Association of child marriage and nutritional status of mothers and their under-five children in Bangladesh: a cross-sectional study with a nationally representative sample.

BACKGROUND: Child marriage remains an important problem around the world with young mothers and their under-five children often experiencing under-nutrition. The problem is rarely studied in the Bangladeshi population. This paper was designed to identify the association between child marriage and nutritional status of mothers and their under-five children in Bangladesh. METHODS: Nationally representative secondary data was used for this study, data was extracted from the Bangladesh Demographic and Health Survey (BDHS) 2017-18. The sample consisted of 7235 mothers aged 18-49 years and their under-five children. The mothers were classified into two classes according to their age at first marriage: (i) child marriage (marriage at < 18 years) and (ii) not child marriage (marriage at ≥ 18 years). The nutritional status of mothers was measured by body mass index (BMI), and under-five children's nutritional status was measured by (i) height-for-age (z-score) (stunting), (ii) weight-for-age (z-score) (underweight), and (iii) weight-for-height (z-score) (wasting). The chi-square test and two-level logistic regression model were used for data analysis using SPSS software (IBM version 20). RESULTS: The prevalence of child marriage among Bangladeshi women was 69.0%, with the mean and median of age at the first marriage being 16.57 ± 2.83 years and 16 years, respectively. Of the mothers, 15.2% suffered from chronic energy deficiency (underweight), and 72.8% were married at < 18 years. The prevalence of stunting, underweight, and wasting among under-five children in Bangladesh was 31.0%, 22.0%, and 8.5%, respectively. Compared to women married at the age of ≥ 18 years, there was a significantly higher likelihood of chronic energy deficiency among women who married at < 18 years [Adjusted OR = 1.27, CI: 1.05-1.82; p < 0.05]. Under-five children of mothers married before the age of 18 were more likely to have stunting [Adjusted OR = 1.201, CI: 1.11-1.72; p < 0.05], wasting [Adjusted OR = 1.519, CI: 1.15-2.00; p < 0.01], and underweight [Adjusted OR = 1.150, CI: 1.09-1.82; p < 0.05] compared to children of mothers who married at age ≥ 18. CONCLUSION: The rate of child marriage among Bangladeshi women is high, and it is significantly associated with malnutrition among mothers and their under-five children. The Bangladesh government can use the findings of this study to prevent and reduce child marriage and malnutrition among mothers and their under-five children to achieve sustainable development goals by 2030.

Factors affecting depression among married adults: a gender-based household cross-sectional study.

BACKGROUND: Depression is a common mental health problem all over the world including Bangladesh. World Health Organization included it in the Mental Health Gap Action Programme as one of its priority conditions. Research on this issue is scanty in Bangladesh. Therefore, we designed to a gender-based household study on associated factors of depression among married adults in Rajshahi City of Bangladesh. METHODS: We conducted this household cross-sectional study from August 01 to October 31, 2019. A total of 708 married adults currently living together in Rajshahi City were recruited for this study. We applied a multi-stage random sampling technique for selecting samples and used a semi-structured questionnaire to collect necessary information from them. The Patient Health Questionnaire-9 was used for measuring depression and frequency distribution and binary logistic regression model were used for data analysis. RESULTS: The prevalence of depression (moderate to severe) was 14.4% (95% CI: 11.9-16.9) among married adults, and females (21.2%, 95% CI: 17.2-25.4) suffered more than males (7.6%, 95% CI: 4.8-10.5). A multiple binary logistic regression model established four main factors of depression among married females: (i) multiple marriage [AOR = 19.982; 95% CI: 10.081-39.610; p < 0.01]; (ii) poor relationship with spouse [AOR = 2.175; 95%CI: 1.068-4.428; p < 0.05]; (iii) chronic medical comorbidity [AOR = 1.876; 95%CI: 1.009-2.626; p < 0.05]; and (iv) 7-12 years duration of conjugal life [AOR = 2.091, 1.009-4.334; p < 0.05]. Two main factors of depression among married males were (i) multiple marriage [AOR = 24.605; 95% CI: 20.228-40.402; p < 0.01] and hard work [AOR = 4.358; 95%CI: 1.109-7.132; p < 0.05]. CONCLUSION: The prevalence of depression was significantly high among the study population, and females were the most vulnerable group. The concerned authorities and stakeholders should take appropriate measures to manage the problem with special focus on the risk factors and the vulnerable groups.

Nutritional status of tribal and non-tribal adults in rural Bangladesh: A comparative study.

BACKGROUND: Nutritional status is an important indicator of health status among adults. However, to date, there exists scanty information on the nutritional status of tribal populations of Bangladesh. The aim of the study was to investigate the nutritional status of tribal (T) and non-tribal (NT) adult people living in the rural area of Rajshahi district, Bangladesh. METHODS: A total of 420 (72 T and 348 NT) households were studied. The samples were selected using multistage stratified sampling with proportional allocation. The nutritional status of adults was measured using body mass index (BMI). Descriptive statistics, t-test, ANOVA and Z-proportional test were utilized for data analysis. RESULTS: The study revealed that 8.3% and 9.2% of T and NT men were suffering from under nutrition respectively, while the corresponding figures in women were 12.5% and 10.1% respectively. Overall, 11.1% and 27.0% men, and 13.9% and 29.3% women T and NT were over-nourished respectively. The rate of over nutrition among T was significantly (p<0.05) higher than NT for both sexes. The mean weight and BMI of the NT men were significantly (p<0.01) higher than T men. The mean weight, height and BMI of NT women were higher (p<0.05) than T women. ANOVA demonstrated that the variation in BMI among education levels of NT men and the variation among occupation for both ethnicities were significant (p<0.01). The variation in BMI among education levels and occupation of T and NT women were significant (p<0.05), moreover ordinal logistic regression model demonstrated that hygienic toilet facilities and father's occupation were predictors of nutritional status. The interaction effects of education and occupation, and education and household monthly income on BMI were significant (p<0.01) for T men and both T and NT women (p<0.05). CONCLUSIONS: The prevalence of over-nutrition among NT is higher than T for both sexes. Some socio-economic and demographic factors were found as predictors of malnutrition. At least 12 of the 17 Sustainable Development Goals (SDGs) contain indicators that are highly related to nutrition, our findings can help Bangladesh Government for achieving SDGs by 2030. Appropriate nutritional intervention and awareness programmes can be initiated by the Government to ameliorate the burden of malnutrition among adults in the country.

Knowledge of prevention of COVID-19 among the general people in Bangladesh: A cross-sectional study in Rajshahi district.

BACKGROUND: Until now, no vaccine or effective drug is available for the control, prevention, and treatment of COVID-19. Preventive measures are the only ways to be protected from the disease and knowledge of the people about the preventive measures is a vital matter. OBJECTIVES: The aim of the study was to assess the knowledge of the general people in Rajshahi district, Bangladesh regarding the COVID-19 preventive measures. METHODOLOGY: This cross sectional study was conducted from March 10 to April 25, 2020. Data were collected with a semi-structured questionnaire from 436 adult respondents selected by using a mixed sampling technique. Frequency analysis, chi-square test, and logistic regression model were utilized in this study. SPSS (IBM, Version 22) was used for data analysis. 95% confidence interval and p-value = 0.05 were accepted for statistical significance. RESULTS: Only 21.6% of the respondents had good knowledge of the COVID-19 preventive measures. The highest 67.2% of them knew that washing hands with soap could prevent the disease, but contrarily, the highest 72.5% did not know that avoidance of touching mouth, nose, and eyes without washing hands was a preventive measure. Only 28.4% and 36.9% of the respondents knew that maintaining physical distancing and avoiding mass gatherings were measures of prevention of COVID-19 respectively. The younger age (≤25 years), low family income (≤15,000 Bangladeshi Taka (BDT), occupation others than business and service, and nuclear family had the lower odds of having no/less knowledge about the preventive measures. CONCLUSIONS: The knowledge level of the general people regarding prevention of COVID-19 was alarmingly low in Bangladesh. The government of Bangladesh, health policy makers and donor agencies should consider the findings and take immediate steps for improving knowledge of the public about prevention of the disease.

Risk factors and etiology of neonatal sepsis after hospital delivery: A case-control study in a tertiary care hospital of Rajshahi, Bangladesh.

BACKGROUND: Sepsis is one of the major causes of neonatal death worldwide as well as in Bangladesh. The objective of the present study was to identify the risk factors and causative organisms of neonatal sepsis after delivery in a tertiary care hospital, Bangladesh. METHODS: This was a case-control study conducted in the neonatal ward of Rajshahi Medical College Hospital (RMCH), a 1000-bed tertiary hospital situated in Rajshahi, Bangladesh. Neonates diagnosed as neonatal sepsis by clinical and laboratory parameters were included as cases in this study. Admitted neonates unsuspected or undiagnosed for sepsis were considered as controls. Maternal and neonatal information and their laboratory reports were collected and analyzed. Both bivariate and multiple logistic regression models were used to identify the risk factors of neonatal sepsis. RESULTS: A total of 91 cases and 193 controls were included in the study. Maternal history of urinary tract infection (UTI) during the third trimester of pregnancy (aOR 2.75, 95% CI: 1.04-7.23, p <0.05), premature birth (aOR 2.77, 95% CI: 1.08-7.13, p <0.05) and APGAR score <7 at five minutes (aOR 2.58, 95% CI: 1.04-6.39, p <0.05) were associated with onset of neonatal sepsis in multiple logistic regression model. All these factors were also associated with developing early-onset neonatal sepsis, while maternal UTI and male sex of neonates were associated with developing late-onset neonatal sepsis. Escherichia coli (40.7%), Staphylococcus aureus (27.5%), and Klebsiella pneumoniae (18.7%) were the commonly isolated organisms causing neonatal sepsis. All these organisms were highly resistant to common antibiotics like amoxicillin, cephalosporins, aminoglycosides and quinolones. Carbapenemase group of drugs along with amikacin, nitrofurantoin and linezolid were the most sensitive drugs. CONCLUSIONS: Strengthening the existing facility for antenatal screening for early diagnosis and treatment of maternal infection during pregnancy as well as identifying high-risk pregnancy for adequate perinatal management is necessary to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics according to local epidemiology and culture and sensitivity reports may minimize the increasing hazards of antibiotic resistance.

Bipolar disorder among married women in Bangladesh: Survey in Rajshahi city.

BACKGROUND: Bipolar disorder (BPD) is a major mental disorder which not only affects the personal and social functioning of an individual, but also inflicts a huge economic burden on the family. Yet, the study of BPD in Bangladesh is rare and poorly documented. Responding to the dire need, we conducted a new study to determine the prevalence of, and detect the associated factors of, BPD among married women in Rajshahi City, Bangladesh. METHODS: We conducted a cross-sectional study, selecting households in Rajshahi City using a multi-stage random sampling design. The data consisted of 279 married women, who were screened for BPD using the bipolar spectrum diagnostic scale (BSDS). Frequency distribution, chi-square test and binary logistic regression model were used respectively to determine the prevalence, identify the associated factors and quantify their effects on BPD. RESULTS: The prevalence of BPD among married women in Rajshahi City was 2.5%, with an additional 7.2% classified as probable BPD. A binary logistic regression analysis established the following six main factors of BPD: (1) comorbid mental disorder [AOR = 8.232, 95% CI = (1.397, 50.000), p<0.05]; (2) poor relationship with husband [AOR = 11.775, 95% CI = (2.070, 66.667), p<0.01]; (3) poverty [AOR = 1.600, 95% CI = (2.086, 122.709), p<0.01]; (4) high educational level [AOR = 0.177, 95% CI = (0.037, 0.843), p<0.05]; (5) lack of immediate treatment if sick [AOR = 2.941, 95% CI = (1.259, 6.871), p<0.05]; and (6) death of beloved one/s [AOR = 2.768, 95% CI = (1.130, 6.777), p<0.05]. LIMITATIONS: Our survey involved self-reporting, which is typically affected by differing levels of understanding and bias. Also, a cross-sectional, observational study cannot establish an actual cause-and-effect relationship. Some other potentially important factors such as environment, lifestyle, familial customs, effects of drugs, treatment options and outcomes, etc. were not studied. Also, save mental disorder, all other comorbidities remained undocumented. CONCLUSION: This study laid down the foundation for conducting further research on identifying different factors affecting BPD, and for studying other issues related to BPD among married women in Bangladesh. Among such factors are familial environment and culture, comorbidities, treatment options, treatment outcomes, biochemical feature, environmental factors, etc. This study also recommends that, while treating BPD patients, health professionals should focus on comorbidities and family matters.

Knowledge of tuberculosis among female sex workers in Rajshahi city, Bangladesh: a cross sectional study.

BACKGROUND: Tuberculosis (TB) is a major public health problem in developing countries like Bangladesh. Female sex workers (FSWs) and their clients are active sources for spreading TB. The purpose of this study was to assess the knowledge of TB among FSWs in Rajshahi city, Bangladesh. METHODS: It was a cross-sectional study with a sample size of 225 FSWs. The knowledge on TB was measured by six different questions. Chi-square test and multinomial logistic regression model were used in this study to find the associated factors of lack of general knowledge on TB among FSWs. RESULTS: Out of 225 FSWs, 43.1, 34.7 and 22.2% came from urban, rural and slum areas respectively. More than 41% FSWs perceived that TB is a non-communicable disease. A large number of FSWs (76.4%) did not know the spread of TB. It was found that more than 90% FSWs did not have knowledge on latent TB. The χ2-test demonstrated that FSWs' education, monthly family income, age, currently marital status and sex trading place were significantly associated with their knowledge on TB. A remarkable number of FWSs (42.2%) had poor knowledge on TB. It was found that comparatively higher educated FWSs were more likely to have good or fair knowledge on TB than lower educated ones (p < 0.01). CONCLUSIONS: This study revealed that near to half of FSWs in Rajshahi city, Bangladesh had poor knowledge on TB. Public health authorities should pay due attention and adopt policy for increasing the knowledge on TB among FSWs to reduce the incidence of TB in Bangladesh. Subsequently, advocacy, communication for social mobilization program is very urgent.