"Even when I’m telling it – it sounds so unbelievably bizarre!" A realist evaluation of self-management behaviours in dementia family caregivers with long-term conditions

Family members of those with dementia are often referred to as ‘invisible’ or ‘hidden’ patients due to their unmet and often unidentified health and care needs. Poor self-management of caregiver health has negative consequences for the caregiver, the care recipient and health and social care systems worldwide. With a rising prevalence in long-term conditions due to an ageing population and a limited amount of health resources, it makes it increasingly important to understand and address the self-management support needs of such vulnerable populations. This research was conducted to investigate the self-management behaviours of individuals who have long-term health conditions, who are also the primary caregiver of a family member with dementia. Using a Realist Evaluation design, a realist evidence synthesis was conducted to guide the development of an interview schedule. Informal discussions with three third-sector caregiver support service managers also informed data collection. Twelve in-depth, semi-structured interviews were conducted with adult male and female dementia family caregivers in the north of England. Data were analysed using Template Analysis; the principles of Realist Evaluation (TARMATO framework) were used to develop the final template into context mechanism-outcome configurations of barriers and facilitators to caregiver self-management behaviours. The findings from this analysis informed a second qualitative study involving interviews with six third-sector service providers and re-interviewing four of the original caregiver participants for further insight into potential support strategies arising from the data. Behavioural and psychological symptoms of dementia (such as wandering behaviours or aggressive and attention-seeking behaviours) appeared as a dominant mechanism in contextualising dementia caregiving as an all-consuming role and contributed to numerous losses (such as the loss of ‘self’) in the caregiver. This resulted in negative self-management outcomes for the caregiver, such as a lack of adherence to medication and recommended treatment regimes, reduction in arranging and attending medical appointments and even an overall lack of acknowledgment of their long-term conditions and self-management needs. Emerging findings also reveal other mechanisms that act as barriers to self-management, such as health beliefs and attachment styles that are embedded within the complexity of this hidden patient population. Additionally, the study highlighted the utility of the policy oriented and practice-based frameworks, such as the Quality and Outcomes Framework of primary care in the UK, as a potentially useful tool if used qualitatively in third-sector settings. Holistic methodological frameworks such as the one employed in this study are recommended for future research in this field. Readers of thesis are encouraged to combine these findings with their own knowledge and experience in order to reflect upon the implications of dementia caregiving on the life of a family caregiver with long-term conditions of their own. Involvement of the researcher as an intentional agent in the research proces

Pathways toward the sustainable improvement of food security: Adopting the household food insecurity access scale in rural farming households in Bangladesh

Achieving food security is a global concern that constitutes a major challenge, particularly for the least developed countries, such as Bangladesh. In the context of globalization, the nation continues to have ongoing food insecurity, particularly in rural areas, despite its overall economic growth and development. This has become a constraint in achieving the Sustainable Development Goals (SDGs) within the established time scale, particularly SDG2 (Zero Hunger). With this consideration in mind, the present study assesses the prevalence of household food in(security) and identifies the factors that influence this among rural farming households in Bangladesh. A sample of 350 farming households was surveyed randomly from the four villages in Mymensingh, Bangladesh. The household food insecurity access scale (HFIAS) was utilized to explore household food security. The results reveal that only 18% of rural farming households were food secure while the remainder were food insecure to some extent. Using a binomial logit regression model, we found that the household head’s educational level, as well as whether the household has a savings account, owns land, receives financial or other forms of support from household members abroad, has larger farm sizes, and practices homestead gardening significantly reduce household food insecurity, whereas a higher number of members in the household increases it. The findings of this study establish a foundational understanding of food security in rural areas by employing contemporary measurement tools and techniques. This addition to the existing knowledge base will assist in the design and implementation of a comprehensive and multifaceted policy outline not only for the rural areas of Bangladesh but also for sustainable development globally

Insights of Handloom Producers of Sirajganj District in Bangladesh

This study was undertaken to measure the current socioeconomic and profitability status of the traditional handloom producers living in Sirajganj district of Bangladesh. Primary data were collected from 60 randomly selected handloom owners. Two main products were considered in this study, i.e., sharee and gamcha . Descriptive statistics and cost-return analysis were performed to assess the present situation and profitability of handloom production. The Gini Coefficient and Lorenz Curve measured inequality among respondents. A log transformed multiple linear regression model was applied to explore the factors influencing handloom products production. Results revealed that most of the handloom weaving was financed through the weavers' own capital and taking loans from the bank. The undiscounted benefit-cost ratios were 1.12 and 1.20 for sharee and gamcha, respectively, indicating both enterprises were profitable but gamcha was more profitable than sharee. The Gini Coefficient of handloom weavers' income is less than 0.25. Results from the regression analysis revealed that human labour, yarn, color, and processing cost significantly impacted sharee and gamcha production. Therefore, efficient utilization of these resources in the production process of handloom products would be essential that can bring more profit for handloom production. [J Bangladesh Agril Univ 2022; 20(4.000): 433-440

Does Over-the-Counter Purchase of Antihistamines by Residents of Dhaka City, Bangladesh Align with the Prescribing Choices of the Physicians Practicing in That City?

Most current guidelines recommend prescribing second-generation antihistamines (SGAs) over first-generation antihistamines because SGAs are less likely to cause sedation and impairment of heavy work performance. However, common residents who use these antihistamines as over-the-counter (OTC) medicines are less likely to know that. So, this study was designed to compare the over-the-counter use of antihistamines by common residents with the prescribing preferences of physicians residing at Dhaka City, Bangladesh. Between June and August of 2017, a total of 100 Physicians from some of the top medical institutions of the city and 350 randomly selected common residents were directly interviewed with two separate semistructured questionnaires specifically designed for each population. Data was statistically analyzed using Fischer’s exact test, Spearman’s rank correlation test and Kendall’s tau rank correlation test. The data shows that physicians prefer second-generation antihistamines with fexofenadine (48.09% of the total responses), desloratadine (16.03%), and rupatadine (13.74%) taking the top spots. Cetirizine (29.46% of total responses), desloratadine (14.73%), and chlorpheniramine (14.52%) were the most used OTC antihistamines by the common residents. Statistical analysis with Fischer’s exact test revealed that the difference in preference of first-generation antihistamines between physicians and common residents were extremely significant (p<0.0001). Furthermore, cetirizine (which is known to have some degree of sedating activity) and chlorpheniramine are more preferred among common residents than among physicians (extremely significant difference, p<0.0001 in both cases). The study concludes that physicians of Dhaka City are complying with practice guidelines, but sedating antihistamines still retain some popularity among the common residents. Hence, a more engaging community pharmacy is needed to minimize adverse effects that can arise from OTC use of sedating antihistamines

Nutritional status of under-five aged children of ready-made garment workers in Bangladesh: A cross-sectional study

Background The ready-made garment (RMG) sector is a significant contributor to the economic growth of Bangladesh, accounting for 10% of the country’s GDP and more than 80% of its foreign exchange earnings. The workforce in this sector is predominantly made up of women, with 2.5 million women working in the industry. However, these women face numerous challenges in carrying out their culturally-expected household responsibilities, including childcare, due to severe resource constraints. As a result, the children of these working women have a higher incidence of malnutrition, particularly stunted growth. This study aims to identify the factors that contribute to stunting in children under the age of five whose mothers work in the RMG sector in Bangladesh. Methods The study collected data from 267 female RMG workers in the Gazipur district of Bangladesh using a simple random sampling technique. Chi-square tests were used to determine the associations between the factors influencing child stunting, and Multinomial Logit Models were used to estimate the prevalence of these factors. Results The study found that the prevalence of moderate and severe stunting among the children of RMG workers living in the Gazipur RMG hub was 19% and 20%, respectively. The study identified several significant predictors of child stunting, including the mother’s education level, nutritional knowledge, control over resources, receipt of antenatal care, household size, sanitation facilities, and childbirth weight. The study found that improving the mother’s education level, increasing household size, and receiving antenatal care during pregnancy were important factors in reducing the likelihood of child stunting. For example, if a mother’s education level increased from no education to primary or secondary level, the child would be 0.211 (0.071–0.627) and 0.384 (0.138–1.065) times more likely to have a normal weight and height, respectively, than to be moderately stunted. Conclusion The study highlights the challenges faced by working women in the RMG sector, who often receive minimal wages and have limited access to antenatal care services. To address these challenges, the study recommends policies that support antenatal care for working-class mothers, provide daycare facilities for their children, and implement a comprehensive social safety net program that targets child nutrition. Improving the socioeconomic status of mothers is also critical to reducing child malnutrition in this population

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BackgroundThe ready-made garment (RMG) sector is a significant contributor to the economic growth of Bangladesh, accounting for 10% of the country’s GDP and more than 80% of its foreign exchange earnings. The workforce in this sector is predominantly made up of women, with 2.5 million women working in the industry. However, these women face numerous challenges in carrying out their culturally-expected household responsibilities, including childcare, due to severe resource constraints. As a result, the children of these working women have a higher incidence of malnutrition, particularly stunted growth. This study aims to identify the factors that contribute to stunting in children under the age of five whose mothers work in the RMG sector in Bangladesh.MethodsThe study collected data from 267 female RMG workers in the Gazipur district of Bangladesh using a simple random sampling technique. Chi-square tests were used to determine the associations between the factors influencing child stunting, and Multinomial Logit Models were used to estimate the prevalence of these factors.ResultsThe study found that the prevalence of moderate and severe stunting among the children of RMG workers living in the Gazipur RMG hub was 19% and 20%, respectively. The study identified several significant predictors of child stunting, including the mother’s education level, nutritional knowledge, control over resources, receipt of antenatal care, household size, sanitation facilities, and childbirth weight. The study found that improving the mother’s education level, increasing household size, and receiving antenatal care during pregnancy were important factors in reducing the likelihood of child stunting. For example, if a mother’s education level increased from no education to primary or secondary level, the child would be 0.211 (0.071–0.627) and 0.384 (0.138–1.065) times more likely to have a normal weight and height, respectively, than to be moderately stunted.ConclusionThe study highlights the challenges faced by working women in the RMG sector, who often receive minimal wages and have limited access to antenatal care services. To address these challenges, the study recommends policies that support antenatal care for working-class mothers, provide daycare facilities for their children, and implement a comprehensive social safety net program that targets child nutrition. Improving the socioeconomic status of mothers is also critical to reducing child malnutrition in this population.</div

Description of the study variables.

BackgroundThe ready-made garment (RMG) sector is a significant contributor to the economic growth of Bangladesh, accounting for 10% of the country’s GDP and more than 80% of its foreign exchange earnings. The workforce in this sector is predominantly made up of women, with 2.5 million women working in the industry. However, these women face numerous challenges in carrying out their culturally-expected household responsibilities, including childcare, due to severe resource constraints. As a result, the children of these working women have a higher incidence of malnutrition, particularly stunted growth. This study aims to identify the factors that contribute to stunting in children under the age of five whose mothers work in the RMG sector in Bangladesh.MethodsThe study collected data from 267 female RMG workers in the Gazipur district of Bangladesh using a simple random sampling technique. Chi-square tests were used to determine the associations between the factors influencing child stunting, and Multinomial Logit Models were used to estimate the prevalence of these factors.ResultsThe study found that the prevalence of moderate and severe stunting among the children of RMG workers living in the Gazipur RMG hub was 19% and 20%, respectively. The study identified several significant predictors of child stunting, including the mother’s education level, nutritional knowledge, control over resources, receipt of antenatal care, household size, sanitation facilities, and childbirth weight. The study found that improving the mother’s education level, increasing household size, and receiving antenatal care during pregnancy were important factors in reducing the likelihood of child stunting. For example, if a mother’s education level increased from no education to primary or secondary level, the child would be 0.211 (0.071–0.627) and 0.384 (0.138–1.065) times more likely to have a normal weight and height, respectively, than to be moderately stunted.ConclusionThe study highlights the challenges faced by working women in the RMG sector, who often receive minimal wages and have limited access to antenatal care services. To address these challenges, the study recommends policies that support antenatal care for working-class mothers, provide daycare facilities for their children, and implement a comprehensive social safety net program that targets child nutrition. Improving the socioeconomic status of mothers is also critical to reducing child malnutrition in this population.</div

Distribution of stunting of ready-made garment workers’ children under the age of five according to different factors.

Distribution of stunting of ready-made garment workers’ children under the age of five according to different factors.</p

The extent of mothers’ nutritional knowledge.

BackgroundThe ready-made garment (RMG) sector is a significant contributor to the economic growth of Bangladesh, accounting for 10% of the country’s GDP and more than 80% of its foreign exchange earnings. The workforce in this sector is predominantly made up of women, with 2.5 million women working in the industry. However, these women face numerous challenges in carrying out their culturally-expected household responsibilities, including childcare, due to severe resource constraints. As a result, the children of these working women have a higher incidence of malnutrition, particularly stunted growth. This study aims to identify the factors that contribute to stunting in children under the age of five whose mothers work in the RMG sector in Bangladesh.MethodsThe study collected data from 267 female RMG workers in the Gazipur district of Bangladesh using a simple random sampling technique. Chi-square tests were used to determine the associations between the factors influencing child stunting, and Multinomial Logit Models were used to estimate the prevalence of these factors.ResultsThe study found that the prevalence of moderate and severe stunting among the children of RMG workers living in the Gazipur RMG hub was 19% and 20%, respectively. The study identified several significant predictors of child stunting, including the mother’s education level, nutritional knowledge, control over resources, receipt of antenatal care, household size, sanitation facilities, and childbirth weight. The study found that improving the mother’s education level, increasing household size, and receiving antenatal care during pregnancy were important factors in reducing the likelihood of child stunting. For example, if a mother’s education level increased from no education to primary or secondary level, the child would be 0.211 (0.071–0.627) and 0.384 (0.138–1.065) times more likely to have a normal weight and height, respectively, than to be moderately stunted.ConclusionThe study highlights the challenges faced by working women in the RMG sector, who often receive minimal wages and have limited access to antenatal care services. To address these challenges, the study recommends policies that support antenatal care for working-class mothers, provide daycare facilities for their children, and implement a comprehensive social safety net program that targets child nutrition. Improving the socioeconomic status of mothers is also critical to reducing child malnutrition in this population.</div