High-resolution mapping of reproductive tract infections among women of childbearing age in Bangladesh: a spatial-temporal analysis of the demographic and health survey.

BACKGROUND: Reproductive tract infections (RTIs) have become major but silent public health problems devastating women's lives in Bangladesh. Accurately and precisely identifying high-risk areas of RTIs through high-resolution risk maps is meaningful for resource-limited settings. METHODS: We obtained data reported with RTI symptoms by women of childbearing age in the years 2007, 2011 and 2014 from Bangladesh Demographic and Health Survey. High-spatial Environmental, socio-economic and demographic layers were downloaded from different open-access data sources. We applied Bayesian spatial-temporal models to identify important influencing factors and to estimate the infection risk at 5 km spatial resolution across survey years in Bangladesh. RESULTS: We estimated that in Bangladesh, there were approximate 11.1% (95% Bayesian credible interval, BCI: 10.5-11.7%), 13.9% (95% BCI: 13.3-14.5%) and 13.4% (95% BCI: 12.8-14.0%) of women of childbearing age reported with RTI symptoms in 2007, 2011 and 2014, respectively. The risk of most areas shows an obvious increase from 2007 to 2011, then became stable between 2011 and 2014. High risk areas were identified in the southern coastal areas, the western Rajshahi Division, the middle of Khulna Division, and the southwestern Chittagong Division in 2014. The prevalence of Rajshahi and Nawabganj District were increasing during all the survey years. CONCLUSION: The high-resolution risk maps of RTIs we produced can guide the control strategies targeted to priority areas cost-effectively. More than one eighth of women of childbearing age reported symptoms suggesting RTIs and the risk of RTIs varies in different geographical area, urging the government to pay more attention to the worrying situation of female RTIs in the country.

Effects of winter chilling vs. spring forcing on the spring phenology of trees in a cold region and a warmer reference region.

Regions at high latitudes and high altitudes are undergoing a more pronounced winter warming than spring warming, and such asymmetric warming will affect chilling and forcing processes and thus the spring phenology of plants. We analyzed winter chilling and spring forcing accumulation in relation to the spring phenology of three tree species (Ulmus pumila, Populus simonii, and Syringa oblata) growing in a cold region (CR) compared with trees in a warmer reference region (WR), using the Dynamic Model and the Growing Degree Hour (GDH) model. We tested that forcing rather than chilling affects the spring phenology of trees in CR (hypothesis I), and that trees in CR have both lower mean chilling and forcing temperature and thus longer accumulation periods than trees in WR (hypothesis II). The modeling results confirmed that chilling and forcing occur simultaneously during the early spring when temperature gradually increases. In line with our hypotheses, forcing played a crucial role in spring phenology in CR, but chilling and forcing combined to determine spring phenology in WR. The temperature during the chilling and forcing periods was lower and the accumulation period started earlier and ended later in CR than in WR. Moreover, the chilling accumulation was broken into two periods by the low deep winter temperature in CR, and that interruption will be removed by future strong winter warming. Future asymmetric warming, with a stronger temperature increase in winter than in spring, could decrease the forcing accumulation effects and increase the chilling effects on the spring phenology of plants in CR. This change in the balance between chilling and forcing will lead to a shift in plant phenology, which will further have major impacts on biogeochemical cycles and on ecosystem functions and services.