Journal Articles (2021)

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Knowledge and practice regarding menstrual hygiene management among the Rohingya refugee adolescent girls in Cox’s Bazar, Bangladesh: A mixed method study
(Emerald Publishing, 5/15/2021) Rakhshanda, Shagoofa; Ahmed, Sahlil; Saidu, Samuel; Nderitu, Christine; Thapa, Basanta; Awal, Abdul; Farnaz, Nadia; Rahman, Atiya; Aktar, Bachera; Faruque, A.S.G.; BRAC James P Grant School of Public Health
Purpose About half of the 16% adolescents in the world experience menstruation. Menstrual hygiene management (MHM) is a health concern and challenge especially in humanitarian situations as experienced by Myanmar Rohingya refugees living in Cox’s Bazar, Bangladesh. This study aims to assess knowledge, practice and influencing factors for MHM among Rohingya refugee adolescent girls of 14–18 years. Design/methodology/approach The study used both quantitative (a cross-sectional survey with 340 adolescent girls through a structured questionnaire) and qualitative (7 in-depth interviews with adolescent girls and 2 focus group discussions with the mothers) approaches. Quantitative data, analyzed using STATA version 13.0, were supported by qualitative data, grouped into themes and presented as matrix. Findings Around 51% adolescent girls learned about menstruation after menarche, at the mean age of 12 years, from their mothers and older sisters. About 75% used sanitary pads as absorbents which they got mostly as relief material or bought from local stores (83%); the rest used cloths and other materials (25%). About 57% of the respondents disposed of their absorbent by burying. Those who used reusable absorbents washed them with soap and water (40%) and mostly dried them indoors (17%). Factors influencing healthy MHM practice included the use of absorbent, privacy, disposal, washing and drying of clothes, physical activities, hygiene and pain management. Adolescents with secondary or higher education were four times more likely to have better MHM practice (odds ratio = 4.27; confidence interval = 1.19–15.31) than those with no formal schooling.
Association of household wealth and education level with hypertension and diabetes among adults in Bangladesh: A propensity score-based analysis
(Wiley Online Library, 5/15/2021) Gupta, Rajat Das; Chakraborty, Promit Ananyo; Hossain, Md. Belal; BRAC James P Grant School of Public Health
Objective: To determine the association of household wealth and education level with hypertension and diabetes in Bangladesh using propensity score (PS) analyses. Methods: A nationally representative sample of the Bangladesh Demographic and Health Survey 2017-18 was analysed to explore the research question. A weighted sample of 11 320 individuals was considered. Hypertension and diabetes were the outcomes of interest, and household wealth status (non-poor and poor) and education level (secondary/higher education and no secondary/higher education) were the exposure variables of interest. A person was defined as hypertensive if their average blood pressure was ≥140/90 mmHg or self-reported history of taking antihypertensive medications. Individuals were classified as diabetic if they had a Fasting Blood Glucose level of ≥7 mmol/l or reported taking prescribed medication for reducing high blood glucose or diabetes. We used the 1:1 nearest neighbour PS matching without replacement and PS weighting approaches to assess the association between the exposures and the outcome variables. Results: Wealth status was significantly associated with diabetes but not with hypertension, while education status was significantly associated with neither diabetes nor hypertension. We also observed a significant interaction effect between household wealth status and education level with diabetes. The odds of diabetes were approximately 60% higher among adults from non-poor households and those without secondary/higher education. Conclusion: Diabetes prevention and control programs should focus on non-poor individuals, while hypertension prevention programs should target populations irrespective of educational attainment and wealth status.
Knotted realities: Understanding what delays early and child marriage for girls in urban slums of Bangladesh
(Bangladesh Development Initiative, 2021-04) Ahsan, Sairana; Karim, Shuchi; Biswas, Subas; Rashid, Sabina Faiz; BRAC James P Grant School of Public Health
Bangladesh has the fourth-highest prevalence of early and child marriage in the world. This trend has declined slightly over the years, but there is a dearth of research regarding underlying reasons. This article explores the phenomenon of delayed marriage for women in the context of understudied urban slums, and seeks to understand both why it happens and its consequences. The article uses data from 14 in-depth interviews (IDI) of girls who delayed their marriage beyond their 18th year, and two focus group discussions (FGD) with adolescent girls and young women aged between 13-24 years from a larger mixed-methods study conducted in two slums of the cities of Dhaka and Chattogram. Findings reveal that the key reasons for delaying marriage are poverty, inability to pay dowry for girls perceived as older, and the pressing obligations faced by young girls in having to take care of their families. It was also found that positive family support, mostly among better-off families, allows some girls pursue education rather than be married off at an early age. Link to journal: https://www.bdiusa.org/journal-bangladesh-studies
Bangla hate speech detection on social media using attention-based recurrent neural network
(De Gruyter, 4/9/2021) Das, Amit Kumar; Al Asif, Abdullah; Paul, Anik; Hossain, Md. Nur; BRAC James P Grant School of Public Health
Hate speech has spread more rapidly through the daily use of technology and, most notably, by sharing your opinions or feelings on social media in a negative aspect. Although numerous works have been carried out in detecting hate speeches in English, German, and other languages, very few works have been carried out in the context of the Bengali language. In contrast, millions of people communicate on social media in Bengali. The few existing works that have been carried out need improvements in both accuracy and interpretability. This article proposed encoder–decoder-based machine learning model, a popular tool in NLP, to classify user’s Bengali comments from Facebook pages. A dataset of 7,425 Bengali comments, consisting of seven distinct categories of hate speeches, was used to train and evaluate our model. For extracting and encoding local features from the comments, 1D convolutional layers were used. Finally, the attention mechanism, LSTM, and GRU-based decoders have been used for predicting hate speech categories. Among the three encoder–decoder algorithms, attention-based decoder obtained the best accuracy (77%).
The effects of polio eradication efforts on health systems: A cross-country analysis using the Develop–Distort Dilemma
(Oxford Academic, 4/21/2021) Rodriguez, Daniela C; Neel, Abigail H; Mahendradhata, Yodi; Deressa, Wakgari; Owoaje, Eme; Akinyemi, Oluwaseun; Sarker, Malabika; Mafuta, Eric; Gupta, Shiv D; Salehi, Ahmad Shah; Jain, Anika; Alonge, Olakunle; BRAC James P Grant School of Public Health
Vertical disease control programmes have enormous potential to benefit or weaken health systems, and it is critical to understand how programmes’ design and implementation impact the health systems and communities in which they operate. We use the Develop–Distort Dilemma (DDD) framework to understand how the Global Polio Eradication Initiative (GPEI) distorted or developed local health systems. We include document review and 176 interviews with respondents at the global level and across seven focus countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia and Nigeria). We use DDD domains, contextual factors and transition planning to analyse interactions between the broader context, local health systems and the GPEI to identify changes. Our analysis confirms earlier research including improved health worker, laboratory and surveillance capacity, monitoring and accountability, and efforts to reach vulnerable populations, whereas distortions include shifting attention from routine health services and distorting local payment and incentives structures. New findings highlight how global-level governance structures evolved and affected national actors; issues of country ownership, including for data systems, where the polio programme is not indigenously financed; how expectations of success have affected implementation at programme and community level; and unresolved tensions around transition planning. The decoupling of polio eradication from routine immunization, in particular, plays an outsize role in these issues as it removed attention from system strengthening. In addition to drawing lessons from the GPEI experience for other efforts, we also reflect on the use of the DDD framework for assessing programmes and their system-level impacts. Future eradication efforts should be approached carefully, and new initiatives of any kind should leverage the existing health system while considering equity, inclusion and transition from the start.
Prevalence and associated factors of underweight, overweight, and obesity Among Bangladeshi adults: An analysis of demographic and health survey 2017-18
(Science Direct, 4/16/2021) Gupta, Rajat Das; Al Kibria, Gulam Muhammed; BRAC James P Grant School of Public Health
This study aimed to determine the prevalence and associated factors of underweight, overweight, and obesity among Bangladeshi adults (≥18 years) using the nationally representative Bangladesh Demographic and Health Survey 2017-18 data. An Asian-specific body mass index cut-off was used to define underweight, overweight, and obesity. Multivariable multilevel logistic regression was conducted to investigate associated factors and was reported with adjusted odds ratio [AOR] with 95% confidence interval (CI). The overall prevalence of underweight, overweight, and obesity was 17.1% (95% CI: 16.2%, 18.0%), 29.4% (95% CI: 28.4%, 30.4%), and 10.8% (95% CI: 10.1%, 11.5%), respectively. Compared to 18-29-year old people, the odds of underweight and overweight/obesity was lower among people with 30–49 years of age, respectively. Males had also lower odds of overweight/obesity than females (AOR: 0.47; 95% CI: 0.42,0.51). The odds of underweight declined with increasing education level and wealth quintile. However, the odds of overweight/obesity increased with increasing education level and wealth quintile. Work status or place of residence did not have any significant association. Multisectoral interventions should be launched by targeting the at-risk population for the underweight and overweight/obesity prevention programs irrespective of work status or place of residence.
Adolescents’ experiences of covid-19 in Chittagong and Sylhet divisions, Bangladesh
(GAGE, 2021-04) Alam, Farhana; Rana, Md Sajib; Raha, Samira Ahmed; Al Mamun, Saklain; Guglielmi, Silvia; BRAC James P Grant School of Public Health
This study is part of a cross-country series designed to share emerging findings in real time from qualitative interviews with adolescents and school teachers in the context of covid-19. The young people involved are part of the Gender and Adolescence: Global Evidence (GAGE) programme, which is conducting longitudinal research in the Middle East, East Africa and South Asia. Our sample for this study was purposefully selected from an ongoing baseline GAGE impact evaluation study, and includes two cohorts: younger adolescents (10–14 years) and older adolescents (15–19 years), all of whom are in-school (grades 7 and 8). Adolescent respondents were drawn from both urban and rural schools in Chittagong and Sylhet divisions of Bangladesh (see Annex 1 for further details). The objectives of the research are as follows: • To understand adolescents’ experiences of transition from childhood to adulthood, and to identify differences in their experiences by age, gender, disability and geographic location. • To identify adolescents’ knowledge of covid-19, and how the pandemic response has affected adolescent lives across the following domains: Young adolescent girls in Chittagong, Bangladesh © Nathalie Bertrams / GAGE 2 » education and remote learning » incomes and livelihoods » nutrition, health and hygiene » psychosocial well-being and coping » voice and agency related to adolescents’ mobility. To inform the pandemic response, this study aims to understand adolescents’ knowledge, perceptions and practices during the covid-19 pandemic, their challenges and worries, and the coping mechanisms they are using to deal with the evolving situation. We explore the impact of covid-19 on the realities and experiences of in-school adolescents in Chittagong and Sylhet who have found themselves out of school since March 2020 until the present, to prevent the spread of the virus. The report also explores the impacts on adolescents in terms of gender and the vulnerability status of the household.
Implications of Birth-Dose Vaccination against Hepatitis B Virus in Southeast Asia
(MDPI, 4/12/2021) Fazle Akbar, Sheikh Mohammad; Al Mahtab, Mamun; Begum, Ferdousi; Hossain, Shaikh A. Shahed; Sarker, Sukumar; Shrestha, Ananta; Khan, Md. Sakirul Islam; Yoshida, Osamu; Hiasa, Yoichi; BRAC James P Grant School of Public Health
The World Health Organization (WHO) South-East Asia Regional Office (SEARO) covers 11 countries with a combined population of about 2 billion people, making it the most populous of the six WHO regions. In 1992, the WHO advocated including the hepatitis B vaccine in the Expanded Program of Immunization (EPI) and vaccinating all infants and children three times within 1 year of birth (HepB3). Recently, the WHO advocate birth-dose hepatitis B vaccination (HepB-BD) as soon as possible after birth, preferably within 24 hours. In 2016, the SEARO endorsed a regional hepatitis B control goal with a target of hepatitis B surface antigen (HBsAg) seroprevalence of ≤1% among children aged ≥5 years by 2020. Of the 11 SEARO countries, four achieved this target on schedule. Out of these four countries, two countries (Bangladesh and Nepal) have not adopted HepB-BD in EPI program. On the other hand, the coverage of HepB3 is not satisfactory in some SEARO countries, including India which adopted HepB-BD but could not achieve the overall target of SEARO. Thus, it is a point of debate whether emphasis should be placed on proper implementation of HepB3 or whether a new agenda of HepB-BD should be incorporated in developing countries of SEARO. The article discusses strengthening and expanding the Hepatitis B vaccination program in SEARO countries with an emphasis on HepB and HepB-BD programs.
Public health education post-COVID-19: A proposal for critical revisions
(BMJ Journals, 4/1/2021) Ghaffar, Abdul; Rashid, Sabina Faiz; Wanyenze, Rhoda Kitti; Hyder, Adnan A; BRAC James P Grant School of Public Health
Association of leisure-time physical activity with perceived general health status among hypertensive people: An analysis of NHANES 2015–18
(Nature, 3/23/2021) Al Kibria, Gulam Muhammed; Gupta, Rajat Das; Crispen, Reese; BRAC James P Grant School of Public Health
Although leisure-time physical activity (LTPA) improves general health, little is known about its impacts on the health of hypertensive people within the United States. We investigated the general health of hypertensive people and the relationship between LTPA and general health within this population. This cross-sectional study analyzed National Health and Nutrition Examination Survey 2015–18 data. None, some, and high LTPA were defined as ‘0’, ‘>0 but <150’, and ‘≥150’ minutes of LTPA in each week, respectively. Hypertension was defined as the systolic/diastolic blood pressure ≥130/80 mmHg or taking BP-lowering drugs. General health status was dichotomized as whether participants reported ‘very good to excellent’ health status or not. After descriptive analysis, logistic regression was performed. Among 8504 participants (48.6% male and mean age: 48.2 years), about 47.9%, 41.4%, and 39.5% of people had hypertension, ‘very good to excellent’ health, and high LTPA, respectively. The odds of ‘very good to excellent’ health was lower among hypertensives than those without hypertension (adjusted odds ratio [AOR]: 0.7, 95% confidence interval [CI]: 0.6–0.8, p < 0.001). Among hypertensive individuals, about one-third reported ‘very good to excellent’ health (33.1%) and high LTPA (32.0%). Lastly, compared to people with no LTPA, those with some (AOR: 1.5, 95% CI: 1.0–2.0, p < 0.05) and high (AOR: 2.3, 95% CI: 1.7–3.0, p < 0.001) LTPA had greater odds of ‘very good to excellent’ health. We found positive relationships between LTPA and ‘very good to excellent’ health of hypertensive people. Therefore, improving general health could be an added advantage of LTPA for hypertensive people.
Loops and Building Blocks: A Knowledge co-Production Framework for Equitable Urban Health
(Springer Link, 3/18/2021) Audia, Camilla; Berkhout, Frans; Owusu, George; Quayyum, Zahidul; Agyei-Mensah, Samuel; BRAC James P Grant School of Public Health
This paper sets out a structured process for the co-production of knowledge between researchers and societal partners and illustrates its application in an urban health equity project in Accra, Ghana. The main insight of this approach is that research and knowledge co-production is always partial, both in the sense of being incomplete, as well as being circumscribed by the interests of participating researchers and societal partners. A second insight is that project-bound societal engagement takes place in a broader context of public and policy debate. The approach to co-production described here is formed of three recursive processes: codesigning, co-analysing, and co-creating knowledge. These ‘co-production loops’ are themselves iterative, each representing a stage of knowledge production. Each loop is operationalized through a series of research and engagement practices, which we call building blocks. Building blocks are activities and interactionbased methods aimed at bringing together a range of participants involved in joint knowledge production. In practice, recursive iterations within loops may be limited due of constraints on time, resources, or attention. We suggest that co-productio
A holistic approach to promoting early child development: A cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh
(BMJ Journals, 3/16/2021) Pitchik, Helen O; Tofail, Fahmida; Rahman, Mahbubur; Akter, Fahmida; Sultana, Jesmin; Shoab, Abul Kasham; Huda, Tarique Md. Nurul; Jahir, Tania; Amin, Md Ruhul; Hossain, Md Khobair; Das, Jyoti Bhushan; Chung, Esther O; Byrd, Kendra A; Yeasmin, Farzana; Kwong, Laura H; Forsyth, Jenna E; Mridha, Malay K; Winch, Peter J; Luby, Stephen P; Fernald, Lia CH; BRAC James P Grant School of Public Health
Introduction In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention. Methods We conducted a 9-month, parallel, multiarm, clusterrandomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers. Results In July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (ageadjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54). Conclusion Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale.
Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight
(eLife, 3/9/2021) NCD Risk Factor Collaboration (NCD-RisC); BRAC James P Grant School of Public Health
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
Barriers and facilitators to knowledge translation activities within academic institutions in low- And middle-income countries
(Oxford Academic, 3/1/2021) Kalbarczyk, Anna; Rodriguez, Daniela C; Mahendradhata, Yodi; Sarker, Malabika; Seme, Assefa; Majumdar, Piyusha; Akinyemi, Oluwaseun O; Kayembe, Patrick; Alonge, Olakunle O; BRAC James P Grant School of Public Health
The barriers and facilitators of conducting knowledge translation (KT) activities are well-established but less is known about the institutional forces that drive these barriers, particularly in low-resource settings. Understanding organizational readiness has been used to assess and address such barriers but the employment of readiness assessments has largely been done in high-income countries. We conducted a qualitative study to describe the institutional needs and barriers in KT specific to academic institutions in low- and middle-income countries. We conducted a review of the grey and published literature to identify country health priorities and established barriers and facilitators for KT. Key-informant interviews (KII) were conducted to elicit perceptions of institutional readiness to conduct KT, including experiences with KT, and views on motivation and capacity building. Participants included representatives from academic institutions and Ministries of Health in six countries (Bangladesh, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria). We conducted 18 KIIs, 11 with members of academic institutions and 7 with policymakers. KIIs were analysed using a deductive and inductive coding approach. Our findings support many well-documented barriers including lack of time, skills and institutional support to conduct KT. Three additional institutional drivers emerged around soft skills and the complexity of the policy process, alignment of incentives and institutional missions, and the role of networks. Participants reflected on often-lacking soft-skills needed by researchers to engage policy makers. Continuous engagement was viewed as a challenge given competing demands for time (both researchers and policy makers) and lack of institutional incentives to conduct KT. Strong networks, both within the institution and between institutions, were described as important for conducting KT but difficult to establish and maintain. Attention to the cross-cutting themes representing barriers and facilitators for both individuals and institutions can inform the development of capacity building strategies that meet readiness needs.
Innovative strategies for providing menstruation-supportive water, sanitation and hygiene (WASH) facilities: Learning from refugee camps in Cox’s bazar, Bangladesh
(BMC, 2/26/2021) Schmitt, Margaret L.; Wood, Olivia R.; Clatworthy, David; Rashid, Sabina Faiz; Sommer, Marni; BRAC James P Grant School of Public Health
Background: There is growing attention to addressing the menstrual hygiene management (MHM) needs of the over 21 million displaced adolescent girls and women globally. Current approaches to MHM-related humanitarian programming often prioritize the provision of menstrual materials and information. However, a critical component of an MHM response includes the construction and maintenance of water, sanitation and hygiene (WASH) facilities, including more female-friendly toilets. This enables spaces for menstruating girls and women to change, dispose, wash and dry menstrual materials; all of which are integral tasks required for MHM. A global assessment identified a number of innovations focused on designing and implementing menstruation-supportive WASH facilities in the Rohingya refugee camps located in Cox’s Bazar (CXB), Bangladesh. These pilot efforts strove to include the use of more participatory methodologies in the process of developing the new MHM-supportive WASH approaches. This study aimed to capture new approaches and practical insights on innovating menstrual disposal, waste management and laundering in emergency contexts through the conduct of a qualitative assessment in CXB. Methods: The qualitative assessment was conducted in the Rohingya refugee camps in CXB in September of 2019 to capture new approaches and practical insights on innovating for menstrual disposal, waste management and laundering. This included Key Informant Interviews with 19 humanitarian response staff from the WASH and Protection sectors of a range of non-governmental organizations and UN agencies; Focus Group Discussions with 47 Rohingya adolescent girls and women; and direct observations of 8 WASH facilities (toilets, bathing, and laundering spaces). Results: Key findings included: one, the identification of new female-driven consultation methods aimed at improving female beneficiary involvement and buy-in during the design and construction phases; two, the design of new multi-purpose WASH facilities to increase female beneficiary usage; three, new menstrual waste disposal innovations being piloted in communal and institutional settings, with female users indicating at least initial acceptability; and four, novel strategies for engaging male beneficiaries in the design of female WASH facilities, including promoting dialogue to generate buy-in regarding the importance of these facilities and debate about their placement. Conclusions: Although the identified innovative participatory methodologies and design approaches are promising, the long term viability of the facilities, including plans to expand them, may be dependent on the continued engagement of girls and women, and the availability of resources.
Association between height and hypertension among US adults: Analyses of National Health and Nutrition Examination Survey 2007–18
(BMC, 2/26/2021) Gupta, Rajat Das; Akonde, Maxwell; Sajal, Ibrahim Hossain; Al Kibria, Gulam Muhammed; BRAC James P Grant School of Public Health
Background: Previous studies that investigated association of height with prevalence and control of hypertension found mixed results. This cross-sectional study explored these associations among US adults (≥20 years). Methods: The National Health and Nutrition Examination Survey (NHANES) 2007–18 data was analyzed. Height was measured in meters and was converted into centimeters (cm) and was further divided into quartiles: Q1 (135.3–159.2 cm), Q2 (159.3–166.2 cm), Q3 (166.3–173.6 cm), Q4 (173.7–204.5 cm). Hypertension definition of the ‘2017 American College of Cardiology/American Heart Association Guideline’ was used. Logistic regression analyses were conducted to find out the association between the dependent variable and the covariates. Linear regression analyses were conducted to find out the association of height with systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and the covariates among the individuals who were not taking any antihypertensive drugs. Crude odds ratio, adjusted odds ratio (AOR), and adjusted beta-coefficient (for linear regression) with 95% confidence interval (CI) were reported. The following covariates were included: age, gender, race/ethnicity, family income, education level, cholesterol level, high-density lipoprotein level, chronic kidney disease status, diabetes status, smoker, aerobic leisure-time physical activity, and survey period. Sample weight of NHANES was adjusted. Results: Among the 21,935 participants (47.1% males), the prevalence of hypertension was 46.1%. Among 6154 participants taking medication (43.0% males), 57.2% had uncontrolled hypertension. In the final logistic regression analyses, participants in Q2 height quartile had 20% lower odds of being hypertensive compared to those in Q4 height quartile (AOR: 0.8; 95% CI: 0.7,1.0). Other height categories did not reveal any significant association. Compared to Q4 height category, Q1 (AOR: 1.7; 95% CI: 1.2,2.3), Q2 (AOR: 1.4; 95% CI: 1.1,1.8), and Q3 (AOR: 1.3; 95% CI: 1.1,1.6) height categories had higher odds of uncontrolled hypertension. PP was inversely associated and DBP was positively Conclusions: Although height was not associated with prevalence of hypertension, it had inverse association with uncontrolled hypertension. It was also significantly associated with DBP and PP among the individuals with untreated hypertension.
Harmful practices prevail despite legal knowledge: A mixed-method study on the paradox of child marriage in Bangladesh
(Taylor & Francis, 2/24/2021) Akter, Sayema; Williams, Chloe; Talukder, Animesh; Islam, Muhammed Nazmul; Escallon, Juanita Vasquez; Sultana, Tania; Kapil, Neha; Sarker, Malabika; BRAC James P Grant School of Public Health
Child marriage is a globally recognised human rights violation that disproportionately affects girls, especially in developing countries. It has serious negative consequences on girls’ physical, mental, sexual, and reproductive health and rights. Although well-pronounced laws against child marriage were enacted in Bangladesh, the practice remains a significant challenge. Lack of law enforcement and persistent social norms ultimately allow child marriage to persist around the country. Social norms have an impact on the prevalent attitudes toward child marriage. Therefore, this mixed-method study aimed to explore the legal knowledge, perception, and practice of child marriage in Bangladesh. This study was part of a broader evaluation of a UNICEF media programme. Adolescent boys and girls aged between 10 and 19 years and their parents were interviewed in three Bangladeshi districts. All the respondents were aware of the legal age of marriage and knew that child marriage is punishable by law. This study illuminated the reasons, including early marriage among boys, poverty, dowry, and sexual harassment. Communities and policymakers need to be engaged to trigger larger structural and cultural changes to remedy the harmful social norm and its practice
Introducing urine‑enriched biochar‑based fertilizer for vegetable production: Acceptability and results from rural Bangladesh
(Springer Link, 2/19/2022) Sutradhar, Ipsita; deGrafenried, Meredith Jackson; Akter, Sayema; McMahon, Shannon A.; Waid, Jillian L.; Schmidt, Hans‑Peter; Wendt, Amanda S.; Gabrysch, Sabine; BRAC James P Grant School of Public Health
Improved agricultural practices that increase yields and preserve soils are critical to addressing food insecurity and undernutrition among smallholder farmer families. Urineenriched biochar has been shown to be an accessible and efective fertilization option in various subtropical countries; however, it is new to Bangladesh. To better understand attitudes and experiences preparing and using urine-enriched biochar fertilizer, mixed-methods research was undertaken among smallholder farmers in northeastern Bangladesh in 2016/2017. In-depth interviews were conducted with 25 respondents who had compared the production of crops grown with biochar-based fertilizer to usual practice. In addition, in areas where trainings on biochar-based fertilization had been ofered, 845 farmers were asked about their experience through a quantitative survey. Interview results indicated that cow urine-enriched biochar was favored over human urine because cow urine was perceived as clean and socially acceptable, whereas human urine was considered impure and disgusting. Respondents praised biochar-based fertilizer because it increased yields, cost little, was convenient to prepare with readily available natural materials, produced tastier crops, and allowed families to share their larger yields which in turn enhanced social and fnancial capital. Comparative feld trials indicated a 60% yield beneft in both cabbage and kohlrabi crops. Challenges included uneven access to ingredients, with some respondents having difculty procuring cow urine and biomass feedstock. The low social, health, and fnancial risk of adoption and the perceived benefts motivated farmers to produce and apply biochar-based fertilizer in their gardens, demonstrating strong potential for scale-up of this technology in Bangladesh.
Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: Evidence from a large-scale multi-country surveillance programme
(Elsevier, 2/13/2021) Kusuma, Dian; Pradeepa, Rajendra; Khawaja, Khadija I.; Hasan, Mehedi; Siddiqui, Samreen; Mahmood, Sara; Shah, Syed Mohsin Ali; De Silva, Chamini K.; de Silva, Laksara; Gamage, Manoja; Loomba, Menka; Rajakaruna, Vindya P.; Hanif, Abu AM; Kamalesh, Rajan Babu; Kumarendran, Balachandran; Loh, Marie; Misra, Archa; Tassawar, Asma; Tyagi, Akansha; Waghdhare, Swati; Burney, Saira; Ahmad, Sajjad; Mohan, Viswanathan; Sarker, Malabika; Goon, Ian Y.; Kasturiratne, Anuradhani; Kooner, Jaspal S.; Katulanda, Prasad; Jha, Sujeet; Anjana, Ranjit Mohan; Mridha, Malay K.; Sassi, Franco; Chambers, John C.; BRAC James P Grant School of Public Health
Background: South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians’ awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. Methods: We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. Results: Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P < 0.001), and household income fell by 52% (P < 0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P < 0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P < 0.001), during the lockdown. Conclusions: Our results identified important knowledge, access and uptake barriers to the prevention of COVID19 in South Asia, and demonstrated major adverse impacts of the pandemic on chronic disease treatment, mental health, health-related behaviours, employment and household finances. We found important sociodemographic differences for impact, suggesting a widening of existing inequalities. Our findings underscore the need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention, along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor.
Tuberculosis infection control in selected facilities managing drug-resistant tuberculosis in Bangladesh: Findings from a mixed-methods study
(Elsevier, 1/20/2021) Parray, A.A.; BRAC James P Grant School of Public Health
Background: Nosocominal Tuberculosis epidemics in hospitals are a major threat to the patient and health workers safety. On the other hand, implementation of Tuberculosis infection control policy, strongly influences the prevention and transmission of Tuberculosis in hospitals. Thus we aimed to check the status of Tuberculosis infection control in the major drug-resistant Tuberculosis management centers of Bangladesh. Methods and materials: We leveraged an explanatory mixed-methods design to contextualize this study. We included (n = 3) major drug-resistant Tuberculosis management centers of Bangladesh to check their complaiance with the national Tuberculosis infection control policy. Non-participatory observations (n = 18) using a structured observation checklist and record review using standard document review checklist were employed to check the extent of the implementation of infection control policy. After the quantitative data were analyzed, indivually at each hospital, we developed guidelines to explain the reasons for non-compliance with the Infection control standards. Hence, we conducted 9 Key-informant interviews with Managers,16 In-depth Interviews with health care providers, 12 In-depth Interviews with patients and 6 In-depth-phone Interviews with field staff (n = 43). The data collection commenced from November 2018 to December 2018. The ethical approval for this study was sought from BRAC James P Grant school of public health. Results: The infection control at drug-resistant Tuberculosis management centers have a scope of improvement. Survey findings revealed absence of dedicated budget for infection control, no capacity building activities, sub-optimal triage practices, sub-optimal ventilation, and non-compliance to personal protective equipment including N-95 masks. However, qualitative findings revealed that the reasons for non-compliance with infection control standards included; lack of funds, lack of infection control committee, lack of authority and lack of training. Conclusion: Infection control practices at drug-resistant Tuberculosis management centers of Bangladesh require special attention of the national policy makers. The reasons for non-compliance with infection control standards are interconnected and represent asymmetries at individual, hospital and national levels.

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