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Background/Objectives: An Android platform-based customised app and web-linked system was developed to aid in implementing selected nutrition interventions by community health workers (CHWs) in a community-based cluster randomised trial (c-RCT) in rural Bangladesh. Methods: Here, we describe the architecture of the intervention delivery system, and explore feasibility of employing mHealth as CHWs' job aid, employing a mixed-method study design covering 17 visits per mother-child dyad. We analysed CHWs' real-time visit information from monitoring and documentation data, and CHWs' qualitative interviews to explore the advantages and barriers of using mHealth as a job aid. Results: Intervention coverage was high across the arms (>90%), except around the narrow perinatal period (51%) due to mothers' cultural practice of moving to their parents' homes and/or hospitals for childbirth. CHWs mentioned technical and functional advantages of the job aid including device portability, easy navigability of content, pictorial demonstration that improved communication, easy information entry, and automated daily scheduling of tasks. Technical challenges included charging tablets, especially in power cut-prone areas, deteriorated battery capacity over continuous device usage, unstable internet network in unsupportive weather conditions, and device safety. Nevertheless, onsite supervision and monitoring by expert supervisors remained important to ensure intervention quality. Conclusions: With appropriate training and supervision, CHWs utilised the tablet-based app proficiently, attaining high coverage of long-term visits. mHealth was thus useful for designing, planning, scheduling, and delivering nutrition interventions through CHWs, and for monitoring and supervision by supervisors. Therefore, this application and job aid can be adopted or replicated into the currently developing national health systems platform for improving coverage and quality of preventive maternal and child nutrition services. In addition, continuous supportive supervision by skilled supervisors must be accompanied to ensure CHWs' task quality. Finally, future studies should rigorously assess undesirable health and environmental effects of mHealth before and after mainstreaming, effective interventions addressing device-induced health hazards should be designed and scaled up, and effective e-waste management must be ensured. [ABSTRACT FROM AUTHOR]

Abstract It remains unclear whether and how maternal exposure to biomass fuel influences infant anthropometry or body proportionality at birth, which are linked to their survival, physical growth, and neurodevelopment. Therefore, this study seeks to explore the association between household-level exposure to biomass cooking fuels and infant size and body proportionality at birth among women in rural Bangladesh. A total of 909 women were derived from the Pregnancy Weight Gain study, which was conducted in Matlab, a rural area of Bangladesh. Infant’s weight (g), length (cm), head circumference (cm), small for gestational age (SGAW), short for gestational age (SGAL), low head circumference for gestational age (SGAHC), ponderal index, and cephalization index at birth were the outcomes studied. Of the women, 721 (79.3%) were dependent on biomass fuel. Compared to infants born to mothers who used gas for cooking, those born to biomass users had lower weight (β − 94.3, CI − 155.9, − 32.6), length (β − 0.36, 95% CI − 0.68, − 0.04), head circumference (β − 0.24, CI − 0.47, − 0.02) and higher cephalization index (β 0.03, CI 0.01, 0.05) at birth. Maternal biomass exposure is more likely to lead to symmetric SGA, although there is evidence for some brain-sparing effects.

Background: Bangladesh's healthcare system faces challenges in providing equitable access and quality healthcare to rural and remote communities compared to urban areas. To address these issues, the country has incorporated telemedicine into its healthcare system. Aims: This study aimed to assess the effectiveness of telemedicine services in rural Bangladesh. Methods: The study employed a mixed-method approach, including survey questionnaires and in-depth interviews. 100 participants were selected for the questionnaire survey for quantitative data, and 20 in-depth interviews were conducted to collect qualitative data. Results: The findings indicate that telemedicine has garnered a positive reception among rural residents. An overwhelming 86% regarded telemedicine as a cost-effective healthcare option. 44% reported accessing telemedicine services within 10 minutes, demonstrating their accessibility. Furthermore, a majority (54%) expressed satisfaction with telemedicine services. However, dissatisfaction was noted concerning the physical environment of the telemedicine centers. Conclusion: Overall, telemedicine in Bangladesh has proven effective in cost savings and time efficiency and has gained significant acceptance among rural residents. To further improve healthcare accessibility, expanding telemedicine centers to reach every remote union in Bangladesh is imperative. Additionally, raising awareness, providing ICT and telemedicine education, and ensuring affordable and reliable internet connectivity will maximize the potential of telemedicine services, ultimately benefiting underprivileged rural populations. Keywords: healthcare, rural Bangladesh, telehealth, telemedicine

Introduction: Women play an important role in maintaining household food security; unfortunately, their food security is frequently neglected. This type of phenomenon has become common in developing nations such as Bangladesh, particularly in its rural areas. The objective of this study is to investigate the variables that lead to the empowerment of rural women and its impact on their food security. In acknowledging women's significant contribution to achieving Sustainable Development Goal 2 (SDG-2)- Zero Hunger, this study investigates howaccess to resources, social support, and policy perceptions impact women's empowerment and food security. Methods: A total of 480 rural women from the southern part of Bangladesh were questioned, and their responses were analyzed using partial least squares structural equation modeling. Results: We found that access to resources, social support, and policy perceptions explain 74% of women's empowerment variance and women's empowerment explains 70% variance of women's food security. Access to resources and social support has significant positive impacts on women's empowerment. However, policy perceptions have a positive but not significant impact on women's empowerment. We also observed that women's empowerment significantly improved their food security. Practical implications: To empower women and improve their food security, the accessibility of resources and support from social networks must be improved. The study emphasizes the importance of strengthening the government's policies, which aim to improve the livelihood conditions of vulnerable people through regular monitoring to overcome underlying obstacles. Our study offers empirical data that policymakers can use to address complex food affordability and security challenges during global crises, enabling the achievement of SDG-2 in rural areas of Bangladesh and similar societies. [ABSTRACT FROM AUTHOR]

Abstract This paper investigates the impact of the COVID-19 pandemic on fertility intentions among families in the Rangpur region of Bangladesh, considering various socio-economic and demographic characteristics. The study aims to understand how the COVID-19 pandemic influenced fertility decisions, patterns, and how different contextual factors are relevant to explain those intentions. This study adopted a qualitative methodological approach, utilizing a non-probability purposive sampling procedure to select sixty-five rural women as participants who conceived babies during the COVID-19 pandemic and seven health care providers. Data were collected through semi-structured interviews and KII to explore the factors influencing intentional and unintentional childbirths during the pandemic. The findings revealed that, among the respondents, intentional childbirths were more prevalent than unintentional childbirths. The perceived causes of intentional childbirth in rural areas were pandemic-induced factors, demographic characteristics and societal practices to have a baby. The factors to unintentional childbirth were limited access to reproductive health care services and contraceptives, leading to unplanned pregnancies. Additionally, the study highlights that COVID-19 related economic and health conditions did not have a significant impact on fertility decisions in rural areas. Societal norms and attitudes towards family planning, childbearing and family size played key roles in determining birth intentions. Overall, the research emphasizes the need for targeted policies and initiatives to address the challenges of fertility planning during a health crisis.

Milk is considered an essential source of protein for people of all ages. However, Bangladeshi people, particularly those living in rural areas, tend to consume less milk and milk products than necessary. Therefore, this study aims to investigate the demand for milk and milk products among rural consumers and the factors affecting their consumption habits. The study utilizes balanced panel data from three waves of the Bangladesh Integrated Household Survey: 2011–12, 2015, and 2018–19, collected by the International Food Policy Research Institute. Both the Almost Ideal Demand System (AIDS) and Fixed Effects Model were employed. The expenditure elasticity for liquid milk, powdered milk, and condensed milk was found to be 1.013, 1.856, and 1.060, respectively, indicating that these products are considered luxury goods in rural Bangladesh. Additionally, powdered milk is more price-sensitive than liquid or condensed milk in these areas. Milk and milk products exhibit a substitutable relationship based on the Slutsky and Cournot cross-price elasticities matrix. Consumption of liquid milk is significantly influenced, either positively or negatively, by several factors, including age, education, family size, ownership of dairy animals, income, expense of food, and year. Furthermore, while the consumption of powdered milk is increasing over time, factors such as family size and livestock ownership negatively impact its consumption. Similarly, the consumption of condensed milk is negatively affected by education and ownership of dairy animals. Based on our study results, we recommend increasing household income through on and off-farm job creation, promoting educational campaigns on the benefits of milk, and supporting livestock ownership to reduce reliance on processed milk products.

Background Chewing betel quid (BQ) – a preparation commonly containing areca nut and slaked lime wrapped in betel leaf – is entrenched in South Asia. Although BQ consumption during pregnancy has been linked to adverse birth outcomes, its effect on postnatal growth remains largely unexplored. Objective We examined the associations of BQ use during pregnancy with children’s height-for-age and body mass index-for-age z-scores (HAZ and BAZ, respectively) and fat and fat-free mass along with sex-based differences in association in rural Bangladesh. Methods With a prospective cohort design, we assessed BQ use among mothers enrolled in the Preterm and Stillbirth Study, Matlab (n = 3140) with a structured questionnaire around early third trimester. Children born to a subset of 614 women (including 134 daily users) were invited to follow-up between October 2021 and January 2022. HAZ and BAZ were calculated from anthropometric assessment, and fat and fat-free mass were estimated using bioelectric impedance. Overall and sex-specific multiple linear regression models were fitted. Results Growth data were available for 501 children (mean age 4.9 years): 43.3% of them were born to non-users, 35.3% to those using prior to or less-than-daily during the survey, and 21.3% to daily users. No statistically significant associations were observed after adjusting for sex, parity, maternal height and education, and household wealth. Conclusions There was no effect of BQ use during pregnancy on postnatal growth in this study. Longitudinal studies following up those born to heavy users beyond childhood are warranted for capturing long-term implications of prenatal BQ exposure.

IntroductionWomen play an important role in maintaining household food security; unfortunately, their food security is frequently neglected. This type of phenomenon has become common in developing nations such as Bangladesh, particularly in its rural areas. The objective of this study is to investigate the variables that lead to the empowerment of rural women and its impact on their food security. In acknowledging women's significant contribution to achieving Sustainable Development Goal 2 (SDG-2)- Zero Hunger, this study investigates how access to resources, social support, and policy perceptions impact women's empowerment and food security.MethodsA total of 480 rural women from the southern part of Bangladesh were questioned, and their responses were analyzed using partial least squares structural equation modeling.ResultsWe found that access to resources, social support, and policy perceptions explain 74% of women's empowerment variance and women's empowerment explains 70% variance of women's food security. Access to resources and social support has significant positive impacts on women's empowerment. However, policy perceptions have a positive but not significant impact on women's empowerment. We also observed that women's empowerment significantly improved their food security.Practical implicationsTo empower women and improve their food security, the accessibility of resources and support from social networks must be improved. The study emphasizes the importance of strengthening the government's policies, which aim to improve the livelihood conditions of vulnerable people through regular monitoring to overcome underlying obstacles. Our study offers empirical data that policymakers can use to address complex food affordability and security challenges during global crises, enabling the achievement of SDG-2 in rural areas of Bangladesh and similar societies.

This paper explores the indispensable role of non-governmental organizations (NGOs) in cultivating, applying, and conserving Indigenous knowledge within rural Bangladesh. It scrutinizes how NGOs sustain Indigenous knowledge by focusing on pivotal sectors like agriculture, local medicine, and disaster management. Employing qualitative methodologies--such as ethnographic interviews, focus group discussions (FGD), and case studies--the research was conducted in the Gabura union, Bangladesh, using primary and secondary data sources. The literature review underscores the significance of Indigenous knowledge in agriculture and disaster management while identifying gaps in comprehending knowledge conservation dynamics and the NGO's impact on Indigenous knowledge. It highlights how locals employ Indigenous Knowledge to combat natural disasters, particularly in agriculture, healthcare, and disaster management. Furthermore, it explores NGOs' active roles in preserving and leveraging Indigenous Knowledge, emphasizing its integration with modern scientific knowledge and significance in rural life. The study delves into Gabura residents' strategies for cyclone resilience, such as seeking refuge on embankments, relocating to higher ground, and preserving seeds and dry food. It emphasizes NGOs like BARCIK and their initiatives--Paramela and Kaviraj Mela--along with resource person engagement and safeguarding local knowledge endangered by globalization. BARCIK's training in disaster management, advocacy for traditional agricultural methods, and promotion of indigenous remedies in healthcare are highlighted. Ultimately, the paper underscores NGOs' significant contributions to fostering and applying Indigenous knowledge for sustainable rural development. It emphasizes the institutional processes in defining knowledge and the NGO's role in its reproduction. [ABSTRACT FROM AUTHOR]

Apart from its medical concern, infertility bears significant socio-cultural consequences. This paper examines the social sufferings of infertile women, their fertility-seeking behavior, and the strategies adopted to cope-up with everyday social discrimination and stigmatization due to infertility. Drawing on ethnographic examples and qualitative research methods, this study has been conducted in three villages of Jessore and Satkhira districts of Southwestern Bangladesh. Findings of the study reveal that infertile women have various social sufferings, including but not limited to isolation, loneliness, fear of getting divorced, stigma, and domestic violence. Many infertile women live with their shotin, which is sometimes more difficult to adjust. Their everyday life becomes unbearable when in-laws and neighbors psychologically and physically abuse them. Infertility becomes a subject of social gossip, and infertile women are stereotypically identified as bajha, haatkhuri, and inauspicious. The social construction of fate or kopal is believed to be unavoidable in the context of explaining infertility. Their fertility-seeking behavior is mostly guided by the options available to them, such as pervasive use of kabiraji, homeopathy, and traditional healers. They, however, use their agency to overcome their stereotypical and stigmatized identities with their own efforts as well as supports from natal family members. [ABSTRACT FROM AUTHOR]

IntroductionCardiovascular diseases (CVDs) stand as the foremost contributor to global mortality, claiming roughly 17.9 million lives each year, constituting 32.1% of total fatalities. Their impact is notably profound in economies such as Bangladesh, exacting a substantial economic burden. Consequently, grasping the landscape of knowledge, attitudes, and practices is essential for timely identification and prevention strategies.MethodsThis cross-sectional study, carried out between January and May 2023 in the rural regions of Zirani, Savar Upazila, Dhaka, Bangladesh, utilized convenient sampling and conducted face-to-face interviews using a semi-structured questionnaire. It encompassed socio-demographic factors, as well as knowledge, attitudes, and practices concerning CVDs. Data analysis employed descriptive statistics, chi-square tests, and regression analyses, utilizing both the R programming language and SPSS (Version 26).ResultA total of 424 participants aged 60 years and above were included. The majority were male (60.8%), and the mean age was 71.21 ± 9.21 years, 57.3% were between 60 and 70 years old. Factors such as education, monthly family income, high blood pressure, diabetes, and non-smoking. Were significantly associated with higher knowledge, attitudes and practices scores.ConclusionThis study illuminates CVD-related KAP among rural Older Individuals in Bangladesh, revealing significant associations between factors such as education, monthly family income, high blood pressure, and non-smoking, with higher scores in knowledge, attitudes, and practices regarding cardiovascular health. These insights underscore the importance of addressing socio-economic factors and health behaviors in developing targeted interventions for the prevention and management of cardiovascular diseases in this demographic.

Abstract Bangladesh has made laudable progress in maternal and child health (MCH). Maternal and child mortalities have reduced substantially accompanied by stellar rise in immunization and contraceptive prevalence rate (CPR). However, such success is distributed unevenly throughout and the country is among one of the top ten countries with highest number of neonatal and under-five children mortalities. Rural Bangladesh is home to more than half of the country’s total population. Yet, disparity in access to healthcare services and information are overt in these areas. Utilization of maternal health services (MHS) is low whereas maternal and child mortalities are high in the rural areas. Thus, this cluster randomized cross sectional study was conducted with the aim to observe the practices that rural women followed in regards to maternal and child health and factors that affected these practices. Primary data was collected from 550 respondents using a structured questionnaire within the time period September—October 2019. All our participants were recently delivered women (RDW), defined in our study as women of reproductive age (15–49 years) who had delivered a child recently, i.e. 12 months prior (September 2018 – August 2019) the data collection. We conducted logistic regression and multivariate analysis to analyze data. Results from this study depict that while 96.3% of RDW opted for ANC visits and 99.1% fed colostrum to their newborn, fewer have had institutional deliveries and the number of RDW who had PNC was only 64.7%. Education was found to be the most prominent factor that affected practices employed by RDW. The more educated a respondent was, the greater the chance was of her engaging in appropriate maternal and child health practices. The RDW preferred and visited private facilities the most to obtain healthcare services with private medical doctors being one of the prime sources of healthcare information for the respondents. On the contrary, monthly expenditure exerted no statistically significant impact on the aforementioned practices. Thus, results of our study imply that interventions enhancing education and health knowledge of women and engaging private sector be designed for improving maternal and neonatal health care in rural areas of Bangladesh.

Enterprise risk management has become one of the crucial steps for households in attaining resilience in their livelihood decisions. However, households must prioritize diversifying their enterprises to effectively tackle the risk factors that propagate negative externalities (i.e., poverty) and obtain resilience in livelihood decisions. As such, this paper assesses households' risk management strategies considering the heterogeneities in the diversification levels in rural Bangladesh by harnessing data from 90 participating farm households from September 2016 to March 2017. We also explore the deterministic factors linked to diversification strategies. The findings of the multivariate regression analysis depict that education, occupation choice, asset portfolio, and family size are the significant determinants of a household's livelihood diversification choices. Shannon diversity index and livelihood typologies like ‘Type 66’ and ‘Type 75’ strategies have been used to assess household risk levels and family earning diversities. The overall diversity index (4.3) reveals that the respondents were moderately diversified. Typology studies confirm that the households in Ishwarganj and Haluaghat are more diversified (earning from multiple sources) than in Gouripur. For instance, under the ‘Type 75’ strategy, households in Ishwarganj earn 33% of the total income from crop-non-farm combined, and households in Haluaghat earn only 3% of their income solely from livestock. However, respondents in Gouripur earn most of their income from single sources (24% solely from crops under ‘Type 66’), and therefore, they are the least diversified and are most likely to be affected by risk. Moreover, FGT and Sen index outcomes of poverty show that BDT 4126 and 5776/year, respectively, are required to improve the poor status of the households where the poverty line is BDT 58,947.

ObjectivesDespite high levels of physical violence against children (VAC) globally (40–50%), the literature on the determinants of VAC remains inconclusive. Most of the literature on this topic is based on cross-sectional data, and the multi-level nature of the drivers of VAC is widely ignored. This leads to model specification problems and an inability to draw causal inferences. Moreover, despite the higher prevalence of VAC in low-and middle-income countries, studies from high income countries dominate the field. We examined the determinants of physical domestic VAC to address these gaps in the literature.MethodsData were collected between 2001 and 2020 from 762 mother–child dyads recruited in the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) study in Bangladesh. We conducted multi-level logistic regression analyses to identify the determinants of physical domestic VAC.ResultsPrevalence of physical domestic violence against girls (69%) and boys (62%) was extremely high. Community-level prevalence of physical domestic VAC increased the likelihood of physical domestic VAC at the individual level across gender (girls - OR-5.66; 95% CI- 3.11-10.32; boys - OR-7.67; CI- 3.95-14.91). While physical domestic violence against mothers was not associated with physical domestic violence against girls, it reduced the likelihood of such violence against boys by 47%. Having 3 or more siblings predicted physical domestic violence against girls (OR-1.97; 95% CI- 1.01-3.81 for 3 siblings; OR-4.58; 95% CI- 2.12-9.90 for 4 or more siblings), but not against boys. While girls in Hindu families were more likely to experience this violence, the boys were not. Mother’s education, employment non-governmental organization (NGO) participation and, household wealth did not predict this violence against any gender.ConclusionWe contend that physical domestic violence against mothers reflects an emphasized patriarchal culture in a family where a boy is less likely to experience physical domestic violence. Social norms and social learning theories explain the greater likelihood of a child experiencing physical domestic violence in a village with a higher level of such violence. We conclude that social norms around physical domestic VAC and patriarchal culture need to be changed to effectively address this violence.

Bangladesh has made laudable progress in maternal and child health (MCH). Maternal and child mortalities have reduced substantially accompanied by stellar rise in immunization and contraceptive prevalence rate (CPR). However, such success is distributed unevenly throughout and the country is among one of the top ten countries with highest number of neonatal and under-five children mortalities. Rural Bangladesh is home to more than half of the country's total population. Yet, disparity in access to healthcare services and information are overt in these areas. Utilization of maternal health services (MHS) is low whereas maternal and child mortalities are high in the rural areas. Thus, this cluster randomized cross sectional study was conducted with the aim to observe the practices that rural women followed in regards to maternal and child health and factors that affected these practices. Primary data was collected from 550 respondents using a structured questionnaire within the time period September—October 2019. All our participants were recently delivered women (RDW), defined in our study as women of reproductive age (15–49 years) who had delivered a child recently, i.e. 12 months prior (September 2018 – August 2019) the data collection. We conducted logistic regression and multivariate analysis to analyze data. Results from this study depict that while 96.3% of RDW opted for ANC visits and 99.1% fed colostrum to their newborn, fewer have had institutional deliveries and the number of RDW who had PNC was only 64.7%. Education was found to be the most prominent factor that affected practices employed by RDW. The more educated a respondent was, the greater the chance was of her engaging in appropriate maternal and child health practices. The RDW preferred and visited private facilities the most to obtain healthcare services with private medical doctors being one of the prime sources of healthcare information for the respondents. On the contrary, monthly expenditure exerted no statistically significant impact on the aforementioned practices. Thus, results of our study imply that interventions enhancing education and health knowledge of women and engaging private sector be designed for improving maternal and neonatal health care in rural areas of Bangladesh. [ABSTRACT FROM AUTHOR]

Background: Bangladesh has experienced growth in the older population in number and proportion, owing to a decline in fertility and mortality, and an increase in life expectancy. Older women in rural Bangladesh have considerably poorer health status than older men, because of women's' higher life expectancy and extreme vulnerability as a result of socioeconomic marginalization. Objectives: The purpose of the current study was to explore the morbidity patterns and healthcare-seeking behaviors, and their determinants, among older women in selected rural areas of the Bagerhat District in Bangladesh, and to provide recommendations for potential future interventions in this context. Material and Methods: A cross-sectional study was conducted at the household level. Data were collected from 233 randomly selected older women ≥ 60 years of age in three selected villages in the Bagerhat district in Bangladesh in November 2021. Univariate and bivariate analyses (Chi-squared test) were applied to explore morbidities and the associations of healthcare-seeking behaviors with various determinants. Multivariable logistic regression was applied to identify the associations between healthcare-seeking behavior and significant determinants extracted from the bivariate analysis. Results: Diabetes and liver diseases were the most common morbidities among older women. Multivariable logistic regression analysis indicated that education, living arrangement, size of the family, and morbidity patterns were significantly associated with seeking healthcare services among older women in rural Bangladesh (P ≤ 0.05). The rates of seeking healthcare services were higher among older women with primary and secondary education, those living with spouses and children, those residing in extended families with seven or more members, and older women with diabetes and liver diseases. Conclusion: On the basis of the findings, we suggest that the traditional extended family structure should be sustained, wherein older people are treated with care and respect, thereby promoting healthy aging in rural Bangladesh. Furthermore, family relationships should be strengthened, because older individuals, particularly older women, require emotional and familial support to lead healthy lives. Because gender roles, norms, and relationships influence people's exposure to disease, awareness programs regarding the prevalence of morbidities in old age, particularly among older women, should be expanded in rural areas to achieve Sustainable Development Goal 3. [ABSTRACT FROM AUTHOR]

Gender ideology has long been a discussed issue in the field of social science, particularly gender studies. This study aims to explore the category of people's gender ideology toward their family and societal responsibilities in rural Bangladesh. Following a mixed-methods approach, this study interviewed 400 rural people (200 men and 200 women, between 18 and 50 years) and conducted two FGDs from eight cluster villages at Paba Upazila of Rajshahi District in Bangladesh. The result shows that people were liberal in the context of household chores and decisions (strongly agreed to share taking care of an infant, housekeeping/cooking, and freedom of choice in taking matrimonial decisions) but traditional and transitional in acceptance of male privilege and preferences for female privilege respectively. This study argues that patriarchal adherence is reflected in people's gender ideology. Our study results suggest better awareness of rural people to transform their traditional gender ideology in the family and societal responsibilities in Bangladesh. These findings add new knowledge about the gender ideology of rural people and contribute as a prior field to promote liberal attitudes among both men and women in Bangladesh. [ABSTRACT FROM AUTHOR]

“Access” dimension of Food insecurity (FI) is directly measured by the Food Insecurity Experience Scale (FIES). The current study assessed the appropriateness of the FIES for measuring FI in rural Bangladesh, followed by an assessment of FI prevalence and its correlates utilizing Bangladesh Integrated Household Survey (BIHS) data. The internal validity of the FIES and the prevalence of FI were investigated using the Rasch modeling approach. We utilized equating procedure to calibrate the study’s result to the global FIES reference scale and determined FI prevalence rates that were comparable across countries. The external validity of the FIES was evaluated by examining its association with other FI measures using Spearman’s rho correlation analysis. With an overall Rasch reliability of 0.84, the FIES met the Rasch model assumptions of conditional independence and equal discrimination, and as well as the fit statistics standards for all eight items. Infit statistics were within the allowed limit for all FIES items indicating good internal validity. However, we noted a high outfit (>2) for the “unable to eat healthy and nutritious food” item indicating the presence of some unusual response patterns. Our analysis found no significant (>0.4) correlation between FIES items. We also found a significant correlation between FIES and other FI proxies, e.g., the Household hunger scale (HHS), Food consumption score (FCS), and Household dietary diversity score (HDDS). Overall, the prevalence of moderate or severe FI was 18.92% in rural Bangladesh. Geographic areas, access to electricity, household ownership, access to sanitation, livestock ownership, family size, education level, and monthly per capita food expenditure significantly explained the variation in FI. Our analyses suggest that the FIES is internally and externally valid for FI measurement in rural Bangladesh. However, FIES questions may need to be reordered to more accurately evaluate lower levels of FI, and the item “unable to eat healthy and nutritious food” may need cognitive testing.

Background: Minimizing raw salt and increasing fruit consumption are important factors for controlling blood pressure. The study aimed to investigate the following associations: (i) the association between socio-demographic characteristics and awareness of, and attitudes towards, raw salt and fruit consumption and (ii) the association between salt and fruit consumption and blood pressure. Methods: In a cluster-RCT, 307 adults, aged 30 to 75 years, with hypertension were recruited in 2021. Blood pressure was the primary outcome, and knowledge, attitudes and intakes of raw salt and fruit were secondary outcomes. Results: Of the participants, 271 (78.5%) consumed raw salt. More than 80% of the participants knew that reduced raw salt was good for controlling blood pressure and almost everyone knew that fruits and vegetables were good for health. Despite this, 95% of the participants had a habit of eating fruit irregularly. A lower proportion (64%) of the participants having at least a secondary school certificate (SSC) consumed raw salt, compared with those having an education level SSC (82%), p = 0.002. Blood pressure was not significantly different for participants, irrespective of raw salt or fruit consumption. Conclusions: Raw salt consumption among rural people was high and regular fruit consumption was deficient. They intended to reduce raw salt consumption. Appropriate intervention programs should be implemented to reduce salt consumption and increase fruit consumption. [ABSTRACT FROM AUTHOR]

Abstract Background This study examined the effect of linking small-scale women farmers to markets, referred to as community marketing, and homestead food production extension services in two districts of rural Bangladesh. Method We particularly focused on identifying the relationship between treatment and food security, monthly expenditure patterns, and food production and marketing by adopting a doubly robust method that mediated bias from project site selection and potential misspecification of the postulated outcome or treatment model. Results The main results showed that establishing community marketing sites along with extension services provided women farmers a secured marketing outlet for food production, plausibly associated with a decreased likelihood of a reduction in monthly expenditures on healthcare (12.7 percentage points), child education (19.4 percentage points), and transportation (51.5 percentage points) during the lean season. However, if farmers did not spend extra income generated from marketing on food purchases, it would be difficult to anticipate an improvement in food security. Conclusion Community marketing was devised to link women smallholders to the markets without conflicting with social and cultural norms for which women were responsive, and our research findings supported the claim that they benefited from community marketing participation. Therefore, government, NGO, or other extension providers looking for a culturally appropriate approach to address women farmers’ limited mobility may consider using or modifying community marketing.

The Department of Fisheries (DoF) has been working in Bangladesh to provide efficient and effective services using Identity (ID) Cards to all categories of fishermen who are involved in inland capture fisheries and marine fisheries. The fisherman ID card services are essential in ensuring the capacity for management, control, and surveillance to manage fisheries effectively and eradicate illegal fishing. To address this issue, we conducted a study to gauge the fishermen's satisfaction level with the services provided by fisherman identity cards. We conducted the study in two unions of Madarganj upazila (sub-district) under Jamalpur district. A Likert-type scale was used to identify the services the respondents mostly received. For each of the statements, they were asked to indicate whether they strongly agree, agree, disagree, strongly disagree with a corresponding score of 4, 3, 2, and 1, respectively. One hundred twenty fishermen were interviewed for data collection with a structured interview schedule in the selected unions from August 20 to September 22, 2022. The highest proportion of the respondents (86.68%) had a medium level of satisfaction, while 9.16% had a low and 4.16% had a high level of satisfaction regarding services provided through the fisherman ID card. Furthermore, providing rice during ban season, forming fishermen cooperative societies, and taking a lease of government open water bodies were the essential services received by the respondents using their ID cards. Among the selected characteristics of the fishermen, credit received, perceived economic return, extension media contact, organizational participation, and attitude towards extension service providers were identified as the influential factors affecting their level of satisfaction. As most of the fishermen had a medium level of satisfaction, concerned authorities should be more careful and take the initiative to make the services easier and more effective for the fishermen to maintain this current level of satisfaction. [ABSTRACT FROM AUTHOR]

Abstract Background The use of antihypertensive medications is critical for controlling high blood pressure. We aimed to investigate associations between socio-demographic factors and antihypertensive medications use, and antihypertensive medications use with different types of drugs use with levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods For the present report we derived data from the baseline measurements of a cluster randomised control trial on 307 participants with previously diagnosed hypertension from the rural district of Narial in Bangladesh. We measured the participant’s current blood pressure levels and recorded antihypertensive medications uses. Associated factors included socio-economic status, diabetes, antihypertensive medications use, and types of drugs and doses used for controlling blood pressure. We applied analysis of variance and logistic regression techniques to identify factors associated with blood pressure. Results Of the total participants, 144 (46.9%) were on antihypertensive medications. After multivariate adjustment, binary logistic regression revealed that employees (odds ratio, (95% confidence interval (CI)) (OR 3.58, 95%CI 1.38-9.28) compared to farmers, and people with diabetes (OR 2.43, 95%CI 1.13-5.26) compared to people without diabetes were associated with a higher proportion of antihypertensive medications use. Of 144 participants on antihypertensive medications, 7 (5%) had taken two doses, 114 (79%) had taken one dose per day and the rest were irregular in medication use. The mean (standard deviation) [min, max] SBP and DBP were 149 (19) mmHg [114, 217] and 90 (10) mmHg [75, 126], respectively. Overall, there was no significant difference in SBP (p = 0.10) or DBP (p = 0.67) between participants with or without antihypertensive medications or using any type of medications (p = 0.54 for SBP and 0.76 for DBP). There was no significant association between antihypertensive medications use and elevated BP levels SBP/DBP≥140/90 mmHg (p = 0.42) Conclusion Less than half of the people with hypertension were on medication. Irrespective of the antihypertensive medications use, most of the participant’s blood pressure was high. Further study is needed with a large sample to understand the factors and aetiology of unmanaged hypertension in rural areas of Bangladesh where the prevalence of hypertension is very high.

Poor households in rural Bangladesh often face concurring idiosyncratic and aggregate shocks, which have adverse impacts on their income and consumption. In this study, we investigate the transmission channels, coping responses, and economic consequences of different shocks including idiosyncratic adverse health events and aggregate agricultural productivity shocks. We use a balanced panel data of 5,655 rural households - interviewed every year between 2010 and 2013 - in northern Bangladesh. We estimate the effects of adverse health shocks on the consumption levels of poor households in a multi-shock framework. We take advantage of the panel data and use fixed effect models to control for unobserved household-level confounders and potential endogeneity. We further examine effects of shocks to agricultural wages on consumption using rainfall as an instrument. We further carry out a number of robustness checks to understand how sensitive our models are to different alternate specifications. Results indicate that households smooth their consumption after experiencing adverse health shocks, with and without the parallel incidence of other types of shocks. Consumption smoothing occurs despite households experiencing a significant decrease of wage income, which appears to be driven by an increase in informal loans from money lenders and households' social networks. To evaluate the effect of a different type of income shock on consumption, we use rainfall as an exogenous instrument for agricultural income. Results indicate that while higher rainfall leads to a significant increase in agricultural income, it does not translate to higher food expenditure for households. Together, these findings offer suggestive evidence that, in this setting, households appear to smooth food consumption in the face of income shocks. Poor households rely on formal and informal, potentially costly channels and exploit existing social networks to insure themselves against adverse shocks. The findings highlight the importance of developing a better framework to evaluate and implement more equitable social safety net policies. [ABSTRACT FROM AUTHOR]

Introduction: Bangladesh introduced professional midwives in 2018 to address gaps in sexual and reproductive health services, focusing on improved maternity care. Facility mentoring has been introduced in selected facilities within the government to enable midwives as they move into their new roles. Objectives: To describe a protocol (1) to determine if introducing international standard midwives in rural sub-district hospitals in Bangladesh, both with and without facility mentoring, improve the availability and quality of maternal and newborn health care compared to the facility without midwives; and (2) to explore the experiences of the midwives, and the maternity staff and managers that they joined, following their introduction. Methods: This will be a mixed-methods study to examine differences between selected hospitals grouped into three categories: without midwives (only nurses), with midwives, and both with midwives and mentorship. Hospital selection will be based on choosing those with the highest birth caseload. The quantitative component will consist of facility observations and clinical data extraction to assess their (hospital and midwives) readiness (birth preparedness and complication readiness) and clinical care to explore whether facilities with newly introduced midwives have improved availability and quality of care. We will use facility assessment tools to extract clinical data. In addition, we will use a structured open-ended interview guideline to conduct focus groups and in-depth interviews to understand the perceptions, attitudes, and experiences among maternity staff (e.g., nurses and paramedics) and health managers (e.g., facility manager, residential medical officer, consultants), as well as the midwives themselves toward the newly introduced midwives and the quality of care. We plan to use a fixed effect logistic regression to compare the relationship between variables in the three hospital types for each observed data point. For analyzing qualitative data, we will adopt content analysis and use NVivo to identify themes related to perceptions, attitudes, and experiences. Expected results: The introduction of professional midwives may improve the quality of maternal health care in rural settings. The addition of a mentoring program can support midwives in transitioning into their new roles and introduce improved care quality. [ABSTRACT FROM AUTHOR]

Abstract Background Malnutrition and depression are highly prevalent in older adults and can lead to disparaging outcomes. Analytical studies on geriatric depression (GD) and its association with malnutrition are very scarce in Bangladesh, although the size of the older population is increasing fast in the country. The current study aimed to assess the association between malnutrition and depression and associated risk factors in rural older adults. Methods A community-based comparative cross-sectional study was conducted in 600 older adult residents (aged ≥60 years) of three rural communities of Bangladesh from January to October 2019. The study enrolled two groups of participants; 300 depressed as cases and another 300 non-depressed older adults as a comparison group matching their age and living area. We used a semi-structured questionnaire to collect data through a face-to-face interview. Geriatric Depression Scale-15 was used to determine depression, and a score of ≥5 was considered as depressed. We used the Bangla version of the Mini-Nutritional Assessment-Short Form to assess nutritional status, which comprised questions related to appetite, weight loss, mobility, recent illness/stress, dementia/depression, and BMI, and considered a score of 0–7 as the cutoff score for malnutrition. Measures included baseline and personal characteristics, malnutrition, GD, and its associated risk factors. A binary logistic regression model was fitted to identify variables associated with the risk of GD. Results The study found no significant difference in gender (male Vs. female) between depressed (44.0% Vs. 56.0%) and non-depressed (46.0% Vs. 54.0%) older individuals. The study revealed that malnutrition was significantly (p

What kind of music teaching and learning takes place among folk musicians and young ones, aiming to reclaim their oral tradition and educate new master teachers? This question will be answered by drawing on extensive fieldwork at nine song-and-music schools in rural Bangladesh, applying critical realism as a meta-theory. An overall aim is to expand views on what music teaching and learning can be, with potential implications for education beyond rural Bangladesh. The empirical material was collected through a focus group interview with 12 students in an advanced class and in-depth interviews with these students and their three master teachers. The analysis shows that the generational transmission can be seen as based on the ‘four pillars’ of music pedagogy. These are re-described through dialectical critical realism in an abductive process, showing that music pedagogy can open an ontology and dialectic on being and becoming human for the participants. Results are discussed with absence and remembrance as key concepts. The study provides practical and philosophical insights into a music pedagogy about deep learning and resonance: towards transformative praxis.

COVID-19 pandemic has had a devastating effect on the global food production system. Large-scale food producing countries restricted exports for food sovereignty, while small and import-dependent countries are at risk. After COVID-19 pandemic, integrated and planned action is necessary to overcome this global stalemate. In this review paper, we have tried to show the damage caused to global agriculture as well as in Bangladesh due to COVID-19 pandemic. At the same time, the prospects and tasks of Bangladesh in the post-pandemic global economy have also been discussed. Due to the middlemen-based marketing system in Bangladesh, farmers have been deprived of their profits from the early period. The government should move forward with a long-term planning to find alternative food market such as processing and export alongside the one-way marketing system. On the other hand, it will benefit the farmers' community of Bangladesh, as well as ensure global food security after this pandemic. [ABSTRACT FROM AUTHOR]

Objective: Community day-care centers (or crèches) are gaining popularity; access to these centers can reduce cognitive gaps. This paper describes the sustained impact of enrollment in day-cares on cognitive gains. Methods: As part of a larger study, a census of all children was conducted in 2012–2013 to identify children between 9 and 17 months of age in rural Bangladesh. A sub-sample of children (n = ~1000) were assigned to receive either a day-care or playpen. Children from two sub-districts were randomly selected and assessed at 9–17 months of age for cognitive and behavioral domains using the Ages and Stages Questionnaire-III. The same children were then followed-up with after one year to see if the scores obtained by the children in the day-care intervention were different from those enrolled in the playpen intervention using a difference-in-difference estimator. Results: Children enrolled in the day-care intervention performed better (in communication, gross-motor, personal-social, and problem-solving domains) than children enrolled in the playpens when followed up with after a one-year period. Total scores were 0.31 (95% CI 0.141–0.472) higher (p value < 0.001) among children in the day-cares. Family care indicators as well as the child's and mother's weight were significantly associated with sustained and increased cognitive gains. Conclusion and relevance: The cognitive and psychosocial improvements seen with short-term exposure to structured ECD programs (day-care) were observed to be sustained over time with continued exposure. Home stimulation and parental involvement add to the long-term benefits of ECD. [ABSTRACT FROM AUTHOR]

Male labour migration can both empower and disempower non-migrating, or left behind, wives – contingent on further distinctions of rural–urban, nuclear-extended households and of class, religion and educational background. Migration catalyses transformations in the gender and religious norms in rural northern Bangladesh. It entrenches patriarchal norms and helps to reinforce the practices of 'modern' Islam – by creating the identity of 'respected' housewife, a woman who stays home, takes care of her in-laws and wears the burqà – that works within the codes of enhanced classic patriarchy. These patriarchal norms and practices dampen women's agency through patriarchal codes – constituted of the power relations between mothers-in-law and daughters-in-law, restrictions on the physical autonomy of women and women's dependency on their male kin. In-laws, and the assistance of natal kin, curtail women's decision-making power. This curtailment serves, ultimately, to sustain the power the in-laws and natal kin exercise over the women. [ABSTRACT FROM AUTHOR]

Background: Chewing betel quid (BQ) - a preparation commonly containing areca nut and slaked lime wrapped in betel leaf - is entrenched in South Asia. Although BQ consumption during pregnancy has been linked to adverse birth outcomes, its effect on postnatal growth remains largely unexplored., Objective: We examined the associations of BQ use during pregnancy with children's height-for-age and body mass index-for-age z-scores (HAZ and BAZ, respectively) and fat and fat-free mass along with sex-based differences in association in rural Bangladesh., Methods: With a prospective cohort design, we assessed BQ use among mothers enrolled in the Preterm and Stillbirth Study, Matlab ( n  = 3140) with a structured questionnaire around early third trimester. Children born to a subset of 614 women (including 134 daily users) were invited to follow-up between October 2021 and January 2022. HAZ and BAZ were calculated from anthropometric assessment, and fat and fat-free mass were estimated using bioelectric impedance. Overall and sex-specific multiple linear regression models were fitted., Results: Growth data were available for 501 children (mean age 4.9 years): 43.3% of them were born to non-users, 35.3% to those using prior to or less-than-daily during the survey, and 21.3% to daily users. No statistically significant associations were observed after adjusting for sex, parity, maternal height and education, and household wealth., Conclusions: There was no effect of BQ use during pregnancy on postnatal growth in this study. Longitudinal studies following up those born to heavy users beyond childhood are warranted for capturing long-term implications of prenatal BQ exposure.

Background: The use of antihypertensive medications is critical for controlling high blood pressure. We aimed to investigate associations between socio-demographic factors and antihypertensive medications use, and antihypertensive medications use with different types of drugs use with levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP).Methods: For the present report we derived data from the baseline measurements of a cluster randomised control trial on 307 participants with previously diagnosed hypertension from the rural district of Narial in Bangladesh. We measured the participant's current blood pressure levels and recorded antihypertensive medications uses. Associated factors included socio-economic status, diabetes, antihypertensive medications use, and types of drugs and doses used for controlling blood pressure. We applied analysis of variance and logistic regression techniques to identify factors associated with blood pressure.Results: Of the total participants, 144 (46.9%) were on antihypertensive medications. After multivariate adjustment, binary logistic regression revealed that employees (odds ratio, (95% confidence interval (CI)) (OR 3.58, 95%CI 1.38-9.28) compared to farmers, and people with diabetes (OR 2.43, 95%CI 1.13-5.26) compared to people without diabetes were associated with a higher proportion of antihypertensive medications use. Of 144 participants on antihypertensive medications, 7 (5%) had taken two doses, 114 (79%) had taken one dose per day and the rest were irregular in medication use. The mean (standard deviation) [min, max] SBP and DBP were 149 (19) mmHg [114, 217] and 90 (10) mmHg [75, 126], respectively. Overall, there was no significant difference in SBP (p = 0.10) or DBP (p = 0.67) between participants with or without antihypertensive medications or using any type of medications (p = 0.54 for SBP and 0.76 for DBP). There was no significant association between antihypertensive medications use and elevated BP levels SBP/DBP≥140/90 mmHg (p = 0.42) CONCLUSION: Less than half of the people with hypertension were on medication. Irrespective of the antihypertensive medications use, most of the participant's blood pressure was high. Further study is needed with a large sample to understand the factors and aetiology of unmanaged hypertension in rural areas of Bangladesh where the prevalence of hypertension is very high. [ABSTRACT FROM AUTHOR]

Energy usage disparity is burgeoning across the world. Therefore, biogas can be promising towards energy solution in bucolic regions of Bangladesh. Exploiting small-scale plants (3.45, 2.4, 2.7, 3 and 3.3 m3), this study elucidates the economic congruity of gasification through cost–benefit analysis. The estimated mean investment cost was BDT 39260/plant, whereas an average BDT of 8792.85 and 6856/year/plant return obtained from biogas and bio-fertiliser. All plants yielded positive net present value (NPV) in both 10% and 15% discount rates. Complacent internal rate of return (average 33.2%), positive benefit–cost ratio and lower PBP (average 2.5) debunk the feasibility of a capital-intensive investment like biogas. Sensitivity analysis elicits discount rate as the most sensitive and endorses inverse relationship between cost items and NPV. The average value of the biogas/plant is approximately tantamount to 1650 kWh electricity/year/plant which is sufficient for the energy demand of seven people. Therefore, this study espouses galvanising rural households to confide more on renewable energies like biogas.

Abstract Background This investigation aims to validate the psychometric properties of the modified 19-item Bengali version World Health Organization Quality of Life (WHOQOL) instrument in a typical healthy rural population in Bangladesh. Method The cross-sectional investigation collected 300 adults aged 18–85 years from Narail, a rural district of Bangladesh using a multi-stage cluster random sampling technique. Face-to-face interviews were conducted between July and August 2018 using an Android phone installed with a mobile data collection application CommCare. SPSS version 25; IBM. and a Rasch analysis software RUMM2030 were used for analyses. Results Results showed good overall fit, as indicated by a significant item-trait interaction with Bonferroni corrected p values, for physical ( χ 20 2 $$ {\upchi}_{(20)}^2 $$ =32.13, p = 0.041), psychological ( χ 16 2 $$ {\upchi}_{(16)}^2 $$ =14.93, p = 0.529), social ( χ 16 2 $$ {\upchi}_{(16)}^2 $$ =12.62, p = 0.397), and environmental ( χ 20 2 $$ {\upchi}_{(20)}^2 $$ =22.01, p = 0.339) domains. Item fit residual (IFR) values for all domains were within the desired limits, indicating no deviation from the expected relationship between the individual items and the rest of the items of the scale. Person fit residual (PFR) values also showed no person misfit among the samples, indicating item threshold are suitable for Rasch analysis. Reliability of the three domains of the 19-item WHOQOL scale was very good as indicated by a person separation index (PSI) = 0.873 and Cronbach’s Alpha (CA) = 0.881 for physical domain, PSI = 0.739 and CA = 0.746 for psychological domain, and PSI = 0.753 and CA = 0.781 for environmental domain. The social domain (PSI = 0.650 and CA = 0.669) had below acceptable reliability. All items in each domain had ordered thresholds except one item of the environmental domain. All four domains of the 19-item WHOQOL scale showed unidimensionality and was free from local dependency. Each domain also showed similar functioning for adults and older adults, males and females, no education and at least primary level of education, low and high socio-economic conditions. Conclusion The 19-item modified WHOQOL scale is confirmed as an efficient screening tool for measuring QoL among healthy rural Bangladeshi people. The scale could be implemented more widely. In particular, validations are required for diseases-specific population in Bangladesh to measure the Health Related Quality of life (HR-QoL) assessments for people suffering from chronic or other diseases.

Background: Minimizing raw salt and increasing fruit consumption are important factors for controlling blood pressure. The study aimed to investigate the following associations: (i) the association between socio-demographic characteristics and awareness of, and attitudes towards, raw salt and fruit consumption and (ii) the association between salt and fruit consumption and blood pressure. Methods: In a cluster-RCT, 307 adults, aged 30 to 75 years, with hypertension were recruited in 2021. Blood pressure was the primary outcome, and knowledge, attitudes and intakes of raw salt and fruit were secondary outcomes. Results: Of the participants, 271 (78.5%) consumed raw salt. More than 80% of the participants knew that reduced raw salt was good for controlling blood pressure and almost everyone knew that fruits and vegetables were good for health. Despite this, 95% of the participants had a habit of eating fruit irregularly. A lower proportion (64%) of the participants having at least a secondary school certificate (SSC) consumed raw salt, compared with those having an education level SSC (82%), p = 0.002. Blood pressure was not significantly different for participants, irrespective of raw salt or fruit consumption. Conclusions: Raw salt consumption among rural people was high and regular fruit consumption was deficient. They intended to reduce raw salt consumption. Appropriate intervention programs should be implemented to reduce salt consumption and increase fruit consumption.

Background: Malnutrition and depression are highly prevalent in older adults and can lead to disparaging outcomes. Analytical studies on geriatric depression (GD) and its association with malnutrition are very scarce in Bangladesh, although the size of the older population is increasing fast in the country. The current study aimed to assess the association between malnutrition and depression and associated risk factors in rural older adults.Methods: A community-based comparative cross-sectional study was conducted in 600 older adult residents (aged ≥60 years) of three rural communities of Bangladesh from January to October 2019. The study enrolled two groups of participants; 300 depressed as cases and another 300 non-depressed older adults as a comparison group matching their age and living area. We used a semi-structured questionnaire to collect data through a face-to-face interview. Geriatric Depression Scale-15 was used to determine depression, and a score of ≥5 was considered as depressed. We used the Bangla version of the Mini-Nutritional Assessment-Short Form to assess nutritional status, which comprised questions related to appetite, weight loss, mobility, recent illness/stress, dementia/depression, and BMI, and considered a score of 0-7 as the cutoff score for malnutrition. Measures included baseline and personal characteristics, malnutrition, GD, and its associated risk factors. A binary logistic regression model was fitted to identify variables associated with the risk of GD.Results: The study found no significant difference in gender (male Vs. female) between depressed (44.0% Vs. 56.0%) and non-depressed (46.0% Vs. 54.0%) older individuals. The study revealed that malnutrition was significantly (p < 0.01) higher in depressed (56.0%) than in non-depressed (18.0%) rural older adults. The malnourished older adults had around three times (AOR = 3.155; 95% CI: 1.53-6.49, p = 0.002) more risk of having depression than the well-nourished older individuals. Older adults who were unemployed (AOR = 4.964; 95% CI: 2.361-10.440; p = 0.0001) and from lower and middle class (AOR = 3.654; 95% CI: 2.266-7.767; p = 0.001) were more likely to experience depression. Older adults having a 'poor diet' were more likely to experience depression (AOR = 3.384; 95% CI: 1.764-6.703; p = 0.0001). The rural older adults who were single (AOR = 2.368; 95% CI: 1.762-6.524; p = 0.001) and tobacco users (AOR = 2.332; 95% CI: 1.663-5.623; p = 0.003) were found more likely to experience depression.Conclusions: A significant association between malnutrition and depression was evident by the current study in the rural older individuals of Bangladesh. It will be a prolific initiative if policymakers merge malnutrition and the risk factors associated with geriatric depression in providing universal health care for better health and well-being of the rural older populations. [ABSTRACT FROM AUTHOR]

Introduction: Bangladesh introduced professional midwives in 2018 to address gaps in sexual and reproductive health services, focusing on improved maternity care. Facility mentoring has been introduced in selected facilities within the government to enable midwives as they move into their new roles. Objectives: To describe a protocol (1) to determine if introducing international standard midwives in rural sub-district hospitals in Bangladesh, both with and without facility mentoring, improve the availability and quality of maternal and newborn health care compared to the facility without midwives; and (2) to explore the experiences of the midwives, and the maternity staff and managers that they joined, following their introduction. Methods: This will be a mixed-methods study to examine differences between selected hospitals grouped into three categories: without midwives (only nurses), with midwives, and both with midwives and mentorship. Hospital selection will be based on choosing those with the highest birth caseload. The quantitative component will consist of facility observations and clinical data extraction to assess their (hospital and midwives) readiness (birth preparedness and complication readiness) and clinical care to explore whether facilities with newly introduced midwives have improved availability and quality of care. We will use facility assessment tools to extract clinical data. In addition, we will use a structured open-ended interview guideline to conduct focus groups and in-depth interviews to understand the perceptions, attitudes, and experiences among maternity staff (e.g., nurses and paramedics) and health managers (e.g., facility manager, residential medical officer, consultants), as well as the midwives themselves toward the newly introduced midwives and the quality of care. We plan to use a fixed effect logistic regression to compare the relationship between variables in the three hospital types for each observed data point. For analyzing qualitative data, we will adopt content analysis and use NVivo to identify themes related to perceptions, attitudes, and experiences. Expected results: The introduction of professional midwives may improve the quality of maternal health care in rural settings. The addition of a mentoring program can support midwives in transitioning into their new roles and introduce improved care quality.

Gender ideology has widely been discussed in the explanation of wife abuse. However, how men's gender ideology influences wife abuse is quite overlooked in Bangladeshi context. This study examined how various types of gender ideology among men are associated with wife abuse in Bangladesh. It included 342 married men randomly selected from 5 villages. Negative binomial regression was employed to predict the incidence‐rate ratio of wife abuse. Of the sample, 55.0% maintained traditional, 31.3% transitional, and 13.7% liberal gender ideologies. On average, the men perpetrated 6.10 abusive acts in a year. Data showed that the rates of overall wife abuse among liberal men were 41% and 48% lower than the traditional and transitional men, respectively. Liberal men also perpetrated less emotional, physical, and sexual abuses than both traditional and transitional men. The study shows that the promotion of liberal gender ideology among men is important for preventing wife abuse. Men should be targeted by diverse violence prevention interventions for enhancing gender equality attitudes. Though the study has provided novel findings in a Bangladeshi context, it was entirely based on male data. Future studies should examine both men's and women's views on the issues. [ABSTRACT FROM AUTHOR]

While relative resource status between husband and wife is widely discussed in the explanation of male marital violence (MMV) behaviors, the influence of relative family authority between husband and wife on the violence has been generally overlooked in previous studies. An examination can provide a better understanding of the issue. This study examined how various levels of female authority within the family are associated with MMV against women in rural Bangladesh. The study adopted a cross-sectional design and included 342 married men randomly selected from five northwest villages. Negative binomial regression was performed to predict the frequency of self-reported MMV behaviors in a 1-year recall period which estimated the ratios comparing absolute male authority to egalitarian authority within the family. Of the sample, 37.4% were the egalitarian/fair female authority, 41.2% were the higher male authority, and 21.4% were absolute male authority families; 71.1% of the men revealed that they had resorted to at least one incident of MMV (psychological or physical or sexual) against their wives in the year preceding the survey. The mean of yearly MMV occurrences was 6.29 (SD = 7.58), ranging from 0 to 42. The study revealed that the frequency of MMV against women was 1.96 times higher among absolute male authority families than in egalitarian families. It further revealed that the frequency of psychological abuse was 1.63 times, physical attack 2.89 times, and sexual coercion 1.88 times higher among absolute male authority families than among egalitarian/fair female authority families. Higher male authority did not appear to be different from egalitarian authority in MMV occurrences. The study suggests that increased female authority within the family unit may prevent women from being exposed to MMV in a patriarchal social order. [ABSTRACT FROM AUTHOR]

Abstract Background To assess the level of awareness, knowledge and help-seeking attitudes and behaviours in relation to mental health conditions (MHCs) and associations with socio-demographic characteristics of a rural district of Bangladesh. Methods We recruited 2425 adult samples (18–90 years) from a Cross-sectional study in Narial district of Bangladesh. Data on awareness, knowledge, help-seeking attitudes and practice in relation to six MHCs were collected. The MHCs were classified as common (depression, anxiety and drug addiction), and severe (psychosis, dementia and bipolar disorder). Associations of MHCs with socio-demographic characteristics were assessed using Chi-square tests. Rasch analysis was performed to transform the latent attribute (awareness) of MHCs from ordinal to interval scale. Multiple regression analysis was performed to determine how the socio-demographic characteristics contribute to the combined awareness score of MHCs. Results Of 2425 participants, 17 (0.7%) were cognizant of all the awareness construct of MHCs, and 1365 (56.28%) were not aware of any of MHCs. The prevalence of awareness of MHCs such as depression (8.5%), anxiety (6.2%), psychosis (3.5%), and bipolar disorder (3.3%), was found to be very low. Awareness was significantly lower in older adults, and in women. Higher levels of education (β 1.77, 95% confidence interval (CI): 1.58–1.97) associated with common MHCs and (β 0.81, 95% CI: 0.67–0.95) those associated with severe MHCs contributed significantly to increased awareness as opposed to having no or primary level of education. Availability of sufficient funds when applied to common MHCs (β 0.43, 95% CI: 0.26–0.61) and severe MHCs (β 0.25, 95% CI: 0.13–0.38) appeared to be more effective in boosting awareness compared to unstable financial situations. Almost 100% of the participants who were aware of the MHCs demonstrated positive attitudes towards seeking medical or psychological counselling. Conclusions Awareness of MHCs appeared to be very limited. However, knowledgeable participants were found to be very receptive to medical or psychological counselling. For improving awareness of MHCs need to conduct various intervention programs in particular those campaigns that focus on women, older adults, low SES and people up to the primary levels of education.

Background: Cholera is a considerable health burden in developing country settings including Bangladesh. The oral cholera vaccine (OCV) is a preventative tool to control the disease. The objective of this study was to describe whether the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), could provide the OCV to rural communities using existing government infrastructure. Methods: The study was conducted in rural sub-district Keraniganj, 20 km from the capital city Dhaka. All listed participants one year and above in age (excluding pregnant women) were offered two doses of OCV at a 14 day interval. Existing government facilities were used to deliver and also maintain the cold chain required for the vaccine. All events related to vaccination were recorded at the 17 vaccination sites to evaluate the coverage and feasibility of OCV program. Results: A total of 29,029 individuals received the 1st dose (90% of target) and 26,611 individuals received the 2nd dose (83% of target and 92% of 1st dose individuals) of OCV. The highest vaccination coverage was in younger children (1–9 years) and the lowest was amongst 18–29-year age group. Somewhat better coverage was seen amongst the female participants than males (92% vs. 88% for the 1st dose and 93% vs. 90% for the 2nd dose). The cost of vaccine cost was calculated as US$1.00 per dose plus freight, insurance, and transportation and the total vaccine delivery cost was US$70,957. Conclusion: This was a project undertaken using existing public health program resources to collect empirical evidence on the use of a mass OCV campaign in the rural setting. Mass vaccination with the OCV is feasible in the rural setting using existing governmental vaccine delivery systems in Bangladesh.

Abstract Background This study aimed to validate the psychometric properties of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire for use in a rural district of Bangladesh. Methods This cross-sectional study recruited a multi-stage cluster random sample of 2425 participants from the rural district Narail of Bangladesh in May–July 2017. Rasch analysis was carried out using the sampled participants, as well as multiple validation random sub-samples of 300 participants, to validate four domains of the WHOQOL-BREF questionnaire: physical, psychological, social and environmental. Results The original WHOQOL-BREF appeared to be a poor fit for both sampled and sub-sampled group of participants in Narail district in all underlying domains: physical, psychological, social and environmental. Two items (sleep and work capacity) from the physical domain, two items (personal belief and negative feelings) from the psychological domain and three items (home environment, health care and transport) from the environment domain were excluded for goodness of fit of the Rasch model. The social domain exhibited reasonably reliable fitness while fulfilling all the assumptions of the Rasch model. A modified version of the WHOQOL-BREF questionnaire using five-items for the physical ( χ202 $$ {\upchi}_{(20)}^2 $$ = 36.47, p = 0.013, Person Separation Index (PSI) = 0.773), four-items for the psychological ( χ162 $$ {\upchi}_{(16)}^2 $$ = 28.30, p = 0.029, PSI = 0.708) and five-items for the environmental ( χ202 $$ {\upchi}_{(20)}^2 $$ = 36.97, p = 0.011, PSI = 0.804) domain was applied, which showed adequate internal consistency, reliability, unidimensionality, and similar functioning for different age-sex distributions. Conclusions The modified WHOQOL-BREF questionnaire translated into Bengali language appeared to be a valid tool for measuring quality of life in a typical rural district in Bangladesh. Despite some limitations of the modified WHOQOL-BREF questionnaire, further application of Rasch analysis using this version or an improved one in other representative rural areas of Bangladesh is recommended to assess the external validity of the outcomes of this study and to determine the efficacy of this tool to measure the quality of life at the national rural level.