A Healthier Future for Bangladesh

Child mortality is a major issue for developing countries where children often die of easily preventable diseases such as diarrhoea, pneumonia, malnutrition and measles. In Bangladesh the mortality rate for children under five is 7.7% or 77 deaths per every 1000 live births (UN 2006). This is in direct contrast to Australia whose mortality rate for children under five is 0.6% (or 6 deaths per every 1000 live births).

The burden of child mortality is primarily held by the poor, with the poorest 20% of the population having an under-five child mortality rate almost double that of the richest 20%. The poor are less likely to have access to quality and affordable care and are often lacking knowledge about preventing and treating childhood illness.

ICDDR,B, the International Centre for Diarrhoeal Disease Research, Bangladesh - better known locally as the Cholera Hospital - is an international health research institution located in Dhaka, the capital of Bangladesh. The mission of the centre is to develop and promote realistic solutions to the major health, population and nutrition problems facing the poor people of Bangladesh.

ICDDR,B has earned its reputation as a centre of excellence in the world for its scientific achievements in diarrhoeal diseases, nutrition, infectious diseases, population programmes and child survival strategies.

Erin Law has been volunteering as an Australian Youth Ambassador for Development in the Child Health Unit at ICDDR,B since October 2006. Specifically, the project Erin is engaged with addresses high under-five child mortality rates in Bangladesh through the Integrated Management of Childhood Illness (IMCI) strategy.

IMCI is a broad strategy designed by the World Health Organization (WHO) and UNICEF to reduce childhood mortality and morbidity and to contribute to improved growth and development of children under five years of age.

The strategy consists of three components adapted to the country’s specific health system needs and environment. The first component focuses on improvements in the case management skills of health service providers through education and training.

The second component of the strategy is to improve the health system by strengthening local and district level health planning and management. This ensures the availability of essential drugs, logistics and other supplies as well as providing quality and supportive supervision for local health officials and improving the referral and health information system.

The final component is to ensure improvements in family and community practice through education and access to information.

In 1998, the Government of Bangladesh adopted IMCI as a key child health strategy to reduce child mortality and to improve child health and development. The World Health Organisation had also chosen Bangladesh as one of the five countries to assess the effectiveness, cost and impact of IMCI.

To see the strategy in practice you need look no further than Matlab thana, a rural sub-district of Bangladesh, home to some 350,000 people. The population is typical of Bangladesh’s rural populations with poor access to quality health services and lack of education about how to prevent disease. The role of the IMCI team is not only to implement the generic IMCI strategy in Matlab but also to adapt and add to the strategy in a way that suits the communities’ needs.

The IMCI team has developed innovative ways to reach the community, providing messages about proper child care and encouraging mothers and care-takers to seek care for their sick children at the newly improved government health facilities. Community theatre using local actors is used to provide messages about care during pregnancy and childbirth. The IMCI team have also met with community leaders including local members of parliament, teachers and religious leaders to gain support for the strategy and its initiatives and worked with local Imams (Muslim religious leaders) to deliver health messages during Friday sermons.

“The key is to communicate ideas clearly in a way that is recognisable and easy to understand”, says Erin, “using community theatre is an entertaining way to get the information across and makes sure that the message is accessible to those without formal education and involving community leaders ensures that there is community ownership of the project.”

The IMCI team recognised that people in the community were often using village doctors (local untrained health practitioners) for primary health care. These doctors were widely accessible within communities but had been shown to engage in harmful and sometimes life-threatening practices.

As part of the effort to improve quality of health care and accessibility to health services the IMCI team trained village doctors encouraging them to stop harmful practices and refer children who were severely ill to the IMCI health facilities.

To improve health care accessibility a new cadre of health professional was introduced, the Village Health Worker. Village Health Workers are female members of the community trained to provide basic curative and preventative care to under-five children in the community in which they live. They conduct door to door visits monitoring the health of children under-five and pregnant mothers as well as providing counselling on healthy caring practices to mothers and care-takers. The Village Health Workers have been one of the most successful interventions in the community and are expected to have a major impact in reducing child mortality.

One Village Health Worker, Fatema, tells how she recently diagnosed a little boy, 18 month old Shohan, with severe pneumonia and malnourishment. Fatema, who is a member of Shohan’s community, knew he had little chance if his nutrition status did not improve. Relying on her training from the IMCI team, Fatema first worked with Shohan’s mother to train her in better nutrition and basic health care for her son and when his health did not improve she was able to refer him to the local government health facility where IMCI trained paramedics could assess him and find him a place in the local district hospital (a hospital also run by ICDDR,B). Without Fatema’s attention to details and the excellent referral linkages that have been set up by the IMCI team it is unlikely that Shohan would still be alive today.

“We’re hearing so many good news stories from the villages about how effective our newly trained Village Health Workers are. Because they are working with mothers and children within their own community they are able to ensure better care and improved understanding of child health issues.”

Erin works with her counterparts in the IMCI team to examine what kind of impact these interventions are having and how they can be improved. Working with the IMCI team, Erin has been amazed to see the huge impact of simple and effectively planned interventions that work with communities on child health. Currently completing her Masters in International Health, Erin is happy to see research put into action.

“I’m always reading studies showing that when you work with communities you can have a huge impact on their health. Now I can see on the ground level how this research is being put into action and witness first hand how research can impact people’s lives”.
Erin is always happy to get out of the bustling streets of Dhaka and go and visit the project site in Matlab, “It’s fantastic to go out into villages and see smiling and healthy children and know that in some small way something you are working on may have contributed to that.”