Research Reports (2010): Health Studies, Vol - XLII

Permanent URI for this collectionhttps://hdl.handle.net/10361/13154

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Status of arsenic test and exposure to arsenic-contaminated tubewell water: a population-based study in Southern Bangladesh
(BRAC Research and Evaluation Division (RED), 2010-09) Dey, Nepal C; Rana, AKM Masud; Barua, Milan K.; Kabir, Babar
This study explores the status of arsenic test of tubewell and exposures to arsenic-contaminated tubewell water in the arsenic prone southern Bangladesh. Through a survey of 6,593 households, a total of 3,812 tubewells were sampled at baseline (2006/07) and 3,591 at midline (2009). Households were selected through multi-stage sampling procedure where each sub-district was considered as a cluster. Findings reveal that proportion of unmarked (to identify presence of arsenic) tubewells increased from 80% at baseline to 90% at midline (p<O.OOI). Proportion of tested tubewells was significantly decreased from 75% at baseline to 69% at midline (p<O.OOI). Of the tested tubewells, 60% was reported to be free from arsenic contamination. Around 44% of the household members usually drink water from arsenic contaminated tubewells. This study underlines that information, education and communication campaigns should be strengthened to raise awareness regarding negative effect of arsenic on health.
Maternal care practices among the ultra poor households in rural Bangladesh: a qualitative exploratory study
(BRAC Research and Evaluation Division (RED), 2010) Choudhury, Nuzhat; Ahmed, Syed Masud
Background Although many studies have been carried out to learn about maternal care practices in rural areas and urban-slums of Bangladesh, none have focused on ultra poor women. Understanding the context in which women would be willing to accept new practices is essential for developing realistic and relevant behaviour change messages. This study sought to fill in this knowledge gap by exploring maternal care practices among women who participated in a grant-based livelihood programme for the ultra poor. This is expected to assist the designing of the health education messages programme in an effort to improve maternal morbidity and survival towards achieving the UN millennium Development Goal 5. Methods Qualitative method was used to collect data on maternal care practices during pregnancy, delivery, and post-partum period from women in ultra poor households. The sample included both currently pregnant women who have had a previous childbirth, and lactating women, participating in a grant-based livelihood development programme. Rangpur and Kurigram districts in northern Bangladesh were selected for data collection. Results Women usually considered pregnancy as a normal event unless complications arose, and most of them refrained from seeking antenatal care (ANC) except for confirmation of pregnancy, and no prior preparation for childbirth was taken. Financial constraints, coupled with traditional beliefs and rituals, delayed care-seeking in cases where complications arose. Delivery usually took place on the floor in the squatting posture and the attendants did not always follow antiseptic measures such as washing hands before conducting delivery. Following the birth of the baby, attention was mainly focused on the expulsion of the placenta and various maneuvres were adapted to hasten the process, which were sometimes harmful. There were multiple food-related taboos and restrictions, which decreased the consumption of protein during pregnancy and post-par tum period.
Knowledge, attitudes and practice about sanitation and hygiene: a midline evaluation in WASH areas of BRAC
(BRAC Research and Evaluation Division (RED), 2010-09) Sifat-E-Rabbi; Ali, ARM Mehrab
This study aimed to evaluate the impact of BRAC WASH (Water, Sanitation and Hygiene) programme on hygiene knowledge and practice of the people in intervention areas compared to baseline status. A population-based cross-sectional study with a pre-test and post-test design was conducted in 50 sub-districts of rural Bangladesh where BRAC WASH programme exists. A two-stage systematic sampling design was followed in drawing the sample. Data collection took place during November 2006- June 2007 at baseline and April-June 2009 at midline using a pre-tested structured questionnaire and physical verification. Findings reveal that knowledge and practice of hand washing at critical times (such as after contact with feaces and waste, before eating, cooking and serving food) significantly increased at midline compared to baseline. Knowledge about water contamination and water-borne diseases, water purification procedure, sanitation hygiene, rules of maintaining good health, and waste disposal at fixed place increased at midline. Availability of slippers, soap and water nearby latrine increased in intervention areas. However, there still exists room for improvement because practice of hygiene behaviour was not universal although they had knowledge of its importance. To achieve the targets of Millennium Development Goal, the WASH programme needs to pay more attention in providing knowledge related to personal hygiene.
Effects of BRAC Water, Sanitation and Hygiene (WASH) Programme in improved sanitation: changes from baseline to midline survey
(BRAC Research and Evaluation Division (RED), 2010-10) Ghosh, Shyamal C; Rana, AKM Masud; Ali, ARM Mehrab; Arif, Tahmid
To facilitate achieving national target of 1 00 percent sanitation in Bangladesh by the year 2013, BRAC Water. Sanitation and Hygiene (WASH) programme has been working in 150 upazilas for improving water supply, sanitation and hygiene practices. This study investigated the effect of BRAC WASH programme on sanitation in the intervention areas after two years of implementation, by comparing the data of baseline and midline surveys. Data of 30,000 households from 50 upazilas were used to measure the improvement in sanitation at household level. The sanitation situation in the same upazilas at institutional level was studied by surveying educational institutions (2 ,395 during baseline and 1,487 during midline), which were financed by the BRAC WASH programme for arranging improved sanitation facilities. Use of sanitary latrines increased significantly (p<0.001) both at household (7.1 %) and institutional level (2.4%). Additionally, the quality of sanitary latrines improved significantly (p<0.001 ). During midline survey higher percentage of latrines were found clean (17.2% at the households, 23.7% at the educational institutes) and with available water nearby the latrines (5.5% at the households, 11.4% at the institutes). There were also reduced percentage of latrines with stink (14 .8% at the households. 22.4% at the institutes) and residual fecal left (12 .8% at the households, 21 .6% at the institutes). The improvements of sanitation status could be attributed to the BRAC WASH activities implemented in the study areas for 2 years. However, there were some impediments revealed from the study, i.e., shifting of households using sanitary latrines to unsanitary practices, poverty, illiteracy etc .. which were slowing down the sanitation improvements. Thus, the BRAC WASH programme needs strengthening of ongoing activities addressing the key impediments at household level together with extended support for educational institutions to achieve the set goals.
Changes in the use of safe water and water safety measures in water, sanitation and hygiene intervention areas of Bangladesh: a midline assessment
(BRAC Research and Evaluation Division (RED), 2010-12) Dey, Nepal C; Ali, ARM Mehrab
The BRAC Water, Sanitation and Hygiene (WASH) programme reached 150 upazilas (sub-districts) in collaboration with the Government of Bangladesh since 2006. This study assessed the changes in the use of tubewell water and water safety measures in the households in the 11 upazilas of Bangladesh after BRAC WASH inteNentions. Data were collected from 6,600 households where 3,812 tubewells were traced in baseline (2006-7) and 3,591 tubewells in midline (2009) . Most of the households (98-99%) used tubewell water for drinking, 70-73% for cooking, 62-66% for washing utensils, 70-73% for cleaning after defecation, and 24 -36% for bathing in midline both in the dry and rainy seasons. The numbers were significantly larger in midline than in baseline (p<0.01) except for drinking in the rainy season. Overall arsenic-free tubewells increased from 58% in baseline to 60% in midline and most households (83%) drank arsenic-free tubewell water in midline. The study revealed that water safety measures including awareness of cleaning/purifying water and hygienic management of water increased significantly (p<0.01 ). The concrete-built platform increased from 63% in baline to 69% in midline. Tubewell platforms were cleaned (32%) in baseline, which increased to 46% in midline. However, there still remained impediments to 100% safe water use by the households include arsenic contamination of tubewell water, financial inabilities of the ultra poor and poor households for installing tubewells for arsenic-free water. unmarked tubewell (whether contaminated by arsenic or not). The study concluded that WASH inteNention has succeeded in increasing access to safe water use. hygienic management of water, and cleanliness of water collecting point in the study areas. It is encouraging to note that ultra poor households had interest to get new tubewells and preferred to pay the costs in monthly instalments, which indicates that these households were aware of the benefits of safe water. Thus, BRAC WASH programe needs to pay further attention to these impediments at the household level in order to further improve the current situation.
Availability and rational use of drugs in primary healthcare facilities following the National Drug Policy of 1982: is Bangladesh on right track?
(BRAC Research and Evaluation Division (RED), 2010) Ahmed, Syed Masud; Islam, Qazi Shafayetul
In Bangladesh, the National Drug Policy (NDP) 1982 was instrumental in improving the supply of essential drugs of quality at an affordable price, especially in the early years. However, over time, evidence showed that the situation deteriorated in terms of both availability of essential drugs and their rational use. The study examined the current status of the outcome of the NDP objectives in terms of the availability and rational use of drugs in the primary healthcare (PHC) facilities in Bangladesh, including affordability by consumers. The study covered a random sample (n=30) of rural Upazila Health Complexes (UHCs) and a convenient sample (n=20) of urban clinics (UCs) in the Dhaka metropolitan area. Observations on prescribing and dispensing practices were made, and exit-interviews with patients and their attendants, and a mini-market survey were conducted to collect data on the core drug-use indicators of the World Health Organization from the health facilities. The findings revealed that the availability of essential drugs for common illnesses was poor, varying from 6% in the UHCs to 15% in the UCs. The number of drugs dispensed out of the total number of drugs prescribed was higher in the UHCs (76%) than in the UCs (44%). The dispensed drugs were not labelled properly, although >70% of patients/care-givers (n=1,496) reported to have understood the dosage schedule. The copy of the list of essential drugs was available in 55% and 47% of the UCs and UHCs respectively, with around two-thirds of the drugs being prescribed from the list. Polypharmacy was higher in the UCs (46%) than in the UHCs (33%). An antibiotic was prescribed in 44% of encounters (n=1,496), more frequently for fever (36-40%) and common cold (26-34%) than for lower respiratory tract infection, including pneumonia (10-20%). The prices of key essential drugs differed widely by brands (500% or more), seriously compromising the affordability of the poor people.

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