Mosiur Rahman

Intimate partner violence and use of reproductive health services among married women: evidence from a national Bangladeshi sample

BackgroundData from a statewide survey in India and clinic-based studies in developed settings have previously suggested an association between maternal physical intimate partner violence (IPV) experiences and the low use of antenatal care (ANC). This study aimed to explore the association between maternal experiences of physical and sexual IPV and the use of reproductive health care services, using a large nationally representative data set from Bangladesh.MethodsThis paper used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on the responses of 2001currently married women living with at least one child younger than 5 years. Exposure was determined from maternal reports of physical and sexual IPV. The utilization of ANC according to amount and type of provider and utilization of delivery assistance according to provider type were used as proxy outcome variables for reproductive health care utilization. Descriptive statistics and multivariate logistic regression analysis used in the study.ResultsApproximately two out of four (48.2%) respondents had experienced physical IPV. Maternal experience of physical IPV was associated with low use of receiving sufficient ANC (adjusted odds ratio [AOR] 0.69; 95% confidence interval [CI] 0.49–0.96), lower likelihood of receiving ANC (AOR 0.69; 95% CI 0.53–0.89), and assisted deliveries from skilled provider (AOR 0.54; 95% CI 0.37–0.78). Women who had been sexually abused were significantly less likely to have visited a skilled ANC and delivery care provider. Furthermore, severity of physical IPV appeared to have more profound consequences on the outcome measured.ConclusionsThe association between exposure to IPV and use of reproductive health care services suggests that partner violence plays a significant role in lower utilization of reproductive health services among women in Bangladesh. Our findings suggest that, in addition to a wide range of socio-demographic factors, preventing maternal physical and sexual IPV need to be considered as an important psychosocial determinates for the higher utilization of reproductive health care services in Bangladesh.

The effect of a school-based educational intervention on menstrual health: an intervention study among adolescent girls in Bangladesh.

Objectives To assess the impact of a school-based menstrual education programme on: (1) menstrual knowledge, beliefs and practices, (2) menstrual disorders experienced, and (3) restrictions on menstruating adolescents. Design Intervention study. Setting Araihazar area, Bangladesh. Participants 416 adolescent female students aged 11–16 years, in grade 6–8, and living with their parents. Interventions A school-based health education study conducted from April 2012 to April 2013. Primary and secondary outcome measures We randomly selected 3 of 26 high schools in the study area. We delivered 6 months of educational intervention by trained (by an obstetrician and gynaecologist) research assistants (RAs) on menstrual hygiene among school girls. RAs read the questionnaire and participants answered. The changes in knowledge, beliefs and practices regarding menstruation, menstrual disorders experienced, and the restrictions and behaviours practiced by menstruating adolescents were compared between the baseline and the follow-up assessments. Results After health education, participants reported a significant improvement (p<0.001) in ‘high knowledge and beliefs’ scores compared to baseline (51% vs 82.4%). Significant improvement was also observed in overall good menstrual practices (28.8% vs 88.9%), including improvements in using sanitary pads (22.4% change after the intervention), frequency of changing pads/cloths per day (68.8%), drying the used absorbent (77.6%), methods of disposing of the used absorbent (25.5%), and cleaning of genitalia (19.2%). During the follow-up, the participants reported significant improvements in the regularity of their menstrual cycle (94.5% vs 99.5%) and fewer complications during menstruation (78.6% vs 59.6%). Conclusions The programme produced significant changes in the knowledge, beliefs and practices of menstrual hygiene, complications from lack of hygiene, and the behaviour and restrictions of the menstruating adolescents. These results demonstrate the feasibility of implementing a health education programme for adolescents on menstrual hygiene in secondary schools serving rural Bangladesh.

Does gender inequity increase the risk of intimate partner violence among women? Evidence from a national Bangladeshi sample.

Background Evidence from developing countries regarding the association between gender inequity and intimate partner violence (IPV) victimization in women has been suggestive but inconclusive. Using nationally representative population-based data from Bangladesh, we examined the association between multidimensional aspects of gender inequity and the risk of IPV. Methods We used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on the responses of 4,467 married women. The main explanatory variable was gender inequity, which reflects the multidimensional aspects of womens autonomy and the relationship inequality between women and their partner. The experience of physical and/or sexual IPV was the main outcome variable of interest. Results Over 53% of married Bangladeshi women experienced physical and/or sexual violence from their husbands. In the adjusted models, women who had a higher level of autonomy (adjusted odds ratio [AOR] 0.48; 99% confidence interval [CI] 0.37–0.61), a particularly high level of economic-decision-making autonomy (AOR 0.12; 99% CI 0.08–0.17), and a higher level of non-supportive attitudes towards wife beating or raping (AOR 0.61; 99% CI 0.47–0.83) were less likely to report having experienced IPV. Education level, age at marriage, and occupational discrepancy between spouses were also found to be significant predictors of IPV. Conclusions In conclusion, dimensions of gender inequities were significant predictors of IPV among married women in Bangladesh. An investigation of the causal link between multidimensional aspects of gender inequity and IPV will be critical to developing interventions to reduce the risk of IPV and should be considered a public health research priority.

Socioeconomic differences in the prevalence, awareness, and control of diabetes in Bangladesh

AIMS To explore the association of the socioeconomic status (SES) in Bangladesh with diabetes prevalence, awareness, and control. METHODS A population sample of 7540 individuals from the 2011 Bangladesh Demographic Health Survey was used. A composite variable of education and wealth calculated the SES indicator. Besides prevalence (age-sex adjusted) of diabetes and pre-diabetes, three other points were analyzed with the socio-demographic characteristics: awareness of diabetes, diabetics receiving medication and adequacy of treatment (measured by achieving normal fasting plasma glucose). RESULTS The age-sex adjusted prevalence of diabetes and pre-diabetes were 10.8% and 25.0%, respectively, in the study population (n=7540). Prevalence of diabetes was 7.2% in the low SES (n=2147) and 17.9% in the high SES group (n=2,418). Among diabetics (n=879), 39.7% were aware of their disease, 35.5% were receiving medication, and 13.0% were receiving adequate medication. Diabetic patients from the medium or high SES group had an increased likelihood of being aware of their disease and of receiving medication. CONCLUSIONS Contrary to other developed countries, diabetes in Bangladesh is more prevalent among the higher SES group. Due to the high prevalence of pre-diabetes, lack of awareness of diabetes and less likelihood of receiving adequate treatment in lower SES group, there is potential for the rapid increase of diabetes. Urgent preventive measures are needed to control the impending diabetes epidemic.

Are survivors of intimate partner violence more likely to experience complications around delivery? Evidence from a national Bangladeshi sample

ABSTRACT Objectives To estimate (i) lifetime prevalence of physical and sexual intimate partner violence (IPV) and (ii) associations of development of complications around delivery and IPV. Methods We used data from the 2007 Bangladesh Demographic Health Survey. The analyses were based on the responses of 2001 currently married women having a child younger than five years. Exposure was determined from maternal reports of physical and sexual IPV. Experience of complications around delivery was the main outcome variable of interest. Results More than half (53%) of the women had experienced IPV. IPV of any type (adjusted odds ratio [AOR]: 1.86; 95% confidence interval [CI]: 1.35–2.56) was associated with development of complications, as was physical IPV only (AOR: 1.63; 95% CI: 1.14–2.33), sexual IPV only (AOR: 2.0; 95% CI: 1.01–3.99), and both types of IPV (AOR: 2.43; 95% CI: 1.55–3.79). There was a dose-response relationship between the number of varieties of physical IPV suffered and complications developing. Conclusions Experience of IPV is an important risk marker for the development of complications around delivery. Our findings underscore the calls for protecting women from all forms of physical and sexual violence from their husbands as part of the interventions to reduce the risk of complications supervening around delivery. They should be considered a public health research priority.

Sociodemographic factors and the risk of developing cardiovascular disease in Bangladesh.

BACKGROUND Sociodemographic determinants of predicted 10-year risk for stroke or myocardial infarction are vital to identify patients who are at increased risk. Although some risk factors of predicted cardiovascular disease (CVD) risk are documented, further exploration is necessary considering various socioeconomic and demographic factors. PURPOSE To examine risk factors for stroke or myocardial infarction according to 10-year prediction, among hypertensive patients and by sociodemographic risk differences, using a nationally representative survey. METHODS Data were obtained from the 2011 Bangladesh Demographic Health Survey and analyzed in March and July 2014. The analyses were based on responses from 1,620 hypertensive individuals. WHO guidelines for predicting 10-year risk of stroke or myocardial infarction were applied to categorize risk of CVD into low, medium, or high strata. RESULTS A total of 21.8% of hypertensive adults were at high risk for CVD. An adjusted ordinal logistic regression model showed that a female- versus male-headed household (AOR=1.85); an urban versus rural residence (AOR=1.32); being overweight/obese versus underweight (AOR=1.80); and being aged 55-69 years (AOR=1.95) or ≥70 years (AOR=2.87) versus 35-54 years were significantly associated with higher CVD risk. A regional difference in distribution of CVD risk strata was observed. CONCLUSIONS Living in a female-headed household, having an urban residence, being overweight/obese, old age, and regional variations are factors associated with higher risk of CVD among hypertensive patients.

Trends in inequalities in utilization of reproductive health services from 2000 to 2011 in Vietnam.

Objective: This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Methods: Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household’s ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Results: Significant increase in overall utilization was observed in all indicators (all p < 0.001). The concentration indices were 0.19 in 2000 and 0.06 in 2011 for antenatal care, 0.10 in 2000 and 0.06 in 2011 for tetanus vaccination, 0.23 in 2000 and 0.08 in 2011 for skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. Conclusions: More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced.

Do tobacco smoking and illicit drug/alcohol dependence increase the risk of mental disorders among men? Evidence from a national urban Bangladeshi sample.

PURPOSE This study sought to examine the relationship between tobacco consumption or illicit drug/alcohol use and mental disorders. DESIGN AND METHODS We used data from the 2006 Bangladesh Urban Health Survey. The analyses were based on the responses of 13,819 men aged 15-59 years. FINDINGS Smoking of any type was associated with an increased risk of mental disorders as were current cigarette smoking, heavy cigarette, or bidi smoking status. Ever and current use of illicit drugs/alcohol was also associated with a greater risk of mental disorders among the participants. PRACTICE IMPLICATIONS The present findings indicate that preventing tobacco smoking and illicit drug/alcohol dependence may help reduce the burden caused by mental disorders among urban Bangladeshi men. Reducing the risk of common mental health problems may also help reduce the prevalence of tobacco consumption and illicit drug/alcohol dependence.