The Role of Formative Research in Scaling Up Zinc in Bangladesh

Abstract

Presenter:Dr Lauren S. Blum; Medical Anthropologist, PHSD, ICDDR,B

Author: Lauren S. Blum and Nazneen Akhtar

Despite 30 years of efforts to improve diarrhea management, diarrhea continues to be a major killer of young children in Bangladesh.  This may relate to the fact that programmes have failed to give sufficient attention to perspectives and the actual situation of communities and families.  As part of the zinc scaling up efforts, formative research was conducted in an urban and rural site.  The research is designed to understand current beliefs and practices related to home management of diarrhea; to determine household decision making and careseeking behaviors linked to a variety of diarrhea illnesses; to examine perceptions of vitamins and minerals; to describe the local health system; and to identify treatment for diarrhea provided by a range of health providers.  Twenty-nine different diarrhea illnesses were identified in the research sites, each with different symptoms and perceived causes and appropriate treatment.  Causal explanations for diarrhea diseases are primarily associated with hot/cold belief theories, and many illnesses are also linked to evil spirits.  The first line of treatment involves home remedies connected to these belief systems.  While financial constraints delay careseeking outside the household, the perceived type of diarrhea illness guides the choice of health provider.  The results point to the complexity of beliefs associated with diarrhea illnesses and highlights the importance of involving multiple types of health practitioners in the distribution of zinc.  The study highlights the complex social processes that must be considered when developing programmatic strategies, demonstrating that interventions need to be devised to fit the local context.  This includes acknowledging differentials related to knowledge between the recipients, health care providers and the agents devising the program.  The information is being used to develop communication messages and tools that bridge the gap between the health care providers and community in regard to language, knowledge, and power dynamics when promoting zinc. 

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