Journal Articles (James P. Grant School of Public Health)

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A holistic approach to promoting early child development: A cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh
(BMJ Journals, 3/16/2021) Pitchik, Helen O; Tofail, Fahmida; Rahman, Mahbubur; Akter, Fahmida; Sultana, Jesmin; Shoab, Abul Kasham; Huda, Tarique Md. Nurul; Jahir, Tania; Amin, Md Ruhul; Hossain, Md Khobair; Das, Jyoti Bhushan; Chung, Esther O; Byrd, Kendra A; Yeasmin, Farzana; Kwong, Laura H; Forsyth, Jenna E; Mridha, Malay K; Winch, Peter J; Luby, Stephen P; Fernald, Lia CH
Introduction In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention. Methods We conducted a 9-month, parallel, multiarm, clusterrandomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers. Results In July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (ageadjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54). Conclusion Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale.
A new social sciences network for infectious threats
(The Lancet, 2019-05) Giles-Vernick, Tamara; Kutalek, Ruth; Napier, David; Kaawa-Mafigiri, David; Dückers, Michel; Paget, John; Ahmed, Syed Masud; Cheah, Phaik Yeong; Desclaux, Alice; De Vries, Daniel; Hardon, Anita; MacGregor, Hayley; Pell, Christopher; Rashid, Sabina F; Rodyna, Roman; Schultsz, Constance; Sow, Khoudia; Wilkinson, Annie
The Ebola epidemic in the Democratic Republic of the Congo (DRC) continues to escalate, new outbreaks of Lassa fever, yellow fever, measles, and other infectious diseases erupt around the world, and antimicrobial resistance intensifies from unmanaged use of these drugs. These infectious threats are intertwined with political and economic instability, changing ecological conditions, livestock management and food production practices, and local communities and their marginalised populations. The challenge in addressing these health security threats surpasses conventional response strategies. National governments and international agencies struggle to understand popular reactions to infectious disease emergence and outbreaks and to control deadly diseases.
A new tool to measure approaches to supervision from the perspective of community health workers: A prospective, longitudinal, validation study in seven countries
(BMC, 10/22/2018) Vallières, Frédérique; Hyland, Philip; McAuliffe, Eilish; Mahmud, Ilias; Tulloch, Olivia; Walker, Polly; Taegtmeyer, Miriam
Background: The global scale-up of community health workers (CHWs) depends on supportive management and supervision of this expanding cadre. Existing tools fail to incorporate the perspective of the CHW (i.e. perceived supervision) in terms of supportive experiences with their supervisor. Aligned to the WHO's strategy on human resources for health, we developed and validated a simple tool to measure perceived supervision across seven low and middle-income countries. Methods: Phase 1 was carried out with 327 CHWs in Sierra Leone. Twelve questions, informed by the extant literature on health worker supervision, were reduced to six questions using confirmatory factor analysis. Phase 2 employed structural equation modelling with 741 CHWs in six countries (Bangladesh, Ethiopia, Indonesia, Kenya, Malawi, Mozambique), to assess the factorial validity, predictive validity, and internal reliability of the questions at three time-points, over 8-months. Results: We developed a robust, 6-item measure of perceived supervision (PSS), capturing regular contact, two-way communication, and joint problem-solving elements as being critical from the perspective of CHWs. When assessed across the six countries, over time, the PSS was also found to have good validity and internal reliability. PSS scores at baseline positively and significantly predicted a range of performance-related outcomes at follow-up. Conclusion: The PSS is the first validated tool that measures supervisory experience from the perspective of CHWs and is applicable across multiple, culturally-distinct global health contexts with a wide range of CHW typologies. Simple, quick to administer, and freely available in 11 languages, the PSS could assist practitioners in the management of community health programmes.
A policy analysis regarding education, career, and governance of the nurses in Bangladesh: A qualitative exploration
(Sage Journals, 1/18/2021) Joarder, Taufique; Parvage, Md. Aslam; Rawal, Lal B.; Ahmed, Syed Masud
Nurses, short in production and inequitable in the distribution in Bangladesh, require the government’s efforts to increase enrolment in nursing education and a smooth career progression. Given the importance of an assessment of the current nursing scenario to inform the decision makers and practitioners to implement the new policies successfully, we analyzed relevant policies on education, career, and governance of nurses in Bangladesh. We used documents review and qualitative methods such as key informant interviews (n = 13) and stakeholder analysis. We found that nursing education faced several backlashes: resistance from diploma nurses while attempting to establish a graduate (bachelor) course in 1977, and the reluctance of politicians and entrepreneurs to establish nursing institutions. Many challenges with the implementation of nursing policies are attributable to social, cultural, religious, and historical factors. For example, Hindus considered touching the bodily excretions as the task of the lower castes, while Muslims considered women touching the body of the men immoral. Nurses also face governance challenges linked with their performance and reward. For example, nurses have little voice over the decisions related to their profession, and they are not allowed to perform clinical duties unsupervised. To improve the situation, the government has made new policies, including upliftment of nurses’ position in public service, the creation of an independent Directorate General, and improvement of nursing education and service. New policies often come with new apprehensions. Therefore, nurses should be included in the policy processes, and their capacity should be developed in nursing leadership and health system governance.
A qualitative study to explore the attitudes of women and obstetricians towards caesarean delivery in rural Bangladesh
(BMC, 9/12/2018) Begum, Tahmina; Ellis, Cathryn; Sarker, Malabika; Rostoker, Jean-Francois; Rahman, Aminur; Anwar, Iqbal; Reichenbach, Laura
Background: Caesarean section is a lifesaving surgical intervention for women and their newborns, though overutilization is a public health concern. The caesarean rate in Bangladesh is approximately 23% overall, and in private facilities it is over 70%. It is essential to know both the supply side (obstetricians) and demand side (parturient women) views on caesarean birth in order to formulate specific interventions to address the escalating rate of caesareans. Methods: This qualitative study took place in Matlab, a rural sub-district in Bangladesh. We interviewed women attending their 3rd antenatal visit, those with recent caesareans, and obstetricians from both public and private health facilities. In total there were twenty in-depth interviews and four focus group discussions. Study participants were asked about their preferences on birthing mode and knowledge of the caesarean section process. Thematic data analysis was done following a deductive approach. Results: Women from this rural community had a strong preference for normal vaginal birth. However, they were willing to accept the attending health care provider’s decision for caesarean birth. Antenatal care sessions did not provide information on the medical indications for caesarean section. Furthermore, some women had the misconception that episiotomy itself is a ‘small caesarean.’ Primary health care providers and clinic agents (brokers) had a strong influence on women’s decision to choose a health facility for giving birth. However, obstetricians, having a preference for caesarean section, were receiving more patients from these brokers which may be an important reason for the high rate of clinically non-indicated caesareans at private hospitals in Bangladesh. Improper labour monitoring and inadequate staffing at health facilities were additional influences on the preference for caesarean section. However, critical knowledge gaps were also observed among study obstetricians, particularly with regards to the indications for and timing of elective caesarean sections. Conclusion: There is a need to educate women about the advantages and disadvantages of different birthing modes to ensure their active participation in the decision making process. Strong policy regulations are needed to ensure legitimate decision making by obstetricians regarding mode of birthing.
A transparent universal health coverage index with decomposition by socioeconomic groups: Application in Asian and African settings
(Springer Nature, 2/16/2019) Khan, Jahangir A. M.; Ahmed, Sayem; Chen, Tao; Tomeny, Ewan M.; Niessen, Louis W.
Background Health and wellbeing as one of the Sustainable Development Goals requires all countries to achieve Universal Health Coverage (UHC). That is, all people must have access to healthcare when needed at an affordable price. While several indices were developed recently to assess UHC status, these indices appeared to be difficult for practitioners to apply without statistical knowledge. Objective This paper presents a transparent and step-by-step practical calculation method of such an index using Excel spreadsheets, applied to some Asian and African countries. We also decompose the contribution of socioeconomic groups to UHC index values. Methods We utilized the well known UHC illustration (three-dimensional box, showing population coverage, service coverage and financial protection) to calculate the UHC index. We also broke down the index into socioeconomic groups. For validation, correlation coefficients between our index and other UHC indices were calculated and the relationship of our index with out-of-pocket (OOP) payments was estimated. Results World Bank data from six Asian and 15 African countries on health-service coverage of people in five socioeconomic quintiles with financial protection were used to calculate our UHC index. Among the Asian countries, indices ranged between 26.0% (Nepal) and 58.7% (Kazakhstan), while in African countries indices ranged between 8.9% (Chad) and 55.3% (Namibia). Decomposition of the UHC index showed a higher contribution to the index by richer socioeconomic groups. The correlation coefficients between our estimated UHC index values and those of others ranged between 0.774 and 0.900. Our index reduced by 1.4% in response to a 1% increase in OOP payments. Conclusions This spreadsheet approach for calculating the UHC index appeared to be useful, where the interrelation of UHC dimensions was easily observed. Decomposition of the index could be useful for policy-makers to identify the subpopulations and health services with need for further interventions towards UHC achievement.
Addressing vulnerabilities in communities facing infectious disease threats: A need for social science-driven assessments
(Journal of Global Health, 2021-01) Osborne, Jacob; Paget, John; Napier, David; Giles-Vernick, Tamara; Kutalek, Ruth; Rodyna, Roman; Ahmed, Syed Masud; Dückers, Michel
Adolescents’ experiences of covid-19 in Chittagong and Sylhet divisions, Bangladesh
(GAGE, 2021-04) Alam, Farhana; Rana, Md Sajib; Raha, Samira Ahmed; Al Mamun, Saklain; Guglielmi, Silvia
This study is part of a cross-country series designed to share emerging findings in real time from qualitative interviews with adolescents and school teachers in the context of covid-19. The young people involved are part of the Gender and Adolescence: Global Evidence (GAGE) programme, which is conducting longitudinal research in the Middle East, East Africa and South Asia. Our sample for this study was purposefully selected from an ongoing baseline GAGE impact evaluation study, and includes two cohorts: younger adolescents (10–14 years) and older adolescents (15–19 years), all of whom are in-school (grades 7 and 8). Adolescent respondents were drawn from both urban and rural schools in Chittagong and Sylhet divisions of Bangladesh (see Annex 1 for further details). The objectives of the research are as follows: • To understand adolescents’ experiences of transition from childhood to adulthood, and to identify differences in their experiences by age, gender, disability and geographic location. • To identify adolescents’ knowledge of covid-19, and how the pandemic response has affected adolescent lives across the following domains: Young adolescent girls in Chittagong, Bangladesh © Nathalie Bertrams / GAGE 2 » education and remote learning » incomes and livelihoods » nutrition, health and hygiene » psychosocial well-being and coping » voice and agency related to adolescents’ mobility. To inform the pandemic response, this study aims to understand adolescents’ knowledge, perceptions and practices during the covid-19 pandemic, their challenges and worries, and the coping mechanisms they are using to deal with the evolving situation. We explore the impact of covid-19 on the realities and experiences of in-school adolescents in Chittagong and Sylhet who have found themselves out of school since March 2020 until the present, to prevent the spread of the virus. The report also explores the impacts on adolescents in terms of gender and the vulnerability status of the household.
Advancing universal health coverage in South Asian cities: A framework
(BMJ Open, 11/29/2018) Adams, Alayne M; Nambiar, Devaki; Siddiqi, Sameen; Alam, Bushra Binte; Reddy, Srinath
An invisible workforce: The neglected role of cleaners in patient safety on maternity units
(Taylor & Francis Online, 1/15/2019) Cross, Suzanne; Gon, Giorgia; Morrison, Emma; Afsana, Koasar; Ali, Said M.; Manjang, Tina; Manneh, Lamin; Rahman, Atiya; Saxena, Deepak; Vorah, Kranti; Graham., Wendy J.
Hospital cleaning has been shown to impact on rates of healthcare-associated infections (HCAIs) and good environmental hygiene is critical to quality care, yet those tasked with the role of ensuring a safe and clean environment often go unrecognised as members of the healthcare workforce. Sepsis is a leading cause of maternal and newborn death, a significant proportion of these cases are estimated to be due to HCAIs. Deliveries in health institutions have now reached 75% globally, and in low and middle income countries the corresponding increased pressure on facilities has impacted both quality of care provided and quality of the birth environment in terms of infection prevention and control (IPC) and HCAIs. The paper discusses the neglected role of health facility cleaners, providing evidence from the literature and from needs assessments conducted by The Soapbox Collaborative and partners in Bangladesh, India, The Gambia and Zanzibar. While not the primary focus of the assessments, common themes emerged consistently pointing to institutional neglect of cleaning and cleaners. The paper argues that low status within facilities, wider societal marginalisation, lack of training, and poor pay and working conditions contribute to the lack of prioritisation placed on health facility environmental hygiene. With increased international attention focused towards health facility water, sanitation and hygiene and a growing focus on IPC, now is the time to address the neglect of this frontline healthcare workforce. We propose that provision of and improved training can enable the recognition of the valuable role cleaning staff play, as well as equipping these staff with the tools required to perform their job to the highest standard. In addition to training, wider systems changes are necessary to establish improvements in environmental hygiene and the role of cleaning staff, including addressing resource availability, supportive supervision, and an increased emphasis on preventative healthcare.
Art therapy to improve quality of life of cancer patients and their carers in Bangladesh
(Scientific Research, 6/24/2019) Dowla, Rumana; Goodman, Annekathryn; Kashem, Tahsin
Abstract Objective: Art as a therapy helps in reparation and recovery. The aim of this study was to see the response of the cancer patients and their carers residing in Bangladesh towards art therapy and the perceived effect of art therapy on their physical and psychological condition. Method: The study was a record review study conducted through a cross-sectional descriptive method from July to November 2018. Along with the cancer patients, their immediate carers were enrolled in this study since patients and their carers both suffer from the distress that comes with the diagnosis of cancer. In-depth interviews and focused group discussions of art therapy were conducted with our study population at BPSCF and BSMMU. Findings: After art therapy, there was an improvement in sensory perception and self-perception, physical and psychological condition, communication and social skills and helped in more personal integration and built stronger insight among the patients and carers. Majority of the participants of art therapy felt good and wanted to continue art therapy. Significance of results: The results of this study will help to create awareness among the community about the importance of psychotherapies like art therapy in the life of the cancer patients and their carers. Introducing the concept of art therapy will also help the public health practitioners to improvise palliative care services in Bangladesh in a very cost-effective approach.
Assessing informed consent practices during normal vaginal delivery and immediate postpartum care in tertiary-level hospitals of Bangladesh
(European Journal of Midwifery, 5/21/2019) Karim, Md Abdul; Ahmed, Syed Imran; Ferdous, Jannatul; Islam, Bushra Zarin; Tegegne, Henok Ayalew; Aktar, Bachera
INTRODUCTION This study was conducted to assess the informed consent practices during normal vaginal delivery (NVD) process and immediate postpartum care in the tertiary-level hospitals of Bangladesh. METHODS A cross-sectional study was conducted at Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMCH) in November 2015. The study population and respondents were mothers who gave normal vaginal childbirth within the past 24 hours and received postpartum care in the study sites (N=190). The interview of every alternate mother from the patient register was conducted by researchers using a structured questionnaire. Descriptive analysis of findings was carried out using MS Excel 2013. RESULTS The study findings revealed the complete absence of informed consent practices during NVD and postpartum care in the tertiary-level hospitals in Bangladesh. Consent (not informed consent) was taken from 95% of the mothers before proceeding with the NVD process, 50–72% of examinations (except breast examination, 0%) and 8–72% of procedures during postpartum care. Choice and preferences of mothers for taking an alternative process/examination/procedure were absent in all cases. CONCLUSIONS The Respectful Maternity Care (RMC) Charter endorsed informed consent as one of the basic rights of child-bearing women. Absence of informed consent practices in the study sites indicates disrespect to maternity care and violation of this right. The Standard Clinical Management Protocols of Bangladesh also lacks clarification of this right. Improvement of the existing protocol, increased awareness and practices are essential to address protection of this right.
Assessing the readiness of health facilities for diabetes and cardiovascular services in Bangladesh: A Cross-sectional survey
(BMJ Open, 10/31/2018) Biswas, Tuhin; Haider, M Moinuddin; Gupta, Rajat Das; Uddin, Jasim
Objective: The objective of this study was to assess the readiness of health facilities for diabetes and cardiovascular services in Bangladesh. Design: This study was a cross-sectional survey. Setting: This study used data from a nationwide Bangladesh Health Facility Survey conducted by the Ministry of Health and Social Welfare in 2014. Participants: A total of 319 health facilities delivering services focused on diabetes and cardiovascular diseases (CVD) were included in the survey. Some of these facilities were run by the public sector while others were managed by the private sector and non-governmental organisations. It was a mix of primary and secondary care facilities. Primary and secondary outcome measures: The primary outcome was readiness of health facilities for diabetes and cardiovascular services. We analysed relevant data following the Service Availability and Readiness Assessment manual of the WHO to assess the readiness of selected health facilities towards services for diabetes and CVD. Results: 58% and 24.1% of the facilities had diagnosis and treatment services for diabetes and CVD, respectively. Shortage of trained staff (18.8% and 14.7%) and lack of adequate medicine supply (23.5% and 43.9%) were identified to be factors responsible for inadequate services for diabetes and CVD. Among the facilities that offer services for diabetes and CVD, only 0.4% and 0.9% had all the four service readiness factors (guideline, trained staff, equipment and medicine). Conclusions: The study suggests that health facilities suffered from numerous drawbacks, such as shortage of trained staff and required medicine. Most importantly, they lack effective guidelines on the diagnosis and treatment for diabetes and CVD. It is, therefore, essential now to ensure that there are trained staff, adequate medicine supply, and appropriate guidelines on the diagnosis and treatment for diabetes and CVD in Bangladesh.
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 height and hypertension among US adults: Analyses of National Health and Nutrition Examination Survey 2007–18
(BMC, 2/26/2021) Gupta, Rajat Das; Akonde, Maxwell; Sajal, Ibrahim Hossain; Al Kibria, Gulam Muhammed
Background: Previous studies that investigated association of height with prevalence and control of hypertension found mixed results. This cross-sectional study explored these associations among US adults (≥20 years). Methods: The National Health and Nutrition Examination Survey (NHANES) 2007–18 data was analyzed. Height was measured in meters and was converted into centimeters (cm) and was further divided into quartiles: Q1 (135.3–159.2 cm), Q2 (159.3–166.2 cm), Q3 (166.3–173.6 cm), Q4 (173.7–204.5 cm). Hypertension definition of the ‘2017 American College of Cardiology/American Heart Association Guideline’ was used. Logistic regression analyses were conducted to find out the association between the dependent variable and the covariates. Linear regression analyses were conducted to find out the association of height with systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and the covariates among the individuals who were not taking any antihypertensive drugs. Crude odds ratio, adjusted odds ratio (AOR), and adjusted beta-coefficient (for linear regression) with 95% confidence interval (CI) were reported. The following covariates were included: age, gender, race/ethnicity, family income, education level, cholesterol level, high-density lipoprotein level, chronic kidney disease status, diabetes status, smoker, aerobic leisure-time physical activity, and survey period. Sample weight of NHANES was adjusted. Results: Among the 21,935 participants (47.1% males), the prevalence of hypertension was 46.1%. Among 6154 participants taking medication (43.0% males), 57.2% had uncontrolled hypertension. In the final logistic regression analyses, participants in Q2 height quartile had 20% lower odds of being hypertensive compared to those in Q4 height quartile (AOR: 0.8; 95% CI: 0.7,1.0). Other height categories did not reveal any significant association. Compared to Q4 height category, Q1 (AOR: 1.7; 95% CI: 1.2,2.3), Q2 (AOR: 1.4; 95% CI: 1.1,1.8), and Q3 (AOR: 1.3; 95% CI: 1.1,1.6) height categories had higher odds of uncontrolled hypertension. PP was inversely associated and DBP was positively Conclusions: Although height was not associated with prevalence of hypertension, it had inverse association with uncontrolled hypertension. It was also significantly associated with DBP and PP among the individuals with untreated hypertension.
Association between height and hypertension in the adult Nepalese population: Findings from a nationally representative survey
(Wiley, 11/7/2019) Gupta, Rajat Das; Haider, Shams Shabab; Hashan, Mohammad Rashidul; Rahman, Muhammad Aziz; Sarker, Malabika
Background and aims The burden of hypertension is increasing in Nepal. Different studies have evaluated the relationship between height and blood pressure in different regions, with mixed results. The relationship between height and hypertension has not yet been explored in the Nepalese context. Given this knowledge gap, this study aims to determine the relationship between height and hypertension among Nepalese adults (aged ≥18 years). Methods This study utilized the dataset from the Nepal Demographic and Health Survey (NDHS) 2016. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg. Height, measured in centimeters (cm), was analyzed as a continuous variable. Based on previous evidence, the following covariates were considered: age, sex, presence of overweight or obesity, educational status, household wealth status, and place, province, and ecological zone of residence. Multilevel multivariable logistic regression was done to evaluate the association between height and hypertension. Both crude odds ratio (COR) and adjusted odds ratio (AOR) are reported, along with a 95% confidence interval (CI). Sample weight of NDHS was adjusted during analysis. Results Among 13 393 weighted individuals over the age of 18 years, the prevalence of hypertension in Nepal was found to be 21.1% (95% CI, 19.9%‐22.4%). In the final multivariable model, after adjusting for relevant covariates, it was found that height was inversely associated with hypertension. For a Nepalese adult, the odds of hypertension decreased by 10% with each 10‐cm increase in height (AOR 0.9; 95% CI 0.8‐0.9; P = 0.003). Conclusion Awareness should be raised among people with low stature for prevention of hypertension. Longitudinal studies are recommended to include genetic and social/environmental determinants of stature in the analyses.
Association between household livestock ownership and childhood stunting in Bangladesh – A spatial analysis
(Oxford Academic, 9/16/2019) Hossain, Md. Belal; Khan, Jahidur Rahman
Livestock is an integrated part of agriculture, yet the relationship between household livestock ownership and child nutrition is a significant knowledge gap. The present study aimed to assess the association between household livestock ownership and childhood stunting and to explore the geospatial variations at district level in Bangladesh. A complete data of 19 295 children aged below 5 years were extracted from the latest Bangladesh Multiple Indicator Cluster Survey 2012–13. The tropical livestock unit (TLU) score calculated as a weighted value for each livestock and categorized as low, medium, and high using tertile. A hierarchical Bayesian spatial logistic model was used to assess the association between TLU and childhood stunting. Children from the household with high TLU were 10% less likely to be stunted (adjusted posterior odds ratio: 0.90, 95% credible interval: 0.84– 0.97) after controlling for demographic, socioeconomic, morbidity, place of residence and spatial effects. There was also a substantial spatial variation in childhood stunting across districts in Bangladesh with the highest burden in the Northern and North-Eastern regions. The positive effect of household livestock ownership on reducing child stunting suggests that, in addition to nutritional intervention in Bangladesh, efforts to strengthen livestock production would be beneficial for improving child nutrition status. However, a small effect size may be owing to the lack of dietary diversity, livestock health and productivity data as well as the complexity of the relationship, requiring further study. Furthermore, a significant regional disparity in stunting highlighted the importance of spatial targeting during the design of interventions and implementation.
Association between socioeconomic status and prevalence of non-communicable diseases risk factors and comorbidities in Bangladesh: Findings from a nationwide cross-sectional survey
(BMJ Open, 3/13/2019) Biswas, Tuhin; Townsend, Nick; Islam, Md Saimul; Islam, Md Rajibul; Gupta, Rajat Das; Das, Sumon Kumar; Mamun, Abdullah Al
Objectives This study aimed to examine the prevalence and distribution in the comorbidity of non-communicable diseases (NCDs) among the adult population in Bangladesh by measures of socioeconomic status (SES). Design This was a cross-sectional study. Setting This study used Bangladesh Demographic and Health Survey 2011 data. Participants Total 8763 individuals aged ≥35 years were included. Primary and secondary outcome measures The primary outcome measures were diabetes mellitus (DM), hypertension (HTN) and overweight/obesity. The study further assesses factors (in particular SES) associated with these comorbidities (DM, HTN and overweight/obesity). Results Of 8763 adults, 12% had DM, 27% HTN and 22% were overweight/obese (body mass index ≥23 kg/m2 ). Just over 1% of the sample had all three conditions, 3% had both DM and HTN, 3%DM and overweight/obesity and 7% HTN and overweight/obesity. DM, HTN and overweight/ obesity were more prevalent those who had higher education, were non-manual workers, were in the richer to richest SES and lived in urban settings. Individuals in higher SES groups were also more likely to suffer from comorbidities. In the multivariable analysis, it was found that individual belonging to the richest wealth quintile had the highest odds of having HTN (adjusted OR (AOR) 1.49, 95% CI 1.29 to 1.72), DM (AOR 1.63, 95%CI 1.25 to 2.14) and overweight/obesity (AOR 4.3, 95%CI 3.32 to 5.57). Conclusions In contrast to more affluent countries, individuals with NCDs risk factors and comorbidities are more common in higher SES individuals. Public health approaches must consider this social patterning in tackling NCDs in the country.
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.
Association of frequency of television watching with overweight and obesity among women of reproductive age in India: Evidence from a nationally representative study
(PLOS ONE, 8/29/2019) Gupta, Rajat Das; Haider, Shams Shabab; Sutradhar, Ipsita; Hashan, Mohammad Rashidul; Sajal, Ibrahim Hossain; Hasan, Mehedi; Haider, Mohammad Rifat; Sarker, Malabika
Background For women of reproductive age, overweight and obesity are an established risk factor for several medical complications. To address the increasing rate of obesity in India through public health awareness programs, the association between common behaviors and overweight and obesity needs to be investigated. This study aims to determine whether there is any association between the frequency of television watching and overweight and obesity among women of reproductive age (15–49 years) in India. Methods This is a cross-sectional study that utilized data from the National Family Health Survey (NFHS-4), which utilized a nationally representative sample from all 29 states and 7 union territories of India. The survey itself followed a two-staged stratified random sampling technique. The primary outcome of interest was overweight (23.0 kg/m2 to <27.5 kg/m2) and obesity (≥27.5 kg/m2), measured by using the Asian body mass index cut-off. The major explanatory variable was the frequency of television watching, measured in days per week. Sample weight of NFHS-4 was adjusted during the analysis. Multilevel ordered logistic regression was conducted to identify the factors associated with overweight and obesity. To show the strength of association, both the unadjusted Crude Odds Ratio (COR) and the Adjusted Odds Ratio (AOR) were reported with a 95% confidence interval (CI). A p-value<0.05 was considered statistically significant. Results The analysis included weighted data from 644,006 Indian women of reproductive age (15–49 years). Among the respondents, 33.5% were overweight or obese (BMI ≥23.0 kg/m2). The prevalence of overweight and obesity increased with age (p-value <0.0001) and almost half of the women aged 35–49 years were either overweight or obese (48.6%). The prevalence was significantly higher among those living in an urban area compared to a rural area (urban 46.5% vs. rural 26.5%; p-value <0.001). The prevalence of overweight and obesity increased with the frequency of watching television and was the highest among the individuals who reported watching television almost every day (p-value <0.0001). Women watching television almost every day had 24% (AOR: 1.24, 95% CI: 1.21–1.26; p-value <0.001) increased odds of being overweight and obese compared to their counterparts who never watched television. Conclusions This study found that the likelihood of being overweight and obese significantly increased with the frequency of watching television; likely due to physical inactivity during leisure time. Further studies should examine the physical activity and food habits of this target group. Public health promotion programs in India should raise awareness regarding the harmful effects of the sedentary lifestyle associated with watching television.