Faculty Publications

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Microfluidic simulation framework for point-of-care diagnostics: modeling advection-diffusion-reaction transport in lab-on-chip systems
(Institute of Electrical and Electronics Engineers Inc., 1/1/2025) Shitab T.A.; Ibnat Oni, Anika; Hossain Emon M.E.; Rayan Rahat R.; Mim A.A.; Fariya Auishe P.; Department of Biotechnology
Point-of-care diagnostics (POCD) rely heavily on microfluidic lab-on-chip systems, yet their design process is often hindered by trial-and-error prototyping and inconsistent reproducibility. Efficient diagnostic performance requires a clear understanding of how advection, diffusion, and biochemical reactions jointly govern analyte transport at the microscale. This work presents a lightweight numerical framework for modeling solute behavior in microfluidic channels using the advection-diffusion-reaction equation. A finite-difference solver was applied to a 5 mm × 100 ?m channel under physiologically relevant flow conditions, comparing three regimes: diffusion-only, advection + diffusion, and advection + diffusion + first-order reaction. Results show that high Péclet numbers (Pe ? 1000) drive plug-like transport with minimal lateral mixing, while Damköhler numbers near unity (Da ? 1) produce significant axial decay due to reaction kinetics. Visualizations of concentration fields and breakthrough curves demonstrate how Pe and Da directly influence sensor placement, analyte preservation, and diagnostic sensitivity. The framework provides a transparent and computationally efficient tool for early-stage device design, offering practical guidance for optimizing flow control, channel geometry, and capture-surface behavior in lab-on-chip diagnostics.
Towards a socially just model: balancing hunger and response to the COVID-19 pandemic in Bangladesh
(BMJ Global Health 2020, 6/1/2020) Rashid, Sabina Faiz; Theobald, Sally; Ozano, Kim
A controlled before-and-after perspective on the improving maternal, neonatal, and child survival program in rural Bangladesh: an impact analysis
(© 2016 Public Library of Science, 2016-09) Rahman, Mahfuzar T.; Yunus, Fakir Md; Yunus, Fakir Md; Shah, Rasheduzzaman; Jhohura, Fatema Tuz; Mistry, Sabuj Kanti; Quayyum, Tasmeen; Aktar, Bachera; Afsana, Kaosar
Objectives We evaluated the impact of the Improving Maternal, Neonatal, and Child Survival (IMNCS) project, which is being implemented by BRAC in rural communities in Bangladesh. Methods Four districts received program intervention i.e. trained community health workers to deliver essential maternal, neonatal, and child healthcare and nutrition services while two districts were treated as comparison group. A quasi-experimental study design (compared beforeand-after) was undertaken. Baseline survey was conducted in 2008 among 7200 women followed by end line in 2012 among 4800 women with similar characteristics in the same villages. We evaluated maternal antenatal and post natal checkup, birth plans and delivery, complication and referred cases during antenatal checkup and post natal period, and child health indicators such as birth asphyxia, neonatal sepsis, and its management by the medically trained provider. Findings Increased number (four or more) antenatal visits, skill-birth attended delivery and postnatal visits (three or more) in the intervention group preceding four-year intervention period were observed compare to their counterpart. We noted negative difference-in-difference estimator (-5.0%, P = 0.159) regarding to the all major birth plans i.e. delivery place, birth attendant, and saved money in the comparison areas. Significant reduction of ante-partum and intra-partum complications occurred in the intervention group, contrary complications of such event increased in the comparison areas (-6.3%, P<0.05 and-20.5%, P<0.001 respectively). Referral case to the health centers due to these complications boosted significantly in intervention group than comparison group (2.3%, P<0.01 and 6.6%, P<0.001 respectively). Mother's knowledge of breastfeeding initiation and the practice of initiating breastfeeding within an hour of birth amplified significantly (14.6%, P<0.001 and 8.3%, P<0.001 respectively). We did not find any significant difference regards to the management of low birth weight by the medically trained health care provider and complete vaccination between the intervention and comparison arm. Conclusion Medically trained health care provider assisted community based public health intervention could increase number of antenatal and postnatal visit, thereby could decrease pregnancy associated complications. These interventions may be considered for further up scaling when resources are limited.
Erratum to: The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: A GIS study [BMC Pregnancy Childbirth, 16, (2016) (240)]
(© 2016 BioMed Central Ltd., 9/27/2016) Panciera, Rocco; Khan, Akib; Rizvi, Syed Jafar Raza; Ahmed, Tanvir; Islam, Rubana; Adams, Alayne M.
Communication for behavioural impact in enhancing utilization of insecticide-treated bed nets among mothers of under-five children in rural North Sudan: an experimental study
(© 2016 BioMed Central Ltd., 10/18/2016) Elmosaad, Yousif Mohammed; Elhadi, Magda; Khan, Asif; Malik, Elfatih Mohamed; Mahmud, Ilias; BRAC James P Grant School of Public Health
Background: Malaria is the leading cause of morbidity and mortality in Sudan. The entire population is at risk of contracting malaria to different levels. This study aimed to assess the effectiveness of communication for behavioural impact (COMBI) strategy in enhancing the utilization of long-lasting insecticidal nets (LLINs) among mothers of under-five children in rural areas. Methods: A randomized community trial was conducted in rural area of Kosti locality, White Nile State, Sudan, among mothers of under-five children, from January 2013 to February 2014. A total of 761 mothers from 12 villages were randomly selected, 412 mothers from intervention villages and 349 were from comparison villages. Results: The knowledge of mothers, in intervention villages, about malaria vector, personal protective measures (PPM) against malaria, and efficacy of LLINs was significantly increased from 86.9 to 97.3 %; 45.9 to 92 % and 77.7 to 96.1 % respectively. Knowledge about usefulness of PPM, types of mosquito nets and efficacy of LLINs was significantly higher in intervention villages compared to comparison villages (p < 0.05), (η2 = 0.64). Mothers in intervention villages increasingly perceived, post-intervention, that malaria was a serious disease (99.3 %), a preventable disease (98.8 %) and also LLINs as an effective intervention in malaria prevention (92.2 %). This resulted in an increase in the utilization rate of LLINs from 19.2 to 82.8 % in intervention villages compared to comparison villages (p < 0.05) [OR = 4.6, 95 %, CI = (3.72-5.72)], (η2 = 0.64). The average of mothers' knowledge about malaria was increased by 64 % (η2 = 0.64), the use of LLINs was increased by 79 % (η2 = 0.79) and a positive attitude towards malaria was 2.25 times higher in intervention villages than among mothers in the comparison villages. Conclusions: These results established the usefulness of COMBI strategy for increasing awareness about malaria, developing a positive perception towards malaria prevention and, increasing the utilization of LLINs.
Socio-economic inequality of chronic non-communicable diseases in Bangladesh
(© 2016 Public Library of Science, 2016-11) Biswas, Tuhin; Islam, Md Saimul; Linton, Natalie; Rawal, Lal Bahadur; BRAC James P Grant School of Public Health
Introduction Chronic non-communicable diseases (NCDs) are a major public health challenge, and undermine social and economic development in much of the developing world, including Bangladesh. Epidemiologic evidence on the socioeconomic status (SES)-related pattern of NCDs remains limited in Bangladesh. This study assessed the relationship between three chronic NCDs and SES among the Bangladeshi population, paying particular attention to the differences between urban and rural areas. Materials and Method Data from the 2011 Bangladesh Demographic and Health Survey were used for this study. Using a concentration index (CI), we measured relative inequality across pre-diabetes, diabetes, pre-hypertension, hypertension, and BMI (underweight, normal weight, and overweight/obese) in urban and rural areas in Bangladesh. A CI and its associated curve can be used to identify whether socioeconomic inequality exists for a given health variable. In addition, we estimated the health achievement index, integrating mean coverage and the distribution of coverage by rural and urban populations. Results Socioeconomic inequalities were observed across diseases and risk factors. Using CI, significant inequalities observed for pre-hypertension (CI = 0.09, p = 0.001), hypertension (CI = 0.10, p = 0.001), pre-diabetes (CI = -0.01, p = 0.005), diabetes (CI = 0.19, p<0.001), and overweight/obesity (CI = 0.45, p<0.001). In contrast to the high prevalence of the chronic health conditions among the urban richest, a significant difference in CI was observed for pre-hypertension (CI = -0.20, p = 0.001), hypertension (CI = -0.20, p = 0.005), pre-diabetes (CI = -0.15, p = 0.005), diabetes (CI = -0.26, p = 0.004) and overweight/obesity (CI = 0.25, p = 0.004) were observed more among the low wealth quintiles of rural population. In the same vein, the poorest rural households had more co-morbidities compared to the richest rural households (p = 0.003), and prevalence of co-morbidities was much higher for the richest urban households compared to the poorest urban households. On the other hand in rural the "disachievement" of health indicators is more noticeable than the urban ones. Conclusion The findings indicate the high burden of selected NCDs among the low wealth quintile populations in rural areas and wealthy populations in urban areas. Particular attentions may be necessary to address the problem of NCDs among these groups.
The next WHO director-general's highest priority: a global treaty on the human right to health
(© 2016 Elsevier Ltd., 12/1/2016) Gostin, Lawrence O.; Friedman, Eric A.; Buss, Paulo Marchiori; Chowdhury, Mushtaque Raza; Grover, Anand; Heywood, Mark J.; Kanchanachitra, C.; Leung, Gabriel M.; Mackay, Judith Mary; Matsoso, Precious; Møgedal, Sigrun M.; Omaswa, Francis G.; Phumaphi, Joy; Reddy, Kenipakapatnam Srinath R.; Periago, Mirta Roses; Thomas, Joe; Tomori, Oyewale; Were, Miriam K.; Zewdie, Debrework Work
Undernutrition, vitamin A and iron deficiency are associated with impaired intestinal mucosal permeability in young Bangladeshi children assessed by lactulose/mannitol test
(© 2017 Public Library of Science, 2016-12) Hossain, Md Iqbal; Haque, Rashidul; Mondal, Dinesh; Mahfuz, Mustafa; Ahmed, Am Shamsir; Islam, Mohammad Munirul; Guerrant, Richard Littleton; Petri, William Arthur; Ahmed, Tahmeed J.; BRAC James P Grant School of Public Health
Background: Lactulose/mannitol (L:M) test has been used as a non-invasive marker of intestinal mucosal-integrity and -permeability (enteropathy). We investigated the association of enteropathy with anthropometrics, micronutrient-status, and morbidity in children. Methods: The urine and blood samples were collected from 925 children aged 6±24 months residing in Mirpur slum of Dhaka, Bangladesh during November 2009 to April 2013. L:M test and micronutrient status were assessed in the laboratory of International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b) following standard procedure. Results: Mean±SD age of the children was 13.2±5.2 months and 47.8% were female. Urinary-lactulose recovery was 0.264±0.236, mannitol recovery was 3.423±3.952, and L:M was 0.109 ±0.158. An overall negative correlation (Spearman's-rho) of L:M was found with age (rs = -0.087; p = 0.004), weight-for-age (rs = -0.077; p = 0.010), weight-for-length (rs = -0.060; p = 0.034), mid-upper-arm-circumference (rs = -0.098; p = 0.001) and plasma-retinol (rs = -0.105; p = 0.002); and a positive correlation with plasma α-1-acid glycoprotein (rs = 0.066; p = 0.027). However, most of the correlations were not very strong. Approximately 44% of children had enteropathy as reflected by L:M of ≥0.09. Logistic regression analysis revealed that younger age (infancy) (adjusted odds ratio (AOR) = 1.35; p = 0.027), diarrhea (AOR = 4.00; p = 0.039) or fever (AOR = 2.18; p = 0.003) within previous three days of L:M test were the risk factors of enteropathy (L:M of ≥0.09). Conclusions: Enteropathy (high L:M) is associated with younger age, undernutrition, low vitamin A and iron status, and infection particularly diarrhea and fever.
Benefit incidence analysis of healthcare in Bangladesh - equity matters for universal health coverage
(© 2017 Oxford University Press, 2017) Khan, Jahangir Am; Ahmed, Sayem; MacLennan, Mary E.; Sarker, Abdur Razzaque; Sultana, Marufa; Rahman, Hafizur E.M.R.; BRAC James P Grant School of Public Health
Background: Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country. Objectives: This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh. Methodology: The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by 'self-reported illness and symptoms') across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used. Results: An overall pro-rich distribution of healthcare benefits was observed (CI = 0.229, t-value = 9.50). Healthcare benefits from private providers (CI = 0.237, t-value = 9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI = 0.044, t-value = 2.98) and NGO (CI = 0.095, t-value = 0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits. Conclusion: Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable.
Mental illness and injuries: emerging health challenges of urbanisation in South Asia
(© 2017 BMJ Publishing Group, 2017) Nambiar, Devaki; Razzak, Junaid Abdul; Afsana, Kaosar; Adams, Alayne M.; Hasan, Arif; Mohan, DInesh; Patel, Vikram H.; BRAC James P Grant School of Public Health
Overweight and obesity among children and adolescents in Bangladesh: a systematic review and meta-analysis
(© 2017 Elsevier B.V., 1/1/2017) Biswas, Tuhin; Islam, Anwar; Islam, Md Serajul; Pervin, Sonia; Rawal, Lal Bahadur; BRAC James P Grant School of Public Health
Objectives The increasing prevalence of overweight and obesity among children (0–12 years) and adolescents (13–19 years) has emerged as a major public health threat in Bangladesh. Unfortunately, there is a serious paucity of credible data on these issues that can be used for policy and programmatic development. This article presents a systematic review of studies on overweight and obesity to present a more accurate estimate by pooling results. Study design Systematic review. Methods The study systematically reviewed relevant literature published between 1998 and 2015 using predefined inclusion/exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to identify relevant studies. Measures of heterogeneity and variability were calculated, and a random effect model was used to report pooled prevalence rates of overweight and obesity. Results The findings show that prevalence rates of overweight and obesity among children and adolescents varied widely from 1.0% to 20.6% and 0.3% to 25.6%, respectively. The pooled prevalence rates of overweight and obesity were 7.0% (95% confidence interval [CI] 5.0–10.0) and 6.0% (95% CI 4.0–8.0), respectively. The pooled prevalence rate of overweight increased substantially over the years, from 3.6% during 1998–2003 (95% CI 0.3–29.2) to 5.7% during 2004–2009 (95% CI 0.8–30.2) and 7.9% by 2010–2015 (95% CI 5.1–12.1). However, the pooled prevalence rate of obesity registered a sharp decline between 1998–2003 and 2004–2009 – from 9.7% (95% CI 5.7–16.2) to 2.0% (95% CI 0.3–11.1) – and subsequently increased significantly to 9.0% by 2010–2015 (95% CI 5.3–14.6). Conclusions This review identified increasing trends in the prevalence of overweight and obesity among children and adolescents in Bangladesh. This study underscores the urgent need to promote healthy lifestyles among children and adolescents with a view to effectively address the increasing problem of overweight and obesity. This would also help to prevent the development of chronic non-communicable diseases in adulthood.
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; BRAC James P Grant School of Public Health
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.
Changing global policy to deliver safe, equitable, and affordable care for women's cancers
(© 2017 Lancet Publishing Group, 2/25/2017) Ginsburg, Ophira M.; Badwe, Rajendra A.; Peter A. Boyle, Peter; Derricks, Gemma; Dare, Anna J.; Evans, Timothy Grant; Eniu, Alexandru E.; Jiménez, Jorge C.Moreno; Kutluk, Tezer M.; De Lima Lopes, Gilberto L.; Mohammed, Sulma Ibrahim; Qiao, Youlin; Rashid, Sabina Faiz; Summers, Diane; Sarfati, Diana; Temmerman, Marleen I.L.; Trimble, Edward Lloyd; Padela, Aasim; Aggarwal, Ajay; Sullivan, Richard; BRAC James P Grant School of Public Health
Breast and cervical cancer are major threats to the health of women globally, particularly in low-income and middle-income countries. Radical progress to close the global cancer divide for women requires not only evidence-based policy making, but also broad multisectoral collaboration that capitalises on recent progress in the associated domains of women's health and innovative public health approaches to cancer care and control. Such multisectoral collaboration can serve to build health systems for cancer, and more broadly for primary care, surgery, and pathology. This Series paper explores the global health and public policy landscapes that intersect with women's health and global cancer control, with new approaches to bringing policy to action. Cancer is a major global social and political priority, and women's cancers are not only a tractable socioeconomic policy target in themselves, but also an important Trojan horse to drive improved cancer control and care.
Examining the relationship between socioeconomic status, WASH practices and wasting
(© 2017 Public Library of Science, 2017-03) Raihan, Mohammad Jyoti; Farzana, Fahmida Dil; Sultana, Sabiha; Haque, Md Ahshanul; Rahman, Ahmed Shafiqur; Waid, Jillian L.; McCormick, Benjamin Joseph James; Choudhury, Nuzhat; Ahmed, Tahmeed J.; BRAC James P Grant School of Public Health
Childhood wasting is a global problem and is significantly more pronounced in low and middle income countries like Bangladesh. Socio Economic Status (SES) and Water, Sanitation and Hygiene (WASH) practices may be significantly associated with wasting. Most previous research is consistent about the role of SES, but the significance of WASH in the context of wasting remains ambiguous. The effect of SES and WASH on weight for length (WHZ) is examined using a Structural Equation Model (SEM) to explicitly describe the direct and indirect role of WASH in the context of SES.A nationally representative survey of 10,478 Bangladeshi children under 5 were examined. An expert defined SEM was used to construct latent variables for SES and WASH. The SEM included a direct pathway from SES to WHZ and an indirect pathway from SES to WHZ via WASH along with regression of relevant covariates on the outcome WHZ and the latent variables. Both SES (p<0.01) and WASH (p<0.05) significantly affect WHZ. SES (p<0.01) also significantly affects WASH. Other structural components showed that child's age (p<0.01) affects WHZ and types of residence (p<0.01) affects SES. WASH practices at least partially mediate the association between SES and wasting status. WASH and SES are both significantly associated with WHZ.
Role of credit in food security and dietary diversity in Bangladesh
(© 2017 Elsevier B.V., 3/1/2017) Bidisha, Sayema Haque; Khan, Akib; Imran, Khalid; Khondker, Bazlul Haque; Suhrawardy, Gazi Mohammad
This work attempts to disentangle the relationship between credit, food security, and dietary diversity in the context of Bangladesh through descriptive and econometric analyses of the Household Income and Expenditure Survey of 2010 as well as a supplementary primary survey of 1200 households. To adequately address potential selection bias, we apply a variant of propensity score matching as well as an instrumental variable technique based on the distance from the nearest financial institution to account for endogeneity in our estimates. Our analysis reveals that access to credit tends to improve food security and allows households to achieve greater dietary diversity. In particular, food security is proxied by calorie consumption, and households with credit access tend to have greater calorie consumption per capita. Dietary diversity is measured through a number of dietary diversity scores, such as the food consumption score and the household dietary diversity score, and households with access to credit score higher than those without according to such measures. The results have been found to be robust following correction for endogeneity issues, and the paper therefore provides empirical evidence in favor of policies supporting accessible credit for poor households in Bangladesh.
Coping strategies related to food insecurity at the household level in Bangladesh
(© 2017 Public Library of Science, 2017-04) Dil Farzana, Fahmida; Rahman, Ahmed Shafiqur; Sultana, Sabiha; Raihan, Mohammad Jyoti; Haque, Md Ahshanul; Waid, Jillian L.; Choudhury, Nuzhat; Ahmed, Tahmeed J.; BRAC James P Grant School of Public Health
Introduction: In connection to food insecurity, adaptation of new techniques or alteration of regular behavior is executed that translates to coping strategies. This paper has used data from food security and nutrition surveillance project (FSNSP), which collects information from a nationally representative sample in Bangladesh on coping behaviors associated with household food insecurity. To complement the current understanding of different coping strategies implemented by the Bangladeshi households, the objective of this paper has been set to examine the demographic and socio-economic characteristics of the food insecure households which define their propensity towards adaptation of different types of coping strategies. Methodology: FSNSP follows a repeated cross-sectional survey design. Information of 23,374 food insecure households available from February 2011 to November 2013 was selected for the analyses. Coping strategies were categorized as financial, food compromised and both. Multinomial logistic regression was employed to draw inference. Results: Majority of the households were significantly more inclined to adopt both multiple financial and food compromisation coping strategies. Post-aman season, educational status of the household head and household women, occupation of the household's main earner, household income, food insecurity status, asset, size and possession of agricultural land were found to be independently and significantly associated with adaptation of both financial and food compromisation coping strategies relative to only financial coping strategies. The relative risk ratio of adopting food compromisation coping relative to financial coping strategies when compared to mildly food insecure households, was 4.54 times higher for households with moderate food insecurity but 0.3 times lower when the households were severely food insecure. Whereas, households were 8.04 times and 4.98 times more likely to adopt both food compromisation and financial relative to only financial coping strategies if moderately and severely food insecure respectively when compared to being mildly food insecure. Conclusion: Households suffering from moderate and severe food insecurity, are more likely to adopt both financial and food compromisation coping strategies.
The prevalence of underweight, overweight and obesity in Bangladeshi adults: data from a national survey
(© 2017 Public Library of Science, 5/5/2017) Biswas, Tuhin; Garnett, Sarah P.; Pervin, Sonia; Rawal, Lal Bahadur; BRAC James P Grant School of Public Health
Background: Over the two last decades Bangladesh, a low-income country, has experienced a rapid demographic and epidemiological transition. The population has increased substantially with rapid urbanization and changing pattern of disease, which at least in part, can be explained by nutritional changes. However, the nutritional status of the adult population has not been previously described. Hence, the objective of this study was to estimate the prevalence and explore socio-demographic determinants of underweight, overweight and obesity among the Bangladeshi adult population. Methods: This study is a secondary data analysis of the national 2011 Bangladesh Demographic and Health Survey. We determined the nutritional status of adults aged ≥35 years of age, who had a measured weight and height, using the Asian body mass index (BMI) cut-offs for underweight (BMI <18.5 kg/m2), overweight (BMI 23 to <27.5 kg/m2) and obesity (BMI ≥27.5 kg/m2). Logistic regression modeling was used to determine the association between socio-demographic factors and nutritional status. Result: Of total sample (n = 5495), 30.4% were underweight, 18.9% were overweight and 4.6% were obese. Underweight was associated with age, education and wealth. The adjusted odd ratios for underweight were higher for older people (≥70 years) compared to younger, the least educated compared to the most educated and the poorest compared to the wealthiest were 2.51 (95%CI: 1.95±3.23, p<0.001), 3.59 (95%CI: 2.30±5.61, p<0.001) and 3.70 (95%CI: 2.76±4.96, p<0.001), respectively. Younger age (35±44 years), being female, higher education, wealthier and living in urban areas were associated with overweight/obesity with adjusted odds ratios of 1.73 (95%CI: 1.24±2.41, p<0.001), 2.48 (95%CI: 1.87±3.28, p<0.001), 3.98 (95%CI: 2.96±5.33, p<0.001), 7.14 (95%CI: 5.20±9.81, p<0.001) 1.27 (95%CI: 1.05±1.55, p-0.02), respectively. Conclusion: Underweight and overweight/obesity are prevalent in Bangladeshi adults. Both conditions are associated with increased morbidity and mortality and increase the risk of developing non-communicable diseases. Effective public health intervention approaches are necessary to address both these conditions.
Socio-demographic characteristics and tobacco use among the adults in urban slums of Dhaka, Bangladesh
(© 2017 BioMed Central Ltd., 5/5/2017) Khandker, Nusrat Nausheen; Biswas, Tuhin; Khan, Abdullah Nurus Salam; Hasib, Enamul; Rawal, Lal Bahadur; BRAC James P Grant School of Public Health
Background: Use of tobacco has become one of the major causes of premature deaths in most developing countries, including Bangladesh. The poorest and most disadvantaged populations, such as those living in slums, are considered to be extremely vulnerable to non-communicable diseases and their risk factors, especially tobacco use. The objective of this study was to assess the current status of tobacco consumption among slum dwellers and its association with socio-demographic factors. Methods: A cross-sectional study was conducted in three slums of Dhaka city. Information about tobacco use as well as socio-demographic characteristics was collected from adult slum dwellers via face to face interviews using WHO STEPS questionnaire. Result: Overall proportion of smoking, smokeless tobacco consumption and dual use of tobacco was 35% [95% CI: 31.6-39.8], 40.6% [95% CI: 36.5-45.2] and 12% [95% CI: 9.3-15.0] respectively. Elderly people (55-64 years) were more likely to smoke (OR: 2.34, 95% CI: 1.21-4.49) than younger people (aged 25-34 years). On the other hand, those who had no schooling history (OR: 2.95, 95% CI: 1.66-5.25) were more likely to consume smokeless tobacco than those who had higher education (secondary or above). At the same time, manual workers were more likely to indulge in dual use of tobacco (OR: 5.17, 95% CI: 2.82-9.48) as compared to non-manual workers. Conclusion: The urban slum population of Dhaka city has a high prevalence of tobacco use, which increases their likelihood of developing non-communicable diseases. Proper attention needs to be directed towards addressing the risk factors related to non-communicable diseases within this vulnerable population.
Cultural attitudes toward postpartum depression in Dhaka, Bangladesh
(© 2017 Taylor and Francis Inc., 5/15/2017) Williams, Anaise; Sarker, Malabika; Ferdous, Syeda Tahmina; BRAC James P Grant School of Public Health
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; BRAC James P Grant School of Public Health
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.

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