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Nasar U Ahmed

Florida International University, Epidemiology, Faculty Member

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Papers by Nasar U Ahmed

Assessment of the Impact of a Hygiene on Environmental Sanitation, Childhood Diarrhoea, and the Growth of Children in Rural Bangladesh

Food and Nutrition Bulletin, Mar 1, 1994

A community-based hygiene intervention was developed and implemented in five villages of lowland ... more A community-based hygiene intervention was developed and implemented in five villages of lowland Bangladesh with the active participation of members of the target group, with the objective of reducing childhood diarrhoea by altering ground sanitation and personal and food hygiene practices such as the washing of hands with ash before handling food and after defecation-related activities, cutting fingernails, removing faeces from the child's body and from the yard, using tube-well water for preparing baby food, and reducing supplementary feeding contamination by proper cleaning of bottles or avoiding bottle-feeding. The project area, typical of Bangladesh, was selected because of its pour hygiene and sanitation conditions and its high rates of diarrhoea and malnutrition. Households with children 0-18 months old in five contiguous villages were targeted for the intervention. Households with children in the same age range in a comparison (control) site selected for observational study without intervention were exposed to about the same amount of contact with the researchers. Baseline surveys of the subset of households with children 9-18 months old were conducted at the control site in July 1985 and at the intervention site in September. The intervention activities were carried out from January to July 1986. A final survey was conducted at both sites in August 1986, using the same questionnaire as for the baseline survey and the children who were then in the same age range, 9-18 months. Both sites had higher cleanliness scores, lower diarrhoeal morbidity, and better growth status at the end of the study period, but the improvement was greater at the intervention site. The effect at the control site may be attributed to the intensive observation exposures, mothers' education, and socioeconomic conditions of the households, whereas the intervention site effects were most likely due to the intervention activities. For evaluation of the effect of interventions, the repeat cross-sectional survey may be adequate for measuring relatively stable outcomes such as knowledge and practices, as well as cumulative growth status, but inadequate for fluctuating morbidity.

COVID-19 morbidity in Afghanistan: a nationwide, population-based seroepidemiological study

BMJ Open

ObjectiveThe primary objectives were to determine the magnitude of COVID-19 infections in the gen... more ObjectiveThe primary objectives were to determine the magnitude of COVID-19 infections in the general population and age-specific cumulative incidence, as determined by seropositivity and clinical symptoms of COVID-19, and to determine the magnitude of asymptomatic or subclinical infections.Design, setting and participantsWe describe a population-based, cross-sectional, age-stratified seroepidemiological study conducted throughout Afghanistan during June/July 2020. Participants were interviewed to complete a questionnaire, and rapid diagnostic tests were used to test for SARS-CoV-2 antibodies. This national study was conducted in eight regions of Afghanistan plus Kabul province, considered a separate region. The total sample size was 9514, and the number of participants required in each region was estimated proportionally to the population size of each region. For each region, 31–44 enumeration areas (EAs) were randomly selected, and a total of 360 clusters and 16 households per EA ...

Shaping Environments for Reductions in Type 2 Diabetes Risk Behaviors: A Look at CVD and Cancer Interventions

Diabetes Spectrum, 2002

In Brief Among the many efforts to reduce the burden of diabetes in the United States, one involv... more In Brief Among the many efforts to reduce the burden of diabetes in the United States, one involves focusing on communities. Evidence from cardiovascular disease and cancer-related community intervention projects indicate that such efforts show promise in reducing behavioral risk factors, many of which are the same for diabetes. Such projects, therefore, may provide insight for diabetes educators, researchers, and others who are interested in designing and implementing diabetes interventions within communities.

Changes in prevalence, and factors associated with tobacco use among Bangladeshi school students: evidence from two nationally representative surveys

BMC Public Health

Background Globally, tobacco kills more than nine million people per year. Annually in Bangladesh... more Background Globally, tobacco kills more than nine million people per year. Annually in Bangladesh, smoking accounts for 1.2 million illnesses and over one hundred fifty thousand deaths. Worldwide, about one out of five school students smoke tobacco, and this problem is also growing significantly in Bangladesh. There is a need to address this problem. However, to the best of knowledge, no published study has been evaluated the changes in factors associated with tobacco use over time among Bangladeshi adolescent students using large, nationally representative comparable surveys. Our objective was to identify the factors associated with tobacco use among school going students, examine any changes in them over time, and explore policy options based on national surveys. Methods We analysed the data from the 2007 and the 2013 Global Youth Tobacco Survey (GYTS), a school-based survey targeting adolescents age 13–15 years (7th–9th grade), developed by the World Health Organization (WHO) and...

Behavioural factors in diarrhoeal illness among Bangladeshi infants

Journal of tropical pediatrics, Dec 1, 1988

Research on 292 Bangladesh infants aged 9-10 months showed that 34% suffer from diarrheal disease... more Research on 292 Bangladesh infants aged 9-10 months showed that 34% suffer from diarrheal disease and 68% suffer from malnutrition. Investigations of 3 sites (Site 1=84 infants from a rural community: Site 2=96 infants from a low-lying village: Site 3= the rest from a village during the dry season) revealed certain features of the infants backgrounds: 79% played in areas contaminated with fecal matter 83% of the caretakers ignored germ theory and 96% did not practice sanitary methods after defecation. Mothers believed that diarrhea was due to supernatural causes bad air or adult foods. Step-wise regression analysis was used to determine the variables that most caused diarrhea at the various sites. Site 1 contributors were infants age and ability to walk fecal matter in the play area mothers education and no household radio. Site 2 contributors included wetness of play area fecal matter in play area and not washing food dropped by infant. Site 3 contributors included no household radio maternal use of latrines and infants age. Behavior certainly needs to be mediated in order to sway inhabitants from local traditions that facilitate poor health especially when infants are very young.

Clustering Very Low-Income, Insured Women’s Mammography Screening Barriers Into Potentially Functional Subgroups

Women's Health Issues, 2012

Background: Mammography screening is essential for early detection of breast cancer and increased... more Background: Mammography screening is essential for early detection of breast cancer and increased survival rates. Women, particularly those of low socioeconomic status, face barriers that impede their screening adherence. Although many studies have sought to identify these barriers, more research is needed on to address these obstacles in practice. The objective of this study is to divide mammography screening barriers into functional clusters using empirical evidence, which may guide the development of effective mammography screening promotion messages. Methods: A sample of 173 low-income White and Black women randomly selected from a managed care organization rated each of 21 potential mammography barriers on a scale ranging from "strongly agree" to "strongly disagree." A maximum clustering similarity method was used to identify relevant clusters of screening barriers. Results: Five clusters were derived, with a high similarity index (0.881). Each cluster was named to reflect the shared theme of the barriers within it: Perceived Lack of Value in Health Care, Lack of Information, Mistrust/Skepticism, Medical Delay Behavior, and Anxiety/No Control. A dominant barrier within each cluster was identified, and bivariate correlation coefficients were reported. Conclusion: Cluster analysis yielded five distinct subgroups of mammography screening barriers.

Disparities in Compliance with Colorectal Cancer Screening: Evidence from Two US National Surveys

Asian Pacific Journal of Cancer Prevention

Services Task Force (USPSTF) recommended that adults aged 50-75 years should screen for CRC to de... more Services Task Force (USPSTF) recommended that adults aged 50-75 years should screen for CRC to detect and prevent CRC at an early stage. However, 60.6% of the US adults 50-75 years or above were up to date with CRC screening (Joseph et al., 2020). Surprisingly, only 37% of CRC is detected at an early localized stage, and 21% are diagnosed at a distant stage (Seigel, 2020). Improving

The Effectiveness of Red Light Cameras in the United States—A Literature Review

Traffic Injury Prevention, 2014

The emergence of separation protest is robust under conditions of severe developmental stress in rural Bangladesh

Infant Behavior and Development, 2012

The response of 185 infants to their mothers' departure was assessed in a rural area of Banglades... more The response of 185 infants to their mothers' departure was assessed in a rural area of Bangladesh. Despite their poor health and nutritional status, this group of infants showed the same peak in separation protest around the end of the first year that has been documented for healthier samples in several cultural contexts; correlational analysis suggests that the healthier infants were more likely to display protest. In addition, there was an earlier rise and decline in distress at maternal departure in the first half year of life, not seen in other reports. In this case, poor health appeared to dispose toward upset, indicating that the most fragile infants were least able to cope with the regulatory demands imposed by maternal departure. Overall, the results are evidence for a very strongly canalized transformation of cognitive and emotional functioning toward the end of the first year of life.

The availability of essential medicines for diabetes at health facilities in Bangladesh: evidence from 2014 and 2017 national surveys

BMC Health Services Research, 2022

Background Bangladesh ranks among the world’s top ten countries in the number of diabetic patient... more Background Bangladesh ranks among the world’s top ten countries in the number of diabetic patients. The prevention of this disease requires treating patients with essential medicines, and the first crucial step in the uptake of these medicines is availability. We aimed to assess the availability of essential medicines for diabetes (EM-Diabetes) and to explore health facility characteristics associated with the availability of those medicines. Methods We performed the analysis using nationally representative data from the two waves of the cross-sectional Bangladesh Health Facility Survey (BHFS) in 2014 and 2017. Data are available for 1548 and 1524 health facilities in the 2014 and 2017 BHFS. Study samples of this study were 217 facilities (73 from 2014 and 144 from 2017) that offer diabetes diagnosis and treatment services. The outcome variable ‘EM-Diabetes availability’ was calculated as a counting score of the tracer medicines: metformin, glibenclamide, injectable insulin, and inj...

Assessment of the effects of teaching germ theory on changes in hygiene behaviors, cleanliness, and diarrheal incidence in rural bangladesh

International quarterly of community health education, 1993

Germ theory was taught as part of a hygiene intervention in five villages in Bangladesh in which ... more Germ theory was taught as part of a hygiene intervention in five villages in Bangladesh in which 87 percent of mothers were illiterate. Volunteer mothers taught other community mothers interactively in small groups using demonstration and teaching aids developed by a community working group. At final measurement 91 percent of mothers could explain five simple messages defining germ theory. Using germ theory in groups they identified forty high risk day-to-day practices and modified them to reduce diarrheal transmission. They adopted these new hygiene practices at rates ranging from 65 percent to 100 percent. Regression analysis suggests that understanding of germ theory was an important determinant of hygiene practices, cleanliness, and reduction in diarrheal incidence. Understanding of germ theory appeared to reduce diarrheal incidence not only through the interventions designed by the project but also changing perceptions of risk in the environment which led to spontaneous improve...

Empowering Factors in Repeat Mammography

Journal of Ambulatory Care Management, 2004

Screening mammography can reduce breast cancer mortality. Although a significant percentage of un... more Screening mammography can reduce breast cancer mortality. Although a significant percentage of underserved women obtain low income, minority mammograms regularly women underutilize mammography and rates of regular screening are also very low in the general population. By structuring focus groups around constructs from the Precede-Proceed Model, our study explored how these underserved women overcame barriers to be screened on a regular basis. Twenty-eight items were categorized as personal factors that helped them overcome the barriers: awareness and knowledge of risk factors (age and family history); knowledge and trust in early detection and treatment processes; personal responsibility about own health and well-being; and pride in self and satisfaction with one's own actions.

Community-Based Trial and Ethnographic Techniques for the Development of Hygiene Intervention in Rural Bangladesh

International Quarterly of Community Health Education, 1991

Community-based three-stage iterative trials were performed to develop interventions for improvin... more Community-based three-stage iterative trials were performed to develop interventions for improving hygiene practices to reduce childhood diarrhea in rural Bangladesh. Ethnographic techniques were used to identify practices associated with diarrhea, to understand cultural beliefs and reasoning related to causes of diarrhea, and to tap community resources. Hygiene behaviors and products designed through in-home problem diagnosis went through trials sequentially at three socio-economic levels consisting of ten educated project workers, twenty-five volunteer mothers and twenty-five very low- income mothers. These levels, chosen in order to meet the needs of all including the poorest, permitted new practices which proved feasible in the workers' trial to be then tried by the volunteers. The results were synthesized, with successful behavioral advice translated into simple verbal messages created to resemble locally popular proverbs, poems and folk songs. The messages and products wer...

A longitudinal study of the impact of behavioural change intervention on cleanliness, diarrhoeal morbidity and growth of children in rural Bangladesh

Social Science & Medicine, 1993

A community-based intervention was developed through direct participation of the target populatio... more A community-based intervention was developed through direct participation of the target population in assessment and iterative trials to improve hygiene practices and to reduce childhood diarrhoea in lowland rural Bangladesh. A total of 185 (98X) households with children ages O-18 months in five contiguous villages were targeted for the interventions. A comparison site was selected for a detailed observational study and for use as a control for the intervention. About 97% of all households with children ages l&l8 months were enrolled for study at the control site. Children in this age group were targeted because at this developmental stage they were most vulnerable to diarrhoeal morbidity and malnutrition (related to unhygienic practices). The intervention was implemented with the assistance of village leaders through a "Clean Life" campaign by local project workers and volunteer mothers who were chosen from the target households. The intervention activities started in January 1986 and lasted for 7 months. Higher adoption rates of the intervention were associated with better cleanliness status, which was related to lower diarrhoea and malnutrition rates in the intervention site. The results of between-site longitudinal analyses showed that after the intervention, the intervention site had substantially higher cleanliness scores, lower diarrhoeal morbidity, and better growth status compared to those of the control site, with differences increasing over time. The findings suggest that this type of community-based intervention can be very beneficial in modifying hygiene behaviours and lowering childhood diarrhoea and malnutrition.

Amniotic fluid concentrations of collagenase-1 and collagenase-3 are increased in polyhydramnios

Journal of Perinatal Medicine, 2004

Objective: Polyhydramnios places increased tension on the fetal membranes and should conceptually... more Objective: Polyhydramnios places increased tension on the fetal membranes and should conceptually be associated with an increased need for tissue remodeling to prevent premature rupture of membranes (PROM). Herein we use polyhydramnios as a model to study the association of the collagenase class of matrix metalloproteinases (MMPs) with tissue remodeling during pregnancy. Methods: Amniotic fluids were collected by transabdominal amniocentesis from women with polyhydramnios and from women with normal amniotic fluid volume at second trimester, third trimester and at term. Fluids were assayed for MMP-1 and MMP-13 (collagenase-1 and 3) using ELISA. The concentrations in polyhydramnios were compared with subjects undergoing amniocentesis with normal amniotic fluid volume. Statistical comparisons were made using Scheffe's method for correction in multiple means comparison. P of -0.05 was considered statistically significant. Results: MMP-1 and MMP-13 are present in the amniotic fluid at all stages of pregnancy. The concentrations of these MMPs were significantly elevated in the polyhydramnios samples independent of gestational age. Conclusion: Polyhydramnios is associated with increased amniotic fluid concentrations of MMP-1 and MMP-13 suggesting their role in tissue remodeling.

Bhat‐dhara— catching rice: A folk milestone in the development of Bangladeshi children: An investigation of parental beliefs and decision making in introducing young children to family meals

Ecology of Food and Nutrition, 1994

... malnutrition at this age, despite prolong breastfeeding up to 30 months and beyond (Brown et ... more

Nutritional correlates of frequency and length of breastfeeds in rural Bangladesh

Early Human Development, 1995

In this rural Bangladeshi sample of 165 mothers and their breastfed infants aged 5-23 months, mea... more In this rural Bangladeshi sample of 165 mothers and their breastfed infants aged 5-23 months, mean maternal body mass index (BMI) was 18, and 12-month infant height-forage z-scores (HAZ),-2.35. Structured observations were conducted over 6 months on 1649 breastfeeds during 3324 weekly daytime observations. Infants' and mothers' 24-h dietary recalls, weights, lengthsiheights and mothers' arm circumferences were taken monthly. When plotted with age, infants' anthropometric z-scores, food energy, and minutes observed breastfeeding revealed three patterns in age periods: 5-12, 13-18, and 19-23 months. In periods one (breastfeeding high) and three (breastfeeding low), food energy increased with age, linear growth paralleled the World Health Organinati (WHO) reference standard, and the children grew thinner. In two, (breastfeeding deciiningf, food energy did not increase and growth stasis occurred. Longer observed breastfeeding accompanied in period one, low maternal arm circumference, low infant energy intake from wary foode and infant shortness and plumpness in period two, infant shortness, thinness, and underweigbt; and in pekd three, infonts energy and thinness. In conclusion, the paper suggests that growth stasis xcurs primarily during the second period, which should have highest priority for culturally sensitive interventions.

Factors Explaining Racial/Ethnic Disparities in Rates of Physician Recommendation for Colorectal Cancer Screening

American Journal of Public Health, 2013

Objectives. Physician recommendation plays a crucial role in receiving endoscopic screening for c... more Objectives. Physician recommendation plays a crucial role in receiving endoscopic screening for colorectal cancer (CRC). This study explored factors associated with racial/ethnic differences in rates of screening recommendation. Methods. Data on 5900 adults eligible for endoscopic screening were obtained from the National Health Interview Survey. Odds ratios of receiving an endoscopy recommendation were calculated for selected variables. Planned, sequenced logistic regressions were conducted to examine the extent to which socioeconomic and health care variables account for racial/ethnic disparities in recommendation rates. Results. Differential rates were observed for CRC screening and screening recommendations among racial/ethnic groups. Compared with Whites, Hispanics were 34% less likely (P < .01) and Blacks were 26% less likely (P < .05) to receive this recommendation. The main predictors that emerged in sequenced analysis were education for Hispanics and Blacks and income...

Statistics &amp

www.idescat.cat/sort/ A comparison of some confidence intervals for estimating the population coe... more

Cesarean delivery and early childhood diseases in Bangladesh: An analysis of Demographic and Health Survey (BDHS) and Multiple Indicator Cluster Survey (MICS)

PLOS ONE

Introduction The rate of cesarean delivery (C-section) has been increasing worldwide, including B... more Introduction The rate of cesarean delivery (C-section) has been increasing worldwide, including Bangladesh, and it has a negative impact on the mother and child's health. Our aim was to examine the association between C-section and childhood diseases and to identify the key factors associated with childhood diseases. Methods We used four nationally representative data sets from multiple indicator cluster survey (MICS, 2012 and 2019) and Bangladesh Demographic and Health Survey (BDHS, 2011and 2014) and analyzed 25,270 mother-child pairs. We used the frequency of common childhood diseases (fever, short or rapid breaths, cough, blood in stools, and diarrhea) as our outcome variable and C-section as exposure variable. We included mother’s age, place of residence, division, mother’s education, wealth index, child age, child sex, and child size at birth as confounding variables. Negative binomial regression model was used to analyze the data. Results In the BDHS data, the prevalence o...