Targeting strategies for balanced energy and protein (BEP) supplementation in pregnancy: study protocol for the TARGET-BEP cluster-randomized controlled trial in rural Bangladesh.

BACKGROUND: The World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this threshold, however, and a large proportion of undernourished women and those with inadequate gestational weight gain could miss benefiting from BEP. This study compares the effectiveness of individual targeting approaches for supplementation with micronutrient-fortified BEP vs. multiple micronutrient supplements (MMS) alone as control in pregnancy in improving birth outcomes. METHODS: The TARGET-BEP study is a four-arm, cluster-randomized controlled trial conducted in rural northwestern Bangladesh. Eligible participants are married women aged 15-35 years old identified early in pregnancy using a community-wide, monthly, urine-test-based pregnancy detection system. Beginning at 12-14 weeks of gestation, women in the study area comprising 240 predefined sectors are randomly assigned to one of four intervention arms, with sector serving as the unit of randomization. The interventions involving daily supplementation through end of pregnancy are as follows: (1) MMS (control); (2) BEP; (3) targeted BEP for those with pre-pregnancy body mass index (BMI) < 18.5 kg/m2 and MMS for others; (4) targeted BEP for those with pre-pregnancy BMI < 18.5 kg/m2, MMS for others, and women with inadequate gestational weight gain switched from MMS to BEP until the end of pregnancy. Primary outcomes include birth weight, low birth weight (< 2500 g), and small for gestational age, defined using the 10th percentile of the INTERGROWTH-21st reference, for live-born infants measured within 72 h of birth. Project-hired local female staff visit pregnant women monthly to deliver the assigned supplements, monitor adherence biweekly, and assess weight regularly during pregnancy. Trained data collectors conduct pregnancy outcome assessment and measure newborn anthropometry in the facility or home depending on the place of birth. DISCUSSION: This study will assess the effectiveness of targeted balanced energy and protein supplementation to improve birth outcomes among pregnant women in rural Bangladesh and similar settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05576207. Registered on October 5th, 2022.

Effect of Rural-Urban Migration on Age at Marriage Among Adolescent Girls in Bangladesh.

Objectives: Bangladesh reports one of the highest rates of child marriage (CM) (59%) in the world and the highest rate within South Asia. Age at marriage of girls is a critical human rights and developmental issue in Bangladesh. Migration has been documented to be positively associated with age at marriage. Bangladesh experiences one of the highest rates of rural to urban migration in the world. An increase in rural-urban migration of adolescent girls has been observed over the last few decades in Bangladesh with the expansion of employment opportunities particularly in the ready-made garment industry (RMG). This analysis explores the effect of migration on age at marriage and CM among adolescent girls living in urban slums of Dhaka. Methods: The sample was selected from icddr,b's Urban Health and Demographic Surveillance System (UHDSS) and comprises of never-married adolescent girls aged 15-19, who migrated in from rural Bangladesh to slums in and around Dhaka during 2015-2019. These in-migrants were matched with their rural counterparts from icddr,b's Matlab HDSS (MHDSS), using one to one nearest neighbor matching with caliper 0.1 using propensity score matching (PSM) method. The sample derived included a total of 2,700 never-married adolescent girls from Dhaka and Matlab. The association between migration and age at first marriage was estimated using a linear regression model and the effect of migration on CM was explored using logistic regression analyses. Results: The in-migrants perfectly matched with their rural peers in terms of age, household wealth and religion. However, their income earning status was hugely different. Urban migrants had significantly higher age at marriage than the rural non-migrants for both 15-19 (Coefficient, 1.77; 95% CI, 1.07-2.46) and 20-24 years age group (Coefficient, 2.87; 95% CI, 2.18-3.55). The migrant girls aged 20-24 years were 71% (aOR, 0.29; 95% CI, 0.12-0.69) less likely to get married before CM age bar in Bangladesh compared to their rural counterparts. Conclusion: Migration has a positive effect on delaying marriage and reducing CM among adolescent girls. Findings from this study suggest that CM can be reduced by creating educational and economic opportunities for females.

Oral Polio Vaccine Campaigns May Reduce the Risk of Death from Respiratory Infections.

Oral polio vaccine (OPV) campaigns, but not other campaigns, have been associated with major reductions in child mortality. Studies have shown that OPV reduces the risk of respiratory infections. We analysed the causes of death at 0-2 years of age in Chakaria, a health and demographic surveillance Systems in Bangladesh, in the period 2012-2019 where 13 national campaigns with combinations of OPV (n = 4), vitamin A supplementation (n = 9), measles vaccine (MV) (n = 2), and albendazole (n = 2) were implemented. OPV-only campaigns reduced overall mortality by 30% (95% confidence interval: -10-56%). Deaths from respiratory infections were reduced by 62% (20-82%, p = 0.01) in the post-neonatal period (1-35 months), whereas there was as slight increase of 19% (-37-127%, p = 0.54) for deaths from other causes. There was no benefit of other types of campaigns. Hence, the hypothesis that OPV may have beneficial non-specific effects, protecting particularly against respiratory infections, was confirmed.

Factors associated with school achievement of children aged 8-10 years in rural Bangladesh: Findings from a post hoc analysis of a community-based study.

BACKGROUND: Education is one of the most important human capitals. Investment in education at early age returns best. A lot of factors influence children's educational achievement. Studies in developed countries well established the relation of school achievement with its associated variables. But information is lack on what factors play important role for school achievement at early age in low resource settings like Bangladesh. We aimed to find factors associated with school achievement in rural Bangladesh. METHOD: The data were acquired from a long-term follow up study, conducted in 8-10 years old children (n = 372). We used a locally developed school achievement tool based on Wide Range Achievement Test-4 to measure reading, spelling and math computation, Wechsler abbreviated scale of intelligence to measure intelligence Quotient (IQ), Digit span forward and backward for short term memory, and locally available Strength and Difficulties Questionnaire to measure behaviour. Socioeconomic and anthropometric information of the mothers and children were also collected. Multicollinearity of the data was checked. Unadjusted and adjusted multiple linear regression analysis was performed. FINDINGS: Years of schooling and short-term memory were positively related to reading, spelling and math computation. For years of schooling it was-reading B = 8.09 (CI 5.84, 10.31), spelling 4.43 (4.33, 8.53) and math computation 5.23 (3.60, 6.87) and for short term memory- reading 3.56 (2.01,5.05), spelling 4.01 (2.56, 5.46) and math computation 2.49 (1.37, 3.62). Older children had lower scores of reading -0.48 (-0.94, -0.02), spelling -0.41 (-0.88, -0.02) and math computation -0.47 (-0.80, -0.14). Children's IQ predicted reading 0.48 (0.14, 0.81) and spelling 0.50 (0.18, 0.82) skills. Mother and father's education predicted Spelling 0.82 (0.16, 1.48) and reading 0.68 (0.06, 1.30) capacity respectively. Children enrolled in private schools had higher reading 10.28 (5.05, 15.51) and spelling 6.22 (1.31, 11.13) than those in the government schools. Children with more difficult behaviour tended to have lower scores in reading -0.51 (-0.96, -0.05). CONCLUSION: Children's school achievement is influenced by their IQ, years of schooling, type of school and parents' education. Therefore, intervention should be made to focus specifically on these variables and establish the effect of this intervention through robust research design.