Department of Statistics

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Impact of Early Childbearing on the Health of the Mother and Child: A Statistical Study
(University of Rajshahi, 2013) Islam, Md. Ashraful; Islam, Md. Nurul; Hossain, Md. Golam
Recent research has document the focus of rapidly growing interest on adolescents’ and their child health in the developing and under developed countries because of its important implications not only for the health of mother but also their children. Early childbearing is an important indicator for women’s and their child health. Body mass index is an indicator of nutritional status in a population. This indicator provides the circumstances that can assist intervention to help eradicate many preventable diseases. Health impact of teenage childbearing is not only due to socio-demographic factors but also due to biological factors. Women early age at first marriage were associated with early childbearing and early childbearing is considered as a risk factor for poor prenatal outcomes. There is a need to study demographic trends particularly trends in marriage under the framework of “basic need strategy”. The objectives of “basic need strategy” among others are to eradicate poverty, unemployment, hunger and literacy is considered as a major precondition for achieving population goals and the participation of women in development. The main objective of this study is to evaluate and analyze the impact of early childbearing on the mother and their child health of rural and urban community in Bangladesh. The specific objectives were: first one, to find the effect of socio-demographic factors on early childbearing mother’s health; second one, to investigate the changes in age at first marriage of Bangladeshi women over time and third one, to estimate the parameters involving in the age patterns of marriage and evaluate the patterns (using single year age distributions) of distributions of first marriage frequencies and risks of the first marriages of ever married women in Bangladesh. Finally, the purposes of the study were to demonstrate the applicability of the generalized Poisson regression (GPR) model as an alternative of other statistical methods and to find some predictors of child malnutrition in Bangladesh. Considering the reproductive women (age 15-49 years), data was extracted from Bangladesh Demographic and Health Survey in this study. For measuring mothers’ health a sample of 1908 ever-married women of age 10-24 were used from the total sample of 10,966. For investigate the age at first marriage and its trends over time, data for 47,109 married Bangladeshi women from 1944-1985 were analyzed. To estimate the parameters of Coale’s nuptiality model and evaluate the patterns of distributions of first marriage frequencies also risks of the first marriages of ever married women in Bangladesh, eventually all of 10,996 ever married women from age 15 to 49 years were taken. To examine the health problem and risks faced by early childbearing mothers’ children in Bangladesh a total sample of 3,207 were extracted. Logistic regression was used to examine the relative importance of socio-demographic factors on early childbearing mothers’ health. ANOVA and linear regression analysis were used to investigate the changes in age at first marriage of Bangladeshi women over four decades. The first marriage frequency and risk of first marriage of women was estimated by Coale and McNeil (1972) model. This model considered five year age group of population. In the present study single year age distribution of ever married female in Bangladesh has been considered. Finally for measuring child health Chi-square test and GPR model were used. More than 33 percent early childbearing mothers have been suffering from chronic energy deficiency, among them 35.4 percent came from rural and 26.9 percent from urban. The BMI varied from 11.95 kg/m2 to 37.79 kg/m2, with a mean of 19.86 ± 2.70 kg/m2 (95% CI: 19.74-19.98). About 15.7 percent women fall below the cutoff of 145 centimeters in height. A decreasing trend was found in the number of CED women with increasing educational level. Student t-test revealed that caesarean mother had a higher BMI than non-caesarean mother (p < 0.001. The coefficients and odds ratio of logistic regression analysis demonstrated that early childbearing mothers who were from rural areas, illiterate, hard laborer, unemployed partner, poorest, non-caesarian, delivered at home, earlier age at first marriage, early age at first birth, having two or more children, were at higher risk for getting chronic energy deficiency (underweight). Based on Wald statistics (16.258) we conclude that age at first marriage was the most influential variable on early childbearing and undernourished mother in Bangladesh. The mean and median age at first marriage of ever married Bangladeshi women was 14.73 ±2.96 years and 14.00 years, respectively; rural women got marriage significantly (p<0.01) earlier than urban women. More than 85 percent (rural 87.6 percent and urban 78.2 percent) Bangladeshi women got marriage before they reached 18 years old, among them 17.0 percent (rural 18.5 percent and urban 13.1 percent) got marriage very early age (before 13 years old). The present study demonstrated that the age at first marriage of ever married Bangladeshi women was showing increasing tendency with changing time. Using ANOVA, age at first marriage for rural and urban showed significant (p<0.01) differences among the birth year cohorts from 1944 to 1985 of the present sample. However, the slope of linear regression line indicated that age at first marriage for both rural and urban women exhibited increasing tendency during the investigated period. Also, the present study demonstrated that the child marriage among Bangladeshi women showed slightly decreasing tendency during birth year cohorts from 1944 to 1985. Coale’s model was used to find the age pattern of marriage among Bangladeshi women. The model gave us interesting results. Most of female got married before the age of 20 years with almost 100 percent getting married by the time they reach age 30. In Bangladesh the legal age of marriage is 18 years old for the women; however a large proportion (about 95 percent) of marriages below this age still take place. The GPR model has been found to be reasonable to study the outcome variable because of its under-dispersion (variance < mean) property. Our study also identify several significant predictors of the outcome variable namely; region, place of residence, father’s and mother’s education, mothers occupation, wealth index, delivery system, place of delivery, source of drinking water of the household, toilet facility, and total number of children ever born to a woman. These above results suggest that for improving health status of Bangladeshi early childbearing mothers, are need to improve the literacy. The result also suggest that age at first marriage of Bangladeshi women has been increasing for last four decades, and increasing rate of urban women is faster than rural women. Moreover, the study confirms that marriage still remains a universal phenomenon among females in Bangladesh. Early marriage prevails that marriage not only start early but progresses fast and are concentrated within a short span of time at least in the female population. Consistencies of our findings we suggest that the GPR model is an ideal alternative of other statistical models for analyzing child malnutrition in a family.
Impact of Socio-Economic and Demographic Variables on Human Fertility Behaviour-A Multivariate Statistical Analysis
(University of Rajshahi, 2009) Mahmud, Md. Nasim; Hossain, Md. Golam
The purpose of this study is to explore the possibility of further fertility decline in Bangladesh, with special attention to the role that might be played by improvements in socio-economic and demographic variables. In particular, researcher has attempted to estimate that after how long, and under what conditions, fertility rate should be taken for Bangladesh to reach replacementlevel fertility (2.1 children per woman). The medium-variant scenario of the United Nations projection indicates that Bangladesh will achieve replacement-level fertility around 2025-2030 (United Nations, 1999, 2001 ). Researcher assess whether the analysis yields a similar conclusion. The rapid decline of fertility, from over 6.5 births per woman to 3.3 births, in the last two decades in Bangladesh is, indeed, a historic record in demographic transition. The country is poor and has remained traditional and conservative. Although the extent and rapidity of the decrease in fertility have been very impressive by international standards, continued fertility decline is desirable, as population crowding, environmental deterioration, massive migration from rural areas to unplanned urban settings, and rapid depletion of resources are becoming acute. However, recent statistics suggest that, despite a continuing increase in contraceptive use, the fertility decline in Bangladesh has been stalled. The present study covers a period of about 30 years, from 1975 to 2004. The study is based on the analysis of secondary data sources mainly obtained from 1993-1994, 1996-1997, 1999-2000 and 2004 Bangladesh Demographic and Health Surveys (BDHSs) and 1975 and 1989 Bangladesh Fertility Surveys (BFSs). The time series data has been taken from the Bangladesh Bureau of Statistics (BBS) from 1985 to 2005, although the number of time series data is small, the annual data of Bangladesh for population studies are limited. In addition, data from the 1981, 1986 and 1991 Bangladesh Contraceptive Prevalence Surveys (CPSs) are also utilized. The samples of these surveys are nationally representative in scope and contain socio-economic and demographic information of individuals. Analyzing these data researcher has tried to focus on the past, present and future fertility situation of Bangladesh in connection with socio-economic and demographic variables based on several multivariate statistical analyses namely, logistic regression model, path model, Bongaarts' proximate determinants of fertility model and time series. It is found from the logistic regression model that the age at marriage, educational level, region, mass media, contraceptive method and child mortality are most influential variables on human fertility behaviour. It suggests that socioeconomic development policies as educational level, region, mass media and demographic indicators as age at first marriage, contraceptive method and child mortality giving special emphasis may produce significant desired effects with regard to fertility control in the national level of Bangladesh. The path analysis reveals that there are regional variations in fertility among the six administration divisions of Bangladesh due to some particular socio-economic and demographic variables. It demonstrates while one of the strategies to reduce fertility should be bringing down the desired family size, other strategies to narrow the gap of the regional variations should include efforts to increase education for female to reduce the preference for male children and to lower infant and child mortality, as well as to promote the effective use of contraceptives. Without a rapid improvement of these factors, it would be difficult to achieve replacement level fertility in near future. Bongaarts' model is applied to estimate the fertility inhibiting effect of four important proximate determinants: marriage, contraception, abortion and lactational infecundability. The model clearly indicates that there is a downward trend in all the proximate indices. Data on induced abortion are not available. So, its effect on the model is about to be immeasurable. Abortion is a sensitive issue in Bangladesh, and many women who have an abortion do not disclose this to others, particularly to outsiders. This makes the situation extremely difficult to get a clear picture of abortion from survey data in this country. Bongaarts' model indicates marriage variable made significant contributions to the overall fertility reduction. Contraceptive use has the highest impact on the total reduction of fertility which may be attributed to the increasing use of contraception from 7% in 1975 to 48.5% in 2004. The average estimated effect of lactational infecundability plays an important role in reducing fertility in Bangladesh. The analysis also shows that a downward effect on fertility at young ages caused by rising age at marriage has been balanced by an upwards effect at older ages caused by decreasing widowhood and divorced. Researcher suggests from the Bongaarts' model that the governmental policies can concentrate on effectively and efficiently increasing contraceptive utilization and effectiveness, on encouraging breastfeeding and on rising the age of marriage. One of the most interesting parts of this study that the researcher has developed a time series model to estimate after how long and under what conditions Bangladesh will achieve the replacement level of fertility (2.1 children per woman). Research has compared the time frame to reach the replacement level of fertility with the medium-variant scenario of the United Nations projection that Bangladesh will achieve replacement level of fertility around 2025-30 (UN, 1999, 2001 ). The research has found the similar result to reach the fertility rate of Bangladesh at the replacement level as the United Nations target year. Researcher has suggested that the total fertility rate (TFR) of Bangladesh will reach at the replacement level within the desired time period around 2025-2030 and to do so the government shall have to take necessary action- to increase mean age at marriage of female to be 20.3 years; to increase labor force participation of female to be 43.5%; and to decrease infant mortality rate per 1000 live births at 35.6. Lastly, it is shown from the study that the fertility rate has remained almost same in the national level of Bangladesh for a long time. But it is also found from the study that fertility rate has reached near to the replacement level in the few divisions of Bangladesh. It is really a matter of hope for us. Being greatly encouraged. Researcher would like to suggest that the regional key measures, responsible for achieving the replacement level of fertility rate must be found out, analyzed and researched and finally applied in other divisions of the country. By doing these, we can reach to our goal to the replacement level of fertility
Modelling of Nutritional Status of Ever-Married Women in Bangladesh
(University of Rajshahi, 2015) Kamruzzaman, Md.; Hossain, Md. Golam; Islam, Md. Nurul; Abedin, Samad
The change in nutritional status plays an important role in the course of a person’s health. Body mass index (BMI) is measure of body fat based on height and weight of a person and it is used to screen for weight categories that may lead to health problems. The first main objective of this thesis was to observe the presence of secular trends in nutritional status of Bangladeshi married women over time. A total of 45,572 Bangladeshi non-pregnant married women in reproductive age were used in this study with average age 30.11±9.04 years. The secondary cross-sectional data used in this study was extracted from Bangladesh Demographic and Health Survey (BDHS) and they collected data from Bangladeshi ever-married women using multistage stratified cluster sampling. The last five rounds (1996-97, 1999-2000, 2004, 2007 and 2011) BDHS measured height and weight from their selected sample, the data was derived from the measurement years 1996-97 to 2011. Descriptive statistics, Analysis of variance (ANOVA) and linear regression analysis were used in this study. The mean value of BMI of Bangladeshi non-pregnant married women was 20.65±3.67 kg/m2 with height and weight were 150.60±5.44 cm and 46.93±9.24 kg, respectively. Using ANOVA, height, weight and BMI showed significant (p<0.001) differences among the measurement year cohorts from 1996-97 to 2011. The increasing tendency in height, weight and BMI of Bangladeshi married women in reproductive age were showed during the measurement years from 1996-97 to 2011. The sample was divided into 40 groups according their birth year cohorts from 1955 to 1995. ANOVA also demonstrated that the variation of height, weight and BMI were significant (p<0.001) among the birth year cohorts from 1955 to 1995. The slope of linear regression demonstrated that an increasing tendency in BMI was found among birth year cohorts from 1955 to 1971, but a decreasing tendency was observed during the birth year cohorts from 1972 to 1995. In this study found that more than 50% women were normal weight and a remarkable number of married women (31.4%) were underweight. More than 10% women were overweight and only 2.1% were obese among non-pregnant Bangladeshi married women. It was found that the proportion of underweight women has been increasing and the opposite direction also observed for the number of obese in those born during the last 40 years of the study period (1955 to 1995). Underweight can be considered as the major health problems of Bangladeshi married women and requires attention. The second objective of the thesis was to investigate the influencing factors of body mass index among Bangladeshi married women. Hierarchy data was used in this study that was collected by Bangladesh Demographic and Health Survey-2011 (BDHS-2011) using multistage stratified cluster sampling. Usually, large-scale survey for public health, demography and sociology follow a hierarchical data structure as the surveys are based on multistage stratified cluster sampling. The appropriate approach to analyzing such survey data is therefore based on nested sources of variability which come from different levels of the hierarchy. The single level statistical model is not appropriate for analyzing such kind of data set. Multilevel (two level) linear regression was utilized in the present study to remove the cluster effect for each outcome. The mean BMI of Bangladeshi married women in reproductive age was 21.60±3.86 kg/m2 with height and weight was 150.92 ±5.36 cm and 49.28 ± 9.69 kg, respectively. The prevalence of underweight, normal weight, overweight and obese were 22.8%, 59.1%, 14.9% and 3.2%, respectively of Bangladeshi non-pregnant married women in reproductive age for BDHS-2011 data set. Analysis of variance (ANOVA) demonstrated that the BMI of Bangladeshi non-pregnant married women in reproductive age was significantly different among respondents’ and her husbands’ education level (p<0.001) and wealth index (p<0.001). The t-test showed that the differences of BMI was significant between (i) urban and rural (p<0.001), (ii) watching television, yes and no ((p<0.001), (iii) currently breastfeeding, yes and no (p<0.001), (iv) currently use contraceptive, yes and no (p<0.05), (v) living with husband, yes and no (p<0.01) and (v) currently working status (p<0.05). Person’s correlation coefficients exhibited that respondent’s age, age at first marriage and age at first birth were significantly (p<0.001) positively related with BMI of married women in reproductive age, and there was a negative association between number of ever born children and BMI (p<0.001). Two level regression model demonstrated that age and age at first marriage of women were positively (p<0.01) related with their BMI. Parity was negatively related with women’s BMI. BMI was especially less pronounced among non-pregnant married women who came from rural, uneducated, uneducated husband, came from poor family, house wife, currently not use contraceptive and currently not breastfeeding. Under-nutrition is considered as a major health problems in Bangladesh especially of married women. Government and non-government organization of Bangladesh should take step to increase people education level and improve economic condition for removing under-nutrition among married women. The third and final main objective of this thesis was to quantify the prevalence of anemia and assessed how various nutritional, socio-economic and demographic factors associated with anemia among non-pregnant women in Bangladesh. Anemia is one of the most common and global public health problems. Highly prevalence of anemia was found among women of reproductive age in the world especially in developing countries. Study on anemia among Bangladeshi non-pregnant married women is poorly documented. Cross-sectional data were used in this study. Data was extracted from Bangladesh Demographic and Health Survey (BDHS) 2011. The nationally representative sample (5,293 married women) was selected by multistage stratified cluster sampling and data was collected from July 8, 2011 to December 27, 2011. Multilevel (two level) logistic regression analysis was done in this study. The prevalence of anemia among Bangladeshi married women was more than 41% and among anemic women, 35.5% was mild, 5.6% and only 0.2% were moderate and severe anemic respectively. Chi-square (χ2-test) test was utilized in this study for selecting independent factors for multilevel logistic regression analysis. χ2-test demonstrated that residence (p<0.001), respondents’ and her husbands’ education levels (p<0.001), currently breastfeeding (p<0.001), currently amenorrhea (p<0.001), currently use contraceptive (p<0.001), toilet facility (p<0.01), religion (p<0.001), wealth index (p<0.001), BMI (p<0.001), age group (p<0.001), number of ever born children (p<0.001) were significantly associated with anemia. The two level logistic regression model demonstrated that women who were currently breastfeeding and amenorrhea had more likely (p<0.01) to get anemia than their counterparts. Underweight women had a higher chance (p<0.01) to get anemia than normal weight, overweight and obese. Uneducated women were more likely to get anemia (p<0.01) than secondary and higher educated. Anemia was especially less pronounced among non-pregnant women who are currently use contraceptive (p<0.05), Muslim (p<0.01) and came from rich family (p<0.01). Moreover, women who were 30-49 years old had more likely to get anemia than younger (p<0.01). Under-nutrition is most important predictor for anemia among Bangladeshi married women and undernourished women are living under poor condition. Government of Bangladesh should take appropriate initiative to improve economic condition for removing anemia among married women.