Browsing by Author "Islam, Md. Akramul"

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An assessment of the social mobilization and accountable local governance towards creating MDG union’s project
(BRAC Research and Evaluation Division (RED), 2013-03) Chodhuary, Shuburna; Islam, Md. Akramul; Akther, Jesmin
Community Empowerment Programme of BRAC and The Hunger Project Bangladesh jointly embraces a participatory approach towards creating Millennium Development Goal unions in Mymensingh district. The study aimed to assess the achievement of this project. A quasi-experimental design including pre-test and post-test surveys was used to assess the achievement of the project. Both quantitative and qualitative techniques were used. A total of 2,007 households in experimental and 1,963 households in control areas were surveyed. Besides, to compare the findings with baseline data were extracted from 1,971 households in baseline. The findings reveal that in experimental areas households were performing better than those in control and baseline areas particularly in children (6-10 years) enrollment rate in primary education, adult literacy rate, knowledge on HIV/AIDS, childhood immunization rate, safe water, sanitary latrine facility and participation in training in income generating activities. However, there are still some challenges which needed to be addressed such as treatment-seeking behaviour during pregnancy, birth registration, and common people satisfaction on local government. Thus, the project should emphasize the above mentioned issues to achieve the objectives of project.
Assessment of BRAC’s enhancing social capital project
(BRAC Research and Evaluation Division (RED), 2011) Islam, Md. Akramul; Khan, Ashrafuzzaman
BRAC embraces a holistic approach towards development that is integrated with village organization (VO). To uphold and maintain the integrity and norms of BRAC VOs, Community Empowerment Programme (CEP) of BRAC initiated the Enhancing Social Capital (ESC) project in 2010. This study aimed to assess the progress in VO discipline in ESC project areas. We used a quasi-experimental design to understand the achievements of this project. Both quantitative and qualitative techniques were used to collect data from 264 VOs representing experimental and control group. The findings reveal that experimental VOs were performing better than control ones, particularly in sanitation, family planning, VO discipline, participation in local shalish, etc. The location of VO sometimes constrained project’s staff in attending VO activities in time. Thus, coordination between ESC and micro-finance staff should be improved to achieve ESC project objectives.
Beyond drugs: TB patients in Bangladesh need urgent attention for nutrition support during convalescence
(BRAC Research and Evaluation Division (RED), 2013-03) Islam, Qazi Shafayetul; Ahmed, Syed Masud; Islam, Md. Akramul; Kamruzzaman, Md.; Rifat, Mahfuza
Tuberculosis (TB) is a global disease, which is responsible for 1.4 million deaths each year (WHO 2010). Bangladesh is the sixth highest TB-burden country in the world. TB treatment may be complicated when malnutrition also coexists in patients. TB has been found to coexist with malnutrition among patients at the beginning of treatment in both developed and developing countries (Zachariah eta/. 2002, Onwubalili JK 1988, Kennedy et at. 1996, Harries et a/. 1988). Nutrition supplementation can play an important role in improving the disease condition to reduce further morbidity and mortality. Some TB-burden countries have already started food supplementation programme for patients' healthy life (Farmer eta/. 1991, Karyadi et a/. 2002, Paton et a/. 2004, Aye and Wyss 2009). There is no nutrition intervention programme for patients in DOTS (Directly observed treatment, short course) approach to TB treatment under National TB Control Programme (NTP) of Bangladesh, where malnutrition is prevalent. Even, Bangladesh does not have much information about the nutritional situation of TB patients to formulate nutrition intervention. To fill-in this knowledge gap and help in informed design of a nutrition intervention for TB patients, this study measured the nutritional status (using Body Mass Index or BMI) of TB patients before, at two months, and after completion of TB treatment (DOTS) to study the changes during treatment and its relation with various socioeconomic and demographic factors including household food availability and consumption.
Changes in knowledge and attitudes of school girls towards sexual harassment and its incidence: an impact assessment of the MEJNIN programme
(BRAC Research and Evaluation Division (RED), 2013-12) Chodhuary, Shuburna; Islam, Md. Akramul; Akter, Jesmin
Gender Justice and Diversity unit of BRAC had a project on sensitizing young people especially girls and community people about sexual harassment in selected areas in Dhaka city in 2011 so that they might act as an individual and collective changemaker and protect, protest and resist such incidence. This study aimed to look into the changes in knowledge and attitudes of those school girls regarding sexual harassment and the changes in reporting rate about the issue as mentioned. Findings show that most of the girls in the intervention areas had better knowledge and appropriate attitudes about sexual harassment compared to the girls in control area. Besides, the reporting rate of the incidence of harassment in the project area was reported much higher compared to the area where there was no project. Different measures were suggested by the girls to combat sexual harassment at school, on the way to school, at home, at workplace and at other places.
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.
Exploring the causes and process of becoming child domestic worker
(BRAC Research and Evaluation Division, 2013-01) Chodhuary, Shuburna; Islam, Md. Akramul; Akter, Jesmin
The study aimed to explore the demographic and socioeconomic characteristics of households with and without Child Domestic Workers (CDW), and explore the causes and process of becoming CDWs in Bangladesh. Both quantitative and qualitative approaches were used to collect data. A purposive sampling technique was applied to select the sample locations. Data were collected from six districts of Bangladesh: Mymensingh, Kishoreganj, Jamalpur, Bhola, Kurigram, Chapai Nawabganj, and a slum of Dhaka city. A total of 1,564 (rural 1,454 and urban 110) parents of with and without CDWs were interviewed. Ten in-depth interviews with CDWs were conducted. The findings reveal that small income, poor savings, marginal land, less access to NGO services, and sickness of main income earner in the family were the causes that compelled parents to allow their children in CDW. The findings also strongly observed that poverty is the root cause to engage children in domestic work. Finally, it was also seen that neighbours, relatives, employers, and middlemen as the intermediary were effective and influential too for CDW in both the study areas. However, parents and CDW herself/himself in urban areas were the most instrumental factors to get into domestic work. Ensuring economic empowerment, educational facilities, health services, and raising awareness on child rights among the households with and without CDWs through BRAC programs could slow down children’s involvement in domestic work.
Knowledge and practice of formal physicians regarding control and prevention of TB in light of national guidelines
(BRAC Research and Evaluation Division (RED), 2013) Islam, Qazi Shafayetul; Ahmed, Syed Masud; Islam, Md. Akramul; Islam, Shayla
The study explored the current knowledge and practice of interns and general physicians regarding control and prevention of tuberculosis in light of national guidelines. The study was conducted on 13 public and seven private medical college hospitals to collect information from intern physicians, and the general physicians who were practicing in a half kilometer radius of each medical college. A total of 1474 intern physicians and 539 general physicians participated in the study. It was a self-administered survey. About three-fourth of physicians (75%) had knowledge about community based TB control programme. However, Only 36% reported that they knew details about the programme. Despite majority (90-96%) had comprehensive knowledge on TB as a major public health problem in Bangladesh but, many of them (70%) did not express their intention to become involved in TB control. Because 92% did not know that the main vision of TB control programme (TB would no more as a public health problems). The knowledge score was constructed on 17 knowledge variables regarding basic and clinical aspects of TB. 61% of intern physicians had adequate knowledge (mean scores~ 1 0.82) unlike among general physicians where as it was 44%, (p<0.0001). The logistic regression depicts that physicians were more likely to be knowledgeable when they were aware of national guidelines for TB control (AOR 2.16, 95% Cl: 1.36, 3.44), when physician had access to more sources of TB information (AOR 1.43, 95%CI: 1.1 0, 2.36), more duration of TB information sharing (>6 hours) (AOR 3.10, 95% Cl: 2.37,.07). We also found, male physicians were less knowledgeable than that of female physician (AOR 0.77, 95% Cl: 0.63, 0.95). The majority of physicians treated TB suspects with antibiotics (40-6%), and only advised for further tests (39-44%). Majority of interns and general physicians did not follow the NTP guideline of three mandatory visits of patients to health facilities for follow up during treatment period. Still significant proportion of physicians (37 -50%) did not refer TB patients and suspects for further investigations and services to the nearest DOTS corner. Majority would not ask for X-ray for further investigation when they got two negative results out of three sputum examinations. Onethird of physicians (39%) perceived that medical curriculum was not sufficient for practicing TB (39%). A great majority of physicians (75%) confessed that they sought TB information beyond classroom. In conclusion, they seriously lacked knowledge regarding its clinical aspect of TB management in light of national guidelines. Most of them did not know the details activities of TB control programmes, and did not follow the national guidelines in managing TB patients. Activities of National TB progamme should be visible more. Guidelines should be incorporated in the final year medical curriculum. Appropriate tools, protocols and customized training packages need to be developed for intern and general physicians.
Mother knowledge and health-seeking behavior towards childhood TB
(BRAC Research and Evaluation Division (RED), 2013-03) Islam, Qazi Shafayetul; Ahmed, Syed Masud; Islam, Md. Akramul; Shatil, Tanvir; Siddique, Zakia Sultana
Introduction: BRAC in association with NTP recently started the community-based child TB programme. So far, no independent study has been conducted to explore the extent to which the objectives of the programme have been achieved in terms of raising knowledge about child TB, and changing health-seeking behavior. This study uses quantitative method to evaluate the knowledge, attitude and practices of mothers towards childhood TB. Methods: The study was a cross-sectional in nature and it included mothers (257 in numbers) as respondents on behalf of child TB patients. Structured and semi-structured questionnaires were applied to elicit information. The study involved interviewing 157 BRAG health workers (Shasthya Sebika. SS) to explore their knowledge regarding childhood TB. Results: Both BRAG health workers (47%) and mothers (35%) did not have adequate knowledge about the primary risk source for child TB (closeness of contact). The knowledge of SSs (13-38%) and mothers (7-40%) regarding BCG and isoniazid therapy as a preventive strategy of TB was inadequate and similar. Both the health workers and the mothers had comprehensive knowledge about sputum test (67-78%) and X-ray (63-77%) for detecting TB in children except about tuberculin test (27-28%). Clinical symptoms like low grade fever (80-88%) and chronic cough (73-83%) were well known to them, but weight loss was not noted profusely (20-54%). Majority of SSs (61 %) and the mothers (47%) perceived that TB in children was dangerous. About half of SSs (50%) had high stigma. One-fourth of mothers (27%) did not want to disclose their child's TB due to fear and 35% of them became frustrated due to it. The time between the onset of symptoms and diagnosis of TB among children was 60 days (mean). The majority of child TB patients were aged between 11-14 years (46-65%) followed by 6-10 years (23-28%). More than one-third of the children (38%) had exposure to TB patients at home, and 16% to neighborhood TB patients. About 4 7% of mothers' children received treatment from informal providers at first time. The providers commonly prescribed cough syrup (41%), tablet for fever (40%) and antibiotics (37%). About 55% of mothers went to providers more than four times before diagnosis of her child's TB. The majority of detected cases were diagnosed at district (23%) and private hospitals (30%). A significant majority of children (85%) referred to BRAG for treatment. Conclusion: Programme should organize special training on child TB for awareness of health workers. Strong collaboration between NTP and local communities are required to develop social mobilization, and sensitization in disseminating childhood TB information. Healthcare providers need to set schedule to provide education, increase awareness of contact case screening, early identifying and treating TB infection and disease in children.
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.
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.
Tuberculosis in 'hard to reach' areas: misperceptions, knowledge, health-seeking behaviour, and challenges
(BRAC Research and Evaluation Division (RED), 2013-03) Islam, Qazi Shafayetul; Ahmed, Syed Masud; Islam, Md. Akramul; Roy, Sanjit; Rifat, Mahfuza
This study was conducted to explore the knowledge and perceptions of health workers and community people about tuberculosis in geographically inaccessible (hard-to-reach) tuberculosis (TB) programme areas of BRAG. The study also explored the health seeking behaviour of TB suspects (having cough >3weeks) and challenges faced by the programme in this particular situation. This cross-sectional survey was conducted in 15 'hard-to-reach' upazilas (out of 30 such upazilas), and another 15 upazilas, adjacent to the above upazilas and selected randomly for comparison. The study included 338 health workers (Shasthya Shebika or SS), 3,600 community people, 1,800 TB suspects and 1,800 non-suspects. Two modules of questionnaires (structured and semistructured) were developed for the health workers and the community people. The study found that the misperception that TB is 'a disease of only male' was common among the health workers (44%) and community people (46-57%). Further, many of them misperceived the common ways of acquiring TB such as by sharing patients' utensils (46-49%), smoking (80-87%), and that TB could be prevented by avoiding smoking (58- 63%). Almost half of the SSs (49%) could not recall at least four messages on TB that they learned from training. Many of the SSs confessed that they were not involved (64%) in delivering TB messages in the community, and a significant numbers of SS (41 %) were not motivated to work in the TB control programme. The community people lacked basic information on TB. Further, almost about half of the community people ( 41-4 7%) were afraid of TB in both the study areas, and a majority of community people (52-56%) reported that they wanted to stay away from the TB patients. The study further found that one-third did not take any treatment for their illness (median duration of illness being six weeks), and two-third did not undergo sputum test. The main sources of treatment of TB suspects were village doctors (26-35%) and attendants at drug shops (35-36%). The geographical distance, treatment noncompliance, and lack of trust in SSs' management were identified as the major constraints in hard-to-reach areas for implementing TB programme efficiently. The implications of these in management of TB control programme are discussed and recommendations are made.