Diarrhea and ARI in rural areas of Bangladesh.

In Bangladesh, one third of the total child death burden is due to diarrhea. Every year, a rural child suffers on average from 4.6 episodes of diarrhea, from which about 230,000 children die. In this study, information was collected from 8,287 children under five years of age and 7,082 caretakers in 120 clusters chosen by a two-stage random cluster sampling method. As compared to the baseline survey, carried out in 1996, children now are about 30% less likely to suffer from diarrhea, and the risk of dying has been reduced by 60%. Although the 2-weeks prevalence of acute respiratory infection (ARI) has risen from 39% (1996) to 46% and that of Acute Respiratory Infections needing assessment (ANA) from 12.4% to 16.9%, now more caretakers (59.9%) than in 1996 (56.7%) are able to identify correctly danger signs for seeking care and 58.4% (1996: 46.6%) of parents seek help when danger signs are present. Similar for diarrhea and ARI, village doctors and traditional healers are most frequently sought for help by caretakers; government health centers and hospitals are sought to a much lesser degree. Since 1996, intervention activities were implemented for four years in the study area using an IEC strategy. This strategy included raising awareness and training of health personnel, NGO personnel and village volunteers, especially women. Diarrhea issues were included in school health education with emphasis on practical exercises of diarrhea management. For all target groups (health personnel, village volunteers, NGOs, mothers and school children) specific education material was developed and deployed. In the political arena, women leaders who are part of the local government were included in an awareness-raising campaign. The results of the study undertaken over four years later show that in a relatively short time behavior of mostly poor and illiterate caretakers can be changed leading to a significant reduction of ARI mortality and diarrhea morbidity, and mortality in children.