Journal Articles (2018)

Permanent URI for this collectionhttps://hdl.handle.net/10361/16377

Browse

Now showing 1 - 20 of 34

Differences in prevalence and determinants of hypertension according to rural-urban place of residence among adults in Bangladesh
(Cambridge University Press, 12/19/2019) Al Kibria, Gulam Muhammed; Swasey, Krystal; Gupta, Rajat Das; Choudhury, Allysha; Nayeem, Jannatun; Sharmeen, Atia; Burrowes., Vanessa; BRAC James P Grant School of Public Health
This cross-sectional study analysed Bangladesh Demographic and Health Survey 2011 data with the aim of investigating the prevalence of, and risk factors for, hypertension in individuals aged over 35 by rural–urban place of residence. After estimation of the stratified prevalence of hypertension by background characteristics, multivariable logistic regression analysis was conducted to calculate the adjusted odds (AORs) and 95% confidence intervals (CIs) for selected factors. Of the 7839 participants, 1830 were from urban areas and 6009 from rural areas. The overall prevalence of hypertension was 32.6% (95% CI: 30.5–34.8) in urban areas and 23.6% (95% CI: 22.5–24.7) in rural areas. The prevalence and odds of hypertension increased with increasing age, female sex, concomitant diabetes and overweight/obesity and richer wealth status in both urban and rural regions. Although residence in Khulna and Rangpur divisions and higher education level were associated with increased odds of hypertension in urban regions, this was not the case in rural regions (p>0.05). Residence in Sylhet and Chittagong divisions had lower odds of hypertension in rural regions. Furthermore, the proportions of overweight/obese, diabetic and higher wealth status participants were higher in urban than in rural regions. The prevalence and odds of hypertension were found to be associated with several common factors after stratifying by place of residence. Some of these factors are more concentrated in urban regions, so urban residents with these risk factors need to be made more aware of these in order to control hypertension in Bangladesh. Public health programmes also need to be tailored differently for urban and rural regions, based on the different distribution of these significant factors in the two areas.
Prevalence and predictors of tobacco smoking among university students in Sylhet Division, Bangladesh
(Oxford Academic, 12/4/2018) Hassan, Muhammad Shaikh; Hossain, Md Kamrul; Khan, Hafiz T A; BRAC James P Grant School of Public Health
Background: Among university students, large numbers are involved with smoking and suffer from many chronic diseases. This study examined tobacco smoking prevalence and potential predictors among university students in Sylhet Division, Bangladesh. Methods: A total of 416 students were selected for face-to-face interviews. Logistic regression analysis was used to fulfil the specific objectives of the study. Results: It was discovered that the prevalence of smoking among university students in Sylhet Division was 37% and almost half of current male students were smokers. Mother’s occupation and peer smoking status were found to be significant factors. Although data were collected using multistage sampling, the stages (type of university, universities, departments and academic levels) were insignificant with smoking status. There is a 2.1 times greater likelihood of a student becoming a smoker if a close friend is a smoker. The adjusted living expenses (>$100) was a proactive factor, though individually it was a significant factor. Conclusions: This study and previous studies found that smoking initiation among female students is negligible, so gender-specific health promotion and intervention is needed in Bangladesh. Tobacco control awareness programs and ‘No smoking’ signage should be displayed within university campuses and sanctioned by university authorities.
Development and validation of a tool to assess appetite of children in low income settings
(Science Direct, 12/21/2018) Nahar, Baitun; Hossain, Muttaquina; Ickes, Scott B.; Naila, Nurun Nahar; Mahfuz, Mustafa; Hossain, Daluwar; Denno, Donna M.; Walson, Judd; Ahmed, Tahmeed; BRAC James P Grant School of Public Health
Reliable and validated tools for measuring appetite of children in South Asia are not available. This study aimed to develop and validate a tool for assessing appetite level of under-five children. Based on literature review and findings from focus group discussions (FGDs), an initial 27-item interview-based tool, the "Early Childhood Appetite and Satiety Tool (ECAST)" was developed in Bangladesh. Fourteen FGDs were carried out in rural and urban settings and constructs for inclusion were derived from the themes and coding of FGDs and appetite assessment tools used in Western contexts. For structural validation, the ECAST-27-was administered on 150 mothers/primary caregivers of children aged 6-59 months, living in urban and rural areas. To validate the association with other variables, the ECAST was administered on mothers of children aged 12-24 months in the community (N = 50), and two groups of wasted, hospitalized children (Weight-for-length, Z score <-2SD) [group1: twenty acutely ill children aged 6-59 months; group 2: twenty children in nutritional rehabilitation aged 18-24 months]. Reliability of ECAST was estimated using Cronbach's alpha and Pearson's correlation coefficient. Kaiser-Meyer-Olkin = 0.73 and the Bartlett's test of sphericity, χ2(253) = 755.791, p < 0.001 indicated that the raw data were suitable. Given the convergence of the Scree plot, Kaiser's criterion and dropping of cross loading items, a 16-item ECAST was produced with three sub scales: Appetite cue; Food responsiveness and Emotion and preference, which were internally valid and had good test-retest reliability (Cronbach's alpha 0.6 and test-retest reliability 0.797). Total ECAST scores of wasted children with good appetite were significantly higher from those with poor appetite (p = 0.004 and 0.001 for two wasted groups respectively). Results suggest that ECAST may provide a useful measure to assess the appetite level of under-five children.
Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: A systematic review and meta-analysis
(The Lancet, 10/29/2018) Stone, Jack; Fraser, Hannah; Lim, Aaron G; Walker, Josephine G; Ward, Zoe; MacGregor, Louis; Trickey, Adam; Abbott, Sam; Strathdee, Steffanie A; Abramovitz, Daniela; Maher, Lisa; Iversen, Jenny; Bruneau, Julie; Zang, Geng; Garfein, Richard S; Yen, Yung-Fen; Azim, Tasnim; Mehta, Shruti H; Milloy, Michael-John; Hellard, Margaret E; Sacks-Davis, Rachel; Dietze, Paul M; Aitken, Campbell; Aladashvili, Malvina; Tsertsvadze, Tengiz; Mravčík, Viktor; Alary, Michel; Roy, Elise; Smyrnov, Pavlo; Sazonova, Yana; Young, April M; Havens, Jennifer R; Hope, Vivian D; Desai, Monica; Heinsbroek, Ellen; Hutchinson, Sharon J; Palmateer, Norah E; McAuley, Andrew; Platt, Lucy; Martin, Natasha K; Altice, Frederick L; Hickman, Matthew; Vickerman, Peter; BRAC James P Grant School of Public Health
Background: People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I² statistic and the P-value for heterogeneity. Findings: We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1∙81, 95% CI 1∙40–2∙34) increase in HIV acquisition risk, with moderate heterogeneity between studies (I²=63∙5%; p=0∙001), and a 62% (RR 1∙62, 95% CI 1∙28–2∙05) increase in HCV acquisition risk, also with moderate heterogeneity between studies (I²=57∙3%; p=0∙002). Past incarceration was associated with a 25% increase in HIV (RR 1∙25, 95% CI 0∙94–1∙65) and a 21% increase in HCV (1∙21, 1∙02–1∙43) acquisition risk. Interpretation: Incarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID.
From Doxastic to Epistemic: A Typology and Critique of Qualitative Interview Styles
(SAGE Journals, 2018-11) Berner-Rodoreda, Astrid; Bärnighausen, Till; Kennedy, Caitlin; Brinkmann, Svend; Sarker, Malabika; Wikler, Daniel; Eyal, Nir; McMahon, Shannon A.; BRAC James P Grant School of Public Health
Qualitative interview styles have been guided by precedent within academic disciplines. The nature of information sought, and the role of interviewer and interviewee are key determinants across styles, which range from doxastic (focused on understanding interviewees’ experiences or behaviors) to epistemic (focused on co-constructing knowledge). In this article, we position common interview styles along a doxastic–epistemic continuum, and according to the role of the interviewee (from respondent to equal partner). Through our typology and critique of interview styles, we enhance epistemic interviewing by introducing “deliberative interviews,” which are more debate oriented and closer to equality in the interviewee and interviewer relationship than existing interview styles. Deliberative interviews require a comprehensive, pre-interview briefing on the subject matter followed by interactive deliberation wherein complex issues are debated across viewpoints in an effort to devise solutions. The effectiveness of this interview style in generating new knowledge warrants empirical testing across academic disciplines.
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; BRAC James P Grant School of Public Health
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; BRAC James P Grant School of Public Health
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.
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; BRAC James P Grant School of Public Health
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.
Prevalence of chronic kidney disease in South Asia: A systematic review
(BMC, 10/23/2018) Hasan, Mehedi; Sutradhar, Ipsita; Gupta, Rajat Das; Sarker, Malabika; BRAC James P Grant School of Public Health
Abstract Background: Chronic kidney disease (CKD) is becoming a major public health problem around the world. But the prevalence has not been reported in South Asian region as a whole. This study aimed to systematically review the existing data from population based studies in this region to bridge this gap. Methods: Articles published and reported prevalence of CKD according to K/DOQI practice guideline in eight South Asian countries between December 1955 and April 2017 were searched, screened and evaluated from seven electronic databases using the PRISMA checklist. CKD was defined as creatinine clearance (CrCl) or GFR less than 60 ml/min/1.73 m2 . Results: Sixteen population-based studies were found from four South Asian countries (India, Bangladesh, Pakistan and Nepal) that used eGFR to measure CKD. No study was available from Sri Lanka, Maldives, Bhutan and Afghanistan. Number of participants ranged from 301 in Pakistan to 12,271 in India. Majority of the studies focused solely on urban population. Different studies used different equations for measuring eGFR. The prevalence of CKD ranged from 10.6% in Nepal to 23.3% in Pakistan using MDRD equation. This prevalence was higher among older age group people. Equal number of studies reported high prevalence among male and female each. Conclusions: This systematic review reported high prevalence of CKD in South Asian countries. The findings of this study will help pertinent stakeholders to prepare suitable policy and effective public health intervention in order to reduce the burden of this deadly disease in the most densely populated share of the globe.
Urban-rural and sex differentials in tuberculosis mortality in Bangladesh: Results from a population-based survey
(Wiley Online Library, 10/22/2022) Sarker, Malabika; Homayra, Fahmida; Rawal, Lal B.; Kabir, Razin; Aftab, Afzal; Bari, Rahmatul; Dzokoto, Agnes; Shargie, Estifanos Biru; Islam, Shayla; Islam, Akramul; Latif, A. H. M. Mahbub; BRAC James P Grant School of Public Health
Objective To assess tuberculosis mortality in Bangladesh through a population-based survey using a Verbal Autopsy tool. Methods Nationwide mortality survey employing the WHO-recommended Verbal Autopsy (VA) tool, and using InsilicoVA, a data-driven method, to assign the cause of death. Using a three-stage cluster sampling method, 3997 VA interviews were conducted in both urban and rural areas of Bangladesh. Cause-specific mortality fractions (CSMF) were estimated using Bayesian probabilistic models. Results 6.8% of total deaths in the population were due to TB [95% CI: (5.1, 8.9)], comprising 12.0% [95% CI: (11.1, 12.8)] and 6.42% [95% CI: (5.4, 7.3)] of total male and female deaths, respectively. This proportion was highest among adults age 15–49 years [12.2%, 95% CI: (9.4, 14.6)]. The urban population is more likely to die from TB, and urban males have highest CSMF [13.6%, 95% CI: (9.1, 16.9)]. Conclusion Our survey results show that TB is the fifth major cause of death in the general population and that sex and place of residence (urban/rural) have a significant effect on TB mortality in Bangladesh. The underlying causes of higher rates of TB-related deaths in urban areas and particularly among urban males, who have better knowledge and higher enrollment in the DOTS Program, need to be explored.
Determinants of hypertension among adults in Bangladesh as per the Joint National Committee 7 and 2017 American College of Cardiology/American Hypertension Association hypertension guidelines
(Science Direct, 2018-11) Al Kibria, Gulam Muhammed; Swasey, Krystal; Hasan, Md. Zabir; Choudhury, Allysha; Gupta, Rajat Das; Abariga, Samuel A.; Sharmeen, Atia; Burrowes., Vanessa; BRAC James P Grant School of Public Health
We investigated determinants of hypertension in Bangladesh using both Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Hypertension Association (2017 ACC/AHA) guidelines. After reporting background characteristics, odds ratios (ORs) were obtained by multilevel logistic regression. Among 7839 respondents aged ≥35 years, 25.7% (n = 2016) and 48.0% (n = 3767) respondents had hypertension as per the JNC7 and 2017 ACC/AHA guidelines, respectively. The following factors were significant according to the 2017 ACC/AHA guideline: ≥65 years (adjusted OR [AOR]: 2.4, 95% confidence interval [CI]: 2.2–3.0), 55–64 years (AOR: 1.6, 95% CI: 1.4–1.9), and 45–54 years (AOR: 1.4, 95% CI: 1.3–1.6) age groups, females (AOR: 2.0, 95% CI: 1.7–2.2), overweight/obesity (AOR: 2.4, 95% CI: 2.0–2.8), diabetes (AOR: 1.4, 95% CI: 1.2–1.6), secondary (AOR: 1.2, 95% CI: 1.1–1.4), or college education level (AOR: 1.8, 95% CI: 1.4–2.3), middle (AOR: 1.3, 95% CI: 1.1–1.6), richer (AOR: 1.5, 95% CI: 1.2–1.8) or richest (AOR: 2.0, 95% CI: 1.6–2.4) wealth quintiles, residence in Khulna (AOR: 1.5, 95% CI: 1.2–1.9), and Rangpur (AOR: 1.7, 95% CI: 1.3–2.2) divisions. All factors were significant as per the JNC7 guideline too. Both guidelines found similar determinants. Prevention and control programs should prioritize increasing awareness among people with higher likelihood of hypertension.
Cities for global health
(The BMJ, 10/3/2018) Ezzati, Majid; Webster, Christopher J; Doyle, Yvonne G; Rashid, Sabina; Owusu, George; Leung, Gabriel M; BRAC James P Grant School of Public Health
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; BRAC James P Grant School of Public Health
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.
Daily maternal lipid-based nutrient supplementation with 20 mg iron, compared with iron and folic acid with 60 mg iron, resulted in lower iron status in late pregnancy but not at 6 months postpartum in either the mothers or their infants in Bangladesh
(Oxford Academic, 9/10/2018) Matias, Susana L; Mridha, Malay K; Young, Rebecca T; Hussain, Sohrab; Dewey, Kathryn G; BRAC James P Grant School of Public Health
Background Maternal anemia and iron deficiency are prevalent in low- and middle-income countries. Objective We aimed to determine the effects of lipid-based nutrient supplements for pregnant and lactating women (LNS-PL) on hemoglobin (Hb), anemia, and iron status (nonprimary outcomes) at 36 weeks of gestation (women) and 6 mo postpartum (women and infants). Methods The Rang-Din Nutrition Study, a cluster-randomized effectiveness trial, enrolled 4011 Bangladeshi pregnant women at ≤20 weeks of gestation to receive either daily LNS-PL (20 mg Fe) during pregnancy and the first 6 mo postpartum, or iron and folic acid (IFA, 60 mg Fe + 400 µg folic acid) daily during pregnancy and every other day during the first 3 mo postpartum. Biochemical measurements from a subsample of women (n = 1128) and their infants (n = 1117) included Hb (g/L), serum ferritin (µg/L), and soluble transferrin receptor (sTfR; mg/L). Anemia was defined as maternal Hb <110 g/L at 36 weeks of gestation, <120 g/L at 6 mo postpartum, or infant Hb <105 g/L; iron deficiency (ID) was defined as ferritin <12 µg/L or elevated sTfR (>8.3 mg/L for women and >11 mg/L for infants). Results Compared with the IFA group, women in the LNS-PL group had lower ferritin (–6.2 µg/L; P < 0.001) and higher sTfR concentrations (+0.5 mg/L; P < 0.001), and higher risk of ID (OR = 1.93; P < 0.05) at 36 weeks of gestation but not at 6 mo postpartum, whereas no consistent differences were observed for Hb or anemia. Among infants at 6 mo, there were no group differences except for a lower risk of elevated sTfR (OR = 0.61; P < 0.05) in the LNS-PL group than in the IFA group. Conclusions Provision of LNS-PL including a lower dose of iron than what is recommended during pregnancy resulted in differences in maternal iron status in late pregnancy that disappeared by 6 mo postpartum, and caused no undesirable effects regarding anemia or iron status of infants. This trial was registered at clinicaltrials.gov as NCT01715038.
Primary health care seeking behaviour of people with physical disabilities in Bangladesh: A cross-sectional study
(BMC, 9/3/2018) Talukdar, Jhalok Ronjan; Mahmud, Ilias; Rashid, Sabina Faiz; BRAC James P Grant School of Public Health
Background People with disabilities constitute about 10% of the total population of Bangladesh. They are more likely to experience poor health than those without disabilities. However, there is a lack of evidence on their primary health care (PHC) seeking behaviour for their general illness. The aim of this study was to understand the PHC seeking behaviour of people with physical disabilities (PWPDs), and to investigate the determinants of such behaviours. Methods We surveyed 282 PWPDs, aged ≥18 years, using a structured questionnaire. Participants were recruited from the out-patient department of a rehabilitation centre in Dhaka between November and December 2014. We explored PHC seeking behaviour using frequency distribution. We performed logistic regression to investigate the factors that determined their PHC seeking behaviours for general illness. In our logistic regression model, the outcome variable was whether PWPDs received treatment from a formal health care provider. The predictors were socio-demographic characteristics and clinical characteristics such as type of impairment and type of illness experienced. Results Among 282 participants, 85% suffered from general illness in the past 6 months. The participants in the higher age group, for example, age group 31–45 years (OR = 3.9, [95% CI 1.2 to 13.4]), 46–59 years (OR = 13.6, [95% CI 2.9 to 63.7) and 60+ years (OR = 12.5, [95% CI 1.7 to 93.0]) were more likely to seek treatment from formal health care providers than the age group 18–30 years. The educational attainment of the primary income earning family member (OR = 3.2, [CI 1.1 to 9.6]), religion (OR = 0.3, [95% CI 0.1 to 0.98]) and mobility aid used (OR = 4.0, [95% CI 1.2 to 13]) were determinants for seeking health care from a formal health care provider. Moreover, the type of illness suffered by participant was a strong predictor of their decision to seek treatment from a formal health care provider. The participants who suffered from urinary tract infections (OR = 10.3, [95% CI 2.3 to 46.6]), ulcers (OR = 13.1, [95% CI 2.11 to 79.3]) and pain (OR = 3.6, [95% CI 1.4 to 9.4]) were more likely to seek treatment from formal health care provider than who suffered from fever. Conclusions Age, religion, earning member’s education, type of mobility aids used and type of illness suffered were explicative determinants of PHC seeking behaviour of PWPDs. The results suggest that these factors should be considered when devising interventions for this population. Moreover, accessibility, quality of care and expertise of the providers in treating disabled people were among the other factors reported by PWPDs which influence their decision to seek health care. In order to provide inclusive health services, primary health centres need to consider these determinants.
Factors enabling comprehensive maternal health services in the benefits package of emerging financing schemes: A crosssectional analysis from 1990 to 2014
(PLOS ONE, 9/25/2018) Vargas, Veronica; Ahmed, Sayem; Adams, Alayne M.; BRAC James P Grant School of Public Health
Introduction Maternal delivery is the costliest event during pregnancy, especially if a complicated delivery occurs that requires emergency hospital services. A health financing scheme or program that covers comprehensive maternal services, including specialized hospital services in the benefits health package, enhances maternal survival and improves financial risk protection. Objectives The objective of this study is to identify factors that enable the inclusion of comprehensive maternal services in the benefits package of emerging health financing schemes in low and middle-income countries across selected world regions. Comprehensive care is presumed if, in addition to normal delivery, primary health care, and secondary or tertiary hospital care are included. Methods Multilevel regression analysis is performed on 220 health financing schemes and programs initiated during the period 1990–2014, in 40 countries in Sub-Saharan Africa, Asia, and Latin America. Findings About two-thirds of emerging health financing schemes explicitly include maternal care in the benefits package, and less-than-half cover comprehensive maternal services. Provision of any type of maternal services and comprehensive services is significantly associated with the presence of donors/philanthropies as funders, and beneficiaries possessing an ID card that links them to entitled services. Other enabling factors are prepayment and risk pooling. However, private and community insurances are negatively associated with covering comprehensive maternal services, because they are subject to market failures, such as adverse and risk selection. Conclusions Emerging health financing schemes in low and upper-middle-income countries lag in coverage of maternal care. Advancing financial protection of these services in the health package needs policy attention, including government oversight and mandatory regulations. The enabling factors identified can enrich the ongoing discourse on Universal Health Coverage.
Retaining doctors in rural Bangladesh: A policy analysis
(International Journal of Health Policy and Management, 2018-09) Joarder, Taufique; Rawal, Lal B.; Ahmed, Syed Masud; Uddin, Aftab; Evans, Timothy G.; BRAC James P Grant School of Public Health
Background Retaining doctors in rural areas is a challenge in Bangladesh. In this study, we analyzed three rural retention policies: career development programs, compulsory services, and schools outside major cities – in terms of context, contents, actors, and processes. Methods Series of group discussions between policy-makers and researchers prompted the selection of policy areas, which were analyzed using the policy triangle framework. We conducted document and literature reviews (1971-2013), key informant interviews (KIIs) with relevant policy elites (n = 11), and stakeholder analysis/position-mapping. Results In policy-1, we found, applicants with relevant expertise were not leveraged in recruitment, promotions were often late and contingent on post-graduation. Career tracks were porous and unplanned: people without necessary expertise or experience were deployed to high positions by lateral migration from unrelated career tracks or ministries, as opposed to vertical promotion. Promotions were often politically motivated. In policy-2, females were not ensured to stay with their spouse in rural areas, health bureaucrats working at district and sub-district levels relaxed their monitoring for personal gain or political pressure. Impractical rural posts were allegedly created to graft money from applicants in exchange for recruitment assurance. Compulsory service was often waived for political affiliates. In policy-3, we found an absence of clear policy documents obligating establishment of medical colleges in rural areas. These were established based on political consideration (public sector) or profit motives (private sector). Conclusion Four cross-cutting themes were identified: lack of proper systems or policies, vested interest or corruption, undue political influence, and imbalanced power and position of some stakeholders. Based on findings, we recommend, in policy-1, applicants with relevant expertise to be recruited; recruitment should be quick, customized, and transparent; career tracks (General Health Service, Medical Teaching, Health Administration) must be clearly defined, distinct, and respected. In policy-2, facilities must be ensured prior to postings, female doctors should be prioritized to stay with the spouse, field bureaucrats should receive non-practising allowance in exchange of strict monitoring, and no political interference in compulsory service is assured. In policy-3, specific policy guidelines should be developed to establish rural medical colleges. Political commitment is a key to rural retention of doctors.
Tuberculosis and the sexual and reproductive lives of women in Bangladesh
(PLOS ONE, 7/19/2018) Barua, Mrittika; Driel, Francien Van; Jansen, Willy; BRAC James P Grant School of Public Health
When they do not meet norms related to sexuality and reproduction, Bangladeshi women often face abandonment and are thus deprived of an active sexual life, a marital relationship, and motherhood. Little is known about how a stigmatised disease such as tuberculosis (TB) may constrain the reproductive health and sexual lives of women. This article, derived from a larger study on the impact of TB on women’s sexual and reproductive health and rights in Narsingdi district and Dhaka, Bangladesh, aims to fill this gap. Based on interviews with nine married women who have or had TB, four husbands, and two mothers-in-law, this article highlights that the ways in which TB impedes on the sexual and reproductive lives of women depends on the stigma within their family and community, their relationships with their husbands, motherhood, their living arrangements, their economic contribution to the family and/or their disclosure of their TB diagnosis. Women with children and supportive husbands retain a stronger position among their in-laws and are less likely to be isolated or rejected. The patients’ narratives revealed that the instructions of health workers influenced their decisions about intercourse or abstinence. Future studies should examine the instructions patients receive from health workers regarding their living and sleeping arrangements, sexual intercourse, and pregnancy, as well as policy documents on TB treatment and prevention.
Prevalence of work related musculoskeletal disorders (WMSDs) and ergonomic risk assessment among readymade garment workers of Bangladesh: A cross sectional study
(PLOS ONE, 7/6/2018) Hossain, Mohammad Didar; Aftab, Afzal; Al Imam, Mahmudul Hassan; Mahmud, Ilias; Chowdhury, Imran Ahmed; Kabir, Razin Iqbal; Sarker, Malabika; BRAC James P Grant School of Public Health
Background Work related Musculoskeletal Disorders (WMSDs) are one of the most common occupational diseases which mainly affects the lower back, neck and upper and lower extremities. The aim of this study was to determine prevalence of WMSDs in nine body regions among Ready Made Garment (RMG) workers in Bangladesh and ergonomics assessment of their exposure to risk factors for the development of WMSDs. Methods This cross-sectional study was conducted among 232 RMG employees (male: 46; female: 186; age: >18yrs) from nine RMG factories in Dhaka division during October 2015 to February 2016. Data were collected using a structured questionnaire consist of demographic questions, Nordic Musculoskeletal Questionnaire-Extended (NMQ-E) for WMSDs assessment in nine body regions and Quick Exposure Check (QEC) method for ergonomic assessment. Prevalence of WMSDs for each body region was determined. The association between WMSDs and ergonomic assessment of their exposure to risk factors were also analyzed. Results Respondents’ mean age was 31.3 years (SD = 7). Their mean Body Mass Index (BMI) was 23.51 kg/m2 (SD = 3.74). Among 186 female respondents, 46 reported lower back pain (24.7%) and 44 reported neck pain (23.7%). Among 46 male respondents, 10 reported neck pain (21.7%) while 6 reported knee pain (13%). Statistically significant relationship was found between twelve month WMSDs in anatomical region in elbows (p = 0.02), hips (p = 0.01), knees (p = 0.01) and ankle (p = 0.05) with age; upper back (p = 0.001), elbows (p = 0.001), wrists (p = 0.03), hips (p = 0.001) and ankles (p = 0.01) with job experience; hips with BMI (p = 0.03); elbows (p = 0.04) with daily working hour. QEC assessment showed that level of exposure to WMSDs risk was high among 80% of the study population (p<0.003). Conclusion The study found that lower back and neck were the most affected areas among RMG workers. Moreover, QEC findings warned the level of exposure to WMSDs risks is high and ergonomics intervention along with investigation and change to decrease exposure level is essential. Addressing musculoskeletal risk factors through ergonomic interventions in terms of working space, workers sitting/standing posture, seat and hand position during work and work-rest cycle are encouraged in RMG sector and policy makers.
Prenatal and postnatal supplementation with lipid-based nutrient supplements reduces anemia and iron deficiency in 18-month-old Bangladeshi children: A cluster-randomized effectiveness trial
(Oxford Academic, 6/13/2018) Matias, Susana L; Mridha, Malay K; Young, Rebecca T; Khan, Md Showkat A; Siddiqui, Zakia; Ullah, Md Barkat; Vosti, Stephen A; Dewey, Kathryn G; BRAC James P Grant School of Public Health
Background: Anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among young children are public health concerns in developing countries. Objective: We evaluated the effects of small-quantity lipid-based nutrient supplements (LNSs) and micronutrient powder (MNP) on anemia, ID, and IDA in 18-mo-old Bangladeshi children. Methods: We enrolled 4011 pregnant women in a cluster-randomized effectiveness trial with 4 arms—1) LNS-LNS: LNSs (including 20 mg Fe) for women daily during pregnancy and 6 mo postpartum and LNSs (including 9 mg Fe) for children daily from 6 to 24 mo of age (LNS-C); 2) IFA-LNS: iron (60 mg) and folic acid (IFA) for women daily during pregnancy and every other day for 3 mo postpartum and LNS-C for children; 3) IFA-MNP: IFA for women, and MNP (including 10 mg Fe) for children daily from 6 to 24 mo; and 4) IFA-Control: IFA for women and no child supplement. Hemoglobin, serum ferritin, and soluble transferrin receptor (sTfR) were assessed in a subsample of children (n = 1121) at 18 mo to identify anemia (hemoglobin <110g/L), ID (ferritin <12 µg/L or sTfR >8.3 mg/L), and IDA. Data were analyzed with the use of mixed-effects modeling. Results: Compared with the IFA-Control arm, hemoglobin was higher in the LNS-LNS and IFA-LNS arms and ferritin was higher and sTfR was lower in the LNS-LNS, IFA-LNS, and IFA-MNP arms; LNS-LNS children had reduced odds of anemia (OR: 0.46; 95% CI: 0.25, 0.84), high sTfR (OR: 0.47; 95% CI: 0.29, 0.73), and ID (OR: 0.45; 95% CI: 0.28, 0.71); and all 3 groups had lower odds of low ferritin [corrected for inflammation; OR (95% CI)—LNS-LNS: 0.29 (0.13, 0.63); IFA-LNS: 0.25 (0.11, 0.59); and IFA-MNP: 0.37 (0.18, 0.76)] and IDA [LNS-LNS: 0.35 (0.18, 0.67); IFA-LNS: 0.45 (0.24,0.85); and IFA-MNP: 0.47 (0.26, 0.87)]. Conclusions: Home fortification using LNSs or MNP reduced IDA in 18-mo-old Bangladeshi children. The provision of LNSs in both pregnancy and childhood also reduced child anemia and ID. These findings are relevant to programs targeting similar populations. This trial was registered at www.clinicaltrials.gov as NCT01715038. J Nutr 2018;148:1167– 1176.

Browse

Recent Submissions