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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 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.Item 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 FaizBackground: 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.Item 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, RichardBreast 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.Item Role of credit in food security and dietary diversity in Bangladesh(© 2017 Elsevier B.V., 3/1/2017) Bidisha, Sayema Haque; Khan, Akib; Imran, Khalid; Khondker, Bazlul Haque; Suhrawardy, Gazi MohammadThis work attempts to disentangle the relationship between credit, food security, and dietary diversity in the context of Bangladesh through descriptive and econometric analyses of the Household Income and Expenditure Survey of 2010 as well as a supplementary primary survey of 1200 households. To adequately address potential selection bias, we apply a variant of propensity score matching as well as an instrumental variable technique based on the distance from the nearest financial institution to account for endogeneity in our estimates. Our analysis reveals that access to credit tends to improve food security and allows households to achieve greater dietary diversity. In particular, food security is proxied by calorie consumption, and households with credit access tend to have greater calorie consumption per capita. Dietary diversity is measured through a number of dietary diversity scores, such as the food consumption score and the household dietary diversity score, and households with access to credit score higher than those without according to such measures. The results have been found to be robust following correction for endogeneity issues, and the paper therefore provides empirical evidence in favor of policies supporting accessible credit for poor households in Bangladesh.Item Coping strategies related to food insecurity at the household level in Bangladesh(© 2017 Public Library of Science, 2017-04) Dil Farzana, Fahmida; Rahman, Ahmed Shafiqur; Sultana, Sabiha; Raihan, Mohammad Jyoti; Haque, Md Ahshanul; Waid, Jillian L.; Choudhury, Nuzhat; Ahmed, Tahmeed J.Introduction: In connection to food insecurity, adaptation of new techniques or alteration of regular behavior is executed that translates to coping strategies. This paper has used data from food security and nutrition surveillance project (FSNSP), which collects information from a nationally representative sample in Bangladesh on coping behaviors associated with household food insecurity. To complement the current understanding of different coping strategies implemented by the Bangladeshi households, the objective of this paper has been set to examine the demographic and socio-economic characteristics of the food insecure households which define their propensity towards adaptation of different types of coping strategies. Methodology: FSNSP follows a repeated cross-sectional survey design. Information of 23,374 food insecure households available from February 2011 to November 2013 was selected for the analyses. Coping strategies were categorized as financial, food compromised and both. Multinomial logistic regression was employed to draw inference. Results: Majority of the households were significantly more inclined to adopt both multiple financial and food compromisation coping strategies. Post-aman season, educational status of the household head and household women, occupation of the household's main earner, household income, food insecurity status, asset, size and possession of agricultural land were found to be independently and significantly associated with adaptation of both financial and food compromisation coping strategies relative to only financial coping strategies. The relative risk ratio of adopting food compromisation coping relative to financial coping strategies when compared to mildly food insecure households, was 4.54 times higher for households with moderate food insecurity but 0.3 times lower when the households were severely food insecure. Whereas, households were 8.04 times and 4.98 times more likely to adopt both food compromisation and financial relative to only financial coping strategies if moderately and severely food insecure respectively when compared to being mildly food insecure. Conclusion: Households suffering from moderate and severe food insecurity, are more likely to adopt both financial and food compromisation coping strategies.Item The prevalence of underweight, overweight and obesity in Bangladeshi adults: data from a national survey(© 2017 Public Library of Science, 5/5/2017) Biswas, Tuhin; Garnett, Sarah P.; Pervin, Sonia; Rawal, Lal BahadurBackground: Over the two last decades Bangladesh, a low-income country, has experienced a rapid demographic and epidemiological transition. The population has increased substantially with rapid urbanization and changing pattern of disease, which at least in part, can be explained by nutritional changes. However, the nutritional status of the adult population has not been previously described. Hence, the objective of this study was to estimate the prevalence and explore socio-demographic determinants of underweight, overweight and obesity among the Bangladeshi adult population. Methods: This study is a secondary data analysis of the national 2011 Bangladesh Demographic and Health Survey. We determined the nutritional status of adults aged ≥35 years of age, who had a measured weight and height, using the Asian body mass index (BMI) cut-offs for underweight (BMI <18.5 kg/m2), overweight (BMI 23 to <27.5 kg/m2) and obesity (BMI ≥27.5 kg/m2). Logistic regression modeling was used to determine the association between socio-demographic factors and nutritional status. Result: Of total sample (n = 5495), 30.4% were underweight, 18.9% were overweight and 4.6% were obese. Underweight was associated with age, education and wealth. The adjusted odd ratios for underweight were higher for older people (≥70 years) compared to younger, the least educated compared to the most educated and the poorest compared to the wealthiest were 2.51 (95%CI: 1.95±3.23, p<0.001), 3.59 (95%CI: 2.30±5.61, p<0.001) and 3.70 (95%CI: 2.76±4.96, p<0.001), respectively. Younger age (35±44 years), being female, higher education, wealthier and living in urban areas were associated with overweight/obesity with adjusted odds ratios of 1.73 (95%CI: 1.24±2.41, p<0.001), 2.48 (95%CI: 1.87±3.28, p<0.001), 3.98 (95%CI: 2.96±5.33, p<0.001), 7.14 (95%CI: 5.20±9.81, p<0.001) 1.27 (95%CI: 1.05±1.55, p-0.02), respectively. Conclusion: Underweight and overweight/obesity are prevalent in Bangladeshi adults. Both conditions are associated with increased morbidity and mortality and increase the risk of developing non-communicable diseases. Effective public health intervention approaches are necessary to address both these conditions.Item Socio-demographic characteristics and tobacco use among the adults in urban slums of Dhaka, Bangladesh(© 2017 BioMed Central Ltd., 5/5/2017) Khandker, Nusrat Nausheen; Biswas, Tuhin; Khan, Abdullah Nurus Salam; Hasib, Enamul; Rawal, Lal BahadurBackground: Use of tobacco has become one of the major causes of premature deaths in most developing countries, including Bangladesh. The poorest and most disadvantaged populations, such as those living in slums, are considered to be extremely vulnerable to non-communicable diseases and their risk factors, especially tobacco use. The objective of this study was to assess the current status of tobacco consumption among slum dwellers and its association with socio-demographic factors. Methods: A cross-sectional study was conducted in three slums of Dhaka city. Information about tobacco use as well as socio-demographic characteristics was collected from adult slum dwellers via face to face interviews using WHO STEPS questionnaire. Result: Overall proportion of smoking, smokeless tobacco consumption and dual use of tobacco was 35% [95% CI: 31.6-39.8], 40.6% [95% CI: 36.5-45.2] and 12% [95% CI: 9.3-15.0] respectively. Elderly people (55-64 years) were more likely to smoke (OR: 2.34, 95% CI: 1.21-4.49) than younger people (aged 25-34 years). On the other hand, those who had no schooling history (OR: 2.95, 95% CI: 1.66-5.25) were more likely to consume smokeless tobacco than those who had higher education (secondary or above). At the same time, manual workers were more likely to indulge in dual use of tobacco (OR: 5.17, 95% CI: 2.82-9.48) as compared to non-manual workers. Conclusion: The urban slum population of Dhaka city has a high prevalence of tobacco use, which increases their likelihood of developing non-communicable diseases. Proper attention needs to be directed towards addressing the risk factors related to non-communicable diseases within this vulnerable population.