Natural disasters, livelihood, and healthcare challenges of the people of a riverine island in Bangladesh: A mixed-method exploration.

BACKGROUND: Bangladesh's islands, because of their geographical location, frequently encounter crises like floods and river erosion, which pose significant threats to the residents' well-being and livelihoods. To delve into the effects of these disasters on livelihood and healthcare challenges, a mixed-method study was undertaken in a riverine-island near a major river of Bangladesh. METHODOLOGY: Between February 15th and February 28th, 2023, a cross-sectional study was conducted on an island in Bangladesh. The quantitative method involved conducting a survey of 442 households, with a total of 2921 participants. Additionally, 10 in-depth interviews and 10 key-informant interviews were conducted using semi-structured guidelines. Qualitative interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Triangulation was employed in this study through the integration of qualitative and quantitative analysis, resulting in the presentation of findings that offer an in-depth comprehension of the phenomenon being investigated. RESULTS: River erosions and floods are common and recurring natural disasters that significantly impact the lives of the riverine island inhabitants. These disasters often disrupted their livelihoods, forced many residents to endure substandard living conditions or relocated during flood events. The island faced a low diagnostic prevalence of chronic diseases (e.g., 5.1% of adults were hypertension and 2.5% are diabetes) because of the absence of diagnostic facilities and a shortage of certified doctors. A significant number of chronic illness people in the community turned to alternative medicine sources (39.3%) such as homeopathy, Kabiraj, and Ayurvedic medicine, especially it gets increased during periods of natural disasters. Moreover, reproductive aged women revealed that 79.4% of them gave birth at home, with 6.0% of these home deliveries resulting in miscarriage or infant death. The destruction of crops, unstable job opportunities, an inadequate educational system, and a deficient healthcare delivery system exacerbated the hardships faced by the population affected by these disasters. CONCLUSION: The failure to seek treatment for chronic diseases and undiagnosed diseases is a significant health issue among the aging adults on the island. Island residents face the challenge of establishing effective prevention strategies for the well-being of older adults especially at the period of natural disasters. It is crucial for the government and non-governmental organizations (NGOs) to collaborate to prevent the negative effects of floods and river erosions. This should include efforts to enhance the quality of education, healthcare services, job opportunities, and financial assistance for rebuilding homes.

Perception and experiences of adolescent mothers and communities in caring for their preterm babies: findings from an in-depth study in rural Bangladesh.

BACKGROUND: A significant concern for Bangladesh is the high prevalence of adolescent pregnancy and the associated negative consequences for mother and baby, including a teen-related increased risk of preterm birth (PTB). Bangladesh also has one of the highest incidences of PTB (19%). Despite these high numbers of adolescent pregnancies and PTB, little is reported about the experiences of adolescent mothers in caring for their preterm babies, and the interventions needed to support them. The aim of this study was to explore gaps and opportunities for improved care for preterm babies among adolescent mothers and communities in rural Bangladesh. METHODS: We conducted a qualitative study in rural villages of Baliakandi sub-district of Bangladesh. Data collection involved in-depth interviews with adolescent mothers of premature and term babies, adult mothers with premature babies, and family members (n = 36); focus groups with community members (n = 5); and key informant interviews with healthcare providers (n = 13). Adolescent mothers with term and adult mothers with PTBs were included to elicit similarities and differences in understanding and care practices of PTB. A thematic approach was used for data analysis. RESULTS: We explored two major themes- perceptions and understanding of PTB; care practices and care-seeking for illnesses. We observed gaps and variations in understanding of preterm birth (length of gestation, appearance, causes, problems faced) and care practices (thermal management, feeding, weight monitoring) among all, but particularly among adolescents. Immediate natal and marital-kins were prominent in the narratives of adolescents as sources of informational and instrumental support. The use of multiple providers and delays in care-seeking from trained providers for sick preterm babies was noted, often modulated by the perception of severity of illness, cost, convenience, and quality of services. Health systems challenges included lack of equipment and trained staff in facilities to provide special care to preterm babies. CONCLUSION: A combination of factors including local knowledge, socio-cultural practices and health systems challenges influenced knowledge of, and care for, preterm babies among adolescent and adult mothers. Strategies to improve birth outcomes will require increased awareness among adolescents, women, and families about PTB and improvement in quality of PTB services at health facilities.

The impact of climate change on the lives and livelihoods of readymade garment (RMG) workers: an exploratory study in selected readymade garment factories in Bangladesh.

BACKGROUND: There is a paucity of resources focusing on the climate change experience of readymade garment (RMG) workers in developing countries such as Bangladesh. Therefore, this mixed method approach aims to understand the distinctive types of climate change experiences from a health and occupational perspective, along with the consequences of these changes among RMG workers in Bangladesh. METHODS: The study was conducted from January 2022 and February 2022 where the quantitative data were collected from 200 RMG workers in 10 randomly selected garments and two focus group discussions took place with 20 conveniently selected RMG workers. The key informants were relevant stakeholders in the industry. Quantitative findings were reported using descriptive methods and qualitative findings were analysed using a content analysis approach. RESULT: A total of 200 RMG workers were included in the study of which the majority belonged to the age group of 26-30 years (44%), were male (55%), worked in a compliant factory (70%), and were machine operators (79%). Half of the respondents experienced damage from natural disasters (51%), but only approximately 37% received humanitarian help. Migration and urbanisation were among the aftermath of the damage caused by e natural disasters, and 42% were forced to shift their homes due to natural disasters. Competition in the job market increased, and the owners had the opportunity to take on employees at a reduced salary. The respondents flagged climate change as a major contributor to their disease patterns. More than three-quarters of the respondents became sick because of increased heat while working; however, only half received any treatment. CONCLUSION: Employee participation in hazard recognition, employer preparedness, prevention through design, research, surveillance, and upholding workplace ethics and standards can be the answers to climate change problems for readymade garment workers.

Evaluating the impact of e-registration and mHealth on institutional delivery in hazard-prone areas of Bangladesh: A protocol for a non-randomized controlled cluster trial.

Despite substantial progress, Bangladesh still has a high rate of maternal deaths owing to difficulties during pregnancy, delivery, and the postpartum period. Increasing facility delivery is mandatory to reach the goal of bringing down the MMR to <70 deaths/100,000 live births by 2030. In the era of digitalization, the introduction of e-registration and mHealth may aid the government in reaching this target. The southern part of Bangladesh is a hazard-prone area, where service uptake from institutions is low. This study aims to determine the effect of an e-registration tracking system and mHealth counseling on institutional deliveries to pregnant mothers in hazard-prone areas of southern Bangladesh. We will conduct an open-label, two-arm, non-randomized controlled cluster trial for six months and use three hazard-prone areas for intervention and another three hazard-prone areas for control. We will collect data at baseline and end-line of the study period using a structured questionnaire. We will enroll at least 268 pregnant mothers from the intervention and 268 pregnant mothers from the control areas after screening based on the inclusion and exclusion criteria. Pregnancy information will be obtained from the Family Welfare Assistant register. The respondents of the intervention arm will be registered in the e-Registration system, and receive voice call and text messages from the midwives to have their deliveries done in healthcare facilities. We will follow the participants until their delivery and exclude those respondents from the study who will have post-dated delivery, migrate out, lost to follow-up, or die during the study period. Random-intercept mixed-effect logistic regression will be performed to explain the relationship of e-registration and mHealth package with institutional delivery. Institutional delivery is still uncommon in Southern Bangladesh despite several interventions. Innovative approaches like e-registration and mHealth counseling may be helpful to bring women to health facilities. The findings from the study might enable the policy makers of Bangladesh to integrate the intervention package into the existing healthcare system. This experiment is registered in the open science framework. Clinical trial registration: Registration number: DOI 10.17605/OSF.IO/YZE5C) and https://www.clinicaltrials.gov/ (registration number: NCT05398978.

A formative research to explore the programmatic approach of vaccinating the Rohingya refugees and host communities against COVID-19 infection in Bangladesh.

BACKGROUND: The vaccination of the Rohingya refugees and host communities against COVID-19 in Cox's Bazar started in August 2021. Government authorities and Non-Government Organisation partners implemented a project around the initial period of vaccination to improve awareness and access to target beneficiaries. We conducted formative research to understand the programmatic approach of this project and identify potential challenges and community perceptions regarding immunisation against COVID-19. METHODOLOGY: This was formative research in which we used a qualitative method of data collection. Purposively chosen 12 key-informant interviews and conveniently chosen 20 in-depth interviews were conducted using semi-structured interview guidelines from August to September 2022 in the Rohingya camp and host communities of Cox's Bazar District, Bangladesh. Ethical approval was obtained from the North South University Institutional Review Board, and written informed consent was obtained from all the participants. We used a thematic analysis approach to analyse the data. RESULTS: The project neither provided any promotional or tailored messages regarding the COVID-19 vaccine nor conducted any vaccine hesitancy surveys before implementing the project. The project did not provide any storage facilities for the vaccines' cold chain management but provided transport support to carry the vaccines from the district to the sub-district level. Community leaders were included in the decision-making process during local-level planning of the vaccination programme. The project supported the reporting of any adverse effects following immunisation from community members to the government health authorities. Vaccine hesitancy among participants was high in the early stages, but mass campaigns and vaccination of frontline health workers increased their acceptance. The major challenges reported by the informants were low budget and lower salaries of field staff, stacking of the registration process at the beginning, reluctance of participants, inadequate transportation and manpower, and inadequate baby feeding corners at vaccination centers. CONCLUSION: The findings from our study will help policymakers from the Government, the UN, and other humanitarian agencies to adapt and better address the issue of vaccine acceptance and strengthen the vaccination programme.