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This paper investigates the mutual relationship between gender‐based violence (GBV) and cyclone‐related disasters. Evidence is sparse on this topic, especially in‐depth research attending to the cultural and socioeconomic aspects of locality. The work reported here is based on a case study of a coastal district of Bangladesh (Barguna)—conducted shortly after Cyclone Roanu struck the country in May 2016—that aimed to shed light on the mechanisms linking GBV to cyclones through the eyes of survivors. The paper maps out the different forms, experiences, and impacts of GBV before, during, and after cyclones, and argues that such events lead directly and indirectly to GBV, and that GBV makes women and children more vulnerable to the effects of disasters. Climate change, economic losses, and poverty compound this cyclical relationship. A conceptual framing, drawing on the notion of 'slow violence', is developed to understand the layering of diverse types of violence that operate on seemingly different temporal and spatial scales. [ABSTRACT FROM AUTHOR]

This paper quantifies the factors explaining long ‐ term improvements in child height for age z ‐ scores in Bangladesh (1996/1997–2011), India (1992/1993–2005/2006), Nepal (1997–2011) and Pakistan (1991–2013). We apply the same statistical techniques to data from a common data source from which we have extracted a set of common explanatory variables that capture ‘nutrition ‐ sensitive’ factors. Three are particularly important in explaining height for age z ‐ score changes over these timeframes: improvements in material well ‐ being; increases in female education; and improvements in sanitation. These factors have comparable associations across all four countries. [ABSTRACT FROM AUTHOR]

The authors discuss the reduction of child stunting or malnutrition in Bangladesh. Topics include the factors contributing to stunting such as lack of education and poverty, environmental enteropathy which causes malabsorption of stunting and nutrients, and the priority of the country to improve its public health nutrition.

Objective: The objective is to assess the reasoning by families in deciding between a home vs. facility delivery and vaginal vs. caesarean. Study design: The authors selected a convenience sample of 16 villages in Sathkira district in southwest Bangladesh. Evidence was drawn from detailed in‐home post‐delivery interviews with all mothers in these villages who delivered in 2015 or 2016. Methods: Local family health workers and paramedics used a structured questionnaire that enabled gathering of relevant quantitative and qualitative evidence. Mothers' reasons for selection of delivery location and type were categorized, and regression analysis was conducted to assess significance of variables that proxy supply and demand factors. Results: Among 492 completed interviews, 48% were home deliveries, 52% facility deliveries; two‐thirds of facility deliveries in private clinics. Overall, sample caesarean rate is 39%, public hospital rate 53%, private clinic rate 86%. Over half of reasons for home delivery refer to pregnancy without complication or access to trusted birth attendant. Over half of reasons for facility delivery refer to medical complications allegedly precluding home delivery, or requiring home‐to‐facility transfer during labour for reasons not clear to the mother. The decision depends on both 'demand' factors originating with the family (proxied by family income, birth order and education levels) and 'supply' factors originating with obstetric care providers (proxied by number of antenatal visits and variation of caesarean rate by village). In a regression controlling for both demand and supply variables, the above proxy variables are all significant. Implications for nursing and health policy: Bangladesh has inadequate nursing support for vaginal delivery in either home or facility. Hence, physicians frequently recommend that women deliver in a facility (usually a physician's clinic). Physicians are reluctant to hire adequate nurses to attend vaginal deliveries. Hence, families with some discretionary income are increasingly opting for a caesarean over vaginal delivery. Facility deliveries reduce incidence of obstructed labour fistula, but probably contribute to rising incidence of iatrogenic fistula. Reducing caesarean rates requires a large increase in numbers of nurses and midwives, and acceptance by physicians of a broad scope of practice for nurses/midwives in vaginal deliveries. [ABSTRACT FROM AUTHOR]

SummaryIntroduction1Definitions of ethnic groups and demographics of minority ethnic groups in the UK○ 1.1 Definitions of 'ethnic groups' and 'ethnicity'○ 1.2 Demographics and characteristics of minority ethnic groups in the UK– Countries of origin– Age/sex distribution and life expectancy– Geographical distribution and size of household– Religious beliefs– Education and employment patternsKey points2Overview of the health profile and dietary habits of minority ethnic groups in the UK○ 2.1 Available surveys○ 2.2 Overview of the health profiles among adults from minority ethnic groups– Overall health– Cardiovascular disease (CVD)– Coronary heart disease (CHD)– Stroke– Type 2 diabetes– Obesity○ 2.3 Possible causes of increased disease risk among minority ethnic groups○ 2.4 Smoking, drinking and physical activity habits○ 2.5 Dietary habits and nutritional status○ 2.6 Overview of the health profiles and dietary and health behaviour patterns of children from minority ethnic groups– Overall health– Diet and health behaviour patterns○ 2.7 Gaps in data availabilityKey points3Factors affecting food choice– Income and socio‐economic status– Food availability and access– Awareness of healthy eating– Religious beliefs– Food beliefs– Time and cooking skills– Generation and genderKey points4Traditional diets of minority ethnic groups○ 4.1 Overview of traditional diets of minority ethic groups– South Asians– African‐Caribbeans– Chinese○ 4.2 Dietary acculturation○ 4.3 Nutritional composition of ethnic‐style cuisineKey points5Nutritional interventions and health promotion among minority ethnic groups○ 5.1 Effective nutritional interventions○ 5.2 Health promotion interventions to prevent problems associated with fasting○ 5.3 Priorities for nutritional interventions and health promotion○ 5.4 Using behaviour change models○ 5.5 Current community initiatives○ 5.6 Catering for institutionalised individuals○ 5.7 Recommendations for future research, policy and practiceKey points6Conclusion• Acknowledgements• References Summary: According to the latest census, non‐white minority ethnic groups made up 7.9% of the UK's population in 2001. The largest of these groups were South Asians, Black African‐Caribbeans and Chinese. Studies have shown that some minority ethnic groups are more likely to experience poorer health outcomes compared with the mainstream population. These include higher rates of cardiovascular disease (CVD), type 2 diabetes and obesity. The differences in health outcomes may reflect interactions between diet and other health behaviours, genetic predisposition and developmental programming, all of which vary across different groups. As is the case for the rest of the population, the dietary habits of minority ethnic groups are affected by a wide variety of factors, but acquiring a better understanding of these can help health professionals and educationalists to recognise the needs of these groups and help them to make healthier food choices. Unfortunately, to date, there have been few tailored, well‐designed and evaluated nutritional interventions in the UK targeting minority ethnic population groups. Further needs assessment and better evaluation of nutritional interventions have been recommended to enhance the understanding of the effectiveness of different approaches amongst minority ethnic groups. This briefing paper will provide an overview of the health profile, dietary habits and other health behaviours of the three largest non‐white minority ethnic groups in the UK, explore the factors affecting their food choices, provide a summary of their traditional diets and review the evidence base to identify the factors that support successful nutrition interventions in these groups. [ABSTRACT FROM AUTHOR]

Background: The New Zealand (NZ) Ministry of Health ethnicity data protocols recommend that people of South Asian (SAsian) ethnicity, other than Indian, are combined with people of Japanese and Korean ethnicity at the most commonly used level of aggregation in health research (level two). This may not work well for perinatal studies, as it has long been observed that women of Indian ethnicity have higher rates of adverse pregnancy outcomes, such as perinatal death. It is possible that women of other SAsian ethnicities share this risk. Aims: This study was performed to identify appropriate groupings of women of SAsian ethnicity for perinatal research. Materials and Methods: National maternity and neonatal data, and singleton birth records between 2008 and 2017 were linked using the Statistics NZ Integrated Data Infrastructure. Socio‐demographic risk profiles and pregnancy outcomes were compared between 15 ethnic groups. Recommendations were made based on statistical analyses and cultural evaluation with members of the SAsian research community. Results: Similarities were observed between women of Indian, Fijian Indian, South African Indian, Sri Lankan, Bangladeshi and Pakistani ethnicities. A lower‐risk profile was seen among Japanese and Korean mothers. Risk profiles of women of combined Indian‐Māori, Indian‐Pacific and Indian‐New Zealand European ethnicity more closely represented their corresponding non‐Indian ethnicities. Conclusions: Based on these findings, we suggest a review of current NZ Ministry of Health ethnicity data protocols. We recommend that researchers understand the risk profiles of participants prior to aggregation of groups in research, to mitigate risks associated with masking differences. [ABSTRACT FROM AUTHOR]

Background: Bangladesh has experienced an alarming increase in birth through cesarean over the last decade. In this article, we examine rural Bangladeshi women's reporting of why they underwent cesarean, who proposed the cesarean, and when in the process, the decision for a surgical birth was made. Methods: We conducted a cross‐sectional household survey of 2299 women in Kushtia district. Of these, 1233 who gave birth through cesarean completed a supplemental questionnaire. Descriptive statistics were used to report cesarean rates, which were disaggregated by sociodemographic characteristics and by antenatal care contacts with health services. We analyzed women's reported reasons for having a cesarean, when the decision was taken, and who proposed the intervention. Findings: Over half (54%) of women gave birth through cesarean. The proportion of cesareans was significantly higher among women with higher educational attainment, higher socioeconomic status, and increased antenatal care during pregnancy, particularly if this care was sought in private facilities (P <.05). Women reported that health service providers primarily proposed the cesarean (73%), followed by family members (21%) and finally, the birthing person themselves (6%). With respect to the reasons for cesarean, 34% of women reported nonmedical reasons (convenience and avoidance of labor pain), and 44% mentioned only medical reasons. Over half of the women reported that the decision to undergo a cesarean was made on the day of birth. Conclusions: Women in rural Bangladesh often report avoidable reasons for cesarean. Better regulation of cesarean services in both public and private health services, as well as improved counseling of women with respect to cesarean indications and their consequences, is recommended. [ABSTRACT FROM AUTHOR]

Inappropriate complementary feeding contributes to linear growth faltering in early childhood. Behaviour change interventions have been effective at improving practice, but few studies have investigated the effects of multicomponent integrated interventions. We conducted a cluster‐randomized controlled trial in rural Bangladesh in which geographic clusters were randomized into seven arms: water treatment (W), sanitation (S), handwashing (H), water, sanitation, and handwashing (WSH), improved nutrition with infant and young child feeding messages and lipid‐based nutrient supplementation for 6‐ to 24‐month olds (N), N+WSH, and control. The objective of this paper was to examine the independent and combined effects of interventions on indicators of complementary feeding. Approximately 1 and 2 years after initiation of the intervention, research assistants surveyed mothers about infant feeding practices. Complementary feeding was examined using the World Health Organization indicators of infant and young child feeding practices. We used Poisson regression models to estimate prevalence ratios and linear regression models for prevalence differences with clustered sandwich estimators to adjust for clustering. A total of 4,718 households from 720 clusters were surveyed at year 1 and 4,667 at year 2. The children in the nutrition arms had a higher prevalence of meeting the minimum dietary diversity score compared with controls (year 1: N: 66.4%; N+WSH: 65.0% vs. C:32.4%; year 2: N: 91.5%; N+WSH: 91.6% vs. C:77.7%). Children in the nutrition arms received diverse food earlier than the children in control arm. In addition, the average consumption of lipid‐based nutrient supplementation was >90% in each follow‐up. Nutrition‐specific interventions could be integrated with nutrition‐sensitive interventions such as WSH without compromising the uptake of the nutrition intervention. [ABSTRACT FROM AUTHOR]

Adequate maternal healthcare practices are crucial to both maternal and infant nutrition outcomes. The Sylhet region of Bangladesh is vulnerable and performs poorly, as maternal and child health indicators are falling behind compared to other areas. Suchana, a large‐scale intervention programme aims to improve the health and nutritional status of mothers and children in this region. The objective of the present analysis is to assess the changes in indicators related to maternal healthcare practices among Suchana beneficiaries. We obtained data from the Suchana baseline and endline evaluation survey. Descriptive statistics were employed to summarize data. The following maternal healthcare practices were considered: if a Suchana beneficiary mother received antenatal care (ANC) from skilled service providers, took day time resting during pregnancy, consumed additional diet during pregnancy, took at least 100 iron‐folic acid (IFA) tablets during pregnancy and took a vitamin A capsule after delivery. Logistic regression analysis was performed to assess the impact of the Suchana intervention on maternal healthcare practices. The prevalence of the outcome variables at endline in the intervention area were as follows: 40% of mothers received at least four ANC from skilled service providers, 50% practiced daytime resting during pregnancy, 51% consumed additional diet during pregnancy, 41% took at least 100 iron‐folic acid tablets during pregnancy, 39% received postnatal care and 30% took a vitamin A capsule after delivery. The Suchana intervention significantly, positively improved indicators related to maternal healthcare practices; these findings support future larger‐scale programmes to improve maternal healthcare practices among vulnerable people in rural Bangladesh. [ABSTRACT FROM AUTHOR]

In this study, we aimed to determine the prevalence and factors associated with overweight and obesity among nonpregnant and nonlactating (NPNL) women of reproductive age with iron deficiency anaemia (IDA) in urban Bangladesh. We obtained data from the baseline assessment of a randomized control trial conducted among 525 women of reproductive age (18–49 years) with IDA (Hb < 12 gdl−1 and serum ferritin <30 μg L−1). The study was carried out in Mirpur, Dhaka, Bangladesh, between December 2017 and January 2019. We collected information on women's socio‐demographic characteristics and anthropometry. Body mass index (BMI) was calculated using the following formula: weight in kilograms per height in square metres. BMI ≥ 25–29.9 kg m−2 was considered as overweight, whereas BMI ≥ 30 kg m−2 as obese. A multivariable logistic regression model was used to ascertain the risk factors of overweight and obesity. The prevalence of overweight and obesity was 29.9% (95% CI: 26.0–34.0) and 13.1% (95% CI: 10.4–16.3), respectively. The combined prevalence of overweight and obesity was 43.0% (95% CI: 38.7–47.4). The multivariable analysis showed married women (aOR: 4.4; CI: 1.8–11.1), women aged 30–49 years (aOR: 7.6; CI: 2.4–24.1), unemployed women (aOR 1.5; CI: 1.0–2.4) and women from the wealthier households (aOR 3.9; CI: 2.3–6.8) had the highest risk of being overweight and obese compared with their counterparts. Both age and household wealth statuses showed dose–response relationships. Combination of overweight and obesity with IDA poses a particular challenge for public health interventions. The policymakers should consider what new interventions and policy initiatives are needed to address this combination of overweight and obesity with IDA. [ABSTRACT FROM AUTHOR]

Limited evidence exists on the complex relationship among interventions, early initiation of breastfeeding (EIBF), prelacteal feeding and exclusive breastfeeding (EBF). We examined whether early breastfeeding practices are associated with EBF and how much improving EIBF and non‐prelacteal feeding contributes to increased prevalence of EBF. Survey data were collected in 2010 and 2014 as part of impact evaluations of Alive & Thrive (A&T) interventions to improve infant and young child feeding (IYCF) practices in Bangladesh, Vietnam and Ethiopia. Multivariable logistic regression analyses were used to examine effects of interventions and early breastfeeding practices on EBF. Structural equation modelling quantified the direct and indirect effects of interventions (via improving EIBF and non‐prelacteal feeding) on EBF. Although breastfeeding is nearly universal in all three countries (≥98%), delayed initiation of breastfeeding is prevalent (>60%) and prelacteal feeding is common. EIBF alone was not associated with EBF, whereas non‐prelacteal feeding was associated with 1.6–3.5 higher odds of EBF. Intervention exposure affected breastfeeding practices in all three countries; these impacts were amplified among those who practiced EIBF or non‐prelacteal feeding [odds ratio (OR) = 11 and 27.5 in Bangladesh and 6.5 and 11.5 in Vietnam, respectively]. The paths through EIBF and non‐prelacteal feeding explained 13%–18% of the effect of the interventions on EBF. Early breastfeeding practices influence EBF, but interventions aimed only at the initiation and early days of breastfeeding will be inadequate to promote EBF. Social and behaviour change interventions should simultaneously target EIBF, non‐prelacteal feeding and EBF to support optimal breastfeeding practices. [ABSTRACT FROM AUTHOR]

The prevalence of stunting, wasting, and underweight are reported separately. However, the data of the multiple anthropometric failures combinations of these conventional indicators are scant. This study attempted to estimate the overall burden of undernutrition among children under 5 years old, using the composite index of anthropometric failure (CIAF), and to explore the correlates. The study used secondary data from the Bangladesh demographic and health surveys (BDHS), undertaken in 2014. CIAF provides an overall prevalence of undernutrition, which gives six mutually exclusive anthropometric measurements of height‐for‐ age, height‐for‐weight, and weight‐for‐age. Multivariable logistic regression was used to explore the correlates of CIAF. The overall prevalence of undernutrition using the CIAF was 48.3% (95% CI [47.1%, 49.5%]) among the children under 5 years old. The prevalence of anthropometric failure due to a combination of both stunting and underweight was 18.2%, wasting and underweight was 5.5%, and wasting, underweight, and stunting was 5.7%. The odds of CIAF were higher among young maternal age, having the poorest socio‐economic status, living in rural areas, higher order of birth, and received no vaccination compared with other counterparts. In Bangladesh, one out of two children has undernutrition, which is preventing the potential of the millions of children. Mothers who gave birth before age 20 living in the rural areas with belonging to lower socio‐economic status and whose children had a higher order of birth and receive no vaccination were observed as the main determinants of undernutrition. Nutrition sensitive interventions along with social protection programmes are crucial to deal the underlying causes of undernutrition. [ABSTRACT FROM AUTHOR]

This study uses novel household survey data that are representative of Bangladesh's large cities, and of slum and nonslum areas within the cities, to investigate the effects of demographic and socioeconomic factors on child nutrition status in 2013. The study also decomposes the difference in mean child nutrition status between slum and nonslum areas in 2013, and the increase in mean child nutrition status in slum and nonslum areas from 2006 to 2013. Mother's education attainment and household wealth largely explain the cross‐sectional difference and intertemporal change in mean child nutrition status. Although positive in some cases, the effects of maternal and child health services, and potential health‐protective household amenities, on child nutrition status differ by the type of health facility, household amenity, and urban area (slum or nonslum). Focusing on nutrition‐sensitive programs for slum residents and the urban poor is consistent with the results. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Bangladesh is an underdeveloped country that has recently joined the ranks of low‐middle‐income countries. This study aims to investigate how socioeconomic and developmental factors have influenced women towards a shift in their body mass index (BMI). Methods: The trend was analysed using data on ever‐married women from 6 nationwide surveys covering the years 1996 to 2014, conducted by the Bangladesh Demographic and Health Survey (BDHS). To assess the relationship between the socioeconomic factors and BMI, binary regression models were fitted for 6 surveys and forest plots were applied to display the results. Results: Factors such as age, education, residence, economic status, and contraceptive use were found to have had an increasing influence on BMI over the years that were being analysed. Age and education for women were potential factors influencing BMI. Growing urbanization and economic inequality were found to have been substantial over time, and marital status and contraceptive use were influential whilst the employment status of women held no consequence. Conclusions: Rapid urbanization allied with growing wealth inequality and dietary alteration seems to have forced a change in the capacity of women in Bangladesh to control their weight. Additional information is still needed on such factors as the amount of time that women are inactive and sitting down, for example, as well as their daily calorie intake in order to assemble all the pieces for addressing necessary health policy changes in Bangladesh. These factors will also help to indicate a shift of focus from rural malnutrition to urban obesity. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in child undernutrition remain one of the main challenges in Bangladesh. The social determinants of health are mostly responsible for such inequalities across different population groups. However, no study has examined the relative contribution of different social determinants to the socioeconomic inequality in child undernutrition in Bangladesh. Our objective is to measure the extent of socioeconomic-related inequalities in childhood stunting and identify the key social determinants that potentially explain these inequalities in Bangladesh. We used data for children younger than 5 years of age for this analysis from 2 rounds of Bangladesh Demographic and Health Surveys conducted in 2004 and 2014. We examined the socioeconomic inequality in stunting using the concentration curve and concentration index. We then decomposed the concentration index into the contributions of individual social determinants. We found significant inequality in stunting prevalence. The negative concentration index of stunting indicated that stunting was more concentrated among the poor than among the well-off. Our results suggest that inequalities in stunting increased between 2004 and 2014. Household economic status, maternal and paternal education, health-seeking behavior of the mothers, sanitation, fertility, and maternal stature were the major contributors to the disparity in stunting prevalence in Bangladesh. Equity is a critical component of sustainable development goals. Health policymakers should work together across sectors and develop strategies for effective intersectoral actions to adequately address the social determinants of equity and reduce inequalities in stunting and other health outcomes. [ABSTRACT FROM AUTHOR]

The lipid composition of breast milk may have a significant impact on early infant growth and cognitive development. Comprehensive breast milk data is lacking from low-income populations in the Indian subcontinent impeding assessment of deficiencies and limiting development of maternal nutritional interventions. A single breast milk specimen was collected within 6 weeks postpartum from two low-income maternal cohorts of exclusively breastfed infants, from Dhaka, Bangladesh ( n = 683) and Kolkata, India ( n = 372) and assayed for percentage composition of 26 fatty acids. Mature milk (>15 days) in Dhaka ( n = 99) compared to Kolkata ( n = 372) was higher in total saturated fatty acid (SFA; mean 48% vs. 44%) and disproportionately lower in ω3-polyunsaturated fatty acid (PUFA), hence the ω6- and ω3-PUFA ratio in Dhaka were almost double the value in Kolkata. In both sites, after adjusting for days of lactation, increased maternal education was associated with decreased SFA and PUFA, and increasing birth order or total pregnancies was associated with decreasing ω6-PUFA or ω3-PUFA by a factor of 0.95 for each birth and pregnancy. In Dhaka, household prosperity was associated with decreased SFA and PUFA and increased ω6- and ω3-PUFA. Maternal height was associated with increased SFA and PUFA in Kolkata (1% increase per 1 cm), but body mass index showed no independent association with either ratio in either cohort. In summary, the socioeconomic factors of maternal education and household prosperity were associated with breast milk composition, although prosperity may only be important in higher cost of living communities. Associated maternal biological factors were height and infant birth order, but not adiposity. Further study is needed to elucidate the underlying mechanisms of these effects. [ABSTRACT FROM AUTHOR]

Background Although the influence of the type of institutional setting on the risk of cesarean birth is well documented, less is known about the regional variations in institution-specific cesarean rates within countries. Our purpose was to examine regional variations in cesarean rates across public and private facilities in five Asian countries with a sizeable private sector: Bangladesh, India, Indonesia, Pakistan, and the Philippines. Methods Demographic Health Survey data and a hierarchical model were used to assess regional variations in the mode of delivery while controlling for a wide range of socioeconomic, demographic, and maternal risk factors. Results The risk of cesarean birth was greater in a private facility than in a government hospital by 36-48 percent in India and Indonesia and by 130 percent in Bangladesh. Regional gradients in cesarean birth were found to be steeper for deliveries in private facilities than in government hospitals in India, Indonesia, and the Philippines. The residents of India's high-use states were 55 percent more likely to undergo a cesarean delivery in a government hospital and 83 percent more likely in a private facility than their counterparts in the medium-use states. Similarly, compared to the residents of the Philippines's medium-use provinces, giving birth in a government facility increased the likelihood of a cesarean delivery by 84 percent and by 173 percent in a private facility. Conclusions Large regional variations in cesarean rates suggest the need for more informed clinical decision making with respect to the selection of cases for cesarean delivery and the establishment of well-developed guidelines and standards at the provincial or state levels. [ABSTRACT FROM AUTHOR]

PROBLEM Few studies have examined the adolescents' depression in low-income countries and no research has yet been carried out in Bangladesh. This study estimated the prevalence of depressive symptoms and explored the associated factors and help seeking behavior among adolescents in Bangladesh. METHODS Data originated from a cross section of 2,440 randomly selected boys and girls aged 13-19 years in a rural district and urban slums of Dhaka city, Bangladesh, during October-November 2012. Beck Depression Inventory (BDI), a 21-item scale, measured the prevalence of depressive symptoms using a cut-off 16 or higher. FINDINGS The prevalence of depressive symptoms among adolescents was 14%, with predominance in urban slums and among girls. Older age (15-19 years), poverty, and poor parental relation were found to be associated with depressive symptoms of both sexes; family history of depressive symptoms for boys; and reproductive illness and sexual abuse for girls. More than 80% of depressed adolescents sought no help. CONCLUSIONS Adolescent depressive symptoms are common and largely undetected public health problem in Bangladesh. Policies aimed at concerted efforts for implementing a school-based counseling program with components of cognitive behavioral therapy and developing referral systems for those who scored at least 30 at BDI may ameliorate the potential harmful consequences of depressive symptoms in adolescents. [ABSTRACT FROM AUTHOR]

Growth patterns in early life are associated with later health. The effect of nutrition during in utero development on later body composition is unclear. We evaluated whether prenatal early invitation to food and/or multiple micronutrient supplementation ( MMS) in pregnancy has an effect on offspring body composition at 54 months of age. In Maternal and Infant Nutrition Interventions in Matlab trial ( ISRCTN16581394) in Bangladesh, 4436 pregnant women were randomised into six equally sized groups: double-masked supplementation with capsules of either 30 mg Fe and 400 μg folic acid, or 60 mg Fe and 400 μg folic acid, or MMS (15 micronutrients), was combined with a randomised early invitation (around 9 weeks) or a usual invitation (around 20 weeks) to start food supplementation (608 kcal 6 days per week). At 54 months, the body composition of the offspring was assessed by leg-to-leg bioelectrical impedance analysis. Of the 3267 live singletons with birth anthropometry, 2290 children were measured at 54 months, representing 70% of the live births. There was no interaction between the food and micronutrient supplementation on body composition outcomes. There were no significant differences in a range of anthropometric and body composition measurements, including weight, height, mid-upper arm circumference, head circumference, skinfold thickness, and fat mass and fat-free mass between the different prenatal food and micronutrient groups using an intention-to-treat analysis. This analysis shows that early invitation to food supplementation and MMS provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age. [ABSTRACT FROM AUTHOR]

Socio-economic and ecological challenges faced by the small-scale fishers dependent on the Old Brahmaputra River, Bangladesh are assessed using a combination of questionnaire survey, co-monitoring of fish catch, focus group discussions and key informant interviews. Results reveal that the fishers are involved in professional, seasonal or subsistence fishing. Fish catches from the river have declined significantly because of overfishing, destructive use of fishing gear, water pollution, siltation, rapid urbanization and human encroachment, thereby threatening the health of the river ecosystem as well as the future of small-scale fishing. We evaluate various social, economic and ecological challenges faced by the fisher communities. We propose a conceptual framework that recognizes linkages among social, economic and ecological aspects in devising a sustainable river fisheries management system. We recommend effective legal enforcement of policies and regulations, strong institutional collaboration and active fisher community participation in management to ensure sustainable use of the resource base. [ABSTRACT FROM AUTHOR]

People of Bangladeshi origin have the highest mortality ratio from coronary heart disease of any minority ethnic group in UK and their rate of kidney disease is three- to five-fold higher than that of the European UK population. However, there is little information regarding their dietary customs or knowledge, beliefs and attitudes towards health and nutrition. This multi-method qualitative study aimed to identify: (i) barriers and facilitators to dietary sodium restriction; (ii) traditional and current diet in the UK; and (iii) beliefs and attitudes towards development of hypertension, and the role of sodium. Methods included focus group discussions, vignettes and food diaries. Twenty female chronic kidney disease patients attended four focus group discussions and maintained food diaries; ten responded to vignettes during telephone interviews. Triangulation of the results obtained from the three methods identified categories and themes from qualitative thematic analysis. Identified barriers to sodium restriction were deeply-rooted dietary beliefs, attitudes and a culturally-established taste for salt. Facilitators of change included acceptable strategies for cooking with less salt without affecting palatability. Dietary practices were culturally determined but modified by participants' prosperity in the UK relative to their previous impoverished agrarian lifestyles in Bangladesh. Cultural background and orientation were strong determinants of the group's dietary practices and influenced their reception and response to health communication messages. Efforts to understand their cultural mores, interpret and convey health-promotion messages in culturally-appropriate ways met with a positive response. [ABSTRACT FROM AUTHOR]

In this article we investigate the complex relationship between environmental risk, poverty, and vulnerability in a case study carried out in one of the poorest and most flood-prone countries in the world, focusing on household and community vulnerability and adaptive coping mechanisms. Based upon the steadily growing amount of literature in this field we develop and test our own analytical model. In a large-scale household survey carried out in southeast Bangladesh, we ask almost 700 floodplain residents living without any flood protection along the River Meghna about their flood risk exposure, flood problems, flood damage, and coping mechanisms. Novel in our study is the explicit testing of the effectiveness of adaptive coping strategies to reduce flood damage costs. We show that, households with lower income and less access to productive natural assets face higher exposure to risk of flooding. Disparity in income and asset distribution at community level furthermore tends to be higher at higher risk exposure levels, implying that individually vulnerable households are also collectively more vulnerable. Regarding the identification of coping mechanisms to deal with flood events, we look at both the ex ante household level preparedness for flood events and the ex post availability of community-level support and disaster relief. We find somewhat paradoxically that the people that face the highest risk of flooding are the least well prepared, both in terms of household-level ex ante preparedness and community-level ex post flood relief. [ABSTRACT FROM AUTHOR]

Adolescence is a critical period characterized by rapid physical, psychological, and social development and growth. In Bangladesh, high rates of undernutrition persist among adolescent females living in low‐income households. Prevalence of adolescent marriage and pregnancy is extremely high, with almost half of Bangladeshi women giving birth by 18 years of age. Qualitative research was carried out from April to June 2017 to examine individual, social, and environmental factors influencing eating behaviours of female adolescents between 15 and 19 years of age living in low‐income families in urban and rural settings in Bangladesh. Methods included freelisting exercises (33), key informant interviews (11), in‐depth interviews (24), direct observations (16), and focus group discussions (12). Findings show that household food insecurity necessitates adjustments in meal food quality and frequency. Gender norms prescribe that females receive small meal portions and make sacrifices in food consumption so that male family members can eat more. Work and school schedules cause long breaks between meal consumption, restricting food intake of adolescent females for extended periods. Gender discrimination and its manifestations likely amplify susceptibility to psychological stresses in adolescent females. An inferior social position makes adolescent females living in food insecure households vulnerable to undernutrition, with factors affecting food deprivation increasing as they approach childbearing. Policies to increase age of marriage and reduce adolescent pregnancy must continue. Programmes must ensure that school‐going adolescents eat adequately during the school day. Prolonging school education and strengthening the economic viability of women should alter cultural expectations regarding marriage age and normative female roles. [ABSTRACT FROM AUTHOR]

Severe acute malnutrition (SAM) affects ~4 million infants under 6 months (u6m) worldwide, but evidence underpinning their care is "very low" quality. To inform future research and policy, the objectives of our study were to identify risk factors for infant u6m SAM and describe the clinical and anthropometric outcomes of treatment with current management strategies. We conducted a prospective cohort study in infants u6m in Barisal district, Bangladesh. One group of 77 infants had SAM (weight‐for‐length Z‐score [WLZ] <−3 and/or bipedal oedema); 77 others were "non‐SAM" (WLZ ≥−2 to <+2, no oedema, mid‐upper‐arm circumference ≥125 mm). All were enrolled at 4–8 weeks of age and followed up at 6 months. Maternal education and satisfaction with breastfeeding were among factors associated with SAM. Duration of exclusive breastfeeding was shorter at enrolment (3·9 ± 2.1 vs. 5.7 ± 2.2 weeks, P < 0.0001) and at age 6 months (13.2 ± 8.9 vs. 17.4 ± 7.9 weeks; P = 0.003) among SAM infants. Despite referral, only 13 (17%) reported for inpatient care, and at 6 months, 18 (23%) infants with SAM still had SAM, and 3 (3.9%) died. In the non‐SAM group, one child developed SAM, and none died. We conclude that current treatment strategies have limited practical effectiveness: poor uptake of inpatient referral being the main reason. World Health Organization recommendations and other intervention strategies of outpatient‐focused care for malnourished but clinically stable infants u6m need to be tested. Breastfeeding support is likely central to future treatment strategies but may be insufficient alone. Better case definitions of nutritionally at‐risk infants are also needed. [ABSTRACT FROM AUTHOR]

Stunting is the core measure of child health inequalities as it reveals multiple dimensions of child health and development status. The main focus of this study is to show the procedure of selecting the most appropriate logistic regression model for stunting by developing and comparing several plausible models, which ultimately helps to identify the predictors of childhood stunting in Bangladesh. This study utilizes child anthropometric data collected in the 2014 Bangladesh Demographic and Health Survey. Valid height‐for‐age anthropometric indices were available for a total of 6,931 children aged 0–59 months, of which about 36% were stunted. Ordinary logistic, survey logistic, marginal logistic, and random intercept logistic regression models were developed assuming independence, sampling design, cluster effect, and hierarchy of the data. Based on a number of model selection criteria, random intercept logistic model is found the most appropriate for the studied children. A number of child, mother, household, regional, and community‐level variables were included in the model specification. The factors that increased the odds of stunting are children older than 11 months, short birth interval, recent morbidity of children, lower maternal education, young maternity, lower maternal body mass index, poor household wealth, urban residential place, and living in Sylhet division. Findings of this study recommend to utilize an appropriate logistic model considering the issues relevant to the data, particularly sampling design and clustering for determining the risk factors of childhood stunting in Bangladesh. [ABSTRACT FROM AUTHOR]

Bangladesh has experienced steady socio‐economic development. However, improvements in child growth have not kept pace. It is important to document complementary feeding (CF) practices—a key determinant of children's growth—and their trends over time. The study aims to examine trends in CF practices in children aged 6–23 months using data from Bangladesh Demographic and Health Surveys conducted in 2004, 2007, 2011, and 2014. Multilevel logistic regression models were applied to identify independent predictors of four CF practice indicators among children 6–23 months, namely, timely introduction of complementary foods, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet. Introduction of complementary foods was achieved among 64–71% of children between 2004 and 2014. The proportion meeting minimum meal frequency increased from 2004 to 2007 (71–81%) and declined and held steady at 65% from 2011 to 2014. The proportion meeting minimum dietary diversity in 2011 and 2014 was low (25% and 28%), and so was minimum acceptable diet (19% and 20%). From 2007 to 2014, child dietary diversity decreased and the most decline was in the consumption of legumes and nuts (29% to 8%), vitamin A‐rich fruits and vegetables (54% to 41%), and other fruits and vegetables (47% to 20%). Young child age (6–11 months), poor parental education, household poverty, and residence in the Chittagong and Sylhet independently predicted poorer feeding practices. Dietary diversity and overall diet in Bangladeshi children are strikingly poor. Stagnation or worsening of feeding practices in the past decade are concerning and call for decisive policy and programme action to address inappropriate child feeding practices. [ABSTRACT FROM AUTHOR]

Globally, undernutrition affects nearly half of all children aged less than 5 years. It is more prominent in low- and middle-income countries. This study aimed to identify the age-specific risk factors for different categories of undernutrition among Bangladeshi children aged less than 2 years. Data of 10,291 children aged less than 2 years were collected between October 2011 to November 2013 through the Food Security Nutritional Surveillance Project in Bangladesh. Simple logistic regression established bivariate relationships between the categories of undernutrition and the relevant risk factors. Multiple logistic regression constructed the age-specific regression models depicting the independent association and effect size of the risk factors contributing to the various categories of undernutrition among study population. Stunting was prevalent among 30.9% of the study children, whereas 9.7% were wasted and 24.9% were underweight. Being a male child, increase in age, maternal body mass index and education, and household food insecurity were the strongest predictors for all categories of undernutrition in terms of effect size. Our study shows that the different categories of childhood undernutrition have different age-specific risk factors. Maternal body mass index and household food insecurity were the common age-specific risk factors for all categories of undernutrition. We expect our findings to enhance the existing evidence base for the risk factors of undernutrition among children aged less than 2 years. [ABSTRACT FROM AUTHOR]