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Table 2 Summary findings of the feasibility of collecting the following proposed SRMNCAH indicators in the humanitarian context of Bangladesh

From: Feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in Bangladesh

No. Indicator name Overall % of agencies reporting Place of collection Facilitators to routine collection Barriers to routine collection   Resources needed for routine collection Exclude/include
Contraception
1.1 Number of clients initiating contraception 82% Health facilities and organizations providing reproductive health services Mandatory reporting to the health sector, MoHFW and the SRHWG; National reporting systems: DHIS2, EWARS Lack of harmonized reporting system leads to increased strain, duplication of data and unreliable data # of clients receiving a contraceptive service, by method
Clarification on the wording surrounding "initiating"
Standardize definition of new user vs. recurrent user
Resources for integration into HIS/existing data collection systems
Enable and implement methods to track specific patients at the facility and community level
Include
1.2 Number of clients receiving emergency contraception 50% Health facilities and organizations providing reproductive health services Mandatory reporting to the health sector, MoHFW and the SRHWG; National reporting systems: DHIS2, EWARS Socio-cultural barriers
Low and unreliable availability of commodities: limited provision of EC for cases that require CMR
# of clients receiving CMR services within 120 h Resources and training regarding security and data privacy
Resources for integration into DHIS2
Resources needed to enable coordination efforts for the SRHWG
Include
1.3 Percentage of clients adopting modern contraceptive method after delivery 0% Secondary and tertiary facilities only Mandatory reporting to the health sector, MoHFW and the SRHWG; National reporting systems: DHIS2, EWARS Unreliable population metrics since reporting systems cannot track individual service users
Applicable in secondary and tertiary facilities only
# of clients adopting a modern contraceptive method after delivery
Removal of denominator
N/A Include
1.4 Percentage of clients adopting modern contraceptive method after abortion 0% N/A N/A Socio-cultural barriers
Legal status of abortion in Bangladesh
# of clients adopting a modern contraceptive method after menstrual regulation Change "abortion" to "menstrual regulation"
Couple indicator with an indicator tracking the number of outreach activities from the CHWs surrounding menstrual regulation
Removal of denominator
Resources and training regarding security and data privacy
Encryption and coding of sensitive information is needed
Enabling policies to ensure confidentiality
Training for CHW on security and data privacy measures in place and communicating these to the Rohingya community
Include
Comprehensive abortion care
2.1 Number of clients requesting an abortion 0% N/A N/A Potential risk for client and primary care provider
Legal status of abortion in Bangladesh
Socio-cultural barriers Insufficient data security and privacy
N/A N/A Exclude
2.2 Number of clients receiving an abortion referral 0% N/A N/A Gaps in coordination between health service providers and referrals Potential risk for patient and primary care provider
Legal status of abortion in Bangladesh
Socio-cultural barriers
Insufficient data security and privacy
N/A N/A Exclude
2.3 Number of clients receiving an induced abortion 27% N/A N/A Socio-cultural barriers cause limited service-provision, underreporting and hesitancy in the Rohingya community
Insufficient data security and privacy measures set in place
Potential risk for client and primary care provider
# of clients receiving menstrual regulation services, disaggregated by age (10–13;13–15;15–18; and equal or greater than 18)
Change "abortion" to "menstrual regulation"
Training on data security and data privacy Encryption and coding of sensitive information is needed
Enabling policies to ensure confidentiality
Training for CHW on security and data privacy measures in place and communicating these to the Rohingya community
Include
2.4 Number of clients presenting for post-abortion care (PAC) 55% Secondary and tertiary facilities only National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Applicable in secondary and tertiary facilities only
Socio-cultural barriers Insufficient data security and privacy Potential risk for patient and primary care provider
N/A N/A Include
2.5 Number of clients receiving PAC 64% Secondary and tertiary facilities only National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Applicable in secondary and tertiary facilities only
Socio-cultural barriers Insufficient data security and privacy Potential risk for patient and primary care provider
N/A N/A Include
Maternal health
3.1 Number of maternal deaths 82% Secondary and tertiary facilities Organizations with allocated funding for data collection developed comprehensive HIS for accurate maternal data collection
National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO
Lack of centralized system to collect quality and timely maternal death data at the facility and community levels # of maternal deaths in the facility, by cause of death
Disaggregate indicator by cause
Couple indicator with indicators that capture maternal death in the community
Increased transparency in auditing practices
Resources needed to develop and implement at the community level to capture the indicators for the maternal deaths in the community
Include
3.2 Number of maternal deaths, disaggregated 73% Secondary and tertiary facilities Organizations with allocated funding for data collection developed comprehensive HIS for accurate maternal data collection
National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO
Lack of centralized system to collect quality and timely maternal death data at the facility and community levels # of maternal deaths in the facility, disaggregated by age (10–13;13–15;15–18; and equal or greater than 18) Training for data collectors on the different causes of maternal death and how to encode for each Develop detailed manuals for frontline workers and data collection Training and capacity building for community health workers Increased transparency in auditing practices surrounding maternal deaths Include
3.3 Percentage of maternal death reviews 73% Secondary and tertiary facilities Routinely collected by secondary and tertiary facilities
Organizations with allocated funding for data collection developed comprehensive HIS for accurate maternal data collection
National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO
Lack of centralized system to collect quality and timely maternal death data at the facility and community levels # of maternal deaths in the facility that were audited and reviewed Disaggregate indicator by cause
Couple indicator with indicators that capture maternal death in the community
Removal of denominator
Training of data collectors on the different causes of maternal death and how to encode for each
Develop detailed manuals for frontline workers and data collectors Training and capacity building for community health workers Increased transparency in auditing practices surrounding maternal deaths
Enable and implement methods and policies to ensure coordination between agencies and systematic undertaking of maternal death reviews
Include
3.4 Number of clients receiving antenatal care (ANC) 64% Secondary and tertiary facilities Routinely collected by secondary and tertiary facilities   N/A N/A Include
3.5 Number of deliveries 73% Secondary and tertiary facilities Routinely collected by secondary and tertiary facilities
Community health workers promote community members to opt for facility-based deliveries
No birth registries at the facility level
Gaps in policies and systems: lack of national civil registry policies for refugees
# of clients delivering in a facility, including both live and stillbirths Couple indicator with indicators to capture births occurring in the community Training for frontline workers on stillbirths
Leveraging systems to capture stillbirths for community births (UNICEF) Training and capacity building for community health workers
Include
3.6 Number of deliveries, disaggregated 55% Secondary and tertiary facilities Routinely collected by secondary and tertiary facilities
Community health workers promote community members to opt for facility-based deliveries
No birth registries at the facility level
Gaps in policies and systems: lack of national civil registry policies for refugees
# of clients delivering in facility, including both live and stillbirths, disaggregated by age (10–13;13–15;15–18; and equal or greater than 18) Training for frontline workers on stillbirths Leveraging systems to capture stillbirths for community births (UNICEF) Training and capacity building for community health workers Include
3.7 Number of clients receiving post-natal care (PNC) 73% Secondary and tertiary facilities Routinely collected by secondary and tertiary facilities
Community health workers promote community members to opt for facility-based deliveries
  # of clients receiving post-natal care, disaggregated between 2 and 7 days N/A Include
3.8 Number of caesarean section deliveries 64% Secondary and tertiary facilities Routinely collected by secondary and tertiary facilities Lack of training/equipment to provide service in some facilities Applicable in secondary and tertiary facilities only # of caesarian section deliveries, disaggregated by medically or nonmedically necessary
Couple indicator with an indicator on the number of referrals for caesareans
Resources needed to improve monitoring referral systems within the camp Include
3.9 Availability of PAC 0% N/A N/A Lack of training/equipment to provide PAC in some facilities
Socio-cultural barriers Insufficient data security and privacy Potential risk for client and primary care provider
N/A Service mapping of PAC providers
Provide specific contours on when, how and by whom these should be collected
Include
3.10 Availability of basic emergency obstetric care (BEmOC) 0% N/A N/A   N/A Service mapping of facilities
Provide specific contours on when, how and by whom these should be collected
Include
3.11 Availability of comprehensive emergency obstetric care (CEmOC) 0% N/A N/A Lack of training/equipment to provide CEmOC in health centres Applicable in secondary and tertiary facilities only N/A Service mapping of facilities Provide specific contours on when, how and by whom these should be collected Include
3.12 Availability of skilled personnel 0% N/A N/A   N/A Service mapping of facilities Include
3.13 Number of antenatal care clients with tetanus vaccination 55% Administered by health sector/state Administered by the health sector/state Vaccination is typically administered by the state N/A Buy-in among immunization teams and immunization reporting systems Resources needed to integrate the health system into data collection systems Include
3.14 Number of ANC clients receiving preventive therapy for malaria 27% Administered by certain NGOs Administered by certain NGOs Service not routinely provided Clients are referred to facilities that offer malaria therapy, but data is not usually collected N/A N/A Include
3.15 Number of ANC clients receiving syphilis screening 36% Secondary and tertiary facilities National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Can be collected under cervical cancer screening Lack of training/equipment to provide service: Not all facilities are equipped with lab equipment and materials for screening practices Clarification on the term "screening". There is confusion on whether screening includes a test or not Develop detailed manuals (with specific definitions) for frontline workers and data collectors Include
3.16 Number of ANC clients receiving urinary tract infection screening or treatment 45% Secondary and tertiary facilities National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Lack of training/equipment to provide service: Not all facilities are equipped with lab equipment and materials for screening practices Clarification on the term "screening". There is confusion on whether screening includes a test or not Develop detailed manuals (with specific definitions) for frontline workers and data collectors Include
3.17 Number of clients with identified maternal morbidities during post-natal care (PNC) 27%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO   # of clients identified maternal morbidities, by type of morbidity, during post-natal care Develop detailed manuals for frontline workers and data collectors on the different types of agreed upon morbidities (outline definitions for accurate reporting) Include
Newborn health
4.1 Number of neonatal deaths 73%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO No birth registries at the facility level: Facilities do not have access to number of babies registered Gaps in policies and systems: Lack of national civil registry policies for refugees #of neonatal deaths (0–28) at the facility level
Couple indicator with an indicator tracking neonatal death within the community
Couple indicator with the age of the mother given the high rates of early marriage
Training for community health workers on recording neonatal deaths within the community Include
4.2 Number of stillbirths 55%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO No birth registries at the facility level: Facilities do not have access to number of babies registered Gaps in policies and systems: Lack of national civil registry policies for refugees Couple indicator with the age of the mother given the high rates of early marriage Training for community health workers on recording neonatal deaths within the community Include
4.3 Number of babies born low birth weight 73%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO No birth registries at the facility level: Facilities do not have access to number of babies registered Gaps in policies and systems: Lack of national civil registry policies for refugees # of babies born low birth weight, disaggregated by age of mother Couple indicator with the age of the mother given the high rates of early marriage
Couple indicator tracking malnutrition among pregnant women
Training for community health workers on recording neonatal deaths within the community Include
4.4 Number of small and sick newborns receiving care 55%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO N/A Couple indicator with the age of the mother given the high rates of early marriage N/A Include
4.5 Number of newborns receiving post-natal care 55%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO N/A N/A N/A Include
4.6 Availability of KMC 18%   KMC is a priority program due to premature and low birth weight deaths N/A N/A Service mapping of facilities Include
4.7 Availability of neonatal resuscitation 55% Secondary and tertiary facilities only Captured and administered at the secondary and tertiary facilities Applicable in secondary and tertiary facilities only N/A Service mapping of facilities Include
4.8 Number of neonatal deaths, disaggregated 45%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Indicator is collected but not disaggregated N/A Training for data collectors on the different causes of neonatal death and how to encode for each Develop detailed manuals for frontline workers and data collectors
Training and capacity building for community health workers Increased transparency in auditing practices surrounding maternal deaths
Enable and implement methods and policies for coordination and systematic collection of neonatal deaths
Include
4.9 Percentage of perinatal death reviews 36%   Cause of death is recorded No formal audit of collected data N/A Training for primary care providers on capturing and recording perinatal death and reviews for cause of death
Training for community health workers on the system for reporting deaths occurring within the community
Include
4.1 Number of newborns receiving Hepatitis B vaccine 18%   N/A Service not routinely provided: Hepatitis B doses are not part of all immunization schedules in Bangladesh N/A Buy-in among immunization teams and integration of immunization data collection systems at the facility and community level Include
4.11 Number of newborns initiating breastfeeding early 27%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO N/A # of newborns initiating breastfeeding before discharge N/A Include
4.12 Number of infants weighed at birth 36%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO N/A N/A Resources needed to establish equipment to weigh babies in all facilities and appropriate equipment for community health workers Include
4.13 Number of babies registered 0% N/A N/A Gaps in policies and systems
No birth registries at the facility level: Facilities do not have access to the number of babies registered
N/A N/A Exclude
4.14 Number of newborns receiving treatment for possible severe bacterial infection (PSBI) 27% Secondary and tertiary facilities only Captured and administered at the secondary and tertiary facilities Applicable in secondary and tertiary facilities only N/A N/A Include
4.15 Number of newborns admitted 27%    Service not routinely provided: Only certain facilities have a NICU or KMC unit Couple indicator with number of referrals N/A Include
4.16 Number of newborns with morbidities identified during PNC 27%     N/A Resources for primary care providers on the definitions for morbidity type Extensive training and capacity building will need to be implemented Include
Child health
5.1 Number of deaths of children under 5 45% Health facilities, primary, and secondary health services National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Unreliable population metrics since reporting systems cannot track individual service users and deaths outside of the facility Removal of denominator Training of CHW and system for reporting deaths occurring within the community Leveraging systems to capture the child health indicators within the community (UNICEF) Include
5.2 Under 5 mortality rate 0% N/A N/A Population-level indicator with impractical denominator Unreliable population metrics since reporting systems cannot track individual service users and deaths outside of the facility N/A N/A Exclude
5.3 Percentage of children under 5 with suspected pneumonia taken to appropriate health facility 36% Health facilities, primary, and secondary health services National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO N/A Standardize definition of acute respiratory infection (ARI)
Clarification on the term “survey”
Develop detailed manuals for frontline workers and data collectors on indicator definition
Leveraging systems to capture the child health indicators within the community (UNICEF)
Include
5.4 Coverage of diarrhea treatment 55%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO N/A N/A Leveraging systems to capture the child health indicators within the community (UNICEF) Include
5.5 Percentage of children under 5 who are wasted 36%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Population-level indicator with impractical denominator # of children under 5 who are wasted
Removal of denominator
  Include
5.6 Percentage of children under 5 who are registered 0% N/A N/A Gaps in policies and systems
No registration of individuals at the facility level: Registration of individuals occurs through the state; facilities do not have access to this information
Removal of denominator N/A Exclude
5.7 Number of children presenting with fever tested for malaria in endemic settings 45% Administered by health sector/state The health sector performs active surveillance of malaria cases in the region N/A N/A N/A Include
5.8 Number of confirmed cases of malaria in endemic settings 55% Administered by health sector/state The health sector performs active surveillance of malaria cases in the region N/A N/A N/A Include
5.9 Percentage of confirmed malaria cases treated 36% Administered by health sector/state The health sector performs active surveillance of malaria cases in the region N/A # of confirmed malaria cases treated
Removal of denominator
Enable and implement methods to track specific patients at facility and community level Include
5.1 Coverage of DPT3 36% Administered by health sector/state Captured and administered at the state level Population-level indicator with impractical denominator Removal of denominator Buy-in among immunization teams and systems Include
Adolescent health
6.1 Adolescent birth rate 64% N/A Data can be extracted from DHIS2 and SRHWG reports Gaps in policies and systems: No current data collection mechanism in place for adolescent health indicator reporting Stakeholders do not collect the exact age of the patient Socio-cultural barriers # of adolescents giving birth, disaggregated by age (10–13;13–15;15–18) Removal of denominator Resources needed to integrate adolescent health indicators into routine service delivery as a specific area of its own, including for data collection to ensure reliability and validity of the data
Resources needed to invest in the adolescent task force to enable camp wide coordination of data capturing and analysis
Include
6.2 Sexual violence against children 0% N/A N/A Information not actionable
Gaps in policies and systems: No current mechanisms of data collection for adolescent health indicator reporting Socio-cultural barriers
N/A N/A Exclude
6.3 Adolescent mortality rate 36% N/A Data can be extracted from DHIS2 and SRHWG reports Gaps in policies and systems: No current mechanisms of data collection for adolescent health indicator reporting
Indicator collected but not all stakeholders disaggregate data
# of adolescent death, disaggregated by age (10–13; 13–15;15–18) Removal of denominator Resources needed to integrate adolescent health indicators into routine service delivery as a specific area of its own, including for data collection to ensure reliability and validity of the data
Resources needed to invest in the adolescent task force to enable camp wide coordination of data capturing and analysis
Include
6.4 Percentage of adolescents living with HIV who are currently receiving antiretroviral therapy, disaggregated 0% N/A N/A Specific infectious disease reporting requirements and management protocols for individual cases of HIV Population-level indicator with impractical denominator Unreliable population metrics since reporting systems cannot track individual service users Gaps in policies and systems: No current mechanisms of data collection for adolescent health indicator reporting N/A N/A Exclude
6.5 Immunization coverage rate 36% Administered by health sector/state Data can be extracted from DHIS2 and SRHWG reports
Not all facilities collect this information, but it is accessible at the health sector/state level
Gaps in policies and systems: No current mechanisms of data collection for adolescent health indicator reporting Vaccination generally administered at the state level # of adolescents receiving the nationally mandated immunization
Removal of denominator
Resources needed to integrate adolescent health indicators into routine service delivery as a specific area of its own, including for data collection to ensure reliability and validity of the data
Resources needed to invest in the adolescent task force to enable camp wide coordination of data capturing and analysis
Include
6.6 Suicide rate, disaggregated 0% N/A N/A Information not actionable Population-level indicator with impractical denominator Unreliable population metrics since reporting systems cannot track individual patients
Gaps in policies and systems: No current mechanisms of data collection for adolescent health indicator reporting Socio-cultural barriers
N/A N/A Exclude
Sexual and gender-based violence
7.1 Number of rape survivors 36%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Socio-cultural barriers cause gaps in reporting # of clients receiving CMR services, disaggregated by sex and age Remove term "rape survivors" Training on data security and & data privacy Encryption and coding of sensitive information is needed
Enabling policies to ensure confidentiality
Training of CHW of security and data privacy measures in place and communicating these to the Rohingya community
Include
7.2 Percentage of health facilities with clinical management of rape services 0% N/A Data could be extracted through data from patient files Lack of training/equipment to provide service: Insufficient community outreach mechanisms for SGBV service availability leads to under-reporting/underutilization of services Socio-cultural barriers N/A Service mapping of facilities Include
7.3 Percentage of rape survivors receiving HIV post-exposure prophylaxis 0% Administered by health sector/state Collected at the state level HIV surveillance and treatment is overseen by the state N/A N/A Exclude
7.4 Percentage of rape survivors receiving emergency contraception 36%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Indicator is collected but data is not disaggregated by method # of clients receiving CMR services disaggregated by method, sex and age Removal of denominator Training on data security and & data privacy Encryption and coding of sensitive information is needed
Enabling policies to ensure confidentiality
Training for CHW on security and data privacy measures in place and communicating these to the Rohingya community
Include
7.5 Number of rape survivors requesting abortion 0% N/A N/A Potential risk for the client Insufficient security and privacy measures set in place Socio-cultural barriers Legal status of abortion in Bangladesh Service not routinely provided N/A N/A Exclude
7.6 Number of rape survivors receiving induced abortion care or referral 0% N/A N/A Gaps in coordination between service providers and referrals Potential risk for patient and primary care provider Insufficient data security and privacy Socio-cultural barriers
Legal status of abortion in Bangladesh
N/A N/A Exclude
7.7 Availability of intimate partner violence front line support (LIVES) 36% Health facilities Part of the community outreach agenda Lack of infrastructure and absence of private spaces is not conducive to confidentiality and safety for women and girls N/A Service mapping of facilities
Training on data security and data privacy Encryption and coding of sensitive information is needed
Enabling policies to ensure confidentiality
Training for CHW on security and data privacy measures in place and communicating these to the Rohingya community
Include
HIV
8.1 Antiretroviral therapy coverage among people living with HIV, disaggregated 0% Administered by health sector/state Captured and administered at the state level Specific infectious reporting requirements and management protocols for individual cases: Strict anonymity and coding of HIV cases Sociocultural barriers N/A N/A Exclude
8.2 Percentage of exposed individuals receiving post-exposure prophylaxis 0% Administered by health sector/state Captured and administered at the state level Specific infectious reporting requirements and management protocols for individual cases: Strict anonymity and coding of IV cases Sociocultural barriers N/A N/A Exclude
8.3 Percentage of donated blood units screened for HIV in quality assured manner 0% Administered by health sector/state Captured and administered at the state level Specific infectious reporting requirements and management protocols for individual cases: Strict anonymity and coding of HIV cases Sociocultural barriers Applicable in secondary and tertiary facilities only
Lack of training/equipment to provide service: Insufficient screening tools
N/A N/A Exclude
Prevention of mother-to-child transmission
9.1 Percentage of antenatal care clients receiving syphilis screening and treatment 36% Administered by certain NGOs and health facilities Syphillis screening can also occur during cervical cancer screening Lack of training/equipment to provide service (at all facilities): Insufficient lab equipment and materials for screening procedures Clarification on the term "screening". There is confusion on whether screening includes a test or not
Removal of denominator
Training on data security and data privacy
Encryption and coding of sensitive information is needed
Enabling policies to ensure confidentiality
Training for CHW on security and data privacy measures in place and communicating these to the Rohingya community
Include
9.2 Percentage of antenatal care clients offered testing for HIV 0% Administered by health sector/state N/A Specific infectious disease reporting requirements and management protocols for individual cases N/A N/A Exclude
9.3 Percentage of HIV-positive pregnant people receiving antiretroviral therapy 0% Administered by health sector/state N/A Specific infectious disease reporting requirements and management protocols for individual cases N/A N/A Exclude
9.4 Percentage of all deliveries to HIV-positive mothers receiving antiretrovirals 0% Administered by health sector/state N/A Specific infectious disease reporting requirements and management protocols for individual cases N/A N/A Exclude
Sexually transmitted infections (STIs) and reproductive tract infections (RTIs)
10.1 Percentage of STI/RTI cases managed 82%   National and humanitarian reporting systems: DHIS2, EWARS, SRHWG, KOBO Socio-cultural barriers prevent adequate treatment of STI cases # of patients with STI/RTI accessing services who are diagnosed symptomatically, and counselled according to protocol
Clarification between the number of cases and the number of cases “managed”
STI and RTI cases need to be formulated as separate indicators
Removal of the denominator
Training on data security and data privacy
Encryption and coding of sensitive information is needed
Enabling policies to ensure confidentiality
Training for CHWs on security and data privacy measures in place and communicating these to the Rohingya community
Include
  1. Texts in italic indicates new indicators recommended to add in the core set of indicators for Bangladesh context