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Background: The partograph has been endorsed by World Health Organization (WHO) since 1994 which presents an algorithm for assessing maternal and foetal conditions and labor progression. Monitoring labour with a partograph can reduce adverse pregnancy outcomes such as prolonged labor, emergency C-sections, birth asphyxia and stillbirths. However, partograph use is still very low, particularly in low and middle income countries (LMICs). In Bangladesh the reported partograph user rate varies from 1.4% to 33.0%. Recently, an electronic version of the partograph, with the provision of online data entry and user aid for emergency clinical support, has been tested successfully in different settings. With this proven evidence, we conducted and operations research to test the feasibility and effectiveness of implementing an e-partograph, for the first time, in 2 public hospitals in Bangladesh Methods: We followed a prospective crossover design. Two secondary level referral hospitals, Jessore and Kushtia District Hospital (DH) were the study sites. All pregnant women who delivered in the study hospitals were the study participants. All nurse-midwives working in the labor ward of study hospitals were trained on appropriate use of both types of partograph along with standard labour management guidelines. Collected quantitative data was analyzed using SPSS 23 statistical software. Discrete variables were expressed as percentages and presented as frequency distribution and cross tabulations. Chi square tests were employed to test the association between exposure and outcome variables. Potential confounding factors were adjusted using multivariate binary logistic regression methods. Ethical approval was obtained from the institutional review board of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Findings: In total 2918 deliveries were conducted at Jessore DH and 2312 at Kushtia DH during one-year study period. Of them, 1012 (506 in each facility) deliveries were monitored using partograph (paper or electronic). The trends of facility based C-section rates was downwards in both the hospitals; 43% to 37% in Jessore and from 36% to 25% in Kushtia Hospital. There was a significant reduction of prolonged labour with e-partograph use. In Kushtia DH, the prolonged labour rate was 42% during phase 1 with the paper version which came down to 29% during phase-2 with the e-partograph use. The similar result was observed in Jessore DH where the prolonged labour rate reduced to 7% with paper partograph from the reported 30% prolonged labour with e-partograph. The e-partograph user rate was higher than the paper partograph during both phases (phase 1: 3.31, CI: 2.04–5.38, p < .001 and in phase 2: 15.20 CI: 6.36–36.33, p < .001) after adjusting for maternal age, parity, gestational age, religion, mother’s education, husband’s education, and fetal sex Conclusion: The partograph user rate has significantly improved with the e- partograph and was associated with an overall reduction in cesarean births. Use of the e-partograph was also associated with reduced rates of prolonged labour. This study has added to the growing body of evidence on the positive impact of e-partograph use. We recommend implementing e-partograph intervention at scale in both public and private hospitals in Bangladesh. Trial registration: ClinicalTrials.gov . [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]

Objective: This paper describes the physical structure and environmental contamination in selected hospital wards in three government hospitals in Bangladesh. Methods: The qualitative research team conducted 48 hours of observation in six wards from three Bangladeshi tertiary hospitals in 2007. They recorded environmental contamination with body secretions and excretions and medical waste and observed ward occupant handwashing and use of personal protective equipment. They recorded number of persons, number of open doors and windows, and use of fans. They measured the ward area and informally observed waste disposal outside the wards. They conducted nine focus group discussions with doctors, nurses and support staff. Results: A median of 3.7 persons were present per 10 m2 of floor space in the wards. A median of 4.9 uncovered coughs or sneezes were recorded per 10 m2 per hour per ward. Floors in the wards were soiled with saliva, spit, mucous, vomitus, feces and blood 125 times in 48 hours. Only two of the 12 patient handwashing stations had running water and none had soap. No disinfection was observed before or after using medical instruments. Used medical supplies were often discarded in open containers under the beds. Handwashing with soap was observed in only 32 of 3,373 handwashing opportunities noted during 48 hours. Mosquitoes and feral cats were commonly observed in the wards. Conclusions: The physical structure and environment of our study hospitals are conducive to the spread of infection to people in the wards. Low-cost interventions on hand hygiene and cleaning procedures for rooms and medical equipment should be developed and evaluated for their practicality and effectiveness. [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: Accurate national information on dietary intakes, including heterogeneity among individuals, is critical to inform health implications and policy priorities. In low- and middle-income countries, household expenditure surveys constitute the major source of food data, but with uncertain validity for individual-level intakes. Objective: To investigate how individualized dietary consumption estimated from household survey data compared with individual-level 24-hr dietary recalls (24hR); and to assess potential heterogeneity by method for individualizing household intakes, dietary indicator, and individual characteristics (age, sex, education, religion, household income). Methods: We evaluated data from the 2011–2012 Bangladesh Household Integrated Survey (BIHS), which included household-level consumption data (5,503 households) and individual-level dietary data based on 24hR from these households (22,173 participants). Household and 24hR estimates were standardized and harmonized for 33 dietary indicators, including 9 food groups, total energy, 8 macronutrients, and 15 micronutrients. Individual consumption was estimated from household data using two approaches, the Adult Male Equivalent (AME) and per capita (PC) approach. For each dietary indicator, differences in household vs. individual mean estimates were evaluated overall and by strata of individual characteristics, using Spearman’s correlations and univariate and multivariate linear regression models. Results: Individualized household estimates overestimated individual intakes from 24hR for all dietary factors using either estimation method (P<0.001 for each), except for starchy vegetables (AME: P = 0.15; PC: P = 0.85). For foods, overestimation ranged from 4% for seafood to about 240% for fruits, and for nutrients from 11% for carbohydrates and poly-unsaturated fats to 55% for vitamin C, with similar overestimation for the AME and the PC method. By strata, overestimation was modestly higher in men vs. women, in children (0-10y) vs. adolescents (11-19y) and adults (20-44y, ≥45y), among adults of higher (≥6y) vs. lower (<6y) education, in Muslims vs. other religions (Christians, Hindus), and for the lowest vs. all other income groups. This overestimation was notably higher in young children (0-5y) vs. all other age groups and in the lowest vs. all other income groups. Underestimation was rarely observed, for example for milk intake (-56%) in young children (0-5y). The PC approach did not capture heterogeneity in validity of estimation of different dietary factors by age, mainly in children (0-5y, 6-10y). Spearman's correlations between individualized household estimates and 24hR data were higher for the AME (0.30–0.70) than PC (0.20–0.50) approach. Findings were similar with and without multivariate regression, with proportions of variance (R2) in 24hR intakes explained by the AME being generally greater than PC estimates, yet still low to modest. Conclusions: In this national survey, established methods for estimating individual level intakes from household surveys produce overestimation of intakes of nearly all dietary indicators, with significant variation depending on the dietary factor and modest variation depending on individual characteristics. These findings suggest a need for new methods to estimate individual-level consumption from household survey estimates. [ABSTRACT FROM AUTHOR]

Recent advances in statistical methods enable the study of correlation among outcomes through joint modeling, thereby addressing spillover effects. By joint modeling, we refer to simultaneously analyzing two or more different response variables emanating from the same individual. Using the 2011 Bangladesh Demographic and Health Survey, we jointly address spillover effects between contraceptive use (CUC) and knowledge of HIV and other sexually transmitted diseases. Jointly modeling these two outcomes is appropriate because certain types of contraceptive use contribute to the prevention of HIV and STDs and the knowledge and awareness of HIV and STDs typically lead to protection during sexual intercourse. In particular, we compared the differences as they pertained to the interpretive advantage of modeling the spillover effects of joint modeling HIV and CUC as opposed to addressing them separately. We also identified risk factors that determine contraceptive use and knowledge of HIV and STDs among women in Bangladesh. We found that by jointly modeling the correlation between HIV knowledge and contraceptive use, the importance of education decreased. The HIV prevention program had a spillover effect on CUC: what seemed to be impacted by education can be partially contributed to one’s exposure to HIV knowledge. The joint model revealed a less significant impact of covariates as opposed to both separate models and standard models. Additionally, we found a spillover effect that would have otherwise been undiscovered if we did not jointly model. These findings further suggested that the simultaneous impact of correlated outcomes can be adequately addressed for the commonality between different responses and deflate, which is otherwise overestimated when examined separately. [ABSTRACT FROM AUTHOR]

Background: Unwanted birth is an important public health concern due to its negative association with adverse outcomes of mothers and children as well as socioeconomic development of a country. Although a number of studies have been investigated the determinants of unwanted births through logistic regression analysis, an extensive assessment using path model is lacking. In the current study, we applied path analysis to know the important covariates for unwanted births in Bangladesh. Methods: The study used data extracted from Bangladesh Demographic and Health Survey (BDHS) 2011. It considered sub-sample consisted of 7,972 women who had given most recent births five years preceding the date of interview or who were currently pregnant at survey time. Correlation analysis was used to find out the significant association with unwanted births. This study provided the factors affecting unwanted births in Bangladesh. The path model was used to determine the direct, indirect and total effects of socio-demographic factors on unwanted births. Results: The result exhibited that more than one-tenth of the recent births were unwanted in Bangladesh. The differentials of unwanted births were women’s age, education, age at marriage, religion, socioeconomic status, exposure of mass-media and use of family planning. In correlation analysis, it showed that unwanted births were positively correlated with women age and place of residence and these relationships were significant. On the contrary, unwanted births were inversely significantly correlated with education and social status. The total effects of endogenous variables such as women age, place of residence and use of family planning methods had favorable effect on unwanted births. Conclusion: Policymakers and program planners need to design programs and services carefully to reduce unwanted births in Bangladesh, especially, service should focus on helping those groups of women who were identified in the analysis as being at increased risks of unwanted births- older women, illiterate, low socioeconomic status, early age at marriage and rural poor susceptible women. [ABSTRACT FROM AUTHOR]

Background: High salt consumption is an important risk factor of elevated blood pressure. In Bangladesh about 20 million people are at high risk of hypertension due to climate change induced saline intrusion in water. The objective of this study is to assess beliefs, perceptions, and practices associated with salt consumption in coastal Bangladesh. Methods: The study was conducted in Chakaria, Bangladesh between April-June 2011. It was a cross sectional mixed method study. For the qualitative study 6 focus group discussions, 8 key informant interviews, 60 free listing exercises, 20 ranking exercises and 10 observations were conducted. 400 adults were randomly selected for quantitative survey. For analysis we used SPSS for quantitative data, and Anthropac and Nvivo for qualitative data. Results: Salt was described as an essential component of food with strong cultural and religious roots. People described both health benefits and risks related to salt intake. The overall risk perception regarding excessive salt consumption was low and respondents believed that the cooking process can render the salt harmless. Respondents were aware that salt is added in many foods even if they do not taste salty but did not recognize that salt can occur naturally in both foods and water. Conclusions: In the study community people had low awareness of the risks associated with excess salt consumption and salt reduction strategies were not high in their agenda. The easy access to and low cost of salt as well as unrecognised presence of salt in drinking water has created an environment conducive to excess salt consumption. It is important to design general messages related to salt reduction and test tailored strategies especially for those at high risk of hypertension. [ABSTRACT FROM AUTHOR]

Background: Since 2007, BRAC has been implementing malaria prevention and control programme in 13 endemic districts of Bangladesh under the National Malaria Control Programme. This study was done to examine the role of different communication media in bringing about changes in knowledge and awareness which facilitate informed decision-making for managing malaria-like illnesses. Methods: A baseline survey in 2007 before inception of the programme, and a follow-up survey in 2012 were done to study changes in different aspects of programme interventions including the communication component. Both the surveys used the same sampling technique to select 25 households at random from each of the 30 mauza/villages in a district. A pre-tested, semi-structured questionnaire was used to collect relevant information from respondents in face-to-face interview. Analysis was done comparing the study areas at two different times. Statistical tests were done as necessary to examine the differences. Results: The intervention succeeded in improving knowledge in some trivial areas (e.g., most frequent symptom suggestive of malaria, importance of using insecticidal bed nets) but not in critical domains necessary for taking informed action (e.g., mode of malaria transmission, awareness about facilities providing free malaria treatment). Inequity in knowledge and practice was quite common depending upon household affluence, location of households in high or low endemic districts, and sex. Of the different media used in Information, Education and communication (IEC) campaigns during the study period, interpersonal communication with community health workers/relatives/neighbours/friends was found to be more effective in improving knowledge and practice than conventional print and audio-visual media. Conclusion: This study reiterates the fact that conventional media may not be user-friendly or culture-sensitive for this semi-literate/illiterate community where dissemination through ‘words of mouth’ is more common, and as such, interpersonal communication is more effective. This is especially important for initiating informed action by the community in managing malaria-like illnesses. [ABSTRACT FROM AUTHOR]