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Background: With the rapid increase in the number of women in their later reproductive years (aged 35 and above) in the present decade, the concern surrounding their contraceptive considerations has reached a critical point of importance. This study aims to examine the trends and determinants of modern contraceptive uptake among later reproductive-aged women in Bangladesh. Methods: A total of 17,736 women aged 35 and above were included in the analysis, utilizing data from three consecutives Bangladesh Demographic and Health Surveys conducted in 2011, 2014, and 2017–18. The outcome variable was the uptake of modern contraceptive methods (yes or no). The explanatory variables encompassed survey years, individual characteristics of the women, as well as characteristics of their partners and the community. Multilevel logistic regression model was used to explore the association of the outcome variable with explanatory variables. Results: We found that approximately 54% of women aged 35 and more do not use modern contraceptive methods, and there have been no significant shifts in their usage observed over the survey years. Compared to women aged 35–39, women aged 40–45 (aOR = 0.53, 95% CI: 0.49–0.57) and 45–49 (aOR = 0.24, 0.22–0.26) reported lower likelihoods of modern contraceptive method uptake. Higher education correlated with increased uptake of modern contraceptive methods (112%-142%), while partner's education showed a negative association. Later reproductive-aged women in richer (aOR = 0.83, 95% CI: 0.74–0.94) and richest (aOR = 0.76, 95% CI: 0.66–0.88) quintiles reported lower uptake of modern contraceptive methods compared to their counterparts in the poorest quintile. Later reproductive-aged women in Dhaka (aOR = 1.22, 95% CI: 1.07–1.38) and Rajshahi (aOR = 1.37, 95% CI: 1.19–1.59) regions had higher uptake of modern contraception than those residing in the Barishal division. Modern contraceptive methods uptake was 1.22 times higher among women who reported exposure to mass media and 1.19 times higher among women who reported engagement in paid work compared to among women who reported no exposure to mass media and participation in no formal work, respectively. Modern contraceptive methods uptake was 43% higher (aOR = 1.43, 95% CI: 1.32–1.55) in women with more than 2 children compared to those with ≤2 children. Conclusion: The study highlights no significant change in modern contraception uptake among later reproductive-aged women in Bangladesh. This raises concerns about the elevated risk of unintended pregnancies and shorter birth intervals, emphasizing the need for targeted interventions to address the specific needs and preferences of this demographic. [ABSTRACT FROM AUTHOR]

Short Birth Interval (SBI, defined as < 33 months interval between the two most recent births or < 24 months between one live birth to the next pregnancy) is a public health problem in most low- and lower-middle-income countries. Understanding geographic variations in SBI, particularly SBI hot spots and associated factors, may help intervene with tailored programs. This study identified the geographical hot spots of SBI in Bangladesh and the factors associated with them. We analyzed women's data extracted from the 2017/18 Bangladesh Demographic and Health Survey and the healthcare facility data extracted from the 2017 Service Provision Assessment. SBI was the outcome variable, and it was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization. The characteristics of mothers and their partners were the explanatory variables. Moran's I was used to examine the spatial variation of SBI in Bangladesh whereas the Getis-Ord G i ∗ (d) was used to determine the hot spots of SBI. The Geographical Weighted Regression (GWR) was used to assess the predictors of SBI at the enumeration areas' level. The variables included in the GWR were selected using the exploratory regression and ordinary least square regression model. Data of 5941 women were included in the analyses. Around 26% of the total births in Bangladesh had occurred in short intervals. A majority of the SBI hot spots were found in the Sylhet division, and almost all SBI cold spots were in the Rajshahi and Khulna divisions. No engagement with formal income-generating activities, high maternal parity, and history of experiencing the death of a child were significantly associated with SBI in the Sylhet division. Women's age of 34 years or less at the first birth was a protective factor of SBI in the Rajshahi and Khulna divisions. The prevalence of SBI in Bangladesh is highly clustered in the Sylhet division. We recommend introducing tailored reproductive health care services in the hot spots instead of the existing uniform approach across the country. [ABSTRACT FROM AUTHOR]

Background: The level of perinatal mortality in Bangladesh is one of the highest in the world. Certain childbearing practices and low use of antenatal care make Bangladeshi women vulnerable to adverse birth outcomes. Women in Bangladesh also remain considerably subordinate to men in almost all aspects of their lives, from education and paid work to healthcare utilisation. Lack of these opportunities contributes to the low status of women within family and society, and to generally poor health outcomes for women and their children. Objective: This study investigates the risk factors of perinatal deaths in light of the low level of women's autonomy, and the relative role of childbearing practices and antenatal care in influencing the relationship between autonomy and perinatal deaths. Methods: The relevant data was extracted from the 2014 Bangladesh Demographic and Health Survey. Causal mediation analysis was undertaken to investigate the effects of mediators on the associations between women's autonomy and perinatal deaths. Results: The risk of perinatal deaths was greater by about 44% and 39% respectively for high-risk maternal age and birth interval. Those who had received sufficient antenatal care had a much lower risk of perinatal deaths compared to those who had not received sufficient care. No significant direct relationship between women's autonomy and perinatal deaths was evident. However, the influence of women's autonomy was mediated through maternal age, birth interval and antenatal care, and the average amount of mediation was approximately 9.7%, 25.6% and 9.9% respectively. Conclusions: In Bangladesh, although women's autonomy did not exert any significant direct influence on perinatal deaths, the influence was transmitted through the pathways of childbearing practices and use of antenatal care. [ABSTRACT FROM AUTHOR]

Short Birth Interval (SBI, defined as < 33 months interval between the two most recent births or < 24 months between one live birth to the next pregnancy) is a public health problem in most low- and lower-middle-income countries. Understanding geographic variations in SBI, particularly SBI hot spots and associated factors, may help intervene with tailored programs. This study identified the geographical hot spots of SBI in Bangladesh and the factors associated with them. We analyzed women's data extracted from the 2017/18 Bangladesh Demographic and Health Survey and the healthcare facility data extracted from the 2017 Service Provision Assessment. SBI was the outcome variable, and it was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization. The characteristics of mothers and their partners were the explanatory variables. Moran's I was used to examine the spatial variation of SBI in Bangladesh whereas the Getis-Ord G i ∗ (d) was used to determine the hot spots of SBI. The Geographical Weighted Regression (GWR) was used to assess the predictors of SBI at the enumeration areas' level. The variables included in the GWR were selected using the exploratory regression and ordinary least square regression model. Data of 5941 women were included in the analyses. Around 26% of the total births in Bangladesh had occurred in short intervals. A majority of the SBI hot spots were found in the Sylhet division, and almost all SBI cold spots were in the Rajshahi and Khulna divisions. No engagement with formal income-generating activities, high maternal parity, and history of experiencing the death of a child were significantly associated with SBI in the Sylhet division. Women's age of 34 years or less at the first birth was a protective factor of SBI in the Rajshahi and Khulna divisions. The prevalence of SBI in Bangladesh is highly clustered in the Sylhet division. We recommend introducing tailored reproductive health care services in the hot spots instead of the existing uniform approach across the country. [ABSTRACT FROM AUTHOR]

Childhood stunting is a serious public health concern in Bangladesh. Earlier research used conventional statistical methods to identify the risk factors of stunting, and very little is known about the applications and usefulness of machine learning (ML) methods that can identify the risk factors of various health conditions based on complex data. This research evaluates the performance of ML methods in predicting stunting among under-5 aged children using 2014 Bangladesh Demographic and Health Survey data. Besides, this paper identifies variables which are important to predict stunting in Bangladesh. Among the selected ML methods, gradient boosting provides the smallest misclassification error in predicting stunting, followed by random forests, support vector machines, classification tree and logistic regression with forward-stepwise selection. The top 10 important variables (in order of importance) that better predict childhood stunting in Bangladesh are child age, wealth index, maternal education, preceding birth interval, paternal education, division, household size, maternal age at first birth, maternal nutritional status, and parental age. Our study shows that ML can support the building of prediction models and emphasizes on the demographic, socioeconomic, nutritional and environmental factors to understand stunting in Bangladesh. [ABSTRACT FROM AUTHOR]

Introduction: Short birth spacing is reported to have health consequences for both mother and child. This study aims to examine the effect of short birth interval on nutritional outcomes of under-five children in Bangladesh. Methods: We used data from the latest five rounds of successive Bangladesh Demographic and Health Surveys conducted during 2004 to 2017-18. Short birth interval is defined as birth spacing of < 24 months between two subsequent live births. The outcomes of interest are stunting and underweight. Both bivariate and multivariate statistical analyses were employed. Results of the multivariate analysis are shown by odds ratios (ORs) with 95% confidence intervals (CIs). Data were analyzed by Stata 15/IC. Results: A total of 16,100 under-five children of second and higher - order births were included for analysis. Of the children, 12% were born at a space of < 24 months, and 19% were born with a space of 24 - 35 months. The proportion of children with short birth interval was found decreasing over successive surveys. Results of the logistic regression analysis show that compared to the birth interval of 24 - 35 and 36 - 59 months, children born to women with birth interval < 24 months were significantly (P < 0.001) at higher risk of being stunted and underweight. Conclusions: Short birth interval has significant impact on childhood stunting and underweight. It remains a major factor resulting in childhood malnutrition in Bangladesh. Research to explore causal pathways and programs to lengthen space between inter-pregnancy should be intensified. [ABSTRACT FROM AUTHOR]