Malabika Sarker

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Utilization of mobile phones for accessing menstrual regulation services among low-income women in Bangladesh: a qualitative analysis
(© 2017 BioMed Central Ltd., 1/14/2017) Messinger, Chelsea Jordan; Mahmud, Ilias; Kanan, Sushama; Jahangir, Yamin Tauseef; Sarker, Malabika; Rashid, Sabina Faiz
Background: As many as one-third of all pregnancies in Bangladesh are unplanned, with nearly one-half of these pregnancies ending in either menstrual regulation (MR) or illegal clandestine abortion. Although MR is provided free of charge, or at a nominal cost, through the public sector and various non-profits organizations, many women face barriers in accessing safe, affordable MR and post-MR care. Mobile health (mHealth) services present a promising platform for increasing access to MR among low-income women at risk for clandestine abortion. We sought to investigate the knowledge, attitudes and practices regarding mHealth of both MR clients and formal and informal sexual and reproductive healthcare providers in urban and rural low-income settlements in Bangladesh. Methods: A total of 58 interviews were conducted with MR clients, formal MR providers, and informal MR providers in four low-income settlements in the Dhaka and Sylhet districts of Bangladesh. Interview data was coded and qualitatively analysed for themes using standard qualitative research practices. Results: Our findings suggest that low-income MR clients in Bangladesh have an inadequate understanding of how to use their mobile phones to obtain health service information or counselling related to MR, and correspondingly low levels of formal or informal mHealth service utilization. Few were aware of any formal mHealth services in place in their communities, despite the fact that providers stated that hotlines were available. Overall, MR clients expressed positive opinions of mHealth services as a means of improving women's access to affordable and timely MR. Formal and informal MR providers believed that mobile phones had benefits with respect to information dissemination and making appointments, but emphasized the necessity of in-person consultations for effective sexual and reproductive healthcare. Conclusions: We report low utilization yet high acceptability of mHealth services among low-income MR clients in Bangladesh. Expanding formal and informal mHealth services targeted towards MR - and increasing publicity of these services in low-income communities - may help increase timely access to accurate MR information and formal providers among women at risk for clandestine abortion. While expanding formal and informal mHealth services for SRHR in Bangladesh may be useful in disseminating information about MR and connecting women with formal providers, in-person visits remain necessary for adequate treatment.
Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries
(© 2016 BMC Infectious Diseases, 2/18/2016) Jaenisch, Thomas; Hoai Tam, Dong Thi; Thanh Kieu, Nguyen Tan; Ngoc, Tran Van; Tran Nam, Nguyen; Kinh, Nguyen Van; Yacoub, Sophie; Chanpheaktra, Ngoun; Kumar, Varun; Chai See, Lucy Lum; Sathar, Jameela; Sandoval, Ernesto Pleités; Marón Alfaro, Gabriela Maria; Laksono, Ida Safitri; Mahendradhata, Yodi; Sarker, Malabika; Ahmed, Firoz; Caprara, Andrea; Benevides, Bruno Souza; Marques, Ernesto T. A.; Magalhaes, Tereza; Brasil, Patricia; Netto, Marco; Tami, Adriana; Bethencourt, Sarah E.; Guzman, Maria; Simmons, Cameron; Quyen, Nguyen Thanh Ha; Merson, Laura; Dung, Nguyen Thi Phuong; Beck, Dorothea; Wirths, Marius; Wolbers, Marcel; Lam, Phung Khanh; Rosenberger, Kerstin; Wills, Bridget
Background The burden of dengue continues to increase globally, with an estimated 100 million clinically apparent infections occurring each year. Although most dengue infections are asymptomatic, patients can present with a wide spectrum of clinical symptoms ranging from mild febrile illness through to severe manifestations of bleeding, organ impairment, and hypovolaemic shock due to a systemic vascular leak syndrome. Clinical diagnosis of dengue and identification of which patients are likely to develop severe disease remain challenging. This study aims to improve diagnosis and clinical management through approaches designed a) to differentiate between dengue and other common febrile illness within 72 h of fever onset, and b) among patients with dengue to identify markers that are predictive of the likelihood of evolving to a more severe disease course. Method/Design This is a prospective multi-centre observational study aiming to enrol 7–8000 participants aged ≥ 5 years presenting with a febrile illness consistent with dengue to outpatient health facilities in 8 countries across Asia and Latin America. Patients presenting within 72 h of fever onset who do not exhibit signs of severe disease are eligible for the study. A broad range of clinical and laboratory parameters are assessed daily for up to 6 days during the acute illness, and also at a follow up visit 1 week later. Discussion Data from this large cohort of patients, enrolled early with undifferentiated fever, will be used to develop a practical diagnostic algorithm and a robust clinical case definition for dengue. Additionally, among patients with confirmed dengue we aim to identify simple clinical and laboratory parameters associated with progression to a more severe disease course. We will also investigate early virological and serological correlates of severe disease, and examine genetic associations in this large heterogeneous cohort. In addition the results will be used to assess the new World Health Organization classification scheme for dengue in practice, and to update the guidelines for “Integrated Management of Childhood Illness” used in dengue-endemic countries.
Intersectoral collaboration: a novel path to promote community health promotion
(© 2012 Global Health Promotion, 2012) Sarker, Malabika; Joarder, Taufique
Intersectoral collaboration: an original way to promote community health promotion
(© 2012 Global Health Promotion, 2012) Sarker, Malabika; Joarder, Taufique
Effective coverage for antiretroviral therapy in a Ugandan district with a decentralized model of care
(© 2013 PLoS ONE, 2013) Scheibe, Florian J. B.; Waiswa, Peter; Kadobera, Daniel; Müller, Olaf; Ekström, Anna M.; Sarker, Malabika; Neuhann, H. W. Florian
Introduction:While increasing access to antiretroviral therapy (ART) is reported from many African countries, data on effective coverage particular from settings without external support or research remains scarce. We examined and report effective coverage data from a public ART program in rural Uganda.Methods:We conducted a retrospective cohort study at all ART-providing governmental health facilities in Iganga District, Eastern Uganda. Based on all HIV patients registered between April 2004 and September 2009 (n = 4775), we assessed indicators of program performance and determined rates of retention and Cox proportional hazards for attrition. Effective ART coverage was calculated using projections (SPECTRUM software) adapted to the district demographic structure and number of people receiving ART.Results:By September 2009, district public sector effective ART coverage was 10.3% for adults and 1.9% for children. After a median follow-up of 26.9 months, overall ART retention was 54.7%. The probability of retention was 0.72 (95% confidence interval (CI) 0.69-0.75) at 12 and 0.58 (CI 0.54-0.62) at 36 months after ART initiation. Individual health facilities differed considerably regarding performance indicators and retention. Overall, 198 (16.9%) individual files of 1171 registered ART patients were lost. Young adult age (15-24 years) had a higher risk of attrition (HR 2.1, CI 1.4-3.2) as well as WHO stage I (HR 4.8, CI 1.9-11.8) and WHO stage IV (HR 2.5, CI 1.3-4.7). An interval ≥6 weeks between HIV testing and ART initiation was associated with a reduced risk (HR 0.6, CI 0.47-0.78).Conclusion:Compared to reported national data effective ART coverage in Iganga District was low. Intensified efforts to improve access, retention in care, and quality of documentation are urgently needed. Children and young adults require special attention in the program.
Achieving universal health coverage through community empowerment: a proposition for Bangladesh
(© 2014 Medknow Publications, 2014) Joarder, Taufique; Sarker, Malabika
Knowledge and attitude of key community members towards tuberculosis: mixed method study from BRAC TB control areas in Bangladesh
(© 2015 BioMed Central Ltd., 2015) Paul, Sukanta; Akter, Rahima; Aftab, Afzal; M Khan, Antora; Barua, Mrittika; Islam, Shayla; Islam, Akramul; Husain, Ashaque; Sarker, Malabika
Background: Bangladesh National Tuberculosis (TB) Control Programme adopted a number of strategies to facilitate TB diagnosis and treatment. 'Advocacy, Communication and Social Mobilization' (ACSM) was one of the key strategies implemented by BRAC (Bangladesh Rural Advancement Committee, a non-governmental development organization) TB control program. The purpose of this study is to assess the knowledge and attitudes of the key community members (KCMs) participated in ACSM in BRAC TB control areas. Methods: This study combined quantitative and qualitative methods using a mixed method approach. KCMs in three districts with low TB case detection rates were targeted to assess the ACSM program. The quantitative survey using a multi-stage random-sampling strategy was conducted among 432 participants. The qualitative study included in-depth interviews (IDIs) of a sub sample of 48 respondents. For quantitative analysis, descriptive statistics were reported using frequencies, percentages, and Chi square tests, while thematic analysis was used for qualitative part. Results: Most (99%) of the participants had heard about TB, and almost all knew that TB is a contagious yet curable disease. More than half (53%) of the KCMs had good knowledge regarding TB, but BRAC workers were found to be more knowledgeable compared to other KCMs. However, considerable knowledge gaps were observed among BRAC community health workers. Qualitative results revealed that the majority of the KCMs were aware about the signs, symptoms and transmission pathways of TB and believed that smoking and addiction were the prime causes of transmission of TB. The knowledge about child TB was poor even among BRAC health workers. Stigma associated with TB was not uncommon. Almost all respondents expressed that young girls diagnosed with TB. Conclusions: This study finding has revealed varying levels of knowledge and mixed attitudes about TB among the KCMs. It also provides insight on the poor knowledge regarding child TB and indicate that despite the significant success of the TB program stigma is yet prevalent in the community. Future ACSM activities should engage community members against stigma and promote child TB related information for further improvement of BRAC TB Control Programme.
Exploring the context in which different close-to-community sexual and reproductive health service providers operate in Bangladesh: a qualitative study
(© 2015 BioMed Central Ltd., 2015) Mahmud, Ilias; Chowdhury, Sadia; Ashraf Siddiqi, Bulbul; Theobald, Sally; Ormel, Hermen; Biswas, Salauddin; Tauseef Jahangir, Yamin; Sarker, Malabika; Faiz Rashid, Sabina
Background: A range of formal and informal close-to-community (CTC) health service providers operate in an increasingly urbanized Bangladesh. Informal CTC health service providers play a key role in Bangladesh's pluralistic health system, yet the reasons for their popularity and their interactions with formal providers and the community are poorly understood. This paper aims to understand the factors shaping poor urban and rural women's choice of service provider for their sexual and reproductive health (SRH)-related problems and the interrelationships between these providers and communities. Building this evidence base is important, as the number and range of CTC providers continue to expand in both urban slums and rural communities in Bangladesh. This has implications for policy and future programme interventions addressing the poor women's SRH needs. Methods: Data was generated through 24 in-depth interviews with menstrual regulation clients, 12 focus group discussions with married men and women in communities and 24 semi-structured interviews with formal and informal CTC SRH service providers. Data was collected between July and September 2013 from three urban slums and one rural site in Dhaka and Sylhet, Bangladesh. Atlas.ti software was used to manage data analysis and coding, and a thematic analysis was undertaken. Results: Poor women living in urban slums and rural areas visit a diverse range of CTC providers for SRH-related problems. Key factors influencing their choice of provider include the following: availability, accessibility, expenses and perceived quality of care, the latter being shaped by notions of trust, respect and familiarity. Informal providers are usually the first point of contact even for those clients who subsequently access SRH services from formal providers. Despite existing informal interactions between both types of providers and a shared understanding that this can be beneficial for clients, there is no effective link or partnership between these providers for referral, coordination and communication regarding SRH services. Conclusion: Training informal CTC providers and developing strategies to enable better links and coordination between this community-embedded cadre and the formal health sector has the potential to reduce service cost and improve availability of quality SRH (and other) care at the community level.
How do Malawian women rate the quality of maternal and newborn care? : experiences and perceptions of women in the central and southern regions
(© 2015 BMC Pregnancy & Childbirth, 2015-04) Kambala, Christabel; Lohmann, Julia; Mazalale, Jacob; Brenner, Stephan; Allegri, Manuela De; Muula, Adamson S.; Sarker, Malabika
Background: While perceived quality of care is now widely recognized to influence health service utilization, limited research has been conducted to explore and measure perceived quality of care using quantitative tools. Our objective was to measure women’s perceived quality of maternal and newborn care using a composite scale and to identify individual and service delivery factors associated with such perceptions in Malawi. Methods: We conducted a cross-sectional survey in selected health facilities from March to May 2013. Exit interviews were conducted with 821 women convenience sampled at antenatal, delivery, and postnatal clinics using structured questionnaires. Experiences and the corresponding perceived quality of care were measured using a composite perception scale based on 27 items, clustered around three dimensions of care: interpersonal relations, conditions of the consultation and delivery rooms, and nursing care services. Statements reflecting the 27 items were read aloud and the women were asked to rate the quality of care received on a visual scale of 1 to 10 (10 being the highest score). For each dimension, an aggregate score was calculated using the un-weighted item means, representing three outcome variables. Descriptive statistics were used to display distribution of explanatory variables and one-way analysis of variance was used to analyse bivariate associations between the explanatory and the outcome variables. Results: A high perceived quality of care rating was observed on interpersonal relations, conditions of the examination rooms and nursing care services with an overall mean score of 9/10. Self-introduction by the health worker, explanation of examination procedures, consent seeking, encouragement to ask questions, confidentiality protection and being offered to have a guardian during delivery were associated with a high quality rating of interpersonal relations for antenatal and delivery care services. Being literate, never experienced a still birth and, first ANC visit were associated with a high quality rating of room conditions for antenatal care service. Conclusions: The study highlights some of the multiple factors associated with perceived quality of care. We conclude that proper interventions or practices and policies should consider these factors when making quality improvements.
Utilization of maternal health services among adolescent women in Bangladesh: a scoping review of the literature
(Tropical Medicine & International Health, 2015-07) Shahabuddin, A. S. M.; Delvaux, Therese; Abouchadi, Saloua; Sarker, Malabika; Brouwere, Vincent De
objective To understand the health-seeking behaviour of adolescent women in Bangladesh with respect to the use of maternal health services. methods Literature review of seven electronic databases: PubMed, ISI Web of Knowledge, PsycINFO, Embase, CINAHL, POPLINE and Global Health. Studies published in English between 1990 and 2013 which describe Bangladeshi adolescent women’s healthcare-seeking behaviour during pregnancy, delivery and post-partum were included. results Twelve studies were included in this review. 11 used quantitative methods and one used a mixed-methods approach. All studies included married adolescent women only. Women with lower educational levels are less likely to seek skilled maternal health services than those with higher levels of education. Use of maternal health services is also less common among rural married adolescent women than women in urban areas. Being part of the richest bands of wealth, having had previous experiences of childbirth and higher women’s autonomy positively influence the use of skilled maternal health services among married adolescent women in Bangladesh. Antenatal care is a key predictor of the use of skilled birth attendants for delivery and post-natal care. conclusion Maternal health-related programmes should be designed targeting rural and uneducated married adolescent women in Bangladesh. More qualitative investigations are required to broaden our understanding on maternal health-seeking behaviour of both married and unmarried adolescent women.
Diseases to spread rapidly on insects: experts point at climate change
(The Daily Star, 2015-11-10) Palma, Porimol
What influences adolescent girls' decision-making regarding contraceptive methods use and childbearing? a qualitative exploratory study in Rangpur District, Bangladesh
(© 2016 Public Library of Science, 2016) Shahabuddin, A. S. M.; Nöstlinger, Christiana; Delvaux, Thérèse; Sarker, Malabika; Bardají, Azucena; De Brouwere, Vincent; E. W. Broerse, Jacqueline
Background: Bangladesh has the highest rate of adolescent pregnancy in South Asia. Child marriage is one of the leading causes of pregnancies among adolescent girls. Although the country's contraceptive prevalence rate is quite satisfactory, only 52% of married adolescent girls use contraceptive methods. This qualitative study is aimed at exploring the factors that influence adolescent girls' decision-making process in relation to contraceptive methods use and childbearing. Methods and Results: We collected qualitative data from study participants living in Rangpur district, Bangladesh. We conducted 35 in-depth interviews with married adolescent girls, 4 key informant interviews, and one focus group discussion with community health workers. Adolescent girls showed very low decision-making autonomy towards contraceptive methods use and child-bearing. Decisions were mainly made by either their husbands or mothers-in-law. When husbands were unemployed and financially dependent on their parents, then the mothers-in-law played most important role for contraceptive use and childbearing decisions. Lack of reproductive health knowledge, lack of negotiation and communication ability with husbands and family members, and mistrust towards contraceptive methods also appeared as influential factors against using contraception resulting in early childbearing among married adolescent girls. Conclusions: Husbands and mothers-in-law of newly married adolescent girls need to be actively involved in health interventions so that they make more informed decisions regarding contraceptive use to delay pregnancies until 20 years of age. Misunderstanding and distrust regarding contraceptives can be diminished by engaging the wider societal actors in health intervention including neighbours, and other family members.
Lessons learned in using realist evaluation to assess maternal and newborn health programming in rural Bangladesh
(© 2016 Oxford University Press, 2016) Adams, Alayne; Sedalia, Saroj; McNab, Shanon; Sarker, Malabika
Realist evaluation furnishes valuable insight to public health practitioners and policy makers about how and why interventions work or don't work. Moving beyond binary measures of success or failure, it provides a systematic approach to understanding what goes on in the 'Black Box' and how implementation decisions in real life contexts can affect intervention effectiveness. This paper reflects on an experience in applying the tenets of realist evaluation to identify optimal implementation strategies for scale-up of Maternal and Newborn Health (MNH) programmes in rural Bangladesh. Supported by UNICEF, the three MNH programmes under consideration employed different implementation models to deliver similar services and meet similar MNH goals. Programme targets included adoption of recommended antenatal, post-natal and essential newborn care practices; health systems strengthening through improved referral, accountability and administrative systems, and increased community knowledge. Drawing on focused examples from this research, seven steps for operationalizing the realist evaluation approach are offered, while emphasizing the need to iterate and innovate in terms of methods and analysis strategies. The paper concludes by reflecting on lessons learned in applying realist evaluation, and the unique insights it yields regarding implementation strategies for successful MNH programming.
Role of spatial tools in public health policymaking of Bangladesh: opportunities and challenges
(© 2016 Journal of Health, Population and Nutrition, 2016-02) Kim, Dohyeong; Sarker, Malabika; Vyas, Priyanka
In spite of the increasing efforts to gather spatial data in developing countries, the use of maps is mostly for visualization of health indicators rather than informed decision-making. Various spatial tools can aid policymakers to allocate resources effectively, predict patterns in communicable or infectious diseases, and provide insights into geographical factors which are associated with utilization or adequacy of health services. In Bangladesh, the launch of District Health Information System 2, along with recent efforts to gather spatial data of facilities location, provides an interesting opportunity to study the current landscape and the potential barriers in advancing the use of spatial tools for informed decision making. This study assessed the current level of map usage and spatial tools for health sector planning in Bangladesh, focusing on investigating why map usage and spatial tools remained at a basic level for the purpose of health policy. The study design involved in-depth interviews, followed by an expert survey (n = 39) obtained through snowball sampling. Our survey revealed that assessing areas with shortage of community health workers emerged as the top most for basic map usage or primarily for visualization purpose, while planning for emergency and obstetric care services, and disease mapping was the most frequent category for intermediate and advanced map usage, respectively. Furthermore, we found lack of inter-institutional collaboration, lack of continuous availability of trained personnel, and lack of awareness on the use of geographic information system (GIS) as a decision-making tool as three most critical barriers in the current landscape. Our findings highlight the barriers in increasing the adoption of spatial tools for health policymaking and planning in Bangladesh.
False and real, but avoidable, dichotomies
(© 2017 Lancet Publishing Group, 2017-08) Ooms, Gorik; Flores, Walter; Mulumba, Moses; Sarker, Malabika; Van De Pas, Remco; Jahn, Albrecht
Lost in care pathway: a qualitative investigation on the health system delay of extra pulmonary tuberculosis patients in Bangladesh
(BRAC Univeristy, 3/28/2017) Sarker, Malabika; Mohammad, Din; Paul, Sukanta; Akter, Rahima; Islam, Shayla; Biswas, Goutam; Hossain, Asheque; Islam, Akramul
Background: Although extra pulmonary tuberculosis (EPTB) has long been known as a major public health concern globally, the complex healthcare-seeking pathways of EPTB patients are not widely studied. This study aims to explore the pattern of healthcare-seeking pathways of rural and urban EPTB patients registered with the BRAC TB control programme. BRAC is a Bangladesh-based non-governmental organization dedicated to alleviating poverty through empowering the poor. Method: Data were collected through 60 in-depth interviews with rural and urban EPTB patients in Bangladesh. Results: The findings reveal that the rural EPTB patients encountered a substantial diagnostic delay as compared to the urban patients. However, the difference between the average number of healthcare providers consulted by the rural verses the urban EPTB patients was not significant. This study also shows that the healthcare-seeking journey of rural and urban EPTB patients usually starts either at pharmacies or private facilities. Through exploring the detailed nature of the pathway, this study reveals the ways in which non-medical informants, mainly relatives and friends, can benefit patients. Conclusions: The private and informal healthcare providers should receive appropriate training on the diagnosis of EPTB. Such training could effectively shorten the long and complex healthcare-seeking pathways of EPTB patients.
Cultural attitudes toward postpartum depression in Dhaka, Bangladesh
(© 2017 Taylor and Francis Inc., 5/15/2017) Williams, Anaise; Sarker, Malabika; Ferdous, Syeda Tahmina
Depression is the leading cause of disability worldwide, yet in many cultures, it remains unaddressed and unacknowledged. Postpartum depression is particularly delicate because of its association with gender and expectations of motherhood. This ethnographic study in Dhaka, Bangladesh sought to understand local perceptions of postpartum depression and cultural influences around mental health care seeking. The results describe the role of culture and stigma in the conceptualization of mental health within both the community and medical spheres. Mental health continues to be unacknowledged and neglected in Bangladeshi communities. We recommend community-based psychosocial programming for new mothers living in slums.
Perceptions of quality across the maternal care continuum in the context of a health financing intervention: Evidence from a mixed methods study in rural Malawi
(© 2017 BioMed Central Ltd., 6/8/2017) Kambala, Christabel; Lohmann, Julia; Mazalale, Jacob; Brenner, Stephan; Sarker, Malabika; Muula, Adamson Sinjani; De Allegri, Manuela
Background: In 2013, Malawi with its development partners introduced a Results-Based Financing for Maternal and Newborn Health (RBF4MNH) intervention to improve the quality of maternal and newborn health-care services. Financial incentives are awarded to health facilities conditional on their performance and to women for delivering in the health facility. We assessed the effect of the RBF4MNH on quality of care from women's perspectives. Methods: We used a mixed-method prospective sequential controlled pre- and post-test design. We conducted 3060 structured client exit interviews, 36 in-depth interviews and 29 focus group discussions (FGDs) with women and 24 in-depth interviews with health service providers between 2013 and 2015. We used difference-in-differences regression models to measure the effect of the RBF4MNH on experiences and perceived quality of care. We used qualitative data to explore the matter more in depth. Results: We did not observe a statistically significant effect of the intervention on women's perceptions of technical care, quality of amenities and interpersonal relations. However, in the qualitative interviews, most women reported improved health service provision as a result of the intervention. RBF4MNH increased the proportion of women reporting to have received medications/treatment during childbirth. Participants in interviews expressed that drugs, equipment and supplies were readily available due to the RBF4MNH. However, women also reported instances of neglect, disrespect and verbal abuse during the process of care. Providers attributed these negative instances to an increased workload resulting from an increased number of women seeking services at RBF4MNH facilities. Conclusion: Our qualitative findings suggest improvements in the availability of drugs and supplies due to RBF4MNH. Despite the intervention, challenges in the provision of quality care persisted, especially with regard to interpersonal relations. RBF interventions may need to consider including indicators that specifically target the provision of respectful maternity care as a means to foster providers' positive attitudes towards women in labour. In parallel, governments should consider enhancing staff and infrastructural capacity before implementing RBF.
Factors affecting the uptake of HIV testing among men: a mixed-methods study in rural burkina faso
(© 2015 PLoS ONE, 7/1/2015) Allegri, Manuela De; Agier, Isabelle; Tiendrebeogo, Justin; Louis, Valerie Renée; Yé, Maurice; Mueller, Olaf; Sarker, Malabika
Background This study aimed to explore factors shaping the decision to undergo Human Immunodeficiency Virus (HIV) testing among men in rural Burkina Faso. Methods The study took place in 2009 in the Nouna Health District and adopted a triangulation mixed methods design. The quantitative component relied on data collected through a structured survey on a representative sample of 1130 households. The qualitative component relied on 38 in-depth interviews, with men purposely selected to represent variation in testing decision, age, and place of residence. A two-part model was conducted, with two distinct outcome variables, i.e. “being offered an HIV test” and “having done an HIV test”. The qualitative data analysis relied on inductive coding conducted by three independent analysts. Result Of the 937 men, 357 had been offered an HIV test and 97 had taken the test. Younger age, household wealth, living in a village under demographic surveillance, and knowing that HIV testing is available at primary health facilities were all positively associated with the probability of being offered an HIV test. Household wealth and literacy were found to be positively associated, and distance was found to be negatively associated with the probability of having taken an HIV test. Qualitative findings indicated that the limited uptake of HIV testing was linked to poor knowledge on service availability and to low risk perceptions. Conclusion With only 10% of the total sample ever having tested for HIV, our study confirmed that male HIV testing remains unacceptably low in Sub-Saharan Africa. This results from a combination of health system factors, indicating general barriers to access, and motivational factors, such as one’s own knowledge of service availability and risk perceptions. Our findings suggested that using antenatal care and curative services as the exclusive entry points into HIV testing may not be sufficient to reach large portions of the male population. Thus, additional strategies are urgently needed to increase service uptake.
Autism Spectrum disorders (ASD) in South Asia: a systematic review
(© 2017 BioMed Central Ltd., 8/1/2017) Hossain, Mohammad Didar; Ahmed, Helal Uddin; Jalal Uddin, M. M.; Chowdhury, Waziul Alam; Iqbal, Mohammad Shamim; Kabir, Razin Iqbal; Chowdhury, Imran Ahmed; Aftab, Afzal; Datta, Pran Gopal; Rabbani, Golam; Hossain, Saima Wazed; Sarker, Malabika
Background: Autism spectrum disorders (ASD) are a group of complex neurodevelopmental disorders. The prevalence of ASD in many South Asian countries is still unknown. The aim of this study was to systematically review available epidemiological studies of ASD in this region to identify gaps in our current knowledge. Methods: We searched, collected and evaluated articles published between January 1962 and July 2016 which reported the prevalence of ASD in eight South Asian countries. The search was conducted in line with the PRISMA guidelines. Results: We identified six articles from Bangladesh, India, and Sri Lanka which met our predefined inclusion criteria. The reported prevalence of ASD in South Asia ranged from 0.09% in India to 1.07% in Sri Lanka that indicates up to one in 93 children have ASD in this region. Alarmingly high prevalence (3%) was reported in Dhaka city. Study sample sizes ranged from 374 in Sri Lanka to 18,480 in India. The age range varied between 1 and 30 years. No studies were found which reported the prevalence of ASD in Pakistan, Nepal, Bhutan, Maldives and Afghanistan. This review identifies methodological differences in case definition, screening instruments and diagnostic criteria among reported three countries which make it very difficult to compare the studies. Conclusions: Our study is an attempt at understanding the scale of the problem and scarcity of information regarding ASD in the South Asia. This study will contribute to the evidence base needed to design further research and make policy decisions on addressing this issue in this region. Knowing the prevalence of ASD in South Asia is vital to ensure the effective allocation of resources and services.