Non-Certified Providers Sought for Treatment of Fatal Non-Communicable Diseases in Bangladesh

Although non-communicable diseases account for a significant burden of deaths among women of reproductive age in low-income countries, little is known about how women and their families seek care for these diseases. A study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health found that a majority of women who died from non-communicable diseases in rural Bangladesh between 2001 and 2007 first visited traditional healers and untrained village doctors, with only a quarter of women seeking care from medically certified providers. Families cited distance to facilities, cost of services and lack of recognition of the severity of their conditions as barriers to receiving medical care.

Using the pregnancy surveillance infrastructure of the JiVitA-1 community trial in northwest rural Bangladesh, Shegufta Sikder, a PhD candidate in the Global Disease Epidemiology and Control Program of the Department of International Health, analyzed care-seeking patterns among 250 women who suffered from fatal non-communicable diseases. Beyond the initial point of care, women appeared to switch to medically certified practitioners when treatment from non-certified providers failed to resolve their illnesses. However, the women typically reached medically certified providers in advanced stages of disease and were usually told that treatment was not possible or were referred to higher-level facilities that they could not afford to visit.

Recognizing the current global attention to non-communicable diseases following the 2011 United Nations summit on the issue, this Johns Hopkins research highlights the importance of addressing the burden of non-communicable disease mortality among adult females. “Improvements in early detection, appropriate care seeking, and service delivery are needed to advance treatment options for NCDs in resource-poor settings,” said Alain Labrique, PhD, assistant professor in the Bloomberg School’s Department of International Health and corresponding author of the study. “While maternal health and safe pregnancy remain vital to the health of women of reproductive age, increased attention is needed to addressing non-communicable diseases among this population in resource-poor settings.”

“Care seeking patterns for fatal non-communicable diseases among women of reproductive age in rural northwest Bangladesh” was published in the August 2012 edition of Biomed Central Women’s Health and written by Shegufta S. Sikder, Alain B. Labrique, Barkat Ullah, Sucheta Mehra, Mahbubur Rashid, Hasmot Ali, Nusrat Jahan, Abu A. Shamim, Keith P. West, Jr., and Parul Christian.

Financial support for the research was provided by the Bill & Melinda Gates Foundation to the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health. Original trial support came from the U.S. Agency for International Development, with additional support from the Sight and Life Research Institute. Partial support for this data analysis was provided by the Bloomberg School of Public Health through a Global Field Experience Fund, a Framework Award in Global Health (Center for Global Health), and a Delta Omega Scholarship (Delta Omega Honor Society).

Media contact: Tim Parsons, director of Public Affairs, at 410-955-7619 or tmparson@jhsph.edu.