Soumyadeep Bhaumik’s review of South Asian medical papers—February 2016

soumyadeep bhaumikWe are now officially in a new era of global health—the era of the Sustainable Development Goals. The month of January saw the publication of some papers from South Asia which provides an opportunity to learn from the previous era of Millennium Development Goals.

Reducing the number of maternal and neonatal deaths has been a challenge in South Asia and the vast majority of global deaths occur in this population—many of them at home. A study from rural Bangladesh on why women still prefer a home delivery with traditional birth attendants revealed some interesting things. Apart from financial constraints and several gender related social issues, it identifies two factors that might be something for public health experts to take notice of—people still do not have information on service delivery points and they think that going to facilities might result in unnecessary Caesarean sections.

The quantitative evidence for unnecessary Caesarean sections is available from the other side of the border in India where a study found that rates of Caesarean sections has increased from 26.6% to 40.7% in a span of just three years (The WHO recommends health facilities should have between 20-25%). The solution to positively modify gender related social constructs for healthcare outcomes probably lies in using participatory women’s groups, as a large study from Bangladesh found. Learning points from the study are to invest in health information, regulate the private sector, and engage the community in “sustainable goals.”

A study from PGI, Chandigarh in India which explored the financial burden of paediatric acute lymphoblastic leukemia found that the mean distance that families travelled to hospital was about 260 kilometres. It found that the monthly healthcare expense was more than seven times the average monthly per capita income, and 34% of fathers lost their jobs while they were seeking care for their child. The learning point from this paper is that more big, specialised, tertiary-care hospitals are not the solution. There is a need to develop primary and secondary healthcare.

Now that using “trained” quacks is being considered as a strategy to counter the shortage of doctors in rural India (BMJ report) a very timely case report and literature review in Indian Journal of Dermatology points towards the need for medical doctors to be “aware of different quackery practices rampant in various geographical regions.”

This article by the former Health Secretary of India provides a brilliant perspective on how reforms for improvement has been stalled and shelved due to corruption and how this has led to the growth of the private sector. Corruption is indeed an all pervading issue in South Asia and implementing anything that could counter it would probably be the key for actual realisation of sustainable development goals.

Soumyadeep Bhaumik is a medical doctor from India and he works on evidence synthesis and public health. He is currently studying international public health at the Liverpool School of Tropical Medicine. All opinions are personal. Twitter @DrSoumyadeepB.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I currently serve in an editorial position at the Journal of Family Medicine and Primary Care and have previously had positions at other journals. I have no other relevant conflicts of interests to declare.