nlp-thedeep/humsetbias huggingface dataset:
[ 8 August 2021, Bangladesh ]  Of those who sought services, around 65.8% took services from public health facilities  ( 22.1% from Upazila Health Complexes, 16.1% from Government District Hospitals, 10.1% Union Health and Family Welfare Centres, 10.1% from Community Clinics ) . 62.4% of households preferred services from private facilities  ( 48.3% from private clinics and 14.1% from private chambers )  and through telemedicine  ( 1.3% ) . In the rural area, women used public health facilities more than private facilities  ( 64.6% vs. 59.6% ) .
[ 26th August 2021, Cox's Bazar ]  Both Host and Refugees: During COVID 19, the worsening of the economic condition and the reduced access to income for both hosts and refugees increased the difficulty in fulfilling the basic needs of the Rohingyas and host communitites. Their frustration exacerbated tensions that were preexisting and resulted in episodes of physical aggression and theft. It has been found that in several locations of Camp 1E.
[ 26th August 2021, Cox's Bazar ]  Refugees: According to refugees reached out through Khobor Khana, the IRC Signpost project, from camp 15 and 16, out of 73 beneficiaries  ( female 29 and male 44 ) , 64% respondents reported a need for COVID 19 information. Since last year, different actors and site management have done awareness on COVID 19, but a significant number of refugees in these two camps have requested more information, e.g. on COVID19 testing. Besides this, requests for information on services about WASH  ( 22% ) , shelter  ( 19% ) , referrals, NFI  ( 15% )  and food  ( 12% )  were requested.
[ 26th August 2021, Cox's Bazar ]  Refugees: In camp 15, Block B 7, a toilet is nonfunctional since early June forcing eight families to go to another place. This has caused conflict and a long waiting time. In block A7, Chakmarkul Site of Camp 21, six families, especially pregnant women and elderly persons, suffer as there are no toilets nearby their homes. In block E2 Omani Site, two out of three toilets are damaged, and one is overflowing.
[ 8 August 2021, Bangladesh ]  Delivery done by untrained midwives in one in five cases: Although the trained health workers or doctors were involved in delivery in most of the cases, 18% of the birth was attended by untrained midwives. Nationally, almost 41.0% of birth is assisted by an unskilled birth attendant  ( Unicef, 2019 ) . This was much higher than the study findings. The difference might be a result of a very small sample size.
[ 8 August 2021, Bangladesh ]  The birth assisted by unskilled birth attendants mainly resides in the rural area. When the respondents were asked why they did not carry out the delivery with the help of an expert's hand or taking to the hospital, financial problems  ( 7 respondents out of 18 )  came out to be the main reason. Besides that risk of getting coronavirus infection  ( 6 respondents out of 18 )  and closure of the nearest health facility  ( 4 respondents out of 18 )  were the major reasons for that.
[ 8 August 2021, Bangladesh ]  One third of the new mothers did not take postnatal care service during the pandemic: More than one third of the mothers  ( 33.50% )  among the 106 new mothers informed that they did not take postnatal care from any health care centre. The new mothers who took postnatal care gave most preference to private entities  ( 68% in private clinics, 32% in private chambers and 32% in private hospitals ) , then to trained health workers  ( 46% )  and then to government entities  ( 28% in Upazila health complexes, 26% in the district level government hospital and 12% in government medical college hospitals ) .
[ 26th August 2021, Cox's Bazar ]  Refugees: As the Covid 19 pandemic continues to surge, its prevalence throughout Bangladesh is very alarming, with a 15% increase of daily confirmed cases at the end of June. Whilst life of the Rohingya refugees seems extremely precarious due to prolonged lockdown with only lifesaving services such as health, food, WASH, and shelter since April 2021.
[ 8 August 2021, Bangladesh ]  Vaccination of under five children was not ensured properly during the pandemic: This is widely claimed that child mortality has decreased in Bangladesh as it has ensured almost 100% coverage in some basic vaccinations such as BCG  ( 99.5% ) , DTP1  ( 99.3% ) , DTP3  ( 97.9% ) , Pol1  ( 99.3% ) , Pl3  ( 97.3% ) , MCV1  ( 95.3% )  in 2015  ( WHO and Unicef, 2019 ) 11. The surveyed households have 794 under five children  ( 32% of total household members ) . Of them, 5.91% of children  ( 47 )  were not vaccinated during the pandemic, from April to August this is more in rural areas compared to the urban level households  ( 6.8% vs. 4.5% ) . The service providers also acknowledged the initial halting of the EPI campaign.
[ 26th August 2021, Cox's Bazar ]  Refugees: In Camp21, community have not received any Personal Protective Equipment  ( PPE )  such as masks for the last three months from the Bangladesh Red Crescent  ( BDRCS )  and without masks the Armed Police Batallion  ( APBN )  do not allow them travel to recieve food at liquefied petroleum gas  ( LPG )  distribution points and support health centers.
[ 8 August 2021, Bangladesh ]  The households that failed to seek physiotherapy service for the household members who required physiotherapy mentioned some reasons, which include financial stress  ( 58.82% ) , fear of coronavirus infection  ( 43.28% ) , increased cost of transportation  ( 6.30% ) , transportation problem  ( 6.30% ) , unknown physiotherapy centres  ( 5.46% ) , absence of physiotherapists  ( 5.04% ) , far distance of physiotherapy centres  ( 4.62% )  and closure of nearest physiotherapy centres  ( 3.78% ) .
[ 26th August 2021, Cox's Bazar ]  Refugees: By reviewing the last six months information of IRC protection monitoring report, polygamy plays a major factor in increasing IPV and violence in the community. GBVIMS data indicates that 93% of women and girls who reported GBV had experienced IPV. Men are unable to treat all of their wives equally, women are deprived of their rights and women are the sole caregivers of children. Moreover, women are economically disempowered and dependent on their husbands which puts them in a subordinate position.
[ 8 August 2021, Bangladesh ]  3.7 Experience in seeking health services for chronic diseases A considerable number of patients with chronic diseases needed emergency treatment during the pandemic: Among the surveyed households 22.1% of households' members took treatment for chronic diseases. People from urban areas got more services for chronic diseases, compared to rural level people  ( 23.8% vs. 20.9% ) . The most common types of health services taken by the patients with chronic diseases were conducting regular check ups  ( 69.3% ) , conducting the diagnostic test  ( 54.2% )  and 15.3% of them sought emergency treatment. The remaining patients with chronic diseases sought healthcare services including therapy, surgery, post operative check up etc
[ 8 August 2021, Bangladesh ]  Female and male aged between 20 60 years were mostly affected by the chronic diseases that account for 54.3% and 37.7% respectively, and old aged people  ( 60+ )  were 29.8%. This data reflects that females aged between 20 60 years are more vulnerable and endangered to chronic diseases. The family members were found to be affected by chronic diseases such as high BP  ( 45.6% ) , diabetes  ( 41.2% ) , cardiovascular diseases  ( CVD )   ( 25.8% ) , hypertension  ( 18.4% ) , old age diseases  ( 15.4% ) , disability  ( 3.9% ) , psychological diseases  ( 2.3% ) , thyroid  ( 1.8% ) , cancer  ( 1.9% )  and others  ( 14.2% ) .
[ 8 August 2021, Bangladesh ]  Another reason for the self exclusion from seeking healthcare services was the financial crisis that accounted for 54.51% of the responses. Due to the ongoing health pandemic, people suffered from economic and financial loss that includes joblessness, business closure, and reduction in income. In addition, the cost of healthcare services increased during this time frame that includes the cost of treatment, cost of diagnosis, and cost of medicines. The financial crisis was more mentioned by rural level respondents than the urban ones  ( 62.5% vs. 45.2% ) .
[ 8 August 2021, Bangladesh ]  3.9 Experience in seeking mental health services: More than half of patients bearing mental illness could not seek treatment due to the fear of corona infection during the pandemic: A total of 37 households  ( 1.5% )  reported that some of their family members took mental health related treatment during the pandemic slightly more in the urban level households than the rural ones  ( 1.7% vs. 1.4% ) .
[ 8 August 2021, Bangladesh ]  However, 17.9% of the households  ( 22 households )  that sought emergency health services faced any kind of problems while seeking services in hospitals. The problems include unavailability of doctors on time  ( mentioned by 13 ) , ignorance by healthcare service providers in providing healthcare service  ( mentioned by 13 ) , the reluctance of health facilities to admit the patients  ( mentioned by 6 ) , providing the patient with appropriate treatment  ( mentioned by 6 ) , claiming extra money to provide emergency healthcare services  ( mentioned by 4 ) , etc.
[ 8 August 2021, Bangladesh ]  Unavailability of doctors  ( 22.02% )  and closure of nearest hospitals  ( 15.16% )  induced the chronic patients to self exclude from taking health services. Due to the ongoing health pandemic, the government along with the private sector hospitals mobilised doctors and medical professionals to contain COVID 19 infection. As a result, many doctors were reassigned to treat COVID 19 patients and in addition, many doctors were also affected. Some of the self exclusion reasons include available hospitals were located at distant places, and unavailability of transportations coupled with higher cost of transportation.
[ 8 August 2021, Bangladesh ]  3.12 Experience in seeking physiotherapy services: Around half of the patients necessitating physiotherapy failed to take service due to economic stress and fear of corona infection: From the surveyed households around 2% or 44 individuals obtained physiotherapy services from health care centres. Less than one in five individuals  ( 18.2% )  among them could not get the frequency of physiotherapy sessions that they required.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees:  Infectious diseases: The likelihood of contracting infectious diseases increases exponentially in congested camp settings. The available studies show high incidence of measles, diphtheria, diarrhea, and acute respiratory infections in the DRP camps. However, there is little evidence on the prevalence of these diseases in the host community.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees: Rates of early child marriage, considered a form of GBV, are high both in the DRP camps and among the HC. The UN and human rights organizations report that many Rohingya women and girls survived sexual and physical violence prior to arriving in Bangladesh. However, given the reluctance to share such experiences, the actual numbers of victims is unknown, and the few available sources offer inconsistent estimates.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees: There are several barriers to school participation and progression for both DRP and HC. Evidence from CXB host communities shows that secondary and higher secondary school enrollment rates here lag behind national averages, with financial constraints constituting the main obstacles to enrolling in and completing education.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees:  
 Both DRP and HC girls and women are at high risk of facing gender based violence  ( GBV )  in the forms of physical and sexual violence like sexual harassment, assault, and even early child marriage. Incidence of these forms of GBV is reported to be high in both communities. In a study by Monash University, among Rohingya girls who reported physical violence and mistreatment, the majority of incidents occurred within the household.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees: Water, sanitation and hygiene  ( WASH ) : Evidence on WASH in the host community shows that the majority of households are using unimproved sanitation and shared water sources. Host households living closer to DRP camps are more likely to access poorer facilities. Among the HC, a greater share of households living in close proximity to camps report using shared water sources.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees: Along with limited access to proper sanitation in the camps, Rohingya households must share these facilities with other camp dwellers. In comparison, fewer host households must use shared waterpoints and sanitation facilities. Some studies showed that the availability and quality of WASH services are determined in part by the seasons.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees: Rohingya children are restricted to learning centers operated by various NGOs with mixed results for educational outcomes. DRP and HC male children often fail to enroll in school or subsequently drop out in order to support their families through work. Girls lose schooling opportunities because of cultural norms, a disproportionate burden of caregiving and domestic work, and other gender based barriers, including early marriage.
[ 6th August 2021, Cox's Bazar ]  MICS data shows that, nationally, 34 percent of Bangladeshi children aged 6 23 months receive the recommended minimum diet diversity, and 27 percent have a minimum acceptable diet. This indicates a poor transition from breastfeeding to a healthy diet, which places children at risk for stunting, wasting, and other malnutrition related illnesses.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees: Gendered social norms affect women and girls from HC and Rohingya communities, constraining all facets of their lives, including their ability to make decisions, propose solutions, and lead. Current leadership infrastructure among DRP is centered on the “majhi'  ( traditional leaders )  system. This excludes women from decision making positions.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees: Nutrition and food security: Cox's Bazar shows a high prevalence of acute and chronic child malnutrition, compared to the Chittagong region and Bangladesh as a whole. . Although consumption patterns of Rohingya households were found to be similar to hosts', Rohingyas' food consumption remains largely supplied through humanitarian aid.
[ 8 August 2021, Bangladesh ]  4.1 Impact of COVID 19 on essential health services: In general, health care services other than COVID 19 services were interrupted: Except for some key informants among the service providers, most of the providers admitted that there was a severe interruption in general health services especially during the initial stage and lockdown situation. The outdoor service was almost closed in most of the areas. To stop the spreading of the virus, the hospitals discouraged patients to come to the hospital unless it was extremely necessary.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees: While DRP mobility and employment is restricted to the camps, their participation as consumers is less limited, and evidence shows that a small percentage has access to markets outside their camps. At the same time, host community members are reported to shop at the informal markets inside the camps and transact with Rohingya traders
[ 6th August 2021, Cox's Bazar ]  Rapid analyses and simulation studies from early in the pandemic suggested that the novel coronavirus had the potential to overwhelm health systems in Cox's Bazar. Further examination is required of how preventative efforts were carried out to curtail infections, given the high risks associated with humanitarian contexts.
[ 6th August 2021, Cox's Bazar ]  Hosts: Host community children are faced with various barriers to education including both social and economic factors. While 83 percent of children in Bangladesh complete primary school, only 29 percent complete upper secondary school. In Chittagong, national data from the MICS shows completion rates for primary, lower secondary and upper secondary at 80, 63, and 25 percent respectively.
[ 8 August 2021, Bangladesh ]  The commonest problem faced while taking telemedicine services was around seven out of ten individuals could not express their symptoms adequately  ( 68.8% ) . The lack of physical signature on prescription was the next most common problem for these patients  ( 37.5% ) . Comparatively high fees charged for telemedicine services was another important issue  ( 18.8% ) .
[ 6th August 2021, Cox's Bazar ]  Refugees: Some reports mention DRP purchasing other foodstuffs using stipends from cash for work programs, bartering, or sometimes selling items received through humanitarian aid. While some studies indicated that DRP routinely barter using food aid, more research is needed to understand the motivations for barter as food assistance has transitioned to a voucher modality.
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees: In general, cultural norms among DRP and HC make discussing sex and sexuality difficult. Some studies discuss cultural and religious barriers to reproductive health  ( e.g., rejection of contraception and high rates of adolescent pregnancy in both populations ) .
[ 6th August 2021, Cox's Bazar ]  Refugees: Rohingya in CXB still struggle to meet basic needs for food, health, education, and access to livelihoods, as they did prior to displacement. Rohingya continue to face economic and movement restrictions, exacerbating the dependence on humanitarian assistance.
[ 26th August 2021, Cox's Bazar ]  Refugees: The active presence of several criminal groups in all camps has been a threat to the safety of both refugees and host community members for the last two years. An extremist group named Arakan Rohingya Salvation Army  ( ARSA )  collects money illegally in camp 1W. In camp 1E, people informed volunteers that the ARSA is forcing community people to work with them at night time. If a selected person is unable to work with ARSA due to any reason, he must hire someone else to replace him. If anyone denies the order of ARSA, then he has to pay for it. Refugees from camps expressed their concern about the increased control and power in camps exerted by the criminal groups due to the decrease in the presence of the camp authority, the army, the police and aid workers during COVID 19.
[ 8 August 2021, Bangladesh ]  Lack of awareness among the population: Overall, the patients were less aware of the safety procedure. Many of the patients came to the hospital without a mask. Patients were hiding COVID 19 infections/information, so the doctors were affected by the virus from the patients. Many of the doctors had to go for quarantine due to the exposure of an infected patient unknowingly. Patients expected that the doctors would physically examine them in the usual way but when the doctors did not do that, they were dissatisfied.
[ 26th August 2021, Cox's Bazar ]  Refugees: During this lockdown and thus shut down of all learning centres and child friendly spaces, child labour has rapidly increased. Now children are working mainly in tea shops, carrying food and NFI items from the distribution point, carrying water, selling things in the local market. Some children go to other camps for work and are also involve in drug dealing.
[ 26th August 2021, Cox's Bazar ]  Refugees: GBVIMS data trends show an increase in reported cases of rape in the community during the month of June. GBVIMS data incates that in June 5% of women and girls who reported GBV were raped where as in January 1% of women and girls who reported GBV were raped. There are instances where women are enticed and then raped.
[ 26th August 2021, Cox's Bazar ]  Refugees: GBV case management actors who are working remotely face challenges and are unable to refer cases to different actors. There is difficulty referring cases to legal service providers due to their absence because of the lockdown. Protection actors are facing challenges providing remote services due to poor phone connectiveity in the camps.
[ 8 August 2021, Bangladesh ]  Coordination gap with other stakeholders: Severe lack of coordination among different departments was observed and experienced by the key informants which delayed the response during the pandemic. Therefore, they suggested establishing a better coordination mechanism within the different departments of the government and other external stakeholders.
[ 26th August 2021, Bangladesh ]  The government has once again decided to extend the ongoing closure of all educational institutions across Bangladesh in light of the Covid 19 situation. The closure was supposed to end on August 31. But now it has been extended until September 11. The Education Ministry, in a notification on Thursday, announced that all secondary and higher secondary level educational institutions, including Ebtedayee and Qawmi madrasahs, would remain closed until during this period.
[ 8 August 2021, Bangladesh ]  Insufficient financial resources: The key informants raised the needs for budget increment in health sectors so that adequate health equipment and human resources could be ensured. The respondents also suggested allocating a separate budget for emergencies so that the response in that situation does not delay due to budget constrain or bureaucratic processes. They also expressed the need for proper budget management and capacity building for budget management.
[ 8 August 2021, Bangladesh ]  The gap in motivating the workforces in the health sector: Although the key informants repeatedly mentioned that they were working out of their professional responsibilities they felt, not for any extra financial benefit still the health service providers felt the need for ensuring proper incentives for the health service providers.
[ 26th August 2021, Bangladesh ]  Universities can reopen from October 15 only after vaccinating all students and teachers, says the University Grants Commission  ( UGC ) . To reopen the universities within October 15, the university authorities have to vaccinate all their students and teachers within September 15, UGC Chairman Prof Kazi Shahidullah told The Daily Star.
[ 8 August 2021, Bangladesh ]  The COVID 19 pandemic situation was new for all both the service seekers and service providers. Fear of getting infected was visible on both sides. Among the surveyed households, many of them did not seek health services despite having illnesses of their family members. On the other hand, many a household had to seek health services and it was found that one in every ten households reported problems in accessing general healthcare services.
[ 8 August 2021, Bangladesh ]  The problems mentioned by the respondents uncovered the untold truth of the entire health sector of Bangladesh. The lack of necessary health service providing resources such as sufficient bed, sufficient doctors and nurses, medical equipment, medicines, skills, professionalisms etc. were exposed and the findings of this survey also suggest that.
[ 8 August 2021, Bangladesh ]  The purchasing capacity of most of the people of this country suggests that most of the people would seek health services from government entities as the costs are less compared to the private entities. However, for some essential health services, the majority of the surveyed households opted for the private entities to seek health services during the pandemic, though the average income of the surveyed households decreased.
[ 8 August 2021, Bangladesh ]  Existing telemedicine platforms and mechanisms require strengthening for institutionalising these services into the government and private healthcare sphere. Sustained campaigning and campaigning need to be carried out to inform communities on a spectrum of issues and topics related to availing telemedicine services for instance, on how to access these services or on what specific services can be provided in teleconsultation.
[ 8 August 2021, Bangladesh ]  Some newborn babies were not taken to hospitals despite having sickness: Out of 49 households, 30  ( 61.2% )  households sought treatment support for their 0 28 day babies. However, 14.29% of babies were not taken to the hospitals despite their sickness and requirement to take to the hospitals because of the distance of the health centre, fear of the COVID 19 virus, high transport cost etc., which were faced more by the rural level households.
[ 23 August 2021, Bangladesh ]  The highest number of weekly cases  ( 99 693 )  was reported in the epi week 30  ( 26 JUL   01 AUG ) , 2021, and the highest daily cases, 16 230, were recorded on 28 July 2021. The highest weekly death  ( 1 736 )  was recorded in week 31  ( 02   08 AUG ) , 2021 with the highest daily death of 264 on 05 August and 10 August 2021. COVID 19 daily average cases decreased by 33.9%  ( 6 157 this week and 9 315 in the previous week ) .
[ 8 August 2021, Bangladesh ]  Financing: Invest in health and improve utilisation efficiency: The health budget needs to be increased up to WHO recommended 5% of the total GDP gradually while the capacity of the health administration to utilise the budget properly also needs to be improved. To utilise the resources optimally, technical and allocative efficiency should be ensured
[ 8 August 2021, Bangladesh ]  Health information system Strengthen health information system: The collection of quality data/information from grass root level should be ensured to identify and analyse the level of emergency situation. Furthermore, data integration among different streams of health service providers can be highly useful for targeted inventions in situations as such the current pandemic. Moreover, uninterrupted time data flow needs to be ensured from local to central level. Proper communication from the central level to the grassroots level will minimise the gaps in fighting any future pandemic while continuing the essential services should also need to be ensured. At present there is no alternative of investing in digitalisation of health records and quality health data integration and management.
[ 8 August 2021, Bangladesh ]  Leadership and governance: Separate public health track within the mainstream health service architecture: The gap in the strategy of the awareness campaign and disseminating the right information to the right people at right time has pointed out the need for proper public health wings within the mainstream health service architecture. So, the structure of the health system needs to be reformed. However, the model of reformation needs to be decided through a transparent and inclusive stakeholder consultation involving all relevant public health experts, clinicians, and other stakeholders.
[ 16th August 2021, Bangladesh ]  For the Countries under Group B: 2.2.1 Passengers vaccinated with Covid 19 vaccine: Passengers completed full dose of Covid 19 vaccine before 14 days of the flight date can travel to Bangladesh and they will have to complete 14  ( fourteen )  days strict home quarantine. However, if any COVID 19 symptoms are detected/observed on arrival, he/she shall be sent to Government Authorized Hospital for further checkup or depending on the nature/intensity of the symptoms, will be sent to isolation at government nominated facilities or Hotel at passenger's own expenses.
[ 16th August 2021, Bangladesh ]  For the Countries under Group C: 2.3.1 Irrespective of the COVID 19 vaccination, any passengers from this group of countries can travel to Bangladesh and they will have to complete 14  ( fourteen )  days strict home quarantine. However, if any COVID 19 symptoms are detected/observed on arrival, he/she shall be sent to Government Authorized Hospital for further checkup or depending on the nature/intensity of the symptoms, will be sent to isolation at government nominated facilities or Hotel at passenger's own expenses. Passengers originating from this group of countries can have transit via the countries of Group A and/or B, provided that they are kept confined within the transit airport under the close supervision of the airlines.
[ 16th August 2021, Bangladesh ]  3. Outgoing passengers of all flights: There is no restriction on the passengers travelling to the countries of any group. However, passengers shall also follow the latest restrictions or requirements imposed by the transit/destination country ( s )  or by the Airlines. Airlines concerned shall keep their passengers well informed about the requirements and formalities of origin / transit / destination countries well before of their travel.
[ 16th August 2021, Bangladesh ]  5. Quarantine  ( institutional/home )  formalities for the diplomats and their family members shall be as per the latest directives/decision of the Ministry of Foreign Affairs Bangladesh. 6. All home and institutional quarantine shall be ensured by the local administration and law enforcing agency ( s ) .
[ 8 August 2021, Bangladesh ]  Formulate an “Emergency Task Force': The delay in response was the result of a gap in decision making, bureaucracy, work division, and authoritative power which could have been solved by a special task force for health  ( Or any )  emergency. The structure of the task force needs to be finalised through transparent and inclusive stakeholder consultation. The structure and guideline of response division might be adopted from other countries  ( e.g. The United kingdom )  and contextualised according to the administrative structure of Bangladesh
[ 8 August 2021, Bangladesh ]  3.2 Change in the financial condition during the pandemic: During the pandemic, the economic conditions of the households changed dramatically. Among the surveyed households, 43.6% households had an income lower than BDT 10,000 in January 2020, which increased to 69% in July. This change means that around a quarter of the surveyed households entered into the lower category of income threshold.
[ 8 August 2021, Bangladesh ]  FINDINGS OF THE STUDY:3.1 Background characteristics A total of 2,483 households were randomly selected for the sample survey. The average family members of the households were 4.89, which means that this study represents a total of 12,142 population from 16 selected districts from all eight divisions. The average number of female members of the selected households was 2.40 and the average number of male members was 2.48.
[ 8 August 2021, Bangladesh ] The uptake of maternal and newborn health services also reduced, approximately 19 percent. Essential maternal health services such as antenatal care visits and postnatal check ups in health facilities declined extensively, and deliveries in facilities declined by 21 percent for the period of January to March 2020, compared with October to December 20194 .
[ 8 August 2021, Bangladesh ] 3.4 Experience in seeking family planning services: Risk of coronavirus infection impacted on family planning: One in five households  ( 20.7% overall, 21.3% in rural areas and 19.9% in urban areas )  responded that they sought family planning services during the reference period of the study, April to August 2020. The household members of high income categories  ( 25.0% )  and with higher education  ( 24.1% )  sought more services compared to other categories. Services related to contraception  ( 85.6% )  were the top reason in these groups of individuals while a minority  ( 16.1% )  cited attempt to conceive as their cause for trying to obtain family planning services and 1.8% of them sought other services related to family planning.
[ 8 August 2021, Bangladesh ]  The pregnant women did not get the full healthcare support they needed during their pregnancy: Around 70% of pregnant women needed to take healthcare support more than three times during their pregnancy period. However, 54% of pregnant women could not get the services according to their needs. The pregnant women went to the hospitals for various reasons such as regular check up  ( 76.5% )  and tests  ( 61.7% ) , vaccination  ( 43.0% )  and emergency service  ( 23.5% ) .
[ 8 August 2021, Bangladesh ]  Among the surveyed households, 49 babies aged between 0 28 days were found 69.4% in rural areas and 30.6% in urban areas. During their age between 0 to 28 days, it was found that 12 households  ( 24.5%; 8 from rural areas and 4 from urban areas )  did not get the BCG or oral polio vaccine within seven days, which was supposed to be given at birth or at the first visit of health worker. The main reasons for not having the first vaccine mentioned were they “did not know about the vaccine'  ( 9 ) , the health worker did not visit the child  ( 3 ) , the child was delivered in absence of a trained health worker  ( 1 ) , and address of vaccination centre was unknown  ( 1 )  financial problem  ( 1 ) , and others  ( 1 ) .
[ 8 August 2021, Bangladesh ]  Treatment cost of essential health services increased during the pandemic: More than a quarter of the respondents from the surveyed households  ( 28.6% )  stated that their clinical cost increased during the COVID situation compared to the normal situation. The average treatment cost in the COVID 19 situation was more than that of January.
[ 8 August 2021, Bangladesh ]  3.6 Experience in seeking health services for new born babies  ( age 0 28 days )  One fourth of newborn babies were not vaccinated during the pandemic: The Expanded Programme on Immunisation  ( EPI )  is a priority programme for the government of Bangladesh. According to the Bangladesh Immunisation Guidelines which is based on the international guidelines recommended by the World Health Organization  ( WHO ) , children are supposed to receive one dose of the vaccine against tuberculosis  ( BCG ) , three doses of pentavalent  ( DPT, Hib, and HepB ) , three doses of polio vaccine  ( excluding polio vaccine given at birth ) , and one dose of measles and rubella vaccine to be considered as fully vaccinated.
[ 8 August 2021, Bangladesh ]  Complications created to pregnant women because of not getting delivery support from trained doctors or health workers: In eight cases out of 19 delivery by untrained midwives, the pregnant women experienced some problems. Three women experienced delivery complications, five women faced short term and one woman faced long term difficulties
[ 8 August 2021, Bangladesh ]  Of the mothers who did not receive any PNC services 75% of them were from rural area. Nationally, 55.3% of new mothers receive postnatal check ups from a medically trained provider within two days of delivery  ( Unicef, 2019 ) . However, the study findings suggest that one third of new mother did not receive postnatal care during the pandemic.
[ 8 August 2021, Bangladesh ]  3.11 Experience in seeking adolescent health services: More than half of the adolescents did not seek health services due to the fear of coronavirus infection: Among the surveyed households, 785 households have reported that they have adolescent members  ( 10 19 years ) . More than a quarter of the adolescents  ( 26.5% )  took health related services during the pandemic rural level households took more services compared to the urban ones  ( 28.1% vs. 24.3% ) . The services include treatment for gynaecological problems  ( 40.9% ) , care for accident cases  ( 55.8% ) , emergency treatment  ( 14.4% ) , etc.
[ 8 August 2021, Bangladesh ]  The persons/children with disabilities who sought healthcare services during the pandemic failed to avail services due to some reasons. The prominent reasons include fear of COVID 19  ( 45.25% ) , financial stress  ( 69.05% ) , unavailability of doctors  ( 19.05% ) , transportation problem  ( 19.05% ) , etc. The risk of the corona, financial problem, far distance, transport problem were more felt among the rural level households than the urban ones  ( see Figure 15 ) .
[ 8 August 2021, Bangladesh ]  3.13 Experience in seeking telemedicine services Telemedicine services did not come as a popular alternative during the pandemic: Nearly 6% of households obtained telemedicine services during the pandemic. Respondents from urban areas attained the service slightly more than those of rural areas  ( 6.5% vs. 5.3% ) . The range of telemedicine services that were provided by healthcare service providers includes first aid  ( 52.8% ) , regular check up  ( 35.4% ) , advice on Covid 19 related symptoms  ( 25% ) , family planning  ( 15.3% ) , pregnancy related treatment  ( 12.5% ) , postnatal service  ( 10.4% ) , treatment for special children  ( 9% ) , etc. Of the households which reported that they used telemedicine services, 11.1% of them  ( 16 )  stated that they encountered difficulty while getting telemedicine services.
[ 14th August 2021, Cox's Bazar ]  Both Host and Refugees: On 27 July, heavy monsoon rainfall in Cox's Bazar led to flash floods, waterlogging and landslides across the refugee camps. As a result of the rains, approximately 13,000 refugees  ( 2,740 households )  required immediate assistance, as well as 150 members of the host community.
[ 8 August 2021, Bangladesh ]  4.2 Limitations and challenges of the health service providing authorities Panic of getting the virus: Initially the service providers were in great fear. Many of them denied providing services to patients. Many of the senior doctors did not provide services out of their age related fear  ( age 60+, had co morbidity ) . The lack of PPE at the initial stage was one of the reasons for this fear. Moreover, the news of service providers affecting by the virus at a mass scale and the death of fellow colleagues made the service providers stressed and panicked. However, many of the providers did not care about their own protection or safety and served patients taking a risk on their health and life.
[ 8 August 2021, Bangladesh ]  COVID 19 pandemic contributed to increasing the level of other diseases: From the surveyed households, it was found that two in five households  ( 39.5% )  that needed to seek essential health services stated that their level of diseases increased due to lack of improper health services during the pandemic. Other losses as reported by the sufferer households include mental stress  ( 29.22% ) , financial stress  ( 28.3% ) , sufferings of family members  ( 11.99% ) , long term physical damage  ( 9.34% ) , loss of family members  ( 1.33% )  and unwanted abortions  ( 1.33% ) .
[ 8 August 2021, Bangladesh ]  Quarantine facilities and other facilities for the health care workers were not sufficient: The doctors and other health workers were supposed to stay in a separate place after providing services in the corona unit or when suspected to ensure the safety of themselves, their family and the patient. The respondents claimed that the instruction especially the financial arrangement was not clear. In many cases, the hotel  ( quarantine place/living place )  and food were arranged by local leaders or just by the health care provider community
[ 8 August 2021, Bangladesh ]  Health workforce Ensure availability of health workforce and proper skill mix: WHO recommended ratio of doctors, nurses, and technologists which is 1:3:5 needs to be ensured. So, recruitment of the workforce against the vacant position is necessary. Furthermore, Bangladesh is still far from achieving WHO recommended doctor to patient ratio. Given the size of the population, and the low number of facilities it is crucial that an added emphasis is given to recruiting and capacitating allied workforce at the community level so that hospitals are not overburdened and many of the primary health complications can be addressed at the community level. Immediate recruitment of necessary supporting workforce is extremely necessary as the lack of third and fourth class staff along with the cleaners was the main concern during the pandemic. Besides, regular capacity building training according to the need of the health system also needs to be ensured. The competency of health care providers on patient centric care to treat patients more sensibly needs to be emphasised.
[ 8 August 2021, Bangladesh ]  The patient can be registered, enrolled, traced and referred to other/next level of health facilities through any unique identification card/certificate e.g. NID/Passport/Birth Certificate /Driving License. The data might also use for IPD admission and future follow up, thus, a holistic approach to provide health services can be enabled and ensured. It needs to be integrated with the EMR/EHR/telemedicine system on the healthcare providers' end so that the service providers  ( e.g. doctors )  can access the data, know patients disease history and use it for treatment purpose. There needs to be improvements in availability of services especially during pandemics and strengthening of a functional referral system, particularly at primary level. A long term mentoring on how to deal with patients more sensitively/ empathetically needs to be institutionalized.
[ 8 August 2021, Bangladesh ]  Ensure incentives or risk allowance for the frontline health workers: The declared health emergency stimulus package  ( incentives )  has not yet given to the frontline health workers. Incentives/risk allowance for the frontline health workers should have been ensured so that they were more motivated to work for continuing essential services. In any pandemic, the incentives should be ensured immediately. A performance based incentive can be a good alternative in this respect. Health emergency stimulus packages  ( incentives )  should be appropriately targeted and reached to the frontline health workers including doctors, nurses, paramedics, cleaners, health technicians, ambulance drivers, and other administrative staff of both public and private health facilities.
[ 11 August 2021, Cox's Bazar ]  AWD reported cases in 2021 through EWARS syndromic surveillance  ( EWARS weekly reporting )  have not significantly differed in comparison to previous years  ( Figure 5 ) . In Bangladesh historically AWD incidence has tended to increase in the pre   and post monsoon seasons
[ 6th August 2021, Cox's Bazar ]  Both Host and Refugees:  Several demand side barriers to accessing education have been identified including the need to support their families financially, early marriage, among others. First, Rohingya children living in camps and in host communities reported interruptions to their schooling to support their families economically. Work was the second most frequently mentioned barrier, especially for boys, with 52 percent reporting it as the primary barrier for Rohingya boys who have been living outside the camps and arrived prior to the 2017 influx. For girls, the burden of work was also reflected in the form of household chores and common gender based barriers, including schools being too far  ( safety issue ) , menstruation related barriers and early marriage. The quality of the education they typically receive also comes to the fore. For instance, nearly half the respondents report that the teachers are largely untrained with high rates of absenteeism.
[ 23 August 2021, Bangladesh ]  Surveillance & Laboratory: As of 22 August 2021, 58.7% of reported cases were from Dhaka division  ( 47.9% at Dhaka city ) , Chattogram – 15.4%, Khulna – 7.3%, Rajshahi – 6.4%, Rangpur – 3.5%, Sylhet – 3.5%, Barishal – 2.9% and the lowest 2.3% from Mymensingh division. While 44.0% of the reported deaths were from Dhaka division  ( 28.7% at Dhaka city ) , Chattogram – 19.8%, Khulna – 13.1%, Rajshahi – 7.5%, Rangpur – 5.0%, Sylhet – 4.2%, Barishal – 3.4%, and the lowest 3.0% from Mymensingh division.
[ 23 August 2021, Bangladesh ]  6. Essential Health Services: Merely 69 000 ANC 1 services were provided by the public health facilities in Bangladesh in July 2021, which is less than half what was provided in the same month in 2019  ( Pre COVID19 situation ) . The ANC 1 service utilization in July 2021 observed a decrease of 28.9% compared to the previous month and 21.9% compared to July 2020. Aggressive strategies need to be adopted at the earliest to maintain essential services like ANC check ups to reduce the maternal mortality rate in the country
[ 11 August 2021, Cox's Bazar ]  Refugee: Situation Update: RDT and culture confirmed positive cases continue to be reported in the Rohingya camps particularly in Ukhiya, 88 out of 100  ( ~90% ) , withthe remaining 12cases from Rohingya camps located in Teknaf. Cases are spread out over different camps.
[ 8 August 2021, Bangladesh ]  The average income of the surveyed households decreased by 37.3% in April 2020, compared to the average income in January 2020  ( from BDT 16,594 to BDT 10,407 ) , which increased slightly in July  ( BDT 10,442 ) . However, the change did not equally happen among the groups such as female headed households, rural households, the households having less educated heads  ( below SSC )  or the heads involved in small business or skilled or unskilled labours or who were under unemployment. They did not show the sign of recovery in average monthly income in July whereas the households from City Corporations had more average income in July 2020 compared to April 2020. As most of the health expenditure in Bangladesh is spent from own pocket, so there is a significant impact of changing in household financial condition on the capacity to bear health expenses.
[ 8 August 2021, Bangladesh ]  One in ten households reported problems in accessing general healthcare services during the pandemic: The respondents were asked whether they faced any problem during the lockdown in accessing general healthcare services. One in ten households  ( 9.9% )  stated that they faced problems during getting treatment from hospitals. The problems include lack of sufficient doctors  ( 70.2% ) , lack of sufficient nurse  ( 39.6% ) , lack of medical equipment  ( 38.8% ) , lack of medicine  ( 38.0% ) , lack of beds  ( 26.1% )  and higher fees of doctors  ( 20.4% ) . They also faced the unwillingness of doctors to provide treatment  ( 23.3% ) , the unwillingness of hospitals to admit patients  ( 20.0% )  and bribery  ( 13.9% ) . People from rural areas complained more about the lack of doctors  ( 75.0% vs. 63.8% )  and nurses  ( 42.9% vs. 35.2% ) , adequate medical equipment  ( 40.0% vs. 37.1% ) , beds  ( 29.3% vs. 21.9% )  and increase of doctor's fees  ( 23.6% vs.16.2% )  compared to people from urban areas
[ 8 August 2021, Bangladesh ]  The increased cost of medicine and medical treatment was burdensome as the average income of the households decreased. Before the pandemic, whereas 43.6% of households belonged to up to BDT 10,000 income category, it went up to 68.3 in April and 69.0% in July  [ see Figure 1 ] , which clearly shows an income depletion among the surveyed households. From the findings, it can be interpreted that as the average income decreased during the lockdown, the average spending on the clinical cost might have been impacted.
[ 8 August 2021, Bangladesh ]  National health statistic suggests that 19% women  ( age 19 49 years )  meet the need for family planning for spacing and 44% women for limiting  ( Unicef, 2019 ) . However, in the surveyed households, only 20.7% households responded that they could take the family planning service.
[ 8 August 2021, Bangladesh ]  More than half of the pregnant women  ( 55% )  expressed that no family planning or health workers visited them to check their health condition during their pregnancy during the pandemic situation. However, 29% of women were visited once a month and 16% of women once in three months.
[ 8 August 2021, Bangladesh ]  More than half of the patients bearing chronic diseases could not continue to take regular treatment due to the fear of coronavirus infection: While responding about self exclusion from taking healthcare services from any health facilities, the family members of the surveyed households having chronic diseases consciously opted out from taking healthcare services directly from any health facility which accounts for 56.32% due to risks associated with COVID 19. This was more in urban areas than in rural level households  ( 61.3% vs. 52.6% ) . The high self exclusion rate was because they were not comfortable taking healthcare services from any hospitals directly due to the ongoing health pandemic. The probable reason behind this was people suffering from chronic diseases were considered as having a higher propensity to be infected by COVID 19.