Rural Areas Of Bangladesh Research Articles

A cohort study of the occurrence of post-term births and its association with perinatal mortality in a rural area in Bangladesh.

We aimed to evaluate the trend of post-term births over time and their association with perinatal mortality based on prospective pregnancy cohorts in a rural area in Bangladesh. This cohort study included 72 373 singleton births with gestational ages ≥28 weeks recorded by a health and demographic surveillance system from 1990 to 2019 in Matlab, Bangladesh. We expressed the gestational age as X (weeks) + Y (days)/7 weeks, where X indicated complete weeks, and Y presented the number of completed days out of seven days or a week. Using Poisson regression with robust variances, we estimated the population-based proportion of post-term births and assessed the association between gestational age categories and perinatal mortality. We presented results by adjusted relative risk (aRR) with 95% confidence intervals (CIs). Post-term births declined from 5.8% in 1990 to 2.8% in 2019. Perinatal mortality declined from 58 to 27 per 1000 births from 1990 to 2019. Compared to full-term births (39 + 0/7 to 40 + 6/7 weeks), the aRRs of perinatal mortality were 1.39 for late-term (41 + 0/7 to 41 + 6/7 weeks) and 1.93 for post-term (≥42 + 0/7 weeks) births. The population-attributable fraction of perinatal mortality was 15% for births at ≥41 + 0/7 weeks out of the total perinatal deaths occurring at ≥39 gestation weeks. In this rural setting in Bangladesh, we observed a decline in post-term birth proportions from 1990 to 2019. We found increased perinatal mortality when pregnancy continued beyond 40 + 6/7 weeks of gestation. This implies that planning the management of pregnant women approaching the post-term period may be needed to further improve perinatal health outcomes.

AN EVALUATION OF THE EFFECTIVENESS OF THE PROVISION OF LAND USE POLICY FOR BUILDING HOUSES IN RURAL BANGLADESH

The paper provides a comprehensive evaluation of the national land use policy in Bangladesh, highlighting the gaps in implementation and the need for strategic improvements for building houses using minimum agricultural land in rural areas of Bangladesh. The main objectives of the policy evaluation research are to explore the extent of the intervention of the National Land Use Policy 2001 that has achieved the objective of minimum use of agricultural land, to determine whether the authority has made the rural people aware of building model houses, multistorey buildings, and planned residential areas in the village and finally to find out the critical factors for effective implementation of national land use policy. It has been used as a mixed evaluation research method with both qualitative and quantitative approaches. Data were collected online using a semistructured questionnaire and checklist for respondent interviews. The main results of the policy evaluation revealed that the objectives of the policy are not achieved and effectively implemented for numerous reasons as such, the implementers are reluctant to implement and make aware the villagers, responsible implementing agencies are not fully well-defined, people are unaware and do not know about the policy, lack of village development planning and design, overpopulation and segregation of families, poverty, lack of monitoring by the ministry, unorganized urbanization and industrialization, local political influence, absence of land zoning and union parishad are unwilling to enforce their laws, etc. To implement the policy effectively, a joint effort of the local government bodies, local communities, and all local administration departments would be required, and each organization’s role would be well classified, and payment or loan support would be transferred to the rural people of Bangladesh.

Obstacles in Instructing English at Village Elementary Schools in Bangladesh: A Study and Proposals

Elementary education serves as the foundation for students' future endeavors. Each year, many students in rural Bangladesh fail public examinations, and those who pass often do so by rote memorization, lacking proficiency in the four key language skills required for competence in English. Primary education was chosen for this study as it is a crucial stage where teachers bear full responsibility for student learning. The primary objective of this research was to identify the obstacles in teaching and learning English at the elementary level in rural areas of Bangladesh. Data were gathered using two sets of questionnaires administered to both students and teachers to assess the state of English language education in these primary schools. Additionally, teacher interviews and classroom observations, guided by an observation checklist, were conducted to gain a comprehensive understanding of the current teaching practices. The findings reveal that the majority of rural students struggle with English due to several factors, including a shortage of skilled and trained teachers, inadequate teacher training, inappropriate teaching methods and materials, limited contact hours, large class sizes, and insufficient pedagogical knowledge. This paper also includes several recommendations based on the research findings to address these challenges effectively.

Application of GIS in Introducing Community-Based Biogas Plants from Dairy Farm Waste: Potential of Renewable Energy for Rural Areas in Bangladesh

Dairy production is one of the most important economic sectors in Bangladesh. However, the traditional management of dairy cow manure and other wastes results in air pollution, eutrophication of surface water, and soil contamination, highlighting the urgent need for more sustainable waste management solutions. To address the environmental problems of dairy waste management, this research explored the potential of community-based biogas production from dairy cow manure in Bangladesh. This study proposed introducing community-based biogas plants using a geographic information system (GIS). The study first applied a restriction analysis to identify sensitive areas, followed by a suitability analysis to determine feasible locations for biogas plants, considering geographical, social, economic, and environmental factors. The final suitable areas were identified by combining the restriction and suitability maps. The spatial distribution of dairy farms was analyzed through a cluster analysis, identifying significant clusters for potential biogas production. A baseline and proposed scenario were designed for five clusters based on the input and output capacities of the biogas plants, estimating the location and capacity for each cluster. The study also calculated electricity generation from the proposed scenario and the net greenhouse gas (GHG) emissions reduction potential of the biogas plants. The findings provide a land-use framework for implementing biogas plants that considers environmental and socio-economic criteria. Five biogas plants were found to be technically and spatially feasible for electricity generation. These plants can collectively produce 31 million m3 of biogas annually, generating approximately 200.60 GWh of energy with a total electricity capacity of 9.8 MW/year in Bangladesh. Implementing these biogas plants is expected to increase renewable energy production by at least 1.25%. Furthermore, the total GHG emission reduction potential is estimated at 104.26 Gg/year CO2eq through the annual treatment of 61.38 thousand tons of dairy manure.

Impacts of Solar Home Systems in Rural Areas: A Case Study in Bangladesh

Access to electricity is important for development in general, but access at low costs is a vital tool of economic and social development, especially for those locations that lie very far from the grid. The present study investigates the impacts of solar home systems in a rural area of Bangladesh, focusing on the ways in which the adoption of SHS transforms household livelihoods. It has improved the lives of the community members through an affordable and reliable source of electricity that allowed enhanced lighting and security, increased educational opportunities, empowerment of women, reduced reliance on harmful energy sources, increased economic productivity, environmental sustainability, human relationships and well-being. These studies emphatically underscore the fact that the biggest challenge remains affordability: in most instances, SHS is accessed through family savings or loans from NGOs. In spite of these barriers, SHS has conventionally been portrayed as an empowering tool that enhances the quality of life and aids in fulfilling the goals of sustainable development in rural areas. The paper concludes by relating conventional energy sources with a comparison, emphasizing broader benefits and possible long-term potentials for SHS in tackling energy poverty within rural Bangladesh.

Geographical variation, socioeconomic inequalities of low birth weight, and its relationship with maternal dietary diversity: Insights from the maternal infant and young child nutrition programme in Bangladesh.

Globally, every year, 20 million neonates are born with weights below 2500 g and are considered low birth weight (LBW). About 90% of these births occur in low- and middle-income countries. Information regarding the geographical variation, socioeconomic inequalities of LBW neonates, and the relationship between maternal inadequate dietary diversity and LBW is limited in rural areas of Bangladesh. We aimed to explore the geographical disparities and socioeconomic inequalities in the prevalence of LBW and its association with inadequate maternal dietary diversity. We extracted data from a large-scale evaluation programme conducted as a part of the maternal infant and young child nutrition phase two in Bangladesh, implemented by BRAC. We used the concentration index (CIX) to measure the socioeconomic inequalities of LBW. We performed a cluster-adjusted multiple logistic regression analysis to determine the association between LBW and maternal dietary diversity. A total of 4651 children aged <5 years with their mother's information were included. The overall prevalence of LBW was 13.5%. About 16% of mothers living in the poorest wealth quintile gave birth to LBW babies, whereas 10% of mothers living in the richest households gave birth to LBW babies. The CIX exhibited LBW babies were more prevalent among the socioeconomically worst-off (poorest) group (CIX = -0.08), indicating mothers of the poorest households are vulnerable to giving birth to normal-weight babies. An adjusted multiple logistic regression model indicated that mothers with inadequate dietary diversity had higher odds (adjusted odds ratio (AOR) = 1.27; 95% confidence interval (CI) = 1.04, 1.54) of giving birth to LBW babies. Notably, in the interaction of mothers' age and dietary diversity, we found that adolescent mothers (aged ≤ 19 years) with inadequate dietary diversity had 2.56 times (AOR = 2.56; 95% CI = 1.14, 5.76) higher odds of giving birth to LBW babies compared to adult mothers (aged >19 years) who consumed diversified foods. Intervention strategies for reducing LBW prevalence should target the poorest households. Also, interventions for improving the dietary diversity of adolescent pregnant mothers are expected to reduce the number of LBW babies from the rural areas of Bangladesh.

A Comprehensive Analysis on Non-Communicable Diseases by Quantitative Approach: Using Graphical Visualization

Non-communicable diseases (NCDs) have already become major killers in Bangladesh. Once NCDs are developed, they become chronic health and economic problems. Their primary prevention is linked to their common risk factors. This study was conducted to visualize the trend of the diseases along with the age factor in rural areas of Bangladesh. A quantitative method was used throughout the research to reach the desired goal of this study. The data was collected from a medical association to use in this research and for processing the graphical visualization some preprocessing techniques are also applied on the raw data. After completing the research, the researchers found the percentage of the patients according to the diseases and the disease count along with the patients’ age. The outcome is totally represented in graphical visualization. This research will help to find the numeric measurement of a particular disease considering age factor which can help to reduce the issues in medical sectors.

Persons with Disabilities Living in Rural Areas of Bangladesh: An Exploration of Their Mental Health and Experiences in Accessing Support During the COVID-19 Pandemic

ABSTRACT The COVID-19 pandemic has presented a major public health challenge across the world, including in Bangladesh. Little scholarly work has explored the mental health experiences of persons with disabilities in rural areas of Bangladesh during the pandemic. A qualitative case study was conducted in the rural areas of Narayanganj, Gazipur, and Narsingdi. A total of 13 in-depth interviews (IDIs) with persons with disabilities and 13 key informant interviews (KIIs) with different stakeholders and caregivers were conducted. Thematic analysis was used to analyse the data. The findings revealed five major themes: lockdown-induced mental health problems, including fear of infection, symptoms of anxiety and depression, sleep disturbance, suicidal ideation, and domestic violence; perceived attitude towards mental health issues, including stigma and discrimination; perceived vulnerability was observed in relation to gender, age, and type of disability; barriers to seeking mental health care including distance, financial burden, and indifference towards mental health care; and finally, availability of mental health care which reaffirms a lack of mental health care in rural areas. The findings highlight the importance of integrating mental health into the primary healthcare system with a focus on persons with disabilities to minimise mental health repercussions during times of emergency.

Food Hygiene Practices and the Risk of Diarrhea in Children of Working Mothers in Rural Bangladesh

Background: This study addresses the imperative role of maternal personal and household hygiene in safeguarding young children from diarrhea in rural Bangladesh. With young children facing heightened susceptibility to diarrhea during weaning, potential sources of contamination include traditional weaning foods, water quality, and utensil hygiene. This study aims to investigate the influence of maternal hygiene practices on the prevalence of diarrhea among young children in rural area of Khulna, Bangladesh. Materials and methods: A cross-sectional study was conducted in rural areas of Bangladesh from January to June 2023, focusing on under-five children and their working mothers. Results: The study revealed significant associations between hygiene practices and diarrhea prevalence. Proper hand washing by mothers before food preparation exhibited a protective effect (OR: 1.83, 95% CI: 1.03 - 3.24). Ensuring utensil hygiene was correlated with lower diarrhea risk (OR: 11.29, 95% CI: 5.19 - 24.55). Moreover, consistent maternal hand washing after using the toilet (OR: 6.92, 95% CI: 3.08 - 15.55) and before feeding (OR:2.38, 95% CI: 1.17 - 4.82) significantly reduced diarrhea risk among children. Conclusion: The study underscores the critical role of maternal personal and household hygiene practices in preventing diarrhea among young children in rural Bangladesh. IAHS Medical Journal Volume 6(2) December 2023; 73-77

Environmental Literacy among Primary Level Students in Bangladesh: A Comparative Study between Urban and Rural Areas

Environmental literacy (EL) is considered a key skill for primary students who will be responsible for solving the environmental problems that affect Bangladesh and other countries. This study explored the EL of primary students in urban and rural areas of Bangladesh, using the five EL components: knowledge, skill, awareness, attitude, ability to evaluate, and participation, declared in 1977 Tbilisi conference on environment education. A qualitative approach was used, and data were collected through surveys, focus group discussions, and student interviews. Thematic and descriptive analysis was performed on the findings. The results indicated that urban students had higher EL scores than rural students in all components. The study also suggested the implications of the findings for curriculum developers, policymakers, environmental NGOs, local project planners, and future research. Teacher’s World: Journal of Education and Res arch, 50(1): 21-42

Prevalence of Hypertension and Its Associated Factors in a Rural Population of Southeastern Bangladesh

Background: More than 75% of the population live in rural area in Bangladesh and morbidity and mortality due to Non-Communicable Diseases (NCDs) has increased over the last few decades in this country. Hypertension is a significant risk factor for NCDs, specifically cardiovascular disease. This study aimed to determine hypertension prevalence and associated factors among Bangladeshi adults in rural areas. Materials and methods: This cross-sectional study was conducted in selected rural areas in the Chattogram district of Bangladesh from January 2014 to December 2014. A total of 2500 individuals aged 18 years and above were determined by a multistage sampling method. Self-reported sociodemographic and hypertension-related data were collected using a structured case record form, and blood pressure was measured. Results: The overall prevalence of hypertension was 32.5% (812/2500) [95% confidence interval (CI), 30.7-34.3] (Men: 34.4%, Women: 30.9%). The prevalence of hypertension was 21.1% and 43.6% in the £40 and &gt;40 years age group, respectively (p&lt;0.001). Hypertension had no association with the gender, educational level and monthly income of the respondents. Overall, 1268 (50.7%, 95% CI 48.8-52.7%) of the study participants had ever had their blood pressure measured. Among the 812 people with hypertension, 478 (58.9%, CI 55.5-62.2%) were aware of the disease. Of those familiar with the disease, 404 (84.5% CI 81.0-87.5%) were on treatment, and 285 (70.5%, CI 64.2-74.9%) had achieved disease control. Only 315 (38.8%, CI 35.542.2) were controlled among all people with hypertension. Conclusion: Hypertension is highly prevalent (One in three) in Bangladeshi rural adults, while awareness, treatment, and control are low. The integrated context specific program must be designed and implemented at scale through a primary healthcare approach. IAHS Medical Journal Volume 6(2) December 2023; 78-82

Sustainable Rural Tourism: A Social Transformation of Rural Area

The study focuses on presenting social transformation through quality of life led by sustainable rural tourism. Social transformation is a tenacious and erratic process pointing towards the society’s changes from ascribed status to achieved status. It is not brought in frontline of the research field of tourism, especially, of sustainable rural tourism and quality of life. This paper has selected three rural areas of Bangladesh as a study area where structured questionnaire survey has piloted among local communities who live there for more than three years. One hypothesis was developed regarding the effects of sustainable rural tourism on the quality of life demographically in selected study areas. This study paper has designed to find how sustainable tourism changes a society in rural area from sociocultural, economical, and environmental aspects. The revolution of sustainability of these three dimensions reflects a quality of life of a society. The result has revealed that rural society has experienced economic growth, infrastructural development, social empowerment, cultural preservation, environmental preservation and conservation, and social awareness. It also shows that sustainable rural tourism and social transformation is sharing a favorable relationship in terms of the three pillars of sustainability. It is evident for certain, sustainable tourism development in rural area improves the quality of life and advances the spatial development.

Adoption of cashless economy in Bangladesh

Bangladesh has seen significant strides in technological developments that have positively affected its GDP. Different modes of financial transactions, such as mobile banking, and credit and debit cards, have proven beneficial for the economy. bKash, Nagad, and other online transaction platforms are widely used by the population of Bangladesh. People, starting from Dhaka to many other rural areas of Bangladesh, are gradually becoming habituated to the digital mode of payment. The case thoroughly analyzed and highlighted the concept of a cashless society and showed how technological advancements in financial services can contribute to broader sustainability goals, including carbon-reduction. Moreover, the case presented three different scenarios on Bangladesh’s devotion towards going cashless. Additionally, the case utilized the diffusion of innovation (DOI) theory, to identify the different categories of innovation adopters, and elucidated their traits in the context of adopting a cashless economy.

Grandparenting and life satisfaction of the aged in rural areas: A study in Kalia Upazila of Narail District

In rural Bangladesh, older adults generally enjoy their role as grandparents and spend their leisure and inactive periods (non-involvement in income-generating activities) with their grandchildren. The life satisfaction of the older adults partly lies in their role-playing as grandparents. The aim of this study was to examine the impact of caring for grandchildren on the life satisfaction of the older adults in rural areas. A survey method was used to conduct the study, and the age of the participants was 60 years and above. Four Mohollas of Kalia Upazilla of Narail district were selected purposively, and 253 older adults (123 male & 130 female) were chosen by using a purposive sampling technique. An interview schedule (containing both open and close-ended questions) was used to collect data in the months of November and December 2018. The findings showed that activities with grandchildren and caregiving roles depended on the age structure, and families with more household income were found to enhance the life satisfaction with grandparenting. There was a significant association between the life satisfaction of older adults and their grandparenting role. By identifying some dimensions of family involvement and socio-demographic conditions, this research aims to provide a deeper understanding of the dynamics of how grandparenting impacts the life satisfaction of older adults in rural areas of Bangladesh. The results might help to minimize the shortfalls of policy regarding the well-being of the older adults by focusing on their social and psychological needs. This will ensure aging is in place for everyone.

Effects of maternal exposure to biomass cooking fuel on birth size and body proportionality in full-term infants born by vaginal delivery

It remains unclear whether and how maternal exposure to biomass fuel influences infant anthropometry or body proportionality at birth, which are linked to their survival, physical growth, and neurodevelopment. Therefore, this study seeks to explore the association between household-level exposure to biomass cooking fuels and infant size and body proportionality at birth among women in rural Bangladesh. A total of 909 women were derived from the Pregnancy Weight Gain study, which was conducted in Matlab, a rural area of Bangladesh. Infant’s weight (g), length (cm), head circumference (cm), small for gestational age (SGAW), short for gestational age (SGAL), low head circumference for gestational age (SGAHC), ponderal index, and cephalization index at birth were the outcomes studied. Of the women, 721 (79.3%) were dependent on biomass fuel. Compared to infants born to mothers who used gas for cooking, those born to biomass users had lower weight (β − 94.3, CI − 155.9, − 32.6), length (β − 0.36, 95% CI − 0.68, − 0.04), head circumference (β − 0.24, CI − 0.47, − 0.02) and higher cephalization index (β 0.03, CI 0.01, 0.05) at birth. Maternal biomass exposure is more likely to lead to symmetric SGA, although there is evidence for some brain-sparing effects.

Understanding antibiotic purchasing practices in community pharmacies: A potential driver of emerging antimicrobial resistance

IntroductionAntimicrobial resistance (AMR), a transboundary health issue, critically impacting low- and middle-income countries (LMICs) where 80% of antibiotics are used in the community, with 20–50% being inappropriate. Southeast-Asia, including Bangladesh, faces heightened AMR risk due to suboptimal healthcare standard and unregulated antibiotic sales. This study aimed to audit antibiotic dispensing patterns from community pharmacies, identifying factors influencing purchasing behaviors. MethodsA cross-sectional survey of 385 antibiotic customers and structured observations of 1000 pharmacy dispensing events were conducted in four urban and rural areas in Bangladesh. Descriptive analysis defined antibiotic use, while Poisson regression examined how patients' demographics and health symptoms influenced prescription behaviors. ResultsAmong 1000 observed medicine dispensing events, 25.9% were antibiotics. Commonly purchased antibiotics included macrolides (22.8%), third-generation-cephalosporins (20.8%), and second-generation-cephalosporins (16.9%). Following WHO-AWaRe classifications, 73.5% of antibiotics were categorized as Watch, and 23.1% as Access. From the survey, 56.6% antibiotics were purchased without a prescription from drug-sellers and informal healthcare providers, primarily for “non-severe” health-symptoms such as upper-respiratory-tract infections (37.4%), fever (31.7%), uncomplicated skin infections (20%), gastrointestinal-infections (11.2%), and urinary-tract infections (7.9%). The likelihood of presenting a prescription while purchasing antibiotics was 27% lower for individuals aged 6–59 compared to those ≤5 or ≥ 60. Lower-respiratory-tract infections and enteric-fever had higher prescription rates, with adjusted prevalence ratios of 1.78 (95% CI: 1.04, 3.03) and 1.87 (95% CI: 1.07, 3.29), respectively. After adjusting for confounders, sex, urban-rural locations, income, education, and number of health-symptoms exhibited no significant influence on prescription likelihood. ConclusionThis study underscores unregulated antibiotic sales without prescriptions, urging tailored interventions considering prevailing health-seeking practices in diverse healthcare settings in LMICs. Enforcing prescription-only regulations is hindered by easy access through community pharmacies and conflicts of interest. Future strategies should consider how stewardship impacts the financial interests of pharmacy personnel in settings lacking clear authority to ensure optimal compliance.

Enhancing women's empowerment as an effective strategy to improve food security in rural Bangladesh: a pathway to achieving SDG-2

IntroductionWomen play an important role in maintaining household food security; unfortunately, their food security is frequently neglected. This type of phenomenon has become common in developing nations such as Bangladesh, particularly in its rural areas. The objective of this study is to investigate the variables that lead to the empowerment of rural women and its impact on their food security. In acknowledging women's significant contribution to achieving Sustainable Development Goal 2 (SDG-2)- Zero Hunger, this study investigates how access to resources, social support, and policy perceptions impact women's empowerment and food security.MethodsA total of 480 rural women from the southern part of Bangladesh were questioned, and their responses were analyzed using partial least squares structural equation modeling.ResultsWe found that access to resources, social support, and policy perceptions explain 74% of women's empowerment variance and women's empowerment explains 70% variance of women's food security. Access to resources and social support has significant positive impacts on women's empowerment. However, policy perceptions have a positive but not significant impact on women's empowerment. We also observed that women's empowerment significantly improved their food security.Practical implicationsTo empower women and improve their food security, the accessibility of resources and support from social networks must be improved. The study emphasizes the importance of strengthening the government's policies, which aim to improve the livelihood conditions of vulnerable people through regular monitoring to overcome underlying obstacles. Our study offers empirical data that policymakers can use to address complex food affordability and security challenges during global crises, enabling the achievement of SDG-2 in rural areas of Bangladesh and similar societies.

Factors associated with adolescent food Security and nutritional status in a selected rural area of the central region of Bangladesh

Food insecurity affects physical growth, health of adolescents and nutritional status while food insecurity is common in rural area of Bangladesh. During adolescence, individuals have gone through series of key transitions into adulthood which may be hindered by food insecurity and poor nutritional status. The present study aimed to identify the most relevant factors that may be associated with food security and nutritional status of adolescents. Additionally, this study also tried to explore the association between adolescent food security and their nutritional status. This Cross-sectional study was carried out among 317 unmarried adolescents aged 10 to 19 years in a selected rural area of central region of Bangladesh. Multistage cluster sampling and purposive sampling were followed to select households and enroll adolescents into the study. Other than descriptive statistics, chi-square test was performed to test the difference between groups as well as to evaluate expected associations between different predictors and outcome variables. Additionally, univariate logistic regression was carried out to estimate the effect of predictor variables on the outcome variable. Moreover, multivariate logistic regression analysis was conducted to control the potential confounder effects upon desired outcome variables. It is observed that around 32.5% adolescents were food secure whereas 67.5% adolescents were food insecure. Our study also reveals that two predictor variables such as family income and family size had significant association with food security where odds of becoming food secure were higher among the adolescents from higher income families (AOR=6.1; 95% CI=2.240-16.718) and smaller families (AOR=3.4; 95% CI=1.563, 7.495). Furthermore, prevalence of underweight, normal nutritional status and overweight was 13%, 83% and 4% respectively where adolescent educational qualification and occupation were significantly associated with normal nutritional status. Adolescents with higher educational qualification (AOR=12.3;95% CI=5.270,28.479) and involved in work (AOR=12.3;95% CI=5.270,28.479) were more likely to have normal nutritional status compared to those who were primarily educated and not involved in work. Further study is recommended to replicate the findings and to generate new knowledge about relevant factors associated with adolescent food security and nutritional status. Bioresearch Commu. 10(2): 1573-1582, 2024 (July)

Decision-making process in seeking antenatal care: A cohort study in a poor urban and a typical rural area in Bangladesh.

Decision-making in choosing and using maternal health care among different care-seeking options is a complex process influenced by multilevel factors. Existing evidence on maternal health care-seeking behaviour stems primarily from cross-sectional studies with limited information. Therefore, we designed a cohort study to better understand the decision-making process in antenatal care (ANC) seeking. We conducted this mixed-methods study among pregnant women at <27 weeks of gestation in a poor urban area (n = 1320) and a typical rural area of Bangladesh (n = 1239) whom we followed up till eight weeks after delivery. In view of quantitative methods, we interviewed all enrolled women 5-6 times four weeks apart. For the qualitative approach, we conducted 70 case studies in the urban area and 46 in the rural area by interviewing the participants and their close family members. In the urban area, about one-third of the pregnant women (38.4%) sought ANC at non-governmental organisations, and nearly an equal proportion went to public facilities (36.6%). In both the situations, women preferred facilities with one-stop services at a reasonable cost. In contrast, the lack of readiness in public facilities of the rural area pushed women (77.8%) toward private facilities for ANC. The reputation of the facilities, availability of skilled care providers, diagnostic tests, and ultrasonography services therein were the key influencing factors in the participants' decisions to seek ANC services from specific facilities. The availability of one-stop services was a key factor for participants' choosing of a facility for ANC. For the urban setting, there is a need to establish large public facilities with one-stop service provision in different zones, along with supporting non-governmental organisations in poor areas. For the rural setting, there is an urgent need to strengthen ANC service provision in public facilities at the community- and the sub-district level to redirect women from the private to the public sector to ensure low cost, quality services.

Does rural transformation affect rural income inequality? Insights from cross-district panel data analysis in Bangladesh

Rural transformation plays a crucial role in enhancing the income and employment prospects of the rural labor force. We investigate the effects of rural transformation on rural income inequality at the district level in Bangladesh using data from five years of nationally representative Household Income and Expenditure Surveys. The Gini coefficient is used to measure rural income inequality. In contrast, the share of high-value agricultural outputs and the share of rural non-farm employment are used as indicators of rural transformation. We find that rural income inequality is positively associated with the share of high-value agricultural outputs and the share of rural non-farm employment. The non-linear regression result shows an inverted U-shaped relationship between rural transformation and income inequality, which indicates that income inequality initially increases with rural transformation but decreases in the long run. Additionally, we find that rural income inequality is positively correlated with the proportion of household education expenditures, agricultural rental activity, and the share of remittances. This study also reveals that income inequality in rural areas of Bangladesh has a significant negative correlation with the government's social safety net program.