Journal Articles (2020)
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Item Prevalence of and Factors Associated with Insufficient Physical Activity Among Adolescents: Evidence from the National Nutrition Surveillance Study(Oxford Academic, 5/29/2020) Hossain, Md Mokbul; Shamim, Abu Ahmed; Hasan, Mehedi; Hanif, Abu Abdullah Mohammad; Hossaine, Moyazzam; Ullah, Mohammad Aman; Sarker, Samir Kanti; Rahman, S M Mustafizur; Mitra, Dipak Kumar; Haque, Md Emdadul; Mridha, MalayObjectives: The World Health Organization (WHO) set a target of 15% relative reduction of the prevalence of insufficient physical activity (IPA) by 2025 among adolescents and adults globally. In Bangladesh, there is no national estimates of the prevalence of IPA among adolescents. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we aimed to estimate the prevalence and risk factors associated with IPA among adolescent girls and boys. Methods: NNS was conducted in 57 rural, 15 urban and 10 slum clusters selected using multistage cluster sampling. In these clusters, we collected data from 4732 adolescent girls and 4761 adolescent boys. We used Global Physical Activity Questionnaire to collect physical activity (PA) data. The WHO recommended cut off points for IPA (5–17 years: <300 minutes of moderate to vigorous-intensity PA weekly; 18–19 years: <150 minutes of moderate intensity PA weekly or <75 minutes of vigorous-intensity PA weekly) were used to estimate the prevalence of IPA. Bivariate and multivariable logistic regression were performed to identify factors associated with IPA. Results: Prevalence of IPA among girls and boys were 50.6% and 29.4%, respectively and the prevalence was significantly higher among early adolescents (10–14 years) than late adolescents in both boys and girls. The IPA prevalence was the highest among the adolescents living in non-slum urban areas (girls: 77.9% and boys: 64.6%). The IPA prevalence in slum areas was 36.6% for girls and 34.0% for boys; and in rural areas was 50.0% for girls and 28.2% for boys. For both girls and boys, age group, occupation and >6 hours of sitting per day were associated with IPA. Place of residence, consumption of fruits and vegetables, education and paternal occupation were associated with IPA only among the boys. On the other hand, maternal and paternal education and overweight/obesity were associated with IPA only among the girls. Conclusions: One in every two adolescent girls and one in every three adolescent boys do not meet the WHO recommended level of PA in Bangladesh. This study identified several modifiable factors associated with IPA among adolescent boys and girls and these factors should be addressed through comprehensive public health interventions in order to improve adolescent health in Bangladesh.Item Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17(Elsevier, 2020-08) Local Burden of Disease Diarrhoea CollaboratorsBackground: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6519000 children (95% UI 5 254000–7733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, withincountry geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52230 diarrhoeal deaths (36910–68860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers’ understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage.Item Documenting the challenges of conducting research on sexual and reproductive health and rights (SRHR) of persons with disabilities in a lowand-middle income country setting: Lessons from Bangladesh(BMJ Journals, 12/17/2020) Amin, Amina; Das, Adity Shayontony; Kaiser, Adrita; Azmi, Raia; Rashid, Sabina Faiz; Hasan, Md TanvirResearch has shown that persons with disabilities require greater sexual and reproductive health (SRH) care and services than persons without disabilities. However, this need is often neglected in most of the low-and-middleincome countries including Bangladesh. There is also a dearth of research and data relevant to this issue. A nationwide mixed-methods research has been conducted to explore persons with disabilities’ specific sexual and reproductive health and rights (SRHR) needs, health seeking behaviour related to SRH and barriers in accessing SRH services, along with the associated factors that influence their SRH outcomes. The purpose of this paper is to discuss the challenges encountered by the researchers while conducting this research and the strategies adopted to resolve those challenges. Some of the challenges experienced by the researchers include development of appropriate tools with questions on sensitive SRHR topics, obtaining informed consent, difficulty to maintain privacy while exploring sensitive SRHR issues and communication difficulties when interviewing individuals with intellectual and sensory impairments. The mitigation strategies include iterative revisions of all tools based on multiple pretests in different filed sites and expert feedback, strategic rapport building and maintaining appropriate contextual etiquette while conducting the interviews. The reflections discussed in this paper will assist future researchers in understanding potential field challenges they might encounter in similar low resource settings while conducting research on SRHR and similar sensitive issues among marginalised population groups, such as persons with disabilities.Item Noncommunicable disease risk factors among adolescent boys and girls in Bangladesh: Evidence from a National survey(Osong public health and research perspectives, 12/11/2020) Urmy, Nushrat Jahan; Hossain, Md. Mokbul; Shamim, Abu Ahmed; Khan, Md. Showkat Ali; Hanif, Abu Abdullah Mohammad; Hasan, Mehedi; Akter, Fahmida; Mitra, Dipak Kumar; Hossaine, Moyazzam; Ullah, Mohammad Aman; Sarker, Samir Kanti; Rahman, SM Mustafizur; Bulbul, Md. Mofijul Islam; Mridha, Malay KantiObjectives: To assess the prevalence of noncommunicable disease (NCD) risk factors and the factors associated with the coexistence of multiple risk factors (≥ 2 risk factors) among adolescent boys and girls in Bangladesh. Methods: Data on selected NCD risk factors collected from face to face interviews of 4,907 boys and 4,865 girls in the national Nutrition Surveillance round 2018-2019, was used. Descriptive analysis and multivariable logistic regression were performed. Results: The prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%, and 6.04%, respectively among boys; and 94.32%, 50.33%, 0.43%, and 8.03%, respectively among girls. Multiple risk factors were present among 34.87% of boys and 51.74% of girls. Younger age (p < 0.001), non-slum urban (p < 0.001) and slum residence (p < 0.001), higher paternal education (p = 0.001), and depression (p < 0.001) were associated with the coexistence of multiple risk factors in both boys and girls. Additionally, higher maternal education (p < 0.001) and richest wealth quintile (p = 0.023) were associated with the coexistence of multiple risk factors in girls. Conclusion: The government should integrate specific services into the existing health and non-health programs which are aimed at reducing the burden of NCD risk factors.Item Challenges and strategies in conducting sexual and reproductive health research among Rohingya refugees in Cox’s Bazar, Bangladesh(BMC, 12/14/2020) Ahmed, Rushdia; Aktar, Bachera; Farnaz, Nadia; Ray, Pushpita; Awal, Abdul; Hassan, Raafat; Bin Shafique, Sharid; Hasan, Md Tanvir; Quayyum, Zahidul; Jafarovna, Mohira Babaeva; Kobeissi, Loulou Hassan; El Tahir, Khalid; Chawla, Balwinder Singh; Rashid, Sabina FaizBackground: Rohingya diaspora or Forcibly Displaced Myanmar Nationals (FDMNs), took shelter in the refugee camps of Cox’s Bazar, Bangladesh due to armed conflict in the Rakhine state of Myanmar. In such humanitarian crises, delivering sexual and reproductive health (SRH) services is critical for better health outcomes of this most-at-risk population where more than half are adolescent girls and women. This is a reflective paper on challenges and related mitigation strategies to conduct SRH research among FDMNs. The research on which this paper is based employed a concurrent mixedmethod design combining a cross-sectional survey and qualitative interviews and group discussions with FDMNs to understand their SRH needs and demand-side barriers. Assessment of health facilities and qualitative interviews with healthcare providers and key stakeholders were carried out to assess facility readiness and supply-side barriers. Challenges and strategies: The researchers faced different challenges while conducting this study due to the unique characteristics of the FDMN population and the location of the refugee camps. The three key challenges researchers encountered include: sensitivity regarding SRH in the FDMNs, identifying appropriate sampling strategies, and community trust issues. The key approaches to overcome these challenges involved: actively engaging community members and gatekeepers in the data collection process to access respondents, identifying sensitive SRH issues through survey and exploring in-depth during qualitative interviews; and contextually modifying the sampling strategy. Conclusion: Contextual adaptation of research methods and involving community and local key stakeholders in data collection are the key lessons learnt from this study. Another important lesson was researchers’ identity and positionality as a member of the host country may create distrust and suspicion among the refugees. The multi-level complexities of humanitarian settings may introduce unforeseen challenges and interrupt research plans at different stages of research which require timely and contextual adaptations.Item Targeting anticorruption interventions at the front line: Developmental governance in health systems(BMJ Journals, 12/3/2020) Hutchinson, Eleanor; Naher, Nahitun; Roy, Pallavi; McKee, Martin; Mayhew, Susannah H; Ahmed, Syed Masud; Balabanova, DinaIn 2008, Vian reported an increasing interest in understanding how corruption affects healthcare outcomes and asked what could be done to combat corruption in the health sector. Eleven years later, corruption is seen as a heterogeneous mix of activity, extensive and expensive in terms of loss of productivity, increasing inequity and costs, but with few examples of programmes that have successfully tackled corruption in low-income or middleincome countries. The commitment, by multilateral organisations and many governments to the Sustainable Development Goals and Universal Health Coverage has renewed an interest to find ways to tackle corruption within health systems. These efforts must, however, begin with a critical assessment of the existing theoretical models and approaches that have underpinned action in the health sector in the past and an assessment of the potential of innovations from anticorruption work developed in sectors other than health. To that end, this paper maps the key debates and theoretical frameworks that have dominated research on corruption in health. It examines their limitations, the blind spots that they create in terms of the questions asked, and the capacity for research to take account of contextual factors that drive practice. It draws on new work from heterodox economics which seeks to target anticorruption interventions at practices that have high impact and which are politically and economically feasible to address. We consider how such approaches can be adopted into health systems and what new questions need to be addressed by researchers to support the development of sustainable solutions to corruption. We present a short case study from Bangladesh to show how such an approach reveals new perspectives on actors and drivers of corruption practice. We conclude by considering the most important areas for research and policy.Item Do social accountability approaches work? A review of the literature from selected low- and middle-income countries in the WHO South-East Asia region(Oxford Academic, 11/9/2020) Naher, Nahitun; Balabanova, Dina; Hutchinson, Eleanor; Marten, Robert; Hoque, Roksana; Tune, Samiun Nazrin Bente Kamal; Islam, Bushra Zarin; Ahmed, Syed MasudGovernance failures undermine efforts to achieve universal health coverage and improve health in low- and middle-income countries by decreasing efficiency and equity. Punitive measures to improve governance are largely ineffective. Social accountability strategies are perceived to enhance transparency and accountability through bottom-up approaches, but their effectiveness has not been explored comprehensively in the health systems of low- and middle-income countries in south and Southeast Asia where these strategies have been promoted. We conducted a narrative literature review to explore innovative social accountability approaches in Bangladesh, Bhutan, India, Indonesia, the Maldives, Myanmar and Nepal spanning the period 2007–August 2017, searching PubMed, Scopus and Google Scholar. To augment this, we also performed additional PubMed and Google Scholar searches (September 2017–December 2019) to identify recent papers, resulting in 38 documents (24 peer-reviewed articles and 14 grey sources), which we reviewed. Findings were analysed using framework analysis and categorized into three major themes: transparency/governance (eight), accountability (11) and community participation (five) papers. The majority of the reviewed approaches were implemented in Bangladesh, India and Nepal. The interventions differed on context (geographical to social), range (boarder reform to specific approaches), actors (public to private) and levels (community-specific to system level). The initiatives were associated with a variety of positive outcomes (e.g. improved monitoring, resource mobilization, service provision plus as a bridge between the engaged community and the health system), yet the evidence is inconclusive as to the extent that these influence health outcomes and access to health care. The review shows that there is no common blueprint which makes accountability mechanisms viable and effective; the effectiveness of these initiatives depended largely on context, capacity, information, spectrum of actor involvement, independence from power agendas and leadership. Major challenges that undermined effective implementation include lack of capacity, poor commitment and design and insufficient community participation.Item Status of the WHO recommended timing and frequency of antenatal care visits in Northern Bangladesh(PLOS ONE, 11/5/2020) Sarker, Bidhan Krishna; Rahman, Musfikur; Rahman, Tanjina; Rahman, Tawhidur; Khalil, Jubaida Jahan; Hasan, Mehedi; Rahman, Fariya; Ahmed, Anisuddin; Mitra, Dipak Kumar; Mridha, Malay Kanti; Rahman, AnisurObjective: There is dearth of information on the timeliness of antenatal care (ANC) uptake. This study aimed to determine the timely ANC uptake by a medically trained provider (MTP) as per the World Health Organization (WHO) recommendations and the country guideline. Methods Cross-sectional survey was done with 2,731 women having livebirth outcome in last one year in Dinajpur, Nilphamari and Rajshahi districts, Bangladesh from August-November,2016. Results About 82%(2,232) women received at least one ANC from a MTP. Overall, 78%(2,142) women received 4 or more ANCs by any provider and 43%(1168) from a MTP. Only 14%(378) women received their first ANC at the 1st trimester by a MTP. As per 4 schedule visits by the WHO FANC model and the country guideline 8%(203) and 20%(543) women respectively received the first 2 timely ANC by a MTP; where only 1%(32) and 3%(72) received the first 3 visits timely and 0.6%(17) and 1%(29) received all the four timely visits. Factors significantly associated with the first two timely visits are: 10 or above years of schooling of women [adj. OR 2.13 (CI: 1.05, 4.30)] and their husbands [adj. OR 2.40 (CI: 1.31, 4.38)], women’s employment [adj. OR 2.32 (CI: 1.43, 3.76)], urban residential status [adj. OR 3.49 (CI: 2.46, 4.95)] and exposure to mass media [adj. OR 1.58 (CI: 1.07, 2.34)] at 95% confidence interval. According to the 2016 WHO ANC model, only 1.5%(40) women could comply with the first two ANC contacts timely by a MTP and no one could comply with all the timely 8 contacts. Conclusion Despite high coverage of ANC utilization, timely ANC visit is low as per both the WHO recommendations and the country guideline. For better understanding, further studies on the timeliness of ANC coverage are required to design feasible intervention for improving maternal and child health.Item Prevalence and associated factors of underweight, overweight and obesity among women of reproductive age group in the Maldives: Evidence from a nationally representative study(PLOS ONE, 10/29/2020) Hashan, Mohammad Rashidul; Rabbi, Md Fazla; Haider, Shams Shabab; Gupta, Rajat DasBackground: Global epidemiological transition across various countries have documented the coexistence of undernutrition and overnutrition. South Asian countries are facing this public health hazard in remarkable manner. To enrich the evidence and relation with women’s health in the Maldives, this study was undertaken to examine the prevalence and associated factors of underweight, overweight and obesity among reproductive age women. Methods This study was conducted utilizing data from the Maldives Demographic and Health Survey 2016–17. After presenting descriptive analyses, multivariable logistic regression analysis method was used to examine the prevalence and associations between different nutritional status categories. These were grouped based on the WHO recommended cut-off value and relevant socio-demographic determinants among reproductive age women. Results A total weighted sample of 6,634 reproductive age Maldivian women (15–49 years) were included in the analysis. The overall prevalence of overweight and obesity was 63%, while the underweight prevalence was 10%. The younger age group (15–24 years) had a higher prevalence of underweight (26%). On the other hand, an overweight and obesity prevalence of 82.6% was observed among the older age group (35–49 years). Regression analysis showed that residents of the North and Central Provinces, those in the higher quintiles of wealth index, married women and those with parity of more than two children, were all significantly negatively correlated to being underweight. Increased age, being married or separated/divorced/widowed and having more than three children was found to have a significant positive association with overweight and obesity. Conclusions Maldives is facing nutritional transition and a major public health hazard demonstrated by the high burden of overweight and obesity and persistence of chronic problem of undernutrition. Surveillance of vulnerable individuals with identified socio-demographic factors and cost-effective interventions are highly recommended to address the persistent underweight status and the emerging problem of overweight/obesity.Item Should we care: A qualitative exploration of the factors that influence the decision of early marriage among young men in urban slums of Bangladesh(BMJ Journals, 10/26/2020) Biswas, Subas Chandra; Karim, Shuchi; Rashid, Sabina FaizObjectives To explore how adolescent and young men negotiate the complex realities of lives to explain their pathways into and reasons for early marriage in urban slums of Bangladesh. Design The qualitative data used here came from a larger 3-year study that used both quantitative and qualitative research methods. Setting Interviews were conducted in two of the largest slums in Dhaka and Chittagong city of Bangladesh between December 2015 and March 2018. Participants This paper uses qualitative data from 22 indepth interviews (IDIs) and three focus group discussions (FGDs) with adolescent and young men aged 15–24 years; 13 IDIs and 4 FGDs with parents and 11 key-informant interviews with community leaders. The purposively selected respondents were interviewed in their respective settings. Results In the context of urban slums, this study revealed multiple factors influence early marriage decision-making processes among young men. These factors include socially perceived phenomenon of adulthood and readiness of marriage, poverty leading to drop out from schools and early initiation to earning livelihood, manifestations of increasing individual aspiration and agency, fulfilment of romance and erotic desires and dreams of forming one’s own family. In addition, parental and immediate societal interference to preserve norms around gender and society can act as catalysts for this decision. Conclusions Study findings imply that complex structural factors, social and gender norms that are contributing to the early marriage for both adolescent boys and young men in Bangladesh’s urban slums. These are locations where conservatism, poverty and urbanisation intersect resulting in early and often unprepared entry to adulthood for young men impacting on their development and wellbeing. It is, therefore, critical that young men should be included in the national and global conversations around child marriage and child marriage prevention programme.