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Objective To directly estimate how much smoking contributes to cause-specific mortality in Bangladesh. Methods A case-control study was conducted with surveillance data from Matlab, a rural subdistrict. Cases (n = 2213) and controls (n = 261) were men aged 25 to 69 years who had died between 2003 and 2010 from smoking-related and non-smoking-related causes, respectively. Cause-specific odds ratios (ORs) were calculated for 'ever-smokers' versus 'never-smokers', with adjustment for education, tobacco chewing status and age. Smoking-attributable deaths among cases, national attributable fractions and cumulative probability of surviving from 25 to 69 years of age among ever-smokers and never-smokers were also calculated. Findings The fraction of ever-smokers was about 84% among cases and 73% among controls (OR: 1.7; 99% confidence interval, CI: 1.1-2.5). ORs were highest for cancers and lower for respiratory, vascular and other diseases. A dose-response relationship was noted between age at smoking initiation and daily number of cigarettes or bidis smoked and the risk of death. Among 25-year-old Bangladeshi men, 32% of ever-smokers will die before reaching 70 years of age, compared with 19% of never-smokers. In 2010, about 25% of all deaths observed in Bangladeshi men aged 25 to 69 years (i.e. 42000 deaths) were attributable to smoking. Conclusion Smoking causes about 25% of all deaths in Bangladeshi men aged 25 to 69 years and an average loss of seven years of life per smoker. Without a substantial increase in smoking cessation rates, which are low among Bangladeshi men, smoking- attributable deaths in Bangladesh are likely to increase. Methodes Une etude cas-temoins a ete menee avec les donnees de surveillance de Matlab, un sous-district rural. Les cas (n = 2213) et les controles (n = 261) etaient des hommes ages de 25 a 69 ans decedes entre 2003 et 2010 des suites ou non du tabagisme, respectivement. Les rapports des cotes (RC) par cause ont ete calcules pour les <> par rapport aux <>, avec un ajustement pour I'education, la consommation de tabac a macher et l'age. On a egalement calcule les deces attribuables au tabagisme parmi les cas, les fractions attribuables a la population nationale et la probabilite de survie de 25 a 69 a ns chez les fumeurs depuis toujours et chez les non-fumeurs. Resultats La fraction des fumeurs depuis toujours etait d'environ 84% chez les cas et de 73% chez les controles (RC: 1,7; intervalle de confiance de 99%, IC: 1,1-2,5). Les rapports de cotes etaient les plus eleves pour les cancers et plus bas pour les maladies respiratoires, vasculaires et autres. Une relation dose-reponse a ete notee entre l'age de l'initiation au tabagisme et le nombre de cigarettes ou de <> fumees chaque jour et le risque de mortalite. Chez les hommes du Bangladesh de 25 ans, 32% des rumeurs depuis toujours mourront avant l'age de 70 ans, par rapport a 19% pour les nomfumeurs. En 2010, environ 25% de tous les deces observes chez les hommes du Bangladesh ages de 25 a 69 ans (c'est-a-dire 42 000 deces) etaient attribuables au tabagisme. Conclusion Le tabagisme est a l'origine de 2.5% de tous les deces chez les hommes du Bangladesh ages de 25 a 69 ans, et d'une perte moyenne de 7 annees de vie pour les rumeurs. Sa ns une augmentation importante des taux d'abandon du tabac, qui sont faibles chez les hommes du Bangladesh, les deces attribuables au tabagisme augmenteront probablement dans ce pays. Objetivo Estimar directamente la medida en la que el tabaquismo contribuye a la mortalidad por causa especifica en Bangladesh. Metodos Se realizo un estudio de casos y controles con datos de vigilancia de Matlab, un subdistrito rural. Los casos (n=2213) y los controles (n=261) se trataron de hombres de edades entre 25 y 69 anos que habian fallecido entre 2003 y 2010 por causas relacionadas y no relacionadas con el tabaquismo, respectivamente. Las razones de posibilidades por causa especifica se calcularon para los <> frente a los <>, ajustando la educacion, el consumo de tabaco de mascar y la edad. Tambien se calcularon las muertes atribuibles al tabaquismo entre los casos, las fracciones nacionales atribuibles y la probabilidad acumulada de sobrevivir de los 25 a los 69 anos de edad entre los fumadores de siempre y los nunca fumadores. Resultados La fraccion de fumadores de siempre fue de aproximadamente el 84% entre los casos y el 73% entre los controles (razon de posibilidades: 1,7; intervalo de confianza 99%: 1,1-2,5). Las razones de posibilidades fueron las mayores en casos de canceres y menores en casos de enfermedades vasculares, respiratorias y de otros tipos. Se senalo una relacion dosis-respuesta entre la edad de la iniciacion en el tabaquismo y el numero diario de cigarrillos o bidis fumados y el riesgo de muerte. Entre los hombres de Bangladesh de 2.5 anos, el 32% de los fumadores de siempre falleceran antes de alcanzar los 70 anos, comparado con el 19% de los nunca fumadores. En 2010, aproximadamente el 25% de las muertes observadas en los hombres de Bangladesh de entre 25 y 69 anos (42 000 muertes) fueron atribuibles al tabaquismo. Conclusion El tabaquismo causa aproximadamente el 25% de todas las muertes en los hombres de Bangladesh de entre 25 y 69 anos y una perdida media de siete anos de vida en cada fumador. Sin un aumento significativo en las tasas de abandono del tabaquismO, que son bajas entre los hombres de Bangladesh, es probable que aumenten las muertes atribuibles al tabaquismo en Bangladesh., Introduction Deaths attributable to smoking are projected to increase substantially throughout the 21st century and much of the increase will occur in low- and middle-income countries (1) such as Bangladesh, [...]

Dissemination of Enterobacteriaceae that produce extended-spectrum p-lactamases (ESBLs) is increasing in humans and animals globally (1,2). Clinically relevant sequence and ESBL types have been reported among wild birds (3). Escherichia [...]

Nipah virus (NiV), a bat-borne paramyxovirus, has caused outbreaks of human disease with high mortality rates in Malaysia, Singapore, India, and Bangladesh. Two divergent NiV strains (NiV-Malaysia and NiV-Bangladesh) share [...]

BACKGROUND: Exposure to arsenic via drinking water has been associated with adverse pregnancy outcomes and infant morbidity and mortality. Little is known, however, about the effects of arsenic on child [...]

After 2 children in North America were confirmed to have pandemic (H1N1) 2009 infections on April 17, 2009 (1), the virus rapidly spread throughout the world. By July 2, 2009, [...]

BACKGROUND: Manganese is a common natural contaminant of groundwater in Bangladesh. In this cross-sectional study we assessed the association between water manganese and all-cause infant mortality in the offspring of [...]

BACKGROUND: There is a need to identify and evaluate an effective mitigation program for arsenic exposure from drinking water in Bangladesh. OBJECTIVE: We evaluated the effectiveness of a multifaceted mitigation [...]

BACKGROUND: Millions of people in Bangladesh are at risk of chronic arsenic toxicity from drinking contaminated groundwater, but little is known about diet as an additional source of As exposure. [...]

We investigated an outbreak of encephalitis in Tangail District, Bangladesh. We defined case-patients as persons from the outbreak area in whom fever developed with new onset of seizures or altered [...]

The impact of war of independence on per capita calorie intake in Bangladesh is analyzed. The relation between per capita income and calorie intake is studied. In Bangladesh poverty is defined by calorie intake.

Acid attacks on women are increasing at alarming rates in Bangladesh, but the government has failed to provide medical care to the victims. Easily available sulfuric acid, which can mutilate a human face in moments, has emerged as a weapon used to disfigure a woman's body. By the mid-1990s, activists had documented acid attacks, and urban protests were followed by demands for better medical care. I show how the interaction between local and international-level civil society organizations made international resources available to local feminist groups engaged in domestic social struggles and helped to improve medical care for acid victims of Bangladesh. Keywords: acid; activism; carework; feminist organizations; globalization; Bangladesh

Based on results of ecological studies demonstrating that Vibrio cholerae, the etiological agent of epidemic cholera, is commensal to zooplankton, notably copepods, a simple filtration procedure was developed whereby zooplankton, most phytoplankton, and particulates >20 [micro]m were removed from water before use. Effective deployment of this filtration procedure, from September 1999 through July 2002 in 65 villages of rural Bangladesh, of which the total population for the entire study comprised [approximately equal to] 133,000 individuals, yielded a 48% reduction in cholera (P < 0.005) compared with the control.

The impact of participation in group-based credit programs, by gender of participant, on the health status of children by gender in rural Bangladesh is investigated. These credit programs are well suited to studies of how gender-specific resources alter intra-household allocations because they induce differential participation by gender. Women's credit is found to have a large and statistically significant impact on two of three measures of the healthiness of both boy and girl children. Credit provided to men has no statistically significant impact and the null hypothesis of equal credit effects by gender of participant is rejected.

This paper reports results from a prospective study of the impact of a woman-focused development programme on child survival in Matlab, a rural area of Bangladesh. The programme was targeted to households owning less than 50 decimals of land and members selling more than 100 days of labour for living in a year. Programme components included formation of women's groups for saving and credit, training on skill development, functional literacy including legal and social awareness, and technical and marketing support to projects undertaken with the loan money from the organization. A total of 13,549 children born alive during 1988-97 in the study area were included in the study. Hazards of mortality during pre- and post-intervention periods were compared among the programme participants and nonparticipants controlling the effects of other relevant variables. There has been a substantial reduction in mortality during the post-intervention period; however, the reduction was much greater for infants whose mothers participated in the development programme compared to infants of non-participant mothers from similar socioeconomic background. In a relative sense, there has been a 52% reduction of the pre-intervention level hazard of death of children during infancy of participant mothers compared to 31% reduction for the infants of non-participant mothers from similar socioeconomic background. There had also been a substantial reduction in hazard of death during childhood (1-4 year age group), however, the reduction was statistically similar for all groups of children irrespective of their mothers' participation in the development programmes. Keywords: Bangladesh; Women's development; Micro-credit; Mortality

This paper defines high-risk areas of cholera based on environmental risk factors of the disease in an endemic area of Bangladesh. The risk factors include proximity to surface water, high population density, and low educational status, which were identified in an earlier study by the authors. Cholera data were analyzed by spatially referenced extended household units for two time periods, 1983-1987 and 1992-1996. These periods were chosen because they had different dominant cholera agents. From 1983-1987 classical cholera was dominant and from 1992-1996 El Tor was dominant. By defining high-risk areas based on risk factors, this study builds a spatial risk model for cholera. The model is then evaluated based on the locations of observed cholera cases. The study also identifies the determinants of death due to cholera for the two different time periods dominated by the different cholera agents. The modeled risk areas that were based on the risk factors were found to correspond with actual distributions of cholera morbidity and mortality. The high-risk areas of the dominant cholera agents are relatively stable over time. However, from 1983-1987 El Tor cholera, which was not the dominant agent during that period, was not associated with high-risk areas, suggesting that the El Tor habitat may have changed over time. The case fatality rate for cholera was related to proximity to a diarrhea treatment hospital in the study area. Keywords: Cholera; Disease risk; Spatial analysis; Bangladesh

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. Keywords: Childbirth; Traditional birth attendants; Trained traditional birth attendants; Rural Bangladesh

An Interview with Zafrullah Chowdhury Dr. ZAFRULLAH CHOWDHURY is regarded as the father of Bangladesh's National Drug Policy, which pioneered an affordable health strategy based in part on the local [...]

The coordination of aid in countries that attract large sums of external resources from numerous donors remains a source of concern to recipient governments and the donor community. This concern [...]

Research in the rural town of Matlab in Bangladesh indicates that seasonal and geographic variations can influence outbreaks of cholera and noncholera diarrhea. While spatial distribution for cholera was found to be partly controlled by environmental factors such as water pollution, the transmission of noncholera diarrhea is controlled by nonenvironmental factors, such as introduction to a population through an infected person.

In efforts to reduce gender and socioeconomic disparities in the health of populations, the provision of medical services alone is clearly inadequate. While socioeconomic development is assumed important in rectifying gender and socioeconomic inequities in health care access, service use and ultimately, outcomes, empirical evidence of its impact is limited. Using cross-sectional data from the BRAC-ICDDR,B Joint Research Project in Matlab, Bangladesh, this paper examines the impact of membership in BRAC's integrated Rural Development Programme (RDP) on gender equity and health-seeking behaviour. Differences in health care seeking are explored by comparing a sample of households who are BRAC members with a sample of BRAC-eligible non-members. Individuals from the BRAC member group report significantly less morbidity (15-day recall) than those from the non-member group, although no gender differences in the prevalence of self-reported morbidity are apparent in either group. Sick individuals from BRAC member households tend to seek care less frequently than non-members. When treatment is sought, BRAC members rely to a greater extent on home remedies, traditional care, and unqualified allopaths than non-member households. While reported treatment seeking from qualified allopaths is more prevalent in the BRAC group, non-members use the para-professional services of community health care workers almost twice as frequently. In both BRAC member and non-member groups, women suffering illness report seeking care significantly less often than men. The policy and programmatic implications of between group and gender differences in care seeking are discussed with reference to the literature.

Case studies of the relationship between kala-azar and diarrheal disease to a flood control project in Bangladesh are presented. Results indicate higher disease risk in flood-protected areas.

A study was conducted to determine whether the addition of vitamin A alone or in combination with zinc has any appreciable effect on standard iron treatment for iron deficiency anemia. Three groups of women subjects from the north-western part of Bangladesh in the urban slums of Dinajpur district were administered with three different treatments and the results were compared. The study found that subjects who were given vitamin A and zinc in addition to iron have higher increases in hemoglobin levels than subjects who were given iron alone.

Qualitative and quantitative data are used to explore postpartum contraceptive use in two populations in Bangladesh. Findings from in-depth interviews with contraceptive users illustrate that women are primarily concerned with their own and their newborn child's health and well-being in the period following childbirth. In addition, women are aware of a diminished risk of pregnancy during the period of postpartum amenorrhea. These perceptions, plus a belief that modern methods of contraception are 'strong' and potentially damaging to health, mean that the majority of women are reluctant to adopt family planning methods soon after birth, despite a desire to avoid closely spaced pregnancies. Supplementation of the child's diet is also shown to be an important factor determining the timing of postpartum contraceptive initiation. The findings suggest that current policies promoting contraception to women in the immediate postpartum period are inappropriate for many Bangladeshi women., Despite the call more than 15 years ago for a 'user perspective' in family planning programs (Zeidenstein, 1980; Bruce, 1980), little is known about clients' beliefs, attitudes, or preferences relating [...]

To the Editor: Cholera, caused by Vibrio cholerae, continues to affect millions of persons in disease-endemic areas where safe drinking water is scarce and sanitation is poor. Of 7 cholera [...]

The Preceding Birth Technique (PBT) can be used to estimate mortality among children aged under three in Bangladesh, but long intervals between births make it less effective for estimating mortality in children aged under two. However, this technique can still give valuable information about under-three mortality trends. Reliable ongoing measures of recent childhood mortality can be obtained from information about the survival of preceding children gained from pregnant mothers who attend antenatal clinics and from mothers with index children who attend vaccination centres.

A growing number of non-governmental organizations (NGOs) are adopting the collateral-free credit programs by anchoring them with their social development programs aimed at improved program effectiveness and sustainability. Drawing upon a sample of 3,564 targeted poor households covered by five small NGOS in rural Bangladesh, this study finds that the NGO credit-members as well as those who reside in the NGO program area are higher adopters of child immunization than those in the non-program area. Similarly, the study found that infant and child mortality is lower among the NGO credit members than among the non-members and that under five-year deaths of children progressively decline with the increase in the doses of vaccines. Implications of these findings are discussed in the study. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com]

To the Editor: Highly pathogenic avian influenza (HPAI) A(H5N1) virus is a deadly zoonotic pathogen. Since 2003, HPAI infections have been reported in millions of poultry and wild birds from [...]

Anaemic adolescent schoolgirls of urban Bangladesh have lower serum retinol content, packed cell volume, serum iron than those with normal haemoglobin levels. The anaemic girls also have a higher serum total iron binding capacity and lower transferrin saturation. This shows a significant relation between the retinol content and the serum iron and haemoglobin content. Higher vitamin A levels are associated with higher levels of iron in the blood.

In 1978, the Bangladesh family planning program launched a national program of outreach services that continues to the present. Young married women were hired and trained to visit women in their homes, offer contraceptive services, provide information, and support sustained use over time. This report uses data from two rural districts to assess the effect of the household visitation program on the continuity of contraceptive use. Results of a multivariate analysis show that household outreach has had a pronounced net effect on the continuity of contraceptive use throughout the study period and that the magnitude of this effect has increased with time. This finding suggests that sustained contraceptive use continues to benefit from home-based outreach even after a decade of service encounters. Policy implications of this finding are discussed. (STUDIES IN FAMILY PLANNING 1996; 27,2: 98-106), Until recently, debate about the demographic role of the Bangladesh family planning program was focused on the question of whether program services could work in that setting, given the economic [...]

This article is based on the ten-year experience of an operations research project in Bangladesh. It assesses how, and under what circumstances, research-based advice and results of pilot projects contribute to change in large-scale public programs. It discusses project research on issues facing the national family planning program: recruitment and training of field-workers; delivery of injectable contraceptives; management information; field-workers' use of service registers;field supervision; satellite clinics; and contraceptive user fees. These issues are used to illustrate the advantages and disadvantages of a long-term institutionalized project, and to describe the diversity of means for communication with policymakers. The analysis shows that research, policy decision, and implementation can occur in any sequence. Policy advice that disrupts long-standing power relationships and organizational culture takes a great deal of effort to implement. Operations research can produce useful changes in organizational behavior, even when large-scale problems remain. (STUDIES IN FAMILY PLANNING 1996; 27,2: 76-87), The project described in this article, the Maternal and Child Health-Family Planning (MCH-FP) Extension Project in Bangladesh (1983-93), represents a model that is relatively uncommon: a program of applied research [...]

This study reports the results of a test of validation of the sisterhood method of measuring the level of maternal mortality using data from a Demographic Surveillance System (DSS) operating since 1966 in Matlab, Bangladesh. The records of maternal deaths that occurred during 1976-90 in the Matlab DSS area were used. One of the deceased woman's surviving brothers or sisters, aged 15 or older and born to the same mother, was asked if the deceased sister had died of maternity-related causes. Of the 384 maternal deaths for which siblings were interviewed, 305 deaths were correctly reported, 16 deaths were underreported, and the remaining 63 were misreported as nonmaternal deaths. Information on maternity-related deaths obtained in a sisterhood survey conducted in the Matlab DSS area was compared with the information recorded in the DSS. Results suggest that in places similar to Matlab, the sisterhood method can be used to provide an indication of the level of maternal mortality if no other data exist, though the method will produce negative bias in maternal mortality estimates. (STUDIES IN FAMILY PLANNING 1995; 26,2: 101-106), Maternal health and mortality, vitally important issues, are overshadowed by other health problems in developing countries, chiefly infant and child mortality (Stoke, 1991). Today the levels of maternal mortality in [...]

A survey was conducted on 131 mothers in rural Bangladesh to examine knowledge and perceptions of helminth infection in relation to use of health facilities and treatment-seeking behaviour. Almost all respondents considered worms to be a cause of bad health and a high percentage of mothers had obtained deworming treatment for their children. However, marked differences were found in mothers' descriptions of the causes and prevention of helminth infection in two adjacent areas; Pullakandi and Shekpara. The discrepancies in biomedical knowledge corresponded with differences in treatment-seeking behaviour in the two areas. All households in the area had access to free deworming treatment provided by a health clinic, but this facility was predominantly used by women living nearby in Pullakandi. Because of the cultural and social constraints on female activities, women living further from the clinic, in Shekpara, preferred to send their husbands to a pharmacy in the nearby town to buy deworming treatment. As a consequence, these households were at a relative disadvantage in respect of the low exposure of women to health education and the greater financial cost of deworming treatment. The study highlights the influences of social and cultural factors on treatment-seeking behaviour, which in turn affect women's exposure to health education and biomedical knowledge of helminths. Further questions are raised, however, on the ability of women to implement preventive measures and the impact of health education on rates of parasitic infection. Key words - helminths, deworming, behaviour, perceptions

A study of maternal nutritional status in Bangladesh revealed the importance of improving the nutritional status of girls to enhance child survival in future generation. A proposed interim measure provides antenatal and obstetric services for mothers shorter than 145 centimeters. Shorter mothers face a greater risk of child loss due to intergenerational effects of poor childhood nutrition on females.

This study in rural lowland Bangladesh used spot and event observations from 185 children aged 4-27 months in order to examine whether child feeding practices differed with mother's education and with household education. Each child and his/her caretakers were observed for a mean of 20 hr over 6 months from February to July 1986. Only 25% of mothers and 51% of fathers had any formal education. Exploratory partial correlations and stepwise multiple regression analyses revealed significant behavioral differences with both maternal and household measures of education while controlling for wealth. Caretakers in families with education were found to feed the children more frequently, with fresher food, and in cleaner, more protected places. They did not allow their children to eat food intended for someone else as often, and were more observant when their children's food dropped during the feeding. These caretakers also used more cups and bottles for feedings, breastfed their children less frequently, and their mothers terminated the breastfeedings more often. These behaviors suggested a shift from less attentive feeding practices and less frequent feedings to more frequent feedings in which the caretaker took more control of the child's feeding sessions. They also suggest a commitment to more labor-intensive child care. These associations between education and child feeding practices are mechanisms through which maternal education may improve child health and growth. They suggest the need for promoting more formal and nonformal education.

Objectives. Tetanus continues to be a leading cause of neonatal death in Bangladesh as in other developing countries, yet little is known about risk factors or the efficacy of tetanus toxoid in this setting. Methods. In May 1990, mothers of 6148 infants born alive between March 15, 1989, and March 14, 1990, in 30 rural unions of Rajshahi Division in Bangladesh were interviewed. Three surviving controls for each neonatal tetanus death were matched for sex, residence, and date of birth. Results. Of 330 neonatal deaths, 112 met the case definition for tetanus. Risk was increased with a history of neonatal tetanus in a previous child, application of coconut oil to the vagina, and use of multiple ties on the umbilical cord. Risk was reduced by the birth attendant washing hands and using a cleaned cord-cutting tool. Risk was not reduced by a maternal history of two doses of tetanus toxoid (TT2), although estimated efficacy of TT2 was 45% (95% confidence interval = 16% to 64%). Subsequent to the survey, a reference laboratory reported no potency in three consecutive lots of tetanus vaccine from the production laboratory in Bangladesh. Conclusions. These findings identify high-risk mothers, stress the importance of washing hands and cleaning the cord-cutting tool, and demand improved quality control of tetanus vaccine production. (Am J Public Health. 1992;82:1365-1369)

In this paper, the health seeking behavior of parents in a rural area of Bangladesh who were unsuccessful in their attempt to save their child's life is dealt with. With use of univariate and multivariate techniques, the role of some selected socioeconomic, demographic, cultural, and spatial factors on the utilization of qualified doctors of modern medicine is examined. The analysis of data indicates that demographic, cultural, and spatial factors have stronger effects on the health search behavior of the parents than the socioeconomic conditions of the parents. The parents' preference for boys emerges as the strongest factors followed by distance to qualified doctors and parity. Implications of the findings are also discussed.

The effect of vitamin A therapy on the severity and duration of acute episodes of non-cholera, watery diarrhea was studied in clinical trials conducted on 83 children afflicted by diarrhea. It was shown that the administration of vitamin A has no effect on the nutritional status and severity of the diarrhea and can thus be given safely to augment hepatic reserves during diarrheal illness.

Acute lower respiratory tract infections (ALRIs) are a major cause of death among young children in developing countries. A targeted programme designed to treat children with ALRI was implemented in 1988 in a primary health care project in rural Bangladesh. In the 2 years preceding the introduction of the programme (1986-87), non-ALRI-specific health services were provided, including promotion of oral rehydration therapy, family planning, immunization of children and mothers, distribution of vitamin A, referral of severely sick children to field clinics, and nutritional rehabilitation of malnourished children. The targeted ALRI programme, which was in place in 1988-89, was based on systematic ALRI case detection and management by community health workers, who were linked to a referral system for medical support. These two levels of intervention have been evaluated by comparing the ALRI-specific mortality in the programme area and a neighbouring control area during the two periods. During the first phase (1986-87), the ALRI mortality among under-5-year-olds was 28% lower in the intervention than in the comparison area (P < 0.01). During the second phase (1988-89), the ALRI mortality was 32% lower in the intervention area than during the preceding phase, while there was no significant difference for the comparison area. These findings suggest that in the study region the combination of specific and nonspecific interventions can reduce ALRI mortality by as much as 50% and the overall mortality among under-5-year-olds by as much as 30%.

The use of sugar-based oral rehydration therapy (ORT) for the treatment of diarrhea is encouraged in developing countries. In Bangladesh, one of the instructional programs reached more than 13 million parents in the proper techniques for the preparation of an ORT, a mixture of sugar and salts called lobon-gur solution (LGS). These homemade preparations, however, were actually used in only 20 percent of the diarrhea cases. More rice than sugar is available in rural homes, and a rice gruel is frequently used as a nourishment during illness. The acceptability and utilization of various rice- and sugar-based ORT preparations were examined in a rural Bangladesh district with a population of 68,345. This area had not yet been reached in the ORT training programs. An effective method was developed for the preparation of rice-salt oral rehydration products (RSORT). This product lent itself readily to teaching, acceptance and preparation. The mothers agreed that the rice-based oral rehydration products were more effective in the rapid treatment of diarrhea, but they continued to use the sugar preparations more frequently because they were more easily prepared. (Consumer Summary produced by Reliance Medical Information, Inc.), Introduction The Bangladesh Rural Advancement Committee (BRAC) has a programme for promoting the use of table salt (lobon), unrefined brown sugar (gur), and water or lobon-gur solution (LGS) for the [...]

Using empirical data collected from a rural area of Bangladesh, this paper examines the relative importance of availability of health care resources on infant death. Following many health care studies, this paper hypothesizes that the likelihood of infant death is a function of accessibility to different types of health facilities and personnel. Both univariate and multivariate analyses of data indicate that the distance to a qualified physician of Western medicine exerts significant influence on infant deaths. Other variables considered are distance to Upazila Health Complex (UHC), Family Welfare Center (FWC), and non-qualified doctors.