Health in Bangladesh

Health and education levels remain relatively low, although they have improved recently as poverty (31% at 2010^[1]) levels have decreased. Most Bangladeshis continue to live on subsistence farming in rural villages. For those in rural areas, village doctors with little or no formal training constitute 62% of the healthcare providers practising modern medicine and the formally trained providers are occupying a mere 4% of the total health workforce. The health seeking pattern of the villagers show that nearly 70% of the patients who consulted a healthcare provider for curative services, contacted a village doctor. Showing clearly that village doctors are a major player in the healthcare system.^[2] As such, health problems abound, springing from poor water quality and prevalence of infectious diseases. The water crisis is acute, with widespread bacterial contamination of surface water and arsenic contamination of groundwater.^[3] Common diseases such as Malaria, Leptospirosis and dengue were rampant in Bangladesh. In 2009, deaths due to Tuberculosis amongst the HIV-negative was 51 per 100 000 population, and prevalence of Tuberculosis was 425 per 100 000 population. The case detection rate for all forms of Tuberculosis is at 44% in 2009. Moreover, the number of cases of Malaria reported in 2009 was 79853 and cases of Leprosy reported was 5239 in 2009 and 3848 in 2010.^[4]

The poor health conditions in Bangladesh are attributed by the lack of healthcare and services provision by the government. The total expenditure on healthcare as a percentage of their GDP was only 3.35% in 2009, according to a World Bank report published in 2010.^[4] The number of hospital beds per 10 000 population is 4.^[5] The General government expenditure on healthcare as a percentage of total government expenditure was only 7.9% as of 2009 and the citizens pay most of their health care bills as the out-of-pocket expenditure as a percentage of private expenditure on health is 96.5%.^[4]

Disease and malnutrition

Child malnutrition in Bangladesh is amongst the highest in the world. Two-thirds of the children, under the age of five, are under-nourished and about 60% of them, who are under six, are stunted.^[6] More than 45 percent of rural families and 76 percent of urban families were below the acceptable caloric intake level.^[7] Malnutrition is passed on through generations as malnourished mothers give birth to malnourished children. According to the World Bank, about one-third of babies in Bangladesh are born with low birth weight, increasing infant mortality rate, and leads to increasing risk of diabetes and heart aliments in adulthood.^[8] According to UNICEF, one neonate dies in Bangladesh every three to four minutes; 120 000 neonates die every year.^[9]

Malnutrition in Bangladesh

Malnutrition in Bangladesh has been a persistent problem for the poverty-stricken country. The World Bank estimates that Bangladesh is ranked 1st in the world of the number of children suffering from malnutrition^[10][11] In Bangladesh, 26% of the population are undernourished^[12] and 46% of the children suffers from moderate to severe underweight problem.^[13] 43% of children under 5 years old are stunted. One in five preschool age children are vitamin A deficient and one in two are anemic.^[14] Women also suffer most from malnutrition. To provide their family with food they pass on quality food which are essential for their nutrition.^[15]

Causes of malnutrition

Most terrain of Bangladesh is low-lying and is prone to flooding. A large population of the country lives in areas that are at risk of experiencing extreme annual flooding that brings large destruction to the crops.^[16] Every year, 20% to 30% of Bangladesh is flooded.^[17] Floods threaten food security and their effects on agricultural production cause food shortage.^[18]

The health and sanitation environment also affects malnutrition. Inadequacies in water supply, hygiene and sanitation have direct impacts on infectious diseases, such as malaria, parasitic diseases, and schistosomiasis. People are exposed to both water scarcity and poor water quality. Groundwater is often found to contain high arsenic concentration.^[19] Sanitation coverage in rural areas was only 35% in 1995.^[20] Almost one in three people in Bangladesh defecates in the open among the poorest families. Only 32% of the latrines in rural areas attain the international standards for a sanitary latrine. People are exposed to feces in their environment daily.^[21] The immune system falls and the disease processes exacerbate loss of nutrients, which worsens malnutrition.^[22] The diseases also contribute through the loss of appetite, lowered absorption of vitamins and nutrients, and loss of nutrients through diarrhea or vomiting.^[23]

Unemployment and job problems also lead to malnutrition in Bangladesh. In 2010, the unemployment rate was 5.1%.^[24] People do not have working facilities all year round^[25] and they are unable to afford the minimum cost of a nutritious diet due to the unsteady income.

Effects of malnutrition in Bangladesh

Health effects

Undernourished mothers often give birth to infants who will have difficulty growing up and developing into a healthy teenager. They develop health problems such as wasting, stunting, underweight, anemia, night blindness and iodine deficiency.^[26] As a result, Bangladesh has a high child mortality rate and is ranked 57 in the under-5 mortality rank.^[27]

Economic effects

As 40% of the population in Bangladesh are children,^[28] malnutrition and its health effects among children can potentially lead to a lower educational attainment rate. Only 50% of an age group of children in Bangladesh managed to enroll into secondary school education.^[27] This would result in a low-skilled and low productivity workforce which would affect the economic growth rate of Bangladesh with only 3% GDP growth in 2009.^[27]

Efforts to combat malnutrition

Many programmes and efforts have been implemented to solve the problem of malnutrition in Bangladesh. UNICEF together with the government of Bangladesh and many other NGOs such as Helen Keller International, focus on improving the nutritional access of the population throughout their life-cycle from infants to the child-bearing mother.^[26] The impacts of the intervention are significant. Night blindness has reduced from 3.76% to 0.04% and iodine-deficiency among school-aged children has decreased from 42.5% to 33.8%.^[26]

Maternal and child health

One in eight women receive delivery care from medically trained providers and fewer than half of all pregnant women in Bangladesh seek ante-natal care. Inequity in maternity care is significantly reduced by ensuring the accessibility of heath services.^[29] In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Bangladesh is 340. This is compared with 338.3 in 2008 and 724.4 in 1990. The under 5 mortality rate, per 1,000 births is 55 and the neonatal mortality as a percentage of under 5's mortality is 57. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal health. In Bangladesh the number of midwives per 1,000 live births is 8 and the lifetime risk of death for pregnant women 1 in 110.^[30]

Hospitals

Medical schools

See also

• Arsenic contamination of groundwater
• Bangladesh health policy
• Blood donation in Bangladesh
• HIV/AIDS in Bangladesh
• Water supply and sanitation in Bangladesh

References

External links

• World Health Organization: Bangladesh

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