The level of utilization and associated factors of WHO recommended antenatal care visits in South Asian countries.

Background: Antenatal care can play an important role in reducing the death of both mothers and children. This study was designed to find out the determinants of world health organization recommended antenatal care visits in six South Asian countries to achieve the targets for Sustainable Development Goal. Methods: This study used recent demographic and health survey data from six South Asian countries such as Afghanistan (2015), Bangladesh (2017-18), India (2015-16), Maldives (2016-17), Nepal (2016), and Pakistan (2047-18). Descriptive statistics were calculated for the distribution and prevalence of antenatal care visits. Bivariate and multivariable logistic regressions were used to investigate the influencing factors of antenatal care visits. Results: 71,862 women aged 15 to 49 years were included in this study, and 46.64% (95% Confidence Interval = 45.59 - 47.69%) had world health organization recommended antenatal care visits. In the pooled data, urban women (AOR ([Adjusted Odds Ratio]=1.48; 95% CI [Confidence Interval]=1.33-1.66), richest family (AOR=1.48; 95% CI=1.25-1.76), women's higher education (AOR=3.76; 95% CI=3.33-4.25), women's partner/husband's higher education (AOR=1.69; 95% CI=1.50-1.92), 35-49 years (AOR=1.25, 95% CI=1.11-1.42), women's age at first birth >25 years (AOR=1.51, 95% CI=1.36-1.68) and fully media exposure (AOR=2.11; 95% CI=1.74-2.56) were significantly positively associated with WHO recommended antenatal care visits. Whereas, working women (AOR=0.82; 95% CI=0.76-0.88), healthcare decision maker by their husband/others (AOR=0.71, 95% CI=0.60-0.84), ≥7 children (AOR=0.59; 95% CI=0.50-0.69), and ≥7 family members (AOR=0.82; 95% CI=0.73-0.93) had significant negative effect on antenatal care visits. In country specific analysis, overall, media exposure, secondary and above education of women, ≥25 of years age at first birth, and <4 living children were the key factors of antenatal care visits. Conclusions: This study reveals an overall scenario of the WHO-recommended antenatal care visit in South Asian countries, and significant factors related to ANC that we can concentrate onto improve accessibility to healthcare services and promote education and media exposure, especially for rural and less educated women, to increase the prevalence of WHO-recommended antenatal visits in South Asian countries In addition, evidence from this study can be used to assist the policymakers in planning and taking proper steps to increase WHO-recommended antenatal care visits by focusing on the related factors in South Asian countries.

Machine learning models for prediction of double and triple burdens of non-communicable diseases in Bangladesh.

Increasing prevalence of non-communicable diseases (NCDs) has become the leading cause of death and disability in Bangladesh. Therefore, this study aimed to measure the prevalence of and risk factors for double and triple burden of NCDs (DBNCDs and TBNCDs), considering diabetes, hypertension, and overweight and obesity as well as establish a machine learning approach for predicting DBNCDs and TBNCDs. A total of 12,151 respondents from the 2017 to 2018 Bangladesh Demographic and Health Survey were included in this analysis, where 10%, 27.4%, and 24.3% of respondents had diabetes, hypertension, and overweight and obesity, respectively. Chi-square test and multilevel logistic regression (LR) analysis were applied to select factors associated with DBNCDs and TBNCDs. Furthermore, six classifiers including decision tree (DT), LR, naïve Bayes (NB), k-nearest neighbour (KNN), random forest (RF), and extreme gradient boosting (XGBoost) with three cross-validation protocols (K2, K5, and K10) were adopted to predict the status of DBNCDs and TBNCDs. The classification accuracy (ACC) and area under the curve (AUC) were computed for each protocol and repeated 10 times to make them more robust, and then the average ACC and AUC were computed. The prevalence of DBNCDs and TBNCDs was 14.3% and 2.3%, respectively. The findings of this study revealed that DBNCDs and TBNCDs were significantly influenced by age, sex, marital status, wealth index, education and geographic region. Compared to other classifiers, the RF-based classifier provides the highest ACC and AUC for both DBNCDs (ACC = 81.06% and AUC = 0.93) and TBNCDs (ACC = 88.61% and AUC = 0.97) for the K10 protocol. A combination of considered two-step factor selections and RF-based classifier can better predict the burden of NCDs. The findings of this study suggested that decision-makers might adopt suitable decisions to control and prevent the burden of NCDs using RF classifiers.

Patterns, prevalence and risk factors of intimate partner violence and its association with mental health status during COVID-19: a cross-sectional study on early married female adolescents in Khulna district, Bangladesh.

OBJECTIVES: This study was designed to identify the patterns, prevalence and risk factors of intimate partner violence (IPV) against female adolescents and its association with mental health problems. DESIGN: Cross-sectional survey. SETTINGS: Dumuria Upazila (subdistrict) under the Khulna district of Bangladesh. PARTICIPANTS: A total of 304 participants were selected purposively based on some specifications: they must be female adolescents, residents of Dumuria Upazila and married during the COVID-19 pandemic when under 18 years of age. OUTCOME MEASURES: By administering a semi-structured interview schedule, data were collected regarding IPV using 12 five-point Likert scale items; a higher score from the summation reflects frequent violence. RESULTS: The findings suggest that the prevalence of physical, sexual and emotional IPV among the 304 participants, who had an average age of 17.1 years (SD=1.42), was 89.5%, 87.8% and 93.7%, respectively, whereas 12.2% of the participants experienced severe physical IPV, 9.9% experienced severe sexual IPV and 10.5% experienced severe emotional IPV. Stepwise regression models identified age at marriage (p=0.001), number of miscarriages (p=0.005), education of spouse (p=0.001), income of spouse (p=0.016), age gap between spouses (p=0.008), marital adjustment (p<0.001) and subjective happiness (p<0.001) as significant risk factors. Hierarchical regression, however, indicated that age at marriage (p<0.001), age gap between spouses (p<0.001), marital adjustment (p<0.001) and subjective happiness (p<0.001) had negative associations with IPV, while the number of miscarriages (p<0.001) had a positive relationship. Pearson's correlation showed that IPV was significantly associated with depression, anxiety and stress. CONCLUSION: During the COVID-19 pandemic, an increase in IPV and mental health problems among early married adolescents was documented. To reduce physical and mental harm and to assure their well-being, preventive and rehabilitative measures should be devised.

Maternal Healthcare Services Utilisation and Its Associated Risk Factors: A Pooled Study of 37 Low- and Middle-Income Countries.

Objectives: The utilisation of maternal healthcare services (MHS) can play an essential role in reducing maternal deaths. Thus, this study examines the prevalence and factors associated with MHS utilisation in 37 low-and-middle-income countries (LMICs). Methods: A total of 264,123 women were obtained from the Demographic and Health Surveys of 37 LMICs. Multivariate logistic regression was performed to identify the factors associated with maternal healthcare services utilisation. Results: Around one-third (33.7%) of the respondents properly utilise MHS among women of childbearing age. In the pooled sample, the odds of MHS utilisation were significantly higher with the increase in wealth index, women's age, age at the first birth, and husband/partner's education. Urban residence (AOR [adjusted odds ratio] = 1.56; 95% CI [confidence interval]: 1.49-1.64), women's autonomy in healthcare decision-making (AOR = 1.19; 95% CI: 1.15-1.24) and media exposure (AOR = 1.70; 95% CI: 1.58-1.83) were found to be the strongest positive factors associated with utilisation of MHS. In contrast, larger family (AOR = 0.93; 95% CI: 0.91-0.96), and families with 7 or more children (AOR = 0.72; 95% CI: 0.68-0.77) were significantly negatively associated with MHS utilisation. Conclusion: The utilisation of MHS highly varied in LMICs and the associated factors. Expanding the wealth status, education, age at first birth, mothers' autonomy in healthcare decisions, and media exposure could be essential strategies for increasing the utilisation of MHS; however, country-specific programs should be considered in national policy discussions. There is a need to formulate policies and design maternal health services programs that target socially marginalised women.

Identification of the risk factors of type 2 diabetes and its prediction using machine learning techniques.

This study identified the risk factors for type 2 diabetes (T2D) and proposed a machine learning (ML) technique for predicting T2D. The risk factors for T2D were identified by multiple logistic regression (MLR) using p-value (p<0.05). Then, five ML-based techniques, including logistic regression, naïve Bayes, J48, multilayer perceptron, and random forest (RF) were employed to predict T2D. This study utilized two publicly available datasets, derived from the National Health and Nutrition Examination Survey, 2009-2010 and 2011-2012. About 4922 respondents with 387 T2D patients were included in 2009-2010 dataset, whereas 4936 respondents with 373 T2D patients were included in 2011-2012. This study identified six risk factors (age, education, marital status, SBP, smoking, and BMI) for 2009-2010 and nine risk factors (age, race, marital status, SBP, DBP, direct cholesterol, physical activity, smoking, and BMI) for 2011-2012. RF-based classifier obtained 95.9% accuracy, 95.7% sensitivity, 95.3% F-measure, and 0.946 area under the curve.

A multilevel analysis of individual and community-level factors associated with childhood immunisation in Bangladesh: Evidence from a pooled cross-sectional survey.

Introduction: Previous studies on childhood vaccinations in Bangladesh relied on single-level analyses and ignored the clustering and hierarchical structure of data collected from people living in different geographical units. This study, therefore, aimed to investigate the association between individual and community-level factors of full childhood immunisation with an improved analytical approach. Methods: Participants were 13,752 children aged 12-59 months. Data were extracted from the Bangladesh Demographic and Health Survey (BDHS) conducted in 2007, 2011, 2014, and 2017-18. A two-level multilevel logistic regression method was used to analyse the data. Results: Approximately 87% of the children were fully immunised. In the fully adjusted model, at the individual level, mothers who had primary and above education (Adjusted odds ratio [AOR] = 1.78; 95% Confidence Interval [CI]: 1.57, 2.01), mass media exposure (AOR = 1.14; 95% CI: 1.00, 1.30), having vaccination cards (AOR = 3.65; 95% CI: 3.23, 4.14), and having at least 4 antenatal care (ANC) visits (AOR = 1.24; 95% CI: 1.06, 1.44) were strongly associated with full childhood immunisation. At community-level, rural residency (AOR = 1.25; 95% CI: 1.08, 1.44), community women's education (AOR = 1.24; 95% CI: 1.07, 1.43), and community ANC utilisation (AOR = 1.38; 95% CI: 1.19, 1.61) were significantly associated with full childhood immunisation. Conclusion: Along with individual-level factors, community-level factors have a significant effect on childhood immunisation. Policymakers should target improving community-level characteristics, such as community poverty, education levels, and the number of community-level ANC visits, to increase the national level of childhood immunisation. Public health intervention programs aiming at increasing awareness of childhood immunisation should include elements at both individual and community levels.

Prevalence and socioeconomic determinants of awareness and visitation of community clinic among ever married women: evidence from Bangladesh Demographic and Health Survey, 2017-2018.

OBJECTIVES: Bangladesh has made remarkable progress in improving the population's health, but maternal health and healthcare facilities are still in a vulnerable situation. This study aims to investigate the prevalence and determinants of awareness and visitation of community clinics (CCs) in Bangladesh. DESIGN: A population-based cross-sectional study. SETTING: The data were collected from the most recent Bangladesh Demographic and Health Survey conducted in 2017-2018. PARTICIPANTS: This study's participants are 18 893 women aged 15-49 years throughout all administrative regions. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcomes are awareness and visitation of CCs, defined as if women are aware and visit of CCs. MATERIALS AND METHODS: Descriptive statistics, bivariate and multivariate binary logistics analysis were used to determine the prevalence and associated factors of awareness and visitation of CCs. RESULTS: The prevalence of awareness and visitation to CCs were 60.26% and 15.92%, respectively. The result of the multivariate analysis revealed that higher education, division and higher number of children were significantly positively associated, whereas the richest wealth index was significantly negatively associated with both awareness and visitation to CCs. Furthermore, the urban residence was negatively and respondent involvement in currently working was positively significantly related to awareness of CCs. Moreover, male household heads and exposure to media were significantly positively related to visitation to CCs. CONCLUSION: The study result highlights that more than half of the women were aware of CCs however, the CCs' visit rates were comparatively low. Priority-based public health programmes for women through community health workers are urgently needed to increase the awareness and visitation of CCs.

Frequency of watching television, owning a mobile phone and risk of being overweight/obese among reproductive-aged women in low- and lower-middle-income countries: A pooled analysis from Demographic and Health Survey data.

People who are overweight and obese suffer from significant health impacts that have increased globally. Concurrently, usage of information and communication devices such as television and mobile phones have also been growing, affecting people's weight. This study examined the association between watching television and owning a mobile phone with overweight and obesity among reproductive-aged women in low- and lower-middle-income countries (LLMICs). Data of 21 LLMICs reported between 2015 and 2020 were collected from the Demographic and Health Surveys. Multivariate logistic regression was performed to determine the association into three pooled segments: a group of 21 countries, the World Bank income classification and the regional categorisation of the countries. The all-inclusive prevalence of overweight or obesity was found at 27.1% among 175,370 reproductive-aged women, and this prevalence varied among countries. Overall, the odds of being overweight or obese were 1.20 (adjusted odds ratio [AOR]=1.20, 95% confidence interval [CI]: 1.15-1.24), 1.40 (AOR=1.40, 95% CI: 1.35-1.44) and 1.18 (AOR=1.18, 95% CI: 1.03-1.35) times higher among those who watched television less than once a week, at least once a week and almost every day, respectively, compared with those who did not watch television. Besides, women's mobile phone ownership is more likely to experience overweight or obesity (AOR=1.72, 95% CI: 1.67-1.77). Consistent results were found for the countries categorised according to the World Bank income and regional classification. Focus on sedentary behaviour, such as television watching and mobile phone use, of women and regional or country-specific innovative strategies and programs are of great immediate importance to decrease the prevalence of overweight and obesity.

Socioeconomic inequalities in low birth weight in South Asia: A comparative analysis using Demographic and Health Surveys.

Background: Low Birth Weight (LBW) continues to be a prominent universal cause of various short- and long-term health hazards throughout infancy and adulthood. However, no study has revealed the socioeconomic inequalities in LBW among South Asian countries. This study assesses the socioeconomic inequalities among under-five South Asian children with LBW. Methods: Secondary data were derived from six (Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan) nationally representative South Asian Demographic and Health Surveys conducted between 2015 and 2021, and included 170,547 under-five years of age children. The study employed the concentration curve and concentration index to assess the socioeconomic inequalities of those with LBW. Additionally, mixed-effect logistic regression was applied to determine the factors associated with LBW. Results: A significant negative concentration index indicates the wealth-related and education-related inequalities of LBW among under-five South Asian children. LBW is highly concentrated in the socio-economically poor section of the society. Our study found statistically significant negative concentration index in all South Asian countries: Afghanistan (Education: -0.108), Bangladesh (wealth: -0.070 & education: -0.083), India (wealth: -0.059 & education: -0.052), Nepal (by wealth: -0.064 & by education: -0.080), and Pakistan (by wealth: -0.080 & by education: -0.095). Findings from the mixed-effects logistic regression model also show that children from the poorest quintiles (AOR: 1.53, 95% CI: 1.41-1.67) and illiterate mothers (AOR: 1.39, 95% CI: 1.29-1.51) had higher odds of being afflicted with LBW compared to the wealthiest quintiles and educated mothers respectively. Women's pregnancy assessments, such as antenatal care utilisation, iron supplementation intake, and normal delivery mode, are significantly correlated with decreased odds of children's LBW. Conclusion: There exists a strong association between LBW cases and socioeconomic inequalities among South-Asian children below five years of age. This indicates the urgent need for health education and prenatal care services for women from Afghanistan, Bangladesh, India, Nepal, and Pakistan, especially those with lower socioeconomic status.

Prevalence and determinants of internet addiction among adults during the COVID-19 pandemic in Bangladesh: An online cross-sectional study.

Background: Globally, internet use has increased significantly during the COVID-19 pandemic, and internet addiction (IA) has become a severe public health issue. Therefore, this study aimed to assess IA prevalence among adults and identify its determinants during the COVID-19 pandemic in Bangladesh. Methods: Using a cross-sectional design, this study recruited 608 participants through a self-administered online-based e-questionnaire. Young's internet addiction test (YIAT) of 20 items was used to assess the prevalence of IA among adults in Bangladesh. Bivariate and binary logistic regression analyses explored the factors influencing IA. Results: The overall prevalence of IA was 29.4% among adults during the COVID-19 pandemic. However, the addiction rate was 34.7% among participants under 20 years old. Tobacco smoking (AOR = 1.88, 95% CI 1.15-3.07) and spending more time on the internet during the COVID-19 pandemic (AOR = 2.06, 95% CI 1.08-3.94) were likely the reasons for IA among Bangladeshi adults. Participants aged over 24 years (AOR = 0.39, 95% CI 0.17-0.91), living in rural areas (AOR = 0.51, 95% CI 0.32-0.81), living away from family (AOR = 0.45, 95% CI 0.26-0.79), attached to physical activity (AOR = 0.35, 95% CI 0.24-0.52), and sleeping less than or equal 6 hours (AOR = 0.63, 95% CI 0.42-0.93) had a lower chance of IA during the COVID-19 pandemic. Conclusion: This study has shown that the prevalence of IA was comparatively higher among younger participants during the COVID-19 pandemic. Smoking, long-time use of the internet, physical activity status, and sleeping duration were the most significant determinants of IA. Thus, raising awareness among the younger generation is the most important strategy to reduce IA. The findings of this study can be used to support health and educational organizations to design their programs, which will help prevent IA in Bangladesh during the COVID-19 pandemic.

Multilevel exploration of individual- and community-level factors contributing to overweight and obesity among reproductive-aged women: a pooled analysis of Bangladesh Demographic and Health Survey, 2004-2018.

OBJECTIVES: Overweight and obesity have been related to a variety of adverse health outcomes. Understanding the overweight and obesity epidemic in Bangladesh, particularly among reproductive-aged women, is critical for monitoring and designing effective control measures. The purpose of this study was to determine the prevalence of overweight and obesity in reproductive-aged women and to identify the risk factors of overweight and obesity. DESIGN: A total of 70 651 women were obtained from the five most recent and successive Bangladesh Demographic and Health Surveys (BDHS). The multilevel logistic regression model was used to explore the individual- and community-level factors of overweight and obesity. SETTING: Five most recent nationally representative household surveys across all regions. PARTICIPANTS: Reproductive-aged (15-49 years) non-pregnant women. RESULTS: Approximately 35·2 % (95 % CI: 34·9-35·6 %) of women were either overweight or obese in Bangladesh. At the individual- and community-level, higher age (adjusted odds ratio (aOR) = 5·79, 95 % CI: 5·28-6·34), secondary or higher education (aOR = 1·69 [1·60-1·78]), relatively wealthiest households (aOR = 4·41 [4·10-4·74]), electronic media access (aOR = 1·32 [1·26-1·37]) and community high literacy (aOR = 1·10 [1·04-1·15]) of women were significantly positively associated with being overweight or obese. Whereas, rural residents (aOR = 0·79 [0·76-0·82]) from larger-sized households (aOR = 0·80 [0·73-0·87]) and have high community employment (aOR = 0·92 [0·88-0·97]) were negatively associated with the probability of being overweight or obese. CONCLUSION: Individual- and community-level factors influenced the overweight and obesity of Bangladeshi reproductive-aged women. Interventions and a comprehensive public health plan aimed at identifying and addressing the growing burden of overweight and obesity should be a top focus.

Disability, physical activity, and health-related quality of life in Australian adults: An investigation using 19 waves of a longitudinal cohort.

BACKGROUND: Any form of long-term physical or mental impairment might negatively influence health-related quality of life (HRQoL). HRQoL, as an independent concept, covers a wide range of characteristics that includes physical, mental, social, and spiritual functions. People with disabilities are continuously exposed to multiple barriers that deteriorate their HRQoL. It also creates impairment in performing physical activities. However, experts opine regular physical exercise as an intervention to help disabled people. This research aims to investigate the association between disability and physical activity with HRQoL among the adult population in Australia. DESIGN: A retrospective cohort study. METHODS: This study utilized the most recent 19 waves of data (2002-2020) from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. Component summary scores such as physical component summary (PCS) and mental component summary (MCS), and SF-6D utility scores were utilized to measure HRQoL. Random-effects GLS regression technique was fitted to estimate the association between disability and physical activity with HRQoL, after adjusting for a range of socio-demographic and health-related characteristics. RESULTS: Disability was negatively associated with the PCS (-5.95), MCS (-2.70) and SF-6D (-0.060) compared with non-disabled counterparts. However, respondents engaged in the recommended level of physical activity had substantial gain in PCS (b = 0.96), MCS (1.57), and SF-6D (0.021) scores. Besides, the results showed that performing the recommended level of physical activity in the presence of disability has lessen the negative effect of disability/ positive moderating effect of physical activity on PCS, MCS, and SF-6D scores by 1.84 points, 0.82 points, and 0.013 percentage points, respectively. CONCLUSION: This study found an inverse association between disability and HRQoL among Australian adults. However, physical activity was associated with improved HRQoL. Therefore, public health interventions, such as the orientation of physical activities, have a higher potential to dwindle the burden regarding HRQoL.

Machine Learning Approaches for Predicting Hypertension and Its Associated Factors Using Population-Level Data From Three South Asian Countries.

Background: Hypertension is the most common modifiable risk factor for cardiovascular diseases in South Asia. Machine learning (ML) models have been shown to outperform clinical risk predictions compared to statistical methods, but studies using ML to predict hypertension at the population level are lacking. This study used ML approaches in a dataset of three South Asian countries to predict hypertension and its associated factors and compared the model's performances. Methods: We conducted a retrospective study using ML analyses to detect hypertension using population-based surveys. We created a single dataset by harmonizing individual-level data from the most recent nationally representative Demographic and Health Survey in Bangladesh, Nepal, and India. The variables included blood pressure (BP), sociodemographic and economic factors, height, weight, hemoglobin, and random blood glucose. Hypertension was defined based on JNC-7 criteria. We applied six common ML-based classifiers: decision tree (DT), random forest (RF), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), logistic regression (LR), and linear discriminant analysis (LDA) to predict hypertension and its risk factors. Results: Of the 8,18,603 participants, 82,748 (10.11%) had hypertension. ML models showed that significant factors for hypertension were age and BMI. Ever measured BP, education, taking medicine to lower BP, and doctor's perception of high BP was also significant but comparatively lower than age and BMI. XGBoost, GBM, LR, and LDA showed the highest accuracy score of 90%, RF and DT achieved 89 and 83%, respectively, to predict hypertension. DT achieved the precision value of 91%, and the rest performed with 90%. XGBoost, GBM, LR, and LDA achieved a recall value of 100%, RF scored 99%, and DT scored 90%. In F1-score, XGBoost, GBM, LR, and LDA scored 95%, while RF scored 94%, and DT scored 90%. All the algorithms performed with good and small log loss values <6%. Conclusion: ML models performed well to predict hypertension and its associated factors in South Asians. When employed on an open-source platform, these models are scalable to millions of people and might help individuals self-screen for hypertension at an early stage. Future studies incorporating biochemical markers are needed to improve the ML algorithms and evaluate them in real life.

Nexus between maternal underweight and child anthropometric status in South and South-East Asian countries.

OBJECTIVES: Maternal underweight and childhood malnutrition are life-threatening public health concerns in several South and South-East Asian nations. The aim of this study was to better design interventions and prevent malnutrition of children in the region by exploring the association of maternal underweight with children's anthropometric status. METHODS: The Demographic and Health Survey's (DHS) most recent nationally representative data from eight South and South-East Asian states, collected between 2014 and 2018, were pooled for the present study. A multivariable logistic regression model was designed to explore the association between maternal underweight and child anthropometric status. Owing to the hierarchical structure of the DHS data, the study also employed the multilevel logistic regression technique. RESULTS: Among the total participants (N = 213 730), 22.66% of women were found to be underweight, whereas 39.03%, 35.88%, and 22.11% of their children had stunting, underweight, and wasting, respectively. The logistic regression model showed that the children from underweight mothers were 1.27 (95% confidence interval [CI]. 1.24-1.30), 1.69 (95% CI, 1.65-1.73), and 1.48 (95% CI, 1.45-1.52) times more likely to experience stunting, underweight, and wasting, respectively, than those with healthy-weight mothers. The significant association between maternal underweight and stunting, underweight, as well as wasting was additionally established by the multilevel logistic regression analysis. CONCLUSIONS: Findings indicate that maternal underweight is positively associated with children's anthropometric status, such as stunting, underweight, and wasting. The information from this research will guide actors and policymakers to scale up interventions with all-inclusive nutritional issues and promote healthier weight status among mothers to ensure higher odds of healthier anthropometric status in their children in the South and South-East Asian countries.

Prevalence and associated factors of underweight and overweight/obesity among reproductive-aged women: A pooled analysis of data from South Asian countries (Bangladesh, Maldives, Nepal and Pakistan).

BACKGROUND AND AIMS: Underweight and overweight/obesity is a critical public health problem among women in South Asian countries. This study aimed to find the prevalence of underweight and overweight/obesity and discover its associated factors among women of reproductive age in four South Asian countries. METHODS: Population-representative cross-sectional latest Demographic and Health Survey data from four South Asian countries, considering Bangladesh (2017-18), Maldives (2016-17), Nepal (2016), and Pakistan (2017-18), were pooled for this study. To investigate the factors related with underweight and overweight/obesity in women, a multivariate multinomial logistic regression model was deployed. RESULTS: The overall prevalence of underweight and overweight/obesity among reproductive-age women in four South Asian countries was 11.8% and 36.3%, respectively. According to adjusted multivariate multinomial logistic regression analysis, women who lived in Pakistan, were older, had a better education, were from the wealthiest home, were currently in union and had media exposure had a considerably decreased probability of being underweight. In contrast, families with a large number of members had a considerably increased risk of becoming underweight. Additionally, women from the Maldives, older age, secondary education, a higher number of children, women from the richest household, currently in the union, the family had media exposure, and pregnant women have been found significantly positively associated with overweight/obesity. However, Nepalese women, large family members, rural residence, and work involvement were significantly negatively associated with overweight/obesity. CONCLUSION: The problem of being underweight and overweight/obesity still exists in South Asian countries. Focusing on women's age, education, wealth index, and media exposure, different public health intervention approaches are imperative to reduce unhealthy weight conditions.

Prevalence and predictors of pornography exposure during the third wave of the COVID-19 pandemic: A web-based cross-sectional study on students in Bangladesh.

Background: Pornography exposure, particularly among students, in Bangladesh, has increased in the twenty-first century. However, pornography exposure during the COVID-19 pandemic, when people were compelled to "stay at home" and relied extensively on the internet for all forms of activities, including academia, socializing, and communication, has remained unexplored. The present study aimed to assess the prevalence of pornography exposure among students during the third wave of the COVID-19 pandemic and to determine the associated predictors. Methods: A web-based cross-sectional study was carried out among students with certain specifications, i.e., current students at high school/college/university with access to the internet and valid social media accounts. By administering a semi-structured e-questionnaire using Google Forms, a total of 646 valid responses were retained for this study. The data were analyzed in two phases by Pearson's Chi-square and multiple logistic regression model, using IBM SPSS Statistics, version 25. The results were expressed as an adjusted odds ratio (AOR) with a 95% confidence interval (95% CI). Results: The findings suggest that 75.9% of students were exposed to pornography during the third wave of the COVID-19 pandemic and preferred to watch the amateur/professional genre of pornography. Pornography exposure was significantly associated with age and relationship status, as students aged 22-24 years (95% CI: 1.01-2.41; p = 0.045) and over 25 years (95% CI: 1.61-10.03; p = 0.003) were more likely to watch pornography, while married students and those in relationships (95% CI: 1.24-3.49; p = 0.006) also watched pornography during the pandemic. In contrast, students who were living alone (95% CI: 0.38-0.92; p = 0.021), were living in the Khulna division (95% CI: 0.16-0.52; p < 0.001) or had a negative attitude toward pornography (95% CI: 0.94-0.99; p = 0.002) were less likely to be exposed to pornography. Conclusion: Pornography exposure was higher among students in Bangladesh during the COVID-19 pandemic, and religiosity and disapproving attitudes toward pornography negatively influenced the pornography exposure. For a better understanding of the complex dynamics of socio-demographic issues with pornography exposure among students, extensive research is required for policymakers to devise appropriate strategies and interventions to ensure healthy and safe sex life for the younger population.

Mental health status of early married girls during the COVID-19 pandemic: A study in the southwestern region of Bangladesh.

Background: Due to unemployment, the prolonged lockdown during the COVID-19 pandemic caused panic and deepened poverty, especially among lower-class and marginal people. The related financial crises led to harmful practices such as the early marriage of adolescent girls, which deteriorated these girl's mental state. Aims: This study attempted to assess the prevalence of mental health problems among early married girls and determine the associated predictors of the growing mental health burden. Methods: This cross-sectional survey was conducted during the third wave of the COVID-19 pandemic in Dumuria Upazila in the Khulna district of Bangladesh. Data were collected purposively from 304 girls who were married off during the COVID-19 pandemic, this was carried out between 22 July and 31 August 2022 by administering a semi-structured interview schedule, with mental health measured by the depression, anxiety, and stress scale 21 (DASS 21). The data were analyzed using IBM SPSS Statistics (version 25), and multiple linear regression was executed in order to predict mental health problems among early married girls. Results: The findings show that the overall prevalence of depression, anxiety, and stress among early married girls during the COVID-19 pandemic in Bangladesh was 60.9% (95% CI: 0.554-0.663), 74.7% (95% CI: 0.698-0.796), and 23.7% (95% CI: 0.189-0.285). The prevalence was relatively higher among girls from the Sanatan (Hindu) religion and younger girls than among Muslim and older girls, respectively. The multiple linear regressions indicate that age, age at marriage, duration of the marriage, spousal occupation, intimate partner violence (IPV), and subjective happiness were the critical predictors of mental health problems among early married girls. Conclusion: Early marriage, along with various adverse outcomes, i.e., IPV, maladjustment, and poor subjective happiness, has resulted in heightened mental health problems for young girls. Policymakers should implement coercive measures to prevent early marriage, especially during social, economic, political, and health crises; in addition, more research is recommended in order to explore the mechanisms that make early married girls psychologically vulnerable and thus formulate protective and preventive programs for addressing such vulnerabilities.

Correction: Prevalence of unintended pregnancy and its associated factors: Evidence from six south Asian countries.

[This corrects the article DOI: 10.1371/journal.pone.0245923.].

Double and triple burden of non-communicable diseases and its determinants among adults in Bangladesh: Evidence from a recent demographic and health survey.

BACKGROUND: Globally, non-communicable diseases (NCDs) are a significant public health problem. NCDs are the leading cause of death in Bangladesh. This study aimed to estimate the prevalence of double burden of NCDs (DBNCDs) and triple burden of NCDs (TBNCDs) such as hypertension, diabetes and overweight or obesity and to explore the risk factors of DBNCDs and TBNCDs in Bangladesh. MATERAILS AND METHODS: This study included 12 685 participants (5465 male and 7220 female) from 2017 - 2018 nationally representative Bangladesh Demographic and Health Survey. Descriptive statistics were calculated for the distribution and prevalence of DBNCDs and TBNCDs. Bivariate and multilevel logistic regression analyses were used to assess the individual- and community-level determinants of DBNCDs and TBNCDs. RESULTS: The prevalence of DBNCDs and TBNCDs was 21.4% and 6.1%, respectively. At individual-level, higher age, female, currently and formerly/ever married, richest, higher education were more likely to suffer from the DBNCDs and TBNCDs. Furthermore, at the community level, the division had a significant association with DBNCDs and TBNCDs. In addition, family size had a significant effect on DBNCDs, and caffeinate drinks and poverty significantly affected TBNCDs. CONCLUSION: Overall, there is a low prevalence of TBNCDs compared with DBNCDs in Bangladesh. Age, gender, marital status, wealth index, education level and division are significantly associated with DBNCDs and TBNCDs. The government and non-government health organisations should pay proper attention to handle the burden of NCDs in Bangladesh.