Journal Articles (2021)

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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.
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.
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
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.
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.
Association of household wealth and education level with hypertension and diabetes among adults in Bangladesh: A propensity score-based analysis
(Wiley Online Library, 5/15/2021) Gupta, Rajat Das; Chakraborty, Promit Ananyo; Hossain, Md. Belal
Objective: To determine the association of household wealth and education level with hypertension and diabetes in Bangladesh using propensity score (PS) analyses. Methods: A nationally representative sample of the Bangladesh Demographic and Health Survey 2017-18 was analysed to explore the research question. A weighted sample of 11 320 individuals was considered. Hypertension and diabetes were the outcomes of interest, and household wealth status (non-poor and poor) and education level (secondary/higher education and no secondary/higher education) were the exposure variables of interest. A person was defined as hypertensive if their average blood pressure was ≥140/90 mmHg or self-reported history of taking antihypertensive medications. Individuals were classified as diabetic if they had a Fasting Blood Glucose level of ≥7 mmol/l or reported taking prescribed medication for reducing high blood glucose or diabetes. We used the 1:1 nearest neighbour PS matching without replacement and PS weighting approaches to assess the association between the exposures and the outcome variables. Results: Wealth status was significantly associated with diabetes but not with hypertension, while education status was significantly associated with neither diabetes nor hypertension. We also observed a significant interaction effect between household wealth status and education level with diabetes. The odds of diabetes were approximately 60% higher among adults from non-poor households and those without secondary/higher education. Conclusion: Diabetes prevention and control programs should focus on non-poor individuals, while hypertension prevention programs should target populations irrespective of educational attainment and wealth status.
Association of leisure-time physical activity with perceived general health status among hypertensive people: An analysis of NHANES 2015–18
(Nature, 3/23/2021) Al Kibria, Gulam Muhammed; Gupta, Rajat Das; Crispen, Reese
Although leisure-time physical activity (LTPA) improves general health, little is known about its impacts on the health of hypertensive people within the United States. We investigated the general health of hypertensive people and the relationship between LTPA and general health within this population. This cross-sectional study analyzed National Health and Nutrition Examination Survey 2015–18 data. None, some, and high LTPA were defined as ‘0’, ‘>0 but <150’, and ‘≥150’ minutes of LTPA in each week, respectively. Hypertension was defined as the systolic/diastolic blood pressure ≥130/80 mmHg or taking BP-lowering drugs. General health status was dichotomized as whether participants reported ‘very good to excellent’ health status or not. After descriptive analysis, logistic regression was performed. Among 8504 participants (48.6% male and mean age: 48.2 years), about 47.9%, 41.4%, and 39.5% of people had hypertension, ‘very good to excellent’ health, and high LTPA, respectively. The odds of ‘very good to excellent’ health was lower among hypertensives than those without hypertension (adjusted odds ratio [AOR]: 0.7, 95% confidence interval [CI]: 0.6–0.8, p < 0.001). Among hypertensive individuals, about one-third reported ‘very good to excellent’ health (33.1%) and high LTPA (32.0%). Lastly, compared to people with no LTPA, those with some (AOR: 1.5, 95% CI: 1.0–2.0, p < 0.05) and high (AOR: 2.3, 95% CI: 1.7–3.0, p < 0.001) LTPA had greater odds of ‘very good to excellent’ health. We found positive relationships between LTPA and ‘very good to excellent’ health of hypertensive people. Therefore, improving general health could be an added advantage of LTPA for hypertensive people.
Bangla hate speech detection on social media using attention-based recurrent neural network
(De Gruyter, 4/9/2021) Das, Amit Kumar; Al Asif, Abdullah; Paul, Anik; Hossain, Md. Nur
Hate speech has spread more rapidly through the daily use of technology and, most notably, by sharing your opinions or feelings on social media in a negative aspect. Although numerous works have been carried out in detecting hate speeches in English, German, and other languages, very few works have been carried out in the context of the Bengali language. In contrast, millions of people communicate on social media in Bengali. The few existing works that have been carried out need improvements in both accuracy and interpretability. This article proposed encoder–decoder-based machine learning model, a popular tool in NLP, to classify user’s Bengali comments from Facebook pages. A dataset of 7,425 Bengali comments, consisting of seven distinct categories of hate speeches, was used to train and evaluate our model. For extracting and encoding local features from the comments, 1D convolutional layers were used. Finally, the attention mechanism, LSTM, and GRU-based decoders have been used for predicting hate speech categories. Among the three encoder–decoder algorithms, attention-based decoder obtained the best accuracy (77%).
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.
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.
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.
Gender-specific prevalence and associated factors of hypertension among elderly Bangladeshi people: Findings from a nationally representative cross-sectional survey
(BMJ Journals, 6/21/2021) Hanif, Abu Abdullah Mohammad; Shamim, Abu Ahmed; Hossain, Md Mokbul; Hasan, Mehedi; Khan, Md Showkat Ali; Hossaine, Moyazzam; Ullah, Mohammad Aman; Sarker, Samir Kanti; Rahman, S M Mustafizur; Mitra, Dipak K; Mridha, Malay Kanti
Objective: We aimed to estimate the gender-specific prevalence and associated factors of hypertension among elderly people in Bangladesh. Design and method We analysed data from the food security and nutrition surveillance round 2018–2019. The multistage cluster sampling method was used to select the study population. Hypertension was defined as systolic blood pressure ≥140mmHg and/or diastolic blood pressure ≥90mmHg and/or having a history of hypertension. We carried out the descriptive analysis, bivariate and multivariable logistic regression to report the weighted prevalence of hypertension as well as crude and adjusted ORs with 95% CI. A p value<0.05 was considered statistically significant. Setting The study was conducted in 82 clusters (57 rural, 15 non-slum urban and 10 slums) in all eight administrative divisions of Bangladesh. Participants A total of 2482 males and 2335 females aged ≥60 years were included in this analysis. Results The weighted prevalence of hypertension was 42% and 56% among males and females, respectively. The prevalence was higher among females across all sociodemographic, behavioural and clinical strata. Factors associated with higher odds of hypertension (adjusted OR (AOR) (95% CI) for males and females, respectively) were age ≥70 years (1.32 (1.09, 1.60) and 1.40 (1.15, 1.71)); insufficient physical activity (1.50 (1.25, 1.81) and 1.38 (1.15, 1.67)); higher waist circumference (2.76 (2.22, 3.43) and 2.20 (1.82, 2.67)); and self-reported diabetes (1.36 (1.02, 1.82) and 1.82 (1.35, 2.45)). Additionally, living in slums decreased (0.71 (0.52, 0.96)) and education >10 years increased odds of hypertension (1.83 (1.38, 2.44)) among males. Conclusion In Bangladesh, half of the elderly persons were hypertensive, with a higher prevalence in females. In both sexes, odds of hypertension was higher among persons with older age (≥70 years), insufficient physical activity, higher waist circumference and self-reported diabetes. The Ministry of Health of Bangladesh should consider these findings while designing and implementing health programmes for elderly population.
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
Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight
(eLife, 3/9/2021) NCD Risk Factor Collaboration (NCD-RisC)
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
Implications of Birth-Dose Vaccination against Hepatitis B Virus in Southeast Asia
(MDPI, 4/12/2021) Fazle Akbar, Sheikh Mohammad; Al Mahtab, Mamun; Begum, Ferdousi; Hossain, Shaikh A. Shahed; Sarker, Sukumar; Shrestha, Ananta; Khan, Md. Sakirul Islam; Yoshida, Osamu; Hiasa, Yoichi
The World Health Organization (WHO) South-East Asia Regional Office (SEARO) covers 11 countries with a combined population of about 2 billion people, making it the most populous of the six WHO regions. In 1992, the WHO advocated including the hepatitis B vaccine in the Expanded Program of Immunization (EPI) and vaccinating all infants and children three times within 1 year of birth (HepB3). Recently, the WHO advocate birth-dose hepatitis B vaccination (HepB-BD) as soon as possible after birth, preferably within 24 hours. In 2016, the SEARO endorsed a regional hepatitis B control goal with a target of hepatitis B surface antigen (HBsAg) seroprevalence of ≤1% among children aged ≥5 years by 2020. Of the 11 SEARO countries, four achieved this target on schedule. Out of these four countries, two countries (Bangladesh and Nepal) have not adopted HepB-BD in EPI program. On the other hand, the coverage of HepB3 is not satisfactory in some SEARO countries, including India which adopted HepB-BD but could not achieve the overall target of SEARO. Thus, it is a point of debate whether emphasis should be placed on proper implementation of HepB3 or whether a new agenda of HepB-BD should be incorporated in developing countries of SEARO. The article discusses strengthening and expanding the Hepatitis B vaccination program in SEARO countries with an emphasis on HepB and HepB-BD programs.
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.
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.
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
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.