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

Distance education has emerged out of social compulsion, the dynamics of change and new cultures. It was the failure of traditional systems to be able to meet the demand in countries, where the resources available for tertiary education are limited, which basically gave birth to the new trend of education known as open and distance education. This new and innovative system of education has received a high level of acceptance in different countries as it offers flexible educational opportunities for continuing education to a large segment of their population. The increasing number of older adult learners with varying lifestyles in the population, increasing competitiveness of getting places in tertiary institutions, higher cost of education and a shortage of teachers are the main factors for increasing the popularity of distance education (Duncan, "et al.," 2003). Bangladesh has also taken the opportunity to provide a uniform and mass oriented universal system of education through open and distance education establishing Bangladesh Open University (BOU) in 1992. Objectives of the Study: The main objectives of this study are: (1) to assess the overall status of BOU in comparison with the open universities of two neighboring South Asian countries considering the following aspects: (a) Administrative structural functions; (b) Courses and instructional strategies; (c) Learning opportunities, and (d) Library, laboratory and counselling facilities; (2) to explore the potential of improvement for BOU to enable it to meet the challenges of the country's educational needs in the next millennium. (Contains 1 figure and 8 tables.)

The paper foregrounds analysis of the significance of English in individual and collective life in relation to a myriad of feelings that religious and ethnic minorities experience in South and Central Asia within their multilingual ecology. The data reveal an entangling of varied yet coexisting emotions on the part of these minorities in Bangladesh, Pakistan, and Tajikistan in relation to English and its positioning vis-à-vis other languages. The discursive realisation of emotion also gives a nascent understanding of the historical, political, social, cultural, and material significance of English at the microlevel -- as the language is practised, nurtured, and sustained with anxieties and insecurities as well as desires and hopes of its users. Most importantly, the data indicate that English is used to legitimise ethnic and religious identity by minority communities. Drawing on findings from two ethnographic case studies, the paper thereby suggests the necessity of exploring individual metalinguistic awareness and subjective "structures of feeling" (Park, Joseph Sung-Yul. 2015. Structures of feeling in unequal Englishes. In Ruanni Tupas (ed.), Unequal Englishes, 59-73. London: Palgrave Macmillan) of users of English in order to understand its shifting meanings in varied contexts of Asia. The paper thereby brings together understudied areas in Asia, whilst also going beyond a South/Central Asia divide by incorporating studies from both (Bolander, Brook and Till Mostoslansky. 2017. Introducing language and globalisation in South and Central Asian spaces. "International Journal of the Sociology of Language" 247; Bolander, Brook & Shaila Sultana. 2019. Ordinary English amongst Muslim communities in South and Central Asia. "International Journal of Multilingualism" 16(2). 162-174).

This paper focuses on English teachers in Asia in the context of globalization, the global spread of English and the emergence of English as an "Asian language." It highlights the dilemmas facing these teachers in meeting the growing social demands of English proficiency in a technology-influenced, managerial and neoliberal education environment with limited expertise, skills and policy support. We locate the paper in language policy and planning (LPP) within which the concept of micro-level agency provides a critical lens. We draw on insights from several Asian countries including Bangladesh, India, Indonesia, Japan, Malaysia, Pakistan and Vietnam. We argue that while English teachers are found to exercise their agency to meet changing demands of English proficiency, this agency can be seen as the result of what we call "policy dumping" at the macro-level--i.e. education policymakers not paying due attention to the requirements of policy implementation but dumping down policies to educational institutions and English teachers for their implementation. We conclude the paper by suggesting implications for English language policies in Asian countries that respond to globalization and the dominant discourses of English in a globalized world.

The Sustainable Development Goals (SDGs) are a universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity. To maintain the pace of development, local government institutions (LGIs) in many countries have started adapting innovative good practices. These practices are being generated as an offshoot of some projects, initiated by local governments, sub-national and/or national governments. However, these innovations are generally so closely associated, and depend so much on those projects, that once the projects officially phase out, the good practices also start falling apart. Those training institutions for LGIs in Asian countries are imparting training and applying participatory methodologies like peer learning. This enhances the capacities of the functionaries of the respective LGIs. However, the learning that emerges from the good practices, that have evolved, is often missed out in these course curricula, despite the fact that both the good practices and capacity for generating good practices, exist at the local level in the form of tacit learning. The Horizontal Learning Process (HLP) helps to overcome the inherent limitations of existing training methodology by capturing, upscaling, and nurturing tacit learning based on good practices. This paper highlights the concept and salient features of HLP, its evolution, process and steps, application areas, achievements and challenges--especially in the context of the SDGs and the role of LGIs.

Sustainable Development Goals (SDGs) are a universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity. To maintain the pace of development, local government institutions (LGIs) in many countries have started adapting innovative good practices. These practices are being generated as an offshoot of some projects, initiated by local governments, sub-national and/or national governments. However, these innovations are generally so closely associated, and depend so much on those projects, that once the projects officially phase out, the good practices also start falling apart. Those training institutions for LGIs in Asian countries are imparting training and applying participatory methodologies like peer learning. This enhances the capacities of the functionaries of the respective LGIs. However, the learning that emerges from the good practices, that have evolved, is often missed out in these course curricula, despite the fact that both the good practices and capacity for generating good practices, exist at the local level in the form of tacit learning. The Horizontal Learning Process (HLP) helps to overcome the inherent limitations of existing training methodology by capturing, upscaling, and nurturing tacit learning based on good practices. This paper highlights the concept and salient features of HLP, its evolution, process and steps, application areas, achievements and challenges--especially in the context of the SDGs and the role of LGIs.

Purpose: It is still unclear how Asian universities incorporate the theory or practice of sustainable development (SD) in their research and education programmes. To address this gap, the purpose of this paper is to report on a study that has examined how universities in Asian countries handle and address matters related to SD. Design/methodology/approach: The study used a bibliometric analysis and an online survey-method. The online survey data were analysed through descriptive analysis and one-sample student's "t"-test. Findings: The study indicates that there is considerable variation among the Asian countries regarding sustainability practices in higher education institutions (HEIs). The HEIs in far eastern countries, such as Indonesia, Malaysia and Thailand are perceived to demonstrate more sustainability practices. Research limitations/implications: Even though a substantial number of participants participated in the survey, it did not cover all Asian countries. The online survey was carried out over a limited period of time, and not all HEIs in the field may have received information about the study. Practical implications: Asia is the largest continent facing a number of sustainability challenges. In this context, the contribution of HEIs is very important. The findings of the current study may serve as a baseline for Asian HEIs to take more initiatives towards SD goals, as HEIs are responsible for the education and training of hundreds of thousands of students who will be occupying key positions in industry, government or education in the coming years. Originality/value: The study contributes to the existing literature in two distinct ways. First, it was possible to develop a comprehensive instrument to measure sustainability practices in HEIs. Second, this study has filled the gap of the scarcity of studies regarding sustainability practices in HEIs in Asia.

This paper explores the role of local knowledges and wisdoms in educational research and theorizing, drawing examples from Oceania and Asia. It draws on Chen's idea of "internationalist localism" as a lens to explore relationships between local wisdom and traditional cultures in Oceania and Asia, and Western theories of education. Examples are drawn from the island nations of Oceania (including Papua New Guinea), Asia (including Indonesia, Vietnam, and Bangladesh) as well as Australia (including Indigenous Australian settings). In each of these examples, researchers grounded their studies in local wisdoms and traditions, albeit embedding them in broader global contexts, thus achieving, at least to some extent, the internationalist localism advocated by Chen.

Typically, an ESP course is designed to develop students' communication skills not solely for the office, but also for useful in a specific workplace. Unfortunately, ESP for Schools of Business at some South-East Asian universities is not being very effective in promoting students' performance in the workplace. Behind this backdrop, this paper explores learners' pragmatic workplace learning practices that impact on their profession and have immediate applicability to their professional responsibilities. This article, in other words, addresses the gaps between what students learn in ESP class and what they need in real workplace. The data were collected through questionnaires from 30 ESP teachers. The data were analysed both qualitatively and quantitatively. The research results revealed that the current ESP in use fails to capture the learners' needs and skills in workplace communication. It, therefore, suggests that ESP textbook has to adapt the practical workplace needs related materials as well as supplementing extra materials through teachers' constant "needs analysis".

The introduction of national qualification frameworks (NQFs), including frameworks specifically for the vocational sector (NVQFs), are policy initiatives that have far reaching implications for the management and delivery of education and training. Despite the caution called for by researchers and the challenging reality of implementation in both developed and developing countries, NQFs and NVQFs continue to be included in national reform programs in many regions of the world. This paper summarises current developments in the Asia-Pacific region, where enthusiasm for national qualification frameworks has reached new heights. The paper also draws on the author's experience in working on NVQF development and implementation in Bangladesh and Papua New Guinea to highlight the role of donors who are active partners in the expansion of the international trend to implement qualification frameworks. (Contains 3 tables.)

This paper explores the distinction between "secular" and "Koranic" schooling and literacy in South Asia. It begins by tracing an archaeology of the distinction between secular "literacy" and religious "illiteracy". It locates the emergence of the distinction in the colonial census of the 19th century, in the development of "English" education, and the responses within madrasa schools. The second part locates these debates and their on-going importance within a contemporary ethnographic setting. It examines the relevance of the distinction in relation to women's literacy practices. The paper argues that both secular and religious literacy practices are significant for women's status and well-being, and illustrates the centrality of religious reading and learning in Bangladesh. The paper challenges the conventional distinction between religious and secular schooling and literacy, noting their complementary and overlapping nature.

It has long been orthodoxy among adult educators that those who teach adults need to take into account the existing knowledge, practices, perceptions and expectations of the learners. This is true at both central level where curricula and teaching-learning materials are developed and at local level where adult teacher/facilitator meets adult learners. The problem has been how to train adult educators in appropriate ways to discover the existing epistemologies and aspirations of the adult learners. This paper outlines such a training programme using ethnographic approaches to discovering the existing numeracy and literacy practices of "dalit" women learners in a rural part of India. The programme is aimed at a group of trainers working with the NGO Nirantar (India) and others from south Asia (India, Nepal, Pakistan and Bangladesh) with the support of ASPBAE (Asian South Pacific Bureau of Adult Education) and a UK-based NGO, Uppingham Seminars in Development. We begin the paper by looking at the theoretical background to the project and then reporting on the workshops held so far, and finally linking it to the next stage of the project. (Contains 3 notes.)

Age gap between spouses has important implications for a range of outcomes—from fertility and longevity, to gender relationships, marital quality, and stability. This paper examines the age gap between spouses in 12 countries in South and Southeast Asia. The average age difference (husband's minus wife's age) is positive in all countries and ranges from 2.7 in Myanmar to 8.4 in Bangladesh. Age homogamous marriages accounted for 5% of all marriages in Bangladesh to close to half of all marriages in Thailand. The proportion of age hypogamous marriages was uniformly low in all the countries except for Myanmar where it reaches close to 10%. Men's marriage age has a stronger effect in determining the age gap. In general, the age gap for women with lower education was larger than for those with higher education. However, much of this effect was explained by the difference in marriage timing across educational groups. [ABSTRACT FROM AUTHOR]

Inclusion has traditionally been conceptualised as integrating children into the formal schooling system. Recent research conducted in South Asia, however, adds to evidence that the huge number of children out of school and the diversity of their needs can only be met by a diversity of provision, formal and non-formal; that because many state education systems cannot meet the demands in quantity and quality, governments must continue to reform, improve and expand the public system, but also consider reconceptualising their role away from being the exclusive provider and towards encouraging a more diversified and equitable educational system. This paper sets out six challenges for reaching marginalised children through such change, highlighting the political commitment needed to embed into national education policy framework a rights-based approach, with quality assurance and greater links between the formal and non-formal. It provides examples of non-formal providers, using open learning principles, which offer models of how a more flexible and equitable system could be delivered for marginalised children, with progression routes and accreditation equivalent to or the same as the formal system. (Contains 2 boxes.)

The objective of this paper is to highlight the role of adult education as a tool in addressing labour migration issues, specifically those concerning the protection of migrant workers' rights and the transformation of the impact of migration into positive holistic developmental gains. The view of labour migration as a means to forge the economic stability of countries in this era of neo-liberal globalisation has put migrant workers at a highly vulnerable position open to persistent forms of exploitation and abuse. Issues that revolve around this topic have been the subject of many international discourse which has led to the formation of national migration regulations/policies, as well as bilateral and regional agreements between states in an attempt to respond to the urgent needs of migrant workers and manage their migration while continuing to benefit from the process. However, migration controls alone have not been progressive in resolving the core problems of labour migration reflecting the need for more structural reforms and strategies. Many civil society groups have recognised adult education as a promising platform from which to launch effectively a campaign to resolve migration issues. In line with this principle, several efforts from this sector have been made such as awareness campaigns that inform migrants of their labour and fundamental human rights. It is imperative for governments of both origin and destination countries to follow suit. Establishing effective and sustainable adult education programmes that build on the dignity and capability of migrant workers is beneficial to both social and economic development. Better pre-departure orientations, widespread information in accessing available protective mechanisms, integration and reintegration processes, savings management are underscored as plausible foci of such programmes. [Abstract presented in English, Spanish, and French.]

Objective: This study aimed to conduct a scoping review to collect current literature on the knowledge, awareness, and perception (KAP) of sexually transmitted infections/diseases (STIs/STDs) among women in Asia. Methodology: The PRISMA-Scoping methodology was used in this study to extract papers from four databases published between 2018 and 2022. Sixty-eight articles were included after screening and elimination. Results: The studies on KAP of STIs/STDs among women were largely undertaken in Southeast Asia (Indonesia, Malaysia, and Vietnam) and South Asia (India, Pakistan, and Bangladesh). Regardless of the specific cohort of women studied, research indicates consistently low levels of knowledge and awareness across Asia. This trend seems to be more prevalent among female commercial sex workers, women with lower educational levels, and those in poorer socioeconomic positions. In South Asia, cultural, sociological, economic, and gender inequalities, particularly male domination, all have a significant impact on KAP levels. Conclusion: As education is a major factor that influences health behaviour, this review underscores the need to allocate more resources to educational initiatives, particularly targeting vulnerable groups such as sex workers, transgender women, pregnant women, and rural housewives. This strategic focus may contribute significantly to preventing STIs/STDs, particularly in less developed regions/countries. [ABSTRACT FROM AUTHOR]

Discussion of the relationship between information and development in Third World countries highlights information systems development in four South Asian nations: India, Pakistan, Sri Lanka, and Bangladesh. The impact of microelectronics technology, development theories, multinational corporations, international information agencies, and variables of national political economy are considered. (57 references) (LRW)

In this paper, we conceptualize markets for underserved communities as being constituted by local institutions that reflect the modalities of these individual's lives. Using data on the activities that four social ventures across India, Bangladesh and Cambodia have undertaken to craft new markets for their clean energy solutions, we highlight how these actors incorporate their technologies within native material understandings, develop transaction systems consistent with resident consumption practices and entrench their organizations into the existing infrastructure. We term these processes indigenizing, microprovisioning and codeveloping, respectively. In meshing local context as part of their market crafting efforts, these ventures seed micro-entrepreneurship activity, generate employment for locals as well as improve standards of living within the community through the provision of productivity enhancing products and services. Our findings highlight the significance of engaging with local institutions as part of market crafting efforts in these scenarios. This paper offers insights that contribute to the sociology of markets, and poverty reduction via entrepreneurship literatures as well as have important practical and policy implications. [ABSTRACT FROM AUTHOR]

Objective: This paper reflected on the prevalence of hypertension and diabetes in Bangladesh, which is spreading rapidly in low-income countries. The rationale of constructing more health centers for addressing NCDs was assessed in this paper by determining the relationship between prevalence of NCDs, particularly hypertension and diabetes, and distance to health facilities. Methods: From BDHS (Bangladesh Health and Demographic Survey) 2011 data set, 7544 samples were analyzed to demonstrate association between Non-communicable diseases (NCD) and distance from respondents’ home to health facilities like hospitals, community clinics, pharmacies or doctors’ chambers, and community facilities like market, post office or cinema hall. Bivariate analysis was conducted between accessibility to health facilities and prevalence of the diseases. The causal relationship between the spatial effects and the prevalence of the diseases were analyzed by applying Generalized Linear Mixed Model (GLMM) was fitted. Results: Fitting linear mixed effect models, we found that hypertension and diabetes react differently with various spatial effects. Distance from home to hospital had significant effect (P < 0.001) on hypertension showing people living further from the facilities or town centers seemed to be less hypertensive, whereas diabetes showed no such affiliation. Conclusion: Higher prevalence of diabetes (40.9%) over hypertension (26.5%) in people aging 35 or higher, have appeared to have caused the difference, which concluded that each non-communicable disease should be dealt to its own merit for policy making instead considering as a group of diseases. [ABSTRACT FROM AUTHOR]

Introduction: In connection to food insecurity, adaptation of new techniques or alteration of regular behavior is executed that translates to coping strategies. This paper has used data from food security and nutrition surveillance project (FSNSP), which collects information from a nationally representative sample in Bangladesh on coping behaviors associated with household food insecurity. To complement the current understanding of different coping strategies implemented by the Bangladeshi households, the objective of this paper has been set to examine the demographic and socio-economic characteristics of the food insecure households which define their propensity towards adaptation of different types of coping strategies. Methodology: FSNSP follows a repeated cross-sectional survey design. Information of 23,374 food insecure households available from February 2011 to November 2013 was selected for the analyses. Coping strategies were categorized as financial, food compromised and both. Multinomial logistic regression was employed to draw inference. Results: Majority of the households were significantly more inclined to adopt both multiple financial and food compromisation coping strategies. Post-aman season, educational status of the household head and household women, occupation of the household’s main earner, household income, food insecurity status, asset, size and possession of agricultural land were found to be independently and significantly associated with adaptation of both financial and food compromisation coping strategies relative to only financial coping strategies. The relative risk ratio of adopting food compromisation coping relative to financial coping strategies when compared to mildly food insecure households, was 4.54 times higher for households with moderate food insecurity but 0.3 times lower when the households were severely food insecure. Whereas, households were 8.04 times and 4.98 times more likely to adopt both food compromisation and financial relative to only financial coping strategies if moderately and severely food insecure respectively when compared to being mildly food insecure. Conclusion: Households suffering from moderate and severe food insecurity, are more likely to adopt both financial and food compromisation coping strategies. [ABSTRACT FROM AUTHOR]

Motivation: Proper management of fecal sludge has significant positive health and environmental externalities. Most research on managing onsite sanitation so far either simulates the costs of, or the welfare effects from, managing sludge in situ in pit latrines. Thus, designing management strategies for onsite rural sanitation is challenging, because the actual costs of transporting sludge for treatment, and sources for financing these transport costs, are not well understood. Methods: In this paper we calculate the actual cost of sludge management from onsite latrines, and identify the contributions that latrine owners are willing to make to finance the costs. A spreadsheet-based model is used to identify a cost-effective transport option, and to calculate the cost per household. Then a double-bound contingent valuation method is used to elicit from pit-latrine owners their willingness-to-pay to have sludge transported away. This methodology is employed for the case of a rural subdistrict in Bangladesh called Bhaluka, a unit of administration at which sludge management services are being piloted by the Government of Bangladesh. Results: The typical sludge accumulation rate in Bhaluka is calculated at 0.11 liters/person/day and a typical latrine will need to be emptied approximately once every 3 to 4 years. The costs of emptying and transport are high; approximately USD 13 per emptying event (circa 14% of average monthly income); household contributions could cover around 47% of this cost. However, if costs were spread over time, the service would cost USD 4 per year per household, or USD 0.31 per month per household—comparable to current expenditures of rural households on telecommunications. Conclusion: This is one of few research papers that brings the costs of waste management together with financing of that cost, to provide evidence for an implementable solution. This framework can be used to identify cost effective sludge management options and private contributions towards that cost in other (context-specific) administrative areas where onsite sanitation is widespread. [ABSTRACT FROM AUTHOR]

This paper analyses the main drivers of growth, challenges faced and performance of ready-made garment (RMG) manufacturing in Bangladesh following the abolition of the Multi-Fibre Arrangement (MFA). It provides evidence to show that both national and international MFA quotas did provide Bangladesh garments with access to guaranteed international markets. However, as shown by the rising export volumes and market shares of Bangladesh RMG over the period 2005-06, the withdrawal of MFA quotas did not impede the further development of the industry in Bangladesh. This is an outcome of safeguard measures imposed against China in major markets such as the USA and the European Union. The paper argues nevertheless that both the government and private sector of Bangladesh should stimulate upgrading so that the removal of its preferential treatment privileges will not adversely hinder the industry's growth in future. [ABSTRACT FROM AUTHOR]

Background: The Bangladesh Lymphatic Filariasis (LF) Elimination Programme has made significant progress in interrupting transmission through mass drug administration (MDA) and has now focussed its efforts on scaling up managing morbidity and preventing disability (MMDP) activities to deliver the minimum package of care to people affected by LF clinical conditions. This paper highlights the Bangladesh LF Programme’s success in conducting a large-scale cross-sectional survey to determine the number of people affected by lymphoedema and hydrocoele, which enabled clinical risk maps to be developed for targeted interventions across the 34 endemic districts (19 high endemic; 15 low endemic). Methodology/Principal findings: In the 19 high endemic districts, 8,145 community clinic staff were trained to identify and report patients in their catchment area. In the 15 low endemic districts, a team of 10 trained field assistants conducted active case finding with cases reported via a SMS mHealth tool. Disease burden and prevalence maps were developed, with morbidity hotspots identified at sub-district level based on a combination of the highest prevalence rates per 100,000 and case-density rates per square kilometre (km2). The relationship between morbidity and baseline microfilaria (mf) prevalence was also examined. In total 43,678 cases were identified in the 19 high endemic districts; 30,616 limb lymphoedema (70.1%; female 55.3%), 12,824 hydrocoele (29.4%), and 238 breast/female genital swelling (0.5%). Rangpur Division reported the highest cases numbers and prevalence of lymphoedema (26,781 cases, 195 per 100,000) and hydrocoele (11661 cases, 169.6 per 100,000), with lymphoedema predominately affecting females (n = 21,652). Rangpur and Lalmonirhat Districts reported the highest case numbers (n = 11,199), and prevalence (569 per 100,000) respectively, with five overlapping lymphoedema and hydrocoele sub-district hotspots. In the 15 low endemic districts, 732 cases were identified; 661 lymphoedema (90.2%; female 39.6%), 56 hydrocoele (7.8%), and 15 both conditions (2.0%). Spearman’s correlation analysis found morbidity and mf prevalence significantly positively correlated (r = 0.904; p<0.01). Conclusions/Significance: The Bangladesh LF Programme has developed one of the largest, most comprehensive country databases on LF clinical conditions in the world. It provides an essential database for health workers to identify local morbidity hotspots, deliver the minimum package of care, and address the dossier elimination requirements. [ABSTRACT FROM AUTHOR]

Background: Bangladesh is one of the most anemia prone countries in South Asia. Children of age under five years and women of reproductive age are particularly vulnerable in this region. Although several studies have investigated the risk factors of anemia, only few have explored its association with malnutrition, despite its high prevalence in the same group. The objective of this paper is to investigate the association of malnutrition with anemia by conducting separate analyses for under-five children and women of reproductive age using data from the nationally representative 2011 Bangladesh Demographic and Health Survey. Methods: Two binary outcome variables are considered separately: presence of anemia in children under five years of age (Hb<11.0 g/dl) and presence of anemia in women of childbearing age (Hb<12.0 g/dl). The exposures of interest corresponding to these two outcomes are stunting (low height-for-age) and low BMI (<18.5 kg/m2), respectively. Preliminary analysis involves estimating the association between exposure and outcome while controlling for a single confounder by computing adjusted odds ratios (adjOR) using the Cochran-Mantel-Haenszel approach in stratified analysis. Later, associations between the exposures and outcomes are estimated separately for under-five children and women of reproductive age by fitting multivariable regression models that adjust simultaneously for several confounders. Results: The prevalence of anemia is found to be higher among both the stunted children and women with low BMI compared to their healthy counterparts (Children: 56% vs 48%; women: 50% vs 43%). Furthermore, stunted children and women with low BMI have significantly increased odds of developing anemia, as reflected by the adjusted ORs of 1.76 (95% CI:1.10–2.83) and 1.81 (95% CI: 1.11–3.48), respectively. The association of stunting with anemia in children was modified by their age and socio-economic condition, where risk of being anemic decreases with increasing age but with a lower rate for stunted children from richest family. In addition, stunted children of anemic mothers are at greater risk of being anemic compared to non-stunted children of anemic or non-anemic mothers. Again the association between BMI and anemia in women is modified by the level of education, with risk of anemia being lowest among women with low BMI and higher education. Conclusion: Evidence–based policies targeting the vulnerable groups are required to combat anemia and nutritional deficiencies simultaneously under the same program. [ABSTRACT FROM AUTHOR]

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

Background: Around 63% of total health care expenditure in Bangladesh is mitigated through out of pocket payment (OOP). Heavy reliance on OOP at the time of care seeking poses great threat for financial impoverishment of the households. Households employ different strategies to cope with the associated financial hardship. Objective: The aim of this paper is to understand the determinants of hardship financing in coping with OOP adopted for health care seeking of under five childhood illnesses in rural setting of Bangladesh. Methods: A community based cross sectional survey was conducted during August to October, 2014 in 15 low performing sub-districts of northern and north-east regions of Bangladesh. Of the 7039 mothers of under five children surveyed, 1895 children who suffered from illness and sought care for their illness episodes were reported in this study. Descriptive statistics and ordinal regression analysis were conducted. Results: A total number of 7,039 under five children reported to have suffered illness by their mothers. Among these children 37% suffered from priority illness. Care was sought for 88% children suffering from illnesses. Among them 26% went to a public or private sector medically trained provider. 5% of households incurred illness cost more than 10% of the household’s monthly expenditure. The need for assistance was higher among those compared to others (31% vs 13%). Different financing mechanisms adopted to meet OOP are loan with interest (6%), loan without interest (9%) and financial help from relatives (6%) Need for financial assistance varied from 19% among households in the lowest quintile to 9% in the highest wealth. Ordinal regression analysis revealed that burden of hardship financing increases by 2.17 times when care is sought from a private trained provider compared to care seeking from untrained provider (CI: 1.49, 3.17). Similarly, for families that incur a health care expenditure that is more than 10% of their total monthly expenditure (CI:1.46, 3.88), the probability of falling into more severe financial burden increases by 2.4 times. We also found severity of the hardship financing to be around half for households with monthly income of more than BDT 7500 (OR = 0.56, CI: 0.37, 0.86). The burden increased by 2.10 times for households with a deficit (CI: 1.53, 2.88) between their monthly income and expenditure. The interaction between family income and severity of illness showed to significantly affect the scale of hardship financing. Children suffering from priority illness belonging to poor households were found have two times (CI: 1.09, 3.47) higher risks of suffering from hardship financing. Conclusion and policy implications: Findings from this study will help the policy makers to identify the target groups and thereby design effective health financing programs. [ABSTRACT FROM AUTHOR]

The prevalence of stunting among children below 5 years of age is higher in the slum-dwelling population of Bangladesh compared to that in both urban and rural areas. Studies have reported that several factors such as inadequate nutrition, low socio-economic status, poor hygiene and sanitation and lack of maternal education are the substantial predictors of childhood stunting. Almost all these factors are universally present in the slum-dwelling population of Bangladesh. However, few studies have prospectively examined such determinants of stunting among slum populations. In this paper, we reveal the findings of a cohort study with an aim to explore the status of micronutrient adequacy among such vulnerable children and establish its association with stunting along with other determinants. Two-hundred-sixty-five children were enrolled and followed since birth until 24 months of age. We collected anthropometric, morbidity and dietary intake data monthly. We used the 24-hour multiple-pass recall approach to collect dietary intake data from the age of 9 months onward. Micronutrient adequacy of the diet was determined by the mean adequacy ratio (MAR) which was constructed from the average intake of 9 vitamins and 4 minerals considered for the analysis. We used generalized estimating equation (GEE) regression models to establish the determinants of stunting between 12–24 months of age in our study population. The prevalence of low-birth-weight (LBW) was about 28.7% and approximately half of the children were stunted by the age of 24 months. The average micronutrient intake was considerably lower than the recommended dietary allowance and the MAR was only 0.48 at 24 months of age compared to the optimum value of 1. However, the MAR was not associated with stunting between 12–24 months of age. Rather, LBW was the significant determinant (AOR = 3.03, 95% CI: 1.69–5.44) after adjusting for other factors such as age (AOR = 2.12, 95% CI: 1.45–3.11 at 24 months and AOR = 1.97, 95% CI: 1.49–2.59 at 18 months, ref: 12 months) and sex (AOR = 1.98, 95% CI: 1.17–3.33, ref: female). Improving the nutritional quality of complementary food in terms of adequacy of micronutrients is imperative for optimum growth but may not be adequate to mitigate under-nutrition in this setting. Further research should focus on identifying multiple strategies that can work synergistically to diminish the burden of stunting in resource-poor settings. [ABSTRACT FROM AUTHOR]

Summary Recent literatures examine the short-run effects of natural disasters on household welfare and health outcomes. However, less advancement has been observed in the use of self-reported data to capture the short-run disaster–development nexus in least developed countries’ with high climatic risks. This self-identification in the questionnaire could be advantageous to capture the disaster impacts on households more precisely when compared to index-based identifications based on geographical exposure. In this paper, we ask: “what are the impacts on household income, expenditure, asset, and labor market outcomes of recurrent flooding in Bangladesh?” We examine the short-run economic impacts of recurrent flooding on Bangladeshi households surveyed in year 2010. In 2010 Household Income and Expenditure Survey (HIES), households answered a set of questions on whether they were affected by flood and its likely impacts. We identify treatment (affected) groups using two measures of disaster risk exposure; the self-reported flood hazard data, and historical rainfall data-based flood risk index. The paper directly compares the impacts of climatic disaster (i.e., recurrent flooding) on economic development. We further examine these impacts by pooling the data for the years’ 2000, 2005, and 2010 and compare the results with our benchmark estimations. Overall, we find robust evidence of negative impacts on agricultural income and expenditure. Intriguingly, the self-reported treatment group experienced significant positive impacts on crop income. [ABSTRACT FROM AUTHOR]

Bangladesh has made significant progress towards elimination of visceral leishmaniasis, and is on track to achieve its target of less than one case per 10,000 inhabitants in each subdistrict in 2017. As the incidence of disease falls, it is likely that the political capital and financial resources dedicated towards the elimination of visceral leishmaniasis may decrease, raising the prospect of disease resurgence. Policy memos may play a crucial role during the transition of the elimination plan from the ‘attack’ to the ‘consolidation’ and ‘maintenance’ phases, highlighting key stakeholders and areas where ongoing investment is crucial. An example of a policy brief is outlined in this paper. The background to the current elimination efforts is highlighted, with emphasis on remaining uncertainties including the impact of disease reservoirs and sustainable surveillance strategies. A stakeholder map is provided outlining the current and projected future activities of key bodies. Identification of key stakeholders subsequently frames the discussion of three key policy recommendations in the Bangladeshi context for the transition to the consolidation and maintenance phases of the elimination program. Recommendations include determining optimal vector control and surveillance strategies, shifting the emphasis towards horizontal integration of disease programs, and prioritising remaining research questions with a focus on operational and technical capacity. Achieving elimination is as much a political as a scientific question. Integrating the discussion of key stakeholders with policy priorities and the research agenda provides a novel insight into potential pathways forwards in the elimination of visceral leishmaniasis in Bangladesh and in the rest of the Indian subcontinent. [ABSTRACT FROM AUTHOR]

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

This paper proposes a heat-wave definition for Bangladesh that could be used to trigger preparedness measures in a heat early warning system (HEWS) and explores the climate mechanisms associated with heat waves. A HEWS requires a definition of heat waves that is both related to human health outcomes and forecastable. No such definition has been developed for Bangladesh. Using a generalized additive regression model, a heat-wave definition is proposed that requires elevated minimum and maximum daily temperatures over the 95th percentile for 3 consecutive days, confirming the importance of nighttime conditions for health impacts. By this definition, death rates increase by about 20% during heat waves; this result can be used as an argument for public-health interventions to prevent heat-related deaths. Furthermore, predictability of these heat waves exists from weather to seasonal time scales, offering opportunities for a range of preparedness measures. Heat waves are associated with an absence of normal premonsoonal rainfall brought about by anomalously strong low-level westerly winds and weak southerlies, detectable up to approximately 10 days in advance. This circulation pattern occurs over a background of drier-than-normal conditions, with below-average soil moisture and precipitation throughout the heat-wave season from April to June. Low soil moisture increases the odds of heat-wave occurrence for 10-30 days, indicating that subseasonal forecasts of heat-wave risk may be possible by monitoring soil-moisture conditions. [ABSTRACT FROM AUTHOR]

By examining the comparative experiences of Rohingya who fled in the early 1990s to Bangladesh and Malaysia, this paper discusses implications for refugee protection in an Asian regional context characterized by generally applicable immigration measures and a reluctance to offer formal durable solutions. Somewhat secure from refoulement but undifferentiated or even deliberately invisible among larger irregular migrant populations, refugees in the region develop certain protection strategies and livelihood mechanisms outside the boundaries of formal asylum, which suggest they possess significant capacities to carve out their own protection space and achieve a level of de facto integration. Given the migration-focused discourse among states and regional processes as well as the impasse on solutions in Asia, this paper makes the case for further recognition of available, intermediate solutions which capitalize on ambiguities between migration management and refugee protection and empower refugee-driven solutions in all dimensions. [ABSTRACT FROM AUTHOR]