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Bangladesh is one of the most populous countries in the world, as well as having one of the fastest growing economies in the world.^[1] Consequently, Bangladesh faces challenges and opportunities in regards to public health. A remarkable metamorphosis has unfolded in Bangladesh, encompassing the demographic, health, and nutritional dimensions of its populace.^[2]

The Human Rights Measurement Initiative^[3] finds that Bangladesh is fulfilling 89.3% of what it should be fulfilling for the right to health based on its level of income.^[4] When looking at the right to health with respect to children, Bangladesh achieves 95.0% of what is expected based on its current income.^[4] In regards to the right to health amongst the adult population, the country achieves only 94.2% of what is expected based on the nation's level of income.^[4] Bangladesh falls into the "bad" category when evaluating the right to reproductive health because the nation is fulfilling only 78.8% of what the nation is expected to achieve based on the resources (income) it has available.^[4]

To ensure equitable healthcare for every resident in Bangladesh, an extensive network of health services has been established. Infrastructure of healthcare facilities can be divided into three levels: medical universities, medical college hospitals, and specialty hospitals exist at the tertiary level. District hospitals, maternal and child welfare centers are considered to be on the secondary level. Upazila health complexes, union health & family welfare centers, and community clinics (lowest-level healthcare facilities) are the primary level healthcare providers. Various NGOs and private institutions also contribute to this intricate network.^[5][6]

The total expenditure on healthcare as a percentage of Bangladesh's GDP was 2.48% in 2019.^[7]

In the parliamentary budget of 2017–18, the budget that was set for the health sector was 16 thousand 203 crore 36 lakhs taka.^[8]

There are 3 hospital beds per 10,000 people.^[9] The general government expenditure on healthcare as a percentage of total government expenditure was 7.9% as of 2009. Citizens pay most of their health care bills as the out-of-pocket expenditures as a percentage of private expenditure on health: 96.5%.^[7] The doctor to population ratio is 1:2,000^[10] and the nurse to population ratio is 1:5,000^[10]

Hospitals in Bangladesh play a vital role in the country's healthcare system, providing essential medical services to the population. With a growing emphasis on improving healthcare infrastructure, Bangladesh has made significant progress in expanding access to hospital facilities across the country. According to the World Health Organization (WHO),^[11] as of 2021, there were approximately 5,146 hospitals in Bangladesh, including both public and private institutions. These hospitals offer a wide range of medical specialties and services, ranging from general healthcare to specialized treatments. The government has also implemented various initiatives to enhance hospital quality and promote patient safety. The availability of hospitals has contributed to improving healthcare outcomes and addressing the healthcare needs of the Bangladeshi population.

• Population – 168. million^[12]
• Rural population – 70%
• Population density – (population/km2) 1,070/sqkm
• People below poverty line – 60%
• Population doubling rate – 25–30 years
• GDP (current US$)(billions) – 300^[13]

^[14]

• CDR – 5.35 /1000
• Maternal mortality ratio – 176 /100000
• IMR – 31 /1000 live births
• Under 5 MR – 38 /1000 live births
• Total fertility rate – 2.1
• Life expectancy at birth – 71 (m) and 73 (f)
• Fully immunized children – 52%

Due to a large population, Bangladesh faces a large burden of disease:

• Non-communicable diseases: diabetes, cardiovascular disease, hypertension, stroke, chronic respiratory disease, cancer
• Communicable diseases: tuberculosis, HIV, tetanus, malaria, measles, rubella, leprosy^[15]

Malnutrition and environmental sanitation problems add to this burden.

Historically, communicable diseases formed the bulk of total diseases in developing and tropical countries such as Bangladesh. By 2015 via Millennium development Goals, where communicable diseases were targeted, Bangladesh attained almost significant control on communicable diseases.^[15] An expanded immunization program against nine major diseases (TB, tetanus, diphtheria, whooping cough, polio, hepatitis B, Haemophilus influenza type B, measles, rubella) was undertaken for implementation.

Background: Tuberculosis is one of the most dangerous chronic infectious diseases in Bangladesh. It is the major public health problem in this country. Mycobacterium tuberculosis is a commonly responsible organism of tuberculosis. It is an airborne disease that spreads through the coughing of an infected person. This disease is more prone to slum dwellers living in unhygienic conditions. Tuberculosis mainly infects the lungs (pulmonary tuberculosis) with the symptoms of persistent cough, evening fever with sweating, chest pain, weakness, weight loss, hemoptysis, etc. But it can also infect the other parts of the body (extrapulmonary tuberculosis) like the brain, kidneys and bones. In most cases patients infected with tuberculosis have other concomitant infections. HIV is more common to them.^[16]

Present TB status of Bangladesh: According to the WHO, 'Global TB Report 2017' total population was 165 million, Bangladesh is one of the world's 30 high TB burden countries and near about 59170 people died due to tuberculosis. The total estimated number of TB patients was 364000, among them male patients were recorded at 236000, and female patients was 128000. In 2017 the total case was notified 244201. The total new and relapse case was 242639. People are mainly suffering from pulmonary TB; it was 81% (197800 patients) of notified cases.^[16] Still now, HIV is considered as the most deadly infectious disease all over the world. It suppresses the immune system of the body. So any kind of infection can be incubated into the body, HIV infected person can be easily infected by mycobacterium tuberculosis.

TB with HIV patient: Still now, HIV is considered as the most deadly infectious disease all over the world. It suppresses the immune system of the body. So any kind of infection can be incubated into the body, HIV infected person can be easily infected by mycobacterium tuberculosis, it is HIV-TB co infection. In 2017, the estimated number of the patient with HIV positive status tuberculosis was 540. Patient with HIV positive status (new and relapse case) notified was 89, out of 540 HIV positive patients. Among 89 patient 84 patients took anti-retroviral therapy.

^[16]

Drug resistance: When micro-organism of TB causes resistance to isoniazid or/and rifampicin the most effective drugs of TB. If the organism causes resistance against both of the drugs then it is called multi-drug-resistant tuberculosis (MDR-TB). In 2017 the estimated number of MDR was 8400, among them 5800 cases was notified and 944 patients were confirmed by laboratory test and 920 patients started immediate treatment. If any patient develops resistance against isoniazid/rifampicin and one of the 2nd line antibiotic fluoroquinolones (i.e. amikacin, kanamycin, or capreomycin), it's called extreme drug resistance tuberculosis (XDR-TB). In 2017, 6 patients were confirmed XDR-TB by laboratory diagnosis and all of them started treatment instantly. As 31 December 2017, countrywide a total 6420 MDR-TB patients were enrolled for treatment including 920. Among 920 patients, 425 patients were in 24 month regimen and 495 patients were 9 months regimen^[17][16]

Bangladesh combats with TB: Under Mycrobacterial Disease Control (MBDC) Unit of the Director-General Health Service (DGHS), National Tuberculosis Control Program (NTP) is working with a goal to eliminate tuberculosis from Bangladesh. The NTP adopted DOTS (directly observed treatment, short-course) strategy during the fourth Population and Health Plan (1992-1998) and implemented it at field level in November 1993. This strategy reduced TB cases significantly. The program achieved 70% new smear-positive case reduction in 2006 and treated 85% of them since 2003. This program has successfully treated 95% of bacteriologically confirmed new pulmonary cases registered in 2016.

Indicator	Milestone		Targets
			SDG	End TB
Year	2020	2025	2030	2035
Reduction of deaths due to tuberculosis ( Projected 2015 baselines (72450) in absolute number	47092	18112	7245	3622

Table-1: Bangladesh Indicator in Line with End TB Strategy

In 2015 the TB case was noted 225/ per 100000 patient and the Government of Bangladesh has taken the target of reduction of TB New cases 10/ per 100000 patients by 2035 that will be around 1650 cases.^[17]

However, recent statistics shows that non-communicable disease burden has increased to 61% of the total disease burden due to epidemiological transition. According to National NCD Risk Factor Survey in 2010, 99% of the survey population revealed at least one NCD risk factor and ≈29% showed >3 risk factors .Social transition, rapid urbanization and unhealthy dietary habit are the major stimulating reasons behind high prevalence of non-communicable diseases in Bangladesh remarkably in under-privileged communities such as rural inhabitants, urban slum dwellers.^[15][18][19]

Diabetes, one of four priority non-communicable diseases targeted by world leaders has become a major health problem globally^[20] (537 million adults with diabetes in 2021 and projected to increase to 642 million by 2040).^[21] High fasting plasma glucose ranks seventh among risk factors for disease in South Asia.^[22] Bangladesh has the eighth highest population of people with diabetes, at 13.1 million.^[21] Studies have shown that the prevalence of diabetes is increasing moderately to significantly in the rural population of Bangladesh.^[23][24] However, compared to Western nations, the major diabetic population is non-obese.^[23][25][26]

The prevalence of Diabetic retinopathy in Bangladesh is about one third of the total diabetic population (nearly 1.85 million) .These recent estimates are higher like western Countries and similar to Asian Malays living in Singapore. Sharp economic transition, urbanization, technology based modern life style, tight diabetes control guidelines and unwillingness to receive health care are thought to be the risk factors of diabetic retinopathy in Bangladesh. Unfortunately to attain that emerging health problem, the current capacity in the country to diagnose and treat diabetic retinopathy is very limited to a few centers. Till this year (2016), as per record of National Eye Care under HPNSDP (Health Population Nutrition Sector Development Program), 10,000 people with Diabetic Retinopathy have received services from Secondary and tertiary Hospitals where the screening programs have been established.^[27][28][29]

Musculoskeletal disorders (MSDs) are a combination of inflammatory and degenerative conditions that influence the muscles, tendons, ligaments, joints or peripheral nerves, normally leading to aches, pains or discomfort. These are the most usual cause of severe long-term pain, physical disability and premature deaths. MSDs are one of the most prevalent occupational diseases liable for work limitation and absenteeism. Besides, these diseases can manifest as acute or chronic problems and can be incapacitating for their patients leading to huge costs for health systems particularly for chronic. pain.^[30]

The causes of MSDs can be exposure to work-related or ergonomic risk factors and individual related risk factors. Repeated manual labor, lifting heavy loads, prolonged static work, overexertion, vibration, or working in an awkward posture usually leads work related MSDs. Extended working hours and uncomfortable postures were significantly associated with the risk of MSDs^[31] and workers who work for conventional working hours (8 hrs per day) were less prone to develop MSDs. Among Ready Made Garments workers lower back and upper back are the most affected area due to prolonged work and wrong posture. Moreover, work breaks, working under pressure or with deadlines, poor job design, job insecurity, and lack of social support from colleagues and supervisors are directly related to stress, and that stress can appear in increased muscle tension and other stress-related differences to the body, making workers more vulnerable to developing MSDs. Workers often work for extended hours in awkward position can also suffer MSDs.^[32] Age, gender, health and lifestyle are the individual risk factors that are responsible for the higher risk of MSDs and other chronic conditions.

Person's skills and functions are affected by Musculoskeletal disorders and therefore influence their activities of daily life. Back and neck pain, osteoarthritis, rheumatoid arthritis and fractures are the most disabling conditions.^[33] Moreover, these are often correlated with major non-communicable co-morbidities (ischemic heart disease, stroke, cancer and chronic respiratory disease) and they jointly increase disabilities and deaths.^[34]

The most prevalent MSDs in Bangladesh is low back pain (18.6%). Rapid urbanization, transition to sedentary work, weight gain; domestic and professional activities in banding posture may be responsible for the higher prevalence of low back pain in Bangladesh. The second commonest MSDs are knee osteoarthritis (7.3%) and it is related to more knee usage during occupational and household chores in Bangladesh. Besides these soft tissue injuries and rheumatism can be the third commonest disorders (3.8%)^[35]

Among the female readymade garment workers in Bangladesh, the prevalence of lower back pain (41%) was the most leading accompanied by pain in the knees(33%) and neck pain (28%).^[36]

Musculoskeletal disorders are mostly preventable and prevention is the best treatment. Therefore, understanding what these disorders are and the risk factors that contribute to their development is very fundamental. Furthermore, developing an effective and efficient prevention strategy requires, risk assessment process and implementation of technical, organizational, and person-oriented measures.^[37]

Zdroj:https://en.wikipedia.org?pojem=Healthcare_in_Bangladesh
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