Burden of undernutrition among under-five Bengali children and its determinants: Findings from Demographic and Health Surveys of Bangladesh and India.

BACKGROUND: Globally, undernutrition is the leading cause of mortality among under-five children. Bangladesh and India were in the top ten countries in the world for under-five mortality. The aim of the study was to investigate the nutritional status of Bengali under-five children. METHODS: Data on 25938 under-five children were retrieved from the Bangladesh Demographic and Health Survey 2017-18 (BDHS) and the National Family Health Survey of India 2015-16 (NFHS-4). Stunting, wasting, underweight and thinness were considered to understand the nutritional status of under-five children. Binary logistic regression was used to identify associated factors of undernutrition among children. RESULTS: Over one-quarter of Bengali under-five children were found to be suffering from the problem of stunting (31.9%) and underweight (28.1%), while other nutritional indicators raised serious concern and revealed inter-country disparities. In the cases of wasting, underweight and thinness, the mean z-scores and frequency differences between Bangladesh and India were significant. The nutritional status of Bengali under-five children appeared to have improved in Bangladesh compared to India. Child undernutrition had significant relations with maternal undernutrition in both countries. Girls in Bangladesh had slightly better nutritional status than boys. In Bangladesh, lack of formal education among mothers was a leading cause of child undernutrition. Stunting and underweight coexist with low household wealth index in both counties. CONCLUSIONS: The research revealed that various factors were associated with child undernutrition in Bengalis. It has been proposed that programmes promoting maternal education and nutrition, along with household wealth index be prioritised. The study recommends that the Governments of Bangladesh and India should increase the budget for health of children so as to reach the sustainable development goals.

Wealth stratified inequalities in service utilisation of breast cancer screening across the geographical regions: a pooled decomposition analysis.

BACKGROUND: Breast cancer is the most commonly occurring cancer among women in low-resourced countries. Reduction of its impacts is achievable with regular screening and early detection. The main aim of the study was to examine the role of wealth stratified inequality in the utilisation breast cancer screening (BCS) services and identified potential factors contribute to the observed inequalities. METHODS: A population-based cross-sectional multi-country analysis was used to study the utilisation of BCS services. Regression-based decomposition analyses were applied to examine the magnitude of the impact of inequalities on the utilisation of BCS services and to identify potential factors contributing to these outcomes. Observations from 140,974 women aged greater than or equal to 40 years were used in the analysis from 14 low-resource countries from the latest available national-level Demographic and Health Surveys (2008-09 to 2016). RESULTS: The population-weighted mean utilisation of BCS services was low at 15.41% (95% CI: 15.22, 15.60), varying from 80.82% in European countries to 25.26% in South American countries, 16.95% in North American countries, 15.06% in Asia and 13.84% in African countries. Women with higher socioeconomic status (SES) had higher utilisation of BCS services (15%) than those with lower SES (9%). A high degree of inequality in accessing and the use of BCS services existed in all study countries across geographical areas. Older women, access to limited mass media communication, being insured, rurality and low wealth score were found to be significantly associated with lower utilisation of BCS services. Together they explained approximately 60% in the total inequality in utilisation of BCS services. CONCLUSIONS: The level of wealth relates to the inequality in accessing BCS amongst reproductive women in these 14 low-resource countries. The findings may assist policymakers to develop risk-pooling financial mechanisms and design strategies to increase community awareness of BCS services. These strategies may contribute to reducing inequalities associated with achieving higher rates of the utilisation of BCS services.

Early age at menarche and its associated factors in school girls (age, 10 to 12 years) in Bangladesh: a cross-section survey in Rajshahi District, Bangladesh.

BACKGROUND: Early onset of menarche is one of the most important factors for breast cancer and other associated health hazards. The aim of this study was to investigate the early age at menarche and its associated factors in school girls (age, 10-12 years) in Rajshahi District, Bangladesh. METHODS: Data was collected from Rajshahi District, Bangladesh, using multistage random sampling. Independent sample t test and binary logistic regression model were used in this study. A total number of 386 school girls aged 10-12 years were considered as a sample for this study. RESULTS: This study revealed that more than 48% girls already attained menarche within the age of 12 years, among them 25.6%, 41.0%, and 58.3% girls experienced menarche at the age of 10, 11, and 12 years, respectively. It was observed that the menarcheal girls were significantly taller (p < 0.01) and heavier (p < 0.01) than non-menarcheal girls. The menarcheal girls' mothers were heavier (p < 0.01), shorter (p < 0.01), had more BMI (p < 0.01), reached menarche (p < 0.05) earlier than non-menarcheal girls' mothers. Menarcheal girls had less number of siblings (p < 0.01) and lower order of birth (p < 0.05) than non-menarcheal girls. After controlling the effect of other factors, multiple logistic regression model demonstrated that obese girls were more likely to attain menarche than under- [AOR = 0.279, CI 95% 0.075-0.986; p < 0.05] and normal [AOR = 0.248, CI 95% 0.082-0.755; p < 0.05] weight girls. Urban school girls had more chance to get menarche than rural school girls at same age (AOR = 0.012, 95% CI 0.003-0.047; p < 0.01). CONCLUSIONS: Therefore, modern lifestyle changes may have the important factors for early age at menarche of the studied girls in Bangladesh.

Cost-effectiveness of the introduction of two-dose bi-valent (Cervarix) and quadrivalent (Gardasil) HPV vaccination for adolescent girls in Bangladesh.

BACKGROUND: Cervical cancer is one of the most prevalent cancers in women caused by the human papillomavirus (HPV) that leads to a substantial disease burden for health systems. Prevention through vaccination can significantly reduce the prevalence of cervical cancer. The objective of this study is to evaluate the potential health and economic impacts of introducing two-dose bivalent (Cervarix) and quadrivalent (Gardasil) HPV vaccines in Bangladesh. METHODS: The study uses the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model to assess the cost-effectiveness of introducing HPV vaccination. The incremental cost-effectiveness ratios (ICERs) were estimated per disability-adjusted life years (DALYs) averted using the cost-effectiveness threshold (CET). The analyses were done from a health system perspective in terms of vaccine delivery routes. RESULTS: Introduction of bi-valent HPV vaccination was found highly cost-effective (ICER = US$488/DALY) at Gavi (The Vaccine Alliance for Vaccines and Immunizations) negotiated prices. The value of ICERs were US$710, US$356 and US$397 per DALY averted for school-based, health facility-based, and outreach-based programs, respectively, which is consistent with the CET range (US$67 to US$854). However, bivalent and quadrivalent vaccines at listed prices were not found cost-effective, with ICERs of US$1405 and US$3250 per DALY averted, respectively, that exceeds the CETs values. CONCLUSIONS: Introducing a two-dose bi-valent HPV vaccination program is cost-effective in Bangladesh at Gavi negotiated prices. Vaccine price is the dominating parameter for the cost-effectiveness of bivalent and quadrivalent vaccines. Both vaccines are not cost-effective at listed prices in Bangladesh. The evaluation highlights that introducing the two-dose bivalent HPV vaccine at Gavi negotiated prices into a national immunization program in Bangladesh is economically viable to reduce the burden of cervical cancer.

Chemical composition and pharmacological activities of Pisum sativum.

BACKGROUND: Consumption of vegetables has been proven to be effective in the prevention of different diseases. Traditionally edible aerial part of Pisum sativum L. subsp. sativum (Fabaceae) is used to treat diabetes, heart diseases and as blood purifier. Present study was aimed to explore the traditional use of aerial parts of P. sativum as a source of antidiabetic agent. In addition, antioxidant activity and chemical composition was carried out. METHODS: Total polyphenol content was spectrophotometrically determined using Folin Chiocalteu's reagent while the flavonoids by aluminum chloride colorimetric assay. Identification of compounds of the extract was made through HPLC and LCMS. Antihyperglycemic activity was assessed by oral glucose tolerance test in mice. Antioxidant activity was determined by DPPH free radical scavenging and reducing power assay. RESULTS: Total polyphenol and total flavonoids content were found to be 51.23 mg gallic acid equivalent and 30.88 mg quercetin equivalent per gram of dried plant extract respectively. Ellagic acid and p-coumeric acid were detected through HPLC. A total of eight compounds including naringenin, ß-sitosterol were indentified through LCMS. In OGTT, extract (200 mg/kg bw) showed a 30.24% decrease (P< 0.05) in blood glucose levels at 30 min compared to the normal control. The extract showed IC50 value of 158.52 µg/mL in DPPH scavenging assay and also showed comparable reducing power. CONCLUSION: Along with other compounds ellagic acid and ß-sitosterol present in the extract may be responsible for its antioxidant as well as antihyperglycemic activities. Altogether these results rationalize the use of this vegetable in traditional medicine.

TP53 codon 72 polymorphism and breast cancer risk in Bangladeshi population.

BACKGROUND: Breast cancer, a hereditary or heterogeneous sporadic disease, is the most common cancer in women worldwide. The tumor suppressor TP53 gene has been found to be the most commonly mutated genes in many types of human cancers, including breast cancer. This study aimed to investigate the association of codon 72 polymorphism of TP53 gene with breast cancer risk in Bangladeshi females. METHODS: The study included 125 cases and 125 healthy controls. Genotyping and polymorphism were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. RESULTS: The frequencies of the three genotypes Arg/Arg, Arg/Pro, and Pro/Pro were 43.2, 33.6, and 23.2% in cases, whereas 48.8, 40.8, and 10.4% in controls, respectively. The frequency of mutant homozygous (Pro/Pro) genotype was significantly increased in breast cancer patients as compared with controls (23.2 vs 10.4%), and showed 2.52-fold significantly increased risk for breast cancer (OR 2.5199, 95% CI 1.19-5.33, p = 0.0157). The frequencies of Pro/Pro genotype were significantly higher in breast cancer cases with non-breast feeding status. Pro allele frequency was found to be significantly increased in breast cancer cases (OR 1.4978, 95% CI 1.0357-2.1662, p = 0.0318). CONCLUSIONS: Our data suggest that mutant (Pro/Pro) homozygosity at codon 72 of TP53 gene is significantly associated with breast cancer susceptibility in Bangladeshi women. In addition, this association was significantly related to lactating status.

Anti-Inflammatory and Antioxidant Activity of Acalypha hispida Leaf and Analysis of its Major Bioactive Polyphenols by HPLC.

PURPOSE: Inflammation and oxidative stress can lead to different chronic diseases including cancer and atherosclerosis. Many medicinal plants have the potential to show as anti-inflammatory activity. Present investigation was performed to investigate anti-inflammatory, antioxidant activity, and quantification of selected bioactive plant polyphenols of the ethanol (EAH) and aqueous (AAH) extracts of Acalypha hispida (Euphorbiaceae) leaves. METHODS: Anti-inflammatory activity was evaluated by carragenan and histamine induced rat paw edema models while antioxidant capacity was evaluated by DPPH free radical scavenging, Fe+2 chelating ability, reducing power, NO scavenging, total phenolic and total flavonoid content assay. Identification and quantification of bioactive polyphenols was done by HPLC. RESULTS: At the doses of 200 and 400 mg/kg, both EAH and AAH showed statistically significant inhibition of paw volume in the anti-inflammatory activity test. Both the extracts showed DPPH scavenging (IC50: 14 and 17 µg/ml, respectively), Fe+2 ion chelating (IC50: 40 and 46 µg/ml, respectively), NO scavenging activity (65.49 and 60.66% inhibition at 100 µg/ml), and concentration dependent reducing power ability. For EAH and AAH, flavonoid content was 126.30 and 149.72 mg QE/g dry extract, while phenolic content was 130.51 and 173.80 mg GAE/g dry extract, respectively. HPLC analysis of EAH and AAH indicated the presence of high content of ellagic acid along with other phenolic constituents. CONCLUSION: High content of ellagic acid along with other phenolic constituents might have played an important role in the observed anti-inflammatory and antioxidant activity.

Differentials in the prevalence of anemia among non-pregnant, ever-married women in Bangladesh: multilevel logistic regression analysis of data from the 2011 Bangladesh Demographic and Health Survey.

BACKGROUND: Anemia is one of the most common public health problems globally, and high prevalence has been reported among women of reproductive age, especially in developing countries. This study was conducted to evaluate differentials in the prevalence of anemia among non-pregnant, ever-married women of reproductive age in Bangladesh, and to examine associations with demographic, socioeconomic, and nutritional factors. METHODS: Data for this cross-sectional study were taken from the 2011 Bangladesh Demographic and Health Survey (BDHS). In a sub-sample of one-third of the households, all ever-married women of reproductive age (15 to 49 years) were selected for the biomarker component of the survey, including anemia. The sample size for our study was 5,293. Data were analyzed using multilevel logistic regression analysis. RESULTS: The prevalence of anemia among non-pregnant, ever-married women was 41.3% (urban: 37.2% and rural: 43.5%). Among anemic women, 35.5% had mild anemia, 5.6% had moderate anemia, and 0.2% had severe anemia. Women with no education were more likely to be anemic than those with secondary education (p < 0.01) or higher education (p < 0.01). Undernourished women (BMI < 18.5) were at greater risk of anemia (p < 0.01) compared with normal women, overweight women, and obese women. Anemia was less pronounced among non-pregnant women using contraception (p < 0.05), Muslim women (p < 0.01), and women living in rich households (p < 0.01). CONCLUSIONS: The prevalence of anemia among non-pregnant, ever-married women in Bangladesh is high. Illiteracy, poverty, and undernutrition are contributing factors.

Central-stimulating and analgesic activity of the ethanolic extract of Alternanthera sessilis in mice.

BACKGROUND: Alternanthera sessilis is a popular vegetable and used in traditional medicinal practice of Bangladesh and other parts of Asia to relive tiredness, laziness, and sleeps as well as pain and inflammation. However, no report was found on the neuropharmacological and analgesic activity of this plant to-date. Present study was undertaken to evaluate the neuropharmacological and analgesic activity of the ethanol extract of A. sessilis whole plant (ETAS) in mice models. METHODS: Central stimulating activity was investigated by pentobarbitone induced sleeping time, open field, and hole cross tests. Analgesic activity was evaluated by acetic acid induced writhing and hot-plate methods. The tests were performed at 250 and 500 mg/kg body weight dose levels. RESULTS: In sleeping time test, ETAS significantly (p < 0.001) increased the onset of sleep, and decreased the duration of sleep. In open field and hole cross tests, ETAS significantly (p < 0.001) increased the movements of mice which persisted throughout the study period. In writhing test, ETAS showed, significant (p < 0.001) inhibition of writhing reflex. In hot plate test, ETAS significantly (p < 0.001) raised the pain threshold. In HPLC analysis for polyphenols, (+)-catechin, rutin, ellagic acid, and quercetin were detected in ETAS (117.72, 490.74, 3007.26, and 13.85 mg/100 g of dry extract, respectively). CONCLUSION: Present study supported the traditional uses of A. sessilis and indicated that the plant can be a potential source of bioactive molecules.

Adult anthropometric measures and socio-demographic factors influencing age at menarche of university students in malaysia.

Early onset of menarche has been shown to be associated with breast cancer and ischaemic heart disease. Studies on age at menarche of the Malaysian population are poorly documented. This study aimed to determine the influence of anthropometric and socio-demographic factors on the age at menarche of university students in Malaysia. Data were obtained in 2010-11 from 961 students between the ages of 18 and 25 years from the University of Malaya using stratified sampling, and multiple regression analysis was applied. Sixty-three per cent of students reached menarche at the age of 12 or 13 years, with the mean and median of age at menarche being 12.45 ± 1.17 and 12.01 years, respectively. Menarcheal age was positively associated with height (p<0.05) and negatively associated with BMI (p<0.001). Students from urban areas attained menarche earlier than those from rural areas (p<0.05). Students from small-sized families attained menarche earlier than those from larger families (p<0.05). First-born students experienced menarche earlier than those who were seventh-born or later. Obese and overweight students reached menarche earlier than students who were underweight or of normal weight (p<0.01). The variations in age at menarche among the Malaysian ethnic groups were statistically insignificant. The results suggest that heavier and first-born students from small families are more likely to attain menarche earlier than their counterparts.

Age at menarche of university students in Bangladesh: secular trends and association with adult anthropometric measures and socio-demographic factors.

Age at menarche has been shown to be an important indicator for diseases such as breast cancer and ischaemic heart disease. The aim of the present study was to document secular trends in age at menarche and their association with anthropometric measures and socio-demographic factors in university students in Bangladesh. Data were collected from 995 students from Rajshahi University using a stratified sampling technique between July 2004 and May 2005. Trends in age at menarche were examined by linear regression analysis. Multiple regression analysis was used to assess the association of age at menarche with adult anthropometric measures and various socio-demographic factors. The mean and median age of menarche were 13.12+/-1.16 and 13.17 years, respectively, with an increasing tendency among birth-year cohorts from 1979 to 1986. Menarcheal age was negatively associated with BMI (p<0.01), but positively associated with height (p<0.05). Early menarche was especially pronounced among students from urban environments, Muslims and those with better educated mothers. Increasing age at menarche may be explained by improved nutritional status among Bangladeshi populations. Early menarche was associated with residence location at adolescence, religion and mother's education.