Research Reports (1997): Health Studies, Vol - XXI
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Item 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 HItem Men’s perceptions about family planning(BRAC Research and Evaluation Division (RED), 1997-10) ShahaduzzamanThis study looked at the men's perception on family planning, their knowledge and opinion about different contraceptives, as well as the motivating factors of the male for accepting family planning. Information was collected in December 1996 from Sherpur district through informal discussions, focus group discussions with men below and above the age of 40 years, religious leaders and with Garo ethnic group. Case histories of 6 condom users and 6 vasectomised clients were also taken. Men generally have a positive attitude towards family planning. They have definite ideas about optimal family size and own fertility, and also have a high knowledge on contraceptives. This knowledge mostly appeared to be superficial. Though there was a trace of the feeling in men that contraceptives were women's responsibility. Men were not properly by the programmes. Thus lack of information and under the influence of rumors their supportive and user roles were hampered. The perceived limitation of male contraceptive choice was also a major determinant of male contraceptive use. However, the male method users were gen;:rally satisfied with their methods. The depotholders of BRAC were found to be popular and well accepted by the male community, though their role was not properly known by men. Male forums and male contact were found to be inadequate. There was a gross misconception about the family planning registration card given by BRAC. To well publicize services and to promote the male contraceptives, to fulfill knowledge gap about BRAC's Family Planning Facilitation Programme by strengthening male forums were recommended.Item Immunization in Bangladesh: studying sustainability through social science approaches(BRAC Research and Evaluation Division (RED), 1997) Nandy, ShailenItem Exploring women’s perception on birth process through body mapping(BRAC Research and Evaluation Division (RED), 1997-09) Shahaduzzaman; Chowdhury, AMRTo explore women's perception on birth process 'body mapping' exercise was conducted with three different categories of rural women; trained traditional birth attendants (TBA), untrained TBAs and women who had never attended any delivery. There were 20 women in each category. Each was given a paper with the outline of a women's body and asked to draw what she imagined about the inside of a pregnant woman to look like. After completion of the drawing, each was asked to label and explain her drawings. The 'body mapping' helped to reveal the diversity of women's perception of the birth process, which would have been difficult to obtain. The drawings highlighted the difference and similarities between biomedical and indigenous concepts. By comparing the body maps done by the three categories of women, it appeared that the perception of the trained TBAs was more consistent with the biomedical model. However, some common patterns of perception and differences in scientific and indigenous vocabulary was found in all categories of women. It appears from the study that body maps have a range of potential uses as a research technique to explore lay perceptions on different health issues and as a tool for training and evaluation.Item Morbidity pattern of infants in rural Bangladesh(BRAC Research and Evaluation Division (RED), 1997-12) Gazi, Rukhsana; Karim, Fazlul; Chowdhury, AMRThis report is part of a prospective study Investigating the consequences of low birth weight on Infant growth, morbidity and feeding practices in rural Bangladesh. The study registered 644 infants who were followed-up for one year of their age. The study was conducted in three unions of Manikganj district of rural Bangladesh during 1993-1994 to observe the morbidity pattern of infants, assess the treatment pattern for illnesses, and to study the consequence of Low birth weight (LBW) on morbidity during infancy. The overall prevalence of illness was 4.6% among infants aged under 1 year. ARI was most prevalent morbidity among infants under 1 year. An infant suffers from 3-4 episodes of ARI or 2 episodes of diarrhoea or 1 episodes of skin infection during the first year of life. Among infants of 5-12 month old, diarrhoeal disorders (watery, mucoid or bloody type) occurred more frequently comparison to infants of 1-4 months old. Low socioeconomic condition, illiteracy of parents. poor and unhygienic living condition, might be linked with infant morbidity. We found high morbidity prevalence among LBW infants compared to normal or high birth weight infants, but this difference was not statistically significant. Among infants who received any treatment, 71% got allopathic treatment, the main treatment provider being the village doctors. A large proportion of infants did not receive any treatment due to the perception that ··tor mild Illness treatment is not necessary. Community should get health education on prevention, care and danger signs of major illnesses such as ARI and diarrhoea. Provision of sanitary latrines, safe water, and promotion of health education on personal hygiene and environmental sanitation might reduce the risk of morbidity among infants.Item Infant feeding practices in rural Bangladesh(BRAC Research and Evaluation Division (RED), 1997-08) Gazi, Rukhsana; Karim, Fazlul; Ali, AhmedThis study was part of a longitudinal study on the consequences of low birth weight (LBW) babies which was carried out in three unions of Manikganj district during 1993- 1994. This study aimed to assess the breastfeeding practices among infants and to compare the weaning practices among LBW and normal birth weight infants. A total of 644 infants were registered within 48 hours of birth and they received monthly follow-up visit upto one year of age. Although breastfeeding was universal in the study population, detrimental feeding practices, such as the administration of pre-lacteal foods (75%) and rejection of colostrum (1 1 %) were prevalent among the mothers. There was a delay in initiation of first breastfeeding. Although 77% of the mothers exclusively breastfed their babies at the first month, the prevalence of exclusive breastfeeding decreased to 50% by the third month. The main reason for giving additional foods was that the mothers felt breastmilk was insufficient. A significantly higher proportion of LBW infants received additional feeding than the normal infants. It might be due to the mothers perception that the additional foeItem Low birth weight(LBW) was the major predictor of infant deaths: evidence from a prospective study in rural Bangladesh(BRAC Research and Evaluation Division (RED), 1997-07) Gazi, Rukhsana; Karim, Fazlul; Ali, AhmedThe study was the part of a longitudinal study on the consequences of low birth weight babies (LBW) in three unions of Manikganj district in Bangladesh. The study aimed to estimate the infant mortality rate In title study population ·and to identify the causes and factors related to infant deaths. Data was collected during 1993-1994. In this study pregnant mothers were registered at the third trimester of pregnancy. After delivery birth weights of a total 644 infants were recorded. The infants received monthly follow-up visits ti ll 1 year of age. All deaths during followup period were recorded. Low birth weight was identified as being the commonest factor contributing to infant deaths. Diarrhoeal disorder and ARI were major killer diseases. Poor weight gain by the mothers during pregnancy, multiparity, low education of parents, poor living condition were found to be linked with infant deaths. Detrimental feeding practices were prevalent among the mothers. It is important to provide information to all members of the community about consequences, prevention and care of LBW.Item TBA programmes: a comprehensive literature review(BRAC Research and Evaluation Division (RED), 1996-12) Khan, Suhaila H; Islam, Md Nazrul; Ali, Ahmad; Karim, FazlulOf the 500,000 women who die every year due to pregnancy related causes 99% live in developing countries. Most deliveries in developing countries are non-institutional and take place at home by traditional birth attendants (TBA). With the expectation cf decreasing maternal mortality TBA training programmes were started in many developing countries. The objectives of this literature review was to identify the issues in TBA programmes, and also identify the gaps in research conducted so far. This review encompasses three perspectives: global, Government of Bangladesh, and non-government organizations specially BRAC. The review identified the following programme relevant issues: bin:h attendants and practices; evolution of TBA programmes; programme objectives; structure of TBA programmes (type of service, service providers and recipients); service giving process: training (target population, trainee selection criteria, course schedule and content, incentives for this work, TBA perceptions about birth process, trainers, monitoring and supervision of TBAs); outcome of TBA training programmes (impact on maternal and infant mortality and morbidity indicators, client satisfaction, change in KAP of trained TBAs (TTBA), evaluation of TTBA's performance, utilization of TTBAs, TTBAs' linkage with other health workers; and cost effectiveness of TBA programmes.Item The story behind the Shasthyo Shebika dropouts: (training and retaining Shasthyo Shebika: reasons for staff turnover)(BRAC Research and Evaluation Division (RED), 1997-03) Khan, Suhaila H; Chowdhury, AMR; Karim, Fazlul; Barua, Milon KantiItem 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, KaosarThe 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.