A review of findings on the impact of health ontervention programmes in two rural areas of Bangladesh

Abstract

This paper provides an overview of major health problems in Bangladesh, with a detailed analyses of the findings of some selected intervention programmes currently being developed by the ICDDR,B in its two field stations at Matlab and Teknaf. One major health problem in Bangladesh is diarrhoeal disease, which accounts for about a third of all deaths. Given that present vaccines are only partially effective and that establishment, maintenance and supervision of a network of treatment centres would be beyond the immediate capacity of Bangladesh, a cost-effective approach to prevent deaths from diarrhoea may be a household programme introducing oral thearapy packets in homes. The findings of the ICDDR,B village-based and domiciliary oral thearapy distribution programmes have shown that not only will such an effort ensure wider service coverage, as evident from over 80% use rate (whoch could be still higher if there were no ICDDR,B treatment centres), but will also substantially reduce the case-fatality rate. A second priority health problem in Bangladesh is tetanus neonatorum, accounting for about 40% of all neonatal deaths. The findings of the Matlab maternal tetanus immunization of clearly demonstrated the impact on neonatal mortality of active immunization of pregnant women with two tetanus injections. However, given the present low acceptance rate by pregnant women (33%), the impact of such a programme on the overall neonatal mortality rate in the community may not be significant. In the rural Bangladesh setting, our recommendations from the Matlab experience would be vaccine campaigns backed up by immunization during pregnancy. Another important health problem in Bangladesh is high fertility. About one-third of all adult female deaths between the age of 15 and 44 years are maternity related. The results of the ICDDR,B maternal-child health and family planning programme suggest that substantial demand for family planning services exist provided such demand is satisfied witha full range of contraceptive methods to better meet the needs of individual women.