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Introduction Smokeless tobacco (ST) is the predominant form of tobacco used in Bangladesh and is associated with adverse health outcomes. Bangladesh ratified the World Health Organization's Framework Convention on Tobacco Control (FCTC) in 2004. There are concerns that FCTC legislation and implementation of ST control policy is insufficient in Bangladesh. The aim of this study was to investigate the achievements and challenges of ST policy in Bangladesh and its alignment with the FCTC. Methods We conducted semi-structured key informant interviews with 20 stakeholders from government and non-government offices and international funding agencies, including tobacco control advocates, policy makers and non-governmental organisation workers. We used NVivo software to create key themes and the framework method for thematic analysis. Results Our findings revealed a lack of national policy in terms of disclosure of harmful contents, illicit trade and standardised packaging of ST. Legislation remains ineffective in relation to graphical health warnings and tax measures. Challenges to ST control identified included inadequate law enforcement; paucity of research, surveillance, and evidence generation; and supply chain control. We identified lack of congruence of ST policies with FCTC due to slow progress in implementation of FCTC measures, lack of a country-specific policy and industry interference. To comply with FCTC, participants recommended strong leadership and political commitment, co-ordination between public and private sectors and proper use of tobacco control resources. Discussion and conclusions Bangladesh has adopted several important FCTC measures, but further strengthening of ST policy is needed to enable full implementation of FCTC.

To estimate the pooled prevalence of smokeless tobacco consumption (STC) by gender and location in Bangladesh, India and Myanmar and to identify periodic changes in STC prevalence using data extracted from published studies.We searched for a combination of keywords in electronic databases and used a standard form to extract data from each article. We undertook a meta-analysis to estimate pooled prevalence and confidence intervals within these countries. To compare periodic changes in STC prevalence, we grouped studies into five-year periods (2000-2004, 2005-2009, 2010-2014 and 2015-2019).The pooled estimates of STC prevalence were 25% (95% CI: 22-28%), 22% (95% CI: 15-28%) and 21% (95% CI: 14-28%) for Bangladesh, India and Myanmar, respectively. In pooled estimates across these countries, we found higher STC prevalence for men (30%; 95% CI: 24-35%) than women (16%; 95% CI: 10-23%) and for rural dwellings (24%; 95% CI: 18-31%) than urban dwellings (17%; 95% CI: 10-24%). We found significant decrease in STC in Bangladesh and India in the period 2010-2014 and 2015-2019, respectively. In Myanmar, STC prevalence increased significantly and substantially in 2010-2014, to levels higher than in Bangladesh and India.The prevalence of STC in Bangladesh, India and Myanmar is highest in rural areas and among men. Public health prevention strategies are needed to maintain decrease in STC in Bangladesh and India, and to reverse the increased use in Myanmar.Estimer la prévalence poolée de la consommation de tabac sans fumée (CTSF) par sexe et lieu au Bangladesh, en Inde et au Myanmar et identifier les changements périodiques de la prévalence des CTSF à l'aide de données extraites d'études publiées. MÉTHODES: Nous avons recherché une combinaison de mots-clés dans les bases de données électroniques et utilisé un formulaire standard pour extraire les données de chaque article. Nous avons entrepris une méta-analyse pour estimer la prévalence poolée et les intervalles de confiance dans ces pays. Pour comparer les changements périodiques de la prévalence des CTSF, nous avons regroupé les études en périodes de cinq ans (2000-2004, 2005-2009, 2010-2014, 2015-2019). RÉSULTATS: Les estimations poolées de la prévalence des CTSF étaient de 25% (IC95%: 22-28%), 22% (IC95%: 15-28%) et 21% (IC95%: 14-28%) pour le Bangladesh, l'Inde et le Myanmar, respectivement. Dans les estimations poolées de ces pays, nous avons constaté une prévalence des CTSF plus élevée pour les hommes (30%; IC95%: 24-35%) que pour les femmes (16%; IC95%: 10-23%) et pour les habitations rurales (24%; IC95%: 18-31%) que les habitations urbaines (17%; IC95%: 10-24%). Nous avons constaté une diminution significative des CTSF au Bangladesh et en Inde au cours de la période 2010-2014 et 2015-2019 respectivement. Au Myanmar, la prévalence des CTSF a augmenté de manière significative et substantielle en 2010-2014, à des niveaux plus élevés qu'au Bangladesh et en Inde.La prévalence des CTSF au Bangladesh, en Inde et au Myanmar est la plus élevée dans les zones rurales et chez les hommes. Des stratégies de prévention de la santé publique sont nécessaires pour maintenir la diminution des CTSF au Bangladesh et en Inde et pour inverser l'augmentation de la consommation au Myanmar.

Objectives This study aims to measure the economic costs of maternal complication and to understand household coping strategies for financing maternal healthcare cost. Methods A household survey of the 706 women with maternal complication of whom 483 had normal delivery was conducted to collect data at 6 weeks and 6 months post-partum. Data were collected on socio-economic information of the household expenditure during delivery and post-partum coping strategies adopted by households and other related information. Results Despite the high cost of health care associated with maternal complications the majority of families were capable of protecting consumption on non-health items. Around one-third of households spent more than 20% of their annual household expenditure on maternal health care. Almost 50% were able to avoid catastrophic spending because of the coping strategies that they relied on. In general households appeared resilient to short-term economic consequences of maternal health shocks due to the availability of informal credit donations from relatives and selling assets. While richer households fund a greater portion of the cost of maternal health care from income and savings the poorer households with severe maternal complication resorted to borrowing from local moneylenders at high interest which may leave them vulnerable to financial difficulties. Conclusion Financial protection especially for the poor may benefit households against economic consequences of maternal complication.

Aims: The aim of this review is to present the status of Visceral Leishmaniasis (VL) in Bangladesh and various steps taken to achieve the Millennium Development Goal (MDG). Additionally, the review covers the related challenges and opportunities to achieve this goal. Main Body: Currently, 45 out of 64 districts of the country are endemic for VL and 20 million people, around 18% of the total population, are considered to be at risk for VL. However, there is a concern about the total number of VL reported cases. It has been mentioned that the number of cases reported in surveillance data is likely to be at least five times underestimated. The current burden of VL disease is 23.4 times higher compare to the MDG of 1 case per 10,000 populations by 2015. In order to achieve the MDG various national strategies have been taken so far to eliminate VL from Bangladesh. Government of Bangladesh constituted a national steering committee and formed a technical working group to provide support to VL elimination program. Lack of trained and efficient labour force, along with lack of knowledge among the people are big

Background Active case detection (ACD) significantly contributes to early detection and treatment of visceral leishmaniasis (VL) and post kala-azar dermal leishmaniasis (PKDL) cases and is cost effective. This paper evaluates the performance and feasibility of adapting ACD strategies into national programs for VL elimination in Bangladesh, India and Nepal. Methods The camp search and index case search strategies were piloted in 2010-11 by national programs in high and moderate endemic districts / sub-districts respectively. Researchers independently assessed the performance and feasibility of these strategies through direct observation of activities and review of records. Program costs were estimated using an ingredients costing method. Results Altogether 48 camps (Bangladesh-27, India-19, Nepal-2) and 81 index case searches (India-36, Nepal-45) were conducted by the health services across 50 health center areas (Bangladesh-4 Upazillas, India-9 PHCs, Nepal-37 VDCs). The mean number of new case detected per camp was 1.3 and it varied from 0.32 in India to 2.0 in Bangladesh. The cost (excluding training costs) of detecting one new VL case per camp varied from USD 22 in Bangladesh, USD 199 in Nepal to USD 320 in India. The camp search strategy detected a substantive number of new PKDL cases. The major challenges faced by the programs were inadequate preparation, time and resources spent on promoting camp awareness through IEC activities in the community. Incorrectly diagnosed splenic enlargement at camps probably due to poor clinical examination skills resulted in a high proportion of patients being subjected to rK39 testing. Conclusion National programs can adapt ACD strategies for detection of new VL/PKDL cases. However adequate time and resources are required for training, planning and strengthening referral services to overcome challenges faced by the programs in conducting ACD.

Various studies in Bangladesh examined the cost of caesarean section delivery. However, no systematic investigation on the quality of these studies has been performed. The aim of this study is to systematically review the published literature on caesarean section delivery cost in Bangladesh and to scrutiny the methodological quality of these studies. A comprehensive search strategy was developed to search Medline by the PubMed interface. Due to small number of article was found, various report that was done in cost of cesarean section delivery in Bangladesh were also identified. Among the selected studies, respondent selection procedure was not consistent. Regarding recall error, only two studies mentioned the problem of recall error and only one studytook steps to minimize the recall bias. Only one study conducted a scientific method to measure the sample size of the study. Only one study disaggregated medical costs according to various components, whereas only two studies considered productivity lost as a part of their total cost analysis. However, no study measured the cost of intangible which refers to the cost of patient pain and sufferings. The majority of the studies did not follow the scientific method of cost of illness study, which consequently resulted into a lack of robustness of the analysis. In general, the less technical issues are targeted by most of the study.The capacity building on cost of illness analysis among the researcher in Bangladesh is required.