Browsing by Author "Mahmud, Shah Noor"

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An implementation guide for the Arsenic mitigation program
(BRAC Research and Evaluation Division (RED), 2002-11) Ahmed, Munir; Jakariya, Md.; Quaiyum, Md.; Mahmud, Shah Noor
Assessment of birth and death recording activities in reproductive health and disease control programme of BRAC
(BRAC Research and Evaluation Division (RED), 1996-07) Ali, Ahmed; Mahmud, Shah Noor; Islam, Md. Nazrul; Karim, Fazlul; Public health; Medicine, Preventive; Health planning; Health surveys--Bangladesh.
This report attempts to determine the accuracy of· recording births, deaths and stillbirths in all the 30 areas of 10 thanas former Women's Health and Development Programme (presently Reproductive Health and Disease Control Programme - RHDC) in 3 regions. One unit (village) having 250-300 households were randomly selected from each area. The survey was conducted during April-May 1995.
Building community based arsenic mitigation response capacity in four upazilas of Bangladesh
(BRAC Research and Evaluation Division (RED), 2002-06) Hossain, Md Zabed; Mahmud, Shah Noor; Jakariya, Md.
BRAC in collaboration with DPHE and 'UNICEF implemented the project entitled "Building community based arsenic mitigation response capacity" during July 2001 to June 2002 in four upazilas named Barura, Haimchar, Bahanga, and Monirampur of Comilla, Chandpur, Faridpur, and Jessore districts respectively. The objectives ofthe project are to (i) raise awareness among the community (ii) determine the extent of arsenic contamination in all tubewell water in the project areas; and (iii) develop resource maps of different villages of the project area to locate safe water sources. The activities executed in the project were creation awareness among the people through training, workshop, formation of different types of arsenic mitigation committees, training for tubewell testing and blanket tubewell testing, providing technical advice on safe water and collation and dissemination of knowledge generated and lessons learnt. At the upazila level, upazila project co-ordinator ofBRAC actively participated at upazila monthly co-ordination meeting in order to appraise different stakeholders and government officials about activities and progress on arsenic mitigation. BRAe provided quarterly report to the co-ordination committee. A working committee was formed whereby local DPHE and BRAC project personnel worked together to plan and review different project activities and its progress. A total of85937 shallow tubewells, among those 21003,26339,3585 and 35010 in Bhanga, Barura, Haimchar, and Monirampur upazilas respectively were tested. Among the four upazilas the highest contamination was found in Bhanga (91 %) and the lowest was in Monirampur (51 %). A total of 378 deep hand set tubewells were tested in the project areas. Among these deep hand set tubewells only 14 (3.7%) were found to be contaminated with arsenic of above permissible 153 limit. In the four upazilas a total of 14989 irrigation wells were tested ofthose 70% were found contaminated. Field testing of the tubewells for arsenic was validated by laboratory analysis using AAS (Atomic absorption spectrophotometry). It was found that the field testers did reasonably well in testing the tubewells. The percentage of correctly tested tubewells (green-green and red-red) was 92% and 90-91 % respectively. There was no significant seasonal variation in concentration of arsenic in tubewell water. Achievement in fonnation of arsenic mitigation committees was 100% at the Upazila level to Ward level in all the four upazilas. In case of fomlation ofY AMC achievement was from 84 to 100% in the project areas. Success in fulfilling the target of organizing meeting in the committees ranged from 63 to 95% in the villages of the project areas. The following issues were encountered during the course of the project implementation below. • Number of communication materials like routine card, flash card, leaflet, posters were not adequate in number. • Although training was arranged for the communication officers of the project but there was no manual for using these materials in written fonn. • Although the Imams of the mosques were found very vital in disseminating the messages on arsenic it was not possible to give orientation and training due to inadequate logistics. • The owners of the restaurant or the teashop were found erasing red paint of the tubewells which were found arsenic and they marked those tubewells with green paints. • In few cases the members of the committees did not work spontaneously since there was no provision of incentive as they expected against their services.
Competence of the programme organizers in antenatal care an issue of the quality of care
(BRAC Research and Evaluation Division (RED), 1996-04) Afsana, Kaosar; Chowdhury, AMR; Mahmud, Shah Noor; Karim, Fazlul
Experiences gained in tackling the arsenic disaster: final report on arsenic mitigation project in Sonargaon and Jhikorgachha
(BRAC Research and Evaluation Division (RED), 2002-06) Hossain, Md Zabed; Mahmud, Shah Noor; Jakariya, Md.
This report describes the experiences gained in the "action research on community-based arsenic mitigation project" implemented by BRAC in Sonargaon and Jhikorgachha upazilas of Bangladesh. The project was implemented in two phases. The first phase of the project was implemented during the period from June 1999 to December 2001 . Experiences of the phase 1 have been described in BRAC report (Chowdhury et a!. 2000). After completion of the phase 1 of the project some further works and follow-up activities were carried out during January 2001 to December 2001. The objectives of the phase 11 of the project were to: (i) assess the present status of arsenic concentration in all green, cross and at least 10% of the red tubewells marked in Phase I; (ii) involve community members in choosing, financing, implementing, and maintaining alternative sources for safe drinking water; (iii) provide alternative safe \I'later options with active participation from the communities; (iv) identify arsenic affected patients in the project areas and provide treatment or referral whichever is appropriate; (v) make community people aware of dangers of arsenic poisoning; and (vi) develop a system involving local communities and local level officials in different phases of the project activities for the long-term sustainability of the safe water implementation plan. A total of 2(),058 tubewells, 10,062 from Sonargaon and IS,<)9() from .Jhikorgachha was selected for re-testing in the Phase 11. from the monitoring of the tube wells for more than two years it was found that there was no significant change in the concentration of arsenic in the tubewell water in both the project areas.
Financing the BRAC Health Centres: their financial sustainability and cost-effectiveness
(BRAC Research and Evaluation Division (RED), 1998-01) Khan, Suhaila H; Mahmud, Shah Noor; Karim, Fazlul; Afsana, Kaosar
The Health ana Population Division (HPO) of BRAC aims to provide supportive secondary level health care services for the community through the BRAC Health Centres (BHCs) or Shushasthyos. The BHCs began operating in HPO areas in 1995. As of January 1998 there were 27 BHCs. All BHCs function through user fees in order to make the BHCs financially sustainable in the long run. HPD is endeavoring strategic planning in order to reduce donor dependence and meet the projected resource gaps through the implementation of certain systems such as, cost recovery and cost sharing through the BHCs, to ensure financial sustainability in the long run. The Research and Evaluation Division (RED) of BRAC aimed to evaluate how much cost recovery was occurring at the BHCs which contributed to BHCs' financially sustainability, and what modifications need consideration to support enhance this sustainability. This was a health facility based study done in 9 BHCs in three regions. Mymensingh, Bogra and Dinajpur. The variables considered for this study were related to cost. revenue, cost sharing and effects. The average or unit cost of operating a BHC was Tk. 422.092. The recurrent cost was Tk. 403 ,547 and capital cost was Tk. 18,545. Average income per BHC was Tk. 89,631. The cost recovery was 22% of recurrent costs and 21% of total costs. And if we considered the variables similar to HPD then cost recovery was 35% of recurrent costs and 33% of total costs. 23% of the indicators mentioned in the monthly disease profile cover gynaecologicals conditions. These constitute about 11% of the total general diseases being identified and/or treated at the BHCs. This is only possible due to having a facility such as a BHC. The unit cost per patient visit was Tk. 93. Some interventions, such as ANC and GM done at BHCs seemed to be cheaper compared to previous findings of WHOP and RDP-PHC.
Knowledge and practices of NFPE-AG graduates regarding menstruation
(BRAC Research and Evaluation Division (RED), 1996-09) Ali, Ahmed; Mahmud, Shah Noor; Karim, Fazlul; Chowdhury, AMR
BRAC canied out a two-year Non-Fonnal Primary Education Programme for Adolescent Girls (NFPE-AG) as part of its fanner Women's Heath and Development Programme (WHOP) to increase basic literacy and nwneracy skills as well as awareness on reproductive health, nutrition and social issues. The first phase of .NFPE-AG was started in September 1991 through 1000 schools in 10 thanas of WHDP and ended in August 1993. This study was undertaken to assess the level of knowledge retained vis-a-vis practices ofNFPE-AG graduates regarding menstruation. A total of 30 fonner NFPE-AG schools (closed 2 years back) were selected from 6 WIIDP areas (5 schools from each area). From each schooL 7 NFPE-AG graduates aged 15-19 years who did not continue their study in fonnal schools after graduation were selected. Seven other girls aged 15-19 years with no schooling (NS-AG) were selected from the adjacent villages of each fanner NFPE-AG school as comparison group. Thus, a total of 420 adolescent girls (210 from each group) were interviewed in January 1996.
Knowledge of NFPE-AG graduates on reproductive health and nutrition
(BRAC Research and Evaluation Division (RED), 1996-08) Ali, Ahmed; Mahmud, Shah Noor; Karim, Fazlul; Islam, Md. Nazrul; Chowdhury, AMR
BRAC educated adolescent girls through its Non-Fonnal Primary Education Programme for Adolescent Girls (NFPE-AG) as a component of its fonner Women's Heath and Development Programme (WliDP). The aim of the NFPE-AG programme was to increase the literacy and numeracy skills . as well as awareness on reproductive health, nutrition and social isSues~ The first phase ofNFPE-AG was started in September 1991 through 1000 schools in 10 thanas of WHDP and ended in August 1993. 1bis study was undertaken to assess the level of knowledge retained by NFPE-AG graduates regarding reproductive health and nutrition issues such as marriage, pregnancy, safe motherhood and contraception, delivecy, lactation, anaemia, goitre and menstruation. A total of 30 former ~"FPE-AG schools (closed 2 years back) were selected from 6 WHDP areas (5 schools from each area). From each schoo~ 7 NFPE-AG graduates aged 15-19 years were selected who did not continue their study in fonnal schools after graduation. Another 7 never schooling girls (NS-AGs) aged 15-19 years from TG families were selected as a comparison group. Thus, a total of 420 adolescent girls (210 from each group) were interviewed in January 1996.
National immunisation days in Bangladesh: an evaluation of the 1996 rounds
(BRAC Research and Evaluation Division (RED), 1996-07) Karim, Fazlul; Chowdhury, AMR; Bhuiya, Abbas; Aziz, KMA; Ali, Ahmed; Islam, Md. Nazrul; Mahmud, Shah Noor; Mol, Dineke
On April 16 and May 16 .1996, Bangladesh implemented the third and fourth of the six National Immunization Days. On those days oral polio vaccine (OPV) was administered to over 20 million children under 5 years of age. The goal of NIOs is to eradicate poliomyelitis from the country by 2000 AD. NID is a challenging campaign for Bangladesh mobilising a huge human and material resources. This study examined how effective NIDs are in terms of implementation and coverage of the target children and what lessons can be learned from it. The study was implemented as a part of the multi-country 'Social Science and Immunisation' project".
Post-partum reproductive behavior regarding contraception and breastfeeding in rural Bangladesh
(BRAC Research and Evaluation Division (RED), 1996-07) Gazi, Rukhsana; Karim, Fazlul; Chowdhury, AMR; Mahmud, Shah Noor
The study was aimed to obtain information on knowledge of mothers about fecundity after childbirth and to explore the reproductive behavior of the mothers related to breastfeeding, postpartum abstinence and contraceptive practices. This was a comparative study between the WHOP of BRAC {Bogra Sadar thana) and a non program {Joypurhat) area. Data was collected by five female interviewers retrospectively from a total of 400 randomly selected women who were in 6 to 12 week of their post partum period. Women are most unlikely to adopt contraception unless they resume ft1enstruation as they believe that fecundity returns only after the resumption of menstruation. Whereas they tend to resume sexual activity within 40 days after childbirth. A significant higher proportion of women in the program area were found to have fed colostrum than in the non program area (92% vs 71 %), they were unlikely to be breast feeding exclusively. Mothers are loosing the contraceptive benefits of breastfeeding very soon after delivery and are at risk of subsequent conception. As reliance on lactational infertility alone is not advisable due to the early weaning and partial breast feeding, the program should increasingly promote the use of appropriate contraceptive methods from the early postpartum period.
Prevalence of post-partum genital tract infections in the mother and selected neonatal infections in rural Bangladesh
(BRAC Research and Evaluation Division (RED), 1996-05) Gazi, Rukhsana; Chowdhury, AMR; Mahmud, Shah Noor; Karim, Fazlul
The present study was designed to estimate the prevalence of post-partum infection and two neonatal infections in rural Bangladesh and to identify the factors and determinants related to these infections. In this study, a total of 400 women (200 from WHOP area and 200 from comparison area) were interviewed retrospectively through structured questionnaire. In general, the prevalence of post-partum infection and selected neonatal infection were lower in WH 0 P area than those of the comparison area. But the difference in prevalence rates between the program and comparison areas were not statistically significant. Again, the presence of trained TBAs during delivery could not provide beneficial effect in the outcome of post-partum infection in the program' area. In the program area, the mothers were still found to be using indigenous materials on cord of the neonates. Although, the results were less conclusive due to small number of samples, the delivery complications (prolonged labour, leaking membrane etc.) and the cultural factors such as using unclean water for washing the materials used as vaginal pads found to be associated with increased risk of post-partum infection.
Quality assessment of BRAC Health Centres
(BRAC Research and Evaluation Division (RED), 1997-11) Afsana, Kaosar; Mahmud, Shah Noor; Chowdhury, AMR; Karim, Fazlul; Khan, Suhaila H
Reaching quality services of BRAC health centers to the People
(BRAC Research and Evaluation Division (RED), 1998-09) Afsana, Kaoser; Mahmud, Shah Noor
Reasons for discontinuation of tuberculosis treatment provided by BRAC
(BRAC Research and Evaluation Division (RED), 1996-12) Mahmud, Shah Noor; Ali, Ahmed; Islam, Md. Nazrul; Karim, Fazlul
To supplement the government tuberculosic; control programme, BRAC has initiated a communitybased tuberculosis programme in 10 thanas under the Women's Health and Development Programme (WHDP) (presently known as Reproductive Health and Disease Control - RHDC) since June 1992. BRAC is delivering services and following up the patients for all compliance. But, a recent study showed that the treatment completion rate achieved was up to 85% (1). Now the question arises: why the remaining 15% of the patients did not complete their treatment course? This study aimed to assess the reasons for discontinuation of treatment from BRAC's community-based TB control programme. The study was carried out in all10 WHDP thanas and dealt with the patients receiving only 12 months treatment regimen. The patients who enrolled and later discontinued treatment dwing June 1993 to May 1994 were selected for the study. Reasons for discontinuation of treatment were collected from progranune records, the patient or his/her relatives, Shastho Shebikas (SSs), Programme Organisers (POs), Area Managers (AMs) and Medical Officers (MOs) through indepth interviews during J\Ule and August 1994. A total of 1,538 patients were enrolled between JWte 1993 and May 1994. Of them, only 40 patients were found to have discontinued from BRAC treatment. Among these patients, 20 (50%) defaulted or dropped out, 5 (12.5%) were migrated and the rest 15 (37.5%) were referred to TB clinic or hospital for treatment.
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.
Rural Study Series
(BRAC Research and Evaluation Division, 1995-12) Banu, Dilruba; Khan, Md Kaisar Ali; Chowdhury, A. Mushtaque R.; Karim, Fazlul; Streefland, Pieter; Ahmed, Salehuddin; Afsana, Kaosar; Ali, Ahmed; Mahmud, Shah Noor
The Rural Study Series is a modest venture for dissemination of BRAC research studies concerned with various aspects of rural development in Bangladesh. Poverty alleviation and empowerment of the poor, particularly of the disadvantaged women are the two major goals of BRAC. Since 1972, BRAC has been implementing a multi-sectoral programme to achieve these objectives. BRAC deals with people whose lives are characterized by absolute poverty, illiteracy, unemployment, disease and malnutrition. The underlying conviction in its development approach is founded on the premise that it is the people who can bring about change in their own lives, either individually or collectively, supported by inputs provided by development agencies, including BRAC. The Research and Evaluation Division (RED), instituted in 1975, is an independent unit within BRAC and it plays a vital role in planning, strategy formulation, monitoring and evaluation of BRAC's development interventions. Its primary responsibility is to provide necessary research support to various BRAC programmes. RED conducts a wide range of research, which includes, among others, surveys, action research, diagnostic studies, impact assessment and evaluation studies on poverty alleviation. In addition, it undertakes studies on request from other NGOs, government organizations, international development agencies, as well as joint studies with academic and research institutions, both in and outside of Bangladesh. The Rural Study Series emphasizes policy relevance and operational features of BRAC's programmes at grassroots level, rather than theoretical and rigid methodological issues. BRAC, in previous years, published several monographs on development issues (list available at the back of this volume). This new series will cover selected research studies, which have been carried out since 1990. The views and interpretations presented in the Series are those of the author(s) and do not necessarily represent the views and policies of BRAC. Comments or brief notes responding to articles are welcome and will be considered for publication to the extent that space permits. Please direct all correspondence to the Editor, The Rural Study Series, BRAC, 66 Mohakhali C/A, Dhaka 1212, Bangladesh.
TB case management at community level: situation of the treatment completed patients in women's health and development programme
(BRAC Research and Evaluation Division (RED), 1994-12) Islam, Md. Nazrul; Mahmud, Shah Noor; Ali, Ahmed; Fazlul Karim
The Women's Health and Development Programme (WHOP) of BRAC initiated a community based tuberculosis {TB) control programme in 10 thanas in June, 1992 to complement and supplement the government TB control programme. The Research and Evaluation Division conducted a study on 181 TB patients who completed the anti-TB treatment on or before June, 1993 to investigate their a) socioeconomic and physical condition and b) measures taken for the patients who had cough for more than four weeks after completion of treatment. The study was conducted in all 10 thanas of WHOP in July 1994 and data· was collected from 181 patients administering a pretested questionnaire. About 72.0% of ~he patients were male indicative that the males are suffering from TB more than female or their morbidity is more reported than the female. Similar results were also found in national prevalence survey in 1987. Almost 67.0% of the patients came ·from target · group {TG), possibly the programme was more focused to the TG families. Moreover, 65.0% of the patients were treated with 12 months, 16.6% with six months, 17.7% with eight months and 1.1% with nine months treatment regimens. Sputum of 5 patients (2.8%) were found to be bacteriologically positive after one month completion of treatment. Moreover, a total of 9 patients died within one year after completion of treatment, but the causes of three deaths were found to be confirm~d (cancer, madness and suicide). Forty (24.4%) of ~he surveyed patients complained of history of cough for more than 4 weeks but 52.5% of them did not take any treatment, while sputum was examined for 32.5% of the cases.
The health situation of adolescents: a literature review
(BRAC Research and Evaluation Division (RED), 1996-01) Ali, Ahmed; Mahmud, Shah Noor
This review paper addresses the health situation of the adolescents. Most of the studies we found were conducted in countries other than Bangladesh. The medical care of the adolescent has always been neglected in the developing world until recently. While their medical needs are now being considered with an increased emphasis, their phychosocial needs, which are so important have not been adequately addressed. A few studies have been conducted in Bangladesh on issues of reproductive health. These studies suggests that early marriage is a serious problem for adolescent girls resulting in early pregnancy and thus enhances other reproductive health problems.
Validation of baseline information of reproductive health & disease control programme
(BRAC Research and Evaluation Division (RED), 1998-06) Afsana, Kaosar; Mahmud, Shah Noor
The Reproductive Health and Disease Control (RHDC) programme has been in operation since 1996. This study was conducted in RHDC programme areas to validate the accuracy of baseline information as collected by the programme. Selected process indicators, such as use of antenatal care, assistance during delivery by the trained personnel, contraceptive prevalence rate and continuation and discontinuation rate of methods were chosen to compare data between the programme and survey. For use of antenatal care and trained personnel during delivery, a sample of210 women who gave birth during January-December 1996 was drawn from among the members of village organisations (VOs). For contraception, 450 currently married women were randomly selected from the same VOs. The validated data of the programme were found in close agreement with the survey data. For use of antenatal care, 99% of the programme data were found to be accurate. Of the women who received assistance during delivery, 91 °u were confirmed by survey. Accuracy was validated in 95% of cases for contraceptive prevalence. Continuation rate of methods during 1996 as validated by the survey was 83% and discontinuation rate 23%. Predictive value of use of antenatal care, use of trained personnel and contraceptive prevalence is very high but in contrast that of discontinuty of methods is very poor. It has been suggested that due to very high accuracy rate of programme data, it can be used as a reliable source of information. However, validation of programme data can be done from time to time to check its accuracy. Moreover, record-keeping system should be well-maintained and SSs' activities well-supervised.