ABSTRACT
Background: Tuberculosis (TB) is a common condition all over the world but more common in developing countries like Bangladesh38. This is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. In 2013, 9 million people fell ill with TB and 1.5 million died from the disease globally. Approximately 15-20 % of total TB cases are extrapulmonary in non-HIV patients. Among extrapulmonary TB, abdominal tuberculosis (ATB) accounts for 11%-16%. Abdominal TB is difficult to diagnose because of its lack of specific symptoms, low yield of acid-fast bacilli (AFB) on smear and culture due to paucibacillary lesion; and variable manifestations depending upon anatomical localization of the disease. The diagnosis of abdominal TB classically requires histopathological, microbiological and culture confirmation of Mycobacterium tuberculosis. Investigations like Imaging (Ultrasound, Barium X-Rays, and CT scan) and the Mantoux test have only supportive value. Aim of the study: The aim of the study was to diagnose modalities and antimicrobial susceptibility in abdominal tuberculosis patients.Material & Methods:This cross-sectional hospital-based observational study was carried out among 73 adult patients with the diagnosis of abdominal TB who met the selection criteria and attended in Gastroenterology department of DMCH through either admission or referral from May 2015 to April 2016.Results:The most frequent symptoms were weight loss (96.9%), abdominal pain (75%), and fever (75%). The most frequent signs were anaemia (34.4%), followed by ascites (27.9%). Basis of diagnosis in abdominal tuberculosis was histolopathogy in 37.5%, Gene Xpert in 28.1%, Positive AFB on culture in 9.4%, ADA value in ascitic fluid (Cutoff >40 IU/L) in 25%, and good clinical response (Based on weight gain and general improvement in wellbeing) to a therapeutic trial of anti-TB treatment in 18.7% patients. Drug sensitivity pattern was analyzed in all three AFB culture-positive patients; resistance was detected in one which showed multidrug resistance (MDR TB).Conclusions:The result of this study highlighted the diagnostic yield of various investigation modalities, particularly newer modalities (Gene Xpert, culture sensitivity in Bactec MGIT 960) and basis of diagnosis in abdominal TB. This study also determined the MTB culture positivity from tissue biopsies in patients with abdominal TB and demonstrated drug-resistant MTB in culture-confirmed abdominal TB.
ABSTRACT
The discourse of dual burden caused through underweight and overweight is well-documented globally but this issue and its connection with women’s health in Bangladesh is yet to be explored widely. To enrich the current debate, this study, in the context of Bangladesh, examines the patterns, prevalence, and socioeconomic factors influencing the ever-married women of being underweight and overweight over normal weight. Data used in this study have been extracted from the most recent 2011 Bangladesh Demographic and Health Survey. To achieve results connected with the research objectives, both bivariate and multivariate statistical analyses have been employed. In bivariate analysis, we used seven categories of BMI cutoff points for Asian countries as prescribed by World Health Organization (WHO). Multinomial logistic regression model was constructed to investigate the net effect of socioeconomic factors on underweight, pre-overweight, and overweight over normal weight. The results confirm the co-existence of underweight and overweight among women as we found the prevalence of underweight, normal weight, pre-overweight, overweight, and obesity to be 24.1%, 46.7%, 12.8%, 13.5%, and 2.9% respectively. Compared to the richest, the women from the poorest households were significantly (p<0.001) most likely to be underweight (OR=2.75, 95% CI 2.27-3.35) and least likely to be overweight (OR=0.15, 95% CI 0.12-0.19) over normal weight. The urban women, compared to their rural counterparts, were significantly (p<0.001) less likely to be underweight (OR=0.80, 95% CI 0.71-0.91) and more likely to be overweight (OR=1.33, 95% CI 1.18-1.51) than normal weight. The other socioeconomic grades that were most marked to be underweight and overweight are age, women’s education, marital status, age at first childbirth, parity, number of children aged ≤5 years at the household, and food security. The findings confirm the dual burden of both under- and overweight. Systematic and regular monitoring and surveillance of the social trajectory of nutritional status of women and men in Bangladesh is crucial to develop apposite strategy that addresses the persistent and chronic problem of underweight and the emerging problem of overweight. The dual existence of both types of malnutrition among women in Bangladesh must be taken into consideration so that public health interventions may be adopted through appropriate policy.
ABSTRACT
In Bangladesh, preference for place of delivery and socioeconomic factors associated with caesarean section are not well-understood. This paper examines the socioeconomic correlates of preference for institutional delivery and caesarean sections in Bangladesh. The study used data from the nationally-representative 2007 Bangladesh Demographic and Health Survey. Both bivariate and multivariate binary logistic regression models were constructed to assess the effect of sociodemographic factors on the use of medical facilities and caesarean section for childbirth. Overall, 15% of women underwent institutional delivery, and 8% deliveries were performed by caesarean sections. Both institutional deliveries and caesarean sections have increased in recent years. The bivariate and multivariate analyses both confirmed that place of residence, religion, birth order, frequent pregnancy, antenatal care-seeking, and wealth index were important predictors of the use of medical facilities and caesarean sections for childbirth. Women’s education appeared as the most single significant determinant for the use of both services. The findings underlie the importance of monitoring caesarean section as well as professional attendance for safe motherhood. Programmes should aim to inform women highlighting the benefits of the use of skilled maternal healthcare services and demerits of home-delivery practices.
ABSTRACT
This paper explores the decline in child marriage and changes in its effect on reproductive outcomes of Bangladeshi women, using the 2007 Bangladesh Demographic and Health Survey data. Chi-square tests, negative binomial Poisson regression and binary logistic regression were performed in analyzing the data. Overall, 82% of women aged 20-49 years were married-off before 18 years of age, and 63% of the marriages took place before 16 years of age. The incidence of child marriage was significantly less among the young women aged 20-24 years compared to their older counterparts. Among others, women’s education appeared as the most significant single determinant of child marriage as well as decline in child marriage. Findings revealed that, after being adjusted for sociodemographic factors, child marriage compared to adult marriage appeared to be significantly associated with lower age at first birth (OR=0.81, 95% CI=76-0.86), higher fertility (IRR=1.45, 95% WCI=1.35-1.55), increased risk of child mortality (IRR=1.64, 95% WCI=1.44- 1.87), decreased risk of contraceptive-use before any childbirths (OR=0.56, 95% CI=0.50-0.63), higher risk of giving three or more childbirth (OR=3.94, 95% CI=3.38-4.58), elevated risk of unplanned pregnancies (OR=1.21, 95% CI=1.02-1.45), increased risk of pregnancy termination (OR=1.16, 95% CI=1.00-1.34), and higher risk of the use of any current contraceptive method (OR=1.20, 95% CI=1.06-1.35). Increased enforcement of existing policies is crucial for the prevention of child marriage. Special programmes should be undertaken to keep girls in school for longer period to raise the age of females at first marriage in Bangladesh and thereby reduce the adverse reproductive outcomes.