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English literature has faced homosexuality in a progressive manner though it has been through a struggling history. That is why a lot of writers of English literature have expressed and enjoyed themselves in their own ways. This paper addresses a few famous writers whose approaches in this regard have been homosexual in type. After looking at the societal love, norms and analysis of Sigmund Freud, this paper approaches Bangladesh and her view in this regard. This paper finds a kind of interdicted move from Bangladesh toward the homosexually important texts and finds the need to have a reciprocal approach. Finally, the outcome of this paper indicates to explain a critical perspective of Bangladeshi readers' psychology that is how and why they avoid homosexuality as well as literary texts implied with it.

The extreme poor in Bangladesh suffer from a particularly severe form of multidimensional poverty. Despite opportunities for investment made available by approaches such as microfinance, which could ensure future subsistence and graduation from poverty, the extreme poor continue to under-invest in long-term income-generating activities. This continued prioritisation of immediate needs perpetuates poverty, and often leads to its intergenerational transfer. While the evolving debate on multidimensional poverty has helped to unpack the structural causes behind this investment behaviour, very little literature has sought to understand the decision process itself. In this paper, we argue that investment decisions by the extreme poor are shaped by the psychological context of life in extreme poverty. We propose a psychological model of how extreme poverty-which is multidimensional as well as commonly chronic-affects the decision-making context of the individual, causing the future to be heavily discounted and inhibiting investment. The psychological impact of extreme poverty could be seen as an overarching and under-emphasised dimension of poverty itself due to its role in undermining the capability to invest, and impeding the long-term security of a household. We argue for a holistic approach to extreme poverty and wellbeing, involving a greater understanding that people's own perceptions of agency and needs impact upon decision making for the present and the future, in this case specifically towards livelihood choices likely to stimulate productive gains. Using a case study of one demand-driven conditional cash transfer project in Bangladesh, we propose that the psychological context of extreme poverty must be addressed in order to stimulate investment. An analysis of the project's success suggests that it was able to effectively promote investment by altering the context within which investment decisions were made. The paper concludes that effective poverty reduction programming must more directly address the psychological context of poverty and decision-making, and recommends that innovative choice architecture could provide one method of doing so. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding within one hour of birth is a critical component of newborn care and is estimated to avert 22% of neonatal mortality globally. Understanding the determinants of early initiation of breastfeeding (EIBF) is essential for designing targeted and effective breastfeeding promotion programmes. The aim of this study was to determine the prevalence and determinants of early initiation of breastfeeding among Bangladeshi women. Methods: This paper analyses the data from the Bangladesh Demographic and Health Survey, 2014. Analysis was based on responses of women who had at least one live birth in the two years preceding the survey (n = 3,162) collected using a structured questionnaire. The primary outcome was breastfeeding initiation within one hour of birth ascertained by women’s self-report. Explanatory variables included woman’s age, education, religion, household wealth, place of residence and place of delivery, birth order, child’s size, antenatal care (ANC), postnatal care (PNC) and skin-to-skin contact. Associations between variables were assessed by simple and multivariable logistic regressions. Results: Of the 3,162 recently delivered mothers, 51% initiated breastfeeding within one hour of delivery. Prevalence of EIBF varied significantly between different types of mode of delivery, among different geographical regions and among women who had PNC with their newborn. Women who had caesarean section (C-section) were less likely to initiate breastfeeding early after birth than women who had normal vaginal delivery (NVD) (AOR: 0.32, 95% CI 0.23 0.43; p value < 0.001). Women who had received PNC with their newborns within one hour of delivery were more likely to breastfeed their babies within one hour of birth compared to those who did not (AOR: 1.61, 95% CI 1.26 2.07; p value < 0.001). Mother’s age, education, religion, household wealth index, place of residence and place of delivery, birth order, number of antenatal visits, child’s size and skin-to-skin contact were not significantly associated with EIBF. Conclusions: Findings from this study suggest that investing more effort in ensuring immediate PNC of mother-newborn pair can increase EIBF. Solutions should be explored to increase EIBF among mothers who undergo C-section as C-section is rising rapidly in Bangladesh. Further research is needed to explore the regional differences in the country, including specific cultural practices that influence EIBF. [ABSTRACT FROM AUTHOR]

The demand for district level statistics has increased tremendously in Bangladesh due to existence of decentralised approach to governance and service provision. The Bangladesh Demographic Health Surveys (BDHS) provide a wide range of invaluable data at the national and divisional level but they cannot be used directly to produce reliable district-level estimates due to insufficient sample sizes. The small area estimation (SAE) technique overcomes the sample size challenges and can produce reliable estimates at the district level. This paper uses SAE approach to generate model-based district-level estimates of diarrhoea prevalence among under-5 children in Bangladesh by linking data from the 2014 BDHS and the 2011 Population Census. The diagnostics measures show that the model-based estimates are precise and representative when compared to the direct survey estimates. Spatial distribution of the precise estimates of diarrhoea prevalence reveals significant inequality at district-level (ranged 1.1–13.4%) with particular emphasis in the coastal and north-eastern districts. Findings of the study might be useful for designing effective policies, interventions and strengthening local-level governance. [ABSTRACT FROM AUTHOR]

Abstract: Improving infant and young child feeding practices is critical for improving growth and reducing child mortality and morbidity. This paper aims to compare predictors of minimum dietary diversity, an important indicator of adequate complementary feeding practices, in Bangladesh in 2011 and 2014. The 2011 and 2014 Bangladesh Demographic and Health Survey were used to examine predictors of minimum dietary diversity among 6–23 months. An additional analysis was conducted for the 18–23‐month group, because a significant increase in meeting minimum dietary diversity recommendations was seen in this age group only. Factors found to be associated with practices were compared across time points. In 2011, minimum dietary diversity was 23.8% and increased to 28.8% in 2014. Among children 18–23 months, in 2011, minimum dietary diversity was 32.5% and increased to 42.8% in 2014. Among all children, wealth, education, exposure to media, and antenatal care were significant predictors of dietary diversity. In the 18–23‐month age group, significant predictors in 2011 were wealth and decision making. In 2014, significant predictors were education and exposure to media. Demographic trends indicated a significant increase in education and exposure to media between 2011 and 2014. As these were significant for minimum dietary diversity in 2014 overall and for 18–23 months, they might be important targets of future interventions, specifically utilizing media channels and tailoring special strategies for women with low education and limited exposure to media. [ABSTRACT FROM AUTHOR]

Bangladesh is a culturally conservative nation with limited freedom for women. A number of studies have evaluated intimate partner violence (IPV) and spousal physical violence in Bangladesh; however, the views of women have been rarely discussed in a quantitative manner. Three nationwide surveys in Bangladesh (2007, 2011, and 2014) were analyzed in this study to characterize the most vulnerable households, where women themselves accepted spousal physical violence as a general norm. 31.3%, 31.9% and 28.7% women in the surveys found justification for physical violence in household in 2007, 2011 and 2014 respectively. The binary logistic model showed wealth index, education of both women and their partner, religion, geographical division, decision making freedom and marital age as significant household contributors for women’s perspective in all the three years. Women in rich households and the highly educated were found to be 40% and 50% less likely to accept domestic physical violence compared to the poorest and illiterate women. Similarly, women who got married before 18 years were 20% more likely accept physical violence in the family as a norm. Apart from these particular groups (richest, highly educated and married after 18 years), other groups had around 30% acceptance rate of household violence. For any successful attempt to reduce spousal physical violence in the traditional patriarchal society of Bangladesh, interventions must target the most vulnerable households and the geographical areas where women experience spousal violence. Although this paper focuses on women’s attitudes, it is important that any intervention scheme should be devised to target both men and women. [ABSTRACT FROM AUTHOR]

Background: We aimed to examine the influence of witnessing father-to-mother violence on: 1) perpetration of intimate partner violence (IPV); and 2) endorsement of attitudes justifying wife beating in Bangladesh.Methods: This paper used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on the responses of 3374 ever-married men. Exposure to IPV was determined by men's self-reports of witnessing inter-parental violence in childhood. We used adjusted binary logistic regression models to assess the influence of exposure on husbands' perpetration of IPV and their endorsement of attitudes justifying wife beating.Results: Nearly 60% of men reported violent behaviour towards an intimate partner and 35.7% endorsed attitudes justifying spousal abuse. Men who witnessed father-to-mother violence had higher odds of reporting any physical or sexual IPV (adjusted OR [AOR] = 3.26; 95% CI = 2.61, 4.06). Men who had witnessed father-to-mother violence were also 1.34 times (95% CI = 1.08, 1.65) more likely endorse attitudes justifying spousal abuse.Conclusions: Committing violence against an intimate partner is an all too frequent practice among men in Bangladesh. The study indicated that men who had witnessed father-to-mother violence were more likley to perpetrate IPV, suggesting an intergenerational transmission of violence. This transmission of violence may operate through the learning and modelling of attitudes favourable to spousal abuse. In support of this, witnnessing inter-parental violence was also associated with the endorsement of attitudes justifying spousal abuse. Our findings indicate the continued importance of efforts to identify and assist boys who have witnessed domestic violence and suggest such efforts should aim to change not just behaviours but also attitudes that facilitate such violence. [ABSTRACT FROM AUTHOR]

Introduction: More than 80% of all smokeless tobacco (ST) products in the world are consumed in South Asia; yet little is known about their consumption behaviour, addictiveness, and toxic properties. This paper, for the first time, describes associations between salivary cotinine concentrations among ST users in Bangladesh and their socio-demographic characteristics and tobacco use behaviours. Methods: In a survey of ST users in Dhaka, Bangladesh, we purposively recruited 200 adults who were non-smokers but consumed ST on a regular basis. In-person interviews were conducted to obtain information about socio-demographic and ST use behaviours, and saliva samples were collected to measure cotinine concentration. Simple and multiple linear regression analyses were conducted to test associations between the log transformed salivary cotinine concentration and other study variables. Results: The geometric mean of cotinine concentration among ST users was 380ng/ml (GSD:2). Total duration of daily ST use in months had a statistically significant association with cotinine concentration. Other ST use characteristics including type and quantity of ST use, swallowing of tobacco juice, urges and strength of urges and attempts to cut down on tobacco use were not found to be associated with cotinine concentration in a multivariable model. Conclusion: This is the first report from Bangladesh studying cotinine concentration among ST users and it points towards high levels of addiction. This warrants effective tobacco control policies to help ST cessation and prevention. [ABSTRACT FROM AUTHOR]

Introduction: In countries such as Bangladesh many women may only seek skilled care at birth when complications become evident. This often results in higher neonatal mortality for women who give birth in institutions than for those that give birth at home. However, we hypothesise that this apparent excess mortality is concentrated among less advantaged women. The aim of this paper is to examine the association between place of birth and neonatal mortality in Bangladesh, and how this varies by socio-economic status. Methodology: The study is based on pooled data from four Bangladesh Demographic and Household Surveys, and uses descriptive analysis and binomial multivariate logistic regression. It uses regression models stratified for place of delivery to examine the impact of socio-economic status and place of residence on neonatal mortality. Results: Poor women from rural areas and those with no education who gave birth in institutions had much worse outcomes than those who gave birth at home. There is no difference for more wealthy women. There is a much stronger socio-economic gradient in neonatal mortality for women who gave birth in institutions than those who delivered at home. Conclusion: In Bangladesh babies from lower socio-economic groups and particularly those in rural areas have very poor outcomes if born in a facility. This suggests poorer, rural and less educated women are failing to obtain the timely access to quality maternal health care services needed to improve newborn outcomes. [ABSTRACT FROM AUTHOR]

This paper offers a novel methodological approach for better understanding how different capital assets can be organized, transformed, and used in different combinations to reduce livelihood sensitivity to climatic stresses – an area that requires greater research attention in the context of adaptation policy. Research was conducted in the northeastern floodplain communities of Bangladesh, regarded as one of the most climate sensitive, resource poor, and highly understudied areas of the country. This wetland-dominated ecosystem is home to diverse resources user groups (e.g., farmer and fisher) who are subjected to regular seasonal flooding, excessive rainfall, drought, and flash floods. Working in 12 adjacent villages of two significant wetlands (Hakaluki haor and Tanguar haor ), qualitative and quantitative data were collected through 15 focus groups ( n  = 15), 35 key informant interviews, and 356 household surveys to better understand how community members adapt in response to their livelihood sensitivity to the climatic stresses. Results indicate that community members organize and transform capital assets in diverse ways to escape climate-induced “poverty traps”. Findings also reveal that interventions from external agencies (e.g., government, non-governmental organizations and market institutions) are an important key to livelihood sustainability for many households. [ABSTRACT FROM AUTHOR]

Inclusive education (IE) has been recognized as a key strategy to ensure education for all in the developing world for the last two decades. As a developing country, Bangladesh is striving to address IE by undergoing various initiatives such as policy reform, awareness creation and teacher development. This paper based on a qualitative approach attempts to explore pre-service teachers' responses to include students with special educational needs (SEN) in regular classrooms in primary schools. A one-on-one interview was conducted with 20 pre-service teachers who were enrolled in a teacher education program of one public university in Bangladesh. The findings revealed from the study indicate that majority of the preservice teachers have unfavourable attitudes to include students with SEN in regular classrooms. Misconception and lack of knowledge about disabilities are revealed from most of the pre-service teachers' responses. Further large class size, high workloads, inflexible curriculum policy of primary education and inadequate experiential learning facilities of teacher education program are identified as barriers to IE reform. Several issues are discussed as implications in order to promote better inclusive practices in regular primary education. [ABSTRACT FROM AUTHOR]

This paper critically examines development interventions and their implications for ethnic communities within the framework of peoplecentered development in specific contexts of southeastern Bangladesh and northern Thailand. The development interventions did not contribute to poverty alleviation and they undermined viable alternative approaches to the livelihoods of the ethnic communities. Moreover, these development interventions failed to or did not recognize the psychological, social, cultural, and spiritual aspects of the concerned communities. It is suggested that development needs to be embedded in and based on local knowledge, culture and bio-physical environments. [ABSTRACT FROM AUTHOR]

We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management. Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained. Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system. The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco smoking is often more prevalent among those with lower socio-economic status (SES) in high-income countries, which can be driven by the inequalities in initiation and cessation of smoking. Smoking is a leading contributor to socio-economic disparities in health. To date, the evidence for any socio-economic inequality in smoking cessation is lacking, especially in low- and middle-income countries (LMICs). This study examined the association between cessation behaviours and SES of smokers from eight LMICs. Methods: Data among former and current adult smokers aged 18 and older came from contemporaneous Global Adult Tobacco Surveys (2008–2011) and the International Tobacco Control Surveys (2009–2013) conducted in eight LMICs (Bangladesh, Brazil, China, India, Mexico, Malaysia, Thailand and Uruguay). Adjusted odds ratios (AORs) of successful quitting in the past year by SES indicators (household income/wealth, education, employment status, and rural-urban residence) were estimated using multivariable logistic regression controlling for socio-demographics and average tobacco product prices. A random effects meta-analysis was used to combine the estimates of AORs pooled across countries and two concurrent surveys for each country. Results: Estimated quit rates among smokers (both daily and occasional) varied widely across countries. Meta-analysis of pooled AORs across countries and data sources indicated that there was no clear evidence of an association between SES indicators and successful quitting. The only exception was employed smokers, who were less likely to quit than their non-employed counterparts, which included students, homemakers, retirees, and the unemployed (pooled AOR≈0.8, p<0.10). Conclusion: Lack of clear evidence of the impact of lower SES on adult cessation behaviour in LMICs suggests that lower-SES smokers are not less successful in their attempts to quit than their higher-SES counterparts. Specifically, lack of employment, which is indicative of younger age and lower nicotine dependence for students, or lower personal disposable income and lower affordability for the unemployed and the retirees, may be associated with quitting. Raising taxes and prices of tobacco products that lowers affordability of tobacco products might be a key strategy for inducing cessation behaviour among current smokers and reducing overall tobacco consumption. Because low-SES smokers are more sensitive to price increases, tobacco taxation policy can induce disproportionately larger decreases in tobacco consumption among them and help reduce socio-economic disparities in smoking and consequent health outcomes. [ABSTRACT FROM AUTHOR]

Background: Millions of children and others across the world are being dangerously exposed to tobacco smoke and toxins in their own homes. Whilst there is limited interest in laws and interventions controlling tobacco use in public places in Bangladesh, no attention has been given to preventing tobacco-use inside homes. This study explores the familial and socio-cultural factors that provide obstacles for ensuring tobacco-free homes in Bangladesh. Materials and methods: A mixed-method design was adopted and from among the 1,436 tobacco users identified in a population of 11,853, 400 (tobacco users) were selected for cross-sectional survey. This survey involved a probability proportional sampling procedure, and 24 In-Depth Interviews. Multivariate logistic regression was performed to explore the association of familial and socio-cultural factors with tobacco-use at home adjusted by other demographic characteristics. Thematic content analysis was done on the qualitative data, and then inferences were drawn out collectively. Results: This study revealed that the prevalence of tobacco-use in the home was 25.7% in urban residential areas in Bangladesh. Multivariate logistic regression analysis identified that familial and socio-cultural factors were significantly associated with tobacco-use at home: marital status (OR 3.23, 95% CI: 1.37–6.61), education (OR 2.14, 95% CI: 1.15–3.99), smoking habits of older family members (OR 1.81 95% CI: 0.91–2.89), tobacco being offered as hospitality and for entertainment (OR 1.85, 95% CI: .94–2.95) and lack of religiosity practice (OR 2.39, 95% CI: 1.27–4.54). Qualitative findings indicated that social customs, lack of religious practice, tobacco-use of older family members, and lack of family guidance were key obstacles for enabling tobacco-free homes in urban areas. Conclusion: Use of tobacco at home is continuing as part of established familial and socio-cultural traditions. If tobacco-use at home is not addressed seriously by the authorities then the emerging threat of second-hand smoke exposure and harmful consequences of tobacco- use will be exacerbated. [ABSTRACT FROM AUTHOR]

Background: The prevalence of overweightness in Bangladesh is increasing, while underweightness also continues to persist. A better understanding of the patterns and socioeconomic risk factors of both conditions, particularly among women, is critical in order to promote the development of interventions to improve maternal health in Bangladesh. This study therefore sought to assess the patterns of under- and overweightness between 2004 and 2014 and to examine the predictors of individual and community-level inequalities of under- and overnutrition in Bangladesh. Methods: Cross-sectional data of 10, 431, and 16,478 ever-married nonpregnant women aged between 15 and 49 years who did not give birth in the two months preceding the survey were extracted from the 2004 and 2014 Bangladesh Demographic and Health Surveys, respectively. Body mass index was used to measure weight status, and underweightness, at-risk for overweightness, overweightness, and obesity were the main outcome variables. Patterns of nutritional change over time was examined by considering the annual average rate of change. Multilevel multinomial logistic regression and quantile regression were used to identify the inequalities. Results: In 2014, the age-adjusted prevalence values of underweightness, at-risk for overweightness, overweightness, and obesity were 19.7%, 14.9%, 18.1% and 4.0%, respectively. A higher average annual rate of reduction of underweightness was found among wealthier, highly educated, and wealthier community–living women, while a rate of increase of overweightness was found among poorer, uneducated, and poor community–living women. Individual and community-level inequalities of malnutrition were observed among these populations. In comparison with women living in low wealth communities, women from wealthier communities were at an increased risk of being at-risk for overweightness [adjusted odds ratio (AOR): 1.53, 95% confidence interval (CI): 1.23–1.91], overweight (AOR: 1.60, 95% CI: 1.27–2.00), and obese (AOR: 2.12, 95% CI: 1.42–3.18). Conclusions: This study suggests the coexistence of a double burden of under- and overnutrition in Bangladesh and that the prevalence of overweightness surpasses that of underweightness. The burdens of under- and overnutrition are strongly associated with women’s individual socioeconomic positions and the nature of the community in which they live. [ABSTRACT FROM AUTHOR]

Introduction: Child health remains an important public health concern at the global level, with preventable diseases such as diarrheal disease, acute respiratory infection (ARI) and fever posing a large public health burden in low- and middle-income countries including Bangladesh. Improvements in socio-economic conditions have tended to benefit advantaged groups in societies, which has resulted in widespread inequalities in health outcomes. This study examined how socioeconomic inequality is associated with childhood morbidity in Bangladesh, and identified the factors affecting three illnesses: diarrhea, ARI and fever. Materials and methods: A total of 43,860 sample observations from the Bangladesh Demographic and Health Survey, spanning a 22-year period (1993–2014), were analysed. Concentration curve and concentration index methods were used to evaluate changes in the degree of household wealth-related inequalities and related trends in childhood morbidity. Regression-based decomposition analyses were used to attribute the inequality disparities to individual determinants for the three selected causes of childhood morbidity. Results: The overall magnitude of inequality in relation to childhood morbidity has been declining slowly over the 22-year period. The magnitude of socio-economic inequality as a cause of childhood morbidity varied during the period. Decomposition analyses attributed the inequalities to poor maternal education attainment, inadequate pre-delivery care, adverse chronic undernutrition status and low immunisation coverage. Conclusions: High rates of childhood morbidity were observed, although these have declined over time. Socio-economic inequality is strongly associated with childhood morbidity. Socio-economically disadvantaged communities need to be assisted and interventions should emphasise improvements of, and easier access to, health care services. These will be key to improving the health status of children in Bangladesh and should reduce economic inequality through improved health over time. [ABSTRACT FROM AUTHOR]

Introduction: Increased mobile phone subscribership in low- and middle-income countries (LMICs) provides novel opportunities to track population health. The objective of this study was to examine reliability of data in comparing participant responses collected using two mobile phone survey (MPS) delivery modalities, computer assisted telephone interviews (CATI) and interactive voice response (IVR) in Bangladesh (BGD) and Tanzania (TZA). Methods: Using a cross-over design, we used random digit dialing (RDD) to call randomly generated mobile phone numbers and recruit survey participants to receive either a CATI or IVR survey on non-communicable disease (NCD) risk factors, followed 7 days later by the survey mode not received during first contact; either IVR or CATI. Respondents who received the first survey were designated as first contact (FC) and those who consented to being called a second time and subsequently answered the call were designated as follow-up (FU). We used the same questionnaire for both contacts, with response options modified to suit the delivery mode. Reliability of responses was analyzed using the Cohen’s kappa statistic for percent agreement between two modes. Results: Self-reported data on demographic characteristics and NCD behavioral risk factors were collected from 482 (CATI-FC) and 653 (IVR-FC) age-eligible and consenting respondents in BGD, and from 387 (CATI-FC) and 674 (IVR-FC) respondents in TZA respectively. Survey follow-up rates were 30.7% (n = 482) for IVR-FU and 53.8% (n = 653) for CATI-FU in BGD; and 42.4% (n = 387) for IVR-FU and 49.9% (n = 674) for CATI-FU in TZA respectively. Overall, there was high consistency between delivery modalities for alcohol consumption in the past 30 days in both countries (kappa = 0.64 for CATI→IVR (BGD), kappa = 0.54 for IVR→CATI (BGD); kappa = 0.66 for CATI→IVR (TZA), kappa = 0.76 for IVR→CATI (TZA)), and current smoking (kappa = 0.68 for CATI→IVR (BGD), kappa = 0.69 for IVR→CATI (BGD); kappa = 0.39 for CATI→IVR (TZA), kappa = 0.50 for IVR→CATI (TZA)). There was moderate to substantial consistency in both countries for history of checking for hypertension and diabetes with kappa statistics ranging from 0.43 to 0.67. There was generally lower consistency in both countries for physical activity (vigorous and moderate) with kappa statistics ranging from 0.10 to 0.41, weekly fruit and vegetable with kappa ranging from 0.08 to 0.45, consumption of foods high in salt and efforts to limit salt with kappa generally below 0.3. Conclusions: The study found that when respondents are re-interviewed, the reliability of answers to most demographic and NCD variables is similar whether starting with CATI or IVR. The study underscores the need for caution when selecting questions for mobile phone surveys. Careful design can help ensure clarity of questions to minimize cognitive burden for respondents, many of whom may not have prior experience in taking automated surveys. Further research should explore possible differences and determinants of survey reliability between delivery modes and ideally compare both IVR and CATI surveys to in-person face-to-face interviews. In addition, research is needed to better understand factors that influence survey cooperation, completion, refusal and attrition rates across populations and contexts. [ABSTRACT FROM AUTHOR]

When they do not meet norms related to sexuality and reproduction, Bangladeshi women often face abandonment and are thus deprived of an active sexual life, a marital relationship, and motherhood. Little is known about how a stigmatised disease such as tuberculosis (TB) may constrain the reproductive health and sexual lives of women. This article, derived from a larger study on the impact of TB on women’s sexual and reproductive health and rights in Narsingdi district and Dhaka, Bangladesh, aims to fill this gap. Based on interviews with nine married women who have or had TB, four husbands, and two mothers-in-law, this article highlights that the ways in which TB impedes on the sexual and reproductive lives of women depends on the stigma within their family and community, their relationships with their husbands, motherhood, their living arrangements, their economic contribution to the family and/or their disclosure of their TB diagnosis. Women with children and supportive husbands retain a stronger position among their in-laws and are less likely to be isolated or rejected. The patients’ narratives revealed that the instructions of health workers influenced their decisions about intercourse or abstinence. Future studies should examine the instructions patients receive from health workers regarding their living and sleeping arrangements, sexual intercourse, and pregnancy, as well as policy documents on TB treatment and prevention. [ABSTRACT FROM AUTHOR]

Abstract: Mass media are increasingly used to deliver health messages to promote social and behaviour change, but there has been little evidence of mass media use for improving a set of child feeding practices, other than campaigns to promote breastfeeding. This study aimed to examine the factors influencing the uptake of infant and young child feeding messages promoted in TV spots that were launched and aired nationwide in Bangladesh. We conducted a mixed‐methods study, using household surveys (n = 2,000) and semistructured interviews (n = 251) with mothers of children 0–23.9 months and other household members. Factors associated with TV spot viewing and comprehension were analysed using multivariable logistic regression models, and interview transcripts were analysed by systematic coding and iterative summaries. Exposure ranged from 36% to 62% across 6 TV spots, with comprehension ranging from 33% to 96% among those who viewed the spots. Factors associated with comprehension of TV spot messages included younger maternal age and receipt of home visits by frontline health workers. Three direct narrative spots showed correct message recall and strong believability, identification, and feasibility of practicing the recommended behaviours. Two spots that used a metaphorical and indirect narrative style were not well understood by respondents. Understanding the differences in the uptake factors may help to explain variability of impacts and ways to improve the design and implementation of mass media strategies. [ABSTRACT FROM AUTHOR]

Background: Allowing a broader range of trained health workers to deliver services can be an important way of improving access to safe abortion care. However, the expansion of health worker roles may be challenging to implement. This study aimed to explore factors influencing the implementation of role expansion strategies for non-physician providers to include the delivery of abortion care.Methods: We conducted a multi-country case study synthesis in Bangladesh, Ethiopia, Nepal, South Africa and Uruguay, where the roles of non-physician providers have been formally expanded to include the provision of abortion care. We searched for documentation from each country related to non-physician providers, abortion care services and role expansion through general internet searches, Google Scholar and PubMed, and gathered feedback from 12 key informants. We carried out a thematic analysis of the data, drawing on categories from the SURE Framework of factors affecting the implementation of policy options.Results: Several factors appeared to affect the successful implementation of including non-physician providers to provide abortion care services. These included health workers' knowledge about abortion legislation and services; and health workers' willingness to provide abortion care. Health workers' willingness appeared to be influenced by their personal views about abortion, the method of abortion and stage of pregnancy and their perceptions of their professional roles. While managers' and co-workers' attitudes towards the use of non-physician providers varied, the synthesis suggests that female clients focused less on the type of health worker and more on factors such as trust, privacy, cost, and closeness to home. Health systems factors also played a role, including workloads and incentives, training, supervision and support, supplies, referral systems, and monitoring and evaluation. Strategies used, with varying success, to address some of these issues in the study countries included values clarification workshops, health worker rotation, access to emotional support for health workers, the incorporation of abortion care services into pre-service curricula, and in-service training strategies.Conclusions: To increase the likelihood of success for role expansion strategies in the area of safe abortion, programme planners must consider how to ensure motivation, support and reasonable working conditions for affected health workers. [ABSTRACT FROM AUTHOR]

Background: With the increase in the understanding of the influence of various lifestyle factors such as sedentary behaviour and level of physical activity (PA) on physical and mental health, there has been a growing research interest on how physical inactivity correlates with depressive outcomes across countries. The present study aimed to examine 1) the pattern of engaging in PA among middle- and older-aged population in four South Asian countries, and 2) whether PA is associated with higher prevalence of depression.Methods: This cross-sectional study is based on country-representative data obtained from WHO's World Health Survey (WHS). Subjects were 7204 men and women aged above 50 years from Bangladesh, India, Nepal and Sri Lanka, all of which are classified as Low-and-middle-income countries (LMICs) in World Bank reports. Outcome variables were self-ported depression (SRD) and ever being diagnosed with depression. Association between frequency of moderate (MPA) and vigorous physical activity (VPA) and depression was analysed by multivariable regression methods.Result: Prevalence of self-reported depression was respectively 47.7%, 40.3%, 40.4% and 11.4% in Bangladesh, India, Nepal and Sri Lanka. Prevalence of being ever diagnosed with depression was highest in Nepal (38.7%), followed by India (17.7%), Bangladesh (2.5%) and Sri Lanka (2%). Multivariable analysis shown statistically significant association between PA and diagnosed depression in Bangladesh and India, but not with SRD. In Bangladesh, compared to those who reported engaging in MPA on daily basis, the odds of reporting diagnosed depression were more than five times higher [AOR = 5.512; 95% CI = 1.159-26.21] for those who never took MPA. In India, those never took VPA had 44% higher [AOR = 1.442; 95% CI = 1.046-1.987] odds of being diagnosed with depression compared those who never engaged in VPA.Conclusion: Lower frequency of vigorous physical activity were significantly associated with higher rates of depression diagnosed. Based on the findings, it is recommendable that health programs targeting mental health among middle- and older-aged population take steps to promote the level of PA within a multi-dimensional depression prevention framework. Longitudinal studies are needed to understand the role of vigorous and moderate physical activity on the onset and intervention of depression among elderly population in the region. [ABSTRACT FROM AUTHOR]

Background: Despite high rates of antenatal care and relatively good access to health facilities, maternal and neonatal mortality remain high in Bangladesh. There is an immediate need for implementation of evidence-based, cost-effective interventions to improve maternal and neonatal health outcomes. The aim of the study is to assess the effect of the intervention namely Group Prenatal Care (GPC) on utilization of standard number of antenatal care, post natal care including skilled birth attendance and institutional deliveries instead of usual care.Methods: The study is quasi-experimental in design. We aim to recruit 576 pregnant women (288 interventions and 288 comparisons) less than 20 weeks of gestational age. The intervention will be delivered over around 6 months. The outcome measure is the difference in maternal service coverage including ANC and PNC coverage, skilled birth attendance and institutional deliveries between the intervention and comparison group.Discussion: Findings from the research will contribute to improve maternal and newborn outcome in our existing health system. Findings of the research can be used for planning a new strategy and improving the health outcome for Bangladeshi women. Finally addressing the maternal health goal, this study is able to contribute to strengthening health system. [ABSTRACT FROM AUTHOR]

Background: Experience of domestic violence has negative mental health consequences for women. The association of cumulative and specific forms of domestic violence, particularly emotional violence and controlling behavior, with common mental disorders and stress has rarely been studied in pregnant women. The aim of this study is to evaluate associations of specific and multiple forms of lifetime domestic violence and controlling behavior with distress and cortisol level during pregnancy in rural Bangladeshi women. Methods and findings: In this observational sub-study of larger MINIMat trial, 3504 pregnant women were interviewed using a shortened Conflict Tactic Scale about their lifetime experience of domestic violence including physical, sexual, emotional domestic violence and controlling behavior. Women’s levels of emotional distress were assessed using the self-reported questionnaire (SRQ-20) developed by WHO, and levels of morning salivary cortisol were measured in a subsample (n = 1300) of women during week 28–32 of pregnancy. Regression analyses were used to estimate the associations of lifetime physical, sexual, emotional domestic violence and controlling behavior with levels of distress and cortisol during pregnancy. The prevalence of lifetime domestic violence was 57% and emotional distress was 35% in these pregnant women. All forms of domestic violence were associated with higher levels of emotional distress. Women who experienced either emotional violence or controlling behavior had the highest levels of emotional distress. There was a dose-response relationship between cumulative number of the different forms of domestic violence and women’s levels of emotional distress. There was no association between women’s experience of domestic violence and level of morning salivary cortisol. Conclusion: Including emotional violence and controlling behavior as major types of violence in future research and health interventions is warranted. Furthermore, the extent of the negative impacts of domestic violence on pregnant women, multiple forms of violence and their cumulative effects need to be investigated. [ABSTRACT FROM AUTHOR]

Background: Perinatal common mental disorders (PCMDs) are a major cause of disability among women and disproportionately affect lower income countries. Interventions to address PCMDs are urgently needed in these settings, and group-based and peer-led approaches are potential strategies to increase access to mental health interventions. Participatory women’s health groups led by local women previously reduced postpartum psychological distress in eastern India. We assessed the effect of a similar intervention on postpartum psychological distress in rural Bangladesh. Method: We conducted a secondary analysis of data from a cluster-randomised controlled trial with 18 clusters and an estimated population of 532,996. Nine clusters received an intervention comprising monthly meetings during which women’s groups worked through a participatory learning and action cycle to develop strategies for improving women’s and children’s health. There was one group for every 309 individuals in the population, 810 groups in total. Mothers in nine control clusters had access to usual perinatal care. Postpartum psychological distress was measured with the 20-item Self Reporting Questionnaire (SRQ-20) between six and 52 weeks after delivery, during the months of January to April, in 2010 and 2011. Results: We analysed outcomes for 6275 mothers. Although the cluster mean SRQ-20 score was lower in the intervention arm (mean 5.2, standard deviation 1.8) compared to control (5.3, 1.2), the difference was not significant (β 1.44, 95% CI 0.28, 3.08). Conclusions: Despite promising results in India, participatory women’s groups focused on women’s and children’s health had no significant effect on postpartum psychological distress in rural Bangladesh. [ABSTRACT FROM AUTHOR]

Violence against women perpetrated by husbands and male partners occurs worldwide, and an increasing number of surveys indicate that it is widely condoned. This article presents findings from a 2002 survey conducted in six rural villages in Bangladesh suggesting that an extremely high proportion of women believe that husband's use of violence against their wives is acceptable. To investigate the reliability and the psychosocial underpinnings of these survey findings, we also examine data from 110 in-depth interviews and 14 small group discussions. The results suggest that although most abused women in the study had resigned themselves to accept a certain level of violence, they did not condone it, and many abused women said that perpetrators of violence should be punished, and in some cases the punishments they suggested were harsh. We conclude by raising questions regarding the meaning of responses to commonly used questions intended to measure women's attitudes toward intimate partner violence and by discussing policy implications. [ABSTRACT FROM AUTHOR]

There has been growing concern about the widespread exposure of the Bangladeshi population to arsenic in tube well water. Many interventions and alternative water sources have been advocated as being appropriate solutions, on the grounds that they are effective in eliminating or reducing arsenic ingestion. However, there has been little consideration given to possible adverse effects of such interventions. This paper provides an evaluation of the possible change in overall burden of disease resulting from implementation of arsenic mitigation interventions in Bangladesh. It does so by estimating the likely impacts on both arsenic related disease and waterborne infectious disease from these interventions, and comparing the effect of projected reductions in the former with estimated increases in the latter.To provide a basis for comparison, both mortality rates and years of life lost were calculated for disease endpoints considered likely to result from arsenic mitigation interventions. To obtain excess rates of disease due to arsenic exposure, the method used was dependant on the data available. Where incidence rates within age specific categories were available for both exposed and reference populations that were comparable to the Bangladeshi population, these were used. Where only risk estimates were available from the literature, these were applied to relevant background disease rates to obtain excess disease burden. It was assumed that interventions to water source would involve a transition from tube wells to primarily surface water sources such as dug wells, ponds and streams. In a country such as Bangladesh, where the majority of the population has limited access to sanitation, a recent study estimated such a transition corresponded to a relative risk of 1.26 for diarrhoeal disease 1. This figure was used to estimate effect on diarrhoeal disease of arsenic mitigation interventionsUnder the most plausible scenario, it was found that any intervention directed at arsenic mitigation would have to achieve a minimum reduction in arsenic related disease burden of 20% (in the case of all arsenic related endpoints) and 60% (if only cancer related endpoints were considered) to be effective in reducing overall burden of disease. Since maximal arsenic related reductions would be delayed for a number of years, in the initial period after intervention, there would be an overall increase in mortality. In addition, a range of scenarios was explored with varying magnitudes of effect on the considered disease endpoints.This evaluation demonstrates the need for more detailed assessments of arsenic mitigation interventions. It is important that further work is done to evaluate the impact of proposed arsenic mitigation interventions on all likely disease endpoints before such interventions are recommend for widespread use in arsenic affected communities. I. Pruss A, Kay D, Fewtrell L, Bartram J. Estimating the burden of disease from water, sanitation, and hygiene at a global level. Environ Health Perspect 2002; 110(5):537-42. [ABSTRACT FROM AUTHOR]

In this article, we examine the relationship between child mortality and subsequent fertility using prospective longitudinal data on births and childhood deaths occurring to nearly 8000 Bangladeshi mothers observed over the 1982-1993 period, a time of rapid fertility decline. Generalized hazard-regression analyses are employed to assess the effect of infant and child mortality on the hazard of conception, with controls for birth order and maternal age and educational attainment. Results show that childhood mortality reduces the time to subsequent conception if the death occurs within a given interval, representing the combined effect of biological and volitional replacement. The time to conception is also reduced if a childhood death occurs during a prior birth interval, a finding that signifies an effect of volitional replacement of the child that died. Moreover, mortality effects in prior birth intervals are consistent with hypothesized insurance (or hoarding) effects. Interaction of replacement with elapsed time suggests that the volitional impact of child mortality increases as the demographic transition progresses. This volitional effect interacts with sex of index child. Investigation of higher-order interactions suggests that this gender-replacement effect has not changed over time. [ABSTRACT FROM AUTHOR]

This article analyzes the determinants of contraceptive use in Bangladesh, focusing on the roles of demand for additional children and of family planning service supply. Data from the Matlab Family Planning Health Services Project are used to examine the contributions of these factors to the difference in prevalence of modern contraceptive use between the project area and a control area served by the government family planning and health programs. Results of multivariate analysis deriving from the Easterlin synthesis framework show the importance of family planning supply factors in reducing psychic and resource costs of fertility regulation and in activating latent demand for contraception. Demand for birth limiting and for birth spacing emerge as important explanatory factors; demand for birth spacing is greater in the project area, and both demand measures exert a stronger effect on contraceptive behavior in that area. [ABSTRACT FROM AUTHOR]

Using the World Fertility Survey data, this study examines how the demand for children, supply of children, and costs of fertility regulation influence the likelihood of contraceptive use in rural Bangladesh. The study shows that both higher demand for and lower supply of children lead to lower contraceptive use, other things remaining equal. It also shows that the lower the costs of fertility regulation, the higher is contraceptive use, other things remaining equal. The research and policy implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

This author discusses the effects of flood disasters in developing countries. The author believes that the poorest suffer most in calamities, wherein the death rate is three to four times higher than in developed countries. One of the poorest developing countries is Bangladesh, which has the highest rates of flooding in the world. Studies have attributed psychological disorders of children from the extreme stress they acquired due to the disasters. The studies also suggest that people may recover from a disaster but the mental distress may still continue.

Background: Early diagnosis of tuberculosis (TB) and involvement of the public-private partnership are critical to eradicate TB. Patients need to receive proper treatment through the National Tuberculosis Control Programme (NTP). This study describes various predictors for health seeking behaviour of TB patients and health system delay made by the different health care providers.Methods: A cross-sectional study was conducted in a public health facility of a rural area in Bangladesh. Newly diagnosed smear positive pulmonary TB (PTB) patients who were ≥ 15 years of age were sequentially enrolled in this study. The socio-demographic characteristics and proportion of health care utilization by the patients, and health system delay made by the health care providers were calculated. Multivariate analysis was conducted to determine the independent association of the risk factors with the time to seek medical care.Results: Two hundred and eighty patients were enrolled in this study. Among them, 73.6% were male and 26.4% were female. A hundred percent of patients primarily sought treatment for their cough, 170 (60.7%) first consulted a non-qualified practitioner while 110 patients (39.3%) first consulted with qualified practitioners about their symptoms. Pharmacy contact was the highest (27.9%) among the non-qualified practitioners, and 58.9% non-qualified practitioners prescribed treatment without any laboratory investigation. The average health system delay was 68.5 days. Multiple logistic regressions revealed a significant difference between uneducated and educated patients (OR 2.33; CI 1.39-3.92), and qualified and non-qualified practitioners (OR 2.34; CI 1.38-3.96) to be independent predictors of health system delay.Conclusions: Compared to men, fewer women sought TB treatment. Uneducated patients and questionably qualified practitioners made for a longer delay in detecting TB. Increasing public health awareness and improving health seeking behavior of females and uneducated patients, and greater participation of the qualified practitioners in the NTP are highly recommended. [ABSTRACT FROM AUTHOR]

Background: Missing from the huge literature on women's attitudes and beliefs concerning specific contraceptive methods is any detailed quantitative documentation for all major methods in low- and middle-income countries. The objectives are to provide such a documentation for women living in Matlab (rural Bangladesh), Nairobi slums and Homa Bay (rural Kenya) and to compare the opinions and beliefs of current, past and never users towards the three most commonly used methods (oral contraceptives, injectables and implants). Methods: In each site, 2424 to 2812 married women aged 15–39 years were interviewed on reproduction, fertility preferences, contraceptive knowledge and use, attitudes and beliefs towards family planning in general and specific methods. We analysed the data from round one of the prospective cohort study. Results: While current users typically expressed satisfaction and held more positive beliefs about their method than past or never users, nevertheless appreciable minorities of current users thought the method might pose serious damage to health, might impair fertility and was unsafe for prolonged use without taking a break. Larger proportions, typically between 25% and 50%, associated their method with unpleasant side effects. Past users of pills and injectables outnumbered current users and their beliefs were similar to those of never users. In all three sites, about half of past injectable users reported satisfaction with the method and the satisfaction of past implant users was lower. Conclusions: High levels of contraceptive use can clearly co-exist with widespread misgivings about methods, even those that are widely used. Serious concerns about damage to health, long term fertility impairment, and dangers of prolonged use without taking a break were particularly common in the Kenyan sites and these beliefs may explain the high levels of discontinuation observed in Kenya and elsewhere in Africa. This documentation of beliefs provides useful guidance for counselling and informational campaigns. The generally negative views of past users imply that programmes may need not only to improve individual counselling but also strengthen community information campaign to change the overall climate of opinion which may have been influenced by dissatisfaction among past users. [ABSTRACT FROM AUTHOR]