Prevalence of and factors associated with insufficient physical activity among adolescents: evidence from a nationwide survey in Bangladesh.

The World Health Organization set a target of a 15% relative reduction in the prevalence of insufficient physical activity (IPA) by 2025 among adolescents and adults globally. In Bangladesh, there are no national estimates of the prevalence of IPA among adolescents. The aim of this study was to estimate the prevalence of and risk factors associated with IPA among adolescent girls and boys. Data for 4865 adolescent girls and 4907 adolescent boys, collected as a part of a National Nutrition Surveillance in 2018-19, were analysed for this study. A modified version of the Global Physical Activity Questionnaire (GPAQ) was used to collect physical activity data. The World Health Organization recommended cut-off points were used to estimate the prevalence of IPA. Bivariate and multivariable logistic regression was performed to identify factors associated with IPA. Prevalences of IPA among adolescent girls and boys were 50.3% and 29.0%, respectively, and the prevalence was significantly higher among early adolescents (10-14 years) than late adolescents (15-19 years) among both boys and girls. The IPA prevalence was highest among adolescents living in non-slum urban areas (girls: 77.7%; boys: 64.1%). For both boys and girls, younger age, non-slum urban residence, higher paternal education and increased television viewing time were significantly associated with IPA. Additionally, residing in slums was significantly associated with IPA only among the boys. Higher maternal education was associated with IPA only among the girls. This study identified several modifiable risk factors associated with IPA among adolescent boys and girls in Bangladesh. These factors should be addressed through comprehensive public health interventions to promote physical activity among adolescent girls and boys.

Addressing Unintentional Exclusion of Vulnerable and Mobile Households in Traditional Surveys in Kathmandu, Dhaka, and Hanoi: a Mixed-Methods Feasibility Study.

The methods used in low- and middle-income countries' (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially and now face unprecedented rates of urbanization and urbanization of poverty. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi and summarize feasibility of our innovative methods in terms of time, cost, skill requirements, and experiences. We used descriptive statistics and regression techniques to compare respondent characteristics in samples drawn with innovative versus standard survey designs and household definitions, adjusting for sample probability weights and clustering. Feasibility of innovative methods was evaluated using a thematic framework analysis of focus group discussions with survey field staff, and via survey planner budgets. We found that a common household definition excluded single adults (46.9%) and migrant-headed households (6.7%), as well as non-married (8.5%), unemployed (10.5%), disabled (9.3%), and studying adults (14.3%). Further, standard two-stage sampling resulted in fewer single adult and non-family households than an innovative area-microcensus design; however, two-stage sampling resulted in more tent and shack dwellers. Our survey innovations provided good value for money, and field staff experiences were neutral or positive. Staff recommended streamlining field tools and pairing technical and survey content experts during fieldwork. This evidence of exclusion of vulnerable and mobile urban populations in LMIC household surveys is deeply concerning and underscores the need to modernize survey methods and practices.

Unhealthy Foods and Sugar-Sweetened Beverages Consumption Among Bangladeshi Adolescents and Their Sociodemographic Determinants: Findings From a Nationally Representative Cross-Sectional Study.

BACKGROUND: Consumption of savory crispy or fried snacks (SCFS), sugary snacks (SS), and sugar-sweetened beverages (SSB) is associated with an increased prevalence of obesity and noncommunicable diseases. We aimed to estimate the consumption of SCFS, SS, and SSB among adolescent males and females in Bangladesh and to report the factors associated with their consumption using data from a nationwide cross-sectional survey. METHODS: We interviewed 4,907 adolescent males and 4,865 females for the seven-day recall on intake of SCFS, SS, and SSB from 82 randomly selected clusters from rural, non-slum urban, and slum areas. Sociodemographic and anthropometry data were also collected. RESULTS: Consumption of SCFS, SS, and SSB for ≥7 times per week was reported by 11.6%, 28.9%, and 25.6% of the males and 4.9%, 24.8%, and 20.7% of the females, respectively. The weekly mean frequency of SCFS, SS, and SSB intake increased after adjustment for potential confounders among females with higher maternal education and for SCFS and SSB among males with the highest level of father's education. Increased intake of SS and SSB for both males and females was associated with dwelling in a female-headed household. SCFS intake was higher among both males and females from the richest households. Nutritional status, both overweight and obesity, and underweight, was not associated with a more frequent intake of SCFS and SS among males and females; however, a lower frequency of intake of SSB was observed among overweight and obese males. Screen time (television viewing: none, up to 1 hour, and more than 1 hour) was not associated with consumption of SCFS and SSB among both males and females. CONCLUSION: Consumption of unhealthy snacks and drinks is high among adolescents in Bangladesh and needs to be addressed through policy and program measures to abate the epidemic of obesity and associated NCD.

Prevalence and socio-economic determinants of inadequate dietary diversity among adolescent girls and boys in Bangladesh: findings from a nationwide cross-sectional survey.

Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018-19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.

Noncommunicable Disease Risk Factors Among Adolescent Boys and Girls in Bangladesh: Evidence From a National Survey.

OBJECTIVES: To assess the prevalence of noncommunicable disease (NCD) risk factors and the factors associated with the coexistence of multiple risk factors (≥ 2 risk factors) among adolescent boys and girls in Bangladesh. METHODS: Data on selected NCD risk factors collected from face to face interviews of 4,907 boys and 4,865 girls in the national Nutrition Surveillance round 2018-2019, was used. Descriptive analysis and multivariable logistic regression were performed. RESULTS: The prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%, and 6.04%, respectively among boys; and 94.32%, 50.33%, 0.43%, and 8.03%, respectively among girls. Multiple risk factors were present among 34.87% of boys and 51.74% of girls. Younger age (p < 0.001), non-slum urban (p < 0.001) and slum residence (p < 0.001), higher paternal education (p = 0.001), and depression (p < 0.001) were associated with the coexistence of multiple risk factors in both boys and girls. Additionally, higher maternal education (p < 0.001) and richest wealth quintile (p = 0.023) were associated with the coexistence of multiple risk factors in girls. CONCLUSION: The government should integrate specific services into the existing health and non-health programs which are aimed at reducing the burden of NCD risk factors.