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Assessing the quality of antenatal care (ANC) is imperative for improving care provisions during pregnancy to ensure the health of mother and baby. In Bangladesh, there is a dearth of research on ANC quality using nationally representative data to understand its levels and determinants. Thus, the current study aimed to assess ANC quality and identify the sociodemographic factors associated with the usage of quality ANC services in Bangladesh. Secondary data analysis was conducted using the last two Bangladesh Demographic and Health Surveys (BDHSs) from 2014 and 2017-18. A total of 8,277 ever-married women were included in the analysis (3,631 from 2014 and 4,646 from 2017-18). The quality ANC index was constructed using a principal component analysis on the following ANC components: weight and blood pressure measurements, blood and urine test results, counselling about pregnancy complications and completion of a minimum of four ANC visits, one of which was performed by a medically trained provider. Multinomial logistic regression was used to determine the strength of the association. The percentage of mothers who received all components of quality ANC increased from about 13% in 2014 to 18% in 2017-18 (p < 0.001). Women from the poorest group, those in rural areas, with no education, a high birth order and no media exposure were less likely to receive high-quality ANC than those from the richest group, those from urban areas, with a higher level of education, a low birth order and media exposure, respectively. Although the quality of ANC improved from 2014 to 2017-18, it remains poor in Bangladesh. Therefore, there is a need to develop targeted interventions for different socio-demographic groups to improve the overall quality of ANC. Future interventions should address both the demand and supply-side perspectives.

The global Coronavirus disease (COVID-19) pandemic disrupted healthcare systems, reducing access to medical services. In Bangladesh, strict lockdowns, healthcare worker shortages, and resource diversion further strained the system. Despite these challenges, the impact on inpatient and outpatient service utilisation in Bangladesh remains unaddressed. This study explored the levels of inpatient admissions and outpatient visits in public healthcare facilities before and during COVID-19 pandemic in Bangladesh. We conducted a cross-sectional secondary analysis of inpatient and outpatient data from all public hospitals collected via District Health Information System, version 2 (DHIS2) from January 2017 to June 2021. Using 2017-2019 as the baseline, we analysed healthcare utilisation indicators (outpatient visits and inpatient admissions) with descriptive and segmented Poisson regression to assess the impact of COVID-19 in 2020 and 2021. In 2020, outpatient visits and inpatient admissions significantly declined to 34.1 million and 37.5 million, respectively, from 47.6 million and 56.2 million in 2019. Segmented regression analysis confirmed these drops, especially in Dhaka (IRR =  0.62, p < 0.001) and Barisal (IRR =  0.69, p < 0.002) for outpatient visits, and in Dhaka (IRR =  0.64, p < 0.000) and Khulna (IRR =  0.70, p < 0.000) for inpatient admissions. In 2021, most divisions saw an increase in outpatient visit and inpatient admission numbers, with the lowest rebound in Sylhet. The COVID-19 pandemic significantly reduced Outpatient Department (OPD) visits and Inpatient Department (IPD) admissions in Bangladesh in 2020, with partial recovery in 2021. To ensure sustained access to care, it is crucial to strengthen healthcare facilities and equip healthcare providers to be prepared for future pandemics or emergencies.

Modern family planning plays a vital role in reducing unintended pregnancies, a major reproductive health issue worldwide. Access to modern family planning services is essential for empowering women to have greater control over their reproductive health and rights. In Bangladesh, there remains an unmet need for modern family planning services among reproductive-aged women. Assessing the capacity of health facilities to address these unmet needs for modern family planning is crucial. The objective of this study was to assess the changes in the availability and readiness of health facilities to provide modern family planning services in Bangladesh between 2014 and 2017, and identify factors associated with facility readiness. We performed a secondary analysis of cross-sectional data from Bangladesh Health Facility Surveys (BHFS) conducted in 2014 and 2017. Availability was determined based on whether a facility offered at least one modern family planning method, and facility readiness was measured following the Service Availability and Readiness Assessment (SARA) manual. Descriptive statistics with 95% confidence intervals (CIs) were reported, and Poisson regression models were used to identify factors associated with health facility readiness. The percentage of facilities offering modern family planning services increased significantly from approximately 81% (95% CI: 78, 85) in 2014 to 89% (95% CI: 87, 91) in 2017. The availability of oral pills, injectables, and male condoms increased over this period, while the availability of long-acting reversible contraceptives (LARCs) slightly decreased, and permanent methods (PMs) remained nearly unchanged. The overall mean readiness score of health facilities declined slightly, from about 54 (95% CI: 52, 56) in 2014 to 51 (95% CI: 50, 53) in 2017. Upazila Health Complexes and Maternal and Child Welfare Centers had significantly higher readiness compared to District Hospitals in 2017. Facilities that performed routine quality assurance activities, ensured 24-hour staff coverage, maintained a system for reviewing clients' feedback, and provided family planning services regularly demonstrated significantly higher readiness to provide modern family planning services in both 2014 and 2017. Regional disparities were also observed; facilities in rural areas had significantly lower readiness than those in urban areas, and facilities from the Rangpur division showed significantly higher readiness compared to those in Dhaka in both survey years. The findings indicate a significant increase in the availability of health facilities offering modern family planning services in Bangladesh; however, a slight decline has been observed in their overall mean readiness score. Ensuring an adequate provision of equipment and supplies, expanding access to LARCs and PMs, and improving staff capacity through regular training are essential. Furthermore, strengthening quality assurance activities and investing in rural facilities are required for improving the facility readiness and advancing progress toward achieving SDG 3.7 targets of universal access to modern family planning services in Bangladesh.

Anxiety and depression are significant concerns among antenatal women in Bangladesh. Despite the critical need for tailored mental health care in health facilities, studies on these symptoms in this demographic remain lacking. Therefore, our study aimed to assess the levels, distribution, and associated factors of depressive and anxiety symptoms and their co-occurrence among women seeking antenatal care at a public healthcare facility in Bangladesh. We conducted a cross-sectional study between May 2024, and June 2024, among women seeking antenatal care (ANC) care in Durgapur Upazila Health Complex, a primary-level public health facility in Bangladesh. Among 640 women who received ANC care, 638 participated in the study. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9), and anxiety symptoms were assessed by the Generalized Anxiety Disorder-7 (GAD-7). Bivariate and multivariable logistic regression were conducted to determine factors contributing to depressive and anxiety symptoms. About 39% of participants had depressive symptoms and 50% had anxiety symptoms, with 26% experiencing both simultaneously. No participants had severe overall depressive or anxiety symptoms. PHQ-9 data indicated half experienced daily fatigue, while GAD-7 data showed over half experienced daily nervousness and two-fifths had daily fears. Women in the second and third trimesters had 43% (aOR: 0.57, 95% CI: 0.36–0.89) and 58% (aOR: 0.42, 95% CI: 0.24–0.71) lower odds of depressive symptoms compared to those in the first trimester respectively. Women with 11 years or more education had 40% (aOR: 0.60, 95% CI: 0.38–0.94) lower odds of anxiety. Additionally, women in the second and third trimesters had 40% (aOR: 0.60, 95% CI: 0.37–0.97) and 49% (aOR: 0.59, 95% CI: 0.29–0.91) lower likelihood of co-occurrence compared to those in the first trimester and women with 6–10 years of education had 48% (aOR: 0.52, 95% CI: 0.34–0.79) and those with 11 or more years had 52% (aOR: 0.48, 95% CI: 0.29–0.81) lower likelihood of co-occurring depressive and anxiety symptoms compared to women with 5 years or less education. Our study found a high prevalence of depressive and anxiety symptoms among antenatal care seekers, with notable co-occurrence of these conditions. Given these findings, there is an urgent need for targeted mental health support for these women, especially those in their first trimester and those with limited education.

Increasing the availability and readiness of basic emergency obstetric and newborn care (BEmONC) services is essential for improving maternal and neonatal health. However, little is known about any progress made in the availability and readiness of BEmONC services in Bangladesh. Using nationally representative data from the Bangladesh Health Facility Survey conducted between 2014 and 2017, we measured changes in the availability and readiness of BEmONC services in health facilities in Bangladesh, calculating the BEmONC service availability and readiness scores according to the World Health Organization Service Availability and Readiness Assessment guideline. The percentage of health facilities performing all seven basic signal functions declined slightly from 13% in 2014 to 11% in 2017. The decline was largely noticed in Maternal and Child Welfare Centers, Upazila Health Complexes, and Union Subcenter/Rural Dispensaries, as well as in all divisions except Rangpur. No remarkable changes in overall readiness of health facilities across location, division and facility type were observed between 2014 and 2017. However, significant reductions in availability and readiness were noticed when item-specific assessment was made. Type of health facility was significantly associated with both availability and readiness scores in adjusted regression models. Appropriate strategies and efforts could improve the availability and readiness of BEmONC services in health facilities in Bangladesh.

The rapid advancement of digital technologies, particularly in big data analytics (BDA), artificial intelligence (AI), machine learning (ML), and deep learning (DL), is reshaping the global health care system, including in Bangladesh. The increased adoption of these technologies in health care delivery within Bangladesh has sparked their integration into health care and public health research, resulting in a noticeable surge in related studies. However, a critical gap exists, as there is a lack of comprehensive evidence regarding the research landscape; regulatory challenges; use cases; and the application and adoption of BDA, AI, ML, and DL in the health care system of Bangladesh. This gap impedes the attainment of optimal results. As Bangladesh is a leading implementer of digital technologies, bridging this gap is urgent for the effective use of these advancing technologies. This scoping review aims to collate (1) the existing research in Bangladesh's health care system, using the aforementioned technologies and synthesizing their findings, and (2) the limitations faced by researchers in integrating the aforementioned technologies into health care research. MEDLINE (via PubMed), IEEE Xplore, Scopus, and Embase databases were searched to identify published research articles between January 1, 2000, and September 10, 2023, meeting the following inclusion criteria: (1) any study using any of the BDA, AI, ML, and DL technologies and health care and public health datasets for predicting health issues and forecasting any kind of outbreak; (2) studies primarily focusing on health care and public health issues in Bangladesh; and (3) original research articles published in peer-reviewed journals and conference proceedings written in English. With the initial search, we identified 1653 studies. Following the inclusion and exclusion criteria and full-text review, 4.66% (77/1653) of the articles were finally included in this review. There was a substantial increase in studies over the last 5 years (2017-2023). Among the 77 studies, the majority (n=65, 84%) used ML models. A smaller proportion of studies incorporated AI (4/77, 5%), DL (7/77, 9%), and BDA (1/77, 1%) technologies. Among the reviewed articles, 52% (40/77) relied on primary data, while the remaining 48% (37/77) used secondary data. The primary research areas of focus were infectious diseases (15/77, 19%), noncommunicable diseases (23/77, 30%), child health (11/77, 14%), and mental health (9/77, 12%). This scoping review highlights remarkable progress in leveraging BDA, AI, ML, and DL within Bangladesh's health care system. The observed surge in studies over the last 5 years underscores the increasing significance of AI and related technologies in health care research. Notably, most (65/77, 84%) studies focused on ML models, unveiling opportunities for advancements in predictive modeling. This review encapsulates the current state of technological integration and propels us into a promising era for the future of digital Bangladesh.

Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.

Background Assessing maternal health care utilisation is imperative for the health of both mother and her child. Maternal education is an important determinant in subsequent maternal health care usage, according to research. There is a dearth of research on the causal relationship between maternal education and maternal health services as well as examining the performance of different propensity score methods for estimating absolute effects. Therefore, this study aims to estimate the effect of maternal education on usage of maternal health services minimising the confounding effect and to compare different propensity score approaches to estimate absolute effects of maternal education on usage of maternal health services. Methods We used data from a cross-sectional study conducted by icddr,b in Bangladesh. A total of 1300 recently delivered mothers were included in this study. We used different propensity score (PS) methods to estimate the causal effect of maternal education on receiving maternal health services, including PS matching, PS weighting, covariate adjustment using PS, as well as used modified log-Poisson regression with and without multiple covariates. Results The study revealed highly imbalanced possible confounding factors for mother's educational level, which might lead to erroneous estimates. All methods indicated a significant effect of higher maternal education, whether measured as a continuous scale or a binary variable (secondary or higher vs. below secondary) on maternal health services, significantly increased the likelihood of receiving four or more ANC, delivered at facility, PNC within 42 days and receiving all maternal health services compared to the mothers with lower level of education. The PS weighting provided precise estimates with a low range of confidence interval. Conclusions The results provided important insights on how well these techniques worked to reduce effect of confounding variables and achieve precise estimates. Propensity score weighting method performed better in terms of providing more precise estimates with a narrower range of confidence intervals, indicating that this method may be a reliable approach for estimating the causal effect of maternal education on maternal health service utilisation. However, careful consideration should be given to selecting the most appropriate method.

Countries like Bangladesh face significant challenges in effectively registering and tracking deaths within their civil registration systems, which are essential for public health. To improve data collection for public health policy, death record-keeping at burial sites should be enhanced, particularly in areas where burial certificates are issued. With this in mind, we examined the traditional paper-based practices for recording deaths, the perceived significance of these practices, and the associated challenges, expectations, and concerns related to death record-keeping in Bangladeshi cemeteries. In 2021, we conducted an exploratory qualitative study involving 25 in-depth interviews with individuals who had lost relatives during the COVID-19 pandemic and key informant interviews with service providers at cemeteries. We complemented these interviews with non-participant observations of burial registration practices in seven cemeteries across urban, peri-urban, and rural settings. We used thematic analysis to interpret the data. Our findings reveal diverse death record-keeping practices influenced by sociocultural and administrative dynamics, emphasising the necessity of accurate documentation for securing legal rights and social benefits, such as inheritance and welfare. Notable tensions exist between bureaucratic demands and the emotional realities of grieving families, particularly in non-standardised cemeteries, where acquiring death certificates poses challenges. Stakeholders view the anticipated digitalisation of death record-keeping as a transformative opportunity to streamline processes and improve access to information. However, this transition also highlights existing generational and educational disparities in technological skills, alongside ethical concerns regarding data security and user confidentiality. Our findings showcase the complex interaction between cultural practices, bureaucratic frameworks, and emerging digital technologies in managing death records in Bangladesh. They also emphasise the challenges of modernising traditional documentation methods, as well as the importance of maintaining death records for enhancing civil registration and vital statistics, asserting property rights, and monitoring mortality. A digital system could provide innovative and reliable mortality surveillance from cemeteries.

IntroductionThe growing prominence of social franchising in healthcare underscores the need to analyse its implementation and impacts; however, substantial research gaps remain. Therefore, we aimed to conduct a systematic review and narrative synthesis of evidence to analyse the social franchise models, implementation and outcomes.MethodsWe conducted a systematic literature search in February 2024 on Medline, Embase, PubMed, Web of Science, CINAHL and Scopus using terms related to ‘social franchising’ in healthcare. We conducted a qualitative narrative synthesis of study findings into five thematic areas: client impact and utilisation, healthcare outcomes, financial sustainability, innovative technologies and awareness activities.ResultsFrom 4184 search results, 47 studies were included in the analysis. We identified 29 social franchises across 25 countries. Social franchises were mostly present in Africa, Asia and Central America. Most franchises focused on sexual, reproductive and maternal health (n=18) and family planning (FP) (n=25), and most included training (n=21), service provision (n=17) and financial support (n=12). Franchising improved client volumes, satisfaction and contraceptive continuation rates and increased access to healthcare. Vouchers and subsidised services reduced the financial burden among clients. Telemedicine and call centres enhanced healthcare delivery, and community outreach and marketing increased awareness and modern contraceptive use. However, franchises struggled to reach poorer populations due to high fees and competition from public services. It often did not improve FP, reproductive healthcare and child nutrition and had limited branding and promotional activities. Additionally, heavy reliance on donor funding threatened long-term sustainability.ConclusionSocial franchising presents a potential strategy for expanding healthcare access and improving service delivery, though outcomes regarding the effectiveness of social franchising vary across regions. More research is needed to evaluate digital technology use and the long-term impact, equity and sustainability of social franchising.PROSPERO registration numberCRD42022328104.