Shafiun Nahin Shimul

Introduction: Bangladesh faces a significant public health burden from tobacco use. The illicit cigarette trade undermines tobacco control measures, yet its actual size remains unclear due to potential industry overestimation and a lack of independent data. This study estimated the size and...

Background Globally, about 74% of deaths are attributed to non-communicable diseases (NCDs). Tobacco use is one of the key risk factors of NCDs. Tobacco taxes can discourage the use of tobacco. However, how increasing tobacco taxation may reduce the burden of NCDs is not well studied. Objectives This study examines whether higher cigarette taxes are associated with reduced premature deaths—death before the age of 70—from NCDs using multicountry panel data. Methods The study analysed country-level panel data of 152 countries from 2008 to 2020 collected from various sources. The annual burden of NCDs was measured by the proportion of deaths due to NCDs before age 70 in each country. The tax rate on cigarettes—both specific and total—was used as a key explanatory variable. Other covariates include MPOWER score net of taxes, tobacco prevalence and other country-level characteristics. Panel data regressions with various combinations of country and year fixed effects were used to estimate the association between tobacco taxation and the burden of NCDs. Findings Cigarette tax was significantly (pInterpretation The study provides important evidence that increasing tobacco taxation could be an effective tool in reducing the burden of NCDs. Countries aiming to curb the burden of NCDs could consider raising tobacco taxes.

Childhood pneumonia affects an estimated 18% of under-five children in Bangladesh. Urban slum-dwellers face challenges in healthcare-seeking. This study examined the factors influencing the healthcare-seeking for childhood pneumonia among under-two children in urban slums in Bangladesh. The study examined influence of children’s characteristics (age, sex, number of ARI/pneumonia symptoms, and duration of symptoms), maternal factors (age, education, and working status), and household characteristics (number of household members, wealth quintile, sex of household heads, age of household heads). The outcome variable was receiving care from a qualified medical provider for childhood pneumonia or pneumonia-like symptoms within 14 days before the collection of surveillance data. The research utilized data from the Urban Health and Demographic Surveillance System, which included 155,000 people from five slums in Dhaka and Gazipur City Corporation areas. Overall, 753 out of 4,679 (16%) children under two years of age were included in this study, all of whom had ARI/pneumonia-like symptoms. The mean age of these children was 11.4 months, and 50% were boys. Of them, 350 (46%) sought care from local pharmacies, while 37% sought care from medically trained providers. Logistic regression analyses indicated that children with multiple symptoms (AOR: 2.32, 95% CI: 1.71–3.14) and illness duration over seven days (AOR: 2.61, 95% CI: 1.51–4.51) had higher odds of receiving care from a medically trained provider. Higher maternal education compared to no formal education, having five or more household members compared to four or fewer, household heads aged 40–49 years compared to those under 25 years, a longer duration of living in the slum (more than 10 years compared to less than five years), and belonging to the richest wealth quintile compared to the poorest were protective factors for care-seeking from qualified providers. Further research is required to understand the context for designing appropriate interventions and comprehensive policies for improved child health regarding ARI/pneumonia-like symptoms.

The impact of income on health expenditure has been studied extensively using national‐level data; however, studies estimating the household‐level income elasticity of health expenditure, particularly by provider types, remain limited. Analysing nationally representative household survey data, we examine outpatient and inpatient out‐of‐pocket (OOP) expenses across healthcare providers and by various income levels. We employed the Heckman two‐step model and OLS regression to estimate income elasticity separately for outpatient and inpatient services. Our findings indicate that income elasticity varies significantly by service type, provider, and income level. Outpatient care at private facilities is a luxury good for the lower‐income households, while outpatient expenses for public and informal outpatient care providers remain inelastic across income levels. Private inpatient care is also income inelastic, whereas public inpatient care shows non‐uniform elasticity. Overall, lower‐income households showed greater elasticity than wealthier ones. The results imply, during income shocks, poorer households switch to cheaper public and informal care. Inpatient care is prioritised over other expenses, increasing the risk of poverty among low‐income households. The study suggests the dire need for financial protection measures, particularly for low‐income groups, as OOP health expenditure often becomes catastrophic for those households. In addition, higher income resulting from economic growth will increase the demand for private outpatient services, suggesting quality improvement for public health facilities as well as the importance of adapting healthcare policies to evolving income dynamics.

The COVID-19 pandemic has been a major health concern in Bangladesh until very recently. Although the Bangladesh government has employed various infection control strategies, more targeted Non-Pharmaceutical interventions (NPIs), including school closure, mask-wearing, hand washing, and social distancing have gained special attention. Despite significant long-term adverse effects of school closures, authorities have opted to keep schools closed to curb the spread of COVID-19 infection. However, there is limited knowledge about the impact of reopening schools alongside other NPI measures on the course of the epidemic. In this study, we implemented a mathematical modeling framework developed by the CoMo Consortium to explore the impact of NPIs on the dynamics of the COVID-19 outbreak and deaths for Bangladesh. For robustness, the results of prediction models are then validated through model calibration with incidence and mortality data and using external sources. Hypothetical projections are made under alternative NPIs where we compare the impact of current NPIs with school closures versus enhanced NPIs with school openings. Results suggest that enhanced NPIs with schools opened may have lower COVID-19 related prevalence and deaths. This finding indicates that enhanced NPIs and school openings may mitigate the long-term negative impacts of COVID-19 in low- and middle-income countries. Potential shortcomings and ways to improve the research are also discussed.

Objectives The overall price elasticity of cigarette consumption in Bangladesh has been studied extensively. The estimates of price elasticity by price tiers are not available in the existing literature. Methods Using cohort data of nearly 6000 individuals from the International Tobacco Control Bangladesh survey, this study estimated the own-price and cross-price elasticity and income elasticity of cigarette demand by price tiers in Bangladesh. The elasticity was estimated in three stages of consumer decisions: whether to smoke, which brand to smoke and finally, how many cigarettes to smoke per day. The decision to smoke cigarettes and the choice of cigarette brands were modelled using instrumental variable probability regression. The cigarette consumption per day was modelled using seemingly unrelated regression. Results The price elasticity of cigarette smoking prevalence with respect to the price of low-price cigarettes is −0.0487. The total elasticity for low-price cigarette consumption with respect to its own price is −0.1678. The own-price elasticity of smoking intensity of high-priced brands is −0.2512. The cross-price elasticity of low-price cigarette consumption with respect to high-price brand prices is 0.2643. The income elasticity of smoking prevalence overall is 0.0564. The income elasticity of daily consumption of low-price cigarettes is −0.1934 and for high-price cigarettes, it is 1.4044. The total income elasticity is 1.4608 for high-price cigarettes. Conclusion A cigarette tax policy that raises the prices of both low-price and high-price brands—but increases prices in the low-price tier at a faster rate than in the high-price tier and increases prices of all brands at a pace faster than income growth—can effectively reduce cigarette consumption in Bangladesh. JEL codes H29, L66, I18.

While labor unrest is a critical factor in ensuring uninterrupted production, there is limited understanding of the causes behind such unrest. This study aims to address this knowledge gap. The subject matter is undoubtedly interesting, but there are...