Association between age at menarche and early-life nutritional status in rural Bangladesh

Age at menarche is associated with anthropometry in adolescence. Recently, there has been growing support for the hypothesis that timing of menarche may be set early in life but modified by changes in body size and composition in childhood. To evaluate this, a cohort of 255 girls aged <5 years recruited in 1988 were followed up in 2001 in Matlab, Bangladesh. The analysis was based on nutritional status as assessed by anthropometry and recalled age at menarche. Data were examined using lifetable techniques and the Cox regression model. The association between nutritional status indicators and age at menarche was examined in a multivariate model adjusting for potential confounding variables. Censored cases were accounted for. The median age at menarche was 15.1 years. After controlling for early-life predictors (birth size, childhood underweight, childhood stunting) it appeared that adolescent stunting stood out as the most important determinant of age at menarche. Adolescent stunting still resonates from the effect of stunting in early childhood (OR respectively 2.63 (p<0.01 CI: 1.32-5.24) and 8.47 (p<0.001 CI: 3.79-18.93) for moderately and severely stunted under-fives as compared with the reference category). Birth size was not a significant predictor of age at menarche. It is concluded that age at menarche is strongly influenced by nutritional status in adolescence, notably the level of stunting, which is in turn highly dependent on the level of stunting in early childhood. A 'late' menarche due to stunting may be detrimental for reproductive health in case of early childbearing because of the association between height and pelvic size.     

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.     

Nutritional status of adults in rural Mali.

An anthropometric assessment was conducted of 441 adults from six rural villages in southern Mali. As is typical for human populations, females are shorter and lighter than males. Both females (N = 320) and males (N = 121) are shorter and lighter than their U.S. counterparts. Mean weight in the sample is 53.4 +/- 8.5 kilos for females and 58.8 +/- 6.5 kilos for males. Mean height is 160.4 +/- 5.7 cm for females and 171.3 +/- 6.6 cm for males. The data for height in males are very similar to those reported from other surveys in Mali, and show no evidence for a positive secular trend in height. Mean body mass index (BMI) is 20.8 for females and 20.0 for males. These are lower than U.S. averages, but well above suggested cutoff points for malnutrition in adults. Average arm circumference is 26.5 cm for females and 26.4 cm for males. Females have relatively large arm circumferences due, in part, to the heavy manual labor they perform. Average head circumference is 53.0 cm for females and 54.8 cm for males. For both sexes, these values are more than 1 standard deviation (SD) below the U.S. means. Adult values for anthropometric measurements reflect childhood stresses of malnutrition and disease, and a lifetime of accommodation to a high-carbohydrate, low-protein diet, and hard physical labor. Females are significantly closer to the U.S. standards than males for weight, height, BMI, and arm circumference; these findings support the idea that females are buffered from environmental stresses relative to males. In addition, females exhibit significantly more variability than males for weight, arm circumference, and head circumference, but not for height, suggesting that variability in adult height does not reflect the presence or absence of female buffering or the level of environmental adversity.     

Nutritional status of under-five children in Bangladesh: a multilevel analysis

The nutritional status of under-five children is a sensitive sign of a country's health status as well as economic condition. This study investigated the differential impact of some demographic, socioeconomic, environmental and health-related factors on the nutritional status among under-five children in Bangladesh using Bangladesh Demographic and Health Survey 2007 data. Two-level random intercept binary logistic regression models were used to identify the determinants of under-five malnutrition. The analyses revealed that 16% of the children were severely stunted and 25% were moderately stunted. Among the children under five years of age 3% were severely wasted and 14% were moderately wasted. Furthermore, 11% of the children were severely underweight and 28% were moderately underweight. The main contributing factors for under-five malnutrition were found to be child's age, mother's education, father's education, father's occupation, family wealth index, currently breast-feeding, place of delivery and division. Significant community-level variations were found in the analyses.     

Socioeconomic determinants of age at first marriage in Bangladesh

Using data from the 1976 Bangladesh Fertility Survey, multiple classification analysis was used to evaluate the effect of socioeconomic factors on age at 1st marriage. The independent variables considered were education, childhood and current residence, religion, work status before marriage, and husband's childhood residence, education, and occupation. Analysis was carried out for the total sample as well as for 3 birth cohorts of approximately equal size: 1) those born before 1940, 2) those born between 1940-50, and 3) those born after 1950. Of all the included variables, women's education has the strongest influence on the variation of age at 1st marriage. For all ever-married women, the mean age at marriage for women with primary education is 13.4 years, 0.9 years higher than for women with no education (12.5 years), and 1.2 years lower than for women with a high school education or beyond (14.6 years). Difference in means for cohorts indicate a gradually increasing influence of education on people's decision in marriage. Husband's education does not appear to be as important. Childhood residence has, directly and indirectly, a strong influence in marriage age. Among other factors, women's premarital work participation, as well as region and husband's occupation, are important. Since women's education, childhood residence, and work participation are the strongest socioeconomic variables affecting marriage age, the modernizing influences of education, urbanization, and female work participation should have an effect on the marriage pattern; this effect is consistent with that observed in other societies.     

Nutritional status and dietary habits of urban and rural Polish adolescents

The aim of this work was to compare the basic food ingredient level and some nutritional status indices between the two groups of adolescents: the first one from the urban environment and the other one from the rural environment. A series of tests were conducted on a 400-teenager-group (200 girls and 200 boys), which was divided into two age groups: 10.5-year-olds and 13.5-year-olds. Nutritional status was estimated on the basis of the following anthropometric measurements: body height, body mass index, upper arm circumference, triceps skinfold thickness. Food intake was assessed by means of a 24-h dietary recall. The analysis of the results of the investigation showed: rare overweight and obesity occur in rural children aged 10.5 years and a higher risk of undernutrition among rural children, especially boys; more frequent overweight and obesity in rural girls and urban boys aged 13.5 years; a lower protein consumption, especially animal protein, and a lower percentage of the accomplishment of the norm for many mineral components and vitamins in rural girls and boys.     

Nutritional status influences peripheral immune cell phenotypes in healthy men in rural Pakistan

ABSTRACT: Immune status is influenced by malnutrition, but how this factor interacts in developing countries and whether these differences are similar to those determined in industrialized countries, is unclear. To establish whether malnutrition-associated immune profiles in a developing country are similar to those in industrialized countries we analyzed peripheral blood immune cell phenotypes by polychromatic flow cytometry in 50 young and 50 elderly subjects. Data on anthropometrics and diet were collected through interviews. Plasma samples were analyzed for common clinical chemistry variables. Subjects in 4 BMI categories differed in their immune parameters demonstrating influence of nutritional status on immunity. This was greater within the young group and affected the CD4 subset more profoundly than the CD8 subset. No nutrition-associated differences were seen in B or NK cells. CD8+ cells as a percentage of CD3+ T cells were positively associated with plasma CRP levels but not other factors. We conclude that there are differences in the immune signatures of obese, overweight and underweight versus normal-weight young and elderly, which seem broadly similar to the more extensively-documented state reported in industrialized countries, despite the marked societal, nutritional and many other differences.     

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.     

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.     

Migration,socio-economic status and age at menarche and age at menopause in the Yucatan,Mexico

The possible effects of migration and socio-economic status (SES) on age at menarche (MENA), age at menopause (MENO), potential reproductive period (PRP), and the correlation between MENA and MENO, were studied in 216 women in the Yucatan, Mexico. They were divided into three groups: migrant from the sisal-growing area on the coast, and sisal and coastal sedentary. Coastal sedentary women, living in the best socio-economic conditions, have the youngest MENA and the oldest MENO. Early migrant women have a significantly younger MENO (p.<0.05) and shorter PRP than Coastal sedentary women. There was no evidence of selective migration for MENA. When the Migrant, Sisal and Coastal sample were divided into cohorts by SES, it was impossible to obtain any clear picture. MENA increases with increased SES for the Coastal and Sisal cohorts, while the Migrant cohorts show an opposite trend. However, only the Low/Middle and High/Middle cohort differences for the Coastal sample are significant (p.<0.05, in both cases). It seems that migration has a limited affect on MENO and the PRP. Contrary to reports in the literature, the correlations between MENA and MENO and migrant status, and migrant socio-economic statuses, are negative, although these correlations were statistically significant in the Coastal sample.     

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.     

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.     

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.     

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.     

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.     

HIV status and age at first marriage among women in Cameroon

Recent research has highlighted the risk of HIV infection for married teenage women compared with their unmarried counterparts (Clark, 2004). This study assesses whether a relationship exists, for women who have completed their adolescence (age 20-29 years), between HIV status with age at first marriage and the length of time between first sex and first marriage. Multivariate analysis utilizing the nationally representative 2004 Cameroon Demographic and Health Survey shows that late-marrying women and those with a longer period of pre-marital sex have the highest risk of HIV. Although women in urban areas overall marry later than their rural counterparts, the positive relationship between age at marriage and HIV risk is stronger in rural areas. The higher wealth status and greater number of lifetime sexual partners of late-marrying women contribute to their higher HIV risk. Given that the age at first marriage and the gap between first marriage and first sex have increased in recent years, focusing preventive efforts on late-marrying women will be of much importance in reducing HIV prevalence among females.