Non-communicable Diseases

Mental health is an integral part of health and well-being. Mental disorders constitute a major public health challenge and account for 13% of the global burden of disease measured as disability adjusted life years. In Bangladesh, data related to mental health service is scarce. A baseline study was conducted to explore the situation analysis of the service provision of mental health in the four selected districts of Bangladesh so that intervention can be designed according to the needs. The four districts considered were Sylhet, Jessore, Chapainawabgonj, and Bandarban for the baseline evaluation. Desk review, health facility checklist and qualitative interviews – these approaches were undertaken. As a whole, only the medical college hospital had an in-patient facility with beds for mental health patients. However, the other government facilities (district hospital, upazila health complexes) work as outpatient centers which are managed by consultants. At every level, there are some services available for the treatment of mental health. However, patients are not aware of the mental health problems as well as importance seeking specialist help in their need. The study made a recommendation to train the existing health workforce at all levels of government healthcare facilities regarding the primary management of psychiatric patients. Researchers also developed a monitoring and evaluation and framework for the further implementation research with WHO Bangladesh.

Globally, more than a billion people are affected by mental and substance use disorders, suicides, and neurological disorders, which results in an estimated one of the global burdens of disability (14% of the global death). In Bangladesh, the prevalence of mental health disorders is 13.6% among children (7-17 years), and 16.8% among adults, providing a high burden of the problem. Like many low and middle-income countries, the mental healthcare service provision in Bangladesh is inadequate because of the shortage of public mental health care facilities, healthcare providers, lack of funds allocation, and stigma. CIPRB conducted the first baseline survey on the situation analysis of mental health service provision in 04 selected district of Bangladesh. In continuation of previous phase, CIPRB is now conducting the extended phase in six more districts of Bangladesh ( Khulna, Jhenaidah, Sherpur, Netrokona, Kurigram, Noakhali).

Malnutrition among pregnant women and children less than two years old is a major public health concern in Bangladesh. In order to improve the maternal diet practice and to reduce under-nutrition among children less than two years old, the SHIKHA project has been designed and implemented in the Feed the Future zone of Bangladesh in 26 sub-districts of Barisal and Khulna Divisions. The project designed a multi-faceted program, consisting of home visits, health forums, social mobilization, and a mass-media campaign. The intervention consisted of interpersonal counseling delivered by trained community workers through home visits, social mobilization conducted during village meetings, women’s health forums, messages given by health workers during antenatal and postnatal sessions, and mass communication. The SHIKHA intervention achieved almost all its objectives for the dietary diversity of pregnant women (PW) and the practices for infant and young child feeding (IYCF). The lone exception was exclusive breast-feeding, which was already high at the baseline, most likely due to inclusion of predominantly breastfed women as exclusively breastfed. Overall this large-scale SBCC project helped to improve the dietary diversity of pregnant women and the IYCF practices among children under two-years old in rural southwest Bangladesh. The scale-up of such projects to cover wider areas should be considered for the future.

The study “Designing a comprehensive model for disability management within the existing health system of Bangladesh” was conducted during January-July 2019 by the Centre for Injury Prevention and Research, Bangladesh (CIPRB) and Disabled Rehabilitation and Research Association (DRRA), with the financial, technical and implementation assistance from the Directorate General of Health Services (DGHS) Bangladesh. This mixed method study (including both qualitative and quantitative components) in the Dhangora Union of Raiganj Upazila in Bangladesh is designed to develop a disability inclusive framework of health services within the existing health system of Bangladesh. About 99.47% of the respondents were without disability (had no, some or a lot of difficulties in any of the six domains) while 0.53% of the respondents had disability (could not function at all in any of the six domains). The qualitative results showed that most of the persons with disability did not seek treatment from the health facilities, and those who did usually went to district hospitals and specialized hospitals instead of the Upazilla Health Complex. All these findings were used to develop a framework for the management of disability within the existing health system of Bangladesh.