Urban Bangladesh Research Articles

Overweight and obesity among urban women with iron deficiency anaemia in Bangladesh.

In this study, we aimed to determine the prevalence and factors associated with overweight and obesity among nonpregnant and nonlactating (NPNL) women of reproductive age with iron deficiency anaemia (IDA) in urban Bangladesh. We obtained data from the baseline assessment of a randomized control trial conducted among 525 women of reproductive age (18–49 years) with IDA (Hb < 12 gdl−1 and serum ferritin <30 μg L−1). The study was carried out in Mirpur, Dhaka, Bangladesh, between December 2017 and January 2019. We collected information on women's socio‐demographic characteristics and anthropometry. Body mass index (BMI) was calculated using the following formula: weight in kilograms per height in square metres. BMI ≥ 25–29.9 kg m−2 was considered as overweight, whereas BMI ≥ 30 kg m−2 as obese. A multivariable logistic regression model was used to ascertain the risk factors of overweight and obesity. The prevalence of overweight and obesity was 29.9% (95% CI: 26.0–34.0) and 13.1% (95% CI: 10.4–16.3), respectively. The combined prevalence of overweight and obesity was 43.0% (95% CI: 38.7–47.4). The multivariable analysis showed married women (aOR: 4.4; CI: 1.8–11.1), women aged 30–49 years (aOR: 7.6; CI: 2.4–24.1), unemployed women (aOR 1.5; CI: 1.0–2.4) and women from the wealthier households (aOR 3.9; CI: 2.3–6.8) had the highest risk of being overweight and obese compared with their counterparts. Both age and household wealth statuses showed dose–response relationships. Combination of overweight and obesity with IDA poses a particular challenge for public health interventions. The policymakers should consider what new interventions and policy initiatives are needed to address this combination of overweight and obesity with IDA.

Developing and testing community-based tuberculosis (TB) screening intervention to increase TB referral, case detection and knowledge among sexual minority people in urban Bangladesh: a mixed-method study protocol

IntroductionAlthough Bangladesh is a country of generalised tuberculosis (TB) epidemic, the HIV prevalence is low among general populations, and 3.9% among key populations. Despite the high possibility of HIV–TB coinfection,...

Healthcare seeking for chronic illness among adult slum dwellers in Bangladesh: A descriptive cross-sectional study in two urban settings.

IntroductionAccompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country’s goal of Universal Health Coverage by 2030.MethodsThis descriptive cross-sectional study compares survey data from slum settlements located in two urban sites in Bangladesh, Tongi and Sylhet. Reported chronic illness symptoms and associated healthcare-seeking strategies are compared, and the catastrophic impact of household healthcare expenditures are assessed.ResultsSignificant differences in healthcare-seeking for chronic illness were apparent both within and between slum settlements related to sex, wealth score (PPI), and location. Women were more likely to use private clinics than men. Compared to poorer residents, those from wealthier households sought care to a greater extent in private clinics, while poorer households relied more on drug shops and public hospitals. Chronic symptoms also differed. A greater prevalence of musculoskeletal, respiratory, digestive and neurological symptoms was reported among those with lower PPIs. In both slum sites, reliance on the private healthcare market was widespread, but greater in industrialized Tongi. Tongi also experienced a higher probability of catastrophic expenditure than Sylhet.ConclusionsStudy results point to the value of understanding context-specific health-seeking patterns for chronic illness when designing delivery strategies to address the growing burden of NCDs in slum environments. Slums are complex social and geographic entities and cannot be generalized. Priority attention should be focused on developing chronic care services that meet the needs of the working poor in terms of proximity, opening hours, quality, and cost.

Exposure of mobile phones and mass media in maternal health services use in developing nations: evidence from Urban Health Survey 2013 of Bangladesh

ABSTRACT Communications through mobile phones and mass media have shown to be useful for health promotion activities in developing nations. This study explored the potential association of mothers’ mobile phone ownership and mass media exposure on maternal health care services in a developing nation setting: urban Bangladesh. The Urban Health Survey 2013 was examined for antenatal care, delivery assistance, and postnatal care of both mothers and children through multiple regression models, adjusting for sociodemographic factors. Among 8987 ever-married female respondents, 64.1% owned mobile phones and 88% were exposed to mass media (TV, radio or newspaper) at least once a week. Mobile phone ownership was associated with a 48% greater likelihood of access to antenatal care, 34% greater delivery assistance and 31% greater postnatal care of the mother, but no differences were found for postnatal care of children. Similarly, frequent media exposure was associated with increased access to antenatal care (38%) and delivery assistance (46%), but not associated with postnatal care of mothers or children. The results suggested that mobile phones and mass media could be valid avenues for promoting access to maternal health services, and thus, support for mobile phone access and investment in awareness campaigns targeting relevant communities are worthwhile.

Campylobacter infection and household factors are associated with childhood growth in urban Bangladesh: An analysis of the MAL-ED study.

The dual burden of enteric infection and childhood malnutrition continues to be a global health concern and a leading cause of morbidity and death among children. Campylobacter infection, in particular, is highly prevalent in low- and middle-income countries, including Bangladesh. We examined longitudinal data to evaluate the trajectories of change in child growth, and to identify associations with Campylobacter infection and household factors. The study analyzed data from 265 children participating in the MAL-ED Study in Mirpur, Bangladesh. We applied latent growth curve modelling to evaluate the trajectories of change in children’s height, as measured by length-for-age z-score (LAZ), from age 0–24 months. Asymptomatic and symptomatic Campylobacter infections were included as 3- and 6-month lagged time-varying covariates, while household risk factors were included as time-invariant covariates. Maternal height and birth order were positively associated with LAZ at birth. An inverse association was found between increasing age and LAZ. Campylobacter infection prevalence increased with age, with over 70% of children 18–24 months of age testing positive for infection. In the final model, Campylobacter infection in the preceding 3-month interval was negatively associated with LAZ at 12, 15, and 18 months of age; similarly, infection in the preceding 6-month interval was negatively associated with LAZ at 15, 18, and 21 months of age. Duration of antibiotic use and access to treated drinking water were negatively associated with Campylobacter infection, with the strength of the latter effect increasing with children’s age. Campylobacter infection had a significant negative effect on child’s growth and this effect was most powerful between 12 and 21 months. The treatment of drinking water and increased antibiotic use have a positive indirect effect on linear child growth trajectory, acting via their association with Campylobacter infection.

Willingness to pay for oral cholera vaccines in urban Bangladesh.

IntroductionCholera is a highly infectious disease and remains a serious public health burden in Bangladesh. The objective of the study was to measure the private demand for oral cholera vaccines (OCV) in Bangladesh and to investigate the key determinants of this demand, reflected in the household’s willingness to pay (WTP) for oral cholera vaccine.MethodsA contingent valuation method was employed in an urban setting of Bangladesh during December 2015 to January 2016. All respondents (N = 1051) received a description of World Health Organization (WHO) prequalified OCV, Shanchol™. Interviews were conducted with either the head of households or their spouse or a major economic contributor of the households. Respondents were asked about how much at maximum they were willing to pay for OCV for their own and their household members’ protection. Results are presented as the average and median of the reported maximum WTP of the respondents with standard deviations and 95% confidence interval. Natural log-linear regression model was employed to examine the factors influencing participants’ WTP for OCV.ResultsAbout 99% of the respondents expressed WTP for OCV with a maximum mean and median WTP per vaccination (2 doses) of US$ 2.23 and US$ 1.92 respectively. On the household level with an average number of 4.62 members, the estimated mean WTP was US$ 10 (median: US$ 7.69) which represents the perceived demand for OCV of a household to vaccinate against cholera.ConclusionsThe demand of vaccination further indicates that there is a potential scope for recovering a certain portion of the expenditure of immunization program by introducing direct user fees for future cholera vaccination in Bangladesh. Findings from this study will be useful for the policy-makers to make decision on cost-recovery in future oral cholera vaccination programs in Bangladesh and in similar countries.

Challenges of promoting physical activity among school children in urban Bangladesh: A qualitative inquiry.

IntroductionPhysical activity (PA) confers a multitude of health benefits. Unfortunately, Bangladeshi school children get little PA. The current study assessed the barriers to promoting PA from the perspectives of school authorities and parents in urban Bangladesh.Materials and methodsThis study was conducted between January-June 2018 in Dhaka city. Fourteen schools were sampled to represent different school types. We used qualitative methods: 14 key Informant interviews (teachers), six focus group discussions (parents), and 14 observations of school environments. Thematic analysis was performed.ResultsPA was not prioritized at most schools for two primary reasons: 1) there was a general lack of understanding of the importance of PA; and 2) physical education classes did not contribute to grades. Little time and resources were allotted for physical education classes because little priority was given to PA by school authorities. Outside school, lack of adequate safe open spaces undermined access to PA. Further, there were social barriers to PA including lack of parental support due to concerns about tiredness and injury and the perception that PA was detrimental to academic achievement. Many parents chose screen-based activities for children over PA.ConclusionDespite policies that mandate PA, PA lost out to school and parental priorities for academic achievement. Parental concerns about tiredness, injury and safe spaces impeded children’s access to PA outside of school. Steps should be taken to enforce existing policies that mandate effective PA for school children, and parents and teachers should be educated about the need for and benefits of PA.

Analyzing Malnutrition Among Children of Urban Areas in Bangladesh: Penalized Logistic Regression Model

This paper focused on the analysis of malnutrition of the children of Bangladesh urban areas in the presence of multicollinearity among the covariates. The ridge regression has been adopted under binary logistic model for analyzing malnutrition data extracted from Bangladesh Urban Health Survey 2013 (UHS 2013) dataset. The study reveals that city corporation slum area, mother’s age at birth, gender of child, birth order number, age of child, wealth index, mother’s education, access to media, toilet facility at household, taking antenatal care service, and place of delivery of index child have significant impact on the nutritional status of urban children of Bangladesh. Some recommendations have been suggested for policy makers to improve the child health of urban areas in Bangladesh.&#x0D; Dhaka Univ. J. Sci. 68(1): 13-18, 2020 (January)

Disease-specific out-of-pocket healthcare expenditure in urban Bangladesh: A Bayesian analysis.

BackgroundBecause of the rapid increase of non-communicable diseases (NCDs) and high burden of healthcare-related financial issues in Bangladesh, there is a concern that out-of-pocket (OOP) payments related to illnesses may become a major burden on household. It is crucial to understand what are the major illnesses responsible for high OPP at the household level to help policymakers prioritize key areas of actions to protect the household from 100% financial hardship for seeking health care as part of universal health coverage.ObjectivesWe first estimated the costs of illnesses among a population in urban Bangladesh, and then assessed the household financial burden associated with these illnesses.MethodA cross-sectional survey of 1593 randomly selected households was carried out in Bangladesh (urban area of Rajshahi city), in 2011. Catastrophic expenditure was estimated at 40% threshold of household capacity to pay. We employed the Bayesian two-stage hurdle model and Bayesian logistic regression model to estimate age-adjusted average cost and the incidence of household financial catastrophe for each illness, respectively.ResultsOverall, approximately 45% of the population of Bangladesh had at least one episode of illness. The age-sex-adjusted average medical expenses and catastrophic health care expenditure among the households were TK 621 and 8%, respectively. Households spent the highest amount of money 7676.9 on paralysis followed by liver disease (TK 2695.4), injury (TK 2440.0), mental disease (TK 2258.0), and tumor (TK 2231.2). These diseases were also responsible for higher incidence of financial catastrophe. Our study showed that 24% of individuals who suffered typhoid incurred catastrophic expenditure followed by liver disease (12.3%), tumor (12.1%), heart disease (8.4%), injury (7.9%), mental disease (7.9%), cataract (7.1%), and paralysis (6.5%).ConclusionThe study findings suggest that chronic illnesses were responsible for high costs and high catastrophic expenditures in Bangladesh. Effective risk pooling mechanism might reduce household financial burden related to illnesses. Chronic illness related to NCDs is the major cause of OOP. It is also important to consider prioritizing vulnerable population by subsidizing the high health care cost for some of the chronic illnesses.

A public-private model to scale up diabetes mellitus screening among people accessing tuberculosis diagnostics in Dhaka, Bangladesh

BackgroundData are scarce regarding the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients in Bangladesh. This study was undertaken to estimate the number needed to screen (NNS) to identify a case of DM among those with TB symptoms and those with confirmed TB disease, and to identify factors predicting treatment outcomes of TB patients with and without DM. MethodsPersons attending public–private model screening centres in urban Dhaka for the evaluation of TB were offered free blood glucose testing in addition to computer-aided chest X-ray and sputum Xpert MTB/RIF. ResultsAmong 7647 people evaluated for both TB and DM, the NNS was 35 (95% confidence interval (CI) 31–40) to diagnose one new case of DM; among those diagnosed with TB, the NNS was 21 (95% CI 17–29). Among those with diagnosed TB, patients with DM were more likely to have cavitation on chest X-ray compared to those without DM (31% vs 22%). Treatment failure (odds ratio (OR) 18.9, 95% CI 5.43–65.9) and death (OR 2.08, 95% CI 1.11–3.90) were more common among TB patients with DM than among TB patients without DM. DM was the most important predictor of a poor treatment outcome in the classification analysis for TB patients aged 39 years and above. ConclusionsA considerable burden of DM was found among patients accessing TB diagnostics through a public–private model in urban Bangladesh, and DM was associated with advanced TB disease and a high rate of poor treatment outcome.

Social determinants of under-five mortality in urban Bangladesh

Rapid urbanization and persistent health inequity are two significant phenomena in contemporary developing world. Urban population, albeit with more modern facilities and amenities at their proximity, are subject to extreme variation depending on economic abilities and living conditions. This results in disparate health status among population sub-groups. Achieving equity in health and reduction in under-five mortality rate (U5MR) are two important agenda of sustainable development goals (SDGs). Hence this paper examines the trends in socioeconomic differentials of under-five mortality rate in urban Bangladesh for two decades since early 1990s. Data on urban samples of seven Bangladesh Demographic and Health Surveys conducted during 1994–2014 were used. Cross-tabular and Cox’s Proportional Hazard Regression analysis were done. Under-five mortality rate decreased from 91.4/1000 in 1994 to 37.3 in 2014 and was 20% higher in towns than cities. Children of illiterate mothers had 2.5 times higher mortality than those of mothers with 6 + years schooling. Mortality in households with the lowest socioeconomic status (SES) was 2.2 times higher than that of children from highest SES households. Inequality in U5MR at various levels of mother’s education and household SES were observed in seven surveys except for 2014 and 2007. For children with birth order of 2 or below and preceding birth interval of 3 + years, U5MR were found lower than their respective counterparts. Steady linear decline in U5MR with increased household SES and birth order of 2 or below observed among children of mothers with 6 + years education and all education category respectively. No significant sex differential in U5MR was observed. No under five mortality were reported among urban under five children who received all basic vaccination. Reduction in U5MR and its socioeconomic inequality will help Bangladesh to achieve SDG targets. Equity focused policies and programmes complemented with monitoring of progress can be of help.

Inequalities in Utilization of Maternal Reproductive Health Care Services in Urban Bangladesh: A Population-Based Study

This study examined inequalities in the utilization of maternal reproductive health care services in urban Bangladesh. Data of 6,617 urban women were extracted from most recent two rounds of Bangladesh Demographic and Health Survey, conducted in the years 2011 and 2014. Inequalities in the utilization of antenatal checkup, receiving care from a skilled birth attendant, delivery in health care facilities, and postnatal care were investigated through concentration index. Contributions of selected predictors to inequalities were estimated by using the regression-based decomposition method. Noticeable inequalities were observed. Concentration index for utilization of at least one antenatal care visit was 0.09, four or more antenatal visits was 0.17, care from skilled birth attendant was 0.16, delivery care in health care facilities was 0.17, and postnatal care within 2 days of delivery was 0.19. Exposure to mass media, educational status of women and their spouses, wealth status, employment, birth order, and age of pregnancy were significant determinants of inequalities. There was a gradient in the utilization of services when examined across wealth status. Those with unfavorable social determinants of health reported low levels of utilization. Alongside providing tailored health care services to urban poor women, efforts should be made to reduce inequalities in social determinants of health.

Associations between enteric pathogen carriage and height-for-age, weight-for-age and weight-for-height in children under 5 years old in urban Dhaka, Bangladesh.

Nutritional factors and infectious agents may contribute to paediatric growth deficits in low- and middle-income countries; however, the contribution of enteric pathogens is only beginning to be understood. We analysed the stool from children <5 years old from an open cohort, cluster-randomised controlled trial of a point-of-collection water chlorinator in urban Bangladesh. We compared the presence/absence of 15 enteric pathogens detected via multiplex, molecular methods in the stool with concurrent Z-scores/Z-score cut-offs (-2 standard deviations (s.d.)) for height-for-age (HAZ/stunting), weight-for-age (WAZ/underweight) and weight-for-height (WHZ/wasting), adjusted for sociodemographic and trial-related factors, and measured caregiver-reported diarrhoea. Enteric pathogen prevalence in the stool was high (88% had ≥1 enteric pathogen, most commonly Giardia spp. (40%), Salmonella enterica (33%), enterotoxigenic E. coli (28%) and Shigella spp. (27%)) while reported 7-day diarrhoea prevalence was 6%, suggesting high subclinical infection rates. Many children were stunted (26%) or underweight (24%). Adjusted models suggested Giardia spp. detection was associated with lower HAZ (-0.22 s.d., 95% CI -0.44 to 0.00; prevalence ratio for stunting: 1.39, 95% CI 0.94-2.06) and potentially lower WAZ. No pathogens were associated with reported diarrhoea in adjusted models. Giardia spp. carriage may be associated with growth faltering, but not diarrhoea, in this and similar low-income settings. Stool-based enteric pathogen detection provides a direct indication of previous exposure that may be useful as a broader endpoint of trials of environmental interventions.

Poor Settlements in Chittagong city, Bangladesh: The context of Pollution and Health Risk

Background: The rapid rate of urbanization in Bangladesh has created some adverse effects on the overall urban environmental health of the cities. Among all, mass poverty, expansion of poor neighbourhood, inadequate supply of urban services such as water, sanitation, waste disposal etc. are mostly responsible for health risks of urban people particularly in low income areas.&#x0D; Objectives: The aim of this paper is to determine the health risks of the environmentally poor neighbourhoods in Chittagong city by exploring the discourse of pollution, risk, and stigma.&#x0D; Methods: The study is predominantly based on qualitative data collection methods like participant observations, a case study and FGDs. The method has delivered an in-depth understanding of the pollution-related risks, the physical and mental sufferings of the urban poor due to pollution. Though it is solely a qualitative study, the study is complemented by a quantitative survey method and personal interviews.&#x0D; Findings: The study revealed that there are two leading environmental risk factors– the structural setting of the neighbourhood and coping practices to everyday life of the poor settlers, who affect the neighbourhood environment. The poor structured living houses, shared kitchens in the environmentally hazardous area, dirty playgrounds, unhygienic latrines, and waste disposal sites near neighbourhoods enhance the risk of diseases and injuries for inhabitants. Similarly, lack of access to pure drinking water, fuel, are generating health risks. Consequently, dwellers, especially women and children, suffer from cough and cold, diarrhoea, gastric/acidity, worm disease, respiratory illness, scabies, headache, allergy, and jaundice regular interval of time.&#x0D; Conclusion: The study concludes that physical structure of the neighbourhood, and the physical and mental sufferings of its inhabitants are interdependent. To reduce the sufferings of inhabitants and their health hazards can be reduced with the combined efforts of the Government and the NGOs and the local people as well. &#x0D; Implications: This findings of the study can be useful to the concerned authorities of Bangladesh in planning appropriate policies to control pollution and minimize health risks. For that purpose this study can serve as reference.

Risk factors associated with wasting among under-5 children residing in urban areas of Bangladesh: a multilevel modelling approach

The main aim of this study was to uncover the risk factors associated with wasting status of under-5 children residing in urban areas of Bangladesh. For analysis purposes, the necessary information was extracted from the Bangladesh Urban Health Survey (BUHS) 2013. The outcome measure was wasting. Chi-square analysis was performed to assess the association between outcome variables and selected factors. Multilevel logistic regression models with a random intercept at each of the individual and regional levels were considered to identify the risk factors of wasting. A total of 10,511 urban children aged 0 to less than 60 months were included in this study. The overall prevalence of wasting was 17.2%. In the bivariate setup, all the selected covariates except child age were found to be significant for wasting status of children (p < 0.05). According to the two-level logistic regression model, the odds of wasting status of children increase with the age of the child and decrease with the increasing level of mother’s education. Compared to children from poor income families, the odds of being wasted were 18% and 47% lower for children coming from middle and rich income families. Among the domains, the odds of having wasted children was higher in the city-corporation slum compared to the city-corporation non-slum. Mothers receiving ANC services had lower odds of having a wasted child. Moreover, a mother who regularly breastfed her baby had 57% lower odds of having a wasted child, compared to a mother who never breastfed her baby. The prevalence of wasting among under-5 children in Bangladesh is still high, and the risk was examined at various multilevel factors. Therefore, top priority should be given to reducing the rate of wasting as a major public health intervention.

Association of biomass fuel smoke with respiratory symptoms among children under 5 years of age in urban areas: results from Bangladesh Urban Health Survey, 2013

BackgroundLittle is known regarding the effect of exposure to biomass fuel smoke inhalation on respiratory symptoms in the Bangladeshi population which is a major health hazard in most of the developing countries. This study aims to explore the association between respiratory symptoms and biomass fuel smoke exposure among children under 5 years of age.MethodsData were extracted from the Bangladesh Urban Health Survey conducted in 2013. A total of 10,575 mothers with at least one surviving children were selected. Respiratory symptoms among children under 5 years of age were considered as the primary outcome. Sequential multiple logistic regression models were used to observe the association between respiratory symptoms and biomass fuel smoke exposure adjusting the effect of residential factors and mother and child characteristics.ResultsAround 40% of the mothers exclusively used biomass fuel irrespective of the kitchen location and 54% of them were habituated in indoor cooking. The prevalence of respiratory symptoms of under-five children among in-house and outdoor biomass fuel users was 23.0% and 21.9%, respectively. Results of fitted multiple logistic regression models showed that the odds of having respiratory symptoms among children under 5 years of age were increased due to in-house biomass fuel use [OR = 1.18; 95% CI, 1.04–1.36] compared with the non-biomass user. An increased risk of respiratory symptoms was also significantly associated with mother’s birth complication [OR = 1.51; 95% CI, 1.36–1.67], non-government organization (NGO) membership of mothers [OR = 1.32; 95% CI, 1.16–1.51], age of the child (6–23m) [OR = 1.29; 95% CI, 1.10–1.52], and nutritional status (stunting) [OR = 1.18; 95% CI, 1.06–1.31].ConclusionThis study found the use of in-house biomass fuel as a significant risk factor associated with respiratory symptoms of children under 5 years of age. More longitudinal studies should be designed to establish a causal relationship between HAP (household air pollution) and respiratory symptoms among children with more direct measures of HAP and clinical procedure.

Impact evaluation of contracting primary health care services in urban Bangladesh

BackgroundThe Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership. The first phase of the project started in 1998 and the project is currently in its fourth phase covering more urban areas than the first three phases. This study evaluates the impact of the second phase project (UPHCP-II) on health outcomes, mainly child diarrhea, acute respiratory infection, antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections, and HIV/AIDS awareness.MethodsThe effect of the project was estimated through propensity score matching between project and non-project areas comparing baseline and endline surveys over a six-year period from 2006 to 2012. An innovation of this study is the recalibration of the sampling weights that allows the use of these two independent surveys in impact evaluation.ResultsOver the six-year period, UPHCP-II improved the health status of the population in project areas compared to non-project areas. The study found significant improvement in health outcomes in terms of reduced diarrhea and acute respiratory infection in children, which explains the downward trend in child mortality rate. Moreover, the project also improved antenatal care and skilled birth attendance. Contraceptive prevalence and HIV/AIDS awareness and avoidance increased, and sexually transmitted infections decreased.ConclusionsUPHCP-II was effective in achieving its health outcome targets, while previous studies show that it was efficient in the delivery of health care and clients were highly satisfied because health facilities were in close proximity, and doctors and staff were perceived as responsive in delivering high quality of care. The results of this study could help inform future design and implementation of urban health interventions that involve contracting primary health care service delivery in Bangladesh and other similar settings.

Burden of major depressive disorder and quality of life among mothers of children with autism spectrum disorder in urban bangladesh.

This cross-sectional study examined the burden of depression and quality of life (QoL) among mothers of children with autism spectrum disorder (ASD) attending six schools offering special educational services for children with ASD in urban Dhaka, Bangladesh. All consenting mothers were 18 years of age and older and met criteria for major depressive disorder (MDD) on the Structured Interview for DSM-V-TR Research Version-non patient edition administered by trained raters. QoL was assessed by the EuroQol five-dimensional standardized questionnaire. MDD was diagnosed in 45% of mothers and was proportionally higher among those who did not work outside the home, had no childcare support at home, expressed low level of satisfaction with the quality of providers when they had sought care for their children with ASD, and reported being recipient of negative attitudes from neighbors toward their children with ASD. QoL was negatively associated with MDD, mothers' illness, and low satisfaction with the health care providers for children with ASD, as well as experiencing a negative attitude by neighbors toward their children. QoL was positively associated with the reported family monthly income and improvement of the children with ASD on school attendance. The prevalence of MDD among mothers of children with ASD was high and associated with poor QoL. Integrating mental health services and supports for mothers in the ASD care of children is likely to address the high burden of depression they face, and improve their overall quality of life. Autism Res 2020, 13: 284-297. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The levels of depression were assessed among mothers of children with autism spectrum disorder (ASD) attending six schools offering special educational services for children with ASD in urban Dhaka, Bangladesh. Almost one in two mothers was found to have major depression. The quality of life of these mothers was generally poor. Integrating mental health services for mothers with ASD care in children is likely to address the burden of depression among the mothers of children with ASD and improve overall quality of life.

Health-care investments for the urban populations, Bangladesh and India.

ObjectiveTo estimate the costs and mortality reductions of a package of essential health interventions for urban populations in Bangladesh and India.MethodsWe used population data from the countries’ censuses and United Nations Population Division. For causes of mortality in India, we used the Indian Million Death Study. We obtained cost estimates of each intervention from the third edition of Disease control priorities. For estimating the mortality reductions expected with the package, we used the Disease control priorities model. We calculated the benefit–cost ratio for investing in the package, using an analysis based on the Copenhagen Consensus method.FindingsPer urban inhabitant, total costs for the package would be 75.1 United States dollars (US$) in Bangladesh and US$ 105.0 in India. Of this, prevention and treatment of noncommunicable diseases account for US$ 36.5 in Bangladesh and U$ 51.7 in India. The incremental cost per urban inhabitant for all interventions would be US$ 50 in Bangladesh and US$ 75 in India. In 2030, the averted deaths among people younger than 70 years would constitute 30.5% (1027/3362) and 21.2% (828/3913) of the estimated baseline deaths in Bangladesh and India, respectively. The health benefits of investing in the package would return US$ 1.2 per dollar spent in Bangladesh and US$ 1.8 per dollar spent in India.ConclusionInvesting in the package of essential health interventions, which address health-care needs of the growing urban population in Bangladesh and India, seems beneficial and could help the countries to achieve their 2030 sustainable development goals.

Poverty in Urban Bangladesh: Trends, Profiles and Spatial Differences

With rapid urbanisation and concomitant rise in urban poverty, a better understanding of urban poverty and urban income dynamics has become an urgent priority. One in five poor households now live in urban Bangladesh and many more urban households are aspiring to be middle class yet vulnerable to falling back into poverty. Progress in reducing poverty has slowed in urban areas, particularly in larger cities. As a result, there are now more people living in extreme poverty in urban Bangladesh (3.7 million) than in 2010 (3 million). At current rates of urbanisation and poverty reduction, more than half of poor households will live in urban areas by 2030. This paper examines what can be learned about trends and drivers in urban poverty from recent nationally representative surveys. It also analyses additional data sources on the capital city, Dhaka, to shed light on spatial inequality within the city. The paper highlights the need for increased data collection and evidence on urban poverty to inform public policy to address this emerging challenge.