Suchergebnisse

Abstract
Background
Rohingya women suffer from inaccessibility to sexual and reproductive health services in Myanmar. After the forcible displacement of the Rohingya from Myanmar to Bangladesh in 2017, pregnancy termination services have been increasingly important and desired, while knowledge gaps and obstacles to access services still exist. The role of community stakeholders is critical as gatekeepers and decision-makers to improve and strengthen pregnancy termination services for women in camps. However, there is paucity of evidence on their perspectives about pregnancy termination. This qualitative study aims to understand the perception and attitudes of Rohingya community stakeholders to pregnancy termination in the camps of Cox's Bazar.

Methods
We used purposive sampling to select 48 participants from the community stakeholders, 12 from each group: majhis (Rohingya leaders), imams (religious leaders), school teachers, and married men. We conducted in-depth interviews of all the participants between May-June 2022 and October-November 2022. Data were coded on Atlas.ti and analysed using a thematic content analysis approach.

Results
Multiple socio-cultural and religious factors, gendered norms and stigma associated with pregnancy termination acted as barriers to women seeking services for it. From a religious stance, there was greater acceptance of pregnancy termination in the earlier period than in the later period of pregnancy. We observed that pregnancy termination among community stakeholders in earlier stages of pregnancy than later. However, circumstances, such as a woman's marital status, whether she sought her husband's permission or her ability of childcare capacity, were often framed by community stakeholders as 'acceptable' for pregnancy termination. Health concerns and social and contextual factors can influence community stakeholders supporting pregnancy termination.

Conclusions
The community stakeholders perspectives on barriers and enablers of pregnancy termination were variable with the context. These perspectives may support or impede women's ability to choice to seek pregnancy termination services. To improve women's choice to pregnancy termination, it is critical to consider roles of community stakeholders in creating their supporting attitudes to women's choice and access, and to designing targeted culturally appropriate interventions with communities support and engagement.

ABSTRACT: The Alive & Thrive programme scaled up infant and young child feeding interventions in Bangladesh from 2010 to 2014. In all, 8.5 million mothers benefited. Approaches – including improved counselling by frontline health workers during home visits; community mobilization; mass media campaigns reaching mothers, fathers and opinion leaders; and policy advocacy – led to rapid and significant improvements in key practices related to breastfeeding and complementary feeding. (Evaluation results are forthcoming.) Intervention design was based on extensive formative research and behaviour change theory and principles and was tailored to the local context. The programme focused on small, achievable actions for key audience segments identified through rigorous testing. Promotion strategies took into account underlying behavioural determinants and reached a high per cent of the priority groups through repeated contacts. Community volunteers received monetary incentives for mothers in their areas who practised recommended behaviours. Programme monitoring, midterm surveys and additional small studies to answer questions led to ongoing adjustments. Scale‐up was achieved through streamlining of tools and strategies, government branding, phased expansion through BRAC – a local non‐governmental implementing partner with an extensive community‐based platform – and nationwide mainstreaming through multiple non‐governmental organization and government programmes. KEY MESSAGES: Well‐designed and well‐implemented large‐scale interventions that combine interpersonal counselling, community mobilization, advocacy, mass communication and strategic use of data have great potential to improve IYCF practices rapidly. Formative research and ongoing studies are essential to tailor strategies to the local context and to the perspectives of mothers, family members, influential community members and policymakers. Continued use of data to adjust programme elements is also central to the process. Scale‐up can be facilitated through ...

OBJECTIVES: We aimed to compare the effect of a comprehensive intervention package focusing on the animal-source protein (egg and milk)-based snack in conjunction with feeding counseling, water sanitation and hygiene, and supplementation with multiple micronutrient powder on linear growth and development of 6‒12-month old children in rural Bangladesh. Primary and secondary outcomes were differences in length-for-age Z score and cognitive development. METHODS: A community-based cluster randomized controlled longitudinal trial included 412 mother-infant pairs from 13 unions (small-administrative-unit) of Harirampur sub-district, allocating to receive treatment (n = 206) or regular health messages (n = 206) as control. The treatment group received monthly food vouchers (30 eggs, 12 L milk, 500 g semolina, 500 mL oil, 500 g sugar) to prepare nutritious children's snacks, micronutrient powder, child feeding and handwashing counseling for 12 months. The Control group received routine health messages from the government. Anthropometry, feeding and morbidity data were collected at baseline, monthly and endpoint. Children's development was assessed only once at an endpoint using Extended Ages and Stages Questionnaire (EASQ), Bayley III and Wolke's behavior rating scales. We used generalized linear regression modelling to conduct intention to treat analysis. RESULTS: Children's mean weight and length were similar between groups at baseline. At endpoint, compared to the control, treatment children had higher mean length (83.52 and 80.89 cm; difference: 2.62, P < 0.001); higher LAZ score (β: 0.38, CI: 0.24, 0.51); 61% lower rate of stunting (IRR: 0.39, CI: 0.22, 0.67); higher cognitive (β: 4.01, CI: 2.08, 5.94), language (β: 2.94, CI: 0.94, 4.94) and motor (β: 4.53, CI: 1.87, 7.20) scores, all being statistically significant. The intervention also improved developmental EASQ outcomes of the treatment children (gross and fine motor, problem-solving, and socio-emotional scores). CONCLUSIONS: A comprehensive intervention ...