Estimating Catastrophic Costs due to Pulmonary Tuberculosis in Bangladesh.

To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to the TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. We, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15-55) suffers from TB. The majority of the OOP expenditures occur before enrolling in. We conducted a cross-sectional study using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15-55 years, were randomly selected from a list collected from BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine robustness of the study findings. We also used linear regression and logit model to identify the drivers of OOP payments and CHE, respectively. The average total cost-of-illness per patient was 124 US$, of which 68% was indirect cost. The average CHE was 4.3% of the total consumption and 3.1% of non-food expenditure among the surveyed households. The poorest quintile of the households experienced higher CHE than their richest counterpart, 5% vs. 1%. Multiple regression model showed that the risk of CHE increased among male patients with smear-negative TB and delayed enrolling in the DOTS. Findings suggested that specific groups are more vulnerable to CHE who needs to be brought under innovative safety-net schemes.

Assessment of physico-chemical characteristics of river water emphasizing tannery industrial park: a case study of Dhaleshwari River, Bangladesh.

Pollution of industry-adjacent surface water bodies become a major environmental concern in Bangladesh recently. Therefore, this study aimed to elaborate assessment of physico-chemical characteristics of the Dhaleshwari River (the adjacent river of newly shifted tannery industrial park) and also the discharged effluent from the central effluent treatment plant (CETP) considering both seasonal and spatial variations. Among the examined 30 water quality parameters (including 11 heavy metals), only TDS, Cl-, NO3-N, EC, Cu, Zn, Cd, and Ni met the standards for discharged wastewater from industrial units into inland surface water set by Bangladesh government. This indicated that the CETP is not fully and/or effectively functioning. Out of 19 parameters (excluding heavy metal), 14 parameters exceeded the Bangladesh standard for drinking water quality either spatially or seasonally. The river water quality indicated slowly biodegradable capacity with algal bloom risk. The concentrations of the studied heavy metals in the river water followed a decreasing order of Ca > K > Mg > Na > Fe > Cr > Pb > Ni > Cu > Zn > Cd, and Cr concentration in the winter season exceeded the standard values. The concentrations of other heavy metals met the quality standard that indicated still the river is capable to self-purify. Furthermore, strong (p < 0.01) and significant (p < 0.05) correlation were observed among the quality parameters in river water. This study suggested that the efficiency of the existing CETP needs to be enhanced, and the proper operation and maintenance are required to meet the desired discharge standard quality. Also, all the unauthorized wastewater outfalls from tanneries must be closed to save the Dhaleshwari River.

Risk assessment and evaluation of heavy metals concentrations in blood samples of plastic industry workers in Dhaka, Bangladesh.

To assess the potential health risk caused by heavy metals twenty-six blood samples were collected from plastic industry workers based on ages and smoking status in Dhaka, Bangladesh. Heavy metals were analyzed with an atomic absorption spectrometer. The mean concentrations of Lead (Pb), Cadmium (Cd), Nickel (Ni), and Zinc (Zn) found in blood samples of the exposed workers were 32.78 ± 9.47, 1.08 ± 0.47, 1.42 ± 1.01, and 9.08 ± 1.95 µgL-1, respectively. The average heavy metal concentrations in blood samples of smoking workers show a narrow range of fluctuation than that of non-smoking workers. A review of different age groups of industry workers shows the workers between the ages of 26 and 40 are more likely to contaminated with Pb (35.90 ± 8.06 µgL-1) and Ni (1.61 ± 1.31 µgL-1). The higher level of Cd (1.26 ± 0.46 µgL-1) and Zn (9.91 ± 2.80 µgL-1) was found in >40 years old workers. The mean concentration in indoor dust samples of different industrial subsections reported as 40.27 ± 10.33, 3.24 ± 0.83, 18.08 ± 3.61, and 103.64 ± 8.16 mg kg-1 for Pb, Cd, Ni, and Zn, respectively. Exposed workers have relatively less critical health implications concluded from the average daily intake (ADI), hazard quotient (HQs), and hazard index (HI) values. The HI values of Pb, Cd, Ni, and Zn were reported as 2.0 × 10-2, 4.64 × 10-4, 1.62 × 10-3, and 5.49 × 10-4, respectively, which have imparted minimal risks (as HI < 1) to the health of the workers. The cancer risks of Pb, Cd, and Ni were reported as 1.46 × 10-10, 1.77 × 10-9, and 1.31 × 10-9, respectively lower than the threshold values. Therefore, the result divulged a potentially lower cancer risk compared to EPA limit value of 1 × 10-6 to 1 × 10-4 for exposed industrial workers.