BackgroundInitiation of breastfeeding within one hour of birth can avert 22% of newborn mortality. Several factors influence breastfeeding practice including mothers’ socio-demographic and obstetric characteristics, and factors related to time around child birth. This study explores breastfeeding initiation practices and associated influencing factors for initiating breastfeeding within one hour of birth in public health facilities of Bangladesh.MethodsIn this study, normal deliveries were observed in 15 public health facilities from 3 districts in Bangladesh. Study participants were selected by convenient sampling i.e. delivery cases attending health facilities during the study period were selected excluding caesarean section deliveries. Among 249 mothers, time of initiation of breastfeeding was observed and its association was measured with type of health facility, privacy in delivery room, presence of separate staff for newborn, spontaneous breathing, skin-to-skin contact and postnatal contact of mother or newborn with health care providers within one hour after delivery. Data was collected during August-September, 2016. Kruskal-Wallis test was used to measure equality of median duration of breastfeeding initiation time among two or more categories of independent variables. Series of simple logistic regressions were conducted followed by multiple logistic regression to identify the determinants for breastfeeding initiation within one hour.ResultsAmong 249 mothers observed, 67% initiated breastfeeding within one hour of birth at health facilities and median time to initiate breastfeeding was 38 minutes (Inter-quartile range: 20–56 minutes). After controlling for maternal age as potential confounder, the odds of initiating breastfeeding within one hour of birth was significantly higher if mothers gave birth in district hospitals (AOR 3.5: 95% CI 1.5, 6.4), visual privacy was well-maintained in delivery room (AOR 2.6: 95% CI 1.2, 4.8), newborns cried spontaneously (AOR 4.9: 95% CI 3.4, 17.2), were put to skin-to-skin contact with mothers (AOR 3.4: 95% CI 1.9, 10.4) or were examined by health care providers in the facilities (AOR 2.4: 95% CI 1.3, 12.9).ConclusionsIn health facilities, initiation of breastfeeding within one hour is associated with some critical practices and events around the time of birth. With the global push toward facility-based deliveries, it is very important to identify those key factors, within the landscape of maternal and newborn care, which significantly enable health care providers and parents to engage in the evidence-based newborn care activities including early initiation of breastfeeding that will, in turn, reduce global rates of newborn mortality.

Background Breastfeeding within one hour of birth is a critical component of newborn care and is estimated to avert 22% of neonatal mortality globally. Understanding the determinants of early initiation of breastfeeding (EIBF) is essential for designing targeted and effective breastfeeding promotion programmes. The aim of this study was to determine the prevalence and determinants of early initiation of breastfeeding among Bangladeshi women. Methods This paper analyses the data from the Bangladesh Demographic and Health Survey, 2014. Analysis was based on responses of women who had at least one live birth in the two years preceding the survey (n = 3,162) collected using a structured questionnaire. The primary outcome was breastfeeding initiation within one hour of birth ascertained by women’s self-report. Explanatory variables included woman’s age, education, religion, household wealth, place of residence and place of delivery, birth order, child’s size, antenatal care (ANC), postnatal care (PNC) and skin-to-skin contact. Associations between variables were assessed by simple and multivariable logistic regressions. Results Of the 3,162 recently delivered mothers, 51% initiated breastfeeding within one hour of delivery. Prevalence of EIBF varied significantly between different types of mode of delivery, among different geographical regions and among women who had PNC with their newborn. Women who had caesarean section (C-section) were less likely to initiate breastfeeding early after birth than women who had normal vaginal delivery (NVD) (AOR: 0.32, 95% CI 0.23 0.43; p value < 0.001). Women who had received PNC with their newborns within one hour of delivery were more likely to breastfeed their babies within one hour of birth compared to those who did not (AOR: 1.61, 95% CI 1.26 2.07; p value < 0.001). Mother’s age, education, religion, household wealth index, place of residence and place of delivery, birth order, number of antenatal visits, child’s size and skin-to-skin contact were not significantly associated with EIBF. Conclusions Findings from this study suggest that investing more effort in ensuring immediate PNC of mother-newborn pair can increase EIBF. Solutions should be explored to increase EIBF among mothers who undergo C-section as C-section is rising rapidly in Bangladesh. Further research is needed to explore the regional differences in the country, including specific cultural practices that influence EIBF.

BackgroundBangladesh had a large reduction in childhood deaths due to diarrhoeal disease in recent decades. This paper explores the preventive, promotive, curative and contextual drivers that helped Bangladesh achieve this exemplary success.MethodsPrimary and secondary data collection approaches were used to document trends in reduction of Diarrhoea Specific Mortality Rate (DSMR) between 1980 and 2015, understand what policies and programmes played key roles, and estimate the contribution of specific interventions that were implemented during the period. Data acquisition involved relevant document reviews and in-depth interviews with key stake-holders. A systematic search of literature was undertaken to explore socio-economic, aetiological, behavioural, and nutritional drivers of diarrhoeal disease reduction in Bangladesh. Finally, we used LiST (Lives Saved Tool) to model the contributions of the relevant interventions during three time periods (1980-2015, 1980-2000 and 2000-2015), and to project the number of lives saved in 2030 (compared to 2015) if these interventions were implemented at near universal coverage (90%).ResultsThe factors which likely had the most impact on DSMR were the coordinated efforts of the Government of Bangladesh (GoB) with non-government organizations (NGOs) and the private sector that enabled swift implementation, at scale, of interventions like oral rehydration solution (ORS) and zinc, promotion of breastfeeding, handwashing and sanitary latrines (WASH), as well as improvements in female education and nutrition. Compared to 1980, we found ORS and reduction in stunting prevalence had the greatest impact on DSMR, saving roughly 70 000 lives combined in 2015. Until 2000, ORS had a higher contribution to DSMR reduction than reduction in stunting prevalence. This proportionate contribution was reversed during 2000-2015. At near universal coverage (90%) of combined direct diarrhoeal disease, nutrition and WASH interventions, we project that an additional 5356 deaths due to diarrhoea could be averted in 2030.ConclusionBangladesh’s achievement in reduction of DSMR highlights the important role of an enabling policy environment that fostered coordinated efforts of the public and private sectors and NGOs for maximal impact. To maintain this momentum, evidence-based interventions should be scaled up at universal coverage.

Drought, the result of regional climatic variability is one of the dominant threats to environment. This study focuses on the biophysical, environmental and health issues concerning drought occurrence in northwest region of Bangladesh. Using both primary and secondary data, the analysis revealed that, during the drought period, rainfall as the dominant factor of supplying surface water and normalizing the dryness of the nature was almost 46% lower than the previous (normal) years. Similarly, average monthly sunshine hours in the drought year was about 7% higher compared to that of the normal year. On an average, groundwater level declined more than one meter compared to the previous years. Thus, many of the tubewells turned dry or failed to supply the required quantity of water for household and irrigation purposes. A significant number of surface water bodies including ponds, ditches, canals and streams had little volume of low quality water. In normal years, almost all households used hand tubewells (HTWs) as the major source of drinking water, while in the drought period only 90% households could use HTW water since substantial proportion of the HTWs turned dry. People had to collect drinking and domestic water from far distance to meet the basic requirements. Increase in temperature and prevalence of severe dust during drought periods compared to the normal years caused different health hazards including dysentery and diarrhoea due to unsafe drinking water.

Background Caesarean section (C-section) is a major obstetric life-saving intervention for the prevention of pregnancy and childbirth related complications. Globally C-section is increasing, as well as in Bangladesh. This study identifies the prevalence of C-section and socioeconomic and health care seeking related determinants of C-section among women living in hard-to-reach (HtR) areas in Bangladesh. Methods A cross-sectional survey was conducted using a structured questionnaire between August and December 2017 at four distinct types of HtR areas of Bangladesh, namely coastal, hilly, haor (wetland), and char areas (shallow land-mass rising out of a river). Total 2,768 women of 15-49 years of age and who had delivery within one year prior to data collection were interviewed. For the analysis of determinants of C-section, the explanatory variables were maternal age, educational status of women and their husbands, women's religion, employment status and access to mobile phone, wealth index of the household, distance to the nearest health facility from the household, the number of ANC visits and presence of complications during pregnancy and the last childbirth. Logistic regression model was run among 850 women, who had facility delivery. Variables found significantly associated with the outcome (C-section) in bivariate analysis were included in the multivariable logistic model. A pvalue <0.05 was considered as statistically significant in the analyses. Results Of the 2,768 women included in the study, 13% had C-sections. The mean (±SD) age of respondents was 25.4 (± 0.1) years. The adjusted prevalence of C-section was 13.1 times