Large-scale rollout of extension training in Bangladesh: Challenges and opportunities for gender-inclusive participation.
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ABSTRACT:
SUBMITTER: Medendorp JW
PROVIDER: S-EPMC9269913 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundBangladesh is one of the fastest-growing older populations in the world. However, there has been little initiative in constructing an Active Aging Index (AAI) to monitor the quality of life of senior citizen.ObjectivesThe objective of the study was to construct an AAI to know the active aging scenario of the population in Bangladesh.MethodsA cross-sectional study was conducted among 518 respondents aged 60 years or older from six villages and six wards. Three villages and three wards from Rangpur district and three villages and three wards from Dhaka district were selected for the collection of data. A semi-structured questionnaire was used to collect data on the eight indicators of the 'health dimension', three indicators of the 'participation dimension', and seven indicators of the 'security dimension' for the AAI using the World Health Organization (WHO) model. The responses for each of the indicators (ranges from 0, 1, 2, or 3) in each dimension were added to create a composite index (CI) for each of the dimensions. Descriptive statistical methods with significance tests were applied to analyze the data.ResultsThe findings provide opportunities to view the 18 aspects of the quality of life of the older population by sex and place of residence. Among the respondents, the overall AAI score shows that 48.1% of the health, 28.9% of the participation, and 48.5% of the security dimensions score fall in the lower active category. Gender differences were distinct in all three dimensions, where the moderate AAI score for females from both rural (41.5%) and urban areas (62.7%) was lower than for males in rural (73.5 %) and urban areas (76.3%). Conversely, the AAI value for urban older adults was higher in all dimensions in comparison with rural older adults. Overall, 62.7% of the respondents were moderately active (a range within 0.50-0.79), while 34.4% were poorly active (a range within 0.0-0.49) and only 3.9% were highly active (a range within 0.80+).ConclusionEffective initiatives are needed to improve the individual scores of each of the three dimensions of the AAI. Attention should be given to addressing the gender and residential variations in all three dimensions of the AAI. The incorporation of indicator-specific measures is essential to the existing plan of action and programs to improve the situation of the older population that is poorly and moderately active. This result will help policymakers from concerned ministries to focus on specific dimensions to improve the AAI situation in the country. A nationally representative study is needed regularly to monitor the AAI situation.
| S-EPMC9547210 | biostudies-literature
Project description:The term "neurodegenerative diseases" (NDs) identifies a group of heterogeneous diseases characterized by progressive loss of selectively vulnerable populations of neurons, which progressively deteriorates over time, leading to neuronal dysfunction. Protein aggregation and neuronal loss have been considered the most characteristic hallmarks of NDs, but growing evidence confirms that significant dysregulation of innate immune pathways plays a crucial role as well. NDs vary from multiple sclerosis, in which the autoimmune inflammatory component is predominant, to more "classical" NDs, such as Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, and spinal muscular atrophy. Of interest, many of the clinical differences reported in NDs seem to be closely linked to sex, which may be justified by the significant changes in immune mechanisms between affected females and males. In this review, we examined some of the most studied NDs by looking at their pathogenic and phenotypical features to highlight sex-related discrepancies, if any, with particular interest in the individuals' responses to treatment. We believe that pointing out these differences in clinical practice may help achieve more successful precision and personalized care.
| S-EPMC10093984 | biostudies-literature
Project description:The extraordinary global growth of digital connectivity has generated optimism that mobile technologies can help overcome infrastructural barriers to development, with 'mobile health' (mhealth) being a key component of this. However, while 'formal' (top-down) mhealth programmes continue to face challenges of scalability and sustainability, we know relatively little about how health-workers are using their own mobile phones informally in their work. Using data from Ghana, Ethiopia and Malawi, we document the reach, nature and perceived impacts of community health-workers' (CHWs') 'informal mhealth' practices, and ask how equitably these are distributed. We implemented a mixed-methods study, combining surveys of CHWs across the three countries, using multi-stage proportional-to-size sampling (N = 2197 total), with qualitative research (interviews and focus groups with CHWs, clients and higher-level stake-holders). Survey data were weighted to produce nationally- or regionally-representative samples for multivariate analysis; comparative thematic analysis was used for qualitative data. Our findings confirm the limited reach of 'formal' compared with 'informal' mhealth: while only 15% of CHWs surveyed were using formal mhealth applications, over 97% reported regularly using a personal mobile phone for work-related purposes in a range of innovative ways. CHWs and clients expressed unequivocally enthusiastic views about the perceived impacts of this 'informal health' usage. However, they also identified very real practical challenges, financial burdens and other threats to personal wellbeing; these appear to be borne disproportionately by the lowest-paid cadre of health-workers, especially those serving rural areas. Unlike previous small-scale, qualitative studies, our work has shown that informal mhealth is already happening at scale, far outstripping its formal equivalent. Policy-makers need to engage seriously with this emergent health system, and to work closely with those on the ground to address sources of inequity, without undermining existing good practice.
| S-EPMC7903241 | biostudies-literature
Project description:Among the different thermo-chemical recycling routes for plastic waste valorization, gasification is one of the most promising, converting plastic waste into syngas (H2+CO) and energy in the presence of an oxygen-rich gas. Plastic waste gasification is associated with many different complexities due to the multi-scale nature of the process, the feedstock complexity (mixed polyolefins with different contaminations), intricate reaction mechanisms, plastic properties (melting behavior and molecular weight distribution), and complex transport phenomena in a multi-phase flow system. Hence, creating a reliable model calls for an extensive understanding of the phenomena at all scales, and more advanced modeling approaches than those applied today are required. Indeed, modeling of plastic waste gasification (PWG) is still in its infancy today. Our review paper shows that the thermophysical properties are rarely properly defined. Challenges in this regard together with possible methodologies to decently define these properties have been elaborated. The complexities regarding the kinetic modeling of gasification are numerous, compared to, e.g., plastic waste pyrolysis, or coal and biomass gasification, which are elaborated in this work along with the possible solutions to overcome them. Moreover, transport limitations and phase transformations, which affect the apparent kinetics of the process, are not usually considered, while it is demonstrated in this review that they are crucial in the robust prediction of the outcome. Hence, possible approaches in implementing available models to consider these limitations are suggested. Finally, the reactor-scale phenomena of PWG, which are more intricate than the similar processes-due to the presence of molten plastic-are usually simplified to the gas-solid systems, which can result in unreliable modeling frameworks. In this regard, an opportunity lies in the increased computational power that helps improve the model's precision and allows us to include those complexities within the multi-scale PWG modeling. Using the more accurate modeling methodologies in combination with multi-scale modeling approaches will, in a decade, allow us to perform a rigorous optimization of the PWG process, improve existing and develop new gasifiers, and avoid fouling issues caused by tar.
| S-EPMC9228121 | biostudies-literature
Project description:BACKGROUND:Community-based programs in rural low-and middle-income country settings are well-placed to conduct gender transformative activities that aid program sustainability and catalyse wider social change, such as reducing gender inequities that in turn improve health outcomes. The Anchal program is a drowning prevention intervention for children aged 1-5?years old in rural Bangladesh. It provides community crèche-based supervision delivered by local trained paid-female volunteers. We aimed to identify the influence of the Anchal program on gender norms and behaviours in the community context, and the effects these had on program delivery and men and women's outcomes. METHODS:Qualitative in-depth interviews, focus group discussions and observations were conducted with program beneficiaries and providers. Gender outcomes were analysed using FHI 360's Gender Integration Framework. RESULTS:The Anchal program was found to be a gender accommodating program as it catered for communities' gender-based roles and constraints but did not actively seek to change underlying beliefs, perceptions and norms that led to these. The program in some cases enhanced the independence and status of female community staff. This changed perceptions of communities towards acceptable levels of physical mobility and community involvement for women. Conversely, gender affected program delivery by reducing the ability of female supervisory staff to engage with male community leaders. The double burden of wage and household labour carried by local female staff also limited performance and progression. Gender-based constraints on staff performance, attrition and community engagement affected efficiency of program delivery and sustainability. CONCLUSIONS:The Anchal program both adapted to and shaped community gender norms and roles. The program has well-established relationships in the community and can be leveraged to implement gender transformative activities to improve gender-based equity. Health programs can broaden their impacts and target social determinants of health like gender equity to increase program sustainability and promote equitable health outcomes.
| S-EPMC7329458 | biostudies-literature
Project description:Women comprise a significant portion of the agricultural workforce in developing countries but are often less likely to attend government sponsored training events. The objective of this study was to assess the feasibility of using machine-supported decision-making to increase overall training turnout while enhancing gender inclusivity. Using data obtained from 1,067 agricultural extension training events in Bangladesh (130,690 farmers), models were created to assess gender-based training patterns (e.g., preferences and availability for training). Using these models, simulations were performed to predict the top (most attended) training events for increasing total attendance (male and female combined) and female attendance, based on gender of the trainer, and when and where training took place. By selecting a mixture of the top training events for total attendance and female attendance, simulations indicate that total and female attendance can be concurrently increased. However, strongly emphasizing female participation can have negative consequences by reducing overall turnout, thus creating an ethical dilemma for policy makers. In addition to balancing the need for increasing overall training turnout with increased female representation, a balance between model performance and machine learning is needed. Model performance can be enhanced by reducing training variety to a few of the top training events. But given that models are early in development, more training variety is recommended to provide a larger solution space to find more optimal solutions that will lead to better future performance. Simulations show that selecting the top 25 training events for total attendance and the top 25 training events for female attendance can increase female participation by over 82% while at the same time increasing total turnout by 14%. In conclusion, this study supports the use of machine-supported decision-making when developing gender inclusivity policies in agriculture extension services and lays the foundation for future applications of machine learning in this area.
| S-EPMC10162538 | biostudies-literature
Project description:ObjectiveGender norms shape individuals' perceptions and behaviours, particularly concerning health outcomes. However, the lack of comprehensive gender norm attitude measures in low- and middle-income countries, including Bangladesh, impedes gender-transformative efforts. This study introduces the Multidomain Gender Norm Attitude Scale (M-GNAS) to evaluate gender norm attitudes among Bangladeshi youths.MethodThree sequential studies were conducted in Bangladesh in 2022 to develop the M-GNAS. Study 1 engaged 124 participants in focus group discussions, generating a 40-item pool reflecting prevalent gender norms. Study 2 involved 1374 youths (mean age 26.82, SD 5.50) to finalise the M-GNAS items and explore its latent structure through exploratory factor analysis (EFA). Study 3, with 1416 participants of similar age, used confirmatory factor analysis (CFA) to assess structural validity and structural equation modelling to evaluate measurement invariance (MI) across genders.ResultsEFA identified a four-domain solution with 13 items: gender-appropriate behaviour, family financial decisions, family responsibility, and career choice. CFA supported this four-domain solution (CFI=0.96, TLI=0.95; RMSEA=0.07; SRMR=0.04). MI across gender was well established (CFI & TLI>0.95, RMSEA≤0.06, SRMR<0.6). Higher education was associated with more egalitarian attitudes (F (5, 1408) = 7.25, p < 0.001), supporting the scale's construct validity.ConclusionThe M-GNAS is a psychometrically robust tool for assessing youths' attitudes toward prevalent gender norm domains in Bangladesh. It holds the potential for contributing to gender-transformative programmes and could be applied in similar initiatives across developing nations, contingent upon appropriate validation.
| S-EPMC11350248 | biostudies-literature
Project description:The emergence of the "4th Industrial Revolution," i.e. the convergence of artificial intelligence, the Internet of Things, advanced materials, and bioengineering technologies, could accelerate socioeconomic insecurities and anxieties or provide beneficial alternatives to the status quo. In the post-Covid-19 era, the entities that are best positioned to capitalize on these innovations are large firms, which use digital platforms and big data to orchestrate vast ecosystems of users and extract market share across industry sectors. Nonetheless, these technologies also have the potential to democratize ownership, broaden political-economic participation, and reduce environmental harms. We articulate the potential sociotechnical pathways in this high-stakes crossroads by analyzing cellular agriculture, an exemplary 4th Industrial Revolution technology that synergizes computer science, biopharma, tissue engineering, and food science to grow cultured meat, dairy, and egg products from cultured cells and/or genetically modified yeast. Our exploration of this space involved multi-sited ethnographic research in both (a) the cellular agriculture community and (b) alternative economic organizations devoted to open source licensing, member-owned cooperatives, social financing, and platform business models. Upon discussing how these latter approaches could potentially facilitate alternative sociotechnical pathways in cellular agriculture, we reflect upon the broader implications of this work with respect to the 4th Industrial Revolution and the enduring need for public policy reform.
| S-EPMC8383920 | biostudies-literature
Project description:This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.
| S-EPMC10988148 | biostudies-literature
Project description:National Institute of Diseases of the Chest and Hospital, Dhaka; Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka; and Chittagong Chest Disease Hospital, Chittagong, Bangladesh.To present operational data and discuss the challenges of implementing FAST (Find cases Actively, Separate safely and Treat effectively) as a tuberculosis (TB) transmission control strategy.FAST was implemented sequentially at three hospitals.Using Xpert® MTB/RIF, 733/6028 (12.2%, 95%CI 11.4-13.0) patients were diagnosed with unsuspected TB. Patients with a history of TB who were admitted with other lung diseases had more than twice the odds of being diagnosed with unsuspected TB as those with no history of TB (OR 2.6, 95%CI 2.2-3.0, P < 0.001). Unsuspected multidrug-resistant TB (MDR-TB) was diagnosed in 89/1415 patients (6.3%, 95%CI 5.1-7.7). Patients with unsuspected TB had nearly five times the odds of being diagnosed with MDR-TB than those admitted with a known TB diagnosis (OR 4.9, 95%CI 3.1-7.6, P < 0.001). Implementation challenges include staff shortages, diagnostic failure, supply-chain issues and reliance on external funding.FAST implementation revealed a high frequency of unsuspected TB in hospitalized patients in Bangladesh. Patients with a previous history of TB have an increased risk of being diagnosed with unsuspected TB. Ensuring financial resources, stakeholder engagement and laboratory capacity are important for sustainability and scalability.
| S-EPMC5757242 | biostudies-other