MOJ ISSN: 2379-6383MOJPH

Public Health
Short Communication
Volume 3 Issue 1 - 2015
Title: Emerging Patterns of Mortality and Morbidity in District Level Hospitals in Bangladesh
Abdur Razzaque Sarker*, Marufa Sultana and Rashidul Alam Mahumud
Health Economics and Financing Research Group, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
Received: February 8, 2015 | Published: November 30, 2015
*Corresponding author: Abdur Razzaque Sarker, Health Economics and Financing Research Group, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Email:
Citation: Sarker AR, Sultana M, Mahumud RA (2015) Title: Emerging Patterns of Mortality and Morbidity in District Level Hospitals in Bangladesh. MOJ Public Health 3(1): 00051. DOI: 10.15406/mojph.2015.03.00051

Abstract

Information on the existing disease pattern is essential to provide need base healthcare delivery to any population. This viewpoint has made an effort to present a picture of disease pattern of a population who has taken services either as inpatient or outpatient in district level hospital in Bangladesh. The picture of top ten diseases (based on mortality and morbidity) intend to suggest need-based resource allocation considering the major type of diseases and the proportion of admit patients in the facility.

Keywords: Mortality; Morbidity; District hospital; Bangladesh

Abbreviations

BHB: Bangladesh Health Bulletin; COPD: Chronic Obstructive Pulmonary Disease; NGO: Non-Governmental Organization

Introduction

Information on the existing disease pattern is essential to provide need base healthcare delivery to any population [1]. The demographic structure of Bangladesh is changing faster and the population pyramid is wider at the bottom than the top and narrows slightly at the youngest age group. This effect on the burden of disease includes both the increase in the numbers of people and the effect of an increasing average age of the population [2]. This demographic nature have attracted considerable attention from health policy makers, healthcare managerial level and public health expertise since the disease pattern is continuously changing that will affect on healthcare costs [3]. Despite substantial gains in health outcome since independence in 1971, hospital beds and physicians per population remain very low, at 1698 and 2894 per population, respectively [4]. A wide range of health indicators such as morbidity, mortality, anthropometric measures and nutritional status generally used to measure health status of a population in a country. Among these indicators, morbidity and mortality data have been commonly used to quantify the burden of disease as they are easily measurable, internationally comparable and data are mostly available. Morbidity is a measure of disease, injuries or ill health of a population, while mortality refers to the number of people who died within the population. Both statistics reflect a country’s level of overall development and quality of life. However, self -reported illness measures to health status of the particular peoples its consistent relationship with future mortality in many countries and its direct linkage with policy changes [5]. In Bangladesh, district hospitals which provide care in several specialty areas of diseases, including indoors, outdoors, and emergencies. These hospitals involved with the diagnosis of the diseases and act as the secondary level referral facility of health services of Bangladesh. The hospital provides services under the management of civil surgeon (administrative head) with a view to render out-patient, in-patient, emergency, laboratory and imaging services to the people. This viewpoint has made an effort to present a picture of disease pattern of a population who have taken services either as inpatient or outpatient in the district level hospital in Bangladesh by using reported morbidity and mortality data which published in ‘Bangladesh Health Bulletin’ (BHB) over 2008-2013 which can be a future attention for allocating resources in the district level hospital.

In spite of all advances in health technology, improved management, and increased use of oral rehydration therapy, diarrhea, water born communicable disease is still a leading cause of morbidity in Bangladesh and it is the top most disease based on morbidity till now and the percentage of share increasing with no change in order from recent years. The incidence of hospital-acquired diarrhea is4.8 cases per 1,000 patient- days, and particularly young children are at risk for hospital acquired diarrhea and associated deaths in Bangladeshi hospitals [6]. Pneumonia, another infectious disease which is one of the leading causes of childhood illness is in the third highest cause of morbidity and also leading cause of mortality. Specifically, In Bangladesh, among the total 183,000 under-5 children who die each year, 14% die of pneumonia [7]. It is threatening that assault and road traffic accidents which are not directly involved with any medical condition ranked within top five and are directly linked with mortality and morbidity. Peptic ulcer also remains as a chronic cause of morbidity with a stable pattern population largely due to the poor socio-economic conditions and lack of awareness about the disease and ranked within top five. Peptic ulcer disease has a point prevalence of approximately 15%, which is much higher (15% vs. 1.5%) than that in the developed countries [8]. The other causes of morbidity include chronic obstructive pulmonary disease (COPD), different types of viral fever, hypertension, poisoning and cerebrovascular accident. According to the reported cause of death, birth asphyxia, a common cause of preventable cerebral injury occurring in the neonatal period, is the top most cause of mortality followed by the acute myocardial infarction which is occurring frequently and the percentage is going to upwards. Recent evidence showed that among the cardiovascular diseases, ischemic heart disease is also emerging as serious health problems associated with mortality and is moved from top eight in 2012 to top 3rd in 2013. Other top causes of mortality include cerebrovascular disease, pneumonia, and injury due to road traffic accident, septicemia and poisoning. Still now low birth weight is a major concern, but notable progress has also been observed with a downward movement and percentage of share is decreasing from recent years. Again, with rapid urbanization and the exponential growth of transport networks, Bangladesh is experiencing a very severe road safety problem and the situation has been deteriorating with increasing number of road accident death in each year.

Since a large number of the population came to the district level hospital as most of the cases the low income people cannot get financial support to admit the private hospitals and the treatment costs for the patients much less than private for-profit and hospitals financed by Non-Governmental Organizations (NGOs). On the contrary, the quality of service in the public hospitals is not so standard and the trend of the health budget is going to lower than the previous fiscal year. While identifying new sources of funding in any sector is a major political decision and usually a long-term plan of the government, many countries concentrate on effective utilization of available resources instead. In public hospitals, budgets for most categories of regular expenditure are determined centrally by the government of Bangladesh. The system can best be characterized as line budgets based on capacity and historically determined normative. Line budgets mean that resources are allocated for specific line items (e.g., diet, medical surgical requisites). Capacity and historically normative mean that budget setting is based both on the size of physical capacity as measured by the number of facilities, staff or beds and also funding provided to the same facilities in previous years and diet cost from patient flows.

The distribution of patients and disease-specific treatment requirement is not considered in budget allocation as we see above. The picture of the top ten diseases (based on mortality and morbidity) intends to suggest need-based resource allocation considering the major type of diseases and the proportion of admit patients in the facility (Table 1).

Morbidity Profile

MortalityProfile

Disease and health related conditions / Year

Rank (%)

Disease and health related conditions / Year

Rank (%)

2008

2009

2010

2011

2012

2013

2008

2009

2010

2011

2012

2013

Diarrheal Disease

1(12.4)

1(13)

1 (9.3)

1(11.15)

1(12.24)

1(12.65)

Birth Asphyxia

1(12.6)

1(11.32)

1(15.36)

-

1(10)

1(4.58)

Assault

2 (9.4)

4(4.1)

2(7.21)

2 (7.48)

2 (7.91)

2 (7.12)

Acute Myocardial Infarction

7 (4.6)

5 (4.61)

4 (6.38)

2 (8)

2(4.4)

2(2.74)

Pneumonia

3 (6.4)

3(5.7)

3(6.13)

3 (5.77)

3 (5.17)

3 (3.93)

Ischemic Heart Disease

5 (6.2)

-

-

-

8(1.8)

3(1.72)

Road Traffic Accident

-

5 (2)

5(3.17)

6 (2.44)

4 (3.71)

4 (3.89)

Low Birth Weight

8(4.4)

8(3.31)

8 (4.41)

3( 7)

4(2.5)

4(1.44)

Peptic Ulcer

4 (3.3)

2(7.6)

4(3.76)

4 (3.45)

5 (3.22)

5 (3.4)

Stroke

-

-

-

-

-

5(1.29)

Bronchial Asthma

-

9(1.7)

6(2.12)

9 (1.97)

6 (2.44)

6 (2.65)

Cerebrovascular Diseases

2 (9.6)

9 (2.69)

2 (10.9)

9 (3)

7(1.8)

6(1.22)

Viral Fever

6 (2.5)

-

-

-

7 (2.3)

7 (2.42)

Pneumonia

3 (8.6)

4 (5.76)

-

1(10)

3(4.1)

7(1.13)

Hypertension

-

7(1.9)

8(1.75)

-

9 (2.04)

8 (2.16)

Road Traffic Accident

-

-

6 (4.55)

8( 4)

-

8(0.94)

Poisoning

7 (2.3)

8(1.7)

7(1.75)

7 (2.25)

8 (2.12)

9 (2.07)

Septicaemia

6 (5.3)

6 (3.6)

5 (5.42)

10(3)

5(2.3)

9(0.89)

Cerebrovascular Accident

-

-

-

-

-

10(1.63)

Poisoning

10(2.6)

10(2.65)

7 (4.5)

5 (5)

-

10(0.84)

Enteric Fever

-

10(1.6)

9(1.62)

5 (2.23)

10 (1.9)

-

Cerebral Infarction

-

-

-

-

6 (2)

-

COPD1

10 (1.6)

-

-

8 (2.09)

-

-

COPD1

-

-

10(2.08)

7 (4)

9 (1.7)

-

Anemia

9 (1.6)

6 (2)

10(1.47)

10 (1.8)

-

-

Asthma

9 (4.1)

-

9 (2.42)

10(1.5)

-

Obstructed Labor

8 (2.1)

-

-

-

-

-

Cardiovascular Disease

-

2(10.45)

-

4 (6)

-

-

Neonantal Semticemia

-

-

-

6 (4)

-

-

IMCI2Disease Category

-

-

3 (8.67)

-

-

-

Cardio-Respiratory Failure

-

3 (8.79)

-

-

-

-

Respiratory Failure

4 (6.8)

7 (3.48)

Table 1: Morbidity and mortality patterns of top 10 diseases in district level hospitals. 1COPD= Chronic obstructive pulmonary disease and
2IMCI= Integrated Management of Childhood Illness disease category
*IMCI13 broad diseasecategories [very severe disease,pneumonia, cough and cold-not pneumonia, diarrhea, dysentery, fever- malaria,fever-not malaria, measles, ear problem, PEM (protein energy malnutrition), drowning, injury other than drowning, and others].

Acknowledgement

icddr,b, b is thankful to the Governments of Australia, Bangladesh, Canada, Sweden and the UK for providing core/unrestricted support.

References

  1. Rahman M, Islam MM, Sadhya G, Latif MA (2011) Disease Pattern and Health Seeking Behavior in Rural Bangladesh. Faridpur Med Coll J 6(1): 32-37.
  2. Murray CJL, Lopez AD (2013) Measuring the Global Burden of Disease. New England Journal of Medicine 369: 448-457.
  3. Sarker AR, Mahumud RA, Sultana M, Ahmed S, Ahmed W, et al. (2014) The impact of age and sex on healthcare expenditure of households in Bangladesh. SpringerPlus, 3: 435.
  4. MOHFW (2014) Health Bulletin 2014. Directorate General of Health Services.
  5. Ghosh S, Arokiasamy P (2010) Emerging patterns of reported morbidity and hospitalisation in West Bengal, India. Glob public health 5(4): 427-440.
  6. Bhuiyan MU, Luby SP, Zaman RU, Rahman MW, Sharker MA, et al. (2014) Incidence of and Risk Factors for Hospital-Acquired Diarrhea in Three Tertiary Care Public Hospitals in Bangladesh. Am J Trop Med Hyg 91(1): 165-172.
  7. Black RE, Cousens S, Johnson HL, Lawn JE, Ruden I, et al. (2010) Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 375(9730): 1969-1987.
  8. Abul R, Siddique H (2014) Prevalence of Peptic Ulcer Disease among the Patients with Abdominal Pain Attending the Department Of Medicine in Dhaka Medical College Hospital, Bangladesh. IOSR Journal of Dental and Medical Sciences 13(1): 5-20.
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