Pregnancy In Rural Bangladesh Research Articles

A formative study of the sociocultural influences on dietary behaviours during pregnancy in rural Bangladesh.

Balanced energy protein supplementation (BEP) is recommended for contexts of high maternal undernutrition by the World Health Organization. Despite recent improvements in undernutrition, Bangladesh remains a context where BEP could help accelerate progress towards nutrition goals. In preparation for an effective trial testing a fortified BEP, a qualitative study was undertaken to better understand sociocultural factors influencing dietary behaviours in pregnancy. Married women of reproductive age (n = 23), their husbands (n = 6) and mothers-in-law (n = 6) were interviewed, and focus group discussions were conducted with women (n = 4). Women had a clear understanding of which nutritious foods are important to consume during pregnancy, including green leafy vegetables, dairy and other animal-source foods. Many explained affordability as a barrier to consuming those foods with the desired frequency. Women acquired information about diet and nutrition in pregnancy from community health workers as well as other women in the community. Most preferred to seek information from their own networks before formal health care providers. Women and husbands generally had positive views about micronutrient supplements, although some mothers-in-law were more hesitant. Some food taboos relating to the consumption of certain foods like duck and pigeon meat persist, mainly stemming from concerns for the unborn child. Opportunities exist to build on existing perceptions of healthy diets, potentially framing food or nutrient supplements as a beneficial 'add-on' to promote a healthy pregnancy. There is a scope to strengthen nutrition counselling, especially for the family members, to dispel myths and misconceptions and promote dietary and other support for pregnant women.

P07-027-23 Maternal Morbidity and Risk of Malnutrition by Mid-Upper Arm Circumference (MUAC) in Early Pregnancy in Rural Bangladesh

P07-027-23 Maternal Morbidity and Risk of Malnutrition by Mid-Upper Arm Circumference (MUAC) in Early Pregnancy in Rural Bangladesh

What Worked for Improving Balanced Maternal Dietary Intake in Rural Bangladesh? Implications for New Programs

Abstract Objectives To assess the strategies that worked to motivate the women and families to adhere to a nutrition behavior change intervention trial that aimed to promote balanced diet in pregnancy in rural Bangladesh. Methods We designed this process evaluation as part of a cluster randomized controlled trial. We conducted in-depth interviews with pregnant women, recently-delivered women, and husbands; focus groups with mothers and mothers-in-law; and key-informant interviews with Shasthya Kormis (community health workers) who provided the balanced plate nutrition intervention. Results The novel finding in the study was that the balanced plate nutrition education helped women through practical demonstration to learn about a balanced meal considering appropriate portion sizes and diversity of foods. We also found that pregnant women needed active involvement of community health workers in mobilizing social support to create an enabling environment essential to bring changes in dietary behavior with self-motivation. Practical demonstration, opportunity to participate and convenience of making of the plate with the food available in own or neighbors’ kitchen were the most commonly mentioned reasons of acceptance of the intervention to the women and families. We identified six key areas within the intervention strategy that played crucial role in achieving desired adherence. These include: practical demonstration of portion sizes engaging the end-users; addressing local food perceptions; demystifying animal-source foods; engaging husbands and mothers-in-law; leveraging women's social networks; and harnessing community health workers’ social role. Conclusions Programs to improve maternal nutritious food consumption should focus on promoting diet through practical demonstration of portion sizes through active engagement of the women and family instead of replicating the conventional information-based counseling. Funding Sources The University of Sydney Faculty of Medicine and Health.

Pregnancy intervals after stillbirth, neonatal death and spontaneous abortion and the risk of an adverse outcome in the next pregnancy in rural Bangladesh

BackgroundStudies have revealed associations between preceding short and long birth-to-birth or birth-to-pregnancy intervals and poor pregnancy outcomes. Most of these studies, however, have examined the effect of intervals that began with live births. Using data from Bangladesh, we examined the effect of inter-outcome intervals (IOI) starting with a non-live birth or neonatal death, on outcomes in the next pregnancy. Pregnancy spacing behaviors in rural northeast Bangladesh have changed little since 2004.MethodsWe analyzed pregnancy histories for married women aged 15-49 years who had outcomes between 2000 and 2006 in Sylhet, Bangladesh. We examined the effects of the preceding outcome and the IOI length on the risk of stillbirth, neonatal death and spontaneous abortion using multinomial logistic regression models.ResultsData included 64,897 pregnancy outcomes from 33,495 mothers. Inter-outcome intervals of 27-50 months and live births were baseline comparators. Stillbirths followed by IOI’s <=6 months, 7-14 months or overall <=14 months had increased risks for spontaneous abortion with adjusted relative risk ratios (aRRR) and 95% confidence intervals = 29.6 (8.09, 108.26), 1.84 (0.84, 4.02) and 2.53 (1.19, 5.36), respectively. Stillbirths followed by IOIs 7-14 months had aRRR 2.00 (1.39, 2.88) for stillbirths.Neonatal deaths followed by IOIs <=6 months had aRRR 28.2 (8.59, 92.63) for spontaneous abortion. Neonatal deaths followed by IOIs 7-14 and 15-26 months had aRRRs 3.08 (1.82, 5.22) and 2.32 (1.38, 3.91), respectively, for stillbirths; and aRRRs 2.81 (2.06, 3.84) and 1.70 (1.24, 3.84), respectively, for neonatal deaths.Spontaneous abortions followed by IOIs <=6 months and 7-14 months had, respectively, aRRRs 23.21 (10.34, 52.13) and 1.80 (0.98, 3.33) for spontaneous abortion.ConclusionIn rural northeast Bangladesh, short inter-outcome intervals after stillbirth, neonatal death and spontaneous abortion were associated with a high risk of a similar outcome in the next pregnancy. These findings are aligned with other studies from Bangladesh. Two studies from similar settings have found benefits of waiting six months before conceiving again, suggesting that incorporating this advice into programs should be considered. Further research is warranted to confirm these findings.

A village-matched evaluation of providing a local supplemental food during pregnancy in rural Bangladesh: a preliminary study

BackgroundPrenatal balanced protein energy supplementation consumed by undernourished women improves mid-upper arm circumference in early infancy. This study aimed to identify whether locally produced maternal food-based supplementation improved anthropometric measures at birth and early infancy.MethodsA village-matched evaluation, applying principles of a cluster randomised controlled trial, of a locally produced supplemental food to 87 undernourished pregnant women. 12 villages (intervention: n = 8; control: n = 4) in Pirganj sub-district, Rangpur District, northern Bangladesh. Daily supplements were provided.ResultsAnthropometric data at birth were available for 77 mother-infant dyads and longer-term infant growth data for 75 infants. Mid-upper arm circumference (MUAC) was significantly larger in infants of mothers in the intervention group compared with the control group at 6 months (p < 0.05). The mean birth weight in babies of supplemented mothers (mean: 2·91 kg; SD: 0·19) was higher than in babies of mothers in the control group (mean: 2·72 kg; SD: 0·13), and these changes persisted until 6 months. Also, the proportion of low birth weight babies in the intervention group was much lower (event rate = 0.04) than in the control group (event rate = 0.16). However, none of these differences were statistically significant (p > 0·05; most likely due to small sample size). The intervention reduced the risk of wasting at 6 months by 63.38% (RRR = 0.6338), and of low birth weight by 88·58% (RRR = 0.8858), with NNT of 2.22 and 6.32, respectively. Only three pregnant women require this intervention in order to prevent wasting at 6 months in one child, and seven need the intervention to prevent low birth weight of one child.ConclusionsLocally produced food-based balanced protein energy supplementation in undernourished pregnant women in northern Bangladesh resulted in larger MUAC in infants at 6 months. Further research, with larger sample sizes, is required to confirm the role of locally produced supplementation for undernourished pregnant women on weight and linear growth in newborns and infants.Trial registrationThis research was registered with the ISRCTN registry (ISRCTN97447076). This project had human research ethical approval from the James Cook University (Australia) Ethics committee (H4498) and the Bangladesh Medical Research Council (BMRC/NREC/2010–2013/58).

Early-Life Selenium Status and Cognitive Function at 5 and 10 Years of Age in Bangladeshi Children.

Background:In older adults, selenium status has been positively associated with cognitive function. We recently reported a positive association between maternal selenium status in pregnancy and children’s cognitive function at 1.5 y.Objective:We followed up the children to assess if prenatal and childhood selenium status was associated with cognitive abilities at 5 and 10 y.Methods:This longitudinal cohort study was nested in Maternal and Infant Nutrition Interventions in Matlab (MINIMat), a population-based, randomized supplementation trial in pregnancy in rural Bangladesh. Selenium in maternal blood [erythrocyte fraction (Ery-Se) at baseline] and in child hair and urine was measured using inductively coupled plasma mass spectrometry. Children’s cognition at 5 and 10 y was assessed using the Wechsler Preschool and Primary Scale of Intelligence™ and the Wechsler Intelligence Scale for Children®, respectively. In total, 1,408 children were included.Results:Multivariable-adjusted linear regression analyses showed that prenatal selenium status was positively associated with children’s cognitive function at 5 and 10 y. An increase in maternal Ery-Se from the fifth to the 95th percentile [median: hemoglobin (Hb)] was associated with an increase in full developmental score of 3.5 [95% confidence interval (CI): 0.1, 7.0], corresponding to 0.16 standard deviation (SD) at 5 y, and 8.1 (95% CI: 3.8, 13), corresponding to 0.24 SD at 10 y. In addition, urine and hair selenium concentrations at 5 and 10 y of age were positively associated with cognitive function at 10 y, although associations were inverse for concentrations . Some associations were slightly stronger for girls than for boys.Conclusions:Measures of prenatal and childhood (below the 98th percentile) selenium status were associated with higher cognitive function scores at 5 and 10 y of age. https://doi.org/10.1289/EHP1691

Dietary Diversity is Low and Associated with Nutritional Status of Women in Early Pregnancy in Rural Bangladesh

Dietary Diversity is Low and Associated with Nutritional Status of Women in Early Pregnancy in Rural Bangladesh

Micronutrient status during pregnancy and effects of antenatal supplementation with multiple micronutrients versus iron‐folic acid in rural Bangladesh (804.3)

Women often enter pregnancy with micronutrient deficiencies that are exacerbated by the demands of pregnancy. Yet micronutrient status of pregnant women is uncommonly assessed, even as momentum toward preventing multiple micronutrient (MM) deficiencies increases worldwide. In a substudy of a trial of MM versus iron‐folic acid (IFA) supplementation from first trimester (TM) through 3 mo postpartum in rural Bangladesh, we identified n=1526 women with plasma samples obtained in the 1st TM, prior to supplementation, and in the 3rd TM, in whom to evaluate micronutrient status. In available data (n=234‐1440 per nutrient assay), 6.8% of women were vitamin A deficient (retinol &lt; 0.7 μmol/L), 41.7% had low β‐carotene (&lt; 0.09 μmol/L), 57.7% were vitamin E (α‐tocopherol &lt; 12 μmol/L) and 73.5% were vitamin D (25‐hydroxyvitamin D &lt; 50 nmol/L) deficient. Folate deficiency (plasma folate &lt; 6.8 nmol/L) was 2.6%, while vitamin B12 deficiency (cobalamin &lt; 150 pmol/L) occurred in 29.8% of women. Anemia affected 20.6% of women, but iron deficiency by TfR (4.7% &gt; 8.3 μg/mL) and ferritin (1.8% &lt; 12 μg/L) was uncommon. Alpha‐1 acid glycoprotein &gt; 1 g/L, indicating inflammation, was present in 8.1% of women. Baseline zinc and iodine status, and MM versus IFA effects on micronutrient status by the 3rd TM, will be presented. Vitamin deficiencies are common early in pregnancy in rural Bangladesh, representing preventable hidden hunger.Grant Funding Source: Supported by the Bill and Melinda Gates Foundation Grant #614

Unmet need, intention to use contraceptives and unwanted pregnancy in rural bangladesh.

Unmet need for contraception has become a central concept in the family planning field and one of the most important indicators for program planning and evaluation. The measure has faced criticism, however, for not taking into account women's stated intention to use contraceptives. Using longitudinal data on more than 2,500 rural Bangladeshi women in 128 villages, this study links women's contraceptive adoption and experience of unwanted pregnancy between 2006 and 2009 to their unmet need status and their stated intention to use contraceptives in 2006. Intention to use a method was predictive of subsequent use for both women with and without an unmet need. Three-quarters of the unintended pregnancies reported between 2006 and 2009 occurred among women without an unmet need in 2006. In addition, nearly half of women without an unmet need who were pregnant or postpartum in 2006 had experienced an unwanted pregnancy, compared with 30% of all women classified as having an unmet need. To adequately meet population family planning needs, programs must look beyond unmet need and focus on the total demand for acceptable and effective methods.

Influence of the Socio-cultural Factors in Health-Seeking Behaviour of Women during Pregnancy in Rural Bangladesh

There are several social, religious and economic barriers that prevent pregnant women from seeking services from health facilities. The conventional economic views promotes that the government health facilities located in rural areas provide free antenatal care (ANC), delivery and postnatal care (PNC) services, yet the cost related to medicines, transportation and surgical operations in the case of complications discourages poor women to seek services from these facilities. This economic view may explain part of the puzzle yet social stigma generated through patriarchal structure deserves some credit. For instance, a prevalent perception among male is that pregnancy is a natural process for women and it will pass normally and thus no extra care and support is needed in this phase of life. Men (and sometimes along with women) promote superstitions like not taking much food during pregnancy arguing that extra feeding shall increase the growth of the fetus and will affect normal delivery. The disarray in health seeking behaviour is strongly associated with inferior status of girls and women in Bangladesh. This is mainly due to entrenched dysfunctional gender relations brought about by dated social and cultural practices and is reinforced by literalist interpretations of religious tomes. Overriding all of these, the poor rural woman is treated as if her body and her future are not hers to own and manage. Naturally, this has a trickle down effect on any health-seeking behaviour of women. Based on empirical evidences this paper aims to explore the health situation of rural pregnant women and their health support seeking behaviour

Prevalence of anemia and micronutrient deficiencies in early pregnancy in rural Bangladesh, the MINIMat trial

To describe the prevalence of anemia and micronutrient deficiencies as well as their determinants in early pregnancy. Baseline data from a population-based randomized intervention trial. The study was conducted in Matlab, a sub-district in rural Bangladesh from 1 January to 31 December 2002. Pregnant women (n= 740) were enrolled in approximately week 14 in pregnancy. Data were collected using questionnaires, physical examinations and laboratory analyses of blood samples for concentrations of hemoglobin, ferritin, zinc, folate and vitamin B-12. Covariates associated with anemia and micronutrient deficiencies in bivariate analyses were evaluated in multivariate logistic regression models adjusting for potential confounders. Anemia was present in 28% of the women, 55% were zinc deficient, 46% were vitamin B-12 deficient and 18% were folate deficient. Anemia was not associated with iron deficiency but rather with vitamin B-12 deficiency. Infestation with Ascaris was highly prevalent (67%) and associated with both folate and vitamin B-12 deficiency. Anemia and micronutrient deficiencies all varied significantly with season. The high prevalences of zinc and vitamin B-12 deficiencies in early pregnancy are a concern, as it could lead to adverse pregnancy outcomes and increased health risks for both mother and child. The prevalence of iron deficiency was low, but as this was during early pregnancy, the women might develop iron deficiency and consequently iron deficiency anemia as the pregnancy progresses.

Duration and magnitude of mortality after pregnancy in rural Bangladesh

Women remain at increased risk of mortality for some time after pregnancy although the length of this period is unclear. The aim of this study is to examine mortality after pregnancy in rural Bangladesh using data from a unique demographic surveillance system. We included all person-time in women aged 15-50 between 1983 and 2001 and compared mortality rates by time since pregnancy outcome (live birth, stillbirth, induced and spontaneous abortion) using Poisson regression, adjusting for socio-demographic factors. Mortality was highest on the first day after pregnancy (adjusted RR compared with third to fourth year post-partum 105.74, 95% CI: 76.08, 146.95) and remained elevated until 180 days (adjusted RR 1.55, 95% CI: 1.13, 2.11). Pregnancies ending in abortions and stillbirths accounted for 50% of deaths in women within 6 weeks of the end of pregnancy, and mortality after these outcomes was between two and four times as high as mortality after a livebirth. The high mortality rates immediately after birth provide strong support for a skilled attendance strategy. After abortions or stillbirths, women should be under surveillance for up to 1 week. Further work on the cause of deaths in the late post-partum period is required to understand the mechanisms behind increased mortality risks at these times.

Anaemia and iron deficiency during pregnancy in rural Bangladesh

To study the prevalence of anaemia and its association with measures of iron deficiency (ID) among a group of pregnant women. Cross-sectional survey. Pregnant women identified through house-to-house visits and participating in community-based antenatal care activities in a rural location of Mymensingh, Bangladesh. The estimates are based on 214 reportedly healthy pregnant women in their second trimester. Information on socio-economic status and reproductive history were obtained through home visits and venous blood samples were collected at antenatal care centres. Haemoglobin concentration (Hb) was measured by HemoCue, serum ferritin (sFt) by radioimmunoassay and serum transferrin receptor (sTfR) by enzyme-linked immunosorbent assay methods. ID was defined as presence of either low sFt (<12 microg l(-1)) or high sTfR (>8.5 mg l(-1)). The prevalence of anaemia (Hb <110 g l(-1)) was 50%, but severe anaemia (Hb <70 g l(-1)) was absent. Low sFt was observed in 42%, high sTfR in 25%, either low sFt or high TfR in 54% and both low sFt and high TfR in 13% of the pregnant women. Two out of three anaemic women had an indication of ID, which was present in 80% of women with moderate (Hb 70-99 g l(-1)) and 50% with mild (Hb 100-109 g l(-1)) anaemia. Four out of 10 non-anaemic women (Hb >/=110 g l(-1)) also had ID, but the prevalence was significantly lower than that observed in anaemic women (P=0.001). Despite the high prevalence of anaemia, severe cases were absent. The prevalence of ID increased at lower Hb. However, an increased prevalence was also found among women in the highest category of Hb.