Describe the maternal health and nutrition situation.

: Demographic, Epidemiologic and Economic Transition (Modules 1 & 2) Comment by Anna Kalbarczyk: Ahmad, there were a few issues with the assignment which significantly affected your score. Most of your data was quite old or from unreliable sources. The instructions provided guidance on appropriate resources and I suggest you take a closer look at these for future assignments. Many of the data points you selected did not support the arguments you were trying to make. While creativity is encouraged, make sure you can use data appropriately. I would recommend discussing citation techniques with a TA. You make many broad sweeping statements with no citations. One citation per paragraph is not sufficient.

Figure 1: Population pyramid – should be the most recent (Drag your picture file and drop it into the center of this box. These can be found at https://www.populationpyramid.net/)

The Population Percentage Comment by Toun Olateju: This should be labeled as a Population Pyramid not percentage. The name of the country, the year that the pyramid refers to and total population should be included.Total points: 0.75 pts

Reference: https://www.populationpyramid.net

Table 1: Demographic and economic indicators. Don’t forget to report at least 2 subgroup (disaggregated) indicators! Comment by Toun Olateju: Total points for Table 1: 6.5/7
Indicators	Value	Year	Reference[footnoteRef:1] [1: Number corresponding to the list of sources on the last page.]
Demographic Indicators (select at least 5)
1. Fertility rate	2.4 children born per woman	2018	Bangladesh Bureau of Statistics
2. Life expectancy at birth	73.4 years	2017	CIA World Factbook Comment by Toun Olateju: The instructions clearly state that CIA Factbook is not an acceptable reference for this course. Use validated data sources
3. Death rate	5.4 deaths/1000 population	2017	CIA World Factbook
4. Indicator by subgroup Comment by Toun Olateju: Expenditure indicators are not demographic indicators. They are economic indicators so include them under the section on economic indicators.It is good practice to give the total expenditure first before giving the subgroup indicators.
a. Education expenditure	2.2% of GDP	2015	CIA World Factbook
b. Health expenditure	2.8%of GDP	2014	CIA World Factbook
5. Indicator by subgroup
a. Religions Comment by Toun Olateju: These are descriptors of a population but they are not demographic indicators. Revise them. Also, in listing subgroup indicators, it is good practice to include the total first, then the sub groups that make up the total.	Muslims 89.1%	2013	CIA World Factbook
b. Ethnic groups	Bengali at least 98%	2011	CIA World Factbook
c. Languages	Bangla 98.8%	2011	CIA World Factbook
Economic Indicators (select at least 2): Comment by Toun Olateju: The indicators selected were not properly defined. For example, GDP can be expressed in several ways: as GDP per capita (current or constant prices), GDP based on purchasing power parity etc. Same for inflation rate.
1. Inflation rate	5.7%	2017	Economic Forecasts from the World’s Leading Economists Comment by Toun Olateju: Reference source is not acceptable.
2. GDP	7.0	2018	IMF- World Economic Outlook Database

Table 2: Burden of disease indicators (Select at least 5). Don’t forget to report at least 2 subgroup (disaggregated) indicators. Comment by Toun Olateju: Update all the values listed in this section. Bangladesh has more recent data. 2004 data is not acceptable. Look for more recent sources of data. Change the reference source because the US Census Bureau is likely to have up to date information on the United States but not on other countries. All the indicators 1-5 are not well defined. Include the denominators in definition of the indicators. An example is: prevalence of diabetes per 100,000 population etc.Total points for Table 2: 7/10
Indicators	Value	Year	Reference
1. Cardio-vascular disease	13.4 %	2004	US Census Bureau, 2013
2. Diabetes	1.2%	2004	US Census Bureau, 2013
3. Cancer	3.9 %	2004	US Census Bureau, 2013
4. Indicator by subgroup Comment by Toun Olateju: This is not a subgroup indicator. Mental health and respiratory diseases are not in the same disease group.
a. Mental health	11.2 %	2004	US Census Bureau, 2013
b. Respiratory diseases	4.0%	2004	US Census Bureau, 2013
5. Indicator by subgroup Comment by Toun Olateju: Is this in children less than 5 years old?
a. Diarrhoea0	16	2004	Public Health and the Environment Geneva 2009
b. Malaria	0.6	2004	Public Health and the Environment Geneva 2009
6. Indicators for Disability-Adjusted Life Years (DALYs) Comment by Toun Olateju: There are more recent data than 2004 and 2013. Include unit of measurement for DALYs.
i. DALYs lost to communicable, maternal, perinatal & nutritional[footnoteRef:2] [2: Note regarding DALY indicators: In the WHO DALY report, DALYs are reported at different sub-levels within the disease/condition categories. Report data for the top 3 DALY causes at the level that you feel is most appropriate/informative. Also, please pay attention to DALY units. They should be reported in thousands.]	39 %	2004	The World Bank, South Asia Human Development, Health Nutrition, and Population
Top three causes of DALY loss for this category a. preterm birth complications	89.07 DALYs	2004	Global Burden of Disease Study
b. lower respiratory infections	83.61DALYs	2004	Global Burden of Disease Study
c. Neonatal encephalopathy	DALYs	2004	Global Burden of Disease Study
ii. DALYs lost to non-communicable diseases	61 %	2004	The World Bank, South Asia Human Development, Health Nutrition, and Population
Top three causes of DALY loss for this category a. Stroke b. Depressive disorder c. Ischemic heart disease	DALYs 43.43 DALYs 71.88 DALYs	2004	Global Burden of Disease Study
iii. DALYs lost to injuries	18 %	2004	The World Bank, South Asia Human Development, Health Nutrition, and Population
Top three causes of DALY loss for this category a. Drowning	DALYs	2013	Global Burden of Disease Study
b. Self-harm	20.26 DALYs	2013	Global Burden of Disease Study
c. Transport injuries	35.06 DALYs	2013	Global Burden of Disease Study

Demographic and epidemiolsogic transition questions: Comment by Toun Olateju: Total points: 7.8/10
Answer the following questions based on figure 1, tables 1 and 2, and your own review of the relevant literature.
1. Provide an explanation for why you chose the indicators reported in Table 1 (200 words)
Population growth is associated with fertility rate. Comment by Toun Olateju: Include reasons for choosing the economic indicators. Life expectancy does not explain the mortality rate in a country. 1.5/2 pts
Bangladesh has witnessed increasing fertility rate and at the same time decline in mortality rate. Population pressure was the leading problem in Bangladesh since 1978. The government of Bangladesh with help from non-governmental organizations and international organizations worked towards solving the problem. Some successes were achieved in different areas as decline of fertility was witnessed. Life expectancy is a measure of overall quality of life in a country. It explains mortality rate in a country. It also shows potential yield on investment in human capital. Life expectancy has been progressing over the past several years. Death rate is the average annual number of deaths per 1000 population at midyear during a year. It is also known as crude death rate. It generally shows the mortality situation of a country. It therefore shows the impact of mortality on population growth. Death rate in Bangladesh is at 5.4 deaths/1000 population in the year 2017. In early years like 1920s, mortality trends have been uneven due to historical events such as independence war and partition. There has been decline in mortality rate to a lower level. There is possibility of increase in mortality rate due to ageing of the population (Bairagi, & Datta, 2001).
2. At what stage (or stages) is your country in the demographic transition? Provide evidence from the data to support your answer. (200 words)
Bangladesh is at early stages of demographic transition. It has achieved significant progress in both mortality and fertility decline. Bangladesh is a traditional agricultural society with poor infrastructure and limited resource base. There has been occurrence of demographic changes despite slow economic progress. It is among the densely populated countries. According to United Nations 2014, about 156 million people reside within a small area of about 147,570 square kilometers. The density of population in Bangladesh is five times that of any other super country. It is nearly five times that of Pakistan and three times that of India. The country has escaped Malthusian trap by speeding up food productions, employing female labor in productive sectors and exporting human capital. It also has steady industrialization especially in garment industry. This has improved child survival and reduced fertility. Since independence, population growth was identified as national problem and strong population control policy was adopted. At now, fertility rate is at 2.4 children per woman. This is not far from replacement-fertility of level of 2.1. Regions like Khuna and Rajshahi have achieved replacement fertility level. The life expectancy at birth has also improved to 73.4 years in 2017. Therefore, demographic transition in Bangladesh has followed a typical pattern of decline in mortality rate followed by decline in fertility rate (Hayes & Jones, 2015). Comment by Toun Olateju: Bangladesh is not in the early stages of the demographic transition. Population density does not explain demographic transition.1.5/2 pts. Comment by Anna Kalbarczyk: Comparing to other countries in the region is a good approach to addressing this question.
3. Describe and explain any significant variation in the stage of demographic transition within the country by region, social class, or ethnic group. (hint: report on data over time) (200 words)
The population of Bangladesh consists of about 70 percent of rural where 50 percent work in agricultural production. The unequal distribution of land together with population pressure has contributed to low level of productivity. Over the several decades, the contribution of agriculture to GDP has been declining. Service sector has been dominant since it generates about 55 percent to GDP. The contribution of industry sector to GDP has been increasing. There has been increased landlessness resulting to shift in industrialized form of production. These changes have made agricultural mode of production unviable. The issue of landlessness has led to the loss of economic value of children. Rural-urban migration has been caused by these changes. The rural poor and urban poor households have sought other means of supplementing their low agricultural incomes. Caste which is a form of social organization became irrelevant resulting to emerging class relations. This is associated with unequal distribution of wealth. The fertility rate in Bangladesh can be characterized based of different groups such as wealthiest and most educated women with low fertility rate while poor women and least educated women have highest fertility rate. There are huge regional differences like Chittagong division in the East having higher fertility rate compared to Khulna in the West. Rural fertility is also higher than urban. Comment by Toun Olateju: These points on landlessness, industrialization do not support the variations in demographic transition. We wanted you to provide how the population changed over time, for example, compare the population 20 years ago and the population presently, what is different? Is the difference related more in men than women? In rural than in urban regions? In adults than in children? In different socioeconomic levels? Comment by Toun Olateju: This gets close to the question asked. 1.5/2 pts. Comment by Anna Kalbarczyk: Yes, please try to focus on the specific questions being asked. Much of your response in this paragraph does not address variance in the transition by subgroups.
4. Is the concept of “epidemiologic transition” applicable to your country and, if so, at what stage is your country in the epidemiologic transition? (150 words)
Bangladesh is developing country which is faced by high inequalities and rampant poverty. There is still increasing burden of non-communicable diseases. Non-communicable diseases cause two thirds of all deaths. This indicates that Bangladesh is under rapid epidemiologic transition. Over the recent years, there has been changing patterns of diseases. Some diseases are disappearing while others are appearing and disappearing (Islam, Rahman & Siddiqui, 2014). Infectious diseases are the important concern in public health but non-communicable diseases are becoming the leading cause of death. Epidemiologic transition is therefore between the age of degenerative and manmade diseases. Increased urbanization has contributed to the rise of chronic disease burden. Rapid urbanization leads to reduced physical activity, change in food habits and increased access to processed food. Therefore, change of life style has contributed to this transition. The shift from infectious diseases to non-communicable diseases shows a double burden of diseases. The age pattern mortality has changed from young to old ages. Comment by Toun Olateju: Inaccurate. Public health includes both communicable and non-communicable diseases. 0.8/1 pt Comment by Anna Kalbarczyk: I know what you’re trying to say but the double burden indicates the significant presence of both infectious disease and non-communicable disease. So a shift away from infectious disease to NCD is more a sign of transition than double burden.
5. Using your topic as a guide, describe direct or indirect evidence that different groups within your country (by region, social, or ethnic group) have distinct patterns of disease burden? (350 words)
Bangladesh has been undergoing rapid epidemiologic transition with non-communicable diseases occupying two-thirds of all deaths. In 2004, non-communicable diseases occupied 61% with the remaining percentage being occupied by communicable diseases, and maternal and child health issues. According to US Census Bureau (2013), cardiovascular diseases occupy 13.4% of the total burden, mental health 11.2%, injuries 10.7%, respiratory diseases 4.0%, cancer 3.9% and diabetes 1.2%. Some years back about 70 years ago, infectious diseases were the leading cause of death. The country has now shifted to non-communicable diseases. This situation has imposed pressure on the country in solving the double burden. Comment by Toun Olateju: 2.5/3 pts
It is true that different groups have different patterns of disease burden. Diabetes affects mostly rural people. Smoking is mostly the cause of chronic respiratory diseases and is therefore more prevalent in men than females. It also affects mostly youths. Smokeless tobacco is leveling tobacco consumption among men and women. This is supported by the culture of Bangladesh due to minimal public health consequence. Most people who are affected by injuries like road traffic injuries are men while those affected by drowning injuries are children. There are also other different disease burdens based on age such as degenerative and manmade diseases. Non-communicable diseases are mostly affecting the aging population. Chronic disease burden is increasing in urban areas due to reduced physical activity, increased access to processed food and change in food habits. The use of tobacco, inadequate intake of fruit and vegetables, abdominal obesity, hypertension and low-level of physical activity are prevalent in Bangladesh adults. Smoking is one of risk factors of non-communicable diseases which bring difference in prevalence of burden of disease. Tobacco use is more in rural areas than in urban areas. The issue of obesity also differs between rural and urban areas where it is high in urban areas than rural areas. This means that unplanned urbanization is the cause of this obesity (Mahmood, Ali & Islam, 2013).
Chronic non-communicable diseases are mostly caused by low physical activity. Special attention need to be put on rich people and urban women. Level of physical activity is affected by poor urban planning. These differences call for prevention and control measures to be designed with their consideration.
References: Comment by Toun Olateju: References are incomplete. Include all the references in the tables to this list. Comment by Anna Kalbarczyk: Also please be mindful of your citations within text. Many of your paragraphs include only one citation at the end but you make many statements throughout the paragraph that are likely supported by multiple sources.
Mahmood, S. A. I., Ali, S., & Islam, R. (2013). Shifting from infectious diseases to non-communicable diseases: A double burden of diseases in Bangladesh. Journal of Public Health and Epidemiology. 5(11), 424-434.
Islam, S. R. U., Rahman , F., & Siddiqui, M. M. R. (2014). Bangladesh is Experiencing Double Burden with Infectious Diseases and Non-Communicable Diseases (NCD’s): An Issue of Emerging Epidemics. Answer Khan Modern Medical College Journal, 5(1), 46-50.
Hayes, G. R., & Jones, G. (2015). The Impact of Demographic Transition on Socio-economic Development in Bangladesh: Future Prospects and Implications for Public Policy Fund, Bangladesh County office.
Bairagi, R., & Datta, A. K. (2001). Demographic transition in Bangladesh: what happened in the twentieth century and what will happen next?. Asia-Pacific Population Journal, 16(4), 3-16.

Part 2: Family Health & Social Determinants (Module 3)

See the Courseplus Schedule for Due Date. All assignments are due at 11:59 PM EST on the due date.

Table 3. Health and Nutrition through the Life Cycle. Don’t forget to report at least 2 subgroup (disaggregated) indicators!
Indicators	Value	Year	Reference
3A. Maternal: (select at least 5)
1.
1.
1.
1. Indicator by subgroup
3.
3.
1. Indicator by subgroup
4.
4.
4.
3B. Neonatal/Perinatal: (select at least 3)
1.
1.
1.
3C. Post-neonatal/Infant/Child: (select at least 5)
1.
1.
1.
1.
1.
1.

Table 4: Indicators of social determinants of health Based on the global health topic you are addressing in this assignment, report at least 8 indicators total for this table. You may want to consider the following categories though some will be more relevant than others: Education, Status of Women, Water & Sanitation, Household Characteristics. Don’t forget to report at least 2 subgroup (disaggregated) indicators!
Indicators	Value	Year	Reference
Indicators of Social Determinants of Health
1.
1.
1.
1.
1.
1.
1. Indicator by subgroup
6.
6.
1. Indicator by subgroup
7.
7.
7.

Health and nutrition through the life cycle questions:
Answer the following questions based on tables 3 and 4 and your own review of the relevant literature. Consider your selected topic and the country’s context!
1. Describe the maternal health and nutrition situation. (200 words)
1. Describe the neonatal/perinatal health and nutrition situation. (200 words)
1. Describe the post-neonatal (1-11 months) and child (12-59 months) health and nutrition situation. (200 words)
1. Using the indicators reported in Tables 3 and 4, how might these data affect the health and social situation for school-aged children and adolescents? (250 words)

Part 3: The National Health Sector Strategic Plan – Modules 4 & 5

See the Courseplus Schedule for Due Date. All assignments are due at 11:59 PM EST on the due date.
Questions

Answer the following questions based on tables 1-4 and your own review of the relevant literature to develop your topic of the National Health Sector Strategic Plan for your country of choice. Make sure your selected consultancy theme is addressed throughout these questions.

1. Reflect on the indicators you identified in parts I, and II. How do they impact your global health theme? How might the indicators of social determinants of health have an impact on the population health indicators you identified. (250 words)

1. Discuss trends in your topic in the country over time. Provide a visual aid (i.e. a chart or graph) to demonstrate one of the trends you identify. (150 words)

1. What are some challenges to and opportunities for addressing the poorly performing indicators to improve public health in your country? (150 words)

1. What recommendations would you make to improve the health situation in your country, in the context of the theme you selected? Identify at least 2 specific recommendations and provide evidence from your research to defend them. (300 words)

References

Use Vancouver or a similar (numbered) formatting for references. Do not supply web links alone.

Notes:

1. Consider using a citation software like RefWorks, Endnote or Mendeley to help with your reference collection and formatting.

1. Do NOT use CIA Factbook or Wikipedia as references.

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