Aminur Rahman

Determinants of childhood burns in rural Bangladesh: A nested case-control study

BACKGROUNDnBurn is one of the major causes of childhood illnesses in Bangladesh and is the third leading cause of illness of 1- to 4-year-old children. Rural children are more at risk compared to urban-dwelling children.nnnOBJECTIVEnThe study was designed to identify the risk factors of childhood burn in rural Bangladesh.nnnMETHODSnThis nested case-control study was conducted in rural Bangladesh. The study population was children of less than 10 years old in three sub-districts of Bangladesh.nnnRESULTSnChildren of families who did not have a household with a separate kitchen, a common occurrence in rural areas, were at significantly higher risk of burn (OR 1.65; 95% CI 1.22-2.24). A kitchen without a door was also found to create a more hazardous environment compared to a kitchen with a door. The traditional kerosene lamp (kupi bati) was found to be one of the major determinants of childhood burn in rural Bangladesh (OR 3.16; 95% CI 1.58-6.35). No use or restricted use of kupi bati significantly reduces the risk of childhood burn. Children of nuclear families were at significantly higher risk of burn compared to combined families.nnnCONCLUSIONnCooking in an open place and use of the traditional kerosene lamp are the major determinants of childhood burn in rural Bangladesh. A combined family environment reduces the risk of childhood burn. Childhood burn can be reduced by prohibiting use of kupi bati and limiting childrens access to the cooking area. Promoting combined family could be an initiative of childhood burn prevention program.

Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study

BackgroundBangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals.MethodologyBoth qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines.ResultsThe hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85xa0% of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health conditions and treatments.ConclusionThe quality of healthcare is poor in district and sub-district hospitals in Bangladesh because of the lack of healthcare personnel and logistic support. An integrated quality improvement approach is needed to improve MNH care service in district and sub-district hospitals in Bangladesh.

The magnitude of injury problems among child labourers in a rural community of Bangladesh: findings from an injury surveillance system

BACKGROUNDnChild labour is an important topic in contemporary society. In this study we have tried to explore the magnitude of injury problems among child labourers in Bangladesh using an injury surveillance system.nnnMETHODSnAn injury surveillance system (ISS) was performed under the Prevention of Child Injuries through Social intervention and Education (PRECISE) project in Bangladesh during 2006-2010 in three sub-districts covering a population of more than 700,000. We used the ISS for assessing child labour. Appropriate epidemiological methods were considered in the study.nnnRESULTSnConsidering the reported main occupation of the children, 30% of children from the surveillance households were identified as child labourers. More than two thirds of child labourers were educated to primary or secondary level. The majority of boys worked as unskilled labourers and girls were employed in domestic work. The incidence of injury and deaths among child labourers was estimated as 24 per 100,000 children years. More than 19 injury related illnesses of moderate to severe intensity were found among 1000 child labourers in a year. Fractures, sprains, dislocations, cuts/wounds, animal bites, abrasions or lacerations, burns, head injuries and internal organ injuries are most common among child labourers.nnnCONCLUSIONSnWorking children are at risk of injury, death and illness in Bangladesh. Child labourers are now even more clearly tied to quantified morbidity and mortality.

PA 09-6-1378 Monitoring process for a comprehensive drowning reduction project: experience from low-middle-income country

Introduction Injury kills about 300 people each day in Bangladesh. Drowning, suicide, road traffic injuries are the topmost causes of injury mortality. Government and non-government organizations are implementing injury prevention projects in Bangladesh. Effective monitoring is the key to make a program successful. Aim To track down and ensure the quality of injury prevention project activities through a systematic process on a regular basis. Method The study developed a logical framework integrated with targeted project indicators. The indicators are finalized in consultation with donors, academic partners, national and international drowning experts. Base on the indicators, individual monitoring tool was developed for each intervention. Later on project staff were oriented on tools and trained to use the tool on electronic data collection devices. Additionally, to oversee routine activities a Management Information System is being used. Result The tools consisted with some substantial variables, likely project staff and beneficiaries’ competency, safety standards, outcomes of the interventions, drop-out of project staff and beneficiaries, injury incidences and its management. Field supervisors visit intervention sites, activities and used the tools on devices and upload data on regular basis. Central project staff also visited and used the tools in intervention areas according to periodic plan. Through the monitoring data, agreed indicators of the interventions were tracked down towards project goals and ensured quality of the interventions as well as identify loopholes of every stage of the intervention. Monitoring data produced monthly and quarterly reports with the specific outcomes and was shared with implementation team, donors and academic partners. By doing so, the project management and donors took steps to ensure quality of the project. Conclusion and policy implications Due to each project personnel`s involvement, the monitoring process was participatory and ensuring accountability, transparency and maintaining quality of project activities.

PA 17-6-1939 Safety perceptions and practices for drowning prevention among fishermen in bangladesh

Introduction Fishermen are an occupational group who are typically highly exposed to water based risk, and face consequences of disaster frequently. A number of fishermen have experienced both fatal and non-fatal drowning, although fishermen are generally not treated as a vulnerable community. There is very limited knowledge on the context of drowning in fishermen and opportunities for prevention in fisherman in Bangladesh. Objectives To explore current safety management perceptions and practices among the fishermen. Methods An anthropological study captured data through in-depth interviews (IDIs-16) and focus group (FGD-3) discussion with fishermen, key informant interviews (KI-4) with lenders and boat owners, we also conducted observations (6) of fishing practices. Data were transcribed and coded into NVIVO-11 software. Data were analyzed by content and thematic areas. Results Most fishermen perceived drowning as a natural incident or as ‘God’s will’ and therefore it cannot be prevented. Many fishermen did not take any safety equipment, as they believe in the case of bad weather they will able to come to inland and also think as fishermen they are strong enough to rescue themselves. They thought themselves as very good swimmers and perceived they could rescue themselves by floating equipment such as that used to float fishing nets. Majority of fishermen reported not carrying any safety equipment as they thought it is necessary only for fishing in the sea. Furthermore, the fishermen reported that as they need to store fish in their boat and there is no space remain to keep safety equipment. Conclusion Most of the fishermen did not perceive drowning as an occupational hazard, had no training of use of life-saving equipment and rescue and did not have adequate safety equipment. Community awareness along with first aid, safety equipment and training are necessary to reduce drowning risk in marginalized fishermen community in Bangladesh.

PW 1359 Digital data collection in a large community-based injury survey: experience from a low-income country setting

Digital data collection is a secured, fast and flexible system by which almost every type of data can be collected. Through this system, data can be collected anywhere in the world. It provides an opportunity to modify the survey questionnaire at any time during the survey. Data can be exported to Microsoft Excel, STATA, R, or SPSS for analysis. This study was designed to investigate the feasibility of digital data collection in a large-scale community survey in a low-income country. A large-scale community-based injury survey was designed to explore the drowning situation in southern part of Bangladesh. Twenty-one sub-districts, approximately 90u2009000 households and nearly 4, 05u2009000 populations were included in this survey. Paper form questionnaire was converted to digital form using REDCap (Research Electronic Data Capture) software and linked to android device through REDCap Mobile Apps. Fifty data collectors, 12 supervisors and 4 area coordinators were involved in the data collection process. An exploratory study was conducted to assess the feasibility, survey cost, time management of the digital data collection process. Face to face interview was conducted by data collectors, supervisors, data manager and research investigators of the survey. Ninety-eight percent respondents mentioned that, digital data collection was convenient compared to paper-based data collection. Among them 96% said, it required less time of data collection. It was also found that digital data collection required 25% less cost considering the questionnaire printing and data entry. This system provided an opportunity to monitor data quality on a regular basis and eliminate the error of data entry. Digital data collection is feasible and convenient, it required less time and resources. So, the benefit of digital data collection needs to disseminate more in low- and middle-income countries where resources are low.

PW 1368 Disaster preparedness in local community: a quantitative baseline study in coastal regions of bangladesh

Bangladesh experiences frequent natural disasters, which cause loss of life damage to infrastructure and economic assets and adversely impacts on lives and livelihoods, especially of poor people. To investigate the impact of aquatic disasters on the community and explore current disaster preparedness practices and resilience in Barisal division. A sub sample survey conducted to identify the risk factors for drowning during disaster at household and community level and understand the situation. We had conducted interview on 10% of the survey population through using systematic random sampling in 24 sub districts in Barisal Division. The 82% respondents gathered experience one or more natural disaster in the last five year, 63% respondents believed that flooding/flash flood to be the biggest threat followed by cyclones/big storms (24%). As a weather forecast information, television was the most common source of weather signals (46%) about the natural disaster that respondents had received. A high proportion of respondents (70%) reported having received warning messages such as television (45%) followed by warnings from local authorities and volunteers, at 21% each, were the most common source for receiving warning signals. The 81% respondent reported not going to any shelter, 44% believed that seeking shelter was not required and that the shelter was not easily accessible, and 38% did not seek shelter for the security of their property and for protecting their cattle (13%). The vulnerability of Bangladesh to climate change with particular reference to tropical cyclone frequency and intensity, flooding against current coping and adaptation-mitigation mechanism through local communities under coastal belt of Bangladesh. Disaster preparedness had predominately managed by individual community members. Warning signals indicates event severity, directing community members towards cyclone shelters and other protected areas of the community. Government initiatives primarily focus on protection at time of disaster and relief post-disaster.

PA 08-2-1720 Caregiver supervision practices and risk of childhood unintentional injury mortality in bangladesh

Background Childhood mortality from unintentional injuries is disproportionately high in low-and-middle-income-countries (LMICs). Inadequate supervision is often described as contributory to these childhood unintentional injury deaths. Objective This paper highlights the relationship between caregiver supervision and unintentional injury mortality among children under five in rural Bangladesh. Method A nested, matched, case-control study was conducted within a large-scale drowning prevention cohort study in Bangladesh. From the baseline survey conducted as part of the study in 2013, 126 cases (under-five children that died from unintentional injuries) and 378 controls (alive, but similarly aged children) were selected at a case-control ratio of 1:3, and individually matched on neighborhood factors. The association between adult caregiver supervision and fatal injuries among under-five children was determined in a multivariable conditional logistic regression analysis, and reported as adjusted matched odds ratio (MOR) with 95% confidence intervals (CIs). Results Overall, 18.4% of the children aged 0–5 years had some form of supervision by an adult caregiver during the peak period for childhood injury events in Bangladesh, 9 am – 1 pm. Less than 5% of the caregivers had an education above secondary level and 28.6% were involved in agriculture or farming. Under-five children who died from unintentional injury deaths, mostly drowning, had three times higher odds of being unsupervised as compared to alive children (MOR=3.3, 95%u2009CI: 1.6–7.0), while adjusting for child’s gender, age, socioeconomic index, and adult caregiver’s age, education, occupation, and marital status. Conclusion Appropriate adult supervision is essential for prevention of childhood unintentional injuries in Bangladesh and other similar LMICs. Multi-sectoral efforts to facilitate the design and implementation childhood supervision strategies e.g. community-based daycare are needed.