Trends and long-term variation explaining nutritional determinants of child linear growth: analysis of Bangladesh Demographic and Health Surveys 1996-2018.

OBJECTIVE: To examine the height-for-age z-score (HAZ) of 0-35 months' children along with stunting prevalence to identify trends, changes and available nutrition-sensitive and specific determinants that could help explain the long-term variation in child linear growth using successive Bangladesh Demographic and Health Surveys (BDHS) data from 1996 to 2018. DESIGN: The BDHS pooled data are used for determining the key outcome variables HAZ, stunting and severe stunting. Trends, kernel-weighted local polynomial smoothing illustrations, pooled multivariable linear probability model (LPM), ordinary least squares method (OLS) and regression decomposition were used. PARTICIPANTS: Mothers having 0-35 months' children, the most critical age range for growth faltering. RESULTS: The mean HAZ increased by 0·91(±1·53) with 0·041 annual average change, while the percentages of stunting (-26·63 ± 0·54) and severe stunting (-21·12 ± 0·48) showed a reduction with 1·21 and 0·96 average annual changes, respectively. The average HAZ improvement (0·42 ± 1·56) in urban areas was less than the rural areas (1·16 ± 1·44). Similar patterns followed for stunting and severe stunting. The prenatal doctor visits (3064·65 %), birth in a medical facility (1054·32 %), breastfeeding initiation (153·18 %) and asset index (144·73 %) demonstrated a huge change. The findings of OLS, LPM and regression decomposition identified asset index, birth order, paternal and maternal education, bottle-fed, prenatal doctor visit, birth in a medical facility, vaccination, maternal BMI and ever-breastfed as influencing factors to predict the long-term changes of stunting and severe stunting. CONCLUSION: The nutrition-sensitive and specific factors identified through regression decomposition describing long-term variation in child linear growth should be focused further to attain the sustainable development goals.

Prevalence and risk factors of underweight among under-5 children in Bangladesh: Evidence from a countrywide cross-sectional study.

BACKGROUND: Underweight is one of the important anthropometric components of malnutrition among under-five children and is a major public health concern in Bangladesh because it contributes to mortality as well as morbidity. In designing suitable health programs and policies with the goal of attaining UN SDG Goals, it is necessary to identify the critical risk factors of under-five malnutrition. It is evident that the quantile regression produces robust estimates in the presence of outliers. However, in the context of Bangladesh, no study has been conducted considering the sequential quantile regression on this topic. Therefore, the authors aimed to find the determinants of underweight among under-5 children in Bangladesh considering the latest country representative dataset. METHODS AND MATERIALS: The paper considers a weighted sample of size 7762 children are used and data were extracted from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18 data. Multivariable simultaneous quantile regression models were used to fulfill the objectives of this study. RESULTS: Findings depict that undernutrition affects the majority of children in the population as compared to the reference population. The WAZ-score of the child increases by 0.202 points at the 10th quantile of the conditional distribution, and by 0.565 points at the 90th quantile as we move from children of underweight to overweight women. Moreover, the WAZ scores of children from the richest families in the 10th, 50th, and 75th quantiles, respectively, are increased by 0.171, 0.016, and 0.084 points. CONCLUSION: Quantile regression revealed the results of several socioeconomic and demographic factors acting differently across the WAZ distribution. Therefore, policymakers may consider the identified risk factors to lessen malnutrition among under-5 children in Bangladesh.

Prevalence, determinants and consequences of problematic smartphone use among preschoolers (3-5 years) from Dhaka, Bangladesh: A cross-sectional investigation.

The problematic smartphone use (PSU) has been becoming a challenging health issue for preschoolers aged 3-5 years as it has severe adverse effect on their psychological, physical, and cognitive development. The scarcity of scientific research on this issue in the context of Bangladesh motivated the authors for conducting this cross-sectional study to explore the prevalence of PSU with its influential factors and adverse effects on preschooler's psychological and physical development based on primary data collected from 400 mothers. The multivariable ordinal logistic regression (OLR) was used to compute the adjusted likelihoods. The estimated prevalence of PSU was approximately 86 %, where about 29 % were severely problematic user. The likelihood of preschoolers' PSU was observed to increase with >1 h/day usage of smartphone by children (Adjusted Odds Ratio (AOR): 3.92). Other important factors were parental smartphone use, education, profession, family income, and mother's age. Both of moderate and severe PSU had adverse effect on preschoolers' health- severe PSU was found to increase the likelihood of psychological and physical problems by 6.03 and 3.29 times, respectively. The preschoolers with PSU reported to suffer from many physical and mental health problems such as attention deficit and hyperactivity disorder (ADHD), emotional instability, aggressiveness, depression, lack of control, impaired vision and hearing, obesity, body imbalance, and lack of brain development. It is now prime time to undertake strategic policies considering the findings for limiting the preschoolers' usage of smartphone, which will make Bangladesh susceptible to protect its future generation from harmful effects of PSU.

Risk factors of caesarean deliveries in urban-rural areas of Bangladesh.

Background and aims: The key interest of this research is to identify the causes of the ongoing increasing trends in caesarean section or C-section (CS) deliveries in both urban and rural areas of Bangladesh. Methods: This study analyzed all Bangladesh Demographic and Health Survey (BDHS) datasets through Chi-square and z tests and the multivariable logistic regression model. Results: CS deliveries were found to be more prevalent in urban than in rural areas of Bangladesh. Mothers above 19 years, above 16 years at first birth, overweight mothers, those with higher educational levels, those who received more than one antenatal care (ANC) visit, fathers having secondary/higher education degrees and employed as workers or in business, and mothers living in wealthy households in the cities of Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions had a significantly higher likelihood of CS deliveries in urban areas. Contrastingly, mothers with ages between 20 and 39 years, above 20 years at first birth, normal weight/overweight mothers, those with primary to higher level of education, those in the business profession, fathers who also received primary to higher education, mothers who received more than one ANC visit, and those living in wealthy households in Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions were more likely to have CS deliveries in rural areas. The 45-49 age group mothers had a five times higher likelihood of CS deliveries [odds ratio (OR): 5.39] in urban areas than in rural areas. Wealthy mothers were more likely to be CS-delivered in urban (OR: 4.84) than in rural areas (OR: 3.67). Conclusion: The findings reveal a gradual upward alarming trend in CS deliveries with an unequal contribution of significant determinants in urban and rural areas of Bangladesh. Therefore, integrated community-level awareness programs are an urgent need in accordance with the findings on the risks of CS and the benefits of vaginal deliveries in this country.

Prevalence and determinants of wasting among under-5 Egyptian children: Application of quantile regression.

Wasting is one of the symptoms of malnutrition that has been connected to the deaths of malnourished children. This study was intended to explain the effect of socio-demographic and economic factors on under-5 wasting by evaluating their conditional effect across the distribution of weight-for-height Z (WHZ) scores using the quantile regression (QR) model. The weighted sample which included 13,680 children under 5 years was taken from the countrywide Egyptian DHS 2014 survey. The results depicted that about 2% of Egyptian children were severely wasted, with the prevalence of wasting being around 8%. It was discovered that across the WHZ distribution, the child's features, maternal characteristics, father's education, and social factors had significant but varied contributions in explaining the wasting status of under-5 children. It was revealed that female children had a significant weight advantage, notably 0.21 standard deviation (SD) higher weight at the 95th quantile over their male counterparts. The WHZ score was also found to be significantly positively associated with both age and household's wealth status at the lower and upper tails of the WHZ distribution, respectively. Moreover, in comparison with children whose mothers were underweight, those whose mothers were normal or overweight had higher WHZ scores, with a 1.45 SD increase in WHZ scores at the 95th quantile for mothers who were normal weights. Furthermore, the children who were breastfed, whose mothers received antenatal care (ANC) services, and/or who had educated parents had an advantage in terms of WHZ scores than their counterparts. In addition, the children with higher birth order and/or who resided in urban areas had weight disadvantages compared to their counterparts. Therefore, in order to improve children's nutritional status and achieve the Sustainable Development Goals (SDGs) by 2030, the government and public-private owner organizations must work together at the community level focusing on vulnerable groups.

Prevalence and risk predictors of childhood stunting in Bangladesh.

BACKGROUND: The child nutritional status of a country is a potential indicator of socioeconomic development. Child malnutrition is still the leading cause of severe health and welfare problems across Bangladesh. The most prevalent form of child malnutrition, stunting, is a serious public health issue in many low and middle-income countries. This study aimed to investigate the heterogeneous effect of some child, maternal, household, and health-related predictors, along with the quantiles of the conditional distribution of Z-score for height-for-age (HAZ) of under five children in Bangladesh. METHODS AND MATERIALS: In this study, a sample of 8,321 children under five years of age was studied from BDHS-2017-18. The chi-square test was mainly used to identify the significant predictors of the HAZ score and sequential quantile regression was used to estimate the heterogeneous effect of the significant predictors at different quantiles of the conditional HAZ distribution. RESULTS: The findings revealed that female children were significantly shorter than their male counterparts except at the 75th quantile. It was also discovered that children aged 7-47 months were disadvantaged, but children aged 48-59 months were advantaged in terms of height over children aged 6 months or younger. Moreover, children with a higher birth order had significantly lower HAZ scores than 1st birth order children. In addition, home delivery, the duration of breastfeeding, and the BCG vaccine and vitamin A received status were found to have varied significant negative associations with the HAZ score. As well, seven or fewer antenatal care visits was negatively associated with the HAZ score, but more than seven antenatal care visits was positively associated with the HAZ score. Additionally, children who lived in urban areas and whose mothers were over 18 years and either normal weight or overweight had a significant height advantage. Furthermore, parental secondary or higher education had a significant positive but varied effect across the conditional HAZ distribution, except for the mother's education, at the 50th quantile. Children from wealthier families were also around 0.30 standard deviations (SD) taller than those from the poorest families. Religion also had a significant relationship with the conditional HAZ distribution in favor of non-Muslim children. CONCLUSIONS: To enhance children's nutritional levels, intervention measures should be designed considering the estimated heterogeneous effect of the risk factors. This would accelerate the progress towards achieving the targets of Sustainable Development Goals (SDGs) related to child and maternal health in Bangladesh by 2030.

Burden of COVID-19 on health and wellbeing, education, and economy of Bangladesh.

The long-term impact of this pandemic will continue in almost all sectors of a country such as health, economic situations, education, mental health, and violence. Therefore, the authors intended to discuss the prolonged effect of COVID-19 on the health along with wellbeing, education, and economy of Bangladesh through a mixed approach. To assess the possible scenario in health sector of Bangladesh, we conducted a short survey through online with a structured questionnaire. The impact of the pandemic is highlighted by graphical presentations and discussed the issues in light of the existing literature. It is realized that health care services and resources are always essential for predominant health conditions and fatal diseases patients. Mental health has also been impacted a lot during this pandemic. Moreover, students of only those schools located in urban areas are attended some online classes but due to the internet interruption and scarcity of devices students from rural areas cannot attend the classes and it will widen the gap between pupils from urban areas and those who live in remote rural areas. Additionally, many students terminate school. The country's youth unemployment is projected to intensify as a result of the economic effects, which would promote antisocial behavior and cause social discontent among young people. Also, the flow of remittances greatly declined in the last couple of months and a many people were jobless abroad, and the majority of them were sent back home. The demographic dividend's intended results are expected to be negatively impacted by COVID-19's overall effect as well as sustainable development goals (SDGs) in Bangladesh. Therefore, many social services systems need strategic backup resources at community, national, and global levels if any basic system may collapse due to COVID-19 and socio-economic as well as geopolitical negligence in handling post-pandemic challenges.

Challenges and difficulties faced in low- and middle-income countries during COVID-19.

Objectives: The ongoing COVID-19 pandemic, caused by a novel coronavirus SARS-CoV-2, has created a severe threat to global human health. We are extremely lucky because within the first year of the COVID-19 pandemic, scientists developed a number of vaccines against COVID-19. In this paper, the authors discuss the difficulties and challenges faced in different low-and middle-income countries due to the ongoing pandemic. Study design and methods: This research is primarily based on secondary data and existing literature reviews. The authors use maps and graphical representations to show information about vaccination coverage. Results: The lacking vaccination coverage and insufficient supply of oxygen tanks in hospitals of low- and middle-income countries (LMICs) raise the likelihood of death of the critical COVID-19 patients. Developed countries vaccinate their citizens more quickly than LMICs. In comparison to wealthy countries, LMICs usually lack the resources and capacity to obtain the required vaccination doses. Conclusion: It is frequently observed that hospitals in low- and middle-income nations with a dearth of oxygen tanks result in increased suffering and mortality. To avoid a worldwide disaster, LMICs urgently require COVID-19 vaccinations since viruses have no borders, and no one is safe until every one is protected in our interconnected world. Therefore, more national and international collaborative supports are urgently necessary for LMICs in this regard.

Prevalence and determinants of wasting of under-5 children in Bangladesh: Quantile regression approach.

BACKGROUND: Wasting is perhaps one of the signs of malnutrition that has been linked to the deaths of children suffering from malnutrition. As a result, understanding its correlations and drivers is critical. Using quantile regression analysis, this research aims to contribute to the discussion on under-5 malnutrition by analyzing the predictors of wasting in Bangladesh. METHODS AND MATERIALS: The dataset was extracted from the 2017-18 Bangladesh demographic and health survey (BDHS) data. The weight-for-height (WHZ) z-score based anthropometric indicator was used in the study as the target variable. The weighted sample constitutes 8,334 children of under-5 years. However, after cleaning the missing values, the analysis is based on 8,321 children. Sequential quantile regression was used for finding the contributing factors. RESULTS: The findings of this study depict that the prevalence of wasting in children is about 8 percent and only approximately one percent of children are severely wasted in Bangladesh. Age, mother's BMI, and parental educational qualification, are all major factors of the WHZ score of a child. The coefficient of the female child increased from 0.1 to 0.2 quantiles before dropping to 0.75 quantile. For a child aged up to three years, the coefficients have a declining tendency up to the 0.5 quantile, then an increasing trend. Children who come from the richest households had 16.3%, 3.6%, and 15.7% higher WHZ scores respectively than children come from the poorest households suggesting that the risk of severe wasting in children under the age of five was lower in children from the wealthiest families than in children from the poorest families. The long-term malnutrition indicator (wasting) will be influenced by the presence of various childhood infections and vaccinations. Furthermore, a family's economic position is a key determinant in influencing a child's WHZ score. CONCLUSIONS: It is concluded that socioeconomic characteristics are correlated with the wasting status of a child. Maternal characteristics also played an important role to reduce the burden of malnutrition. Thus, maternal nutritional awareness might reduce the risk of malnutrition in children. Moreover, the findings disclose that to enrich the nutritional status of children along with achieving Sustainable Development Goal (SDG)-3 by 2030, a collaborative approach should necessarily be taken by the government of Bangladesh, and non-governmental organizations (NGOs) at the community level in Bangladesh.

Likelihood of infectious diseases due to lack of exclusive breastfeeding among infants in Bangladesh.

BACKGROUND: Bangladesh is a South Asian developing country trying to achieve the Sustainable Development Goals (SDG)-3 and the objective of the Rural Electrification Board (REB) regarding child mortality. Infectious diseases are leading causes of child mortality, and lack of exclusive breastfeeding (EBF) among infants aged 0-6 months increases child morbidity and mortality from various infectious diseases in developing countries. However, as per existing literature, no study has been conducted yet to determine the lack of EBF practice effect on child mortality in Bangladesh. With this backdrop, the authors intend to measure the likelihood of infectious diseases due to the lack of EBF of infants aged 0-6 months in Bangladesh. MATERIALS AND METHODS: This study used Bangladesh Demographic and Health Survey (BDHS) data over 1996-97 to 2017-18. The mothers of infants aged 0-6 months who were willingly participated in the BDHSs were considered to include in our analysis. Initially, there were 9,133 cases in the combined dataset. After filtering, there were 5,724 cases in the final dataset. We have considered diarrhea (D), acute respiratory infection (ARI) separately as well as the presence of either D or ARI or both and named as CoDARI as outcome variables. This study used both graphical and statistical techniques (Chi-square test, Wald test, and logistic regression) to analyze the data. The odds ratio (OR) and 95% confidence interval (CI) were used to quantify the likelihood of infectious diseases due to lack of EBF practice and its elasticity, respectively. RESULTS: The EBF practice got a conspicuous increasing trend, but the prevalence of infectious diseases was declined from 0 to 3 months of age of infants, whereas an inverse scenario is observed between 4-6 months. The significance of that inverse relationship was confirmed by p-value corresponding to the chi-square test and the Wald test of the adjusted regression coefficients after adjusting the associated factor's effect on infectious diseases. The adjusted ORs also concluded that the lack of EBF practice up to six months of age could enhance the risk of D, ARI, and CoDARI by 2.11 [95% CI: 1.56-2.85], 1.43 [95% CI: 1.28-1.60], and 1.48 [95% CI: 1.32-1.66] times higher, respectively. CONCLUSION: Findings of this study emphasize the importance of EBF up to six months of age of infants against diarrhea and ARI specific morbidity and mortality. Our results also agreed to the recommendation of the World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and National Nutrition Programme of Ethiopia (NNPE) that the EBF practice for the first six months of age could be a best, cost-effective, long-lasting natural preventive way to reduce the child morbidity and mortality due to infectious diseases in developing countries. Therefore, findings would help policymakers ensuring the achievement target of REB and SDG-3 associated with the health sector in Bangladesh.

Child marriage and its association with morbidity and mortality of under-5 years old children in Bangladesh.

INTRODUCTION: Child marriage is a significant social and health concern in many low- and middle-income countries (LMICs). This harmful practice violates children's rights and continues to be widespread across developing nations like Bangladesh. This study investigated the mortality trend among Bangladeshi children and the impact of child marriage on under-5 children morbidity and mortality in Bangladesh. METHODS AND MATERIALS: A sample of 8,321 children under-5 years old was analyzed using bivariate and multivariate statistical techniques collected from the recent 2017-18 BDHS data. Chi-square test and logistic regression (unadjusted and adjusted) were used to determine the influence of covariates on the target variable. RESULTS: Results revealed that child mortality was significantly higher among children whose mothers married at an early age than their counterparts. Although the general trend in the prevalence of different childhood mortality in Bangladesh was declining gradually from 1993 to 2018, it was still high in 2018. Also, marriage after 18 years lessens likelihood of diarrhea (adjusted OR = 0.93; 95% CI: 0.76-1.16) and cough (adjusted OR = 0.91; 95% CI: 0.78-1.17) among children. Furthermore, findings reveal that likelihood of different child mortality is higher among early married women. CONCLUSION: Immediate intervention through rigorous enforcement of policies and different programs to raise the age at marriage and by lessening socioeconomic disparities can combat the prevalence of high morbidity and mortality of under-5 years old children. Findings from this study will be helpful to accelerate strategies for achieving the Sustainable Development Goals (SDGs) related to child and maternal health by 2030.

Prevalence and determinants of wife-beating in Bangladesh: evidence from a nationwide survey.

BACKGROUND: Intimate partner violence (IPV) is a global public health concern, with women in low- and middle-income countries (LMICs) bearing a disproportionately high burden. This study investigates the prevalence and factors correlated with attitudes regarding wife-beating among Bangladeshi women in urban-rural contexts. METHODS: A sample of 13,033 urban women and 51,344 rural women data from the Bangladesh Multiple Indicator Cluster Survey (MICS) 2019 were analyzed using the Chi-square test and ordinal logistic regression model. RESULTS: The findings reveal that arguing with her husband is the widespread reason for wife-beating in Bangladesh (urban: 17.3%, rural: 21.9%), followed by neglecting the children (urban: 12.7%, rural: 15.8%). About 8% of urban women and 10% of rural women favoured the opinion that refusing to involve sexual intercourse is a legitimate justification for wife-beating. In comparison, around 5% feel that a husband has a right to beat his wife due to burning food. The respondents' age, education, marital status, number of children, socioeconomic level, any health or physical difficulty, having problems becoming pregnant, and the husband's age are all significant factors in justifying wife-beating. CONCLUSIONS: Bangladesh has a massive challenge in eliminating IPV. Women from lower socioeconomic classes, low levels of education, other challenges, and residents of rural areas are particularly more vulnerable than their urban counterparts. Therefore, it is vital to develop a proper action plan that considers women's education and occupation to raise awareness of the various implications of wife-beating in women, particularly in Bangladesh's rural areas.

Rural-urban determinants of vitamin a deficiency among under 5 children in Bangladesh: Evidence from National Survey 2017-18.

BACKGROUND: Vitamin A supplementation reduces child morbidity, mortality, and blindness of people, especially in developing countries like Bangladesh. This study explores significant determinants of vitamin A deficiency among preschool children in rural and urban areas of Bangladesh. METHODS: The data set was extracted from a nationally representative survey based on a cross-sectional study, the BDHS-2017-18. The base survey was conducted using a two-stage stratified sample of households. A sample of 8364 (urban 2911, rural 5453) children under-5 years old was analyzed using bivariate and multivariate statistical techniques. RESULTS: Results have demonstrated that 73.9 and 73.2% of children have had a vitamin A supplementation from urban and rural areas, respectively. Logistic regression analysis showed that parents' education plays a vital role in consuming vitamin A supplements in urban and rural areas. Children whose mothers have secondary (OR: 1.17, CI: 0.76-1.81) and higher (OR: 1.21, CI: 0.72-2.04) education were more likely to consume vitamin A supplementation than children whose mothers were illiterate in urban areas. However, in rural areas, children whose mothers have secondary education were about 24% and higher education with 60% more likely to consume vitamin A supplementation than children whose mothers were illiterate. Child's age, regional variation and wealth index also contributing factors for vitamin A deficiency in Bangladesh. CONCLUSIONS: These findings indicated that the consumption of vitamin A does not cover the target of sustainable development goals. Thus special national and community level efforts are required to ensure the coverage of the national vitamin A program is increased adequately to the most vulnerable groups of children in Bangladesh.

Intergenerational educational mobility in Bangladesh.

INTRODUCTION: Social mobility is considered as an important indicator of the economic development of a country. However, it varies widely across geographical regions and social groups in developing countries like Bangladesh. This paper intends to evaluate the intergenerational mobility in Bangladesh across generations. METHODS AND MATERIALS: This paper considers a nationally representative sample survey of 8,403 respondents (rural: 5,436 and urban: 2,967). The male and female respondents aged 23 years and above were included in the sample. The education attainment of a son or daughter as compared to their father's education level was considered as the measure of intergenerational mobility. Transition probability matrix and different social mobility indices were used to find out the intergenerational education mobility in Bangladesh. RESULTS: The findings reveal that approximately three-fourth (74.5%) of the respondents attained formal education, while more than half (58.3%) of the respondents' father was illiterate. The educational status of the respondents and their father who lived in urban areas was relatively better than who lived in rural areas. It is also observed that 91.2% and 81.6% of the intergenerational class movement was upward among sons and daughters respectively. The probability of a higher educated father will have a higher educated child is higher in urban areas than in rural areas of Bangladesh. The intergenerational mobility is higher in the primary, secondary, and higher secondary educational levels, though the illiterate and higher education levels are the least mobile classes. In addition, the limiting probabilities reveal that the chance of sending sons to schools by an illiterate father is less as compared to their daughters. Such difference is more obvious in the urban areas, i.e., it is highly likely that sons of the illiterate father are also illiterate. CONCLUSION: Bangladesh has been progressing remarkably in recent years. To keep the pace of the ongoing economic development in the country, it is necessary to give more attention to the illiterate people especially the girls who live in rural areas. The authors anticipate that the findings will be helpful for the policymakers as the relationship between inequality and intergenerational mobility is vital for several aspects of the economic development of a country.

A Non-Linear Biostatistical Graphical Modeling of Preventive Actions and Healthcare Factors in Controlling COVID-19 Pandemic.

BACKGROUND: With the insurgence of the COVID-19 pandemic, many people died in the past several months, and the situation is ongoing with increasing health, social, and economic panic and vulnerability. As most of the countries relying on different preventive actions to control the outcomes of COVID-19, it is necessary to boost the knowledge about the effectiveness of such actions so that the policymakers take their country-based appropriate actions. This study generates evidence of taking the most impactful actions to combat COVID-19. OBJECTIVE: In order to generate community-based scientific evidence, this study analyzed the outcome of COVID-19 in response to different control measures, healthcare facilities, life expectancy, and prevalent diseases. METHODS: It used more than a hundred countries' data collected from different databases. We performed a comparative graphical analysis with non-linear correlation estimation using R. RESULTS: The reduction of COVID-19 cases is strongly correlated with the earliness of preventive initiation. The apathy of taking nationwide immediate precaution measures has been identified as one of the critical reasons to make the circumstances worse. There is significant non-linear relationship between COVID-19 case fatality and number of physicians (NCC = 0.22; p-value ≤ 0.001), nurses and midwives (NCC = 0.17; p-value ≤ 0.001), hospital beds (NCC = 0.20; p-value ≤ 0.001), life expectancy of both sexes (NCC = 0.22; p-value ≤ 0.001), life expectancy of female (NCC = 0.27; p-value ≤ 0.001), and life expectancy of male (NCC = 0.19; p-value ≤ 0.001). COVID-19 deaths were found to be reduced with increased medical personnel and hospital beds. Interestingly, no association between the comorbidities and severity of COVID-19 was found excluding asthma, cancer, Alzheimer's, and smoking. CONCLUSIONS: Enhancing healthcare facilities and early imposing the control measures could be valuable to prevent the COVID-19 pandemic. No association between COVID-19 and other comorbidities warranted further investigation at the pathobiological level.