M. A. Kabir

Predictors of the number of under-five malnourished children in Bangladesh: application of the generalized poisson regression model

BackgroundMalnutrition is one of the principal causes of child mortality in developing countries including Bangladesh. According to our knowledge, most of the available studies, that addressed the issue of malnutrition among under-five children, considered the categorical (dichotomous/polychotomous) outcome variables and applied logistic regression (binary/multinomial) to find their predictors. In this study malnutrition variable (i.e. outcome) is defined as the number of under-five malnourished children in a family, which is a non-negative count variable. The purposes of the study are (i) to demonstrate the applicability of the generalized Poisson regression (GPR) model as an alternative of other statistical methods and (ii) to find some predictors of this outcome variable.MethodsThe data is extracted from the Bangladesh Demographic and Health Survey (BDHS) 2007. Briefly, this survey employs a nationally representative sample which is based on a two-stage stratified sample of households. A total of 4,460 under-five children is analysed using various statistical techniques namely Chi-square test and GPR model.ResultsThe GPR model (as compared to the standard Poisson regression and negative Binomial regression) is found to be justified to study the above-mentioned outcome variable because of its under-dispersion (variance < mean) property. Our study also identify several significant predictors of the outcome variable namely mother’s education, father’s education, wealth index, sanitation status, source of drinking water, and total number of children ever born to a woman.ConclusionsConsistencies of our findings in light of many other studies suggest that the GPR model is an ideal alternative of other statistical models to analyse the number of under-five malnourished children in a family. Strategies based on significant predictors may improve the nutritional status of children in Bangladesh.

Determinants of tobacco use among students aged 13–15 years in Nepal and Sri Lanka: Results from the Global Youth Tobacco Survey, 2007

Objectives: This study aimed to investigate tobacco use behaviours and their correlates among secondary school students in Nepal and Sri Lanka together with cross-country comparisons. Design: Cross-sectional survey. Methods and Settings: The data were obtained from the Global Youth Tobacco Survey (GYTS), 2007. Current tobacco use was considered as a response variable. Predictors were selected based on existing literature and theories on adolescent tobacco use. The data of 1,444 Nepalese and 1,377 Sri Lankan students aged 13–15 years was used for analysis. Results: Prevalence of tobacco use varies with 9.4% and 9.1% among Nepalese and Sri Lankan students respectively. Boys (13.2 vs. 5.3 for Nepal, 12.4 vs. 5.8 for Sri Lanka), older and senior students was more likely to be tobacco users in both countries. The average age of tobacco initiation was 10.2 years in Nepal and 8.6 years in Sri Lanka. Factors, namely, individual characteristics, tobacco use among friends, smoking at home and public places, free tobacco products, and lessons about negative effects of tobacco in class were significantly associated with tobacco use in Nepal and Sri Lanka. For instance, friends’ tobacco use was a good predictor for adolescents’ usage (odds ratio [OR] = 4.0, confidence interval [CI] = 2.61–6.23 in Nepal; OR = 2.5, CI = 1.50–4.23 in Sri-Lanka). Similarly, course curriculum significantly reduced smoking among students. Conclusion: Prevention of tobacco use among school students should be top priority of a country as they are long-term customers and replacement smokers who quit or die. Therefore comprehensive strategies as we proposed along with existing prevention programmes should be tightened to stop them from hazardous behaviours.

Adolescent Tobacco Use and Its Determinants Evidence From Global Youth Tobacco Survey, Bangladesh 2007

Adolescent tobacco use (ATU) is on the rise worldwide and the problem is particularly severe in developing countries. Based on nationally representative data, this study aims to investigate the association between ATU and its possible correlates for Bangladesh, where the prevalence rate of ATU is high. The data set is extracted from the Global Youth Tobacco Survey for Bangladesh conducted in 2007. The survey collected information from a total of 3113 students from 52 schools, with a response rate of 100% at the school level, while a response rate of 88.9% was achieved from the students. Students covered in the survey were in grades 7, 8, 9, and 10, with age ranging from 11 to 17 years. The prevalence rate of ATU at the time of the survey was 8.4%, while 35.6% of the students had used at least a type of tobacco products before. Logistic regressions were used to obtain the odds ratios (ORs) in favor of ATU for each of the possible determinants and the confidence intervals (CIs) of these ratios. Use of tobacco among friends (OR = 3.46; CI = 2.37-5.05), the experience of seeing others smoking at home (OR = 2.10; CI = 1.36-3.22) or other places (OR = 1.6; CI = 1.02-2.57), receiving pocket money (OR = 7.6; CI = 4.59-13.28), receiving free tobacco from vendors (OR = 2.3; CI = 1.44-3.78), and exposure to advertisements and promotions of tobacco products (OR = 1.83; CI = 1.23-2.79) were associated with a higher likelihood of ATU. Increased awareness of health hazards of tobacco use through education in schools helped mitigate the problem of ATU. The findings of this study have ramifications for tobacco control prevention strategies in Bangladesh.

Tobacco consumption and illegal drug use among Bangladeshi males: association and determinants.

This article aimed to identify the determinants of tobacco consumption and illegal drug use (IDU) as well as to examine the association between these two variables using a representative sample of 3,771 Bangladeshi males aged 15 to 54 years. Data were collected through Bangladesh Demographic and Health Survey 2007. To identify the determinants, the patterns of tobacco consumption and IDU were analyzed by age, education and occupation, residence, mass media, premarital sex, wealth, and sexually transmitted infections (STIs). Prevalence of smoking cigarette and bidi was roughly 60%. However, the prevalence of IDU was 3.4%, and this proportion is statistically significant (Z = 11.32, p = .000). After bivariate analysis, almost all variables except STIs were significantly associated with tobacco consumption. Similarly, all variables except residence and mass media were associated with IDU. Based on multivariable adjusted logistic regression analysis, the likelihood of using IDU was approximately twofold (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.23-2.53) among bidi smokers and fourfold (OR = 3.8, 95% CI = 2.62-5.56) among cigarette smokers as compared with nonsmokers.

Safe delivery practices: experience from cross-sectional data of Bangladeshi women.

This study examines the safe delivery practices of Bangladeshi women using data on 4905 ever-married women aged 15 to 49 years from the 2007 Bangladesh Demographic and Health Survey. Variables that included age, region of origin, education level of respondent and spouse, residence, working status, religion, involvement in NGOs, mass media exposure, and wealth index were analyzed to find correlates of safe delivery practices. More than 80% of the deliveries took place at home, and only 18% were under safe and hygienic conditions. The likelihood of safe deliveries was significantly lower among younger and older mothers than middle-aged mothers and higher among educated mothers and those living in urban areas. Economically better-off mothers and those with greater exposure to mass media had a significantly higher incidence of safe delivery practices. A significant association with religion and safe delivery practices was revealed. Demographic, socioeconomic, cultural, and programmatic factors that are strongly associated with safe delivery practices should be considered in the formulation of reproductive health policy.

Tobacco Smoking and Its Association with Illicit Drug Use among Young Men Aged 15-24 Years Living in Urban Slums of Bangladesh

Background Tobacco smoking (TS) and illicit drug use (IDU) are of public health concerns especially in developing countries, including Bangladesh. This paper aims to (i) identify the determinants of TS and IDU, and (ii) examine the association of TS with IDU among young slum dwellers in Bangladesh. Methodology/Principal Findings Data on a total of 1,576 young slum dwellers aged 15–24 years were extracted for analysis from the 2006 Urban Health Survey (UHS), which covered a nationally representative sample of 13,819 adult men aged 15–59 years from slums, non-slums and district municipalities of six administrative regions in Bangladesh. Methods used include frequency run, Chi-square test of association and multivariable logistic regression. The overall prevalence of TS in the target group was 42.3%, of which 41.4% smoked cigarettes and 3.1% smoked bidis. The regression model for TS showed that age, marital status, education, duration of living in slums, and those with sexually transmitted infections were significantly (p<0.001 to p<0.05) associated with TS. The overall prevalence of IDU was 9.1%, dominated by those who had drug injections (3.2%), and smoked ganja (2.8%) and tari (1.6%). In the regression model for IDU, the significant (p<0.01 to p<0.10) predictors were education, duration of living in slums, and whether infected by sexually transmitted diseases. The multivariable logistic regression (controlling for other variables) revealed significantly (p<0.001) higher likelihood of IDU (OR = 9.59, 95% CI = 5.81–15.82) among users of any form of TS. The likelihood of IDU increased significantly (p<0.001) with increased use of cigarettes. Conclusions/Significance Certain groups of youth are more vulnerable to TS and IDU. Therefore, tobacco and drug control efforts should target these groups to reduce the consequences of risky lifestyles through information, education and communication (IEC) programs.

Inequality of the use of skilled birth assistance among rural women in Bangladesh: facts and factors.

This study examines the inequality of the use of skilled delivery assistance by the rural women of Bangladesh using the 2007 Bangladesh Demographic and Health Survey data. Simple cross-tabulation and univariate and multivariate statistical analyses were employed in the study. Overall, 56.1% of the women received at least one antenatal care visit, whereas only 13.2% births were assisted by skilled personnel. Findings revealed apparent inequality in using skilled delivery assistance by socioeconomic strata. Birth order, women’s education, religion, wealth index, region and antenatal care are important determinants of seeking skilled assistance. To ensure safe motherhood initiative, government should pay special attention to reduce inequality in seeking skilled delivery assistance. A strong focus on community-based and regional interventions is important in order to increase the utilization of safe maternal health care services in rural Bangladesh.

Explaining fertility transition of a developing country: an analysis of quantum and tempo effect

BackgroundThe Total Fertility Rate (TFR) is defined as the average number of births a woman would have if she were to live throughout the reproductive span and bear children at each age at the rates observed in a particular year or period. The current demographic explanation for decline in TFR is primarily attributed to an increase in postponement in pregnancy. Being cross-sectional, fertility measures can be confounded by changes in the timing of births across women’s lifetimes (tempo) and by changes in the numbers of children that they have by the time they end their childbearing (quantum). After a sharp fall in the last two decades, TFR of Bangladesh is now 2.3; whereas the TFR was greater than 3 in the last decade. However, mean age at childbearing showed decreasing trend in the last decade.MethodsThis is a secondary analysis of data from the three consecutive Bangladesh Demographic Health Surveys; BDHS-2004, 2007 and 2011. The method of Bongaarts and Feeney has been applied to estimate the tempo of fertility. Life Table analyses were applied on birth intervals to explain the tempo effect.ResultsThere was a sustained decline of the fertility quantum (the number of births per woman) as estimated by the conventional TFR; due to tempo effects during the last three BDHS surveys. Mean age at childbearing also showed decreasing trend in the last decade.ConclusionsThe current study shows the presence of a significant tempo effect with variability of timing in having first or higher order births. If this trend continues, Bangladesh will be able to achieve below replacement level of fertility soon.

Patterns, prevalence and determinants of environmental tobacco smoke exposure among adults in Bangladesh

Background Exposure to environmental tobacco smoke (ETS) has been suggested as a risk factor for various health problems. Thus, this study examines the patterns and predictors of ETS exposure among adults at home, workplace and public places. Methods The dataset covered a nationally representative sample of 9629 respondents extracted from the Global Adult Tobacco Survey. Diamond-shaped equiponderant graphs were used to exhibit the prevalence of ETS. In Logistic regressions, ETS exposure at home, workplace and public places were used as response variables. Demographic and socioeconomic variables, health knowledge about ETS, attitude towards ETS, perception of smoking restrictions were considered as predictors. Results Adults in higher age groups and females were less exposed to ETS. Better education, high wealth status, better health knowledge on ETS, practice of no smoking at home, and support smoking restrictions were significantly associated with lower ETS exposure at home. Those residing in rural areas and living with many people together were more likely to be exposed to ETS at home. In contrast with home and workplace exposure, adults with higher education, better wealth status, good knowledge on ETS, and support smoking restrictions experienced a high level of exposure at public places. Interestingly, results suggest that those with high levels of ETS exposure at home and workplace had lower exposure to ETS in public places. Conclusions ETS control should not be overlooked in public health policy. Protection from ETS at home is particularly important, given its impact on the attitude towards and awareness about ETS exposure at all places.

Elderly Population Growth in Bangladesh: Preparedness in Public and Private Sectors

Ageing of the population is now one of the most important facts that came to the foreground in the 21 st century. The rapid growth in the elderly of Bangladesh population after 2040 will challenge existing health care services, family relationships on social security. Because of change in the family structure there will be implications on health care of elderly from the family and unmet need of health care services in the public sector will rapidly increase. the aim of this research is to explore how the aging situation in Bangladesh is addressing and anticipating the challenges of an aging society. A review of program activities suggests that Bangladesh preparedness for an aging population is decidedly mixed. Public policy may have an important influence on the role of family support systems in the future but it is not significant considering the absolute size of the elderly population. Current demographic trends indicate that Bangladesh will very different in the coming decades than is to day. Mortality and fertility will be lower, and life expectancy will be rising. Population growth will have slowed substantially as supported by the medium and low variants projections respectively. Strengthening human capital by ensuring empowerment education and employment of all citizens will yield a high return to investment and will help countries reap a demographic dividend that can lift millions out of poverty. Creating hope and opportunity for young people to develop their full potential can drive progress in the years to come and ultimately result in a second demographic dividend of healthy lives, wealthier and more productive older person.