Neeloy Ashraful Alam
@sydney.edu.au
Associate Professor, Sydney School of Public Health, Faculty of Medicine and Health
The University of Sydney
EDUCATION
PhD (Medical Anthropology)
MA (Medical Anthropology)
Master of Social Science
Bachelor of Social Science
RESEARCH, TEACHING, or OTHER INTERESTS
Health (social science), Public Health, Environmental and Occupational Health, Anthropology
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Elizabeth K. Kirkwood, Shahreen Raihana, Neeloy Ashraful Alam, and Michael J. Dibley
Wiley
AbstractGender‐based inequities prevent women from partaking in decision‐making. This study is a secondary analysis of the 2017–2018 Bangladesh Demographic and Health Survey (BDHS) data. We examined women's participation in no‐decisions against a set of independent variables to determine the factors associated with not participating in any decisions. The adjusted multivariable logistic regression revealed that women, aged 15–19, with no children, living in larger households, not employed for cash, agreed with at least one reason for husband's beating their wives and were not exposed to print media, were significantly less likely to be involved in any household decisions. This study sheds light on ways to promote women's active participation in decisions and to identify programme‐modifiable indicators for future research.
Bunga Astria Paramashanti, Michael J Dibley, Tanvir M Huda, Yayi Suryo Prabandari, and Neeloy Ashraful Alam
Springer Science and Business Media LLC
Abstract Background Global and Indonesian guidelines suggest that breastfeeding should continue for at least the first two years of life. While many studies have focused on six-month exclusive breastfeeding practices, little is known about why mothers do not sustain breastfeeding beyond this period. This qualitative study aimed to explore factors influencing breastfeeding continuation and formula feeding beyond six months, regardless of any additional food consumed, focusing on Indonesia’s rural and urban areas. Methods We collected the data through 46 in-depth interviews in Pati District and Surakarta City, Central Java, Indonesia. Participants were mothers, grandmothers, health care practitioners, and village kader (frontline female health workers). We used thematic analysis combining deductive and inductive techniques for analysing the data. Results Rural mothers practised breastfeeding and intended to breastfeed for a longer duration than urban mothers. Maternal attitude towards breastfeeding, breastfeeding knowledge, previous experiences, and other breastfeeding strategies (e.g., enhancing maternal dietary quality) positively influenced breastfeeding sustainability. In the urban setting, mothers encountered several breastfeeding barriers, such as perceived breast milk insufficiency and child hunger and satiety, child biting, and breastfeeding refusal, causing them to provide formula milk as a breast milk substitute or supplement. In addition, families, communities, health practitioners, and employment influenced maternal decisions in breastfeeding continuation and formula-feeding practices. Conclusions Optimal breastfeeding practices up to two years of age are determined by the individual and setting (i.e., community, healthcare, employment) factors. Providing breastfeeding education covering practical breastfeeding guidance will encourage mothers to breastfeed for longer. Such interventions should involve families, communities, health workers, and the work environment as a breastfeeding support system. Policymakers should develop, enforce, and monitor the implementation of breastfeeding policies to protect, promote, and support breastfeeding in households, communities, health systems, and work settings.
Amina Razzaq, Niamh Stephenson, Camille Raynes-Greenow, Joanne Travaglia, and Neeloy Ashraful Alam
Elsevier BV
Myat Pan Hmone, Mu Li, Kingsley Emwinyore Agho, Neeloy Ashraful Alam, Nina Chad, and Michael J. Dibley
Elsevier BV
Elizabeth Kirkwood, Michael J Dibley, Wajiha Khatun, Gulshan Ara, Mansura Khanam, Anowarul Bokshi, Mu Li, and Neeloy Ashraful Alam
Nova Southeastern University
Many agricultural and home gardening interventions aim to improve the nutritional status of women and children in low- and middle-income countries by focusing on women as the recipients of the intervention and make assumptions that women will be empowered as a result. This paper examines the potential impact of an intervention study that combined home garden training and support, and nutrition behaviour change communication, with a social safety net payment, on women’s empowerment in rural Bangladesh. We assessed the implementation of this study in terms of feasibility, acceptability, and practical application. Twenty in-depth interviews were conducted with randomly selected women that took part in the study. Qualitative data was coded using thematic analysis (Braun & Clarke 2006) and the results presented using the following five indicators: control over use of income, input into productive decisions, respect among household members, self-efficacy, and input into nutrition and health care decisions. Our study showed that a combined nutrition-specific (nutrition counselling) and nutrition-sensitive (agricultural training and unconditional cash transfer) intervention, delivered on a mobile platform, to women from low-income families in rural Bangladesh was feasible and acceptable. The study further revealed evidence on behaviour change across five key indicators related to women’s empowerment. The study highlights the potential for such an intervention to impact women’s empowerment and provides insight for the aid in the design of larger-scale trials implemented in similar settings.
Ngoc-Minh Nguyen, Michael J. Dibley, Hong K. Tang, and Ashraful Alam
Springer Science and Business Media LLC
Camille Raynes-Greenow, Sk Masum Billah, Sajia Islam, S. M. Rokonuzzaman, Fahmida Tofail, Elizabeth K. Kirkwood, Ashraful Alam, Ryan Chartier, Tarana E. Ferdous, Shams El Arifeen,et al.
Springer Science and Business Media LLC
Abstract Background Globally, household air pollution (HAP) is a leading environmental cause of morbidity and mortality. Our trial aims to assess the impact of liquefied petroleum gas (LPG) for cooking to reduce household air pollution exposure on child health outcomes, compared to usual cooking practices in Bangladesh. The primary aim is to evaluate if reduced exposure to HAP through the provision of LPG for cooking from early gestation through to age 2 improves child anthropometry, health, and neuro-cognitive developmental outcomes, compared to children exposed to emissions from usual practice. Methods Two-arm parallel cluster randomized controlled trial (cCRT). We will extend the intervention and follow-up of our existing “Poriborton” trial. In a subset of the original surviving participants, we will supply LPG cylinders and LPG stoves (intervention) compared to usual cooking practices and extend the follow-up to 24 months of age. The expected final sample size, for both (intervention and control) is 1854 children with follow-up to 2 years of age available for analysis. Discussion This trial will answer important research gaps related to HAP and child health and neuro-cognitive developmental outcomes. This evidence will help to understand the impact of a HAP intervention on child health to inform policies for the adoption of clean fuel in Bangladesh and other similar settings. Trial registration The Poriborton: Change trial: Household Air Pollution and Perinatal and early Neonatal mortality is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001214224, original trial registered on 19th July 2018, extension approved on 23rd June 2021. www.anzctr.org.au.
Camille Raynes-Greenow, Ashraful Alam, Sk Masum Billah, Sajia Islam, Kingsley Agho, S. M. Rokonuzzaman, Jonathan Thornburg, Shams El Arifeen, Atique Iqbal Chowdhury, Bin Jalaludin,et al.
Springer Science and Business Media LLC
Abstract Background Household air pollution is a leading health risk for global morbidity and mortality and a major health risk in South Asia. However, there are no prospective investigations of the impact of household air pollution on perinatal morbidity and mortality. Our trial aims to assess the impact of liquefied petroleum gas (LPG) for cooking to reduce household air pollution exposure on perinatal morbidity and mortality compared to usual cooking practices in Bangladesh. Hypothesis In a community-based cluster randomised controlled trial of pregnant women cooking with LPG throughout pregnancy, perinatal mortality will be reduced by 35% compared with usual cooking practices in a rural community in Bangladesh. Methods A two-arm community-based cluster randomised controlled trial will be conducted in the Sherpur district, Bangladesh. In the intervention arm, pregnant women receive an LPG cookstove and LPG in cylinders supplied throughout pregnancy until birth. In the control or usual practice arm, pregnant women continue their usual cooking practices, predominately traditional stoves with biomass fuel. Eligible women are pregnant women with a gestational age of 40–120 days, aged between 15 and 49 years, and permanent residents of the study area. The primary outcome is the difference in perinatal mortality between the LPG arm and the usual cooking arm. Secondary outcomes include (i) preterm birth and low birth weight, (ii) personal level exposure to household air pollution, (iii) satisfaction and acceptability of the LPG stove and stove use, and (iv) cost-effectiveness and cost-utility in reducing perinatal morbidity and mortality. We follow up all women and infants to 45 days after the birth. Personal exposure to household air pollution is assessed at three-time points in a sub-sample of the study population using the MicroPEM™. The total required sample size is 4944 pregnant women. Discussion This trial will produce evidence of the effectiveness of reduced exposure to household air pollution through LPG cooking to reduce perinatal morbidity and mortality compared to usual cooking practices. This evidence will inform policies for the adoption of clean fuel in Bangladesh and other similar settings. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618001214224. Prospectively registered on 19 July 2019
Morseda Chowdhury, Camille Raynes-Greenow, Patrick Kelly, Neeloy Ashraful Alam, Kaosar Afsana, Sk Masum Billah, and Michael John Dibley
MDPI AG
Low birth weight (LBW) is a global public health problem with the highest prevalence in South Asia. It is strongly associated with maternal undernutrition. In South Asia, intra-household food distribution is inequitable, with lower dietary adequacy in women. Evidence that nutrition education improves diet during pregnancy and reduces LBW is weak. We assessed the impact of nutrition education for pregnant women on birth weight in rural Bangladesh. We conducted a parallel, two-arm, cluster-randomised controlled trial, with 36 clusters allocated equally to intervention (n = 445) or standard care (n = 448). From their first trimester until delivery, intervention participants received education about eating balanced meals to meet daily dietary requirements with diverse food groups. The primary outcome of mean birth weight was 127.5 g higher in the intervention compared to control women, and the intervention reduced the risk of LBW by 57%. Post hoc analyses showed a significantly higher birth weight and a greater reduction in LBW amongst adolescent mothers. The mean number of food groups consumed was significantly higher in the intervention from the third month of pregnancy than in the control. A community-based balanced plate nutrition education intervention effectively increased mean birth weight and reduced LBW, and improved dietary diversity in rural Bangladeshi women.
Ngoc-Trinh Thi Nguyen, Hong K. Tang, Minh Ngoc Nguyen, Michael J. Dibley, and Neeloy Ashraful Alam
Springer Science and Business Media LLC
Bunga A Paramashanti, Tanvir M Huda, Ashraful Alam, and Michael J Dibley
Cambridge University Press (CUP)
AbstractObjective:To examine minimum dietary diversity (MDD) trends and determinants among children aged 6–23 months.Design:Secondary analysis of the Indonesia Demographic and Health Surveys (IDHS) between 2007 and 2017. The primary outcome was MDD, the consumption of at least five out of eight food groups (MDD-8). We included a total of 5015 (IDHS 2007), 5050 (IDHS 2007) and 4925 (IDHS 2017) children aged 6 to 23 months to estimate trends of MDD-8 and to identify factors associated with MDD-8. We used multiple logistic regression analysis adjusted for the complex sampling design to investigate the association between the study factors and MDD-8.Setting:Indonesia.Participant:A total of 14 990 children aged 6–23 months.Results:Over the 10 years, the percentage of children who consumed a diversified diet was 53·1 % in 2007, 51·7 % in 2012 and 53·7 % in 2017. Multivariate analyses showed that older age children, higher maternal education, maternal weekly access to media, paternal non-agricultural occupation, history of at least four antenatal care visits and wealthier households were associated with the increased odds of MDD-8. Children living in rural areas, Sulawesi and Eastern Indonesia, were less likely to eat a diversified diet.Conclusions:The proportion of children meeting MDD-8 has stagnated in the last decade. Child, parental, health care, household and community factors are associated with MDD-8. Therefore, nutrition education programmes and behaviour change communication activities should target mothers and families from socio-economically and geographically disadvantaged populations.
Elizabeth K Kirkwood, Caitlin Clymer, Kheminda Imbulana, Sumaya Mozumder, Michael J Dibley, and Neeloy Ashraful Alam
JMIR Publications Inc.
Background The rapid and widespread growth of mobile technologies in low- and middle-income countries can offer groundbreaking ways of disseminating public health interventions. However, gender-based inequalities present a challenge for women in accessing mobile technology. Research has shown that mobile health (mHealth) interventions can affect gender relations in both positive and negative ways; however, few mHealth programs use a gender-sensitive lens when designing, implementing, or analyzing programs. Objective This systematic review aims to identify and summarize the findings of qualitative research studies that explore the impact of mHealth interventions on gender relations as a result of participating in such initiatives in low- and middle-income countries. Methods We performed a systematic literature review to examine empirical evidence of changes in gender relations attributed to participation in an mHealth intervention in low- and middle-income countries. Peer-reviewed articles were included based on whether they evaluated an mHealth intervention and were published between 2013 and 2020. Articles using mHealth that solely targeted health workers, did not assess a specific intervention, used mobile technology for data collection only, or were formative or exploratory in nature were excluded. The search terms were entered into 4 key electronic databases—MEDLINE, EMBASE, PsycINFO, and Scopus—generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report the themes that emerged from our data. Results Of the 578 full-text articles retrieved, 14 (2.4%) were eligible for inclusion in the study. None of the articles appraised gender from the outset. The articles uncovered findings on gender relations through the course of the intervention or postprogram evaluation. Most studies took place in sub-Saharan Africa, with the remainder in South and Southeast Asia. The articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found that mHealth programs could enhance spousal communication, foster emotional support between couples, improve women’s self-efficacy and autonomy in seeking health information and services, and increase their involvement in health-related decision-making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision-makers, and exacerbating relationship problems. Conclusions These results suggest that given the rapid and persistent upscale of mHealth interventions in low- and middle-income settings, it is imperative to design interventions that consider their impact on power dynamics and gender relations. Future research is needed to fill the evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and that they need to actively participate and be empowered by mHealth interventions.
Christiana Rialine Titaley, Michael J. Dibley, Iwan Ariawan, Anifatun Mu'asyaroh, Bunga Astria Paramashanti, Ashraful Alam, Rita Damayanti, Tran Thanh Do, Elaine Ferguson, Min Kyaw Htet,et al.
Wiley
AbstractSuboptimal infant young child feeding practices are frequently reported globally, including in Indonesia. This analysis examined the impact of a package of behaviour change interventions on breastfeeding practices in Malang and Sidoarjo Districts, East Java Province, Indonesia. The BADUTA study (which in the Indonesian Language is an acronym for BAwah DUa TAhun, or children aged less than 2 years) was an impact evaluation using a cluster‐randomized controlled trial with two parallel treatment arms. We conducted household surveys in 12 subdistricts from Malang and Sidoarjo. We collected information from 5175 mothers of children aged 0–23 months: 2435 mothers at baseline (February 2015) and 2740 mothers at endline (January to February 2017). This analysis used two indicators for fever and diarrhoea and seven breastfeeding indicators (early initiation of breastfeeding, prelacteal feeding, exclusive breastfeeding under 6 months, predominant breastfeeding, continued breastfeeding, age‐appropriate breastfeeding and bottle‐feeding). We used multilevel logistic regression analysis to assess the effect of the intervention. After 2 years of implementation of interventions, we observed an increased odds of exclusive breastfeeding under 6 months (adjusted odds ratio [aOR] = 1.85; 95% confidence interval [CI]: 1.35–2.53) and age‐appropriate breastfeeding (aOR = 1.39; 95% CI: 1.07–1.79) in the intervention group than in the comparison group, at the endline survey. We found significantly lower odds for prelacteal feeding (aOR = 0.52; 95% CI: 0.41–0.65) in the intervention than in the comparison group. Our findings confirmed the benefits of integrated, multilayer behaviour change interventions to promote breastfeeding practices. Further research is required to develop effective interventions to reduce bottle use and improve other breastfeeding indicators that did not change with the BADUTA intervention.
Bunga A. Paramashanti, Michael J. Dibley, Tanvir M. Huda, and Ashraful Alam
Elsevier BV
Bunga A. Paramashanti, Michael J. Dibley, Ashraful Alam, and Tanvir M. Huda
Informa UK Limited
ABSTRACT Background Over the last two decades, Indonesia has experienced remarkable economic growth. However, the percentage of infants and young children meeting the minimum dietary diversity (MDD) criteria has stagnated. Despite the growing body of evidence of the association between MDD and socioeconomic factors, there is little information about socioeconomic inequalities in MDD in Indonesia. Objectives The current study seeks to quantify the wealth- and education-related inequalities in MDD among infants and young children in Indonesia and determine the contribution of different factors to these disparities. Methods We included a total of 5038 children aged 6–23 months of the 2017 Indonesia Demographic and Health Survey. We measured wealth- and education-related inequalities using the concentration curve and Wagstaff normalised concentration index. Using a concentration index decomposition analysis, we then examined factors contributing to wealth- and education-related inequalities in MDD. Results The concentration indices by household wealth and maternal education were 0.220 (p < 0.001) and 0.192 (p < 0.001), respectively, indicating more concentration of inequalities among the advantaged population. The decomposition analysis revealed that household wealth (29.8%), antenatal care (ANC) visits (16.6%), paternal occupation (15.1%), and maternal education (11.8%) explained the pro-rich inequalities in MDD in Indonesia. Maternal education (26.1%), household wealth (19.1%), ANC visits (14.9%), and paternal occupation (10.9%) made the most considerable contribution to education-related inequalities in MDD. Conclusions There is substantial wealth- and education-related inequalities in MDD. Our findings suggest an urgent need to address the underlying causes of not reaching dietary diversity by promoting infant and young child feeding equity in Indonesia.
Seema Mihrshahi, Gulshan Ara, Mansura Khanam, Sabrina Rasheed, Kingsley Emwinyore Agho, AKM Iqbal Kabir, S K Roy, Rukhsana Haider, Jena Derakhshani Hamadani, Fahmida Tofail,et al.
JMIR Publications Inc.
Background The aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age. Objective Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development. Methods This study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements. The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months). Results We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses. Conclusions This study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development. Trial Registration ClinicalTrials.gov NCT01333995; https://clinicaltrials.gov/ct2/show/NCT01333995 International Registered Report Identifier (IRRID) DERR1-10.2196/31475
Jonathan Thornburg, Sajia Islam, Sk Masum Billah, Brianna Chan, Michelle McCombs, Maggie Abbott, Ashraful Alam, and Camille Raynes-Greenow
MDPI AG
The use of liquefied petroleum gas (LPG) for cooking is a strategy to reduce household air pollution (HAP) exposure and improve health. We conducted this feasibility study to evaluate personal exposure measurement methods to representatively assess reductions in HAP exposure. We enrolled 30 pregnant women to wear a MicroPEM for 24 h to assess their HAP exposure when cooking with a traditional stove (baseline) and with an LPG stove (intervention). The women wore the MicroPEM an average of 77% and 69% of the time during the baseline and intervention phases, respectively. Mean gravimetric PM2.5 mass and black carbon concentrations were comparable during baseline and intervention. Temporal analysis of the MicroPEM nephelometer data identified high PM2.5 concentrations in the afternoon, late evening, and overnight during the intervention phase. Likely seasonal sources present during the intervention phase were emissions from brick kiln and rice parboiling facilities, and evening kerosene lamp and mosquito coil use. Mean background adjusted PM2.5 concentrations during cooking were lower during intervention at 71 μg/m3, versus 105 μg/m3 during baseline. Representative real-time personal PM2.5 concentration measurements supplemented with ambient PM2.5 measures and surveys will be a valuable tool to disentangle external sources of PM2.5, other indoor HAP sources, and fuel-sparing behaviors when assessing the HAP reduction due to intervention with LPG stoves.
Ngoc‐Minh Nguyen, Hong K Tang, Michael John Dibley, and Ashraful Alam
Wiley
AbstractBackgroundThe aim of this research was to describe the patterns of consumption of multiple sugar‐sweetened beverages (including modern and traditional ones) among adolescents in Ho Chi Minh City and to identify a possible relationship between this consumption and overweight, obesity, and other factors.MethodsA secondary analysis from a cross‐sectional study of 11–15‐year‐old students from 31 junior high schools across Ho Chi Minh City was used. We measured the students’ anthropometric status and assessed beverage consumption using a validated Food Frequency Questionnaire. Multivariate logistic regression models were used to identify the association between the consumption of sugar‐sweetened beverages, obesity and other factors.ResultsThe sugar‐sweetened beverages (SSB) ranged widely from modern soft drinks and powdered drinks to traditional sugar‐added fruit and leaf juices, and milk‐based drinks. These beverages were very popular among 2,660 participants with 36% consuming at least one variety daily. Factors positively associated with sugar‐sweetened beverage consumption included a higher level of physical activity, higher consumption of fast foods, and daily fruit and vegetable consumption. We found a negative association between milk‐based SSBs and the overweight and obesity status of the students, i.e. every kcal more of fresh milk with sugar and condensed milk can reduce an obesity odd of 0.005 (95% CI [0.002–0.008], p < 0.001) and 0.004 (95% CI [0.002–0.010], p = 0.044) consecutively. None of the other SSBs was significantly related to adolescent overweight and obesity.ConclusionsMilk‐based drinks potentially protect adolescents against overweight and obesity. Further research to assess this protection is needed.
Amina Razzaq, Camille Raynes‐Greenow, and Ashraful Alam
Wiley
BackgroundHuman immunodeficiency virus (HIV) testing is a gateway to HIV treatment, care and preventive services for pregnant women attending antenatal clinics. Despite this, uptake of HIV testing is not optimal among pregnant women in many low‐ and middle‐income countries (LMICs) and it could negatively impact the effectiveness of prevention of mother‐to‐child transmission of HIV programs.AimTo understand the factors that hinder the uptake of HIV testing among pregnant women attending antenatal clinics in LMICs.Materials and methodsA systematic search of the CINAHL, EMBASE, JSTOR, Medline, PubMed and Web of Science electronic databases was performed. We limited the search to peer‐reviewed qualitative studies including mixed method studies. The titles and abstracts of the retrieved publications were screened for relevance then information was extracted.ResultsOur search yielded 2179 citations, out of which 312 full‐text articles were reviewed and 22 studies that met the eligibility criteria were included in this review. We found that a lack of HIV testing kits, poor health infrastructure and shortage of healthcare workers were the main health system‐related factors. Poor HIV knowledge, fear of HIV test results, HIV‐related stigma and social exclusion negatively influenced pregnant women’s decision to be tested for HIV.ConclusionThis review has identified that pregnant women faced a wide range of health system, individual, social and lack of women’s empowerment related challenges that negatively influenced the uptake of HIV testing among pregnant women in LMICs. Our findings would be useful in developing strategies to overcome barriers that could enhance the uptake of HIV testing among pregnant women.
Samreen S Khan, Nanda K Tawale, Archana Patel, Michael J Dibley, and Ashraful Alam
Elsevier BV
Jamil Ahmed, Carmen Huckel Schneider, Ashraful Alam, and Camille Raynes-Greenow
Springer Science and Business Media LLC
Introduction Pakistan has made slow progress towards reducing the newborn mortality burden; as a result, it has the highest burden of newborn mortality worldwide. This article presents an analysis of the current policies, plans, and strategies aimed at reducing the burden of newborn death in Pakistan for the purpose of identifying current policy gaps and contextual barriers towards proposing policy solutions for improved newborn health. Methods We begin with a content analysis of federal-level policies that address newborn mortality within the context of health system decentralization over the last 20 years. This is then followed by a case study analysis of policy and programme responses in a predominantly rural province of Pakistan, again within the context of broader health system decentralization. Finally, we review successful policies in comparable countries to identify feasible and effective policy choices that hold promise for implementation in Pakistan, considering the policy constraints we have identified. Results The major health policies aimed at reduction of newborn mortality, following Pakistan’s endorsement of global newborn survival goals and targets, lacked time-bound targets. We found confusion around roles and responsibilities of institutions in the implementation process and accountability for the outcomes, which was exacerbated by an incomplete decentralization of healthcare policy-making and health service delivery, particularly for women around birth, and newborns. Such wide gaps in the areas of target-setting, implementation mechanism, and evaluation could be because the policy-making largely ignored international commitments and lessons of successful policy-making in comparable regional counties. Conclusions Inclusion of clear goals and targets in newborn survival policies and plans, completion of the decentralization process of maternal and child healthcare service delivery, and policy-making and implementation by translating complex evidence and using regional but locally applicable case studies will be essential to any effective policy-making on newborn survival in Pakistan.
Christiana Rialine Titaley, Michael J. Dibley, Iwan Ariawan, Anifatun Mu’asyaroh, Ashraful Alam, Rita Damayanti, Tran Thanh Do, Elaine Ferguson, Kyaw Htet, Mu Li,et al.
Springer Science and Business Media LLC
Abstract Background Despite the increasing rate of exclusive breastfeeding in Indonesia, there is still a need for supportive interventions. The breastfeeding self-efficacy of mothers is a key factor positively associated with optimum breastfeeding practices. Our analysis aims to assess the determinants of low breastfeeding self-efficacy amongst a sample of women with children aged under 6 months in Malang and Sidoarjo Districts, East Java, Indonesia. Methods We used information from 1210 mothers of children aged < 6 months recruited in the BADUTA study conducted in 2015–2016 in Malang and Sidoarjo Districts. The outcome variable in this analysis was mothers’ self-efficacy for breastfeeding using the 14 statements in the Breastfeeding Self-Efficacy-Short Form. We evaluated 17 potential predictors of breastfeeding self-efficacy, organized into six sub-groups of variables: (1) context/demographic; (2) household factors; (3) maternal characteristics; (4) child characteristics; (5) breastfeeding practices; and (6) antenatal and delivery care. Logistic regression analyses were employed to examine factors associated with mothers’ self-efficacy with breastfeeding. Results More than half of the women in this study had a low level of self-efficacy. One of the factors associated with low breastfeeding self-efficacy found in this study was mothers’ problems related to breastfeeding. Mothers who had problems with breastfeeding not related to illness (adjusted odds ratio [aOR] 3.27; 95% CI 2.45, 4.36) or problems related to both illness and non-illness conditions (aOR 3.57; 95% CI 1.37, 9.33) had higher odds of low breastfeeding self-efficacy than those who did not have any problems. Compared to mothers who completed university education, there was a significantly higher odds of low breastfeeding self-efficacy in mothers who completed primary school or lower (aOR 1.88; 95% CI 1.16, 3.05); completed junior high school (aOR 2.27; 95% CI 1.42, 3.63); and completed senior high school (aOR 1.94; 95% CI 1.29, 2.91). Other significant predictors of low breastfeeding self-efficacy were mothers not exposed to any breastfeeding interventions (aOR 1.87; 95% CI 1.09, 3.22); working outside the house (aOR 1.69; 95% CI 1.23, 2.32); not obtaining any advice on breastfeeding (aOR 1.40; 95% CI 1.08, 1.82); with low knowledge of breastfeeding (aOR 1.38; 95% CI 1.03, 1.84); and delivered by Caesarean section (aOR 1.34; 95% CI 1.05, 1.70). Conclusions Multipronged breastfeeding education programs and support are required to improve women’s self-efficacy with breastfeeding. Improved access to breastfeeding counselors, active support for mothers following cesarean delivery, and increased supporting facilities at workplaces are essential to improve self-efficacy with breastfeeding.
Shahreen Raihana, Ashraful Alam, Tanvir M. Huda, and Michael J. Dibley
Springer Science and Business Media LLC
Abstract Background Irrespective of the place and mode of delivery, ‘delayed’ initiation of breastfeeding beyond the first hour of birth can negatively influence maternal and newborn health outcomes. In Bangladesh, 49% of newborns initiate breastfeeding after the first hour. The rate is higher among deliveries at a health facility (62%). This study investigates the maternal, health service, infant, and household characteristics associated with delayed initiation of breastfeeding among health facility deliveries in Bangladesh. Methods We used data from the 2014 Bangladesh Demographic and Health Survey. We included 1277 last-born children born at a health facility in the 2 years preceding the survey. ‘Delayed’ breastfeeding was defined using WHO recommendations as initiating after 1 h of birth. We performed univariate and multivariable logistic regression to determine factors associated with delayed initiation. Results About three-fifth (n = 785, 62%) of the children born at a health facility delayed initiation of breastfeeding beyond 1 h. After adjusting for potential confounders, we found delayed initiation to be common among women, who delivered by caesarean section (adjusted Odds Ratio (aOR): 2.93; 95% CI 2.17, 3.98), and who were exposed to media less than once a week (aOR: 1.53; 95% CI 1.07, 2.19). Women with a higher body mass index had an increased likelihood of delaying initiation (aOR: 1.05; 95% CI 1.01, 1.11). Multiparous women were less likely to delay (aOR: 0.71; 95% CI 0.53, 0.96). Conclusions Delayed initiation of breastfeeding following caesarean deliveries continues to be a challenge, but several other health facility and maternal factors also contributed to delayed initiation. Interventions to promote early breastfeeding should include strengthening the capacity of healthcare providers to encourage early initiation, especially for caesarean deliveries.
Aliki Christou, Ashraful Alam, Sayed Murtaza Sadat Hofiani, Adela Mubasher, Mohammad Hafiz Rasooly, Mohammad Khakerah Rashidi, and Camille Raynes-Greenow
Springer Science and Business Media LLC
Elizabeth K Kirkwood, Michael John Dibley, John Frederick Hoddinott, Tanvir Huda, Tracey Lea Laba, Tazeen Tahsina, Mohammad Mehedi Hasan, Afrin Iqbal, Jasmin Khan, Nazia Binte Ali,et al.
BMJ
IntroductionThere is growing interest in assessing the impact of health interventions, particularly when women are the focus of the intervention, on women’s empowerment. Globally, research has shown that interventions targeting nutrition, health and economic development can affect women’s empowerment. Evidence suggests that women’s empowerment is also an underlying determinant of nutrition outcomes. Depending on the focus of the intervention, different domains of women’s empowerment will be influenced, for example, an increase in nutritional knowledge, or greater control over income and access to resources.ObjectiveThis study evaluates the impact of the Shonjibon Cash and Counselling (SCC) Trial that combines nutrition counselling and an unconditional cash transfer, delivered on a mobile platform, on women’s empowerment in rural Bangladesh.Methods and analysisWe will use a mixed-methods approach, combining statistical analysis of quantitative data from 2840 women in a cluster randomised controlled trial examining the impact of nutrition behaviour change communications (BCCs) and cash transfers on child undernutrition. Pregnant participants will be given a smartphone with a customised app, delivering nutrition BCC messages, and will receive nutrition counselling via a call centre and an unconditional cash transfer. This study is a component of the SCC Trial and will measure women’s empowerment using a composite indicator based on the Project-Level Women’s Empowerment in Agriculture Index, with quantitative data collection at baseline and endline. Thematic analysis of qualitative data, collected through longitudinal interviews with women, husbands and mothers-in-law, will elicit a local understanding of women’s empowerment and the linkages between the intervention and women’s empowerment outcomes. This paper describes the study protocol to evaluate women’s empowerment in a nutrition-specific and sensitive intervention using internationally validated, innovative tools and will help fill the evidence gap on pathways of impact, highlighting areas to target for future programming.Ethics and disseminationEthical approval has been obtained from the International Centre for Diarrhoeal Disease Research (Ref. PR 17106) and The University of Sydney (Ref: 2019/840). Findings from this study will be shared in Bangladesh with dissemination sessions in-country and internationally at conferences, and will be published in peer-reviewed journals.