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Quality of life among pregnant women with chronic energy deficiency in rural Bangladesh.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
2006 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 78, no 2-3Article in journal (Refereed) Published
Abstract [en]

Quality of life scores of health conditions are needed for measuring quality adjusted life years (QALY), the most common outcome measure in cost-utility analysis. To measure QALY scores we used EQ-5D and a visual analogue scales (VIS). EQ-5D is a standardised instrument for measuring quality of life using five dimensions applicable to a wide range of health conditions. VAS had the endpoints "full health" and "death". We assessed the scores for chronic energy deficiency (CED) characterised by low body mass index (BMI<18.5), a condition highly prevalent among rural Bangladeshi women. EuroQol (EQ)-5D and VAS were used to measure when the condition was worst and VAS measured the current health status. We interviewed 285 pregnant and postpartum women, with 236 (83%) having complete information. Mean scores for CED when perceived to be most severe were 0.30 (EQ-5D, interquartile range -0.02 to 0.52) and 0.27 (visual analogue scale, interquartile range 0.12-0.39) in scales with scores ranging from -0.54 to 1.00 and from 0 to 1.00, respectively. The mean score for current health status derived from the visual analogue scale was 0.49 (95% CI for mean 0.45-0.52) in a scale with scores ranging from 0 to 1.00. Rural Bangladeshi women attached very low quality of life scores to CED. The scores are comparable to scores attached to severe debilitating conditions like cancer in western countries. If considered in the global perspective, prevention of chronic energy deficiency among women in developing countries should be given high priority.

Place, publisher, year, edition, pages
2006. Vol. 78, no 2-3
National Category
Health Sciences
URN: urn:nbn:se:uu:diva-267576DOI: 10.1016/j.healthpol.2005.11.008PubMedID: 16388875OAI: oai:DiVA.org:uu-267576DiVA: diva2:873638
Available from: 2015-11-24 Created: 2015-11-24 Last updated: 2016-01-13
In thesis
1. Prenatal food and micronutrient supplementation to malnourished women in Bangladesh: Effects, Equity, and Cost-effectiveness
Open this publication in new window or tab >>Prenatal food and micronutrient supplementation to malnourished women in Bangladesh: Effects, Equity, and Cost-effectiveness
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Maternal nutrition is closely linked to child health and survival. In Bangladesh there is a high prevalence of undernutrition in the form of chronic energy deficiency [CED, Body Mass Index <18.5 (kg/m2)] in women and low birth weight. The aims of this thesis are to explore women’s perceptions of maternal undernutrition, to analyse the association between prenatal food supplementation and birth weight (BW), to analyse whether food- and multiple micronutrient interventions generate pro-disadvantaged equity in child survival, and to examine whether an early prenatal invitation to food supplementation and multiple micronutrient supplements (MMS) represents value for money in infant survival compared to invitation to food supplementation at usual time combined with 60 mg iron and 400 µg folic acid (standard practice).

The study on women’s perceptions (n=236) was nested into the MINIMat randomized trial where women (n=4436) were allocated to early (E), or usual (U) time of invitation to prenatal food supplementation and 30 mg iron with 400 µg folic acid, or 60 mg iron with 400 µg folic acid, or MMS. Live births (n=3625) were followed-up. The analyses of equity and cost-effectiveness were based on this trial. A cohort design (n=619) was employed for the analysis of food supplements and BW.

Women perceived maternal undernutrition as a serious health problem and attached very low scores to CED in pregnancy. An average of four months of prenatal food supplementation increased BW by 118 g. An early invitation to prenatal food supplementation and MMS lowered mortality in children before the age of five years and reduced social disparity in child survival chances. An increment from standard practice to E-MMS averted one extra infant death at a cost of US$797 to US$907, and saved one extra life year at a cost of US$27 to US$30.

High priority should be given to the nutritional status of pregnant women in societies where undernutrition and food insecurity occurs. Prenatal food supplementation has the potential to significantly increase BW, and an early initiation of prenatal food supplementation combined with MMS was considered cost-effective in lowering infant mortality and increase social equity in child survival chances.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 68 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1165
malnutrition, pregnancy, food supplement, micronutrient supplement, birth weight, infant mortality, effectiveness, economic evaluation, equity, Bangladesh
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Medical Science
urn:nbn:se:uu:diva-267601 (URN)978-91-554-9426-1 (ISBN)
Public defence
2016-01-27, Rosénsalen, Paediatric Hospital, Akademiska sjukhuset, Entrance 95/96, Uppsala, 13:15 (English)
Available from: 2015-12-21 Created: 2015-11-25 Last updated: 2016-01-13

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