Research Reports (2001): Health Studies, Vol - XXX

Permanent URI for this collectionhttps://hdl.handle.net/10361/13018

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Reproductive tract infections and sexually transmitted diseases in a rural area of Bangladesh: insights for action from research
(BRAC Research and Evaluation Division (RED), 2001-06) Hashima-E-Nasreen
Objectives: The study aimed· to assess the magnitude of problem associated with RTis/STDs in rural Matlab, Bangladesh. It estimates the prevalence and attempts to explore the risk indicators for RTis and STDs among people of different age group within the existing socio-cultural context. Methods: A combination of qualitative and quantitative research methods was utilized. Indepth interview, focus group discussion, and a cross-sectional survey of randomly selected men, women, and adolescent boys and girls were the main methods employed. The ICDDR, B surveillance database provided the sampling frame. Results: About 19% of people in Matlab have had STDs. Lack of awareness, risky sexual behaviour, lack of accessibility and availability of adequate services, traditional and unhygienic health practices, absence of programme efforts, and illiteracy and poverty were the prevalent soia-cultural factors that potentially has put people at risk of RTis, STDs as well as HIV/AIDS epidemic. The bridge between non-commercial and commercial partners was laid by men whom work in urban area push up the likelihood of infection from the high risk (urban) to low risk group of women in the village. Risky sexual behaviour was also prevalent among adolescents. Partners' communication and treatment seeking behaviour were found to be very poor among adults and not at all among adolescents. There is a need for collaborative action addressing rural people's riskassessment component. Conclusion: To avert the situation, a holistic approach should be adopted with greater emphasis on RTI/STD control and prevention together with human relationship, communication , gender, family interaction and socio-economic status that would determine the nature and extent of people's risk and vulnerabilities. Because of the sensitivity of issue, it is important to think about how to achieve community acceptance. so that programme can expand and sustain itself.
Poverty status and differential access to health services in RDHC area
(BRAC Research and Evaluation Division (RED), 2001-12) Karim, Fazlul; Tripura, Abhilash; Gani, Md. Showkat
Mortality and fertility: impact evaluation of BRAC reproductive health and disease control programme
(BRAC Research and Evaluation Division (RED), 2001-06) Karim, Fazlul; Gani, Md. Showkat; Tripura, Abhilash
This study assessed the impact of BRAC's RHDC programme on fertility and mortality compared to the baseline status as well as the comparison area. Subsequently, a number of variables such as total fertility rate (TFR), age-specific fertility rates (ASFR), crude birth rate (CBR), crude death rate (CDR), infant mortality rate (IMR), child mortality rate (CMR), under-five mortality rate (USMR) and age-specific death rates (ASDR) were chosen for analysis. These variables are measurable and widely accepted to reveal the impact of any reproductive health programme. Moreover, we have baseline data on these variables for comparison. In the baseline study (1992) fertility and mortality data were collected from 12,073 households (programme 8,072 and comparison 4,001) representing a total of 261 villages (programme 184 and comparison 77). But, in the follow-up study done in 2000, 103 villages (programme 80 and comparison 23) were revisited. Using the cluster survey method, data were collected from 8,033 households (programme 4,003 and comparison 4,030) in the follow-up study. Each married woman was asked to provide information on the number of children she had given birth during the 12 months recall period. Information on all the live births were collected, such as name, sex, date and place of birth, age, father's name and occupation, and birth order of the child. Similarly, data on death that occurred during the last 12 months along with name, sex, month and year of death, age at death, marital status and causes of death, were also collected. The study found that the reduction of TFR from the baseline to the follow-up study was sharper in the programme area than in the comparison (21% versus 13%). The present TFR for both the areas was identical (programme 2.7 and comparison 2.6/1,000 women). It is to be noted that the benchmark TFR was higher in the programme area than in the comparison area (3.4 versus 3.0).
Impact of BRAC reproductive health and disease control programme on practice of personal hygiene
(BRAC Research and Evaluation Division (RED), 2001-12) Karim, Fazlul; Tripura, Abhilash; Gani, Md. Showkat
The campaign on safe water, sanitation and hygiene practices has been an important priority in BRAC's health interventions including RHDC. The RHDC hygiene education is concerned with establishing or inducing changes in personal and group attitudes and behaviour that promote healthy living. Given the situation, one may ask about the achievements of RHDC in improving the sanitation and hygiene practice. Thus, this study evaluated the impact of BRAC's RHDC programme on different issues of personal hygiene compared to baseline status as well as the comparison area. In the baseline study (1992) fertility and morality data were collected from 12,073 households (programme 8,072 and comparison 4,001) representing a total of 261 villages (programme 184 and comparison 77). But, in the follow-up study done in 2000, 103 vi II ages (programme 80 and comparison 23) were revisited. Using the cluster survey method, data were collected from 8,033 households (programme 4,003 and comparison 4,030). The programme vilbges were drawn from Bogra and Dinajpur districts whilst the comparison villages from Jaipurhat district. It is to be noted that for measuring the level of different health service use and hygienic practices, data were collected from IQI'';(. and 25% on the total households covered for mortality and estimate during the baseline and the follow-up studies respective! y, because measurement of these issues required lesser number of sample than the mortality and fertility estimates. However, the following sections present the key findings of the study.
Impact of BRAC reproductive health and disease control programme on different health services utilisation
(BRAC Research and Evaluation Division (RED), 2001-12) Karim, Fazlul; Tripura, Abhilash; Gani, Md. Showkat
This study assessed the impact of BRAC's RHDC programme on different health services utilisation compared to the baseline status as well as the comparison area. In the baseline study (199:.?.) fertility and mortality data were collected from 12,073 households (programme 8,072 and comparison 4,001) representing a total of 261 villages (programme 184 and comparison 77). But, in the follow-up study clone in 2000, 103 villages (programme 80 and comparison 23) were revisited. Using the cluster survey method, data were collected from 8,033 households (programme 4,003 and comparison 4,030) in the follow-up study. The programme villages were drawn from Bogra and Dinajpur districts whilst the comparison villages from Jaipurhat district. It is to be noted that for measuring the level of different health service use data were collected from toe;~ and 25% of the total households covered for mortality and fertility estimate during the baseline and the follow-up studies respectively, because measurement of other service utilisation required lesser number of sample than the mortality and fertility estimates. However, the following sections present the key findings of the study.
Impact of BRAC on community health networks: a village study
(BRAC Research and Evaluation Division (RED), 2001-07) Begum, Shamim Ara; Hannan, Rowshan; Chowdhury, AMR
Mere health service provision may be unable to bring about the desired impacts on health outcomes. Such outcome impact is mediated by changes in health seeking behavior underpinned by changes in health kr!Owledge, attitude and practice---variables which are socially embedded and transmitted through networks. BRAC, the largest national NGO in the world, in an effort to provide cost-effective and mass scale essential health service coverage in rural areas, makes use of locally recruited community health workers-shasthya shebikas. This study attempts to describe the health network in a village where the shebika has been working for many years. It has tried to assess the past health network in the village and how the introduction of a shebika has influenced this network. It also examines the power and influence of the shebikas in a village, and how this influence has changed over time. The study finds that far from polarising the village between members and non-members the shebikas are actually consulted by a range of people. Thus it can be said that the health network in the village, which is dominated by the shebikas have created an inclusive health network of different NGO and non-NGO members. After ten years of BRAC's Mainstream Health Programme in the study village we found that the shebikas reached a large and inclusive group transcending social and wealth categories. This is even more encouraging in view of the fact that the shebikas come from the lowest wealth category. Though only six percent of the households did not visit any health practitioner at all, they were noted to include some of the poorest in the village, suffering from exclusion from multiple networks. Future research should explore the pathways through which such exclusions happen and the general interlinkages between health and other socio-economic networks.
Factors affecting mortality and disbursement of insurance benefits to female members of BRAC village organization
(BRAC Research and Evaluation Division (RED), 2001-01) Chowdhury, A Mushtaque R; M Showkat Gani
BRAC has been implementing multi faceted programmes such as rural development programme, education prograrnme, health and nutrition programme for poverty alleviation. The core of rural development programme IS the fom1ation of village organizations (VO) . Through the YOs BRAC organizes the poor (BRAC members), and provide them with credit facility and other technical support. Unlike developed countries, taking up life insurance policy is not very common in Bangladesh. In 1990, BRAC introduced a life insurance scheme for its YO members. At the death of any member BRAC pays Tk. 5000 for each claim from the interest fund of the micro finance programme. There are some eligibility of receiving the insurance claims; however, all members are entitled to the insurance. In 1998, 3,879 VO members died and the insurance claims of a total of Tk. 19,395,000 was paid to their nominees. The mam goals of this study were to find out the causes of death and mortality differentials of BR;\C members and also to look at the settlement of insurance claims of BRAC members. To know the hum:m health status, mortality is the key indicator. It is hardly found the mortality study among BRAC members (adult female) . So Research and Evaluation Di\'ision (RED) took an initiative to study the BRAC members who died in 1998. Before actual study a pilot survey was carried out in Tangail and Sylhet regionsa during December 1999 - February :woo and survey methods and tools were tested and finalised . Based on the learning from the pilot survey, RED therefore decided to conduct a crosssectional sample survey. The broad objective of this study was to assess the death rates of BRAC YO members in 1998 and also to provide the sociodemographic determinants of mortality and causes of "Region constitutes of 12-20 BR..AC areas which consists of 160 units each with 50 target households to form a village organization. death of the members. This study also looked at the disbursement process against insurance claims; and the ways the money was used by beneficiaries.
Fighting arsenic at the grassroots: experience of the community awareness initiative of BRAC in Bangladesh
(BRAC Research and Evaluation Division (RED), 2001) Hadi, Abdullahel
The study evaluates the arsentc mitigation project of BRAC in ra1smg the awareness of arsenic poisoning in the rural communities in Bangladesh. Data came from the selected villages in the southwestern Bangladesh where BRAC had arsenic mitigation project. Comparison villages were also selected from the same region. A total of 1,240 randomly selected adult persons were interviewed in May 2000. Findings reveal that the mitigation project played a significant positive role in raising awareness of the safe water options, signs of arsenicosis, mode of transmission and the type of treatment. Testing tube-well water for arsenic created curiosity, innovations and interest in the community. Similarly, water treatment plant became a symbol of arsenic campaign that created the context for promoting awareness. The study concludes that the behavioural change aspects of the arsenic mitigation project have the potential to significantly improve the level of understanding about arsenic contamination in the traditional communities.
Arsenicosis in Bangladesh: prevalence and sociodemographic correlates
(BRAC Research and Evaluation Division (RED), 2001) Hadi, Abdullahel
Arsenic contamination in drinking water has created concern for its potential health effects but our understanding of the risk factors of arsenicosis remains limited. This study assesses the prevalence of and soeio-demographic differentials in arsenic-associated skin lesions in a rural community in Bangladesh. Data were collected from a village \-Vhere BRAC had both health surveillance system and community-based arsenic mitigation project since 1999. A total of I ,654 residents in the study village were examined to detect arsenic-associated lesions on their skin in May 2000. The socio-demographic infom1ation \\'as extracted from the surveillance system database covering the village. Finding reveals that nearly 2. 9% of the study population had clinical manifestations of arsenic poisoning. The prevalence of arsenicosis was associated with age, sex, education and the economic status of the household. Multivariate analysis identified age and economic status as significant predictors of arsenicosis controlling for education and gender. The study concludes that arsenic contan1ination in drinking water became a major public health problem in the affected communities although the burden of disease \\·as spread unevenly and fell most heavily on certain groups. A detailed understanding of the distribution of arsenicosis is needed in designing an effective mitigation project.

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