Acute lower respiratory infections in rural Bangladeshi children: patterns of treatment and identification of barriers.

A study conducted in rural Bangladesh examined the patterns of health seeking behavior, mothers' recognition of symptoms, the perceived causes and barriers to timely treatment of acute lower respiratory infections (ALRI). A total of 194 children under 5 years of age suffering from ALRI in an intensive maternal child health and family planning area was prospectively followed. About 62% of the mothers sought allopathic treatment for their children within 24 hours of case detection. No treatment of any kind was sought in 45 (23.2%) cases. Most of the mothers could recognize the different symptoms of ALRI. Cold was reported as the most common cause of ALRI. No significant difference was observed in the reported symptoms or perceived cause of the disease between those who sought no treatment and those who sought allopathic, homeopathic, spiritual or combined treatments. Failure to recognize severity followed by work loss were the most common reasons identified for not seeking any medical care. Whether or not a mother sought allopathic treatment was not associated with the child's age, sex, mother's age, mother's education, duration of illness, birth order, housing type or distance from the health center. The study indicates the potential value of giving parents clear guidelines on recognition of severity of symptoms of ALRI and motivating them to seek treatment quickly when these symptoms present. Health service providers should be aware of the heavy work loads which rural women have and the severe time constraints which deter them from seeking timely treatment from the appropriate sources.

Privileged knowledge and mothers' "perceptions": the case of breast-feeding and insufficient milk in Bangladesh.

This article uses the example of breast-feeding and insufficient-milk syndrome in Bangladesh to illustrate the privileged status of professional discourse. While health professionals' discourse is given the status of scientific knowledge, the views and opinions expressed by breast-feeding women are referred to as "perceptions" and thus regarded as less objective. We use data gathered in two anthropological studies undertaken between 1987 and 1992 to examine some of the ambiguous qualities that breast-feeding mothers, their relatives, and health practitioners attribute to breast milk in Bangladesh. We discuss how old beliefs are incorporated into new systems and how bottles, which are associated with allopathy and science, provide a way of circumventing anxieties about female physiology and breast milk. Medical, religious, and popular ideas on breast-feeding and insufficient milk represent different intersecting discourses on the same theme-that female physiology and sexuality are problematic.

Promoting sanitation in Bangladesh.

A community-level survey was made in Bangladesh to assess the effectiveness of a health promotion campaign on sanitation. The data collected showed that the mobilization of schoolchildren to promote the construction and use of sanitary latrines had a significant impact on local practices. Poorer families appeared to be more responsive to the idea of building their own sanitary latrines than those who were slightly better off, who sometimes saw the homemade latrine as a symbol of low status. In several cases the woman of the household did the construction work rather than the man, and this aspect of women's participation could usefully be emphasized in future campaigns.

The ethnophysiology of digestion and diarrhoea in a Bangladeshi hospital population.

The results presented in this paper are drawn from a study of the acceptability of the weaning food, ARGC. The study aimed to investigate attitudes and practices surrounding weaning and the dietary management of diarrhoea. One hundred and twenty mothers of children aged between six months and 24 months suffering from mild diarrhoea and admitted to the ICDDR,B treatment centre were randomly selected. Diarrhoea was attributed by mothers to a number of causes; most common were contaminated food and breastmilk. Breastmilk was understood to have been spoiled either by the mother's diet or mystical forces termed batash. Batash was also suspected to directly making children sick in some instances. Thirty-six per cent of mothers attempted to manage diarrhoea at home by withholding normal foods from their children's diets and others modified their own diets. Less than a quarter of the children were normally fed vegetables, dal (lentils) or small fish. It appeared that fish was rarely given to young children and was regarded with some ambivalence and considered potentially attractive as a vehicle for malign forces that might attack young children and their mothers and cause illness. People were unwilling to feed their children fish and other items of the normal family diet because of notions about the digestive system and the concept of "digestive power" and the idea that young children did not have the digestive power to digest certain foods. It was suggested that early weaning might lead to poor and abnormal growth and development.

Compliance with diphtheria, tetanus, and pertussis immunisation in Bangladesh: factors identifying high risk groups.

OBJECTIVE: To evaluate factors associated with non-compliance with having second vaccination against diphtheria, tetanus, and pertussis in a treatment centre in Dhaka to determine which children were most at risk of not completing immunisation. DESIGN: Cohort study of infants given first dose of the vaccine and followed up six weeks later to ascertain compliance with having second dose. Factors associated with non-compliance were evaluated. SETTING: Dhaka treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh. SUBJECTS: 136 unimmunised children aged 6 weeks to 23 months who lived within reach of the treatment centre. At time of the six week follow up 16 of the children could not be traced and seven had died. INTERVENTIONS: All children received their first dose of the vaccine. In each case health education workers had informed the mother about the value of immunisation, and she was given clear instructions to bring the child back after four weeks for the second dose. MAIN OUTCOME MEASURE: Rate of non-compliance with advice to return child for second vaccination. RESULTS: 46 of 113 children (41%) received the second dose of the vaccine. Factors most closely associated with mothers' failure to comply with the second dose were lack of education and low income. Children whose mothers knew most about immunisation at first interview were more likely to have their second dose. CONCLUSIONS: Preventive health care services such as immunisation are appropriately offered in treatment centres, but compliance among children varies with socioeconomic status and mother's education. Further research should be aimed at ways to make health education more effective among uneducated parents.

PIP: Factors associated with noncompliance with have a 2nd vaccination against diphtheria, tetanus, and pertussis in a treatment center in Dhaka were evaluated in order to determine which children were most at risk for not completing their immunization. This cohort study of infants was conducted at the Dhaka treatment center of the International Center for Diarrheal Disease Research, Bangladesh and included 136 unimmunized children ages 6 weeks-23 months who lived within reach of the treatment center. 1st doses of the vaccination were given and followed up 6 weeks later to ascertain compliance with having the 2nd dose. At the 6-week followup, 16 of the children could not be traced and 7 had died. All children received their 1st dose of the vaccine. In each case, health education workers had informed the mother about the value of immunization, and she was provided clear instructions concerning the return of the child after 4 weeks had passed for the 2nd dose. Rate of noncompliance with advice to return the child for 2nd vaccination was the main outcome measure. 46 of 113 children (41%) received the 2nd vaccine dose. Factors most closely associated with maternal failure to comply with 2nd dose were lack of education and low income. Children whose mothers know most about immunization at 1st interview were more likely to have their 2nd dose. Preventive health care services such as immunization are appropriately offered in treatment centers but compliance among children varies with socioeconomic status and maternal education. Further research should be aimed at ways to make health education more effective among uneducated parents.

The use of soap and water in two Bangladeshi communities: implications for the transmission of diarrhea.

Efforts to reduce the incidence of diarrheal infections in which enteropathogens are endemic have focused on education about the importance of hand washing to interrupt transmission of such organisms. Since the effectiveness of health education depends on an understanding of the recipients' ideas and customs, we studied perceptions of cleanliness and the role of soap and hand washing in two poor Bangladeshi communities, one rural and one urban. We found that ideas about cleanliness generally are not based on germ theory; cleanliness is viewed in a larger, socioreligious context of purity vs. impurity. Washing serves both physical and spiritual needs and is performed according to defined patterns that may not effectively interrupt transmission of microorganisms. Soap is regarded as a cosmetic rather than an agent for removal of microorganisms.