Deaths Due to Cancer Among Women of Reproductive Age in Bangladesh on the Rise: Findings From Two National Level Mortality and Health Care Survey

Background: Bangladesh, a developing country from southeast Asia has the population of 160 million and currently ranks as being the 7th most populated country in the world. Like many other developing countries, Bangladesh is going through an epidemiologic transition, with significant reductions in mortality due to acute, infectious, and parasitic diseases and increases in noncommunicable, degenerative, and chronic diseases over the last 20 years. In this course, of transition, the deaths due to cancer is also on the rise. Among all adult deaths, cancer the third leading cause of death and accounts for one fifth of all mortality in Bangladesh. However, for women the proportions are even higher. Aim: This abstract looks into the datasets of 2 national surveys - Bangladesh maternal mortality and health care survey 2010 and 2016 - and assess the cause of death among women from reproductive age in Bangladesh. The 2010 survey covered over 150,000 households around Bangladesh, while the 2016 survey covered over 310,000 households from the whole of Bangladesh. Methods: Both the survey followed the same clustering process and sampling procedure, to ensure the compatibility among the surveys. Though the main objective of the survey was to look into the status of maternal mortality and corresponding health service seeking behavior, the surveys also shed lights on overall cause of death for women of reproductive age in Bangladesh. The death cases were assessed by verbal autopsy - using WHO process - and the cause of deaths were classified following ICD 10. The particular deaths due to cancer or neoplasm were separated from the main datasets and then it was looked by demographic information of the respondents. Results: The comparison between the national datasets reveals that, in 2010, 21% Bangladeshi women of reproductive age (15-49 years) were dying due to cancer, meaning 1 in 5 Bangladeshi women from reproductive age is dying due to cancer. However, in 2016 the proportion of death due to cancer raised up to 24% women of reproductive age (15-49 years), meaning 1 in 4 Bangladeshi women from reproductive age is dying due to cancer. Age segregated data shows that, only within this 6 years of timespan, more women from younger age (40-45 vs 50-55 years) are dying out of cancer. Conclusion: The findings of this comparison between the 2 national survey shows that, deaths due to cancer among women of reproductive age in Bangladesh is on the rise. Though Bangladesh has developed a National Cancer Control Strategy and Action Plan with the aim of delivering a universal, quality-based and timely service, the initiative are still boutique. A comprehensive preventive approach through tobacco control, health promotion and vaccination program, in addition to, early detection needs to be established with effective referral chain.

Team composition and chronic disease management within primary healthcare practices in eastern Ontario: an application of the Measuring Organizational Attributes of Primary Health Care Survey

BackgroundVarious organizational-level attributes are being implemented in primary healthcare to improve healthcare delivery. There is a need to describe the distribution and nature of these attributes and explore differences across practices.AimThe aim of this study was to better understand organizational attributes of primary care teams, focusing specifically on team composition, nursing roles, and strategies that support chronic disease management.MethodsWe employed a cross-sectional survey design. Team composition, nursing roles, availability of health services, and chronic disease management activities were described using the ‘Measuring Organizational Attributes of Primary Health Care Survey.’FindingsA total of 76% (n=26 out of 34) of practice locations completed the survey, including family health teams (FHT; n=21) and community health centers (CHC; n=4). Nurse practitioners (NPs) and registered nurses (RNs) were the most common non-physician providers, and CHCs had a greater proportion of non-physician providers than FHTs. There was overlap in roles performed by NPs and RNs, and registered practical nurses engaged in fewer roles compared with NPs and RNs. A greater proportion of FHTs had systematic chronic disease management services for hypertension, depression and Alzheimer’s disease compared with CHC practices. The ‘Measuring Organizational Attributes of Primary Health Care Survey’ was a useful tool to highlight variability in organizational attributes across PHC practices. Nurses are prominent within PHC practices, engaging in a wide range of roles related to chronic disease management, suggesting a need to better understand their contributions to patient care to optimize their roles.

Protocol for a nationwide survey of primary health care in China: the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project) Primary Health Care Survey

IntroductionChina has pioneered advances in primary health care (PHC) and public health for a large and diverse population. To date, the current state of PHC in China has not been subjected to systematic assessments. Understanding variations in primary care services could generate opportunities for improving the structure and function of PHC.Methods and analysisThis paper describes a nationwide PHC study (PEACE MPP Primary Health Care Survey) conducted across 31 provinces in China. The study leverages an ongoing research project, the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project (MPP). It employs an observational design with document acquisition and abstraction and in-person interviews. The study will collect data and original documents on the structure and financing of PHC institutions and the adequacy of the essential medicines programme; the education, training and retention of the PHC workforce; the quality of care; and patient satisfaction with care. The study will provide a comprehensive assessment of current PHC services and help determine gaps in access and quality of care. All study instruments and documents will be deposited in the Document Bank as an open-access source for other researchers.Ethics and disseminationThe central ethics committee at the China National Centre for Cardiovascular Disease (NCCD) approved the study. Written informed consent has been obtained from all patients. Findings will be disseminated in future peer reviewed papers, and will inform strategies aimed at improving the PHC in China.Trial registration numberNCT02953926