Birth preparedness and complication readiness (BPCR) among pregnant women in hard-to-reach areas in Bangladesh

BackgroundBirth preparedness and complication readiness aims to reduce delays in care seeking, promote skilled birth attendance, and facility deliveries. Little is known about birth preparedness practices among populations living in hard-to-reach areas in Bangladesh.ObjectivesTo describe levels of birth preparedness and complication readiness among recently delivered women, identify determinants of being better prepared for birth, and assess the impact of greater birth preparedness on maternal and neonatal health practices.MethodsA cross-sectional survey with 2,897 recently delivered women was undertaken in 2012 as part of an evaluation trial done in five hard-to-reach districts in rural Bangladesh. Mothers were considered well prepared for birth if they adopted two or more of the four birth preparedness components. Descriptive statistics and multivariable logistic regression were used for analysis.ResultsLess than a quarter (24.5%) of women were considered well prepared for birth. Predictors of being well-prepared included: husband’s education (OR = 1.3; CI: 1.1–1.7), district of residence, exposure to media in the form of reading a newspaper (OR = 2.2; CI: 1.2–3.9), receiving home visit by a health worker during pregnancy (OR = 1.5; CI: 1.2–1.8), and receiving at least 3 antenatal care visits from a qualified provider (OR = 1.4; CI: 1.0–1.9). Well-prepared women were more likely to deliver at a health facility (OR = 2.4; CI: 1.9–3.1), use a skilled birth attendant (OR = 2.4, CI: 1.9–3.1), practice clean cord care (OR = 1.3, CI: 1.0–1.5), receive post-natal care from a trained provider within two days of birth for themselves (OR = 2.6, CI: 2.0–3.2) or their newborn (OR = 2.6, CI: 2.1–3.3), and seek care for delivery complications (OR = 1.8, CI: 1.3–2.6).ConclusionGreater emphasis on BPCR interventions tailored for hard to reach areas is needed to improve skilled birth attendance, care seeking for complications and essential newborn care and facilitate reductions in maternal and neonatal mortality in low performing districts in Bangladesh

Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh

BackgroundDespite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children’s Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization.MethodTwo surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index.ResultsMean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370).ConclusionsOverall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups. Maternal health programs, if properly designed and implemented, can improve access, partially overcoming the negative effects of socioeconomic disparities

Human Emotion and Sentiment in Natural Language Understanding and Generation using Large Language Models with Limited to No Labeled Data

Natural Language Processing (NLP) aims to utilize computational resources to comprehend and generate human language. Emotion and sentiment are integral parts of human beings, and they are often reflected in human language. Consequently, these two closely related ideas are of paramount importance to NLP. In this thesis, we focus on several NLP tasks related to human emotion and sentiment. Particularly, we focus on the domains of Sentiment Analysis and Emotion-Cause Analysis (ECA). Like most other NLP tasks, machine learning technologies are frequently leveraged to perform various NLP tasks in these two domains. A common challenge in applying machine learning technology to context-dependent tasks like Sentiment Analysis is that they require a large amount of labeled data to develop a performant model. In this thesis, we develop several techniques leveraging Transformer-based large language models (LLMs) to perform various NLP tasks within these two domains in a limited to no labeled data setting. Specifically, we devise two technical architectures to perform multi-class Sentiment Analysis with limited labeled data. We introduce two new NLP tasks within the domain of ECA, which are also the first Natural Language Generation (NLG) tasks in this domain. We devise technical solutions to perform these NLG tasks, one with limited labeled data, and the other with no labeled data. We publish a new dataset for one of these novel NLG tasks. Lastly, we propose leveraging conversational LLMs for the automatic evaluation of open-ended NLG tasks, which also does not require any new training or labeled data

Ever-increasing Caesarean section and its economic burden in Bangladesh

BackgroundCesarean Section (CS) delivery has been increasing rapidly worldwide and Bangladesh is no exception. In Bangladesh, the CS rate has increased from about 3% in 2000 to about 24% in 2014. This study examines trend in CS in Bangladesh over the last fifteen years and implications of this increasing CS rates on health care expenditures.MethodsBirth data from Bangladesh Demographic and Health Survey (BDHS) for the years 2000-2014 have been used for the trend analysis and 2010 Bangladesh Maternal Mortality Survey (BMMS) data were used for estimating health care expenditure associated with CS.ResultsAlthough the share of institutional deliveries increased four times over the years 2000 to 2014, the CS deliveries increased eightfold. In 2000, only 33% of institutional deliveries were conducted through CS and the rate increased to 63% in 2014. Average medical care expenditure for a CS delivery in Bangladesh was about BDT 22,085 (USD 276) in 2010 while the cost of a normal delivery was BDT 3,565 (USD 45). Health care expenditure due to CS deliveries accounted for about 66.5% of total expenditure on all deliveries in Bangladesh in 2010. About 10.3% of Total Health Expenditure (THE) in 2010 was due to delivery costs, while CS costs contribute to 6.9% of THE and rapid increase in CS deliveries will mean that delivering babies will represent even a higher proportion of THE in the future despite declining crude birth rate.ConclusionHigh CS delivery rate and the negative health outcomes associated with the procedure on mothers and child births incur huge economic burden on the families. This is creating inappropriate allocation of scarce resources in the poor economy like Bangladesh. Therefore it is important to control this unnecessary CS practices by the health providers by introducing litigation and special guidelines in the health policy

Automated Classification of Medical Percussion Signals for the Diagnosis of Pulmonary Injuries

Used for centuries in the clinical practice, audible percussion is a method of eliciting sounds by areas of the human body either by finger tips or by a percussion hammer. Despite its advantages, pulmonary diagnostics by percussion is still highly subjective, depends on the physician's skills, and requires quiet surroundings. Automation of this well-established technique could help amplify its existing merits while removing the above drawbacks. In this study, an attempt is made to automatically decompose clinical percussion signals into a sum of Exponentially Damped Sinusoids (EDS) using Matrix Pencil Method, which in this case form a more natural basis than Fourier harmonics and thus allow for a more robust representation of the signal in the parametric space. It is found that some EDS represent transient oscillation modes of the thorax/abdomen excited by the percussion event, while others are associated with the noise. It is demonstrated that relatively few EDS are usually enough to accurately reconstruct the original signal. It is shown that combining the frequency and damping parameters of these most significant EDS allows for efficient classification of percussion signals into the two main types historically known as "resonant" and "tympanic". This classification ability can provide a basis for the automated objective diagnostics of various pulmonary pathologies including pneumothorax

Tourist Satisfaction, Destination Image, Loyalty and Revisit Intention to Malaysia’s National Parks.

The emergence of the tourism sector is creating thousands of job opportunities in the industry. It is one of the significant economic growth contributors in Malaysia. Realising the importance of this industry, this study aims to provide an overview of the critical determinants of tourists’ revisit intention to Malaysia’s national parks. To contemplate possible factors for revisit intention, the study will investigate the relationship between tourist satisfaction, destination image, loyalty and revisit intention. This study is conceptual. A comprehensive review will be presented based on the most recently selected literature from an academic journal and relevant online platforms. However, as mentioned in the conceptual analysis, this study focuses less on the critical and comprehensive outcomes of revisiting the intention of Malaysia’s national parks. Based on the thorough literature, this study attempts to find academic and industry perspective contributions that engage with ecotourism, one of the potential tourism industry sectors. The study will provide a holistic pedagogy to destination management authorities to focus on the related factors for domestic tourist revisit intention. The practical implication of this study is to assist and provide clear ideas to the national park management authorities about the determinants of domestic tourist revisit intention. By providing a glimpse of tourist revisit intention factors, the national park management can implement strategies to increase the rate of revisiting tourists. Nevertheless, national park management may implement these factors as part of recovery strategies after covid 19 pandemic, especially to encourage domestic tourists for reviewing. This study exposes the potential and possibility of the massive impact of ecotourism on the Malaysian tourism industry. Consequently, the study will suggest some critical sustainable resilience strategies which can support tourists’ revisit intention to Malaysia’s national park. The study finding will be original in their form and will be a unique attempt. Therefore, the study observations will be precious to all the stakeholders and policymakers of Malaysia’s ecotourism sector.&nbsp

Mistreatment of newborns after childbirth in health facilities in Nepal: results from a prospective cohort observational study

Background: Patient experience of care reflects the quality of health care in health facilities. While there are multiple studies documenting abuse and disrespect to women during childbirth, there is limited evidence on the mistreatment of newborns immediately after childbirth. This paper addresses the evidence gap by assessing the prevalence and risk factors associated with mistreatment of newborns after childbirth in Nepal, based on a large-scale observational study. Methods and findings: This is a prospective observational cohort study conducted over a period of 18 months in 4 public referral hospitals in Nepal. All newborns born at the facilities during the study period, who breathed spontaneously and were observed, were included. A set of indicators to measure mistreatment for newborns was analysed. Principal component analysis was used to construct a single newborn mistreatment index. Uni-variate, multi-variate, and multi-level analysis was done to measure the association between the newborn mistreatment index and demographic, obstetric, and neonatal characteristics. A total of 31,804 births of newborns who spontaneously breathed were included. Among the included newborns, 63.0% (95% CI, 62.5-63.5) received medical interventions without taking consent from the parents, 25.0% (95% CI, 24.5-25.5) were not treated with kindness and respect (roughly handled), and 21.4% (95% CI, 20.9-21.8) of them were suctioned with no medical need. Among the newborns, 71.7% (95% CI, 71.2-72.3) had the cord clamped within 1 minute and 77.6% (95% CI, 77.1-78.1) were not breast fed within 1 hour of birth. Only 3.5% (95% CI, 3.2-3.8) were kept in skin to skin contact in the delivery room after birth. The mistreatment index showed maximum variation in mistreatment among those infants born to women of relatively disadvantaged ethnic groups and infants born to women with 2 or previous births. After adjusting for hospital heterogeneity, infants born to women aged 30-34 years (beta, -0.041; p value, 0.01) and infants born to women aged 35 years or more (beta, -0.064; p value, 0.029) were less mistreated in reference to infants born to women aged 18 years or less. Infants born to women from the relatively disadvantaged (chhetri) ethnic groups (beta, 0.077; p value, 0.000) were more likely to be mistreated than the infants born to relatively advantaged (brahmin) ethnic groups. Female newborns (beta, 0.016; p value, 0.015) were more likely to be mistreated than male newborns. Conclusions: The mistreatment of spontaneously breathing newborns is high in public hospitals in Nepal. Mistreatment varied by hospital, maternal ethnicity, maternal age, and sex of the newborn. Reducing mistreatment of newborns will require interventions at policy, health system, and individual level. Further, implementation studies will be required to identify effective interventions to reduce inequity and mistreatment of newborns at birth