The association of solid fuel use in households for cooking with elevated blood pressure among reproductive-aged married women in Bangladesh.

Bangladesh is experiencing a rapid increase in hypertension prevalence, particularly in socio-economically disadvantaged communities. The higher use of solid fuel in these communities could be one of the significant factors contributing to this trend, but evidence supporting this hypothesis is limited in Bangladesh. Therefore, this study aims to investigate the associations of household solid fuel use and its exposure level with systolic and diastolic blood pressure (DBP) and hypertension. We analysed 7,320 women's data from 2017/18 Bangladesh Demographic and Health Survey. We considered three outcome variables: (i) systolic blood pressure (BP) (continuous response), (ii) DBP (continuous response), and (iii) hypertension status (yes, no). Our primary exposures of interest were fuel type (clean vs solid) and the potential level of household air pollution exposure through solid fuel use (unexposed, moderately exposed, and highly exposed). We used a multilevel mixed-effects Poisson regression model with robust variance to determine association between exposure and outcome variables while adjusting for confounders. Of the total respondents analysed, approximately 82% used solid fuel for cooking. The age-standardised prevalence of hypertension was 28%. Respondents using solid fuel were found to be 1.44 times (95% confidence interval [CI], 1.04-1.89) more likely to develop hypertension compared to clean fuel users. Compared to women using clean fuel, the likelihood of hypertension was found to be 1.61 times (95% CI, 1.07-2.20) higher among the moderately exposed group and 1.80 times (95% CI, 1.27-2.32) higher among the highly exposed group. Similar associations were reported for systolic and DBP. The use of solid fuel increases the risk of becoming hypertensive and elevates systolic and DBP. Policies and programmes are necessary to increase awareness of the adverse effects of solid fuel use on health, including hypertension. Efforts should be made to reduce solid fuel use and ensure proper ventilation systems in households where solid fuel is used.

Trends and projections of under-5 mortality in Bangladesh including the effects of maternal high-risk fertility behaviours and use of healthcare services.

OBJECTIVE: This study examines trends and puts forward projections of under-5 mortality (U5M) in Bangladesh and identifies the effects of maternal high-risk fertility behaviours and use of healthcare services. METHODS: Data from seven waves of the Bangladesh Demographic and Health Survey (1994-2014) were analyzed for trends and projections of U5M and a Chi-square (χ2) test was used to identify if there was any association with maternal high-risk fertility behaviours and use of healthcare services. A multivariate logistic regression model was used to determine the effects of fertility behaviors and healthcare usage on the occurrence of U5M adjusting with confounders. RESULTS: U5M declined from 82.5 to 41.0 per 1000 livebirths during 1994-2014 and is projected to further reduce to 17.6 per 1000 livebirths by 2030. The study identified a noticeable regional variation in U5M with maternal high-risk fertility behaviours including age at birth <18 years (aOR: 1.84, 95% CI: 1.23-2.76) and birth interval <24 months (aOR: 1.56, 95% CI: 1.02-2.37) found to be significant determinants. There was a 39-53% decline in this rate of mortality among women that had used antenatal care services at least four times (aOR, 0.51, 95% CI: 0.27-0.97), delivery care (aOR, 0.47, 95% CI: 0.24-0.95), and had received postnatal care (aOR, 0.61, 95% CI: 0.41-0.91) in their last birth. Cesarean section was found to be associated with a 51% reduction in U5M (aOR, 0.49, 95% CI: 0.29-0.82) compared to its non-use. CONCLUSION: The Sustainable Development Goals require a U5M rate of 25 per 1000 livebirths to be achieved by 2030. This study suggests that with the current trend of reduction, Bangladesh will achieve this target before the deadline. This study also found that maternal high-risk fertility behaviours and non-use of maternal healthcare services are very prevalent in some regions of Bangladesh and have increased the occurrence of U5M in those areas. This suggests therefore, that policies and programmes designed to reduce the pregnancy rates of women that are at risk and to encourage an increase in the use of maternal healthcare services are needed.

Association between Maternal High-Risk Fertility Behavior and Childhood Morbidity in Bangladesh: A Nationally Representative Cross-Sectional Survey.

In this cross-sectional study, we evaluated data from the 2014 Bangladesh Demographic and Health Survey (BDHS), which consisted of 7,707 married women aged 15-49 years who lived with at least one child younger than 5 years. This study's primary aim was to examine the relationship between maternal high-risk fertility behavior and child morbidity. To define high-risk fertility behaviors, we considered three variables: maternal age at the time of delivery, birth order, and birth interval. The main outcome measures were mortality-related disease in the past 2 weeks (acute respiratory infection [ARI], diarrhea, and fever) and low birth weight (LBW). We used modified Poisson regression with generalized estimating equations to assess the relationships between the variables of interest. Results indicate that a substantial portion of women (34%) exhibited high-risk fertility patterns; 28.7% engaged in a single high-risk behavior and 5.4% engaged in multiple high-risk behaviors. After adjusting for relevant covariates, high-risk fertility behaviors were significantly associated with an increased likelihood of ARI (adjusted relative risk [ARR]: 1.22, 95% CI: 1.05-1.50), diarrhea (ARR: 1.18, 95% CI: 1.03-1.35), fever (ARR: 1.29, 95% CI: 1.11-1.58), and LBW (ARR: 1.27, 95% CI: 1.10-1.52). In addition, engaging in multiple high-risk fertility behaviors appeared to have far-reaching consequences on the outcomes measured. Maternal high-risk fertility behaviors are important predictors of morbidity in children younger than 5 years. Preventing high-risk fertility behavior may reduce childhood morbidity and mortality in Bangladesh.