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Background: Research to date suggests that frailty is higher in women and is associated with functional difficulty. This study builds on the evidence by examining the association between frailty and functional difficulty between low- and higher-income groups and between older men and women in these income groups., Methods: This study adopted a cross-sectional design that complied with the STROBE checklist and included steps against confounding and common methods bias. The population was community-dwelling older adults aged 50 years or older in two urban neighbourhoods in Accra, Ghana. Participants were either in the low-income group in a low socioeconomic neighbourhood (n = 704) or the higher-income group in a high socioeconomic neighbourhood (n = 510). The minimum sample necessary was calculated, and the hierarchical linear regression analysis was utilised to analyse the data., Results: Frailty was positively associated with functional difficulty in the low- and higher-income samples, but this association was stronger in the higher-income sample. Frailty was positively associated with frailty in men and women within the low- and higher-income samples., Conclusion: The association of frailty with functional difficulty was consistent between low- and higher-income samples, although the strength of the relationship differed between these samples. In both income samples, the foregoing relationship was consistent between men and women, although the strength of the relationship differed between men and women., Competing Interests: Declarations Ethics approval and consent to participate This study received an institutional ethics review and approval from Africa Centre for Epidemiology (004–10-2022-ACE) after its study protocol was reviewed. All the participants provided written informed consent before participating, and all research protocols were approved by the foregoing ethics review committee. All methods and procedures were carried out in accordance with ethical regulations and guidelines. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Workplace Age Discrimination Experienced (WADE) can be disorientating and detrimental to well-being. Hence, older employees would like to avoid it, but those who experience it may discriminate against their older peers. WADE may be associated with Age Discrimination of Peers (ADP), and this relationship can be moderated by Occupational Health Literacy (OHL)., Aim: This study aimed to assess the association of WADE with ADP and to ascertain whether this relationship is moderated by OHL., Methods: A cross-sectional design based on a research-reporting checklist was adopted. Measures against confounding and common methods bias were utlised to avoid or minimise bias. The participants were 1025 middle-aged and older employees (average age = 58 years) who were permanent residents of Accra, Ghana. Hierarchical Linear Regression (HLR) analysis was utilised to analyse the data. Curve estimation was among the methods used to assess assumptions governing HLR analysis., Results: WADE and OHL were positively associated with ADP, but OHL was negatively associated with WADE in the ultimate models incorporating the covariates. WADE was more positively associated with ADP at moderate and higher OHL, which signified positive moderation of the WADE-ADP relationship by OHL., Conclusion: Older employees who experience higher age discrimination at work are more likely to discriminate against peers. OHL can be associated with lower WADE but higher ADP. Qualitative studies are needed to understand why OHL may be related to higher ADP., Competing Interests: Declarations Ethics approval and consent to participate Ethical review and approval were received from an institutional ethics review board (#: 0072023ACE) in Accra, Ghana. The participants provided written informed consent after reading and understanding the study's risks and ethical procedures. The participant information sheet showed information about data privacy and storage. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Throughout the twentieth century and beyond, a global trend of declining mortality rates and an increase in life expectancies was noted until the onset of the coronavirus disease 2019 (COVID-19) pandemic. A reduction in life expectancies was observed in most countries, including South Asia, during 2020 and 2021 due to the excess mortality caused by the pandemic., Objective: This study aims to examine the change in life expectancy in selected South Asian countries and the relative change in age- and sex-specific mortality rates over time due to the COVID-19 pandemic. In addition to that, we further examined the effect of a pandemic on a short-term forecast of life expectancy., Data and Methods: Estimated age- and sex-specific mortality rates of seven South Asian countries were utilised from the 2022 revision of the World Population Prospects (WPP 2022). Changes in life expectancies are estimated using standard life table estimation techniques. To estimate the relative change in age- and sex-specific mortality levels and change in mortality forecasts as a result of the pandemic, we applied the Lee-Carter method., Results: The application of the Lee-Carter model revealed age- and sex-specific variations in mortality improvements, reflecting heightened mortality rates within the region. This decline in mortality improvement is highly observed for both sexes in Pakistan, followed by India and Bangladesh. Populations exhibiting slower rates of improvement throughout their lifespan demonstrated minimal alterations attributable to the pandemic's impact. Comparative life expectancy forecasts indicate a slower rise in post-pandemic life expectancy at birth and in remaining life expectancies at older ages among most of these populations., Conclusion: These findings highlight the pandemic's profound impact on mortality dynamics, emphasising the need for targeted interventions to mitigate its long-term effects on population health and longevity., (© 2024 John Wiley & Sons Ltd.)

Background: Disability-free life expectancy (DFLE) has been used to gain a better understanding of the population's quality of life., Objectives: The authors aimed to estimate age and sex-specific disability-free life expectancy (DFLE) for urban and rural areas of Bangladesh, as well as to investigate the differences in DFLE between males and females of urban and rural areas., Methods: Data from the Bangladesh Sample Vital Statistics-2016 and the Bangladesh Household Income and Expenditure Survey (HIES)-2016 were used to calculate the disability-free life expectancy (DFLE) of urban and rural males and females in Bangladesh in 2016. The DFLE was calculated using the Sullivan method., Results: With only a few exceptions, rural areas have higher mortality and disability rates than urban areas. For both males and females, statistically significant differences in DFLE were reported between urban and rural areas between the ages of birth and 39 years. In comparison to rural males and females, urban males and females had a longer life expectancy (LE), a longer disability-free life expectancy, and a higher share of life without disability., Conclusion: This study illuminates stark urban-rural disparities in LE and DFLE, especially among individuals aged < 1-39 years. Gender dynamics reveal longer life expectancy but shorter disability-free life expectancy for Bangladeshi women compared to men, emphasizing the need for targeted interventions to address these pronounced health inequalities., (© 2024. The Author(s).)

Background: Increasing medical expenditure is viewed as one of the critical challenges in the context of population ageing. Physical activity (PA), as a primary prevention strategy for promoting health, is considered as an effective way to curb the excessive growth in medical expenditure. This study aimed to analyze the association between PA and the household out-of-pocket medical expenditure (HOPME) among Chinese urban adults aged 45 and over, and to explore the mediating role of spousal health behaviour., Methods: This study analyzed a nationally longitudinal survey: 2014-2018 China Family Panel Studies (CFPS). Fixed effects regression model was applied to estimate the association between PA and annual HOPME. Sobel model was utilized to test the mediating effect., Results: (1) PA was negatively associated with the annual HOPME among urban resident aged 45 and over in China. Exercising 1-5 times per week and maintaining the duration of each exercise session at 31-60 min were effective in reducing annual HOPME. (2) Spousal PA played a significant mediating role in the relationship between respondent's PA and annual HOPME. (3) The negative association between the respondent's PA and HOPME were found among women and those aged between 45 and 65, so was the mediating effect of spouse's PA., Conclusion: Individual PA not only directly reduces HOPME but also indirectly contributes to this reduction by enhancing the PA levels of their spouses. To capitalize on these benefits, more actions should be taken to increase the availability of PA facilities, enhance the public awareness of PA's benefits, and encourage residents to consistently engage in regular PA., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Authors.)

Objective: Exposure to tobacco smoke causes numerous health problems in children, and create burden on the population in terms of economy, morbidity and mortality. In order to protect the child from exposure to tobacco smoke in the outdoor environment, sufficient legislative enactments are available in Indian legislation. The objective of the present study is to investigate the fact that in absence of any specific laws stating about protection of children from exposure to tobacco smoke in indoor environment, whether outdoor related legislations are sufficient to protect children from exposureand to explore the scope for enforcement of both state and central laws in improving health of children in India., Study Design: The s tudy considered cross-sectional survey data of Demographic and Health Survey Data on India, National Family and Health Survey fourth round (NFHS-4) for the year 2015-16 on Indian children (below age of four)., Methods: Both bivariate and multivariate logistic regression models were used to assess the impact of anti-smoking laws on the prevalence of acute respiratory infection (ARI) based on the place of residence, indoor tobacco smoke exposure and age of the child., Results: The results have shown an inclination of ARI among children in association with states having single law, rural area resident, exposure to indoor tobacco smoke and age of the child, both as independent or in combination are quite conspicuous, and are found to be underestimated. The logistic regression also revealed the influence of these factors both as independent and even in interaction with other., Conclusions: Legislative intervention through both at central (or national)and state levels through anti-smoking laws will decrease the indoor tobacco smoke exposure as a result ARI prevalence will also decrease among children in India., Competing Interests: Authors have no conflicts of interest with respect to the contents of this paper., (© 2024 The Authors.)

Background: Research shows that frailty is associated with higher sedentary behaviour, but the evidence to date regarding this association is inconclusive. This study assessed whether the above association is moderated or modified by gender and age, with sedentary behaviour measured with a more inclusive method., Methods: This study adopted a STROBE-compliant cross-sectional design with sensitivity analyses and measures against common methods bias. The participants were community-dwelling older adults (mean age = 66 years) in two Ghanaian towns. A self-reported questionnaire was used to collect data from 1005 participants after the minimum sample size necessary was calculated. The hierarchical linear regression analysis was used to analyse the data., Results: After adjusting for the ultimate confounders, frailty was associated with higher sedentary behaviour (β = 0.14; t = 2.93; p <0.05) as well as partial and absolute sedentary behaviour. Gender modified the above associations in the sense that frailty was more strongly associated with sedentary behaviour among women, compared with men. Age also modified the association between frailty and sedentary behaviour, which suggests that frailty was more strongly associated with higher sedentary behaviour at a higher age., Conclusion: Sedentary behaviour could be higher at higher frailty among older adults. Frailty is more strongly associated with sedentary behaviour at a higher age and among women, compared with men., Competing Interests: The authors declare no competiting interests., (Copyright: © 2023 Asiamah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Living in hilly neighbourhoods can be associated with sedentary behaviour, but no study has compared sedentary behaviour and its associations with frailty, chronic diseases, and poor health between flat and hilly neighbourhoods among older adults. This study, therefore, compared older adults' sedentary behaviour and its association with frailty, poor health, and chronic disease status between low and hilly neighbourhoods., Methods: This study utilised a STROBE-compliant cross-sectional design with sensitivity analyses and a common methods bias assessment. The participants were 1,209 people aged 50 + years who resided in flat (Ablekuma North, n = 704) and hilly (Kwahu East, n = 505) neighbourhoods in Ghana. The data were analysed with the independent samples t-test and hierarchical linear regression., Results: Older adults in the hilly neighbourhood were more sedentary than those in the flat neighbourhood. The association between sedentary behaviour and chronic disease status was significant in both neighbourhoods, but this relationship was stronger in the hilly neighbourhood. Older adults in the flat neighbourhood reported lower sedentary behaviour at higher frailty (β = -0.18; t = -3.2, p < 0.001), but those in the hilly neighbourhood reported higher sedentary behaviour at higher frailty (β = 0.16; t = 3.54, p < 0.001)., Conclusions: Older adults living in the hilly neighbourhood reported higher sedentary behaviour. In the hilly neighbourhood, sedentary behaviour was more strongly associated with frailty and chronic disease status. Older adults in hilly neighbourhoods may need extra support to avoid sedentary behaviour., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: The World Health Organization (WHO) kept track of COVID-19 data at country level daily during the pandemic that included the number of tests, infected cases and fatalities. This daily record was susceptible to change depending on the time and place and impacted by underreporting. In addition to reporting cases of excess COVID-19-related deaths, the WHO also provided estimates of excess mortality based on mathematical models., Objective: To evaluate the WHO reported and model-based estimate of excess deaths to determine the degree of agreement and universality., Methodology: Epidemiological data gathered from nine different countries between April 2020 and December 2021 are used in this study. These countries are India, Indonesia, Italy, Russia, United Kingdom, Mexico, the United States, Brazil and Peru and each of them recorded more than 1.5 million deaths from COVID-19 during these months. Statistical tools including correlation, linear regression, intraclass correlation and Bland-Altman plots are used to assess the degree of agreement between reported and model-based estimates of excess deaths., Results: The WHO-derived mathematical model for estimating excess deaths due to COVID-19 was found to be appropriate for only four of the nine chosen countries, namely Italy, United Kingdom, the United States and Brazil. The other countries showed proportional biases and significantly high regression coefficients., Conclusion: The study revealed that, for some of the chosen nations, the mathematical model proposed by the WHO is practical and capable of estimating the number of excess deaths brought on by COVID-19. However, the derived approach cannot be applied globally., (© 2023 John Wiley & Sons Ltd.)

Introduction: Multimorbidity is a rising health issue globally and it is likely to become challenging in developing countries like Nigeria as they experience economic, demographic, and epidemiological transition. Yet, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. This study aims to systematically review studies of the prevalence, patterns, and determinants of multimorbidity in Nigeria., Methods: Studies were identified by searching 5 electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, Africa Index Medicus/Global Index Medicus). Multimorbidity as well as other versions of it was used to search. The prevalence and determinants were also searched. According to preestablished inclusion criteria, and using different search strategies, 6 articles were included. The quality and risk of bias were assessed using Joanna Briggs Institute appraisal tool for prevalence studies. Two researchers assessed the eligibility of studies for inclusion. The protocol was registered on PROSPERO Ref no. CRD42021273222. The overall prevalence, pattern, and determinants were analyzed., Results: We identified 6 eligible publications describing studies that included a total of 3332 (men 47.5%, women 52.5%) patients from 4 states plus the federal capital territory Abuja. The multimorbidity prevalence ranges from 27% to 74% among elderly Nigerians. Cardiovascular together with metabolic and/or musculoskeletal conditions were the frequent patterns of multimorbidity. A positive association was observed between age and multimorbidity in most studies. Other factors associated with multimorbidity were female gender, low education status, poor monthly income/unemployment, hospitalization, medical visits, and emergency services., Conclusion: There has been a growing need for more applied health services research to understand better and manage multimorbidity in developed countries. The scarcity of studies in our review reveals that multimorbidity is not a priority area of research in Nigeria, and this will continue to hinder policy development in that area., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Objective: The present study examines the association between attitudes towards wife beating and intimate partner violence (IPV) using a dyadic approach in three sub-Saharan countries., Setting: We use data from the most recent Demographic and Health Survey cross-sectional studies which were conducted between 2015 and 2018 in Malawi, Zambia and Zimbabwe PARTICIPANTS: Our sample comprised 9183 couples who also had completed the information on the domestic violence questions and our variables of interest., Results: Our results indicate that women in these three countries are generally comparatively more inclined to justify marital violence than their husbands or partners. In terms of IPV experience, we found that when both partners endorsed wife beating, the risk of experiencing IPV was twice as likely after controlling for other couple-level and individual factors (OR=1.91, 95% CI 1.54-2.50, emotional violence; OR=2.42, 95% CI 1.96-3.00, physical violence; OR=1.97, 95% CI 1.47-2.61, sexual violence). The risk of IPV was also higher when the women alone endorsed IPV (OR=1.59, 95% CI 1.35-1.86, emotional violence; OR=1.85, 95% CI 1.59-2.15, physical violence; OR=1.83, 95% CI 1.51-2.22, sexual violence) than when the men alone were tolerant (OR=1.41, 95% CI 1.13-1.75, physical violence; OR=1.43, 95% CI 1.08-1.90, sexual violence)., Conclusions: Our findings confirm that attitudes towards violence are perhaps one of the key indicators of IPV prevalence. Therefore, to break the cycle of violence in the three countries, more attention must be paid to attitudes towards the acceptability of marital violence. Programmes tailored to gender role transformation and promote non-violent gender attitudes are also needed., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: This study investigated the association between fear of falling and self-care behaviours of older people with hypertension., Design: A cross-sectional study., Methods: This study was conducted in 2019 on 301 older people with hypertension above the age of 60 years in Tehran, Iran. Data were collected using a demographic questionnaire, the Persian Falls Efficacy Scale-International, and a hypertension-related self-care behaviour questionnaire., Results: Analyses revealed that gender, educational level and history of falling were significant factors associated with fear of falling; and marital status, educational level and income source were significant factors associated with self-care behaviours (p < 0.05). Partial correlations controlling for education revealed a significant positive correlation showing that high fear of falling is associated with worse health promotion self-care behaviours and significant inverse correlations with psycho-emotional, social and daily self-care behaviours (p < 0.05), meaning that high fear of falling is associated with better self-care for these dimensions., Patient or Public Contribution: This study involved patients in order to evaluate the validity and reliability of the questionnaires. The study was conducted on older people with hypertension referred to hypertension clinics in hospitals., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

The problematic smartphone use (PSU) has been becoming a challenging health issue for preschoolers aged 3-5 years as it has severe adverse effect on their psychological, physical, and cognitive development. The scarcity of scientific research on this issue in the context of Bangladesh motivated the authors for conducting this cross-sectional study to explore the prevalence of PSU with its influential factors and adverse effects on preschooler's psychological and physical development based on primary data collected from 400 mothers. The multivariable ordinal logistic regression (OLR) was used to compute the adjusted likelihoods. The estimated prevalence of PSU was approximately 86 %, where about 29 % were severely problematic user. The likelihood of preschoolers' PSU was observed to increase with >1 h/day usage of smartphone by children (Adjusted Odds Ratio (AOR): 3.92). Other important factors were parental smartphone use, education, profession, family income, and mother's age. Both of moderate and severe PSU had adverse effect on preschoolers' health- severe PSU was found to increase the likelihood of psychological and physical problems by 6.03 and 3.29 times, respectively. The preschoolers with PSU reported to suffer from many physical and mental health problems such as attention deficit and hyperactivity disorder (ADHD), emotional instability, aggressiveness, depression, lack of control, impaired vision and hearing, obesity, body imbalance, and lack of brain development. It is now prime time to undertake strategic policies considering the findings for limiting the preschoolers' usage of smartphone, which will make Bangladesh susceptible to protect its future generation from harmful effects of PSU., Competing Interests: Conflict of interest All authors have no conflicts of interest to disclose and have approved the final manuscript and agreed with submission to Journal of Affective Disorders., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The available evidence suggests that social networks can contribute to physical activity (PA) enjoyment, which is necessary for the maintenance of PA over the life course. This study assessed the associations of active and sedentary social networks with PA enjoyment and ascertained whether walkability moderates or modifies these associations. A cross-sectional design compliant with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) was employed. The participants were 996 community-dwelling older Ghanaians aged 50 years or older. A hierarchical linear regression analysis was used to analyse the data. After adjusting for age and income, the study found that the active social network size (β = 0.09; p < 0.05) and sedentary social network size (β = 0.17; p < 0.001) were positively associated with PA enjoyment. These associations were strengthened by walkability. It is concluded that active and sedentary social networks may better support PA enjoyment in more walkable neighbourhoods. Therefore, enabling older adults to retain social networks and live in more walkable neighbourhoods may be an effective way to improve their PA enjoyment.

Background and Objectives: More people are living alone across the life course: in later life this can have implications for practical and psychosocial support. The Covid pandemic emphasised the importance of this when the UK government restricted movement outside of households to limit the spread of disease. This had important ramifications regarding social contact and practical support. The objectives of this study were to explore the experience of older women living alone during this time, with a focus on health and wellbeing., Research Design and Methods: This study used an Interpretative Phenomenological approach. Semi-structured interviews were undertaken with seven women (aged 65 +), living alone in the UK. Interviews were carried out between May and October 2020. Interpretative Phenomenological Analysis was used to analyse the transcripts., Results: Findings show that life course events shaped how living alone was experienced in later life. Convergences and divergences in lived experience were identified. Three superordinate themes emerged from the Interpretative Phenomenological Analysis: Productivity, Ownership, and Interconnectedness., Discussion and Implications: Findings highlight the importance of life course events in shaping the experience of later life. They also provide a better understanding of the lived experience of living alone as an older woman, increasing knowledge of this group and how living alone can affect health and wellbeing. Implications for research and practice are discussed, such as the importance of recognising the specific support needs for this group in later life, and the need for further knowledge about groups whose needs are not met by standard practice., (© 2023. The Author(s).)

From the year 2003 when the first walkability scale was published to date, person-environment fit models and empirical research, some of which was published in Health Promotion International, have encapsulated healthy communities in 'neighborhood walkability'. While there is no doubt that neighborhood walkability positively influences health-seeking behaviors and health, recent models suggest that their measurement and conceptualization have not emphasized the role played by psychosocial and personal factors in aging in place. Thus, the development of scales measuring human ecosystem factors has not recognized all critical factors suited for older adults. In this paper, we aim to draw on relevant literature to frame a more holistic construct, hereby referred to as Socially Active Neighborhoods (SAN), that would better support aging in place in older populations. Through a narrative review based on a systematic search of the literature, we define the scope of SAN and delineate some contextual implications for gerontology, health promotion and psychometric testing. SAN, unlike neighborhood walkability in its current measurement and conceptualization, incorporates critical theory-informed psychosocial factors (i.e. safety and disability friendliness of neighborhood infrastructure) that can encourage older adults with physiological and cognitive limitations to maintain physical and social activities as well as health in later life. The SAN is the result of our adaptation of key person-environment models, including the Context Dynamics in Aging (CODA) framework, that recognizes the role of context in healthy aging., (© The Author(s) 2023. Published by Oxford University Press.)

With an increased prevalence of people living alone in later life, understanding the health and wellbeing of older women living alone in the UK is an important area of research. Little is known about health and wellbeing in this population and whether they differ from those who cohabit. This paper fills this research gap. Analysis was undertaken of Wave 8 of the Understanding Society Household Panel Survey, including variables such as internet use and volunteering. Differences were found between those who live alone and cohabit. Volunteering was a predictor of better health outcomes for those who lived alone but not for those who cohabit, despite similar rates of volunteering. Internet use predicted some better health outcome for those who cohabit but poorer for those who live alone. This suggests lifestyle factors vary in how they affect the health and wellbeing of older women, depending on cohabitation status., (© The Author(s), under exclusive licence to Springer Nature B.V. 2021.)

Mortality forecasts are essential part for policymaking in any aging society. In recent years, methods to model and forecast mortality have improved considerably. Among them, Lee-Carter method is one of the most influential method. In this paper, Lee-Carter method is applied to forecast mortality and life expectancy of Bangladesh. A functional data analysis approach is used to decompose the smoothed log-mortality rates in Lee-Carter framework for higher goodness-of-fit of the models and for longer forecast horizons. Bangladesh has been experiencing a mortality transition and has gained life expectancy in last few decades. The fitted model here showed higher pace of mortality decline for women in Bangladesh than that of men. The forecasts showed continuation of mortality improvement in long run and by 2060 life expectancy at birth is expected to reach over 80 years for both sexes in Bangladesh. The study also predicts the effect of reduction in infant mortality on the life expectancy in Bangladesh., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Fazle Rabbi, Khan. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Several studies have compared physical activity (PA) levels between countries, but none of these studies focused on older adults and occupational PA. This study aimed to assess potential inequalities in older adults' occupational PA across six countries and to ascertain whether having multiple jobs is a factor that interacts with country of residence to modify inequalities. This study adopted a cross-sectional design with a statistical technique screening for potential covariates. Older adults (mean age = 64 years; range = 50-114 years) from six countries (Russia, Mexico, China, India, Ghana, and South Africa) participated in the study. We utilised data from the first wave of the Study on Global AGEing and Adult Health (SAGE). These data were collected from 2007 to 2010. A random sample of 34,114 older adults completed the survey. We analysed the data with a two-way multivariate analysis of variance after screening for the ultimate covariates. There were differences in occupational PA levels (i.e., vigorous and moderate PA) among the six countries. Occupational PA levels were not significantly associated with having multiple jobs. However, having multiple jobs interacted with country of residence to influence vigorous occupational PA. Older adults from most countries who had more than one job reported more vigorous occupational PA. Older adults' occupational PA differed among the six countries, and having multiple jobs was associated with more vigorous occupational PA. Older adults who keep multiple jobs at a time may be more active than their counterparts who had one job or were unemployed.

Background: Although Bangladesh has made noticeable progress in reducing the prevalence of stunting, wasting, and being underweight among under-5 children, it has not been very successful in reducing overall severe anthropometric failure (SAF) among them. Therefore, the study aims to identify the prevalence and risk factors of SAF measured by the Composite Index of Severe Anthropometric Failure (CISAF) among under-5 children in Bangladesh., Methods: Data was drawn from a cross-sectional Bangladesh Demographic Health Survey (BDHS) conducted in 2017-2018. A bivariate analysis (Chi-square test) and logistic regression analysis were used to estimate the unadjusted, and age and sex-adjusted prevalence of SAF. Odds ratio (OR) and confidence interval (CI) were assessed using logistic regression analysis to identify the various risk factor of SAF., Results: The overall adjusted prevalence of under-5 child SAF was 11.3% (95% CI: 10.6-12.0) and it was highly prevalent among children of uneducated mothers (adjusted, 22%, 95% CI: 17.3-26.8). The key factors associated with SAF were children in the age group 24-35 months (OR: 2.43, 95% CI: 1.83-3.23), children born with low birth weight (OR: 3.14, 95% CI: 2.24-4.97), children of underweight mothers (OR: 1.82, 95% CI: 1.44-2.29), children of parents with no formal education (OR: 2.28, 95% CI: 1.56-3.31) and children from lower socio-economic status (OR: 2.25, 95% CI: 1.55-3.26)., Conclusion: Prioritizing and ensuring context-specific interventions addressing individual, community, public policy, and environment level risk factors from policy level to implementation to reduce structural and intermediary determinants of under-5 SAF., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Chowdhury, Khan, Rashid, Mondal, Bornee and Billah.)

Rationale/aim: Falls can have severe consequences particularly for older patients with cancer undergoing ambulatory care. The aim of the study is to identify the predictors of falls in older patients receiving cancer ambulatory care and evaluate the accuracy of the final multivariable model in detecting older patients with falls., Method: A retrospective study was conducted on 300 older patients aged 60 years and above that were referred for ambulatory care in three oncology clinics based at hospitals in Tehran, Iran. Participants completed a questionnaire comprising demographic, history of falls, and cancer-related factors. Logistic regression was used to determine risk factors associated with falls., Results: A total of 35.3% of the older patients with cancer had experienced a fall in the 6 months following the start of their ambulatory care. The most important predictors of falls include the fourth stage of cancer (odds ratio [OR]: 6.47, 95% confidence interval [CI]: 3.20-13.08, p < 0.001), fear of falling (OR: 5.64, 95% CI: 2.58-12.33, p < 0.001), use of hearing (OR: 2.38, 95% CI: 1.07-5.29, p = 0.033) and visual aids (OR: 2.36, 95% CI: 1.12-5.01, p = 0.025), and the number of visits to the doctor (OR: 1.10, 95% CI: 1.01-1.21, p = 0.035)., Conclusions: The results indicate that a reduction in falls is possible by introducing strategies to improve care for older patients in the advanced stage of cancer, eliminating the causes of fear of falling, examining and improving vision and hearing, and identifying and addressing the underlying causes of visits to the doctor., (© 2021 John Wiley & Sons Ltd.)

The importance of developing an effective action-based model of care for multimorbid patients has become common knowledge, but it remains unclear why researchers in Nigeria have not paid attention to the issue. Hence, this study assessed the quality of health services using the Donabedian model and aimed to recommend an effective hospital care delivery model for older people in Nigeria with multimorbidity. A cross-sectional study using face-to-face data was conducted between October 2021 and February 2022. The reported data were collated, checked, coded, and entered into JISC online survey software and then exported to IBM Statistical Package for Social Science (SPSS) version 27 for analysis, sourced from the University of West London, London, United Kingdom. The data were collected from the outpatient department of four high-volume public secondary hospitals in Niger State (the largest hospital in the three senatorial zones and that of the state capital). Systematic random sampling was used to select 734 patients with two or more chronic diseases (multimorbidity) aged 60 years and above who presented for routine ambulatory outpatient and consented to participate in the study. A Service Availability and Readiness Assessment (SARA) tool was used to assess the structure, and the process quality was assessed by the patients' experiences as they navigated the care pathway, whereas the outcome was measured using the patients' overall satisfaction. Using Spearman's correlation, no statistically significant association was observed between satisfaction level with the healthcare that was received and the five domains of health facility readiness (Total score Basic Amenities, Total score Basic Equipment, Total score infection control, Total score diagnostic capacity, Total score essential drugs), and the general facility readiness. Finally, the process component superseded the structure as the determinant of the quality of healthcare among multimorbid patients in Niger State. The emphasis of the process should be on improving access to quality of care, improving patient-physician relationships and timing, reducing the financial burden of medical care, and building confidence and trust in medical care. Therefore, these factors should be incorporated into designing the healthcare model for multimorbid patients in Nigeria.

Background: The social support provided or given to others play a key role in healthy ageing. Empirical and anecdotal evidence suggests that walkable neighbourhoods can positively influence social support given. Higher health self-consciousness may strengthen the positive association between walkability and social support provided., Aim: This study investigated whether the association between walkability and social support provided is moderated by health self-consciousness., Methods: A cross-sectional design with sensitivity analysis and recommended procedures against common methods bias was employed. The study's population was community-dwelling older adults living in Accra, Ghana. Data from 923 participants were analysed using the hierarchical linear regression analysis., Findings: The study found a positive association between walkability and social support provided after adjusting for the ultimate confounding variables. Health self-consciousness positively moderated the association between walkability and social support provided., Conclusion: The study concludes that social support provided in older adults may be higher in more walkable neighbourhoods. Health self-consciousness can enhance the contribution of walkability to social support provided. Our results reinforce the importance of campaigns aimed at improving walkability of neighbourhoods., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Intimate partner violence (IPV) is a pervasive social challenge with severe health and demographic consequences. Global statistics indicate that more than a third of women have experienced IPV at some point in their lives. In South Africa, IPV is considered a significant contributor to the country's broader problem with violence and a leading cause of femicide. Consequently, IPV has been the major focus of legislation and research across different disciplines. The present article aims to contribute to the growing scholarly literature by predicting factors that are associated with the risk of experiencing IPV. We used the 2016 South African Demographic and Health Survey dataset and restricted our analysis to 1,816 ever-married women who had complete information on the variables that were used to generate IPV. Prior research has mainly used regression analysis to identify correlates of IPV; however, while regression analysis can test a priori specified effects, it cannot capture unspecified inter-relationship across factors. To address this limitation, we opted for machine learning methods, which identify hidden and complex patterns and relationships in the data. Our results indicate that the fear of the husband is the most critical factor in determining the experience of IPV. In other words, the risk of IPV in South Africa is associated more with the husband or partner's characteristics than the woman's. The models developed in this study can be used to develop interventions by different stakeholders such as social workers, policymakers, and or other interested partners.

Using the stress process model and data from the 2011-2018 China Health and Retirement Longitudinal Study (CHARLS), this study examined the effect of spousal caregiving intensity on the depression level of older caregivers in China. The moderating role that socioeconomic status plays in the relationship between spouses was explored by constructing multilevel growth models (MGMs). The care intensity for a spouse was found to relate to significantly increased depression levels in older caregivers, while the degree of disability of the spouse being cared for (B = 0.200, p < 0.001) having a greater effect on depression than the duration of care (B = 0.007, p < 0.01). There was a threshold effect where the provision of more than 10 h of care per week for a spouse (B = 0.931, p < 0.001; B = 0.970; p < 0.01) or caring for a disabled spouse with limited ADLs (B = 0.709, p < 0.01; B = 1.326; p < 0.001; B = 1.469, p < 0.01) increased depression in older caregivers. There were moderating influences, including higher professional prestige before retirement (B = -0.006, p < 0.05) and higher annual family income (B = -0.037, p < 0.10), that increased depression related to the spouse's degree of disability. It was considered that active familism measures should be formulated for older spousal caregivers, especially those with lower socioeconomic status.

Background: Intimate partner violence (IPV) is a global public health concern, with women in low- and middle-income countries (LMICs) bearing a disproportionately high burden. This study investigates the prevalence and factors correlated with attitudes regarding wife-beating among Bangladeshi women in urban-rural contexts., Methods: A sample of 13,033 urban women and 51,344 rural women data from the Bangladesh Multiple Indicator Cluster Survey (MICS) 2019 were analyzed using the Chi-square test and ordinal logistic regression model., Results: The findings reveal that arguing with her husband is the widespread reason for wife-beating in Bangladesh (urban: 17.3%, rural: 21.9%), followed by neglecting the children (urban: 12.7%, rural: 15.8%). About 8% of urban women and 10% of rural women favoured the opinion that refusing to involve sexual intercourse is a legitimate justification for wife-beating. In comparison, around 5% feel that a husband has a right to beat his wife due to burning food. The respondents' age, education, marital status, number of children, socioeconomic level, any health or physical difficulty, having problems becoming pregnant, and the husband's age are all significant factors in justifying wife-beating., Conclusions: Bangladesh has a massive challenge in eliminating IPV. Women from lower socioeconomic classes, low levels of education, other challenges, and residents of rural areas are particularly more vulnerable than their urban counterparts. Therefore, it is vital to develop a proper action plan that considers women's education and occupation to raise awareness of the various implications of wife-beating in women, particularly in Bangladesh's rural areas., (© 2021. The Author(s).)

In the United Kingdom (UK), women are more likely to live alone in later life. Social factors such as household composition have been shown to affect health and wellbeing as we age. The health and well-being of older women who live alone are of interest to researchers, care providers, health organizations, and policymakers. This article contributes to the literature by detailing a scoping review, establishing the current evidence in this field. The purpose and context of the review are given. The methodology and resulting data are described. Gaps in the literature and implications for practice and research are given.

Objectives: The study aims to differentiate the risk factors of single and multiple concurrent forms of undernutrition among children under 5 in Bangladesh., Design: A nationally representative cross-sectional study., Setting: Bangladesh., Respondents: Children age under 5 years of age., Outcome Measure: This study considered two dichotomous outcomes: single form (children without single form and with single form) and multiple concurrent forms (children without multiple forms and with multiple forms) of undernutrition., Statistical Analysis: Adjusted OR (AOR) and CI of potential risk factors were calculated using logistic regression analysis., Results: Around 38.2% of children under 5 in Bangladesh are suffering from undernutrition. The prevalence of multiple concurrent forms and single form of child undernutrition was 19.3% and 18.9%, respectively. The key risk factors of multiple concurrent forms of undernutrition were children born with low birth weight (AOR 3.76, 95% CI 2.78 to 5.10); children in the age group 24-35 months (AOR 2.70, 95% CI 2.20 to 3.30) and in the lowest socioeconomic quintile (AOR 2.57, 95% CI 2.05 to 3.23). In contrast, those children in the age group 24-35 months (AOR 1.94, 95% CI 1.61 to 2.34), in the lowest socioeconomic quintile (AOR 1.79, 95% CI 1.45 to 2.21) and born with low birth weight (AOR 1.52, 95% CI 1.11 to 2.08) were significantly associated with a single form of undernutrition. Parental education, father's occupation, children's age and birth order were the differentiating risk factors for multiple concurrent forms and single form of undernutrition., Conclusion: One-fifth of children under 5 years of age are suffering multiple concurrent forms of undernutrition, which is similar to the numbers suffering the single form. Parental education, father's occupation, children's age and birth order disproportionately affect the multiple concurrent forms and single form of undernutrition, which should be considered to formulate an evidence-based strategy for reducing undernutrition among these children., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Severe undernutrition among under-5 children is usually assessed using single or conventional indicators (i.e., severe stunting, severe wasting, and/or severe underweight). But these conventional indicators partly overlap, thus not providing a comprehensive estimate of the proportion of malnourished children in the population. Incorporating all these conventional nutritional indicators, the Composite Index of Severe Anthropometric Failure (CSIAF) provides six different undernutrition measurements and estimates the overall burden of severe undernutrition with a more comprehensive view. This study applied the CISAF indicators to investigate the prevalence of severe under-5 child undernutrition in Bangladesh and its associated socioeconomic factors in the rural-urban context., Methods: This study extracted the children dataset from the 2017-18 Bangladesh Demographic Health Survey (BDHS), and the data of 7661 children aged under-5 were used for further analyses. CISAF was used to define severe undernutrition by aggregating conventional nutritional indicators. Bivariate analysis was applied to examine the proportional differences of variables between non-severe undernutrition and severe undernutrition group. The potential associated socioeconomic factors for severe undernutrition were identified using the adjusted model of logistic regression analysis., Results: The overall prevalence of severe undernutrition measured by CISAF among the children under-5 was 11.0% in Bangladesh (rural 11.5% vs urban 9.6%). The significant associated socioeconomic factors of severe undernutrition in rural areas were children born with small birth weight (AOR: 2.84), children from poorest households (AOR: 2.44), and children aged < 36 months, and children of uneducated mothers (AOR: 2.15). Similarly, in urban areas, factors like- children with small birth weight (AOR: 3.99), children of uneducated parents (AOR: 2.34), poorest households (APR: 2.40), underweight mothers (AOR: 1.58), mothers without postnatal care (AOR: 2.13), and children's birth order ≥4 (AOR: 1.75), showed positive and significant association with severe under-5 undernutrition., Conclusion: Severe undernutrition among the under-5 children dominates in Bangladesh, especially in rural areas and the poorest urban families. More research should be conducted using such composite indices (like- CISAF) to depict the comprehensive scenario of severe undernutrition among the under-5 children and to address multi-sectoral intervening programs for eradicating severe child undernutrition., (© 2021. The Author(s).)

A Scoping Review was conducted to explore key issues that underpin the experiences of family caregivers of older adults with chronic illness. The review aims to identify the gap in literature and synthesise evidence on this topic. Globally, family caregivers of older adults with chronic illness experience burden. Evidence suggests that family caregivers' needs are poorly understood and remain largely under recognised by healthcare services. Moreover, little is known about the experience of family caregivers caring for older adults with multiple chronic conditions. Data bases used included: (EBSCOhost, CINAHL, Science Direct, SCOPUS, MEDLINE, PubMed, ISI web of science and grey literature. 3352 records were identified, 58 full-text articles were assessed for eligibility, and 11 papers included in the literature review. Data are narratively synthesized. This review provides findings that suggest further research., Competing Interests: Declaration of Competing Interests The author(s) declared no potential conflicts of interest concerning this article's research, authorship, and/or publication., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Bangladesh recently experienced a COVID-19 second wave, resulting in the highest number of new cases and deaths in a single day. This study aims to identify the challenges for COVID-19 preventive practices and risk communications and associated factors among Bangladeshi adults. A cross-sectional survey was conducted between December 2020 and January 2021 involving 1382 Bangladeshi adults (aged ≥ 18-years) in randomly selected urban and rural areas from all eight divisions in Bangladesh. Descriptive data analysis was conducted to highlight the challenges for preventive practices and risk communications for COVID-19. Multiple logistic regression analysis was used to determine the sociodemographic groups vulnerable to these challenges. Lack of availability of protective equipment (44.4%), crowded living situations/workspaces (36.8%), inadequate information on the proper use of protective measures (21.9%), inadequate handwashing and sanitation facilities (17.6%), and negative influences on family/friends (17.4%) were identified as barriers to COVID-19 preventive practices. It was also found that males (OR = 1.3, 95% CI = 1.01, 1.7), rural residents (OR = 1.5, 95% CI = 1.2, 2), respondents with a low level of education: no schooling vs. ≥higher secondary (OR = 3.5, 95% CI = 2.3, 5.2), primary vs. ≥higher secondary (OR = 2.5, 95% CI = 1.7, 3.8), respondents engaged in agricultural (OR = 1.7, 95% CI = 1.2, 2.4), laboring (OR = 3.2, 95% CI = 2, 5), and domestic works (OR = 1.6, 95% CI = 1.07, 2.5), and people with disabilities (OR = 1.7, 95% CI = 1.1, 2.6) were all likely to have difficulty in practicing effective COVID-19 protective behaviors. Respondents' education and occupation were significant predictors of inadequate understanding of COVID-19 risk communications and was identified as a problem among 17.4% of the respondents. A substantial percentage of Bangladeshi adults have difficulty practising COVID-19 protective behaviours and have poor comprehension of risk communications, particularly in rural areas and among those with low education. This research can aid policymakers in developing tailored COVID-19 risk communications and mitigation strategies to help prevent future waves of the pandemic.

Objectives: This study investigates the prevalence and determinants of undernutrition among children <5 years living in Bangladesh using the Composite Index of Anthropometric Failure (CIAF) and highlights the differences between urban and rural areas., Study Design: Data are drawn from three cross-sectional Bangladesh Demographic Health Surveys conducted from 2007 to 2014., Methods: A Chi-square test was used to assess the prevalence of <5 years child undernutrition. Logistic regression analysis was performed to identify various sociodemographic risk factors., Results: The prevalence of undernutrition based on the CIAF was 52% among children <5 years in Bangladesh. The prevalence of undernutrition in children living in urban areas and rural areas were found to be 45% and 54%, respectively. As per the CIAF, undernutrition was highly prevalent among children in the older age group, children of uneducated and currently working mothers, those of underweight mothers, children of fourth and above in the birth order, children of fathers who were manual labourers, children of households who had no access to television and those in the poorest households whether in urban or rural areas. Children in the older age group, children of uneducated mothers, those with underweight mothers and those from the poorest households provided common key risk factors for undernutrition in both urban and rural areas. Children of fourth and above birth order and not watching television at all were additional risk factors of child undernutrition in rural areas., Conclusion: Half of the children in rural areas and two-fifths of them in urban areas are suffering undernutrition in Bangladesh, and several sociodemographic factors heighten the risks. Also, birth order and watching television were identified as the differential risk factors. This study therefore concludes that evidence-based interventions are needed to reduce the burden of undernutrition in children in the country., (Copyright © 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Intimate partner violence is a persistent social problem in Zimbabwe and has been linked to patriarchal attitudes that promote the superiority of men in marital relationships while denying women agency. Using 2015 Zimbabwe Demographic and Health Survey data, we examined the influence of female autonomy on intimate partner violence. Our analysis was restricted to 2847 women who were in some form of sexual union. Consistent with earlier studies, our results show that more than 40% of the women had experienced some form of intimate partner violence. The most prevalent form of intimate partner violence was emotional violence, followed by physical violence and sexual violence. Low levels of economic autonomy and supportive attitudes towards wife-beating increased the risk of intimate partner violence, while late marriage reduced the risk of all forms of intimate partner violence. Findings provide a basis for interventions that may increase economic control and improve decision making for women, although the association between economic violence and economic decision making requires further research that examines the possibility of reverse causality.

Tackling malnutrition is a major health priority for a developing country like Bangladesh. This study explored the differences in prevalence of having only one form, and multiple forms, of severe malnutrition (stunting, wasting and underweight) among under-5 children in Bangladesh, and aimed to identify the important factors affecting these. Data were extracted from the Bangladesh Demographic Health Surveys conducted in 2007, 2011 and 2014. The outcome measures were 'only one form' and 'multiple forms' of severe malnutrition in children aged under 5 years. A Chi-squared test was performed to find the association of outcome variables with selected socio-demographic factors and logistic regression models were applied to identify risk factors. A total of 19,874 children aged under 5 years were included in the analysis. The overall proportion with one form of severe child malnutrition was approximately 12%, and the proportion with multiple forms was 8%. Age, mother's education, father's occupation, mother currently working, watching television, source of water, solid waste used in cooking, intimate partner violence (IPV), wealth index, urban/rural place of residence and birth cohort were found to be significant factors for both having only one and having multiple forms of severe child malnutrition. Children with an uneducated mother of poor socioeconomic class had a higher risk of severe malnutrition. Children of fathers with a professional occupation were at lower risk of having multiple forms of severe malnutrition. The proportions of children aged under 5 years with one or multiple forms of severe malnutrition were shown to be high in Bangladesh. The prevention of malnutrition in the country should be seen as a significant public health issue and given top priority.

Background: There are currently 1.5 million indigenous people in Bangladesh, constituting 1.8% of the total population and representing one of the country's most deprived communities. This study explores the health status and quality of life along with their determinants among indigenous older people in Bangladesh in order to fill the knowledge and evidence gap on this topic., Methods: A mixed-methods approach was deployed in October 2019 in the Sylhet division of Bangladesh which involved a cross-sectional survey among 400 indigenous older adults (200 males, 200 females) from 8 tea gardens using a pre-tested semi-structured questionnaire. Ten in-depth interviews were also conducted with providers of the tea garden health facilities. Descriptive analysis, multiple logistic and multi-nominal linear regression were performed to explore associated factors around health and quality of life., Results: Of the total respondents, the majority (79.5%) had chronic diseases, with visual difficulty being predominant (74%) among the conditions. Almost all (94%) of the respondents experienced delays in receiving treatment and poverty was identified by most (85%) as the primary cause of those delays. Extreme age, being male, living alone and low family income were significantly associated with suffering from chronic conditions. Furthermore, having a chronic condition and extreme age were found to be significantly associated with a low quality of life. Health service providers identified lack of logistical support in the health facilities, the economic crisis and lack of awareness as the major causes of poor health status and poor health seeking behaviour of the indigenous older adults., Conclusion: Indigenous older men in extreme old age are more vulnerable to adverse health conditions and poor quality of life. Health literacy and health seeking behaviour is poor among indigenous older adults generally and there is a huge gap in the health services and social supports available to them., Competing Interests: The authors have declared that no competing interests exist.

Objective: This study examines trends and puts forward projections of under-5 mortality (U5M) in Bangladesh and identifies the effects of maternal high-risk fertility behaviours and use of healthcare services., Methods: Data from seven waves of the Bangladesh Demographic and Health Survey (1994-2014) were analyzed for trends and projections of U5M and a Chi-square (χ2) test was used to identify if there was any association with maternal high-risk fertility behaviours and use of healthcare services. A multivariate logistic regression model was used to determine the effects of fertility behaviors and healthcare usage on the occurrence of U5M adjusting with confounders., Results: U5M declined from 82.5 to 41.0 per 1000 livebirths during 1994-2014 and is projected to further reduce to 17.6 per 1000 livebirths by 2030. The study identified a noticeable regional variation in U5M with maternal high-risk fertility behaviours including age at birth <18 years (aOR: 1.84, 95% CI: 1.23-2.76) and birth interval <24 months (aOR: 1.56, 95% CI: 1.02-2.37) found to be significant determinants. There was a 39-53% decline in this rate of mortality among women that had used antenatal care services at least four times (aOR, 0.51, 95% CI: 0.27-0.97), delivery care (aOR, 0.47, 95% CI: 0.24-0.95), and had received postnatal care (aOR, 0.61, 95% CI: 0.41-0.91) in their last birth. Cesarean section was found to be associated with a 51% reduction in U5M (aOR, 0.49, 95% CI: 0.29-0.82) compared to its non-use., Conclusion: The Sustainable Development Goals require a U5M rate of 25 per 1000 livebirths to be achieved by 2030. This study suggests that with the current trend of reduction, Bangladesh will achieve this target before the deadline. This study also found that maternal high-risk fertility behaviours and non-use of maternal healthcare services are very prevalent in some regions of Bangladesh and have increased the occurrence of U5M in those areas. This suggests therefore, that policies and programmes designed to reduce the pregnancy rates of women that are at risk and to encourage an increase in the use of maternal healthcare services are needed., Competing Interests: The authors have declared that no competing interests exist.

Rationale, Aims, and Objectives: The recent outbreak of coronavirus (COVID-19) has infected around 1 560 000 individuals till 10 April 2020, which has resulted in 95 000 deaths globally. While no vaccine or anti-viral drugs for COVID-19 are available, lockdown acts as a protective public health measures to reduce human interaction and lower transmission. The study aims to explore the impact of delayed planning or lack of planning for the lockdown and inadequate implementation of the lockdown, on the transmission rate of COVID-19., Method: Epidemiological data on the incidence and mortality of COVID-19 cases as reported by public health authorities were accessed from six countries based on total number of infected cases, namely, United States and Italy (more than 100 000 cases); United Kingdom, and France (50 000-100 000 cases), and India and Russia (6000-10 000 cases). The Bayesian inferential technique was used to observe the changes (three points) in pattern of number of cases on different duration of exposure (in days) in these selected countries 1 month after World Health Organization (WHO) declaration about COVID-19 as a global pandemic., Results: On comparing the pattern of transmission rates observed in these six countries at posterior estimated change points, it is found that partial implementation of lockdown (in the United States), delayed planning in lockdown (Russia, United Kingdom, and France), and inadequate implementation of the lockdown (in India and Italy) were responsible to the spread of infections., Conclusions: In order to control the spreading of COVID-19, like other national and international laws, lockdown must be implemented and enforced. It is suggested that on-time or adequate implementation of lockdown is a step towards social distancing and to control the spread of this pandemic., (© 2020 John Wiley & Sons Ltd.)

Rationale, Aims, and Objectives: The COVID-19 pandemic of 2020 has overpowered the most advanced health systems worldwide with thousands of daily deaths. The current study conducted a situation analysis on the pandemic preparedness of Bangladesh and provided recommendations on the transition to the new reality and gradual restoration of normalcy., Method: A complex adaptive system (CAS) framework was theorized based on four structural dimensions obtained from the crisis and complexity theory to help evaluate the health system of Bangladesh. Data sourced from published reports from the government, non-governmental organizations, and mainstream media up to June 15, 2020 were used to conduct a qualitative analysis and visualize the spatial distribution of countrywide COVID-19 cases., Results: The findings suggested that Bangladesh severely lacked the preparedness to tackle the spread of COVID-19 with both short- and long-term implications for health, the economy, and good governance. Absence of planning and coordination, disproportionate resource allocations, challenged infrastructure, adherence to bureaucratic delay, lack of synchronized risk communication, failing leadership of concerned authorities, and incoherent decision-making have led to a precarious situation that will have dire ramifications causing many uncertainties in the coming days., Conclusions: Implementation of response protocols addressing the needs of the community and the stakeholders from the central level is urgently needed. The development of mechanisms for dynamic decision-making based on regular feedback and long-term planning for a smooth transition between the new reality and normalcy should also be urgently addressed in Bangladesh., (© 2020 John Wiley & Sons Ltd.)

Rationale, Aims, and Objectives: There is a general lack of awareness and understanding of dementia within ethnic minority groups in the United Kingdom. There is also a dearth of research involving ethnic minority caregivers about reducing barriers to accessing services and optimizing engagements with religiously tailored interventions. This paper reports findings from a qualitative study that examined the barriers to health care service use in the Bangladeshi community living in the United Kingdom., Methods: The research draws on findings from a doctoral level research study on understanding dementia among the Bangladeshi community in England. The data for the doctoral research were gathered in two ways: (a) focus group discussions and (b) semi-structured interviews. All data were audio-recorded and analysed using thematic analysis. NVivo software was used to aid transcribing, coding, and interpretation of emergent themes., Results: The data showed that there were some barriers experienced by participants due to their religious and cultural beliefs and practices with other barriers related to the complexity of the UK health care system. Gender-based caregiving also appeared to interfere with religious ideologies while religiously appropriate health care services were deemed of great importance for successfully accessing those services., Conclusions: The findings provide an understanding of the experiences of the Bangladeshi community when seeking to access mainstream UK health care services and may help to provide useful directions for future research., (© 2020 John Wiley & Sons, Ltd.)

Introduction: Anemia is a common problem in children particularly in developing countries and taking steps to tackle it is one of the major public health challenges for Nepal. The objective of this study is to investigate the prevalence of individual, household and community level determinants of childhood anemia in Nepal., Methods: Data was taken from a nationally representative sample of 1,942 Nepalese children aged from 6-59 months. The Chi-square test was used to determine the bivariate relationship between the selected variables and childhood anemia and a multilevel logistic regression model with a random intercept at household and community level was used to identify important determinants of this kind of anemia., Results: The results showed that 52.6% (95% CI: 49.8%-55.4%) of the children were anemic while 26.6% (95% CI: 24.0%-29.3%) of them were moderate to severe. The prevalence of overall anemia was higher among children aged less than 11 months as well as in underweight children, children of underweight, anemic and uneducated mothers and those in the terrain ecological regions. Multivariable analysis showed that children aged less than 11 months, who were underweight and had anemic mothers were more likely to have moderate or severe anemia. Children in the hilly ecological region were less likely to have it compared to mountain and terrain ecological regions. Children in middle-class families and children of mothers who completed secondary education were more likely to have anemia., Conclusion: Nepal is facing a serious public health problem due to the high prevalence of childhood anemia. This adverse situation occurs due to socio-demographic and geographical factors such as age, malnutrition status, mother's anemia status, socio-economic status and regional variations. Prevention of childhood anemia should be given top priority in Nepal and should be considered as a major public health intervention., Competing Interests: The authors have declared that no competing interests exist.

Background: The outbreak of coronavirus disease, 2019 (COVID-19), which started from Wuhan, China, in late 2019, have spread worldwide. A total of 5,91,971 cases and 2,70,90 deaths were registered till 28th March, 2020. We aimed to predict the impact of duration of exposure to COVID-19 on the mortality rates increment., Methods: In the present study, data on COVID-19 infected top seven countries viz., Germany, China, France, United Kingdom, Iran, Italy and Spain, and World as a whole, were used for modeling. The analytical procedure of generalized linear model followed by Gompertz link function was used to predict the impact lethal duration of exposure on the mortality rates., Findings: Of the selected countries and World as whole, the projection based on 21st March, 2020 cases, suggest that a total (95% Cl) of 76 (65-151) days of exposure in Germany, mortality rate will increase by 5 times to 1%. In countries like France and United Kingdom, our projection suggests that additional exposure of 48 days and 7 days, respectively, will raise the mortality rates to10%. Regarding Iran, Italy and Spain, mortality rate will rise to 10% with an additional 3-10 days of exposure. World's mortality rates will continue increase by 1% in every three weeks. The predicted interval of lethal duration corresponding to each country has found to be consistent with the mortality rates observed on 28th March, 2020., Conclusion: The prediction of lethal duration was found to have apparently effective in predicting mortality, and shows concordance with prevailing rates. In absence of any vaccine against COVID-19 infection, the present study adds information about the quantum of the severity and time elapsed to death will help the Government to take necessary and appropriate steps to control this pandemic., Competing Interests: The authors have declared that no competing interests exist.

Background: Caesarean section is considered a relatively preferable and safe method of delivery as compared to normal delivery. Since the last decade, its prevalence has increased in both developed and developing countries. In the context of developing countries viz., South Asia (the highest populated region) and South-East Asia (the third-highest populated region), where a significant proportion of home deliveries were reported,however, the preference for, caesarean delivery and its associated factors are not well understood., Objective: To study the caesarean delivery in the South and South-East Asian countries and to determine the factors associated with the preference for caesarean delivery., Methodology: Demographic and Health Survey Data on from ever-married women of nine developing countries of South and South-East Asia viz., Vietnam, India, Maldives, Timor-Leste, Nepal, Indonesia, Pakistan, Bangladesh, and Cambodia have been considered. Both bivariate and binary logistic regression models were used to estimate the propensity of a woman undergoing for caesarean delivery and to assess the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery., Results: Obtained results have shown an inclination of caesarean delivery among urban than rural women and are quite conspicuous, but is found to be underestimated mostly among rural women. Caesarean delivery in general is mostly predisposed among women whose baby sizes are either very large or smaller than average, have a higher level of education and place of delivery is private medical institutions. The logistic regression also revealed the influence of maternal socioeconomic characteristics towards the preference for caesarean delivery. Based on nine South and South-East Asian countries an overall C-section prevalence of 13%, but based on institutional births its increase to 19%. The forest plot demonstrated that a significant inclination of C-section among urban than rural regions. In Meta-Analysis, very high and significant heterogeneity among countries is observed, but confirms that in terms of prevalence of C-section all of the countries follow independent pattern., Conclusion: Study of seven urban and four rural regions of nine South and South- East Asian countries showed, a significant inclination towards the caesarean delivery above the more recent outdated WHO recommended an optimal range of 10-15%and are associated maternal socioeconomic characteristics. In order to control unwanted caesarean delivery, the government needs to develop better healthcare infrastructure and along with more antenatal care related schemes to reduce the risks associated with increased caesarean delivery., Competing Interests: The authors have read the journal's policy and the authors of this study have the following competing interests: RP is a paid employee of Eurofins Limited (https://www.eurofins.com/agroscience-services/about-us/latest-news/eurofins-scientific-to-acquire-advinus-therapeutics/). There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The aim of this study was to examine the gender differential effects of eating habits and physical activity on overweight and obesity among school-aged adolescents in Bangladesh. Nationally representative data extracted from the 2014 Global School-based Student Health Survey (GSHS) were utilized. The survey collected information related to physical and mental health from 2989 school-aged adolescents in Bangladesh. An exploratory data analysis and multivariate logistic regression model were employed in this study. Female adolescents were at a lower risk of being overweight or obese (AOR=0.573) than males, with a prevalence of 7.4% (males: 9.9%). The results showed that high consumption of vegetables (both: AOR=0.454; males: AOR=0.504; females: AOR=0.432), high soft drink consumption (both: AOR=2.357; males: AOR=2.929; females: AOR=1.677), high fast food consumption (both: AOR=2.777; males: AOR=6.064; females: AOR=1.695), sleep disturbance (both: AOR=0.675; males: AOR=0.590; females: AOR=0.555) and regular walking or cycling to school (both: AOR=0.472; males: AOR=0.430; females: AOR=0.557) were vital influencing factors for being overweight or obese among adolescents for both sexes. Sedentary activities during leisure time were also identified as significant predictors of being overweight or obese for males. Regular fruit and vegetable consumption, the avoidance of soft drinks and fast food, an increase in vigorous physical activity, regular attendance at physical education classes and fewer sedentary leisure time activities could all help reduce the risk of being overweight or obese for both sexes.

Rationale, Aims, and Objectives: This article aims to examine global population ageing and to evaluate the likely risks and dilemmas of demographic ageing within the context of the health and well-being of individuals., Methods: This paper is based on the author's research in the field of social gerontology, demography, and public health. In addition, a literature review has been carried out focused on the objectives of the research., Results: The study has identified potential risks and dilemmas that the older people may face in the globalized world. There are four main aspects that contribute to an unequal distribution of risks in later life: (a) burden of disease in epidemiological transition, (b) financial security in retirement, (c) familial resources for older peoples' care, and (d) availability of workforce for older peoples' care. Whilst population ageing is a global trend, its impact is not equal across the world, and this is highlighted in this research. There are some important dilemmas which are identified in this paper that may also fuel the potential risks and challenges facing ageing societies., Conclusions: It is apparent that older people will face numerous risks in later life and those in developing countries are likely to face more challenges than those in developed countries. The findings may be useful to policymakers for formulating future plans and policy implementation. Further research is required to identify the number of health care workers needed to tackle the challenges of an ageing societies across the globe., (© 2018 John Wiley & Sons, Ltd.)

Rationale, Aims and Objectives: Although Bangladeshis are three times more likely to be carers than White British, Bangladeshi family carers are the most deprived, neglected, and effectively a hidden group in the United Kingdom. 1 There is a paucity of research within the Bangladeshi community that is capable of explaining and predicting the experiences and concerns of Bangladeshi family carers providing care for their relatives with dementia. The purpose of this study is to explore the perspectives of Bangladeshi family carers' knowledge and day-to-day experiences living in England., Methods: This is a qualitative study involving semistructured face-to-face interviews with six Bangladeshi family carers living in London and Portsmouth. Interviews were recorded with the consent and transcribed verbatim. Data were managed by using NVivo software, and thematic analysis was performed., Results: This paper explores that most carers have a lack of knowledge and awareness of the symptoms of dementia. The results of this study are in contrast to previous studies, where South Asian carers perceived dementia as being possessed by evil spirits or God's punishment for previous life's sins; this study reveals that Bangladeshi family carers believed dementia was a medical condition. Unlike earlier South Asian studies, however, all family carers in this study also believed that there was no stigma attached to dementia., Conclusions: Further research is warranted to investigate the religious beliefs, familism, and interpersonal motives as theoretical perspectives to explain how Bangladeshi family carers negotiate and construct their caregiving roles for their relatives with dementia., (© 2019 John Wiley & Sons, Ltd.)

Background: Millions of children and others across the world are being dangerously exposed to tobacco smoke and toxins in their own homes. Whilst there is limited interest in laws and interventions controlling tobacco use in public places in Bangladesh, no attention has been given to preventing tobacco-use inside homes. This study explores the familial and socio-cultural factors that provide obstacles for ensuring tobacco-free homes in Bangladesh., Materials and Methods: A mixed-method design was adopted and from among the 1,436 tobacco users identified in a population of 11,853, 400 (tobacco users) were selected for cross-sectional survey. This survey involved a probability proportional sampling procedure, and 24 In-Depth Interviews. Multivariate logistic regression was performed to explore the association of familial and socio-cultural factors with tobacco-use at home adjusted by other demographic characteristics. Thematic content analysis was done on the qualitative data, and then inferences were drawn out collectively., Results: This study revealed that the prevalence of tobacco-use in the home was 25.7% in urban residential areas in Bangladesh. Multivariate logistic regression analysis identified that familial and socio-cultural factors were significantly associated with tobacco-use at home: marital status (OR 3.23, 95% CI: 1.37-6.61), education (OR 2.14, 95% CI: 1.15-3.99), smoking habits of older family members (OR 1.81 95% CI: 0.91-2.89), tobacco being offered as hospitality and for entertainment (OR 1.85, 95% CI: .94-2.95) and lack of religiosity practice (OR 2.39, 95% CI: 1.27-4.54). Qualitative findings indicated that social customs, lack of religious practice, tobacco-use of older family members, and lack of family guidance were key obstacles for enabling tobacco-free homes in urban areas., Conclusion: Use of tobacco at home is continuing as part of established familial and socio-cultural traditions. If tobacco-use at home is not addressed seriously by the authorities then the emerging threat of second-hand smoke exposure and harmful consequences of tobacco- use will be exacerbated., Competing Interests: The authors have declared that no competing interests exist.

Background: Intimate partner violence is a major problem worldwide and it is one of the most social issues in Armenia. Empowerment is one of the important factors that helps women to break the cycle of violence by their husband/partner. The aim of this research is to explore the impact of intimate partner violence on empowerment of Armenian women of reproductive age group., Methods: This cross-sectional study used data Armenia Demography and Health Survey Data 2015-16. A total 6116 women were selected from 8749 households at both urban and rural places of Armenia for interview using multistage cluster sampling technique. Data analysis was performed using SPSS version 24., Results: The respondents aged between 35 and 49 years are more likely to face violence compared to other age group (p≤0.001). The respondents who have no decision-making power, about 89% of them, are experiencing intimate partner violence, whereas only 11% are facing intimate partner violence among those who have decision-making power (p≤0.001). The logistic regression analysis reveals that age of the respondents, number of children in the households, wealth index, and empowerment status are significantly associated with intimate partner violence., Conclusion: Intimate partner violence has significant impact on the empowerment of women in Armenia. This study revealed that women with no empowerment are more likely to experience intimate partner violence compared to those women who are empowered in Armenian society., Competing Interests: The authors declared that there are no conflicts of interest.