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Many women justify intimate partner violence (IPV), resulting in adverse health outcomes. This study investigates the relationship between household ownership of information and communication technologies (ICTs), along with the frequency of listening to the radio and watching television with women's attitudes towards IPV in Bangladesh. The cross-sectional study analyzed a weighted sample of 20,032 women and used a multivariable logistic regression analysis to determine the association between predictor variables and outcome variables. The results showed that 19.47% of women justified wife beating for at least one reason. We found that household ownership of computers (AOR = 0.73 [95% CI = 0.57, 0.95]), women in households with three ICTs (AOR = 0.67 [95% CI = 0.47, 0.96]), and women who watched television at least once a week (AOR = 0.85 [95% CI = 0.74, 0.97]) were associated with decreased odds of justifying wife beating for at least one reason after adjustment for the frequency of reading newspaper or magazine, age, wealth, education, religion, and type of place of residence. The study suggests that not all ICTs affect women's attitudes toward IPV equally. Computers and television were more influential than other ICTs. This finding suggests that awareness-building and educational programs targeted towards women via computer and television may deliver better outcomes about gender norms. [ABSTRACT FROM AUTHOR]

Animal source foods (ASF) are nutrient-dense and essential for the growth and development of children. The Bangladesh Demographic and Health Survey (BDHS) 2022 reported that approximately two-thirds of children aged 6–23 months consumed eggs/flesh foods. However, overall consumption patterns, trends, and factors influencing ASF intake among children in Bangladesh were not well-documented. Therefore, the study aimed to assess the trends and associated factors of ASF consumption among children aged 6–23 months in Bangladesh. A total of 9401 children were extracted from four consecutive BDHS (2011, 2014, 2017/18, and 2022). The Cochran-Armitage test was conducted to assess the trends in ASF consumption, while a two-stage multilevel mixed-effects logistic regression was performed to identify the associated factors. The consumption of ASF significantly increased to 79.1% in 2017/18 from 67% in 2011 but decreased to 73.3% in 2022. ASF consumption was found to be higher among children whose mothers were educated (AOR = 1.60, 95% CI = 1.30–1.98), employed in either agricultural (AOR = 1.27, 95% CI = 1.04–1.54) or non-agricultural (AOR = 1.36, 95% CI = 1.07–1.72) activities, pregnant (AOR = 2.54, 95% CI = 1.66–3.87), had received ANC 1–3 times (AOR = 1.43, 95% CI = 1.20–1.72) or ≥4 times (AOR = 1.59, 95% CI = 1.29–1.95), and was exposed to media (AOR = 1.21, 95% CI = 1.04–1.39). Furthermore, consumption increased with increasing the age of children, and the wealth of their families. However, children who experienced illness were less likely to consume ASF (AOR = 0.76, 95% CI = 0.68–0.86). The recent declines in ASF consumption emphasize the need for targeted interventions to increase ASF consumption among children in Bangladesh.

Abstract Background Currently, food price inflation is a widespread issue in Bangladesh as well as the rest of the world. Malnutrition is a common issue among children that can have long-lasting effects on their development and overall health. There have been lots of studies conducted to identify the factors responsible for child malnutrition, but inflation is rarely considered a factor in child malnutrition. We aimed to determine the relationship between food price inflation and stunting (Height-for-Age Z-score (HAZ)) in children under five years of age in Bangladesh. Method The study utilized food price data from the World Food Programme database and malnutrition (stunting) information from the 2014 and 2017-18 Bangladesh Demographic Health Surveys (BDHS). This includes the total study period from 2009 to 2018. Food prices were linked to the BDHS dataset using each child’s birth month. For each child, the average food prices from 9 months prior to 5 months post-birth, including their birth month, were recorded to calculate month-to-month inflation. This inflation was computed for rice (coarse), oil, wheat flour, and lentils by comparing the price sum of each item from one month to the previous month and dividing by the total price of the preceding month. A generalized linear regression model was used to assess the relationship between food price inflation and stunting, with stunting as the dependent variable. Other explanatory variables included wealth index, sex of the child, height, weight, mother’s education, respondent’s current pregnancy, and breastfeeding status. Results Our study has revealed that food price inflation has a significant negative effect on stunting, with a coefficient of -0.127 (p

Background: Currently, food price inflation is a widespread issue in Bangladesh as well as the rest of the world. Malnutrition is a common issue among children that can have long-lasting effects on their development and overall health. There have been lots of studies conducted to identify the factors responsible for child malnutrition, but inflation is rarely considered a factor in child malnutrition. We aimed to determine the relationship between food price inflation and stunting (Height-for-Age Z-score (HAZ)) in children under five years of age in Bangladesh. Method: The study utilized food price data from the World Food Programme database and malnutrition (stunting) information from the 2014 and 2017-18 Bangladesh Demographic Health Surveys (BDHS). This includes the total study period from 2009 to 2018. Food prices were linked to the BDHS dataset using each child's birth month. For each child, the average food prices from 9 months prior to 5 months post-birth, including their birth month, were recorded to calculate month-to-month inflation. This inflation was computed for rice (coarse), oil, wheat flour, and lentils by comparing the price sum of each item from one month to the previous month and dividing by the total price of the preceding month. A generalized linear regression model was used to assess the relationship between food price inflation and stunting, with stunting as the dependent variable. Other explanatory variables included wealth index, sex of the child, height, weight, mother's education, respondent's current pregnancy, and breastfeeding status. Results: Our study has revealed that food price inflation has a significant negative effect on stunting, with a coefficient of -0.127 (p < 0.001). Furthermore, we have identified several other factors that have also significantly negative associations with stunting, including the wealth index (p < 0.001), mother's education level (p < 0.001), mother's pregnancy status (p < 0.001), breastfeeding (p < 0.001), child's age (p < 0.001). child's weight (p < 0.001) has significantly positive effect on stunting. However, we did not find any significant differences in stunting between boys and girls. Conclusion: In conclusion, the findings of this study underscore the significant negative impact of food price inflation on child stunting, emphasizing the need to acknowledge this factor alongside others. These results highlight the critical role of addressing food price inflation as a key determinant of stunting, in conjunction with various other contributing factors, in efforts to combat childhood malnutrition. [ABSTRACT FROM AUTHOR]

Abstract Introduction Hypertension is a widespread and life-threatening condition globally, with its prevalence increasing rapidly, particularly among adults. This study aims to examine the trend in adult hypertension prevalence and associated risk factors in both urban and rural areas of Bangladesh from 2011 to 2018. Methods Nationally representative cross-sectional data from the Bangladesh Demographic and Health Survey was used at two time points, 2011 and 2018. In our study, we used a two-step approach for variable selection, combining traditional statistical methods ( $${\chi }^{2}$$ χ 2 test) with a machine learning algorithm (Boruta algorithm).. This study also employed two different multivariate binary logistic regression models to identify the risk factors that are most closely connected to the presence of hypertension (respectively for urban and rural locations). Results According to the study, hypertension has been on the rise in Bangladesh. In 2011, over a third of adults (38.7%) in urban Bangladesh had hypertension, a number that rose by 22.6% in 2017-18. Though rural areas had a lower hypertension prevalence in 2011 (36%), it surged to 64% in 2017-18, surpassing the rate in urban areas. The results of the multivariate analysis showed that age, gender, education, wealth status, area, and survey year had a significant influence on the determinants of hypertension status in connection to place of residence. According to the odds ratio, the prevalence was significantly higher among older respondents, female respondents, wealthy families and higher-educated respondents. Conclusion A large proportion of Bangladesh’s adult population suffers from hypertension. A health education program is required to develop appropriate strategies, including appropriate weight control, appropriate physical activity, and healthier eating habits. Health authorities should take initiatives to spread awareness among people, particularly at an older age.

Abstract Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.

Introduction: Hypertension is a widespread and life-threatening condition globally, with its prevalence increasing rapidly, particularly among adults. This study aims to examine the trend in adult hypertension prevalence and associated risk factors in both urban and rural areas of Bangladesh from 2011 to 2018. Methods: Nationally representative cross-sectional data from the Bangladesh Demographic and Health Survey was used at two time points, 2011 and 2018. In our study, we used a two-step approach for variable selection, combining traditional statistical methods ( χ 2 test) with a machine learning algorithm (Boruta algorithm).. This study also employed two different multivariate binary logistic regression models to identify the risk factors that are most closely connected to the presence of hypertension (respectively for urban and rural locations). Results: According to the study, hypertension has been on the rise in Bangladesh. In 2011, over a third of adults (38.7%) in urban Bangladesh had hypertension, a number that rose by 22.6% in 2017-18. Though rural areas had a lower hypertension prevalence in 2011 (36%), it surged to 64% in 2017-18, surpassing the rate in urban areas. The results of the multivariate analysis showed that age, gender, education, wealth status, area, and survey year had a significant influence on the determinants of hypertension status in connection to place of residence. According to the odds ratio, the prevalence was significantly higher among older respondents, female respondents, wealthy families and higher-educated respondents. Conclusion: A large proportion of Bangladesh's adult population suffers from hypertension. A health education program is required to develop appropriate strategies, including appropriate weight control, appropriate physical activity, and healthier eating habits. Health authorities should take initiatives to spread awareness among people, particularly at an older age. [ABSTRACT FROM AUTHOR]

Sustainable Development Goal-3, as defined by the United Nations, aims to ensure healthy lives, and promote well-being for all at all ages. In the context of Bangladesh, achieving the targets of SDG-3 is a critical priority for public health and development. This study presents a data-driven exploration of SDG-3 in Bangladesh, focusing on maternal and child health indicators. We utilized data from multiple Bangladesh Demographic and Health Surveys conducted in 2011, 2014, and 2018 to provide a comprehensive analysis of health-related trends and determinants. We employed rigorous statistical techniques, including backward stepwise logistic regression and Pearson correlation coefficients, to uncover insights into the status of maternal and child health in Bangladesh. The prevalence of safe childbirth practices exhibited a gradual improvement from 2011 (32.5%) to 2018 (50.2%). Notably, women with higher levels of education demonstrated a significantly higher likelihood of safe childbirth practices (odd ratio = 1.73, 95% Confidence Interval: 1.19 – 1.97). Additionally, residing in urban regions (odd ratio = 1.07, 95% Confidence Interval: 0.96 – 1.39), having access to mass media (odd ratio = 1.34, 95% Confidence Interval: 0.98 – 1.41), receiving antenatal care (odd ratio = 1.62, 95% Confidence Interval: 1.16 – 1.92), being in the rich wealth index category (odd ratio = 1.13, 95% Confidence Interval: 0.92 – 1.39), and choosing to deliver outside the home (odd ratio = 1.48, 95% Confidence Interval: 1.11 – 1.86) were all associated with a higher likelihood of safe childbirth practices. The findings from this study show the power of data-driven decision-making in shaping health policies and interventions. They reveal critical factors affecting health outcomes, offering a roadmap for policymakers and stakeholders to design evidence-based strategies for improving maternal and child health in Bangladesh. This proposed work not only contributes to the academic understanding of public health in Bangladesh but also serves as a practical guide for those working to achieve SDG-3. As Bangladesh continues its journey toward health and well-being for all, this study sets a benchmark for evidence-based policymaking, emphasizing the importance of data-driven perspectives in the pursuit of SDG. [ABSTRACT FROM AUTHOR]

Abstract Background Evidence suggested that inequalities based on education, wealth status, place of residence, and geographical regions significantly influence the key breastfeeding indicators including early initiation of breastfeeding. This study aimed to estimate the trends and magnitude of inequalities in early initiation of breastfeeding practice in Bangladesh from 2004 to 2017 applying both absolute and relative measures of inequality. Methods We used data from the last five Bangladesh Demographic Health Survey (BDHS) from 2004 to 2017 to measure the inequalities in early initiation of breastfeeding practice using the WHO’s Health Equity Assessment Toolkit (HEAT) software. Following summary measures were estimated to measure the inequalities: Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) where the equity dimensions were wealth status, education level, sex of child, place of residence, and subnational regions (divisions). For each measure, point estimates along with a 95% confidence interval (CI) were reported. Results An uprising pattern in the prevalence of early initiation of breastfeeding was found, where early initiation of breastfeeding increased from 24.9% to 2004 to 59.0% in 2017. We found significant wealth-driven inequalities in early initiation of breastfeeding practice in every wave of survey favoring the poorest wealth quintile (in 2017, D -10.5; 95% CI -16.6 to -4.3). We also identified geographical disparities in early initiation of breastfeeding practice (in 2017, PAF 11.1; 95% CI 2.2 to 19.9) favoring the Rangpur (65.5%), and Sylhet (65.3%) divisions. Education-related disparities were observed in 2004 only, but not in later survey years, which was due to a much lower level of adherence among those with secondary or higher education. There were no significant disparities in early initiation of breastfeeding based on the urban vs. rural residence and sex of the child. Conclusions The highest attention should be placed in Bangladesh to attain the WHO’s 100% recommendation of timely initiation of breastfeeding. This study emphasizes on addressing the existing socioeconomic and geographic inequalities. Awareness-raising outreach programs focusing the mothers from wealthier sub-groups and divisions with lower prevalence should be planned and implemented by the joint effort of the government and non-government organizations.

Abstract Background Barriers to healthcare access for women have a substantial influence on maternal and child health. By removing barriers to accessing healthcare, several sustainable development goals can be achieved. The goal of this study, based on the dominance analysis, was to examine how living standards and spousal education play role in removing barriers to healthcare access for women in Bangladesh. Methods The study used the nationally representative Bangladesh Demographic and Health Survey (BDHS), 2017-18 data. A binary logistic regression model was applied for analyzing different types of health access barriers in the study. Additionally, a dominance analysis was conducted to identify the most responsible factors for removing barriers. Results In Bangladesh, 66% of women faced at least one barrier in accessing healthcare. The results obtained from logistic regression and dominance analysis revealed that women’s standard of living and spousal education explained the highest variation of having at least one barrier in accessing healthcare. Specifically, a high standard of living explained 24% of the total explained variation (OR 0.56, 95% CI 0.52–0.62), while both spousal education accounted for 27% (OR 0.49, 95% CI 0.45–0.54) of the total explained variation. The regression results also showed that women with higher standards of living as well as educated women having educated partners had lower odds of facing barriers in getting permission (OR 0.87, 95% CI 0.76-1.00 and OR 0.66, 95% CI 0.58–0.75) to go for advice/treatment, obtaining money (OR 0.43, 95% CI 0.39–0.47 and OR 0.37, 95% CI 0.34–0.40), distance to a health facility (OR 0.60, 95% CI 0.55–0.66 and OR 0.70, 95% CI 0.65–0.76), and not wanting to go alone (OR 0.72, 95% CI 0.66–0.89 and OR 0.75, 95% CI 0.69–0.81) for getting medical advice/treatment. Conclusion The findings of the study suggest paying extra attention to the spousal education and living standard of women to strengthen and reform the existing strategies and develop beneficial interventions to enhance unhindered accessibility to healthcare facilities for women.

Background and Aims: Bangladesh did not have enough evidence on the current estimates and trend in inequities in the under‐five mortality rate (U5MR). There is also a shortage of evidence on trends and inequalities in healthcare‐seeking for pneumonia among under‐five children (U5C) in Bangladesh. Hence, this study investigated the inequalities in U5MR and health care seeking for pneumonia in U5C through socioeconomic and geographic disparities in Bangladesh between 2007 and 2017. Methods: Data from 2007, 2011, 2014, and 2017 Bangladesh Demographic and Health surveys were analyzed using the Health Equity Assessment Toolkit (HEAT) software by World Health Organization (WHO). The data on U5MR and healthcare‐seeking for pneumonia were first disaggregated into five equity dimensions: wealth status, education, child sex, place of residence, and administrative divisions. Second, using summary metrics such as difference (D), population attributable risk (PAR), ratio (R), and population attributable fraction (PAF), inequalities were assessed. Results: The U5MR declined from 73.9 deaths per 1000 live births in 2007 to 48.6 deaths in 2017, while the prevalence of healthcare‐seeking for pneumonia in U5C fluctuated over time (34.6% in 2007, 35.4% in 2011, 42.0% in 2014, and 39.8% in 2017). Profound socioeconomic and geographic disparities in U5MR and the prevalence of healthcare‐seeking for pneumonia in U5C favored the wealthy, educated, and urban residents. At the same time, the Sylhet division showed the worst situation for U5MR. There were also sex‐related disparities in U5MR (PAR = −4.5, 95% confidence interval: −5.3 to −3.7) with higher risk among male children than females. Conclusion: These results indicate that improving disadvantaged women, such as the poor, uneducated, and rural inhabitants, who exhibit disproportionate disparities in U5MR and healthcare‐seeking behavior is important. To reduce childhood mortality, it is essential to improve healthcare‐seeking for pneumonia among U5C. Facilitating women for better education and economic encompasses would help reducing disparity. [ABSTRACT FROM AUTHOR]

Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage. [ABSTRACT FROM AUTHOR]

Abstract Background Maternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across socioeconomic and geographic regions. Therefore, we aim to estimate the trends and magnitude of inequality in SBA use in Bangladesh over the last two decades. Methods Data from the last 5 rounds of Bangladesh Demographic and Health Surveys (BDHS; 2017-18, 2014, 2011, 2007, and 2004) were used to measure the inequalities in the SBA use utilizing the WHO’s Health Equity Assessment Toolkit (HEAT) software. Inequality was assessed by four summary measures, namely, Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) based on the four equity dimensions: wealth status, education level, place of residence, and subnational regions (divisions). Point estimates and a 95% confidence interval (CI) were reported for each measure. Results An increasing trend in the overall prevalence of SBA use was observed (From 15.6% in 2004 to 52.9% in 2017). We found significant inequalities in SBA use in every wave of BDHS (from 2004 to 2017), with the result concentrating on the rich (in 2017, PAF: 57.1; 95% CI: 52.5–61.7), educated (in 2017, PAR: 9.9; 95% CI: 5.2–14.5), and people from urban areas (in 2017, PAF: 28.0; 95% CI: 26.4–29.5). We also identified geographic disparities in SBA use favoring Khulna and Dhaka divisions (in 2017, PAR: 10.2; 95% CI: 5.7–14.7). Our study also observed inequality in using SBA among Bangladeshi women decreased over time. Conclusion To increase SBA use and to decrease inequality in all four equity dimensions, disadvantaged sub-groups should be prioritized in policies and planning for program implementation.

Abstract Background Bangladesh is one of the most densely populated countries in the world. This large population predominantly affects the socioeconomic development of the people living in this country. Therefore, it is essential to identify the determinants of household size in the country and suggest implications for future interventions in similar contexts. Objectives The primary purpose of the present study was to explore the distribution of household size and its determinants based on the nationally representative Bangladesh Demographic and Health Survey (BDHS) data. Material and Methods The data were extracted from BDHS 2017–2018, a national survey. Individual responses from the adult women of each household were considered in this nationwide survey. We applied univariate and bivariate analyses (chi-squared test) to explore the distribution of household size and different selected determinants. The multinomial logistic regression was utilized to identify the association between household size and the selected independent determinants in our study. Results Findings of our multinomial logistic regression analysis showed that sex of the household head, division, decision about health, respondent’s age, residence, respondent’s education, husband’s education, wealth index, religion, husband’s occupation, and respondent’s working status were significantly associated with the household size (P ≤ 0.05). We observed that household size tended to be more prominent in rural areas, in the Sylhet division, in families where the head of the household was a male, and in families where others except the respondents and their husbands made health-related decisions. Besides, large household size was also common among respondents aged 25 years or less, respondents and their husbands with higher education, respondents from the rich and middle class, respondents who were Muslim, respondents whose husbands were businessmen and jobholders, and respondents who were workers. Conclusions The findings of our study suggest that household size in Bangladesh is associated with different socioeconomic factors. We recommend promoting awareness programs on family planning promotion and early marriage prevention, especially in rural areas, to prevent the rapid growth of the population. Expansion of education for both men and women and female involvement in income-generating activities should be encouraged to effectively control the household size in Bangladesh.

Abstract Background and Aims Bangladesh did not have enough evidence on the current estimates and trend in inequities in the under‐five mortality rate (U5MR). There is also a shortage of evidence on trends and inequalities in healthcare‐seeking for pneumonia among under‐five children (U5C) in Bangladesh. Hence, this study investigated the inequalities in U5MR and health care seeking for pneumonia in U5C through socioeconomic and geographic disparities in Bangladesh between 2007 and 2017. Methods Data from 2007, 2011, 2014, and 2017 Bangladesh Demographic and Health surveys were analyzed using the Health Equity Assessment Toolkit (HEAT) software by World Health Organization (WHO). The data on U5MR and healthcare‐seeking for pneumonia were first disaggregated into five equity dimensions: wealth status, education, child sex, place of residence, and administrative divisions. Second, using summary metrics such as difference (D), population attributable risk (PAR), ratio (R), and population attributable fraction (PAF), inequalities were assessed. Results The U5MR declined from 73.9 deaths per 1000 live births in 2007 to 48.6 deaths in 2017, while the prevalence of healthcare‐seeking for pneumonia in U5C fluctuated over time (34.6% in 2007, 35.4% in 2011, 42.0% in 2014, and 39.8% in 2017). Profound socioeconomic and geographic disparities in U5MR and the prevalence of healthcare‐seeking for pneumonia in U5C favored the wealthy, educated, and urban residents. At the same time, the Sylhet division showed the worst situation for U5MR. There were also sex‐related disparities in U5MR (PAR = −4.5, 95% confidence interval: −5.3 to −3.7) with higher risk among male children than females. Conclusion These results indicate that improving disadvantaged women, such as the poor, uneducated, and rural inhabitants, who exhibit disproportionate disparities in U5MR and healthcare‐seeking behavior is important. To reduce childhood mortality, it is essential to improve healthcare‐seeking for pneumonia among U5C. Facilitating women for better education and economic encompasses would help reducing disparity.

Background: Evidence suggested that inequalities based on education, wealth status, place of residence, and geographical regions significantly influence the key breastfeeding indicators including early initiation of breastfeeding. This study aimed to estimate the trends and magnitude of inequalities in early initiation of breastfeeding practice in Bangladesh from 2004 to 2017 applying both absolute and relative measures of inequality. Methods: We used data from the last five Bangladesh Demographic Health Survey (BDHS) from 2004 to 2017 to measure the inequalities in early initiation of breastfeeding practice using the WHO's Health Equity Assessment Toolkit (HEAT) software. Following summary measures were estimated to measure the inequalities: Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) where the equity dimensions were wealth status, education level, sex of child, place of residence, and subnational regions (divisions). For each measure, point estimates along with a 95% confidence interval (CI) were reported. Results: An uprising pattern in the prevalence of early initiation of breastfeeding was found, where early initiation of breastfeeding increased from 24.9% to 2004 to 59.0% in 2017. We found significant wealth-driven inequalities in early initiation of breastfeeding practice in every wave of survey favoring the poorest wealth quintile (in 2017, D -10.5; 95% CI -16.6 to -4.3). We also identified geographical disparities in early initiation of breastfeeding practice (in 2017, PAF 11.1; 95% CI 2.2 to 19.9) favoring the Rangpur (65.5%), and Sylhet (65.3%) divisions. Education-related disparities were observed in 2004 only, but not in later survey years, which was due to a much lower level of adherence among those with secondary or higher education. There were no significant disparities in early initiation of breastfeeding based on the urban vs. rural residence and sex of the child. Conclusions: The highest attention should be placed in Bangladesh to attain the WHO's 100% recommendation of timely initiation of breastfeeding. This study emphasizes on addressing the existing socioeconomic and geographic inequalities. Awareness-raising outreach programs focusing the mothers from wealthier sub-groups and divisions with lower prevalence should be planned and implemented by the joint effort of the government and non-government organizations. [ABSTRACT FROM AUTHOR]

Background: Barriers to healthcare access for women have a substantial influence on maternal and child health. By removing barriers to accessing healthcare, several sustainable development goals can be achieved. The goal of this study, based on the dominance analysis, was to examine how living standards and spousal education play role in removing barriers to healthcare access for women in Bangladesh. Methods: The study used the nationally representative Bangladesh Demographic and Health Survey (BDHS), 2017-18 data. A binary logistic regression model was applied for analyzing different types of health access barriers in the study. Additionally, a dominance analysis was conducted to identify the most responsible factors for removing barriers. Results: In Bangladesh, 66% of women faced at least one barrier in accessing healthcare. The results obtained from logistic regression and dominance analysis revealed that women's standard of living and spousal education explained the highest variation of having at least one barrier in accessing healthcare. Specifically, a high standard of living explained 24% of the total explained variation (OR 0.56, 95% CI 0.52–0.62), while both spousal education accounted for 27% (OR 0.49, 95% CI 0.45–0.54) of the total explained variation. The regression results also showed that women with higher standards of living as well as educated women having educated partners had lower odds of facing barriers in getting permission (OR 0.87, 95% CI 0.76-1.00 and OR 0.66, 95% CI 0.58–0.75) to go for advice/treatment, obtaining money (OR 0.43, 95% CI 0.39–0.47 and OR 0.37, 95% CI 0.34–0.40), distance to a health facility (OR 0.60, 95% CI 0.55–0.66 and OR 0.70, 95% CI 0.65–0.76), and not wanting to go alone (OR 0.72, 95% CI 0.66–0.89 and OR 0.75, 95% CI 0.69–0.81) for getting medical advice/treatment. Conclusion: The findings of the study suggest paying extra attention to the spousal education and living standard of women to strengthen and reform the existing strategies and develop beneficial interventions to enhance unhindered accessibility to healthcare facilities for women. [ABSTRACT FROM AUTHOR]

Background Early initiation breastfeeding (EIBF) is a sign of good health for both the mother and the newborn baby. The objective of this study was to estimate the prevalence of EIBF among mothers in Bangladesh and to identify its associated factors. Methods The study used the most recent Bangladesh Demographic and Health Survey 2017–2018 data. A total of 4776 (weighted) respondents were included in the final analysis. The association between the outcome and the independent variables was determined using multilevel (mixed effects) logistic regression analysis. Results The overall weighted prevalence of EIBF among Bangladeshi mothers was 61.19% (confidence interval [CI] 59.80 to 62.56). The study shows that non-poor wealth status (adjusted odds ratio [AOR] 0.81 [95% CI 0.68 to 0.95]), institutional delivery (AOR 0.77 [95% CI 0.61 to 0.96]) and caesarean delivery (AOR 0.31 [95% CI 0.26 to 0.38]) were associated with the lower odds of EIBF. Mother's secondary education (AOR 1.34 [95% CI 1.01 to 1.83]), at least four antenatal care visits (AOR 1.36 [95% CI 1.04 to 1.53]), normal birthweight (AOR 1.42 [95% CI 1.09 to 1.85]) and placed on mother's chest and bare skin after birth (AOR 1.33 [95% CI 1.11 to 1.60]) were associated with higher odds of EIBF. Conclusion In order to enhance EIBF in Bangladesh, health professionals should emphasise skin-to-skin contact after delivery. [ABSTRACT FROM AUTHOR]

Abstract Background Much scholarly debate has centered on Bangladesh's family planning program (FPP) in lowering the country's fertility rate. This study aimed to investigate the prevalence of using modern and traditional contraceptive methods and to determine the factors that explain the contraceptive methods use. Methods The study used data from the 2017–18 Bangladesh Demographic and Health Survey (BDHS), which included 11,452 (weighted) women aged 15–49 years in the analysis. Multilevel multinomial logistic regression was used to identify the factors associated with the contraceptive method use. Results The prevalence of using modern contraceptive methods was 72.16%, while 14.58% of women used traditional methods in Bangladesh. In comparison to women in the 15–24 years age group, older women (35–49 years) were more unwilling to use modern contraceptive methods (RRR: 0.28, 95% CI: 0.21–0.37). Women who had at least a living child were more likely to use both traditional and modern contraceptive methods (RRR: 4.37, 95% CI: 3.12–6.11). Similarly, given birth in the previous 5 years influenced women 2.41 times more to use modern method compared to those who had not given birth (RRR: 2.41, 95% CI: 1.65–3.52). Husbands'/partners’ decision for using/not using contraception were positively associated with the use of both traditional (RRR: 4.49, 95% CI: 3.04–6.63) and modern methods (RRR: 3.01, 95% CI: 2.15–4.17) rather than using no method. This study suggests rural participants were 21% less likely to utilize modern methods than urban participants (RRR: 0.79, 95% CI: 0.67–0.94). Conclusion Bangladesh remains a focus for contraceptive use, as it is one of the most populous countries in South Asia. To lower the fertility rate, policymakers may design interventions to improve awareness especially targeting uneducated, and rural reproductive women in Bangladesh. The study also highlights the importance of male partners’ decision-making regarding women's contraceptive use.

Background: Maternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across socioeconomic and geographic regions. Therefore, we aim to estimate the trends and magnitude of inequality in SBA use in Bangladesh over the last two decades. Methods: Data from the last 5 rounds of Bangladesh Demographic and Health Surveys (BDHS; 2017-18, 2014, 2011, 2007, and 2004) were used to measure the inequalities in the SBA use utilizing the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequality was assessed by four summary measures, namely, Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) based on the four equity dimensions: wealth status, education level, place of residence, and subnational regions (divisions). Point estimates and a 95% confidence interval (CI) were reported for each measure. Results: An increasing trend in the overall prevalence of SBA use was observed (From 15.6% in 2004 to 52.9% in 2017). We found significant inequalities in SBA use in every wave of BDHS (from 2004 to 2017), with the result concentrating on the rich (in 2017, PAF: 57.1; 95% CI: 52.5–61.7), educated (in 2017, PAR: 9.9; 95% CI: 5.2–14.5), and people from urban areas (in 2017, PAF: 28.0; 95% CI: 26.4–29.5). We also identified geographic disparities in SBA use favoring Khulna and Dhaka divisions (in 2017, PAR: 10.2; 95% CI: 5.7–14.7). Our study also observed inequality in using SBA among Bangladeshi women decreased over time. Conclusion: To increase SBA use and to decrease inequality in all four equity dimensions, disadvantaged sub-groups should be prioritized in policies and planning for program implementation. [ABSTRACT FROM AUTHOR]

Abstract Background Childhood stunting, wasting and underweight are significant public health challenges. There is a gap in knowledge of the coexistence of stunting, wasting, and underweight among children under five years (under-5) in Bangladesh. This study aims to (i) describe the prevalence of the coexistence of stunting, wasting, and underweight and ii) examine the risk factors for the coexistence of stunting, wasting, and underweight among children under-5 in Bangladesh. Methods This study included 6,610 and 7,357 under-5 children from Bangladesh Demographic Health Surveys (BDHS) 2014 and 2017/18, respectively. The associations between the coexistence of stunting, wasting, and underweight and independent variables were assessed using the Chi-square test of independence. The effects of associated independent variables were examined using negative binomial regression. Results The prevalence of coexistence of stunting, wasting, and underweight gradually declined from 5.2% in 2014 to 2.7% in 2017/18. Children born with low birth weight ((adjusted incidence rate ratios, aIRR) 2.31, 95% CI 1.64, 3.24)); children of age group 36–47 months (aIRR 2.26, 95% CI 1.67, 3.08); children from socio-economically poorest families (aIRR 2.02, 95% CI 1.36, 2.98); children of mothers with no formal education (aIRR 1.98, 95% CI 1.25, 3.15); and children of underweight mothers (aIRR 1.73, 95% CI 1.44, 2.08) were the most important risk factors. Further, lower incidence among children with the coexistence of stunting, wasting, and underweight was observed in the 2017–18 survey (aIRR 0.59, 95% CI 0.49, 0.70) compared to children in the 2014 survey. Conclusions One out of thirty-five under-5 children was identified to have coexistence of stunting, wasting, and underweight in Bangladesh. The burden of coexistence of stunting, wasting, and underweight was disproportionate among children born with low birth weight, socio-economically poorest, a mother with no formal education, and underweight mothers, indicating the need for individual, household, and societal-level interventions to reduce the consequences of coexistence of stunting, wasting, and underweight.

Abstract Background There exists a lack of research in explaining the link between dropout from school and antenatal care (ANC) visits of women during pregnancy in Bangladesh. The aim of this study is to investigate how the drop out from school influences the ANC visits after controlling the relevant covariates using an appropriate count regression model. Methods The association between the explanatory variables and the outcome of interest, ANC visits, have been performed using one-way analysis of variance/independent sample t-test. To examine the adjusted effects of covariates on the marginal mean of count data, Marginalized Poison-Poisson mixture regression model has been fitted. Results The estimated incidence rate of antenatal care visits was 10.6% lower for the mothers who were not continued their education after marriage but had at least 10 years of schooling (p-value

Abstract Background Unmet need for family planning (FP) is a core concept in designing FP programmes and reduction of unmet need for FP can improve reproductive and maternal health services. Bangladesh is still away from achieving the target regarding unmet need for FP. This study aimed to explore the composite effect of economic status and place of residence on unmet need for FP among currently married women of reproductive age in Bangladesh after controlling the effect of other selected covariates. Methods The study used the data extracted from the Bangladesh Demographic and Health Survey (BDHS) 2017–2018, which is a nationally representative survey implemented using a stratified two-stage cluster sample design. A total of 13,031 currently married women of reproductive age were included in the final analysis. Binary logistic regression model has been employed to identify the factors influencing the unmet need for FP. Model-I investigated the effect of composite variable place-wealth on unmet need for FP and Model-II examined the effect of place-wealth on unmet need for FP after adjusting for the effect of other selected covariates. The Odds Ratios with p-values were reported to identify significant covariates. Results The rate of unmet need for FP was 15.48%. The composite factor of economic status and place of residence had significant influence on unmet need for FP in both models. Generally, rural women were significantly more likely to have unmet need for FP than their urban counterparts. In particular, women from rural areas and belong to rich families had the highest likelihoods of unmet need for FP. The other selected covariates also had significant influence on unmet need for FP. Conclusion This study shows that rural women had higher odds of unmet need for FP than urban women. The healthcare providers and stakeholders should take necessary actions to motivate women to use contraceptive specially the women who are residing in the rural areas.

Background: Bangladesh is one of the most densely populated countries in the world. This large population predominantly affects the socioeconomic development of the people living in this country. Therefore, it is essential to identify the determinants of household size in the country and suggest implications for future interventions in similar contexts. Objectives: The primary purpose of the present study was to explore the distribution of household size and its determinants based on the nationally representative Bangladesh Demographic and Health Survey (BDHS) data. Material and Methods: The data were extracted from BDHS 2017–2018, a national survey. Individual responses from the adult women of each household were considered in this nationwide survey. We applied univariate and bivariate analyses (chi-squared test) to explore the distribution of household size and different selected determinants. The multinomial logistic regression was utilized to identify the association between household size and the selected independent determinants in our study. Results: Findings of our multinomial logistic regression analysis showed that sex of the household head, division, decision about health, respondent's age, residence, respondent's education, husband's education, wealth index, religion, husband's occupation, and respondent's working status were significantly associated with the household size (P ≤ 0.05). We observed that household size tended to be more prominent in rural areas, in the Sylhet division, in families where the head of the household was a male, and in families where others except the respondents and their husbands made health-related decisions. Besides, large household size was also common among respondents aged 25 years or less, respondents and their husbands with higher education, respondents from the rich and middle class, respondents who were Muslim, respondents whose husbands were businessmen and jobholders, and respondents who were workers. Conclusions: The findings of our study suggest that household size in Bangladesh is associated with different socioeconomic factors. We recommend promoting awareness programs on family planning promotion and early marriage prevention, especially in rural areas, to prevent the rapid growth of the population. Expansion of education for both men and women and female involvement in income-generating activities should be encouraged to effectively control the household size in Bangladesh. [ABSTRACT FROM AUTHOR]

Background and aims: The key interest of this research is to identify the causes of the ongoing increasing trends in caesarean section or C-section (CS) deliveries in both urban and rural areas of Bangladesh. Methods: This study analyzed all Bangladesh Demographic and Health Survey (BDHS) datasets through Chi-square and z tests and the multivariable logistic regression model. Results: CS deliveries were found to be more prevalent in urban than in rural areas of Bangladesh. Mothers above 19 years, above 16 years at first birth, overweight mothers, those with higher educational levels, those who received more than one antenatal care (ANC) visit, fathers having secondary/higher education degrees and employed as workers or in business, and mothers living in wealthy households in the cities of Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions had a significantly higher likelihood of CS deliveries in urban areas. Contrastingly, mothers with ages between 20 and 39 years, above 20 years at first birth, normal weight/overweight mothers, those with primary to higher level of education, those in the business profession, fathers who also received primary to higher education, mothers who received more than one ANC visit, and those living in wealthy households in Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions were more likely to have CS deliveries in rural areas. The 45-49 age group mothers had a five times higher likelihood of CS deliveries [odds ratio (OR): 5.39] in urban areas than in rural areas. Wealthy mothers were more likely to be CS-delivered in urban (OR: 4.84) than in rural areas (OR: 3.67). Conclusion: The findings reveal a gradual upward alarming trend in CS deliveries with an unequal contribution of significant determinants in urban and rural areas of Bangladesh. Therefore, integrated community-level awareness programs are an urgent need in accordance with the findings on the risks of CS and the benefits of vaginal deliveries in this country. [ABSTRACT FROM AUTHOR]

Background and aimsThe key interest of this research is to identify the causes of the ongoing increasing trends in caesarean section or C-section (CS) deliveries in both urban and rural areas of Bangladesh.MethodsThis study analyzed all Bangladesh Demographic and Health Survey (BDHS) datasets through Chi-square and z tests and the multivariable logistic regression model.ResultsCS deliveries were found to be more prevalent in urban than in rural areas of Bangladesh. Mothers above 19 years, above 16 years at first birth, overweight mothers, those with higher educational levels, those who received more than one antenatal care (ANC) visit, fathers having secondary/higher education degrees and employed as workers or in business, and mothers living in wealthy households in the cities of Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions had a significantly higher likelihood of CS deliveries in urban areas. Contrastingly, mothers with ages between 20 and 39 years, above 20 years at first birth, normal weight/overweight mothers, those with primary to higher level of education, those in the business profession, fathers who also received primary to higher education, mothers who received more than one ANC visit, and those living in wealthy households in Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions were more likely to have CS deliveries in rural areas. The 45–49 age group mothers had a five times higher likelihood of CS deliveries [odds ratio (OR): 5.39] in urban areas than in rural areas. Wealthy mothers were more likely to be CS-delivered in urban (OR: 4.84) than in rural areas (OR: 3.67).ConclusionThe findings reveal a gradual upward alarming trend in CS deliveries with an unequal contribution of significant determinants in urban and rural areas of Bangladesh. Therefore, integrated community-level awareness programs are an urgent need in accordance with the findings on the risks of CS and the benefits of vaginal deliveries in this country.

Background: Much scholarly debate has centered on Bangladesh's family planning program (FPP) in lowering the country's fertility rate. This study aimed to investigate the prevalence of using modern and traditional contraceptive methods and to determine the factors that explain the contraceptive methods use. Methods: The study used data from the 2017–18 Bangladesh Demographic and Health Survey (BDHS), which included 11,452 (weighted) women aged 15–49 years in the analysis. Multilevel multinomial logistic regression was used to identify the factors associated with the contraceptive method use. Results: The prevalence of using modern contraceptive methods was 72.16%, while 14.58% of women used traditional methods in Bangladesh. In comparison to women in the 15–24 years age group, older women (35–49 years) were more unwilling to use modern contraceptive methods (RRR: 0.28, 95% CI: 0.21–0.37). Women who had at least a living child were more likely to use both traditional and modern contraceptive methods (RRR: 4.37, 95% CI: 3.12–6.11). Similarly, given birth in the previous 5 years influenced women 2.41 times more to use modern method compared to those who had not given birth (RRR: 2.41, 95% CI: 1.65–3.52). Husbands'/partners' decision for using/not using contraception were positively associated with the use of both traditional (RRR: 4.49, 95% CI: 3.04–6.63) and modern methods (RRR: 3.01, 95% CI: 2.15–4.17) rather than using no method. This study suggests rural participants were 21% less likely to utilize modern methods than urban participants (RRR: 0.79, 95% CI: 0.67–0.94). Conclusion: Bangladesh remains a focus for contraceptive use, as it is one of the most populous countries in South Asia. To lower the fertility rate, policymakers may design interventions to improve awareness especially targeting uneducated, and rural reproductive women in Bangladesh. The study also highlights the importance of male partners' decision-making regarding women's contraceptive use. [ABSTRACT FROM AUTHOR]

BackgroundAlthough undiagnosed hypertension (HTN) is a serious concern worldwide, it is less of an importance in Bangladesh, where there is a dearth of research on the subject. So, we aimed to identify the prevalence and associated factors for diagnosed and undiagnosed HTN.MethodsWe analyzed the recent 2017–2018 Bangladesh Demographic and Health Survey data. We included 11,981 participants aged 18 years and above for the analysis. The prevalence rates of both diagnosed and undiagnosed hypertension were computed for all individuals and subgroups. The influence of socio-demographic, household, and community-related variables on HTN and undiagnosed HTN was investigated using multinomial regression analysis.ResultsThe study finds 1,464 (12.2%) of the 11,981 respondents [6,815 females [56.9 %]; mean age 39.4 years] had diagnosed HTN, whereas 1 898 (15.8%) had undiagnosed HTN. The HTN and undiagnosed HTN were significantly prevalent in the elderly, type 2 diabetic (T2DM), and overweight and obese individuals. In terms of residential regions, people from coastal region had a significantly higher prevalence of both HTN (RRR: 1.37; 95% CI: 1.17–1.62) and undiagnosed HTN (RRR: 1.35; 95% CI: 1.17–1.56) compared to those from the central region of Bangladesh.ConclusionsThe high prevalence of undetected hypertension in Bangladesh suggests that screening procedures for the current chronic illness may be inadequate in routine clinical practice. All populations should have access to hypertension screening, but it is especially crucial for the elderly, those with diabetes, those who are overweight or obese, and those from coastal and northern regions of Bangladesh.

Abstract Background Vaccination has important consequences for childhood development, mortality, and inequalities in health and well-being. This research explores the trend of vaccinations coverage from 1993 to 2014 and determines the significant factors for vaccinations coverage in Bangladesh, considering geospatial, socioeconomic, and demographic characteristics. Methods This study uses a secondary dataset extracted from the Bangladesh Demographic and Health Survey (BDHS) from 1992 to 93 to 2014. The association between selected independent variables and vaccination coverage of children was examined through the Chi-square test. In addition, unadjusted and adjusted logistic regression approaches were applied to determine the effects of covariates on vaccination status by using the BDHS-2014 dataset. Results The results reveal that the trend of the vaccination coverage rate has gradually been increased over the study period. The coverage rate of BCG is observed maximum while the lowest for Measles vaccination among all types of vaccinations. The findings revealed that the significantly lower coverage of all vaccination had been observed in the Sylhet region. Children of higher educated mothers (OR 10.21; CI: 4.10–25.37) and father (OR 8.71; CI: 4.03–18.80), born at health facilities (OR 4.53; CI: 2.4–8.55) and whose mother has media exposure (OR 3.20; CI: 2.22–4.60) have more chance of receiving BCG vaccine. For DPT vaccination coverage, there is a significant difference from children whose mothers have primary (OR 1.7; CI: 1.35–2.15), secondary (OR 3.5; CI: 2.75–4.45), and higher (OR 9.6; CI: 5.28–17.42) educational qualification compared to children of illiterate mothers. Findings demonstrated that children born in wealthier households have a higher likelihood of being immunized against DPT, Polio, and Measles vaccination than children born in the poorest households. Conclusions The findings reveal that to enhance and make sustainable the overall country’s vaccination coverage, we should pay more attention to the mother’s education, socioeconomic condition, children’s age, birth order number, having media exposure, place of residence, and religion. The authors think that this finding would be helpful to accelerate the achievement target of Sustainable Development Goals (SDGs) for children’s health in Bangladesh.

Background: Childhood stunting, wasting and underweight are significant public health challenges. There is a gap in knowledge of the coexistence of stunting, wasting, and underweight among children under five years (under-5) in Bangladesh. This study aims to (i) describe the prevalence of the coexistence of stunting, wasting, and underweight and ii) examine the risk factors for the coexistence of stunting, wasting, and underweight among children under-5 in Bangladesh. Methods: This study included 6,610 and 7,357 under-5 children from Bangladesh Demographic Health Surveys (BDHS) 2014 and 2017/18, respectively. The associations between the coexistence of stunting, wasting, and underweight and independent variables were assessed using the Chi-square test of independence. The effects of associated independent variables were examined using negative binomial regression. Results: The prevalence of coexistence of stunting, wasting, and underweight gradually declined from 5.2% in 2014 to 2.7% in 2017/18. Children born with low birth weight ((adjusted incidence rate ratios, aIRR) 2.31, 95% CI 1.64, 3.24)); children of age group 36–47 months (aIRR 2.26, 95% CI 1.67, 3.08); children from socio-economically poorest families (aIRR 2.02, 95% CI 1.36, 2.98); children of mothers with no formal education (aIRR 1.98, 95% CI 1.25, 3.15); and children of underweight mothers (aIRR 1.73, 95% CI 1.44, 2.08) were the most important risk factors. Further, lower incidence among children with the coexistence of stunting, wasting, and underweight was observed in the 2017–18 survey (aIRR 0.59, 95% CI 0.49, 0.70) compared to children in the 2014 survey. Conclusions: One out of thirty-five under-5 children was identified to have coexistence of stunting, wasting, and underweight in Bangladesh. The burden of coexistence of stunting, wasting, and underweight was disproportionate among children born with low birth weight, socio-economically poorest, a mother with no formal education, and underweight mothers, indicating the need for individual, household, and societal-level interventions to reduce the consequences of coexistence of stunting, wasting, and underweight. [ABSTRACT FROM AUTHOR]

Background: There exists a lack of research in explaining the link between dropout from school and antenatal care (ANC) visits of women during pregnancy in Bangladesh. The aim of this study is to investigate how the drop out from school influences the ANC visits after controlling the relevant covariates using an appropriate count regression model.Methods: The association between the explanatory variables and the outcome of interest, ANC visits, have been performed using one-way analysis of variance/independent sample t-test. To examine the adjusted effects of covariates on the marginal mean of count data, Marginalized Poison-Poisson mixture regression model has been fitted.Results: The estimated incidence rate of antenatal care visits was 10.6% lower for the mothers who were not continued their education after marriage but had at least 10 years of schooling (p-value <0.01) and 20.2% lower for the drop-outed mothers (p-value <0.01) than the mothers who got continued their education after marriage.Conclusions: To ensure the WHO recommended 8+ ANC visits for the pregnant women of Bangladesh, it is essential to promote maternal education so that at least ten years of schooling should be completed by a woman and dropout from school after marriage should be prevented. [ABSTRACT FROM AUTHOR]

Background: Unmet need for family planning (FP) is a core concept in designing FP programmes and reduction of unmet need for FP can improve reproductive and maternal health services. Bangladesh is still away from achieving the target regarding unmet need for FP. This study aimed to explore the composite effect of economic status and place of residence on unmet need for FP among currently married women of reproductive age in Bangladesh after controlling the effect of other selected covariates.Methods: The study used the data extracted from the Bangladesh Demographic and Health Survey (BDHS) 2017-2018, which is a nationally representative survey implemented using a stratified two-stage cluster sample design. A total of 13,031 currently married women of reproductive age were included in the final analysis. Binary logistic regression model has been employed to identify the factors influencing the unmet need for FP. Model-I investigated the effect of composite variable place-wealth on unmet need for FP and Model-II examined the effect of place-wealth on unmet need for FP after adjusting for the effect of other selected covariates. The Odds Ratios with p-values were reported to identify significant covariates.Results: The rate of unmet need for FP was 15.48%. The composite factor of economic status and place of residence had significant influence on unmet need for FP in both models. Generally, rural women were significantly more likely to have unmet need for FP than their urban counterparts. In particular, women from rural areas and belong to rich families had the highest likelihoods of unmet need for FP. The other selected covariates also had significant influence on unmet need for FP.Conclusion: This study shows that rural women had higher odds of unmet need for FP than urban women. The healthcare providers and stakeholders should take necessary actions to motivate women to use contraceptive specially the women who are residing in the rural areas. [ABSTRACT FROM AUTHOR]

Background: In Bangladesh, intimate partner violence (IPV) is high among women faced by their husband. Regrettably, IPV is often justified by the women themselves, resulting in poor social and health outcomes among them. In this paper, we explored the factors that influence the approval of IPV among the women by their husband in Bangladesh. Method: The present used the data from the most recent Bangladesh Demographic and Health Survey (BDHS) 2017–18. The BDHS 2017–18 followed a two-stage stratified random sampling techniques and the present analysis was carried out among a weighted sample of 20,127 women. Multivariate logistic regression was used to identify the demographic and socio-economic factors associated with the approval of IPV among the women. Results: Overall, one in five women (20.5%) approved at least one form of violence by their husband. In adjusted analysis, women who completed secondary education were 57% less likely [AOR = 0.43, 95% CI: 0.34–0.54] to approve IPV compared to those who had no formal education. Similarly, women who belonged to Hinduism and other religious group were 42% less likely [AOR = 0.58, 95% CI: 0.45–0.74] to approve IPV compared to those who practiced Islam. Moreover, women who were exposed to television, participated in the decision on household purchase and moving outside home had 14%, 19%, and 21% less chance for approving IPV by the husband for at least one reason (p < 0.05). Conclusion: This study highlighted that many women in Bangladesh approve violence by their husband which could be a major obstacle to the reduction of violence from society. Behavior change intervention should be implemented, particularly targeting the less-educated Muslim women to increase the awareness on IPV in Bangladesh.

The purpose of the present study is to examine the major factors related to the participation of women in the economic activities of Bangladesh, using the data of the nationally representative provided by the Bangladesh Demographic and Health Survey (BDHS) 2017/18. The survey interviewed a total of 20127 women aged 15-49 on social, economic, and demographic factors. The study used women's occupations as the dependent variable to understand the patterns and dynamics of women's participation in economic activities in Bangladesh. The result shows that 49.6% of women didn’t associate with any work, 7.9% of women worked as a professional, technical or managerial specialist, and 42.5% of women worked as non-professional, such as: in agriculture, and domestic-related work. Two policy implications emerged from the study: 1) The economic activity of women in Bangladesh is still low, most of them earn their livelihood utilizing non-professional works; 2) Women who are relatively from poorer families, not very well educated, located in the rural area are largely seen in economic activities in Bangladesh. Finally, the study indicates an idea about important determinants of women's employment, as poor women with little formal education remain economically active. The study recommends that women must be provided with new skills and knowledge to expand their ability and the education of women must be given the highest priority, which is the fundamental problem.

Background: Vaccination has important consequences for childhood development, mortality, and inequalities in health and well-being. This research explores the trend of vaccinations coverage from 1993 to 2014 and determines the significant factors for vaccinations coverage in Bangladesh, considering geospatial, socioeconomic, and demographic characteristics.Methods: This study uses a secondary dataset extracted from the Bangladesh Demographic and Health Survey (BDHS) from 1992 to 93 to 2014. The association between selected independent variables and vaccination coverage of children was examined through the Chi-square test. In addition, unadjusted and adjusted logistic regression approaches were applied to determine the effects of covariates on vaccination status by using the BDHS-2014 dataset.Results: The results reveal that the trend of the vaccination coverage rate has gradually been increased over the study period. The coverage rate of BCG is observed maximum while the lowest for Measles vaccination among all types of vaccinations. The findings revealed that the significantly lower coverage of all vaccination had been observed in the Sylhet region. Children of higher educated mothers (OR 10.21; CI: 4.10-25.37) and father (OR 8.71; CI: 4.03-18.80), born at health facilities (OR 4.53; CI: 2.4-8.55) and whose mother has media exposure (OR 3.20; CI: 2.22-4.60) have more chance of receiving BCG vaccine. For DPT vaccination coverage, there is a significant difference from children whose mothers have primary (OR 1.7; CI: 1.35-2.15), secondary (OR 3.5; CI: 2.75-4.45), and higher (OR 9.6; CI: 5.28-17.42) educational qualification compared to children of illiterate mothers. Findings demonstrated that children born in wealthier households have a higher likelihood of being immunized against DPT, Polio, and Measles vaccination than children born in the poorest households.Conclusions: The findings reveal that to enhance and make sustainable the overall country's vaccination coverage, we should pay more attention to the mother's education, socioeconomic condition, children's age, birth order number, having media exposure, place of residence, and religion. The authors think that this finding would be helpful to accelerate the achievement target of Sustainable Development Goals (SDGs) for children's health in Bangladesh. [ABSTRACT FROM AUTHOR]

Abstract Objectives The purpose of the study was to explore the association between couples’ joint participation in household decision making and modern contraceptive use (MCU) among fecund (physically able to bear child) young women in Bangladesh. Methods This study utilized a cross-sectional data (n = 3507) extracted from the Bangladesh Demographic and Health Survey (BDHS) 2011. Differences in the utilization of modern contraceptives (MC) by socio-demographic characteristics were assessed by χ2 analyses. Binary logistic regression was used to identify the associated factors of usingMC, and the odds ratio with a 95% CI was computed to assess the strength of association. Multicollinearity was also checked by examining the standard errors in the fitted model. Results Desire for a child after two years go by and no child at all contributed the most to increasing MCU followed by receiving family planning (FP) methods from FP workers. Couples’ joint decision making power on women’s health care, child’s health care and visiting family members or relatives emerged as the third most influential factor that might be associated with MCU. Conclusions Since spousal joint decision making increases the likelihood of using MC, government should include strategic interventions in FP programs to elevate women’s status through creating educational and employment opportunities and encouraging more visible involvement in household decision making.

Purpose: Early initiation of breastfeeding is essential for newborns after birth to reduce mortality and morbidity. Early initiation of breastfeeding awareness/activities may be a vital role in Bangladesh to minimize the infant deaths. The aim of this study is to identify factors associated with the early initiation of breastfeeding practices. Methods: In this study, Bangladesh Demographic and Health Survey (BDHS) 2017 to 2018 data was used that will be the first analysis for early initiation of breastfeeding practices in this data set in Bangladesh. Considering the importance of early breastfeeding practices, the dependent variable was divided into 3 categories (immediately: breastfeeding for less than 20 minutes, within an hour, and after 1 hour) to find a significant association with early breastfeeding practices in Bangladesh. Bivariate analysis is used to examine the differentials to early initiation of breastfeeding according to the selected number of background variables. Multinomial logistic regression is used to determine predictive independent factors associated with the dependent variable. Results: Using BDHS 2017 to 2018 data on 4950 observations, this study revealed that 24.6% of mothers breastfed their babies immediately after birth and 36.2% of mothers breastfed their babies within an hour. The rate of mothers who breastfeed their babies immediately after birth is lowest at the age of 20 to 25, mothers with a higher level of education, richer class, Khulna division, the first child born, Islam, and private/NGO. With a multivariate analysis of breastfeeding within an hour compared to immediate breastfeeding: richest (OR = 0.71), Barisal division (OR = 0.72), and Buddhism (O R = 0. 52) are less likely to breastfeed newborns compared to the reference category. On the other hand, primary, secondary, and higher educated mothers are more likely to breastfeed newborns compared to no educated mothers. Besides, breastfeeding newborns after 1 hour compared to immediate after birth: mothers aged 20 to 25 (OR = 1.40), richer (OR = 1.46), higher secondary (OR = 2.06), Khulna division (OR = 1.81), and private/NGO (OR = 2.51) are more likely breastfeed newborn. Conclusion: Mother's education, wealth index, region, birth order, religion, and place of delivery have a significant impact on the early initiation of breastfeeding practices, but the rate of immediate breastfeeding is relatively lower than others. Ultimately, this information will help planners and other professionals plan strategies and interventions to provide good quality health services. [ABSTRACT FROM AUTHOR]

Women's health is highly influenced by early childbearing in 95% of developing countries such as Bangladesh. Women who have their first child at an early age receive fewer years of schooling, which also influences their employment life. Women's early age at first birth creates health complications, increases both maternal and child mortality, and prolongs the reproductive duration as well as a country's fertility rate. This is a major social and public health problem around the world. This study aims to investigate the existing situation in Bangladesh and to identify the triggering influencing factors of age at first birth. A cross-sectional study design was implemented in this study, where we used the Bangladesh Demographic and Health Survey data from 2004, 2007, 2011, and 2014. Firstly, to identify different factors associated with first birth at an early age, the bi-variate analysis method was carried out. Then a logistic regression analysis was performed to assess the simultaneous effect of socioeconomic and demographic factors. Findings of the study reveal that respondent education level, partner's education level, religion, reading newspaper, and type of place of residence had significant contributions for early age at first birth among the female in Bangladesh. Based on the findings, there seems a decreasing trend of having early childbearing in Bangladeshi women over the years, but still, no optimal fertility rate has been achieved. For complex socio-cultural settings in Bangladesh, it is difficult to reduce the fertility rate. Hence, to reduce the prevalence of the age at early childbearing in Bangladesh, the Government and non-government organizations should take proper initiatives considering our study findings. [ABSTRACT FROM AUTHOR]

At least 24 aldehyde reductases from Saccharomyces cerevisiae have been characterized and most function in in situ detoxification of lignocellulosic aldehyde inhibitors, but none is classified into the polyol dehydrogenase (PDH) subfamily of the medium-chain dehydrogenase/reductase (MDR) superfamily. This study confirmed that two (2R,3R)-2,3-butanediol dehydrogenases (BDHs) from industrial (denoted Y)/laboratory (denoted B) strains of S. cerevisiae, Bdh1p(Y)/Bdh1p(B) and Bdh2p(Y)/Bdh2p(B), were members of the PDH subfamily with an NAD(P)H binding domain and a catalytic zinc binding domain, and exhibited reductive activities towards lignocellulosic aldehyde inhibitors, such as acetaldehyde, glycolaldehyde, and furfural. Especially, the highest enzyme activity towards acetaldehyde by Bdh2p(Y) was 117.95 U/mg with cofactor nicotinamide adenine dinucleotide reduced (NADH). Based on the comparative kinetic property analysis, Bdh2p(Y)/Bdh2p(B) possessed higher specific activity, substrate affinity, and catalytic efficiency towards glycolaldehyde than Bdh1p(Y)/Bdh1p(B). This was speculated to be related to their 49% sequence differences and five nonsynonymous substitutions (Ser41Thr, Glu173Gln, Ile270Leu, Ile316Met, and Gly317Cys) occurred in their conserved NAD(P)H binding domains. Compared with BDHs from a laboratory strain, Bdh1p(Y) and Bdh2p(Y) from an industrial strain displayed five nonsynonymous mutations (Thr12, Asn61, Glu168, Val222, and Ala235) and three nonsynonymous mutations (Ala34, Ile96, and Ala369), respectively. From a first analysis with selected aldehydes, their reductase activities were different from BDHs of laboratory strain, and their catalytic efficiency was higher towards glycolaldehyde and lower towards acetaldehyde. Comparative investigation of kinetic properties of BDHs from S. cerevisiae as aldehyde reductases provides a guideline for their practical applications in in situ detoxification of aldehyde inhibitors during lignocellulose bioconversion. Key Points • Two yeast BDHs have enzyme activities for reduction of aldehydes. • Overexpression of BDHs slightly improves yeast tolerance to acetaldehyde and glycolaldehyde. • Bdh1p and Bdh2p differ in enzyme kinetic properties. • BDHs from strains with different genetic backgrounds differ in enzyme kinetic properties. [ABSTRACT FROM AUTHOR]

Abstract Background Socioeconomic inequality in health and mortality remains a disturbing reality across nations including Bangladesh. Inequality drew renewed attention globally. Bangladesh though made impressive progress in health, it makes an interesting case for learning. This paper examined the trends and changing pattern of socioeconomic inequalities in under-five mortality in rural Bangladesh. It also examined whether mother’s education had any effect in reducing socioeconomic inequalities. Methods Data from rural samples of seven Bangladesh Demographic Health Surveys, carried out so far, were used. Children born alive during 5 years preceding the surveys were included in the analysis. Univariate, bivariate and multivariate analyses were carried out. Results Under-five mortality rate steadily declined over the years from 128/1000 in 1994 to 48 in 2014. Females had 8% lower mortality rates than males. Children of mothers with no schooling had 1.88 times higher mortality than those whose mother had six or more years of schooling. Similarly, children from low asset category households had on an average 1.17 times higher mortality rate than those from high asset category households. Inequality by mother’s education disappeared in the recent years, and inequality by household socioeconomic condition persisted all through. The pattern of inequality by sex, mother’s education, and household socioeconomic status was not changed statistically significantly over the years, and mothers’ education did not reduce socioeconomic inequalities. Discussion The reduction in mortality was consistent with changes in the proximate determinants of child survival in the country. Proximate determinants included maternal factors, environmental contamination, nutrient deficiency, personal illness control, and injury. Health and population programmes have been effective in increasing immunization coverage, use of ORS for managing diarrhoeal diseases, and increasing contraceptive use. Development activities on the other hand raised the literacy, especially among females, demand for modern health services, and reduction of poverty. However, socioeconomic inequality still exists in both under-five mortality and proximate determinants of child survival. Conclusions The socioeconomic inequality in under-five mortality is showing resistance against further reduction. An assessment of the adequacy of the existing programmes taking the proximate determinants of child survival into consideration will be useful for further improvement.

This cross-sectional study intends to explore the factors associated with the prevalence of early marriage among female teenagers in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS, 2014) were used to meet the study objective. Two binary logistic models were run to estimate the factors that influence early marriage. In Model-I, the covariates were considered in a bivariate setup, and unadjusted odds ratios (UOR) were obtained from Model-II, where all the covariates were taken into account to get the adjusted odds ratio. Results show that the level of education for both females and their partners, religiosity, possession of wealth and geographical location are some important factors with significant effects on the prevalence of early marriage in Bangladesh. Based on the findings, this study recommends gearing up provisions of education for all, awareness-building through social mobilization, reform initiatives concerning Islamic beliefs and strengthening poverty-reduction strategies to speed up the process of eliminating early marriage. [ABSTRACT FROM AUTHOR]

Acute respiratory infections (ARIs) are one of the major causes of child morbidity and mortality in the developing world. There is a lack of information regarding ARIs in children in Bangladesh. The study aims to determine the potential risk factors that are associated with ARIs among children younger than 5 years in Bangladesh. A cross-sectional study design was used. Data were retrieved from the 2014 Bangladesh Demographic and Health Survey, which provides data for monitoring indicators in population, health and nutrition. In total, 7032 children (weighted) younger than 5 years were eligible for our analysis. Children with a cough and chest-related short, rapid breathing in the 2 weeks before the survey were considered having an ARI. A binary logistic regression model was used to determine the significant risk factors. The prevalence of ARI was 5.3% (95% confidence interval [CI]: 4.7–6.0) in the sample population. Infants aged 0–11 months (odds ratio [OR] = 2.87, 95% CI: 1.92–4.28), toddlers aged 12–23 months (OR = 2.03, 95% CI: 1.21–3.38) and children aged 24–35 months (OR = 1.67, 95% CI: 1.11–2.50) had a greater risk of ARI than older children. Children of lower economic (OR = 2.03, 95% CI: 1.27–3.27) and middle economic (OR = 1.67, 95% CI: 1.06–2.64) families were also at a higher risk of ARI. Girls (OR = 0.75, 95% CI: 0.56–0.99) had a lower risk of ARI compared with boys. In addition, stunting or slow growth rate in children (OR = 1.42, 95% CI: 1.02–1.97) was significantly associated with ARI. Young children, boys and stunted children are at greater risk of ARI. Educating mothers on the nutritional needs of children and subsequently reducing stunting due to malnutrition would help in the effort to reduce child morbidity and mortality caused by ARI. • Acute respiratory infection (ARI) is a major cause of child mortality in Bangladesh. • Young children (e.g. infants) are at greater risk of ARI than older children. • Boys and stunted children are at higher risk of ARI than girls and healthy children. • Based on our study, mother's education has no longer significant effect on childhood ARI in Bangladesh. [ABSTRACT FROM AUTHOR]

Objective This study aimed to explore the association between socio-demographic factors and contraceptive use among fecund women under 25 years old. Methods This study utilized a cross-sectional data (n = 3744) extracted from the Bangladesh Demographic and Health Survey 2011. Differences in the use of contraceptives by socio-demographic characteristics were assessed by χ 2 analyses. Binary logistic regression was used to identify the determinants of contraceptive use among young women. Results This study observed that 71% fecund women aged below 25 years used contraceptives. Getting family planning (FP) methods from FP workers increases the likelihood of using contraceptives among young women because outreach activities by FP workers and accessibility of FP related information pave the way of using contraceptives. Husband-wife joint participation in decision making on health care increases the likelihood of using contraceptives. Participation of women in decision making on health care could be achieved by promoting higher education and gainful employment for women. Conclusions Reproductive and sex education should be introduced in schools to prepare the young for healthy and responsible living. Moreover, policy makers should focus on developing negotiation skills in young women by creating educational and employment opportunities since husband-wife joint participation in decision making increases contraceptive use. [ABSTRACT FROM AUTHOR]

Background: Hypertension is an increasing problem in Southeast Asia, particularly in Bangladesh. Although some epidemiological studies on hypertension have been conducted in Bangladesh, the factors associated with hypertension in this nation remain unclear. We aimed to determine the factors associated with hypertension among the adults in Bangladesh.Methods: We conducted a cross-sectional study using data from the nationally representative 2011 Bangladesh Demographic and Health Survey (BDHS). A total of 7,839 (3,964 women and 3,875 men) adults aged 35 years and older who participated in the survey was included. Hypertension was defined by a systolic blood pressure ≥ 140 mmHg and/or, diastolic blood pressure ≥ 90 mmHg and/or, receipt of an anti-hypertensive medication at time of the survey. The degree of association between the risk factors and the outcome was assessed by the odd ratio (OR) obtained from the bivariate and multivariable logistic regression models.Results: The overall prevalence of hypertension was 26.4 %, and the prevalence was higher in women (32.4%) than men (20.3%). Study participants with the age group of 60-69 years had higher odds of having hypertension (AOR: 3.77, 95% CI: 3.01-4.72) than the age group 35-39 years. Moreover, individuals who had higher educational attainment (AOR: 1.63, 95% C.I: 1.25-2.14) and higher wealth status (AOR = 1.91, 95% CI: 1.54-2.38) had higher odds of having hypertension than the individuals with no education and lower social status, respectively. The analysis also showed that high BMI (AOR: 2.19, 95% C.I: 1.87-2.57) and having diabetes (AOR: 1.54, 95% C.I: 1.31-1.83) were associated with the increasing risk of hypertension.Conclusions: Our study shows that the risk of hypertension was significantly associated with older age, sex, education, place of residence, working status, wealth index, BMI, and diabetes. Moreover, hypertension is largely untreated, especially in rural settings. The health system needs to develop appropriate strategies including early diagnosis, awareness via mass media, and health education programs for changing lifestyles should be initiated for older age, wealthy, and/or higher educated individuals in Bangladesh. Moreover, area-specific longitudinal research is necessary to find out the underlying causes of regional variations. [ABSTRACT FROM AUTHOR]