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

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Social science and immunization: a pilot study in a rural area of Bangladesh
(BRAC Research and Evaluation Division (RED), 1996) Islam, Md. Shafiqul
Social science and immunization: a pilot study in a rural area of Bangladesh (the second report)
(BRAC Research and Evaluation Division (RED), 1996) Islam, Md. Shafiqul
Reasons for discontinuation of tuberculosis treatment provided by BRAC
(BRAC Research and Evaluation Division (RED), 1996-12) Mahmud, Shah Noor; Ali, Ahmed; Islam, Md. Nazrul; Karim, Fazlul
To supplement the government tuberculosic; control programme, BRAC has initiated a communitybased tuberculosis programme in 10 thanas under the Women's Health and Development Programme (WHDP) (presently known as Reproductive Health and Disease Control - RHDC) since June 1992. BRAC is delivering services and following up the patients for all compliance. But, a recent study showed that the treatment completion rate achieved was up to 85% (1). Now the question arises: why the remaining 15% of the patients did not complete their treatment course? This study aimed to assess the reasons for discontinuation of treatment from BRAC's community-based TB control programme. The study was carried out in all10 WHDP thanas and dealt with the patients receiving only 12 months treatment regimen. The patients who enrolled and later discontinued treatment dwing June 1993 to May 1994 were selected for the study. Reasons for discontinuation of treatment were collected from progranune records, the patient or his/her relatives, Shastho Shebikas (SSs), Programme Organisers (POs), Area Managers (AMs) and Medical Officers (MOs) through indepth interviews during J\Ule and August 1994. A total of 1,538 patients were enrolled between JWte 1993 and May 1994. Of them, only 40 patients were found to have discontinued from BRAC treatment. Among these patients, 20 (50%) defaulted or dropped out, 5 (12.5%) were migrated and the rest 15 (37.5%) were referred to TB clinic or hospital for treatment.
Post-partum reproductive behavior regarding contraception and breastfeeding in rural Bangladesh
(BRAC Research and Evaluation Division (RED), 1996-07) Gazi, Rukhsana; Karim, Fazlul; Chowdhury, AMR; Mahmud, Shah Noor
The study was aimed to obtain information on knowledge of mothers about fecundity after childbirth and to explore the reproductive behavior of the mothers related to breastfeeding, postpartum abstinence and contraceptive practices. This was a comparative study between the WHOP of BRAC {Bogra Sadar thana) and a non program {Joypurhat) area. Data was collected by five female interviewers retrospectively from a total of 400 randomly selected women who were in 6 to 12 week of their post partum period. Women are most unlikely to adopt contraception unless they resume ft1enstruation as they believe that fecundity returns only after the resumption of menstruation. Whereas they tend to resume sexual activity within 40 days after childbirth. A significant higher proportion of women in the program area were found to have fed colostrum than in the non program area (92% vs 71 %), they were unlikely to be breast feeding exclusively. Mothers are loosing the contraceptive benefits of breastfeeding very soon after delivery and are at risk of subsequent conception. As reliance on lactational infertility alone is not advisable due to the early weaning and partial breast feeding, the program should increasingly promote the use of appropriate contraceptive methods from the early postpartum period.
National immunization day 1996: performance and differentials
(BRAC Research and Evaluation Division (RED), 1996-12) Hadi, Abdullahel; Nath, Samir R
National immunisation days in Bangladesh: an evaluation of the 1996 rounds
(BRAC Research and Evaluation Division (RED), 1996-07) Karim, Fazlul; Chowdhury, AMR; Bhuiya, Abbas; Aziz, KMA; Ali, Ahmed; Islam, Md. Nazrul; Mahmud, Shah Noor; Mol, Dineke
On April 16 and May 16 .1996, Bangladesh implemented the third and fourth of the six National Immunization Days. On those days oral polio vaccine (OPV) was administered to over 20 million children under 5 years of age. The goal of NIOs is to eradicate poliomyelitis from the country by 2000 AD. NID is a challenging campaign for Bangladesh mobilising a huge human and material resources. This study examined how effective NIDs are in terms of implementation and coverage of the target children and what lessons can be learned from it. The study was implemented as a part of the multi-country 'Social Science and Immunisation' project".
Knowledge of NFPE-AG graduates on reproductive health and nutrition
(BRAC Research and Evaluation Division (RED), 1996-08) Ali, Ahmed; Mahmud, Shah Noor; Karim, Fazlul; Islam, Md. Nazrul; Chowdhury, AMR
BRAC educated adolescent girls through its Non-Fonnal Primary Education Programme for Adolescent Girls (NFPE-AG) as a component of its fonner Women's Heath and Development Programme (WliDP). The aim of the NFPE-AG programme was to increase the literacy and numeracy skills . as well as awareness on reproductive health, nutrition and social isSues~ The first phase ofNFPE-AG was started in September 1991 through 1000 schools in 10 thanas of WHDP and ended in August 1993. 1bis study was undertaken to assess the level of knowledge retained by NFPE-AG graduates regarding reproductive health and nutrition issues such as marriage, pregnancy, safe motherhood and contraception, delivecy, lactation, anaemia, goitre and menstruation. A total of 30 former ~"FPE-AG schools (closed 2 years back) were selected from 6 WHDP areas (5 schools from each area). From each schoo~ 7 NFPE-AG graduates aged 15-19 years were selected who did not continue their study in fonnal schools after graduation. Another 7 never schooling girls (NS-AGs) aged 15-19 years from TG families were selected as a comparison group. Thus, a total of 420 adolescent girls (210 from each group) were interviewed in January 1996.
Knowledge and practices of NFPE-AG graduates regarding menstruation
(BRAC Research and Evaluation Division (RED), 1996-09) Ali, Ahmed; Mahmud, Shah Noor; Karim, Fazlul; Chowdhury, AMR
BRAC canied out a two-year Non-Fonnal Primary Education Programme for Adolescent Girls (NFPE-AG) as part of its fanner Women's Heath and Development Programme (WHOP) to increase basic literacy and nwneracy skills as well as awareness on reproductive health, nutrition and social issues. The first phase of .NFPE-AG was started in September 1991 through 1000 schools in 10 thanas of WHDP and ended in August 1993. This study was undertaken to assess the level of knowledge retained vis-a-vis practices ofNFPE-AG graduates regarding menstruation. A total of 30 fonner NFPE-AG schools (closed 2 years back) were selected from 6 WIIDP areas (5 schools from each area). From each schooL 7 NFPE-AG graduates aged 15-19 years who did not continue their study in fonnal schools after graduation were selected. Seven other girls aged 15-19 years with no schooling (NS-AG) were selected from the adjacent villages of each fanner NFPE-AG school as comparison group. Thus, a total of 420 adolescent girls (210 from each group) were interviewed in January 1996.
Involving the other half: male perception of BRAC's health program
(BRAC Research and Evaluation Division (RED), 1996-07) Shahaduzzaman; Chowdhury, AMR; Karim, Fazlul
In July 1991, BRAC integrated its diverse health activities into the newly established Women Health and Development Programme (WHDP). But as men play a key role in making decisions in deferent spheres of women's life, health programme managers increasingly recognize the importance of male involvement in women focused health program. This study was therefore done with the objectives, to determine the knowledge, attitude and felt need of the male population of the community regarding BRAC's Women's Health and Development Program. The principal investigator stayed for nearly a month (Jan1996) with a family in a typical village of a WHDP working area to gather information. Informal conversation , key informant interview and observation of health care service delivery was done . The study reveals that , men have a gep.eralized feeling of being neglected by the BRAC's health program. Men have knowledge only about the curative components of the programme though more programmatic input was given to the preventive components. Contradictory attitude was revealed among men regarding BRAC's programme. This was also found that there is lack of regular male contact by the field workers. However. a strong felt need \vas expressed by most men regarding health information and services. In order to ensure male involvement in the program. it was recommended to organize orientation session for field workers on male involvement, to strengthen male torums, to specify male audience, to open male only clinic and to recruit male community health workers.
Enhancing the effectiveness of acute respiratory tract infection control program of BRAC
(BRAC Research and Evaluation Division (RED), 1996-07) Kamal, Firoz Mahboob
This study was aimed at evaluating the Acute RespiratOr')' Tract Infection (ARI) Control Program of BRAC (Bangladesh Rural Advancement Committee - the largest NGO in Bangladesh) with the purpose of enhancing its effectiveness. So, along with diagnostic deliberation. problem solving has been a major imperative of the study. In the health care sector in Bangladesh, the strategic management issues enjoy little attention. Most emphases are usually spent to establish sophisticated hospital with huge physical infra-structures focused to an urban clientele. Even in its impoverished economy, large hospitals are not few. But a great irony is that severai thousands of beds in these hospitals lie vacant or not utilized. This situation is not only because of inadequate amenities in state-run hospitals, rather largely owes to lack of strategic management. Previously the sector was run on charity or public funds granted by the altruistic motive of the government, so its financial sustainability Oi competitive positioning in the market were not perceived as a worthy concern. But now, the global economic constraints as well as competitive health care initiatives of some entrepreneurial genius have crept into this domain df charity and altruism. The health care sector is now called the 'health care industry' - especially in developed countries. so the competitive positioning of a health program essentially becomes crucial in present day perspectives. In USA, health care went from S 11.5 billion in 1960 and the tenth largest portion of economy to near1y S 1 trillion in 1995 - only second in size to real estate ( Duncan et al., 1995). Due to such rapid boom in this sector, strategic thinking, strategic planning and strategic management of health care industry have attained the pick of importance now-a-days. The ARI control program of BRAC is funded by donors. The program can not continue relying on donations. hence can not help BRAC fulfill its mission of serving the rural people in the long run. Therefore its strategic planning and management are crucial not only for its .effective functioning but for self-reliance. In Bangladesh, the formal health care sector does very little for the rural majority, it seldom stretches out beyond the country's urban boundary. The rural poor are still dependent on. indeed hostage to, quacks and untrained practitioners. In this context. BRAC's ARI control program has to compete for patients. mar1<ets, revenues, employees and more; and as such needs competitive strengths to be successful and sustainable. This report, though restricted in its deliberation by much constraints, has been focused on addressing those issues with a view at positioning the program as an effective caregiver - both at present and in the future. So in this report. emphasis will be on strategic planning component more so than on conventional evaluation analysis.
Differentials of the immunization program in rural Bangladesh
(BRAC Research and Evaluation Division (RED), 1996) Kamal, Firoz M.; Hadi, AbduUahel; Chowdhury, AMR
This study investigated the association of immunization coverage with some selected socioeconomic variables in rural Bangladesh. It was conducted in 75 villages in I 0 areas of five administrative divisions. The eligible interviewees were the mothers having a child of age 12 to 23 months living in the ~elected villages. Both paternal and maternal education of 4-5 years of schooling were found to have a significant influence on immunization. No significant association exists between immunization coverage and child's sex. household land and labor sale. Parental religion impacts significantly. Exposure to media like radio increases predictability of immunization by about two folds. Most people favor none or minimal userfee, therefore restricting the self-sustainability of the program. An increase in parental education enhances affordability of userfees.
Credit programme, women's autonomy a reproductive behaviour evidence from BRAC villages, Bangladesh
(BRAC Research and Evaluation Division (RED), 1996-12) Hadi, Abdullahel; Nath, Samir R; Chowdhury, AMR
This paper investigates the role of women's autonomy on their acceptance of contraceptive method in 87 BRAC villages in Manikganj district of Bangladesh. Data for this study were obtained from 1995 sample survey of married women of reproductive age in these villages. Findings reveal that women's autonomy, as measured by the extent to which she believes that the wife should have a decision-making role in five different areas of family life, is positively associated with contraceptive use. While socioeconomic differentials in the acceptance of contraceptive are noticeable in terms of age, number of children ever born, years of schooling. exposure to mass media. land size and occupation of husband, the contraceptive practice among women involved in credit programme is found significantly higher than those not similarly involved. The multivmiate analysis reveals that participation in credit programmes is positively associated with women's empowerment when socioeconomic differentials are taken into account On the other hand, women having high autonomy score are nearly 36 percent more likely to use contraceptives (p<.OS) than those having low autonomy score, controlling for age and number of children ever born of the women. When other factors such as involvement in credit programme. years of schooling. household ownership of land. occupation of husband and exposure to mass media are systematically added to the regression equation, the influence of women's autonomy on contraceptive usc remains high with the same level of significance. The paper concludes that credit-based income generating programme has the potential to bring a significant change in reproductive behaviour of women through increased autonomy.
Client satisfaction with services provided at the antenatal care centres of BRAC
(BRAC Research and Evaluation Division (RED), 1996-08) Afsana, Kaosar; Chowdhury, Amr
BRAC has implemented the Women's Health and Development Programme (WHDP) in the northern and central rcgi.oni of Bangladesh to reduce maternal and child death. Among the various components of the programme, organization of antenatal care centres (ANCC) is an important activity. This study measured satisfaction of the pregnant with the services provided at the ANCCs in three thanas ofBogra region. A total of 33 ANCCs was observed for a study which assessed competence of the programme organizers (POs ). Two pregnant women who received services from the 33 ANCCs were randomly selected. Following their attendance at the ANCCa, women were interviewed at home by the experienced field workers to know their satisfaction with services. Field activities were carried out Wlder meticulous supervision of a medical doctor. Client satisfaction was measured by focusing on eight quality aspects which include overall quality, accessibility, availability, cost, interpersonal relations, competence of the programme organizers (PO), faciJities and continuity of care. Satisfaction was ranked according to the proportion of women satisfied, i.e., higher the proportion more is the rank. Satisfaction ranged from high to low with the eight quality aspects. The overall quality, facilities and accessibilities arc ranked at the top, which are related to the structural quality. The bottom five ranks reflect the process of antenatal care as wen as the socio-psychological factors of the clients. A vast difference was observed . ~ between the top and lowest rank.. It is indicated by the fact that women's satisfaction with the continuity of care (64%) was very low in comparison to satisfaction with the o~ quality (98%). This finding gives some impression about women's view on the quality of care. Further, women put few suggestions in order to improve services offered at the ANCC., such as improvement of the physical facilities, availability of medicine at the ANCC8 and treatment of the • complicated cases. With reference to women's view about the quality and women'a suggestions to improve the services, some recommendations were made to further improve the quality of care. Suggestions inelude women's awareness about pregnancy related problems should be raised through health education as wen as fonnal education; interactions with the clients needs to be strengthened to avail services of the ANCCs and the trained traditional birth attendants (TBAs); the POs should be more skiJlcd in attending the complicated cases; more medicine needs to be available in the ANCCs; rewarding the efforts of the POs and TBAs needs to be considered.
Assessment of birth and death recording activities in reproductive health and disease control programme of BRAC
(BRAC Research and Evaluation Division (RED), 1996-07) Ali, Ahmed; Mahmud, Shah Noor; Islam, Md. Nazrul; Karim, Fazlul; Public health; Medicine, Preventive; Health planning; Health surveys--Bangladesh.
This report attempts to determine the accuracy of· recording births, deaths and stillbirths in all the 30 areas of 10 thanas former Women's Health and Development Programme (presently Reproductive Health and Disease Control Programme - RHDC) in 3 regions. One unit (village) having 250-300 households were randomly selected from each area. The survey was conducted during April-May 1995.

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