Human rabies in rural Bangladesh

Rabies is a major public health problem in Bangladesh, where most of the population live in rural areas. However, there is little epidemiological information on rabies in rural Bangladesh. This study was conducted in 30 upazilas (subdistricts) covering all six divisions of the country, to determine the levels of rabies and animal bites in Bangladesh. The total population of these upazilas was 6 992 302. A pretested questionnaire was used and data were collected by interviewing the adult members of families. We estimated that in Bangladesh, 166 590 [95% confidence interval (CI) 163 350-170 550] people per year are bitten by an animal. The annual incidence of rabies deaths in Bangladesh was estimated to be 1·40 (95% CI 1·05-1·78)/100 000 population. By extrapolating this, we estimated that 2100 (95% CI 1575-2670) people die annually from rabies in Bangladesh. More than three-quarters of rabies patients died at home. This community-based study provides new information on rabies epidemiology in Bangladesh.     

Communication and contraception in rural Bangladesh

This paper examines the association of communication in explaining the decision of women in rural Bangladesh to use or not to use contraception. Using survey data from villages in Bangladesh, we found that communication is an important influence on the ideational change for a smaller family norm and the practice of contraception. This is evident even when socioeconomic and cultural variables are controlled for. We recommend that to foster the use of contraception, communication factors should be given greater emphasis, especially to target husbands in the family planning program and to improve the image of female children.     

Responsive complementary feeding in rural Bangladesh

It is now widely recognized that malnutrition can partly be attributed to caregiver-child interaction during feeding episodes. Current conceptual frameworks emphasize the importance of responsiveness (including active and social behaviour), psychomotor abilities of the child to self-feed, and a non-distracting feeding environment. The present observational study had three main objectives: (1) to define operationally key terms such as responsive and active feeding and observe their frequency in a rural Bangladesh sample; (2) to examine whether self-feeding, responsive and active behaviours of the mother and child varied with child's age and amounts eaten; and (3) to determine associations between mother and child behaviours. Fifty-four mother-child pairs were observed during one feeding episode and behaviours were coded for 5 categories, namely self-feeding, responsive, active, social and distracting behaviours. Children were between 8 and 24 months of age. Results indicated that the five behaviours could be observed and reliably coded. Two-thirds of mothers had an active feeding style but only a third were responsive; the two styles did not overlap. With older children, mothers encouraged more eating and more self-feeding, but children did not feed themselves more; instead older children were more negatively responsive (refusing offered food). Positively responsive mothers tended to have active children who explicitly signaled their desire for food or water, and who ate more mouthfuls of food. Positively active mothers adopted different strategies to encourage eating, such as verbally directing the child to eat, focusing, and temporarily diverting. These mothers tended to have children who were negatively responsive and refused food. Children accepted on average 5.31 mouthfuls of food and rejected 2.13. Mothers who used intrusively active strategies (e.g. force feeding) tended to have children who were both positively and negatively responsive, thus partially reinforcing her forceful behaviour. Thus, the responsive feeding framework, once operationalized, has the potential to identify specific behaviours that support or impede mother-child interaction during complementary feeding.     

Women's health education in rural Bangladesh

Each year in Bangladesh scores of women and children suffer and die from diseases that are largely preventable or curable. In an effort to address this problem, CARE-Bangladesh established its Women's Health Education (WHE) program. The WHE program, which targets poor women in rural areas, was designed to teach women how to prevent and treat health problems which routinely afflict them and their families. The health education sessions emphasize preventative measures and cover topics concerning health and hygiene of women and children. Surveys are conducted immediately following course completion and again six months later to assess the short and long-term impact of the program. Surveys conducted at the end of the 12 week course period indicate that, on average, participants retain 97% of the material covered. Measurement of knowledge retention 6 months after course completion revealed only a 5% decline from the post-course survey results. These findings illustrate the program's success in increasing knowledge and awareness of health interventions. Since imparting knowledge is a first step toward changing behavior, WHE's success in this regard suggests a significant role for health education in preventing and treating common health hazards, and thus in improving the health status of women and children in developing countries.     

Education and infant survival in rural Bangladesh

This paper explores the mechanism through which socioeconomic status affects infant deaths. The data used here come from a prospective study in rural Bangladesh. Both neonatal deaths and postneonatal deaths were found to be higher in number among those whose mothers have no schooling. Again, education of the mother has been found to be related to gestational month at termination and this gestational month at termination (which is the maturity of the newborn) determines the neonatal death. The other factors affecting infant mortality were the height of the mother and the weight of the infant. The taller the mother, the fewer the neonatal and post-natal deaths. The weight of the infant has a direct relationship to its survival during infancy.     

Older widow mortality in rural Bangladesh.

Prospective data from rural Bangladesh are used to explore the adverse impact of widowhood on old age female mortality. The results indicate that widows aged 45 and above have significantly higher mortality than their currently married counterparts. Controlling for age and disability status, much of this excess mortality risk can be accounted for by patterns of living arrangements and household assets. An analysis of older widows suggests that the presence of adult male kin in the household (primarily sons), and to a lesser extent household headship (both of which may be interpreted as reflecting individual access to resources in this society) have a substantial impact on mortality risks for this group of women.     

Assessment of Water Use and Sanitation Behavior in a Rural Area of Bangladesh

A health development project was established in a rural area of Bangladesh that entailed training village health promoters to provide health education and to motivate families to install tubewells and sanitary latrines. Following a 2-y period of project implementation, the authors sought to assess knowledge and practice of mothers and family members about use of safe water and household tubewells. A household survey in the project area was compared with a similar one in a nearby control area. Three-hundred households in each area were selected, and mothers were interviewed with a standard questionnaire. Significantly more mothers in the health development project area (45.7%) used tubewell water for domestic purposes than in the control area (32.8%). However, hygienic practices of mothers were inadequate. Sanitary latrines were present in less than 20% of households in both areas. Approximately 97% of mothers and 78% of adult family members always used household latrines. However, the use of household latrines by children was low (26.7%). There was no statistically significant difference in the use of household latrines between the project and control areas. The results showed an improvement in use of household tubewells in the project area; however, there was no improvement in sanitation practices of families in the project area. Health education alone, without improvement of socioeconomic status, is not effective in changing behavior.     

Risk factors for perinatal deaths in rural Bangladesh

Perinatal mortality refers to stillbirths and deaths which occur during the first week of life. 7 million such deaths occur annually worldwide, almost all of which are in developing countries. Rates as high as 75-100 deaths/1000 births have been documented in developing countries. The 3 leading causes of perinatal mortality are complications of pre-term birth, birth asphyxia and birth trauma, and bacterial infections. The other causes of perinatal mortality are largely unknown due to difficulties in documenting stillbirths in developing countries. In many developing country societies, it is culturally unacceptable to acknowledge a birth until it has survived its first week of life. This study identified and quantified the risk factors for perinatal deaths in a rural community in Manikganj district, Bangladesh. Cases were mothers whose infants died in the perinatal period, while comparison mothers were those whose infants survived the perinatal period. Of the 186 infant deaths recorded, 130 (69.9%) were in the perinatal period, and included 53 stillbirths. The perinatal death rate was 64.5/1000 births. Logistic regression confirmed that maternal age, parity, and mal-presentation were significantly associated with perinatal deaths. Mal-presentation was independently associated with a increased risk of perinatal death.     

Induced abortion in a rural area of Bangladesh

Mortality rates from indigenous abortion practices have not been described previously. From September 1982 to August 1983, traditional birth attendants, under medical supervision, collected data on all identifiable pregnant women and pregnancy outcomes in a geographically defined population in rural Bangladesh. Of 9,906 pregnancies, 9,317 ended in live birth, 412 in induced abortion, and 177 in spontaneous abortion. All abortions were induced by indigenous health practitioners. The abortion-to-live-birth ratio was 44.2 per 1,000. Ten women died after induced abortion, yielding a death-to-case rate of 2.4 percent. The death-to-case rate was highest for women 35 and older and women of parity five and higher. The authors conclude that improved distribution of safe, acceptable means of fertility regulation may save many mothers' lives.     

Economic consequences of maternal illness in rural Bangladesh

We use panel data on household consumption combined with information taken from the medical records of women who gave birth in health facilities to explore the economic consequences of maternal ill health, in the context of a rural population in Bangladesh. The findings suggest that there is a large reduction in household resources associated with maternal illness, driven almost entirely by spending on health care. In spite of this loss of resources, we find that households are able to fully insure consumption against maternal ill health, although confidence intervals are unable to rule out a small effect. Households in our study area are shown to have good access to informal credit (whether it be from local money lenders or family relatives), and this appears critical in helping to smooth consumption in response to these health shocks, at least in the short term.     

Noncompliance among oral contraceptive acceptors in rural Bangladesh

The levels of noncompliance among 175 oral contraceptive acceptors in a rural area of Bangladesh were monitored for three to four months. Unexpectedly high levels of noncompliance were observed, including both overconsumption and underconsumption of oral contraceptive pills. Although the study was designed to investigate only the levels of noncompliance and not the causes and consequences of noncompliance, some useful indications of the factors associated with noncompliance were obtained. The results indicate that noncompliance is a significant factor in family planning programs and, as such, warrants further in-depth investigation.     

Analysis of ante-partum maternal morbidity in rural Bangladesh

ABSTRACT: This paper presents the results of a prospective study of maternal morbidity during the ante-partum period in rural areas of Bangladesh. The data came from a survey of Maternal Morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT) during the period from November 1992 to December 1993. Since then no such national level survey has been conducted in Bangladesh. This paper employs multiple-decrement life table technique, a convenient way of analysing the risks of different types of disease conditions that women experience during the antenatal period for different age categories. The high-risk complications such as ante-partum haemorrhage, excessive vomiting, fits/ convulsion and oedema were considered in this study. In this study a cause specific model was applied to explore the differences in the risks exerted at different ages of reproductive life attributable to some selected complications of pregnancy. The results of this study indicate that women of age 25–29 years are less susceptible to most of the selected life-threatening and high-risk complications during pregnancy such as haemorrhage, fits/convulsion and oedema. However, younger women (age < 25 years) are more likely to have excessive vomiting during pregnancy, and older women (age < 30 years) are at greater risk of haemorrhage, fits/convulsion and oedema.     

Assessment of early-life lead exposure in rural Bangladesh

Lead is a well-known neurotoxic metal and one of the most toxic chemicals in a child’s environment. The aim of this study was to assess early-life lead exposure in a pristine rural area of Bangladesh. The exposure was expected to be very low because of the absence of vehicle traffic and polluting industries. Lead was measured in erythrocytes, urine, and breast milk of 500 randomly selected pregnant women, participating in a randomized food and micronutrient supplementation trial in Matlab (MINIMat). Lead was also measured in urine of their children at 1.5 and 5 years of age, and in rice, well water, cooking pots, and materials used for walls and roof. All measurements were performed using ICPMS. We found that the women had relatively high median erythrocyte lead levels, which increased considerably from early pregnancy to late lactation (81-136 μg/kg), probably due to release from bone. Urinary lead concentrations were unchanged during pregnancy (median ∼3.5 μg/L) and non-linearly associated with maternal blood lead levels. Children, at 1.5 and 5 years of age, had a median urinary lead concentration of 4 μg/L, i.e., similar to that in their mothers. Rice, the staple food in Matlab, collected from 63 homes of the study sample, contained 1-89 μg/kg (median 13 μg/kg) dry weight and seems to be an important source of lead exposure. Other sources of exposure may be cooking pots and metal sheet roof material, which were found to release up to 380 and 4200 μg/L, respectively, into acidic solutions. Based on breast milk lead concentrations (median 1.3 μg/L) a median daily intake of 1.2 μg was estimated for 3 months old infants. However, alternatives to breast-feeding are likely to contain more lead, especially rice-based formula. To conclude, lead exposure in women and their children in a remote unpolluted area was found to be surprisingly high, which may be due to their living conditions.     

Health, disease and health-care in rural Bangladesh

During two periods of almost 3 months each, a study was done in three villages of Tangail District in Bangladesh. One of the objectives was to find out how the fields of traditional medicine (Ayurveda and Unani), folk medicine and allopathic medicine were related to each other, and which processes could be discerned in these interrelationships. In this respect an important outcome was that traditional medicine had almost disappeared in this area and that Western medicine holds a very strong position. Another objective was to study the illness-behaviour of various economic categories of villagers. Here we found that the poor made much more use of the government facilities than the rich. In fact, these facilities have a large potential, but there are many defects in the way they are operating, so that the potential is not realized at all. We also studied the cures which the practitioners of folk medicine and those of Western medicine are offering to their clients. One of the conclusions was that the practices of the unqualified allopathic practitioners, who hold a strong position in the countryside, are often a hazard to health.