2.1. Contrato de préstamo de mutuo
2.1.7 Cumplimiento del contrato de préstamo de mutuo
1. Socio-economic demography
Monthly income, housing, and drinking water supply: the prospective study was more representative of Bangladeshi population because the majority of them came from lower income and rural areas with a poor standard o f living in kancha or semipakka houses sharing a common bathroom, and kitchen with other families.
In the retrospective study one-third o f the population represented lower-income families, while the majority came from middle-income families and from the urban area. The reasons for this were:
1. these patients were identified from the first 1000 EEGs done at a privately run clinic (started for the first time in the country).
2. data were collected from a specialist centre, where patients are seen on an appointment basis on referral from other centres or private practitioners and therefore direct access for the poorest was often limited.
3. in BD, other than cost of travel cultural barriers also hinder the mothers from travelling independently to service centres (McConachie et al. 2001).
4. the service providers' negative behaviour and attitude acts as another barrier to the poorest in making use of hospital services as has been demonstrated in a very poor population adjacent to Dhaka Shishu Hospital (Khan 1998).
These barriers can be overcome by establishing more community-based links with the hospital services and with attitudinal changes of the service providers. This has been shown within the CDC which has utilized known epidemiological methodologies (Zaman, Khan, Islam, Banu, Dixit, Shrout, & Durkin 1990) to establish a door-to-door surveillance of impairments and disabilities within a community and by establishing a separate community service to provide outpatient services not only to neurologically impaired children, but also their siblings and neighbours. This has resulted in optimum utilization of services by this community (Khan et al. 1997; Khan 1998).
2. The rate of consanguinity
Consanguineous marriage was recorded in a lower proportion in the prospective (3.8%) compared to the retrospective (7.9%) study population. The rate found in the retrospective population was comparable with that found in one population based study (10%) in Bangladesh (Durkin, Khan, Davidson, Zaman, & Stain 1993). When compared with international studies, the rate o f consanguineous marriage is much less than in other regional countries such as in Pakistan (Durkin, Hasan, & Hasan 1998). The lower rate of consanguinity in the prospective group is most likely to be due to changing social and family attitudes; the fact that the younger generation is less
dependent on land and family properties, an increase in family diversity and the spread o f families to different regions of the country.
Consanguinity was found to be a high risk factor for cognitive disabilities in
Bangladesh (Durkin, Khan, Devidson, Huq, Rasul, & Zaman 2000). This feature also needs to be further studied to determine its effects on seizure prevalence, diagnosis, and outcomes.
3. Maternal age
The median maternal age during related pregnancy was 23 years, however, the minimum age was 14 years. Early marriage and early pregnancy is much reduced in last decade in BD but still occurs in the rural community.
4. Improvement in female literacy
Bangladesh had made a significant progress in female education and female
empowerment in last 15 years, which has directly influenced the family size (birth rate 2.6, UNICEF) and maternal literacy. Parents’ concern and demand for a higher quality of life for their children has increased compared with one decade ago. When the key care-providers of the children are mothers the basic literacy skills and education may have long-term implications for the child and family. In one study o f mothers with disabled children in BD Mobarak et al. have shown that more literate and educated mothers are better able to cope with stress (Mobarak et al. 2000). Non-literate and poor rural mothers of children with cerebral palsy were found to be at high risk (>35%) of psychiatric morbidity. Furthermore, when intervention o f developmental stimulation therapy was provided for these same children, after two years the mothers felt an increase in formal support (professionals) but none in informal support (family, closest neighbours etc.) (McConachie et al, 2001). Further study needs to be made to correlate family background, parental education and available resources and stress in the basic care-provider of children with epilepsy.
5. Educating the family about epilepsy and home management of seizures: parental knowledge measured before and after education (Section 6.10.2)
The majority of the family members had either no knowledge or a wrong idea about seizures and epilepsy and this was greatly changed to an appropriate knowledge level after an epilepsy education (Section 6.10.2, Table 6.2.2). Home management o f febrile and no-febrile seizures by per rectal diazepam was well conducted by many parents. The seizure record diary was also a successful introduction to this population. Initially, many parents would forget to bring the diary to each follow-up day, although they were able to keep the records irrespective o f the literacy rate. The majority of the parents (68%) were able to show their recorded diary more than 3 times during the follow up period. This information, however, is not enough on which to comment further. More systematically collected information is required, using a set of validated
questionnaires to gain knowledge of the existing attitudes and practices relating to epilepsy among the population.