Journal Articles (2021)

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Prevalence and associated factors of depression among adolescent boys and girls in Bangladesh: Findings from a nationwide survey
(BMJ Journals, 1/17/2021) Mridha, Malay Kanti; Hossain, Md Mokbul; Khan, Md Showkat Ali; Hanif, Abu Abdullah Mohammad; Hasan, Mehedi; Mitra, Dipak; Hossaine, Moyazzam; Ullah, Mohammad Aman; Sarker, Samir Kanti; Rahman, S M Mustafizur; Bulbul, Md M Islam; Shamim, Abu Ahmed
Objective: To assess the prevalence of and factors associated with depression among adolescent boys and girls. Design: We conducted a nationwide cross-sectional study. Setting: This study was carried out in 82 randomly selected clusters (57 rural, 15 non-slum urban and 10 slums) from eight divisions of Bangladesh. Participants: We interviewed 4907 adolescent boys and 4949 adolescent girls. Primary and secondary outcome measures The primary outcome measure was ‘any depression’ and the secondary outcome measures were types of depression: no or minimal, mild, moderate, moderately severe and severe. Results: The overall prevalence of no or minimal, mild, moderate, moderately severe and severe depression was 75.5%, 17.9%, 5,4%, 1.1% and 0.1%, respectively. Across most of the sociodemographic, lifestyle and anthropometric strata, the prevalence of any depression was higher among adolescent girls. In both sexes, depression was associated with higher age, higher maternal education, paternal occupation e.g., business, absence of a 6–9-year-old member in the household, food insecurity, household consumption of unfortified oil, household use of non-iodised salt, insufficient physical activity (adjusted odds ratio, AOR: 1.24 for boys, 1.44 for girls) and increased television viewing time e.g., ≥121minute/day (AOR: 1.95 for boys, 1.99 for girls). Only among boys, depression was also associated with higher paternal education e.g., complete secondary and above (AOR: 1.42), absence of another adolescent member in the household (AOR: 1.34), household use of solid biomass fuel (AOR: 1.39), use of any tobacco products (AOR: 2.17), and consumption of processed food (AOR: 1.24). Only among girls, non-slum urban residence, Muslim religion, and household size ≤4 were also associated with depression. Conclusion: The prevalence of depression among adolescent boys and girls is high in Bangladesh. In most sociodemographic, lifestyle and anthropometric strata, the prevalence is higher among girls. In this age group, depression is associated with a number of sociodemographic and lyfestyle factors. The government of Bangladesh should consider these findings while integrating adolescent mental health in the existing and future programmes.
A policy analysis regarding education, career, and governance of the nurses in Bangladesh: A qualitative exploration
(Sage Journals, 1/18/2021) Joarder, Taufique; Parvage, Md. Aslam; Rawal, Lal B.; Ahmed, Syed Masud
Nurses, short in production and inequitable in the distribution in Bangladesh, require the government’s efforts to increase enrolment in nursing education and a smooth career progression. Given the importance of an assessment of the current nursing scenario to inform the decision makers and practitioners to implement the new policies successfully, we analyzed relevant policies on education, career, and governance of nurses in Bangladesh. We used documents review and qualitative methods such as key informant interviews (n = 13) and stakeholder analysis. We found that nursing education faced several backlashes: resistance from diploma nurses while attempting to establish a graduate (bachelor) course in 1977, and the reluctance of politicians and entrepreneurs to establish nursing institutions. Many challenges with the implementation of nursing policies are attributable to social, cultural, religious, and historical factors. For example, Hindus considered touching the bodily excretions as the task of the lower castes, while Muslims considered women touching the body of the men immoral. Nurses also face governance challenges linked with their performance and reward. For example, nurses have little voice over the decisions related to their profession, and they are not allowed to perform clinical duties unsupervised. To improve the situation, the government has made new policies, including upliftment of nurses’ position in public service, the creation of an independent Directorate General, and improvement of nursing education and service. New policies often come with new apprehensions. Therefore, nurses should be included in the policy processes, and their capacity should be developed in nursing leadership and health system governance.
Exploration of attendance, active Participation, and behavior change in a group-based responsive stimulation, maternal and child health, and nutrition intervention
(ASTMH, 1/18/2021) Yeasmin, Farzana; Winch, Peter J.; Hwang, Sharon T.; Leontsini, Elli; Jahir, Tania; Das, Jyoti B.; Amin, Mohammad R.; Hossain, Md K.; Huda, Tarique Md. Nurul; Akter, Fahmida; Shoab, Abul Kashem; Tofail, Fahmida; Mridha, Malay K.; Sultana, Jesmin; Pitchik, Helen; Fernald, Lia C. H.; Luby, Stephen P.; Rahman, Mahbubur
Delivery of interventions through group sessions allows for in-depth discussions and creates opportunities for group members to work together to identify and solve common problems. However, low attendance may limit impact. We explored factors affecting attendance, active participation, and behavior change in an integrated group-based child development and maternal and child health intervention in Bangladesh. Community health workers (CHWs) facilitated two sessions a month including material on child stimulation; water, sanitation, and hygiene; nutrition, maternal depression, and lead exposure prevention. Sessions were conducted with 320 pregnant women and mothers with children younger than 24 months, in 16 villages in Kishoreganj district. After 4 and 9 months of intervention, we conducted focus group discussions and in-depth interviews with mothers (n = 55 and n = 48) to identify determinants of attendance and behavior change, and to examine potential for intervention scale-up. Recruiting family members to assist with childcare resulted in improved attention during sessions. Adopting a storytelling format for presentation of session materials resulted in more engaged participation during courtyard sessions. Session attendance and behavior change, especially purchasing decisions, were difficult for participants without the support of male heads of the household. Selecting a rotating leader from among the group members to remind group members to attend sessions and support CHWs in organizing the sessions was not successful. Facilitating self-appraisals and planning for water and sanitation allowed participants to identify areas for improvement and track their progress. Key determinants of a participant’s attendance were identified, and the resulting intervention shows promise for future implementation at scale.
Tuberculosis infection control in selected facilities managing drug-resistant tuberculosis in Bangladesh: Findings from a mixed-methods study
(Elsevier, 1/20/2021) Parray, A.A.
Background: Nosocominal Tuberculosis epidemics in hospitals are a major threat to the patient and health workers safety. On the other hand, implementation of Tuberculosis infection control policy, strongly influences the prevention and transmission of Tuberculosis in hospitals. Thus we aimed to check the status of Tuberculosis infection control in the major drug-resistant Tuberculosis management centers of Bangladesh. Methods and materials: We leveraged an explanatory mixed-methods design to contextualize this study. We included (n = 3) major drug-resistant Tuberculosis management centers of Bangladesh to check their complaiance with the national Tuberculosis infection control policy. Non-participatory observations (n = 18) using a structured observation checklist and record review using standard document review checklist were employed to check the extent of the implementation of infection control policy. After the quantitative data were analyzed, indivually at each hospital, we developed guidelines to explain the reasons for non-compliance with the Infection control standards. Hence, we conducted 9 Key-informant interviews with Managers,16 In-depth Interviews with health care providers, 12 In-depth Interviews with patients and 6 In-depth-phone Interviews with field staff (n = 43). The data collection commenced from November 2018 to December 2018. The ethical approval for this study was sought from BRAC James P Grant school of public health. Results: The infection control at drug-resistant Tuberculosis management centers have a scope of improvement. Survey findings revealed absence of dedicated budget for infection control, no capacity building activities, sub-optimal triage practices, sub-optimal ventilation, and non-compliance to personal protective equipment including N-95 masks. However, qualitative findings revealed that the reasons for non-compliance with infection control standards included; lack of funds, lack of infection control committee, lack of authority and lack of training. Conclusion: Infection control practices at drug-resistant Tuberculosis management centers of Bangladesh require special attention of the national policy makers. The reasons for non-compliance with infection control standards are interconnected and represent asymmetries at individual, hospital and national levels.
Prevalence and associated factors of hypertension in selected urban and rural areas of Dhaka, Bangladesh: Findings from SHASTO baseline survey
(BMJ Journals, 1/20/2021) Hasan, Mehedi; Khan, Md Showkat Ali; Sutradhar, Ipsita; Hossain, Md Mokbul; Hossaine, Moyazzam; Yoshimura, Yukie; Choudhury, Sohel Reza; Sarker, Malabika; Mridha, Malay Kanti
Objective: We implemented this study to report the prevalence and associated risk factors of hypertension among adult men and women aged >30 years residing in selected urban and rural areas of Dhaka division, Bangladesh. Design Cross-sectional study. Setting Two urban (Dhaka city north and Dhaka city south) and two rural (Narsinghdi and Gazipur district) areas of the Dhaka division. Participants A total of 4856 male and female participants were included in the final analysis, of whom 2340 (48.2%) were from urban and 2516 (51.8%) were from rural areas. Primary outcome Hypertension was the dependent variable for this study and was operationally defined as systolic blood pressure >140mm of Hg and/or diastolic blood pressure >90mm of Hg, and/or persons with already diagnosed hypertension. Results The overall prevalence of hypertension was 31.0%, and the prevalence was higher among urban participants (urban: 36.9%, rural: 30.6%). Age (across all categories), female (urban—adjusted OR (AOR): 1.3, 95%CI: 1.0 to 1.5 and rural—AOR: 1.7, 95%CI: 1.4 to 2.1)), higher educational status (urban—AOR: 1.7, 95%CI: 1.3 to 2.2 and rural—AOR: 2.1, 95%CI: 1.5 to 3.1), inadequate physical activity (urban—AOR: 1.3, 95%CI: 1.0 to 1.7 and rural—AOR: 1.5, 95%CI: 1.2 to 1.9) and overweight/obesity (urban—AOR: 2.7, 95%CI: 2.1 to 3.3 and rural—AOR: 2.1, 95%CI: 1.7 to 2.5) were associated with hypertension in both urban and rural areas. Women who were not currently married during the survey had higher odds of hypertension only in the rural areas (rural—AOR: 1.8, 95%CI: 1.3 to 2.4), and respondents who were not working during the survey had higher odds of hypertension only in the urban areas (AOR: 1.7, 95%CI: 1.0 to 2.6). Conclusion Since the prevalence of hypertension was high in urban and rural areas, the government of Bangladesh should consider implementing hypertension prevention programmes focusing young population of Dhaka division. In addition, early screening programmes and management of hypertension need to be strengthened for people with hypertension in both the areas.
Solidarity and universal preparedness for health after covid-19
(BMJ, 1/22/2021) Tomson, Göran; Causevic, Sara; Ottersen, Ole Petter; Peterson, Stefan Swartling; Rashid, Sabina; Wanyenze, Rhoda Kitti; Yamin, Alicia Ely
Humankind has set a historical precedent in the past century with enormous social and economic transformations, advancement, and prosperity in many parts of the world. These have been supported by technological innovations, increased life expectancy, and changing governance from autocratic to democratic in many countries. However, socioeconomic disparities remain worldwide, limiting the achievement of the UN 2030 Agenda for Sustainable Development.1 An important reason for these disparities is that megatrends—activities, movements, or patterns that fundamentally alter individual, social, and technological behavioural structures—have never been so pervasive, explosive, or accelerated.2 Megatrends such as demographic changes, global environmental change, power imbalances, and technological innovations are having long lasting effects.3 Adding to these, gender inequality has failed to recognise and reward women’s potential.4 The scarcity of natural resources and increased consumption have reinforced the competition for global resources, further intensifying distribution inequities. Because of these inequities, the covid-19 pandemic has hit unevenly. Automation after the industrial revolution transformed the labour market, population growth caused increased urbanisation, while fossil fuels carbon emissions, urbanisation, and environmental pollution have accelerated the global threat of climate change and are still spiralling out of control. Demographic changes have led us to encroach on habitats of species that are hosts to viruses with pandemic potential and increased their opportunities to jump from one species to another.5 Once new viruses have entered a human host, our interconnectedness resulting from urbanisation and mobility allow them to spread quickly and effectively. We witnessed this scenario in the initial phase of the covid-19 pandemic when the virus got a foothold on all continents within weeks of its first known occurrence in Wuhan, China.6
Mobilising demand for primary health care services among urban slums: Insights from a case study in Bangladesh
(Taylor & Francis, 1/23/2021) Adams, Alayne M.; Rashid, Sabina F.
This qualitative case study examines a pilot community mobilisation initiative to increase access to qualified primary health care services among slum dwellers in Bangladesh. Emerging from analysis are a series of key considerations in the design and implementation of mobilisation activities in poor urban settlements. These include who best to mobilise in highly stratified social settings; how to bridge communities in need with outside resources; the role of development agents in organising participation; whether mobilisation processes can be phased over time; and the imperative of policy advocacy to shift complex structural inequities that preclude investments in health care for the urban disadvantaged.
Combating the COVID-19 infodemic: a three-level approach for low and middle-income countries
(BMJ Journals, 1/29/2021) Dash, Sambit; Parray, Ateeb Ahmad; De Freitas, Loren; Mithu, Md Imran Hossain; Rahman, Md Mustafizur; Ramasamy, Aarthy; Pandya, Apurva Kumar
The COVID-19 crisis has contributed to the development of an ‘infodemic’ that hinders an adequate public health approach to managing the crisis. The WHO defines an infodemic as an ‘overabundance of information—some accurate and some not—that occurs during an epidemic’.1 Fake news, propaganda and conspiracy theories, ubiquitous in the era of social media, have spread since the beginning of the COVID-19 pandemic. Reports suggest that a rumour is three times more likely to be spread in social media than accurate information.2 This is of great concern as it often leads to reduced trust in health institutions and services and impedes the evidence-informed approach in managing the pandemic. The infodemic may also promote hate speech and associated stigmatisation which may contribute to exclusions of vulnerable sections of society. The adverse effects of the infodemic may be exacerbated in low and middle-income countries (LMICs) where low health literacy levels, poor health infrastructure and poor resource settings exist. One example is the spread of misinformation that concentrated alcohol can kill the novel coronavirus. This led to methanol poisoning that contributed to the deaths of more than 700 people in Iran and resulted in blindness in 60 people in other LMICs.3 Misperceptions about COVID-19 also entail less adherence with proven precautionary behaviours such as social distancing interventions.4 Broad categories of misinformation related to COVID-19 include those about the disease itself, conspiracy theories, scapegoating and false cures. A concerted, tailor-made, evidence-informed effort from a transdisciplinary perspective is required to address the impact of the infodemic in LMICs. In this article, we suggest measures and approaches that LMICs can undertake in order to combat the COVID-19 infodemic and future infodemics.
COVID-19: The next steps for the World
(Borneo Journal of Medical Sciences, 1/31/2021) Mridha, Malay Kanti
Since December 2019, COVID-19 is impacting the health, economy, education, and well-being of every country in the world. The total number of reported COVID-19 cases will soon surpass 100 million and the death toll will be more than 20 million. At this moment, the top 10 countries with the most reported number of cases currently are the USA, India, Brazil. Russia, UK, France, Turkey, Italy, Spain, and Germany. These countries altogether represent 31.7% of the world’s population. However, they reported 65.5% of the total COVID-19 cases and 58.9% of total deaths. For containing the spread of SARS-CoV-2, the virus that causes COVID-19, Malaysia was one of the most successful countries in the world. However, since September 2020, the situation in Malaysia started changing, and at this moment Malaysia is reporting more than 2,500 new cases per day. During the past year, all the countries in the world acted fast and took different initiatives to reduce transmission of SARS-CoV-2, find effective drugs that can improve the clinical outcomes of COVID-19, and invent vaccines that can give immune protection. The first vaccine that was approved was invented by Pfizer/BioNTech and in December 2020, within one year of the beginning of the pandemic, the UK was the first country to start mass vaccination. As reported by the World Health Organization (WHO) in January 2021, more than 50 COVID-19 vaccines were in different phases of clinical trial and five vaccines received certain national regulatory approval for mass vaccination. However, given all these developments the COVID-19 pandemic is still making a devastating impact on the whole world and the pandemic is not going to over soon. Therefore, we need to discuss what we can do now to deal with the pandemic and ensure the health and wellbeing of the citizens of the world.
Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: Evidence from a large-scale multi-country surveillance programme
(Elsevier, 2/13/2021) Kusuma, Dian; Pradeepa, Rajendra; Khawaja, Khadija I.; Hasan, Mehedi; Siddiqui, Samreen; Mahmood, Sara; Shah, Syed Mohsin Ali; De Silva, Chamini K.; de Silva, Laksara; Gamage, Manoja; Loomba, Menka; Rajakaruna, Vindya P.; Hanif, Abu AM; Kamalesh, Rajan Babu; Kumarendran, Balachandran; Loh, Marie; Misra, Archa; Tassawar, Asma; Tyagi, Akansha; Waghdhare, Swati; Burney, Saira; Ahmad, Sajjad; Mohan, Viswanathan; Sarker, Malabika; Goon, Ian Y.; Kasturiratne, Anuradhani; Kooner, Jaspal S.; Katulanda, Prasad; Jha, Sujeet; Anjana, Ranjit Mohan; Mridha, Malay K.; Sassi, Franco; Chambers, John C.
Background: South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians’ awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. Methods: We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. Results: Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P < 0.001), and household income fell by 52% (P < 0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P < 0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P < 0.001), during the lockdown. Conclusions: Our results identified important knowledge, access and uptake barriers to the prevention of COVID19 in South Asia, and demonstrated major adverse impacts of the pandemic on chronic disease treatment, mental health, health-related behaviours, employment and household finances. We found important sociodemographic differences for impact, suggesting a widening of existing inequalities. Our findings underscore the need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention, along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor.
Introducing urine‑enriched biochar‑based fertilizer for vegetable production: Acceptability and results from rural Bangladesh
(Springer Link, 2/19/2022) Sutradhar, Ipsita; deGrafenried, Meredith Jackson; Akter, Sayema; McMahon, Shannon A.; Waid, Jillian L.; Schmidt, Hans‑Peter; Wendt, Amanda S.; Gabrysch, Sabine
Improved agricultural practices that increase yields and preserve soils are critical to addressing food insecurity and undernutrition among smallholder farmer families. Urineenriched biochar has been shown to be an accessible and efective fertilization option in various subtropical countries; however, it is new to Bangladesh. To better understand attitudes and experiences preparing and using urine-enriched biochar fertilizer, mixed-methods research was undertaken among smallholder farmers in northeastern Bangladesh in 2016/2017. In-depth interviews were conducted with 25 respondents who had compared the production of crops grown with biochar-based fertilizer to usual practice. In addition, in areas where trainings on biochar-based fertilization had been ofered, 845 farmers were asked about their experience through a quantitative survey. Interview results indicated that cow urine-enriched biochar was favored over human urine because cow urine was perceived as clean and socially acceptable, whereas human urine was considered impure and disgusting. Respondents praised biochar-based fertilizer because it increased yields, cost little, was convenient to prepare with readily available natural materials, produced tastier crops, and allowed families to share their larger yields which in turn enhanced social and fnancial capital. Comparative feld trials indicated a 60% yield beneft in both cabbage and kohlrabi crops. Challenges included uneven access to ingredients, with some respondents having difculty procuring cow urine and biomass feedstock. The low social, health, and fnancial risk of adoption and the perceived benefts motivated farmers to produce and apply biochar-based fertilizer in their gardens, demonstrating strong potential for scale-up of this technology in Bangladesh.
Harmful practices prevail despite legal knowledge: A mixed-method study on the paradox of child marriage in Bangladesh
(Taylor & Francis, 2/24/2021) Akter, Sayema; Williams, Chloe; Talukder, Animesh; Islam, Muhammed Nazmul; Escallon, Juanita Vasquez; Sultana, Tania; Kapil, Neha; Sarker, Malabika
Child marriage is a globally recognised human rights violation that disproportionately affects girls, especially in developing countries. It has serious negative consequences on girls’ physical, mental, sexual, and reproductive health and rights. Although well-pronounced laws against child marriage were enacted in Bangladesh, the practice remains a significant challenge. Lack of law enforcement and persistent social norms ultimately allow child marriage to persist around the country. Social norms have an impact on the prevalent attitudes toward child marriage. Therefore, this mixed-method study aimed to explore the legal knowledge, perception, and practice of child marriage in Bangladesh. This study was part of a broader evaluation of a UNICEF media programme. Adolescent boys and girls aged between 10 and 19 years and their parents were interviewed in three Bangladeshi districts. All the respondents were aware of the legal age of marriage and knew that child marriage is punishable by law. This study illuminated the reasons, including early marriage among boys, poverty, dowry, and sexual harassment. Communities and policymakers need to be engaged to trigger larger structural and cultural changes to remedy the harmful social norm and its practice
Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: Learning from refugee camps in Cox’s bazar, Bangladesh
(BMC, 2/26/2021) Schmitt, Margaret L.; Wood, Olivia R.; Clatworthy, David; Rashid, Sabina Faiz; Sommer, Marni
Background: There is growing attention to addressing the menstrual hygiene management (MHM) needs of the over 21 million displaced adolescent girls and women globally. Current approaches to MHM-related humanitarian programming often prioritize the provision of menstrual materials and information. However, a critical component of an MHM response includes the construction and maintenance of water, sanitation and hygiene (WASH) facilities, including more female-friendly toilets. This enables spaces for menstruating girls and women to change, dispose, wash and dry menstrual materials; all of which are integral tasks required for MHM. A global assessment identified a number of innovations focused on designing and implementing menstruation-supportive WASH facilities in the Rohingya refugee camps located in Cox’s Bazar (CXB), Bangladesh. These pilot efforts strove to include the use of more participatory methodologies in the process of developing the new MHM-supportive WASH approaches. This study aimed to capture new approaches and practical insights on innovating menstrual disposal, waste management and laundering in emergency contexts through the conduct of a qualitative assessment in CXB. Methods: The qualitative assessment was conducted in the Rohingya refugee camps in CXB in September of 2019 to capture new approaches and practical insights on innovating for menstrual disposal, waste management and laundering. This included Key Informant Interviews with 19 humanitarian response staff from the WASH and Protection sectors of a range of non-governmental organizations and UN agencies; Focus Group Discussions with 47 Rohingya adolescent girls and women; and direct observations of 8 WASH facilities (toilets, bathing, and laundering spaces). Results: Key findings included: one, the identification of new female-driven consultation methods aimed at improving female beneficiary involvement and buy-in during the design and construction phases; two, the design of new multi-purpose WASH facilities to increase female beneficiary usage; three, new menstrual waste disposal innovations being piloted in communal and institutional settings, with female users indicating at least initial acceptability; and four, novel strategies for engaging male beneficiaries in the design of female WASH facilities, including promoting dialogue to generate buy-in regarding the importance of these facilities and debate about their placement. Conclusions: Although the identified innovative participatory methodologies and design approaches are promising, the long term viability of the facilities, including plans to expand them, may be dependent on the continued engagement of girls and women, and the availability of resources.
Association between height and hypertension among US adults: Analyses of National Health and Nutrition Examination Survey 2007–18
(BMC, 2/26/2021) Gupta, Rajat Das; Akonde, Maxwell; Sajal, Ibrahim Hossain; Al Kibria, Gulam Muhammed
Background: Previous studies that investigated association of height with prevalence and control of hypertension found mixed results. This cross-sectional study explored these associations among US adults (≥20 years). Methods: The National Health and Nutrition Examination Survey (NHANES) 2007–18 data was analyzed. Height was measured in meters and was converted into centimeters (cm) and was further divided into quartiles: Q1 (135.3–159.2 cm), Q2 (159.3–166.2 cm), Q3 (166.3–173.6 cm), Q4 (173.7–204.5 cm). Hypertension definition of the ‘2017 American College of Cardiology/American Heart Association Guideline’ was used. Logistic regression analyses were conducted to find out the association between the dependent variable and the covariates. Linear regression analyses were conducted to find out the association of height with systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and the covariates among the individuals who were not taking any antihypertensive drugs. Crude odds ratio, adjusted odds ratio (AOR), and adjusted beta-coefficient (for linear regression) with 95% confidence interval (CI) were reported. The following covariates were included: age, gender, race/ethnicity, family income, education level, cholesterol level, high-density lipoprotein level, chronic kidney disease status, diabetes status, smoker, aerobic leisure-time physical activity, and survey period. Sample weight of NHANES was adjusted. Results: Among the 21,935 participants (47.1% males), the prevalence of hypertension was 46.1%. Among 6154 participants taking medication (43.0% males), 57.2% had uncontrolled hypertension. In the final logistic regression analyses, participants in Q2 height quartile had 20% lower odds of being hypertensive compared to those in Q4 height quartile (AOR: 0.8; 95% CI: 0.7,1.0). Other height categories did not reveal any significant association. Compared to Q4 height category, Q1 (AOR: 1.7; 95% CI: 1.2,2.3), Q2 (AOR: 1.4; 95% CI: 1.1,1.8), and Q3 (AOR: 1.3; 95% CI: 1.1,1.6) height categories had higher odds of uncontrolled hypertension. PP was inversely associated and DBP was positively Conclusions: Although height was not associated with prevalence of hypertension, it had inverse association with uncontrolled hypertension. It was also significantly associated with DBP and PP among the individuals with untreated hypertension.
Addressing vulnerabilities in communities facing infectious disease threats: A need for social science-driven assessments
(Journal of Global Health, 2021-01) Osborne, Jacob; Paget, John; Napier, David; Giles-Vernick, Tamara; Kutalek, Ruth; Rodyna, Roman; Ahmed, Syed Masud; Dückers, Michel
Knotted realities: Understanding what delays early and child marriage for girls in urban slums of Bangladesh
(Bangladesh Development Initiative, 2021-04) Ahsan, Sairana; Karim, Shuchi; Biswas, Subas; Rashid, Sabina Faiz
Bangladesh has the fourth-highest prevalence of early and child marriage in the world. This trend has declined slightly over the years, but there is a dearth of research regarding underlying reasons. This article explores the phenomenon of delayed marriage for women in the context of understudied urban slums, and seeks to understand both why it happens and its consequences. The article uses data from 14 in-depth interviews (IDI) of girls who delayed their marriage beyond their 18th year, and two focus group discussions (FGD) with adolescent girls and young women aged between 13-24 years from a larger mixed-methods study conducted in two slums of the cities of Dhaka and Chattogram. Findings reveal that the key reasons for delaying marriage are poverty, inability to pay dowry for girls perceived as older, and the pressing obligations faced by young girls in having to take care of their families. It was also found that positive family support, mostly among better-off families, allows some girls pursue education rather than be married off at an early age. Link to journal: https://www.bdiusa.org/journal-bangladesh-studies
Adolescents’ experiences of covid-19 in Chittagong and Sylhet divisions, Bangladesh
(GAGE, 2021-04) Alam, Farhana; Rana, Md Sajib; Raha, Samira Ahmed; Al Mamun, Saklain; Guglielmi, Silvia
This study is part of a cross-country series designed to share emerging findings in real time from qualitative interviews with adolescents and school teachers in the context of covid-19. The young people involved are part of the Gender and Adolescence: Global Evidence (GAGE) programme, which is conducting longitudinal research in the Middle East, East Africa and South Asia. Our sample for this study was purposefully selected from an ongoing baseline GAGE impact evaluation study, and includes two cohorts: younger adolescents (10–14 years) and older adolescents (15–19 years), all of whom are in-school (grades 7 and 8). Adolescent respondents were drawn from both urban and rural schools in Chittagong and Sylhet divisions of Bangladesh (see Annex 1 for further details). The objectives of the research are as follows: • To understand adolescents’ experiences of transition from childhood to adulthood, and to identify differences in their experiences by age, gender, disability and geographic location. • To identify adolescents’ knowledge of covid-19, and how the pandemic response has affected adolescent lives across the following domains: Young adolescent girls in Chittagong, Bangladesh © Nathalie Bertrams / GAGE 2 » education and remote learning » incomes and livelihoods » nutrition, health and hygiene » psychosocial well-being and coping » voice and agency related to adolescents’ mobility. To inform the pandemic response, this study aims to understand adolescents’ knowledge, perceptions and practices during the covid-19 pandemic, their challenges and worries, and the coping mechanisms they are using to deal with the evolving situation. We explore the impact of covid-19 on the realities and experiences of in-school adolescents in Chittagong and Sylhet who have found themselves out of school since March 2020 until the present, to prevent the spread of the virus. The report also explores the impacts on adolescents in terms of gender and the vulnerability status of the household.
Barriers and facilitators to knowledge translation activities within academic institutions in low- And middle-income countries
(Oxford Academic, 3/1/2021) Kalbarczyk, Anna; Rodriguez, Daniela C; Mahendradhata, Yodi; Sarker, Malabika; Seme, Assefa; Majumdar, Piyusha; Akinyemi, Oluwaseun O; Kayembe, Patrick; Alonge, Olakunle O
The barriers and facilitators of conducting knowledge translation (KT) activities are well-established but less is known about the institutional forces that drive these barriers, particularly in low-resource settings. Understanding organizational readiness has been used to assess and address such barriers but the employment of readiness assessments has largely been done in high-income countries. We conducted a qualitative study to describe the institutional needs and barriers in KT specific to academic institutions in low- and middle-income countries. We conducted a review of the grey and published literature to identify country health priorities and established barriers and facilitators for KT. Key-informant interviews (KII) were conducted to elicit perceptions of institutional readiness to conduct KT, including experiences with KT, and views on motivation and capacity building. Participants included representatives from academic institutions and Ministries of Health in six countries (Bangladesh, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria). We conducted 18 KIIs, 11 with members of academic institutions and 7 with policymakers. KIIs were analysed using a deductive and inductive coding approach. Our findings support many well-documented barriers including lack of time, skills and institutional support to conduct KT. Three additional institutional drivers emerged around soft skills and the complexity of the policy process, alignment of incentives and institutional missions, and the role of networks. Participants reflected on often-lacking soft-skills needed by researchers to engage policy makers. Continuous engagement was viewed as a challenge given competing demands for time (both researchers and policy makers) and lack of institutional incentives to conduct KT. Strong networks, both within the institution and between institutions, were described as important for conducting KT but difficult to establish and maintain. Attention to the cross-cutting themes representing barriers and facilitators for both individuals and institutions can inform the development of capacity building strategies that meet readiness needs.
A holistic approach to promoting early child development: A cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh
(BMJ Journals, 3/16/2021) Pitchik, Helen O; Tofail, Fahmida; Rahman, Mahbubur; Akter, Fahmida; Sultana, Jesmin; Shoab, Abul Kasham; Huda, Tarique Md. Nurul; Jahir, Tania; Amin, Md Ruhul; Hossain, Md Khobair; Das, Jyoti Bhushan; Chung, Esther O; Byrd, Kendra A; Yeasmin, Farzana; Kwong, Laura H; Forsyth, Jenna E; Mridha, Malay K; Winch, Peter J; Luby, Stephen P; Fernald, Lia CH
Introduction In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention. Methods We conducted a 9-month, parallel, multiarm, clusterrandomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers. Results In July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (ageadjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54). Conclusion Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale.
Loops and Building Blocks: A Knowledge co-Production Framework for Equitable Urban Health
(Springer Link, 3/18/2021) Audia, Camilla; Berkhout, Frans; Owusu, George; Quayyum, Zahidul; Agyei-Mensah, Samuel
This paper sets out a structured process for the co-production of knowledge between researchers and societal partners and illustrates its application in an urban health equity project in Accra, Ghana. The main insight of this approach is that research and knowledge co-production is always partial, both in the sense of being incomplete, as well as being circumscribed by the interests of participating researchers and societal partners. A second insight is that project-bound societal engagement takes place in a broader context of public and policy debate. The approach to co-production described here is formed of three recursive processes: codesigning, co-analysing, and co-creating knowledge. These ‘co-production loops’ are themselves iterative, each representing a stage of knowledge production. Each loop is operationalized through a series of research and engagement practices, which we call building blocks. Building blocks are activities and interactionbased methods aimed at bringing together a range of participants involved in joint knowledge production. In practice, recursive iterations within loops may be limited due of constraints on time, resources, or attention. We suggest that co-productio