Correction: Impact of a Participatory Intervention with Women's Groups on Psychological Distress among Mothers in Rural Bangladesh: Secondary Analysis of a Cluster-Randomised Controlled Trial.
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SUBMITTER: Clarke K
PROVIDER: S-EPMC5552076 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:Despite efforts to reduce under-5 mortality rates worldwide, an estimated 6.6 million under-5 children die every year. Community mobilisation through participatory women's groups has been shown to improve maternal and newborn health in rural settings, but little is known about the potential of this approach to improve care and health in children after the newborn period.Following on from a cluster-randomised controlled trial to assess the effect of participatory women's groups on maternal and neonatal health outcomes in rural Bangladesh, 162 women's groups continued to meet between April 2010 and December 2011 to identify, prioritise and address issues that affect the health of children under 5 years. A controlled before-and-after study design and difference-in-difference analysis was used to assess morbidity outcomes and changes in knowledge and practices related to child feeding, hygiene and care-seeking behaviour.Significant improvements were measured in mothers' knowledge of disease prevention and management, danger signs and hand washing at critical times. Significant increases were seen in exclusive breast feeding for at least 6 months (15.3% (4.2% to 26.5%)), and mean duration of breast feeding (37.9 days (17.4 to 58.3)). Maternal reports of under-5 morbidities fell in intervention compared with control areas, including reports of fever (-10.5% (-15.1% to -6.0%)) and acute respiratory infections (-12.2% (-15.6% to -8.8%)). No differences were observed in dietary diversity scores or immunisation uptake.Community mobilisation through participatory women's groups can be successfully adapted to address health knowledge and practice in relation to child's health, leading to improvements in a number of child health indicators and behaviours.
| S-EPMC4392217 | biostudies-other
Project description:Participatory learning and action women's groups (PLA) have proven effective in reducing neonatal mortality in rural, high-mortality settings, but their impacts on women's agency in the household remain unknown. Cash transfer programmes have also long targeted female beneficiaries in the belief that this empowers women. Drawing on data from 1309 pregnant women in a four-arm cluster-randomised controlled trial in Nepal, we found little evidence for an impact of PLA alone or combined with unconditional food or cash transfers on women's agency in the household. Caution is advised before assuming PLA women's groups alone or with resource transfers necessarily empower women.
| S-EPMC6540743 | biostudies-literature
Project description: Not available
| S-EPMC5640793 | biostudies-literature
Project description:The relationship between women's empowerment and women's nutrition is understudied. We aimed to elucidate this relationship by quantifying possible pathways between empowerment and dietary diversity among women in rural Bangladesh. In 2015, we conducted a cross-sectional survey of 2,599 married women ages 15-40 (median: 25) living in 96 settlements of Habiganj District, Bangladesh, as a baseline for the Food and Agricultural Approaches to Reducing Malnutrition trial. We collected data on women's empowerment (highest completed grade of schooling and agency), dietary diversity, and demographic factors, including household wealth. We used exploratory factor analysis and confirmatory factor analysis on random split-half samples, followed by structural equation modelling, to test pathways from schooling, through domains of women's agency, to dietary diversity. Factor analysis revealed 3 latent domains of women's agency: social solidarity, decision-making, and voice with husband. In the adjusted mediation model, having any postprimary schooling was positively associated with voice with husband (β41 = .051, p = .010), which was positively associated with dietary diversity (β54 = .39, p = .002). Schooling also had a direct positive association with women's dietary diversity (β51 = .22, p < .001). Neither women's social solidarity nor decision-making mediated the relationship between schooling and dietary diversity. The link between schooling and dietary diversity was direct and indirect, through women's voice with husband but not through women's social solidarity or decision-making. In this population, women with postprimary schooling seem to be better able to negotiate improved diets for themselves.
| S-EPMC6866060 | biostudies-literature
Project description:BackgroundWomen in rural Bangladesh face multiple, inter-related challenges including food insecurity, malnutrition, and low levels of empowerment. We aimed to investigate the pathway towards empowerment experienced by women participating in a three-year nutrition-sensitive homestead food production (HFP) program, which was evaluated through the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial.MethodsWe conducted 44 in-depth interviews and 12 focus group discussions with men and women in both intervention and control communities of the FAARM study site in rural, north-eastern Bangladesh. Using a modified grounded theory approach to data collection and analysis, we developed a framework to explain the pathway towards empowerment among HFP program participants.ResultsThe analysis and resulting framework identified seven steps towards empowerment: 1) receiving training and materials; 2) establishing home gardens and rearing poultry; 3) experiencing initial success with food production; 4) generating social or financial resources; 5) expanding agency in household decision-making; 6) producing renewable resources (e.g. farm produce) and social resources; and 7) sustaining empowerment. The most meaningful improvements in empowerment occurred among participants who were able to produce food beyond what was needed for household consumption and were able to successfully leverage these surplus resources to gain higher bargaining power in their household. Additionally, women used negotiation skills with their husbands, fostered social support networks with other women, and developed increased self-efficacy and motivation. Meanwhile, the least empowered participants lacked support in critical areas, such as support from their spouses, social support networks, or sufficient space or time to produce enough food to meaningfully increase their contribution and therefore bargaining power within their household.ConclusionsThis study developed a novel framework to describe a pathway to empowerment among female participants in an HFP intervention, as implemented in the FAARM trial. These results have implications for the design of future nutrition-sensitive agriculture interventions, which should prioritize opportunities to increase empowerment and mitigate the barriers identified in our study.Trial registrationFAARM is registered with ClinicalTrials.gov ( NCT02505711 ).
| S-EPMC8772198 | biostudies-literature
Project description:BackgroundPsychological distress including depression and anxiety are among the most serious causes of morbidity and mortality in Bangladesh. There has been no study in the rural area to report the prevalence of and risk factors for psychological distress. The aim of this study was to estimate the prevalence of and risk factors for psychological distress in a rural district in Bangladesh.MethodsA total of 2425 adults (1249 women) aged 18-90 years were selected from the Narail upazilla using multi-level cluster random sampling for a cross-sectional study. Psychological distress was assessed using the Kessler 10 items questionnaire. Participants' socio-demographic status, life style factors and health conditions were also collected. Odds ratios and 95% confidence intervals for binary outcomes and mean changes for continuous outcomes of psychological distress score were computed. Logistic regression and generalized linear model techniques were used for analytical purpose.ResultsThe overall prevalence of psychological distress was 52.5%. This proportion included 22.7% people rated as having mild psychological distress, 20.8% moderate and 9.0% severe. The prevalence of moderate (24.7% vs. 17.5%, p<0.001) and severe (16.2% vs. 2.5%, p<0.001) psychological distress was significantly higher in older adults of age 60-90 years than that in younger adults of age 18-59 years. The prevalence of severe psychological distress was higher in females than males and the difference increased with age (vs. (females vs males: 1.9% vs. 1.1% at age of <30 years, 12.2% vs. 10.1% at age between 60-69 years, and 45.5% vs. 25.4% at age of 80 years or older). After multivariate adjustment, compared to degree or equivalent level of education, no education (odds ratio (OR), 1.71, 95% confidence interval (CI), 1.03-2.82) was associated with higher prevalence of any psychological distress in the total sample. Compared to married, psychological distress among widowed older adults was almost five times higher prevalence (OR, 4.89, 95% CI, 2.51-9.55). Socio-economic status showed a U-shaped relationship with the prevalence of psychological distress; being very poor or wealthy was associated with higher prevalence of psychological distress compared to those of moderate socio-economic status. People living in pourashava (semi-urban areas) reported significantly higher prevalence of psychological distress compared to people living in typical rural unions.ConclusionsIn this rural Bangladeshi community, the prevalence of psychological distress was high, especially among older women. Factors including lower level of education, inability to work, and living in semi-urban areas were associated with higher prevalence of psychological distress. Public health programmes should target people in high risk groups to reduce their psychological distress in Bangladesh.
| S-EPMC6415806 | biostudies-literature
Project description:BackgroundWomen's groups and health education by peer counsellors can improve the health of mothers and children. We assessed their effects on mortality and breastfeeding rates in rural Malawi.MethodsWe did a 2×2 factorial, cluster-randomised trial in 185,888 people in Mchinji district. 48 equal-sized clusters were randomly allocated to four groups with a computer-generated number sequence. 24 facilitators guided groups through a community action cycle to tackle maternal and child health problems. 72 trained volunteer peer counsellors made home visits at five timepoints during pregnancy and after birth to support breastfeeding and infant care. Primary outcomes for the women's group intervention were maternal, perinatal, neonatal, and infant mortality rates (MMR, PMR, NMR, and IMR, respectively); and for the peer counselling were IMR and exclusive breastfeeding (EBF) rates. Analysis was by intention to treat. The trial is registered as ISRCTN06477126.FindingsWe monitored outcomes of 26,262 births between 2005 and 2009. In a factorial model adjusted only for clustering and the volunteer peer counselling intervention, in women's group areas, for years 2 and 3, we noted non-significant decreases in NMR (odds ratio 0.93, 0.64-1.35) and MMR (0.54, 0.28-1.04). After adjustment for parity, socioeconomic quintile, and baseline measures, effects were larger for NMR (0.85, 0.59-1.22) and MMR (0.48, 0.26-0.91). Because of the interaction between the two interventions, a stratified analysis was done. For women's groups, in adjusted analyses, MMR fell by 74% (0.26, 0.10-0.70), and NMR by 41% (0.59, 0.40-0.86) in areas with no peer counsellors, but there was no effect in areas with counsellors (1.09, 0.40-2.98, and 1.38, 0.75-2.54). Factorial analysis for the peer counselling intervention for years 1-3 showed a fall in IMR of 18% (0.82, 0.67-1.00) and an improvement in EBF rates (2.42, 1.48-3.96). The results of the stratified, adjusted analysis showed a 36% reduction in IMR (0.64, 0.48-0.85) but no effect on EBF (1.18, 0.63-2.25) in areas without women's groups, and in areas with women's groups there was no effect on IMR (1.05, 0.82-1.36) and an increase in EBF (5.02, 2.67-9.44). The cost of women's groups was US$114 per year of life lost (YLL) averted and that of peer counsellors was $33 per YLL averted, using stratified data from single intervention comparisons.InterpretationCommunity mobilisation through women's groups and volunteer peer counsellor health education are methods to improve maternal and child health outcomes in poor rural populations in Africa.FundingSaving Newborn Lives, UK Department for International Development, and Wellcome Trust.
| S-EPMC3796349 | biostudies-literature
Project description:Little is known about fasting practices and dietary changes during Ramadan in low- and lower-middle-income countries. Although pregnant women are exempt from fasting, they may still fast. This is of interest as dietary habits during pregnancy may affect the development of the unborn child. In a community-based sample of young women in rural Sylhet division, Bangladesh, we described fasting practices and beliefs (n = 852). We also examined reported food group consumption and minimally adequate dietary diversity for women (MDD-W) by Ramadan occurrence (n = 1,895) and by fasting adherence (n = 558) using logistic regression with Hindu women as a seasonal control. During Ramadan in 2018, 78% of pregnant Muslim women fasted every day. Over 80% of Muslim women believe that they should fast during pregnancy and over 50% expect positive health effects on the mother and the unborn child. We found strong evidence that Muslim women have more diverse diets during Ramadan, with higher odds of MDD-W (OR [95% CI]: 5.0 [3.6, 6.9]) and increased consumption of pulses, dairy, fruit, and large fish. Dietary diversity increased to a lesser extent on non-fasting days during Ramadan. Ramadan appears to improve dietary quality in both fasting and non-fasting Muslim women in a rural population in Bangladesh. These results help to interpret findings from studies on Ramadan during pregnancy on later-life outcomes and thus contribute to a better understanding of intrauterine influences of maternal nutrition on healthy child development.
| S-EPMC8189200 | biostudies-literature
Project description:ObjectiveThe aim of this study was to translate, adapt and validate the Kessler 10-item questionnaire (K10) for measuring psychological distress in rural Bangladesh.DesignCohort study.SettingNarail district, Bangladesh.ParticipantsA random sample of 2425 adults of age 18-90 years was recruited.Outcome measureValidation of the K10 was the major outcome. Sociodemographic factors were measured to assess if the K10 needed adjustment for factors such as age or gender. The Rasch measurement model was used for the validation, and RUMM 2030 and SPSS V.24 software were used for analyses.ResultsInitial inspection of the total sample showed poor overall fit. A sample size of 300, which is more satiated for Rasch analysis, also showed poor overall fit, as indicated by a significant item-trait interaction (?2= 262.27, df=40, p<0.001) and item fit residual values (mean=-0.25, SD=2.49). Of 10 items, five items were disordered thresholds, and seven items showed misfit, suggesting problems with the response format and items. After removing three items ('feel tired', 'depressed' and 'worthless') and changing the Likert scale categories from five to four categories, the remaining seven items showed ordered threshold. A revised seven-item scale has shown adequate internal consistency, with no evidence of multidimensionality, no differential item functioning on age and gender, and no signs of local dependency.ConclusionsAnalysis of the psychometric validity of K10 using the Rasch model showed that 10 items are not appropriate for measuring psychological distress in rural Bangladesh. A modified version of seven items (K7) with four response categories would provide a psychometrically more robust scale than the original K10. The study findings suggest repeating the K7 version in other remote areas for further validation can substantiate an efficient screening tool for measuring psychological distress among the general Bangladeshi population.
| S-EPMC6042570 | biostudies-literature
Project description:Up to 25% of postpartum women experience psychological distress including stress, depressive, or anxiety symptoms during the postpartum period. The purpose of this study was to explore the extent to which social determinants of health and allostatic load score, a 10-item index of biologic measures of chronic stress, predict psychological distress in low-income pregnant women over the first postpartum year. We conducted a secondary data analysis of the Child Community Health Research Network data set. The psychological distress outcome variables were perceived stress (n?=?842), depression ( n?=?845), and anxiety ( n?=?846) symptoms, all measured categorically over the first year postpartum (T1:1 month, T2: 24-29 weeks, and T3: 50-65 weeks). Our predictors were social determinants of health (e.g., demographics, maternal hardship, percent poverty level, interpersonal violence, and food security) and allostatic load score. Generalized linear mixed models were used to determine which predictors were significantly associated with psychological distress symptoms across the first postpartum year. Interpersonal violence was a statistically significant risk factor for stress, depression, and anxiety symptoms over the first year postpartum. Other significant risk factors included low-income level, nativity, and perceived food security. Receiving food stamps was a significant protective factor for stress symptoms. The significance of risk factors for psychological distress, both modifiable and nonmodifiable, can be used as potential targets for further research, screening, and intervention. Future work should explore why and in what conditions these risk factors vary over time.
| S-EPMC6472896 | biostudies-literature