Knowledge of gendered needs among the planners and policy makers for prevention of NCDs in Bangladesh: a qualitative exploration.

BACKGROUND: Globally, non-communicable diseases (NCDs) are increasingly the primary cause of mortality and morbidity among women. Like many developing countries, Bangladesh also faces a growing burden of NCDs. The "Multisectoral Action Plan for Prevention and Control of Non-communicable Diseases, 2018-2025" signifies Bangladesh's commitment to comprehensively combating the rising burden of NCDs. This study investigates the perceptions of those involved in developing the action plan and if/how a gender lens was incorporated into its implementation. METHODS: In-depth interviews were conducted with 25 key individuals involved in a high-level committee to develop and implement Bangladesh's multisectoral action plan to address the burden of NCDs. Data were collected between July and November 2021, and thematic analysis was conducted. RESULTS: The findings revealed that interviewees believed the multisectoral action plan adopted a population-wide approach without considering gender-specific needs. This study presents the explanations for this inattention under five themes: (1) A population-level approach to NCD prevention; (2) Understanding women's health beyond reproductive health; (3) Absence of gender-specific programs; (4) Lack of consideration of gender constraints on physical activity; and (5) Lack of collaborative efforts to address NCDs beyond the health ministry. CONCLUSION: In conclusion, governments in countries like Bangladesh can develop more effective strategies to reduce the disease burden of NCDs among women by recognizing and addressing the gendered nature of preventive health. This can be achieved by promoting gender-responsive research, programs, and policy initiatives that consider women's specific health concerns, ultimately leading to better health outcomes for all.

A systematic review of the health of internal migrants in Bangladesh.

Internal migrants are more disadvantaged than non-migrants in terms of their health. However, the extent of this difference is unclear. Following the PRISMA guideline, we conducted a systematic review to explore the existing evidence on the health of internal migrants of Bangladesh. We searched Pubmed, Web of Science and Google Scholar to identify peer-reviewed literature on health related issues of the internal migrant population and identified 29 papers for inclusion. Included studies reported health issues or risk factors relating to water, sanitisation and hygiene access and practice, risky sexual behaviour and sexually transmitted infection, mental health status, occupational health status, general healthcare availability, healthcare service utilisation and healthcare seeking behaviour. This systematic review reveals that research on health issues of internal migrants of Bangladesh is limited for common communicable and noncommunicable diseases like waterborne and skin disease, tuberculosis, hypertension and diabetes. Further, despite that many of these migrants are labourers, occupational health related issues like work place accidents, musculoskeletal disorders are insufficiently explored. Barriers to healthcare accessibility in this population are poor socioeconomic status, illiteracy and low general health knowledge. For improved development and implementation of health policies targeting this important population, future studies should focus on understudied diseases and disease prevalence and be designed to elicit from the perspectives of internal migrants, their key health needs around risk factors and health services accessibility.

A Rapid Ethnographic Assessment of Cultural and Social Perceptions and Practices About COVID-19 in Bangladesh: What the Policy Makers and Program Planners Should Know.

Anthropological literature on health beliefs and practices related to COVID-19 is scarce, particularly in low and middle-income countries. We conducted a qualitative research on perceptions of COVID-19 among slum residents of Dhaka, Bangladesh from November 2020 through January, 2021. Methods included in-depth interviews and photo elicitation with community residents. Interviews were transcribed and analyzed thematically. Results show scientific explanations of COVID-19 conflicted with interviewees' cultural and spiritual beliefs such as: coronavirus is a disease of rich, sinful people; the virus is a curse from Allah to punish sinners. Interviewees rejected going to hospitals in favor of home remedies, and eschewed measures such as mask-wearing or social distancing instead preferring to follow local beliefs. We have highlighted a gap between community beliefs about the pandemic and science-led interventions proposed by health professionals. For public health policy to be more effective it requires a deeper understanding of and response to community perceptions.

Mental health condition of physicians working frontline with COVID-19 patients in Bangladesh.

BACKGROUND: The impact of the unpredictable COVID-19 pandemic had triggered new challenges for mental health. This quick survey aimed to identify the mental health status of physicians who served the people during COVID-19 in Bangladesh. METHODOLOGY: The cross sectional survey was conducted adopting a quantitative approach and using an online questionnaire through Facebook Platform Group. Data was collected from August-October, 2020, on socio-demographic status, information on COVID-19 and questionnaires about Depression Anxiety Stress Scale (DASS-21). A total of 395 participants were enrolled from all eight administrative divisions of Bangladesh. RESULT: Our study reported a higher prevalence of depression (55.3%), anxiety (35.2%), and stress (48.4%) among 347 participants. Female physicians were found to have more stress (OR = 2.16, 95% CI: 1.09 - 4.30) compared to the male. Physicians who were previously diagnosed as mentally ill were found to be significantly more depressed (OR = 3.45, 95% CI: 1.07 - 11.10) and stressed (OR = 4.22, 95% CI: 1.48 - 12.02) compared to them who did not. Along with that, having a chronic disease, working in non-government and COVID hospitals significantly contributed to poor mental health outcomes. CONCLUSION: The study findings denoted that, the mental health of physicians was deeply affected by the pandemic situation. The availability of appropriate mental health support will help foster resilience by giving them the ability and confidence to manage crisis moments like the COVID-19 pandemic.

Exploring the lived experiences of pregnant women and community health care providers during the pandemic of COVID-19 in Bangladesh through a phenomenological analysis.

BACKGROUND: Like many countries, the government of Bangladesh also imposed stay-at-home orders to restrict the spread of severe acute respiratory syndrome coronavirus-2 (COVID-19) in March, 2020. Epidemiological studies were undertaken to estimate the early possible unforeseen effects on maternal mortality due to the disruption of services during the lockdown. Little is known about the constraints faced by the pregnant women and community health workers in accessing and providing basic obstetric services during the pandemic in the country. This study was conducted to explore the lived experience of pregnant women and community health care providers from two southern districts of Bangladesh during the pandemic of COVID-19. METHODS: The study participants were recruited through purposive sampling and non-structured in-depth interviews were conducted. Data was collected over the telephone from April to June, 2020. The data collected was analyzed through a phenomenological approach. RESULTS: Our analysis shows that community health care providers are working under tremendous strains of work load, fear of getting infected and physical and mental fatigue in a widely disrupted health system. Despite the fear of getting infected, the health workers are reluctant to wear personal protective suits because of gender norms. Similarly, the lived experience of pregnant women shows that they are feeling helpless; the joyful event of pregnancy has suddenly turned into a constant fear and stress. They are living in a limbo of hope and despair with a belief that only God could save their lives. CONCLUSION: The results of the study present the vulnerability of pregnant women and health workers during the pandemic. It recognizes the challenges and constraints, emphasizing the crucial need for government and non-government organizations to improve maternal and newborn health services to protect the pregnant women and health workers as they face predicted waves of the pandemic in the future.

'Working to stay healthy', health-seeking behaviour in Bangladesh's urban slums: a qualitative study.

BACKGROUND: Kamrangirchar and Hazaribagh are the largest slum areas in Dhaka, Bangladesh. In 2013, Médecins Sans Frontières initiated an urban healthcare programme in these areas providing services for factory workers and responding to the sexual and reproductive health needs of young women. Little in-depth information is available on perceptions of health and health seeking behaviour in this population. We aimed to provide a better understanding of community perceptions toward health and health care in order to inform programme strategies. METHODS: In-depth interviews were conducted with women (n = 13); factory workers (n = 14); and key informants (n = 13). Participants were selected using purposive maximum variation sampling and voluntarily consented to take part. Topic guides steered participant-led interviews, which were audio-recorded, translated and transcribed from Bangla into English. By comparing cases, we identified emerging themes, patterns and relationships in the data. NVivo11© was used to sort and code the data. RESULTS: Emerging themes indicated that in Kamrangirchar and Hazaribagh, health is seen as an asset necessary for work and, thus, for survival. Residents navigate a highly fragmented health system looking for 'quick fixes' to avoid time off work, with the local pharmacy deemed 'good enough' for 'common' health issues. Health care seeking for 'serious' conditions is characterised by uncertainty, confusion, and unsatisfactory results. Decisions are made communally and shaped by collective perceptions of quality care. People with limited socio-economic capital have few options for care. 'Quality care' is perceived as comprehensive care 'under one roof,' including predictive biomedical diagnostics and effective medication, delivered through a trusting relationship with the care provider. CONCLUSIONS: Health seeking behaviour of slum dwellers of Kamrangirchar and Hazaribagh is based on competing priorities, where quick and effective care is key, focussed on the ability to work and generate income. This takes place in a fragmented healthcare system characterised by mistrust of providers, and where navigation is informed by word-of-mouth experiences of peers. Improving health in this context demands a comprehensive and integrated approach to health care delivery, with an emphasis on rapid diagnosis, effective treatment and referral, and improved trust in care providers. Health education must be developed in collaboration with the community to identify knowledge gaps, support decision-making, and be channelled through existing networks. Further research should consider the effectiveness of interventions aiming to improve the practice of pharmacists.

Exploring the system capacity to meet occupational health and safety needs: the case of the ready-made garment industry in Bangladesh.

BACKGROUND: Since the 2013 Rana Plaza incident in Bangladesh, the government of Bangladesh has been under pressure to improve health and safety conditions for workers in the ready-made garment industry. Its efforts have focused heavily on structural safety of the buildings but have largely ignored broader occupational health system issues. This qualitative study explores contextual factors and system challenges that create barriers for ensuring a healthy and safe workplace in the ready-made garment industry in Bangladesh. METHODS: Data were collected through key informant interviews (n = 14) with government officials from the Department of Inspection for Factories and Establishments (DIFE), factory employers, factory doctors and representatives from the Bangladesh Garment Manufacturers and Exporters Association (BGMEA). A thematic analysis was conducted using Atlas-ti v 5.2. RESULTS: A thematic analysis suggests that the capacity of the DIFE to provide adequate occupational health services remains a problem. There is a shortage of both appropriately trained staff and equipment to monitor occupational health and safety in factories and to gather useful data for evidence-based decision-making. Another barrier to effective occupational health and safety of workers is the lack of cooperation by employers in recording data on workers' health and safety problems. Finally, government officials have limited resources and power to enforce compliance with regulations. Such deficiencies threaten the health and safety of this important, largely female, working population. CONCLUSION: This case example focused on the valuable ready-made garment industry sector of Bangladesh's economy. It identifies the critical need for occupational health system strengthening. Specifically system capacity needs to be improved by both increasing human resources for in-factory hazards and health monitoring, regulatory inspection, enforcement, and improved training of government officials around monitoring and reporting.

Sewing shirts with injured fingers and tears: exploring the experience of female garment workers health problems in Bangladesh.

BACKGROUND: The ready-made garment industry in Bangladesh not only contributes to the nation's economic development, but has created income opportunities for women, benefiting their whole family. However, these benefits come at considerable cost to the women. This research examines how the work environment and gendered family role in this conservative society affect the health of the female industrial workers. METHODS: A qualitative study employed in-depth interviews (n-20) and focus group discussions with female garment workers (n-4) in two cities of Dhaka district. Further, key informant interviews (n = 4) with factory doctors, along with eight workplace observations were conducted to explore the lived experience of female workers' health issues. Interview transcripts were coded in Atlas-ti, 5.2. The data were analysed using thematic analysis approach. The themes are illustrated with case narratives. RESULTS: The female workers reported that their work has led to back and joint pain, continuous headache, eye pain and difficulty in breathing associated with inhaling fabric dust. Inadequate lighting, constantly sitting in one position without back rest and continuous noise from hundreds of machines makes them feel permanently tired. Further, the female workers reported that working in the factory and meeting the expectations of the families at home has doubled their workload. The doctors indicated that the physical work environment, their low job status and the nature of the job affect the health of female workers. CONCLUSION: This study found that female workers in the ready-made garment industry face a high risk of health problems. Both government and non-government organizations need to be better involved in designing interventions targeting these women, to protect them from such health risks. In addition, recognition by the whole society of the important role the women play in the economy is needed, so that support by both family and society can be improved.

What makes pregnant workers sick: why, when, where and how? An exploratory study in the ready-made garment industry in Bangladesh.

BACKGROUND: Bangladesh has made significant progress in reducing maternal mortality. Many factors have contributed to this; one is the socio-economic development of the country. The ready-made garment industry is at the forefront of this development creating employment for many women. However, the work environment has the potential to create health problems, particularly for vulnerable groups such as pregnant women. This paper explores perceptions of health problems during pregnancy of factory workers, in this important industry in Bangladesh. METHODS: This study was conducted in four factories using qualitative research methods to provide a view of pregnant workers' health risks beyond a bio-medical approach. Data was collected through in-depth interviews of pregnant workers and observations of their homes and workplaces. Further, key informant interviews with factory health care providers, government officials and employers revealed different perspectives and experiences. Data was collected in the local language (Bengali), then transcribed and analysed using a framework analysis approach. RESULTS: Female workers reported that participation in paid work created an opportunity for them to earn money but pregnancy and the nature of the job, including being pressured to meet the production quota, pressure to leave the job because of their pregnancy and withholding of maternity benefits, cause stress, anxiety and may contribute to hypertensive disorders of pregnancy. This was confirmed by factory doctors who suggested that developing hypertensive disorders during pregnancy was influenced by the nature of work and stress. The employers seemed focused on profit and meeting quotas and the health of pregnant workers appeared to be a lower priority. This study found that the government lacks the resources to understand the extent of the problem or the level of compliance with maternity related regulations. CONCLUSIONS: These results indicate the vulnerability of female workers to physical and mental stress at work and associations with their health problems during pregnancy. It identifies the deficiencies of family, workplace and health service support for these pregnant workers, highlighting the urgent need for government and non-government organisations to work with this important export industry to improve health surveillance and monitoring and the enforcement of existing laws to protect the rights and conditions of pregnant women.

Assessing the capacity of ministries of health to use research in decision-making: conceptual framework and tool.

BACKGROUND: The capacity to demand and use research is critical for governments if they are to develop policies that are informed by evidence. Existing tools designed to assess how government officials use evidence in decision-making have significant limitations for low- and middle-income countries (LMICs); they are rarely tested in LMICs and focus only on individual capacity. This paper introduces an instrument that was developed to assess Ministry of Health (MoH) capacity to demand and use research evidence for decision-making, which was tested for reliability and validity in eight LMICs (Bangladesh, Fiji, India, Lebanon, Moldova, Pakistan, South Africa, Zambia). METHODS: Instrument development was based on a new conceptual framework that addresses individual, organisational and systems capacities, and items were drawn from existing instruments and a literature review. After initial item development and pre-testing to address face validity and item phrasing, the instrument was reduced to 54 items for further validation and item reduction. In-country study teams interviewed a systematic sample of 203 MoH officials. Exploratory factor analysis was used in addition to standard reliability and validity measures to further assess the items. RESULTS: Thirty items divided between two factors representing organisational and individual capacity constructs were identified. South Africa and Zambia demonstrated the highest level of organisational capacity to use research, whereas Pakistan and Bangladesh were the lowest two. In contrast, individual capacity was highest in Pakistan, followed by South Africa, whereas Bangladesh and Lebanon were the lowest. CONCLUSION: The framework and related instrument represent a new opportunity for MoHs to identify ways to understand and improve capacities to incorporate research evidence in decision-making, as well as to provide a basis for tracking change.

Geospatial variation in dietary patterns and their association with heart disease in Bangladeshi population: Evidence from a nationwide survey.

Heart disease is a significant public health threat, and its burden is increasing worldwide. Recent evidence suggests that dietary pattern is a key modifiable factor for heart disease. Research regarding dietary patterns and heart disease in Bangladesh with their spatial variability is limited. In this study, the spatial variation and relationship between dietary patterns and heart disease among Bangladeshi people was investigated. The country-representative Household Income and Expenditure Survey 2016 dataset was used, and a total of 77,207 participants aged 30 years and over were included. A principal component analysis was conducted to derive the dietary patterns. Both statistical and spatial analyses were performed. The overall prevalence of heart disease was 3.6%, with a variation of 0.6% to 10.4% across districts of Bangladesh. Three major dietary patterns, named "festival pattern", "pickles and fast foods pattern", and "rice and vegetable pattern" were identified, accounting for 25.2% of the total dietary variance. Both the dietary pattern and heart disease rate varied across the region. A higher risk of heart disease was persistent in the western-south, southern, central, and eastern regions, as was greater adherence to the "festival pattern" and "pickles and fast foods pattern." After adjusting for confounders, participants with the highest adherence to the "rice and vegetable pattern" were associated with a lower likelihood of developing heart disease (AOR: 0.78, 95% CI: 0.64-0.95, p <0.05), while the highest adherence to the "pickles and fast foods pattern" was associated with a higher likelihood of developing heart disease (AOR: 1.50, 95% CI: 1.27-1.76, p <0.001). The spatial disparities in the prevalence of heart disease and dietary patterns underscore the significance of prioritizing intervention at the district level, especially in the western-south, southern, central, and eastern regions, to control the rising heart disease trends in Bangladesh.

Health service providers' views on barriers and drivers to childhood vaccination of FDMN/Rohingya refugees: a qualitative study in Cox's Bazar, Bangladesh.

Background: Despite established vaccination programs, vaccine-preventable diseases persist among about 900,000 Forcibly Displaced Myanmar Nationals (FDMN)/Rohingya refugees in the world's largest refugee settlement in Bangladesh. Health service providers (HSPs) play a key role in the delivery of childhood vaccination programs. This study explored their views on individual and context barriers and drivers to childhood vaccination in this setting. Methods: Informed by the theoretical framework of the Capability-Opportunity-Motivation-Behavior (COM-B) model for behavior change, this qualitative study collected data through eight focus group discussions (FGDs) with community health workers (CHWs) and vaccinators in selected camps with high or low vaccination coverage rates, and through 11 in-depth interviews (IDIs) with key informants working in strategic, management, and administrative roles. Findings: Barriers and drivers were evident across all COM factors for HSPs and caregivers. Among HSPs, knowledge around vaccination acted both as a barrier and driver, while communication skills and confidence in vaccination served as drivers. Caregivers' lack of awareness of vaccination, concerns and mistrust were described as main barriers. Context barriers included information system deficiencies, family dynamics, HSPs' working conditions, and vaccination site accessibility. Context drivers included effective communication, mobilization, and incentives. Differences between high and low coverage camps in Cox's Bazar included variations in HSPs' knowledge, communication strategies, incentive use, and stakeholder collaboration. Discussion: For better vaccination coverage in the camps, context-related changes regarding collaboration, health workforce and the use of incentives seem necessary. Caregivers' mistrust toward vaccination needs to be considered under the social and historical background of the Rohingya community, and further addressed with targeted communication and campaigning.

A Scoping Review of Studies Evaluating the Healthiness of Street Food Vendors.

PURPOSE OF REVIEW: This scoping review investigates the available tools for monitoring the healthiness of the food sold at street food outlets globally. RECENT FINDINGS: Several tools were identified that have been used to evaluate the healthiness of street food outlets; however, these tools are not applicable globally, do not provide simple measures for evaluating the healthiness of foods sold, and generally have not been used across more than one study. The development of a comprehensive tool for measuring the healthiness of the street food environment that can be used across different jurisdictions and with different levels of resourcing is essential in order to understand the current street food environment and how it changes over time. As a major source of food in low- and middle-income countries globally, the street food environment is important to understand in order to know how it might help address the growing burden of diet-related diseases.

Exploring mental health challenges and coping strategies in university students during the COVID-19 pandemic: A case study in Dhaka city, Bangladesh.

Background: Mental health challenges have emerged worldwide during the COVID-19 pandemic. University students experienced changes in their lifestyles, academic life, family relationships, earning capacity, and support systems. This study explores the common mental health challenges in university students and their coping strategies using social support in the first wave of lockdowns in Dhaka city in 2020. By learning from young people's impacts and coping responses, we can help build an improved strategy for future events of this magnitude. Methods: A qualitative study design was employed to conduct 20 in-depth interviews and two focus group discussions with students from purposively selected three public and three private universities in Dhaka city and five key informant interviews with different stakeholders. We used inductive reflexive thematic analysis and applied six phases of the thematic analysis. Codes retrieved from two differently prepared codebooks were merged and compared to identify themes for a fair interpretation of the underlying data. Data were manually indexed, summarized, and interpreted to categorize codes into sub-themes leading to themes. Results: Financial constraints, academic pressure, learning resources shortages, losing confidence, relationship breakup, excessive internet dependency, and traumatic experiences challenged the mental health conditions of the students unevenly across universities during the COVID-19 pandemic. Expressed mental health well-being impacts ranged from anxiety, stress, and depression to self-harm and suicidal ideation. Family bonding and social networking appeared as robust social support mechanisms to allow students to cope with anxiety, stress, and depression. Partial financial subsidies, soft loans to purchase electronic resources, faculty members' counseling, and sessional health counseling contributed to minimizing the mental health impacts of COVID-19. Conclusion: Mental health is still not a resourced area of health and well-being in Bangladesh. Concentration on developing strong social support and improving increased financial subsidies, including learning resources, can be effective in assisting students in coping with the common mental health burdens during pandemic periods. A national intervention plan should be immediately designed and implemented by engaging different stakeholders including healthcare professionals and establishing effective mental healthcare support centers at universities to avoid immediate and prolonged negative mental health impacts.

Risk communication and community engagement in the context of COVID-19 response in Bangladesh: a qualitative study.

Background: The global COVID-19 pandemic profoundly impacted nations worldwide, and Bangladesh was no exception. In response, the government of Bangladesh implemented community awareness initiatives aimed at containing the spread of the virus, aligned with international guidelines and recommendations. Despite these efforts, a lack of comprehensive community awareness programs played an essential role during the pandemic, not the preventive measures. A qualitative study employing framing theory was conducted to gain a deeper insight into how the social context influenced risk communication and community response throughout the COVID-19 pandemic in Bangladesh. Methods: The study was conducted in four selected districts of Bangladesh from February to May 2022 using complementary data collection methods, including key informant interviews, in-depth interviews, and focus group discussions with purposely selected participants. Data were analyzed thematically by following six steps of the thematic analysis process. Codes were developed based on the data and summarized into themes and sub-themes grounded on the codes. Results: The findings indicate that the government of Bangladesh, along with development partners and non-government organizations, made a significant effort to raise awareness about COVID-19 in the community. However, there were certain limitations to this effort. These include a lack of social science and public health approaches to understanding the pandemic; inadequate coordination among the authorities for COVID-19 prevention and control; technological and geographical barriers for disseminating messages; the living conditions and lack of facilities; socio-cultural norms in understanding the COVID-19 health messages, and the gendered understanding of the messages. The findings also revealed that the awareness activities remained a one-way approach to inform the people and faced challenges to actively engage and create ownership of the community in the pandemic response. Conclusion: The study identified gaps in implementing risk communication and community engagement strategies in Bangladesh during the COVID-19 pandemic. Increasing focus on public health and prioritizing community ownership is essential to designing a more effective community awareness campaign. This approach will help ensure that health messages are communicated effectively and tailored to different communities' needs.

Impact of the COVID-19 lockdown on intimate partner violence: Issues of non-reporting in Bangladesh.

INTRODUCTION: COVID-19 pandemic induced lockdown as prevention and control measure, forced people globally to limit their movements and to stay at home for extended period of time. The objective of this study was to analyze the impact of lockdown on intimate partner violence in Bangladesh. METHODS: We conducted a secondary research by employing a Poisson regression model to estimate the effect of pandemic-led lockdown policy on the change in the number of intimate partner violence-related calls during pandemic using national emergency helpline 999 call logs. Data from January 2019 to May 2020 for 64 districts produced 1088 district-month-year observations which had been used for the main analysis. RESULTS: We found a 46% decrease in the incidence rate of intimate partner violence-related calls during the pandemic after adjusting for year, month, district fixed-effects-suggesting, non-reporting of the violence might have exacerbated during lockdown. CONCLUSION: While increasing rate of intimate partner violence is one side of issue, non-reporting of it has received less attention and during the lockdown non-reporting might grow large and have severe health impacts for women.

Challenges and facilitators of implementation of an information communication and technology (ICT)-based human resources management tool in the government health sector in Bangladesh: protocol for an exploratory qualitative research study.

INTRODUCTION: To improve human resources for health (HRH) management in Bangladesh, the directorate general of health services (DGHS) introduced a new information and communications technology (ICT) tool, named 'human resources information system (HRIS)', to process real-time HRH data of all facilities under the DGHS. However, synchronisation is a major concern since multiple authorities are involved in the implementation of the tool at different tiers of the health system. Introducing ICT tools in healthcare organisations has always proved challenging as evidence from low-income and middle-income countries suggests. The knowledge gap in terms of factors that support or constrain the successful implementation of the HRIS in Bangladesh will be investigated in this exploratory study to identify ways of engaging the key stakeholders in a better way for an effective use of the tool. METHODS AND ANALYSIS: Desk review and qualitative data collection methods will be used to address the study objectives. Key informant interviews and in-depth interviews will be conducted to explore perspectives of policy-makers, programme managers, service providers and other stakeholders to understand the barriers to implementing HRIS in the context of Bangladesh. We plan to organise stakeholder consultation workshops to validate the qualitative study findings and to seek suggestions for ensuring a successful implementation of the HRIS. Framework analysis will be applied to analyse qualitative data, and an outline with the definitions of a priori codes guided by the policy engagement framework will be prepared. Besides, emerging themes will also be identified. A data display matrix will be prepared to summarise and interpret the findings for policy review. ETHICS AND DISSEMINATION: The research review committee and the ethical review committee of icddr,b have approved the research protocol. Findings from the study will be communicated through national and international forums, conferences, policy briefs and peer-reviewed journal publications.

The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a 'policy cube' approach.

We assessed the technical content of sugar, salt and trans-fats policies in six countries in relation to the World Health Organization 'Best Buys' guidelines for the prevention and control of non-communicable diseases (NCDs). National research teams identified policies and strategies related to promoting healthy diets and restricting unhealthy consumption, including national legislation, development plans and strategies and health sector-related policies and plans. We identified relevant text in relation to the issuing agency, overarching aims, goals, targets and timeframes, specific policy measures and actions, accountability systems, budgets, responsiveness to inequitable vulnerabilities across population groups (including gender) and human rights. We captured findings in a 'policy cube' incorporating three dimensions: policy comprehensiveness, political salience and effectiveness of means of implementation, and equity/rights. We compared diet-related NCD policies to human immunodeficiency virus policies in relation to rights, gender and health equity. All six countries have made high-level commitments to address NCDs, but dietary NCDs policies vary and tend to be underdeveloped in terms of the specificity of targets and means of achieving them. There is patchwork reference to internationally recognized, evidence-informed technical interventions and a tendency to focus on interventions that will encounter least resistance, e.g. behaviour change communication in contrast to addressing food reformulation, taxation, subsidies and promotion/marketing. Policies are frequently at the lower end of the authoritativeness spectrum and have few identified budgetary commitments or clear accountability mechanisms. Of concern is the limited recognition of equity and rights-based approaches. Healthy diet policies in these countries do not match the severity of the NCDs burden nor are they designed in such a way that government action will focus on the most critical dietary drivers and population groups at risk. We propose a series of recommendations to expand policy cubes in each of the countries by re-orienting diet-related policies so as to ensure healthy diets for all.

A responsive feeding intervention increases children's self-feeding and maternal responsiveness but not weight gain.

Responsive complementary feeding, whereby the mother feeds her child in response to child cues and psychomotor abilities, is low in some countries and likely contributes to malnutrition. Interventions are needed to evaluate whether promoting responsive feeding would add any benefit. Using a cluster-randomized field trial, we evaluated a 6-session educational program that emphasized the practice of child self-feeding and maternal responsiveness. A total of 108 mothers and their 8- to 20-mo-old children in 19 clusters were randomly assigned to the intervention group and 95 in 18 clusters were assigned to the informational control group. Outcomes were assessed at pretest, postintervention, and follow-up. Research assistants, who were unaware of group assignment, observed and coded mother and child midday meal behaviors. At follow-up, the percent of self-fed mouthfuls was 47.8 +/- 42.4 (mean +/- SD) in the responsive feeding group children compared with 32.2 +/- 41.0 in the controls (P = 0.01); likewise, the number of responsive verbalizations was 6.55 +/- 5.9 in the responsive feeding mothers and 4.62 +/- 4.5 in controls (P = 0.01). Intervention mothers recalled more messages. Mouthfuls of food eaten by children and weight were equivalent in the 2 groups. Lack of change in foods eaten and small quantities may explain the similarly low levels of weight gain. These results provide evidence that self-feeding and maternal verbal responsiveness, two developmentally important behaviors, can be increased by targeting specific behaviors with appropriate behavior change strategies of modeling and coached practice. Weight gain may require more nutritional input, especially in areas of high food insecurity.