Reducing health inequalities among girls and adolescent women living in poverty: the success of Bangladesh

This is an Accepted Manuscript of an article published by Taylor & Francis in Annals of Human Biology on 14th January 2016, available online: http://www.tandfonline.com/10.3109/03014460.2016.1141985.Background: Bangladesh has made dramatic improvements in the health of girls and women in the last 20 years. This paper examines whether gender inequalities in health are evident among older children and adolescents among extremely poor households, and identifies future health challenges for improving the health of girls and women. Method: Gender inequalities in health were examined using data from a school health survey of school children and adolescents (n=900, 6.5-13.5 years). Anthropometric status; household possessions and number of siblings were measured. Undernutrition was assessed as stunting (height-for-age z-score) and thinness (BMI-for-age z-score). Results: The prevalence of undernutrition was high (35.3% stunting; 42.4% thinness), but there were no significant differences according to gender or socio-economic indicators (via possession score). Girls had more younger siblings (p<0.05), while boys had more older siblings (p<0.05). Conclusions: These findings accord with the national picture of successful reductions in gender inequalities in health through low cost, community-based health programmes and education policies targeting the poorest sectors. The prevalence of undernutrition, however, remains high. Reproductive behaviours may still be influenced by poverty and the gender of existing offspring. Future challenges lie in reducing the adverse health consequences to women and their infants associated with early age at marriage and childbirth

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

Reductions in abortion-related mortality following policy reform: evidence from Romania, South Africa and Bangladesh

Unsafe abortion is a significant contributor to worldwide maternal mortality; however, abortion law and policy liberalization could lead to drops in unsafe abortion and related deaths. This review provides an analysis of changes in abortion mortality in three countries where significant policy reform and related service delivery occurred. Drawing on peer-reviewed literature, population data and grey literature on programs and policies, this paper demonstrates the policy and program changes that led to declines in abortion-related mortality in Romania, South Africa and Bangladesh. In all three countries, abortion policy liberalization was followed by implementation of safe abortion services and other reproductive health interventions. South Africa and Bangladesh trained mid-level providers to offer safe abortion and menstrual regulation services, respectively, Romania improved contraceptive policies and services, and Bangladesh made advances in emergency obstetric care and family planning. The findings point to the importance of multi-faceted and complementary reproductive health reforms in successful implementation of abortion policy reform