Socioeconomic inequalities in utilizing maternal health care in five South Asian countries: A decomposition analysis.

BACKGROUND: High maternal mortality rates still today remain a significant public health concern in South Asian countries. The majority of maternal deaths occur during pregnancy, and these deaths may typically be avoided by ensuring that women have access to reliable maternity care such as antenatal care (ANC) and facility delivery. The objectives of this research were to assess socioeconomic disparities in the utilization of health care services by mothers and to determine the factors influencing this utilization among women aged 15 to 49 in five South Asian countries. METHODS: For this study, nationally representative data from the Demographic and Health Survey (DHS) were analyzed. This research included a total of 262,531 women between the ages of 15 and 49. To determine the likely causes of maternal health care utilization, simple bivariate statistics and binary logistic regression were applied, and decomposition analysis and the concentration curve were used to quantify disparity (Lorenz curve). RESULTS: ANC and institutional delivery were both prevalent in 59.27% and 86.52% of cases, respectively. Among the five nations, Maldives has the greatest ANC (96.83%) and institutional delivery (99.39%), while Bangladesh has the lowest ANC (47.01%) and institutional delivery (49.81%). Women's and husbands' education, household wealth status, BMI, and urban residents are the most important factors influencing maternal health service utilization, whereas higher education level, affluent wealth quintiles, and place of residence are the major contributors to socioeconomic inequalities in access to maternal health care that favor the wealthy. CONCLUSION: Maternal health care services must be utilized properly in order to promote optimal health and prevent maternal mortality. Several socioeconomic and sociodemographic variables of the individual population, as well as policy issues, all have an impact on maternal mortality. This research recommends for concerted action to enhance how successfully women use maternity care services.

The use of self-management strategies for stroke rehabilitation: a scoping review.

INTRODUCTION: Self-management is generally considered a dynamic and collaborative process by individuals and caregivers to manage a chronic condition. Self-management has recently emerged as a promising strategy for stroke rehabilitation. This scoping review aims to examine and summarize self-management strategies utilized by stroke survivors for stroke rehabilitation. METHODS: PubMed, Scopus, CINAHL (EBSCO), Embase, and ProQuest were searched for articles published between January 2010 and December 2021. Studies were selected if they were published in English in a peer-reviewed journal, utilized a non-experimental research design, and focused on adult stroke survivors. All relevant information from the included articles was extracted in a systematic way using a pre-developed data extraction form. Two authors performed data extraction and quality evaluation independently. All issues were resolved through discussion among the authors. RESULTS: We narratively summarized the findings of 15 quantitative, qualitative, and mixed-method studies, including a total of 1,494 stroke survivors. The stroke survivors used a range of self-management strategies for their stroke rehabilitation, including domains related to lifestyle, social support, communication, knowledge and information, and goal-setting. Gender, age, stroke-related disability, fatigue, self-management education, social support, and communication with others were found to be associated with self-management use in stroke rehabilitation. CONCLUSIONS: This scoping review provides an important overview on stroke survivors' use of self-management strategies and their experience. Their use of self-management strategies is complicated and multifaceted, comprising several domains and involving a diverse range of approaches and personal experiences. However, we identified several gaps in the literature and more research is required.

Correction: Poverty and childhood malnutrition: Evidence-based on a nationally representative survey of Bangladesh.

[This corrects the article DOI: 10.1371/journal.pone.0256235.].

Poverty and childhood malnutrition: Evidence-based on a nationally representative survey of Bangladesh.

BACKGROUND: Malnutrition contributes to children's morbidity and mortality, and the situation undermines the economic growth and development of Bangladesh. Malnutrition is associated with lower levels of education that decrease economic productivity and leads to poverty. The global burden of malnutrition continues to be unacceptably high amid social and economic growth, including in Bangladesh. Therefore, identifying the factors associated with childhood malnutrition and poverty is necessary to stop the vicious cycle of malnutrition leaded poverty. METHODS: The study utilized the 2017-18 Bangladesh Demographic and Health Survey (BDHS), accumulating 7,738 mother-child pairs. Associations between potential risk factors and nutritional status were determined using chi-square tests, and multivariate logistic regression models were utilized on significant risk factors to measure their odds ratio (OR) with their 95% confidence intervals (CI). RESULTS: The prevalence of moderate and severe wasting was 7.0% and 1.8%, respectively, whereas the prevalence of moderate and severe stunting was 19.2% and 8.0%, while 16.4% and 3.6% of children were moderately and severely underweight. Children from the poorest and poor households were suffering from at least one form of malnutrition. Adjusted ORs were estimated by controlling socio-economic and demographic risk factors, such as poor maternal body mass index, parents' lower education level, use of unhygienic toilet, child age in months, and recent experience of diarrhea and fever. The pattern was almost similar for each malnutrition status (i.e., stunting, underweight, and wasting) in the poorest and poor households. CONCLUSION: Bangladesh achieved the Millennium Development Goals, focusing primarily on health-related indicators and working to achieve the Sustainable Development Goals. Even considering this success, the prevalence of malnutrition and poverty in same household remains relatively high compared to other developing countries. Therefore, the study recommends the implementation of nationwide systematic measures to prevent poverty and malnutrition.

Factors influencing place of delivery: Evidence from three south-Asian countries.

BACKGROUND: High maternal mortality is still a significant public health challenge in many countries of the South-Asian region. The majority of maternal deaths occur due to pregnancy and delivery-related complications, which can mostly be prevented by safe facility delivery. Due to the paucity of existing evidence, our study aimed to examine the factors associated with place of delivery, including women's preferences for such in three selected South-Asian countries. METHODS: We extracted data from the most recent demographic and health surveys (DHS) conducted in Bangladesh (2014), Nepal (2016), and Pakistan (2017-18) and analyzed to identify the association between the outcome variable and socio-demographic characteristics. A total of 16,429 women from Bangladesh (4278; mean age 24.57 years), Nepal (3962; mean age 26.35 years), and Pakistan (8189; mean age 29.57 years) were included in this study. Following descriptive analyses, bivariate and multivariate logistic regressions were conducted. RESULTS: Overall, the prevalence of facility-based delivery was 40%, 62%, and 69% in Bangladesh, Nepal, and Pakistan, respectively. Inequity in utilizing facility-based delivery was observed for women in the highest wealth quintile. Participants from Urban areas, educated, middle and upper household economic status, and with high antenatal care (ANC) visits were significantly associated with facility-based delivery in all three countries. Interestingly, watching TV was also found as a strong determinant for facility-based delivery in Bangladesh (aOR = 1.31, 95% CI:1.09-1.56, P = 0.003), Nepal (aOR = 1.42, 95% CI:1.20-1.67, P<0.001) and Pakistan (aOR = 1.17, 95% CI: 1.03-1.32, P = 0.013). Higher education of husband was a significant predictor for facility delivery in Bangladesh (aOR = 1.73, 95% CI:1.27-2.35, P = 0.001) and Pakistan (aOR = 1.19, 95% CI: 0.99-1.43, P = 0.065); husband's occupation was also a significant factor in Bangladesh (aOR = 1.30, 95% CI:1.04-1.61, P = 0.020) and Nepal (aOR = 1.26, 95% CI:1.01-1.58, P = 0.041). CONCLUSION: Our findings suggest that the educational status of both women and their husbands, household economic situation, and the number of ANC visits influenced the place of delivery. There is an urgent need to promote facility delivery by building more birthing facilities, training and deployment of skilled birth attendants in rural and hard-to-reach areas, ensuring compulsory female education for all women, encouraging more ANC visits, and providing financial incentives for facility deliveries. There is a need to promote facility delivery by encouraging health facility visits through utilizing social networks and continuing mass media campaigns. Ensuring adequate Government funding for free maternal and newborn health care and local community involvement is crucial for reducing maternal and neonatal mortality and achieving sustainable development goals in this region.

Prevalence of and factors associated with anaemia in women of reproductive age in Bangladesh, Maldives and Nepal: Evidence from nationally-representative survey data.

BACKGROUND: Anaemia is a significant public health problem in most South-Asian countries, causing increased maternal and child mortality and morbidity. This study aimed to estimate the prevalence of and factors associated with anaemia in women of reproductive age in Bangladesh, Maldives, and Nepal. METHODS: We used the nationally-representative Demographic and Health Surveys Program data collected from women of reproductive age (15-49 years) in 2011 in Bangladesh (n = 5678), 2016 in Maldives (n = 6837), and 2016 in Nepal (n = 6419). Anaemia was categorized as mild (haemoglobin [Hb] of 10.0-10.9 g/dL for pregnant women and 11.0-11.9 g/dL for non-pregnant women), moderate (Hb of 7.0-9.9 g/dL for pregnant women and 8.0-10.9 g/dL for non-pregnant women), and severe (Hb <7.0 g/dL for pregnant women and <8.0 g/dL for non-pregnant women). Multinomial logistic regression analyses were used to identify factors associated with anaemia. RESULTS: The prevalence of anaemia was 41.8% in Bangladesh, 58.5% in Maldives, and 40.6% in Nepal. In Bangladesh, postpartum amenorrhoeic, non-educated, and pregnant women were more likely to have moderate/severe anaemia compared to women who were menopausal, had secondary education, and were not pregnant, respectively. In Maldives, residence in urban areas, underweight, having undergone female sterilization, current pregnancy, and menstruation in the last six weeks were associated with increased odds of moderate/severe anaemia. In Nepal, factors associated with increased odds of moderate/severe anaemia were having undergone female sterilization and current pregnancy. CONCLUSION: Anaemia remains a significant public health issue among 15-49-year-old women in Bangladesh, Maldives, and Nepal, which requires urgent attention. Effective policies and programmes for the control and prevention of anaemia should take into account the unique factors associated with anaemia identified in each country. In all three countries, strategies for the prevention and control of anaemia should particularly focus on women who are pregnant, underweight, or have undergone sterilization.

Determinants of depressive symptoms among older people in Bangladesh.

BACKGROUND: Depressive symptoms are common among older people which are associated with disability, morbidity and mortality. The aim of this study was to determine the associated risk factors for depressive symptoms among older people in Bangladesh. METHODS: A cross-sectional survey was conducted among 400 people aged ≥65 years from the Meherpur district in Bangladesh. Depressive symptoms were measured by the 15-item Geriatric Depression Scale and categorized into: no depressive symptoms, mild, moderate and severe depressive symptoms. Information was also collected on socio-economic and demographic characteristics, health problems, feeling of loneliness, history of falls and concern about falling. Chi-square test of association and multinomial logistic regression was performed to reveal the determinants of depressive symptoms. RESULTS: Just over half of the sample were female, aged 70+ years, and lived in rural areas. The prevalence of depressive symptoms was 55.5%, and 23.0% mild, 19.0% moderate, and 13.5% having severe levels of depressive symptoms. Older age, sex, residence, marital status, presence of co-morbidities, visual impairment, previous falls, loneliness, and fear of falling were the significant determinants for developing depressive symptoms. LIMITATIONS: A convenience sampling method was used for data collection among older people from selected communities in a district of Bangladesh. The results do not represent the entire population of Bangladesh. Besides, it was a cross-sectional study, and causality cannot be determined. CONCLUSION: Depressive symptoms among older people in Bangladesh is prevalent, and needs to be addressed. Public health programs and strategies are needed to reduce depressive symptoms among older adults in Bangladesh.

Determinants of tobacco cultivation in Bangladesh.

BACKGROUND: Tobacco production continues to increase in low-income and middle-income countries including in Bangladesh. It has spreads to different parts of Bangladesh and is now threatening food cultivation, the environment and health. The aim of this study is to determine the factors those are influenced farmers' decisions to grow tobacco. METHODS: We surveyed 371 tobacco farmers using a simple random sampling in the Meherpur district of Bangladesh. Binary logistic regression was used to examine the variables affecting farmers' decision to cultivate tobacco. RESULTS: Approximately 87.0% of the respondents were contract farmers with different tobacco companies. Almost 83.3% of the farmers had intentions to continue tobacco farming. Binary logistic regression results suggest that company's incentives to farmers, farmers' profitability, a guaranteed market for the tobacco crop and economic viability were the variables most affecting the decision to cultivate tobacco. CONCLUSIONS: Governments seeking to shift farmers away from tobacco will need to consider how to address the dynamics revealed in this research.

Prevalence of undernutrition in Bangladeshi children.

Child undernutrition is a major public health problem throughout the world, particularly in developing countries. The main objective of this study was to identify the risk factors for acute undernutrition among under-5 children in Bangladesh. Data were taken from the nationally representative Bangladesh Demographic Health and Survey conducted in 2014. The study sample comprised 7131 under-5 children. Of these, 4.6% were found to be severely wasted (Z-score < -3.0), 11.1% moderately wasted (-3.0≤Z-score < -2.0) and 84.3% adequately nourished (Z-score ≥-2.0). Chi-squared analysis was used to investigate the association between child nutrition status and selected covariates. Multinomial logistic regression was applied to identify the risk factors for acute undernutrition. The selected factors division, place of residence, sex of child, place of delivery, child age, respiratory illness, size at birth, measles vaccination, fever, diarrhoea, maternal BMI, maternal education, paternal occupation, wealth index and household toilet facilities were found to be highly significant (p < 0.05) in the analysis. Multinomial regression analysis revealed that residence in Barisal and Chittagong divisions, a smaller than average size at birth and low maternal BMI (≤18.50 kg/m2) were significant determinants of both moderate and severe acute undernutrition among under-5 children in Bangladesh.