The Geography of Diabetes among the General Adults Aged 35 Years and Older in Bangladesh: Recent Evidence from a Cross-Sectional Survey

Khan MH, Gruebner O, Krämer A. The Geography of Diabetes among the General Adults Aged 35 Years and Older in Bangladesh: Recent Evidence from a Cross-Sectional Survey. PLoS ONE. 2014;9(10): e110756.Objective To report geographical variations of sex-specific diabetes by place of residence (large cities/city corporations, small towns/other urban areas, rural areas) and region of residence (divided into seven divisions) among general adults (35+ years of age) in Bangladesh. Methods The recent cross-sectional data, extracted from the nationally representative Bangladesh Demographic and Health Survey 2011, was used. A total of 3,720 men and 3,823 women aged 35+ years, who participated in the fasting blood sugar testing, were analysed. Any person with either fasting plasma glucose level (mmol/L) ≥7.0 or taking medication for diabetes was considered as a person with diabetes. Results The prevalence of diabetes was 10.6% in men and 11.3% in women. Bivariable analyses indicated significant variations of diabetes by both geographical variables. The prevalence was highest in city corporations (men 18.0%, women 22.3%), followed by small towns (men 13.6%, women 15.2%) and rural areas (men 9.3%, women 9.5%). Regional disparities in diabetes prevalence were also remarkable, with the highest prevalence in Chittagong division and lowest prevalence in Khulna division. Multivariable logistic regression analyses provided mixed patterns of geographical disparities (depending on the adjusted variables). Some other independent risk factors for diabetes were advancing age, higher level of education and wealth, having TV (a proxy indicator of physical activity), overweight/obesity and hypertension. Conclusions Over 10% of the general adults aged 35 years and older were having diabetes. Most of the persons with diabetes were unaware of this before testing fasting plasma glucose level. Although significant disparities in diabetes prevalence by geographical variables were observed, such disparities are very much influenced by the adjusted variables. Finally, we underscore the necessities of area-specific strategies including early diagnosis and health education programmes for changing lifestyles to reduce the risk of diabetes in Bangladesh

Prevalence and risk factors of childhood anemia in Nepal: A multilevel analysis

Introduction Anemia is a common problem in children particularly in developing countries and taking steps to tackle it is one of the major public health challenges for Nepal. The objective of this study is to investigate the prevalence of individual, household and community level determinants of childhood anemia in Nepal. Methods Data was taken from a nationally representative sample of 1,942 Nepalese children aged from 6–59 months. The Chi-square test was used to determine the bivariate relationship between the selected variables and childhood anemia and a multilevel logistic regression model with a random intercept at household and community level was used to identify important determinants of this kind of anemia. Results The results showed that 52.6% (95% CI: 49.8%-55.4%) of the children were anemic while 26.6% (95% CI: 24.0%-29.3%) of them were moderate to severe. The prevalence of overall anemia was higher among children aged less than 11 months as well as in underweight children, children of underweight, anemic and uneducated mothers and those in the terrain ecological regions. Multivariable analysis showed that children aged less than 11 months, who were underweight and had anemic mothers were more likely to have moderate or severe anemia. Children in the hilly ecological region were less likely to have it compared to mountain and terrain ecological regions. Children in middle-class families and children of mothers who completed secondary education were more likely to have anemia. Conclusion Nepal is facing a serious public health problem due to the high prevalence of childhood anemia. This adverse situation occurs due to socio-demographic and geographical factors such as age, malnutrition status, mother’s anemia status, socio-economic status and regional variations. Prevention of childhood anemia should be given top priority in Nepal and should be considered as a major public health intervention

Indirect consequences of extreme weather and climate events and their associations with physical health in coastal Bangladesh: a cross-sectional study

Beier D, Brzoska P, Khan MH. Indirect consequences of extreme weather and climate events and their associations with physical health in coastal Bangladesh: a cross-sectional study. Global Health Action. 2015;8(1): 29016.Background: Bangladesh is one of the countries in the world which is most prone to natural disasters. The overall situation is expected to worsen, since extreme weather and climate events (EWCE) are likely to increase in both frequency and intensity. Indirect consequences caused in the events' aftermath widen the range of possible adverse health outcomes. Objective: To assess the association of indirect consequences of EWCE and physical health. Design: We used recent cross-sectional self-reported data from 16 coastal villages in Bangladesh. A total of 980 households were surveyed using a structured questionnaire. The outcome of physical health was categorized into three groups, reflecting the severity of reported diseases by the respective source of treatment as a proxy variable (hospital/clinic for severe disease, other source/no treatment for moderate disease, and no disease). The final statistical analysis was conducted using multinomial logistic regression. Results: Severe diseases were significantly associated with drinking water from open sources [odds ratio (OR): 4.26, 95% confidence interval (CI): 2.25-8.09] and tube wells (OR: 2.39, 95% CI: 1.43-4.01), moderate harm by river erosion (OR: 6.24, 95% CI: 2.76-14.11), food scarcity (OR: 1.98, 95% CI: 1.16-3.40), and the perception of increased employment problems (OR: 2.19, 95% CI: 1.18-4.07). Moderate diseases were significantly associated with moderate harm by river erosion (OR: 2.65, 95% CI: 1.28-5.48) and fully experienced food scarcity (OR: 1.75, 95% CI: 1.16-2.63). For both categories, women and the elderly had higher chances for diseases. Conclusions: Indirect consequences of EWCE were found to be associated with adverse health outcomes. Basic needs such as drinking water, food production, and employment opportunities are particularly likely to become threatened by EWCE and, thus, may lead to a higher likelihood of ill-health. Intervention strategies should concentrate on protection and provision of basic needs such as safe drinking water and food in the aftermath of an event

Levels and determinants of complementary feeding based on meal frequency among children of 6 to 23 months in Bangladesh

Chowdhury MRK, Rahman MS, Khan MH. Levels and determinants of complementary feeding based on meal frequency among children of 6 to 23 months in Bangladesh. BMC Public Health. 2016;16(1): 944.Background Information concerning complementary feeding (CF) practice during infancy and early childhood is still scarce in Bangladesh. Therefore, this study aimed to estimate the level of CF among children of 6–23 months and identify individual, household and community level determinants in Bangladesh. Methods Secondary data from the Bangladesh Demographic Health Survey (BDHS) 2011 was used. A total of 2,373 children aged 6–23 months were selected. A simplified index called “dimension index” was used to estimate the level of CF. The score of this index was used either as continuous or categorical dependent variables. The highest score based on dimension index is associated to an adequate CF. Statistical analyses and tests were guided by types of variables. Finally, multivariable logistic regression (binary and multinomial) analyses were performed to identify the significant determinants of CF. Results The overall level of CF among children of 6–23 months was low. More than 90 % of children experienced either no (2.9 %) or inadequate CF (92.7 %). According to bivariable analyses, mean levels of CF as well as percentages of no/inadequate CF were significantly lower among children of the youngest age group, uneducated parents, unemployed/laborer fathers, socio-economically poor families, food insecure families and rural areas. No weekly exposure to mass media (namely watching TV and reading newspapers/magazines) also revealed significant associations with CF. However, only few variables remained significant for adequate CF in the multivariable logistic regression analysis. For example, the likelihood of experiencing adequate CF was significantly lower among children of 6–11 months (OR: 0.22, 95 % CI: 0.10–0.47), children of illiterate fathers (OR: 0.32, 95 % CI: 0.11–0.95) and socio-economically middle-class families (OR: 0.28, 95 % CI: 0.09–0.86) as compared to their reference categories. Conclusion A high level of inadequate CF leading to malnutrition may cause serious health problems among children of 6–23 months in Bangladesh. Vulnerable groups of children (e.g., the children aged 6 to 11 months and children of illiterate fathers), who received low levels of adequate CF, should be targeted by government and other stakeholders while developing strategies and interventions in order to improve overall situation of CF in Bangladesh

Exploring the factors contributing to increase in facility child births in Bangladesh between 2004 and 2017-2018

Although Bangladesh has gained rapid improvement in births at health facilities, yet far behind to achieve the SDG target. Assessing the contribution of factors in increased use of delivery at facilities are important to demonstrate. To explore the determinants and their contribution in explaining increased use of facility child births in Bangladesh. Reproductive-aged women (15-49 years) of Bangladesh. We used the latest five rounds (2004, 2007, 2011, 2014, 2017-2018) of Bangladesh Demographic and Health Surveys (BDHSs). The regression based classical decomposition approach has been used to explore the determinants and their contribution in explaining the increased use of facility child birth. A sample of 26,686 reproductive-aged women were included in the analysis, 32.90% (8780) from the urban and 67.10% (17,906) from the rural area. We observed a 2.4-fold increase in delivery at facilities from 2004 to 2017-2018, in rural areas it is more than three times higher than the urban areas. The change in mean delivery at facilities is about 1.8 whereas, the predicted change is 1.4. In our full sample model antenatal care visits contribute the largest predicted change of 22.3%, wealth and education contributes 17.3% and 15.3% respectively. For the rural area health indicator (prenatal doctor visit) is the largest drivers contributing 42.7% of the predicted change, hereafter education, demography and wealth. However, in urban area education and health contributed equally 32.0% of the change followed by demography (26.3%) and wealth (9.7%). Demographic variables (maternal BMI, birth order, age at marriage) contributing more than two-thirds (41.2%) of the predicted change in the model without the health variables. All models showed more than 60.0% predictive power. Health sector interventions should focus both coverage and quality of maternal health care services to sustain steady improvements in child birth facilities. [Abstract copyright: © 2023 The Authors. Published by Elsevier Ltd.

Alcohol consumption among university students: a Sino-German comparison demonstrates a much lower consumption of alcohol in Chinese students

Chu JJ, Jahn HJ, Khan MH, Krämer A. Alcohol consumption among university students: a Sino-German comparison demonstrates a much lower consumption of alcohol in Chinese students. JOURNAL OF HEALTH POPULATION AND NUTRITION. 2016;35(1): 25.Background: Alcohol use is reported in university students with discrepancy between countries. The study objectives were to assess prevalence and associated factors of alcohol consumption among university students in Germany and China. Methods: Data used were from 1853 Chinese and 3306 German university students. Alcohol consumption frequency was measured by a question "How often did you drink alcohol in the last three months?" with six possible responses, which were later collapsed into three categories of "At least once a week", "Less than once a week" and "Never". Problem drinking was measured by the CAGE test and defined as a CAGE score of two or more (four as the maximum). Simple and multivariable logistic regressions were used for association analyses. Results: German students reported more often "At least once a week" drinking (59.8 vs. 9.0 %). Among Germans, women drank less often "At least once a week" (OR = 0.40, 0.30-0.53). Among Chinese, a higher BMI was associated with drinking "At least once a week" (OR = 1.09, 1.02-1.18). Age revealed a positive association with "At least once a week" drinking in Chinese (1.33, 1.21-1.46) but a negative association in Germans (OR = 0.97, 0.94-0.99). Having a father with high educational level was positively related to "At least once a week" drinking in both countries (OR = 4.25, 2.67-6.78 for Chinese; OR = 1.32, 1.01-1.72 for Germans). Doing less than once a week physical exercise was negatively associated with "At least once a week" drinking in Chinese and German students (OR = 0.27, 0.15-0.48 for Chinese; OR = 0.69, 0.49-0.96 for Germans). Among the German students, 20.3 % reported problem drinking. Being a female (OR = 0.32, 0.26-0.40) and performing less than once a week physical activity (OR = 0.73, 0.56-0.95) were negatively associated with problem drinking, while having a father with high educational level (OR = 1.32, 1.09-1.60) and experiencing higher level of perceived stress (OR = 1.08, 1.04-1.13) were positively related to problem drinking. Conclusions: Country-specific strategies for reducing alcohol consumption, e.g. educational awareness programmes of alcohol use on Chinese campuses and alcohol prevention schemes among German youth before entering university, are sensible

Comparison of Subjective Health Complaints between Chinese and German University Students: A Cross-Sectional Study

Chu JJ, Khan MH, Jahn HJ, Krämer A. Comparison of Subjective Health Complaints between Chinese and German University Students: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2015;12(12):15794-15806.High rates of health complaints (HCs) with substantial variation are reported in different university populations, which can be linked to socio-demographic, lifestyle-related factors, and cultural differences. HCs can be categorized into distinct components. This study aimed to identify and compare underlying dimensions of HCs (HC components); to access and compare HC prevalence, and the associations between HC components, socio-demographic, lifestyle-related factors, and perceived stress in German and Chinese university students. Two health surveys were conducted among 5159 university students (1853 Chinese, 3306 German). Factor analysis and logistic regression were applied. The prevalence of HC ranged from 4.6% to 40.2% over the two countries. Germans reported at least three HCs more often (47.2% vs. 35.8%). Chinese students more often reported gastrointestinal complaints. Perceived stress was positively associated with all three HC components in both countries (OR = 1.03–1.50) with stronger associations among Germans. Women more often reported HCs (OR = 1.32–2.43) with stronger associations among the Germans. Having a father with a low educational level was associated with high psychological symptoms among the Chinese (OR = 1.51), but with low gastrointestinal complaints among the Germans (OR = 0.79). The high prevalence of HCs in students requires country-specific interventions

Sense of coherence and associated factors among university students in China: cross-sectional evidence

Chu JJ, Khan MH, Jahn HJ, Krämer A. Sense of coherence and associated factors among university students in China: cross-sectional evidence. BMC Public Health. 2016;16(1): 336

Only-child status in relation to perceived stress and studying-related life satisfaction among university students in China: a comparison with international students

Chu JJ, Khan MH, Jahn HJ, Krämer A. Only-child status in relation to perceived stress and studying-related life satisfaction among university students in China: a comparison with international students. Plos One. 2015;10(12): e0144947.Objectives University students in general face multiple challenges, which may affect their levels of perceived stress and life satisfaction. Chinese students currently face specific strains due to the One-Child Policy (OCP). The aim of this study was to assess (1) whether the levels of perceived stress and studying-related life satisfaction are associated with only-child (OC) status after controlling for demographic and socio-economic characteristics and (2) whether these associations differ between Chinese and international students. Materials and Methods A cross-sectional health survey based on a self-administrated standardised questionnaire was conducted among 1,843 (1,543 Chinese, 300 international) students at two Chinese universities in 2010-2011. Cohen's Perceived Stress Scale (PSS-14) and Stock and Kraemer's Studying-related Life Satisfaction Scale were used to measure perceived stress and studying-related life satisfaction respectively. Multivariable logistic regression analyses were used to examine the associations of OC status with perceived stress and studying-related life satisfaction by sex for Chinese students and international students separately. Results The Chinese non-only-children (NOCs) were more likely to come from small cities. Multivariable regression models indicate that the Chinese NOCs were more stressed than OCs (OR = 1.39, 1.11-1.74) with a stronger association in men (OR = 1.48, 1.08-2.02) than women (OR = 1.26, 0.89-1.77). NOCs were also more dissatisfied than their OC fellows in the Chinese subsample (OR = 1.37, 1.09-1.73). Among international students, no associations between OC status and perceived stress or studying-related life satisfaction were found. Conclusions To promote equality between OCs and NOCs at Chinese universities, the causes of more stress and less studying-related life satisfaction among NOCs compared to OCs need further exploration

Alcohol consumption among university students: a Sino-German comparison demonstrates a much lower consumption of alcohol in Chinese students

Background: Alcohol use is reported in university students with discrepancy between countries. The study objectives were to assess prevalence and associated factors of alcohol consumption among university students in Germany and China. Methods: Data used were from 1853 Chinese and 3306 German university students. Alcohol consumption frequency was measured by a question \u201cHow often did you drink alcohol in the last three months?\u201d with six possible responses, which were later collapsed into three categories of \u201cAt least once a week\u201d, \u201cLess than once a week\u201d and \u201cNever\u201d. Problem drinking was measured by the CAGE test and defined as a CAGE score of two or more (four as the maximum). Simple and multivariable logistic regressions were used for association analyses. Results: German students reported more often \u201cAt least once a week\u201d drinking (59.8 vs. 9.0 %). Among Germans, women drank less often \u201cAt least once a week\u201d (OR = 0.40, 0.30\u20130.53). Among Chinese, a higher BMI was associated with drinking \u201cAt least once a week\u201d (OR = 1.09, 1.02\u20131.18). Age revealed a positive association with \u201cAt least once a week\u201d drinking in Chinese (1.33, 1.21\u20131.46) but a negative association in Germans (OR = 0.97, 0.94\u20130.99). Having a father with high educational level was positively related to \u201cAt least once a week\u201d drinking in both countries (OR = 4.25, 2.67\u20136.78 for Chinese; OR = 1.32, 1.01\u20131.72 for Germans). Doing less than once a week physical exercise was negatively associated with \u201cAt least once a week\u201d drinking in Chinese and German students (OR = 0.27, 0.15\u20130.48 for Chinese; OR = 0.69, 0.49\u20130.96 for Germans). Among the German students, 20.3 % reported problem drinking. Being a female (OR = 0.32, 0.26\u20130.40) and performing less than once a week physical activity (OR = 0.73, 0.56\u20130.95) were negatively associated with problem drinking, while having a father with high educational level (OR = 1.32, 1.09\u20131.60) and experiencing higher level of perceived stress (OR = 1.08, 1.04\u20131.13) were positively related to problem drinking. Conclusions: Country-specific strategies for reducing alcohol consumption, e.g. educational awareness programmes of alcohol use on Chinese campuses and alcohol prevention schemes among German youth before entering university, are sensible