Disputation i folkhälsovetenskap med A.H.M. Enayet Hussain
Välkommen att närvara när A.H.M. Enayet Hussain försvarar sin avhandling "Challenges in Pediatric Eye Care Services in Bangladesh".
Disputationen äger rum kl. 10.00 den 21 september i sal C312 på Mittuniversitetets campus i Sundsvall och via Zoom. Ingen anmälan krävs.
Efter disputationsakten är du välkommen till ett mingel med lättare förtäring i väntan på betygsnämndens beslut. Sista dag för anmälan till minglet är den 11 september.
Om avhandlingen
Doktorsavhandlingen ”Challenges in Pediatric Eye Care Services in Bangladesh” belyser just dessa utmaningar genom fem sammanlänkade studier. Studie I, II och III fastställer en epidemiologisk utgångspunkt och kartlägger socioekonomiska hinder för att tidigt söka och få tillgång till ögonsjukvård i landsbygdssamhällen i Bangladesh. Studie IV kvantifierar den sjukhusbaserade ekonomiska bördan av förebyggbara ögonsjukdomar hos barn. Slutligen sammanför studie V dessa insikter och föreslår ett integrerat ramverk som prioriterar uppgiftsväxling, samhällsbaserad finansiering, sektorsövergripande samverkan och stärkta hälsoinformationssystem. Sammantaget ger resultaten en evidensbaserad väg framåt för att minska undvikbar blindhet och synnedsättning hos barn, och för att omsätta folkhälsopolitik i hållbara, sektorsövergripande insatser på lokal nivå.
Huvudhandledare: Professor Koustuv Dalal, Mittuniversitetet
Biträdande handledare: Docent Eija Viitasara, Mittuniversitetet
Biträdande handledare: Professor Saidur Rahman Mashreky, North South University, Bangladesh
Opponent: Professor Jahangir Khan, Avdelningen för samhällsmedicin och folkhälsa, Göteborgs universitet
Betygsnämnd:
Professor Neil Lagali, Linköpings Universitet
Docent David Haage, Mittuniversitetet
Docent Teresa Silva, Mittuniversitetet
Professor Marko Laaksonen, Mittuniversitetet (ersättare)
Abstract
Background: Childhood visual impairment and blindness impose substantial health, educational, social, and economic burdens on affected children and their families. An estimated 19 million children worldwide are visually impaired, of whom 1.4 million are permanently blind. This thesis aimed to generate comprehensive evidence on the epidemiology, health-seeking behavior, economic burden, and health-system barriers related to pediatric eye care in Bangladesh, and to develop an integrated framework to reduce childhood ocular morbidity and blindness.
Methods: Five complementary studies were conducted, including a population-based survey of childhood blindness, a school-based survey of refractive error, mixed-methods assessments of health-seeking behavior and economic burden, and a framework development study that combined a literature review with expert consultation. Quantitative data were analyzed using descriptive and multivariable statistical methods, and qualitative data were analyzed using thematic analysis.
Results: Study I detected 6.3 blind per 10,000 children. Of 198 detected cases, only 87 (44%) had parents who sought care; over half sought no services. Key barriers were poor knowledge, financial constraints, and taboo (Study II). Refractive error prevalence was 5.3%, predominantly myopia (78.8%); urban children were most affected (9.9%), and only 15.7% of affected children wore spectacles; secondary school girls were at higher risk (Study III). Nearly 90% of families experienced catastrophic health expenditure (CHE); median out-of-pocket costs were highest for squint (BDT 65,000) and cataract (BDT 50,000). Families bypassed local facilities due to low trust, inadequate equipment, and a lack of awareness, traveling to tertiary centers in the capital at great expense (Study IV). An integrated framework based on the WHO six building blocks was developed, emphasizing multi sectoral collaboration, task shifting, community financing, and the strengthening of health information systems (Study V).
Conclusion: Childhood blindness and ocular morbidity in Bangladesh persist due to socioeconomic inequities, limited awareness, delayed care-seeking, and health-system weaknesses. Strengthening pediatric eye care through an integrated, multisector health-system approach is essential to prevent avoidable blindness and ensure equitable access to services.