15 research outputs found
Menging in een bad veroorzaakt door een plonzende waterstraal
No full textKramers Laboratorium voor Fysische TechnologieApplied Science
Comparison between tank cleaning models and full-scale tests
No full textKramers Laboratorium voor Fysische TechnologieApplied Science
Birth preparedness and complication readiness (BPCR) among pregnant women in hard-to-reach areas in Bangladesh.
No full textBackgroundBirth preparedness and complication readiness aims to reduce delays in care seeking, promote skilled birth attendance, and facility deliveries. Little is known about birth preparedness practices among populations living in hard-to-reach areas in Bangladesh.ObjectivesTo describe levels of birth preparedness and complication readiness among recently delivered women, identify determinants of being better prepared for birth, and assess the impact of greater birth preparedness on maternal and neonatal health practices.MethodsA cross-sectional survey with 2,897 recently delivered women was undertaken in 2012 as part of an evaluation trial done in five hard-to-reach districts in rural Bangladesh. Mothers were considered well prepared for birth if they adopted two or more of the four birth preparedness components. Descriptive statistics and multivariable logistic regression were used for analysis.ResultsLess than a quarter (24.5%) of women were considered well prepared for birth. Predictors of being well-prepared included: husband's education (OR = 1.3; CI: 1.1-1.7), district of residence, exposure to media in the form of reading a newspaper (OR = 2.2; CI: 1.2-3.9), receiving home visit by a health worker during pregnancy (OR = 1.5; CI: 1.2-1.8), and receiving at least 3 antenatal care visits from a qualified provider (OR = 1.4; CI: 1.0-1.9). Well-prepared women were more likely to deliver at a health facility (OR = 2.4; CI: 1.9-3.1), use a skilled birth attendant (OR = 2.4, CI: 1.9-3.1), practice clean cord care (OR = 1.3, CI: 1.0-1.5), receive post-natal care from a trained provider within two days of birth for themselves (OR = 2.6, CI: 2.0-3.2) or their newborn (OR = 2.6, CI: 2.1-3.3), and seek care for delivery complications (OR = 1.8, CI: 1.3-2.6).ConclusionGreater emphasis on BPCR interventions tailored for hard to reach areas is needed to improve skilled birth attendance, care seeking for complications and essential newborn care and facilitate reductions in maternal and neonatal mortality in low performing districts in Bangladesh
Standard Patient History Relating to Food Can Be Augmented Using Ethnographic Foodlife Questions
No full textThe relationship between what and how individuals eat and their overall and long-term health is non-controversial. However, for decades, food and nutrition discussions have often been highly medicalized. Given the significant impact of poor nutrition on health, broader discussions about food should be integrated into routine patient history taking. We advocate for an expansion of the current, standard approach to patient history taking in order to include questions regarding patients’ ‘foodlife’ (total relationship to food) as a screening and baseline assessment tool for referrals. We propose that healthcare providers: (1) routinely engage with patients about their relationship to food, and (2) recognize that such dialogues extend beyond nutrition and lifestyle questions. Mirroring other recent revisions to medical history taking—such as exploring biopsychosocial risks—questions about food relationships and motivators of eating may be essential for optimal patient assessment and referrals. We draw on the novel tools of ‘foodlife’ ethnography (developed by co-author ethnographer J.J.L., and further refined in collaboration with the co-authors who contributed their clinical experiences as a former primary care physician (D.M.E.), registered dietitian (J.W.M.), and diabetologist (H.Z.)) to model a set of baseline questions for inclusion in routine clinical settings. Importantly, this broader cultural approach seeks to augment and enhance current food intake discussions used by registered dietitian nutritionists, endocrinologists, internists, and medical primary care providers for better baseline assessments and referrals. By bringing the significance of food into the domain of routine medical interviewing practices by a range of health professionals, we theorize that this approach can set a strong foundation of trust between patients and healthcare professionals, underscoring food’s vital role in patient-centered care
Is there any association between parental education and child mortality? A study in a rural area of Bangladesh
No full textObjectives: To assess the association between parental education and under-five mortality, using the Integrated Management of Childhood Illness (IMCI) data from rural Bangladesh. It also investigated whether the association of parental education with under-five mortality had changed over time.Study design: This study was nested in the IMCI cluster randomized controlled trial.Methods: Participants considered for the analysis were all children aged under five years from the baseline (1995-2000) and the final (2002-2007) IMCI household survey. The analysis sample included 39,875 and 38,544 live births from the baseline and the final survey respectively. The outcome variable was under-five mortality and the exposure variables were mother's and fathers education. Data were analysed with logistic regression.Results: In 2002-2007, the odds of the under-five mortality were 38% lower for the children with mother having secondary education, compared to the children with uneducated mother. For similar educational differences for fathers, at the same time period, the odds of the under-five mortality were 16% lower. The association of mothers education with under-five mortality was significantly stronger in 2002-2007 compared to 1995-2000.Conclusions: Mother's education appears to have a strong and significant association with under-five mortality, compared to father's education. The association of mother's education with under-five mortality appears to have increased over time. Our findings indicate that investing on girls' education is a good strategy to combat infant mortality in developing countries. (C) 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved
Quality of care for under-fives in first-level health facilities in one district of Bangladesh
No full textOBJECTIVE: The multi-country evaluation of Integrated Management of Childhood Illness (IMCI) effectiveness, cost and impact (MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. MCE studies are under way in Bangladesh, Brazil, Peru, Uganda and the United Republic of Tanzania. The objective of this analysis from the Bangladesh MCE study was to describe the quality of care delivered to sick children under 5 years old in first-level government health facilities, to inform government planning of child health programmes. METHODS: Generic MCE Health Facility Survey tools were adapted, translated and pre-tested. Medical doctors trained in IMCI and these tools conducted the survey in all 19 health facilities in the study areas. The data were collected using observations, exit interviews, inventories and interviews with facility providers. FINDINGS: Few of the sick children seeking care at these facilities were fully assessed or correctly treated, and almost none of their caregivers were advised on how to continue the care of the child at home. Over one-third of the sick children whose care was observed were managed by lower-level workers who were significantly more likely than higher-level workers to classify the sick child correctly and to provide correct information on home care to the caregiver. CONCLUSION: These results demonstrate an urgent need for interventions to improve the quality of care provided for sick children in first-level facilities in Bangladesh, and suggest that including lower-level workers as targets for IMCI case-management training may be beneficial. The findings suggest that the IMCI strategy offers a promising set of interventions to address the child health service problems in Bangladesh
Sex and Socioeconomic Differentials in Child Health in Rural Bangladesh: Findings from a Baseline Survey for Evaluating Integrated Management of Childhood Illness
No full textThis paper reports on a population-based sample survey of 2,289
children aged less than five years (under-five children) conducted in
2000 as a baseline for the Bangladesh component of the Multi-country
Evaluation (MCE) of the Integrated Management of Childhood Illness
strategy. Of interest were rates and differentials by sex and
socioeconomic status for three aspects of child health in rural
Bangladesh: morbidity and hospitalizations, including severity of
illness; care-seeking for childhood illness; and home-care for illness.
The survey was carried out among a population of about 380,000 in
Matlab upazila (subdistrict). Generic MCE Household Survey tools were
adapted, translated, and pretested. Trained interviewers conducted the
survey in the study areas. In total, 2,289 under-five children were
included in the survey. Results showed a very high prevalence of
illness among Bangladeshi children, with over two-thirds reported to
have had at least one illness during the two weeks preceding the
survey. Most sick children in this population had multiple symptoms,
suggesting that the use of the IMCI clinical guidelines will lead to
improved quality of care. Contrary to expectations, there were no
significant differences in the prevalence of illness either by sex or
by socioeconomic status. About one-third of the children with a
reported illness did not receive any care outside the home. Of those
for whom outside care was sought, 42% were taken to a village doctor.
Only 8% were taken to an appropriate provider, i.e. a health facility,
a hospital, a doctor, a paramedic, or a community-based health worker.
Poorer children than less-poor children were less likely to be taken to
an appropriate healthcare provider. The findings indicated that
children with severe illness in the least poor households were three
times more likely to seek care from a trained provider than children in
the poorest households. Any evidence of gender inequities in child
healthcare, either in terms of prevalence of illness or care-seeking
patterns, was not found. Care-seeking patterns were associated with the
perceived severity of illness, the presence of danger signs, and the
duration and number of symptoms. The results highlight the challenges
that will need to be addressed as IMCI is implemented in health
facilities and extended to address key family and community practices,
including extremely low rates of use of the formal health sector for
the management of sick children. Child health planners and researchers
must find ways to address the apparent population preference for
untrained and traditional providers which is determined by various
factors, including the actual and perceived quality of care, and the
differentials in care-seeking practices that discriminate against the
poorest households
Sex and Socioeconomic Differentials in Child Health in Rural Bangladesh: Findings from a Baseline Survey for Evaluating Integrated Management of Childhood Illness
No full textThis paper reports on a population-based sample survey of 2,289
children aged less than five years (under-five children) conducted in
2000 as a baseline for the Bangladesh component of the Multi-country
Evaluation (MCE) of the Integrated Management of Childhood Illness
strategy. Of interest were rates and differentials by sex and
socioeconomic status for three aspects of child health in rural
Bangladesh: morbidity and hospitalizations, including severity of
illness; care-seeking for childhood illness; and home-care for illness.
The survey was carried out among a population of about 380,000 in
Matlab upazila (subdistrict). Generic MCE Household Survey tools were
adapted, translated, and pretested. Trained interviewers conducted the
survey in the study areas. In total, 2,289 under-five children were
included in the survey. Results showed a very high prevalence of
illness among Bangladeshi children, with over two-thirds reported to
have had at least one illness during the two weeks preceding the
survey. Most sick children in this population had multiple symptoms,
suggesting that the use of the IMCI clinical guidelines will lead to
improved quality of care. Contrary to expectations, there were no
significant differences in the prevalence of illness either by sex or
by socioeconomic status. About one-third of the children with a
reported illness did not receive any care outside the home. Of those
for whom outside care was sought, 42% were taken to a village doctor.
Only 8% were taken to an appropriate provider, i.e. a health facility,
a hospital, a doctor, a paramedic, or a community-based health worker.
Poorer children than less-poor children were less likely to be taken to
an appropriate healthcare provider. The findings indicated that
children with severe illness in the least poor households were three
times more likely to seek care from a trained provider than children in
the poorest households. Any evidence of gender inequities in child
healthcare, either in terms of prevalence of illness or care-seeking
patterns, was not found. Care-seeking patterns were associated with the
perceived severity of illness, the presence of danger signs, and the
duration and number of symptoms. The results highlight the challenges
that will need to be addressed as IMCI is implemented in health
facilities and extended to address key family and community practices,
including extremely low rates of use of the formal health sector for
the management of sick children. Child health planners and researchers
must find ways to address the apparent population preference for
untrained and traditional providers which is determined by various
factors, including the actual and perceived quality of care, and the
differentials in care-seeking practices that discriminate against the
poorest households
Knowledge and involvement of husbands in maternal and newborn health in rural Bangladesh
No full textBackgroundAccess to skilled health services during pregnancy, childbirth and postnatal period for obstetric care is one of the strongest determinants of maternal and newborn health (MNH) outcomes. In many countries, husbands are key decision-makers in households, effectively determining women’s access to health services. We examined husbands’ knowledge and involvement regarding MNH issues in rural Bangladesh, and how their involvement is related to women receiving MNH services from trained providers.MethodsWe conducted a cross-sectional survey in two rural sub-districts of Bangladesh in 2014 adopting a stratified cluster sampling technique. Women with a recent birth history and their husbands were interviewed separately with a structured questionnaire. A total of 317 wife-husband dyads were interviewed. The associations between husbands accompanying their wives as explanatory variables and utilization of skilled services as outcome variables were assessed using multiple logistic regression analyses.ResultsIn terms of MNH knowledge, two-thirds of husbands were aware that women have special rights related to pregnancy and childbirth and one-quarter could mention three or more pregnancy-, birth- and postpartum-related danger signs. With regard to MNH practice, approximately three-quarters of husbands discussed birth preparedness and complication readiness with their wives. Only 12% and 21% were involved in identifying a potential blood donor and arranging transportation, respectively. Among women who attended antenatal care (ANC), 47% were accompanied by their husbands. Around half of the husbands were present at the birthplace during birth. Of the 22% women who received postpartum care (PNC), 67% were accompanied by their husbands. Husbands accompanying their wives was positively associated with women receiving ANC from a medically trained provider (AOR 4.5, p < .01), birth at a health facility (AOR 1.5, p < .05), receiving PNC from a medically trained provider (AOR 48.8, p < .01) and seeking care from medically trained providers for obstetric complications (AOR 3.0, p < 0.5).ConclusionHusbands accompanying women when receiving health services is positively correlated with women’s use of skilled MNH services. Special initiatives should be taken for encouraging husbands to accompany their wives while availing MNH services. These initiatives should aim to increase men’s awareness regarding MNH issues, but should not be limited to this
Out-of-pocket expenditure for seeking health care for sick children younger than 5 years of age in Bangladesh: findings from cross-sectional surveys, 2009 and 2012.
No full textBackground:
Bangladesh has committed to universal health coverage, and options to decrease household out-of-pocket expenditure (OPE) are being explored. Understanding the determinants of OPE is an essential step. This study aimed to estimate and identify determinants of OPE in seeking health care for sick under-five children.
Methods:
Cross-sectional data was collected by structured questionnaire in 2009 (n = 7362) and 2012 (n = 6896) from mothers of the under-five children. OPE included consultation fees and costs of medicine, diagnostic tests, hospital admission, transport, accommodation, and food. Expenditure is expressed in US dollars and adjusted for inflation. Linear regression was used for ascertaining the determinants of OPE.
Results:
Between 2009 and 2012, the median OPE for seeking care for a sick under-five child increased by ~ 50%, from USD 0.82 (interquartile range 0.39-1.49) to USD 1.22 (0.63-2.36) per child/visit. Increases were observed in every component OPE measured, except for consultation fees which decreased by 12%. Medicine contributed the major portion of overall OPE. Higher overall OPE for care seeking was associated with a priority illness (20% increase), care from trained providers (90% public/~ 2-fold private), residing in hilly/wet lands areas (20%), and for mothers with a secondary education (19%).
Conclusion:
OPE is a major barrier to quality health care services and access to appropriate medicine is increasing in rural Bangladesh. To support the goal of universal health care coverage, geographic imbalances as well as expanded health financing options need to be explored
