Stakeholder engagement to introduce a standardised register for improved inpatient care of newborns and sick children in Bangladesh.

Background: Despite a global decrease of 59% in under-five mortality rates from 1990 to 2021, child survival remains a pressing issue. This holds true for Bangladesh, as well. In response, the Government of Bangladesh introduced a standardised register for strengthening the inpatient management of newborns and sick children in 2021. Methods: We employed a comprehensive four-phase stakeholder engagement process to implement an inpatient register for newborns and sick children. The first stage included identifying and prioritising potential stakeholders at the national and district levels. We identified eight organisations involved in newborn and child health and selected 24 participants from various other sectors for workshops aimed at raising awareness about the register's introduction. These stakeholders also participated in the register's design, development strategies planning, and implementation phases. These phases were led by the 'National Newborn Health and IMCI programme' with support from various partners. A technical working group reviewed existing registers and helped prepare training materials. Feedback from each workshop was crucial in finalising the register. Results: The Government of Bangladesh has recognised the need for an indoor register for newborns and sick children, which was to be established in collaboration with development partners. This initiative can enhance the quality of care for sick children and increase service provider accountability. Due to its successful implementation, it will continue to be used in the Kushtia and Dinajpur districts, with plans for a nationwide scale-up. The Government has allocated funds in the next health sector programme for orientation and register printing. A strengths, weaknesses, opportunities, and threats (SWOT) analysis of the stakeholder engagement process highlighted strengths such as a context-specific approach and collaborative engagement, as well as challenges such as time resource requirements. Conclusions: Implementing an inpatient register for newborns and sick children through stakeholder engagement can effectively improve child health care services. Aside from challenges such as resource intensiveness and stakeholder commitments, success depended on the organising authority's expertise in relationship building, budget allocation, time management, and workforce dedication. Therefore, strategic planning, staff recruitment, networking, and budgeting are crucial for successful stakeholder engagement and health care initiatives.

Introducing a standardised register for strengthening the inpatient management of newborns and sick children: Implementation research in selected health facilities of Bangladesh.

Background: It is imperative to maintain accurate documentation of clinical interventions aimed at enhancing the quality of care for newborns and sick children. The National Newborn Health and IMCI programme of Bangladesh led the development of a standardised register for managing newborns and sick children under five years of age during inpatient care through stakeholder engagement. We aimed to assess the implementation outcomes of the standardised register in the inpatient department. Methods: We conducted implementation research in two district hospitals and two sub-district hospitals of Kushtia and Dinajpur districts from November 2022 to January 2023 to assess the implementation outcomes of the standardised register. We assessed the following World Health Organization implementation outcome variables: usability, acceptability, adoption (actual use), fidelity (completeness and accuracy), and utility (quality of care) of the register against preset benchmarks. We collected data through structured interviews with health care providers; participant enrolment; and data extraction from inpatient registers and case record forms. Results: The average usability and acceptability scores among health care providers were 73 (standard deviation (SD) = 14) and 82 (SD = 14) out of 100, respectively. The inpatient register recorded 96% (95% confidence interval (CI) = 95-97) of under-five children who were admitted to the inpatient department (adoption - actual use). The proportions of completed data elements in the inpatient register were above the preset benchmark of 70% for all the assessed data elements except 'investigation done' (24%; 95% CI = 23-26) (fidelity - completeness). The percentage agreements between government-appointed nurses posted and study-appointed nurses were above the preset benchmark of 70% for all the reported variables (fidelity - accuracy). The kappa coefficient for the overall level of agreement between these two groups regarding reported variables indicated moderate to substantial agreement. The proportion of newborns with sepsis receiving injectable antibiotics was 62% (95% CI = 47-75) (utility - quality of care). We observed some variability in the completeness and accuracy of the inpatient register by district and facility type. Conclusions: The inpatient register was positively received by health care providers, with evaluations of implementation outcome variables showing encouraging results. Our findings could inform evidence-based decision-making on the implementation and scale-up of the inpatient register in Bangladesh, as well as other low- and middle-income countries.

Perceptions of the Muslim religious leaders and their attitudes on herbal medicine in Bangladesh: a cross-sectional study.

BACKGROUND: Herbal Medicines (HMs) are playing major roles in the health of the millions of people worldwide. Muslim Religious Leader (MRLs), being an important component of the society with huge influence on it, could contribute a lot to promote HM. This study was aimed at evaluating perceptions of the MRLs, their satisfaction and attitudes towards HM in Bangladesh. METHODS: This cross-sectional study collected data from a purposive sample of 503 MRLs using an interviewer-administered structured questionnaire during December 2010 and January 2011. Main outcome measures included sociodemographic variables, MRLs' preferences in using HMs, their satisfaction and intent to use HMs in the future, and finally MRLs' attitudes toward HM use. RESULTS: Although two-fifth (40.4%) of the MRLs preferred HM among different form of complementary and alternative medicines, they used orthodox medicine (OM) more frequently than HM in last one year. Majority believed that HM was effective for all age groups (52.6%) and both sexes (74.5%). One-third felt that HM was more effective for chronic diseases, 68.5% felt that it only promotes health, and 40.8% said it keeps them relaxed. About 98.0% of the respondents experienced 'no harm' but 'benefit' from HM; naturally, they were satisfied with HM and were willing to recommend it to others. Urban, older (>40 years), and 'single' respondents were more likely to use HM (gender and education adjusted odds ratios = 1.7 [95% confidence interval, CI = 1.1-2.6], 1.9 [95% CI = 1.3-3.0], and 1.6 [95% CI = 1.2-2.1], respectively). Overall, respondents exhibited very positive attitude towards HM with mean score of 4.2 (range, 3.7-4.6) of a 5-point Likert scale (Score 5 for strongly agree to 1 for strongly disagree). CONCLUSIONS: We report adequate perceptions, satisfaction, and very positive attitudes towards HM among MRLs. Mass media had a significant contribution towards its promotion. If HM are to assume a respected place in the contemporary healthcare, its acceptance among general population needs to be established through incorporating MRLs in the process of HM promotion in Bangladesh.