Increased screen time and its association to migraine and tension-type headache: a cross-sectional investigation among Bangladeshi students

Background

Increasing prevalence of screens among young people is a notable characteristic of the modern digital era. The study aimed to explore the prevalence and associated factors of migraine headache (MH) and tension-type headache (TTH) among Bangladeshi students continuing online education.

Methods

A total of 771 students were selected conveniently and using the quota sampling method. A pretested semistructured and self-administered questionnaire containing the background information, Headache Screening Questionnaire-English Version, Patient Health Questionnaire-9, Speech, Spatial and Qualities of Hearing scale and Insomnia Severity Index was used for data collection. Multivariate logistic regression analysis was conducted to explore the relationship between different headaches and screen use.

Results

The prevalence of MH, TTH and mixed headache (both MH and TTH) in the study population was 26.07%, 47.08% and 14.75%, respectively. Longer duration of online study (>12 months, adjusted ORs (AORs): 2.83, 95% CI 0 1.00 to 8.00), history of eye problem (AOR: 1.48, 95% CI 1.01 to 2.17), insomnia (AOR: 1.53, 95% CI 1.01 to 2.33) and moderate-to-severe depression (AOR: 2.35, 95% CI 1.55 to 3.56) were significantly associated with migraine headache. Conversely, longer duration of online study (>12 months, AOR: 2.87, 95% CI 1.40 to 5.86), moderate-to-severe depression (AOR=1.47, 95% CI 1.05 to 2.10) and use of multiple devices (AOR<1) for online study were significantly associated with TTH. In addition, longer duration of screen exposure (for >12 months, AOR: 4.56, 95% CI 0.99 to 20.93), moderate-to-severe depression (AOR: 2.25, 95% CI 1.37 to 3.72) and family history of headache (AOR: 2.66, 95% CI 1.65 to 4.29) were associated with mixed headache.

Conclusion

Considering the current prevalence of TTH and MH among students and their relationship with screentime, providing health education on the proper use of electronic devices can be a promising strategy in mitigating the negative consequences.

Natural disasters, livelihood, and healthcare challenges of the people of a riverine island in Bangladesh: A mixed-method exploration

BACKGROUND

Bangladesh's islands, because of their geographical location, frequently encounter crises like floods and river erosion, which pose significant threats to the residents' well-being and livelihoods. To delve into the effects of these disasters on livelihood and healthcare challenges, a mixed-method study was undertaken in a riverine-island near a major river of Bangladesh.

METHODOLOGY

Between February 15th and February 28th, 2023, a cross-sectional study was conducted on an island in Bangladesh. The quantitative method involved conducting a survey of 442 households, with a total of 2921 participants. Additionally, 10 in-depth interviews and 10 key-informant interviews were conducted using semi-structured guidelines. Qualitative interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Triangulation was employed in this study through the integration of qualitative and quantitative analysis, resulting in the presentation of findings that offer an in-depth comprehension of the phenomenon being investigated.

RESULTS

River erosions and floods are common and recurring natural disasters that significantly impact the lives of the riverine island inhabitants. These disasters often disrupted their livelihoods, forced many residents to endure substandard living conditions or relocated during flood events. The island faced a low diagnostic prevalence of chronic diseases (e.g., 5.1% of adults were hypertension and 2.5% are diabetes) because of the absence of diagnostic facilities and a shortage of certified doctors. A significant number of chronic illness people in the community turned to alternative medicine sources (39.3%) such as homeopathy, Kabiraj, and Ayurvedic medicine, especially it gets increased during periods of natural disasters. Moreover, reproductive aged women revealed that 79.4% of them gave birth at home, with 6.0% of these home deliveries resulting in miscarriage or infant death. The destruction of crops, unstable job opportunities, an inadequate educational system, and a deficient healthcare delivery system exacerbated the hardships faced by the population affected by these disasters.

CONCLUSION

The failure to seek treatment for chronic diseases and undiagnosed diseases is a significant health issue among the aging adults on the island. Island residents face the challenge of establishing effective prevention strategies for the well-being of older adults especially at the period of natural disasters. It is crucial for the government and non-governmental organizations (NGOs) to collaborate to prevent the negative effects of floods and river erosions. This should include efforts to enhance the quality of education, healthcare services, job opportunities, and financial assistance for rebuilding homes.

Socioeconomic and geographical inequalities in delivery by cesarean section among women in Bangladesh, 2004-2017

BACKGROUND

There is a dearth of evidence on the trends and inequalities in utilizing cesarean section (CS) among women in Bangladesh. Hence, this study aimed to estimate the socioeconomic and geographical inequalities in delivery by CS among Bangladeshi women from 2004 to 2017.

METHODS

Data from Bangladesh Demographic and Health Survey 2004, 2007, 2011, 2014, and 2017 were analyzed using the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequalities were measured using four summary measures: Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF), and Ratio (R). Socioeconomic inequalities were assessed using two equity dimensions: household wealth status, and level of education, while geographical disparities were measured using two equity dimensions: place of residence, and sub-national regions. For each measure, point estimates and their 95% confidence intervals were reported.

RESULTS

An increasing trend in the prevalence (weighted) of CS in Bangladesh use was found from 4.50% in 2004 to 32.73% in 2017 We found significant socioeconomic inequalities in CS in every survey point, with a higher concentration of CS among the rich (in 2017, PAR = 28.57; 95% CI: 26.69-30.46) indicating a pro-rich inequality, and higher educated (in 2017, PAF = 23.97; 95% CI: 12.26-35.68) sub-groups. We also identified significant geographical disparities in CS with a higher concentration of CS among people from urban areas (in 2017, PAR = 10.99; 95% CI: 10.19-11.79), and a coastal region (Khulna division) (in 2017, PAF: 30.48 (95% CI: 18.66-42.30).

CONCLUSION

We observed both socioeconomic and geographical inequalities in CS exist in Bangladesh, though the trends of these inequalities were curved over time. Thus, it is important to comprehend these pro-rich and geographical inequalities better and implement appropriate interventions and policies to alleviate them.

Inequalities in early initiation of breastfeeding in Bangladesh: an estimation of relative and absolute measures of inequality

BACKGROUND

Evidence suggested that inequalities based on education, wealth status, place of residence, and geographical regions significantly influence the key breastfeeding indicators including early initiation of breastfeeding. This study aimed to estimate the trends and magnitude of inequalities in early initiation of breastfeeding practice in Bangladesh from 2004 to 2017 applying both absolute and relative measures of inequality.

METHODS

We used data from the last five Bangladesh Demographic Health Survey (BDHS) from 2004 to 2017 to measure the inequalities in early initiation of breastfeeding practice using the WHO's Health Equity Assessment Toolkit (HEAT) software. Following summary measures were estimated to measure the inequalities: Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) where the equity dimensions were wealth status, education level, sex of child, place of residence, and subnational regions (divisions). For each measure, point estimates along with a 95% confidence interval (CI) were reported.

RESULTS

An uprising pattern in the prevalence of early initiation of breastfeeding was found, where early initiation of breastfeeding increased from 24.9% to 2004 to 59.0% in 2017. We found significant wealth-driven inequalities in early initiation of breastfeeding practice in every wave of survey favoring the poorest wealth quintile (in 2017, D -10.5; 95% CI -16.6 to -4.3). We also identified geographical disparities in early initiation of breastfeeding practice (in 2017, PAF 11.1; 95% CI 2.2 to 19.9) favoring the Rangpur (65.5%), and Sylhet (65.3%) divisions. Education-related disparities were observed in 2004 only, but not in later survey years, which was due to a much lower level of adherence among those with secondary or higher education. There were no significant disparities in early initiation of breastfeeding based on the urban vs. rural residence and sex of the child.

CONCLUSIONS

The highest attention should be placed in Bangladesh to attain the WHO's 100% recommendation of timely initiation of breastfeeding. This study emphasizes on addressing the existing socioeconomic and geographic inequalities. Awareness-raising outreach programs focusing the mothers from wealthier sub-groups and divisions with lower prevalence should be planned and implemented by the joint effort of the government and non-government organizations.

Imposter phenomenon among health professionals and students: A protocol for systematic review and meta analysis

Health professionals and medical students are at increased risk of the imposter phenomenon (IP) in other words, the imposter syndrome, due to the challenging nature of their professions. It is particularly concerning since it is linked to a higher incidence of burnout and suicidal ideation. We must first thoroughly grasp its prevalence and associated factors to address this issue. However, no published review of the data includes a meta-analysis to help understand the character and associated factors of IP among medical workers and medical students. This study aims to investigate IP prevalence and risk factors among healthcare personnel. Five online databases will be searched for papers published in English between January 2000 and December 2022, and 2 independent reviewers will filter, select studies, extract data, and evaluate the risk of bias in each piece. The retrieved articles will be included based on strict inclusion and exclusion criteria. A third reviewer will decide on any disagreements between the 2 reviewers. Where appropriate, a meta-analysis will be conducted using the random-effects model. The heterogeneity of the studies will be examined, and a sensitivity analysis will be done depending on the study quality. The purpose of this review is to determine the prevalence and risk factors for IP among healthcare personnel. The review's findings will emphasize the severity and contributing factors of the problem, therefore guiding policy for future actions.

Permanent, long-acting and short-acting reversible contraceptive methods use among women in Bangladesh: an analysis of Bangladesh Demographic and Health Survey 2017-2018 data

OBJECTIVES

This study aims to explore the factors associated with the permanent and long-acting reversible contraceptive (LARC) method use compared with short-acting reversible contraceptive (SARC) methods among Bangladeshi ever-married women aged 15-49 years.

DESIGN

Cross-sectional study.

SETTING

We used data from Bangladesh Demographic Health Survey (BDHS) 2017-2018.

PARTICIPANTS

A total of 9669 Bangladeshi reproductive-aged women who gave information on contraception use were the study participants. A multilevel multinomial logistic regression model was employed where the SARC method was considered as the base category and the cluster was considered as level-2 factor.

RESULTS

Among the contraceptive users in Bangladeshi women, about 83.48% used the SARC method, while 11.34%, and 5.18% used permanent and LARC methods, respectively. Compared with SARC, women with no formal education and only primary education who were non-Muslims, and had parity of ≥3 had a higher likelihood of using both permanent and LARC methods. Women from the age group of 25-34 years (adjusted relative risk ratio (aRRR): 7.03, 95% CI: 4.17 to 11.85) and 35-49 years (aRRR: 12.53, 95% CI: 7.27 to 21.58) who were employed (aRRR: 1.19, 95% CI: 1.00 to 1.40), had media access (aRRR: 1.24, 95% CI: 1.03 to 1.49), gave birth in last 5 years (aRRR: 1.40, 95% CI: 1.11 to 1.76), whose contraception decision solely made by their husband (aRRR: 7.03, 95% CI: 5.15 to 9.60) and having high decision-making power (aRRR: 2.12, 95% CI: 1.62 to 2.77) were more likely to use permanent contraceptive methods. We observed that women from households with richer (aRRR: 0.65, 95% CI: 0.45 to 0.93) and richest (aRRR: 0.38, 95% CI: 0.23 to 0.63) wealth quintiles were less likely to use LARC methods.

CONCLUSIONS

This study identified that women with no/less education, non-Muslims, and having parity of ≥3 were more likely to use both permanent and LARC methods than SARC methods. Targeted interventions could be developed and implemented to promote personalised contraceptive use.

Stress resilience in patients with drug-resistant TB

BACKGROUND: The worldwide increase in drug-resistant pulmonary TB (DR-PTB) has a significant impact on patient´s physical and mental health. The objective of this study is to assess the stress resilience of DR-PTB patients along with the factors associated with it.METHODS: A total of 385 adult DR-PTB patients with multidrug-resistant (MDR) and pre-extensive drug-resistant (pre-XDR) TB admitted to the National Institute of Diseases of the Chest Hospital (Dhaka, Bangladesh) between January 2020 and March 2021 were conveniently recruited. Resilience data were collected using a validated Stress Resilience Scale (RS 25) questionnaire.RESULTS: The mean resilience scores were significantly higher for patients with MDR-PTB than those with pre-XDR-PTB (P = 0.02). A majority of the MDR-PTB (77.0%) and pre-XDR-PTB (65.1%) patients belonged to the ≤45 years age group. Multiple linear regression revealed that sex (P < 0.001), level of education (P < 0.001), employment status (P = 0.003) and presence of asthma (P = 0.010) were significantly associated with stress resilience.CONCLUSION: We observed that stress resilience significantly differed between patients with MDR-PTB and those with pre-XDR-PTB based on sociodemographic characteristics.

Changes in dietary habit and physical activity among the diabetic patients of Bangladesh during COVID-19: A cross-sectional study

In an effort to avert further Covid-19 transmission, the Bangladesh government took several initiatives which disrupted the routine food intake and exercise of diabetic patients. This study sought to examine the difference in dietary and exercise habits of diabetic patients between their pre-pandemic status and during COVID-19 which may be attributed to the observed poor health outcomes during the study period. This was a cross-sectional study that enrolled 604 diabetic patients using a convenience sampling technique who were attending outpatient clinics of the three selected hospitals in Bangladesh. A validated semi-structured questionnaire was used to collect information regarding eating habit and physical activity of the respondents pre- and during COVID-19 pandemic via direct interview. McNemar-Bowker test was used to assess the changes in dietary and physical activity behaviors. The current study reveals that 93.9% of the respondents were type-2 diabetic patients. During the pandemic, there was a decrease in the consumption of rice, bread, meat, fish, eggs, and dessert, while the consumption of cereals, milk, and potato/starchy vegetables increased. There was also a decrease in the frequency of drinking tea or coffee, while the consumption of soft drinks remained relatively stable. The level and duration of physical activity significantly decreased among the respondents during the pandemic. This study explored the changes in dietary habits and physical activity among the study population which not only disrupt the metabolic control of the diabetic patients but also pose a significant threat to their overall health. Therefore, it is critical to prioritize measures that support diabetic patients to maintain healthy dietary habit and to engage in regular physical activity during unprecedented times such as COVID-19 pandemic.

Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades

BACKGROUND

Maternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across socioeconomic and geographic regions. Therefore, we aim to estimate the trends and magnitude of inequality in SBA use in Bangladesh over the last two decades.

METHODS

Data from the last 5 rounds of Bangladesh Demographic and Health Surveys (BDHS; 2017-18, 2014, 2011, 2007, and 2004) were used to measure the inequalities in the SBA use utilizing the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequality was assessed by four summary measures, namely, Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) based on the four equity dimensions: wealth status, education level, place of residence, and subnational regions (divisions). Point estimates and a 95% confidence interval (CI) were reported for each measure.

RESULTS

An increasing trend in the overall prevalence of SBA use was observed (From 15.6% in 2004 to 52.9% in 2017). We found significant inequalities in SBA use in every wave of BDHS (from 2004 to 2017), with the result concentrating on the rich (in 2017, PAF: 57.1; 95% CI: 52.5-61.7), educated (in 2017, PAR: 9.9; 95% CI: 5.2-14.5),  and people from urban areas (in 2017, PAF: 28.0; 95% CI: 26.4-29.5). We also identified geographic disparities in SBA use favoring Khulna and Dhaka divisions (in 2017, PAR: 10.2; 95% CI: 5.7-14.7). Our study also observed inequality in using SBA among Bangladeshi women decreased over time.

CONCLUSION

To increase SBA use and to decrease inequality in all four equity dimensions, disadvantaged sub-groups should be prioritized in policies and planning for program implementation.

Perceived barriers to maintain physical activity and its association to mental health status of Bangladeshi adults: a quantile regression approach

Insufficient physical activity and unhealthy lifestyle preferences have been significant concerns for decades. This study aimed to determine the perceived barriers to maintaining physical activity among adults in three major cities of Bangladesh and their association with mental health status. This is a cross-sectional study where 400 participants were selected using a multistage sampling technique. Twenty municipal wards were randomly selected from three cities, followed by a convenient selection of the study participants from each ward. Questionnaires about perceived physical activity barriers were developed based on previously published literature. The DASS-21 scale assessed the mental health status of the study participants. Descriptive statistics were applied to narrate the baseline characteristics of the respondents. The Shapiro-Wilk test was used to check the normality of the perceived physical activity scores. Quantile regression analysis was applied to model the physical activity barrier scores depending on several covariates. Five quantiles were used: the 10th, 25th, 50th, 75th, and 90th. A p-value less than 0.05 was considered significant for hypothesis testing. Among the respondents, 68.50% were male, half of them were married, 68.0% belonged to nuclear families, 48.0% completed graduate level education, 34.25% were service holders, one-third of the respondent's working hours were 6-8 h, and 19.50% belongs to the overweight and obese groups. Poor traffic and construction work near the road (60.30%) was seen as the most significant barrier to physical activity. Over half of the respondents stated that lack of time, facilities, and expenses hinder physical activity. Mental health status reported mild to extremely severe levels of depression (32%), anxiety (47%), and stress (42.50%), respectively. Significant associations between the perceived physical activity scores and gender, family type, occupation, income, BMI, anxiety, and depression were obtained. Ensuring a safe environment, facilitating accessibility and availability of low-cost exercise facilities, improving road and traffic conditions, and providing appropriate mental health counseling may help to mitigate physical activity barriers.

Suicide stigma and suicide literacy among Bangladeshi young adults: a cross-sectional study

Introduction

Suicide is one of the leading causes of death worldwide. Owing to poor suicide literacy, people are not aware of the consequences of the suicide stigma, which may affect individuals. This study aimed to examine the status of suicide stigma and literacy among young adults in Bangladesh.

Methods

This cross-sectional study included 616 male subjects and female subjects residing in Bangladesh aged between 18 and 35 years who were invited to complete an online survey. Suicide literacy and suicide stigma among the respondents were assessed by using the validated Literacy of Suicide Scale and Stigma of Suicide Scale, respectively. Other independent variables that have been found to affect suicide stigma or literacy were included in this study based on prior research. Correlation analysis was used to assess the relationships between the study's main quantitative variables. Multiple linear regression models were used to assess factors affecting suicide stigma and suicide literacy, respectively, after controlling for covariates.

Results

The mean literacy score was 3.86. The participants' mean scores in the stigma, isolation, and glorification subscale were 25.15, 14.48, and 9.04, respectively. Suicide literacy was negatively associated with stigmatizing attitudes (p = 0.005). Male subjects, unmarried/divorced/widowed, less educated (below HSC), smokers, less exposure to suicide, and respondents with chronic mental illness had lower suicide literacy and more stigmatizing attitudes.

Conclusion

The findings suggest that addressing suicide literacy and stigma by developing and executing awareness programs on suicide and mental health among young adults may increase knowledge, decrease stigma, and hence prevent suicide among this population.

Unavoidable online education due to COVID-19 and its association to computer vision syndrome: a cross-sectional survey

Background

During the COVID-19 pandemic, online education and entertainment have increased significantly due to strict isolation and frequent lockdowns. This study intended to explore the prevalence and potential factors associated with computer vision syndrome (CVS) among the postsecondary students of Bangladesh pursuing online education.

Methods

In total, there were 917 postsecondary students participated in this study. Information on sociodemographic variables, and CVS symptom-related variables were collected using a prevalidated self-administered questionnaire. The CVS questionnaire was used to assess an individual’s CVS status. The bivariate association between CVS and other categorical variables was obtained using a χ² test. A multivariable logistic regression model was used to explore variables associated with the CVS.

Results

The overall prevalence of CVS was 68.16%. Most common symptoms were headache (42.4%), feeling of worsening eyesight (23.2%), and eye pain (23.2%). CVS was associated with educational status (p=0.03), family history of eye-related problems (p<0.001), personal history of eye-related problems (p<0.001), usage of eye accessories (p<0.001), type of device used for online education (p<0.01), average daily use (p<0.01), and usage pattern (p=0.02). After adjusting for confounders, CVS was significantly related to the use of mobile or tablet (adjusted OR, AOR 8.954, 95% CI 1.57 to 51.063), continuing online education for more than 12 hours/day without any break or insufficient break (AOR 7.654, 95% CI 1.625 to 36.053), and previous family (AOR 3.189, 95% CI 1.751 to 5.811) or personal history of eye problems or headaches, or insomnia (AOR 6.214, 95% CI 2.783 to 13.878).

Conclusion

A high prevalence of CVS was observed among the post-secondary students in Bangladesh. Since an extensive use of digital screens is somewhat unavoidable during unprecedented times, such as COVID-19, educators should include CVS awareness and prevention in their curricula.