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Background Food insecurity and early sexual behaviors increase the risk of suicidal behavior, however their combined association on social behaviors receive little attention. Therefore, this study estimated the magnitude of adolescent global suicidal burden, it correlates with food insecurity and sexual behaviors, and assessed the combined association of food insecurity and sexual behaviors on the burden of suicidal behaviors (SBs) among school-going adolescent girls aged between 11 and 17 years. Methods The study design is multi-county, and pooled cross-sectional in nature. Data for 67 countries from the Global School-based Student Health Survey (GSHS) were used. A random-effects meta-analysis was used to generate national and overall pooled estimates of suicidal behaviors. Multinomial logistic regression analyses were employed to estimate the adjusted effect of independent factors and the combined associations of sexual behaviors and food insecurity on adolescent SBs in the context of global, regional, and country income groups and adjusted by a set of explanatory factors. Results The study included 121,248 girls aged 11–17 years. The population-weighted prevalence of high-level (SBs) was 40.65% among school-going girls who experienced sexual intercourse and 7.41% among those who reported severe food insecurity. However, the burden of SBs varied according to type of sexual behaviors and the age. The burden of SB among girls who had sexual intercourse with 1–2 sex partners, 3–4 sex partners, or >4 sex partners was 11.49%, 13.28%, or 18.43%, respectively. The high-level SB was double (23.08%) among adolescent girls who had first sexual intercourse aged 11–13 years old compared to adolescent girls aged 14–17 years (11.49%). The burden of SBs (for at least one SB, for two SBs, or for three SBs) were significantly associated with adolescent girls who experienced sexual intercourse (relative risk ratio, RRR = 2.04, 95% confidence interval, CI:1.83–2.28; RRR = 2.24, 1.99–2.52; RRR = 1.86, 1.59–2.18), sexual intercourse with four or more sex partners (RRR = 1.44, 1.15–1.79; RRR = 1.65, 1.33–2.06; RRR = 2.47, 1.94–3.16), first sexual intercourse aged 11–13 years (RRR = 1.22, 1.02–1.46; RRR = 1.51, 1.26–1.82; RRR = 2.26, 1.81–2.83), compared to adolescents who had no experience of SBs. Compared to adolescent girls who did neither experience food insecurity nor sexual intercourse, the overall burden of SBs (for at least one SB, for two SBs or for three SBs) were significantly higher among girls reporting to have experienced both food insecurity and sexual intercourse (RRR = 1.55, 1.29–1.86; RRR = 1.70, 1.42–2.04; RRR = 1.54, 1.26–1.88); and those reporting having experienced food insecurity but have never had sexual intercourse (RRR = 1.66, 1.48–1.87; RRR = 1.45, 1.26–1.67; RRR = 1.62, 1.36–1.92). However, it was significantly lower among girls reporting to have had sexual intercourse but never experienced food insecurity. This association was extended among adolescents in the context of regional and country income groups. Conclusion The high burden of suicidal behaviors among adolescents calls for an urgent policy interventions to address food insecurity as a means to keep adolescents in school. The interventions should also aim to integrate safeguards that dissuade youngsters from early sex and protect them from sexual victimisation, and the associated adverse outcomes that that hamstring the attainment of SDG 3.4.2.

Background Cervical cancer is one of the most prevalent cancers in women caused by the human papillomavirus (HPV) that leads to a substantial disease burden for health systems. Prevention through vaccination can significantly reduce the prevalence of cervical cancer. The objective of this study is to evaluate the potential health and economic impacts of introducing two-dose bivalent (Cervarix) and quadrivalent (Gardasil) HPV vaccines in Bangladesh. Methods The study uses the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model to assess the cost-effectiveness of introducing HPV vaccination. The incremental cost-effectiveness ratios (ICERs) were estimated per disability-adjusted life years (DALYs) averted using the cost-effectiveness threshold (CET). The analyses were done from a health system perspective in terms of vaccine delivery routes. Results Introduction of bi-valent HPV vaccination was found highly cost-effective (ICER = US$488/DALY) at Gavi (The Vaccine Alliance for Vaccines and Immunizations) negotiated prices. The value of ICERs were US$710, US$356 and US$397 per DALY averted for school-based, health facility-based, and outreach-based programs, respectively, which is consistent with the CET range (US$67 to US$854). However, bivalent and quadrivalent vaccines at listed prices were not found cost-effective, with ICERs of US$1405 and US$3250 per DALY averted, respectively, that exceeds the CETs values. Conclusions Introducing a two-dose bi-valent HPV vaccination program is cost-effective in Bangladesh at Gavi negotiated prices. Vaccine price is the dominating parameter for the cost-effectiveness of bivalent and quadrivalent vaccines. Both vaccines are not cost-effective at listed prices in Bangladesh. The evaluation highlights that introducing the two-dose bivalent HPV vaccine at Gavi negotiated prices into a national immunization program in Bangladesh is economically viable to reduce the burden of cervical cancer.

To identify the factors associated with adolescent maternal healthcare utilization in Bangladesh.A secondary analysis was undertaken using the latest data set from the Bangladesh Demographic and Health Survey (2014). Data were collected from the cross-sectional survey carried out from June to mid November 2014. In total, 17,863 ever-married women aged 15-49 years were interviewed. According to the definition of the World Health Organization, 2029 of these women were adolescents and therefore eligible for inclusion in this study.Both bivariate and multivariate logistic regression models were used to determine the factors influencing adolescent pregnancy, use of contraception, use of antenatal care services, facility-based delivery and presence of a skilled birth attendant at the last birth. The results are presented in terms of adjusted odds ratio (OR) with 95% confidence interval (CI), at a significance level of 5%.Maternal age, education, knowledge of menstrual regulations i.e. any procedure which disrupts the intra uterine environment, awareness of community clinic, household size, socio-economic status and administrative division were found to have a significant effect on adolescent pregnancy in Bangladesh. Sexual knowledge has a significant positive role in the use of modern contraceptives. Adolescents of low socio-economic status are significantly more likely to deliver at home compared with adolescents in the richest quintile (OR 0.26, 95% CI 0.15-0.47; P 0.001). The likelihood of delivering at a health facility was higher among adolescents who had knowledge about sexually transmitted infections (OR 1.84, 95% CI 1.28-2.65; P 0.001) and menstrual regulations (OR 1.41, 95% CI 1.04-1.91; P 0.05).Adolescent maternal healthcare utilization was associated with a number of factors including low socio-economic status, limited reproductive knowledge (e.g. menstrual regulations, sexually transmitted infections) and geographical region. The study findings will serve to inform policy and would be beneficial for introducing need-based adolescent maternal health programmes by targeting a range of maternal health services and opportunities that contribute to better health and development for adolescent mothers in Bangladesh.

This cross-sectional study aimed to determine the age at menarche and its socioeconomic determinants among urban female students (n=680) in Bangladesh. The mean age of the respondents was 14±1.43years. Majority of the respondents were unmarried (98.4%). The mean age at menarche was 11.6±3.6years, median 12years. Almost one-third (35.7%) of the participants had menarche at the age of 12years. There was no statistically significant difference between age at menarche before and after 12years with the socio-economic characteristics, except education (p=0.001). In the multivariate model, only higher education was statistically significant predictor of age at menarche.

Background: Adolescent suicide is a global public health concern, and the second leading cause of adolescent death worldwide. There is a lack of knowledge concerning specific risk factors such as physical violence and unintentional injury, lifestyle related factors, and food security across geographical distribution. This study aimed to measure the burden of adolescent suicidal behaviour and its association with violence and unintentional injury, and psychosocial (e.g., anxiety and loneliness), protective (e.g., peer support and parental regulation and monitoring), and lifestyle related (e.g., obesity, sedentary behaviours and food security) factors, amongst school going adolescents across 77 countries. Methods: This study comprised a sample of 251,763 adolescents drawn from the latest Global School-based Student Health Survey of school children, aged 11-17 years (2003 and 2016), across 77 countries in the six World Health Organization regions. Logistic regression analyses were employed to estimate the adjusted effect of independent factors on adolescent suicidal behaviours. Findings: The population weighted prevalence of suicidal ideation, suicidal planning and suicidal attempts amongst adolescents was 18%, 18% and 16%, respectively. Adolescent suicidal behaviours (ideation, planning, and attempts) were respectively associated with being physically attacked (OR = 1·28, 95% CI: 1·23-1·33; OR = 1·30, 1·24-1·35; and OR = 1·45, 1·39-1·52), physical fighting (OR = 1·34, 1·29-1·39; OR = 1·35, 1·30-1·41, and OR = 1·55, 1·48-1·62), high levels of anxiety (OR = 2·48, 2·34-2·63, OR = 2·23, 2·10-2·37; and OR = 2·57, 2·40-2·75), feeling lonely (OR = 2·90, 2·74-3·07; OR = 2·19, 2·07-2·32; and OR = 1·97, 1·85-2·11), being bulled (OR = 1·56, 1·50-1·62; OR = 1·53, 1·47-1·59; and OR = 1·87, 1·79-1·96), not having parental support (OR = 1·44, 1·36-1·51; OR = 1·45, 1·38-1·53; OR = 1·41, 1·32-1·49), poor peer support (OR = 1·29, 1·22-1·37; OR = 1·19, 1·12-1·26; and OR = 1·16, 1·09-1·24), not having close friends (OR = 1·54, 1·45-1·65; OR = 1·91, 1·80-2·04; OR = 1·95, 1·82-2·10), and high levels of sedentary behaviours (OR = 1·54, 1·46-1·62; OR = 1·42, 1·35-1·49; and OR = 1·19, 1·12-1·26). Overall, these association also extended to the context of food insecurity, where the magnitude of association slightly varied from 1·25 times to 3·13. Interpretation: The burden of adolescent suicidal thoughts, suicide planning, and suicide attempts is of particular concern in low resource countries. Comprehensive suicide prevention programs for school going adolescents in LMICs are needed that address socio-cultural inequities related to violence and unintentional injury, social support. and psychological, factors, protective, and lifestyle related factors. Funding Statement: None. Declaration of Interests: The authors declare no competing interests.