Women In Matlab Research Articles

Betel quid use is associated with anemia among both men and women in Matlab, Bangladesh.

Anemia accounts for 8.8% of total disability burden worldwide. Betel quid use among pregnant women has been found to increase anemia risk. Betel quid is prepared by wrapping the betel (or areca) nut, with spices and other additions, in betel or tobacco leaf and it is chewed or placed in the mouth. We explored the association between betel quid use and anemia among men and non-pregnant women. We collected data from a random sample of women and their husbands in Matlab, Bangladesh. Participants reported their current betel quid use and individual characteristics. We assessed hemoglobin (a biomarker of anemia) with a hemoglobinometer and soluble transferrin receptor (a biomarker of iron deficiency) and C-reactive protein (a biomarker of inflammation) in dried blood spots via enzyme immunoassay. We estimated logistic regression models to evaluate the association between betel quid use and anemia and structural equation models (SEM) to evaluate mediating roles of iron deficiency and elevated inflammation. A total of 1133 participants (390 men and 743 non-pregnant women) were included. After controlling for important confounders, any betel quid use was positively associated with anemia among men (OR: 1.80; 95% CI: 1.12, 2.89). Among women, betel quid use was associated with anemia only among the most frequent users (OR: 1.62; 95% CI: 1.03, 2.53). SEM did not reveal indirect paths through inflammation or iron deficiency. Betel quid use may contribute to the burden of anemia among adults in Bangladesh. Our findings suggest the burden of disease attributed to betel quid use has been underestimated.

Labor migration is associated with lower rates of underweight and higher rates of obesity among left-behind wives in rural Bangladesh: a cross-sectional study

BackgroundAmong Bangladeshi men, international labor migration has increased ten-fold since 1990 and rural to urban labor migration rates have steadily increased. Labor migration of husbands has increased household wealth and redefined women’s roles, which have both positively and negatively impacted the health of wives “left behind”. We examined the direct and indirect effects of husband labor migration on chronic disease indicators and outcomes among wives of labor migrants.MethodsWe collected survey, anthropometric, and biomarker data from a random sample of women in Matlab, Bangladesh, in 2018. We assessed associations between husband’s migration and indicators of adiposity and chronic disease. We used structural equation modeling to assess the direct effect of labor migration on chronic disease, undernutrition, and adiposity, and the mediating roles of income, food security, and proportion of food purchased from the bazaar. Qualitative interviews and participant observation were used to help provide context for the associations we found in our quantitative results.FindingsAmong study participants, 9.0% were underweight, 50.9% were iron deficient, 48.3% were anemic, 39.6% were obese, 27.3% had a waist circumference over 35 in., 33.1% had a high whole-body fat percentage, 32.8% were diabetic, and 32.9% had hypertension. Slightly more women in the sample (55.3%) had a husband who never migrated than had a husband who had ever migrated (44.9%). Of those whose husband had ever migrated, 25.8% had a husband who was a current international migrant. Wives of migrants were less likely to be underweight, and more likely to have indicators of excess adiposity, than wives of non-migrants. Protection against undernutrition was attributable primarily to increased food security among wives of migrants, while increased adiposity was attributable primarily to purchasing a higher proportion of food from the bazaar; however, there was a separate path through income, which qualitative findings suggest may be related to reduced physical activity.ConclusionsLabor migration, and particularly international labor migration, intensifies the nutrition transition in Bangladesh through increasing wealth, changing how foods are purchased, and reducing physical activity, which both decreases risk for undernutrition and increases risk for excess adiposity.

Women's Experiences of Intimate Partner Violence, Economic Coercion, and Depressive Symptoms in Bangladesh

Background: Prior studies of the association between intimate partner violence (IPV) and depressive symptoms have typically excluded economic coercion (EC), a common form of partner violence. We estimated associations of EC and other forms of IPV with depressive symptoms among women in Matlab, Bangladesh. Methods: Data were collected from cross-sectional surveys with married women 15-49 years. We examined relationships of EC, physical/psychological/sexual IPV, and depressive symptoms using structural equation models (SEM). Past-week depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression scale. Lifetime EC was assessed using a bi-dimensional, 36-item scale. Lifetime physical/sexual/psychological IPV was assessed with a 20-item scale. Covariates were age, age at marriage, and schooling; partner’s schooling; and household wealth. Findings: Among 929 women, 82·2% reported any past-week depressive symptoms. Lifetime experience of EC ranged from 41·9% (control over access to work, schooling, and training) to 50·0% (control over use/maintenance of economic resources), while any lifetime physical/psychological/sexual IPV was 89·5%. The standardized association of physical/psychological/sexual IPV with depressive symptoms, adjusted for covariates, was 0·350 (p < 0.0001, R2 = 0·143); when additionally adjusted for two EC measures, the association was attenuated (0.017, p = 0·817). Coercion involving the use and maintenance of economic resources had a significant, adjusted association with depressive symptoms (0·480, p < 0·001, R2 = 0·221). Interpretation: EC is prevalent and attenuates the association of physical/sexual/psychological IPV with depressive symptoms. Addressing EC with other forms of IPV may be necessary to reduce depressive symptoms in exposed women. Funding Statement: This study was supported by research grant 1R21HD093027 (PI Yount) from the Eunice Kennedy Shriver National Institute of Child Health and Development. Declaration of Interests: The authors have no conflicts of interest to report. Ethics Approval Statement: The Institutional Review Boards of Emory University (IRB00097428) and the International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b) (PR17077) reviewed and approved the study protocol.

Randomization inference with general interference and censoring.

Interference occurs between individuals when the treatment (or exposure) of one individual affects the outcome of another individual. Previous work on causal inference methods in the presence of interference has focused on the setting where it is a priori assumed that there is "partial interference," in the sense that individuals can be partitioned into groups wherein there is no interference between individuals in different groups. Bowers et al. (2012, Political Anal, 21, 97-124) and Bowers et al. (2016, Political Anal, 24, 395-403) consider randomization-based inferential methods that allow for more general interference structures in the context of randomized experiments. In this paper, extensions of Bowers et al. that allow for failure time outcomes subject to right censoring are proposed. Permitting right-censored outcomes is challenging because standard randomization-based tests of the null hypothesis of no treatment effect assume that whether an individual is censored does not depend on treatment. The proposed extension of Bowers et al. to allow for censoring entails adapting the method of Wang et al. (2010, Biostatistics, 11, 676-692) for two-sample survival comparisons in the presence of unequal censoring. The methods are examined via simulation studies and utilized to assess the effects of cholera vaccination in an individually randomized trial of 73 000 children and women in Matlab, Bangladesh.

Magnitude and determinants of inadequate third-trimester weight gain in rural Bangladesh.

ObjectivesThe objective of this study was to estimate the magnitude and determinants of inadequate weight gain in the third-trimester among rural women in Matlab, Bangladesh.MethodsThe study analyzed data on weight gain in the third trimester in 1,883 pregnant women in Matlab, Bangladesh. All these women were admitted to Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) for childbirth during 2012–2014, and they had singleton live births at term. Data were retrieved from the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital. A multivariable logistic regression for inadequate weight gain in the third trimester (≤4 kg) was built with sociodemographic, environmental and maternal factors as predictors.ResultsOne thousand and twenty-six (54%) pregnant women had inadequate weight gain in the third trimester. In the multivariable model, short stature turned out to be the most robust risk factor for inadequate weight gain in the third trimester (OR = 2.5; 95% CI 1.8, 3.5 for short compared to tall women). Pre-third-trimester BMI was inversely associated with insufficient weight gain (OR = 0.96; 95% CI 0.93, 0.99 for 1 unit increase in BMI). Other risk factors for inadequate weight gain in the third trimester were advanced age (OR = 1.9; 95% CI 1.2, 3.1 for ≥35 years compared to ≤19 years), parity (OR = 1.5; 95% CI 1.2, 1.9 for multipara compared to nulliparous women), low socioeconomic status (OR = 1.7; 95% CI 1.2, 2.3 for women in the lowest compared to women in the highest wealth quintile), low level of education (OR = 1.6; 95% CI 1.2, 2.1 for ≤5 years compared to ≥10 years of education), belonging to the Hindu religious community (OR = 1.8; 95% CI 1.3, 2.5), consuming arsenic-contaminated water (OR = 1.4; 95% CI 1.1, 1.9), and conceiving during monsoon or dry season compared to summer (OR = 1.4; 95% CI 1.1, 1.8).ConclusionsAmong rural Bangladeshi women in Matlab, third-trimester weight gain was in general poor. Maternal characteristics such as short stature, low BMI, advanced age, parity, low level of education and socioeconomic status, being Hindu, intake of arsenic contaminated water, and conceiving during monsoon or dry season were the risk factors for inadequate weight gain in the third trimester. Special attention should be given during prenatal care to women with the risk factors identified in this study.

Effect of a randomised exclusive breastfeeding counselling intervention nested into the MINIMat prenatal nutrition trial in Bangladesh.

AimIt is unknown whether maternal malnutrition reduces the effect of counselling on exclusive breastfeeding. This study evaluated the effect of breastfeeding counselling on the duration of exclusive breastfeeding, and whether the timing of prenatal food and different micronutrient supplements further prolonged this duration.MethodsPregnant women in Matlab, Bangladesh, were randomised to receive daily food supplements of 600 kcal at nine weeks of gestation or at the standard 20 weeks. They also were allocated to either 30 mg of iron and 400 μg folic acid, or the standard programme 60 mg of iron and folic acid or multiple micronutrients. At 30 weeks of gestation, 3188 women were randomised to receive either eight breastfeeding counselling sessions or the usual health messages.ResultsThe median duration of exclusive breastfeeding was 135 days in the counselling group and 75 days in the usual health message group (p < 0.001). Prenatal supplements did not modify the effects of counselling. Women in the usual health message group who were randomised to multiple micronutrients exclusively breastfed for 12 days longer than mothers receiving the standard iron–folate combination (p = 0.003).ConclusionBreastfeeding counselling increased the duration of exclusive breastfeeding by 60 days. This duration was not influenced by the supplements.

Urinary iodine concentrations of pregnant women in rural Bangladesh: A longitudinal study

Iodine is an essential dietary element required for normal fetal growth and development. We aimed to explore intraindividual and interindividual variations in iodine intake in pregnant women and whether non-dietary factors might influence the intake. Iodine intake was assessed in 271 women, residing in Matlab, rural Bangladesh, by measuring their urinary iodine concentration (UIC) at gestational week (GW) 8, 14, 19, and 30 with inductively coupled plasma mass spectrometry. The women's UIC increased significantly during pregnancy (median 241 (GW8) and 300 μg/l (GW30)). About 6% of the women had insufficient iodine intake (UIC<150 μg/l) and 10% had excessive iodine intake (UIC≥500 μg/l) at all of their four sampling occasions. The women's UIC were dependent on their education, socio-economic status, and BMI, as well as the season of sampling and iodine concentrations in drinking water. Supplementation with a multi-micronutrient capsule, including 150 μg potassium iodine, increased the UIC in women with the lowest UIC (10th percentile) at GW30 but decreased the UIC in women with the highest UIC (90th percentile) at GW30. In conclusion, median UIC throughout pregnancy indicated adequate intake of iodine among pregnant women in Matlab, but, notably, consistently insufficient and excessive intake was also prevalent.

Occurrence and Determinants of Postpartum Maternal Morbidities and Disabilities among Women in Matlab, Bangladesh

The burden of maternal ill-health includes not only the levels of maternal mortality and complications during pregnancy and around the time of delivery but also extends to the standard postpartum period of 42 days with consequences of obstetric complications and poor management at delivery. There is a dearth of reliable data on these postpartum maternal morbidities and disabilities in developing countries, and more research is warranted to investigate these and further strengthen the existing safe motherhood programmes to respond to these conditions. This study aims at identifying the consequences of pregnancy and delivery in the postpartum period, their association with acute obstetric complications, the sociodemographic characteristics of women, mode and place of delivery, nutritional status of the mother, and outcomes of birth. From among women who delivered between 2007 and 2008 in the icddr,b service area in Matlab, we prospectively recruited all women identified with complicated births (n=295); a perinatal mortality (n=182); and caesarean-section delivery without any maternal indication (n=147). A random sample of 538 women with uncomplicated births, who delivered at home or in a facility, was taken as the control. All subjects were clinically examined at 6-9 weeks for postpartum morbidities and disabilities. Postpartum women who had suffered obstetric complications during birth and delivered in a hospital were more likely to suffer from hypertension [adjusted odds ratio (AOR)=3.44; 95% confidence interval (CI)=1.14-10.36], haemorrhoids (AOR=1.73; 95% CI=1.11-3.09), and moderate to severe anaemia (AOR=7.11; 95% CI=2.03-4.88) than women with uncomplicated normal deliveries. Yet, women who had complicated births were less likely to have perineal tears (AOR=0.05; 95% CI=0.02-0.14) and genital prolapse (AOR=0.22; 95% CI=0.06-0.76) than those with uncomplicated normal deliveries. Genital infections were more common amongst women experiencing a perinatal death than those with uncomplicated normal births (AOR=1.92; 95% CI=1.18-3.14). Perineal tears were significantly higher (AOR=3.53; 95% CI=2.32-5.37) among those who had delivery at home than those giving birth in a hospital. Any woman may suffer a postpartum morbidity or disability. The increased likelihood of having hypertension, haemorrhoids, or anaemia among women with obstetric complications at birth needs specific intervention. A higher quality of maternal healthcare services generally might alleviate the suffering from perineal tears and prolapse amongst those with a normal uncomplicated delivery.

Cadmium interacts with the transport of essential micronutrients in the mammary gland—A study in rural Bangladeshi women

Although the concentrations of the toxic metal cadmium in breast milk are generally low (<1 μg/L), experimental studies indicated neurobehavioral and endocrine effects in the suckling offspring. The aim of the present study was to elucidate how cadmium is transported to breast milk by assessing interactions with essential micronutrients. The study is nested into a food and micronutrient supplementation trial conducted among pregnant women in Matlab, a rural area in Bangladesh, where malnutrition is prevalent and the cadmium exposure is relatively high. We measured cadmium in breast milk (BM–Cd; median 0.14 μg/kg; range <0.050–1.0 μg/kg), in erythrocytes (Ery–Cd; median 1.5 μg/kg; range 0.46–4.8 μg/kg) and in urine (U–Cd; median 0.63 μg/L; range 0.050–4.5 μg/L), using inductively coupled plasma mass spectrometry (ICPMS). We found a significant positive association between Ery–Cd and BM–Cd and a breast milk-plasma ratio of ∼3–4, indicating no barrier against cadmium transport from plasma to breast milk. BM–Cd was positively associated with manganese ( r s = 0.56; p < 0.01) and iron ( r s = 0.55; p < 0.01) in breast milk, but not with plasma ferritin. On the other hand, BM–Cd was negatively associated with BM–Ca ( r s = −0.17; p = 0.05), indicating that cadmium inhibits the transport of calcium to breast milk. In conclusion, the present study may indicate that cadmium shares common transporters with iron and manganese for transfer to breast milk, but inhibits secretion of calcium to breast milk.

Effect of Arsenic Exposure during Pregnancy on Infant Development at 7 Months in Rural Matlab, Bangladesh

BackgroundExposure to arsenic-contaminated drinking water during pregnancy is associated with low birth weight and fetal loss, and there is concern that the infants’ development may be affected.ObjectiveWe assessed the effects of in utero arsenic exposure during pregnancy on infants’ problem-solving ability and motor development.MethodsWe conducted a large population-based study of nutritional supplementation with 4,436 pregnant women in Matlab, Bangladesh, an area of high-arsenic–contaminated tube wells. We measured arsenic concentration in spot urine specimens at 8 and 30 weeks of pregnancy. We assessed a subsample of 1,799 infants, born to these mothers, at 7 months of age on two problem-solving tests (PSTs), the motor scale of the Bayley Scales of Infant Development–II, and behavior ratings.ResultArsenic concentrations in maternal urine were high, with a median (interquartile range) of 81 μg/L (37–207 μg/L) at 8 weeks of gestation and of 84 μg/L (42–230 μg/L) at 30 weeks. Arsenic exposure was related to many poor socioeconomic conditions that also correlated with child development measures. Multiple regressions of children’s motor and PST scores and behavior ratings, controlling for socioeconomic background variables, age, and sex, showed no significant effect of urinary arsenic concentration on any developmental outcome.ConclusionWe detected no significant effect of arsenic exposure during pregnancy on infant development. However, it is possible that other effects are as yet unmeasured or that effects will become apparent at a later age.

Nutritional status has marginal influence on the metabolism of inorganic arsenic in pregnant Bangladeshi women.

BackgroundThe interindividual variation in metabolism of inorganic arsenic (iAs), involving methylation via one-carbon metabolism, has been well documented, but the reasons remain unclear.ObjectivesIn this population-based study we aimed to elucidate the effect of nutrition on As methylation among women in Matlab, Bangladesh, where people are chronically exposed to iAs via drinking water.MethodsWe studied effects of macronutrient status using body mass index (BMI) among 442 women in early pregnancy (gestational week 8), and effects of micronutrient status (plasma folate, vitamin B12, zinc, ferritin, and selenium) among 753 women at gestational week 14. Arsenic metabolites in urine were measured by HPLC combined with hydride generation inductively coupled plasma mass spectrometry.ResultsThe median concentration of As in urine was 97 μg/L (range, 5–1,216 μg/L, adjusted by specific gravity). The average proportions of iAs, monomethylarsonic acid, and dimethylarsinic acid in urine in gestational week 8 were 15%, 11%, and 74%, respectively. Thus, the women had efficient As methylation in spite of being poorly nourished (one-third had BMIs < 18.5 kg/m2) and having elevated As exposure, both of which are known to decrease As methylation. The metabolism of iAs was only marginally influenced by micronutrient status, probably because women, especially in pregnancy and with low folate intake, have an efficient betaine-mediated remethylation of homocysteine, which is essential for an efficient As methylation.ConclusionsIn spite of the high As exposure and prevalent malnutrition, overall As methylation in women in early pregnancy was remarkably efficient. The As exposure level had the greatest impact on As methylation among the studied factors.

Mother's perception related to introduction of other foods to infants in Matlab, Bangladesh

Exclusive breastfeeding (BF) for 6 months has been promoted as an ideal way of infant feeding worldwide. In Bangladesh, BF is universal, but exclusive BF is rare as mothers offer pre-lacteal feeds and other foods along with human milk to the infants. Through ethnographic interviews and focus group discussions (FGDs) with mothers of 5–8 month old children, we studied how decisions about introducing other foods were made. We interviewed 27 mothers, 18 key informants and held 3 FGDs with 30 women in Matlab, Bangladesh between December 2004 and February 2005. Interviews were taped and analyzed using ATLAS TI. Mothers described three decision points at which other foods were introduced to the baby. Decision point 1 was pre-lacteal feeding, when people assisting the birth made decisions. Decision point 2 was “playful feeding,” when foods were offered intermittently as a medicine, as a response to infant demand and to develop taste. Decision point 3 was when mothers experienced breast milk inadequacy. Mothers perceived inability to eat, illness and contraceptive use as main reasons for inadequate milk. Thus, mothers did not have complete control over exclusive BF. Moreover, mothers offered food for reasons other than nourishment and in response to external cues like infant crying. To support exclusive BF, mothers and other family members need to be educated not only about the meaning and importance of exclusive BF, but also be taught to expect various external cues and to manage them successfully. (SR was supported by NIH/Fogarty training grant D43 TW001271 to KMR.)

Marital disruption: determinants and consequences on the lives of women in a rural area of Bangladesh.

This study, carried out during the second half of 1995, investigated the predisposing factors leading to marital disruption and its consequences on the lives of women in Matlab, a rural area of Bangladesh. Both qualitative and quantitative methods were used. Data were generated from detailed case studies and quantitative surveys of a small number of maritally-disrupted women. Additional data were used from the ongoing demographic surveillance system of ICDDR,B: Centre for Health and Population Research. The findings revealed that divorced and abandoned women and their children were extremely vulnerable, both socially and economically. Various factors that influence marital disruption were identified, the most important ones being: aspects determining the process of marriage, various family problems due to non-fulfillment of demand for dowry, mutual distrust, extramarital relationships, quality of sexual life, education of women, and other behavioural characteristics of individuals. Level of education of the wife showed an inverse relationship with the risk of divorce. Women who did not have livebirths from their first pregnancy had a higher risk of divorce. The effect of pregnancy outcome was dependent on the level of education of women. Illiterate women with unsuccessful pregnancy outcomes were at the highest risk of being divorced, with the lowest risk for women with some education and a livebirth. The findings clearly indicate the need for broad-based social development programmes for women, especially to enhance their education to reduce their vulnerability to marital instability and its consequences.

Childbearing and Women's Survival: New Evidence from Rural Bangladesh

Effects of childbearing on women's mortality and the implications of family planning programs in reducing these effects are examined in a 20‐year prospective study of more than 2,000 women in Matlab, Bangladesh. Maternal mortality is defined as a death occurring in the six weeks after childbirth. But childbearing may affect women's survival beyond this brief period. Additional hypotheses considered relate to 1) cumulative exposure to childbearing, whether measured by parity or pace of childbearing, 2) age at first birth, and 3) effects beyond the reproductive ages. The results offer no support to cumulative exposure hypotheses, showing no link between parity or pace of childbearing and mortality risk. Instead, we identify an extended period of heightened mortality risk associated with each birth—the year of the birth and the two subsequent years. Family planning programs, by reducing the number of children and therefore a woman's exposure to extended maternal mortality risk, potentially increase survival. Research is needed to identify and address the specific causes of extended maternal mortality risk so that appropriate ameliorative programs may be developed.

Plausible Evidence of Effectiveness of an Iron-Supplementation Programme for Pregnant and Post-Partum Women in Rural Bangladesh

Since 1978 iron and folic acid pills have been distributed, along with other family-planning and health services, to women in Matlab subdistrict, Bangladesh, through fortnightly visits of community health workers. In 1986 the iron dose was set at three pills daily (198 mg of iron) during pregnancy and two pills daily for 6 months post-partum. Haemoglobin concentrations were determined in a representative sample of 218 women who gave birth from June through August 1994 and who were followed prospectively from 0.5 to 9 months post-partum. At 0.5 months post-partum, 88% of women reported that they had taken iron pills on the previous day. The prevalence of anaemia declined from 36% at 0.5 months to 9% at 9 months post-partum, with an overall average prevalence of 23% in this period. To estimate the impact of the programme, these results were compared to anaemia results from representative samples of non-pregnant women in Matlab in 1975 and 1976 and in three other rural communities in Bangladesh in 1996. The estimated reduction in the prevalence of anaemia resulting from the programme ranged from 48% to 70%, and the estimated increase in haemoglobin concentration ranged from 0.9 to 2.1 g/dl. This evidence suggests that the Matlab programme has been highly effective in controlling anaemia.

Contraceptive Use in Matlab, Bangladesh: The Role of Gender Preference

Research in several Asian societies has suggested that sons are generally preferred over daughters. The implications of gender preferences for actual fertility behavior have not been adequately investigated, however. This analysis examines the effect of the sex composition of surviving children on the acceptance and discontinuation of contraception in a sample of 3,145 women in Matlab, Bangladesh, who were observed for 60 months. Hazards regression analyses are employed in the analysis. Strong and highly significant effects of gender preference on contraceptive use are observed. The preference is not monotonically son-biased but is moderated toward a balanced composition, because parents desire to have several sons and at least one daughter. These findings suggest that gender preferences, particularly a preference for sons, represent a significant barrier to fertility regulation in rural Bangladesh.

Nutritional status and age at secondary sterility in rural Bangladesh.

SummaryIn a prospective study of 2324 women in Matlab, Bangladesh, the occurrence of primary and secondary sterility by age groups was examined. The results were related to the nutritional status of the women, as assessed by measurements of height, weight, arm circumference and ponderal index. There is evidence that nutritional status is an important factor in estimated age at sterility, with thinner women experiencing a slightly earlier menopause.