Factors associated with knowledge and practices of COVID-19 prevention among mothers of under-2 children in Bangladesh.

The COVID-19 pandemic extensively impacted maternal, neonatal, and child health (MNCH) in Bangladesh. Misconceptions arising from a lack of knowledge related to the virus contributed to reduced uptake of MNCH services, which eventually helped increase maternal and neonatal mortality rates during the pandemic. In this study, we assessed the knowledge and practices related to COVID-19 prevention among the mothers of under-2 children in Bangladesh. The study was conducted in May 2021 as part of a broader research project related to COVID-19 response on MNCH service utilization. We collected data from 2207 mothers in six districts of Bangladesh using a multi-stage cluster sampling technique. We constructed weighted and unweighted composite knowledge and practice scores and identified different socio-demographic characteristics associated with the scores using multilevel generalized mixed-effect linear regression models. In general, the mothers revealed poor knowledge and practices related to COVID-19. On a weighted scale of 100, the mean composite knowledge and practice scores were 32.6 (SD = 16.4) and 53.1 (SD = 13.9), respectively. The mothers presented inadequate knowledge about COVID-19 transmission, symptoms, and the recommended preventive measures. At the same time, maintaining a safe physical distance was the least practiced preventative measure (10.3%). Level of education, access to television, and the internet were significantly positively associated with their knowledge and practices related to COVID-19. Knowledge score was also positively associated with the practice score (OR = 1.26; p-value <0.001). Mothers living in islands or wetlands scored poorly compared to those living in inland. The results indicate significant gaps in knowledge and practices related to COVID-19 prevention among mothers of under-2 children. Addressing these gaps, particularly by targeting mothers with lower levels of education and residing in hard-to-reach geographic locations, could consequently help enhance MNCH service uptake during pandemics like COVID-19.

Prevalence and correlates of knowledge and practices regarding infection prevention and control, and triage in primary healthcare settings: A cross-sectional study in Bangladesh.

Background: Despite the high prevalence of healthcare-acquired infection in resource-limited settings, healthcare workers' (HCWs') knowledge and practices of infection prevention and control (IPC) and triage are not well-researched. We examined thisin Bangladesh's primary healthcare facilities (HCFs) during the COVID-19 pandemic. Methods: We surveyed 312 HCWs in 94 community clinics (CCs) and 90 family welfare centres (FWCs) in six districts from February to April 2021. We assessed HCWs' self-reported knowledge and observed practices in four domains: personal hygiene, medical instrument processing, waste management, and triage. We constructed a weighted composite knowledge score and estimated the association between knowledge and background characteristics using a generalised linear mixed effects model. Practices were described through univariate analysis. Findings: On a scale of 100, the mean composite knowledge score was 38.3 (SD: 13.3) overall and 44.0 (SD: 13.1) and 33.8 (SD: 11.6) for FWCs and CCs, respectively. The HCWs of FWCs were more aged, experienced, and educated than those of CCs. Knowledge score was the highest in personal hygiene and the lowest in medical waste segregation. Knowledge was significantly associated with HCWs' designation and education. Concerning practices, not more than one-third of the HCWs or HCFs, on average, followed the recommended protocols, except for wearing face masks while on duty (87.1%) and referring potential COVID-19 patients to higher-level facilities (68.3%). Conclusions: HCWs' capacity in instrument processing, waste management, and triage needs to be improved through formal education and training initiatives. Our study can contribute to the under-researched IPC and triage domains in resource-limited settings.

Knowledge and practices related to COVID-19 among mothers of under-2 children and adult males: a cross-sectional study in Bangladesh.

OBJECTIVES: To assess the knowledge and practices related to COVID-19 among Bangladeshi mothers with children aged 2 years or less and adult males. DESIGN: We conducted a cross-sectional study to assess the knowledge and practices using a multistage cluster sampling technique. SETTINGS: Six districts with high COVID-19 infection rates in Bangladesh. PARTICIPANTS: 2185 mothers of under-2 children and 657 adult males were surveyed in December 2020. MAIN OUTCOME MEASURES: We constructed weighted composite knowledge and practice scores and examined associations between composite scores and background characteristics using linear regression models. RESULTS: Knowledge on possible routes of transmission of the novel coronavirus and the critical handwashing and mask-wearing etiquettes was poor. On a scale of 100, the mean composite knowledge scores of mothers and adult males were respectively 33.5 (SD=15; 95% CI 32.9 to 34.1) and 38.2 (SD=14.8; 95% CI 37.1 to 39.4). In contrast to knowledge, adult males obtained lower practice scores than mothers, primarily due to poor physical distancing practices. The mean practice scores of mothers and adult males were 63.0 (SD=18.1; 95% CI 62.3 to 63.8) and 53.4 (SD=17.5; 95% CI 52.0 to 54.7). Moreover, education, household income and access to television and the internet are significantly associated with knowledge. People residing proximal to a city revealed higher knowledge than the relatively distant ones. This was also the case for practice scores; however, the other factors associated with knowledge did not have a significant association with practices. CONCLUSIONS: In general, both mothers and adult males presented with poor knowledge and practices related to COVID-19. While local, national and international institutions should design and implement educational interventions to help improve knowledge, our research shows that mere knowledge may not be enough to ensure practice. Hence, authorities could reinforce positive social norms by setting benchmarks and introducing rewards or sanctions to improve practices.

Harmful practices prevail despite legal knowledge: a mixed-method study on the paradox of child marriage in Bangladesh.

Child marriage is a globally recognised human rights violation that disproportionately affects girls, especially in developing countries. It has serious negative consequences on girls' physical, mental, sexual, and reproductive health and rights. Although well-pronounced laws against child marriage were enacted in Bangladesh, the practice remains a significant challenge. Lack of law enforcement and persistent social norms ultimately allow child marriage to persist around the country. Social norms have an impact on the prevalent attitudes toward child marriage. Therefore, this mixed-method study aimed to explore the legal knowledge, perception, and practice of child marriage in Bangladesh. This study was part of a broader evaluation of a UNICEF media programme. Adolescent boys and girls aged between 10 and 19 years and their parents were interviewed in three Bangladeshi districts. All the respondents were aware of the legal age of marriage and knew that child marriage is punishable by law. This study illuminated the reasons, including early marriage among boys, poverty, dowry, and sexual harassment. Communities and policymakers need to be engaged to trigger larger structural and cultural changes to remedy the harmful social norm and its practice.

Health shock and preference instability: assessing health-state dependency of willingness-to-pay for corrective eyeglasses.

BACKGROUND: Differences in contingent valuation (CV) estimates for identical healthcare goods can cast considerable doubt on the true economic measures of consumer preferences. Hypothetical nature of CV methods can potentially depend on the salience, context and perceived relevance of the good or service under consideration. Thus, the high demand elasticity for healthcare goods warrants careful selection of study population as the contexts of valuation significantly changes after experiencing health shock. METHODS: In this study, using triple-bounded dichotomous choice (TBDC) experiments, we test how negative health shock (namely, being diagnosed with refractive errors), can alter preference over a common health good (namely, corrective eyeglasses). We compared elicited WTP of diagnosed patients with a synthetically constructed comparable cohort without the same health shock, controlling for the possible self-selection using a number of matching techniques based on the observable socio-demographic characteristics. RESULTS: The consumers diagnosed with vision problems exhibit a rightward shift in their demand curve compared to observationally identical consumers without such problems resulting in about 17% higher consumer surplus. The consumers without the health shock are willing to pay about BDT 762.4 [95% CI: BDT 709.9 - BDT 814.9] for corrective eyeglasses, which gets 15-30% higher for the matched with-health-shock consumers. Multivariable analyses suggest more educated and wealthier individuals are willing to pay respectively BDT 208 and BDT 119 more for corrective eyeglasses. We have tested the models for different matching protocols. Our results are fairly robust to alternate specifications and various matching techniques. CONCLUSION: The preferences for healthcare goods, such as eyeglasses, can significantly depend upon the respondent being diagnosed with refractive errors. Our findings have implications for general cost-benefit analyses often relying on WTP, which can vary depending on the contexts. There are also increasing interests in cost recovery models, which require understanding the demand for healthcare goods and services. We find eliciting the demand needs to consider the health status of the population from which the respondents are sampled.

Willingness to Pay for Cataract Surgeries Among Patients Visiting Eye Care Facilities in Dhaka, Bangladesh.

BACKGROUND: Cataract is the leading cause of avoidable blindness globally. It is estimated that 89% of people with visual impairment live in low- and middle-income countries where the cost of cataract surgery represents a major barrier for accessing these services. Developing self-sustaining healthcare programs to cater the unmet demands warrants a better understanding of patients' willingness to pay (WTP) for their services. OBJECTIVES: Using a sample of patients visiting eye care facilities in Dhaka, Bangladesh, we estimate WTP for two different cataract extraction techniques, namely small incision cataract surgery (SICS) and phacoemulsification. METHODS: We used contingent valuation (CV) approach and elicited WTP through double-bounded dichotomous choice experiments. We interviewed 556 randomly selected patients (283 for SICS and 273 for phacoemulsification) from five different eye care hospitals of Dhaka. In this paper, we estimated the mean and marginal WTP using interval regression models. We also compared the estimated WTP and stated demand for cataract surgeries against the prevailing market prices of SICS and phacoemulsification. RESULTS: We found the mean WTP of BDT 7579 (US$93) for SICS and BDT 10,208 (US$126) for phacoemulsification are equivalent to 12 and 16 days of household income, respectively. Household income and assets appeared as the major determinants of WTP for cataract surgeries. However, we did not find any significant association with gender, occupation, and household size among other socioeconomic characteristics. Comparisons between market prices and average WTP suggest it is possible to have a viable market for SICS, but a subsidy-based model for phacoemulsification will be financially challenging because of low WTP and high costs. CONCLUSION: Our findings suggest lower-cost SICS can potentially provide patients access to surgeries to treat cataract conditions. Moreover, price discrimination and cross-subsidization could be a viable strategy to increase the service-uptake as well as ensure financial sustainability.

Determinants of health seeking behavior for chronic non-communicable diseases and related out-of-pocket expenditure: results from a cross-sectional survey in northern Bangladesh.

BACKGROUND: In spite of high prevalence rates, little is known about health seeking and related expenditure for chronic non-communicable diseases in low-income countries. We assessed relevant patterns of health seeking and related out-of-pocket expenditure in Bangladesh. METHODS: We used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self-care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs). RESULTS: Eight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub-district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care. CONCLUSION: Our study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.