Md. Golam Hossain

Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy

The use of open wedge high tibial osteotomy (HTO) to correct varus deformity of the knee is well established. However, the stability of the various implants used in this procedure has not been previously demonstrated. In this study, the two most common types of plates were analysed (1) the Puddu plates that use the dynamic compression plate (DCP) concept, and (2) the Tomofix plate that uses the locking compression plate (LCP) concept. Three dimensional model of the tibia was reconstructed from computed tomography images obtained from the Medical Implant Technology Group datasets. Osteotomy and fixation models were simulated through computational processing. Simulated loading was applied at 60:40 ratios on the medial:lateral aspect during single limb stance. The model was fixed distally in all degrees of freedom. Simulated data generated from the micromotions, displacement and, implant stress were captured. At the prescribed loads, a higher displacement of 3.25 mm was observed for the Puddu plate model (p<0.001). Coincidentally the amount of stresses subjected to this plate, 24.7 MPa, was also significantly lower (p<0.001). There was significant negative correlation (p<0.001) between implant stresses to that of the amount of fracture displacement which signifies a less stable fixation using Puddu plates. In conclusion, this study demonstrates that the Tomofix plate produces superior stability for bony fixation in HTO procedures.

BODY MASS INDEX OF MARRIED BANGLADESHI WOMEN: TRENDS AND ASSOCIATION WITH SOCIO-DEMOGRAPHIC FACTORS

Body mass index (BMI) is a good indicator of nutritional status in a population. In underdeveloped countries like Bangladesh, this indicator provides a method that can assist intervention to help eradicate many preventable diseases. This study aimed to report on changes in the BMI of married Bangladeshi women who were born in the past three decades and its association with socio-demographic factors. Data for 10,115 married and currently non-pregnant Bangladeshi women were extracted from the 2007 Bangladesh Demographic and Health Survey (BDHS). The age range of the sample was 15-49 years. The mean BMI was 20.85 ± 3.66 kg/m(2), and a decreasing tendency in BMI was found among birth year cohorts from 1972 to 1992. It was found that the proportion of underweight females has been increasing in those born during the last 20 years of the study period (1972 to 1992). Body mass index increased with increasing age, education level of the woman and her husband, wealth index, age at first marriage and age at first delivery, and decreased with increasing number of ever-born children. Lower BMI was especially pronounced among women who were living in rural areas, non-Muslims, employed women, women not living with their husbands (separated) or those who had delivered at home or non-Caesarean delivery.

Multiple regression analysis of factors influencing dominant hand grip strength in an adult Malaysian population

Grip strength is an important measure used to monitor the progression of a condition, and to evaluate outcomes of treatment. We assessed how various physical and social factors predict normal grip strength in an adult Malaysian population of mixed Asian ethnicity (254 men, 246 women). Grip strength was recorded using the Jamar dynamometer. The mean grip strength for the dominant hand was 29.8 kg for men and 17.6 kg for women. Multiple regression analysis demonstrated that the dominant hand grip strength was positively associated with height and body mass index, and negatively associated with age for both sexes. Dominant hand grip strength was related to work status for men (p < 0.05) but not for women. However, there was no difference in grip strength among ethnic groups.

AGE AT MENARCHE OF UNIVERSITY STUDENTS IN BANGLADESH: SECULAR TRENDS AND ASSOCIATION WITH ADULT ANTHROPOMETRIC MEASURES AND SOCIO-DEMOGRAPHIC FACTORS

Age at menarche has been shown to be an important indicator for diseases such as breast cancer and ischaemic heart disease. The aim of the present study was to document secular trends in age at menarche and their association with anthropometric measures and socio-demographic factors in university students in Bangladesh. Data were collected from 995 students from Rajshahi University using a stratified sampling technique between July 2004 and May 2005. Trends in age at menarche were examined by linear regression analysis. Multiple regression analysis was used to assess the association of age at menarche with adult anthropometric measures and various socio-demographic factors. The mean and median age of menarche were 13.12+/-1.16 and 13.17 years, respectively, with an increasing tendency among birth-year cohorts from 1979 to 1986. Menarcheal age was negatively associated with BMI (p<0.01), but positively associated with height (p<0.05). Early menarche was especially pronounced among students from urban environments, Muslims and those with better educated mothers. Increasing age at menarche may be explained by improved nutritional status among Bangladeshi populations. Early menarche was associated with residence location at adolescence, religion and mothers education.

Prevalence of child marriage among Bangladeshi women and trend of change over time.

Many Bangladeshi women marry early, and many marry before the legal age of 18 years. This practice has been associated with a higher risk of health and medical morbidities, and also early pregnancy with higher pre- and postnatal complications. The aim of this study was to determine the prevalence, and factors associated with, child marriage among Bangladeshi women using multiple binary logistic regression analysis of data from the BDHS-2011. Further analysis on the trend of age at first marriage was performed with additional data sets from previous surveys. The mean and median of ages at first marriage of Bangladeshi women in 2011 were 15.69±2.97 and 15.00 years, respectively. A remarkably high percentage (78.2%) married before the age of 18; of these, 5.5% married at a very early age (before 13 years of age). Binary logistic regression analysis demonstrated that uneducated women were more likely to be married early (p<0.001) than those with secondary and higher education. Child marriage was especially pronounced among women with uneducated husbands, Muslims, those with poor economic backgrounds and those living in rural areas. Further analysis including data from previous BDHS surveys showed that child marriage among Bangladeshi women had a decreasing trend from 1993-94 to 2011. These results show that child marriage was very common in Bangladesh, and closely associated with low level of education and low economic status. The decreasing trend in child marriage indicates an improvement over the past two decades but more effort is needed to further reduce and eventually eliminate the practice.

Knee laxity of Malaysian adults: Gender differentials, and association with age and anthropometric measures.

BACKGROUND Knee laxity measurements have been shown to be associated with some medical conditions such as chronic joint pain and collagen tissue diseases. The aim of this study was to determine the effects of demographic factors and anthropometric measures on knee laxity. MATERIALS AND METHODS Data were collected from 521 visitors, staffs and students from the University Malaya Medical Centre and University of Malaya between December 2009 and May 2010. Knee laxity was measured using a KT-1000 arthrometer. Multiple regression analysis was used to find the association of knee laxity with age and anthropometric measures. RESULTS Using ANOVA, knee laxity did not show significant differences among ethnic groups for both genders. The average knee laxity in men was 3.47 mm (right) and 3.49 mm (left); while in women were 3.90 mm (right) and 3.67 mm (left). Knee laxity in women was significantly higher (right knee p<0.01 and left knee p<0.05) than men. Right knee laxity of men was negatively associated with height (p<0.05) and BMI (p<0.05); also a negative association was observed between left knee laxity and BMI (p<0.05). Overweight and obese men had less knee laxity than normal weight and underweight individuals. Elderly men and women (age 55 and above) had lower knee laxity (p<0.01) than young adults (ages 21-39). CONCLUSION These results suggest that age and body size are important factors in predicting knee laxity.

Adult anthropometric measures and socio-demographic factors influencing age at menarche of university students in malaysia

Early onset of menarche has been shown to be associated with breast cancer and ischaemic heart disease. Studies on age at menarche of the Malaysian population are poorly documented. This study aimed to determine the influence of anthropometric and socio-demographic factors on the age at menarche of university students in Malaysia. Data were obtained in 2010-11 from 961 students between the ages of 18 and 25 years from the University of Malaya using stratified sampling, and multiple regression analysis was applied. Sixty-three per cent of students reached menarche at the age of 12 or 13 years, with the mean and median of age at menarche being 12.45 ± 1.17 and 12.01 years, respectively. Menarcheal age was positively associated with height (p<0.05) and negatively associated with BMI (p<0.001). Students from urban areas attained menarche earlier than those from rural areas (p<0.05). Students from small-sized families attained menarche earlier than those from larger families (p<0.05). First-born students experienced menarche earlier than those who were seventh-born or later. Obese and overweight students reached menarche earlier than students who were underweight or of normal weight (p<0.01). The variations in age at menarche among the Malaysian ethnic groups were statistically insignificant. The results suggest that heavier and first-born students from small families are more likely to attain menarche earlier than their counterparts.

Prevalence and Associated Determinants of Low Birth Weight in Developing Countries: A Multi-country Analysis from Nationwide Population-Based Survey

Low birth weight (LBW) is a major public health concern especially in developing countries which frequently is related to child morbidity and mortality. This study aimed to identify key determinants that influence the prevalence of LBW babies in 10 selected developing countries. We conducted a secondary data analyses from the recent Demography and Health Surveys (DHS) in 10 selected developing countries. Only numerical type of birth weight data were considered for the analyses. We performed multivariate logistic regression analysis to present the unadjusted and adjusted odds ratio (OR) and 95% confidence interval (CI). We find that the overall prevalence of LBW in the study countries was 15.9% with a range of 9.0–35.1%. Results of the study demonstrated that maternal age of 35–49 years (OR = 1.66, 95% CI: 0.45–1.96), antenatal care (OR = 1.75; 95% CI: 1.08–2.82), illiteracy (OR = 1.54;0.39–1.74), later conception (OR = 1.88; 95% CI: 1.40–2.53), underweight (OR = 1.59; 95% CI: 1.21–2.09) and wealth status (OR = 1.15, 95% CI: 0.93–1.41) were significantly associated with prevalence of low birth weight. This study identified a number of determinants that have a direct influence on the prevalence of low birth weight. Strategies should be taken to improve the overall maternal health status, and thus to reduce further adverse health sequence progression. Efforts on community-based intervention programs will likely reduce the occurrence of LBW infants.

The Determinants Out-of-Pocket Healthcare Expenditure in Bangladesh: Evidence from Household Income and Expenditure Survey-2010

Like many low- and middle income countries, out-of-pocket payment (OOPP) is the most common healthcare financing mechanism in Bangladesh. Higher and unpredictable health payments can expose households to substantial financial risk along with, at their most extreme, can result in economic impoverishment. Health policy-makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. This study intends to examine the factors that are mostly influencing out-of-pocket payments healthcare in Bangladesh. A total of 10,705 populations who spent for receiving any type of healthcare services were analyzed from Bangladesh Household Income and Expenditure Survey data, 2010. We used a multiple regression model for the determinants of OOPP using Ordinary Least Square (OLS) considering socio-economic, demographic, social financial security as well as health-related indicators. Adjusted findings showed that, household characteristics like unsafe water, unhygienic toilet and household belonging to urban community were significantly associated with OOP payments. The other significant factors were household income, age, sex, informal healthcare. Finding can help for the decision-makers by stating OOPP determinants, discussing the mechanism causing them and thus making them into account to adapt OOP relevant regulations which highlights the emphasis to develop financial protection mechanisms in Bangladesh. Government should consider enhancing resources of healthcare policy. Parallel to government, spending other prudent and sustainable risk-pooling mechanism can help reducing intensity of OOP payments.

Two-Level Logistic Regression Analysis of Factors Influencing Anemia Among Nonpregnant Married Women of Reproductive Age in Bangladesh

Anemia is a common and difficult health problem in Bangladesh. Study on anemia of Bangladeshi nonpregnant married women is weakly recognized. This study examined how various anthropometric, socioeconomic, and demographic factors associated with anemia of married women in Bangladesh. For this is a cross-sectional study, data was taken from Bangladesh Demographic and Health Survey (BDHS)-2011. The nationally representative sample (5293 married women) was selected by multistage cluster sampling. Multilevel logistic regression analysis was used in this study. The prevalence of anemia among Bangladeshi married women is more than 41% and among anemic women, 35.5, 5.6, and 0.2% were, respectively, mildly, moderately, and severely affected. Multilevel logistic regression model demonstrated that women, who are currently breastfeeding and with amenorrhea, are more likely (p < 0.01) to get anemia than their counterparts. Underweight women have a higher chance (p < 0.01) to get anemia than normal weight, overweight, and obese. Uneducated women are more likely to get anemia (p < 0.01) than secondary and higher educated. Anemia is particularly marked among married women who have electricity at home (p < 0.01), currently use contraceptive (p < 0.05), are non-Muslim (p < 0.01) and come from highest wealth quintile family (p < 0.01). Moreover, women who are 30–49 years old are more likely to get anemia than those who are younger. Undernutrition is the most important predictor for anemia among Bangladeshi married women and undernourished women are usually living under poor condition. Government of Bangladesh should take administrative steps to improve economic condition for removing anemia among married women.