Research Reports (1999): Health Studies, Vol - XXVIII

Permanent URI for this collectionhttps://hdl.handle.net/10361/12945

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Towards 2000: health scenario of Bangladesh
(BRAC Research and Evaluation Division (RED), 1999-02) Ahmed, Syed Masud; Chowdhury, A Mushtaque R
Targeted nutrition project at Muktagacha in Bangladesh: lessons learned
(BRAC Research and Evaluation Division (RED), 1999) Chowdhury, A Mushtaque R; Hyder, S.M. Ziauddin; Mahmud, Zeba; Chowdhury, Sadia A.
Millions of people suffer and many of them die from malnutrition in developing countries. BRAC, a non-governmental organisation in Bangladesh, has made significant progress towards planning and implementing nutrition programmes. Targeted nutrition interventions incorporated into programmes aimed at poverty alleviation significantly contribute to nutritional improvement.
Reproductive and sexual health promotion in a sensitive socio-cultural environment developing a module for the grassroots
(BRAC Research and Evaluation Division (RED), 1999) Hashima-e-Nasreen; Cash, Kathy; Chowdhury, Mushtaque; Bhuiya, Abbas; Ahmed, Syed Masud
The general population of Bangladesh is in poor health, has little access to health facilities, has increasing incidence of STDs and is in close proximity to countries with high rates of HIV/AIDS. Up to date little has been done to educate rural Bangladesh citizens about STDs including HIV/AIDS, RTls and other sexual and reproductive health problems. In 1997 a sexual and reproductive health project began in a rural community under the collaborative research model of two organizations, the International Centre for Diarrheal Disease Research (ICDDR,B) and the Bangladesh Rural Advancement Committee (BRAC), an indigenous non-governmental organization which pursues integrated rural development strategies. The goal of this project was to improve the sexual and reproductive health of rural women, men and youth in Bangladesh. The target population was a representative sample of the rural poor. Initial qualitative in-depth interviews with 65 different women, men, boys and girls revealed significant sexual health problems and experiences and little knowledge about treatment and prevention. Data from these initial interviews was transformed into a series of flip-charts which contained both sex education information and picture stories that mirrored risk behavior. Because of the sensitive nature of the topics, only those who had perceived legitimacy to talk about sexual health were identified and trained. Sixty eight health providers and 1890 community people were trained. Qualitative evaluations of health providers revealed significant changes in their knowledge and bt4iiefs about sexual health and disease. Health providers integrated the program into their ongoing work. Furthermore, they reported improvements in their selfconfidence, btJsiness, personal interactions with their family members and with their clients due to this program. In conclusion, this program demonstrated that a gender-sensitive sexual and reproductive health initiative could be a positive force for change in a rural Bangladesh setting.
Providing the urban poor with water and sanitation: an introduction
(BRAC Research and Evaluation Division (RED), 1999) Sharmin, Lammia; Rainer, Helga
Poverty alleviation programmes reduce inequities in health : evidence from Bangladesh*
(BRAC Research and Evaluation Division (RED), 1999) Chowdhury, A Mushtaque R
Over the previous two decades many poverty alleviation programmes have been implemented in developing countries. Evaluation of such programmes have traditionally looked at their success in increasing the income levels of participants but less on the broader goals of human well-being. This chapter looks a~ the poverty alleviation programme of BRAe, a large non-governmental organization in Bangladesh, and, based on a scientifically designed study, presents its impact on selected components of 'human well-being'. The study found better child survival and nutritional status in households served by the programme. Similar impacts were also found in other areas such as expenditure pattern, family planning practice and children's education. The likely influence of 'selectively bias ' on the above results is also discussed
Medical waste management: a review
(BRAC Research and Evaluation Division (RED), 2000-01) Akter, Nasima
A review of medical waste management systems was performed to understand (a) the various handling and disposal procedures in different countries. (b) the knowledge and awareness of individuals involved in medical waste generation. handling and disposal, and (c) the potential impacts of the waste stream on both human health and the natural environment. The purpose of the study is to provide direction for further study. Information was collected mainly from literature review and online search. It was found that a variety of methods were used by the medical facilities to dispose their wastes including burning, burial. entombing, selling, dumping, and removal by municipal bins. The waste disposal practice was found to be quite unsafe. and both clinical and non-clinical wastes were found to be thrown together. There was insufficient awareness of the magnitude of the medical wastes issue by concerned individuals at different levels from director or divisional head to tokai (waste pickers). One study (Akter et al. 1998) showed that the hospital staff including high officials. and waste "haulers" were not aware of the safe disposal and handling of hospital waste. Laboratory analysis showed severe contamination of infectious wastes to the environment. Children. adults. and animals all have the potential to come into contact with these wast.es which may pose severe health risks to them. There was no safety measure observed in dealing with waste disposal or laboratory analysis of infectious or hazardous diseases. The chemicals used for the staining and preservation of slides and for the sterilization and cleaning of equipment and surroundings are potentially harmful to the laboratory technician and the environment. Hospital wastes pose a significant impact on health and environment. From this study it can be said that there is an urgent need for raising awareness and education on medical waste issues. Proper waste management strategy is needed to ensure health and environmental safety. For further study, it is needed to collect more information on impacts. disposal and management to draw a clear conclusion. Need to collect information and examples from developed country or the country, which has sound medical waste management system. Find alternatives and appropriate technologies for developing countries. Need extensive study on this medical waste and its management aspects as well.
Managing pneumonia by community health volunteers: the case of ARI control programme of BRAC, Bangladesh
(BRAC Research and Evaluation Division (RED), 1999) Hadi, Abdullahel
The study examined the role of ARl management practices in improving the competency of community health volunteers in diagnosing and treating pneumonia among children. Data were collected by a group of research physicians who observed the performance ofa sample of 120 health volunteers in Bangladesh where BRAC has been providing community-based ARl control programme in 10 sub-districts since mid 1992. About 1,166 children aged 3-60 months were diagnosed and treated at the households by both the volunteers and physicians. The sensitivity, specificity and overall agreement rates in diagnosing and treating pneumonia were significantly higher among volunteers who had basic training and were regularly supervised. BRAC approach was flexible enough in replacing dropout volunteers by a system of in-service training. Findings revealed that an extended basic training for new entrants, frequent supervision and an integrated programme approach would further improve the programme. The study concludes that the diagnosis and treatment of pneumonia by the community health volunteers were possible at the households in developing countries if intensive basic training and close supervision of the service providers could be ensured.
Improving maternal knowledge of childhood acute respiratory infections (ARIs) in BRAC villages, Bangladesh
(BRAC Research and Evaluation Division (RED), 1999) Hadi, Abdullahel
The contribution of community-based ARI control programme of BRAC in improving maternal knowledge of acute respiratory infections in children was assessed. Data came from a cross-sectional survey of 2,938 mothers of under 5 year-old children residing in 200 randomly selected villages in two regions of Bangladesh. Three aspects of maternal knowledge such as clinical symptoms, preventive practices and home remedies were considered. While the achievement in improving knowledge had remained modest in BRAC villages, findings revealed that the programme was able to create an enable environment for change among women. The ARI promotional activities were suggested to be sensitive to the belief of mothers and their ability to understand. The chapter concludes that the ARI intervention had significance in improving maternal knowledge and points to the need of addressing more relevant issues in its intervention strategy for better performance.
Health and nutritional status of 'target population' in Kachua thana, Bangladesh: baseline survey 1999
(BRAC Research and Evaluation Division (RED), 1999) Hyder, S.M. Ziauddin; Roy, Rita Das; JalaI, Chowdhury SB; Yusuf, Harun KM
The state of nutrition in Bangladesh is precariously poor. The diet, being heavily deficient in calories and seriously imbalanced, leads to the obvious consequences of widespread protein-energy and micronutrient malnutrition among infants, children and women. This is a great loss of human resources potential for productivity and much of ·the low per capita gross domestic product (GOP) and low human development index (HOI) of the country (0.336) is attributable to this scourge of malnutrition. The overall health situation of the Bangladeshi population is also far below any acceptabie standard. This is particularly true for women and children with worst possible health statistics in terms of both morbidity and mortality. For example, the maternal mortality rate has been over 600 per 100,000 live births for many years. This has now improved slightly to about 470 per 100,000 live births. The latter figure is still one of the highest in the world. Similarly, 1 in 10 infant in Bangladesh does not live up to his/her first birthday; the infant mortality rate is around 80 per 1000 live births. The above circumstances had led the Institute for Integrated Rural Development (IIRD) to find out innovative and appropriate programs to overcome the deplorable health, nutrition and basic education scenario of the people of some selected areas in Bangladesh. The proposed project titled "Shadaron Shikha 0 Prathomic Shastho Sheba Prokolpo (SSP SSP)" has been formulated on the basis of that realisation. The Kachua Thana under Chandpur District is one such area where such a project has been taken up. On request from IIRD, the Research and Evaluation Division (RED) of BRAC undertook a baseline survey among the target households of the project area under Kachua thana of Chand pur District.
Diagnosis of pneumonia by community health volunteers: experience of BRAC, Bangladesh
(BRAC Research and Evaluation Division (RED), 1999) Hadi, Abdullahel
The study assessed the competency of community health volunteers in diagnosing pneumonia in children through simple clinical signs. Data were collected by a group of research physicians who observed the case management performance of 120 health volunteers in Bangladesh where BRAe has been providing community-based acute respiratory infection (ARI) control programme since mid 1992. About 1,166 children aged 3-60 months were diagnosed at household level using simple signs. Findings revealed that the health volunteers' competency in correctly diagnosing pneumonia and no pneumonia was quite high although they had difficulties in diagnosing severe and very severe pneumonia cases. Among the clinical signs such as coarse breath sounds and chest in-drawing, the correct diagnoses of pneumonia was lower than no pneumonia. Overall agreement rates for most signs were very high. The study concludes that the less educated health volunteers can also be effectively used in diagnosing pneumonia at grassroots level in developing countries.
Arsenic testing of newly installed tubewells and quality control
(BRAC Research and Evaluation Division (RED), 1999-04) Jakariya, Md.; Johnstony, Richard; Chowdhury, AMR
The presence of arsenic in groundwater in Bangladesh has aroused widespread concern. It is estimated that over half of the Bangladesh population are at risk of arsenic poising. The source of arsenic in drinking water is from the tubewells. There are over four million tubewells in Bangladesh. During 1997-1998, DPHE installed over 13,000 tubewells in a UNICEF supported Safe Water Supply Project .. At the request of UNICEF, BRAC test all the above mentioned tubewells for Arsenic contamination. In doing this, BRAC need a field kit and the quality of the testing was also assessed by simultaneous testing in a laboratory. The proportion of tubewells with an arsenic content above the acceptable limit (=1< 50 ppb) was found to be 4.27% of 12,604 tubewells tested. Tubewells above the accepted limit were painted red , whereas those within the accepted limit were painted green by the field testers. The quality of testing by the field testers was found to be high ana the effectiveness of the field kits was found to be adequate. DPHE have been relatively successful to avoid arsenic affected areas as the number of tubewells contaminated with arsenic above the acceptable limit was low. The sub assistant engineers also mentioned that one of the main reasons for not installing all the allocated tubewells particularly in the arsenic affected areas was due to arsenic contamination in ground water. Caretakers of each tubewell were given information on what to do if the tubewell tested arsenic contaminated. They were also given a leaflet provided by UNICEF containing information on arsenic and altenative safe water options.

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