Knowledge and involvement of husbands in maternal and newborn health in rural Bangladesh

Abstract Background Access to skilled health services during pregnancy, childbirth and postnatal period for obstetric care is one of the strongest determinants of maternal and newborn health (MNH) outcomes. In many countries, husbands are key decision-makers in households, effectively determining women’s access to health services. We examined husbands’ knowledge and involvement regarding MNH issues in rural Bangladesh, and how their involvement is related to women receiving MNH services from trained providers. Methods We conducted a cross-sectional survey in two rural sub-districts of Bangladesh in 2014 adopting a stratified cluster sampling technique. Women with a recent birth history and their husbands were interviewed separately with a structured questionnaire. A total of 317 wife-husband dyads were interviewed. The associations between husbands accompanying their wives as explanatory variables and utilization of skilled services as outcome variables were assessed using multiple logistic regression analyses. Results In terms of MNH knowledge, two-thirds of husbands were aware that women have special rights related to pregnancy and childbirth and one-quarter could mention three or more pregnancy-, birth- and postpartum-related danger signs. With regard to MNH practice, approximately three-quarters of husbands discussed birth preparedness and complication readiness with their wives. Only 12% and 21% were involved in identifying a potential blood donor and arranging transportation, respectively. Among women who attended antenatal care (ANC), 47% were accompanied by their husbands. Around half of the husbands were present at the birthplace during birth. Of the 22% women who received postpartum care (PNC), 67% were accompanied by their husbands. Husbands accompanying their wives was positively associated with women receiving ANC from a medically trained provider (AOR 4.5, p < .01), birth at a health facility (AOR 1.5, p < .05), receiving PNC from a medically trained provider (AOR 48.8, p < .01) and seeking care from medically trained providers for obstetric complications (AOR 3.0, p < 0.5). Conclusion Husbands accompanying women when receiving health services is positively correlated with women’s use of skilled MNH services. Special initiatives should be taken for encouraging husbands to accompany their wives while availing MNH services. These initiatives should aim to increase men’s awareness regarding MNH issues, but should not be limited to this

Protocol for a cluster randomised controlled trial of LPG cookstoves compared to usual cooking practices to reduce perinatal mortality and morbidity in rural Bangladesh called Poriborton : the CHANge trial

Background: Household air pollution is a leading health risk for global morbidity and mortality and a major health risk in South Asia. However, there are no prospective investigations of the impact of household air pollution on perinatal morbidity and mortality. Our trial aims to assess the impact of liquefied petroleum gas (LPG) for cooking to reduce household air pollution exposure on perinatal morbidity and mortality compared to usual cooking practices in Bangladesh. Hypothesis: In a community-based cluster randomised controlled trial of pregnant women cooking with LPG throughout pregnancy, perinatal mortality will be reduced by 35% compared with usual cooking practices in a rural community in Bangladesh. Methods: A two-arm community-based cluster randomised controlled trial will be conducted in the Sherpur district, Bangladesh. In the intervention arm, pregnant women receive an LPG cookstove and LPG in cylinders supplied throughout pregnancy until birth. In the control or usual practice arm, pregnant women continue their usual cooking practices, predominately traditional stoves with biomass fuel. Eligible women are pregnant women with a gestational age of 40–120 days, aged between 15 and 49 years, and permanent residents of the study area. The primary outcome is the difference in perinatal mortality between the LPG arm and the usual cooking arm. Secondary outcomes include (i) preterm birth and low birth weight, (ii) personal level exposure to household air pollution, (iii) satisfaction and acceptability of the LPG stove and stove use, and (iv) cost-effectiveness and cost-utility in reducing perinatal morbidity and mortality. We follow up all women and infants to 45 days after the birth. Personal exposure to household air pollution is assessed at three-time points in a sub-sample of the study population using the MicroPEM™. The total required sample size is 4944 pregnant women. Discussion: This trial will produce evidence of the effectiveness of reduced exposure to household air pollution through LPG cooking to reduce perinatal morbidity and mortality compared to usual cooking practices. This evidence will inform policies for the adoption of clean fuel in Bangladesh and other similar settings

A community-based cluster randomised controlled trial in rural Bangladesh to evaluate the impact of the use of iron-folic acid supplements early in pregnancy on the risk of neonatal mortality: The Shonjibon trial

Abstract Background Iron-deficiency is the most common nutritional deficiency globally. Due to the high iron requirements for pregnancy, it is highly prevalent and severe in pregnant women. There is strong evidence that maternal iron deficiency anaemia increases the risk of adverse perinatal outcomes. However, most of the evidence is from observational epidemiological studies except for a very few randomised controlled trials. IFA supplements have also been found to reduce the preterm delivery rate and neonatal mortality attributable to prematurity and birth asphyxia. These results combined indicate that IFA supplements in populations of iron-deficient pregnant women could lead to a decrease in the number of neonatal deaths mediated by reduced rates of preterm delivery. In this paper, we describe the protocol of a community-based cluster randomised controlled trial that aims to evaluate the impact of maternal antenatal IFA supplements on perinatal outcomes. Methods/design The effect of the early use of iron-folic acid supplements on neonatal mortality will be examined using a community based, cluster randomised controlled trial in five districts with 30,000 live births. In intervention clusters trained BRAC village volunteers will identify pregnant women & provide iron-folic acid supplements. Groundwater iron levels will be measured in all study households using a validated test kit. The analysis will follow the intention to treat principle. We will compare neonatal mortality rates & their 95% confidence intervals adjusted for clustering between treatment groups in each groundwater iron-level group. Cox proportional hazards mixed models will be used for mortality outcomes & will include groundwater iron level as an interaction term in the mortality model. Discussion This paper aims to describe the study protocol of a community based randomised controlled trial evaluating the impact of the use of iron-folic acid supplements early in pregnancy on the risk of neonatal mortality. This study is critical because it will determine if antenatal IFA supplements commenced in the first trimester of pregnancy, rather than later, will significantly reduce neonatal deaths in the first month of life, and if this approach is cost-effective. Trial registration This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on 31 May 2012. The registration ID is ACTRN12612000588897

Self-adopted ‘natural users’ of liquid petroleum gas for household cooking by pregnant women in rural Bangladesh: characteristics of high use and opportunities for intervention

The use of clean fuel such as liquid petroleum gas (LPG) is globally recommended for household cooking to reduce exposure to household air pollution and its adverse health consequences. Adoption of LPG in resource-poor settings such as South Asia is low and driven by many factors. In Bangladesh, more than 90% of the rural population relies on biomass fuels for cooking. Identifying factors among households that self-adopt LPG, i.e. ‘natural users’ may provide insight into how LPG programs could be modified to improve the adoption of clean fuels. We aimed to assess factors that drive LPG adoption and use in a rural setting amongst natural users of LPG in Bangladesh. We conducted a household survey of natural users of LPG who were pregnant and were identified by a census listing of households in 63 villages of five unions of Tangail district. Of 337 existing pregnant natural users, we could complete interview of 299 women using a structured questionnaire which included socio-demographic, kitchen structure, cooking behaviours and potential factors related to LPG use. Nearly all natural users had multiple cookstoves, and 85% reported using LPG as an alternative fuel to their main cooking and fuel (traditional cooking with biomass fuels). Factors related to high use of LPG (defined as at least 50% of all cooking time in previous 24 h) included households in second wealth quintile, (adjusted Prevalence Ratio, aPR 3.03; 95% CI:1.15–8.00), middle wealth quintile, (aPR 2.72; 95% CI:1.01–7.30) and highest wealth quintile (aPR2.71;95% CI: 1.02–7.28. Health issues also influenced LPG use; if LPG was described as alleviating breathing problems (aPR 1.65; 95% CI: 1.08–2.52), there was more LPG use. Adoption of LPG stove as a backup option for emergency purpose cooking reduced greater use of LPG (aPR 0.59; 95% CI: 0.39–0.91). High use of LPG was associated with LPG cooking being reported as easy to use (aPR 4.13; 95% CI: 1.95–8.73). Women’s perception that LPG alleviated breathing difficulties was associated with high-use of LPG cooking, as was household wealth and ease of use. Women who reported to use LPG only for emergency purposes were less likely to be high users. Clean fuel programs as well as being financially supportive could be modified to include a trial period so that the experience of LPG would further support clean cooking adoption

Dealer-customer partnership in rice production demonstration: Assessment of private extension system in Bangladesh

Traditional public extension worker-farmer cooperation in rice production demonstration is not working efficiently, therefore, private partnership-based demonstration has been attempted to introduce as its alternative very recently involving dealer-customer farmer. The study evaluated the private extension services rendered through dealer-customer farmer cooperation in Bangladesh. Thirty-three rice seed dealers and ninety-two customer farmers formed the samples for the study. Face-to-face interviews were employed as a quantitative method while focus group discussion was used as a qualitative method in the present study. Involving in the private rice production demonstration approach, customer farmers indicated high profit, greater involvement in decision-making, and improved marketing skills as the major advantages; while the dealers stressed the benefit received by the small farmers, improvement in their decision-making capacity and increased local rice production. However, the slow distribution of inputs during the production period was a weakness in the arrangement, which was mostly because of the dealers' lack of understanding of the customer farmers’ needs. The private extension system being a new concept in the country may be observed over a period and gradually extended to the nooks and crannies of the country

A Feasibility Study Assessing Acceptability and Supply Issues of Distributing LPG Cookstoves and Gas Cylinders to Pregnant Women Living in Rural Bangladesh for Poriborton: The CHANge Trial

Our aim was to develop a protocol for a cluster randomised controlled trial to assess the impact of liquid petroleum gas (LPG) cooking compared to usual cooking on perinatal mortality in pregnant women in rural Bangladesh. We, therefore, aimed to assess the feasibility of the planned trial and the barriers/facilitators of distributing LPG to rural households. We conducted a feasibility study in rural Bangladesh using an iterative design. We included pregnant women, their families, and local LPG stakeholders. We distributed LPG to households for 3 months (3 cylinders) and assessed process issues, acceptability, and cooking/food behaviours. We interviewed LPG stakeholders, and conducted focus groups and in-depth interviews with the users. The initial distribution and uptake of LPG were hampered by process issues, most of these were due to the non-established supply chain in the study area. LPG cooking was very acceptable and all users reported a preference for continued use, fuel-sparing was heavily practiced. Safety concerns were an initial issue. LPG stakeholders reported that LPG demand differed by season. This study demonstrated the feasibility of our planned trial and the need for safety messages. These results are relevant beyond our trial, including for programs of LPG fuel promotion

A community-based cluster randomized controlled trial (cRCT) to evaluate the impact and operational assessment of “safe motherhood and newborn health promotion package”: study protocol

Abstract Background Despite considerable progress in reduction of both under-five and maternal mortality in recent decades, Bangladesh is still one of the low and middle income countries with high burden of maternal and neonatal mortality. The primary objective of the current study is to measure the impact of a comprehensive package of interventions on maternal and neonatal mortality. In addition, changes in coverage, quality and utilization of maternal and newborn health (MNH) services, social capital, and cost effectiveness of the interventions will be measured. Methods A community-based, cluster randomized controlled trial design will be adopted and implemented in 30 unions of three sub-districts of Chandpur district of Bangladesh. Every union, the lowest administrative unit of the local government with population of around 20,000–30,000, will be considered a cluster. Based on the baseline estimates, 15 clusters will be paired for random assignment as intervention and comparison clusters. The primary outcome measure is neonatal mortality, and secondary outcomes are coverage of key interventions like ANC, PNC, facility and skilled provider delivery. Baseline, midterm and endline household survey will be conducted to assess the key coverage of interventions. Health facility assessment surveys will be conducted periodically to assess facility readiness and utilization of MNH services in the participating health facilities. Discussion The current study is expected to provide essential strong evidences on the impact of a comprehensive package of interventions to the Bangladesh government, and other developmental partners. The study results may help in prioritizing, planning, and scaling-up of Safe Motherhood Promotional interventions in other geographical areas of Bangladesh as well as to inform other developing countries of similar settings. Trial registration NCT03032276

Dhaka Food Agenda 2041 Foresight and Scenario development : Workshop Report Dhaka Food Systems project

This report is a compilation of a workshop sessions held with stakeholders engaged in a foresight and scenario develop process to develop a Dhaka Food Agenda 2041. The report describes the rationale and the different steps undertaken in the process as well as its outputs. Stakeholders have interacted and explored the Dhaka Metropolitan food system and discussed the linkages between issues in the domain of food and nutrition security, food safety, food loss and waste, fresh markets and value chains. In terms of output they have deliberated that one of the major uncertainties is the shift in diets of citizens related to the uncertainty of having thriving small and sustainable businesses versus big- companies (supermarketisation). The participants developed different scenarios and their narratives that are varying from least to most desirable situation. The workshops have led to evidence and dialogue on the needs and opportunities to aim for a sustainable and inclusive food system in Dhaka in 2041. In conclusion, the report presents the steps that will follow the scoping, mapping, analysis of drivers and trends and the scenario development feeding into the further development of the Dhaka Food Agenda 2041

Legislative Documents

Also, variously referred to as: House bills; House documents; House legislative documents; legislative documents; General Court documents

Early initiation of breastfeeding and severe illness in the early newborn period: An observational study in rural Bangladesh.

BackgroundIn Bangladesh, neonatal sepsis is the cause of 24% of neonatal deaths, over 65% of which occur in the early-newborn stage (0-6 days). Only 50% of newborns in Bangladesh initiated breastfeeding within 1 hour of birth. The mechanism by which early initiation of breastfeeding reduces neonatal deaths is unclear, although the most likely pathway is by decreasing severe illnesses leading to sepsis. This study explores the effect of breastfeeding initiation time on early newborn danger signs and severe illness.Methods and findingsWe used data from a community-based trial in Bangladesh in which we enrolled pregnant women from 2013 through 2015 covering 30,646 newborns. Severe illness was defined using newborn danger signs reported by The Young Infants Clinical Science Study Group. We categorized the timing of initiation as within 1 hour, 1 to 24 hours, 24 to 48 hours, ≥48 hours of birth, and never breastfed. The analysis includes descriptive statistics, risk attribution, and multivariable mixed-effects logistic regression while adjusting for the clustering effects of the trial design, and maternal/infant characteristics. In total, 29,873 live births had information on breastfeeding among whom 19,914 (66.7%) initiated within 1 hour of birth, and 4,437 (14.8%) neonates had a severe illness by the seventh day after birth. The mean time to initiation was 3.8 hours (SD 16.6 hours). The proportion of children with severe illness increased as the delay in initiation increased from 1 hour (12.0%), 24 hours (15.7%), 48 hours (27.7%), and more than 48 hours (36.7%) after birth. These observations would correspond to a possible reduction by 15.9% (95% CI 13.2-25.9, p ConclusionsBreastfeeding initiation within the first hour of birth is significantly associated with severe illness in the early newborn period. Interventions to promote early breastfeeding initiation should be tailored for populations in which newborns are delivered at home by unskilled attendants, the rate of low birth weight (LBW) is high, and postnatal care is limited.Trial registrationTrial Registration number: anzctr.org.au ID ACTRN12612000588897