Kaosar Afsana

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• MBBS, MPH, PhD
• Professor (Full) at BRAC University

The Sustainable Development Goals (SDGs) establish a roadmap for global development based on national priorities. SDG3, addressing health and well-being, is interwoven with indicators related to health and interconnected with other SDGs. Despite improvement, the world is struggling to attain SDG 3. Maternal death is a key marker of SDG 3, divulging...

Introduction The extensive network of community health workers in rural Bangladesh has the potential to deliver maternal and child nutrition services, while promoting linkages with healthcare facilities. A strategy for strengthening community-based nutrition services was developed and tested. Methods The three-phased strategy included review of ex...

Key messages Formative research to understand the sociocultural and economic context into which interventions are introduced can help to maximize the uptake of interventions both in the context of effectiveness trials and ultimately for nutrition programs. Findings from the formative research study were used to inform different facets of the design...

Balanced energy protein supplementation (BEP) is recommended for contexts of high maternal undernutrition by the World Health Organization. Despite recent improvements in undernutrition, Bangladesh remains a context where BEP could help accelerate progress towards nutrition goals. In preparation for an effective trial testing a fortified BEP, a qua...

The growing health challenges in South Asia require further adaptations of community health worker (CHW) programs as a key element of primary health care (PHC). This paper provides a comparative analysis of CHW programs in five countries (Bangladesh, India, Nepal, Pakistan, and Sri Lanka), examines successes and challenges, and suggests reforms to...

Background The World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this thr...

Background: Rohingya women suffer from inaccessibility to sexual and reproductive health services in Myanmar. After the forcible displacement of the Rohingya from Myanmar to Bangladesh in 2017, pregnancy termination services have been increasingly important and desired, while knowledge gaps and obstacles to access services still exist. The role of...

A Process Documentation Study on the BRAC Accelerated Education Model

Summary Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data...

Background Anemia poses a significant public health problem, affecting 1.6 billion people and contributing to the loss of 68.4 million disability-adjusted life years. We assessed the impact of a market-based home fortification program with micronutrient powder (MNP) called Pushtikona-5 implemented by Bangladesh Rural Advancement Committee (BRAC) on...

Background: Anemia poses a significant public health problem, affecting 1.6 billion people and contributing to the loss of 68.4 million disability-adjusted life years. We assessed the impact of a market-based home fortification program with micronutrient powder (MNP) called Pushtikona-5 implemented by Bangladesh Rural Advancement Committee (BRAC) o...

Transforming Agrifood Systems in South Asia (TAFSSA) district agrifood systems assessment aims to provide a reliable, accessible, and integrated evidence base that links farm production, market access, dietary patterns, climate risk responses, and natural resource management with gender as a cross-cutting issue in rural areas of Bangladesh, India,...

Balanced energy protein (BEP) supplementation is an efficacious intervention in pregnancy for improving birthweight and is recommended by World Health Organization (WHO) in countries with high maternal undernutrition. Few countries have implemented BEP programmes due in part to high cost, lack of data on acceptability and feasibility, and complexit...

Balanced energy protein (BEP) supplementation in pregnancy is recommended in the context of undernutrition for the reduction of small‐for‐gestational age neonates and stillbirths. To inform an effectiveness trial, we evaluated the acceptability of a packaged, ready‐to‐eat fortified BEP product among women of reproductive age and their health care p...

Background In Bangladesh, undernutrition and anemia are more occurrent among adolescent girls. BRAC, the largest non-governmental organization (NGO), has been implementing a community-based nutrition education service package targeting adolescent girls for reducing their undernutrition and anemia. Objective We aimed to explore the underlying facto...

Background: In 2017, approximately 770,000 Rohingya people were forcibly displaced from Myanmar and fled to Bangladesh and are currently residing in camps in Cox’s Bazar. Myanmar has a restrictive abortion law; in Bangladesh, menstrual regulation (MR) is legally allowed on demandup to 12 weeks after a woman’s last menstrual period. Little is known...

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6 . Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural an...

Predictor of anaemia among adolescent girls

This Open Access book compiles the findings of the Scientific Group of the United Nations Food Systems Summit 2021 and its research partners. The Scientific Group was an independent group of 28 food systems scientists from all over the world with a mandate from the Deputy Secretary-General of the United Nations. The chapters provide science- and...

Food Systems at the global level and in many countries and regions are failing to end hunger, assure the safety of foods, provide adequate nutritious foods and contribute to obesity. How we produce and consume food has implications for the health of people, animals, plants and the planet itself. In this chapter, we focus on priority actions and the...

Science offers many important contributions to achieving the SDGs, of which we highlight two here: first, science generates the basic inputs for innovations, i.e., policy and institutional innovations (including social and business innovations), as well as technology-based innovations to catalyze, support, and accelerate food system transformation;...

The United Nations with its Food Systems Summit 2021 and member countries seek to alter food systems to be healthier, safer, more sustainable, efficient and equitable. This chapter informs about concepts and definitions of food systems and the determinants of their change. To foster a clear understanding of food systems, especially regarding the UN...

Approximately one-third of children under the age of five are stunted in developing countries and many of them are micronutrient-deficient. We designed a comprehensive intervention package including egg/milk-based snacks to improve linear growth and dietary diversity among 6 to 12-month-old children in rural Bangladesh. In this 1-year community-bas...

Background The first wave of COVID-19 during April to July 2020 in Singapore largely affected the migrant workers living in residential dormitories. A government taskforce working with dormitory operators, employers and non-government agencies came together to deliver behavioral interventions and health care services for migrant worker as dorms wer...

Low birth weight (LBW) is a global public health problem with the highest prevalence in South Asia. It is strongly associated with maternal undernutrition. In South Asia, intra-household food distribution is inequitable, with lower dietary adequacy in women. Evidence that nutrition education improves diet during pregnancy and reduces LBW is weak. W...

Access to nutrition and safe food is a key to sustaining life and promoting good health. Thus, the sustainable development goals (SDGs) reawaken the world alluding to the interweaving connects of health, nutrition, and food safety. This chapter introduces the current scenario of nutrition and food safety and how both traverse important issues in he...

Covid-19 infection is an additional burden to the life of the Rohingya children living in cramped camps of Cox’s Bazar, Bangladesh. BRAC has introduced Humanitarian Play Lab (HPL) for children’s playful learning in the camps since 2017. During the Covid-19 pandemic, the modality was changed from face-face interactions to a telecommunication model....

Introduction Measures to mitigate the COVID-19 outbreak in the migrant worker dormitories in Singapore included lockdown and isolation of residents for prolonged periods. In this paper, we explore efforts to ease tensions and support mental health under these conditions. Methods Case study of dormitory residents under lockdown from April to Aug...

Approximately one-third of children under-five in developing countries are stunted and many are micronutrient-deficient. We aimed to compare the effect of an intervention package including egg and milk-based snacks on linear growth and dietary diversity of children of 6‒12 months in rural Bangladesh. It was a community-based cluster randomized cont...

Background Low birth weight (LBW) is a global public health problem with the highest prevalence in South Asia. It is strongly associated with maternal under nutrition. In South Asia, intra household food distribution is inequitable with lower dietary adequacy in women, regardless of pregnancy. Evidence that nutrition education improves diet during...

For fruitful deliberations and concerted action at the science–politics interface, the concepts of food systems and drivers of change need to be clearly understood and employed by all.

Background Social innovations in health are inclusive solutions to address the healthcare delivery gap that meet the needs of end users through a multi-stakeholder, community-engaged process. While social innovations for health have shown promise in closing the healthcare delivery gap, more research is needed to evaluate, scale up, and sustain soci...

Here’s how the United Nations should harness science and technology to improve nutrition and safeguard the environment. Here’s how the United Nations should harness science and technology to improve nutrition and safeguard the environment.

In 2019, the EAT-Lancet Commission proposed a planetary health diet (PHD)—optimal for the planet and its people. Yet concerns have arisen regarding its universality and potential tradeoffs and conflicts. This Voice piece asks: is a PHD realistic, where are the remaining knowledge gaps and opportunities, and where do we go from here?

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30...

NAVOĐENJE LITERATURE PREMA APA STANDARDU: IVAN BILIĆ

Objectives We aimed to compare the effect of a comprehensive intervention package focusing on the animal-source protein (egg and milk)-based snack in conjunction with feeding counseling, water sanitation and hygiene, and supplementation with multiple micronutrient powder on linear growth and development of 6‒12-month old children in rural Banglades...

Objectives Iron deficiency (ID) and iron deficiency anaemia (IDA) remain a public health concern among women and girls globally, and have numerous impacts on health, nutrition and socioeconomic status. Our objective was to investigate the efficacy of consuming iron-fortified lentils on iron status among rural Bangladeshi adolescent girls. Methods...

Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys (1996–2017, n = 12,006 primiparous women with living children <5 years old)....

Letter of Agreement number (reference) 1506981 Stamp of the service provider organization Signature of the responsible officer

Widely consumed daal (lentils) in Bangladesh are an ideal vehicle for iron (Fe) fortification; however, an acceptable portion size in meals needs to be determined to carry out a community feeding study in at-risk adolescent girls. A non-randomized crossover trial was conducted with n = 100 Bangladeshi girls (12.9 ± 2.0 years of age). Two recipes (t...

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in di...

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in di...

Early marriage (EM) and early childbearing (ECB) have far‐reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever‐married women aged 20–24 years (n = 105,150) married before 18...

While social innovations in health have shown promise in closing the healthcare delivery gap, especially in low- and middle-income countries (LMICs), more research is needed to evaluate, scale up, and sustain social innovations. Research checklists can standardize and improve reporting of research findings, promote transparency, and increase replic...

Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled ana...

The transformation of the BRAC MANOSHI programme from humanitarian to a social enterprise model, has made it increasingly urgent to enumerate the minimum number of door-to-door antenatal care (ANC) visits by community health workers (CHWs), for the purpose of effectively improving facility delivery. Thus prevent social exclusion of poor slum commun...

Objectives In South Asia, many women are married before their 18th birthday and give birth soon after. Delaying marriage is an attractive nutrition policy target as previous research shows that early marriage (EM) is associated with poor child growth outcomes, operating through many pathways. We sought to describe the prevalence, trends, inequities...

Objectives Adolescent pregnancy is a major global concern due to its adverse effects on maternal and child health and wellbeing. Bangladesh has one of the highest rates of adolescent pregnancy globally. We sought to examine trends in adolescent pregnancy and associated factors in Bangladesh in the last two decades, and to understand why children of...

Background Client satisfaction and competency of the healthcare providers are key areas to ensure good health service delivery anywhere. The objective of this study was to understand the competency of the healthcare providers of BRAC maternity centres (BMC) in rural areas of Bangladesh and acceptance of their services at client level. Methods It wa...

Background: The period from birth to two years is the "critical window" for achieving optimal growth and development. An inadequate quality and quantities of complementary foods, poor child-feeding practices and infection negatively impact the growth of under-twos. Approximately one-third of under-fives in developing countries are stunted; many ar...

Objective This study aimed to report prevalence and evaluate the association between multimorbidity and associated risk factors in the adult population of Bangladesh. Design A cross-sectional study was conducted using a multistage clustered random sampling strategy. Setting The study was conducted among the general population of 58 districts in B...

Background Maternal morbidity is common in Bangladesh, where the maternal mortality rate has plateaued over the last 6 years. Maternal undernutrition and micronutrient deficiencies contribute to morbidity, but few interventions have measured maternal outcomes. We compared reported prevalence of antepartum, intrapartum, and postpartum complications...

Ever rising prevalence of Cardiovascular Diseases (CVD) is a major challenge for the health sector in Bangladesh. This study aimed to explore the prevalence of CVD and sociodemographic and lifestyle factors associated with it in Bangladesh. The data were collected through a cross-sectional survey following a two-stage cluster random sampling proced...

Objectives: Despite all efforts, iron deficiency (ID) and iron deficiency anaemia (IDA) among adolescent girls remains a public health concern for Bangladesh. The objective of the current analysis was to examine baseline data from an effectiveness trial with the aim to compare prevalence of anemia, ID and IDA with Bangladesh's National Micronutrie...

Background Lentils are generally considered to be a nutrient-dense food, and a good source of iron (Fe). This study aims to establish novel evidence of the effectiveness of the consumption of Fe-fortified lentils in improving the body Fe status and thus cognitive performance in non-pregnant adolescent girls in rural Bangladesh, compared to consumpt...

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3–6. Here we use 2,009 population-based studies, with measurements of height and...

Hospital cleaning has been shown to impact on rates of healthcare-associated infections (HCAIs) and good environmental hygiene is critical to quality care, yet those tasked with the role of ensuring a safe and clean environment often go unrecognised as members of the healthcare workforce. Sepsis is a leading cause of maternal and newborn death, a s...

Bangladesh is currently going through a nutritional transition with rapid increase in overnutrition while undernutrition is still remaining prevalent. Nevertheless, population-based data on demographic, socio-economic and lifestyle factors associated with underweight and overweight among adult population is scarce. Employing a nationwide cross-sect...

Objective Childhood stunting remains a major public health concern in Bangladesh. To accelerate the reduction rate of stunting, special focus is required during the first 23 months of a child’s life when the bulk of growth takes place. Therefore the present study explored individual-, maternal- and household-level factors associated with stunting a...

Background Evidence suggests that daily supplementation of 1500 to 2000 mg of calcium during pregnancy reduces pregnancy-induced hypertension (PIH). However, the evidence on the efficacy of low-dose calcium supplementation on PIH is limited. This paper assesses the longitudinal correlation between low-dose calcium intake (500 mg daily) and change i...

Abstract 548, Category: 1.9. Other

Background Maternal undernutrition is a significant public health concern globally, contributing to poor fetal and early childhood growth and increased infant morbidity and mortality, with long‐term adverse consequences for child development and lifelong health. Limited evidence exists, however, on delivering multiple interventions for maternal nut...

Background Sustained improvements in infant and young child feeding (IYCF) require continued implementation of effective interventions. From 2010–2014, Alive & Thrive (A&T) provided intensive interpersonal counseling (IPC), community mobilization (CM), and mass media (MM) in Bangladesh, demonstrating impact on IYCF practices. Since 2014, implementa...

Background: Iron-deficiency is the most common nutritional deficiency globally. Due to the high iron requirements for pregnancy, it is highly prevalent and severe in pregnant women. There is strong evidence that maternal iron deficiency anaemia increases the risk of adverse perinatal outcomes. However, most of the evidence is from observational ep...

Background: Although husbands may provide support during pregnancy, limited evidence exists on how to promote husbands' engagement and what impact it has. Alive & Thrive integrated nutrition-focused interventions, targeting both wives and husbands, through an existing Maternal, Neonatal, and Child Health (MNCH) platform in Bangladesh. Objectives:...

Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive pop...

Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hype...

Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hyp...

Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those...

BACKGROUND:Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends...