Journal and Book Publications by RED Researchers, 2002

Permanent URI for this collectionhttps://hdl.handle.net/10361/13304

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Enrolment at primary level: gender difference disappears in Bangladesh
(International Journal of Educational Development, 2002-03) Chowdhury, AMR; Nath, Samir R; Choudhury, Rasheda K.
In the recent past, there have been a number of new initiatives to improve the access to primary education in many developing countries. Such initiatives, which came from the public, private and non-governmental (NGO) sectors, have resulted in improved performance in various efficiency indicators. This paper reports results from a nationwide study in Bangladesh on the levels and changes in enrolment pattern of children at the primary level. The gross enrolment ratio has reached 107% and the net enrolment rate 77%. Gender gap has disappeared; in fact girls have surpassed boys! However, the increase in enrolment taking place is not at the desired speed; it is less than one percentage point per year. The government is still the major provider of primary education with two-thirds of all enrolments, but non-formal schools run by NGOs also have important contributions to the positive changes that are taking place in Bangladesh.
Efficacy and trial effectiveness of weekly and daily iron supplementation among pregnant women in rural Bangladesh: disentangling the issues
(The American Journal of Clinical Nutrition, 2002) Ekstrom, Eva-Charlotte; Hyder, S.M. Ziauddin; Chowdhury, AMR; Chowdhury, Sadia A.; Lonnerdal, Bo; Habicht, Jean-Pierre; Persson, Lars Ake
BACKGROUND: According to our current understanding, iron absorption with weekly iron supplements is not higher than that with daily supplements (ie, there is no mucosal block). However, community-based trials have repeatedly shown that a weekly regimen is as effective as a daily one. Furthermore, when differences in absorption are found, they are commonly smaller than would be expected on the basis of differences in the amount of iron provided. The possibility of differential compliance between the regimens needs to be evaluated to explain these findings. OBJECTIVE: Taking compliance into account, we compared the efficacy and trial effectiveness of weekly and daily iron supplementation during pregnancy. DESIGN: In Bangladesh, 50 antenatal centers were randomly assigned to prescribe either 2 doses of 60 mg Fe once weekly or 1 dose of 60 mg Fe/d. Compliance was monitored by using a pill bottle equipped with an electronic counting device. Hemoglobin concentrations were measured at baseline and after 4, 8, and 12 wk of supplementation. RESULTS: There was no differential effect per iron tablet between weekly and daily regimens. A 12-wk daily regimen (68% compliance) produced a small but significantly greater hemoglobin response than did the weekly regimen (104% compliance). The first 20 tablets consumed produced most of the effect; after 40 tablets, there was no further response. CONCLUSIONS: There was no evidence of a mucosal block in the daily regimen. Over 12 wk, 50% of the amount of iron in a daily regimen was sufficient for maximum hemoglobin effect. The weekly regimen provided a large part of this amount, explaining the limited difference in effect. It appears that the current international recommendation for iron supplementation in pregnancy is higher than necessary.
Drinking water in the hilly region of Bangladesh: how is the quality?
(Carfax Publishing, 2002) Karim, Fazlul; Rafi, Mohammad
This paper assesses the chemical and bacteriological quality of drinking water in three districts of the Chittagong Hill Tract (CHT), a region within Bangladesh. Drawing water samples from tubewells, chharas /springs, lakes/canals, wells, and ponds, analysis was done on pH, alkalinity, arsenic, phosphate (PO 4 ), sulphate (SO 4 ), ammonium-nitrogen, conductivity, and faecal coliform bacteria. The PO 4 and SO 4 concentrations were within the permissible limits. In contrast, 100% of the water samples contained alkalinity below 400 mg/l. Varied proportions, ranging from 14% to 50%, of tubewells, chharas /springs, lakes/canals, and well water had a pH of less than 6.5. Three out of 16 (18.8%) tubewell water samples tested had arsenic contamination and 18% of the chhara /spring and 11% of the well water samples had an unacceptable level of conductivity. In addition, faecal coliform bacteria contaminated almost all sources of water, ranging from 81% to 100%. The water used for drinking in CHT in general is harmful for health.
Do side-effects reduce compliance to iron supplementation? a study of daily- and weekly-dose regimens in pregnancy
(Springer, 2002-06) Hyder, S.M. Ziauddin; Persson, Lars Åke; Chowdhury, AMR; Ekström, Eva-Charlotte
Side-effects of iron supplementation lead to poor compliance. A weekly-dose schedule of iron supplementation rather than a daily-dose regimen has been suggested to produce fewer side-effects, thereby achieving a higher compliance. This study compared side-effects of iron supplementation and their impact on compliance among pregnant women in Bangladesh. These women were assigned to receive either weekly doses of 2×60 mg iron (one tablet each Friday morning and evening) or a daily dose of 1×60 mg iron. Fifty antenatal care centres were randomly assigned to prescribe either a weekly- or a daily-supplementation regimen (86 women in each group). Side-effects were assessed by recall after one month of supplementation and used for predicting compliance in the second and third months of supplementation. Compliance was monitored using a pill bottle equipped with an electronic counting device that recorded date and time whenever the pill bottle was opened. Of five gastrointestinal side-effects (heartburn, nausea, vomiting, diarrhoea, or constipation) assessed, vomiting occurred more frequently in the weekly group (21%) than in the daily group (11%, p<0.05). Compliance (ratio between observed and recommended tablet intake) was significantly higher in the weekly-supplementation regimen (93%) than in the daily-supplementation regimen (61%, p<0.05). Overall, gastrointestinal side-effects were not significantly associated with compliance. However, the presence of nausea and/or vomiting reduced compliance in both the regimens—but only among women from the lower socioeconomic group. In conclusion, weekly supplementation of iron in pregnancy had a higher compliance compared to daily supplementation of iron despite a higher frequency of side-effects. The findings support the view that gastrointestinal side-effects generally have a limited influence on compliance, at least in the dose ranges studied. Efforts to further reduce side-effects of iron supplementation may not be a successful strategy for improving compliance and effectiveness of antenatal iron supplementation.
Dimensions and dynamics of microfinance membership overlap – a micro study from Bangladesh
(Small Enterprise Development, 2002-06) Chaudhury, Iftekhar A.; Matin, Imran
The microfinance market of Bangladesh is getting rapidly crowded. In certain areas there is also quite high incidence of households taking loans from a number of microfinance providers. Why is this happening? How does it affect the providers? What should be done? These are some of the questions that this paper begins to address based on data collected from BRAC's operations in Tangail. We find that a number of crises often gives rise to an urgent need for lump sums of cash, and this is why households often need access to several loan sources. Though repayment irregularity is found to be on the increase, somehow it is being managed from turning into a major default problem, suggesting a level of in-built resilience of the system. This needs further research. In terms of what should be done, we chalk a broad agenda consisting of better information-sharing mechanisms and developing better risk-responsive financial products. In this sense, the phenomenon of multiple microfinance membership is as much an opportunity as it is a challenge.
Cost-effectiveness of community health workers in tuberculosis control in Bangladesh
(Bulletin of the World Health Organization, 2002) Islam, Md. Akramul; Wakai, Susumu; Ishikawa, Nobukatsu; Chowdhury, A.M.R.; Vaughan, J. Patrick
Objective To compare the cost-effectiveness of the tuberculosis (TB) programme run by the Bangladesh Rural Advancement Committee (BRAC), which uses community health workers (CHWs), with that of the government TB programme which does not use CHWs. Methods TB control statistics and cost data for July 1996-June 1997 were collected from both government and BRAC thanas (subdistricts) in rural Bangladesh. To measure the cost per patient cured, total costs were divided by the total number of patients cured. Findings In the BRAC and government areas, respectively, a total of 186 and 185 TB patients were identified over one year, with cure rates among sputum-positive patients of 84% and 82%. However, the cost per patient cured was US$ 64 in the BRAC area compared to US$ 96 in the government area. Conclusion The government programme was 50% more expensive for similar outcomes. Although both the BRAC and government TB control programmes appeared to achieve satisfactory cure rates using DOTS (a five-point strategy), the involvement of CHWs was found to be more cost-effective in rural Bangladesh. With the same budget, the BRAC programme could cure three TB patients for every two in the government programme.
Beneficial effects of a woman-focused development programme on child survival: evidence from rural Bangladesh
(Social Science and Medicine, 2002-11) Bhuiy, Abbas; Chowdhury, Mushtaque
This paper reports results from a prospective study of the impact of a woman-focused development programme on child survival in Matlab, a rural area of Bangladesh. The programme was targeted to households owning less than 50 decimals of land and members selling more than 100 days of labour for living in a year. Programme components included formation of women's groups for saving and credit, training on skill development, functional literacy including legal and social awareness, and technical and marketing support to projects undertaken with the loan money from the organization. A total of 13,549 children born alive during 1988–97 in the study area were included in the study. Hazards of mortality during pre- and post-intervention periods were compared among the programme participants and non-participants controlling the effects of other relevant variables. There has been a substantial reduction in mortality during the post-intervention period; however, the reduction was much greater for infants whose mothers participated in the development programme compared to infants of non-participant mothers from similar socioeconomic background. In a relative sense, there has been a 52% reduction of the pre-intervention level hazard of death of children during infancy of participant mothers compared to 31% reduction for the infants of non-participant mothers from similar socioeconomic background. There had also been a substantial reduction in hazard of death during childhood (1–4 year age group), however, the reduction was statistically similar for all groups of children irrespective of their mothers’ participation in the development programmes.

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