Browsing by Author "Aktar, Bachera"

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A controlled before-and-after perspective on the improving maternal, neonatal, and child survival program in rural Bangladesh: an impact analysis
(© 2016 Public Library of Science, 2016-09) Rahman, Mahfuzar T.; Yunus, Fakir Md; Yunus, Fakir Md; Shah, Rasheduzzaman; Jhohura, Fatema Tuz; Mistry, Sabuj Kanti; Quayyum, Tasmeen; Aktar, Bachera; Afsana, Kaosar
Objectives We evaluated the impact of the Improving Maternal, Neonatal, and Child Survival (IMNCS) project, which is being implemented by BRAC in rural communities in Bangladesh. Methods Four districts received program intervention i.e. trained community health workers to deliver essential maternal, neonatal, and child healthcare and nutrition services while two districts were treated as comparison group. A quasi-experimental study design (compared beforeand-after) was undertaken. Baseline survey was conducted in 2008 among 7200 women followed by end line in 2012 among 4800 women with similar characteristics in the same villages. We evaluated maternal antenatal and post natal checkup, birth plans and delivery, complication and referred cases during antenatal checkup and post natal period, and child health indicators such as birth asphyxia, neonatal sepsis, and its management by the medically trained provider. Findings Increased number (four or more) antenatal visits, skill-birth attended delivery and postnatal visits (three or more) in the intervention group preceding four-year intervention period were observed compare to their counterpart. We noted negative difference-in-difference estimator (-5.0%, P = 0.159) regarding to the all major birth plans i.e. delivery place, birth attendant, and saved money in the comparison areas. Significant reduction of ante-partum and intra-partum complications occurred in the intervention group, contrary complications of such event increased in the comparison areas (-6.3%, P<0.05 and-20.5%, P<0.001 respectively). Referral case to the health centers due to these complications boosted significantly in intervention group than comparison group (2.3%, P<0.01 and 6.6%, P<0.001 respectively). Mother's knowledge of breastfeeding initiation and the practice of initiating breastfeeding within an hour of birth amplified significantly (14.6%, P<0.001 and 8.3%, P<0.001 respectively). We did not find any significant difference regards to the management of low birth weight by the medically trained health care provider and complete vaccination between the intervention and comparison arm. Conclusion Medically trained health care provider assisted community based public health intervention could increase number of antenatal and postnatal visit, thereby could decrease pregnancy associated complications. These interventions may be considered for further up scaling when resources are limited.
A controlled before-and-after perspective on the improving maternal, neonatal, and child survival program in rural Bangladesh: an impact analysis
(© 2016 Public Library of Science, 2016-09) Rahman, Mahfuzar T.; Yunus, Fakir Md; Yunus, Fakir Md; Shah, Rasheduzzaman; Jhohura, Fatema Tuz; Mistry, Sabuj Kanti; Quayyum, Tasmeen; Aktar, Bachera; Afsana, Kaosar
Objectives We evaluated the impact of the Improving Maternal, Neonatal, and Child Survival (IMNCS) project, which is being implemented by BRAC in rural communities in Bangladesh. Methods Four districts received program intervention i.e. trained community health workers to deliver essential maternal, neonatal, and child healthcare and nutrition services while two districts were treated as comparison group. A quasi-experimental study design (compared beforeand-after) was undertaken. Baseline survey was conducted in 2008 among 7200 women followed by end line in 2012 among 4800 women with similar characteristics in the same villages. We evaluated maternal antenatal and post natal checkup, birth plans and delivery, complication and referred cases during antenatal checkup and post natal period, and child health indicators such as birth asphyxia, neonatal sepsis, and its management by the medically trained provider. Findings Increased number (four or more) antenatal visits, skill-birth attended delivery and postnatal visits (three or more) in the intervention group preceding four-year intervention period were observed compare to their counterpart. We noted negative difference-in-difference estimator (-5.0%, P = 0.159) regarding to the all major birth plans i.e. delivery place, birth attendant, and saved money in the comparison areas. Significant reduction of ante-partum and intra-partum complications occurred in the intervention group, contrary complications of such event increased in the comparison areas (-6.3%, P<0.05 and-20.5%, P<0.001 respectively). Referral case to the health centers due to these complications boosted significantly in intervention group than comparison group (2.3%, P<0.01 and 6.6%, P<0.001 respectively). Mother's knowledge of breastfeeding initiation and the practice of initiating breastfeeding within an hour of birth amplified significantly (14.6%, P<0.001 and 8.3%, P<0.001 respectively). We did not find any significant difference regards to the management of low birth weight by the medically trained health care provider and complete vaccination between the intervention and comparison arm. Conclusion Medically trained health care provider assisted community based public health intervention could increase number of antenatal and postnatal visit, thereby could decrease pregnancy associated complications. These interventions may be considered for further up scaling when resources are limited.
Assessing informed consent practices during normal vaginal delivery and immediate postpartum care in tertiary-level hospitals of Bangladesh
(European Journal of Midwifery, 5/21/2019) Karim, Md Abdul; Ahmed, Syed Imran; Ferdous, Jannatul; Islam, Bushra Zarin; Tegegne, Henok Ayalew; Aktar, Bachera
INTRODUCTION This study was conducted to assess the informed consent practices during normal vaginal delivery (NVD) process and immediate postpartum care in the tertiary-level hospitals of Bangladesh. METHODS A cross-sectional study was conducted at Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in November 2015. The study population and respondents were mothers who gave normal vaginal childbirth within the past 24 hours and received postpartum care in the study sites (N=190). The interview of every alternate mother from the patient register was conducted by researchers using a structured questionnaire. Descriptive analysis of findings was carried out using MS Excel 2013. RESULTS The study findings revealed the complete absence of informed consent practices during NVD and postpartum care in the tertiary-level hospitals in Bangladesh. Consent (not informed consent) was taken from 95% of the mothers before proceeding with the NVD process, 50–72% of examinations (except breast examination, 0%) and 8–72% of procedures during postpartum care. Choice and preferences of mothers for taking an alternative process/examination/procedure were absent in all cases. CONCLUSIONS The Respectful Maternity Care (RMC) Charter endorsed informed consent as one of the basic rights of child-bearing women. Absence of informed consent practices in the study sites indicates disrespect to maternity care and violation of this right. The Standard Clinical Management Protocols of Bangladesh also lacks clarification of this right. Improvement of the existing protocol, increased awareness and practices are essential to address protection of this right.
Challenges and strategies in conducting sexual and reproductive health research among Rohingya refugees in Cox’s Bazar, Bangladesh
(BMC, 12/14/2020) Ahmed, Rushdia; Aktar, Bachera; Farnaz, Nadia; Ray, Pushpita; Awal, Abdul; Hassan, Raafat; Bin Shafique, Sharid; Hasan, Md Tanvir; Quayyum, Zahidul; Jafarovna, Mohira Babaeva; Kobeissi, Loulou Hassan; El Tahir, Khalid; Chawla, Balwinder Singh; Rashid, Sabina Faiz
Background: Rohingya diaspora or Forcibly Displaced Myanmar Nationals (FDMNs), took shelter in the refugee camps of Cox’s Bazar, Bangladesh due to armed conflict in the Rakhine state of Myanmar. In such humanitarian crises, delivering sexual and reproductive health (SRH) services is critical for better health outcomes of this most-at-risk population where more than half are adolescent girls and women. This is a reflective paper on challenges and related mitigation strategies to conduct SRH research among FDMNs. The research on which this paper is based employed a concurrent mixedmethod design combining a cross-sectional survey and qualitative interviews and group discussions with FDMNs to understand their SRH needs and demand-side barriers. Assessment of health facilities and qualitative interviews with healthcare providers and key stakeholders were carried out to assess facility readiness and supply-side barriers. Challenges and strategies: The researchers faced different challenges while conducting this study due to the unique characteristics of the FDMN population and the location of the refugee camps. The three key challenges researchers encountered include: sensitivity regarding SRH in the FDMNs, identifying appropriate sampling strategies, and community trust issues. The key approaches to overcome these challenges involved: actively engaging community members and gatekeepers in the data collection process to access respondents, identifying sensitive SRH issues through survey and exploring in-depth during qualitative interviews; and contextually modifying the sampling strategy. Conclusion: Contextual adaptation of research methods and involving community and local key stakeholders in data collection are the key lessons learnt from this study. Another important lesson was researchers’ identity and positionality as a member of the host country may create distrust and suspicion among the refugees. The multi-level complexities of humanitarian settings may introduce unforeseen challenges and interrupt research plans at different stages of research which require timely and contextual adaptations.
Engagement of husbands in a maternal nutrition program substantially contributed to greater intake of micronutrient supplements and dietary diversity during pregnancy: Results of a cluster-randomized program evaluation in Bangladesh
(Oxford Academic, 8/1/2018) Nguyen, Phuong Hong; Frongillo, Edward A; Sanghvi, Tina; Wable, Gargi; Mahmud, Zeba; Tran, Lan Mai; Aktar, Bachera; Afsana, Kaosar; Alayon, Silvia; Ruel, Marie T; Menon, Purnima
Background: Although husbands may provide support during pregnancy, limited evidence exists on how to promote husbands' engagement and what impact it has. Alive & Thrive integrated nutrition-focused interventions, targeting both wives and husbands, through an existing Maternal, Neonatal, and Child Health (MNCH) platform in Bangladesh. Objectives: We evaluated 1) the impact of a nutrition-focused MNCH program, compared with the standard MNCH program, on husbands' behavioral determinants (i.e., awareness, knowledge, self-efficacy) and support to wives to adopt optimal nutrition practices and 2) how much of the previously documented impact on women's supplement intake and dietary diversity was explained by husbands' behavioral determinants and support. Methods: We used a cluster-randomized design with cross-sectional surveys at baseline (2015) and endline (2016) (n = ∼1000 women and ∼700 husbands/survey). We used mixed linear regression accounting for clustering to estimate difference-in-differences (DIDs) for impact on husbands' behavioral determinants and path analysis to examine how much these determinants explained the impact on women's nutrition behaviors. Results: Of husbands in the nutrition-focused MNCH group, 62% were counseled by health workers, 66% attended a husbands' forum, and 34% saw video shows. The nutrition-focused MNCH, compared with the standard MNCH group, resulted in greater husbands' awareness (DID: 2.74 of 10 points), knowledge (DID: 1.31), self-efficacy and social norms with regard to optimal nutrition practices (difference: 1.08), and support to their wives (DID: 1.86). Husbands' behavioral determinants and support explained nearly half of the program impact for maternal supplement intake and one-quarter for dietary diversity. Conclusions: A nutrition-focused MNCH program that promoted and facilitated husbands' engagement during their wives' pregnancies significantly improved husbands' awareness, knowledge, self-efficacy, and support. These improvements substantially explained the program's impact on women's intake of micronutrient supplements and dietary diversity. Targeting wives and husbands and designing activities to engage men in maternal nutrition programs are important to maximize impact. This trial was registered at www.clinicaltrials.gov as NCT02745249.
Ethics and methods for collecting sensitive data: Examining sexual and reproductive health needs of and services for Rohingya refugees at Cox’s Bazar, Bangladesh
(The International Journal of Information, Diversity, & Inclusion, 7/13/2020) Aktar, Bachera; Ahmed, Rushdia; Hassan, Raafat; Farnaz, Nadia; Ray, Pushpita; Awal, Abdul; Bin Shafique, Sharid; Hasan, Md Tanvir; Quayyum, Zahidul; Rashid, Sabina Faiz
During humanitarian emergencies, such as the forced displacement of the Rohingya diaspora, women and adolescent girls become highly vulnerable to sexual and reproductive health (SRH) issues and abuse. Although sensitive in nature, community-driven information is essential for designing and delivering effective community-centric SRH services. This article provides an overview of the theoretical framework and methodologies used to investigate SRH needs, barriers, and challenges in service-delivery and utilization in the Rohingya refugee camps in Cox’s Bazar, Bangladesh. It also offers insights on important methodological and ethical factors to consider while conducting research in a similar context.A concurrent mixed-method study was undertaken in ten randomly selected Rohingya refugee camps between July and November2018. The design consisted of a cross-sectional household survey of 403 Rohingya adolescent girls and women, along with an assessment of 29 healthcare facilities. The team also completed in-depth interviews with nine adolescent girls, 10 women, nine formal andnine informal healthcare providers, key informant interviews with seven key stakeholders and seven influential community members. Lastly, three focus group discussions were undertaken with a group of 18 Rohingya men. Our theoretical framework drew from the socio-ecological models developed by Karl Blanchet and colleagues(2017) insofar as they considered a multiplicity of related contextual and cross-cutting factors.Building good rapport with community gatekeepers was key in accessing and sustaining the relationship with the various respondents. The data collected through such context-specific research approaches is critical in designing community-centric service-delivery mechanisms, and culturally and gender-sensitiveSRH interventions in humanitarian crises.
Exploring adolescent reproductive health knowledge, perceptions, and behavior, among students of non-government secondary schools supported by BRAC mentoring program in rural Bangladesh
(Journal of Asian Midwives (JAM), 2014-09) Aktar, Bachera; Sarker, Malabika; Jenkins, Andrew
Adolescence is the transition period from childhood to adulthood. Since Bangladesh is such a conservative society, reproductive health education for adolescents has not been widely introduced. Very small adolescent health components are included in the secondary and higher secondary school curricula. The BRAC Mentoring Program provides mentorship training to secondary school pupils to develop them as peer leaders. However, this program does not provide adolescent reproductive health education. Therefore, a study, supported by BRAC Education Program in rural Bangladesh, was conducted to explore the current status of reproductive health knowledge, perceptions and practice among the students of secondary schools. This study was conducted in November 2012 among the students of three secondary schools supported by BRAC Education Program in two sub-districts of Mymensingh district, Bangladesh. The qualitative study explored students’ reproductive health knowledge, perceptions, and behavior. Twenty four In-Depth Interviews and four Focus Group Discussions were conducted with students and four Key Informant Interviews were also conducted with teachers. The findings indicated that there is a lack of knowledge on reproductive health among the adolescent girls and boys of rural secondary schools. The students did not know about physical changes in puberty before the onset of such changes and mostly learnt about them from their own bodily experience. Mothers were the main source of information on menstruation for girls, and in case of boys, friends were the main source of information on wet dreams. All girls had comparatively good menstrual hygiene knowledge and practices. On the other hand, boys had very poor knowledge about wet dreams. Both girls and boys had poor knowledge about sexually transmitted diseases. However, they had better knowledge and perceptions about AIDS, in comparison with other issues of adolescent reproductive health. Though teachers and students felt uncomfortable with the teaching of reproductive health issues in class, but, interestingly, books were found to be the most reliable source of information for the students. Most of the students and teachers felt that the available information was inadequate for the adolescents. The study findings also showed that adolescent boys and girls had limited knowledge about reproductive health. Therefore, it is recommended that BRAC Education Program needs to provide adolescent reproductive health education in the school through peer education approach and provide special training to the teachers on teaching reproductive health education in class as well.
Exploring the experiences of community health workers during covid-19 pandemic in urban slums of Dhaka city
(BRAC University, 2021) Nyara, Baba James; Rashid, Sabina Faiz; Aktar, Bachera
Introduction: Community Health Workers (CHWs) are largely female who are employed by different private and public organizations with an aim to bridge the gap between formal healthcare and community, primarily working in rural and urban settings in Bangladesh. However the COVID-19 pandemic has posed unique challenges in urban slums of Dhaka because dwellers live in overcrowded spaces, lack access to WASH facilities and experience poverty which undermine COVID-19 prevention measures. In this context, CHWs play vital roles such as awareness, relief distribution and contact tracing to combat the spread of COVID-19. This study explored their experiences during the shutdown for service delivery organizations to recognize them as essential workforce. Method: The study drawn from 19 qualitative data transcripts from a larger research conducted by James P. Grant School of Public health at BRAC University which explored experiences of urban slums dwellers including CHWs during the COVID-19 shutdown in urban slums of Dhaka. Data was collected on phone from participants and coded inductively after organizing and categorizing according to themes and later placed on data matrix for easy visualization, analysis and interpretation. Findings: CHWs play key role in fighting COVID-19 in urban slums by linking the community and formal health care but they face challenges that include, disrupted personal and social lives, non-recognition and mistrust, increased workload, community expectations, poor remuneration and mental and emotional distress. Conclusion: The current COVID-19 situation has resulted to unprecedented challenges that affect the health and wellbeing of CHWs in urban slums in Dhaka, therefore government and service delivery organizations are urged to recognize CHWs as essential health workforce and implement feasible measures such as work shifts and leaves, improved remuneration, counseling support and regular training to enhance their performance. It is important to conduct additional exploratory research in other slums to generate more evidence.
How to prevent and address safeguarding concerns in global health research programmes: Practice, process and positionality in marginalised spaces
(BMJ Journals, 5/13/2020) Aktar, Bachera; Alam, Wafa; Ali, Samiha; Awal, Abdul; Bayoh, Margaret; Chumo, Ivy; Contay, Yirah; Conteh, Abu; Dean, Laura; Dobson, Skye; Edstrom, Jerker; Elsey, Helen; Farnaz, Nadia; Garimella, Surekha; Gray, Linsay; Gupte, Jaideep; Hawkins, Kate; Hollihead, Beth; Josyula, Kunhi Lakshmi; Kabaria, Caroline; Karuga, Robinson; Kimani, Joseph; Leyland, Alastair H; te Lintelo, Dolf; Mansaray, Bintu; MacCarthy, Joseph; MacGregor, Hayley; Mberu, Blessing; Muturi, Nelly; Okoth, Linet; Otiso, Lilian; Ozano, Kim; Parray, Ateeb; Phillips-Howard, Penny; Rao, Vinodkumar; Rashid, Sabina; Raven, Joanna; Refell, Francis; Saidu, Samuel; Sobhan, Shafinaz; Saligram, Prasanna Subramanya; Sesay, Samira; Theobald, Sally; Tolhurst, Rachel; Tubb, Phil; Waldman, Linda; Wariutu, Jane; Whittaker, Lana; Wurie, Haja
Safeguarding is rapidly rising up the international development agenda, yet literature on safeguarding in related research is limited. This paper shares processes and practice relating to safeguarding within an international research consortium (the ARISE hub, known as ARISE). ARISE aims to enhance accountability and improve the health and well-being of marginalised people living and working in informal urban spaces in low-income and middle-income countries (Bangladesh, India, Kenya and Sierra Leone). Our manuscript is divided into three key sections. We start by discussing the importance of safeguarding in global health research and consider how thinking about vulnerability as a relational concept (shaped by unequal power relations and structural violence) can help locate fluid and context specific safeguarding risks within broader social systems. We then discuss the different steps undertaken in ARISE to develop a shared approach to safeguarding: sharing institutional guidelines and practice; facilitating a participatory process to agree a working definition of safeguarding and joint understandings of vulnerabilities, risks and mitigation strategies and share experiences; developing action plans for safeguarding. This is followed by reflection on our key learnings including how safeguarding, ethics and health and safety concerns overlap; the challenges of referral and support for safeguarding concerns within frequently underserved informal urban spaces; and the importance of reflective practice and critical thinking about power, judgement and positionality and the ownership of the global narrative surrounding safeguarding. We finish by situating our learning within debates on decolonising science and argue for the importance of an iterative, ongoing learning journey that is critical, reflective and inclusive of vulnerable people.
Importance of coverage and quality for impact of nutrition interventions delivered through an existing health programme in Bangladesh
(Wiley Online Library, 2018-10) Nguyen, Phuong Hong; Frongillo, Edward A.; Sanghvi, Tina; Kim, Sunny S.; Alayon, Silvia; Tran, Lan Mai; Mahmud, Zeba; Aktar, Bachera; Menon, Purnima
Understanding implementation of interventions is critical to illuminate if, how, and why the interventions achieve impact. Alive & Thrive integrated a nutrition intervention into an existing maternal, neonatal, and child health (MNCH) programme in Bangladesh, documenting improvements in women's micronutrient supplement intake and dietary diversity. Here, we examined how well the nutrition intervention was implemented and which elements of implementation explained intervention impact. Survey data were collected in 2015 and 2016 from frontline health workers (FLW) and households in areas randomized to nutrition‐focused MNCH (intensified interpersonal counselling, community mobilization, distribution of free micronutrient supplements, and weight‐gain monitoring) or standard MNCH (antenatal care with standard nutrition counselling). Seven intervention elements were measured: time commitment, training quality, knowledge, coverage, counselling quality, supervision, and incentives. Multiple regression was used to derive difference‐in‐differences (DID) estimates. Using village‐level endline data, path analysis was used to determine which elements most explained intervention impacts. FLWs in both areas were highly committed and well supervised. Coverage was high (>90%) for counselling, supplement provision, and weight‐gain monitoring. Improvements were significantly greater for nutrition‐focused MNCH, versus standard MNCH, for training quality (DID: 2.42 points of 10), knowledge (DID: 1.20 points), delivery coverage (DID: 4.16 points), and counselling quality (DID: 1.60 points). Impact was substantially explained by coverage and delivery quality. In conclusion, integration nutrition intervention into the MNCH programme was feasible and well‐implemented. Although differences in coverage and counselling quality most explained impacts, all intervention elements—particularly FLW training and performance—were likely important to achieving impact.
Knowledge and practice regarding menstrual hygiene management among the Rohingya refugee adolescent girls in Cox’s Bazar, Bangladesh: A mixed method study
(Emerald Publishing, 5/15/2021) Rakhshanda, Shagoofa; Ahmed, Sahlil; Saidu, Samuel; Nderitu, Christine; Thapa, Basanta; Awal, Abdul; Farnaz, Nadia; Rahman, Atiya; Aktar, Bachera; Faruque, A.S.G.
Purpose About half of the 16% adolescents in the world experience menstruation. Menstrual hygiene management (MHM) is a health concern and challenge especially in humanitarian situations as experienced by Myanmar Rohingya refugees living in Cox’s Bazar, Bangladesh. This study aims to assess knowledge, practice and influencing factors for MHM among Rohingya refugee adolescent girls of 14–18 years. Design/methodology/approach The study used both quantitative (a cross-sectional survey with 340 adolescent girls through a structured questionnaire) and qualitative (7 in-depth interviews with adolescent girls and 2 focus group discussions with the mothers) approaches. Quantitative data, analyzed using STATA version 13.0, were supported by qualitative data, grouped into themes and presented as matrix. Findings Around 51% adolescent girls learned about menstruation after menarche, at the mean age of 12 years, from their mothers and older sisters. About 75% used sanitary pads as absorbents which they got mostly as relief material or bought from local stores (83%); the rest used cloths and other materials (25%). About 57% of the respondents disposed of their absorbent by burying. Those who used reusable absorbents washed them with soap and water (40%) and mostly dried them indoors (17%). Factors influencing healthy MHM practice included the use of absorbent, privacy, disposal, washing and drying of clothes, physical activities, hygiene and pain management. Adolescents with secondary or higher education were four times more likely to have better MHM practice (odds ratio = 4.27; confidence interval = 1.19–15.31) than those with no formal schooling.
Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: a nested cross-sectional study
(PLOS Medicine, 10/4/2019) Todd, Catherine S.; Chowdhury, Zakaria; Mahmud, Zeba; Islam, Nazia; Shabnam, Sadia; Parvin, Musarrat; Bernholc, Alissa; Martinez, Andres; Aktar, Bachera; Afsana, Kaosar; Sanghvi, Tina
Background Maternal morbidity is common in Bangladesh, where the maternal mortality rate has plateaued over the last 6 years. Maternal undernutrition and micronutrient deficiencies contribute to morbidity, but few interventions have measured maternal outcomes. We compared reported prevalence of antepartum, intrapartum, and postpartum complications among recently delivered women between maternal nutrition intervention and control areas in Bangladesh. Methods and findings We conducted a cross-sectional assessment nested within a population-based cluster-randomized trial comparing a nutrition counseling and micronutrient supplement intervention integrated within a structured home-based maternal, newborn, and child health (MNCH) program to the MNCH program alone in 10 sub-districts each across 4 Bangladesh districts. Eligible consenting women, delivering within 42–60 days of enrollment and identified by community-level health workers, completed an interviewer-administered questionnaire detailing the index pregnancy and delivery and allowed review of their home-based care register. We compared pooled and specific reported antepartum, intrapartum, and postpartum complications between study groups using hierarchical logistic regression. There were 594 women in the intervention group and 506 in the control group; overall, mean age was 24 years, 31% were primiparas, and 39% reported facility-based delivery, with no significant difference by study group. There were no significant differences between the intervention and control groups in household-level characteristics, including reported mean monthly income (intervention, 6,552 taka, versus control, 6,017 taka; p = 0.48), having electricity (69.6% versus 71.4%, p = 0.84), and television ownership (41.1% versus 38.7%, p = 0.81). Women in the intervention group had higher recorded iron and folic acid and calcium supplement consumption and mean dietary diversity scores, but reported anemia rates were similar between the 2 groups (5.7%, intervention; 6.5%, control; p = 0.83). Reported antepartum (69.4%, intervention; 79.2%, control; p = 0.12) and intrapartum (41.4%, intervention; 48.5%, control; p = 0.18) complication rates were high and not significantly different between groups. Reported postpartum complications were significantly lower among women in the intervention group than the control group (33.5% versus 48.2%, p = 0.02), and this difference persisted in adjusted analysis (adjusted odds ratio [AOR] = 0.51, 95% CI 0.32–0.82; p < 0.001). For specific conditions, odds of retained placenta (AOR = 0.35, 95% CI 0.19–0.67; p = 0.001), postpartum bleeding (AOR = 0.37, 95% CI 0.15–0.92; p = 0.033), and postpartum fever/infection (AOR = 0.27, 95% CI 0.11–0.65; p = 0.001) were significantly lower in the intervention group in adjusted analysis. There were no significant differences in reported hospitalization for antepartum (49.8% versus 45.1%, p = 0.37), intrapartum (69.9% versus 59.8%, p = 0.18), or postpartum (36.1% versus 29.9%, p = 0.49) complications between the intervention and control groups. The main limitations of this study are outcome measures based on participant report, non-probabilistic selection of community-level workers’ catchment areas for sampling, some missing data for variables derived from secondary sources (e.g., dietary diversity score), and possible recall bias for reported dietary intake and supplement use. Conclusions Reported overall postpartum and specific intrapartum and postpartum complications were significantly lower for women in intervention areas than control areas, despite similar rates of facility-based delivery and hospitalization for reported complications, in this exploratory analysis. Maternal nutrition interventions providing intensive counseling and micronutrient supplements may reduce some pregnancy complications or impact women’s ability to accurately recognize complications, but more rigorous evaluation is needed for these outcomes.
Mothers’ education and the effectiveness of nutrition programmes: Evidence from a matched cross-sectional study in rural Bangladesh
(Taylor & Francis, 10/14/2020) de Hoop, Thomas; Fallon, Shelby; Yunus, Fakir Md; Munrat, Sabeth; Jolly, Saira Parveen; Sehrin, Farzana; Aktar, Bachera; A Ghani, Ruhina Binta; Sennett, Joshua
BRAC Bangladesh trains community health workers to communicate about nutrition in its Maternal, Newborn and Child Health programme. We estimate the programme’s impact on nutrition outcomes among rural Bangladeshi children of two years and younger. We find positive effects on dietary diversity, and show that the programme reduces stunting with 7 percentage points using data from 1600 households in 40 beneficiary mouzas and 40 comparison mouzas. We find larger effects for households where primary caregivers have finished primary school. We did not find effects on wasting, which in contrast to stunting is higher among children with primary caregivers without education.
Nutrition interventions integrated into an existing maternal, neonatal, and child health program reduce food insecurity among recently delivered and pregnant women in Bangladesh.
(Oxford Academic, 1/13/2019) Frongillo, Edward A; Nguyen, Phuong H; Sanghvi, Tina; Mahmud, Zeba; Aktar, Bachera; Alayon, Silvia; Menon, Purnima
Background: Antenatal care may be a means to reduce food insecurity in pregnancy and postpartum periods. Objective: With the use of a cluster-randomized design, we tested whether participation in nutrition-focused antenatal care intending to improve household knowledge about the importance of nutrition for pregnant and lactating women and encourage allocation of household resources to ensure sufficient quality and quantity of foods, without providing food assistance, would reduce household food insecurity. Methods: Alive & Thrive integrated nutrition interventions into an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. The nutrition-focused MNCH package was delivered in 10 subdistricts through antenatal care visits with the use of interpersonal communication, community mobilization, and monitoring of weight gain, aiming to improve maternal diet quality, quantity, and micronutrient intake during pregnancy and breastfeeding. The package included components that could reduce food insecurity, measured using the Household Food Insecurity Access Scale. To examine the impact of the nutrition-focused MNCH package compared with the standard MNCH package, we used linear and multinomial logit regression models, adjusted for subdistrict clustering, to test differences at endline in items, domains, and categories of food insecurity, after first confirming no differences at baseline. Results: At baseline, nearly half of households were food insecure. At endline, the groups differed in food insecurity, whether expressed as items, domains, or categories, with food insecurity in the nutrition-focused MNCH group 22 percentage points lower than in the standard MNCH group and 20 percentage points lower than at baseline. Conclusions: Participation in nutrition-focused antenatal care reduced household food insecurity among recently delivered and pregnant women. Integration of social and behavioral nutrition interventions into antenatal care with components that promote food security provides a potentially effective means to reduce food insecurity, without incurring high costs of providing supplemental food, in populations where limited resources can be directed towards accessing adequate and appropriate foods. Registered at clinicaltrials.gov as NCT02745249. J Nutr 2019;149:159–166.
Situation analysis for delivering integrated comprehensive sexual and reproductive health services in humanitarian crisis condition for Rohingya refugees in Cox’s Bazar, Bangladesh: Protocol for a mixed-method study
(BMJ, 7/3/2019) Ahmed, Rushdia; Farnaz, Nadia; Aktar, Bachera; Hassan, Raafat; Shafique, Sharid Bin; Ray, Pushpita; Awal, Abdul; Rahman, Atiya; Urbaniak, Veronique; Kobeissi, Loulou Hassan; Rosie, Jeffries; Say, Lale; Hasan, Md Tanvir; Quayyum, Zahidul; Rashid, Sabina Faiz
Introduction Rohingya diaspora are one of the most vulnerable groups seeking refuge in camps of Cox’s Bazar, Bangladesh, arising an acute humanitarian crisis. More than half of the Rohingya refugees are women and adolescent girls requiring quality sexual and reproductive health (SRH) services. Minimum initial service package of SRH are being rendered in the refugee camps; however, WHO is aiming to provide integrated comprehensive SRH services to meet the unmet needs of this most vulnerable group. For sustainable and successful implementation of such comprehensive SRH service packages, a critical first step is to undertake a situation analysis and understand the current dimensions and capture the lessons learnt on their SRH-specific needs and implementation challenges. This situation analysis is pertinent in current humanitarian condition and will provide an overview of the needs, availability and delivery of SRH services for adolescent girls and women, barriers in accessing and providing those services in Rohingya refugee camps in Cox’s Bazar, Bangladesh, and similar humanitarian contexts. Methods and analysis A concurrent mixed-methods design will be used in this study. A community-based household survey coupled with facility assessments as well as qualitative in-depth interviews, key informant interviews and focus group discussions will be conducted with community people of Rohingya refugee camps and relevant stakeholders providing SRH services to Rohingya population in Cox’s Bazar, Bangladesh. Survey data will be analysed using univariate, bivariate and multivariable regression statistics. Descriptive analysis will be done for facility assessment and thematic analysis will be conducted with qualitative data. Ethics and dissemination Ethical approval from Institutional Review Board of BRAC James P Grant School of Public Health (2018-017-IR) has been obtained. Findings from this research will be disseminated through presentations in local, national and international conferences, workshops, peer-reviewed publications, policy briefs and interactive project report.
Urban Health Innovation Challenge 2021: Promoting youth-led, community-centric solutions for building resilient and inclusive cities
(The Daily Star, 2021-06-18) Yeamin, Afsana; Aktar, Bachera