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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 Bahadur
Objectives 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.
Utilization of mobile phones for accessing menstrual regulation services among low-income women in Bangladesh: a qualitative analysis
(© 2017 BioMed Central Ltd., 1/14/2017) Messinger, Chelsea Jordan; Mahmud, Ilias; Kanan, Sushama; Jahangir, Yamin Tauseef; Sarker, Malabika; Rashid, Sabina Faiz
Background: As many as one-third of all pregnancies in Bangladesh are unplanned, with nearly one-half of these pregnancies ending in either menstrual regulation (MR) or illegal clandestine abortion. Although MR is provided free of charge, or at a nominal cost, through the public sector and various non-profits organizations, many women face barriers in accessing safe, affordable MR and post-MR care. Mobile health (mHealth) services present a promising platform for increasing access to MR among low-income women at risk for clandestine abortion. We sought to investigate the knowledge, attitudes and practices regarding mHealth of both MR clients and formal and informal sexual and reproductive healthcare providers in urban and rural low-income settlements in Bangladesh. Methods: A total of 58 interviews were conducted with MR clients, formal MR providers, and informal MR providers in four low-income settlements in the Dhaka and Sylhet districts of Bangladesh. Interview data was coded and qualitatively analysed for themes using standard qualitative research practices. Results: Our findings suggest that low-income MR clients in Bangladesh have an inadequate understanding of how to use their mobile phones to obtain health service information or counselling related to MR, and correspondingly low levels of formal or informal mHealth service utilization. Few were aware of any formal mHealth services in place in their communities, despite the fact that providers stated that hotlines were available. Overall, MR clients expressed positive opinions of mHealth services as a means of improving women's access to affordable and timely MR. Formal and informal MR providers believed that mobile phones had benefits with respect to information dissemination and making appointments, but emphasized the necessity of in-person consultations for effective sexual and reproductive healthcare. Conclusions: We report low utilization yet high acceptability of mHealth services among low-income MR clients in Bangladesh. Expanding formal and informal mHealth services targeted towards MR - and increasing publicity of these services in low-income communities - may help increase timely access to accurate MR information and formal providers among women at risk for clandestine abortion. While expanding formal and informal mHealth services for SRHR in Bangladesh may be useful in disseminating information about MR and connecting women with formal providers, in-person visits remain necessary for adequate treatment.
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, Ilias
Background: 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.
From joint thinking to joint action: a call to action on improving water, sanitation and hygiene for maternal and newborn health
(© 2014 Public Library of Science, 12/1/2014) Campbell, Oona M R; Afsana, Kaosar; Hounton, Sennen; Benova, Lenka; Wijesekera, Sanjay; Mason, Elizabeth; Magoma, Moke; Graham, Wendy; Esteves Mills, Joanna; Cumming, Oliver; Curtis, Val; Velleman, Yael; Boisson, Sophie; Cairncross, Sandy; Chopra, Mickey; Gordon, Bruce
This paper, authored by scientists and technical experts from leading universities and international agencies, outlines the importance of water, sanitation and hygiene (WASH) for maternal and newborn health (MNH) outcomes and calls for greater inter-sectoral collaboration. It was launched at LSHTM on 15th December 2014.
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 Work
Changing global policy to deliver safe, equitable, and affordable care for women's cancers
(© 2017 Lancet Publishing Group, 2/25/2017) Ginsburg, Ophira M.; Badwe, Rajendra A.; Peter A. Boyle, Peter; Derricks, Gemma; Dare, Anna J.; Evans, Timothy Grant; Eniu, Alexandru E.; Jiménez, Jorge C.Moreno; Kutluk, Tezer M.; De Lima Lopes, Gilberto L.; Mohammed, Sulma Ibrahim; Qiao, Youlin; Rashid, Sabina Faiz; Summers, Diane; Sarfati, Diana; Temmerman, Marleen I.L.; Trimble, Edward Lloyd; Padela, Aasim; Aggarwal, Ajay; Sullivan, Richard
Breast and cervical cancer are major threats to the health of women globally, particularly in low-income and middle-income countries. Radical progress to close the global cancer divide for women requires not only evidence-based policy making, but also broad multisectoral collaboration that capitalises on recent progress in the associated domains of women's health and innovative public health approaches to cancer care and control. Such multisectoral collaboration can serve to build health systems for cancer, and more broadly for primary care, surgery, and pathology. This Series paper explores the global health and public policy landscapes that intersect with women's health and global cancer control, with new approaches to bringing policy to action. Cancer is a major global social and political priority, and women's cancers are not only a tractable socioeconomic policy target in themselves, but also an important Trojan horse to drive improved cancer control and care.
Impact of flooding on feeding practices of infants and young children in Dhaka, Bangladesh Slums: what are the coping strategies?
(© 2010 Blackwell Publishing Ltd., 2010) Goudet, Sophie M.; Griffiths, Paula L.; Bogin, Barry A.; Selim, Nasima
Previous research has shown that urban slums are hostile environments for the growth of infants and young children (IYC). Flooding is a hazard commonly found in Dhaka slums (Bangladesh) which negatively impacts IYC's nutritional and health status. This paper aims 1) to identify the impact of flooding on IYC's feeding practices, and 2) to explore the coping strategies developed by caregivers. Qualitative data (participant observation and semi-structured interviews) and quantitative data (household questionnaire and anthropometric measurements) collected in slums in Dhaka (n=18 mothers, n=5 community health workers, and n=55 children) were analysed. The subjects of the interviews were mothers and Bangladesh Rural Advancement Committee (BRAC) community health workers living and working in the slums. Research findings showed that breastfeeding and complementary feeding practices for IYC were poor and inappropriate due to lack of knowledge, time, and resources in normal times and worse during flooding. One coping strategy developed by mothers purposely to protect their IYC's nutritional status was to decrease their personal food intake. Our research findings suggest that mothers perceived the negative impact of flooding on their IYC's nutritional health but did not have the means to prevent it. They could only maintain their health through coping strategies which had other negative consequences. The results suggests a holistic approach combining 1) provision of relief for nutritionally vulnerable groups during flooding, 2) support to mothers in their working role, 3) breastfeeding counseling and support to lactating mothers with difficulties, and 4) preventing malnutrition in under 2 year old children.
Mixing methods, tasting fingers: notes on an ethnographic experiment
(© 2011 School of Social and Political Sciences, 2011) Mann, Anna; Mol, Annemarie; Satalkar, Priya; Savirani, Amalinda; Selim, Nasima; Sur, Malini; Yates-Doerr, Emily
This article reports on an ethnographic experiment. Four finger eating experts and three novices sat down for a hot meal and ate with their hands. Drawing on the technique of playing with the familiar and the strange, our aim was not to explain our responses, but to articulate them. As we seek words to do so, we are compelled to stretch the verb "to taste."Tasting, or so our ethnographic experiment suggests, need not be understood as an activity confined to the tongue. Instead, if given a chance, it may viscously spread out to the fingers and come to include appreciative reactions otherwise hard to name. Pleasure and embarrassment, food-like vitality, erotic titillation, the satisfaction or discomfort that follow a meal - we suggest that these may all be included in "tasting." Thus teasing the language alters what speakers and eaters may sense and say. It complements the repertoires available for articulation. But is it okay? Will we be allowed to mess with textbook biology in this way and interfere, not just with anthropological theory, but with the English language itself?
Creating a public space and dialogue on sexuality and rights: a case study from Bangladesh
(© 2011 Rashid et al; licensee BioMed Central Ltd., 2011) Rashid, Sabina Faiz; Standing, Hilary; Mohiuddin, Mahrukh; Ahmed, Farah M.
This article describes and analyses a research based engagement by a university school of public health in Bangladesh aimed at raising public debate on sexuality and rights and making issues such as discrimination more visible to policy makers and other key stakeholders in a challenging context. The impetus for this work came from participation in an international research programme with a particular interest in bridging international and local understandings of sexual and reproductive rights. The research team worked to create a platform to broaden discussions on sexuality and rights by building on a number of research activities on rural and urban men's and women's sexual health concerns, and on changing concepts of sexuality and understandings of sexual rights among specific population groups in Dhaka city, including sexual minorities. Linked to this on-going process of improving the evidence base, there has been a series of learning and capacity building activities over the last four years consisting of training workshops, meetings, conferences and dialogues. These brought together different configurations of stakeholders - members of sexual minorities, academics, service providers, advocacy organisations, media and policy makers. This process contributed to developing more effective advocacy strategies through challenging representations of sexuality and rights in the public domain. Gradually, these efforts brought visibility to hidden or stigmatised sexuality and rights issues through interim outcomes that have created important steps towards changing attitudes and policies. These included creating safe spaces for sexual minorities to meet and strategise, development of learning materials for university students and engagement with legal rights groups on sexual rights. Through this process, it was found to be possible to create a public space and dialogue on sexuality and rights in a conservative and challenging environment like Bangladesh by bringing together a diverse group of stakeholders to successfully challenge representations of sexuality in the public arena. A further challenge for BRAC University has been to assess its role as a teaching and research organisation, and find a balance between the two roles of research and activism in doing work on sexuality issues in a very sensitive political context.
The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution
(© 2011 Ahmed et al; licensee BioMed Central Ltd., 2011) Ahmed, Syéd Masud; Hossain, Md Awlad; RajaChowdhury, Ahmed Mushtaque; Bhuiya, Abbas Uddin
Bangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007.Methods: The study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward.Results: HCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditional healers, homeopaths (qualified and non-qualified) and basic care providers.Conclusions: Bangladesh is suffering from a severe HRH crisis--in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution--which requires immediate attention from policy makers.
The sexual and reproductive health care market in Bangladesh: where do poor women go?
(© 2011 Reproductive Health Matters., 2011) Rashid, Sabina Faiz; Akram, Owasim; Standing, Hilary
In Bangladesh, the formal public health system provides few services for common sexual and reproductive health problems such as white discharge, fistula, prolapse, menstrual problems, reproductive and urinary tract infections, and sexual problems. Recent research has found that poor women and men resort to informal providers for these problems instead. This paper draws on interviews with 303 providers and 312 women from two rural and one urban area of Bangladesh from July 2008 to January 2009. Both informal and formal markets played an important role in treating these problems, including for the poor, but the treatments were often unlikely to resolve the problems. Providers ranged from village doctors without formal training to qualified private practitioners. The health system is heavily marketised and boundaries between "public" and "private" are blurred. There exists a huge, neglected domain of sexual and reproductive health needs which are a source of silent suffering and for which there are no trained health staff providing treatment in government facilities. The complexity of this situation calls for engaged debate in Bangladesh on how to improve the quality of existing services, discourage or prevent obviously harmful practices, and develop financing mechanisms to enable women to access effective treatment, regardless of the source, for these neglected problems.
Human rights and reproductive health: political realities and pragmatic choices for married adolescent women living in urban slums, Bangladesh
(© 2011 Rashid; licensee BioMed Central Ltd., 2011) Rashid, Sabina Faiz
In Bangladesh, particularly in urban slums, married adolescent womens human rights to life, health, and reproductive and sexual health remain adversely affected because of the structural inequalities and political economic, social and cultural conditions which shape how rights are understood, negotiated and lived. Methods. The focus of the research and methods was anthropological. An initial survey of 153 married adolescent women was carried out and from this group, 50 in-depth interviews were conducted with selected participants and, from the in-depth interviews, a further eight case studies of women and their families were selected for in-depth repeated interviews and case histories. Results: This paper speaks of the unanticipated complexities when writing on reproductive rights for poor adolescent women living in the slums, where the discourses on universal human rights are often removed from the reality of adolescent womens everyday lives. Married adolescent women and their families remain extremely vulnerable in the unpredictable, crime-prone and insecure urban slum landscape because of their age, gender and poverty. Adolescent womens understanding of their rights such as the decision to marry early, have children, terminate pregnancies and engage in risky sexual behaviour, are different from the widely accepted discourse on rights globally, which assumes a particular kind of individual thinking and discourse on rights and a certain autonomy women have over their bodies and their lives. This does not necessarily exist in urban slum populations. Conclusions: The lived experiences and decisions made pertaining to sexual and reproductive health and rights exercised by married adolescent women, their families and slum communities, allow us to reflect on the disconnect between the international legal human rights frameworks as applied to sexual and reproductive health rights, and how these are played out on the ground. These notions are far more complex in environments where married adolescent women and their families live in conditions of poverty and socioeconomic deprivation.
Evidence aid and the disaster response in Pakistan and Haiti
(© 2011 Cochrane database of systematic reviews (Online), 2011) Koehlmoos, Tracey Pérez
Nutrition of children and women in Bangladesh: trends and directions for the future
(© 2012 Journal of Health, Population and Nutrition, 2012) Ahmed, Tahmeed; Mahfuz, Mustafa; Ireen, Santhia; Ahmed, A. M. Shamsir; Rahman, Sabuktagin; Islam, M Munirul; Alam, Nurul; Hossain, Md Iqbal; Rahman, S M Mustafizur; Ali, M Mohsin; Choudhury, Fatima Perveen; Cravioto, Alejandro
Although child and maternal malnutrition has been reduced in Bangladesh, the prevalence of underweight (weight-for-age z-score <-2) among children aged less than five years is still high (41%). Nearly one-third of women are undernourished with body mass index of <18.5 kg/m2. The prevalence of anaemia among young infants, adolescent girls, and pregnant women is still at unacceptable levels. Despite the successes in specific programmes, such as the Expanded Programme on Immunization and vitamin A supplementation, programmes for nutrition interventions are yet to be implemented at scale for reaching the entire population. Given the low annual rate of reduction in child undernutrition of 1.27 percentage points per year, it is unlikely that Bangladesh would be able to achieve the United Nations' Millennium Development Goal to address undernutrition. This warrants that the policy-makers and programme managers think urgently about the ways to accelerate the progress. The Government, development partners, non-government organizations, and the academia have to work in concert to improve the coverage of basic and effective nutrition interventions, including exclusive breastfeeding, appropriate complementary feeding, supplementation of micronutrients to children, adolescent girls, pregnant and lactating women, management of severe acute malnutrition and deworming, and hygiene interventions, coupled with those that address more structural causes and indirectly improve nutrition. The entire health system needs to be revitalized to overcome the constraints that exist at the levels of policy, governance, and service-delivery, and also for the creation of demand for the services at the household level. In addition, management of nutrition in the aftermath of natural disasters and stabilization of prices of foods should also be prioritized.
Sex, pornography and medicines in the markets of Dhaka
(© 2012 Taylor and Francis, 2012) Rashid, Sabina F; Anam, Mujibul; Akram, O
Informal markets in sexual and reproductive health services and commodities in rural and urban Bangladesh
(© 2012 Taylor and Francis, 2012) Standing, Hilary; Rashid, Sabina; Akram, Owasim
Intersectoral collaboration: a novel path to promote community health promotion
(© 2012 Global Health Promotion, 2012) Sarker, Malabika; Joarder, Taufique
Health threats as nontraditional security challenges for Bangladesh
(© 2012 National Bureau of Asian Research, 2012) Bhuiya, Abbas
This essay discusses health problems that have the potential to emerge as nontraditional security challenges for Bangladesh in the coming decades.
Intersectoral collaboration: an original way to promote community health promotion
(© 2012 Global Health Promotion, 2012) Sarker, Malabika; Joarder, Taufique
Financial aid for the rehabilitation of individuals with spinal cord injuries in Bangladesh
(© 2012 Asia Pacific Disability Rehabilitation Journal, 2012) Nahar, Nazmun; Nuri, Reshma Parvin; Mahmud, Ilias
In Bangladesh, a majority of individuals with spinal cord injuries (SCI) are either poor or very poor. In most cases, their families undergo extreme hardship as they lose the income of the only or main earning member, and are unable to bear costs of rehabilitation. Purpose: This mixed method study explored perspectives of individuals with SCI regarding financial aid in the form of interest-free loans for their treatment and rehabilitation at the Centre for the Rehabilitation of the Paralysed (CRP). Method: In the first part of the study, 10 semi-structured face-to-face interviews were conducted. In the second part of the study, 40 persons with SCI were surveyed. The qualitative method involved selection of respondents according to their age, sex and severity of disability. Quantitative interviews were conducted with all persons with SCI in the final stage of hospital rehabilitation, in the third quarter of 2008. Results: Though CRP provides financial support depending on the individual's economic status, many persons with SCI needed additional funding from multiple sources, such as savings (42.5%), mortgaging assets (12.5%), selling assets (45%), receiving loans (37.5%), begging for money (42.5%), and receiving donations from relatives (47.5%) or the community (30%), to meet the direct and indirect costs of rehabilitation. Majority (85%) of those interviewed wanted to receive financial aid in the form of interest-free loans. 76.4% of them wanted the loans to be disbursed in two phases; initially, to offset some of their costs during rehabilitation at CRP, and thereafter, for economic reintegration in their community. The remaining 23.6% wanted the loan only for vocational reintegration. 70.59% of those interviewed proposed repayment in monthly instalments, while 17.64% suggested quarterly instalments and 11.76% favoured annual instalments. Over half of the participants (55.88%) wanted to have vocational training, and the rest wanted vocational training for their family members, to enable them to repay the loan. Conclusions: This study revealed that there is a huge demand for interestfree loans among people with SCI. An appropriately designed interest-free loan programme, which would be sensitive to individual needs, could save people with SCI and their families from bankruptcy. This would also make SCI rehabilitation programmes more sustainable, and possibly reduce over-dependence on the donors. Further action research is recommended to evaluate the effectiveness of such a course of action.