Hypertension among adults in Bangladesh: evidence from a national cross-sectional survey.

BACKGROUND: Hypertension is an increasing problem in Southeast Asia, particularly in Bangladesh. Although some epidemiological studies on hypertension have been conducted in Bangladesh, the factors associated with hypertension in this nation remain unclear. We aimed to determine the factors associated with hypertension among the adults in Bangladesh. METHODS: We conducted a cross-sectional study using data from the nationally representative 2011 Bangladesh Demographic and Health Survey (BDHS). A total of 7,839 (3,964 women and 3,875 men) adults aged 35 years and older who participated in the survey was included. Hypertension was defined by a systolic blood pressure ≥ 140 mmHg and/or, diastolic blood pressure ≥ 90 mmHg and/or, receipt of an anti-hypertensive medication at time of the survey. The degree of association between the risk factors and the outcome was assessed by the odd ratio (OR) obtained from the bivariate and multivariable logistic regression models. RESULTS: The overall prevalence of hypertension was 26.4 %, and the prevalence was higher in women (32.4%) than men (20.3%). Study participants with the age group of 60-69 years had higher odds of having hypertension (AOR: 3.77, 95% CI: 3.01-4.72) than the age group 35-39 years. Moreover, individuals who had higher educational attainment (AOR: 1.63, 95% C.I: 1.25-2.14) and higher wealth status (AOR = 1.91, 95% CI: 1.54-2.38) had higher odds of having hypertension than the individuals with no education and lower social status, respectively. The analysis also showed that high BMI (AOR: 2.19, 95% C.I: 1.87-2.57) and having diabetes (AOR: 1.54, 95% C.I: 1.31-1.83) were associated with the increasing risk of hypertension. CONCLUSIONS: Our study shows that the risk of hypertension was significantly associated with older age, sex, education, place of residence, working status, wealth index, BMI, and diabetes. Moreover, hypertension is largely untreated, especially in rural settings. The health system needs to develop appropriate strategies including early diagnosis, awareness via mass media, and health education programs for changing lifestyles should be initiated for older age, wealthy, and/or higher educated individuals in Bangladesh. Moreover, area-specific longitudinal research is necessary to find out the underlying causes of regional variations.

REGIONAL VARIATIONS IN CHILD MARRIAGE IN BANGLADESH.

This study aimed to investigate the regional variations in the prevalence of child marriage in Bangladesh with a view to providing recommendations for division-specific policy interventions. Data from the 2011 Bangladesh Demographic and Health Survey were analysed using multivariate logistic regression. Substantial regional variations in child marriage were found in Bangladesh. Rangpur and Khulna had more than four times higher odds of child marriage than Sylhet (4.57 and 4.11 times, respectively). Barisal and Rajshahi had more than three times higher odds of child marriage than Sylhet (3.70 and 3.48 times, respectively). Chittagong and Dhaka had about two times odds of child marriage than Sylhet (1.98 and 2.67 times, respectively), even after controlling for selected socio-demographic, economic and cultural characteristics. Respondent's education, employment status, husband's education and wealth index were inversely associated with the prevalence of child marriage. The policy implications of these findings are discussed in the context of Bangladesh.

Type 2 diabetes and its correlates among adults in Bangladesh: a population based study.

BACKGROUND: Type 2 diabetes is one of the most prevalent non-communicable diseases in Bangladesh. However, the correlates of type 2 diabetes among adults in Bangladesh remain unknown. We aimed to investigate the correlates of type 2 diabetes among the adults in Bangladesh. METHODS: We conducted a cross-sectional study using data from the nationally representative 2011 Bangladesh Demographic and Health Survey. A random sample of 7,543 (3,823 women and 3,720 men) adults of age 35 years and older from both urban and rural areas, who participated in the survey was included. Diabetes was defined as having a fasting plasma blood glucose level of ≥ 7 mm/L or taking diabetes medication during the survey. Hypothesized factors, e.g., age, sex, education, place of residence, social status, body mass index, and hypertension were considered in the analyses. Multivariable logistic regression models were used to identify the important correlates of type 2 diabetes. RESULTS: Among the respondents, the overall prevalence of diabetes was 11 %, and the prevalence was slightly higher in women (11.2 %) than men (10.6 %). Respondents with the age group of 55-59 years had higher odds of having diabetes (odds ratios (OR) = 2.37, 95 % confidence interval (CI): 1.76-3.21) than the age group of 35-39 years. Moreover, respondents who had higher educational attainment (OR = 1.67, 95 % CI: 1.18-2.36) and higher social status (OR = 2.01, 95 % CI: 1.50-2.70) had higher odds of having diabetes than the respondents with no education and lower social status, respectively. We also found socioeconomic status, place of residence (rural or urban), regions of residence (different divisions), overweight and obesity, and hypertension as significant correlates of type 2 diabetes in Bangladesh. CONCLUSIONS: Our study shows that older age, higher socioeconomic status, higher educational attainment, hypertension, and obesity were found to be significant correlates of type 2 diabetes. Need-based policy program strategies including early diagnosis, awareness via mass media, and health education programs for changing lifestyles should be initiated for older age, wealthy, and/or higher educated individuals in Bangladesh. Moreover, area-specific longitudinal research is necessary to find out the underlying causes of regional variations.

Geographical variation in the association between physical violence and sleep disturbance among adolescents: A population-based, sex-stratified analysis of data from 89 countries.

OBJECTIVE: To examine geographical variations in involvement in physical violence and sleep disturbance among adolescents. DESIGN: Cross-sectional study. SETTING: Eighty-nine low- to middle-income and high-income countries PARTICIPANTS: Adolescents 13-17 years of age. MEASUREMENTS: Multiple binary logistic regression analyses and meta-analyses were performed to assess the link between physical violence (number of physical fights) and sleep disturbance ("mostly" or "always" experienced worry-induced sleep loss). RESULTS: Among 296,212 adolescents, 8.9% reported sleep disturbance (male: 7.5%, female: 9.6%), with the highest prevalence among adolescents from the Eastern Mediterranean region (14.1%) and high-income countries (14.1%). Overall, sleep disturbance prevalence increased gradually with the increased episodes of physical violence. Adolescents who were involved in physical violence once, 2-3 times, and 4+ times were respectively 18%, 26%, and 77% more likely than their counterparts to experience sleep disturbance (1 time: OR 1.18, 95% CI 1.13-1.24; 2-3 times: 1.26, 1.20-1.34; 4+ times: 1.77, 1.66-1.88). The association between physical violence and sleep disturbance was observed in all regions and country-income groups, with the highest odds of sleep disturbance among adolescents experiencing 4+ times of physical violence in the European region (2.34, 1.17-4.67) and upper-middle-income countries (1.91, 1.73-2.11). The association of physical violence with sleep disturbance by sex was significant in all regions and country-income groups, except the European region. CONCLUSIONS: Exposure to physical violence is associated with increased odds of sleep disturbances in adolescents. School and community-level interventions, vigilance, and programs to promote violence-free environments may improve the sleep health of adolescents exposed to physical violence.

Young mothers' attitudes towards domestic violence and their maternal healthcare services utilization in Bangladesh: A multilevel cluster analysis.

This paper examined the association between young mothers' attitudes towards domestic violence and four or more antenatal care (ANC) and health-center-based delivery service utilization using two cross-sectional waves of the Bangladesh Demographic and Health Surveys (2014 and 2018) data. We carried out a multilevel logistic regression analysis. Findings show that a strong cluster variation exists in four or more ANC and health-center-based delivery service utilization. Although the utilization of four or more ANC and health-center-based delivery services has increased over the years, it is far behind the targets of SDGs, particularly for young mothers with justified attitudes towards domestic violence. Extension of maternity allowance coverage and motivational programs are important policy recommendations.

Determinants of anxiety and depression among Bangladeshi adults during COVID-19 lockdown: An online survey.

Background: Human health and well-being are adversely affected by the effects of COVID-19. This study examined the prevalence of anxiety and depression during COVID-19 lockdown in Bangladesh, and their association with some less explored factors like perceived and relative health status, having elderly members in the family, fear for own and family future, and others from the Asian context. Methods: Using an online survey, data were collected from the population aged 18 years and above, on socio-demographic and economic attributes, and two separate standardized twelve-item scales were used to assess the level of anxiety and depression. Both descriptive and multivariate linear regression were used to analyze the factors associated with anxiety and depression scores. Results: The respondents had an average anxiety score of 21.74 (SD = 8.20) on a scale ranging from 12 to 60 and an average depression score of 24.39 (SD = 10.30) on the same scale. The study findings revealed that respondents' concern for future well-being, perceived physical health status compared to others in the same cohort, and perceived physical health status during the survey compared to prior COVID-19 were significantly associated with anxiety and depression scores during COVID-19 lockdown. In addition, the anxiety score was significantly higher (p = 0.046) for women respondents than men. Moreover, respondents aged 18-24 years had significantly higher (p < 0.001) depression than others. Conclusions: The increased level of anxiety and depression during COVID-19 of adult people in Bangladesh are associated with several factors of which their greater concern about the future of their own and family members and health-related attributes are important. These findings may lead to developing interventions to reduce the psychological crisis during the pandemic in Bangladesh.

Changes in prevalence and risk factors of hypertension among adults in Bangladesh: An analysis of two waves of nationally representative surveys.

INTRODUCTION: Bangladesh is one of the countries where the prevalence of non-communicable diseases (NCDs) such as hypertension is rising due to rising living standards, sedentary lifestyles, and epidemiological transition. Among the NCDs, hypertension is a major risk factor for CVD, accounting for half of all coronary heart disease worldwide. However, detailed research in this area has been limited in Bangladesh. The objective of the study was to estimate changes in the prevalence and risk factors of hypertension among Bangladeshi adult population. The study also sought to identify socioeconomic status-related inequality of hypertension prevalence in Bangladesh. METHODS: Cross-sectional analysis was conducted using nationally representative two waves of the Bangladesh Demographic and Health Survey (BDHS) in 2011 and 2017-18. Survey participants were adults 18 years or older- which included detailed biomarker and anthropometric measurements of 23539 participants. The change in prevalence of hypertension was estimated, and adjusted odds ratios were obtained using multivariable survey logistic regression models. Further, Wagstaff decomposition method was also used to analyze the relative contributions of factors to hypertension. RESULTS: From 2011 to 2018, the hypertension prevalence among adults aged ≥35 years increased from 25.84% to 39.40% (p<0.001), with the largest relative increase (97%) among obese individuals. The prevalence among women remained higher than men whereas the relative increase among men and women were 75% and 39%, respectively. Regression analysis identified age and BMI as the independent risk factors of hypertension. Other risk factors of hypertension were sex, marital status, education, geographic region, wealth index, and diabetes status in both survey years. Female adults had significantly higher hypertension risk in both survey years in the overall analysis in, however, in the subgroup analysis, the gender difference in hypertension risk was not significant in rural 2011 and urban 2018 samples. Decomposition analysis revealed that the contributions of socio-economic status related inequality of hypertension in 2011 were46.58% and 20.85% for wealth index and BMI, respectively. However, the contributions of wealth index and BMI have shifted to 12.60% and 55.29%, respectively in 2018. CONCLUSION: The prevalence of hypertension among Bangladeshi adults has increased significantly, and there is no subgroup where it is decreasing. Population-level approaches directed at high-risk groups (overweight, obese) should be implemented thoroughly. We underscore prevention strategies by following strong collaboration with stakeholders in the health system of the country to adopt healthy lifestyle choices.

Climate-Related Displacement and Antenatal Care Service Utilization in Rural Bangladesh.

CONTEXT: Extreme weather events cause large-scale population displacement in Bangladesh. It is important to know how household displacement due to such events might affect women's antenatal care (ANC) service utilization. METHODS: In 2017, a cross-sectional household survey was conducted in 25 rural villages in either displacement prone or non-displacement prone areas of Bangladesh. Data were collected from 611 respondents (a woman or her husband) who reported having had a live birth in the past three years; of those, 289 had experienced household displacement due to an extreme weather event. Logistic regression analyses were conducted to examine the relationship between experience of household displacement and women's ANC service utilization during their last pregnancy resulting in a live birth. RESULTS: Eighty-three percent of women had received at least one ANC visit during their last pregnancy resulting in a live birth; of those, 31% received at least four visits with a trained provider. Women from households that had been displaced three or more times were less likely than those from nondisplaced households to have received an ANC visit and at least four visits with a trained provider (odds ratios, 0.3 and 0.4, respectively). Receiving at least four visits with a trained provider was also associated with having previous children (0.3-0.4), age at pregnancy (2.5-3.9), husband's occupation (2.2 for "other") and joint parental decision-making about ANC visits (1.8). CONCLUSIONS: Strengthening family planning services and extending eligibility for Bangladesh's Maternity Allowance benefits in the areas prone to floods and riverbank erosion are recommended to improve ANC service utilization.

RESUMEN Contexto: Los eventos climáticos extremos causan desplazamientos de población a gran escala en Bangladesh. Es importante conocer cómo el desplazamiento de hogares debido a tales eventos podría afectar la utilización que las mujeres hacen de los servicios de atención prenatal (APN). Métodos: En 2017, se condujo una encuesta transversal de hogares en 25 pueblos rurales de Bangladesh tanto en áreas propensas al desplazamiento como en áreas no propensas al mismo. Se recolectaron datos de 611 personas entrevistadas (mujeres o sus cónyuges) que reportaron haber tenido un nacido vivo en los tres años previos; de ellas, 289 habían experimentado desplazamiento del hogar debido a un evento climático extremo. Se llevaron a cabo análisis de regresión logística para examinar la relación entre la experiencia del desplazamiento del hogar y la utilización de servicios de APN por las mujeres durante su último embarazo que resultó en un nacido vivo. Resultados: Ochenta y tres por ciento de las mujeres habían tenido al menos una visita de APN durante su último embarazo que resultó en un nacido vivo; de ellas, 31% tuvo al menos cuatro visitas con un proveedor de servicios capacitado. Las mujeres de hogares que habían sido desplazados tres o más veces tuvieron menos probabilidad que las mujeres de hogares no desplazados de haber tenido una visita de APN y al menos cuatro visitas con un proveedor de servicios capacitado (razón de probabilidades, 0.3 y 0.4, respectivamente). Tener hijos previamente (0.3­0.4), edad al embarazo (2.5­3.9), ocupación del cónyuge (2.2 para "otro") y toma de decisiones parentales conjunta sobre visitas de APN (1.8) también estuvieron asociados con el hecho de tener al menos cuatro visitas con un proveedor de servicios capacitado. Conclusiones: Se recomienda fortalecer los servicios de planificación familiar y extender la elegibilidad para los beneficios de la Prestación por Maternidad del Gobierno de Bangladesh en las áreas propensas a inundaciones y erosión de las riberas de los ríos para mejorar la utilización de servicios de APN.

RÉSUMÉ Contexte: Les phénomènes météorologiques extrêmes sont la cause de déplacements de population à grande échelle au Bangladesh. Il importe de documenter l'effet éventuel de ce déplacement des ménages sur le recours des femmes aux prestations de soins prénatals (SPN). Méthodes: En 2017, une enquête transversale auprès des ménages a été menée dans 25 villages bangladais situés dans des zones sujettes ou non au déplacement. Les données ont été collectées auprès de 611 répondants (les femmes ou leur mari) ayant déclaré avoir eu une naissance vivante au cours des trois dernières années. Parmi ces répondants, 289 avaient connu un déplacement du ménage dû à un phénomène météorologique extrême. La relation entre le vécu de ce déplacement et le recours des femmes aux prestations SPN durant leur dernière grossesse ayant abouti sur une naissance vivante a été examinée par analyses de régression logistique. Résultats: Quatre-vingt-trois pour cent des femmes avaient obtenu au moins une consultation SPN durant leur dernière grossesse ayant abouti sur une naissance vivante; parmi elles, 31% en avaient obtenu au moins quatre avec un prestataire qualifé. Les femmes des ménages déplacés trois fois ou davantage étaient moins susceptibles que celles des ménages non déplacés d'avoir obtenu une consultation SPN et au moins quatre consultations avec un prestataire qualifié (RC, 0,3 et 0,4, respectivement). L'expérience antérieure de la maternité (0,3­0,4), l'âge au moment de la grossesse (2,5­3,9), l'activité professionnelle du mari (2,2 pour « autre ¼) et la prise de décision parentale conjointe concernant les consultations SPN (1,8) se sont aussi avérés associés à l'obtention d'au moins quatre consultations avec un prestataire qualifié. Conclusions: Le renforcement des services de planification familiale et l'admissibilité accrue aux prestations de maternité du gouvernement bangladais dans les zones vulnérables aux inondations et à l'érosion des rives sont recommandés pour améliorer le recours aux prestations SPN.

The effects of household's climate-related displacement on delivery and postnatal care service utilization in rural Bangladesh.

Exposure to extreme climate events causes population displacement and adversely affects the health of mothers and children in multiple ways. This paper investigates the effects of displacement on whether a child is delivered at a health center, as opposed to at home, and on postnatal care service utilization in Bangladesh. Using cross-sectional survey data from 599 mothers who gave birth in the three years prior to the date of interview, including 278 from households which had previously been displaced and 231 from households which had not been displaced, we use multivariate logistic regression to identify the factors associated with maternal healthcare service utilization. The results show that displaced households' mothers are only about a quarter as likely to deliver at a health center as mothers from non-displaced households. The use of health center-based delivery decreases as the numbers of past displacements increases. Higher number of previous children, lower use of antenatal care during pregnancy, lower household income, and lack of access to radio/television also significantly reduce a mother's likelihood of delivery at a health center. Displaced mothers are also substantially less likely to use postnatal care services for their neonates, especially those supplied by trained providers. Use of health facilities for delivery, use of antenatal care services, and previous number of children are other important predictors of postnatal care service utilization for neonates. In light of these findings, relocation of local health facilities with basic and emergency care provisions to areas in which the displaced have resettled, reinforcement of Family Planning services, and extension of coverage of the Maternity Allowance benefits in the displacement-prone mainland riverine areas are recommended policy responses.

Regional variations of contraceptive use in Bangladesh: A disaggregate analysis by place of residence.

This study advances current knowledge on contraceptive use in Bangladesh by providing new insights into the extent of regional variations in contraceptive use across rural and urban areas of Bangladesh. We examined the regional variations in contraceptive use among 15,699 currently married women ages 15-49 years using data from the 2014 Bangladesh Demographic and Health Survey (BDHS). Multivariate logistic regression models of contraceptive use were calibrated with sociodemographic attributes and cultural factors. Based on the aggregate sample (i.e., rural and urban combined), we found significant regional variations in contraceptive use across the administrative divisions in Bangladesh. Based on a disaggregate sample (i.e., rural and urban separately), we found that there were significant differences in divisional variations in contraceptive use in rural areas. In contrast, no significant variation in contraceptive use across divisions in urban areas of Bangladesh was found. More specifically, among women living in rural areas, the Rajshahi and Rangpur divisions had higher odds of contraceptive use than the Barisal division, whereas the Chittagong and Sylhet divisions had much lower odds of contraceptive use even after adjusting for selected sociodemographic attributes and cultural factors. A separate analysis of the divisional variations in usage of modern methods of contraception also revealed similar findings with only one exception. Findings of this study provide an evidence-based direction for adapting a pragmatic approach to reducing the divisional disparity of contraceptive use in rural areas of Bangladesh.

Parents' healthcare-seeking behavior for their children among the climate-related displaced population of rural Bangladesh.

In Bangladesh climate change has contributed to a massive displacement of people. This study examines the effects of climate-related displacement, socioeconomic status, availability of healthcare providers and disease-related attributes on the healthcare-seeking behaviors of parents for their children. Using cross-sectional survey data from the parents of 1003 children aged under 15 who were ill in the four weeks prior to the interview, collected from 600 randomly-selected households in climate displacement-susceptible areas and 600 households in non-climate-displacement-susceptible areas in Bangladesh, we use multivariate logistic regression to identify the factors associated with parental healthcare-seeking behaviors. The results show that 15.5% of the children who had been ill receive either no care or curative care at home. Of those receiving care outside the home, only 22.1% are treated by trained providers. Climate-related displaced parents are significantly less likely to seek care or to use provider-prescribed care to manage children's illnesses. Areas lacking local healthcare providers, poorer households, females, child age and mild illness are also associated with a child being significantly less likely to be treated outside the home. The children of climate-related displaced parents are around half as likely as those of non-displaced parents to be treated by a trained provider. The local availability of medical doctors, cost of reaching a healthcare center, household income, type and severity of illness, child's age, and joint parental decision-making about care providers are also important predictors of the selection of trained healthcare providers for children. Thus, climate-related displacement affects the healthcare-seeking behaviors of parents for their children. Policy aimed at improving child health should address the socioeconomic disadvantage and access to healthcare of the displaced, the training of local untrained providers about Primary Health Care service provision, and the numbers of medical doctors in the displacement-prone areas.

Awareness regarding risk factors of type 2 diabetes among individuals attending a tertiary-care hospital in Bangladesh: a cross-sectional study.

BACKGROUND: Awareness regarding risk factors is a prerequisite for the prevention of diabetes in general population. However, there are great variations in the level of this awareness from population to population and this needs to be explored in different ethnic and social groups for designing appropriate preventive strategies. The purpose of the study was to assess the level of awareness regarding the risk factors responsible for the development of type 2 diabetes and its determinants among individuals who attended a tertiary care hospital. METHODS: Under an analytical cross-sectional design, 400 non-diabetic respondents, aged >30 years, were conveniently selected from the Out-Patient Department of BIRDEM, the tertiary care hospital of the Diabetic Association of Bangladesh. A pretested, semi-structured questionnaire was developed to assess knowledge and attitude of the respondents. Respondents' level of knowledge and attitude were categorized as good, average and poor (GAP). Multivariate along with bivariate statistics was used to measure knowledge and attitude of type 2 diabetes. RESULTS: Among the respondents the levels of knowledge and attitude were 13%, 10% good; 68%, 75% average and 19%, 14% poor respectively. In multivariate analysis, high literacy (p = 0.0001), respondents who are in service (p = 0.02) and family history of diabetes (p = 0.02) were found significantly associated with the knowledge score after adjustment. Respondents who had passed secondary and higher secondary education had a significant association (p = 0.03) with the attitude score. Housewives had a significantly lower attitude score than others (p = 0.04). Family history of diabetes and knowledge on the risk factors of diabetes showed significant positive association with the attitude score (p = 0.013 and p = 0.0001 respectively). CONCLUSIONS: Overall, respondents participating in this study have average awareness regarding risk factors of diabetes. From a public health perspective, there is a decisive need of innovative prevention programs for targeting people including high-risk individuals.