Pattern and predictors of non-adherence to diabetes self-management recommendations among patients in peripheral district of Bangladesh.

OBJECTIVES: This study was designed to determine the extent of non-adherence to the different dimensions of diabetes self-management and to identify the factors influencing non-adherence among peripheral patients in Bangladesh. METHODS: A cross-sectional study was conducted among 990 adult diabetic patients residing in Thakurgaon district, Bangladesh. Data were collected through face-to-face interviews including socio-demographic information, disease and therapeutic, health services, knowledge and adherence to self-management components. RESULTS: The proportion of non-adherence to drug prescription was 66.7%, dietary regimen (68.9%), physical exercise (58.0%), follow-up visit/blood glucose test (88.2%), stopping tobacco (50.6%), and regular foot care (93.9%). Significant predictors for non-adherence to drug were poorest socio-economic status (OR = 2.47), absence of diabetic complications (OR = 1.43), using non-clinical therapy (OR = 5.61), and moderate level of knowledge (OR = 1.87). Non-adherence to dietary recommendations was higher for women (OR = 1.72), poorest socio-economic status (OR = 3.17), and poor technical knowledge (OR = 4.68). Non-adherence to physical exercise was lower for women (OR = 0.62), combined family (OR = 0.63), middle socio-economic status (OR = 0.54), and moderate knowledge on physical exercise (OR = 0.55). Non-adherence to follow-up visits/blood glucose test was higher among patients who did not have diabetic complications (OR = 1.81) and with own transport (OR = 2.57), and respondents from high-income group (OR = 0.23) were less likely to be non-adherent. Non-adherence to stopping tobacco was higher for older individuals (OR = 1.86); but lower for women (OR = 0.48), individuals with higher education level (OR = 0.17) and patients sick for a longer time (OR = 0.52). Non-adherence to foot care was higher for patients who needed longer time to go to hospital (OR = 4.07) and had poor basic knowledge on diabetes (OR = 17.80). CONCLUSION: An alarmingly high proportion of diabetic patients did not adhere to diabetes self-management. Major predictors for non-adherence were related to patient's demographic characteristics and their experience with disease, treatment and health care services.

Exploring the factors contributing to increase in facility child births in Bangladesh between 2004 and 2017-2018.

Background: Although Bangladesh has gained rapid improvement in births at health facilities, yet far behind to achieve the SDG target. Assessing the contribution of factors in increased use of delivery at facilities are important to demonstrate. Objective: To explore the determinants and their contribution in explaining increased use of facility child births in Bangladesh. Participants: Reproductive-aged women (15-49 years) of Bangladesh. Methods and materials: We used the latest five rounds (2004, 2007, 2011, 2014, 2017-2018) of Bangladesh Demographic and Health Surveys (BDHSs). The regression based classical decomposition approach has been used to explore the determinants and their contribution in explaining the increased use of facility child birth. Results: A sample of 26,686 reproductive-aged women were included in the analysis, 32.90% (8780) from the urban and 67.10% (17,906) from the rural area. We observed a 2.4-fold increase in delivery at facilities from 2004 to 2017-2018, in rural areas it is more than three times higher than the urban areas. The change in mean delivery at facilities is about 1.8 whereas, the predicted change is 1.4. In our full sample model antenatal care visits contribute the largest predicted change of 22.3%, wealth and education contributes 17.3% and 15.3% respectively. For the rural area health indicator (prenatal doctor visit) is the largest drivers contributing 42.7% of the predicted change, hereafter education, demography and wealth. However, in urban area education and health contributed equally 32.0% of the change followed by demography (26.3%) and wealth (9.7%). Demographic variables (maternal BMI, birth order, age at marriage) contributing more than two-thirds (41.2%) of the predicted change in the model without the health variables. All models showed more than 60.0% predictive power. Conclusion: Health sector interventions should focus both coverage and quality of maternal health care services to sustain steady improvements in child birth facilities.

Contribution of sociodemographic determinants in explaining the nutritional gap between the richest-poorest women of Bangladesh: A decomposition approach.

BACKGROUND: Malnutrition among women disproportionately exists across socioeconomic classes of Bangladesh. According to our knowledge, studies which attempted to identify determinants and their contributions to explain BMI-based nutritional gap between the poorest and the richest categories of Wealth Index are still scarce. OBJECTIVES: To identify the nutritional gap of women between the richest-poorest classes in Bangladesh, and to determine how much of this gap are attributed to differences in predictors and differences in coefficients. STUDY POPULATION: Reproductive-aged (15-49 years) women of Bangladesh. METHODS AND PROCEDURES: We utilized the latest round (2017-2018) data of the Bangladesh Demographic and Health Survey (BDHS). Body mass index (BMI) has been used to measure the nutritional status of women. The kernel density was used to visualize the nutritional gap. The Oaxaca-Blinder (OB) decomposition method was used to ascertain influential determinants and their contributions to the existing gap between the richest-poorest classes of women. RESULTS: We analyzed the data of 18,682 reproductive-aged women. There was a significant mean BMI gap of 4.1 unit (95% CI: 3.90-4.35) between the poorest-richest (25.6 vs 21.5) women. The overall prevalence of underweight, overweight and obese were 11.8%, 33.8% and 15.4%, respectively. The richest women were less underweight (7.5%) but more overweight (23.7%) and obese (42.2%). In contrast, the poorest women were more underweight (32.0%) but less overweight (13.9%) and obese (7.0%). According to results of OB decomposition method, all predictors combinedly can explain 1.62 units (95% CI: 1.31-1.93) of the total mean BMI gap (equivalent to 40%). Some of the major predictors were women years of education (0.45 units, 95% CI: 0.27-0.64), spouse years of education (0.16 units, 95% CI: -0.02-0.34), current working status (0.17 units, 95% CI: 0.10-0.34), access to Television (0.50 units, 95% CI: 0.28-0.72), and place of residence (0.37 units, 95% CI: 0.22-0.72). The unexplained part of the poorest-richest gap was 2.51 units (95% CI: 2.13-2.89), which means that this particular gap will remain unchanged even though the mean difference of the predictors was diminished. CONCLUSIONS: A large part of the nutritional gap (approximately 60%) between the poorest and richest classes of women are found to be unchanged by the predictors of the study. Therefore, further predictors should be identified to minimize such gap. Moreover, policy makers and relevant stakeholders should implement feasible strategies to minimize the existing differences in the major predictors.

COVID-19: Marking the Gaps in Migrant and Refugee Health in Some Massive Migration Areas.

The health of migrants and refugees, which has long been a cause for concern, has come under greatly increased pressure in the last decade. Against a background where the world has witnessed the largest numbers of migrants in history, the advent of the COVID-19 pandemic has stretched the capacities of countries and of aid, health and relief organizations, from global to local levels, to meet the human rights and pressing needs of migrants and refugees for access to health care and to public health measures needed to protect them from the pandemic. The overview in this article of the situation in examples of middle-income countries that have hosted mass migration in recent years has drawn on information from summaries presented in an M8 Alliance Expert Meeting, from peer-reviewed literature and from reports from international agencies concerned with the status and health of migrants and refugees. The multi-factor approach developed here draws on perspectives from structural factors (including rights, governance, policies and practices), health determinants (including economic, environmental, social and political, as well as migration itself as a determinant) and the human security framework (defined as "freedom from want and fear and freedom to live in dignity" and incorporating the interactive dimensions of health, food, environmental, economic, personal, community and political security). These integrate as a multi-component 'ecological perspective' to examine the legal status, health rights and access to health care and other services of migrants and refugees, to mark gap areas and to consider the implications for improving health security both for them and for the communities in countries in which they reside or through which they transit.

Risk factors for early childhood disability in Bangladesh: Evidence from Multiple Indicator Cluster Survey 2019.

INTRODUCTION: Early childhood is a vital part of human life because most of the brain developments occur in this particular period. Early childhood disability is a significant global public health burden, which can negatively impact the children's quality of life and their overall productivity. It is also a major social and economic problem in Bangladesh. Therefore, it is very important to understand the associated factors for early childhood disability, which may help disability prevention, better management and policy formulation. The main objective of this study is to investigate the child, family, and community-level factors associated with early childhood disability in Bangladesh. METHODS: A cross sectional nationally representative data was derived from Multiple Indicator Cluster Survey (MICS), 2019. A total of 14,072 Bangladeshi children under five years of age were selected for this study. Various types of statistical analysis (simple, bivariate, multivariable) were performed. To assess the bivariate relationship between chosen categorical variables (independent) and early childhood disability (dependent), a chi-square test was used. The multivariable ordinal logistic regression was used to find out the association of disability with child, family, and community-level factors. RESULTS: The results show that 2.0% of the children have at least one disability and 0.8% have more disabilities. Several factors namely not attending in early childhood education [Odds Ratio (OR) = 0.65; 95% confidence interval (CI) = 0.13-1.17 Ρ = 0.01], having mother's functional difficulty (OR = 1.23; 95% (CI) = 0.58-1.88 Ρ <0.001), unhappy mother's life (OR = 0.85; 95% CI = 0.30-1.39 Ρ <0.001), parents without internet access (OR = 0.68; 95% CI = 0.06-1.29 Ρ = 0.03) and parents using mobile phone (OR = 0.52; 95% CI = 0.09-0.95 Ρ = 0.02) were found to be important for early childhood disability in Bangladesh. CONCLUSION: Early childhood disability is still neglected in Bangladesh and further epidemiological studies are recommended. The findings of this study may help policy makers and relevant stakeholders to develop interventions for reducing the overall burden of early childhood disability.

Prevalence and risk factors of childhood anemia in Nepal: A multilevel analysis.

INTRODUCTION: Anemia is a common problem in children particularly in developing countries and taking steps to tackle it is one of the major public health challenges for Nepal. The objective of this study is to investigate the prevalence of individual, household and community level determinants of childhood anemia in Nepal. METHODS: Data was taken from a nationally representative sample of 1,942 Nepalese children aged from 6-59 months. The Chi-square test was used to determine the bivariate relationship between the selected variables and childhood anemia and a multilevel logistic regression model with a random intercept at household and community level was used to identify important determinants of this kind of anemia. RESULTS: The results showed that 52.6% (95% CI: 49.8%-55.4%) of the children were anemic while 26.6% (95% CI: 24.0%-29.3%) of them were moderate to severe. The prevalence of overall anemia was higher among children aged less than 11 months as well as in underweight children, children of underweight, anemic and uneducated mothers and those in the terrain ecological regions. Multivariable analysis showed that children aged less than 11 months, who were underweight and had anemic mothers were more likely to have moderate or severe anemia. Children in the hilly ecological region were less likely to have it compared to mountain and terrain ecological regions. Children in middle-class families and children of mothers who completed secondary education were more likely to have anemia. CONCLUSION: Nepal is facing a serious public health problem due to the high prevalence of childhood anemia. This adverse situation occurs due to socio-demographic and geographical factors such as age, malnutrition status, mother's anemia status, socio-economic status and regional variations. Prevention of childhood anemia should be given top priority in Nepal and should be considered as a major public health intervention.

Levels and determinants of complementary feeding based on meal frequency among children of 6 to 23 months in Bangladesh.

BACKGROUND: Information concerning complementary feeding (CF) practice during infancy and early childhood is still scarce in Bangladesh. Therefore, this study aimed to estimate the level of CF among children of 6-23 months and identify individual, household and community level determinants in Bangladesh. METHODS: Secondary data from the Bangladesh Demographic Health Survey (BDHS) 2011 was used. A total of 2,373 children aged 6-23 months were selected. A simplified index called "dimension index" was used to estimate the level of CF. The score of this index was used either as continuous or categorical dependent variables. The highest score based on dimension index is associated to an adequate CF. Statistical analyses and tests were guided by types of variables. Finally, multivariable logistic regression (binary and multinomial) analyses were performed to identify the significant determinants of CF. RESULTS: The overall level of CF among children of 6-23 months was low. More than 90 % of children experienced either no (2.9 %) or inadequate CF (92.7 %). According to bivariable analyses, mean levels of CF as well as percentages of no/inadequate CF were significantly lower among children of the youngest age group, uneducated parents, unemployed/laborer fathers, socio-economically poor families, food insecure families and rural areas. No weekly exposure to mass media (namely watching TV and reading newspapers/magazines) also revealed significant associations with CF. However, only few variables remained significant for adequate CF in the multivariable logistic regression analysis. For example, the likelihood of experiencing adequate CF was significantly lower among children of 6-11 months (OR: 0.22, 95 % CI: 0.10-0.47), children of illiterate fathers (OR: 0.32, 95 % CI: 0.11-0.95) and socio-economically middle-class families (OR: 0.28, 95 % CI: 0.09-0.86) as compared to their reference categories. CONCLUSION: A high level of inadequate CF leading to malnutrition may cause serious health problems among children of 6-23 months in Bangladesh. Vulnerable groups of children (e.g., the children aged 6 to 11 months and children of illiterate fathers), who received low levels of adequate CF, should be targeted by government and other stakeholders while developing strategies and interventions in order to improve overall situation of CF in Bangladesh.

Clinical and spatial features of Zika virus in Mexico.

BACKGROUND: Zika virus (ZIKV) is an emerging arbovirus transmitted to humans by Aedes mosquitoes, the same vectors that transmit dengue virus and chikungunya. Recent work has suggested that prior infection with dengue could lead to more severe clinical disease in ZIKV patients. Here, we describe the spatial distribution of and clinical symptoms experienced by ZIKV cases in Mexico. METHODS: We performed Fisher's Exact test and Pearson's Chi-Square tests on data from Mexico's national surveillance system on the demographic and clinical characteristics of ZIKV patients (N=84), and then a multivariate logistic regression analysis to determine demographic risk factors for patients presenting with at least 9 symptoms. We also mapped the cases to describe the spatial distribution of ZIKV in Mexico. RESULTS: Results from the multivariate logistic regression analysis indicate that, controlling for all covariates, sex (male) is a significant protective factor in reporting a high number of symptoms (OR=0.36, 95% CI: 0.14, 0.92), and that a one-year increase in age is associated with a 4% increase in odds of having at least 9 symptoms (95% CI: 1.00, 1.08). Spatial analysis revealed more than 50% cases reported within 50km of railways. CONCLUSION: We found that sex and age are both significant risk factors for ZIKV infection severity, using number of reported symptoms as a proxy. The presence of cases along railways indicates that transportation networks within Mexico may be relevant for the national and international spread of the disease.

Indirect consequences of extreme weather and climate events and their associations with physical health in coastal Bangladesh: a cross-sectional study.

BACKGROUND: Bangladesh is one of the countries in the world which is most prone to natural disasters. The overall situation is expected to worsen, since extreme weather and climate events (EWCE) are likely to increase in both frequency and intensity. Indirect consequences caused in the events' aftermath widen the range of possible adverse health outcomes. OBJECTIVE: To assess the association of indirect consequences of EWCE and physical health. DESIGN: We used recent cross-sectional self-reported data from 16 coastal villages in Bangladesh. A total of 980 households were surveyed using a structured questionnaire. The outcome of physical health was categorized into three groups, reflecting the severity of reported diseases by the respective source of treatment as a proxy variable (hospital/clinic for severe disease, other source/no treatment for moderate disease, and no disease). The final statistical analysis was conducted using multinomial logistic regression. RESULTS: Severe diseases were significantly associated with drinking water from open sources [odds ratio (OR): 4.26, 95% confidence interval (CI): 2.25-8.09] and tube wells (OR: 2.39, 95% CI: 1.43-4.01), moderate harm by river erosion (OR: 6.24, 95% CI: 2.76-14.11), food scarcity (OR: 1.98, 95% CI: 1.16-3.40), and the perception of increased employment problems (OR: 2.19, 95% CI: 1.18-4.07). Moderate diseases were significantly associated with moderate harm by river erosion (OR: 2.65, 95% CI: 1.28-5.48) and fully experienced food scarcity (OR: 1.75, 95% CI: 1.16-2.63). For both categories, women and the elderly had higher chances for diseases. CONCLUSIONS: Indirect consequences of EWCE were found to be associated with adverse health outcomes. Basic needs such as drinking water, food production, and employment opportunities are particularly likely to become threatened by EWCE and, thus, may lead to a higher likelihood of ill-health. Intervention strategies should concentrate on protection and provision of basic needs such as safe drinking water and food in the aftermath of an event.

Prevalence and determinants of secondhand smoke exposure among women in Bangladesh, 2011.

BACKGROUND AND OBJECTIVES: The population of Bangladesh is highly susceptible to secondhand smoke (SHS) exposure due to high smoking rates and low awareness about the harmful effects of SHS. This study aims to determine the prevalence of SHS exposure and highlight the essential determinants in developing successful strategies to prevent adverse health effects in Bangladesh. METHODS: The analysis is based on the Bangladesh Demographic Health Survey 2011, in which 17,749 women in the reproductive age group (12-49 years) were included. The information regarding SHS exposure at home was derived from the question: "How often does anyone smoke inside your house?" The variable was recoded into 3 groups: daily exposure, low exposure (exposed weekly, monthly, or less than monthly), and no SHS exposure. We performed descriptive and bivariable analyses and multinomial logistic regression. RESULTS: A total of 46.7% of the women reported high exposure to SHS at home. According to the multinomial logistic regression model, relatively lower education and lower wealth index were significantly associated with daily SHS exposure at home. The exposure differed significantly between the divisions of Bangladesh. Having children at home (vs. not) and being Islamic (compared to other religious affiliations) were protective factors. CONCLUSIONS: The study indicates that women from socioeconomically disadvantaged households are more likely to experience daily exposure to SHS at home. Therefore, especially these groups have to be targeted to reduce tobacco consumption. In addition to aspects of legislation, future strategies need to focus educational aspects to improve the population's health status in Bangladesh.

The geography of diabetes among the general adults aged 35 years and older in Bangladesh: recent evidence from a cross-sectional survey.

OBJECTIVE: To report geographical variations of sex-specific diabetes by place of residence (large cities/city corporations, small towns/other urban areas, rural areas) and region of residence (divided into seven divisions) among general adults (35+ years of age) in Bangladesh. METHODS: The recent cross-sectional data, extracted from the nationally representative Bangladesh Demographic and Health Survey 2011, was used. A total of 3,720 men and 3,823 women aged 35+ years, who participated in the fasting blood sugar testing, were analysed. Any person with either fasting plasma glucose level (mmol/L) ≥7.0 or taking medication for diabetes was considered as a person with diabetes. RESULTS: The prevalence of diabetes was 10.6% in men and 11.3% in women. Bivariable analyses indicated significant variations of diabetes by both geographical variables. The prevalence was highest in city corporations (men 18.0%, women 22.3%), followed by small towns (men 13.6%, women 15.2%) and rural areas (men 9.3%, women 9.5%). Regional disparities in diabetes prevalence were also remarkable, with the highest prevalence in Chittagong division and lowest prevalence in Khulna division. Multivariable logistic regression analyses provided mixed patterns of geographical disparities (depending on the adjusted variables). Some other independent risk factors for diabetes were advancing age, higher level of education and wealth, having TV (a proxy indicator of physical activity), overweight/obesity and hypertension. CONCLUSIONS: Over 10% of the general adults aged 35 years and older were having diabetes. Most of the persons with diabetes were unaware of this before testing fasting plasma glucose level. Although significant disparities in diabetes prevalence by geographical variables were observed, such disparities are very much influenced by the adjusted variables. Finally, we underscore the necessities of area-specific strategies including early diagnosis and health education programmes for changing lifestyles to reduce the risk of diabetes in Bangladesh.

The effects of season and meteorology on human mortality in tropical climates: a systematic review.

Research in the field of atmospheric science and epidemiology has long recognized the health effects of seasonal and meteorological conditions. However, little scientific knowledge exists to date about the impacts of atmospheric parameters on human mortality in tropical regions. Working within the scope of this systematic review, this investigation conducted a literature search using different databases; original research articles were chosen according to pre-defined inclusion and exclusion criteria. Both seasonal and meteorological effects were considered. The findings suggest that high amounts of rainfall and increasing temperatures cause a seasonal excess in infectious disease mortality and are therefore relevant in regions and populations in which such diseases are prevalent. On the contrary, moderately low and very high temperatures exercise an adverse effect on cardio-respiratory mortality and shape the mortality pattern in areas and sub-groups in which these diseases are dominant. Atmospheric effects were subject to population-specific factors such as age and socio-economic status and differed between urban and rural areas. The consequences of climate change as well as environmental, epidemiological and social change (e.g., emerging non-communicable diseases, ageing of the population, urbanization) suggest a growing relevance of heat-related excess mortality in tropical regions.

An analysis of heat effects in different subpopulations of Bangladesh.

A substantial number of epidemiological studies have demonstrated an association between atmospheric conditions and human all-cause as well as cause-specific mortality. However, most research has been performed in industrialised countries, whereas little is known about the atmosphere-mortality relationship in developing countries. Especially with regard to modifications from non-atmospheric conditions and intra-population differences, there is a substantial research deficit. Within the scope of this study, we aimed to investigate the effects of heat in a multi-stratified manner, distinguishing by the cause of death, age, gender, location and socio-economic status. We examined 22,840 death counts using semi-parametric Poisson regression models, adjusting for a multitude of potential confounders. Although Bangladesh is dominated by an increase of mortality with decreasing (equivalent) temperatures over a wide range of values, the findings demonstrated the existence of partly strong heat effects at the upper end of the temperature distribution. Moreover, the study demonstrated that the strength of these heat effects varied considerably over the investigated subgroups. The adverse effects of heat were particularly pronounced for males and the elderly above 65 years. Moreover, we found increased adverse effects of heat for urban areas and for areas with a high socio-economic status. The increase in, and acceleration of, urbanisation in Bangladesh, as well as the rapid aging of the population and the increase in non-communicable diseases, suggest that the relevance of heat-related mortality might increase further. Considering rising global temperatures, the adverse effects of heat might be further aggravated.

Levels, trends and disparities in public-health-related indicators among reproductive-age women in Bangladesh by urban-rural and richest-poorest groups, 1993-2011.

BACKGROUND AND OBJECTIVES: Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. METHODS: The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. RESULTS: The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. CONCLUSION: The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further.

Tobacco smoking and its association with illicit drug use among young men aged 15-24 years living in urban slums of Bangladesh.

BACKGROUND: Tobacco smoking (TS) and illicit drug use (IDU) are of public health concerns especially in developing countries, including Bangladesh. This paper aims to (i) identify the determinants of TS and IDU, and (ii) examine the association of TS with IDU among young slum dwellers in Bangladesh. METHODOLOGY/PRINCIPAL FINDINGS: Data on a total of 1,576 young slum dwellers aged 15-24 years were extracted for analysis from the 2006 Urban Health Survey (UHS), which covered a nationally representative sample of 13,819 adult men aged 15-59 years from slums, non-slums and district municipalities of six administrative regions in Bangladesh. Methods used include frequency run, Chi-square test of association and multivariable logistic regression. The overall prevalence of TS in the target group was 42.3%, of which 41.4% smoked cigarettes and 3.1% smoked bidis. The regression model for TS showed that age, marital status, education, duration of living in slums, and those with sexually transmitted infections were significantly (p<0.001 to p<0.05) associated with TS. The overall prevalence of IDU was 9.1%, dominated by those who had drug injections (3.2%), and smoked ganja (2.8%) and tari (1.6%). In the regression model for IDU, the significant (p<0.01 to p<0.10) predictors were education, duration of living in slums, and whether infected by sexually transmitted diseases. The multivariable logistic regression (controlling for other variables) revealed significantly (p<0.001) higher likelihood of IDU (OR = 9.59, 95% CI = 5.81-15.82) among users of any form of TS. The likelihood of IDU increased significantly (p<0.001) with increased use of cigarettes. CONCLUSIONS/SIGNIFICANCE: Certain groups of youth are more vulnerable to TS and IDU. Therefore, tobacco and drug control efforts should target these groups to reduce the consequences of risky lifestyles through information, education and communication (IEC) programs.

Ovarian cancer mortality among women aged 40-79 years in relation to reproductive factors and body mass index: latest evidence from the Japan Collaborative Cohort study.

OBJECTIVE: This study mainly aimed to investigate the association of ovarian cancer mortality with reproductive factors and body mass index among Japanese women aged 40-79 years. METHODS: The source of the data was the Japan Collaborative Cohort (JACC) study which covered the period of 1988 to 2009. A representative sample of 64,185 women was used. Cox model was used to estimate the relative risk (RR) and 95% confidence interval (CI). RESULTS: The total number of ovarian cancer deaths was 98, with a mortality rate of 9.30 per 100,000 person-years. Women with single marital status revealed significantly higher age-adjusted RR (RR, 4.11; 95% CI, 1.66 to 10.23; p=0.005) as compared to married women. The effect of single marital status was stronger among older women aged 50+ years (RR, 4.58; 95% CI, 1.65 to 12.72; p=0.003) than younger women. An elevated risk was found for both nulliparous and nullipregnant women. Similarly, an increased risk of ovarian cancer mortality was estimated among overweight among aged 50 years or less. CONCLUSION: Out of many factors only single marital status indicated a higher risk for ovarian cancer mortality. All other factors provided inconclusive results, which imply further epidemiological investigations.

Predictors of the number of under-five malnourished children in Bangladesh: application of the generalized poisson regression model.

BACKGROUND: Malnutrition is one of the principal causes of child mortality in developing countries including Bangladesh. According to our knowledge, most of the available studies, that addressed the issue of malnutrition among under-five children, considered the categorical (dichotomous/polychotomous) outcome variables and applied logistic regression (binary/multinomial) to find their predictors. In this study malnutrition variable (i.e. outcome) is defined as the number of under-five malnourished children in a family, which is a non-negative count variable. The purposes of the study are (i) to demonstrate the applicability of the generalized Poisson regression (GPR) model as an alternative of other statistical methods and (ii) to find some predictors of this outcome variable. METHODS: The data is extracted from the Bangladesh Demographic and Health Survey (BDHS) 2007. Briefly, this survey employs a nationally representative sample which is based on a two-stage stratified sample of households. A total of 4,460 under-five children is analysed using various statistical techniques namely Chi-square test and GPR model. RESULTS: The GPR model (as compared to the standard Poisson regression and negative Binomial regression) is found to be justified to study the above-mentioned outcome variable because of its under-dispersion (variance < mean) property. Our study also identify several significant predictors of the outcome variable namely mother's education, father's education, wealth index, sanitation status, source of drinking water, and total number of children ever born to a woman. CONCLUSIONS: Consistencies of our findings in light of many other studies suggest that the GPR model is an ideal alternative of other statistical models to analyse the number of under-five malnourished children in a family. Strategies based on significant predictors may improve the nutritional status of children in Bangladesh.

Trends in sociodemographic and health-related indicators in Bangladesh, 1993-2007: will inequities persist?

OBJECTIVE: To assess levels, trends and gaps between the poorest and the richest in selected health and human development indicators in Bangladesh. METHODS: Data for selected indicators associated with sociodemographic characteristics among ever-married women, contraception use, child vaccination, antenatal care practices and health conditions were extracted from the Bangladesh Demographic and Health Surveys conducted in 1993-94, 1996-1997, 1999-2000, 2004 and 2007. Results for the whole sample and for the poorest and the richest wealth quintiles are presented. FINDINGS: Positive trends were noted in urbanization, availability of electricity, age at first marriage, use of modern contraception, access to skilled antenatal care, child vaccination, knowledge of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome and overweight and obesity. In contrast, negative trends were seen in factors such as literacy, infant and child mortality, fertility rate, home delivery and malnutrition and underweight. However, changes in these indicators differed between the poorest and richest quintiles. For instance, only the richest quintile experienced rapid urbanization, whereas illiteracy declined more among the poorest. Noteworthy gaps were found in almost all factors. Rich-poor gaps in urbanization, age at marriage, fertility, condom use, home delivery and overweight increased; in contrast, gaps in education, water and sanitation, use of contraception (except condoms) and child vaccination declined. CONCLUSION: Persistent inequities in Bangladesh endanger equitable and sustainable human development in the country. Pro-poor development strategies based on the principles of equity and quality should be implemented to narrow existing gaps and further promote holistic and equitable human development.

Prevalence and correlates of smoking among urban adult men in Bangladesh: slum versus non-slum comparison.

BACKGROUND: Smoking is one of the leading causes of premature death particularly in developing countries. The prevalence of smoking is high among the general male population in Bangladesh. Unfortunately smoking information including correlates of smoking in the cities especially in the urban slums is very scarce, although urbanization is rapid in Bangladesh and slums are growing quickly in its major cities. Therefore this study reported prevalences of cigarette and bidi smoking and their correlates separately by urban slums and non-slums in Bangladesh. METHODS: We used secondary data which was collected by the 2006 Urban Health Survey. The data were representative for the urban areas in Bangladesh. Both slums and non-slums located in the six City Corporations were considered. Slums in the cities were identified by two steps, first by using the satellite images and secondly by ground truthing. At the next stage, several clusters of households were selected by using proportional sampling. Then from each of the selected clusters, about 25 households were randomly selected. Information of a total of 12,155 adult men, aged 15-59 years, was analyzed by stratifying them into slum (= 6,488) and non-slum (= 5,667) groups. Simple frequency, bivariable and multivariable logistic regression analyses were performed using SPSS. RESULTS: Overall smoking prevalence for the total sample was 53.6% with significantly higher prevalences among men in slums (59.8%) than non-slums (46.4%). Respondents living in slums reported a significantly (P < 0.001) higher prevalence of smoking cigarettes (53.3%) as compared to those living in non-slums (44.6%). A similar pattern was found for bidis (slums = 11.4% and non-slums = 3.2%, P < 0.001). Multivariable logistic regression revealed significantly higher odds ratio (OR) of smoking cigarettes (OR = 1.12, 95% CI = 1.03-1.22), bidis (OR = 1.90, 95% CI = 1.58-2.29) and any of the two (OR = 1.23, 95% CI = 1.13-1.34) among men living in slums as compared to those living in non-slums when controlled for age, division, education, marital status, religion, birth place and types of work. Division, education and types of work were the common significant correlates for both cigarette and bidi smoking in slums and non-slums by multivariable logistic regressions. Other significant correlates of smoking cigarettes were marital status (both areas), birth place (slums), and religion (non-slums). Similarly significant factors for smoking bidis were age (both areas), marital status (slums), religion (non-slums), and birth place (both areas). CONCLUSION: The men living in the urban slums reported higher rates of smoking cigarettes and bidis as compared to men living in the urban non-slums. Some of the significant correlates of smoking e.g. education and division should be considered for prevention activities. Our findings clearly underscore the necessity of interventions and preventions by policy makers, public health experts and other stakeholders in slums because smoking was more prevalent in the slum communities with detrimental health sequelae.