Prevalence and determinants of hypertension in South-Asian Urban Communities: findings from Demographic and Health Surveys (DHS) data of South Asian countries

Hypertension increases risk of stroke and other cardiovascular diseases, however, its prevalence and determinants in South Asian urban communities using country representative community-based datasets is lacking. This study evaluated prevalence of hypertension and it's determinants among urban residents of three South Asian countries. Urban population data from demographic and health surveys in Bangladesh, India, and Nepal were extracted. Hypertension prevalence was defined as systolic/diastolic blood pressure ≥ 140/ 90 mmHg. Age, education, wealth, physical activity, alcohol, BMI were considered as risk factors associated with the increased risk of hypertension. We performed binary logistic regression and calculated adjusted Odds Ratios (AOR) with 95% confidence interval (CI) to assess factors related to hypertension. Hypertension prevalence was 37.4% in India, 25.1% in Bangladesh and 18.4% in Nepal. Prevalence increased with age in all settings. Females had reduced odds of hypertension in Bangladesh (AOR 0.75; CI: 0.69, 0.81) and Nepal (AOR 0.62; CI: 0.54, 0.71), but higher risk in India (AOR 2.54; CI: 2.45, 2.63). Low education, caffeine consumption, obesity was associated with higher prevalence of hypertension in all three countries. Smokers had increased odds of hypertension in India (AOR 1.11; CI: 1.06, 1.15) and Nepal (AOR 1.23; 1.02, 1.47). Overall, hypertension prevalence is high in all three countries. Modifiable socioeconomic and lifestyle factors (education, wealth index, smoking status, caffeine consumption and BMI) associated with hypertension. Comprehensive hypertension pacific and sensitive interventions (including behavioral modification treatments and timely screening and access to health care) are urgently needed to prevent and control hypertension among urban populations in South Asia.

Qualitative assessment of programmatic constraints in delivery of effective interventions for improving maternal nutrition in Bangladesh

INTRODUCTION

Maternal undernutrition is highly prevalent in most of the developing countries. Prevalence of both extremes of maternal malnutrition (undernutrition and overweight/obesity) are common in those countries. For Bangladesh, the scenario is not different. The Government of Bangladesh recognises maternal nutrition as a public health priority and addresses the issue in its policies and programmes. We identified and analysed the existing maternal nutrition programmes and determined the bottlenecks in implementing the programmes in Bangladesh using qualitative approach.

METHODS

We followed a qualitative research approach and conducted 25 key informant interviews with the programme managers and policymakers, 10 in-depth interviews with the service providers and six focus group discussions with the pregnant women to identify the constraints of programme implementation. We analysed data using thematic and inductive approaches of qualitative research methods.

RESULTS

We have found that successful implementation of maternal nutrition intervention was being hampered by both the demand and supply side issues. On the demand side, major constraints were financial inability of the families to avail maternal nutrition-related services, ignorance of the family members and cultural barriers of using maternal nutrition-related services. Lack of priority and heavy workload of the service providers, lack of human resources, poor monitoring system, lack of medicine to supply and incoordination have been identified as major supply-side constraints in providing maternal nutrition-related interventions in Bangladesh.

CONCLUSION

Both supply side and demand side issues are responsible for the existing bottlenecks in implementing maternal nutrition-related programmes in Bangladesh. Findings of this study will help the policymakers to learn about the programmatic constraints regarding maternal nutrition services in Bangladesh.

Parental Influence on Usage of Electronic Gadgets and Students' Grades: Primary Students' Perspective

This study intended to find out the children's usage of gadgets and the parents' role regarding their usage and finally its influence on grades. This cross-sectional study was conducted using quantitative method. A total of 340 students of class four were selected by a random sampling method from four schools. Data collection was done by face-to-face interview and the study tool was structured by pretested questionnaire. The study took place at Dhanmondi Govt. Boys' High School, Kamrunnessa Govt. Girls School, Dhanmondi, Bangladesh International School and College (BISC), Mohakhali and SOS Hermann Gmeiner College, Mirpur, Dhaka, Bangladesh. Data collection was carried out from May 2019 to October 2019. Then the analysis of data and results were prepared in November and December 2019. Among 340 respondents of this study, a maximum (78.2%) of students watch TV, 55.9% of them play with mobile and a half (50%) of the students use tablet daily. Maximum (91.8%) parents monitor the use and time of gadgets. About 53.8% of parents use gadgets as a parenting tool. The majority of parents have a positive opinion of electronic gadgets on their children's reading (52.9% somewhat positive and 24.7% very positive) and writing (56.8% somewhat positive and 20.3% very positive) skills. The parents had negative opinion regarding attention spans to studies (33.8% somewhat negative), physical activity (38.2% somewhat negative and 16.5% parents are very negative) and sleep (38.8% are somewhat negative and 17.9% are very negative). Children are the future generation of our country. It is the duty of the parents as well as the country to establish a balanced use of this modern invention in our children's life.

Musculoskeletal pain and physical health status among confirmed COVID-19 patients of Bangladesh

COVID-19 pandemic is now a great headache for the world population. Respiratory symptoms are the main presentation of COVID-19. However, musculoskeletal pain, headache, loss of taste and smell sense, and neurological manifestations may occur. Identification of patterns of musculoskeletal pain, fatigue and physical health status in COVID-19 is crucial. In this cross sectional study, a total 380 individuals with COVID-19 were recruited from the population following selection criteria. Pain varied widely in hip, neck, leg and calf muscles, back and spine, shoulder, arms and hand, and other parts of the body among the respondents. Inconstant, among respondents of younger age group (aged ≤50 year), 37.59% had moderate pain, 6.77% had severe pain, 13.91% had mild pain, and 41.17% had no pain. On the other hand, among older respondents (aged >50 year) 47.37% had moderate pain, 25.44% had severe pain, 13.15% had mild pain, and 14.03% had no pain. The differences between two groups was statistically significant (p<0.05). However, there was no difference in frequency of pain between males and females. Those respondents who had pain was reported having physical health worse than the average compared to that of those who had no pain. BSMMU J 2021; 14 (COVID -19 Supplement): 1-7

Influence of Parental Factors on Tobacco Smoking among Male Adolescents

In Bangladesh, more than one-fifth (20.5 percent) of the total population, that is 30.68 million is adolescents. Most of the adult smokers initiate smoking in their adolescent period. This study aimed to investigate parental influencing factors for the initiation of tobacco smoking in adolescence period among 15-19 years old college students of Dhaka city, Bangladesh. This was an unmatched case-control study. The information was collected from 91 ever-smokers in the case group and 91 never-smokers in the control group. The respondents were 11th and 12th-grade male college students selected from two colleges of Dhaka city, Bangladesh. The results were analysed using univariate, bivariate and multivariate analysis. Parental control variable was categorized by using Likert Scale. Around 68.7 percent (n=57) respondents were 18-19 years old who were ever-smoker and about 44 percent (n=40) ever-smokers initiated smoking at or below the age of 16. Father's smoking status was found significant (p value <0.05) in bivariate analysis. In binary logistic regression, respondents who received intermediate to low control from their father compared to high control (OR 3.35, 95% CI 1.08-10.38, p value 0.035), respondents who received intermediate to low control from their mother compared to high control (OR 3.73, 95% CI 1.07-13.05, p value 0.039), and presence of any smoking member in their family compared to who did not have (OR 6.23, 95% CI 2.57-15.12, p value 0.001) found significantly higher odds of being ever-smoker. Respondents whose mother passed up to 8 hours in a day with them compared to mothers who gave limited time (less than 1 hour) in a day was found significantly lower odds (OR 0.07, 95% CI 0.01-0.65, p value 0.019) which was a protective factor of being ever-smoker. The result of the study concludes that parental influencing factors had a significant role in tobacco smoking of college-going male adolescents. Parent focused tobacco prevention program may be effective to reduce tobacco smoking prevalence. Further interventional studies are required.

Use of indices to measure socio-economic status (SES) in South-Asian urban health studies: a scoping review

BACKGROUND

Universal health coverage (UHC) is a key area in post-2015 global agenda which has been incorporated as target for achieving health-related Sustainable Development Goals (SDGs). A global framework has been developed to monitor SDG indicators disaggregated by socioeconomic and demographic markers. This review identifies the indices used to measure socio-economic status (SES) in South Asian urban health studies.

METHODS

Two reviewers searched six databases including Cochran Library, Medline, LILACS, Web of Science, Science Direct, and Lancet journals independently. All South Asian health studies covering urban population, with any research-designs, written in English language, and published between January 2000 and June 2016 were included. Two reviewers independently screened and assessed for selection of eligible articles for inclusion. Any conflict between the reviewers was resolved by a third reviewer.

RESULTS

We retrieved 3529 studies through initial search. Through screening and applying inclusion and exclusion criteria, this review finally included 256 articles for full-text review. A total of 25 different SES indices were identified. SES indices were further categorized into 5 major groups, e.g., (1) asset-based wealth index, (2) wealth index combining education, (3) indices based on income and expenditure, (4) indices based on education and occupation, and (5) "indices without description." The largest proportion of studies, irrespective of country of origin, thematic area, and study design, used asset-based wealth index (n = 142, 54%) as inequality markers followed by the index based on income and expenditure (n = 80, 30%). Sri Lankan studies used income- and expenditure-based indices more than asset-based wealth index. Majority of the reviewed studies were on "maternal, neonatal, and child health" (n = 98, 38%) or on "non-communicable diseases" (n = 84, 33%). Reviewed studies were mostly from India (n = 145, 57%), Bangladesh (n = 42, 16%), and Pakistan (n = 27, 11%). Among the reviewed articles, 55% (n = 140) used primary data while the rest 45% studies used secondary data.

CONCLUSION

This scoping review identifies asset-based wealth index as the most frequently used indices for measuring socioeconomic status in South Asian urban health studies. This review also provides a clear idea about the use of other indices for the measurement SES in the region.

Perceptions and behavior related to noncommunicable diseases among slum dwellers in a rapidly urbanizing city, Dhaka, Bangladesh: a qualitative study

The increasing burden of noncommunicable diseases (NCDs) in Bangladesh can be attributable to rapid urbanization and coinciding changes in lifestyle accompanied by nutrition transition. The objective of this study is to explore respondents' lived experiences and perceptions relating to NCDs and nutrition change in an urban slum community in Dhaka. Qualitative methods were employed to explore a general understanding of behavior related to NCDs among residents of the slum community. We conducted key informant interviews of six men and seven women of various backgrounds and five focus group discussions to focus salient topics emerged from the interviews. The transcriptions of the audio-recordings were thematically analyzed, using the constant comparison method. Four major themes emerged: (1) financial hardship influencing health; (2) urbanized lifestyle affecting diet; (3) tobacco and sweetened tea as cornerstones of social life; and (4) health-seeking behavior utilizing local resources. One notable finding was that even with general economic improvement, respondents perceived poverty to be one of the major causes of NCDs. A promising finding for potentially curbing NCDs was the current trend for women to walk for exercise contrary to the commonly held notion that urban dwellers generally lead sedentary lifestyles. This study described how urban slum dwellers in Dhaka, experiencing a transition from a traditional to urbanized lifestyle, perceived their daily practices in relation to NCDs and nutrition. Our research revealed both adverse and encouraging elements of perceptions and behavior related to NCDs, which may contribute to the optimal design of NCD prevention and health promotion programs.

Non-pharmacological interventions for the prevention of hypertension in low-income and middle-income countries: protocol for a systematic review and meta-analysis

INTRODUCTION

In recent times, hypertension has become one of the major public health concerns in both the developed and the developing world and is responsible for death due to heart diseases and stroke. The increasing trend of the prevalence of hypertension in low-income and middle-income countries (LMICs) and it's catastrophic consequences have made the phenomenon important to continue to investigate interventions for its prevention and control. Different dietary and lifestyle-related approaches have been recommended for the prevention of hypertension. The aim of this proposed review is to explore the available non-pharmacological interventions tried for the prevention of hypertension in LMICs.

METHODS AND ANALYSIS

Eight electronic databases will be searched covering the period between 1990 and 2016 to identify relevant studies and will be screened by two independent reviewers. The searched articles will be included for full-text extraction applying definitive inclusion and exclusion criteria. Appropriate critical appraisal tools including the Cochrane Handbook for Systematic Reviews of Interventions will be used to assess the risk of bias. Disagreement between the two reviewers will be resolved by a third reviewer. Narrative synthesis of the findings will be provided along with summaries of the intervention effect. A meta-analysis will be undertaken using the random-effects model where applicable. Heterogeneity between the studies will be assessed, and sensitivity analysis will be conducted based on study quality.

ETHICS AND DISSEMINATION

Approval from the institutional review board has been taken for this review. Findings will be summarised in a single manuscript.This review is an attempt to explore the available non-pharmacological approaches for the prevention of hypertension in LMICs. Findings from the review will highlight effective non-pharmacological measures for the prevention of hypertension to guide policy for future strategies.

PROSPERO REGISTRATION NUMBER

CRD42017055423.

Early versus late rehabilitation for stroke survivors: A prospective study

<p>The aim of this study was to examine the optimum time of rehabilitation initiation after stroke in terms of disabilities, mobility and fall risk assessment. Data were collected prospectively at seven tertiary level health care centers in Bangladesh during the 36 months period from 2013 to 2016. All respondents were divided into four groups based on the initiation of rehabilitation as: a) 0-24 hours, b) 25-72 hours, c) 4-7 days and d) 8-60 days. Results show that significant improvement on stroke recovery, disabilities reduction, improvement in mobility restriction and reduction of fall risks in all the four groups but more improvement was observed in 0-24 hour’s group during follow-up after 3 and 12 weeks. On multinomial logistic regression analysis, the independent factors shows the mobility restriction and fall risk were more in the younger patients, male gender, married, hemorrhagic lesion and bilateral stroke.</p>

Cervical Cancer and Ethical issues in HPV Vaccination

Human Papilloma Virus (HPV) infection causes death of 270,000 people die from every year. Sexually transmitted HPV was found one of the major causes of cervical cancer. World Health Organization (WHO). Cervical cancer (CC) is one of the top five cancers that affect women around the world. In June 2006, the Food and Drug Administration (FDA) approved a new vaccine for women, Gardasil, produced by the pharmaceutical company Merck that protects against infection by certain strains of HPV, including the two strains that cause most cases of cervical cancer. Vaccinations are counted as one of public health’s important development but there is an ethical dilemma between balancing personal autonomy and protection of the entire at risk population. The vaccine caused very few side effects like local reactions whereas signs or symptoms of greater importance were very. Moreover it was considered that the vaccine is has an efficacy of practically 100% in prevention of precancerous lesion caused by the viral genotypes included in the vaccine. Bioethicists were not convinced about compulsory vaccination laws as the values of patient autonomy and informed consent to be preeminent to them. Not surprisingly, some have expressed wariness about or opposition to mandating HPV vaccination. A critical question is whether achieving a higher level of coverage justifies the infringement on parental autonomy that compulsory vaccination inevitably entails. Recommendation of the universal vaccination of girls and young women may evolve ethical challenges which might make it difficult for smooth implementation of the vaccination campaigns. Review of the ethical issues in HPV vaccination will constitute the main part of our paper.

Young people's exposure to point-of-sale tobacco products and promotions

OBJECTIVES

Point of sale (POS) displays are one of the most important forms of tobacco marketing still permitted in many countries. Reliable methods for measuring exposure to such displays are needed in order to assess their potential impact, particularly on smoking attitudes and uptake among young people. In this study we use a novel method for evaluating POS exposure based on young people's use of retail outlets and recall of tobacco displays and observational data on the characteristics of displays.

STUDY DESIGN

Observational audit of retail outlets (n = 96) and school-based pupil survey (n = 1482) in four Scottish communities reflecting different levels of social deprivation and urbanisation, conducted in 2013 before legislation to remove POS displays was implemented in supermarkets.

METHODS

Measures were taken of: visibility and placement of tobacco displays; internal and external advertising; display unit size, branding and design; visibility of pack warnings; proximity of tobacco products to products of potential interest to children and young people; pupils' self-reported frequency of visiting retail outlets; and pupils' recall of tobacco displays. Variation in POS exposure across social and demographic groups was assessed.

RESULTS

Displays were highly visible within outlets and, in over half the stores, from the public footway outside. Tobacco products were displayed in close proximity to products of interest to children (e.g. confectionery, in 70% of stores). Eighty percent of pupils recalled seeing tobacco displays, with those from deprived areas more likely to recall displays in small shops. When confectioners, tobacconists and newsagents (CTNs) and grocery/convenience stores (two of the outlet types most often visited by young people) were examined separately, average tobacco display unit sizes were significantly larger in those outlets in more deprived areas.

CONCLUSIONS

POS displays remain a key vector in most countries for advertising tobacco products, and it is important to develop robust measures of exposure. The data reported in this paper provide a baseline measure for evaluating the efficacy of legislation prohibiting such displays.

Does exposure to cigarette brands increase the likelihood of adolescent e-cigarette use? A cross-sectional study

OBJECTIVE

To examine the relationship between tobacco cigarette brand recognition, and e-cigarette use in adolescents.

DESIGN

Cross-sectional observational study.

SETTING

High schools in Scotland.

PARTICIPANTS

Questionnaires were administered to pupils in Secondary 2 (S2 mean age: 14.0 years) and Secondary 4 (S4 mean age: 15.9 years) across 4 communities in Scotland. An 86% response rate with a total sample of 1404 pupils was achieved.

MAIN OUTCOME MEASURES

Self-reported previous use of e-cigarettes and self-reported intention to try e-cigarettes in the next 6 months.

RESULTS

75% (1029/1377) of respondents had heard of e-cigarettes (69.5% S2, 81.1% S4), and of these, 17.3% (10.6% S2, 24.3% S4 n=1020) had ever tried an e-cigarette. 6.8% (3.7% S2, 10.0% S4 n=1019) reported that they intended to try an e-cigarette in the next 6 months. Recognition of more cigarette brands was associated with greater probability of previous e-cigarette use (OR 1.20, 99% CI 1.05 to 1.38) as was having a best friend who smoked (OR 3.17, 99% CI 1.42 to 7.09). Intention to try e-cigarettes was related to higher cigarette brand recognition (OR 1.41, 99% CI 1.07 to 1.87), hanging around in the street or park more than once a week (OR 3.78, 99% CI 1.93 to 7.39) and living in areas of high tobacco retail density (OR 1.20, 99% CI 1.08 to 1.34). Never having smoked was a protective factor for both future intention to try, and past e-cigarette use (OR 0.07, 99% CI 0.02 to 0.25; and OR 0.10, 99% CI 0.07 to 0.16, respectively).

CONCLUSIONS

Higher cigarette brand recognition was associated with increased probability of previous use and of intention to use e-cigarettes. The impact of tobacco control measures such as restricting point-of-sale displays on the uptake of e-cigarettes in young people should be evaluated.

Sexually transmitted infections and sexual behaviour among youth clients of hotel-based female sex workers in Dhaka, Bangladesh

A cross-sectional study was conducted among youth clients of hotel-based female sex workers (YCHBFSWs) in nine randomly selected hotels in Bangladesh to examine sexual-risk behaviour, condom use and determinants of condom use in last sex, knowledge of HIV, sexually transmitted infection (STI) prevalence and STI care-seeking behaviour. A prestructured questionnaire was used to collect sociodemographic, behavioural, clinical information; urine specimens (before sex) and blood were collected for diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, syphilis and herpes simplex virus 2 (HSV2) infection. One thousand and thirteen participants were enroled in the study. Approximately half of them reported visiting female sex workers (FSWs) at least once a month and 25% visited FSWs at least once a week. Only 12% of participants reported regular condom use. The prevalence of N. gonorrhoeae, C. trachomatis, T. vaginalis, syphilis and HSV2 was 2.2%, 3.9%, 7.2%, 2.6% and 12.9%, respectively. Only 15.3% of the YCHBFSW sought STI care in the past year. Negotiation of condom use with FSWs was the main determinant (odds ratio = 17.95) for condom use at last sex. Male clients of FSWs, including YCHBFSW, are an important bridge population for HIV transmission in Bangladesh and HIV interventions should be designed and implemented for them.

Predictors of depression among older people living in rural areas of Thailand

Global population is ageing and Thailand has one of the fastest growing ageing populations in this region. Combined with this, depression has become a major mental health problem for older people. The objective of this paper is to examine the predictors of depression among rural older people of Thailand. This study has used information from the Study on Health and Social Support among Older Population living in Kanchanaburi Demographic Surveillance System (KDSS), Thailand in 2006. Depression was measured by a 12 item questionnaire of Thai validated Euro-D scale among 1001 respondents. The questions were on depression, pessimism, wishing to die, guilt, sleep disturbance, loss of interest, irritability, eating problems, fatigue, problem in concentration, lack of enjoyment, and tearfulness. Among the respondents 28.5% had depression. The results of logistic regression found that infirmity, disability and serious life events had significant effect on depression of the respondent. Those who had 4 or more infirmity, they were 2.08 times more likely to have depression compare to those who had no or only 1 infirmity. Disability was another strong predictor of the depression. It should be mentioned here that those who had medium disability, had the chance of depression 3.12 times more compare to those who had no disability. Serious life event was also a major factor for the respondents. Those who had 3 or more serious life events they had the depression 5.25 times more compare to those who had no serious life event.This study identified three major predictors of depression for older people in KDSS, Thailand. The finding will help to design specific prevention program to reduce the depression of older people living in the rural area of Thailand.

Labor force participation in later life: evidence from a cross-sectional study in Thailand

BACKGROUND

The labor force participation rate is an important indicator of the state of the labor market and a major input into the economy's potential for creating goods and services. The objectives of this paper are to examine the prevalence of labor force participation among older people in Thailand and to investigate the factors affecting this participation.

METHODS

The data for this study were drawn from the '2007 Survey of Older Persons' in Thailand. Bivariate analysis was used to identify the factors associated with labor force participation. The variables were further examined using multivariate analysis in order to identify the significant predictors of the likelihood of older people participating in the labor force, after controlling for other variables.

RESULTS

Overall, 30,427 elderly people aged 60 or above were interviewed. More than a third (35%) of all respondents had participated in the labor force during the seven days preceding the survey. Respondents who were female (OR=0.56), those who were older (OR=0.47 for 70-79 and 0.21 for 80+ years), those who were widowed/divorced (OR=0.85), those who were living with their children (OR=0.69), those whose family income was relatively low, and those who worked in government sectors (OR=0.33) were less likely to participate in the labor force than were their counterparts. On the other hand, those who lived in urban areas (OR=1.2), those who had a low level of education (OR, secondary level 1.8, primary 2.4, and no schooling 2.5), those who were the head of the household (OR=1.9), and those who were in debt (OR=2.3) were more likely be involved in the labor force than their comparison groups. Furthermore, respondents who experienced greater difficulty in daily living, those who suffered from more chronic diseases, and those who assessed their health as poor were less likely to participate in the labor force than their counterparts.

CONCLUSION

Labor force participation in their advanced years is not uncommon among the Thai elderly. The results suggest that improving the health status of the elderly is necessary in order to encourage their employment. By doing so, the country can fulfill the labor shortage and further improve the economic condition of the nation. The results of this study also suggest that for policies encouraging employment among older persons to succeed, special focus on the rural elderly is necessary.

Self-assessed health among Thai elderly

BACKGROUND

The ageing of the population is rapidly progressing in Thailand. Self-assessed health status can provide a holistic view of the health of the elderly. This study aims to identify the determinants of self-assessed health among older Thai people.

METHODS

The data for this study were drawn from a national survey of older persons conducted in 2007. Stratified two-stage random sampling was used for data collection. The analysis was restricted to the population aged 60 and above. The study used univariate, bivariate, and multivariate analysis procedures to analyze the data. Bivariate analysis was used to identify the factors associated with self assessment of health status. After controlling for other variables, the variables were further examined using multivariate analysis (binary logistic regression) in order to identify the significant predictors of the likelihood of reporting poor health.

RESULTS

Overall, 30,427 elderly people were interviewed in this study. More than half of the sampled respondents (53%) were aged 60-69 years and about one out of seven (13%) were aged 80 years or above. About three in five respondents (56%) reported that their health was either fair or very bad/bad. Logistic regression analysis found that age, education, marital status, working status, income, functional status, number of chronic diseases, and number of psychosocial symptoms are significant predictors in determining health status. Respondents who faced more difficulty in daily life were more likely to rate their health as poor compared to those who faced less such difficulty. For instance, respondents who could not perform 3 or more activities of daily living (ADLs) were 3.3 times more likely to assess their health as poor compared to those who could perform all the ADLs. Similarly, respondents who had 1, 2, or 3 or more chronic diseases were 1.8 times, 2.4 times, and 3.7 times, respectively, more likely to report their health as poor compared to those who had no chronic disease at all. Moreover, respondents who had 1-2, 3-4, or 5 or more psychosocial symptoms in the previous months were 1.6 times, 2.2 times, and 2.7 times, respectively, more likely to report poor health compared to those who did not have any psychosocial symptoms during the same period.

CONCLUSION

Self-assessed poor health is not uncommon among older people in Thailand. No single factor accounts for the self-assessed poor health. The study has found that chronic disease, functional status, and psychosocial symptoms are the strongest determinants of self-assessed poor health of elderly people living in Thailand. Therefore, health-related programs should focus on all the factors identified in this paper to improve the overall well-being of the ageing population of Thailand.

HIV and AIDS in Bangladesh

Bangladesh initiated an early response to the HIV epidemic starting in the mid-1980s. Since then, the response has been enhanced considerably, and many HIV-prevention interventions among the most at-risk populations and the general youth are being undertaken. Alongside prevention activities, gathering of data has been a key activity fostered by both the Government and individual development partners. This paper reviews available sources of data, including routine surveillance (HIV and behavioural among most at-risk populations), general population surveys, and various research studies with the aim to understand the dynamics of the HIV epidemic in Bangladesh. Available data show that the HIV epidemic is still at relatively low levels and is concentrated mainly among injecting drug users (IDUs) in Dhaka city. In addition, when the passively-reported cases were analyzed, another population group that appears to be especially vulnerable is migrant workers who leave their families and travel abroad for work. However, all sources of data confirm that risk behaviours that make individuals vulnerable to HIV are high--this is apparent within most at-risk populations and the general population (adult males and youth males and females). Based on the current activities and the sources of data, modelling exercises of the future of the HIV epidemic in Dhaka suggest that, if interventions are not enhanced further, Bangladesh is likely to start with an IDU-driven epidemic, similar to other neighbouring countries, which will then move to other population groups, including sex workers, males who have sex with males, clients of sex workers, and ultimately their families. This review reiterates the often repeated message that if Bangladesh wants to be an example of how to avert an HIV epidemic, it needs to act now using evidence-based programming.

Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control

BACKGROUND/OBJECTIVES

Despite repeated public commitments and availability of various forms of iron supplements, rates of anaemia in developing countries remain high. A major reason for this lack of success has been poor adherence. The objective of this study was to compare the effectiveness of daily and flexible administration of micronutrient Sprinkles on adherence, acceptability and haematological status among young children in rural Bangladesh.

SUBJECTS/METHODS

A sample of 362 children (haemoglobin (Hb)>or=70 g l(-1)) aged 6-24 months were cluster-randomized to receive 60 sachets of Sprinkles either (i) daily over 2 months; (ii) flexibly over 3 months; or (iii) flexibly over 4 months. With a flexible regimen, mothers/caregivers decided how frequently to use Sprinkles without exceeding one sachet per day. Adherence was assessed monthly by counting the number of sachets used and acceptability was evaluated through focus group discussions. Haemoglobin was measured at baseline, at the end of each intervention period and 6 months post-intervention.

RESULTS

Mean percent adherence was significantly higher in the flexible-4-month group (98%) compared to the flexible-3-month (93%) and daily-2-month (88%) groups (P<0.01). Most mothers found flexible administration to be more acceptable than daily due to perceived benefits of use. Hb at the end of intervention was significantly higher in the flexible-4-month group compared to the daily group (P=0.03). Anaemia prevalence decreased by 65% in the flexible-4-month group compared to 54% in the flexible-3-month and 51% in the daily-2-month groups. Percent of cured children who maintained a non-anaemic status 6 months post-intervention was significantly higher in the flexible-4-month (82%) and flexible-3-month (80%) groups than the daily-2-month (53%) group (P<0.05).

CONCLUSIONS

The adherence, acceptability and haematological response to flexible administration over 4 months were found preferable to daily.

Risk factors for neonatal mortality in rural areas of Bangladesh served by a large NGO programme

Neonatal deaths account for about half of all deaths among children under 5 years of age in Bangladesh, making prevention a major priority. This paper reports on a study of neonatal deaths in 12 areas of Bangladesh served by a large NGO programme, which had high coverage of reproductive health outreach services and relatively low neonatal mortality in recent years. The study aimed to identify the main factors associated with neonatal mortality in these areas, with a view to developing appropriate strategies for prevention. A case-control design was adopted for collection of data from mothers whose children, born alive in 2003, died within 28 days postpartum (142 cases), or did not (617 controls). Crude and adjusted odds ratios (AOR) were calculated as estimates of relative risk for neonatal death, using 'neighbourhood' controls (241) and 'non-neighbourhood' controls (376). A similar proportion of case and control mothers had received NGO health education and maternal health services. The main risk factors for neonatal death among 122 singleton babies, based on the two sets of controls, were: complications during delivery [AOR, 2.6 (95% CI: 1.5-4.5) and 3.1 (95% CI: 1.8-5.3)], prematurity [AOR, 7.2 (95% CI: 3.6-14.4) and 8.3 (95% CI: 4.2-16.5)], care for a sick neonate from an unlicensed 'traditional healer' [AOR, 2.9 (95% CI 0.9-9.5 and 5.9 (95% CI: 1.3-26.3)], or care not sought at all [AOR, 23.3 (95% CI: 3.9-137.4)]. The strongest predictor of neonatal death was having a previous sibling not vaccinated against measles [AOR, 5.9 (95% CI: 2.2-15.5) and 12.0 (95% CI: 4.5-31.7)]. The findings of this study indicate the need for identification of babies at high risk and early postpartum interventions (40.2% of the deaths occurred within 24 hours of delivery). Relevant strategies include special counselling during pregnancy for mothers with risk characteristics, training birth attendants in resuscitation, immediate postnatal check-up in the home for high-risk babies identified at delivery, advice for mothers on appropriate care-seeking for sick babies, improving the capacity of sub-district hospitals for emergency obstetric and newborn care, and promotion of institutional deliveries.

Validating Neonatal Mortality and Use of NGO Reproductive Health Outreach Services in Rural Bangladesh

Although the neonatal mortality rate (NMR) in Bangladesh remained steady between 1995-99 and 1999-2003 (41-42 deaths per 1,000 live births), evidence from the management information system (MIS) of a large nongovernmental organization (NGO) program indicates that the NMR declined by about 50 percent between 1996 and 2002 in the area served. This study aims to validate the recording of neonatal deaths among the cohort of children registered as born in 2003 and to assess the evidence of a decline in the NMR. It also measures the coverage of reproductive health outreach services, focusing on 12 of the 27 NGOs that have provided services in the same areas since 1996. Field-workers' registers, verbal autopsy reports, and immunization records were checked to confirm infants' survival. Interviews were conducted with 142 mothers of children who died within 28 days postpartum and with a random sample of 109 women with registered stillbirths. Out of 11,253 registered live births in 2003, 210 neonatal deaths were found, compared with 194 deaths that were reported in the MIS for 2003. The corrected NMR was 19 deaths per 1,000 live births, and it was in the range of 15-29 deaths per 1,000 live births in 11 of the NGO areas. Because underreporting of neonatal deaths was probably higher in 1996 when the MIS-reported NMR was 39 deaths per 1,000 live births, the decline in the NMR is likely to have been genuine.

Use of Family Planning Services in the Transition To a Static Clinic System in Bangladesh: 1998–2002

CONTEXT

In rural Bangladesh, family planning services--previously provided through household visits and satellite clinics--were transferred to static community clinics under the government's sectoral program for 1998-2003, but the next sectoral program reversed the change without a formal evaluation. It is important to assess changes in utilization and coverage to inform further development of the service delivery system.

METHODS

Longitudinal data on use of family planning services and contraceptive methods were collected quarterly in 1998-2002 from married women in about 11,000 households in two rural surveillance areas--Abhoynagar and Mirsarai. Cross-sectional surveys were conducted among women and service providers in 2003 to gather detailed information about the transition to static clinics and women's response to the changes. Quarterly time series graphs of selected indicators were plotted for areas served by community clinics.

RESULTS

In a time of considerable change in service delivery and sources of contraceptive supply, contraceptive prevalence remained constant in Abhoynagar and increased in Mirsarai. Community clinics quickly became the source of supplies for one-third of contraceptive users in Abhoynagar and one-fifth in Mirsarai. In wards where community clinics became operational (mostly in 2001-2002), three-quarters of women had used one at some time.

CONCLUSIONS

Despite cultural constraints on mobility, women do not appear to have become dependent on home delivery of contraceptives.