Individual- and community-level factors associated with the presence of adequate iodized salt in households in Bangladesh: a multilevel modelling approach.

BACKGROUND: The aim of this study is to estimate the factors at both the individual and community levels related to the adequacy of iodized salt in households in Bangladesh. METHODS: For this study we utilized the 2019 Multiple Indicator Cluster Survey data. A total of 61 242 households were chosen as samples from Bangladesh. In our study of socio-economic disparities, we applied a concentration indexing method. To identify the factors associated with the adequacy of iodine in salt at both the individual and community levels, we employed multilevel logistic regression. Aside from the multilevel regression used in the study, we also applied spatial analysis. RESULTS: The results indicated that the prevalence of iodine adequacy in household salt was found to be 57.8% (95% confidence interval 57.4 to 58.2). Rural areas have a higher concentration of iodine than urban areas. According to the multilevel model, younger women (adjusted odds ratio [aOR] 0.70), Muslim women (aOR 0.89), illiterate women (aOR 0.80) and those from poor households (aOR 0.33) were found to be less likely to consume iodine in concentrated salt compared with their counterparts. Disabled women and those with low media exposure have a lower likelihood of iodine adequacy in salt compared to their reference group. Furthermore, households in urban areas exhibited higher odds of having iodine adequacy in salt compared with households in rural areas. Barisal, Chattogram, Dhaka, Khulna, Mymensingh, Rajshahi and Rangpur Divisions have lower iodine adequacy in salt compared with Sylhet Division. CONCLUSIONS: The findings reveal that religion, physical disability and exposure to media exert an equal influence on the presence of iodized salt intake. Moreover, women's age, wealth status, education level and the educational background of the household head positively contribute to the adequacy of iodine in household salt. In light of these results, policymakers are advised to prioritize efforts aimed at enhancing iodine concentration, with a particular focus on mass media advertising, especially in rural areas (excluding Sylhet Division).

Double burden of malnutrition among women of reproductive age in Bangladesh: A comparative study of classical and Bayesian logistic regression approach.

Although the prevalence of undernutrition among women of reproductive age has declined in Bangladesh, the increase in the prevalence of overnutrition remains a major challenge. To achieve Sustainable Development Goal 2.2, it is important to identify the drivers of the double burden of malnutrition on women in Bangladesh. The Bangladesh Demographic and Health Survey, 2017-2018 was used to model the relationship between the double burden of malnutrition among women and the risk factors using a logistic regression model under the classical and Bayesian frameworks and performed the comparison between the regression models based on the narrowest confidence interval. Regarding the Bayesian application, the Metropolis-Hastings algorithm with two types of prior information (historical and noninformative prior) was used to simulate parameter estimates from the posterior distributions. The Boruta algorithm was used to determine the significant predictors. Almost half of reproductive aged women experienced a form of malnutrition (12% were underweight, 26.1% were overweight, and 6.8% were obese). In terms of the narrowest interval estimate, it was found that Bayesian logistic regression with informative priors performs better than the noninformative priors and the classical logistic regression model. Women who were older, highly educated, from rich families, unemployed, and from urban residences were more likely to experience the double burden of malnutrition. This study recommended using the historical prior as the informative prior rather than the flat/noninformative prior to estimating the parameter uncertainty if historical data are available. The double burden of malnutrition among women is a major public health challenge in Bangladesh. This study was to determine the impact of effective risk factors on the double burden of malnutrition among women by applying the Bayesian framework. Using both informative and noninformative priors, "historical prior" was proposed as informative prior information. The main strength is that the proposed prior (historical prior) provided improved estimation as compared to the flat prior distribution.

Socioeconomic correlates of Adequate Maternal Care in Bangladesh: Analysis of the Bangladesh Demographic and Health Survey 2017-18.

Introduction: In recent times, Bangladesh has made significant improvements in various health outcomes, but not so much in maternal death. The current flat trend in reducing maternal mortality in Bangladesh has been mainly due to the lower coverage of maternal health care. To improve the coverage, it is essential to find biosocial factors related to adequate maternal health care. Therefore, this study is aimed at finding out the socioeconomic correlates of adequate maternal health care in Bangladesh. Methods: The study used data from the Bangladeshi demographic and health survey 2017-18. The total unweighted sample of 4012 women who reported pregnancy before three years of the survey was analyzed. A composite binary indicator of adequate maternal care has been constructed using the variables-access to maternal care service, four antenatal care visits, at least one visit with qualified providers, and institutional delivery. A binary logistic regression model was employed to find out the socioeconomic correlate of adequate maternal care. Results: Only 24.4% percent of sample women received adequate maternal care. The result of the logistic regression model shows that urban, Khulna, Rajshahi, and Rangpur were associated with an increase in the odds of having adequate maternal care. High education and health care decisions taken by the partner or husband were also associated with an increased odd of adequate maternal care. Islam and lower wealth status were associated with a lower probability of adequate maternal care. Conclusions: Policymakers and health administration should pay attention to the variation in the utilization of maternal health care across residence, region, religion, education, and wealth status to ensure safe motherhood.

Biosocial correlates of adolescent's knowledge on pubertal changes in rural Bangladesh: A structural equation model.

BACKGROUND: The present study aimed to identify factors that are associated with puberty knowledge among school-going rural adolescents in Bangladesh. METHODS: This cross-sectional study was conducted on 2724 school-going (grades VI-IX) adolescents who were aged between 10-24 years. The adolescents resided only in rural areas of Bangladesh. In this study, relationship between socio-demographic factors and controlling behaviour was assessed considering Bronfenbrenner's bioecological model. Considering the complex nature of Bronfenbrenner's bioecological model the structural equation model to explore factors related to the Adolescents' knowledge of pubertal changes. RESULTS: The structural equation model result showed a significant association among gender, education, age, and parental limit setting on daily activities with student's knowledge on pubertal changes. peer connection, and peer regulation were associated with adolescent knowledge on puberty directly as well as through the mediator variables year of schooling, academic performance and, parental behavioural control. CONCLUSION: Adolescents Age, years of schooling, and teachers concerns are positively associated with adolescents' knowledge on puberty. Whereas, parents' and peers' controlling behaviors are negatively associated with adolescents' understanding of pubertal changes. Therefore, there is needed an effective plan to raise the attention of parents and teachers on adolescents' pubertal issues to ensure adolescents' informed pubertal period.

Prevalence and risk factors for uveitis in spondyloarthritis.

AIM: To determine the prevalence and risk factors for uveitis in spondyloarthritis (SpA) patients. METHODS: A total of 225 patients who fulfilled Assessment of Spondyloarthritis International Society classification criteria for axial and peripheral SpA were enrolled. The diagnosis of uveitis was confirmed by an ophthalmologist. From medical records and from clinical evaluation associated information like disease duration, and human leukocyte antigen B27 was collected. Relevant laboratory tests were done and disease severity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score - erythrocyte sedimentation rate and C-reactive protein. Characteristics of uveitis positive and uveitis negative groups were compared. Multivariate logistic regression analysis was done for the risk factors, and P values <.05 were considered significant. RESULTS: Prevalence of uveitis was 18.7%. The disease duration was 9.3 ± 7 years and 5.4 ± 4.5 years in uveitis and no uveitis groups respectively (P ≤ .001). Family history of SpA was positive in 45.2% in the uveitis group (P ≤ .001). The frequency of axial SpA was 92.9% and 73.8% in the uveitis and no uveitis groups respectively (P ≤ .008). The mean BASDAI was 2.4 ± 1.9 and 3.3 ± 2.8 in uveitis and no uveitis groups respectively (P = .050). In multivariate logistic regression analysis, among the selected variables, family history of SpA (odds ratio [OR] =3.697; 95% CI =1.616-8.457; P = .002) and duration of disease (OR =1.089; 95% CI =1.004-1.181; P = .039) were independently associated with the occurrence of uveitis. CONCLUSIONS: The prevalence of uveitis was 18.7%. The family history and the disease duration of SpA were independently associated with uveitis.

Translation, cultural adaptation and validation of the WHO fracture risk assessment tool (FRAX(®) ) into Bengali.

AIM: To develop a translated and culturally adapted Bengali version of the WHO Fracture Risk Assessment Tool (FRAX(®) ) and to test its feasibility, content validity and reliability. METHOD: The English FRAX was translated and culturally adapted for use in Bangladeshi populations following established forward-backward translation methods and being extensively field-tested. The final version was interviewer-administered to 130 consecutive osteoporotic patients between 40 and 90 years of age. For test-retest reliability, the questionnaire was re-administered after 14 days in 60 odd serial-numbered patients. RESULTS: To better match with the Bengali culture, several adaptations were made to the FRAX items, including replacements and additions for tobacco, prednisolone and alcohol use. The response rate of the pre-final Bengali version of FRAX was 100% and all patients could understand the questions. Test-retest reliability (Pearson's r) in osteoporotic patients was > 0.93 for all items. CONCLUSION: The culturally adapted Bengali version of the FRAX appears to be an acceptable and reliable instrument. Further studies are needed to confirm the ability of the tool to accurately predict the 10-year probability of hip and major osteoporotic fractures in the Bengali population.