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Hennegan J, Hasan MT, Jabbar A, Jalil T, Kennedy E, Hunter E, Kaiser A, Akter S, Zaman A, Rahman MU, Dunstan L, Head A, Scott N, Weiss HA, Win TM, Melendez-Torres GJ, Than KK, Hughes CL, Grover S, Hasan M, Rashid SF, Azzopardi P. Protocol for the Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study in Khulna, Bangladesh: A Prospective cohort to quantify the influence of menstrual health on adolescent girls' health and education outcomes. BMJ Open 2024; 14:e079451. [PMID: 38604626 PMCID: PMC11015194 DOI: 10.1136/bmjopen-2023-079451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Menstrual health is essential for gender equity and the well-being of women and girls. Qualitative research has described the burden of poor menstrual health on health and education; however, these impacts have not been quantified, curtailing investment. The Adolescent Menstrual Experiences and Health Cohort (AMEHC) Study aims to describe menstrual health and its trajectories across adolescence, and quantify the relationships between menstrual health and girls' health and education in Khulna, Bangladesh. METHODS AND ANALYSIS AMEHC is a prospective longitudinal cohort of 2016 adolescent girls recruited at the commencement of class 6 (secondary school, mean age=12) across 101 schools selected through a proportional random sampling approach. Each year, the cohort will be asked to complete a survey capturing (1) girls' menstrual health and experiences, (2) support for menstrual health, and (3) health and education outcomes. Survey questions were refined through qualitative research, cognitive interviews and pilot survey in the year preceding the cohort. Girls' guardians will be surveyed at baseline and wave 2 to capture their perspectives and household demographics. Annual assessments will capture schools' water, sanitation and hygiene, and support for menstruation and collect data on participants' education, including school attendance and performance (in maths, literacy). Cohort enrolment and baseline survey commenced in February 2023. Follow-up waves are scheduled for 2024, 2025 and 2026, with plans for extension. A nested subcohort will follow 406 post-menarche girls at 2-month intervals throughout 2023 (May, August, October) to describe changes across menstrual periods. This protocol outlines a priori hypotheses regarding the impacts of menstrual health to be tested through the cohort. ETHICS AND DISSEMINATION AMEHC has ethical approval from the Alfred Hospital Ethics Committee (369/22) and BRAC James P Grant School of Public Health Institutional Review Board (IRB-06 July 22-024). Study materials and outputs will be available open access through peer-reviewed publication and study web pages.
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Affiliation(s)
- Julie Hennegan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Md Tanvir Hasan
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abdul Jabbar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Tasfiyah Jalil
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Elissa Kennedy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- School of Population Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Erin Hunter
- Department of Public Health Sciences, Clemson University College of Behavioral Social and Health Sciences, Clemson, South Carolina, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Adrita Kaiser
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Akter
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Afreen Zaman
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Laura Dunstan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Social and Political Sciences, University of Melboune, Melbourne, Victoria, Australia
| | - Alexandra Head
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nick Scott
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Helen Anne Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Thin Mar Win
- Myanmar Country Program, Burnet Institute, Yangon, Myanmar
| | | | - Kyu Kyu Than
- Myanmar Country Program, Burnet Institute, Yangon, Myanmar
| | - Chad L Hughes
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Sonia Grover
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Peter Azzopardi
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Telethon Kids Institute, Adelaide, South Australia, Australia
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Jahan I, Vuckovic M, Sara Kabir S, Rashid SF, Bouey J. Reproductive health service access and utilisation among migrant women in Dhaka's urban slums: a qualitative study. Cult Health Sex 2024:1-15. [PMID: 38279843 DOI: 10.1080/13691058.2024.2302052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/02/2024] [Indexed: 01/29/2024]
Abstract
This study explores the impact of migration on the access and utilisation of sexual and reproductive health services by women living in an informal settlement in Dhaka, Bangladesh. A total of 16 in-depth interviews were conducted in March and April of 2019 with women (18-49 years old) who had migrated from rural areas to Dhaka. They reported continued economic insecurity while receiving minimal support from the state. All women reported financial and infrastructural barriers to accessing formal sexual and reproductive health services and tended to seek resources and support through social networks within the slum and from informal health services. Compared with more recent migrants, women who had migrated and resided in the slums for longer found it easier to utilise social networks and resources for sexual and reproductive health. Women had more agency in experimenting with contraceptives but had less power in making decisions during pregnancy and when seeking health care. Menstrual health was a neglected aspect of public health. The study indicates that public health policy targeting the urban poor needs to address the unique challenges faced by migrant women in informal settlements to rectify inequities in health services that leave significant portions of the urban poor population behind.
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Affiliation(s)
- Ishrat Jahan
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Myriam Vuckovic
- Department of Global Health, School of Health, Georgetown University, Washington, DC, USA
| | - Selima Sara Kabir
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Jennifer Bouey
- Department of Global Health, School of Health, Georgetown University, Washington, DC, USA
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Nasar S, Nadim ASM, Raz S, Jabbar A, Hossain MR, Aktar B, Rahman MS, Rashid SF. Livelihood challenges of single female household heads in the Rohingya and host communities in Cox's Bazar, Bangladesh during the COVID-19 pandemic. BMC Public Health 2023; 23:2084. [PMID: 37875875 PMCID: PMC10599043 DOI: 10.1186/s12889-023-16964-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Following the mass influx of Rohingya refugees into Cox's Bazaar, Bangladesh in 2017, makeshift settlement camps in Ukhiya and Teknaf have been overburdened, leading to livelihood challenges for both Rohingya and host communities. The humanitarian crisis has had adverse effects on vulnerable populations, which include older people, persons with disabilities, adolescents, and single female household heads. Using a subset of a larger dataset on households with most vulnerable groups in both communities, we analysed the effect of the pandemic and lockdown on the livelihood of single female household (HH) heads. METHODS A cross-sectional household roster survey was designed to collect data from households with most vulnerable groups (MVGs) of host and Rohingya communities from December 2020 to March 2021; 11 host community villages and 10 Rohingya camps purposively selected as per the affiliated intervention of the project. The paper analysed quantitative and qualitative data from the sub-group of single female household heads without any income/low income. Participants were surveyed for their socio-demographic characteristics, COVID-19 experiences and knowledge, food security situation, social experiences and mental health using PHQ-2 test for depression. RESULTS We surveyed 432 single female HH heads. Support during the pandemic was reported to be low, with less than 50% of HHs reporting relief meeting their needs; only 36% and 15% of these HHs received rations in camps and host communities respectively. Loan facilities were mostly unavailable and there were reported insufficiencies in food consumption. Over 50% of respondents tested positive on the PHQ-2, a scale used to screen for depression. Further analyses indicates that having a chronic health issue (OR 2.2, 95% CI 1.33-3.66) was positively associated with the PHQ-2 score for Rohingya single females. For host single females, having an ill member in the HH (OR 1.46, 95% CI 1.02-2.08) and the inability to save before the pandemic (OR 1.57 95% CI 1.11-2.23) increased the odds of screening positive for depression. CONCLUSION Our study findings revealed insufficiencies with economic opportunities and food security for single female-headed households, as well as a high rate of positive screening for depression amongst this population. These findings call for a more in-depth understanding of the needs of this group.
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Affiliation(s)
- Sameen Nasar
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh.
| | | | - Saifa Raz
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
| | - Abdul Jabbar
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
| | - Muhammad Riaz Hossain
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
| | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - M Shafiqur Rahman
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, 6th Floor Medona Tower, Mohakhali, Dhaka, 1212, Bangladesh
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Sultana R, Parray AA, Hossain MR, Aktar B, Rashid SF. "We are invisible to them"-Identifying the most vulnerable groups in humanitarian crises during the COVID-19 pandemic: The case of Rohingyas and the Host communities of Cox's Bazar. PLOS Glob Public Health 2023; 3:e0000451. [PMID: 37289703 DOI: 10.1371/journal.pgph.0000451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/01/2023] [Indexed: 06/10/2023]
Abstract
The COVID-19 pandemic has had an adverse impact on the Rohingya and the Bangladeshi host communities, which have been well documented in the literature. However, the specific groups of people rendered most vulnerable and marginalized during the pandemic have not been studied comprehensively. This paper draws on data to identify the most vulnerable groups of people within the Rohingya and the host communities of Cox's Bazar, Bangladesh, during the COVID-19 pandemic. This study employed a systematic sequential method to identify the most vulnerable groups in the context of Rohingya and Host communities of Cox's Bazar. We conducted a rapid literature review (n = 14 articles) to list down Most vulnerable groups (MVGs) in the studied contexts during the COVID-19 pandemic and conducted four (04) group sessions with humanitarian providers and relevant stakeholders in a research design workshop to refine the list. We also conducted field visits to both communities and interviewed community people using In-depth interviews (n = 16), Key-informant Interviews (n = 8), and several informal discussions to identify the most vulnerable groups within them and their social drivers of vulnerabilities. Based on the feedback received from the community, we finalized our MVGs criteria. The data collection commenced from November 2020 to March 2021. Informed consent was sought from all participants, and ethical clearance for this study was obtained from the IRB of BRAC JPGSPH. The most vulnerable groups identified in this study were: single female household heads, pregnant and lactating mothers, persons with disability, older adults, and adolescents. Our analysis also found some factors that may determine the different levels of vulnerabilities and risks faced by some groups more than others in the Rohingya and host communities during the pandemic. Some of these factors include economic constraints, gender norms, food security, social safety-security, psychosocial well-being, access to healthcare services, mobility, dependency, and a sudden halt in education. One of the most significant impacts of COVID-19 was the loss of earning sources, especially for the already economically vulnerable; this had far-reaching consequences on individuals' food security and food consumption. Across the communities, it was found that the economically most affected group was single female household heads. The elderly and pregnant and lactating mothers face challenges seeking health services due to their restricted mobility and dependency on other family members. Persons living with disabilities from both contexts reported feelings of inadequacy in their families, exacerbated during the pandemic. Additionally, the shutdown in the formal education, and informal learning centres in both communities had the most significant impact on the adolescents during the COVID-19 lockdown. This study identifies the most vulnerable groups and their vulnerabilities amid the COVID-19 pandemic in the Rohingya and Host communities of Cox's Bazar. The reasons behind their vulnerabilities are intersectional and represent deeply embedded patriarchal norms that exist in both communities. The findings are essential for the humanitarian aid agencies and policymakers for evidence-based decision-making and service provisions for addressing the vulnerabilities of the most vulnerable groups.
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Affiliation(s)
- Rafia Sultana
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ateeb Ahmad Parray
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Muhammad Riaz Hossain
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Bachera Aktar
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Mahmud I, Siddiqua S, Akhter I, Sarker M, Theobald S, Rashid SF. Factors affecting motivation of close-to-community sexual and reproductive health workers in low-income urban settlements in Bangladesh: A qualitative study. PLoS One 2023; 18:e0279110. [PMID: 36638097 PMCID: PMC9838845 DOI: 10.1371/journal.pone.0279110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/29/2022] [Indexed: 01/14/2023] Open
Abstract
Close-to-community (CTC) health workers play a vital role in providing sexual and reproductive health services in low-income urban settlements in Bangladesh. Retention of CTC health workers is a challenge, and work motivation plays a vital role in this regard. Here, we explored the factors which affect their work motivation. We conducted 22 in-depth interviews in two phases with purposively selected CTC health workers operating in low-income urban settlements in Dhaka, Bangladesh. We analyzed our data using the framework technique which involved identifying, abstracting, charting, and matching themes across the interviews following the two-factor theory on work motivation suggested by Herzberg and colleagues. Our results suggest that factors affecting CTC sexual and reproductive health workers' work motivation include both extrinsic and intrinsic factors. Extrinsic or hygiene factors include financial incentives, job security, community attitude, relationship with the stakeholders, supportive and regular supervision, monitoring, and physical safety and security. While, the intrinsic factors or motivators are the perceived quality of the services provided, witnessing the positive impact of the work in the community, the opportunity to serve vulnerable clients, professional development opportunities, recognition, and clients' compliance. In the context of a high unemployment rate, people might take a CTC health worker's job temporarily to earn a living or to use it as a pathway move to more secure employment. To maintain and improve the work motivation of the CTC sexual and reproductive health workers serving in low-income urban settlements, organizations should provide adequate financial incentives, job security, and professional development opportunities in addition to supportive and regular supervision.
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Affiliation(s)
- Ilias Mahmud
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
- * E-mail:
| | - Sumona Siddiqua
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Irin Akhter
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
- Heidleberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
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Barua P, Kibuchi E, Aktar B, Chowdhury SF, Mithu IH, Quayyum Z, Filha NTDS, Leyland AH, Rashid SF, Gray L. The effects of social determinants on children's health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). PLOS Glob Public Health 2023; 3:e0001588. [PMID: 36963045 PMCID: PMC10022045 DOI: 10.1371/journal.pgph.0001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
Empirical evidence suggests that the health outcomes of children living in slums are poorer than those living in non-slums and other urban areas. Improving health especially among children under five years old (U5y) living in slums, requires a better understanding of the social determinants of health (SDoH) that drive their health outcomes. Therefore, we aim to investigate how SDoH collectively affects health outcomes of U5y living in Bangladesh slums through an intersectionality lens. We used data from the most recent national Urban Health Survey (UHS) 2013 covering urban populations in Dhaka, Chittagong, Khulna, Rajshahi, Barisal, Sylhet, and Rangpur divisions. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to estimate the Discriminatory Accuracy (DA) of the intersectional effects estimates using Variance Partition Coefficient (VPC) and the Area Under the Receiver Operating Characteristic Curve (AUC-ROC). We also assessed the Proportional Change in Variance (PCV) to calculate intersectional effects. We considered three health outcomes: cough, fever, and acute respiratory infections (ARI) in U5y.We found a low DA for cough (VPC = 0.77%, AUC-ROC = 61.90%), fever (VPC = 0.87%, AUC-ROC = 61.89%) and ARI (VPC = 1.32%, AUC-ROC = 66.36%) of intersectional strata suggesting that SDoH considered do not collectively differentiate U5y with a health outcome from those with and without a health outcome. The PCV for cough (85.90%), fever (78.42%) and ARI (69.77%) indicates the existence of moderate intersectional effects. We also found that SDoH factors such as slum location, mother's employment, age of household head, and household's garbage disposal system are associated with U5y health outcomes. The variables used in this analysis have low ability to distinguish between those with and without health outcomes. However, the existence of moderate intersectional effect estimates indicates that U5y in some social groups have worse health outcomes compared to others. Therefore, policymakers need to consider different social groups when designing intervention policies aimed to improve U5y health outcomes in Bangladesh slums.
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Affiliation(s)
- Proloy Barua
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eliud Kibuchi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Imran Hossain Mithu
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Zahidul Quayyum
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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Hossain MR, Parray AA, Sultana R, Aktar B, Rashid SF. Exploring healthcare-seeking behavior of most vulnerable groups amid the COVID-19 pandemic in the humanitarian context in Cox's Bazar, Bangladesh: Findings from an exploratory qualitative study. PLOS Glob Public Health 2023; 3:e0000382. [PMID: 36962934 PMCID: PMC10027208 DOI: 10.1371/journal.pgph.0000382] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 02/27/2023] [Indexed: 03/26/2023]
Abstract
The COVID-19 pandemic has raised new concerns about healthcare service availability, accessibility, and affordability in complex humanitarian settings where heterogeneous populations reside, such as Rohingya refugees in Bangladesh. This study was conducted in ten Rohingya camps and four wards of the adjacent host communities in Cox's Bazar to understand the factors influencing healthcare-seeking behavior of the most vulnerable groups (MVGs) during COVID-19 pandemic. Data were extracted from 48 in-depth interviews (24 in each community) conducted from November 2020 to March 2021 with pregnant and lactating mothers, adolescent boys and girls, persons with disabilities, elderly people, and single female-household heads. This study adopted Andersen's behavioral model of healthcare-seeking for data analysis. Findings suggest that the healthcare-seeking behavior of the participants amid COVID-19 pandemic in the humanitarian context of Cox's Bazar was influenced by several factors ranging from socioeconomic and demographic, existing gender, cultural and social norms, health beliefs, and various institutional factors. Lack of household-level support, reduced number of healthcare providers at health facilities, and movement restrictions at community level hampered the ability of many participants to seek healthcare services in both Rohingya and host communities. Most of the female participants from both communities required permission and money from their male family members to visit healthcare facilities resulting in less access to healthcare. In both communities, the fear of contracting COVID-19 from healthcare facilities disproportionately affected pregnant mothers, elderly people, and persons with disabilities accessing health services. Additionally, the economic uncertainty had a significant impact on the host communities' ability to pay for healthcare costs. These findings have the potential to influence policies and programs that can improve pandemic preparedness and health system resilience in humanitarian contexts.
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Affiliation(s)
- Muhammad Riaz Hossain
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ateeb Ahmad Parray
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Rafia Sultana
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Bachera Aktar
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sabina Faiz Rashid
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Lazarus JV, Romero D, Kopka CJ, Karim SA, Abu-Raddad LJ, Almeida G, Baptista-Leite R, Barocas JA, Barreto ML, Bar-Yam Y, Bassat Q, Batista C, Bazilian M, Chiou ST, Del Rio C, Dore GJ, Gao GF, Gostin LO, Hellard M, Jimenez JL, Kang G, Lee N, Matičič M, McKee M, Nsanzimana S, Oliu-Barton M, Pradelski B, Pyzik O, Rabin K, Raina S, Rashid SF, Rathe M, Saenz R, Singh S, Trock-Hempler M, Villapol S, Yap P, Binagwaho A, Kamarulzaman A, El-Mohandes A. A multinational Delphi consensus to end the COVID-19 public health threat. Nature 2022; 611:332-345. [PMID: 36329272 PMCID: PMC9646517 DOI: 10.1038/s41586-022-05398-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York City, NY, USA.
| | - Diana Romero
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York City, NY, USA
| | | | - Salim Abdool Karim
- University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Program of Research in South Africa (CAPRISA), Durban, South Africa
| | - Laith J Abu-Raddad
- Weill Cornell Medicine, Cornell University, Ithaca, NY, USA
- Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | | | - Ricardo Baptista-Leite
- UNITE Global Parliamentarians Network, Lisbon, Portugal
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Institute of Health Sciences (CIIS), Catholic University of Portugal, Lisbon, Portugal
| | | | - Mauricio L Barreto
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
- University of Bahia, Salvador, Brazil
| | - Yaneer Bar-Yam
- New England Complex Systems Institute, Cambridge, MA, USA
| | - Quique Bassat
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Manhiça Health Research Center (CISM), Maputo, Mozambique
- Catalan Institute for Research and Advanced Studies (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Carolina Batista
- Doctors Without Borders (MSF), Geneva, Switzerland
- Baraka Impact Finance, Geneva, Switzerland
| | | | - Shu-Ti Chiou
- National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Gregory J Dore
- University of New South Wales (UNSW) Sydney, Sydney, New South Wales, Australia
| | - George F Gao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lawrence O Gostin
- The O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | | | - Jose L Jimenez
- Department of Chemistry, University of Colorado Boulder, Boulder, CO, USA
- Cooperative Institute for Research in Environmental Sciences (CIRES), University of Colorado Boulder, Boulder, CO, USA
| | | | | | - Mojca Matičič
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Martin McKee
- The London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Bary Pradelski
- French National Centre for Scientific Research (CNRS), Grenoble, France
| | | | - Kenneth Rabin
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York City, NY, USA
| | - Sunil Raina
- Dr. Rajendra Prasad Government Medical College, Himachal Pradesh, India
| | - Sabina Faiz Rashid
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Rocio Saenz
- University of Costa Rica, San José, Costa Rica
| | - Sudhvir Singh
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Sonia Villapol
- Department of Neurosurgery, Houston Methodist Research Institute, Houston, TX, USA
| | - Peiling Yap
- International Digital Health & AI Research Collaborative (I-DAIR), Geneva, Switzerland
| | | | | | - Ayman El-Mohandes
- City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), New York City, NY, USA
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9
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Azmi R, Mahmud I, Islam KF, Hasan MT, Rashid SF. Married men’s sexual and reproductive health concerns and related health-seeking behavior in Bangladesh: A mixed methods study. J Health Popul Nutr 2022; 41:39. [PMID: 36042467 PMCID: PMC9426265 DOI: 10.1186/s41043-022-00313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background In Bangladesh, men’s sexual and reproductive health (SRH) needs and related services are often neglected. Little is known of men’s SRH concerns, and of the phenomenal growth of the informal and private health actors in the provision of sexual health services to men in rural and urban areas of Bangladesh. Methods Using a mixed methods approach, a survey of 311 married men in three rural and urban sites was conducted in three different districts of Bangladesh and 60 in-depth interviews were conducted to understand their SRH concerns and choice of providers to seek treatment. Results The research findings reveal that- men’s various SRH concerns are embedded in psychosocial and cultural concerns about their masculinity and expectations of themselves as sexual beings, with worries about performance, loss of semen and virility being dominant concerns. Sexually transmitted infections (STIs) were also mentioned as a concern but ranked much lower. Informal providers such as village doctors (rural medical practitioners and palli chikitsoks), drug store salespeople, homeopaths, traditional healers (Ojha/pir/fakir, kabiraj, totka) and street sellers of medicines are popular, accessible and dominate the supply chain. Conclusion There is a need of appropriate interventions to address men’s anxieties and worries about their sexual abilities, well-being and choice of providers. This would go a long way to address and alleviate concerns, as well as identify and push men to seek formal care for asymptomatic STIs, and thereby reduce costs incurred and gender tensions in households.
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10
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Manzoor F, Alam W, Hossain I, Farnaz N, Aktar B, Rashid SF. Social capital and accessing services and support during COVID-19 in informal settlements of Dhaka, Bangladesh: a cross-sectional study. The Lancet Global Health 2022. [PMCID: PMC8967341 DOI: 10.1016/s2214-109x(22)00138-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Social capital, which describes the social ties enjoyed by groups and networks with common interests, is one of the most useful resources in society. These networks could be both formal and informal, with positive effects seen at both individual and community levels—especially during crisis management. In building urban resilience and to ensure access to support and services, social capital has been fundamental throughout the COVID-19 pandemic. We aimed to explore different forms of social capital networks in the informal urban settlements (known as slums) of Dhaka, Bangladesh, and how these networks were helpful during the pandemic. Methods This qualitative study was conducted in three urban slums (Kallyanpur pora bosti, Dholpur, and Shyampur) in Dhaka city). In-depth phone interviews with residents (aged ≥18 years) of the slums were carried out by the research team, using a semi-structured questionnaire of 13 open-ended questions. Additional probing was done as necessary, depending on the clarity and specificity of the information provided by respondents. We used a snowballing sampling technique and verbal, informed consent was obtained before interviews. Thematic analysis was done. Ethical clearance was acquired from the institutional review board of BRAC James P Grant School of Public Health (2019-034-IR). Findings Between Oct 21, 2020, and Jan 12, 2021, 30 phone interviews were conducted with 22 women and 8 men. Thematic analysis showed that the most marginalised individuals in urban slums are highly dependent upon their social structures, in whom bonding social capital through informal networks is most evident. These networks are based on the trust and reliance built among people whilst living together in close proximity for a long time. Immediate family members and relatives were described as the primary point of contact for any support during emergencies. Respondents who had bridged social capital networks, and were now affiliated with different local community groups, had greater access to relief (such as food, face masks, and soap) and financial support than those who did not form social networks beyond the slums. Informal networks with landlords, local shopkeepers, pharmacies, and neighbours played a crucial role during the COVID-19 pandemic, by providing food or cash support or lending goods in credit. Interpretation Strengthening different forms of social capital is vital in building urban resilience and our findings highlight the importance of prevailing social capital networks and their roles during the COVID-19 pandemic. Funding GCRF UKRI funded ARISE Consortium.
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11
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Zhang L, Rashid SF, Leung G. Social Determinants, Data Science, and Decision Making: The 3-D Approach to Achieving Health Equity in Asia. Health Data Sci 2022; 2022:9805154. [PMID: 38487479 PMCID: PMC10880146 DOI: 10.34133/2022/9805154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/18/2022] [Indexed: 03/17/2024]
Affiliation(s)
- Luxia Zhang
- National Institute of Health Data Science, Peking University, Beijing, China
- Advanced Institute of Information Technology, Peking University, Hangzhou, Zhejiang Province, China
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Gabriel Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative RegionChina
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12
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McConnell M, Mahajan M, Bauhoff S, Croke K, Verguet S, Castro MC, Furtado KM, Mehndiratta A, Farzana M, Rashid SF, Cash R. How are health workers paid and does it matter? Conceptualising the potential implications of digitising health worker payments. BMJ Glob Health 2022; 7:bmjgh-2021-007344. [PMID: 35078811 PMCID: PMC8796226 DOI: 10.1136/bmjgh-2021-007344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Margaret McConnell
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mansha Mahajan
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Sebastian Bauhoff
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Kevin Croke
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Stéphane Verguet
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Marcia C Castro
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | | | - Misha Farzana
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Sabina Faiz Rashid
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Richard Cash
- Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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13
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Parray AA, Hossain MR, Sultana R, Aktar B, Rashid SF. "Younger women had more access to COVID-19 information": An intersectional analysis of factors influencing women and girls' access to COVID-19 information in Rohingya and host communities in Bangladesh. PLOS Glob Public Health 2022; 2:e0000459. [PMID: 36962717 PMCID: PMC10022011 DOI: 10.1371/journal.pgph.0000459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
The Rohingya and Bangladeshi host communities live at a heightened risk of COVID-19 impact due to their pre-existing vulnerabilities, religious beliefs, and strict socio-cultural and gender norms that render primarily women and girls vulnerable. However, the extent of this vulnerability varies within and across population groups in the host and Rohingya communities. The intersectionality lens helps identify, recognize, and understand these factors that create inequities within populations. This study explored the factors that influenced the women and girls' access to information during the COVID-19 pandemic through an intersectional lens. This paper presents partial findings from the exploratory qualitative part of mixed-method research conducted in ten Rohingya camps and four wards of the adjacent host communities in Cox's Bazar, Bangladesh. Data were extracted from 24 in-depth interviews (12 in each community) conducted from November 2020 to March 2021 with diverse participants, including adolescent girls, younger women, adult women, pregnant and lactating mothers, persons with disabilities, older adults, and single female-household heads. All participants provided verbal informed consent before the interviews. In the case of the adolescents, assent was taken from the participants, and verbal informed consent was taken from their parents/guardians. The ethical clearance of this study was sought from the institutional review board of BRAC James P Grant School of Public Health, BRAC University. We find that the women and girls living in Rohingya communities exhibit a more profound structural interplay of factors within their socio-ecological ecosystem depending on their age, power, and position in the society, physical (dis)abilities, and pre-existing vulnerabilities stemming from their exodus, making them more vulnerable to COVID-19 impact by hindering their access to information. Unlike Rohingya, the host women and girls explain the impact of the COVID-19 pandemic on their access to information through the lens of intergenerational poverty and continuous strain on existing resources, thereby highlighting shrinking opportunities due to the influx, COVID-19 infodemic and misinformation, access to digital devices amongst the adolescents, and restricted mobility mainly due to transport, school closures, and distance-related issues. Moreover, the socio-cultural beliefs and the gender norms imposed on women and adolescent girls played an essential role in accessing information regarding the COVID-19 pandemic and consequently influenced their perception of and response to the disease and its safety protocols. Socio-cultural gender norms led to mobility restrictions, which compounded by lockdowns influenced their access to information resulting in dependency on secondary sources, usually from male members of their families, which can easily mislead/provide mis/partial information. The younger age groups had more access to primary sources of information and a broader support network. In comparison, the older age groups were more dependent on secondary sources, and their social networks were limited to their family members due to their movement difficulty because of age/aging-related physical conditions. This study explored and analyzed the intersectional factors that influenced the women and girls' access to information during the COVID-19 pandemic from two contexts with varying degrees of pre-existing vulnerability and its extent. These include gender, age, state of vulnerability, power and privilege, socio-economic status, and physical (dis)ability. It is imperative that services geared towards the most vulnerable are contextualized and consider the intersectional factors that determine the communities' access to information.
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Affiliation(s)
- Ateeb Ahmad Parray
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Muhammad Riaz Hossain
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Rafia Sultana
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Bachera Aktar
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- The Center of Excellence for Gender, Sexual and Reproductive Health and Rights, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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14
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Das AS, Bonny FA, Mohosin AB, Rashid SF, Hasan MT. Co-exploring the effects of COVID-19 pandemic on the livelihood of persons with disabilities in Bangladesh. DSQ 2021. [DOI: 10.18061/dsq.v41i3.8377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: According to World Health Organization (WHO), vulnerable groups such as persons with disabilities are facing severe impacts of the pandemic. There has always been significant challenges and hurdles in terms of achieving adequate and equitable inclusivity of persons with disabilities in all sections of social life. Education and employment of persons with disabilities were least focused which created more marginalization for the community. The long term impact of these marginalization has also led to the lack of jobs and social security of persons with disabilities, which is very clear now given the crisis in place. In low and middle income countries like Bangladesh the situation is even worse. To better understand the conditions of persons with disabilities in this crisis situation, the present study was initiated to explore the dimensions of livelihood with respect to income and wellbeing of persons with disabilities and to generate evidence for developing policies around these issues.Methods: A qualitative study was undertaken among 30 persons with disabilities from 8 different geographical divisions of Bangladesh. The interviews were conducted through telephone calls due to the existing COVID-19 crisis and mobility restrictions. The respondents were purposively selected based on gender, type of disability, area of resident (urban, rural) and their ability to communicate, therefore most (25/30) respondents were persons with physical disability. Thematic analysis was conducted to generate the findings of the study.Findings: Study findings revealed that majority of the respondents were involved in informal jobs. Predominantly males were daily wage-earners and often the sole breadwinner of the families, very few females were involved in economic activities. Since they had no stable income, the economic shock from the COVID-19 pandemic had affected them badly even leading to household level famine. The study identifies low level of education and informal job security as the primary causes of socio-economic insecurity among persons with disabilities, resulting in challenges in ensuring a stable livelihood during crisis situations, such as COVID-19.Conclusion: Constant alienation of persons of disabilities from the formal sector results in the deterioration of their livelihood standards which even worsen during any emergency crisis such as COVID-19. The study pinpoints that only aided services are not adequate to ensure persons with disabilities' rights rather there is an urgent need of disability inclusion in formal job sector and livelihood training for persons with disabilities. To achieve the Sustainable Development Goals 2030 and to irradiate the inequality towards persons with disabilities in the society it is important for the Government and concern bodies to focus on the inclusiveness with better implementation and monitoring strategies.
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15
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Mwoka M, Biermann O, Ettman CK, Abdalla SM, Ambuko J, Pearson M, Rashid SF, Zeinali Z, Galea S, Valladares LM, Mberu B. Housing as a Social Determinant of Health: Evidence from Singapore, the UK, and Kenya: the 3-D Commission. J Urban Health 2021; 98:15-30. [PMID: 34480327 PMCID: PMC8415197 DOI: 10.1007/s11524-021-00557-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 10/31/2022]
Abstract
Housing is a paradigmatic example of a social determinant of health, as it influences and is influenced by structural determinants, such as social, macroeconomic, and public policies, politics, education, income, and ethnicity/race, all intersecting to shaping the health and well-being of populations. It can therefore be argued that housing policy is critically linked to health policy. However, the extent to which this linkage is understood and addressed in public policies is limited and highly diverse across and within countries. This analysis seeks to describe the linkages between housing policies and health and well-being using examples from three countries at different levels of the wealth spectrum: Singapore, the UK, and Kenya.We conducted a comparative policy analysis across three country contexts (Singapore, the UK, and Kenya) to document the extent to which housing policies address health and well-being, highlighting commonalities and differences among them. To guide our analysis, we used the United Nations (UN) definition of adequate housing as it offers a broad framework to analyze the impact of housing on health and well-being.The anatomy of housing policies has a strong correlation to the provision of adequate housing across Singapore, the UK, and Kenya, especially for vulnerable groups. The paper demonstrates that contextual factors including population composition (i.e., aging versus youthful), political ideologies, legal frameworks (i.e., welfare versus market-based provision of housing), and presence (or absence) of adequate, quality, timely, reliable, robust data systems for decision-making, which are taken up by stakeholders/state, have strong implications of the type of housing policies developed and implemented, in turn directly and indirectly impacting the overall health and well-being of populations.This analysis demonstrates the value of viewing housing policies as public health policies that could significantly impact the health and well-being of populations, especially vulnerable groups. Moreover, the findings highlight the importance of the Health in All Policies approach to facilitate integrated policy responses to address social determinants of health such as housing. This is more critical than ever, given the context of the global pandemic that has led to worsening overall health and well-being.
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Affiliation(s)
- Meggie Mwoka
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Olivia Biermann
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Catherine K Ettman
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Boston University School of Public Health, Boston, USA
| | - Salma M Abdalla
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA. .,Department of Epidemiology, Boston University School of Public Health, Boston, USA.
| | - Jane Ambuko
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,University of Nairobi, Nairobi, Kenya
| | - Mark Pearson
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,OECD, Paris, France
| | - Sabina Faiz Rashid
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Brac James P Grant School of Public Health, Brac University, Dhaka, Bangladesh
| | - Zahra Zeinali
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Sandro Galea
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Laura Magaña Valladares
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Association of Schools and Programs of Public Health (ASPPH), Washington DC, USA
| | - Blessing Mberu
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,African Population and Health Research Center, Nairobi, Kenya
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16
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Amin A, Das AS, Kaiser A, Azmi R, Rashid SF, Hasan MT. Documenting the challenges of conducting research on sexual and reproductive health and rights (SRHR) of persons with disabilities in a low-and-middle income country setting: lessons from Bangladesh. BMJ Glob Health 2021; 5:bmjgh-2020-002904. [PMID: 33334901 PMCID: PMC7747532 DOI: 10.1136/bmjgh-2020-002904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/13/2020] [Accepted: 11/11/2020] [Indexed: 12/02/2022] Open
Abstract
Research has shown that persons with disabilities require greater sexual and reproductive health (SRH) care and services than persons without disabilities. However, this need is often neglected in most of the low-and-middle-income countries including Bangladesh. There is also a dearth of research and data relevant to this issue. A nationwide mixed-methods research has been conducted to explore persons with disabilities’ specific sexual and reproductive health and rights (SRHR) needs, health seeking behaviour related to SRH and barriers in accessing SRH services, along with the associated factors that influence their SRH outcomes. The purpose of this paper is to discuss the challenges encountered by the researchers while conducting this research and the strategies adopted to resolve those challenges. Some of the challenges experienced by the researchers include development of appropriate tools with questions on sensitive SRHR topics, obtaining informed consent, difficulty to maintain privacy while exploring sensitive SRHR issues and communication difficulties when interviewing individuals with intellectual and sensory impairments. The mitigation strategies include iterative revisions of all tools based on multiple pretests in different filed sites and expert feedback, strategic rapport building and maintaining appropriate contextual etiquette while conducting the interviews. The reflections discussed in this paper will assist future researchers in understanding potential field challenges they might encounter in similar low resource settings while conducting research on SRHR and similar sensitive issues among marginalised population groups, such as persons with disabilities.
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Affiliation(s)
- Amina Amin
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Adrita Kaiser
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Raia Azmi
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Tanvir Hasan
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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17
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Nguyen PH, Scott S, Khuong LQ, Pramanik P, Ahmed A, Rashid SF, Afsana K, Menon P. Adolescent birth and child undernutrition: an analysis of demographic and health surveys in Bangladesh, 1996-2017. Ann N Y Acad Sci 2021; 1500:69-81. [PMID: 33988256 PMCID: PMC8518722 DOI: 10.1111/nyas.14608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys (1996–2017, n = 12,006 primiparous women with living children <5 years old). Adolescent birth (10–19 years old) declined slowly, from 84% in 1996 to 71% in 2017. Compared with adult mothers (≥20 years old), young adolescent mothers (10–15 years old) were more likely to be underweight (+11 pp), have lower education (−24 pp), have less decision‐making power (−10 pp), live in poorer households (−0.9 SD) with poorer sanitation (−15 pp), and have poorer feeding practices (10 pp), and were less likely to access health and nutrition services (−3 to −24 pp). In multivariable regressions controlled for known determinants of child undernutrition, children born to adolescents had lower height‐for‐age Z‐scores (−0.29 SD for young and −0.10 SD for old adolescents (16–19 years old)), weight‐for‐age Z‐score (−0.18 and −0.06 SD, respectively) as well as higher stunting (5.9 pp) and underweight (6.0 pp) than those born to adults. In conclusion, birth during adolescence, a common occurrence in Bangladesh, is associated with child undernutrition. Policies and programs to address poverty and improve women's education can help delay marriage, reduce early childbearing, and improve child growth.
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Affiliation(s)
| | - Samuel Scott
- International Food Policy Research Institute, Washington, DC
| | | | | | - Akhter Ahmed
- International Food Policy Research Institute, Washington, DC
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Kaosar Afsana
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Purnima Menon
- International Food Policy Research Institute, Washington, DC
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18
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Ghaffar A, Rashid SF, Wanyenze RK, Hyder AA. Public health education post-COVID-19: a proposal for critical revisions. BMJ Glob Health 2021; 6:e005669. [PMID: 33811101 PMCID: PMC8023738 DOI: 10.1136/bmjgh-2021-005669] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 01/09/2023] Open
Affiliation(s)
- Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Sabina Faiz Rashid
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | - Adnan A Hyder
- George Washington University Milken Institute of Public Health, Washington, DC, USA
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Corburn J, Vlahov D, Mberu B, Riley L, Caiaffa WT, Rashid SF, Ko A, Patel S, Jukur S, Martínez-Herrera E, Jayasinghe S, Agarwal S, Nguendo-Yongsi B, Weru J, Ouma S, Edmundo K, Oni T, Ayad H. Correction to: Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health 2021; 98:309-310. [PMID: 33570740 PMCID: PMC7877315 DOI: 10.1007/s11524-020-00491-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jason Corburn
- School of Public Health & Department of City & Regional Planning, University of California, Berkeley, CA, USA.
| | | | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health, Research Centre (APHRC), Nairobi, Kenya
| | - Lee Riley
- Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Waleska Teixeira Caiaffa
- Epidemiology and Public Health, Federal University of Minas, Gerais School of Medicine, Belo Horizonte, Brazil
| | | | - Albert Ko
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Sheela Patel
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | - Smurti Jukur
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | | | | | | | | | - Jane Weru
- Akiba Mashinani Trust (AMT), Nairobi, Kenya
| | - Smith Ouma
- Cardiff Law and Global Justice, Cardiff, UK
| | | | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge UK & School of Public Health and Family Medicine, Cambridge, UK.,University of Cape Town, Cape Town, South Africa
| | - Hany Ayad
- Alexandria University, Alexandria, Egypt
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Schmitt ML, Wood OR, Clatworthy D, Rashid SF, Sommer M. Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: learning from refugee camps in Cox's bazar, Bangladesh. Confl Health 2021; 15:10. [PMID: 33637096 PMCID: PMC7912835 DOI: 10.1186/s13031-021-00346-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background There is growing attention to addressing the menstrual hygiene management (MHM) needs of the over 21 million displaced adolescent girls and women globally. Current approaches to MHM-related humanitarian programming often prioritize the provision of menstrual materials and information. However, a critical component of an MHM response includes the construction and maintenance of water, sanitation and hygiene (WASH) facilities, including more female-friendly toilets. This enables spaces for menstruating girls and women to change, dispose, wash and dry menstrual materials; all of which are integral tasks required for MHM. A global assessment identified a number of innovations focused on designing and implementing menstruation-supportive WASH facilities in the Rohingya refugee camps located in Cox’s Bazar (CXB), Bangladesh. These pilot efforts strove to include the use of more participatory methodologies in the process of developing the new MHM-supportive WASH approaches. This study aimed to capture new approaches and practical insights on innovating menstrual disposal, waste management and laundering in emergency contexts through the conduct of a qualitative assessment in CXB. Methods The qualitative assessment was conducted in the Rohingya refugee camps in CXB in September of 2019 to capture new approaches and practical insights on innovating for menstrual disposal, waste management and laundering. This included Key Informant Interviews with 19 humanitarian response staff from the WASH and Protection sectors of a range of non-governmental organizations and UN agencies; Focus Group Discussions with 47 Rohingya adolescent girls and women; and direct observations of 8 WASH facilities (toilets, bathing, and laundering spaces). Results Key findings included: one, the identification of new female-driven consultation methods aimed at improving female beneficiary involvement and buy-in during the design and construction phases; two, the design of new multi-purpose WASH facilities to increase female beneficiary usage; three, new menstrual waste disposal innovations being piloted in communal and institutional settings, with female users indicating at least initial acceptability; and four, novel strategies for engaging male beneficiaries in the design of female WASH facilities, including promoting dialogue to generate buy-in regarding the importance of these facilities and debate about their placement. Conclusions Although the identified innovative participatory methodologies and design approaches are promising, the long term viability of the facilities, including plans to expand them, may be dependent on the continued engagement of girls and women, and the availability of resources.
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Affiliation(s)
- Margaret L Schmitt
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
| | - Olivia R Wood
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA
| | - David Clatworthy
- International Rescue Committee, 122 E 42nd St, New York, NY, 10168, USA
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, Bangladesh
| | - Marni Sommer
- Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
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Hasan MT, Amin A, Chowdhury MU, Faizul Islam K, Huq SM, Parvin R, Ahmed SJ, Ali ML, Rashid SF. Health sufferings, healthcare seeking behavior, awareness about health insurance, and health related rights of ready made garments workers in Bangladesh: Findings from a cross-sectional study. J Occup Health 2021; 63:e12256. [PMID: 34382289 PMCID: PMC8357819 DOI: 10.1002/1348-9585.12256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/01/2021] [Accepted: 07/04/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study aimed at examining health sufferings of readymade garments (RMG) workers, the factors that affect their health sufferings, their healthcare seeking pattern, knowledge about health insurance and health related rights in Bangladesh. METHODS A cross-sectional study was conducted among 486 RMG workers recruited randomly from eight garments factories located on the periphery of Dhaka, Bangladesh. The prevalence of musculoskeletal pain, headache, fever and abdominal pain was estimated and multivariable logistic regression analysis was performed to examine association between these illnesses of workers and their socio-demographic characteristics and other work related information. We also explored their healthcare seeking patterns, knowledge about health insurance and health related rights. RESULTS The prevalence of musculoskeletal pain, headache, fever and abdominal pain was found to be 78.1%, 57.9%, 52.2% and 24.6%, respectively, among the RMG workers. Factors that increased the odds of: musculoskeletal pain were working for more than 10 h per day (adjusted odds ratio [AOR]: 2.3, 95% confidence interval [CI]: 1.1-4.7) and being female [AOR: 4.6, 95% CI: 2.0-10.6]; fever was living in slums [AOR: 1.9, 95% CI: 1.1-3.5]; and abdominal pain was being female [AOR: 3.6, 95% CI: 1.4-9.3]. The workers commonly reported visiting drug sellers in local pharmacies for reported illnesses. They also had better knowledge of health related rights but poor knowledge of health insurance. CONCLUSION In order to address the overall health and well-being of the RMG workers, it is imperative to lay out a blueprint for a safe and healthy workplace.
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Affiliation(s)
- Md Tanvir Hasan
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | - Amina Amin
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | - Md Uzzal Chowdhury
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | - Kuhel Faizul Islam
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
| | | | | | | | | | - Sabina Faiz Rashid
- BRAC James P Grant School of Public HealthBRAC UniversityDhakaBangladesh
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Ahmed R, Aktar B, Farnaz N, Ray P, Awal A, Hassan R, Shafique SB, Hasan MT, Quayyum Z, Jafarovna MB, Kobeissi LH, El Tahir K, Chawla BS, Rashid SF. Publisher Correction to: Challenges and strategies in conducting sexual and reproductive health research among Rohingya refugees in Cox's Bazar, Bangladesh. Confl Health 2020; 14:88. [PMID: 33380343 PMCID: PMC7772906 DOI: 10.1186/s13031-020-00335-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Rushdia Ahmed
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Nadia Farnaz
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Pushpita Ray
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Abdul Awal
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Raafat Hassan
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sharid Bin Shafique
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Tanvir Hasan
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Zahidul Quayyum
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Loulou Hassan Kobeissi
- Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Khalid El Tahir
- Health Sector Coordination Office, World Health Organization, Cox's Bazar, Bangladesh
| | | | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Ahmed R, Aktar B, Farnaz N, Ray P, Awal A, Hassan R, Shafique SB, Hasan MT, Quayyum Z, Jafarovna MB, Kobeissi LH, El Tahir K, Chawla BS, Rashid SF. Challenges and strategies in conducting sexual and reproductive health research among Rohingya refugees in Cox's Bazar, Bangladesh. Confl Health 2020; 14:83. [PMID: 33292373 PMCID: PMC7708138 DOI: 10.1186/s13031-020-00329-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/24/2020] [Indexed: 12/01/2022] Open
Abstract
Background Rohingya diaspora or Forcibly Displaced Myanmar Nationals (FDMNs), took shelter in the refugee camps of Cox’s Bazar, Bangladesh due to armed conflict in the Rakhine state of Myanmar. In such humanitarian crises, delivering sexual and reproductive health (SRH) services is critical for better health outcomes of this most-at-risk population where more than half are adolescent girls and women. This is a reflective paper on challenges and related mitigation strategies to conduct SRH research among FDMNs. The research on which this paper is based employed a concurrent mixed-method design combining a cross-sectional survey and qualitative interviews and group discussions with FDMNs to understand their SRH needs and demand-side barriers. Assessment of health facilities and qualitative interviews with healthcare providers and key stakeholders were carried out to assess facility readiness and supply-side barriers. Challenges and strategies The researchers faced different challenges while conducting this study due to the unique characteristics of the FDMN population and the location of the refugee camps. The three key challenges researchers encountered include: sensitivity regarding SRH in the FDMNs, identifying appropriate sampling strategies, and community trust issues. The key approaches to overcome these challenges involved: actively engaging community members and gatekeepers in the data collection process to access respondents, identifying sensitive SRH issues through survey and exploring in-depth during qualitative interviews; and contextually modifying the sampling strategy. Conclusion Contextual adaptation of research methods and involving community and local key stakeholders in data collection are the key lessons learnt from this study. Another important lesson was researchers’ identity and positionality as a member of the host country may create distrust and suspicion among the refugees. The multi-level complexities of humanitarian settings may introduce unforeseen challenges and interrupt research plans at different stages of research which require timely and contextual adaptations.
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Affiliation(s)
- Rushdia Ahmed
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Nadia Farnaz
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Pushpita Ray
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Abdul Awal
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Raafat Hassan
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sharid Bin Shafique
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Md Tanvir Hasan
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Zahidul Quayyum
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Loulou Hassan Kobeissi
- Department of Reproductive Health Research, World Health Organization, Geneva, Switzerland
| | - Khalid El Tahir
- Health Sector Coordination Office, World Health Organization, Cox's Bazar, Bangladesh
| | | | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddrb Building, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Abstract
OBJECTIVES To explore how adolescent and young men negotiate the complex realities of lives to explain their pathways into and reasons for early marriage in urban slums of Bangladesh. DESIGN The qualitative data used here came from a larger 3-year study that used both quantitative and qualitative research methods. SETTING Interviews were conducted in two of the largest slums in Dhaka and Chittagong city of Bangladesh between December 2015 and March 2018. PARTICIPANTS This paper uses qualitative data from 22 in-depth interviews (IDIs) and three focus group discussions (FGDs) with adolescent and young men aged 15-24 years; 13 IDIs and 4 FGDs with parents and 11 key-informant interviews with community leaders. The purposively selected respondents were interviewed in their respective settings. RESULTS In the context of urban slums, this study revealed multiple factors influence early marriage decision-making processes among young men. These factors include socially perceived phenomenon of adulthood and readiness of marriage, poverty leading to drop out from schools and early initiation to earning livelihood, manifestations of increasing individual aspiration and agency, fulfilment of romance and erotic desires and dreams of forming one's own family. In addition, parental and immediate societal interference to preserve norms around gender and society can act as catalysts for this decision. CONCLUSIONS Study findings imply that complex structural factors, social and gender norms that are contributing to the early marriage for both adolescent boys and young men in Bangladesh's urban slums. These are locations where conservatism, poverty and urbanisation intersect resulting in early and often unprepared entry to adulthood for young men impacting on their development and well-being. It is, therefore, critical that young men should be included in the national and global conversations around child marriage and child marriage prevention programme.
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Affiliation(s)
| | - Shuchi Karim
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Women's Studies and Feminist Research, University of Western Ontario, London, Ontario, Canada
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Afifi RA, Novak N, Gilbert PA, Pauly B, Abdulrahim S, Rashid SF, Ortega F, Ferrand RA. 'Most at risk' for COVID19? The imperative to expand the definition from biological to social factors for equity. Prev Med 2020; 139:106229. [PMID: 32763263 PMCID: PMC7831462 DOI: 10.1016/j.ypmed.2020.106229] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/10/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022]
Abstract
First recognized in December 2019, the Coronavirus Disease 2019 (COVID19) was declared a global pandemic by the World Health Organization on March 11, 2020. To date, the most utilized definition of 'most at risk' for COVID19 morbidity and mortality has focused on biological susceptibility to the virus. This paper argues that this dominant biomedical definition has neglected the 'fundamental social causes' of disease, constraining the effectiveness of prevention and mitigation measures; and exacerbating COVID19 morbidity and mortality for population groups living in marginalizing circumstances. It is clear - even at this early stage of the pandemic - that inequitable social conditions lead to both more infections and worse outcomes. Expanding the definition of 'most at risk' to include social factors is critical to implementing equitable interventions and saving lives. Prioritizing populations with social conditions is necessary for more effective control of the epidemic in its next phase; and should become standard in the planning for, and prevention and mitigation of all health conditions. Reversing disparities and health inequities is only possible through an expansion of our 'most-at-risk' definition to also include social factors.
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Affiliation(s)
- Rima A Afifi
- University of Iowa College of Public Health, Department of Community and Behavioral Health, 145 N Riverside Drive, Iowa City, IA 52242, USA.
| | - Nicole Novak
- University of Iowa College of Public Health, Department of Community and Behavioral Health, 145 N Riverside Drive, Iowa City, IA 52242, USA.
| | - Paul A Gilbert
- University of Iowa College of Public Health, Department of Community and Behavioral Health, 145 N Riverside Drive, Iowa City, IA 52242, USA.
| | - Bernadette Pauly
- University of Victoria School of Nursing, Victoria, British Columbia, Canada.
| | - Sawsan Abdulrahim
- American University of Beirut, Faculty of Health Sciences, Department of Health Promotion and Community Health, Beirut, Lebanon.
| | - Sabina Faiz Rashid
- BRAC University, James P Grant School of Public Health, Dhaka, Bangladesh.
| | - Fernando Ortega
- Universidad San Francisco de Quito, College of Health Sciences, Quito, Ecuador.
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Nakkash R, Ali A, Alaouie H, Asmar K, Hirschhorn N, Mugharbil S, Nuwayhid I, London L, Saban A, Rashid SF, Ahmed MK, Knai C, Bigland C, Afifi RA. Attitudes and practices of public health academics towards research funding from for-profit organizations: cross-sectional survey. Int J Public Health 2020; 65:1133-1145. [PMID: 32840634 PMCID: PMC7497330 DOI: 10.1007/s00038-020-01416-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives The growing trend of for-profit organization (FPO)-funded university research is concerning because resultant potential conflicts of interest might lead to biases in methods, results, and interpretation. For public health academic programmes, receiving funds from FPOs whose products have negative health implications may be particularly problematic. Methods A cross-sectional survey assessed attitudes and practices of public health academics towards accepting funding from FPOs. The sampling frame included universities in five world regions offering a graduate degree in public health; 166 academics responded. Descriptive, bivariate, and logistic regression analyses were conducted. Results Over half of respondents were in favour of accepting funding from FPOs; attitudes differed by world region and gender but not by rank, contract status, % salary offset required, primary identity, or exposure to an ethics course. In the last 5 years, almost 20% of respondents had received funding from a FPO. Sixty per cent of respondents agreed that there was potential for bias in seven aspects of the research process, when funds were from FPOs. Conclusions Globally, public health academics should increase dialogue around the potential harms of research and practice funded by FPOs. Electronic supplementary material The online version of this article (10.1007/s00038-020-01416-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rima Nakkash
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ahmed Ali
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Alaouie
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Khalil Asmar
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | | | - Sanaa Mugharbil
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Leslie London
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Amina Saban
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Sabina Faiz Rashid
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md Koushik Ahmed
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Cecile Knai
- London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Bigland
- UK Specialty Registrar, Severn Postgraduate Medical Education School of Public Health, Health Education England, London, UK
| | - Rima A Afifi
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Drive, Iowa City, IA, USA.
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Rashid SF, Theobald S, Ozano K. Towards a socially just model: balancing hunger and response to the COVID-19 pandemic in Bangladesh. BMJ Glob Health 2020; 5:bmjgh-2020-002715. [PMID: 32487518 PMCID: PMC7276238 DOI: 10.1136/bmjgh-2020-002715] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sabina Faiz Rashid
- BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Sally Theobald
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kim Ozano
- Liverpool School of Tropical Medicine, Liverpool, UK
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Corburn J, Vlahov D, Mberu B, Riley L, Caiaffa WT, Rashid SF, Ko A, Patel S, Jukur S, Martínez-Herrera E, Jayasinghe S, Agarwal S, Nguendo-Yongsi B, Weru J, Ouma S, Edmundo K, Oni T, Ayad H. Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health 2020; 97:348-357. [PMID: 32333243 PMCID: PMC7182092 DOI: 10.1007/s11524-020-00438-6] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.
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Affiliation(s)
- Jason Corburn
- School of Public Health & Department of City & Regional Planning, University of California, Berkeley, CA USA
| | | | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health Research Centre (APHRC), Nairobi, Kenya
| | - Lee Riley
- Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA USA
| | - Waleska Teixeira Caiaffa
- Epidemiology and Public Health, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | | | - Albert Ko
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
| | - Sheela Patel
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | - Smurti Jukur
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | | | | | | | | | - Jane Weru
- Akiba Mashinani Trust (AMT), Nairobi, Kenya
| | - Smith Ouma
- Cardiff Law and Global Justice, Cardiff, UK
| | | | - Tolu Oni
- MRC Epidemiology unit, University of Cambridge, UK & School of Public Health and Family Medicine, Cambridge, UK
- University of Cape Town, Cape Town, South Africa
| | - Hany Ayad
- Alexandria University, Alexandria, Egypt
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Ormel H, Kok M, Kane S, Ahmed R, Chikaphupha K, Rashid SF, Gemechu D, Otiso L, Sidat M, Theobald S, Taegtmeyer M, de Koning K. Salaried and voluntary community health workers: exploring how incentives and expectation gaps influence motivation. Hum Resour Health 2019; 17:59. [PMID: 31324192 PMCID: PMC6642499 DOI: 10.1186/s12960-019-0387-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/20/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND The recent publication of the WHO guideline on support to optimise community health worker (CHW) programmes illustrates the renewed attention for the need to strengthen the performance of CHWs. Performance partly depends on motivation, which in turn is influenced by incentives. This paper aims to critically analyse the use of incentives and their link with improving CHW motivation. METHODS We undertook a comparative analysis on the linkages between incentives and motivation based on existing datasets of qualitative studies in six countries. These studies had used a conceptual framework on factors influencing CHW performance, where motivational factors were defined as financial, material, non-material and intrinsic and had undertaken semi-structured interviews and focus group discussions with CHWs, supervisors, health managers and selected community members. RESULTS We found that (a mix of) incentives influence motivation in a similar and sometimes different way across contexts. The mode of CHW engagement (employed vs. volunteering) influenced how various forms of incentives affect each other as well as motivation. Motivation was negatively influenced by incentive-related "expectation gaps", including lower than expected financial incentives, later than expected payments, fewer than expected material incentives and job enablers, and unequally distributed incentives across groups of CHWs. Furthermore, we found that incentives could cause friction for the interface role of CHWs between communities and the health sector. CONCLUSIONS Whether CHWs are employed or engaged as volunteers has implications for the way incentives influence motivation. Intrinsic motivational factors are important to and experienced by both types of CHWs, yet for many salaried CHWs, they do not compensate for the demotivation derived from the perceived low level of financial reward. Overall, introducing and/or sustaining a form of financial incentive seems key towards strengthening CHW motivation. Adequate expectation management regarding financial and material incentives is essential to prevent frustration about expectation gaps or "broken promises", which negatively affect motivation. Consistently receiving the type and amount of incentives promised appears as important to sustain motivation as raising the absolute level of incentives.
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Affiliation(s)
- Hermen Ormel
- Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA Amsterdam, The Netherlands
| | - Maryse Kok
- Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA Amsterdam, The Netherlands
| | - Sumit Kane
- Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA Amsterdam, The Netherlands
| | - Rukhsana Ahmed
- Eijkman Institute for Molecular Biology, Jalan Diponegoro 69, Jakarta, 10430 Indonesia
| | - Kingsley Chikaphupha
- Research for Equity and Community Health (REACH) Trust, P.O. Box 1597, Lilongwe, Malawi
| | - Sabina Faiz Rashid
- BRAC James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka Bangladesh
| | | | - Lilian Otiso
- LVCT Health, Research and Strategic Information Department, P.O. Box 19835-00202, Nairobi, Kenya
| | - Mohsin Sidat
- Department of Community Health, University Eduardo Mondlane, P.O. Box 257, Maputo, Mozambique
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Korrie de Koning
- Royal Tropical Institute, KIT Health, P.O. Box 95001, 1090 HA Amsterdam, The Netherlands
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Ahmed R, Farnaz N, Aktar B, Hassan R, Shafique SB, Ray P, Awal A, Rahman A, Urbaniak V, Kobeissi LH, Rosie J, Say L, Hasan MT, Quayyum Z, Rashid SF. Situation analysis for delivering integrated comprehensive sexual and reproductive health services in humanitarian crisis condition for Rohingya refugees in Cox's Bazar, Bangladesh: protocol for a mixed-method study. BMJ Open 2019; 9:e028340. [PMID: 31272979 PMCID: PMC6615844 DOI: 10.1136/bmjopen-2018-028340] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Rohingya diaspora are one of the most vulnerable groups seeking refuge in camps of Cox's Bazar, Bangladesh, arising an acute humanitarian crisis. More than half of the Rohingya refugees are women and adolescent girls requiring quality sexual and reproductive health (SRH) services. Minimum initial service package of SRH are being rendered in the refugee camps; however, WHO is aiming to provide integrated comprehensive SRH services to meet the unmet needs of this most vulnerable group. For sustainable and successful implementation of such comprehensive SRH service packages, a critical first step is to undertake a situation analysis and understand the current dimensions and capture the lessons learnt on their SRH-specific needs and implementation challenges. This situation analysis is pertinent in current humanitarian condition and will provide an overview of the needs, availability and delivery of SRH services for adolescent girls and women, barriers in accessing and providing those services in Rohingya refugee camps in Cox's Bazar, Bangladesh, and similar humanitarian contexts. METHODS AND ANALYSIS A concurrent mixed-methods design will be used in this study. A community-based household survey coupled with facility assessments as well as qualitative in-depth interviews, key informant interviews and focus group discussions will be conducted with community people of Rohingya refugee camps and relevant stakeholders providing SRH services to Rohingya population in Cox's Bazar, Bangladesh. Survey data will be analysed using univariate, bivariate and multivariable regression statistics. Descriptive analysis will be done for facility assessment and thematic analysis will be conducted with qualitative data. ETHICS AND DISSEMINATION Ethical approval from Institutional Review Board of BRAC James P Grant School of Public Health (2018-017-IR) has been obtained. Findings from this research will be disseminated through presentations in local, national and international conferences, workshops, peer-reviewed publications, policy briefs and interactive project report.
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Affiliation(s)
- Rushdia Ahmed
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Nadia Farnaz
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Raafat Hassan
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sharid Bin Shafique
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Pushpita Ray
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abdul Awal
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Atiya Rahman
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | | | - Jeffries Rosie
- Health Sector Coordination Office, WHO, Cox's Bazar, Bangladesh
| | - Lale Say
- Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Md Tanvir Hasan
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Zahidul Quayyum
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Logie CH, Khoshnood K, Okumu M, Rashid SF, Senova F, Meghari H, Kipenda CU. Self care interventions could advance sexual and reproductive health in humanitarian settings. BMJ 2019; 365:l1083. [PMID: 30936067 PMCID: PMC6441869 DOI: 10.1136/bmj.l1083] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Forcibly displaced people often lack access to adequate sexual and reproductive health services. Carmen Logie and colleagues examine the role of self care interventions in filling the gap
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Moses Okumu
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Fidan Senova
- Çukurova University Faculty of Medicine, Balcalı Hospital, Adana, Turkey
| | - Hamza Meghari
- Institute for Global Health, University College London, London, UK
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Talukdar JR, Mahmud I, Rashid SF. Primary health care seeking behaviour of people with physical disabilities in Bangladesh: a cross-sectional study. Arch Public Health 2018; 76:43. [PMID: 30186603 PMCID: PMC6120090 DOI: 10.1186/s13690-018-0293-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with disabilities constitute about 10% of the total population of Bangladesh. They are more likely to experience poor health than those without disabilities. However, there is a lack of evidence on their primary health care (PHC) seeking behaviour for their general illness. The aim of this study was to understand the PHC seeking behaviour of people with physical disabilities (PWPDs), and to investigate the determinants of such behaviours. METHODS We surveyed 282 PWPDs, aged ≥18 years, using a structured questionnaire. Participants were recruited from the out-patient department of a rehabilitation centre in Dhaka between November and December 2014. We explored PHC seeking behaviour using frequency distribution. We performed logistic regression to investigate the factors that determined their PHC seeking behaviours for general illness. In our logistic regression model, the outcome variable was whether PWPDs received treatment from a formal health care provider. The predictors were socio-demographic characteristics and clinical characteristics such as type of impairment and type of illness experienced. RESULTS Among 282 participants, 85% suffered from general illness in the past 6 months. The participants in the higher age group, for example, age group 31-45 years (OR = 3.9, [95% CI 1.2 to 13.4]), 46-59 years (OR = 13.6, [95% CI 2.9 to 63.7) and 60+ years (OR = 12.5, [95% CI 1.7 to 93.0]) were more likely to seek treatment from formal health care providers than the age group 18-30 years. The educational attainment of the primary income earning family member (OR = 3.2, [CI 1.1 to 9.6]), religion (OR = 0.3, [95% CI 0.1 to 0.98]) and mobility aid used (OR = 4.0, [95% CI 1.2 to 13]) were determinants for seeking health care from a formal health care provider. Moreover, the type of illness suffered by participant was a strong predictor of their decision to seek treatment from a formal health care provider. The participants who suffered from urinary tract infections (OR = 10.3, [95% CI 2.3 to 46.6]), ulcers (OR = 13.1, [95% CI 2.11 to 79.3]) and pain (OR = 3.6, [95% CI 1.4 to 9.4]) were more likely to seek treatment from formal health care provider than who suffered from fever. CONCLUSIONS Age, religion, earning member's education, type of mobility aids used and type of illness suffered were explicative determinants of PHC seeking behaviour of PWPDs. The results suggest that these factors should be considered when devising interventions for this population. Moreover, accessibility, quality of care and expertise of the providers in treating disabled people were among the other factors reported by PWPDs which influence their decision to seek health care. In order to provide inclusive health services, primary health centres need to consider these determinants.
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Affiliation(s)
- Jhalok Ronjan Talukdar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Ilias Mahmud
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- College of Public Health & Health Informatics, Qassim University, Bukayriah, Qassim Kingdom of Saudi Arabia
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Joarder T, George A, Ahmed SM, Rashid SF, Sarker M. What constitutes responsiveness of physicians: A qualitative study in rural Bangladesh. PLoS One 2017; 12:e0189962. [PMID: 29253891 PMCID: PMC5734771 DOI: 10.1371/journal.pone.0189962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 12/05/2017] [Indexed: 11/18/2022] Open
Abstract
Responsiveness entails the social actions by health providers to meet the legitimate expectations of patients. It plays a critical role in ensuring continuity and effectiveness of care within people centered health systems. Given the lack of contextualized research on responsiveness, we qualitatively explored the perceptions of outpatient users and providers regarding what constitute responsiveness in rural Bangladesh. An exploratory study was undertaken in Chuadanga, a southwestern Bangladeshi District, involving in-depth interviews of physicians (n = 17) and users (n = 7), focus group discussions with users (n = 4), and observations of patient provider interactions (three weeks). Analysis was guided by a conceptual framework of responsiveness, which includes friendliness, respecting, informing and guiding, gaining trust and optimizing benefits. In terms of friendliness, patients expected physicians to greet them before starting consultations; even though physicians considered this unusual. Patients also expected physicians to hold social talks during consultations, which was uncommon. With regards to respect patients expected physicians to refrain from disrespecting them in various ways; but also by showing respect explicitly. Patients also had expectations related to informing and guiding: they desired explanation on at least the diagnosis, seriousness of illness, treatment and preventive steps. In gaining trust, patients expected that physicians would refrain from illegal or unethical activities related to patients, e.g., demanding money against free services, bringing patients in own private clinics by brokers (dalals), colluding with diagnostic centers, accepting gifts from pharmaceutical representatives. In terms of optimizing benefits: patients expected that physicians should be financially sensitive and consider individual need of patients. There were multiple dimensions of responsiveness- for some, stakeholders had a consensus; context was an important factor to understand them. This being an exploratory study, further research is recommended to validate the nuances of the findings. It can be a guideline for responsiveness practices, and a tipping point for future research.
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Affiliation(s)
- Taufique Joarder
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of International Health (Health Systems), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Asha George
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Syed Masud Ahmed
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Ginsburg O, Badwe R, Boyle P, Derricks G, Dare A, Evans T, Eniu A, Jimenez J, Kutluk T, Lopes G, Mohammed SI, Qiao YL, Rashid SF, Summers D, Sarfati D, Temmerman M, Trimble EL, Padela AI, Aggarwal A, Sullivan R. Changing global policy to deliver safe, equitable, and affordable care for women's cancers. Lancet 2017; 389:871-880. [PMID: 27814964 DOI: 10.1016/s0140-6736(16)31393-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/16/2016] [Accepted: 08/04/2016] [Indexed: 10/20/2022]
Abstract
Breast and cervical cancer are major threats to the health of women globally, particularly in low-income and middle-income countries. Radical progress to close the global cancer divide for women requires not only evidence-based policy making, but also broad multisectoral collaboration that capitalises on recent progress in the associated domains of women's health and innovative public health approaches to cancer care and control. Such multisectoral collaboration can serve to build health systems for cancer, and more broadly for primary care, surgery, and pathology. This Series paper explores the global health and public policy landscapes that intersect with women's health and global cancer control, with new approaches to bringing policy to action. Cancer is a major global social and political priority, and women's cancers are not only a tractable socioeconomic policy target in themselves, but also an important Trojan horse to drive improved cancer control and care.
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Affiliation(s)
- Ophira Ginsburg
- Women's College Research Institute, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; World Health Organization, Geneva, Switzerland.
| | | | - Peter Boyle
- International Prevention Research Institute, Lyon, France; University of Strathclyde Institute of Global Public Health @iPRI, Glasgow, UK
| | | | - Anna Dare
- Centre for Global Health Research & Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Tim Evans
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | | | - Jorge Jimenez
- Pontificia Universidad, Católica de Chile, Santiago, Chile
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University, Ankara, Turkey
| | - Gilberto Lopes
- Oncoclinicas Group, São Paulo, Brazil; University of Miami, Miller School of Medicine, Coral Gables, FL, USA
| | - Sulma I Mohammed
- Purdue Center for Cancer Research, Purdue University, West Lafayette, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - You-Lin Qiao
- Department of Cancer Epidemiology, National Cancer Centre, Chinese Academy of Medical Sciences, Beijing, China; Peking Union Medical College, Beijing, China
| | - Sabina Faiz Rashid
- James P Grant School of Public Health at BRAC University, Dhaka, Bangladesh
| | - Diane Summers
- UNICEF, South Asia Regional Office, Kathmandu, Nepal
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Marleen Temmerman
- World Health Organization, Geneva, Switzerland; Ghent University, Ghent, Belgium; Aga Khan University, East Africa, Nairobi, Kenya
| | | | - Aasim I Padela
- Initiative on Islam and Medicine and Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Ajay Aggarwal
- London School of Hygiene & Tropical Medicine, London, UK; Institute of Cancer Policy, Kings Health Partners Comprehensive Cancer Centre, King's Centre for Global Health, King's Health Partners and King's College London, UK
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Comprehensive Cancer Centre, King's Centre for Global Health, King's Health Partners and King's College London, UK
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Messinger CJ, Mahmud I, Kanan S, Jahangir YT, Sarker M, Rashid SF. Utilization of mobile phones for accessing menstrual regulation services among low-income women in Bangladesh: a qualitative analysis. Reprod Health 2017; 14:7. [PMID: 28088232 PMCID: PMC5237487 DOI: 10.1186/s12978-016-0274-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 12/28/2016] [Indexed: 11/28/2022] Open
Abstract
Background As many as one-third of all pregnancies in Bangladesh are unplanned, with nearly one-half of these pregnancies ending in either menstrual regulation (MR) or illegal clandestine abortion. Although MR is provided free of charge, or at a nominal cost, through the public sector and various non-profits organizations, many women face barriers in accessing safe, affordable MR and post-MR care. Mobile health (mHealth) services present a promising platform for increasing access to MR among low-income women at risk for clandestine abortion. We sought to investigate the knowledge, attitudes and practices regarding mHealth of both MR clients and formal and informal sexual and reproductive healthcare providers in urban and rural low-income settlements in Bangladesh. Methods A total of 58 interviews were conducted with MR clients, formal MR providers, and informal MR providers in four low-income settlements in the Dhaka and Sylhet districts of Bangladesh. Interview data was coded and qualitatively analysed for themes using standard qualitative research practices. Results Our findings suggest that low-income MR clients in Bangladesh have an inadequate understanding of how to use their mobile phones to obtain health service information or counselling related to MR, and correspondingly low levels of formal or informal mHealth service utilization. Few were aware of any formal mHealth services in place in their communities, despite the fact that providers stated that hotlines were available. Overall, MR clients expressed positive opinions of mHealth services as a means of improving women’s access to affordable and timely MR. Formal and informal MR providers believed that mobile phones had benefits with respect to information dissemination and making appointments, but emphasized the necessity of in-person consultations for effective sexual and reproductive healthcare. Conclusions We report low utilization yet high acceptability of mHealth services among low-income MR clients in Bangladesh. Expanding formal and informal mHealth services targeted towards MR – and increasing publicity of these services in low-income communities – may help increase timely access to accurate MR information and formal providers among women at risk for clandestine abortion. While expanding formal and informal mHealth services for SRHR in Bangladesh may be useful in disseminating information about MR and connecting women with formal providers, in-person visits remain necessary for adequate treatment.
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Affiliation(s)
- Chelsea Jordan Messinger
- Yale College, Yale University, New Haven, CT, USA.,James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.,Present Address: Harvard Medical School, Boston, MA, 02115, USA
| | - Ilias Mahmud
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Sushama Kanan
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Yamin Tauseef Jahangir
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Malabika Sarker
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 ShahidTajudin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
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Mohiuddin M, Rashid SF, Shuvro MI, Nahar N, Ahmed SM. Qualitative insights into promotion of pharmaceutical products in Bangladesh: how ethical are the practices? BMC Med Ethics 2015; 16:80. [PMID: 26625723 PMCID: PMC4666091 DOI: 10.1186/s12910-015-0075-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/19/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The pharmaceutical market in Bangladesh is highly concentrated (top ten control around 70 % of the market). Due to high competition aggressive marketing strategies are adopted for greater market share, which sometimes cross limit. There is lack of data on this aspect in Bangladesh. This exploratory study aimed to fill this gap by investigating current promotional practices of the pharmaceutical companies including the role of their medical representatives (MR). METHODS This qualitative study was conducted as part of a larger study to explore the status of governance in health sector in 2009. Data were collected from Dhaka, Chittagong and Bogra districts through in-depth interview (healthcare providers and MRs), observation (physician-MR interaction), and round table discussion (chief executives and top management of the pharmaceutical companies). RESULTS Findings reveal a highly structured system geared to generate prescriptions and ensure market share instituted by the pharmaceuticals. A comprehensive training curriculum for the MRs prepares the newly recruited science graduates for generating enough prescriptions by catering to the identified needs and demands of the physicians expressed or otherwise, and thus grab higher market-share for the companies they represent. Approaches such as inducements, persuasion, emotional blackmail, serving family members, etc. are used. The type, quantity and quality of inducements offered to the physicians depend upon his/her capacity to produce prescriptions. The popular physicians are cultivated meticulously by the MRs to establish brand loyalty and fulfill individual and company targets. The physicians, willingly or unwillingly, become part of the system with few exceptions. Neither the regulatory authority nor the professional or consumer rights bodies has any role to control or ractify the process. CONCLUSIONS The aggressive marketing of the pharmaceutical companies compel their MRs, programmed to maximize market share, to adopt unethical means if and when necessary. When medicines are prescribed and dispensed more for financial interests than for needs of the patients, it reflects system's failed ability to hold individuals and entities accountable for adhering to basic professional ethics, code of conduct, and statutory laws.
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Affiliation(s)
| | - Sabina Faiz Rashid
- James P Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh.
| | | | - Nahitun Nahar
- James P Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh.
| | - Syed Masud Ahmed
- Centre for Equity and Health Systems, icddr,b and Centre of Excellence for Universal Health Coverage, icddr,b and JPGSPH, icddr,b and JPGSPH, BRAC University, 5th Floor(Level-6), icddrb Building, 68 ShahidTajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
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Hussain S, Ruano AL, Rahman A, Rashid SF, Hill PS. From knowing our needs to enacting change: findings from community consultations with indigenous communities in Bangladesh. Int J Equity Health 2015; 14:126. [PMID: 26552485 PMCID: PMC4638081 DOI: 10.1186/s12939-015-0264-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 11/03/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Indigenous peoples are among the most marginalized peoples in the world due to issues relating to well-being, political representation, and economic production. The research consortium Goals and Governance for Global Health (Go4Health) conducted a community consultation process among marginalized groups across the global South aimed at including their voices in the global discourse around health in the post-2015 development agenda. This paper presents findings from the consultations carried out among indigenous communities in Bangladesh. Methods For this qualitative study, our research team consulted the Tripura and Mro communities in Bandarban district living in the isolated Chittagong Hill Tracts region. Community members, leaders, and key informants working in health service delivery were interviewed. Data was analyzed using thematic analysis. Findings Our findings show that remoteness shapes the daily lives of the communities, and their lack of access to natural resources and basic services prevents them from following health promotion messages. The communities feel that their needs are impossible to secure in a politically indifferent and sometimes hostile environment. Conclusion Communities are keen to participate and work with duty bearers in creating the conditions that will lead to their improved quality of life. Clear policies that recognize the status of indigenous peoples are necessary in the Bangladeshi context to allow for the development of services and infrastructure.
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Affiliation(s)
- Sameera Hussain
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh. .,School of Population Health, University of Queensland, Brisbane, Australia.
| | - Ana Lorena Ruano
- Department of Global Public Health and Primary Care, Center for International Health, University of Bergen, Bergen, Norway. .,Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud, Guatemala, Guatemala.
| | | | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | - Peter S Hill
- School of Population Health, University of Queensland, Brisbane, Australia.
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Mahmud I, Chowdhury S, Siddiqi BA, Theobald S, Ormel H, Biswas S, Jahangir YT, Sarker M, Rashid SF. Exploring the context in which different close-to-community sexual and reproductive health service providers operate in Bangladesh: a qualitative study. Hum Resour Health 2015; 13:51. [PMID: 26323508 PMCID: PMC4556024 DOI: 10.1186/s12960-015-0045-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/17/2015] [Indexed: 05/23/2023]
Abstract
BACKGROUND A range of formal and informal close-to-community (CTC) health service providers operate in an increasingly urbanized Bangladesh. Informal CTC health service providers play a key role in Bangladesh's pluralistic health system, yet the reasons for their popularity and their interactions with formal providers and the community are poorly understood. This paper aims to understand the factors shaping poor urban and rural women's choice of service provider for their sexual and reproductive health (SRH)-related problems and the interrelationships between these providers and communities. Building this evidence base is important, as the number and range of CTC providers continue to expand in both urban slums and rural communities in Bangladesh. This has implications for policy and future programme interventions addressing the poor women's SRH needs. METHODS Data was generated through 24 in-depth interviews with menstrual regulation clients, 12 focus group discussions with married men and women in communities and 24 semi-structured interviews with formal and informal CTC SRH service providers. Data was collected between July and September 2013 from three urban slums and one rural site in Dhaka and Sylhet, Bangladesh. Atlas.ti software was used to manage data analysis and coding, and a thematic analysis was undertaken. RESULTS Poor women living in urban slums and rural areas visit a diverse range of CTC providers for SRH-related problems. Key factors influencing their choice of provider include the following: availability, accessibility, expenses and perceived quality of care, the latter being shaped by notions of trust, respect and familiarity. Informal providers are usually the first point of contact even for those clients who subsequently access SRH services from formal providers. Despite existing informal interactions between both types of providers and a shared understanding that this can be beneficial for clients, there is no effective link or partnership between these providers for referral, coordination and communication regarding SRH services. CONCLUSION Training informal CTC providers and developing strategies to enable better links and coordination between this community-embedded cadre and the formal health sector has the potential to reduce service cost and improve availability of quality SRH (and other) care at the community level.
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Affiliation(s)
- Ilias Mahmud
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | - Sadia Chowdhury
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | | | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Hermen Ormel
- Royal Tropical Institute, Amsterdam, The Netherlands.
| | - Salauddin Biswas
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | | | - Malabika Sarker
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | - Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
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Hasan T, Muhaddes T, Camellia S, Selim N, Rashid SF. Prevalence and experiences of intimate partner violence against women with disabilities in Bangladesh: results of an explanatory sequential mixed-method study. J Interpers Violence 2014; 29:3105-26. [PMID: 24860077 DOI: 10.1177/0886260514534525] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study was aimed to estimate the prevalence of intimate partner violence (IPV) in a sample of 226 women with disabilities living in four different districts of Bangladesh. It also explored the physical and psychological suffering of women experiencing violence and their various coping strategies. A cross-sectional survey was carried out with 226 women with disabilities to measure the prevalence of IPV, and 16 in-depth interviews were conducted to document in detail the experiences of violence encountered by the abused women. Among the 226 women interviewed in the survey, about 84% reported ever having experienced at least one act of emotional abuse, physical, or sexual violence from their partner during their lifetime. Women who were older (aged above 32 years), separated, and members of economic/savings group were more likely to report ever having experienced any IPV than women with disabilities who were younger (aged 32 years and less), married, and not members of economic/savings group. Most of the women experiencing violence reported sufferings from physical and psychological problems. Of all the women who experienced violence, less than half (45%) reported seeking support to minimize or avoid violence experiences. However, seeking support from informal network such as family and relatives was commonly reported by many (81.4%) of them. Study findings suggest that women with disabilities who possess poor socio-economic status coupled with economic dependency on husbands' income and wide-spread social stigma against disability make them vulnerable to IPV. Future interventions to address IPV against women with disabilities should include building community knowledge of disability and IPV, countering the pervasive social stigma against disabilities, and improving the socio-economic conditions of women with disabilities through education and employment.
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Affiliation(s)
- Tanvir Hasan
- James P. Grant School of Public Health (JPGSPH), BRAC Institute of Global Health (BIGH), BRAC University, Dhaka, Bangladesh
| | - Tisa Muhaddes
- Formerly worked at James P. Grant School of Public Health (JPGSPH), BRAC University, Dhaka, Bangladesh
| | - Suborna Camellia
- James P. Grant School of Public Health (JPGSPH), BRAC Institute of Global Health (BIGH), BRAC University, Dhaka, Bangladesh
| | - Nasima Selim
- James P. Grant School of Public Health (JPGSPH), BRAC Institute of Global Health (BIGH), BRAC University, Dhaka, Bangladesh
| | - Sabina Faiz Rashid
- James P. Grant School of Public Health (JPGSPH), BRAC Institute of Global Health (BIGH), BRAC University, Dhaka, Bangladesh
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Levay AV, Mumtaz Z, Faiz Rashid S, Willows N. Influence of gender roles and rising food prices on poor, pregnant women's eating and food provisioning practices in Dhaka, Bangladesh. Reprod Health 2013; 10:53. [PMID: 24069937 PMCID: PMC3849683 DOI: 10.1186/1742-4755-10-53] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/24/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Maternal malnutrition in Bangladesh is a persistent health issue and is the product of a number of complex factors, including adherence to food 'taboos' and a patriarchal gender order that limits women's mobility and decision-making. The recent global food price crisis is also negatively impacting poor pregnant women's access to food. It is believed that those who are most acutely affected by rising food prices are the urban poor. While there is an abundance of useful quantitative research centered on maternal nutrition and food insecurity measurements in Bangladesh, missing is an understanding of how food insecurity is experienced by people who are most vulnerable, the urban ultra-poor. In particular, little is known of the lived experience of food insecurity among pregnant women in this context. This research investigated these lived experiences by exploring food provisioning strategies of urban, ultra-poor, pregnant women. This knowledge is important as discussions surrounding the creation of new development goals are currently underway. METHODS Using a focused-ethnographic approach, household food provisioning experiences were explored. Data from participant observation, a focus group discussion and semi-structured interviews were collected in an urban slum in Dhaka, Bangladesh. Interviews were undertaken with 28 participants including 12 pregnant women and new mothers, two husbands, nine non-pregnant women, and five health care workers. RESULTS The key findings are: 1) women were aware of the importance of good nutrition and demonstrated accurate, biomedically-based knowledge of healthy eating practices during pregnancy; 2) the normative gender rules that have traditionally constrained women's access to nutritional resources are relaxing in the urban setting; however 3) women are challenged in accessing adequate quality and quantities of food due to the increase in food prices at the market. CONCLUSIONS Rising food prices and resultant food insecurity due to insufficient incomes are negating the recent efforts that have increased women's knowledge of healthy eating during pregnancy and their gendered empowerment. In order to maintain the gains in nutritional knowledge and women's increased mobility and decision-making capacity; policy must also consider the global political economy of food in the creation of the new development goals.
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Affiliation(s)
- Adrienne V Levay
- School of Public Health, 3–309 Edmonton Clinic Health Academy, University of Alberta, 11405 – 87 Ave, Edmonton AB T6G 1C9, Canada
| | - Zubia Mumtaz
- School of Public Health, 3–309 Edmonton Clinic Health Academy, University of Alberta, 11405 – 87 Ave, Edmonton AB T6G 1C9, Canada
| | - Sabina Faiz Rashid
- James P. Grant School of Public Health, 5th Floor (Level-6), icddr,b Building, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Noreen Willows
- Department of Agricultural, Food & Nutritional Science, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave, Edmonton AB T6G 1C9, Canada
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Rashid SF, Gani S, Sarker M. Urban Poverty, Climate Change and Health Risks for Slum Dwellers in Bangladesh. Climate Change Adaptation Actions in Bangladesh 2013. [DOI: 10.1007/978-4-431-54249-0_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Rashid SF. Human rights and reproductive health: political realities and pragmatic choices for married adolescent women living in urban slums, Bangladesh. BMC Int Health Hum Rights 2011; 11 Suppl 3:S3. [PMID: 22376023 PMCID: PMC3287459 DOI: 10.1186/1472-698x-11-s3-s3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background In Bangladesh, particularly in urban slums, married adolescent women’s human rights to life, health, and reproductive and sexual health remain adversely affected because of the structural inequalities and political economic, social and cultural conditions which shape how rights are understood, negotiated and lived. Methods The focus of the research and methods was anthropological. An initial survey of 153 married adolescent women was carried out and from this group, 50 in-depth interviews were conducted with selected participants and, from the in-depth interviews, a further eight case studies of women and their families were selected for in-depth repeated interviews and case histories. Results This paper speaks of the unanticipated complexities when writing on reproductive rights for poor adolescent women living in the slums, where the discourses on ‘universal human rights’ are often removed from the reality of adolescent women’s everyday lives. Married adolescent women and their families remain extremely vulnerable in the unpredictable, crime-prone and insecure urban slum landscape because of their age, gender and poverty. Adolescent women’s understanding of their rights such as the decision to marry early, have children, terminate pregnancies and engage in risky sexual behaviour, are different from the widely accepted discourse on rights globally, which assumes a particular kind of individual thinking and discourse on rights and a certain autonomy women have over their bodies and their lives. This does not necessarily exist in urban slum populations. Conclusions The lived experiences and decisions made pertaining to sexual and reproductive health and ‘rights’ exercised by married adolescent women, their families and slum communities, allow us to reflect on the disconnect between the international legal human rights frameworks as applied to sexual and reproductive health rights, and how these are played out on the ground. These notions are far more complex in environments where married adolescent women and their families live in conditions of poverty and socioeconomic deprivation.
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Affiliation(s)
- Sabina Faiz Rashid
- James P Grant School of Public Health, BRAC University, Dhaka 1212, Bangladesh.
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Rashid SF, Standing H, Mohiuddin M, Ahmed FM. Creating a public space and dialogue on sexuality and rights: a case study from Bangladesh. Health Res Policy Syst 2011; 9 Suppl 1:S12. [PMID: 21679379 PMCID: PMC3121129 DOI: 10.1186/1478-4505-9-s1-s12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This article describes and analyses a research based engagement by a university school of public health in Bangladesh aimed at raising public debate on sexuality and rights and making issues such as discrimination more visible to policy makers and other key stakeholders in a challenging context. The impetus for this work came from participation in an international research programme with a particular interest in bridging international and local understandings of sexual and reproductive rights. The research team worked to create a platform to broaden discussions on sexuality and rights by building on a number of research activities on rural and urban men's and women's sexual health concerns, and on changing concepts of sexuality and understandings of sexual rights among specific population groups in Dhaka city, including sexual minorities. Linked to this on-going process of improving the evidence base, there has been a series of learning and capacity building activities over the last four years consisting of training workshops, meetings, conferences and dialogues. These brought together different configurations of stakeholders - members of sexual minorities, academics, service providers, advocacy organisations, media and policy makers. This process contributed to developing more effective advocacy strategies through challenging representations of sexuality and rights in the public domain. Gradually, these efforts brought visibility to hidden or stigmatised sexuality and rights issues through interim outcomes that have created important steps towards changing attitudes and policies. These included creating safe spaces for sexual minorities to meet and strategise, development of learning materials for university students and engagement with legal rights groups on sexual rights. Through this process, it was found to be possible to create a public space and dialogue on sexuality and rights in a conservative and challenging environment like Bangladesh by bringing together a diverse group of stakeholders to successfully challenge representations of sexuality in the public arena. A further challenge for BRAC University has been to assess its role as a teaching and research organisation, and find a balance between the two roles of research and activism in doing work on sexuality issues in a very sensitive political context.
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Affiliation(s)
- Sabina Faiz Rashid
- James P,Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka 1212, Bangladesh.
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Moran AC, Choudhury N, Uz Zaman Khan N, Ahsan Karar Z, Wahed T, Faiz Rashid S, Alam MA. Newborn care practices among slum dwellers in Dhaka, Bangladesh: a quantitative and qualitative exploratory study. BMC Pregnancy Childbirth 2009; 9:54. [PMID: 19919700 PMCID: PMC2784437 DOI: 10.1186/1471-2393-9-54] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 11/17/2009] [Indexed: 11/18/2022] Open
Abstract
Background Urbanization is occurring at a rapid pace, especially in low-income countries. Dhaka, Bangladesh, is estimated to grow to 50 million by 2015, with 21 million living in urban slums. Although health services are available, neonatal mortality is higher in slum areas than in urban non-slum areas. The Manoshi program works to improve maternal, newborn, and child health in urban slums in Bangladesh. This paper describes newborn care practices in urban slums in Dhaka and provides program recommendations. Methods A quantitative baseline survey was conducted in six urban slum areas to measure newborn care practices among recently delivered women (n = 1,256). Thirty-six in-depth semi-structured interviews were conducted to explore newborn care practices among currently pregnant women (n = 18) and women who had at least one delivery (n = 18). Results In the baseline survey, the majority of women gave birth at home (84%). Most women reported having knowledge about drying the baby (64%), wrapping the baby after birth (59%), and cord care (46%). In the in-depth interviews, almost all women reported using sterilized instruments to cut the cord. Babies are typically bathed soon after birth to purify them from the birth process. There was extensive care given to the umbilical cord including massage and/or applying substances, as well as a variety of practices to keep the baby warm. Exclusive breastfeeding was rare; most women reported first giving their babies sweet water, honey and/or other foods. Conclusion These reported newborn care practices are similar to those in rural areas of Bangladesh and to urban and rural areas in the South Asia region. There are several program implications. Educational messages to promote providing newborn care immediately after birth, using sterile thread, delaying bathing, and ensuring dry cord care and exclusive breastfeeding are needed. Programs in urban slum areas should also consider interventions to improve social support for women, especially first time mothers. These interventions may improve newborn survival and help achieve MDG4.
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Affiliation(s)
- Allisyn C Moran
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
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Abstract
The health and rights of populations living in informal or slum settlements are key development issues of the twenty-first century. As of 2007, the majority of the world's population lives in urban areas. More than one billion of these people, or one in three city-dwellers, live in inadequate housing with no or a few basic resources. In Bangladesh, urban slum settlements tend to be located in low-lying, flood-prone, poorly-drained areas, having limited formal garbage disposal and minimal access to safe water and sanitation. These areas are severely crowded, with 4-5 people living in houses of just over 100 sq feet. These conditions of high density of population and poor sanitation exacerbate the spread of diseases. People living in these areas experience social, economic and political exclusion, which bars them from society's basic resources. This paper overviews policies and actions that impact the level of exclusion of people living in urban slum settlements in Bangladesh, with a focus on improving the health and rights of the urban poor. Despite some strategies adopted to ensure better access to water and health, overall, the country does not have a comprehensive policy for urban slum residents, and the situation remains bleak.
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Affiliation(s)
- Sabina Faiz Rashid
- James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka 1212, Bangladesh.
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Rashid SF. Kal Dristi, Stolen Babies and ‘Blocked Uteruses’: Poverty and Infertility Anxieties among Married Adolescent Women Living in a Slum in Dhaka, Bangladesh. Anthropol Med 2007; 14:153-66. [DOI: 10.1080/13648470701381465] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rashid SF. Durbolota (weakness), chinta rog (worry illness), and poverty: explanations of white discharge among married adolescent women in an urban slum in Dhaka, Bangladesh. Med Anthropol Q 2007; 21:108-32. [PMID: 17405700 DOI: 10.1525/maq.2007.21.1.108] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
I carried out ethnographic fieldwork among 153 married adolescent girls, aged 15-19, in a Dhaka slum from December 2001 to January 2003, including 50 in-depth interviews and eight case studies. I also held discussions with family and community members. In this article, I focus on popular understandings of vaginal discharge being caused by durbolota (weakness) and chinta rog (worry illness), as mentioned by young women. Eighty-eight young women reported that they had experienced white discharge, blaming it on a number of factors such as stress and financial hardships, tensions in the household, marital instability, hunger anxiety, and reproductive burdens. For married adolescent women in the urban slum, white discharge has many levels of meaning linked to the broader social, political, and material inequalities in their everyday lives.
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Affiliation(s)
- Sabina Faiz Rashid
- Social and Medical Anthropology, James P. Grant School of Public Health, BRAC University, Bangladesh
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Abstract
Structural and social inequalities, a harsh political economy and neglect on the part of the state have made married adolescent girls an extremely vulnerable group in the urban slum environment in Bangladesh. The importance placed on newly married girls' fertility results in high fertility rates and low rates of contraceptive use. Ethnographic fieldwork among married adolescent girls, aged 15-19, was carried out in a Dhaka slum from December 2001-January 2003, including 50 in-depth interviews and eight case studies from among 153 married adolescent girls, and observations and discussions with family and community members. Cultural and social expectations meant that 128 of the girls had borne children before they were emotionally or physically ready. Twenty-seven had terminated their pregnancies, of whom 11 reported they were forced to do so by family members. Poverty, economic conditions, marital insecurity, politics in the household, absence of dowry and rivalry among family, co-wives and in-laws made these young women acquiesce to decisions made by others in order to survive. Young married women's status is changing in urban slum conditions. When their economical productivity takes priority over their reproductive role, the effects on reproductive decision-making within families may be considerable. This paper highlights the vulnerability of young women as they pragmatically make choices within the social and structural constraints in their lives.
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Affiliation(s)
- Sabina Faiz Rashid
- Social & Medical Anthropology: Reproductive Health and Gender, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
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Abstract
Despite initiatives and interventions undertaken at national and international levels, maternal health is still neglected in Bangladesh, and the maternal mortality ratio remains one of the highest in the world. In order to improve rural women's access to maternity care, in 1996 the Bangladesh Rural Advancement Committee (BRAC) instituted services for birthing women in 21 health facilities in each Thana. This paper reports on research conducted three years later, based on interviews with women who gave birth in one BRAC Health Centre (BHC) and women who gave birth at home, interviews with staff of the BHC and observation of provider-patient relations. Acceptance of delivery in a health facility by rural women is still minimal. Most women only attended the BHC due to complications, yet the BHC was unable to handle most complications and referred women to the district hospital, where they received poor quality care. Cost, fear of hospitals and the stigma of an 'abnormal' birth were also important constraints. Female paramedics who attended normal deliveries were praised for being caring, but made women deliver lying down, did not always use aseptic procedures and were too busy to give information, making birth a passive experience. Recommendations to provide comprehensive emergency obstetric care at the BHC and upgrade staff skills, introduce rural health insurance and others have already begun to be implemented.
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