Levels and differentials in child nutritional status and morbidity in a rural area of Bangladesh

This study investigates the levels and differentials in child nutritional status and morbidity in five villages of Bangladesh. Data for this study came from surveys conducted in 1981. Anthropometric measurements of weight, height, and arm circumference are used to assess child nutritional status. Morbidity information is retrospective, covering the thirty days preceding the survey. Differentials in child nutritional status and morbidity have been examined for different household characteristics and sex of the children. Malnutrition was highly prevalent among the children of the study villages. As regards morbidity, 65% of the children had some sort of illnesses in the week preceeding the survey. Differentials in child nutritional status for most of the household characteristics were found to exist, but for morbidity no such relationship was observed. The adverse effect of illness during the week preceding the survey on nutritional status was also found. The nutritional status of the children coming from lower status households was relatively more affected by illness episodes in the week prior to the survey. With regard to sex differentials, girls were found to be relatively more malnourished than boys, and the difference increased as the status of the household increased

Factors affecting child survival in Matlab, Bangladesh

This study investigated the factors that might affect child survival in Matlab, a rural area in Bangladesh, using a ‘proximate determinants’ conceptual framework. The analysis involved three sets of data. Identification of the important covariates of childhood mortality was based on follow-up of the 1982 birth cohort of the whole Matlab population until December 1984. Their household and maternal characteristics were collected during the 1982 census of the area carried out by the International Centre for Diarrhoeal Disease Research, Bangladesh. A survey conducted in late 1986 collected information in seven purposively selected villages on some selected proximate determinants from the mothers of 1128 children bom between 1 October 1983 and 30 June 1986. A survey of 63 health care providers in the area was also conducted during the first half of 1987. The covariates represented various characteristics of the household, of the mother, and of the children; among them economic condition, health program status, maternal age and education, sex and birth order of the children were found, through a hazard logit model analysis, to have significant relationships with child mortality when the age of the children was controlled. The survey revealed widespread malnutrition and morbidity among the children, and the risk of death of the severely malnourished children was found to be very high in comparison to the less severely malnourished and normally nourished children. This pattern supports the argument that child death in this community is mostly preceded by growth faltering. Moreover, most of the previously identified independent variables (excepting birth order, information on which was not available in the survey) maintained a pattem of relationship with severe malnutrition similar to that with mortality. This implied that mortality differentials, as observed for those variables among the children in the study area, are largely due to differentials in malnutrition or growth faltering. A high incidence of morbidity and inappropriate feeding practices may be important causes of malnutrition among the children. Prevalence among mothers of unhygienic practices and lack of appropriate knowledge about disease may be responsible for higher incidences of diseases like diarrhoea among the children. Traditional beliefs prevailing in the community about causes and transmission of diseases may be an important factor deterring parents from approaching scientific or modem methods of treatment and prevention. The practice of food withholding during sickness may also play an important role in aggravating the poor nutritional situation of the study children

The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution

<p>Abstract</p> <p>Background</p> <p>Bangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007.</p> <p>Methods</p> <p>The study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward.</p> <p>Results</p> <p>HCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditional healers, homeopaths (qualified and non-qualified) and basic care providers.</p> <p>Conclusions</p> <p>Bangladesh is suffering from a severe HRH crisis--in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution--which requires immediate attention from policy makers.</p

Application of the Capture-Recapture Method for Estimating Number of Mobile Male Sex Workers in a Port City of Bangladesh

Male sex workers (MSWs) and sex trades are not new in Bangladesh. Current HIV interventions for MSWs need to be expanded in the major cities, but the number of MSWs needs to be scientifically estimated. Although two-sample capture-recapture surveys are suitable for closed populations, this method was here applied to indirectly estimate the number of mobile MSWs in a conservative social setting, a port city of Bangladesh. Use of the method resulted in an estimation of 248 MSWs (95% confidence interval, 246-250) who picked up clients only at open and known contact venues. This estimate does not, however, reflect the total number as MSWs who worked in unknown hidden venues and could not be reached. Experience suggests that the two-sample capture-recapture method is a simple technique for reliably estimating an unrecognized population. The limitation of this method can be minimized by shortening the time gap between surveys, creating an enabling environment to encounter harassment of MSWs, and offering safety to peer-staff

Knowledge on, and attitude toward, HIV/AIDS among staff of an international organization in Bangladesh.

Two hundred and ninety-three randomly-selected members of the staff of ICDDR,B: Centre for Health and Population Research were surveyed anonymously in June 1998, using a pre-tested and self-administered questionnaire, to assess their knowledge on, and attitude toward, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). All except 4 (1.4%) heard of AIDS. Main sources of information were radio and television (93%), newspapers and magazines (84.8%), posters and leaflets (70.2%), and friends (59.2%). About 94% of the respondents believed that HIV might spread in Bangladesh. Only 61.6% knew about the causative agent for AIDS. More than 96% had knowledge that HIV could be detected through blood test. The respondents were aware that unprotected sexual intercourse (92%), transfusion of blood and blood components (93.8%), sharing unsterile needles for injections (94.1%), and delivery of babies by infected mothers (82.7%) could transmit HIV. Similarly, the respondents had the knowledge that HIV infection could be prevented by using condom during sexual intercourse (85.5%), having sex only with an HIV-negative faithful partner (87.2%), avoiding transfusion of blood not screened for HIV (88.9%), and taking injections with sterile needles (86.5%). However, only 33.0% had the knowledge that HIV-infected persons can look healthy, and 56.4% were unaware of transmission through breastmilk. Most members of the staff, particularly at lower level, had misconceptions about transmission and prevention of HIV/AIDS. More than 40% of the respondents had the attitude that HIV-infected persons should not be allowed to work, while another 10% did not have any idea about it. The findings of the study suggest that the members of the Centre's staff have a satisfactory level of essential knowledge on HIV/AIDS, although half of them have poor attitudes toward persons with HIV/AIDS. Therefore, preventive strategy for the staff should be directed toward behaviour change communication

Impact of mobile phone-based technology to improve health, population and nutrition services in Rural Bangladesh: a study protocol

Abstract Background Mobile phone-based technology has been used in improving the delivery of healthcare services in many countries. However, data on the effects of this technology on improving primary healthcare services in resource-poor settings are limited. The aim of this study is to develop and test a mobile phone-based system to improve health, population and nutrition services in rural Bangladesh and evaluate its impact on service delivery. Methods The study will use a quasi-experimental pre-post design, with intervention and comparison areas. Outcome indicators will include: antenatal care (ANC), delivery care, postnatal care (PNC), neonatal care, expanded programme on immunization (EPI) coverage, and contraceptive prevalence rate (CPR). The study will be conducted over a period of 30 months, using the existing health systems of Bangladesh. The intervention will be implemented through the existing service-delivery personnel at various primary-care levels, such as community clinic, union health and family welfare centre, and upazila health complex. These healthcare providers will be given mobile phones equipped with Apps for sending text and voice messages, along with the use of Internet and device for data-capturing. Training on handling of the Smartphones, data-capturing and monitoring will be given to selected service providers. They will also be trained on inputs, editing, verifying, and monitoring the outcome variables. Discussion Mobile phone-based technology has the potential to improve primary healthcare services in low-income countries, like Bangladesh. It is expected that our study will contribute to testing and developing a mobile phone-based intervention to improve the coverage and quality of services. The learning can be used in other similar settings in the low-and middle-income countries

Additional file 1: of Impact of mobile phone-based technology to improve health, population and nutrition services in Rural Bangladesh: a study protocol

Household survey questionnaire. (DOCX 91 kb