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Food intake inequality at the individual level is rarely analyzed in intrahousehold settings. We examine dietary diversity scores of household members with a focus on their family roles (fathers, mothers, sons, daughters and grandparents) and age groups (children, adults and elderly). Whereas theory suggests that members in a household should have equal dietary diversity by receiving a certain share of available foods, this research hypothesizes that they do not do so by their roles and/or age groups. We conduct questionnaire surveys, collecting sociodemographic information and dietary data by using a 24 h recall method of 3248 subjects in 811 households from 1 urban and 2 rural areas in Bangladesh. The statistical analysis demonstrates three findings. First, poor and rural people have lower dietary diversity than nonpoor and urban people, respectively. Second, grandparents (children) have lower dietary diversity than do fathers (adults), confirming the existence of intrahousehold food intake inequality by the roles and/or age groups, irrespective of poverty level and areas of residence. Third, father and mother educations are crucial determinants that raise the dietary diversity of household members; however, they do not resolve the inequality. Overall, it is suggested that awareness programs of dietary diversity shall be necessary with a target group of fathers and mothers for the betterment of intrahousehold inequality and health at the household level, contributing to sustainable development goals.

Diet is a recognized risk factor and cornerstone for chronic kidney disease (CKD) management; however, a tool to assess dietary intake among Bangladeshi dialysis patients is scarce. This study aims to validate a prototype Bangladeshi Hemodialysis Food Frequency Questionnaire (BDHD-FFQ) against 3-day dietary recall (3DDR) and corresponding serum biomarkers. Nutrients of interest were energy, macronutrients, potassium, phosphate, iron, sodium and calcium. The BDHD-FFQ, comprising 132 food items, was developed from 606 24-h recalls and had undergone face and content validation. Comprehensive facets of relative validity were ascertained using six statistical tests (correlation coefficient, percent difference, paired t -test, cross-quartiles classification, weighted kappa, and Bland-Altman analysis). Overall, the BDHD-FFQ showed acceptable to good correlations ( p < 0.05) with 3DDR for the concerned nutrients in unadjusted and energy-adjusted models, but this correlation was diminished when adjusted for other covariates (age, gender, and BMI). Phosphate and potassium intake, estimated by the BDHD-FFQ, also correlated well with the corresponding serum biomarkers ( p < 0.01) when compared to 3DDR ( p > 0.05). Cross-quartile classification indicated that <10% of patients were incorrectly classified. Weighted kappa statistics showed agreement with all but iron. Bland-Altman analysis showed positive mean differences were observed for all nutrients when compared to 3DDR, whilst energy, carbohydrates, fat, iron, sodium, and potassium had percentage data points within the limit of agreement (mean ± 1.96 SD), above 95%. In summary, the BDHD-FFQ demonstrated an acceptable relative validity for most of the nutrients as four out of the six statistical tests fulfilled the cut-off standard in assessing dietary intake of CKD patients in Bangladesh.

This study investigated the self-defining periods (SPs) in private and public memories of Bangladeshi older adults ( N  = 476; mean age = 67.16 years) who, during adolescence and early adulthood, witnessed the 1960s Bengali nationalist movement and the 1971 Bangladesh War of Independence. Each participant retrieved three private and three public memories they considered to be highly significant. The lifespan distributions for private and public memories were identical; in both cases, participants recalled more than half of their memories from 10 to 29 years of age. The calendar-year distributions revealed that nearly one-fourth of private and one-third of public memories were recalled from the year of the War of Independence. The memory content analysis showed that participants sampled more negative than positive memories: 55% versus 45% for private memory and 66% versus 34% for public memory. The enhanced recollection of private and public memories from 10 to 29 years of age was predominantly shaped by memories of the independence struggle-a period that was self-defining for the entire Bangladeshi society.

Objective: The present paper aimed to demonstrate how 24 h dietary recall data can be used to generate a nutrition-relevant food list for household consumption and expenditure surveys (HCES) using contribution analysis and stepwise regression., Design: The analysis used data from the 2011/12 Bangladesh Integrated Household Survey (BIHS), which is nationally representative of rural Bangladesh. A total of 325 primary sampling units (PSU=village) were surveyed through a two-stage stratified sampling approach. The household food consumption module used for the analysis consisted of a 24 h open dietary recall in which the female member in charge of preparing and serving food was asked about foods and quantities consumed by the whole household., Setting: Rural Bangladesh.ParticipantsA total of 6500 households., Results: The original 24 h open dietary recall data in the BIHS were comprised of 288 individual foods that were grouped into ninety-four similar food groups. Contribution analysis and stepwise regression were based on nutrients of public health interest in Bangladesh (energy, protein, fat, Fe, Zn, vitamin A). These steps revealed that a list of fifty-nine food items captures approximately 90 % of the total intake and up to 90 % of the between-person variation for the key nutrients based on the diets of the population., Conclusions: The study illustrates how 24 h open dietary recall data can be used to generate a country-specific nutrition-relevant food list that could be integrated into an HCES consumption module to enable more accurate and comprehensive household-level food and nutrient analyses.

Background: Gestational age (GA) is a key determinant of newborn survival and long-term impairment. Accurate estimation of GA facilitates timely provision of essential interventions to improve maternal and newborn outcomes. Menstrual based dating, ultrasound based dating, and neonatal estimates are the primarily used methods for assessing GA; all of which have some strength and weaknesses that require critical consideration. Last menstrual period (LMP) is simple, low-cost self-reported information, recommended by the World Health Organization for estimating GA but has issues of recall mainly among poorer, less educated women and women with irregular menstruation, undiagnosed abortion, and spotting during early pregnancy. Several studies have noted that about 20-50% of women cannot accurately recall the date of LMP. The goal of this study is therefore to improve recall and reporting of LMP and by doing so increase the accuracy of LMP based GA assessment in a rural population of Bangladesh where antenatal care-seeking, availability and utilization of USG is low., Method: We propose to conduct a 4- parallel arm, superiority, community based cluster randomized controlled trial comparing three interventions to improve recall of GA with a no intervention arm. The interventions include (i) counselling and a paper based calendar (ii) counselling and a cell phone based SMS alert system (iii) counselling and smart-phone application. The trial is being conducted among 3360 adolescent girls and recently married women in Mirzapur sub-district of Bangladesh., Discussion: Enrolment of study participants continued from January 24, 2017 to March 29, 2017. Data collection and intervention implementation is ongoing and will end by February, 2019. Data analysis will measure efficacy of interventions in improving the recall of LMP date among enrolled participants. Results will be reported following CONSORT guideline. The innovative conventional & e-platform based interventions, if successful, can provide substantial evidence to scale-up in a low resource setting where m-Health initiatives are proliferating with active support from all sectors in policy and implementation., Trial Registration: ClinicalTrials.gov NCT02944747 . The trial has been registered before starting enrolment on 24 October 2016.

Background: The best method of gestational age assessment is by ultrasound in the first trimester; however, this method is impractical in large field trials in rural areas. Our objective was to assess the validity of gestational age estimated from prospectively collected date of last menstrual period (LMP) using crown-rump length (CRL) measured in early pregnancy by ultrasound., Methods: As part of a large, cluster-randomized, controlled trial in rural Bangladesh, we collected dates of LMP by recall and as marked on a calendar every 5 weeks in women likely to become pregnant. Among those with a urine-test confirmed pregnancy, a subset with gestational age of <15 weeks (n = 353) were enrolled for ultrasound follow-up to measure CRL. We compared interview-assessed LMP with CRL gestational age estimates and classification of preterm, term, and post-term births., Results: LMP-based gestational age was higher than CRL by a mean (SD) of 2.8 (10.7) days; differences varied by maternal education and preterm birth (P < 0.05). Lin's concordance correlation coefficient was good at ultrasound [0.63 (95 % CI 0.56, 0.69)] and at birth [0.77 (95 % CI 0.73, 0.81)]. Validity of classifying preterm birth was high but post-term was lower, with specificity of 96 and 89 % and sensitivity of 86 and 67 %, respectively. Results were similar by parity., Conclusions: Prospectively collected LMP provided a valid estimate of gestational age and preterm birth in a rural, low-income setting and may be a suitable alternative to ultrasound in programmatic settings and large field trials., Trial Registration: ClinicalTrials.gov NCT00860470.

Background: Diet diversity of pregnant women is associated with nutrition sufficiency, micronutrient adequacy, and pregnancy outcomes. However, the sociodemographic determinants of diet diversity among pregnant women in low-income countries are not well studied., Objective: The analysis was undertaken to study the determinants of high dietary diversity and consumption of micronutrient-rich foods by pregnant women from rural Bangladesh., Methods: Pregnant women (508) were randomly selected from southwestern Bangladesh and interviewed to collect data about diet and sociodemographic characteristics. A 24-hour recall was used to collect information about diet. Diet diversity score was calculated for 9 major food groups. All analyses were conducted using STATA SE 12., Result: The overall mean diet diversity score was low at 4.28 and was significantly high among pregnant women who have higher educational achievement, whose husbands' occupation was business, who live in households of 4 or more family members, and who were dwelling in a house with more than 1 room. Highest gap on knowledge and consumption was reported for 3 food groups including dairy foods, eggs, and dark green leafy vegetables. Consumption of dairy and eggs was lower among women from low socioeconomic status, but no significant association was found between sociodemographic characteristics and consumption of leafy vegetables., Conclusion: Our analysis has shown that diet quality of pregnant women was poor and intake of micronutrient-rich foods was low despite having knowledge about the importance of these foods, underscoring the need for promoting the diet quality in developing countries through behavior change communication programs., (© The Author(s) 2016.)

There is limited research documenting objectively measured physical activity (PA) and sedentary time (ST) in South Asian (SA) women, with no published evidence of the validity of self-report methods for assessment of PA/ST in SA. The purpose of this study was to compare accelerometer- and International Physical Activity Questionnaire (IPAQ)-derived PA/ST among SA women in the United Kingdom (UK) via a mixed-methods approach. One hundred and forty SA women wore an accelerometer for seven consecutive days; a sub-sample (n = 50) completed the IPAQ-Short Form (IPAQ-SF) and a brief structured interview. Accelerometer-derived metabolic equivalent (MET) minutes per week (min/wk) moderate-to-vigorous physical activity (MVPA) (mean ± SD) for the full sample was 793.94 (±519.44) and mean accelerometer-derived ST wk was 530.20 (±81.76). IPAQ-SF-derived MVPA (MET min/wk) was 636.80 (±2113.56) and mean ST wk was 315.31 (±266.98). Pearson correlations were not significant between accelerometer- and IPAQ-SF-assessed MVPA (r = -.119, p = .579) and ST (r = -.140, p = .229). Major themes synthesised from interviews included inability to recall sitting time and limited general knowledge of real-life examples of MVPA. These results suggest that the IPAQ-SF may not accurately measure PA/ST in the UK SA women. These findings are supported by qualitative evidence indicating several issues with interpretation and recall of PA/ST as assessed via this questionnaire.

Background: Antibiotic treatment for pneumonia as measured by Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) is a key indicator for tracking progress in achieving Millennium Development Goal 4. Concerns about the validity of this indicator led us to perform an evaluation in urban and rural settings in Pakistan and Bangladesh., Methods and Findings: Caregivers of 950 children under 5 y with pneumonia and 980 with "no pneumonia" were identified in urban and rural settings and allocated for DHS/MICS questions 2 or 4 wk later. Study physicians assigned a diagnosis of pneumonia as reference standard; the predictive ability of DHS/MICS questions and additional measurement tools to identify pneumonia versus non-pneumonia cases was evaluated. Results at both sites showed suboptimal discriminative power, with no difference between 2- or 4-wk recall. Individual patterns of sensitivity and specificity varied substantially across study sites (sensitivity 66.9% and 45.5%, and specificity 68.8% and 69.5%, for DHS in Pakistan and Bangladesh, respectively). Prescribed antibiotics for pneumonia were correctly recalled by about two-thirds of caregivers using DHS questions, increasing to 72% and 82% in Pakistan and Bangladesh, respectively, using a drug chart and detailed enquiry., Conclusions: Monitoring antibiotic treatment of pneumonia is essential for national and global programs. Current (DHS/MICS questions) and proposed new (video and pneumonia score) methods of identifying pneumonia based on maternal recall discriminate poorly between pneumonia and children with cough. Furthermore, these methods have a low yield to identify children who have true pneumonia. Reported antibiotic treatment rates among these children are therefore not a valid proxy indicator of pneumonia treatment rates. These results have important implications for program monitoring and suggest that data in its current format from DHS/MICS surveys should not be used for the purpose of monitoring antibiotic treatment rates in children with pneumonia at the present time.

Difficulties of vaccination documentation in developing countries lead to a dependence on maternal recollection of vaccination to evaluate tetanus toxoid (TT) vaccination. To date, the validity of this approach has not been assessed. Recollection of TT immunization in 1477 women was compared with carefully maintained records of immunization in Matlab, rural Bangladesh. Sensitivity, specificity and predictive values for maternal recall were calculated in a highly vaccinated population of women of reproductive age. Maternal recollection of the second TT dose was good, but considerably reduced if they had received more than two doses. Recollection was also reduced if the doses were administered more than a year prior to questioning. Up to 40% of women did not remember doses received 12-23 months earlier. Logistic regression evaluated the effect of confounding variables on recalling the number of TT doses received. Younger women, with fewer children and with a good vaccination status, tended to have a better recollection of the number of doses received. Maternal education, household characteristics, religion or family planning resumption within 1 year of the last delivery had no effect on the accuracy of recall. These results suggest that maternal recall may underestimate TT doses received a year before the date of questioning. Current methods to determine TT status by asking mothers at infant vaccination contacts may result in underestimating coverage.

The accuracy of responses to a question on the frequency of sexual intercourse in the 4-week period prior to an interview is expected to be low. This paper examines the reliability of an alternative question: 'How many days since you last had sexual intercourse?'. This was a part of a larger longitudinal study of fertility dynamics in Matlab, Bangladesh. The response pairs of 61 women who were asked the same question by an interviewer and on the next day by a supervisor, were analysed. Refusals were more common among older women and among women who gave a response at the extremes of the distribution for the other interview. Of the pairs of two responses, 78% had a difference of 3 days or less. Further study and use of the question on days since last intercourse is recommended.

To estimate inaccuracy in a diarrhoea recall survey mothers of pre-school children in Teknaf, Bangladesh were interviewed every week from July 1980 through June 1983. Because the likelihood of an episode starting on any given day of the week should be equal, we were able to quantify any deviation observed. Results show an average of 34% less diarrhoea episodes reported prior to a 48-hour recall period in any week. The amount of reporting error was (a) directly related to the length of the recall period, and (b) inversely related to the severity of diarrhoea as indicated by presence of fever and frequency of motions. This analysis reveals that weekly diarrhoea recall surveys in Bangladesh underestimate severe diarrhoea cases by 20-22% and less severe cases by 42-44%. The findings also indicate that morbidity surveys based on lengthy recall are likely to mislead health planners with regard to the magnitude of the problem and the volume of resources required to combat it.

Many community based studies of diarrhoea in the developing world employ face-to-face interviews to obtain diarrhoeal histories. An alternative recording device that preserved the accuracy but avoided the expense and time commitment of the interview would be extremely valuable. To evaluate the comparability of episodes of diarrhoea obtained from a home-maintained two-week calendar with those histories given in response to a two-week health recall interview in a largely uneducated population, we studied approximately 1500 families for six months in Dhaka, Bangladesh. The diarrhoea records obtained for children by the two methods were highly comparable (Kappa value 0.83). The comparability was not impaired either by lack of maternal education nor by increased numbers of children in the household. We conclude that the two-week home maintained diarrhoea calendar offers comparable results with the two-week recall and in certain situations could be a useful substitute.

Although responses to 24-hour recall and knowledge-attitude-practice questionnaires are commonly used in water-sanitation studies as surrogates for direct observation of behaviour, the validity of this approach is questionable. We therefore compared questionnaire data with those obtained by direct observation of practices related to water storage, handwashing, and defecation among 247 families in urban Dhaka, Bangladesh. Analysis of the results indicates that accord between the replies to the questionnaires and the data collected by direct observation was poor and that the responses to the two questionnaires were often contradictory. Significant disagreements between the results of questionnaires and observations arose usually because desirable practices were over-reported by the respondents. The results of the study suggest that in urban Bangladesh 24-hour recall and knowledge-attitude-practice questionnaires should not be used as proxies for direct observation of hygiene practices.