Life Style, Health Behavior and Health Status of different FDMN community people in Rohingya Refugee Settlement, Cox’s Bazar, Bangladesh.

Abstract

Globally, 79.5 million people live outside their country. They are mostly migrants, people who leave their homelands in search of better opportunities. However, over one-third of them are refugees, escaping political violence and other threats in their own country. Currently, the Rohingya refugee issue has become a big humanitarian crisis in Bangladesh. This community has been compelled to leave their home place due to violence. According to the data of the United Nations High Commissioner for Refugees (UNHCR), as of March 2023, 960,539 Rohingya refugees have been registered and issued to be migrated from Myanmar to Bangladesh. This densely populated community is facing many health-related difficulties due to their living conditions, limitation of resources, restricted healthcare access, lack of sanitation etc. In many places, Rohingya camps are mostly overcrowded, with few supplies and major management issues. Because of the crowded living conditions in the camps and the absence of appropriate water, sanitation, and hygiene (WASH) protocols, the refugees are placed in a situation where they pose a significant threat to the health of the general population, particularly at the Kutupalong extension sites. Rohingya people are also exposed to traumatic events related to the war, such as the destruction of property, the loss of family members, witnessing extreme violence, and injuries or losses of property at home earlier etc. These traumatic experiences may result in severe mental health problems among them. Based on these circumstances, we aimed to study the epidemiology and socio-demographic factors associated with different diseases (both communicable and non-communicable) and the impact of health education in improving health behavior, lifestyle and health status of different FDMN communities in the Rohingya Refugee Settlement, Cox’s Bazar, Bangladesh. The other associating objectives were to determine the knowledge, attitude and practices regarding different diseases among the FDMN community, and to estimate the disease burden/occurrence among the community people. To satisfy the requirement of the study objectives a cross-sectional survey was conducted on 3060 Rohingya people living in the refugee camps at Cox’s Bazar in Bangladesh. After receiving voluntary consent, information was gathered through in-person interviews utilizing a language-validated, pretested questionnaire. The questionnaire was developed on socio-demography, knowledge, awareness, attitude and behavioral practices, disease burden and impact of health education-based variables. The questions were designed on that particular variable/s with suitable options rationally. A non-probability purposive sampling method has been used in this study. In chapter one based on the first objective, we observed that the knowledge, attitude and practice variables had significant association with different diseases when the respondents were asked abouttheir knowledge, attitude and practices on different diseases and related issues. Here 64% of respondents believed that eating regular meals in time is important for health. Around 53% thought that sanitary latrine is important to prevent different water-borne diseases. Also, 62% of respondents mentioned that consulting doctor immediately is important in case of any clinical conditions. However, still 36% respondents believed that TB, Cancer and HIV are the result of great sin. About 58% of respondents were used to wash hands before meals and after toilet properly with soap. About 54% of respondents used to treat or boil water to drink. About 41% of respondents used to cut nails regularly and 69% of respondents used anti-mosquito nets/coils/spray at home. About 36% respondents used to clean bushes and water containing pots regularly to prevent mosquito breeding. In chapter two based on objective two, we evaluated the knowledge level of the study participants on different communicable and non-communicable diseases. We revealed that 84% of the respondents knew about water-borne diseases, 81% knew about transmission of water borne diseases and 78% of respondents knew about the signs and symptoms of water-borne diseases. About 68% of respondents could identify A, B complex, C, D, E and K as examples of vitamins, where 24% identified K, Fe, Zn, Cu and 8% identified Na, I, Ca and electrolyte as vitamins. Around 72% respondents identified Cholera, Typhoid, Diarrhea, Dysentery and Giardiasis as examples of water-borne diseases and 69% identified Malaria, Dengue and Chikunguniya as mosquito-borne diseases correctly. Moreover, 39% of respondents correctly identified sexually transmitted diseases like Gonorrhoea, Syphilis, HIV and Viral Hepatitis. Pneumonia, Influenza, COVID-19 and TB were identified correctly as respiratory diseases by 49% of respondents. Again when the respondents were asked about examples of non-communicable diseases, 48% replied about Diabetes, Hypertension, MI, Dyslipidemia, Stroke and Osteoporosis. In chapter three based on objective three, we assessed the impact of health education on the knowledge, attitude and practice of health-related behavior of the respondents. We observed that, 71% of respondents are currently using anti-mosquito nets/coils/spray compared to 57% in 6 months back. Around 68% of respondents found practising hand washing properly before meal and after toilet with soap compared to 51% during 6 months back. It was seen that 61% of the respondents knew about essential nutrients whereas it was 47% during 6 months back. Again 73% of respondents thought that fruits and vegetables are good sources of vitamins and minerals which was recorded as 68% in 6 months back. 78% of respondents used to wash fruits, vegetables and other raw foods before consumption which was 61% before 6 months. Also seen that 66% of respondents believed that a healthy lifestyle and healthy food habits can prevent diseases whereas 52% thought similar in 6 months earlier. xv In chapter four based on objective four it was observed that socio-demographic variables had a significant association with different diseases knowledge and practice part. Age groups were significantly associated with the practice part when the respondents were asked about washing hands after defecation with soap (p<0.05). Gender was significantly associated with the practice part when the respondents were asked about cooking foods properly (p<0.001). Age groups had a significant association with knowledge of TB (p<0.05). Age groups were significantly associated with knowledge of mosquito-borne diseases (p<0.001) and on the causes of Mosquito-borne diseases (p<0.001). Monthly family income had a significant association with taking sufficient fruits and vegetables regularly (p<0.05) and having regular meals (p<0.05). According to this study, we found that socio-demographic characteristics and health education had a significant effect on the health behavior and knowledge, attitude and practice towards different communicable and non-communicable diseases in the respondents. The findings showed that age and education shape health knowledge and attitudes. Health education's impact on Rohingya refugees is consistent with other refugee studies, indicating its value in improving health outcomes. Besides these, there was a noticeable impact of health education in improving the knowledge, attitude and practices regarding different health issues. Nevertheless, it is imperative to acknowledge the limitations of the study and take them into account when interpreting the results. Additional research is required in various refugee settings to corroborate and build upon the existing discoveries, thereby augmenting the efficacy of healthcare interventions for marginalized populations on a global scale.