Thesis/ Project Report, Master of Public Health (James P. Grant School of Public Health)

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Exploring care pathways for hypertensive patients at government subdistrict health facility in Bangladesh: a qualitative study
(BRAC University, 1/5/2024) Kairi, Suchona Rani; Ahmed, Syed Masud; Naher, Nahitun
Introduction: Hypertension prevalence is 26.4% in Bangladesh (Naheed et al., 2018), which is a significant contributor to high morbidity and mortality. The rising prevalence and current state of NCD intervention at the primary healthcare (PHC) level are often insufficient to manage the condition. Therefore, understanding the care pathways that patients navigate throughout their lives is crucial for managing this disease. Methods: This facility-based qualitative exploratory study was conducted at the Upazila Health Complex in Keraniganj, Dhaka, Bangladesh Applying convenient sampling a total 24 in-depth interviews were conducted with respondents visiting the NCD corner of the UHC during from November 22, 2024 to December 11, 2024. Descriptive statistics about the respondents were evaluated using STATA V17. Thematic analysis of the interviews was done. Findings: Majority of the respondents were aged 40-69 years, female, married and lived in periurban areas. A significant portion had no formal education (37.5%), and most were unemployed (75%). Respondents navigating a complex pathway. Among all respondents, we have identified four points of hypertensive care pathways. As their first contact for care services, 50.0% of the respondents had consultations with drug sellers. The remaining, 22.7% at private practitioner’s care, 4.5% at tertiary care, and 27.3% at UHC for their first point of care. Only 5 of them, continue their services at UHC. Then, simultaneously, the second point 9 of them reached UHC, the third point 8 of them, and at final point 2 of them reached UHC after all the transition. The main care providers identified are UHC, drug sellers, private practitioners, tertiary, and traditional healers. Most respondents delayed seeking care due to attributing symptoms to other diseases, managing the symptoms through self-management. Factors such as accessibility, and affordability played a main role for decision-making to choose each service. UHCs were preferred for their affordability, accessibility and ability to manage comorbidities. Although respondents rated UHC services as good, still they mentioned challenges regarding the unavailability of essential medicine. They viewed this condition as a burden as it caused health issues as well as a financial burden. Conclusion: The majority of the respondents with hypertension in Bangladesh access various categories of providers before reaching UHC care, and use a diverse range of pathways and loops, which results in a delay or missing appropriate care. We hope that our findings are useful for planning interventions to improve access to hypertension care in general, in Bangladesh.
Infant and young child feeding knowledge and practices among lactating mothers attending an urban health care facility in Dhaka, Bangladesh
(BRAC University, 1/5/2025) Tabassum, Tasbiha; Ireen, Santhia; Akter, Fahmida
Introduction: The first 1,000 days of a child’s life are critical for growth and development as proper nutrition during this period plays a significant role in health outcomes in future. In Bangladesh, though breastfeeding rates are relatively high, challenges persist in achieving optimal Infant and Young Child Feeding (IYCF) practices. Concerning stunting and wasting rates with lack of data in urban areas like Dhaka highlights the need for understanding the influencing factors of IYCF adherence. This study examines IYCF knowledge and practices among lactating mothers of children aged 0-6 months attending an urban MNCH facility in Dhaka. Method: A cross-sectional, quantitative study was conducted at two Maternal Neonatal and Child Health (MNCH) facilities in Dhaka City from November 24 to December 11, 2024. The participants included 342 lactating mothers of infants aged 0-6 months, selected through convenience sampling. Data were collected via a semi-structured questionnaire on socio-demographic factors, antenatal and postnatal care utilization, and IYCF knowledge, practices and barriers. Data analyses included descriptive statistics, chi-squared tests, and multivariable regression analysis. Findings: The study found that overall IYCF knowledge among the mothers was quite well, specifically regarding early breastfeeding initiation (90.4%) and colostrum feeding (99.1%). Knowledge gaps existed in complementary feeding, proper breastfeeding techniques and understanding broader benefits of exclusive breastfeeding. Out of 342 mothers, 100% breastfed their child at least once, 62.6% initiated breastfeeding within 1 hour, 81.6% exclusively breastfed and 17.0% practiced mixed feeding. Barriers such as low milk secretion, post-C-section complications, and cultural factors were significant challenges to optimal IYCF practices. Conclusion: The findings highlight the need for targeted interventions to improve optimal IYCF practices. Addressing barriers as well as strengthening of healthcare service are crucial for enhancing child nutrition in urban Bangladesh.
Assessing the feasibility and acceptability of a wearable device for early detection and monitoring of pediatric sepsis among healthcare workers and health facility managers in a peri-urban hospital in Dhaka, Bangladesh: a scenario-based exploration
(BRAC University, 1/5/2025) Levi, Fiona Pauru; Barua, Mrittika; Anwar, Humayra Binte
Background: Sepsis remains a leading cause of morbidity and mortality in under-five children globally, particularly in low-resource settings, with early detection playing a critical role in improving outcomes. This study explores the feasibility and acceptability of a wearable device designed for early sepsis detection and monitoring in a peri-urban hospital setting in Bangladesh, where such technology is not yet widely used. Methods: A qualitative approach was used involving key informant interviews (KII) with nurses and doctors working in the pediatric department and the health facility managers at Sajida Foundation Hospital. Participants were asked about their perceptions of the wearable device, its usability, and potential barriers to its acceptance. The study applied the Theoretical Framework of Acceptability (TFA) and the data was analyzed thematically to identify key themes. Results: Participants highlighted the device's ease of use, remote monitoring capabilities, ability to provide real-time updates, and potential to improve workflow efficiency and neonatal sepsis management. Concerns include infection control, cost, and the need for comprehensive training. The device was perceived as a valuable tool, particularly in resource-limited settings, provided that these challenges were addressed. Suggestions for integration with existing hospital systems and pilot testing were emphasized. Conclusion: The findings demonstrate that wearable device technology for under five children sepsis monitoring is feasible and acceptable. Recommendations include pilot testing, healthcare provider training, and public awareness efforts. With careful implementation and ongoing evaluation, this technology has the potential to significantly improve early sepsis detection and outcomes in pediatric care settings in low-resource environments.
Understanding healthcare pathways of patients with diabetes: insights from an exploratory study in a government sub-district hospital of Bangladesh
(BRAC University, 1/5/2025) Hasan, Sadah; Ahmed, Syed Masud; Naher, Nahitun
Introduction: The prevalence of diabetes mellitus in Bangladesh was 13.75% in 2018. The healthcare system of Bangladesh makes it challenging to deliver integrated non-communicable disease service. There is a lack of resources at the primary healthcare level, a difficult pluralistic healthcare system to navigate, and limited evidence on diabetic care pathways in the context of Bangladesh. As diabetes mellitus is a leading cause of morbidity and mortality, understanding these pathways is vital for developing an equitable healthcare system tailored to chronic disease management. Methods: This facility-based qualitative exploratory study was conducted at the Upazila Health Complex in Keraniganj, Dhaka, Bangladesh. By applying convenient sampling, a total of 22 in-depth interviews were conducted with respondents visiting the NCD corner of the UHC, from November 22, 2024 to December 11, 2024. Descriptive statistics about the respondents were evaluated using STATA V17. Thematic analysis of the interviews were done. Results: The majority of the respondents were aged 40-69 years (81.8%) and female (68.2%), married (86.4%), Muslim (91%) and living in peri-urban areas (91%). 45.5% of the respondents had no formal education, 72,7% were unemployed and most household incomes were generally less than 15,000 BDT. 59% of respondents have lived with diabetes for 2-5 years and 77.3% had other comorbidities too. Respondents navigated complex care pathways, involving both formal and informal healthcare providers, with the longest pathway having five points of care. Most participants delayed seeking care due to attributing symptoms to other diseases, minimal perceived severity, or beliefs about diabetes, with many managing symptoms through home remedies. Delays were longest among women. Triggers that prompted seeking care were worsening symptoms, advice from social networks, or referrals from providers. The common initial points of care were private providers and drug-sellers, with UHCs generally becoming the final care provider by the third point of care. UHCs were preferred for their affordability, accessibility, and ability to manage comorbidities. Most respondents rated UHC services as good, yet unavailable essential medicine or diagnostic tests, short consultation times, disrespectful behavior, and insufficient privacy impacted patient experiences. Elderly and women with children struggled with access to distant hospitals. Private care was expensive and often led to discontinuation, while informal providers were chosen for affordability. One respondent took service from parallel providers. Expenses, especially for those with comorbidities, caused financial strain, often forcing difficult decisions between managing diabetes and other health conditions. Conclusion: Respondents with diabetes navigated complex care pathways and encountered various categories of healthcare providers. While PHC facilities serve as critical hubs, there is a need to address challenges such as inconsistent medicine supply, unavailability of diagnostic facilities, inadequate consultation practices, and the financial burden of respondents to create equitable, patient-centered care for diabetes chronic diseases in resource-limited settings.
Prevalence and associated factors of depression & anxiety among drug-sensitive TB patients at urban BRAC DOTS TB program in Dhaka city with a focus on facilitators and barriers of integrating mental health services – a mixed-methods convergent study
(BRAC University, 1/5/2025) Zaw, Aung Khine; Rahman, Ataur; Islam, Shayla
Introduction: Tuberculosis (TB) remains a major public health concern in Bangladesh, with significant challenges in addressing the psychological well-being of patients. Depression among TB patients is often underdiagnosed and untreated, despite its impact on treatment adherence and outcomes. This study aimed to assess the prevalence and associated factors of depression among drug-sensitive TB patients and explore their experiences with mental health challenges, as well as the facilitators and barriers to integrating mental health services into TB programs at BRAC DOTS centers in Dhaka, Bangladesh. Method: This mixed-methods convergent study utilized quantitative and qualitative approaches to investigate mental health challenges among drug-sensitive TB patients and identify facilitators and barriers to integrating mental health services. Quantitative data were collected through structured surveys at the Kamrangirchar BRAC DOTS-TB center, analyzed using descriptive statistics and multivariable logistic regression. Qualitative data were gathered via in-depth and key informant interviews with patients and healthcare providers and analyzed using thematic inductive analysis. Findings: The study found that 50.4% of drug-sensitive TB patients experienced mild to severe depression, and a similar proportion had mild to severe anxiety. Depression was significantly associated with female gender (OR = 3.1, p = 0.023), short sleep duration (OR = 4.2, p = 0.003), and anxiety (OR = 8.39, p < 0.001). Anxiety was linked to financial deficits (OR = 4.63, p = 0.001), comorbidities (OR = 2.81, p = 0.037), and dissatisfaction with sleep (OR = 3.25, p = 0.011). Patients reported stigma, lack of social support, and a need for urgent psychosocial interventions. Both patients and providers emphasized that integrating mental health services into TB care could improve treatment adherence, reduce relapses, and enhance outcomes, though challenges such as stigma, resource constraints, and systemic barriers were noted. Conclusion: This study emphasizes the high level of depression and anxiety among DSTB patients and stresses the need for improving mental health services for DSTB patients addressing the barriers and leveraging the factors could improve patient outcomes and augment TB management in Bangladesh.
Assessment of the status and its associated factors among lactating mothers taking services in an urban healthcare facility in Dhaka city: a cross-sectional study
(BRAC University, 1/5/2025) Delwar, Umama Binte; Ireen, Santhia; Akter, Fahmida
Our study aims to determine the nutritional status of lactating mothers attending an urban MNCH facility in Dhaka, Bangladesh, and identify the associated factors. A cross-sectional study was conducted which analyzed socio-demographic data, dietary diversity, and body mass index (BMI). Among the participants, 39.7% were aged 21–25 years, and 40% held a bachelor’s degree or higher. The majority (79.2%) were homemakers, with a median monthly income of 50,000 BDT. Nutritional assessment revealed a dual burden, with overweight and obesity prevalent in 64% of the lactating mothers and undernutrition observed in 10%. When regression analysis was done it highlighted that mothers aged more than 30 years had significantly higher the odds of being overweight or obese (AOR=9.98; p=0.001), emphasizing the impact of age on BMI. Attainment of education also influenced BMI significantly; mothers completing higher secondary education were more likely to have increased BMI (AOR=3.02; p=0.026), likely due to calorie-dense food choices, while those who had completed their education up to bachelors and above education appeared to mitigate this risk. Mothers coming from middle-income households were less likely to be overweight or obese (AOR=0.37; p=0.023), this indicated the impact of income on nutritional outcomes. Dietary factors also played a significant role; frequent consumption of sugary foods increased the likelihood of higher BMI (AOR=2.73; p=0.001), whereas sweets consumption showed an inverse association with overweight and obesity (AOR=0.40; p=0.003) which could be due to differential reporting or cultural practices. Thus interventions should focus on the enhancement of nutritional literacy particularly women of lactational phase and additionally, introduce policies that ensure access to affordable, nutrient-rich foods which could mitigate the rising burden of overweight and obesity. Future longitudinal studies are necessary to explore the long-term effects of these factors on maternal and child health in urban Bangladesh.
Exploring caregivers’ perception of wearable technology for sepsis management for children aged under 5: a scenario-based qualitative study in Dhaka, Bangladesh
(BRAC University, 1/5/2025) Ankon, Sabrina Kamal; Anwar, Humayra Binte; Barua, Mrittika
Background: Sepsis is a condition when the body's extreme immunological reaction to an infection can harm organs, resulting in shock, organ failure, or even death if treatment is not received. People all across the world are affected by sepsis, although lower-middle-income nations (LMICs) have far higher incidence and fatality rates. Notably, neonatal sepsis is a major cause of death in these areas, accounting for 99% of infant deaths worldwide. Bangladesh continues to have a serious problem with pediatric sepsis mortality, especially in areas with low resources. Before a specific sepsis treatment management was implemented, the death rate for high-risk children with sepsis at Dhaka Hospital was startlingly high, approaching 60% which demonstrates the need for urgent standardized treatments for vulnerable pediatric populations. Objective: This study aims to explore caregivers' perceptions of children under five about wearable technology for sepsis control. Methods: An exploratory design using a qualitative method was followed to conduct this study. The study population was the caregivers of children under five hospitalized for any illness including sepsis from Sajida Foundation Hospital at Keraniganj in Dhaka. A purposive sampling technique was finalized to make the sample size. To find out how caregivers felt about the wearable device for sepsis management, 10 IDIs (In-depth Interviews) were done until the data was saturated. Data collection was done following the Theoretical Framework of acceptability. For analyzing data framework analysis was followed. Results: This study observed the possibilities and difficulties of using a wearable device to monitor children's health in settings with limited resources. Its noninvasive, user-friendly design and efficient vital sign monitoring, capacity to lower hospital visits, and conformed to Islamic principles helped caregivers build confidence and trust to use the device in the future. Caregivers were concerned about the hospital stay due to their work, household chores, and caring for other children as well as the device’s signal sound. Despite recognizing its benefits, some remained hesitant due to conservative views. Conclusion: The wearable device's non-invasive, user-friendly design demonstrated potential in enhancing children's health monitoring; nevertheless, greater acceptance and implementation require addressing caregivers' concerns and practical challenges.
Assessment of self-management behavior and psychological adjustment practices among drug-sensitive tuberculosis patients at BRAC DOTS TB Center in Dhaka city: a cross-sectional study
(BRAC University, 1/5/2025) Musavi, Zainab; Rahman, Ataur; Islam, Shayla
Introduction: the study used a cross-sectional study design to assess the self-management behaviors and self-efficacy practices of drug-sensitive TB (DS-TB) patients at the BRAC TB DOTS center Kamrangirchar located in Dhaka South City Corporation (DSCC). The primary goal of this study was to assess and evaluate DS-TB patient's self-management behaviors and psychological adjustment practices with a focus on socio-demographic factors. Method: The study was conducted among the 121 DS-TB patients with validated tools self-management scale for tuberculosis patients (SMSTP) & tuberculosis self-efficacy scale (TBSES). The study tool consisted of 24 questions within 4 domains including adherence to treatment, support behavior, disease transmission prevention behavior, and psychological adjustment. Data analysis was conducted using descriptive and inferential statistics including chi-square and t-tests to examine the associations between self-management behaviors, self-efficacy, and socio-demographic characteristics. Findings: The study found variability across each domain of self-management behaviors and self-efficacy practices. The findings indicate the majority of the participants (51.1%) have moderate self-management behaviors followed by 25.7% with low self-management behaviors and 23.1% with high self-management behaviors. Gender-based findings were particularly significant, with females exhibiting moderate and higher self-management 80.6% compared to male patients 66.7%. In addition, education level and occupation of the patients have also been found to be influencing factors, 83.54% of patients with secondary or higher education have moderate and high self-management compared to 57.14% uneducated or primary education completed. Students 94.12% and homemakers 82.05%, have higher self-management behaviors. Additionally, larger household sizes impact the psychological adjustment negatively as 76.92% of patients with 7 or more family members have lower psychological adjustment score. Conclusion: The study found gender as one influencing factor that is important to be considered for gender-specific interventions addressing health education, mental health support, and community-based awareness to improve the effectiveness of the DOTS intervention through self-management behaviors and self-efficacy practices in urban Bangladesh. The findings emphasize the need for community-based interventions and policy development to address the gap in self-management and psychological adjustment to achieve the targeted goal of the End TB strategy and National Tuberculosis Program (NTP).
Understanding healthcare pathways of patients with chronic respiratory disease: insights from an exploratory study in a government sub-district hospital of Bangladesh
(BRAC University, 1/5/2025) Sikder, Sadia; Ahmed, Syed Masud; Naher, Nahitun
Introduction: Chronic respiratory diseases (CRD) comprise a major burden of public health, especially in low-resource settings like rural Bangladesh. Many systemic, sociocultural and structural factors influence the care seeking journey of CRD patients, impact outcomes. There is an urgent need to understand the patient pathways for seeking CRD care in order to address the gaps in service delivery and to meet the unique needs of CRD patients. Method: The study adopted a qualitative exploratory approach to elicit relevant data from the CRD patients. A total 20 respondents were sampled conveniently and interviewed to explore symptoms, onset of illness, self-management practices, healthcare seeking journey including choice and decision to choose service delivery points, experiences at each care point, and the overall impact on health and financial conditions. Data analysis involved both quantitative and qualitative methods, utilizing STATA V17 for descriptive statistics and thematic analysis for qualitative data. Ethical clearance was obtained, ensuring informed consent and confidentiality for all participants. Findings: Respondents with CRD reported diverse care pathways, involving both formal and informal healthcare providers. The length of these pathways ranged from a single point of care to as many as five. Many participants delayed seeking treatment, often due to misattributing symptoms, underestimating their severity, or relying on beliefs about CRD that led them to manage symptoms with home remedies. Though the private providers and drug sellers were the most common initial points of care, while Upazila Health Complex (UHC) ultimately became the source of consistent care provider for most respondents due to their affordability and accessibility. Although the majority of respondents expressed satisfaction with UHC services , several challenges such as unavailability of essential medicines, lack of diagnostic facilities, shortened consultation times, disrespectful behavior from staff and insufficient privacy affected their overall experience. Receiving a CRD diagnosis often caused respondents to experience significant anxiety and worry, perceiving it as a lifelong burden. Moreover, the financial stress was another major concern and there were patients who relied on family or borrowing to cover treatment costs. The combination of prolonged illness and economic hardship exacerbated feelings of anxiety, hopelessness and despair. Conclusion: Patients with CRD often use multiple pathways for various reasons to access various categories of providers before reaching UHC. This complex and challenging journey in accessing and using healthcare services, leading to delays in receiving proper formal care. Even though, UHC, a primary health care point, is not yet fully equipped to deliver high-quality CRD services, it remains a more accessible and affordable option for CRD patients, particularly those from poor, rural, and socioeconomically disadvantaged backgrounds. Addressing the underlying factors highlighted in the study can be useful for planning interventions to improve access to CRD care. Our findings aim to inform policymakers and guide program planning to enhance awareness, accessibility, and affordability of healthcare for CRD patients, thereby improving NCD care in Bangladesh.
Exploring the experiences of community health workers during covid-19 pandemic in urban slums of Dhaka city
(BRAC University, 2021) Nyara, Baba James; Rashid, Sabina Faiz; Aktar, Bachera
Introduction: Community Health Workers (CHWs) are largely female who are employed by different private and public organizations with an aim to bridge the gap between formal healthcare and community, primarily working in rural and urban settings in Bangladesh. However the COVID-19 pandemic has posed unique challenges in urban slums of Dhaka because dwellers live in overcrowded spaces, lack access to WASH facilities and experience poverty which undermine COVID-19 prevention measures. In this context, CHWs play vital roles such as awareness, relief distribution and contact tracing to combat the spread of COVID-19. This study explored their experiences during the shutdown for service delivery organizations to recognize them as essential workforce. Method: The study drawn from 19 qualitative data transcripts from a larger research conducted by James P. Grant School of Public health at BRAC University which explored experiences of urban slums dwellers including CHWs during the COVID-19 shutdown in urban slums of Dhaka. Data was collected on phone from participants and coded inductively after organizing and categorizing according to themes and later placed on data matrix for easy visualization, analysis and interpretation. Findings: CHWs play key role in fighting COVID-19 in urban slums by linking the community and formal health care but they face challenges that include, disrupted personal and social lives, non-recognition and mistrust, increased workload, community expectations, poor remuneration and mental and emotional distress. Conclusion: The current COVID-19 situation has resulted to unprecedented challenges that affect the health and wellbeing of CHWs in urban slums in Dhaka, therefore government and service delivery organizations are urged to recognize CHWs as essential health workforce and implement feasible measures such as work shifts and leaves, improved remuneration, counseling support and regular training to enhance their performance. It is important to conduct additional exploratory research in other slums to generate more evidence.
Experiences of the beneficiaries of Interactive Popular Theatre (IPT): a qualitative study on the experiences of the beneficiaries of IPT as a part of BRAC CST program on COVID-19 prevention at Cox’s Bazar Sadar, Ramu & Chakoria upazila in Bangladesh
(Brac University, 2023) Rahman, Md. Mizanur; Sarker, Malabika; Barua, Mrittika
The COVID-19 pandemic is still ongoing across the globe as well in Bangladesh which spreads very fast in human contact. To prevent this disease from spreading, we need to follow certain guidelines and some behavioral modifications which need a conscious effort from all of us. Aiming to that, BRAC is conducting a community-based CST program in six sub-districts of Cox’s Bazar. Interactive Popular Theater (IPT) is one of the components among other interventions of the CST program like handwashing stations, mask-wearing, social distancing and miking. IPT incorporates awareness messages regarding COVID-19, cervical cancer and other social issues into it. The focus was COVID-19 preventive messages while cervical cancer also bears great importance as well. IPT transfers knowledge to its audience through entertainment like singing, dancing and acting. This study looked into the experiences of the beneficiaries, from their perspective. Our study investigated their feeling about IPT. This study wanted to know whether the IPT was entertaining, the reason for liking or disliking it, they got benefitted or learned new things. Knowledge gained from the IPT and their application in real life was also a topic of interest. All the respondents reported an overall good experience with IPT. The reason for expressing satisfaction with the IPT is learning new knowledge. The study also found out the daily applications of these messages in their life which mean, there are positive behavioral changes have been noticed like adopting wearing masks and handwashing as habits. As this kind of intervention is very new in our country, we need more research in this field from different perspectives. The use of IPT also has a great impact on building people’s awareness and understanding. It could be a great tool and might be used to educate the common people in Bangladesh on a larger scale.
Knowledge and practices regarding Covid-19 prevention among students of selected madrasas in Cox’s Bazar, Bangladesh
(Brac University, 2023) Blasius, Camilla Megusa; Sarker, Malabika; Chowdhury, Mohiuddin Ahsanul Kabir
The adherence to COVID-19 preventive practices can be influenced by the level of knowledge regarding prevention practices. This study assessed the knowledge and practices of COVID-19 prevention among Madrasa students in Cox’s Bazar, Bangladesh. Method This cross-sectional study was conducted using face to face structured questionnaire that collected responses from 917 Madrasa students who attended six different Madrasas in six different unions of two upazilas of Cox’s Bazar District. Participants were recruited through convenience sampling and interviewed after acquiring informed consents and assents. Level of knowledge and practices were scored using frequencies (percentages) and chi-square test was performed in STATA® 17. Logistic regressions were used to find associations between knowledge and practices and the demographics of the study population. Findings Among 917 students, 73.72% were females and 26.28% were males from Classes 6-9 with secondary education. Overall, it was found that students with inadequate knowledge of COVID-19 prevention was at 47.33% when compared to them having adequate practices of COVID-19 prevention which was 65.98%. The most significant finding was class 9 having adequate practices of COVID-19 prevention in both the adjusted (1.7) and unadjusted (2.08) odds ratios with less than 0.05 p-values. Handwashing and wearing of facemasks were common among them. There was no statistical difference between males and females. However, statistically significant differences were found in knowledge and practice levels relating to their different Madrasas and upazilas with weak associations. Conclusion This study showed inadequate knowledge for the COVID-19 preventive measures among both male and female students in the Madrasa institutions studied. Positively, they had adequate practices of COVID-19 prevention. Their adherence to COVID-19 practices may depend on their level of knowledge of prevention and some other factors worth studying in future.
An exploratory qualitative study on the enabling factors of volunteerism: the perspective of BRAC volunteers and their family members in Cox’s Bazar District, Bangladesh
(Brac University, 2023) Lastima, Jorina; Barua, Mrittika
Introduction: Volunteers have a vital role in the community. Their motivation to volunteer can influence other people to change their behavior. Especially in the time of the COVID-19 pandemic, volunteers assisted institutions to help deliver service. Similarly, the BRAC CST project is dealing with COVID-19 in 6 project sites in Cox’s Bazar, Bangladesh with the aid of volunteers. BRAC volunteers are disseminating COVID-19 messages and distributing masks in the community. The volunteers and their families have the relevant information to determine their perception, motivation, and experiences on volunteerism. This study aimed to understand enabling factors of volunteerism from BRAC volunteers and their family members' perspectives in Cox’s Bazar, Bangladesh. Method: The study design used is a qualitative study. An in-depth interview was conducted with 10 BRAC volunteers and 4 family members in 3 BRAC CST project sites located in Cox’s Bazar, Bangladesh. The purposive sampling method was used to select the samples. A semi-structured IDI guideline was developed along with a consent form. IDIs were recorded, transcribed, translated, coded, and analyzed thematically. Clustering and comparing were done by using a data matrix and the results were summarized. Data triangulation was done to verify the responses from the volunteers and family members. Ethical approval from BRAC University James P Grant School of Public Health Institutional Review Board was obtained. The study purpose, risks, benefits, and right to refuse and withdraw from the study were explained to the participants. Anonymity and confidentiality were maintained during the entire time of the study. o Findings: The study discovered that enabling factors on volunteerism contribute to volunteers’ positive experience in volunteer work. The volunteers' and family members’ perception of volunteerism was that it is noble work to do. Volunteers serve the people willing to improve their health which people find respectable. Representing a respectable institution such as BRAC gave the volunteers a sense of pride. Volunteers along with their family members enjoy volunteering activities as they experienced good interactions with the people. Gaining knowledge on COVID-19 prevention benefited the volunteers as well as their families as it enhanced their health practices. Volunteers also developed their communication skills in dealing with many people. The family supported and encouraged volunteers in joining and doing volunteer work. They are proud of their family member as the volunteer is doing a good deed for others. The supervisors were also supportive of the volunteer’s time in taking leaves for their schoolwork. Recognition in the community is also experienced by the volunteers. People’s participation facilitated the discussion that helped the volunteer convey COVID-19 messages in the community. Conclusion: This study concluded that there were different factors of volunteerism. Each one was interconnected with the other that making volunteers motivated to do volunteering. Factors discovered where volunteer work is perceived as an honorable act, being proud to be part of a respectable institution, enjoying volunteering, experiencing benefits, acceptability, and support from the family, institution, and the community. These enabling factors identified made volunteer work on COVID-19 awareness feasible in Cox’s Bazar, Bangladesh.
Exploring the sexual health seeking behaviors of hijra community in Dhaka: a qualitative study
(Brac University, 2023) Manzur, Mehnaz; Alam, Farhana; Rashid, Sabina Faiz
Introduction Hijra people in Bangladesh are stigmatized in various aspects of their lives including the healthcare system. This study aimed to explore the sexual health service seeking behavior of Hijra people in Dhaka city, along with its influencing factors. Method This study followed a qualitative approach to explore sexual health seeking behavior of Hijra people in Dhaka. Using snow-ball sampling technique, in-depth interviews were conducted with 26 Hijra people. To achieve an overview on the sexual health seeking behavior of the Hijra community, key informant interviews were conducted with 4 Hijra community leaders and 1 program personnel of a Hijra based NGO. The interviews were conducted in Bangla, translated verbatim in English and coded by using both inductive and deductive approaches. Selected interview responses were clustered and arranged according to themes and sub-themes in a data matrix for interpretation. Findings The criminalization of sex-reassignment surgeries in Bangladesh compels the Hijra people to take unmonitored risky surgeries from unqualified doctors in Bangladesh. The information on these illegal surgeons are kept secret by the Hijra people. Despite having knowledge on safe sex practices, many Hijra people were not consistently following these measures due to reasons like their personal preferences, and unwillingness of customers of Hijra sex workers to wear condoms. For sexual health services like supply of condoms, testing and treatment of STIs, most preferred facility by Hijra people is NGO based health facilities, followed by government hospitals. The negative experience they face in government hospitals often divert them to seek services from informal health service providers like local pharmacies and homeopathic doctors. Conclusion Legalization of sex-reassignment surgeries for Hijra people, establishing designated health facilities for them and sensitizing health service providers on Hijra people will improve sexual health status of Hijra people in Bangladesh.
Prevalence of wasting and associated factors among under 5 children in Korail slum, Dhaka, Bangladesh: a cross-sectional study
(Brac University, 2023) Tarikujjaman, Md. Rabbi; Chakraborty, Barnali; Naher, Nahitun
Introduction: Among Bangladeshi children under the age of five (U5), malnutrition is a major health concern. Wasting is one of the malnutrition symptoms associated with malnourished children's deaths. Southern Asia has a 14.1% prevalence of wasting, according to the world nutrition survey. According to the Global Nutrition Report, the prevalence of wasting among under-5 children is 9.8% in Bangladesh. Objective: The goal of this research to assess the prevalence and associated factors of wasting among Under 5 children in Korail slum. Method: A descriptive cross-sectional study was conducted among 342 children under the age of five living at Korail slum in Dhaka city from October 15, 2022 to January 11, 2023. A standard anthropometric measurement method was used for the measurements. The measurements were height and weight. Software named STATA 17 was used to analyze the data. A multivariate and bivariate logistic regression analysis was conducted. Findings: In this study, the mean age of under-5 children was 26.7 months. Male was 54.4% and female was 45.6%. 10.23% of the anthropometric assessment was wasted based on the weight for height Z-score. According to the study, females were more likely to suffer from wasting than males. Conclusion: In Bangladesh, under nutrition among children under the age of five is a public health problem. We observed that the prevalence of wasting in Korail was slightly higher than the national prevalence. To reduce the wasting status of children under 5 years old, the government, nongovernmental organizations, and the community must work together.
Double burden of malnutrition among mothers having under-five children: a cross-sectional study in the slums of Dhaka city
(Brac University, 2023) Shapla, Mst. Sharmin Akter; Chakraborty, Barnali
Objective: We sought to estimate the prevalence and factors associated factors with the double burden of malnutrition (underweight, overweight/obesity) among mothers who have children less than 5 years of age residing in the slum areas of Dhaka city. Methods: We conducted a cross-sectional quantitative study to assess the prevalence and related factors that affect the double burden of malnutrition including underweight, overweight/obesity of those mothers who have children less than 5 years of age. The study was conducted in two big slums; Dholpur slum from South Dhaka city corporations and Korail slum from North Dhaka city corporations in Bangladesh. A total of 424 mothers who have children less than 5 years of age were included in this analysis. The primary outcome variable was underweight and overweight/obesity compared to normal weight as reference category, measured by mother’s body mass index (BMI). And BMI was calculated following by dividing body weight (kg) by total height squared (m2). Results The overall prevalence of underweight and overweight/obesity was respectively 13.4% and 45.3% among under-five children’s mothers who were living in big slums of Dhaka city in Bangladesh. The prevalence of both underweight and overweight/obesity was higher among mothers of 20-29 years of age. We got significant relationship between underweight and overweight/obesity with the mothers’ age, household monthly income, no. of children, frequency of pregnancy, childbirth order, mode of delivery, NCD history, and food insecurity. The associated factors of being underweight are frequency of pregnancy and food insecurity (AOR=4.8, 95% CI: 1.2- 18.3) and (AOR=2.4, 95% CI: 1.1- 5.4) respectively. The most significant factors of being overweight/obese are household monthly income, childbirth order, and mode of delivery (AOR=2.7, 95% CI: 1.3– 5.9), (AOR=3.0, 95% CI: 2.0–9.0) and (AOR=0.4, 95% CI: 0.2-0.7). Conclusion In Bangladesh, overweight and as well as obesity have been tremendously rising but simultaneously underweight did not fall significantly. The Ministry of Health of Bangladesh should consider these findings while whereas creating and executing health programs for the double burden of malnutrition among mothers who have under-five years of children.
Experiences of volunteers as change agents for prevention of COVID-19 in Cox’s Bazaar, Bangladesh: an exploratory qualitative study
(Brac University, 2023) Mariam, Warisha; Sarker, Malabika; Barua, Mrittika
Background: Community volunteers are an important backbone for engaging communities to bring about health related behaviour change among the people of the communities. In recent years the pandemic due to Coronavirus 2019 has gained all the momentum and most of the preventive strategies have been shifted in reducing the further transmission of this virus and curbing the pandemic. This study examines the volunteering experience of the volunteers working in the BRAC Community Support Team intervention as change agents in the Cox Bazaar community. The area has been chosen for its high urban and peri urban type of population density. Methods: This was an exploratory qualitative study done among ten volunteers involved in BRAC CST project in Ramu, Sadar and Kutubdia upazilas of Cox’s Bazaar. In depth interviews were conducted and data was organised, coded and analysed using manual coding and web-based software Dedoose. Thematic analysis has been done and results has been interpreted using the Social Cognitive Theory. Results: Ten volunteers were interviewed, out of which 1 is female and 9 males. The age ranges from 21 to 38 years. All volunteers perceived their desire to work as a volunteer a noble cause for the community. They were also recognised and respected in the society for their work done. Social recognition, job satisfaction for working in public welfare and support from their families and communities helped them to perform their job better. However, social, cultural and language barrier and shaming of their work by abusing and harassing played an important role in hindrance to performing their activities as change agents. There were also some power distribution roles in community which hampered the volunteering activity. Lack of refresher training and limited resources and absence of mobility support are some of the identified factors that also hampered their activity as a change agent. Conclusion: In general volunteers were able to perform their assigned tasks. However, ensuring continuous organisational support, refresher trainings can lead to a greater motivation for acting as a change agent and performing their tasks better. Future research directed towards exploring the gender differences in experiences will also add to the knowledge gap.
Comparing knowledge and practice of Covid-19 vaccination between general school (Grade 6 to 9) and madrasa-going students (Grade 6 to 9 equivalent) at Cox’s Bazar, Bangladesh
(Brac University, 2023) Neeher, Nishantika; Chowdhury, Mohiuddin Ahsanul Kabir; Sarker, Malabika
Background Schools and madrasas are regarded as high-risk locations for COVID-19 epidemics due to the crowded campus atmosphere, high movement, and constrained space. Therefore, vaccination is believed to be an essential tactic that can significantly reduce the occurrence and spread of this deadly infectious disease. However, there may be variations between a madrasa and a school regarding students’ desire to receive the COVID-19 vaccination. Therefore, a study comparing knowledge and practice of COVID-19 vaccination between general school and madrasa-going students is essential to improve vaccine coverage and prevent a future outbreak. Methods A cross-sectional quantitative survey was conducted on students from six schools and six madrasas in Bangladesh. A semi-structured and self-reported questionnaire containing informed consent, four sections containing the socio-demographics section, the impact of COVID section, knowledge about COVID vaccine section, and uptake of COVID vaccine was used. Multiple logistic regression was performed to determine the variables affecting the uptake of COVID-19 vaccinations. Results A total of 2361 respondents were included in the final analysis, out of whom 1550 (65.65%) were school students and 811 (34.35%) were from the madrasa. The average age of students was 13.74±1.41 (SD), and more than half were females (64.00%). Both students from school and madrasa had adequate knowledge about the COVID-19 vaccine, and the proportion of madrasa students with correct answers was higher than that of school students. The common source of knowledge for school students was school; for madrasa students, it was mass media. There was more than 95% vaccine uptake for both institutions, and the primary reason for taking the vaccine was the perception that the vaccine was safe. Socio-demographic factors like age, family size, and location had a significant association with vaccine uptake. Conclusions The findings reflect that there is no significant difference in uptake of the COVID vaccine between schools and madrasa. The proportion of madrasa students was higher than school students when asked about knowledge.
Assessing knowledge and practices for covid-19prevention among students from class 8th & 9th standard in selected schools and equivalent grades level of madrasas in cox bazar districts, Bangladesh
(Brac University, 2023) Chand, Deepika Joyec; Sarker, Malabika; Chowdharyz, Mohiuddin Ahsanul Kabir
Background: Knowledge and practices are crucial cognitive components in public health, especially in health promotion and prevention (Ferdous et al., 2020).this paper examines knowledge and practice among students of 8th and 9th grade in schools and madrasas of Cox’s bazar district as this will help in developing effective intervention to increase knowledge and practice among students. Method: quantitative approach and cross-sectional design used to collect data among all student in grade 8 & 9 in schools and madrasas. Results: it was found that students have inadequate knowledge score about covid prevention whereas adequate practice score is observed to prevent covid-19. The level of knowledge varied by sociodemographic characteristics. Females [AOR .605,95% CI: (0.484 -0.755) < 0.01] and individuals studying in 9th grade [1.307(1.024 - 1.668) p<0.05 demonstrated inadequate levels of knowledge. Whereas the students living in Pekua were having odds .630 times performing more practice about COVID-19 prevention [OR .630, 95% CI: (0.396 - 1.004)] than students living in Sadar. the study predicts that the odds of a female student being carrying out practice about COVID-19 prevention are 1.014 times [OR 1.014 95% CI: (0.687 - 1.498) than those of a male student. Conclusion: Our findings suggest the need for effective and tailored health education programs aimed at improving COVID-19knowledge among students and to implementation and maintenance of safe practices.
Wars and Conflicts and its Impact on Sexual Reproductive Health Rights (SRHR) among forcibly displaced women of reproductive age (15-49 years): a scoping review
(Brac University, 2023) Oishi, Shafiqua Nawrin; Hossain, Shaikh A Shahed
Introduction: With growing political instability, war and conflict has been disrupting the access to SRHR service and in some cases, they are left neglected. Even though the international agencies have provided relevant guidance, there is still no agreement on the effective way to provide Sexual Reproductive Health (SRH) services in the humanitarian settings. Thus, this study will explore the impact of forced displacement due to war and conflict on Sexual Reproductive Health Right (SRHR) of the displaced women of reproductive age Method: This study adhered the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for systematic reviews. Indexed Articles from databases such as PubMed, Scopus, and Google Scholar were methodically searched in addition to other sources and grey literatures by two reviewers independently step by step based on a pre-determined inclusion and exclusion criteria. A total of 285 record were screened of which 15 studies were included. Findings: 15 studies were included in this review from 17 countries covering Asia and African Among the 15 studies, 2 were literature review, 1 qualitative study, 8 quantitative study, 1 policy review and 3 mixed-method studies design. Findings suggest, regardless of policies in place, due to lack of proper utilization, women displaced due to war or conflict are not receiving SRH services to the full. However, some of the effective community-based interventions can help the update of SRH services. In addition, issues like transactional sex work among female in the conflict affected settings are underrated thus gap remains in appropriate measures and intervention dedicated for them. Conclusion: The review was able to highlight some of the effective interventions across the humanitarian setting focusing on SRH for women. Community based approach has been at the heart of all the progress in SRH service and intervention.