Research Reports (2004): Health Studies, Vol - XXXVII

Permanent URI for this collectionhttps://hdl.handle.net/10361/13510

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Arsenic in drinking water and birth outcomes: a study of the Bangladesh Integrated Nutrition Programme
(BRAC Research and Evaluation Division (RED), 2004-09) Jakariya, Md.; Sarkar, Md. Quaiyum; Sultana, Samina
This paper assesses the impact of arsenic (As) exposure on pregnancy outcomes in Bangladesh. A total of 261 villages from 3 highly As contaminated upazilas of two districts were selected for this study. The upazilas were Faridpur sadar ofFaridpur district and Matlab and Shahrasti of Chandpur district. Data were collected from 742 women under 106 CNCs from 100 villages ofFaridpur Sadar, 710 women from 55 villages under 80 CNCs of Matlab, and 73 7 women under 33 CNCs from 106 villages of Shahrasti upazila. Water samples were collected from the tubewells (TWs) where from the pregnant mothers were drinking water, at least during the year 2002 for analysis in the laboratory with Atomic Absorption Spectrophotometric (AAS) method. A total of 2,189 women who gave births in 2002 participated in the study. Their mean age was 26.52 years, the mean duration of As exposure of the participants was 6 years, and the median was 7 years. The majority of them (72%) used As contaminated water (>50 ppb) for drinking purpose during their last pregnancies. The mean and median As concentration of the TW water of the study participants was 158.21 and 151 ppb respectively, ranging from non-detectable level to 668 ppb. Overall incidence of spontaneous abortion, stillbirth, premature birth, low birth weight, and neonatal death were found to be 23.3/1000 live birth, 26.9511000 live birth, 42.49/1000 live birth, 113.75/1000 live birth, and 28.78/1000 live birth respectively. About 28% of newborn babies were malnourished ( <2.5 kg of weight). No significant difference was observed between the two categories of As exposed and non-exposed babies. The majority of the mothers (72%) exposed to As at above 50 ppb gave normal births. A statistically significant difference was observed in the total pregnancy outcome status of the respondent mothers, particularly for low birth weight (p<0.002), premature birth (p<0.006), and abortion (p<0.06) when compared with As exposed and non-exposed groups, after adjustment for maternal education, age of mothers, antenatal care, parity, and household socioeconomic condition. It seems from the study that the rate of adverse pregnancy outcomes including abortion, premature birth, low weight birth, still birth, and post-natal death of the mothers exposed to As above 50 ppb was higher than those of the mothers exposed to As below 50 ppb. However, these differences were not found to be statistically significant for mothers who gave first birth in the year 2002 in spite of drinking As contaminated water. In contrary, a significant difference was observed particularly for spontaneous abortion, premature birth, and low birth weight cases for the mothers who had previous pregnancy history including for the year 2002. Further study is needed to establish this finding by mapping the precise exposure assessment.
Water and sanitation status relating to the poorest in Bangladesh
(BRAC Research and Evaluation Division (RED), 2004-09) Akter, Nasima; Jakariya, Md.
This study aimed to see the level of access to safe water and sanitation and discusses the knowledge on arsenic contamination in drinking water among the poorest in rural Bangladesh. This was a part of baseline survey for CFPR/TUP. Household survey method was used to collect information through structured questionnaire. The survey was conducted during July-September 2002 in Rangpur, Kurigram and Nilphamari districts. Variables considered were safe water and sanitation. Sources of drinking and cooking water, water quality with regard to arsenic, and knowledge on arsenic contamination were considered under safe water variable. Type, practice and ownership of latrine was considered under sanitation. Coverage of access to drinking water for SUP and NSUP of three study districts was above 96% which is similar to national rural water supply coverage (97%). Nevertheless, most of the households did not have their own tubewell and did not guarantee safe drinking water. It was also found that about 87% of the households drank water from tubewell those were not tested for arsenic contamination. Sanitation coverage of the study households was 5.4-9.4%, much lower than national sanitation coverage for rural area (30% or 4 1% including pit latrines). Lack of awareness along with unavailability of resources are some causes of poor water and sanitation coverage for the poorest. Raising awareness on safe drinking water and sanitation as well as ensuring safe drinking water and sanitation access to these districts need immediate attention to ensure and secure their healthy and sustainable livelihood.
Improving in-house medical waste management: a pilot research
(BRAC Research and Evaluation Division (RED), 2004-12) Akter, Nasima; Ali, Miah Rahmat
BRAC has undertaken a pilot project on improving in-house medical waste management in collaboration with three selected hospitals (Dhaka Shishu Hospital, Institute of Child Health and Shishu Shasthya Foundation, and one BRAC upgraded Shushastha). As an outcome of this project, a manual on in-house medical waste management has been prepared. The pilot programme was designed to build awareness/consciousness among hospital staff and initiate some action programs with the hospital staff to streamline the existing waste management systems. To make the pilot programme successful the following steps were selected: i) baseline survey, ii) manual development and training, iii) implementation and follow up, and iv) finalize the manual on in-house medical waste management. The eight-month long project was implemented during January-August 2004. Baseline survey found that, a number of hospital staff specifically nurses and cleaners had been suffering from various kinds of infectious diseases, such as hepatitis B/C, skin disease/allergy, infection, diarrhoea, fever, headache, cough, asthma, and typhoid. Nurses were mostly injured during needle breaking (42%) and ampoule breaking (34%), and cleaners were injured during handling and cleaning waste. It was found that, 60% of sold items were plastics collected by unauthorized waste pickers such as used syringes, saline bags, water bottles, etc. from hospitals. After introducing the in-house management system in three hospitals, the amount of infectious waste became around 2%, recyclable 4-6% and above 90% were general waste that could be dumped to the municipal bin without treatment. Nevertheless, it should be kept in mind that the amount and quality of waste depends on proper segregation, hospital size, services, diseases type, waste category, and seasonality. To improve the medical waste management in Bangladesh, we recommend the following: i) raising awareness, training, and capacity building of hospital staff, ii) responsibilities inside hospital (designated personnel), iii) monitoring mechanism and committee, iv) role of City Corporation (transportation and central treatment system), v) hospital initiatives for proper medical waste management (cost, return), and vi) private sector and NGOs involvement.
Cultivation prospect of medicinal plants in Bangladesh: experiences from Natore
(BRAC Research and Evaluation Division (RED), 2004-09) Sharmin, Lammia
The study aimed to explore the possibility of medicinal plant cultivation as a sustainable livelihood option. The study was conducted among the medicinal plant cultivators of five villages of Laxmipur union of Natore sadar upazila in Natore district. Both qualitative and quantitative approaches were used. Data were collected during February-April 2004 from both primary and secondary sources. The findings show that the farmers were motivated to cultivate medicinal plants because of its profitability. The cost-benefit analysis of some of the medicinal plants also supported this. But the market of the medicinal plants is still in a pre-mature stage. A linkage between the cultivators and the herbal medicine or cosmetic producers could definitely help develop the medicinal plant cultivation prospect.
Early childhood development: child -to-child approach
(BRAC Research and Evaluation Division (RED), 2004-03) Hashima-E-Nasreen; Ahmed, Syed Masud
In Bangladesh, programs for children up to five years have been directed to ensure their survival, physical growth and good health. There is no nation wide structured program that addresses the cognitive, emotional, and social development of young children, resulting in lost opportunities to develop full potential of the child during the early years. Taking this into consideration, the Early Childhood Development (ECD) program has been initiated in the current country program cycle (2001-2005) of the Government and UNICEF. One of the strategies is to accomplish this through "Child-to-child approach", a time honoured system by which older children is taking care of their younger siblings. The objective of the child-to-child approach is to provide adolescents with the knowledge and skills to interact creatively and effectively with the young children, and to develop skills of critical-thinking and problem solving.
BRAC HIV/AIDS program
(BRAC Research and Evaluation Division (RED), 2004) Ahmed, Syed Masud; Nasreen, Hashima
Primary Health-Care in Later Life: improving services in Bangladesh and Vietnam (PHILL)
(BRAC Research and Evaluation Division (RED), 2004-02) Biswas, Priti; Hossain, Md. Awlad
Customized development interventions for the ultra-poor: preliminary change assessments of health and health-seeking behaviour
(BRAC Research and Evaluation Division (RED), 2004-11) Ahmed, Syed Masud; Rana, AKM Masud
Primary Healthcare Later Life (PHILL) improving services in Bangladesh and Vietnam
(BRAC Research and Evaluation Division (RED), 2004) Ahmed, Syed Masud; Rana, AKM Masud; Kabir, Zarina Nahar
The Primary Health-Care in Later Life: Improving Service in Bangladesh and Vietnam (PHILL) project seeks to identify the effectiveness of low-cost, preventive and health promotion interventions in improving the primary health care (PHC) of people sixty and over in rural communities in Bangladesh and Vietnam. The three-year project (October 2002-September 2005) is supported by the European Commission (EC) and is being implemented under a four member partnership. Partner institutions are the Karolinska Institute (K.I) in Sweden, the Bangladesh Rural Advancement Committee (BRAC) in Bangladesh, the Health Strategy and Policy Institute (HSPI) in Vietnam and University of East Anglia (UEA) in the UK. The principal strategy of the project is to integrate existing primary health care infrastructures and promote the active participation of family and community in the health care of the elderly people. The project defines primary health care as including the first level public institutional (government health care system), community level (private and voluntary health services), and self-care at the household and individual levels.

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