Breast feeding,nutritional state,and child survival in rural Bangladesh

The effect of breast feeding on nutritional state, morbidity, and child survival was examined prospectively in a community in rural Bangladesh. Every month for six months health workers inquired about breast feeding and illness and measured arm circumference in an average of 4612 children aged 12-36 months. Data from children who died within one month of a visit were compared with those from children who survived. Roughly one third of the deaths in the age range 18-36 months were attributable to absence of breast feeding. Within this age range protection conferred by breast feeding was independent of age but was evident only in severely malnourished children.In communities with a high prevalence of malnutrition breast feeding may substantially enhance child survival up to 3 years of age.     

The impact of childhood malnutrition on schooling: evidence from Bangladesh

This paper examines the impact of childhood malnutrition on schooling performance in rural Bangladesh. The results reveal that malnourished children are less likely to enrol in school on time and achieve an age-appropriate grade by 26 percentage points and 31 percentage points, respectively. Other important determinants of schooling outcomes include infrastructure and education level of parents. One major contribution of this paper is the control for the endogeneity of malnutrition status, which otherwise might lead to bias estimates.     

The effect of women's status on infant and child mortality in four rural areas of Bangladesh

In South Asia women are often the primary decision-makers regarding child health care, family health and nutrition. This paper examines the proposition that constraints on women's status adversely affect the survival of their children. Survey data are used to construct indices of women's household autonomy and authority, which are then linked to longitudinal data on survival of their children. Proportional hazard models indicate that enhanced autonomy significantly decreases post-neonatal mortality. Enhanced household authority significantly decreases child mortality. A simulation based on estimated effects of eliminating gender inequality suggests that achieving complete gender equality could reduce child mortality by nearly fifty per cent and post-neonatal mortality by one-third.     

Oral contraceptive non-compliance in rural Bangladesh

This paper examines incorrect use of oral contraceptives (OCs) in rural Bangladesh by using data from an OC compliance survey. Of the 1031 current users of OCs interviewed, about 13% took their pills out of sequence, while 17% left incorrect intervals between pill packs. Forty per cent of the women reported missing one active pill during the 6 months prior to the survey, and 74% of them took correct action with the missed pill. Of the women who missed two active pills (16%), only 9% took correct action. Multivariate analyses revealed that women's education and their husbands' support helped protect against taking incorrect action with a missed pill. The fieldworker's contact was found to protect against leaving an incorrect interval between pill packs. Women who had membership of non-government organizations were less likely to interrupt their pill use, and more likely to take their pill out of sequence. The present study underscores the need for providing women with more support in their pill use, and advocates that service providers should be the focal point of efforts. Husbands' support is essential to improve the pill-taking behaviour of Bangladeshi women.     

Infant and child mortality in Bangladesh

Socioeconomic differences and trends in infant and child mortality in Bangladesh are examined using data from the 1975 World Fertility Survey and 1979 Contraceptive Prevalence Survery. There is evidence of some recent decline in infant mortality and child mortality. Logit analysis of infant and child mortality indicates that sociodemographic variables such as mother's education, recent period, or higher birth orders, has significant independent effects upon the reduction of infant and child mortality. Other variables such as fetal loss, father's education, or land ownership had no consistent significant effect. On the other hand the effect of urban residence on infant and child mortality was positive after the control of sociodemographic variables. Mere concentration on the supply of modern medical services may bring limited returns unless they are reinforced by appropriate social changes, in particular those affecting the socioeconomic status of women. Educated mothers are likely to belong to higher income households, have better knowledge of how to care for children, and can bring more resources to the care of a sick child.     

The cost-effectiveness of health education in improving knowledge and awareness about intestinal parasites in rural Bangladesh

The impact of regular health education in improving knowledge, attitude and practices in the control of intestinal parasites was examined in four rural areas of Bangladesh; two areas received health education and the other two areas were controls. By the end of the 18-month study households receiving health education showed highly significant improvements in knowledge, water and sanitation facilities and personal hygiene compared with households in the control areas. Improving knowledge by 1% cost between US dollars 0.75 and 0.82 per household, while a 1% improvement in personal hygiene cost between US dollars 1.10 and 1.32 per household and water and sanitation between US dollars 1.39 and 1.52 per household.     

Determinants of pill failure in rural Bangladesh

The pill is the most popular family planning method in Bangladesh. However, the failure rate of this method in Matlab, a typical rural area, has been found to be very high. It is estimated that with the current level of failure of the pill and other temporary contraceptives in Matlab, it is unlikely that fertility in Bangladesh will come down to replacement level without a change in contraceptive method mix. It is, therefore, important to know the reasons for the high failure in pill use. Data for this study came from a case-control study in Matlab. A pill failure was considered a case, and no-failure was considered a control. The study included 167 cases and 167 controls. In addition, five focus group discussions were conducted to supplement the data collected from the cases and controls to gain a deeper understanding of pill failure. Results of the analysis of both quantitative and qualitative data suggested that the following were the risk factors for pill failure: no mobility of women, poor knowledge of women about the effectiveness and consequences of drop-out from pill use, weak confidence in the pill, a gap between the use of subsequence pill cycles, delay in starting the pill after menstruation for the first use, not taking any measures consistently for missing the pill, and not following the arrow sign given on the pill cycle. Extensive training of field workers and pill users, covering the reasons for pill failure identified in this study and strong supervision of the work of field workers, is likely to reduce the rate of pill failure in Bangladesh. Also, information, education and communication services for users, and management of side-effects, may be helpful in reducing pill failure.     

The fitness of twin mothers: evidence from rural Gambia

We used a longitudinal database from a natural fertility population in rural Gambia to compare the overall fertility of mothers who had given birth to twins at some point in their reproductive history and mothers who had only ever given birth to singletons. We found that twin mothers had shorter birth intervals, higher age‐specific fertility and more surviving children than singleton mothers. This suggests that, despite the considerably higher mortality of twins found in this population, twin mothers have a fitness advantage over singleton mothers, even in the absence of modern medical care. We ran a simple simulation model to estimate the relative fitness of twin and singleton mothers, and found that the model also estimated higher fitness for twin mothers. Further, girls who went on to become twin mothers were of higher anthropometric status during their teenage years than those who became singleton mothers.     

Socioeconomic status and fertility in rural Bangladesh

Using a unique set of birth registration data from the Demographic Surveillance System of the International Center for Diarrheal Disease Research, Bangladesh, for the period 1974-77, and socioeconomic information collected in the 1974 census, fertility was studied in relation to occupation, size of dwelling, number of cows and number of boats owned. The total fertility rate was found to vary between 6 and 6.5 except in the famine year of 1975. There was no consistent relationship between fertility and education of women. The age-specific fertility rates by religion show that Muslims had higher fertility at all ages in 1974 and 1977 and at older ages in 1975 and 1976. Overall, however, fertility of Hindus is consistently lower than that of Muslims, but the relative differences are under 10%. Fertility differentials by occupation showed that the household heads who were farm laborers had relatively lower fertility compared to other occupational groups, except for the year 1977 where the families of service holders were found to have relatively lower fertility. Women in households whose heads were businessmen or farmers (owning their land) had above average fertility. In 1974, households in the business occupational groups had, on average, 1 birth more than other households. Women in households with fishermen as heads had below average fertility in 1974 and 1975, but very high fertility in 1976 and 1977. Fertility levels differed according to the type of household in which the family resided. Nuclear families had below average fertility up to the age of 35 and above average fertility at the end of the reproductive age. In the 15-19 age group, augmented families had higher fertility each year examined. The association between dwelling place and fertility is positive each year, the relative differences in fertility between the groups being largest in 1974. Positive relations were found between economic status and fertility.     

Infant mortality in Bangladesh: a review of recent evidence

Estimates of child mortality are mainly based on reports by mothers on the survival status of their children. Infant mortality estimates from such data do not seem to have declined in recent years. The Bangladesh Bureau of Statistics sample registration infant mortality estimates appear to be suspiciously low.     

Twinning rates in a rural area of Bangladesh

In this study we investigate the incidence of twin births over a period of 16 years in a rural area of Bangladesh using data from the Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research. Over the study period twinning rates fluctuated between 7.8 and 11.2 per 1000 live births. The twinning rate was strongly correlated with maternal age; the rate for mothers over 35 years of age was about 3 times higher than for mothers younger than 20 years. The variation in twinning rate with maternal age is due to the variation in dizygotic twinning; the rate of monozygotic twinning is almost constant for all ages. Twinning rates were higher in the treatment area than in the comparison area after controlling for maternal age and parity. The rates were lower for monozygotic twinning and higher for dizygotic twinning in the treatment area than in the comparison area. Seasonality was observed for both twins and singletons, but the peak for twinning precedes that for singleton births by more than a month.     

Determinants of contraceptive continuation in rural Bangladesh.

A contraceptive study of rural Bangladeshi women indicated that the previous death of children, number of living children, desire for additional children and son preference were important determinants of contraceptive continuation. The importance of these factors varies to some extent with use of different contraceptive methods.     

Regulation of birthweight by placenta-derived miRNAs: evidence from an arsenic-exposed birth cohort in Bangladesh

Altered expression of microRNAs (miRNAs) is implicated in fetal growth. However, the mechanisms by which placenta-derived miRNAs regulate birthweight are not well understood. In Phase 1, we compared the expression of 754 miRNAs in the placenta of mothers from two extreme birthweight groups (0.8–2.2 kg vs. 3.3–3.9 kg, n = 77 each) selected from an arsenic-exposed Bangladeshi birth cohort (n = 1,141). We identified 49 miRNAs associated with the extreme birthweight groups and/or gestational age in Phase 1, which were further analyzed in Phase 2 among 364 randomly selected mother-infant pairs. Gestational age was determined by ultrasound. Causal mediation analysis was used to estimate the effect of miRNAs on birthweight considering gestational age a mediator, adjusting for core blood arsenic and other risk factors. miR-1290, miR-195, and let-7g showed significant inverse associations with gestational age, while miR-328 showed significant positive association [false discovery rate (FDR) <0.05]. Via changing gestational age, miR-1290, miR-195, and miR-27a showed significant inverse associations with birthweight, while miR-328 and miR-324-5p showed significant positive associations (FDR <0.05). The effect of miRNAs on birthweight varied by gestational age (for miR-1290, miR-195, miR-328) and in utero arsenic exposure (for miR-1290): stronger effect was observed among infants delivered early in gestation or exposed to higher concentrations of arsenic in cord blood. Gene enrichment analysis with in silico predicted targets identified cell proliferation, inflammation, apoptosis, insulin, and IGF family signaling cascades associated with these miRNAs. Future studies are warranted to replicate these findings and assess these miRNAs as early biomarkers of fetal growth.     

Application of a marriage model in rural Bangladesh

The standard marriage model is evaluated with respect to its applicability in Bangladesh, so that reliable and consistent estimates of mean marriage age for females in Bangladesh can be made. The standard marriage model proposes that a person enters the marriage market and waits until marriage occurs. The distribution of age at entry into the marriage market is generally normal. The delays until marriage occurs are modelled as negative exponential distributions. In a population where marriage is universal, the standard schedule of 1st marriage frequencies developed by Coale and McNeil is a close approximation to the convolution of a normal curve and several exponential distributions G(x), the cumulative probability of marriage at age x. Since the standard distribution of age at 1st marriage is closely approximated by the convolution of a normal curve and several negative exponential distributions, the age at entry to the marriage market for females, and whether this is normally distributed, should be examined. 1 cross-sectional study in Bangladesh concludes that onset of menarche determines entry into the marriage market. The proportion of ever married females by single year of age which is available from cross sectional demographic surveys can be fitted to the Coale-McNeil model. Marriages in the rural areas of Bangladesh seem to follow the pattern of entering the marriage market at puberty, then waiting until actual marriage takes place. This model of entries and delays can also be fitted to cross-sectional data from rural Bangladesh. The use of the Coale-McNeil marriage model in rural Bangladesh is appropriate for estimating the mean age of marriage.     

Unmet need for additional medical care for sick children in mother's view in rural Bangladesh: implications for improving child health services

While a country's health policy aims to provide health services to all who need them, very little in known about unmet need for additional medical care from users' perspectives in Bangladesh. This study examined unmet medical need (defined as whether a mother felt that, to manage sickness, her child had required medical care that was not available, regardless of reasons and medical care sought) of 2123 under-15 sick children by illness and child's socioeconomic characteristics in rural Bangladesh. The 1996 Health and Socioeconomic Survey conducted in Matlab recorded children's chronic (a disease or a condition lasting 3 months or more) and acute (a disease or a condition with a rapid onset and a short, severe course) morbidity, medical care sought to combat illness and unmet needs for additional medical services in mothers' views to manage the illness. The survey also recorded household socioeconomic data. Logistic regression was used to examine the data. The results reveal that unmet needs for additional medical care were 5.4% for children with acute illnesses, and 30.2% for children with chronic illnesses. For chronic illnesses, seeking medical care to manage illness from any health provider outside the home reduced unmet medical needs. Economic inequalities existed for both acute and chronic illnesses: the odds ratio of unmet medical needs for sick children of the least poor households was 0.42 (95% CI: 0.28-0.64) times that for sick children of the very poor households. The critically high unmet needs for children's chronic morbidity reveal that the chronic disease control programme in Bangladesh needs urgent revisiting and strengthening.     

Men's involvement in family planning in rural Bangladesh

Contraceptive prevalence has risen markedly in rural Bangladesh due in part to a doorstep-delivery system initiated by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). This study investigates effects of residence in the Matlab MCH-FP treatment area on men's involvement in family planning. The analysis compares for treatment and comparison areas knowledge of and attitudes toward contraception, as well as levels of contraceptive use, among 413 married men interviewed at the baseline of an ICDDR,B men's involvement project. Although residence in the MCH-FP area is associated with a higher overall contraceptive prevalence, it also is associated with a lower adjusted ratio of male-to-female method use, and lower odds of other indicators of men's involvement in family planning. Historical decisions to exclude men from contraceptive decision-making may place the 'burden' of contraception on women and may preclude the productive involvement of men. These and other implications and strategies for increased men's involvement are discussed.     

Son preference and child replacement in Bangladesh: a new look at the child survival hypothesis

Birth history data from women in the 1975-76 Bangladesh Fertility Survey were used to search for intentions to replace dead children. The median intervals between successive births of orders (i) and (i + 1) were not shorter when some siblings of orders below (i) had died. Nor was the median duration between the death of a child and the first posthumous birth shorter when the dead child was a boy or when it was survived by fewer than two brothers. The median intervals were generally shorter when the mother lived in an urban rather than a rural area but this difference was attributable only to the shorter duration of breast-feeding by urban women. These results disputed the notions that the timing of births was deliberately quicker to replace a dead child, that attempts at replacement were sex-selective, or that child replacement intentions were stronger in urban than in rural populations.     

The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study

Background

Standard public health interventions to improve hand hygiene in communities with high levels of child mortality encourage community residents to wash their hands with soap at five separate key times, a recommendation that would require mothers living in impoverished households to typically wash hands with soap more than ten times per day. We analyzed data from households that received no intervention in a large prospective project evaluation to assess the relationship between observed handwashing behavior and subsequent diarrhea.

Methods and Findings

Fieldworkers conducted a 5-hour structured observation and a cross-sectional survey in 347 households from 50 villages across rural Bangladesh in 2007. For the subsequent 2 years, a trained community resident visited each of the enrolled households every month and collected information on the occurrence of diarrhea in the preceding 48 hours among household residents under the age of 5 years. Compared with children living in households where persons prepared food without washing their hands, children living in households where the food preparer washed at least one hand with water only (odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.57–1.05), washed both hands with water only (OR = 0.67; 95% CI = 0.51–0.89), or washed at least one hand with soap (OR = 0.30; 95% CI = 0.19–0.47) had less diarrhea. In households where residents washed at least one hand with soap after defecation, children had less diarrhea (OR = 0.45; 95% CI = 0.26–0.77). There was no significant association between handwashing with or without soap before feeding a child, before eating, or after cleaning a child''s anus who defecated and subsequent child diarrhea.

Conclusions

These observations suggest that handwashing before preparing food is a particularly important opportunity to prevent childhood diarrhea, and that handwashing with water alone can significantly reduce childhood diarrhea. Please see later in the article for the Editors'' Summary     

Maternal factors and infant and child mortality in Bangladesh

Using data from The World Fertility Survey, this study shows that the length of the preceding birth interval was the most important maternal factor influencing infant and child mortality risks in Bangladesh. This was such a crucial factor that its effects remain unaltered whether or not the influences of mother's age at birth and birth order are controlled. Infant and child mortality in Bangladesh can be expected to decline considerably if successive births can be spaced by an interval of at least 1.5 years. Child spacing seems to be the major factor requiring program attention. The effects of mother's education and place of residence on infant and child mortality are independent of the effects of maternal age at birth, birth order, and the preceding birth interval. The higher survival chances of children of educated mothers resulted neither through the age at which childbearing started nor through birth spacing but are likely to be related to their smaller family size and to other non-maternal proximate determinants of early mortality.