Identifying risk factors in explaining women's anaemia in limited resource areas: evidence from West Bengal of India and Bangladesh.

BACKGROUND: Anaemia among women is a public health problem with associated adverse outcomes for mother and child. This study investigates the determinants of women's anaemia in two Bengals; West Bengal (a province of India) and Bangladesh. These two spaces are inhabitated by Bengali speaking population since historic past. The study argues that open defecation, contraceptive method use and food consumption patterns are playing crucial role in explaining anaemia. METHODS: Using non-pregnant women belonging to different religious groups, we analyzed a total of 21,032 women aged 15-49 from the nationally representative cross-sectional surveys, i.e., Bangladesh Demographic Health Survey (BDHS-VI, 2011) and National Family Health Survey (NFHS round 4, 2015-16). We performed spatial, bivariate and logistic regression analyses to unfold the important risk factors of anaemia in two Bengals. RESULTS: The prevalence of anaemia was 64% in West Bengal and 41% in Bangladesh. The significant risk factors explaining anaemia were use of sterilization, vegetarian diet and open defecation. Further, women who used groundwater (tube well or well) for drinking suffered more from anaemia. Also, younger women, poor, less educated and having more children were highly likely to be anaemic. The study also indicates that those who frequently consumed non-vegetarian items and fruits in West Bengal and experienced household food security in Bangladesh were less prone to be anaemic. Hindus of West Bengal, followed by Muslims of that state and then Hindus of Bangladesh were at the higher risk of anaemia compared to Muslims of Bangladesh, indicating the stronger role of space over religion in addressing anaemia. Unlike West Bengal, Bangladesh observed distinct regional differences in women's anaemia. CONCLUSIONS: Propagating the choices of contraception mainly Pill/ injection/IUDs and making the availability of iron rich food along with a favourable community environment in terms of safe drinking water and improved sanitation besides better education and economic condition can help to tackle anaemia in limited-resource areas.

Contraceptive use, birth spacing, and child survival in Matlab, Bangladesh.

To reduce infant mortality through improved family planning, a better understanding of the factors driving contraceptive use and how this decision affects infant survival is needed. Using dynamic panel-data models of infant deaths, birth intervals, and contraceptive use, this study analyzes the causal effects of birth spacing on subsequent infant mortality and of infant mortality on the use of contraceptives and the length of the next birth interval. Data are drawn from the Health and Demographic Surveillance System in Matlab, Bangladesh, where almost 32,000 births have been observed from 1982 to 2005. Our main finding is that complete contraceptive use could reduce infant mortality of birth order two and higher by 7.9 percent. The net effect of complete contraceptive use on the total infant mortality rate is small (2.9 percent), however, because the favorable effect on higher order births is partly offset by the rise in the proportion of high-risk first births.

Infant death clustering in families: magnitude, causes, and the influence of better health services, Bangladesh 1982-2005.

This analysis of infant mortality in Bangladesh focuses on explaining death clustering within families, using prospective data from a rural region in Bangladesh, split into areas with and without extensive health services (the area covered by the International Centre for Diarrhoeal Disease Research and the comparison area, respectively). The modelling framework distinguishes between two explanations of death clustering: (observed and unobserved) heterogeneity across families and a causal 'scarring' effect of the death of one infant on the survival chances of the next to be born. Keeping observed and unobserved characteristics constant, we find scarring in the comparison area only. There the likelihood of infant death is about 29 per cent greater if the previous sibling died in infancy than otherwise. This effect mainly works through birth intervals: infant deaths are followed by shorter birth intervals, which increases the risk of infant death for the next child.

Impact monitoring of the national scale up of zinc treatment for childhood diarrhea in Bangladesh: repeat ecologic surveys.

BACKGROUND: Zinc treatment of childhood diarrhea has the potential to save 400,000 under-five lives per year in lesser developed countries. In 2004 the World Health Organization (WHO)/UNICEF revised their clinical management of childhood diarrhea guidelines to include zinc. The aim of this study was to monitor the impact of the first national campaign to scale up zinc treatment of childhood diarrhea in Bangladesh. METHODS/FINDINGS: Between September 2006 to October 2008 seven repeated ecologic surveys were carried out in four representative population strata: mega-city urban slum and urban nonslum, municipal, and rural. Households of approximately 3,200 children with an active or recent case of diarrhea were enrolled in each survey round. Caretaker awareness of zinc as a treatment for childhood diarrhea by 10 mo following the mass media launch was attained in 90%, 74%, 66%, and 50% of urban nonslum, municipal, urban slum, and rural populations, respectively. By 23 mo into the campaign, approximately 25% of urban nonslum, 20% of municipal and urban slum, and 10% of rural under-five children were receiving zinc for the treatment of diarrhea. The scale-up campaign had no adverse effect on the use of oral rehydration salt (ORS). CONCLUSIONS: Long-term monitoring of scale-up programs identifies important gaps in coverage and provides the information necessary to document that intended outcomes are being attained and unintended consequences avoided. The scale-up of zinc treatment of childhood diarrhea rapidly attained widespread awareness, but actual use has lagged behind. Disparities in zinc coverage favoring higher income, urban households were identified, but these were gradually diminished over the two years of follow-up monitoring. The scale up campaign has not had any adverse effect on the use of ORS. Please see later in the article for the Editors' Summary.

Inconsistencies in the relationship between contraceptive use and fertility in Bangladesh.

CONTEXT: Contraceptive prevalence increased by nine percentage points from 1993 to 2000 in Bangladesh, but there was almost no decline in the total fertility rate. METHODS: Data from the 1999-2000 Bangladesh Demographic and Health Survey and from the Matlab Demographic Surveillance System area collected between 1978 and 2001 were analyzed to explain the lack of change in fertility and to examine relationships among contraceptive prevalence, the abortion ratio, desired fertility and total fertility. RESULTS: After a maternal and child health and family planning program was initiated in part of Matlab in 1977, the total fertility rate in the intervention area declined from 4.8 in 1979 to 2.9 in 2000, while fertility in the comparison area dropped from 6.3 to 3.5. Over this period, contraceptive prevalence rose from 30% to 70% and from 16% to 50% in the two areas, respectively; meanwhile, the abortion ratio fell from 4.3 to 3.6 in the intervention area, but rose from around two to 8.2 in the comparison area. Trends in desired fertility in each area were similar, declining from about 4.0 children per woman in 1979 to about 2.5 children in 2000. Among women at each level of parity, fertility generally decreased as the number of sons increased, and fertility was highest for women without sons. CONCLUSIONS: Preference for male children and parental concern over infant and child mortality may partially explain the difference between desired family size and fertility. A reduction in breast-feeding and an increase in use of less-effective contraceptive methods might be responsible for the inconsistency in the relationship between contraceptive use and fertility.

Inequalities in reproductive healthcare utilization: evidence from Bangladesh Demographic and Health Survey 2004.

Utilization of reproductive healthcare services such as antenatal care (ANC), delivery place facilities and postnatal care (PNC) is essential and a basic need for mothers around the globe. However, in Bangladesh inequalities in many forms affect the use of these facilities. These inequalities include socio-economic status, age, education, household size, existence of living children, occupation and household location. Using the database from the Bangladesh Demographic and Health Survey (BDHS) 2004, this study investigated the inequalities and implications of receiving facility-based maternity care such as ANC, delivery place and PNC in Bangladesh. Based on our findings, it is assumed that with the current inequalities in wealth and education, less attention to mothers with bigger family size and to mothers those existing children, lack of facilities and awareness, in rural areas, increased use of reproductive healthcare is unlikely without a change in wealth inequalities and attention to more equity in the health sector. Bivariate and multivariate analyses were done for the study, including tests of significance. Overall, findings revealed significant socio-economic inequalities in the use of reproductive healthcare services. Use of services was much lower among the poor than the rich. These socio-economic inequalities may be reduced by expanding outreach health programs and bringing services closer to the disadvantaged (poor people). The study concluded that many of these inequalities are social constructs that can be reduced by prioritizing the needs of the poor and disadvantaged and adopting appropriate policy change options.

Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care.

BACKGROUND: Monitoring for disparities in health and services received based upon gender, income, and geography should continue as renewed efforts to reduce under-five mortality are made in response to millennium development goal #4. The purpose of this survey was to provide a nationally representative description of current childhood diarrhoea management practices and disparities in Bangladesh. METHODS: A nationally representative, cross-sectional, cluster-sample survey was carried out in randomly selected rural and urban populations across Bangladesh. The survey was completed over an 8 month period between November 2003 and June 2004. RESULTS: A total of 7308 children with a prevalent diarrhoeal illness episode within 560 clusters were identified and enrolled in the survey. In 61% of the cases help was sought from a health care provider, with over 90% practicing in the private sector. Caretaker practice disparities favouring males and higher income households were identified. Significant trends (P < 0.001) favouring higher income households were found for having sought help from any provider or a licensed doctor and for treating their child with oral rehydration solution or an antibiotic. Female children in urban households were less likely to be seen by a licensed allopath, adj OR 0.73 (95% CI 0.57, 0.94). Among rural households gender disparities were limited to females being less likely to receive an antibiotic, adj OR 0.74 (95% CI 0.65, 0.86). CONCLUSION: Households seeking help from a health provider overwhelmingly utilize the private sector in Bangladesh. Gender inequities in the utilization of licensed providers and purchase of antibiotics, favouring males were identified. Findings suggest that higher income, urban households tend to practice greater gender discrimination. In order to better understand health dynamics in urban populations, in particular slum-dwellers, there is a need to disaggregate survey data by household location.