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Title: Tobacco usage and nutritional status of adults living in rural and urban Bangladesh
Author: Flora, M. S.
Awarding Body: University of Cambridge
Current Institution: University of Cambridge
Date of Award: 2007
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Three annual cross-sectional surveys between 2001 and 2003 were carried out to determine the extent of all forms of tobacco usage as well as the combined risk of malnutrition (under- and over-nutrition) in adult Bangladeshis. A total of 35,446 individuals, 18 years and above, from both urban and rural areas took part of whom 54.3% were female and 51% were rural dwellers. Data on socio-demographic background and knowledge about the harmful effects of tobacco were collected through a structured questionnaire. In the second and third year, height, weight and waist circumference were measured and body mass index (BMI), waist-to-height ration (WtHR) and conicity index (Cindex) were determined. Nutritional status was defined by the World Health Organization (WHO) BMI cut-offs (< 18.5, 18.5-24.99, 25-29.99 and > 30 for underweight, normal, pre-obese and obesity, respectively) and Asian cut-offs (< 18.5, 18.5-22.99, 23-27.49 and > 27.5 for underweight, low, moderate and high). Cut-offs for central obesity were also used: for waist circumference the international cut-offs for males were > 94cm and > 102cm and females, 80cm and > 88cm (reflecting high and very high levels). There was no increase in tobacco prevalence over the three year study and 37.5% of the sample used at least one form of tobacco. The overall prevalences of smoking, chewing tobacco and gul usage were 20.5%, 20.6% and 1.8% respectively. In addition 8% and 4.5% were past and occasional smoker, respectively. Current smoking and gul usages were significantly higher in males (42.2% and 2.2%, respectively) than females (2.3% and 1.5% respectively) while chewing tobacco was more common in females (21.6%) than males (19.4%). No significant locality difference was observed in smoking rate after adjusting for socio-demographic variables while chewing tobacco was 1.5 times more likely to occur in rural residents and gul usage was 3.6 times more likely to occur in urban residents. Smoking, chewing tobacco and gul usage all decreased with better educational status. The overall mean BMI, WC, WtHR and Cindex were 20.83, 74 cm, 0.48 and 1.20, respectively with higher means in urban residents; no sex difference was found in mean BMI and WC. One-quarter of sample were chronically energy deficient (CED) and all grades of CED were more common in rural residents, manual labourers and farmers and those who had no schooling. Using the WHO cut-offs 59% of the sample were at some risk from either underweight, overweight and smoking which increased to 66% for any tobacco usage. When the Asian cut-offs were used there were substantial increases to 77% for underweight, overweight and smoking and 81% for underweight, overweight and tobacco usage.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available