Ethnicity and access to water, sanitation, and hygiene in Bangladesh: a study using MICS data and policy reviews.

INTRODUCTION: Safe drinking water, sanitation, and hygiene (WASH) are crucial to human health. Reducing inequalities and ensuring universal access to WASH are essential to achieving the agenda of sustainable development. We aimed to measure access to WASH among ethnic minority populations in Bangladesh and understand the situation and factors affecting WASH practices among them. Additionally, we reviewed policy related to WASH to highlight the inequality faced by ethnic minority populations. METHODOLOGY: We utilized data from the multiple indicator cluster survey-2019. We used the chi-square test for bivariate analysis and multilevel mixed-effect logistic regression analyses to identify the effect of ethnicity on WASH in Bangladesh after controlling selected covariates. Furthermore, we systematically reviewed Bangladesh's WASH-related policies and programs. FINDINGS: While 98.5% of Bengalis had access to basic drinking water services, the percentage is 60.6% for the ethnic minority population. For improved sanitation facilities not shared with others, the difference between Bengali and ethnic populations was 22.3% (64.6% vs. 42.3%). On the other hand, 75% of the Bengali population had a handwashing facility with water and soap, and 50% of the ethnic population had them. Ethnicity appeared to be a statistically significant predictor of every component of WASH. Compared to Bengali, the ethnic population had 87%, 45%, 31%, and 45% less access to water (aOR = 0.13, p ≤ 0.001), sanitation (aOR = 0.55, p ≤ 0.001), and handwashing (aOR = 0.69, p ≤ 0.05), and WASH facilities aOR = 0.55, p ≤ 0.001), respectively. Among the policies of Bangladesh, only one identified action for WASH rights of ethnic minorities. CONCLUSION: The government should identify the issues of WASH among ethnic minorities and represent them adequately in policies to achieve the aim of 'leaving none behind' of sustainable development goals.

Menstrual hygiene management practice among adolescent girls: an urban-rural comparative study in Rajshahi division, Bangladesh.

INTRODUCTION: Adolescence is a critical period characterized by significant physical, emotional, cognitive, and social changes, including the monthly occurrence of menstruation of adolescent girls. Despite being an inevitable natural event, most societies consider menstruation and menstrual blood as taboos and impure. Such consideration prevents many adolescent girls from proper health education and information related to menstrual health, which forces them to develop their ways of managing the event. This study attempted to explore the pattern, the urban-rural differences, and the determinants of menstrual hygiene management practices (MHMP) among adolescent girls in the Rajshahi division, Bangladesh. METHODOLOGY: Using a cross-sectional study design with multistage random sampling, we collected data from 586 adolescent girls (aged 14-19 years) from the Rajshahi division of Bangladesh. The MHMP was measured using eight binary items, where the value from zero to five as 'bad,' six as 'fair,' and seven-eight as 'good' practices. Finally, we employed bivariate analysis and multinomial logistic regression analysis. FINDINGS: Only 37.7% continuously used sanitary pads. Among the cloth users, nearly three-fourths reused cloths, and about 57% used water and soap to wash them. About 49% changed menstrual absorbent, and 44% washed their genitalia three times daily. About 41% used water only to wash genitalia, and 55% buried sanitary materials under the soil. Around 36.9% of the girls practiced bad, 33.4% fair, and 29.7% good menstrual management. We found significant differences in MHMP among adolescent girls between urban and rural areas (32.3% vs. 27.7% good users, p ≤ 0.05). Multinomial logistic regression found that place of residence, age, family size, parental education, and age at first menstruation were the significant determinants of MHMP. CONCLUSION: Although there are some cases of sanitary pad use, still menstrual hygiene management is unhealthy in most cases. The continuous supply of sanitary pads at affordable cost, change in existing social norms about menstruation, proper education, information, and services are essential for achieving health-related SDG goals in both rural and urban areas of Bangladesh.

Is there any association between undesired children and health status of under-five children? Analysis of a nationally representative sample from Bangladesh.

BACKGROUND: Child health, especially childhood mortality, is one of the critical indicators of human development. No child mortality is desirable, but it is still high in Bangladesh. We aimed to assess the effect of the child's desired status on childhood morbidity and mortality in Bangladesh. METHODS: We used the data from the nationally representative cross-sectional Bangladesh Demographic and Health Survey (BDHS) 2017-18 and restricted the analyses to children born in the past five years preceding the survey. We estimated the undesired status (excess in boy, girl, both, and parity) by subtracting an ideal number of children from the total live birth. We measured childhood mortality (perinatal, early neonatal, neonatal, post-neonatal, infant, child, and under-five mortality), morbidity (fever, diarrhea, cough, and acute respiratory infectious-ARI), nutritional problems (stunting, wasting, underweight, and low birth weight), and treatments (postnatal care, treatment for fever, diarrhea/cough, and vitamin A supplementation). Finally, we utilized the chi-square test and multilevel mixed-effects logistic regression analyses. RESULTS: The prevalence of undesired children was 19.2%, 21.5%, 3.7%, and 25.4% for boys, girls, both boys and girls, and parity, respectively. Age, education, residence, division, and wealth index were significantly associated with undesired children. The prevalence of under-five mortality was 3.3% among desired children, almost double (5.4%) among undesired children. The likelihood of under-five mortality was [adjusted odds ratio (aOR): 2.05, p ≤ 0.001] higher among undesired children. Despite lower under-five mortality among higher socioeconomic status, the relative contribution of undesired children to under-fiver mortality was substantial. The undesired girl children were associated with an increased likelihood of moderately wasting (aOR: 1.28, p = 0.072), severely underweight (aOR: 1.41, p = 0.066), and low birth weight (aOR: 1.50, p ≤ 0.05). Moreover, the undesired children were 19% (p ≤ 0.05) more likely to be infected with fever. The undesired children had lower treatment for diarrhea and fever/cough and were less likely to get vitamin A supplementation (aOR: 0.71, p ≤ 0.001). CONCLUSIONS: The share of childhood morbidity, mortality, and malnutrition were higher among undesired children. Every child should be wanted, and no unwanted pregnancies are desirable; thereby, the government should reemphasize the proper use of family planning methods to reduce child mortality and malnutrition.

Spike of Motorbike Accidents in Bangladesh: An Emerging Public Health Concern.

The on-road traffic accident is a significant public health concern for Bangladesh, impeding the country's way to building safe, resilient, and sustainable cities and human settlements. On-road accidents and causalities doubled in the country between 2011 and 2020, and it increased by 30% in 2021, a shifting pattern of traffic accidents with an increasing number of motorbike accidents. The fatalities by motorcycle traffic accidents were only 4% in 1995 and rose substantially to 35% in 2021, and the situation has been more alarming during the festivals, especially Eid in Bangladesh.

The burden of diabetes and hypertension on healthy life expectancy in Bangladesh.

Diabetes and hypertension are among the leading causes of death in Bangladesh. This study examined hypertension, diabetes, and either or both, free life expectancy, to measure the effect of the diseases on the overall health of individuals in Bangladesh with regional variations. We utilized data from Bangladesh Sample Vital Statistics 2018 for mortality and Bangladesh Demographic and Health Survey 2017-2018 for diabetes and hypertension. The Sullivan method was employed to estimate age-specific hypertension and diabetes-free life expectancy. Altogether, 10.3% of the people aged 18-19 years lived with either diabetes or hypertension. The hypertension-free life expectancy was 40.4 years, and the diabetes-free life expectancy was 53.2 years for those aged 15-19. Overall, individuals would expect to spend 38.7% of their lives with either of the diseases. Females suffered more from hypertension and males from diabetes. Still, females suffered more from the aggregate of both. Rural people had more diabetes and hypertension-free life expectancy than those of urban. Individuals of Mymensingh had the highest life expectancy free of both diseases compared to other divisions of Bangladesh. Diabetes and hypertension affect a considerable proportion of the life of the population in Bangladesh. Policy actions are needed to guide the prevention, diagnosis, and treatment of both diseases, specifically focusing on women and urban populations. Widespread health-enhancing actions need to be taken to diminish the effect of these two diseases in Bangladesh.

Dynamics of internal migration in Bangladesh: Trends, patterns, determinants, and causes.

INTRODUCTION: Internal migration is essential to understand the population dynamics and the multifaceted relationship between population and development of a nation. In Bangladesh, the study of international migration is more frequent due to its socioeconomic importance and data availability. However, the study of internal migration is less frequent as there lie complexities in measuring internal migration, and data are less available. Thus, this paper aimed to explore the dynamics of internal in Bangladesh. DATA AND METHODS: We utilized data from the Bangladesh Population and Housing Census 1991-2011. The number of internal migrants was estimated using the United Nations Manual on Methods of Measuring Internal Migration- Manual VI. District-wise lifetime and net internal migration rate were the dependent variables where several socioeconomic variables were used as independent variables. The correlation and the stepwise multiple linear regression analysis were employed. RESULTS: Dhaka, Gazipur, Narayanganj, and all the Divisional cities have the highest in-migration rate, whereas the northern and southern districts of Bangladesh have the highest out-migration rate. The regression model showed that activity rate appeared to be the strongest predictor (ß = 0.419, P<0.001) of net migration for 2011, followed by city corporation (ß = 0.275, P<0.01) and poverty rate (ß = -0.246, P<0.01). However, the lifetime internal migration rate was 9.8% in 2011. The pooled model (1991-2011) for lifetime internal migration showed that activity rate (ß = 0.408, P<0.001), population density (ß = 0.386, P<0.001), literacy rate (ß = 0.341, P<0.001), and city corporation (ß = 0.139, P<0.01) were the significant factors of internal migration. Marriage, looking for a job, employment/business, education, and natural calamities were the reasons for internal migration. DISCUSSION AND CONCLUSION: The destinations of migrants are few developed and urbanized cities which needs particular attention in policy planning. If the current migration trends continue, few cities will have an excessive population, which will increase density and pollution, thereby decreasing living standards. Thus, along with comprehensive urban planning, decentralization of government and private institutions must be ensured. Since the rural to urban migration rate is high, the findings recommend more development and concentration in the rural area. Finally, education, training, and work opportunities for migrants should be safeguarded in the area of origin.

Hesitancy in COVID-19 vaccine uptake and its associated factors among the general adult population: a cross-sectional study in six Southeast Asian countries.

BACKGROUND: Vaccines are effective and reliable public health interventions against viral outbreaks and pandemics. However, hesitancy regarding the Coronavirus disease (COVID-19) vaccine is evident worldwide. Therefore, understanding vaccination-related behavior is critical in expanding the vaccine coverage to flatten the infection curve. This study explores the public perception regarding COVID-19 vaccination and identifies factors associated with vaccine hesitancy among the general adult populations in six Southeast Asian countries. METHODS: Using a snowball sampling approach, we conducted a descriptive cross-sectional study among 5260 participants in Indonesia, Malaysia, Myanmar, Philippines, Thailand, and Vietnam between February and May 2021. Binary logistic regression analysis with a backward conditional approach was applied to identify factors associated with COVID-19 vaccine hesitancy. RESULTS: Of the total, 50.6% were female, and the median age was 30 years (range: 15-83 years). The majority of the participants believed that vaccination effectively prevents and controls COVID-19 (81.2%), and 84.0% would accept COVID-19 vaccines when they become available. They agreed that health providers' advice (83.0%), vaccination convenience (75.6%), and vaccine costs (62.8%) are essential for people to decide whether to accept COVID-19 vaccines. About half (49.3%) expressed their hesitancy to receive the COVID-19 vaccines. After adjustment for other covariates, COVID-19 vaccine hesitancy was significantly associated with age, residential area, education levels, employment status, and family economic status. Participants from Indonesia, Myanmar, Thailand, and Vietnam were significantly more likely to express hesitancy in receiving COVID-19 vaccines than those from Philippines. CONCLUSIONS: In general, participants in this multi-country study showed their optimistic perception of COVID-19 vaccines' effectiveness and willingness to receive them. However, about half of them still expressed their hesitancy in getting vaccinated. The hesitation was associated with several socioeconomic factors and varied by country. Therefore, COVID-19 vaccination programs should consider these factors essential for increasing vaccine uptake in the populations.

Is Population Density a Risk Factor for Communicable Diseases Like COVID-19? A Case of Bangladesh.

Bangladesh is one of the most densely populated countries in the world struggling to prevent COVID-19 (coronavirus disease 2019). This study employed correlation, cluster analysis, and multiple linear regression analyses using district-wise COVID-19 infection and socioeconomic data. It is observed that there is a strong positive correlation (r = 0.876, P < .001) between population density and COVID-19, explaining a 60% variation in Bangladesh. The relationship between urbanization and COVID-19 is also positively strong (r = 0.802, P < .001). Urban settlements have a higher risk of spreading diseases due to the enormous population density. For future planning to prevent COVID-19 and other related infectious diseases, population density should be considered a risk factor.

Women outweighed men at life expectancy in Bangladesh: does it mean a better quality of life?

INTRODUCTION: Men had a higher life expectancy than women until 2000 in Bangladesh. After 2000, statistics showed that women had a higher life expectancy than men. We aimed to address whether higher life expectancy is a gain or burden (Failures of Success) for older women. METHODS: We utilised data from Bangladesh Demographic and Health Survey-2011, Health and Morbidity Status Survey-2014, Population and Housing Census-2011, Household Income and Expenditure Survey-2010, and primary data. We calculated and estimated gender-specific different aspects of quality of life. FINDINGS: Findings showed that the mean age at marriage was 5.8 years lower for women, while life expectancy was three years higher than men; thus, women were expected to live for 8.8 years alone. Both disabilities and morbidities were higher among women than men; hence they had lower healthy life expectancy. About 53% of women could work daily activities while 8% higher for men. Only 2.4% of women earned while almost 58% for men. Depression and loneliness were also higher among women than men. The value of the active ageing index and quality of life were also lower for women than men. CONCLUSION: This study overall found that there were the Failures of Success especially for older women in Bangladesh, as increasing life expectancies led them to extra years of chronic illness, economic insolvency, more anxiety and depression, and increasing misery. Therefore, sex and gender and their inherent differences should inform decision making to promote gender equity in health. The government and policymakers may intervene for quality of life, especially for women, through reducing gender stereotypes and increasing community engagement. Without considering the quality of life, healthy ageing cannot be ensured.

COVID-19 vaccine hesitancy among the adult population in Bangladesh: A nationwide cross-sectional survey.

INTRODUCTION: Studies related to the COVID-19 vaccine hesitancy are scanty in Bangladesh, despite the growing necessity of understanding the population behavior related to vaccination. Thus, the present study was conducted to assess the prevalence of the COVID-19 vaccine hesitancy and its associated factors in Bangladesh to fill the knowledge gap. METHODS AND MATERIALS: This study adopted a cross-sectional design to collect data from 1497 respondents using online (Google forms) and face-to-face interviews from eight administrative divisions of Bangladesh between 1-7 February 2021. We employed descriptive statistics and multiple logistic regression analysis. RESULTS: The prevalence of vaccine hesitancy was 46.2%. The Muslims (aOR = 1.80, p ≤ 0.01) and the respondents living in the city corporation areas (aOR = 2.14, p ≤0.001) had more hesitancy. There was significant variation in vaccine hesitancy by administrative divisions (geographic regions). Compared to the Sylhet division, the participants from Khulna (aOR = 1.31, p ≤0.001) had higher hesitancy. The vaccine hesitancy tended to decrease with increasing knowledge about the vaccine (aOR = 0.88, p≤0.001) and the vaccination process (aOR = 0.91, p ≤ 0.01). On the other hand, hesitancy increased with the increased negative attitudes towards the vaccine (aOR = 1.17, p≤0.001) and conspiracy beliefs towards the COVID-19 vaccine (aOR = 1.04, p≤0.01). The perceived benefits of COVID-19 vaccination (aOR = 0.85, p≤0.001) were negatively associated with hesitancy, while perceived barriers (aOR = 1.16, p ≤0.001) were positively associated. The participants were more hesitant to accept the vaccine from a specific country of origin (India, USA, Europe). CONCLUSIONS: Our findings warrant that a vigorous behavior change communication campaign should be designed and implemented to demystify negative public attitudes and conspiracy beliefs regarding the COVID-19 Vaccine in Bangladesh. The policymakers should also think about revisiting the policy of the online registration process to receive the COVID-19 vaccine, as online registration is a key structural barrier for many due to the persistent digital divide in the country. Finally, the government should consider the population's preference regarding vaccines' country of manufacture to reduce the COVID-19 vaccine hesitancy.

Health Belief Model, Theory of Planned Behavior, or Psychological Antecedents: What Predicts COVID-19 Vaccine Hesitancy Better Among the Bangladeshi Adults?

This study aimed to determine the prevalence and investigate the constellations of psychological determinants of the COVID-19 vaccine hesitancy among the Bangladeshi adult population utilizing the health belief model-HBM (perceived susceptibility to and severity of COVID-19, perceived benefits of and barriers to COVID-19 vaccination, and cues to action), the theory of planned behavior-TPB (attitude toward COVID-19 vaccine, subjective norm, perceived behavioral control, and anticipated regret), and the 5C psychological antecedents (confidence, constraints, complacency, calculation, and collective responsibility). We compared the predictability of these theoretical frameworks to see which framework explains the highest variance in COVID-19 vaccine hesitancy. This study adopted a cross-sectional research design. We collected data from a nationally representative sample of 1,497 respondents through both online and face-to-face interviews. We employed multiple linear regression analysis to assess the predictability of each model of COVID-19 vaccine hesitancy. We found a 41.1% prevalence of COVID-19 vaccine hesitancy among our study respondents. After controlling the effects of socio-economic, demographic, and other COVID-19 related covariates, we found that the TPB has the highest predictive power (adjusted R 2 = 0.43), followed by the 5C psychological antecedents of vaccination (adjusted R 2 = 0.32) and the HBM (adjusted R 2 = 0.31) in terms of explaining total variance in the COVID-19 vaccine hesitancy among the adults of Bangladesh. This study provides evidence that theoretical frameworks like the HBM, the TPB, and the 5C psychological antecedents can be used to explore the psychological determinants of vaccine hesitancy, where the TPB has the highest predictability. Our findings can be used to design targeted interventions to reduce vaccine hesitancy and increase vaccine uptake to prevent COVID-19.

Do knowledge and attitudes matter for preventive behavioral practices toward the COVID-19? A cross-sectional online survey among the adult population in Bangladesh.

The Government of Bangladesh has adopted several non-therapeutic measures to tackle the pandemic of SARS-CoV-2. However, the curve of COVID-19 positive cases has not significantly flattened yet, as the adoption of preventive measures by the general population is predominantly a behavioral phenomenon that is often influenced by people's knowledge and attitudes. This study aimed to assess the levels of knowledge, attitudes, and preventive behavioral practices toward COVID-19 and their interrelationships among the population of Bangladesh aged 18 years and above. This study adopted a web-based cross-sectional survey design and collected data from 1056 respondents using the online platform Google Form. We employed the independent sample t-test, one-way ANOVA, Pearson's product-moment correlation, and Spearman rank-order correlation to produce the bivariate level statistics. We also run multiple linear and logistic regression models to identify the factors affecting knowledge, attitudes, and preventive behavioral practices toward COVID-19. The respondents had an average knowledge score of 17.29 (Standard Deviation (SD) = 3.30). The average score for attitude scale toward COVID-19 was 13.6 (SD = 3.7). The respondents had excellent preventive behavioral practices toward COVID-19 (mean 7.7, SD = 0.72). However, this study found that knowledge and attitudes did not matter for preventive behavioral practices toward COVID-19. Instead, education appeared as a sole predictor for preventive behavioral practices toward COVID-19; that means preventive behavioral practices toward COVID-19 was lower among the less educated respondents. This study suggests increasing education as a long-term strategy and taking immediate action to increase knowledge and decrease negative attitudes toward COVID-19 through targeted health education initiatives as a short-term strategy.

Population-Level Preparedness About Preventive Practices Against Coronavirus Disease 2019: A Cross-Sectional Study Among Adults in Bangladesh.

This study assessed the preparedness regarding the preventive practices toward the coronavirus disease 2019 (COVID-19) among the adult population in Bangladesh. Data were collected through an online survey with a sample size of 1,056. We constructed four variables (individual, household, economic, and community and social distancing) related to preparedness based on the principal component analysis of eight items. We employed descriptive statistics and multiple linear regression analysis. The results showed that the accuracy rate of the overall preparedness scale was 68.9%. The preparedness level related to economic, individual, household, and community and social distancing was 64.9, 77.1, 50.4, and 83.2%, respectively. However, the economic preparedness significantly varied by sex, education, occupation, attitude, and worries related to COVID-19. Individual preparedness was significantly associated with education, residence, and attitudes. The household preparedness significantly varied by education, residence, and worries, while the respondent's community and social distancing-related preparedness significantly varied by sex, region, residence, and attitude. This study implies the necessity of the coverage of financial schemes for the vulnerable group. Increased coverage of health education regarding personal hygiene targeting the less educated and rural population should be ensured.