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Abstract Background There is a dearth of evidence on the trends and inequalities in utilizing cesarean section (CS) among women in Bangladesh. Hence, this study aimed to estimate the socioeconomic and geographical inequalities in delivery by CS among Bangladeshi women from 2004 to 2017. Methods Data from Bangladesh Demographic and Health Survey 2004, 2007, 2011, 2014, and 2017 were analyzed using the WHO’s Health Equity Assessment Toolkit (HEAT) software. Inequalities were measured using four summary measures: Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF), and Ratio (R). Socioeconomic inequalities were assessed using two equity dimensions: household wealth status, and level of education, while geographical disparities were measured using two equity dimensions: place of residence, and sub-national regions. For each measure, point estimates and their 95% confidence intervals were reported. Results An increasing trend in the prevalence (weighted) of CS in Bangladesh use was found from 4.50% in 2004 to 32.73% in 2017 We found significant socioeconomic inequalities in CS in every survey point, with a higher concentration of CS among the rich (in 2017, PAR = 28.57; 95% CI: 26.69–30.46) indicating a pro-rich inequality, and higher educated (in 2017, PAF = 23.97; 95% CI: 12.26–35.68) sub-groups. We also identified significant geographical disparities in CS with a higher concentration of CS among people from urban areas (in 2017, PAR = 10.99; 95% CI: 10.19–11.79), and a coastal region (Khulna division) (in 2017, PAF: 30.48 (95% CI: 18.66–42.30). Conclusion We observed both socioeconomic and geographical inequalities in CS exist in Bangladesh, though the trends of these inequalities were curved over time. Thus, it is important to comprehend these pro-rich and geographical inequalities better and implement appropriate interventions and policies to alleviate them.

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

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

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

In response to the critical need for enhanced resource management in the construction industry, this research develops an innovative, integrated methodology that synergistically combines Agent-Based Modeling (ABM), Building Information Modeling (BIM), and Bluetooth Low Energy (BLE) technologies. Central to our approach is a sophisticated technological framework that incorporates a Client Early Warning System (CEWS) and a Decision Support System (DSS). These systems facilitate real-time monitoring and management of construction resources, ensuring operational efficiency and optimal resource utilization. Our methodology was empirically validated through a comprehensive case study at Helwan University's College of Engineering. The results demonstrated a significant enhancement in operational efficiency, particularly in resource allocation and progress tracking. Key practical outcomes include the development of a CEWS master dashboard that provides in-depth, real-time insights into project metrics. This dashboard was crucial for managing compliance with health protocols during the COVID-19 pandemic, showcasing the framework's adaptability to critical health standards. Further, the integration of indoor tracking technology revolutionized attendance tracking by replacing outdated manual methods with automated processes. This capability not only underscores the practical applicability of our research but also establishes a new benchmark for future technological advancements in construction project management. Our study sets the stage for subsequent innovations, paving the way for a more connected, efficient, and data-driven approach in the construction industry. [ABSTRACT FROM AUTHOR]

Background: There are reconstructing methods of the alimentary tract after TLG as Roux-en-Y anastomosis and functional Jejunal interposition (FJI), and each of these methods has its advantages and drawbacks. But, no consensus has been reached yet about the best method. We aim to assess the post-operative outcomes of performing FJI or the Roux-en-Y procedure then jejunum transection as reconstruction procedures of the alimentary tract after performing TLG in gastric cancer patients and to compare between both procedures regarding post-operative complications and functional recovery. Patients and methods: We included 100 cases with clinical and radiological evidence of gastric carcinoma stages I-III. Patients were randomly divided for 2 equal groups the first group underwent FJI and the second group underwent Roux-en-Y as reconstructive techniques after performing gastrectomy. We correlate between both groups of patients regarding, operative parameters, post-operative complications. Results: time of the operation in patients who underwent PJI procedure was longer than that in patients who underwent Roux-en-Y procedure (P < 0.001). The postoperative hemoglobin, total protein and albumin in patients who underwent PJI procedure were higher than in patients who underwent Roux-en-Y procedure (P < 0.001). The post-operative loss in bodyweight at 3 and 12 months in the group of patients who underwent FJI groups was less than that in group of patients who underwent Roux-en-Y (P = 0.011). Conclusions: performing jejunal interposition as a reconstructive post-gastrectomy procedure is more effective than performing Roux-en-Y anastomosis regarding lowed incidence of postoperative complications and improving long-term post-operative life quality of patients. [ABSTRACT FROM AUTHOR]

Background: Using minimally invasive surgeries (MISs) in non-elective and urgent cases was assessed by many previous studies and found to be nearly similar to and even better than open surgeries. There was no sufficient data regarding long-term, follow-up, tumor recurrence, or survival data of studied patients in those studies. Aim of our study is to compare performing MIS and open colectomy in patients undergoing urgent (nonemergency, non-elective) colectomies, regarding primary outcomes of 30-day morbidity and mortality, secondary short-term outcomes, long-term and follow-up findings of included patients. Patients and methods: A total of 200 patients were included, and we divided them into two groups according to the performed surgical approach: The first group included 100 patients who underwent MISs and the second group underwent open surgery and included 100 patients. We evaluated the primary patients' outcome which was 30-day postoperative morbidity and mortality. Secondary evaluated patients' outcomes included; ICU admissions, surgical reintervention, wound infection or dehiscence, postoperative ileus, postoperative leakage at an anastomotic site, and occurrence of intra-abdominal infections. Long-term evaluated patients' outcomes included the occurrence of incisional hernias and oncological outcomes as overall survival rates and recurrence rates. Results: Regarding demographic and baseline data, patients who underwent open surgery were older (65 years vs 58 years, p < 0.001). More females underwent open surgery (54% vs 50%, p = 0.002). Overweight and obese patients were more likely to have MIS colectomy (p < 0. 001). There is a statistically significant relation between approach and all histopathological types (24.2% within the laparoscopic approach vs 11.6% within the open approach had mucoid carcinoma), N stage (82.8% within the laparoscopic approach vs 43.8% within open the approach had N stage 0), American Joint Committee on Cancer (AJCC) stage (63.8% within laparoscopic approach vs 20.8% within open approach had AJCC stage II) Open colectomy were liable to be diagnosed with acute diverticulitis and volvulus (p < 0.001). Operative time is longer in MIS patients in comparison to open colectomy patients the median time to complete an MIS colectomy was 21 minutes longer (p < 0.001). Postoperative mortality is less in MIS patients than the open surgery patients. On univariable analysis, 30-day postoperative mortality following MIS colectomy was lower than that after open surgery (p < 0.05). Conclusions: Using MIS in urgent colectomy is associated with less postoperative, morbidity, mortality, short-term complications, and longterm complications than open colectomy. [ABSTRACT FROM AUTHOR]

The combined remediation of cadmium (Cd) and arsenic (As) in paddy soils faces many challenges due to their opposite behavior. A pot study was conducted to evaluate the impact of biochar (BC), goethite (G), and goethite modified biochar (GBC) at a 1% application rate on the Chinese cabbage growth, uptake and immobilization of Cd and As in co-contaminated paddy soil. GBC composites were prepared at two different initial mass ratios (1:1 and 2:1) of iron/biochar (Fe/BC). Goethite modified biochar composite at Fe/BC initial mass ratios of 1:1 and 2:1 were labeled as GBC1 and GBC2, respectively. The results showed that GBC amendments significantly improved Chinese cabbage growth, chlorophyll content, and gas exchange attributes compared to BC and G applied singly. Biochar decreased Cd uptake by Chinese cabbage shoots and roots while increased As uptake by shoots and roots. The GBC1 amendment reduced Cd and As uptake by Chinese cabbage shoots (47.27% and 35.20%) and roots (36.80% and 41.12%), respectively, and reduced Cd and As bioaccessibility by 40.09% and 39.35%, respectively, compared to unamended soil. GBC is generally simple to synthesize from crop residue and is an environmentally acceptable material when used for Cd and As remediation in co-contaminated paddy soil. [ABSTRACT FROM AUTHOR]