Research Reports (1996): Health Studies, Vol - XlX
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Item Raising sanitary latrine use in rural Bangladesh: can BRAC play any role?(BRAC Research and Evaluation Division (RED), 1996-05) Hadi, Abdullahel; Nath, Samir RThis study estimates the sanitation coverage and investigates impact of the participation in development program on the sanitation behavior in rural Bangladesh. Findings reveal that nearly a quarter of the study population has been using sanitary latrines though there are differences in use in terms of age, sex, education, occupation, land size and involvement with credit based development program. The multivariate analysis reveals that households involved with BRAC program are 3.66 times more likely to use sanitary latrine (p<.OI) than those who are socioeconomically similar with BRAC members but not involved in such program controlling for education and occupation of the household head. When other factors such as religion, ownership of land, housing condition, level of media exposure and the presence of BRAC programs are systematically added to the regression equation, the role of BRAC on sanitation behavior is still found significant. The study argues that social and behavioral aspects of the organized development program in rural Bangladesh can significantly increase safe sanitation practice in a traditional society.Item Perspective of women about their own illness(BRAC Research and Evaluation Division (RED), 1996-09) Mahbub, Amina; Ahmed, Syed MasudIntroduction In Bangladesh women's health issues are traditionally neglected and inadequate importance is given by all concerns. A majority of the women experience significant morbidity associated with pregnancy and delivery (Goodburn et al., 1994). Since women's health is a fundamental human right and must clearly be promoted as such immediate attention should be given to this concern (WHO, 1995). With this interest, women's health problem should be recognized and addressed from their own perspective. Because research results show that women's health behaviour is governed by what they perceive as good or ill health, whether this is consistent with bio-medical model or not (Khatib, 1992). So to promote women's health, their health problems should be addressed from their own perspective. Objectives The study aimed to understand illnesses from the perspective of women in the community and their health seeking behaviour with respect to some specific illness. Methodology This qualitative study was exploratory by nature. The cognitive and symbolic aspects were the main focus in the study. K1~an's concept of 'explanatory model' helped to map out and interpret the ideas in the study. Being a part of the BRAC-ICDDR,B joint research project the study was done in Matlab DSS (Demographic Surveillance System) area purposively. The study population was the married women in the study area (age ranges from 18 to 50). The study dealt with both BRAC and non BRAC women separately. Simple random sampling technique and convenient sampling were used to select the informants. Different qualitative methods were used for data collection, such as- free listing, pile sorting, matrix ranking, key informant interview and group discussions. Findings The study revealed that women had their own definition about ill health condition. They were also found to link up different illnesses based on their own reasoning. While determining the severity of a condition immediate threat to life was of prime concern to them. The study women had their own perspective in explaining every illness they experienced and thus they identified the causes of ill health and amplified a pattern of the ailment. There were certain folk theories such as hot and cold, purity and pollution, batas laga, 110sto kora, etc. by which they constructed the causal relations. In diagnosing ill health, knowledge about different illnesses (learned from other's experiences) and consultation with relatives, neighbors or traditional healers were the significant factors. Therapeutic Choice of the women largely depended on beliefs about the causes of illness, explanation of illness, availability of health services, socioeconomic condition, and past experience of efficacy of treatment. It was found that the women did not rely on one therapeutic method throughout the whole course of illness episode. They tried one by one accessible medical services and sometimes repeated the earliest one. However, other pattern of 'illness specific' health seeking behavioural was also observed (Hardon et aL 1995). The women usually termed bhute dhora, alga dhora, etc. as illnesses caused by evil spirit. In such cases, they seek kabiraji and moulovi treatment. They blindly believed that only the Allahar kalam (divine verses) could help cure the illness. Attitude of the society and family towards illness acted as an influencing factor at every stage from illness identification to treatment seeking behaviour. Women often tried to conceal some illnesses which have social stigma attached. In such situation women tried not to disclose the illness to their in-laws and husbands, rather getting treatment themselves through peer network and as a last resort, went to natal home for treatment. Conclusion It was explicit in the study that the identification of the illness and therapeutic choice were primarily done by the women themselves. Therefore, knowledge about women's perspective towards the illness and its gravity, is very much crucial. In conclusion, we would like to make the following recommendations: • On the basis of this study finding some focused ethnography on particular women's illnesses can be designed. That will help us to get a detailed picture on different illness situation specifically. That may provide new insight regarding women's health intervention issues. • BRAC could help the destitute women in the village who have been suffering from different reproductive health problems for a long time but can not seek medical helpItem 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 AThe 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.Item The health situation of adolescents: a literature review(BRAC Research and Evaluation Division (RED), 1996-01) Ali, Ahmed; Mahmud, Shah NoorThis 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.Item 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, FazlulThe 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.Item 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, FazlulItem Pregnant women's knowledge on health and iron supplementation(BRAC Research and Evaluation Division (RED), 1996-05) Hyder, SM Ziauddin; Roy, Rita Das; Tarannum, SabahItem The prevalence of Anaemia among men and women in rural Bangladesh(BRAC Research and Evaluation Division (RED), 1996-08) Hyder, SM ZiauddinAnaemia is a major public health problem in many developing countries including Bangladesh. Iron deficiency is known to be the commonest cause of anaemia resulting from inadequate iron intake, reduced bio-availability of ingested iron, defective mobilisation of iron reserves, increased needs for iron under certain physiological and pathological conditions and so on. This study aimed at investigating the prevalence of anaemia among rural men and women. The survey was conducted in March 1996 in 12 villages of Mymensingh District located about 100 km north of Dhaka city. Eighty four adult men and 184 adult women aged 15-48 years and 22 adolescent boys and 44 adolescent girls aged 11-14 years were randomly selected. Information was obtained on haemoglobin concentration, parasitic infestation, literacy and on other household socioeconomic parametres. It was revealed from the study that mean haemoglobin concentration of the study population was 114 gIL, and about 69% adult men, 71% adult women, 68% adolescent boys and 64% adolescent girls were suffering from anaemia according to the WHO criteria. This study suggests that anaemia is highly prevalent in the rural communities of Bangladesh which victimises both men and women equally. There is an urgent need to conduct further studies to confirm if male and female are equally anaemic to provide important feedback to the existing anaemia control programmes in the country.Item Socioeconomic development and human well-being: seasonal survey on nutrition: first round(BRAC Research and Evaluation Division (RED), 1996-12) Khatun, Masuma; MCkim, Andrew; Tarannum, Sabah; Hyder, SM Ziauddin; Chowdhury, Mushtaque; Bhuiya, Abbas; Khan, Monirul Islam; Adams, AlayneItem Community perception on the Muktagacha pilot nutrition initiative of BRAC(BRAC Research and Evaluation Division (RED), 1996-04) Khatun, Masuma; Hyder, SM Ziauddin