INFORME DE DIAGNÓSTICO DEL SECTOR DE ALIMENTOS Y BEBIDAS

In order to establish and sustain this study among the women and infants in an illiterate and destitute community, it was crucial to build up a good rapport including the provision of appropriate health care facilities. This is why 1, as the team leader of the project, involved the local community leaders, teachers, and the local health complex staffs as motivators.

Establishing good personal lines of communication helped to alleviate a second problem, the tedium associated with the lengthy initial interview that lasted for up to three hours for each household. Also I discovered that women in the household seemed to feel more comfortable answering the personal questions when interviewed privately. So most of the time the Project Physician interviewed the women in the privacy of their bedrooms.

It was quite difficult to obtain certain kind of information from the women, especially about their previous reproductive losses e.g., many women would not like to talk about the induced abortions. A few of them even refused to talk about their obstetric histories. Some women found it difficult to remember what happened over the past decade or a longer period.

Therefore, these questions were asked again with their consent to some other adult females in the household (e.g. mother-in-law, sister-in-law, mother, and sister) or even a neighbour.

Underestimation and overestimation of the respondents were thus overcome by cross checking. I found that when interviewing the pregnant women, the presence of another female peer group member was helpful to improve data accuracy as peers often made corrections.

We also provided outreach antenatal and postnatal care to the pregnant women in this community which included provision of safe delivery kits for traditional birth attendants (TBAs); health education and advice on contraceptives and family planning, breast-feeding, cord care, screening of all the pregnant women for high risk pregnancies, and free medical services for common ailments and accidents.

Any acutely ill case was referred to the local hospital by a local-made pedal van ambulance. But in case of emergencies a motor vehicle was used.

Although the FRAs visited the pregnant women daily to check any complications including pallor, jaundice, and oedema, they found it difficult to do so without a supply of medicine.

Therefore we trained the FRAs in the recognition of the common ailments including checking for pallor, cyanosis, oedema, jaundice, glycosuria, and proteinuria.

The FRAs carried with them some analgesics, antipyretics, antihistamines, benzyl benzoate lotion, W hitfield’s ointment, and anthelmintics for non-pregnant members in the family and multivitamin (B-complex) and iron and folic acid tablets for the pregnant women and their elderly relatives and their immediate neighbours.

In addition along with the Project Physician, I provided a clinical diagnosis and treatment service for the women and their children. This earned the confidence of the villagers in the project activities.

It was culturally acceptable for a woman with several children to use sterile plastic container for collecting the casual urine sample. But for the newly married young women, it was culturally difficult, especially in the presence of the male in-laws which were very difficult to avoid.

As found elsewhere in Bangladesh (Aziz et al., 1994), the blood was considered a highly valuable item as people have seen on the television that blood can be collected for transfusion and often sold by some of the professional donors.

Initially many people believed that the project was selling the collected blood in the hospitals and clinics in Dhaka. Even the finger prick blood collection from the infants created concern among many individuals as the prevailing belief was that there is a fixed amount of the blood in the body and even the loss of a single drop would result in a permanent loss of their strength and vigour.

We tried to explain that everyday a portion of blood is renewed with the destruction of another, and that during the menstrual period there is a much more blood loss. However, a few women argued that the menstrual blood was bad blood and the blood being collected was fresh and good for their health and vigour.

There were beliefs that at least 80 morsels of rice have to be eaten to make every single drop of blood. Some were scared of the needles to be pricked for the blood collection.

Initially, there was some non-compliance with 20 drop outs. Later with the provision of a good medical service previously unknown in the community, the compliance and persistence was almost complete.

When the project started, there were rumours that the project workers were taking away bottles of blood to sell in the markets of Dhaka for a lot of money. To some people it was almost confirmed by the evidence that the project workers who started to work in cycle rickshaws subsequently used a motor car although for the project workers it was sometimes essential with the increase in the workload.

Initially, as the project workers approached a household for recruitment, the women sometimes fled to their vegetable garden, as they were scared about the prick of the Vacutainer needles. Fortunately the older women and the sisters and the sister- in-laws who had previous experience of the tetanus toxoid (XT) injections convinced our subjects to participate.

Although the EPI programme was active in the area many of the women in the locality were reluctant to take a shot of TT, as they were scared of the needles.

However, the skilful venesection using the Vacutainer system blood collection ensured that the women felt very little pain. Some of them were reassured and accepted the TT. But some complained that the TT was painful whereas the Vacutainer system was not.

During the establishment of the project, the local health workers reported very high mortality rates, especially from neonatal tetanus. Puerperal infection and cord sepsis was also reported to be common.

A simple, cheap, and safe delivery kit comprising of a sterile surgical blade, a piece of soap, sterile surgical silk, and sterile cotton in a small, sealed polythene packet was introduced. The kit was made with all the locally available materials.

The TBAs and the elderly women in the community were trained in the safe use of the delivery kit. They were encouraged to continue with their good traditional practices. However, they were encouraged to give up the harmful traditional practices such as the application of very tight rope knots over the abdomen and vigorous massaging of the abdomen (sometimes even standing on the abdomen!), when there is a slight delay in the expulsion of the placenta and also the use of cow dung, application of blue dye, or even dew drops from the grass as a dressing for the cord care.