Areal variations in use of modern contraceptives in rural Bangladesh.

In Bangladesh, use of modern contraceptive methods has increased dramatically in the last decade. However, the level of use has not been the same between rural clusters. This dissertation investigates the plausible reasons for areal variations in use of modern contraception in rural Bangladesh. This study randomly selects sixteen rural clusters as sub-samples from the 1991 Contraceptive Prevalence Survey of Bangladesh. Information from female respondents of eligible age, as well as family heads and family planning workers are collected along with cluster-level community data, and family level information. The data are analyzed using simple bivariate tables as well as more sophisticated multilevel analysis using the software 'MLn'. Analysis of respondents using modern reversible methods finds that apart from the woman's age and number of living children, education of the family planning worker is the most influential predictor of use. Other significant predictors of ever use of modern reversible methods are the woman's education, religion, socio-economic status and her position within the family. Bari-level random effects were significant, indicating that a woman with `typical' characteristics but residing in the most favourable bari would have a higher probability of use than a woman with very favourable characteristics residing in a `typical' bari. Simultaneous confidence intervals of probabilities of use, for all clusters, found that most clusters were not significantly different in their ever use, although pockets of low use were observed. Analysis of acceptors of sterilization finds that apart from age and number of living sons, religion is the most influential predictor of use. Non-Muslims are more likely to be acceptors. Other significant predictors are the woman's education, position within the family, the participation of bari members with non-government organisations, and sanction of bari girls' education by bari head. Bari-level random effects showed in the same directions as those in the modern reversible methods model. Heterogeneity in the bari-level effect could not be explained by the recorded explanatory variables. After controlling for these explanatory variables, between-cluster variance was very small for users of sterilization. However, educated women had more between-cluster variance compared to non-educated women. Religiosity, attitude and beliefs of the respondents are vitally important in shaping attitudes towards contraceptive use. Replacement of some family planning workers with those having appropriate education and training are recommended. Family Planning programmes are strongly recommended to target `bari heads' and encourage them to look favourably upon modern contraception. Attempts should be made at removing ill-conceived religious barriers. Further recommendations are to encourage non-government organisations in areas which have low contraceptive prevalence, and encourage female education and emancipation generally

Determinants of Contraceptive Use in Bangladesh

Background: Bangladesh is experiencing a plateau phase in fertility decline after its dramatic reduction in early nineties. Aspects of contraceptive use dynamics have important influences on fertility. Methods: This study used data from the 2004 Bangladesh Demographic and Health Survey and applied Multinomial Logistic Regression model to examine the determinants of use of modern methods of contraception. Results: The results showed that individual level characteristics had strong influence on contraceptive use. These variables included educational level of the couples, autonomy of woman, male child preference, woman’s membership with an NGO, visit by family planning worker, region and type of residence. Conclusion: The analysis indicated that further increase of contraceptive prevalence rate to achieve decline in fertility level depended on the improvement of educational status of couples and as well as increase in societal value of girl child. It was evident that household visit by a family planning worker was a significant factor in contraceptive use. Influences of Muslim religion were found to be declining in the case of several methods of contraception use. NGOs could take this opportunity to advocate condom use among their credit clients, which would also benefit the country as a policy against sexually transmitted diseases and AIDS. Ibrahim Med. Coll. J. 2014; 8(2): 34-4

Depression, anxiety, and performance status among the women with metastatic breast cancer receiving palliative care in Bangladesh: A cross sectional study

Abstract Background and Aims Advanced breast cancer patients suffer from various psychological issues including depression and anxiety. This study aims to explore these psychological issues and their relationship with the performance status. Methods This cross‐sectional study was conducted among 95 patients with metastatic breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face‐to‐face interview using a structured questionnaire along with Hospital Depression and Anxiety Scale. The performance status of the patients was determined by the Eastern Cooperative Oncology Group (ECOG) performance scale. The association between different variables were assessed by χ2 test and Fisher Exact test. Result Mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), muslim (92.6%) and homemakers (82.1%). More than half (52.6%) of the patients were evaluated having ECOG performance status grade II. Four out of ten  (44.2%) patients had moderate to severely anxiety, and almost one‐third (36.9%) patients were suffering from moderate to severe depression. The patients with high educational status were found to have less depression. In addition, patients faring better on ECOG performance scale (Grade 0 to I) had significantly (p < 0.05) less depression and anxiety. Conclusion Depression and anxiety are one of the major psychological sufferings among the women with metastatic breast cancers. All women suffering from breast cancer should be routinely screened and assessed for phychological distress and ensure early intervention

Coping strategy among the women with metastatic breast cancer attending a palliative care unit of a tertiary care hospital of Bangladesh.

BackgroundBreast cancer is one of the leading cancers among the Bangladeshi women. Coping helps these patients to adjust with this life-changing disease. Each individual has unique and different coping mechanism. But we know a little regarding their coping strategies. This study aims to explore the different coping strategies adopted by the women with metastatic (stage IV) breast cancer attending the palliative care unit and their relationship with the common mental health issues like anxiety and depression.MethodsThis cross-sectional study was conducted among 95 patients with metastatic (stage IV) breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face-to-face interview using a structured questionnaire adapted from Hospital Depression and Anxiety Scale (HADS), Brief COPE inventory and Eastern Cooperative Oncology Group (ECOG) performance scale. Pearson correlation test was used to find the relationships between various domains of coping strategies and psychological variables. Correlation matrix was done to observe the internal correlation among different coping strategies. Kruskal-Wallis H test was done to find the relationship between different coping strategies and ECOG performance status.ResultThe mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), Muslim (92.6%) and homemakers (82.1%). Commonly used coping strategies by the patients were: acceptance (median 10; IQR 10), religion (median 9; IQR 8-10) and instrumental support (median 9; IQR 6-10). Significantly strong positive correlation was found between emotional and instrumental support (R = 0.7; p = 0.01), planning, acceptance and active coping (R = 0.7; p = 0.01); behavioral disengagement, self distraction and denial (R = 0.5; p = 0.01). Significantly fair negative correlation was observed between active coping and depression (R = -0.4, p ConclusionDifferent coping strategies, especially positive coping helps the patients to adapt with their disease over time. All women suffering from breast cancer should be routinely screened and assessed for psychological distress and ensure early intervention and management to promote a better quality of life

The influence of wives’ and husbands’ fertility preferences on progression to a third birth in Nepal, 1997–2009

As couples across the globe increasingly exercise conscious control over their reproduction, and as both spouses’ preferences have the opportunity to influence fertility, there is a growing need to examine the influence of both husbands’ and wives’ preferences on fertility outcomes. Using couple-level measures of rural Nepalese spouses’ family size preferences—followed by more than a decade of monthly panel data on fertility outcomes—we investigate how both spouses’ preferences influence the rate of progression beyond the widely-reported ideal family size of two children to third births. Contrary to expectations based on women’s relative disadvantage, we find that wives’ preferences drive couples’ progression to third births. We further investigate possible mechanisms and find that contraceptive use does not explain the influence of wives’ preferences, but that couple communication about family planning moderates this influence: Wives’ preferences drive third parity births among couples who had discussed how many children to have