Journal Articles (2019)

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Author: search.filters.author.Ahmed, Syed Masud

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    Non-communicable disease (NCD) corners in public sector health facilities in Bangladesh: A qualitative study assessing challenges and opportunities for improving NCD services at the primary healthcare level
    (BMJ Journals, 10/7/2019) Rawal, Lal B; Kanda, Kie; Biswas, Tuhin; Tanim, Md. Imtiaz; Poudel, Prakash; Renzaho, Andre M N; Abdullah, Abu S; Shariful Islam, Sheikh Mohammed; Ahmed, Syed Masud
    Objective To explore healthcare providers’ perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services delivery at the primary healthcare level. Design We used a grounded theory approach involving in-depth qualitative interviews with healthcare providers. We also used a health facility observation checklist to assess the NCD corners’ service readiness. Furthermore, a stakeholder meeting with participants from the government, non-government organisations (NGOs), private sector, universities and news media was conducted. Setting Twelve subdistrict health facilities, locally known as upazila health complex (UHC), across four administrative divisions. Participants Participants for the in-depth qualitative interviews were health service providers, namely upazila health and family planning officers (n=4), resident medical officers (n=6), medical doctors (n=4) and civil surgeons (n=1). Participants for the stakeholder meeting were health policy makers, health programme managers, researchers, academicians, NGO workers, private health practitioners and news media reporters. Results Participants reported that diabetes, hypertension and chronic obstructive pulmonary disease were the major NCD-related problems. All participants acknowledged the governments’ initiative to establish the NCD corners to support NCD service delivery. Participants thought the NCD corners have contributed substantially to increase NCD awareness, deliver NCD care and provide referral services. However, participants identified challenges including lack of specific guidelines and standard operating procedures; lack of trained human resources; inadequate laboratory facilities, logistics and medications; and poor recording and reporting systems. Conclusion The initiative taken by the Government of Bangladesh to set up the NCD corners at the primary healthcare level is appreciative. However, the NCD corners are still at nascent stage to provide prevention and management services for common NCDs. These findings need to be taken into consideration while expanding the NCD corners in other UHCs throughout the country
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    ‘Connecting the dots’ for generating a momentum for Universal Health Coverage in Bangladesh: Findings from a cross-sectional descriptive study
    (BMJ Journals, 7/17/2019) Ahmed, Syed Masud; Rawal, Lal B; Naher, Nahitun; Hossain, Tarek
    Objective This study was conducted to explore how and whether, the strategic grants made by the Rockefeller Foundation (RF) in different sectors of health systems in the inception phase were able to ‘connect the dots’ for ‘generating a momentum for Universal Health Coverage (UHC)’ in the country. Design Cross-sectional descriptive study, using document review and qualitative methods. Setting Bangladesh, 17 UHC-related projects funded by the RF Transforming Health Systems (THS) initiative during 2010–2013. Data Available reports of the completed and on-going UHC projects, policy documents of the government relevant to UHC, key-informant interviews and feedback from grant recipients and relevant stakeholders in the policy and practice. Outcome measures Key policy initiatives undertaken for implementing UHC activities by the government post grants disbursement. Results The RF THS grants simultaneously targeted and connected the academia, the public and non-profit development sectors and news media for awarenessbuilding and advocacy on UHC, develop relevant policies and capacity for implementation including evidence generation. This strategy helped relevant stakeholders to come together to discuss and debate the core concepts, scopes and modalities of UHC in an attempt to reach a consensus. Additionally, experiences gained from implementation of the pilot projects helped in identifying possible entry points for initiating UHC activities in a low resource setting like Bangladesh. Conclusions During early years of UHC-related activities in Bangladesh, strategic investments of the RF THS initiative played a catalytic role in sensitising and mobilising different constituencies for concerted activities and undertaking necessary first steps. Learnings from this strategy may be of help to countries under similar conditions of ‘low resource, apparent commitment, but poor governance,’ on their journey towards UHC.
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    Perceptions of appropriate treatment among the informal allopathic providers: Insights from a qualitative study in two peri-urban areas in Bangladesh
    (BMC, 6/26/2019) Sizear, M. Monaemul Islam; Nababan, Herfina Y.; Bin Siddique, Md. Kaoser; Islam, Shariful; Paul, Sukanta; Paul, Anup Kumar; Ahmed, Syed Masud
    Background: How the informal providers deliver health services are not well understood in Bangladesh. However, their practices are often considered inappropriate and unsafe. This study attempted to fill-in this knowledge gap by exploring their perceptions about diagnosis and appropriate treatment, as well as identifying existing barriers to provide appropriate treatment. Methods: This exploratory study was conducted in two peri-urban areas of metropolitan Dhaka. Study participants were selected purposively, and an interview guideline was used to collect in-depth data from thirteen providers. Content analysis was applied through data immersion and themes identification, including coding and sub-coding, as well as data display matrix creation to draw conclusion. Results: The providers relied mainly on the history and presenting symptoms for diagnosis. Information and guidelines provided by the pharmaceutical representatives were important aids in their diagnosis and treatment decision making. Lack of training, diagnostic tools and medicine, along with consumer demands for certain medicine i.e. antibiotics, were cited as barriers to deliver appropriate care. Effective and supportive supervision, training, patient education, and availability of diagnostics and guidelines in Bangla were considered necessary in overcoming these barriers. Conclusion: Informal providers lack the knowledge and skills for delivering appropriate treatment and care. As they provide health services for substantial proportion of the population, it’s crucial that policy makers become cognizant of the fact and take measures to remedy them. This is even more urgent if government’s goal to reach universal health coverage by 2030 is to be achieved.
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    A new social sciences network for infectious threats
    (The Lancet, 2019-05) Giles-Vernick, Tamara; Kutalek, Ruth; Napier, David; Kaawa-Mafigiri, David; Dückers, Michel; Paget, John; Ahmed, Syed Masud; Cheah, Phaik Yeong; Desclaux, Alice; De Vries, Daniel; Hardon, Anita; MacGregor, Hayley; Pell, Christopher; Rashid, Sabina F; Rodyna, Roman; Schultsz, Constance; Sow, Khoudia; Wilkinson, Annie
    The Ebola epidemic in the Democratic Republic of the Congo (DRC) continues to escalate, new outbreaks of Lassa fever, yellow fever, measles, and other infectious diseases erupt around the world, and antimicrobial resistance intensifies from unmanaged use of these drugs. These infectious threats are intertwined with political and economic instability, changing ecological conditions, livestock management and food production practices, and local communities and their marginalised populations. The challenge in addressing these health security threats surpasses conventional response strategies. National governments and international agencies struggle to understand popular reactions to infectious disease emergence and outbreaks and to control deadly diseases.
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    Pathways of antibiotic use in Bangladesh: Qualitative protocol for the PAUSE study
    (BMJ Open, 1/25/2019) Rousham, Emily K; Islam, Mohammad Aminul; Nahar, Papreen; Lucas, Patricia Jane; Naher, Nahitun; Ahmed, Syed Masud; Nizame, Fosiul Alam; Unicomb, Leanne
    Introduction Global actions to reduce antimicrobial resistance (AMR) include optimising the use of antimicrobial medicines in human and animal health. In countries with weak healthcare regulation, this requires a greater understanding of the drivers of antibiotic use from the perspective of providers and consumers. In Bangladesh, there is limited research on household decision-making and healthcare seeking in relation to antibiotic use and consumption for humans and livestock. Knowledge is similarly lacking on factors influencing the supply and demand for antibiotics among qualified and unqualified healthcare providers. The aim of this study is to conduct integrated research on household decision-making for healthcare and antibiotic use, as well as the awareness, behaviours and priorities of healthcare providers and sellers of antibiotics to translate into policy development and implementation. Methods and analysis In-depth interviews will be conducted with (1) household members responsible for decision-making about illness and antibiotic use for family and livestock; (2) qualified and unqualified private and government healthcare providers in human and animal medicine and (3) stakeholders and policy-makers as key informants on the development and implementation of policy around AMR. Participant observation within retail drug shops will also be carried out. Qualitative methods will include a thematic framework analysis. A holistic approach to understanding who makes decisions on the sale and use of antibiotics, and what drives healthcare seeking in Bangladesh will enable identification of routes to behavioural change and the development of effective interventions to reduce the health risks of AMR. Ethics and dissemination Approval for the study has been obtained from the Institutional Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh following review by the Research and Ethics Committees (PR-16100) and from Loughborough University (R17-P081). Information about the study will be provided in a participant information letter in Bangla (to be read verbally and given in writing to participants). A written informed consent form in Bangla will be obtained and participants will be informed of their right to withdraw from the study. Dissemination will take place through a 1 day dissemination workshop with key stakeholders in public health and policy, practitioners and scientists in Bangladesh, and through international conference presentations and peer-review publications. Anonymised transcripts of interviews will be made available through open access via institutional data repositories after an embargo period. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made
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    Women’s preferences for maternal healthcare services in Bangladesh: Evidence from a discrete choice experiment.
    (MDPI, 1/23/2019) Mahumud, Rashidul Alam; Alamgir, Nadia Ishrat; Hossain, Md. Tarek; Baruwa, Elaine; Sultana, Marufa; Gow, Jeff; Alam, Khorshed; Ahmed, Syed Masud; Khan, Jahangir A.M.
    Despite substantial improvements in several maternal health indicators, childbearing and birthing remain a dangerous experience for many women in Bangladesh. This study assessed the relative importance of maternal healthcare service characteristics to Bangladeshi women when choosing a health facility to deliver their babies. The study used a mixed-methods approach. Qualitative methods (expert interviews, focus group discussions) were initially employed to identify and develop the characteristics which most influence a women’s decision making when selecting a maternal health service facility. A discrete choice experiment (DCE) was then constructed to elicit women’s preferences. Women were shown choice scenarios representing hypothetical health facilities with nine attributes outlined. The women were then asked to rank the attributes they considered most important in the delivery of their future babies. A Hierarchical Bayes method was used to measure mean utility parameters. A total of 601 women completed the DCE survey. The model demonstrated significant predictive strength for actual facility choice for maternal health services. The most important attributes were the following: consistent access to a female doctor, the availability of branded drugs, respectful provider attitudes, a continuum of maternal healthcare including the availability of a C-section delivery and lesser waiting times. Attended maternal healthcare utilisation rates are low despite the access to primary healthcare facilities. Further implementation of quality improvements in maternal healthcare facilities should be prioritised.
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    ‘Feminization’ of physician workforce in Bangladesh, underlying factors and implications for health system: Insights from a mixed-methods study.
    (PLOS ONE, 1/11/2019) Hossain, Puspita; Gupta, Rajat Das; YarZar, Phyoe; Jalloh, Mohamed Salieu; Tasnim, Nishat; Afrin, Ayesha; Naher, Nahitun; Hossain, Md. Tarek; Joarder, Taufique; Ahmed, Syed Masud
    Background Bangladesh is currently faced with an emerging scenario of increased number of female physicians in the health workforce which has health system implications. For a health system to attract and retain female physicians, information is needed regarding their motivation to choose medical profession, real-life challenges encountered in home and workplaces, propensity to choose a few particular specialties, and factors leading to drop-out from the system. This exploratory mixed-methods study attempted to fill-in this knowledge gap and help the policy makers in designing a gender-sensitive health system. Methods Three-hundred and fifteen final year female medical students from four purposively selected medical colleges of Dhaka city (two each from public and private colleges) were included in a quantitative survey using self-administered questionnaire. Besides, 31 in-depth interviews with female students, their parents, and in-service trainee physicians, and two focus group discussions with female students were conducted. Gender disaggregated data of physicians and admitted students were also collected. Data were analysed using Stata version 13 and thematic analysis method, as appropriate. Results During 2006–2015, the female physicians outnumbered their male peers (52% vs. 48%), which is also supported by student admission data during 2011–2016 from the sampled medical colleges, (67% in private compared to 52% in public). Majority of the female medical graduates specialized in Obstetrics and Gynaecology (96%). Social status (66%), respect for medical profession (91%), image of a ‘noble profession’ (91%), and prospects of helping common people (94%) were common motivating factors for them. Gender disparity in work, career and work environment especially in rural areas, and problems of work-home balance, were a few of the challenges mentioned which forced some of them to drop-out. Also, this scenario conditioned them to crowd into a few selected specialties, thereby constraining health system from delivering needed services. Conclusions Increasing number of female physicians in health workforce, outnumbering their male peers, is a fact of life for health system of Bangladesh. It’s high time that policy makers pay attention to this and take appropriate remedial measures so that women can pursue their career in an enabling environment and serve the needs and priorities of the health system.