Search

Supplemental Material - A Rapid Ethnographic Assessment of Cultural and Social Perceptions and Practices About COVID-19 in Bangladesh: What the Policy Makers and Program Planners Should Know by Sadika Akhter, Farzana Bashar, Mohammed Kamruzzaman, Nabila Mahmood, Aminur Rahman, Iqbal Anwar, and Sarah Hawkes in Qualitative Health Research

We conducted a nonrandomized trial of strategies to promote soapy water for handwashing in rural Bangladesh and measured uptake. We enrolled households with children < 3 years for three progressively intensive study arms: promotion of soapy water (N = 120), soapy water promotion plus handwashing stations (N = 103), and soapy water promotion, stations plus detergent refills (N = 90); we also enrolled control households (N = 72). Our handwashing stations included tap-fitted buckets and soapy water bottles. Community promoters visited households and held community meetings to demonstrate soapy water preparation and promote handwashing at key times. Field workers measured uptake 4 months later. In-depth interviews and focus group discussions assessed factors associated with uptake. More households had soapy water at the handwashing place in progressively intensive arms: 18% (promotion), 60% (promotion plus station), and 71% (promotion, station with refills). Compared with the promotion-only arm, more households that received stations had soapy water at the primary handwashing station (44%, P ≤ 0.001; 71%, P < 0.001 with station plus detergent refill). Qualitative findings highlighted several dimensions that affected use: contextual (shared courtyard), psychosocial (perceived value), and technology dimensions (ease of use, convenience). Soapy water may increase habitual handwashing by addressing barriers of cost and availability of handwashing agents near water sources. Further research should inform optimal strategies to scale-up soapy water as a handwashing agent to study health impact.

Guideline of Key Informant Interview. (DOCX 12 kb)

Topic guide for in-depth interviews. (PDF 24 kb)

Guideline of IDI/FGD. Guideline of an In-Depth Interview/FGD with Female Worker. (DOCX 17 kb)

In the 1980s, Bangladesh entered the global market by establishing export-oriented industries, the largest of which was the ready-made garment (RMG) industry. This industry has recruited a mainly female workforce consisting of millions of poor women with little formal education. Coming from mainly rural areas, they are drawn to the cities to work in the RMG factories there. This group of women has normally assumed the traditional roles of stay-at home wife, mother or daughter, hence their engagement in paid work as migrant labourers presents a new challenge in the form of their having to fulfill ‘dual roles’. Combined with workplace health and safety issues associated with the RMG industry, this can have significant implications for their physical health and mental wellbeing. Yet, it was not until the 2013 Rana Plaza incident, which killed over a thousand workers, that the world’s attention focused on the issues of health and safety of female garment workers in Bangladesh. Although the RMG industry contributes significantly to Bangladesh’s economic development, helping to raise it to the status of lower-middle-income nation, the benefits to the nation have come at a considerable cost to these women, with consequences for their physical and mental wellbeing. Regrettably, these consequences have not been adequately investigated and little data is available to fully understand their health needs and working conditions. This research aims to fill this gap by offering a more in-depth exploration of the health and safety issues as they are experienced by the women in the RMG industry in Bangladesh. It will do so by focusing on understanding their work, including the tasks, work environment, and the treatment they receive at work. It will also present and discuss women’s voices about their experience at work, incorporating key stakeholders’ views and the researcher’s own observations, in order to examine the health and safety issues of these workers through a gender lens. Using qualitative research methods, the study was conducted in four factories in two industrial areas of Dhaka district during the eight months from December 2015 to July 2016. Data collection included a literature review, 20 in-depth interviews and four focus-group discussions with female garment workers, as well as worksite and household observations. Further, 14 key-informant interviews were conducted with officials from the Ministry of Labour and Employment, health-service providers within the garment factories, factory managers, and representatives of the Bangladesh Garment Manufacturers and Exporters Association. The data collected were analyzed using a framework analysis approach. The women reported that paid work creates an opportunity for them to earn their own income, and hence improve their families’ living standards and education. However, they also reported mental and physical health issues due to the stressful nature of the work (e.g., long work hours with few breaks and sitting in one position for long hours); and the work environment (e.g., heat and dust, noise, plus poor lighting and ventilation) They are also under constant threat of losing their jobs because of their ‘slow’ work habits and in more serious cases, separation from their children, pregnancy, the double burden of work and domestic expectations, as well as the threat of physical and verbal violence in the workplace. Factories provide health services through their clinics, but these lack the proper medical facilities required to manage work-related injuries and other health conditions, especially the workers’ mental health problems caused by stress and anxiety. Workers generally do not access these limited services. In particular, pregnant workers are less likely to do so, for fear that revealing their pregnancy to their supervisors will result in a loss of employment. Further, the workers cannot easily access government hospital services, due to their long work hours. Similarly, they are blocked from using private health services because of the high costs entailed. Their employers seem focused primarily on profit and on meeting quotas in a buyer-driven market, such that the health of workers appears to be a low priority. Furthermore, this study found that the government, despite its obligations under international conventions, lacks the resources and capacity to monitor working conditions or to ensure compliance with existing labour regulations. This study found that female workers participating in paid work in the RMG industry are vulnerable to significant short- and long-term physical and mental health problems. It concludes with three sets of recommendations to (a) address the health and safety of workers, (b) build the capacity of the government’s Occupational Health and Safety (OHS) system, and (c) enlist the support of global buyers in supporting proper OHS in the RMG industry. This is important not only for the government and the industry itself, but for the whole society to recognise the important role that the female garment workers play in the national economy. As such, this study takes the position that there is an urgent necessity to improve these women’s health and safety, not just for their own sake, but also for the sustainable development of the nation.

Publications abstracted during literature review. (DOC 136Â kb)

Publications reviewed in detail. (DOCX 16Â kb)

Final tool and sampling rubric. (DOCX 25Â kb)

Test-retest correlation results (n = 24). (DOCX 14Â kb)

In Bangladesh, postpartum hemorrhage (PPH) is the leading cause of maternal mortality accounting for 31% of all blood transfusions in the country. Although safe blood transfusion is one of the 8 signal functions of Comprehensive Emergency Obstetric Care (CEmOC) strategy, most of the designated public sector CEmOC facilities do not have on-site blood storage system. Emergent blood is mainly available from external blood banks. As a result, emergent patients are to rely on an unregulated network of brokers for blood which may raise question about blood safety. This study explored lived experiences of patients’ attendants, managers, providers, and blood brokers before and after the implementation of an on-line Blood Information and Management Application (BIMA) in regards to barriers and facilitators of blood transfusion for emergent patients.

To uncover the antioxidant and free radical scavenging activity, five different extracts of Terminalia arjuna bark were examined. In the present study, the free radical scavenging potential of five extracts of the bark of Terminalia arjuna was assessed by measuring its capability for scavenging 2, 2-diphenyl-1picrylhydrazyl (DPPH) radical, hydrogen peroxide radical, nitric oxide radicals (NO), as well as its ability in reducing power capacity assessment, cupric reducing antioxidant capacity, using appropriate assay systems compared to natural and synthetic antioxidants. Total antioxidant capacity, phenolic and flavonoid contents were determined spectrophotometrically. In DPPH free radical scavenging activity, the highest IC 50 value was showed by methanol extract with a value of 6.34 µg/ml followed by ethanol and petroleum ether having value of 7.76 and 25.63, respectively, as opposed to that of the scavenging effects of ascorbic acid and butylated hydroxytoluene (BHT) of 5.698 and 8.816, respectively. Methanol extract showed highest activity having IC 50 value of 14.436 and 25.184 µg/ml in hydrogen peroxide and nitric oxide scavenging assay, respectively. All the five fractions showed good reducing power and cupric reducing capacity with increasing concentration again taking methanol extract to the top position. The methanol extract yielded 817.488 ± 8.108 mg/g gallic acid equivalent phenolic content and 199.122 ± 8.282 mg/g Quercetin equivalent flavonoid content that was highest among five extracts. Methanol extract of T. arjuna was found to possess the highest total antioxidant capacity (415.925 ± 2.291) followed by ethanol (377.675 ± 1.889) mg/g Ascorbic Acid Equivalent, respectively. A linear correlation appeared between the total antioxidant capacity and the total phenolic contents of the extracts with good correlation coefficient (R 2 = 0.891). n-Hexane and chloroform extract showed least