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Rahman MM, Franklin M, Jabin N, Sharna TI, Nower N, Alderete TL, Mhawish A, Ahmed A, Quaiyum MA, Salam MT, Islam T. Assessing household fine particulate matter (PM 2.5) through measurement and modeling in the Bangladesh cook stove pregnancy cohort study (CSPCS). Environ Pollut 2023; 338:122568. [PMID: 37717899 DOI: 10.1016/j.envpol.2023.122568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/25/2023] [Accepted: 09/14/2023] [Indexed: 09/19/2023]
Abstract
Biomass fuel burning is a significant contributor of household fine particulate matter (PM2.5) in the low to middle income countries (LMIC) and assessing PM2.5 levels is essential to investigate exposure-related health effects such as pregnancy outcomes and acute lower respiratory infection in infants. However, measuring household PM2.5 requires significant investments of labor, resources, and time, which limits the ability to conduct health effects studies. It is therefore imperative to leverage lower-cost measurement techniques to develop exposure models coupled with survey information about housing characteristics. Between April 2017 and March 2018, we continuously sampled PM2.5 in three seasonal waves for approximately 48-h (range 46 to 52-h) in 74 rural and semi-urban households among the participants of the Bangladesh Cook Stove Pregnancy Cohort Study (CSPCS). Measurements were taken simultaneously in the kitchen, bedroom, and open space within the household. Structured questionnaires captured household-level information related to the sources of air pollution. With data from two waves, we fit multivariate mixed effect models to estimate 24-h average, cooking time average, daytime and nighttime average PM2.5 in each of the household locations. Households using biomass cookstoves had significantly higher PM2.5 concentrations than those using electricity/liquefied petroleum gas (626 μg/m3 vs. 213 μg/m3). Exposure model performances showed 10-fold cross validated R2 ranging from 0.52 to 0.76 with excellent agreement in independent tests against measured PM2.5 from the third wave of monitoring and ambient PM2.5 from a separate satellite-based model (correlation coefficient, r = 0.82). Significant predictors of household PM2.5 included ambient PM2.5, season, and types of fuel used for cooking. This study demonstrates that we can predict household PM2.5 with moderate to high confidence using ambient PM2.5 and household characteristics. Our results present a framework for estimating household PM2.5 exposures in LMICs, which are often understudied and underrepresented due to resource limitations.
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Affiliation(s)
- Md Mostafijur Rahman
- Department of Population and Public Health Sciences, University of Southern California, USA; Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, USA.
| | - Meredith Franklin
- Department of Population and Public Health Sciences, University of Southern California, USA; Department of Statistical Sciences and School of the Environment, University of Toronto, Canada
| | - Nusrat Jabin
- Department of Population and Public Health Sciences, University of Southern California, USA
| | - Tasnia Ishaque Sharna
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, (icddr,B), Bangladesh
| | - Noshin Nower
- Department of Statistical Sciences and School of the Environment, University of Toronto, Canada
| | - Tanya L Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Alaa Mhawish
- Sand and Dust Storm Warning Regional Center, National Center for Meteorology, Jeddah, KSA
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, (icddr,B), Bangladesh
| | - M A Quaiyum
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, (icddr,B), Bangladesh
| | - Muhammad T Salam
- Department of Population and Public Health Sciences, University of Southern California, USA; Department of Psychiatry, Kern Medical, Bakersfield, CA, USA
| | - Talat Islam
- Department of Population and Public Health Sciences, University of Southern California, USA
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Jabin N, Rahman MM, Salam MT, Sharna TI, Franklin M, Bailey MJ, Alderete TL, Ahmed A, Quaiyum MA, Islam T. Cohort profile: Bangladesh Cook Stove Pregnancy Cohort Study (CSPCS). BMJ Open 2023; 13:e068539. [PMID: 37164456 PMCID: PMC10174037 DOI: 10.1136/bmjopen-2022-068539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
PURPOSE The Cook Stove Pregnancy Cohort Study (CSPCS) was designed to assess the effects of biomass fuel use on household air pollution (HAP) as well as the effects of HAP (fine particulate matter, PM2.5) on birth outcomes and acute lower respiratory infection (ALRI) among infants in Bangladesh. PARTICIPANTS We recruited 903 women within 18 weeks of pregnancy from rural and semiurban areas of Bangladesh between November 2016 and March 2017. All women and their infants (N=831 pairs) were followed until 12 months after delivery and a subset have undergone respiratory and gut microbiota analysis. METHODS Questionnaires were administered to collect detailed sociodemographic, medical, nutritional and behavioural information on the mother-child dyads. Anthropometric measurements and biological samples were also collected, as well as household PM2.5 concentrations. FINDINGS TO DATE Published work in this cohort showed detrimental effects of biomass fuel and health inequity on birth outcomes. Current analysis indicates high levels of household PM2.5 being associated with cooking fuel type and infant ALRI. Lastly, we identified distinct gut and respiratory microbial communities at 6 months of age. FUTURE PLANS This study provides an economical yet effective framework to conduct pregnancy cohort studies determining the health effects of adverse environmental exposures in low-resource countries. Future analyses in this cohort include assessing the effect of indoor PM2.5 levels on (1) physical growth, (2) neurodevelopment, (3) age of first incidence and frequency of ALRI in infants and (4) the development of the respiratory and gut microbiome. Additional support has allowed us to investigate the effect of in utero exposure to metals on infant neurodevelopment in the first year of life.
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Affiliation(s)
- Nusrat Jabin
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Md Mostafijur Rahman
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Muhammad T Salam
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Department of Psychiatry, Kern Medical Center, Bakersfield, California, USA
| | | | - Meredith Franklin
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Maximilian J Bailey
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Tanya L Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Anisuddin Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - M A Quaiyum
- Projohnmo Research Foundation (PRF), Dhaka, Bangladesh
| | - Talat Islam
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Jabin N, Salam MT, Rahman MM, Sharna TI, Franklin M, Ahmed A, Quaiyum MA, Islam T. Social inequality influences the impact of household air pollution on birth outcomes. Sci Total Environ 2022; 822:153405. [PMID: 35092774 PMCID: PMC8969117 DOI: 10.1016/j.scitotenv.2022.153405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Studies demonstrated associations between maternal exposure to household air pollution from cooking and increased risk of adverse birth outcomes in offspring; however, the modifying effect of socioeconomic status (SES) on this association has not been explored. OBJECTIVES In a cohort of pregnant women with 800 single live births between 2016 and 2017 in rural and semi urban areas of Bangladesh, we tested the hypotheses that kitchen location and cooking fuel type affect birth outcomes (birth weight, low birth weight [LBW] and small for gestational age [SGA]) and these associations vary by SES. METHODS Demographic characteristics including SES, kitchen location and fuel type were assessed in prenatal visits. Neonatal anthropometric measurements were recorded within 72 h of births. We performed multivariable linear and logistic regressions adjusting for potential confounders to test the study hypotheses. RESULTS For newborns from households with indoor kitchens, adjusted mean birth weight was 65.13 g (95% confidence interval [CI]: -118.37, -11.90) lower and the odds of LBW and SGA were 58% (odds ratio [OR]:1.58, 95% CI: 1.12, 2.24) and 41% (OR: 1.41, 95% CI: 1.05, 1.92) higher compared to those born in households with outdoor kitchens. We found SES significantly modified the associations between kitchen location and birth outcomes in households using biomass fuels. Newborns from low SES households with indoor kitchens had 89 g lower birth weight and a higher odds of being born with LBW (OR: 2.08, 95% CI 1.23, 3.58), and SGA (OR: 1.70, 95% CI 1.06, 2.76) than those born in high SES households using outdoor kitchens. CONCLUSIONS In areas with poor access or affordability to clean fuel such as in our study population, cooking in an outdoor kitchen can reduce the burden of LBW and SGA, particularly for low SES households. Promoting outdoor kitchens is a possible intervention strategy to mitigate adverse birth outcomes.
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Affiliation(s)
- Nusrat Jabin
- Department of Population and Public Health Sciences, University of Southern California, USA
| | - Muhammad T Salam
- Department of Population and Public Health Sciences, University of Southern California, USA; Department of Psychiatry, Kern Medical, Bakersfield, CA, USA
| | - Md Mostafijur Rahman
- Department of Population and Public Health Sciences, University of Southern California, USA
| | - Tasnia Ishaque Sharna
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh
| | - Meredith Franklin
- Department of Population and Public Health Sciences, University of Southern California, USA
| | - Anisuddin Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh
| | - M A Quaiyum
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh
| | - Talat Islam
- Department of Population and Public Health Sciences, University of Southern California, USA.
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Contrepois K, Chen S, Ghaemi MS, Wong RJ, Jehan F, Sazawal S, Baqui AH, Nisar MI, Dhingra U, Khanam R, Ilyas M, Dutta A, Mehmood U, Deb S, Hotwani A, Ali SM, Rahman S, Nizar A, Ame SM, Muhammad S, Chauhan A, Khan W, Raqib R, Das S, Ahmed S, Hasan T, Khalid J, Juma MH, Chowdhury NH, Kabir F, Aftab F, Quaiyum MA, Manu A, Yoshida S, Bahl R, Rahman A, Pervin J, Price JT, Rahman M, Kasaro MP, Litch JA, Musonda P, Vwalika B, Stringer JSA, Shaw G, Stevenson DK, Aghaeepour N, Snyder MP. Prediction of gestational age using urinary metabolites in term and preterm pregnancies. Sci Rep 2022; 12:8033. [PMID: 35577875 PMCID: PMC9110694 DOI: 10.1038/s41598-022-11866-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
Assessment of gestational age (GA) is key to provide optimal care during pregnancy. However, its accurate determination remains challenging in low- and middle-income countries, where access to obstetric ultrasound is limited. Hence, there is an urgent need to develop clinical approaches that allow accurate and inexpensive estimations of GA. We investigated the ability of urinary metabolites to predict GA at time of collection in a diverse multi-site cohort of healthy and pathological pregnancies (n = 99) using a broad-spectrum liquid chromatography coupled with mass spectrometry (LC–MS) platform. Our approach detected a myriad of steroid hormones and their derivatives including estrogens, progesterones, corticosteroids, and androgens which were associated with pregnancy progression. We developed a restricted model that predicted GA with high accuracy using three metabolites (rho = 0.87, RMSE = 1.58 weeks) that was validated in an independent cohort (n = 20). The predictions were more robust in pregnancies that went to term in comparison to pregnancies that ended prematurely. Overall, we demonstrated the feasibility of implementing urine metabolomics analysis in large-scale multi-site studies and report a predictive model of GA with a potential clinical value.
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LeFevre AE, Mir F, Mitra DK, Ariff S, Mohan D, Ahmed I, Sultana S, Winch PJ, Shakoor S, Connor NE, Islam MS, El-Arifeen S, Quaiyum MA, Baqui AH, Gravett MG, Santosham M, Bhutta ZA, Zaidi A, Saha SK, Ahmed S, Soofi S, Bartlett LA. Validation of community health worker identification of maternal puerperal sepsis using a clinical diagnostic algorithm in Bangladesh and Pakistan. J Glob Health 2021; 11:04039. [PMID: 34912547 PMCID: PMC8645220 DOI: 10.7189/jogh.11.04039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Puerperal sepsis (PP sepsis) is a leading cause of maternal mortality globally. The majority of maternal sepsis cases and deaths occur at home and remain undiagnosed and under-reported. In this paper, we present findings from a nested case-control study in Bangladesh and Pakistan which sought to assess the validity of community health worker (CHW) identification of PP sepsis using a clinical diagnostic algorithm with physician assessment and classification used as the gold standard. Methods Up to 300 postpartum women were enrolled in each of the 3 sites 1) Sylhet, Bangladesh (n = 278), 2) Karachi, Pakistan (n = 278) and 3) Matiari, Pakistan (n = 300). Index cases were women with suspected PP Sepsis as diagnosed by CHWs clinical assessment of one or more of the following signs and symptoms: temperature (recorded fever ≥38.1°C, reported history of fever, lower abdominal or pelvic pain, and abnormal or foul-smelling discharge. Each case was matched with 3 control women who were diagnosed by CHWs to have no infection. Cases and controls were assessed by trained physicians using the same algorithm implemented by the CHWs. Using physician assessment as the gold standard, Kappa statistics for reliability and diagnostic validity (sensitivity and specificity) are presented with 95% CI. Sensitivity and specificity were adjusted for verification bias. Results The adjusted sensitivity and specificity of CHW identification of PP sepsis across all sites was 82% (Karachi: 78%, Matiari: 78%, Sylhet: 95%) and 90% (Karachi: 95%, Matiari: 85%, Sylhet: 90%) respectively. CHW-Physician agreement was highest for moderate and high fever (range across sites: K = 0.84-0.97) and lowest for lower abdominal pain (K = 0.30-0.34). The clinical signs and symptoms for other conditions were reported infrequently, however, the CHW-physician agreement was high for all symptoms except severe headache/ blurred vision (K = 0.13-0.38) and reported "lower abdominal pain without fever" (K = 0.39-0.57). Conclusion In all sites, CHWs with limited training were able to identify signs and symptoms and to classify cases of PP sepsis with high validity. Integrating postpartum infection screening into existing community-based platforms and post-natal visits is a promising strategy to monitor women for PP sepsis - improving delivery of cohesive maternal and child health care in low resource settings.
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Affiliation(s)
- Amnesty E LeFevre
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fatima Mir
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Dipak K Mitra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Public Health, North South University, Dhaka, Bangladesh
| | - Shabina Ariff
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Imran Ahmed
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Shazia Sultana
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sadia Shakoor
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Nicholas E Connor
- The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh.,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mohammad Shahidul Islam
- The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Shams El-Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - M A Quaiyum
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael G Gravett
- University of Washington, Departments of Obstetrics & Gynecology and of Global Health, Seattle, Washington, USA
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Zulfiqar A Bhutta
- Centre of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistan.,Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Anita Zaidi
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Samir K Saha
- The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sajid Soofi
- Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Linda A Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Khanam R, Fleischer TC, Boghossian NS, Nisar I, Dhingra U, Rahman S, Fox AC, Ilyas M, Dutta A, Naher N, Polpitiya AD, Mehmood U, Deb S, Choudhury AA, Badsha MB, Muhammad K, Ali SM, Ahmed S, Hickok DE, Iqbal N, Juma MH, Quaiyum MA, Boniface JJ, Yoshida S, Manu A, Bahl R, Jehan F, Sazawal S, Burchard J, Baqui AH. Performance of a validated spontaneous preterm delivery predictor in South Asian and Sub-Saharan African women: a nested case control study. J Matern Fetal Neonatal Med 2021; 35:8878-8886. [PMID: 34847802 DOI: 10.1080/14767058.2021.2005573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To address the disproportionate burden of preterm birth (PTB) in low- and middle-income countries, this study aimed to (1) verify the performance of the United States-validated spontaneous PTB (sPTB) predictor, comprised of the IBP4/SHBG protein ratio, in subjects from Bangladesh, Pakistan and Tanzania enrolled in the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, and (2) discover biomarkers that improve performance of IBP4/SHBG in the AMANHI cohort. STUDY DESIGN The performance of the IBP4/SHBG biomarker was first evaluated in a nested case control validation study, then utilized in a follow-on discovery study performed on the same samples. Levels of serum proteins were measured by targeted mass spectrometry. Differences between the AMANHI and U.S. cohorts were adjusted using body mass index (BMI) and gestational age (GA) at blood draw as covariates. Prediction of sPTB < 37 weeks and < 34 weeks was assessed by area under the receiver operator curve (AUC). In the discovery phase, an artificial intelligence method selected additional protein biomarkers complementary to IBP4/SHBG in the AMANHI cohort. RESULTS The IBP4/SHBG biomarker significantly predicted sPTB < 37 weeks (n = 88 vs. 171 terms ≥ 37 weeks) after adjusting for BMI and GA at blood draw (AUC= 0.64, 95% CI: 0.57-0.71, p < .001). Performance was similar for sPTB < 34 weeks (n = 17 vs. 184 ≥ 34 weeks): AUC = 0.66, 95% CI: 0.51-0.82, p = .012. The discovery phase of the study showed that the addition of endoglin, prolactin, and tetranectin to the above model resulted in the prediction of sPTB < 37 with an AUC= 0.72 (95% CI: 0.66-0.79, p-value < .001) and prediction of sPTB < 34 with an AUC of 0.78 (95% CI: 0.67-0.90, p < .001). CONCLUSION A protein biomarker pair developed in the U.S. may have broader application in diverse non-U.S. populations.
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Affiliation(s)
- Rasheda Khanam
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States
| | | | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, United States
| | - Imran Nisar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Usha Dhingra
- Global Division, Center for Public Health Kinetics, New Delhi, India
| | | | - Angela C Fox
- Sera Prognostics, Inc., Salt Lake City, United States
| | - Muhammad Ilyas
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Arup Dutta
- Global Division, Center for Public Health Kinetics, New Delhi, India
| | - Nurun Naher
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | - Usma Mehmood
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Saikat Deb
- Global Division, Center for Public Health Kinetics, New Delhi, India.,Public Health Laboratory-IDC, Pemba, Tanzania
| | | | | | - Karim Muhammad
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Najeeha Iqbal
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Md Abdul Quaiyum
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | | | | | - Alexandar Manu
- World Health Organization (MCA/MRD), Geneva, Switzerland
| | - Rajiv Bahl
- World Health Organization (MCA/MRD), Geneva, Switzerland
| | - Fyezah Jehan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sunil Sazawal
- Global Division, Center for Public Health Kinetics, New Delhi, India.,Public Health Laboratory-IDC, Pemba, Tanzania
| | | | - Abdullah H Baqui
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States
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Rahman S, Choudhury AA, Khanam R, Moin SMI, Ahmed S, Begum N, Shoma NN, Quaiyum MA, Baqui AH. Effect of a package of integrated demand- and supply-side interventions on facility delivery rates in rural Bangladesh: Implications for large-scale programs. PLoS One 2017; 12:e0186182. [PMID: 29073229 PMCID: PMC5657632 DOI: 10.1371/journal.pone.0186182] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/06/2017] [Indexed: 12/03/2022] Open
Abstract
Background According to the Bangladesh Demographic and Health Survey 2014, only approximately 37 percent of women deliver in a health facility. Among the eight administrative divisions of Bangladesh, the facility delivery rate is lowest in the Sylhet division (22.6 percent) where we assessed the effect of integrated supply- and demand-side interventions on the facility-based delivery rate. Methods Population-based cohort data of pregnant women from an ongoing maternal and newborn health improvement study being conducted in a population of ~120,000 in Sylhet district were used. The study required collection and processing of biological samples immediately after delivery. Therefore, the project assembled various strategies to increase institutional delivery rates. The supply-side intervention included capacity expansion of the health facilities through service provider refresher training, 24/7 service coverage, additions of drugs and supplies, and incentives to the providers. The demand-side component involved financial incentives to cover expenses, a provision of emergency transport, and referral support to a tertiary-level hospital. We conducted a before-and-after observational study to assess the impact of the intervention in a total of 1,861 deliveries between December 2014 and November 2016. Results Overall, implementation of the intervention package was associated with 52.6 percentage point increase in the proportions of facility-based deliveries from a baseline rate of 25.0 percent to 77.6 percent in 24 months. We observed lower rates of institutional deliveries when only supply-side interventions were implemented. The proportion rose to 47.1 percent and continued increasing when the project emphasized addressing the financial barriers to accessing obstetric care in a health facility. Conclusions An integrated supply- and demand-side intervention was associated with a substantial increase in institutional delivery. The package can be tailored to identify which combination of interventions may produce the optimum result and be scaled. Rigorous implementation research studies are needed to draw confident conclusions and to provide information about the costs, feasibility for scale-up and sustainability.
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Affiliation(s)
- Sayedur Rahman
- Johns Hopkins University-Bangladesh, Dhaka, Bangladesh
- * E-mail:
| | | | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | - Nazma Begum
- Johns Hopkins University-Bangladesh, Dhaka, Bangladesh
| | | | - Md Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Abdullah H. Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Khanam R, Creanga AA, Koffi AK, Mitra DK, Mahmud A, Begum N, Moin SMI, Ram M, Quaiyum MA, Ahmed S, Saha SK, Baqui AH. Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study. PLoS One 2016; 11:e0167814. [PMID: 27997537 PMCID: PMC5172566 DOI: 10.1371/journal.pone.0167814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The burden of maternal complications during antepartum and intrapartum periods is high and care seeking from a trained provider is low, particularly in low middle income countries of sub-Saharan Africa and South Asia. Identification of barriers to access to trained care and development of strategies to address them will contribute to improvements in maternal health. Using data from a community-based cohort of pregnant women, this study identified the prevalence of antepartum and intrapartum complications and determinants of care-seeking for these complications in rural Bangladesh. METHODS The study was conducted in 24,274 pregnant women between June 2011 and December 2013 in rural Sylhet district of Bangladesh. Women were interviewed during pregnancy to collect data on demographic and socioeconomic characteristics; prior miscarriages, stillbirths, live births, and neonatal deaths; as well as data on their ability to make decision to go to health center alone. They were interviewed within the first 7 days of child birth to collect data on self-reported antepartum and intrapartum complications and care seeking for those complications. Bivariate analysis was conducted to explore association between predisposing (socio-demographic), enabling (economic), perceived need, and service related factors with care-seeking for self-reported antepartum and intrapartum complications. Multivariable multinomial logistic regression was performed to examine the association of selected factors with care-seeking for self-reported antepartum and intrapartum complications adjusting for co-variates. RESULTS Self-reported antepartum and intrapartum complications among women were 14.8% and 20.9% respectively. Among women with any antepartum complication, 58.9% sought care and of these 46.5% received care from a trained provider. Of the women with intrapartum complications, 61.4% sought care and of them 46.5% did so from a trained provider. Care-seeking for both antepartum and intrapartum complications from a trained provider was significantly higher for women with higher household wealth status, higher literacy level of both women and their husbands, and for those living close to a health facility (<10 km). Women's decision making ability to go to health centre alone was associated with untrained care only for antepartum complications, but was associated with both trained and untrained care for intrapartum complications. CONCLUSIONS Nearly 40.0% of the women who experienced either an antepartum or intrapartum complications did not seek care from any provider and 11.5% -14.9% received care from untrained providers, primarily because of economic and geographic barriers to access. Development and evaluation of context specific, cost-effective, and sustainable strategies that will address these barriers to access to care for the maternal complications will enhance care seeking from trained health care providers and improve maternal health.
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Affiliation(s)
- Rasheda Khanam
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
- * E-mail:
| | - Andreea A. Creanga
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alain K. Koffi
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Arif Mahmud
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Nazma Begum
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Syed Mamun Ibne Moin
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Malathi Ram
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Md Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Samir K. Saha
- Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Abdullah H. Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Bartlett LA, LeFevre AE, Mir F, Soofi S, Arif S, Mitra DK, Quaiyum MA, Shakoor S, Islam MS, Connor NE, Winch PJ, Reller ME, Shah R, El Arifeen S, Baqui AH, Bhutta ZA, Zaidi A, Saha S, Ahmed SA. The development and evaluation of a community-based clinical diagnosis tool and treatment regimen for postpartum sepsis in Bangladesh and Pakistan. Reprod Health 2016; 13:16. [PMID: 26916141 PMCID: PMC4766721 DOI: 10.1186/s12978-016-0124-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postpartum sepsis accounts for most maternal deaths between three and seven days postpartum, when most mothers, even those who deliver in facilities, are at home. Case fatality rates for untreated women are very high. Newborns of ill women have substantially higher infection risk. METHODS/DESIGN The objectives of this study are to: (1) create, field-test and validate a tool for community health workers to improve diagnostic accuracy of suspected puerperal sepsis; (2) measure incidence and identify associated risk factors and; (3) describe etiologic agents responsible and antibacterial susceptibility patterns. This prospective cohort study builds on the Aetiology of Neonatal Infection in South Asia study in three sites: Sylhet, Bangladesh and Karachi and Matiari, Pakistan. Formative research determined local knowledge of symptoms and signs of postpartum sepsis, and a systematic literature review was conducted to design a diagnostic tool for community health workers to use during ten postpartum home visits. Suspected postpartum sepsis cases were referred to study physicians for independent assessment, which permitted validation of the tool. Clinical specimens, including urine, blood, and endometrial material, were collected for etiologic assessment and antibiotic sensitivity. All women with puerperal sepsis were given appropriate antibiotics. DISCUSSION This is the first large population-based study to expand community-based surveillance for diagnoses, referral and treatment of newborn sepsis to include maternal postpartum sepsis. Study activities will lead to development and validation of a diagnostic tool for use by community health workers in resource-poor countries. Understanding the epidemiology and microbiology of postpartum sepsis will inform prevention and treatment strategies and improve understanding of linkages between maternal and neonatal infections.
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Affiliation(s)
- L A Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - A E LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - F Mir
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - S Soofi
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - S Arif
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - D K Mitra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - M A Quaiyum
- Centre for Reproductive Health, icddr,b, Dhaka, Bangladesh.
| | - S Shakoor
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - M S Islam
- Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
| | - N E Connor
- Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
| | - P J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - M E Reller
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - R Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - S El Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh.
| | - A H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Z A Bhutta
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - A Zaidi
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - S Saha
- Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
| | - S A Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Huq NL, Azmi AJ, Quaiyum MA, Hossain S. Toll free mobile communication: overcoming barriers in maternal and neonatal emergencies in Rural Bangladesh. Reprod Health 2014; 11:52. [PMID: 25015126 PMCID: PMC4107484 DOI: 10.1186/1742-4755-11-52] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 07/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Toll free mobile telephone intervention to support mothers in pregnancy and delivery period was tested in one sub district of Bangladesh. Qualitative research was conducted to measure the changes of mobile phone use in increasing communication for maternal and neonatal complications. Methods In-depth interviews were conducted among twelve Community Skilled Birth Attendants and fourteen mothers along with their husbands prior to intervention. At intervention end, six Community Skilled Birth Attendants were purposively selected for in-depth interview. Semi structured interviews were conducted among all 27 Community Skilled Birth Attendants engaged in the intervention. One Focus Group Discussion was conducted with 10 recently delivered mothers. Thematic analysis and triangulation of different responses were conducted. Results Prior to intervention, Community Skilled Birth Attendants reported that mobile communication was not a norm. It was also revealed that poor mothers had poor accessibility to mobile services. Mothers, who communicated through mobile phone with providers noted irritability from Community Skilled Birth Attendants and sometimes found phones switched off. At the end of the project, 85% of mothers who had attended orientation sessions of the intervention communicated with Community Skilled Birth Attendants through mobile phones during maternal health complications. Once a complication is reported or anticipated over phone, Community Skilled Birth Attendants either made a prompt visit to mothers or advised for direct referral. More than 80% Community Skilled Birth Attendants communicated with Solution Linked Group for guidance on maternal health management. Prior to intervention, Solution Linked Group was not used to receive phone call from Community Skilled Birth Attendants. Community Skilled Birth Attendants were valued by the mothers. Mothers viewed that Community Skilled Birth Attendants are becoming confident in managing complication due to communication with Solution Linked Group. Conclusions The use of mobile technology in this intervention took a leap from simply rendering information to providing more rapid services. Active participation of service providers along with mothers’ accessibility motivated both the service providers and mothers to communicate through mobile phone for maternal health issues. These altogether made the shift towards adoption of an innovation.
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Affiliation(s)
- Nafisa Lira Huq
- International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68, Shahid Tajuddin Ahmed Sarani, Mohokhali, Dhaka 1212, Bangladesh.
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11
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Prata N, Bell S, Quaiyum MA. Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention. BMC Pregnancy Childbirth 2014; 14:78. [PMID: 24555848 PMCID: PMC3932142 DOI: 10.1186/1471-2393-14-78] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 02/05/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Bangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh. METHODS Using data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions. RESULTS Using project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births. CONCLUSION This theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further reduce maternal mortality at home births.
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Affiliation(s)
- Ndola Prata
- Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, 229 University Hall, UC Berkeley, Berkeley, CA 94720-7360, USA
| | - Suzanne Bell
- Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, 17 University Hall, UC Berkeley, Berkeley, CA 94720-7360, USA
| | - Md Abdul Quaiyum
- icddr,b, Centre for Reproductive Health, GPO Box 128, Dhaka 1000, Bangladesh
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Prata N, Quaiyum MA, Passano P, Bell S, Bohl DD, Hossain S, Azmi AJ, Begum M. Training traditional birth attendants to use misoprostol and an absorbent delivery mat in home births. Soc Sci Med 2012; 75:2021-7. [PMID: 22921713 DOI: 10.1016/j.socscimed.2012.06.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/20/2012] [Accepted: 06/27/2012] [Indexed: 10/28/2022]
Abstract
A 50-fold disparity in maternal mortality exists between high- and low-income countries, and in most contexts, the single most common cause of maternal death is postpartum hemorrhage (PPH). In Bangladesh, as in many other low-income countries, the majority of deliveries are conducted at home by traditional birth attendants (TBAs) or family members. In the absence of skilled birth attendants, training TBAs in the use of misoprostol and an absorbent delivery mat to measure postpartum blood loss may strengthen the ability of TBAs to manage PPH. These complementary interventions were tested in operations research among 77,337 home births in rural Bangladesh. The purpose of this study was to evaluate TBAs' knowledge acquisition, knowledge retention, and changes in attitudes and practices related to PPH management in home births after undergoing training on the use of misoprostol and the blood collection delivery mat. We conclude that the training was highly effective and that the two interventions were safely and correctly used by TBAs at home births. Data on TBA practices indicate adherence to protocol, and 18 months after the interventions were implemented, TBA knowledge retention remained high. This program strengthens the case for community-based use of misoprostol and warrants consideration of this intervention as a potential model for scale-up in settings where complete coverage of skilled birth attendants (SBAs) remains a distant goal.
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Affiliation(s)
- Ndola Prata
- Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, 17 University Hall, UC-Berkeley, Berkeley, CA 94720-7360, USA.
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Uddin J, Koehlmoos TP, Saha NC, Islam Z, Khan IA, Quaiyum MA. Strategies for providing healthcare services to street-dwellers in Dhaka city: evidence from an operations research. Health Res Policy Syst 2012; 10:19. [PMID: 22694892 PMCID: PMC3536682 DOI: 10.1186/1478-4505-10-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 05/16/2012] [Indexed: 12/02/2022] Open
Abstract
Background In almost every major urban city, thousands of people live in overcrowded slums, streets, or other public places without any health services. Bangladesh has experienced one of the highest rates of urban population growth in the last three decades compared to the national population growth rate. The numbers of the urban poor and street-dwellers are likely to increase at least in proportion to the overall population growth of the country. The street-dwellers in Bangladesh are extremely vulnerable in terms of their health needs and healthcare-seeking behaviours. In Bangladesh, there is no health service-delivery mechanism targeting this marginalized group of people. This study, therefore, assessed the effectiveness of two models to provide primary healthcare (PHC) services to street-dwellers. Methods This study of experimental pre-post design tested two models, such as static clinic and satellite clinics, for providing PHC services to street-dwellers in the evening through paramedics in Dhaka city during May 2009-April 2010. Both quantitative and qualitative techniques were used for collecting data. Data were analyzed comparing before and after the implementation of the clinics for the assessment of selected health and family-planning indicators using the statistical t-test. Services received from the model l and model 2 clinics were also compared by calculating the absolute difference to determine the relative effectiveness of one model over another. Results The use of healthcare services by the street-dwellers increased at endline compared to baseline in both the model clinic areas, and the difference was highly significant (p < 0.001). Institutional delivery among the female street-dwellers increased at endline compared to baseline in both the clinic areas. The use of family-planning methods among females also significantly (p < 0.001) increased at endline compared to baseline in both the areas. Conclusions As the findings of the study showed the promise of this approach, the strategies could be implemented in all other cities of Bangladesh and in other countries which encounter similar problems.
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Affiliation(s)
- Jasim Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka 1222, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh.
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14
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Uddin MJ, Saha NC, Islam Z, Khan IA, Shamsuzzaman, Quaiyum MA, Koehlmoos TP. Improving low coverage of child immunization in rural hard-to-reach areas of Bangladesh: findings from a project using multiple interventions. Vaccine 2011; 30:168-79. [PMID: 22108489 DOI: 10.1016/j.vaccine.2011.11.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/03/2011] [Accepted: 11/09/2011] [Indexed: 11/27/2022]
Abstract
The study was conducted to assess the impact of combined interventions to improve the child immunization coverage in rural hard-to-reach areas of Bangladesh. The valid coverage increased at endline compared to baseline in the study areas, and the difference of the increase was highly significant (p<0.001). The findings also showed that the number of drop-outs, left-outs, and invalid doses decreased at endline compared to baseline in the study areas, and the difference was also highly significant (p<0.001). The immunization coverage improved significantly in all the four study sub-districts that received interventions, although the relative contribution of each intervention is unknown. The interventions can be implemented in all other hard-to-reach areas of Bangladesh and other countries which are facing similar challenges.
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Affiliation(s)
- Md Jasim Uddin
- Health Systems and Infectious Disease Division, ICDDR, B, GPO Box 128, Dhaka 1000, Bangladesh.
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15
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Quaiyum MA, Gazi R, Khan AI, Uddin J, Islam M, Ahmed F, Saha NC. Programmatic aspects of dropouts in child vaccination in Bangladesh: findings from a prospective study. Asia Pac J Public Health 2010; 23:141-50. [PMID: 20566520 DOI: 10.1177/1010539509342119] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study investigated prospectively programmatic factors relating to dropouts in child vaccination in 6 subdistricts of Bangladesh. A cross-sectional survey (n = 2700) was conducted estimating overall coverage of immunization using cluster sampling. The eligible subsample of children (n = 1064) was followed up prospectively to understand reasons for dropouts. In-depth interviews (n = 73) with mothers/caregivers and service providers were done and EPI (Expanded Programme on Immunization) sessions were observed (n = 131). Irregular EPI sessions were the prime cause of dropouts particularly in low-performing subdistricts. The other programmatic factors linked with dropouts were (a) no reminder about subsequent session/doses, (b) unfriendly behavior or absence of vaccinator, ( c) refusal due to lost card or vaccine exhausted, and (d) short duration of sessions. Providers highlighted constraints such as financial problems for transportation, particularly in the hard-to-reach areas and vacancies of the posts of health assistants. The barriers to completing full schedules of vaccination can be removed to a large extent through programmatic adjustments.
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Affiliation(s)
- Md Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research Bangladesh, Mohakhali, Dhaka, Bangladesh
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16
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Hossain S, Larson CP, Quaiyum MA, Khan AI, Zaman K, Begum V, Saha NC. Adults with chronic cough in urban Bangladesh: healthcare utilization and management of cases by private practitioners. World Health Popul 2010; 12:5-17. [PMID: 21157187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Tuberculosis (TB) case detection under the Directly Observed Treatment - Short-course (DOTS) strategy largely relies upon care seeking of chronic coughers and the actions taken by their healthcare providers. This study aimed to describe the healthcare utilization of people 15 years of age with a chronic cough in urban areas of Bangladesh and to understand their management by private practitioners. A community-based, household survey included 60,382 persons ≥ 15 years of age from two administrative areas of Dhaka City. A total of 1138 (2%) were identified to have had a cough for 3 weeks or more. This survey was linked to interviews of licensed and unlicensed practitioners in Dhaka and the Chittagong City Corporation of Bangladesh. Among identified coughers, 1046 (92%) were interviewed, of whom 648 (62%) reported having sought care from any provider. Among care seekers, 16% directly attended a DOTS facility. The remaining 84% sought care from the private sector, where less than 1% reported referral to a DOTS facility. Bivariate and multivariate assessments showed that care seeking from a licensed private practitioner or a DOTS centre was significantly associated with severity of the disease and previous diagnosis of TB.
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Affiliation(s)
- S Hossain
- Health Systems and Infectious Diseases Division, ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh.
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17
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Ashraf A, Quaiyum MA, Ng N, Van Minh H, Razzaque A, Masud Ahmed S, Hadi A, Juvekar S, Kanungsukkasem U, Soonthornthada K, Huu Bich T. Self-reported use of tobacco products in nine rural INDEPTH Health and Demographic Surveillance Systems in Asia. Glob Health Action 2009; 2. [PMID: 20027256 PMCID: PMC2785137 DOI: 10.3402/gha.v2i0.1997] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 08/01/2009] [Accepted: 08/20/2009] [Indexed: 11/25/2022] Open
Abstract
Background Tobacco use is the most preventable cause of premature death and disability. Even though tobacco use is common in many Asian countries, reliable and comparable data on the burden imposed by tobacco use in this region are sparse, and surveillance systems to track trends are in their infancy. Objective To assess and compare the prevalence of tobacco use and its associated factors in nine selected rural sites in five Asian countries. Methods Tobacco use among 9,208 men and 9,221 women aged 25–64 years in nine Health and Demographic Surveillance System (HDSS) sites in five Asian countries of the INDEPTH Network were examined in 2005 as part of a broader survey of the major chronic non-communicable disease risk factors. All sites used a standardised protocol based on the WHO STEPS approach to risk factor surveillance; expanded questions of local relevance, including chewing tobacco, were also included. Multivariable logistic regression was used to assess demographic factors associated with tobacco use. Results Tobacco use, whether smoked or chewed, was common across all sites with some notable variations. More than 50% of men smoked daily; this applied to almost all age groups. Few women smoked daily in any of the sites. However, women were more likely to chew tobacco than men in all sites except Vadu in India. Tobacco use in men began in late adolescence in most of the sites and the number of cigarettes smoked daily ranged from three to 15. Use of both forms of tobacco, smoked and chewed, was associated with age, gender and education. Men were more likely to smoke compared to women, smoking increased with age in the four sites in Bangladesh but not in other sites and with low level of education in all the sites. Conclusion The prevalence of tobacco use, regardless of the type of tobacco, was high among men in all of these rural populations with tobacco use started during adolescence in all HDSS sites. Innovative communication strategies for behaviour change targeting adolescents in schools and adult men and women at work or at home, may create a mass awareness about adverse health consequences of tobacco smoking or chewing tobacco. Such efforts, to be effective, however, need to be supported by strong legislation and leadership. Only four of the five countries involved in this multi-site study have ratified the Framework Convention on Tobacco Control, and even where it has been ratified, implementation is uneven.
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Affiliation(s)
- Ali Ashraf
- AMK Health and Demographic Surveillance System, Bangladesh
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Uddin MJ, Larson CP, Oliveras E, Khan AI, Quaiyum MA, Saha NC. Child immunization coverage in urban slums of Bangladesh: impact of an intervention package. Health Policy Plan 2009; 25:50-60. [DOI: 10.1093/heapol/czp041] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Perry HB, Begum S, Begum A, Kane TT, Quaiyum MA, Baqui AH. A comprehensive assessment of the quality of services provided by family planning field workers in one major area of Dhaka city, Bangladesh. J Health Popul Dev Ctries 2002; 2:45-57. [PMID: 12349109 DOI: 10.12927/whp..17501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Quaiyum MA, Tuñon C, Hel Baqui A, Quayyum Z, Khatun J. Impact of national immunization days on polio-related knowledge and practice of urban women in Bangladesh. Health Policy Plan 1997; 12:363-71. [PMID: 10176271 DOI: 10.1093/heapol/12.4.363] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bangladesh began to hold National Immunization Days (NIDs) from 1995 as part of the country's goal to eradicate poliomyelitis by the turn of the century. The NIDs brought together government agencies, the media, voluntary organisations and individual volunteers in social mobilization and service delivery activities. This paper assesses the impact of the first two polio NIDs in terms of the immunization coverage and change in knowledge about the disease among women living in Dhaka city, the capital of the country. Data were collected through pre- and post-NID cross-sectional surveys in a sample of one area of Dhaka city which included slum and non-slum households. Knowledge data were collected from 525 women with at least one child aged less than five years. The oral polio vaccine (OPV) coverage during NIDs was obtained from 720 children. Knowledge of polio as a vaccine preventable disease increased after NIDs among both slum and non-slum women. The knowledge gap between the two groups was significantly reduced. Field workers, who regularly visit women at their homes to promote health and family planning services, were the main source of information for the slum women while television was cited as the most important source of information by non-slum women. The study revealed that 88% of children under five years received at least one dose of oral polio vaccine (OPV) during NIDs, and 67% received two stipulated doses with no significant differences between slum (65%) and non-slum (69%) groups. In addition, 68% of the children contacted during the NIDs were given vitamin A supplementation. The study suggests that strategies like NID can be effectively used to tap into community resources and to generate political commitments for health programmes.
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Affiliation(s)
- M A Quaiyum
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B)
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