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Permanent URI for this collectionhttps://hdl.handle.net/10361/7366

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Communication for behavioural impact in enhancing utilization of insecticide-treated bed nets among mothers of under-five children in rural North Sudan: an experimental study
(© 2016 BioMed Central Ltd., 10/18/2016) Elmosaad, Yousif Mohammed; Elhadi, Magda; Khan, Asif; Malik, Elfatih Mohamed; Mahmud, Ilias; BRAC James P Grant School of Public Health
Background: Malaria is the leading cause of morbidity and mortality in Sudan. The entire population is at risk of contracting malaria to different levels. This study aimed to assess the effectiveness of communication for behavioural impact (COMBI) strategy in enhancing the utilization of long-lasting insecticidal nets (LLINs) among mothers of under-five children in rural areas. Methods: A randomized community trial was conducted in rural area of Kosti locality, White Nile State, Sudan, among mothers of under-five children, from January 2013 to February 2014. A total of 761 mothers from 12 villages were randomly selected, 412 mothers from intervention villages and 349 were from comparison villages. Results: The knowledge of mothers, in intervention villages, about malaria vector, personal protective measures (PPM) against malaria, and efficacy of LLINs was significantly increased from 86.9 to 97.3 %; 45.9 to 92 % and 77.7 to 96.1 % respectively. Knowledge about usefulness of PPM, types of mosquito nets and efficacy of LLINs was significantly higher in intervention villages compared to comparison villages (p < 0.05), (η2 = 0.64). Mothers in intervention villages increasingly perceived, post-intervention, that malaria was a serious disease (99.3 %), a preventable disease (98.8 %) and also LLINs as an effective intervention in malaria prevention (92.2 %). This resulted in an increase in the utilization rate of LLINs from 19.2 to 82.8 % in intervention villages compared to comparison villages (p < 0.05) [OR = 4.6, 95 %, CI = (3.72-5.72)], (η2 = 0.64). The average of mothers' knowledge about malaria was increased by 64 % (η2 = 0.64), the use of LLINs was increased by 79 % (η2 = 0.79) and a positive attitude towards malaria was 2.25 times higher in intervention villages than among mothers in the comparison villages. Conclusions: These results established the usefulness of COMBI strategy for increasing awareness about malaria, developing a positive perception towards malaria prevention and, increasing the utilization of LLINs.
Utilization of mobile phones for accessing menstrual regulation services among low-income women in Bangladesh: a qualitative analysis
(© 2017 BioMed Central Ltd., 1/14/2017) Messinger, Chelsea Jordan; Mahmud, Ilias; Kanan, Sushama; Jahangir, Yamin Tauseef; Sarker, Malabika; Rashid, Sabina Faiz; BRAC James P Grant School of Public Health
Background: As many as one-third of all pregnancies in Bangladesh are unplanned, with nearly one-half of these pregnancies ending in either menstrual regulation (MR) or illegal clandestine abortion. Although MR is provided free of charge, or at a nominal cost, through the public sector and various non-profits organizations, many women face barriers in accessing safe, affordable MR and post-MR care. Mobile health (mHealth) services present a promising platform for increasing access to MR among low-income women at risk for clandestine abortion. We sought to investigate the knowledge, attitudes and practices regarding mHealth of both MR clients and formal and informal sexual and reproductive healthcare providers in urban and rural low-income settlements in Bangladesh. Methods: A total of 58 interviews were conducted with MR clients, formal MR providers, and informal MR providers in four low-income settlements in the Dhaka and Sylhet districts of Bangladesh. Interview data was coded and qualitatively analysed for themes using standard qualitative research practices. Results: Our findings suggest that low-income MR clients in Bangladesh have an inadequate understanding of how to use their mobile phones to obtain health service information or counselling related to MR, and correspondingly low levels of formal or informal mHealth service utilization. Few were aware of any formal mHealth services in place in their communities, despite the fact that providers stated that hotlines were available. Overall, MR clients expressed positive opinions of mHealth services as a means of improving women's access to affordable and timely MR. Formal and informal MR providers believed that mobile phones had benefits with respect to information dissemination and making appointments, but emphasized the necessity of in-person consultations for effective sexual and reproductive healthcare. Conclusions: We report low utilization yet high acceptability of mHealth services among low-income MR clients in Bangladesh. Expanding formal and informal mHealth services targeted towards MR - and increasing publicity of these services in low-income communities - may help increase timely access to accurate MR information and formal providers among women at risk for clandestine abortion. While expanding formal and informal mHealth services for SRHR in Bangladesh may be useful in disseminating information about MR and connecting women with formal providers, in-person visits remain necessary for adequate treatment.
Financial aid for the rehabilitation of individuals with spinal cord injuries in Bangladesh
(© 2012 Asia Pacific Disability Rehabilitation Journal, 2012) Nahar, Nazmun; Nuri, Reshma Parvin; Mahmud, Ilias; BRAC James P Grant School of Public Health
In Bangladesh, a majority of individuals with spinal cord injuries (SCI) are either poor or very poor. In most cases, their families undergo extreme hardship as they lose the income of the only or main earning member, and are unable to bear costs of rehabilitation. Purpose: This mixed method study explored perspectives of individuals with SCI regarding financial aid in the form of interest-free loans for their treatment and rehabilitation at the Centre for the Rehabilitation of the Paralysed (CRP). Method: In the first part of the study, 10 semi-structured face-to-face interviews were conducted. In the second part of the study, 40 persons with SCI were surveyed. The qualitative method involved selection of respondents according to their age, sex and severity of disability. Quantitative interviews were conducted with all persons with SCI in the final stage of hospital rehabilitation, in the third quarter of 2008. Results: Though CRP provides financial support depending on the individual's economic status, many persons with SCI needed additional funding from multiple sources, such as savings (42.5%), mortgaging assets (12.5%), selling assets (45%), receiving loans (37.5%), begging for money (42.5%), and receiving donations from relatives (47.5%) or the community (30%), to meet the direct and indirect costs of rehabilitation. Majority (85%) of those interviewed wanted to receive financial aid in the form of interest-free loans. 76.4% of them wanted the loans to be disbursed in two phases; initially, to offset some of their costs during rehabilitation at CRP, and thereafter, for economic reintegration in their community. The remaining 23.6% wanted the loan only for vocational reintegration. 70.59% of those interviewed proposed repayment in monthly instalments, while 17.64% suggested quarterly instalments and 11.76% favoured annual instalments. Over half of the participants (55.88%) wanted to have vocational training, and the rest wanted vocational training for their family members, to enable them to repay the loan. Conclusions: This study revealed that there is a huge demand for interestfree loans among people with SCI. An appropriately designed interest-free loan programme, which would be sensitive to individual needs, could save people with SCI and their families from bankruptcy. This would also make SCI rehabilitation programmes more sustainable, and possibly reduce over-dependence on the donors. Further action research is recommended to evaluate the effectiveness of such a course of action.
Exploring the context in which different close-to-community sexual and reproductive health service providers operate in Bangladesh: a qualitative study
(© 2015 BioMed Central Ltd., 2015) Mahmud, Ilias; Chowdhury, Sadia; Ashraf Siddiqi, Bulbul; Theobald, Sally; Ormel, Hermen; Biswas, Salauddin; Tauseef Jahangir, Yamin; Sarker, Malabika; Faiz Rashid, Sabina; BRAC James P Grant School of Public Health
Background: A range of formal and informal close-to-community (CTC) health service providers operate in an increasingly urbanized Bangladesh. Informal CTC health service providers play a key role in Bangladesh's pluralistic health system, yet the reasons for their popularity and their interactions with formal providers and the community are poorly understood. This paper aims to understand the factors shaping poor urban and rural women's choice of service provider for their sexual and reproductive health (SRH)-related problems and the interrelationships between these providers and communities. Building this evidence base is important, as the number and range of CTC providers continue to expand in both urban slums and rural communities in Bangladesh. This has implications for policy and future programme interventions addressing the poor women's SRH needs. Methods: Data was generated through 24 in-depth interviews with menstrual regulation clients, 12 focus group discussions with married men and women in communities and 24 semi-structured interviews with formal and informal CTC SRH service providers. Data was collected between July and September 2013 from three urban slums and one rural site in Dhaka and Sylhet, Bangladesh. Atlas.ti software was used to manage data analysis and coding, and a thematic analysis was undertaken. Results: Poor women living in urban slums and rural areas visit a diverse range of CTC providers for SRH-related problems. Key factors influencing their choice of provider include the following: availability, accessibility, expenses and perceived quality of care, the latter being shaped by notions of trust, respect and familiarity. Informal providers are usually the first point of contact even for those clients who subsequently access SRH services from formal providers. Despite existing informal interactions between both types of providers and a shared understanding that this can be beneficial for clients, there is no effective link or partnership between these providers for referral, coordination and communication regarding SRH services. Conclusion: Training informal CTC providers and developing strategies to enable better links and coordination between this community-embedded cadre and the formal health sector has the potential to reduce service cost and improve availability of quality SRH (and other) care at the community level.
Understanding the lives of caregivers of children with cerebral palsy in rural Bangladesh: use of mixed methods
(© 2015 Action for Disability Regional Rehabilitation Centre, 2015-06) Zuurmond, Maria A; Mahmud, Ilias; Polack, Sarah; Evans, Jenny; BRAC James P Grant School of Public Health
Cerebral palsy is the most prevalent health condition linked to childhood disability in Bangladesh, yet support and rehabilitation for this group is limited. Understanding the impact of cerebral palsy at family level is important forthe development of appropriate interventions. Purpose: This study aims to explore the impact on the lives of caregivers of children with cerebral palsy. Methods: The study used mixed methods. The PedsQL™Family Impact Questionnaire Module was administered to the main caregivers in 135 families with a child with cerebral palsy and 150 families that did not have a child with a disability, from the same villages. In-depth interviews and observations were undertaken with 10 families, and 2 focus group discussions were conducted with representatives from 14 parent/caregiver groups. The project was conducted from April 2011- April 2013. Data collection was from September 2011- Dec 2012. Results: The mean overall and sub-scale PedsQL™ scores were significantly poorer (p<0.001) for caregivers of a child with cerebral palsy compared to scores from families that did not have a child with disability. Caregivers reported high levels of stress, anxiety, isolation, stigma, physical tiredness, and lack of time to complete everyday tasks. Knowledge and understanding about cerebral palsy was generally low. Conclusion: This study demonstrates the particular vulnerability of families of children with disabilities in resource-limited settings. It reveals the extent of the impact on the caregivers. Interventions therefore need to be holistic, addressing the well-being and empowerment of caregivers as well as children.

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