Health Facilities Readiness and Determinants to Manage Cardiovascular Disease in Afghanistan, Bangladesh, and Nepal: Evidence from the National Service Provision Assessment Survey.

Background: In South Asia, cardiovascular diseases (CVDs) are an increasing public health concern. One strategy for dealing with the growing CVDs epidemic is to make health facilities more ready to provide CVDs services. The study's objectives were to: (1) assess healthcare facilities' readiness to offer CVDs services; and (2) identify the variables that influence such readiness. Methods: This study employed data from the Afghanistan Service Provision Assessment Survey 2018-2019, Bangladesh Health Facility Survey 2017, and Nepal Health Facility Survey 2021 that were cross-sectional and nationally representative. In Afghanistan, Bangladesh, and Nepal, 117, 368, and 1,381 health facilities, respectively, were examined. A total of 10 items/indicators were used to measure a health facility's readiness to provide CVDs services across three domains. Results: The mean readiness scores of managing CVDs were 6.7, 5.6, and 4.6 in Afghanistan, Bangladesh, and Nepal, respectively. Availability of trained staff for CVD services are not commonly accessible in Afghanistan (21.5%), Bangladesh (15.3%), or Nepal (12.9%), except from supplies and equipment. Afghanistan has the highest levels of medicine and other commodity availability. Among the common factors linked with readiness scores, we ought to expect a 0.02 unit rise in readiness scores for three nations for every unit increase in number of CVDs care providers. In Afghanistan, Bangladesh, and Nepal, availability of both diagnosis and treatment facilities was associated with increases in readiness scores of 27%, 9%, and 17%, respectively. Additionally, an association was observed between nation-specific facility types and the readiness scores. Conclusions: Country-specific factors as well as universal factors present in all three nations must be addressed to improve a health facility's readiness to provide CVDs care. To create focused and efficient country-specific plans to raise the standard of CVD care in South Asia, more investigation is necessary to ascertain the reasons behind country-level variations in the availability of tracer items.

Assessing the readiness of health facilities to provide family planning services in low-resource settings: Insights from nationally representative service provision assessment surveys in 10 Countries.

BACKGROUND: Many low-income countries continue to have high fertility levels and unmet need for family planning (FP) despite progress in increasing access to modern contraceptive methods and in reducing the total fertility rate (TFR). Health facilities in sub-Saharan Africa (SSA) and South Asia (SA) are thought to be unable to adequately deal with the burden of high unmet FP demands due to their weaker health systems. As a result, determining the readiness of health facilities that offer FP services is critical for identifying weaknesses and opportunities for continued development of FP health systems in those regions. Service Provision Assessment (SPA) tools-which break down health systems into measurable, trackable components-are one useful way to assess service readiness and the ability of health institutions to deliver FP services. METHODS: Using data from nationally representative SPA surveys, we conducted a study that aimed to: (1) evaluate healthcare facilities' readiness to provide FP services; and (2) identify the factors that affect FP service readiness. Using a cross-sectional survey design, we used data from SPA surveys conducted in 10 low-resource SA and SSA countries: Afghanistan, Bangladesh, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and the Democratic Republic of the Congo (DRC). We analyzed data from public and private health facilities in Afghanistan (84), Bangladesh (1,303), Kenya (567), Malawi (810), Namibia (357), Nepal (899), Rwanda (382), Senegal (334), Tanzania (933), and the DRC (1,061) for a total of 6,730 facilities. We used 17 items/indicators recommended by the Service Availability and Readiness Assessment to measure a health facility's readiness to provide FP services across four domains. RESULTS: Only 3.6% to 34.1% of the health facilities were reporting at least 75% (12-13 of 17) of the relevant items for FP service provision. Most of the health facilities in the countries under investigation suffered from lack of readiness, meaning that they did not fulfill at least 75% of the standards (12-13 items of 17 items on the availability of trained staff and guidelines, equipment, and commodities components). The factors associated with higher readiness scores varied among the 10 countries analyzed. Regression models showed that increases in the number of FP healthcare providers available at a health facility and infection control measures for FP exams were factors linked to increased readiness scores in all 10 countries. The low readiness of health facilities to provide FP services in the countries studied showed that the health systems in these low-resource settings faced significant problems with providing FP services. Differences in country-specific variability in the characteristics linked with better preparedness ratings could be attributed to data collected across different years in different nations or to country-specific healthcare financing policies. CONCLUSIONS: To increase a health facility's readiness to offer FP services, country-specific factors must be addressed, in addition to common factors found in all 10 countries. Further research is required to determine the causes of country-level differences in FP tracer item availability to develop targeted and effective country-specific strategies to improve the quality of FP services in the SA and SSA regions and address unmet need for FP.

Association between contraceptive use and socio-demographic factors of young fecund women in Bangladesh.

OBJECTIVE: This study aimed to explore the association between socio-demographic factors and contraceptive use among fecund women under 25years old. METHODS: This study utilized a cross-sectional data (n=3744) extracted from the Bangladesh Demographic and Health Survey 2011. Differences in the use of contraceptives by socio-demographic characteristics were assessed by χ2 analyses. Binary logistic regression was used to identify the determinants of contraceptive use among young women. RESULTS: This study observed that 71% fecund women aged below 25years used contraceptives. Getting family planning (FP) methods from FP workers increases the likelihood of using contraceptives among young women because outreach activities by FP workers and accessibility of FP related information pave the way of using contraceptives. Husband-wife joint participation in decision making on health care increases the likelihood of using contraceptives. Participation of women in decision making on health care could be achieved by promoting higher education and gainful employment for women. CONCLUSIONS: Reproductive and sex education should be introduced in schools to prepare the young for healthy and responsible living. Moreover, policy makers should focus on developing negotiation skills in young women by creating educational and employment opportunities since husband-wife joint participation in decision making increases contraceptive use.

Validation of a Dish-Based Semiquantitative Food Questionnaire in Rural Bangladesh.

A locally validated tool was needed to evaluate long-term dietary intake in rural Bangladesh. We assessed the validity of a 42-item dish-based semi-quantitative food frequency questionnaire (FFQ) using two 3-day food diaries (FDs). We selected a random subset of 47 families (190 participants) from a longitudinal arsenic biomonitoring study in Bangladesh to administer the FFQ. Two 3-day FDs were completed by the female head of the households and we used an adult male equivalent method to estimate the FD for the other participants. Food and nutrient intakes measured by FFQ and FD were compared using Pearson's and Spearman's correlation, paired t-test, percent difference, cross-classification, weighted Kappa, and Bland-Altman analysis. Results showed good validity for total energy intake (paired t-test, p < 0.05; percent difference <10%), with no presence of proportional bias (Bland-Altman correlation, p > 0.05). After energy-adjustment and de-attenuation for within-person variation, macronutrient intakes had excellent correlations ranging from 0.55 to 0.70. Validity for micronutrients was mixed. High intraclass correlation coefficients (ICCs) were found for most nutrients between the two seasons, except vitamin A. This dish-based FFQ provided adequate validity to assess and rank long-term dietary intake in rural Bangladesh for most food groups and nutrients, and should be useful for studying dietary-disease relationships.

Factors affecting unmet need for contraception among currently married fecund young women in Bangladesh.

OBJECTIVES: The aim of our study was to explore the factors associated with unmet need for contraception among currently married fecund women under age 25, in Bangladesh. METHODS: This study utilised a cross-sectional data (n = 4982) extracted from the Bangladesh Demographic and Health Survey (BDHS) 2011. Multinomial logistic regression was used to identify the determinants of unmet need for contraception among currently married fecund young women. RESULTS: The unmet need for contraception was 17% and contraceptive prevalence was 54% in this young group. Total demand for contraception was 71% and the proportion of demand satisfied was 77%. The results suggest that region, place of residence, religion, husband's desire for children, visits of FP workers, decision-making power on child health care, reading about FP in newspaper/magazine and number of births in three years preceding the survey were significant predictors of unmet need for contraception. CONCLUSIONS: The BDHS of 2011 found that unmet need for contraception among currently married, fecund women under 25 years old is higher than the national level, and hence different or more intensive programme initiatives are required for them than for older women. The present study identifies important predictors of unmet need for contraception among fecund married Bangladeshi women under age 25.

Reproductive health care utilization among young mothers in Bangladesh: does autonomy matter?

OBJECTIVE: To examine the linkage between the possible influences of the extent of autonomy on young mothers use of reproductive health care services. METHODS: This paper used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on responses of 1,778 currently married women aged 15 to 24 years, living with at least one 0- to 35-month-old child. Utilization of antenatal health services (ANC) services by amount and type of provider, and utilization of delivery assistance according to provider type were used as proxy outcome variables of reproductive health care utilization. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. RESULTS: Approximately one third (31%) of the currently married young women in Bangladesh had a higher level of overall decision-making autonomy. Only 24.0% of the sampled women received sufficient ANC; 54% and 18% received ANC and assisted deliveries from a medically trained provider. respectively. In adjusted models, young women who had a higher level of overall autonomy were more likely to receive sufficient ANC (adjusted odds ratio [AOR], 1.64; 95% confidence interval [CI], 1.17-2.23) and receiving ANC from medically trained provider (AOR, 1.91; 95% CI, 1.42-2.45). Women who had medium overall autonomy were 1.40 times more likely (95% CI, 1.03-1.98) to have deliveries assisted by a medically trained provider than women who had low autonomy. CONCLUSION: Association between young mother's autonomy and reproductive health care utilization suggest that maternal autonomy needs to be considered as an important sociocultural determinant for the higher utilization of reproductive health care services for young mothers in Bangladesh.