Journal Articles (2014)

Permanent URI for this collectionhttps://hdl.handle.net/10361/5119

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Meaning of death: an exploration of perception of elderly in a Bangladeshi Village
(6/25/2014) Joarder, Taufique; Cooper, Alicia; Zaman, Shahaduz; BRAC James P Grant School of Public Health
The aim of this qualitative study was to explore the perceptions of meaning of death among the elderly in a Bangladeshi community, and to understand how the meaning of death affects one’s overall well-being. Understandings of death were explored through the explanations respondents provided on the journey of the soul during lifetime and the afterlife, concepts of body-soul duality, and perceived “good” and “bad” deaths. The relationship to well-being was expressed in terms of longevity, anxiety/acceptance of death, and preferred circumstances for death. Seven in-depth interviews and one informal discussion session provided the bulk of the data, while Participatory Rapid Appraisal (PRA) tools, including daily routines and body mapping, supplemented our findings. Elderly members of the community had very specific ideas about the meaning of death, and provided clear explanations regarding the journey of the soul, drawing on ideas of body-soul duality to substantiate claims. Due to long coexistence fusion of Hindu and Muslim ideas around death was found. Anxiety/fear of death was associated with some secular issues, on the contrary the perception of longevity was found linked with spirituality. Insights revealed from this study of subtle differences in the perceptions regarding issues around death may aid the policy makers develop effective end-of-life interventions.
Informal allopathic provider knowledge and practice regarding control and prevention of TB in rural Bangladesh
(International Health, 6/17/2014) Islam, Qazi S.; Ahmed, Syed M.; Islam, Mohammad A.; Chowdhury, Anita S.; Siddiquea, Bodrun N.; Husain, Mohammad A.; BRAC James P Grant School of Public Health
Background: BRAC (formerly Bangladesh Rural Advancement Committee), in collaboration with the National Tuberculosis Control Programme, provides one full-day training on TB to make informal allopathic providers knowledgeable for managing TB in rural Bangladesh. This study explored the knowledge and practices of the providers receiving the above training in the control and prevention of TB. Methods: The study was conducted in 30 subdistricts, with 30 trained and 30 untrained providers randomly selected from each subdistrict. Approximately 3% (49/1800) did not provide complete information. Pre-tested structured and semi-structured questionnaires were used. Results: TB was commonly perceived as a disease of only males (66.1%, 1157/1751). Only one-quarter knew about the bacterial cause of TB. Very few providers (2.1%, 36) had adequate knowledge regarding prevention of TB. They also lacked knowledge about TB treatment duration (71.6%, 1253), the meaning of DOTS (directly observed treatment, short course) (26.0%, 455) and multidrug resistance (20.6%, 360). Antibiotics (79.7%, 1396) and cough syrup (75.0%, 1313) were commonly prescribed by providers despite symptoms suggestive of TB. However, 70.2% (613) and 74.5% (650) of trained providers’ knowledge and practice scores were equal to or more than the mean scores (≥6.97 and ≥6.6, respectively), whereas they were only 49.5% (435) and 64.2% (563), respectively, among untrained providers (p,0.0001). Conclusions: Misperception, lack of knowledge and irrational use of antibiotics are challenges that need to be addressed for controlling and preventing TB efficiently.
Conventional or interpersonal communication: which works best in disseminating malaria information in an endemic rural Bangladeshi community?
(PloS One, 2014) Ahmed, Syed Masud; Hossain, Mohammad Shamim; Kabir, Moktadir; BRAC James P Grant School of Public Health
Background: Since 2007, BRAC has been implementing malaria prevention and control programme in 13 endemic districts of Bangladesh under the National Malaria Control Programme. This study was done to examine the role of different communication media in bringing about changes in knowledge and awareness which facilitate informed decision-making for managing malaria-like illnesses. Methods: A baseline survey in 2007 before inception of the programme, and a follow-up survey in 2012 were done to study changes in different aspects of programme interventions including the communication component. Both the surveys used the same sampling technique to select 25 households at random from each of the 30 mauza/villages in a district. A pretested, semi-structured questionnaire was used to collect relevant information from respondents in face-to-face interview. Analysis was done comparing the study areas at two different times. Statistical tests were done as necessary to examine the differences. Results: The intervention succeeded in improving knowledge in some trivial areas (e.g., most frequent symptom suggestive of malaria, importance of using insecticidal bed nets) but not in critical domains necessary for taking informed action (e.g., mode of malaria transmission, awareness about facilities providing free malaria treatment). Inequity in knowledge and practice was quite common depending upon household affluence, location of households in high or low endemic districts, and sex. Of the different media used in Information, Education and communication (IEC) campaigns during the study period, interpersonal communication with community health workers/relatives/neighbours/friends was found to be more effective in improving knowledge and practice than conventional print and audio-visual media. Conclusion: This study reiterates the fact that conventional media may not be user-friendly or culture-sensitive for this semiliterate/ illiterate community where dissemination through ‘words of mouth’ is more common, and as such, interpersonal communication is more effective. This is especially important for initiating informed action by the community in managing malaria-like illnesses.
Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi
(BMC Health Services Research, 2014) Brenner, Stephan; Muula, Adamson S; Robyn, Paul Jacob; Bärnighausen, Till; Sarker, Malabika; Mathanga, Don P; Bossert, Thomas; Allegri, Manuela De; BRAC James P Grant School of Public Health
Background: In this article we present a study design to evaluate the causal impact of providing supply-side performance-based financing incentives in combination with a demand-side cash transfer component on equitable access to and quality of maternal and neonatal healthcare services. This intervention is introduced to selected emergency obstetric care facilities and catchment area populations in four districts in Malawi. We here describe and discuss our study protocol with regard to the research aims, the local implementation context, and our rationale for selecting a mixed methods explanatory design with a quasi-experimental quantitative component. Design: The quantitative research component consists of a controlled pre- and post-test design with multiple post-test measurements. This allows us to quantitatively measure ‘equitable access to healthcare services’ at the community level and ‘healthcare quality’ at the health facility level. Guided by a theoretical framework of causal relationships, we determined a number of input, process, and output indicators to evaluate both intended and unintended effects of the intervention. Overall causal impact estimates will result from a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time. To further explain heterogeneity of quantitatively observed effects and to understand the experiential dimensions of financial incentives on clients and providers, we designed a qualitative component in line with the overall explanatory mixed methods approach. This component consists of in-depth interviews and focus group discussions with providers, service user, non-users, and policy stakeholders. In this explanatory design comprehensive understanding of expected and unexpected effects of the intervention on both access and quality will emerge through careful triangulation at two levels: across multiple quantitative elements and across quantitative and qualitative elements. Discussion: Combining a traditional quasi-experimental controlled pre- and post-test design with an explanatory mixed methods model permits an additional assessment of organizational and behavioral changes affecting complex processes. Through this impact evaluation approach, our design will not only create robust evidence measures for the outcome of interest, but also generate insights on how and why the investigated interventions produce certain intended and unintended effects and allows for a more in-depth evaluation approach.
Exploring adolescent reproductive health knowledge, perceptions, and behavior, among students of non-government secondary schools supported by BRAC mentoring program in rural Bangladesh
(Journal of Asian Midwives (JAM), 2014-09) Aktar, Bachera; Sarker, Malabika; Jenkins, Andrew; BRAC James P Grant School of Public Health
Adolescence is the transition period from childhood to adulthood. Since Bangladesh is such a conservative society, reproductive health education for adolescents has not been widely introduced. Very small adolescent health components are included in the secondary and higher secondary school curricula. The BRAC Mentoring Program provides mentorship training to secondary school pupils to develop them as peer leaders. However, this program does not provide adolescent reproductive health education. Therefore, a study, supported by BRAC Education Program in rural Bangladesh, was conducted to explore the current status of reproductive health knowledge, perceptions and practice among the students of secondary schools. This study was conducted in November 2012 among the students of three secondary schools supported by BRAC Education Program in two sub-districts of Mymensingh district, Bangladesh. The qualitative study explored students’ reproductive health knowledge, perceptions, and behavior. Twenty four In-Depth Interviews and four Focus Group Discussions were conducted with students and four Key Informant Interviews were also conducted with teachers. The findings indicated that there is a lack of knowledge on reproductive health among the adolescent girls and boys of rural secondary schools. The students did not know about physical changes in puberty before the onset of such changes and mostly learnt about them from their own bodily experience. Mothers were the main source of information on menstruation for girls, and in case of boys, friends were the main source of information on wet dreams. All girls had comparatively good menstrual hygiene knowledge and practices. On the other hand, boys had very poor knowledge about wet dreams. Both girls and boys had poor knowledge about sexually transmitted diseases. However, they had better knowledge and perceptions about AIDS, in comparison with other issues of adolescent reproductive health. Though teachers and students felt uncomfortable with the teaching of reproductive health issues in class, but, interestingly, books were found to be the most reliable source of information for the students. Most of the students and teachers felt that the available information was inadequate for the adolescents. The study findings also showed that adolescent boys and girls had limited knowledge about reproductive health. Therefore, it is recommended that BRAC Education Program needs to provide adolescent reproductive health education in the school through peer education approach and provide special training to the teachers on teaching reproductive health education in class as well.
The informal health sector and health care-seeking behaviour of mothers in urban Dhaka slums
(Journal of Population Research, 4/22/2014) Caldwell, Bruce K.; Rashid, Sabina Faiz; Murthy, Shivani; BRAC James P Grant School of Public Health
Infant and child mortality in Bangladesh has declined in recent years but early death rates remain high among Bangladesh’s urban poor, even in comparison to rates in rural Bangladesh. Although they live close to the country’s leading public hospitals and private health clinics, the urban poor continue to rely heavily on services and advice provided by the informal health sector. This paper examines the use of the informal health sector by urban poor children’s main caregivers, their mothers, and the key role performed by pharmacists in treating these children. It explores the nature of the relationship between the mothers and the health providers and the implications for the broader health system. The study combines in-depth interviews with survey data.

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