Effectiveness of tobacco control initiatives is subject to the status of trade regulations of a region. As a direct effect of trade liberalisation by many countries, the world has experienced stimulation in trade volume of tobacco and tobacco products in recent years. Reduction in trade barriers might increase possibility of tobacco marketing and reduce their price causing higher consumption of tobacco. This effect of liberalisation on consumption is more prominent in low and middle income countries (LMIC) than their high-income counterparts according to researcher Taylor and Bettcher.

Similar to licit trade of tobacco validated by trade openness among countries, presence of illicit trade in the sector also enhances easy accessibility of tobacco products by undercutting tobacco prices. The extent of illicit trade, therefore, possesses a complex and pressing challenge for effective control of tobacco in any country.

Empirical estimation of the extent of illicit trade in tobacco market often remains as an intricate task because of its stealthy nature. Tobacco researchers around the world quite often triangulate several methods to improve preciseness of measurement of magnitude of illicit trade.

In 24 November 2019, reputed researcher Dr. Rumana Huque, SM Abdullah (Faculty members at Department of Economics, the University of Dhaka) and Nahian Azad Shashi (Research associate at Bangladesh Institute of Development Studies) have written an editorial about illicit trade at business daily The Financial Express (Bangladeshi national English newspaper). Where they underlined to monitor in tobacco trade to reduce Illicit tobacco trade. And they also emphasize on tracking and tracing system for proper implementation of the FCTC protocol on illicit trade. Because it would be the key to addressing the concern over illicit supply of tobacco products. They think addressing underreporting of tobacco trade might help increasing fiscal revenue and making tobacco combat successful in Bangladesh.

To read this article in brief please click the bottom link …

Underreporting in Bangladesh perspective

In Bangladesh, every year, more than 350,000 people are affected by Tuberculosis (TB), and more than 70,000 people die due to the same. 20% of the deaths are attributed to tobacco. These toll of death can easily be avoided by collecting information and counselling on tobacco use among TB patients by the TB care providers. The information was revealed in a study conducted by ARK Foundation.

A dissemination seminar titled as ‘Tobacco cessation within TB Programme’ on the TB & Tobacco project was organized at a hotel in the capital city on 6th October 2019. Md. Saidur Rahman, Additional Secretary (World Health) of the Health Services Division of the Ministry of Health and Family Welfare was the chief guest of the event. Prof. Dr Shamiul Islam, Line Director, National Tuberculosis Control Program and Prof. Dr Shah Monir Hossain were the special guests of the seminar. The findings of the study were presented by the Executive Director of ARK Foundation, Dr Rumana Huque.

In this study funded by the European Union, it was further revealed, that 18% of the TB patients are smokers. At least one in every three male patients smoke. The risk of death among TB patients who are smokers increases two-fold. A brief counselling session provided by the healthcare provider can play a vital role in helping patients quit smoking. This kind of support for tobacco cessation can annually help 14,000 TB patients to quit tobacco.

Prof. Rumana Huque mentioned, taking the initiative to integrate the information collected on tobacco use, reporting and counselling, is of extreme importance.

Within this study, ARK foundation has trained healthcare providers of 4 districts, to hone their skills in counselling patients for tobacco cessation. Later, 28% of the TB patients and 40% of males were identified as smokers. The trained healthcare workers were successful in providing counselling and supporting these patients to quit smoking. This proves that, for patients to quit tobacco, providing support through a brief counselling session, is effective and feasible on a large scale.

Through the provision of straightforward simple training to the healthcare providers, it is possible to support patients quit tobacco, and this will cost the government only 65 BDT per month.

In his speech, Chief Guest Md. Saidur Rahman mentioned, “Quitting tobacco use must be made mandatory for those who attended the DOTS centre for treatment. It is possible to help patients quit tobacco during their treatment period of six months. Today, from here, we should make a decision that we will begin a support programme to help TB patients stop smoking and quit tobacco.”  He mentioned, “All TB patients should be free from tobacco use. This programme must be made compulsory in all hospitals providing treatment for TB”.

The Line Director of the National TB Control Programme, Dr Shamiul Islam stated, “The government has committed to making the country TB free by 2035 and tobacco-free by 2040. For this commitment to be fulfilled, integrating tobacco control within TB treatment, and incorporating information on tobacco use, and helping patients to quit tobacco, is extremely important. For this reason, it is necessary to enhance the skills of healthcare providers and maintain their professional safety.”

Prof. Dr Shah Monir stated, “For the treatment of TB patients who use tobacco, collecting information on their use of tobacco and quitting the same, coupled with counselling which is easy for them to understand, is very important.

The integration of this arrangement is not only possible for TB patients but in other sectors of health is as well.

As a consequence, this will not only help in the development of evidence-based policies and management to control the disease, but it’ll also help to improve the condition of the patients and reduce the death rates due to TB.

The seminar was also attended by Honourable Former Joint Secretary Md. Ruhul Kuddus,  Dr Golam Mohiuddin Faruque from the Cancer Society, Dr Sohel Reza Chowdhury from the National Heart Foundation, Syedul Mahbubul Alam, Technical Advisor of The Union, and renowned clinician Dr M. S. Choudhury Lelin.

Few newspapers in the country reported abou this event which can be found as follows:

Dr. Rumana Huque, Professor, Department of Economics, University of Dhaka and Executive Director, ARK Foundation, moderated a panel discussion on “Sustainable Health Financing ” yesterday, in International Conference for Economists organized jointly by Bureau of Economic Research and Department of Economics, University of Dhaka.

Among the panelists were Professor Sushil Ranjan Howlader, Founder Director of Institute of Health Economics (IHE), University of Dhaka, Dr. Shakil Ahmed, Senior Economist (Health), The World Bank, and Md. Ashadul Islam, Secretary, Health Services Division, Ministry of Health and Family Welfare. Professor Syed Abdul Hamid, IHE, DU presented the key note paper.

The event was also covered in a leading newspaper of the country:

Newspaper Coverage

Two of the researchers from ARK Foundation, Fariza Fieroze and Zunayed Al Azdi, joined the Global Conference on Implementation Science and Scale-up, 2019 to present their research work in front of the researchers and implementers from all over the world. The conference was held at Radisson Blu, Dhaka from June 29 to July 1, 2019, organised by BRAC James P Grant of School Health, BRAC University and UNICEF.

Fariza Fieroze, Research Associate, presented a paper titled ‘ Urban day-care for improved health and social outcomes: research to understand demand and implementation of day-care in Dhaka’. This research sought to understand the demand for day-care and the challenges of implementing a day-care model to improve health and ECD among under-5 children from Dhaka’s urban poor. Researchers used a sequential mixed methods design, including participatory action research (PAR) to understand how to implement day-care in the urban context.

The team found a great need for day-care among vulnerable families. Our survey found 71% [95% CI: 56, 83] of respondents living in ‘slum’ (UNHabitat definition) households needed daycare compared to 44% [95% CI: 24, 67] non-slum (AOR 3.5 [95% CI: 1.6, 7.6]). Qualitative findings confirmed women’s need for long day-care, current lack of provision and concerns for children’s safety. PAR highlighted implementation issues:
i) building trust in the community, ii) providing food, iii) role of Madrassa schools, iv) the need for a curriculum to strengthen ECD and v) sustainability.

Zunayed Al Azdi, Research Associate and Uptake Manager, presented a poster titled ‘Muslims for Better Health: Developing a smoke-free home intervention for delivery in mosques’ in the conference. The poster was to show the methodologies, strategies and ideas that helped develop an intervention to be delivered by the religious leaders to change smoking behaviour of people inside their homes. This intervention is the first of its kind in the country that targets second-hand smoking (SHS).

The intervention components were targeted to improve knowledge, develop a positive attitude, encourage motivation, enhance confidence and increase peoples’ intention to act on quitting smoking at homes. The findings of the study have the potential to influence policy and practice on tobacco control, particularly SHS exposure, in Bangladesh.

To see the poster along with the full abstract, please click on the link below:

Poster and Abstract

For more information, you can communicate with the presenters via the following e-mail address:

fariza@arkfoundationbd.org

azdi@arkfoundationbd.org

The spread of antimicrobial resistance (AMR) is an issue of growing global concern. It is often cited as one of the most critical threats to global health, food security and development. Antibiotic drugs are used to treat the bacterial diseases. When these drugs become no longer sensitive to the bacteria then it is called Anti-microbial resistance (AMR) which refers to ineffectiveness of antibiotics. As a result, bacterial diseases become untreatable, even simple bacterial infections become difficult to treat. Ineffectiveness of antibiotic is rapidly increasing in eleven Asian countries including Bangladesh. Taking antibiotic without prescription of registered health care providers; non-completion of prescribed antibiotic course; sharing antibiotic drugs with other people and mixing the drugs in poultry-feed and fish-food – are the main reasons of AMR in Bangladesh. Changing behaviour with regard to how antibiotics are prescribed and used (in humans and animals) is a key strategy to minimising the spread of resistance. Successfully changing people’s behaviour and ensuring appropriate use of antibiotics will require innovative and participatory community mobilisation approaches.

On March 25, 2019, a workshop has held on “Antimicrobial resistance, One Health and Community Engagement” at Six Seasons Hotel, Gulshan-2, Dhaka. The workshop was organized by ARK Foundation, Bangladesh in partnership with University of Leeds and Malaria Consortium, UK. Professor Dr. Md. Abul Hashem Khan, Line Director, Community Based Health Care, Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare, Bangladesh chaired the workshop. Professor Sayedur Rahman Khasru, Professor of Pharmacology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Professor Nitish C Debnath, Chittagong Veterinary and Animal Sciences University, Dr. Prudence Hamade, Sr. Technical Advisor of Malaria Consortium, Dr. Rebecca King, Associate Professor of University of Leeds, Ms. Lauren E. Smith, Social and Behaviour Change Specialist of Malaria Consortium, Dr. Rumana Huque, Executive Director of ARK Foundation were present in the workshop among others.

Professor Dr. Md. Abul Hashem Khan stated that ARK Foundation has taken a commendable step by conducting the community based awareness programme on AMR. Mr. Prudence Hamade said that AMR is a serious public health problem affecting people all over the world. Antimicrobials are lifesaving drugs.  In order to delay resistance, antimicrobials need to be taken only when needed to treat serious infections. The drugs need to be of high quality, besides full courses should be taken. Antibiotic misuse in animal is one of the main causes of antibiotic resistance and should be used for the treatment of sick animal, not for prevention or growth promotion.

Dr. Rebecca King said that community engagement approaches that are designed to be appropriate to deliver within existing health care system show great potential as mechanisms through which communities can identify solutions to addressing antimicrobial resistance. Ms. Lauren E. Smith, Social and Behaviour Change Specialist said that community Participation is key to designing effective interventions that can be scalable and sustainable. The community dialogue approach can empower communities to take action and improve their health. Dr. Rumana Huque, Executive Director, ARK Foundation said that a recent study conducted by ARK Foundation, University of Leeds and Malaria Consortium titled “Community Dialogues to prevent and control antibiotic resistance in Bangladesh” suggests that the community dialogue approach can play an important role to increase awareness among people on appropriate use of antibiotics. She added that tackling AMR will require a coordinated, collaborative and multidisciplinary approach, which will need to bring together stakeholders from a range of sectors, including human health, animal health, environment, agriculture and WASH (One Health).

We are happy to announce that we became a part of ASTRA – a brand new programme to address Smokeless Tobacco use and build research capacity in South Asia. This is funded by the National Institute for Health Research, the largest national clinical research funder in Europe and partnered with University of York, Brunel University, University of Edinburgh, University of Stirling, King’s College, Khyber Medical University, University of Warwick and National Institute of Cancer Prevention And Research, India.

See the info-graph for more details.

With the title “Designing Interventions to Improve Patient Feedback Systems at Upazila Health Complexes in Bangladesh” an workshop and dissemination session was held at BMA Bhaban on 20th June, 2018.

The program was chaired by Muhammad Ruhul Quddus, Director General of Health Economics Unit (HEU) of Ministry of Health & Family Welfare (MOHFW). We were also honored to have Md. Ashadul Islam, Director General of BKKB and Former DG of HEU as our Chief Guest and Ashrafunnessa, Director of IEM as our Special Guest.

ARK foundation is conducting multiple researches to strengthen health service delivery in Bangladesh, funded by UKAid. ARK, from its experiences working at Upazila Health Complexes and Community Clinics (CC), believes that, responsiveness of both supply and demand side is crucial for ensuring quality health care at Community, Upazila and District levels. We are aware of many challenges related to health system and service delivery, however, we need to find out feasible solutions for short, medium and long term to mitigate the challenges. This requires continuous engagement and commitment of all relevant actors to work in a coordinated way to achieve the stated goals.

Against this backdrop, ARK Foundation, in collaboration with Health Economics Unit of Health Services Division, Ministry of Health and Family Welfare, and with the technical support of University of Leeds, UK and UKAid, organised a policy dialogue with senior level policy makers, service delivery personnel, development partners, academia and researchers on 29th March, 2018. The dialogue primarily focused on strengthening health service delivery in the context of achieving universal health coverage.

Objective of the dialogue

The objectives of the dialogue were to share the learning from COMDIS-HSD research carried out in Bangladesh, assess the present state of service delivery and apprise the options for future course in order to move progressively to the planned goal of universal health coverage.

The full report of the event is available here:

Report-on-Policy-Dialogue_ARK_COMDIS