Intimate partner violence and chronic undernutrition among married Bangladeshi women of reproductive age: are the poor uniquely disadvantaged?

BACKGROUND/OBJECTIVES: To investigate (i) associations of intimate partner violence (IPV) and chronic undernutrition among women of reproductive age and (ii) whether women who experience both poverty and IPV are unique in their nutritional disadvantages. SUBJECTS/METHODS: This study used the data from the 2007 Bangladesh Demographic Health Survey, a cross-sectional, nationally representative study. Analyses were based on the responses of 3861 currently married, non-pregnant women. Exposure was determined from maternal reports of physical and sexual IPV. Chronic undernutrition among women was the main outcome variable of interest. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. RESULTS: Over 53% of married Bangladeshi women experienced physical and/or sexual violence from their husbands. Experience of physical IPV (adjusted odds ratio (AOR)=1.22; 95% confidence interval (CI)=1.02-1.46) and both physical and sexual IPV (AOR=1.24; 95% CI=1.04-1.58) was associated with an increased risk of chronic undernutrition among women. A magnitude of three or more types of physical IPV appeared to have more profound consequences on women's undernutrition. Findings also revealed that women who are poor and have experienced IPV are unique in their nutritional disadvantages. CONCLUSIONS: Experience of IPV is an important risk marker for the increased risk of chronic undernutrition among women of reproductive age in Bangladesh. Women experiencing IPV need help irrespective of the socioeconomic status they belong to. Targeted intervention at IPV among the poor may help improve nutritional status among women of reproductive age.

Non-hospital DOT and early diagnosis of tuberculosis reduce costs while achieving treatment success.

OBJECTIVE: 1) To evaluate the tuberculosis (TB) related financial burden of patients and health care providers over the course of diagnosis and treatment by choice of directly observed treatment (DOT); and 2) to examine treatment outcomes for different DOT programmes in Cambodia. SETTING AND DESIGN: Subjects were patients diagnosed with smear-positive pulmonary TB between July 2008 and January 2009 at 17 health facilities providing multiple DOT programmes. Treatment outcomes for the different DOT programmes as well as direct and indirect household costs and medical delivery costs for the treatment and care of 277 patients were examined. RESULTS: Per patient costs of anti-tuberculosis treatment for patients with non-multidrug-resistant TB who did not have human immunodeficiency virus co-infection ranged from a high of US$1900 for in-patient DOT to a low of $395 for DOT provided at home. All costs among patients treated with hospital DOT were consistently higher than for those treated with non-hospital DOT. The percentage of treatment success was not significantly different between hospital and non-hospital DOT programmes (all >89%). CONCLUSION: Non-hospital DOT programmes ease the financial burden on both patients and health care providers, while resulting in treatment success rates similar to those of hospital DOT.

Correlation between national income, HIV/AIDS and political status and mortalities in African countries.

OBJECTIVES: To investigate associations between mortalities in African countries and problems that emerged in Africa in the 1990s (reduction of national income, HIV/AIDS and political instability) by adjusting for the influences of development, sanitation and education. METHODS: We compiled country-level indicators of mortalities, national net income (the reduction of national income by the debt), infection rate of HIV/AIDS, political instability, demography, education, sanitation and infrastructure, from 1990 to 2000 of all African countries (n=53). To extract major factors from indicators of the latter four categories, we carried out principal component analysis. We used multiple regression analysis to examine the associations between mortality indicators and national net income per capita, infection rate of HIV/AIDS, and political instability by adjusting the influence of other possible mortality determinants. RESULTS: Mean of infant mortality per 1000 live births (IMR); maternal mortality per 100,000 live birth (MMR); adult female mortality per 1000 population (AMRF); adult male mortality per 1000 population (AMRM); and life expectancy at birth (LE) in 2000 were 83, 733, 381, 435, and 51, respectively. Three factors were identified as major influences on development: education, sanitation and infrastructure. National net income per capita showed independent negative associations with MMR and AMRF, and a positive association with LE. Infection rate of HIV/AIDS was independently positively associated with AMRM and AMRF, and negatively associated with LE in 2000. Political instability score was independently positively associated with MMR. CONCLUSIONS: National net income per capita, HIV/AIDS and political status were predictors of mortality indicators in African countries. This study provided evidence for supporting health policies that take economic and political stability into account.