"They were quick, insipid, and stuck to the typical medical checkups": A Narrative Study on Women's Expectations and Experiences of Maternity Care in Bangladesh.

The quality of healthcare service delivery is generally determined by how patients' expectations were met successfully. This narrative study explores how women perceive and experience healthcare during childbirth in the context of Bangladesh. This study is inspired by Clandinin and Connelly's three-dimensional paradigm of narrativity that combines temporality, social interaction, and place. To unearth patient-driven narratives, the researcher purposely picked 12 women who gave birth in different private and public health facilities in Bangladesh. Four themes standout from the women's narratives. Excerpts of women's stories have been included in discussing the themes as well as author's conviction on this phenomenon. Most of the participants experienced a shared level of difficulty in choosing the health facilities (private vs public), motivated primarily by delivery costs and social background. Women with a higher level of education and financial means often opted to give birth in private facilities due to their negative perception and experience of the public facility. There was evident discontent when doctors decided for cesarean deliveries. Women were dissatisfied by providers' general lack of empathy and vicarious emotion. However, those women who gave birth in public hospitals expressed some degree of satisfaction which might be attributed to their low expectations and moderate social standing. Women's stories also delved into how societal norms, taboos, and elderly relatives put them in uncomfortable situations. To improve patient-provider interactions, healthcare practitioners should prioritize patient-centered care and collaborative decision-making. Reducing healthcare disparity and resolving superannuated pregnancy norms are also critical challenges.

Menopausal experiences of women of Chinese ethnicity: A meta-ethnography.

OBJECTIVE: Menopause and the changes it brings to a woman's life necessitate a comprehensive approach to face and experience the transition. This paper aims at synthesizing results from qualitative studies of menopausal experiences among Chinese and other women of similar ethnicity and culture. DESIGN AND METHOD: A comprehensive search strategy of multiple databases along with bibliographic hand searches was employed to identify qualitative studies published in English peer-reviewed journals between 2008 and 2022 focused on the menopausal experiences (peri and post-menopause) of Chinese and other women of similar ethnic backgrounds. Twelve studies met the inclusion criteria. The final sample consisted of 238 women aged between 40 to 60 years who had experienced menopausal symptoms. This qualitative systematic literature review adopted Noblit and Hare's seven-stage theoretical meta-ethnographic approach to construct an inductive and interpretive form of synthesis and subsequent analysis. SYNTHESES OF FINDINGS: The synthesis of primary data identified four key concepts that entitle women's menopausal experiences: being menopausal, ramifications on well-being, family and social support around menopause, and healthcare throughout menopause. The subsequent second-order interpretation revealed that women accepted the inevitability of the natural aging process in the decline of sexual drive, reinvented relationships with partners, and expressed the significance of a supportive environment in order to successfully navigate the transition. Third-order interpretations sought to establish a link between physiological complications, loss of femininity, patriarchal-dominated societal norms, and a support system that spans the entire menopause experience. Healthcare's contribution has also been deemed to be insufficient due to a lack of information and empathy from health experts. Negligence or reluctance to seek healthcare and skepticism toward hormone replacement therapy (HRT) had also been a source of concern, as they have had the potential to exacerbate medical difficulties and emotional turmoil. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A comprehensive approach that considers women's physiological and psychological well-being and major attempts to change cultural beliefs and norms about women's sexual health may be effective in aiding menopausal women during their transition. Additionally, appropriate guidelines and management should be in place to enable women to address menopause difficulties effectively with the assistance of healthcare experts and the support of their families and community.

"Do we even have a voice?" Health providers' perspective on the patient accommodation strategies in Bangladesh.

OBJECTIVE: In a resource-constrained setting like Bangladesh, effective patient-provider communication is critical to the delivery of maternal healthcare services. Using communication accommodation theory, this study tried to understand how providers perceive, engage, and accommodate patients' needs in maternity wards. METHODS: This qualitative exploratory study used a semi-structured interview guide to conduct in-depth face-to-face interviews of ten healthcare providers in two government-funded public health facilities in Bangladesh. The interview data were analyzed using MAXQDA 2020 software. RESULTS: The thematic analyses revealed that nurses and midwives faced conceivable neglect from patients and their attendees due to possible service and facility constraints, indicating their low status and control within the service operation. Despite efforts to address patients' emotional and psychological concerns, providers appear to avoid (divergence strategy) confronting patients and their irate visitors. Unimodal convergence emerged when providers accepted patients' arguments about the systematic inadequacy of service facilities. Providers have employed interpretability tactics to communicate medical opinions and applied nonverbal cues where necessary. CONCLUSION: A lack of open communication between healthcare providers and patients necessitated various forms of accommodation. Integrated strategies addressing service restrictions and initiatives fostering patient understanding and cooperation may improve patient-provider communication.

How do traditional media access and mobile phone use affect maternal healthcare service use in Bangladesh? Moderated mediation effects of socioeconomic factors.

BACKGROUND: Exposure to traditional media (TV, radio, and newspapers) and the use of mobile as an interpersonal communication tool allow for a variety of information provision. The purpose of this study is to investigate how women's media and mobile access affect maternal health service (MHS) utilization. The study also aims to look into the moderated mediation effects of socioeconomic variables on the association mentioned above. METHODS: The study analyzed reproductive and media data of 5,011 ever-married women extracted from the latest nationally representative Bangladesh Demographic and Health Survey. Hierarchical logistic regression and moderated mediation analysis are performed to determine the association. RESULTS: Only 26.9% of women used mobile for health service use, while more than 55% had media access. Media access is significantly associated with all three types of MHS use; mobile usage also has a significant association with antenatal and delivery care. When women have both access to media and mobile, the likelihood of delivering in a health facility increased by 1.82 times (AOR: 1.82, 95%CI: 1.51, 2.20) which is slightly better than having access to only one type of media channel. Women's education, household wealth, place of residence, religion, and current working status are among the socioeconomic factors associated with access to media and mobile. Women's education mediates the relationship of media and MHS; however, the mediation effect of women (ß: .45; LLCI: .21, ULCI: .68) on the association of media and place of delivery is seen to be moderated by household wealth. Women who belong to well-off families moderates positively (Effect: .33, 95%CI: .27, .40) the education effect of media and where to deliver. Place of residence, another moderator, significantly moderates (Effect: .09, BootLLCI: .02, BootULCI: .16) the mediation effect of women's education on the association of media and antenatal care visits; women living in urban areas seems to have positively moderated the education effects on the mentioned association. CONCLUSIONS: Provision of media access and mobile use indicate better utilization of MHS in Bangladesh, and women's education mediates these relationships via the influence of household wealth and area of residence. Therefore, while planning interventions to increase MHS use, its relationships with the media and mobile use should be extrapolated. The collective use of these channels could be a catalyst for the success of health promotion initiatives to improve women's health behaviors, build community capacity, and create mass awareness that supports the optimal use of MHS in Bangladesh.

Linking farm production diversity to household dietary diversity controlling market access and agricultural technology usage: evidence from Noakhali district, Bangladesh.

BACKGROUND AND OBJECTIVE: Diversified agricultural production is considered a means to enhance food diversity at the household level, particularly in developing countries where subsistence farming is common. Given the importance of a diversified diet for human health and the persistent malnutrition problem in Bangladesh, a pressing issue is how different crops and livestock production affect household food diversification, and this study sought to answer that question. METHODS: Using a multistage sampling procedure, data were collected from 190 small farm holder households from Hatiya (a coastal rural sub-district of Noakhali, Bangladesh). Farm production diversity (FPD) is measured using the household biodiversity index (HBI), a simple count of all crops and livestock produced on the farm. The household dietary diversity score (HDDS) is calculated, according to Food and Agriculture Organization (FAO) guidelines, by counting 12 food groups consumed by the households in the last 24 h preceding the survey. RESULTS: On average, households consumed 6.49 food groups during the reference day, according to the household biodiversity index (HBI). The generalized Poisson log-linear regression results indicated that farm production diversity had a positive association with HDDS; one group of farm production increased the household dietary diversity (HDD) by 0.084 unit [ß: 0.084, 95% CI: 0.064, 0.106; Exp (B): 1.087], an 8.7% increase in dietary diversity. Total land size, less time to reach the district market, and improved irrigation process affect dietary diversity in bivariate analysis. Farmer's reliance on production diversity reduces when the market is more accessible and improved irrigation is used for production. CONCLUSION: Smallholder farm households in Bangladesh could benefit from context-specific, food-based nutrition-sensitive agriculture policies that focus on triangulation of diversified production, greater market access, and updated agricultural technology utilization.

Provision of renal-specific nutrition knowledge for changing dietary practice in Bangladeshi hemodialysis patients.

Objective: Studies show that provision of nutrition knowledge help renal patients make informed food choices. This study aimed to evaluate the impact of nutrition knowledge for changing dietary practice among Bangladeshi dialysis patients. Methods: Following development of a renal-specific nutrition booklet, a pilot study was conducted among 50 hemodialysis patients from a single dialysis setting. Demographic, anthropometric, clinical, biochemical, dietary data, and a 10-item MCQ on renal-specific nutrition information were collected before and 3 months after the provision of the booklet. Results: 52% of the participants were male, 54% had twice weekly dialysis, age 53 ± 12 years, and dialysis vintage was 46 ± 25 months. Serum potassium and phosphorous, dietary potassium, phosphorous, and phosphorous to protein ratio were significantly reduced after the provision of the booklet. Additionally, patients consuming >3 meals/day increased to 66% while adherence to renal-specific cooking method and vegetable preference were significantly increased to 70% and 62%, respectively. Conclusion: Provision of knowledge via renal-specific nutrition booklet was able to improve patients' dietary practice and enhance their dietary adherence to renal specific recommendations. Innovation: The booklet was developed using locally available food items in local language and was found beneficial in low-resource settings where overall health care facilities, including nutrition support are limited.

Balanced diet related knowledge, attitude and practices (KAP) among adolescent school girls in Noakhali district, Bangladesh: a cross sectional study.

OBJECTIVES: Adolescence, a crucial period for growth velocity including sexual maturation, is an important period of life and young adolescent girls need to have proper knowledge, positive attitudes and practice of balanced diet to achieve optimum growth and development. Considering its importance this study attempts to assess the knowledge, attitude and practice (KAP) of balanced diets among adolescent schoolgirls in Noakhali district, Bangladesh. METHODS: A descriptive cross-sectional study was conducted in three secondary schools in Noakhali district, Bangladesh. A multistage sampling techniques was used to select schools and study participants. A total of 485 adolescent school girls participated and a pre-designed, validated and structured questionnaire was used for data collection. In addition to descriptive statistics, chi-square test and logistic regression were employed for analysis. RESULTS: The results from the study revealed that more than half of the students did not have good knowledge about a balanced diet, 42.8% had a positive attitude, whereas the practice of consuming a balanced diet was rather low (only 4.5%). Students studying in government schools had better knowledge and attitudes than non-government school students. Moreover, 41.1% of students were underweight; more than 60% of respondent's mothers did not have an education higher than secondary school and were mostly unemployed housewives. Parent's education, mother's occupation, and types of school have a strong association with KAP; however, father's education and occupation showed an association of varying degrees. Being knowledgeable was related to positive attitudes, and students with good knowledge had (OR: 1.828; 95% CI: 1.270-2.631) more likely to have positive attitudes towards a balanced diet. CONCLUSIONS: Thus, proper knowledge about a balanced diet should be introduced with basic nutritional knowledge to all levels of public education. Interventions and programs can be designed to improve knowledge, attitude, and more specifically the practice at the household level so that adolescent girls can have a proper diet during their sexual maturation phase.

Effect of supplementary omega-3 fatty acids on pregnant women with complications and pregnancy outcomes: review from literature.

Numerous benefits have been associated with omega-3 fatty acid consumption during pregnancy and the postpartum period, whether it is consumed in the diet with seafood or via supplements such as fish oil. This review primarily aimed to assess the current situation of the impact of omega-3 long-chain Poly Unsaturated Fatty Acid (PUFA) supplementation on the outcomes of pregnancy. The electronic search of Medline, PubMed, Public Library of Science (PLOS) and Google Scholar databases was carried out for papers from 01 February 1995 to 01 March 2017 using keywords such as "pregnancy," "supplement," "long-chain polyunsaturated fatty acids," "omega 3 fatty acids," and "clinical trials." Out of twenty-six studies, both observational and interventional, fourteen studies found the influence of omega 3 fatty acids during pregnancy or the early postpartum period on the duration of gestation and infant size at birth, preeclampsia, depression, and infant visual function and neurodevelopment have been reported. Omega 3 fatty acid intakes (both in terms of absolute amounts of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) and the ratio of these 2 fatty acids) varied widely in these studies, however, and no clear consensus exists regarding the effects of omega 3 fatty acids on any of these outcomes. Because of the potential importance of these fatty acids for pregnant or lactating women, fetus, and newborn infants and the limited data from clinical trials assessing the effect of these fatty acids on pregnancy and infant outcomes, additional research is required to better define optimal intakes of specific omega 3 fatty acids during these critical periods.

Factors Affecting Fast Food Consumption among College Students in South Asia: A Systematic Review.

Unhealthy dietary practices have increased among college students in South Asia. Higher intakes of energy-dense foods may increase health risks such as weight gain in college students. The purpose of the study was to gather evidence on fast food consumption patterns and factors that influenced fast food consumption among college students in South Asia. Electronic databases (CINAHL, PsycINFO, PubMed, and ScienceDirect) were used to find relevant potential English-written articles. We followed the standard process of identification, screening, eligibility assessment, study quality assessment, and data extraction from the included articles in this review. In total, data were synthesized from 28 articles. Factors such as gender, being younger, higher socio-economic class, higher body mass index (being overweight or obese), study groups such as students from Humanities, low nutrition knowledge, and the internet addiction played the roles as positive determinants (all P values < 0.05) of consuming fast food frequently. Furthermore, taste, brand reputation, accessibility, location, price, ambiance, hygiene practice, variety, promotional offers, and timely service significantly (all P values < 0.05) increased intakes of fast food in college students. Engaged institutional nutrition education intervention and multisectoral approaches are necessary to reduce fast food consumption in college students along with enabling them to make healthy food choices.Key teaching pointsFrequency of fast food consumption (daily to several times a week) has increased among college students in recent years in South Asia.This systematic review shows that a number of socio-economic, physiological, and behavioral factors influence fast food consumption in college students.Commonly, male students and persons with higher body mass index consume fast food more often. Taste, price, and convenience, accessibility, availability, ambiance, and location also promote fast food consumption in college students.Nutrition interventions are needed to promote healthy dietary intake behavior among college students in South Asia.

Adopting Andersen's behavior model to identify factors influencing maternal healthcare service utilization in Bangladesh.

BACKGROUND: Equitable maternal healthcare service access and it's optimum utilization remains a challenge for many developing countries like Bangladesh, and different predisposing, enabling, and need-based factors affect the level of maternal healthcare use. The evidently poor maternal healthcare service utilization and disparities among groups in Bangladesh are concerning considering its effect on maternal health outcomes. The study aimed to identify the factors that influence maternal healthcare service (MHS) utilization in Bangladesh by adopting Andersen's behavior model of health service use as the theoretical framework. METHODS: The 2017-18 Bangladesh Demographic Health Survey (2017-18 BDHS) data were used which is nationally representative. The survey study used two-stage stratified sampling to select study households, and data were collected through face-to-face interviews. The desirable, moderate, and undesirable maternal health service (MHS) package was developed based on antenatal, and delivery care services use during pregnancy and childbirth. Multinomial logistic regression and discriminant analysis were performed to analyze the factors that affect MHS use. RESULTS: Out of 5,011 ever-married women, only 31.2% of women utilized the desirable level of MHS. The likelihood of using the desirable level of MHS package, relative to the undesirable category, was 9.38 times (OR: 9.38, 95% CI: 4.30-20.44) higher for women with a higher level of education compared to illiterate women, and the same trend was noticed for husband's education. The wealth index had the highest standardized function coefficients (Beta coefficient: 0.49) in discriminatory function. Women with the richest wealth index were more than 23 times (OR: 23.27, 95% CI: 12.69-42.68) likely to have utilized desirable MHS than their poorest counterparts. The likelihood of service uses also varied according to the child's birth order, administrative regions, and area of residence (rural vs. urban). CONCLUSIONS: Policies and interventions directed towards poverty reduction, universal education, and diminishing geographical disparities of healthcare access might influence the desirable use of maternal healthcare services in Bangladesh.

Geriatric malnutrition and depression: Evidence from elderly home care population in Bangladesh.

Malnutrition is the root of numerous complications ranging from physical disability to mental health problems like depression. Depending on the intensity, depression can lead to emotional fluctuations, even suicidal attempts. Geriatric health in a country like Bangladesh is often ignored, although they are a growing segment of society. This community-based cross-sectional study aimed to determine the prevalence and severity of depression and malnutrition in the elderly to evaluate the relationship between depression and malnutrition. Mini Nutritional Assessment (MNA) was used to determine nutritional status, and Geriatric Depression Scale (GDS) was used to assess depression. About 84% of the participants showed a different array of depression symptoms. The rate of malnutrition and depression is higher among the male participants. Being malnourished (OR: 4.05, 95% CI: 2.79-5.87) and people are at risk of malnutrition (OR:1.67, 95% CI:1.24-2.24) had a significantly higher risk of suffering from depression. Maintaining a good physical state, a healthy lifestyle, and a supportive family environment are among the factors that can reduce depression in the elderly population. Therefore, to fight depression, specific programs and targeted interventions focusing on physical and mental stability for the elderly at the community level can enhance awareness at the individual and family levels.

Comorbidities might be a risk factor for the incidence of COVID-19: Evidence from a web-based survey.

The global pandemic of COVID-19 is posing the biggest threat to humanity through its ubiquitous effect of unfathomable magnitude. Although COVID-19 is a viral disease, there might be an association between different comorbidities and the occurrence of the disease. Our study aims to determine the association between the COVID-19 infection and pre-existing comorbidities such as asthma, diabetes, liver disease, lung disease, heart disease, kidney disease, hypertension, and obesity through a web-based self-reported survey. Univariate and multivariate logistic regression analyses were done using these risk factors as independent variables. A total of 780,961 participants from 183 different countries and territories participated in this study. Among them, 1516 participants were diagnosed with COVID-19 prior to this study. A significant risk association was observed for age above 60 years, female gender, as well as different pre-existing disease conditions such as diabetes, kidney disease, liver disease, and heart diseases. Asthma and diabetes were the major dominant comorbidities among patients, and patients with existing diabetes were more likely to develop the disease than others who did not diagnose as diseased. Therefore, older adults, females, as well as people with comorbidities such as diabetes mellitus, heart disease, kidney disease, and liver disease are the most vulnerable population for COVID-19. However, further studies should be carried out to explain the pathway of these risk associations.

Prevalence and Associated Factors of Early Cessation of Exclusive Breastfeeding Practice in Noakhali, Bangladesh: A Mixed-Method Study.

PURPOSE: Though the benefits of exclusive breastfeeding (EBF) till the age of six months are unanimously perceived and ubiquitously accepted, there are several factors that impede this great practice all over the world, and Bangladesh is no exception. DESIGN AND METHODS: A clinic-based, mixed-method, cross-sectional study was conducted to investigate the EBF practice and the possible causes of early cessation in Noakhali district, Bangladesh. The Kaplan-Meier survival curve with a log-rank test was used to compare the survival differences of recommended and observed EBF practices. The life table for EBF practice was also presented, and the multivariate cox proportional regression model was used to identify the predictors of EBF duration. Two focus group discussions were conducted to generate qualitative data on EBF cessation. RESULTS: The mean duration of EBF was five months; only 30% of mothers did not complete EBF, and the cumulative survival curve showed a sharp fall after four months of breastfeeding. However, factors such as mother's advanced age (30 years or above; AHR: 0.376, 90% CI: 0.158-0.893) and low level of education increase the risk of the EBF cessation, while being housewife mothers, preceding birth interval of more than 2 years and living in urban areas decreases the risk of EBF termination. Perceived inadequacy of breast milk and some cultural norms were among the cessation factors revealed in qualitative analysis. CONCLUSIONS: Although the completion rates of EBF practice seem to be high in this study population, some socio-cultural issues remain to be addressed, and further promotional efforts should be made to continue and improve the EBF practice.

Trans fatty acids and lipid profile: A serious risk factor to cardiovascular disease, cancer and diabetes.

Trans Fatty acids (TFAs) have long been used in food manufacturing due in part to their melting point at room temperature between saturated and unsaturated fats. However, increasing epidemiologic and biochemical evidence suggests that excessive trans fats in the diet are a significant risk factor for cardiovascular events as well as a risk factor for cancer and diabetes. A 2% absolute increase in energy intake from trans-fat has been associated with a 23% increase in cardiovascular risk. They increase the levels of low-density lipoprotein which is bad for health. Moreover, several epidemiological studies have been demonstrated that a high intake of TFAs increases the incidence of cancer and diabetes. On the other hand, total elimination of TFAs is not possible in a balanced diet due to their natural presence in dairy and meat products. Many products with almost 0.5 g trans-fat, if consumed over the course of a day, may approximate or exceed the 2 g maximum as recommended by the American Heart Association. The objective of the review to demonstrate the causal association between trans fatty acid intake and increase the risk of coronary heart disease through their influence on lipoprotein, association with atherosclerosis, stroke, diabetes and cancer.

Comparison of the energy and environmental performances of nine biomass/coal co-firing pathways.

Life cycle energy and environmental performances of nine different biomass/coal co-firing pathways to power generation were compared. Agricultural residue (AR), forest residue (FR), and whole trees (WT) as feedstock were analyzed for direct (DC) and parallel co-firing (PC) in various forms (e.g., chip, bale and pellet). Biomass co-firing rate lies in the range of 7.53-20.45% (energy basis; rest of the energy comes from coal) for the co-firing pathways, depending on type of feedstock and densification. Net energy ratios (NER) for FR-, WT-, and AR-based co-firing pathways were 0.39-0.42, 0.39-0.41, and 0.37-0.38, greenhouse gas (GHG) emissions were 957-1004, 967-1014, and 1065-1083 kg CO(2eq)/MWh, acid rain precursor (ARP) emissions were 5.16-5.39, 5.18-5.41, and 5.77-5.93 kgSO(2eq)/MWh, and ground level ozone precursor (GOP) emissions were 1.79-1.89, 1.82-1.93, and 1.88-1.91 kg (NO(x)+VOC)/MWh, respectively. Biomass/coal co-firing life cycle results evaluated in this study are relevant for any jurisdiction around the world.

Development of net energy ratio and emission factor for biohydrogen production pathways.

This study investigates the energy and environmental aspects of producing biohydrogen for bitumen upgrading from a life cycle perspective. Three technologies are studied for biohydrogen production; these include the Battelle Columbus Laboratory (BCL) gasifier, the Gas Technology Institute (GTI) gasifier, and fast pyrolysis. Three different biomass feedstocks are considered including forest residue (FR), whole forest (WF), and agricultural residue (AR). The fast pyrolysis pathway includes two cases: truck transport of bio-oil and pipeline transport of bio-oil. The net energy ratios (NERs) for nine biohydrogen pathways lie in the range of 1.3-9.3. The maximum NER (9.3) is for the FR-based pathway using GTI technology. The GHG emissions lie in the range of 1.20-8.1 kg CO2 eq/kg H2. The lowest limit corresponds to the FR-based biohydrogen production pathway using GTI technology. This study also analyzes the intensities for acid rain precursor and ground level ozone precursor.