Research

Objectives

To develop and participate in high quality ethical research that seeks to address rural health problems in Bangladesh.

The scope of the program includes clinical (hospital and community), epidemiological, economic and systems research.

We also aim to:

• Provide resources and support tools for other parts of LAMB to participate in research and to disseminate research results.
• Improve LAMB’s ability to do research by developing a pool of staff with a variety of research skills.
• Develop systems to monitor ongoing research at LAMB.
• Ensure that research at LAMB is done in a way that respects subjects.

Recent and Current International Collaborative Research

Infant and Young Child Feeding

MIS-R started a 2-year project at the beginning of 2011 to improve feeding practices in children less than two years of age. The work at LAMB is part of a bigger project in Bangladesh, organized by Alive and Thrive (A&T); funded by the Bill and Melinda Gates Foundation.

Project Goal:

To improve the scalability of Alive and Thrive (A&T) infant and young child feeding (IYCF) activities through testing the outcomes/ impact of activities modified to improve scalability of the program with that of current standard program components in the context of the maternal child health program of LAMB in target unions of Rangpur, Nilphamari and Dinajpur Districts and developing a sentinel surveillance system to monitor the uptake of nutritional messages from various media and interpersonal sources.

Project Objectives:

1. To develop a package of IYCF activities with improved scalability and equal or better results compared to current standard activities
2. To document the coverage of media campaigns and face to face education for improving IYCF practices on a large scale
3. Provide recommendations for scale up of effective and feasible nutrition interventions for IYCF through government and NGO channels

Project Activities: The partnership with LAMB will focus on three activities which have the potential to improve the scalability of IYCF interventions.

1. Sentinel Surveillance on uptake of media messages on Infant and Young Child Feedings to determine if and how TV and radio reinforce and expand IYCF awareness and improved practices,
2. Evaluate the effectiveness of three days training on IYCF for community volunteers and health workers compared to the standard six day training module, and
3. Evaluate the effectiveness of four follow up visits (< 1 year of age) compared to 8 follow up visits (up to 2 years) by volunteers on mothers’ ability to feed her child according to the recommended IYCF feeding practices.  An assessment of the effect of different types of incentives on volunteers’ performance (number of visits/ child and mothers’ feedback) will be folded into this assessment.

This is 2 years project and funded by the Bill and Melinda Gates Foundation.

Nutrition Supplement:

A partnership began in November 2009 with University of California (Davis) and ICDDR,B. A five year Community trial evaluating the effect of nutritional supplementation in women and children will be carried out in 10 LAMB (and LAMB/ PLAN partnership) community target unions. Phase 1 field work (looking mainly at acceptability of different flavors of lipid based nutritional supplements) took place in December 2009.  Phase 2, the program effectiveness trial started in 2010.

Program Title: Home-fortification approaches for the prevention of malnutrition in pregnant and lactating women and their children in Bangladesh: Program efficacy study.

Project Goal: 

1. Nutritional supplement Lipid-based nutrient supplement (LNS)
2. Vitamins & minerals included.
3. Micronutrient powder (just vitamins & minerals) “sprinkles”
4. Context of under nutrition in Bangladesh 

Project Objectives:  

1. Formative research & acceptability testing
2. Program efficacy study effect of LNS in programmatic context for improving nutrition
3. Cost-effectiveness
4. Willingness-to-pay
5. Process evaluation of intervention

This is a 5-year project and funded by University of California (Davis)

Virtue and dilemma

Virtues in Conflict: A Cross-Cultural Study of Virtue Dilemmas and Their Resolution. This study helps us understand what people in different cultural settings think are the characteristics and behaviors of a good person. This study is conducting a study of how people make decisions to do things for themselves and for others.

Project Goal:  How do people make decisions to share resources when the best path is not straightforward? Virtue Dilemma—a situation where one is confronted with competing predispositions to be good. 

Project Activity:  This study was done in community non-target area and groups will be chosen so that members ideally help each other and cooperate on a regular basis. Total 52 people were selected and interviewed about hypothetical stories and behavioral study involving allocation of real money (to self, to someone in group, to someone outside of group). Data collection has finished in May 2011.

This study is funded by School of Human Evolution & Social Change, Arizona State University and this is a 1 year project.

Social Closeness, Helping and Neglect

This study is subtitles: ‘Examining the Roots of Favoritism in Rural Bangladesh’.  It is a follow-up to the above study of virtues in partnership with Arizona State University.

The 5-year study will examine religious and economic influences on people’s willingness to help and to cooperate with others that are outside their immediate social circle (e.g., bari, para, gram, rokto shomporko).  The study will focus on four para stratified by religion (2 predominantly Muslim and 2 predominantly Hindu) and by material wealth (2 relatively wealthy and 2 relatively poor).  In the first year, a demographic survey of adults will provide a sampling frame for later years, and 40 open-ended interviews stratified on gender and para will examine how people in each community help each other and cooperate with each other.  In the second year, a social network survey will identify important relationships among adults in each para.  In years 3-5, surveys, interviews and behavioral activities with randomly selected adults from the four paras will assess how people choose to help and to cooperate with people based on their group membership and social closeness.

The project will identify why certain people are more willing to cooperate outside their community and their immediate family.  Some common issues at LAMB that this could address are how to promote community support for SDUs outside of one’s immediate para, how to promote blood donations, and how to promote community activities that benefit from larger-scale cooperation (e.g. common community wells).

Prolonged Labor/ Birth Asphyxia

Information gathered from women and their caregivers was used to develop interventions, such as a pictorial partogram and labor timing tool. The value of these tools to help women and their families make timely decisions regarding care for and referral of mothers and babies was assessed (2007-2010).

Program Title: Improving recognition of and initial response to prolonged/ obstructed labor and birth asphyxia in settings characterized by homebirth with unskilled attendants: A multi site study and academic partnership development project.

Prolonged Labor/ Birth Asphyxia has finished in December 2010.

This three years research was done by three steps. Phase 1, 2 and 3.

Project Goal:

1. Preventing use of syntocinon outside hospital or safe delivery unit
2. Recognition of prolonged labor
3. Timely referral-birth preparedness and crisis recognition skill
4. Manage babies at home

Project activity:

1. Qualitative and quantitative research strategies
2. Design implementation and evaluation of new strategies and interventions

The dissemination of PLBA research was done in ICDDR.B on February 5, 2011. There LAMB and other two organisations BRAC and ICDDR.B presented the findings of this project.

This project is funded by Emory University USA.

Recent and Current Local Research

Several Masters of Public Health students (eg BRAC University, State University of Bangladesh, University of Albany, USA) have worked with LAMB staff on thesis-related research or internships.  Their topics have included:

• Determining the accuracy of neonatal sepsis score (NSS) as a tool for assessing risks requiring further treatment of hospital-born neonates.
• Perception and understanding of mothers, husbands/fathers and mother-in-laws towards breastfeeding.
• Knowledge and Practice of Family Planning among the Santal Community in NW Bangladesh
• The Bangladesh Clubfoot Project – The first 5000 feet
• Evaluation of Integrated Management of Childhood Illness at LAMB, Bangladesh
• Health Decision Making in Communities:  Overcoming Social Barriers to Health