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Despite being potentially remediable, central nervous system tuberculosis continues to be a major cause of morbidity and mortality in developing countries. Intracranial tuberculoma is one of the many presentations of CNS tuberculosis that can occur as solitary or multiple lesions. When tuberculomas are solitary and extremely large, they may cause increased intracranial pressure, compressive focal neurological deficits, or epileptic seizures mimicking a malignant lesion. Even using magnetic resonance imaging and spectrography, giant tuberculoma and brain tumors could be mistaken for one another, which warrants consideration of an infectious etiology as a diagnostic differential for prompt diagnosis and appropriate treatment plan. This case study demonstrates a 22-year-old woman who presented with headache, nausea and vomiting ,blurring of vision , weakness of the right side of the body, and features of frontal lobe syndrome with no particular clinical features of TB, and underwent craniotomy who had a preoperative diagnosis of brain tumor. Histopathology later revealed it to be a tuberculoma. J Shaheed Suhrawardy Med Coll 2021; 13(2): 177-182

BackgroundDemographic and Health Survey’s timing-based measure is commonly used in Low and Middle Income Countries to estimate unintended pregnancy despite its limitations, including ambivalent responses and failure to consider the partner’s intention, while LMUP, which can address these limitations, is not widely used in LMICs and is yet to be administered in Bangladesh. This study compared unintended pregnancy rates measured by the DHS timing-based measure and LMUP, as well as explored the extent of discordance between the measures and their determinants.MethodsA cross-sectional survey was conducted in four districts of Bangladesh using two-stage stratified random sampling. Data was collected from 1,200 postnatal women. The study focused on discordance in reporting pregnancy intention between DHS timing-based measure and LMUP. Multivariate logistic regression models were used to identify predictors of discordant responses in reporting pregnancy intention.ResultsThe prevalence of unintended pregnancy was found to be 24.3% through the DHS timing-based measure and 31.0% through the LMUP. Discordance in responses to pregnancy intention in the two measures was around 28%. Key predictors of discordance included older age, female last child, more than two children, poorer wealth quintile, and rural residence. Conclusions: Prevalence of unintended pregnancy in Bangladesh and other LMICs, measured by DHS timing-based measure, may grossly underestimated. This suggests that the negative effects of unintended pregnancy are even more significant than currently believed, further highlighting the need to strengthen the family planning program in Bangladesh.

BackgroundIn low- and middle-income countries (LMICs), including Bangladesh, modern contraception use remains lower than desired, resulting in a higher unmet need. A potential factor contributing to lower contraceptive use is reduced access to and use of lower tiers of government healthcare facilities, including home visits by family welfare assistants (FWAs), as well as women’s visits to community and satellite clinics. These relationships, however, are still unexplored in Bangladesh and LMICs more broadly. The aim of this study was to explore effects of lower tiers of government healthcare facilities on unmet need for contraception and contraception use in Bangladesh.MethodsData from 17,585 sexually active married women were analyzed from the 2017 Bangladesh Demographic and Health Survey. The outcome variables were any contraceptive use, modern contraceptive use, unmet need for contraception, and unmet need for modern contraception. The explanatory variables considered were respondent’s home visits by FWAs, respondent’s visits to a community clinic, and respondent’s visits to a satellite clinic. Multilevel mixed-effect Poisson regression with robust variance was used to determine the association between the outcome and explanatory variables, adjusted for individual-, household-, and community-level factors.ResultsApproximately 18% of respondents were visited by FWAs in the three months prior to the survey date and only 3.4% and 3.1% of women attended community and satellite clinics, respectively. Women who reported being visited by FWAs in the three months prior to the survey were approximately 36% less likely to report an unmet need for modern contraception and 42% more likely to report using modern contraception than women who did not report such a visit. A higher likelihood of unmet need for contraception and a lower likelihood of contraception use was found among women who did not visit these community or satellite clinics or visited these clinics for other reasons than collecting contraception as compared to women who visited these clinics to collect contraception.ConclusionFWAs’ visits to respondents’ homes to provide contraception, as well as respondent’s visits to satellite and community clinics play a major role in Bangladesh to ensure contraception use and reduce the unmet need for contraception. However, their coverage is quite low in Bangladesh. The findings suggest an urgent need for greater government initiatives to increase the number of FWAs and engage in proper monitoring them at the field level.

The study of life-history features of least-concerned fishes like Liza parsia is critical for developing long-term management and conservation methods for this species. The current study delivers the very first detailed clarification of life-history traits (LHT), containing length-frequency distribution (LFD), length-weight and length-length relationships (LWR and LLR), form factor (a3.0), condition factors, length at first sexual maturity (Lm), natural mortality (Mw) and optimum catchable length (Lopt) of L. parsia from the Passur River in southern Bangladesh. Fish samples (n =150) were randomly collected from May to August 2021, using gill nets. Each individual fish's total length (TL), fork length (FL), standard length (SL), and bodyweight (BW) were recorded. The size classes of TL were 15–17cmleadingmaximum sizes among the fish population. Length-Weight relations (LWR) from exponential b values (TL vs. BW) revealed a negative allometric growth trend (b = 2.6174). The b value based on the LLR similarly specifies the identical growth configuration. The a3.0 score was determined to be 0.01, demonstrating that the fish has extended body morphology. KF is the finest method for measuring the well-being of L. parsia in the Passur River among the four types of condition parameters. Moreover, WR also showed a significant deviation from 100 (p < 0.05) signifying an unstable habitat for L. parsia. The calculated Lm, Mw and Lopt values were 11.20 cm in TL, 0.76/year and 12.64 cm in TL respectively. As a consequence, the findings of this research could be conducted in the future to effectively manage this species in the Passur River, and its interconnecting environments.

Maternal parity, which is usually measured as the number of children born to a mother, has a substantial impact on the social and environmental factors around children and their development. This paper estimates the Early Childhood Development Index (ECDI) of 3- and 4-year-old children in Bangladesh and examines the relationship between maternal parity and early childhood development.The study analysed nationally representative data from the Bangladesh Multiple Indicator Cluster Survey 2019. The dataset had 9453 children aged from 36 to 59 months. The ECDI was computed following the UNICEF's approach involving psychometric computation of four domains of development: physical, literacy-numeracy, learning and social-emotional. Since the dataset has a hierarchical structure, we used multilevel logistic regression.A quarter (25%) of the children were not on track in their early childhood development. Seventy-one percent were not developmentally on track in the literacy-numeracy domain, 27% were not in the social-emotional and smaller percentages were not in learning (9%) and physical (1%) domains. There was a significant negative association between maternal parity and ECDI (adjusted odds ratio [AOR] 0.95; 95% CI: 0.91-0.99). Attendance at early childhood education programmes was significantly associated with early childhood development (AOR 1.73; 95% CI: 1.47-2.03). Also, female children, those who were not stunted, located in rural areas, received parental stimulation activities, lived in relatively wealthy households or had mothers who had received secondary or further education were more likely than others to be on track of early childhood development.Early childhood development is negatively correlated with maternal parity. The literacy-numeracy domain constitutes the major developmental delay. Programmes for parental awareness should be widely expanded.

BackgroundHigh risk fertility behaviours including pregnancy early or late in the reproductive life course, higher parity and short birth intervals are ongoing concerns in Low- and Middle-Income Countries (LMICs) such as Bangladesh. Although such factors have been identified as major risk factors for perinatal mortality, there has been a lack of progress in the area despite the implementation of the Millennium and Sustatinable Development Goals. We therefore explored the effects of high risk maternal fertility behaviour on the occurrence of perinatal mortality in Bangladesh.MethodsA total of 8,930 singleton pregnancies of seven or more months gestation were extracted from 2017/18 Bangladesh Demographic and Health Survey for analysis. Perinatal mortality was the outcome variable (yes, no) and the primary exposure variable was high-risk fertility behaviour in the previous five years (yes, no). The association between the exposure and outcome variable was determined using a mixed-effect multilevel logistic regression model, adjusted for covariates.ResultsForty-six percent of the total births that occurred in the five years preceding the survey were high-risk. After adjusting for potential confounders, a 1.87 times (aOR, 1.87, 95% CI, 1.61-2.14) higher odds of perinatal mortality was found among women with any high-risk fertility behaviour as compared to women having no high-risk fertility behaviours. The odds of perinatal mortality were also found to increase in line with an increasing number of high-risk behaviour. A 1.77 times (95% CI, 1.50-2.05) increase in odds of perinatal mortality was found among women with single high-risk fertility behaviour and a 2.30 times (95% CI, 1.96-2.64) increase in odds was found among women with multiple high-risk fertility behaviours compared to women with no high-risk fertility behaviour.ConclusionWomen’s high-risk fertility behaviour is an important predictor of perinatal mortality in Bangladesh. Increased contraceptive use to allow appropriate birth spacing, educational interventions around the potential risks associated with high risk fertility behaviour (including short birth interval) in future pregnacies, and improved continuity of maternal healthcare service use among this population are required to improve birth outcomes in Bangladesh.

ObjectiveWe assessed spatial variations in the non-use of modern contraception in Bangladesh, and identified associated individual, household and community level factors.MethodsWe analysed data from 16,135 women extracted from the 2017/18 Bangladesh Demographic and Health Survey. The study outcome was non-use of modern contraception (yes, no), and the explanatory variables were factors at the individual (e.g., women’s education), household (e.g., husband education) and community level (e.g., community level poverty and illiteracy). Moran’s I statistics was applied to examine whether any geographical heterogeneity in non-use of modern contraception exists in Bangladesh. The Gettis-ord Gi*was calculated to measure how spatial autocorrelation differed across study locations. A geographically weighted regression model was used to assess the relationship of non-use of modern contraception at the cluster level.ResultsOverall, 42.8% (95% CI, 41.6-43.8) of respondents reported non-use of modern contraception in Bangladesh with a significant variation across geographical locations (pConclusionPrevalence of, and risk factors for, modern contraception non-use in Bangladesh differed depending on geographical location. This suggests a need for targeted area-specific policies and programs to improve knowledge and uptake of modern contraception.

Background: Sustainable Development Goals 3.7 targets to ensure universal access to sexual and reproductive healthcare services, where antenatal care (ANC) is a core component. This study aimed at examining the influence of health facility availability and readiness on uptake of four or more ANC in Bangladesh. Methods: The 2017/18 Bangladesh Demographic and Health Survey data were linked with the 2017 Health Facility Survey and analysed in this study. The associations of health facility level factors with recommended number of ANC uptake were determined. Multilevel mixed-effect poison regression model was used to determine the association adjusting for potential confounders. Results: Nearly 44% of mothers reported four or more ANC uptake with significant variations across several areas in Bangladesh. The average distance of mothers' homes from the nearest health facilities was 6.12 km, which was higher in Sylhet division (7.90 km) and lower in Dhaka division (4.01 km). The overall uptake of the recommended number of ANC visits was positively associated with higher scores for the management (adjusted prevalence ratio (APR) 1.85; 95% CI, 1.16-2.82) and infrastructure (APR, 1.59; 95% CI, 1.09-1.82) of health facilities closest to mothers' homes. The APRs for mothers reporting using the recommended number of ANC were increased to 3.02 (95% CI, 2.01-4.19) and 2.36 (95% CI, 2.09-4.16) times for each unit increase in the availability and readiness scores to provide ANC services at the closest health facilities, respectively. Every kilometre increase in the average regional-level distance between mothers' homes and the nearest health facilities reduced the likelihood of receiving the recommended number of ANC visits by nearly 42%. Conclusion: The availability of healthcare facilities closes to residence as well as their improved management, infrastructure, and readiness to provide ANC play crucial role to increase ANC services uptake. Policies and programmes should prioritise to increase availability, accessibility, and readiness of health facilities to provide ANC services.

BackgroundSexual engagement before marriage (premarital sex) can influence child marriage; however, the evidence is scarce in low- and middle-income countries (LMICs), including Bangladesh. This study aimed to explore the association between premarital sex and child marriage among ever-married women aged 15-24 years.MethodsWe analysed data of ever-married women aged 15-24 years after extracting from the 2017/18 Bangladesh Demographic Health Survey (BDHS). Premarital sex (yes, no) was the primary exposure in this study, and child marriage was the outcome variable. Multilevel mixed-effect logistic regression models were used to determine the extent to which premarital sex influences the occurrence of child marriage.ResultsThe prevalence of premarital sex and child marriage was 27% and 76.6%, respectively. Ever-married women who experienced child marriage had higher odds of reporting that they had engaged in premarital sex (aOR: 2.68; 95% CI: 2.20-3.26). The odds of premarital sex for women who experienced child marriage were higher in both urban (aOR: 2.67; 95% CI: 1.88-3.80) and rural areas (aOR: 2.69; 95% CI: 2.11-3.43). Child marriage was more common among women of relatively poor households who had premarital sex than those from other wealth quintiles.ConclusionPremarital sex significantly impacts girls’ child marriage in Bangladesh, and it varies greatly depending on the household’s socioeconomic status. Expanding existing school and community-based programmes aimed at reducing girls’ child marriage, abstinence from early premarital-sexual intercourse and context-specific multi-component interventions for at-risk young people may reduce these practices.

Background Early marriage is highly prevalent in Bangladesh. It is linked with a range of adverse outcomes, including maternal and child mortality. However, research on regional variations and factors associated with early marriage is scarce in Bangladesh. This study aimed to explore the geographical variations and predictors of early marriage in Bangladesh. Methods Data of women aged 20–24 in the 2017-18 Bangladesh Demographic and Health Survey were analysed. The occurrence of early marriage was the outcome variable. Explanatory variables were several individual-, household- and community-level factors. Geographical hot spots and cold spots of early marriage were first determined using Global Moran’s I statistic. Multilevel mixed-effect Poisson regression was used to determine the association of early marriage with individual-, household-, and community-level factors. Results Almost 59% of women aged 20–24 reported they were married before reached18. The hotspots of early marriage were mainly concentrated in Rajshahi, Rangpur and Barishal, and the cold spots were in Sylhet and Chattogram divisions. The prevalence of early marriage was lower among higher educated (adjusted prevalence ratio (aPR): 0.45; 95% CI: 0.40, 0.52), and non-Muslim women (aPR: 0.89; 95% CI: 0.79, 0.99) than their counterparts. Higher community-level poverty was significantly associated with early marriage (aPR, 1.16; 95% CI: 1.04, 1.29). Conclusion Early marriage is highly prevalent in Bangladesh. Promoting girls’ education, awareness-building programs about the adverse effects of early marriage and proper application of the child marriage restraint act, particularly in disadvantaged communities are recommended.

COVID-19 is one of the worst pandemics in recent human history, causing huge health, economic, and psychosocial damage. Since the pandemic hit, several unsubstantiated claims regarding exposure, transmission and management have been disseminated. Misinformation and associated public confusion now extend to the COVID-19 vaccines, spanning from claims based on possible links between some vaccine types and rare blood clots, to baseless claims. As a result, the public's trust in COVID-19 vaccines has been eroded, fuelling an already troubling trend of vaccine hesitancy. As medication experts and the most accessible healthcare providers, pharmacists are well equipped with the required skills and knowledge to improve COVID-19 vaccine uptake by taking roles that range from dispelling myths, to providing reliable evidence-based information, through to vaccine administration. This paper discusses public hesitancy to COVID-19 vaccines, major contributing factors, and the role pharmacists can play in reducing hesitancy and increasing vaccine uptake.

Objectives To explore relationship among perceived stress regarding loneliness, interpersonal trust and institutional trust of expatriates during the early COVID-19 period (from 30th March to 30th May 2020). Methods Data from 21,439 expatriates were extracted from COVIDiSTRESS global survey. The outcome variable was perceived stress. The explanatory variables were age, perceived loneliness, trust (interpersonal and institutional). Pairwise correlation, and structural equation modelling were used to determine relationship among outcome and explanatory variables. Results The majority of the expatriates were female (73.85%), married (60.20%), had college degree (47.76%), and employed (48.72%). Over 63% of the total expatriates reported that the COVID-19 pandemic changed their lives. The average age of the respondents was 40.4 years (± 13.7), and the average score of perceived stress, loneliness, interpersonal and institutional trust were 25.5, 7.4, 14.2 and 40.4, respectively. We found a moderate correlation of perceived stress with age, perceived loneliness, interpersonal trust and institutional trust (p Conclusion Perceived stress can be reduced through trusting others and alleviating the loneliness. Making strong linkage among migrants as well as between migrants and local community is important to ensure proper mental wellbeing of expatriates.

Background The prevalence of Short Birth Interval (SBI) is higher in Low- and Middle-Income countries (LMICs), including Bangladesh. Previous studies in LMICs have estimated the effects of SBI on child mortality by comparing two unequal groups of mothers based on their socio-economic status. This approach may lead to overestimation or underestimation of the true effect of birth interval on child mortality, particularly when sample sizes are relatively small. Objective We determined the effects of SBI on several forms of child mortality in Bangladesh by comparing two equal groups created by applying the propensity score matching technique. Methods This study analyzed data from 5,941 mothers and 1,594 health facilities extracted from the 2017/18 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. The exposure variable was SBI (defined as the interval between two subsequent births Results The prevalence rates of neonatal, infant, and under-five mortality were 48.8, 30.8, and 23.1 per 1000 live births, respectively. Newborns of SBI mothers were found to have a 63% higher likelihood of neonatal mortality (aPR, 1.63; 95% CI, 1.08–2.46) compared to newborns of non-SBI mothers. Furthermore, the prevalence of infant mortality and under-five mortality was 1.45 times higher (aPR, 1.45; 95% CI, 1.01–2.08) and 2.82 times higher (aPR, 2.82; 95% CI, 2.16–3.70), respectively, among babies born in a short interval of their immediately preceding sibling as compared to babies born in a normal interval of their immediately preceding sibling. Conclusions Findings of this study indicate that SBI is an important predictor of child mortality. Consequently, around 1 million children born in a short interval every year in Bangladesh are at risk of dying before reaching their fifth birthday. This indicates a challenge for Bangladesh to achieve the SDG 3 target to reduce neonatal and under-five mortality to 12 and 25 deaths per 1000 live births, respectively. Hence, awareness-building programs about the adverse effects of SBI and strengthening existing healthcare facilities are important.

BackgroundUnder-five mortality is unacceptably high in Bangladesh instead of governmental level efforts to reduce its prevalence over the years. Increased availability and access to the healthcare services can play a significant role to reduce under-five mortality. We explored the associations of several forms of child mortality with health facility level factors adjusted for individual-, household-, and community level factors.MethodsThe 2017-18 Bangladesh Demographic and Health Survey data and 2017 Bangladesh Health Facility Survey data were linked and analysed. Our outcome variables were neonatal mortality, infant mortality, and under-five mortality. Health facility level factors were considered as major explanatory variables. They were the basic management and administrative system of the healthcare facility, availability of the child healthcare services at the nearest healthcare facility, readiness of the nearest healthcare facility to provide child healthcare services and the average distance of the nearest healthcare facility providing child healthcare services. The associations between the outcome variables and explanatory variables were determined using the multilevel mixed-effect logistic regression model.ResultsReported under-five, infant and neonatal mortality were 40, 27, and 22 per 10000 live births, respectively. The likelihood of neonatal mortality was found to be declined by 15% for every unit increase in the score of the basic management and administrative system of the mothers’ homes nearest healthcare facility where child healthcare services are available. Similarly, the availability and readiness of the mothers’ homes nearest healthcare facilities to provide child healthcare services were found to be linked with the 18-24% reduction in neonatal and infant mortality. On contrary, for every kilometre increased distance between mothers’ homes and their nearest healthcare facility was found to be associated with a 15-20% increase in the likelihoods of neonatal, infant and under-five mortality.ConclusionThe availability of health facilities providing child healthcare services close to residence and their improved management, infrastructure, and readiness to provide child healthcare services play a significant role in reducing under-five mortality in Bangladesh. Policies and programs should prioritize to increase the availability and accessibility of health facilities that provide child healthcare services.

Background The prevalence of chronic conditions such as diabetes and hypertension is increasing among reproductive-aged women in Bangladesh. However, the pattern of contraceptive use among this population remains unknown. We, therefore, explored the pattern of contraceptive use among reproductive-aged women with diabetes and/or hypertension in Bangladesh. Methods We extracted and analysed data of 3,947 women from the 2017/18 Bangladesh Demographic and Health Survey. Women’s pattern of contraceptive use was our outcome variable. We first classified the contraceptive using status as no method use, traditional method use (periodic abstinence, withdrawal, other traditional) and modern method use (pill, intra-uterine device, injections, male condom, female sterilization, male sterilization). We later classified these as (i) no contraceptive use vs any contraceptive use, (ii) traditional method or no use vs modern method use, (iii) traditional method vs modern method use. The explanatory variables were diagnosis of diabetes only, hypertension only or both diabetes and hypertension. The multilevel Poisson regression with robust variance was used to explore the associations. Results The overall prevalence of contraceptive use was 68.0% (95% CI 66.3–69.7). The corresponding prevalences were 69.4% (95% CI 61.8–76.1) in women with diabetes only, 67.3% (95% CI 63.5–70.9) with hypertension only, and 62.0% (95% CI 52.8–70.4) in women having both diabetes and hypertension. The prevalence of modern methods of contraceptive use was lower (46.4%, 95% CI 37.4–55.6) and traditional methods use was higher (16.6%, 95% CI 13.8–16.8) in women who had both diabetes and hypertension than in women who did not have these conditions. The fully adjusted regression model showed that the prevalence of traditional method use was 31% (Prevalence ratio: 1.31, 95% CI 1.02–2.01) higher in women having both diabetes and hypertension compared with their counterparts who had none of these conditions. Conclusion In Bangladesh, women with both diabetes and hypertension were more likely to use traditional contraception methods. These women are likely to experience increased risks of unwanted pregnancies and associated adverse maternal and child health outcomes. Targeted policies and programs should be undertaken to promote modern contraceptive use among women living with both chronic conditions.

Short Birth Interval (SBI, defined as $${G}_{i}^{*}$$ G i ∗ (d) was used to determine the hot spots of SBI. The Geographical Weighted Regression (GWR) was used to assess the predictors of SBI at the enumeration areas’ level. The variables included in the GWR were selected using the exploratory regression and ordinary least square regression model. Data of 5941 women were included in the analyses. Around 26% of the total births in Bangladesh had occurred in short intervals. A majority of the SBI hot spots were found in the Sylhet division, and almost all SBI cold spots were in the Rajshahi and Khulna divisions. No engagement with formal income-generating activities, high maternal parity, and history of experiencing the death of a child were significantly associated with SBI in the Sylhet division. Women’s age of 34 years or less at the first birth was a protective factor of SBI in the Rajshahi and Khulna divisions. The prevalence of SBI in Bangladesh is highly clustered in the Sylhet division. We recommend introducing tailored reproductive health care services in the hot spots instead of the existing uniform approach across the country.

IntroductionPrevalence of hypertension is now increasing rapidly in Bangladesh, particularly among the socio-economically disadvantaged population. This could be linked to their higher use of solid fuel; however, related evidence is scarce in Bangladesh. We aimed to determine the associations of household solid fuel use and its exposure level with systolic blood pressure, diastolic blood pressure and hypertension.MethodsTotal of 7,320 women’s data extracted from the 2017/18 Bangladesh Demographic and Health Survey were analysed. We considered three outcome variables: (i) systolic blood pressure (continuous response), (ii) diastolic blood pressure (continuous response) and (iii) hypertension status (yes, no). Cooking fuel use (clean fuel vs solid fuel) and levels of exposure to household air pollution (HAP) through solid fuel use (unexposed, moderately exposed, highly exposed) were our primary exposure of interest. A multilevel mixed-effects Poisson regression model with robust variance was used to determine the association between exposure and outcome variable adjusting for confounders.ResultsAround 82% of the total respondents analysed used solid fuel for cooking. The overall age-standardised prevalence of hypertension was 28%. The likelihood of becoming hypertension was found 1.44 times (95% CI, 1.04-1.89) higher among respondents who used solid fuel as compared to the respondents who used clean fuel. The likelihood of hypertension was found to be increased with the increased exposure to HAP through the solid fuel used; 1.61 times (95% CI, 1.07-2.20) higher among the moderate exposure group and 1.80 times (95% CI, 1.27-2.32) higher among higher exposure group as compared to the women who used clean fuel. Similar associations were reported for systolic blood pressure and diastolic blood pressure.ConclusionSolid fuel use elevate systolic blood pressure, diastolic blood pressure and increases the likelihood of becoming hypertensive. Policies and programs are important to increase awareness about the adverse effects of solid fuel use on health, including hypertension. Focus should also be given to reducing solid fuel use and ensuring proper ventilation at the solid fuel use place.

ObjectiveThe objective of this study was to investigate the effects of health facility-level factors, including the availability of long-acting modern contraceptives (LAMC) at the nearest health facility and its distance from women’s homes, on the occurrence of unintended pregnancy that resulted in a live birth. Methods We analysed the 2017/18 Bangladesh Demographic and Health Survey data linked with the 2017 Bangladesh Health Facility Survey. The weighted sample comprised 5,051 women of reproductive age, who had at least one live birth within three years of the survey. The outcome variable was women’s intention to conceive at their most recent pregnancy that ended with a live birth. The explanatory variables were the health facility, individual, household, and community-level factors. A multi-level multinomial logistic regression model was used to assess the association of the outcome variable with explanatory variables. Results Nearly 21% of the total respondents reported that their most recent live birth was unintended at conception. Better health facility management systems and health facility infrastructure were found to be 14-30% protective of unintended pregnancy that resulted in a live birth. LAMC availability at the nearest health facility was associated with a 31% reduction (95% CI, 0.50-0.92) in the likelihood of an unwanted pregnancy that resulted in a live birth. Health facility readiness to provide LAMC was also associated with a 14-16% reduction in unintended pregnancy that ended with a birth. The likelihood of unintended pregnancy that resulted in a live birth increased around 20-22% with the increased distance of the nearest health facility providing LAMC from the women’s homes. Conclusion The availability of health facilities near women’s homes and access to LAMC can significantly reduce unintended pregnancy. Policies and programs to ensure access and affordability of LAMC across current health facilities and increasing the number of health facilities are recommended.

BackgroundAround 47% of the total conceptions in Bangladesh are unintended which leads to several adverse consequences, including maternal and child mortality. Availability of menstrual regulation (MR) service and its use can help women to end conception at an earlier stage, as such, reducing adverse consequences related to the unintended pregnancy. We explored the prevalence and determinants of MR service knowledge and its use among ever-married women in Bangladesh.MethodsA total of 20 127 ever-married women data from the 2017 Bangladesh Demographic and Health Survey were analyzed. Knowledge about menstrual regulation (MR) and its use were our outcomes of interest. Several individual, household and community-level factors were considered as explanatory variables. The multilevel mixed-effects Poisson regression model was used to determine the factors associated with MR service knowledge and its use in Bangladesh.ResultsAround 71% of the total analyzed women reported they know about MR service while only 7% of them reported they used this service within three years of the survey date. MR service knowledge was found to be higher among women with increased age and education and engaged in income-generating employment. Knowledge about MR service was also found to be higher among women whose husbands were higher educated and engaged in physical work or business. Rural women and women who resided in the community with lower poverty and higher illiteracy were reported lower knowledge of MR service. MR service use was found higher among higher-aged women, women whose husbands were either physical workers or businessmen, women who have an increased number of children and inherent in the community with lower poverty. Lower use of MR service was found among women who resided in the Chattogram, Khulna, and Mymensingh divisions and women who resided in the community with increased illiteracy.ConclusionUse of MR service is very low in Bangladesh. This could be responsible for higher adverse consequences related to unintended pregnancy including higher maternal and child mortality. Policies and programs are important to aware women of MR.

Background: The prevalence of chorionic conditions such as diabetes and hypertension is increasing among reproductive-aged women in Bangladesh. Pregnancy in women with uncontrolled chronic conditions may increase the risks of adverse consequences, including maternal and child morbidity and mortality. Appropriate contraception use can help women to prevent pregnancy until women have controlled chronic conditions and reduce the risks of adverse maternal and child health consequences. We investigate the associations between diabetes and/or hypertension and contraception use among reproductive-aged women in Bangladesh.Methods: We analysed data of 3,947 women, extracted from the 2017/18 Bangladesh Demographic and Health Survey. Women’s contraception using patterns were our outcome variable, which was classified as (i) any contraception method use vs no use, (ii) modern methods vs traditional methods or no use, (iii) modern methods vs traditional methods use. The explanatory variables were diagnosis of diabetes only, hypertension only or both diabetes and hypertension. The multilevel Poisson regression with robust variance was used to explore the associations.Results The overall prevalence of contraception use was 68.0% (95% CI: 66.3-69.7), 69.4% (95% CI: 61.8-76.1) in women with diabetes only, 67.3% (95% CI: 63.5-70.9) with hypertension only, and 62.0% (95% CI: 52.8-70.4) in women having both diabetes and hypertension. The prevalence of modern methods of contraception use was lower (46.4%, 95% CI: 37.4-55.6) and traditional methods use higher (16.6%, 95% CI: 13.8-16.8) in women who had both diabetes and hypertension than women who did not have these conditions. The fully adjusted regression model showed that the prevalence of traditional method use was 31% (95% CI: 1.02-2.01) higher in women having both diabetes and hypertension compared with their counterparts who had none of these conditions. Conclusion: In Bangladesh, women with both diabetes and hypertension were more likely to use traditional contraception methods. These women are likely to experience increased risks of unwanted pregnancies and associated adverse maternal and child health outcomes.

The objective of this study was to investigate the effects of health facility-level factors, including the availability of long-acting modern contraceptives (LAMC) at the nearest health facility and its distance from women’s homes, on the occurrence of unintended pregnancy that resulted in a live birth. We analysed the 2017/18 Bangladesh Demographic and Health Survey data linked with the 2017 Bangladesh Health Facility Survey. The weighted sample comprised 5051 women of reproductive age, who had at least one live birth within 3 years of the survey. The outcome variable was women’s intention to conceive at their most recent pregnancy that ended with a live birth. The major explanatory variables were the health facility level factors. A multi-level multinomial logistic regression model was used to assess the association of the outcome variable with explanatory variables adjusting for individual, household, and community-level factors. Nearly 21% of the total respondents reported that their most recent live birth was unintended at conception. Better health facility management systems and health facility infrastructure were found to be 14–30% protective of unintended pregnancy that resulted in a live birth. LAMC availability at the nearest health facility was associated with a 31% reduction (95% CI 0.50–0.92) in the likelihood of an unwanted pregnancy that resulted in a live birth. Health facility readiness to provide LAMC was also associated with a 14–16% reduction in unintended pregnancies that ended with a birth. The likelihood of unintended pregnancy that resulted in a live birth increased around 20–22% with the increased distance of the nearest health facility providing LAMC from the women’s homes.The availability of health facilities near women’s homes and access to LAMC can significantly reduce unintended pregnancy. Policies and programs to ensure access and affordability of LAMC across current health facilities and to increase the number of health facilities are recommended.

Change in environmental salinity level is a major limiting factor for the aquaculture productivity because it imposes severe stress on organisms that in turn retards growth. The orange mud crab (Scylla olivacea) is an important coastal aquaculture species (farming is practised in 10‰–20‰ salinity levels) in Bangladesh. The present study was conducted to investigate the changes in growth, O2 consumption and mRNA expression levels of five selected genes in the orange mud crab (S. olivacea) exposed to three different experimental salinity levels (0‰, 10‰ and 20‰) for three months. Crabs reared at 10‰ and 20‰, showed significantly higher (p < .05) growth performance and expression of growth regulatory genes (Actin and α-amylase). The highest levels (p < .05) of O2 consumption and expression of ion regulatory genes (Na+-K+-ATPase, V-type H+-ATPase and Diuretic Hormone) were obtained at 0‰. Moderate levels of growth and expression of selected candidate genes were observed at 10‰ treatment while the highest levels of growth and gene expression were obtained at 20‰ (control salinity). Strong interactions were observed between growth performance and expression of growth genes (R2 = 0.81–0.91), and rate of O2 consumption and expression of ion regulatory genes (R2 = 0.83–0.93), implying that the selected genes are important candidates for growth and ionic balance in S. olivacea. Growth performance was found to be very low at 0‰ initially, after 30 days crabs showed better growth performance at this salinity level. It is thus inferred that orange mud crab individuals might require 3–5 days for acclimation to salinity stress but it can take at least 30 days for acclimation to regular growth. Results indicate that with proper acclimation, the orange mud crab (Scylla olivacea) can be farmed at low salinity conditions and possibly in freshwater condition.

Objective: This study is designed to understand the impacts of demographic events, socioeconomic differentials, health factors’ availability, and environmental reasons which influence life expectancy (LE) globally. Methods: Data of 183 countries were taken from the United Nations agencies. The predicted variable was LE, and the determinants were demographic events, socioeconomic factors, health-related factors, and environmental issues. Descriptive statistics, correlation analysis, and backward multiple regression analysis were used to reach the research objectives. Results: The lowest LEs were found in the African countries; and LE was found significantly associated (p

Aim Increasing access to long-acting modern contraceptives (LMAC) is one of the key factors in preventing unintended pregnancy and protecting women’s health rights. However, the availability and accessibility of health facilities and their impacts on LAMC utilisation (implant, intrauterine devices, sterilisation) in low- and middle-income countries is an understudied topic. This study aimed to examine the association between the availability and readiness of health facilities and the use of LAMC in Bangladesh. Methods In this survey study, we linked the 2017/18 Bangladesh Demographic and Health Survey data with the 2017 Bangladesh Health Facility Survey data using the administrative-boundary linkage method. Mixed-effect multilevel logistic regressions were conducted. The sample comprised 10,938 married women of 15–49 years age range who were fertile but did not desire a child within 2 years of the date of survey. The outcome variable was the current use of LAMC (yes, no), and the explanatory variables were health facility-, individual-, household- and community-level factors. Results Nearly 34% of participants used LAMCs with significant variations across areas in Bangladesh. The average scores of the health facility management and health facility infrastructure were 0.79 and 0.83, respectively. Of the facilities where LAMCs were available, 69% of them were functional and ready to provide LAMCs to the respondents. The increase in scores for the management (adjusted odds ratio (aOR), 1.59; 95% CI, 1.21–2.42) and infrastructure (aOR, 1.44; 95% CI, 1.01–1.69) of health facilities was positively associated with the overall uptake of LAMC. For per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities, the aORs for women to report using LAMC were 2.16 (95% CI, 1.18–3.21) and 1.74 (95% CI, 1.15–3.20), respectively. A nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometre increase in the average regional-level distance between women’s homes and the nearest health facilities. Conclusion The proximity of health facilities and their improved management, infrastructure, and readiness to provide LAMCs to women significantly increase their uptake. Policies and programs should prioritise improving health facility readiness to increase LAMC uptake.

Background Maternal anemia is an ongoing public health challenge in low- and middle- income countries, including Bangladesh. The aim of this study was to explore the association of maternal anemia with a range of adverse maternal health and birth outcomes in Bangladesh. Methods A total of 2,259 maternal women data was analyzed, extracted from the 2011 Bangladesh Demographic and Health Survey. Outcome variables considered were a range of maternal health and birth outcomes. Adverse maternal health outcomes were pregnancy complications, pregnancy termination, menstrual irregularities, cesarean delivery, diabetes, and hypertension. Adverse birth outcomes considered were low birth weight, stillbirths, early neonatal deaths, perinatal deaths, preterm birth, and prolonged labor. The main exposure variable was maternal anemia status. Mixed effect multilevel logistic/poisson regression model was used to determine the association between exposure and outcome variable adjusted for individual-, household-, and community-level factors. Results The reported prevalence of anemia was 44%. A higher likelihoods pregnancy complication (AOR, 1.39, 95% CI, 1.09–2.41, pp.05), diabetes (AOR, 0.78, 95% CI, 0.49–0.98, p.05) and hypertensive (AOR, 0.79, 95% CI, 0.60–0.96, p.05) were found among anemic maternal women as compared to the non-anemic maternal women. Adverse birth outcomes, including preterm birth (AOR, 2.03, 95% CI, 1.01–4.25, p.05), early neonatal mortality (AOR, 1.87, 95% CI, 1.06–5.10), and perinatal mortality (AOR, 1.54, 95% CI, 1.09–3.52, p.05), were also found higher among newborn of anemic maternal women as compared to the newborn of non-anemic maternal women. Conclusion Anemia during pregnancy increases the occurrence of adverse maternal health and birth outcomes. Strategies to reduce anemia, such as iron supplementation, during pregnancy and among reproductive-aged women need to be prioritized in the policies and programs.

Background Medically unnecessary caesarean section (CS) is now an ongoing concern worldwide including in Bangladesh. This intensifies the occurrence of adverse maternal and child health outcomes. We investigated the associations of CS with some basic health and behavioural outcomes of the mothers and their children in Bangladesh. Methods We conducted a community-based case–control study from May to August 2019. A total of 600 mother–child dyads were interviewed using a structured questionnaire, 300 of them had CS, and 300 had vaginal delivery (VD) in their most recent live births. The exposure variable was the mode of delivery, classified as 1 if mothers had CS and 0 if mothers had VD. The outcome variables were a group of health and behavioural problems of the mothers and their children. Multivariate or multiple logistic regression model, separately for each health and behavioural outcome, was used to determine the effect of exposure variable on outcome variable after adjusting for possible confounders. Results The mean age and weight of mothers were 25.1 years and 53.1 kg, respectively. Likelihoods of headache, after delivery hip pain, problem of daily activities, and breastfeeding problem were reported higher among mothers who had CS in their most recent live birth than mothers who had VD. Similarly, children who were born through the CS operation were more likely to report breathing problem, frequent illness, lower food demand and lower hours of sleeping. Conclusion The use of CS increases the risks of health and behavioural problems of the mothers and their children. Policies and programs to avoid medically unnecessary CS and increase awareness over its adverse effects are important.

Ineffective or no use of contraception following an unintended pregnancy contributes to a subsequent unintended pregnancy. This study aimed to determine whether women's experiences of unintended pregnancies affect changing their contraceptive using patterns.We analysed the 2017/2018 Bangladesh Demographic and Health Survey data. The contraceptive switching pattern was computed by comparing women's contraceptives using data before and after pregnancy. Women were categorised into the following three groups, depending on their patterns of contraceptive use before and after pregnancy: no change, if there were no change in contraceptive using pattern; switched to higher effective contraceptives, if changed from pre-pregnancy less effective contraceptives to post-pregnancy more effective contraceptives; switched to less effective contraceptives, if changed from pre-pregnancy more effective contraceptives to post-pregnancy less effective contraceptives. Women's intention in the most recent pregnancy was our primary explanatory variable, classified as wanted, mistimed and unwanted. Multinomial multilevel logistics regression was used to determine the association between women's intention in the most recent pregnancy and women's contraceptive methods switching patterns from before to after pregnancy.Around 20% of the most recent pregnancies that ended with a live birth were unintended at conception. No contraceptive use was reported by 37% of women before their pregnancies which decreased to 24% after pregnancies. Overall, around 54% of women who reported no contraceptive use before pregnancy used modern contraceptives after pregnancy. The rate was higher among women who experienced unwanted pregnancy (73.4%) than mistimed (58.8%) and wanted (53.4%) pregnancy. Experience of mistimed pregnancy was associated with a higher likelihood of no contraceptive change (aOR, 1.84, 95% CI 1.41-2.39) and switching to less effective contraceptives (aOR, 1.58, 95% CI 1.10-2.26) than switching to more effective contraceptives. However, unwanted pregnancy was not associated with any significant change in contraceptives use from before to after pregnancy.Experience of unintended pregnancy did not change women's contraception using patterns, which indicates the risk of repeat unintended pregnancies and associated adverse consequences, including maternal and child morbidity and mortality. Policies to ensure access to and use of modern contraceptives among women facing unwanted or mistimed pregnancies are recommended.Unintended pregnancy is considered a public health challenge in low- and middle-income countries (LMICs). Around 89% of the global occurrences of unintended pregnancies occur in LMICs. In absolute numbers, this is equivalent to nearly 88 million pregnancies. Adverse pregnancy consequences, including bleeding, haemorrhage and maternal mortality are common in this group. The adverse consequences are even higher among women facing unintended pregnancies more than once, i.e., repeat unintended pregnancies, which represent around half of the total occurrences of unintended pregnancies in LMICs. Ensuring proper access to effective contraceptives following birth is key to reducing repeat unintended pregnancies and associated adverse consequences. It is critical to know the patterns of women’s pre-pregnancy contraceptive methods use and whether experiences of unintended pregnancies affect their contraceptive methods uptake and their types. However, this data is completely lacking in the context of LMICs. Using nationally representative survey data from Bangladesh, we examined women’s contraceptive switching patterns from before to after pregnancy and their association with pregnancy types. We found increased likelihood of no change in contraceptive using pattern or switching to less effective contraceptives among women after they experienced mistimed pregnancy compared to those whose pregnancy was wanted. This pattern increases the risk of repeat unintended pregnancies in Bangladesh and associated adverse consequences, including maternal and child morbidity and mortality.

The objective of this study was to determine how changes in pre-pregnancy contraceptive methods used between 2011 and 2017/18 contributed to the changes in pregnancy resulting from contraceptive methods failure in Bangladesh. We used 2011 and 2017/18 Bangladesh Demographic and Health Survey data. Pre-pregnancy contraceptive methods failure was our outcome of interest, which was determined using women’s response about whether they became pregnant while using contraceptives before the most recent pregnancy. The year of the survey was the main explanatory variable. Descriptive statistics were used to describe the characteristics of the respondents. The difference in contraceptive methods failure across the socio-demographic characteristics was assessed by Chi-squared test. Multilevel poison regressions were used to determine the changes in the prevalence ratio of contraceptive methods failure across the survey years. Contraceptive methods failure rate increased between the surveys, from 22.8% in 2011 to 27.3% in 2017/18. Also, male condom use increased by 2.8%, while withdrawal/periodic abstinence and/or other methods decreased by 2.9%. The failure rates in these two categories of contraceptive methods increased substantially by 4.0% and 9.0%, respectively. Compared to the 2011 survey, the prevalence ratio (PR) of contraceptive methods failure was 20% (PR 1.2, 95% CI 1.1–1.3) high in the 2017/18 survey. This PR declined 13% (PR 1.1, 95% CI 1.04–1.2) once the model was adjusted for women’s and their partner’s characteristics along with the last contraceptives used. This study provides evidence of increasing rates of pregnancy due to contraceptive failure in Bangladesh. Given that this type of pregnancy is known to cause adverse pregnancy outcomes, including abortion, pregnancy complications, maternal and early child morbidity and mortality, policy and programs are needed to reduce its prevalence. Effective coordination between the contraception providers at the healthcare facilities and the households and a proactive role of family planning workers to make couples aware of the effective use of contraceptives are recommended.

BackgroundThe Sustainable Development Goals target significant reductions in maternal and under-five deaths by 2030. The prevalence of these deaths is significantly associated with short birth interval (SBI). Identification of factors associated with SBI is pivotal for intervening with appropriate programmes to reduce these adverse consequences. This study aimed to determine the factors associated with SBI in Bangladesh.MethodsThe Bangladesh Demographic and Health Survey 2017/18 and Bangladesh Health Facility Data 2017 were linked and analysed. SBI was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization. We used descriptive statistics to summarise respondents’ characteristics and multilevel Poisson regression to assess the predictors of SBI.ResultsAround 26% of live births occurred in short intervals, with a further higher prevalence among younger, uneducated, or rural women. The likelihoods of SBI were lower among women aged 20-34 years (PR, 0.14; 95% CI, 0.11-0.17) and ≥ 35 years (PR, 0.03; 95% CI, 0.02-0.05) as compared to the women aged 19 years or less. Women from households with the richest wealth quintile experienced lower odds of SBI (PR, 0.61; 95% CI, 0.45-0.85) compared to those from the poorest wealth quintile. The prevalences of SBI were higher among women for whom the children born from the second most pregnancies died (PR, 5.23; 95% CI, 4.18-6.55), those who were living in Chattogram (PR, 1.52; 95% CI, 1.12-2.07) or Sylhet (PR, 2.83, 95% CI, 2.08-3.86) divisions. Availability of modern contraceptives at the nearest healthcare facilities was 66% protective to the occurrence of SBI (PR, 0.34; 95% CI, 0.22-0.78). Also, the prevalence of SBI increased around 85% (PR, 1.85; 95% CI, 1.33-2.18) for every kilometer increase in the distance of nearby health facilities from women’s homes.ConclusionMore than a quarter of live births in Bangladesh occurred in short intervals. This relatively high prevalence is a challenge for Bangladesh in reducing pregnancy-related adverse consequences, including maternal and child mortality. Policies and programmes are needed to increase awareness of SBI and associated adverse health outcomes and expand access to modern contraceptives.

BackgroundSolid fuel use was found to be associated with under-five mortality in low- and lower-middle income countries (LMICs). However, the current understanding of this association for Bangladesh is absent through around 80% of the total households in Bangladesh used solid fuel and the higher under-five mortality rate is a significant public health burden. We explored the associations of household cooking fuels used and the level of exposure to HAP through cooking fuels used with neonatal, infant, and under-five child mortality in Bangladesh.MethodsWe analysed 4,198 mother-child dyads data extracted from the 2017/18 Bangladesh Demographic and Health Survey data. Type of cooking fuels used (solid fuel, clean fuel) and level of exposure to HAP through cooking fuels used (unexposed, moderately exposed, highly exposed) were considered as exposure variables. Neonatal, infant and under-five mortality were considered as the outcome variables. Relationships between the exposure and outcome variable were explored by using the multilevel mixed-effect logistic regression model adjusting for possible confounders.ResultsSolid fuels were found to be used in nearly 80% of the total mothers analysed. A higher likelihood of mortality was found among neonates (aOR, 3.78; 95% CI, 1.14-12.51) and infants (aOR, 2.93; 95% CI, 1.60-6.15) of the women who used solid fuels as compared to the mothers who used clean fuel. The association was found strongest when we considered solid fuel used together with place of cooking. The likelihood of neonatal and infant mortality was found 4.33 (95% CI, 1.16-16.23) and 2.05 (95% CI, 1.18-7.23) times higher among mothers who were highly exposed to solid fuel used as compared to the mothers who were unexposed to solid fuel used.ConclusionSolid fuel used and its increased exposure increased the occurrence of neonatal and infant mortality. Prioritizing the use of clean fuel use and increasing awareness about the adverse effects of solid fuel use are important.

ObjectiveTo estimate the age-standardised prevalence, awareness, treatment, and control of hypertension and to identify their risk factors in Bangladeshi adults using the Bangladesh Demographic and Health Survey (BDHS) 2017-18 data.MethodsData from 12, 904 adults aged 18-95 years old, median (IQR) = 36 years (26-50), available from the most recent nationally representative BDHS 2017-18 were used. Hypertension was defined as having systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, and/or taking anti-hypertensive drugs to control blood pressure. Age-standardised prevalence of hypertension and management were estimated with direct standardisation. A multilevel mixed-effects Poisson regression model with a robust variance was used to identify risk factors associated with hypertension and its awareness, treatment, and control.ResultsThe overall age-standardised prevalence of hypertension was 26.2% (95% CI, 25.5-26.9); (men: 23.5%, women: 28.9%). Among those with hypertension (n=3531), 36.7% were aware that they had the condition, and only 31.1% received anti-hypertensive medication. Among those treated for hypertension (n=1306), 43.6% had controlled hypertension. Factors independently associated with hypertension were increasing age, higher body mass index, being women, having diabetes, and residing in selected administrative divisions. A declining trend of hypertension control was observed with increasing age and low education.ConclusionsHypertension is highly prevalent (1 in 4) in Bangladeshi adults, while awareness, treatment, and control are low. Irrespective of the risks associated with hypertension and its management, awareness, treatment, and control programmes should be given high priority in reducing hypertension and improving hypertension control in Bangladesh.

To estimate the age-standardized prevalence of diabetes and prediabetes and identify factors associated with these conditions at individual, household, and community levels. Data from 11952 Bangladeshi adults aged 18–95 years available from the most recent Bangladesh Demographic and Health Survey 2017–18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of diabetes and prediabetes were age-standardized with direct standardization, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance. The overall age-standardised prevalence of diabetes was 9.2% (95%CI 8.7–9.7) (men: 8.8%, women: 9.6%), and prediabetes was 13.3% (95%CI 12.7–13.9) (men: 13.0%, women: 13.6%). Among people with diabetes, 61.5% were unaware that they had the condition. 35.2% took treatment regularly, and only 30.4% of them had controlled diabetes. Factors associated with an increased prevalence of having diabetes were increasing age, male, overweight/obesity, hypertension, being in the highest wealth quintile, and living in the Dhaka division. People currently employed and living in the Rangpur division were less likely to have diabetes than those currently not employed and living in the Barishal division. Diabetes and prediabetes affect a substantial proportion (over one-quarter) of the Bangladeshi adult population. Continuing surveillance and effective prevention and control measures, focusing on obesity reduction and hypertension management, are urgently needed.

The Sustainable Development Goals 3 targets significant reductions in maternal and under-five deaths by 2030. The prevalence of these deaths is significantly associated with short birth intervals (SBI). Identification of factors associated with SBI is pivotal for intervening with appropriate programmes to reduce occurrence of SBI and associated adverse consequences. This study aimed to determine the factors associated with SBI in Bangladesh. A total of 5,941 women included in the 2017/18 Bangladesh Demographic and Health Survey 2017/18 and 1,524 healthcare facilities included in the 2017 Bangladesh Health Facility were linked and analysed. The sample was selected based on the availability of the birth interval data between the two most recent subsequent live birth. SBI was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization and was the outcome variable. Several individual-, households-, and community-level factors were considered as exposure variables. We used descriptive statistics to summarise respondents’ characteristics and multilevel Poisson regression to assess the association between the outcome variable with exposure variables. Around 26% of live births occurred in short intervals, with a further higher prevalence among younger, uneducated, or rural women. The likelihoods of SBI were lower among women aged 20–34 years (PR, 0.14; 95% CI, 0.11–0.17) and ≥35 years (PR, 0.03; 95% CI, 0.02–0.05) as compared to the women aged 19 years or less. Women from households with the richest wealth quintile experienced lower odds of SBI (PR, 0.61; 95% CI, 0.45–0.85) compared to those from the poorest wealth quintile. The prevalences of SBI were higher among women whose second most recent child died (PR, 5.23; 95% CI, 4.18–6.55), those who were living in Chattogram (PR, 1.52; 95% CI, 1.12–2.07) or Sylhet (PR, 2.83, 95% CI, 2.08–3.86) divisions. Availability of modern contraceptives at the nearest healthcare facilities was 66% protective to the occurrence of SBI (PR, 0.34; 95% CI, 0.22–0.78). Also, the prevalence of SBI increased around 85% (PR, 1.85; 95% CI, 1.33–2.18) for every kilometer increase in the distance of nearby health facilities from women’s homes. Targeted and tailored regional policies and programmes are needed to increase the awareness of SBI and associated adverse health outcomes and availability of modern contraception in the healthcare facilities.

BackgroundTo estimate the age-standardized prevalence of diabetes and prediabetes and identify factors associated with these conditions at individual, household, and community levels.MethodsData from 11952 Bangladeshi adults aged 18-95 years available from the most recent Bangladesh Demographic and Health Survey 2017-18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of diabetes and prediabetes were age-standardized with direct standardization, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance.ResultsThe overall age-standardised prevalence of diabetes was 9.2% (95%CI 8.7-9.7) (men: 8.8%, women: 9.6%), and prediabetes was 13.3% (95%CI 12.7-13.9) (men: 13.0%, women: 13.6%). Among people with diabetes, 61.5% were unaware that they had the condition. 35.2% were taking treatment regularly, and only 30.4% of them had controlled diabetes. Factors associated with an increased prevalence of having diabetes were increasing age, male, overweight/obesity, hypertension, being in the highest wealth quintile, and living in the Dhaka division. People currently employed and living in the Rangpur division were less likely to have diabetes than those currently not employed and living in the Barishal division.ConclusionsDiabetes and prediabetes affect a substantial proportion (over one-quarter) of the Bangladeshi adult population. Continuing surveillance and effective prevention and control measures, focusing on obesity reduction and hypertension management, are urgently needed.

Background: Household air pollution (HAP) from solid fuel use (SFU) for cooking has been considered a public health threat, particularly for women and children in low and middle-income countries (LMICs), with limited evidence. This study was undertaken to investigate the effects of HAP on neonatal, infant, and under-five child mortality in Myanmar. Methods: This cross-sectional study employed data from the Myanmar Demographic and Health Survey (MDHS), the first nationally representative survey conducted in 2016. Data were collected from MDHS based on stratified two-stage cluster sampling design applied in urban and rural areas. The sample consists of 3249 under-five children in the household with a 98% response rate. Exposure measures were HAP (coal and biomass) and level of exposure to HAP (no exposure, moderate and high exposure). The main outcomes were neonatal, infant, and under-five child mortality reported by mothers presented in rates and risk ratios with 95% confidence intervals, accounting for survey weight and cluster variation. Results: The prevalence of SFU was 79.0%. The neonatal, infant and under-five child mortality rates were 26, 45, and 49 per 1,000 live births, respectively. The risks of infant (aRR 2.02; 95% CI: 1.01-4.05) and under-five mortality (aRR 2.16; 95% CI: 1.07-4.36) mortality were higher among children from households with SFU compared to children from households using clean fuel. When applying an augmented measure of exposure to HAP by incorporating SFU and the kitchen's location, the likelihoods of infant and under-five mortality were even higher among moderate and highly exposed children than unexposed children with similar trends. Neonatal mortality was not associated with either HAP exposure or levels of exposure to HAP.Conclusion: Infants and under-five children are at higher risk of mortality from exposure to HAP. Increasing access to cookstoves and clean fuels is imperative to reduce the risk of infant and under-five child mortality in LMICs, including Myanmar.

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases., Central Illustration, Highlights • The burden of CVD, in number of DALYs and deaths, continues to increase globally. • CVD burden attributable to modifiable risk factors continues to increase globally. • Countries should invest in existing cost-effective public health programs and clinical interventions to target modifiable risks, promote healthy aging across the lifespan, and reduce disability and premature death due to CVD.

To estimate the prevalence of undiagnosed diabetes, and to identify the relative importance of risk factors for undiagnosed diabetes among Bangladeshi adults.Data from 11, 421 Bangladeshi adults aged 18 years and older available from the most recent nationally representative Bangladesh Demographic and Health Survey 2017-18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of undiagnosed diabetes was age-standardised with direct standarisation, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance.The overall age-standardised prevalence of undiagnosed diabetes was 6.0% (95 %CI, 5.5-6.4%) (men: 6.1%, women: 5.9%). Risk factors associated with undiagnosed diabetes were older age, elevated body mass index (BMI), highest wealth quintile, hypertension, and being male. The top two modifiable risk factors contributing over 50% to undiagnosed diabetes were BMI and wealth quintiles.Undiagnosed diabetes affects a substantial proportion of Bangladeshi adults. Since elevated BMI and the highest wealth quintile are strong risk factors, these offer an opportunity for early detection and screening to reduce undiagnosed diabetes in Bangladesh. In addition, wide-reaching awareness campaigns among the general public, clinicians, and policymakers are needed.

Caesarean section (CS) use is rising rapidly in Bangladesh, though lack of CS use remains common among disadvantage women. This increases risks of long-term obstetric complications as well as maternal and child deaths among disadvantage women. We aimed to determine the interaction effects of women’s disadvantage characteristics on CS use in Bangladesh. For this we have analysed a total of 27,093 women’s data extracted from five rounds of Bangladesh Demographic and Health Survey conducted during 2004 and 2017/18. The outcome variable was CS use, coded as use (1) and non-use (0). The major exposure variables were individual level, household level, and community level characteristics. Multilevel logistic regression model was used to determine association of CS use with socio-demographic characteristics and the interactions of three variables: working status, wealth quintile, and place of residence. We found a 751% increase of CS use over the last 13 years—from 3.88% in 2004 to 33% in 2017/18. Nearly, 80% of the total CS operation occurred in the private health facilities followed by the government health facilities (15%). Women living in rural areas with no engagement in formal income generating activities showed a 11% (OR, 0.89, 95% CI, 0.71–0.99) lower use of CS in 2004. This association was further strengthened over time, and a 51% (OR, 0.49, 0.03–0.65) lower in CS use was reported in 2017/18. Similarly, around 12%-83% lower likelihoods of CS use were found among rural poor and poorer women. These indicate Bangladesh is facing a double burden of CS use, that is a group of women with improved socio-economic condition are using this life saving procedure without medical necessity while their counterpart of disadvantage characteristics could not access the service. Improved monitoring from the government along with support to use CS services for the disadvantage groups on necessity are important.

Background Worldwide people in disorder of sex development (DSD) faces multiple barriers while seeking their social rights, particularly healthcare services. We aimed to explore the healthcare opportunities available to them, using patterns of healthcare utilization and difficulties faced by DSD population in accessing healthcare services in Bangladesh. Methods Data from a total of 945 DSD population and 71 medical staff were analyzed, collected from three major divisions (Dhaka, Chittagong, and Rajshahi) in Bangladesh during the period of January to December of 2017. A structured questionnaire was used to collect data via face-to-face interviews. Descriptive statistic was used to determine the frequencies of the visit by the DSD population in healthcare facilities as well as to analyze difficulties experienced by the DSD population in getting healthcare services. Multivariate regression analysis was used to explore the association between perceived barriers in getting healthcare services and failures of the DSD population to receive the healthcare services. Results Present data revealed that around 80% of DSD population sought healthcare services from government healthcare facilities, where the overall success rate in getting healthcare services was less than 50%. The DSD population reported a number of reasons for failures in getting healthcare services, including non-friendly interaction by non-clinical hospital’s staff, non-friendly interaction by physicians, public fright as general people do not want to mingle with a DSD person, undesirable excess public interest in DSD individuals, and limitation of the treatment opportunities of hospitals to merely male or female patients. Among the stated reasons, the most frequently reported reason was non-friendly interaction by physicians (50.27%), followed by undesirable excess public interest in DSD individuals (50.16%). Conclusion DSD population in Bangladesh have limited access to healthcare facilities and facing multiple barriers to get healthcare services. Initiatives from the government and social organizations are important to ensure their access to healthcare services.

BackgroundThe coronavirus (COVID-19) is now a global concern because of its higher transmission capacity and associated adverse consequences including death. The reproductive number of COVID-19 provides an estimate on possible extent of the transmission. This study aims to provide the average reproductive number of COVID-19 based on available global level evidence.MethodsWe searched three databases (PubMed, Web of Science, and Science Direct) to find studies reported the reproductive number of COVID-19. The searches were conducted using a pre-specified search strategy that includes keywords of COVID-19 and its reproductive number related terms, which were combined using the Boolean operators. We used meta-analysis to provide average reproduction number of COVID-19.ResultsTotal of 30 studies included in this review whereas 24 of them were included in the meta-analysis. The average estimated reproductive number was 2.70 (95% CI, 2.21-3.30). We found evidence of very high heterogeneity (99.5%) of the reproductive number reported in the included studies. The highest reproductive number was reported for Diamond Princes Cruise Ship, Japan (14.8). In the country-level, higher reproductive number was reported for France (R, 6.32, 95% CI, 5.72-6.98) following Germany (R, 6.07, 95% CI, 5.51-6.69) and Spain (R, 5.08, 95% CI, 4.50-5.73). We also found estimation models, methods, and the number of cases considered to estimate reproductive number were played a role in arising the heterogeneity of the estimated reproductive number.ConclusionThe estimated reproductive number indicates an exponential increase of COVID-19 infection in coming days. Comprehensive policies and programs are important to reduce new infections as well as the associated adverse consequences including death.

BackgroundWith the exponential increase in coronavirus disease 2019 (COVID-19) worldwide, an increasing proportion of pregnant women are now infected during their pregnancy. The aims of this systematic review were to summarize the possible symptoms, treatments, and pregnancy outcomes of women infected with COVID-19 during their pregnancy.MethodsFour databases (Medline, Web of Science, Scopus, and CINAHL) were searched on March 25, 2020, using the following keywords: “COVID-19”, “nCoV-2019”, and “coronavirus.” Articles included if they reported either the symptoms, treatments for the women who had been infected with the COVID-19 during their pregnancy or pregnancy outcomes. The selected articles’ results were summarized employing a narrative synthesis approach.ResultsA total of nine studies were selected for this study, comprising 101 infected pregnant women. Other than the infected general population, infected pregnant women reported different symptoms; however, fever (66.7%), cough (39.4%), fatigue (15.2%), and breathing difficulties (14.1%) were common. Infected pregnant women were given different treatments than the general infected population. The C-section was a common (83.9%) mode of delivery among infected pregnant women, and a higher proportion of births were preterm births (30.4%) and low birth weight (17.9%).ConclusionsPregnant infected women had different symptoms, and they were given dissimilar treatments than the general infected population. Healthcare providers may have appropriately informed about these symptoms and treatments. They, therefore, would be able to handle infection during pregnancy effectively, which would reduce common adverse consequences among infected pregnant women.

Additional file 1. DSD questionnaire (DSD population interviewed). Disorder sex development (DSD) population were interviewed using questions of this questionnaire.

Supplemental material, Supplimentary_Tables for Inequalities in Utilization of Maternal Reproductive Health Care Services in Urban Bangladesh: A Population-Based Study by Md. Nuruzzaman Khan, Pushpendra Kumar, Md. Mijanur Rahman, Md. Nazrul Islam Mondal and M. Mofizul Islam in SAGE Open

Additional file 2. DSD questionnaire (Medical staff interviewed). Healthcare services provider’s (physicians) perceptions in providing healthcare services to the DSD population were collected using questions of this questionnaire.