Magnitude and trends in inequalities in healthcare-seeking behavior for pneumonia and mortality rate among under-five children in Bangladesh: Evidence from nationwide cross-sectional survey 2007 to 2017.

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

Determinants of meeting the minimum acceptable diet among children aged 6 to 23 months in Bangladesh: Evidence from a national representative cross-sectional study.

Background: Minimum acceptable diet (MAD) is a core indicator of infant and child feeding practices (IYCF). Meeting the MAD is essential to enhance the nutritional status of children aged 6-23 months. Objective: To identify the determinants of meeting the MAD among children aged 6-23 months in Bangladesh. Methods: The study was based on a secondary dataset of the 2017-2018 Bangladesh Demographic and Health Survey (BDHS 2017-18). Complete (weighted) data from 2,426 children aged 6-23 months were analyzed. Results: The overall percentage of meeting the MAD was 34.70%, whereas, in terms of urban and rural, it was 39.56% and 32.96%, respectively. Age of the children 9-11 months [Adjusted odds ratio (AOR) = 3.54; 95% CI: 2.33-5.4], 12-17 months [AOR = 6.72; 95% CI: 4.63-9.77], and 18-23 months [AOR = 7.12; 95% CI: 1.72-5.98], the maternal primary [AOR = 1.75; 95% CI: 1.07-2.86], secondary [AOR = 2.3; 95% CI: 1.36-3.89], and higher education [AOR = 3.21; 95% CI: 1.72-5.98], currently working mothers [AOR = 1.45; 95% CI: 1.13-1.79], mothers' access to mass media [AOR = 1.29; 95% CI: 1-1.66], and at least four antenatal care (ANC) from medically skilled providers [AOR = 1.74; 95% CI: 1.39,2.18] were independent determinants of meeting the MAD. Conclusions: Many children are still far behind in meeting the MAD. Nutritional interventions like improved nutrition recipes, nutrition education and homemade food supplementation, nutritional counseling by home visits, community mobilization, health forums, antenatal and postnatal sessions, and media campaigns on IYCF are needed to meet MAD practice.

Determinants of minimum dietary diversity of lactating mothers in rural northern region of Bangladesh: A community-based cross-sectional study.

Background: Breastfeeding requires additional diversified foods for the nutritional requirements of mothers and children, especially in preventing micronutrient deficiencies. The minimum dietary diversity for women (MDD-W) is a proxy indicator of micronutrient adequacy for women. Objectives: This study aimed to identify the determinants associated with MDD in lactating women. Methods: A community-based cross-sectional study was conducted among lactating mothers having at least one live birth in last three years from two districts of Bangladesh between 31st May 2021 and 9th June 2021. Dietary and socio-demographic information was obtained using a single 24-h recall and socio-economic status questionnaires. MDD was defined as at least four food groups consumed in the last 24 hours. In binary logistic regression, adjusted models were used to assess the relationship between MDD and socio-economic factors. Results: The mean Dietary Diversity Score (DDS) was 3.9 ± 1.2. The MDD was met by 29.7% of women. Respondent's ages 20-24 years [Adjusted Odds Ratio (AOR) = 0.5; 95% CI: 0.3-0.9], 25-34 years [AOR = 0.5; 95% CI: 0.3-0.8], and 35-49 years [AOR = 0.5; 95% CI: 0.2-0.9], husband's academic qualifications more than 12 years [AOR = 1.9; 95% CI: 1.0-3.7], family income more than 15000 BDT per month [AOR = 2.3; 95% CI: 1.2-4.3], and husband's profession as a day labor [AOR = 0.5; 95% CI: 0.3-0.7] were significant factors to have MDD. Conclusions: DDS and MDD were very poor among the mothers, whereas women's age, husband's education, and the family's monthly income were independent determinants of MDD. Special interventions may be needed to improve MDD.

Association between depressive symptoms and poor sleep quality among pregnant women in Northern Rural Bangladesh: a community-based cross-sectional study.

BACKGROUND: Adequate good quality of sleep is essential for physical fitness during pregnancy as well as being a depressive symptoms-free mind. However, there is little evidence of the relationship between depressive symptoms and poor sleep quality among pregnant women in Bangladesh. This study aimed to find the association between depressive symptoms and poor sleep quality among pregnant women in northern rural Bangladesh. METHODS: A community-based cross-sectional study was carried out from May 2021 to June 2021 among 481 pregnant women tested positive in the pregnancy test of Jaldhaka and Dimla Upazila of Nilphamari district, Rangpur Division. Data were collected with a structured questionnaire including socio-demographic conditions, sleep quality, and depressive symptoms, comprising the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire- 9 (PHQ-9). RESULTS: 8.94% of the women had depressive symptoms, whereas 38.88% of the participants were bad sleepers. However, women who had depressive symptoms [Adjusted odds ratio (AOR) = 2.55; 95% CI 1.33-4.9] and educational qualifications above 10 years [AOR = 0.60; 95% CI: 0.39-0.92] were associated with poor sleep quality. CONCLUSIONS: A higher percentage of pregnant women had poor sleep quality, whereas depressive symptoms and academic background of the participants were significantly associated with poor sleep quality. Ensuring adequate sleep time and better quality could be helpful to prevent depressive symptoms.

Eating habits and lifestyle changes among higher studies students post-lockdown in Bangladesh: A web-based cross-sectional study.

BACKGROUND: The Coronavirus is still exhibiting cases in Bangladesh thus educational institutes are still ceased over one year, it becomes burdens to students at post lockdown period. OBJECTIVES: Identifying the changes in eating habits and lifestyles including, physical activity, sleeping hours, and sleep quality after the cancellation of lockdown than the period of restrictions. METHODS: A quasi-experimental cross-sectional study was conducted among 394 students in Bangladesh using a structured questionnaire from February 3, 2021, to February 13, 2021. RESULTS: Consuming homemade foods drops by 8.63% at post lockdown than lockdown period. At post lockdown, 26.67% of students gained weight whereas 47.46% of respondents never engaged in any physical works. There has been a significant correlation between weight gain and physical activities (p = 0.007). Not continuing the academic activities from home was significantly associated with weight changes (AOR = 1.73; 95% CI: 1.01, 2.95), meals per day (AOR = 3.25; 95% CI: 1.79, 5.92), screen time for entertainment (AOR = 3.08; 95% CI: 1.78, 5.33), sleeping hours (AOR = 2.23; 95% CI: 1.30, 3.83), and sleep quality (AOR = 2.38; 95% CI: 1.35, 4.23) whereas female gender was related to meals per day (AOR = 1.77; 95% CI: 1.06, 2.95) and sleep quality (AOR = 1.76; 95% CI: 1.09, 2.85). However, 43.91% of respondents never felt any sleep disturbances. The rates of students who always experienced mentally tired, resentment, and sadness at post lockdown was lower than lockdown period. All of these changes were significant (p < 0.000) in terms of the lockdown situation. CONCLUSIONS: This study shows notable changes in eating habits and lifestyles after lockdown which may indicate the tendency to adopt normal life than restrictions.