Background: Early initiation of breastfeeding within 1 hour after birth is essential for newborns, because it reduces risk of neonatal mortality and hypothermia to a great extent and also helps in preventing the long-term chronic diseases and in increasing energy and immunity to newborn. In order to reach the 'very good state' of timely or early initiation of breastfeeding recommended by WHO, Bangladesh needs to increase the current rate of 51.24 to 100%. An attempt has been made in this study to examine how the early breastfeeding practice changes among male and female children with time controlling the factors associated with this practice. Methods: Data from last four consecutive Bangladesh Demographic and Health Surveys (BDHS) have been used in the study. The participants were included whose child born within the last 5 years preceding the surveys of 2004, 2007 and 2011, and within the last 3 years preceding the survey of 2014 in the study and the respective selected participants were 5145, 4765, 7099 and 4370. To conduct the trend analysis, the descriptive statistics of selected variables along with prevalence of early initiation of breastfeeding have been computed by different years and a multiple logistic regression model has been fitted to the pooled dataset of 2004-2014 considering survey years as time. Results: Rate of early initiation of breastfeeding increased as time progressed and it was faster for female child compared to male child. For example, female children were significantly 10 and 6% less likely to be initiated early than their counterparts in 2004 and 2007, respectively; whereas after 2007 both male and female children were equally treated for breastfeeding practice. It was also found that rate of early initiation significantly increased for one unit increased in survey year and this increasing rate was higher for female child compared to male child. For example, for one unit of increased in survey year, the early initiation of breastfeeding increased by 60% for male child and by 67% for female child. Besides, survey time, gender, education of parents, wanted index child, mode of delivery, antenatal care visits, wealth index, exposure to media and division were found to have potential influence on early initiation of breastfeeding. Conclusion: Demographic and health surveys conducted in Bangladesh since 2011 have shown no evidence of gender discrimination regarding timely initiation of breastfeeding. In order to achieve the target rate of early initiation of breastfeeding recommended by WHO, it requires to take effective intervention regarding maternal and child health education.

The potential factors associated with women‟s empowerment in household decision making as well as attitudes toward wife beating were determined in the study. The Bangladesh Demographic Health Survey (BDHS), 2014 data were used to get the determinants of women‟s empowerment. To measure the women‟s empowerment, the principal component analysis was used in the study. The ordinal logistic regression model was applied to determine the potential factors for women‟s empowerment. Results were also compared with the results obtained from classical linear regression model. The study revealed that lower difference of spousal ages and lower number of daughters were more likely to increase women‟s empowerment. Similar to other studies, early marriage and living in rural area gave the women lower empowerment but education, 1-4 family members, having at least one child, exposed to media, belonging to NGO and working outside home had greater positive influence on women‟s empowerment. Dhaka Univ. J. Sci. 66(2): 129-134, 2018 (July)

Background Unlike developed countries, higher socioeconomic status (SES-education, and wealth) is associated with hypertension in low and middle-income countries (LMICs) with limited evidence. We examined the associations between SES and hypertension in Nepal and the extent to which these associations vary by sex and urbanity. The body mass index (BMI) was examined as a secondary outcome and assessed as a potential mediator. Materials and methods We analyzed the latest Nepal Demographic and Health Survey data (N = 13,436) collected between June 2016 and January 2017, using a multistage stratified sampling technique. Participants aged 15 years or older from selected households were interviewed with an overall response rate of 97%. Primary outcomes were hypertension and normal blood pressure defined by the widely used Seventh Report of the Joint National Committee (JNC7) and the American College of Cardiology/American Heart Association (ACC/AHA) 2017. Results The prevalence of hypertension was higher in Nepalese men than women. The likelihood of being hypertensive was significantly higher in the higher education group compared with the lowest or no education group for men (OR 1.89 95% CI: 1.36, 2.61) and for women (OR 1.20 95% CI: 0.79, 1.83). People in the richest group were more likely to be hypertensive compared with people in the poorest group for men (OR 1.66 95% CI: 1.26, 2.19) and for women (OR 1.60 95% CI: 1.20, 2.12). The associations between SES (education) and

Background Despite the remarkable reduction of maternal mortality, unsafe and untimely menstrual regulation (MR) remains a major maternal health problem in Bangladesh. This study aimed to determine the prevalence and identify determinants of MR among ever-married women in Bangladesh. Methods Data for this study have been extracted from Bangladesh Demographic and Health Survey (BDHS) 2014. The survey followed a two-stage stratified sampling procedure and the study used a sub-sample of 8084 ever-married women aged 15 to 49 years extracted from survey sample of 17,863. Univariate and multivariate mixed-effect logistic regression analyses were used to identify risk factors for MR accounting for potential between-clusters variations. Results The weighted prevalence of MR was 12.3% (95% CI: 11.1–13.4%) among (991/8084) ever-married women. Women were less likely to have MR if they were from Chittagong (AOR 0.74, 95% CI: 0.57–0.96; p = 0.026) and Sylhet (AOR 0.53, 95% CI: 0.36–0.77; p = 0.001) divisions. Women were more likely to have MR if they were from high (AOR 1.47, 95% CI: 1.18–1.83; p = 0.001) and the highest (AOR 1.62, 95% CI: 1.27–2.05; p < 0.001) socioeconomic status (SES) group; being employed (AOR 1.35, 95% CI: 1.16–1.56; p < 0.001), having one or two children (AOR 1.73, 95% CI: 1.24–2.40: p = 0.001) and ≥ 3 children (AOR 2.56, 95% CI: 1.82–3.58; p < 0.001), and having membership of non-government organization (NGO) (AOR 1.18, 95% CI: 1.02–1.38; p = 0.030). Conclusion MR is prevalent among Bangladeshi women and independently associated with geographic location, SES, parity, employment and NGO membership status. Health policy should prioritize in reducing spatial and socioeconomic inequalities in relation to MR services by ensuring accessibility and availability of MR services, especially in suburban divisions. Furthermore, abortion should be legalized in Bangladesh that will ultimately reduce the morbidity and mortality associated with unsafe abortion.

Background Women’s empowerment, education, and economic status are jointly introduced as women’s 3E. A number of studies found the significant association of these three variables with maternal health outcomes, but no studies, to the best of knowledge, have been found to justify the joint influence of women’s 3E on the birth interval. As several studies have revealed that the short birth interval increases the risk of adverse maternal, perinatal, and infant outcomes and it is also responsible for increasing the country’s population size, more research is needed on the birth interval. Therefore, the present study aimed to investigate the influence of women’s 3E on the short birth interval after controlling the other selected covariates. Methods Data from the Bangladesh Demographic and Health Survey (BDHS), 2017–18 have been used to serve the purpose of the study. To measure the birth interval, at least two live births for non-pregnant mothers and at least one live birth for currently pregnant mothers born in the 5 years before the survey were included in the study. The Chi-Square test was applied to know the unadjusted association of the selected covariates including women’s 3E with the short birth interval. In order to find out the adjusted association of women’s 3E with the short birth interval, sequential binary logistic regression models have been used. Results The study found that about 23% of births in Bangladesh were born in a short birth interval. The likelihood of subsequent births of women decreases with an increase in the score of women’s 3E before or after controlling the characteristics of women, child, and households. The results of the final model show that mothers with the coverage of 50% - 75%, 75% - 100%, and full coverage (100%) in 3E have a 23%, 41%, and 42% lower odds of having short birth interval compared to mothers with coverage of below 50% in 3E, respectively. Conclusion and recommendation Bangladesh still lags behind in meeting the minimum requirements for inter-birth intervals set by the World Health Organization. The study has shown that the 3E in women can contribute in prolonging the duration of subsequent births in Bangladesh. Policy-making interventions are needed to raise awareness among uneducated, under-empowered and economically poor reproductive women through family planning and fertility control programs so that the country can achieve the desired fertility rate.

27Background: Unlike developed countries; higher socioeconomic status (SES, education, and 28 wealth) is associated with hypertension in low and middle-income countries (LMICs) with 29 limited evidence. We examined the associations between SES and hypertension in Nepal and 30 the extent to which these associations vary by sex and urbanity. The body mass index (BMI) 31 was examined as a secondary outcome and assessed as a potential mediator. , using a multistage stratified 34 sampling technique. Participants aged 15 years or older from selected households were 35 interviewed with an overall response rate of 97%. Main outcomes were hypertension and 36 normal blood pressure defined by the widely used Seventh Report of the Joint National 37 Committee (JNC 7), and the American College of Cardiology/American Heart Association 38 (ACC/AHA) 2017. 39Results: The prevalence of hypertension was higher in Nepalese men than women. The 40 likelihood of having hypertension was more than double for individuals in the highest versus 41 lowest wealth quintiles [men: OR 2.13, 95% CI 1.60-2.85); women: OR 2.54, 95% CI 2.00-42 3.24] and for individuals with the higher education versus no education [men: OR 2.38, 95% 43 CI 1.75-3.23; women: OR 1.63, 95% CI 1.18-2.25]. The associations between SES and 44 hypertension were different by sex and urbanity. These associations were mediated by BMI. 45 Conclusions: Higher SES was positively associated with the higher likelihood of having 46 hypertension in Nepal according to both JNC 7 and ACC/AHA 2017 guidelines. These47 associations were mediated by BMI, which may help to explain broader socioeconomic 48 differentials in CVD and related risk factors, particularly in terms of education and wealth. Our 49 study suggests that the mediating factor of BMI should be tackled to diminish the risk of CVD 50 in people with higher SES in LMICs. Introduction 56 57 Hypertension is a growing public health problem in low and middle-income countries 58 (LMICs) 1 with concurrent risks of cardiovascular and kidney diseases. 2 A review warned that 59 although about three-quarters of people with hypertension (639 million people) live in LMICs, 60 there is no improvement in awareness or control rates. 1 Hypertension is a major contributor to 61 death and disability in South Asian countries, including Nepal with a low level of control and 62 awareness. 3-6 The World Health Organization (WHO) implemented `STEP-wise approach to 63 surveillance' (STEPS) using nationally representative sample in 2008 and 2013 reported an 64 increasing trend of prevalence of hypertension among 15-69 years Nepalese population ranging 65 from 21.5% in 2008 to 26.0% in 2013. 7,8 Based on the recent Nepal Demographic and Health 66 Survey (NDHS) 2016, Kibria and colleagues reported that the estimated prevalence of 67 hypertension in Nepal using the widely used Seventh Report of the Joint National Committee 68 (JNC 7) guideline 9 was 21.2%, and the corresponding prevalence was 44.2% when using a 69 new hypertension guideline rec...

Women’s autonomy is an important element of the economic and reproductive health developments in a country. The aim of this study was to find out the potential factors associated with women’s decision-making autonomy in Bangladesh. To fulfill this purpose, the cross-sectional data obtained from the Bangladesh Demographic Health Survey (BDHS), 2014 was used. The generalized linear mixed model approach has been applied to calculate the adjusted effects of the covariates by taking into account the correlation among subjects within clusters. The study reveals that women with age at marriage ≥ 18 years, having family size ≤ 4, having at least one child, exposed to media, belonging to NGO, living in urban areas and working outside home have greater influence on autonomy in household decision making. Dhaka Univ. J. Sci. 66(2): 115-120, 2018 (July)

Background Although Bangladesh has an impressive track record in the reduction of maternal and child mortality, tetanus, a dreadful disease, impedes the way to achieve Sustainable Development Goal (SDG) in this respect. Sufficient doses of tetanus toxoid containing vaccine during pregnancy ensure immunity against tetanus to mothers as well as newborns. Since inequalities persist across vaccination programs globally, in this paper, an attempt has been made to examine whether tetanus toxoid immunization (TTI) status among the women of reproductive age in Bangladesh for their most recent live birth born preceding 2 years of the survey changes with their living standard index (LSI). Methods Five domains of deprivation such as energy use, improved sanitation, drinking water, housing and assets ownership were used to compute the LSI using a approach proposed by Alkire and Foster. The adjusted association between LSI and TTI was established by using logistic regression model. For the purpose of statistical analysis, a nationally representative cross-sectional data extracted from Bangladesh Multiple Indicator Cluster Survey (BMICS), 2019 have been used. Result The bivariate analysis revealed that 79.5% (95% CI 78.0–81.0) of women with low and 83.1% (95% CI 81.3–84.9) with moderate living standards had sufficient vaccination coverage for their most recent pregnancies while this percentage was higher for the women who belonged to high living standard (85.2, 95% CI = 84.2–86.2). A strong evidence for greater odds of sufficient immunization with TT among the women maintaining a high standard of living (AOR = 1.24, 95% CI = 1.08–1.42, p < 0.01) was found from regression analysis. Conclusion The results depict existing living standard disparity with respect to TT vaccination coverage among women in Bangladesh. Present research suggests that immunization campaigns need to be conducted especially for the disadvantaged people to improve their health care and immunization service utilization among women within the age bracket of 15 to 49. This study proposed a scientific way to enhance TT vaccination among Bangladeshi women, which could help Bangladesh attain a widespread tetanus protection and thus, meet the SDGs for maternal and child mortality reduction.