Research Reports (1996): Health Studies, Vol - XlX

Permanent URI for this collectionhttps://hdl.handle.net/10361/12845

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Raising sanitary latrine use in rural Bangladesh: can BRAC play any role?
(BRAC Research and Evaluation Division (RED), 1996-05) Hadi, Abdullahel; Nath, Samir R
This study estimates the sanitation coverage and investigates impact of the participation in development program on the sanitation behavior in rural Bangladesh. Findings reveal that nearly a quarter of the study population has been using sanitary latrines though there are differences in use in terms of age, sex, education, occupation, land size and involvement with credit based development program. The multivariate analysis reveals that households involved with BRAC program are 3.66 times more likely to use sanitary latrine (p<.OI) than those who are socioeconomically similar with BRAC members but not involved in such program controlling for education and occupation of the household head. When other factors such as religion, ownership of land, housing condition, level of media exposure and the presence of BRAC programs are systematically added to the regression equation, the role of BRAC on sanitation behavior is still found significant. The study argues that social and behavioral aspects of the organized development program in rural Bangladesh can significantly increase safe sanitation practice in a traditional society.
Perspective of women about their own illness
(BRAC Research and Evaluation Division (RED), 1996-09) Mahbub, Amina; Ahmed, Syed Masud
Introduction In Bangladesh women's health issues are traditionally neglected and inadequate importance is given by all concerns. A majority of the women experience significant morbidity associated with pregnancy and delivery (Goodburn et al., 1994). Since women's health is a fundamental human right and must clearly be promoted as such immediate attention should be given to this concern (WHO, 1995). With this interest, women's health problem should be recognized and addressed from their own perspective. Because research results show that women's health behaviour is governed by what they perceive as good or ill health, whether this is consistent with bio-medical model or not (Khatib, 1992). So to promote women's health, their health problems should be addressed from their own perspective. Objectives The study aimed to understand illnesses from the perspective of women in the community and their health seeking behaviour with respect to some specific illness. Methodology This qualitative study was exploratory by nature. The cognitive and symbolic aspects were the main focus in the study. K1~an's concept of 'explanatory model' helped to map out and interpret the ideas in the study. Being a part of the BRAC-ICDDR,B joint research project the study was done in Matlab DSS (Demographic Surveillance System) area purposively. The study population was the married women in the study area (age ranges from 18 to 50). The study dealt with both BRAC and non BRAC women separately. Simple random sampling technique and convenient sampling were used to select the informants. Different qualitative methods were used for data collection, such as- free listing, pile sorting, matrix ranking, key informant interview and group discussions. Findings The study revealed that women had their own definition about ill health condition. They were also found to link up different illnesses based on their own reasoning. While determining the severity of a condition immediate threat to life was of prime concern to them. The study women had their own perspective in explaining every illness they experienced and thus they identified the causes of ill health and amplified a pattern of the ailment. There were certain folk theories such as hot and cold, purity and pollution, batas laga, 110sto kora, etc. by which they constructed the causal relations. In diagnosing ill health, knowledge about different illnesses (learned from other's experiences) and consultation with relatives, neighbors or traditional healers were the significant factors. Therapeutic Choice of the women largely depended on beliefs about the causes of illness, explanation of illness, availability of health services, socioeconomic condition, and past experience of efficacy of treatment. It was found that the women did not rely on one therapeutic method throughout the whole course of illness episode. They tried one by one accessible medical services and sometimes repeated the earliest one. However, other pattern of 'illness specific' health seeking behavioural was also observed (Hardon et aL 1995). The women usually termed bhute dhora, alga dhora, etc. as illnesses caused by evil spirit. In such cases, they seek kabiraji and moulovi treatment. They blindly believed that only the Allahar kalam (divine verses) could help cure the illness. Attitude of the society and family towards illness acted as an influencing factor at every stage from illness identification to treatment seeking behaviour. Women often tried to conceal some illnesses which have social stigma attached. In such situation women tried not to disclose the illness to their in-laws and husbands, rather getting treatment themselves through peer network and as a last resort, went to natal home for treatment. Conclusion It was explicit in the study that the identification of the illness and therapeutic choice were primarily done by the women themselves. Therefore, knowledge about women's perspective towards the illness and its gravity, is very much crucial. In conclusion, we would like to make the following recommendations: • On the basis of this study finding some focused ethnography on particular women's illnesses can be designed. That will help us to get a detailed picture on different illness situation specifically. That may provide new insight regarding women's health intervention issues. • BRAC could help the destitute women in the village who have been suffering from different reproductive health problems for a long time but can not seek medical help
Relapse of tuberculosis in rural areas of Bangladesh
(BRAC Research and Evaluation Division (RED), 1996-04) Islam, Md Nazrul; Mahmud, Shah Noor; Ali, Ahmed; Afsana, Kaosar; Hashima-E-Nasreen; Islam, Md. Akramul; Chowdhury, AMR; Chowdhury, Sadia A
The study conducted to investigate the relapse rate of TB in two thanas (KahaIoo and Furbari) of ' Women's Health and Development Programme (WlIDP) in August 1995. Of the 482 study cases, 435 (900A» treatment completed cases were interviewed, 4.7% died, 2.7% migrated and the rest did not response. The overall relapse rate was 4.10/0. Relapse rate was more than double (6.6%) in Kahaloo compared to Fulbari thana (3%). The rate was found to be highest among those who completed treatment for more than two years. Ten out of 18 relapse cases were identified by the TB control programme of WHDP. All the relapse cases were previously treated with anti-TB drugs for more than two months before the initiation of BRAC treatment Routine sputum examination for cured patients with complains of cough might be a strategy for identification of an relapse cases on time.
The health situation of adolescents: a literature review
(BRAC Research and Evaluation Division (RED), 1996-01) Ali, Ahmed; Mahmud, Shah Noor
This review paper addresses the health situation of the adolescents. Most of the studies we found were conducted in countries other than Bangladesh. The medical care of the adolescent has always been neglected in the developing world until recently. While their medical needs are now being considered with an increased emphasis, their phychosocial needs, which are so important have not been adequately addressed. A few studies have been conducted in Bangladesh on issues of reproductive health. These studies suggests that early marriage is a serious problem for adolescent girls resulting in early pregnancy and thus enhances other reproductive health problems.
Prevalence of post-partum genital tract infections in the mother and selected neonatal infections in rural Bangladesh
(BRAC Research and Evaluation Division (RED), 1996-05) Gazi, Rukhsana; Chowdhury, AMR; Mahmud, Shah Noor; Karim, Fazlul
The present study was designed to estimate the prevalence of post-partum infection and two neonatal infections in rural Bangladesh and to identify the factors and determinants related to these infections. In this study, a total of 400 women (200 from WHOP area and 200 from comparison area) were interviewed retrospectively through structured questionnaire. In general, the prevalence of post-partum infection and selected neonatal infection were lower in WH 0 P area than those of the comparison area. But the difference in prevalence rates between the program and comparison areas were not statistically significant. Again, the presence of trained TBAs during delivery could not provide beneficial effect in the outcome of post-partum infection in the program' area. In the program area, the mothers were still found to be using indigenous materials on cord of the neonates. Although, the results were less conclusive due to small number of samples, the delivery complications (prolonged labour, leaking membrane etc.) and the cultural factors such as using unclean water for washing the materials used as vaginal pads found to be associated with increased risk of post-partum infection.
Competence of the programme organizers in antenatal care an issue of the quality of care
(BRAC Research and Evaluation Division (RED), 1996-04) Afsana, Kaosar; Chowdhury, AMR; Mahmud, Shah Noor; Karim, Fazlul
Pregnant women's knowledge on health and iron supplementation
(BRAC Research and Evaluation Division (RED), 1996-05) Hyder, SM Ziauddin; Roy, Rita Das; Tarannum, Sabah
The prevalence of Anaemia among men and women in rural Bangladesh
(BRAC Research and Evaluation Division (RED), 1996-08) Hyder, SM Ziauddin
Anaemia is a major public health problem in many developing countries including Bangladesh. Iron deficiency is known to be the commonest cause of anaemia resulting from inadequate iron intake, reduced bio-availability of ingested iron, defective mobilisation of iron reserves, increased needs for iron under certain physiological and pathological conditions and so on. This study aimed at investigating the prevalence of anaemia among rural men and women. The survey was conducted in March 1996 in 12 villages of Mymensingh District located about 100 km north of Dhaka city. Eighty four adult men and 184 adult women aged 15-48 years and 22 adolescent boys and 44 adolescent girls aged 11-14 years were randomly selected. Information was obtained on haemoglobin concentration, parasitic infestation, literacy and on other household socioeconomic parametres. It was revealed from the study that mean haemoglobin concentration of the study population was 114 gIL, and about 69% adult men, 71% adult women, 68% adolescent boys and 64% adolescent girls were suffering from anaemia according to the WHO criteria. This study suggests that anaemia is highly prevalent in the rural communities of Bangladesh which victimises both men and women equally. There is an urgent need to conduct further studies to confirm if male and female are equally anaemic to provide important feedback to the existing anaemia control programmes in the country.
Socioeconomic development and human well-being: seasonal survey on nutrition: first round
(BRAC Research and Evaluation Division (RED), 1996-12) Khatun, Masuma; MCkim, Andrew; Tarannum, Sabah; Hyder, SM Ziauddin; Chowdhury, Mushtaque; Bhuiya, Abbas; Khan, Monirul Islam; Adams, Alayne
Community perception on the Muktagacha pilot nutrition initiative of BRAC
(BRAC Research and Evaluation Division (RED), 1996-04) Khatun, Masuma; Hyder, SM Ziauddin
Assessment of supplementary food in Muktagacha pilot nutrition initiative of BRAC
(BRAC Research and Evaluation Division (RED), 1996-07) Khatun, Masuma; Hyder, SM Ziauddin
Food supplementation refers to providing additional food to the nutritional deprived population in addition to their regular diet to reduce or meet the gap between intake and requirement in order to improve their nutritional status. Since 1993 BRAC, through its Women's Health and Development Program (W1IDP), has been operating a pilot Nutrition Initiative in 158 villages of Muktagacha thana. The initiative used supplementary food as the vehicle to communicating nutritional messages to the community in addition to providing nutritional supplements to the target beneficiaries. This study was carried out to determine the nutritional quality and the cost of the supplemental foods as wen as the actual additional calorie consumption of the recipients from the food supplementation project. Nutrient analysis of the foods was performed at the Institute of Nutrition and Food Science (ThTFS), Dhaka University on 12 packets of supplemental foods which were randomly selected. It was revealed from the cost calculation that the cost per packet of adult and child food was Tk. 7.50 and 4.30 respectively. It was estimated that supplementary food, if taken completely, could provide energy equivalent to 752 kcal to a mother and 212 Kcal to a child under two years of age. However, mothers consumed around 75% of the food which provided 564 Kcallday. It was obsetved that the food was shared mostly with young children and husbands. In-depth interview ~ith mothers also suggest that they usually skip breakfast if the food is given in the morning. The children liked the food because of the taste and unless the child was sick or had some food before coming to the center, he ate the food completely (212 Kcal/day). Although the main purpose of the project was to provide nutrition education, it was observed that the activities at the feeding center was limited to food distribution and had very little to do with communication of nutritional messages. Therefore in the conclusion it was recommended that the service providers should be trained to communicate nutritional messages effectively as a part of understanding the goal of the initiative.
An assessment of clients' knowledge of family planning in Matlab
(BRAC Research and Evaluation Division (RED), 1996) Hashima-E-Nasreen; Chowdhury, Mushtaque; Bhuiya, Abbas; Rana, AKM Masud; Caldwell, Indrani Pieris
The study aimed to assess the level of effective knowledge of women on different family planning methods to see the impact of quality of care. The study was carried out in two villages chosen from ICDDR,B intervention and comparison areas of Matlab thana where BRAC's Rural Development Programme (RDP) has also been working since 1992. From both the areas 600 women of reproductive age were randomly selected and interviewed. The findings reveal that in the MCH-FP area 56% of women practiced family planning while only 33% did so in the comparison area. In both the areas the main methods used were pills and injectables. Regarding the knowledge of contraceptives, most women in the MCH-FP area were able to name five modem methods while the majority in the comparison area could name only three methods. Virtually all women in both the villages could describe the nature of the pill and ligation while many had no idea about IUD and condom. Correct categorization of methods as temporary or permanent was found to be higher in the MCH-FP area than in the comparison area. The study found that women in both the areas had little or no knowledge of the specific indications of all methods. The majority of women in the MCH-FP area knew about proper use of pill, injection and condom compared to those in the comparison area where none had complete knowledge regarding any method. However, even in the MCH-FP area women did not know what to do if two pills were missed. The nature and the function of the brown tablets were not known to the women in the comparison area but some women in the MCH-FP area had some idea of the furmm. . In the MCH-FP area 78.4 % of the women knew the specific date of menstrual period from which injection should be started compared to the comparison area where only some of them knew about that. The majority of respondents in both the areas knew that it should be taken regularly at an interval of three months on a· fixed date. which was significantly higher in the MCH-FP area. The study found that maj~rity of women in the MCH-FP area knew the exact time and frequency of using condom compared to the comparison area where only a few .knew that. This is not surprising given that only a small proportion of women in the comparison area ever heard of condoms and that none of the couples were using it. \Vomen had no knowledge about the timing of insertion of IUD, but only that it had to be replaced periodically at an interval of2-4 years. - Women's general perception about the mechanism of action of the different methods was that they act by damaging the sperm or ovum. Women had no clear idea about the advantages of any of the methods. It was found that most of the women in the MCH-FP area were interested in injection, as the main advantage was that one injection provided three months' protection and maintained privacy (as it was administered like any other injection). This was specially appreciated by those who were shy about using contraceptives. Women had little knowledge of the side-effects of contraceptive methods. The commonly mentioned side-effects of pill and injection were: giddiness, weakness, headache, and irregular and heavy menstrual bleeding. Some respondents mentioned that injection caused prolonged amenorrhoea which in tum caused bodyache, and burning sensation in hands and feet. The women in the MCH-FP area had misconceptions about condoms such as that it might cause genital ulcer. The side-effects of ligation were more often assumed than actually experienced.
Selling latrines to the poor: how effective it is?
(BRAC Research and Evaluation Division (RED), 1996) Biswas, Sadhana; Ahmed, Syed Masud
BRAC has been promoting personal hygiene practices and the use of safe water and sanitary latrines through its Rural Development Programme (RDP) since 1991. RDP sold a large number of latrines (45,000 as of June 1995) in it's operational areas (including Matlab) as part of a drive to improve rural sanitation through NGO forum. To study the impact of this on health as part of BRAC-ICDDR,B research framework in Matlab, it is important to understand how this programme is implemented. To provide feedback to the programme, this study aimed to explore the current status of the latrines sold by RDP in Matlab. A total of 262 latrines (one latrine per household) were sold by RDP's Essential Health Care (EHC) at Matlab during July 1994 to October 1995. Data were collected during November December 1995 from the persons to whom (mostly female) the latrines were sold, using a str..lctUred questionnaire. Of these 262 latrines, a little more than 60% were installed and around 12% of the installed latrines remained unused. The government subsidy (declared in July 1995) was a major factor motivating the villagers to buy latrines. Sixty nine percent of the recipients bought latrines after declaration of government subsidy, and only 10% after motivation by BRAC health workers. Some VO members mentioned that they bought slab latrines because they were assured of getting the government subsidy or housing loan by the BR..\C staff. The reasons for not setting up latrines even after buying these from BRAC office were: want of additional money to build the structure of the latrine (49%); not getting the promised government subsidy (37%); and inundation by flood (12.5%). From the findings of this study following recommendations are made: 1) RDP may encourage the villagers to use inexpensive local materials for constructing latrines; alternatively, loans may be given to the BRAC-eligible buyers to cover the cost of constructing the latrine structure and other ancillary expenditures; 2) close monitoring of installation by the local BRAC management is needed; and 3) more effort is required to follow up latrine recipients to identifY obstacles in installation and use after they received slabs and rings and provide necessary help in overcoming those.

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