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Item Towards a socially just model: balancing hunger and response to the COVID-19 pandemic in Bangladesh(BMJ Global Health 2020, 6/1/2020) Rashid, Sabina Faiz; Theobald, Sally; Ozano, KimItem 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, KaosarObjectives 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.Item Erratum to: The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: A GIS study [BMC Pregnancy Childbirth, 16, (2016) (240)](© 2016 BioMed Central Ltd., 9/27/2016) Panciera, Rocco; Khan, Akib; Rizvi, Syed Jafar Raza; Ahmed, Tanvir; Islam, Rubana; Adams, Alayne M.Item Communication for behavioural impact in enhancing utilization of insecticide-treated bed nets among mothers of under-five children in rural North Sudan: an experimental study(© 2016 BioMed Central Ltd., 10/18/2016) Elmosaad, Yousif Mohammed; Elhadi, Magda; Khan, Asif; Malik, Elfatih Mohamed; Mahmud, IliasBackground: Malaria is the leading cause of morbidity and mortality in Sudan. The entire population is at risk of contracting malaria to different levels. This study aimed to assess the effectiveness of communication for behavioural impact (COMBI) strategy in enhancing the utilization of long-lasting insecticidal nets (LLINs) among mothers of under-five children in rural areas. Methods: A randomized community trial was conducted in rural area of Kosti locality, White Nile State, Sudan, among mothers of under-five children, from January 2013 to February 2014. A total of 761 mothers from 12 villages were randomly selected, 412 mothers from intervention villages and 349 were from comparison villages. Results: The knowledge of mothers, in intervention villages, about malaria vector, personal protective measures (PPM) against malaria, and efficacy of LLINs was significantly increased from 86.9 to 97.3 %; 45.9 to 92 % and 77.7 to 96.1 % respectively. Knowledge about usefulness of PPM, types of mosquito nets and efficacy of LLINs was significantly higher in intervention villages compared to comparison villages (p < 0.05), (η2 = 0.64). Mothers in intervention villages increasingly perceived, post-intervention, that malaria was a serious disease (99.3 %), a preventable disease (98.8 %) and also LLINs as an effective intervention in malaria prevention (92.2 %). This resulted in an increase in the utilization rate of LLINs from 19.2 to 82.8 % in intervention villages compared to comparison villages (p < 0.05) [OR = 4.6, 95 %, CI = (3.72-5.72)], (η2 = 0.64). The average of mothers' knowledge about malaria was increased by 64 % (η2 = 0.64), the use of LLINs was increased by 79 % (η2 = 0.79) and a positive attitude towards malaria was 2.25 times higher in intervention villages than among mothers in the comparison villages. Conclusions: These results established the usefulness of COMBI strategy for increasing awareness about malaria, developing a positive perception towards malaria prevention and, increasing the utilization of LLINs.Item Socio-economic inequality of chronic non-communicable diseases in Bangladesh(© 2016 Public Library of Science, 2016-11) Biswas, Tuhin; Islam, Md Saimul; Linton, Natalie; Rawal, Lal BahadurIntroduction Chronic non-communicable diseases (NCDs) are a major public health challenge, and undermine social and economic development in much of the developing world, including Bangladesh. Epidemiologic evidence on the socioeconomic status (SES)-related pattern of NCDs remains limited in Bangladesh. This study assessed the relationship between three chronic NCDs and SES among the Bangladeshi population, paying particular attention to the differences between urban and rural areas. Materials and Method Data from the 2011 Bangladesh Demographic and Health Survey were used for this study. Using a concentration index (CI), we measured relative inequality across pre-diabetes, diabetes, pre-hypertension, hypertension, and BMI (underweight, normal weight, and overweight/obese) in urban and rural areas in Bangladesh. A CI and its associated curve can be used to identify whether socioeconomic inequality exists for a given health variable. In addition, we estimated the health achievement index, integrating mean coverage and the distribution of coverage by rural and urban populations. Results Socioeconomic inequalities were observed across diseases and risk factors. Using CI, significant inequalities observed for pre-hypertension (CI = 0.09, p = 0.001), hypertension (CI = 0.10, p = 0.001), pre-diabetes (CI = -0.01, p = 0.005), diabetes (CI = 0.19, p<0.001), and overweight/obesity (CI = 0.45, p<0.001). In contrast to the high prevalence of the chronic health conditions among the urban richest, a significant difference in CI was observed for pre-hypertension (CI = -0.20, p = 0.001), hypertension (CI = -0.20, p = 0.005), pre-diabetes (CI = -0.15, p = 0.005), diabetes (CI = -0.26, p = 0.004) and overweight/obesity (CI = 0.25, p = 0.004) were observed more among the low wealth quintiles of rural population. In the same vein, the poorest rural households had more co-morbidities compared to the richest rural households (p = 0.003), and prevalence of co-morbidities was much higher for the richest urban households compared to the poorest urban households. On the other hand in rural the "disachievement" of health indicators is more noticeable than the urban ones. Conclusion The findings indicate the high burden of selected NCDs among the low wealth quintile populations in rural areas and wealthy populations in urban areas. Particular attentions may be necessary to address the problem of NCDs among these groups.Item The next WHO director-general's highest priority: a global treaty on the human right to health(© 2016 Elsevier Ltd., 12/1/2016) Gostin, Lawrence O.; Friedman, Eric A.; Buss, Paulo Marchiori; Chowdhury, Mushtaque Raza; Grover, Anand; Heywood, Mark J.; Kanchanachitra, C.; Leung, Gabriel M.; Mackay, Judith Mary; Matsoso, Precious; Møgedal, Sigrun M.; Omaswa, Francis G.; Phumaphi, Joy; Reddy, Kenipakapatnam Srinath R.; Periago, Mirta Roses; Thomas, Joe; Tomori, Oyewale; Were, Miriam K.; Zewdie, Debrework WorkItem Undernutrition, vitamin A and iron deficiency are associated with impaired intestinal mucosal permeability in young Bangladeshi children assessed by lactulose/mannitol test(© 2017 Public Library of Science, 2016-12) Hossain, Md Iqbal; Haque, Rashidul; Mondal, Dinesh; Mahfuz, Mustafa; Ahmed, Am Shamsir; Islam, Mohammad Munirul; Guerrant, Richard Littleton; Petri, William Arthur; Ahmed, Tahmeed J.Background: Lactulose/mannitol (L:M) test has been used as a non-invasive marker of intestinal mucosal-integrity and -permeability (enteropathy). We investigated the association of enteropathy with anthropometrics, micronutrient-status, and morbidity in children. Methods: The urine and blood samples were collected from 925 children aged 6±24 months residing in Mirpur slum of Dhaka, Bangladesh during November 2009 to April 2013. L:M test and micronutrient status were assessed in the laboratory of International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b) following standard procedure. Results: Mean±SD age of the children was 13.2±5.2 months and 47.8% were female. Urinary-lactulose recovery was 0.264±0.236, mannitol recovery was 3.423±3.952, and L:M was 0.109 ±0.158. An overall negative correlation (Spearman's-rho) of L:M was found with age (rs = -0.087; p = 0.004), weight-for-age (rs = -0.077; p = 0.010), weight-for-length (rs = -0.060; p = 0.034), mid-upper-arm-circumference (rs = -0.098; p = 0.001) and plasma-retinol (rs = -0.105; p = 0.002); and a positive correlation with plasma α-1-acid glycoprotein (rs = 0.066; p = 0.027). However, most of the correlations were not very strong. Approximately 44% of children had enteropathy as reflected by L:M of ≥0.09. Logistic regression analysis revealed that younger age (infancy) (adjusted odds ratio (AOR) = 1.35; p = 0.027), diarrhea (AOR = 4.00; p = 0.039) or fever (AOR = 2.18; p = 0.003) within previous three days of L:M test were the risk factors of enteropathy (L:M of ≥0.09). Conclusions: Enteropathy (high L:M) is associated with younger age, undernutrition, low vitamin A and iron status, and infection particularly diarrhea and fever.Item Benefit incidence analysis of healthcare in Bangladesh - equity matters for universal health coverage(© 2017 Oxford University Press, 2017) Khan, Jahangir Am; Ahmed, Sayem; MacLennan, Mary E.; Sarker, Abdur Razzaque; Sultana, Marufa; Rahman, Hafizur E.M.R.Background: Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country. Objectives: This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh. Methodology: The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by 'self-reported illness and symptoms') across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used. Results: An overall pro-rich distribution of healthcare benefits was observed (CI = 0.229, t-value = 9.50). Healthcare benefits from private providers (CI = 0.237, t-value = 9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI = 0.044, t-value = 2.98) and NGO (CI = 0.095, t-value = 0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits. Conclusion: Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable.Item Mental illness and injuries: emerging health challenges of urbanisation in South Asia(© 2017 BMJ Publishing Group, 2017) Nambiar, Devaki; Razzak, Junaid Abdul; Afsana, Kaosar; Adams, Alayne M.; Hasan, Arif; Mohan, DInesh; Patel, Vikram H.Item Overweight and obesity among children and adolescents in Bangladesh: a systematic review and meta-analysis(© 2017 Elsevier B.V., 1/1/2017) Biswas, Tuhin; Islam, Anwar; Islam, Md Serajul; Pervin, Sonia; Rawal, Lal BahadurObjectives The increasing prevalence of overweight and obesity among children (0–12 years) and adolescents (13–19 years) has emerged as a major public health threat in Bangladesh. Unfortunately, there is a serious paucity of credible data on these issues that can be used for policy and programmatic development. This article presents a systematic review of studies on overweight and obesity to present a more accurate estimate by pooling results. Study design Systematic review. Methods The study systematically reviewed relevant literature published between 1998 and 2015 using predefined inclusion/exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to identify relevant studies. Measures of heterogeneity and variability were calculated, and a random effect model was used to report pooled prevalence rates of overweight and obesity. Results The findings show that prevalence rates of overweight and obesity among children and adolescents varied widely from 1.0% to 20.6% and 0.3% to 25.6%, respectively. The pooled prevalence rates of overweight and obesity were 7.0% (95% confidence interval [CI] 5.0–10.0) and 6.0% (95% CI 4.0–8.0), respectively. The pooled prevalence rate of overweight increased substantially over the years, from 3.6% during 1998–2003 (95% CI 0.3–29.2) to 5.7% during 2004–2009 (95% CI 0.8–30.2) and 7.9% by 2010–2015 (95% CI 5.1–12.1). However, the pooled prevalence rate of obesity registered a sharp decline between 1998–2003 and 2004–2009 – from 9.7% (95% CI 5.7–16.2) to 2.0% (95% CI 0.3–11.1) – and subsequently increased significantly to 9.0% by 2010–2015 (95% CI 5.3–14.6). Conclusions This review identified increasing trends in the prevalence of overweight and obesity among children and adolescents in Bangladesh. This study underscores the urgent need to promote healthy lifestyles among children and adolescents with a view to effectively address the increasing problem of overweight and obesity. This would also help to prevent the development of chronic non-communicable diseases in adulthood.