Rural Households In Bangladesh Research Articles

Assessment of the association between health problems and cooking fuel type, and barriers towards clean cooking among rural household people in Bangladesh

BackgroundIn low- and middle-income countries, households mainly use solid fuels like wood, charcoal, dung, agricultural residues, and coal for cooking. This poses significant public health concerns due to the emission of harmful particles and gases. To address these issues and support Sustainable Development Goals (SDGs), adopting cleaner cooking fuels like electricity and gas are acknowledged as a viable solution. However, access to these cleaner fuels is limited, especially in rural areas.MethodsThis study conducted a face-to-face survey with 1240 individuals in rural Bangladesh to explore the link between health issues and cooking fuel type, as well as barriers to transitioning to clean cooking. Using a convenient sampling technique across four divisions/regions, the survey gathered socio-demographic and health data, along with information on clean cooking barriers through a semi-structured questionnaire. Binary and multivariable logistic regression analyses were then employed to identify significant associations between cooking fuel type and health problems.ResultsThe study revealed that a majority of participants (73.3%) relied on solid fuel for cooking. The use of solid fuel was significantly correlated with factors such as lower education levels, reduced family income, location of residence, and the experience of health issues such as cough, chest pressure while breathing, eye discomfort, diabetes, asthma, and allergies. Economic challenges emerged as the foremost obstacle to the adoption of clean cooking, accompanied by other contributing factors.ConclusionThe use of solid fuel in rural Bangladeshi households poses substantial health risks, correlating with respiratory, eye, cardiovascular, and metabolic issues. Lower education and income levels, along with specific residential locations, were associated with higher solid fuel usage. Economic challenges emerged as the primary obstacle to adopting clean cooking practices. These findings emphasize the need for implementing strategies to promote clean cooking, address barriers, and contribute to achieving Sustainable Development Goal targets for health and sustainable energy access in Bangladesh.

Assessing the Impact of a Handwashing Knowledge and Practices Program among Poor Households in Rural Bangladesh: A Cluster-Randomized Pre-Post Study.

Improvement in hand hygiene has been strongly associated with positive outcomes in maternal and child health. Although Bangladesh has a high level of awareness of key hygiene messages, the practice of handwashing, the most effective hygiene behavior, is low. Suchana, a multisectoral nutrition program, aims to increase knowledge and practices around various water, sanitation, and hygiene settings in Sylhet region, the northeast of rural Bangladesh. This study aimed to investigate the changes in indicators related to handwashing knowledge and practices among Suchana beneficiaries in final compared with baseline evaluations. Data were derived from the baseline and final cross-sectional evaluation survey. The following handwashing knowledge and practices were considered: handwashing before preparing food, before eating food and feeding children, before serving food, after defecation, and after touching animals. The descriptive findings indicate that Suchana intervention improved handwashing knowledge and practices in the intervention area compared with the control. The odds of having knowledge of hand washing before preparing food (adjusted odds ratio [aOR]: 1.60; 95% CI: 1.30-1.98), before eating food and feeding children (aOR: 1.68; 95% CI: 1.25-2.25), before serving food (aOR: 1.35; 95% CI: 1.04-1.76), after defecation (aOR: 1.74; 95% CI: 1.25-2.41), and after touching animals (aOR: 1.67; 95% CI: 1.29-2.16) were higher in intervention area than the control area. Similarly, the impact on maternal handwashing practices at final evaluation indicated successful effects of the intervention. These results suggest scaling-up of similar interventions for larger populations living in vulnerable areas of rural Bangladesh.

Prevalence and Factors Associated with Maternal Stress Among Mothers of Children with Cerebral Palsy in Rural Bangladesh

This research aim to identify the prevalence and factors associated with maternal stress among mothers of children with cerebral palsy in rural Bangladesh. A cross-sectional study was performed among 200 mothers of children with cerebral palsy picked up from rural Bangladesh using a simple random sampling technique. A questionnaire divided into various sections and administered by the researchers was used for data collection. Descriptive statistics and logistic regression models were applied to summarize the respondents’ characteristics, main outcomes (maternal stress levels), and factors associated with maternal stress. The overall prevalence of maternal stress among mothers of children with CP was 56.5%, and the median (IQR) age of respondents was 30 (14), whereas that of the children with CP was 6 (8). Factors associated with a higher prevalence of maternal stress were older mothers, divorced/separated, living in a nuclear family, income, male children, and higher negative family impact (p < 0.05). The factors identified in this study could help to develop policies and strategies to minimize maternal stress associated with parenting children with cerebral palsy in rural Bangladeshi households.

Effectiveness of a community health worker-led low-sodium salt intervention to reduce blood pressure in rural Bangladesh: protocol for a cluster randomized controlled trial

BackgroundHigh blood pressure is a major public health problem in low- and middle-income countries. Low-sodium salt substitute (LSSS) is a promising population-level blood pressure-lowering intervention requiring minimal behavioral change. The optimal method of delivering LSSS to individuals, however, is currently unknown. Community health workers (CHWs) have successfully been used to implement health interventions in Bangladesh and may provide a venue for the dissemination of LSSS.MethodsWe aim to conduct a cluster-randomized controlled trial involving 309 households in rural Bangladesh previously identified and characterized by the BRAC James P Grant School of Public Health, BRAC University (BRAC JPGSPH). These households will be randomly assigned to three arms: (1) control, i.e., no intervention; (2) information only, i.e., community health workers will provide basic information on high blood pressure, the health consequences of excessive salt consumption, and feedback to the participant on the likely quantity of salt s/he consumes (estimated using a questionnaire); (3) free LSSS arm: the same information as in arm 2 will be provided, but participants will receive 6 months of free low-sodium salt along with education on the benefits of LSSS. One male and one female adult (age ≥ 18 years) in each household will be invited to participate, the exclusion criteria being households with members known to have high serum potassium levels, are taking medications known to elevate potassium levels (e.g., ACE inhibitors, ARBs, potassium-sparing diuretics), are already taking potassium supplements, or those who have known kidney disease or abnormal serum creatinine at baseline. The primary endpoint will be blood pressure at 6 months post-intervention.DiscussionRecent large clinical trials of LSSS in China and India have shown not only blood pressure improvements, but also stroke, major cardiac event, and all-cause mortality reductions. Nevertheless, how to best translate this intervention to population-level effectiveness remains unclear. Our study would test whether a community health worker-based program could be effectively used to disseminate LSSS and achieve measurable blood pressure benefits.Trial registrationClinicalTrials.gov NCT05425030. Registered on June 21, 2022.

Farmers’ usage of information and communication technologies for integrated farm management: An analytical study focusing on rural households of Bangladesh

Agricultural farming consists of multiple components and information related to farm management is one of the crucial factors. Information and communication technologies (ICTs) provide reliable and need based information in an effective way. This study focuses on investigating the extent of ICTs usage for integrated farm management and to clarify the underlying factors in Gauripur upazila (sub-district) under Mymensingh district of Bangladesh. To achieve the purpose of the study, data were collected from 75 randomly sampled farmers using structured questionnaire. Both descriptive and inferential statistical techniques were applied to obtain the findings of the study. The findings of the study clearly revealed that the highest proportion of the farmers (46%) had the tendency to use ICTs to a moderate extent. The analytical findings from the study showed that among the socio-demographic attributes annual income, training received, access to information sources and knowledge level were significantly associated with the usage of ICTs by the farmers. The step-wise multiple regression analysis indicated that knowledge on ICT usage, annual income and access to information sources were the most influential factors affecting the usage of ICTs by the farmers. The policy implications of the study suggests paying more attention to increase the operational knowledge and access to ICTs with provision to hands-on training and economic incentives for rural poor farmers. The integrated approach combining both public and private sectors can be effective to improve the extent of ICT usage for efficient farm management.

Diets of Men and Women in Rural Bangladesh Are Equitable but Suboptimal

BackgroundRecent evidence suggests that diet inequities between men and women may have diminished within rural Bangladeshi households. However, this has not been directly tested with appropriate physiologic adjustments and it is unclear whether changes have occurred across socioeconomic strata. Understanding intrahousehold dietary patterns at different points on the income and food-security distribution in rural Bangladesh—particularly, within ultrapoor and farm households—is important for appropriate design of gender-sensitive and nutrition-sensitive interventions, which often target these groups. ObjectiveUsing 2012 and 2016 data, we aimed to examine gender differences in diet quantity and quality among ultrapoor and farm households in rural Bangladesh. MethodsThe study used baseline 24-h dietary data from 2 randomized control trials conducted in rural Bangladesh: the Transfer Modality Research Initiative (ultrapoor households) and the Agriculture, Nutrition, and Gender Linkages project (farm households). Ordinary least squares regressions with household-level fixed effects tested for gender differences among constructed diet measures, such as caloric intake, caloric adequacy ratio, dietary diversity score, global diet quality score, and probability of consuming moderate or high levels of healthy food groups. ResultsIn both samples, on average, women consumed fewer calories than men in the same households but consumed near equal or more in reference to their caloric needs. Women scored <1% lower than men on diet quality indicators and showed similar probabilities to men of consuming healthy foods. Most men and women in both samples were calorically inadequate (>60%) and recorded poor diet quality scores that indicated high risk of nutrient inadequacy and chronic disease (>95%). ConclusionsIn both ultrapoor and farm households, although men record higher intake quantities and diet quality scores, the apparent male advantage disappear when energy requirements and the magnitudes of difference are considered. Diets of men and women in these rural Bangladeshi households are equitable but suboptimal.

Deep tubewell use is associated with increased household microbial contamination in rural Bangladesh: Results from a prospective cohort study among households in rural Bangladesh

Deep tubewells are important sources of arsenic mitigation in rural Bangladesh. Compared to commonly available shallow tubewells, deep tubewells tap into deeper low-arsenic aquifers and greatly reduce exposure to arsenic in drinking-water. However, benefits from these more distant and expensive sources may be compromised by higher levels of microbial contamination at point-of-use (POU). This paper examines differences in microbial contamination levels at source and POU among households using deep tubewells and shallow tubewells, and investigates factors associated with POU microbial contamination among deep tubewell users. We assessed a prospective longitudinal cohort of 500 rural households in Matlab, Bangladesh, across 135 villages. Concentration of Escherichia coli (E. coli) in water samples at source and POU using Compartment Bag Tests (CBTs) was measured across rainy and dry seasons. We employed linear mixed-effect regression models to measure the effect of different factors on log E. coli concentrations among deep tubewell users. CBT results show that log E. coli concentrations are similar at source and at POU during the first dry and rainy season, but are significantly higher at POU among deep tubewell users during the second dry season. Log E. coli at POU among deep tubewell users is positively associated with both presence (exponentiated beta exp(b) = 2.52, 95% Confidence Interval (CI) = 1.70, 3.73) and concentration of E. coli (exp(b) = 1.36, 95% CI = 1.19, 1.54) at source, and walking time to the tubewell source (exp(b) = 1.39, 95% CI = 1.15, 1.69). Drinking-water during the second dry season is associated with reduced log E. coli (exp(b) = 0.33, 95% CI = 0.23, 0.57) compared to the rainy season. These results suggest that while households that use deep tubewells have lower arsenic exposure, they may be at higher risk of consuming microbially contaminated water compared to households that use shallow tubewells.

A harm reduction model for environmental tobacco smoke exposure among Bangladeshi rural household children: A modified Delphi technique approach.

This paper aimed to develop a harm reduction model to reduce exposure to environmental tobacco smoke among children of rural households in Bangladesh. A mixed-methods exploratory sequential design has been applied, and data has been collated from six randomly selected villages of Munshigonj district, Bangladesh. The research was divided into three phases. In the first phase, the problem was identified through key informant interviews and a cross-sectional study. In the second phase, the model was developed by focus group discussion, and in the third phase, the model was evaluated through the modified Delphi technique. The data was analyzed by thematic analysis and multivariate logistic regression in phase one, qualitative content analysis for phase two, and descriptive statistics in phase three. The key informant interviews showed attitude toward environmental tobacco smoke, lack of awareness, inadequate knowledge as a reason and smoke-free rules, religious beliefs, social norms, and social awareness as preclusion of environmental tobacco smoke. The cross-sectional study detected that households with no smoker (OR 0.006, 95% CI 0.002-0.021), high implantation of smoke-free household rules (OR 0.005, 95% CI 0.001-0.058), moderate (OR 0.045, 95% CI 0.004-0.461) to strong (OR 0.023, 95% CI 0.002-0.224) influence of social norm and culture along with neutral (OR 0.024, 95% CI 0.001-0.510) and positive (OR 0.029, 95% CI 0.001-0.561) peer pressure had been significantly associated with environmental tobacco smoke exposure. The final components of the harm reduction model consist of a smoke-free household, social norms and culture, peer support, social awareness and religious practice identified by the FGDs and modified Delphi technique.

Private disaster expenditures by rural Bangladeshi households: evidence from survey data

ABSTRACT This paper investigates household’s private expenditures to cope with the harmful losses of climate change and disasters. Using household-level survey data from Bangladesh, this paper finds that disaster-affected rural Bangladeshi households allocate between $499 and $1076 in disaster-related expenditures. Such expenditures are always greater than their relevant precautionary savings, implying that those households may debt-finance their defensive measures. Households with greater precautionary savings spend more: a 100% increase in precautionary savings can increase disaster expenditures by 5%. Moreover, there are considerable regional heterogeneities in household’s disaster expenditures. Increased public sector allocations in addition to carefully designed affordable market-based financing instruments can potentially ease the pressure on disaster-affected households in their fight against the harms of climate change and disaster.

Social and financial incentives for overcoming a collective action problem

Addressing public health externalities often requires community-level collective action. Due to social norms, each person’s sanitation investment decisions may depend on the decisions of neighbors. We report on a cluster randomized controlled trial conducted with 19,000 households in rural Bangladesh where we grouped neighboring households and introduced (either financial or social recognition) rewards with a joint liability component for the group, or asked each group member to make a private or public pledge to maintain a hygienic latrine. The group financial reward has the strongest impact in the short term (3 months), inducing a 7.5–12.5 percentage point increase in hygienic latrine ownership, but this effect dissipates in the medium term (15 months). In contrast, the public commitment induced a 4.2–6.3 percentage point increase in hygienic latrine ownership in the short term, but this effect persists in the medium term. Non-financial social recognition or a private pledge has no detectable effect on sanitation investments.

Geographical variations of food insecurity and its associated factors in Bangladesh: Evidence from pooled data of seven cross-sectional surveys.

Food insecurity has multiple negative effects on maternal and child health and nutritional outcomes. There is a dearth of up-to-date evidence on the prevalence of food insecurity in Bangladesh based on geographical variations. We investigated the prevalence of food insecurity based on geographical variations and its associated factors. We pooled data from seven cross-sectional surveys conducted in 15,009 households from March 2015 to May 2018. This study was a part of the evaluation of the Maternal Infant Young Child Nutrition Phase 2 programme implemented by BRAC, one of the largest international non-governmental organizations located in Bangladesh that covered rural areas in 26 districts and two urban slums in Dhaka, Bangladesh. We used Household Food Insecurity Access Scale (a widely used scale to measure household food insecurity) to estimate the food insecurity status from the data collected through a face-to-face interview using a structured questionnaire. Hot spot analysis was conducted using the Getis-Ord Gi* statistic. The multiple logistic regression model was applied to explore the associated factors of food insecurity. The food insecurity hotspots were in the northwestern, central-southwestern, and coastal districts of Bangladesh. The overall prevalence of mild, moderate, and severe food insecurity were 12.7%, 13.8%, and 3.5%, respectively. In the adjusted model, household heads and caregivers of children with five or more years of schooling had respectively 42% (adjusted odds ratio (AOR): 0.58, 95% confidence interval (CI): 0.52, 0.64) and 46% (AOR: 0.54; 95% CI: 0.49, 0.61) less likelihood to suffer from food insecurity. Households in the middle (AOR: 0.58, 95% CI: 0.52, 0.65) and rich (AOR: 0.32, 95% CI: 0.28, 0.36) wealth status had lower odds of food insecurity. Food insecurity is widely spread in rural districts of Bangladesh and the degree of vulnerability is higher among the households of the northwestern, central-southwestern, and coastal areas of Bangladesh. Comprehensive interventions including strategies for poverty reduction and education for all might be effective to reduce food insecurity at rural households in Bangladesh.

Health treatment costs of rural households in Bangladesh

Health treatment costs of rural households in Bangladesh

Factors associated with low and medium household dietary diversity compared with high dietary diversity among marginalised households in rural Bangladesh: Findings from a Suchana baseline survey

ObjectiveThis study aimed to identify the associated factors of low and medium household (HH) dietary diversity (DD) compared with high DD among marginalised households in rural Bangladesh.MethodsThrough the Suchana baseline...

A Community-Based Cross-Sectional Study about the Knowledge, Attitude, and Practices of Food Safety Measures among Rural Households in Bangladesh.

Food handlers have been found to play essential roles in transmitting foodborne diseases and can pose a significant public health problem. Our study aimed to assess the knowledge, attitude, and practices (KAP) of food safety measures among the rural households of Bangladesh. We conducted this community-based cross-sectional study among women above 18 years involved with food preparation in rural households of four villages in Bangladesh. A total of 400 respondents were selected using the multistage cluster sampling technique. Data were collected using pretested and predesigned questionnaires based on the World Health Organization's (WHO) five keys for food safety. We used Stata (Version 16) for all statistical analyses. The mean age of the participants was 42.09 ± 12.96 years. The median KAP scores [interquartile range (IQR)] were 7 (21-10), 16 (5-18), and 26 (9-30), respectively. We found the median KAP scores were significantly lower in the age group >55 years than in age groups of 18-25, 26-35, 36-45, and 46-55 years (P < 0.05 for all). In addition, the median KAP scores were significantly higher in respondents who were married, literate, employed/active, living in pakka/semipakka house, and with a monthly family income of >5,000 BDT (P < 0.05 for all). Among all, 33.75%, 80.25%, and 69.00% had good (≥80% of total) KAP scores, respectively. Multivariable regression analysis revealed that monthly family income >5,000 BDT was a significant predictor of good knowledge [Adjusted Odds Ratio (aOR): 3.51, 95%CI: 1.55-7.98], good attitude (aOR: 5.82, 95%CI: 2.80-11.70), and good practice (aOR: 3.18, 95%CI: 1.67-6.07). Age >55 years was a significant predictor of good attitude (aOR: 0.38, 95%CI: 0.17-0.81) and good practice (aOR: 0.48, 95%CI: 0.21-0.89). Having ≤4 members in the family was a significant predictor of good practice (aOR: 1.85, 95%CI: 1.13-3.03) regarding food safety measures. The study found that KAP among rural Bangladeshi women regarding food safety were relatively satisfactory. However, having a poor monthly income and living in a large family were impediments to good food-safety practices where work can be done. The findings of this study may help develop health intervention programs for food handlers to further improve KAP toward food safety, thereby reducing foodborne illness in households.

Household Shocks and Consumption Smoothing: Evidence from Northern Bangladesh

Poor households in rural Bangladesh often face concurring idiosyncratic and aggregate shocks, which have adverse impacts on their income and consumption. In this study, we investigate the transmission channels, coping responses, and economic consequences of different shocks including idiosyncratic adverse health events and aggregate agricultural productivity shocks. We use a balanced panel data of 5,655 rural households–interviewed every year between 2010 and 2013–in northern Bangladesh. We estimate the effects of adverse health shocks on the consumption levels of poor households in a multi-shock framework. We take advantage of the panel data and use fixed effect models to control for unobserved household-level confounders and potential endogeneity. We further examine effects of shocks to agricultural wages on consumption using rainfall as an instrument. We further carry out a number of robustness checks to understand how sensitive our models are to different alternate specifications. Results indicate that households smooth their consumption after experiencing adverse health shocks, with and without the parallel incidence of other types of shocks. Consumption smoothing occurs despite households experiencing a significant decrease of wage income, which appears to be driven by an increase in informal loans from money lenders and households' social networks. To evaluate the effect of a different type of income shock on consumption, we use rainfall as an exogenous instrument for agricultural income. Results indicate that while higher rainfall leads to a significant increase in agricultural income, it does not translate to higher food expenditure for households. Together, these findings offer suggestive evidence that, in this setting, households appear to smooth food consumption in the face of income shocks. Poor households rely on formal and informal, potentially costly channels and exploit existing social networks to insure themselves against adverse shocks. The findings highlight the importance of developing a better framework to evaluate and implement more equitable social safety net policies.

Digital Divide or Digital Provide? Technology, Time Use, and Learning Loss during COVID-19

COVID-19 school closure has caused a worldwide shift towards technology-aided home schooling. Given widespread poverty in developing countries, this has raised concerns over new forms of learning inequalities. Using nationwide data on primary and secondary school children in slum and rural households in Bangladesh, we examine how learning time at home during the early months of school closure varies by access to technology at home. Data confirms a significant socio-economic and gender divide in access to TV, smartphone, computer, and internet among rural households. However, the analysis of daily time use data shows only a modest return to a technology in terms of boosting learning time at home. The learning-grade gradient is shallow and insensitive to TV, smartphone, and computer access at home. We also find no evidence that technology access per se helps learning by boosting time spent in online schooling and private supplementary coaching/tutoring. While technology access matters in households where parents act as home tutors, the magnitude of such a complementary effect are not large. The results imply a loss of out-of-school learning time during school closure even in households with technology access. We consider additional hypotheses relating to institutional and socio-economic barriers to home-based learning in developing countries.

Molecular Characterization of Clinically Relevant Extended-Spectrum β-Lactamases blaCTX-M-15-Producing Enterobacteriaceae Isolated from Free-Range Chicken from Households in Bangladesh.

The study explored the potential colonization and characterization of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in the gut of free-range poultry from the rural households in Bangladesh. From 48 households located in several rural regions (eastern, western, and southern) of Bangladesh, 180 poultry fecal samples were collected to isolate ESBL-producing Enterobacteriaceae. ESBL producers were characterized by susceptibility testing, conjugation experiment, conventional polymerase chain reactions (PCRs), and multilocus sequence typing (MLST) followed by sequencing. Total 23% (42/180) poultry were ESBL positive consisting of Escherichia coli (n = 41) and Klebsiella pneumoniae (n = 1). ESBL producers were resistant to Cefotaxime (CTX; 100%), Cefepime (100%), Amoxicillin-clavulanic acid (36%), Ciprofloxacin (31%), and Trimethoprim-sulfamethoxazole (24%), and 12% isolates were multidrug resistant. All ESBL producers were carrying blaCTX-M-15-like genotype.Isolates were also carrying genes for quinolone resistance [qnrS1, aac(6')-Ib-cr], silver resistance (silE), and mercury resistance (merA). Isolates were negative for 025b-ST131 clone, mcr-1, and blaOXA-48 gene. The repetitive element PCR revealed 15 different clones of E. coli and some of these clones were found to be common in 3 sampling locations. MLST analysis of E. coli revealed 9 different sequence types (STs); ST4, ST156, ST542, ST1140, ST1290, ST4628, ST5114, ST9768, and ST11317. ESBL producers were carrying transferable plasmids and 4 different plasmid replicon types; IncI1 (29%), IncY (7%), IncFIB (7%), and IncF1A (5%). The findings from the study confirmed that free-range poultry are potential ESBL carriers with coresistance to other antibiotic classes, metals, and biocides. This study confirms that free-range poultry in Bangladesh living close to humans without any direct antibiotic exposure could carry ESBL bacteria. Free-range poultry could be reservoir as well as a potential spreader of pathogenic E. coli and antibiotic- or biocide-resistant genes.

Trade-Off Between Schooling and Labor for Children: Understanding the Determinative Factors Among Rural Households in Bangladesh.

This research is concerned with understanding the factors behind the trade-off between child labor and child schooling, given the well-documented links between the two. It examines parents' behavior in their decision-making on their children's schooling or practicing child labor. Depending on qualitative research methods including 28 semi-structured interviews and two focus group discussions conducted in the rural areas of Bangladesh in 2020, this study reveals the following: subsistence needs compel households, particularly the ultra-poor and the female-headed, to trade off child labor with schooling; due to higher demand of labor, parents engage their children into work instead of schooling; parents of labor-intensive occupations tend to trade off child labor with schooling; sexual division of labor remains obvious; finally, credit constraints and cultural beliefs have negative impacts on parental decision-making on child schooling. Interventions aiming to reduce child labor and increase schooling in these rural areas must remain mindful of the socio-economic and cultural needs.

Gender Differences in Diet Quality and Quantity in Rural Bangladesh. Are Men Still Favored?

ObjectivesStudies from Bangladesh have long documented pro-male biases in intrahousehold food allocation. However, many of these earlier studies were conducted against the backdrop of caloric scarcity and since then, food availability and affordability in the country have significantly improved. This study re-examines gender differences in diet quantity and quality in rural Bangladesh with 2012 data. MethodsThe study uses 24-hour dietary recall data collected in 2012 (12,970 individuals within 5,000 households, ages 15+) from ultra-poor rural Bangladeshi households and OLS regressions to test for gender differences in constructed diet measures. Measures include caloric intake, Caloric Adequacy Ratio (CAR: intake divided by estimated requirements based on sex, occupation, and life stage), Dietary Diversity Score (DDS; range 0–10), Global Dietary Quality Score (DGQS; range 0–49), food group intakes (intake per GDQS food group, grams), and ratios of food group intake to total intake. Between-household differences are accounted for by adjusting for demographic and geographic factors. ResultsPreliminary results show that men consume more calories than women (mean kcal: male = 2217.99, female = 2022.25, p < 0.001), but women consume more in reference to their caloric needs (CAR: m = 0.75, f = 0.90, p < 0.001). Men also score higher on diet quality measures (DDS: m = 3.43, f = 3.32, p < 0.001; GDQS: m = 8.27, f = 7.69, p < 0.001) and have greater mean intakes in 18 of the 25 GDQS food groups, but the absolute magnitude of male-female differences is small (e.g., < 10 gr. differences in all animal sourced foods). Moreover, compared to women, men did not consume significantly higher proportions of nutrient-dense foods groups. ConclusionsResults indicate that while men’s intake quantities and diet quality scores are marginally higher, the slight male advantage disappears when energy requirements and food group proportions are accounted for. Accordingly, the study results do not provide evidence of male favoritism in household food allocation. Funding SourcesNational Institutes of Health (award T32DK007158), German Ministry for Economic Cooperation and Development, UK Department for International Development, Swiss Agency for Development and Cooperation, UN Development Programme, World Food Programme.

Reducing gender bias in household consumption data: Implications for food fortification policy

Household Consumption Expenditure Survey (HCES) data are increasingly used to inform nutrition policy around the world, most prominently for food fortification programs. However, they risk providing incorrect and gender-biased estimates of dietary intakes. We use both 7-day HCES and 24-hour dietary recall (24HR) data on all members of 5604 households in rural Bangladesh to disentangle the two main sources of error: 1) mismeasurement of household consumption, and 2) intra-household allocation assumptions used to individualize household consumption. We show that, relative to 24HR, HCES overestimate household-level quantities and underestimate women’s share of household foods. Errors from modeling the potential benefits and risks of fortification depend on the food – better measurement is needed for foods consumed episodically (e.g. wheat flour or sugar) or in small quantities (e.g. salt and oil). Beyond mean bias, we find poor and heteroskedastic agreement between HCES and 24HR methods, which is more driven by mismeasurement of food quantities than the application of flawed assumptions about food allocation – at least in the Bangladeshi context. We demonstrate a novel generalizable method for improving HCES intake estimates by drawing on the advantages of both HCES and 24HR data. Using a small sample of 24HR data to generate context- and food-specific quantity and allocation corrections, we can almost eliminate mean bias. With further validation, we hope our proposed method can be used to ensure that HCES estimates account for locally-specific measurement error and gender norms, and that nutrition policy based on these data will be safer and more gender-sensitive.