Journal Articles (2020)

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Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method
(BMJ Journals, 2/13/2020) Joarder, Taufique; Bente Kamal Tune, Samiun Nazrin; Nuruzzaman, Md; Alam, Sabina; de Oliveira Cruz, Valeria; Zapata, Tomas
Objective This study aimed to assess the current workload and staffing need of physicians and nurses for delivering optimum healthcare services at the Upazila Health Complexes (UpHCs) in Bangladesh. Design Mixed-methods, combining qualitative (eg, document reviews, key informant interviews, in-depth interviews, observations) and quantitative methods (timemotion survey). Setting Study was conducted in 24 health facilities of Bangladesh. However, UpHCs being the nucleus of primary healthcare in Bangladesh, this manuscript limits itself to reporting the findings from the providers at four UpHCs under this project. Participants 18 physicians and 51 nurses, males and females. Primary outcome measures Workload components were defined based on inputs from five experts, refined by nine service providers. Using WHO Workload Indicator of Staffing Need (WISN) software, standard workload, category allowance factor, individual allowance factor, total required number of staff, WISN difference and WISN ratio were calculated. Results Physicians have very high (WISN ratio 0.43) and nurse high (WISN ratio 0.69) workload pressure. 50% of nurses’ time are occupied with support activities, instead of nursing care. There are different workloads among the same staff category in different health facilities. If only the vacant posts are filled, the workload is reduced. In fact, sanctioned number of physicians and nurses is more than actual need. Conclusions It is evident that high workload pressures prevail for physicians and nurses at the UpHCs. This reveals high demand for these health workforces in the respective subdistricts. WISN method can aid the policy-makers in optimising utilisation of existing human resources. Therefore, the government should adopt flexible health workforce planning and recruitment policy to manage the patient load and disease burden. WISN should, thus, be incorporated as a planning tool for health managers. There should be a regular review of health workforce management decisions, and these should be amended based on periodic reviews.
Association between the frequency of television watching and overweight and obesity among women of reproductive age in Nepal: Analysis of data from the Nepal Demographic and Health Survey 2016
(PLOS ONE, 2/10/2020) Gupta, Rajat Das; Haider, Shams Shabab; Hashan, Mohammad Rashidul; Hasan, Mehedi; Sutradhar, Ipsita; Sajal, Ibrahim Hossain; Joshi, Hemraj; Haider, Mohammad Rifat; Sarker, Malabika
Background The prevalence of overweight and obesity, particularly among women, is increasing in Nepal. Previous studies in the South Asia have found television watching to be a risk factor for overweight and obesity among women of reproductive age. However, this association had not been studied in the context of Nepal. This study aims to identify the association between frequency of television watching and overweight and obesity among Nepalese women of reproductive age. Methods This cross-sectional study utilized the Nepal Demographic and Health Survey 2016 (NDHS 2016) data. A total weighted sample of 6,031 women were included in the final analyses. The women were 15–49 years of age and were either not pregnant or had not delivered a child within the two months prior to the survey. Body mass index (BMI) was the primary outcome of this study, which was categorized using an Asia-specific cutoff value. Normal and/ or underweight was defined as a BMI <23.0 kg/m2 , overweight was defined as a BMI between 23.0 kg/m2 and <27.5 kg/m2 , and obesity was defined as a BMI �27.5 kg/m2 . Frequency of watching television was the main independent variable of this study, which was divided into the following three categories: not watching television at all, watching television PLOS ONE | https://doi.org/10.1371/journal.pone.0228862 February 10, 2020 1 / 13 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Das Gupta R, Haider SS, Hashan MR, Hasan M, Sutradhar I, Sajal IH, et al. (2020) Association between the frequency of television watching and overweight and obesity among women of reproductive age in Nepal: Analysis of data from the Nepal Demographic and Health Survey 2016. PLoS ONE 15(2): e0228862. https:// doi.org/10.1371/journal.pone.0228862 Editor: Cindy Gray, University of Glasgow, UNITED KINGDOM Received: July 20, 2019 Accepted: January 25, 2020 Published: February 10, 2020 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0228862 Copyright: © 2020 Das Gupta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The dataset of NDHS 2016 is available at the Demographic and Health less than once a week, and watching television at least once a week. Multilevel ordered logistic regression was conducted to find the factors associated with overweight and obesity. A p-value <0.05 was considered significant in the final model. Results Around 35% of the participants were overweight or obese (overweight: 23.7% and obese: 11.6%). A majority of the study participants was aged between 15 and 24 years (36.5%), and resided in an urban area (63.2%), Province No. 3 (22.3%), and the Terai ecological region (49.5%). Around one-third (34.0%) of the participants received no formal education while an almost similar proportion (35.5%) completed secondary education. Approximately half of the study participants (50.6%) reported watching television at least once a week, whereas more than a quarter (28.7%) of them did not watch television at all. Women who watched television at least once a day had a higher prevalence of overweight and obesity than the other groups (p-value <0.0001). Women who watched television at least once a week were 1.3 times more likely to be overweight or obese in comparison to women who never watched television (Adjusted Odds Ratio (AOR): 1.3, 95% CI: 1.0–1.7; p-value <0.05). In the urban areas, women who watched television at least once a week were 40% more likely to be overweight or obese than those who did not watch television at all (AOR: 1.4, 95% CI: 1.1–1.7; p-value <0.01). No significant association between overweight and obesity and the frequency of viewing television was observed in the rural area. Conclusions Watching television at least once a week is associated with overweight and obesity in women of reproductive age living in the urban areas of Nepal. Public health promotion programs should raise awareness among women regarding harmful health consequences of sedentary lifestyle due to television watching.
Attitudes and practices of public health academics towards research funding from for-profit organizations: Cross-sectional survey
(Springer Link, 8/25/2020) Nakkash, Rima; Ali, Ahmed; Alaouie, Hala; Asmar, Khalil; Hirschhorn, Norbert; Mugharbil, Sanaa; Nuwayhid, Iman; London, Leslie; Saban, Amina; Rashid, Sabina Faiz; Ahmed, Md Koushik; Knai, Cecile; Bigland, Charlotte; Afifi, Rima A.
Objectives: The growing trend of for-profit organization (FPO)-funded university research is concerning because resultant potential conflicts of interest might lead to biases in methods, results, and interpretation. For public health academic programmes, receiving funds from FPOs whose products have negative health implications may be particularly problematic. Methods A cross-sectional survey assessed attitudes and practices of public health academics towards accepting funding from FPOs. The sampling frame included universities in five world regions offering a graduate degree in public health; 166 academics responded. Descriptive, bivariate, and logistic regression analyses were conducted. Results Over half of respondents were in favour of accepting funding from FPOs; attitudes differed by world region and gender but not by rank, contract status, % salary offset required, primary identity, or exposure to an ethics course. In the last 5 years, almost 20% of respondents had received funding from a FPO. Sixty per cent of respondents agreed that there was potential for bias in seven aspects of the research process, when funds were from FPOs. Conclusions Globally, public health academics should increase dialogue around the potential harms of research and practice funded by FPOs.
Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: A cross-sectional analysis of service provision assessments in eight low-income countries
(BMJ Journals, 10/10/2020) Gupta, Neil; Coates, Matthew M; Bekele, Abebe; Dupuy, Roodney; Fénelon, Darius Leopold; Gage, Anna D; Getachew, Theodros; Karmacharya, Biraj Man; Kwan, Gene F; Lulebo, Aimée M; Masiye, Jones K; Mayige, Mary Theodory; Mbaye, Maïmouna Ndour; Mridha, Malay Kanti; Park, Paul H; Dagnaw, Wubaye Walelgne; Wroe, Emily B; Bukhman, Gene
Context and objectives: Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions. Design: Secondary analysis of existing cross-sectional survey data. Setting: We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country. Outcome measures: We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities. Results: Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1-2 hypertension (28%-83%). Availability was low for type 1 diabetes (1%-70%), type 2 diabetes (3%-57%), asthma (0%-7%) and acute presentations of diabetes (0%-26%) and asthma (0%-4%). Few hospitals had equipment or medications for heart failure (0%-32%), rheumatic heart disease (0%-23%), hypertensive emergencies (0%-64%) or acute minor surgical conditions (0%-5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability. Conclusions: Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.
Beyond the talking imperative: The value of silence on sexuality in youth-parent relations in Bangladesh
(Taylor & Francis, 4/15/2020) Camellia, Suborna; Rommes, Els; Jansen, Willy
Research conducted in various parts of the globe suggests that young people who can openly communicate with their parents about sexuality benefit in many ways. Correspondingly, in Bangladesh, the lack of an open communication on sexuality in the youth–parent relationship is considered a barrier to ensuring young people’s sexual and reproductive health and overall well-being. Taking ‘silence’ as a core concept, this paper investigates what silence on sexuality means to Bangladeshi young people in their relationship with parents. It draws on findings from an ethnographic study conducted among 72 middle-class boys and girls aged between 15 and 19 years and 18 parents living in Dhaka over a year between 2016 and 2017. The findings suggest that silence is not always perceived as problematic by young people, and this is particularly true for topics related to sexual pleasure. This paper challenges the monolithic understanding that silence is necessarily bad and hinders young people from getting what they need. It offers an additional conceptual understanding to silence for studying sexuality among youths and designing interventions for their sexual and reproductive well-being.
Carrying out embedded implementation research in humanitarian settings: A qualitative study in Cox's Bazar, Bangladesh
(PLOS ONE, 7/16/2020) Shahabuddin, A. S. M.; Sharkey, Alyssa B.; Jackson, Debra; Rutter, Paul; Hasman, Andreas; Sarker, Malabika
Background: Embedded implementation research (IR) promotes evidence-informed policy and practices by involving decision-makers and program implementers in research activities that focus on understanding and solving existing implementation challenges. Although embedded IR has been conducted in multiple settings by different organizations, there are limited experiences of embedded IR in humanitarian settings. This study highlights some of the key challenges of conducting embedded IR in a humanitarian setting based on our experience with the Rohingya refugee population in Cox's Bazar, Bangladesh. Methods and findings: We collected qualitative data in between January and July 2019. First, we visited Rohingya refugee camps and interviewed representatives from different humanitarian organizations. Second, we conducted interviews with researchers from BRAC University who were engaged with data collection and analysis in a broader embedded IR study on maternal, newborn, child, and adolescent health (MNCAH) program implementation challenges. Data were analyzed using a thematic analysis approach. Two researchers developed and agreed on codes and relevant themes based on the objectives of this study. The findings of this study highlight several challenges encountered while conducting embedded IR in the Rohingya emergency setting in Cox's Bazar, which may have implications for other humanitarian settings. The overall context of the camps was complex, with more than 100 organizations devoted to providing health services for approximately 1 million refugees. Despite the presence of the Bangladesh government, United Nations agencies and other international organizations played key roles in making programmatic and policy decisions for the Rohingya. Because health service delivery modalities and policies and related implementation challenges for MNCAH programs for the refugees changed rapidly, the embedded IR approach used was flexible and able to adapt to changes identified, with research questions and methods modified accordingly. Access to the camps, reaching Rohingya respondents, overcoming language barriers in order to get quality information, and the limited availability of local research collaborators were additional challenges. Working with researchers or research institutes that are familiar with the context and have experience in conducting implementation and health systems research can help with collection of quality data, identifying key stakeholders and bringing them on board to ensure the execution of the project, and ensuring utilization of the research findings. Study limitations include possible constraints in generalizing our conclusions to other humanitarian settings. Implementation research conducted in additional humanitarian settings can contribute to the evidence on this topic. Conclusions: Findings indicate that embedded IR can be done effectively in humanitarian settings if the challenges are anticipated, and appropriate strategies and in-country partners put in place to address or mitigate them, before commencing the funding or starting of the project. Understanding the context and analyzing the role of relevant stakeholders prior to conducting the research, considering a simple descriptive method appropriate to answering real-time IR questions, and working with local researchers or research institutes with specific skill sets and prior experience conducting research in humanization contexts may reduce costs and time spent, and ensure collection of quality data relevant for policy and practice.
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 Faiz
Background: 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.
Community-level environmental characteristics predictive of childhood stunting in Bangladesh - a study based on the repeated cross-sectional surveys
(Taylor & Francis, 6/30/2020) Khan, Jahidur Rahman; Hossain; Awand, Nabil
Coastal morphology makes Bangladesh vulnerable to environmental hazards and climate change. Therefore, environmental characteristics may shape population health, including child health. The prevalence of stunting among under-five aged (U5) children is high in Bangladesh. However, there is a lack of research on environmental predictors of stunting. This study aimed to assess the association between community-level environmental characteristics and stunting using pooled data from the three latest Bangladesh demographic and health surveys (BDHS). According to the multilevel model, rainfall, distance to protected areas, and vegetation index showed a nonlinear association with stunting. The temperature was inversely, and distance to water bodies was positively related to stunting. Overall, results evidence the environmental characteristics are predictive of stunting, and these characteristics should be taken into account during intervention design to minimise the negative effects of environmental change on child health. Further research is also necessary to comprehend the causal pathways between environmental characteristics and stunting in Bangladesh.
Depression, sleeping pattern, and suicidal ideation among medical students in Bangladesh: A cross-sectional pilot study
(Springer Link, 6/1/2020) Hasan, M. Tasdik; Hossain, Sahadat; Gupta, Rajat Das; Podder, Vivek; Mowri, Naima Afroz; Ghosh, Anindita; Mahmood, Hassan Rushekh; Ahmmed, Faisal; Khatun, M. S. T. Halima; Nodi, Rhedeya Nury; Koly, Kamrun Nahar; Yasmeen, Sharmeen; Islam, Nazrul
Background Depression is a major morbidity and the most common mental disorder among the medical students in medical schools globally. Undergraduate students suffer stress more due to their academic curriculum than the students of other faculties. In low-resource settings like Bangladesh, there is a dearth in research on the mental health of undergraduate medical students. This pilot study was conducted to add to the existing limited evidence by reporting the prevalence of depression and describing sleeping pattern and suicidal tendencies among medical students. Relevantly, we have investigated the overall mental health status among the medical students in Bangladesh. Methods This cross-sectional study was conducted in two medical colleges of Dhaka between July 2013 and December 2013, among 221 Bangladeshi medical students from first to fifth year. By the convenience sampling technique, data were collected by a pretested, structured, self-administered questionnaire and analysis was done by SPSS version 18.0. Depression was assessed by the validated Patient Health Questionnaire-9 (PHQ-9) tool among the respondents. Goldberg’s General Health Questionnaire (GHQ-28) was used for assessing overall mental health status. Results Depression was found in 38.9% of participants, with 3.6%, 14.5%, and 20.8% being severe, moderate, and mild depression, respectively. 17.6% of medical students had suicidal tendency or attempted suicide at least once after attending medical school. The sleeping hours were inadequate and altered after starting this stressful academic course. 33.5% of medical students had poor mental health status. There was a statistically significant association between poor mental health status in the age group less than 22 years old and initial academic study year (1st to 3rd of MBBS). Conclusion The findings are suggestive of a higher prevalence of depression among early-year medical students and marginal predominance in males. Suicidal tendency is also higher. This calls for further investigation with situation analysis, qualitative explorations, and surveys to explore the burden of such disorders in Bangladesh.
Developing core economic parameter sets for asthma studies: A realist review and an analytical framework
(BMJ Journals, 10/20/2020) Roukas, Chris; Quayyum, Zahidul; Patel, Anita; Fitzsimmons, Deborah; Phillips, Ceri; Hounsome, Natalia
Objective: To develop a standardised set of economic parameters (core economic parameter set) for economic evaluations in asthma studies. Design A systematic literature review and an analytical framework. Outcome measures Economic parameters used to evaluate costs and cost-effectiveness of healthcare interventions for people with asthma. Data sources PubMed, the Cochrane Database of Systematic Reviews, the National Health Service Economic Evaluation Database, the Database of Abstracts of Reviews of Effects and the Health Technology Aaaessment Library starting from 1990. Review methods Research methods were based on the realist review methodology and included a number of nonsequential, iterative and overlapping components, such as developing an analytical framework for the realist review; systematic literature review of economic parameters; identifying and categorising economic parameters; producing preliminary list of core economic parameters. Results Database searches found 2531 publications of which 224 were included in the systematic review. We identified 65 economic parameters that were categorised into 11 groups to enable the realist synthesis. Parameters related to secondary care, primary care, medication use, emergency care and work productivity comprised 84% of all economic parameters. An analytical framework was used to investigate the rationale behind the choices of economic parameters in these studies. The main framework domains included type of intervention, research population, study design, study setting and a stakeholder’s perspective. Conclusion Past research thus suggests that in asthma study parameters depicting the use of secondary care, primary care, medication, emergency care and work productivity can be considered as core economic parameters, since they apply to different types of studies. Parameters including diagnostics, healthcare delivery, school activity, informal care, medical devices and health utility apply to a particular type of study (or research question), and thus can be recommended as supplemental parameters.
Dietary practices of men in Bangladesh: Evidence from the National Nutrition Surveillance
(Oxford Academic, 2020-06) Mridha, Malay; Shamim, Abu Ahmed; Hossain, Md. Mokbul; Hasan, Mehedi; Hanif, Abu Abdullah Mohammad; Hossaine, Moyazzam; Ullah, Mohammad Aman; Sarker, Samir Kanti; Rahman, S. M. Mustafizur; Mitra, Dipak Kumar; Haque, Md. Emdadul
Objectives: Bangladesh has a paucity of information about the dietary practices of adult men. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we explored the dietary practices of adult men and factors associated with insufficient dietary diversity (IDD) and insufficient intake of fruits and vegetables. Methods In the NNS, between October 2018 and 2019, we collected data from from 82 clusters (57 rural, 15 non-slum urban, and 10 slums) selected using multistage cluster sampling. In these clusters we interviewed and took physical measurements of 4904 20–59 years old men (3471 in rural, 832 in urban, and 601 in slum). We used minimum dietary diversity for women (MDD-W) questionnaire to collect dietary data. IDD was defined as consumption of < 5 food groups out of 10 food groups, and insufficient fruits and vegetables intake was defined as consumption of < 5 servings of fruits and vegetables in the past 24 hours. Results The prevalence of IDD was 53% (54% in rural, 42% in non-slum urban, and 56% in slum areas) among the adult men. In the past 24 hours, 73% consumed meat/fish/poultry, 28% consumed eggs, and 22% consumed dairy products. The consumption of dark green leafy vegetables, vitamin A rich fuits and vegetables, other vegetables, other fruits was 34%, 22%, 73%, and 37%, respectively. Among the respondents, 27% had savory snacks, 52% had sweets, and 75% had sugary drinks. The prevalence of insufficient fruits and vegetables intake was 86% (83% in rural, 92% in non-slum urban and 93% in slum areas). IDD was associated with education (partial secondary education: Adjusted odds ratio (AOR) 0.67, P < 0.001; ≥10 years of schooling: AOR 0.48, P < 0.001), and sufficient intake of fruits and vegetables (AOR 0.82, P = 0.022). On the other hand, insufficient fruits and vegetables intake was associated with IDD (AOR 1.23, P = 0.014), hypertension (AOR 0.77, P = 0.020) and adequate physical activity (AOR 0.46, P < 0.001). Conclusions More than half of the men aged 20–59 years consume an inadequately diversified diet in Bangladesh and 86% had insufficient intake of fruits and vegetables. This study identified a number of factors associated with IDD, and insufficient intake of fruits and vegetables. The government of Bangladesh should address them while developing interventions to improve nutrition.
Differences in prevalence and associated factors of underweight and overweight/obesity according to rural–urban residence strata among women of reproductive age in Bangladesh: Evidence from a cross-sectional national survey
(BMJ, 2/4/2020) Hashan, Mohammad Rashidul; Gupta, Rajat Das; Day, Brendan; Al Kibria, Gulam Muhammed
Objectives This study aimed to investigate the differences in prevalence and factors influencing underweight and overweight/obesity stratified by region of residence among women of reproductive age in Bangladesh. Design Secondary analysis of cross-sectional nationwide data. Setting This study used Bangladesh Demographic and Health Survey 2014 data. Participants A weighted sample of 16 478 women of reproductive age (15–49 years) were included in the analysis. Primary and secondary outcome measures Using the Asian-specific cut-off for body mass index, the primary outcome of this study was categorised as: underweight (<18.5 kg/m2), normal weight (18.5 to <23.0) kg/m2 and overweight/obese (≥23.0 kg/m2) stratified according to rural–urban residence. Results More than half of urban women (53%, n=2493) and one-third of rural women (33%, n=3968) were found to be overweight/obese. Around one-fifth of rural women (21%, n=2490) and almost one in eight urban women (12%, n=571) were reported as underweight. In the final multivariable analyses, increasing age, higher educational status and higher order wealth quintile, each had a significant positive association with being overweight/obese and an inverse association with being underweight. Urban unmarried women had lower odds of being overweight/obese compared with their married counterparts. Rural women who used contraceptives had significantly decreased odds (adjusted OR (AOR) 0.8, 95% CI 0.7 to 0.9) of being underweight compared with contraceptive non-users; no such association was noted in urban women. Women from Sylhet division in both urban (AOR 1.7, 95% CI 1.2 to 2.5) and rural regions (AOR 1.5, 95% CI 1.2 to 1.8) had increased odds of being underweight compared with women in Barisal division. Conclusions This study found association of multiple factors with both overweight/obesity and underweight among Bangladeshi women of reproductive age. Public health programmes in Bangladesh aiming to prevent the double burden of malnutrition should focus these factors through comprehensive public awareness and cost-effective operational health interventions.
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 Masud
Governance 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.
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 Tanvir
Research 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.
Double burden of malnutrition among elderly people in Bangladesh: Evidence from the National Nutrition Surveillance Study
(Oxford Academic, 2020-06) Hasan, Mehedi; Shamim, Abu Ahmed; Hossain, Md. Mokbul; Hanif, Abu Abdullah Mohammad; Hossaine, Moyazzam; Ullah, Mohammad Aman; Sarker, Samir Kanti; Rahman, S M Mustafizur; Mitra, Dipak Kumar; Haque, Md. Emdadul; Mridha, Malay
Objectives: Double burden of malnutrition (DBM), referred as the coexistence of undernutrition and overnutrition, is an evolving public health concern. There is a paucity of data about DBM among elderly people in Bangladesh. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we assessed the prevalence and determinants of DBM among elderly people. Methods In the NNS, we collected data from 30,005 persons in 6 population groups from 82 clusters (57 rural, 15 non-slum urban, and 10 slums) selected using multistage cluster sampling. We collected socio-demographic, life-style and anthropometric data from 4817 respondents aged >60 years. Underweight was defined as body mass index (BMI) <18.5 kg/m2 and overweight/obesity as BMI ≥ 23 kg/m2. Results The weighted prevalence of underweight was 26.8%, and was higher among elderly aged ≥70 years (34.4%), male (28.5%), non-diabetic (28.5%), rural residents (27.1%) and with inadequate fruits and vegetables consumption (27.1%). The weighted prevalence of overweight was 27.0%, and was higher among elderly aged 60–69 years (29.8%), female (30.8), diabetic (51.0%), urban residents (48.2%), with poor physical activity (31.3%), and with inadequate fruits and vegetables consumption (27.4%). As education and wealth status increased, the prevalence of underweight decreased and the prevalence of overweight and obesity increased. In multivariable logistic regression, male gender (AOR: 1.33, 95% CI: 1.18,1.51), being non-diabetic (AOR: 1.50, 95% CI: 1.23,1.82), having no education (AOR: 1.73, 95% CI: 1.35,2.22), and having adequate physical activity (AOR: 1.19, 95% CI: 1.05,1.35) were associated with underweight. However, urban residency (AOR: 1.73, 95% CI: 1.41,2.12), 60–69 years age (AOR: 1.59, 95% CI: 1.36,1.85), being female (AOR: 1.81, 95% CI: 1.56,2.10), having diabetes (AOR: 2.52, 95% CI:2.07,3.08), being Muslim (AOR: 1.25, 95% CI: 1.04,1.53), and having inadequate physical activity (AOR: 1.36, 95% CI: 1.18,1.57) were associated with overweight. Conclusions The overall prevalence of undernutrition and overnutrition is very high among elderly population in Bangladesh. The government together with national and international organizations should implement population-based interventions to prevent and control DBM.
Economic evaluation of culprit lesion only PCI vs. immediate multivessel PCI in acute myocardial infarction complicated by cardiogenic shock: the CULPRIT‑SHOCK trial
(Springer Link, 10/7/2020) Robles‑Zurita, Jose Antonio; Briggs, Andrew; Rana, Dikshyanta; Quayyum, Zahidul; Oldroyd, Keith G.; Zeymer, Uwe; Desch, Stefen; de Waha‑Thiele, Suzanne; Thiele, Holger
Background The CULPRIT-SHOCK trial compared two treatment strategies for patients with acute myocardial infarction and multivessel coronary artery disease complicated by cardiogenic shock: (a) culprit vessel only percutaneous coronary intervention (CO-PCI), with additional staged revascularisation if indicated, and (b) immediate multivessel PCI (MV-PCI). Methods A German societal and national health service perspective was considered for three diferent analyses. The cost utility analysis (CUA) estimated costs and quality adjusted life years (QALYs) based on a pre-trial decision analytic model taking a lifelong time horizon. In addition, a within trial CUA estimated QALYs and costs for 1 year. Finally, the cost efectiveness analysis (CEA) used the composite primary outcome, mortality and renal failure at 30-day follow-up, and the within trial costs. Econometric and survival analysis on the trial data was used for the estimation of the model parameters. Subgroup analysis was performed following an economic protocol. Results The lifelong CUA showed an incremental cost efectiveness ratio (ICER), CO-PCI vs. MV-PCI, of €7010 per QALY and a probability of CO-PCI being the most cost-efective strategy>64% at a €30,000 threshold. The ICER for the within trial CUA was €14,600 and the incremental cost per case of death/renal failure avoided at 30-day follow-up was €9010. Cost-efectiveness improved with patient age and for those without diabetes. Conclusions The estimates of cost-efectiveness for CO-PCI vs. MV-PCI have been shown to change depending on the time horizon and type of economic evaluation performed. The results favoured a long-term horizon analysis for avoiding underestimation of QALY gains from the CO-PCI arm.
Effective maternal, newborn and child health programming among Rohingya refugees in Cox’s Bazar, Bangladesh: Implementation challenges and potential solutions
(PLOS ONE, 3/26/2022) Sarker, Malabika; Saha, Avijit; Matin, Mowtushi; Mehjabeen, Saima; Tamim, Malika Asia; Sharkey, Alyssa B.; Kim, Minjoon; Nyankesha, Ele´vanie U.; Widiati, Yulia; Shahabuddin, A. S. M.
Background The health status of Rohingya refugees or Forcibly Displaced Myanmar Nationals (FDMNs), especially women and children, is a significant challenge for humanitarian workers in Bangladesh. Though the Government of Bangladesh, in partnership with other organizations, is offering health care services to FDMNs, a comprehensive understanding of the program implementation is required for continuation in the future. This study explores the challenges and potential solutions for effective implementation of maternal, newborn, and child health (MNCH) programs for FDMNs residing in camps of Cox’s Bazar, Bangladesh. Methods We conducted a qualitative study conducted in Cox’s Bazar district, Bangladesh, which involved 34 interviews (15 key informant interviews and 19 in-depth interviews) with relevant persons working in organizations responsible for MNCH services to FDMNs. We relied on both inductive and deductive coding and applied the Consolidated Framework for Implementation Research (CFIR) as a guide to our thematic analysis and presentation of qualitative data. Results Our study identified some key challenges hindering the effective implementation of MNCH service delivery for the FDMNs. High turnover and poor retention of staff, overlapping of service, weak referral mechanism, complex health information system, and lack of security of the front line health providers were some of the key challenges identified. Motivating the PLOS ONE PLOS ONE | https://doi.org/10.1371/journal.pone.0230732 March 26, 2020 1 / 18 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Sarker M, Saha A, Matin M, Mehjabeen S, Tamim MA, Sharkey AB, et al. (2020) Effective maternal, newborn and child health programming among Rohingya refugees in Cox’s Bazar, Bangladesh: Implementation challenges and potential solutions. PLoS ONE 15(3): e0230732. https://doi.org/10.1371/journal.pone.0230732 Editor: Vijayaprasad Gopichandran, ESIC Medical College & PGIMSR, INDIA Received: October 13, 2019 Accepted: March 6, 2020 Published: March 26, 2020 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0230732 Copyright: © 2020 Sarker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Selected transcript quotes appear within the paper. Audio files from interviews cannot be made publicly available health workers, task shifting, capacity building on emergency obstetric care, training CHW & TBA on danger signs, and ensuring the security of the workers are the potential solutions suggested by the respondents. Selecting a few indicators and the introduction of E-tracker can harmonize the health information system. Conclusion Providing healthcare in an emergency setting has several associated challenges. Considering the CFIR as the base for identifying different challenges and their potential solutions at a different level of the program can prove to be an excellent asset for the program implementers in designing their plans. Two additional domains, context, and security should be included in the CFIR framework for any humanitarian settings.
Elderly women are disproportionately vulnerable to hypertension in Bangladesh: Evidence from the National Nutrition Surveillance Study
(Oxford Academic, 2020-06) Hanif, Abu Abdullah Mohammad; Shamim, Abu Ahmed; Hossain, Md. Mokbul; Hasan, Mehedi; Hossaine, Moyazzam; Ullah, Mohammad Aman; Sarker, Samir Kanti; Rahman, S M Mustafizur; Mitra, Dipak Kumar; Haque, Md. Emdadul; Mridha, Malay
Objectives: Bangladesh has a dearth of information on the prevalence and factors associated with hypertension among elderlies. We assessed the prevalence, sex differences in prevalence, and factors associated with hypertension in the most recent national nutrition surveillance round (2018–19). Methods We analyzed data of 4817 elderlies (≥60 years) from 82 clusters (57 rural, 15 urban and 10 slum) selected by multistage cluster sampling. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or having a history of hypertension. We analyzed data using Stata 15.0. Results The weighted prevalence of hypertension was 42%, and 56% for elderly males, and females, respectively; and was higher among females for many socio-demographic, behavioural and anthropetric variables including age 70 + years (58% vs. 46%); high waist circumference (69% vs. 65%); diabetes (69% vs. 65%); living in rural (55% vs. 41%), urban (63% vs. 45%) and slum (50% vs. 30%) area; Muslim (56% vs. 42%); insufficient physical activity (60% vs 52%); and inadequate fruits/vegetables intake (56% vs. 43%). Among females, the factors associated with hypertension were age 70 + years (AOR: 1.40, 95% CI: 1.15–1.71), waist circumference ≥80 cm (AOR: 2.20, 95% CI: 1.82–2.67), diabetes (AOR: 1.82, 95% CI: 1.35–2.45), and inadequate physical activity (AOR: 1.38, 95% CI: 1.15–1.67). Among males, these factors were age 70 + years (AOR: 1.32, 95% CI: 1.09–1.60), waist circumference ≥90 cm (AOR: 2.76, 95% CI: 2.22–3.43), diabetes (AOR: 1.36, 95% CI: 1.02–1.82), slum-dwelling (AOR: 0.71, 95% CI: 0.52–0.96), > 10 years of education (AOR: 1.83; 95% CI: 1.38, 2.44), inadequate physical activity (AOR: 1.50, 95% CI: 1.25–1.81), and current smoking (AOR: 0.74; 95% CI: 0.61, 0.89). In both males and females, fruits and vegetables intake was not assicaited with hypertension. Conclusions In Bangladesh, the elderly female population is disproportionately affected by hypertension. They were found having a consistent pattern of higher prevalence of hypertension for many socio-demographic, behavioral, and anthropometric variables. The ministry of health of Bangladesh should consider this disproportionately high prevalence of hypertension among elderly females while designing and implementing health programs.
Ethics and methods for collecting sensitive data: Examining sexual and reproductive health needs of and services for Rohingya refugees at Cox’s Bazar, Bangladesh
(The International Journal of Information, Diversity, & Inclusion, 7/13/2020) Aktar, Bachera; Ahmed, Rushdia; Hassan, Raafat; Farnaz, Nadia; Ray, Pushpita; Awal, Abdul; Bin Shafique, Sharid; Hasan, Md Tanvir; Quayyum, Zahidul; Rashid, Sabina Faiz
During humanitarian emergencies, such as the forced displacement of the Rohingya diaspora, women and adolescent girls become highly vulnerable to sexual and reproductive health (SRH) issues and abuse. Although sensitive in nature, community-driven information is essential for designing and delivering effective community-centric SRH services. This article provides an overview of the theoretical framework and methodologies used to investigate SRH needs, barriers, and challenges in service-delivery and utilization in the Rohingya refugee camps in Cox’s Bazar, Bangladesh. It also offers insights on important methodological and ethical factors to consider while conducting research in a similar context.A concurrent mixed-method study was undertaken in ten randomly selected Rohingya refugee camps between July and November2018. The design consisted of a cross-sectional household survey of 403 Rohingya adolescent girls and women, along with an assessment of 29 healthcare facilities. The team also completed in-depth interviews with nine adolescent girls, 10 women, nine formal andnine informal healthcare providers, key informant interviews with seven key stakeholders and seven influential community members. Lastly, three focus group discussions were undertaken with a group of 18 Rohingya men. Our theoretical framework drew from the socio-ecological models developed by Karl Blanchet and colleagues(2017) insofar as they considered a multiplicity of related contextual and cross-cutting factors.Building good rapport with community gatekeepers was key in accessing and sustaining the relationship with the various respondents. The data collected through such context-specific research approaches is critical in designing community-centric service-delivery mechanisms, and culturally and gender-sensitiveSRH interventions in humanitarian crises.
Evaluating the process of partnership and research in global health: Reflections from the STRIPE project
(BMC, 8/12/2020) Kalbarczyk, Anna; Rao, Aditi; Mahendradhata, Yodi; Majumdar, Piyusha; Decker, Ellie; Binte Anwar, Humayra; Akinyemi, Oluwaseun O.; Rahimi, Ahmad Omid; Kayembe, Patrick; Alonge, Olakunle O.
Background: Thoughtful and equitable engagement with international partners is key to successful research. STRIPE, a consortium of 8 academic and research institutions across the globe whose objective is to map, synthesize, and disseminate lessons learned from polio eradication, conducted a process evaluation of this partnership during the project’s first year which focused on knowledge mapping activities. Methods: The STRIPE consortium is led by Johns Hopkins University (JHU) in partnership with 6 universities and 1 research consultancy organization in polio free, at-risk, and endemic countries. In December 2018 JHU team members submitted written reflections on their experiences (n = 9). We held calls with each consortium member to solicit additional feedback (n = 7). To establish the partnership evaluation criteria we conducted preliminary analyses based on Blackstock’s framework evaluating participatory research. In April 2019, an in-person consortium meeting was held; one member from each institution was asked to join a process evaluation working group. This group reviewed the preliminary criteria, adding, subtracting, and combining as needed; the final evaluation criteria were applied to STRIPE’s research process and partnership and illustrative examples were provided. Results: Twelve evaluation criteria were defined and applied by each member of the consortium to their experience in the project. These included access to resources, expectation setting, organizational context, external context, quality of information, relationship building, transparency, motivation, scheduling, adaptation, communication and engagement, and capacity building. For each criteria members of the working group reflected on general and context-specific challenges and potential strategies to overcome them. Teams suggested providing more time for recruitment, training, reflection, pre-testing. and financing to alleviate resource constraints. Given the large scope of the project, competing priorities, and shifting demands the working group also suggested a minimum of one fulltime project coordinator in each setting to manage resources. Conclusion: Successful management of multi-country, multicentered implementation research requires comprehensive communication tools (which to our knowledge do not exist yet or are not readily available), expectation setting, and institutional support. Capacity building activities that address human resource needs for both individuals and their institutions should be incorporated into early project planning.