Bimal Kanti Paul

Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study

The majority of births in rural Bangladesh are carried out in unhygienic conditions by relatives and traditional birth attendants (TBAs). This results in a high incidence of maternal and infant mortality that could be reduced if childbirth were to occur in health centers or under the supervision of trained TBAs (TTBAs). In this paper, we examined factors associated with utilization of modern health resources for childbirth in 39 villages of Bangladesh. We followed a retrospective survey research design to collect relevant information from couples who experienced childbirth during a two-year period from July 1, 1995 to June 1997. The data indicate that slightly over 11% of the deliveries were performed by trained personnel with the rest attended by TBAs. Multivariate analysis clearly shows that delivery complications was the most significant factor determining the use of modern health care resources for childbirth, followed by parental education, and pre-natal care. We conclude that quick response to delivery complications and improved access to hospitals and TTBAs can reduce the risk of infant and maternal mortality and morbidity in rural Bangladesh.

Coping mechanisms practised by drought victims (1994/5) in North Bengal, Bangladesh

Abstract Droughts are recurrent features in Bangladesh, affecting plant growth and leading to loss of crop production, food shortages and, for many people, starvation. The main objective of this study is to examine the means by which residents of a drought-affected area of Bangladesh cope with this hazard. Data were collected during the summer of 1995 from 301 drought-affected households located in northwestern Bangladesh. Analysis suggests that respondent households practised an array of adjustments to mitigate adverse effects of the 1994/5 drought. While both high- and low-income households were affected by the drought, households belonging to the lower socioeconomic group suffered the most, receiving the least support from the national government. Government responses were delayed and inadequate in providing financial and other assistance to the drought victims. It is suggested that the government should be prepared for drought long before the occurrence of such an event.

Flood research in Bangladesh in retrospect and prospect: a review

Abstract The purpose of this paper is to present main findings of flood research conducted so far in Bangladesh. The paper emphasizes unconventional findings and points out how some of these findings differ from the popular perceptions regarding some important aspects of flooding. The available studies clearly suggests that research into the impact of flooding on human settlement and other relevant aspects is much less developed in Bangladesh than the body of literature focusing on human adjustment to flood hazard. The paper identifies flood research gaps in the context of Bangladesh and suggests a new arena for future research.

Urban earthquake hazard: perceived seismic risk and preparedness in Dhaka City, Bangladesh.

Bangladesh is vulnerable to seismic events. Experts suspect that if an earthquake with a 7.0 magnitude occurred in large cities of Bangladesh, there would be a major human tragedy due to the structural failure of many buildings. The primary objectives of this paper are to examine seismic risk perception among residents of Dhaka City and investigate their levels of earthquake preparedness. A questionnaire survey conducted among 444 residents of the city provided the major source of data for the paper. The survey results suggest that an overwhelming majority of the respondents were not prepared for a major earthquake, which is anticipated to occur in Dhaka. Multivariate analysis of survey data reveals that value of residential unit and respondent educational levels appear as the most significant determinants of preparedness status of the respondents. This study recommends increasing earthquake awareness and preparedness among residents of Dhaka City.

Maternal mortality in Africa: 1980-87.

African women of reproductive age have the highest death risk from maternal causes of any women in the world. The lifetime chance of maternal death is 1 in 21 in Africa as compared to 1 in 54 in Asia, which ranks second. Using published data, this paper examines the level and correlates of maternal mortality ratio (MMR) in Africa. The data indicates that MMR greatly differs among the countries of Africa. High MMR is found in most countries of sub-Saharan Africa, while countries of Northern Africa are characterized by relatively low maternal death. Reasons for high MMR in sub-Saharan Africa are explored in detail. Analysis using multiple regression suggests that the MMR in Africa is strongly influenced by population size, crude birth rate (CBR), crude death rate (CDR), calorie supply as a percentage of requirements, access to safe water, and percentage of urban population. Some cultural and behavioral factors, such as female circumcision and infibulation, are also associated with a high MMR. Future programs aimed at reducing the maternal mortality in African countries may benefit from the findings of this study.

Tourism in Saudi Arabia: Asir National Park.

Abstract This article discusses the results of a survey conducted at the Al-Sawdah resort, Saudi Arabia. The purpose was to collect information on the nationalities of visitors, their duration of stay, and the catchment area of the resort. The results indicate that the majority of the visitors came from Asir and neighboring provinces. Visitors from distant places usually stayed longer, compared to those traveling shorter distances. Additionally, the number of previous trips was found to be inversely related to the duration of stay. The findings suggest that there is a large domestic tourism market. The study points to the need to promote tourism in Asir National Park.

Relief assistance to 1998 flood victims: a comparison of the performance of the government and NGOs

With increasing support from the international community, non-governmental organizations (NGOs) have played an important role in Bangladesh since the early 1970s in providing emergency assistance to disaster victims. After observing widespread corruption and misuse of relief aid by the Bangladesh government in 1974 and subsequent years, external sources began to channellize emergency assistance to the victims through NGOs. Realizing that NGOs were usurping its authority over external disaster assistance, the government looked for opportunities to demonstrate its ability to deliver services to victims. An opportunity came in July 1998 when Bangladesh experienced a devastating flood. Using data collected from 348 households in 11 villages, this paper compares support received by the respondents from the Bangladesh government and NGOs during and immediately after the flood. Respondent opinions regarding emergency relief distribution suggest that both sources performed satisfactorily and an overwhelming majority of them thought that the government performed better than it had previously in distributing relief assistance to flood victims. Following an analysis of the survey data, this paper discusses the policy implications for future disaster assistance efforts in Bangladesh and elsewhere.

Factors Affecting Evacuation Behavior: The Case of 2007 Cyclone Sidr, Bangladesh

Cyclone Sidr, a Category 4 storm, struck the southwestern coast of Bangladesh on 15 November 2007. Despite early cyclone warnings and emergency evacuation orders for coastal residents, thousands of individuals stayed in their homes. This study examines Sidr victims’ responses to cyclone warnings and evacuation orders, and explores the factors that would explain why the victims did or did not comply with the orders. Based on survey data collected from 277 Sidr survivors living in the four most severely impacted coastal districts, this study found that more than 75 percent of all respondents were aware of the cyclone warnings and evacuation orders before Sidrs landfall. Despite the efforts of the Bangladesh government, there were lapses in cyclone warnings and evacuation procedures. Field data also reveal several reasons cited by respondents for not complying with evacuation orders. Multivariate analyses of survey data show that trust in warning messages was the most important determinant in the decision to seek refuge in safer shelters, followed by distance to nearest shelter and annual level of education. Several recommendations have been made to improve cyclone warnings and the use of public shelters for similar future events.

AIDS in Asia

In the mid-1980s, when AIDS (acquired immune deficiency syndrome) was well established in North America and Africa, it was little known in Asia. Now the World Health Organization (WHO) estimates that before 2000 most new cases of HIV (human immunodeficiency virus) infection, which causes AIDS, will occur in Asia (Mann 1992, 4; World Bank 1993, 33). Worldwide the number of HIV-infected persons will increase from nine million in 1990 to twenty-six million by 2000 (World Bank 1993, 99). During that period the number of infected people in south, east, and southeastern Asia will rise from fewer than half a million to nine million, which means that an additional 8.6 million cases will be recorded for Asia by the end of the twentieth century. The corresponding tally for Africa is 6.2 million (World Bank 1993, 33). The Global AIDS Policy Coalition asserts that by 2000 Asia will overtake Africa as the most Aids-afflicted continent (Mann 1992). HIV is transmitted primarily by three methods: sexual intercourse; intravenous exposure to HIV-infected blood through transmission, donated organs, and drug use; and vertical transmission from mother to child (Over and Piot 1993, 460). The patterns and prevalence of these three modes of transmitting HIV vary geographically. On the bases of data from the period when the virus began to spread significantly, the prevalence of each mode, and its specific mechanisms, WHO distinguishes three epidemiological patterns of HIV infection (Mosley and Cowley 1991, 20). Pattern I is typical of western Europe, North America, Australia, and New Zealand, where the most common form of transmission is male homosexual or bisexual intercourse and the second most is intravenous drug use. Pattern II, in which heterosexuals are the main group affected, is found in sub-Saharan Africa, the Caribbean, and parts of South America. Pattern III is typical of countries where HIV has recently been introduced. Much of Asia and eastern Europe fit this pattern. Prostitutes, their clients, and intravenous drug users account for most cases. The first AIDS case in Asia was reported in Israel in 1980, post diagnosis (Dossier 1988, 154). No AIDS case was detected in any other Asian country for the next three years. The Philippines, Thailand, and Turkey reported AIDS cases in 1984; first-time reports of cases came from China, Hong Kong, Japan, and Qatar in 1985. By 1 January 1992, as many as twenty-eight Asian countries, outside the former Soviet Union, had officially reported cases (Fig. 1). A relatively large number of countries reported cases for the first time in the mid-1980s, in contrast with the early and late years of that decade. Thirty new cases were reported in 1985 (Fig. 2). The number rose steadily to 1990, when 403 were officially reported. The tally dropped in 1991 but sharply increased in 1992 and soared to more than three thousand in 1993. One source (Economist 1994b, 128) used WHO data to assert that a total of 10,387 AIDS cases had been officially recorded in Asia as of February 1994. That tally is less than for the Americas in 1984 or for Europe by 1987. But if the current trend persists, Asia will have the largest number of AIDS cases in the world in a decade. Without proper intervention programs to slow the spread of AIDS in Asia, the epidemic will bring catastrophe to many countries. The main objective of this article is to examine the spatial patterns of AIDS distribution in Asia. Data were available from twenty-eight countries, all outside the former Soviet Union. Three variables are usually used to study distribution patterns of AIDS: HIV-infected cases, AIDS cases, and deaths attributed to AIDS. Data on the first and third variables are available only for a few Asian countries. Therefore, the AIDS cases alone are used to show the spatial distribution of the disease in Asia. Additionally, I examine the status of AIDS in Thailand and India in detail as case studies. …

Disaster relief efforts: an update

A vast literature currently exists focusing on disaster response. This literature clearly suggests that victims of natural disasters need outside support to cope with hardships and distress caused by extreme events. This is particularly true for victims in developing countries, where disasters create demands that cannot be met by domestic resources. However, many hazard researchers claim that relief goods that are often sent are not properly distributed and these goods are often not of the appropriate type nor sufficient in quantity. These researchers further claim that emergency aid is counter-productive and it increases dependency on external sources. The objective of this paper is to critically review the provision of disaster relief in developing countries, with special reference to Bangladesh. The primary emphasis of this paper is on changes that have occurred in the area of disaster relief over the last three decades. This paper provides evidence that, because of these changes, relief efforts have become more integrated with development projects and less burdened with the problems outlined in earlier literature critical of the provision of emergency relief to disaster victims.