Trends and correlates of low HIV knowledge among ever-married women of reproductive age: Evidence from cross-sectional Bangladesh Demographic and Health Survey 1996-2014.

BACKGROUND: The human immunodeficiency virus (HIV) burden has frequently been changing over time due to epidemiological and demographic transitions. To safeguard people, particularly women of reproductive age, who can be exposed to transmitting this burden to the next generation, knowledge regarding this life-threatening virus needs to be increased. This research intends to identify the trends and associated correlates of "low" HIV knowledge among ever-married women of reproductive age in Bangladesh from 1996 to 2014. METHODS: We analyzed data derived from six surveys of Bangladesh Demographic and Health Surveys conducted in 1996, 1999, 2004, 2007, 2011, and 2014. Analyses were primarily restricted to ever-married women aged 15-49 years who had ever heard of HIV. The correlates of "low" HIV knowledge were investigated using multiple binary logistic regression models. RESULTS: The study found that the proportion of women with "low" HIV knowledge decreased from 72% in 1996 to 58% in 2014. In adjusted models, age at first marriage, level of education, wealth quintile, and place of residence (except in the survey year 2011) were found to be potential correlates of "low" HIV knowledge in all survey years. In the pooled analysis, we found lower odds of "low" HIV knowledge in the survey years 1999 (Adjusted Odds Ratio: 0.67; 95% CI: 0.57, 0.78), 2004 (AOR: 0.60; 95% CI: 0.52, 0.70), 2007 (AOR: 0.51; 95% CI: 0.44, 0.60), 2011 (AOR: 0.36; 95% CI: 0.32, 0.42) and 2014 (AOR: 0.47; 95% CI: 0.41, 0.54) compared to the survey year 1996. CONCLUSION: The proportion of "low" HIV knowledge has declined over time, although the proportion of women with "low" HIV knowledge still remains high. The prevention of early marriage, the inclusion of HIV-related topics in the curricula, reduction of disparities between urban-rural and the poorest-richest groups may help to improve the level of HIV knowledge among ever-married Bangladeshi women.

Understanding fertility behavior of the Forcibly Displaced Myanmar Nationals in Bangladesh: A qualitative study.

INTRODUCTION: Rohingya- the Forcibly Displaced Myanmar Nationals (FDMN)- are largely characterized by a high total fertility rate (TFR) and a low contraceptive prevalence rate. This study aimed to explore the reasons behind their high fertility behavior by utilizing the Theory of Planned Behavior. DATA AND METHOD: We adopted a cross-sectional qualitative research approach. Fifteen semi-structured, face-to-face in-depth interviews were conducted with the Rohingya husbands, wives, and community leaders (Majhi and Imam/Khatib) living in Camps 1 and 2 of Ukhiya Refugee Camp, Cox's Bazar, Bangladesh. We analyzed the qualitative data using the thematic analysis approach. RESULTS: The Muslim-majority FDMN predominantly constructed the fertility outcome as the will and order of Allah. On the one hand, the Rohingya parents highlighted various religious, political, economic, and social advantages of having more children, especially sons. On the other hand, beliefs about religious restriction, fear of side effects, and community pressure against contraception sustained the reality of the low contraceptive prevalence rate in the community. Alarmingly, the Rohingya religious leaders and mass people were found highly politically motivated to continue the practice of high fertility with a view to 'expanding the Rohingya community' or 'to increase Muslim soldiers', so that they may fight back and take control of their ancestors' place in Myanmar in the future. Furthermore, these pronatalist attitudes and beliefs translated into high TFR through various high-fertility-supportive social norms and practices widely prevalent in the Rohingya community. These include child marriage, gendered division of labor, women's subordinate nature, the Purdah system, and joint-family members' support during childbirth and rearing. CONCLUSION: Religion, ethnic identity, and the unique political context and experiences of the Rohingya people jointly explain their high fertility behavior. This study warrants the urgency of initiating social and behavior change communication programs to change the religiopolitically-motivated high-fertility notions that prevailed in the Rohingya community.

Awareness, Treatment, and Control of Diabetes in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey 2017/18.

Background: The prevalence of diabetes is increasing in Bangladesh from ∼5% in 2001 to ∼13% in 2017/18 (∼8.4 million cases). The prevalence of undiagnosed diabetes was also found to be higher at 6% in 2017/18. However, very little is known about the management of diabetes assessed by diabetes awareness, treatment, and control. We aimed to estimate the age-standardised prevalence of awareness, treatment, and control of diabetes and its associated factors. Methods: Cross-sectional data from 1,174 Bangladeshi adults aged 18 years and older available from the most recent nationally representative Bangladesh Demographic and Health Survey (BDHS) 2017-18 were analysed. Outcomes were age-standardised prevalence of awareness, treatment, and control of diabetes, estimated using the direct standardisation. Multilevel mixed-effects Poisson regression models were used to identify factors associated with awareness, treatment, and control of diabetes. Results: Of the respondents we analysed, 30.9% (95% CI, 28.2-33.6) were aware that they had the condition, and 28.2% (95% CI, 25.6-30.7) were receiving treatment. Among those treated for diabetes, 26.5% (95% CI, 19.5-33.5) had controlled diabetes. The prevalence of diabetes awareness, treatment, and control was lower in men than women. Factors positively associated with awareness and treatment were increasing age and hypertension, while factors negatively associated with awareness and treatment were being men and lower education. Factors associated with poor control were secondary education and residing in Rajshahi and Rangpur divisions. Conclusions: This study provides evidence of poor management of diabetes in Bangladesh, especially in men. Less than one-third of the people with diabetes were aware of their condition. Just over one-fourth of the people with diabetes were on treatment, and among those who were treated only one-fourth had controlled diabetes. Interventions targeting younger people, in particular men and those with lower education, are urgently needed. Government policies that address structural factors including the cost of diabetes care and that strengthen diabetes management programmes within primary healthcare in Bangladesh are urgently needed.

Prevalence of undiagnosed diabetes and the relative importance of its risk factors among adults in Bangladesh: Findings from a nationwide survey.

AIM: To estimate the prevalence of undiagnosed diabetes, and to identify the relative importance of risk factors for undiagnosed diabetes among Bangladeshi adults. METHOD: Data from 11, 421 Bangladeshi adults aged 18 years and older available from the most recent nationally representative Bangladesh Demographic and Health Survey 2017-18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of undiagnosed diabetes was age-standardised with direct standarisation, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance. RESULTS: The overall age-standardised prevalence of undiagnosed diabetes was 6.0% (95 %CI, 5.5-6.4%) (men: 6.1%, women: 5.9%). Risk factors associated with undiagnosed diabetes were older age, elevated body mass index (BMI), highest wealth quintile, hypertension, and being male. The top two modifiable risk factors contributing over 50% to undiagnosed diabetes were BMI and wealth quintiles. CONCLUSION: Undiagnosed diabetes affects a substantial proportion of Bangladeshi adults. Since elevated BMI and the highest wealth quintile are strong risk factors, these offer an opportunity for early detection and screening to reduce undiagnosed diabetes in Bangladesh. In addition, wide-reaching awareness campaigns among the general public, clinicians, and policymakers are needed.

Prevalence of, and risk factors for, diabetes and prediabetes in Bangladesh: Evidence from the national survey using a multilevel Poisson regression model with a robust variance.

To estimate the age-standardized prevalence of diabetes and prediabetes and identify factors associated with these conditions at individual, household, and community levels. Data from 11952 Bangladeshi adults aged 18-95 years available from the most recent Bangladesh Demographic and Health Survey 2017-18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of diabetes and prediabetes were age-standardized with direct standardization, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance. The overall age-standardised prevalence of diabetes was 9.2% (95%CI 8.7-9.7) (men: 8.8%, women: 9.6%), and prediabetes was 13.3% (95%CI 12.7-13.9) (men: 13.0%, women: 13.6%). Among people with diabetes, 61.5% were unaware that they had the condition. 35.2% took treatment regularly, and only 30.4% of them had controlled diabetes. Factors associated with an increased prevalence of having diabetes were increasing age, male, overweight/obesity, hypertension, being in the highest wealth quintile, and living in the Dhaka division. People currently employed and living in the Rangpur division were less likely to have diabetes than those currently not employed and living in the Barishal division. Diabetes and prediabetes affect a substantial proportion (over one-quarter) of the Bangladeshi adult population. Continuing surveillance and effective prevention and control measures, focusing on obesity reduction and hypertension management, are urgently needed.

COVID-19 vaccine hesitancy among the adult population in Bangladesh: A nationwide cross-sectional survey.

INTRODUCTION: Studies related to the COVID-19 vaccine hesitancy are scanty in Bangladesh, despite the growing necessity of understanding the population behavior related to vaccination. Thus, the present study was conducted to assess the prevalence of the COVID-19 vaccine hesitancy and its associated factors in Bangladesh to fill the knowledge gap. METHODS AND MATERIALS: This study adopted a cross-sectional design to collect data from 1497 respondents using online (Google forms) and face-to-face interviews from eight administrative divisions of Bangladesh between 1-7 February 2021. We employed descriptive statistics and multiple logistic regression analysis. RESULTS: The prevalence of vaccine hesitancy was 46.2%. The Muslims (aOR = 1.80, p ≤ 0.01) and the respondents living in the city corporation areas (aOR = 2.14, p ≤0.001) had more hesitancy. There was significant variation in vaccine hesitancy by administrative divisions (geographic regions). Compared to the Sylhet division, the participants from Khulna (aOR = 1.31, p ≤0.001) had higher hesitancy. The vaccine hesitancy tended to decrease with increasing knowledge about the vaccine (aOR = 0.88, p≤0.001) and the vaccination process (aOR = 0.91, p ≤ 0.01). On the other hand, hesitancy increased with the increased negative attitudes towards the vaccine (aOR = 1.17, p≤0.001) and conspiracy beliefs towards the COVID-19 vaccine (aOR = 1.04, p≤0.01). The perceived benefits of COVID-19 vaccination (aOR = 0.85, p≤0.001) were negatively associated with hesitancy, while perceived barriers (aOR = 1.16, p ≤0.001) were positively associated. The participants were more hesitant to accept the vaccine from a specific country of origin (India, USA, Europe). CONCLUSIONS: Our findings warrant that a vigorous behavior change communication campaign should be designed and implemented to demystify negative public attitudes and conspiracy beliefs regarding the COVID-19 Vaccine in Bangladesh. The policymakers should also think about revisiting the policy of the online registration process to receive the COVID-19 vaccine, as online registration is a key structural barrier for many due to the persistent digital divide in the country. Finally, the government should consider the population's preference regarding vaccines' country of manufacture to reduce the COVID-19 vaccine hesitancy.

The impact of COVID-19 on health of the older persons in Bangladesh.

The COVID-19 is impacting the health of the population, including older persons. Available evidence shows that older people are highly vulnerable and more likely to have adverse health outcomes. In Bangladesh, the older population is rapidly increasing, living with various disadvantaged socio-economic conditions, including inadequate access and healthcare services. These disparities are likely to increase during the COVID-19, resulting in high morbidity and mortality among them. Thus, we have examined the health vulnerabilities of older persons due to the COVID-19 pandemic using content analysis. We have analyzed 102 content collected from various online and printed articles published in newspapers, journals, and other relevant sources. The study has found increased health risks, deteriorated mental health, and poor health system functioning during the pandemic and its impact on older persons in Bangladesh. Strengthening health systems through an integrated model with capacity development of existing health care providers to deal with elderly health problems, including mental health and psychosocial wellbeing; promoting preventive measures, facilitating access to healthcare is required. Bangladesh can learn the Chinese experience to adopt innovative, specialized, and advanced systems to efficiently fight against the COVID-19.

Health Belief Model, Theory of Planned Behavior, or Psychological Antecedents: What Predicts COVID-19 Vaccine Hesitancy Better Among the Bangladeshi Adults?

This study aimed to determine the prevalence and investigate the constellations of psychological determinants of the COVID-19 vaccine hesitancy among the Bangladeshi adult population utilizing the health belief model-HBM (perceived susceptibility to and severity of COVID-19, perceived benefits of and barriers to COVID-19 vaccination, and cues to action), the theory of planned behavior-TPB (attitude toward COVID-19 vaccine, subjective norm, perceived behavioral control, and anticipated regret), and the 5C psychological antecedents (confidence, constraints, complacency, calculation, and collective responsibility). We compared the predictability of these theoretical frameworks to see which framework explains the highest variance in COVID-19 vaccine hesitancy. This study adopted a cross-sectional research design. We collected data from a nationally representative sample of 1,497 respondents through both online and face-to-face interviews. We employed multiple linear regression analysis to assess the predictability of each model of COVID-19 vaccine hesitancy. We found a 41.1% prevalence of COVID-19 vaccine hesitancy among our study respondents. After controlling the effects of socio-economic, demographic, and other COVID-19 related covariates, we found that the TPB has the highest predictive power (adjusted R 2 = 0.43), followed by the 5C psychological antecedents of vaccination (adjusted R 2 = 0.32) and the HBM (adjusted R 2 = 0.31) in terms of explaining total variance in the COVID-19 vaccine hesitancy among the adults of Bangladesh. This study provides evidence that theoretical frameworks like the HBM, the TPB, and the 5C psychological antecedents can be used to explore the psychological determinants of vaccine hesitancy, where the TPB has the highest predictability. Our findings can be used to design targeted interventions to reduce vaccine hesitancy and increase vaccine uptake to prevent COVID-19.

Prevalence, awareness, treatment, and control of hypertension in Bangladesh: Findings from National Demographic and Health Survey, 2017-2018.

The purpose of this study was to estimate the age-standardised prevalence, awareness, treatment, and control of hypertension and to identify their risk factors in Bangladeshi adults. Data from 12 904 adults aged 18-95 years, available from the most recent nationally representative 2017-2018 Bangladesh Demographic and Health Survey were used. Hypertension was defined as having systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, and/or taking anti-hypertensive drugs to control blood pressure. Age-standardized prevalence of hypertension and management were estimated with direct standardisation. A multilevel mixed-effects Poisson regression model with a robust variance was used to identify risk factors associated with hypertension and its awareness, treatment, and control. The overall age-standardized prevalence of hypertension was 26.2% (95% CI, 25.5-26.9); (men: 23.5%, women: 28.9%). Among those with hypertension (n = 3531), 36.7% were aware that they had the condition, and only 31.1% received anti-hypertensive medication. The prevalence of controlled hypertension was 12.7% among those with hypertension and 43.6% among those treated for hypertension (n = 1306). Factors independently associated with hypertension were increasing age, higher body mass index, being women, having diabetes, and residing in selected administrative divisions. A declining trend of hypertension control was observed with increasing age and low education. Hypertension is highly prevalent (one in four) in Bangladeshi adults, while awareness, treatment, and control are low. Irrespective of the risks associated with hypertension and its management, programs to increase its awareness, treatment, and control should be given high priority in reducing hypertension prevalence and improving hypertension control in Bangladesh.

Do knowledge and attitudes matter for preventive behavioral practices toward the COVID-19? A cross-sectional online survey among the adult population in Bangladesh.

The Government of Bangladesh has adopted several non-therapeutic measures to tackle the pandemic of SARS-CoV-2. However, the curve of COVID-19 positive cases has not significantly flattened yet, as the adoption of preventive measures by the general population is predominantly a behavioral phenomenon that is often influenced by people's knowledge and attitudes. This study aimed to assess the levels of knowledge, attitudes, and preventive behavioral practices toward COVID-19 and their interrelationships among the population of Bangladesh aged 18 years and above. This study adopted a web-based cross-sectional survey design and collected data from 1056 respondents using the online platform Google Form. We employed the independent sample t-test, one-way ANOVA, Pearson's product-moment correlation, and Spearman rank-order correlation to produce the bivariate level statistics. We also run multiple linear and logistic regression models to identify the factors affecting knowledge, attitudes, and preventive behavioral practices toward COVID-19. The respondents had an average knowledge score of 17.29 (Standard Deviation (SD) = 3.30). The average score for attitude scale toward COVID-19 was 13.6 (SD = 3.7). The respondents had excellent preventive behavioral practices toward COVID-19 (mean 7.7, SD = 0.72). However, this study found that knowledge and attitudes did not matter for preventive behavioral practices toward COVID-19. Instead, education appeared as a sole predictor for preventive behavioral practices toward COVID-19; that means preventive behavioral practices toward COVID-19 was lower among the less educated respondents. This study suggests increasing education as a long-term strategy and taking immediate action to increase knowledge and decrease negative attitudes toward COVID-19 through targeted health education initiatives as a short-term strategy.

Population-Level Preparedness About Preventive Practices Against Coronavirus Disease 2019: A Cross-Sectional Study Among Adults in Bangladesh.

This study assessed the preparedness regarding the preventive practices toward the coronavirus disease 2019 (COVID-19) among the adult population in Bangladesh. Data were collected through an online survey with a sample size of 1,056. We constructed four variables (individual, household, economic, and community and social distancing) related to preparedness based on the principal component analysis of eight items. We employed descriptive statistics and multiple linear regression analysis. The results showed that the accuracy rate of the overall preparedness scale was 68.9%. The preparedness level related to economic, individual, household, and community and social distancing was 64.9, 77.1, 50.4, and 83.2%, respectively. However, the economic preparedness significantly varied by sex, education, occupation, attitude, and worries related to COVID-19. Individual preparedness was significantly associated with education, residence, and attitudes. The household preparedness significantly varied by education, residence, and worries, while the respondent's community and social distancing-related preparedness significantly varied by sex, region, residence, and attitude. This study implies the necessity of the coverage of financial schemes for the vulnerable group. Increased coverage of health education regarding personal hygiene targeting the less educated and rural population should be ensured.

Prevalence and determinants of menstrual regulation among ever-married women in Bangladesh: evidence from a national survey.

BACKGROUND: Despite the remarkable reduction of maternal mortality, unsafe and untimely menstrual regulation (MR) remains a major maternal health problem in Bangladesh. This study aimed to determine the prevalence and identify determinants of MR among ever-married women in Bangladesh. METHODS: Data for this study have been extracted from Bangladesh Demographic and Health Survey (BDHS) 2014. The survey followed a two-stage stratified sampling procedure and the study used a sub-sample of 8084 ever-married women aged 15 to 49 years extracted from survey sample of 17,863. Univariate and multivariate mixed-effect logistic regression analyses were used to identify risk factors for MR accounting for potential between-clusters variations. RESULTS: The weighted prevalence of MR was 12.3% (95% CI: 11.1-13.4%) among (991/8084) ever-married women. Women were less likely to have MR if they were from Chittagong (AOR 0.74, 95% CI: 0.57-0.96; p = 0.026) and Sylhet (AOR 0.53, 95% CI: 0.36-0.77; p = 0.001) divisions. Women were more likely to have MR if they were from high (AOR 1.47, 95% CI: 1.18-1.83; p = 0.001) and the highest (AOR 1.62, 95% CI: 1.27-2.05; p < 0.001) socioeconomic status (SES) group; being employed (AOR 1.35, 95% CI: 1.16-1.56; p < 0.001), having one or two children (AOR 1.73, 95% CI: 1.24-2.40: p = 0.001) and ≥ 3 children (AOR 2.56, 95% CI: 1.82-3.58; p < 0.001), and having membership of non-government organization (NGO) (AOR 1.18, 95% CI: 1.02-1.38; p = 0.030). CONCLUSION: MR is prevalent among Bangladeshi women and independently associated with geographic location, SES, parity, employment and NGO membership status. Health policy should prioritize in reducing spatial and socioeconomic inequalities in relation to MR services by ensuring accessibility and availability of MR services, especially in suburban divisions. Furthermore, abortion should be legalized in Bangladesh that will ultimately reduce the morbidity and mortality associated with unsafe abortion.

Adolescent motherhood in Bangladesh: Trends and determinants.

BACKGROUND: While studies on fertility and contraceptives issues are available, until recently adolescent motherhood has not received enough attention among policy makers in understanding adolescent motherhood in Bangladesh. We aimed to examine the trends and determinants of adolescent motherhood among women aged 15-49 years. METHODS: For trend analysis we used all the 7 waves of Bangladesh Demographic and Health Survey (BDHS, 1993-2014) data but for multivariate analysis 4 waves of BDHS (2004-2014). Two separate analyses were carried out on ever married women aged 15-49: (1) teenage girls aged 15-19 and (2) adult women aged 20 and above. RESULTS: The prevalence of adolescent motherhood had declined to a slower pace from 1993 to2014 (from 33.0% to 30.8%). Lower spousal age gap and higher education were found to be associated with lower likelihood of adolescent motherhood both among teenage girls [OR 0.447 (0.374-0.533)] and adult women [OR 0.451 (0.420-0.484)]. Teenage girls in the poorest wealth quintile [OR 1.712 [1.350-2.173] were more likely to experience adolescent motherhood than the richest wealth quintile. Teenage girls who had no education were found to have 2.76 times higher odds of adolescent motherhood than their counterparts who had higher than secondary education. Concerning the time effect, the odds of adolescent motherhood among adult women was found to decline overtime. CONCLUSIONS: Despite substantial decrease in total fertility rate in Bangladesh adolescent motherhood is still highly prevalent though declining from 1993 to 2014. Social policies including those addressing poverty, ensuring greater emphasis on education for women; and adolescent mothers in rural areas are needed.

REGIONAL VARIATIONS IN CHILD MARRIAGE IN BANGLADESH.

This study aimed to investigate the regional variations in the prevalence of child marriage in Bangladesh with a view to providing recommendations for division-specific policy interventions. Data from the 2011 Bangladesh Demographic and Health Survey were analysed using multivariate logistic regression. Substantial regional variations in child marriage were found in Bangladesh. Rangpur and Khulna had more than four times higher odds of child marriage than Sylhet (4.57 and 4.11 times, respectively). Barisal and Rajshahi had more than three times higher odds of child marriage than Sylhet (3.70 and 3.48 times, respectively). Chittagong and Dhaka had about two times odds of child marriage than Sylhet (1.98 and 2.67 times, respectively), even after controlling for selected socio-demographic, economic and cultural characteristics. Respondent's education, employment status, husband's education and wealth index were inversely associated with the prevalence of child marriage. The policy implications of these findings are discussed in the context of Bangladesh.

HIV-related discriminatory attitudes of healthcare workers in Bangladesh.

This study aimed at identifying the level of HIV-related discriminatory attitudes and related factors in a purposively-selected sample of healthcare workers (HCWs) in Bangladesh. In total, 526 HCWs from a number of hospitals and healthcare centres were interviewed using a structured questionnaire. A moderate level of discriminatory attitudes was observed. The factors associated with a high level of such attitudes among the HCWs were: high level of irrational fear about HIV and AIDS; working in teaching hospital rather than in non-teaching hospital and diagnostic centres; low level of education; and being male. The results indicate that programmes to reduce irrational fear about transmission of HIV are urgently needed.

Knowledge of HIV and AIDS among tertiary students in Bangladesh.

To examine the levels and predictors of knowledge on HIV and AIDS, a survey was conducted among 392 tertiary level students in the University of Dhaka, Bangladesh. Students demonstrated a high knowledge of transmission and prevention of HIV and AIDS yet with considerable misconception. All students said that unprotected sex with an HIV-positive man or woman can transmit the HIV virus to a negative man or woman but at the same time 43.6% of students believed that there is a preventive vaccine for HIV and 39.8% understood that HIV can be cured if it is diagnosed early. Multivariate regression analysis indicated that the students who had more knowledge on HIV and AIDS were: older boys, fathers having more income, business or service as father's occupation, having more mass media exposure, being senior students, living in a university dormitory, and being students of faculty of arts, social sciences, and science. The findings of this study suggest that a special course on health education, including risk perceptions of HIV and AIDS and issues related to sexual and other high risk behavior, should be included in the course curricula irrespective of disciplines at tertiary levels.