Karar Zunaid Ahsan

Background: Equity in health service utilization refers to equal treatment for equal health needs, regardless of socioeconomic status. In low- and middle-income countries, inequity in maternal health service use remains a pressing issue in the pursuit of universal health coverage by 2030. This study examines whether socioeconomic equity in the use of key maternal health services—antenatal care (ANC) from a medically trained provider, facility delivery, and management of complications—improved faster in districts with high facility readiness than elsewhere in Bangladesh between 2001 and 2016. Methods and findings: We analyzed data from three rounds of the Bangladesh Maternal Mortality and Health Care Survey and corresponding Bangladesh Health Facility Survey rounds. These datasets were linked at the district level and pooled for the years 2001, 2010, and 2016. Using an adaptation of the Difference-in-Differences (DID) model based on linear probability models, we estimated whether poor-nonpoor gaps in maternal health service utilization changed differently over time in districts with high facility readiness than in districts with lower readiness. Bangladesh achieved substantial improvements in overall maternal health service use during the study period. However, these gains were not equitably distributed. Socioeconomic equity improved modestly for ANC and complication management but worsened significantly for facility deliveries. The gap between nonpoor and poor women widened more in high facility readiness districts than in low readiness districts (p < 0.05). Additionally, equity in ANC use improved among women living within one hour of a private facility (p < 0.05). Conclusions: This is the first systematic investigation of the role of facility readiness in maternal health equity in Bangladesh using nationally representative data. Despite overall progress, persistent and, in some cases, widening socioeconomic inequities were observed—especially in facility-based delivery. These findings highlight the need for targeted policy action to ensure that improvements in service readiness translate into more equitable maternal healthcare access and outcomes.

This study examines whether higher maternity cash incentives under Nepal’s Aama Program —intended to reduce household out-of-pocket (OOP) expenditures for delivery care—are associated with completion of the continuum of maternity care across Nepal’s three ecological regions: mountainous, hilly, and Terai . A difference-in-differences (DID) analysis was conducted using data from the Nepal Demographic and Health Surveys 2011 and 2022. The treatment group included mountainous and hilly districts (n = 55), which received higher cash incentives for facility deliveries, while the control group comprised Terai districts (n = 20). The primary outcome was a binary ‘continuum of care’ indicator, coded as 1 if a woman received 4 or more antenatal care (ANC) visits, at least 1 ANC from a skilled provider, and skilled birth attendance (SBA) during delivery, and 0 otherwise. From 2011 to 2022, continuum-of-care coverage increased from 16.2% to 46.3% in treatment districts and from 18.9% to 42.4% in control districts, yielding an unadjusted DID of 6.7 percentage points. The regression DID analysis found that the higher cash incentive in hilly and mountainous regions was associated with a statistically significant 0.7 percentage point increase in the likelihood of completing the continuum of maternity care ( P = .014). While statistically significant, the magnitude is modest, indicating incremental improvement rather than a transformational shift in service utilization. Mother’s age, mother’s education, and husband’s education were positively associated with completion, whereas poverty, rural residence, and higher parity were negatively associated (all P < .001). These findings suggest that targeted financial incentives can positively influence maternal health service utilization, but achieving larger improvements will likely require refining the program and addressing non-financial barriers. Limitations include the two-period DID design, reliance on parallel trends, and potential residual confounding.

The United States government’s (USG) commitment to improving the overall health and well-being of women and children has been instrumental in improving coverage and quality of essential health services in low- and middle-income countries (LMICs) [1]. Through deploying robust funding from the American people, the USG – including the United States Agency for International Development […]

As calls for improved menstrual health management have gained momentum in sociopolitical contexts, period poverty and menstrual equity have gradually been established and recognized in the discipline of public health. These conversations typically take place in the context of low- and middle-income countries (LMICs) where donor-sponsored projects are already underway. Nevertheless, research on period poverty in high-income countries (HICs) is seldom performed. In addition, current literature on the topic tends to generalize HICs and LMICs, thereby ignoring crucial cultural and socioeconomic distinctions that necessitate a more detailed comparison of individual countries facing period poverty. This case examines the current body of research on period poverty in the United States and India, and compares the causes, effects, and approaches toward ameliorating this phenomenon. Through performing a scoping review of the current literature on period poverty, this case illustrates that—as opposed to the breadth of research available on period poverty in LMICs—research on period poverty in HICs is underrepresented. In addition, the findings demonstrate a stunning parallel between the contributing factors of period poverty in India and the United States, suggesting that the current approach to isolate conversations on the topic based on regional economic incongruencies is inappropriate. Finally, this case identifies dismantling the stigmatization of periods, investing in water or hygiene infrastructure, promoting the economic mobilization of females, and reforming menstrual health curricula in schools as essential to ending period poverty.

Globally, nearly 300 000 mothers die from preventable causes related to pregnancy and childbirth, of which 94% occur in low-income and lower-middle-income countries [1]. Improving maternal health by increasing coverage of reproductive health services and reducing maternal morbidity, as well as mortality, has long been a priority within the global development agenda. Indicators of maternal mortality […]

Background: Since March 2020, the coronavirus disease 2019 (COVID-19) pandemic has been a major shock to health systems across the world. We examined national usage patterns for selected basic, essential health services, before and during the COVID-19 pandemic in Uganda and Bangladesh, to determine whether COVID-19 affected reporting of service utilization and the use of health services in each country.Methods: We used routine health information system data since January 2017 to analyze reporting and service utilization patterns for a variety of health services. Using time series models to replicate pre-COVID-19 trajectories over time we estimated what levels would have been observed if COVID-19 had not occurred during the pandemic months, starting in March 2020. The difference between the observed and predicted levels is the COVID-19 effect on health services.Results: The time trend models for Uganda and Bangladesh closely replicated the levels and trajectories of service utilization during the 38 months prior to the COVID-19 pandemic. Our results indicate that COVID-19 had severe effects across all services, particularly during the first months of the pandemic, but COVID-19 impacts on health services and subsequent recovery varied by service type. In general, recovery to expected levels was slow and incomplete across the most affected services.Conclusion: Our analytical approach based on national information system data could be very useful as a form of surveillance for health services disruptions from any cause leading to rapid responses from health service managers and policymakers.

Background: Malnutrition imposes enormous costs resulting from lost investments in human capital and increased healthcare expenditures. There is a dearth of research focusing on the prediction of women’s body mass index (BMI) and malnutrition outcomes (underweight, overweight, and obesity) in developing countries. This paper attempts to fill out this knowledge gap by predicting the BMI and the risks of malnutrition outcomes for Bangladeshi women of childbearing age from their economic, health, and demographic features.Methods: Data from the 2017–18 Bangladesh Demographic and Health Survey and a series of supervised machine learning (SML) techniques are used. Additionally, this study circumvents the imbalanced distribution problem in obesity classification by utilizing an oversampling approach.Results: Study findings demonstrate that the support vector machine and k-nearest neighbor are the two best-performing methods in BMI prediction based on the coefficient of determination (R2), root mean square error (RMSE), and mean absolute error (MAE). The combined predictor algorithms consistently yield top specificity, Cohen’s kappa, F1-score, and AUC in classifying the malnutrition status, and their performance is robust to alternative standards. The feature importance ranking based on several nonparametric and combined predictors indicates that socioeconomic status, women’s age, and breastfeeding status are the most important features in predicting women’s nutritional outcomes. Furthermore, the conditional inference trees corroborate that those three features, along with the partner’s educational attainment and employment status, significantly predict malnutrition risks.Conclusion: To the best of our knowledge, this is the first study that predicts BMI and one of the pioneer studies to classify all three malnutrition outcomes for women of childbearing age in Bangladesh, let alone in any lower-middle income country, using SML techniques. Moreover, in the context of Bangladesh, this paper is the first to identify and rank features that are critical in predicting nutritional outcomes using several feature selection algorithms. The estimators from this study predict the outcomes of interest most accurately and efficiently compared to other existing studies in the relevant literature. Therefore, study findings can aid policymakers in designing policy and programmatic approaches to address the double burden of malnutrition among Bangladeshi women, thereby reducing the country’s economic burden.

Background: Diabetes, one of the major metabolic disorders, is rising in Bangladesh. Studies indicate there is inequality in prevalence and care-seeking behavior, which requires further exploration to understand the socioeconomic disparities in the pathophysiology of diabetes. This study examined the latest nationally representative estimates of diabetes prevalence, awareness, and management among adults aged 18 years and above in Bangladesh and its association with socioeconomic status in 2017–18. Methods: We used the 2017–18 Bangladesh Demographic and Health Survey data. Diabetic status of 12,092 adults aged 18 years and above was measured in the survey using fasting plasma glucose levels. We applied multivariate logistic regressions to examine the role of socioeconomic status on diabetes prevalence, awareness, and management, after controlling for relevant covariates. Results: Overall, 10% of adults had diabetes in Bangladesh in 2017–18, with the highest prevalence of 16% in the age group 55−64 years. Our analyses found statistically significant disparities by socioeconomic status in the prevalence of diabetes as well as the person’s awareness of his/her diabetic condition. However, the effect of socioeconomic status on receiving anti-diabetic medication only approached significance (p = 0.07), and we found no significant association between socioeconomic status and control of diabetes. Conclusions: We expect to see an ‘accumulation’ of the number of people with diabetes to continue in the coming years. The rising prevalence of diabetes is only the tip of an iceberg; a large number of people with uncontrolled diabetes and a lack of awareness of their condition will lead to increased morbidity and mortality, and that could be the real threat. Immediate measures to increase screening coverage and exploration of poor control of diabetes are required to mitigate the situation.