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Rahman R, Talukder A, Das S, Saha J, Sarma H. Understanding and predicting pregnancy termination in Bangladesh: A comprehensive analysis using a hybrid machine learning approach. Medicine (Baltimore) 2024; 103:e38709. [PMID: 38941421 DOI: 10.1097/md.0000000000038709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
Reproductive health issues, including unsafe pregnancy termination, remain a significant concern for women in developing nations. This study focused on investigating and predicting pregnancy termination in Bangladesh by employing a hybrid machine learning approach. The analysis used data from the Bangladesh Demographic and Health Surveys conducted in 2011, 2014, and 2017 to 2018. Ten independent variables, encompassing factors such as age, residence, division, wealth index, working status, BMI, total number of children ever born, recent births, and number of living children, were examined for their potential associations with pregnancy termination. The dataset undergoes preprocessing, addressing missing values and balancing class distributions. To predict pregnancy termination, 8 classical machine learning models and hybrid models were used in this study. The models' performance was evaluated based on the area under the curve, precision, recall, and F1 score. The results highlighted the effectiveness of the hybrid models, particularly the Voting hybrid model (area under the curve: 91.97; precision: 84.14; recall: 83.87; F1 score: 83.84), in accurately predicting pregnancy termination. Notable predictors include age, division, and wealth index. These findings hold significance for policy interventions aiming to reduce pregnancy termination rates, emphasizing the necessity for tailored approaches that consider regional disparities and socioeconomic factors. Overall, the study demonstrates the efficacy of hybrid machine learning models in comprehending and forecasting pregnancy termination, offering valuable insights for reproductive health initiatives in Bangladesh and similar contexts.
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Affiliation(s)
- Riaz Rahman
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, Bangladesh
| | - Ashis Talukder
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, Bangladesh
- Applied Epidemiology, National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia
| | - Shatabdi Das
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, Bangladesh
| | - Joy Saha
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna, Bangladesh
| | - Haribondhu Sarma
- Applied Epidemiology, National Centre for Epidemiology and Population Health, Australian National University, Acton, ACT, Australia
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Factors influencing menstrual regulation and its socioeconomic inequalities among ever-married women in Bangladesh: Findings from a nationwide cross-sectional survey. J Biosoc Sci 2022:1-12. [PMID: 36239089 DOI: 10.1017/s002193202200030x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Despite a significant drop in maternal mortality in Bangladesh, unsafe abortion remains a critical maternal health issue that could be reduced by promoting menstrual regulation (MR). This study aimed to investigate the prevalence and determinants of MR use among ever-married women as well as to identify the socioeconomic inequalities in MR use in Bangladesh. The latest Bangladesh Demographic and Health Survey (BDHS) 2017-18 data were used in this study. We used a sub-sample of 12,586 ever-married women aged 15 to 49 years for this study. To identify the determinants of MR, multilevel (mixed-effect) binary logistic regression analysis was used while accounting for potential between-clusters variations. The weighted prevalence of MR was 7.64% (95% CI: 7.19 - 8.12). Women of aged 20-29 years (AOR: 2.50, 95% CI: 1.46, 4.30) and ≥ 30 years (AOR: 4.17, 95% CI: 2.39, 7.26), from urban areas (AOR: 1.24, 95% CI: 1.04, 1.47), having one or two children (AOR: 1.96, 95% CI: 1.25, 3.09) and ≥ 3 children (AOR: 2.26, 95% CI: 1.40, 3.65), who used traditional contraceptive method (AOR: 1.39, 95% CI: 1.12, 1.73), and from Barishal division (AOR: 1.44, 95% CI: 1.08, 1.93) were more likely to have MR. Women were less likely to have MR if they were from Chittagong (AOR: 0.62, 95% CI: 0.46, 0.84) and Mymensingh (AOR: 0.51, 95% CI: 0.36, 0.73) divisions. MR use was found to be higher among higher socioeconomic status (SES) groups as the concentration index (CIX) value was positive and the Lorenz curve lay below the line of equality (CIX: 0.095, p<0.001). Health policy and intervention design should prioritize minimizing socioeconomic inequities concerning MR services.
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Ojo IE, Ojo TO, Orji EO. Why do married women procure abortion? Experiences from Ile-Ife, south western Nigeria. Afr Health Sci 2021; 21:327-337. [PMID: 34394314 PMCID: PMC8356588 DOI: 10.4314/ahs.v21i1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In Nigeria, about 1.25million induced abortions occur annually and the country accounts for one-fifth of abortion-related deaths globally. Objectives The study aimed to assess the determinants of induced abortion among married women. Methods A mixed methods study was conducted in Ile-Ife, Nigeria. The quantitative component employed a cross-sectional study design while the qualitative aspect comprised focus group discussions. Information on contraceptives use, unintended pregnancy and induced abortion were obtained from 402 married women (with at least one child) aged 18–49 years using a semi-structured questionnaire. Four focus group discussion sessions were conducted among women of reproductive age. Results Majority (67.2%) of respondents had ever used a contraceptive method. However, 34.3% of the women have had unintended pregnancies and 14.2% had induced abortion. FGD findings revealed that non-use of contraceptives and contraceptive failure were major reasons for unintended pregnancies and induced abortion. The significant predictors of induced abortion were non-use of contraceptives, age≥ 40 years and multiparity. Conclusion Induced abortion still occur among married women particularly those not using contraceptives, aged ≥40 years and those with high parity. More emphasis should be placed on making contraceptives more accessible to married women.
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Affiliation(s)
| | | | - Ernest Okechukwu Orji
- Obafemi Awolowo University College of Health Sciences, Department of Obstetrics, Gynaecology and Perinatology
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Enuameh YAK, Dzabeng F, Blencowe H, Thysen SM, Abebe SM, Asante KP, Tawiah C, Gordeev VS, Adeapena W, Kwesiga D, Kasasa S, Zandoh C, Imam MA, Amenga-Etego S, Newton SK, Owusu-Agyei S, Lawn JE, Waiswa P, Cresswell JA. Termination of pregnancy data completeness and feasibility in population-based surveys: EN-INDEPTH study. Popul Health Metr 2021; 19:12. [PMID: 33557867 PMCID: PMC7869447 DOI: 10.1186/s12963-020-00238-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Termination of pregnancy (TOP) is a common cause of maternal morbidity and mortality in low- and middle-income countries. Population-based surveys are the major data source for TOP data in LMICs but are known to have shortcomings that require improving. The EN-INDEPTH multi-country survey employed a full pregnancy history approach with roster and new questions on TOP and Menstrual Restoration. This mixed methods paper assesses the completeness of responses to questions eliciting TOP information from respondents and reports on practices, barriers, and facilitators to TOP reporting. METHODS The EN-INDEPTH study was a population-based cross-sectional study. The Full Pregnancy History arm of the study surveyed 34,371 women of reproductive age between 2017 and 2018 in five Health and Demographic Surveillance System (HDSS) sites of the INDEPTH network: Bandim, Guinea-Bissau; Dabat, Ethiopia; IgangaMayuge, Uganda; Kintampo, Ghana; and Matlab, Bangladesh. Completeness and time spent in answering TOP questions were evaluated using simple tabulations and summary statistics. Exact binomial 95% confidence intervals were computed for TOP rates and ratios. Twenty-eight (28) focus group discussions were undertaken and analysed thematically. RESULTS Completeness of responses regarding TOP was between 90.3 and 100.0% for all question types. The new questions elicited between 2.0% (1.0-3.4), 15.5% (13.9-17.3), and 11.5% (8.8-14.7) lifetime TOP cases over the roster questions from Dabat, Ethiopia; Matlab, Bangladesh; and Kintampo, Ghana, respectively. The median response time on the roster TOP questions was below 1.3 minutes in all sites. Qualitative results revealed that TOP was frequently stigmatised and perceived as immoral, inhumane, and shameful. Hence, it was kept secret rendering it difficult and uncomfortable to report. Miscarriages were perceived to be natural, being easier to report than TOP. Interviewer techniques, which were perceived to facilitate TOP disclosure, included cultural competence, knowledge of contextually appropriate terms for TOP, adaptation to interviewee's individual circumstances, being non-judgmental, speaking a common language, and providing detailed informed consent. CONCLUSIONS Survey roster questions may under-represent true TOP rates, since the new questions elicited responses from women who had not disclosed TOP in the roster questions. Further research is recommended particularly into standardised training and approaches to improving interview context and techniques to facilitate TOP reporting in surveys.
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Affiliation(s)
- Yeetey Akpe Kwesi Enuameh
- Kintampo Health Research Centre, Kintampo, Ghana
- Dept of Epidemiology & Biostatistics, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London Sch. of Hygiene & Tropical Medicine, London, UK
| | - Sanne M. Thysen
- Bandim Health Project, Bissau, Guinea-Bissau
- Research Centre for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research Open Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Solomon Mekonnen Abebe
- Dabat Research Centre Health and Demographic Surveillance System, Dabat, Ethiopia
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | | | | | - Vladimir Sergeevich Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London Sch. of Hygiene & Tropical Medicine, London, UK
- The Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | | | - Doris Kwesiga
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- International Maternal & Child Health, Department of Women and Children’s Health, Uppsala University, Uppsala, Sweden
- Centre of Excellence for Maternal Newborn and Child Health Research, Makerere University, Kampala, Uganda
| | - Simon Kasasa
- IgangaMayuge Health and Demographic Surveillance System, Iganga, Uganda
- Makerere University Centre for Health and Population Research, Makerere, Uganda
- Department of Epidemiology & Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - Md. Ali Imam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Sam K. Newton
- Kintampo Health Research Centre, Kintampo, Ghana
- Department of Global Health, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Kintampo, Ghana
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Joy E. Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London Sch. of Hygiene & Tropical Medicine, London, UK
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Centre of Excellence for Maternal Newborn and Child Health Research, Makerere University, Kampala, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jenny A. Cresswell
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London Sch. of Hygiene & Tropical Medicine, London, UK
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Ahmed MS, Yunus FM. Factors associated with knowledge and use of the emergency contraceptive pill among ever-married women of reproductive age in Bangladesh: findings from a nationwide cross-sectional survey. EUR J CONTRACEP REPR 2020; 26:195-201. [PMID: 33251881 DOI: 10.1080/13625187.2020.1850675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The study aimed to assess the prevalence and factors associated with knowledge and use of the emergency contraceptive pill (ECP) among ever-married women in Bangladesh. METHODS The study was based on a secondary dataset of the 2014 Bangladesh Demographic and Health Survey. Complete (weighted) data of 17,592 women aged 15-49 years were analysed. RESULTS The prevalence of having knowledge and use of the ECP among ever-married women in Bangladesh was 13.6% and 1.8%, respectively. Administrative region and type of residence (urban or rural), household wealth index, educational level (of both the woman and her spouse), spouse's occupation, number of living children, weight, current use of contraception and a history of pregnancy termination were positively associated with knowledge and use of the ECP. CONCLUSION A large proportion of Bangladeshi women of reproductive age had a lack of knowledge and use of the ECP. Nationwide reproductive health education programmes may improve the situation.
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Affiliation(s)
- Md Sabbir Ahmed
- Department of Community Health and Hygiene, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Dumki, Bangladesh
| | - Fakir Md Yunus
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
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Zahan R, Feng CX. Bayesian spatial analysis of socio-demographic factors influencing pregnancy termination and its residual geographic variation among ever-married women of reproductive age in Bangladesh. BMC Public Health 2020; 20:1348. [PMID: 32887581 PMCID: PMC7472707 DOI: 10.1186/s12889-020-09401-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unsafe pregnancy termination is a major public health concern among reproductive-aged women in many developing countries. This study evaluated the socio-demographic characteristics, as well as residual spatial correlation in pregnancy termination among Bangladeshi women. METHODS Secondary data was obtained from the Bangladesh Demographic and Health Survey for the survey year 2014. Data included 17,863 samples of ever-married women between the ages of 15-49 years, which is a national representative sample in Bangladesh. Bayesian spatial logistic regression was used to assess the associations between socio-demographic characteristics and pregnancy termination. We flexibly modeled the non-linear effects of the continuous covariates while accounting for residual spatial correlation at the district level. RESULTS Our findings revealed that about 19% of the respondents in Bangladesh reported ever had a pregnancy terminated. The risk of pregnancy termination was higher among women who had been working, had a higher wealth index, were in a conjugal relationship, had no children, were older and started their cohabitation earlier. Residual spatial patterns revealed the areas at a higher risk of pregnancy termination, including Panchagarh, Habiganj, and Sylhet after adjusting for covariates. CONCLUSIONS Prevalence of pregnancy termination remains considerably high in Bangladesh. The study revealed significant associations of women's age at survey time, age at first cohabitation, occupational status, socio-economic status, marital status and the total number of children ever born with reporting having a history of terminated pregnancy among Bangladeshi ever-married women. The identified socio-demographic characteristics and districts at an increased likelihood of pregnancy termination can inform localized intervention and prevention strategies to improve the reproductive healthcare of women in Bangladesh.
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Affiliation(s)
- Rifat Zahan
- Department of Computer Science, University of Saskatchewan, 176 Thorvaldson Building, Saskatoon, S7N 5C9, Saskatchewan, Canada
| | - Cindy Xin Feng
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, B3H 4R2, Nova Scotia, Canada. .,School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, S7N 2Z4, Saskatchewan, Canada. .,School of Epidemiology and Public Health Faculty of Medicine, University of Ottawa, 600 Peter Morand Cres, Ottawa, K1G 5Z3, Ontario, Canada.
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