Rubana Islam | International Centre for Diarrhoeal Disease Research, Bangladesh (original) (raw)

Papers by Rubana Islam

Acute Health Problems Across all age and sex groups, the most common types of acute health proble... more Acute Health Problems
Across all age and sex groups, the most common types of acute health problems reported were of a
general/unspecified kind, such as fever and weakness, and respiratory symptoms. Women complained
more of neurological, musculoskeletal, and psychological health problems than men. Respiratory
symptoms were more of a problem in men than women. Other than the prevalent symptoms already
mentioned, children were reported to frequently suffer from skin and nutritional problems.
Three fourths of people suffering from acute health problems sought treatment; this included selftreatment/
home remedy. Rates of seeking care were nearly the same for both males and females.
However more women reported seeking care multiple times. Those not seeking treatment felt that the
health condition would resolve spontaneously.
By far care seeking from pharmacies was the most widespread, followed by government hospitals,
doctor’s chambers, and private clinics/hospitals. Public hospitals were frequented by men more than by
women whereas more women went to Doctor’s chambers and NGO clinics than men. In choosing a
health facility, proximity to their place of residence played the most important role. Other factors that
were considered in making decisions about where to seek care included whether or not the provider
was perceived to have special skills, gave effective treatment, or provided low cost services.
The average waiting time was the lowest, around 6 minutes, in pharmacies followed by NGO clinics. The
slowest service was reported in government hospitals where it typically takes 42 minutes on an average
to get services. More than half of the respondents said that they were fully satisfied with their
treatment and one-third of respondents were moderately satisfied. Overall, people who went to private
clinics were more inclined (80%) to go to the same facility in future. Seventy five percent of those who
visited a private doctor’s office (doctor’s chamber) said they would do so again.
Within SCC, a comparatively smaller city, the average time taken to reach a facility was less than 20
minutes and was mostly covered by foot or by rickshaw. Median cost for all subgroups was under 200
taka (USD 2.60), with most money spent on diagnostic tests (up to 600 taka) followed by
drugs/medicines and consultation fees. To pay for the costs of healthcare, most respondents spent their
household wages, suggesting high levels of out of pocket expenditures.
Chronic Health Problems
Shortness of breath or dyspnoea was the most frequently reported chronic health problem and was
more prominent in men, children and older age groups, although lower back pain was the most
prevalent complaint (13.5%) in the older group. Respondents had been experiencing these symptoms
for a mean duration of 41 months. On average, women were affected by chronic health problems 6
months longer than men, and also complained more about functional difficulty in daily activities from
viii
these conditions. In children, severe functional disability was quite rare, but 40% of all children up to 14
years experienced mild to moderate restriction in their daily activities.
People suffering from chronic health problems were more likely to seek treatment than those who were
suffering acute health problems. Almost 90% of respondents sought treatment at some point or other
and most of them went to a provider at least once a month.
Three out of five people sought treatment from qualified (MBBS) doctors and 26% visited a pharmacist
or a village doctor. The criteria on which their choice was based were effective treatment, low cost,
proximity to home, and qualified doctors in that order. Among those receiving treatment, lack of money
was frequently mentioned.
The mean monthly expenditure for chronic health problems was 445 taka (USD 6), and was the highest
among people aged 65 and above who paid up to 1200 taka. The median cost for healthcare during their
most recent visit to a healthcare provider was 400 taka, with older age groups spending somewhere
between 500 and 700 taka. Cost of drugs, tests and consultation fees added a considerable amount to
their expenses, with people aged 65 and above spending a median of 600 taka for drugs alone.
As for acute cases, costs for health care were made from regular household wages. However males
reported spending household wages more than females. Women reported paying for their treatment
with donations from neighbors more often than men.

This compendium of maps and information on the composition and distribution of health facilities ... more This compendium of maps and information on the
composition and distribution of health facilities in urban
Bangladesh has been prepared by the Urban Health Group of
the Centre for Equity & Health Systems, icddr,b. Led by Prof.
Alayne Adams, and supported by DFID, Bangladesh and GIZ.
The preparation of these maps and associated data involved
a multi-disciplinary team of public health researchers, GIS
experts, and computer programmers (see page 15 - 16). All
public, NGO, and privately owned and managed facilities,
inclusive of informal or non-medically trained providers,
displaying visible signage indicating their services, were
identified by the urban mapping field team. A total of 58
field worker surveyed over 19,000 facilities accross urban
Bangladesh between 2012 and 2015. GPS coordinates of each
facility were recorded and located on updated road networks,
and basic facility data gathered according to WHO’s guidance
on the creation of a Master Facility List1. These reported
data were solicited from person/persons deemed most
able or knowledgeable about the facility. Several visits were
sometimes necessary to access an appropriate respondent.
This report summarizes maps and facility information
gathered to produce the Urban Health Atlas2, an interactive
tool that has been developed to assemble, display and query
health facility data in a visual fashion. The purpose of this
report is to provide a quick reference and introduction to this
rich set of data useful to policy makers, health planners and
researchers. It includes summary data on the number, type,
location and distribution of health facilities in the major city
corporations of Dhaka (North and South), Khulna, Sylhet,
Rajshahi, and Narayanganj City Corporations. Mapping data
for Chittagong City Corporation will be published shortly as
an addendum.

IDS is a charitable company limited by guarantee and registered in England (No. 877338).

Innovation and Entrepreneurship in Health, 2015

Health policy and planning, 2015

In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by th... more In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by the urban poor. At the same time, affordable formal primary care services are scarce, and what exists is almost exclusively provided by non-government organizations (NGOs) working on a project basis. So where do the poor go for health care? A health facility mapping of six urban slum settlements in Dhaka was undertaken to explore the configuration of healthcare services proximate to where the poor reside. Three methods were employed: (1) Social mapping and listing of all Health Service Delivery Points (HSDPs); (2) Creation of a geospatial map including Global Positioning System (GPS) co-ordinates of all HSPDs in the six study areas and (3) Implementation of a facility survey of all HSDPs within six study areas. Descriptive statistics are used to examine the number, type and concentration of service provider types, as well as indicators of their accessibility in terms of location and hours ...

Background: The speed of urbanization and rapid growth of health markets in urban Bangladesh have... more Background: The speed of urbanization and rapid growth of health markets in urban Bangladesh have overwhelmed the capacity of government to regulate, plan or ensure quality or equity. Existing policy frameworks are ambiguous in defining responsibilities for urban health service provision between relevant ministries and government agencies. This study examines the configuration of urban health stakeholders around the provision of MNCH-FP among the urban poor. Method: Following document review and key informant interviews, a list of stakeholders was prepared, and stakeholder consultations through group and informal discussions were organized and conducted. Codes and data displays were created with the purpose of examining three levels of understanding: their specific roles and responsibilities vis-a -vis the health of the urban poor, their interrelations and power influence, and stakeholder engagement around addressing policy gaps. Results: Government, service providers, media and oth...

BMC Health Services Research, 2014

Background: The health system of Bangladesh is haunted by challenges of accessibility and afforda... more Background: The health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential.

Background: Availability of Emergency Obstetric Care (EmOC) is crucial to avert maternal death du... more Background: Availability of Emergency Obstetric Care (EmOC) is crucial to avert maternal death due to life-threatening complications potentially arising during delivery. Research on the determinants of utilization of EmOC has neglected urban settings, where traffic congestion can pose a significant barrier to the access of EmOC facilities, particularly for the urban poor due to costly and limited transportation options. This study investigates the impact of travel time to EmOC facilities on the utilization of facility-based delivery services among mothers living in urban poor settlements in Sylhet, Bangladesh. Methods: A cross-sectional EmOC health-seeking behavior survey from 39 poor urban clusters was geo-spatially linked to a comprehensive geo-referenced dataset of EmOC facility locations. Geo-spatial techniques and logistic regression were then applied to quantify the impact of travel time on place of delivery (EmOC facility or home), while controlling for confounding socio-cultural and economic factors.

Acute Health Problems Across all age and sex groups, the most common types of acute health proble... more Acute Health Problems
Across all age and sex groups, the most common types of acute health problems reported were of a
general/unspecified kind, such as fever and weakness, and respiratory symptoms. Women complained
more of neurological, musculoskeletal, and psychological health problems than men. Respiratory
symptoms were more of a problem in men than women. Other than the prevalent symptoms already
mentioned, children were reported to frequently suffer from skin and nutritional problems.
Three fourths of people suffering from acute health problems sought treatment; this included selftreatment/
home remedy. Rates of seeking care were nearly the same for both males and females.
However more women reported seeking care multiple times. Those not seeking treatment felt that the
health condition would resolve spontaneously.
By far care seeking from pharmacies was the most widespread, followed by government hospitals,
doctor’s chambers, and private clinics/hospitals. Public hospitals were frequented by men more than by
women whereas more women went to Doctor’s chambers and NGO clinics than men. In choosing a
health facility, proximity to their place of residence played the most important role. Other factors that
were considered in making decisions about where to seek care included whether or not the provider
was perceived to have special skills, gave effective treatment, or provided low cost services.
The average waiting time was the lowest, around 6 minutes, in pharmacies followed by NGO clinics. The
slowest service was reported in government hospitals where it typically takes 42 minutes on an average
to get services. More than half of the respondents said that they were fully satisfied with their
treatment and one-third of respondents were moderately satisfied. Overall, people who went to private
clinics were more inclined (80%) to go to the same facility in future. Seventy five percent of those who
visited a private doctor’s office (doctor’s chamber) said they would do so again.
Within SCC, a comparatively smaller city, the average time taken to reach a facility was less than 20
minutes and was mostly covered by foot or by rickshaw. Median cost for all subgroups was under 200
taka (USD 2.60), with most money spent on diagnostic tests (up to 600 taka) followed by
drugs/medicines and consultation fees. To pay for the costs of healthcare, most respondents spent their
household wages, suggesting high levels of out of pocket expenditures.
Chronic Health Problems
Shortness of breath or dyspnoea was the most frequently reported chronic health problem and was
more prominent in men, children and older age groups, although lower back pain was the most
prevalent complaint (13.5%) in the older group. Respondents had been experiencing these symptoms
for a mean duration of 41 months. On average, women were affected by chronic health problems 6
months longer than men, and also complained more about functional difficulty in daily activities from
viii
these conditions. In children, severe functional disability was quite rare, but 40% of all children up to 14
years experienced mild to moderate restriction in their daily activities.
People suffering from chronic health problems were more likely to seek treatment than those who were
suffering acute health problems. Almost 90% of respondents sought treatment at some point or other
and most of them went to a provider at least once a month.
Three out of five people sought treatment from qualified (MBBS) doctors and 26% visited a pharmacist
or a village doctor. The criteria on which their choice was based were effective treatment, low cost,
proximity to home, and qualified doctors in that order. Among those receiving treatment, lack of money
was frequently mentioned.
The mean monthly expenditure for chronic health problems was 445 taka (USD 6), and was the highest
among people aged 65 and above who paid up to 1200 taka. The median cost for healthcare during their
most recent visit to a healthcare provider was 400 taka, with older age groups spending somewhere
between 500 and 700 taka. Cost of drugs, tests and consultation fees added a considerable amount to
their expenses, with people aged 65 and above spending a median of 600 taka for drugs alone.
As for acute cases, costs for health care were made from regular household wages. However males
reported spending household wages more than females. Women reported paying for their treatment
with donations from neighbors more often than men.

This compendium of maps and information on the composition and distribution of health facilities ... more This compendium of maps and information on the
composition and distribution of health facilities in urban
Bangladesh has been prepared by the Urban Health Group of
the Centre for Equity & Health Systems, icddr,b. Led by Prof.
Alayne Adams, and supported by DFID, Bangladesh and GIZ.
The preparation of these maps and associated data involved
a multi-disciplinary team of public health researchers, GIS
experts, and computer programmers (see page 15 - 16). All
public, NGO, and privately owned and managed facilities,
inclusive of informal or non-medically trained providers,
displaying visible signage indicating their services, were
identified by the urban mapping field team. A total of 58
field worker surveyed over 19,000 facilities accross urban
Bangladesh between 2012 and 2015. GPS coordinates of each
facility were recorded and located on updated road networks,
and basic facility data gathered according to WHO’s guidance
on the creation of a Master Facility List1. These reported
data were solicited from person/persons deemed most
able or knowledgeable about the facility. Several visits were
sometimes necessary to access an appropriate respondent.
This report summarizes maps and facility information
gathered to produce the Urban Health Atlas2, an interactive
tool that has been developed to assemble, display and query
health facility data in a visual fashion. The purpose of this
report is to provide a quick reference and introduction to this
rich set of data useful to policy makers, health planners and
researchers. It includes summary data on the number, type,
location and distribution of health facilities in the major city
corporations of Dhaka (North and South), Khulna, Sylhet,
Rajshahi, and Narayanganj City Corporations. Mapping data
for Chittagong City Corporation will be published shortly as
an addendum.

IDS is a charitable company limited by guarantee and registered in England (No. 877338).

Innovation and Entrepreneurship in Health, 2015

Health policy and planning, 2015

In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by th... more In Bangladesh, the health risks of unplanned urbanization are disproportionately shouldered by the urban poor. At the same time, affordable formal primary care services are scarce, and what exists is almost exclusively provided by non-government organizations (NGOs) working on a project basis. So where do the poor go for health care? A health facility mapping of six urban slum settlements in Dhaka was undertaken to explore the configuration of healthcare services proximate to where the poor reside. Three methods were employed: (1) Social mapping and listing of all Health Service Delivery Points (HSDPs); (2) Creation of a geospatial map including Global Positioning System (GPS) co-ordinates of all HSPDs in the six study areas and (3) Implementation of a facility survey of all HSDPs within six study areas. Descriptive statistics are used to examine the number, type and concentration of service provider types, as well as indicators of their accessibility in terms of location and hours ...

Background: The speed of urbanization and rapid growth of health markets in urban Bangladesh have... more Background: The speed of urbanization and rapid growth of health markets in urban Bangladesh have overwhelmed the capacity of government to regulate, plan or ensure quality or equity. Existing policy frameworks are ambiguous in defining responsibilities for urban health service provision between relevant ministries and government agencies. This study examines the configuration of urban health stakeholders around the provision of MNCH-FP among the urban poor. Method: Following document review and key informant interviews, a list of stakeholders was prepared, and stakeholder consultations through group and informal discussions were organized and conducted. Codes and data displays were created with the purpose of examining three levels of understanding: their specific roles and responsibilities vis-a -vis the health of the urban poor, their interrelations and power influence, and stakeholder engagement around addressing policy gaps. Results: Government, service providers, media and oth...

BMC Health Services Research, 2014

Background: The health system of Bangladesh is haunted by challenges of accessibility and afforda... more Background: The health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential.

Background: Availability of Emergency Obstetric Care (EmOC) is crucial to avert maternal death du... more Background: Availability of Emergency Obstetric Care (EmOC) is crucial to avert maternal death due to life-threatening complications potentially arising during delivery. Research on the determinants of utilization of EmOC has neglected urban settings, where traffic congestion can pose a significant barrier to the access of EmOC facilities, particularly for the urban poor due to costly and limited transportation options. This study investigates the impact of travel time to EmOC facilities on the utilization of facility-based delivery services among mothers living in urban poor settlements in Sylhet, Bangladesh. Methods: A cross-sectional EmOC health-seeking behavior survey from 39 poor urban clusters was geo-spatially linked to a comprehensive geo-referenced dataset of EmOC facility locations. Geo-spatial techniques and logistic regression were then applied to quantify the impact of travel time on place of delivery (EmOC facility or home), while controlling for confounding socio-cultural and economic factors.