Thesis/ Project Report, Master of Public Health (James P. Grant School of Public Health)

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    Exploring the experiences of community health workers during covid-19 pandemic in urban slums of Dhaka city
    (BRAC University, 2021) Nyara, Baba James; Rashid, Sabina Faiz; Aktar, Bachera
    Introduction: Community Health Workers (CHWs) are largely female who are employed by different private and public organizations with an aim to bridge the gap between formal healthcare and community, primarily working in rural and urban settings in Bangladesh. However the COVID-19 pandemic has posed unique challenges in urban slums of Dhaka because dwellers live in overcrowded spaces, lack access to WASH facilities and experience poverty which undermine COVID-19 prevention measures. In this context, CHWs play vital roles such as awareness, relief distribution and contact tracing to combat the spread of COVID-19. This study explored their experiences during the shutdown for service delivery organizations to recognize them as essential workforce. Method: The study drawn from 19 qualitative data transcripts from a larger research conducted by James P. Grant School of Public health at BRAC University which explored experiences of urban slums dwellers including CHWs during the COVID-19 shutdown in urban slums of Dhaka. Data was collected on phone from participants and coded inductively after organizing and categorizing according to themes and later placed on data matrix for easy visualization, analysis and interpretation. Findings: CHWs play key role in fighting COVID-19 in urban slums by linking the community and formal health care but they face challenges that include, disrupted personal and social lives, non-recognition and mistrust, increased workload, community expectations, poor remuneration and mental and emotional distress. Conclusion: The current COVID-19 situation has resulted to unprecedented challenges that affect the health and wellbeing of CHWs in urban slums in Dhaka, therefore government and service delivery organizations are urged to recognize CHWs as essential health workforce and implement feasible measures such as work shifts and leaves, improved remuneration, counseling support and regular training to enhance their performance. It is important to conduct additional exploratory research in other slums to generate more evidence.
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    Barriers and facilitators in implementing human papillomavirus vaccination for adolescent girls: qualitative insights from healthcare implementers in the Korail slum, Dhaka, Bangladesh
    (BRAC University, 2025) Powjithan, Natkunarajah; Anwar, Humayra Binte; Barua, Mrittika
    Introduction: Cervical cancer remains as a significant global health issue, ranking fourth among cancers among women. Low- and middle-income countries (LMICs) account for over 90% of related deaths due to limited access to prevention and treatment. The Human Papilloma (Virus) vaccine offers up to 97% protection against cervical cancer when given to women during adolescence, yet the uptake remains alarmingly low in disadvantaged communities. This study explores the qualitative insights from the implementors to identify the barriers and facilitators to HPV vaccination in the urban Korail slum in Dhaka, Bangladesh. Method: A qualitative exploratory design was employed, involving Key Informant Interviews (KIIs) with nine healthcare implementers, including vaccinators, school principals, and field-level supervisors. Data were analyzed using thematic analysis framed by the Consolidated Framework for Implementation Research (CFIR), highlighting contextual and systemic challenges in the Korail slum setting. Findings: The study identified significant facilitators, including high awareness among healthcare workers involved in HPV vaccination, parents and school teachers about cervical cancer prevention, free vaccine provision, and trust in schools as vaccination sites. Training programs boosted implementers' confidence, while stakeholder engagement involving local leaders, parents, and school teachers enhanced vaccine uptake. However, barriers such as misinformation among community members, the sociocultural stigma among adolescent girls and their parents, logistical constraints, and financial challenges faced by the healthcare workers impeded widespread coverage. Logistical hurdles, including the lack of male assistants and transportation support for healthcare workers, added operational inefficiencies. Conclusion: The study highlights the need to address sociocultural barriers through tailored, community-driven strategies. Enhancing implementers' capacity, combating misinformation with culturally sensitive campaigns, and ensuring sustained logistical support are pivotal to improving vaccine uptake. These insights contribute to refining HPV vaccination programs in resource-constrained settings, aligning with global goals to reduce cervical cancer-related morbidity and mortality. Future interventions should focus on sustainable models and scaling successful practices to similar LMIC contexts.
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    Challenges to dengue treatment access and delivery at Savar Upazila Health Complex, Dhaka, Bangladesh: a concurrent mixed-methods study
    (BRAC University, 2025) Ahmadzai, Mahaz Rahman; Hasan, Md Tanvir; Ashrafi, Shah Ali Akbar
    Introduction: Dengue remains a critical public health challenge in Bangladesh, particularly during peak seasons when healthcare facilities encounter high demand. A concurrent mixedmethods research examines the challenges that patients face in accessing treatment and healthcare providers experience in delivering care at the Savar Upazila Health Complex in Dhaka, Bangladesh. Method: Quantitative data on satisfaction with services were gathered from 167 dengue patients, through semi-structured surveys, while qualitative data were obtained from 8 key informant interviews with healthcare providers. Findings: Quantitative findings indicated that 64.07% of dengue patients received adequate details about diagnostic tests, and 77.25% of dengue patients perceived the facility as wellequipped. However, only 34.73% of patients expressed satisfaction with the healthcare services they received. Additionally, 55.09% of patients reported long waiting times, 57.49% rushed consultations, and 61.08% difficulties making appointments as important service delivery challenges that need to be addressed. More than half (52.10%) of patients shared financial issue as an important barrier to accessing treatment on time. Qualitative findings revealed critical shortages of resources, including beds, medical supplies, and diagnostic tools, particularly during peak dengue seasons as important challenges for the efficient delivery of services. The healthcare providers highlighted operational inefficiencies, overcrowded wards, and limited post-hours diagnostic services as key challenges. Conclusion: The results of this study demonstrate significant gaps in service delivery that influence patient satisfaction and effective care. These challenges include inadequate infrastructure, insufficient medical supplies, long waiting times, and rushed. Recommended interventions include expanding facility capacity to serve more patients, increasing healthcare staff, and ensuring consistent availability of diagnostic tools and other medical supplies. Engaging the community through focused awareness campaigns is also crucial to enhancing treatment-seeking and disease-prevention practices.
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    Healthcare seeking behaviors and control of clinical parameters among people with diabetes and hypertension comorbidity in Chirirbandar, Dinajpur, Bangladesh: a cross-sectional study
    (BRAC University, 2025) Shuvo, Md Mashuk Shahriar; Mridha, Malay Kanti; Latif, Mahbub A.H.M
    Introduction: The global burden of non-communicable diseases (NCDs), including diabetes and hypertension comorbidities, disproportionately affects low and middle-income countries (LMICs). This study investigates healthcare seeking behaviors and the control of clinical parameters among adults living with diabetes and hypertension comorbidity in Chirirbandar, Dinajpur, Bangladesh. Method: A cross-sectional study was conducted from November 20 to December 10, 2024, targeting adults aged 18 and above with diagnosed diabetes and hypertension co-morbidity. Data were collected from 387 participants using semi-structured questionnaires and clinical measurements, following the national and World Health Organization guidelines. Descriptive and multivariable logistic regression were performed to report prevalence and identify associated factors. Findings: The majority of the study participants were female. Approximately 60% of participants exhibited uncontrolled diabetes, while 89% showed uncontrolled hypertension. Healthcare seeking behaviors revealed a reliance on private dispensaries and rural practitioners, with limited adherence to recommended follow-ups and medication. Older age and retired individuals were associated with better blood sugar control. Behavioral risk factors, including sedentary behavior, and high BMI, were associated with poor hypertension control. Surprisingly, physical inactivity was associated with better hypertension control and increased fruits and vegetables intake correlated with worse diabetes control, warranting further investigation. Conclusion: The findings highlight significant gaps in the management of diabetes and hypertension comorbidity in rural Bangladesh. Strengthening healthcare infrastructure, promoting self-care practices, and targeted public health interventions are critical for improving blood pressure and blood sugar control among people with hypertension and diabetes co-morbidity.
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    Factors associated with depression and generalized anxiety disorder among adults living with diabetes and hypertension comorbidity in Chirirbandar, Bangladesh: a cross-sectional study
    (BRAC University, 2025) Chakravartty, Meghna; Mridha, Malay Kanti; Latif, Mahbub A.H.M
    Introduction: Coexistence of non-communicable diseases like diabetes and hypertension increases the risk of common mental health conditions such as depression and generalized anxiety disorder (GAD). Mental health is underexplored in general population of Bangladesh let alone among population with diabetes and hypertension comorbidity. This study aims to assess the prevalence of depression and GAD and explore the associated factors among adults with diabetes and hypertension comorbidity in Chirirbandar, Bangladesh. Method: A cross-sectional study was conducted from November 21, 2024 to December 10, 2024 in Chirirbandar, Dinajpur. Data from 387 adults diagnosed with both diabetes and hypertension were included in the final analysis. Data were collected using a pre-tested structured questionnaire, incorporating GAD-7 and PHQ-9 scales to screen GAD and depression respectively. Multivariable logistic regression was used to explore the factors associated with GAD and depression. Results: The prevalence of depression was 17.83%. Factors singnificantly associated with depression included marital status and wealth index. Higher odds of depression among participants with controlled hypertension (aOR =3.65, 95%CI: 1.70-7.81, p=0.001) was observed. The prevalence of GAD was 7.24%. Education level, sedentary time spent per day, and kitchen location were found to be associated with GAD. Behavioral factors, such as tobacco use, fruits and vegetable intake, physical activity were not significantly associated with either condition. Conclusion: A high prevalence of depression and GAD were observed among the adults with diabetes and hypertension comorbidity. The findings from the study emphasize the need to integrate mental health services into the existing non-communicable disease care, with particular attention to socio-demographic, behavioural and environmental factors. Further research is required to establish prospective associations in people with hypertension and diabetes comorbidity and develop targeted interventions in Bangladesh.
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    Healthcare worker perceived barriers and facilitators to implementing a tuberculosis preventive treatment (TPT) program in Dhaka BRAC TB centers
    (BRAC University, 2025) Niki, Atqiya Faizah; Rahman, Ataur; Rahman, Atiya; Ireen, Santhia; Islam, Shayla
    Introduction: Tuberculosis preventive Treatment (TPT) is a crucial step that will prevent the further development of latent tuberculosis infection (LTBI) into active tuberculosis. Yet, it faces numerous constraints when implemented in resource-limited urban environments, e.g., Dhaka, Bangladesh. This research analyzes the barriers and facilitators of TPT uptake at BRAC urban TB centers and provides direction for enhancing program delivery. Methods: Using an explanatory sequential mixed-methods design, qualitative and quantitative data were collected. In the above procedures, interviews with 17 healthcare providers were also conducted, and 41 Field Organizers (FOs) were polled through a survey. The qualitative data were coded thematically, and quantitative data were summarized using descriptive statistics. The Consolidated Framework for Implementation Research (CFIR) was applied to describe the study's outcome. Results: Barriers included resource constraints, such as drug shortages, funding gaps, and insufficient human resources. Logistical difficulties, stigmatization, lack of patient information, and inefficiencies in data capture also hampered the provision of TPT. Patient adherence was influenced by beliefs, pill size, side effects, and competing demands, including daily earnings. Factors included a willingness to use BRAC health care providers, adaptable TPT guidelines (e.g., 3HP regimen), suitable staffing, and working in partnership with the National Tuberculosis Program (NTP). Community support and engagement also emerged as critical enablers. Conclusion: Results underscore the need to take action on funding, staffing, and supply chains to enhance TPT delivery. Improvements to community education, private-sector collaboration, and streamlined documentation and monitoring practices can improve adherence and coverage. These recommendations offer a pathway to enhance TPT programs in settings with limited resources and help set targets to achieve the ambitious goal of TB elimination globally.
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    Air quality and respiratory health: prevalence, knowledge, and practices in Dhaka’s informal settlements - a cross-sectional study
    (BRAC University, 2025) Akter, Rabeya; Quayyum, Zahidul; Saha, Priom
    Background: Several studies suggest that air pollution causes morbidity and mortality, this problem is particularly severe in developing countries. However, little is known about the prevalence of respiratory symptoms among adults in informal settlements with varying air pollution and their practice and knowledge status regarding air pollution and its impact on health. The objective of this study is to explore the prevalence of respiratory symptoms in two informal settlements in Dhaka and the knowledge and practice status of the adult residents. Methods: The study design was cross-sectional and was conducted in Shyampur and Dakshinkhan areas. These study sites were selected based on air quality data collected from a study conducted in BRAC JPGSPH in 2023. Shyampur was selected for having comparatively high air pollution, whereas Dakshinkhan was chosen for having comparatively low air pollution. A total of 316 adult residents were interviewed. This study used multiple sequential logistic regression models to examine the relationship between respiratory symptoms, sociodemographic, and environmental factors, and knowledge and practice status. Results: The proportion of people having respiratory symptoms in Shyampur and Dashinkhan areas were 60.26% and 55.41% respectively. Knowledge status varied in the two areas, while the practice status was almost equal in Shyampur and Dakshinkhan. Results of the sequential multiple logistic regression revealed that the participants in Dakshinkhan had lower odds of having respiratory symptoms (OR= 0.61; 95% CI: 0.36-1.01) compared to Shyampur area. The odds of suffering from respiratory symptoms were significantly associated with individuals who are aged 50 years and above ( OR= 2.31; 95% CI: 1.07-4.98); those who were aged 30-39 years old (OR= 2.05; 95% CI: 1.11-3.82); exposure to indoor smoking (OR= 1.53; 95% CI:0.93-2.50), higher income level ( OR=1.91; 95% CI:1.04-3.49), knowledge status (Good level) ( OR= 2.07; 95% CI: 1.06-4.05), knowledge status (moderate level) ( OR = 2.07, 95% CI: 1.06-4.05). In stratified logistic regression analysis age, income, and exposure to smoking indoors showed a significant association, while in Dakshinkhan resident’s knowledge status was significantly associated with respiratory symptoms. Conclusion: The impact on respiratory symptoms is higher in areas with comparatively high pollution than in areas with comparatively low pollution. Along with socio-demographic and environmental factors, housing conditions, and participant’s knowledge status emerged as significant variables in predicting respiratory symptoms in informal settlements.
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    Understanding healthcare pathways of patients with diabetes: insights from an exploratory study in a government sub-district hospital of Bangladesh
    (BRAC University, 1/5/2025) Hasan, Sadah; Ahmed, Syed Masud; Naher, Nahitun
    Introduction: The prevalence of diabetes mellitus in Bangladesh was 13.75% in 2018. The healthcare system of Bangladesh makes it challenging to deliver integrated non-communicable disease service. There is a lack of resources at the primary healthcare level, a difficult pluralistic healthcare system to navigate, and limited evidence on diabetic care pathways in the context of Bangladesh. As diabetes mellitus is a leading cause of morbidity and mortality, understanding these pathways is vital for developing an equitable healthcare system tailored to chronic disease management. Methods: This facility-based qualitative exploratory study was conducted at the Upazila Health Complex in Keraniganj, Dhaka, Bangladesh. By applying convenient sampling, a total of 22 in-depth interviews were conducted with respondents visiting the NCD corner of the UHC, from November 22, 2024 to December 11, 2024. Descriptive statistics about the respondents were evaluated using STATA V17. Thematic analysis of the interviews were done. Results: The majority of the respondents were aged 40-69 years (81.8%) and female (68.2%), married (86.4%), Muslim (91%) and living in peri-urban areas (91%). 45.5% of the respondents had no formal education, 72,7% were unemployed and most household incomes were generally less than 15,000 BDT. 59% of respondents have lived with diabetes for 2-5 years and 77.3% had other comorbidities too. Respondents navigated complex care pathways, involving both formal and informal healthcare providers, with the longest pathway having five points of care. Most participants delayed seeking care due to attributing symptoms to other diseases, minimal perceived severity, or beliefs about diabetes, with many managing symptoms through home remedies. Delays were longest among women. Triggers that prompted seeking care were worsening symptoms, advice from social networks, or referrals from providers. The common initial points of care were private providers and drug-sellers, with UHCs generally becoming the final care provider by the third point of care. UHCs were preferred for their affordability, accessibility, and ability to manage comorbidities. Most respondents rated UHC services as good, yet unavailable essential medicine or diagnostic tests, short consultation times, disrespectful behavior, and insufficient privacy impacted patient experiences. Elderly and women with children struggled with access to distant hospitals. Private care was expensive and often led to discontinuation, while informal providers were chosen for affordability. One respondent took service from parallel providers. Expenses, especially for those with comorbidities, caused financial strain, often forcing difficult decisions between managing diabetes and other health conditions. Conclusion: Respondents with diabetes navigated complex care pathways and encountered various categories of healthcare providers. While PHC facilities serve as critical hubs, there is a need to address challenges such as inconsistent medicine supply, unavailability of diagnostic facilities, inadequate consultation practices, and the financial burden of respondents to create equitable, patient-centered care for diabetes chronic diseases in resource-limited settings.
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    Resource allocation and system efficiency in dengue management: a mixed methods study at Savar Upazila Health Complex
    (BRAC University, 2025) Sultana, Salma; Hasan, Md Tanvir; Ashrafi, Shah Ali Akbar
    Introduction: Dengue fever, a mosquito-borne disease, is a significant public health issue in Bangladesh, with outbreaks exacerbated by urban density, inadequate resources, and seasonal patterns. The country reported over 203,000 cases and 989 deaths in 2023, with rising hospitalizations and fatalities in 2024. Challenges include ICU shortages, insufficient diagnostic tools, and economic impacts. Despite national protocols for dengue management, gaps in adherence at primary healthcare facilities hinder effective response, necessitating focused research and interventions. Method: This study utilized a concurrent mixed-method design at the Savar Upazila Health Complex, combining an observation checklist, supply chain mapping, and qualitative interviews with 12 healthcare providers. The checklist assessed facility resources and dengue management practices, while supply chain mapping identified bottlenecks in resource flow. Interviews explored challenges in protocol adherence, resource limitations, and patient care. Data analysis integrated thematic and quantitative methods, revealing critical deficiencies. Ethical considerations ensured confidentiality, informed consent, and minimal disruption at the UHC. Findings: The health complex has 50 beds but struggles to accommodate dengue patients during peak seasons, often using floor spaces due to overcrowding. Inadequate isolation facilities increase cross-contamination risks. Staff shortages, particularly nurses and health assistants, compromise care quality, though training on dengue protocols exists. Essential supplies, such as diagnostic kits and PPE, face frequent shortages due to inefficiencies in the government-led supply chain. While IV fluids and medicines are generally available, mosquito repellents and equipment are inconsistent. Proactive measures, like sanitation and mosquito control, are limited by resource constraints. Improved infrastructure, staffing, training, and supply chain management are critical for effective dengue care. Conclusion: Resource constraints, staffing shortages, and inefficient procurement hinder dengue management at Savar Upazila Health Complex, compromising patient care. Addressing these challenges requires a comprehensive national policy, intersectoral coordination, and increased funding. Integrating dengue management into broader public health frameworks is essential to improve system capacity and ensure sustained preparedness.
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    Knowledge, perceptions and practices regarding human papillomavirus (HPV) vaccination among 10 to 14 years school going adolescent girls and parents of Korail slum in Dhaka, Bangladesh
    (BRAC University, 2025) Akash, Sheikh Mohammad Rafi; Anwar, Humayra Binte; Barua, Mrittika
    Cervical cancer remains a leading cause of mortality among women in low- and middle-income countries (LMICs), including Bangladesh. However, the Human Papillomavirus (HPV) vaccine provides up to 97% protection against cervical cancer when given to women during adolescence. Barriers such as limited healthcare access, misinformation and cultural norms hinder HPV vaccination efforts. This study aimed to explore the knowledge, perceptions and practices regarding HPV vaccination among adolescent girls aged 10 to14 years and their parents in Korail slum, Dhaka by using the Behavioral and Social Drivers (BeSD) framework. A mixed-method approach was adopted. Quantitative data were collected through a census survey of 161 school-going adolescent girls aged 10 to 14 years. On the other hand, qualitative insights were derived from three focus group discussions (FGDs), two with mothers and one with fathers. Challenges in conducting FGDs with fathers arose due to their work schedules and heightened political tensions in the area, limiting their participation. Data analysis combined descriptive statistics for the quantitative findings and thematic analysis for the qualitative data. Quantitative results revealed that while 99.38% of participants had heard about the HPV vaccine, primarily through schools, only 62.73% understood its purpose. Schools (95.71%) and the perceived health benefits of vaccination (96.43%) were key motivators for uptake. However, barriers like fear of side effects (20%), lack of parental approval (13.33%) and misinformation (71.43%) persisted. Qualitative findings emphasized the role of trusted figures, such as teachers and healthcare workers, in addressing misconceptions. Community members valued the vaccine’s preventive benefits and it's free availability but stressed the need for clearer communication and community outreach. In conclusion, high awareness of HPV vaccination was observed. Yet detailed knowledge and acceptance were limited among the residents by misinformation and logistical challenges. Effective interventions must focus on targeted health education campaigns, community engagement and strategies to overcome socio-political barriers to improve vaccine uptake and reduce cervical cancer prevalence in underserved communities.