Anisuddin Ahmed

Background: Premature (<40 years) or early (40–44 years) menopause is associated with increased risks of cardiovascular disease, osteoporosis and premature mortality. Low- and middle-income countries (LMICs) appear to have a higher prevalence, although multicountry comparative data are scarce. Therefore, this study aimed to estimate the pooled prevalence and determinants of premature or early menopause among women aged 30–49 years in 44 LMICs. Methods: The most recent round of Demographic and Health Surveys from 44 countries conducted since 2015 was pooled together, accounting for 716 648 women aged 30–49. Premature or early menopause was defined as cessation of menstruation for ≥6 months, self-reported menopause or hysterectomy before age 45. We calculated pooled weighted prevalence with 95% CIs and used multivariable logistic regression to identify associated factors, accounting for complex survey design. Results: The pooled prevalence of premature or early menopause was 7.1% (95% CI 7.0% to 7.2%). Country-level prevalence ranged from 2.3% in Jordan and 2.6% in Gabon to 12% in Ethiopia and 11.5% in Indonesia. Prevalence was consistently higher in rural than urban areas across all regions, with South Asia and East Asia and Pacific showing the highest regional burden. In multivariable analysis, higher education, employment, marriage at age 18 years or older, first birth at age 18 years or older and parity of three or more children were associated with lower odds of early menopause. Conversely, middle wealth index and rural residence were associated with increased odds of premature or early menopause. Conclusion: Premature or early menopause affects 1 in 14 women aged 30–49 in LMICs, with marked rural disadvantage and strong protective effects of education and delayed childbearing. Findings underscore the urgent need to integrate menopause into reproductive health and non-communicable disease programmes, particularly targeting rural areas and addressing social determinants, including girls’ education and delayed marriage.

Background: Despite progress in reducing global maternal mortality in recent decades, low- and lower-middle-income countries (LLMICs) continue to face major challenges. To reduce preventable maternal deaths, the WHO recommends emergency obstetric care (EmOC) in health facilities (HFs). However, up-to-date multi-country evidence on availability and readiness in LLMICs remains very limited. Hence, we analysed EmOC service availability and readiness in HFs across eight LLMICs. Methods: We did a multi-country facility-based analysis of data from nationally representative Service Provision Assessment (SPA) surveys conducted between 2014 and 2022 in eight LLMICs (Afghanistan, Bangladesh, Democratic Republic of the Congo, Ethiopia, Haiti, Nepal, Senegal and Tanzania). A total of 4,382 facilities offering normal delivery services were included in the analysis. Service availability was assessed using seven signal functions for basic EmOC (BEmOC) with an additional two for comprehensive EmOC (CEmOC). The readiness score was calculated across three equally weighted domains—staff training and guidelines, essential equipment and supplies and essential medicines, resulting in a total score of 100. Descriptive statistics and multivariable regression were used to analyse the data. Results: The average availability of BEmOC services was 13%, ranging from 2% in Nepal to 47% in Ethiopia. For CEmOC, average availability was 5%, ranging from 2% in Nepal to 19% in Afghanistan. Among facilities providing caesarean delivery services, 11% lacked blood transfusion services on average—this was highest in Bangladesh (20%), followed by Tanzania (12%) and Afghanistan (11%). Overall, the mean EmOC readiness score was 47, ranging from 40 in Tanzania to 60 in Ethiopia. Conclusion: The availability of BEmOC and CEmOC services and the related readiness of HFs were low. This study reveals critical gaps in selected LLMICs, including where facilities perform caesarean deliveries without having blood transfusion services. If not addressed, these gaps will limit the contribution of EmOC to reducing maternal mortality in LLMICs.

The term ‘pregnancy loss’ is defined by intrauterine foetal demise before the viable age of gestation [1], which can range from 20 to 28 weeks of pregnancy, depending on geographical region [2]. It can bring significant physical, psychological, and financial burden to the woman, regardless of whether it is unintentional (miscarriage/spontaneous abortion) or intentional (induced […]

The World Health Organization (WHO) defines a stillbirth as the death of a baby occurring at or after 28 weeks of gestation but before or during delivery [1]. According to the United Nations Inter-agency Group for Child Mortality Estimation, approximately 1.9 million stillbirths occurred globally in 2021 – equivalent to 14 stillbirths per 1000 […]

BACKGROUND Bangladeshi adolescents, who constitute a fifth of the country's population, experience barriers in accessing sexual and reproductive health (SRH) information. Previous studies have shown that mobile health (mHealth) interventions provide adolescents with timely access to evidence-based curricula, gamified, and interactive content, sessions, and information. The widespread adoption of mHealth technologies among adolescents and their willingness to embrace emerging technologies are encouraging specialists to employ mHealth approaches to share health information. Despite the high mobile phone usage among adolescents in Bangladesh, there are a few mHealth interventions specifically targeting their SRH needs. OBJECTIVE We aimed to assess changes in SRH knowledge and awareness among adolescents in Bangladesh following exposure to "Mukhorito", an interactive mobile app-based intervention. METHODS This pilot study employing a pre-post non-randomized experimental approach was conducted in three selected secondary schools in Feni, Bangladesh, from June 2023 to March 2024. 46 students from class 9 across the three schools were recruited, with a minimum of 10 per school. Bivariate analyses were performed to assess the association between SRH knowledge and awareness scores with other covariates. Significantly associated covariates for both scores were used in building the adjusted linear regression models. RESULTS The adjusted models indicated a significant improvement in the end-line group compared with the baseline group for both knowledge (1.2 units; 95% CI: 0.8-1.6 units) and awareness scores (1.0 units; 95% CI: 0.3-1.5 units), indicating a high level of intervention effect. CONCLUSIONS These findings demonstrate the potential of mobile app-based innovations to improve adolescent SRH education within a national program in resource-constrained settings, specially where conventional methods may be less effective.

In Bangladesh, the rate of caesarean sections (c-sections) has risen sharply in recent years, rising from 41.4% in 2022 to 50.7% in 2023 according to the Bangladesh Sample Vital Statistics 2023 report [1]. This rise is alarming, as in 2018, a study found that 77% of all c-sections in the country were medically unnecessary […]

Premature delivery and low birthweight (LBW) are major global health challenges, significantly impacting neonatal mortality and long-term health outcomes. Despite the worldwide prevalence of preterm and LBW births decreasing every year, approximately 13 million neonates are born prematurely (<37 weeks of gestation), and over 20 million neonates are born with LBW (<2500 g) [1,2]. […]

Background: Kangaroo Mother Care (KMC) is a cornerstone of neonatal thermal care for preterm and low birthweight neonates, yet sustained implementation is often constrained in low-resource settings. Limited evidence exists on how biomedical warming technologies are used in everyday practice alongside KMC. This study aims to explore how caregivers and healthcare providers experienced and adapted neonatal thermal care between KMC and the Thermal Jacket under health system constraints.Methods: We conducted an exploratory qualitative study in three district hospitals in Bangladesh between August 2024 and June 2025. Data were collected through 30 In-Depth Interviews with caregivers, three Focus Group Discussions with nurses, and 12 Key Informant Interviews with clinicians, managers, and policymakers. Data were analysed inductively using thematic network analysis.Findings: Caregivers and healthcare providers adapted the Thermal Jacket alongside KMC to maintain neonatal thermal care despite practical constraints, including maternal physical limitations and health system challenges. Mothers felt maintaining warmth was a moral responsibility central to good parenthood and simultaneously exercised agency by making situational decisions about when and how to use KMC or the Thermal Jacket in family and institutional settings. At the system level, effective adaptation of the Thermal Jacket depended on its integration into existing KMC guidelines, training, infrastructure, and supply systems. While the Thermal Jacket maintained warmth, some caregivers and providers expressed unease, highlighting concern about an emotional detachment and a reduced ability to recognise early signs of neonatal distress.Interpretation: This study demonstrates that biomedical supplementation to KMC is adapted through everyday practice rather than implemented as a fixed protocol. Clinical priorities, caregiving expectations, and contextual conditions interplayed in navigating the use of the Thermal Jacket and KMC to support continuity of neonatal thermal care. However, successful scale-up requires governance solutions to strengthen neonatal care in resource-constrained settings.

Effective vital registration systems are either incomplete or unavailable in most low- and middle-income countries, making it difficult to accurately provide information on deaths [1–4]. Civil registration refers to the systematic, comprehensive, enduring, and mandatory documentation of vital events within a nation’s population, in accordance with its legal framework [5]. The United Nations has identified […]