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Haque MA, Zaman Wahid B, Farzana FD, Tanvir Ahmed SM, Ali M, Naz F, Rahman SS, Siddiqua TJ, Faruque ASG, Choudhury N, Ahmed T. Influence of the Suchana intervention on exclusive breastfeeding and stunting among children aged under 6 months in the Sylhet region of Bangladesh. MATERNAL & CHILD NUTRITION 2023; 19:e13535. [PMID: 37244871 PMCID: PMC10483947 DOI: 10.1111/mcn.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/25/2023] [Accepted: 05/06/2023] [Indexed: 05/29/2023]
Abstract
Exclusive breastfeeding (EBF) provides significant health benefits to children. However, mothers may find it difficult to continue EBF for 6 months. The present analysis aimed to examine the influence of the Suchana intervention-a large-scale programme implemented with the aim of improving the health and nutritional status of mothers and children from poor households in the Sylhet region of Bangladesh-on EBF and stunting among children under 6 months. Baseline and endline data were obtained from the Suchana evaluation. EBF was defined as an infant (<6 months) only receiving breast milk in the previous 24 h. Childhood stunting was defined as a length-for-age z-score of less than -2 among children of the same age. Multiple logistic regression analysis was used to assess the associations of the Suchana intervention with EBF and stunting. EBF prevalence improved from 64% at baseline to 85% at the endline in the intervention area, with the intervention group having 2.25 times higher odds of EBF compared to the control group. Stunting prevalence reduced from 28% at baseline to 24% at the endline in the intervention group, but after controlling for covariates, the association between stunting and the intervention was not significant. However, the interaction analysis showed significantly lower stunting prevalence among EBF children in both intervention and control areas. The Suchana intervention had a positive impact on the EBF practice of rural children in a vulnerable region of Bangladesh, and EBF was identified as a significant factor associated with stunting. The findings suggest that the continuation of the EBF intervention has the potential to have an impact on reducing stunting in the region, highlighting the importance of promoting EBF to improve child health and development.
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Affiliation(s)
| | | | | | | | - Mohammad Ali
- Nutrition and Clinical Services DivisionDhakaBangladesh
| | - Farina Naz
- Nutrition and Clinical Services DivisionDhakaBangladesh
| | - Sheikh S. Rahman
- Child Poverty Sector, Save the Children BangladeshDhakaBangladesh
| | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services DivisionDhakaBangladesh
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Haque MA, Choudhury N, Wahid BZ, Ahmed ST, Farzana FD, Ali M, Naz F, Siddiqua TJ, Rahman SS, Faruque A, Ahmed T. A predictive modelling approach to illustrate factors correlating with stunting among children aged 12-23 months: a cluster randomised pre-post study. BMJ Open 2023; 13:e067961. [PMID: 37185644 PMCID: PMC10151845 DOI: 10.1136/bmjopen-2022-067961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE The aim of this study was to construct a predictive model in order to develop an intervention study to reduce the prevalence of stunting among children aged 12-23 months. DESIGN The study followed a cluster randomised pre-post design and measured the impacts on various indicators of livelihood, health and nutrition. The study was based on a large dataset collected from two cross-sectional studies (baseline and endline). SETTING The study was conducted in the north-eastern region of Bangladesh under the Sylhet division, which is vulnerable to both natural disasters and poverty. The study specifically targeted children between the ages of 12 and 23 months. MAIN OUTCOME MEASURES Childhood stunting, defined as a length-for-age z-score <-2, was the outcome variable in this study. Logistic and probit regression models and a decision tree were constructed to predict the factors associated with childhood stunting. The predictive performance of the models was evaluated by computing the area under the receiver operating characteristic (ROC) curve analysis. RESULTS The baseline survey showed a prevalence of 52.7% stunting, while 50.0% were stunted at endline. Several factors were found to be associated with childhood stunting. The model's sensitivity was 61% and specificity was 56%, with a correctly classified rate of 59% and an area under the ROC curve of 0.615. CONCLUSION The study found that childhood stunting in the study area was correlated with several factors, including maternal nutrition and education, food insecurity and hygiene practices. Despite efforts to address these factors, they remain largely unchanged. The study suggests that a more effective approach may be developed in future to target adolescent mothers, as maternal nutrition and education are age-dependent variables. Policy makers and programme planners need to consider incorporating both nutrition-sensitive and nutrition-specific activities and enhancing collaboration in their efforts to improve the health of vulnerable rural populations. TRIAL REGISTRATION NUMBER RIDIE-STUDY-ID-5d5678361809b.
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Affiliation(s)
- Md Ahshanul Haque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Sm Tanvir Ahmed
- Child Poverty Sector, Save the Children Bangladesh, Dhaka, Bangladesh
| | | | - Mohammad Ali
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Farina Naz
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | | | - Asg Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
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Das R, Nasrin S, Palit P, Sobi RA, Sultana AA, Khan SH, Haque MA, Nuzhat S, Ahmed T, Faruque ASG, Chisti MJ. Vibrio cholerae in rural and urban Bangladesh, findings from hospital-based surveillance, 2000-2021. Sci Rep 2023; 13:6411. [PMID: 37076586 PMCID: PMC10115832 DOI: 10.1038/s41598-023-33576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
With more than 100,000 cases estimated each year, Bangladesh is one of the countries with the highest number of people at risk for cholera. Moreover, Bangladesh is formulating a countrywide cholera-control plan to satisfy the GTFCC (The Global Task Force on Cholera Control) Roadmap's goals. With a particular focus on cholera trends, variance in baseline and clinical characteristics of cholera cases, and trends in antibiotic susceptibility among clinical isolates of Vibrio cholerae, we used data from facility-based surveillance systems from icddr,b's Dhaka, and Matlab Hospitals from years 2000 to 2021. Female patients comprised 3,553 (43%) in urban and 1,099 (51.6%) in rural sites. Of the cases and most patients 5,236 (63.7%) in urban and 1,208 (56.7%) in the rural site were aged 15 years and more. More than 50% of the families belonged to the poor and lower-middle-class; in 2009 (24.4%) were in urban and in 1,791 (84.2%) were in rural sites. In the urban site, 2,446 (30%) of households used untreated drinking water, and 702 (9%) of families disposed of waste in their courtyard. In the multiple logistic regression analysis, the risk of cholera has significantly increased due to waste disposal in the courtyard and the boiling of water has a protective effect against cholera. Rotavirus (9.7%) was the most prevalent co-pathogen among the under-5 children in both sites. In urban sites, the percentage of V. cholerae along with co-existing ETEC and Campylobacter is changing in the last 20 years; Campylobacter (8.36%) and Enterotoxigenic Escherichia coli (ETEC) (7.15%) were the second and third most prevalent co-pathogens. Shigella (1.64%) was the second most common co-pathogen in the rural site. Azithromycin susceptibility increased slowly from 265 (8%) in 2006-2010 to 1485 (47.8%) in 2016-2021, and erythromycin susceptibility dropped substantially over 20 years period from 2,155 (98.4%) to 21 (0.9%). Tetracycline susceptibility decreased in the urban site from 2051 (45.9%) to 186 (4.2%) and ciprofloxacin susceptibility decreased from 2,581 (31.6%) to 1,360 (16.6%) until 2015, then increased 1,009 (22.6%) and 1,490 (18.2%) in 2016-2021, respectively. Since 2016, doxycycline showed 902 (100%) susceptibility. Clinicians need access to up-to-date information on antimicrobial susceptibility for treating hospitalized patients. To achieve the WHO-backed objective of eliminating cholera by 2030, the health systems need to be put under a proper surveillance system that may help to improve water and sanitation practices and deploy oral cholera vaccines strategically.
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Grants
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
- 1992-011 International Centre for Diarrhoeal Disease Research, Bangladesh
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Affiliation(s)
- Rina Das
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh.
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
| | - Sabiha Nasrin
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, 01003, USA
| | - Parag Palit
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rukaeya Amin Sobi
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
| | - Al-Afroza Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
| | - Soroar Hossain Khan
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
| | - Md Ahshanul Haque
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
| | - Sharika Nuzhat
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
- James P. Grant School of Public Health, BRAC University, Dhaka, 1212, Bangladesh
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
| | - A S G Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh
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Haque MA, Choudhury N, Ahmed SMT, Farzana FD, Ali M, Naz F, Raihan MJ, Rahman SS, Siddiqua TJ, Faruque ASG, Ahmed T. Does a child's mid‐upper arm circumference‐for‐age
z
‐score represent another nutritional indicator of childhood malnutrition status? MATERNAL & CHILD NUTRITION 2022; 18:e13404. [PMID: 35821653 PMCID: PMC9480943 DOI: 10.1111/mcn.13404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/26/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddr,b Dhaka Bangladesh
| | | | | | - Mohammad Ali
- Nutrition and Clinical Services Division, icddr,b Dhaka Bangladesh
| | - Farina Naz
- Nutrition and Clinical Services Division, icddr,b Dhaka Bangladesh
| | | | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b Dhaka Bangladesh
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Haque MA, Choudhury N, Ahmed SMT, Farzana FD, Ali M, Naz F, Khan A, Wahid BZ, Siddiqua TJ, Akter R, Rahman SS, Faruque ASG, Ahmed T. Food security status of Suchana-participating households in north-eastern rural Bangladesh. Front Public Health 2022; 10:950676. [PMID: 36176515 PMCID: PMC9513544 DOI: 10.3389/fpubh.2022.950676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/22/2022] [Indexed: 01/21/2023] Open
Abstract
Despite achieving remarkable progress, food insecurity remains a major public health challenge in Bangladesh, and severe food insecurity status has not been reduced in susceptible areas and vulnerable regions in Bangladesh. Wetlands that are susceptible to flooding can be found in Bangladesh's north-eastern Sylhet division. Suchana, a large-scale nutrition programme, implemented nutrition-specific and sensitive interventions in poor and very poor households in Sylhet and Moulvibazar districts in the north-eastern region of Bangladesh. The aim of this article is to assess the association between the Suchana intervention and household food security status among poor and very poor households in north-eastern rural Bangladesh using the Suchana baseline and endline survey databases. The baseline survey was conducted between November 2016 and February 2017, while the endline survey was undertaken 3 years later, during the same months. The outcome variable in this analysis was household food security status, which was measured using the Food and Nutrition Technical Assistance's Guideline. Descriptive statistics were used to summarize the data; after controlling for the union as a cluster and relevant covariates, a multiple multinomial logistic regression model was used to estimate the independent effect of the Suchana intervention as an exposure. Overall, 14.0% of households were food secure at the baseline survey (intervention: 14.1%, control: 14.0%) and 22.0% were food secure (intervention: 26.6%, control: 20.2%) at the endline survey. For households in the intervention area in comparison to the control area, the odds of being moderately food insecure [aOR: 1.36 (1.05, 1.76), p < 0.05], mildly food insecure [aOR: 1.83 (1.33, 2.51), p < 0.001], or food secure [aOR: 2.21 (1.47, 3.33), p < 0.001] compared to being severely food insecure was significantly higher. Thus, we infer that the 3 years of Suchana intervention marginally increased household food security status among the socio-economically disadvantaged population in north-eastern rural Bangladesh. If concerns regarding gender equity, women's education, and income-generating activities are addressed, the population could experience even greater benefits in food security. In order to overcome these challenges, all stakeholders including programme implementers and policymakers should work together to implement the appropriate measures.
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Affiliation(s)
- Md Ahshanul Haque
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh,*Correspondence: Md Ahshanul Haque
| | - Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | | | | | - Mohammad Ali
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Farina Naz
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Ashfaque Khan
- Child Poverty Sector, Save the Children Bangladesh, Dhaka, Bangladesh
| | | | | | - Rumana Akter
- Child Poverty Sector, Save the Children Bangladesh, Dhaka, Bangladesh
| | | | - A. S. G. Faruque
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
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Haque MA, Choudhury N, Ahmed SMT, Farzana FD, Ali M, Naz F, Raihan MJ, Rahman SS, Siddiqua TJ, Faruque ASG, Ahmed T. The large-scale community-based programme 'Suchana' improved maternal healthcare practices in north-eastern Bangladesh: Findings from a cluster randomized pre-post study. MATERNAL & CHILD NUTRITION 2022; 18:e13258. [PMID: 34467636 PMCID: PMC8710100 DOI: 10.1111/mcn.13258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Adequate maternal healthcare practices are crucial to both maternal and infant nutrition outcomes. The Sylhet region of Bangladesh is vulnerable and performs poorly, as maternal and child health indicators are falling behind compared to other areas. Suchana, a large-scale intervention programme aims to improve the health and nutritional status of mothers and children in this region. The objective of the present analysis is to assess the changes in indicators related to maternal healthcare practices among Suchana beneficiaries. We obtained data from the Suchana baseline and endline evaluation survey. Descriptive statistics were employed to summarize data. The following maternal healthcare practices were considered: if a Suchana beneficiary mother received antenatal care (ANC) from skilled service providers, took day time resting during pregnancy, consumed additional diet during pregnancy, took at least 100 iron-folic acid (IFA) tablets during pregnancy and took a vitamin A capsule after delivery. Logistic regression analysis was performed to assess the impact of the Suchana intervention on maternal healthcare practices. The prevalence of the outcome variables at endline in the intervention area were as follows: 40% of mothers received at least four ANC from skilled service providers, 50% practiced daytime resting during pregnancy, 51% consumed additional diet during pregnancy, 41% took at least 100 iron-folic acid tablets during pregnancy, 39% received postnatal care and 30% took a vitamin A capsule after delivery. The Suchana intervention significantly, positively improved indicators related to maternal healthcare practices; these findings support future larger-scale programmes to improve maternal healthcare practices among vulnerable people in rural Bangladesh.
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Affiliation(s)
- Md Ahshanul Haque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - S M Tanvir Ahmed
- Child Poverty Sector, Save the Children Bangladesh, Dhaka, Bangladesh
| | | | - Mohammad Ali
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Farina Naz
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
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