Demographic And Health Analysis: Country Report & Analysis Overview

Part 1: Demographic, Epidemiologic and Economic Transition (Modules 1 & 2)

Figure 1: Population pyramid – should be the most recent (Drag your picture file and drop it into the center of this box. These can be found at https://www.populationpyramid.net/

Source: PopulationPyramid.net11

Demographic and epidemiologic transition questions:

Answer the following questions based on figure 1, tables 1 and 2, and your own review of the relevant literature.

1. Provide an explanation for why you chose the indicators reported in Table 1 (200 words)

Population growth is associated with fertility rate. Bangladesh has witnessed increasing fertility rate and at the same time decline in mortality rate. Population pressure was the leading problem in Bangladesh since 1978. The government of Bangladesh with help from non-governmental organizations and international organizations worked towards solving the problem. Some successes were achieved in different areas as decline of fertility was witnessed (2). Life expectancy is a measure of overall quality of life in a country. It explains mortality rate in a country. It also shows potential yield on investment in human capital. Life expectancy has been progressing over the past several years. Death rate is the average annual number of deaths per 1000 population at midyear during a year. It is also known as crude death rate. It generally shows the mortality situation of a country. It therefore shows the impact of mortality on population growth. Death rate in Bangladesh is at 5.4 deaths/1000 population in the year 2017. In early years like 1920s, mortality trends have been uneven due to historical events such as independence war and partition. There has been decline in mortality rate to a lower level. There is possibility of increase in mortality rate due to ageing of the population (2). These indicators reflect the population health status overtime, as well as between populations at a single point of time. Hence they permit the health system comparison, besides highlighting populations in need of particular healthcare services.

2. At what stage (or stages) is your country in the demographic transition? Provide evidence from the data to support your answer. (200 words)

Bangladesh is at early stages of demographic transition. It has achieved significant progress in both mortality and fertility decline. Bangladesh is a traditional agricultural society with poor infrastructure and limited resource base. There has been occurrence of demographic changes despite slow economic progress. It is among the densely populated countries. According to UNFPA14, about 156 million people reside within a small area of about 147,570 square kilometers. The density of population in Bangladesh is five times that of any other super country. It is nearly five times that of Pakistan and three times that of India. The country has escaped Malthusian trap by speeding up food productions, employing female labor in productive sectors and exporting human capital. It also has steady industrialization especially in garment industry. This has improved child survival and reduced fertility. Since independence, population growth was identified as national problem and strong population control policy was adopted. At now, fertility rate is at 2.4 children per woman. This is not far from replacement-fertility of level 2.1. Regions like Khuna and Rajshahi have achieved replacement fertility level. The life expectancy at birth has also improved to 73.4 years in 2017. Therefore, demographic transition in Bangladesh has followed a typical pattern of decline in mortality rate followed by decline in fertility rate (6).

3. Describe and explain any significant variation in the stage of demographic transition within the country by region, social class, or ethnic group. (hint: report on data over time) (200 words)

The demographic transition has not occurred uniformly geographically, because some areas are in the fifth stage and some are in the second stage. These could be due to industrialization prospects such as technology diffusion from developed world that champion’s reduction in death rates in some regions. UNFPA14 points out that the fertility rate in Bangladesh can be characterized based on different groups such as wealthiest and most educated women with low fertility rate while poor women and least educated women have highest fertility rate. There are huge regional differences like Chittagong division in the East having higher fertility rate compared to Khulna in the West. Rural fertility is also higher than urban. Furthermore, disproportional planning and investment for the regions in terms of special populations such as persons with disabilities, the elderly, indigenous people, besides youth and adolescents (14), leads to variations in fertility rate that makes the non-uniformity of the demographic transition. Likewise, internal and international migration infiltration, unplanned urbanization, human lifestyle changes, education and health investments affects the uniformity. Moreover, the UNFPA14 urges that the lack of addressing gender inequality and gender based violence in some regions worsens the girls and women potential towards increasing regional and national productivity, yet they constitute 50 percent of the population.

4. Is the concept of “epidemiologic transition” applicable to your country and, if so, at what stage is your country in the epidemiologic transition? (150 words)

Bangladesh is developing country which is faced by high inequalities and rampant poverty. There is still increasing burden of non-communicable diseases. Non-communicable diseases cause two thirds of all deaths. This indicates that Bangladesh is under rapid epidemiologic transition. Over the recent years, there has been changing patterns of diseases. Some diseases are disappearing while others are appearing and disappearing (8). UNFPA14 emphasizes that the demographic transition with unplanned urbanization besides human lifestyle changes are championing the burden of non-communicable diseases. Epidemiologic transition is therefore between the age of degenerative and manmade diseases. Increased urbanization has contributed to the rise of chronic disease burden. Rapid urbanization leads to reduced physical activity, change in food habits and increased access to processed food. Therefore, change of life style has contributed to this transition. The age pattern mortality has changed from young to old ages.

5. Using your topic as a guide, describe direct or indirect evidence that different groups within your country (by region, social, or ethnic group) have distinct patterns of disease burden? (350 words)

Bangladesh has been undergoing rapid epidemiologic transition with non-communicable diseases occupying two-thirds of all deaths. In 2004, non-communicable diseases occupied 61% with the remaining percentage being occupied by communicable diseases, and maternal and child health issues. According to Bangladesh Bureau of Standards3, cardiovascular diseases occupy 13.4% of the total burden, mental health 11.2%, injuries 10.7%, respiratory diseases 4.0%, cancer 3.9% and diabetes 1.2%. Some years back about 70 years ago, infectious diseases were the leading cause of death. The country has now shifted to non-communicable diseases. This situation has imposed pressure on the country in solving the double burden.

It is true that different groups have different patterns of disease burden. Diabetes affects mostly rural people. Smoking is mostly the cause of chronic respiratory diseases and is therefore more prevalent in men than females. It also affects mostly youths. Smokeless tobacco is leveling tobacco consumption among men and women. This is supported by the culture of Bangladesh due to minimal public health consequence. Most people who are affected by injuries like road traffic injuries are men while those affected by drowning injuries are children. There are also other different disease burdens based on age such as degenerative and manmade diseases. Non-communicable diseases are mostly affecting the aging population. Chronic disease burden is increasing in urban areas due to reduced physical activity, increased access to processed food and change in food habits. The use of tobacco, inadequate intake of fruit and vegetables, abdominal obesity, hypertension and low-level of physical activity are prevalent in Bangladesh adults. Smoking is one of risk factors of non-communicable diseases which bring difference in prevalence of burden of disease. Tobacco use is more in rural areas than in urban areas. The issue of obesity also differs between rural and urban areas where it is high in urban areas than rural areas. This means that unplanned urbanization is the cause of this obesity (9).

Chronic non-communicable diseases are mostly caused by low physical activity. Special attention need to be put on rich people and urban women. Level of physical activity is affected by poor urban planning. These differences call for prevention and control measures to be designed with their consideration.

Part 2: Family Health & Social Determinants (Module 3)

Total grade: 32.5/40 pts

See the Courseplus Schedule for Due Date. All assignments are due at 11:59 PM EST on the due date.

Health and nutrition through the life cycle questions:

Answer the following questions based on tables 3 and 4 and your own review of the relevant literature. Consider your selected topic and the country’s context!

1. Describe the maternal health and nutrition situation. (200 words)

Bangladesh’s maternal health and nutrition situation has achieved significant progress so far in terms of reducing low birth weight prevalence, reducing prevalence of anemia in pregnant women aged 15-49 years-old, and increasing full coverage Vitamin A supplementation (3). The increase in supplement feeding besides breastfeeding, could be as a result of increase in female literacy level, in addition to employment status that positively fosters education for mothers on significance of maternal health and nutrition such as immunization, prescription medication, sanitation and safe drinking water (4). The increase in female literacy level has also fostered increase in antenatal as well as postnatal care by means of medically trained providers. Moreover, there has been moderate increase in the rate of pregnant women delivering from institutions that have medically trained attendants. As a consequence, family members and communities have become aware and careful about the hygiene; which has seen a positive increase in hygiene, sanitation, and safe drinking water (16). In addition, the percentage of obese pregnant women as well as overweight ones, is decreasing.

2. Describe the neonatal/perinatal health and nutrition situation. (200 words)

The Bangladesh’s neonatal/perinatal health and nutrition situation has had reduced low birth weight, decreased anemia prevalence, and supplementations such as Vitamins A during the first twenty-eight months of life in females aged between fifteen and forty years-old. Therefore, neonatal health and nutrition care has significantly improved. Furthermore, the combination of these and facility deliveries as well as skilled birth attendance, have subsidized the reduction of neonatal and perinatal infections plus deaths (4). Increased female literacy has ensured that most women attend antenatal care at least four times, and giving birth in a delivery facility in the presence of a medically trained birth attendant. Furthermore, it has supported women to check their body mass index during pregnancy, thus reducing the number of low birth weight delivery (17). Moreover, it has championed a positive increase in the importance of maternal health and nutrition, consumption of antiretroviral medication for those who test HIV positive. Female participation in full time work has also championed them to attend antenatal care, deliver in institutions that have a medically trained birth attendant, as they can be able to contribute to the household budget (3). These have also led to a decline in the percentage of overweight as well as obese pregnant women.

3. Describe the post-neonatal (1-11 months) and child (12-59 months) health and nutrition situation. (200 words)

Bangladesh’s post-neonatal [1-11 months] health and nutrition situation has registered positive results, since essential newborn care practices have remarkably increased, including percentage of newborns being breastfed within one hour of birth, newborns being dried and wrapped within five minutes of birth, and newborns being bathed after seventy-two hours of delivery. Furthermore, the percentage of post-neonatal [1-11 months] newborns and their mothers receiving care within two days of birth and delivery respectively from a medically trained provider (4). Likewise, there has been a positive increase in percentage of newborns receiving exclusive breastfeeding under six months. On the other hand, child [12-59 month’s] health and nutrition situation includes, increase in percentage of immunization of infants and children between 12 and 23 months with measles and DPT3 prevalent (17). Similarly, increase in percentage of children having diarrhea under five years receiving oral rehydration therapy for diarrhea, and those above five years receiving the same plus zinc, have significantly registered positive rates. Moreover, increase in percentage of children under five years receiving vitamin A supplement in the previous six months (4). As a consequence, both have contributed to decrease in in infant and child mortality, with the latter’s rate reducing considerably as compared to the former.

4. Using the indicators reported in Tables 3 and 4, how might these data affect the health and social situation for school-aged children and adolescents? (250 words)

These indicates a positive influence in the health and social situation for school-aged children besides adolescents. This is for the reason that mortality declines are significantly positively correlated with enhanced coverage of appropriate interventions to curb as well as treat the most significant causative factors of child mortality in addition with enhancements in socio-economic environments (17). Furthermore, increment in the coverage of immunization towards preventing diseases, diarrhea treatment, and other maternal health and nutrition interventions, will significantly reduce disparities that can hamper school-aged children and adolescents from attending school at the early age of school-going.

The data will also ensure that they acquire effective preventive amenities such as physical and psychosocial growth besides development monitoring, with particular responsiveness to delicate periods in which effective healthcare is substantial for comprehensive progress and development (1). These will ascertain that they are not limited by chronic conditions towards their capacity of realizing performance of regular activities, cognitive development, as well as playing and attending school. Moreover, this will ensure that any problems experienced during their significant stages of development are identified and that proper interventions are made to reverse the consequences, before they go well beyond out of hand (17). Furthermore, it allow for adolescents with an opportunity of preventing the onset of health-destructive behavior at the same time as introducing and establishing healthy behavioral patterns that might span over generations.

For instance ensuring within one hour early initiation of breastfeeding, continued breastfeeding, exclusive breastfeeding for children under the age six months, immunization of infants and children between 12 and 23 months with measles and DPT3 prevalent. Similarly, increased percentage of children having diarrhea under five years receiving oral rehydration therapy for diarrhea, and those above five years receiving the same plus zinc. As well, increase in percentage of children under five years receiving vitamin A supplement in the previous six months. As a consequence, the health and social situation for school-aged children besides adolescents will be positively influenced.

Part 3: The National Health Sector Strategic Plan - Modules 4 & 5

See the Courseplus Schedule for Due Date. All assignments are due at 11:59 PM EST on the due date.

Questions

Answer the following questions based on tables 1-4 and your own review of the relevant literature to develop your topic of the National Health Sector Strategic Plan for your country of choice. Make sure your selected consultancy theme is addressed throughout these questions.

1. Reflect on the indicators you identified in parts I, and II. How do they impact your global health theme? How might the indicators of social determinants of health have an impact on the population health indicators you identified? (250 words)

Although Bangladesh’s health is still relatively low, its population growth has been fostered through increasing fertility rate and at the same time decline in mortality rate, due to the decline in poverty levels and population growth being identified as national problem and adoption by the government of strong population control policy. Life expectancy has been progressing over the past several years. The Bangladesh’s neonatal/perinatal health and nutrition situation has had reduced low birth weight, decreased anemia prevalence, and supplementations such as Vitamins A during the first twenty-eight months of life in females aged between fifteen and forty years-old. Therefore, neonatal health and nutrition care has significantly improved. Furthermore, the combination of these and facility deliveries as well as skilled birth attendance, have subsidized the reduction of neonatal and perinatal infections plus deaths (4). Increased female literacy has ensured that most women attend antenatal care at least four times, and giving birth in a delivery facility in the presence of a medically trained birth attendant.

The demographic transition has not occurred uniformly geographically, because some areas are in the fifth stage and some are in the second stage. These could be due to industrialization prospects such as technology diffusion from developed world that champion’s reduction in death rates in some regions. UNFPA14 points out that the fertility rate in Bangladesh can be characterized based on different groups such as wealthiest and most educated women with low fertility rate while poor women and least educated women have highest fertility rate.

Consideration of critical economic conditions besides low literacy levels on negative women health experiences are still worrying. Collaboration between social determinants of health can negatively impact on the population health indicators, if policies that can enhance in particular women health in the low education besides income brackets are not appropriately addressed (17); because there are still inequalities in relation to geographical regions and amongst the population.

1. Discuss trends in your topic in the country over time. Provide a visual aid (i.e. a chart or graph) to demonstrate one of the trends you identify. (150 words)

Bangladesh population growth has been fostered through increasing fertility rate and at the same time decline in mortality rate. Life expectancy has been progressing over the past several years. Death rate in Bangladesh was at 5.4 deaths/1000 population in the year 2017. Although, there has been decline in mortality rate to a lower level, still there is a possibility of increase in mortality rate due to ageing of the population (2). Bangladesh is at early stages of demographic transition, which has followed a typical pattern of decline in mortality rate followed by decline in fertility rate (6). Since independence, population growth was identified as national problem and strong population control policy was adopted. At now, fertility rate is at 2.4 children per woman. This is not far from replacement-fertility of level 2.1. Regions like Khuna and Rajshahi have achieved this replacement fertility level. The life expectancy at birth has also improved to 73.4 years in 2017 (3). Its maternal health and nutrition situation has achieved significant progress so far in terms of reducing low birth weight prevalence, reducing prevalence of anemia in pregnant women aged 15-49 years-old, and increasing full coverage Vitamin A supplementation (3); which is as a result of increase in female literacy level, and employment status that positively fosters education for mothers on significance of maternal health and nutrition such as immunization, prescription medication, sanitation and safe drinking water (4). This has also fostered increase in antenatal as well as postnatal care by means of medically trained providers. Moreover, there has been moderate increase in the rate of pregnant women delivering from institutions that have medically trained attendants.

Figure 1: Trend in Maternal Mortality Ration, 1987 to 2013

Source: El-Saharty, Ahsan, & May19

1. What are some challenges to and opportunities for addressing the poorly performing indicators to improve public health in your country? (150 words)

Some of the challenges to and opportunities for addressing the poorly performing indicators to improve public health in Bangladesh include inequitable access to health services that hinders universal health coverage at no cost regardless of the household socioeconomic status; and healthcare financing through the disastrous out-of-pocket payments by households combined with informal payments for healthcare services at public health facilities that are annually impoverishing millions of households (20). Also, disproportionate and inadequate healthcare services coverage such as in addressing the double burden of non-communicable diseases, and control of neonatal sepsis or pneumonia child death. Moreover, there is healthcare resources inadequacy and impact on healthcare quality such as adequate medically trained human resources, drugs, supplies, and instruments (17). However, there is the opportunity of Bangladesh having an extensive health infrastructure in both the private and public sectors, besides provision by government of comprehensive healthcare services delivered by both public and private sectors through the ministries of local government, rural development and cooperatives, and health and family welfare.

1. What recommendations would you make to improve the health situation in your country, in the context of the theme you selected? Identify at least 2 specific recommendations and provide evidence from your research to defend them. (300 words)

Towards strengthening human resources in the public health sector, particularly in the hard-to-reach and remote areas of Bangladesh, as well as achieving universal healthcare coverage. The Bangladesh government should mobilize the huge informal healthcare teams outside the sanctioned allopathic system (20). For instance, it incorporate village health teams at the grass root level to handle public health issues and interventions that include control of the double burden of non-communicable diseases, conducting vaccination and immunization, as well as other emerging infectious diseases. This approach will indeed, expand the opportunity for providing public healthcare services, in particular in rural areas where access to healthcare services is still inadequate. To ascertain that this approach remains an attractive proposition, institutional constraints that can hamper it should be significantly addressed. For instance policy changes that can negatively impact effective and efficient service delivery, for the most part among the ultra-poor.

To further increase the utilization of healthcare facilities services by the underprivileged pregnant women, the government ought to introduce the demand-side financing scheme, in more healthcare facilities, with the intention of influencing health seeking behavior amongst these women (20). The scheme should appropriately channel part of the government subsidized healthcare services directly to households, thus allowing them to purchase high quality maternal healthcare services themselves but not through an agency. Certainly, this will be an appropriate strategy towards improving access to and utilization of high quality maternal healthcare services through subsidizing transport to and from the healthcare facility, tests, in addition to medicines. Moreover, the benchmark for the eligibility should be defined by means of poverty standard, authenticated by authorized representatives from the local government. Besides the identified beneficiary, should be fully entitled to all maternal healthcare services, including transportation costs, complications treatment and laboratory tests, antenatal and postnatal services, as well as safe delivery. Without a doubt, this will increase the rate of safe delivery, facility delivery rate, antenatal care services utilization, while decreasing significantly the maternal mortality rate.

References:

1. Abel, H.C. ed. (1993). Paying attention to children in a changing health care system: Summaries of workshops. Washington (DC): National Academies Press

2. Bairagi, R., & Datta, A. K. (2001). Demographic transition in Bangladesh: what happened in the twentieth century and what will happen next?. Asia-Pacific Population Journal, 16(4), 3-16.