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Rahman MM, Ara T, Aninda MHHMK, Nurul A, Haider MM. Rural-urban differentials in the influences of individual and geospatial preparedness on institutional childbirth: a cross-sectional study in Bangladesh. BMJ Open 2022; 12:e060718. [PMID: 36691141 PMCID: PMC9445825 DOI: 10.1136/bmjopen-2021-060718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/18/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study aims to explore the rural-urban differentials in the influences of individual and geospatial preparedness on institutional childbirth in Bangladesh. A related aim of this paper is to derive estimates to measure geospatial preparedness for institutional births, through statistical modelling, when no data are available for measuring this areal indicator. DESIGN, SETTINGS AND PARTICIPANTS The paper used data from a large-scale nationally representative Bangladesh Multiple Indicator Cluster Survey 2019. The analytical sample included 9203 currently married women of reproductive age who had a live birth in the 2 years preceding the survey. METHODS Mixed effect logistic regression models were employed to explore the rural-urban differentials in influences of individual and geospatial preparedness on institutional childbirth. The district-level random effect estimation was done to measure geospatial preparedness. The conditional autoregressive model was used to examine the association of geospatial preparedness with areal variation in institutional births. RESULTS In rural settings, women who gave birth to a female newborn were 18% less likely to have facility births compared with women who gave birth to a male newborn. Also, women from households in the highest wealth quintile were twice as likely to have facility births compared with those from households in the poorest wealth quintile. In contrast, in urban areas, facility births did not vary by sex of the fetus or by households' socioeconomic status. The geospatial preparedness explained 8% and 9% of the variability in institutional births in rural and urban areas, respectively. Geospatial mapping revealed low preparedness in the hill tracts. Findings identified geospatial preparedness as a potential source of areal variation in facility births. CONCLUSION Findings suggest improving district-level preparedness and developing differential programme strategies for urban and rural areas to increase the national prevalence and more equitable use of institutional childbirth in Bangladesh.
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Affiliation(s)
- Md Mahabubur Rahman
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tasnim Ara
- Institute of Statistical Research and Training, Dhaka, Bangladesh
| | | | - Alam Nurul
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - M Moinuddin Haider
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Zhou S, Zou G, Chen X, Yu H, Wang J, Fang P, Song F. Educational attainment and mortality: results from the Sixth Population Census in China. J Glob Health 2020; 9:020604. [PMID: 31893036 PMCID: PMC6927737 DOI: 10.7189/jogh.09.020604] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Health and education are two closely related factors that affect human development. A limited number of studies have been conducted in China, most of which have been based on small sample sizes and with inconsistent results. The study investigates the association between mortality rate and educational level in China based on the sixth national population census in 2010. Methods This is large-scale population study based on the nationally administrated data sets of population census in 2010, 2000 and 1990. The 2010 census covered a total population of 1 332 810,869 in China. Results In general, standardized mortality rate decreased as educational level increased. The standardized mortality rate is higher among males than among females with equivalent educational levels. The standardized mortality rate in all the educational groups declined to varying degrees from 1990. 2000 to 2010. The standardised mortality rate declined with increasing educational levels from no education to university undergraduate groups in 1990, 2000 and 2010. The standardized mortality rate declined as the degree of education increased in cities, towns, and villages, but gradually increased at the same educational level from cities, towns, to villages in general. The difference in each region is considerable and the population quality of the developed area is generally high. The percentage of the uneducated population to the total population aged 15 years and over (%) was positively correlated with the standardized mortality rate. By contrast, the percentage of the population with a high school education to the total population aged 6 years and over (%) was negatively correlated with the standardized mortality rate. Conclusions We found that educational level was negatively correlated with the mortality rate. The crude and standardized death rate is lower among individuals with higher educational level. Together with previous research findings, this study indicates that improving total population education attainment remains an important challenge that requires imperative action, while reducing educational inequities remains crucial for the government.
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Affiliation(s)
- Shangcheng Zhou
- School of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Guanyang Zou
- School of Economics and Management, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaping Chen
- Shiyan Taihe hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Hongxing Yu
- Shiyan Taihe hospital, Hubei University of Medicine, Shiyan, Hubei, China
| | - Jing Wang
- Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan, Hubei, China
| | - Pengqian Fang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fujian Song
- Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
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Saif-Ur-Rahman KM, Anwar I, Hasan M, Hossain S, Shafique S, Haseen F, Khalequzzaman M, Rahman A, Islam S. Use of indices to measure socio-economic status (SES) in South-Asian urban health studies: a scoping review. Syst Rev 2018; 7:196. [PMID: 30447696 PMCID: PMC6240202 DOI: 10.1186/s13643-018-0867-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 11/01/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Universal health coverage (UHC) is a key area in post-2015 global agenda which has been incorporated as target for achieving health-related Sustainable Development Goals (SDGs). A global framework has been developed to monitor SDG indicators disaggregated by socioeconomic and demographic markers. This review identifies the indices used to measure socio-economic status (SES) in South Asian urban health studies. METHODS Two reviewers searched six databases including Cochran Library, Medline, LILACS, Web of Science, Science Direct, and Lancet journals independently. All South Asian health studies covering urban population, with any research-designs, written in English language, and published between January 2000 and June 2016 were included. Two reviewers independently screened and assessed for selection of eligible articles for inclusion. Any conflict between the reviewers was resolved by a third reviewer. RESULTS We retrieved 3529 studies through initial search. Through screening and applying inclusion and exclusion criteria, this review finally included 256 articles for full-text review. A total of 25 different SES indices were identified. SES indices were further categorized into 5 major groups, e.g., (1) asset-based wealth index, (2) wealth index combining education, (3) indices based on income and expenditure, (4) indices based on education and occupation, and (5) "indices without description." The largest proportion of studies, irrespective of country of origin, thematic area, and study design, used asset-based wealth index (n = 142, 54%) as inequality markers followed by the index based on income and expenditure (n = 80, 30%). Sri Lankan studies used income- and expenditure-based indices more than asset-based wealth index. Majority of the reviewed studies were on "maternal, neonatal, and child health" (n = 98, 38%) or on "non-communicable diseases" (n = 84, 33%). Reviewed studies were mostly from India (n = 145, 57%), Bangladesh (n = 42, 16%), and Pakistan (n = 27, 11%). Among the reviewed articles, 55% (n = 140) used primary data while the rest 45% studies used secondary data. CONCLUSION This scoping review identifies asset-based wealth index as the most frequently used indices for measuring socioeconomic status in South Asian urban health studies. This review also provides a clear idea about the use of other indices for the measurement SES in the region.
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Affiliation(s)
- K. M. Saif-Ur-Rahman
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
| | - Md. Hasan
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Shahed Hossain
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
| | - Sohana Shafique
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
| | - Fariha Haseen
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Md. Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Aminur Rahman
- Health Systems and Population Studies Division, icddr,b , Dhaka, Bangladesh
| | - Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
- Systematic Review Centre (SRC), Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Fatima-Tuz-Zahura M, Mohammad KA, Bari W. Log-Logistic Proportional Odds Model for Analyzing Infant Mortality in Bangladesh. Asia Pac J Public Health 2016; 29:60-69. [PMID: 27920225 DOI: 10.1177/1010539516680023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Log-logistic parametric survival regression model has been used to find out the potential determinants of infant mortality in Bangladesh using the data extracted from Bangladesh Demographic and Health Survey, 2011. First, nonparametric product-limit approach has been used to examine the unadjusted association between infant mortality and covariate of interest. It is found that maternal education, membership of nongovernmental organizations, age of mother at birth, sex of child, size of child at birth, and place of delivery play an important role in reducing the infant mortality, adjusting relevant covariates.
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Predictors of Poor Pregnancy Outcomes Among Antenatal Care Attendees in Primary Health Care Facilities in Cross River State, Nigeria: A Multilevel Model. Matern Child Health J 2016; 20:1662-72. [PMID: 27004795 PMCID: PMC4935728 DOI: 10.1007/s10995-016-1965-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objectives Pregnancy carries a high risk for millions of women and varies by urban–rural location in Nigeria, a country with the second highest maternal deaths in the world. Addressing multilevel predictors of poor pregnancy outcomes among antenatal care (ANC) attendees in primary health care (PHC) facilities could reduce the high maternal mortality rate in Nigeria. This study utilised the “Risk Approach” strategy to (1) compare the risks of poor pregnancy outcomes among ANC attendees by urban–rural location; and (2) determine predictors of poor pregnancy outcomes among ANC attendees in urban–rural PHC facilities in Cross River State, Nigeria. Methods A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15–49 years recruited through multistage sampling. Data on risk factors of poor pregnancy outcomes were collected using interviewer-administered questionnaires and clinic records. Respondents were categorised into low, medium or high risk of poor pregnancy outcomes, based on their overall risk scores. Predictors of poor pregnancy outcomes were determined by multilevel ordinal logistic regression. Results A greater proportion of the women in the rural areas were below the middle socio-economic quintile (75 vs. 4 %, p < 0.001), had no education (12 vs. 2 %, p < 0.001), and were in the 15–24 age group (58 vs. 35 %, p < 0.001) whereas women in the urban areas were older than 35 years (10 vs. 5 %, p < 0.001). The women attending antenatal care in the urban PHC facilities had a low overall risk of poor pregnancy outcomes than those in the rural facilities (64 vs. 50 %, p = 0.034). Pregnant women in the urban areas had decreased odds of being at high risk of poor pregnancy outcomes versus the combined medium and low risks compared with those in the rural areas (OR 0.55, 95 % CI 0.09–0.65). Conclusions for Practice Pregnant women attending antenatal care in rural PHC facilities are more at risk of poor pregnancy outcomes than those receiving care in the urban facilities. Health programmes that promote safe pregnancy should target pregnant women in rural settings.
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Khan MMH, Zanuzdana A, Kraemer A. Levels, trends and disparities in public-health-related indicators among reproductive-age women in Bangladesh by urban-rural and richest-poorest groups, 1993-2011. PLoS One 2013; 8:e75261. [PMID: 24086485 PMCID: PMC3783385 DOI: 10.1371/journal.pone.0075261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/13/2013] [Indexed: 11/18/2022] Open
Abstract
Background And Objectives Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. Methods The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. Results The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. Conclusion The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further.
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Affiliation(s)
- Md. Mobarak Hossain Khan
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
- * E-mail:
| | - Arina Zanuzdana
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Alexander Kraemer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
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Kamal SMM, Hassan CH, Alam GM. Determinants of institutional delivery among women in Bangladesh. Asia Pac J Public Health 2013; 27:NP1372-88. [PMID: 23666835 DOI: 10.1177/1010539513486178] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examines the factors that influence institutional delivery among women in Bangladesh extracting data from 2007 Bangladesh Demographic and Health Survey. We employed both bivariate and multivariate statistical analyses in this study. Findings revealed that, only 14.7% of the women went for institutional delivery and 28.8% births were delivered by trained birth attendance. The multivariate logistic regression analysis yielded quantitatively important and reliable estimates of facility delivery. The likelihood of institutional delivery was significantly higher for first-order pregnancy, couples' higher education, the richest, higher autonomy, TV ownership, non-Muslims, who received antenatal care services, pregnancy complications, and urban residents. Government should ensure quality of care, easy accessibility, and availability of all facilities free of cost in the public medical institutions. Women should be informed regarding the long-term benefit of institutional delivery through information, education, and communication program.
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Affiliation(s)
- S M Mostafa Kamal
- University of Malaya, Kuala Lumpur, Malaysia Islamic University, Kushtia, Bangladesh
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