Hassan Rushekh Mahmood

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 […]

Background: Adolescents in Bangladesh, approximately one-fifth of the total population, face significant challenges accessing relevant sexual and reproductive health (SRH) information, with the added burdens of cultural taboo, limited accessibility, and poor communication channels. Traditional adolescent-friendly approaches have shown limited effectiveness in addressing these challenges. In response, Mukhorito was developed as a peer-led, mobile-based digital platform to facilitate SRH, education, and communication among ninth-grade students. Objective: This study explored the feasibility and constraints of piloting the Mukhorito app to enhance adolescent SRH education in Bangladesh. It also sought to determine the self-reported usage, usability, and effect on knowledge and peer communication of the app, as well as to identify implementation and adoption challenges. Methods: A qualitative design was applied in the context of a broader mixed-methods study. Data were collected through 6 in-depth interviews, 3 key informant interviews, and 1 focus group discussion from 19 participants, including students, peer leaders, teachers, and government representatives, across 3 secondary schools (a boys’ school, girls’ school, and coeducational school) in the Feni district. Thematic analysis was conducted using NVivo software (QSR International) under Braun and Clarke’s guidelines. Results: The Mukhorito app was perceived as a valuable tool to meet the SRH needs of adolescents in Bangladesh owing to its well-structured, easily navigable content with relatable stories. Participants described increased awareness of critical SRH issues, including reproductive health, nutrition, early marriage, violence against adolescents, and drug addiction, and reported sharing this knowledge with their families and communities. The app was seen as creating a safe space to discuss previously taboo SRH topics, reducing cultural reluctance to communicate, and promoting peer-to-peer communication. Interactive sessions were noted to strengthen decision-making skills and leadership qualities. Many users reported feeling more comfortable discussing SRH issues without shyness. However, challenges such as limited smartphone access, unreliable internet connection, and economic factors hindered adoption, especially in rural settings. Participants suggested the integration of the Mukhorito app in school curricula, aligning it with the government adolescent health program, adding visually rich and interactive content (eg, short dramas, videos, and animations), and enabling offline access to address connectivity challenges and maximize the effectiveness of the app. Conclusions: Mukhorito possesses strong potential as a culturally relevant, digital SRH education tool for Bangladeshi adolescents. The app enabled knowledge and openness in SRH discourse. Alignment with national health programs and enhanced app functionality may promote greater and more sustainable adolescent health.

Daily, 6500 newborn deaths and 810 maternal deaths occur worldwide, and more than 90% of these deaths occur in low- and middle-income countries (LMICs), mainly from complications related to pregnancy and childbirth [1–3]. In Bangladesh, almost 14 mothers are dying every day due to these complications [4]. One of the leading causes of these deaths […]

BACKGROUND Bangladeshi adolescents face significant challenges accessing relevant sexual and reproductive health (SRH) information, with the added burdens of cultural taboo, limited accessibility, and poor communication channels. Traditional adolescent-friendly approaches have shown limited effectiveness in addressing these challenges. In response, Mukhorito was developed as a peer-led, mobile-based digital platform to facilitate SRH, education, and communication among ninth-grade students. OBJECTIVE This study explored the feasibility and constraints of piloting the Mukhorito app to enhance adolescent SRH education in Bangladesh. It also sought to determine the self-reported usage, usability, and effect on knowledge and peer communication of the app, as well as to identify implementation and adoption challenges. METHODS Qualitative design was applied in the context of a broader mixed-methods study. Data were collected through six In-Depth Interviews (IDIs), three Key Informant Interviews (KIIs), and one Focus Group Discussion (FGD) from 19 participants, including students, peer leaders, teachers, and government representatives, across three secondary schools in the Feni district. Thematic analysis was conducted using NVivo software under Braun and Clarke's guidelines. RESULTS The Mukhorito app was received positively for its structured material, interactivity, and easy peer-to-peer communication. Almost all participants shared improved SRH awareness and leadership skills, as well as reduced stigma when discussing delicate topics. The main challenges were limited smartphone access, poor internet connectivity, and affordability. Potential ways to improve the app’s usability were integrating the application into the school curriculum, improving offline functionality, and adding visual material such as short dramas or videos. CONCLUSIONS Mukhorito possesses strong potential as a culturally relevant, digital SRH education tool for Bangladeshi adolescents. The app enabled knowledge and openness in SRH discourse. Alignment with national health programs and enhanced app functionality may promote greater and more sustainable adolescent health.

The global burden of maternal mortality ratio (MMR) (223 per 100 000 live births) remains a pressing issue, with the majority (94%) of deaths occurring in low- and middle-income countries (LMICs), particularly in South Asia [1,2]. The disparities in health care service access and quality among LMICs contribute to the high MMR [3,4]. This highlights the […]

The Sustainable Development Goal (SDG) Target 3.1 aims to reduce the global Maternal Mortality Ratio (MMR) to no more than 140 per 100 000 live births by 2030 [1]. A 2023 recent report by United Nations (UN) agencies estimated that a woman dies every two minutes due to pregnancy or childbirth, with MMR either increasing or […]