Socioeconomic and geographical inequalities in delivery by cesarean section among women in Bangladesh, 2004-2017.

BACKGROUND: There is a dearth of evidence on the trends and inequalities in utilizing cesarean section (CS) among women in Bangladesh. Hence, this study aimed to estimate the socioeconomic and geographical inequalities in delivery by CS among Bangladeshi women from 2004 to 2017. METHODS: Data from Bangladesh Demographic and Health Survey 2004, 2007, 2011, 2014, and 2017 were analyzed using the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequalities were measured using four summary measures: Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF), and Ratio (R). Socioeconomic inequalities were assessed using two equity dimensions: household wealth status, and level of education, while geographical disparities were measured using two equity dimensions: place of residence, and sub-national regions. For each measure, point estimates and their 95% confidence intervals were reported. RESULTS: An increasing trend in the prevalence (weighted) of CS in Bangladesh use was found from 4.50% in 2004 to 32.73% in 2017 We found significant socioeconomic inequalities in CS in every survey point, with a higher concentration of CS among the rich (in 2017, PAR = 28.57; 95% CI: 26.69-30.46) indicating a pro-rich inequality, and higher educated (in 2017, PAF = 23.97; 95% CI: 12.26-35.68) sub-groups. We also identified significant geographical disparities in CS with a higher concentration of CS among people from urban areas (in 2017, PAR = 10.99; 95% CI: 10.19-11.79), and a coastal region (Khulna division) (in 2017, PAF: 30.48 (95% CI: 18.66-42.30). CONCLUSION: We observed both socioeconomic and geographical inequalities in CS exist in Bangladesh, though the trends of these inequalities were curved over time. Thus, it is important to comprehend these pro-rich and geographical inequalities better and implement appropriate interventions and policies to alleviate them.

Magnitude and trends in inequalities in healthcare-seeking behavior for pneumonia and mortality rate among under-five children in Bangladesh: Evidence from nationwide cross-sectional survey 2007 to 2017.

Background and Aims: Bangladesh did not have enough evidence on the current estimates and trend in inequities in the under-five mortality rate (U5MR). There is also a shortage of evidence on trends and inequalities in healthcare-seeking for pneumonia among under-five children (U5C) in Bangladesh. Hence, this study investigated the inequalities in U5MR and health care seeking for pneumonia in U5C through socioeconomic and geographic disparities in Bangladesh between 2007 and 2017. Methods: Data from 2007, 2011, 2014, and 2017 Bangladesh Demographic and Health surveys were analyzed using the Health Equity Assessment Toolkit (HEAT) software by World Health Organization (WHO). The data on U5MR and healthcare-seeking for pneumonia were first disaggregated into five equity dimensions: wealth status, education, child sex, place of residence, and administrative divisions. Second, using summary metrics such as difference (D), population attributable risk (PAR), ratio (R), and population attributable fraction (PAF), inequalities were assessed. Results: The U5MR declined from 73.9 deaths per 1000 live births in 2007 to 48.6 deaths in 2017, while the prevalence of healthcare-seeking for pneumonia in U5C fluctuated over time (34.6% in 2007, 35.4% in 2011, 42.0% in 2014, and 39.8% in 2017). Profound socioeconomic and geographic disparities in U5MR and the prevalence of healthcare-seeking for pneumonia in U5C favored the wealthy, educated, and urban residents. At the same time, the Sylhet division showed the worst situation for U5MR. There were also sex-related disparities in U5MR (PAR = -4.5, 95% confidence interval: -5.3 to -3.7) with higher risk among male children than females. Conclusion: These results indicate that improving disadvantaged women, such as the poor, uneducated, and rural inhabitants, who exhibit disproportionate disparities in U5MR and healthcare-seeking behavior is important. To reduce childhood mortality, it is essential to improve healthcare-seeking for pneumonia among U5C. Facilitating women for better education and economic encompasses would help reducing disparity.

Socio-economic inequalities in and factors associated with minimum dietary diversity among children aged 6-23 months in South Asia: a decomposition analysis.

OBJECTIVE: This study aimed to determine the factors associated with minimum dietary diversity (MDD) and estimate the socioeconomic inequalities in MDD among children from five South Asian countries. DESIGN: Cross-sectional. SETTING: The study used the most recent round of secondary databases of Demographic Health Survey data of Bangladesh (2017-2018), India (2019-2021), Maldives (2016-2017), Nepal (2018) and Pakistan (2017-2018). PARTICIPANTS: This study used information on MDD and other explanatory variables from a total of 136 980 (weighted) children aged 6-23 months. METHODS: Multivariable logistic regression was employed to identify the factors associated with MDD and concentration index (CIX) and Lorenz curve were used to measure the socioeconomic inequalities in MDD. RESULTS: The overall weighted prevalence of MDD in South Asia was 23.37%. The highest prevalence of MDD was found among children from Maldives (70.7%), while the lowest was in Pakistan (14.2%). Living in affluent versus poor households, having a mother who is employed versus a mother who is unemployed, exposure to various forms of media (newspapers and magazines), seeking antenatal care (ANC) more than four times compared with those who sought ANC less than four times and having children older than 4 years old are the most common significant factors associated with MDD deficiency. This study found the value of the CIX for MDD (MDD: CI=0.0352; p<0.001) among children with a higher socioeconomic status, suggesting inequality in MDD in favour of the more among well-off households. CONCLUSION: Inequality in the prevalence of MDD favours the affluent. Health policy and intervention design should prioritise minimising socioeconomic inequalities concerning the MDD. In addition, policy-makers should prioritise the associated factors of MDD such as education, wealth status, employment, media exposure while designing intervention or policies.

Emerging burdens of adolescent psychosocial health problems: a population-based study of 202 040 adolescents from 68 countries.

BACKGROUND: Psychosocial health problems are major public health burdens for adolescents. Identifying risk factors is essential to containing negative health implications. AIMS: This study aimed to estimate the burden of psychosocial health problems among adolescents, and identify potential risk and protective factors. METHOD: We used the Global School-based Student Health Survey data from 68 countries across six World Health Organization regions. We computed the overall, national- and regional-level weighted estimates of the mean number of psychosocial health problems. Adjusted Poisson regression models examined the factors associated with psychosocial health problems. RESULTS: Our sample totalled 202 040 adolescents aged 11-17 years (mean age 14.6 [s.d. 1.18] years), composed of 95 589 (47.31%) boys and 104 191 (51.57%) girls (2260 (1.12%) missing answers). Samoa had the highest mean number of psychosocial health problems (mean 2.64 [s.d. 1.41]), and Niue had the lowest (mean 0.33 [s.d. 0.72]). In the pooled analysis, the following factors were associated with higher rates of psychosocial health problems in adolescents globally: ≥13 years of age, being female, experiencing food insecurity, experiencing physical violence, having been bullied, engagement in physical altercation, experiencing serious injury, missing school without parental permission, lack of parental support or monitoring, parents who were not understanding of their child's problems and high sedentary behaviour. Being female, food insecurity, bullying, physical attacks or serious injury were all significantly associated with higher rates of psychosocial health problems in each of the six regions separately. CONCLUSIONS: The prevalence of psychosocial health problems is high among adolescents, although there are country-level variations. Health promotion strategies should consider the identified factors to promote adolescents' health and well-being.

Exposure to secondhand smoke is associated with poor sleep quality among non-smoking university students in Bangladesh: a cross-sectional survey.

Although secondhand smoke (SHS) exposure is predominant in Bangladesh, the adverse effect of SHS exposure on health-related behaviors, such as sleep quality, have remained an under-investigated area of the country's public health landscape. Therefore, the purpose of this study was to examine the association between SHS exposure and poor sleep quality among non-smoking university students in Bangladesh. A cross-sectional survey was carried out between May and September 2022. SHS exposure (main predictor variable) and other covariates (e.g., age, sex, etc.) were measured using a self-reported questionnaire and sleep quality (outcome variable) was measured via the Pittsburgh Sleep Quality Index. Multiple logistic regression models investigated the association between SHS exposure and poor sleep quality. The study included 390 students (mean age: 22 years, 53.8% male). Approximately 41.8% of the participants reported SHS exposure, and 50.5% had poor sleep quality. Students exposed to SHS were more likely to have poor sleep quality compared to their counterparts (AOR = 1.61; 95% CI 1.01, 2.58). Subgroup analysis revealed poor sleep quality was 2-times higher among male students exposed to SHS than those male students without SHS exposure (AOR = 2.03; 95% CI 1.05, 3.93). No association was found in female students. Findings from this study warrant increased awareness and public health initiatives on the implications of SHS on health behaviors, such as sleep quality, in non-smoking Bangladeshi university students.

Inequalities in early initiation of breastfeeding in Bangladesh: an estimation of relative and absolute measures of inequality.

BACKGROUND: Evidence suggested that inequalities based on education, wealth status, place of residence, and geographical regions significantly influence the key breastfeeding indicators including early initiation of breastfeeding. This study aimed to estimate the trends and magnitude of inequalities in early initiation of breastfeeding practice in Bangladesh from 2004 to 2017 applying both absolute and relative measures of inequality. METHODS: We used data from the last five Bangladesh Demographic Health Survey (BDHS) from 2004 to 2017 to measure the inequalities in early initiation of breastfeeding practice using the WHO's Health Equity Assessment Toolkit (HEAT) software. Following summary measures were estimated to measure the inequalities: Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) where the equity dimensions were wealth status, education level, sex of child, place of residence, and subnational regions (divisions). For each measure, point estimates along with a 95% confidence interval (CI) were reported. RESULTS: An uprising pattern in the prevalence of early initiation of breastfeeding was found, where early initiation of breastfeeding increased from 24.9% to 2004 to 59.0% in 2017. We found significant wealth-driven inequalities in early initiation of breastfeeding practice in every wave of survey favoring the poorest wealth quintile (in 2017, D -10.5; 95% CI -16.6 to -4.3). We also identified geographical disparities in early initiation of breastfeeding practice (in 2017, PAF 11.1; 95% CI 2.2 to 19.9) favoring the Rangpur (65.5%), and Sylhet (65.3%) divisions. Education-related disparities were observed in 2004 only, but not in later survey years, which was due to a much lower level of adherence among those with secondary or higher education. There were no significant disparities in early initiation of breastfeeding based on the urban vs. rural residence and sex of the child. CONCLUSIONS: The highest attention should be placed in Bangladesh to attain the WHO's 100% recommendation of timely initiation of breastfeeding. This study emphasizes on addressing the existing socioeconomic and geographic inequalities. Awareness-raising outreach programs focusing the mothers from wealthier sub-groups and divisions with lower prevalence should be planned and implemented by the joint effort of the government and non-government organizations.

A formative research to explore the programmatic approach of vaccinating the Rohingya refugees and host communities against COVID-19 infection in Bangladesh.

BACKGROUND: The vaccination of the Rohingya refugees and host communities against COVID-19 in Cox's Bazar started in August 2021. Government authorities and Non-Government Organisation partners implemented a project around the initial period of vaccination to improve awareness and access to target beneficiaries. We conducted formative research to understand the programmatic approach of this project and identify potential challenges and community perceptions regarding immunisation against COVID-19. METHODOLOGY: This was formative research in which we used a qualitative method of data collection. Purposively chosen 12 key-informant interviews and conveniently chosen 20 in-depth interviews were conducted using semi-structured interview guidelines from August to September 2022 in the Rohingya camp and host communities of Cox's Bazar District, Bangladesh. Ethical approval was obtained from the North South University Institutional Review Board, and written informed consent was obtained from all the participants. We used a thematic analysis approach to analyse the data. RESULTS: The project neither provided any promotional or tailored messages regarding the COVID-19 vaccine nor conducted any vaccine hesitancy surveys before implementing the project. The project did not provide any storage facilities for the vaccines' cold chain management but provided transport support to carry the vaccines from the district to the sub-district level. Community leaders were included in the decision-making process during local-level planning of the vaccination programme. The project supported the reporting of any adverse effects following immunisation from community members to the government health authorities. Vaccine hesitancy among participants was high in the early stages, but mass campaigns and vaccination of frontline health workers increased their acceptance. The major challenges reported by the informants were low budget and lower salaries of field staff, stacking of the registration process at the beginning, reluctance of participants, inadequate transportation and manpower, and inadequate baby feeding corners at vaccination centers. CONCLUSION: The findings from our study will help policymakers from the Government, the UN, and other humanitarian agencies to adapt and better address the issue of vaccine acceptance and strengthen the vaccination programme.

Permanent, long-acting and short-acting reversible contraceptive methods use among women in Bangladesh: an analysis of Bangladesh Demographic and Health Survey 2017-2018 data.

OBJECTIVES: This study aims to explore the factors associated with the permanent and long-acting reversible contraceptive (LARC) method use compared with short-acting reversible contraceptive (SARC) methods among Bangladeshi ever-married women aged 15-49 years. DESIGN: Cross-sectional study. SETTING: We used data from Bangladesh Demographic Health Survey (BDHS) 2017-2018. PARTICIPANTS: A total of 9669 Bangladeshi reproductive-aged women who gave information on contraception use were the study participants. A multilevel multinomial logistic regression model was employed where the SARC method was considered as the base category and the cluster was considered as level-2 factor. RESULTS: Among the contraceptive users in Bangladeshi women, about 83.48% used the SARC method, while 11.34%, and 5.18% used permanent and LARC methods, respectively. Compared with SARC, women with no formal education and only primary education who were non-Muslims, and had parity of ≥3 had a higher likelihood of using both permanent and LARC methods. Women from the age group of 25-34 years (adjusted relative risk ratio (aRRR): 7.03, 95% CI: 4.17 to 11.85) and 35-49 years (aRRR: 12.53, 95% CI: 7.27 to 21.58) who were employed (aRRR: 1.19, 95% CI: 1.00 to 1.40), had media access (aRRR: 1.24, 95% CI: 1.03 to 1.49), gave birth in last 5 years (aRRR: 1.40, 95% CI: 1.11 to 1.76), whose contraception decision solely made by their husband (aRRR: 7.03, 95% CI: 5.15 to 9.60) and having high decision-making power (aRRR: 2.12, 95% CI: 1.62 to 2.77) were more likely to use permanent contraceptive methods. We observed that women from households with richer (aRRR: 0.65, 95% CI: 0.45 to 0.93) and richest (aRRR: 0.38, 95% CI: 0.23 to 0.63) wealth quintiles were less likely to use LARC methods. CONCLUSIONS: This study identified that women with no/less education, non-Muslims, and having parity of ≥3 were more likely to use both permanent and LARC methods than SARC methods. Targeted interventions could be developed and implemented to promote personalised contraceptive use.

Home environment factors associated with early childhood development in rural areas of Bangladesh: evidence from a national survey.

Background: Knowing the relationship between the factors related to home environment and early childhood development (ECD) in Bangladeshi children aged 3 to 4 years would help to find out appropriate interventions for the children with lower ECD outcomes. Therefore, we aimed to understand the relationship between the home environment factors and ECD in rural Bangladeshi children aged 3 to 4 years. Methods: We used data from the Multiple Indicator Cluster Survey (MICS) 2019, and included 7,326 rural children aged 3 to 4 years. The ECD index (ECDI) included four domains: literacy-numeracy, learning, physical and socio-emotional development. If a child met at least three of these four domains, the child was indicated as developmentally "on track". Results: The findings show that 27.4% of rural children missed to reach developmentally on-track while 72.2% of children did not attain the literacy-numeracy domain of ECD. The home environment factors including parental participation in children's activities, was found to be associated with ECD. For instance, reading books to child had 26% (aOR = 1.26, 95% CI = 1.08-1.48), and telling stories to child had 29% (aOR = 1.29, 95% CI = 1.09-1.53) more developmentally on-track in overall ECDI. Similar associations between home environment factors and specific ECD domains were also obtained. We also identified that children aged 4 years, girls, and children of mothers with higher socio-economic status (SES) were higher developmentally on-track than their counterparts. Conclusion: Home environment factors like reading books and telling stories to children were found to be significantly associated with ECD in rural areas of Bangladesh. Our study's findings would assist in implementing the essential public health intervention to enhance the ECD program especially in the rural Bangladeshi context.

Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades.

BACKGROUND: Maternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across socioeconomic and geographic regions. Therefore, we aim to estimate the trends and magnitude of inequality in SBA use in Bangladesh over the last two decades. METHODS: Data from the last 5 rounds of Bangladesh Demographic and Health Surveys (BDHS; 2017-18, 2014, 2011, 2007, and 2004) were used to measure the inequalities in the SBA use utilizing the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequality was assessed by four summary measures, namely, Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) based on the four equity dimensions: wealth status, education level, place of residence, and subnational regions (divisions). Point estimates and a 95% confidence interval (CI) were reported for each measure. RESULTS: An increasing trend in the overall prevalence of SBA use was observed (From 15.6% in 2004 to 52.9% in 2017). We found significant inequalities in SBA use in every wave of BDHS (from 2004 to 2017), with the result concentrating on the rich (in 2017, PAF: 57.1; 95% CI: 52.5-61.7), educated (in 2017, PAR: 9.9; 95% CI: 5.2-14.5),  and people from urban areas (in 2017, PAF: 28.0; 95% CI: 26.4-29.5). We also identified geographic disparities in SBA use favoring Khulna and Dhaka divisions (in 2017, PAR: 10.2; 95% CI: 5.7-14.7). Our study also observed inequality in using SBA among Bangladeshi women decreased over time. CONCLUSION: To increase SBA use and to decrease inequality in all four equity dimensions, disadvantaged sub-groups should be prioritized in policies and planning for program implementation.

Prevalence and factors associated with chronic school absenteeism among 207,107 in-school adolescents: Findings from cross-sectional studies in 71 low-middle and high-income countries.

BACKGROUND: Despite the negative impact of chronic school absenteeism on the psychological and physical health of adolescents, data on the burden of adolescent chronic school absenteeism (ACSA) and interventions and programs to address it are lacking. We estimated the global, regional and national level prevalence of ACSA and its correlation with violence and unintentional injury, psychosocial, protective, lifestyle, and food security-related factors among in-school adolescents across low and middle-income, and high-income countries (LMICs-HICs). OBJECTIVES: This study aimed to estimate the prevalence of chronic school absenteeism (CSA) as well as to determine its associated factors among in-school adolescents across 71 low-middle and high-income countries. METHODS: We used data from the most recent Global School-based Student Health Survey of 207,107 in-school adolescents aged 11-17 years in 71 LMICs-HICs countries across six WHO regions. We estimated the weighted prevalence of ACSA from national, regional and global perspectives. Multiple binary logistic regression analyses were used to estimate the adjusted effect of independent factors on ACSA. RESULTS: The overall population-weighted prevalence of CSA was 11·43% (95% confidence interval, CI: 11·29-11·57). Higher likelihood of CSA was associated with severe food insecurity, peer victimisation, loneliness, high level of anxiety, physically attack, physical fighting, serious injury, poor peer support, not having close friends, lack of parental support, being obese, and high levels of sedentary behaviours. Lower likelihood of CSA was associated with being female (odds ratio, OR = 0·76, 95% CI: 0·74-0·78). CONCLUSION: Our findings indicate that a combination of different socio-economic factors, peer conflict and injury factors, factors exacerbate CSA among adolescents. Interventions should be designed to focus on these risk factors and should consider the diverse cultural and socioeconomic contexts.

Factors influencing and changes in childhood vaccination coverage over time in Bangladesh: a multilevel mixed-effects analysis.

INTRODUCTION: This study aimed to investigate the associated factors and changes in childhood vaccination coverage over time in Bangladesh. METHODS: Bangladesh's Demographic and Health Surveys from 2011, 2014, and 2017-18 provided data for this study on vaccination coverage among children aged 12 to 35 months. For three survey periods, multilevel binary logistic regression models were employed. RESULTS: The overall prevalence (weighted) of full vaccination among children aged 12-35 months were 86.17% in 2011, 85.13% in 2014, and 89.23% in 2017-18. Children from families with high wealth index, mothers with higher education, and over the age of 24 and who sought at least four ANC visits, as well as children from urban areas were more likely to receive full vaccination. Rangpur division had the highest change rate of vaccination coverage from 2011 to 2014 (2.26%), whereas Sylhet division had the highest change rate from 2014 to 2017-18 (34.34%). CONCLUSION: To improve immunization coverage for Bangladeshi children, policymakers must integrate vaccine programs, paying special attention to mothers without at least a high school education and families with low wealth index. Increased antenatal care visits may also aid in increasing the immunization coverage of their children.

Food neophobia and its association with sociodemographic factors and food preferences among Bangladeshi university students: Evidence from a cross-sectional study.

Food neophobia, described as a reluctance to eat and or avoid new food, is a personality trait that affects food choice. Despite its potential influence on an individual's food intake, food neophobia has been poorly investigated in Bangladesh. This cross-sectional study was designed to evaluate food neophobia and its association with sociodemographic factors and food preferences in a sample of Bangladeshi university students. Five hundred students from five public universities completed the structured surveys. Food neophobia was assessed by a 10-item validated food neophobia scale with some minor modifications based on study settings. A multiple linear regression model was used to observe the factors associated with food neophobia. The mean food neophobia score among study participants was 37.45 (SD: 13.39, Range: 13-67). According to the adjusted statistical model, being female (regression coefficient, ß = 2.73), having higher monthly family income (ß = -6.64), being underweight (ß = 4.68), being overweight (ß = -4.63), having any food allergy (ß = 9.09), and a history of sickness after eating a new food item (ß = 5.16) were significantly associated with food neophobia amongst the participants. The participants' liking of various food items such as vegetables were significantly correlated with food neophobia scores. Nutrition education policies and programs are of importance to address the students' food neophobia during their tertiary education so that they maintain lifelong healthy dietary habits and consume a variety of foods to improve their physical health and well-being.

The burden of chronic diseases, disease-stratified exploration and gender-differentiated healthcare utilisation among patients in Bangladesh.

BACKGROUND: Chronic diseases are considered one of the major causes of illness, disability, and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) among Bangladesh patients with chronic diseases from a gender perspective. METHODS: Data from the nationally representative Household Income and Expenditure Survey 2016-2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed to identify the potential factors to higher or lower utilisation of healthcare services. Logistic regression with step-by-step adjustment for independent confounding factors was the method used. RESULTS: The five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female, M/F: 16.77%/16.40%), arthritis/rheumatism (M/F: 13.70%/ 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types, which held true for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51-3.26) than their female counterparts (OR = 1.44; 1.02-2.04). A similar association was observed among patients with diabetes and respiratory diseases. CONCLUSION: A burden of chronic diseases was observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient's gender as well as their employment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people in society might enhance reaching universal health coverage.

Investigating problematic uses of Facebook and other Internet activities among university students in Bangladesh during the COVID-19 pandemic.

Problematic use of Internet (PUI) and problematic use of Facebook (PUF) has been linked to escalating behavioral health issues among university students and has increased during the COVID-19 pandemic. This study estimated the prevalence of and explored associated factors for PUI and PUF among Bangladeshi university students during the COVID-19 pandemic. A cross-sectional online survey was undertaken among 1101 Bangladeshi university students between November and December 2020. The Internet Addiction Test and Facebook Addiction Scale were used to assess PIU and PUF, respectively. A multiple linear regression analysis was performed to adjust for confounders. Among the participants, PUI and PUF were found in 39.3% and 37.1%, respectively. The multiple linear regression model indicated PUI was significantly associated with participants residing in a village, arts majors, those unsatisfied with their major, having mediocre parental relationships, failure in romantic relationships, physical comorbidities, longer use of the Internet, using the Internet for purposes other than education, using social media, and downloading movies/TV series. PUF was significantly associated with village residence, lower income, arts majors, failure in romantic relationships, longer use of the Internet, using the Internet for purposes other than education, and downloading movies/TV series. Both PUI and PUF have been prevalent among Bangladeshi university students during the COVID-19 pandemic. Longitudinal & exploratory studies are warranted in the future to identify causal factors for PUI and PUF and appropriate interventions should be designed quickly for this population.

Change in prevalence over time and factors associated with depression among Bangladeshi older adults during the COVID-19 pandemic.

BACKGROUND: Globally, the COVID-19 pandemic seriously affected both physical and mental health conditions. This study aims to assess changes in the prevalence of depression among older adults during the COVID-19 pandemic in Bangladesh and explore the correlates of depression in pooled data. METHODS: This study followed a repeated cross-sectional design and was conducted through telephone interviews on two successive occasions during the COVID-19 pandemic (October 2020 and September 2021) among 2077 (1032 in 2020-survey and 1045 in 2021-survey) older Bangladeshi adults aged 60 years and above. Depression was measured using the 15-item Geriatric Depression Scale (GDS-15). The binary logistic regression model was used to identify the factors associated with depression in pooled data. RESULTS: A significant increase in the prevalence of depression was noted in the 2021 survey compared to the 2020 survey (47.2% versus 40.3%; adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.11-1.75). Depression was significantly higher among participants without a partner (aOR 1.92, 95% CI 1.45-2.53), with a monthly family income of <5000 BDT (aOR: 2.65, 95% CI 1.82-3.86) or 5000-10 000 BDT (aOR: 1.30, 95% CI 1.03-1.65), living alone (aOR 2.24, 95% CI 1.40-3.61), feeling isolated (aOR 3.15, 95% CI 2.49-3.98), with poor memory/concentration (aOR 2.02, 95% CI 1.58-2.57), with non-communicable chronic conditions (aOR 1.34, 95% CI 1.06-1.69), overwhelmed by COVID-19 (aOR 1.54, 95% CI 1.18-2.00), having difficulty earning (aOR 1.49, 95% CI 1.15-1.92) or obtaining food (aOR 1.56, 95% CI 1.17-2.09) during COVID-19 pandemic, communicating less frequently (aOR 1.35, 95% CI 1.07-1.70) and needing extra care (aOR 2.28, 95% CI 1.75-2.96) during the pandemic. CONCLUSIONS: Policymakers and public health practitioners should provide immediate mental health support initiatives for this vulnerable population during the COVID-19 pandemic and beyond. Policymakers should also invest in creating safe places to practise mindful eating, exercise, or other refuelling activities as a means of preventing and managing depression.

Factors influencing menstrual regulation and its socioeconomic inequalities among ever-married women in Bangladesh: Findings from a nationwide cross-sectional survey.

Despite a significant drop in maternal mortality in Bangladesh, unsafe abortion remains a critical maternal health issue that could be reduced by promoting menstrual regulation (MR). This study aimed to investigate the prevalence and determinants of MR use among ever-married women as well as to identify the socioeconomic inequalities in MR use in Bangladesh. The latest Bangladesh Demographic and Health Survey (BDHS) 2017-18 data were used in this study. We used a sub-sample of 12,586 ever-married women aged 15 to 49 years for this study. To identify the determinants of MR, multilevel (mixed-effect) binary logistic regression analysis was used while accounting for potential between-clusters variations. The weighted prevalence of MR was 7.64% (95% CI: 7.19 - 8.12). Women of aged 20-29 years (AOR: 2.50, 95% CI: 1.46, 4.30) and ≥ 30 years (AOR: 4.17, 95% CI: 2.39, 7.26), from urban areas (AOR: 1.24, 95% CI: 1.04, 1.47), having one or two children (AOR: 1.96, 95% CI: 1.25, 3.09) and ≥ 3 children (AOR: 2.26, 95% CI: 1.40, 3.65), who used traditional contraceptive method (AOR: 1.39, 95% CI: 1.12, 1.73), and from Barishal division (AOR: 1.44, 95% CI: 1.08, 1.93) were more likely to have MR. Women were less likely to have MR if they were from Chittagong (AOR: 0.62, 95% CI: 0.46, 0.84) and Mymensingh (AOR: 0.51, 95% CI: 0.36, 0.73) divisions. MR use was found to be higher among higher socioeconomic status (SES) groups as the concentration index (CIX) value was positive and the Lorenz curve lay below the line of equality (CIX: 0.095, p<0.001). Health policy and intervention design should prioritize minimizing socioeconomic inequities concerning MR services.

Determinants of health care seeking behavior for childhood infectious diseases and malnutrition: A slum-based survey from Bangladesh.

This study aimed to explore the magnitude and determinants of health care seeking behaviors for common infectious disease and malnutrition among Bangladeshi under-five children living in slum areas. A cross-sectional study of 300 children-caregiver dyads was conducted in an urban slum of Bangladesh. Data were collected via a structured questionnaire with accompanying anthropometric assessments of children administered by research staff. Multiple logistic regression was employed to identify associated factors of health care seeking behaviors. Only 44.7% and 13.0% of respondents sought care for childhood infectious diseases and malnutrition, respectively. Being a male child, 2-5 years old, having ≤5 family members, monthly family income >125$, and living in close proximity to a health facility were found to be potential determinants of health care seeking behavior for childhood infectious diseases. Mother/caregivers with poor nutritional information knowledge and who had a child 2-5 years old reported engaging in less care seeking behaviors regarding their child's malnutrition compared to their counterparts. Caregivers of children under the age of 5 years old reported low participation in health care seeking behaviors in relation to childhood infectious disease and malnutrition. Families living in slums require additional support targeting health and nutritional educational programs.

Prevalence and associated factors of depression among Bangladeshi university students: A cross-sectional study.

Objective:  The study aimed to assess the prevalence of depression and its associated factors among university students in Bangladesh. Participants: A total of 403 undergraduate students from Patuakhali Science and Technology University, and Barisal University participated in the study. Method: A cross-sectional study was conducted using Beck's Depression Inventory (BDI). Result: The prevalence of depression (BDI ≥ 14) was 47.14%. Depression was 3.4 times (95% CI: 1.6-7.1), 3.8 times (95% CI: 1.7-8.6), and 3.9 times (95% CI: 1.5-8.9) higher among 2nd, 3rd, and 4th-year students, respectively than 1st-year students. Students with a history of stressful life events (aOR = 2.7, 95% CI: 1.7-4.4), suicidal attempts (aOR = 3.0, 95% CI: 1.2-7.9), and who received inadequate monthly allowance from their family (aOR = 0.53 95% CI: 0.3-0.9) were more likely to develop depressive symptoms. Conclusion: This study reports a high level of depression among university students which needs further discussion, exploration, and calls for designing appropriate interventions.

Prevalence of and factors associated with early initiation of breastfeeding in Bangladesh: a multilevel modelling.

BACKGROUND: Early initiation breastfeeding (EIBF) is a sign of good health for both the mother and the newborn baby. The objective of this study was to estimate the prevalence of EIBF among mothers in Bangladesh and to identify its associated factors. METHODS: The study used the most recent Bangladesh Demographic and Health Survey 2017-2018 data. A total of 4776 (weighted) respondents were included in the final analysis. The association between the outcome and the independent variables was determined using multilevel (mixed effects) logistic regression analysis. RESULTS: The overall weighted prevalence of EIBF among Bangladeshi mothers was 61.19% (confidence interval [CI] 59.80 to 62.56). The study shows that non-poor wealth status (adjusted odds ratio [AOR] 0.81 [95% CI 0.68 to 0.95]), institutional delivery (AOR 0.77 [95% CI 0.61 to 0.96]) and caesarean delivery (AOR 0.31 [95% CI 0.26 to 0.38]) were associated with the lower odds of EIBF. Mother's secondary education (AOR 1.34 [95% CI 1.01 to 1.83]), at least four antenatal care visits (AOR 1.36 [95% CI 1.04 to 1.53]), normal birthweight (AOR 1.42 [95% CI 1.09 to 1.85]) and placed on mother's chest and bare skin after birth (AOR 1.33 [95% CI 1.11 to 1.60]) were associated with higher odds of EIBF. CONCLUSION: In order to enhance EIBF in Bangladesh, health professionals should emphasise skin-to-skin contact after delivery.