This study examined the impact of disability on the quality of life of disabled people in rural Bangladesh. A primary healthcare specialist conducted a door-to-door survey in two villages in Bangladesh to collect socioeconomic and demographic information on the villagers and for identification of disabled people. Information on disability and how it affected their life was also obtained either from the disabled people or from their caregivers by interviewing them. The study revealed that disability had a devastating effect on the quality of life of the disabled people with a particularly negative effect on their marriage, educational attainment, employment, and emotional state. Disability also jeopardized their personal, family and social life. More than half of the disabled people were looked at negatively by society. Disabled women and girl children suffered more from negative attitudes than their male counterparts, resulting in critical adverse effects on their psychological and social health. A combination of educational, economic and intensive rehabilitative measures should be implemented urgently to make them self-reliant. Collaborative communication between professionals and parents, behavioural counselling, formation of a self-help group, and comprehensive support to families will reduce their suffering.

In rural Bangladesh, mothers were interviewed to identify factors that determine the use of oral rehydration therapy (ORT) for management of diarrhoea in children aged less than 5 years. The point prevalence of diarrhoea among 1,600 children was 11.6%, with 46% having acute watery diarrhoea. The overall ORT-use rate was 29%; only 17% of the cases used it adequately. Common reasons for not using ORS included misperception about diarrhoea and age of patients. Other reasons included incorrect assessments, severity, and difficulties with the administration of oral rehydration solutions. Promotion of ORT can be effected by improving the level of understanding of mothers with regard to assessment of severity, early initiation of treatment regardless of age, sex, type of diarrhoea, breast-feeding, and nutrition status.

This study examines the health, nutritional status, and health care seeking behaviour of a community based sample of 122 postpartum women from an urban slum in Dhaka, Bangladesh. It describes a physically impoverished environment in which malnutrition is serious, and non-trivial morbid episodes as a consequence of childbirth are very common. Malnutrition was found to be widespread: about one-quarter of the study mothers were short in stature, measuring 145cm or less in height; over two-thirds of the women weighed <45 kg; and a similar proportion had a BMI of <20. Based on mid-upper arm circumference, an overwhelming majority (96%) suffered from some degree of malnutrition. During the first 6 weeks postpartum over three-quarters of the women reported a non-trivial illness. The frequency of reported illnesses was significantly associated with both increasing age and parity. Despite severe poverty, most of the women reporting illnesses (71%) received some form of health care from a wide range of western and traditional health care providers, with Traditional Birth Attendants (TBAs) and unqualified western care providers being the most frequently utilised. This study highlights the plight of these women in a precarious environment and shows how their health is compromised by cultural and political constraints. We conclude that while the burden of postpartum morbidity is very high, the incorporation of traditional practitioners and unqualified western care providers into maternal health training programs, together with efforts to empower women, could be effective in improving the health status of mothers in this marginalised and fragmented community. To achieve this outcome, a clearly articulated and integrated approach to development in slum communities is required.

This paper argues that a good question lies at the heart of the research process, and should possess four attributes: clarity, relevance, and be both worth answering and answerable. That is, it should lead to something that can be defined and measured.

BACKGROUND:Smoking is now recognized as a major public health problem in the developing world. Despite this, there is a dearth of relevant data on smoking prevalence and on the characteristics and attitudes of smokers: in particular, studies are lacking among teenagers and young adults, the group in which the habit frequently begins. The present study addresses this issue by examining the smoking patterns of a sample of teenagers in Dhaka, Bangladesh, during 1991.METHODS:The study investigated smoking behavior and attitudes among two groups of male teenagers: the first consisted of 555 students, age 12-20 years, selected from two metropolitan high schools; the second, chosen to provide a broad comparison group from a different socioeconomic stratum, contained 112 males of similar age residing in an urban slum. Data were collected largely by interview supplemented by some direct observation and relevant secondary data.RESULTS:The results showed that 29% of the students and 68% of the slum dwellers said they were regular smokers. In addition, the slum youths smoked substantially more and had smoked for longer than the students. While the study suggests both groups of smokers had been influenced to take up smoking by the smoking behavior of peers and parents, peers were more important for the students. Advertising may also have been a important influence on students since smokers in this group could better identify tobacco advertisements compared with their nonsmoking peers. No significant association was found between respondents' knowledge of the health risks of smoking and their actual smoking behavior.CONCLUSIONS:This study demonstrates that in Bangladesh, smoking is very common among middle-class male teenagers and even more prevalent among youths from nearby slums. Clearly, local and national programs that draw on relevant knowledge from other countries, but are appropriate to Bangladesh, need to be developed to tackle a major epidemic.

This study reports the findings of a survey undertaken in 1990/1991 in a poor and predominantly Malay-Muslim community in southern Thailand. The aims were to estimate the prevalence and type of childhood disability and to examine some of the ways in which this disability can be prevented and treated. The result showed that the overall prevalence rate of child disability was 1.2%. Most disabled children were suffering from limb impairment, followed by muteness, deafness, and mental retardation. Nearly half of the children had never been treated or assessed by a modern rehabilitation service, two-thirds would be expected to gain significant improvement from assessment and appropriate referral, and one-third of the disabilities could have been prevented using the application of modem technologies. Cost, inaccessibility and strong cultural beliefs explained the failure of the children's families to bring them to the service. The study indicates several ways in which disability could be better prevented, detected or treated in rural Thailand.

Data on the attendances of all patients at three general practices in Western Australia for two 6-month periods 11 months apart were collected as part of a previous study. The present study examined the stability of the attendance patterns of the patients over the two study periods in terms of number of patients, number of visits and diagnoses. The patients who attended in both study periods were classified into four attendance groups: low to low; low to high; high to low; and high to high. The age, sex and diagnoses for each were compared. The results showed that whilst the patient populations remained constant over the two periods, these populations were not comprised of the same patients. Only 45% of those who attended in the first 6 months also attended in the second. Similarly, whilst 8% of patients in each study period were classified as high attenders, only 22% of the high attenders in the first period were also high attenders in the second. The long-term high attenders were older and suffered from chronic diagnoses. The short-term high attenders were found to suffer from more self-limiting diseases and conditions such as depression and pregnancy.

If research is to be of any use the phenomena being studied must be clearly defined. Almost 30 years ago the difficulty of classifying primary care problems using the International Classification of Diseases (ICD-8) was demonstrated. This led to the development of the International Classification of Health Problems in Primary Care-2-Defined which is based on ICD-9. Despite the work that has gone into the development of ICHPPC-2-Defined, relatively little work has been undertaken to assess the validity and reliability of its use. This paper describes the results of such a study conducted as a preliminary to the use of ICHPPC-2-Defined in a study of consulting patterns in general practice. The participating general practitioners were trained in the use of ICHPPC-2-Defined and then coded problems which they identified in a set of clinical vignettes. Following the coding exercise, a review session was held in which difficulties and errors in the use of ICHPPC-2-Defined were discussed. Subsequently, the general practitioners were required to code two more sets of vignettes, which included some problems repeated from the preceding sets. Comparisons were then made of changes in the validity and reliability of coding from one round to the next. The results of the study suggest that the reliability and validity of morbidity data collected using ICHPPC-2-Defined can be increased by training sessions for the coders which focus on the main sources of error in the use of ICHPPC-2-Defined.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper reports a trial which assessed the clinical effectiveness of adding a behavioural self-management programme to the existing management of chronic headache by general practitioners (GPs). Eighty-seven chronic headache sufferers, referred to the study by 35 GPs, were randomly allocated to either a self-care group or a GP-control group. Headaches, drug usage, visits to health-care providers and time off work were self-monitored daily by all subjects for 4 weeks prior to intervention, for 4 weeks during intervention, and for 4 weeks immediately after intervention. Additionally, self-monitoring was carried out for two further 4-week periods, one at 6 months and one at 12 months post intervention. Headache records showed that the self-care program significantly enhanced GP management. This effect was well maintained. However, drug usage, visits to health-care providers and time off work did not differ significantly between the treatment and control groups. ‘No-show’ rates, defined as those referred by a GP but who did not attend, were high—largely due to time requirements of the self-care program. However, drop-out rates, defined as those who left the self-care groups were low. It was concluded that this behavioural self-management program was a clinically effective adjunct to general practice management of headache but its use is likely to be limited due to problems of patient enrollment.

Medical Journal of AustraliaVolume 146, Issue 10 p. 547-552 Personal Aside Errors — acceptable and non-acceptable† Peter Underwood MD, FRACGP, Peter Underwood MD, FRACGP Senior Lecturer Department of Community Practice, The University of Western Australia, Stirling Highway, Claremont, WA, 6010Search for more papers by this author Peter Underwood MD, FRACGP, Peter Underwood MD, FRACGP Senior Lecturer Department of Community Practice, The University of Western Australia, Stirling Highway, Claremont, WA, 6010Search for more papers by this author First published: 01 May 1987 https://doi.org/10.5694/j.1326-5377.1987.tb120398.x †Based on a paper that was delivered to the Conference on “Body, Self and Society” which was held by the West Australian Professional Association of Applied Anthropology and Sociology, Perth, Western Australia on May 29–30, 1986. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume146, Issue10May 1987Pages 547-552 RelatedInformation

This paper reports a study on the growth and feeding patterns of children from an isolated region of North Yemen. Marasmus was extremely common and was associated with poor infant feeding practices--particularly the widespread use of bottled milk--and frequent infections. Despite the appearance of a homogeneous traditional society, there were significant differences in the growth of children from adjacent areas. Children from a small township serving as the administrative centre of the region grew more poorly and had a higher mortality than those from the immediate rural hinterland. While poorer living conditions and more frequent infections may explain much of the worse growth and higher mortality of the township children, it is likely less adequate patterns of feeding, particularly greater use of artificial milk, also contribute significantly to the observed difference in growth. Despite the remote rural setting of the study, feeding patterns and growth may be influenced by a number of social factors associated with 'urbanisation'.

Despite a warm sunny climate, rickets is extremely common in children living in an isolated mountainous area of North Yemen. In a small township the overall prevalence amongst children under five years attending for vaccination was 27%. The condition was most common at the end of the first year and had disappeared by the fifth year. Marasmus was commonly associated with rickets. Children from the rural villages outside the township had significantly lower rates of rickets. Several factors may contribute to the very high rates of rickets in rural Yemen. However, lack of exposure to sunlight as a consequence of particular cultural practices is likely to be the most important. The major social and behavioural factors which restrict the young child access to sunlight are outlined, and possible remedies discussed.

The medical task itself needs to be examined and re-defined so that medicine can become but one of several social responses required to raise health status. Dominant now is a clockwork model which defines illness in terms of specific causes located inside the individual. In contrast, social medicine has been the poor relation, despite strong evidence that past and present mortality patterns are strongly influenced by key social factors. The major forces working for or against a social model of medicine are outlined. The paper concludes with a summary of some of the questions to which a resurgent social medicine might address itself.

In 1983 I received an unusual invitation to speak at a conference. The conference was the fourth annual conference of the Australian and New Zealand Association of Psychodramatists, Sociodramatists, Role Trainers, and Sociometrists. This group, whose work is based on the teachings of the American therapist Moreno, has exerted a lively influence on a growing group of Australian teachers, health professionals, and social workers, as well as therapists and even the odd administrator and doctor. (For those of you who are unaware of Moreno and psychodrama the essence of the method is the use of a dramatic setting in which participants move in and out of the roles of people in their lives: a sort of exalted role play.) The theme of the conference was The Journey. I was asked to talk about my own journey in medicine: the following talk resulted. The peculiar demands of the theme and the audience inspired an individual response; for this reason I have decided here not to change the original style. I hope that by leaving the piece as a talk you, the reader, will allow me to talk to you.