Shaki Aktar

Access to comprehensive emergency obstetric care, particularly caesarean section (CS), is key to reducing maternal and neonatal mortality and to achieving Sustainable Development Goal 3 (SDG3) [1–4...

Sexual and Reproductive Health and Rights (SRHR) aim to enhance quality of life through safe sexual experiences, reproductive autonomy, and protection against gender-based violence. However, existing SRHR research and interventions in low- and middle-income countries like Bangladesh predominantly focus on women, often understating men and neglecting the nuanced contextual issues faced by married couples. This study contributes to filling this gap by examining SRHR dynamics among newlyweds in rural and poor urban areas of Bangladesh, especially focusing on marital satisfaction, fertility preferences, and post-marriage adaptation mechanisms. Employing a prospective cohort design across four Health and Demographic Surveillance Systems (HDSS) managed by icddr,b, the study spans from November 2021 to March 2025, with data collection starting in December 2022. Of the 2011 newlywed couples identified, 666 who met eligibility criteria (married for ≤6 months, first marriage, and no pregnancy history) were enrolled. Participants will undergo six quantitative interview sessions over a two-year period. Additionally, 44 in-depth qualitative interviews were conducted with 22 purposefully selected couples. Demographic data reveal that a significant proportion of husbands (67.3% in rural areas, 71.8% in poor urban areas) are aged 20–29 years, while a majority of wives (67.9% in rural areas, 84.8% in poor urban areas) are adolescents. Education levels varied, with a higher proportion of poor urban husbands lack formal education compared to their rural counterparts (7.2% vs. 3.0%), while no significant variation was observed among wives (0.6% vs 1.0%). Arranged marriages are more common among rural couples (80%) compared to those in poor urban areas (50%). Moreover, poor urban participants tend to marry at a younger age than the rural participants, with poor urban wives marrying earlier than rural wives (60.4% vs 39.7%). This pioneering study provides valuable insights into the SRHR needs of newlywed couples in Bangladesh. The findings will be instrumental for designing targeted interventions aimed at improving SRHR service utilization and enhancing overall well-being, particularly in rural and poor urban areas of the country.

Post-term birth is birth at a gestation of ≥42 weeks [1–3]. It has been associated with increased perinatal morbidity and mortality [4–7]. The estimated global prevalence of post-term births ranges from 1–10% of all deliveries [8–10]. The occurrence differs within and between countries [11], partly depending on assessments by reported last menstrual period (LMP) dates […]

Worldwide, nearly one-third of an estimated 210 million pregnancies occurring each year are unplanned, with some resulting in unwanted births and others being terminated through induced abortions [1,2]. In countries with restrictive abortion laws or with inadequate or poor-quality abortion services, women turn to unqualified providers, risking serious health issues or death [3]. Despite being […]

Chewing betel quid (BQ) - a preparation commonly containing areca nut and slaked lime wrapped in betel leaf - is entrenched in South Asia. Although BQ consumption during pregnancy has been linked to adverse birth outcomes, its effect on postnatal growth remains largely unexplored. We examined the associations of BQ use during pregnancy with children's height-for-age and body mass index-for-age z-scores (HAZ and BAZ, respectively) and fat and fat-free mass along with sex-based differences in association in rural Bangladesh. With a prospective cohort design, we assessed BQ use among mothers enrolled in the Preterm and Stillbirth Study, Matlab (n = 3140) with a structured questionnaire around early third trimester. Children born to a subset of 614 women (including 134 daily users) were invited to follow-up between October 2021 and January 2022. HAZ and BAZ were calculated from anthropometric assessment, and fat and fat-free mass were estimated using bioelectric impedance. Overall and sex-specific multiple linear regression models were fitted. Growth data were available for 501 children (mean age 4.9 years): 43.3% of them were born to non-users, 35.3% to those using prior to or less-than-daily during the survey, and 21.3% to daily users. No statistically significant associations were observed after adjusting for sex, parity, maternal height and education, and household wealth. There was no effect of BQ use during pregnancy on postnatal growth in this study. Longitudinal studies following up those born to heavy users beyond childhood are warranted for capturing long-term implications of prenatal BQ exposure.

Preterm birth (PTB) is the leading cause of death in children under five, yet comprehensive studies are hindered by its multiple complex etiologies. Epidemiological associations between PTB and maternal characteristics have been previously described. This work used multiomic profiling and multivariate modeling to investigate the biological signatures of these characteristics. Maternal covariates were collected during pregnancy from 13,841 pregnant women across five sites. Plasma samples from 231 participants were analyzed to generate proteomic, metabolomic, and lipidomic datasets. Machine learning models showed robust performance for the prediction of PTB (AUROC = 0.70), time-to-delivery ( r = 0.65), maternal age ( r = 0.59), gravidity ( r = 0.56), and BMI ( r = 0.81). Time-to-delivery biological correlates included fetal-associated proteins (e.g., ALPP, AFP, and PGF) and immune proteins (e.g., PD-L1, CCL28, and LIFR). Maternal age negatively correlated with collagen COL9A1, gravidity with endothelial NOS and inflammatory chemokine CXCL13, and BMI with leptin and structural protein FABP4. These results provide an integrated view of epidemiological factors associated with PTB and identify biological signatures of clinical covariates affecting this disease.

Background: The emergence of Drug-Resistant Tuberculosis (DR-TB) has become a major threat globally and Bangladesh is no exception. Delays in healthcare seeking, proper diagnosis and initiation of treatment cause continuous transmission of the resistant tubercule bacilli through the communities. This study aimed to assess the different health care-seeking behaviors and delays among DR-TB patients in Bangladesh. Method: A prospective cross-sectional study was conducted from November to December 2018, among 92 culture positive and registered DR-TB patients in four selected hospitals in Bangladesh. Data were collected through face-to-face interviews with survey questionnaire as well as record reviews. Result: Among the 92 study participants, the median patient delay was 7 (IQR 3, 15) days, the median diagnostic delay was 88 (IQR 36.5, 210), the median treatment delay was 7 (IQR 4,12) days, and the median total delay among DR-TB patients was 108.5 (IQR 57.5, 238) days. 81.32% sought initial care from informal healthcare providers. The majority (68.48%) of the informal healthcare providers were drug sellers while 60.87% of patients sought care from more than four healthcare points before being diagnosed with DR-TB. The initial care seeking from multiple providers was associated with diagnostic and total delays. Conclusion: In Bangladesh, DR-TB cases usually seek care from multiple providers, particularly from informal providers, and among them, alarmingly higher healthcare-seeking related delays were noted. Immediate measures should be taken both at the health system levels and, in the community, to curb transmission and reduce the burden of the disease.