Prevalence of Infant and Young Child Feeding Practices and Differences in Estimates of Minimum Dietary Diversity Using 2008 and 2021 Definitions: Evidence from Bangladesh

Background

Infant and young child feeding (IYCF) practices directly impact the health of <2-y-old children. Minimum dietary diversity (MDD) is an IYCF indicator to assess feeding practices of children aged 6-23 mo. The definition of MDD has recently been updated by the WHO and UNICEF, substituting "≥4 out of 7 food groups" (MDD-7FG) with "≥5 out of 8 food groups" (MDD-8FG).

Objectives

The goals of this study were to estimate the prevalence of IYCF indicators and identify the implications of the change in the prevalence of MDD at the national and regional levels of Bangladesh.

Methods

This study used data from the National Food Security and Nutrition Surveillance 2018-2019 round. A total of 1992 children aged 0-23 mo were included in this analysis. IYCF indicators and MDD were calculated according to the WHO-UNICEF guidelines. The difference between the prevalence of MDD-7FG and MDD-8FG is presented as percentage points.

Results

The prevalence of early initiation of breastfeeding was 43.8%, and exclusive breastfeeding was 56.2%. Approximately 55% of children maintained MDD (MDD-7FG), 48% received minimum meal frequency, and 28% received a minimum acceptable diet. Compared with MDD-7FG, the prevalence of MDD-8FG was lower among 6-23-mo-old children. The difference between MDD prevalence (MDD-8FG vs. MDD-7FG) was high for boys (44.0% vs. 53.2%), children aged 12-23 mo (53.4% vs. 63.4%), in urban areas (30.2% vs. 42.4%), in the Dhaka administrative division (42.0% vs. 56.3%), among uneducated mothers (37.1% vs. 47.1%), in households with ≤4 members (44.3% vs. 55%), and for middle-class households (40.3% vs. 57.6%).

Conclusions

The new method led to a decrease in the prevalence of MDD in Bangladesh. As the country prepares to implement the new indicator, it is critical to disseminate the new knowledge and its positive implication for improved child feeding and nutrition.

Nutrition and Food Security in Bangladesh: Achievements, Challenges, and Impact of the COVID-19 Pandemic

BACKGROUND

Bangladesh has experienced remarkable transformation in demographic, health, and nutritional status of the population. The changes have exposed the population to a number of challenges, the detrimental effect of which on health and nutrition is likely to be increased by the coronavirus disease 2019 (COVID-19) pandemic. We provide an overview of health and nutritional challenges in Bangladesh in relation to demographic transition and the COVID-19 pandemic.

METHODS

We identified and reviewed recent reports, published articles, and pertinent gray literature on nutrition and food security in Bangladesh to provide historical and contextual information.

RESULTS

The review identifies the progress as well as existing burden regarding nutrition and food security in Bangladesh and highlights the challenges in the coming days in regard to population growth and the COVID-19 pandemic. The country is on track to reduce all forms of childhood undernutrition, while the proportion of nutrition-related noncommunicable diseases is rising owing to changes in dietary intake, low physical activity, and sedentary lifestyle.

CONCLUSIONS

Despite remarkable progress, health and nutritional status of the population in Bangladesh faces challenges, particularly in relation to demographic transition and compounded by the COVID-19 pandemic, which require concerted attention from policymakers as well as stakeholders.

Prevalence and socio-economic determinants of inadequate dietary diversity among adolescent girls and boys in Bangladesh: findings from a nationwide cross-sectional survey

Malnutrition among adolescents is often associated with inadequate dietary diversity (DD). We aimed to explore the prevalence of inadequate DD and its socio-economic determinants among adolescent girls and boys in Bangladesh. A cross-sectional survey was conducted during the 2018-19 round of national nutrition surveillance in Bangladesh. Univariate and multivariable logistic regression was performed to identify the determinants of inadequate DD among adolescent girls and boys separately. This population-based survey covered eighty-two rural, non-slum urban and slum clusters from all divisions of Bangladesh. A total of 4865 adolescent girls and 4907 adolescent boys were interviewed. The overall prevalence of inadequate DD was higher among girls (55⋅4 %) than the boys (50⋅6 %). Moreover, compared to boys, the prevalence of inadequate DD was higher among the girls for almost all socio-economic categories. Poor educational attainment, poor maternal education, female-headed household, household food insecurity and poor household wealth were associated with increased chances of having inadequate DD in both sexes. In conclusion, more than half of the Bangladeshi adolescent girls and boys consumed an inadequately diversified diet. The socio-economic determinants of inadequate DD should be addressed through context-specific multisectoral interventions.

Prevalence and associated factors of insufficient physical activity among elderly people in Bangladesh: a nationally representative cross-sectional study

OBJECTIVES

Insufficient physical activity (IPA) is a crucial risk factor for non-communicable diseases (NCDs). The elderly population has a higher likelihood of suffering from NCDs. We aimed to estimate the prevalence of and factors associated with IPA among the elderly people in Bangladesh.

METHODS

We analysed data from the Bangladesh Food Security and Nutrition Surveillance round 2018-2019, collected from 82 rural, non-slum urban and slum clusters selected using multistage cluster sampling. IPA was defined as <150 min of moderate intensity or <75 min of vigorous intensity or equivalent in a typical week. The weighted prevalence of IPA was estimated by gender and across different variables. Crude and adjusted prevalence ratios were calculated using Poisson regression with robust variance.

RESULTS

The weighted prevalence of IPA among elderly people was 38.4%, with a slightly higher prevalence in women (39.7% vs 37.3%). Factors associated with higher prevalence of IPA in both sexes were-higher age, living in non-slum urban areas, unemployed or homemaker, not currently married, sedentary behaviour and self-reported hypertension. Further, >10 years of education, inadequate fruits and vegetable consumption, self-reported asthma and higher waist circumference among men; and higher household income and self-reported diabetes among women were associated with a higher prevalence of IPA.

CONCLUSIONS

IPA is highly prevalent among Bangladeshi elderly men and women. Sedentary behaviour, inadequate fruits and vegetable consumption and higher waist circumference were the modifiable factors of IPA. Evidence from this study can guide the development of appropriate interventions to promote healthy ageing in Bangladesh.

Nutrition and Health Status of Elderly People in Bangladesh: Evidence From a Nationwide Survey

Objectives

Though Bangladesh is passing through demographic, epidemiologic and nutritional transitions, national estimates on nutrition and health status of the elderly population are largely unknown. We aimed to determine the status of selected health and nutrition indicators among the elderly population in Bangladesh.

Methods

For the first time in Bangladesh, we included elderly population (≥60 years old females and males) as a separate population group in the national food security and nutrition surveillance round 2018–2019. We collected data on dietary diversity, nutritional status,

behavioral risk factors of non-communicable diseases, blood pressure, and self-reported chronic diseases from 4,818 elderly people (48% female) living in 82 clusters (57 rural, 15 non-slums urban, and 10 slums) randomly selected from eight administrative division of Bangladesh.

Results

Majority (59% in rural, 53% in non-slum urban, and 69% in slums) of elderly people were consuming an inadequately diverse (4 or less food groups out of 10) diet. Overall, 89% of elderly people were malnourished (20%) or at risk of malnutrition (69%). The highest prevalence of malnutrition was in Mymensingh division (37%) followed by Sylhet division (27%). The prevalence of obesity was 5%, 16%, and 11%, in rural, non-slum urban, and slums, respectively. The national prevalence of smoking, smokeless tobacco consumption, physical inactivity was 18%, 52%, and 38%, respectively. There was a high burden of hypertension (49% in rural, 53% in non-slum urban, and 39% in slums). Overall, 16% of elderly people had heart diseases, 14% had chronic respiratory diseases, 3% had kidney diseases, 9% had diabetes, 8% had stroke, 0.5% had cancer and 1.4% had mental health problems.

Conclusions

The government of Bangladesh should design and implement health and nutrition programs among the elderly population. The regional differences in the prevalence of health and nutrition indicators should be considered while designing such programs.

Funding Sources

Ministry of Health and Family Welfare, Government of Bangladesh

Gender-specific prevalence and associated factors of hypertension among elderly Bangladeshi people: findings from a nationally representative cross-sectional survey

OBJECTIVE

We aimed to estimate the gender-specific prevalence and associated factors of hypertension among elderly people in Bangladesh.

DESIGN AND METHOD

We analysed data from the food security and nutrition surveillance round 2018-2019. The multistage cluster sampling method was used to select the study population. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or having a history of hypertension. We carried out the descriptive analysis, bivariate and multivariable logistic regression to report the weighted prevalence of hypertension as well as crude and adjusted ORs with 95% CI. A p value<0.05 was considered statistically significant.

SETTING

The study was conducted in 82 clusters (57 rural, 15 non-slum urban and 10 slums) in all eight administrative divisions of Bangladesh.

PARTICIPANTS

A total of 2482 males and 2335 females aged ≥60 years were included in this analysis.

RESULTS

The weighted prevalence of hypertension was 42% and 56% among males and females, respectively. The prevalence was higher among females across all sociodemographic, behavioural and clinical strata. Factors associated with higher odds of hypertension (adjusted OR (AOR) (95% CI) for males and females, respectively) were age ≥70 years (1.32 (1.09, 1.60) and 1.40 (1.15, 1.71)); insufficient physical activity (1.50 (1.25, 1.81) and 1.38 (1.15, 1.67)); higher waist circumference (2.76 (2.22, 3.43) and 2.20 (1.82, 2.67)); and self-reported diabetes (1.36 (1.02, 1.82) and 1.82 (1.35, 2.45)). Additionally, living in slums decreased (0.71 (0.52, 0.96)) and education >10 years increased odds of hypertension (1.83 (1.38, 2.44)) among males.

CONCLUSION

In Bangladesh, half of the elderly persons were hypertensive, with a higher prevalence in females. In both sexes, odds of hypertension was higher among persons with older age (≥70 years), insufficient physical activity, higher waist circumference and self-reported diabetes. The Ministry of Health of Bangladesh should consider these findings while designing and implementing health programmes for elderly population.

Prevalence and associated factors of depression among adolescent boys and girls in Bangladesh: findings from a nationwide survey

OBJECTIVE

To assess the prevalence of and factors associated with depression among adolescent boys and girls.

DESIGN

We conducted a nationwide cross-sectional study.

SETTING

This study was carried out in 82 randomly selected clusters (57 rural, 15 non-slum urban and 10 slums) from eight divisions of Bangladesh.

PARTICIPANTS

We interviewed 4907 adolescent boys and 4949 adolescent girls.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was 'any depression' and the secondary outcome measures were types of depression: no or minimal, mild, moderate, moderately severe and severe.

RESULTS

The overall prevalence of no or minimal, mild, moderate, moderately severe and severe depression was 75.5%, 17.9%, 5,4%, 1.1% and 0.1%, respectively. Across most of the sociodemographic, lifestyle and anthropometric strata, the prevalence of any depression was higher among adolescent girls. In both sexes, depression was associated with higher age, higher maternal education, paternal occupation e.g., business, absence of a 6-9-year-old member in the household, food insecurity, household consumption of unfortified oil, household use of non-iodised salt, insufficient physical activity (adjusted odds ratio, AOR: 1.24 for boys, 1.44 for girls) and increased television viewing time e.g., ≥121 minute/day (AOR: 1.95 for boys, 1.99 for girls). Only among boys, depression was also associated with higher paternal education e.g., complete secondary and above (AOR: 1.42), absence of another adolescent member in the household (AOR: 1.34), household use of solid biomass fuel (AOR: 1.39), use of any tobacco products (AOR: 2.17), and consumption of processed food (AOR: 1.24). Only among girls, non-slum urban residence, Muslim religion, and household size ≤4 were also associated with depression.

CONCLUSION

The prevalence of depression among adolescent boys and girls is high in Bangladesh. In most sociodemographic, lifestyle and anthropometric strata, the prevalence is higher among girls. In this age group, depression is associated with a number of sociodemographic and lyfestyle factors. The government of Bangladesh should consider these findings while integrating adolescent mental health in the existing and future programmes.

Nutritional Status Among School-Age Children of Bangladeshi Tea Garden Workers

BACKGROUND

While considerable progress has been made in reducing undernutrition in Bangladesh, regional disparities are known to exist, and certain population subgroups may lag behind.

OBJECTIVE

To characterize nutritional status among school-age children in a historically marginalized population of Bangladesh.

METHODS

We conducted a cross-sectional assessment of children attending 14 nongovernmental organization-operated schools serving the tea estate population in Kulaura Upazila, Sylhet Division. We randomly selected 168 children from a population of 418 whose parents attended school-organized Parent-Teacher Association meetings. Parents provided consent and data on household food consumption in the past week, foods consumed by children in the past 24 hours, and household food insecurity. We drew venous blood from assenting children for the analysis of hemoglobin and plasma retinol, C-reactive protein, and α₁-acid glycoprotein. Children were classified as stunted, underweight, or thin based on comparisons with the World Health Organization standards for height-for-age, weight-for-age, or body mass index-for-age, respectively.

RESULTS

Food insecurity was highly prevalent, with ∼85% of households affected. Roughly half of children had low dietary diversity. Prevalence estimates for stunting, underweight, and thinness were 32%, 50%, and 49%, respectively. Approximately 60% of children had a hemoglobin concentration <11 g/dL. The mean (±SD) plasma retinol concentration was 0.79 μmol/L (±0.23 μmol/L), with 34% deficient using a 0.70 μmol/L cutoff.

CONCLUSIONS

A heightened focus on tracking progress in underserved populations and appropriately targeted programming will be critical as Bangladesh seeks to accelerate progress toward global development goals for nutrition.

Elderly Women Are Disproportionately Vulnerable to Hypertension in Bangladesh: Evidence from the National Nutrition Surveillance Study

Objectives

Bangladesh has a dearth of information on the prevalence and factors associated with hypertension among elderlies. We assessed the prevalence, sex differences in prevalence, and factors associated with hypertension in the most recent national nutrition surveillance round (2018–19).

Methods

We analyzed data of 4817 elderlies (≥60 years) from 82 clusters (57 rural, 15 urban and 10 slum) selected by multistage cluster sampling. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or having a history of hypertension. We analyzed data using Stata 15.0.

Results

The weighted prevalence of hypertension was 42%, and 56% for elderly males, and females, respectively; and was higher among females for many socio-demographic, behavioural and anthropetric variables including age 70 + years (58% vs. 46%); high waist circumference (69% vs. 65%); diabetes (69% vs. 65%); living in rural (55% vs. 41%), urban (63% vs. 45%) and slum (50% vs. 30%) area; Muslim (56% vs. 42%); insufficient physical activity (60% vs 52%); and inadequate fruits/vegetables intake (56% vs. 43%). Among females, the factors associated with hypertension were age 70 + years (AOR: 1.40, 95% CI: 1.15–1.71), waist circumference ≥80 cm (AOR: 2.20, 95% CI: 1.82–2.67), diabetes (AOR: 1.82, 95% CI: 1.35–2.45), and inadequate physical activity (AOR: 1.38, 95% CI: 1.15–1.67). Among males, these factors were age 70 + years (AOR: 1.32, 95% CI: 1.09–1.60), waist circumference ≥90 cm (AOR: 2.76, 95% CI: 2.22–3.43), diabetes (AOR: 1.36, 95% CI: 1.02–1.82), slum-dwelling (AOR: 0.71, 95% CI: 0.52–0.96), &gt; 10 years of education (AOR: 1.83; 95% CI: 1.38, 2.44), inadequate physical activity (AOR: 1.50, 95% CI: 1.25–1.81), and current smoking (AOR: 0.74; 95% CI: 0.61, 0.89). In both males and females, fruits and vegetables intake was not assicaited with hypertension.

Conclusions

In Bangladesh, the elderly female population is disproportionately affected by hypertension. They were found having a consistent pattern of higher prevalence of hypertension for many socio-demographic, behavioral, and anthropometric variables. The ministry of health of Bangladesh should consider this disproportionately high prevalence of hypertension among elderly females while designing and implementing health programs.

Funding Sources

Ministry of Health and Family Welfare, Bangladesh.

Dietary Practices of Men in Bangladesh: Evidence from the National Nutrition Surveillance

Objectives

Bangladesh has a paucity of information about the dietary practices of adult men. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we explored the dietary practices of adult men and factors associated with insufficient dietary diversity (IDD) and insufficient intake of fruits and vegetables.

Methods

In the NNS, between October 2018 and 2019, we collected data from from 82 clusters (57 rural, 15 non-slum urban, and 10 slums) selected using multistage cluster sampling. In these clusters we interviewed and took physical measurements of 4904 20–59 years old men (3471 in rural, 832 in urban, and 601 in slum). We used minimum dietary diversity for women (MDD-W) questionnaire to collect dietary data. IDD was defined as consumption of &lt; 5 food groups out of 10 food groups, and insufficient fruits and vegetables intake was defined as consumption of &lt; 5 servings of fruits and vegetables in the past 24 hours.

Results

The prevalence of IDD was 53% (54% in rural, 42% in non-slum urban, and 56% in slum areas) among the adult men. In the past 24 hours, 73% consumed meat/fish/poultry, 28% consumed eggs, and 22% consumed dairy products. The consumption of dark green leafy vegetables, vitamin A rich fuits and vegetables, other vegetables, other fruits was 34%, 22%, 73%, and 37%, respectively. Among the respondents, 27% had savory snacks, 52% had sweets, and 75% had sugary drinks. The prevalence of insufficient fruits and vegetables intake was 86% (83% in rural, 92% in non-slum urban and 93% in slum areas). IDD was associated with education (partial secondary education: Adjusted odds ratio (AOR) 0.67, P &lt; 0.001; ≥10 years of schooling: AOR 0.48, P &lt; 0.001), and sufficient intake of fruits and vegetables (AOR 0.82, P = 0.022). On the other hand, insufficient fruits and vegetables intake was associated with IDD (AOR 1.23, P = 0.014), hypertension (AOR 0.77, P = 0.020) and adequate physical activity (AOR 0.46, P &lt; 0.001).

Conclusions

More than half of the men aged 20–59 years consume an inadequately diversified diet in Bangladesh and 86% had insufficient intake of fruits and vegetables. This study identified a number of factors associated with IDD, and insufficient intake of fruits and vegetables. The government of Bangladesh should address them while developing interventions to improve nutrition.

Funding Sources

Ministry of Health and Family Welfare, Bangladesh.

Inadequate Dietary Diversity and Its Determinants Among Adolescent Girls and Boys: Evidence from the National Nutrition Surveillance Study in Bangladesh

Objectives

Bangladesh is experiencing triple burden of malnutrition among adolescents, which may be associated with inadequate dietary diversity (IDD). In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we explored the prevalence of IDD and its determinants among adolescent girls and boys.

Methods

A total of 4808 adolescent girls and 4761 adolescent boys were interviewed. We used minimum dietary diversity for women (MDD-W) questionnaire to collect dietary data. IDD was defined as consumption of &lt;5 food groups out of 10 food groups in the past 24 hours. Bivariate and multivariable logistic regression were performed to identify risk factors for IDD among adolescent girls and boys.

Results

The prevalence of IDD was 55.5% and 50.6% among the adolescent girls and boys. Prevalence of IDD decreased with an increase of educational attainment among girls (no education 77.8% and grade 10 completed education 49.2%) and boys (no education 68.2% and grade 10 completed education 44.2%). The prevalence of IDD in slum, urban and rural areas was 66.4%, 55.6%, and 51.9% among girls and 61.4%, 50.5% and 52.6% among boys, respectively. Prevalence of IDD was lowest among the richest wealth quintile (girls: 45.4% and boys: 43.1%). Among adolescent girls education (e.g., for grade 10 completed, AOR: 3.42, P = 0.002), marital status (AOR: 1.24, P = 0.046), processed food consumption (AOR: 1.66, P &lt; 0.001), television viewing time (e. g. for ≤60 min/day, AOR: 1.37, P &lt; 0.001), and sex of household head (AOR: 0.81, P = 0.003) were significantly associated with IDD. Among the adolescent boys age (AOR: 0.82, P = 0.024), education (e.g., for grade 10 completed, AOR: 2.36, P &lt; 0.001), sex of household heads (AOR: 0.80, P = 0.002), livestock ownership (AOR: 1.22, P = 0.012), fruits and vegetable consumption (AOR: 1.38, P = 0.004), processed food intake (AOR: 1.74, P &lt; 0.001), physical activity (AOR: 0.76, P = 0.001), and television viewing time (e. g. for ≤60 min/day, AOR: 1.19, P = 0.021) were significantly associated with IDD.

Conclusions

About more than half of the adolescent girls and boys consume inadequately diversified diet in Bangladesh. The study identified a number of factors associated with IDD, which should be addressed through comprehensive and sustainable public health interventions.

Funding Sources

Ministry of Health and Family Welfare, Bangladesh.

Double Burden of Malnutrition Among Elderly People in Bangladesh: Evidence from the National Nutrition Surveillance Study

Objectives

Double burden of malnutrition (DBM), referred as the coexistence of undernutrition and overnutrition, is an evolving public health concern. There is a paucity of data about DBM among elderly people in Bangladesh. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we assessed the prevalence and determinants of DBM among elderly people.

Methods

In the NNS, we collected data from 30,005 persons in 6 population groups from 82 clusters (57 rural, 15 non-slum urban, and 10 slums) selected using multistage cluster sampling. We collected socio-demographic, life-style and anthropometric data from 4817 respondents aged &gt;60 years. Underweight was defined as body mass index (BMI) &lt;18.5 kg/m2 and overweight/obesity as BMI ≥ 23 kg/m2.

Results

The weighted prevalence of underweight was 26.8%, and was higher among elderly aged ≥70 years (34.4%), male (28.5%), non-diabetic (28.5%), rural residents (27.1%) and with inadequate fruits and vegetables consumption (27.1%). The weighted prevalence of overweight was 27.0%, and was higher among elderly aged 60–69 years (29.8%), female (30.8), diabetic (51.0%), urban residents (48.2%), with poor physical activity (31.3%), and with inadequate fruits and vegetables consumption (27.4%). As education and wealth status increased, the prevalence of underweight decreased and the prevalence of overweight and obesity increased. In multivariable logistic regression, male gender (AOR: 1.33, 95% CI: 1.18,1.51), being non-diabetic (AOR: 1.50, 95% CI: 1.23,1.82), having no education (AOR: 1.73, 95% CI: 1.35,2.22), and having adequate physical activity (AOR: 1.19, 95% CI: 1.05,1.35) were associated with underweight. However, urban residency (AOR: 1.73, 95% CI: 1.41,2.12), 60–69 years age (AOR: 1.59, 95% CI: 1.36,1.85), being female (AOR: 1.81, 95% CI: 1.56,2.10), having diabetes (AOR: 2.52, 95% CI:2.07,3.08), being Muslim (AOR: 1.25, 95% CI: 1.04,1.53), and having inadequate physical activity (AOR: 1.36, 95% CI: 1.18,1.57) were associated with overweight.

Conclusions

The overall prevalence of undernutrition and overnutrition is very high among elderly population in Bangladesh. The government together with national and international organizations should implement population-based interventions to prevent and control DBM.

Funding Sources

Ministry of Health and Family Welfare, Bangladesh.

Prevalence of and Factors Associated with Insufficient Physical Activity Among Adolescents: Evidence from the National Nutrition Surveillance Study

Objectives

The World Health Organization (WHO) set a target of 15% relative reduction of the prevalence of insufficient physical activity (IPA) by 2025 among adolescents and adults globally. In Bangladesh, there is no national estimates of the prevalence of IPA among adolescents. In the recently completed round of the national nutrition surveillance (NNS 2018–2019), we aimed to estimate the prevalence and risk factors associated with IPA among adolescent girls and boys.

Methods

NNS was conducted in 57 rural, 15 urban and 10 slum clusters selected using multistage cluster sampling. In these clusters, we collected data from 4732 adolescent girls and 4761 adolescent boys. We used Global Physical Activity Questionnaire to collect physical activity (PA) data. The WHO recommended cut off points for IPA (5–17 years: &lt;300 minutes of moderate to vigorous-intensity PA weekly; 18–19 years: &lt;150 minutes of moderate intensity PA weekly or &lt;75 minutes of vigorous-intensity PA weekly) were used to estimate the prevalence of IPA. Bivariate and multivariable logistic regression were performed to identify factors associated with IPA.

Results

Prevalence of IPA among girls and boys were 50.6% and 29.4%, respectively and the prevalence was significantly higher among early adolescents (10–14 years) than late adolescents in both boys and girls. The IPA prevalence was the highest among the adolescents living in non-slum urban areas (girls: 77.9% and boys: 64.6%). The IPA prevalence in slum areas was 36.6% for girls and 34.0% for boys; and in rural areas was 50.0% for girls and 28.2% for boys. For both girls and boys, age group, occupation and &gt;6 hours of sitting per day were associated with IPA. Place of residence, consumption of fruits and vegetables, education and paternal occupation were associated with IPA only among the boys. On the other hand, maternal and paternal education and overweight/obesity were associated with IPA only among the girls.

Conclusions

One in every two adolescent girls and one in every three adolescent boys do not meet the WHO recommended level of PA in Bangladesh. This study identified several modifiable factors associated with IPA among adolescent boys and girls and these factors should be addressed through comprehensive public health interventions in order to improve adolescent health in Bangladesh.

Funding Sources

Ministry of Health and Family Welfare, Bangladesh.

Thunderstorms and Lightning in Bangladesh

Abstract not available Bangladesh Med Res Counc Bull 2019; 45: 01-02

Investigation of methicillin-resistant Staphylococcus aureus among clinical isolates from humans and animals by culture methods and multiplex PCR

Background

Staphylococcus aureus is responsible for large numbers of hospital-related and community-acquired infections. In this study, we investigated the presence of S. aureus and methicillin-resistant S. aureus (MRSA) in 100 samples from animals (55 cattle, 36 dogs, and 9 cats) and 150 samples from hospitalized human patients. The samples were collected from healthy and diseased animals and from diseased humans and included milk, wound swab, pus, exudates, nasal swab and diabetic ulcer. Initially, S. aureus was isolated and identified by colony morphology, Gram staining, and biochemical tests (catalase and coagulase tests). The S. aureus-positive samples were examined by polymerase chain reaction (PCR) to determine their MRSA status.

Results

Of the 100 animal samples, 29 were positive for S. aureus. Four samples (13.8%) from dogs were MRSA-positive, but samples from cattle and cats were MRSA-negative. Of the 150 human samples we collected, 64 were S. aureus-positive and, of these, 34 (53.1%) were MRSA-positive. Most (28%) of the MRSA samples were isolated from surgical wound swabs, followed by the pus from skin infections (11%), exudates from diabetic ulcers (6%), exudates from burns (4%), and aural swabs (3%). By contrast, a low MRSA detection rate (n = 4) was seen in the non-human isolates, where all MRSA bacteria were isolated from nasal swabs from dogs. The antimicrobials susceptibility testing results showed that S. aureus isolates with mecA genes showed resistance to penicillin (100%), oxacillin (100%), erythromycin (73.5%), ciprofloxacin (70.6%), and gentamicin (67.7%). The lowest resistance was found against ceftazidime, and no vancomycin-resistant isolates were obtained.

Conclusions

We detected S. aureus and MRSA in both human and canine specimens. Isolates were found to be resistant to some of the antimicrobials available locally. MRSA carriage in humans and animals appears to be a great threat to effective antimicrobials treatment. The prudent use of antimicrobials will reduce the antimicrobial resistance. Our findings will help to find the most appropriate treatment and to reduce antimicrobial resistance in the future by implementing prudent use of antimicrobials. Further studies are required to better understand the epidemiology of MRSA human–animal inter-species transmission in Bangladesh.

Electronic supplementary material

The online version of this article (10.1186/s12917-018-1611-0) contains supplementary material, which is available to authorized users.

Challenges and opportunities of integration of community based Management of Acute Malnutrition into the government health system in Bangladesh: a qualitative study

BACKGROUND

Severe acute malnutrition (SAM) in children is the most serious form of malnutrition and is associated with very high rates of morbidity and mortality. For sustainable SAM management, United Nations recommends integration of community based management of acute malnutrition (CMAM) into the health system. The objective of the study was to assess the preparedness of the health system to implement CMAM in Bangladesh.

METHODS

The assessment was undertaken during January to May 2014 by conducting document review, key informant interviews, and direct observation. A total of 38 key informant interviews were conducted among government policy makers and program managers (n = 4), nutrition experts (n = 2), health and nutrition implementing partners (n = 2), development partner (n = 1), government health system staff (n = 5), government front line field workers (n = 22), and community members (n = 2). The assessment was based on: workforce, service delivery, financing, governance, information system, medical supplies, and the broad socio-political context.

RESULTS

The government of Bangladesh has developed inpatient and outpatient guidelines for the management of SAM. There are cadres of community health workers of government and non-government actors who can be adequately trained to conduct CMAM. Inpatient management of SAM is available in 288 facilities across the country. However, only 2.7% doctors and 3.3% auxiliary staff are trained on facility based management of SAM. In functional facilities, uninterrupted supply of medicines and therapeutic diet are not available. There is resistance and disagreement among nutrition stakeholders regarding import or local production of ready-to-use therapeutic food (RUTF). Nutrition coordination is fragile and there is no functional supra-ministerial coordination platform for multi-sectoral and multi-stakeholder nutrition.

CONCLUSION

There is an enabling environment for CMAM intervention in Bangladesh although health system strengthening is needed considering the barriers that have been identified. Training of facility based health staff, government community workers, and ensuring uninterrupted supply of medicines and logistics to the functional facilities should be the immediate priorities. Availability of ready-to-use therapeutic food (RUTF) is a critical component of CMAM and government should promote in-country production of RUTF for effective integration of CMAM into the health system in Bangladesh.

Nationwide prevalence of Rickettsia felis infections in patients with febrile illness in Bangladesh

From July 2015 to December 2016, the presence of rickettsial pathogens was investigated for 414 patients with unknown fever in eight places in all the divisions of Bangladesh. Rickettsia felis was identified in blood samples from all the regions (overall detection rate, 19.6%), suggesting nationwide prevalence of R. felis infections.

Comparison of TaqMan(®) Array Card and MYCOTB(TM) with conventional phenotypic susceptibility testing in MDR-TB

BACKGROUND

Although phenotypic drug susceptibility testing (DST) is endorsed as the standard for second-line drug testing of Mycobacterium tuberculosis, it is slow and laborious.

METHODS

We evaluated the accuracy of two faster, easier methodologies that provide results for multiple drugs: a genotypic TaqMan(®) Array Card (TAC) and the Sensititre(®) MYCOTB(TM) plate. Both methods were tested at three central laboratories in Bangladesh, Tanzania, and Thailand with 212 multidrug-resistant tuberculosis (MDR-TB) isolates and compared with the laboratories' phenotypic method in use.

RESULTS

The overall accuracy for ethambutol, streptomycin, amikacin, kanamycin, ofloxacin, and moxifloxacin vs. the phenotypic standard was 87% for TAC (range 70-99) and 88% for the MYCOTB plate (range 76-98). To adjudicate discordances, we re-defined the standard as the consensus of the three methods, against which the TAC and MYCOTB plate yielded 94-95% accuracy, while the phenotypic result yielded 93%. Some isolates with genotypic mutations and high minimum inhibitory concentration (MIC) were phenotypically susceptible, and some isolates without mutations and low MIC were phenotypically resistant, questioning the phenotypic standard.

CONCLUSIONS

In our view, the TAC, the MYCOTB plate, and the conventional phenotypic method have similar performance for second-line drugs; however, the former methods offer speed, throughput, and quantitative DST information.

Nutrition of children and women in Bangladesh: trends and directions for the future

Although child and maternal malnutrition has been reduced in Bangladesh, the prevalence of underweight (weight-for-age z-score <-2) among children aged less than five years is still high (41%). Nearly one-third of women are undernourished with body mass index of <18.5 kg/m2. The prevalence of anaemia among young infants, adolescent girls, and pregnant women is still at unacceptable levels. Despite the successes in specific programmes, such as the Expanded Programme on Immunization and vitamin A supplementation, programmes for nutrition interventions are yet to be implemented at scale for reaching the entire population. Given the low annual rate of reduction in child undernutrition of 1.27 percentage points per year, it is unlikely that Bangladesh would be able to achieve the United Nations' Millennium Development Goal to address undernutrition. This warrants that the policy-makers and programme managers think urgently about the ways to accelerate the progress. The Government, development partners, non-government organizations, and the academia have to work in concert to improve the coverage of basic and effective nutrition interventions, including exclusive breastfeeding, appropriate complementary feeding, supplementation of micronutrients to children, adolescent girls, pregnant and lactating women, management of severe acute malnutrition and deworming, and hygiene interventions, coupled with those that address more structural causes and indirectly improve nutrition. The entire health system needs to be revitalized to overcome the constraints that exist at the levels of policy, governance, and service-delivery, and also for the creation of demand for the services at the household level. In addition, management of nutrition in the aftermath of natural disasters and stabilization of prices of foods should also be prioritized.

Energy intake and expenditure of obese and non-obese urban Bangladeshi children

A case control study was conducted in Dhaka city to measure the energy intake and expenditure among 220 obese children of 4-10 years age group and 220 randomly selected age and sex matched controls. A 24 hour dietary recall was used to assess the energy intake. Data on energy expenditure was obtained by 24 hour physical activity recall. The mean energy intake of obese children (2056 +/- 751 kcal/d) was found to be significantly higher (P<0.001) compared to the non obese (1508 +/- 529 kcal/d). No sex difference was found in both obese and non obese groups. Mean energy expenditure of the obese children (1868 +/- 313 kcal/d vs 1495 +/- 200 kcal/d) was significantly higher than the non-obese (P<0.001). Of the obese, boys expended more energy than the girls (P=0.01). Furthermore, physical activity level (1.40 +/- 0.09 vs 1.35 +/- 0.14) was significantly higher among the non obese than their obese counterpart (P<0.001). However, energy balance was significantly higher among the obese (P<0.001). Dose response of energy balance shows the estimated relative risk of obesity increases with higher level of energy balance (P<0.001). The findings of this study revealed that energy balance as a result of higher energy intake and lower energy expenditure was one of the important risk factors for the development of obesity among the children of Dhaka city. Thus, appropriate interventions like behavioural change regarding food habits and physical activities are recommended.