Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators ...in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1-1.3) and 0.2% (0.0-0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps.
This article analyses overall NGO accountability and accountability to beneficiaries in particular. It is based on the collection of qualitative data from four NGOs in Bangladesh. The participation ...of beneficiaries has been disaggregated into three phases for more analytical discussion: decision-making, implementation, and evaluation. The study results reveal that the participation of beneficiaries is much higher in the project/program implementation phase. The condition is alarming for the decision-making and evaluation phase, where participation is more rhetoric and sham rituals than the actual exercise. The study also identified some formal and informal mechanisms of participation.
Maternal anemia affects approximately 56 million women worldwide and increases the risk of adverse pregnancy outcomes. Our study aimed to summarize the evidence for the association between maternal ...hemoglobin (Hb) concentrations and maternal or infant outcomes, evaluating it in a continuous manner. In this systematic review and meta‐analysis, we conducted an electronic search on PubMed, Embase, CINAHL, and Web of Science from inception to April 19, 2017, and further updated to November 21, 2018, applying subject heading terms related to pregnant women with anemia. We included 117 studies with 4,127,430 pregnancies. Maternal anemia increased the risk of low birth weight (odds ratio (OR), 1.65; 95% confidence interval (CI): 1.45−1.87), preterm birth (PTB) (OR, 2.11; 95% CI: 1.76–2.53), perinatal mortality (PNM) (OR, 3.01; 95% CI: 1.92−4.73), stillbirth (OR, 1.95; 95% CI: 1.15−3.31), and maternal mortality (OR, 3.20; 95% CI: 1.16−8.85). A nonlinear relationship was found between maternal Hb and adverse maternal and infant outcomes. The OR of outcomes such as PTB, small‐for‐gestational age, PNM, preeclampsia, gestational hypertension, and postpartum hemorrhage was increased by two to three times. Assessing Hb as a continuous variable is important to determine the associated risk of adverse outcomes with decreasing or increasing levels.
Maternal anemia affects approximately 56 million women worldwide and increases the risk of adverse pregnancy outcomes. Our study aimed to summarize the evidence for the association between maternal hemoglobin (Hb) concentrations and maternal or infant outcomes, evaluating it in a continuous manner.
•The effect of contamination on the microstructural characteristics is investigated.•The change in microstructural characteristics is highlighted via microscale tests.•The mechanical and ...microstructural properties present a good mutual correspondence.
Soil contamination not only can cause environmental problems but also lead to a notable change in the mechanical properties of soil. Loess widely distributed over North-West (NW) China is featured with the metastable structure, and chemical contaminants produced especially during the rapid development of NW China in recent years seriously threaten the fragile loess environments. When exposed to chemical contaminants, the impacts on the microstructural characteristics of the loess and the resultant mechanical properties are deemed critical for land reclamation in NW China. In light of this, the microscale structural characteristics of the loess exposed to acetic acid, phosphoric acid, sodium hydroxide, and sodium sulfate respectively are studied using scanning electron microscopy, X-ray diffraction, and energy dispersive spectroscopy tests. Additionally, their resultant macroscale mechanical properties are determined by direct shear tests. The deterioration mechanism regarding the microscale structural characteristics when exposed to the contaminants is revealed, and the resultant macroscale mechanical properties present a good correspondence with the deteriorated microscale structural characteristics. The findings of this work provide some guideposts for contaminated land reclamation in NW China.
Several kinds of acrylic-acid-grafted-starch (starch/AAc) hydrogels were prepared at room temperature (27°C) by applying 5, 10, 15, 20, and 25 kGy of gamma radiation to 15% AAc aqueous solutions ...containing 5, 7.5, and 15% of starch. With increment of the radiation dose, gel fraction became higher and attained the maximum (96.5%) at 15 kGy, above which the fraction got lowered. On the other hand, the gel fraction monotonically increased with the starch content. Swelling ratios were lower for the starch/AAc hydrogels prepared with higher gamma-ray doses and so with larger starch contents. Significant promotions of the swelling ratios were demonstrated by hydrolysis with NaOH: 13632±10% for 15 kGy radiation-dosed 5% starch/15% AAc hydrogel, while the maximum swelling ratio was ~200% for those without the treatment. The authors further investigated the availability of the starch/AAc hydrogel as an adsorbent recovering dye waste from the industrial effluents by adopting methylene blue as a model material; the hydrogels showed high dye-capturing coefficients which increase with the starch ratio. The optimum dye adsorption was found to be 576 mg per g of the hydrogel having 7.5 starch and 15% AAc composition. Two kinetic models, (i) pseudo-first-order and (ii) pseudo-second-order kinetic models, were applied to test the experimental data. The latter provided the best correlation of the experimental data compared to the pseudo-first-order model.
Rural electrification (RE) can be modelled as a multifactorial task connected to a large number of variables: decision makers need to choose the appropriate options by considering not only the ...techno-economic competitiveness but also socio-cultural dynamics and environmental consequences, making the task intricate. Many rural electrification projects have failed due to lack of attention to the issues beyond financial and technical dimensions. This paper presents a standardized approach for decision making concerning the extension of electricity services to rural areas. This approach first determines whether the supply provision should be grid expansion or off-grid on the basis of levelized cost of delivered electricity. If the grid expansion is found nonviable over off-grid options then a multicriteria decision aiding tool, SMAA-2 (Stochastic Multicriteria Acceptability Analysis), will evaluate off-grid technologies by aggregating 24 criteria values. While applying this approach, the delivered costs of electricity by the grid in remote areas within the 1–25km distances vary in a range of 0.10–7.85 US$/kWh depending on the line lengths and load conditions. In the off-grid evaluation, the solar PV (photovoltaic) and biogas plants are found as the most preferable alternatives with 59% and 41% acceptability in their first rank, respectively.
•Rural electrification involves a large number of socio-cultural issues in addition to technical and environmental considerations.•Decision makers need to choose the appropriate options by considering many criteria.•Many off-grid projects failed due to noncomplying of societal issues.•Multicriteria based decision choice can safeguard the projects from these issues.•SMAA analysis can select the alternatives based on merits.
Because of the rapid increase of non-communicable diseases (NCDs) and high burden of healthcare-related financial issues in Bangladesh, there is a concern that out-of-pocket (OOP) payments related to ...illnesses may become a major burden on household. It is crucial to understand what are the major illnesses responsible for high OPP at the household level to help policymakers prioritize key areas of actions to protect the household from 100% financial hardship for seeking health care as part of universal health coverage.
We first estimated the costs of illnesses among a population in urban Bangladesh, and then assessed the household financial burden associated with these illnesses.
A cross-sectional survey of 1593 randomly selected households was carried out in Bangladesh (urban area of Rajshahi city), in 2011. Catastrophic expenditure was estimated at 40% threshold of household capacity to pay. We employed the Bayesian two-stage hurdle model and Bayesian logistic regression model to estimate age-adjusted average cost and the incidence of household financial catastrophe for each illness, respectively.
Overall, approximately 45% of the population of Bangladesh had at least one episode of illness. The age-sex-adjusted average medical expenses and catastrophic health care expenditure among the households were TK 621 and 8%, respectively. Households spent the highest amount of money 7676.9 on paralysis followed by liver disease (TK 2695.4), injury (TK 2440.0), mental disease (TK 2258.0), and tumor (TK 2231.2). These diseases were also responsible for higher incidence of financial catastrophe. Our study showed that 24% of individuals who suffered typhoid incurred catastrophic expenditure followed by liver disease (12.3%), tumor (12.1%), heart disease (8.4%), injury (7.9%), mental disease (7.9%), cataract (7.1%), and paralysis (6.5%).
The study findings suggest that chronic illnesses were responsible for high costs and high catastrophic expenditures in Bangladesh. Effective risk pooling mechanism might reduce household financial burden related to illnesses. Chronic illness related to NCDs is the major cause of OOP. It is also important to consider prioritizing vulnerable population by subsidizing the high health care cost for some of the chronic illnesses.
This research aimed to examine the factors at both the individual and community levels that are linked to discrimination experienced by women aged 15-49 in Bangladesh.
The relevant data was taken ...from the 2019 Multiple Indicator Cluster Survey in Bangladesh. The risk factors for discrimination against women in Bangladesh were determined using multilevel logistic regression models.
The overall prevalence of discrimination against women was found to be 10.4% (95% CI: 10.1-10.6). Based on the final model (Model 1V), at the individual level higher odds of discrimination were observed among women from poor (AOR:1.21,95%CI: 1.12-1.32) and middle income households (AOR:1.12, 95%CI:1.02-1.22) compared to those from rich households etc. Women who have never used ICT were 1.27 times (AOR = 1.27, 95% CI = 1.07-1.51) higher odds of discrimination when compared with women who were ICT exposed. Respondents who married before 18 years 10% more likely to (AOR = 1.10, 95% CI:1.02-1.19) discriminated than women married aged 18 years old or above. Women from urban communities were 15% less likely to experience discrimination than their rural counterparts. In comparison to the Sylhet Division, women in the Barisal, Chattogram, Dhaka, Khulna Mymensingh, Rajshahi, and Rangpur Divisions were respectively 3.02, 1.84, 1.68, 2.06, 4.97, 4.06, and 1.74 times more likely to experience discrimination.
Findings revealed that various individual-level factors such as wealth index, CEB, ICT exposure, marital status, functional difficulty, age, women's happiness, magazine and radio exposure, age at marriage, current contraceptive use, polygamy, husband beating, place of attack, and household head age were found to have a significant association with women discrimination. Community-level factors such as residence and division were also found to have a notable impact on discrimination. Policymakers should incorporate substantial components targeting both individual and community levels into intervention programs with the goal of raising awareness about women's discrimination.
To estimate the prevalence of diabetes and prediabetes in Bangladesh using national survey data and to identify risk factors.
Sociodemographic and anthropometric data and data on blood pressure and ...blood glucose levels were obtained for 7541 adults aged 35 years or more from the biomarker sample of the 2011 Bangladesh Demographic and Health Survey (DHS), which was a nationally representative survey with a stratified, multistage, cluster sampling design. Risk factors for diabetes and prediabetes were identified using multilevel logistic regression models, with adjustment for clustering within households and communities.
The overall age-adjusted prevalence of diabetes and prediabetes was 9.7% and 22.4%, respectively. Among urban residents, the age-adjusted prevalence of diabetes was 15.2% compared with 8.3% among rural residents. In total, 56.0% of diabetics were not aware they had the condition and only 39.5% were receiving treatment regularly. The likelihood of diabetes in individuals aged 55 to 59 years was almost double that in those aged 35 to 39 years. Study participants from the richest households were more likely to have diabetes than those from the poorest. In addition, the likelihood of diabetes was also significantly associated with educational level, body weight and the presence of hypertension. The prevalence of diabetes varied significantly with region of residence.
Almost one in ten adults in Bangladesh was found to have diabetes, which has recently become a major public health issue. Urgent action is needed to counter the rise in diabetes through better detection, awareness, prevention and treatment.
Oropouche virus (OROV) is an emerging pathogen which causes Oropouche fever and meningitis in humans. Several outbreaks of OROV in South America, especially in Brazil, have changed its status as an ...emerging disease, but no vaccine or specific drug target is available yet. Our approach was to identify the epitope-based vaccine candidates as well as the ligand-binding pockets through the use of immunoinformatics. In this report, we identified both T-cell and B-cell epitopes of the most antigenic OROV polyprotein with the potential to induce both humoral and cell-mediated immunity. Eighteen highly antigenic and immunogenic CD8+ T-cell epitopes were identified, including three 100% conserved epitopes (TSSWGCEEY, CSMCGLIHY, and LAIDTGCLY) as the potential vaccine candidates. The selected epitopes showed 95.77% coverage for the mixed Brazilian population. The docking simulation ensured the binding interaction with high affinity. A total of five highly conserved and nontoxic linear B-cell epitopes “NQKIDLSQL,” “HPLSTSQIGDRC,” “SHCNLEFTAITADKIMSL,” “PEKIPAKEGWLTFSKEHTSSW,” and “HHYKPTKNLPHVVPRYH” were selected as potential vaccine candidates. The predicted eight conformational B-cell epitopes represent the accessibility for the entered virus. In the posttherapeutic strategy, ten ligand-binding pockets were identified for effective inhibitor design against emerging OROV infection. Collectively, this research provides novel candidates for epitope-based peptide vaccine design against OROV.
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