Health Care Behavior Study in Bangladesh-Socioeconomic information

Socioeconomic and demographic information:

1. About 71.8% respondents were interviewed from Rangpur District and the rest 28.2% were from Kurigram District.

71.8% respondents were interviewed from Rangpur District and the rest 28.2% were from Kurigram District. Rangpur district was sampled as a typical Rajshahi Division district for the mentioned research study. It was shown in the previous chapter regarding methodology and the sampling that sampled rural respondents of Rangpur District would fulfill the requirements for typical Rajshahi Division samples. But Bangladesh has about 2% other ethnic minority population apart from the majority Bengalis in totality and Rajshahi Division possesses a little of that ethnic population or their successors. In the social-anthropological points of view, they have some different traditional beliefs, customs and manners and behaviors. So, to document those and to minimize these "ethnic gaps", the researcher took about 28.2% respondents from Kurigram District where there live some descendants from once Pundro-Khastrio/Rajbanshi/Kuch and Bairagi/Nath-hath-yogi/Baisnab and the Khyan tribes (detailed anthropological discussion was done in the previous chapters).

2. Rangpur Sadar Upazilla was accounted for the highest number of interviews (71.8%), Rajar Hat and Ulipur Upazilla, both within Kurigram District, were accounted for about 14.4% and 13.8% interviews respectively. For the same reason mentioned above, Sadar Upazilla of Rangpur District accounted for highest number of respondents and two Upzillas of Kurigram District were accounted for the rest of the sampled respondents.

3. Uttam Union of Rangpur Sadar Upazilla was accounted for the highest number of interviews (71.8%), Chhinai Union of Rajar Hat Upazilla and Pandul Union of Ulipur Upazilla, both within Kurigram District, were accounted for about 14.4% and 13.8% interviews respectively. Sampled Unions were accounted for mentioned sampling.

% Respondents by Unions

4. Among the respondents for in-depth interview, 37.4% live in Goalu, 34.5% is from the village of Bahadur Singha, whereas, Purbo-Debottor and Joykumar both accounted for 7.2% and Apuar Khata and Paschim Apuar Khata accounted for 6.9% respondents. Villages were purposively chosen purposively in sampling (details in the sampling technique chapter).

5. About 6.6 % respondents were from East Para of the Goalu village, where as other Paras of Goalu namely West Para, Khayan and "other" Paras accounted for 10.1%, 16.1% and 14.7% respondents respectively. Paras in the village Bahadur Singha accounted for 13.5% of the interviewed respondents. Mollah Para, Kamar Para and Char Joy kumar accounted for 10.9%, 6.9% and 7.2% respectively.Random/systematic random sampling techniques have been used (details in the sampling technique chapter).

6. About 51.7% of the interviewed respondents were female. Attempt was made to take females as at least half of respondents to achieve the gender variations in response.

7. Mean age of the respondents interviewed was 44.4 years. The highest aged respondent interviewed was/were of 62 years and lowest of 30 years. The ages of the respondents were between 30-62 years. These are the ages in which a respondent can be mentioned as of normal age of knowledge and capable of understand and disseminate any information normally.

8. Among the interviewed primary respondents 8.9% was Pundro-Khastrio/Rajbanshi/Kuch1. About 74.4% and 4.3% was Muslim and general mainstream Hindu, Bairagi/Nath-hath-yogi/Baisnab2 and the Khyan were accounted for 5.2% and 7.2% respectively. It is interesting that although the mentioned population claim that they belong to the religion of Hindu, the mainstream of the Hindus have been continually refuse to admit the claim. In the observation at the field, it was seen that most of these unconventional Hindus are the descendants of the ethnic aboriginals, mostly the mongoloids anthropologically i.e. mostly possibly from Garos. Moe or less, it is the same scenario in everywhere of the rural population of Bangladesh, where this scheduled Hindus constitute a considerable portion of the total Hindu population of the area.

(1= they are not real Khastrio who are rare in East Bengal or Bangladesh. Real Khastrio are the martial race of the ancient Hindu religion and use to be the rulers, fighters etc. and the Rajputs and other north Indian castes are known as Khastrio. Population in the northern Bengal identifies them as Khastrio for some mythical reasons that were introduced by their kings like king Bishwashor of Kuch kingdom. According to the myth, 3^rd Pandob Arjun came to this land and married the indigenous princess Chitrangada. Arjun was one of the top most Khastrio of the era, hence the Kuch king defined themselves as the Khastrio. Typical Khastrio likely to have pure Aryan builds, whereas these Pundro- Khastrio are of Mongolian origin without doubt in their body and skull builds and in appearances!

2= Other than the Muslims, all counted as the Hindus)

9. Among the interviewed primary respondents, 44.5% were illiterate and 55.5% respondents were claimed to be literate. Again about 32.2% respondents interviewed were literate to the extent of primary level. Only 5.7% respondents interviewed were educated up to the S.S.C. level and above. Reflecting the situation in rural Bangladesh as a whole in the context of education. Only 5.7% SSC level education leaves the rural Rajshahi areas extremely vulnerable to superstitions and obstructs positive changes in the contexts of any modern and scientific knowledge and practice among the population.

10. Among the interviewed primary respondents, about 34.5% accounted for number of family members as 4, whereas about 17.2% have 8 member families. About 24.2% have family members more than 6. Only about 3.5% have families with 3 members. Expresses the excessive population in the rural areas and the family size in the households which is important to any design for health delivery system in the study population.

9. Among the interviewed primary respondents, about 29.3% belonged to the agriculture as their occupation, whereas about 46.6% were the housewives. About 8.3% were different professional groups. As we saw in previous table analyses, more than half of the respondents (51.7%) were females and here it is seen that about 46.6% of the total respondents are housewives. So, some of the females respondents had been doing something other than their roles as housewives.

10. Among the interviewed primary respondents, about 65.5% respondents’ economical condition was assumed as "not good". Only about 10.3% were identified having "good" or well off economic conditions. (Dresses, household utensils and other assets were indicators for the assumption). As the interview process was totally participatory and community based, interviewers were deployed from the community and they applied their indigenous techniques as they usually use to describe the economical conditions in their community and no highly precision scaling system was used due to the nature of the interviews. They could do it most preciously as the researcher thought. Economic conditions were predicted by the interviewer on certain general findings/criteria. How they pass their lives, what they eat, what they wear and what they do for income earning. Also idea was taken by observing their household for built and other criteria. This is the general understanding of the economic condition expressed in their livelihoods, not a very technical analysis and in most cases, it fulfills the objective to understand population’s situation. No strict economic measurement scale from any institute has been used, rather assumptions have been made with the indigenous idea found in the locality among the population to tell some one having "good", "average" or "not good" economic condition and those are dependent on the livelihood indicators of the assessed families or households (this is common practice in the rural Bangladesh to describe anyone’s economic condition)

11. Among the interviewed primary respondents, about 58.6% have the income source related to agriculture. About 20.7% have the income source related to the business i.e. small business like grocery shop or village market shops, tea-stalls etc. Different types of low-graded services contributed for about 13.8% of the income source, whereas different professional activities constituted the rest 6.9% of the responses regarding the income sources. Showing a predominantly agrigarian society, but a large proportion of the ethnic originated population are dependent on the other professions like craftsmanship in different trades. The later is partly due to their family heritage and partly due to their lack of cultivable lands, most of which have been known to be grabbed by the majority Muslim and mainstream Hindu populations since hundreds of years!

12. As per the statement of the interviewed primary respondents, their mean family income earning per month had been seen as about Tk. 2345 of which Tk. 4000.00 is the highest and Tk. 800/month is the lowest income earning per family. This expresses the income earning per household as stated by the respondents.

13.Among the interviewed primary respondents, about 58.6% are income earning, whereas about 41.4% are not income earning members of their families (mostly the housewives and the old/disabled persons). The finding shows that some female respondents were also accounted for the income earning (51.7% respondents are females)

14. Among the interviewed primary respondents income earners, the mean income earring were about Tk. 1306, whereas, Tk. 3000.00 and Tk. 500.00 were the maximum and the minimum income earrings respectively. About 82.4% respondents stated their monthly income earning as Taka 1500 or less.

15. Among the interviewed respondents’ families, about 86.2% lived in the houses owned by them; however about 13.8% were sheltered in the houses of their relatives or known families. Absence of rented house as any interviewed family’s living place reflects the normal rural phenomenon of the area.

In the rural Bangladesh, rented houses are rarely seen except the areas adjacent to the Thana or Distrcit headquarters. Majority of the respondents have their own homes, others are sheltered in their relatives’ households.

17. Among the interviewed respondents’ families, about 13.8% live in houses with good road communications and 41.4% with average road communication. About 44.9% has the household with bad road communications. Here only 13.8% respondents, who live at the side of the highways and other subways, stated they had good road communications. Other stated it as "average" or "bad". Road communication has a great role in the health seeking behavior as people have to go to the service centers through the roads. However, not only the road, also the transportations are required, and in most good roads, some types of transportations are present.

18. Among the interviewed respondents’ families, about 55.7% have no tube wells or electricity in their houses, whereas, 39.4% and 20.4% have tube wells and electricity respectively in their houses. It is of value to the interested quarters as it is reflecting the WatSan (water and sanitation) situation in the study population which cries significance for disease prevalence and health care behaviors of the population in general.

Household amenities

Pct of Pct of

Count Responses Cases

Tube well 137 34.1 39.4

Electricity 71 17.7 20.4

No tube well or electricity 194 48.3 55.7

------- ----- -----

Total responses 402 100.0 115.5

19. Among the interviewed respondents’ families, 74.7% and 69% owned watches and radios respectively, whereas, 52.9% owned bicycles (proportion is seen pretty higher, possibly for transport of the adult males to Rangpur or other places wherever necessary in the mud road). About 4.6% had televisions (mostly in their grocery shops), whereas, 12.4% had nothing such in there houses. About 10.3% have rickshaw or bull-carts, mostly for giving rent for income earning. Important for understanding of message dissemination processes through media, bicycles are pretty higher in number for communications.

Ownership of household commodity

Count Responses Cases

Radio 240 30.6 69.0

Television 16 2.0 4.6

Watch 260 33.1 74.7

Bi-cycle 184 23.4 52.9

Rickshaw/Bull cart 36 4.6 10.3

Boat 6 .8 1.7

Nothing 43 5.5 12.4

------- ----- -----

Total responses 785 100.0 225.6

20. Of the interviewed respondent females, 36.1% husbands were illiterate, whereas, 40.7% were literate to the extent of primary levels. Only 2.8% husbands were educated up to degree (Bachelor) level. This is a very important account as predominantly the males are the decision makers, so their educational levels can contribute/influence the health care behavior of the family members to a great extent. About 76.8% of the female respondents’ husbands are either illiterate or of primary level educated, thus limits the scopes for dissemination of modern knowledge through printed media and recalls importance of audio-visual approaches.

21. Of the interviewed respondent males, 54.8% wives were illiterate, whereas, 32.1% were literate to the extent of primary levels. Only 3.6% wives were educated up to S.S.C. level. About 1.8% has no wives then, either died or separated. About 86.9% of the wives of the respondent males are either illiterate or primary levelers. It is also an important indicator in the health care behavior as the women are the household caretakers for the diseased persons in the family.

Chapter –II: Methodology

A. Study design:

Main theme of the study is a survey, was planned to investigate the health care behaviour of the representative sample rural population under Rajshahi Division. Health seeking behaviours of the sampled population have been documented through a Knowledge, Attitude and Practice (KAP) survey and their links or relations were investigated with different factors like knowledge, traditional beliefs (perceived etiologist), economic condition, education, gender and distance with the health facilities etc.

In the research study entitled "Psychosocial Factors related to Health Care Behaviour of the rural people under Rajshahi Division", the survey planned was qualitative and methodology was adopted for qualitative data collection in the survey.

Rationale for intensive study of the population in limited study areas for qualitative data:

An in-depth study of rural population with samples of statistically valid number in limited study areas of Rajshahi Division (in Uttam Union of Rangpur and Chhinai and Pandul Union in Kurigram) was "representative" for whole Rajshahi Division rural people for yielding result. Study of the rural population all over the Rajshahi Division was not required for the qualitative behavioural study "Psychosocial Factors related to Health Care Behaviour of the Rural people under Rajshahi Division".

The rationale is as follows:

For qualitative data of a population with homogenous culture, language, and ethnicity etc. in a very small but populous country, intensive study of the typical population in any place is enough and repeating the procedures in the other places within the same typical population groups allover the Division or country is not absolute as they have almost the similar traditional beliefs, socioeconomic conditions, cultures and practices etc. so, results will be almost similar. This is particularly true for Bangladesh. Mentioned factors are almost similar for whole Bangladesh (homogenous culture), or more truly for whole Rajshahi Division would be almost similar for the following reasons (reasons for cultural homogeneity population):

1. Unlike India, Russia or other very large counties (where number of population groups inhabit in different areas and have individual own cultures), Bangladesh is a small country with tiny area of 147.570 Sq. Km. (56977 Sq. miles) only. Bangladesh has almost homogenous population in respect to religion, linguistics, socioeconomic conditions and traditional beliefs etc. Typical population groups (98% Bengali) in this country are homogenous so as the Rajshahi Division. Rajshahi Division is one of the 6 administrative Divisions and has same characteristic population groups.

"Except for about 400,000 Bihari, the Muslims who immigrated from Bihār, India—and some small groups in the southeast, the Bangladeshis consider themselves homogeneous people. They have an Indo-European heritage, with some Arab, Persian, and Turkish influence. The people of West Bengal in India are of the same ethnic group as the Muslim Bangladeshis, but they are mostly Hindu. To emphasize this difference, most people refer to themselves as Bangladeshi rather than Bengali, the cultural-linguistic term for Bangla speakers. With a population density of 864 persons per square kilometer (1998) (more than 2,239 persons per square mile), Bangladesh is one of the most densely populated countries in the world. Most of the people live in thousands of small villages that blanket the country. Only about 19 percent (1997) live in cities."¹

2. Unlike other countries depicted above, there is only one language (Bangla) among all the inhabitants (sometimes with negligible local variations in spoken forms i.e. in he Districts of Chittagong, Sylhet Noakhali etc. but the written script is same everywhere). For Rajshahi Division, the fact is more conspicuous, language is more strongly typical allover its areas regarding the common and only language, Bengali compared to other administrative Divisions of Bangladesh.

Unlike the described countries, Bengali is the only local newspaper language through out the country. Text and other books are published in the only local language (Bengali). Radio and Television media broadcast programs in the Bengali. So, information and knowledge disseminations and all communications are in the same language (Bengali). No ethnic community in this area has any functional written language other than Bengali and their spoken ethnic languages are mostly Bengali in variant forms. Regardless the religious identities, all of them have the same language both spoken as well as written.

"Bangla (also known as Bengali), the official language, is also spoken in India’s West Bengal. Spoken Bangla has several distinct dialects, the most guttural of which are spoken in the northeastern and southeastern districts of Bangladesh. Most Bangla dialects are soft and somewhat musical. People with a university education usually also speak English, but they often incorporate various colloquialisms derived from Bangla. The Bihari speak Urdu, an official language in Pakistan. Small groups along the southeastern border speak in their own languages"².

3. Religious proportion of the typical population groups is almost same in all parts of Bangladesh and that is more evident in Rajshahi Division, i.e. Muslims, Hindus, Buddhist and Christians.

"Bangladesh has the second largest Muslim population in the world; more than four-fifths of the people are Muslim, mostly Sunni Muslim. Most of the rest of the population is Hindu, although there are also Buddhist and Christian minorities. Education system is same for whole country"³.

"Ethnic divisions - Bengali-98 percent, Other-2 percent

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Languages --

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Bangla (official), Urdu, English

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Religions: -

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Muslim-88 percent, Hindu-10 percent, Other-2 percent"⁴

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Literacy rates are almost similar in the regions. Similar political trends are observed. Almost all people have similar appearance, height, hue and other anthropological aspects.

As the behavioral aspects like health care behavior etc. depend mainly on the above determinants or factors, intensive study of a population in a single place would satisfactorily yield the expected qualitative data for the total population or the statistically defined "universe".

B. Rationale for the Sample size:

For qualitative data, intense and in-depth study (qualitative survey) of statistically defined "large" Sample size among the population fulfilled the demand of the study (qualitative survey) and give statistical validity. In the study, 348 in-depth interviews were conducted. The number is statistically valid for the followings:

1. When over more than 30 were taken as the samples and selected for in-depth study, it can be called statistically "large" sample⁵. So, total number of respondents >=300 proposed for the study can be defined as "large" statistical sample for investigation or in-depth study of a population.

2. "If you intend to analyze cross-tabulations of variables, you should keep two points in mind when determining sample size. First, each category of an independent variable included in a cross-tabulation should contain at least 50 cases, since percentages calculated on the basis of fewer than 50 cases tend to be unreliable. The minimum sample size required ensuring at least 50 cases in each category of the independent variables is obtained by dividing 50 by the proportion (Ps) of total cases you expect in the smallest category of variables" ⁶:

m = 50/ Ps

3. "Qualitative data can be collected through qualitative methods such as unstructured interviews, focus group discussions, direct observations, and content analysis etc.

The chief drawback of structured interviews is that the responses obtained tend to be superficial. An alternative approach to interviewing, which allows greater depth of exploration, is to seek detailed, open-ended responses to questions. Such interviews are usually known as in-depth interviews. In this procedure, instead of reading formal questions from a structured interview schedule, the interviewer has an outline of topics or a set of general questions to serve as a guide to the kind of information required. Details that are not brought out initially are sought through follow up questions, called probes.

The chief drawbacks of unstructured interviews are (1) the responses, being un-standardized, are difficult to quantify; (2) the interviews require highly skilled and experienced interviewers; (3) the analysis is extremely time-consuming. The shortage of qualified interviewers and analysis, and the high cost of conducting and processing such interviews usually mean a small sample size must be used (sometimes as few as 20-30 respondents).

In-depth interviews are generally most useful exploratory studies that seek to clarify important concepts or generate hypothesis prior to developing questionnaires for quantitative surveys. They also are useful for generating supplementary, explanatory data to augment the relatively superficial findings from larger surveys" ⁷.

References:

1, 2, 3, 4: © & (p) 1995-1999 Microsoft Corporation, sources:

United States Census Bureau, International Programs Center; International database, 1999; (www.census.gov). Population density data are from the individual country statistical bureaus, and the United States Census Bureau, International Programs Center; International database, 1999; (www.census.gov).Ethnic divisions and religion data are largely from the latest Central Intelligence Agency (CIA) World Fact book, as well as various country censuses and reports. Language data are largely from the Ethnologue, Languages of the World, Summer Institute of Linguistics; (www. sil.org).-

5. Dr. Md. Zainul Abedin. A Handbook of Research for the Fellows of M.Phill and Ph.D. Programmes (Dhaka, Chittagong: Book Syndicate, 1996). Pp. 66-67.

6. Andrew A. Fisher, John E. Laing, John E. Stoeckel, John W. Townsend. Handbook for Family Planning Operations Research Design (2^nd ed.; New York: The Population Council, 1991), pp.43-44.

7. Andrew A. Fisher, John E. Laing, John E. Stoeckel, John W. Townsend. Handbook for Family Planning Operations Research Design (2^nd ed.; New York: The Population Council, 1991), pp.50

C. Sampling technique

1. The study was designed to conduct in the typical villages of rural areas under Rajshahi Division of Bangladesh and all the respondents were selected from there for study as per the subject of the study. For the purpose, a two-fold methodology was adopted to select respondents for the study for in-depth interview: i) from a Union of Rangpur District, about 250 (covering about 5% of the total number of households in the Union) were taken as the respondents. ii) To minimize the possible gaps and variations in responses regarding the social, traditional and cultural beliefs for aboriginal, tribal or ethnic populations (of Rajshahi Division/Bangladesh, approximately 2% population of the total for Bangladesh), a number of in-depth studies (100) were conducted in two pockets in Kurigram District within the geographical area of Rajshahi Division (District of Kurigram, from Pandul and Chhinai Unions of Upazillas of Ulipur and Rajarhat) where significant number of ethnic population is present (Rajbanshi, Khen and Kuch etc.).

Thus in total about 350 (250+100) respondents were selected for interview and 348 of in-depth interviews were conducted with them.

Stratified Random, Systematic Random and Purposive sampling techniques were adopted for drawing the samples for the study as follows:

Among the Districts of Rajshahi Division, 2 Districts were taken (Rangpur and Kurigram)-Random Sampling technique

Among the Thanas of Rangpur District and Kurigram District, 1 Thana was taken from Rangpur District and 2 Thanas from Kurigram Districts (Rangpur Sadar from Rangpur and Ulipur and Rajarhat from Kurigram ) though Random Sampling technique

Among the Unions of Rangpur Sadar Thana, Ulipur Thana and Rjarhat Thana, 1 Union was taken from each Thana (Uttam Union from Rangpur, Pandul Union from Ulipur Thana and Chhinai from Rajarhat Thana) through Random Sampling technique

Among the Mouzas/villages/clusters of Uttam union, 2 Mouza/cluster/village is taken (Golau and Bahadursinha) for Rangpur through Random Sampling technique and for Kurigram from Pandul Union and Chhinai Union through Random Sampling technique among purposively identified ethnic/aborigine population.

In Goalu and Bahadursinha villages of Uttam Union of Rangpur Sadar Thana of Rangpur District, households have been chosen through Systematic Random Sampling technique. In places, Purposive sampling technique also has been used.

2. Effective and proper data management has been ensured throughout. Tabulation plan has been complied with the objectives of the study. Data and information from the in-depth interviews have been gathered and compiled in the reporting forms with proper importance to the salient and atypical findings in respect of the track of the study subject.

Strange and interesting issues, incidences, stories, findings etc. explored and elicited from the in-depth interviews in the process of the study have been noted, preserved, and analyzed for further clarifications in the compiled report. From the in-depth interviews, salient features of the quantitative data and the quantitative accounts of the qualitative data have been presented first in words followed by the corresponding tabular presentations. Interesting findings have been compiled and compared against the prevailing knowledge about the topics and emphases have been given to establish the causes and justifications of the exceptions of the common norms in subsequent chapter.

The information has been compiled in the report in relevance with the in-depth interview end products for the qualitative presentations.

Case studies gave an opportunity to track the study topics in the individual variations and made possible for the researcher to re-examine and re-observe the individual trends, variations and scopes in the topics.

D. Study period

The period of the study was planned for a time relevant to the time length for the M. Phil and Ph.D. course and was planned to conclude at least within August 2003, thus providing enough time for data management and writing the final report within June 2004. A period of three months was required for the preparatory works for the thesis; almost two years were taken for fieldworks which were not done at a time as time was required for different works like primary reporting for seminar for transfer to Ph.D. and suggestions from the supervisor to select valid sample size for the samples etc. Rest of the time was required for data compilation, analysis and report writing.

E. Study area

The study area was the Village of Golau in Mouza Goalu of Union of Uttam in Rangpur Sadar Thana of the District of Rangpur. The particulars of the study area are as follows:

Locality Name					Population
District	Thana	Union	Mouza	Village	All	Male	Female
Rangpur	Rangpur Sadar	Uttam	Golau*	Golau	192	259+16%**	( )	727+ 6% ***	677+ 6%
Kurigram	1.Ulipur 2.Rajarhat	1.Pandul 2.Chhinai	Pockets of Ethnic population	-	-	-	24,637 in Pandul 26,302 in Chhinai

* Golau Mouza contains only one village.

(Census 1991, published by BBS)

**/*** as suggested for 2001 counts by the officials of the Rangpur Sadar Thana Statistical Officials

Goalu and Bahadur Sinha are the typical villages of rural Rajshahi Division of Bangladesh and inhabited by typical rural population. They are nearly within 8 kilometer radius from the Rangpur town. Like other typical Bangladeshi villages, the rural populations of the village enjoy the usual facilities and drawbacks with respect to their health care access. Literacy rate of the village for 7+ years is 23.2 for all, of which males and females accounted for 32.5 and 13.3 respectively.

As mentioned earlier, Chhinai and Pandul are 2 Unions under Rajarhat and Ulipur Upazillas (Thanas) respectively of the District of Kurigram and they are at about 10 and 14 km. from Kurigram District Headquarter respectively.

F. Data collection technique (quantities/qualitative)

Data collection technique was participatory and community based. Two eligible volunteers (Female) were deployed from the same community, trained by the researcher who himself took part in conducting the interviews. They charged only a pocket expense. As from the same community, they could penetrate maximum while interviewing and observing.

A) Surveys have been conducted with the sampled respondents determined through sampling techniques as mentioned in households among family members (adult females and males depending upon the opportunities) i) two villages in Uttam Union of Rangpur Distrcit’s Sadar Upazilla and ii) in the Unions of Pandul and Chhinai of Ulipur and Rajarhat Upazillas of Kurigram District through prior-visit by a team headed by the researcher to make a list of addresses and names all the households and family adults/heads

B) In order to collect data to meet the study objectives and queries, respondents were interviewed in-depth with a semi-structured questionnaire.

A total of 256 in-depth interviews have been conducted in the village of Goalu and Bhahadr Sinha in the Uttam Union of Rangpur Sadar Upazilla. A total of 106 in-depth interviews were conducted in the villages under Pandul and Chhinai Unions of Ulipur and Rajarhat Upazillas respectively of the District of Kurigram.

C) Direct observation by the data collection/investigation team whenever/wherever required.

G. Data collection instruments

Semi-structured in-depth questionnaire (each questionnaire with 397 fields and of both single and multiple responses))

Direct observation (whenever and wherever possible)

H. Data collection plan/ Work Plan (field work):

Data Collection

Data collection constituted a most important task of the proposed study. However, obtaining accurate and reliable data depends on, among others, realistic planning, data collection procedure and constant monitoring, therefore elaborate and proper arrangement was done for the purpose.

The whole operation was conceived to entail three steps: planning, procedures and monitoring (or quality control). These three steps had been planned in conjunction with each other so that the whole operation was carried out smoothly and timely.

Planning for Data Collection

The planning of field data collection is outlined below:

Our previous experience on field operations called for a well-thought, realistic and feasible work plan. It was essential for ensuring timely completion of fieldwork and to obtain high quality data. In this regard, therefore, the first priority had been to prepare a work plan before the actual fieldwork was started, and it was done accordingly.

Work Plan for Data Collection:

The researcher collected relevant reports and research findings for literature review with the help of the respected supervisor Professor in the Department of Psychology, Rajshahi University mostly using the latest Internet technology from the websites. He reviewed the collected literatures and prepared a synopsis of those reports. For the purpose of collection of data from the respondents, a team of 3 was deployed for conducting in-depth interviews. As the best data could be obtained through a participatory and community based data collection procedure, i.e to involve community members in data collection and as the in-depth interviews were lengthy and time consuming process; hence more manpower was required in excess to the researcher alone, able volunteers were collected from the indigenous community to collect conduct the interviews and for observations. They were duly trained by the researcher and field tests were conducted. As male investigators seemed to be less welcomed in the extremely rural households for interview, female data collectors were deployed by the researcher.

The team was formed as under:

Designation	Number
Researcher	1
Field Assistants (female)	2
Total	3

The researcher himself conducted interviews as well as supervised the Field Assistants’ interviews for ensuring the quality of the fieldwork.

A total of 248 sampled respondents from village of Goalu and Bahadur Sinha were interviewed for the Rangpur District study area. Again about 100 respondents were interviewed in Kurigram study areas of the Pandul and Chhinai Unions in the ethnic pockets. Special efforts were taken to maintain gender equity among the interviewed respondents by trying equal percentage from both the sexes (50% female and 50% male)

Systematic Random Sampling technique was applied to select respondents in the Rangpur District segment, whereas in Kurigram District segment, ethnic pockets were identified purposively and then Systematic Random Sampling technique was used to draw respondent samples.

I. Quality control of the data

Researcher’s past experiences as a investigators for a number of research works greatly helped him in the data collection procedures.

The questionnaires were printed (please see the appendix). Monitoring of listing/data collection work has been ensured in different ways. The researcher undertook some specific steps for monitoring the data collection and listing works of interviewers. The researcher reviewed daily activities of the team and discussing problems with the other team members at the end of each day and used to edit all the listing formats/schedules at the field camp as well as check for inconsistencies and incompleteness. For ensuring quality of data, the researcher checked the consistencies of the completed schedules, re-visited a few of the already interviewed cases to make sure whether they were properly interviewed and solved/clarified any new problem that arose in the field. Furthermore, the researcher took assistance from one of his friend experienced in quality control of the data who also contributed as quality controller for the interview.

Also the following mechanism was exercised for quality control of the data collected:

- 100% questionnaires were scrutiny checked in the field by the researcher

- 20% questionnaires were back checked by the researcher

- 20% Interview were cross accompany called by the team members

- 20% questionnaires were scrutiny checked in the field by the researcher

- 10% questionnaires were back checked in the field by the researcher

- 10% Interview were accompany called by the researcher

- 100% questions in a questionnaire were checked at the time of back check.

J. Confidentiality of the data

As the study design was an "ethical study design", the confidentiality was kept as followings:

- Data collected from the respondents were kept fully confidential

- Unless felt absolutely essential for the interest of the study, sensitive issue was avoided in the interview.

- For data management including the coding, editing, computerization and analysis, always code numbers were used instead of the names of the respondents.

- No other persons/parties have access to the information collected except the supervisor and the Rajshahi University authority.

- Interviews were always conducted with the willingness and informed consent of the respondents.

K. Data management (tabulation-coding/editing and analysis plan)

Data management

Data management consisted of registration of schedules, editing, coding, and computerization, preparation of dummy tables (tabulation plan), analysis and matching of data.

The researcher undertook the responsibilities of the technical matters of editing, coding and computerization.

Computerization

The process of computerization have been carried out through the following stages

i) Designing of databases and program in Statistical Package in Social Science (SPSS/PC 11.0)

ii) Data entry

iii) Data cleaning (by validity check, consistency check, etc.)

iv) Report/table/information generation and printing

v) Taking backup for further/future analysis.

Total data management including the compilation of computer program, data editing, data entry and analysis has been performed by the researcher himself.

Survey data were analyzed according to the purpose of the specific objectives and research questions. Simple tables were preferred. Frequency tables were made for all the relevant variables and cross-tabulations were also prepared for necessary highlighting of any existing correlation between two sets of variables, such as gender and knowledge etc.

Also attempt was taken to present key findings through bar, line or pie charts wherever comparative analysis was felt necessary.

Report has been prepared with frequency and cross-tables, followed by write up. In suitable cases, multi-variate analysis has been performed.

Statistical tests (t-test, chi-square) were used for assessing the significance of difference between two sets of data for drawing inference whenever felt necessary.

The report contained an abstract with a set of recommendations.

L. Dissemination of the research finding (Dissemination strategy and report writing)

Dissemination strategy:

- Emphases were given to the objective related issues for making the information useful to the potential users (i.e. policy makers etc.) so that they could use those for the betterment of the health facilities of target population (the rural people).

- Emphases were given to highlight the most significant but achievable problems unveiled by the research.

- Both printed hard copy and soft copy in the CD were submitted for the convenience of the supervisor Professor, the Department and for the University of Rajshahi.

- Except the University of Rajshahi, Department of Psychology, the report or any part of the data was not disseminated to anybody.

- Researcher hopes that the report and the data will be disseminated through multiple approaches using a variety of channels to maximum number of audience/ readers after its final acceptance by the University of Rajshahi authority for the betterment of human beings and for the improvement of the knowledge of the mankind.

M. Writing of report

As per the general rule, primarily, the whereabouts of the study including findings was presented through a report as per the given outline by the supervisor professor of the study that suits with the requirement of the Department of Psychology, University of Rajshahi protocol. As the present report is an academic one, special thrust were put on the methodology and other academic issues as prescribed by the Department of Psychology, University of Rajshahi.

Health Care Behavior Study in Bangladesh-Knowledge, Attitude and Practice -First part

They informed of their knowledge, perceptions and practices related to their health care behavior in relation to their world of imagination and myths. They freely described about the presence of the government health service delivery centers nearby them also informed about their interests in those. They didn’t hesitate to express the causes of their interests and disinterests regarding those. Thus one of the main objective of the research study is fulfilled by knowing the traces of the views of the rural population of Rajshahi Division about Government health services and opportunities can be made by examining these views, comments and causes to explore the actual situation in the ground to submit those before the state level policy makers to compile real people oriented national policy through which the health service requirements of the vast rural population can be dealt effectively.

Also the most important context of the findings for the study exist here as these are the responses from where one can find the relation of the existing social factors with their health seeking practices.

Meaning of factor (noun forms plural: factors), cause; agent; broker; financier; money lender; number which is multiplied with another to produce a given result (Ref: TOEIC Vocab -- TOEIC Vocabulary -- 684 TOEIC Word Lists Online, http://www.english-test.net/toeic/vocabulary/meanings/173/toeic-words).

Definition of factor (FACT) noun [C], a fact or situation which influences the result of something:
People's voting habits are influenced by political, social and economic factors.

Heavy snow was a contributing factor in the acciden.

Price will be a major/crucial factor in the success of this new product.

The economy is regarded as the decisive/key factor which will determine the outcome of the general election.

INFORMAL The film's success is largely due to its feel-good factor (= its ability to make people feel happy). (Ref: Cambridge Advanced Learner's Dictionary, © Cambridge University Press 2004.)

22. Among the interviewed respondents, 48.3% had no knowledge of any UHC/MCWC /FWC nearby, whereas, 51.7% had that knowledge. Lack of the knowledge in the issue reflects possibly their lack of interest in the government service delivery outlets.

The factors related to the development of such knowledge influence health care behavior of an individual for their service seeking.

Here we see that large proportion of the respondents have no knowledge about the presence of UHC (Upazilla Health Complex) or Mother and Child Welfare Centers (MCWC) or Family Welfare Centers, the Government health service delivery centers nearby. It became a burning question, whether is it possible that residing in the area and facing health problems, even if in very small extents, still they didn’t know their presence in the area? In cross-checking of the interview results, it was seen that they really told so. Now, it is a clear cut psychological manifestation. It might be very much possible for a portion of the respondents who responded as they didn’t know the presence of these Government service centers around them, even after knowing the presence, they simply denied their knowledge regarding their presence as they didn’t like them. The social factors here are influencing their mind affecting the development of such "knowledge" of options of health care facilities nearby. This may be possible that they refused to acknowledge the presence of the Government health facilities as they couldn’t satisfy them.

Knowledge of UHC/MCWC/THC nearby
	Frequency		Valid Percent
Within knowledge	168		48.28
Not within knowledge	180		51.72
Total	348		100.00

23. Among the interviewed respondents, none informed of their regular contact with the Government hospitals for treatment, whereas 27.6% stated that they never go GoB (Government of Bangladesh) outlets for treatment. However, 72.4% go there for treatment only occasionally—factors influencing their propulsion to Government health centers are of importance.

The picture showed the extents of non-confidence in Government health service delivery as most of the respondents informed that they went there only occasionally, i.e. when they badly needed the service, but no body stated that they were going in those government service enters regularly when their family members were diseased! A large proportion of the respondents (27.6%) informed that they never went to the Government health service centers, i.e. hospital etc. So, the health care behavior of the population is special about the Government service centers or hospitals, but what are reasons behind that? It may be the confidence underlying. They know that the services there are not enough effective to meet their needs.

Whether going government hospital for treatment
	Frequency		Valid Percent
Don't go to government health facilities	96		27.59
Occasionally go to government health facilities	252		72.41
Total	348		100.00

24. Among the interviewed respondents, only 6.9% expressed their satisfaction in treatment in Government service outlets or hospitals any where. A vast majority of 89.7% expressed their dissatisfaction for treatment in Government hospitals, whereas, a much lower proportion (3.5%) stated differently in the issue i.e. too much rush causes trouble for treatment in Government hospitals, without medicines what the doctors would do? There are certain factors like presence of doctors, availability of the medicines, friendly environment in the hospitals etc. influence the individuals’ satisfaction in the service of any care facilities which came later in the findings.

It is interesting that only 6.9% respondents expressed their satisfaction (client satisfaction) in the treatment in the Government hospitals/service centers and about 89.7% expressed their dissatisfaction for their treatment in Government hospitals. But this is also interesting that still they are occasionally going there for their treatment as they have only a few alternatives where they can go for the treatment.

Whether satisfied in treatment in GOB
	Frequency		Valid Percent
Satisfied	24		6.90
Not satisfied	312		89.66
Others	12		3.45
Total	348		100.00

25. Among the interviewed respondents, 82.8% informed "no medicines available" as their reason for not going to Government hospitals (anyone) for treatment, whereas, 65.5%, 44.8% and 41.4% informed of their reasons as the absence of doctors, bad road communication for going for treatment and "bad" behavior of the doctors respectively— "availability of medicines", "absence of doctors", "bad road communication" and "behavior of the doctors" revealed as the factors those play an important role in their perceptions of "satisfaction" in the management of disease in Government hospitals. These are the quantitative and qualitative aspects of a service which are the determinants for service seeking.

-This finding expresses how the service providers’ service quality can affect health care behavior of any population. In health ailments management, the extents of quality and quantity are important factors to attract the beneficiaries and are capable of influencing the target populations’ health care behaviors.

Reasons (if anyone) of not going to GOB

Pct of Pct of

Count Response Cases

Doctors available rarely 228 21.8 65.5

Doctors/providers behavior not good 144 13.8 41.4

No medicines available 288 27.6 82.8

Road communication to government hospital 156 14.9 44.8

Transport not available/expensive 36 3.4 10.3

------- ----- -----

otal responses 1044 100.0 300.0

26. Among the interviewed respondents, all (100%) informed of quack/non-MBBS private doctors as the service outlet for the treatment of their family members, whereas, 82.8% informed both of religious/spiritual healers and Homeopath/Kabiraji/traditional healers for the same indicating the strong affinity of the rural population of Bangladesh for medieval treatment procedures for different reasons. Curiously NGO outlets had been described for the same by only 6.9% of the respondents. These are the health seeking practices evolved for the benefit of the individual as a result of different influencing factors. Factors associated with the choice of the service providers are related with this finding.

All the respondents (100%) informed of their treatment outlets as the quack/non-MBBS private doctors and 82.8% respondents informed both the religious/spiritual healers and Homeopath/Kabiraji/ traditional healers as their treatment outlets. This is really very much interesting! Didn’t they understand any thing about the qualities of treatment of the mentioned outlets? I think at least they assume up to an extent. Then why again they thought theses outlets as their highest hopes? In the next discussion, we shall see the reasons behind this psychology. In practical, they are the "doctors" or the "remedy outlets" where the poor and lees knowledgeable rural people can go in their health problems as they are present in their vicinities, at least the rural people can get them and of course, their treatment is cheap regardless the qualitative standardizations! In medical science, we care about several factors which can affect the healing process strongly like placebo effects (psychological perception of taking appropriate medications), assurance and re-assurances etc which are scientifically proved phenomenon. So, apart from the extents real pharmacological effects, added psychological boost benefits the service seekers and thus contributing to the health care behaviors, i.e. the people come to them in diseases.

Outlets for family treatment

Pct of Pct of

Count Responses Cases

Government hospital 240 18.3 69.0

Private M.B.B.S. doctors 120 9.2 34.5

Quack/non-M.B.B.S. private doctors 348 26.6 100.0

Homeopath/Kabiraji/traditional healers 288 22.0 82.8

Religious/spiritual healers 288 22.0 82.8

NGO hospital 24 1.8 6.9

------- ----- -----

Total responses 1308 100.0 375.9

27. Among the interviewed respondents, all (100%) respondents described "low cost treatment" as the reason to select treatment outlets for the family members. Again 58.6% and 51.7% respondents described the reasons as "treatment facilities always available" and "nearer to the patient's house" respectively. About 44.8% respondents accounted for "treat with care and listen/counsel well" as the reason for the same. Here the factors influencing their choice of the service providers have been revealed.

-In the finding, the reasons related with the demand versus capacities for spending were describe by the service seeking rural population. Treatment costs, availabilities, counseling and the easier ways of approach etc. have been described by the beneficiaries as the indicators which they use to assess while go for a treatment to coup up with their own capacities.

Reasons to go to the outlets for family

Pct of Pct of

Count Responses Cases

Treatment/medicines are good 120 11.5 34.5

Low cost treatment/expenditure 348 33.3 100.0

Nearer to the patient's house 180 17.2 51.7

Treatment facilities always available/do 204 19.5 58.6

Treat with care and listens/counsel well 156 14.9 44.8

Others 36 3.4 10.3

------- ----- -----

Total responses 1044 100.0 300.0

28. Among the interviewed respondents, only 17.3% expressed their satisfaction in treatment wherever they get that. Curiously interesting is the finding is that, a vast majority of 82.8% remained "unsatisfied" with treatment, even in their outlets/hospitals of choice for the treatment of their family members! Here, the service seekers expressed their satisfaction/dissatisfaction in the service provided by any service providers. There are some factors causes their perceptions of client satisfactions.

-Only 17.3% of the respondents expressed their satisfactions in the treatment from anywhere they availed while diseased (they went in the service outlets where they could fit themselves in regards to the treatment costs and other factors!). It is interesting to note that about 82.8% respondents stated their dissatisfaction even after taking treatment in the outlets of their own choice! The mentioned satisfaction of the service seekers plays an important role in their health seeking behaviors and thus in their health care behaviors!

Whether satisfied or not in treatment there
	Frequency		Valid Percent
Satisfied in treatment there	60		17.24
Not satisfied in treatment there	288		82.76
Total	348		100.00

29. Among the interviewed respondents, 75.9% disclosed their reason for dissatisfaction as "Needs time to cure/can’t diagnose properly", whereas, 51.7% for "high fee", 41.4% stated their reasons of dissatisfactions for both "requires repeated visit" and "frequently prescribing injection/I.V. saline". About 31% described their reason for dissatisfaction as "bad behavior of the doctors and staffs of the hospitals".

Among the reasons for satisfaction, "see the patients with care" and "good treatment" accounted for 17.2% and 6.9% respondents respectively.

Factors causes their perceptions of satisfactions have been described here by the respondents. Those are again associated with many other factors .i.e. the factor "high fee of the doctors" is associated with financial capacity of the respondents to utilize his services.

-The respondents expressed their reasons for satisfactions and dissatisfactions which are directly related with their health care behavior. By careful following the reasons and the findings can be very efficiently utilized by keeping the reasons and their possible remedies in the mind during the health policy formation in different levels.

Cause of satisfaction/dissatisfaction

Pct of Pct of

Count Responses Cases

They see the pts. with care 60 6.1 17.2

Needs time to cure/can't diagnose prope 264 26.8 75.9

Requires repeated visit 144 14.6 41.4

Frequently prescribing injection/I.V. sa 144 14.6 41.4

High fee 180 18.3 51.7

Ordering costly pathologies 60 6.1 17.2

Behave badly 108 11.0 31.0

Good treatment 24 2.4 6.9

------ ----- -----

Total responses 984 100.0 282.8

30. Among the interviewed respondents, 93.1% believed the etiology of disease as "from the anger of Allah/God", whereas, 65.5% thought the etiology as "from infection by germs". About 41.4% informed of "other" reasons as the etiology i.e. "dissatisfaction of gods", "dissatisfactions of the nymph" etc. The factor like the traditional belief plays the major role in the context.

-Here, the findings show the extents of the resultants evolved through the dynamic interactions between the traditional beliefs of the population and the influences of the modern knowledge disseminated through different sources regarding the etiology (cause) of the diseases. Surprisingly, still 93.1% respondents stated the etiology as the "punishment from the Allah/God for sins". There are a large proportion of the respondents who believe that also the scheduled Gods/Goddesses and the nymphs are also capable of inflicting diseases to the human beings. It is still unclear to them about the mode of the transmission of the diseases but they thought that as a very complicated method, i.e. some respondents among them who believe in the mentioned "anger or dissatisfactions of the Allah/God or nymph", also believe in the infections by the germs (microorganisms). Their health seeking or care behavior will be thus dependent on the perceived etiology of the diseases!

Etiology of disease

Pct of Pct of

Count Responses Cases

Through bacterial/virus infection 228 32.8 65.5

From the anger of Allah/God 324 46.6 93.1

Others 144 20.7 41.4

------- ----- -----

Total responses 696 100.0 200.0

31. Among the interviewed respondents, 72.4% informed of providing first aids in home for patients, whereas, 27.6% informed of not providing first-aid in home. This is the community based resource playing role in need. These are the skills existing in the community and transferred to the next generation.

A large proportion of the respondents informed about the presence of the important health care behavior in the family diseases in their households, first-aid arrangements in the family.

Whether providing first aids for diseases in home
	Frequency		Valid Percent
Providing first aid in home	252		72.41
Not providing first-aid in home	96		27.59
Total	348		100.00

32. Among the interviewed respondents, 65.5% informed that the female chiefs of the corresponding families had supervised the family first aid. Only 17.2% informed that the male chiefs did it. Another 17.2% informed of the supervision by others like other family members etc. By tradition in Bangladesh, mothers usually are the caretakers in the family members’ sickness. The tradition passes from the mother to her daughter and skills are also transferred. This is an important community based participatory sustainable service option as the solution is available within the family or community. This is again the community resources. If limited modern skills can be infused in this level with modern information and the household level possible skill with the knowledge of effective referral, health hazards could be minimized to a great extent.

-Among the respondents informing their arrangements for family first aid, 65.5% respondents informed of the females in their households as family health care takers which signifies the importance of dissemination the health knowledge among the household females to achieve desired health care behaviors in a population. Traditionally in Bangladesh, specially in the rural areas, mothers, sisters and wives are the caretakers in almost all the places

Supervising home treatment
	Frequency		Valid Percent
Supervised by female chief	228		65.52
Supervised by male chief	60		17.24
Others	60		17.24
Total	348		100.00

33. Among the interviewed respondents, 93.1% expressed their beliefs in traditional/folk medicine, whereas, the rest 6.9% informed of their no belief in traditional/folk medicine. This reflects the important issue of the traditional beliefs and it causes people’s decision for the type of management they would seek for the illness of the family members.

-This finding expresses the strong traditional beliefs of the rural population on folk/traditional medicines. To bring positive changes in their health care behavior, this issues should be keenly considered with respect to indigenous and traditional practices and thus to introduce the modern practice or health care behavior with logics or instances in their own languages and through their own community people in a community based participatory way.

Belief in traditional/folk treatment
	Frequency		Valid Percent
Believe in traditional/Kabiraji/country medicine	324		93.10
Not believing in traditional/Kabiraji/country medicine	24		6.90
Total	348		100.00

34. Among the interviewed respondents, all (100%) respondents stated "green coconut water/ liquid /ORS/ laban-gur preparation (salt-molasses solution)" as the traditional/folk or indigenous treatment of diarrhoea, whereas, 93.1% respondents informed of the "holly water/talisman/exorcism" as the as the traditional/folk or indigenous treatment of diarrhoea. "Herbal extracts/herbs" accounted for 31%, whereas, unfortunately another 51.7% and 24.1% of the respondents opted for "heals spontaneously" and "closure of feeding" respectively indicating existence of potential grave public health risk in the issue still existing in the rural Bangladesh regardless the highly advertised optimistic views of government and many NGOs. These harmful practices evolve from the traditional beliefs of the population, although the lack of education and the financial conditions are also the factors to propel them towards such choices. Their knowledge for home fluids possibly the effects of the information dissemination community based field programs and media campaigns.

-This finding shows the natural modifications of the traditional/indigenous health behaviors in the community by the dissemination of the modern knowledge. It is interesting to note that regardless all respondents’ believe in both traditional and modern remedy of "green coconut water/ liquid /ORS/ laban-gur preparation (salt-molasses solution)" for diarrhea (replenishing depleted body water and electrolytes), almost all them also believe in holy water/talisman or verities of exorcisms! We shall see later in this report the so called presence of influential Ola and Obba, the supernatural deities who were frequently blamed for the disease diarrhea in the rural areas as per the existing traditional myths!

Traditional/folk treatment for diarrhea

Pct of Pct of

Count Responses Cases

Green coconut water/liquid/ORS/laban-gur 348 33.3 100.0

Holly water/talisman/exorcism 324 31.0 93.1

Herbal extracts/herbs 108 10.3 31.0

Closure of feeding 84 8.0 24.1

Heals spontaneously 180 17.2 51.7

------- ----- -----

Total responses 1044 100.0 300.0

35. Among the interviewed respondents, 96.6% described "massaging warm oil/garlic-warm oil in chest" as the traditional/folk treatment for the respiratory infections including pneumonitis in the rural Bangladesh. About 72.4% opted for "ingesting tulsi/other herb extracts", whereas, 48.3% and 31% had opted for "drinking honey with or without hot water" and "eating onion-rice" respectively. About 10.3% opted for "spontaneous healing" signifying potential public risk in the disease still prevailing in rural Bangladesh.

Traditional beliefs, lack of education, lack of information and also the poverty etc. factors are responsible for their options for respiratory tract infections.

-The respondents informed about the various health care behaviors related with indigenous remedies for respiratory infections. But the important most issue is the 10.3% respondents, who informed about the spontaneous healing processes, which may result in grave conditions some times as the patients are not given any treatment.

Traditional/folk treatment of respiratory infection

Pct of Pct of

Count Responses Cases

Massaging warm oil/garlic-worm oil in th 336 33.7 96.6

Hot water drinking/gargling 96 9.6 27.6

Ingesting tulsi/other herb extracts 252 25.3 72.4

Drinking honey with or without hot water 168 16.9 48.3

Eating onion-rice 108 10.8 31.0

Heals spontaneously 36 3.6 10.3

------- ----- -----

Total responses 996 100.0 286.2

36. Among the interviewed respondents, it was curiously unveiled that 62.1% stated the traditional/folk treatment or remedy of RTI/STD as "coitus with virgin/fresh women"! Again 55.2% described "ingesting herbal extracts" as the traditional/folk treatment of RTI/STD, whereas another 69% had opted for "ingesting country elixirs (Saribadi salsa etc). Only 34.5% and 20.7% had been accounted for the more scientific approaches like "irrigating/washing genital organs with saline" and "drinking excess of water" respectively. However, 34.5% opted for potentially risky "heals spontaneously". These harmful knowledge are the results of partially the traditional beliefs, partially for the lack of the proper information in the RTI/STD in the rural areas. Here also the education, poverty and the prohibition of the information flow are the causative factors to retain this knowledge. When the issue becomes forbidden, imaginary information are usually added to that issue, fabrications are made. So, it is better to arrange a limited information flow in the community even on the most forbidden issue to avoid such harmful beliefs and to restrict malicious practices.

-This finding reveals some of the most interesting findings of this study. It is necessary to look after the health care behaviors of the population to design any fruitful and outcome oriented health policy but to do that with appropriate carefulness for the sensitive issues. However, community based strong participatory programs should be taken in right direction to diffuse the confusions and the malpractices in a community’s health care behaviors like the one as "coitus with a virgin to be cured from any venereal disease"! In no circumstances, that can be allowed, but the knowledge dissemination about the etiology and remedy of any venereal disease should be conducted with sufficient skills and through the respects to the indigenous good values of the community.