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In this chapter, we review the physical processes that affect the elevation of coastal settlements relative to the sea, and identify current and projected rates of change, describe the impacts of MSLR on coastal settlements and on small island states, provide rough estimates of the number of people exposed, identify options for in situ adaptation, describe common challenges in implementing planned relocations of communities at risk, with case studies from the Carteret Islands and Fiji, and conclude by reviewing the cascading risks faced in Bangladesh.
This study aimed to explore situations where caregivers and patients are likely to collude, from the perspective of caregivers of advanced cancer patients in Bangladesh.
Methods
This study took place in 2 different tertiary care hospitals in Bangladesh. The study design included both quantitative and qualitative components. In this study, we focused on situations in which caregivers choose not to disclose the truth, regardless of their patients’ desire to know it. This may include instances of mutual withholding or cases of deliberate withholding by caregivers, even when patients express a desire to know the truth. While collusion may occur in some instances, not all situations qualify as collusion; nonetheless, all of these situations were broadly considered as collusion-prone. The intensity of enactment was assessed using the “Caregiver Collusion Questionnaire,” and in-depth exploration of collusion-prone situations was conducted through key person interviews with the caregivers.
Results
The intensity of enactment was medium to high among two-thirds (83.1%) of caregivers. This intensity was significantly associated with the caregivers’ relationship with the patients and their intention to disclose the truth (p < 0.01). Higher intensity of enactment has been observed among the children who are tending to their terminally ill parents. Four major themes regarding collusion-prone situation were generated by the qualitative analysis: (1) Reasons for nondisclosure; (2) Time of disclosure; (3) Selective disclosure; and (4) Discloser of truth.
Significance of Results
The nature of collusion-prone situations is shaped by culture and social values. By gradually and indirectly addressing these situations, healthcare professionals can assist families in navigating through difficult conversations and ensure that the patient’s wishes and values are respected.
Animal source foods (ASF) are nutrient-dense and essential for the growth and development of children. The Bangladesh Demographic and Health Survey (BDHS) 2022 reported that approximately two-thirds of children aged 6–23 months consumed eggs/flesh foods. However, overall consumption patterns, trends, and factors influencing ASF intake among children in Bangladesh were not well-documented. Therefore, the study aimed to assess the trends and associated factors of ASF consumption among children aged 6–23 months in Bangladesh. A total of 9401 children were extracted from four consecutive BDHS (2011, 2014, 2017/18, and 2022). The Cochran-Armitage test was conducted to assess the trends in ASF consumption, while a two-stage multilevel mixed-effects logistic regression was performed to identify the associated factors. The consumption of ASF significantly increased to 79.1% in 2017/18 from 67% in 2011 but decreased to 73.3% in 2022. ASF consumption was found to be higher among children whose mothers were educated (AOR = 1.60, 95% CI = 1.30–1.98), employed in either agricultural (AOR = 1.27, 95% CI = 1.04–1.54) or non-agricultural (AOR = 1.36, 95% CI = 1.07–1.72) activities, pregnant (AOR = 2.54, 95% CI = 1.66–3.87), had received ANC 1–3 times (AOR = 1.43, 95% CI = 1.20–1.72) or ≥4 times (AOR = 1.59, 95% CI = 1.29–1.95), and was exposed to media (AOR = 1.21, 95% CI = 1.04–1.39). Furthermore, consumption increased with increasing the age of children, and the wealth of their families. However, children who experienced illness were less likely to consume ASF (AOR = 0.76, 95% CI = 0.68–0.86). The recent declines in ASF consumption emphasize the need for targeted interventions to increase ASF consumption among children in Bangladesh.
Adolescence is a critical period marked by significant physical and psychological changes, yet there is limited understanding of suicidal behaviors among adolescents in Bangladesh. To address this gap, the MeLiSA study utilizing a two-stage stratified cluster sampling approach was conducted to investigate the prevalence and associated factors of suicidal ideation, plans and attempts among adolescents. A total of 1,496 participants were recruited from urban and rural areas, and their socio-demographic characteristics and data on smoking, alcohol use, depression, anxiety and insomnia were obtained. Chi-square and Fisher’s exact tests were used for univariate analyses, followed by multivariable logistic regression to identify factors associated with suicidal behaviors. The findings revealed that 6.8% reported experiencing lifetime suicidal ideation, with 2.3% suicide plans and 0.8% suicide attempts. The 12-month prevalence rates were 3.2% for suicidal ideation, 1.5% for suicide plans and 0.6% for suicide attempts. Smoking emerged as a significant predictor of suicidal ideation, plans and attempts, while alcohol use was strongly linked to past-year suicide attempts. Depression was associated with lifetime suicidal ideation, whereas anxiety significantly influenced both lifetime and past-year suicide plans. These results provide valuable insights that could inform evidence-based interventions and policies to address prevalent mental disorders and suicidal behaviors among adolescents in Bangladesh.
The current study is an attempt to explore under-five child malnutrition in a low-income population setting using the Extended Composite Index of Anthropometric Failure (ECIAF).
Design:
Data from the Bangladesh Demographic and Health Survey 2017–2018 were analysed. Malnutrition using ECIAF was estimated using stunting, wasting underweight and overweight. Multilevel logistic regression models identified factors associated with malnutrition. Geospatial analysis was conducted using R programming.
Setting:
Bangladesh.
Participants:
Children under 5 years of age.
Results:
In Bangladesh, as indicated by the ECIAF, approximately 40·8 % (95 % CI: 39·7, 41·9) of children under five experience malnutrition, whereas about 3·3 % (95 % CI: 2·9, 3·7) were overweight. Children of parents with no formal education (56·3 %, 95 % CI: 50·8, 61·8), underweight mothers (53·4 %, 95 % CI: 50·4, 56·3), belonging to the lowest socio-economic strata (50·6 %, 95 % CI: 48·3, 53·0), residing in rural areas (43·3 %, 95 % CI: 41·9, 44·6) and aged below 3 years (47·7 %, 95 % CI: 45·2, 50·2) demonstrated a greater age- and sex-adjusted prevalence of malnutrition. The Sylhet division (Eastern region) exhibited a higher prevalence of malnutrition (> 55·0 %). Mothers with no formal education (adjusted OR (AOR): 1·51, 95 % CI: 1·08, 2·10), underweight mother (AOR: 1·54, 95 % CI: 1·03, 1·83), poorest socio-economic status (AOR: 2·14, 95 % CI: 1·64, 2·81), children aged 24–35 months (AOR: 2·37, 95 % CI: 1·97, 2·85) and fourth and above birth order children (AOR: 1·41, 95 % CI: 1·16, 1·72) were identified key factors associated with childhood malnutrition while adjusting community- and household-level variations.
Conclusions:
In Bangladesh, two out of five children were malnourished, and one in thirty-five children was overweight. Continuous monitoring of the ECIAF over time would facilitate tracking changes in the prevalence of different forms of malnutrition, helping to plan interventions and assess the effectiveness of interventions aimed at addressing both undernutrition and overweight.
This chapter investigates the impact of anti-sweatshop activism on garment industry employment and the number of firms in Bangladesh following the 2013 Rana Plaza factory disaster. The disaster led to activism that created two major brand-enforced factory fire and safety agreements. The chapter uses a synthetic control methodology to investigate the trade-offs associated with the reaction to the disaster and finds that they led to 33.3 percent fewer garment factories in Bangladesh by 2016 and 28.3 percent fewer people employed in Bangladesh’s garment industry by 2017. Given the importance of the garment industry in Bangladesh’s development in providing a pathway out of extreme property, this finding raises important questions about the efficacy of anti-sweatshop activism.
In 2023, Bangladesh experienced its largest and deadliest outbreak of the Dengue virus (DENV), reporting the highest-ever recorded annual cases and deaths. Historically, most of the cases were recorded in the capital city, Dhaka. We aimed to characterize the geographical transmission of DENV in Bangladesh. From 1 January–31 December 2023, we extracted and analyzed daily data on dengue cases and deaths from the Management Information System of the Ministry of Health and Family Welfare. We performed a generalized linear mixed model to identify the associations between division-wise daily dengue counts and various geographical and meteorological covariates. The number of dengue cases reported in 2023 was 1.3 times higher than the total number recorded in the past 23 years (321,179 vs. 244,246), with twice as many deaths than the total fatalities recorded over the past 23 years (1705 vs. 849). Of the 1,705 deaths in 2023, 67.4% (n = 1,015) died within one day after hospital admission. The divisions southern to Dhaka had a higher dengue incidence/1000 population (2.30 vs. 0.50, p <0.01) than the northern divisions. Festival-related travel along with meteorological factors and urbanization are likely to have contributed to the shift of dengue from Dhaka to different districts in Bangladesh.
We use childhood exposure to disasters as a natural experiment inducing variations in adulthood outcomes. Following the fetal origin hypothesis, we hypothesize that children from households with greater famine exposure will have poorer health outcomes. Employing a unique dataset from Bangladesh, we test this hypothesis for the 1974–75 famine that was largely caused by increased differences between the price of coarse rice and agricultural wages, together with the lack of entitlement to foodgrains for daily wage earners. People from northern regions of Bangladesh were unequally affected by this famine that spanned several months in 1974 and 1975. We find that children surviving the 1974–75 famine have lower health outcomes during their adulthood. Due to the long-lasting effects of such adverse events and their apparent human capital and growth implications, it is important to enact and enforce public policies aimed at ameliorating the immediate harms of such events through helping the poor.
South of 25°N, the rugged, riparian, mixed evergreen forests of eastern Bangladesh mark the western edge of the ranges of the globally Vulnerable Asiatic black bear Ursus thibetanus and sun bear Helarctos malayanus. According to the IUCN Red List, the distribution of bears in Bangladesh is unclear: black bears are described as ‘scattered’ and ‘likely to be very low in number’ and sun bears as ‘vagrants’ entering from the adjoining north-east Indian forests. These statements are not based on any population or habitat assessments, impeding focused research and conservation investment. We compiled recent evidence of bear presence in Bangladesh based on camera trapping, literature reviews and analysis of media reports. From peer-reviewed and grey literature published during 2010–2022 we traced 43 verifiable accounts of black bears in the country. Our camera-trap survey in Rajkandi Reserve Forest produced the first ever evidence of a small population of black bears in north-eastern Bangladesh. Two field studies (in 2016 and 2021) reported camera-trap observations and multiple incidents of poaching of sun bears in Kassalong Reserve Forest and Sangu-Matamuhuri Reserve Forest in south-eastern Bangladesh. Media reports on conflict incidents presented 83 human casualties (80 injured, three dead) and 13 bear casualties (six dead, seven rescued) during 2003–2023. The incidents peaked in the summer (17); 79% were reported during 2018–2023. Cognizant of the fact that the absence of evidence is not evidence of absence, our study calls for systematic conservation measures for both of these bear species in unprotected hill forests in eastern Bangladesh.
The objective of this study was to explore the burden of disasters and adverse health outcomes during and following disasters in Bangladesh.
Methods
We analyzed 6 788 947 respondents’ data from a cross-sectional and nationally representative 2021 Bangladesh Disaster-related Statistics (BDRS). The key explanatory variables were the types of disasters respondents faced, while the outcome variables were the disease burden during and following disasters. Descriptive statistics were used to determine disease burden. A multilevel mixed-effects logistic regression model assessed the association between disease burden and disaster types, along with socio-demographic characteristics of respondents.
Results
Nearly 50% of respondents experienced diseases during disasters, rising to 53.4% afterward. Fever, cough and diarrhea were prevalent during and after disasters, with increases in skin diseases, malnutrition, and asthma post-disaster. Vulnerable groups, such as children aged 0–4, hijra individuals, those with lower education, people with disabilities, and rural residents, especially in Chattogram, Rangpur, and Sylhet divisions, were most affected. Floods, cyclones, thunderstorms, and hailstorms significantly increased disease likelihood during and after disasters.
Conclusions
The study underscores the complex relationship between disasters and health outcomes in Bangladesh, stressing the need for targeted public health interventions, improved health care infrastructure, and evidence-based policies to mitigate disaster-related health risks.
Undernutrition among children under the age of five years is a prevalent global issue, especially in Bangladesh. This study aimed to explore the relationships of household environmental conditions (HECs) with child undernutrition in Bangladesh, with a specific focus on rural–urban variations.
Design:
We analysed children’s data from the 2017/18 Bangladesh Demographic Health Survey. The outcome variable considered were measures of child undernutrition, including stunting, wasting and underweight. The primary exposure variables considered were indicators of HEC. We used a hierarchical multilevel mixed-effect generalized linear models (GLM) modified with a Poisson regression to explore the association between outcomes and exposures, adjusting for potential confounders.
Setting:
Nationally representative cross-sectional survey.
Participants:
8,057 under-5 children.
Results:
The prevalence of stunting, wasting and underweight in Bangladesh was 31%, 8%, and 22%, respectively, with notable urban–rural variations. Under-5 children who lived in houses constructed with unimproved materials (aRR: 1·17), exposed to household air pollution (aPR: 1·37), had unimproved drinking water sources (aPR: 1·28) or had poor handwashing facilities (aPR: 1·24) had a greater likelihood of stunting compared to their counterparts. Similar associations were observed for underweight. The likelihood of stunting and underweight increased with increasing scores of poor HECs, with variations in the effect size across urban–rural areas.
Conclusion:
The high prevalence of stunting and underweight in Bangladesh is linked to poor HECs, therefore, integrated approaches should be adopted to address these environmental factors collectively. Policies and programmes should prioritse enhancing housing quality to achieve sustainable improvements in child nutritional outcomes.
This empirical study examines the potential and the obstacles of transitional justice in addressing the denial of the Rohingya genocide in Myanmar (also known as Burma). It utilizes a qualitative research approach, drawing on relevant scholarship of truth-seeking as a transitional justice mechanism, criminology and international law. Empirical data were collected through in-depth interviews with victims of the Rohingya community and key informants in two separate stages between 2022 and 2023. This study presents an interdisciplinary approach to assess the role of a truth commission – a truth-seeking tool – in confronting Myanmar’s denial of this crime. It suggests that examining amnesties, as well as disarmament, reintegration and rehabilitation programmes for the individual perpetrators within the framework of a truth commission can provide a more nuanced discourse of addressing the decades-long denial of the Rohingya genocide in Myanmar.
This study investigates the stigma against people with mental illness in Bangladesh through in-depth interviews with 14 patients and 9 healthcare professionals, and 33 focus group discussions with people without mental illness. The research has delved into the understanding of different types of stigma against mental illness in the context of Bangladesh. The findings revealed four types of stigma which were categorized into four themes namely self-stigma, public stigma, professional, and institutional stigma. Patients had internalized negative attitudes, thereby discriminated toward themselves. The public discriminated against patients because of believing in prejudices against them. Other health professionals had negative conceptions toward patients, and they devalued mental health professionals (MHPs). A culture of negative attitude and belief had emerged in institutional settings which encouraged discrimination. Policymakers and healthcare professionals can use the findings to develop a mental health service by addressing the stigma. Mental health practitioners can assess the impact of stigma to improve the mental well-being of their patients. Students and workplace staff will benefit from intentional or unintentional discrimination in educational institutions and workplace settings by addressing the effects of stigma. Importantly, other health care providers will be aware of their thoughts against patients and MHPs.
Toxocara vitulorum is one of the deadliest parasite of buffalo calves in Bangladesh. This study was conducted to explore genetic variability within and among the T. vitulorum populations in buffalo calves of Bangladesh. Genomic DNA was extracted, ITS2, COX1 and NAD1 gene were amplified and sequenced. Distinct 29 ITS2, 21 unique NAD1 and 24 COX1 genotypes were detected among the T. vitulorum of different geographic regions. These three gene genotypes similarities ranged from 97 to 99%, when these were compared to best hit scoring T. vitulorum sequences retrieved from GenBank. A total of 12 and 6 unique haplotypes were detected for COX1 and NAD1 gene sequences. The average nucleotide and haplotype diversity for COX1 and NAD1 were 0.0931 & 0.89493 and 0.00658 & 0.77895 respectively and the recorded values were more dispersed than previously published values. The pairwise Nst values ranged from −0.050 to 0.602 and Fst from −0.050 to 0.600 between all the T. vitulorum genotypes indicated huge genetic differentiation which were reportedly higher than other published reports Fst values. This is the first report of T. vitulorum on the basis of COX1 gene in Bangladesh. The study findings will be helpful for further extensive epidemiological studies regarding anthelmintic resistance, control and prevention of T. vitulorum infection in buffalo calves.
Bangladesh is experiencing a rapid increase in hypertension prevalence, particularly in socio-economically disadvantaged communities. The higher use of solid fuel in these communities could be one of the significant factors contributing to this trend, but evidence supporting this hypothesis is limited in Bangladesh. Therefore, this study aims to investigate the associations of household solid fuel use and its exposure level with systolic and diastolic blood pressure (DBP) and hypertension. We analysed 7,320 women’s data from 2017/18 Bangladesh Demographic and Health Survey. We considered three outcome variables: (i) systolic blood pressure (BP) (continuous response), (ii) DBP (continuous response), and (iii) hypertension status (yes, no). Our primary exposures of interest were fuel type (clean vs solid) and the potential level of household air pollution exposure through solid fuel use (unexposed, moderately exposed, and highly exposed). We used a multilevel mixed-effects Poisson regression model with robust variance to determine association between exposure and outcome variables while adjusting for confounders. Of the total respondents analysed, approximately 82% used solid fuel for cooking. The age-standardised prevalence of hypertension was 28%. Respondents using solid fuel were found to be 1.44 times (95% confidence interval [CI], 1.04–1.89) more likely to develop hypertension compared to clean fuel users. Compared to women using clean fuel, the likelihood of hypertension was found to be 1.61 times (95% CI, 1.07–2.20) higher among the moderately exposed group and 1.80 times (95% CI, 1.27–2.32) higher among the highly exposed group. Similar associations were reported for systolic and DBP. The use of solid fuel increases the risk of becoming hypertensive and elevates systolic and DBP. Policies and programmes are necessary to increase awareness of the adverse effects of solid fuel use on health, including hypertension. Efforts should be made to reduce solid fuel use and ensure proper ventilation systems in households where solid fuel is used.
The Muslims of South Asia are more than five hundred million people, distributed between Pakistan, India, and Bangladesh, and there are more Muslims in South Asia than in any other region in the world. After Indonesia, which is the largest Muslim country in the world, India, Pakistan, and Bangladesh are the second, third, and fourth largest Muslim countries, respectively. Although the prevalent approach in the study of Islam is to consider its so-called Arab character as central, the Muslims in pre-Partition India constituted the largest body of Muslims in the world, and the vast political and intellectual influence exerted by South Asian Muslims on the wider Muslim world is often neglected. Many of the most important political, intellectual, and spiritual developments within Islam have had their origins, or have flourished, in South Asia, and Muslims from the region have played important roles in the global history of Islam, including during the colonial period, in resistance to colonial rule, and in intellectual responses to and dialogue with Western thought. Pakistan was specifically created to provide a homeland for South Asia’s Muslim population and its trials and tribulations over the past seventy-five years have been carefully watched by Muslims and non-Muslims alike. Muslims constitute India’s largest minority, with an often uneasy—to say the least—relationship to the majority. In the context of the three books under discussion, I explore issues, such as secularism, modernity, and religion, and their impacts on the conception of the nation-state that was promoted during the nineteenth and twentieth centuries as an expression of political modernity.
Suicidal behaviours among students pose a significant public health concern, with mental health problems being well-established risk factors. However, the association between food insecurity (FIS) and suicidal behaviours remains understudied, particularly in Bangladesh. This study aimed to investigate the relationship between FIS and suicidal behaviours among Bangladeshi university students.
Design:
A cross-sectional survey using convenience sampling was conducted between August 2022 and September 2022. Information related to socio-demographics, mental health problems, FIS and related events and suicidal behaviours were collected. Chi-squared tests and multivariable logistic regression models, both unadjusted and adjusted, were employed to examine the relationship between FIS and suicidal behaviour.
Setting:
Six public universities in Bangladesh.
Participants:
This study included 1480 students from diverse academic disciplines.
Results:
A substantial proportion of respondents experienced FIS, with 75·5 % reporting low or very low food security. Students experiencing FIS had a significantly higher prevalence of suicidal ideation, plans and attempts compared with food-secure students (18·6 % v. 2·8 %, 8·7 % v. 0·8 % and 5·4 % v. 0·3 %, respectively; all P < 0·001). In addition, students who have personal debt and participate in food assistance programmes had a higher risk of suicidal behaviours.
Conclusions:
This study highlights the association between FIS and suicidal behaviours among university students. Targeted mental health screening, evaluation and interventions within universities may be crucial for addressing the needs of high-risk students facing FIS.
Indigenous people worldwide are at increased risk of mental health problems compared with non-Indigenous people. Longstanding impacts of colonisation, systematic exclusion from rights and subsequent discrimination, and lack of access to quality education and healthcare, including mental healthcare, have been identified as contributory factors to these disproportionate mental health problems. With limited access, Indigenous people are less likely to seek healthcare, owing to the insufficient number of healthcare professionals representing Indigenous communities. In the face of growing numbers of mental health problems in Indigenous people in Bangladesh, this paper sheds light on the inadequate number of mental health professionals, particularly from Indigenous communities, and the potential impacts of this on the well-being of Indigenous people, and considers ways to increase representation of Indigenous mental health professionals. The aim is to ensure that the mental health system in Bangladesh is inclusive and embraces the country's diversity.
This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports.
Methods
In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters.
Results
Significant within-group improvements in BFSIE were observed for distres (−.48, p = .014), functional impairment (−.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = −.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons.
Discussion
Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.
This study explores Bangladesh’s mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it’s mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.