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The association between maternal depressive and anxiety symptoms and impaired bonding with infants were widely studied, but not in fathers and none in Malaysia. We investigated the impact of different trajectories of perinatal depressive and anxiety symptoms on parent-infant impaired bonding during 2–3 months postpartum in both mothers and fathers in two areas of Malaysia. This study originated from a psychiatric morbidity cohort study carried out in health clinics in east and west Malaysia. Edinburgh Postnatal Depression Scale and anxiety subscale of Depression, Anxiety, and Stress Scale at late pregnancy and 2–3 months postpartum and Postpartum Bonding Questionnaire were completed by 566 mothers and 457 fathers. About 11.7% mothers and 16.1% fathers reported depressive symptoms during pregnancy, 6.5% mothers and 10.5% fathers during 2–3 months postpartum, and 3–4% mothers and fathers both depressive and anxiety symptoms 2–3 months postpartum. The mean impaired bonding score was highest in mothers and fathers who had both depressive and anxiety symptoms 2–3 months postpartum. Impaired bonding is associated with higher EPDS and DASS (anxiety subscale) scores 2–3 months postpartum in both parents. Physical partner violence and deteriorated marital relationship were associated with increased risk of impaired bonding in mothers. The association between depressive, anxiety, and comorbidity of depressive and anxiety symptoms in both mothers and fathers and parent-infant impaired bonding during 2–3 months postpartum urges for screening and treatment of depressive and anxiety symptoms in both parents during early parenthood.

INTRODUCTION: COVID-19 pandemic has caused a major impact to global public health including one of the high risk groups which is the medical students. This study was intended to assess knowledge, attitudes and practices (KAP) towards COVID-19 among medical students in International Islamic University Malaysia (IIUM). MATERIAL AND METHOD: An online cross-sectional study was conducted among 438 medical students of IIUM from 6th July 2020 to 9th July 2020. KAP towards COVID-19 was measured using a structured Malay and English version questionnaire consisting of 13 items on knowledge, 3 items on attitudes and 3 items on practices. RESULTS: The average correct response rate on knowledge was 85.4%. Only 12.1% of the students had correct knowledge on all items, and 1 in every 4 and 5 students had misconceptions on the clinical features and transmission of COVID-19. In term of attitudes towards COVID-19, majority of the respondents believed that COVID-19 would be effectively controlled (85%) and had faith that Malaysia could overcome the war against COVID-19 (99%). Most of the respondents practiced good towards COVID-19 in avoiding crowded places (90%), wearing face masks (95%) and practicing hand hygiene (91.6%). CONCLUSION: Although the results are positive towards KAP, only 1 in every 10 students responded correctly to all knowledge questions, and few proportions had misconceptions on the disease and did not maintain adequate practices. Policies aimed at appropriate health promotion activities may ensure empowering the medical students with adequate knowledge on all aspects of COVID-19, and practice properly following the standard operating procedure implemented by the government.

INTRODUCTION: One of the most important and debilitating complication of diabetes mellitus is foot problem such as ulcers, infections and amputations. However, these complications are preventable by simple intervention such as regular foot care practice. This study aims to assess the foot care practice and its associated factors among type 2 diabetes mellitus patients attending primary health clinics in Kuantan. MATERIALS AND METHODS: This was a cross-sectional study conducted at four primary health clinics in Kuantan involving 450 study participants who were selected by using universal sampling method. Level of awareness and practice toward diabetic foot care was assessed using validated self-administered questionnaire. Multiple logistic regressions were performed to identify factors associated with poor foot care practice among the respondents. RESULTS: About 59.6% of respondents had poor foot care practice and 50.9% had poor awareness level. Multivariate logistic regression analysis identified that, increasing age (OR 0.97, 95% CI: 0.955-0.993) and good awareness towards foot problem (OR 0.43, 95%CI: 0.289-0.643) were less likely to have poor foot care practice. However, Malay ethnicity (OR 1.81, 95% CI: 1.002-3.271) and obesity (OR 1.9, 95% CI: 1.225-2.976) were associated with poor foot care practice after controlling other variables. CONCLUSION: Majority of the respondents had poor foot care practice and poor awareness. Respondents who are older and have better awareness are less likely to have poor foot care practice. Diabetic patients who are Malays and/or obese are predicted to have poor diabetic foot practice and hence must be prioritized for a sustainable patient education and compliance towards foot care practice at primary care level.

Background: Foot complications are considered to be a serious consequence of diabetes mellitus, posing a major medical and economic threat. Identifying the extent of this problem and its risk factors will enable health providers to set up a better prevention programs. Objectives: This study aims to assess the prevalence of diabetic foot at risk and its associated factors among the type 2 diabetes mellitus patients’ attending primary health clinics in Kuantan. Methods: This was a cross-sectional study conducted at four primary health clinics in Kuantan involving 450 study participants who were selected by using universal sampling method. Level of awareness and practice toward diabetic foot care was assessed using validated self-administered questionnaire. Foot examination carried out and foot at risk was classified based on Kings’ Classification. Multiple logistic regressions were performed to identify the risk factors for diabetic foot at risk. Results: The prevalence of diabetic foot at risk was 31.3% (95% CI: 0.27, 0.36) according to Kings Classification (stage 2). Mean age of respondents involved was 56.36 (SD±10.9) years. Multivariate logistic regression analysis identified age (OR 1.04, 95%CI: 1.01-1.06), smoker (OR .911, 95%CI: 1.96-8.63) and duration of diabetes more than 10 years (OR1.77, 95%CI: 1.05-2.98) were risk factors for diabetic foot at risk. However, respondents with good practice score (OR 0.87, 95%CI: 0.774-0.980) have lesser risk of developing diabetic foot at risk. However, level of awareness, race, gender, education level and diabetic control did not show any significant association with diabetic foot at risk. Conclusion: Based on the result, it can be concluded that the screening for diabetic foot at risk is vital for early detection and intervention to prevent serious complication. A sustainable patient education and compliance towards practice of foot care at primary care level should be emphasized more to ensure good foot care practice implementation.

Introduction: Most of the smokers remain as active smokers and unrecognized their nicotine dependence (ND) level. ND was an important reason to addict smoking. The study determined the prevalence of smoking and ND among adult males and their difficulties to quit smoking. Methods: A cross-sectional study was conducted among 296 males aged 18 years and above from Felda Bukit Goh at Kuantan, Malaysia in 2015. Socio-economic status, history of smoking, quit attempt and reasons for failing quit were explored by using a self-administered questionnaire. Level of ND was assessed by validated Malay version of Fagerstrom Test for ND questionnaires. Stratified analysis on relationship among socio-economic status and current smoking status, level of ND was done. Results: The prevalence of current smokers was 61.1% and the prevalence of low and moderate to high ND level was 76.2 % and 23.8 % respectively. Among them 54.1% of smokers were tried to quit smoking ranging from 1 to 30 times by self-awareness (48%) and their main reason to fail was addiction (71.9%). Smokers with monthly household income (RM2000-2999) was independently associated with moderate to high ND with AOR=4.73 (95% CI 1.83-12.18) compared to those with income (less than RM2000). Conclusion: Despite high prevalence of smoking, majority of smokers have low ND and addiction was the main reason to fail quit attempt. Household income was a contributing factor for moderate to high ND. The finding provides hope for the success of smoking cessation programme if it is to be done in this locality.

Introduction: Eating disorders are a poorly understood condition characterised by severe psychiatric and medical manifestations, in which eating habits, physical health and psychosocial functioning are disturbed. College and university students are among the population who are prone to eating disorder. The aim of this study is to determine the prevalence of eating disorders risk in the International Islamic University Malaysia (IIUM), Kuantan campus amongst the medical students and to identify its associated factors. Materials and Methods: A cross sectional study involving 200 medical students of IIUM Kuantan campus session 2014/2015 of all years (20-26 years old) of both genders using a self-administered questionnaire through an online website which is a Google drive between 29th June till 10th July 2015. Result: This study revealed that the prevalence of risk for eating disorder among IIUM Kuantan campus medical students is 15.0 percent. On the same note, the risk is noted to be higher among single female of Malay ethnicity, being middle child, overweight and physically inactive; albeit none of these factors significantly associated with risk of eating disorder among this population. Conclusion: The prevalence of those who have the risk of eating disorder in this study is comparable to the result from the previous studies conducted among college and university students in Malaysia. Nevertheless, the risk of eating disorder is documented among IIUM medical students and warrant a closer look and appropriate reference for those who have the risk.

Background Research on antepartum psychiatric morbidities investigating depressive and anxiety symptoms in expectant mothers and fathers is lacking in low- and middle-income countries. This study aimed to estimate the prevalence of antepartum depressive, anxiety and co-occurring significant symptoms and explore the associated factors in a cross-section of Malaysian expectant mothers and fathers. Methods We used cross-sectional data from a prospective cohort study of 911 expectant mothers and 587 expectant fathers during their third trimester of pregnancy, from health clinics of two states in the east and west coasts of Malaysia. The validated Malay version of Edinburgh Postnatal Depression Scale and the anxiety sub-scale of Depression, Anxiety and Stress Scale were used to measure the depressive and anxiety symptoms. Multiple logistic regression analyses identified the determinants of antepartum depressive and anxiety symptoms (ADS and AAS). Results Prevalence of ADS was 12.2% in expectant mothers and 8.4% in expectant fathers, while AAS was 28.8% in expectant mothers and 13.3% in expectant fathers, and co-occurring significant symptoms was 8.0% in expectant mothers and 4.0% in expectant fathers. Expectant mothers and fathers having perceived social/family support were less likely to suffer from ADS. Intimate partner violence, poor relationship with husbands, depression in earlier pregnancy and husband’s depression in current pregnancy in expectant mothers, and living in rented house, sex preference for the unborn child, stressful life events and wife’s depression in current pregnancy in expectant fathers were associated with a greater likelihood of ADS. The determinants for AAS were living in rented house and with parents/in-laws, poor relationship with husbands, restrictions during pregnancy and stressful life events for expectant mothers, and stressful life events and being unsupportive towards wives in household chores for expectant fathers. Conclusion Both ADS and AAS are prevalent in expectant mothers and fathers, and largely an undetected problem in Malaysia. Administration of couple-based screening and referral program during antenatal check-up should be universal practices to identify and treat the psychiatric morbidities.

Introduction: Obstructive sleep apnea (OSA) is an insidious sleep breathing disorder, with cardinal manifestations of snoring, witnessed breathing pause during sleep and excessive daytime sleepiness. The aim of the study was to estimate the prevalence of OSA and its associated factors among adult population in Taman Dato’ Rashid Salleh, Kuantan. Materials and method: A cross-sectional study was carried out among 157 participants who lived in Taman Dato’ Rashid Salleh from May 2018 to June 2018. Obstructive sleep apnea was quantified using the self-administered Malaynvalidated Berlin questionnaire which apart from the demographic data included three categories (10 questions) designed to elicit information regarding snoring (category 1), daytime somnolence (category 2) and the presence of obesity and/or hypertension (category 3). The respondents were considered as high risk of OSA if two or more categories were positive. Weight, height and neck circumference were measured by using Secca© weight scales, Secca© stadiometer and non-elastic plastic tape, respectively. Descriptive statistics was used to measure the prevalence, while chi-square test was used to explore the association of OSA and its background variables. Results: Out of 157 respondents, female and Malay were dominant with the 56.7% and 91.0 %, respectively. The mean age of the respondents was 36.7 (12.2) years old. The prevalence of high risk of OSA in was 18.5%. There was no association between gender, age, race, smoking and neck circumference with risk of OSA while Body Mass Index (BMI) and hypertension were significantly related to an increased risk for developing OSA (p-value < 0.001 and p=0.001, respectively). Conclusions: Two in every 10 adults in Taman Dato’ Rashid Salleh, Kuantan were at high risk of OSA. It is recommended that appropriate health promotion should be targeted to this community to instill awareness and increase the level of understanding of the public on OSA.

Introduction: Despite significant improvement in health status in Malaysia, the prevalence of low birth weight (LBW) in newborns remained unchanged over the past 12 years. In the past decade, there have been assumptions regarding the potential etiologic association of psychosocial factors with LBW. It is widely believed that only mothers are affected by depression and anxiety during pregnancy. However, this study aimed to investigate the independent effects of paternal antepartum depressive and anxiety symptoms on LBW newborns in Kuantan, Pahang. Materials and Methods: A prospective cohort study of 450 expectant fathers was carried out in six conveniently selected government health clinics in Kuantan, Pahang. Paternal antepartum depressive symptoms were assessed using Edinburgh Postpartum Depression Scale (EPDS) and anxiety symptoms using Depression Anxiety Stress Scale-21 (DASS-21) and they were followed-up until delivery. Newborn birth weight of singleton live babies delivered at term (≥37 weeks) were recorded to the nearest 0.1kg from Infant and Child Health Record. Descriptive analysis along with chi-square and independent sample t-test were carried out together with multiple logistic regression model to identify predictors of LBW. Results: After adjusting for potential cofounders, paternal depressive (OR=4.29; 95% CI 1.17-15.72) and paternal anxiety (OR= 4.62; 95% CI 1.74-12.26) symptoms were significantly associated with LBW (≤2.5kg). Conclusion: This study showed that paternal depressive and anxiety symptoms increased the risk of newborn LBW. Therefore, it is crucial to detect and manage the depressive and anxiety symptoms for expectant fathers during antenatal care to reduce the burden of LBW.

BACKGROUND Research findings have linked exposure to pesticides to an increased risk of cardiovascular (CVS) diseases. Therefore, this study aimed to assess the impact of chronic mix-pesticides exposure on CVS hemodynamic parameters. METHODS A total of 198 male Malay pesticide-exposed and 195 male Malay nonexposed workers were examined. Data were collected through exposure-matrix assessment, questionnaire, blood analyses, and CVS assessment. Explanatory variables comprised of lipid profiles, paraoxonase 1 (PON1), and oxidized low-density lipoprotein (ox-LDL). Outcome measures comprised of brachial and aortic diastolic blood pressure (DBP) and systolic BP (SBP), heart rate, and pulse wave velocity (PWV). Linear regressions identified the B coefficient showing how many units of CVS parameters are associated with each unit of covariates. RESULTS Diazoxonase was significantly lower and ox-LDL was higher among pesticide-exposed workers than the comparison group. The final multivariate linear regression model revealed that age, body mass index (BMI), smoking, and pesticide exposure were independent predictors of brachial and aortic DBP and SBP. Pesticide exposure was also associated with heart rate, but not with PWV. Lipid profiles, PON1 enzymes, and ox-LDL showed no association with any of the CVS parameters. CONCLUSIONS Chronic mix-pesticide exposure among workers involved in mosquito control has possible association with depression of diazoxonase and the increase in ox-LDL, brachial and aortic DBP and SBP, and heart rate. This study raises concerns that those using pesticides may be exposed to hitherto unrecognized CVS risks among others. If this is confirmed by further studies, greater efforts will be needed to protect these workers.

Intimate partner violence (IPV) during the first year postpartum is common in Bangladesh, and many infants are exposed to hostile and aggressive environment. The aim of the current study was to investigate how IPV (physical, emotional, and sexual) impacts on the mother’s perception of her infant’s temperament 6 to 8 months postpartum, and whether maternal depressive symptom at 6 to 8 months postpartum is a mediator in this association. A total of 656 rural Bangladeshi women and their children 6 to 8 months postpartum were included in this study. Data were collected by structured interviews. The women were asked about physical, sexual, and emotional IPV; depressive symptoms (Edinburgh Postnatal Depressive Symptoms [EPDS]); and their perception of infant temperament assessed by the Infant Characteristic Questionnaire (ICQ). Descriptive analyses were conducted for prevalence of IPV and maternal depressive symptoms. Mediation analysis was conducted with a series of linear regressions with types of IPV as independent variables, ICQ including its subscales as dependent variables and maternal depressive symptoms as potential mediator. All the analyses were adjusted for the woman’s and her husband’s ages and number of children of the couple. Nearly 90% of the mothers reported some kind of IPV at 6 to 8 months postpartum. All types of IPV were directly associated with the mother’s perception of her infant as unadaptable. Maternal depressive symptom was a mediating factor between physical IPV and the ICQ subscales fussy-difficult and unpredictable. In addition, depressive symptoms mediated between sexual and emotional IPV, and the mother’s perception of the infant as unpredictable. The results showed that IPV influenced how mothers perceived their infant’s temperament. It is important that health care professionals at maternal and child health services enquire about IPV with possibilities to refer the family or the mother and infant for appropriate support.

Aim: To investigate the impact of postnatal depressive symptoms and infant sex on perceived and observed mother-infant interaction among rural Bangladeshi women. Methods: Fifty women with depressive symptoms and their infants at 2 - 3 months were compared with 50 women without depressed symptoms and their infants, matched on geographic areas, parity and infant sex. The Edinburgh Postnatal Depression Scale assessed depressive symptoms, the Postpartum Bonding Questionnaire assessed the mother’s perception of bonding with the infant and mother-infant interactions were videotaped and analyzed with the Global Rating Scale. Results: Mothers with depressive symptoms were poorer, were less educated and rated lower infant bonding than mothers without depressive symptoms (p = 0.03), yet objective observation revealed no difference between the two groups regarding maternal interactive behavior (p = 0.57). However, infants, particularly boys (p = 0.002), of mothers with depressive symptoms fretted more in mother-infant interaction than infants of mothers without depressive symptoms (p = 0.009). Conclusion: Although mothers with depressive symptoms did not show less sensitivity in interactive behavior at 2 - 3 months than those without depressive symptoms, our results indicate that infants, particularly boys, of mothers with depressive symptoms may be negatively influenced by depressive symptoms.

Background Studies on a limited scale in urban settings of Bangladesh report stillbirth rates that do not specifically provide information on the situation of underprivileged slum populations. This study aims to estimate the prevalence of, and risk factors associated with, stillbirth in a developing population. Methods A case–control study was conducted on women having a singleton birth between November 2008 and April 2009 in 34 slum areas in Dhaka. Data were collected on 231 women with stillbirth (cases) and 464 women having livebirth (controls). This study utilised the records of the Manoshi programme and supplemented it with data obtained through interview of the women. Results The stillbirth rate was 26 per 1000 total births, of which 62% occurred during the intrapartum period. Obstetrical complications contributed to 61.4% of stillbirths. Illiterate women [odds ratio (OR) 1.6 [95% confidence interval (CI) 1.1, 2.2]], women aged ≥35 years (OR 2.9 [95% CI 1.5, 25.5]), preterm delivery (OR 5.2 [95% CI, 3.2, 8.5]), prolonged labour (OR 2.8 [95% CI 1.6, 4.6]) and failure of labour progress (OR 2.4 [95% CI 1.1, 5.5]) were significant maternal risk factors, while decreased fetal movement, fetal malpresentation and fetal distress were the fetal risk factors associated with stillbirth. Conclusions Risk factors associated with stillbirths are amenable to intervention. There is an urgent need to educate pregnant women about risk factors for stillbirths during antenatal visits. Encouraging women to deliver at health facilities and better management of obstetrical complications may help reduce the burden of stillbirths in Bangladesh.

Over recent years, researchers have found evidence which indicates that the prevalence of postpartum depressive symptoms crosses cultural boundaries and is reported to be at least as high in non-Western countries as in Western countries. However, qualitative studies about new mothers’ experiences from non-Western countries, such as Bangladesh, are rare, particularly in rural areas. This study aims to describe the experiences and concerns of rural Bangladeshi mothers with postpartum depressive symptoms. Open narrative interviews were conducted with 21 mothers with depressive symptoms 2–3 months postpartum, consecutively selected from a longitudinal study about prevalence and risk factors of perinatal depressive symptoms. Inductive content analysis was used to analyse data and three themes emerged: family dynamics, living at the limits of survival, and role of the cultural context after childbirth. These themes were based on six categories and 15 subcategories. The findings show that troublesome family relationships, including intimate partner violence and violence in the family, influenced the mothers’ mental well-being. They and their families lived at the limit of survival and the mothers expressed fear and worries about their insecure situation regarding economic difficulties and health problems. They felt sorry for being unable to give their infants a good start in life and sad because they could not always follow the traditional norms related to childbirth. Thus, it is important to focus on the depressive symptoms among new mothers and offer counselling to those showing depressive symptoms, as the cultural traditions do not always alleviate these symptoms in the changing Bangladeshi society today.

Objective: Limited evidence exists on the incidence of postpartum depressive symptoms (PDS) in low-income countries. This study aims to determine the incidence of and risk factors for developing PDS in a cohort of women in rural Bangladesh. Methods: A total of 588 consecutive women were assessed during the last trimester of pregnancy, 2-3 and 6-8 months postpartum for depressive symptoms and for putative risk factors. The validated Bangla version of Edinburgh Postnatal Depression Scale was used to measure PDS. Background information was collected using a structured questionnaire at the respondents' homes. Multiple Cox's regression analyses identified risk factors of PDS. Results: The incidence proportion of PDS from third trimester of pregnancy to 2-3 months postpartum was 8.0%, and from 2-3 to 6-8 months postpartum 18.4%. Poor socioeconomic status (HR 2.62, 95% CI 1.83-3.73), physical partner violence during pregnancy (HR 1.65, 95% CI 1.08-2.50), anxiety symptoms during pregnancy (HR 1.69, 95% CI 1.16-2.46), and previous depressive symptoms (HR 2.95, 95% CI 1.80-4.84) were identified as risk factors. Conclusion: PDS are common, heterogeneous and largely undetected public health problem in Bangladesh. Screening for depressive symptoms in the last trimester of pregnancy or in the 6-8 months postpartum ought to be integrated into maternal and child health programmes. Intervention to reduce depressive symptoms during postpartum needs to target those women who are poor, experienced violence during pregnancy, had anxiety symptoms during pregnancy, and had a previous history of depressive symptoms.

In 1997, two organizations, BRAC (Bangladesh Rural Advancement Committee) and ICDDR,B (International Center for Diarrheal Disease Research), as part of their collaborative research model, developed an HIV/AIDS prevention strategy for rural Bangladeshi youth. Currently, HIV/AIDS is not apparent in rural Bangladesh. Other sexual and reproductive health problems are more pressing. Moreover, there are few inor out-of-school sex education programs for adolescents in Bangladesh. Therefore, preliminary qualitative research was conducted to understand the broad parameters of sexual and reproductive health within the sociocultural context of young people's risks and vulnerabilities. Exploratory research revealed that youth were vulnerable to sexual diseases, late-term abortions, sexual violence, reproductive tract infections, and premarital pregnancies. Adolescents and adults thought that youth today need sex education. Adults said that youth should not be educated about condom use because this would conflict with...

Most people in Bangladesh are rural, poor and underprivileged. The incidence of sexual disease has increased, but little has been done to educate rural people about sexual and reproductive health. In 1997, a sexual and reproductive health project was initiated within a collaborative research agreement between the International Centre for Diarrhoeal Disease Research (ICDDR,B) and the Bangladesh Rural Advancement Committee (BRAC), an indigenous non-governmental organization which pursues integrated rural development strategies. Qualitative in-depth interviews with 65 different women, men, boys and girls revealed significant sexual health problems and a lack of knowledge of sexual and reproductive health. The interviews were transformed into composite problem-solving picture stories and information about sexual and reproductive health. Stories mirrored respondents' interpretations of sexual behavior. Those who had achieved or ascribed legitimacy to talk about sex, e.g. traditional health providers, were trai...

Objective To explore the role of a community-based intervention in reducing delays in accessing emergency obstetric care (EmOC) in rural Bangladesh, and the factors associated with delayed decision making, reaching the health facility and receiving treatment. Study design Quasi-experimental study. Methods Multistage random sampling was used to select 540 villages, from which 1200 women who reported obstetric complications in March–April 2010 were interviewed. Results The median time taken to make the decision to access health care was significantly lower in the intervention areas compared with the control areas (80 vs 90 min). In addition, the median time taken to reach the health facility was significantly lower in the intervention areas compared with the control areas (110 vs 135 min). However, no difference was found in the median time taken to receive treatment. Multiple linear regressions demonstrated that the community intervention significantly reduced decision making and time taken to reach the health facility when accessing EmOC in rural Bangladesh. However, for women experiencing haemorrhage, the delays were longer in the intervention areas. Protective factors against delayed decision making included access to television, previous medical exposure, knowledge, life-threatening complications during childbirth and use of a primary health facility. Financial constraints and traditional perceptions were associated with delayed decision making. Complications during labour, use of a motorized vehicle and use of a primary health facility were associated with faster access to EmOC, and poverty, distance, transportation difficulties and decision made by male guardian were associated with slower access to EmOC. Conclusions The intervention appeared to reduce the time taken to make the decision to access health care and the time taken to reach the health facility when accessing EmOC. This study provides support for a focus on emergency preparedness for timely referral from the community.

Background The status of men’s knowledge of and awareness to maternal, neonatal and child health care are largely unknown in Bangladesh and the effect of community focused interventions in improving men’s knowledge is largely unexplored. This study identifies the extent of men’s knowledge and awareness on maternal, neonatal and child health issues between intervention and control groups. Methods This cross sectional comparative study was carried out in six rural districts of Bangladesh in 2008. BRAC health programme operates ‘improving maternal, neonatal and child survival’ intervention in four of the above-mentioned six districts. The intervention comprises a number of components including improving awareness of family planning, identification of pregnancy, providing antenatal, delivery and postnatal care, newborn care, under-5 child healthcare, referral of complications and improving clinical management in health facilities. In addition, communities are empowered through social mobilization and advocacy on best practices in maternal, neonatal and child health. Three groups were identified: intervention (2 years exposure); transitional (6 months exposure) and control. Data were collected by interviewing 7,200 men using a structured questionnaire. Results Men prefer to gather in informal sites to interact socially. Overall men’s knowledge on maternal care was higher in intervention than control groups, for example, advice on tetanus injection should be given during antenatal care (intervention = 50%, control = 7%). There were low levels of knowledge about birth preparedness (buying delivery kit = 18%, arranging emergency transport = 13%) and newborn care (wrapping = 25%, cord cutting with sterile blade = 36%, cord tying with sterile thread = 11%) in the intervention. Men reported joint decision-making for delivery care relatively frequently (intervention = 66%, control = 46%, p Conclusion Improvement in men’s knowledge in intervention district is likely. Emphasis of behaviour change communications messages should be placed on birth preparedness for clean delivery and referral and on newborn care. These messages may be best directed to men by targeting informal meeting places like market places and tea stalls.

Background Evidence linking maternal depressive symptoms with infant’s growth and development in low-income countries is inadequate and conflicting. This study investigated the independent effect of maternal perinatal depressive symptoms on infant’s growth and motor development in rural Bangladesh. Methods A cohort of 720 pregnant women was followed from the third trimester of pregnancy to 6–8 months postpartum. For growth and developmental outcomes, 652 infants at 2–3 months and 6–8 months were assessed. Explanatory variables comprised maternal depressive symptoms, socioeconomic status, and infant’s health and temperament. Outcome measures included infant’s underweight, stunting and motor development. Multiple linear regression analyses identified predictors of infant growth and development. Results Maternal postpartum depressive symptoms independently predicted infant’s underweight and impaired motor development, and antepartum depressive symptoms predicted infant’s stunting. Infant’s unadaptable temperament was inversely associated with infant’s weight-for-age and motor development, and fussy and unpredictable temperament with height-for-age and motor development. Limitations Repeated measures design might threaten the internal validity of the results 8.3% of the participant does not participate in the measurements at different times. As the study was conducted in two sub-districts of rural Bangladesh, it does not represent the urban scenario and cannot be generalized even for other rural areas of the country. Conclusion This study provides evidence that maternal ante- and postpartum depressive symptoms predict infant’s growth and motor development in rural Bangladesh. It is recommended to integrate psychosocial components in maternal and child health interventions in order to counsel mothers with depressive symptoms.

Aims: Evidence exists about prevention of postpartum haemorrhage (PPH) by oral administration of misoprostol in low-income countries, but effectiveness of prevention by lay community health workers (CHW) is not sufficient. This study aimed to investigate whether a single dose (400 µg) of oral misoprostol could prevent PPH in a community home-birth setting and to assess its acceptability and feasibility among rural Bangladeshi women. Methods: This quasi-experimental trial was conducted among 2,017 rural women who had home deliveries between November 2009 and February 2010 in two rural districts of northern Bangladesh. In the intervention district 1,009 women received 400 µg of misoprostol immediately after giving birth by the lay CHWs, and in the control district 1,008 women were followed after giving birth with no specific intervention against PPH. Primary PPH (within 24 hours) was measured by women’s self-reported subjective measures of the normality of blood loss using the ‘cultural consensus model.’ Baseline data provided socio-economic, reproductive, obstetric, and bleeding disorder information. Findings: The incidence of primary PPH was found to be lower in the intervention group (1.6%) than the control group (6.2%) ( p

The purpose of this study was to investigate the impact of depressive and anxiety symptoms on maternal bonding to the infant 2–3 months postpartum and the influence of the mother’s bonding to the infant during pregnancy and to her own caregiver during her childhood on maternal bonding 2–3 months postpartum. This study originated from a community-based cohort study carried out in rural Bangladesh. Trained staff collected data and administrated the questionnaires during the third trimester of pregnancy, at childbirth and 2–3 months postpartum. Maternal depressive and anxiety symptoms were assessed with the Edinburgh Postnatal Depression Scale and the State Anxiety Inventory and the mother’s emotional bonding to the infant with the Postpartum Bonding Questionnaire. The results showed that 11% of the women reported depressive symptoms, 35% anxiety symptoms, 3.4% both depressive and anxiety symptoms and 51% neither depressive nor anxiety symptoms. Mothers with depressive symptoms were older, were poorer, fewer were literate, reported more intimate partner violence and showed lower emotional bonding to their infants 2–3 months postpartum compared to mentally well and anxious mothers. Approximately 11% of the mothers reported mild bonding disturbances and nearly one third of them showed depressive symptoms. Depressive symptoms and giving birth to a girl were negatively associated to a mother’s emotional bonding to her infant, while maternal anxiety symptoms and high bonding to the foetus during pregnancy were positively associated to the mother's emotional bonding to the infant 2–3 months postpartum.

Background : The prevalence of intimate partner violence (IPV), a gross violation of human rights, ranges widely across the world with higher prevalence reported in low- and middle-income countries. Evidence related mainly to physical health shows that IPV has both direct and indirect impacts on women's health. Little is known about the impact of IPV on the mental health of women, particularly after childbirth. Objective : To describe the prevalence of IPV experienced by women 6–8 months after childbirth in rural Bangladesh and the factors associated with physical IPV. The study also aims to investigate the association between IPV and maternal depressive symptoms after childbirth. Design : The study used cross-sectional data at 6–8 months postpartum. The sample included 660 mothers of newborn children. IPV was assessed by physical, emotional, and sexual violence. The Edinburgh Postnatal Depression Scale assessed maternal depressive symptoms. Results : Prevalence of physical IPV was 52%, sexual 65%, and emotional 84%. The husband's education (OR: 0.41, CI: 0.23–0.73), a poor relationship with the husband (OR: 2.64, CI: 1.07–6.54), and emotional violence by spouse (OR: 1.58, CI: 1.35–1.83) were significantly associated with physical IPV experienced by women. The perception of a fussy and difficult child (OR: 1.05, CI: 1.02–1.08), a poor relationship with the husband (OR: 4.95, CI: 2.55–9.62), and the experience of physical IPV (OR: 2.83, CI: 1.72–4.64) were found to be significant predictors of maternal depressive symptoms among women 6–8 months after childbirth. Neither forced sex nor emotional violence by an intimate partner was found to be significantly associated with maternal depressive symptoms 6–8 months postpartum. Conclusions : It is important to screen for both IPV and depressive symptoms during pregnancy and postpartum. Since IPV and spousal relationships are the most important predictors of maternal depressive symptoms in this study, couple-focused interventions at the community level are suggested. Keywords : intimate partner violence; mental health; South Asia; Bangladesh; maternal depression (Published: 12 September 2014) Citation : Glob Health Action 2014, 7 : 24725 - http://dx.doi.org/10.3402/gha.v7.24725 SPECIAL ISSUE : This paper is part of the Special Issue: Intimate Partner Violence and Mental Health . More papers from this issue can be found at http://www.globalhealthaction.net

Background Evidence from low and middle income countries (LMICs) suggests that maternal mortality is more prevalent among the poor whereas access to maternal health services is concentrated among the rich. In Bangladesh substantial inequities exist both in the use of facility-based basic obstetric care and for home births attended by skilled birth attendant. BRAC initiated an intervention on Improving Maternal, Neonatal, and Child Survival (IMNCS) in the rural areas of Bangladesh in 2008. One of the objectives of the intervention is to improve the utilization of maternal and child health care services among the poor. This study aimed to look at the impact of the intervention on utilization and also on equity of access to maternal health services. Methods A quasi-experimental pre-post comparison study was conducted in rural areas of five districts comprising three intervention (Gaibandha, Rangpur and Mymensingh) and two comparison districts (Netrokona and Naogaon). Data on health seeking behaviour for maternal health were collected from a repeated cross sectional household survey conducted in 2008 and 2010. Results Results show that the intervention appears to cause an increase in the utilization of antenatal care. The concentration index (CI) shows that this has become pro-poor over time (from CI: 0.30 to CI: 0.04) in the intervention areas. In contrast the use of ANC from medically trained providers has become pro-rich (from, CI: 0.18 to CI: 0.22). There was a significant increase in the utilisation of trained attendants for home delivery in the intervention areas compared to the comparison areas and the change was found to be pro-poor. Use of postnatal care cervices was also found to be pro-poor (from CI: 0.37 to CI: 0.14). Utilization of ANC services provided by medically trained provider did not improve in the intervention area. However, where the intervention had a positive effect on utilization it also seemed to have had a positive effect on equity. Conclusions To sustain equity in health care utilization, the IMNCS programme needs to continue providing free home based services. In addition to this, the programme should also continue to provide funding to bear the cost to those mothers who are not able to have the comprehensive ANC from medically trained providers.

Background Recognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC. Methods This cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. Pearson's chi-square test, t-test and Mann-Whitney test were performed. Results The median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities. Conclusions Manoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.

Background There is a high prevalence of antepartum depression and low birth weight (LBW) in Bangladesh. In high- and low-income countries, prior evidence linking maternal depressive and anxiety symptoms with infant LBW is conflicting. There is no research on the association between maternal mental disorders and LBW in Bangladesh. This study aims to investigate the independent effect of maternal antepartum depressive and anxiety symptoms on infant LBW among women in a rural district of Bangladesh. Methods A population-based sample of 720 pregnant women from two rural subdistricts was assessed for symptoms of antepartum depression, using the Edinburgh Postpartum Depression Scale (EPDS), and antepartum anxiety, using the State Trait Anxiety Inventory (STAI), and followed for 6-8 months postpartum. Infant birth weight of 583 (81%) singleton live babies born at term (≥37 weeks of pregnancy) was measured within 48 hours of delivery. Baseline data provided socioeconomic, anthropometric, reproductive, obstetric, and social support information. Trained female interviewers carried out structured interviews. Chi-square, Fisher's exact, and independent-sample t tests were done as descriptive statistics, and a multiple logistic regression model was used to identify predictors of LBW. Results After adjusting for potential confounders, depressive (OR = 2.24; 95% CI 1.37-3.68) and anxiety (OR = 2.08; 95% CI 1.30-3.25) symptoms were significantly associated with LBW (≤2.5 kg). Poverty, maternal malnutrition, and support during pregnancy were also associated with LBW. Conclusions This study provides evidence that maternal depressive and anxiety symptoms during pregnancy predict the LBW of newborns and replicates results found in other South Asian countries. Policies aimed at the detection and effective management of depressive and anxiety symptoms during pregnancy may reduce the burden on mothers and also act as an important measure in the prevention of LBW among offspring in Bangladesh.