Effect of famine on fertility in a rural area of Bangladesh

Data on household socioeconomic status collected in the 1974 census and registration data on births, deaths, and migrations for the 1974-77 period from the Demographic Surveillance System of the International Centre for Diarrheal Disease Research, Bangladesh, were used to investigate the effects of the 1974-75 famine on differential fertility in a rural population of Bangladesh. Occupation of household head was used as a measure of socioeconomic status. Overall, fertility declined by 34% over the 1975-76 period and increased by 17% in 1976-77 from the 1974-75 figure. Significantly lower fertility was observed in 1975-76, irrespective of socioeconomic status, but the lower socioeconomic groups were affected more than the higher groups. Post-famine fertility was significantly higher only in the 2 middle occupation categories. The age-specific fertility rates suggest that the famine affected all age groups. The post-famine fertility was higher than that of 1974-75 in all but those aged below 20. At age 40 and over the recovery was slight. Husband-wife separation showed an increase during the famine and particularly among the lower socioeconomic groups. The males of the lower socioeconomic households migrated to other regions to obtain food for the family, thus affecting frequency of coitus. The decline in fertility may be due to several factors: deferred marriage; increase in divorces and husband-wife separations; high fetal wastage; voluntary fertility control through contraception, abstention, or induced abortion; and infecundability. An indirect measure of marriage rate indicated that fewer couples entered into marriage in 1974-75, particularly in the lower socioeconomic groups. Both the higher and lower socioeconomic groups were affected by the famine but the precise mechanisms were not the same. At this stage, it is not feasible to estimate the contribution of each factor to the fertility decline. The lower socioeconomic groups were more affected by husband-wife separations and deferred marriages; the higher socioeconomic groups were affected by mental stress and anxiety.     

Microbiological analysis of tube-well water in a rural area of Bangladesh.

Five tube-wells in Matlab, Bangladesh, were selected for analysis of selected biophysicochemical parameters. The results showed that all tube-well water samples contained zooplankton and bacteria. Results for some of the parameters were outside the accepted limits recommended by the World Health Organization for drinking water. It is concluded that water from tube-wells should be treated if used as drinking water.     

Twinning rates in Ghana.

The incidence of twin births in Accra and Kumasi, the two major cities in Ghana, was investigated. In Accra, data were collected from the Korle-Bu Teaching Hospital while data were collected and analyzed from the Komfo Anokye Teaching Hospital in Kumasi. Both hospitals are the leading teaching hospitals in Ghana. The data consisted mainly of single and twin births recorded in the hospitals over a period of 12 years in Accra (1988-1999) and 15 years in Kumasi (1985-1999). The study revealed an incidence of 33.4 twin births per thousand live births for Accra and 26.6 twin births per thousand live births for Kumasi. Though these values are not as high as those reported among the Yoruba tribe of southwest Nigeria, who are reported to have the highest twin birth rates in the world, the present values still rank among the highest recorded twin birth rates.     

The relationship between sociodemographic variables and pregnancy loss in a rural area of Bangladesh

This study examines the relationship between eight sociodemographic variables and the risk of pregnancy loss in a rural area of Bangladesh. The risks of spontaneous miscarriage and stillbirth were significantly associated with maternal age, pregnancy order and previous pregnancy wastage.     

Sociodemographic differentials in mortality during the 1974-75 famine in a rural area of Bangladesh

This study investigates the socio-demographic differentials in mortality during the 1974-75 famine in a rural area of Bangladesh. It is based on household socioeconomic information collected in the 1974 census and registration data on births, deaths and migrations for the period 1974-79 from the Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh. Ownership of selected household items was considered in the analysis as an indicator of household socioeconomic status. Mortality was 62% higher during the famine period and 31% higher during the post-famine period compared to the non-famine period. The mortality of both the poor and the rich increased during the famine period, by 117% and 28% respectively compared to the non-famine period. The poor suffered significantly in all age groups except 5-14 years, while the rich suffered only for ages 65 and over. Poor males suffered more than poor females except for ages 65 and over, while rich females suffered more than rich males except for ages under 1 year.     

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.     

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.     

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.     

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.     

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.     

Twinning propensity and offspring in utero growth covary in rural African women

In humans and other mammals, some females are more likely to experience twin pregnancies than others, but the reasons behind such individual variation are poorly understood. One hypothesis invokes variation in the dynamics of the insulin-like growth factor (IGF) system, which also regulates foetal growth. Using data from a rural African population living in a highly seasonal environment, we test a novel prediction generated by this hypothesis, that maternal twinning status predicts offspring birthweight. We found that among singleton offspring who experience a favourable in utero environment (born January-June), births before and after twins are, respectively, associated with a 134.07 g and 226.41 g increase in birthweight compared with those born to non-twinning mothers. These results were not mediated by maternal anthropometry. This is consistent with a role for the IGF system in individual variation in twinning propensity, a possibility with implications for understanding mechanisms of life-history variation in humans and other vertebrates.     

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.     

Management of myocardial infarction in a rural area

In an attempt to determine the most appropriate type of facility for the treatment of myocardial infarction in a rural community, the five-year experience of a practice serving 10,000 people is reviewed. This population is found to have a low incidence of myocardial infarction, a low death rate from the condition both in hospitalized patients and in the general population, and a low incidence of complications in the survivors. None of the deaths either in or out of hospital would likely have been prevented through the use of specialized facilities. It is concluded that no such facilities are necessary in this community and that other areas considering their acquisition should justify the need on the basis of their own experience and not on accounts in the literature.     

Malnutrition, menarche, and marriage in rural Bangladesh

In order to assess the impact of nutritional status on the onset of menarche and the association between age at menarche and age at marriage, a survey of 1155 girls, ages 10 through 20, was conducted in a rural area of Bangladesh in March 1976. In order to obtain an estimated mean of age of menarche, probit analysis was used. The mean age of menarche using this technique is estimated at 15.65 for Muslims and 15.91 for Hindus. It was learned that in recent years the age of menarche has increased in a rural area. This increase seems to be associated with malnutrition caused by the war, postwar inflation, floods and famines during the 1971-75 period. When age is controlled for, the prominent effect of weight on menstrual status is evident. 98% of the girls whose weights were 88 pounds or greater had reached menarche compared to only 1% of those weighing less than 66 pounds. Body weight appears to be 1 of the most important factors for the determination of onset of menarche. There exists a seasonality of onset of menarche with a peak in winter. Age of marriage among this rural population has increased and may be associated with the increasing age of menarche. Since both age of menarche and age of marriage have increased, fertility among females age 15-19 may be expected to decrease in the future if this pattern continues.     

Colostrum feeding behaviour and initiation of breast-feeding in rural Bangladesh

Human breast milk is primarily colostrum immediately following birth. Colostrum gradually changes to mature milk over the next several days. The role of colostrum in fighting infections and promoting growth and development of the newborn is widely acknowledged. This role is mediated by differences across cultures in the acceptability of colostrum and the prevalence of colostrum feeding. This study examined the prevalence of colostrum feeding and time to initiation of breast-feeding in 143 rural Bangladeshi women in Matlab thana. Structured interviews were collected during a 9-month prospective study conducted in 1993. Women were usually interviewed within 4 days of giving birth and were asked about whether or not they fed their child colostrum and the number of hours until they began breast-feeding the baby. Ninety per cent of the mothers reported feeding their newborn colostrum. A logistic regression found no effect on the prevalence of colostrum feeding from the following covariates: mother's age, parity, history of pregnancy loss, child's sex, mother's self-report of delivery complications, and the time from birth to interview. Fifty-nine per cent of mothers initiated breast-feeding within 4 h, and 88% within 12 h of parturition. Survival analysis was used to estimate the effects of covariates on the time from delivery to initial breast-feeding. Time to initial breast-feeding was delayed slightly, but significantly, for older mothers, for male infants, and by mothers who did not report delivery complications. The percentage of mothers who fed their child colostrum was higher, and times to initial breast-feeding were shorter, than almost all previous reports from South Asia. These findings might be explained, in part, by methodological differences among studies, but it is suggested that recent changes towards earlier initiation of breast-feeding have taken place in rural Bangladesh.     

Infant mortality in relation to internal migration in rural Bangladesh

In Matlab thana, a rural area of Bangladesh, there is a substantial deficit of males of reproductive age owing to urban migration of males who leave their families behind. These men nevertheless return to visit their families frequently. 30% of the births in this area occur to families with migrant fathers: neonatal mortality rates in these families are nearly double those of families with non-migrant fathers. This high risk, in turn, interacts with educational attainment and maternal nutrition. Only those migrant families where mothers have no education or have low body weight experience high neonatal mortality rates. Psychological stress during pregnancy, probably caused by fear and anxiety related to the husband's absence may in part be responsible for such differential risk during the neonatal period.     

The effect of divorce on infant mortality in a remote area of Bangladesh

The process of divorce is usually lengthy and hazardous, and can start quarrels that can lead to the abuse of women and their children. This study examines the effects of divorce on neonatal and postneonatal mortality of babies born before and after divorce in Teknaf, a remote area of Bangladesh. The longitudinal demographic surveillance system (DSS) followed 1,762 Muslim marriages in 1982-83 for 5 years to record divorce, deaths of spouse, emigration and births. It recorded 2,696 live births during the follow-up period, and their survival status during infancy. Logistic regression models were used to estimate the effect of divorce on neonatal and postneonatal mortality, controlling for maternal age at birth, parity, sex of the child and household economic status. The odds of neonatal and postneonatal deaths among babies born after divorce or less than 12 months before mothers were divorced were more than double the odds of those born to mothers of intact marriages. The odds of postneonatal deaths were two times higher among babies born more than 12 months before divorce happens than their peers. The high mortality of infants born before and after mothers were divorced may reflect how abusive marriage and divorce increase the vulnerability of women and children in rural Bangladesh. Divorce and abuse of women are difficult and intractable social and health problems that must be addressed.     

Area variations in use of modern contraception in rural Bangladesh: a multilevel analysis.

This study in Bangladesh found that inter-cluster variation in the use of modern reversible methods of contraception was significantly attributable to the educational levels of the female family planning workers working in the clusters. Women belonging to clusters served by educated workers had a higher probability of being contraceptive users than those whose workers had only completed primary education. At the household level, important determinants of use were socioeconomic status and religion. At the individual level, the woman being the wife of the household head and having some education were positively related to her being a user. The model also found that inter-household variation was significantly greater than inter-cluster variation. Finally, the study concludes that after controlling for various covariates at all three levels, the clusters do not have significantly different levels of use of modern reversible methods of contraception. There are, however, some special areas where contraceptive use is dramatically low, and these contribute significantly to the observed inter-cluster variation.