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Background: There is a dearth of evidence on the trends and inequalities in utilizing cesarean section (CS) among women in Bangladesh. Hence, this study aimed to estimate the socioeconomic and geographical inequalities in delivery by CS among Bangladeshi women from 2004 to 2017. Methods: Data from Bangladesh Demographic and Health Survey 2004, 2007, 2011, 2014, and 2017 were analyzed using the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequalities were measured using four summary measures: Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF), and Ratio (R). Socioeconomic inequalities were assessed using two equity dimensions: household wealth status, and level of education, while geographical disparities were measured using two equity dimensions: place of residence, and sub-national regions. For each measure, point estimates and their 95% confidence intervals were reported. Results: An increasing trend in the prevalence (weighted) of CS in Bangladesh use was found from 4.50% in 2004 to 32.73% in 2017 We found significant socioeconomic inequalities in CS in every survey point, with a higher concentration of CS among the rich (in 2017, PAR = 28.57; 95% CI: 26.69–30.46) indicating a pro-rich inequality, and higher educated (in 2017, PAF = 23.97; 95% CI: 12.26–35.68) sub-groups. We also identified significant geographical disparities in CS with a higher concentration of CS among people from urban areas (in 2017, PAR = 10.99; 95% CI: 10.19–11.79), and a coastal region (Khulna division) (in 2017, PAF: 30.48 (95% CI: 18.66–42.30). Conclusion: We observed both socioeconomic and geographical inequalities in CS exist in Bangladesh, though the trends of these inequalities were curved over time. Thus, it is important to comprehend these pro-rich and geographical inequalities better and implement appropriate interventions and policies to alleviate them. [ABSTRACT FROM AUTHOR]

Background: Evidence suggested that inequalities based on education, wealth status, place of residence, and geographical regions significantly influence the key breastfeeding indicators including early initiation of breastfeeding. This study aimed to estimate the trends and magnitude of inequalities in early initiation of breastfeeding practice in Bangladesh from 2004 to 2017 applying both absolute and relative measures of inequality. Methods: We used data from the last five Bangladesh Demographic Health Survey (BDHS) from 2004 to 2017 to measure the inequalities in early initiation of breastfeeding practice using the WHO's Health Equity Assessment Toolkit (HEAT) software. Following summary measures were estimated to measure the inequalities: Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) where the equity dimensions were wealth status, education level, sex of child, place of residence, and subnational regions (divisions). For each measure, point estimates along with a 95% confidence interval (CI) were reported. Results: An uprising pattern in the prevalence of early initiation of breastfeeding was found, where early initiation of breastfeeding increased from 24.9% to 2004 to 59.0% in 2017. We found significant wealth-driven inequalities in early initiation of breastfeeding practice in every wave of survey favoring the poorest wealth quintile (in 2017, D -10.5; 95% CI -16.6 to -4.3). We also identified geographical disparities in early initiation of breastfeeding practice (in 2017, PAF 11.1; 95% CI 2.2 to 19.9) favoring the Rangpur (65.5%), and Sylhet (65.3%) divisions. Education-related disparities were observed in 2004 only, but not in later survey years, which was due to a much lower level of adherence among those with secondary or higher education. There were no significant disparities in early initiation of breastfeeding based on the urban vs. rural residence and sex of the child. Conclusions: The highest attention should be placed in Bangladesh to attain the WHO's 100% recommendation of timely initiation of breastfeeding. This study emphasizes on addressing the existing socioeconomic and geographic inequalities. Awareness-raising outreach programs focusing the mothers from wealthier sub-groups and divisions with lower prevalence should be planned and implemented by the joint effort of the government and non-government organizations. [ABSTRACT FROM AUTHOR]

Background Early initiation breastfeeding (EIBF) is a sign of good health for both the mother and the newborn baby. The objective of this study was to estimate the prevalence of EIBF among mothers in Bangladesh and to identify its associated factors. Methods The study used the most recent Bangladesh Demographic and Health Survey 2017–2018 data. A total of 4776 (weighted) respondents were included in the final analysis. The association between the outcome and the independent variables was determined using multilevel (mixed effects) logistic regression analysis. Results The overall weighted prevalence of EIBF among Bangladeshi mothers was 61.19% (confidence interval [CI] 59.80 to 62.56). The study shows that non-poor wealth status (adjusted odds ratio [AOR] 0.81 [95% CI 0.68 to 0.95]), institutional delivery (AOR 0.77 [95% CI 0.61 to 0.96]) and caesarean delivery (AOR 0.31 [95% CI 0.26 to 0.38]) were associated with the lower odds of EIBF. Mother's secondary education (AOR 1.34 [95% CI 1.01 to 1.83]), at least four antenatal care visits (AOR 1.36 [95% CI 1.04 to 1.53]), normal birthweight (AOR 1.42 [95% CI 1.09 to 1.85]) and placed on mother's chest and bare skin after birth (AOR 1.33 [95% CI 1.11 to 1.60]) were associated with higher odds of EIBF. Conclusion In order to enhance EIBF in Bangladesh, health professionals should emphasise skin-to-skin contact after delivery. [ABSTRACT FROM AUTHOR]

Despite a significant drop in maternal mortality in Bangladesh, unsafe abortion remains a critical maternal health issue that could be reduced by promoting menstrual regulation (MR). This study aimed to investigate the prevalence and determinants of MR use among ever-married women as well as to identify the socioeconomic inequalities in MR use in Bangladesh. The latest Bangladesh Demographic and Health Survey (BDHS) 2017-18 data were used in this study. We used a sub-sample of 12,586 ever-married women aged 15 to 49 years for this study. To identify the determinants of MR, multilevel (mixed-effect) binary logistic regression analysis was used while accounting for potential between-clusters variations. The weighted prevalence of MR was 7.64% (95% CI: 7.19 - 8.12). Women of aged 20-29 years (AOR: 2.50, 95% CI: 1.46, 4.30) and ≥ 30 years (AOR: 4.17, 95% CI: 2.39, 7.26), from urban areas (AOR: 1.24, 95% CI: 1.04, 1.47), having one or two children (AOR: 1.96, 95% CI: 1.25, 3.09) and ≥ 3 children (AOR: 2.26, 95% CI: 1.40, 3.65), who used traditional contraceptive method (AOR: 1.39, 95% CI: 1.12, 1.73), and from Barishal division (AOR: 1.44, 95% CI: 1.08, 1.93) were more likely to have MR. Women were less likely to have MR if they were from Chittagong (AOR: 0.62, 95% CI: 0.46, 0.84) and Mymensingh (AOR: 0.51, 95% CI: 0.36, 0.73) divisions. MR use was found to be higher among higher socioeconomic status (SES) groups as the concentration index (CIX) value was positive and the Lorenz curve lay below the line of equality (CIX: 0.095, p<0.001). Health policy and intervention design should prioritize minimizing socioeconomic inequities concerning MR services. [ABSTRACT FROM AUTHOR]

Background: Maternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across socioeconomic and geographic regions. Therefore, we aim to estimate the trends and magnitude of inequality in SBA use in Bangladesh over the last two decades. Methods: Data from the last 5 rounds of Bangladesh Demographic and Health Surveys (BDHS; 2017-18, 2014, 2011, 2007, and 2004) were used to measure the inequalities in the SBA use utilizing the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequality was assessed by four summary measures, namely, Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) based on the four equity dimensions: wealth status, education level, place of residence, and subnational regions (divisions). Point estimates and a 95% confidence interval (CI) were reported for each measure. Results: An increasing trend in the overall prevalence of SBA use was observed (From 15.6% in 2004 to 52.9% in 2017). We found significant inequalities in SBA use in every wave of BDHS (from 2004 to 2017), with the result concentrating on the rich (in 2017, PAF: 57.1; 95% CI: 52.5–61.7), educated (in 2017, PAR: 9.9; 95% CI: 5.2–14.5), and people from urban areas (in 2017, PAF: 28.0; 95% CI: 26.4–29.5). We also identified geographic disparities in SBA use favoring Khulna and Dhaka divisions (in 2017, PAR: 10.2; 95% CI: 5.7–14.7). Our study also observed inequality in using SBA among Bangladeshi women decreased over time. Conclusion: To increase SBA use and to decrease inequality in all four equity dimensions, disadvantaged sub-groups should be prioritized in policies and planning for program implementation. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the associated factors and changes in childhood vaccination coverage over time in Bangladesh. Methods: Bangladesh's Demographic and Health Surveys from 2011, 2014, and 2017-18 provided data for this study on vaccination coverage among children aged 12 to 35 months. For three survey periods, multilevel binary logistic regression models were employed. Results: The overall prevalence (weighted) of full vaccination among children aged 12–35 months were 86.17% in 2011, 85.13% in 2014, and 89.23% in 2017-18. Children from families with high wealth index, mothers with higher education, and over the age of 24 and who sought at least four ANC visits, as well as children from urban areas were more likely to receive full vaccination. Rangpur division had the highest change rate of vaccination coverage from 2011 to 2014 (2.26%), whereas Sylhet division had the highest change rate from 2014 to 2017-18 (34.34%). Conclusion: To improve immunization coverage for Bangladeshi children, policymakers must integrate vaccine programs, paying special attention to mothers without at least a high school education and families with low wealth index. Increased antenatal care visits may also aid in increasing the immunization coverage of their children. [ABSTRACT FROM AUTHOR]

Background: Much scholarly debate has centered on Bangladesh's family planning program (FPP) in lowering the country's fertility rate. This study aimed to investigate the prevalence of using modern and traditional contraceptive methods and to determine the factors that explain the contraceptive methods use. Methods: The study used data from the 2017–18 Bangladesh Demographic and Health Survey (BDHS), which included 11,452 (weighted) women aged 15–49 years in the analysis. Multilevel multinomial logistic regression was used to identify the factors associated with the contraceptive method use. Results: The prevalence of using modern contraceptive methods was 72.16%, while 14.58% of women used traditional methods in Bangladesh. In comparison to women in the 15–24 years age group, older women (35–49 years) were more unwilling to use modern contraceptive methods (RRR: 0.28, 95% CI: 0.21–0.37). Women who had at least a living child were more likely to use both traditional and modern contraceptive methods (RRR: 4.37, 95% CI: 3.12–6.11). Similarly, given birth in the previous 5 years influenced women 2.41 times more to use modern method compared to those who had not given birth (RRR: 2.41, 95% CI: 1.65–3.52). Husbands'/partners' decision for using/not using contraception were positively associated with the use of both traditional (RRR: 4.49, 95% CI: 3.04–6.63) and modern methods (RRR: 3.01, 95% CI: 2.15–4.17) rather than using no method. This study suggests rural participants were 21% less likely to utilize modern methods than urban participants (RRR: 0.79, 95% CI: 0.67–0.94). Conclusion: Bangladesh remains a focus for contraceptive use, as it is one of the most populous countries in South Asia. To lower the fertility rate, policymakers may design interventions to improve awareness especially targeting uneducated, and rural reproductive women in Bangladesh. The study also highlights the importance of male partners' decision-making regarding women's contraceptive use. [ABSTRACT FROM AUTHOR]

This study aimed to measure the socio-economic inequalities in having minimum dietary diversity (MDD) among Bangladeshi children aged 6–23 months as well as to determine the factors that potentially contribute to the inequity. The Bangladesh Demographic and Health Survey (BDHS) 2017–2018 data were used in this study. A sample of 2405 (weighted) children aged 6–23 months was included. The overall weighted prevalence of MDD was 37.47%. The concentration index (CIX) value for inequalities in MDD due to wealth status was positive and the concentration curve lay below the line of equality (CIX: 0.1211, p < 0.001), where 49.47% inequality was contributed by wealth status, 25.06% contributed by the education level of mother, and 20.41% contributed by the number of ante-natal care (ANC) visits. Similarly, the CIX value due to the education level of mothers was also positive and the concentration curve lay below the line of equality (CIX: 0.1341, p < 0.001), where 52.68% inequality was contributed by the education level of mother, 18.07% contributed by wealth status, and 14.69% contributed by the number of ANC visits. MDD was higher among higher socioeconomic status (SES) groups. Appropriate intervention design should prioritize minimizing socioeconomic inequities in MDD, especially targeting the contributing factors of these inequities. [ABSTRACT FROM AUTHOR]

Background: In many low- and middle-income countries (LMICs), including Bangladesh, socioeconomic inequalities in access to maternity care remain a substantial public health concern. Due to the paucity of research, we attempted to determine the factors affecting the facility delivery, quantify wealth-related inequality, and identify potential components that could explain the inequality. Methods: We used the latest Bangladesh Demographic and Health Survey (BDHS 2017–18) data in this study. We utilized logistic regression to investigate the associated factors of facility delivery. The concentration curves (CC), concentration index (CIX) and decomposition of CIX techniques were used to analyze the inequality in-facility delivery. Results: Women living in the urban areas, age at first birth after (18–24 years ≥25 years), being overweight/obese, having secondary and higher-level education of the women and their husband, seeking four or more ANC, coming from more affluent households, and women with high enlightenment were significant determinants of facility delivery. The concentration curve was below the line of equality, and the relative concentration index (CIX) was 0.205 (p <0.001), indicating that women from wealthy groups were disproportionately more prevalent to facility delivery. The decomposition analysis reveals that wealth status of women (57.40%), age at first birth (10.24%), husband's education (8.96%), husband's occupation (7.35%), education of women (7.13%), women's enlightenment (6.15%), residence (8.64%) and ANC visit (6.84%) are the most major contributors to the inequalities in utilizing facility delivery. Conclusion: The study demonstrates a clear disparity in the use of facility delivery among Bangladeshi women; hence, immediate action is required to lower the inequalities, with a special emphasis on the contributing factors. [ABSTRACT FROM AUTHOR]

Background Dietary diversity (DD) is a key component of diet quality, and malnutrition due to poor diet quality leads to child morbidity and mortality. However, in Bangladesh, there is a lack of information on childhood DD (for children aged 6–59 mo) amid the coronavirus disease 2019 (COVID-19) pandemic. Objectives The purpose of this study was to assess the minimum DD and its associated factors among children aged 6–59 mo during the COVID-19 pandemic in Bangladesh. Methods A cross-sectional study was carried out in 6 districts of Bangladesh. A total of 1190 respondents were included using cluster random sampling. The Individual Dietary Diversity Score (IDDS) for children was used to assess the children's DD. Factors associated with DD of children were identified using a multilevel binary logistics regression model. Results About 70% of the children aged 6–59 mo had minimum DD during the COVID-19 pandemic in Bangladesh. Children who belonged to slum areas [adjusted odds ratio (AOR): 0.45; 95% CI: 0.24, 0.83], family income 12,000–15,000 Bangladeshi taka (BDT) (AOR: 1.79; 95% CI: 1.06, 3.05) and >15,000 BDT (AOR: 2.59; 95% CI: 1.47, 4.57), mothers aged 26–30 y (AOR: 0.35; 95% CI: 0.20, 0.62) and >30 y (AOR: 0.43; 95% CI: 0.22, 0.85), respondents who had 2 children <5 y old (AOR: 0.43; 95% CI: 0.28, 0.66), and children aged 12–23 mo (AOR: 1.89; 95% CI: 1.14, 3.20) were significantly associated with DD among children aged 6–59 mo. Conclusions The findings of this study highlight the need for food and nutrition-related intervention, particularly targeting mothers of younger age and with >2 children <5 y old, mothers from slum regions, and fathers who were unemployed, to improve children's DD practices. [ABSTRACT FROM AUTHOR]

Street food business provides low-cost ready-made meals and employments for the marginal people in developing countries. But the lack of good hygiene in the street food shops is a major concern for consumer. This research examined the effect of the socio-demography of vendors and other factors on hygienic practices in street food shops. This cross-sectional study was conducted among 137 street food vendors in the Barishal and Patuakhali cities of Bangladesh. A pre-structured questionnaire was used to collect information on sellers and shops. A logistic regression model was employed to check the effect of the factors on the hygiene practice score of respondents. Among the vendors, only 27.7% recruited an extra employee in their shops and 43.1% had a good score on the hygienic practices. Regression analysis showed that vendors who completed secondary education (AOR = 3.308; 95% CI: 1.560 to 7.015) and recruited extra employee (AOR = 3.381; 95% CI: 1.465 to 7.800) were more likely to have a higher score than the counterparts. The overall hygiene practices of the vendors were not satisfactory. The education of sellers and the employee's assistance will boost the hygienic standards of the street food shops. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to determine the associated factors of household food security (HFS) and household dietary diversity (HDD) during the COVID−19 pandemic in Bangladesh. Design: Both online survey and face-to-face interviews were employed in this cross-sectional study. The Household Food Security Scale and Household Dietary Diversity Score were used to access HFS and HDD, respectively. The HDD scores were derived from a 24-h recall of food intake from 12 groups. Setting: Bangladesh. Participants: A total sample of 1876 households were recruited. Results: The overall mean scores of HFS and HDD were 31·86 (sd 2·52) and 6·22 (sd 5·49), respectively. Being a rural resident, having no formal education, occupation of household head other than government job and low monthly income were potential determinants of lower HFS and HDD. Approximately 45 % and 61 % of Bangladeshi households did not get the same quantity and same type of food, respectively, as they got before the pandemic. Over 10 % of respondents reported that they lost their job or had to close their businesses, and income reduction was reported by over 70 % of household income earners during the COVID-19 pandemic, which in turn was negatively associated with HFS and HDD. Conclusion: Household socio-economic variables and COVID-19 effects on occupation and income are potential predictors of lower HFS and HDD scores. HFS and HDD deserve more attention during this pandemic particularly with reference to low-earning households and the households whose earning persons' occupation has been negatively impacted during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to determine the associated factors of household food security (HFS) and household dietary diversity (HDD) during the COVID-19 pandemic in Bangladesh.Design: Both online survey and face-to-face interviews were employed in this cross-sectional study. The Household Food Security Scale and Household Dietary Diversity Score were used to access HFS and HDD, respectively. The HDD scores were derived from a 24-h recall of food intake from 12 groups.Setting: Bangladesh.Participants: A total sample of 1876 households were recruited.Results: The overall mean scores of HFS and HDD were 31·86 (sd 2·52) and 6·22 (sd 5·49), respectively. Being a rural resident, having no formal education, occupation of household head other than government job and low monthly income were potential determinants of lower HFS and HDD. Approximately 45 % and 61 % of Bangladeshi households did not get the same quantity and same type of food, respectively, as they got before the pandemic. Over 10 % of respondents reported that they lost their job or had to close their businesses, and income reduction was reported by over 70 % of household income earners during the COVID-19 pandemic, which in turn was negatively associated with HFS and HDD.Conclusion: Household socio-economic variables and COVID-19 effects on occupation and income are potential predictors of lower HFS and HDD scores. HFS and HDD deserve more attention during this pandemic particularly with reference to low-earning households and the households whose earning persons' occupation has been negatively impacted during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Despite the negative impact of chronic school absenteeism on the psychological and physical health of adolescents, data on the burden of adolescent chronic school absenteeism (ACSA) and interventions and programs to address it are lacking. We estimated the global, regional and national level prevalence of ACSA and its correlation with violence and unintentional injury, psychosocial, protective, lifestyle, and food security-related factors among in-school adolescents across low and middle-income, and high-income countries (LMICs–HICs). Objectives: This study aimed to estimate the prevalence of chronic school absenteeism (CSA) as well as to determine its associated factors among in-school adolescents across 71 low-middle and high-income countries. Methods: We used data from the most recent Global School-based Student Health Survey of 207,107 in-school adolescents aged 11–17 years in 71 LMICs-HICs countries across six WHO regions. We estimated the weighted prevalence of ACSA from national, regional and global perspectives. Multiple binary logistic regression analyses were used to estimate the adjusted effect of independent factors on ACSA. Results: The overall population-weighted prevalence of CSA was 11·43% (95% confidence interval, CI: 11·29–11·57). Higher likelihood of CSA was associated with severe food insecurity, peer victimisation, loneliness, high level of anxiety, physically attack, physical fighting, serious injury, poor peer support, not having close friends, lack of parental support, being obese, and high levels of sedentary behaviours. Lower likelihood of CSA was associated with being female (odds ratio, OR = 0·76, 95% CI: 0·74–0·78). Conclusion: Our findings indicate that a combination of different socio-economic factors, peer conflict and injury factors, factors exacerbate CSA among adolescents. Interventions should be designed to focus on these risk factors and should consider the diverse cultural and socioeconomic contexts. [ABSTRACT FROM AUTHOR]

Maintaining quality and safety of street-vended foods (SVFs) is a challenge and a public health priority in low-and middle-income countries due to its affordability, availability and association with foodborne diseases and microbial hazards. The purpose of this study was to assess the knowledge and awareness of food safety, foodborne diseases, and microbial hazards among Bangladeshi consumers of SVFs. A cross-sectional survey was administered among 650 Bangladeshi adults who purchase and consume SVFs. The mean food safety knowledge score of consumers was 10.73 (SD = 2.84, range: 3–18), indicating moderate knowledge. Multiple linear regression analysis found that male consumers (B = - 0.549, p < 0.030), consumers with 'no formal education' (B = −1.815, p < 0.045), and consumers with 'secondary education' (B = −1.476, p < 0.016) were less knowledgeable about food safety compared to their counterparts. Older consumers (36–45 years) were more knowledgeable about food safety compared to younger consumers (18–25 years) (B = 1.300, p < 0.011). Three-quarters of the respondents (76.9%) were not always confident about food safety issues when they bought SVFs, and affordability was the main reason (37.8%) for purchasing SVFs. Increased education and awareness on food safety education for Bangladeshi consumers of SVFs is needed, specifically targeting young adult males, and individuals with lower educational backgrounds. • Overall, food safety knowledge (FSK) of street food consumers was moderate. • Being a male and aged 18–25 years were associated with lower FSK. • Having lower educational attainment was a risk factor of low FSK. • Street food consumers had lower knowledge and awareness about microbial hazards. • Affordability was the main reason for purchasing street-vended foods. [ABSTRACT FROM AUTHOR]

Background: Low‐ and middle‐income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh. Methods: The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016–2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service‐related factors with patients' preferences for healthcare services. Results: The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%) and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio [RRR] = 0.71; 0.56–0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80–9.86) or affordability of healthcare services (RRR = 3.13; 2.25–4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15–1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70–5.04) than the quality of treatment in the health facility, when compared with private service providers. Conclusions: Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management. Patient or Public Contribution: Our research team includes four researchers (co‐authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases. [ABSTRACT FROM AUTHOR]

• This is the first few studies exploring the perceptions of Bangladeshi students towards the COVID-19 pandemic. • Female students showed higher stress levels, greater anxiety symptoms and, depressive symptoms. • Younger students had a greater psychological impact due to COVID-19 than senior students. • The psychological impact is higher among those students who have at least one COVID-19 like symptoms. Although the COVID-19 pandemic triggered commination on both physical and mental wellbeing since its outbreak, the impact of the pandemic on mental health difficulties among Bangladeshi students is still lack in substantial evidence. The study aimed to explore such an impact on mental health among Bangladeshi students and their perception towards the COVID-19 pandemic. A web-based cross-sectional study was conducted among 589 students from Bangladesh in between April 29th to 7th May 2020. Data was collected by using an online questionnaire on demographic status, perceptions towards COVID-19, and mental health symptoms by using the Depression, Anxiety and Stress Scale (DASS 21). About 26.66% and 61.97% of students reported mild to extremely severe anxiety symptoms, and depressive symptoms, respectively, and 57.05% reported mild to extremely severe levels of stress. Multivariate logistic regression reported that students' age, gender, family income, residence, and family size are associated with mental health difficulties. Negative perceptions on the effect of the pandemic on life events, mental health, disruptions in education, and health care system, existing physical health conditions, and COVID-19 like symptoms were significantly associated with poor mental outcomes. It is suggested that students' mental health difficulties should be monitored to provide adequate support and services during this ongoing pandemic. [ABSTRACT FROM AUTHOR]

The recent COVID-19 pandemic has imposed threats on both physical and mental health since its outbreak. This study aimed to explore the impact of the COVID-19 pandemic on mental health among a representative sample of home-quarantined Bangladeshi adults. A cross-sectional design was used with an online survey completed by a convenience sample recruited via social media. A total of 1,427 respondents were recruited, and their mental health was assessed by the DASS-21 measure. The prevalence of anxiety symptoms and depressive symptoms was 33.7% and 57.9%, respectively, and 59.7% reported mild to extremely severe levels of stress. Perceptions that the pandemic disrupted life events, affected mental health, jobs, the economy and education, predictions of a worsening situation, and uncertainty of the health care system capacities were significantly associated with poor mental health outcomes. Multivariate logistic regressions showed that sociodemographic factors and perceptions of COVID-19 significantly predict mental health outcomes. These findings warrant the consideration of easily accessible low-intensity mental health interventions during and beyond this pandemic. [ABSTRACT FROM AUTHOR]

Background: We aimed to determine the factors that increase the risk of HRFB in Bangladeshi women of reproductive age 15–49 years. Methods: The study utilised the latest Bangladesh Demographic and Health Survey (BDHS) 2017–18 dataset. The Pearson's chi-square test was performed to determine the relationships between the outcome and the independent variables, while multivariate logistic regression analysis was used to identify the potential determinants associated with HRFB. Results: Overall 67.7% women had HRFB among them 45.6% were at single risk and 22.1% were at multiple high-risks. Women's age (35–49 years: AOR = 6.42 95% CI 3.95–10.42), who were Muslims(AOR = 5.52, 95% CI 2.25–13.52), having normal childbirth (AOR = 1.47, 95% CI 1.22–1.69), having unwanted pregnancy (AOR = 10.79, 95% CI 5.67–18.64) and not using any contraceptive methods (AOR = 1.37, 95% CI 1.24–1.81) were significantly associated with increasing risk of having HRFB. Alternatively, women and their partners' higher education were associated with reducing HRFB. Conclusion: A significant proportion of Bangladeshi women had high-risk fertility behaviour which is quite alarming. Therefore, the public health policy makers in Bangladesh should emphasis on this issue and design appropriate interventions to reduce the maternal HRFB. Plain Language Summary: High rates of maternal high-risk fertility behaviour (HRFB) have a variety of unfavourable repercussions for both the mother and the child. However, because there have been few studies on this topic to date, we set out to identify the determinants that enhance the risk of HRFB in Bangladeshi women between the ages of 15 and 49. Using latest demographic and health survey (BDHS) data we have found that 67.7% of women had HRFB, with 45.6% having a single high-risk factor and 22.1% having multiple high-risk factors. This high prevalence rate demonstrates that HRFB are all too common in Bangladesh, potentially endangering the health of the country's women. We found that women practicing Islam as core religion, age above 35 years, having normal childbirth, having above 3 children, having unwanted pregnancies and not using birth control methods were at increased risk of having HRFB. As a result of the study's findings, interventions are urgently needed to prevent high-risk fertility behaviour among Bangladeshi women aged 15 to 49 years. [ABSTRACT FROM AUTHOR]

Although secondhand smoke (SHS) exposure is predominant in Bangladesh, the adverse effect of SHS exposure on health-related behaviors, such as sleep quality, have remained an under-investigated area of the country's public health landscape. Therefore, the purpose of this study was to examine the association between SHS exposure and poor sleep quality among non-smoking university students in Bangladesh. A cross-sectional survey was carried out between May and September 2022. SHS exposure (main predictor variable) and other covariates (e.g., age, sex, etc.) were measured using a self-reported questionnaire and sleep quality (outcome variable) was measured via the Pittsburgh Sleep Quality Index. Multiple logistic regression models investigated the association between SHS exposure and poor sleep quality. The study included 390 students (mean age: 22 years, 53.8% male). Approximately 41.8% of the participants reported SHS exposure, and 50.5% had poor sleep quality. Students exposed to SHS were more likely to have poor sleep quality compared to their counterparts (AOR = 1.61; 95% CI 1.01, 2.58). Subgroup analysis revealed poor sleep quality was 2-times higher among male students exposed to SHS than those male students without SHS exposure (AOR = 2.03; 95% CI 1.05, 3.93). No association was found in female students. Findings from this study warrant increased awareness and public health initiatives on the implications of SHS on health behaviors, such as sleep quality, in non-smoking Bangladeshi university students. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess the prevalence of depression and its associated factors among university students in Bangladesh. Participants: A total of 403 undergraduate students from Patuakhali Science and Technology University, and Barisal University participated in the study. Method: A cross-sectional study was conducted using Beck's Depression Inventory (BDI). Result: The prevalence of depression (BDI ≥ 14) was 47.14%. Depression was 3.4 times (95% CI: 1.6–7.1), 3.8 times (95% CI: 1.7–8.6), and 3.9 times (95% CI: 1.5–8.9) higher among 2nd, 3rd, and 4th-year students, respectively than 1st-year students. Students with a history of stressful life events (aOR = 2.7, 95% CI: 1.7–4.4), suicidal attempts (aOR = 3.0, 95% CI: 1.2–7.9), and who received inadequate monthly allowance from their family (aOR = 0.53 95% CI: 0.3–0.9) were more likely to develop depressive symptoms. Conclusion: This study reports a high level of depression among university students which needs further discussion, exploration, and calls for designing appropriate interventions. [ABSTRACT FROM AUTHOR]

Background: Chronic diseases are considered one of the major causes of illness, disability, and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) among Bangladesh patients with chronic diseases from a gender perspective. Methods: Data from the nationally representative Household Income and Expenditure Survey 2016–2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed to identify the potential factors to higher or lower utilisation of healthcare services. Logistic regression with step-by-step adjustment for independent confounding factors was the method used. Results: The five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female, M/F: 16.77%/16.40%), arthritis/rheumatism (M/F: 13.70%/ 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types, which held true for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51–3.26) than their female counterparts (OR = 1.44; 1.02–2.04). A similar association was observed among patients with diabetes and respiratory diseases. Conclusion: A burden of chronic diseases was observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient's gender as well as their employment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people in society might enhance reaching universal health coverage. [ABSTRACT FROM AUTHOR]

Background: Globally, the COVID‐19 pandemic seriously affected both physical and mental health conditions. This study aims to assess changes in the prevalence of depression among older adults during the COVID‐19 pandemic in Bangladesh and explore the correlates of depression in pooled data. Methods: This study followed a repeated cross‐sectional design and was conducted through telephone interviews on two successive occasions during the COVID‐19 pandemic (October 2020 and September 2021) among 2077 (1032 in 2020‐survey and 1045 in 2021‐survey) older Bangladeshi adults aged 60 years and above. Depression was measured using the 15‐item Geriatric Depression Scale (GDS‐15). The binary logistic regression model was used to identify the factors associated with depression in pooled data. Results: A significant increase in the prevalence of depression was noted in the 2021 survey compared to the 2020 survey (47.2% versus 40.3%; adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.11–1.75). Depression was significantly higher among participants without a partner (aOR 1.92, 95% CI 1.45–2.53), with a monthly family income of <5000 BDT (aOR: 2.65, 95% CI 1.82–3.86) or 5000–10 000 BDT (aOR: 1.30, 95% CI 1.03–1.65), living alone (aOR 2.24, 95% CI 1.40–3.61), feeling isolated (aOR 3.15, 95% CI 2.49–3.98), with poor memory/concentration (aOR 2.02, 95% CI 1.58–2.57), with non‐communicable chronic conditions (aOR 1.34, 95% CI 1.06–1.69), overwhelmed by COVID‐19 (aOR 1.54, 95% CI 1.18–2.00), having difficulty earning (aOR 1.49, 95% CI 1.15–1.92) or obtaining food (aOR 1.56, 95% CI 1.17–2.09) during COVID‐19 pandemic, communicating less frequently (aOR 1.35, 95% CI 1.07–1.70) and needing extra care (aOR 2.28, 95% CI 1.75–2.96) during the pandemic. Conclusions: Policymakers and public health practitioners should provide immediate mental health support initiatives for this vulnerable population during the COVID‐19 pandemic and beyond. Policymakers should also invest in creating safe places to practise mindful eating, exercise, or other refuelling activities as a means of preventing and managing depression. [ABSTRACT FROM AUTHOR]

Problematic use of Internet (PUI) and problematic use of Facebook (PUF) has been linked to escalating behavioral health issues among university students and has increased during the COVID-19 pandemic. This study estimated the prevalence of and explored associated factors for PUI and PUF among Bangladeshi university students during the COVID-19 pandemic. A cross-sectional online survey was undertaken among 1101 Bangladeshi university students between November and December 2020. The Internet Addiction Test and Facebook Addiction Scale were used to assess PIU and PUF, respectively. A multiple linear regression analysis was performed to adjust for confounders. Among the participants, PUI and PUF were found in 39.3% and 37.1%, respectively. The multiple linear regression model indicated PUI was significantly associated with participants residing in a village, arts majors, those unsatisfied with their major, having mediocre parental relationships, failure in romantic relationships, physical comorbidities, longer use of the Internet, using the Internet for purposes other than education, using social media, and downloading movies/TV series. PUF was significantly associated with village residence, lower income, arts majors, failure in romantic relationships, longer use of the Internet, using the Internet for purposes other than education, and downloading movies/TV series. Both PUI and PUF have been prevalent among Bangladeshi university students during the COVID-19 pandemic. Longitudinal & exploratory studies are warranted in the future to identify causal factors for PUI and PUF and appropriate interventions should be designed quickly for this population. [ABSTRACT FROM AUTHOR]

Objectives: Overweight and obesity has an adverse effect on public health, and emerging adulthood (18–25 years) is recognized as a potential period for the onset of obesity, thus, this study aimed to explore risk factors associated with overweight and obesity in Bangladeshi university students. Participants: Bangladeshi university students (n = 280). Methods: A case–control study of 140 students with overweight and obesity and 140 students with normal weight. Results: Multiple logistic regression revealed having at least one overweight or obese parent (AOR = 4.2; 95% CI: 2.2–8.4) and participating in no physical activity (AOR = 3.2; 95% CI: 1.0–9.9) were potential risk factors. Reported consumption ≥4 meals in a day, junk food/fast food, and soft drinks for ≥3 days a week were potential determinants of overweight and obesity in this population. Conclusion: Increased awareness on the importance of regular physical activity and a healthy diet may reduce the risk of overweight and obesity among Bangladeshi university students. [ABSTRACT FROM AUTHOR]

Aims: Diabetes is a major health problem in Bangladesh, but nationally representative studies on its trends and associated factors are scarce to guide policy formulation. Therefore, the study aims to determine trends in the prevalence and associated factors of prediabetes and diabetes in Bangladesh.Methods: The study included two population-based cross-sectional surveys from Bangladesh Demographic and Health Survey (n = 7,505 in 2011 and n = 11,959 in 2017-18). Chi-square association tests were performed to determine the associated factors. Logistic regression models (univariate and multivariable) were used to estimate unadjusted and adjusted relative risks of having diabetes, reported with odds ratios. Age-adjusted prevalence was also reported for both surveys.Results: The overall age-adjusted prevalence of prediabetes and diabetes decreased from 52.77% (95% CI: 52.61-52.92) and 10.43% (95% CI: 10.33-10.53) in 2011 to 34.10% (95% CI: 33.43-34.78) and 8.50% (95% CI: 8.11-8.90) in 2017-18. Compared to males, females had a higher odds of diabetes in 2011, but in 2017-18 a significant inverse result was observed. In both surveys, the odds of prediabetes and diabetes increased with advancing age, obesity, better wealth status, and hypertension.Conclusion: The study shows that the prevalence of prediabetes and diabetes is high in Bangladesh despite decreasing trends. Therefore, the study recommends promoting healthy lifestyles and regular screening for non-communicable diseases. [ABSTRACT FROM AUTHOR]

Introduction: The usage of dietary supplement (DS) such as vitamins, minerals, and fish oil has expanded, but there is limited data on their use by sub-populations such as university students. The study was aimed to investigate the prevalence of DS use among Bangladeshi university students and its associated factors. Methods: A cross-sectional survey of 390 students was conducted from two public universities from Barishal Division in Bangladesh using a structured questionnaire with 72 questions divided into five sections: sociodemographic, knowledge, opinions, and attitudes, types of DS, reasons and sources for using DS, and adverse reactions after taking DS. Descriptive statistics and logistic regression were utilized to estimate the results. Results: Among all the students, 15.6% students were using DS where only 7.7% of them used DS according to physicians' recommendation. Additionally, students used DS for general health and well-being, weight gaining and as a source of energy for physical and sporting activities, etc. The use of DS was significantly associated with female sex (AOR = 5.44, 95% CI: 2.18–13.52), ≥25 years age (AOR = 0.08, 95% CI: 0.01–0.67), underweight (AOR = 5.86, 95% CI: 1.95–17.62), having major illness (AOR = 6.99, 95% CI: 1.98–24.70) and good knowledge of DS (AOR = 2.64, 95% CI: 1.23–5.64). Conclusion: This study provides new findings on DS use and its correlates in Bangladeshi students which may be used by the policymakers to improve DS usage among students. Adaptation of an appropriate program is recommended to educate students on proper and safer ways of using DS. [ABSTRACT FROM AUTHOR]

Indigenous vegetables are available at low cost but there is little information about their nutritional composition. The study was conducted to compare the nutritional status of exotic and indigenous vegetables. Most indigenous vegetables contained more minerals than exotic vegetables. Potassium was the most abundant macro-element (135–746 mg/100 g) followed by phosphorus (16–98 mg/100 g). The most calcium was in leaves of Colocasia esculenta (L) (238 mg/100 g). The most magnesium (91 mg/100 g) and Vitamin-C (76 mg/100 g) was in Nymphaea nouchali (Burman) bulb, and Brassica oleracea (L), respectively. Regular consumption of indigenous vegetables may meet nutritional requirements in the human diet. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the relation between weight status and eating disorders symptomatology among Bangladeshi university students. Moreover, the sociocultural climate in Bangladesh has changed in ways that might increase young adults' vulnerability to eating disorder symptomatology. Therefore, this study explored disordered eating attitudes and behaviors among Bangladeshi university students, and their association with Body Mass Index.Method: This cross-sectional study included 398 students from one Bangladeshi university [mean age = 21.12 and 50.25% women]. Anthropometric measures (height and weight) were collected in-person by study staff. Participants also completed the Eating Attitudes Test-26 (EAT-26). The established EAT-26 cutoff score of ≥20 was used to identify participants as having elevated risk for disordered eating attitudes and behaviors. Participants' BMIs were classified according to World Health Organization guidelines.Result: Over one-fifth (20.4%) of students in the sample had EAT-26 scores ≥20 (17.2% male and 23.5% female). Students with BMIs classified as overweight or obese were more likely to have elevated EAT-26 scores (OR = 3.572[2.12-6.03], p < .001). A significant positive correlation was found between overweight/obesity, and disordered eating attitudes and behaviors (r = 0.41, p < .001).Conclusion: These findings suggest that additional research is needed to investigate eating disorder symptomatology in Bangladeshis. In particular, future studies should use longitudinal designs, and large and diverse samples. [ABSTRACT FROM AUTHOR]

• The prevalence of Problematic Internet Use (PIU) was 44%. • The odds of PIU was 1.72 times higher among male students and 1.87 times higher among students with depressive symptoms. • PIU was predicted by having experienced a breakup (p < 0.001). • PIU was 2.50 and 2.87 times higher among students who do not use the internet for educational purposes, and use chat rooms respectively. • PIU was 1.70, and 4.24 times higher among students who play online games, and regularly watch videos on YouTube, respectively. Problematic Internet Use (PIU) is a growing behavioral health problem among university students globally. Data on PIU among university students in Bangladesh is scarce despite growing interest in the research topic. This study aimed to determine the prevalence of PIU and its relationship with depressive symptoms, health, and internet-use behaviors among university students in Bangladesh. A cross-sectional study among 404 students was conducted between February and March 2020 within two Bangladeshi universities residing in the southern territory of the country. Data were collected on socio-demographic characteristics, health, and internet-use behaviors. The Internet Addiction Test (IAT) and the Beck Depression Inventory-21 scale were used to assess the risk of PIU and depressive symptoms of students. Among the study sample, nearly 44% (95% CI: 39.9–48.8) of the participants exhibited PIU. PIU was predicted by gender (p = 0.039), experiencing a breakup (p < 0.001), depressive symptoms (p = 0.010), and non-educational internet use (p = 0.010); particularly usage of chat rooms (p = 0.025), online gaming (p = 0.039), and watching YouTube videos (p = 0.024). Targeting populations that engage in these internet-use behaviors for enrollment in low-intensity online interventions may aid in the prevention and control of PIU among university students. [ABSTRACT FROM AUTHOR]

• The prevalence of Facebook addiction was 36.9%. • FA was 1.67 and 2.51 times higher among the students with depressive symptoms and a domestic violence history respectively. • Participants who did not fail or fall into love were less likely to be at risk of FA than those who did. • Appropriate behavioral interventions targeting these factors should be envisaged to reduce FA among university students. Facebook addiction (FA) has been suggested as a potential behavioral addiction. Data about FA among university students in Bangladesh has been scarce despite being a research topic of growing interest. This study aimed to determine the prevalence of FA and its related factors amongst university students in Bangladesh. A cross-sectional study was conducted between February to March 2020 within two Bangladeshi universities (i.e., Patuakhali Science and Technology University and Barishal University) residing in the southern territory of the country. Data were collected on socio-demographic characteristics, behavioral and online activities. The Bergen Facebook Addiction Scale and the Beck Depression Inventory-21 Scale were used to access the risk of FA, and depressive symptoms of students. About 36.9% of the students were identified as at risk of Facebook addiction using 18 as the cutoff score out of 30 on the Bergen Facebook Addiction Scale. The risk factors of Facebook addiction were predicted to be failure in love, having history of domestic violence, having stressful life event, sufferings from sleep disturbance (i.e., more than 8 h sleep status compared to 6–8 h normal status), spending more than 5 h daily time on Facebook, and having symptoms of depression. Future research should use longitudinal designs to identify FA contributing factors among university students in Bangladesh. [ABSTRACT FROM AUTHOR]