Prevalence and determinants of antibiotics self-medication among indigenous people of Bangladesh: a cross-sectional study.

OBJECTIVES: Self-medication with antibiotics (SMA) contributes significantly to the emergence of antimicrobial resistance (AMR), especially in low-income countries including Bangladesh. This study aimed to generate evidence on the self-reported prevalence of antibiotic self-medication and its determinants among indigenous people residing in Bangladesh's Chittagong Hill Tracts (CHT) districts. DESIGN: This study used a cross-sectional design with data collected through a survey using a semi-structured questionnaire. SETTING: This study was conducted from late January to early July 2021; among different indigenous group populations aged 18 years or more olders residing in the three districts of CHT. PARTICIPANTS: A total of 1336 indigenous people residing in Bangladesh's CHT districts were included. PRIMARY OUTCOME AND EXPLANATORY VARIABLES: The primary outcome measure was SMA while explanatory variables were socio-demographic characteristics, health status of participants, and knowledge of antibiotics usage and its side effects. RESULTS: Among the study participants, more males (60.54%) than females (51.57%) reported using antibiotics. The SMA rate was high among individuals with education levels below secondary (over 50%) and those in the low-income group (55.19%). The most common diseases reported were cough, cold and fever, with azithromycin being the most frequently used antibiotic. Levels of education, family income, having a chronic illness and place of residence were found to be the significant predictors of having good knowledge of antibiotic use as found in the ordered logit model. Findings from a logistic regression model revealed that men had 1.6 times higher odds (adjusted OR (AOR) 1.57; 95% CI 1.12 to 2.19) of SMA than women. Participants with ≥US$893 per month family income had lowest odds (AOR 0.14; 95% CI 0.03 to 0.64) of SMA than those who earned

Covariates of Knowledge, Attitude, Practice, and Burdens among the Caregivers of Hypertensive Patients.

Caregivers of hypertensive patients play a significant role in ensuring adequate patient care and lowering the risk of hypertension-relatedcomplications. Caregivers are ideal study subjects for identifying gaps in hypertension management. Our study aimed to assess the knowledge, attitude, and practice (KAP) of hypertensive patients' caregivers, to identify their extent of involvement in patients' care, and to assess their care-related attributes. A descriptive cross-sectional study was conducted from August 2020 to February 2021 in the eight largest tertiary care medical college hospitals and all eight divisions of Bangladesh, with 949 caregivers enrolled. Data were collected using a pretested interviewer-administered questionnaire through snowball sampling and analyzed using a one-way ANOVA, independent-sample T-test, and chi-square test. Among the 949 interviewed caregivers, 541 (57.0%) were female, and 479 (50.5%) were aged 18 to 25 years. The percentage scores regarding overall knowledge, attitude, and practice of the caregivers were 54.83 ± 17.95, 47.95 ± 24.05, and 61.26 ± 17.50, respectively. Caregivers' education, history of hypertension, residence, age, relationship with the patient, occupation, and caregiving duration were significantly associated with the KAP scores. In addition, factors such as relationship with the patient, age, educational status, occupation, residence, and caregiving duration/day had significant correlations with all types of burden. Findings of this study suggest the necessity for awareness programs for the caregivers of hypertensive patients to diminish the gap in their KAP and improve their mental and physical health.

Prevalence and determinants of adolescent childbearing: comparative analysis of 2017-18 and 2014 Bangladesh Demographic Health Survey.

Objectives: Bangladesh has one of the highest adolescent childbearing rates in South Asia, which prevent women from realizing their full potential in life. This study aimed to compare the prevalence and determinants of adolescent childbearing in Bangladesh using data from the 2014 and 2017-18 Bangladesh Demographic and Health Survey (BDHS). Methods: Nationally representative surveys of respondents were selected using a two-stage sampling process. The study recruited 2,023 and 1,951 ever-married women aged 15-19 from 2014 and 2017-18 BDHS surveys, respectively, from rural and urban settings from all eight geographic divisions of Bangladesh. Univariate and multivariate logistic regression models were fit to determine the factors associated with adolescent childbearing. Result: The adolescent childbearing prevalence rate was 30.8% in 2014 BDHS and 27.6% in 2017-18 BDHS. Marriage at age 13 years or less also reduced significantly in 2017-18 compared to 2014 (12.7% vs. 17.4%, respectively). Significantly higher odds of adolescent childbearing were found in 2014 among women in the Sylhet Division (adjusted odds ratio (AOR) = 3.0; 95% confidence interval (CI): 1.6-6.1) and the Chittagong Division (AOR = 1.8; 95% CI: 1.8-2.7) compared to the Barisal Region; however, in 2017, there were no significant differences was found across the geographic Divisions. Compared to women in the lowest wealth quintile, women in all other quintiles had lower odds of adolescent childbearing, with the lowest odds found among women in the wealthiest quintile (AOR = 0.3; 95% CI: 0.2-0.6). Women who married at age 14-17 had 60% lower odds of adolescent childbearing compared to the women who married at age 10-13. Conclusion: Nearly one-third of married adolescents in Bangladesh were pregnant or had at least one child in 2014, and it was reduced only marginally in 2017-18. Marriage at an early age and income inequalities among families were significant predictors of adolescent childbearing in Bangladesh. This study highlighted change in the magnitude and determinants of adolescent childbearing in Bangladesh taken data from two nationally representative surveys conducted 4 years apart.

Prevalence and determinants of self-medication practices among general population: A cross-sectional study in Thimphu, Bhutan and Chattogram, Bangladesh.

Background: Self-medication is a global phenomenon and a potential contributor to negative health consequences on human health including emergence of antibiotic drug resistance globally. Objective: The primary objective of this study was to estimate the prevalence and determinants of self-medication in Thimphu, Bhutan and Chattogram, Bangladesh, two neighbouring South Asian country. Methodology: A community-based cross-sectional study was conducted in the city of Thimphu, Bhutan and Chattogram, Bangladesh. A pre-tested and semi-structured questionnaire was used to collect information on socio-demographic characteristics, health status and self-medication practices in the previous year. Results: Out of the 998 recruited participants, 61.8% (170/275) from Thimphu and 41.5% (300/723) from Chattogram reported self-medication practices in last year of interview. In Thimphu, eye/ear infection (90.9%), fever (84.9%), headache (80.5%) and cough and cold (78.2%) were the major illnesses reported for self-medication, whereas in Chattogram people mostly self-medicated for skin disorder (74.4%), diarrhoeal illness (59.1%) and eye/ear infection (48.1%). Knowledge on side-effects of the drugs taken for self-medication was comparatively higher in Thimphu than in Chattogram. Both in Thimphu and Chattogram, higher odds of self-medication were found for common illnesses with adjusted OR 7.8; 95% CI 3.3-18.4 and adjusted OR 2.0; 95% CI 1.4-2.8, respectively in Thimphu and Chattogram. Conclusion: Self-medication was found to be substantially high in both the cities, however, rate of self-medication was higher in Thimphu compared to Chattogram. Knowledge and awareness raising about harmful effect of self-medication and effective regulation over selling of prescription medication in pharmacies should be strengthened in both countries.

Knowledge, attitude and practice of diabetes among secondary school-going children in Bangladesh.

Diabetes Mellitus (DM) is a global public health concern. DM has been increasing alarmingly among the young people and childhood-onset has now become an emerging issue worldwide. Unlike other chronic diseases, DM requires constant and active attention of the patients, sometimes of their family members for successful management of this disease. Knowledge, attitude, and practices make significant differences at the population level, which largely depend on socioeconomic status, area of residence, level of education, and other socio-demographic attributes. A descriptive cross-sectional study was carried out among secondary school students in grades 6 through 10 attending schools in 18 districts of Bangladesh. A total of 2009 students were enrolled for the study from the selected schools and madrasas from Bengali, English, and Arabic medium. The majority of responders (79.34%) reported that they had heard of diabetes, however, only 45% knew that diabetes can cause blood glucose levels to rise. Among different therapeutic options, only 15% of students had heard the name of metformin, while 56.2% were familiar with insulin. English medium students were significantly more likely to have good knowledge than the Bangla medium students (19.31%, OR: 1. 44; 95% CI: 1.07, 1.95). Respondents of semi-urban (19.66%, OR: 1.7; 95% CI: 1.21, 2.36) and urban (18.47%, OR: 1.48; 95% CI: 1.17, 1.86) areas were more likely to have good knowledge than rural areas. Of the respondents, 20.61% did not know of any diabetic treatment options. Only a small percentage of students (11%) attended any diabetes education classes and 10.7% of students followed any recommended diabetes prevention methods. Knowledge, attitude, and practice related to diabetes were found to have been influenced by socioeconomic factors, societal practices, and behavioral patterns. This is the first nationwide research study in Bangladesh among secondary school students to study knowledge, attitudes, and practices related to diabetes. With a focus on Bangladesh's youthful population, this study sought to provide an informational framework that can be supportive for effective intervention to increase knowledge of diabetes and its implications.

The relationship between medical comorbidities and health-related quality of life among adults with type 2 diabetes: The experience of different hospitals in southern Bangladesh.

OBJECTIVE: Health-related quality of life (HRQoL) is a critical determinant to assess the severity of chronic diseases like diabetes mellitus. It has a close association with complications, comorbidities, and medical aid. This study aimed to estimate the prevalence of medical comorbidities and determine the relationship between comorbidities and HRQoL among type 2 diabetic patients of southern Bangladesh. METHOD: This study was a cross-sectional study conducted through face to face interviews using a pre-tested structured questionnaire and by reviewing patient's health records with prior written consent. The study was conducted on 2,136 patients with type 2 diabetes attending five hospitals of Chattogram, Bangladesh, during the tenure of November 2018 to July 2019. Quality of life was measured using the widely-used index of EQ-5D that considers 243 different health states and uses a scale in which 0 indicates a health state equivalent to death and 1 indicates perfect health status. The five dimensions of the quality index included mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. RESULTS: Patients with three comorbidities and with four or more comorbidities had a higher probability of reporting "extreme problem" or "some problem" in all five dimensions of the EQ-5D index compared with those without comorbidity (Odds ratio: mobility, 3.99 [2.72-5.87], 6.22 [3.80-10.19]; usual activity, 2.67 [1.76-4.06], 5.43 [3.28-8.98]; self-care, 2.60 [1.65-4.10], 3.95 [2.33-6.69]; pain or discomfort, 2.22 [1.48-3.33], 3.44 [1.83-6.45]; anxiety or depression, 1.75 [1.07-2.88], 2.45 [1.19-5.04]). The number of comorbidities had a negative impact on quality of life. CONCLUSION: Prevalent comorbidities were found to be the significant underlying cause of declined HRQoL. To raise diabetes awareness and for better disease management, the exposition of comorbidities in regards to HRQoL of people with diabetes should be considered for type 2 diabetes management schemas.

Association between comorbidity and health-related quality of life in a hypertensive population: a hospital-based study in Bangladesh.

BACKGROUND: Hypertension is a known risk factor for several chronic conditions including diabetes and cardiovascular diseases. However, little is known about its impact on Health-related quality of life (HRQoL) in the context of Bangladesh. This study aimed to evaluate the association of hypertension on HRQoL among Bangladeshi patients corresponding to the socio-demographic condition, comorbid conditions, treatment, and health outcomes. METHODS: A hospital based cross-sectional study was conducted using a pre-tested structured questionnaire among patients with hypertension in 22 tertiary medical college hospitals in Bangladesh. The study recruited male and female hypertensive patients of age ≥18 years between July 2020 to February 2021 using consecutive sampling methods. Health related quality of life was measured using the widely-used index of EQ-5D that considers 243 different health-related attributes and uses a scale in which 0 indicates a health state equivalent to death and 1 indicates perfect health status. The five dimensions of the quality index included mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. Ordered logit regression and linear regression models were used to estimate the predictors of comorbidity and HRQoL. RESULTS: Of the 1,912 hypertensive patients, 56.2% were female, 86.5% were married, 70.7% were either overweight or obese, 67.6% had a family history of hypertension, and 85.5% were on anti-hypertensive medication. Among the individuals with comorbidities, 47.6% had diabetes, 32.3% were obese, 16.2% had heart disease, 15% were visually impaired, and 13.8% were suffering from psychological diseases. HRQoL was found to be inversely proportional to the number of comorbidities. The most frequent comorbidities of diabetes and obesity showed the highest EQ- 5D mean utilities of 0.59 and 0.64, respectively. CONCLUSIONS: Prevalent comorbidities, diabetes and obesity were found to be the significant underlying causes of declining HRQoL. It is recommended that the comorbidities should be adequately addressed for better HRQoL. Special attention should be given to address mental health issues of patients with hypertension.

Condom use, symptoms of suggestive sexually transmitted infections, and health care seeking among female sex workers in Bangladesh.

This article presents a mixed-method cross-sectional study reporting condom use, sexually transmitted infection (STI) symptoms, and care seeking of female sex workers (FSWs) in Dhaka, Bangladesh. A survey of 1228 FSWs, in-depth interviews (n = 24), and key informants' interviews (n = 26) were used for data collection. Among the 1228 FSWs included in this study, 50% of them were illiterate and 39.3% were married, and their mean age was 27.1 years. The consistent use of condoms was reported by 75.6% of the FSWs, 88.7% reported having STI symptoms in the last 6 months, while 91.8% visited one of the drop-in centers for services. FSWs without formal education had lower odds of using condoms consistently (AOR: 0.72; 95% CI: 0.55-0.95), and those working elsewhere than in the streets showed higher odds (AOR: 1.63; 95% CI: 1.23-2.15) to use condoms. Stigma to access health care services, poor knowledge about STI/HIV, and low perceived risk were mentioned as causes of having STI symptoms in the survey as well as in qualitative in-depth interviews. Self-reported condom use, STI symptoms, and care-seeking practices were found to be high among the FSWs. Inconsistent condom use and a high number of sex partners could be the reasons for high levels of STI symptoms. Innovative objectively verifiable approaches should be tested to collect condom use data.

Knowledge of cervical cancer and HPV vaccine in Bangladeshi women: a population based, cross-sectional study.

BACKGROUND: The objective of this study was to assess the level of knowledge of cervical cancer among Bangladeshi women and to assess their willingness to receive the human papillomavirus (HPV) vaccine. METHODS: A population-based, cross-sectional survey was conducted from July to December 2011 in one urban and one rural area of Bangladesh. A total of 2037 ever-married women, aged 14 to 64 years, were interviewed using a structured questionnaire. Data on socio-demographic characteristics and knowledge of cervical cancer were collected. Willingness to receive the HPV vaccine was assessed. Univariate analyses were completed using quantitative data collected. Multivariable logistic regression models were developed to identify factors associated with having heard of cervical cancer and the HPV vaccine. RESULTS: The majority of study participants reported to have heard of cervical cancer (urban: 89.7%, rural 93.4%; P = 0.003). The odds of having heard of cervical cancer were significantly higher in urban women aged 35-44 years (aOR: 2.92 (1.34-6.33) and rural women aged 25-34 years (aOR: 2.90 (1.24-6.73) compared to those aged less than 24 years. Very few women reported to have detailed knowledge on risk factors (urban:9.1%, rural: 8.8%) and prevention (urban: 6.4%, rural: 4.4%) of cervical cancer. In our sample, one in five urban women and one in twenty rural women heard about a vaccine that can prevent cervical cancer. Among urban women, secondary education or higher (aOR: 3.48, 95% CI: 1.67-7.25), age of 20 years and above at marriage (aOR: 2.83, 95% CI: 1.61-5.00), and high socioeconomic status (aOR: 2.25, 95% CI: 1.28-3.95) were factors associated with having heard of the HPV vaccine. Willingness to receive the HPV vaccine among study participants either for themselves (urban: 93.9%, rural: 99.4%) or for their daughters (urban: 91.8%, rural: 99.2%) was high. CONCLUSIONS: Detailed knowledge of cervical cancer among Bangladeshi women was found to be poor. Education on cervical cancer must include information on symptoms, risk factors, and preventive methods. Despite poor knowledge, the study population was willing to receive the HPV vaccine.

Barriers to sexual and reproductive healthcare services as experienced by female sex workers and service providers in Dhaka city, Bangladesh.

OBJECTIVES: This study aimed to identify the barriers female sex workers (FSWs) in Bangladesh face with regard to accessing sexual and reproductive health (SRH) care, and assess the satisfaction with the healthcare received. METHODS: Data were collected from coverage areas of four community-based drop-in-centers (DICs) in Dhaka where sexually transmitted infection (STI) and human immunovirus (HIV) prevention interventions have been implemented for FSWs. A total of 731 FSWs aged 15-49 years were surveyed. In addition, in-depth interviews (IDIs) were conducted with 14 FSWs and 9 service providers. Respondent satisfaction was measured based on recorded scores on dignity, privacy, autonomy, confidentiality, prompt attention, access to social support networks during care, basic amenities, and choice of institution/care provider. RESULTS: Of 731 FSWs, 353 (51%) reported facing barriers when seeking sexual and reproductive healthcare. Financial problems (72%), shame about receiving care (52.3%), unwillingness of service providers to provide care (39.9%), unfriendly behavior of the provider (24.4%), and distance to care (16.9%) were mentioned as barriers. Only one-third of the respondents reported an overall satisfaction score of more than fifty percent (a score of between 9 and16) with formal healthcare. Inadequacy or lack of SRH services and referral problems (e.g., financial charge at referral centers, unsustainable referral provision, or unknown location of referral) were reported by the qualitative FSWs as the major barriers to accessing and utilizing SRH care. CONCLUSIONS: These findings are useful for program implementers and policy makers to take the necessary steps to reduce or remove the barriers in the health system that are preventing FSWs from accessing SRH care, and ultimately meet the unmet healthcare needs of FSWs.

Nonacademic Attributes Predict Medical and Nursing Student Intentions to Emigrate or to Work Rurally: An Eight-Country Survey in Asia and Africa.

AbstractWe sought to identify independent, nonacademic predictors of medical and nursing student intent to migrate abroad or from rural to urban areas after graduation in low- and middle-income countries (LMIC). This was a cross-sectional survey of 3,199 first- and final-year medical and nursing students at 16 training institutions in eight LMIC. Questionnaires assessed demographics, career intentions, and preferences regarding selected career, location, and work-related attributes. Using principal component analysis, student preferences were reduced into four discrete categories of priorities: 1) work environment resources, 2) location livability, 3) altruistic job values, and 4) individualistic job values. Students' preferences were scored in each category. Using students' characteristics and priority scores, multivariable proportional odds models were used to derive independent predictors of intentions to emigrate for work outside the country, or to work in a rural area in their native country. Students prioritizing individualistic values more often planned international careers (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.16-1.78), whereas those prioritizing altruistic values preferred rural careers (aOR = 1.82, 95% CI = 1.50-2.21). Trainees prioritizing high-resource environments preferentially planned careers abroad (aOR = 1.38, 95% CI = 1.12-1.69) and were unlikely to seek rural work (aOR = 0.60, 95% CI = 0.49-0.73). Independent of their priorities, students with prolonged prior rural residence were unlikely to plan emigration (aOR = 0.67, 95% CI = 0.50-0.90) and were more likely to plan a rural career (aOR = 1.53, 95% CI = 1.16-2.03). We conclude that use of nonacademic attributes in medical and nursing admissions processes would likely increase retention in high-need rural areas and reduce emigration "brain drain" in LMIC.

Sexual and reproductive health behaviors of female sex workers in Dhaka, Bangladesh.

OBJECTIVES: The objective of this study was to document sexual and reproductive health (SRH) practices among female sex workers (FSWs) including abortion, pregnancy, use of maternal healthcare services and sexually transmitted infections (STIs) with the aim of developing recommendations for action. METHODS: A total of 731 FSWs aged between 15 and 49 years were surveyed using a stratified sampling in Dhaka, Bangladesh. A workshop with 23 participants consisted of policy makers, researchers, program implementers was conducted to formulate recommendations. RESULTS: About 61.3% of 731 FSWs reported SRH-related experiences in the past one year, including abortion (15.5%), ongoing pregnancy (9.0%), childbirth (8.3%) or any symptoms of STIs (41.6%). Among FSWs who had an abortion (n = 113), the most common methods included menstrual regulation through manual vacuum aspiration (47.8%), followed by Dilation and Curettage procedure (31%) and oral medicine from pharmacies (35.4%). About 57.5% of 113 cases reported post abortion complications. Among FSWs with delivery in the past year (n = 61), 27.7% attended the recommended four or more antenatal care visits and more than half did not have any postnatal visit. Adopting sustainable and effective strategies to provide accessible and adequate SRH services for FSWs was prioritized by workshop participants. CONCLUSION: There was substantial unmet need for SRH care among FSWs in urban areas in Dhaka, Bangladesh. Therefore, it is important to integrate SRH services for FSWs in the formal healthcare system or integration of abortion and maternal healthcare services within existing HIV prevention services.

The role of transportation to access maternal care services for women in rural Bangladesh and Burkina Faso: A mixed methods study.

OBJECTIVE: To understand the role of transportation in accessing health care during pregnancy, delivery, and the postpartum period among women in rural Bangladesh and Burkina Faso. METHODS: An exploratory mixed methods study was conducted in Mymensingh district in Bangladesh and Kaya district in Burkina Faso. We recruited 300 women from Bangladesh and 340 from Burkina Faso with a delivery outcome within one year of interview. Key informant interviews were conducted with 19 participants and 12 focus group discussions took place with attendees in selected community clinics. RESULTS: Of the interviewees, 45.7% in Bangladesh and 73.2% in Burkina Faso reported having had health complications during their last pregnancy, delivery, or postpartum period. Of all women, 42.7% in Bangladesh and 67.4% in Burkina Faso sought facility care for their complications. Facility-based delivery was much higher in Burkina Faso (87.7%) than Bangladesh (38.2%). Literacy, transport availability, transportation costs, and travel time were associated with care seeking behavior. CONCLUSION: Lack of reliable transportation was reported as a significant barrier to accessing care during pregnancy, delivery, and postpartum by women in Bangladesh and Burkina Faso. Effort should be made to improve access to emergency obstetric care, and transport intervention should be strengthened.

Medicine Sellers for Prevention and Control of Sexually Transmitted Infections: Effect of a Quasi-Experimental Training Intervention in Bangladesh.

This study used a quasi-experimental pre-post design to test whether short training can improve medicine sellers' (MSs) practices and skills for prevention and control of sexually transmitted infections (STIs) in Bangladesh. The training included lectures, printed materials, and identification of referral sites. Difference-in-differences estimation was used to determine the effects of intervention on key primary and secondary outcomes. Advice given by the MSs in intervention group for partner treatment and condoms use increased significantly by 11% and 9%, respectively, after adjusting for baseline differences in education, religion, age, duration of training, and study site. Referral of clients to qualified service providers increased by 5% in the intervention group compared to the comparison group, but this change was not found to be statistically significant. Significantly higher proportion of MSs in the intervention group recognized the recommended medications as per the national syndromic management guidelines in Bangladesh for treatment of urethral discharge and genital ulcer symptoms. Short training intervention was found to be effective in improving MSs' practice of promoting condom use and partner treatment to the clients. We anticipate the need for broad based training programs of MSs to improve their skills for the prevention and control of STI/HIV in Bangladesh.

Knowledge and skills for management of sexually transmitted infections among rural medical practitioners in Bangladesh.

Sexually transmitted infection (STI) management is considered rudimentary among rural medical practitioners (RMPs) in Bangladesh. We sought to understand the level of knowledge and skills in STI management and to assess the impact of a two-day training orientation among RMPs in Tangail district. Data were collected through a baseline survey of 225 practicing RMPs in the study area and a three-month follow-up survey of 99 RMPs who participated in a two-day STI/HIV orientation training. The level of formal training among RMPs ranged from none (22.7%), to paramedical training (14.7%) and local medical assistant training (62.6%). The baseline survey revealed a low level of STI/HIV knowledge and misconceptions about the transmission of STI/HIV among RMPs. RMPs mostly prescribed first line antibiotics for treatment of common reproductive tract infections (RTIs) including STIs, but they rarely prescribed the correct dosages according to the national RTI/STI management guidelines. Only 3% of RMPs were able to correctly answer all four HIV transmission (unprotected sexual intercourse, blood transfusion, needle sharing and mother to child transmission) questions at baseline, while 94.9% of RMPs answered all four correctly at three months following the training (p=0.001). Only 10% of RMPs reported suggesting the recommended drug (azithromycin) and only 2% mentioned about the recommended dosage (2gm single dose) for the treatment of urethritis/cervicitis; compared to 49.5% suggested azithromycin at follow-up with 39.4% mentioned the recommended 2gm single dose (p=0.001). Our study found low level of knowledge and poor practices related RTI/STI management among RMPs. Short orientation training and education intervention shown promise to increase knowledge and management skills for RTIs/STIs.

Inequalities in maternal health care utilization in sub-Saharan African countries: a multiyear and multi-country analysis.

To assess social inequalities in the use of antenatal care (ANC), facility based delivery (FBD), and modern contraception (MC) in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda) had <350 MMR in 2010 with >4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe) had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS) before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda), ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in countries which made progress towards reducing maternal mortality.

Social inequalities in the utilization of maternal care in Bangladesh: Have they widened or narrowed in recent years?

BACKGROUND: Notwithstanding the significant progress in reducing maternal mortality in recent years, social inequalities in the utilization of maternal care continue to be a challenge in Bangladesh. In this study, we aim to provide a comprehensive analysis of trends in social inequalities in utilization of antenatal care (ANC), facility based delivery (FBD), and skilled birth attendance (SBA) in Bangladesh between 1995 and 2010. METHODS: Data were extracted from the five latest rounds of Bangladesh Demographic Health Surveys (BDHS). The Theil index (T) and between-group variance (BGV) were used to calculate relative and absolute disparities in the utilization of three measures (ANC, FBD, and SBA) of maternal care across six administrative regions. The relative and slope indices of inequality (RII and SII, respectively) were also used to calculate wealth- and education-based inequality in the utilization of maternal care. RESULTS: The results of the T-index suggest that relative inequality in SBA has declined by 0.2% per year. Nevertheless, the estimated BGV demonstrated that absolute inequalities in all three measures of maternal care have increased across administrative divisions. For all three measures of maternal care, the RII and SII indicated consistent socioeconomic inequalities favouring wealthier and more educated women. The adjusted RII suggested that wealth- and education-related inequalities for ANC declined by 9% and 6%, respectively, per year during the study period. The adjusted SII, however, showed that wealth- and education-related inequalities for FBD increased by 0.6% per year. CONCLUSIONS: Although socially disadvantaged mothers increased their utilization of care relative to mothers of higher socioeconomic status, the absolute gap in utilization of care between socioeconomic groups has increased over time. Our findings indicate that wealthier and more educated women, as well as those living in urban areas, are the major users of ANC, FBD and SBA in Bangladesh. Thus, priority focus should be given to implementing and evaluating interventions that benefit women who are poorer, less educated and live in rural areas.

Genital human papillomavirus infection among women in Bangladesh: findings from a population-based survey.

BACKGROUND: There has been no population-based study on human papillomavirus (HPV) prevalence or its genotypes in Bangladesh; a country eligible for GAVI funding for HPV vaccine. METHODS: We used baseline survey data of a prospective cohort study that was conducted in one urban and one rural area of Bangladesh. A total of 997 urban and 905 rural married women, aged 13 to 64 years, were enrolled in the baseline during July-December, 2011. Information was collected on socio-demographic characteristics and potential risk factors for HPV infection followed by gynecological examination and collection of endocervical samples using the cervical cytobrush (Digene cervical sampler). HPV DNA testing was done by Polymerase Chain Reaction (PCR) using a consensus primer set. RESULTS: Prevalence of any HPV infection was 7.7% with no significant difference between urban and rural women. Most common high-risk genotypes were HPV16, HPV66, HPV18, HPV45, HPV31 and HPV53. Urban women working as housemaids or garment workers were at higher risk of any HPV infection (OR = 2.15, 95% CI: 1.13-4.11) compared to housewives. Rural women whose husband lived overseas were almost two times more likely to have any HPV infection (OR = 1.93; 95% CI 1.05-3.55) compared to women whose husbands lived with them. CONCLUSION: The prevalence of HPV infection among Bangladeshi women is similar to other regions of Asia. However, type-specific patterns are different. The study findings will inform the formulation of HPV vaccination policies in Bangladesh, monitoring the impact of vaccination programmes, and the identification of target populations for screening.