BackgroundA continuous influx of poor people to urban slums poses a challenge to Bangladesh’s health system as it has failed to tackle maternal morbidity and mortality. BRAC is the largest non-governmental organisation in Bangladesh. BRAC has been working to reduce maternal, neonatal and under-five children morbidity and mortality of slum dwellers in cities. BRAC has been doing this work for a decade through a programme called MANOSHI. This programme provides door-to-door services to its beneficiaries through community health workers (CHWs) and normal delivery service through its delivery and maternity centres. BRAC started the ‘MANOSHI’ programme in Narayanganj City Corporation during 2011 to address maternal, neonatal and child health problems facing slum dwellers. We investigated the existing maternal health-service indicators in the slums of Narayanganj City Corporation and compared the findings with a non-intervention area.MethodsThis cross-sectional study was conducted during 2012, in 47 slums of Narayanganj City Corporation as intervention and 10 slums of Narsingdi Sadar Municipality as comparison area. A total of 1206 married women, aged 15–49 years, with a pregnancy outcome in the previous year were included for interview. Data on socio-demographic characteristics, reproductive and maternal health-care practices like use of contraceptive methods, antenatal care (ANC), delivery care, postnatal care (PNC) were collected through a structured questionnaire. The chi-square test, Student t test, Mann Whitney U-test, factor analysis and log-binominal test were performed by using STATA statistical software for analysing data.ResultsThe activities of BRAC CHWs significantly improved four or more ANC (47% vs. 21%; p<0.000) and PNC (48% vs. 39%; p<0.01) coverage in the intervention slums compared to comparison slums. Still, about half of the deliveries in both areas were attended at home by unskilled birth attendants, of which a very few received PNC within 48 hours after delivery. The poorest and illiterate women received fewer maternal health services from medically trained providers (MTPs). The poorest had a lower likelihood of receiving services from MTPs during delivery complications.ConclusionThe MANOSHI programme service coverage for delivery care and PNC-checkup for women who prefer home delivery needs to be improved. For sustainable improvement of maternal health outcomes in urban slums, the programme needs to facilitate access to services for poor and illiterate women.

ObjectiveChildhood stunting remains a major public health concern in Bangladesh. To accelerate the reduction rate of stunting, special focus is required during the first 23 months of a child’s life when the bulk of growth takes place. Therefore the present study explored individual-, maternal- and household-level factors associated with stunting among children under 2 years of age in Bangladesh.DesignData were collected through a nationwide cross-sectional survey conducted between October 2015 and January 2016. A two-stage cluster random sampling procedure was applied to select 11 428 households. In the first stage, 210 enumerations areas (EA) were selected with probability proportional to EA size (180 EA from rural areas, thirty EA from urban slums). In the second stage, an average of fifty-four households were selected from each EA through systematic random sampling.SettingRural areas and urban slums of Bangladesh.ParticipantsA total of 6539 children aged 0–23 months.ResultsOverall, 29·9 % of the children were stunted. After adjusting for all potential confounders in the modified Poisson regression model, child’s gender, birth weight (individual level), maternal education, age at first pregnancy, nutrition (maternal level), administrative division, place of residence, socio-economic status, food security status, access to sanitary latrine and toilet hygiene condition (household level) were significantly associated with stunting.ConclusionsThe study identified a number of potentially addressable multilevel risk factors for stunting among young children in Bangladesh that should be addressed through comprehensive multicomponent interventions.

Arsenic contamination in drinking water has a detrimental impact on human health which profoundly impairs the quality of life. Despite recognition of the adverse health implications of arsenic toxicity, there have been few studies to date to suggest measures that could be taken to overcome arsenic contamination. After the statement in 2000 WHO Bulletin that Bangladesh has been experiencing the largest mass poisoning of population in history, we researched existing literature to assess the magnitude of groundwater arsenic contamination in Bangladesh. The literature reviewed related research that had been initiated and/or completed since the implementation of the Millennium Development Goals (MDGs) under four domains: (1) extent of arsenic contamination; (2) health consequences; (3) mitigation and technologies and (4) future directions. To this means, a review matrix was established for analysis of previous literature based on these four core domains. Our findings revealed that several high-quality research articles were produced at the beginning of the MDG period, but efforts have dwindled in recent years. Furthermore, there were only a few studies conducted that focused on developing suitable solutions for managing arsenic contamination. Although the government of Bangladesh has made its population's access to safe drinking water a priority agenda item, there are still pockets of the population that continue to suffer from arsenic toxicity due to contaminated water supplies.

BackgroundAnemia is a significant wide spread public health threat especially among the adolescent girls who are more vulnerable towards low level of hemoglobin particularly of low and middle income countries (LMICs). We investigated the prevalence of anemia among the adolescent girls (10–19 years) in Bangladesh and its socio-demographics distribution.MethodsWe collected data digitally in ODK platform from a sub-sample of a nationwide cross-sectional survey of 1314 adolescent girls in 2015. Capillary blood hemoglobin level was estimated using HemoCue®; anthropometric measurements through standardized procedure and details socio-demographic information were captured and analyzed. Malnutrition was defined as BMI-for-age Z-score below -2SD (BAZ < −2SD), measured in WHO-AnthroPlus. Univariate analysis followed by multiple logistic regression were performed to examine the association between socio-demographic variables and anemia, while controlling the effect of potential confounding variables.ResultsOverall, 51.6% girls were suffering from any form of anemia (non-pregnant-Hb < 12 g/dl; pregnant-Hb < 11 g/dl) while 46% were mildly (non-pregnant-Hb: 10–11.9 g/dl; pregnant-Hb: 10–10.9 g/dl) and 5.4% were moderately (Hb: 7–9.9 g/dl) anemic while only 0.2% were severely anemic. After controlling for relevant covariates in multiple logistic regression model, malnutrition (AOR: 1.42, 95% CI = 1.0–2.10, p-value = 0.083), non-pregnancy (AOR: 6.10, 95% CI = 2.70–13.78, p-value < 0.001), and households with bottom wealth quintile (AOR: 1.54, 95% CI = 1.03–2.30, p-value = 0.037) were identified as significant risk factors of anemia among adolescent girls of Bangladesh.ConclusionsHigher number of adolescent girls are still suffering from anemia in Bangladesh and non-pregnant adolescent girls contributed the most. Immediate, long term and sustainable public health intervention would require to combat the situation.

Purpose: To identify and compare important risk and protective factors associated with suicidality and self-harm among traditional bullying and cyberbullying victims aged 14-17-years in Australia. Design: Cross-sectional population-based study. Setting: Young Minds Matter, a nationwide survey in Australia. Subjects: Adolescents aged 14-17-years (n = 2125). Measures: Suicidality and self-harm were outcome variables, and explanatory variables included sociodemographic factors (age, gender, country of birth, household income, location, family type), risk factors (parental distress, family functioning, family history of substance use, child substance use, mental disorder, psychosis, eating disorders, sexual activity) and protective factors (high self-esteem, positive mental health or resilience, school connectedness, sleep) among 2 types of bullying victims—traditional and cyber. Traditional bullying includes physical (hit, kick, push) or verbal (tease, rumors, threat, ignorance), and cyberbullying includes teasing messages/pictures via email, social medial using the internet and/or mobile phones. Analysis: Bivariate analysis and binary logistic regression models. Statistical metrics include Hosmer-Lemeshow Goodness-of-Fit-test, VIF test, Linktest and ROC curve for model performance and fitness. Results: Overall, 25.6% of adolescents were traditional bullying victims and 12% were cyberbullying victims. The percentages of suicidality (34.4% vs 21.6%) and self-harm (32.8% vs 22.3%) were higher in cyberbullying victims than in traditional bullying victims. Girls were more often bullied and likely to experience suicidal and self-harming behavior than boys. Parental distress, mental disorder and psychosis were found to be significantly associated with the increase risk for self-harm and suicidality among both bullying victims (p < 0.05). While, eating disorder and sexual activity increased the risk of suicidality in traditional bullying victims and self-harm in cyberbullying victims, respectively. Positive mental health/resilience and adequate sleep were found be significantly associated with decreased suicidality and self-harm in both bullying victims. Conclusion: Suicidality and self-harm were common in bullying victims. The findings highlight that the risk and protective factors associated with suicidality and self-harm among adolescent who experienced traditional and cyberbullying victimization should be considered for the promotion of effective self-harm and suicide prevention and intervention programs.

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SUMMARYThis study investigated total sleep time in the Bangladeshi population and identified the proportion of the population at greater risk of developing chronic diseases due to inadequate sleep. Using a crosssectional survey, total sleep time was captured and analysed in 3968 respondents aged between 6 and 106 years in 24 (of 64) districts in Bangladesh. Total sleep time was defined as the hours of total sleep in the previous 24 h. We used National Sleep Foundation (2015) guidelines to determine the recommended sleep hours in different age categories. Less or more than the recommended total sleep time (in hours) was considered 'shorter' and 'longer' sleep time, respectively. Linear and multinomial logistic regression models were used to determine the relationship between demographic variables and estimated risk of shorter and longer total sleep time. The mean (AEstandard deviation) total sleep time of children (6-13 years), teenagers (14-17 years), young adults and adults (18-64 years) and older adults (≥65 years) were 8.6 (AE1.1), 8.1 (AE1.0), 7.7 (AE0.9) and 7.8 (AE1.4) h, respectively, which were significantly different (P < 0.01). More than half of school-age children (55%) slept less than, and 28.2% of older adults slept longer than, recommended. Residents in all divisions (except Chittagong) in Bangladesh were less likely to sleep longer than in the Dhaka division. Rural populations had a 3.969 greater chance of sleeping for a shorter time than urban residents. The Bangladeshi population tends to sleep for longer and/or shorter times than their respective recommended sleep hours, which is detrimental to health.