HEALTH RELATED QUALITY OF LIFE AMONG THE RANA PLAZA TRAGEDY SURVIVORS IN THE COMMUNITY.

Purpose: The purpose of the study was to identify Health-related Quality of life among Rana Plaza tragedy survivors in the community. Methodology : Study was conducted through Cross-sectional study design among 50 participants of Rana Plaza survivors who were selected by convenient sampling technique. SF-36 questionnaire was used to conduct the research and data was analysed by SPSS. Results: Mean age of the participants was 32.74 years and SD was 6.963.


Introduction:-
Bangladesh is one of the most disaster-prone nations in the world. The geographical location, land characteristics, multiplicity of rivers and the monsoon climate render Bangladesh highly vulnerable to natural hazards (UNOPS, 2008). Natural disaster is the significant cause for mortality, morbidity, and disability and most of the disability occurs due to high numbers of traumatic injuries that severely impact health of the injured population and the overall health system of the affected country (Phalkey et al., 2011).
In recent Bangladeshi people have face some manmade disaster and Rana Plaza tragedy was one of them. On 24th April 2013, Bangladesh skilled a sad prevalence and it became the maximum bad occurrence than preceding which is known as "Rana Plaza Tragedy".Rana Plaza situated at Savar sub district in Dhaka suddenly collapsed around 9 o"clock in the morning.Its miles one of the Worst tragedies of building collapse in the history of the field which took greater than 1000 lives. Approximately 1129 people died due to crumble of the building and extra than 2000 human beings are dwelling without or with disabilities in Bangladesh (WHO, 2013).
Rana Plaza built as a nine-storied building in Savar that housed 4 garment factories with a selection of stores. Despite of the fact that Rana Plaza had allow building a five-storied constructing for stores and residential accommodation, the owner made it nine testimonies. The Bangladeshi information media stated that inspection groups determined cracks in the shape of Rana Plaza on Tuesday (the day before disintegrate). Stores and a financial institution department at the decrease flooring have been at once closed (Malkin, 2014). But, the proprietors of the garment factories on the top floors ordered employees to work on Wednesday (the day of collapse), without any protection to prevent the risk. Jahangir (2013) said in a piece of writing that once Rana plaza incident, the rescue teams through their super efforts succeeded to store 2465 lives from the rubbles. It is predicted that more or less 3122 people were trapped interior. consistent with WHO document it's far located that approximately 1127 survivors died on the spot and health facility, about 1,885 humans were discharged through may also 2, 2013 (after one week) with receiving instant treatments from specific hospitals.
Consequently, we encounter a few tragic and sad incidents because of over population, proprietor careless mindset, absence of regularity authority and "danger" taking tendencies of the unsafe workers as this job is primarily the sole profits of the families. In Bangladesh, humans are familiar with constructing disintegrate incidents; the building collapsing records are not always unknown with those who are conducting production zone. Clothes manufacturing unit related uncertain instants are going to be horrible day by day. The Tajrneen factory fire, Bipail building collapse, Tejgaon building collapse, Sankharibazar building collapse is are some of the tragedies now(Alvi, 2014). Building collapses are a major motive of mortality and morbidity around the area. Within the remaining decade, some of building has collapsed causing a full-size wide variety of deaths and illness. In current years, high and middle earnings nations like America, South Korea, Turkey, Austria, and China have experienced screw ups due to collapsed building(BBC news, 2014).
The world health organization define quality of life (QoL) as "an individual perception of his/her position in life in the context of the culture and value systems in which he or she lives, and in relation to his/ her goals, expectations, standards, concern". According to this definition, Quality of life is a complex concept. Entailing the people"s physical health and level of independence, as well as psychological wellbeing, social perception and the relationship with specific and relevant aspects of the environment (Hill et al., 2010).
When any disasters occur, disaster management institutions and health care institutions have to provide major services. Quality and efficiency of these emergency services depend on the degree of the comprehensiveness of the disaster management plan available resources. So hospital function is very extensively related to the management of earthquake management and its recovery. Unlike to other disasters, earthquakes can damage the hospital severely. Hospital can be damaged structurally and non-structurally (Urmi et al., 2014).
Living with an injury or disability affect the ones quality of life and after any damage or building collapse who are survive after this accident it makes an enormous effect on their physical, mental, social, psychological life (Hyeon,2007). Therefore, the researcher is involved to find out the health-related quality of life of the existing survivors who've face that terrible tragedy (Rana plaza), is probably affected undoubtedly or harmfully on their physical, mental, psychosocial satisfactory of life.

Study design
A quantitative research model in the form of a cross-sectional type survey design is used Cross sectional study (also called a prevalence survey) aim at describing and quantifying the distribution of certain variables in a study population at point of time. It provides a snapshot of the health experience of a population at a given time (Hannan, 2007).

study area
It is being worked for persons with disabilities to reintegrate them at their community life. The investigator was chosed Savar, Dhamrai upazilla and Manikgonj district as a study area for collecting data.

Study population
"Rana Plaza" tragedy survivors in the community who lives in Savar, Dhamrai Upazila and Manikgonj district.

Sampling procedure
In the study here used convenient sampling technique, considering the inclusion and exclusion criteria.

Sampling technique
After taking permission from the ethical body of BHPI, the investigator wascollected a list of people of Rana plaza victims. Researcher also observed the persons with disabilities who had survived after the breakdown. Those participants had fulfilled inclusion criteria they were the participants of the study.

Sample sizes
Sampling procedure for cross sectional study done by following equation-

{ } ×pq
Here, = 1.96 d = 0.05 p = 0.84 (Liang, 2016). q = (1-p) = (1-0.84) =0. 16 According to this formula of sample size calculation, the actual sample size was about 211 but due to the limitation of time 50 samples was collected as my target data because that number is very easy for me to collect and to analyse the data.

Data collection procedure
Before data collection, researcher was first introduced himself to the participants & took verbal consent. Then provide written consent form to the participant, and after signed the consent form, data was collected through a questionnaire from the participants by face to face conversation. In the questionnaire, there was participant"s demographic information including age, sex, educational level, marital status, previous occupation etc. along with questionnaire of SF-36.

Data analysis
After complete the initial data collection, every questionnaire was check again to find out any mistake or unclear information. Then data wasanalyzed through Statistical package of social science (SPSS) version 20 and data was levelled in Microsoft Excel worksheet and arranged in results. Then data wasanalyzed through descriptive statistics and descriptive statistics was used to fulfil research objectives.

Ethical considerations
The proposal of the dissertation was presented to the Institutional Review Board (IRB) of Bangladesh Health Professions Institute (BHPI). Ethical permission was taken from IRB to conduct the study. The whole process of this research project was done by following the Bangladesh Medical Research Council (BMRC) guidelines and World Health Organization (WHO) Research guidelines. Verbal and written inform consent was taken from every patient. And ensure every patient that they can leave any time during data collection. The researcher strictly maintained the confidentiality regarding participant"s condition and treatment.

Vitality
Variable   (2012) has revealed in his study that after any disaster the female exposure suffers a lot than male due to their physical structure and cultural aspect, in that study about 60% participants were female survivors.
One article showed that most of the respondents among the survivors surveyed are women. Out of the 1300 survivors surveyed, 35% were men and 65% were women. Majority of the respondents are young with 32%aged between 21-25 years and 30% between 26-30 years. Of them, 76% are married, 17% are single, 3% are widowed and 4% each are divorced and separated.
Zhang et al. (2012) has mentioned in their study that after SICHUAN earthquake in China; most of the survivors were females with fractures rather than male. In case of garments working sectors, females are highly getter than male workers. Therefore, the study participants are smaller than other study, thus why it does not match with other statistics of Bangladeshi garments sector. In case of their marital status, about 2% were unmarried, 98% were married. The number of married men and women worker with children are higher than no child workers (Monitoring the Rana Plaza Follow-ups 2013). In Bangladesh, one study in garments factory says that about 53% garments worker are married and secondly 36% are unmarried where divorce persons rate is 6% (Chowdhury &Ullah, 2010). Among all of the participants, about 12% participants have never attended on any formal education and 68% of the participant has completed primary education, 18% of the participant has finished their S.S.C level and 2% of the participant has completed their H.S.C level. In Bangladesh, the garments workers are poor and their educational qualifications are not significant (Bhuiyan, 2012). Chowdhury and Ullah, (2010) said that in Bangladesh, most of the garment workers" educational level is between class I-IV (38%) and between classes VI-X for about 28% in Chittagong district. Generally, the survivors" educational level is poor in fact they have shown risk taking behaviour for their livelihood but have also poor awareness about building collapse impact.
A survey was done by Action aid at 2015; here they found that 52 percent survivors got engaged in various types of wage and self-employment. 48 percent survivors claimed that they are currently unemployed. The previous (2015) survey found that 55 percent survivors were unemployed during the survey conducted, while 44 percent survivors were engaged in various types of wage and self-employment, and only 0.6 percent survivors claimed that they were not able to work. Among the 50 participants 42% of the participants are involved in job among them 68.1% were involved with selfemployment and 38.1% worked in a non-government organization and 58% are struggling without any job due to poor financial support and physical impairments.
Among the participants most of the survivor"s injury type was musculoskeletal 64%, lower limb amputee survivors were 6%, Fracture survivors was 26%, spinal cord injury survivors was 2% and 2% others survivors. In India, after earthquake, huge numbers of buildings were collapsed. It is found that most of the survivor (23%) was diagnosed with upper extremity fracture and about 18% are diagnosed with head injury. Therefore, the situations are little bit similar. On the other hand Yang (2013) state that female were get more injured than male workers.
In this study, for the eight subscales, total scores may range from 0 to 100. Each scales ranging from 0 (presence all problems) to 100 (no problems at all) with in the dimension (Roux et al., 2004). In this study total participant was 50, among the participants 42% (n=21) had a lot of limitation in vigorous activities, 26% (n=52) had little limitation in vigorous activities and 6% (n=3) had no limitation in vigorous activities. The study also shows that 6% (n=3) had lot of, 66% (n=33) had little, 28% (n=14) had no limitation in moderate activities. 12% (n=6) had lot of, 58% (n=29) had little, 30% (n=15) had no limitation on carrying heavy objective. 36% (n=18) had lot of, 52% (n=26) had little and 12% (n=6) had no limitation on climbing several flights stairs, 18% (n=9) had lot of, 50% (n=25) had little, 32% (n=16) had no limitation on climbing one flights stairs. 34% (n=17) had lot of, 50% (n=25) had little, 16% (n=8) no limitation on forward bending, 30% (n=15) had lot of, 56% (n=28) had little and 14% (n=7) had no limitation on walking more than one kilometer. 2% (n=1) had lot of, 20% (n=10) had little and 78% (n=39) had no limitation on bathing or dressing by own. Here maximum physical functioning is 100.00% and minimum physical functioning is 25.00% and mean and standard deviation is 54.  In Action aid 2015 they found that 78.8% survivors reported that their condition is more or less stable. 14.6% who reported that their condition is deteriorating listed headache, difficulty in movement, pain in hand and leg, back pain as some of the major problems.
Among the participants mean of the role emotion was 75.40 according to SF-36 this range was good and the mean physical functioning was 54.50, vitality was 55.73, mental health was 56.73, social functioning was 53.60 according to SF-36 this range was moderate score and the general health of participants mean was 40.20, role physical, bodily pain was 45.15 according to SF-36 this range was poor. So among the participants their physical health quality of life was poor and mental health quality of life was fair.
Yiang 2013 found on his research the HRQOL of earthquake is relatively poor, especially in the GH, MH, SF, VT and so on. He found on his research some factors that influence the HRQOL, which were health, gender, education, monthly income and age that significantly affect the HRQOL in survivors.

Association between demographic factors and overall quality of life: Association between Age and health related quality life
Regarding survivors age, there was significant association between Rana Plaza survivors" age and the vitality of domains of SF-36. Tsai et al., (2007) has mentioned that the survivors" age and quality of life have significant association where the younger aged quality of life is good than older survivors.

Association between sex and quality of life
Study shows there is no significant association between survivor"s sex and quality of life that. Ceyhan &Aykut, (2007) and Nuhu et al. (2013) have mentioned in their study that the male survivors have poor quality of life than females. In Asian context the males are the main income personnel for family members.

Association between type of injury and health related quality of life
There was no significant association between type of injury and health related quality of life.

Association between Education and health related o quality of life
Among the survivors there was significant association between education and quality of life. Regarding survivors who have educational background they have good physical functioning and health.

Association between income and health related o quality of life
Income is significantly associated with survivors HRQOL. Those incomes more their HRQOL is significantly good. Yiang 2013 found on his research the HRQOL is associated with income also.

Conclusion: -
Now-a-days, building collapse in Bangladesh is a significant and traumatic experience. Some risk factors such as gender, type of disabilities and diagnosis after the event can affect the HRQOL and health prospect with their physical, social, psychological and environmental aspect of survivors. Among the survivors their physical health is poor and mental health is fair. People are still struggling with their life in the community. Some people are who working on the community they are now still suffering post-traumatic stress. Though the governmental and nongovernmental organization helped them lot but this is not sufficient for them. Some of them requaire further treatmeant but they are not continuing thier treatment due to thier poor economical statusand this situation indirectly create a bad impact into their life. so the goverment and non-government organization should take necessary steps for provide support to the survivors and try to improve their health status to live with a quality full health within community.