ABSTRACT
Flood is one of the most common hazards in many countries, affecting both life and properties. The recent climatic changes have brought a rise in both flood frequency and intensity making this phenomenon more devastating to people. Especially, the riparian communities of Jamalpur along the Jamuna river suffer at least once every year accounting for this natural hazard. In a scenario like this, precaution is a crucial task to fight against this natural phenomenon. Therefore, this study attempts to identify the flood vulnerable zones of Jamalpur district situating beside Jamuna river with a multi-criteria analysis. Assessment of flood vulnerability included consideration of physical indicators like rainfall, drainage density, distance from river, slope, land use land cover, elevation, soil classes as well as social indicators like population density, female density, literacy rate, number of shelters, unmetalled road and number of health personnel. All these parameters were analyzed in Geographic Information System (GIS) and assigned weightage with a multi-criteria decision-making technique namely- Analytic Hierarchy Process (AHP). Finally, a flood vulnerability map was generated for the seven Upazilas of Jamalpur district. Very high, high, moderate and low vulnerable zones were identified after overlaying all physical and social indicator maps under consideration. 45.96% portion of a total of 2115.2 sq. Km. Area was under very high and highly vulnerable zones in the final vulnerability map of Jamalpur. Such type of assessment process is significant for flood mitigation projects with a view to providing the greatest concern to the most vulnerable zones. The vulnerability maps can also help the policymakers to provide emergency aids and other privileges to those who are in most need of it.
ABSTRACT
BACKGROUND: Low rates of contraceptive continuation in Bangladesh are a symptom of poor quality family planning (FP) counseling. Improving family planning counseling by the country's community health care workers (CHWs) could improve contraceptive continuation. This study explores client experiences of care from CHWs, as measured by the method information index plus (MII+) and communication quality metric. METHODS: Conducted in a peri-urban sub-district with low contraceptive use rates, this mixed methods study explores FP client experiences with community-based counseling and referrals by Family Welfare Assistants (FWAs), a CHW cadre providing FP services. Client- and patient-reported experience with community FP services was measured by the MII+ and communication quality metric. A quantitative post-service exit survey was coupled with observations of the interactions between 62 FWAs and 692 female clients to measure FWA and client FP knowledge, FWA capacities, attitudes, quality of FP communication, FP referrals, and contraceptive uptake. RESULTS: Summary MII+ scores suggest that only 20% of clients reported adequate provision of information for informed decisions. Observations and self-reporting alike suggest moderate to high quality of communication during FWA and client interactions. Despite FWAs' theoretical knowledge of long-acting reversible and permanent FP methods, few clients were referred to facilities for them; 81% of clients who preferred a pill received it, while only 34% of clients seeking long-acting methods received needed referrals. CONCLUSIONS: Quality community-based FP counseling could help address rising contraceptive discontinuation rates in Bangladesh. While MII and MII+ scores in this study were low, and FWA evinced numerous misconceptions, FWAs demonstrated strong communication skills that facilitate rapport and trust with their clients and communities. Bangladesh's policy and programs should capitalize upon these relationships and enhance CHWs' knowledge of all method types, and side effects management, with updated job aids, refresher training, and supervision.
