Research Reports (2011): Health Studies, Vol - XLIII

Permanent URI for this collectionhttps://hdl.handle.net/10361/13161

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Now showing 1 - 9 of 9

Voice and accountability: the role of maternal, neonatal and child health committee
(BRAC Research and Evaluation Division (RED), 2011-09) Leppard, Margaret; Rashid, Sarawat; Rahman, Atiya; Akter, Mahmuda; Hashima-E-Nasreen
The study aims to explore how the MNCH committee encouraged community participation and how its communication activities empowered the community people to ensure the healthcare needs of the poor and disadvantaged people. A range of qualitative method was used in the study. In-depth interview, focus-group discussion, informal discussion, observation and document review were used as data collection method. This study conducted in two sub-districts of Nilphamarl and Mymensingh districts of Bangladesh during February-April 2010. Thematic content analysis technique was followed. Findings reveal that the committee members took necessary steps to solve the maternal complication by referral, follow-up of referred cases, and providing financial support to the extreme poor if needed, and the committee helped increase the availability of healthcare service providers and Improve the nature of services accessible to the community people. However, the capacity of the committees to raise the voice of poor people was fairly limited due to lack of adequate orientation of the committee members and also for lack of publicity about their roles. Besides, the committee could not run properly due to disagreement between power and literacy among the committee members. The MNCH committee has potential as it allowed the people's voice and could, thus, serve as a pathway through which ordinary people could hold local health authorities and local service providers to account. The findings informed the further development of an enabling environment in which the voices of MNCH committee members and community people would be stronger.
Occupational Pulmonary Tuberculosis among BRAC Community Health Workers of Trishal, Bangladesh
(BRAC Research and Evaluation Division (RED), 2011-09) Karim, Fazlul; Islam, Qazi Shafayetul; Islam, Md. Akramul; Ahmed, Jalaluddin
Different studies reported 2-14 times higher risk of TB for the healthcare workers than the general populations. This poses a serious challenge to the healthcare workers involved in TB control worldwide. BRAG has been using services of thousands of community-based health workers (GHW) known as shasthya shebikas for TB control all over the country. Their continuous exposure to infectious pulmonary TB (PTB) patients might have increased the risk of disease transmission. This concem led RED to implement a pilot study in Trishal upazila to (i) assess the operational feasibility of using GXR (chest X-ray) as a tool for PTB diagnosis, and obtaining and testing sputum samples; and (ii) measure the rate of active TB in different health workers of BRAG. Data were generated through face-to-face interview using structured and semi-structured instruments. Each eligible GHW gave a GXR at a designated private clinic at Trishal. Three independent specialist physicians examined the GXRs. Besides, three sputum samples (night, moming and spot) were collected from each of the study participants, and tested at BRAG field laboratories. Five percent of them were re-tested at an extemal quality assurance laboratory in Mymensingh for quality control. Additional sputum samples of 26 respondents (two from each) were cultured at the national TB programme reference laboratory in Dhaka. Positive agreement of two examiners on an individual GXR or two sputum slides test-positive or one sputum slide test-positive supported by one GXR-positive or one sputum culture-positive was defined as a TB patient. Quantitative data were analyzed by SPSS software, while the qualitative data were handled manually. The estimated prevalence rate of smear-negative PTB among the shasthya shebikas was 1,612.9/100,000. This was 4-fold higher than the prevalence of all forms of TB in the general population of Bangladesh. This implies that the grassroots health workers are at a greater risk of PTB. Qualitative explorations revealed that contact with PTB patients and poverty were major causes of PTB among SSs, warranting appropriate measures for preventing disease transmission.
Factors affecting the performance of delivery centre
(BRAC Research and Evaluation Division (RED), 2011-08) Banu, Morsheda; Hashima-E-Nasreen; Nahar, Shamsun
The study aimed to measure the performance of delivery centres (DC) and explore the factors related to performance of DCs. Data were collected using qualitative methods during December 2009 - January 2010 from six DCs in the slums of Dhaka city. Findings reveal that the DCs at Magbazar and Kamrangir Char performed 'well' due to availability of community health workers (CHW) , their emotional support and caring attitude, regular antenatal care (ANC) visits, convenient location, cleanliness and free services of the DCs. The DCs at Madertek and Shyampur performed 'average' and Ramna and Kotwali DCs performed poor. Poor performance was largely due to lack of CHWs, less motivation, frequent dropout due to low remuneration, and recurrent slum demolition. As women reported, the reasons for not attending DCs was fear of being referred to the hospital which might compel them to have a caesarean delivery, lack of comprehensive services at DCs including doctor-assisted normal deliveries, medicines, and emergency case management. Neonatal mortality rate in poor performed DCs found to be high. The respondents suggested that instead of referring women for minor complications, DCs should be competent of providing supervised skilled service package with basic treatment during childbirth, tetanus toxoid during ANC and child immunizations and postnatal care.
"Why do I have to clean teeth regularly?": perceptions and state of oral and dental health in a low-income rural community in Bangladesh
(BRAC Research and Evaluation Division (RED), 2011-03) Khan, Antora Mahmud; Ahmed, Syed Masud
The general perception that dentistry is expensive keeps many people away from seeking treatment from registered professionals and make them hostage to the services of non-registered lay practitioners. In Bangladesh, no statistics on dental health problems or seeking dental healthcare is available which necessitates study for informed planning of a preventive programme. BRAC Research and Evaluation Division carried out a pilot survey in three unions of Gauripur upazila to document the knowledge and awareness and existing oral hygiene practices among the rural people and also, to explore the care-giving practices of the health care practitioners - both professionals and non-professionals. Both quantitative and qualitative methods were used for data collection. Also clinical examination was done to record their current state of oral cavity. Findings reveal poor oral and dental health condition of the survey population and their lack of knowledge and awareness conducive to good oral and dental health. Findings also reveal their reliance on informal sector providers for treatment of oral and dental health illnesses due to non-availability of qualified professionals. Oral hygiene practice is a neglected chore in the daily routine of the survey population as revealed through real life observation in the study area. The community people hardly used tooth brush and/or tooth paste/powder. Instead, they used various abrasive materials like charcoal powder, branches of trees claimed to have medicinal properties, etc. for cleaning teeth which is damaging, and in turn, cause different oral and dental health problems. The implication of these findings for programme development is discussed.
Revisiting the ARI Programme of BRAC: how well are we doing?
(BRAC Research and Evaluation Division (RED), 2011-06) Islam, Qazi Shafayetul; Ahmed, Syed Masud; Khan, Mohammed Abbas Uddin
The ARI (Acute Respiratory Infection) control programme of BRAC has been in operation for the last few years. No independent evaluation has so far been conducted to explore how far the objectives of the programme have been achieved in terms of raising awareness among the health workers and community people, especially mother/caregivers about ARI, increasing capacity of health workers in managing ARI cases in the community, and changing health-seeking behaviour of mothers for appropriate and quick treatment. This is a cross-sectional population based study comparing groups with or without ARI programmes. The study was conducted in 30 upazilas where BRAC ARI control programme is being implemented since 2007. In addition, 10 upazilas were selected from adjacent programme areas to serve as control. The study included 2,800 mothers, 1,440 children with ARI symptoms, and 238 community health workers who were actively involved in the implementation of the ARI programme. The Shasthya shebikas (SS), frontline workers of BRAC, appeared to have insufficient knowledge about ARI, its prevention and other related information. Similarly, the level of awareness among mothers in terms of recognition of symptoms of ARI and its prevention remains inadequate. However, the awareness was higher in programme areas compared to non-programme areas. The majority of the mothers heard about the community-based BRAe ARI control programme, but they were unaware about the detail activities of the programme. The overall management of ARI with respect to diagnosis and treatment by the health workers especially SSs was not up to the expected level. They did not count the rate of respiration regularly while diagnosing different stages of pneumonia. The SSs did not tell mothers about the doses of co-trimmoxazole syrup in many cases, and about the danger symptoms and signs, and prevention of ARI further. Sixty percent of mothers would not seek ARI treatment from BRAC in programme areas. Mothers preferred to go to the village doctors and drug sellers in both the programme and non-programme areas. During health-seeking, one-fourth of the mothers did not seek treatment, and one-fourth received spiritual treatment. The knowledge of BRAC SSs and the mothers was not enough to deal with ARI management. Thus, it is difficult to expect quick management of ARI to save life of the children in the community. Many mothers still sought treatment from unqualified providers. Furthermore, the quality of management by BRAC SSs was not of expected level. So, we conclude that many children were at risk of mortality due to ARI. BRAG ARI programme should look into the matter seriously to achieve the programme goal, and to reduce child morbidity and mortality.
Current state of the Model Shasthya Shebikas of BRAC: a quick exploration of the 'pilot project for SS sustainability'
(BRAC Research and Evaluation Division (RED), 2011-12) Khan, Antora Mahmud; Ahmed, Syed Masud
Knowledge and practice of hygiene in BRAC's WASH Programme areas
(BRAC Research and Evaluation Division (RED), 2011-12) Akter, Tahera; Ali, ARM Mehrab
Improved hygiene behaviour is one of the most effective means of reducing disease occurrence. However, question may arise, which factors did contribute to such improvement? Past studies seldom addressed these issues systematically nor explained the influencing factors that facilitate or impede hygiene knowledge and practice from the perspectives of successful and unsuccessful households. This study, combining qualitative and quantitative methods, measured the changes in knowledge and practice of hygiene and explored factors that facilitate or impede hygiene behaviours in water, sanitation and hygiene (WASH) intervention areas of BRAC. Indepth interviews were conducted with 144 purposively selected women. Some of their practices were physically verified to get the proof of their claims. Besides, 30,000 systematically chosen households studied in the baseline were revisited in the midline survey for collecting quantitative data. Results on common variables investigated through both quantitative and qualitative approaches were triangulated. Findings show that respondent's hygiene behaviours were mainly facilitated by improved knowledge and awareness about health and environment-related issues. BRAC's financial assistance had positive impact on latrine ownership resulting in increased privacy and dignity of the households. Latrine or tubewell ownership also increased their social prestige and sense of responsibility. In this regard, maintaining hygiene behaviours for healthy life was perceived as everybody's responsibility. On the other hand, lack of interest in attending cluster meeting, traditional knowledge, poverty, difficulties in carrying water, location of latrine, lack of will to practice, and complex mind-set were the impeding factors to hygiene knowledge and practice. Mainly the psychosocial aspects made the difference between successful and unsuccessful households, as successful households followed hygiene behaviours irrespective of poverty and other barriers. To increase awareness to a further extent and to transform knowledge into practice and practice into habit, more cluster meetings ensuring participation of all including children and home visits by the programme organizers are imperative.
Comparative status of safe water use and hygiene practices in areas with and without NGO-Ied Water, Sanitation and Hygiene (WASH) Programme
(BRAC Research and Evaluation Division (RED), 2011-01) Ghosh, Shyamal C; Ali, ARM Mehrab; Arif, Tahmid
More than 90% people in Bangladesh have access to improved water supply system, but arsenic is posing a threat to this achievement. Additionally, hygiene is considered as one of the challenging areas to deal in the development sector. A number of organizations (both government and non-goverment) are working to improve the water supply, sanitation and hygiene practices through various water, sanitation and hygiene programmes. OBJECTIVE The overall objective of this study is to reveal the role of non-government organizations (NGOs) in improving safe water use and hygiene practices by the rural people of Bangladesh. METHODS Ten upazi/as with both NGO-Ied sanitation programme intervention and without any such activity (Comparison group) were selected for the study. Among the study upazilas, four were comparison upazilas, three were with BRAC facilitated WASH programme intervention areas and the rest three were with other NGO-Ied intervention areas. A multistage 30-cluster sampling method was adopted and 420 households were selected randomly from every upazila for the survey. In selecting 30 villages from every upazila, interval-sampling method was used. KEY FINDINGS 1. Tubewell water was used predominantly for drinking in the study areas. Significantly higher proportion of households in the BRAC WASH areas used tubewell water for drinking than the comparison and other NGO intervention areas (p<0.001). 2. The expenditure for tubewell drilling was mostly covered by self arrangement (95.1 %) in the study areas. However, in BRAC WASH intervention areas 1.2% and in other NGO-covered areas 1.1 % tubewells were financed by NGOs. Households not having their own tubewell mentioned financial problem (90.8%) as the major reason for not being able to install tubewell. 3. Overall knowledge about the demerits of using arsenic-contaminated water in the comparison areas was found less than the NGO-Ied WASH intervention areas. Regardless of the NGO-facilitated WASH programme prevalence, social institutions (54%), NGOs (23.5%) and mass media (26.6%) were the most common sources of information for knowing the demerits of using arseniccontaminated water. 4. Significantly higher proportion of people in NGO intervention areas (either BRAe or other NGOs) mentioned to wash hands during critical times than the comparison areas. The overall hygiene practice among the households in the other NGO intervention areas with regard to all relevant issues was found higher than the BRAe WASH and comparison areas, since less proportion of respondents mentioned not to know about the hygiene issues (p<O.001). 5. Respondents from all intervention areas strongly opined for the necessity of NGO-Ied WASH programme for the improvement of safe water use (95.1%) and hygiene (95.8%) practices. 6. While asked about the source of information regarding safe water use and hygiene practices social institution and mass media were found predominant among all intervention areas. However, in areas with WASH programme intervention the respondents also mentioned NGO as a major information source. CONCLUSIONS The overall status of use of tubewell water and hygiene practices was found better in the NGO-Ied WASH intervention areas than the comparison areas. People mentioned about the effects of NGO interventions on the improvement of use of safe water and hygiene practices through the support for tubewell installation, arsenic testing, motivation and raising awareness through the village level committees organized by the NGOs. Majority of the respondents mentioned about the necessity of NGO intervention for ensuring 100% safe water use and hygiene practices. However, it needs more support (both tubewell supply and awareness activities) from
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), 2011-11) 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 intentions. 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 installments, which indicates that these households were aware of the benefits of safe water. Thus, BRAC WASH programme needs to pay further attention to these impediments at the household level in order to further improve the current situation.

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