Prevalence and associated factors of depression among adolescent boys and girls in Bangladesh: findings from a nationwide survey.

OBJECTIVE: To assess the prevalence of and factors associated with depression among adolescent boys and girls. DESIGN: We conducted a nationwide cross-sectional study. SETTING: This study was carried out in 82 randomly selected clusters (57 rural, 15 non-slum urban and 10 slums) from eight divisions of Bangladesh. PARTICIPANTS: We interviewed 4907 adolescent boys and 4949 adolescent girls. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was 'any depression' and the secondary outcome measures were types of depression: no or minimal, mild, moderate, moderately severe and severe. RESULTS: The overall prevalence of no or minimal, mild, moderate, moderately severe and severe depression was 75.5%, 17.9%, 5,4%, 1.1% and 0.1%, respectively. Across most of the sociodemographic, lifestyle and anthropometric strata, the prevalence of any depression was higher among adolescent girls. In both sexes, depression was associated with higher age, higher maternal education, paternal occupation e.g., business, absence of a 6-9-year-old member in the household, food insecurity, household consumption of unfortified oil, household use of non-iodised salt, insufficient physical activity (adjusted odds ratio, AOR: 1.24 for boys, 1.44 for girls) and increased television viewing time e.g., ≥121 minute/day (AOR: 1.95 for boys, 1.99 for girls). Only among boys, depression was also associated with higher paternal education e.g., complete secondary and above (AOR: 1.42), absence of another adolescent member in the household (AOR: 1.34), household use of solid biomass fuel (AOR: 1.39), use of any tobacco products (AOR: 2.17), and consumption of processed food (AOR: 1.24). Only among girls, non-slum urban residence, Muslim religion, and household size ≤4 were also associated with depression. CONCLUSION: The prevalence of depression among adolescent boys and girls is high in Bangladesh. In most sociodemographic, lifestyle and anthropometric strata, the prevalence is higher among girls. In this age group, depression is associated with a number of sociodemographic and lyfestyle factors. The government of Bangladesh should consider these findings while integrating adolescent mental health in the existing and future programmes.

Nutritional Status Among School-Age Children of Bangladeshi Tea Garden Workers.

BACKGROUND: While considerable progress has been made in reducing undernutrition in Bangladesh, regional disparities are known to exist, and certain population subgroups may lag behind. OBJECTIVE: To characterize nutritional status among school-age children in a historically marginalized population of Bangladesh. METHODS: We conducted a cross-sectional assessment of children attending 14 nongovernmental organization-operated schools serving the tea estate population in Kulaura Upazila, Sylhet Division. We randomly selected 168 children from a population of 418 whose parents attended school-organized Parent-Teacher Association meetings. Parents provided consent and data on household food consumption in the past week, foods consumed by children in the past 24 hours, and household food insecurity. We drew venous blood from assenting children for the analysis of hemoglobin and plasma retinol, C-reactive protein, and α1-acid glycoprotein. Children were classified as stunted, underweight, or thin based on comparisons with the World Health Organization standards for height-for-age, weight-for-age, or body mass index-for-age, respectively. RESULTS: Food insecurity was highly prevalent, with ∼85% of households affected. Roughly half of children had low dietary diversity. Prevalence estimates for stunting, underweight, and thinness were 32%, 50%, and 49%, respectively. Approximately 60% of children had a hemoglobin concentration <11 g/dL. The mean (±SD) plasma retinol concentration was 0.79 µmol/L (±0.23 µmol/L), with 34% deficient using a 0.70 µmol/L cutoff. CONCLUSIONS: A heightened focus on tracking progress in underserved populations and appropriately targeted programming will be critical as Bangladesh seeks to accelerate progress toward global development goals for nutrition.

Double burden of malnutrition in children aged 24 to 59 months by socioeconomic status in five South Asian countries: evidence from demographic and health surveys.

OBJECTIVES: We aimed to investigate the socioeconomic inequalities in the burden of underweight and overweight among children in South Asia. We also examined other factors that were associated with these outcomes independently of household's socioeconomic status. DESIGN: Nationally-representative surveys. SETTINGS: Demographic and Health Surveys from Bangladesh, India, Pakistan, Maldives and Nepal, which were conducted between 2009 and 2016. PARTICIPANTS: Children aged 24 to 59 months with valid measurement for height and weight (n=146 996). PRIMARY EXPOSURE AND OUTCOME MEASURES: Primary exposures were household's wealth index and level of education. Underweight and overweight were defined according to the WHO and International Obesity Task Force definitions, respectively. RESULTS: Underweight prevalence was 37% in Bangladesh, 38% in India, 19% in Maldives, 29% in Nepal and 28% in Pakistan. Bangladesh, India and Nepal had similar overweight prevalence (between 2% and 4%) whereas Pakistan (7%) and Maldives (9%) had higher prevalence. Households with higher wealth index or education had lower odds of having underweight children. Adjusted ORs of underweight for richest versus poorest households were 0.4 (95% CI: 0.3 to 0.5), 0.5 (95% CI: 0.5 to 0.6), 0.5 (95% CI: 0.2 to 1.4), 0.5 (95% CI: 0.3 to 0.8) and 0.7 (95% CI: 0.5 to 1.1) for Bangladesh, India, Maldives, Nepal and Pakistan, respectively. Compared with poorest households, richest households were more likely to have overweight children in all countries except Pakistan, but such associations were not significant after adjustment for other factors. There were higher odds of having overweight children in households with higher education in Bangladesh (OR 2.1 (95% CI: 1.3 to 3.5)), India (OR 1.2 (95% CI: 1.2 to 1.3)) and Pakistan (OR 1.8 (95% CI: 1.1 to 2.9)) when compared with households with no education. Maternal nutritional status was consistently associated with children's nutritional outcomes after adjustments for socioeconomic status. CONCLUSIONS: Our study provides evidence for socioeconomic inequalities for childhood underweight and overweight in South Asian countries, although the directions of associations for underweight and overweight might be different.

Protocol for a quasiexperimental study testing the effectiveness of strengthening growth monitoring and promotion in community clinics for improving the nutritional status of under-two children in rural Bangladesh.

INTRODUCTION: The Government of Bangladesh is implementing growth monitoring and promotion (GMP) through community clinics (CC) to improve the nutritional status of children. However, little primary evidence is available on the effectiveness of GMP when delivered through CCs. We aim to examine the effectiveness of GMP activities strengthened in CCs to improve the nutritional status of children under 2 years of age. METHODS AND ANALYSIS: This is a quasiexperimental, two-arm, mixed methods study. In the intervention arm, a non-governmental organisation is providing support to strengthen GMP implementation in the 30 CCs. The comparison arm has no intervention to strengthen GMP implementation in the 30 CCs. Study participants will be under-two children and their caregivers, and CC service providers (community healthcare provider, CHCP). We will collect quantitative information on children and mothers' anthropometry, sociodemographic condition, food security, children's feeding practices, morbidity and vaccination history at baseline, and follow them up every third month thereafter for 12 months. We will collect qualitative information on (1) knowledge, skill and practice of CHCPs to implement GMP; (2) mothers/caregivers' perception, knowledge and experience of GMP from CCs; (3) experience and suggestions of programme managers about operational challenges and for improving quality of GMP service delivery; and (4) views of the concerned policy planners to strengthen GMP at the CC level. Qualitative information will be collected through key informant and in-depth interviews at baseline and endline. The primary outcome will be the change observed in length-for-age Z-score of children. A difference-in-difference and linear mixed effects analysis of quantitative data will be done. Thematic analysis will be conducted for qualitative information. Triangulation of data derived from different methods will be carried out. ETHICS AND DISSEMINATION: This study received ethical approval from the Institutional Review Board of International Centre for Diarrhoeal Disease Research, Bangladesh, and results will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT03824756.