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Abstract Background Type 2 diabetes mellitus (T2DM) has increased globally; with a disproportionate burden in South and Southeast Asian countries, including Nepal. There is an urgent need for clinically and cost-effective culturally adapted T2DM management programs. In this study, we aim to assess the effectiveness of community based culturally appropriate lifestyle intervention in improving the management and care of people with T2DM. Methods We will conduct a cluster randomized control trial to evaluate the effectiveness of community based culturally appropriate lifestyle intervention in improving T2DM outcomes. The trial will be conducted in 30 randomly selected healthcare facilities from two purposively selected districts (Kavrepalanchowk and Nuwakot districts) of Bagmati province, Nepal. The selected healthcare facilities are being randomized into 15 interventions (n = 15) and usual care (n = 15) groups. Those in the intervention will receive group-based 12 an hour-long fortnightly session delivered over 6 months period. The intervention package includes 12 planned modules related to diabetes care, ongoing support, supervision and monitoring, follow-up from the trained community health workers, and educational materials on diabetes self-management. The participants in the usual care groups will receive pictorial brochure on diabetes management and they will continue receiving the usual care available from the local health facilities. The primary outcome is HbA1c level, and the secondary outcomes include quality of life, health care utilization, and practice of self-care behaviour, depression, oral health quality of life, and economic assessment of the intervention. Two points measurements will be collected by the trained research assistants at baseline and at the end of the intervention. Discussion This study will provide tested approaches for culturally adapting T2DM interventions in the Nepalese context. The findings will also have practice and policy implications for T2DM prevention and management in Nepal. Trial registration Australia and New Zealand Clinical Trial Registry (ACTRN12621000531819). Registered on May 6, 2021.

Background Adverse childhood experiences (ACEs) have a profound negative impact on health. However, the strength of the association between ACEs and pregnancy complications and adverse pregnancy outcomes is not well quantified or understood.Objective To conduct a systematic review and meta-analysis of the association between ACEs and risk of pregnancy complications and adverse pregnancy outcomes.Search strategy A comprehensive search was conducted using PubMed, Embase, CINAHL, PsycINFO, ClinicalTrials.gov and Google scholar up to July 2022.Data collection and analysis Two reviewers independently conducted the screening and quality appraisal using a validated tool. Meta-analysis using the quality-effects model on the reported odds ratio (OR) was conducted. Heterogeneity and inconsistency were examined using the I2 statistics.Results 32 studies from 1508 met a priori inclusion criteria for systematic review, with 21 included in the meta-analysis. Pooled analyses showed that exposure to ACEs increased the risk of pregnancy complications (OR 1.37, 95% CI 1.20 to 1.57) and adverse pregnancy outcomes (OR 1.31, 95% CI 1.17 to 1.47). In sub-group analysis, maternal ACEs were associated with gestational diabetes mellitus (OR 1.39, 95% CI 1.11 to 1.74), antenatal depression (OR 1.59, 95% CI 1.15 to 2.20), low offspring birth weight (OR 1.27, 95% CI 1.02 to 1.47), and preterm delivery (OR 1.41, 95% CI 1.16 to 1.71).Conclusion The results suggest that exposure to ACEs increases the risk of pregnancy complications and adverse pregnancy outcomes. Preventive strategies, screening and trauma-informed care need to be examined to improve maternal and child health.

Summary: Background: There is a strong societal belief that parents are role models for their child's dietary behaviours in early life that may persist throughout the life course. Evidence has shown inconclusive dietary resemblance in parent-child (PC) pairs. This systematic review and meta-analysis aimed to examine dietary resemblance between parent and children. Methods: We systematically searched for studies on PC dietary resemblance, via six electronic databases (PubMed, Ovid MEDLINE, Embase, APA PsycNet, CINAHL, and Web of Science) and other grey sources of literature between 1980 and 2020. We performed quality effect meta-analysis model on transformed correlation coefficients (z) to examine the resemblance in dietary intakes including nutrient intakes, food group intakes and whole diet. Finally, the Fisher's transformed coefficient (z) was used for meta-regression analysis to identify potential moderators. Heterogeneity and inconsistency were examined using the Q and I2 statistic. The study is registered on PROSPERO, CRD42019150741. Findings: A total of 61 studies met the inclusion criteria for systematic review, 45 were included in the meta-analysis. Pooled analyses showed weak to moderate PC dietary intake associations for energy: (r: 0.19; 95% CI: 0.16, 0.22), fat (% energy): (r: 0.23; 95% CI: 0.16, 0.29), protein (% energy): (r: 0.24; 95% CI: 0.20, 0.27), carbohydrate (% energy): (r: 0.24; 95% CI: 0.19, 0.29), fruits and vegetable (g/d): (r: 0.28; 95% CI: 0.25, 0.32), confectionary food (g/d): (r: 0.20; 95% CI: 0.17, 0.23), and whole diet (r: 0.35; 95% CI: 0.28, 0.42). Dietary intakes associations by study characteristics, including population, study year, dietary assessment method, person reporting dietary intake, quality of the study, and study design were highly variable, but associations were similar between PC pairs. Interpretation: The resemblance among parent-child pairs was weak to moderate for most aspects of dietary intakes. These findings challenge the social myth that parental dietary intake behaviour shapes their child's dietary intake. Funding: None.

Summary: Background: The aim of this study is to assess the current status of metabolic and behavioural risk factors for cardiovascular diseases among the adult population in South and Southeast Asia using World Health Organization (WHO) STEPS data. Methods: We used WHO STEPS surveys data in ten South and Southeast Asian countries. Weighted mean estimates of prevalence of five metabolic risk factors and four behavioural risk factors were calculated by country and overall region. We used random-effects meta-analysis to generate country and regional pooled estimates of metabolic and behavioural risk factors, using the DerSimonian and Laird inverse-variance method. Finding: Around 48,434 participants aged 18–69 years were included in this study. Overall 32.00% (95% CI: 31.15–32.36) of individuals in the pooled sample had one metabolic risk factor, 22.10% (95% CI: 21.73–22.47) had two, and 12.38% had three or more (95% CI: 9.09–14.00). Twenty-four percent (95% CI: 20.00–29.00) of individuals in the pooled sample had only one behavioural risk factor, 49.00% (95% CI: 42.00–56.00) had two, and 22.00% had three or more (95% CI: 16.00–29.00). Risk of high three or more metabolic risk factors was higher among women, those of older age, and those with a higher education. Interpretation: The existence of multiple metabolic and behavioural risk factors among the South and Southeast Asian population demand appropriate prevention strategies to halt the progress of non-communicable disease burden within the region. Funding: Not applicable.

Abstract Background The aim of this study is to assess the current status of non-communicable disease (NCD) risk factors amongst adolescents in Bangladesh. We also critically reviewed the existing policy responses to NCD risk among adolescents in Bangladesh. Methods This study used a mixed method approach. To quantify the NCD risk burden, we used data from the Global School-based Student Health Survey conducted in Bangladesh. To understand policy response, we reviewed NCD-related policy documents introduced by the Government of Bangladesh between 1971 and 2018 using the WHO recommended NCD Action Plan 2013–2020as study framework. Information from the policy documents was extracted using a matrix, mapping each document against the six objectives of the WHO 2013–2020 Action Plan. Results Almost all adolescents in Bangladesh had at least one NCD risk factor, and there was a high prevalence of concurrent multiple NCD risk factors; 14% had one NCD risk factor while 22% had two, 29% had three, 34% had four or more NCD risk factors. Out of 38 policy documents, eight (21.1%) were related to research and/or surveys, eight (21.1%) were on established policies, and eleven (29%) were on legislation acts. Three policy documents (7.9%) were related to NCD guidelines and eight (21.1%) were strategic planning which were introduced by the government and non-government agencies/institutes in Bangladesh. Conclusions The findings emphasize the needs for strengthening NCD risk factors surveillance and introducing appropriate intervention strategies targeted to adolescents. Despite the Government of Bangladesh introducing several NCD-related policies and programs, the government also needs more focus on clear planning, implementation and monitoring and evaluation approaches to preventing NCD risk factors among the adolescents in Bangladesh.

Abstract Background Access to and utilization of health services have remained major challenges for people living in low- and middle-income countries, especially for those living in impaired public health environment such as refugee camps and temporary settlements. This study presents health problems and utilization of health services among Forcibly Displaced Myanmar Nationals (FDMNs) living in the southern part of Bangladesh. Methods A mixed-method (quantitative and qualitative) approach was used. Altogether 999 household surveys were conducted among the FDMNs living in makeshift/temporary settlements and host communities. We used a grounded theory approach involving in-depth interviews (IDIs), focus group discussions (FGDs), and key informant interviews (KIIs) including 24 IDIs, 10 FGDs, and 9 KIIs. The quantitative data were analysed with STATA. Results The common health problems among the women were pregnancy and childbirth-related complications and violence against women. Among the children, fever, diarrhoea, common cold and malaria were frequently observed health problems. Poor general health, HIV/AIDS, insecurity, discrimination, and lack of employment opportunity were common problems for men. Further, 61.2% women received two or more antenatal care (ANC) visits during their last pregnancy, while 28.9% did not receive any ANC visit. The majority of the last births took place at home (85.2%) assisted by traditional birth attendants (78.9%), a third (29.3%) of whom suffered pregnancy- and childbirth-related complications. The clinics run by the non-governmental organizations (NGOs) (76.9%) and private health facilities (86.0%) were the most accessible places for seeking healthcare for the FDMNs living in the makeshift settlements. All participants heard about HIV/AIDS. 78.0% of them were unaware about the means of HIV transmission, and family planning methods were poorly used (45.2%). Conclusions Overall, the health of FDMNs living in the southern part of Bangladesh is poor and they have inadequate access to and utilization of health services to address the health problems and associated factors. Existing essential health and nutrition support programs need to be culturally appropriate and adopt an integrated approach to encourage men’s participation to improve utilization of health and family planning services, address issues of gender inequity, gender-based violence, and improve women empowerment and overall health outcomes.

Summary: Background: Modifiable non-communicable disease (NCD) risk factors are becoming increasingly common among adolescents, with clustering of these risk factors in individuals of particular concern. The aim of this study was to assess global status of clustering of common modifiable NCD risk factors among adolescents. Methods: We used latest available data from nationally representative survey for 140 countries, namely the Global School-based Student Health Survey, the Health Behaviour in School-Aged Children and the longitudinal study of Australian Children. Weighted mean estimates of prevalence with corresponding 95% confidence intervals of nine NCD risk factors - physical inactivity, sedentary behaviour, insufficient fruits and vegetable consumption, carbonated soft drink consumption, fast food consumption, tobacco use, alcohol consumption and overweight/obesity - were calculated by country, region and sex. Findings: Over 487,565 adolescents, aged 11–17 years, were included in this study. According to trend analysis, prevalence of four or more NCD risk factors increased gradually over time. Prevalence of four or more NCD risk factors was 14.8% in 2003–2007 and increased to 44% in 2013–2017, an approximately three-fold increase (44.0%). Similar trends were also observed for three and two risk factors. Large variation between countries in the prevalence of adolescents with four or more risk factors was found in all regions. The country level range was higher in the South-East Asia Region (minimum Sri Lanka = 8%, maximum Myanmar = 84%) than Western Pacific Region (minimum China = 3%, maximum Niue = 72%), European Region (minimum Sweden = 13.9%, maximum Ireland = 66.0%), African Region (minimum Senegal = 0.8%, maximum Uganda = 82.1%) and Eastern Mediterranean Region (minimum Libya = 0.2%, maximum Lebanon = 80.2%). Insufficient vegetable consumption, insufficient fruit consumption and physically inactivity were three of the four most prevalent risk factors in all regions. Interpretation: Our results suggest a high prevalence of four or more NCD risk factors in adolescents globally, although variation was found between countries. Results from our study indicate that efforts to reduce adolescent NCD risk factors and the associated health burden need to be improved. These findings can assist policy makers to target the rollout of country- specific interventions. Funding: None.

Objectives The objective of this study was to determine the level of type 2 diabetes (T2DM) and hypertension (HTN) in Vietnam and to assess the trend and recommend the future direction of prevention research efforts.Design We searched scientific literature, databases including PubMed, EMBASE, CINHAL and Google Scholar; grey literature and reference lists for primary research published, nation database websites between 1 January 2000 and 30 September 2020. We adapted the modified Newcastle Ottawa Scale for assessing the quality of the study, as recommended by the Cochrane Collaboration.Results In total, 83 studies met our inclusion criteria, representing data of approximately 239 034 population of more than 15 years of age in Vietnam. The findings show that prevalence rates varied widely across studies, from 1.0% to 29.0% for T2DM and 2.0% to 47.0% for HTN. For the total study period, pooled prevalence of T2DM and HTN in Vietnam for all studies was 6.0% (95% CI: 4.0% to 7.0%) and 25% (95% CI: 19% to 31%), respectively. Prevalence rate of both T2DM and HTN was higher among the male population compared with female counterpart.Conclusion There is evidence of a rising trend of HTN and T2DM prevalence in Vietnam. Future research should focus on the major drivers, incidence and prognosis of T2DM and HTN. Policy approaches should base upon the trends of T2DM and HTN in Vietnam over the last 20 years and pay more attention on the effective interventions to combat T2DM and HTN. In our study, we included both English and Vietnamese language articles and seems that majority of the articles came from Vietnamese language.PROSPERO registration number CRD42020182959.

Summary: Background: Countries in the South and Southeast Asia region grapple with significant challenges due to the double burden of malnutrition (DBM) in women. An understanding of the country specific DBM geographical and socioeconomic distribution in South and Southeast Asian countries will enable targeting of DBM interventions towards high-risk populations in the region. This study aimed to analyse anthropometric indicators for women's nutrition at national and subnational levels in seven South and Southeast Asian countries and assess the association between nutritional status and socioeconomic factors. Methods: We used population-representative cross-sectional data from the Demographic and Health Surveys conducted between 2000 and 2017, for seven South and Southeast Asian countries (Bangladesh, Cambodia, India, Myanmar, Nepal, Pakistan, and Timor-Leste) and estimated national and subnational prevalence of women underweight and overweight. Using a concentration index (CI), we measured relative and absolute inequality across underweight and overweight in urban and rural areas in these countries. In addition, we estimated the health achievement index, integrating mean coverage of nutritional status and the distribution of coverage by rural and urban populations. Findings: The prevalence of underweight women ranged from 7.0% (95% CI: 7.0-8.0%) in Pakistan in 2017 to 44.0% (95% CI: 42-45%) in Bangladesh in 2000 and overweight from 11.0% (95% CI: 10-12%) in Bangladesh in 2000 to 67.0% (95% CI: 66-68%) in Pakistan in 2017. In most countries, underweight disproportionately affected the poorest. The concentration indices for underweight were significant in all countries and ranged from –0.04 in Cambodia in 2014 to –0.38 in Pakistan in 2017. In contrast, overweight disproportionately affected the richest, with concentration indices for overweight significant in all countries, ranging from 0.16 in Cambodia in 2010 to 0.45 in Bangladesh in 2007. In most of the countries an absolute measure of inequality decreased overtime, whereas relative measures increased. Disachievement of underweight is more pronounced in rural populations compared to the urban ones. Interpretations: We noted large geographical and socioeconomic disparities in women DBM in South and Southeast Asian countries, at national and subnational levels. Planning, implementation, and evaluation of existing intervention programmes for food and nutrition should be based on subnational level needs and outcomes. Funding: This research is partially funded by the Australian Government through the Australian Research Council's Centre of Excellence for Children and Families over the Life Course (Project ID CE200100025).

Background: Metabolic syndrome is an important risk factor for cardiovascular disease and premature mortality. This study aimed to determine the prevalence and associated factors of metabolic syndrome among Bangladeshi adults (aged 18–69 years) using a nationally representative survey: Stepwise Approach to Surveillance (STEPS). Methods: Metabolic syndrome was defined according to Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. Design based multivariable log-binomial regression was conducted to explore the associated factors. The adjusted prevalence ratio (APR) was reported along with a 95% confidence interval (CI). Findings: In total, 6851 samples were included. Overall, 15.5% and 16.6% of the participants had metabolic syndrome according to ATP III and IDF criteria, respectively. According to ATP III criteria, the prevalence of metabolic syndrome was higher among those aged 30–49 years (APR: 2.4; 95% CI: 1.8–3.2) and 50–69 years (APR: 3.5; 95% CI: 2.5–4.5) compared to those aged 18–29 years, being educated up to college and higher (APR: 1.6; 95% CI: 1.2–2.0) compared to those who did not receive any formal education, residence in the urban area (APR: 1.2; 95% CI: 1.0–1.4) compared to rural residents, having an abnormal waist-hip ratio (APR: 2.0; 95% CI: 1.6–2.6) compared to having normal waist-hip ratio, being overweight (APR: 1.8; 95% CI: 1.4–2.3), and obese (APR: 3.5; 95% CI: 2.8–4.4) compared to those who had normal BMI/underweight. Compared to the residents in the Dhaka Rural, residents in Mymensingh, and Rangpur division had lower odds of having metabolic syndrome. Except for the place of residence, the associated factors were similar according to IDF criteria. Conclusion: As approximately every one in six adults are suffering from the metabolic syndrome in Bangladesh, the public health prevention and promotion programs should target the high-risk groups to curtail the high burden.

Objectives This study was performed to identify the distribution of undiagnosed isolated hypertension subtypes and their correlates amongst adults aged 35 years and older in Bangladesh using data from the Bangladesh Demography and Health Survey 2011. Methods Out of a total of 17,964 selected households, 7,880 were included in the final analysis for this study. Systolic and diastolic blood pressure (BP) were measured 3× at 10-minute intervals. Hypertension subtypes were defined for individuals not under antihypertensive treatment as systolic-diastolic hypertension (SDH): systolic BP (SBP) ≥ 140 mm Hg and diastolic BP (DBP) ≥ 90 mm Hg; isolated diastolic hypertension (IDH): SBP < 140 mm Hg and DBP ≥ 90 mm Hg, and isolated systolic hypertension (ISH): SBP ≥140 mm Hg and DBP < 90 mm Hg. Results The predominant hypertension subtypes were SDH and IDH [5.2%; 95% confidence interval (CI): 4.7–5.1] followed by ISH (3.8%; 95% CI: 3.4–4.2). Multiple logistic regression showed that age and gender were significant predictors of ISH. SDH was associated with females [odds ratio (OR): 1.8; 95% CI: 1.3–2.6], the older age group (OR-7.4; 95% CI: 4.3–12.7), and overweight or obese individuals (OR: 1.6; 95% CI: 1.1–2.4). Non-manual work (OR: 1.5; 95% CI: 1.0–2.0]) and being overweight or obese (OR: 1.9; 95% CI: 1.4–2.8) were factors associated with IDH. Conclusion ISH, IDH and SDH represent salient subtypes of hypertension in Bangladesh. To identify preventive intervention for averting adverse cardiovascular events, further research is needed.

Background: Diabetic individuals must adhere to their medications to control their glucose levels and prevent diabetes-related complications. However, there is limited evidence of medication adherence in patients with type 2 diabetes in Bangladesh. Objectives: We assessed the level of adherence and factors associated with low adherence to anti-diabetic medication among patients with type 2 diabetes at different health facilities in southern Bangladesh. Methods: This cross-sectional study included 2,070 patients with type 2 diabetes who presented at five health facilities in the Chittagong Division between November 2018 and June 2019. We assessed medication adherence using a self-reported, structured, eight-item questionnaire and performed multiple logistic regression to investigate the factors associated with low medication adherence. Results: The overall prevalence of low medication adherence was 46.3% (95% CI: 41.4–55.8%) of our study population. Multiple logistic regression analysis revealed that males (OR: 1.37; 95% CI: 1.13–1.67), those with a family income of < 233 USD (OR: 1.54, 95% CI: 1.17–2.03), and those with a diabetic ulcer (OR: 1.42, 95% CI: 1.04–1.94) showed low adherence. Diabetic ulcers, retinopathy, and obesity were relatively more elevated among diabetic patients with low medication adherence. Conclusion: Low medication adherence among patients with type 2 diabetes in southern Bangladesh is a key public health challenge. Factors such as male sex, low annual family income, and diabetic ulcers were associated with low medication adherence. Patient counseling and awareness programs may enhance medication adherence among people with type 2 diabetes. Our findings will help physicians and public health workers to develop targeted strategies to increase awareness of the same among their patients.

Background/objective The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal.Design We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders’ consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically.Setting Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level.Participants We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6).Results The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation.Conclusion Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW’s capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.

Background: Suicidal ideation and anxiety are common among adolescents although their prevalence has predominantly been studied in high income countries. This study estimated the population prevalence of suicidal ideation and anxiety and their correlates with peer support, parent-adolescent relationship, peer victimization, conflict, isolation and loneliness across a range of low-income, lower-middle-income, upper-middle-income countries and high-income countries (LMICHICs). Methods: Data were drawn from the Global School-based Student Health Survey (GSHS) of adolescents aged 12–17 years between 2003 and 2015 in 82 LM-HICs from the six World Health Organization (WHO) regions. For those countries with repeated time point data in this study, we used data from the most recent survey. We estimated weighted prevalence of suicidal ideation and anxiety by country, region and at a global level with the following questions:-“Did you ever seriously consider attempting suicide during the past 12 months?” and “During the past 12 months, how often have you been so worried about something that you could not sleep at night?”. We used multiple binary logistic regression to estimate the adjusted association between adolescent age, sex, socioeconomic status, peer support, parent-adolescent relationship, peer victimization, conflict, isolation and loneliness with suicidal ideation and anxiety. Findings: The sample comprised of 275,057 adolescents aged 12–17 years (mean age was 14.6 (SD 1.18) years of whom 51.8% were females). The overall 12 months pooled prevalence of suicidal ideation and anxiety were 14.0% (95% CI 10.0–17.0%) and 9.0% (7.0–12.0%) respectively. The highest pooled prevalence of suicidal ideation was observed in the Africa Region (21.0%; 20.0–21.0%) and the lowest was in the Asia region (8.0%, 8.0–9.0%). For anxiety, the highest pooled prevalence was observed in Eastern Mediterranean Region (17.0%, 16.0–17.0%) the lowest was in the European Region (4.0%, 4.0–5.0%). Being female, older age, having a lower socioeconomic status and having no close friends were associated with a greater risk of suicidal ideation and anxiety. A higher levels of parental control was positively associated with a greater likelihood of experiencing suicidal ideation (OR: 1.65, 1.45–1.87) and anxiety (1.53, 1.30–1.80). Parental understanding and monitoring were negatively associated with mental health problems. Similarly, the odds of experiencing suicidal ideation and anxiety were higher among adolescents who had been experiencing peer conflict (1.36, 1.24–1.50; 1.54, 1.40–1.70), peer victimization (1.26, 1.15–1.38; 1.13, 1.02–1.26), peer isolation (1.69, 1.53–1.86; 1.76, 1.61–1.92) and reported loneliness (2.56, 2.33–2.82; 5.63, 5.21–6.08). Interpretations: Suicidal ideation and anxiety are prevalent among adolescents although there is significant global variation. Parental and peer supports are protective factors against suicidal ideation and anxiety. Peer based interventions to enhance social connectedness and parent skills training to improve parent-child relationships may reduce suicidal ideation and anxiety. Research to inform the factors that influence country and regional level differences in adolescent mental health problems may inform preventative strategies. Funding: None

Summary: Background: Bullying victimisation is a global public health problem that has been predominantly studied in high income countries. This study aimed to estimate the population level prevalence of bullying victimisation and its association with peer and parental supports amongst adolescents across low and middle income to high income countries (LMICHICs). Methods: Data were drawn from the Global School-based Student Health Survey of school children aged 12–17 years, between 2003 and 2015, in 83 LMICHICs in the six World Health Organization (WHO) regions. We estimated the weighted prevalence of bullying victimisation at country, region and global level. We used multiple binary logistic regression models to estimate the adjusted association of age, gender, socioeconomic status, and parental support and peer support, and country level variables (GDP and government expenditure on education) with adolescent bullying victimisation. Findings: Of the 317,869 adolescents studied, 151,036 (48%) were males, and 166,833 (52%) females. The pooled prevalence of bullying victimisation on one or more days in the past 30 days amongst adolescents aged 12–17 years was 30·5% (95% CI: 30·2–31·0%). The highest prevalence was observed in the Eastern Mediterranean Region (45·1%, 44·3–46·0%) and African region (43·5%, 43·0–44·3%), and the lowest in Europe (8·4%, 8·0–9·0%). Bullying victimisation was associated with male gender (OR: 1·21; 1·11–1·32), below average socio-economic status (OR: 1·47, 1·35–1·61), and younger age (OR: 1·11, 1·0–1·24). Higher levels of peer support (0·51, 0·46–0·57), higher levels of parental support (e.g., understanding children's problems (OR: 0·85, 0·77–0·95), and knowing the importance of free time spent with children (OR: 0·77, 0·70–0·85)), were significantly associated with a reduced risk of bullying victimisation. Interpretations: Bullying victimisation is prevalent amongst adolescents globally, particularly in the Eastern Mediterranean and African regions. Parental and peer supports are protective factors against bullying victimisation. A reduction in bullying victimisation may be facilitated by family and peer based interventions aimed at increasing social connectedness of adolescents.

Abstract Background Mobile phone-based technology has been used in improving the delivery of healthcare services in many countries. However, data on the effects of this technology on improving primary healthcare services in resource-poor settings are limited. The aim of this study is to develop and test a mobile phone-based system to improve health, population and nutrition services in rural Bangladesh and evaluate its impact on service delivery. Methods The study will use a quasi-experimental pre-post design, with intervention and comparison areas. Outcome indicators will include: antenatal care (ANC), delivery care, postnatal care (PNC), neonatal care, expanded programme on immunization (EPI) coverage, and contraceptive prevalence rate (CPR). The study will be conducted over a period of 30 months, using the existing health systems of Bangladesh. The intervention will be implemented through the existing service-delivery personnel at various primary-care levels, such as community clinic, union health and family welfare centre, and upazila health complex. These healthcare providers will be given mobile phones equipped with Apps for sending text and voice messages, along with the use of Internet and device for data-capturing. Training on handling of the Smartphones, data-capturing and monitoring will be given to selected service providers. They will also be trained on inputs, editing, verifying, and monitoring the outcome variables. Discussion Mobile phone-based technology has the potential to improve primary healthcare services in low-income countries, like Bangladesh. It is expected that our study will contribute to testing and developing a mobile phone-based intervention to improve the coverage and quality of services. The learning can be used in other similar settings in the low-and middle-income countries.

Abstract Background This paper is aimed at critically assessing the extent to which Non-Communicable Disease NCD-related policies introduced in Bangladesh align with the World Health Organization’s (WHO) 2013–2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs. Methods The authors reviewed all relevant policy documents introduced by the Government of Bangladesh since its independence in 1971. The literature review targeted scientific and grey literature documents involving internet-based search, and expert consultation and snowballing to identify relevant policy documents. Information was extracted from the documents using a specific matrix, mapping each document against the six objectives of the WHO 2013–2020 Action Plan for the Global Strategy for the Prevention and Control of NCDs. Results A total of 51 documents were identified. Seven (14%) were research and/or surveys, nine were on established policies (17%), while seventeen (33%) were on action programmes. Five (10%) were related to guidelines and thirteen (25%) were strategic planning documents from government and non-government agencies/institutes. The study covered documents produced by the Government of Bangladesh as well as those by quasi-government and non-government organizations irrespective of the extent to which the intended policies were implemented. Conclusions The policy analysis findings suggest that although the government has initiated many NCD-related policies or programs, they lacked proper planning, implementation and monitoring. Consequently, Bangladesh over the years had little success in effectively addressing the growing burden of non-communicable diseases. It is imperative that future research critically assess the effectiveness of national NCD policies by monitoring their implementation and level of population coverage.

Objective To explore healthcare providers’ perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services delivery at the primary healthcare level.Design We used a grounded theory approach involving in-depth qualitative interviews with healthcare providers. We also used a health facility observation checklist to assess the NCD corners’ service readiness. Furthermore, a stakeholder meeting with participants from the government, non-government organisations (NGOs), private sector, universities and news media was conducted.Setting Twelve subdistrict health facilities, locally known as upazila health complex (UHC), across four administrative divisions.Participants Participants for the in-depth qualitative interviews were health service providers, namely upazila health and family planning officers (n=4), resident medical officers (n=6), medical doctors (n=4) and civil surgeons (n=1). Participants for the stakeholder meeting were health policy makers, health programme managers, researchers, academicians, NGO workers, private health practitioners and news media reporters.Results Participants reported that diabetes, hypertension and chronic obstructive pulmonary disease were the major NCD-related problems. All participants acknowledged the governments’ initiative to establish the NCD corners to support NCD service delivery. Participants thought the NCD corners have contributed substantially to increase NCD awareness, deliver NCD care and provide referral services. However, participants identified challenges including lack of specific guidelines and standard operating procedures; lack of trained human resources; inadequate laboratory facilities, logistics and medications; and poor recording and reporting systems.Conclusion The initiative taken by the Government of Bangladesh to set up the NCD corners at the primary healthcare level is appreciative. However, the NCD corners are still at nascent stage to provide prevention and management services for common NCDs. These findings need to be taken into consideration while expanding the NCD corners in other UHCs throughout the country.

Introduction Use of tobacco has become one of the major causes of premature deaths in most developing countries, including Bangladesh. The poorest and most disadvantaged populations, such as those living in slums, are considered to be extremely vulnerable to non-communicable diseases and their risk factors, especially tobacco use. The objective of this study was to assess the current status of tobacco consumption among slum dwellers and its association with socio-demographic factors. Material and Methods A cross-sectional study was conducted in three slums of Dhaka city. Information about tobacco use as well as socio-demographic characteristics was collected from adult slum dwellers via face to face interviews using WHO STEPS questionnaire. Results Overall proportion of smoking, smokeless tobacco consumption and dual use of tobacco was 35% [95% CI: 31.6-39.8], 40.6% [95% CI: 36.5–45.2] and 12% [95% CI: 9.3–15.0] respectively. Elderly people (55–64 years) were more likely to smoke (OR: 2.34, 95% CI: 1.21–4.49) than younger people (aged 25–34 years). On the other hand, those who had no schooling history (OR: 2.95, 95% CI: 1.66–5.25) were more likely to consume smokeless tobacco than those who had higher education (secondary or above). At the same time, manual workers were more likely to indulge in dual use of tobacco (OR: 5.17, 95% CI: 2.82–9.48) as compared to non-manual workers. Conclusions The urban slum population of Dhaka city has a high prevalence of tobacco use, which increases their likelihood of developing non-communicable diseases. Proper attention needs to be directed towards addressing the risk factors related to non-communicable diseases within this vulnerable population.

BackgroundOver the two last decades Bangladesh, a low-income country, has experienced a rapid demographic and epidemiological transition. The population has increased substantially with rapid urbanization and changing pattern of disease, which at least in part, can be explained by nutritional changes. However, the nutritional status of the adult population has not been previously described. Hence, the objective of this study was to estimate the prevalence and explore socio-demographic determinants of underweight, overweight and obesity among the Bangladeshi adult population.MethodsThis study is a secondary data analysis of the national 2011 Bangladesh Demographic and Health Survey. We determined the nutritional status of adults aged ≥35 years of age, who had a measured weight and height, using the Asian body mass index (BMI) cut-offs for underweight (BMI ResultOf total sample (n = 5495), 30.4% were underweight, 18.9% were overweight and 4.6% were obese. Underweight was associated with age, education and wealth. The adjusted odd ratios for underweight were higher for older people (≥70 years) compared to younger, the least educated compared to the most educated and the poorest compared to the wealthiest were 2.51 (95%CI: 1.95-3.23, pConclusionUnderweight and overweight/obesity are prevalent in Bangladeshi adults. Both conditions are associated with increased morbidity and mortality and increase the risk of developing non-communicable diseases. Effective public health intervention approaches are necessary to address both these conditions.

BACKGROUND:Despite one-third of the urban population in Bangladesh living in urban slums and at increased risk of non-communicable diseases (NCDs), little is known about the NCD risk profile of this at-risk population. The aim of the study was to identify the prevalence of the NCD risk factors and the association of NCD risk factors with socio-demographic factors among the adults of urban slums in Dhaka, Bangladesh. METHOD:A cross-sectional study was conducted among adult slum dwellers (aged 25 and above) residing in three purposively selected urban slums of Dhaka for at least six months preceding the survey. The risk factors assessed were- currently smoking, fruit and vegetable intake, physical activity, hypertension and body mass index (BMI). Information on self-reported diabetes was also taken. A total of 507 participants (252 females; 49.7%) were interviewed and their physical measures were taken using the WHO NCD STEPS instrument. RESULT:The overall prevalence of NCD risk factors was: 36.0% (95% CI: 31.82-40.41) for smoking; 95.60% (95% CI: 93.60-97.40) for insufficient fruit and vegetable intake; 15.30% (95% CI:12.12-18.71) for low physical activity;13.70% (95% CI: 10.71-16.92) for hypertension; 22.70% (95% CI: 19.31-26.02) for overweight or obesity; and 5.00% (95%: 3.20-7.00) for self-reported diabetes. In the logistic regression model, the clustering of three or more NCD risk factors was positively associated with younger age groups (p = 0.02), no formal education (p

BACKGROUND:Overweight and obesity are a particular concern for women of reproductive age. They not only increase the risk of chronic diseases but they are also associated with adverse perinatal, neonatal, infant and child outcomes. The objective of this study was to examine the trend of overweight and obesity among Bangladeshi women of reproductive age between 2004 and 2014. METHOD:This is a secondary data analysis of the 2004, 2007, 2011 and 2014 Bangladesh Demographic and Health Surveys (BDHS). We determined the age standardized prevalence of overweight and obesity of women aged 15-49 years, who had their weight and height measured. Overweight and obesity were determined using the Asian specific BMI cut-offs criteria. RESULT:The prevalence of overweight increased from 11.4% [95% CI: 10.4to 12.5] in 2004 to 25.2% [95% CI: 24.0 to 26.4] in 2014. The prevalence of obesity increased from 3.5% [95% CI: 3.0to4.2] to 11.2% [95% CI: 10.1to12.5%] over the same period of time. This was seen in all age groups. However, the greatest increase was observed in women aged 35 to 49 years. The highest prevalence of overweight and obesity were observed in those women with the highest education level and wealth, larger family size, living in urban areas and not being in paid employment. CONCLUSION:The prevalence of overweight and obesity among women of reproductive age in Bangladesh is high and increasing. We speculate that this has the potential to jeopardize the improvements that have been made in maternal and infant health over the last two decades. Evidence based prevention strategies are required to address this serious public health issue.

Chronic non-communicable diseases (NCDs) are a major public health challenge, and undermine social and economic development in much of the developing world, including Bangladesh. Epidemiologic evidence on the socioeconomic status (SES)-related pattern of NCDs remains limited in Bangladesh. This study assessed the relationship between three chronic NCDs and SES among the Bangladeshi population, paying particular attention to the differences between urban and rural areas.Data from the 2011 Bangladesh Demographic and Health Survey were used for this study. Using a concentration index (CI), we measured relative inequality across pre-diabetes, diabetes, pre-hypertension, hypertension, and BMI (underweight, normal weight, and overweight/obese) in urban and rural areas in Bangladesh. A CI and its associated curve can be used to identify whether socioeconomic inequality exists for a given health variable. In addition, we estimated the health achievement index, integrating mean coverage and the distribution of coverage by rural and urban populations.Socioeconomic inequalities were observed across diseases and risk factors. Using CI, significant inequalities observed for pre-hypertension (CI = 0.09, p = 0.001), hypertension (CI = 0.10, p = 0.001), pre-diabetes (CI = -0.01, p = 0.005), diabetes (CI = 0.19, p