Browsing by Author "Hashima-E-Nasreen"

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An assessment of clients' knowledge of family planning in Matlab
(BRAC Research and Evaluation Division (RED), 1996) Hashima-E-Nasreen; Chowdhury, Mushtaque; Bhuiya, Abbas; Rana, AKM Masud; Caldwell, Indrani Pieris
The study aimed to assess the level of effective knowledge of women on different family planning methods to see the impact of quality of care. The study was carried out in two villages chosen from ICDDR,B intervention and comparison areas of Matlab thana where BRAC's Rural Development Programme (RDP) has also been working since 1992. From both the areas 600 women of reproductive age were randomly selected and interviewed. The findings reveal that in the MCH-FP area 56% of women practiced family planning while only 33% did so in the comparison area. In both the areas the main methods used were pills and injectables. Regarding the knowledge of contraceptives, most women in the MCH-FP area were able to name five modem methods while the majority in the comparison area could name only three methods. Virtually all women in both the villages could describe the nature of the pill and ligation while many had no idea about IUD and condom. Correct categorization of methods as temporary or permanent was found to be higher in the MCH-FP area than in the comparison area. The study found that women in both the areas had little or no knowledge of the specific indications of all methods. The majority of women in the MCH-FP area knew about proper use of pill, injection and condom compared to those in the comparison area where none had complete knowledge regarding any method. However, even in the MCH-FP area women did not know what to do if two pills were missed. The nature and the function of the brown tablets were not known to the women in the comparison area but some women in the MCH-FP area had some idea of the furmm. . In the MCH-FP area 78.4 % of the women knew the specific date of menstrual period from which injection should be started compared to the comparison area where only some of them knew about that. The majority of respondents in both the areas knew that it should be taken regularly at an interval of three months on a· fixed date. which was significantly higher in the MCH-FP area. The study found that maj~rity of women in the MCH-FP area knew the exact time and frequency of using condom compared to the comparison area where only a few .knew that. This is not surprising given that only a small proportion of women in the comparison area ever heard of condoms and that none of the couples were using it. \Vomen had no knowledge about the timing of insertion of IUD, but only that it had to be replaced periodically at an interval of2-4 years. - Women's general perception about the mechanism of action of the different methods was that they act by damaging the sperm or ovum. Women had no clear idea about the advantages of any of the methods. It was found that most of the women in the MCH-FP area were interested in injection, as the main advantage was that one injection provided three months' protection and maintained privacy (as it was administered like any other injection). This was specially appreciated by those who were shy about using contraceptives. Women had little knowledge of the side-effects of contraceptive methods. The commonly mentioned side-effects of pill and injection were: giddiness, weakness, headache, and irregular and heavy menstrual bleeding. Some respondents mentioned that injection caused prolonged amenorrhoea which in tum caused bodyache, and burning sensation in hands and feet. The women in the MCH-FP area had misconceptions about condoms such as that it might cause genital ulcer. The side-effects of ligation were more often assumed than actually experienced.
Communication network in reproductive health information dissemination to the adolescents
(BRAC Research and Evaluation Division (RED), 1997-12) Hashima-E-Nasreen; Chowdhury, Mushtaque; Bhuiya, Abbas; Ahmed, Syed Masud; Aziz, Ayesha; Rana, AKM Masud
Early childhood development: child -to-child approach
(BRAC Research and Evaluation Division (RED), 2004-03) Hashima-E-Nasreen; Ahmed, Syed Masud
In Bangladesh, programs for children up to five years have been directed to ensure their survival, physical growth and good health. There is no nation wide structured program that addresses the cognitive, emotional, and social development of young children, resulting in lost opportunities to develop full potential of the child during the early years. Taking this into consideration, the Early Childhood Development (ECD) program has been initiated in the current country program cycle (2001-2005) of the Government and UNICEF. One of the strategies is to accomplish this through "Child-to-child approach", a time honoured system by which older children is taking care of their younger siblings. The objective of the child-to-child approach is to provide adolescents with the knowledge and skills to interact creatively and effectively with the young children, and to develop skills of critical-thinking and problem solving.
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.
Newborn care practices in Nilphamari District of Bangladesh after a year of maternal, neonatal and child health intervention
(BRAC Research and Evaluation Division (RED), 2008-12) Choudhury, Nuzhat; Hashima-E-Nasreen
This study aimed to describe newborn care practices in an area where maternal, neonatal and child health (MNCH) intervention is being implemented, and to assess the effect of such intervention on newborn care. A cross sectional survey was carried out on 600 mothers to describe newborn care practices in Nilphamari district of Bangladesh. Logistic regression was used to identify socio-demographic, ante-natal and delivery care factors that were associated with newborn care practices. Mothers who had at least three ante-natal care visits had significantly better newborn care practice. Likewise, the presence of an individual trained in newborn care management was significantly associated with better newborn care. The association between 'newborn care practices' with 'ante-natal care visits' and 'presence of trained person in delivery' suggests that evidence-based newborn care practices can be promoted through community-based health worker with existing health services.
Oral administration of misoprostol reduces postpartum Haemorrhage in urban slums of Bangladesh
(BRAC Research and Evaluation Division (RED), 2013-04) Banu, Morsheda; Nahar, Shamsun; Hashima-E-Nasreen
To avert deaths from postpartum haemorrhage (PPH), Manoshi initiated community health workers (CHW) administered oral misoprostol (400~g) to women following childbirth either at delivery centers or home in slums of Dhaka and under Gazipur City Corporation in 2009. To study whether the supervised use of misoprostol would reduce primary PPH following childbirth including its feasibility and community acceptability. A non-randomized control trial was undertaken among 3,900 women in urban slums of Dhaka and Gazipur City Corporation during January-August 2011 . Oral misoprostol was prophylactically given to the treatment group following childbirth, while the control group did not receive it. The misoprostol significantly reduced incidence of primary PPH in the intervention group (4.5%) compared to the control group (7.5%). The median blood loss of PPH cases was 868 ml in the treatment and 928 ml in control group. It reduced the rate of bleeding-related emergency transfer, additional medical interventions compared to control group. However, no significant difference was found in blood transfusion between the two groups. We found one-third of the women were aware about misoprostol in intervention while none were aware in the control. The median risk for developing PPH was lesser in the intervention and prolonged third stage of labour found significantly higher in the control group. Misoprostol was found to be widely accepted in the community and feasible to offer parturient by CHWs within 5 minutes following childbirth in intervention group. Prophylactic use of misoprostol administered by CHWs is feasible and effective in reducing the incidence of primary PPH in the parturient of slums of Bangladesh. Besides, community-based education on misoprostol and iron intake throughout pregnancy to reduce the need for blood transfusion should be ensured.
Providing AIDS awareness education through village based women’s organization
(BRAC Research and Evaluation Division (RED), 1997-11) Hashima-E-Nasreen; Chowdhury, Mushtaque; Ahmed, Syed Masud; Bhuiya, Abbas; Rana, AKM Masud
Objectives: This study aimed to assess the effectiveness of a basic AIDS education module delivered through grassroot NGO network in rural Matlab, Bangladesh. It also explored the level of dissemination of knowledge gained by the BRAC members to their spouses and neighbours. Methods: Some basics of AIDS awareness education was provided to the local BRAC staff, shasthya shebika (village health workers) and village women through a one-day training workshop, village organization meetings and campaign. Two surveys, one before intervention (baseline) and the another after intervention were carried out in 10 villages of Matlab RDP area where BRAC is working either alone or jointly with ICDDR,B. A total of 788 BRAC members, their husbands and neighbours were surveyed randomly using a pretested structured questionnaire covering sociodernographic information, respondents' knowledge on what HIV/AIDS is, its transmission, facts and myths of HIV/AIDS, prevention and high risk behaviour/population. Pre- and post intervention findings were compared. Appropriate statistical tests were done where needed. Results: The analysis showed significant improvement in knowledge of BRAC members following intervention. This improvement was not seen in case of neighbours and husbands. The dissemination of knowledge from the BRAC members to their neighbours and husbands was found to be very poor. Conclusion: Findings of this study would be helpful for the policymakers in formulating low-cost strategies for effective IEC on AIDS through grassroot NGO network in rural Bangladesh.
Quality of care an overview
(BRAC Research and Evaluation Division (RED), 1995-06) Afsana, Kaosar; Hashima-E-Nasreen
Relapse of tuberculosis in rural areas of Bangladesh
(BRAC Research and Evaluation Division (RED), 1996-04) Islam, Md Nazrul; Mahmud, Shah Noor; Ali, Ahmed; Afsana, Kaosar; Hashima-E-Nasreen; Islam, Md. Akramul; Chowdhury, AMR; Chowdhury, Sadia A
The study conducted to investigate the relapse rate of TB in two thanas (KahaIoo and Furbari) of ' Women's Health and Development Programme (WlIDP) in August 1995. Of the 482 study cases, 435 (900A» treatment completed cases were interviewed, 4.7% died, 2.7% migrated and the rest did not response. The overall relapse rate was 4.10/0. Relapse rate was more than double (6.6%) in Kahaloo compared to Fulbari thana (3%). The rate was found to be highest among those who completed treatment for more than two years. Ten out of 18 relapse cases were identified by the TB control programme of WHDP. All the relapse cases were previously treated with anti-TB drugs for more than two months before the initiation of BRAC treatment Routine sputum examination for cured patients with complains of cough might be a strategy for identification of an relapse cases on time.
Reproductive tract infections and sexually transmitted diseases in a rural area of Bangladesh: insights for action from research
(BRAC Research and Evaluation Division (RED), 2001-06) Hashima-E-Nasreen
Objectives: The study aimed· to assess the magnitude of problem associated with RTis/STDs in rural Matlab, Bangladesh. It estimates the prevalence and attempts to explore the risk indicators for RTis and STDs among people of different age group within the existing socio-cultural context. Methods: A combination of qualitative and quantitative research methods was utilized. Indepth interview, focus group discussion, and a cross-sectional survey of randomly selected men, women, and adolescent boys and girls were the main methods employed. The ICDDR, B surveillance database provided the sampling frame. Results: About 19% of people in Matlab have had STDs. Lack of awareness, risky sexual behaviour, lack of accessibility and availability of adequate services, traditional and unhygienic health practices, absence of programme efforts, and illiteracy and poverty were the prevalent soia-cultural factors that potentially has put people at risk of RTis, STDs as well as HIV/AIDS epidemic. The bridge between non-commercial and commercial partners was laid by men whom work in urban area push up the likelihood of infection from the high risk (urban) to low risk group of women in the village. Risky sexual behaviour was also prevalent among adolescents. Partners' communication and treatment seeking behaviour were found to be very poor among adults and not at all among adolescents. There is a need for collaborative action addressing rural people's riskassessment component. Conclusion: To avert the situation, a holistic approach should be adopted with greater emphasis on RTI/STD control and prevention together with human relationship, communication , gender, family interaction and socio-economic status that would determine the nature and extent of people's risk and vulnerabilities. Because of the sensitivity of issue, it is important to think about how to achieve community acceptance. so that programme can expand and sustain itself.
Telling them their own stories : legitimizing sexual and reproductive health education in rural Bangladesh
(2001) Cash, Kathleen; Khan, Sharful Islam; Hashima-E-Nasreen; Bhuiya, Abbas; Chowdhury, Sadia; Chowdhury, A. Mushtaque R.
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.
Without sex education : exploring the social and sexual vulnerabilities of rural Bangladeshi girls and boys
(2001) Cash, Kathleen; Hashima-E-Nasreen; Aziz, Ayesha; Bhuiya, Abbas; Chowdhury, A. Mushtaque
Without sex education: exploring the social and sexual vulnerabilities of rural Bangladeshi girls and boys
(2001) Cash, Kathleen; Hashima-E-Nasreen; Aziz, Ayesha; Bhuiya, Abbas; Chowdhury, A. Mushtaque R.; Chowdhury, Sadia
Women focused development intervention reduces neonatal mortality in rural Bangladesh: a study of the pathways of influence
(BRAC Research and Evaluation Division (RED), 2003-05) Hashima-E-Nasreen; Bhuiya, Abbas; Ahmed, Syed Masud; Chowdhury, Mushtaque
Background: There has been a substantial reduction in hazard of childhood death in Bangladesh over the last decade. The reduction was much greater in case of infants whose mothers participated in the development program. However, the pathways through which development interventions influence neonatal survival remain to be explored. Objective: Study the impact of BRAC's women focused development interventions on neonatal mortality in Matlab. Methods: A case-control study comprising 117 cases (died within 28 days) and 351 controls (live children taken from the nearest door of cases) born during the year 1999- 2000 was employed. Twelve case studies from both cases and controls were done to complement the quantitative data. ICDDR, B surveillance database provided the sampling frame. The risk ratio was estimated to see how BRAC program participation reduces risk of mortality, and stratified analysis was done to see the effects of third variables over the association. Finally, log regression was done to see the net effect of variables on neonatal death. Results: Neonates of BRAC non-members were at 1.9 times increased risk (CL; 1.09- 3.25) of dying compared to neonates of BRAC members. This association works through two intermediate variables including antenatal care and family planning. Mothers' age and fathers' occupation acted as confounders over this association. Physical violence against mothers and psychological stress, pre-maturity and low-birth-weight had respectively 2.2, 1.7, 13 and 2 times increased risk of neonatal death. However, BRAe membership did not have any influence over these factors. When simultaneously accounting for all variables in a multivariate log regression, a dose response association was maintained for antenatal care, family planning, physical violence and pre-maturity. Conclusion: There has been a substantial reduction of neonatal morality among mothers who participated in BRAC intervention. For an effective reduction of these deaths, program planners should think about ways to address all risk factors together rather than antenatal care and family planning alone. Acknowledgements: The financial support of the Ford Foundation and Aga Khan Foundation is acknowledged.