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Permanent URI for this collectionhttps://hdl.handle.net/10361/7418

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A controlled before-and-after perspective on the improving maternal, neonatal, and child survival program in rural Bangladesh: an impact analysis
(© 2016 Public Library of Science, 2016-09) Rahman, Mahfuzar T.; Yunus, Fakir Md; Yunus, Fakir Md; Shah, Rasheduzzaman; Jhohura, Fatema Tuz; Mistry, Sabuj Kanti; Quayyum, Tasmeen; Aktar, Bachera; Afsana, Kaosar
Objectives We evaluated the impact of the Improving Maternal, Neonatal, and Child Survival (IMNCS) project, which is being implemented by BRAC in rural communities in Bangladesh. Methods Four districts received program intervention i.e. trained community health workers to deliver essential maternal, neonatal, and child healthcare and nutrition services while two districts were treated as comparison group. A quasi-experimental study design (compared beforeand-after) was undertaken. Baseline survey was conducted in 2008 among 7200 women followed by end line in 2012 among 4800 women with similar characteristics in the same villages. We evaluated maternal antenatal and post natal checkup, birth plans and delivery, complication and referred cases during antenatal checkup and post natal period, and child health indicators such as birth asphyxia, neonatal sepsis, and its management by the medically trained provider. Findings Increased number (four or more) antenatal visits, skill-birth attended delivery and postnatal visits (three or more) in the intervention group preceding four-year intervention period were observed compare to their counterpart. We noted negative difference-in-difference estimator (-5.0%, P = 0.159) regarding to the all major birth plans i.e. delivery place, birth attendant, and saved money in the comparison areas. Significant reduction of ante-partum and intra-partum complications occurred in the intervention group, contrary complications of such event increased in the comparison areas (-6.3%, P<0.05 and-20.5%, P<0.001 respectively). Referral case to the health centers due to these complications boosted significantly in intervention group than comparison group (2.3%, P<0.01 and 6.6%, P<0.001 respectively). Mother's knowledge of breastfeeding initiation and the practice of initiating breastfeeding within an hour of birth amplified significantly (14.6%, P<0.001 and 8.3%, P<0.001 respectively). We did not find any significant difference regards to the management of low birth weight by the medically trained health care provider and complete vaccination between the intervention and comparison arm. Conclusion Medically trained health care provider assisted community based public health intervention could increase number of antenatal and postnatal visit, thereby could decrease pregnancy associated complications. These interventions may be considered for further up scaling when resources are limited.
Mental illness and injuries: emerging health challenges of urbanisation in South Asia
(© 2017 BMJ Publishing Group, 2017) Nambiar, Devaki; Razzak, Junaid Abdul; Afsana, Kaosar; Adams, Alayne M.; Hasan, Arif; Mohan, DInesh; Patel, Vikram H.; BRAC James P Grant School of Public Health
From joint thinking to joint action: a call to action on improving water, sanitation and hygiene for maternal and newborn health
(© 2014 Public Library of Science, 12/1/2014) Campbell, Oona M R; Afsana, Kaosar; Hounton, Sennen; Benova, Lenka; Wijesekera, Sanjay; Mason, Elizabeth; Magoma, Moke; Graham, Wendy; Esteves Mills, Joanna; Cumming, Oliver; Curtis, Val; Velleman, Yael; Boisson, Sophie; Cairncross, Sandy; Chopra, Mickey; Gordon, Bruce; BRAC James P Grant School of Public Health
This paper, authored by scientists and technical experts from leading universities and international agencies, outlines the importance of water, sanitation and hygiene (WASH) for maternal and newborn health (MNH) outcomes and calls for greater inter-sectoral collaboration. It was launched at LSHTM on 15th December 2014.
Recognition of and response to neonatal intrapartum-related complications in home-birth settings in Bangladesh
(© 2014 International Centre For Diarrhoeal, Disease Research, Bangladesh, 2014) Vanderende, Kristin E; Moran, Allisyn C; Leasure, Karen; Day, Louise T; Afsana, Kaosar; Kalim, Nahid; Munira, Shirajum; Rahman, Nazneen; Islam, Munia; Khan, Jasmin; Sibley, Lynn; BRAC James P Grant School of Public Health
Intrapartum-related complications (previously called 'birth asphyxia') are a significant contributor to deaths of newborns in Bangladesh. This study describes some of the perceived signs, causes, and treatments for this condition as described by new mothers, female relatives, traditional birth attendants, and village doctors in three sites in Bangladesh. Informants were asked to name characteristics of a healthy newborn and a newborn with difficulty in breathing at birth and about the perceived causes, consequences, and treatments for breathing difficulties. Across all three sites 'no movement' and 'no cry' were identified as signs of breathing difficulties while 'prolonged labour' was the most commonly-mentioned cause. Informants described a variety of treatments for difficulty in breathing at birth, including biomedical and, less often, spiritual and traditional practices. This study identified the areas that need to be addressed through behaviour change interventions to improve recognition of and response to intrapartum-related complications in Bangladesh.
Commentary: sustaining progress towards comprehensive reproductive health services in Bangladesh
(© 2015 Routledge, 2015) Jahan, Rounaq; Afsana, Kaosar; BRAC James P Grant School of Public Health
Getting the basic rights - the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework
(© 2015 Blackwell Publishing Ltd, 2015) M. R. Campbell, Oona; Benova, Lenka; Gon, Giorgia; Afsana, Kaosar; Cumming, Oliver; BRAC James P Grant School of Public Health
Objective: To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review. Methods: We developed a conceptual framework iteratively, amalgamating three literature-based lenses. We then searched literature and identified risk factors potentially linked to maternal and perinatal health. We conducted a systematic scoping review for all chemical and biological WASH risk factors identified using text and MeSH terms, limiting results to systematic reviews or meta-analyses. The remaining 10 complex behavioural associations were not reviewed systematically. Results: The main ways poor WASH could lead to adverse outcomes are via two non-exclusive categories: 1. 'In-water' associations: (a) Inorganic contaminants, and (b) 'water-system' related infections, (c) 'water-based' infections, and (d) 'water borne' infections. 2. 'Behaviour' associations: (e) Behaviours leading to water-washed infections, (f) Water-related insect-vector infections, and (g-i) Behaviours leading to non-infectious diseases/conditions. We added a gender inequality and a life course lens to the above framework to identify whether WASH affected health of mothers in particular, and acted beyond the immediate effects. This framework led us to identifying 77 risk mechanisms (67 chemical or biological factors and 10 complex behavioural factors) linking WASH to maternal and perinatal health outcomes. Conclusion: WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes. Whilst major gaps exist, the evidence strongly suggests that poor WASH influences maternal and reproductive health outcomes to the extent that it should be considered in global and national strategies
Making a commitment to ethics in global health research partnerships: a practical tool to support ethical practice
(© 2015 Kluwer Academic Publishers, 2015) Murphy, Jill; Margaret Hatfield, Jennifer; Afsana, Kaosar; Neufeld, Vic; BRAC James P Grant School of Public Health
Global health research partnerships have many benefits, including the development of research capacity and improving the production and use of evidence to improve global health equity. These partnerships also include many challenges, with power and resource differences often leading to inequitable and unethical partnership dynamics. Responding to these challenges and to important gaps in partnership scholarship, the Canadian Coalition for Global Health Research (CCGHR) conducted a three-year, multi-regional consultation to capture the research partnership experiences of stakeholders in South Asia, Latin America, and sub-Saharan Africa. The consultation participants described persistent inequities in the conduct of global health research partnerships and called for a mechanism through which to improve accountability for ethical conduct within partnerships. They also called for a commitment by the global health research community to research partnership ethics. The Partnership Assessment Toolkit (PAT) is a practical tool that enables partners to openly discuss the ethics of their partnership and to put in place structures that create ethical accountability. Clear mechanisms such as the PAT are essential to guide ethical conduct to ensure that global health research partnerships are beneficial to all collaborators, that they reflect the values of the global health endeavor more broadly, and that they ultimately lead to improvements in health outcomes and health equity.

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