Determinants of stunting among under-five children: Evidence from Cambodian Demographic and Health Survey 2021-2022.

BACKGROUND: Epidemiological and nutritional modifications are causing an increase in stunting in many low- and middle-income countries (LMIC), which will eventually result in juvenile diseases and mortality. Therefore, this study aimed to identify the influential factors contributing to stunting among under-five children in Cambodia. METHODS: A secondary dataset consisting of 3268 under-five children was extracted from the latest Cambodian Demographic and Health Survey (CDHS)-2021/2022 dataset. The Chi-square test and Boruta algorithm were used for covariate selection, and logistic regression approaches were used to determine the influence of demographic, socioeconomic and other factors on the presence of stunting. RESULTS: Findings revealed that about 21% of under-five children were stunted, and the prevalence of stunting was higher in rural areas than in urban areas. The prevalence of child stunting was lower in families with highly educated parents. A child whose father had a secondary education had 0.71 times lower (adjusted odds ratio [AOR]: 0.71, 95% CI: 0.520-0.969) chance of stunting than a child whose father had no education. Findings revealed that Ratnak Kiri, Mondul Kiri, Stung Treng, Pursat and Kampot had a greater prevalence of stunting than other places, ranging from 27.11% to 35.70%, whereas Banteay Meanchey, Phnom Penh and Kandal had the lowest rates, ranging from 12.80% to 16.00%. Results of the Boruta algorithm and logistic regression suggested that under-five stunting is significantly influenced by factors such as the child's age, size at birth, mother's age at first birth, mother's body mass index (BMI), father's educational status, cooking fuel, and wealth index. CONCLUSIONS: It is necessary to take initiatives for reducing the prevalence of stunted children prioritising the identified factors that ultimately help to reduce the burden of child health. The authors believed that the findings of this study will be helpful for policymakers in designing the appropriate policies and actions to achieve the Sustainable Development Goals (SDGs) by reducing stunting among under-five children in Cambodia.

Rural-Urban Determinants of Receiving Skilled Birth Attendants among Women in Bangladesh: Evidence from National Survey 2017-18.

Background: SBAs (skilled birth attendants) play a crucial role in reducing maternal mortality. The proportion of maternal healthcare in Bangladesh that receives quality care at birth has increased; the reasons for this are unknown. The purpose of this study is to see if there has been a change in the use of specific maternal healthcare indicators in urban and rural areas, as well as significant risk factors. Materials and Methods: The data set was extracted from a nationally representative survey based on a cross-sectional study, the Bangladesh Health and Demographic Survey (BDHS) 2017-18. The frequency distribution reveals the general state of SBAs. To identify the association, we performed the chi-square test. Finally, multiple logistic regression was used to analyse the factors associated with SBAs and determine the degree of SBAs disparity between urban and rural areas. Results: In Bangladesh, 53% of women received SBAs during childbirth, with urban and rural areas receiving 68.1 and 52.2 percent, respectively. Women with secondary (AOR: 1.79, CI: 1.05-3.08) and higher (AOR: 4.18, CI: 2.09-8.50) education were more likely to receive SBAs than women in urban areas who were illiterate. Husband's education, women's working status, wealth index, children's birth order, and number of ANC visit are significant factors in receiving SBSs in both urban and rural areas. Higher educated husbands are 1.83 times (AOR = 1.83, CI: 1.04-3.25, p = 0.037) and 1.82 times (AOR = 1.82, CI: 1.29-2.59, p = 0.001) more likely to attend skilled births than uneducated husbands in both urban and rural areas. Respondents from the richest families are more likely to attend skilled births than those from the poorest families in both urban and rural areas. Conclusion: During delivery, significant risk factors are substantially related to SBAs. More attention must be given to rural and illiterate populations, who are less likely to obtain these services, to minimize maternal and neonatal mortality. Special programs could be developed to raise awareness and facilitate the poor in receiving the basic necessities of maternal care.

Exploring the relationship between blood platelet and other components utilizing count regression: A cross-sectional study in Bangladesh.

Background and Aims: Blood, vital for transporting nutrients and maintaining balance, comprises red blood cells, white blood cells, and platelets, each pivotal. Imbalances lead to issues-low red cells cause fatigue (anemia), high white cells hint at infection, low counts raise infection risks. Using trendy statistical approaches, investigating the complex link between platelet counts and numerous blood components. Our investigation, leveraging count regression approaches, revealed deep insights into the interaction between platelet counts and other important hematological markers. Methods: A cross-sectional study utilized data from 3120 individuals, including both male and female participants, who visited these hospitals between June 16, 2022 and December 17, 2022, to assess their blood samples through testing by using convenience non-parametric sampling framework. Platelet count was taken into account as a measure of outcome in this research. This specific study region was chosen for its easy accessibility, which helped the seamless execution of the data-gathering technique. Count regression, negative binomial regression, and quasi-Poisson regression techniques have been employed for examining relationship of the data sets. Results: Three different count regression models were utilized to assess the proper association between the response and the relevant covariates and we found negative binomial count regression model (Akaike information criterion = 76.55, Bayesian information criterion = 76.59, and deviance = 3.14) was providing comparatively better performance than others. Based on the chosen model we found white blood cell, erythrocyte sedimentation rate, and eosinophils are significant but neutrophil, monocyte, and lymphocyte are not significant. We have also gone through proper model adequacy checking for our selected model and we found enough evidence to justify our model. Conclusion: From the result, we found insightful remarks into the mechanisms involved in platelet production and regulation, which can aid in developing increased effective treatments and interventions to maintain optimal platelet levels and prevent health problems related to abnormal platelet counts.

A cross-country comparison of tobacco consumption among youths from selected South-Asian countries.

BACKGROUND: Tobacco consumption (TC) among youths poses significant public health problem in developing countries. This study utilized the data of Global Youth Tobacco Survey (GYTS), 2007 to examine and compare youth TC behavior in Bangladesh, Nepal and Sri Lanka. METHODS: The GYTS covered a total of 2,242 Bangladeshi, 1,444 Nepalese and 1,377 Sri-Lankan youths aged 13-15 years. They represented response rates of 88.9%, 94.6%, and 85.0% for the three countries, respectively. Socioeconomic, environmental, motivating, and programmatic predictors of TC were examined using cross tabulations and logistic regressions. RESULTS: Prevalence of TC was 6.9% (9.1% in males, 5.1% in females) in Bangladesh, 9.4% (13.2% in males, 5.3% in females) in Nepal and 9.1% (12.4% in males, 5.8% in females) in Sri Lanka. The average tobacco initiation age was 9.6, 10.24 and 8.61 years, respectively. Cross tabulations showed that gender, smoking among parents and friends, exposure to smoking at home and public places, availability of free tobacco were significantly (P < 0.001) associated with TC in all three countries. The multivariable analysis [odds ratio (95% confidence interval)] indicated that the common significant predictors for TC in the three countries were TC among friends [1.9 (1.30-2.89) for Bangladesh, 4.10 (2.64-6.38) for Nepal, 2.34 (1.36-4.02) for Sri Lanka], exposure to smoking at home [1.7 (1.02-2.81) for Bangladesh, 1.81 (1.08-2.79) for Nepal, 3.96 (1.82-8.62) for Sri Lanka], exposure to smoking at other places [2.67 (1.59-4.47) for Bangladesh, 5.22 (2.76-9.85) for Nepal, 1.76 (1.05-2.88) for Sri Lanka], and the teaching of smoking hazards in schools [0.56 (0.38-0.84) for Bangladesh, 0.60 (0.41-0.89) for Nepal, 0.58 (0.35-0.94) for Sri Lanka]. CONCLUSIONS: An understanding of the influencing factors of youth TC provides helpful insights for the formulation of tobacco control policies in the South-Asian region.

Predictors of the number of under-five malnourished children in Bangladesh: application of the generalized poisson regression model.

BACKGROUND: Malnutrition is one of the principal causes of child mortality in developing countries including Bangladesh. According to our knowledge, most of the available studies, that addressed the issue of malnutrition among under-five children, considered the categorical (dichotomous/polychotomous) outcome variables and applied logistic regression (binary/multinomial) to find their predictors. In this study malnutrition variable (i.e. outcome) is defined as the number of under-five malnourished children in a family, which is a non-negative count variable. The purposes of the study are (i) to demonstrate the applicability of the generalized Poisson regression (GPR) model as an alternative of other statistical methods and (ii) to find some predictors of this outcome variable. METHODS: The data is extracted from the Bangladesh Demographic and Health Survey (BDHS) 2007. Briefly, this survey employs a nationally representative sample which is based on a two-stage stratified sample of households. A total of 4,460 under-five children is analysed using various statistical techniques namely Chi-square test and GPR model. RESULTS: The GPR model (as compared to the standard Poisson regression and negative Binomial regression) is found to be justified to study the above-mentioned outcome variable because of its under-dispersion (variance < mean) property. Our study also identify several significant predictors of the outcome variable namely mother's education, father's education, wealth index, sanitation status, source of drinking water, and total number of children ever born to a woman. CONCLUSIONS: Consistencies of our findings in light of many other studies suggest that the GPR model is an ideal alternative of other statistical models to analyse the number of under-five malnourished children in a family. Strategies based on significant predictors may improve the nutritional status of children in Bangladesh.

Determinants of coexisting forms of undernutrition among under-five children: Evidence from the Bangladesh demographic and health surveys.

In many underdeveloped and developing countries, epidemiological and nutritional transitions are leading to an increase in malnutrition, resulting in pediatric diseases and eventually deaths. Therefore, this study intents to determine the important factors of the presence of coexisting forms of malnutrition (CFM), i.e., pediatric undernutrition. This study used the latest Bangladesh Demographic and Health Survey (BDHS)-2017/18 dataset consisting of 7127 under-five children. The logistic regression model has been utilized to gain explicit and in-depth knowledge of the relationship between the presence of pediatric undernutrition with socioeconomic and demographic factors. Findings revealed that about 31%, 22%, and 8% suffered from stunted, underweight, and wasted, respectively. The prevalence of stunted, underweighted, wasted, and CFM among children in the Sylhet division is higher than in any other region. A child of a secondary-level completed mother is 27.6% (OR: 0.724, 95% CI: 0.58-0.90) less likely to suffer from undernutrition than a child of an uneducated mother. The rate of undernutrition of children was less among children of highly educated parents. Age, birth order of the child, twin status, mother's age, body mass index (BMI), working status, parental educational qualification, cooking fuel, toilet facility, region, residence, and wealth index are important for determining the nutritional status of a child. The authors believe that the study findings will be helpful to the policymakers to take proper actions for achieving the sustainable development goal (SDGs) by reducing pediatric undernutrition in Bangladesh by 2030.

Relationships between total reserve and financial indicators of Bangladesh: Application of generalized additive model.

BACKGROUND: The reserve of a country is a reflection of the strength of fulfilling its financial liabilities. However, during the past several years, a regular variation of the total reserve has been observed on a global scale. The reserve of Bangladesh is also influenced by several economic and financial indicators such as total debt, net foreign assets, net domestic credit, inflation GDP deflator, net exports (% of GDP), and imports of goods and services (% of GDP), as well as foreign direct investment, GNI growth, official exchange rate, personal remittances, and so on. Therefore, the authors aimed to identify the nature of the relationship and influence of economic indicators on the total reserve of Bangladesh using a suitable statistical model. METHODS AND MATERIALS: To meet the objective of this study, the secondary data set was extracted from the World Bank's website which is openly accessible over the period 1976 to 2020. Moreover, the model used the appropriate splines to describe the non-linearity. The performance of the model was evaluated by the Akaike information criterion (AIC), Bayesian information criterion (BIC), and adjusted R-square. RESULTS: The total reserve of Bangladesh gradually increased since 2001, and it reached its peak in 2020 which was 43172 billion US dollars. The data were first utilized to build a multiple linear regression model as a base model, but it was later found that the model has severe multicollinearity problems, with a maximum value of VIF for GNI of 499.63. Findings revealed that total debt, inflation, import, and export are showing a non-linear relationship with the total reserve in Bangladesh. Therefore, the authors applied the Generalized Additive Model (GAM) model to take advantage of the nonlinear relationship between the reserve and the selected covariates. The overall response, which is linearly tied to the net foreign asset in the GAM model, will change by 14.43 USD for every unit change in the net foreign asset. It is observed that the GAM model performs better than the multiple linear regression. CONCLUSION: A non-linear relationship is observed between the total reserve and different economic indicators of Bangladesh. The authors believed that this study will be beneficial to the government, monetary authorities also to the people of the country to better understand the economy.

Human exposures to multiple water sources in the southwestern coastal region of Bangladesh: water quality, pollution sources, and preliminary health risks appraisals.

The coastal areas of Bangladesh have poor accessibility to fresh drinking water and the groundwater is not suitable for drinking, cooking, and other domestic uses due to high levels of salinity and potentially toxic elements. The current study focuses on understanding of the distribution of some physicochemical parameters (temperature, pH, EC, TDS, and salinity) and chemical elements (Fe, Mn, Zn, Ca, Mg, Na, K, Cu, Co, Pb, As, Cr, Cd, and Ni) with health perspective in drinking water from the southwestern coastal area of Bangladesh. The physicochemical properties of the water samples were examined with a multiparameter meter, while the elemental concentrations were analyzed using atomic absorption spectrometer. Water quality index (WQI) and irrigation indices were utilized to determine the drinking water quality and irrigation feasibility, respectively, whereas hazard quotients (HQs) and hazard index (HI) were used to assess the probable pathways and the associated potential risks to human health. The concentrations of some toxic elements in measured samples were relatively higher compared to drinking water guidelines, indicating that ground and surface water are not apt for drinking and/or domestic uses. The multivariate statistical approaches linked the source of the pollutants in the studied water body mostly to the geogenic origin including saline water intrusion. WQI values ranged from 18 to 430, reflecting excellent to unsuitable categories of water quality. The assessment of human health risks due to exposure to contaminated water demonstrated both carcinogenic and non-carcinogenic health risks in the exposed residents of the study area. Therefore, appropriate long-term coastal area management strategies should be adopted in the study region for environmental sustainability. The findings of this research will be supportive in understanding the actual situation of fresh drinking water in the area for policymakers, planners, and environmentalists to take effective necessary measures to ensure safe drinking water in the study area.

Measuring the impact of climate change on potato production in Bangladesh using Bayesian Hierarchical Spatial-temporal modeling.

BACKGROUND: Potato is a staple food and a main crop of Bangladesh. Climate plays an important role in different crop production all over the world. Potato production is influenced by climate change, which is occurring at a rapid pace according to time and space. OBJECTIVE: The main objective of this research is to observe the variation in potato production based on the discrepancy of the variability in the spatial and temporal domains. The research is based on secondary data on potato production from different parts of Bangladesh and five major climate variables for the last 17 years ending with 2020. METHODS: Bayesian Spatial-temporal modelling for linear, analysis of variance (ANOVA), and auto-Regressive models were used to find the best-fitted model compared with the independent Error Bayesian model. The Watanabe-Akaike information criterion (WAIC) and Deviance Information Criterion (DIC) were used as the model choice criteria and the Markov Chain Monte Carlo (MCMC) method was implemented to generate information about the prior and posterior realizations. RESULTS: Findings revealed that the ANOVA model under the Spatial-temporal framework was the best model for all model choice and validation criteria. Results depict that there is a significant impact of spatial and temporal variation on potato yield rate. Besides, the windspeed does not show any influence on potato production, however, temperature, humidity, rainfall, and sunshine are important components of potato yield rate in Bangladesh. CONCLUSION: It is evident that there is a potential impact of climate change on potato production in Bangladesh. Therefore, the authors believed that the findings will be helpful to the policymakers or farmers in developing potato varieties that are resilient to climate change to ensure the United Nations Sustainable Development Goal of zero hunger.

Patterns, prevalence and determinants of environmental tobacco smoke exposure among adults in Bangladesh.

BACKGROUND: Exposure to environmental tobacco smoke (ETS) has been suggested as a risk factor for various health problems. Thus, this study examines the patterns and predictors of ETS exposure among adults at home, workplace and public places. METHODS: The dataset covered a nationally representative sample of 9629 respondents extracted from the Global Adult Tobacco Survey. Diamond-shaped equiponderant graphs were used to exhibit the prevalence of ETS. In Logistic regressions, ETS exposure at home, workplace and public places were used as response variables. Demographic and socioeconomic variables, health knowledge about ETS, attitude towards ETS, perception of smoking restrictions were considered as predictors. RESULTS: Adults in higher age groups and females were less exposed to ETS. Better education, high wealth status, better health knowledge on ETS, practice of no smoking at home, and support smoking restrictions were significantly associated with lower ETS exposure at home. Those residing in rural areas and living with many people together were more likely to be exposed to ETS at home. In contrast with home and workplace exposure, adults with higher education, better wealth status, good knowledge on ETS, and support smoking restrictions experienced a high level of exposure at public places. Interestingly, results suggest that those with high levels of ETS exposure at home and workplace had lower exposure to ETS in public places. CONCLUSIONS: ETS control should not be overlooked in public health policy. Protection from ETS at home is particularly important, given its impact on the attitude towards and awareness about ETS exposure at all places.

Tobacco smoking and its association with illicit drug use among young men aged 15-24 years living in urban slums of Bangladesh.

BACKGROUND: Tobacco smoking (TS) and illicit drug use (IDU) are of public health concerns especially in developing countries, including Bangladesh. This paper aims to (i) identify the determinants of TS and IDU, and (ii) examine the association of TS with IDU among young slum dwellers in Bangladesh. METHODOLOGY/PRINCIPAL FINDINGS: Data on a total of 1,576 young slum dwellers aged 15-24 years were extracted for analysis from the 2006 Urban Health Survey (UHS), which covered a nationally representative sample of 13,819 adult men aged 15-59 years from slums, non-slums and district municipalities of six administrative regions in Bangladesh. Methods used include frequency run, Chi-square test of association and multivariable logistic regression. The overall prevalence of TS in the target group was 42.3%, of which 41.4% smoked cigarettes and 3.1% smoked bidis. The regression model for TS showed that age, marital status, education, duration of living in slums, and those with sexually transmitted infections were significantly (p<0.001 to p<0.05) associated with TS. The overall prevalence of IDU was 9.1%, dominated by those who had drug injections (3.2%), and smoked ganja (2.8%) and tari (1.6%). In the regression model for IDU, the significant (p<0.01 to p<0.10) predictors were education, duration of living in slums, and whether infected by sexually transmitted diseases. The multivariable logistic regression (controlling for other variables) revealed significantly (p<0.001) higher likelihood of IDU (OR = 9.59, 95% CI = 5.81-15.82) among users of any form of TS. The likelihood of IDU increased significantly (p<0.001) with increased use of cigarettes. CONCLUSIONS/SIGNIFICANCE: Certain groups of youth are more vulnerable to TS and IDU. Therefore, tobacco and drug control efforts should target these groups to reduce the consequences of risky lifestyles through information, education and communication (IEC) programs.