Over one-quarter of deaths among 1–4 year-olds in Bangladesh were due to drowning in 2003, and the proportion increased to 42% in 2011. This study describes the current burden and risk factors for drowning across all demographics in rural Bangladesh. A household survey was carried out in 51 union parishads of rural Bangladesh between June and November 2013, covering 1.17 million individuals. Information on fatal and nonfatal drowning events was collected by face-to-face interviews using a structured questionnaire. Fatal and non-fatal drowning rates were 15.8/100,000/year and 318.4/100,000/6 months, respectively, for all age groups. The highest rates of fatal (121.5/100,000/year) and non-fatal (3057.7/100,000/6 months) drowning were observed among children 1 to 4 years of age. These children had higher rates of fatal (13 times) and non-fatal drowning (16 times) compared with infants. Males had slightly higher rates of both fatal and non-fatal drowning. Individuals with no education had 3 times higher rates of non-fatal drowning compared with those with high school or higher education. Non-fatal drowning rates increased significantly with decrease in socio-economic status (SES) quintiles, from the highest to the lowest. Drowning is a major public health issue in Bangladesh, and is now a major threat to child survival.

BackgroundBirth preparedness and complication readiness aims to reduce delays in care seeking, promote skilled birth attendance, and facility deliveries. Little is known about birth preparedness practices among populations living in hard-to-reach areas in Bangladesh.ObjectivesTo describe levels of birth preparedness and complication readiness among recently delivered women, identify determinants of being better prepared for birth, and assess the impact of greater birth preparedness on maternal and neonatal health practices.MethodsA cross-sectional survey with 2,897 recently delivered women was undertaken in 2012 as part of an evaluation trial done in five hard-to-reach districts in rural Bangladesh. Mothers were considered well prepared for birth if they adopted two or more of the four birth preparedness components. Descriptive statistics and multivariable logistic regression were used for analysis.ResultsLess than a quarter (24.5%) of women were considered well prepared for birth. Predictors of being well-prepared included: husband’s education (OR = 1.3; CI: 1.1–1.7), district of residence, exposure to media in the form of reading a newspaper (OR = 2.2; CI: 1.2–3.9), receiving home visit by a health worker during pregnancy (OR = 1.5; CI: 1.2–1.8), and receiving at least 3 antenatal care visits from a qualified provider (OR = 1.4; CI: 1.0–1.9). Well-prepared women were more likely to deliver at a health facility (OR = 2.4; CI: 1.9–3.1), use a skilled birth attendant (OR = 2.4, CI: 1.9–3.1), practice clean cord care (OR = 1.3, CI: 1.0–1.5), receive post-natal care from a trained provider within two days of birth for themselves (OR = 2.6, CI: 2.0–3.2) or their newborn (OR = 2.6, CI: 2.1–3.3), and seek care for delivery complications (OR = 1.8, CI: 1.3–2.6).ConclusionGreater emphasis on BPCR interventions tailored for hard to reach areas is needed to improve skilled birth attendance, care seeking for complications and essential newborn care and facilitate reductions in maternal and neonatal mortality in low performing districts in Bangladesh.

Background This paper estimates the impact on childhood drowning rates of community-based introduction of crèches or playpens or both in rural Bangladesh for children aged 0–47 months. Methods A baseline census of the whole population of 270,387 households in 51 unions, 451 villages from 7 rural sub-districts in Bangladesh was conducted in 2013. The baseline census determined retrospective, age-specific, and cumulative drowning incidence rates (IR) experienced in the target households in the 12 months prior to the intervention. Beginning in late 2013, creches for drowning prevention were established across the study area. Acceptance into creches was provided and written assent to attend a creche was obtained for all children aged 9–47 months in all participating unions. Playpens were provided to 45,460 of these children, of which 5981 children received only the playpens. All children were followed-up until their 48-month birthday or administrative censoring (fixed timepoint to stop observing the drowning deaths), after a two-year implementation period (2014–2016). Drowning IR were estimated for children and compared to corresponding baseline rates from 2012. Age-specific drowning IR under different “as treated” categories (playpen-only, creche-only, and playpen-plus-creche) were compared to the baseline rates experienced by the categorized households prior to intervention. Results A total of 3205 creches (average of 7 creches per village) were established, and 116,054 children aged 9–47 months were exposed to the intervention packages. Aggregated drowning IRs between age 0 and 47 were estimated per 100,000 population per year at 86.73 (95% CI: 69.67–107.97) and 43.03 (95% CI: 35.55–52.10) in the baseline and post implementation period, respectively. Risk ratios were 0.40 (95% CI: 0.28–0.57) overall, and 0.34 (95% CI: 0.13–0.90), 0.09 (95% CI: 0.02–0.36), and 0.04 (95% CI: 0.002–0.60) in children under the creche-only, aged, 1, 2, and 3 years old respectively. Inexplicably, drowning rates were statistically significantly higher post-intervention in children 0-11 months. There was no mortality reduction with playpen use (alone or in combination), and this group may actually have had a higher risk of drowning. Conclusions Creches are effective for preventing childhood drowning in rural Bangladesh for children above age 1-year, and should be considered for further scale-up.

Non-fatal injuries have a significant impact on disability, productivity, and economic cost, and first-aid can play an important role in improving non-fatal injury outcomes. Data collected from a census conducted as part of a drowning prevention project in Bangladesh was used to quantify the impact of first-aid provided by trained and untrained providers on non-fatal injuries. The census covered approximately 1.2 million people from 7 sub-districts of Bangladesh. Around 10% individuals reported an injury event in the six-month recall period. The most common injuries were falls (39%) and cuts injuries (23.4%). Overall, 81.7% of those with non-fatal injuries received first aid from a provider of whom 79.9% were non-medically trained. Individuals who received first-aid from a medically trained provider had more severe injuries and were 1.28 times more likely to show improvement or recover compared to those who received first-aid from an untrained provider. In Bangladesh, first-aid for non-fatal injuries are primarily provided by untrained providers. Given the large number of untrained providers and the known benefits of first aid to overcome morbidities associated with non-fatal injuries, public health interventions should be designed and implemented to train and improve skills of untrained providers.

BackgroundBangladesh has committed to universal health coverage, and options to decrease household out-of-pocket expenditure (OPE) are being explored. Understanding the determinants of OPE is an essential step. This study aimed to estimate and identify determinants of OPE in seeking health care for sick under-five children.MethodsCross-sectional data was collected by structured questionnaire in 2009 (n = 7362) and 2012 (n = 6896) from mothers of the under-five children. OPE included consultation fees and costs of medicine, diagnostic tests, hospital admission, transport, accommodation, and food. Expenditure is expressed in US dollars and adjusted for inflation. Linear regression was used for ascertaining the determinants of OPE.ResultsBetween 2009 and 2012, the median OPE for seeking care for a sick under-five child increased by ~ 50%, from USD 0.82 (interquartile range 0.39–1.49) to USD 1.22 (0.63–2.36) per child/visit. Increases were observed in every component OPE measured, except for consultation fees which decreased by 12%. Medicine contributed the major portion of overall OPE. Higher overall OPE for care seeking was associated with a priority illness (20% increase), care from trained providers (90% public/~ 2-fold private), residing in hilly/wet lands areas (20%), and for mothers with a secondary education (19%).ConclusionOPE is a major barrier to quality health care services and access to appropriate medicine is increasing in rural Bangladesh. To support the goal of universal health care coverage, geographic imbalances as well as expanded health financing options need to be explored.Electronic supplementary materialThe online version of this article (10.1186/s41043-017-0110-4) contains supplementary material, which is available to authorized users.