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  • 1.
    Ali, DK
    et al.
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Yousefzade-Chabok, S
    Trauma Research Center, Guilan University of Medical Science, Rasht, Iran.
    Jansson, B
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Mohammadi, R
    Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
    Costs related to drowning and near drowning in northern Iran (Guilan province)2011In: Ocean and Coastal Management, ISSN 0964-5691, E-ISSN 1873-524X, Vol. 54, no 3, p. 250-255Article in journal (Refereed)
    Abstract [en]

    In Iran and many other low- and middle-income countries, few  studies have been carried out in order to assess which cost analysis methods should be  undertaken at the household and community level in relation to incidences of drowning. In this study, we have attempted to develop a model for  estimating the impact of the economic burden that drowning and near drowning events incur for victims’ families in the Guilan province in the north of  Iran by  using an  incidence approach. During the financial year of March 2007 to 2008,  the following cost-related aspects of  drowning episodes were evaluated: (note: main cost elements were income adjusted by family and years) medical costs, productivity loss  costs and death costs. A total of 137 drowning fatalities and 104 near drowning incidents were recorded. Males in the age  span of  10e29  years constitute a  majority of  the epidemiology and economy data. When the number of variables included in cost analysis was expanded, the estimated burden of economic duress increased dramatically; however, drowning cost for  one drowned victim was equivalent to 17  times the country’s  gross domestic product(GDP) per capital. Identification of  injured person-based costs in  this study will  enable development of  more effective prevention programs and provide indicators of  other costs related to drowning episodes such as  property damage and the impact of  these accidents on community services and the public health care system.

  • 2.
    Andrews, Johanna Y.
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Department of Medical and Health Sciences, Centre for Medical Technology Assessment, Division of Social Medicine and Public Health Sciences, Linköping University, Linköping, Sweden.
    Umbilical cord-cutting practices and place of delivery in Bangladesh2011In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479, Vol. 114, no 1, p. 43-6Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate place of delivery, umbilical cord-cutting instruments used, and substances applied to the cord stump in Bangladesh.

    Methods: A cross-sectional data analysis was performed on a nationally representative sample of 4925 women of reproductive age (15-49 years) with at least 1 child.

    Results: More than 80% of women delivered at home. In 6% of cases, blades from a clean-delivery kit (CDK) were used to cut the cord; in 90% of cases, the blades used were from another source; in 4% of cases, other instruments such as bamboo strips and scissors were used to cut the cord. In 51% of cases, a substance (e.g. antibiotic powder/ointment, alcohol/spirit, mustard oil with garlic, boric powder, turmeric, and chewed rice) was applied to the stump after the cord was cut.

    Conclusion: The present findings underscore the need for further advocacy, availability, and use of cord-cutting instruments from CDKs, especially for deliveries that occur outside healthcare facilities.

  • 3.
    Andrews-Chavez, Johanna
    et al.
    Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA.
    Biswas, Animesh
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gifford, Mervyn
    Department of Public Health Sciences, University of Skövde, Skövde, Sweden.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Identifying households with low immunisation completion in Bangladesh2012In: Health, ISSN 1949-4998, E-ISSN 1949-5005, Vol. 4, no 11, p. 1088-1097Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate if the mothers’ demographics and household characteristics—including type of use of cooking fuel, energy and toilet facilities—have any implication for complete immunisation rates among their children. A cross-sectional data analysis of a nationally representative sample of 4925 women with at least one child was performed. Chisquared tests and multivariate logistic regression analyses were used. Immunisation coverage was positively associated with the mother’s education and with household characteristics such as toilet facility, electricity and involvement in a microfinance group. These findings indicate the need for further advocacy for increased knowledge on the importance of vaccination and affordable public immunisation programs focusing on higher risk households such as those with pit facilities, lack of electricity and no participation in a microfinance group. Such households warrant further attention and can be targeted for immunisation coverage.

  • 4.
    Aremu, Olatunde
    et al.
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden; College of Medicine, University of Ibadan Oyo State, Ibadan, Nigeria.
    Lawoko, Stephen
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköpings University, Linköping, Sweden.
    Childhood vitamin A capsule supplementation coverage in Nigeria: a multilevel analysis of geographic and socioeconomic inequities.2010In: The Scientific World Journal, ISSN 1537-744X, Vol. 10, p. 1901-14Article in journal (Refereed)
    Abstract [en]

    Vitamin A deficiency (VAD) is a huge public health burden among preschool-aged children in sub-Saharan Africa, and is associated with a high level of susceptibility to infectious diseases and pediatric blindness. We examined the Nigerian national vitamin A capsule (VAC) supplementation program, a short-term cost-effective intervention for prevention of VAD-associated morbidity for equity in terms of socioeconomic and geographic coverage. Using the most current, nationally representative data from the 2008 Nigerian Demographic and Health Survey, we applied multilevel regression analysis on 19,555 children nested within 888 communities across the six regions of Nigeria. The results indicate that there was variability in uptake of VAC supplement among the children, which could be attributed to several characteristics at individual, household, and community levels. Individual-level characteristics, such as maternal occupation, were shown to be associated with receipt of VAC supplement. The results also reveal that household wealth status is the only household-level characteristic that is significantly associated with receipt of VAC, while neighborhood socioeconomic disadvantage and geographic location were the community-level characteristics that determined receipt of VAC. The findings from this study have shown that both individual and contextual socioeconomic status, together with geographic location, is important for uptake of VAC. These findings underscore the need to accord the VAC supplementation program the much needed priority with focus on characteristics of neighborhoods (communities), in addition to individual-level characteristics.

  • 5.
    Aremu, Olatunde
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; College of Medicine, University of Ibadan, Ibadan, Nigeria.
    Lawoko, Stephen
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medicine and Health Sciences, Centre for Health Technology Assessment, Linköping University, Linköping, Sweden.
    Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis.2011In: International Journal of Women's Health, ISSN 1179-1411, E-ISSN 1179-1411, Vol. 3, p. 167-74Article in journal (Refereed)
    Abstract [en]

    Background: High maternal mortality continues to be a major public health problem in most part of the developing world, including Nigeria. Understanding the utilization pattern of maternal healthcare services has been accepted as an important factor for reducing maternal deaths. This study investigates the effect of neighborhood and individual socioeconomic position on the utilization of different forms of place of delivery among women of reproductive age in Nigeria.

    Methods: A population-based multilevel discrete choice analysis was performed using the most recent population-based 2008 Nigerian Demographic and Health Surveys data of women aged between 15 and 49 years. The analysis was restricted to 15,162 ever-married women from 888 communities across the 36 states of the federation including the Federal Capital Territory of Abuja.

    Results: The choice of place to deliver varies across the socioeconomic strata. The results of the multilevel discrete choice models indicate that with every other factor controlled for, the household wealth status, women's occupation, women's and partner's high level of education attainment, and possession of health insurance were associated with use of private and government health facilities for child birth relative to home delivery. The results also show that higher birth order and young maternal age were associated with use of home delivery. Living in a highly socioeconomic disadvantaged neighborhood is associated with home birth compared with the patronage of government health facilities. More specifically, the result revealed that choice of facility-based delivery is clustered around the neighborhoods.

    Conclusion: Home delivery, which cuts across all socioeconomic strata, is a common practice among women in Nigeria. Initiatives that would encourage the appropriate use of healthcare facilities at little or no cost to the most disadvantaged should be accorded the utmost priority.

  • 6. Aremu, Olatunde
    et al.
    Lawoko, Stephen
    Dalal, Koustuv
    The influence of individual and contextual socioeconomic status on obstetric care utilization in the democratic republic of Congo: a population-based study2012In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 3, no 4, p. 278-285Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal health care utilization continues to focus on the agenda of health care planners around the world, with high attention being paid to the developing countries. The devastating effect of maternal death at birth on the affected families is untold. This study examines the utilization of obstetric care in the Democratic Republic of Congo.

    METHODS: We have used the nationally representative data from the 2007. Democratic Republic of Congo Demographic and Health Survey. Multilevel regression analysis has been applied to a nationally representative sample of 6,695 women, clustered around 299 communities in the country.

    RESULTS: The results show that there are variations in the use of antenatal care and delivery care. Individual-level characteristics, such as women's occupation and household wealth status are shown to be associated with the use of antenatal care. Uptake of facility-based delivery has been seen to be dependent on the household wealth status, women's education, and partner's education. The effect of the neighborhoods' socioeconomic disadvantage on the use of antenatal care and facility-based delivery are the same. Women from highly socioeconomically disadvantaged communities, compared to their counterparts from less socioeconomically disadvantaged neighborhoods, are less likely to utilize both the antenatal services and healthcare facility for child delivery. The result of this study has shown that both individual and contextual socioeconomic status play an important role in obstetric care uptake.

    CONCLUSION: Thus, intervention aimed at improving the utilization of obstetrics care should target both the individual economic abilities of the women and that of their environment when considering the demand side.

  • 7.
    Aremu, Olatunde
    et al.
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Southampton Health Technology Assessment Centre, School of Medicine University of Southampton, Southampton, UK; College of Medicine, University of Ibadan, Ibadan, Nigeria .
    Lawoko, Stephen
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Moradi, Tahereh
    Division of Epidemiology, The institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Dalal, Koustuv
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; Departments of Medicine and Health Science, Centre for Health Technology Assessment Linköping University, Linköping, Sweden.
    Socio-economic determinants in selecting childhood diarrhoea treatment options in Sub-Saharan Africa: a multilevel model.2011In: The Italian Journal of Pediatrics, ISSN 1720-8424, E-ISSN 1824-7288, Vol. 37, no 13Article in journal (Refereed)
    Abstract [en]

    Background: Diarrhoea disease which has been attributed to poverty constitutes a major cause of morbidity and mortality in children aged five and below in most low-and-middle income countries. This study sought to examine the contribution of individual and neighbourhood socio-economic characteristics to caregiver's treatment choices for managing childhood diarrhoea at household level in sub-Saharan Africa.

    Methods: Multilevel multinomial logistic regression analysis was applied to Demographic and Health Survey data conducted in 11 countries in sub-Saharan Africa. The unit of analysis were the 12,988 caregivers of children who were reported to have had diarrhoea two weeks prior to the survey period.

    Results: There were variability in selecting treatment options based on several socioeconomic characteristics. Multilevel-multinomial regression analysis indicated that higher level of education of both the caregiver and that of the partner, as well as caregivers occupation were associated with selection of medical centre, pharmacies and home care as compared to no treatment. In contrast, caregiver's partners' occupation was negatively associated with selection medical centre and home care for managing diarrhoea. In addition, a low-level of neighbourhood socio-economic disadvantage was significantly associated with selection of both medical centre and pharmacy stores and medicine vendors.

    Conclusion: In the light of the findings from this study, intervention aimed at improving on care seeking for managing diarrhoea episode and other childhood infectious disease should jointly consider the influence of both individual SEP and the level of economic development of the communities in which caregivers of these children resides.

  • 8.
    Bazargan-Hejazi, Shahrzad
    et al.
    College of Medicine, Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles CA, USA; David Geffen School of Medicine, Department. Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles CA, USA.
    Medeiros, Sarah
    College of Medicine, Charles R Drew University & David Geffen School of Medicine, University of California, Los Angeles CA, USA.
    Mohammadi, Reza
    Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Lin, Johnny
    Department of Psychology, University of California, Los Angeles CA, USA.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Patterns of intimate partner violence: a study of female victims in Malawi2013In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 5, no 1, p. 38-50Article in journal (Refereed)
    Abstract [en]

    Background: The term “intimate partner violence” (IPV) encompasses physical, sexual andpsychological violence, or any combination of these acts, and globally is the most common type ofviolence against women. This study aims to examine the lifetime prevalence of different types ofintimate partner violence (IPV) among Malawi women ages 15 to 49, and its association withage, education, and living in rural versus urban areas.

    Methods: Data was obtained from a cross-sectional study of data as part of the 2004 MalawiDemographic and Health Survey. Women were eligible for the study if they met the followingcriteria: 1) lived in one of the 15,041 households randomly selected from 522 rural and urbanclusters located in 10 large districts of Malawi; 2) were married or cohabitating; and 3) werebetween the ages of 15 and 49 years. Consenting, eligible women responded to acomprehensive questionnaire covering demographic factors, health issues, as well as items relatedto physical, emotional and sexual IPV. To assess bivariate associations, chi-squared tests andmultivariate logistic regressions were conducted.

    Results: Among the 8291 respondents, 13% reported emotional violence; 20% reported beingpushed, shaken, slapped or punched; 3% reported experiencing severe violence, such as beingstrangled or burned, threatened with a knife, gun or with another weapon; and 13% reportedsexual violence. Data showed women ages 15 to 19 were significantly less likely to reportemotional IPV, women ages 25 to 29 were significantly more likely to report being pushed orshaken, slapped or punched (OR 1.35; CI: 1.05-1.73), and women ages 30 to 34 weresignificantly more likely to report sexual IPV, compared to women ages 45 to 49 (OR 1.40; CI:1.03-1.90). Finally, women who had no ability to read were less likely to report sexual IPV thantheir counterparts who could read a full sentence (OR 0.76; CI: 0.66-0.87).

    Conclusion: The prevalence of different types of IPV in Malawi appears slightly lower than thatreported for other countries in sub-Saharan Africa. Further studies are needed to assess theattitudes and behaviors of Malawi women towards acceptability and justification of IPV as wellas their willingness to disclose it.

  • 9.
    Bendtsen, Preben
    et al.
    Department of Medicine and Health, Linköping University, Linköping, Sweden.
    Karlsson, Nadine
    Department of Medicine and Health, Linköping University, Linköping, Sweden.
    Dalal, Koustuv
    Department of Medicine and Health, Linköping University, Linköping, Sweden.
    Nilsen, Per
    Department of Medicine and Health, Linköping University, Linköping, Sweden.
    Hazardous drinking concepts, limits and methods: low levels of awareness, knowledge and use in the Swedish population2011In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 46, no 5, p. 638-45Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate the awareness and knowledge of hazardous drinking limits among the general population in Sweden and the extent to which people estimate their alcohol consumption in standard drinks to assess their level of drinking.

    Methods: A population-based study involving 6000 individuals selected from the total Swedish population was performed. Data were collected by means of a postal questionnaire. The mail survey response rate was 54.3% (n = 3200) of the net sample of 5891 persons.

    Results: With regard to drinking patterns, 10% of the respondents were abstainers, 59% were sensible drinkers and 31% were classified as hazardous drinkers. Most of the abstainers (80%), sensible drinkers (64%) and hazardous drinkers (56%) stated that they had never heard about the standard drink method. Familiarity with the hazardous drinking concept also differed between the three categories although ∼61% of sensible and hazardous drinkers expressed awareness of the concept (46% of the abstainers). Knowledge about the limits for sensible drinking was very poor. Between 94 and 97% in the three categories did not know the limit. There was a statistically significant association between having visited health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits. Similarly, there was a significant association between having had at least one alcohol conversation in health care within the last 12 months and being aware of the standard drink method and the hazardous drinking concept, but not with knowing the hazardous drinking limits.

    Conclusion: The results can be seen as a major challenge for the health-care system and public health authorities because they imply that a large proportion of the Swedish population does not know when alcohol consumption becomes a threat to their health. The current strategy to disseminate knowledge about sensible drinking limits to the population through the health-care system seems to have failed and new means of informing the population are warranted.

  • 10.
    Biswas, Animesh
    et al.
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh.
    Abdullah, Abu Sayeed Md
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences. Department of Public Health Science.
    Deave, Toity
    Centre for Child and Adolescent Health, Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom.
    Rahman, Fazlur
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh; Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.
    Mashreky, Saidur Rahman
    Reproductive and Child Health Department, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Mohakhali Dhaka, Bangladesh; Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh.
    Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh2018In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 18, article id 467Article in journal (Refereed)
    Abstract [en]

    Background: Burns can be the most devastating injuries in the world, they constitute a global public health problem and cause widespread public health concern. Every year in Bangladesh more than 365,000 people are injured by electrical, thermal and other causes of burn injuries. Among them 27,000 need hospital admission and over 5600 people die. Immediate treatment and medication has been found to be significant in the success of recovering from a burn. However, common practices used in the treatment of burn injuries in the community is not well documented in Bangladesh. This study was designed to explore the perception of local communities in Bangladesh the common practices used and health-seeking behaviors sought immediately after a burn injury has occurred.

    Methods: A qualitative study was conducted using Focus Group Discussions (FGD) as the data collection method. Six unions of three districts in rural Bangladesh were randomly selected and FGDs were conducted in these districts with six burn survivors and their relatives and neighbours. Data were analyzed manually, codes were identified and the grouped into themes.

    Results: The participants stated that burn injuries are common during the winter in Bangladesh. Inhabitants in the rural areas said that it was common practice, and correct, to apply the following to the injured area immediately after a burn: egg albumin, salty water, toothpaste, kerosene, coconut oil, cow dung or soil. Some also believed that applying water is harmful to a burn injury. Most participants did not know about any referral system for burn patients. They expressed their dissatisfaction about the lack of available health service facilities at the recommended health care centers at both the district level and above.

    Conclusions: In rural Bangladesh, the current first-aid practices for burn injuries are incorrect; there is a widely held belief that using water on burns is harmful.

  • 11.
    Biswas, Animesh
    et al.
    Örebro University, School of Health Sciences. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Abdullah, Abu Sayeed Md
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Gifford, Mervyn
    Örebro University, School of Health Sciences.
    Halim, M.A.
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Maternal complications in a geographically challenging and hard to reach district of Bangladesh: a qualitative study2016In: F1000 Research, E-ISSN 2046-1402, Vol. 5, article id 2417Article in journal (Refereed)
    Abstract [en]

    Background: Maternal complications contribute to maternal deaths in developing countries. Bangladesh still has a high prevalence of maternal mortality, which is often preventable. There are some geographically challenging and hard to reach rural districts in Bangladesh and it is difficult to get information about maternal complications in these areas. In this study, we examined the community lay knowledge of possible pregnancy complications. We also examined the common practices associated with complications and we discuss the challenges for the community.

    Methods: The study was conducted in Moulvibazar of north east Bangladesh, a geographically challenged, difficult to reach district. Qualitative methods were used to collect the information. Pregnant women, mothers who had recently delivered, their guardians and traditional birth attendants participated in focus group discussions. Additionally, in-depth interviews were conducted with the family members. Thematic analyses were performed.

    Results: The study revealed that there is a lack of knowledge of maternal complications. In the majority of cases, the mothers did not receive proper treatment for maternal complications. There are significant challenges that these rural societies need to address: problems of ignorance, traditional myths and family restrictions on seeking better treatment. Moreover, traditional birth attendants and village doctors also have an important role in assuring appropriate, effective and timely treatment.

    Conclusions: The rural community lacks adequate knowledge on maternal complications. Reduction of the societal barriers including barriers within the family can improve overall practices. Moreover, dissemination of adequate information to the traditional birth attendant and village doctors may improve the overall situation, which would eventually help to reduce maternal deaths.

  • 12.
    Biswas, Animesh
    et al.
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh .
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Deave, Toity
    University of the West of England, Bristol, United Kingdom.
    Mashreky, Saidur Rahman
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh; Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh .
    Burn Injury of a Pregnant Mother in Rural Bangladesh: A Case Report2017In: Health Scope, ISSN 2251-8959, Vol. 6, no 4, article id e63168Article in journal (Refereed)
    Abstract [en]

    Introduction: This paper describes a case of pregnant mother who died of burn injury in order to understand the societal factors related to the event. We reviewed the case in the rural community. Initially, the case was reported as a maternal death to maternal and neonatal death review (MNDR) system being conducted in Bangladesh within exiting health system to explore the medical and social causes of maternal and newborn deaths. However, during the verbal autopsy, it was found that the mother died of bun injury. Therefore, we performed detailed case study.

    Case Presentation: A woman aged 18 years was nine months pregnant in a rural community in Moheskhali upazila of Cox's Bazar district. During the wintertime, themotherfeels coldandgoes near to the oven in the yard to bewarm. Suddenly, part of her clothing (Anchal of Sari) catches fire; she does not recognized and starts to walk towards her room. A neighbor notices and starts to shout. The woman scars and tries to run. The neighbors come with a bucket of water. By this time, the fire spreads over whole body and cloths. Immediately after the event, she is transferred to a medical college hospital.

    Conclusions: Doctors tried to do immediate cesarean section; however, they could not save the life of the baby inside. The mother who was severely burnt also died after 10 days. Rural community in Bangladesh still does not have adequate awareness and knowledge about risk of burn. The scarce knowledge of appropriate steps immediately after burn was explored. Moreover, delays in decision-making and transferring the patient to the facility were identified. Specific interventions need to be taken to increase knowledge and awareness in the community, which could save thousands of lives.

  • 13.
    Biswas, Animesh
    et al.
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Hossain, Jahangir
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Baset, Kamran Ul
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Mashreky, Saidur Rahman
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Lightning Injury is a disaster in Bangladesh?: Exploring its magnitude and public health needs2016In: F1000 Research, E-ISSN 2046-1402, Vol. 5, article id 2931Article in journal (Refereed)
    Abstract [en]

    Background: Lightning injury is a global public health issue. Low and middle-income countries in the tropical and subtropical regions of the world are most affected by lightning. Bangladesh is one of the countries at particular risk, with a high number of devastating lightning injuries in the past years, causing high mortality and morbidity. The exact magnitude of the problem is still unknown and therefore this study investigates the epidemiology of lightning injuries in Bangladesh, using a national representative sample.

    Methods: A mixed method was used. The study is based on results from a nationwide cross-sectional survey performed in 2003 in twelve randomly selected districts. In the survey, a total of 819,429 respondents from 171,336 households were interviewed using face-to-face interviews. In addition, qualitative information was obtained by reviewing national and international newspaper reports of lightning injuries sustained in Bangladesh between 13 and 15 May 2016.

    Results: The annual mortality rate was 3.661 (95% CI 0.9313–9.964) per 1,000,000 people. The overall incidence of lightning injury was 19.89/100,000 people. Among the victims, 60.12% (n=98) were males and 39.87% (n=65) were females. Males were particularly vulnerable, with a 1.46 times increased risk compared with females (RR 1.46, 95% CI 1.06–1.99). Rural populations were more vulnerable, with a 8.73 times higher risk, than urban populations (RR 8.73, 95% CI 5.13–14.86). About 43% of injuries occurred between 12 noon and 6 pm. The newspapers reported 81 deaths during 2 days of electric storms in 2016. Lightning has been declared a natural disaster in Bangladesh.

    Conclusions: The current study indicates that lightning injuries are a public health problem in Bangladesh. The study recommends further investigations to develop interventions to reduce lightning injuries, mortality and related burden in Bangladesh.

  • 14.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh; Deptartment of Public Health Sciences, Region Örebro County, Örebro, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rahman, Fazlur
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Deave, Toity
    Centre for Child & Adolescent Health, Health & Applied Sciences, University of the West of England, Bristol, UK.
    Intimate Partner Violence during pregnancy and victim’s perception on miscarriage2015In: International Journal of Public Health Research, ISSN 2381-4837, Vol. 3, no 2, p. 58-63Article in journal (Refereed)
    Abstract [en]

    Introduction: Women who suffer intimate partner violence (IPV) encounter reproductive health problems including miscarriages. IPV in Bangladeshi women is known to be acute socio- medical problem. The aim of the current study was to determine the prevalence of intimate partner violence from the husband during pregnancy and to explore the victims’ perceptions of IPV and miscarriage.

    Methods: Women who were admitted to a sub-district level hospital in Bangladesh due to miscarriage between July and December 2007 were invited to participate. A cross-sectional study was performed using mixed methods. Descriptive statistics were applied to the quantitative data and the qualitative data were analysed using thematic analysis.

    Results: Majority of women aged between 18 – 30 years (68.4%), more than 38% had no education and most of them had low socio-economic conditions. 43 (56.6%) women reported that they had experienced sexual violence in the last four months. 20 (26.3%) women suffered this once a week and 30% (n=23) faced sexual violence twice or more in a week. 29 (38.2%) women believed that current miscarriage was due to their husband’s sexual violence. The women reported that their husband forced sexual intercourse on them and that they were highly controlling over their day-to-day lives.

    Conclusion: Sexual violence during pregnancy is a hidden health problem for women in rural Bangladesh. Education and information need to be made more widely available to improve maternal health and child survival.

  • 15.
    Biswas, Animesh
    et al.
    Örebro University, School of Health Sciences. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Halim, Abdul
    Centre for Injury Prevention and Research (CIPRB) , Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research (CIPRB) , Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health Sciences.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    The Economic Cost of Implementing Maternal and Neonatal Death Review in a District of Bangladesh2016In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036, Vol. 5, no 3, p. 99-103, article id 729Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Maternal and neonatal death review (MNDR) introduced in Bangladesh and initially piloted in a district during 2010. MNDR is able to capture each of the maternal, neonatal deaths and stillbirths from the community and government facilities (hospitals). This study aimed to estimate the cost required to implement MNDR in a district of Bangladesh during 2010-2012.

    Materials and Methods: MNDR was implemented in Thakurgaon district in 2010 and later gradually extended until 2015. MNDR implementation framework, guidelines, tools and manual were developed at the national level with national level stakeholders including government health and family planning staff at different cadre for piloting at Thakurgaon. Programme implementation costs were calculated by year of costing and costing as per component of MNDR in 2013. The purchasing power parity conversion rate was 1 $INT = 24.46 BDT, as of 31st Dec 2012.

    Results: Overall programme implementation costs required to run MNDR were 109,02,754 BDT (445,738 $INT $INT) in the first year (2010). In the following years cost reduced to 8,208,995 BDT (335,609 $INT, during 2011) and 6,622,166 BDT (270,735 $INT, during 2012). The average cost per activity required was 3070 BDT in 2010, 1887 BDT and 2207 BDT required in 2011 and 2012 respectively. Each death notification cost 4.09 $INT, verbal autopsy cost 8.18 $INT, and social autopsy cost 16.35 $INT. Facility death notification cost 2.04 $INT and facility death review meetings cost 20.44 $INT. One death saved by MNDR costs 53,654 BDT (2193 $INT).

    Conclusions: Programmatic implementation cost of conducting MPDR give an idea on how much cost will be required to run a death review system for a low income country settings using government health system.

  • 16.
    Biswas, Animesh
    et al.
    Örebro University, School of Health Sciences. Reproductive and Child Health Unit, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Halim, M. A.
    Reproductive and Child Health Unit, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Rahman, Fazlur
    Reproductive and Child Health Unit, Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Exploration of social factors associated to maternal deaths due to haemorrhage and convulsions: Analysis of 28 social autopsies in rural Bangladesh2016In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, no 1, article id 659Article in journal (Refereed)
    Abstract [en]

    Background: Social autopsy is an innovative approach to explore social barriers and factors associated to a death in the community. The process also sensitize the community people to avert future deaths. Social autopsy has been introduced in maternal deaths in Bangladesh first time in 2010. This study is to identify the social factors in the rural community associated to maternal deaths. It also looks at how the community responses in social autopsy intervention to prevent future maternal deaths.

    Methods: The study was conducted in the Thakurgaon district of Bangladesh in 2010. We have purposively selected 28 social autopsy cases of which maternal deaths occurred due to either haemorrhage or due to convulsions. The autopsy was conducted by the Government health and family planning first line field supervisors in rural community. Family members and neighbours of the deceased participated in each autopsy and provided their comments and responses.

    Results: A number of social factors including delivery conducted by the untrained birth attendant or family members, delays in understanding about maternal complications, delays in decision making to transfer the mother, lack of proper knowledge, education and traditional myth influences the maternal deaths. The community identified their own problems, shared within them and decide upon rectify themselves for future death prevention.

    Conclusions: Social autopsy is a useful tools to identify social community within the community by discussing the factors that took place during a maternal death. The process supports villagers to think and change their behavioural patterns and commit towards preventing such deaths in the future.

  • 17.
    Biswas, Animesh
    et al.
    Centre for Injury Prevention Research, Dhaka, Bangladesh.
    Rahman, Aminur
    Centre for Injury Prevention Research, Dhaka, Bangladesh.
    Mashreky, Saidur
    Centre for Injury Prevention Research, Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention Research, Dhaka, Bangladesh.
    Dalal, Koustuv
    Department of Medical and Health Sciences, Center for Medical Technology Assessment and Division of Social Medicine and Public Health Sciences, Linköping Universtity, Linköping, Sweden.
    Unintentional injuries and parental violence against children during flood: a study in rural Bangladesh.2010In: Rural and remote health, ISSN 1445-6354, Vol. 10, no 1, p. 1199-Article in journal (Refereed)
    Abstract [en]

    Introduction: Violence and injuries are under-reported in developing countries, especially during natural disasters such as floods. Compounding this, affected areas are isolated from the rest of the country. During 2007 Bangladesh experienced two consecutive floods which affected almost one-third of the country. The objective of this study was to examine unintentional injuries to children in rural Bangladesh and parental violence against them during floods, and also to explore the association of socioeconomic characteristics.

    Methods: A cross-sectional rural household survey was conducted in the worst flood-affected areas. A group of 638 randomly selected married women of reproductive age with at least one child at home were interviewed face-to-face using pre-tested structured questionnaires. The chi2 test and logistic regression were used for data analysis.

    Results: The majority of families (90%) were affected by the flood and were struggling to find food and shelter, resulting in the parents becoming violent towards their children and other family members in the home. Cuts (38%), falls (22%) and near drowning (21%) comprised the majority of unintentional injuries affecting children during the floods. A large number of children were abused by their parents during the floods (70% by mothers and 40% by fathers). The incidence of child injuries and parental violence against children was higher among families living in poor socio-economic conditions, whose parents were of low occupational status and had micro-credit loans during the floods.

    Conclusions: Floods can have significant effects on childhood injury and parental violence against children. The improvement of socio-economic conditions would assist in preventing child injuries and parental violence.

  • 18.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh; Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh; WHO Collaborating Centre On Community Safety Promotion, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Rahman, Aminur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Rahman Mashkreky, Saidur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Humaira, Tasnuva
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rescue and emergency management of a man-made disaster: Lesson learnt from a collapse factory building, Bangladesh2015In: Scientific World Journal, ISSN 1537-744X, E-ISSN 1537-744X, article id 136434Article in journal (Refereed)
    Abstract [en]

    A tragic disaster occurred on April 24, 2013, in Bangladesh, when a nine storied building in a suburban area collapsed and killed 1115 people and injured many more.The study describes the process of rescue operation and emergency management services provided in the event. Data were collected using qualitative methods including in-depth interviews and a focus group discussion with the involved medical students, doctors, volunteers, and local people. Immediately after the disaster, rescue teams came to the place from Bangladesh Armed Forces, Bangladesh Navy, Bangladesh Air Force, and Dhaka Metropolitan and local Police and doctors, medical students, and nurses fromnearbymedical college hospitals and private hospitals and students fromcolleges and universities including local civil people. Doctors and medical students provided 24-hour services at the disaster place and in hospitals. Minor injured patients were treated at health camps and major injured patients were immediately carried to nearby hospital. Despite the limitations of a low resource setting, Bangladesh faced a tremendous challenge to manage the man-made disaster and experienced enormous support from different sectors of society to manage the disaster carefully and saved thousands of lives. This effort could help to develop a standard emergency management system applicable to Bangladesh and other counties with similar settings.

  • 19.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Rahman, F.
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Maternal and neonatal death review (MNDR): A useful approach in identifying appropriate and effective maternal and neonatal health initiative in Bangladesh2014In: Health, ISSN 1949-5005, Vol. 6, p. 1669-1679Article in journal (Refereed)
    Abstract [en]

    Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh.

    Methods: Both quantitative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangladesh. Death notifications from households, subsequent data collections from a focus-group discussion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines.

    Results: A total of four maternal deaths, 21 neonatal deaths and 15 still birthswere reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness programmes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community healthcare providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, stillbirth = 8; in 2012 maternal death = 1, neonatal death = 8, still birth = 13).

    Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

  • 20.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh2014In: Health, ISSN 1949-5005, Vol. 6, no 16, p. 2218-2226Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the study was to examine the process of community maternal, neonatal deaths and still births notification within the Bangladesh government health structure using the Maternal and Neonatal Death Review (MNDR) system. The study also explored the feasibility and acceptance of community death notification in the MNDR system.

    Methods: The study was under-taken in the Thakurgaon district of Bangladesh during 2010. During the study a mix of both qualitative and quantitative information was collected. A review of the documentation process of community death notification was undertaken and focus group discussions (FGDs) with community members, health care providers and managers in a sub-district were conducted, with in-depth interviews (IDIs) with district heath and family planning managers. Quantitative data were collected from community death notifications in the district during January to December 2010.

    Results: The death notification process was implemented by the government health care system within the Thakurgaon district. Field level health and family planning staff collected maternal and neonatal death information, recorded the death on the notification form and reported back to the Upazila (sub-district of the district) focal point at the Upazila health complex (primary health care centre). Community people were encouraged to share their death information to field level health staff. The health and family planning managers in the district periodically discussed the maternal and neonatal deaths and prepared remedial action plans in high death notified areas. In 2010, 59 maternal deaths, 739 neonatal deaths and 633 still births were reported in Thakurgaon district. District health and family planning departments performed community death notification as part of their routine daily work and integrated these procedures with other field level activities.

  • 21.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The economic cost of implementing maternal and neonatal death review in a district of BangladeshManuscript (preprint) (Other academic)
  • 22.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Halim, Abdul
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Facility Death Review of Maternal and Neonatal Deaths in Bangladesh2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 11, article id e0141902Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.

    Methods This was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.

    Results: FDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.

    Discussion: FDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.

  • 23.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Halim, Abdul
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Social Autopsy: A Social Intervention to Generate Community Awareness of Maternal and Neonatal DeathsManuscript (preprint) (Other academic)
  • 24.
    Biswas, Animesh
    et al.
    Örebro University, School of Health Sciences. Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health Sciences.
    Halim, Abdul
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Social Autopsy of maternal, neonatal deaths and stillbirths in rural Bangladesh: qualitative exploration of its effect and community acceptance2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 8, article id e010490Article in journal (Refereed)
    Abstract [en]

    Objectives: Social Autopsy (SA) is an innovative strategy where a trained facilitator leads community groups through a structured, standardised analysis of the physical, environmental, cultural and social factors contributing to a serious, non-fatal health event or death. The discussion stimulated by the formal process of SA determines the causes and suggests preventative measures that are appropriate and achievable in the community. Here we explored individual experiences of SA, including acceptance and participant learning, and its effect on rural communities in Bangladesh. The present study had explored the experiences gained while undertaking SA of maternal and neonatal deaths and stillbirths in rural Bangladesh.

    Design: Qualitative assessment of documents, observations, focus group discussions, group discussions and in-depth interviews by content and thematic analyses.

    Results: Each community's maternal and neonatal death was a unique, sad story. SA undertaken by government field-level health workers were well accepted by rural communities. SA had the capability to explore the social reasons behind the medical cause of the death without apportioning blame to any individual or group. SA was a useful instrument to raise awareness and encourage community responses to errors within the society that contributed to the death. People participating in SA showed commitment to future preventative measures and devised their own solutions for the future prevention of maternal and neonatal deaths.

    Conclusions: SA highlights societal errors and promotes discussion around maternal or newborn death. SA is an effective means to deliver important preventative messages and to sensitise the community to death issues. Importantly, the community itself is enabled to devise future strategies to avert future maternal and neonatal deaths in Bangladesh.

  • 25.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Halim, Abdul
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Experiences of community verbal autopsy in maternal and newborn health in Bangladesh2015In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 9, no 8, p. 329-338Article in journal (Refereed)
    Abstract [en]

    Introduction: Verbal autopsy in maternal and neonatal deaths is commonly used in developing countries to understand the medical and social causes of death in the community. Bangladesh first undertook a community verbal autopsy program in 2010. This was implemented under the maternal and neonatal death review (MNDR) system.

    Objectives: To know the process of implementation of community verbal autopsy, its acceptability and effect in maternal and neonatal health, Bangladesh.

    Methods: A qualitative study was performed In two districts of Bangladesh in 2011. A review of documents, observations, focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted with health care providers from different systems. Data were analysed using a thematic approach

    Results: Community verbal autopsy was developed in Bangladesh using existing available tools and guidelines. First line field supervisors from health and family planning departments conducted verbal autopsies at the deceased’s home. It has been adopted within the government health system and is able to identify medical and social causes, including delays within the community that are the major contributing factors of maternal and neonatal deaths. Verbal autopsy findings are shared at the Upazila level (sub-district) and these influence the development and implementation of local action plans. Recall bias and hard to reach areas are still challenges to be overcome in the conduction of verbal autopsies.

    Conclusions: The use of community verbal autopsy to identify medical and social causes of maternal and neonatal deaths is possible in an encouraging country context. The Government health system can comfortably conduct autopsies within the community. The findings of autopsy can be an effective tool and can be used by the local health and family planning managers to take the initiative at local level to improve health status of the mother and newborn.

  • 26.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Halim, Abdul
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Experiences of Community Verbal Autopsy in Maternal and Newborn Health of Bangladesh2015Manuscript (preprint) (Other academic)
  • 27.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Rahman, Fazlur
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh.
    Halim, Abdul
    Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh; Department of Obstetrics and Gynaecology, Kumudini Women’s Medical College, Tangail, Bangladesh.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Maternal and neonatal death review (MNDR): A useful approach to identifying appropriate and effective maternal and neonatal health initiatives in Bangladesh2014Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh.

    Methods: Both quan- titative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangla- desh. Death notifications from households, subsequent data collections from a focus-group discus- sion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines.

    Results: A total of four maternal deaths, 21 neonatal deaths and 15 still births were reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness pro- grammes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community health- care providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, still birth = 8; in 2012 maternal death = 1, neonatal death = 8, still birth = 13).

    Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

  • 28.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Rahman Mashkreky, Saidur
    Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
    Abdullah, Abu Sayeed Md
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    A manmade urban disaster caused a child death: Experience and lessons learnt from a tragic case study in Bangladesh2015In: International Journal of Current Research, ISSN 0975-833X, E-ISSN 0975-833X, Vol. 7, no 6, p. 17383-17386Article in journal (Refereed)
  • 29.
    Biswas, Animesh
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rahman Mashreky, Saidur
    Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
    Dalal, Koustuv
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Deave, Toity
    Centre for Child & Adolescent Health, University of the West of England, Bristol, UK.
    Response to an earthquake in Bangladesh: Experiences and Lesson Learnt2016In: Open Journal of Earthquake Research, ISSN 2169-9631, Vol. 5, p. 1-6Article in journal (Refereed)
    Abstract [en]

    A powerful earthquake occurred in Nepal on 25th April 2015 where the highest measure of the tremor was 7.9 on the Richter scale with a minimum of 6.6. The death toll was around 3000 and thousands were injured in the devastation of the disaster. The earthquake and subsequent earth tremors were also felt in other South East Asian countries including Bangladesh, India and China. Bangladesh was jolted twice by tremors and, although the tremor was not as severe, it was reported to be between 4 and 5 on the Richter scale. Aftershocks over the next few days were also experienced and these ranged around 5 on the Richter scale. In Bangladesh, six lives were lost, and more than 200 people were injured and were taken to hospital. There were also many buildings that collapsed in the mega city Dhaka and its surrounding areas. This study describes the country’s response to the earthquake. This experience and the lessons learnt highlight the importance for national earthquake-proof building regulations and systems to lessen the damage and devastation of any future earthquake.

  • 30.
    Dalal, Koustuv
    Department of Medical and Health Sciences, Centre for Medical Technology assessment & Division of Social Medicine and Public Health Sciences, Linköping University, Linköping, Sweden.
    Does economic empowerment protect women from intimate partner violence?2011In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 3, no 1, p. 35-44Article in journal (Refereed)
    Abstract [en]

    Background: The current study compared working and non-working groups of women in relation to intimate partner violence. The paper aims to explore the relationship between women's economic empowerment, their exposures to IPV and their help seeking behavior using a nationally representative sample in India.

    Methods: This was a cross sectional study of 124,385 ever married women of reproductive age from all 29 member states in India. Chi-square tests were used to examine differences in proportions of dependent variables (exposure to IPV) and independent variables. Multivariate logistic regressions were used to assess the independent contribution of the variables of economic empowerment in predicting exposure to IPV.

    Results: Out of 124,385 women, 69432 (56%) were eligible for this study. Among those that were eligible 35% were working. In general, prevalence of IPV (ever) among women in India were: emotional violence 14%, less severe physical violence 31%, severe physical violence 10% and sexual violence 8%. For working women, the IPV prevalence was: emotional violence 18%, less severe physical violence 37%, severe physical violence 14% and sexual violence 10%; whilst for non-working women the rate was 12, 27, 8 and 8 percents, respectively. Working women seek more help from different sources.

    Conclusions: Economic empowerment is not the sole protective factor. Economic empowerment, together with higher education and modified cultural norms against women, may protect women from IPV. ‎

  • 31.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Health and development: scenario in top and bottom 20*2 countries2017In: Socialmedicinsk tidskrift, ISSN 2000-4192, Vol. 94, no 6, p. 778-787Article in journal (Refereed)
    Abstract [en]

    Encouraged by the philosophy of Hans Rosling, the current study has tried to visualize development and health perspectives of the bottom 20 and top 20 countries ranked by health access quality (HAQ) index based on Socio-demographic Index (SDI), during last two and half decades (1990-2015). Also, the study has included BRICS countries (Brazil, Russia, India, China and South Africa) and the USA. The study has used secondary data from UNDP, WHO, World Bank and Global Burden of Disease and risk factor studies. Healthcare, health systems and development scenario of bottom 20 and top 20 countries ranked by HAQ index 2015 under SDI quartiles and BRICS countries and USA are presented in three different tables. It is evident that HAQ based on SDI quartiles reflects the better development and health outcomes. Instead of only 46 countries, more countries should be included and more health outcomes could be included in future studies.

  • 32.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 20152017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10091, p. 231-266Article in journal (Refereed)
  • 33.
    Dalal, Koustuv
    et al.
    Division of Public Health Science, School of Life Sciences, University of Skövde, Skövde, Sweden.
    Andrews, Johanna
    Karolinska Institutet, Stockholm, Sverige.
    Dawad, Suraya
    HEARD University, Durban, South Africa .
    Contraception use and associations with intimate partner violence among women in Bangladesh2012In: Journal of Biosocial Science, ISSN 0021-9320, E-ISSN 1469-7599, Vol. 44, no 1, p. 83-94Article in journal (Refereed)
    Abstract [en]

    This study examines the association between contraception use and intimate partner violence (IPV) among women of reproductive age in Bangladesh. The observational study of 10,996 women used the chi-squared test and logistic regressions to assess the associations. Almost 80% of all respondents had used contraceptives at some point in their lives. About half of the respondents (48%) were victims of physical violence, while 11% experienced sexual abuse from their husbands. Urban residents, higher educated women and women aged 20-44 were more likely to use contraceptives than their peers in rural areas, those with lower education and those in their late forties (45-49 years). Women exposed to physical violence were almost two times (OR 1.93, CI 1.55-2.41) more likely to use contraceptives compared with their non-abused peers. Sexual abuse had no significant association with contraceptive use. Physical violence is a predictor for higher levels of contraceptive use among women in Bangladesh. The findings emphasize the importance of screening for IPV at health care centres. The differences in urban and rural contraceptive use and IPV exposure identified by the study have policy implications for service delivery and planning.

  • 34.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health Sciences.
    Aremu, O.
    School of Health Sciences, Birmingham City University, Birmingham, UK.
    Ussatayeva, G.
    Higher School of Public Health, Al-Farabi Kahakz National University, Almaty, Kazakhstan.
    Biswas, A.
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Out-of-pocket health expenditure and fairness in utilization of health care facilities in Cambodia in 2005 and 20102017In: F1000 Research, E-ISSN 2046-1402, no 6, article id 2066Article in journal (Refereed)
    Abstract [en]

    Background: Out-of-pocket (OOP) payments for health care are highly pervasive in several low-and-middle income countries. The Cambodian health system has envisaged massive repositioning of various health care financing to ensure equitable access to health care. This analysis examines catastrophic, economic, as well as fairness, impacts of OOP health care payments on households in Cambodia over time. 

    Methods: Data from two waves of a nationally representative household survey conducted in Cambodia (CDHS Surveys 2005 and 2010) were utilized. Healthcare utilizations based on economic status were compared during 2005 and 2010. Variables of interests were i) where care was sought and the instances of treatments, i.e. was treatment sought the first, second or third time; (ii) the mode of payment for treatment of the respondent or for any household member due to sickness or injury in the last 30 days prior to the survey period. Lorenz curves were applied to assess the degree of distribution of inequality in OOP expenditures between different income brackets. 

    Results: The findings revealed that there was inequality and unfairness in health care payments, and catastrophic spending is more common among the poor in Cambodia. The majority of people from poorer households experienced economic hardship and have taken to catastrophic health care spending through sales of personal possessions.  

    Conclusion: Based on the findings from this analysis, more attention is needed on effective financial protection for Cambodians to promote fairness. The government should increase spending on services being provided at public health care facilities to reduce ever increasing reliance on private sector providers. These approaches would go a long way to reduce the economic burden of care utilization among the poorest.

  • 35.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Aremu, Olatunde
    Fairness of utilizing health care facilities and out-of-pocket payment burden: evidence from Cambodia2013In: Journal of Biosocial Science, ISSN 0021-9320, E-ISSN 1469-7599, Vol. 45, no 3, p. 345-357Article in journal (Refereed)
    Abstract [en]

    Catastrophic spending on health care through out-of-pocket payment is a huge problem in most low- and middle-income countries all over the world. The collapse of health systems and poverty have resulted in the proliferation of the private health sector in Cambodia, but very few studies have examined the fairness in ease of utilization of these services based on mode of payment. This study examined the utilization of health services for sickness or injury and identified its relationship with people's ability to pay for treatment seeking at various instances. Based on cross-sectional data from the Cambodian 2007 Demographic and Health Survey, the economic index estimated through principal component analysis and Lorenz curve was used to quantify the degree of fairness and equality in utilization and payment burden among the respondents. A distinct level of fairness was found in health care utilization and out-of-pocket payments. Specifically, use of private health care facilities and over-the-counter remedies dominate, and out-of-pocket payments cut across all socioeconomic strata. As many countries in low- and middle-income regions, and most importantly those in transition such as Cambodia, are repositioning their health systems, efforts should be made towards maintaining equitable access through adoption of finance mechanisms that make utilization of health care services fair and equitable.

  • 36.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Dahlström, Örjan
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden.
    Timpka, Toomas
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Interactions between microfinance programmes and non-economic empowerment of women associated with intimate partner violence in Bangladesh: a cross-sectional study2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 12, article id e002941Article in journal (Refereed)
    Abstract [en]

    Objective: This study aims to examine the associations between microfinance programme membership and intimate partner violence (IPV) in different socioeconomic strata of a nationally representative sample of women in Bangladesh. Methods: The cross-sectional study was based on a nationally representative interview survey of 11 178 ever-married women of reproductive age (15-49 years). A total of 4465 women who answered the IPV-related questions were analysed separately using chi(2) tests and Cramer's V as a measure of effect size to identify the differences in proportions of exposure to IPV with regard to microfinance programme membership, and demographic variables and interactions between microfinance programme membership and factors related to non-economic empowerment were considered. Results: Only 39% of women were members of microfinance programmes. The prevalence of a history of IPV was 48% for moderate physical violence, 16% for severe physical violence and 16% for sexual violence. For women with secondary or higher education, and women at the two wealthiest levels of the wealth index, microfinance programme membership increased the exposure to IPV two and three times, respectively. The least educated and poorest groups showed no change in exposure to IPV associated with microfinance programmes. The educated women who were more equal with their spouses in their family relationships by participating in decision-making increased their exposure to IPV by membership in microfinance programmes. Conclusions: Microfinance plans are associated with an increased exposure to IPV among educated and empowered women in Bangladesh. Microfinance firms should consider providing information about the associations between microfinance and IPV to the women belonging to the risk groups.

  • 37.
    Dalal, Koustuv
    et al.
    Department of Public Health Science, School of Life Sciences, University of Skövde, Skövde, Sweden.
    Dawad, S
    The Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu Natal, Durban, South Africa.
    Economic cost of domestic violence: A community study in South Africa2011In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 5, no 6 Suppl. 1, p. 1931-40Article in journal (Refereed)
    Abstract [en]

    The present study estimated economic costs of domestic violence against women who sought help from a community care centre in South Africa. It aimed to relate the victims’ income and victims’ family income to violence related injuries and related costs. This was a cross sectional study with face-to-ˇace interviews in a community care center in which victims of domestic violence sought various kinds of assistance. In total, 261 women were interviewed. The average economic cost of each domestic violence incidence was 691 USD while average cost for medical expenditure was 29 USD and average loss of income due to domestic violence was 2092 USD. Larger families and higher individual and family incomes were protective factors for severity of violence related injuries. Pain and discomfort due to domestic violence emerged as expensive for both medical costs and productivity losses. Considering the average monthly income of 482 USD, domestic violence averaged a cost per incident of 691 USD during the previous month, indicating a deficit in household budget. We found that domestic violence against women resulted with expensive injuries, pain and discomforts.

  • 38.
    Dalal, Koustuv
    et al.
    Department of Public Health Sciences, Social Medicine, Karolinska Institutet, Stockholm.
    Dawad, Suraya
    University of KwaZulu Natal, Durban, South Africa.
    Non-utilization of public health care facilities: examining the reasons through a national study of women in India2009In: Rural and remote health, ISSN 1445-6354, Vol. 9, no 3, p. 1178-Article in journal (Refereed)
    Abstract [en]

    Introduction: This article examines women's opinions about their reasons for the non-utilization of appropriate public health care facilities, according to categories of their healthcare seeking in India.

    Methods: This cross-sectional article uses nationally representative samples from the Indian National Family Health Surveys NFHS-3 (2005-2006), which were generated from randomly selected households. Women of reproductive age (15-49 years) from the 29 states of India participated (n = 124 385 women). The respondents were asked why they did not utilize public health care facilities when members of their households were ill, identifying their reasons with a yes/no choice. The following five reasons were of primary interest: (1) 'there is no nearby facility'; (2) 'facility timing is not convenient'; (3) 'health personnel are often absent'; (4) 'waiting time is too long'; and (5) 'poor quality of care'.

    Results: Results from logistic regression analyses indicate that respondents' education, economic status and standard of living are significant predictors for non-utilization of public health care facilities. Women who sought the services of care delivery and health check-ups indicated that health personnel were absent. Service seekers for self and child's medical treatments indicated that there were no nearby health facilities, service times were inconvenient, there were long waiting times and poor quality health care.

    Conclusions: This study concludes that improving public health care facilities with user-friendly opening times, the regular presence of staff, reduced waiting times and improved quality of care are necessary steps to reducing maternal mortality and poverty.

  • 39.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eriksson, Charli
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Do functional problem and livelihood disturbances in and around home trigger injuries?2014In: Health, ISSN 1949-5005, Vol. 6, p. 1085-1091Article in journal (Refereed)
    Abstract [en]

    The study has tried to identify whether poor self-rated health and home and neighbourhood environmental problems trigger injuries. The study used data from the Life & Health year 2008 survey, a postal questionnaire administered by Statistics Sweden in five administrative regions in central Sweden  (Uppsala,  Södermanland,  Örebro,  Varmland  and  Västmanland).  A  random  sample  of 1,060,032 respondents aged 18 - 79 years had participated in the study. Örebro and Varmland re- gion had the highest proportions of injuries. People at their age between 18 to 24 years—males—tobacco and alcohol addicted had the highest proportions of injuries. Environmental factors such as disturbances in and around home had emerged as major triggering factors for injuries. Physical functional problems such as problem of buying own food, cooking, dressing-up and walking had been emerged as very strong predicting factors of injuries. Policy makers in Sweden could identify the poor neighborhood, disturbing living condition through the housing companies and the cooperative housing societies to control injuries and promote safety.

  • 40.
    Dalal, Koustuv
    et al.
    Karolinska Institute, Stockholm.
    Jansson, Bjarne
    Karolinska Institute, Stockholm.
    Cost calculation and economic analysis of violence in low-income country: a model for India2007In: African Safety Promotion: A Journal of Injury and Violence Prevention, ISSN 1728-774X, Vol. 5, no 1, p. 45-56Article in journal (Refereed)
  • 41.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lao, Zhinqin
    Gifford, Mervyn
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Wang, Shu-Mei
    School of Public Health, Key Laboratory of Public Health Safety Ministry of Education, Fudan University, Shanghai, China .
    Knowledge and attitudes towards childhood injury prevention: a study of parents in Shanghai, China2012In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 6, no 11, p. 3783-3789Article in journal (Refereed)
    Abstract [en]

    Childhood injuries are a major problem worldwide. The study explored the parents' knowledge and attitudes towards childhood injury prevention in relation to theirsocioeconomic status. The study also tried to compare parents' perceptions of cause and place of child injury with actual cause and place of injury. This was a cross sectional study of 986 randomly selected parents whose children (3-6 years old) were enrolled at selected kindergartens in a 'Safe Community' in Shanghai, China. Chi-square tests and bar diagrams were used. Almost all parents (97%) thought that injury was a serious problem for their children. Around half of the parents thought that child injuries could be prevented while almost one-third (29%) of parents indicated that there were risk factors in the living environment of their children. Parental perceptions of cause of injuries and place of injuries significantly differed from that of the reality. Parents identified the most common barriers of childhood injury prevention: lack of parental attention (41.6%), environment (35.6%) and children's risky behavior (22.7%). The difference between parental opinions and reality illustrated that parents had incorrect knowledge of childhood injuries, which might lead to incorrect foci of prevention programs.

    Before tackling environmental modifications to prevent child injuries, policy makers should focus on rectifying parents' incorrect perceptions and on modifying their attitudes as key players. It is important to first raise awareness about childhood injury prevention among the parents for appropriate intervention strategies.

  • 42.
    Dalal, Koustuv
    et al.
    Department of Medical and Health Sciences, Centre for Medical Technology Assessment & Division of Social Medicine and Public Health Sciences, Linköping University, Linköping, Sweden.
    Lawoko, Stephen
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    Jansson, Bjarne
    Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
    The relationship between intimate partner violence and maternal practices to correct child behavior: a study on women in Egypt2010In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 2, no 1, p. 25-33Article in journal (Refereed)
    Abstract [en]

    Background: This paper scrutinizes the association between maternal practices to correct child behavior and the mothers' exposure to and attitudes towards intimate partner violence (IPV).

    Methods: Nationally representative data comprising 14 016 married women were retrieved from the Egyptian Demographic and Health Survey, 2005. Data on practices used to correct child behavior, exposure to IPV, attitudes towards IPV were our primary interest. Data were analyzed using Chi-square test and logistic regression.

    Results: The majority of the mothers reported use of violent methods, like shouting (90.6%), striking (69.1%) and slapping (39.3%) to correct child behavior. Seven percent of the mothers used only the explanation option. Exposure to physical IPV and tolerant attitudes towards IPV were associated with an augmented risk of using violent methods (shouting, striking or slapping) to correct child behavior. On the other hand non-tolerant attitudes towards IPV were associated with increased likelihood of sole use of the explanation method.

    Conclusions: We thus recommend the implementation of local parental education programs focusing on communicative skills to reduce IPV and related child abuse. ‎

  • 43.
    Dalal, Koustuv
    et al.
    Centre for Medical Technology Assessment & Division of Social Medicine and Public Health, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Lawoko, Stephen
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Jansson, Bjarne
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Women's attitudes towards discontinuation of female genital mutilation in Egypt2010In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 2, no 1, p. 41-5Article in journal (Refereed)
    Abstract [en]

    Background: To examine women's attitude towards discontinuation of female genital mutilation (FGM) in association with their access to information, knowledge of health effects and cultural beliefs concerning FGM in Egypt.

    Methods: A cross-sectional study of 9159 women, using data from the household survey in Egypt by Demographic and Health survey 2003. A comprehensive questionnaire covering attitudes towards FGM, demographics, and access to information was used. Chi-square analysis and logistic regression were applied to investigate how demographics, level of education, access to information, knowledge of health consequences and cultural beliefs influence women's attitudes towards FGM.

    Results: Among the demographic variables, discontinuation of FGM was independently associated with urban residency and post-secondary education. Moreover, women who were informed by the media, and those who had attended community meetings, church, or mosque where FGM was discussed, as well as women who were aware of the negative health consequences of FGM, were more likely to support discontinuation of FGM. By contrast, women with positive cultural conceptions of FGM were less likely to favor its discontinuation.

    Conclusions: Public education and information dissemination aiming to change current cultural notions favoring FGM practice - through community and religious leaders, and radio and television programs - may play an important role in modifying women's attitudes towards FGM. These findings have some implications for intervention and policy. ‎

  • 44.
    Dalal, Koustuv
    et al.
    Dept Publ Hlth Sci, Univ Skövde, Skövde, Sweden.
    Lee, Ming Shinn
    Natl Dong Hwa Univ, Dept Curriculum Design & Human Potentials Dev, Hualien, Taiwan.
    Gifford, Mervyn
    Dept Publ Hlth Sci, Univ Skövde, Skövde, Sweden.
    Male adolescents' attitudes toward wife beating: a multi-country study in South Asia2012In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 50, no 5, p. 437-442Article in journal (Refereed)
    Abstract [en]

    Purpose: This study has aimed to address the gaps in knowledge about male adolescents and their attitudes toward wife beating in multi-country study in Bangladesh, India, and Nepal.

    Methods: The study used secondary data generated from nationally representative samples of male adolescents (aged 15-19 years) in the demographic and health surveys data in Bangladesh, India, and Nepal. These were household surveys using structured questionnaires, with 275 boys in Bangladesh, 13,078 boys in India, and 939 boys in Nepal. Chi-square tests and logistic regressions were used to assess the associations.

    Results: In Bangladesh, 42% of 275 respondents had justified wife beating; in India, 51% of 13,078 male adolescents had supported wife beating; and in Nepal, 28% of 939 respondents had supported wife abuse. Individual-level factors, such as rural residency, low educational attainment, low economic status, being unemployed, and having a history of family violence, were positively associated with the justification of wife abuse.

    Conclusions: This multi-country study indicates a general trend of male adolescents' strong supportive attitude toward wife beating, and hence may suggest that policy makers can specifically target young groups of the population for various interventions for reducing violence against women.

  • 45.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Public Health Science, University of Skövde, Skövde, Sweden.
    Lee, Ming-Shinn
    National Dong Hwa University, Hualien, Taiwan.
    Ussatayeva, Ganiel
    Kazakhstan School of Public Health, Almaty, Kazakhstan.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Female genital mutilation: multi country study2015In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 9, no 4, p. 161-167Article in journal (Refereed)
    Abstract [en]

    Objective: Female genital mutilation (FGM) is a major women’s health problem and human right violation. FGM has several physical and psychological consequences. The focus of the current study is the extent of FGM, the association of demographic and economic factors with FGM and women’s beliefs and attitudes towards FGM in Egypt, Guinea, Mali and Sierra Leone.

    Methods: The study used national representative, cross-sectional, household sample surveys with large sample of women of reproductive age (15 – 49 years) from each country. Multi stage cluster sampling and face-to-face interviews were used. It was cross-sectional analysis, using DHS data. Cross tabulation, multivariate analyses and bar-diagram were used.

    Results: In Egypt 94%, in Guinea 97%, in Mali 89% and in Sierra Leone, 91%) women had genital mutilation. The majority of the respondents believe that FGM that FGM is socially acceptable and a religious obligation. Majority of the respondents believe that FGM helps to maintain virginity and that it leads to better marriage prospects and the prevention of adultery.

    Conclusions: The majority of women in the four countries argued in favor for the continuation of FGM. There is an inverse relationship between FGM and higher education and affluence. Proper policies and awareness generation among less educated and less affluent women in rural areas are warranted in an attempt to reduce FGM.

  • 46.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lin, Zhiquin
    BGI Tech, Shenzhen, China.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Svanström, Leif
    Department of Public Health Science, School of Life Sciences, University of Skövde, Skövde, Sweden.
    Economics of global burden of road traffic injuries and their relationship with health system variables2013In: International Journal of Preventive Medicine, ISSN 2008-7802, E-ISSN 2008-8213, Vol. 4, no 12, p. 1442-1450Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To estimate the economic loss due to road traffic injuries (RTIs) of the World Health Organization (WHO) member countries and to explore the relationship between the economic loss and relevant health system factors.

    METHODS: Data from the World Bank and the WHO were applied to set up the databases. Disability-adjusted life year (DALY) and gross domestic product per capita were used to estimate the economic loss relating to RTIs. Regression analysis was used. Data were analyzed by IBM SPSS Statistics, Versions 20.0.

    RESULTS: In 2005, the total economic loss of RTIs was estimated to be 167,752.4 million United States Dollars. High income countries (HIC) showed the greatest economic losses. The majority (96%) of the top 25 countries with the greatest DALY losses are low and middle income countries while 48% of the top 25 countries with the highest economic losses are HIC. The linear regression model indicates an inverse relationship between nurse density in the health system and economic loss due to RTI.

    CONCLUSIONS: RTIs cause enormous death and DALYs loss in low-middle income countries and enormous economic loss in HIC. More road traffic prevention programs should be promoted in these areas to reduce both incidence and economic burden of RTIs.

  • 47.
    Dalal, Koustuv
    et al.
    Linköping University, Linköping, Sweden.
    Lindqvist, Kent
    Linkoping University, Linkoping, Sweden.
    A national study of the prevalence and correlates of domestic violence among women in India2012In: Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public Health, ISSN 1941-2479, Vol. 24, no 2, p. 265-77Article in journal (Refereed)
    Abstract [en]

    This article estimates the national prevalence rate of domestic violence in India and examines the demographic and socioeconomic status of the victims of domestic violence. The study used the Indian National Family Health Survey 3, a cross-sectional national survey of 124 385 ever-married women of reproductive age from all the 29 member states. χ(2) Analysis and logistic regression were used. Lifetime experiences of violence among respondents were as follows: emotional violence, 14%; less severe physical violence, 31%; severe physical violence, 10%; and sexual violence, 8%. Women of scheduled castes and Muslim religion were most often exposed to domestic violence. Women's poorer economic background, working status, and husband's controlling behavior emerged as strong predictors for domestic violence in India. Elimination of structural inequalities inherent in the indigenous oppressive institutions of religion, caste, and the traditional male hierarchy in society could prevent domestic violence.

  • 48.
    Dalal, Koustuv
    et al.
    Karolinska Institutet, Division of Social Medicine, Department of Public Health Sciences, Stockholm.
    Rahman, Aminur
    Centre for Injury Prevention and Research, Mohakhali Dhaka-1206, Bangladesh.
    Out-of-pocket payments for unintentional injuries: a study in rural Bangladesh.2009In: International Journal of Injury Control and Safety Promotion, ISSN 1745-7300, E-ISSN 1745-7319, Vol. 16, no 1, p. 41-7Article in journal (Refereed)
    Abstract [en]

    This paper studies the nature and extent of out-of-pocket expenses for unintentional injuries, using the context of rural Bangladesh. A cross-sectional study consisting of 23,113 people was performed through multistage cluster sampling. Chi-square analysis and pie-diagrams were used. A total of 3411 injury victims were identified in this survey. Only 14% of victims received government medical assistance while 17% of victims benefited from public health care and 13% benefited from private health care facilities. However, 94% of the injury victims have purchased drugs out-of-pocket. With a minimum of US $0.07 and maximum of US $140 their mean out-of-pocket payment for drugs was US $4 (half of the Bangladeshis are living under US $1 per day). Instead of relying on public health care facilities most rural Bangladeshi people spent money from their own pockets for treatments. Proper health care distribution with a community-based insurance scheme and safety awareness programmes are warranted to reduce both injury and economic burdens.

  • 49.
    Dalal, Koustuv
    et al.
    Karolinska Institutet, Stockholm.
    Rahman, F
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Jansson, B
    Karolinska Institutet, Stockholm.
    The origin of violent behaviour among child labourers in India2008In: Global Public Health, ISSN 1744-1692, E-ISSN 1744-1706, Vol. 3, no 1, p. 77-92Article in journal (Refereed)
    Abstract [en]

    We explored the causes and circumstances of violent behaviour among a group of child labourers in the Indian unorganized sectors. From 14 categories of occupations, a total of 1,400 child labourers were interviewed in both urban and rural areas. The average family size of these mostly illiterate child labourers is seven, and average family income is 3,200 INR per month. In the short term child labourers become violent, aggressive, and criminal, following a pyramid of violent behaviour, including socio-economic pressure, cultural deviance, and psychological pressure. When considering family history it seems that the problem is part of a vicious cycle of violence, which persists through generations and evolves with financial crisis, early marriage, and violence in the family and workplace. Our study demonstrates that the most vulnerable groups of child labourers belong to the following workplaces: dhabas, food stalls, rail/bus stations, rail-floor cleaning, and rag picking. Giving high priority to capacity building within the community, including support for locally-generated solutions, is warranted.

  • 50.
    Dalal, Koustuv
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rahman, Fazlur
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    Gifford, Mervyn
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Rahman, Aminur
    Centre for Injury Prevention and Research, Dhaka, Bangladesh.
    The magnitude of injury problems among child labourers in a rural community of Bangladesh: findings from an injury surveillance system2016In: International Health, ISSN 1876-3405, Vol. 8, no 1, p. 73-76Article in journal (Refereed)
    Abstract [en]

    Background: Child labour is an important topic in contemporary society. In this study we have tried to explore the magnitude of injury problems among child labourers in Bangladesh using an injury surveillance system.

    Methods: An injury surveillance system (ISS) was performed under the Prevention of Child Injuries through Social intervention and Education (PRECISE) project in Bangladesh during 2006–2010 in three sub-districts covering a population of more than 700 000. We used the ISS for assessing child labour. Appropriate epidemiological methods were considered in the study.

    Results: Considering the reported main occupation of the children, 30% of children from the surveillance households were identified as child labourers. More than two thirds of child labourers were educated to primary or secondary level. The majority of boys worked as unskilled labourers and girls were employed in domestic work. The incidence of injury and deaths among child labourers was estimated as 24 per 100 000 children years. More than 19 injury related illnesses of moderate to severe intensity were found among 1000 child labourers in a year. Fractures, sprains, dislocations, cuts/wounds, animal bites, abrasions or lacerations, burns, head injuries and internal organ injuries are most common among child labourers.

    Conclusions:Working children are at risk of injury, death and illness in Bangladesh. Child labourers are now even more clearly tied to quantified morbidity and mortality.

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