BACKGROUND: Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective. METHODS: The conceptual framework designed is based on a combination of Levesque’s Health Access Framework and the Foreign, Commonwealth and Development Office’s Resilience Framework to address both outputs and the processes of resilience of healthcare systems. It uses a mixed-method sequential exploratory research design combining multi-sites and longitudinal approaches. Forty clusters spread over four sites will be studied to understand the importance of context, involving more than 40 healthcare service providers and 2000 households to be surveyed. We will collect primary data through questionnaires, in-depth and semi-structured interviews, focus groups and participatory filming. We will also use secondary data on environmental events sensitive to climate change and potential health risks, healthcare providers’ functioning and organisation. Statistical analyses will include event-history analyses, development of composite indices, multilevel modelling and spatial analyses. DISCUSSION: This research will generate inter-disciplinary evidence and thus, through knowledge transfer activities, contribute to research on low and middle-income countries (LMIC) health systems and global changes and will better inform decision-makers and populations.
Bangladesh, being the world’s most climate-vulnerable country, is affected by plenty of climate-related hazards every year, mostly along its south-western coast. As a consequence, many people relocated from these regions’ worst-affected neighborhoods to Khulna city, and began to live as slum dwellers. They faced a variety of issues in these informal settlements, particularly regarding water, sanitation, and hygiene (WASH) facilities and livelihood options, but no research has been conducted in Bangladesh. With an emphasis on WASH services and livelihood prospects, this study therefore aimed to provide a comprehensive understanding of the challenges/hardships and needs of climate migrants living in urban slums in both general and COVID-19 contexts. Qualitative methods were applied to collect data from the climate migrants of slums in five wards (3, 12, 17, 21, and 30) of the Khulna City Corporation. Nine focus group discussions and four key informant interviews were conducted to collect the data from primary (community people) and secondary (local government and non-government and community-based organizations officials) stakeholders. The thematic analysis was used to analyze the data. The findings revealed that climate migrants experienced significant water scarcity, insufficient drainage systems, a lack of toilets, tube wells, and bathing facilities, inadequate hygiene management, a lack of core skills required for urban jobs, low payment, and an income shortage. Similarly, sustainable drinking water sources, sanitary toilets with WASH blocks, personal hygiene materials and awareness building, skill development for diverse livelihood opportunities, and income-generating capacity development were their top priorities. Overall, the findings of this study provided a holistic overview of the challenges/hardships and needs of climate migrants in urban slums regarding WASH services and livelihood opportunities. The authorities should intervene and develop policy initiatives to alleviate the hardships and meet the needs of climate migrants.
Long-term trends in air quality by studying the criteria pollutants (PM2.5, PM10, CO, O-3, NO2, and SO2) and climate variables (temperature, surface pressure, and relative humidity) were depicted in this study. The 17-year (2003-2019) average values of PM2.5, PM10, CO, O-3, NO2, and SO2 were 88.69 +/- 9.76 mu g/m(3), 124.57 +/- 12.75 mu g/m(3), 0.69 +/- 0.06 ppm, 51.42 +/- 1.82 ppb, 14.87 +/- 2.45 ppb, and 8.76 +/- 2.07 ppb, respectively. The trends among the ambient pollutants were increasingly significant (p < 0.05) except for O-3 with slopes of 1.83 +/- 0.15 mu g/m(3)/year, 2.35 +/- 0.24 mu g/m(3)/year, 0.01 +/- 0.002 ppm/year, 0.47 +/- 0.03 ppb/year, and 0.40 +/- 0.02 ppb/year for PM2.5, PM10, CO, NO2, and SO2, respectively. Pearson correlations revealed a significant association among the pollutants while a noteworthy correlation was observed between ambient pollutants and surface temperature. Principal component analysis (PCA) and positive matrix factorization (PMF) have been employed collectively to examine the main sources of the pollutants. PCA revealed similar trends for PMs and CO, as well as NO2 and SO2 being equally distributed variables. PMF receptor modeling resulted in attributing four sources to the pollutants. The factors inferred from the PMF modeling were signified as vehicular emissions, road/soil dust, biomass burning, and industrial emissions. The hazard quotient (HQ) values were not antagonistic (HQ < 1) in acute exposure levels for the three age groups (infants, children, and adults) while showing significant health risk (HQ < 1) in chronic exposure for infants and children. Children are identified as the worst sufferers among the age groups, which points to low breathing levels and high exposure to traffic pollution in Dhaka, Bangladesh.
In Bangladesh, many people are being displaced in riverine island (char) areas every year due to climate change and its associated natural catastrophes. This study intends to investigate the impact of climate change on internally displaced char people’s lives and livelihoods along with local adaptation strategies and hindrances to the coping mechanism. Data have been collected from 280 internally displaced households in two sub-districts. A mixed-method approach has been considered combined with qualitative and quantitative methods. The results disclose that frequent flooding, riverbank erosion, and crop loss are the leading causes for relocation, and social relations are impeded in the new place of residence. Increasing summer and winter temperatures, recurrent flooding, severity of riverbank erosion, and expanding disease outbreaks are also important indicators of climate change identified by displaced people, which are consistent with observed data. This study also reveals that almost all households come across severe livelihood issues like food shortage, unemployment and income loss, and housing and sanitation problems due to the changing climate associated with disasters in the former and present places. In response to this, the displaced people acclimatize applying numerous adaptation strategies in order to boost the livelihood resilience against climate change. However, fragile housing, financial conditions, and lack of own land are still the highest impediments to the sustainability of adaptation. Therefore, along with the government, several organizations should implement a dynamic resettlement project through appropriate scrutiny to eradicate the livelihood complications of internally displaced people.
Child malnutrition is indisputably a multi-faceted phenomenon. Comprehending the aforesaid crucial issue this paper intended to identify climatic and non-climatic factors for the spatial variation of malnutrition prevalence in Bangladesh. The climatic data on temperature and rainfall are obtained from the WorldClim dataset. We obtained a set of global climate layers that included monthly data on minimum temperature, maximum temperature, mean temperature, and rainfall for the period 1960-1990, at a spatial resolution up to 30 ‘onds (~ 1 × 1 km at the equator). The data are extracted at the district level using the zonal-statistics in QGIS. This study performed a spatial lag regression to evaluate association of malnutrition with climate characteristics and other factors. The prevalence of malnutrition exhibited substantial association with temperature and precipitation. Food production, water access, improved sanitation, literacy, road density, solvency ratio and GDP had a significant association with the spatial variation of malnutrition in Bangladesh.
Introduction: Human exposure is the most visible effect of different pollutants, which come at a hidden cost to society due to their impacts on human health and the environment. Objective: The purpose of this research is to gain a better knowledge of the environmental effects of motorized vehicles’ gas emissions and the resulting economic losses in a developing country. Methods: In this paper, the authors estimated vehicular emissions, emission costs, climate change costs (CCCs), and noise pollution costs (NPCs) for 84 road segments (18 important intersections) in Dhaka City in 2009 and 2017. The top-down method was used to determine the vehicular emissions in each intersection using average daily traffic data and previously defined emission factors. Climatic change costs were evaluated using the damage cost approach, and noise pollution costs were estimated using the bottom-up noise exposure model.Results: Analysis showed that the enormous and uncontrolled surge in personal vehicles resulted in significant spikes in emissions as well as economic losses. Result shows the massive increase of all types of pollutants due to the rise of vehicular populations. From 2009 to 2017, the exhaust emission costs increased by 77.89%, (from 20.71 x 10(6) to 36.84 x 10(6) Tk/day), CCCs by 63.96% (from 18.73 x 10(6) to 30.71 x 10(6) Tk/day), NPCs by 101.61% (from 11.20 x 10(6) to 22.58 x 10(6) Tk/day). The study illustrated the spatial GHG emissions, CCCs, and NPCs statistics of all the traffic nodes and signified the regulation of vehicular activities in a sustainable manner. Conclusion: Proper adaptation of the recommended policies and strategies can improve the scenario and potentially lessen the other negative consequences.
WHAT IS ALREADY KNOWN ON THIS TOPIC? Different socioecological factors were associated with childhood pneumonia in Bangladesh. However, previous studies did not assess spatial patterns, and socioecological factors and spatial variation have the potential to improve the accuracy and predictive ability of existing models. WHAT IS ADDED BY THIS REPORT? The spatial random effects were present at the district level and were heterogeneous. Average temperature, temperature variation, and population density may influence the spatial pattern of childhood pneumonia in Bangladesh. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE? The study results will help policymakers and health managers to identify the vulnerable districts, plan further investigations, help to improve proper resource allocation, and improve health interventions.
Natural hazards disrupt the social-ecological system, causing much suffering, death, injury, and devastation of property and the environment. This study explores the factors influencing the disaster psychology and psychological adaptation of people living in disaster-vulnerable areas in Bangladesh. Data have been collected from 100 households in Bangladesh’s riverine island areas (char) of northern Bangladesh. Several criteria have been used to measure char dwellers’ disaster psychology (vulnerability concern, factor, and intensity) and psychological adaptation (weakness concern and emotional response). This study reveals that char dwellers perceived several hazards like floods (100%), riverbank erosion (83%), drought (29%), and earthquakes (14%). It is also found that females (88%) are more concerned about earthquakes than males (12%). The key vulnerability factors in the char areas are geographic position (100%), no access to migration (75%), resources (76%), housing (83%), training (18%), and alternative livelihood (24%). Flood and drought are identified as the most destructive hazards in char areas. Most household heads also felt anxiety (88%). fear (54%), helplessness, sadness, and anger due to natural hazards. The government should implement a context-specific disaster management plan to reduce household vulnerability and create livelihood opportunities in char areas to enhance char dwellers’ psychological resilience against disasters.
Access to quality and affordable mental health care is not always available to disaster-prone countries experiencing climate change, which may result in psychological trauma. Although environmental support has been provided, the consequences of disasters have not been addressed within the mental health realm. Inadequate knowledge and practice about crisis responses for mental health was addressed in Bangladesh with the influx of Rohingya people escaping persecution. To provide mental health support, Crisis Preparedness for Mental Health (CPM-MH) was developed and implemented addressing the psychological consequences of traumatic events. CP M-MH has its foundation in post-trauma stabilization through establishment of psychological equilibrium providing proactive rather than reactive methods linked to positive mental health outcomes. With adoption of CPM-MH in Bangladesh addressing mental health needs after traumatic events, mental health damage experienced by manmade and natural disasters may be considered the best strategy to build coping skills and resiliency for further traumatic event.
The monsoon season in Bangladesh is an example of how climate-related events can have a significant impact on mental wellbeing of affected individuals and communities. In this field report, we reflect on the integration of mental health and psychosocial support (MHPSS) services into emergency preparedness efforts. The report aims to offer an understanding of the risk associated with the monsoon season on both refugees and host communities and how likely this risk could affect mental health and mental health services. The MHPSS working group in Cox’s Bazar identified four major areas resulting from the impact of the monsoon season: increased incidence of mental health and psychosocial problems, relocation of individuals and families from high-risk areas to safer locations, disrupted provision of mental health and psychosocial services, and lack of self-care knowledge and practice for the humanitarian staff. To mitigate these impacts, an emergency preparedness and response plan was developed and included a wide range of activities aiming to better coordinate and scale up mental health services during the monsoon season.
Climate change adversely impacts the health and well-being of billions of people worldwide and will increasingly do so over the next few decades. Although all populations are at risk, some are more vulnerable than others. It is therefore critical to increase resilience to climate-related risks and build the capacity of national health systems by considering climate risks in health policy and decision making, strengthening leadership and governance to address impacts, and implementing strategies to build climate-resilient health care systems.
Bangladesh is a densely populated emerging country in South Asia. Since its harsh independence war, it has suffered from repeated floods and other natural and man-inflicted disasters. Internal migration from rural areas to the urban centres has increased crowdedness, pollution and social conflicts. Furthermore, in recent years, the country has absorbed close to a million refugees from Myanmar. These stressors have been associated with an increase in mental disorders and symptoms with which the country is struggling. Lack of resources and a shortage of human capital have weakened the national capacity to efficiently respond to situational stressors or disasters. For assessment of stress-related mental health issues, information available from the Ministry of Health and the National Institute of Mental Health was collected and supplemented by external reports. It is promising that the government’s approach of responding to mental health needs only after the occurrence of a crisis has recently been replaced by the concept of total management through primary healthcare. There is a need for development of adequate infrastructure, logistics and workforce support, as well as establishment of multidisciplinary teams of management and clinical services. Collaboration of all related sectors of the government and an overall increase in government funding for mental health are essential.
This study aimed at assessing the Livelihood Vulnerability Index (LVI) using the IPCC framework approach and a modified approach to estimate climate change vulnerability in south-west coastal area of Bangladesh. Nine Upazillas (sub-districts) in the south west coastal community were considered for this study. The major component indices of LVI such as socio-demographic profile, livelihood strategies, social network, health, food, water, natural disaster and climate variability were calculated based on the household survey data. The LVI based on the IPCC approach (LVI-IPCC) in nine upazillas in southwest coastal region of Bangladesh were found within a range of -0.02 to + 0.04 (on the scale of -1 to +1). In the modified approach. the LVI for the nine study areas was found within a wide range from 0.253 to 0.544 (on a scale of 0 to 1). For the LVI-IPCC approach, although the contributing factors (exposure, sensitivity and adaptive capacity) individually show variations in their indices from one to another, no significant variation is observed for the total livelihood index. However, the modified approach shows significant variation in LVI among the studied nine areas. It is concluded that the modified approach is suitable for community or district level assessment, whereas the LVI-IPCC may be suitable for regional level evaluation.
Bangladesh is one of the countries that is most likely to be affected by natural disasters and climate change. However, much less is known about the integrated livelihood and climate vulnerabilities of coastal communities to natural disasters in southwestern Bangladesh. Therefore, this paper proposes a holistic approach to measuring livelihood vulnerability in the southwestern coast of Bangladesh based on primary data from 300 respondents through face-to-face interviews, focus group discussion (FGD), and key informant interviews (KII), and secondary data on rainfall and temperature for the years 2010-2017. This study developed the livelihood vulnerability index (LVI), the climate vulnerability index (CVI), and the LVI-IPCC to estimate climate vulnerability by incorporating 36 indicators of 9 major components under three dimensions. The pragmatic results show that the three coastal unions have different LVI, CVI, and LVI-IPCC values. Still, the households of the Gabura union showed more vulnerability than the rest of the two, with the highest LVI, CVI, and LVI-IPCC values due to their inadequate access to fresh water, limited physical resources, fewest livelihood strategies, the least variety of crops, and worst health conditions. This logical approach may be applied in data-scarce regions to assess vulnerability and evaluate potential policy efficiency for baseline comparison. The study demonstrates that the requirement for focused interventions and context-specific sustainable policies and development approaches should be implemented to lessen the vulnerability of coastal dwellers. These findings have implications for developing and implementing household resilience and climate change adaptation projects by the government, donor organizations, and other pertinent groups in three susceptible unions.
This study has been conducted to identify vulnerabilities and effects of climate change on women in 12 unions in Shyamnagar upazila in the Satkhira district in the Southwestern Coastal Region of Bangladesh (SWCRB). Climate vulnerability and gender inequality may increase due to climate change. Women may, thus, face specific conditions of vulnerability in society and daily livelihood. This paper focuses on investigating factors that influence women’s vulnerability from climate change, their adaptations, and the importance of women empowerment to reduce their inequality in SWCRB. This study also emphasizes gender inequality caused by climate change, and looks at accommodations for women to reduce hostile influences of climate change. From the 9 unions in SWCRB, a total of 320 household respondents were randomly selected to complete a questionnaire. The results of the statistical analysis showed that most of the survey’s perimeter has significant. Interviews, case studies, focus group discussions, workshops, and key informant interviews were also conducted from 12 unions, and it was found that climate change impacts men and women differently, with women being more vulnerable than men. Through case study this paper investigated the main factors influencing the vulnerability of women. In terms of empowerment women may also be well positioned to lead adaptation efforts alongside men, as this analysis represent that gender inequalities are leading by social norms. Women being more vulnerable both in short-term i.e., major natural disasters, cyclones, flood, and long-term i.e., sea level rise, salinity intrusion in water and soil, land erosion, droughts, climatic events, as they enhance gender inequalities. Further, gender inequality is seen in illiteracy, food shortages and poor health conditions, traditional norms, religious taboos, and patriarchy. Moreover, gender-based economic opportunities, women’s mobility, and income are changing, while household authority relations and gender-based socio-economic, cultural, and institutional constraints remain. This study examines the increased vulnerability of women in SWCRB to climate change, which can be mitigated through women empowerment; female involvement with environmentally friendly stoves, rural electrification and renewable energy development, microfinancing, and nakshikantha. (Nakshikantha is a special type of sewing art that is made by creating designs with different types of colored threads on plain stitches). Lastly, women may also lead adaptation efforts alongside men, make decisions, and promote their participation.
Severe pneumonia is one of the leading contributors to morbidity and deaths among hospitalized under-five children. We aimed to assess the association of the socio-demographic characteristics of the patients and the climatic factors with the length of hospital stay (LoS) of under-five children with severe pneumonia managed at urban hospitals in Bangladesh. We extracted relevant data from a clinical trial, as well as collecting data on daily temperature, humidity, and rainfall from the Meteorological Department of Bangladesh for the entire study period (February 2016 to February 2019). We analyzed the data of 944 children with a generalized linear model using gamma distribution. The average duration of the hospitalization of the children was 5.4 ± 2.4 days. In the multivariate analysis using adjusted estimation of duration (beta; β), extended LoS showed remarkably positive associations regarding three variables: the number of household family members (β: 1.020, 95% confidence intervals (CI): 1.005-1.036, p = 0.010), humidity variation (β: 1.040, 95% Cl: 1.029-1.052, p < 0.001), and rainfall variation (β: 1.014, 95% Cl: 1.008-1.019), p < 0.001). There was also a significant negative association with LoS for children's age (β: 0.996, 95% Cl: 0.994-0.999, p = 0.006), well-nourishment (β: 0.936, 95% Cl: 0.881-0.994, p = 0.031), and average rainfall (β: 0.980, 95% Cl: 0.973-0.987, p < 0.001). The results suggest that the LoS of children admitted to the urban hospitals of Bangladesh with severe pneumonia is associated with certain socio-demographic characteristics of patients, and the average rainfall with variation in humidity and rainfall.
PURPOSE: This report describes the general impact and direct health effects including death and traumatic injuries on populations impacted by the 2017 landslides in the affected hilly and coastal districts in southeastern Bangladesh. The medical response including emergency treatment and rehabilitation provided at pre-hospital and hospital care sites is also described. MATERIALS AND METHODS: An electronic literature search of appropriate databases was performed to identify relevant articles on landslides in Bangladesh, Southeast Asia, and other developing countries from 1990-2017. Summary landslide impact data was extracted from official government and non-government reports and injury data from selected district and tertiary level hospitals was reviewed. RESULTS AND CONCLUSIONS: Most fatalities in the 2017 Bangladesh landslides were due to suffocation and asphyxiation from burial. In Rangamati District, 6343 persons with minor injuries were treated in 22 emergency shelters. One hundred fifty-four injuries were treated at Rangamati General Hospital and 12 of the most severely injured persons were referred to regional tertiary Chittagong Medical College Hospital for specialized injury and rehabilitation management. Physical rehabilitation capacity and services in future landslides may be increased by providing rehabilitation technical skills training to responders and augmenting the emergency response with individual rehabilitation specialists and/or teams of rehabilitation professionals.Implications for rehabilitationLandslides may result in significant direct health effects including death and rehabilitation conditions such as severe traumatic physical injuries and less severe musculoskeletal conditions.Pre-hospital and hospital emergency medical response systems may lack capacity to adequately manage the surge of rehabilitation conditions in landslides.Physical rehabilitation treatment capacity in future landslides may be increased by providing rehabilitation technical skills training to responders and augmenting the emergency response structure with individual rehabilitation specialists and/or teams of rehabilitation professionals.Rehabilitation, disability, emergency management, and other stakeholders are advised to employ such training and workforce strategies to reduce rehabilitation-related health effects in Bangladesh and other South-East Asian countries which are heavily impacted by landslides due to seasonal monsoons.
Bangladesh is repeatedly threatened by tropical storms and cyclones, exposing one-third of the total population of the country. As a preparedness measure, several cyclone shelters have been constructed, yet a large proportion of the coastal population, especially women, are unwilling to use them. Existing studies have demonstrated a range of concerns that discourage women from evacuating and have explored the limitations of the shelters, but the experiences of female evacuees have not been apparent in these stories. This study explores the lived-experiences of women in the cyclone shelters of Bangladesh and discusses their health and well-being as evacuees in the shelters. Nineteen women from three extremely vulnerable districts of coastal Bangladesh were interviewed. Seven research themes were identified from the participants’ narratives using van Manen’s thematic analysis process. The most salient theme, being understood (as a woman), portrayed the quintessential image of these women, which subsequently influenced their vulnerability as evacuees. The next themes-being a woman during crisis, being in a hostile situation, being fearful, being uncertain, being faithful, and being against the odds-focused on the incidents they lived through which affected their physical and mental health and the emotions they felt as evacuees. The paper offers a deep inquiry into women’s experiences of well-being in the shelters and recognizes the significance of women’s voices to improve their experiences as evacuees.
Every year Bangladesh faces enormous damages due to flooding. Facing these damages the Government adopts various recovery approaches. However, the psychological dimension of any disaster is generally overlooked in disaster management. Researchers have found that the spatial distribution of post-disaster mental health can help the authorities to apply recovery procedures where they are most needed. For this research, Posttraumatic Stress Checklist (PCL-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to estimate posttraumatic stress, major depressive disorder and anxiety following three episodes of severe floods in 2017 that affected at least 8 million people. To better understand the spatial pattern of psychological vulnerability and reach a comprehensive scenario of post-disaster mental health, Moran’s I was applied for spatial autocorrelation and Pearson’s correlation and regression analysis for a study of the relationship between the psychological aspects. It was found that psychological vulnerability showed a spatial clustering pattern and that there was a strong positive linear relationship among psychological aspects in the study area. This research might help to adopt disaster management policies that consider the psychological dimension and spatial distribution of various psychological aspects to identify areas characterized by high vulnerability and risk so that they can be reached without delay.
BACKGROUND: Bangladeshi flood survivors are reported with such higher mental disorders that are not ever observed in any other cohorts. Although there are a few studies that assessed mental disorders, suicide or suicidal behaviors are not investigated yet. Hence, the present study for the first time investigated suicidal behaviors and its relationship with socio-demographics, flood effects and psychopathology. METHODS: A cross-sectional interview study was carried out between November and December 2019, after 4/5 months of the flood occurrence. Two completely affected villages from two districts residing in two parts of the country were randomly selected (whereas Manikganj district was less affected by the recent flood compared to Kurigram), and a total of 348 flood survivors were interviewed (45.53 ± 14.85 years). Questions related to basic socio-demographics, flood effects, psychological impacts, and suicidal behaviors were asked in the interviews. RESULTS: In the total sample, 57.5% of flood survivors reported having suicidal ideation, whereas 5.7% and 2.0% madea suicide plan and suicide attempt, respectively. Within two study sites, participants belonging to Kurigram reported significantly higher suicidal ideation compared to Manikganj (84.8% vs 33.2%, χ (2) = 94.475, p<0.001). Belonging to a lower-class family, having less education, and less earning members in the family, being affected severely by the flood, suffering from depression, anxiety, and PTSD, and experiencing financial threat, and economic hardship were suicidal behavior risk factors in the total sample. CONCLUSION: Considering the present findings (ie, suicidality commensurately increases with flood effects), a multi-sectoral policy and its effective implementation should be adopted for alleviating the flood-related psychological burdens.
In the Ganges-Brahmaputra-Meghna delta, covering most of Bangladesh, more than 165 million people live in low-lying coasts facing major extreme climatic events, such as cyclones. This article reviews the current scientific literature publications (2007-2020) in order to define vulnerability in the context of coastal Bangladesh facing cyclonic flooding. Based on this review, a new metric, called the socio-spatial vulnerability index (SSVI), is defined as function of both the probability of the cyclonic flood hazard and the sensitivity of delta inhabitants. The main result shows that the districts of Shariatpur, Chandpur and Barisal situated in the tidal floodplain of the Ganges-Brahmaputra-Meghna delta are in the fourth quartile, i.e., highest category, the most vulnerable areas. These districts are very densely populated (from 870 up to 1400 inhabitants per square kilometer) and exposed to inundation hazards with a large number of vulnerability factors. Finally, the delta’s mouth was identified as a very vulnerable area to cyclonic flooding as well.
Floods are a common natural hazard in Bangladesh, and climate change is expected to further increase flooding frequency, magnitude and extent. Pregnant women in flood contexts could face challenges in utilisation of maternal healthcare. The aim of this paper is to analyse associations between flood exposure and the use of maternal healthcare (antenatal care visits, birth assisted by skilled birth attendants, and giving birth in a health facility) in Bangladesh for pregnancies/births between 2004 and 2018. Bangladesh Demographic and Health Survey data from four surveys in the time period 2007-2018 and data on floods from the Emergency Events Database and the Geocoded Disasters Dataset are analysed using multilevel linear probability models. In line with previous results, we find clear bivariate associations between exposure to flooding and maternal healthcare use. These associations are largely confounded by socioeconomic and demographic variables. In general, exposure to flooding – whether measured as exposure to any floods or severe floods – does not affect maternal healthcare use, and we suggest that the lower usage of maternal healthcare in areas exposed to flooding rather relates to the characteristics of the flood-prone areas and their populations, which also relate to lower maternal healthcare use. However, we find negative associations in some supplementary analyses, which suggest that even if there is no effect of floods on average, specific floods may have negative effects on maternal healthcare use.
Purpose The quality and availability of sexual and reproductive health care are key determinants to reducing maternal mortalities and morbidities in disaster settings; yet, these services are often lacking in developing countries. Reducing maternal mortality and morbidity is currently the main targets of the UN’s Sustainable Development Goal (SDG) 3. The purpose of this study was to develop an intervention package called RHCC (Reproductive Health Kit 8; Capacity building; Community awareness), and to implement and evaluate it in three primary health-care (PHC) facilities in Belkuchi, Bangladesh, in order to improve the quality and availability of post-abortion care (PAC) during the 2017 floods. Design/methodology/approach This research used both quantitative and qualitative methods to develop, implement and assess the RHCC in three flood-prone PHC facilities in Belkuchi. Findings The RHCC was implemented during the floods of 2017. The findings pre- and post-intervention suggest it led to an increase in skilled management among health workers, an increase in the quality of care for clients and the availability of PAC at three PHC facilities during floods. Originality/value Due to its geographic location, Bangladesh is exposed to recurrent floods and cyclones. Evidence-based integrated intervention packages, such as the RHCC, can improve the quality and availability of reproductive health care during disasters at PHC level and, in doing so, can promote the UN’s agenda on “disaster resilient health system” to achieve the SDG 3, and the WHO’s campaign on universal health coverage.
OBJECTIVES: As climate change continues to increase the frequency and severity of flooding in Bangladesh and globally, it becomes increasingly critical to understand the pathways through which flooding influences health outcomes, particularly in lower-income and subsistence-based communities. We aim to assess economic pathways that link flooding to nutritional outcomes among Shodagor fishing families in Bangladesh. METHODS: We examine longitudinal economic data on kilograms of fish caught, the income earned from those fish, and household food expenditures (as a proxy for dietary intake) from before, during, and after severe flooding in August-September of 2017 to enumerate the impacts of flooding on Shodagor economics and nutrition. We also analyze seasonally collected anthropometric data to model the effects of flooding and household food expenditures on child growth rates and changes to adult body size. RESULTS: While Shodagor fishing income declined during the 2017 flooding, food expenditures simultaneously spiked with market inflation, and rice became the predominant expenditure only during and immediately following the flood. Our nutritional models show that children and adults lost more body mass in households that spent more money on rice during the flood. Shodagor children lost an average of 0.36 BMI-for-age z-scores and adults lost an average of 0.32 BMI units during the flooded 2017 rainy season, and these metrics continued to decline across subsequent seasons and did not recover by the end of the study period in 2019. CONCLUSIONS: These results show major flood-induced economic impacts that contributed to loss of child and adult body mass among Shodagor fishing families in Bangladesh. More frequent and severe flooding will exacerbate these nutritional insults, and more work is needed to effectively stabilize household nutrition throughout natural disasters and economic hardship.
We study the educational outcomes of the 1974-75 Bangladesh famine among early life survivors using the 1991 Bangladesh micro-census data. We find that famine adversely affected survivor children in areas that experienced higher rice prices relative to labour wages. However, children living in wealthy households in famine-stricken areas escaped the adverse effects and had similar educational outcomes as those with no famine exposure. We also find that, surprisingly, exposure to a double catastrophe (i.e., concurrent famine and flood) in early life had weaker effects on survivor children’s education than exposure to a single catastrophe. We show that disaster-alleviation mechanisms were more effective in districts affected by double disasters.
This paper investigates the extent to which in-utero exposure to droughts influences the health outcomes of Bangladeshi children in early childhood. Exploiting the plausibly exogenous deviations of rainfall from the location-specific norms, we find that deficient rainfall during the prenatal period is harmful to child health. Specifically, in-utero exposure to droughts decreases the height-for-age, weight-for-height, and weight-for-age z-scores by 0.10, 0.11, and 0.11 standard deviations among children under five years old, respectively. Our heterogeneity analyses reveal that the adverse health setbacks fall disproportionately on children of disadvantaged backgrounds. Exploring the differential effects by trimesters of exposure, we further show that experiencing droughts during the second and the third trimesters leaves injurious effects on early childhood health.
BACKGROUND: Drought has been a considerable problem for many years in northern Bangladesh. However, the health impacts of drought in this region are not well understood. METHODS: This study analyzed the impact of drought duration and severity on select causes of mortality in northern Bangladesh. Rainfall data from three meteorological stations (Rangpur, Dinajpur and Nilphamari) in northern Bangladesh were used to assess drought and non-drought periods, and the Standardized Precipitation Index was used to categorize mild, moderate, severe, and extreme drought. Mortality data from 2007 to 2017 for the three areas were collected from the Sample Vital Registration System, which is a survey of 1 million people. The generalized linear model with Poisson regression link was used to identify associations between mortality and the drought severity and 1-month preceding SPI. RESULTS: Only severe and extreme drought in the short-term drought periods affected mortality. Long-term drought was not associated with natural cause mortality in Rangpur and Nilphamari. In Dinajpur, mild and moderate drought was associated with circulatory- and respiratory-related mortality. CONCLUSION: The impact of drought on mortality varied by region. This study improves our understanding of how droughts affect specific causes of mortality and will help policy makers to take appropriate measures against drought impacts on selected cause of mortality. Future research will be critical to reduce drought-related risks of health.
The aim of this study was to develop a database of historical cold-related mortality in Bangladesh using information obtained from online national newspapers and to analyze such data to understand the spatiotemporal distribution, demographic dynamics, and causes of deaths related to cold temperatures in winter. We prepared a comprehensive database containing information relating to the winter months (December to February) of 2009-2021 for the eight administrative divisions of Bangladesh and systematically removed redundant records. We found that 1249 people died in Bangladesh during this period due to cold and cold-related illnesses, with an average of 104.1 deaths per year. The maximum number of cold-related deaths (36.51%) occurred in the Rangpur Division. The numbers were much higher here than in the other divisions because Rangpur has the lowest average monthly air temperature during the winter months and the poorest socioeconomic conditions. The primary peak of cold-related mortality occurred during 21-31 December, when cold fronts from the Himalayas entered Bangladesh through the Rangpur Division in the north. A secondary peak occurred on 11-20 January each year. Our results also showed that most of the cold-related mortality cases occurred when the daily maximum temperature was lower than 21 °C. Demographically, the highest number of deaths was observed in children aged six years and under (50.68%), followed by senior citizens 65 years and above (20.42%). Fewer females died than males, but campfire burns were the primary cause of female deaths. Most mortality in Bangladesh was due to the cold (75.5%), cold-triggered illness (10.65%), and campfire burns (5.8%). The results of this research will assist policymakers in understanding the importance of taking necessary actions that protect vulnerable public health from cold-related hazards in Bangladesh.
Cyclone Amphan battered the coastal communities in the southwestern part of Bangladesh in 2020 during the COVID-19 pandemic. These coastal communities were experiencing such a situation for the first time and faced the dilemma of whether to stay at home and embrace the cyclone or be exposed to the COVID-19 virus in the cyclone shelters by evacuating. This article intends to explore individuals’ decisions regarding whether to evacuate in response to cyclone Amphan and in light of the risks of the COVID-19 pandemic. Consequently, this study investigated evacuation behaviors among the households and explored the impacts of COVID-19 during the evacuation procedures. We conducted household surveys to collect primary information and undertook 378 samples for interviews at a precision level of 0.05 in fourteen villages. Despite the utmost effort of the government, the results demonstrated that 96.6% of people in the coastal area received a cyclone evacuation order before the cyclone’s landfall, and only 42% of people followed the evacuation order. The majority of households chose to stay at home because of fear of COVID-19 exposure in the crowded shelters. Although half of the evacuees were housed in cyclone shelters, COVID-19 preventive measures were apparently not set in place. Thus, this study will assist in crafting future government policies to enhance disaster evacuation plans by providing insights from the pandemic that can inform disaster management plans in the Global South.
Vector-borne disease risk assessment is crucial to optimize surveillance, preventative measures (vector control), and resource allocation (medical supplies). High arthropod abundance and host interaction strongly correlate to vector-borne pathogen transmission. Increasing host density and movement increases the possibility of local and long-distance pathogen transmission. Therefore, we developed a risk-assessment framework using climate (average temperature and rainfall) and host demographic (host density and movement) data, particularly suitable for regions with unreported or underreported incidence data. This framework consisted of a spatiotemporal network-based approach coupled with a compartmental disease model and nonhomogeneous Gillespie algorithm. The correlation of climate data with vector abundance and host-vector interactions is expressed as vectorial capacity-a parameter that governs the spreading of infection from an infected host to a susceptible one via vectors. As an example, the framework is applied for dengue in Bangladesh. Vectorial capacity is inferred for each week throughout a year using average monthly temperature and rainfall data. Long-distance pathogen transmission is expressed with human movement data in the spatiotemporal network. We have identified the spatiotemporal suitability of dengue spreading in Bangladesh as well as the significant-incidence window and peak-incidence period. Analysis of yearly dengue data variation suggests the possibility of a significant outbreak with a new serotype introduction. The outcome of the framework comprised spatiotemporal suitability maps and probabilistic risk maps for spatial infection spreading. This framework is capable of vector-borne disease risk assessment without historical incidence data and can be a useful tool for preparedness with accurate human movement data.
Dengue is endemic in Bangladesh and is an important cause of morbidity and mortality. Suppressing the mosquito vector activity at the optimal time annually is a practical strategy to control dengue outbreaks. The objective of this study was to estimate the monthly growth factor (GF) of dengue cases over the past 12 years as a means to identify the optimal time for a vector-control programme in Bangladesh. We reviewed the monthly cases reported by the Institute of Epidemiology, Disease Control and Research of Bangladesh during the period of January 2008-December 2019. We calculated the GF of dengue cases between successive months during this period and report means and 95% confidence intervals (CI). The median number of patients admitted to the hospital with dengue fever per year was 1554 (range: 375-101,354). The mean monthly GF of dengue cases was 1.2 (95% CI: 0.4-2.4). The monthly GF lower CI between April and July was > 1, whereas from September to November and January the upper CI was <1. The highest GF of dengue was recorded in June (mean: 2.4; 95% CI: 1.7-3.5) and lowest in October (mean: 0.43; 95% CI: 0.24-0.73). More than 81% (39/48) months between April and July for the period 2008-2019 had monthly GF >1 compared to 20% (19/96) months between August and March of the same period. The monthly GF was significantly correlated with monthly rainfall (r = 0.39) and monthly mean temperature (r = 0.30). The growth factor of the dengue cases over the last 12 years appeared to follow a marked periodicity linked to regional rainfall patterns. The increased transmission rate during the months of April-July, a seasonally determined peak suggests the need for strengthening a range of public health interventions, including targeted vector control efforts and community education campaigns.
Numerous studies on climate change and variability have revealed that these phenomena have noticeable influence on the epidemiology of dengue fever, and such relationships are complex due to the role of the vector—the Aedes mosquitoes. By undertaking a step-by-step approach, the present study examined the effects of climatic factors on vector abundance and subsequent effects on dengue cases of Dhaka city, Bangladesh. Here, we first analyzed the time-series of Stegomyia indices for Aedes mosquitoes in relation to temperature, rainfall and relative humidity for 2002–2013, and then in relation to reported dengue cases in Dhaka. These data were analyzed at three sequential stages using the generalized linear model (GLM) and generalized additive model (GAM). Results revealed strong evidence that an increase in Aedes abundance is associated with the rise in temperature, relative humidity, and rainfall during the monsoon months, that turns into subsequent increases in dengue incidence. Further we found that (i) the mean rainfall and the lag mean rainfall were significantly related to Container Index, and (ii) the Breteau Index was significantly related to the mean relative humidity and mean rainfall. The relationships of dengue cases with Stegomyia indices and with the mean relative humidity, and the lag mean rainfall were highly significant. In examining longitudinal (2001–2013) data, we found significant evidence of time lag between mean rainfall and dengue cases.
RATIONALE: To date, there is no published local epidemiological evidence documenting the respiratory health effects of source specific air pollution in South Asia, where PM2.5 composition is different from past studies. Differences include more biomass and residue crop-burning emissions, which may have differing health implications. OBJECTIVES: We assessed PM2.5 associations with respiratory emergency department (ED) visits in a biomass-burning dominated high pollution region, and evaluated their variability by pollution source and composition. METHODS: Time-series regression modeling was applied to daily ED visits from January 2014 through December 2017. Air pollutant effect sizes were estimated after addressing long-term trends and seasonality, day-of-week, holidays, relative humidity, ambient temperature, and the effect modification by season, age, and sex. RESULTS: PM2.5 yielded a significant association with increased respiratory ED visits [0.84% (95% CI: 0.33%, 1.35%)] per 10 μg/m3 increase. The PM2.5 health effect size varied with season, the highest being during monsoon season, when fossil-fuel combustion sources dominated exposures. Results from a source-specific health effect analysis was also consistent with fossil-fuel PM2.5 having a larger effect size per 10 μg/m3 than PM2.5 from other sources [fossil-fuel PM2.5: 2.79% (0.33% to 5.31%), biomass-burning PM2.5: 1.27% (0% to 2.54%), and other-PM2.5: 0.95% (0.06% to 1.85%)]. Age-specific associations varied, with children and older adults being disproportionately affected by the air pollution, especially by the combustion-related particles. CONCLUSIONS: This study provided novel and important evidence that respiratory health in Dhaka is significantly affected by particle air pollution, with a greater health impact by fossil-fuel combustion derived PM2.5.
Bangladesh’s unique climate vulnerability is well-investigated but the mental health impacts of climate change remain relatively unexplored. Three databases were searched for English primary qualitative studies published between 2000 and 2020. Out of 1202 publications, 40 met the inclusion criteria. This systematic review applies a systems approach to further understand Bangladesh’s ‘climate-wellbeing’ network. The literature indicates diverse factors linking environmental stress and mental ill-health including four key themes: (1) post-hazard mental health risks, (2) human (im)mobility, (3) social tension and conflict, and (4) livelihood loss and economic hardship. This systems analysis also revealed that people’s mental wellbeing is strongly mediated by socio-economic status and gender. The article illustrates how multiple pathways may amplify stress, anxiety, violence, and psychological damage. Greater recognition of the ‘climate-wellbeing’ connections, and incorporation of mental health in current climate action and policy frameworks, will be an effective way to achieve a more sustainable future.
Secure potable water is indispensable to life. The presence of salinity in potable water has become a serious problem worldwide and it is essential to ensure secure potable water, particularly in the coastal areas of Bangladesh. In this work, 48 (forty-eight) harvested rainwater samples were assessed from Upazila (sub-district) of Mongla and Sarankhola, Bagerhat district, Bangladesh during the monsoon (May) and post-monsoon (October) periods. The objective was to examine the effect of seasonal variations on the quality of harvested rainwater. The harvested rainwater was analyzed for fecal coliform, total coliform, lead (Pb), zinc (Zn), pH, and turbidity. The mean pH in monsoon and post-monsoon periods was 6.93 and 7.24, respectively, which was within both the WHO guideline and Bangladesh Drinking Standard. In the monsoon season, turbidity levels in samples met the Bangladesh water quality standard but 10% of the harvested rainfall samples had Pb levels that exceeded the WHO drinking water limit. The turbidity of harvested rainwater in post-monsoon exceeded the WHO and Bangladesh Drinking Standard by 21% (10 out of 48) and 6% (3 out of 48), respectively. The fecal coliform of harvested rainwater exceeded both WHO and Bangladesh Drinking Standard by 56% (27 out of 48) and 67% (32 out of 48) in the monsoon and post-monsoon, correspondingly. Conversely, total coliform of harvested rainwater exceeded both the WHO and Bangladesh Drinking Standard by 67% (32 out of 48) and 79% (38 out of 48), accordingly in the monsoon and post-monsoon seasons. The Zn was below the WHO and Bangladesh Drinking Standard but Pb exceeded the WHO guideline in the monsoon and post-monsoon by 15% (7 out of 48) and 17% (8 out of 48), respectively. Pb is toxic to humans and children are especially vulnerable. The harvested rainwater should be treated effectively to reduce the toxicity and danger posed by Pb, fecal coliform, and total coliform before it is fit for drinking purposes.
Bangladesh stands out as a climate change hot spot due to its unique geography, climate, high population density, and limited adaptation capacity. Mounting evidence suggests that the country is already suffering from the effects of climate change which may get worse without aggressive action. Here, we use an ensemble of high-resolution (10 km) regional climate model simulations to project near-term change in climate extremes, mainly heat waves and intense rainfall, for the period (2021–2050). Near-term climate projections represent a valuable input for designing sound adaptation policies. Our climate projections suggest that heatwaves will become more frequent and severe in Bangladesh under the business-as-usual scenario (RCP8.5). In particular, extremes of wet-bulb temperature (a temperature and humidity metric important in evaluating humid heat stress) in the western part of Bangladesh including Bogra, Ishurdi, and Jessore are likely to exceed the extreme danger threshold (according to U.S. National Weather Service criterion), which has rarely been observed in the current climate. The return periods of extreme heat waves are also significantly shortened across the country. In addition, country-averaged rainfall is projected to increase by about 6% during the summer months, with the largest increases (above 10%) in the eastern mountainous areas, such as Sylhet and Chittagong. Meanwhile, insignificant changes in extreme rainfall are simulated. Our results suggest that Bangladesh is particularly susceptible to climate extremes in the near future, in the form of extreme heat waves over the western part of the country.
Bangladesh is a country of natural disasters and climatic hazards, which frequently affect its inhabitants’ lives and livelihoods. Among the various risks and disasters, floods are the most frequent hazard that makes haor households vulnerable. Therefore, this study was undertaken to estimate livelihood vulnerability to flooding within the flood-prone haor ecosystem in Bangladesh. Primary data were collected from 100 haor households each from Kishoreganj, Netrokona, and Sunamganj districts (N?=?300) by applying a multistage random sampling technique. Data were collected through face-to-face interviews using a pretested structured questionnaire. The Livelihood Vulnerability Index (LVI) and the Intergovernmental Panel on Climate Change (IPCC) framework of vulnerability were applied to compare vulnerabilities among the selected haor-based communities. The empirical results revealed that haor households in Sunamganj district were more vulnerable to flood hazard and natural disaster in terms of food, water, and health than households in the other two districts. Taking into account the major components of the LVI, the IPCC framework of vulnerability indicated that households in Sunamganj district were the most vulnerable due to their lowest adaptive capacity and highest sensitivity and exposure. These findings enable policymakers to formulate and implement effective strategies and programs to minimize vulnerability and enhance resilience by improving the livelihoods of the vulnerable haor households of Bangladesh, especially those in Sunamganj district.
Non-migration is an adaptive strategy that has received little attention in environmental migration studies. We explore the leveraging factors of non-migration decisions of communities at risk in coastal Bangladesh, where exposure to both rapid- and slow-onset natural disasters is high. We apply the Protection Motivation Theory (PMT) to empirical data and assess how threat perception and coping appraisal influences migration decisions in farming communities suffering from salinization of cropland. This study consists of data collected through quantitative household surveys (n?=?200) and semi-structured interviews from four villages in southwest coastal Bangladesh. Results indicate that most respondents are unwilling to migrate, despite better economic conditions and reduced environmental risk in other locations. Land ownership, social connectedness, and household economic strength are the strongest predictors of non-migration decisions. This study is the first to use the PMT to understand migration-related behaviour and the findings are relevant for policy planning in vulnerable regions where exposure to climate-related risks is high but populations are choosing to remain in place.
This study aims to explore the impact of climate change on health, including local adaptation strategies. A mixed-method approach has been used in this study. The results reveal that increasing the frequency of flooding, severity of riverbank erosion and drought, and rising disease outbreak are the highest indicators of climate change perceived by riverine island (char) dwellers, which is similar to the observed data. It also uncovers, approximately all respondents encounter several health-related issues during different seasons where prevailing cold and cough with fever, skin diseases, and diarrhoea are the leading ailments. Several adaptation strategies are accommodated by char inhabitants in order to enhance resilience against the climate change health impacts, but the paucity of money, disrupted communication, lack of formal health-care centre are the most obstacles to the sustainability of adaptation. This research recommends that healthcare-associated project should be performed through proper monitoring for exterminating char dwellers’ health issues.
Floods are the most common hazard in Bangladesh adversely affecting the lives and livelihoods of millions of riverine people. Flood-affected households adopt a variety of post-disaster mitigation measures, to the best of their ability, in recognition that similar events are likely to occur again in the future. However, little is known about what drives a household to adopt risk mitigation measures after experiencing a severe flood. The objective of this study was to investigate the determinants of households’ decisions on the implementation of flood risk mitigation measures, following the severe flood in 2017 in northern Bangladesh. The data used for this study were collected from the right bank of the Teesta River in Bangladesh through a survey of 377 households and six key informant interviews. Most of the households (83.3%) adopted at least one risk mitigation measure from either structural or nonstructural categories after the 2017 flood. Binary logistic regression models provide useful insights into the determinants of the implementation of mitigation measures and intention to implement mitigation measures in future. The results showed that the perceived probability of flood, perceived preparedness, flood experience, exposure to flood, membership, household head’s sex, income source, and landownership significantly influenced households to implement mitigation measures in the post-disaster period. Additionally, the intention to implement mitigation measures was influenced by the membership and education of households. This study contributes in terms of useful information about the determinants of post-disaster mitigation measures in riverine areas of Bangladesh. These findings can be used to target specific households to promote disaster risk reduction interventions.
BACKGROUND: Climate change influences patterns of human mobility and health outcomes. While much of the climate change and migration discourse is invested in quantitative predictions and debates about whether migration is adaptive or maladaptive, less attention has been paid to the voices of the people moving in the context of climate change with a focus on their health and wellbeing. This qualitative research aims to amplify the voices of migrants themselves to add nuance to dominant migration narratives and to shed light on the real-life challenges migrants face in meeting their health needs in the context of climate change. METHODS: We conducted 58 semi-structured in-depth interviews with migrants purposefully selected for having moved from rural Bhola, southern Bangladesh to an urban slum in Dhaka, Bangladesh. Transcripts were analysed using thematic analysis under the philosophical underpinnings of phenomenology. Coding was conducted using NVivo Pro 12. FINDINGS: We identified two overarching themes in the thematic analysis: Firstly, we identified the theme “A risk exchange: Exchanging climate change and health risks at origin and destination”. Rather than describing a “net positive” or “net negative” outcome in terms of migration in the context of climate change, migrants described an exchange of hazards, exposures, and vulnerabilities at origin with those at destination, which challenged their capacity to adapt. This theme included several sub-themes-income and employment factors, changing food environment, shelter and water sanitation and hygiene (WaSH) conditions, and social capital. The second overarching theme was “A changing health and healthcare environment”. This theme also included several sub-themes-changing physical and mental health status and a changing healthcare environment encompassing quality of care and barriers to accessing healthcare. Migrants described physical and mental health concerns and connected these experiences with their new environment. These two overarching themes were prevalent across the dataset, although each participant experienced and expressed them uniquely. CONCLUSION: Migrants who move in the context of climate change face a range of diverse health risks at the origin, en route, and at the destination. Migrating individuals, households, and communities undertake a risk exchange when they decide to move, which has diverse positive and negative consequences for their health and wellbeing. Along with changing health determinants is a changing healthcare environment where migrants face different choices, barriers, and quality of care. A more migrant-centric perspective as described in this paper could strengthen migration, climate, and health governance. Policymakers, urban planners, city corporations, and health practitioners should integrate the risk exchange into practice and policies.
INTRODUCTION: Global climate change has produced growing natural disasters across the world especially in Global South. Different countries experience varied vulnerabilities depending on their geographical location, economic status and ability of management. In a highly disaster susceptible developing country like Bangladesh, many individuals experience a greater rate of natural disasters with devastating health effects. Compare with men, women have a higher incidence of mortality and health effects following natural disasters. The study aims to explore women’s experience of physical and psychological health vulnerabilities with primary causes in natural disaster-affected areas of Bangladesh. METHODS AND ANALYSIS: This is an exploratory mixed-method study comprising survey and in-depth interviews with equal priority to identify physical and psychological health vulnerabilities of women living in natural disaster-affected areas of Bangladesh. Quantitative data will be collected using self-administered sociodemographic and perceived severity instrument, 12-item Short-Form, Impact of Event Scale-Revised and Brief Coping Scale, while specific open-ended guidelines will be used for the qualitative part. The instruments will be translated into Bangla following the Brislin (1970) model of translation. The survey will be administered in paper copies, with at least 384 respondents, whereas 30 participants will be in-depth interviewed using an audio recorder. Survey data will be analysed using SPSS V.25 following descriptive and inferential statistics as required. The recorded open-ended responses will be transcribed and analysed using thematic analysis. Finally, both data sets will be integrated and synthesised according to the sequential mixed-method approach. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the Human Research Ethics Committee of the University of New England. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, the internet and various community engagement activities.
Existing efforts to ensure safe water access in coastal Bangladesh are challenged by increasing freshwater salinity. This research explored/explores safe water consumption choices in coastal Bangladesh, which data are scarce to date, using a mixed-methods approach. In 2014, a cross-sectional survey was conducted in southwestern coastal Bangladesh (n=261) and data was generated on water supply and consumption. Data collection also involved 29 in-depth interviews of household care givers and focus group discussions were performed with three community groups. Descriptive statistics were applied to analyse quantitative data and thematic analysis was used for qualitative data. The survey showed that 60% of the study population used tube well water while 40% used pond water for drinking. It was observed that for cooking purposes, the use of pond water was slightly higher than the tube well water. Only 13% of the respondents mentioned that their drinking water tasted salty whereas 6% of the respondents reported health problem (diarrhoea, dysentery, gastric issues and skin problems) after using these water sources. The qualitative data reveals that water available for drinking and cooking is causing a serious threat to this coastal community, particularly during the dry season. In-depth assessments indicated that drinking water choices were less driven by concerns for health than practical issues such as travel distance and time taken and taste. The palatability of water was an important determinant of choice for drinking and other domestic uses. Furthermore, the utility of alternative options for safe drinking water is driven by beliefs and traditions and source maintenance. Given the increasing salinisation of freshwaters in many low-lying countries and likely exacerbation related to climate change-induced sea level rise, therefore, promotion of low saline drinking water along with salt reducing interventions consider that community beliefs and practices must be a made priority.
Levees protect floodplain areas from frequent flooding, but they can paradoxically contribute to more severe flood losses. The construction or reinforcement of levees can attract more assets and people in flood-prone area, thereby increasing the potential flood damage when levees eventually fail. Moreover, structural protection measures can generate a sense of complacency, which can reduce preparedness, thereby increasing flood mortality rates. We explore these phenomena in the Jamuna River floodplain in Bangladesh. In this study area, different levels of flood protection have co-existed alongside each other since the 1960s, with a levee being constructed only on the right bank and its maintenance being assured only in certain places. Primary and secondary data on population density, human settlements, and flood fatalities were collected to carry out a comparative analysis of two urban areas and two rural areas with different flood protection levels. We found that the higher the level of flood protection, the higher the increase of population density over the past decades as well as the number of assets exposed to flooding. Our results also show that flood mortality rates associated with the 2017 flooding in Bangladesh were lower in the areas with lower protection level. This empirical analysis of the unintended consequences of structural flood protection is relevant for the making of sustainable policies of disaster risk reduction and adaptation to climate change in rapidly changing environments.
Exposure to extreme climate events causes population displacement and adversely affects the health of mothers and children in multiple ways. This paper investigates the effects of displacement on whether a child is delivered at a health center, as opposed to at home, and on postnatal care service utilization in Bangladesh. Using cross-sectional survey data from 599 mothers who gave birth in the three years prior to the date of interview, including 278 from households which had previously been displaced and 231 from households which had not been displaced, we use multivariate logistic regression to identify the factors associated with maternal healthcare service utilization. The results show that displaced households’ mothers are only about a quarter as likely to deliver at a health center as mothers from non-displaced households. The use of health center-based delivery decreases as the numbers of past displacements increases. Higher number of previous children, lower use of antenatal care during pregnancy, lower household income, and lack of access to radio/television also significantly reduce a mother’s likelihood of delivery at a health center. Displaced mothers are also substantially less likely to use postnatal care services for their neonates, especially those supplied by trained providers. Use of health facilities for delivery, use of antenatal care services, and previous number of children are other important predictors of postnatal care service utilization for neonates. In light of these findings, relocation of local health facilities with basic and emergency care provisions to areas in which the displaced have resettled, reinforcement of Family Planning services, and extension of coverage of the Maternity Allowance benefits in the displacement-prone mainland riverine areas are recommended policy responses.
OBJECTIVE: Floods are one of the most common types of disasters in Bangladesh and lead to direct and indirect impacts on health. The aim of the study was to assess the impact of floods on Maternal and Newborn Healthcare (MNH) utilization in Bangladesh between the years 2011 and 2014. METHODS: We used variables from the Bangladesh Demographic and Health Survey 2014 data and georeferenced data of floods between 2011 and 2014 from the Emergency Events Database. Multivariate logistic regression was used to determine whether the flood-affected exposures were significant in predicting differences in MNH utilization. RESULTS: The odds for the received antenatal care by skilled providers, institutional deliveries, deliveries by c-section, and postnatal care of the babies were significantly lower (Unadjusted OR?=?0.81, 0.88, 0.83, and 0.82 respectively; P?
OBJECTIVES: Pneumonia is a significant contributor to mortality and morbidity in children aged <5 years, and it is also one of the leading causes of hospitalisation for children in this age group. This study assessed the association between climate variability, patient characteristics (i.e. age, sex, weight, parental education, socio-economic status) and length of stay (LOS) in hospital for childhood pneumonia and its economic impact on rural Bangladesh. STUDY DESIGN: An ecological study design was used. METHODS: Data on daily hospitalisation for pneumonia in children aged <5 years (including patient characteristics) and daily climate data (temperature and relative humidity) between 1st January 2012 and 31st December 2016 were obtained from the Matlab Hospital (the International Centre for Diarrhoeal Disease Research, Bangladesh) and the Bangladesh Meteorological Department, respectively. A generalised linear model with Poisson link was used to quantify the association between climate factors, patient characteristics and LOS in hospital. RESULTS: The study showed that average temperature, temperature variation and humidity variation were positively associated with the LOS in hospital for pneumonia. A 1°C rise in average temperature and temperature variation during hospital stay increased the LOS in hospital by 1% (relative risk [RR]: 1.010, 95% confidence interval [CI]: 1.001-1.018) and 9.3% (RR: 1.093, 95% CI: 1.051-1.138), respectively. A 1% increase in humidity variation increased the LOS in hospital for pneumonia by 2.2% (RR: 1.022, 95% CI: 1.004-1.039). In terms of economic impact, for every 1° C temperature variation during the period of hospital stay, there is an addition of 0.81 USD/day/patient as a result of direct costs and 1.8 USD/day/patient for total costs. Annually, this results in an additional 443 USD for direct and 985 USD for total costs. CONCLUSIONS: Climate variation appears to significantly contribute to the LOS in hospital for childhood pneumonia. These findings may help policymakers to develop effective disease management and prevention strategies.
This paper aims to scrutinize in what way peri-urbanization triggers climate change vulnerabilities. By using spatial analysis techniques, the study undertakes the following tasks. First, the study demarcates Dhaka’s-the capital of Bangladesh-peri-urban growth pattern that took place over the last 24-year period (1992-2016). Afterwards, it determines the conformity of ongoing peri-urban practices with Dhaka’s stipulated planning documents. Then, it identifies Dhaka’s specific vulnerabilities to climate change impacts-i.e., flood, and groundwater table depletion. Lastly, it maps out the socioeconomic profile of the climate change victim groups from Dhaka. The findings of the study reveal that: (a) Dhaka lacks adequate development planning, monitoring, and control mechanisms that lead to an increased and uncontrolled peri-urbanization; (b) Dhaka’s explicitly undefined peri-urban growth boundary is the primary factor in misguiding the growth pockets-that are the most vulnerable locations to climate change impacts, and; (c) Dhaka’s most vulnerable group to the increasing climate change impacts are the climate migrants, who have been repeatedly exposed to the climate change-triggered natural hazards. These study findings generate insights into peri-urbanization-triggered climate change vulnerabilities that aid urban policymakers, managers, and planners in their development policy, planning, monitoring and control practices.
Malaria occurrence in the Chittagong Hill Tracts in Bangladesh varies by season and year, but this pattern is not well characterized. The role of environmental conditions on the occurrence of this vector-borne parasitic disease in the region is not fully understood. We extracted information on malaria patients recorded in the Upazila (sub-district) Health Complex patient registers of Rajasthali in Rangamati district of Bangladesh from February 2000 to November 2009. Weather data for the study area and period were obtained from the Bangladesh Meteorological Department. Non-linear and delayed effects of meteorological drivers, including temperature, relative humidity, and rainfall on the incidence of malaria, were investigated. We observed significant positive association between temperature and rainfall and malaria occurrence, revealing two peaks at 19 °C (logarithms of relative risks (logRR) = 4.3, 95% CI: 1.1-7.5) and 24.5 °C (logRR = 4.7, 95% CI: 1.8-7.6) for temperature and at 86 mm (logRR = 19.5, 95% CI: 11.7-27.3) and 284 mm (logRR = 17.6, 95% CI: 9.9-25.2) for rainfall. In sub-group analysis, women were at a much higher risk of developing malaria at increased temperatures. People over 50 years and children under 15 years were more susceptible to malaria at increased rainfall. The observed associations have policy implications. Further research is needed to expand these findings and direct resources to the vulnerable populations for malaria prevention and control in the Chittagong Hill Tracts of Bangladesh and the region with similar settings.
BACKGROUND: Dengue, a febrile illness, is caused by a Flavivirus transmitted by Aedes aegypti and Aedes albopictus mosquitoes. Climate influences the ecology of the vectors. We aimed to identify the influence of climatic variability on the occurrence of clinical dengue requiring hospitalization in Zone-5, a high incidence area of Dhaka City Corporation (DCC), Bangladesh. METHODS AND FINDINGS: We retrospectively identified clinical dengue cases hospitalized from Zone-5 of DCC between 2005 and 2009. We extracted records of the four major catchment hospitals of the study area. The Bangladesh Meteorological Department (BMD) provided data on temperature, rainfall, and humidity of DCC for the study period. We used autoregressive integrated moving average (ARIMA) models for the number of monthly dengue hospitalizations. We also modeled all the climatic variables using Poisson regression. During our study period, dengue occurred throughout the year in Zone-5 of DCC. The median number of hospitalized dengue cases was 9 per month. Dengue incidence increased sharply from June, and reached its peak in August. One additional rainy day per month increased dengue cases in the succeeding month by 6% (RR = 1.06, 95% CI: 1.04-1.09). CONCLUSIONS: Dengue is transmitted throughout the year in Zone-5 of DCC, with seasonal variation in incidence. The number of rainy days per month is significantly associated with dengue incidence in the subsequent month. Our study suggests the initiation of campaigns in DCC for controlling dengue and other Aedes mosquito borne diseases, including Chikunguniya from the month of May each year. BMD rainfall data may be used to determine campaign timing.
Floods are one of the greatest hazards in Bangladesh. It is assumed that people who reside in a riverine area have adapted to flood pulses. However, in most cases, household-level risk-reduction strategies are inadequate for ensuring a livelihood resilient to floods. This is because riverine people are exposed to recurrent floods, which increases their vulnerability to floods. In order to formulate effective risk-reduction policies and programs for riverine areas, it is crucial to measure flood risk at the local level. This study, therefore, aims to assess the flood risk of riverine households. A multi-dimensional integrated flood risk assessment framework was adopted to quantify household-level flood risk. Using a systematic random sampling technique, 377 respondents from the right bank of the Teesta River in Bangladesh were interviewed to characterize flood hazards, exposure to floods, and their vulnerability and capacity to absorb flood risk. The survey also includes key informant interviews. The collected data were aggregated using a composite index, while comparing the components of flood risk. Descriptive and analytical statistics were also computed. The results showed that flood risk was higher in downstream areas, followed by upstream areas and the midstream segments of the right bank of the Teesta River. The degree of flood risk in these three clusters was significantly different. A significant negative correlation was observed between vulnerability and capacity. No significant associations were found between the exposure and vulnerability components. The multivariate analysis suggested that households’ perceived preparedness was influenced by their ability to responds to floods. The empirical approach presented in this study could be used to assess flood risk in other regions, especially where data is scarce.
