Background Association between poor infant and young child feeding (IYCF) practices and malnutrition in infants and young children (IYC) is well established. Furthermore, appropriate IYCF practices are important during the first 1,000 days of life to ensure optimal health and development. Understanding IYCF practices and associated socioeconomic and demographic factors will inform interventions to achieve the UN 2030 Sustainable Development Goal (SDG) target to end malnutrition in all forms. Objective This study estimates the prevalence of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF), and Minimum Acceptable Diet (MAD), and examines their association with socioeconomic and demographic characteristics among children aged 6–23 months in Ghana. Method We used data from the Ghana Multiple Indicator Cluster Survey 6 (GMICS6) conducted in 2017–18. Participants were recruited through multi-stage stratified cluster sampling. Information on caregiver’s self-reported breastfeeding status and 24-hour dietary recall of foods IYC were fed with were collected through face-to-face interviews. We estimated the prevalence of MDD, MMF and MAD with a 95% confidence interval (CI). We investigated the socioeconomic and demographic determinants of MDD, MMF and MAD using univariate and multivariable logistic regression analyses. Findings Among 2,585 IYC aged 6–23 months, MDD, MMF and MAD were estimated as 25.46%, 32.82% and 11.72% respectively. Age of the IYC, educational status of the mothers/primary caregivers, and resident regions were found to have positive associations with MDD, MMF and MAD. In addition, the richest household wealth index and urban area of residence were found to have significant positive associations with MDD. Conclusion We report a low prevalence of MDD, MMF and MAD. Efforts to improve IYCF practices among children aged 6–23 months in Ghana should focus on multi-sectorial approaches including increasing access to formal education, income-generating activities and addressing regional and rural-urban inequity.
Contact tracing can play an important role in controlling infectious disease outbreaks such as the COVID-19 pandemic. Containing the spread of COVID-19 is crucial in humanitarian settings such as in the Rohingya camps in Cox’s Bazar, Bangladesh. This manuscript describes the COVID-19 contact tracing activities undertaken by a group of researchers and implementers in Cox’s Bazar, Bangladesh. The paper details the design and development of the Commcare ‘Contact tracing and case monitoring app’, subsequent implementation of the contact tracing activity, challenges faced during the implementation process, and the strategies adopted by the research team to overcome these challenges. The research team leveraged the suite of template applications for COVID-19 response developed by Dimagi in response to the COVID-19 pandemic. Research partners organized a series of brainstorming meetings and workshops with relevant stakeholders to finalize the ‘COVID- 19 contact tracing and case monitoring app’ for final implementation. This app was implemented in 10 Rohingya camps from Ukhiya and Teknaf sub-districts of Cox’s Bazar for 4.5 months from 1st January 2021 to 15th May 2021. Due to a restriction on internet availability in the Rohingya camps by the government of the host country, the research team had to adopt a manual approach to implement the contact tracing activity. During these 4.5 months, 249,452 individuals from 10 Rohingya camps were screened for COVID-19 case registration. Of all the screened individuals, 431 were identified as COVID suspected cases, and 77 were identified as confirmed cases. The research team experienced several implementation challenges such as inexperience of contact tracers with the nature of the work, convincing the community to register in a digital system, obtaining information around COVID-19 symptoms, and many cultural, linguistic, gender, and other social barriers. The team adopted challenge-specific mitigation strategies for the effective implementation of the activity. The modalities of operation adopted by the team engaged with this present intervention to overcome the difficulties experienced in its conduction can hopefully provide some guidance to future parties attempting to conduct similar activities in complex humanitarian settings.
Research has shown that persons with disabilities require greater sexual and reproductive health (SRH) care and services than persons without disabilities. However, this need is often neglected in most of the low-and-middle-income countries including Bangladesh. There is also a dearth of research and data relevant to this issue. A nationwide mixed-methods research has been conducted to explore persons with disabilities’ specific sexual and reproductive health and rights (SRHR) needs, health seeking behaviour related to SRH and barriers in accessing SRH services, along with the associated factors that influence their SRH outcomes. The purpose of this paper is to discuss the challenges encountered by the researchers while conducting this research and the strategies adopted to resolve those challenges. Some of the challenges experienced by the researchers include development of appropriate tools with questions on sensitive SRHR topics, obtaining informed consent, difficulty to maintain privacy while exploring sensitive SRHR issues and communication difficulties when interviewing individuals with intellectual and sensory impairments. The mitigation strategies include iterative revisions of all tools based on multiple pretests in different filed sites and expert feedback, strategic rapport building and maintaining appropriate contextual etiquette while conducting the interviews. The reflections discussed in this paper will assist future researchers in understanding potential field challenges they might encounter in similar low resource settings while conducting research on SRHR and similar sensitive issues among marginalised population groups, such as persons with disabilities.
Background Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings is often sparse and varies in quality across different humanitarian settings. To address this gap in quality data, the World Health Organization (WHO) developed a core set of indicators for monitoring and evaluating SRMNCAH services and outcomes, and assessed their feasibility in Bangladesh, Afghanistan, Jordan, and the Democratic Republic of Congo. Methods The feasibility assessments aggregated information from global consultations and field-level assessments to reach a consensus on a set of core SRMNCAH indicators among WHO partners. The feasibility assessment in Bangladesh focused on the following constructs: relevance/usefulness of the core set of indicators, the feasibility of measurement, availability of systems and resources, and ethical issues during data collection and management. The field-level multi-methods assessment included five components; a desk review, key informant interviews, focus group discussions, and facility assessments including observations of facility-level data management. Results The findings suggest that there is widespread support among stakeholders for developing a standardized core set of SRMNCAH indicators to be collected among all humanitarian actors in Bangladesh. There are numerous resources and data collection systems that could be leveraged, built upon, and improved to ensure the feasibility of collecting this proposed set of indicators. However, the data collection load requested from donors, the national government, international and UN agencies, coordination/cluster systems must be better harmonized, standardized, and less burdensome. Conclusion This core set of indicators would only be useful if it has the buy-in from the international community that results in harmonizing and coordinating data collection efforts and relevant indicators’ reporting requirements.
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