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.

Factors mediating the association between recurring floods and child chronic undernutrition in northern Bangladesh.

OBJECTIVES: Although there is some evidence that flood exposure in Bangladesh and other developing countries increases the risk of chronic undernutrition in children, the underlying mechanisms are, to our knowledge, unknown. The objectives of this research are to examine the association between recurrent flood exposure and the likelihood of chronic undernutrition in children and to investigate the mediators of this association. METHODS: This cross-sectional study was conducted in the Naogaon District in northern Bangladesh. Purposive sampling was used to choose 800 children between the ages of 12 and 59 mo in equal numbers in the specified flood-affected and flood-unaffected areas: 400 children from the flood-affected area and 400 from the flood-unaffected area. The nutrition indicator height for age, expressed as z scores, was used to define child chronic undernutrition. Our study focused on children who have been exposed to multiple floods in the past 5 y. RESULTS: In our sample data, children who had experienced flooding had a 1.74-times higher chance of having chronic undernutrition (95% CI, 1.53-2.28) than children who had not experienced flooding. The mediation analyses found inadequate minimum dietary diversity, history of diarrhea, not being fully vaccinated, not using clean cooking fuel, and not having a separate kitchen contributed 19.5%, 10%, 9.8%, 14.8%, and 10%, respectively, to the flood exposure-child undernutrition association. CONCLUSIONS: Flood exposure was found associated with the likelihood of child chronic undernutrition, and this relationship was mediated through lack of having a separate kitchen, history of diarrhea, insufficient vaccination, use of unclean cooking fuel, and poor minimum dietary diversity. Interventions to reduce the prevalence of these risk factors could contribute to reducing the disparities in child undernourishment brought on by exposure to flooding.

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.

Assessing the link between witnessing inter-parental violence and the perpetration of intimate partner violence in Bangladesh.

BACKGROUND: We aimed to examine the influence of witnessing father-to-mother violence on: 1) perpetration of intimate partner violence (IPV); and 2) endorsement of attitudes justifying wife beating in Bangladesh. METHODS: This paper used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on the responses of 3374 ever-married men. Exposure to IPV was determined by men's self-reports of witnessing inter-parental violence in childhood. We used adjusted binary logistic regression models to assess the influence of exposure on husbands' perpetration of IPV and their endorsement of attitudes justifying wife beating. RESULTS: Nearly 60% of men reported violent behaviour towards an intimate partner and 35.7% endorsed attitudes justifying spousal abuse. Men who witnessed father-to-mother violence had higher odds of reporting any physical or sexual IPV (adjusted OR [AOR] = 3.26; 95% CI = 2.61, 4.06). Men who had witnessed father-to-mother violence were also 1.34 times (95% CI = 1.08, 1.65) more likely endorse attitudes justifying spousal abuse. CONCLUSIONS: Committing violence against an intimate partner is an all too frequent practice among men in Bangladesh. The study indicated that men who had witnessed father-to-mother violence were more likley to perpetrate IPV, suggesting an intergenerational transmission of violence. This transmission of violence may operate through the learning and modelling of attitudes favourable to spousal abuse. In support of this, witnnessing inter-parental violence was also associated with the endorsement of attitudes justifying spousal abuse. Our findings indicate the continued importance of efforts to identify and assist boys who have witnessed domestic violence and suggest such efforts should aim to change not just behaviours but also attitudes that facilitate such violence.

Association between high-risk fertility behaviours and the likelihood of chronic undernutrition and anaemia among married Bangladeshi women of reproductive age.

OBJECTIVE: To explore the association between high-risk fertility behaviours and the likelihood of chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women of reproductive age. DESIGN: The 2011 Bangladesh Demographic and Health Survey, conducted from 8 July to 27 December 2011. SETTING: Selected urban and rural areas of Bangladesh. SUBJECTS: A total of 2197 ever-married women living with at least one child younger than 5 years. Exposure was determined from maternal reports of high-risk fertility behaviours. We considered three parameters, maternal age at the time of delivery, birth order and birth interval, to define the high-risk fertility behaviours. Chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women were the outcome variables. RESULTS: A substantial percentage of women were exposed to have a high-risk fertility pattern (41·8 %); 33·0 % were at single high-risk and 8·8 % were at multiple high-risk. After adjusting for relevant covariates, high-risk fertility behaviours were associated with increased likelihood of chronic undernutrition (adjusted relative risk; 95 % CI: 1·22; 1·03, 1·44), anaemia (1·12; 1·00, 1·25) and the coexistence of anaemia and undernutrition (1·52; 1·17, 1·98). Furthermore, multiple high-risk fertility behaviours appeared to have more profound consequences on the outcome measured. CONCLUSIONS: Maternal high-risk fertility behaviours are shockingly frequent practices among women in Bangladesh. High-risk fertility behaviours are important predictors of the increased likelihood of women's chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition.

Characterizing the relationship between temperature and mortality in tropical and subtropical cities: a distributed lag non-linear model analysis in Hue, Viet Nam, 2009-2013.

BACKGROUND: The relationship between temperature and mortality has been found to be U-, V-, or J-shaped in developed temperate countries; however, in developing tropical/subtropical cities, it remains unclear. OBJECTIVES: Our goal was to investigate the relationship between temperature and mortality in Hue, a subtropical city in Viet Nam. DESIGN: We collected daily mortality data from the Vietnamese A6 mortality reporting system for 6,214 deceased persons between 2009 and 2013. A distributed lag non-linear model was used to examine the temperature effects on all-cause and cause-specific mortality by assuming negative binomial distribution for count data. We developed an objective-oriented model selection with four steps following the Akaike information criterion (AIC) rule (i.e. a smaller AIC value indicates a better model). RESULTS: High temperature-related mortality was more strongly associated with short lags, whereas low temperature-related mortality was more strongly associated with long lags. The low temperatures increased risk in all-category mortality compared to high temperatures. We observed elevated temperature-mortality risk in vulnerable groups: elderly people (high temperature effect, relative risk [RR]=1.42, 95% confidence interval [CI]=1.11-1.83; low temperature effect, RR=2.0, 95% CI=1.13-3.52), females (low temperature effect, RR=2.19, 95% CI=1.14-4.21), people with respiratory disease (high temperature effect, RR=2.45, 95% CI=0.91-6.63), and those with cardiovascular disease (high temperature effect, RR=1.6, 95% CI=1.15-2.22; low temperature effect, RR=1.99, 95% CI=0.92-4.28). CONCLUSIONS: In Hue, the temperature significantly increased the risk of mortality, especially in vulnerable groups (i.e. elderly, female, people with respiratory and cardiovascular diseases). These findings may provide a foundation for developing adequate policies to address the effects of temperature on health in Hue City.

Developmental risk factors in Vietnamese preschool-age children: Cross-sectional survey.

BACKGROUND: Early childhood development (ECD) strongly influences children's basic learning, school success, economic participation, social citizenry and health. Although some risk factors related to childhood development are documented, further exploration is necessary considering various sociodemographic, nutritional, and psychosocial factors. This study investigated factors affecting ECD in Vietnamese preschoolers. METHODS: We used data from the representative, cross-sectional round of the Vietnam Multiple Indicator Clusters Survey 2011. Early Childhood Development Index questionnaires were administered to mothers of all children aged 36-59 months in the household (n = 1459). Descriptive statistics and multivariate logistic regression were used in the analysis. RESULTS: In Vietnam, 17.2% of children did not reach their full developmental potential within the first 5 years. Children who had been breast-fed (AOR, 2.78; 95%CI: 1.28-6.02), attended preschool (AOR, 1.75; 95%CI: 1.28-2.39), were of major ethnicity (AOR, 2.41; 95%CI: 1.55-3.74), had a mother with secondary or higher education (AOR, 1.69; 95%CI: 1.19-2.38) and had relatives who engaged with them in four or more activities that promote learning (AOR, 1.55; 95%CI: 1.13-2.14) were more likely to have a normal developmental trajectory. Furthermore, children who experienced physical punishment and stunting were 0.69-fold (95%CI: 0.51-0.95) and 0.71-fold (95%CI: 0.51-0.98) less likely to be on track for ECD, respectively. CONCLUSIONS: The risk factors associated with delayed ECD were low level of maternal education; family ethnicity; lack of preschool attendance; relatives who did not engage with them in learning; physical punishment; not being breast-fed; and stunting.

Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam.

OBJECTIVE: This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. METHODS: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household's ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. RESULTS: Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. CONCLUSIONS: More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced.