Unveiling the effects of living standards on diabetes and hypertension with the mediating role of overweight and obesity: a cross-sectional study in Bangladesh.

OBJECTIVE: The purpose of the study was to ascertain how the standard of living is associated with the likelihood of developing diabetes and hypertension directly as well as indirectly through overweight and obesity. STUDY DESIGN: The study used 2017-2018 Bangladesh Demographic and Health Survey data. It examined the household living standard (LSD) as the main factor, and body mass index (BMI) as a mediator. Outcomes included diabetes status, hypertension status and their co-occurrence. Structural equation modelling with logistic regression and bootstrapping were used for mediation analysis and computing bias-corrected SEs. SETTING: The research was carried out in Bangladesh and included both male and female adults. PARTICIPANTS: The study encompassed a total of 11 961 adults (5124 males and 6837 females) aged 18 years or older. RESULTS: Among the participants, 10.3% had diabetes, 28.6% had hypertension and 4.9% had both conditions. The prevalence of diabetes, hypertension or both conditions was 18.5%, 33.5% and 9.7%, respectively, among those with a high LSD. Regression analysis demonstrated that individuals with high LSD had significantly elevated risks of these conditions compared with those with low LSD: 133% higher odds for diabetes (OR 2.22; 95% CI 1.97 to 2.76), 25% higher odds for hypertension (OR 1.25; 95% CI 1.10 to 1.42) and 148% higher odds for both conditions (OR 2.48; 95% CI 1.96 to 3.14). Moreover, the indirect effects of high LSD through obesity surpassed its direct effects for developing diabetes, hypertension or both conditions. CONCLUSION: This study emphasises that with the enhancement of LSD, individuals often experience weight gain, resulting in elevated BMI levels. This cascade effect significantly amplifies the risks of diabetes, hypertension or both conditions. To counteract this concerning trajectory, policy interventions and targeted awareness campaigns are imperative. These efforts must prioritise the promotion of heightened physical activity and the mitigation of the overweight/obesity surge associated with rising LSD.

Do education and living standard matter in breaking barriers to healthcare access among women in Bangladesh?

BACKGROUND: Barriers to healthcare access for women have a substantial influence on maternal and child health. By removing barriers to accessing healthcare, several sustainable development goals can be achieved. The goal of this study, based on the dominance analysis, was to examine how living standards and spousal education play role in removing barriers to healthcare access for women in Bangladesh. METHODS: The study used the nationally representative Bangladesh Demographic and Health Survey (BDHS), 2017-18 data. A binary logistic regression model was applied for analyzing different types of health access barriers in the study. Additionally, a dominance analysis was conducted to identify the most responsible factors for removing barriers. RESULTS: In Bangladesh, 66% of women faced at least one barrier in accessing healthcare. The results obtained from logistic regression and dominance analysis revealed that women's standard of living and spousal education explained the highest variation of having at least one barrier in accessing healthcare. Specifically, a high standard of living explained 24% of the total explained variation (OR 0.56, 95% CI 0.52-0.62), while both spousal education accounted for 27% (OR 0.49, 95% CI 0.45-0.54) of the total explained variation. The regression results also showed that women with higher standards of living as well as educated women having educated partners had lower odds of facing barriers in getting permission (OR 0.87, 95% CI 0.76-1.00 and OR 0.66, 95% CI 0.58-0.75) to go for advice/treatment, obtaining money (OR 0.43, 95% CI 0.39-0.47 and OR 0.37, 95% CI 0.34-0.40), distance to a health facility (OR 0.60, 95% CI 0.55-0.66 and OR 0.70, 95% CI 0.65-0.76), and not wanting to go alone (OR 0.72, 95% CI 0.66-0.89 and OR 0.75, 95% CI 0.69-0.81) for getting medical advice/treatment. CONCLUSION: The findings of the study suggest paying extra attention to the spousal education and living standard of women to strengthen and reform the existing strategies and develop beneficial interventions to enhance unhindered accessibility to healthcare facilities for women.

Women's multidimensional empowerment index and essential newborn care practice in Bangladesh: The mediating role of skilled antenatal care follow-ups.

INTRODUCTION: The World Health Organization recommended a set of five neonatal care practices that are most essential for good health of a newborn. As good essential newborn care (ENC) practice reduces the risk of neonatal morbidity and mortality, this paper focuses how women's multidimensional empowerment index is associated with this practice through the skilled antenatal care. To the best of knowledge, no such study has been conducted yet. The composite index of women's multidimensional empowerments was constructed using family decision, intimate partner violence, social status, healthcare access and economic status of women; and skilled antenatal care was defined if a pregnant woman received eight or more checkups during pregnancy from skilled health professionals. MATERIALS AND METHODS: Data extracted from Bangladesh Demographic and Health Survey, 2017-18 have been utilized in the study. A total of 2441 mothers have been considered who delivered their last live birth at home within three years preceding the survey. A mediation analysis was performed considering the structural equation modeling to find out the adjusted association of women's empowerment on both skilled antenatal care and good ENC practice, but the unadjusted associations were also checked using a chi-square test. To test the indirect as well as total effect of women's empowerment through skilled antenatal care on good ENC practice, bias-corrected standard errors were estimated using a bootstrapping sampling. RESULTS: Good ENC practice was considerably low in Bangladesh with 7.6% of newborns receiving the practice. Both adjusted and unadjusted analyses showed the significant association of women's empowerment with both skilled antenatal care and good ENC practice. The study revealed that the indirect effect of high empowerment through skilled antenatal care was greater than its direct effect on good ENC practice. CONCLUSION: This study explored that the prevalence of good ENC practice can be accelerated through women's empowerment, where skilled antenatal care plays an important mediating role in improving good ENC practice among highly empowered mothers. The study suggests that a woman should follow the latest guidelines recommended by WHO for antenatal care follow-up. Policymakers can modify some of the maternal and child health care interventions based on the research findings.

Examining the influence of correlates on different quantile survival times: infant mortality in Bangladesh.

BACKGROUND: Several studies have identified factors influencing infant mortality, but, to the best of knowledge, no studies assessed the factors considering unequal effects on different survival times of infant mortality in Bangladesh. In this study, it was examined how a set of covariates behaves on different quantile survival times related with the infant mortality. METHODS: Data obtained from Bangladesh multiple indicator cluster survey (BMICS), 2019 have been used for purpose of the study. A total of 9,183 reproductive women were included in the study who gave their most recent live births within two years preceding the survey. Kaplan-Meier product limit approach has been applied to find the survival probabilities for the infant mortality, and the log-rank test has also been used to observe the unadjusted association between infant mortality and selected covariates. To examine the unequal effects of the covariates on different quantile survival time of infant mortality, the Laplace survival regression model has been fitted. The results obtained from this model have also been compared with the results obtained from the classical accelerated failure time (AFT) and Cox proportional hazard (Cox PH) models. RESULTS: The infant mortality in Bangladesh is still high which is around 28 per 1000 live births. In all the selected survival regression models, the directions of regression coefficients were similar, but the heterogenous effects of covariates on survival time were observed in quantile survival model. Several correlates such as maternal age, education, gender of index child, previous birth interval, skilled antenatal care provider, immediate breastfeeding etc. were identified as potential factors having higher impact on initial survival times. CONCLUSION: Infant mortality was significantly influenced by the factors more in the beginning of the infant's life period than at later stages, suggesting that receiving proper care at an early age will raise the likelihood of survival. Policy-making interventions are required to reduce the infant deaths, and the study findings may assist policy makers to revise the programs so that the sustainable development goal 3.2 can be achieved in Bangladesh.

Skilled maternal healthcare and good essential newborn care practice in rural Bangladesh: A cross-sectional study.

Background and Aims: Essential newborn care (ENC) practices play an important role in reducing the risk of infant mortality and morbidity. Therefore, more studies are needed on ENC practices. Skilled maternal healthcare can be a good strategy to increase the practice. Learn about the independent and joint effects of skilled maternal healthcare during pregnancy and childbirth on newborn care practices. Methods: The study used a cross-sectional data obtained from Bangladesh Multiple Indicator Cluster Survey, 2019. To investigate the association between maternal healthcare utilization and good ENC practice (cord care, delayed bathing, and immediate breast-feeding), χ 2 test and t-test in bivariate and binary logistic regression analysis, respectively have been performed after taking into account complex survey design. Results: Only about 24% (95% confidence interval [CI]: 22.95%-25.89%) women given birth at home in rural Bangladesh followed good newborn care practice. The results obtained from adjusted regression analysis showed that a woman was 24%, 49%, and 75% more likely of having good ENC practice if she received four or more skilled checkups during antenatal period only (adjusted odds ratios [AOR]: 1.24, 95% CI: 0.97, 1.60), received assistance from SBA during delivery only (AOR: 1.49, 95% CI 1.12, 1.97) and received skilled healthcare in both pregnancy and delivery (AOR: 1.75, 95% CI 1.13, 2.71), respectively compared to a woman who did not get an opportunity to receive skilled healthcare during pregnancy and delivery. Among the selected confounders, maternal age at birth, birth order, education of household heads and religion showed a significant association with good ENC practice. Conclusion: The study revealed that proper maternal healthcare during pregnancy and childbirth from skilled health personnel can improve the rate of ENC practices. For this, more training programs should be started, especially at the community level, and health promotion activities are needed to create awareness about efficient maternal healthcare practices.

On estimation for accelerated failure time models with small or rare event survival data.

BACKGROUND: Separation or monotone likelihood may exist in fitting process of the accelerated failure time (AFT) model using maximum likelihood approach when sample size is small and/or rate of censoring is high (rare event) or there is at least one strong covariate in the model, resulting in infinite estimates of at least one regression coefficient. METHODS: This paper investigated the properties of the maximum likelihood estimator (MLE) of the regression parameters of the AFT models for small sample and/or rare-event situation and addressed the problems by introducing a penalized likelihood approach. The penalized likelihood function and the corresponding score equation is derived by adding a penalty term to the existing likelihood function, which was originally proposed by Firth (Biometrika, 1993) for the exponential family models. Further, a post-hoc adjustment of intercept and scale parameters is discussed keeping them out of penalization to ensure accurate prediction of survival probability. The penalized method was illustrated for the widely used log-location-scale family models such as Weibull, Log-normal and Log-logistic distributions and compared the models and methods uisng an extensive simulation study. RESULTS: The simulation study, performed separately for each of the log-location-scale models, showed that Firth's penalized likelihood succeeded to solve the problem of separation and achieve convergence, providing finite estimates of the regression coefficients, which are not often possible by the MLE. Furthermore, the proposed penalized method showed substantial improvement over MLE by providing smaller amount of bias, mean squared error (MSE), narrower confidence interval and reasonably accurate prediction of survival probabilities. The methods are illustrated using prostate cancer data with existence of separation, and results supported the simulation findings. CONCLUSION: When sample size is small (≤ 50) or event is rare (i.e., censoring proportion is high) and/or there is any evidence of separation in the data, we recommend to use Firth's penalized likelihood method for fitting AFT model.

Does dropout from school matter in taking antenatal care visits among women in Bangladesh? An application of marginalized poisson-poisson mixture model.

BACKGROUND: There exists a lack of research in explaining the link between dropout from school and antenatal care (ANC) visits of women during pregnancy in Bangladesh. The aim of this study is to investigate how the drop out from school influences the ANC visits after controlling the relevant covariates using an appropriate count regression model. METHODS: The association between the explanatory variables and the outcome of interest, ANC visits, have been performed using one-way analysis of variance/independent sample t-test. To examine the adjusted effects of covariates on the marginal mean of count data, Marginalized Poison-Poisson mixture regression model has been fitted. RESULTS: The estimated incidence rate of antenatal care visits was 10.6% lower for the mothers who were not continued their education after marriage but had at least 10 years of schooling (p-value <0.01) and 20.2% lower for the drop-outed mothers (p-value <0.01) than the mothers who got continued their education after marriage. CONCLUSIONS: To ensure the WHO recommended 8+ ANC visits for the pregnant women of Bangladesh, it is essential to promote maternal education so that at least ten years of schooling should be completed by a woman and dropout from school after marriage should be prevented.

How does mode of delivery associate with double burden of malnutrition among mother-child dyads?: a trend analysis using Bangladesh demographic health surveys.

BACKGROUND: The simultaneity of undernourishment among child and overweight/obesity among mothers in lower-and-middle-income-countries (LMICs) introduces a new nutrition dilemma, known as double burden of malnutrition (DBM). Amidst of such paradox, the hike of caesarean section (CS) delivery is also triggering child undernutrition and maternal obesity. A gap of knowledge regarding the effect of mode of delivery on DBM still persists. The study aims to explore the association between DBM at household level and mode of delivery over time in LMICs. METHOD: The study used data from recent four consecutive waves of Bangladesh Demographic and Health Survey (BDHS) ranging from BDHS 2007 to BDHS 2017. It considered the mother-child pairs from data where mothers were non-pregnant women aged 15-49 years having children born in last 3 years preceding the survey. Bivariate analysis and Logistic Regression were performed to explore the unadjusted and adjusted effect of covariates on DBM. An interaction term of mode of delivery and survey year was considered in regression model. RESULTS: The study evinces a sharp increase of DBM rate in Bangladesh from 2007 to 2017 (2.4% vs. 6.4%). The prevalence of DBM in household level among the children delivered by CS is more than two times of those born by normal delivery (8.2% vs. 3.5%). The multivariate analysis also indicates that the children born by CS delivery are more likely to be affected by DBM at household level significantly than those born by normal delivery in each waves. Moreover, the odds ratio (OR) of DBM at household is increased by 43% for one unit change in time for normal delivery whereas CS delivery births have 12% higher odds of DBM at household level with one unit change in time. CONCLUSION: The study discloses a drastic increase of rate of DBM among mother-child pairs over the time. It stipulates inflated risk of DBM at household with time for both mode of delivery but the children with CS delivery are at more risk to the vulnerability of DBM at household level. The study recommends a provision of special care to the mothers with CS delivery to reduce DBM at household.

Living standard and access to tetanus toxoid immunization among women in Bangladesh.

BACKGROUND: Although Bangladesh has an impressive track record in the reduction of maternal and child mortality, tetanus, a dreadful disease, impedes the way to achieve Sustainable Development Goal (SDG) in this respect. Sufficient doses of tetanus toxoid containing vaccine during pregnancy ensure immunity against tetanus to mothers as well as newborns. Since inequalities persist across vaccination programs globally, in this paper, an attempt has been made to examine whether tetanus toxoid immunization (TTI) status among the women of reproductive age in Bangladesh for their most recent live birth born preceding 2 years of the survey changes with their living standard index (LSI). METHODS: Five domains of deprivation such as energy use, improved sanitation, drinking water, housing and assets ownership were used to compute the LSI using a approach proposed by Alkire and Foster. The adjusted association between LSI and TTI was established by using logistic regression model. For the purpose of statistical analysis, a nationally representative cross-sectional data extracted from Bangladesh Multiple Indicator Cluster Survey (BMICS), 2019 have been used. RESULT: The bivariate analysis revealed that 79.5% (95% CI 78.0-81.0) of women with low and 83.1% (95% CI 81.3-84.9) with moderate living standards had sufficient vaccination coverage for their most recent pregnancies while this percentage was higher for the women who belonged to high living standard (85.2, 95% CI = 84.2-86.2). A strong evidence for greater odds of sufficient immunization with TT among the women maintaining a high standard of living (AOR = 1.24, 95% CI = 1.08-1.42, p < 0.01) was found from regression analysis. CONCLUSION: The results depict existing living standard disparity with respect to TT vaccination coverage among women in Bangladesh. Present research suggests that immunization campaigns need to be conducted especially for the disadvantaged people to improve their health care and immunization service utilization among women within the age bracket of 15 to 49. This study proposed a scientific way to enhance TT vaccination among Bangladeshi women, which could help Bangladesh attain a widespread tetanus protection and thus, meet the SDGs for maternal and child mortality reduction.

Link between unmet need and economic status in Bangladesh: gap in urban and rural areas.

BACKGROUND: Unmet need for family planning (FP) is a core concept in designing FP programmes and reduction of unmet need for FP can improve reproductive and maternal health services. Bangladesh is still away from achieving the target regarding unmet need for FP. This study aimed to explore the composite effect of economic status and place of residence on unmet need for FP among currently married women of reproductive age in Bangladesh after controlling the effect of other selected covariates. METHODS: The study used the data extracted from the Bangladesh Demographic and Health Survey (BDHS) 2017-2018, which is a nationally representative survey implemented using a stratified two-stage cluster sample design. A total of 13,031 currently married women of reproductive age were included in the final analysis. Binary logistic regression model has been employed to identify the factors influencing the unmet need for FP. Model-I investigated the effect of composite variable place-wealth on unmet need for FP and Model-II examined the effect of place-wealth on unmet need for FP after adjusting for the effect of other selected covariates. The Odds Ratios with p-values were reported to identify significant covariates. RESULTS: The rate of unmet need for FP was 15.48%. The composite factor of economic status and place of residence had significant influence on unmet need for FP in both models. Generally, rural women were significantly more likely to have unmet need for FP than their urban counterparts. In particular, women from rural areas and belong to rich families had the highest likelihoods of unmet need for FP. The other selected covariates also had significant influence on unmet need for FP. CONCLUSION: This study shows that rural women had higher odds of unmet need for FP than urban women. The healthcare providers and stakeholders should take necessary actions to motivate women to use contraceptive specially the women who are residing in the rural areas.

Behavioural changes in air-conditioner use owing to the COVID-19 movement control order in Malaysia.

Remote work (working from home) became a norm rather than an exception for the global workforce during the COVID-19 pandemic, influencing every facet of life in both positive and negative ways. The stringent action of the Malaysian government in enacting the Movement Control Order (MCO) motivated the investigation of its impact on the energy consumption behaviour of working people regarding air-conditioner (AC) use. To this end, this study conducted a cross-sectional survey through an online platform. An ordinal logistic regression model (ORL) was used to analyse the collected data of 1873 respondents to determine the factors influencing the ordinal variable of interest, AC-usage behaviour during remote work. Next, the variable with unordered categories, the MCO-induced change in AC-usage behaviour, was analysed using a multinomial regression model (MLT) to identify the potential determinants. Finally, a reason analysis unveiled aspects behind the transition in AC use during remote work. This study identified stopping AC use during remote work despite using it at the office before the MCO period as the most significant change in AC-usage behaviour due to MCO. This change was frequently adopted by people with medium-level incomes and high electricity bills. By contrast, participants unfamiliar with their electricity bill were most likely to start AC use during remote work, although they did not use it before the MCO. Participants working remotely in the communal spaces of their houses preferred to stop using ACs during MCO compared to private room users. Furthermore, age group and ethnicity significantly influenced AC-usage behaviour in remote work and changes in such demeanours. These findings recommend policy interventions to expedite limited AC use for a sustainable energy sector, even during future climatic emergencies .

Can women's 3E index impede short birth interval? evidence from Bangladesh Demographic and Health Survey, 2017-18.

BACKGROUND: Women's empowerment, education, and economic status are jointly introduced as women's 3E. A number of studies found the significant association of these three variables with maternal health outcomes, but no studies, to the best of knowledge, have been found to justify the joint influence of women's 3E on the birth interval. As several studies have revealed that the short birth interval increases the risk of adverse maternal, perinatal, and infant outcomes and it is also responsible for increasing the country's population size, more research is needed on the birth interval. Therefore, the present study aimed to investigate the influence of women's 3E on the short birth interval after controlling the other selected covariates. METHODS: Data from the Bangladesh Demographic and Health Survey (BDHS), 2017-18 have been used to serve the purpose of the study. To measure the birth interval, at least two live births for non-pregnant mothers and at least one live birth for currently pregnant mothers born in the 5 years before the survey were included in the study. The Chi-Square test was applied to know the unadjusted association of the selected covariates including women's 3E with the short birth interval. In order to find out the adjusted association of women's 3E with the short birth interval, sequential binary logistic regression models have been used. RESULTS: The study found that about 23% of births in Bangladesh were born in a short birth interval. The likelihood of subsequent births of women decreases with an increase in the score of women's 3E before or after controlling the characteristics of women, child, and households. The results of the final model show that mothers with the coverage of 50% - 75%, 75% - 100%, and full coverage (100%) in 3E have a 23%, 41%, and 42% lower odds of having short birth interval compared to mothers with coverage of below 50% in 3E, respectively. CONCLUSION AND RECOMMENDATION: Bangladesh still lags behind in meeting the minimum requirements for inter-birth intervals set by the World Health Organization. The study has shown that the 3E in women can contribute in prolonging the duration of subsequent births in Bangladesh. Policy-making interventions are needed to raise awareness among uneducated, under-empowered and economically poor reproductive women through family planning and fertility control programs so that the country can achieve the desired fertility rate.

Gender inequality in early initiation of breastfeeding in Bangladesh: a trend analysis.

BACKGROUND: Early initiation of breastfeeding within 1 hour after birth is essential for newborns, because it reduces risk of neonatal mortality and hypothermia to a great extent and also helps in preventing the long-term chronic diseases and in increasing energy and immunity to newborn. In order to reach the 'very good state' of timely or early initiation of breastfeeding recommended by WHO, Bangladesh needs to increase the current rate of 51.24 to 100%. An attempt has been made in this study to examine how the early breastfeeding practice changes among male and female children with time controlling the factors associated with this practice. METHODS: Data from last four consecutive Bangladesh Demographic and Health Surveys (BDHS) have been used in the study. The participants were included whose child born within the last 5 years preceding the surveys of 2004, 2007 and 2011, and within the last 3 years preceding the survey of 2014 in the study and the respective selected participants were 5145, 4765, 7099 and 4370. To conduct the trend analysis, the descriptive statistics of selected variables along with prevalence of early initiation of breastfeeding have been computed by different years and a multiple logistic regression model has been fitted to the pooled dataset of 2004-2014 considering survey years as time. RESULTS: Rate of early initiation of breastfeeding increased as time progressed and it was faster for female child compared to male child. For example, female children were significantly 10 and 6% less likely to be initiated early than their counterparts in 2004 and 2007, respectively; whereas after 2007 both male and female children were equally treated for breastfeeding practice. It was also found that rate of early initiation significantly increased for one unit increased in survey year and this increasing rate was higher for female child compared to male child. For example, for one unit of increased in survey year, the early initiation of breastfeeding increased by 60% for male child and by 67% for female child. Besides, survey time, gender, education of parents, wanted index child, mode of delivery, antenatal care visits, wealth index, exposure to media and division were found to have potential influence on early initiation of breastfeeding. CONCLUSION: Demographic and health surveys conducted in Bangladesh since 2011 have shown no evidence of gender discrimination regarding timely initiation of breastfeeding. In order to achieve the target rate of early initiation of breastfeeding recommended by WHO, it requires to take effective intervention regarding maternal and child health education.

Association of biomass fuel smoke with respiratory symptoms among children under 5 years of age in urban areas: results from Bangladesh Urban Health Survey, 2013.

BACKGROUND: Little is known regarding the effect of exposure to biomass fuel smoke inhalation on respiratory symptoms in the Bangladeshi population which is a major health hazard in most of the developing countries. This study aims to explore the association between respiratory symptoms and biomass fuel smoke exposure among children under 5 years of age. METHODS: Data were extracted from the Bangladesh Urban Health Survey conducted in 2013. A total of 10,575 mothers with at least one surviving children were selected. Respiratory symptoms among children under 5 years of age were considered as the primary outcome. Sequential multiple logistic regression models were used to observe the association between respiratory symptoms and biomass fuel smoke exposure adjusting the effect of residential factors and mother and child characteristics. RESULTS: Around 40% of the mothers exclusively used biomass fuel irrespective of the kitchen location and 54% of them were habituated in indoor cooking. The prevalence of respiratory symptoms of under-five children among in-house and outdoor biomass fuel users was 23.0% and 21.9%, respectively. Results of fitted multiple logistic regression models showed that the odds of having respiratory symptoms among children under 5 years of age were increased due to in-house biomass fuel use [OR = 1.18; 95% CI, 1.04-1.36] compared with the non-biomass user. An increased risk of respiratory symptoms was also significantly associated with mother's birth complication [OR = 1.51; 95% CI, 1.36-1.67], non-government organization (NGO) membership of mothers [OR = 1.32; 95% CI, 1.16-1.51], age of the child (6-23m) [OR = 1.29; 95% CI, 1.10-1.52], and nutritional status (stunting) [OR = 1.18; 95% CI, 1.06-1.31]. CONCLUSION: This study found the use of in-house biomass fuel as a significant risk factor associated with respiratory symptoms of children under 5 years of age. More longitudinal studies should be designed to establish a causal relationship between HAP (household air pollution) and respiratory symptoms among children with more direct measures of HAP and clinical procedure.

The Cytotoxic Necrotizing Factor of Yersinia pseudotuberculosis (CNFy) is Carried on Extracellular Membrane Vesicles to Host Cells.

In this study we show Yersinia pseudotuberculosis secretes membrane vesicles (MVs) that contain different proteins and virulence factors depending on the strain. Although MVs from Y. pseudotuberculosis YPIII and ATCC 29833 had many proteins in common (68.8% of all the proteins identified), those located in the outer membrane fraction differed significantly. For instance, the MVs from Y. pseudotuberculosis YPIII harbored numerous Yersinia outer proteins (Yops) while they were absent in the ATCC 29833 MVs. Another virulence factor found solely in the YPIII MVs was the cytotoxic necrotizing factor (CNFy), a toxin that leads to multinucleation of host cells. The ability of YPIII MVs to transport this toxin and its activity to host cells was verified using HeLa cells, which responded in a dose-dependent manner; nearly 70% of the culture was multinucleated after addition of 5 µg/ml of the purified YPIII MVs. In contrast, less than 10% were multinucleated when the ATCC 29833 MVs were added. Semi-quantification of CNFy within the YPIII MVs found this toxin is present at concentrations of 5 ~ 10 ng per µg of total MV protein, a concentration that accounts for the cellular responses seen.

Fine and Gray competing risk regression model to study the cause-specific under-five child mortality in Bangladesh.

BACKGROUND: The cause-specific under-five mortality of Bangladesh has been studied by fitting cumulative incidence function (CIF) based Fine and Gray competing risk regression model (1999). For the purpose of analysis, Bangladesh Demographic and Health Survey (BDHS), 2011 data set was used. METHODS: Three types of mode of mortality for the under-five children are considered. These are disease, non-disease and other causes. Product-Limit survival probabilities for the under-five child mortality with log-rank test were used to select a set of covariates for the regression model. The covariates found to have significant association in bivariate analysis were only considered in the regression analysis. RESULTS: Potential determinants of under-five child mortality due to disease is size of child at birth, while gender of child, NGO (non-government organization) membership of mother, mother's education level, and size of child at birth are due to non-disease and age of mother at birth, NGO membership of mother, and mother's education level are for the mortality due to other causes. CONCLUSION: Female participation in the education programs needs to be increased because of the improvement of child health and government should arrange family and social awareness programs as well as health related programs for women so that they are aware of their child health.

Log-Logistic Proportional Odds Model for Analyzing Infant Mortality in Bangladesh.

Log-logistic parametric survival regression model has been used to find out the potential determinants of infant mortality in Bangladesh using the data extracted from Bangladesh Demographic and Health Survey, 2011. First, nonparametric product-limit approach has been used to examine the unadjusted association between infant mortality and covariate of interest. It is found that maternal education, membership of nongovernmental organizations, age of mother at birth, sex of child, size of child at birth, and place of delivery play an important role in reducing the infant mortality, adjusting relevant covariates.

Trend of determinants of birth interval dynamics in Bangladesh.

BACKGROUND: The distribution of birth intervals can be used to draw attention to important characteristics of dynamics of fertility process. The main objective of this paper is to examine the effects of socioeconomic, demographic and proximate determinants on the length of birth intervals of women of Bangladesh and also to see whether the effects are changed over the years. METHODS: Birth intervals can be considered as correlated time-to-event data because two or more birth intervals could correspond to a single mother. Moreover, women from the same neighborhood usually share certain unobserved characteristics, which may also lead to correlated time-to-event data (birth interval). A parametric random effect (frailty) model is used to analyze correlated birth interval data obtained from three Bangladesh Demographic and Health Surveys (BDHS 2004, 2007, and 2011). RESULTS: The results show that alongside different socioeconomic, demographic determinants, unobserved community and mother effects have considerable impact on birth interval in Bangladesh. However, the effects of different factors on birth interval changes in a small scale over the duration of 2004-2011. CONCLUSIONS: Efficient policy is a priority for promoting longer birth spacing and achieving a decline in fertility.

Investigating the Responses of Human Epithelial Cells to Predatory Bacteria.

One beguiling alternative to antibiotics for treating multi-drug resistant infections are Bdellovibrio-and-like-organisms (BALOs), predatory bacteria known to attack human pathogens. Consequently, in this study, the responses from four cell lines (three human and one mouse) were characterized during an exposure to different predatory bacteria, Bdellovibrio bacteriovorus HD100, Bacteriovorus BY1 and Bacteriovorax stolpii EB1. TNF-α levels were induced in Raw 264.7 mouse macrophage cultures with each predator, but paled in comparison to those obtained with E. coli. This was true even though the latter strain was added at an 11.1-fold lower concentration (p < 0.01). Likewise, E. coli led to a significant (54%) loss in the Raw 264.7 murine macrophage viability while the predatory strains had no impact. Tests with various epithelial cells, including NuLi-1 airway, Caco2, HT29 and T84 colorectal cells, gave similar results, with E. coli inducing IL-8 production. The viabilities of the NuLi-1 and Caco-2 cells were slightly reduced (8%) when exposed to the predators, while T84 viability remained steady. In no cases did the predatory bacteria induce actin rearrangement. These results clearly demonstrate the gentle natures of predatory bacteria and their impacts on human cells.