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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]

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]

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]

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]

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]

Background: Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children’s Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Method: Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Results: Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Conclusions: Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups. Maternal health programs, if properly designed and implemented, can improve access, partially overcoming the negative effects of socioeconomic disparities. [ABSTRACT FROM AUTHOR]

Asian pangolins are a highly-threatened species group, mainly due to the perceived medicinal value of their scales. Increased demand from China has resulted in pangolins being the most trafficked mammal in the world. Three pangolin species are reported to occur in Bangladesh: Manis pentadactyla, M. crassicaudata, and M. javanica. No peer-reviewed studies exist detailing these species’ current distribution or status within Bangladesh. A literature review was conducted resulting in the clarification of conflicting reports and misidentified observations and specimen records. In this paper, we also report the current status of pangolins (Manis spp.) in Bangladesh based on semi-structured interviews, camera trapping, media queries, and field surveys employing traditional ecological knowledge and non-randomized transect surveys. Ethnozoological knowledge pertaining to the natural history of M. pentadactyla is also reported from experienced Mro tribal hunters. The critically endangered M. pentadactyla was verified to occur in northwest, northeast, and southeast Bangladesh in natural and degraded habitats. Interviews with the Mro tribe in the southeast indicate that pangolin populations there were likely extirpated in 2014 due to skilled commercial collection beginning in 2010. Evidence of extant M. crassicaudata and M. javanica populations remain unverified and questionable, and historical records of M. crassicaudata and M. javanica are likely a result of misidentification. [ABSTRACT FROM AUTHOR]

Background: Bangladesh had one of the highest burdens of lymphatic filariasis (LF) at the start of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) with an estimated 70 million people at risk of infection across 34 districts. In total 19 districts required mass drug administration (MDA) to interrupt transmission, and 15 districts were considered low endemic. Since 2001, the National LF Programme has implemented MDA, reduced prevalence, and been able to scale up the WHO standard Transmission Assessment Survey (TAS) across all endemic districts as part of its endgame surveillance strategy. This paper presents TAS results, highlighting the momentous geographical reduction in risk of LF and its contribution to the global elimination target of 2020. Methodology/Principal findings: The TAS assessed primary school children for the presence of LF antigenaemia in each district (known as an evaluation unit—EU), using a defined critical cut-off threshold (or ‘pass’) that indicates interruption of transmission. Since 2011, a total of 59 TAS have been conducted in 26 EUs across the 19 endemic MDA districts (99,148 students tested from 1,801 schools), and 22 TAS in the 15 low endemic non-MDA districts (36,932 students tested from 663 schools). All endemic MDA districts passed TAS, except in Rangpur which required two further rounds of MDA. In total 112 students (male n = 59; female n = 53), predominately from the northern region of the country were found to be antigenaemia positive, indicating a recent or current infection. However, the distribution was geographically sparse, with only two small focal areas showing potential evidence of persistent transmission. Conclusions/Significance: This is the largest scale up of TAS surveillance activities reported in any of the 73 LF endemic countries in the world. Bangladesh is now considered to have very low or no risk of LF infection after 15 years of programmatic activities, and is on track to meet elimination targets. However, it will be essential that the LF Programme continues to develop and maintain a comprehensive surveillance strategy that is integrated into the health infrastructure and ongoing programmes to ensure cost-effectiveness and sustainability. [ABSTRACT FROM AUTHOR]

The advent of cheap smartphones in rural areas across the globe presents an opportunity to change the mode with which researchers engage hard-to-reach populations. In particular, smartphones allow researchers to connect with respondents more frequently than standard household surveys, opening a new window into important short-term variability in key measures of household and community wellbeing. In this paper, we present early results from a pilot study in rural Bangladesh using a ‘microtasks for micropayments’ model to collect a range of community and household living standards data using Android smartphones. We find that more frequent task repetition with shorter recall periods leads to more inclusive reporting, improved capture of intra-seasonal variability, and earlier signals of events such as illness. Payments in the form of mobile talk time and data provide a positive development externality in the form of expanded access to mobile internet and social networks. Taken to scale, programs such as this have potential to transform data collection in rural areas, providing near-real-time windows into the development of markets, the spread of illnesses, or the diffusion of ideas and innovations. [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]

The paper uses qualitative and quantitative data collected by the Wellbeing in Developing Countries ESRC research group in Bangladesh and Thailand to explore the extent to which objective need deprivation predicts subjective and psychological wellbeing, controlling for location, socio-economic status, and gender. The regression analysis is triangulated with qualitative analysis of three illustrative case studies to explore why people experiencing great need deprivation nevertheless report high subjective and psychological wellbeing and propose factors that might support their resilience. The paper reports perhaps unsurprisingly that need deprivation was lower in Thailand than Bangladesh, and subjective and psychological wellbeing higher, with the exception of life satisfaction which was higher in Bangladesh. While goal attainment was significantly associated with affect and life satisfaction in both countries, in Thailand life satisfaction and goal attainment were negatively correlated (−.334), so the more goals respondents felt they had attained, the less satisfied they were. These apparent anomalies are explored further using data from the case studies. The findings confirm that although measures of subjective and psychological wellbeing are correlated, they are not substitutable. For example, subjective wellbeing, especially positive affect, is more influenced by need deprivation than psychological wellbeing, while psychological wellbeing is more influenced by demographic factors, especially in Thailand. Finally, the paper discusses whether the distinct relationships of subjective and psychological wellbeing with need deprivation and income have any implications for policymakers. [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]

The aim of this research is to explore factors influencing the management decisions to adopt human resource information system (HRIS) in the hospital industry of Bangladesh—an emerging developing country. To understand this issue, this paper integrates two prominent adoption theories—Human-Organization-Technology fit (HOT-fit) model and Technology-Organization-Environment (TOE) framework. Thirteen factors under four dimensions were investigated to explore their influence on HRIS adoption decisions in hospitals. Employing non-probability sampling method, a total of 550 copies of structured questionnaires were distributed among HR executives of 92 private hospitals in Bangladesh. Among the respondents, usable questionnaires were 383 that suggesting a valid response rate of 69.63%. We classify the sample into 3 core groups based on the HRIS initial implementation, namely adopters, prospectors, and laggards. The obtained results specify 5 most critical factors i.e. IT infrastructure, top management support, IT capabilities of staff, perceived cost, and competitive pressure. Moreover, the most significant dimension is technological dimension followed by organisational, human, and environmental among the proposed 4 dimensions. Lastly, the study found existence of significant differences in all factors across different adopting groups. The study results also expose constructive proposals to researchers, hospitals, and the government to enhance the likelihood of adopting HRIS. The present study has important implications in understanding HRIS implementation in developing countries. [ABSTRACT FROM AUTHOR]

Background: As Bangladesh, India and Nepal progress towards visceral leishmaniasis (VL) elimination, it is important to understand the role of asymptomatic Leishmania infection (ALI), VL treatment relapse and post kala-azar dermal leishmaniasis (PKDL) in transmission. Methodology/ Principal Finding: We reviewed evidence systematically on ALI, relapse and PKDL. We searched multiple databases to include studies on burden, risk factors, biomarkers, natural history, and infectiveness of ALI, PKDL and relapse. After screening 292 papers, 98 were included covering the years 1942 through 2016. ALI, PKDL and relapse studies lacked a reference standard and appropriate biomarker. The prevalence of ALI was 4–17-fold that of VL. The risk of ALI was higher in VL case contacts. Most infections remained asymptomatic or resolved spontaneously. The proportion of ALI that progressed to VL disease within a year was 1.5–23%, and was higher amongst those with high antibody titres. The natural history of PKDL showed variability; 3.8–28.6% had no past history of VL treatment. The infectiveness of PKDL was 32–53%. The risk of VL relapse was higher with HIV co-infection. Modelling studies predicted a range of scenarios. One model predicted VL elimination was unlikely in the long term with early diagnosis. Another model estimated that ALI contributed to 82% of the overall transmission, VL to 10% and PKDL to 8%. Another model predicted that VL cases were the main driver for transmission. Different models predicted VL elimination if the sandfly density was reduced by 67% by killing the sandfly or by 79% by reducing their breeding sites, or with 4–6y of optimal IRS or 10y of sub-optimal IRS and only in low endemic setting. Conclusion/ Significance: There is a need for xenodiagnostic and longitudinal studies to understand the potential of ALI and PKDL as reservoirs of infection. [ABSTRACT FROM AUTHOR]

• Managing risks to production and assets is central to achieving sustained rather than temporary escapes from extreme poverty. • The enabling environment is critical in determining whether households can ultimately sustain escapes from poverty. • Factors constitutive of this enabling environment may be social, economic, political, infrastructural, or climatic. • Policy-makers should acknowledge risks and develop multi-level collective risk management policy portfolios to enhance poverty eradication. The objectives of this research are to identify the difference between sustained and temporary poverty escapes for policy and program design, based on research in Bangladesh, Cambodia, Ethiopia, Kenya, Malawi, Nepal, Niger, the Philippines, Rwanda, Tanzania, and Uganda. The method adopted is the q-squared method used in studies on the dynamics of poverty, embedded in a conceptual extension of the capability approach through a risk chain analysis. The results show that key livelihood factors conducive to sustained escapes include diversification of economic activities typically spanning agricultural and off-farm sectors, and sometimes involving rural-urban migration. Important tangible assets include general asset holdings of consumer durables, farm or business equipment, livestock, and electricity. Intangible assets include the completion of at least lower secondary education of the household head, good health, and different forms of social relationships and networks. However, while livelihood strategies help improve income and build assets necessary for resilience, various risks permeate. In these risky contexts, the study finds that the enabling environment is critical in determining whether households can ultimately sustain escapes from poverty. Interactive features of this environment that are conducive to sustained escapes include context-specific pro-poor policy and infrastructure, for example around livestock insurance, climate-smart agriculture alongside predictable disaster risk management, universal health coverage, and supporting a negotiated approach to norm change. Together, these features place an emphasis on collective risk management, beyond a focus only or even primarily on inclusive growth policies. The paper argues that it is essential to understand the circumstances in which people live, from the local (micro) up to the societal (macro) contexts that can influence their ability to sustain a poverty escape, and respond in ways that together address the multifaceted sources of risk and vulnerability, which in turn allows for the less interrupted development of people's capabilities. [ABSTRACT FROM AUTHOR]

Abstract: Industry has contributed to serious and widespread deterioration in the quality of water, land and air in Bangladesh. The objectives of the study are: to document pollution prevention options and their current use in Bangladesh; to compare practices across five different highly polluting industries; and to contribute to the pollution prevention literature from a developing country's perspective. The study is an exploratory one, using both primary and secondary data. Five industries were selected from the top-ten environment polluting industries in Bangladesh; these are the tannery, pulp & paper, fertilizer, textile and cement industries. From each industry group, two sample plants were selected with five executives participating from each plant. This study highlights the reality of Bangladeshi industrial plants in applying pollution prevention initiatives. It reveals that compared to leading firms in developed countries, pollution prevention initiatives in Bangladesh are considerably underutilized. All of the industries undertook some pollution prevention activities, though each of them had potential for improvement. For example, none of the case sites engaged in pollution prevention through designing environmentally compatible products. [Copyright &y& Elsevier]

Summary: Experimental impact evaluation methods have recently emerged as a dominant force within the development effectiveness movement. Although these methods have improved understanding of what works, their “gold standard” status threatens to exclude a large body of alternative evidence. This paper evaluates the impact of CARE’s SHOUHARDO project in Bangladesh, which employed a rights-based, livelihoods approach. Using a mixed-methods protocol, we find plausible evidence that the project led to an extraordinarily large reduction in child malnutrition. While offering valuable policy lessons, we illustrate how rigorous evaluation can be undertaken even without the randomization and control groups required by the experimental methods. [ABSTRACT FROM AUTHOR]

Summary: Recent research in Bangladesh highlights an interesting paradox: impressive development outcomes combined with extremely poor quality of governance. The country’s active development NGO sector has been credited with some of the more positive development achievements. The question that this paper sets out to address is why the sector has not made an equivalent contribution on the governance front. It draws on primary survey data to explore the hypothesis that the problem lies in the increasing homogenization of NGOs around the delivery of services, primarily microfinance services, and its shift away from social mobilization organizations. [ABSTRACT FROM AUTHOR]

Summary: Whereas a large number of studies have been devoted to analyzing consumer demand for dietary quantity, much less attention has been paid to the demand for dietary quality. To address this gap in the literature, this paper explores the determinants of dietary quality in Bangladesh using data from a nationally representative household expenditure survey conducted in 2000. We find that while male education plays a positive role, female education has a substantially stronger influence. Further, female household headship is associated with lower dietary quality than male headship. Thus, promoting female education and addressing the unique constraints faced by female headed households with respect to diet quality could be a significant policy instrument for addressing food insecurity in Bangladesh. [ABSTRACT FROM AUTHOR]

This paper describes a fully automated scheme that has provided calibrated 1–10-day ensemble river discharge forecasts and predictions of severe flooding of the Brahmaputra and Ganges Rivers as they flow into Bangladesh; it has been operational since 2003. The Bangladesh forecasting problem poses unique challenges because of the frequent life-threatening flooding of the country and because of the absence of upstream flow data from India means that the Ganges and Brahmaputra basins must be treated as if they are ungauged. The meteorological–hydrological forecast model is a hydrologic multimodel initialized by NASA and NOAA precipitation products, whose states and fluxes are forecasted forward using calibrated European Centre for Medium-Range Weather Forecasts ensemble prediction system products, and conditionally postprocessed to produce calibrated probabilistic forecasts of river discharge at the entrance points of the Ganges and Brahmaputra into Bangladesh. Forecasts with 1–10-day horizons are presented for the summers of 2003–07. Objective verification shows that the forecast system significantly outperforms both a climatological and persistence forecast at all lead times. All severe flooding events were operationally forecast with significant probability at the 10-day horizon, including the extensive flooding of the Brahmaputra in 2004 and 2007, with the latter providing advanced lead-time warnings for the evacuation of vulnerable residents. [ABSTRACT FROM AUTHOR]

The problem of arsenic pollution of groundwater used for domestic water supplies is now well recognised in Bangladesh, India and some other countries of South and South-east Asia. However, it has recently become apparent that arsenic-polluted water used for irrigation is adding sufficient arsenic to soils and rice to pose serious threats to sustainable agricultural production in those countries and to the health and livelihoods of affected people. This paper reviews the nature of those threats, taking into account the natural sources of arsenic pollution, areas affected, factors influencing arsenic uptake by soils and plants, toxicity levels and the dietary risk to people consuming arsenic-contaminated rice. [Copyright &y& Elsevier]

Summary: This paper applies a CGE model to analyze the effects of better addressing worker’s rights in Bangladesh’s textile and apparel industries. Results show that an increased minimum wage for unskilled, low-, and medium-skilled workers has negative impacts for these workers in aggregate and also for the economy in terms of export, GDP, and welfare. This comes from the decrease in employment. However, labor productivity-increasing improvements in factory conditions and services to workers not only increase incomes of workers, but also welfare. Entrepreneurs also enjoy higher incomes, enabling them to pay for improving the work environment. [Copyright &y& Elsevier]

Summary: This paper analyzes the effects of riverine floods on agricultural wages in Bangladesh. Drawing upon the district-wise monthly data over 1979–2000, we model wages as a dynamic process. We find that floods have positive implications for wages in the long run. In flood months, however, agricultural wages decline in the inundated districts. We obtain difference-in-difference estimates to show that the magnitude of impact of flood depends on the relative flood proneness of a district and the relative severity of flood conditions. Our results indicate that favorable demand and supply conditions in the agricultural labor market can mitigate the impact of disasters on wages in Bangladesh. [Copyright &y& Elsevier]

This paper examines empirically the impact of micro-credit on poverty in Bangladesh. Unlike previous studies, the focus is on both objective and subjective poverty and particular attention is paid to the length of time programme participants have had access to micro-credit. A household-level survey (N = 954) was carried out, collecting information about micro-credit recipients from Grameen Bank, the Bangladesh Rural Advancement Committee and the Association of Social Advancement. Our two main findings are, first, micro-credit is associated with both lower objective and subjective poverty and, secondly, the impact of micro-credit on poverty is particularly strong for about six years with some levelling off after that point. [ABSTRACT FROM AUTHOR]

This paper examines the sustainability of conventional and ecological agricultural systems based on their environmental soundness, economic viability and social acceptability. Significant differences were found in crop diversification, soil fertility management, pests and diseases management, and use of agrochemicals. No remarkable variations were found in land-use pattern, crop yield and stability, financial and economic returns, risk and uncertainties, or food security. The findings suggest that ecological agriculture is relatively more sustainable, and it could be an economically and environmentally viable alternative to the conventional agricultural system. Ecological agriculture could become an alternative if market distortions created by subsidies were removed, and financial benefits were provided to resource-conserving farmers along with necessary support through extension, credit, research, and marketing. [Copyright &y& Elsevier]

Drawing on survey data and ethnographic findings, this paper presents a profile of women’s work participation among slum dwellers in Dhaka city. Overall, almost 50% of adult women are engaged in income-generating work outside the home. Life-cycle factors, socioeconomic status and residential location are associated with both level of work participation and type of employment. Women’s contributions to household livelihoods via paid employment are found to be significant and multifaceted. The analysis highlights heterogeneity among poor women’s work experiences and the intense “informalization” of most employment options. Implications for policy aimed at improving the conditions of working women are identified. [Copyright &y& Elsevier]

This paper analyzes a panel dataset on 379 rural households in Bangladesh interviewed in 1987–88 and 2000. Using a “livelihoods” framework it contrasts the fortunes of ascending households (which escape poverty) and descending households (which fall into poverty). These two dynamics are not mirror images of each other. Escapees overcome structural obstacles by pursuing multiple strategies (crop intensification, agricultural diversification, off-farm activity, livelihood migration) that permitted them to relatively rapidly accumulate a mix of assets. Descents into poverty were associated with lifecycle changes and crises such as flooding and ill-health. The findings confirm that Bangladesh made considerable progress in reducing poverty in the 1980s and 1990s. [Copyright &y& Elsevier]

• Co-existence of non-fortified products disincentivizes producers to fortify. • Limited product traceability disincentivizes producers to comply with the policy. • Economic pressure prevents small-scale producers from adequately fortifying. • Political tension leads to inconsistent law enforcement, and limited compliance. • Enforcement should focus on the origin of bulk items by large-scale producers. Micronutrient deficiency is a pertinent global challenge that affects billions of people and has deleterious health effects. Large-scale food fortification (LSFF) is a cost- effective way to tackle micronutrient deficiency and improve health outcomes, particularly in low- and middle-income countries (LMICs). However, the success of LSFF in LMICs is often hampered by limited compliance with fortification mandates by the private sector, who supply fortified foods. In this paper, we use a case study of the edible oil produced in Bangladesh to analyze the factors facilitating and impeding this compliance by for-profit actors. We identified four bottlenecks that disincentivize private sector actors' decision to comply. First, fortified and non-fortified products co-exist in the market, disincentivizing producers to invest in fortification. Second, the lack of traceability reduces the risk for large-scale producers' non-compliance with the regulation. Third, small-scale producers face economic pressures that prevent them from adequately fortifying oil products. Lastly, law enforcement is currently inconsistent, allowing the supply of under-fortified oil in the market. Given the evidence, we recommend to strengthen the control of bulk item fortification through more frequent and rigorous surveillance at the production level. This will ensure that resource constrained consumers who also have the greatest potential to benefit from added nutrients, remain able to access affordable and nutrient-enriched food. [ABSTRACT FROM AUTHOR]

• The share of mixed households (with farm and non-farm jobs) in rural Bangladesh rose from 23 to 39% between 2000 and 2013. • The share of mixed households of the youngest cohort (those with heads age 15–30 years in 2000) increased from 17% to 30%. • In areas near cities, the share of pure farm households fell; the share of mixed households rose from 15 to 34%. This paper explores patterns of exit from agriculture in rural Bangladesh by utilizing nationally representative repeat cross-section and pseudo-panel survey data. Our analysis focuses at the rural household level where we focus on three types of households: (a) "pure" agriculture households in which all workers are employed only in agriculture; (b) "mixed" households in which some members remain in the farm sector and others pursue nonfarm activities, and (c) rural "nonfarm" households who are exclusively dependent on non-agricultural employment. We find that non-farm orientation has increased over the 2000 to 2013 period, and that nonfarm households rely more on salaried employment and less on unpaid work. Pseudo-panel data based on age-cohort of household heads from the Labor Force Survey (LFS) of 2000 and 2013 also shows a notable increase in mixed households formed by diversification of activities of formerly farm-only households. Employment patterns of younger households are changing especially rapidly: the share of mixed households among households with heads age 15–30 years increased from 17% to 30% in this period. Proximity to urban areas also is associated with a rapid shift in household employment patterns over time. In areas less than 2.5 kms from cities, the share of pure farm households fell from 46.5 to 30.3 percent of households, while the share of mixed households rose from 14.8 to 33.7 percent. Overall, our findings confirm a process of transformation involving a shift from predominantly agriculture employment to increased non-farm employment. We find that the structural transformation considered does not necessarily involve large-scale permanent migration to cities. Rather, much of the shift out of agriculture occurs within rural areas with especially rapid change happening in areas of close proximity to cities. [ABSTRACT FROM AUTHOR]