ObjectivesThe Three Delays Model has been commonly used to understand and prevent maternal mortality but has not been systematically applied to emergency medical conditions more generally. The objective of this study was to identify delays in emergency medical care seeking and delivery in rural Bangladesh and factors contributing to these delays by using the Three Delays Model as a framework.DesignA qualitative approach was used. Data were collected through focus group discussions and in-depth interviews using semistructured guides. Two analysts jointly developed a codebook iteratively and conducted a thematic analysis to triangulate results.SettingSix unions in Raiganj subdistrict of Bangladesh.ParticipantsEight focus group discussions with community members (n=59) and eight in-depth interviews with healthcare providers.ResultsDelays in the decision to seek care and timely receipt of care on reaching a health facility were most prominent. The main factors influencing care-seeking decisions included ability to recognise symptoms and decision-making power. Staff and resource shortages and lack of training contributed to delays in receiving care. Delay in reaching care was not perceived as a salient barrier. Both community members and healthcare providers expressed interest in receiving training to improve management of emergency conditions.ConclusionsThe Three Delays Model is a practical framework that can be useful for understanding barriers to emergency care and developing more tailored interventions. In rural Bangladesh, training community members and healthcare providers to recognise symptoms and manage acute conditions can reduce delays in care seeking and receiving adequate care at health facilities.

BackgroundNumber of deaths due to road traffic injuries (RTI) is increasing in the urban areas due to rapid urbanization in the low- and middle-income countries including Bangladesh. However, the real burden of RTI among the urban population has neither been recognized nor been addressed properly by the policy makers in Bangladesh due to lack of reliable data.ObjectiveThe study aimed at exploring the epidemiological burden of RTI among urban population in Bangladesh.MethodologyA nationwide cross-sectional survey was conducted between March and June 2016. Multi-stage cluster sampling was used to select required number of households. It uses a complex sampling strategy based on probability-proportional-to-size (PPS) methodologies with separate urban and rural samples. After cleaning and validation, data from 2 99 216 household residents including 1 06 233 urban residents was available for analysis. 64 data collectors and 16 supervisors were engaged in the study. Data was collected on tablets using a custom data entry program developed for the survey. Once data was transferred to the server, the data was validated, and exported to SPSS v21 for analysis.ResultsRTI (40.5%) was the leading cause of injury mortality among urban population followed by falls (21.4%) and drowning (19.0%) with a rate of 16.0/100,000 population. More than 70% of all deaths occur on the way to hospital. Almost two-thirds (64.7%) of all died on the urban roads are the people in the most productive age group (25–59 years) and pedestrians (23.5%) were the most vulnerable group. Around 60% of RTI victims received treatment from district level hospitals. Male involvement in road traffic injuries were significantly higher than female in the urban areas.ConclusionFindings of this study could an information base for reducing the toll of RTI among the urban population in a comprehensive way considering their involvement and health care seeking pattern.

BackgroundAn estimated 23 166 people die from road traffic injuries each year in Bangladesh. Identifying the risk factors, including hazardous locations are the prime concern in addressing the toll of road traffic injuries, which is a major challenge in Bangladesh like other low-income settings.ObjectiveThe objective of this study was to explore the process of using road traffic crash data from multiple sources in identifying the hazardous locations with maximum accuracy for future policy direction.MethodologyDesk review, physical observation and in-depth interviews were used to document necessary information for the study. Pre-tested structured checklist was used for the desk review and physical observation while semi-structure guideline was used for the in-depth interview. Road condition, engineering factors, epidemiological aspect of crashes, nature of nearby populations and existing safety measures were the key variables. The study was conducted between July and August 2016. Last 8 years’ data (2008–2015) of Ashuganj to Sylhet section of N/2 highway (95 kilometers) was reviewed.FindingsIt was found that approximately 25–35 people died each year on the selected section during the review period. Major engineering factors were risky curvature (39%); absence of bus bay (19%), sign markings (17%) and hard shoulder (13%); and obstacle for vegetation (12%). Around 42% of pedestrians were unaware about road safety while 29% of victims were engaged in daily activities besides the observed road section. 17% of all vehicles involved in crashes were found to be on high speed. 12 intersections on the observed section were found as hazardous location considering all risk factors. 92% of the identified hazardous locations were matched with the previously identified blackspots by the government using costly advance technologies.ConclusionThe approaches used in this study are recommended for identifying hazardous locations to address road traffic crashes in low-income settings considering its cost-effectiveness.

BackgroundIn Bangladesh, thousands of pedestrians are dying on the roads every year. However, the real burden of RTI focusing on pedestrian safety has neither been recognized nor been addressed properly by the policy makers in Bangladesh due to lack of reliable data.ObjectiveThe study aimed at exploring the current scenario of road traffic injuries and involvement of pedestrians in Bangladesh to generate information-base for the policy makers.MethodologyA nationwide cross-sectional survey was conducted between March and June 2016. Multi-stage cluster sampling was used to select required number of households. Sampling strategy was based on probability-proportional-to-size (PPS) methodologies with separate urban and rural samples. Data from 2 99 216 household residents was available for analysis of which 1 00 842 were children aged 0–17 years. 64 data collectors and 16 supervisors were engaged in the study. Data was collected on tablets using a custom data entry program. Once data was transferred to the server, the data was validated, and exported to SPSS v21 for analysis.ResultsIn the year before the survey, an estimate 22 437 deaths were recorded due to road traffic injuries i.e 14.4/100,000 population. Over 3.4 million were injured (2163.7/100,000 population) of which 80 448 were permanently disabled, over 220 each day. Pedestrians comprises around one third of all RTI deaths while a clear male predominance in most age groups for both death and injuries were found. Pedestrians contributed around 14% of the permanent disabilities due to road traffic injuries. Infants, younger children (<9 years) and older people (60+years) became more frequent victims as pedestrians.ConclusionFindings of this study could an insight for the policy makers of Bangladesh and other low- and middle-income countries for future policy guidance. We have to act without any delay to address the alarming involvement of pedestrians in road traffic injuries.

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