Research Reports (2000): Health Studies, Vol - XXIX

Permanent URI for this collectionhttps://hdl.handle.net/10361/12981

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Promoting health knowledge through micro-credit programs: experience of BRAC, Bangladesh
(BRAC Research and Evaluation Division (RED), 2000) Hadi, Abdullahel
The paper aims to assess the contribution of micro-credit program in raising health knowledge among the poor women in rural Bangladesh. Data were collected from the 1998 sample survey of 500 mothers aged 15-49 who had at least one <5 year-old child. Findings revealed that the socio-demographic factors such as age of woman, land ownership of the family and occupation of husband had no association with the prevalence of maternal knowledge. The knowledge was much higher among credit forum participants than non-participants although exposure to media and education of women had also played significant role in raising knowledge. Multivariate analysis suggested that the duration of credit program participation and exposure to media were significantly more likely to raise the health knowledge among women when the jilfluence of demographic and socio-economic factors were controlled. The paper concludes that micro-credit program can be an effective tool in promoting health among the poor women in Bangladesh.
Operational constraints in BRAC' s adolescent program: a qualitative perspective
(BRAC Research and Evaluation Division (RED), 2000-01) Rashid, Sabina Faiz
Measuring generic health outcomes from individual's perspective: using SF-36 in a rural area of Bangladesh
(BRAC Research and Evaluation Division (RED), 2000-11) Ahmed, Syed Masud; Rana, AKM Masud; Chowdhury, Mushtaque; Bhuiya, Abbas
Is there a role for non-formal health practitioners in controlling sexually transmitted diseases: a plea for a community perspective
(BRAC Research and Evaluation Division (RED), 2000-08) Hashima-e-Nasreen
In a country like Bangladesh, where sexual health problems other than HIV/AIDS are more apparent and immediate, and when most women are impoverished and illiterate, a broad genderbased approach to sexual health is needed. Given the importance of non-formal sector in rural health care for the poor, it is expected that sexual health services would be improved when traditional healers and other existing practices become integrated rationally into the system. This paper describes the existing practices of the non-formal practitioners in managing STD patients and also, the possibility of their participation in public health interventions to improve STD management and services. Study findings revealed that rural people, when infected with a STD often seek help from pharmacists or village doctors, traditional healers and community health workers. They do not feel free to go to the formal health sector due in part to the social stigmatization of the discussion of sexuality and sexual health related problems. The too often high cost of treatment and the low quality of clinic counseling also discourage people from going to STD clinics. Therefore, a community based RTI/STD control and prevention programme is needed which will bring the networks of the non-formal health sectors together with the formal health sectors. Study findings also revealed that neither the non-formal nor the formal health providers were able to give adequate information about control and prevention of STDs. Programmes should be innovative in the planning and designing of materials and training curriculum for the non-formal health practitioners. Because of the high level of illiteracy, picture stories would be the most appropriate means to mirror the social context of risk and vulnerability and to encourage active participation of the target community. With regards to some of their high-risk treatments, both healers and patients will have to be taught about the dangers so that they can easily avoid them and make appropriate referrals, if needed. It is encouraging to note that the non-formal health providers in Matlab expressed their interest in becoming sexual health educators if they receive appropriate training and incentives.
Health insurance in rural Bangladesh: proposal on a pilot project
(BRAC Research and Evaluation Division (RED), 2000-07) Karim, Fazlul; Hossain, Monjur; Ahmed, Jalaluddin
Evaluation of the WFP assisted wheat-soya blended (WSB) food supplementation on nutrional status
(BRAC Research and Evaluation Division (RED), 2000-06) Hyder, S.M. Ziauddin; JalaI, Chowdhury S B; Roy, Rita Das; Rahman, Mizanur
Wheat soya blended (WSB) food was distributed ~ong 74,000 'poorest of the poor' households in 5 highly flood-affected districts in Bangladesh under an agreement signed in May 1999 between BRAC and World Food Programme. Each selected household received 10 kg WSB per month, and only under-5 children and pregnant/lactating mothers were entitled to consume the food for a period of five months. The objective of the study was to evaluate the impact of WSB supplementation programme with special emphasis on nutritional status of under-5 children. Other aspects · of the programme such as efficacy of targeting, quality of the WSB food distributed, acceptability and consumption of WSB food were also evaluated. The study followed a pre-post design with a comparison group. Karnarkhond thana (subdistrict) in Sirajganj district was selected as the intervention area (n=760 under-5 children), while Dhunot thana in Bogra district was selected as the comparison area (n=764 under-5 children). Data were collected at baseline and after 5 months intervention in both the areas. In addition, monthly data were also collected on some selected indicators. The Salter scale was used to collect weight data to nearest 1 00 g and TALC MUAC tape was used to collect mid-upper-arm circumference (MUAC) to nearest 1 mm. Age of children was recalled by mothers with the help of a local calendar of events specifically developed for this study. Gomez classification was used to define severity of malnutrition and underweight was defined according to criterion set by WHO (weightfor- age <80% NCHS median). Severe malnutrition was defined as MUAC <125 mm. The results indicate that selection of the households according to the set socio-economic criteria was quite accurate. All the selected households belonged to the poorest of the poor as indicated by household landholding, occupation of household head, sanitation and literacy. As high as 98% of the selected households did not have BRAC RDP membership. The quality of WSB food at the point of distribution was not acceptable since 85% of the children received the food infested with insects during first month. Although the situation improved over time, 64% of the children received WSB food either infested (11 %) or damp/clustered (53%) during the last round of the distribution. Most women (88%) could prepare the WSB as per instruction given prior to distribution by BRAC staff. On average, 1.5 children shared WSB food per households. Consumption of WSB food by pregnant/lactating mothers was at minimum level. About 98% of the children liked the taste of WSB food. Median consumption of WSB in 24 hours was 300 g per child during the first month, which went down to 200 g during second and third month, and finally to 100 g during the last month. The reason for such downward trend of WSB food consumption was probably sharing of the food by other 'family members, which often-- remained unreported. The 5-month WSB food supplementation showed a significant impact on reducing the prevalence of malnutrition. The intervention was also found effective in treating underweight as well as severe malnutrition. The reduction of the prevalence of underweight was 9% in supplemented children compared to 6% in non-supplemented children (p=O.OO). In regression analysis, the intervention showed significant effect on increasing mean MUAC (p=O.OO) and mean weight-for-age {p=0.03) after controlling for important confounding factors, such as sex and age of the children, total duration of diarrhoea in days during the five months supplementation period and nutritional status at baseline. A subset of children was analysed to study the effectiveness of the intervention in treating underweight and severe malnutrition. Children who were found underweight and severely malnourished at baseline were included. A significantly higher reduction of the prevalence of underweight was observed among children in the intervention area compared to the nonintervention area (68% vs. 76%; p=0.007). Similarly, the prevalenc~ of severe malnutrition reduced to 28% from the baseline figure of 100% in the intervention area compared to its reduction to 43% in the non-intervention area (p=0.02).
Effects of family life education in improving adolescents’ knowledge and attitude on reproductive health
(BRAC Research and Evaluation Division (RED), 2000-05) Khan, Md. Iftakhar Hassan; Karim, Fazlul
The study assessed the effects of Family Life Education meant for the Adolescents (AFLE) in improving their knowledge and attitude on the fundamental elements of reproductive health vis-a-vis explored their pattern of sharing about the learning with the peers, and identified further information needs on reproductive health. Data were collected from 444 adolescents through one to one interviews (148 with BRAC AFLE and 148 without BRAC AFLE, and 148 adolescents who had never been enrolled in schools). Adolescents from the BRAC school (296) were chosen by using multistage sampling method while the never school going adolescents (148) were selected conveniently. The study outcomes were compared between the three groups of adolescents mentioned above. Bivariate analysis showed that a majority of AFLE students had significantly higher correct knowledge on puberty (95.3%), menstruation (98.6%), marriage and pregnancy ·(99.3%), STD/AIDS (78.4%), and family planning (95.3%) compared to the adolescents without AFLE as well as those who never went school. Except in the case of correct age at first marriage of a girl, the adolescents with AFLE had higher level of satisfactory knowledge on most of the specific RH issues than those other two groups. In the logistic regression analysis, the AFLE appeared to be the strongest influential predictor, followed by the respondents' age, TV-exposure, radioexposure, and sharing of RH lessons with others. Thus, it appears that AFLE has played a positive role in improving rural adolescents' knowledge and attitude on RH issues. But it warrants addressing sex inequality and involving peers and family.
Does mobilisation help change mothers' behaviour towards health and nutrition?
(BRAC Research and Evaluation Division (RED), 2000) Hyder, S.M. Ziauddin; Jalal, Chowdhury S B; Roy, Rita Das; Chowdhury, AMR; Yusuf, Harun KM
A study was done to assess the impact of mobilization on the change of mothers' behaviour towards health and nutrition practices. Mobilization was given by adolescent girls trained on various aspects of health and nutrition. Like regular growth monitoring of their children, immunization, colostrums feeding, complementary feeding, night blindness, hookworm infestation and hand washing practices before eating and after defecation. The adolescent girls were trained in BRAC non-formal schools in some villages of Muktagachha Upazila of Mymensingh district. They made house to house visits and mobilized and motivated the mothers on the above subjects. Mothers living in neighbouring areas but not visited by the ·adolescent girls were considered as non-mobilized. Results show that mobilization has important effects on some aspects of health and nutrition behaviour such as age at which complementary feeding should be started, vegetables as sources of vitamin A nightblindness, and personal hygiene like hand washing practice before eating. However, no significant difference was found between mobilized and non-mobilized mothers in respect of importance of growth monitoring, immunization, colostrum feeding and washing of hand after defecation. The reason for this is not know at present but it may be due to weakness of the mobilization procedure/programme, leakage of information from mobilized mothers to non-mobilized mothers, or gaining of knowledge by the non-mobilized mothers from other source like radio and TV. Further in-depth study is needed to resolve the question.
Does food supplementation increase efficacy of a school-based nutrition education programme for adolescent girls? lessons learned at BRAC
(BRAC Research and Evaluation Division (RED), 2000) Roy, Rita Das; Hyder, S.M. Ziauddin; Chowdhury, AMR; Mahmud, Zeba
Annual health check up for the members of BRAC's village organisation: an observation
(BRAC Research and Evaluation Division (RED), 2000-01) Shahaduzzaman
Effectiveness of the daily and weekly doses of iron supplementation in pregnancy and puerperium on Haemoglobin and iron status at 6 weeks postpartum
(BRAC Research and Evaluation Division (RED), 2000) Hyder, S.M. Ziauddin; Persson, Lars-Ake; Chowdhury, AMR; Lonnerdal, B; Ekstrom, Eva-Charlotte
Objective: Describe the effectiveness of continuous daily and weekly doses of iron supplementation during pregnancy and puerperium on haemoglobin and iron status at 6 weeks postpartum. Design: An iron supplementation trial conducted at antenatal care centre (ANCC) assigned randornly_·either to the daily (lx60-mg) or weekly (2x60-mg) doses of iron supplementation. Setting: Fifty community-based ANCCs in a rural area of Bangladesh. Subjects: In the trial, 209 pregnant women during second trimester were recruited. Fifty-one were lost to follow-up and the final sample size consisted of 158 women (daily n=72 and weekly n=86). Intervention: Each woman in the daily group received I tablet (60 mg Fe) per day and in the weekly group 2 tablets (120 mg Fe) per week. Intake of iron tablets was monitored by the MEMS~ during 11 weeks in ~pregnancy. Haemoglobin was assessed on venous blood by HemoCue~, serum concentrations of ferritin by radio immunoassay and serum transferrin receptors by immunoassay double sandwich method. Results: At 6 weeks postpartum, haemoglobin and iron status did not differ between the two supplementation groups. However, an overall improvement in haemoglobin and iron status was observed compared to the baseline status. Women who took 2:40 tablets in 11 weeks had higher haemoglobin (P=0 .05) and SFt (P=0.04) and lower sTfR (P=0.32) at 6 weeks postpartum. Conclusions: A lack of difference in response was observed between the daily and weekly doses of iron supplementation. Higher number of iron tablet intake during pregnancy and puerperium was associated with better haemoglobin and iron status at 6 weeks postpartum. Sponsorship: SIDA/SAREC, Sweden and BRAC, Bangladesh. Descriptors: Anaemia, iron deficiency, daily weekly supplementation. postpartum, Bangladesh
Anemia and iron deficiency during pregnancy in rural Bangladesh
(BRAC Research and Evaluation Division (RED), 2000) Hyder, S.M. Ziauddin; Persson, Lars-Ake; Chowdhury, AMR; Lonnerdal, B; Ekstrom, Eva-Charlotte
Objective: To assess the prevalence of anemia, iron deficiency and iron deficiency anemia (IDA) among pregnant women in rural Bangladesh Design: Baseline data on 215 pregnant women who were invited to participate in an iron supplementation trial were used. The women were in their second trimester and selected at registration from 50 antenatal care centers. Hemoglobin (Hb) concentration of venous blood samples was measured by HemoCue® system. Serum was collected for \ . assessment of ferritin by imrnuno-radiometric assay and transferrin receptors (sTtR) by immunoassay double sandwich method. , Anemia was defined as having Hb concentration <110 giL, iron deficiency as serum ferritin <12 f.Lg/L and/or sTtR >8.5 mg/L and IDA as the combination of anemia and iron deficiency. High sTfR/serum ferritin ration was >500. Setting: The central part of Bangladesh, in a rural area of Mymensingh district between May-November, 1997. Results: Mean (SD) of Hb was 110 giL (14 giL), while median serum ferritin, sTfR and sTfRJserum ferritin was 13.7 f.Lg/L, 6.2 mg!L and 458, respectively. The prevalence of anemia was 50%, iron deficiency 54% and high sTfR/serum ferritin 48%. None of the study women had severe anemia. The ·prevalence of IDA was 33%. Of the anemic women 66% had iron deficiency and 64% high sTfR/serum ferritin. Conclusion: Both anemia and iron deficiency were highly prevalent. About two-thirds of the anemia cases were associated with iron deficiency. Sponsorship: The study was financially supported by Sida/SAREC, Sweden and BRAC, Bangladesh. Descriptors: Anemia, iron deficiency, iron deficiency anemia, serum transferrin receptor, serum ferritin, pregnant women, Bangladesh

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