Abstract Height is an anthropometric measure of nutritional levels and health status during childhood and adolescence and can strongly predict health and developmental outcomes across the lifespan. There is little evidence on the growth trends of Chinese children and adolescents living at high altitudes. This paper aimed to examine the secular trends and pubertal growth spurts in height among Tibetan children and adolescents in Lhasa from 1965 to 2019. Height data among Tibetan children and adolescents aged 7–17 years were obtained from ten cross-sectional surveys (1965, 1975, 1985, 1991, 1995, 2000, 2005, 2010, 2014, and 2019). Sample-weighted regressions (linear or quadratic or cubic regressions) were performed to estimate trends in height by sex and age. A population-weighting procedure was used to calculate the changes for boys and girls. The SuperImposition by Translation and Rotation model was used to separately fit height–distance and height–velocity curves for boys and girls, yielding sex- and wave-specific peak height velocity (PHV) and age at PHV (APHV). The results showed that population-based height increased by 17.8 cm or 2.28 effect size (ES) for boys and by 14.1 cm or 1.98 ES for girls from 1965 to 2019. Among boys, there was a moderate increase per decade (0.76 ES) from 1965 to 1970, followed by a gradual deceleration in this trend. For girls, there was a largest increase per decade (0.74 ES) in 1960s. Then, the trend slowed and remained stable in the last decades. From 1965 to 2019, the PHV for boys increased from 6.53 cm/year to 7.36 cm/year ( P = 0.007), whereas the APHV decreased from 15.84 years to 13.39 years ( P < 0.001). Girls showed no significant trend in PHV, but APHV decreased from 12.85 years to 10.00 years. In sum, this study reveals a secular trend in height among Tibetan children and adolescents in Lhasa over the past five decades, with a recent deceleration in trends. Puberty development has advanced in both sexes. More public health policies are needed to promote the growth and development of Tibetan children and adolescents and prevent negative impacts from sustained growth and early puberty.
Antibiotic resistance is a critical global health threat, with over a million deaths linked to resistant infections every year. Inappropriate antibiotic use for childhood diarrhoeal illness is a significant contributor to antimicrobial resistance. This is particularly important in low-resource settings where antibiotics are often used without clear clinical indication. This study explored the knowledge and perspectives of antibiotic stewardship among clinicians and caregivers of paediatric patients in Bangladesh. In-depth interviews were conducted with 18 clinicians and 36 patient caregivers across three government hospitals. While few clinicians were familiar with the term 'antibiotic stewardship', most understood its core principles and supported judicious prescribing. Caregivers were generally unfamiliar with the concept of antimicrobial stewardship, though a few acknowledged the risks of antibiotic overuse. Clinicians described informal stewardship efforts but highlighted the absence of structured programmes. Key challenges to stewardship included community-level antibiotic dispensing by informal providers, staffing shortages, caregiver expectations for antibiotics, and pressure to satisfy families' perceived expectations. Despite barriers, clinicians expressed support for educational initiatives and system-level efforts to promote antibiotic stewardship. These findings underscore the need for integrated, facility-and community-based approaches like decision-making support tools for providers, institutional reviews of antibiotic use, and community education on the dangers of inappropriate antibiotic use. Strengthening antibiotic stewardship in low-resource settings like Bangladesh is essential to curb misuse and combat the growing threat of antibiotic resistance.
Over the past decade, Bangladesh has experienced substantial demographic change alongside increasing climate-related disruption. This study examines the links between extreme climatic events and fertility among married Bangladeshi women of childbearing age who already have children, focusing on how cyclones and floods relate to fertility behaviour in cyclone- and flood-prone villages. A mixed-methods design was used, drawing on 544 household surveys, 74 in-depth interviews with women, 10 focus group discussions with men, and 8 key informant interviews. Comparing two ecologically distinct sites allowed examination of how communities experience and respond to different hazards. The findings indicate divergent fertility patterns by hazard type. In the cyclone-prone site, physical destruction, displacement, and disrupted health-care access were associated with lower fertility. In the flood-prone site, recurrent inundation, reliance on children's labour, and constrained contraceptive access were associated with higher fertility. Socio-demographic factors, including education, age at marriage, and contraceptive access, were also strongly associated with fertility behaviour. Households in the cyclone-prone area showed greater livelihood vulnerability and lower fertility, whereas those in the flood-prone area showed higher fertility alongside elevated child mortality and a marked preference for sons, who were perceived as better able to assist in disaster recovery. These results suggest that extreme climatic events are associated with differentiated fertility responses, shaped by socio-demographic context, and point to the value of integrating reproductive health services into disaster risk reduction. The study highlights the intersection of climate change, socio-demographic factors, and reproductive health and offers evidence on how hazard-type conditions fertility responses, with implications for climate adaptation and population health policy in climate-vulnerable regions such as Bangladesh.
This qualitative study explores the contraceptive use behaviours among women with disabilities in low-resource settings in Ghana, a group whose reproductive health needs are often overlooked in mainstream family planning programmes. Sixteen women with visual, physical, and hearing impairments in Apam, Central Region, were purposively selected to participate in semi-structured in-depth interviews conducted in their preferred languages, including Ghanaian Sign Language. Reflexive thematic analysis was used to identify key patterns in the data, revealing four main themes: (1) pathways for acquiring contraceptive knowledge, which included institutional outreach, maternal health visits, and informal peer networks; (2) determinants of non-utilisation, such as fear of side effects, religious stigma, and the desire to have children for future caregiving support; (3) drivers of modern contraceptive uptake, including the pursuit of educational and vocational goals, partner support, and the desire to prevent obstetric trauma; and (4) structural and systemic health inequalities, characterised by communication barriers, inaccessible physical infrastructure, and inconsistent provider attitudes. The findings advance scientific knowledge by moving beyond a simple narrative of unmet need to illustrate how women with disabilities exercise reproductive agency within a complex landscape of intersecting personal, social, and structural constraints. The novel findings highlight the dual role of informal networks in disseminating both accurate information and persistent myths, as well as the nuanced ways in which fertility is viewed as a long-term survival strategy in the absence of robust social support. These insights inform policy by underscoring the urgent need for disability-inclusive family planning services. This requires a multi-pronged approach that includes accessible communication through sign language interpretation, disability-sensitivity training for healthcare workers, retrofitting health facilities to improve physical access, and linking contraceptive services with broader social protection programmes to address the root causes of non-use.
