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Objectives This study aimed to explore the effects of short birth spacing (SBS), which is defined as a period of less than 33 months between two successive births, on multiple concurrent forms of child malnutrition (MCFCM) and at least one form of child malnutrition (ALOFCM) using propensity score matching (PSM).Methods This study used data extracted from the 2017-18 Bangladesh Demographic and Health Survey. PSM with four different distance functions, including logistic regression, classification and regression tree, single hidden layer neural network and random forest, were performed to evaluate the effects of SBS on MCFCM and ALOFCM. We also explored how the effects were modified in different subsamples, including women’s empowerment, education and economic status (women’s 3E index)–constructed based on women’s decision-making autonomy, education level, and wealth index, and age at marriage, and place of residence.Results The prevalence of SBS was 22.16% among the 4652 complete cases. The matched samples of size 2062 generated by PSM showed higher odds of MCFCM (adjusted OR (AOR)=1.25, 95% CI=1.02 to 1.56, p=0.038) and ALOFCM (AOR=1.20, 95% CI=1.01 to 1.42, p=0.045) for the SBS children compared with their counterparts. In the subsample of women with 3E index≥50% coverage, the SBS children showed higher odds of MCFCM (AOR: 1.43, 95% CI=1.03 to 2.00, p=0.041] and ALOFCM (AOR: 1.33, 95% CI=1.02 to 1.74, p=0.036). Higher odds of MCFCM (AOR=1.27, 95% CI=1.02 to 1.58, p=0.036) and ALOFCM (AOR=1.23, 95% CI=1.02 to 1.51, p=0.032) for SBS children than normal children were also evident for the subsample of mothers married at age≤18 years.Conclusion SBS was significantly associated with child malnutrition, and the effect was modified by factors such as women’s autonomy and age at marriage.

Abstract Background and Aims Non‐communicable diseases such as hypertension and diabetes are matters of huge concern worldwide, with an increasing trend in prevalence over the previous decade. First of all, this study aimed to evaluate the association between economic status (ES) and body mass index (BMI), ES and comorbidity of hypertension and diabetes, and BMI and comorbidity independently. Second, it explored the mediating role of BMI in the association between ES and comorbidity of hypertension and diabetes. Finally, it investigated whether the mediating effect differs with the place of residence, gender, and education levels. Methods A total of 11,291 complete cases from the Bangladesh demographic and health survey 2017–18 were utilized for this study. Survey‐based binary logistic regression or multiple logistic regression was used to find the association among outcome, exposure, and mediator variables, and a counterfactual framework‐based weighting approach was utilized for mediation analysis. Results Middle‐income (adjusted odds ratio [AOR]: 1.696, 95% confidence interval [CI]: 1.219, 2.360) and rich (AOR: 2.770, CI: 2.054, 3.736) respondents were more likely to have comorbidity of hypertension and diabetes compared to the poor. The odds of comorbidity increased with the increase in BMI. A positive association was observed between ES and BMI. A significant mediating role of BMI in the association between ES and comorbidity was found. We observed that 19.85% (95% CI: 11.50%, 49.6%) and 20.35% (95% CI: 14.9%, 29.3%) of total effect was mediated by BMI for middle and rich respondents, respectively, compared to the poor. Conclusions The mediating role of BMI was greater for female, no or primary educated respondents, and respondents from rural areas. Therefore, the study will facilitate policymakers of Bangladesh and other countries with a similar set‐up to decide on health policies regarding hypertension and diabetes.

Purpose – This study aims to explore whether there is an association between women's empowerment and the utilization of maternal healthcare facilities. Design/methodology/approach – This study considered four indices for measuring women's empowerment – labor force participation index (LFPI), decision-making power index (DMPI), attitude toward partner’s violence index (ATPVI) and knowledge level index (KLI) – and three healthcare facilities – number of antenatal visits, delivery with healthcare facilities and postnatal checkup after delivery. Data extracted for this study were from the Bangladesh Demographic and Health Survey 2011 and 2014. A chi-square test was used for bivariate analysis, and a three-level logistic regression model was applied for multivariate analysis. Findings – An increment was observed in the practice of all considered healthcare facilities, and the percentage of highly empowered women in DMPI decreased from 2011 to 2014. This study found that higher empowerment of women in DMPI, KLI and ATPVI significantly (p-value < 0.05) increases the utilization of healthcare facilities. High empowerment of mothers in LFPI was found negatively associated with facility delivery and positively associated with the postnatal checkup. Originality/value – Women's empowerment was found significantly associated with the utilization of maternal healthcare facilities. This study is seeking the attention of corresponding authority to come up with a more effective intervention program to empower women to utilize maternal healthcare facilities.

Abstract Background and aims Irrational antibiotic (AB) usage poses a serious concern to third‐world countries because of poor surveillance, lack of information, and patients' propensity for self‐medication. Additionally, the unpredictability of the coronavirus disease 2019 (COVID‐19) pandemic promoted the abuse of ABs, which accelerated the prevalence of antibiotic resistance (ABR). The primary aim of this study was to assess the pattern of AB usage and irrational use of ABs‐related potential factors associated with ABR among the students and teachers of a leading public university of Bangladesh. Methods A cross‐sectional web‐based survey was conducted among the students and teachers (n = 783) of the selected university, from January 1 to February 28, 2022. Descriptive statistics, χ2 test, and logistic regression analysis were employed to analyze the collected data. Results The regression analysis supported that male participants had a 34% lower experience of acquiring ABR than female respondents (adjusted odds ratio [AOR] = 0.66, 95% confidence interval [CI] = 0.448, 0.973; p = 0.036). The 1st/2nd‐year level students had more than two times higher experience with ABR than the master's or higher‐class students (AOR = 2.149, 95% CI = 1.047, 4.412; p = 0.037). The participants who took ABs for 4–6 days showed more than two times ABR experience than those who took ABs for above 10 days (AOR = 2.016, 95% CI = 1.016, 4.003; p = 0.045). Respondents who finished their AB medication (dose completion) had a 57% less chance of acquiring ABR than the participants who did not complete their dose. Conclusion This study found that irrational use of ABs is more prevalent among the youth and female participants. At this stage, there is an urgent need for comprehensive statutory AB control rules, as well as measures for appropriate information, education, and surveillance throughout different groups of Bangladesh.

Abstract Background World Health Organization (WHO) has classified drowning as a major public health problem. The most vulnerable victims of drowning are children from low and middle‐income countries. Previously, it was the primary cause of death among children aged between 1 and 17 years in Bangladesh. Aims This study explored the surrounding circumstances and associated factors of child drownings in Bangladesh. Methods A qualitative phenomenological approach has been used to conduct the study. Bangladesh was chosen as the study area, and data were gathered using a semi‐structured, open‐ended questionnaire. Using convenience and snowball sampling methods, we have collected data from Dhaka and seven additional districts in Bangladesh. We reached a total of 44 individuals, where 22 agreed to participate in an interview (face‐to‐face and online interviews). The remaining 22 participants were selected in two focus group discussions via the web platform “ZOOM cloud meeting.” Results Our investigation revealed several factors associated with child drowning, including a lack of adequate parental supervision and monitoring, geographic locations and environment, seasonal factors, low living standards, peer pressure and risky behaviors, social stigma and prejudices, and natural disasters and calamities. According to our findings, a lower socioeconomic position is linked to a higher risk of nonfatal drowning. Moreover, this research also indicates a substantial nexus between child drowning fatalities and the socioeconomic conditions of the families of the victims. Conclusion The study adds to the existing body of knowledge by underlining the associated factors of child drowning fatalities in Bangladesh, which will aid in developing preventive policies. An essential aspect of any drowning prevention program for Bangladesh should be enhanced for community awareness of safe water rescue and resuscitation practices.

Abelmoschus esculentus (L.) Moench, commonly known as okra, is one of the most widely used vegetable crops currently used for diabetes treatment as well. It is thought that the large amount of soluble dietary fibers present in okra is responsible for the slowing of the absorption of glucose from the gut. However, its role in concomitant administration with commonly prescribed medications, including metformin (MET) and acarbose (ACR) for diabetes, is unclear. Therefore, this study assessed the effect of A. esculentus pod extract (AEE) administered concomitantly with MET and ACR in the glucose-induced hyperglycemic mice model. The AEE was prepared using green okra pods. In this experiment, each male Swiss Webster mouse was administered a 2.5 gm/kg/BW dose of glucose via gastric lavage to induce hyperglycemia. The experimental animals were divided into five groups: (i) negative control, (ii) positive control, (iii) MET only, (iv) MET and ACR, and (v) MET, ACR, and AEE. The orally administered doses of the MET, ACR, and the extract were 150 mg/kg/BW, 15 mg/kg/BW, and 0.2 mL/kg/BW, respectively. We found that MET only and a combination of MET and ACR reduced glucose levels significantly (p < 0.01) compared to the positive control. On the other hand, when MET, ACR, and AEE were administered simultaneously, the synergistic antihyperglycemic action of the MET and ACR was diminished. After 150 min, the blood glucose level was 4.50 ± 0.189 mmol/L (iv) and 6.58 ± 0.172 mmol/L (v). This study suggests that taking AEE concurrently with MET and ACR would reduce the effectiveness of antidiabetic drugs; thereby, concomitant administration of these antidiabetic agents is not recommended. This study provides an essential basis for decision-making about the consumption of AEE with conventional medicine. Further study is required to find the molecular insight of drug interactions in combination therapy of medicinal plants for diabetes.

Exclusive breastfeeding (EBF) is essential for infant and child health. This study aimed to explore the trend in the EBF over the last decade in Bangladesh and investigated if there was a significant association with maternal employment by analyzing the data extracted from three consecutive nationally representative surveys: Bangladesh Demographic and Health Surveys (BDHS) of 2011, 2014, and 2017–2018. Prevalence of EBF (95% confidence interval) with the Cochran-Armitage test was reported to see the trend in EBF. A chi-square (χ2) test was applied to find the potential factors associated with EBF. Finally, a three-level logistic regression was utilized to find the significant association between maternal employment and EBF while adjusting other covariates. We observed no increase in the practice of EBF over the last decade (P = 0.632). The prevalence of EBF was 64.9% (95% CI: 61.41, 68.18) in 2011, followed by 60.1% (95% CI: 56.25, 64) in 2014, and 64.9% (95% CI: 61.82, 67.91) in 2017. Regression results showed that employed mothers had 24% (p < 0.05) lower odds of EBF than unemployed mothers. Early initiation of breastfeeding was also found to be significantly associated [Adjusted odds ratio (AOR): 1.22, P < 0.05] with EBF. Government and policymakers must come forward with new interventions to increase the practice of EBF, providing basic education and campaigns on the topic of EBF. Maternity leave should be extended up to 6 months of the child's age to achieve an optimal level of EBF.

Abstract Early initiation of breastfeeding (EIBF) is an essential practice for child health as well as for maternal health. This study aims to determine trends, prevalence, and factors associated with EIBF in Bangladesh. Data for this study were extracted from Bangladesh demographic and health surveys (BDHS) 2004, 2007, 2011, and 2014. This study found an increasing trend in EIBF in Bangladesh irrespective of the different characteristics of mothers and children. Chi-square test was conducted to find the association between EIBF and different factors. Multilevel logistic regression analysis was used to consider the hierarchical structure of the data. Regression result showed that educated parents [Adjusted odds ratio (AOR) = 1.14, 95% Confidence Interval (CI) = 1.04, 1.26 ], exposure to media [AOR = 1.13, CI = 1.05, 1.21], 2nd or 3rd birth order [AOR = 1.13, CI = 1.04, 1.23], wanted child [AOR = 1.12, CI = 1.02, 1.23], antenatal visit [AOR = 1.07, CI = 1.00, 1.15], antenatal visit by medically trained provider [AOR = 1.06, CI = 1.00,1.13] and rich wealth index [AOR = 1.10, CI = 1.01, 1.20] were positively associated with EIBF. In contrast, mothers with caesarian delivery [AOR = 0.36, CI = 0.31, 0.40], delivery in private facility [AOR = 0.83, CI = 0.73, 0.95], multiple birth, and higher maternal age were less likely to EIBF.

ObjectivesThis current study aims to assess the prevalence and factors associated with body mass index (BMI), dietary patterns, and the extent of physical activities among university students following the prolonged coronavirus disease 2019 (COVID-19) lockdown in Bangladesh.MethodsA cross-sectional web-based survey was conducted between July 10 to August 10, 2021, through a pre-designed Google Form to collect the data from Bangladeshi university students (age: ≥18 years). Informed consent was electronically obtained from each participant, and a simple snowball technique was employed during the sampling. Frequency and percentage distribution, paired t-test, chi-square [χ2] test, and multinomial and binary logistic regression analyses were consecutively applied to analyze the collected data.ResultsAmong the total participants (n = 1,602), 45.1% were female and 55.6% were 22–25 years' age group students. The BMI (mean ± standard deviation, SD) during the COVID-19 lockdown was 23.52 ± 7.68 kg/m2, which was 22.77 ± 4.11 kg/m2 during the pre-lockdown period (mean difference = 0.753; p < 0.001). The multinomial logistic regression analysis found a significant impact of gender [male vs. female: adjusted relative risk ratio (RRR) = 1.448; 95% confidence interval (CI) = 1.022, 2.053; p = 0.037], age (years) (25: RRR =0.389, 95% CI = 0.213,0.710; p = 0.002, and 22–25 vs. >25: RRR = 0.473, 95% CI = 0.290, 0.772; p = 0.003), monthly family income (BDT) (50,000: RRR = 0.525, 95% CI = 0.334,0.826; p = 0.005), university type (public vs. private: RRR = 0.540, 95% CI = 0.369, 0.791; p = 0.002), eating larger meals/snacks (increased vs. unchanged: RRR = 2.401, 95% CI = 1.597, 3.610; p < 0.001 and decreased vs. unchanged: RRR = 1.893, 95% CI = 1.218, 2.942; p = 0.005), and verbally or physically abuse (yes vs. no: RRR = 1.438, 95% CI = 0.977, 2.116; p = 0.066) on obesity during COVID-19 pandemic. Besides, the female students and those who have constant eating habits, were more likely to be underweight. Additionally, the binary logistic regression analysis found that the students from private universities [others vs. private: adjusted odds ratio (AOR) = 0.461, 95% CI = 0.313, 0.680; p < 0.001], urban areas (urban vs. rural: AOR = 1.451, 95% CI = 1.165, 1.806; p = 0.001), wealthier families (50,000 BDT: AOR = 0.727, 95% CI = 0.540, 0.979; p = 0.036), and who were taking larger meals/snacks (increased vs. unchanged: AOR = 2.806, 95% CI = 2.190, 3.596; p < 0.001) and had conflicts/arguments with others (no vs. yes: AOR = 0.524, 95% CI = 0.418, 0.657; p < 0.001), were significantly more physically inactive. Finally, the level of education and smoking habits significantly influenced the eating habits of university students during the extended strict lockdown in Bangladesh.ConclusionThe current findings would be helpful tools and evidence for local and international public health experts and policymakers to reverse these worsening effects on students mediated by the prolonged lockdown. Several effective plans, programs, and combined attempts must be earnestly implemented to promote a smooth academic and daily life.

Severe session jam phobia (SJP), the extent of underprivileged online education, and subsequent mental health disorders among students have emerged as distinguished global problems due to the overwhelming effects of coronavirus disease 2019 (COVID-19). The purpose of this research was to evaluate the impact of extended COVID-19 lockdown and its mediating factors on current e-Learning activities, the prevalence of severe SJP and psychological distress among university students in Bangladesh. A web-based cross-sectional study was conducted to assemble responses through Google Form by applying a simple snowball sampling technique among university students aged 18 years or above in Bangladesh. All ethical considerations were maintained, and univariate, bivariate, and multivariate analyses were employed to analyze the acquired data set. Among the total analyzed data (n = 1,122), the male and female ratio was almost 1:1, and a remarkable segment (63.7%) was aged between 21–24 years. Alarmingly, around 50–60% of the students were suffering from severe SJP, prevailing underprivileged education in the e-Learning platform, and severe mental distress. Logistic regression analyses demonstrated that the students from public universities, lower- and mid-income families, lower-aged, and junior years education groups were significantly (p < 0.05) more underprivileged than their counter groups. Besides, the monthly family income and university type significantly influenced the extent of severe SJP. Finally, the students who were female, rustic, come from low-income families (below 25,000 BDT), who had academic uncertainty, job insecurity, online exam phobia, and dissatisfaction with e-Learning education, were significantly suffering from moderate to severe mental distress. The current evidence demonstrates that a substantial number of Bangladeshi university students are struggling with extreme session jam phobia, underprivileged e-Learning education, and subsequent psychological distress, which need to be immediately addressed through concerted efforts by the government, parents, and university authorities.

Students' severe affective mental distress has emerged as significant public health attention globally because of the disastrous effects of coronavirus disease 2019 (COVID-19). The current study aimed at exploring the prevalence of two alarming psychological distresses, depression and anxiety, among university students following a prolonged shutdown of educational institutions in Bangladesh. A cross-sectional online-based study was conducted by deploying two standard scales to assess the depression and anxiety among Bangladeshi students from various universities amid the 2nd stream of the COVID-19 pandemic. A total of 568 Bangladeshi university students participated in this questionnaire-based survey through various social media platforms. Frequency and percentage distribution as univariate, chi-square (χ2) test as bivariate, and logistic regression as multivariate analyses were applied to investigate the prevalence of depression and anxiety and their associated various sociodemographic factors. After cleaning and eliminating the partial data, we analyzed 465 responses, where 42% were female and 64.3% were from public universities. Both mental disorders were prevalent in more than 50% of Bangladeshi university students. The students from the private universities were two times and 2.7 times more depressed and anxious, respectively than the students from the public universities. In addition, the students who became incomeless had significantly more anxiety (adjusted odds ratio [AOR] = 1.711; p = 0.018) than those who did not lose income source during the COVID-19 lockdown. The present study revealed that more than 50% of Bangladeshi university students were suffering from depression and anxiety. Several effective measures must be assured by the concerted efforts of university authorities, educationalists, and the Government to alleviate these distressing mental health burdens.

Today, healthcare has become one of the largest and most fast-paced industries due to the rapid development of digital healthcare technologies. The fundamental thing to enhance healthcare services is communicating and linking massive volumes of available healthcare data. However, the key challenge in reaching this ambitious goal is letting the information exchange across heterogeneous sources and methods as well as establishing efficient tools and techniques. Semantic Web (SW) technology can help to tackle these problems. They can enhance knowledge exchange, information management, data interoperability, and decision support in healthcare systems. They can also be utilized to create various e-healthcare systems that aid medical practitioners in making decisions and provide patients with crucial medical information and automated hospital services. This systematic literature review (SLR) on SW in healthcare systems aims to assess and critique previous findings while adhering to appropriate research procedures. We looked at 65 papers and came up with five themes: e-service, disease, information management, frontier technology, and regulatory conditions. In each thematic research area, we presented the contributions of previous literature. We emphasized the topic by responding to five specific research questions. We have finished the SLR study by identifying research gaps and establishing future research goals that will help to minimize the difficulty of adopting SW in healthcare systems and provide new approaches for SW-based medical systems’ progress.

Objectives: Extreme fear of academic delay (FAD) and psychological distress among students have arisen as great public health concerns worldwide due to the devastating actions of coronavirus disease 2019 (COVID-19). The precise aim of this study was to assess the impact of ongoing online education on current university students’ FAD and psychological stress symptoms following one year of calamitous COVID-19 outbreak in Bangladesh. Methods: A cross-sectional web-based survey was conducted from March 15 to 30, 2021, for data collection through a snowball simple sampling technique among Bangladeshi University students, where a total of 1,299 respondents (age: ≥ 18 years) responded in the questionnaire. After obtaining informed consent from the participants, we evaluated the association of various sociodemographic factors and the effects of current e-Learning activities on FAD and subsequent psychological distress among university students in Bangladesh. After excluding the partial responses (n = 177), we analyzed the clean data sheet (n = 1,122) by three consecutive statistical methods: univariate, bivariate, and multivariate analyses. Results: Alarmingly, near 60% of the current students exerted extreme FAD and were suffering from severe stress. Besides, 78.1% of students having severe FAD were severely psychologically stressed. Logistic regression analyses revealed that the students of the female gender, rural area, lower-income families, and who suffered from the highest FAD were more significantly (p < 0.05) stressed than their reference groups. Conclusion: The current analysis demonstrates that most Bangladeshi university students are battling with the unrivaled trend of FAD and facing severe psychological stress symptoms, which must be alleviated by the concerted efforts of the Government, Universities, and educationalists.

A growing trend in the caesarian section (CS) for delivery is a threat to child health as well as maternal health. This study was conducted to identify the potential socioeconomic and demographic factors associated with CS delivery in Bangladesh. Data obtained from the Bangladesh Demographic and Health Survey (BDHS) 2014 has been used for this study. The prevalence of CS delivery among Bangladeshi mothers was 24% (Urban: 36.9%, Rural: 17.9%). A two-level logistic regression showed that mothers having delivery in the private sector or private hospital (adjusted odds ratio [AOR] = 38.70, 95% confidence interval [CI] = 29.58 to 50.62), mother's age 25-35 years (AOR = 1.73, 95% CI = 1.26 to 2.37), wealth index average (AOR = 1.61, 95% CI = 1.15 to 2.27) and rich (AOR = 1.80, 95% CI = 1.29 to 2.51), antenatal visit 1-2 (AOR = 2.31, 95% CI = 1.47 to 3.64) and ≥ 3 (AOR = 3.68, 95% CI = 2.35 to 5.76), overweight mothers (AOR = 1.44, 95% CI = 1.09 to 1.90), multiple births (AOR = 3.87, 95% CI = 1.15 to 12.58), husband's occupation professional/technical/managerial (AOR = 1.68, 95% CI = 1.15 to 2.47) were significantly more prone to CS delivery. Also, place of residence, number of family members, birth order, child's size during birth, and divisions of Bangladesh, were potentially associated with CS delivery. The current epidemiological findings and evidence suggest adopting and implementing some urgent clinical practices and strict guidelines in the healthcare system to avoid unnecessary CS delivery in Bangladesh.

Vaccine willingness among the mass populace, as well as their proper knowledge and perception regarding vaccines and the vaccination process, may contribute extensively towards attaining their anticipated vaccination rates. The current study endeavored to ascertain the Bangladeshi population’s knowledge, perception, and willingness towards COVID-19 vaccination. Relevant information was collected from 1201 adults aged 18 years or older by employing an online-based survey from 1 to 30 July 2021. Descriptive statistics, the chi-square (χ2) test, and a binary logistic regression analysis were applied in order to compare the extent of knowledge and perception prevalent among different demographic groups and correlate such prevalence with respective vaccine willingness. The participants expressed mean (± standard deviation) knowledge and perception scores of 6.48 ± 1.13 out of 8 and 5.37 ± 1.22 out of 7, respectively. A multivariate analysis confirmed the significant association (p < 0.05) of gender, age, and family income with the knowledge score, whereas age and knowledge level significantly influenced perception. Current living area, family income, and age were considerable contributors to COVID-19 vaccine willingness. Overall vaccine willingness was found to be significantly curtailed by inadequate knowledge (AOR 0.514, CI 95% 0.401–0.658, p < 0.001) and perception (AOR 0.710, CI 95% 0.548–0.920, p = 0.010) among the participants. All of the concerned authorities’ efforts are warranted in order to improve public understanding, perception, and inclination towards vaccination.