for the
diarrhea management practices
80. Community-based maternal, newborn and child health program (Manoshi) for urban
Bangladesh
81. An assessment of public-health effectiveness of approaches to promote key family and
community behaviors for child survival
82. Helping Manoshi to achieve its goals: Rapid monitoring for results
83. Acceptability and feasibility of mifepristone-misoprostol for menstrual regulation in
Bangladesh: A collaborative project between Gynuity and ICDDR,B
84. An evaluation of expansion of the Community-IMCI Village Health Worker service
package to improve utilization, care-seeking, quality of care, and community satisfaction
85. Improvement of maternal and neonatal health by operationalizing an integrated
evidence-based intervention package through strengthening of the health system in
Bangladesh
86. Exploring the use of oxytocin during labor at home-setting in urban slums
87. Performance of community health workers (CHW) of Manoshi
88. Shasthya Sena Pilot Phase-A strategy for engaging with the informal healthcare providers
for improving health of children from poor families in rural Bangladesh
89. Retention and performance of BRAC health volunteers: Role of incentives and
disincentives
90. Production cost estimation of child healthcare services in Bangladesh
91. Scaling up of a local health watch model and measuring its impact on the utilization and

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 Chapter 15: Research and Development

performance of the health system

92. Effect of oral phage application to pregnant mothers on the transmission of
Staphylococcus aureus (S. aureus) colonization from mother-to-child and the neonatal route
of S. aureus infection
93. Develop and test strategies for providing essential healthcare services to urban street-
dwellers in Bangladesh
94. Strengthening health system capacity to monitor and evaluate programs targeted at
reducing abortion-related maternal mortality
95. Characterization of "Hysterical Conversion Reaction" as an admitting diagnosis in
women's wards of Bangladeshi hospitals
96. Socio-cultural aspects and women's perceptions on menstrual regulation and menstrual
regulation services in Bangladesh
97. Formative research on maternal, neonatal and child-care knowledge and practices
among indigenous people of Bandarban and Sunamganj districts in Bangladesh
98. Improving knowledge, recognition, referral, and prevention practices for sexually
transmitted infections among medicine-sellers in Bangladesh
99. Use of mobile phone to strengthen the health systems for improving maternal and
newborn healthcare in rural Bangladesh
100. Assessment of behavior change communication (BCC) interventions of Manoshi in slums
of Dhaka city
101. Good Health at Low Cost 2010: Identifying factors within health systems and the wider
policy context, which influence health outcomes
102. Evaluation of a Community-based management of neonatal sepsis
103. Delineation of optimum catchment of community health workers for community case
management of childhood illness in rural Bangladesh: A GIS-based approach
104. Vulnerability to HIV/AIDS among Bangladeshi street-children: A situation analysis
105. Impact of measles eradication activities on routine immunization services and health
systems in Bangladesh
106. Promoting better infant and young child feeding practice in the slums through
performance-based payment
107. Demand assessment of 4% chlorhexidine solution among potential users and promoters
in rural Bangladesh
108. Impact of drop-out of Shasthya Shebika of Manoshi in Dhaka urban slums
109. Examining birth-planning and responses to delivery complications: A qualitative
investigation to supplement the Bangladesh Maternal Mortality Survey (BMMS) 2010
110. Developing a toolkit to measure the effectiveness of development activities which
target or include people with disabilities
111. Evaluation of teachers' training program of curriculum-based HIV and AIDS education
among teachers and students in Bangladesh
112. Safeguarding consent, combating coercion: Securing young women's rights to health

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 Chapter 15: Research and Development

and freedom from violence in Bangladesh

113. Women's empowerment and intimate partner violence in Bangladesh: A multilevel
study
114. Measuring the impact of changes in the modalities for delivering STI services and selling
and distributing condoms among female sex workers in Dhaka
115. Enhancing capacity to apply research evidence in policy making for reproductive health
in Bangladesh
116. Genital human papillomavirus infection among females in Bangladesh: Burden and risk
factors
117. Reducing tobacco-use by cellphone messaging to the community, motivating women,
young men, school and college students, and counseling patients through village doctors
118. Assessment of knowledge, attitudes and practices (KAP) with respect to eclampsia and
pre-eclampsia among first-line healthcare providers and beneficiaries in rural Bangladesh
119. Quality of care and IUD uptake in family-planning clinics of Bangladesh
120. Caesarean delivery in urban slums of Dhaka city: Indications and consequences
121. Influence of maternal factors on birthweight in different socioeconmic levels
122. Nutritional status and dietary pattern of adolescent girls between upper and lower
socioeconomic status in Dhaka city
123. Effect of nutrition education on low birthweight and pregnancy weight-gain in a
selected hospital in Dhaka city
124. Intervention with dietary education for improving pregnancy outcome
125. Effect of nutrition education on people living with HIV/AIDs in Bangladesh
126. Quantifying the unmet need for family planning among most-at-risk population in Asia
127. Introducing medical MR in Bangladesh
128. Introducing mefipreston and mesoprostol for MR in public-sector facilities in
Bangladesh
129. Examination of participation in community development for HIV prevention with MSM
in Bangladesh
130. Factors influencing contraceptive-use and plan for number of children among couples in
Bangladesh
131. Impact evaluation of MNCH program of BRAC
132. Community-based postnatal care in Bangladesh
133. Women's experience and recall of delivery and neonatal care: A study of terms,
concepts and questions
134. Sexual behavior relating to HIV, STI among the rickshaw-pullers in Dhaka city in
Bangladesh
135. Assessment on the availability and routine use of AMTSL for prevention of PPH in
Bangladesh
136. Assessing acceptability of two-rod progesterone-only contraceptive implant (Jaddle)
among Bangladeshi women of reproductive age

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 Chapter 15: Research and Development

137. Study on right-based approach about women's access to healthcare with reference to
safe motherhood at government facilities
138. Operations research to address unmet need for contraception in the post-partum
period in Sylhet district, Bangladesh.

Research at the Institute of Child and Mother Health (ICMH)

Clinical Research in 2010
1. Safety and efficacy of simplified antibiotic regimens for outpatient treatment of suspected
sepsis in neonates and young infants in Bangladesh
2. Effect of maternal oral hydration therapy in oligo-hydramnios
3. Association between iron-deficiency and febrile seizure in children
4. Effect of intravenous iron sucrose complex versus oral iron therapy in iron-deficiency
anemia in pregnancy
5. A comparative study on the efficacy of cefixime, ceftriaxone, and azithromycin in the
treatment of typhoid fever in children
6. Medical Record & Data Management System of ICMH
7. Antenatal counseling improves early initiation of EBF
8. Characteristics of breastfeeding and complementary feeding practices among the under-
two children with their nutritional status in a selected periurban area of Bangladesh
Major areas of ongoing clinical research in ICMH
1. Asthma
2. Bronchiolitis
3. Complementary feeding
4. Early childhood development
5. Nutrition
6. Neuro-disability
7. Anemia in pregnancy
Major Areas of Health Systems Research in ICMH
1. Maternal and perinatal morbidity and mortality
2. Emergency obstetric care
3. Essential newborn care.

James P. Grant School of Public Health (BRAC University)

James P. Grant School of Public Health conducts multidisciplinary studies on various
development issues of national and global importance in close link with ICDDR,B and the
Research and Evaluation Division (RED) of BRAC. The fields of studies include poverty
alleviation, socioeconomic development, agriculture, nutrition, health equity, education,
reproductive health, environment, gender and related disciplines.

Some of the notable studies/research projects conducted by the School are listed below:
1. Urban Gates Manoshi Project

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 Chapter 15: Research and Development

2. Communicable disease: Vulnerability risk and poverty

3. Globalization as social determinant of health
4. Revitalizing Health for All: Developing a comprehensive primary healthcare model for
Bangladesh
5. National Food Security Nutritional Surveillance Program (FSNSP)
6. District Investment Case Analysis
7. Study on the Pay for Performance (P4P) Approach to increase utilization of maternal,
newborn and child health services in Bangladesh
8. Study on universal access to health/neglected sexual and reproductive health rights of
married men and women in a rural village in Bangladesh
9. PLHAs Index Study in Bangladesh
10. Study on HIV/AIDS Program: Successes and challenges
11. Study on the improvement of reproductive health in Bangladesh
12. Study on the barriers to adequate and equitable access in the provision of menstrual
regulation services in Bangladesh
13. Revealing the challenges of periurban and district town TB Control Program of BRAC in
Bangladesh.

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 Information System and eHealth

As in 2009 and 2010, the Management Informa
on System (MIS-Health) of the Directorate
General of Health Services (DGHS) con
nued its journey in 2011 towards expanding and
improving the quality of the health services of the country. The lack of skilled human resources
con
nued and, in some instances, even increased. However, as in the past years, that could not
stop the progress, although more could be done if skilled human resources were available. One
of the remarkable achievements of MIS-Health is the receipt of the United Na
ons ICT Award

tled “Digital Health for Digital Development” in a ceremony held in the Waldorf Astoria Hotel
of New York on 19 September 2011, organized on the occasion of the 66th Assembly of the
United Na
ons. The award was given as recogni
on of Bangladesh Government’s success in
using the informa
on and communica
on technology for development of health and nutri
on,
par
cularly for contribu
ng to improvement of maternal and child health. The digital health
program, on behalf of the Government of Bangladesh, is implemented by the Ministry of Health
and Family Welfare through MIS-Health.
“New York, 19 September 2011: Honorable
Prime Minister of Bangladesh Sheikh Hasina is
seen receiving the United Na
ons “Digital
Health for Digital Development” Award for
outstanding contribu
on of her government in
successfully using ICT for development of
Health and Nutri
on. Dr Hamadoun Ibrahim
Toure, Secretary-General of the Interna
onal
Tele-communica
on Union, is seen handing
over the award to the Bangladesh PM ”

Dr Hamadoun Ibrahim Toure, Secretary-General of the Interna
onal Telecommunica
on Union

(ITU) of the United Na
ons Organiza
on,formally handed over the award. The Hon'ble Minister
for Health and Family Welfare Professor AFM Ruhal Haque, Hon’ble Minister for Foreign Affairs
Dr Dipu Moni, and Son of Hon’ble Prime Minister Mr Sajeeb Wajed Joy were present, among
others, in the ceremony. Dr Hamadoun visited Bangladesh from1 to 4 March 2010 when he met
with the Hon’ble Minister for Health and Family Welfare at his office and witnessed
demonstra
on on the various digital health ini
a
ves of the MOHFW, including live
video-conferencing with district health managers. On 3 March 2010, Dr Hamadoun visited Savar
Upazila Health Complex and witnessed working process of digital health in sub-na
onal health
facili
es. He witnessed live demonstra
on of rural telemedicine program between community
clinic and upazila health complex where a doctor at Savar Upazila Health Complex provided
consulta
on to a poor woman in a distant community clinic. He also witnessed how the Mobile
Phone Health Service was func
oning. Dr Hamadoun was so impressed that he commented:

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 Chapter 17: Information System and eHealth

"Bangladesh should teach digital health to the whole world." A landmark publica
on by the
World Health Organiza
on
tled "mHealth—New horizons for health through mobile
technologies" based on the findings of the second global survey on eHealth, probably created a
good ground for giving due recogni
on to the achievements of Bangladesh in digital health. The
publica
on covered detailed story about the ac
vi
es of MIS-Health in digital health,
par
cularly in mHealth and included case study on "Pregnancy care advice by SMS."

“ Dhaka, 6 July 2011: Hon’ble Prime Minister Sheikh

Hasina inaugurates the telemedicine service of
MIS-Health at the Digital Innova
on Fair 2011,
organized by the Access to Informa
on Program of
Prime Minister’s Office. The Hon’ble Minister for
Health and Family Welfare Professor AFM Ruhal
haque and Professor Dr Abul Kalam Azad,
Director-MIS, DGHS, were present ”

As in the previous year, MIS-Health was one of the most successful par
cipants at the Na
onal
Digital Innova
on Fair 2011 held during 6-8 July 2011 and organized by the Access to
Informa
on (A2I) Program of the Prime Minister’s Office. Honorable Prime Minister Sheikh
Hasina once again expressed her apprecia
on for the achievements in Health Informa
on
System (HIS) and eHealth towards building Digital Bangladesh. MIS-Health received three
awards in the Na
onal Digital Innova
on Fair 2011.

Health Informa
on System

The ac
vi
es of MIS-Health rela
ng to health informa
on system include collec
on of data
from various sources and cleaning, analyzing, and summarizing the data to generate and
distribute informa
on through rou
ne administra
ve report, website, yearbook, health
bulle
n, newsleer, etc. The exis
ng data-flow system comprises wireless Internet network,
covering all health facili
es and health administra
ve points from the na
onal to the upazila
level. Data from health facili
es below the upazila levels are sent to upazila health offices
through paper-based forms where these are processed electronically. Several online databases
have been created. Database soware called District Health Informa
on System (version 2) is
used for collec
ng health service data across the country. However, efforts are undergoing to
rapidly transform the remaining data inputs through online databases. Expansion of the Internet
backbone to as low as the community clinics will soon be implemented. MIS-Health introduced
GIS (Geographical Informa
on System) in the health sector of the country. The GIS device,
namely Global Posi
oning System (GPS), has been provided to each of the six divisional and 64
district health offices of the DGHS. Using these devices, GIS-based HIS data resources are being
built gradually.

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 Chapter 17: Information System and eHealth

Informa
on on health facili
es

As of April 2011, there were 10,323 independently-running community clinics. Primary
healthcare facili
es at the upazila and union levels totaled 1,825 (463 hospitals and 1,362
outdoor facili
es) and the number of secondary- and ter
ary-care hospitals was 124 under the
Directorate General of Health Services. MIS-Health created a web-searchable database of the
health facili
es accessible to the public at its website: www.dghs.gov.bd. All health facili
es
other than the community clinics have been included in this database. The list of the
community clinics will be added soon to the database. Name, loca
on, address, type of facility,
and the number of beds, if any, of each facility have been presented. The facili
es can be sorted
by division, district, and upazila; and automated summary can be prepared. In Chapter 5, more
informa
on is provided on the distribu
on of public-health facili
es among divisions. Chapter 5
also shows informa
on on some private health facili
es.

Health facility u
liza
on

For the last year (January to December 2010), MIS-Health collected data on health facility
u
liza
on from quite a good number of hospitals and health centers. Data were available from
595 hospitals and centers of different types (Bangabandhu Sheikh Mujib Medical University;
postgraduate teaching and specialized hospitals: 7; medical college hospitals: 12; district and
general hospitals: 61; upazila hospitals: 413; 31-bed hospitals: 3; infec
ous disease hospitals: 2;
labor hospitals: 5; leprosy hospitals: 2; tuberculosis hospitals: 9; government employees
hospital: 1; mental hospital: 1; rural health centers: 13). Besides, 2 drug-addic
on treatment
centers, 33 tuberculosis clinics, 12 urban dispensaries, 16 school health clinics, one tuberculosis
center, and secretariat clinic also provided similar data. In these health facili
es, reportedly
52,035,866 pa
ents received healthcare from the outpa
ent departments. The number of
children (both sexes) was 11,932,632. The number of male adult pa
ents was 17,209,849, and
that of female adult pa
ents was 22,279,861. The number of reported admissions was
3,470,963, which included 1,553,381 male pa
ents and 1,893,920 female pa
ents. Data on
health facility u
liza
on were collected from a number of private and non-profit/NGO facili
es
also. Chapter 6 provides detailed informa
on on health facility u
liza
on.

Morbidity profiles
In 2010, MIS-Health collected data on disease profile of indoor pa
ents from 444 public
hospitals. Data on disease profile of outdoor and emergency pa
ents were not collected due to
concerns about reliability of the diagnoses. Of the 444 hospitals, 376 were upazila hospitals, 57
were district and general hospitals, 6 were medical college hospitals, 4 were postgraduate
teaching ins
tute hospitals, and one was medical university hospital (BSMMU). We included
about 2.72 million indoor pa
ents in the analysis of disease profile and tried to iden
fy the top
10 diseases for each type of hospitals. As disease paern varies by type of hospitals, we
performed the analysis for upazila hospitals, district and general hospitals, and for medical
college hospitals separately. As the postgraduate teaching ins
tute hospitals are specialty

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 Chapter 17: Information System and eHealth

hospitals and each of them deals with special kinds of pa
ents, we analyzed data on the disease
profile from each of the postgraduate teaching ins
tute hospitals separately. We also analyzed
data on the disease profile from the medical university hospitals separately. Table 17.1 shows
the number of indoor pa
ents by type of hospital, who were included in the analysis of disease
profile. Chapter 7 shows results of analysis of the disease profile in details.

Table 17.1. Number of indoor pa
ents by type of hospital, who were included in the analysis of disease profile
(2010)
No. of No. of indoor
Type of hospital
hospitals pa
ents
Upazila hospitals 376 1,681,459
District and general hospitals 57 984,386
Medical college hospitals 6 2,64,375
Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital 1 11,062
Na
onal Ins
tute of Traumatology, Orthopedics & Rehabilita
on (NITOR) 1 20,735
Na
onal Ins
tute of Kidney Diseases & Urology (NIKDU) 1 3,381
Na
onal Ins
tute of Diseases of Chest & Hospital (NIDCH) 1 8,929
Na
onal Ins
tute of Ophthalmology (NIO) 1 9,783
Total 444 2,719,735

Mortality profile
In 2010, we analyzed 51,550 deaths reported from 480 government hospitals of Bangladesh.
Among these hospitals, 390 were upazila hospitals, 62 were district and general hospitals, 14
were medical college hospitals, 6 were postgraduate teaching ins
tute hospitals, 3 were
infec
ous disease hospitals, and 5 were chest hospitals. Table 17.2 shows the distribu
on of
death events by type of hospital.

Table 17.2. Distribu
on of death events by type of government hospital (2010)

Type of health facility No. of

No. of deaths
facili
es
Upazila health complexes 390 5,775
District-level hospitals (district hospitals and general hospitals) 62 14,111
Medical college hospitals 14 27,255
Infec
ous disease hospitals (Dhaka, Khulna, and Rajshahi) 3 129
Na
onal Ins
tute of Diseases of Chest and Hospital (NIDCH) and other chest
6 876
hospitals (Bogra, Rajshahi, Jessore, Barisal, and Brahmanbaria)
Other postgraduate specialized teaching hospitals (NICVD, NIKDU, NIRCH,
5 3,404
NITOR and NIMHR)
Total 480 51,550

Chapter 8 shows the summary of data on the causes of death. In the analysis, top 10 causes of
death were iden
fied. Like the disease paern, causes of death also vary by type of hospital.
Therefore, analyses of the causes of death were done for upazila hospitals, district hospitals,
general hospitals, medical college hospitals, and infec
ous disease hospitals separately. As the
postgraduate teaching ins
tute hospitals are specialty hospitals and each of them deals with

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 Chapter 17: Information System and eHealth

special kinds of pa
ents, we analyzed data on the causes of death recorded in each of the
postgraduate teaching ins
tute hospitals separately. However, deaths reported from the Na
onal
Ins
tute of Diseases of Chest and Hospital and other 5 chest hospitals of the country were
analyzed together as they deal with similar types of pa
ents. We also analyzed data on the causes
of death recorded in the medical university hospitals separately.

Emergency obstetric care profile

Emergency Obstetric Care (EOC) is an important maternal healthcare service provided by the
Ministry of Health and Family Welfare for achieving the Millennium Development Goal 5. All
medical college hospitals, 59 district hospitals, 3 general hospitals, 132 upazila health complexes,
and 63 maternal and child welfare centers (MCWCs) provide comprehensive emergency obstetric
care (CEmOC) services. The rest of the upazila health complexes provide basic emergency
obstetric care (BEmOC) services. The NGO and private care providers from a number of districts
also provide similar services. For this publica
on, data from 690 health facili
es, including 14
medical college hospitals, 62 district hospitals, 416 upazila health complexes, 63 maternal and
child welfare centers (MCWCs), NGO and private hospitals from 64 districts, and 7 other types of
hospitals have been used for analysis. The data contained events of 558,712 deliveries in the
country’s emergency obstetric care facili
es in 2010. There were 546,233 livebirths. The number
of neonatal deaths in these facili
es was 2,280, and that of maternal deaths was 1,700. Chapter
4 shows the results of analysis of emergency obstetric care data.

Sta
s
cs of Integrated Management of Childhood Illness

Integrated Management of Childhood Illness (IMCI) is a worldwide program supported by
UNICEF, WHO, and other development partners. The morbidi
es included for the integrated
management under this program are responsible for almost 75% of under-5 deaths. The
Management Informa
on System (MIS) of the DGHS tries to capture the data from IMCI services
provided in various IMCI facili
es. Community IMCI Program is a newer interven
on, and a
separate system for data-collec
on has been developed. An online database-soware has been
hosted in MIS-Health server to automate the data-collec
on procedure and genera
on of report
on IMCI. In 2010, data on 1,844,658 pa
ents from the IMCI facili
es of 42 districts have been
received by MIS-Health.

Informa
on on health personnel

MIS-Health maintains an online database of the health personnel working under the DGHS. Staff
members can maintain detailed service-related personal resume in the database under their own
control and can access it through the Internet from anywhere. This personal resume is popularly
known as PDS which stands for ‘personal datasheet’. Due to the inherent staff management
processes of the MOHFW and the DGHS, demand to maintain the personal datasheets on staff
members other than the medical doctors is less. Therefore, the online personnel database largely
contains informa
on on medical doctors. MIS-Health would need policy support to create an

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 Chapter 17: Information System and eHealth

accountability system on the staff members so that they maintain and update the personal data
in the database as soon as a service-related event occurs. MIS-Health frequently collects
informa
on on staff availability from all health offices, ins
tu
ons, and facili
es. The informa
on
works as a basis for understanding the exis
ng staffing paern of health services from
me to

me. The status of health personnel is provided in Chapter 16 of this bulle
n. The latest available
data as of June 2011 state that there are 113,640 sanc
oned posts under the DGHS. The
distribu
on of these posts among Class I, Class II, Class III, and Class IV was 20,704 (18.22%);
1,607 (1.41%); 65,284 (57.45%); and 26,045 (22.92%) respec
vely. The doctors dominate the
Class I sanc
oned posts than the non-doctors (20,230 vs. 474). Doctors comprise 17.80% of the
sanc
oned posts of all staff categories. Class I non-doctors cons
tute only 0.42% of the total
sanc
oned posts. It is seen that 82% of the total sanc
oned posts were filled-up, leaving an
overall vacancy of 18%. The vacancy rate was more in Class I posi
ons for non-doctors (55%; 261
vacancies against 474 posts), followed by the posi
ons for doctors (21%; 4,195 vacancies against
20,230 posi
ons). There were 31% vacancies in Class II posi
ons (497 vacancies against 1,607
posts), 17% vacancies in Class III posi
ons (10,859 vacancies against 65,284 posts), and 19%
vacancies in Class IV posi
ons (5,072 vacancies against 26,045 posts).

Figure 17. Propor
on of females among available staff members of DGHS (June 2011)

65.9%

38.9%
34.1%
28.9%
22.8% 23.5% 22.8%

Class I doctor; Class I non- Class I all Class II Class III Class IV All (n=92,759)
(n=16,035) doctor; (n=16,248) (n=1,110) (n=54,425) (n=20,973)
(n=213)

Slightly more than one-third (34.1%) of the total available staff members are female (Figure 17).
This propor
on is 22.8% for the doctors, 23.5% for the Class I non-doctors, 22.8% for all Class I
posi
ons, 65.9% for Class II staff members, 38.9% for Class III staff members, and 28.9% for Class
IV staff members. Data collected by MIS-Health on sex distribu
on of the new medical doctors,
with degrees obtained from various medical and dental colleges, show that the percentage of
female doctors is gradually increasing, which was 40.1% in 2004 and 49.2% in 2009. However, the
percentage of female doctors in government service is s
ll lower compared to their produc
on
rate. The high percentage of females among Class II employees is due to the fact that most of the
staff nurses who belong to the Class II group are female.

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One of the limita
ons of the current personnel management informa
on system is its inability to
produce updated personnel status in real
me. There are a number of reasons. The personnel
deployment system is done through paper-based manual system and in well over 600 places
(MOHFW, DGHS, divisional directors’ offices; civil suregons’ offices, upazila health offices, and
each ins
tu
onal level). There are many aspects of staff movements, viz. recruitment, leave,
transfer, joining, promo
on, suspension, termina
on, re
rement, death, etc. If data rela
ng to all
these are not fed into personnel informa
on system from the source in real
me, assessing a
complete real-
me status of na
onal health personnel is not possible. Our experience shows
that, in the given context of accountability system without full process-automa
on, only reliance
on human compliance for upda
ng data from the mul
ple points, will not gurranty complete
real-
me staff profiles. MIS-Health is currently developing a web-based database solu
on
accessible to all health authori
es-real
me and for full process-automa
on.

However, fucn
ons of MIS-Health in maintaining the human resource informa
on are not at all
unsa
sfactory. Health personnel status has been analyzed in detail according to staff categories
and presented in Chapter 16. Personnel status of other departments of MOHFW, viz. Directorate
General of Family Planning (DGFP), Directorate General of Drug Administra
on (DGDA), and
Directorate of Nursing (DNS) was also collected. We gathered informa
on on the academic and
training ins
tu
ons for health and alterna
ve medicine, both in public and private sector, along
with the numbers, types of courses, and the number of seats in each course. A profile of
on-the-job training given under the Opera
onal Plan of In-service Training has also been
provided. There are more opportuni
es to improve the health personnel informa
on system,
integra
ng the human resource produc
on, training, re-training, and deployment system.
However, strong policy support and coordina
on among MIS-Health, personnel department, and
medical educa
on department would be required to achieve this success.

Logis
cs informa
on system

One of the greatest challenges of the government health system of Bangladesh is the poor
maintenance of logis
c inventory at the health facility level. At the na
onal level, efforts were
made to collect equipment status reports periodically on the numbers of major equipment by
type in each ins
tu
on, their func
onal status, if non-func
onal whether repairable or not, etc.
However, it remains a difficult task to get periodic data to keep the database updated. Trackable
inventory management for ins
tu
on-wise logis
cs was not aempted before. The ICT backbone
as well as informa
on culture of the Bangladesh health facili
es in the public sector are not yet
good enough that may create interest for locally-hosted computer-based inventory management
system. Under an USAID-supported program, the Management Sciences for Health (MSH) has
started building a logis
c management database system.

Monthly and annual repor
ng for Cabinet Division

The Cabinet Division of the Government of Bangladesh requires rou
ne repor
ng from each

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 Chapter 17: Information System and eHealth

ministry each month and an annnual report in July each year on many management issues
rela
ng to the respec
ve ministries. The items to be reported by the DGHS contain an exhaus
ve
list, and MIS-Health has to carry out this func
on each month and annually, on behalf of the
DGHS. MIS-Health could add beer quality to this job than ever.

Popula
on informa
on
There is no rou
ne data source in the country yet to es
mate the status of health-related MDGs,
especially MDG 4 and MDG 5, to know the child and maternal mortality rates. In our country,
most births and deaths occur in the households. There is a strong presence of private and
informal sector in healthcare. Owing to these factors, public-health facili
es encounter only a
propor
on of the healthcare-seekers. Therefore, the households are the best source of data to
es
mate the age, sex, and cause-specific death rates, disease burden, and other
popula
on-based health informa
on. The health census by the Bureau of Sta
s
cs is carried out
once every 10 years, which lacks adequate data on health profiles. Moreover, the health service
at the local levels suffers acutely from lack of reliable denominators to plan and execute health
programs. There are regularly-paid permanent health workers at the community level in
Bangladesh. They provide domiciliary service, hold immuniza
on camps, and run the community
clinics. They maintain a lot of registers locally. However, there is an absence of mechanism to
document the informa
on on individual ci
zen to whom the service is offered. Important
popula
on indicators, such as child and maternal mortality rates, are es
mated through sample
surveys at intervals. For example, the last child mortality rate was es
mated by Bangladesh
Demographic and Health Survey (BDHS) in 2007. The latest maternal mortality survey was done
in 2009, the report of which was published in 2010. The prior maternal mortality survey was done
in 2001. Fortunately, the DGHS had a historical system of collec
ng popula
on data annually
since 1961. Popularly abbreviated as GR, the Geographical Reconnaissance was once a good
source of popula
on data for local-level planning. GR was literally a kind of annual health census,
carried out to collect popula
on data by visi
ng every household each year in the month of
January and February. Health workers used to visit the households in the rural areas and collect
socio-demographic data on family-size, age and sex distribu
on, death(s) in the past year,
pregnancy, immuniza
on informa
on, drinking-water source, etc. GR was done every year un
l
2008. However, due to lack of proper supervision and for using manual system of data-collec
on
and entry, GR data lost their credibility; therefore, no report was published aer 2004.In 2009, it
was felt that GR should not be abandoned as it provides local-level up-to-date health data. The
DGHS, due to its large number of health workers spread throughout the rural areas of
Bangladesh, has the capability to conduct GR. Moreover, field workers of the DGHS, with
experience built over many years to collect the GR data, may be considered to have inherent
strength, which should not be allowed to die down. Experts in several workshops of stakeholders
have worked out that the use of ICT in the GR process may minimize repe

ve work and help
develop a computer-based permanent popula
on health database. Accordingly, a
machine-readable data form has been designed, printed, and distributed in all divisions for use in

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 Chapter 17: Information System and eHealth

the GR data-collec
on procedure in rural Bangladesh. The GR form has the provision of providing
a unique iden
fica
on number to each member of the family as well as using the Na
onal
Iden
fica
on Number (NID), if any. As of July 2011, training on the GR data-collec
on has been
provided to 24,111 field staff of 480 upazila health complexes and offices of 64 civil surgeons.
Aer data-collec
on, the job of data-entry will be outsourced. Aer finaliza
on, data will be
stored in na
onal database. Data center, data backup, and other necessary arrangements will be
made. It is planned that no annual GR will be conducted subsequently. Rather, the health workers
will update household data during their rou
ne visits using mobile devices or from community
clinics using mini-laptops. The data will be accessible from any health-points (viz. hospital,
immuniza
on camp, etc.) for upda
ng as well as decision-making. The database is expected to be
very helpful for both na
onal and local-level decision-making.

“ The thema
c diagram of the integrated

health informa
on system surrounding the
popula
on health database of MIS-Health ”

Data from other health programs and organiza
ons

MIS-Health con
nued collec
on of data from other programs and organiza
ons for prepara
on
and distribu
on of reports. Informa
on from programs, like essen
al service delivery (ESD),
communicable disease control (CDC), non-communicable diseases and other public health
interven
ons (NCD&OPHI), micronutrient supplementa
on (MS), na
onal nutri
on program
(NNP), mycobacterial disease control program (MBDC) and organiza
ons, like the Ins
tute of
Epidemiology, Disease Control and Research (IEDCR), Ins
tute of Public Health (IPH), Na
onal
Ins
tute of Preven
ve and Social Medicine (NIPSOM), Ins
tute of Child and Mother Health
(ICMH), Directorate General of Family Planning (DGFP), Directorate of Drug Administra
on
(DGDA), Directorate of Nursing Services (DNS) and from a number of non-government
organiza
ons has been gathered. Reports have been prepared using those data and informa
on
for this bulle
n. As the capacity of MIS-Health is improving, reports using data from other
organiza
ons will be further enriched in future.

Geographical Informa
on System (GIS) for mapping of health service and disease paern
In 2009, MIS-Health undertook a pilot program in Nilphamari district of Bangladesh to see
whether GIS can be introduced in health sector through the exis
ng informa
on staff for mapping

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 Chapter 17: Information System and eHealth

of health facili
es and services. The pilot was highly successful, and the report was highly
appreciated by policy-makers. Being inspired from this pilot, each divisional and district health
office has been provided with a GIS device called global posi
oning system (GPS). The divisional
and district informa
on personnel are being assigned to collect geospa
al data and present them
on maps for easy visualiza
on. Training on this system has by now been completed. One of the
objec
ves of our GIS program, among others, is to build GIS resources for mapping the loca
ons
of health facili
es in Bangladesh to make these available on the Internet for public use.

Dissemina
on of informa
on and publica
ons

Several seminars and discussions were held to disseminate informa
on and progress of
MIS-Health. Media features and news were frequently published in na
onal newspapers. The
website of MIS-Health was a vibrant plaorm for informa
on dissemina
on as a focal point for
the DGHS. The email and SMS were other stronger tools of informa
on dissemina
on within the
organiza
on. The rou
ne publica
ons, like Health Bulle
n, IMCI Newsleer, EOC Newsleer, etc.,
have been con
nued.

eHealth
Although health informa
on system is part of eHealth, we described above the health
informa
on system separately, given the special importance of health informa
on system in the
mandate of MIS-Health. However, eHealth is being given special emphasis due to the Digital
Bangladesh campaign of the present government, which gives special preference to delivery of
health services to ci
zens through ICT. MIS-Health introduced a number of eHealth programs and
services in the health sector of the country. These are briefly described below.

Mobile phone health service

Launched in May 2009, each of the government upazila health complexes and district hospitals
(grand total 482) of the country has been provided a mobile phone to act as a local call center for
delivering round-the-clock (non-stop) medical advice to the ci
zens who make calls to the mobile
phone. The contact numbers of the mobile phones have been circulated in the communi
es,
using local channels. The mobile phone numbers are also available on the website of the DGHS
(www.dghs.gov.bd). A doctor on duty in the hospital remains available to answer the phone calls.
The service is free of charge and has a number of benefits, viz. wider coverage that reaches
everybody everywhere and simplicity of use even by the technologically-lagging people. As a
medical doctor is available within distance of a phone call round-the-clock for free, people have
a beer op
on to avoid unqualified healers. Mobile phone health service also helps pa
ents to
avoid unnecessary visits to health centers, which indirectly benefits the health centers to provide
beer aen
on and supplies to the pa
ents who physically visit the health centers. Being local,
the service is also culturally responsive and customizable to local situa
ons. Owing to the comfort
of people in geng medical advice easily and quickly, it has been planned to roll out mobile
phone health service up to community clinics. In 2010, a monitoring cell has been established in

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 Chapter 17: Information System and eHealth

MIS-Health to randomly call several hospitals and check the quality of mobile phone health
service (viz., whether the calls are answered; if answered whether it is done warmly; whether a
doctor remains available to provide the advice, etc.). The “Union Informa
on and Service
Centers” project of the Access 2 Informa
on Program of the Prime Minister’s Office has also been
engaged in promo
ng the mobile phone health service to the rural communi
es. Mobile phone
health service received recogni
on through ICT 4 Development Award in 2010 and special
men
on in Manthan India Award in 2011.

Telemedicine
Telemedicine services have now been established in eight hospitals (two ter
ary hospitals, three
district hospitals, and three upazila hospitals) equipped with high-quality video-conferencing
devices. This has created a whole new era in the public-health service of Bangladesh. Honorable
Prime Minister of Bangladesh Sheikh Hasina formally inaugurated the telemedicine service on 6
July 2011 from the Na
onal Digital Innova
on Fair held in Bangabandhu Novo-theater. To further
expand the telemedicine service in all hospitals, MIS-Health also provided web-cameras to all
upazila hospitals. The telemedicine dream of the MIS-Health and Community Clinics Project is to
expand the service up to the community levels. For this purpose, it has been planned to provide
mini-laptops and/or mobile devices to the community clinics where health workers will use those
to help pa
ents consult upazila hospital doctors by video-conferencing. The laptops in the
community clinics will be used for mul
ple purposes, viz. telemedicine, upda
ng community
health data, health educa
on of people, training of health staff, communica
on, and
Internet-browsing. The telemedicine project of MIS-Health received the Na
onal ICT 4
Development Award in 2011.

Office aendance monitoring system

Governments in all countries face difficulty in delivering health services to ci
zens living in the
rural or remote areas. The healthcare providers oen do not like to do their jobs in those areas.
In developing countries, absenteeism of the clinical staff from the health sta
ons is another
serious problem. Bangladesh also faces similar difficul
es. MIS-Health has introduced an Office
Aendance Monitoring System to improve office aendance of health staff. The system uses
combina
on of (i) Telephone-based monitoring; (ii) Surveillance by web-camera; (iii) Web-based
aendance monitoring; and (iv) Remote Biometric Time Aendance System. The
telephone-monitoring system works in the following way:

A Monitoring Cell works at MIS office from 9:00 am to 5:00 pm every working day. Eight to 10 staff
members work there. They randomly choose any hospital or health center and make phone calls
to check staff aendance, par
cularly of doctors. They use both land-phones and mobile phones.
The web-camera surveillance works in conjunc
on with telephone-based monitoring system.
While telephone-monitoring con
nues, the staff members are oen asked to show up in front of
the web-camera to confirm the presence of staff. Most commonly, the web-camera plaorm is
Skype. The Skype is a free video-conferencing solu
on. Staff members absent unauthorized are

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 Chapter 17: Information System and eHealth

recorded in database, and the informa
on is reported to the Ministry. The Ministry takes ac
ons,
including punishment. For the Web-based monitoring, a simple web-based form has been
designed. On each working day, the head of the office ensures filling-up of the web-based form
by 9:00 am. The form can only be accessed with a specific user’s name and password. The form
requires entering informa
on on the number of sanc
oned posts, filled-up posts, and the
number of staff members absent authorized or unauthorized on a par
cular day. The form also
requires providing names of those staff members absent unauthorized. The Ministry checks the
informa
on from central level and takes necessary ac
ons against defaulters to bring discipline.
Just in one week aer launching, the web form-based monitoring system reduced the rate of
unauthorized absence dras
cally. Currently, the Remote Biometric Time Aendance System is
being gradually rolled out across various public-health facili
es. Low-cost fingerprint biometric
system has been placed in several ins
tu
ons. Biometric reading of all 10 fingers of each staff
member has been taken. Job profile of staff has also been recorded. Staff members need to touch
the sensor of the machine during check-in and check-out. The machine itself can keep in memory
30,000 encounters. It is connected to a local computer through USB. When the local computer is
switched on, the machine transfers the data to the soware for
me aendance system. At MIS
office, a locally-developed web-server runs all the
me and tries to find the computer connected
to the
me-aendance machine. Whenever the local machine becomes connected to the
Internet through USB modem, the server collects the
me-aendance data to MIS office without
knowledge of the local computer operator. Predefined web-based reports can be generated on
the server-side, which can be accessed through web-browser from anywhere. The policy-makers
see the reports and take ac
ons. This Remote Biometric System is efficient, easy to use, and
allows exact authen
ca
on of staff members and their check-in and check-out
mes. The Office
Aendance Monitoring System has improved doctors’ presence in the public-health facili
es
drama
cally. Many newspapers appreciated its success. The Honorable Minister for Health and
Family Welfare Professor Dr AFM Ruhal Haque informed the Na
onal Parliament about efficiency
of this system. The tradi
onal Vigilance Team requires travel by high officials, incurs loss in
rou
ne office work, and causes wastage of fuels; its implementa
on is occasional and also is less
efficient. The ICT-based Office Aendance Monitoring System has overcome all those barriers.
The ci
zens are geng immense benefits. Government’s money paid as staff salaries is now
realized. Pa
ents visi
ng health centers are geng more doctors to see them. It is improving
dura
on of consulta
on
me per pa
ent. Pa
ents’ confidence on public-health facili
es is
increasing.

SMS advice for safe pregnancy

Launched in March 2010, the SMS-based pregnancy advice is expected to emerge as one of the
pioneering programs of MIS-Health. On registra
on via cellphone SMS, pregnant mothers receive
appropriate periodic antenatal, safe delivery and postnatal care advices through SMS. This
service is expected to contribute to achievement of MDG 4 and 5 through improving neonatal and
maternal health. Currently, the mobile-operator TeleTalk is opera
ng this service. We are working

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for engaging other mobile operators to deliver similar service. The Ministry of Health and Family
Welfare has signed a partnership agreement with D.Net to provide the service in a much
improved way through voice-messaging IVR system. The USAID is providing the ini
al
seed-money to develop this service. MIS-Health aims to use the large number of health workers
under the DGHS to undertake promo
onal ac
vity for the mobile-based pregnancy-care advice.
The recent United Na
ons “Digital Health for Digital Development” Award received by Honorable
Prime Minister Sheikh Hasina took into account the mobile-based pregnancy-care advice as one
of the important considera
ons.

Complaint-sugges
on box
MIS-Health introduced SMS-based complaint-sugges
on box for all public hospitals and health
ins
tu
ons. A display board has been mounted on wall of each hospital and organiza
on, which
describes how to send complaints about quality of service(s) or sugges
ons to improve or
introduce certain service(s). A web-server located at MIS-Health receives the
complaints-sugges
ons and instantly forward them by email to the head of the hospital or
organiza
on about which the complaints and sugges
ons are given. MIS-Health manually checks
the complaints and sugges
ons and forwards these to respec
ve higher authori
es.

Bulk SMS
The innova
ve bulk SMS system of MIS-Health introduced in 2009 remained an effec
ve solu
on
even as of now to disseminate quick and urgent messages to health staff. The use of bulk SMS was
frequent and demand-driven.

Digital training facility

The digital training facility created by MIS-Health in 2009 was efficiently used in 2010. Its
arac
on as one of the best mee
ng and seminar place con
nues to increase. Equipped with
state-of-the-art gadgets, such as digital podium and sound, interac
ve board, wireless
presenta
on, wifi network, video-conferencing, etc., the facility aracts the organiza
ons to hold
their workshops, mee
ngs, etc.

A well-connected health systems

MIS-Health was the only innovator in the en
re public sectors of Bangladesh that created the
Internet connec
vity across all health-points down to the upazila level (~800 places) by April
2009. Un
l November 2010, this was the largest Internet network in the public sector of
Bangladesh. However, on 11 November 2010, Honorable Prime Minister Sheikh Hasina
inaugurated 4,500 Union Informa
on and Service Centers (UISCs), each connected to the
Internet. The laer is a project of Access 2 Informa
on Program of the Prime Minister’s Office
supported by UNDP. As of now, USICS project is the largest public-sector Internet network in the
country. However, the MIS-Health is working to connect 18,000 community clinics of Bangladesh
beginning from fiscal 2011-2012. If this happens, the Ministry of Health and Family Welfare will
become again the largest provider of the public-sector Internet network in the country. With the

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 Chapter 17: Information System and eHealth

addi
on of web-cameras to the end-users at the community clinics, MIS-Health will also have the
largest video-conferencing and telemedicine network. MIS-Health provided connec
vity in the
DGHS and in the MOHFW through wifi network.

HPNSDP 2011-2016 and hospital automa
on

MIS-Health has developed its 5-year development plan under the Health, Popula
on and
Nutri
on Sector Development Program 2011-2016. The Opera
onal Plan is
tled “Health
Informa
on System, eHealth and Medical Biotechnology.” The Opera
onal Plan has ambi
ous
goal to improve the connec
vity and digital health vision to such a level that would enable
real-
me communica
on across health systems digitally from the points where staff members
work. A number of hospitals have been planned to be fully automated in terms of hospital
processes. Paper-use will be minimized.

Human resource of MIS-Health

Currently, there are 721 sanc
oned posts under the MIS-Health throughout the country for
carrying out various ac
vi
es rela
ng to the health informa
on system and eHealth. Yet, there is
no sanc
oned post for Director of MIS-Health. The current director has been assigned to carry
out the func
on of Director of MIS-Health, in addi
on to his regular job of Addi
onal Director
General (Planning and Development) of Health Services. Including the posi
on of the director,
Table 17.3 shows a total of 721 sanc
oned posts. Of the sanc
oned posts, 533 were filled-up as
of June 2011, and 188 were vacant (vacancy rate: 26%). At the MIS-Health head office, there were
59 sanc
oned posts, of which 26 were vacant (vacancy rate: 44%). In the district hospitals, there
are no posts for sta
s
cal staff. In some of the medical college hospitals and also in some
postgraduate teaching ins
tute hospitals, there are no posts of sta
s
cal staff. In each civil
surgeon’s office, there is a post of class I sta
s
cian. However, in only eight districts, this posi
on
is filled-up. In the rest 56 districts, this posi
on is vacant.

Table 17.3. Human resource status of MIS-Health at various levels (June 2011)

Total Vacant
Place Class Type of post Filled-up (N)
(N) (N)
Class I Medical/Non-medical 18 10 8
Class II Assistant sta
s
cian 4 4 0
Sta
s
cal/Data-entry
MIS-Health Class III 30 12 18
operator/Clerical
Class IV MLSS/Security guard 7 7 0
Total 59 33 26
Class I At MBDC 1 0 1
Class II At EPI 1 1 0
DGHS At CDC, Hospital, IMCI, EPI,
Class III 7 5 2
MBDC , IEDCR
Total 9 6 3

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 Chapter 17: Information System and eHealth

Table 17.3. Human resource status of MIS-Health at various levels (June 2011) (Con
nued...)
Total Vacant
Place Class Type of post Filled-up (N)
(N) (N)
Class I Assistant chief 5 5 0
Data-entry operator (5);
Division Class III 18 16 2
Sta
s
cal assistant (12)
Total 23 21 2
Class I Sta
s
cian 64 6 58
District Class III Sta
s
cal assistant 56 56 0
120 62 58
Class I Sta
s
cal officer 0 0 0
Class II Sta
s
cian 1 0 1
Upazila Sta
s
cal assistant (5);
Class III 482 400 82
Sta
s
cian (475)
Total 483 400 83
Medical college hospitals
Class I Sta
s
cian/Sta
s
cal officer 10 2 8
(8 old, SSMCH, SZMCH)
Class I Sta
s
cian/Sta
s
cal officer 5 2 3
Class II Sta
s
cian/Sta
s
cal officer 3 2 1
Postgraduate ins
tute (IPHN,
NIPSOM, NICVD, NIDCH, NIKDU, Assistant
NICRH, NCCRFH) Class III sta
s
cian/Sta
s
cal 5 4 1
assistant
Total 13 8 5
200-bed and 250-bed hospitals
Class III Sta
s
cal assistant 3 1 2
(Narayanganj, Khulna, Noakhali)
TB Clinic (Chankhar Pul) Class III Sta
s
cian 1 0 1
Class I 103 25 78
Class II 9 7 2
Men
oned above
All places Class III 602 494 108
Class IV 7 7 0
Total 721 533 188

The limita
on of the MIS-Health throughout the country, including its head office, is serious lack
of appropriate technical persons both for informa
on technology as well as for sta
s
cal analysis
and interpreta
on. The available sta
s
cal staff members have gradua
on and/or higher
secondary-level educa
on and not in sta
s
cs discipline. To meet the current and future
challenges of MIS-Health, it is very essen
al to create adequate number of posi
ons of
competent persons in all relevant areas. As an interim measure, manpower or services should be
hired by outsourcing.

Capacity-building and maintenance support

MIS-Health con
nued capacity-building through training, supply of ICT equipment, computer
sta
oneries, payment of Internet bills, and also repair and maintenance support.

Training
In 2010-2011, fieen types of training courses/workshops of different dura
ons were held both
at MIS-Health office in Dhaka as well as at local hospital/health offices. A total of 39,997 officers
and staff members par
cipated in the training courses/workshops held under the HNPSP

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 Chapter 17: Information System and eHealth

2003-2011. In the UNICEF-supported training program, another 3,253 personnel par
cipated.

Table 17.4 summarizes the training and workshop events, which also includes a par
al list of
WHO-supported training courses/workshops where 334 personnel par
cipated.

Table 17.4. Training courses/workshops held in fiscal 2010-2011

Descrip
on Batch (N) Dura
on Par
cipants (N)
Training/Workshop under the HNPSP 2003-2011
Advanced computer training for MIS staff all over the country and/or
16 15 days 240
data-entry/clerical staff
Computer training for doctors 12 14 days 180
Training for data-handling staff 6 6 days 90
Computer training for MIS data access for policy-makers 4 4 days 60
Orienta
on training/workshop of divisional directors and civil surgeons 1 1 day 72
Tools/methods/reports development consulta
ve workshop 4 4 days 40
MIS coordina
on consulta
ve workshop at the MOHFW 4 1 day 16
MIS coordination consulta
ve workshop at the DGHS 8 1 day 56
MIS coordina
on workshop at medical colleges/ter
ary hospitals 4 1 day 1120
MIS coordina
on workshop at divisions 4 1 day 192
MIS coordina
on workshop at district/sadar hospitals 4 1 day 1,560
MIS coordina
on workshop at upazila hospitals 4 1 day 11568
GR mapping training (A1, H1, AH1, HA, Sta
s
cian) 1 4 days 24611
Dissemina
on workshop 4 1 day 136
Consulta
ve workshop for reviewing HIS status 8 1 day 56
Total (HNPSP) 39997
Training under UNICEF
Training on Integrated Management of Childhood Illness and Emergency Obstetric Care
Training on IMCI and EmOC customized soware for sta
s
cal ass. and
15 2 days 428
upazila sta
s
cian
Capacity development of MIS staff on matenal, neonatal and child health
1 1 day 24
informa
on system at the na
onal level
Orienta
on on IMCI monthly repor
ng format for paramedics (UH&FPO,
8 1 day 258
UFPO, MO-MCH, IMCI MO, M.A, SACMO)
Orienta
on on IMCI monthly repor
ng format UH&FPO, UFPO, MO-MCH,
14 1 day 372
RMO, MO-IMCI trained, at the district level
One-day training on IMCI monthly repor
ng format for RMO,, MO, MA,
71 1 day 2171
Sta
s
cian, SACMO, FWV, Sr. Staff Nurse at the upazila level
Total (UNICEF) 3253
Training/Workshop under WHO (par
al list)
Service availability mapping (SAM); 64 districts, 22 upazilas
4 4 days 102
(Class 1, Class III)
Improved collec
on of informa
on by NGO/private hospitals 6 2 days 158
Service availability mapping (SAM) by MIS personnel 1 4 days 28
Methods of collec
on of Informa
onby MIS personnel 1 4 days 30
Consulta
ve workshop to develop a guideline on district-level health
1 4 day 8
informa
on system (MIS)
Consulta
ve workshop to develop a guideline on hospital informa
on
1 4 days 8
system
Total (WHO) 334

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 Chapter 17: Information System and eHealth

Supply of ICT equipment and computer sta
oneries

In 2009-2010, a total of 420 computers, 550 laser printers, 1,100 toners, 550 printer-cables, 70
global posi
oning systems, 428 web-cameras, 614 copies of an
virus soware, 434 tables and
630 chairs have been procured and distributed to different health facili
es and health offices.
MIS-Health collected 1,500 web-cameras from the Na
onal Elec
on Commission for distribu
on
among the hospitals under the DGHS to introduce telemedicine service. Table 17.5 summarizes
the distribu
on list. Besides, some laptop computers were bought for MIS-Health training room.
Different health offices were also provided financial assistance for buying computer sta
oneries.

Table 17.5. Number of computers, printers, toners, printer-cables, tables, and chairs procured and distributed
from MIS-Health in fiscal 2009-2010

Printer- Web- An
virus

Name of the ins
tution Computer Printer Toner GPS Table Chair
cable camera soware
MIS-Health Head Office/
46 204 408 204 49 203
DGHS/MOHFW
Divisional health offices 6 6 6 6
Civil surgeons’offices 64 64 128 64 64 65 64 64
District hospitals 65 65 130 65 9 64 71 92
Tongi 50-bed Hospital ,
1 1 2 1 1 1
Gazipur , Dhaka
Upazila health complexes 18 18 36 18 419 419 24 45
50-bed Hospital, Saidpur,
1 1 2 1 1 1
Nilphamari
Sadar upazila healthooffices 60
Health complexes 4 4 8 4 4 4
Rural health centers (10-
14 14 28 14 14 14
bed)
Medical college hospitals 75 74 148 74 74 74
Specialized ins
tutes and
60 33 66 33 60 60
hospitals
Chiagong Skin and
Social Hygiene Centre, 1 1 2 1 1 1
Chiagong
Government Employees
1 1 2 1 1 1
Hospital, Dhaka
Urban dispensaries 33 33 66 33 33 33
Stores (Health) in
3 3 6 3 3 3
divisional level
School health clinics 21 21 42 21 21 21
Port Health Office,
1 1 2 1 1 1
Chiagong
Medical Assistant Training
6 6 12 6 6 6
Schools
Total 420 550 1,100 550 70 428* 614 434 630
*MIS-Health also received 1,500 web-cameras for distribu
on among all hospitals under the Ministry of Health
and Family Welfare for introducing telemedicine services

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 Chapter 17: Information System and eHealth

Repair and maintenance of computers, printers, and other accessories

MIS-Health experiences that, even in divisional or district towns, there is lack of appropriate
private firms for fixing computers and related accessories. So, MIS-Health has found out an
innova
ve solu
on. Under this approach, the respec
ve health facili
es or health offices having
trouble with computers or related accessories are told to first try locally to fix the problems or
seek advice over phone from the MIS-Health offices during the first 24 hours.
Table 17.6. Number of computers, monitors, printers, and UPS repaired in fiscal 2010-2011 by MIS-Health
Ins
tution Computer Monitor Printer UPS Total
Directorate General of Health Services 23 8 4 11 46
Specialized ins
tutes 6 0 2 0 8
Civil surgeon’offices 7 1 7 0 15
District hospitals 6 0 2 2 10
Upazila hospitals 92 10 50 23 175
Total 134 19 65 36 254

If it is not possible within this period to fix the problems locally, they are asked to send the
troubled machine to MIS-Health head office. MIS-Health head office, with the help of a repairing
vendor in Dhaka, tries to fix the problem in the next two days. On the fourth or fih day, the
computer should go back to the place from where it is brought. If it is not possible to fix within
this period, an effort is undertaken, in most cases, to replace a workable computer to the
respec
ve places. This has been done to ensure that computer does not sit ideal for longer
period. In 2010-2011, MIS-Health fixed 134 computers, 19 monitors, 65 printers, and 36 units of
uninterrup
ble power supply (UPS). Table 17.6 shows the list.

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 National Eye Care
Avoidable blindness is one of the major public-health problems in Bangladesh. According to a
recently-conducted na
onal blindness and low-vision survey, about 7.5 lakh people aged 30
years and above in the country are blind. In addi
on, blindness also afflicts about 40,000
children. About 5 million people, including children, suffer from refrac
ve errors while 250,000
adults are vic
ms of low vision. It is feared that the number of blind popula
on will go double
by the year 2020 if no interven
on is ini
ated immediately. However, it is interes
ng to note
that nearly 80% of these blind people are cataract vic
ms.

Cataract is avoidable or treatable through simple and cost-effec
ve surgical interven
on. The
other causes of blindness in the country include refrac
ve errors and low vision, corneal
diseases, glaucoma, diabe
c re
nopathy, and ocular trauma.

The Government of Bangladesh, being a signatory to Vision 2020 (a global campaign for
elimina
on of avoidable blindness by the year 2020) formulated a na
onal eye-care plan under
the leadership of the Bangladesh Na
onal Council for the Blind, an apex body under the
Ministry of Health and Family Welfare. Development of this plan involved stakeholders across
the country, including some interna
onal NGOs.

An Opera
onal Plan (OP) under the Health, Nutri
on and Popula
on Sector Program 2003-2011
is named Na
onal Eye Care. The OP will con
nue in the Health, Popula
on and Nutri
on Sector
Development Program 2011-2016. Three major areas of disease control have been priori
zed in
the plan. These are cataract surgery, childhood blindness preven
on, correc
on of refrac
ve
errors and low vision while recognizing the need for focusing on the sub-specialty services, such
as for cornea, re
na, glaucoma, etc. as the emerging priori
es. The Opera
onal Plan
emphasized the need for capacity-building from secondary-care facili
es down to the upazila
level and primary care to the community level, with effec
ve referral chain from primary to
ter
ary level of eye care. This will demand increased government investment in eye-care
infrastructure and development of various categories of manpower for this services. The OP
further emphasized the need for effec
ve na
onal coordina
on as well as district-level
coordina
on through establishing na
onal and district coordina
on commiees, bringing all
ac
ve eye-care providers to work together for the common goal.

Through this OP, a na
onwide program has been undertaken for the preven
on and control of
blindness. Special stress has been given for the control of childhood blindness. As the plan
states, the surgical services will be provided through development and moderniza
on of
secondary- and ter
ary-level hospitals with eye-care infrastructure which includes facility,
equipment, and manpower support. The secondary-level hospitals will be the nucleus of all
eye-care ac
vi
es, including surgical services, par
cularly cataract surgery, in each district. The
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 Chapter 18: National Eye Care

outcome of this eye-care plan will directly contribute to the people with unnecessary blindness,
par
cularly for the elderly poor, women, and children. The ac
vi
es will be implemented
through a strong GO-NGO-Private partnership and collabora
on. A na
onal advisory body for
VISION 2020 will steer this whole process. The implementa
on of this plan will directly support
crea
on of a produc
ve human resource. The stated ac
vi
es in this OP will help the
development of both demand and supply sides. The pa
ents will get a benefit to avail standard
eye-care services affordable and accessible from their nearest loca
on, with provisions of free
services for the poor and the disadvantaged (around 30% of the ophthalmic surgical pa
ents,
par
cularly cataract vic
ms). This can be iden
fied through various methods, like VGF/VGD
cards, cer
ficate from elected public representa
ves/local elites/local district-level Vision 2020
commiees). On the other hand, from the supply-side, the eye-care personnel at the service-
delivery end will be provided adequate training to improve their poten
als and skills to
maximize the u
liza
on of their services. Stated ac
vi
es will contribute towards improvement
of quality of life.

The key success factors of this OP will depend on the na
onal-level leadership of the VISION
2020 advisory commiee, deployment and reten
on of eye-care manpower in the district-level
hospitals, supply of ophthalmic equipment and supplies, development of eye-care infrastructure
at the ter
ary, secondary and primary level, establishment of a strong referral chain,
mobiliza
on of addi
onal resources, and above all, poli
cal commitment of the Government in
the form of administra
ve and financial support.

The objec
ves of the Opera
on Plan include: (i) developing/improving eye-care infrastructure at
the secondary and primary level; (ii) increasing country-level cataract surgical rate through
improving skills of ophthalmologists; (iii) strengthening coordina
on among GO, NGO and
private eye-care providers; (iv) preven
ng childhood blindness; (v) increasing affordability of
eye-care services by the poor pa
ents, par
cularly the elderly, women, and children through
voucher scheme; (vi) increasing awareness of mass people on eye-care; and (vii) suppor
ng
low-vision pa
ents.

The strategies are: (i) strengthening advocacy; (ii) development of facili
es and technology; (iii)
human resource development and management; (iv) reducing the disease burden; (v)
improving/expanding coordina
on and partnership; (vi) developing/strengthening eye-health
promo
on system; (vii) introducing/strengthening in-built supervision system; (viii) suppor
ng
low-vision pa
ents with appropriate devices; (ix) introducing in-built MIS for eye-health; and
(viii) sustaining voucher scheme.

Following ac
vi
es were carried out in 2010-2011

• Training, deployment, and retaining of eye-care providers
• Procurement, distribu
on, installa
on, and maintenance of eye-care equipment

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 Chapter 18: National Eye Care

• MSR support to district hospitals for intra-ocular lens (IOL) surgery

• MSR support to outreach eye-camps through district health administra
on
• Forma
on and func
oning of Vision 2020 district commiees
• Observance of World Sight Day 2010, jointly with interna
onal NGOs and WHO at the
na
onal and selected district level
• Organizing PSP (Pa
ents Screening Program) for screening of cataract cases.

Achievements in 2010-2011
• Thirteen ophthalmologists from different eye-care service centers have been trained on
micro-surgery (SICS)
• Ten nurses were trained on eye-opera
on theater and ward management
• Vision 2020 district commiees were formed and are func
oning in 6 districts (Tangail,
Khush
a, Meherpur, Chuadanga, Rangpur, and Bagerhat)
• Eye-care equipment were procured and distributed to Naogaon, Kurigram, Rajbari,
Manikganj, and Narayanganj district hospitals
• MSR support were given to district hospitals of Brahmanbaria, Satkhira, Narayanganj,
Shariatpur, Madaripur, Bhola, Rajbari, Chandpur, Munshiganj, Netrokona, Pirojpur,
Gopalganj, Kishoreganj, Jhaloka
, Gazipur, Laxmipur, Jamalpur, Manikganj, Chapainababganj,
Nilphamari, Noakhali, Jhenaidaha, Jhaloka
, Dinajpur, Narsingdi, Natore, Gaibhandha,
Naogaon, Kurigram, Tangail, Bagerhat, Khush
a, Meherpur, Jessore, Cox’s Bazar, Narail,
Manikganj, Khulna, Mymensingh, Chuadanga, and Sirajganj
• World Sight Day 2010 were observed in collabora
on with interna
onal NGOs and WHO
• PSP and free cataract surgery camps were organized at Nalta, Assasuni, Debhata, Kaliganj,
and Shymnagar of Satkhira, Kotalipara and Tungipara of Gopalganj, and Pirganj of Rangpur
• Eye-care equipment were repaired for Satkhira, Faridpur, Natore, Narsingdi,
ChapaiNababganj, Gopalganj, Jhaloka
, Nilphamari, Brahmanbaria, Narail, and Sherpur
• Cataract surgical rate for adults increased from 900 in 2004 to 1164 in 2010 per million per
year
• Cataract surgical rate for children increased from 400 in 2004 to 1000 in 2010 per million
per year.

Future plan of ac
ons

• Improve coopera
on and coordina
on among eye-care providers
• Introduc
on/strengthening of primary and secondary facili
es to improve quality and
expand coverage of eye-care service delivery
• Strengthening behavior change communica
on to increase awareness of primary eye car
• Establishing dedicated eye-opera
on theaters in all district (sadar) hospitals in phases
• Career-building opportunity for ophthalmologists working in district hospitals and below
• Forma
on of Vision 2020 district commiee in all 64 districts in phases.

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 Chapter 18: National Eye Care

Challenges
• Retaining trained staff at service centers
• Keeping equipment in regular func
oning
• Low priority of eye-care at secondary and primary-care level
• Healthcare-seeking behavior of people in the community

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 Financing Healthcare

Financing development program of the DGHSduring 2010-2011 fiscal

Funds for the development program of the Directorate General of Health Services (DGHS) came
from the Health, Nutri
on and Popula
on Sector Program (HNPSP) 2003-2011. In the fiscal
2010-2011, there was a total alloca
on of 90,840 lakh taka for the 19 Opera
onal Plans of the
DGHS in the revised annual development program (RADP) (Fig. 21.1).

Table 21.1. Alloca
on and expenditure of fund (lakh taka) against 19 opera
onal plans of DGHS in FY2010-
2011 under HNPSP 2003-2011 (parentheses show fund u
liza
on rate)

20,810.00
Alloca
on Expense

18,620.41
13,504.00

13,184.62

12,804.00

12,684.62

700.00

500.00

500.00

325.52
Total (97.63%) GOB (99.07%) RPA Total (71.43%) RPA-GOB (89.48% RPA-Others (65.10%)

The total expenditure was 82,046.31 lakh taka, the u
liza
on rate being 90.32%. Of the total
RADP alloca
on, GOB fund was 41,764.00 lakh taka (45.98%), and World Bank pooled fund was
21,310.00 lakh taka (23.46%). The u
liza
on rate of GOB money was 93.30% (38,965.94 lakh
taka),and that of RPA (RPA-GOB plus RPA-Other) was 88.91% (18,945.93 lakh taka).

Table 21.2. Alloca
on and expenditure of HNPSP 2003-2011 fund (lakh taka) in the fiscal year 2010-2011
against 8 investment projects of DGHS (parentheses show fund u
liza
on rate)
13,504.00

13,184.62

12,804.00

12,684.62

Alloca
on Expense
700.00

500.00

Total (97.63%) GOB (99.07%) RPA Total (71.43%)

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 Chapter 21: Financing Healthcare

There were eight investment projects under the DGHS in the HNPSP 2003-2011 during the fiscal
2010-2011. The total alloca
on in the revised annual development program (RADP) was
13,504.00 lakh taka (Fig.21.2). The total expenditure was 13,184.62 lakh taka. The u
liza
on rate
was 97.63%. Of the total alloca
on, GOB contribu
on was 12,804.00 lakh taka (99.07%), and RPA
contribu
on was 700.00 lakh taka (5.18%). The u
liza
on rate of GoB fund was 99.07%
(12,684.62 lakh taka). The u
liza
on rate of RPA fund was 71.43% (500.00 lakh taka). Table 21.1
shows the alloca
on, expenditure, and u
liza
on rate by Opera
onal Plan of the HNPSP
2003-2011 development fund of the DGHSfor the fiscal 2010-2011.

Table 21.1. Summary of alloca
on, expenditure and u
liza
on of the HNPSP 2003-2011 fund against 19
Opera
onal Plans of the DGHS in the fiscal 2010-2011
Alloca
on in the revised ADP 2010-2011 (Lakh Taka) Expenditure 2010-2011 (Lakh Taka) Progress
against RADP
Other RPA- Other alloca
on
Total GOB RPA-GOB RPA-Other Total GOB RPA-GOB
than RPA Other than RPA (%)
Opera
onal Plan
Alterna
ve
Medical Care 1,449.00 1,395.00 54.00 0.00 0.00 1,421.43 1,369.71 51.72 0.00 0.00 98.10

Communicable
6,961.00 2,900.00 3,561.00 500.00 0.00 6,640.67 2,878.46 3,436.69 325.52 0.00 95.40
Disease Control
Essen
al Service
35,053.00 7,820.00 4,433.00 0.00 22,800.00 27,382.11 5,775.25 2,653.80 0.00 18,953.06 78.12
Delivery
Health Educa
on
1,074.00 874.00 150.00 0.00 50.00 1,069.66 869.68 149.98 0.00 50.00 99.60
and Promo
on
Human Resource
Management 100.00 75.00 25.00 0.00 0.00 100.00 75.00 25.00 0.00 0.00 100.00

Improved
Financial 25.00 10.00 15.00 0.00 0.00 25.00 10.00 15.00 0.00 0.00 100.00
Management
Improved
Hospital Services 15,200.00 5,000.00 10,000.00 0.00 200.00 13,333.36 4,450.62 8,780.68 0.00 102.06 87.72
Management
In-service
Training (IST) 2,830.00 400.00 1,930.00 0.00 500.00 3,326.15 333.17 1,892.98 0.00 1,100.00 117.53

Management
Informa
on
System 1,271.00 400.00 765.00 0.00 106.00 1,270.81 399.91 764.90 0.00 106.00 99.99
(MIS-Health)

Micronutrient
Supplementa
on 2,000.00 400.00 1,600.00 0.00 0.00 1,855.48 299.08 1,556.40 0.00 0.00 92.77

Tuberculosis and
Leprosy Control 8,590.00 220.00 472.00 0.00 7,898.00 6,217.35 193.07 307.72 5,537.70 178.86 72.38

Na
onal
AIDS/STD 3,716.00 200.00 3,216.00 0.00 300.00 3,534.80 195.72 3,039.08 0.00 300.00 95.12
Program (NASP))

Na
onal Eye Care 320.00 200.00 20.00 0.00 100.00 305.89 188.04 17.85 0.00 100.00 95.59
Non-
communicable
Diseases and
2,386.00 1,836.00 340.00 0.00 210.00 2,157.00 1,825.00 332.00 0.00 0.00 90.40
Other Public-
health
Interven
ons
Pre-service
Educa
on (PSE) 6,000.00 4,000.00 2,000.00 0.00 0.00 5,887.47 3,902.96 1,984.51 0.00 0.00 98.12

Procurement and
Supplies 13,020.00 13,000.00 20.00 0.00 0.00 13,018.55 12,998.81 19.74 0.00 0.00 99.99
Management
Quality Assurance 61.00 16.00 45.00 0.00 0.00 60.83 15.83 45.00 0.00 0.00 99.72
Research and
125.00 25.00 100.00 0.00 0.00 121.47 21.47 100.00 0.00 0.00 97.18
Development
Sector-wide
Program 96.00 60.00 36.00 0.00 0.00 93.60 57.60 36.00 0.00 0.00 97.50
Management

Total 90,840.00 41,764.00 20,810.00 500.00 27,766.00 82,046.31 38,965.94 18,620.41 3,364.91 21,095.05 90.32

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 Chapter 21: Financing Healthcare
Table 21.2 shows the alloca
on, expenditure, and u
liza
on rate of the investment projects of
the HNPSP 2003-2011 under the DGHS for the fiscal 2010-2011.

Table 21.2. Summary of alloca
on, expenditure, and u
liza
on rate of the HNPSP fund against 8 investment
projects of the DGHS in the fiscal 2010-2011
RAD Plloca
on (2010 -2011) Expenditure (2010-2011) Progress
Project
Name of the project RPA Total RPA against
cost Total GOB GOB
GOB Other GOB Other alloca
on (%)
Establishment of 250-bed Na
onal
Ins
tute of Ophthalmology & Hospital 13287.43 9.00 9.00 0.00 0.00 4.58 4.58 0.00 0.00 50.89
(2003-2012)
Upgrada
on of 50-bed Na
onal Cancer
Research Ins
tute & Hospital to 300- 29552.30 1900.00 1200.00 0.00 700.00 1463.70 963.70 0.00 500.00 77.04
bed (2nd Revised) (2003-2010)
Establishment of Na
onal Ins
tute of
Neuro-science 19398.00 8000.00 8000.00 0.00 0.00 7721.58 7721.58 0.00 0.00 96.52
(2003-2011 )
Establishment of 150-bed
Sarkari Karmachari Hospital, Fulbaria, 4239.00 1100.00 1100.00 0.00 0.00 1091.00 1091.00 0.00 0.00 99.2
Dhaka
Establishment of Na
onal Ins
tute of
ENT–1st Phase at Tejgaon Health 5547.45 495.00 495.00 0.00 0.00 409.54 409.54 0.00 82.74
Complex Campus (2008-2012)
Expansion and moderniza
on of Dhaka
Medical College Hospital
6000.00 2000.00 2000.00 0.00 0.00 1990.56 1990.56 0.00 0.00 99.53
Establishment of Sheikh
Fazilatunnesa Mujib Eye Hospital, 14131.00 500.00 500.00 0.00 0.00 497.00 497.00 0.00 0.00 99.40
Gopalganj
Establishment of Na
onal Ins
tute of
Laboratory Medicine and Referral Center 13814.00 200.00 200.00 0.00 0.00 73.00 73.00 0.00 0.00 36.50

Total 105969.18 14204.00 13504.00 0.00 700.00 13250.96 12750.96 0.00 500.00 93.29

Bangladesh Na
onal Health Accounts 1997-2007

The Bangladesh Na
onal Health Accounts (NHA) 1997–2007 was officially published in 2010 by
the Health Economics Unit (HEU) of the Ministry of Health and Family Welfare. The work was
done by a consul
ng firm—Data Interna
onal Limited—with the financial and technical
assistance from German Technical Corpora
on (gtz). Mr Ravi P Rannan-Eliya from the Ins
tute for
Health Policy, Sri Lanka, was the editor of the report. Although selected por
ons of that report
was published in the 2010 Health Bulle
n, we are reproducing this sec
on in this bulle
n too as
the new NHA is not available. Table 21.3 shows the total health expenditure and annual growth
rates from 1997 to 2007.

Table 21.3. Total health expenditure, current and constant 2007 prices, and annual growth rates, 1997–2007

Amount (Taka in million) Growth rate over previous year (%)

Fiscal year
Current Constant (a) Current Constant
1996-1997 48,699 74,392 - -
1997-1998 53,602 78,966 10.1 6.1
1998-1999 59,433 84,554 10.9 7.1
1999-2000 65,497 91,796 10.2 8.6
2000-2001 74,193 103,256 13.3 12.5
2001-2002 82,978 111,652 11.8 8.1
2002-2003 89,709 115,867 8.1 3.8
2003-2004 102,229 126,624 14.0 9.3
2004-2005 117,085 136,075 14.5 7.5
2005-2006 138,955 152,588 18.7 12.1
2006-2007 160,899 160,899 15.8 5.4

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 Chapter 21: Financing Healthcare

Figure 21.3 shows the total health expenditure each year as percentage of GDP of Bangladesh
from 1997 to 2007. As the figure reveals, the total health expenditure increased at a very
negligible rate of only 0.1% each year from 2003-2004 to 2006-2007.

Figure 21.3. Ra
o of total health expenditure each year as percentage of GDP (1997 -2007)

3.3 3.4
3.1 3.2
2.9 3.0 3.0
2.7 2.7 2.7 2.8

1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07

Table 21.4 shows the total health expenditure and GDP of Bangladesh from 1997 to 2007.

Table 21.4. Total health expenditure and GDP from 1997 to 2007 in Bangladesh

Total health expenditure GDP

Current Constant Current Real Current Constant Current
Fiscal year (Taka ) (Taka )* (US$) growth (Taka ) (Taka )* US$
rate (%)
1996 -1997 393 600 9.2 14,571 22,258 341
1997 -1898 426 627 9.4 4.5 15,901 23,425 350
1998-1999 466 662 9.7 5.6 17,209 24,483 358
1999 -2000 506 709 10.1 7.1 18,313 25,666 364
2000 -2001 571 794 10.6 12.0 19,499 27,137 361
2001 -2002 624 840 10.9 5.8 20,557 27,661 358
2002 -2003 665 860 11.5 2.3 22,298 28,800 385
2003 -2004 742 920 12.6 7.0 24,181 29,951 410
2004 -2005 845 982 13.8 6.8 26,747 31,085 436
2005 -2006 988 1,085 14.7 10.5 29,568 32,469 441
2006 -2007 1,118 1,118 16.2 3.0 32,831 32,831 476
*Constant price of health expenditure and GDP were expressed in terms of 2007 prices

Figure 21.4 shows the gap between per-capita GDP and per-capita total health expenditure from
1997 to 2007. The figure clearly reveals that the gap has been widened over the years from
2002-2003 to 2006-2007.

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 Chapter 21: Financing Healthcare

Figure 21.4. Gap between per-capita GDP and per-capita total health expenditure from 1997 to 2007

Total health expenditure GDP

$476
$436 $441
$385 $410
$341 $350 $358 $364 $361 $358

$9.20 $9.40 $9.70 $10.10 $10.60 $10.90 $11.50 $12.60 $13.80 $14.70 $16.20

1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07

Figure 21.5 shows the per-capita purchasing power parity (PPP)-adjusted total health
expenditure in Bangladesh from 1997 to 2007. The per-capita expenditure has increased slowly
over the years. However, was this increase what we expected or similar to that in other countries?
One should find answer to this ques
on before making a conten
on.

Figure 21.5. Per-capita purchasing power parity (PPP)-adjusted total health expenditure nominal from 1997
to 2007 in Bangladesh
$43 $46
$33 $37
$27 $29 $30
$20 $21 $22 $24

Table 21.5 shows the contribu
on of total health expenditure from different sources from 1997
to 2007. Household (out-of-pocket) contribu
on con
nues to be two-thirds of the total health
expenditure, which was 57% in 1996-1997 and became 64% in 2006-2007.

Table 21.5. Contribu
on of total health expenditure (THE) from different sources from 1997 to 2007
Development
Public sector Household Private Insurance NGO Total THE
partners
Fiscal year
Million % of Million % of Million % of Million % of Million % of Million % of Million
taka THE taka THE taka THE taka THE taka THE taka THE taka
1996 -1997 17,682 36% 27,573 57% 562 1% 35 0% 548 1% 2,300 5% 48,699
1997 -1998 18,341 34% 31,055 58% 605 1% 41 0% 685 1% 2,875 5% 53,602
1998-1999 19,292 32% 35,071 59% 487 1% 47 0% 849 1% 3,688 6% 59,433
1999 -2000 20,217 31% 38,719 59% 910 1% 54 0% 1,019 2% 4,578 7% 65,497
2000 -2001 23,128 31% 43,456 59% 594 1% 97 0% 1,260 2% 5,659 8% 74,193
2001 -2002 25,223 30% 48,944 59% 657 1% 117 0% 1,265 2% 6,772 8% 82,978
2002 -2003 24,810 28% 54,461 61% 871 1% 142 0% 1,422 2% 8,004 9% 89,709
2003 -2004 29,316 29% 61,078 60% 854 1% 167 0% 1,579 2% 9,235 9% 102,229
2004 -2005 29,918 26% 74,506 64% 937 1% 224 0% 1,765 2% 9,734 8% 117,085
2005 -2006 38,696 28% 86,419 62% 1,100 1% 256 0% 1,954 1% 10,530 8% 138,955
2006 -2007 41,318 26% 103,459 64% 1,325 1% 314 0% 2,092 1% 12,391 8% 160,899

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 Chapter 21: Financing Healthcare
Figure 21.6 shows that the Ministry of Health and Family Welfare is the largest contributor to the
public-sector expenditure for health. In the fiscal 2006-2007, it contributed 97.1%, followed by
the Ministry of Local Government, Rural Development and Coopera
ves (1.0%), and the Ministry
of Home Affairs (0.6%). The rest of the ministries of the Government of Bangladesh together
contributed 1.3%.

Figure 21.6. Share of different ministries to public-sector fund for total health expenditure in FY 2006-2001

Other MOLGRD
1.00% MOHA
ministries
0.60%
1.30%

MOHFW
97.10%

Figure 21.7 shows the contribu
on of different development partners as percentage of total
donors’ funds to health expenditure in the fiscal 2006-2007.

Figure 21.7. Contribu
on of development partners to the external funds for health (FY 2006-2007)

gtz, 0.3%
Netherlands AusAid, 0.1%
UNFPA, 1.8%
Embassy, 4.7%
SID
A,
6.

World
8%

Bank, 27.6%
WHO, 9.8%

USAID, 10.9%

EC, 18.9%

DFID, 18.4%

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 Chapter 21: Financing Healthcare
Figure 21.8 shows the distribu
on of total health expenditure by type of provider in the fiscal
2006-2007.

Figure 21.8. Distribu
on of total health expenditure by type of healthcare providers in 2006-2007

43.0%

26.7%
21.8%

4.7% 2.7% 1.1%

Drugs & medical Hospitals Providers of Other in- Public health General
goods retailers ambulatory country programs administra
on
cares expenses

Table 21.6 shows the distribu
on of health expenditure on different types of healthcare providers
in the fiscal 2006-2007. Of the hospital expenditure, more than half (54.5%) went to the
private/NGO hospitals. Of the ambulatory healthcare expenditure, majority (32.5%) went to
family-planning centers, followed by general physicians (27.0%) and medical and diagnos
c
centers (18.4%). Other outpa
ent health centers got 12.1% of the share. The home-care
providers got 3.5%.

Table 21.6. How much each type of health facili
es got in the fiscal 2006-2007 out of health expenditure used for
hospitals

Share of hospital expenditure Share of ambulatory healthcare expenditure

Type of health facility Percentage Type of health facility Percentage
Private/NGO hospitals 54.5 General physicians 27.0
Hospitals at the upazila level and below 24.1 Den
sts 0.9
District/General hospitals 8.7 Homeopaths 3.2
Medical college hospitals 5.2 Ayurvedic/Unani prac

oners 2.4
Specialized hospitals 3.4 Family-planning centers 32.5
Hospitals under other ministries 3.1 All other outpa
ent health centers 12.1
University hospital and PG ins
tute
0.8 Medical and diagnos
c centers 18.4
hospitals
Government mental hospitals 0.2 Home-care providers 3.5

Figure 21.9 shows the distribu
on of public-sector health expenditure by func
on of health services in the fiscal
2006-2007. Cura
ve care drained 33%. Another 14% was drained by medicines and medical goods. Preven
ve care
used 27%.

Health Bulle
n 2011 |Page-198

 Chapter 21: Financing Healthcare

Figure 21.9. Distribu
on of public sector health expenditure by func
ons of health services in 2006-2007

Health
administra
on
4% Medical
educa
on &
Capital training
investment 4%
Preven
ve 18%
services
27%

Medicines & Cura
ve care

medical goods 33%
14%

Table 21.7 shows the comparison of health expenditure between Bangladesh and some
neighboring countries in the fiscal 2005-2006 and 2006-2007.

Table 22.7. Comparison of health expenditure between Bangladesh and neighboring countries

Total health Public expenditure

Per-capita health Public expenditure
Country Year expenditure as % of as % of total health
expenditure (US$) as % of GDP
GDP expenditure
2006-
Bangladesh 16 3.6 26 0.9
2007
Bangladesh 14 3.3 27 0.9
India 29 3.6 25 0.9
2005-
Nepal 17 5.1 30 1.6
2006
Pakistan 19 2.6 32 0.8
Sri Lanka 57 4.2 49 2.1

It is revealed from Table 21.7 that per-capita health expenditure in Bangladesh during the
2005-2006 period was lower than in several neighbouring countries, viz. India, Nepal, Pakistan,
and SriLanka. Among these countries, all except Pakistan had more total expenditure as
percentage of GDP than Bangladesh had. Contribu
on of Bangladesh and India from public fund
as percentage of total health expenditure was 27% and 25% respec
vely.

Health Bulle
n 2011 |Page-199

Annexure
 Annexure 5. 2: Age and sex distribution of the diseases/conditions among the admitted
patients in hospitals
5. 2. A. Age and sex distribution of the diseases/conditions among the admitted patients in upazila health
complexes (n=376)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50+y Total
Disease/condition
M F M F M F M F M F M F M F M F
Abortion 0 0 0 0 0 0 0 0 0 3895 0 7070 0 485 0 11450
Acid burn 0 10 15 46 50 52 78 105 177 290 234 185 101 562 655 1250
AIDS/HIV 0 0 0 0 0 0 0 0 12 19 95 103 59 54 166 176
Allergic reaction 19 18 12 6 66 66 125 125 213 166 283 203 145 160 863 744
Anemia 32 47 91 103 625 647 1153 1566 2126 3479 3345 6178 3278 4715 10650 16735
Anal fistula 1 0 3 11 15 25 36 92 217 123 180 95 134 436 586 782
Angina pectoris 0 0 0 0 0 0 0 0 122 365 578 369 353 466 1053 1200
Anxiety and
0 0 0 0 0 0 0 0 1290 2988 1610 4452 965 1647 3865 9087
depressive disorders
APH 0 0 0 0 0 0 0 0 0 750 0 1575 0 529 0 2854
Appendicitis 0 0 0 0 90 94 380 808 865 1478 1129 1413 265 318 2729 4111
Arsenicosis 0 0 0 3 10 15 19 30 42 44 62 40 30 95 163 227
Arthritis 0 1 153 300 328 312 337 330 759 734 1162 1102 1133 2371 3872 5150
Assault 0 0 0 0 0 0 0 0 30833 26645 53826 44793 25756 18065 110415 89503
Bacillary dysentery 2 3 117 78 373 437 638 638 978 646 1160 1374 1204 1272 4472 4448
Bone tumor 0 8 15 32 37 40 72 23 79 40 74 6 6 143 283 292
Brain tumor 0 0 0 0 0 0 0 0 100 222 215 259 182 784 497 1265
Bronchial asthma 0 13 195 310 459 456 934 1054 1539 2013 4407 4634 6634 5721 14168 14201
Bronchiectasis 0 0 0 0 0 0 0 0 199 397 379 486 501 1334 1079 2217
Bronchiolitis 100 113 866 659 453 364 204 214 217 240 510 426 479 430 2829 2446
Burn (Others) 10 64 64 67 541 461 487 604 513 589 608 643 329 406 2552 2834
C.C.F 0 0 0 0 0 0 0 0 48 87 101 227 308 392 457 706
Ca- Cervix 0 0 0 0 0 0 0 0 0 440 0 573 0 940 0 1953
Ca-Bladder 0 32 20 60 42 36 24 31 46 85 100 52 47 291 279 587
Ca-Breast 0 0 0 0 0 0 0 0 0 15 0 580 0 282 0 877
Ca-Colon 0 42 0 0 0 0 38 0 240 40 47 5 5 117 330 204
Ca-Gall bladder 0 0 0 0 0 90 176 232 475 415 312 303 68 1002 1031 2042
Ca-Kidney 0 5 4 20 18 90 111 200 657 800 712 300 90 1416 1592 2831
Ca-Larynx 0 0 0 20 553 320 43 339 147 165 81 101 102 85 926 1030
Ca-Liver 0 0 0 2 5 20 18 61 68 158 131 87 51 258 273 586
Ca-Lungs 0 0 0 0 1 0 0 0 0 0 16 10 28 9 45 19
Ca-Esophagus 0 0 0 10 20 15 14 16 46 0 7 1 10 44 97 86
Ca-Oral cavity 1 0 4 2 5 9 14 57 139 299 267 187 200 658 630 1212
Ca-Pancreas 0 2 1 10 7 18 17 11 13 16 115 20 70 77 223 154
Ca-Crostate 0 0 0 0 0 0 0 0 72 0 100 0 89 0 261 0
Ca-Rectum and anal
0 0 0 10 11 22 50 55 66 84 47 49 29 216 203 436
canal
Ca-Scrotum 0 0 0 0 0 0 0 0 70 0 714 0 567 0 1351 0
Ca-Skin 0 0 0 0 5 6 32 39 10 15 100 117 101 154 248 331
Ca-Stomach 0 0 0 0 6 10 8 23 55 27 34 56 92 118 195 234
Cataract 0 17 27 78 74 63 40 67 38 149 107 40 54 417 340 831
Ca-Thyroid 0 0 0 0 0 0 0 0 31 28 38 58 56 152 125 238
Cholecystitis 0 0 0 0 0 0 0 0 24 122 95 203 69 107 188 432
Cholilithiasis 0 0 0 8 14 29 20 66 67 41 108 100 24 103 233 347
Cirrhosis of liver 0 0 0 0 0 0 0 0 65 47 111 110 187 288 363 445
Congenital heart
2 4 6 2 1 1 3 151 192 313 446 1466 1225 1893 1875 3830
disease
COPD 17 27 80 84 243 194 670 781 1768 2610 3943 4585 8573 5829 15294 14110
Corneal ulcer 0 0 0 0 3 15 36 65 141 161 228 283 349 188 757 712
CVA 0 0 0 0 0 0 0 0 199 275 658 846 2181 1980 3038 3101
Dengue 0 65 128 107 127 168 148 104 160 159 166 188 111 667 840 1458
Diabetes mellitus 0 0 25 60 165 215 154 238 460 437 1037 1083 1260 1510 3101 3543
Diarrhea 1347 1356 18548 13954 33429 25041 16748 14342 17488 21244 25035 30350 16616 17169 129211 123456
Diphtheria 0 1 51 45 52 72 45 49 66 65 132 148 86 82 432 462
Disc prolapse 0 0 0 12 2 2 11 5 43 100 79 116 80 228 215 463
Drowning/Near-
0 1 13 19 463 382 307 176 189 115 206 50 58 164 1236 907
drowning
Drug reaction 0 1 1 6 16 25 30 35 54 123 116 292 83 158 300 640
Dysentery 2 90 294 368 774 783 937 930 1094 1057 1384 1621 1579 2288 6064 7137
Ectopic pregnancy 0 0 0 0 0 0 0 0 0 621 0 847 0 431 0 1899
Electric shock 2 31 53 33 80 53 146 102 206 130 306 184 123 200 916 733
Emphysema 0 0 99 85 60 55 71 39 40 31 69 97 51 343 390 650
Encephalitis 0 0 0 0 0 0 0 0 889 869 1579 1189 972 2955 3440 5013
Enteric fever 93 81 852 787 2749 2483 3932 3750 6171 5934 8424 8504 5005 4388 27226 25927
Epilepsy 0 84 50 72 94 182 162 155 135 56 56 103 111 590 608 1242
Fibroid 0 0 0 0 0 0 0 0 0 76 0 202 0 179 0 457
Filariasis 8 182 138 84 46 13 6 0 5 81 94 74 99 307 396 741
Food poisoning 26 24 105 125 364 368 574 512 625 678 711 569 484 495 2889 2771
Fracture 10 25 18 18 104 124 248 257 340 273 501 380 223 367 1444 1444
Fungal infections 1 25 31 62 168 160 204 280 292 671 905 1418 488 850 2089 3466
Gangrene 0 0 0 0 0 0 11 2 33 68 109 114 115 111 268 295
Glaucoma 0 0 0 0 0 0 0 0 3 59 56 0 1 56 60 115
Glomerulonephritis 0 0 7 7 19 37 120 27 32 16 14 81 2 32 194 200
Gonorrhea 4 8 0 9 5 58 20 60 93 27 46 115 10 124 178 401
Hemolytic jaundice 0 0 0 0 2 9 6 19 30 34 32 28 18 82 88 172
Hemorrhoids (Piles) 0 0 0 2 4 7 5 22 38 28 27 17 19 74 93 150
Head injury 1 3 37 43 84 124 470 336 1502 826 2268 1116 1353 540 5715 2988
Heart failure 0 0 2 0 3 24 30 25 85 75 362 283 663 448 1145 855

Health Bulletin 2011 |Page-228

 Annexure 5. 2: Age and sex distribution of the diseases/conditions among the admitted
patients in hospitals
5. 2. A. Age and sex distribution of the diseases/conditions among the admitted patients in upazila health
complexes (n=376) (Continued...)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50+y Total
Disease/condition
M F M F M F M F M F M F M F M F
Hepatic failure 0 0 0 0 0 0 0 0 145 310 286 206 241 725 672 1241
Hepatitis 0 0 0 0 0 0 0 0 315 256 512 401 470 384 1297 1041
Hernia 0 0 1 0 19 7 158 60 159 51 354 80 426 89 1117 287
Hydrocephalous 0 0 0 0 0 15 10 8 8 10 12 10 16 44 46 87
Hydrocele 0 0 0 0 0 0 0 0 235 104 498 317 238 716 971 1137
Hydronephrosis 0 0 0 0 0 0 0 0 31 25 26 60 60 147 117 232
Hypercholesterolemia 0 0 0 0 0 0 0 0 43 29 21 29 32 108 96 166
Hypertension 0 0 0 0 0 0 0 0 668 1062 3636 4530 6516 6462 10820 12054
Hyperthyroidism 0 0 0 0 0 0 0 0 346 77 162 117 84 245 592 439
Hypertrophied
0 0 0 0 0 0 0 0 21 0 3 0 25 0 49 0
Prostate
Hypothyroidism 0 0 0 8 14 29 14 13 14 16 16 29 16 91 74 186
Infective endocarditis 0 0 0 0 0 0 0 0 305 316 406 271 199 744 910 1331
Intestinal obstruction 1 0 4 1 13 31 122 111 309 265 730 444 264 183 1443 1035
Kala-azar 0 0 6 17 82 121 246 260 389 394 616 267 306 424 1645 1483
Leprosy 0 0 9 8 2 19 30 21 2 11 15 20 3 72 61 151
Leukemia 1 60 30 72 56 25 33 29 11 98 67 86 31 367 229 737
Liver abscess 0 1 0 1 0 1 4 12 21 17 40 31 28 41 93 104
Lymphoma 0 0 0 12 22 34 60 184 170 192 135 39 34 457 421 918
Lymphosarcoma 0 13 17 92 71 51 55 77 117 135 160 92 129 452 549 912
Malaria (Vivax/
0 2 53 37 339 298 596 456 828 502 702 475 244 123 2762 1893
Falciparum)
Mastoiditis 0 0 0 12 3 64 56 59 101 9 16 14 3 26 179 184
Measles 3 2 65 39 26 31 27 24 61 53 35 42 33 114 250 305
Meningitis 0 6 59 40 83 91 68 76 112 71 86 88 57 78 465 450
Mental retardation 0 0 0 0 0 0 0 0 402 292 546 594 263 1156 1211 2042
Mumps 1 0 5 9 68 161 137 259 215 337 236 206 127 620 789 1592
Myocardial infarction 0 0 120 300 500 426 142 130 388 181 261 219 459 1473 1870 2729
Nasal polyp 0 0 0 0 3 4 0 0 24 13 7 13 1 0 35 30
Nasopharyngal
1 11 58 145 189 110 129 148 97 225 200 91 110 771 784 1501
carcinoma
Nephrotic syndrome 0 0 3 5 41 51 67 93 70 79 100 45 30 139 311 412
Night blindness 0 21 25 52 16 19 3 10 7 7 26 26 36 48 113 183
Obst. jaundice 4 4 0 3 7 8 15 17 40 119 57 935 70 95 193 1181
Obstructed labour 0 0 0 0 0 0 0 0 0 6928 0 12034 0 1592 0 20554
Orchitis 0 0 0 0 0 0 0 0 88 0 117 0 72 0 277 0
Osteomyelitis 0 0 2 2 1 24 18 36 66 53 25 22 30 122 142 259
Osteosarcoma 0 43 59 86 97 102 90 162 133 217 161 161 91 770 631 1541
Ovarian tumor 0 0 0 0 0 0 0 0 0 86 0 128 0 61 0 275
Pancreatitis 0 0 3 12 6 5 0 4 126 1 134 27 10 3 279 52
Pelvic infectious
0 0 0 0 0 0 0 0 0 902 0 1598 0 547 0 3047
Disease
Peptic ulcer 0 0 0 0 0 0 0 0 8871 10882 20537 25002 15292 14828 44700 50712
Perforation (GI Tract) 0 0 0 0 0 9 7 15 65 70 268 75 201 173 541 342
Peripheral vascular
0 0 6 91 142 288 173 352 354 463 289 469 226 1470 1190 3133
disease
Pleural effusion 0 2 10 7 20 7 6 4 7 13 28 12 57 31 128 76
Pneumonia 7286 6571 35203 23888 23668 16127 3859 2463 609 480 526 421 443 763 71594 50713
Pneumothorax 12 59 95 37 121 330 73 77 141 147 211 159 60 596 713 1405
Poisoning 3 4 84 68 736 531 1180 1702 6519 7324 8531 8516 2177 1648 19230 19793
Poliomyelitis 0 0 5 2 14 27 34 20 124 144 123 141 45 129 345 463
PPH 0 0 0 0 0 0 0 0 0 771 0 1395 0 89 0 2255
Prostatic tumour 0 0 0 0 0 0 0 0 37 0 1111 0 691 0 1839 0
Prostatitis 0 0 0 0 0 0 0 0 34 0 74 0 145 0 253 0
Protein energy
4 9 64 49 253 234 175 181 182 159 108 130 131 309 917 1071
malnutrition
Pulmonary fibrosis 0 17 33 148 142 117 102 96 83 163 108 424 100 469 568 1434
Pyelonephritis 0 16 4 25 31 43 36 27 91 68 102 52 27 193 291 424
Rabis 0 0 0 0 0 0 0 0 1 1 1 1 3 1 5 3
Rectal prolapse 0 0 0 8 15 32 24 13 6 17 9 21 13 86 67 177
Refractive error 0 0 0 0 0 0 0 0 119 136 284 207 164 526 567 869
Renal failure 0 0 0 1 1 0 1 2 14 46 45 60 54 90 115 199
Renal stone 0 0 0 7 7 8 21 25 128 173 154 26 58 227 368 466
Retinal problem 0 0 0 0 0 13 10 2 3 8 10 3 7 17 30 43
Rheumatic fever 2 28 23 36 90 60 189 187 235 240 313 359 152 192 1004 1102
Rhinitis 0 0 0 1 0 7 0 0 1 5 1 6 2 18 4 37
Rickets 0 0 0 7 12 29 25 94 125 140 108 24 19 283 289 577
Road-traffic accident 8 16 35 58 542 510 2540 2152 6525 3836 10697 5214 5601 2775 25948 14561
Rupture uterus 0 0 0 0 0 0 0 0 0 29 0 102 0 30 0 161
Scabies 0 0 11 24 136 185 292 417 366 195 415 432 202 238 1422 1491
Schizophrenia 0 0 0 1 0 2 4 8 14 7 37 46 33 56 88 120
Septicemia 0 0 0 0 0 0 0 0 265 84 487 333 6 18 758 435
Spinal cord injury 0 0 0 25 19 50 39 42 29 69 64 116 76 292 227 594
Suppurative otitis
0 0 0 3 12 24 15 107 85 159 134 69 37 338 283 700
media
Syphilis 0 0 0 1 2 1 0 0 1 0 0 0 1 0 4 2
Tetanus 0 0 0 0 9 11 4 4 29 6 12 6 5 7 59 34
Thalassaemia 113 45 11 7 58 99 165 142 82 260 199 94 96 450 724 1097
Tonsillitis 0 0 3 34 120 103 238 193 405 277 362 214 162 176 1290 997

Health Bulletin 2011 |Page-229

 Annexure 5. 2: Age and sex distribution of the diseases/conditions among the admitted
patients in hospitals
5. 2. A. Age and sex distribution of the diseases/conditions among the admitted patients in upazila health
complexes (n=376) (Continued...)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50+y Total
Disease/condition
M F M F M F M F M F M F M F M F
Tuberculosis (Extra-
0 14 5 19 9 8 10 15 157 137 248 275 207 158 636 626
pulmonary)
Tuberculosis
0 0 3 0 1 0 6 19 33 57 180 143 162 85 385 304
(Pulmonary)
Urethritis 0 0 0 0 0 0 0 0 232 192 135 279 115 385 482 856
Urinary stone disease 0 0 0 0 0 0 0 0 49 59 120 113 69 72 238 244
Urinary tract
0 0 0 0 0 0 0 0 974 2182 2161 3709 2012 2117 5147 8008
Infection
Valvular heart disease 9 204 116 271 207 125 145 58 99 346 503 184 159 1140 1238 2328
Viral fever 64 69 631 661 1620 1412 2272 2103 2940 3055 3382 3632 2241 2659 13150 13591
Whooping cough 0 0 2 1 6 16 3 162 64 176 83 92 22 11 180 458
Worm infestation
0 0 113 552 827 864 967 1467 767 852 881 1463 611 641 4166 5839
(Intestinal)
Others 3773 4279 7651 8320 12346 15491 19405 25041 30061 76754 45785 97501 36735 40450 155756 267836

5. 2. B. Age and sex distribution of the diseases/conditions among the admitted patients in district-level
hospitals (n=53)*
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50y+ Total
Disease/condition
M F M F M F M F M F M F M F M F
Abortion 0 0 0 0 0 0 0 0 0 3334 0 3440 0 489 0 7263
Acid burn 0 0 0 0 11 9 21 29 16 37 11 10 1 1 60 86
AIDS/HIV 0 0 0 0 0 0 0 0 15 10 25 37 0 0 40 47
Allergic reaction 0 0 12 10 216 160 153 192 201 248 158 167 61 80 801 857
Anemia 15 18 58 62 449 476 748 698 945 1463 1491 4195 1202 2462 4908 9374
Anal fistula 0 0 0 0 2 1 157 153 203 176 303 247 232 193 897 770
Angina pectoris 0 0 0 0 0 0 0 0 46 96 315 278 494 145 855 519
Anxiety and depressive
0 0 0 0 0 0 0 0 325 894 762 1601 881 839 1968 3334
disorders
APH 0 0 0 0 0 0 0 0 0 460 0 592 0 213 0 1265
Appendicitis 0 0 0 2 16 32 403 742 771 1456 1086 1198 157 490 2433 3920
Arsenicosis 0 0 9 0 8 6 8 6 71 3 13 50 0 7 109 72
Arthritis 0 0 91 0 4 3 210 189 420 352 668 546 500 530 1893 1620
Assault 0 0 0 0 0 0 131 65 10110 6855 21067 11967 11478 8052 42786 26939
Bacillary dysentery 4 7 114 148 405 407 548 578 462 493 963 886 477 389 2973 2908
Bone tumor 0 0 0 0 0 0 112 115 122 133 140 209 20 0 394 457
Brain tumor 0 0 0 0 0 0 0 0 154 156 194 250 130 124 478 530
Bronchial asthma 3 2 199 172 398 301 751 1045 1867 1905 2897 3200 3988 3887 10103 10512
Bronchiectasis 0 0 0 0 0 0 0 0 384 366 524 509 449 450 1357 1325
Bronchiolitis 165 361 1662 1328 859 627 235 184 46 53 91 118 83 106 3141 2777
Burn (Others) 36 2 97 66 496 535 573 725 652 803 814 885 476 542 3144 3558
C.C.F 0 0 0 0 0 0 0 0 100 70 376 230 372 349 848 649
Ca- Cervix 0 0 0 0 0 0 0 0 0 202 0 395 0 303 0 900
Ca-Bladder 0 0 0 0 0 0 0 0 0 18 1 23 9 19 10 60
Ca-Breast 0 0 0 0 0 0 0 0 0 145 0 328 0 170 0 643
Ca-Colon 0 0 0 0 0 0 0 0 1 3 6 5 13 1 20 9
Ca-Gall blodder 0 0 0 0 0 0 0 0 141 145 181 180 205 203 527 528
Ca-Kidney 0 0 0 0 0 0 7 4 21 0 12 10 3 3 43 17
Ca-Larynx 0 0 0 0 0 0 0 0 0 0 1 0 13 6 14 6
Ca-Liver 0 0 1 0 0 0 1 0 8 30 99 45 76 27 185 102
Ca-Lungs 0 0 0 0 1 0 1 22 169 174 224 176 326 257 721 629
Ca-Oesophagus 0 0 0 0 0 0 0 0 0 0 1 1 5 3 6 4
Ca-Oral Cavity 0 0 0 0 24 30 35 39 40 60 75 41 98 72 272 242
Ca-Pancreas 0 0 0 0 0 0 0 0 0 18 2 27 12 8 14 53
Ca-Prostate 0 0 0 0 0 0 0 0 143 0 429 0 223 0 795 0
Ca-Rectum and anal canal 0 0 0 0 0 0 0 0 80 68 103 48 70 36 253 152
Ca-Scrotum 0 0 0 0 0 0 0 0 54 0 186 0 72 0 312 0
Ca-Skin 10 12 15 18 13 16 25 30 25 27 28 33 37 40 153 176
Ca-Stomach 0 0 0 0 30 25 12 10 35 21 33 49 93 31 203 136
Cataract 0 0 0 0 0 0 0 0 48 36 663 652 2508 2617 3219 3305
Ca-Thyroid 0 0 0 0 0 0 0 0 33 25 44 48 147 163 224 236
Cholicystitis 0 0 0 0 0 0 0 0 55 211 283 574 209 346 547 1131
Cholilithiasis 0 0 0 0 0 1 2 14 74 223 226 752 185 368 487 1358
Cirrhosis of liver 0 0 0 0 0 0 0 0 98 158 295 249 345 183 738 590
Congenital heart disease 12 24 26 15 29 41 117 106 116 113 666 403 1040 315 2006 1017
COPD 1 0 40 42 218 83 375 168 810 781 2001 2038 3711 2211 7156 5323
Corneal ulcer 0 0 0 0 0 0 2 1 147 125 460 489 301 230 910 845
CVA 0 0 0 0 0 0 0 0 275 308 1441 1287 3944 2713 5660 4308
Dengue 0 0 0 0 0 0 0 0 0 0 9 10 25 15 34 25
Diabetes mellitus 0 24 338 299 419 198 118 105 192 304 1861 1966 2843 2294 5771 5190
Diarrhoea 758 700 7688 5963 11203 9340 6531 6155 5929 6765 8461 9691 5349 6210 45919 44824
Diptheria 5 3 110 105 191 150 231 155 180 231 233 268 77 111 1027 1023
Disc prolapse 0 0 0 0 1 1 0 0 0 0 6 1 9 4 16 6
Drowning/near-drowning 0 0 45 33 187 147 86 49 34 41 2 29 4 13 358 312
Drug reaction 0 0 0 0 8 8 24 3 32 17 58 43 17 24 139 95
Dysentry 50 53 95 110 421 380 626 565 554 598 742 821 817 844 3305 3371
Ectopic pregnency 0 0 0 0 0 0 0 0 0 263 0 571 0 225 0 1059
Electric shock 0 0 0 0 6 9 88 35 118 118 215 114 76 24 503 300
Emphysema 0 0 0 0 1 1 0 2 0 4 0 3 9 19 10 29
Encephalitis 0 0 0 0 1 1 0 0 197 93 427 386 413 352 1038 832

Health Bulletin 2011 |Page-230

 Annexure 5. 2: Age and sex distribution of the diseases/conditions among the admitted
patients in hospitals
5. 2. B. Age and sex distribution of the diseases/conditions among the admitted patients in district-level
hospitals (n=53)* (Continued...)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50y+ Total
Disease/condition
M F M F M F M F M F M F M F M F
Enteric fever 131 137 268 238 877 809 1349 1201 1370 1337 2495 2627 1364 1399 7854 7748
Epilepsy 6 15 36 48 93 69 95 96 58 89 51 55 88 70 427 442
Fibroid 0 0 0 0 0 0 0 0 0 167 0 299 0 253 0 719
Filariasis 0 0 0 0 1 2 2 0 0 0 1 0 1 0 5 2
Food poisoning 0 0 20 19 238 223 450 324 669 648 1061 577 731 531 3169 2322
Fracture 2 2 124 223 264 406 694 685 1083 1136 2302 1517 1019 725 5488 4694
Fungal infections 52 21 109 91 89 631 373 126 427 336 190 146 94 109 1334 1460
Gangreen 0 0 0 0 1 1 37 11 30 24 125 32 134 53 327 121
Glaucoma 0 0 0 0 0 0 16 0 0 1 20 14 57 45 93 60
Glomerulonephritis 3 2 6 12 63 68 106 68 22 37 15 18 5 9 220 214
Gonorrhoea 0 0 0 0 0 0 3 1 8 8 15 1711 27 43 53 1763
Haemolytic jaundice 37 12 125 124 121 134 134 137 160 141 169 171 142 155 888 874
Haemorrhoids (Piles) 0 0 0 0 1 0 2 2 106 122 271 195 207 190 587 509
Head injury 0 1 14 8 116 164 471 512 1453 686 1724 978 1061 724 4839 3073
Heart failure 0 0 0 0 0 0 0 0 373 272 831 542 1267 994 2471 1808
Hepatic failure 0 0 0 0 0 0 0 0 33 82 65 66 76 84 174 232
Hepatitis 0 0 4 5 1 1 2 1 381 353 780 689 617 561 1785 1610
Hernia 0 0 1 2 54 25 143 32 362 129 790 188 675 224 2025 600
Hydrocephalous 0 0 0 0 1 1 2 3 4 5 11 1 0 0 18 10
Hydrocyle 0 0 0 0 0 0 0 0 64 37 246 59 255 32 565 128
Hydronephrosis 0 0 0 0 0 0 0 0 0 9 9 16 7 1 16 26
Hypercholesteremia 0 0 0 0 0 0 0 0 20 30 85 33 46 198 151 261
Hypertension 0 0 0 0 0 0 0 0 600 956 2642 3888 4603 4290 7845 9134
Hyperthyroidism 0 0 0 0 0 0 0 0 155 194 176 190 181 176 512 560
Hypertophid prostate 0 0 0 0 0 0 0 0 0 0 4 0 25 0 29 0
Hypothyroidism 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 4
Infective endocarditis 0 0 0 0 0 0 0 0 1 2 5 4 17 7 23 13
Intestinal obstruction 2 3 5 12 33 47 253 68 199 503 1351 518 661 572 2504 1723
Kala-azar 0 0 0 0 16 10 17 14 20 11 40 20 7 5 100 60
Leprosy 0 0 0 0 1 0 0 1 0 75 96 99 120 101 217 276
Leukemia 0 1 1 0 114 117 147 132 165 162 25 42 7 13 459 467
Liver absess 0 0 1 0 4 2 26 20 94 99 150 64 109 75 384 260
Lymphoma 0 0 0 0 0 0 2 7 113 138 132 116 144 136 391 397
Lymphosarcoma 0 0 0 0 0 2 0 3 0 23 0 4 0 0 0 32
Malaria(Vivax/Falciparum) 0 1 6 4 21 13 64 56 103 73 170 110 97 77 461 334
Mastoiditis 0 0 29 50 28 60 30 0 0 1 6 0 3 7 96 118
Measles 27 13 51 150 178 116 80 98 37 17 28 63 92 52 493 509
Meningitis 31 35 179 172 188 166 215 164 97 242 93 118 101 128 904 1025
Mental retardation 0 0 0 0 0 0 0 0 23 185 57 228 116 220 196 633
Mumps 5 5 119 113 144 165 105 82 34 51 87 46 187 114 681 576
Myocardial infarction 0 0 0 0 0 0 0 0 233 191 1699 618 2839 828 4771 1637
Nasal polyp 0 2 0 0 172 146 155 173 202 205 154 141 131 112 814 779
Nasopharyngal carcinoma 0 0 0 0 0 0 1 0 5 1 5 0 0 0 11 1
Nephrotic syndrome 5 5 11 24 176 137 236 182 57 88 90 68 42 46 617 550
Night blindness 0 0 0 0 30 33 30 36 3 11 80 49 286 392 429 521
Obst. jaundice 97 49 130 126 110 115 121 116 148 139 191 237 112 81 909 863
Obstructed labour 0 0 0 0 0 0 0 0 0 1967 0 3186 0 526 0 5679
Orchitis 0 0 0 0 0 0 0 0 23 0 152 0 14 0 189 0
Osteomyelitis 0 0 0 0 2 13 7 9 76 84 53 71 49 40 187 217
Osteosarcoma 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 7
Ovarian tumour 0 0 0 0 0 0 0 0 0 241 0 329 0 188 0 758
Pancreatitis 0 0 0 0 0 0 1 0 0 5 23 7 3 0 27 12
Pelvic infectious disease 0 0 0 0 0 0 0 0 0 387 0 713 0 446 0 1546
Peptic ulcer 0 0 0 0 0 1 3 20 3502 3500 8921 9096 5810 5847 18236 18464
Perforation (GI Tract) 0 0 0 0 0 0 7 4 188 33 693 228 516 369 1404 634
Peripheral vascular disease 0 0 0 0 0 0 2 1 4 7 69 6 86 19 161 33
Pleural effusion 144 112 705 462 256 125 201 186 237 241 546 381 347 159 2436 1666
Pneumonia 5445 4026 15055 10437 9632 7438 3123 2401 689 416 647 417 324 207 34915 25342
Pneumothorax 80 65 80 42 81 56 30 36 6 16 35 16 20 5 332 236
Poisoning 1 1 49 67 435 288 555 554 2539 2681 3922 3911 984 914 8485 8416
Poliomyelitis 0 0 6 4 10 8 11 8 33 203 31 42 27 15 118 280
PPH 0 0 0 0 0 0 0 0 0 880 0 707 0 211 0 1798
Prostatic tumour 0 0 0 0 0 0 0 0 165 0 178 0 227 0 570 0
Prostatitis 0 0 0 0 0 0 0 0 180 0 197 0 253 0 630 0
Protein energy
37 22 112 147 245 157 145 115 113 97 78 80 62 56 792 674
malnutrition
Pulmonary fibrosis 0 0 0 0 0 0 0 0 40 45 30 25 35 28 105 98
Pyelonephritis 0 0 0 0 0 0 1 0 12 0 41 69 18 85 72 154
Rabis 0 0 2 9 24 19 25 36 28 12 21 25 27 39 127 140
Rectal prolapse 0 0 0 1 29 24 35 33 75 62 172 100 160 101 471 321
Refractive error 0 0 0 0 0 0 0 0 55 38 68 37 83 83 206 158
Renal failure 0 0 1 0 1 10 17 43 121 383 178 180 325 135 643 751
Renal stone 0 0 0 0 0 0 0 1 27 29 229 195 247 274 503 499
Retinal problem 0 0 0 0 0 2 30 40 56 109 104 157 116 95 306 403
Rheumatic fever 0 0 0 0 17 21 158 132 177 191 93 96 45 36 490 476
Rhinitis 0 0 0 0 0 0 4 3 3 8 1 3 1 0 9 14
Rickets 0 0 0 0 4 1 111 122 115 113 127 115 125 121 482 472
Road-traffic accident 0 1 25 43 473 677 2232 1536 4018 1903 10833 3075 4312 1779 21893 9014
Rupture uterus 0 0 0 0 0 0 0 0 0 92 0 134 0 90 0 316
Scabies 13 14 42 204 1488 2135 1948 1830 1000 1227 244 210 232 244 4967 5864

Health Bulletin 2011 |Page-231

 Annexure 5. 2: Age and sex distribution of the diseases/conditions among the admitted
patients in hospitals
5. 2. B. Age and sex distribution of the diseases/conditions among the admitted patients in district-level
hospitals (n=53)* (Continued...)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50y+ Total
Disease/condition
M F M F M F M F M F M F M F M F
Schizophrenia 10 10 4 0 0 0 0 0 11 11 9 17 0 6 34 44
Septicemia 0 0 0 0 0 0 0 0 668 482 1731 1437 322 335 2721 2254
Spinal cord injury 0 0 0 0 0 0 5 1 44 49 76 73 86 92 211 215
Suppurative otitis media 0 0 21 25 59 21 24 5 15 14 49 112 46 18 214 195
Syphilis 0 0 0 0 5 3 0 0 0 0 59 85 124 145 188 233
Tetanus 126 111 5 3 7 7 26 20 19 53 41 31 43 6 267 231
Thalassemia 1 2 124 141 678 615 1039 739 315 231 222 262 78 116 2457 2106
Tonsillitis 75 62 6 16 45 48 146 157 156 136 116 151 67 37 611 607
Tuberculosis (Extra-
0 0 0 0 6 2 26 39 47 93 342 230 476 211 897 575
pulmonary)
Tuberculosis (Pulmonary) 0 0 0 0 6 5 18 18 130 146 207 173 358 180 719 522
Urethritis 0 0 0 0 0 0 0 0 47 53 69 66 77 87 193 206
Urinary stone disease 0 0 0 0 0 0 0 0 137 187 188 162 214 220 539 569
Urinary tract infection 0 0 0 0 0 0 0 0 460 1231 1136 1884 1203 1407 2799 4522
Valvular heart disease 0 0 1 0 1 0 38 17 93 47 406 149 338 150 877 363
Viral fever 156 153 666 553 1105 971 1077 799 1319 1384 1965 1439 1233 1098 7521 6397
Whooping cough 0 0 31 35 56 59 35 197 55 265 78 295 120 131 375 982
Worm infestation
0 0 80 153 459 688 739 984 415 779 294 652 176 416 2163 3672
(Intestinal)
Others 11701 8579 9357 8365 10337 10681 17598 20010 21467 35686 39765 56810 29773 34297 139998 174428
* Although in Chapter 7, consolidated data of 57 district level hospitals are given, the detailed age-wise data of 54 hospitals are available.

5. 2. C. Age and sex distribution of the diseases/conditions among the admitted patients in medical college
hospitals (n=6)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50y+ Total
Disease/condition
M F M F M F M F M F M F M F M F
Abortion 0 0 0 0 0 0 0 4 0 1640 0 1849 0 15 0 3508
Acid burn 0 0 0 0 0 0 1 2 0 1 1 7 0 1 2 11
AIDS/HIV 0 0 0 0 0 0 0 0 2 1 6 4 0 0 8 5
Allergic reaction 0 0 1 1 5 6 10 17 52 49 54 53 28 25 150 151
Anemia 1 2 4 19 68 62 235 134 250 488 808 644 370 286 1736 1635
Anal fistula 0 0 0 0 0 1 4 3 72 140 179 180 107 74 362 398
Angina pectoris 0 0 0 0 0 0 29 14 120 84 536 281 716 464 1401 843
Anxiety and depressive
0 0 0 0 0 0 12 13 276 661 555 952 394 271 1237 1897
disorders
APH 0 0 0 0 15 9 10 11 14 315 25 373 27 74 91 782
Appendicitis 0 0 2 3 18 12 169 113 705 414 445 298 96 40 1435 880
Arsenicosis 0 0 18 14 7 5 0 0 7 18 10 25 1 15 43 77
Arthritis 0 0 0 0 9 2 20 20 175 92 359 336 326 350 889 800
Assault 0 0 0 0 38 81 379 241 2501 1249 3850 1678 1469 711 8237 3960
Bacillary dysentery 0 0 44 69 135 60 110 97 143 127 591 474 438 327 1461 1154
Bone tumor 0 0 0 0 1 1 22 19 44 57 56 62 55 26 178 165
Brain tumor 0 0 0 0 0 3 6 7 22 9 25 27 22 4 75 50
Bronchiectasis 0 2 32 35 29 29 25 23 10 8 59 30 67 54 222 181
Bronchial asthma 0 1 1 12 66 94 116 196 245 757 786 644 636 344 1850 2048
Bronchiolitis 4 2 527 408 314 244 40 24 63 29 157 47 66 34 1171 788
Burn (Others) 0 0 9 15 48 30 98 54 163 115 282 227 138 151 738 592
C.C.F 0 1 2 8 11 12 7 6 18 23 242 213 505 393 785 656
Ca-Breast 0 0 0 0 0 0 0 0 1 12 18 151 12 126 31 289
Ca-Cervix 0 0 1 1 2 2 4 7 7 6 5 119 5 118 24 253
Ca-Bladder 0 0 0 0 0 0 3 1 1 2 7 3 36 12 47 18
Ca-Colon 0 0 0 0 0 0 1 0 6 6 55 29 49 30 111 65
Ca-Gall bladder 0 0 0 0 0 0 8 3 5 0 18 34 88 41 119 78
Ca-Kidney 0 0 0 0 0 0 0 0 0 0 12 13 16 19 28 32
Ca-Larynx 0 0 0 0 0 0 0 0 1 2 56 61 112 53 169 116
Ca-Liver 0 0 0 0 1 1 0 0 1 0 42 26 70 85 114 112
Ca-Lungs 0 0 0 0 0 0 2 0 2 8 70 48 191 69 265 125
Ca-Esophagus 0 0 0 0 0 0 0 0 5 5 42 31 99 55 146 91
Ca-Oral cavity 0 0 0 0 0 0 0 0 1 2 27 11 43 15 71 28
Ca-Pancreas 0 0 0 0 0 0 0 0 0 1 17 3 34 18 51 22
Ca-Prostate 0 0 0 0 0 0 0 0 0 1 6 1 27 1 33 3
Ca-Rectum & anal canal 0 0 0 0 0 0 2 1 34 3 53 31 48 31 137 66
Ca-Scrotum 0 0 4 2 1 1 0 0 0 0 8 2 12 3 25 8
Ca-Skin 2 2 2 1 2 3 1 4 0 0 5 8 10 5 22 23
Ca-Stomach 0 0 0 0 0 0 0 0 2 39 94 89 158 124 254 252
Cataract 0 0 0 0 3 4 410 623 138 179 242 215 251 211 1044 1232
Ca-Thyroid 0 0 0 0 0 0 0 0 0 1 14 18 27 13 41 32
Cholecystitis 0 0 0 0 12 9 6 4 63 64 171 312 153 222 405 611
Cholilithiasis 0 0 0 0 0 1 4 1 28 44 148 304 104 169 284 519
Cirrhosis of liver 0 0 3 2 1 0 7 7 81 34 361 263 340 286 793 592
Congenital heart disease 0 8 37 18 18 18 19 21 55 37 95 52 75 68 299 222
COPD 0 0 1 4 16 22 28 29 73 142 565 364 1165 467 1848 1028
Corneal ulcer 5 2 42 27 33 134 113 214 411 18 46 108 220 199 870 702
CVA 0 0 0 0 0 0 25 16 140 80 947 803 1496 985 2608 1884
Dengue 0 0 0 0 0 0 14 10 15 31 69 45 57 49 155 135
Diabetes mellitus 1 0 41 75 31 41 28 43 64 89 307 634 942 727 1414 1609
Diarrhea 2 2 491 406 536 703 428 706 577 696 1477 637 2827 2306 6338 5456
Diphtheria 0 0 55 74 27 43 22 4 10 7 10 6 2 0 126 134
Disc prolapse 0 0 0 0 0 0 0 0 37 16 96 46 44 42 177 104

Health Bulletin 2011 |Page-232

 Annexure 5. 2: Age and sex distribution of the diseases/conditions among the admitted
patients in hospitals
5. 2. C. Age and sex distribution of the diseases/conditions among the admitted patients in medical college
hospitals (n=6) (Continued...)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50y+ Total
Disease/condition
M F M F M F M F M F M F M F M F
Drowning/Near
0 0 11 5 40 26 13 19 8 16 39 51 175 35 286 152
Drowning
Drug reaction 0 0 0 0 2 1 5 3 11 18 49 54 30 11 97 87
Dysentery 0 0 0 1 13 16 11 4 24 24 80 53 128 131 256 229
Ectopic pregnancy 0 0 0 0 0 0 0 0 1 119 16 138 17 16 34 273
Electric shock 0 1 0 2 1 2 29 5 44 30 122 43 99 7 295 90
Emphysema 0 0 0 1 8 7 7 7 7 28 60 34 63 28 145 105
Encephalitis 0 0 47 37 148 111 93 91 101 95 257 142 172 119 818 595
Enteric fever 0 0 5 15 127 113 194 181 344 266 615 380 437 297 1722 1252
Epilepsy 0 0 1 0 38 20 61 39 49 75 99 54 86 32 334 220
Fibroid 0 0 0 0 4 4 7 7 0 142 3 308 8 101 22 562
Filariasis 0 0 0 0 1 0 0 18 7 27 32 80 27 16 67 141
Food poisoning 0 0 1 48 51 39 26 26 82 97 119 95 93 39 372 344
Fracture 5 7 17 20 77 79 212 294 639 564 1288 1004 1348 414 3586 2382
Fungal infections 23 35 175 136 281 230 516 950 1509 656 1420 1248 1744 968 5668 4223
Gangrene 0 0 2 1 9 8 25 11 31 27 187 53 193 57 447 157
Glaucoma 0 0 0 0 2 0 200 251 11 4 22 13 36 28 271 296
Glomerulonephritis 0 1 14 10 33 26 121 71 76 68 70 72 64 52 378 300
Gonorrhea 0 0 0 0 0 0 6 6 7 18 26 33 27 44 66 101
Hemolytic jaundice 4 6 0 0 1 0 5 3 43 41 43 32 22 20 118 102
Hemorrhoids (Piles) 0 0 0 0 0 10 20 16 70 37 132 42 113 69 335 174
Head injury 1 2 2 13 95 85 203 181 356 218 947 1712 1052 678 2656 2889
Heart failure 0 0 9 7 10 18 2 39 80 176 494 398 667 414 1262 1052
Hepatic failure 0 0 0 0 0 0 1 0 45 63 175 79 201 178 422 320
Hepatitis 0 0 1 1 10 51 52 49 176 336 843 590 334 193 1416 1220
Hernia 0 0 8 3 47 7 59 16 140 27 511 30 475 33 1240 116
Hydrocephalous 0 0 16 6 11 4 1 0 20 6 21 5 43 20 112 41
Hydrocele 0 0 1 0 28 5 18 6 44 31 161 19 150 10 402 71
Hydronephrosis 0 0 5 3 13 9 8 5 12 7 67 25 40 40 145 89
Hypercholesterolemia 0 0 0 0 0 0 1 0 6 2 55 36 65 58 127 96
Hypertension 0 0 0 0 6 5 10 16 72 113 962 744 1226 866 2276 1744
Hyperthyroidism 0 0 1 0 0 0 0 0 5 24 70 99 129 89 205 212
Hypertrophied prostate 0 0 0 0 0 0 0 0 0 2 7 14 96 1 103 17
Hypothyroidism 2 0 0 0 4 0 0 0 3 5 20 41 10 21 39 67
Infective endocarditis 0 0 0 0 0 0 3 0 13 14 25 26 43 12 84 52
Intestinal obstruction 2 2 7 9 24 17 44 33 68 38 226 155 199 129 570 383
Kala-azar 0 0 0 0 0 1 1 15 2 3 15 11 16 15 34 45
Leprosy 0 0 0 0 0 0 0 0 5 2 25 12 25 5 55 19
Leukemia 0 0 0 0 5 53 24 55 70 100 101 113 163 58 363 379
Liver abscess 0 0 0 2 1 1 5 1 17 14 129 45 59 16 211 79
Lymphoma 0 0 1 0 8 6 11 22 27 43 71 94 45 39 163 204
Lymphosarcoma 0 0 0 0 0 3 0 5 0 7 39 4 2 3 41 22
Malaria
0 0 4 3 17 12 10 10 55 55 93 58 27 20 206 158
(vivax/falciparum)
Mastoiditis 0 0 0 0 0 1 4 7 26 56 29 64 29 15 88 143
Measles 0 0 0 1 0 3 3 4 11 9 25 25 7 6 46 48
Meningitis 2 4 56 43 94 80 120 114 131 109 181 166 70 62 654 578
Mental retardation 0 0 2 4 7 1 5 6 12 20 64 47 39 23 129 101
Mumps 0 0 0 0 33 17 44 198 223 186 65 53 91 19 456 473
Myocardial infarction 0 0 0 0 1 0 2 10 21 81 1971 638 2938 1365 4933 2094
Nasal polyp 0 0 0 0 0 0 22 6 53 14 97 16 59 6 231 42
Nasopharyngeal
0 0 0 0 4 0 6 7 0 2 4 4 9 2 23 15
Carcinoma
Nephrotic syndrome 0 0 8 12 138 95 80 73 82 87 232 154 128 86 668 507
Night blindness 0 0 0 0 27 25 31 43 0 2 44 25 34 32 136 127
Obst. jaundice 0 0 0 1 0 0 0 7 21 61 105 133 66 64 192 266
Obstructed labor 0 0 0 0 0 0 0 0 0 244 2 378 8 95 10 717
Orchitis 0 0 0 0 0 0 3 0 14 19 24 32 14 15 55 66
Osteomyelitis 0 0 0 1 7 8 23 20 46 53 94 48 31 23 201 153
Osteosarcoma 0 0 0 0 0 0 4 3 12 6 9 15 6 4 31 28
Ovarian tumor 0 0 0 0 0 0 0 6 0 97 15 282 14 28 29 413
Pancreatitis 0 0 0 0 0 0 1 1 15 24 64 72 24 28 104 125
Pelvic inf. disease 0 0 0 0 0 0 2 4 2 97 10 180 8 26 22 307
Peptic Ulcer 0 0 0 0 20 6 94 102 321 380 985 971 864 717 2284 2176
Perforation (GI Tract) 1 0 0 0 4 3 25 43 84 59 325 144 212 74 651 323
Peripheral vascular
0 0 0 0 0 0 0 0 21 19 180 56 134 38 335 113
disease
Pleural effusion 0 0 29 28 24 25 6 2 56 113 346 230 411 335 872 733
Pneumonia 214 165 1354 1044 1014 686 330 262 231 105 267 210 193 120 3603 2592
Pneumothorax 0 45 2 11 37 33 19 10 19 19 45 31 28 9 150 158
Poisoning 0 3 4 8 60 75 120 157 542 625 687 553 279 239 1692 1660
Poliomyelitis 0 0 0 0 1 0 10 5 12 38 31 38 17 8 71 89
PPH 0 0 0 0 0 0 0 6 0 203 0 397 0 83 0 689
Prostatic tumor 0 0 0 0 0 0 0 0 0 0 13 12 32 3 45 15
Prostatitis 0 0 0 0 0 0 0 0 14 1 5 4 6 0 25 5
Protein energy
6 4 95 84 152 243 170 155 131 165 159 65 8 8 721 724
malnutrition
Pulmonary fibrosis 0 0 0 0 0 0 0 0 0 0 23 13 10 12 33 25
Pyelonephritis 0 0 0 0 1 1 0 0 4 6 23 33 12 11 40 51
Rabies 0 0 0 0 0 0 0 0 5 10 6 19 8 3 19 32

Health Bulletin 2011 |Page-233

 Annexure 5. 2: Age and sex distribution of the diseases/conditions among the admitted
patients in hospitals
5. 2. C. Age and sex distribution of the diseases/conditions among the admitted patients in medical college
hospitals (n=6) (Continued...)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50y+ Total
Disease/condition
M F M F M F M F M F M F M F M F
Rectal prolapse 0 0 0 0 11 11 14 7 6 2 16 16 22 22 69 58
Refractive error 0 0 0 0 0 0 0 0 4 3 3 11 5 2 12 16
Renal failure 0 0 1 2 1 2 2 0 53 91 424 357 739 397 1220 849
Renal stone 0 0 0 0 5 4 7 3 32 33 130 122 132 48 306 210
Retinal problem 0 0 0 0 0 0 0 3 6 8 52 31 89 56 147 98
Rheumatic fever 0 0 0 0 24 22 34 28 60 86 121 102 77 66 316 304
Rhinitis 0 0 2 2 0 2 33 42 122 52 91 72 49 26 297 196
Rickets 0 0 1 1 21 19 0 0 6 4 8 9 4 4 40 37
Road-traffic accident 0 1 31 31 144 169 649 465 1270 725 5865 1666 2854 868 10813 3925
Rupture uterus 0 0 1 4 5 5 4 2 0 95 0 90 0 4 10 200
Scabies 69 52 254 317 184 166 541 536 761 634 1326 1249 939 1350 4074 4304
Schizophrenia 90 70 12 10 1 1 0 1 10 10 115 94 76 83 304 269
Septicemia 255 183 183 53 16 12 10 4 33 36 330 280 158 140 985 708
Spinal cord injury 0 0 0 0 2 2 65 20 78 54 118 71 81 68 344 215
Suppurative otitis media 0 0 0 1 1 149 149 811 887 1029 1998 478 510 77 3545 2545
Syphilis 0 0 0 0 1 0 6 2 35 19 57 22 1 2 100 45
Tetanus 7 4 2 1 3 5 13 10 36 11 12 19 27 5 100 55
Thalassemia 0 0 12 9 69 45 133 241 72 90 116 174 127 170 529 729
Tonsillitis 0 0 0 34 33 63 57 572 717 632 798 191 119 56 1724 1548
Tuberculosis (Extra-
0 0 1 2 22 9 49 98 212 180 388 256 272 243 944 788
Pulmonary)
Tuberculosis
0 0 6 1 11 8 20 8 73 72 263 169 223 141 596 399
(Pulmonary)
Urethritis 0 0 0 0 0 0 0 1 6 16 61 40 34 37 101 94
Urinary stone disease 0 0 0 0 7 4 10 15 25 31 138 74 80 18 260 142
Urinary tract infection 0 0 0 1 12 30 64 71 194 214 374 517 344 335 988 1168
Valvular heart disease 0 0 6 3 15 11 9 10 117 116 386 288 385 335 918 763
Viral fever 0 0 12 16 60 44 107 56 195 126 270 203 204 30 848 475
Whooping cough 0 0 25 38 43 46 2 93 95 172 84 121 77 74 326 544
Worm infestation
0 0 2 3 315 164 282 144 188 139 140 245 97 173 1024 868
(Intestinal)
Others 3323 2543 1106 1240 2123 2910 2651 3932 7888 6719 9344 7957 8472 4431 34907 29732

5. 2. D. Age and sex distribution of the diseases/conditions among the admitted patients in National Institute of
Traumatology, Orthopaedics and Rehabilitation (NITOR)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50+y Total
Disease/condition
M F M F M F M F M F M F M F M F
Assault 0 0 0 0 1 0 23 1 222 15 479 32 80 9 805 57
Bone tumor 0 0 0 0 0 0 0 0 1 1 3 1 0 1 4 3
Burn (Others) 0 0 3 0 8 11 21 10 24 12 37 2 8 1 101 36
Disc prolapse 0 0 0 0 3 0 7 6 8 1 22 8 5 3 45 18
Fracture 1 0 0 1 19 11 126 60 136 43 337 139 163 116 782 370
Gangrene 0 0 0 0 0 0 4 1 13 1 30 9 28 2 75 13
Osteomyelitis 0 0 0 0 3 0 6 1 3 2 8 1 1 0 21 4
Osteosarcoma 0 0 0 0 0 0 6 1 5 0 5 0 1 0 17 1
Poliomyelitis 0 0 0 0 0 0 1 2 2 0 1 1 0 0 4 3
Rickets 0 0 0 0 0 0 0 0 1 0 2 0 0 0 3 0
Road-traffic accident 1 1 5 9 117 54 844 272 1417 326 2970 676 1098 340 6452 1678
Spinal cord injury 0 0 0 1 1 3 26 8 64 13 157 41 65 19 313 85
Tuberculosis (Extra-
0 0 0 0 0 0 10 0 13 7 38 12 19 8 80 27
pulmonary)
Other 2 4 33 34 356 244 1626 583 1692 472 2338 693 958 703 7005 2733

5. 2. E. Age and sex distribution of the diseases/conditions among the admitted patients in National Institute of
Disease of Chest and Hospital (NIDCH)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50+y Total
Disease/condition
M F M F M F M F M F M F M F M F
Tuberculosis
0 0 0 0 29 49 68 92 159 135 409 268 348 195 1013 739
(Pulmonary)
Bronchial asthma 0 0 0 0 31 40 51 139 310 250 211 201 218 106 821 736
Tuberculosis (Extra-
0 0 0 0 16 59 58 75 140 125 324 102 409 135 947 496
pulmonary)
COPD 0 0 0 0 0 0 0 0 150 139 286 180 350 205 786 524
Pleural effusion 0 0 0 0 0 0 75 79 78 68 82 83 85 88 320 318
Bronchiolitis 0 0 0 0 5 4 65 21 85 65 145 85 95 30 395 205
Bronchiectasis 0 0 0 0 0 0 0 0 41 32 141 102 140 128 322 262
Ca-Esophagus 0 0 0 0 0 0 0 0 15 17 98 89 142 182 255 288
Ca-Lungs 0 0 0 0 0 0 0 0 42 25 98 35 85 138 225 198
Pneumothorax 0 0 0 0 0 0 0 0 0 0 7 4 25 9 32 13
Pulmonary fibrosis 0 0 0 0 0 0 0 0 0 0 7 4 12 11 19 15

Health Bulletin 2011 |Page-234

 Annexure 5. 2: Age and sex distribution of the diseases/conditions among the admitted
patients in hospitals
5. 2. F. Age and sex distribution of the diseases/conditions among the admitted patients in National Institute of
Ophthalmology & Hospital (NIOH)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50+y Total
Disease/condition
M F M F M F M F M F M F M F M F
Cataract 2 5 6 5 22 14 52 50 122 122 122 295 1143 1300 1469 1791
Corneal ulcer 0 1 3 4 16 11 30 19 51 45 76 56 72 61 248 197
Glaucoma 8 4 4 4 10 11 55 20 37 28 60 60 48 55 222 182
Retinal problem 0 0 0 0 4 4 3 4 8 17 18 54 67 55 100 134
Others 54 55 75 73 232 195 379 372 407 454 507 743 910 984 2564 2876

5. 2. G. Age and sex distribution of the diseases/conditions among the admitted patients in BSMMU
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50+y Total
Disease/condition
M F M F M F M F M F M F M F M F
Abortion 0 0 0 0 0 0 0 0 0 0 0 36 0 0 0 36
AIDS/HIV 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 3
Allergic reaction 0 0 0 0 1 1 2 3 1 2 0 0 0 0 6 4
Anemia 0 0 20 30 5 0 8 10 15 20 2 4 1 3 51 67
Anal fistula 0 0 0 0 0 0 0 0 25 37 196 116 234 158 455 311
APH 0 0 0 0 0 0 0 0 0 0 0 53 0 4 0 57
Appendicitis 0 0 0 0 0 0 2 0 7 5 4 3 11 4 24 12
Arsenicosis 0 0 0 0 0 0 5 3 0 0 0 0 0 0 5 3
Arthritis 0 0 3 6 10 58 32 60 8 10 20 25 200 225 273 384
Assault 0 0 0 1 1 4 2 5 8 6 12 30 2 3 25 49
Bacillary dysentery 0 0 40 30 20 60 30 40 0 0 0 0 0 0 90 130
Bone tumor 0 0 0 0 0 1 10 13 8 10 12 8 10 10 40 42
Brain tumor 0 0 0 0 0 0 0 0 5 2 4 1 13 9 22 12
Bronchial asthma 0 0 0 0 1 0 0 0 0 0 0 26 0 0 1 26
Bronchiectasis 0 0 0 0 0 0 2 3 0 0 0 0 0 0 2 3
Bronchiolitis 0 0 0 0 0 0 2 3 0 0 0 0 0 0 2 3
Ca- Cervix 0 0 0 0 0 0 0 0 0 28 0 152 0 27 0 207
Ca-Bladder 0 0 0 0 0 0 0 0 13 3 15 6 34 12 62 21
Ca-Breast 0 0 0 0 0 0 0 0 0 29 0 40 0 24 0 93
Ca-Colon 0 0 0 0 0 0 0 0 15 9 13 11 14 8 42 28
Ca-Gall bladder 0 0 0 0 0 0 0 0 6 12 4 9 8 11 18 32
Ca-Kidney 0 0 0 0 3 4 2 1 0 0 7 3 27 13 39 21
Ca-Larynx 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1
Ca-Liver 0 0 1 1 3 0 0 1 0 0 0 0 0 0 4 2
Ca-Lungs 0 0 0 0 0 0 0 0 3 1 7 4 3 2 13 7
Ca-Esophagus 0 0 0 0 0 0 0 0 0 0 6 3 4 4 10 7
Ca-Pancreas 0 0 0 0 0 0 0 0 9 7 6 6 18 15 33 28
Ca-Prostate 0 0 0 0 0 0 0 0 0 0 37 0 58 0 95 0
Ca-Rectum and anal canal 0 0 0 0 0 0 1 0 15 13 20 16 24 19 60 48
Ca-Scrotum 0 0 0 0 0 0 0 0 0 0 15 5 18 0 33 5
Ca-Stomach 0 0 0 0 0 0 0 0 13 10 14 8 13 11 40 29
Cataract 0 0 0 0 0 0 3 3 2 2 0 0 0 0 5 5
Ca-Thyroid 0 0 0 0 0 0 0 0 0 0 13 6 13 9 26 15
Cholecystitis 0 0 0 0 0 0 5 2 8 18 10 14 8 20 31 54
Cholilithiasis 0 0 0 0 0 0 0 0 29 59 57 72 44 98 121 199
Congenital heart disease 12 12 16 18 38 29 48 44 49 60 54 133 32 36 249 332
COPD 0 0 0 0 0 0 1 1 35 15 95 68 585 108 716 192
CVA 0 0 0 0 0 0 0 0 13 6 69 43 199 98 281 147
Dengue 0 0 0 0 0 0 0 0 2 3 10 8 0 0 12 11
Diabetes mellitus 0 0 0 0 0 0 0 0 1 2 149 0 0 1 151
Diarrhea 0 0 0 0 4 6 0 0 0 0 0 0 0 0 4 6
Disc prolapse 0 0 0 0 0 0 0 0 2 1 40 52 24 15 66 68
Drug reaction 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 2
Dysentery 0 0 3 2 7 3 0 0 0 0 0 0 0 0 10 5
Ectopic pregnancy 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 5
Electric shock 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1
Emphysema 0 0 0 1 1 1 1 1 0 0 0 0 0 0 3 2
Enteric fever 0 0 4 6 10 5 5 5 0 0 0 1 0 0 19 16
Epilepsy 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 3
Fibroid 0 0 0 0 0 0 0 0 0 0 0 45 0 0 0 45
Filariasis 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 4
Food poisoning 0 0 1 0 1 0 0 0 0 0 0 0 0 0 2 0
Fracture 0 1 1 2 53 46 91 42 180 134 315 99 70 59 710 383
Fungal infections 0 0 0 0 0 0 3 2 6 4 0 0 0 0 9 6
Gangrene 0 0 0 0 0 0 0 0 2 1 2 3 1 0 5 4
Glaucoma 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1

Health Bulletin 2011 |Page-235

 Annexure 5. 2: Age and sex distribution of the diseases/conditions among the admitted
patients in hospitals
5. 2. G. Age and sex distribution of the diseases/conditions among the admitted patients in BSMMU (Continued...)
0-28d 29d-11m 1-4y 5-14y 15-24y 25-49y 50+y Total
Disease/condition
M F M F M F M F M F M F M F M F
Glomerulonephritis 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 3
Gonorrhea 0 0 2 3 0 0 0 0 0 0 0 0 0 0 2 3
Head injury 0 0 0 0 0 0 0 0 10 14 38 48 100 84 148 146
Heart failure 2 2 1 0 0 0 0 0 0 0 0 0 0 0 3 2
Hepatic failure 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2
Hepatitis 0 0 0 0 0 0 0 0 1 2 0 76 0 0 1 78
Hernia 0 0 0 0 2 0 0 0 0 0 0 0 0 0 2 0
Hydrocephalous 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 4
Hypertension 0 0 0 0 0 0 2 3 4 1 38 120 32 32 76 156
Hyperthyroidism 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2
Hypothyroidism 0 0 0 0 0 0 0 0 0 0 0 62 0 0 0 62
Infective endocarditis 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 2
Kala-azar 0 0 0 0 0 1 1 2 1 0 0 0 0 0 2 3
Leprosy 0 0 0 0 0 0 1 0 1 0 2 1 1 2 5 3
Leukemia 0 0 0 0 0 0 4 2 0 0 0 0 0 0 4 2
Liver abscess 0 0 0 0 0 0 0 0 2 2 16 4 13 9 31 15
Lymphoma 0 0 0 0 7 0 0 0 0 0 0 0 0 0 7 0
Malaria
0 0 0 0 1 1 5 3 0 0 0 0 0 0 6 4
(vivax/falciparum)
Measles 0 0 2 1 4 3 0 0 0 0 0 0 0 0 6 4
Meningitis 0 0 0 0 0 0 0 0 30 18 41 20 32 18 103 56
Mumps 0 0 0 0 0 0 7 5 0 0 0 0 0 0 7 5
Myocardial infarction 0 0 0 0 0 0 0 0 12 2 144 74 308 180 464 256
Nasal polyp 0 0 0 0 0 0 0 0 0 0 32 20 42 29 74 49
Nephrotic syndrome 0 0 0 0 0 0 0 0 1 2 0 0 0 0 1 2
Obstructed labor 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 2
Osteomyelitis 0 0 0 0 0 0 0 0 26 19 14 17 10 9 67 58
Osteosarcoma 0 0 0 0 0 0 0 0 1 2 3 4 0 0 7 10
Ovarian tumor 0 0 0 0 0 0 0 0 0 0 0 51 0 0 0 51
Pancreatitis 0 0 0 0 0 0 0 0 5 6 3 3 8 0 0 9
Pelvic infectious disease 0 0 0 0 0 0 0 0 0 0 0 112 0 0 0 112
Peptic ulcer 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1
Perforation (GI Tract) 0 0 0 0 0 0 0 0 2 0 2 2 0 0 0 2
Peripheral vascular disease 0 0 0 0 0 0 0 0 3 5 14 6 15 11 0 23
PPH 0 0 0 0 0 0 0 0 0 0 0 117 0 0 0 117
Prostatic tumor 0 0 0 0 0 0 0 0 50 0 15 0 0 0 65 0
Rectal prolapse 0 0 0 0 0 0 0 0 0 0 5 7 0 0 5 7
Renal failure 0 0 0 0 0 0 0 0 20 0 24 2 0 0 44 2
Retinal problem 0 0 0 0 0 0 0 0 60 0 62 12 0 0 122 12
Rheumatic fever 0 0 0 0 0 0 2 4 3 1 0 0 0 0 5 5
Rickets 0 0 1 2 8 12 16 14 6 8 0 0 0 0 31 36
Road-traffic accident 0 0 0 0 0 0 2 6 12 10 32 10 8 4 54 30
Schizophrenia 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 3
Spinal cord injury 0 0 0 0 0 0 0 0 13 10 20 7 22 9 55 26
Syphilis 0 0 0 0 0 0 0 0 0 0 3 0 0 0 3 0
Thalassemia 0 0 1 0 0 0 0 0 0 0 0 7 0 0 1 7
Tuberculosis (Extra-pulmonary) 0 0 0 1 6 7 8 12 26 18 42 29 50 29 132 96
Urethritis 0 0 0 0 3 0 0 12 0 0 0 0 0 0 3 12
Urinary stone disease 0 0 0 0 0 0 10 5 16 19 18 5 12 5 56 34
Urinary tract infection 0 0 0 0 0 0 0 0 35 10 37 25 22 12 94 47
Valvular heart disease 0 0 0 0 0 0 0 0 31 28 25 41 22 26 70 95
Others 0 0 0 0 0 0 6 4 105 52 115 130 65 75 291 261

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. A. Mortality profiles in upazila health complexes (n=390)

Age 0-28 day(s)
Boy Girl Both sexes
IMCI diseases 33.37 IMCI diseases 38.70 IMCI diseases 35.60
Perinatal asphyxia 30.01 Perinatal asphyxia 21.63 Perinatal asphyxia 26.50
Prematurity/low birthweight 5.66 Septicemia 4.80 Prematurity/Low birthweight 4.67
Septicemia 4.14 Prematurity/Low birthweight 3.30 Septicemia 4.42
Total deaths 460 Total deaths 332 Total deaths 792
Age 29 day - 11 months
Boy Girl Both sexes
IMCI diseases 66.00 IMCI diseases 71.76 IMCI diseases 69.00
Septicemia 1.89 Other infective conditions 1.49 Septicemia 1.55
Septicemia Meningitis/
Meningitis/Encephalitis 1.35 1.24 1.29
Encephalitis
Other infective conditions 1.08 Meningitis / Encephalitis 1.24 Other infective conditions 1.29
Perinatal asphyxia 0.54 Perinatal asphyxia 0.25 Perinatal asphyxia 0.39
Total deaths 371 Total deaths 404 Total deaths 775
Age 1- 4 year(s)
Boy Girl Both sexes
IMCI diseases 62.90 IMCI diseases 65.98 IMCI diseases 64.50
Meningitis/Encephalitis 2.71 Meningitis/Encephalitis 5.00 Meningitis/Encephalitis 3.90
Injury 2.26 Injury 1.67 Injury 1.95
Asthma 2.26 Congenital heart diseases 1.67 Asthma 1.74
Acute abdomen 1.81 Septicemia 1.67 Septicemia 1.52
Septicemia 1.36 Asthma 1.25 Congenital heart diseases 1.30
Congenital heart diseases 0.90 Acute abdomen 0.42 Acute abdomen 1.08
Total deaths 221 Total deaths 240 Total deaths 461
Age 5 -14 years
Boy Girl Both sexes
Meningitis/Encephalitis 18.42 Pneumonia and other RTIs 19.40 Pneumonia and other RTIs 18.88
Pneumonia and other RTIs 18.42 Meningitis/Encephalitis 14.93 Meningitis/Encephalitis 16.78
IMCI diseases 11.84 IMCI diseases 13.57 IMCI diseases 12.65
Diarrhea/Dysentery 3.95 Diarrhea/Dysentery 10.45 Diarrhea/Dysentery 6.99
Nutritional problems 3.95 Acute abdomen 5.97 Nutritional problems 4.90
Acute abdomen 2.63 Nutritional problems 5.97 Acute abdomen 4.20
Total deaths 76 Total deaths 67 Total deaths 143
Age 15 - 24 years
Male Female Both sexes
Pneumonia and other RTIs 12.70 Pregnancy-related problems 17.65 Other cardiovascular diseases 11.56
Other cardiovascular diseases 12.70 Other cardiovascular diseases 11.03 Nutritional problems 7.04
Asthma 7.94 Nutritional problems 6.62 Pneumonia and other RTIs 7.04
Injury 7.94 Injury 5.15 Injury 6.03
Nutritional problems 7.94 Meningitis/Encephalitis 5.15 Meningitis/Encephalitis 4.52
Meningitis/Encephalitis 3.17 Cerebro-vascular accident 4.41 Cerebro-vascular accident 3.52
Cerebro-vascular accident 1.59 Pneumonia & other RTI 4.41 Asthma 3.52
Total deaths 63 Total deaths 136 Total deaths 199

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. A. Mortality profiles in upazila health complexes (n=390) (Continued...)

Age 25 - 49 years
Male Female Both sexes
Other cardiovascular diseases 11.97 Pregnancy-related problems 11.56 Cerebro-vascular accident 9.74
Injury 11.47 Cerebro-vascular accident 11.34 Injury 7.72
Myocardial infarction 8.98 Asthma 9.07 Other cardiovascular diseases 7.24
Asthma 8.73 Nutritional problems 5.90 Myocardial infarction 5.82
Cerebro-vascular accident 7.98 Injury 4.31 Asthma 4.75
Malignant condition 4.49 Pneumonia and other RTIs 3.40 Nutritional problems 3.92
COPD 3.49 Other Cardio-vascular diseases 2.95 Pneumonia and other RTIs 2.97
Pneumonia and other RTIs 2.99 Myocardial infarction 2.95 COPD 2.73
Septicemia 2.49 Septicemia 2.27 Malignant condition 2.73
Hypertension 2.24 COPD 2.04 Septicemia 2.49
Total deaths 401 Total deaths 441 Total deaths 842
Age 50 years and above
Male Female Both sexes
Asthma 15.86 Cerebro-vascular accident 24.35 Cerebro-vascular accident 18.3
Cerebro-vascular accident 15.08 Other cardiovascular diseases 10.69 Asthma 13.9
Other cardiovascular diseases 11.05 Asthma 10.01 Other cardiovascular diseases 10.9
Myocardial infarction 8.729 Myocardial infarction 5.69 Myocardial infarction 7.69
COPD 8.492 Hypertension 5.12 COPD 6.71
Acute abdomen 3.207 COPD 3.30 Hypertension 3.51
Hypertension 2.672 Acute abdomen 3.19 Acute abdomen 3.2
Malignant condition 2.138 Malignant condition 1.25 Malignant condition 1.83
Pneumonia and other RTI 1.247 Nutritional problems 1.25 Nutritional problems 0.98
Diarrhea/Dysentery 0.95 Peptic ulcer diseases 1.14 Pneumonia and other RTIs 0.94
Total deaths 1,684 Total deaths 879 Total deaths 2,563
All ages
Male Female Both sex es
IMCI diseases 16.67 IMCI diseases 23.45 IMCI diseases 19.6
Asthma 9.83 Cerebro-vascular accident 10.92 Cerebro-vascular accident 9.73
Cerebro-vascular accident 8.82 Poisoning 9.24 Asthma 7.97
Poisoning 5.74 Asthma 5.52 Poisoning 7.26
Myocardial infarction 5.65 Perinatal asphyxia 4.44 Perinatal asphyxia 4.35
COPD 4.55 Pregnancy-related cause 3.16 Myocardial infarction 4.31
Perinatal Asphyxia 4.27 Injury 2.92 Injury 3.39
Injury 3.75 Myocardial infarction 2.56 COPD 3.31
Hypertension 1.95 Hypertension 2.4 Hypertension 2.15
Meningitis/Encephalitis 1.34 Septicemia 1.92 Meningitis/Encephalitis 1.54
Total deaths 3,276 Total deaths 2,499 Total deaths 5,775

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. B. Mortality profiles in district and general hospitals (n=62)

Age 0 - 28 day(s)
Boy Girl Both sexes
Perinatal asphyxia 60.47 Perinatal asphyxia 60.19 Perinatal asphyxia 60.35
IMCI diseases 11.46 IMCI diseases 10.37 IMCI diseases 11.00
Septicemia 13.34 Septicemia 12.69 Septicemia 13.06
Low birthweight 9.75 Low birthweight 10.37 Low birthweight 10.01
Meningitis/ Meningitis/ Meningitis/
2.32 2.55 2.54
Encephalitis Encephalitis Encephalitis
Total deaths 1,867 Total deaths 1,379 Total deaths 3,246
Age 29 day -11 months
Boy Girl Both sexes
IMCI diseases 49.41 IMCI diseases 33.80 IMCI diseases 41.59
Low birthweight 16.58 Low birthweight 14.06 Low birthweight 15.31
Septicemia 9.69 Perinatal asphyxia 13.95 Perinatal asphyxia 11.23
Perinatal asphyxia 8.50 Septicemia 10.19 Septicemia 9.94
Meningitis/Encephalitis 7.27 Meningitis/Encephalitis 7.62 Meningitis/Encephalitis 7.45
Total deaths 929 Total deaths 932 Total deaths 1,861
Age 1- 4 year(s)
Boy Girl Both sexes
Pneumonia 16.33 Pneumonia 15.87 Pneumonia 16.10
Meningitis/ Meningitis/ Meningitis/
10.51 10.08 10.30
Encephalitis Encephalitis Encephalitis
Other respiratory Other respiratory Other respiratory
9.76 9.18 9.49
tract infections tract infections tract infections
IMCI diseases 9.73 IMCI diseases 7.04 IMCI diseases 7.17
Septicemia 9.20 Septicemia 6.67 Injury 6.21
Injury 8.67 Injury 6.67 Septicemia 6.05
Poisoning 2.10 Poisoning 4.44 Poisoning 5.57
Nutritional Nutritional Nutritional
2.10 2.89 2.49
Problem/Anemia Problem/Anemia Problem/Anemia
Total deaths 565 Total deaths 563 Total deaths 1,128
Age 5 - 14 years
Boy Girl Both sexes
Injury Meningitis/ Meningitis/
8.72 9.65 8.87
Encephalitis Encephalitis
Meningitis/ Injury Injury
8.23 7.55 8.19
Encephalitis
Pneumonia 6.26 AGN 5.87 Pneumonia 5.97
Septicemia 5.13 Pneumonia 5.62 AGN 5.28
AGN 4.80 Septicemia 3.77 Septicemia 4.52
Other respiratory Poisoning Poisoning
4.21 3.77 3.95
tract infections
Poisoning Other respiratory Other respiratory
4.10 3.76 3.14
tract infections tract infections
Nutritional Nutritional Nutritional
2.82 3.07 2.93
Problem / Anemia Problem / Anemia Problem / Anemia
Total deaths 195 Total deaths 159 Total deaths 354

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. B. Mortality profiles in district and general hospitals (n=62) (Continued...)

Age 15 - 24 years
Male Female Both sexes
Myocardial infarction 22.00 Pregnancy-related causes 17.22 Injury 16.59
Injury 16.67 Injury 16.56 Myocardial infarction 12.61
Asthma 9.33 Asthma 9.27 Asthma 9.29
Meningitis/
COPD 6.67 Myocardial infarction 7.95 5.02
Encephalitis
Meningitis/
Septicemia 5.33 5.55 COPD 4.42
Encephalitis
Poisoning 4.00 Septicemia 3.31 Poisoning 4.42
Meningitis/
3.96 Poisoning 4.64 Septicemia 3.98
Encephalitis
Total deaths 150 Total deaths 301 Total deaths 451
Age 25 - 49 years
Male Female Both sexes
Myocardial infarction 27.46 Pregnancy-related causes 28.86 Myocardial infarction 18.56
Cerebro-vascular accident 19.25 Cerebro-vascular accident 14.50 Cerebro-vascular accident 16.77
Injury 11.94 Myocardial infarction 10.40 Injury 11.13
Asthma 11.19 Injury 10.40 Asthma 8.28
Nutritional Nutritional
COPD 10.90 8.03 7.52
Problem/Anemia Problem /Anemia
Poisoning 6.64 Poisoning 7.87 Poisoning 7.28
Nutritional Problem /
6.97 Asthma 5.61 COPD 6.64
Anemia
Other Other Other
1.89 1.64 1.76
Cardio vascular diseases* Cardio vascular diseases Cardio vascular diseases
Acute abdomen 1.02 COPD 2.74 Acute abdomen 1.01
Total deaths 670 Total deaths 731 Total deaths 1,401
Age 50 years and above
Male Female Both sexes
Cerebro-vascular accident 21.51 Cerebro-vascular accident 40.66 Cerebro-vascular accident 27.43
Myocardial infarction 9.90 Myocardial infarction 7.71 Myocardial infarction 9.22
Other Other
Injury 7.78 6.35 6.30
Cardio vascular diseases Cardio vascular diseases
Other Nutritional
6.27 4.42 Injury 6.14
Cardio vascular diseases Problem /Anemia
Nutritional
COPD 3.50 Asthma 3.94 3.63
Problem/Anemia
Nutritional
3.28 Poisoning 2.74 Asthma 3.25
Problem /Anemia
Asthma 2.93 COPD 2.51 COPD 3.19
Poisoning 2.25 Injury 2.46 Poisoning 2.40
Total deaths 3,919 Total deaths 1,751 Total deaths 5,670

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. B. Mortality profiles in district and general hospitals (n=62) (Continued...)

All ages
Male Female Both sexes
Perinatal asphyxia 14.56 Perinatal asphyxia 16.51 Perinatal asphyxia 15.36
Cerebro-vascular accident 11.72 Cerebro-vascular accident 14.06 Cerebro-vascular accident 10.90
IMCI diseases 8.78 IMCI diseases 8.51 IMCI diseases 8.67
Myocardial infarction 8.26 Septicemia 5.78 Myocardial infarction 6.38
Injury 5.62 Poisoning 5.57 Septicemia 5.42
Septicemia 5.17 Low birthweight 4.71 Injury 4.55
Low birthweight 4.05 Pregnancy related cause 4.52 Poisoning 4.50
Poisoning 3.75 Myocardial infarction 3.70 Low birthweight 4.41
COPD 2.77 Injury 3.03 Asthma 2.42
Asthma 2.63 Asthma 2.13 COPD 2.08
Total deaths 8,295 Total deaths 5,816 Total deaths 14,111
* Cardiovascular diseases except cerebro-vascular accident, myocardial infarction and hypertension

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. C. Mortality profiles in medical college hospitals (n=14)

Age 0 - 28 day(s)
Boy Girl Both sexes
Perinatal asphyxia 36.12 Perinatal asphyxia 40.75 Perinatal asphyxia 38.39
Low birthweight 26.14 Low birthweight 31.94 Low birthweight 28.99
Septicemia 8.35 Septicemia 6.75 Septicemia 7.56
IMCI diseases 2.94 IMCI diseases 1.74 IMCI diseases 2.35
Total patients 1,905 Total patients 1,838 Total patients 3,743
Age 29 day - 11 months
Boy Girl Both sexes
Perinatal asphyxia 39.98 Perinatal asphyxia 57.84 Perinatal asphyxia 48.18
IMCI diseases 19.38 IMCI diseases 15.15 IMCI diseases 17.44
Septicemia 16.94 Septicemia 14.09 Septicemia 15.63
Low birthweight 6.79 Low birthweight 4.59 Low birthweight 5.78
Meningitis/Encephalitis 2.90 Meningitis/Encephalitis 2.56 Meningitis/Encephalitis 2.74
Total deaths 1,104 Total 937 Total deaths 2,041
Age 1 - 4 year(s)
Boy Girl Both sexes
Septicemia 7.10 Septicemia 7.96 Septicemia 7.53
Meningitis/Encephalitis 6.83 IMCI diseases 8.35 IMCI diseases 7.49
IMCI diseases 6.83 Injury 7.53 Injury 6.99
Injury 6.57 Meningitis/Encephalitis 6.87 Meningitis/Encephalitis 6.85
Poisoning 3.41 Poisoning 3.11 Poisoning 3.28
Other cardiovascular Other cardiovascular Other cardiovascular
2.65 2.13 2.43
diseases* diseases* diseases*
Asthma 1.26 Asthma 1.15 Asthma 1.21
Total deaths 791 Total deaths 611 Total deaths 1,402
Age 5 -14 years
Boy Girl Both sexes
Injury 28.72 Injury 30.28 Injury 29.32
Pneumonia and other RTIs 11.82 Pneumonia and other RTIs 11.06 Pneumonia and other RTIs 11.49
Septicemia 11.14 Septicemia 12.01 Septicemia 11.56
Meningitis/Encephalitis 6.71 Meningitis/Encephalitis 7.51 Meningitis/Encephalitis 7.01
Poisoning 5.25 Poisoning 5.40 Poisoning 5.31
Other cardiovascular Other cardiovascular
3.79 IMCI diseases 4.93 3.51
diseases* diseases*
Other cardiovascular
IMCI diseases 2.33 3.05 IMCI diseases 3.33
diseases*
Asthma 1.17 Asthma 1.17 Asthma 1.17
Total deaths 686 Total deaths 426 Total deaths 1,112
Age 15 -24 years
Male Female Both sexes
Pneumonia and other RTIs 12.68 Pneumonia and other RTIs 11.92 Pneumonia and other RTIs 12.36
Meningitis/Encephalitis 12.11 Low birthweight 12.27 Meningitis/Encephalitis 11.67
Other cardiovascular Other cardiovascular
13.72 Meningitis/Encephalitis 11.18 11.17
diseases* diseases*
Myocardial infarction 9.15 Myocardial infarction 10.36 Myocardial infarction 9.67
Poisoning 8.59 Asthma 4.27 Poisoning 5.62
Other cardiovascular
COPD 4.57 4.00 Low birthweight 5.31
diseases*
Asthma 3.88 COPD 3.82 COPD 4.25
Cerebro-vascular accident
2.98 Poisoning 1.73 Asthma 4.05
/stroke
Cerebro-vascular accident/
Injury 1.73 Injury 1.36 2.04
stroke
Cerebro-vascular accident
Hypertension 0.55 0.82 Injury 1.57
/stroke
Total deaths 1,443 Total deaths 1,100 Total deaths 2,543

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. C. Mortality profiles in medical college hospitals (n=14) (Continued...)

Age 25 - 49 years
Male Female Both sexes
Cerebro-vascular accident Cerebro-vascular accident Cerebro-vascular accident /
/stroke 30.27 /stroke 31.05 stroke 30.56
Myocardial infarction 12.68 Poisoning 6.25 Myocardial infarction 8.58
Other cardiovascular Other cardiovascular Other cardiovascular
diseases* 7.30 diseases* 4.77 diseases* 6.37
Injury 7.27 Hypertension 4.28 Injury 5.97
Hypertension 4.57 Injury 3.74 Poisoning 4.90
COPD 4.20 Septicemia 3.69 Hypertension 4.46
Poisoning 4.11 Meningitis/Encephalitis 2.61 COPD 3.08
Septicemia 2.33 Myocardial infarction 1.57 Septicemia 2.83
Meningitis/Encephalitis 1.98 COPD 1.18 Meningitis/Encephalitis 2.21
Pneumonia & other RTI 1.92 Pneumonia and other RTIs 1.56 Pneumonia and other RTIs 1.77
Total deaths 3,479 Total deaths 2,032 Total deaths 5,511
Age 50 years and above
Male Female Both sexes
Cerebro vascular accident Cerebro vascular accident Cerebro vascular accident/
19.56 24.28 21.33
/stroke /stroke stroke
Other cardiovascular
Myocardial infarction 9.90 9.45 Myocardial infarction 9.58
diseases*
Other cardiovascular Other cardiovascular
8.34 Myocardial infarction 9.06 8.76
diseases* diseases*
Meningitis/Encephalitis 5.64 Meningitis/Encephalitis 6.26 Meningitis/Encephalitis 5.87
Hepatic Problem 5.41 Hepatic problem 5.43 Hepatic problem 5.42
COPD 3.87 Hypertension 3.73 Hypertension 3.26
Hypertension 2.97 Poisoning 2.14 COPD 2.94
Injury 2.15 Septicemia 1.97 Injury 1.86
Poisoning 1.41 COPD 1.41 Poisoning 1.69
Pneumonia and other RTIs 1.12 Injury 1.39 Septicemia 1.22
Total deaths 6,796 Total deaths 4,107 Total deaths 10,903

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. D. Mortality profiles in National Institute of Diseases of Chest & Hospital and other chest hospitals (n=6)
Age 29 day- 11 months
Boy Girl Both sexes
Cardio-respiratory failure 100 Cardio-respiratory failure 75.00 Cardio-respiratory failure 83.33
- - Tuberculosis 25.00 Tuberculosis 16.67
Total deaths 2 Total deaths 4 Total deaths 6
Age 1 year - 4 year(s)
Boy Girl Both sexes
Cardio-respiratory failure 75.00 Cardio-respiratory failure 100.00 Cardio-respiratory failure 83.33
Septicemia 25.00 - - Septicemia 16.67
Total deaths 4 Total deaths 2 Total deaths 6
Age 5 years -14 years
Boy Girl Both sexes
Cardio-respiratory failure 28.57 Cardio-respiratory failure 75.00 Cardio-respiratory failure 45.45
Others 28.57 Others 25.00 Others 27.27
Tuberculosis 14.29 Tuberculosis 0.00 Tuberculosis 9.09
Respiratory failure 14.29 Respiratory failure 0.00 Respiratory failure 9.09
Malignancy 14.29 Malignancy 0.00 Malignancy 9.09
Total deaths 7 Total deaths 4 Total deaths 11
Age 15 years- 24 years
Male Female Both sexes
Cardio-respiratory failure 74.36 Cardio-respiratory failure 78.95 Cardio-respiratory failure 74.58
Tuberculosis 12.82 Respiratory failure 10.53 Tuberculosis 11.86
Respiratory failure 12.82 Tuberculosis 5.26 Others 10.17
Cardiovascular diseases 0.00 Cardiovascular diseases 5.26 Cardiovascular diseases 1.69
Others 0.00 Others 5.26 Respiratory failure 1.69
Total deaths 19 Total deaths 20 Total deaths 59
Age 25 years - 49 years
Male Female Both sexes
Cardio-respiratory failure 77.40 Cardio-respiratory failure 77.78 Cardio-respiratory failure 77.49
Tuberculosis 10.73 Respiratory failure 7.41 Tuberculosis 8.66
Others 3.95 Asthma 3.70 Others 3.90
Cardio vascular diseases 2.26 Cardio vascular diseases 3.70 Respiratory failure 3.46
Respiratory failure 2.26 Others 3.70 Cardio vascular diseases 2.60
Malignancy 1.69 Malignancy 1.85 Malignancy 1.73
Asthma 0.56 Tuberculosis 1.85 Asthma 1.30
COPD 0.56 COPD 0.00 COPD 0.43
Pneumonia 0.56 Pneumonia 0.00 Pneumonia 0.43
Total deaths 177 Total deaths 54 Total deaths 231
Age 50 years and above
Male Female Both sexes
Cardio-respiratory failure 68.91 Cardio-respiratory failure 59.54 Cardio-respiratory failure 66.73
Others 10.44 Tuberculosis 6.11 Others 8.90
COPD 7.89 Others 3.82 COPD 6.05
Tuberculosis 5.57 Malignancy 3.05 Tuberculosis 5.69
Respiratory failure 4.41 Respiratory failure 2.29 Respiratory failure 3.91
Malignancy 3.48 Asthma 1.53 Malignancy 3.38
Cardiovascular diseases 1.39 Cardiovascular diseases 1.53 Cardiovascular diseases 1.42
Pneumonia 1.16 Pneumonia 1.53 Pneumonia 1.25
Asthma 0.93 COPD 0.00 Asthma 1.07
Lung abscess 0.93 Lung abscess 0.00 Lung abscess 0.71
Total deaths 431 Total deaths 131 Total deaths 562

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. E. Mortality profiles in infectious disease hospitals (n=3)

Age 0 -28 day(s)
Boy Girl Both sexes
Tetanus 100 Tetanus 100 Tetanus 100
Total deaths 10 Total deaths 7 Total deaths 17
Age 29 days- 11 months
Boy Girl Both sexes
Chicken pox 33.33 - - Chicken pox 33.33
Other 33.33 - - Other 33.33
Tetanus 33.33 - - Tetanus 33.33
Total deaths 3 Total deaths 0 Total deaths 3
Age 1- 4 years
Boy Girl Both sexes
Tetanus 50.00 - - Tetanus 50.00
Other 50.00 - - Other 50.00
Total deaths 2 Total deaths 0 Total deaths 2
Age 5-14 years
Boy Girl Both sexes
Tetanus 90.00 Diphtheria 50.00 Tetanus 83.33
Encephalitis 10.00 Tetanus 50.00 Diphtheria 8.33
- - - - Encephalitis 8.33
Total deaths 10 Total deaths 2 Total deaths 12
Age 15-24 years
Male Female Both sexes
Tetanus 50.00 Tetanus 67.67 Tetanus 57.14
Chicken pox 25.00 Others 33.33 Chicken pox 14.29
Rabies 25.00 - - Rabies 14.29
- - - - Others 14.29
Total deaths 4 Total deaths 3 Total deaths 7
Age 25- 49 years
Male Female Both sexes
Tetanus 78.13 Tetanus 60.00 Tetanus 75.68
Chicken pox 6.25 AIDS 20.00 AIDS 5.41
Herpes infection 6.25 Encephalitis 20.00 Chicken pox 5.41
AIDS 3.13 - - Herpes infection 5.41
Others 3.13 - - Encephalitis 2.70
Rabies 3.13 - - Others 2.70
- - - - Rabies 2.70
Total deaths 32 Total deaths 5 Total deaths 37

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. E. Mortality profiles in infectious disease hospitals (n=3) (Continued...)

Age 50 years and above
Male Female Both sexes
Tetanus 78.95 Tetanus 84.62 Diphtheria 80.39
Chicken pox 18.42 Chicken pox 15.38 Tetanus 17.65
Diphtheria 2.63 - - Chicken pox 1.96
Total deaths 38 Total deaths 13 Total deaths 51
All ages
Male Female Both sexes
Tetanus 78.79 Tetanus 80.00 Tetanus 79.07
Chicken pox 11.11 Chicken pox 6.67 Chicken pox 10.08
Diphtheria 1.01 Diphtheria 3.33 Diphtheria 1.55
Herpetic infection 2.02 Encephalitis 3.33 Herpetic infection 1.55
Encephalitis 1.01 HIV/AIDS 3.33 Encephalitis 1.55
Rabies 2.02 Others 3.33 Rabies 1.55
HIV/AIDS 1.01 - HIV/AIDS 1.55
Others 3.03 - - Others 3.10
Total deaths 99 Total deaths 30 Total deaths 129

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. F. Mortality profiles in National Institute of Cardiovascular Diseases and Hospital

Age 0 - 28 day(s)
Boy Girl Both sexes
Tetralogy of fallot 30.00 Atrial septal defect 50.00 Ventricular septal defect 33.33
Ventricular septal defect 30.00 Ventricular septal defect 50.00 Tetralogy of fallot 16.67
Valvular diseases 20.00 - - Valvular diseases 16.67
Other 20.00 - - Other 16.67
- - - - Atrial septal defect 8.33
Total deaths 10 Total deaths 2 Total deaths 12
Age 29 days- 11 months
Boy Girl Both sexes
Tetralogy of fallot 75.00 Tetralogy of fallot 45.45 Tetralogy of fallot 57.89
Ventricular septal defect 25.00 Left ventricular failure 18.18 Left ventricular failure 10.53
Tetanus 33.33 Other 18.18 Ventricular septal defect 10.53
- - Congestive cardiac failure 9.09 Other 10.53
- - Valvular diseases 9.09 Congestive cardiac failure 5.26
- - - - Valvular diseases 5.26
Total deaths 8 Total deaths 11 Total deaths 19
Age 1- 4 year(s)
Boy Girl Both sexes
Tetralogy of fallot 100 Tetralogy of fallot 87.50 Tetralogy of fallot 93.33
- - DCM 12.50 DCM 6.67
Total deaths 7 Total deaths 8 Total deaths 15
Age 5- 14 years
Boy Girl Both sex es
Tetralogy of fallot 87.5 Tetralogy of fallot 37.5 Tetralogy of fallot 62.5
Other 12.5 Congestive cardiac failure 12.5 Other 12.5
- - Left ventricular failure 12.5 Congestive cardiac failure 6.25
- - Rheumatic heart disease 12.5 Left ventricular failure 6.25
- - Ventricular septal defect 12.5 Rheumatic heart disease 6.25
- - Other 12.5 Ventricular septal defect 6.25
Total deaths 8 Total deaths 8 Total deaths 16
Age 15 -24 years
Male Female Both sexes
Tetralogy of fallot 19.23 Valvular diseases 40.74 Valvular diseases 28.30
Valvular diseases 15.38 DCM 14.81 Tetralogy of fallot 16.98
Other 15.38 Tetralogy of fallot 14.81 DCM 11.32
Rheumatic heart disease 11.54 Left ventricular failure 11.11 Left ventricular failure 9.43
DCM 7.69 Atrial septal defect 7.41 Other 9.43
Left ventricular failure 7.69 Acute myocardial infarction 3.70 Rheumatic heart disease 7.55
Unstable angina 7.69 Rheumatic heart disease 3.70 Atrial septal defect 5.66
Acute myocardial infarction 3.85 Other 3.70 Acute myocardial infarction 3.77
Atrial septal defect 3.85 - - Unstable angina 3.77
Congestive cardiac failure 3.85 - - Congestive cardiac failure 1.89
Non-ST elevation Non-ST elevation
3.85 - - 1.89
myocardial infarction myocardial infarction
Total deaths 26 Total deaths 27 Total deaths 53

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. F. Mortality profiles in National Institute of Cardiovascular Diseases and Hospital (Continued...)

Age 25 - 49 years
Male Female Both sexes
Acute myocardial infarction 30.33 Left ventricular failure 19.13 Acute myocardial infarction 23.62
Left ventricular failure 19.43 Valvular diseases 18.26 Left ventricular failure 19.33
Unstable angina 8.06 Rheumatic heart disease 17.39 Rheumatic heart disease 10.74
Rheumatic heart disease 7.11 Acute myocardial infarction 11.30 Valvular diseases 9.20
Other 5.21 Other 11.30 Other 7.36
Valvular diseases 4.27 Atrial septal defect 4.35 Unstable angina 6.44
Non-ST elevation Non-ST elevation
3.79 Unstable angina 3.48 3.07
myocardial infarction myocardial infarction
Old myocardial infarction 3.79 Congestive cardiac failure 2.61 Old myocardial infarction 2.76
Recurrent myocardial infarction 3.32 Tetralogy of fallot 2.61 Congestive cardiac failure 2.45
Non-ST elevation
DCM 2.84 1.74 Recurrent myocardial infarction 2.45
myocardial infarction
Congestive cardiac failure 2.37 Cerebro vascular accident 0.87 Atrial septal defect 2.15
Ischemic cardiomyopathy 2.37 DCM 0.87 DCM 2.15
Tetralogy of fallot 1.90 Ischemic-cardio myopathy 0.87 Tetralogy of fallot 2.15
Atrial septal defect 0.95 Old myocardial infarction 0.87 Ischemic cardiomyopathy 1.84
Ventricular septal defect 0.47 Recurrent myocardial infarction 0.87 Cerebro-vascular accident 0.31
- - - - Ventricular septal defect 0.31
Total deaths 211 Total deaths 115 Total deaths 326
Age 50+ years
Male Female Both sexes
Acute myocardial infarction 36.86 Acute myocardial infarction 27.62 Acute myocardial infarction 34.41
Left ventricular failure 24.21 Left ventricular failure 22.18 Left ventricular failure 23.67
Non-ST elevation Non-ST elevation Non-ST elevation
6.20 7.81 6.63
myocardial infarction myocardial infarction myocardial infarction
Other 4.34 Other 6.56 Other 4.93
Old myocardial infarction 3.63 Valvular diseases 5.30 Old myocardial infarction 3.41
Valvular diseases 2.52 Rheumatic heart disease 4.60 Valvular diseases 3.26
Ischemic cardiomyopathy 2.17 Old myocardial infarction 2.79 Ischemic cardiomyopathy 2.07
Ventricular septal defect 1.71 Ventricular septal defect 2.51 Rheumatic heart disease 2.04
Atrial septal defect 1.31 Atrial septal defect 2.23 Ventricular septal defect 1.93
Rheumatic heart disease 1.11 Ischemic cardiomyopathy 1.81 Atrial septal defect 1.56
Congestive cardiac failure 1.01 Congestive cardiac failure 1.39 Congestive cardiac failure 1.11
Cor-pulmonale 0.40 Cor-pulmonale 0.28 Cor-pulmonale 0.37
Total deaths 1,983 Total deaths 717 Total deaths 2,700

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. F. Mortality profiles in National Institute of Cardiovascular Diseases and Hospital (Continued...)

All ages
Male Female Both Sexes
Acute myocardial infarction 35.63 Acute myocardial infarction 24.20 Acute myocardial infarction 32.41
Left ventricular failure 23.55 Left ventricular failure 21.35 Left ventricular failure 22.93
Unstable angina 6.45 Valvular diseases 7.42 Unstable angina 6.46
Non ST-elevation myocardial Non ST-elevation myocardial Non ST-elevation myocardial
5.95 6.62 6.14
infarction infarction infarction
Old myocardial infarction 3.58 Unstable angina 6.51 Valvular diseases 4.18
Atrial/Ventricular septal defect 3.09 Rheumatic heart disease 6.28 Atrial/ Ventricular septal defect 3.63
Recurrent myocardial infarction 2.91 Atrial/ Ventricular septal defect 5.02 Old myocardial infarction 3.25
Valvular diseases 2.91 Tetralogy of fallot 2.51 Rheumatic heart disease 3.05
Ischemic cardiomyopathy 2.15 Old myocardial infarction 2.40 Recurrent myocardial infarction 2.60
Rheumatic heart disease 1.79 Dilated cardiomyopathy 2.28 Ischemic cardiomyopathy 1.99
Total deaths 99 Total deaths 30 Total deaths 129

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. G. Mortality profiles in National Institute of Cancer Research and Hospital

Age 5 -14 years
Boy Girl Both sexes
Non-Hodgkin lymphoma 50.00 Brain tumor 100 Brain tumor 33.33

Retinoblastoma 50.00 - - Non-Hodgkin lymphoma 33.33

- - - - Retinoblastoma 33.33
Total deaths 2 Total deaths 1 Total deaths 3
Age 15-24 years
Boy Girl Both sexes
Acute myeloid leukemia 40.00 Ewing’s sarcoma 33.33 Acute lymphatic leukemia 18.18
Acute lymphatic leukemia 20.00 Acute lymphatic leukemia 16.67 Acute myeloid leukemia 18.18
Ca-Lung 20.00 Ca-Kidney 16.67 Ewing’s sarcoma 18.18
Non-Hodgkin lymphoma 20.00 Soft-tissue sarcoma 16.67 Ca-Kidney 9.09
- - Other 16.67 Ca-Lung 9.09
- - - - Non Hodgkin lymphoma 9.09
Total deaths 5 Total deaths 6 Total deaths 11
Age 25 - 49 years
Male Female Both sexes
Ca-Lung 40.00 Ca-Breast 33.33 Ca-Breast 20.00
Adenocarcinoma 10.00 Choriocarcinoma 20.00 Ca-Lung 16.00
Acute myeloid leukemia 10.00 Ewing’s sarcoma 13.33 Choriocarcinoma 12.00

Ca-Rectum 10.00 Adenocarcinoma 6.67 Adenocarcinoma 8.00

Ca-Testes 10.00 Acute myeloid leukemia 6.67 Acute myeloid leukemia 8.00
Fibrosarcoma 10.00 ca-Colon 6.67 Ewing’s sarcoma 8.00
Non-Hodgkin lymphoma 10.00 Ca-Kidney 6.67 Non-Hodgkin lymphoma 8.00
- - Ca-Ovary 6.67 ca-Colon 4.00
- - Ca-Stomach 6.67 Ca-Kidney 4.00
- - Leiomyosarcoma 6.67 Ca-Ovary 4.00
- - Non-Hodgkin lymphoma 6.67 Ca-Rectum 4.00
- - Soft-tissue sarcoma 6.67 Ca-Stomach 4.00
- - Other 6.67 Ca-Testes 4.00
- - - - Fibrosarcoma 4.00
- - - - Leiomyosarcoma 4.00
- - - - Soft-tissue sarcoma 4.00
- - - - Other 4.00
Total deaths 10 Total deaths 15 Total deaths 25

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 Annexure 6: Mortality profiles of different types of public hospitals in Bangladesh

6. G. Mortality profiles in National Institute of Cancer Research and Hospital (Continued...)

Age 50+ years

Male Female Both sexes
Ca-Lung 55.56 Ca-Lung 22.22 Ca-Lung 48.89
Ca-Stomach 8.33 Adenocarcinoma 11.11 Ca-Stomach 8.89
Ca-Prostate 5.56 ca-Colon 11.11 Other 6.67
Other 5.56 Ca-Gall bladder 11.11 Adenocarcinoma 4.44
Adenocarcinoma 2.78 Ca-Stomach 11.11 Ca-Gall bladder 4.44
Acute myeloid leukemia 2.78 Ca-Tongue 11.11 Ca-prostate 4.44
Ca-Gall bladder 2.78 Squamous cell carcinoma 11.11 Squamous cell carcinoma 4.44
Ca-Pancreas 2.78 Other 11.11 Acute myeloid leukemia 2.22
Ca-Tonsil 2.78 Ventricular septal defect 2.51 ca-Colon 2.22
Fibrosarcoma 2.78 Atrial septal defect 2.23 Ca-Pancreas 2.22
Hepato-cellular carcinoma 2.78 Ischemic cardiomyopathy 1.81 Ca-Tongue 2.22
Non-Hodgkin lymphoma 2.78 Congestive cardiac failure 1.39 Ca-Tonsil 2.22
Squamous cell carcinoma 2.78 - - Fibrosarcoma 2.22
- - - - Hepato-cellular carcinoma 2.22
- - - - Non-Hodgkin lymphoma 2.22
Total deaths 36 Total deaths 9 Total deaths 45
All ages
Male Female Both sexes
Ca-Lung 44.44 Ca-Breast 16.13 Ca-Lung 30.59
Acute myeloid leukemia 7.41 Chorio-carcinoma 9.68 Acute myeloid leukemia 5.88
Non-Hodgkin lymphoma 5.56 Adenocarcinoma 6.45 Non-Hodgkin lymphoma 5.88
Ca-Stomach 5.56 Ca-Colon and Ca-Rectum 6.45 Ca-Stomach 5.88
Adenocarcinoma 3.70 Ca-Lung 6.45 Adenocarcinoma 4.71
Ca-Prostate 3.70 Non-Hodgkin lymphoma 6.45 Ca-Colon and Ca-Rectum 3.53
Ca-Gall bladder 3.70 Ca-Stomach 6.45 Acute lymphatic leukemia 2.35
Acute lymphatic leukemia 1.85 Acute lymphatic leukemia 3.23 Squamous cell carcinoma 2.35
Ca-Colon and Ca-Rectum 1.85 Acute myeloid leukemia 3.23 Ca-Gall bladder 2.35
Fibrosarcoma 1.85 Ca-Gall bladder 3.23 Fibrosarcoma 2.35
Total deaths 54 Total deaths 31 Total deaths 85

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