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Background Out-of-pocket (OOP) cost of cancer treatment has increased substantially globally. In low- and middle-income countries, many patients face financial distress due to cancer. For patients with cancers in Bangladesh, this study aimed to (1) estimate the annual OOP cost of cancers from households’ perspective, (2) assess the coping strategies and financial distress, and (3) examine factors associated with OOP cost. Methods We used data from a cross-sectional hospital-based survey conducted in three randomly selected hospitals in Bangladesh. A bottom-up micro-costing approach was used to estimate the OOP cost components. We used the logistic regression model and the generalized linear model to examine the determinants of distress financing and OOP cost, respectively. Results The average annual OOP cost per cancer patient was US$ 6,504 (range, US$ 959 − 29,681), which was greater than 2 times the average annual household income. About 90% of households faced distress financing due to cancer. Having at least one comorbid condition, cancer stage 2 or higher, households having no elderly people, or having treatment abroad was significantly associated with a higher OOP cost compared to those without the condition. Conclusion OOP cost of cancer treatment and the proportions of patients with distress financing and financial catastrophe are alarmingly high in Bangladesh. Earlier cancer diagnosis and implementation of Government financial health protection schemes are crucial and urgent to alleviate the enormous economic burden and ensure equitable access to care for the patients.

Background Out-of-pocket (OOP) expenditure is one of the most common payment strategies for hospitalization care in Bangladesh, and the share of OOP expenditure has been increasing at an alarming rate. This study aimed to investigate the OOP costs of hospitalization care, the impact of OOP on catastrophic healthcare expenditure (CHE) and financial distress, and the associated factors. Methods We used data from the most recent nationally representative dataset, the Bangladesh Household Income and Expenditure Survey 2022. A total of 14,395 households were surveyed, with 1973 household members hospitalized due to various illnesses. Respondents were asked to provide information regarding hospitalization care for the year preceding the survey. Households were considered to have CHE if they spent at least 25% of their total consumption expenditure or 40% of their non-food consumption expenditure on healthcare. Distress financing was defined as covering OOP healthcare costs by selling assets, borrowing money, or receiving financial assistance from friends or relatives. Multivariate logistic regression models were used to identify the determinants of CHE and distress financing. Results The annual average OOP cost of hospitalization was USD 418, with the OOP cost nearly twice as high in private facilities compared to public ones (USD 538 vs. USD 283). The highest OOP costs were observed for cancer treatment (USD 2365), followed by COVID-19 (USD 1391). Overall, 6.72% and 9.03% of hospitalized patients experienced CHE at 25% of total expenditure and 40% of non-food expenditure, respectively, while about 61% of patients faced distress financing due to hospitalization. Conclusion Financial hardship due to hospitalization remains high in Bangladesh. These findings will help policymakers adopt more effective healthcare financing strategies and improve the efficiency of public health investments.

IntroductionDespite advancements in water sanitation and vaccination, childhood diarrhoeal diseases (CDDs) continue to pose significant public health challenges, especially in South Asia. This study aims to estimate the pooled prevalence of CDDs in South Asia and identify the key factors contributing to its persistence, providing crucial insights for future policy and intervention strategies.MethodsThis study utilised data from the most recent Demographic Health Surveys conducted between 2015 and 2022 in Afghanistan, Bangladesh, India, Nepal, the Maldives and Pakistan, focusing on children under 5 years old. Descriptive statistics were used to measure the prevalence of CDDs and multivariable logistic regression was performed to identify significant factors. A p value of <0.05 was considered as the level of significance.ResultsThe overall pooled prevalence of CDDs was 10.13% (95% CI 9.83 to 10.45). Afghanistan had the highest rate of childhood diarrhoea in the South Asian region, with a prevalence of 29.15% (95% CI 28.01% to 30.31%), while the Maldives had the lowest prevalence at 4.17% (95% CI 3.20% to 5.42%). Higher odds of CDDs were associated with younger children, male sex, younger mothers, mothers with little or no education, larger households, unimproved drinking water and type of toilet facilities, lack of access to antimicrobial agents for handwashing and limited electronic media access. However, these factors varied from country to country.ConclusionThis study highlights the persistently high prevalence of childhood diarrhoea in South Asia. Country-specific findings underscore the urgency for focused interventions, particularly in Afghanistan and Pakistan, to effectively reduce CDDs in the region.

Upper limb dysfunctions (ULD) are common following a stroke. Annually, more than 15 million people suffer a stroke worldwide. We have developed a 7 degrees of freedom (DoF) exoskeleton robot named the smart robotic exoskeleton (SREx) to provide upper limb rehabilitation therapy. The robot is designed for adults and has an extended range of motion compared to our previously designed ETS-MARSE robot. While providing rehabilitation therapy, the exoskeleton robot is always subject to random disturbance. Moreover, these types of robots manage various patients and different degrees of impairment, which are quite impossible to model and incorporate into the robot dynamics. We hypothesize that a model-independent controller, such as a PID controller, is most suitable for maneuvering a therapeutic exoskeleton robot to provide rehabilitation therapy. This research implemented a model-free proportional–integral–derivative (PID) controller to maneuver a complex 7 DoF anthropomorphic exoskeleton robot (i.e., SREx) to provide a wide variety of upper limb exercises to the different subjects. The robustness and trajectory tracking performance of the PID controller was evaluated with experiments. The results show that a PID controller can effectively control a highly nonlinear and complex exoskeleton-type robot.

Introduction The aim of this research is to develop a robot-assistive training approach for the disabled individuals with impaired upper limb functions. People with impaired upper limb function can regain their motor functionality undergoing intense rehabilitation exercises. With increasing number of disabled individuals, we face deficiency in the number of expert therapists. One promising remedy could be the use of robotic assistive devices. Method To instruct and demonstrate rehabilitation exercise, this research used NAO robot. A library of recommended rehabilitation exercises involving shoulder (i.e., abduction/adduction, vertical flexion/extension, and internal/external rotation), and elbow (i.e., flexion/extension) joint movements was formed in Choregraphe (graphical programming interface). For this purpose, a kinematic model of human upper-extremity was developed based on modified Denavit-Hartenberg notations. Result In experiments, NAO robot gave voice instruction and was maneuvered to cooperate and demonstrate the exercises from the library. NAO also plays some complex game with the subject that represents a multi-joint movement's exercise, which was also included in the library. Conclusions Experimental results with healthy participants reveal that the NAO robot can successfully instruct and demonstrate upper-extremity rehabilitation exercises for single and multi-joint movements. It implies a technical development of cooperative rehabilitation system for which target group will be individuals with upper limb impairment.

The design of an upper limb rehabilitation robot for post-stroke patients is considered a benchmark problem regarding improving functionality and ensuring better human–robot interaction (HRI). Existing upper limb robots perform either joint-based exercises (exoskeleton-type functionality) or end-point exercises (end-effector-type functionality). Patients may need both kinds of exercises, depending on the type, level, and degree of impairments. This work focused on designing and developing a seven-degrees-of-freedom (DoFs) upper-limb rehabilitation exoskeleton called ‘u-Rob’ that functions as both exoskeleton and end-effector types device. Furthermore, HRI can be improved by monitoring the interaction forces between the robot and the wearer. Existing upper limb robots lack the ability to monitor interaction forces during passive rehabilitation exercises; measuring upper arm forces is also absent in the existing devices. This research work aimed to develop an innovative sensorized upper arm cuff to measure the wearer’s interaction forces in the upper arm. A PID control technique was implemented for both joint-based and end-point exercises. The experimental results validated both types of functionality of the developed robot.

In this study, we present an IoT-based robot for wrist rehabilitation with a new protocol for determining the state of injured muscles as well as providing dynamic model parameters. In this model, the torque produced by the robot and the torque provided by the patient are determined and updated taking into consideration the constraints of fatigue. Indeed, in the proposed control architecture based on the EMG signal extraction, a fuzzy classifier was designed and implemented to estimate muscle fatigue. Based on this estimation, the patient’s torque is updated during the rehabilitation session. The first step of this protocol consists of calculating the subject-related parameters. This concerns axis offset, inertial parameters, passive stiffness, and passive damping. The second step is to determine the remaining component of the wrist model, including the interaction torque. The subject must perform the desired movements providing the torque necessary to move the robot in the desired direction. In this case, the robot applies a resistive torque to calculate the torque produced by the patient. After that, the protocol considers the patient and the robot as active and all exercises are performed accordingly. The developed robotics-based solution, including the proposed protocol, was tested on three subjects and showed promising results.

Home-based hand rehabilitation has excellent potential as it may reduce patient dropouts due to travel, transportation, and insurance constraints. Being able to perform exercises precisely, accurately, and in a repetitive manner, robot-aided portable devices have gained much traction these days in hand rehabilitation. However, existing devices fall short in allowing some key natural movements, which are crucial to achieving full potential motion in performing activities of daily living. Firstly, existing exoskeleton type devices often restrict or suffer from uncontrolled wrist and forearm movement during finger exercises due to their setup of actuation and transmission mechanism. Secondly, they restrict passive metacarpophalangeal (MCP) abduction–adduction during MCP flexion–extension motion. Lastly, though a few of them can provide isolated finger ROM, none of them can offer isolated joint motion as per therapeutic need. All these natural movements are crucial for effective robot-aided finger rehabilitation. To bridge these gaps, in this research, a novel lightweight robotic device, namely “Flexohand”, has been developed for hand rehabilitation. A novel compliant mechanism has been developed and included in Flexohand to compensate for the passive movement of MCP abduction–adduction. The isolated and composite digit joint flexion–extension has been achieved by integrating a combination of sliding locks for IP joints and a wire locking system for finger MCP joints. Besides, the intuitive design of Flexohand inherently allows wrist joint movement during hand digit exercises. Experiments of passive exercises involving isolated joint motion, composite joint motions of individual fingers, and isolated joint motion of multiple fingers have been conducted to validate the functionality of the developed device. The experimental results show that Flexohand addresses the limitations of existing robot-aided hand rehabilitation devices.

Geriatric disorders, strokes, spinal cord injuries, trauma, and workplace injuries are all prominent causes of upper limb disability. A two-degrees-of-freedom (DoFs) end-effector type robot, iTbot (intelligent therapeutic robot) was designed to provide upper limb rehabilitation therapy. The non-linear control of iTbot utilizing modified sliding mode control (SMC) is presented in this paper. The chattering produced by a conventional SMC is undesirable for this type of robotic application because it damages the mechanical structure and causes discomfort to the robot user. In contrast to conventional SMC, our proposed method reduces chattering and provides excellent dynamic tracking performance, allowing rapid convergence of the system trajectory to its equilibrium point. The performance of the developed robot and controller was evaluated by tracking trajectories corresponding to conventional passive arm movement exercises, including several joints. According to the results of experiment, the iTbot demonstrated the ability to follow the desired trajectories effectively.

Women’s empowerment is crucial for sustainable development and the realisation of human rights for all. This study aims to categorise women’s empowerment levels—low, medium, and high—using the Survey-based Women’s Empowerment Index (SWPER) and to analyse the relationship between these levels and various child and women’s health indicators, using data from the latest three rounds of nationwide BDHS surveys. In Bangladesh, as of 2022, the majority of women were found to be moderately empowered (74.61 per cent), followed by highly empowered (18.16 per cent) and low empowered (7.22 per cent). Several factors showed significant associations with women’s empowerment, including age, educational attainment, gender of the household head, employment status, age at first childbirth, exposure to mass media, place of residence, and administrative division. The analysis revealed notable disparities in child health outcomes based on maternal empowerment levels. Children of low-empowered mothers experienced the highest rates of childhood stunting (28.6 per cent, p<0.001), wasting (12.1 per cent, p<0.01), and underweight (25.05 per cent, p<0.001). An inverse relationship was observed between women’s empowerment and nutritional status. For instance, a consistently higher prevalence of underweight was observed among women with low empowerment across all assessed domains—decision-making, social independence, and tolerance of violence—relative to highly empowered women. Similarly, institutional childbirth was consistently higher among highly empowered mothers across all empowerment domains over the years. These findings underscore the vital role of women’s empowerment in improving maternal and child health outcomes in Bangladesh. To advance sustainable development and promote human rights, it is imperative to implement policies that prioritise women’s empowerment at all levels of society.