Underweight, Overweight and Obesity among Reproductive Bangladeshi Women: A Nationwide Survey
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources
2.2. Exclusion Criteria
2.3. Dependent Variables
2.4. Independent Variables
2.5. Statistical Analyses
3. Results
3.1. Prevalence of Underweight, Normal, Overweight and Obesity among Reproductive-Age Women in Bangladesh
3.2. Factors Associated with Underweight among Reproductive Age Women in Bangladesh
3.3. Factors Associated with Overweightamong Reproductive Age Women in Bangladesh
3.4. Factors Associated with Obesity among Reproductive Age Women in Bangladesh
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement and Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | n (%) | Underweight | Normal | Overweight | Obesity | |
---|---|---|---|---|---|---|
% (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | p* | ||
Parental level factors | ||||||
Working status | ||||||
Non-working | 10,554 (52.4) | 8.1 (4.5–8.7) | 56.3 (54.9–57.7) | 27.7 (26.5–29.0) | 7.9 (7.1–8.6) | <0.001 |
Working (past 12 months) | 9573 (47.6) | 9.4 (8.7–10.2) | 62.5 (61.3–63.6) | 22.9 (21.9–24.0) | 5.2 (4.7–5.7) | |
Education | ||||||
No education | 3333 (16.6) | 11.4 (10.3–12.7) | 63.6 (61.7–65.4) | 21.0 (19.3–22.8) | 4.0 (3.4–4.9) | |
Primary | 6290 (31.2) | 9.4 (8.6–10.2) | 60.1 (58.6–61.6) | 24.5 (23.2–25.8) | 6.0 (5.3–6.8) | <0.001 |
Secondary and above | 10,504 (52.2) | 7.5 (6.8–8.2) | 57.4 (56.0–58.7) | 27.4 (26.3–28.6) | 7.7 (7.0–8.5) | |
Father’s education (n = 18,983) | ||||||
No education | 4130 (21.8) | 10.7 (9.6–11.8) | 63.7 (62.0–65.4) | 21.2 (19.8–22.7) | 4.3 (3.7–5.1) | |
Primary | 6080 (32.0) | 9.8 (8.9–10.7) | 61.7 (60.1–63.3) | 22.9 (21.5–24.3) | 5.6 (4.9–6.3) | <0.001 |
Secondary and above | 8773 (46.2) | 6.7 (6.1–7.3) | 54.9 (53.5–56.3) | 29.9 (28.8–31.1) | 8.5 (7.7–9.3) | |
Literacy (n = 20,117) | ||||||
Cannot read at all | 5364 (26.7) | 11.0 (10.1–12.0) | 62.4 (60.9–63.9) | 21.8 (20.5–23.2) | 4.8 (4.1–5.5) | <0.001 |
Able to read only part of sentence | 14,753 (73.3) | 7.9 (7.3–8.4) | 58.1 (56.9–59.3) | 26.8 (25.8–27.8) | 7.2 (6.7–7.9) | |
Age | ||||||
15–24 years | 4882 (24.2) | 13.3 (12.3–14.5) | 69.3 (67.8–70.8) | 14.7 (13.6–16.0) | 2.6 (2.1–3.2) | |
25–34 years | 7785 (38.7) | 6.9 (6.2–7.6) | 58.2 (56.7–59.7) | 27.9 (26.7–29.3) | 6.9 (6.2–7.7) | <0.001 |
35–49 years | 7460 (37.0) | 7.6 (6.9–8.4) | 53.7 (52.2–55.2) | 29.8 (28.5–31.2) | 8.8 (8.0–9.7) | |
Women status | ||||||
Adolescence (15–19 years) | 2063 (10.3) | 16.7 (14.9–18.6) | 7.8 (7.3–8.3) | 10.2 (8.8–11.8) | 1.0 (0.7–1.7) | <0.001 |
Non adolescence (20–49 years) | 18,064 (89.7) | 72.0 (69.8–74.2) | 57.8 (56.7–58.9) | 27.2 (26.3–28.1) | 7.2 (6.7–7.8) | |
Marital status | ||||||
Currently married | 18,984 (93.3) | 8.5 (8.0–9.1) | 59.1 (58.0–60.1) | 25.8 (24.9–26.7) | 6. 6 (6.1–7.2) | <0.001 |
Formerly married † | 1143 (5.7) | 11.7 (9.9–13.8) | 62.5 (59.3–65.6) | 20.1 (17.6–22.9) | 5.6 (4.3–7.3) | |
Births in last 5 years | ||||||
No birth | 12,517 (62.2) | 7. 9 (7.3–8.5) | 56.9 (55.8–58.1) | 27.9 (26.8–28.9) | 7.3 (6.7–7.9) | <0.001 |
Yes | 7610 (37.8) | 10.1 (9.3–10.9) | 63.1 (61.6–64.5) | 21.4 (20.2–22.6) | 5.5 (4.8–6.1) | |
Currently breastfeeding | ||||||
Yes | 4138 (20.6) | 12.2 (11.2–13.3) | 7.8 (7.3–8.4) | 15.9(14.6–17.3) | 3.9 (3.2–4.7) | <0.001 |
No | 15,989 (79.4) | 67.9 (66.3–69.7) | 67.9 (66.3–69.7) | 27.9 (27.0–28.9) | 7.28 (6.7–7.9) | |
Contraceptive use | ||||||
Use | 11,742 (58.3) | 8.1 (7.5–8.8) | 59.7 (58.6–60.9) | 25.6 (24.7–26.6) | 6.5 (5.9–7.1) | 0.6129 |
Not using | 8385 (41.7) | 9.6 (8.8–10.3) | 58.6 (57.2–60.0) | 25.1 (23.8–26.4) | 6.7 (6.0–7.4) | |
Reads newspaper or magazine | ||||||
At least once a week | 648 (3.2) | 2.8 (1.8–4.4) | 42.0 (37.3–46.9) | 38.5 (34.2–43.0) | 16.7 (13.7–20.1) | |
Less than once a week | 1218 (6.1) | 4.6 (3.4–6.1) | 54.2 (51.0–57.3) | 30.3 (27.6–33.2) | 10.9 (9.1–13.0) | <0.001 |
Never | 18,261 (90.7) | 9.2 (8.7–9.7) | 60.2 (59.2–61.2) | 24.7 (23.8–25.6) | 6.0 (5.5–6.4) | |
Listens to radio (n = 20,125) | ||||||
At least once a week | 414 (2.0) | 8.3 (5.7–11.9) | 61.7 (56.2–66.8) | 24.9 (20.5–29.9) | 5.1 (3.2–8.0) | |
Less than once a week | 561 (2.6) | 8.6 (5.8–11.1) | 57.4 (52.0-61.8) | 26.9 (22.9–31.3) | 7.7 (5.7–10.3) | <0.001 |
Never | 19,150 (95.2) | 8.7 (8.2–9.3) | 59.3 (58.2–60.3) | 25.4 (24.5–26.3) | 6.6 (6.1–7.1) | |
Watches television | ||||||
At least once a week | 11,061 (54.9) | 6.3(5.7–6.9) | 54.7 (53.3–56.0) | 29.8 (28.7–30.9) | 9.3 (8.5–10.1) | |
Less than once a week | 1842 (9.2) | 10.6(9.1–12.3) | 62.7 (60.3–65.1) | 22.2 (20.1–24.5) | 4.4 (3.4–5.8) | <0.001 |
Never | 7224 (35.9) | 11.9 (11.0–12.9) | 65.3 (64.0–66.6) | 19.7 (18.6–20.8) | 3.1 (2.6–3.5) | |
Power over earnings | ||||||
Husband alone | 7119 (35.4) | 9.9 (9.1–10.8) | 61.5 (60.1–62.39) | 22.7 (21.5–23.9) | 5.8 (5.2–6.5) | <0.001 |
Woman alone or joint decision | 13,008 (64.6) | 8.1 (7.5–8.7) | 58.0 (56.8–59.2) | 26.9 (25.9–28.0) | 7.0 (6.4–7.6) | |
Autonomy Health Care | ||||||
Husband alone | 5617 (27.9) | 10.8 (9.8–11.8) | 62.5 (61.0–64.0) | 21.7 (20.5–23.7) | 4.9 (4.3–5.6) | <0.001 |
Woman alone or joint decision | 14,510 (72.1) | 7.9 (7.4–8.5) | 58.0 (56.8–59.2) | 26.9 (25.9–27.9) | 7.2 (6.6–7.8) | |
Power over Household Decision making | ||||||
Husband alone | 3405 (16.9) | 11.6 (10.4–12.9) | 63.5 (61.7–65.3) | 20.1 (18.6–21.7) | 4.8 (4.0–5.6) | <0.001 |
Woman alone or joint decision | 16,722 (83.1) | 8.1 (7.6–8.7) | 58.4 (57.3–59.5) | 26.5 (25.6–27.5) | 6.9 (6.4–7.5) | |
Wife beaten for refusing sex | ||||||
Yes | 634 (3.2) | 10.6 (8.3–13.6) | 60.7 (55.9–65.2) | 22.84 (19.4-26.7) | 5.7 (4.1–8.3) | 0.252 |
No | 19,493 (96.8) | 8.7 (8.2–9.2) | 59.2 58.2–60.2) | 25.5 (24.6-26.4) | 6.6 (6.1–7.1) | |
Attitudes to domestic Violence | ||||||
Yes | 4048 (20.1) | 10.1 (9.0–11.3) | 60.1 (58.1–62.2) | 23.9 (22.2–25.6) | 5.9 (5.0–7.0) | 0.0043 |
No | 16,079 (79.9) | 8.4 (7.8–8.9) | 59.1 (57.9–60.2) | 25.8 (24.9–26.8) | 6.7 (6.2–7.3) | |
Household level factors | ||||||
Household Wealth Index | ||||||
Poorest | 3743 (18.6) | 14.9 (13.5–16.3) | 68.9 (67.1–70.6) | 14.5 (13.3–15.7) | 1.8 (1.4–2.3) | |
Poorer | 3957 (19.7) | 11.6 (10.5–12.9) | 66.4 (64.6–68.1) | 19.0 (17.5–20.6) | 3.0 (2.4–3.7) | <0.001 |
Middle | 4059 (20.2) | 7.9 (7.0–8.9) | 61.9 (60.2–63.7) | 25.1 (23.5–26.8) | 5.0 (4.3–5.7) | |
Richer | 4184 (20.7) | 6.6 (5.7–7.5) | 56.9 (55.1–58.7) | 29.3 (27.7–31.0) | 7.2 (6.4–8.3 | |
Richest | 4184 (20.8) | 3.2 (2.6–3.9) | 43.2 (41.2–45.2) | 38.2 (36.4–40.0) | 15.4 (14.1–16.9) | |
Source of drinking water | ||||||
Unimproved | 2197 (10.9) | 9.1 (7.7–10.6) | 61.2 (58.5–63.9) | 23.6 (21.3–26.0) | 6.1 (5.0–7.5) | <0.001 |
Improved | 17,930 (89.1) | 8.7 (8.2–9.2) | 59.0 (57.9–60.1) | 25.7 (24.7–26.6) | 6.6 (6.1–7.2) | |
Community level factors | ||||||
Residence | ||||||
Urban | 5729 (28.5) | 6.2 (5.5–7.0) | 50.8 (49.0–50.6) | 32.2 (30.7–33.8) | 10.8 (9.7–11.9) | <0.001 |
Rural | 14,398 (71.5) | 9.7 (9.1–10.4) | 62.6 (61.4–63.7) | 22.8 (21.8–23.8) | 4.9 (4.5–5.5) | |
Geographical region (n = 20,126) | ||||||
Barishal | 1125 (5.6) | 7.6 (6.2–9.2) | 61.1 (58.6–63.5) | 26.6 (24.4–28.8) | 4.7 (3.7–6.0) | |
Chattogram | 3622 (18.0) | 5.9 (4.9–7.1) | 56.3 (53.8–58.8) | 29.7 (27.6–31.9) | 8.1 (6.9–9.5) | |
Dhaka | 5123 (25.5) | 7.0 (6.0–8.2) | 55.9 (53.2–58.6) | 28.3(26.1–30.7) | 8.7 (7.4–10.2) | <0.001 |
Khulna | 2336 (11.6) | 8.2 (6.9–9.5) | 57.2 (54.5–59.9) | 27.3 (25.1–29.6) | 7.3 (6.2–8.7) | |
Mymensingh | 1546 (7.7) | 13.1 (11.3–15.1) | 63.9 (61.3–66.4) | 19.4 (15.2–21.7) | 3.7 (2.6–5.3) | |
Rajshahi | 2802 (13.9) | 9.43 (8.2–10.8) | 61.1 (58.6–63.4) | 23.8 (21.7–26.1) | 5.7 (4.6–6.9) | |
Rangpur | 2380 (11.8) | 10.1 (8.5–11.9) | 65.5 (62.9–67.9) | 19.9 (17.9–22.2) | 4.5 (3.5–5.8) | |
Sylhet | 1192 (5.9) | 16.3 (14.4–18.6) | 62.0 (58.8–65.2) | 18.3 (15.8–21.1) | 3.3 (2.4–4.6) |
Characteristic | Underweight (n = 2367) | |||||
---|---|---|---|---|---|---|
Unadjusted | Adjusted | |||||
OR | 95% CI | p-Value | AOR | 95% CI | p-Value | |
Maternal education | ||||||
No education | 1.00 | 1.00 | ||||
Primary | 0.80 | 0.69, 0.93 | 0.004 | 0.80 | 0.68, 0.94 | 0.007 |
Secondary and above | 0.63 | 0.54, 0.72 | <0.001 | 0.76 | 0.65, 0.90 | 0.001 |
Watches television | ||||||
At least once a week | 1.00 | 1.00 | ||||
Less than once a week | 1.77 | 1.45, 2.16 | <0.001 | 1.29 | 1.05, 1.59 | 0.015 |
Never | 2.02 | 1.79, 2.30 | <0.001 | 1.23 | 1.06, 1.43 | 0.006 |
Currently breastfeeding | ||||||
No | 1.00 | 1.00 | ||||
Yes | 0.61 | 0.54, 0.68 | <0.001 | 0.68 | 0.60, 0.76 | <0.001 |
Women status | ||||||
Adolescence (15–19 years) | 1.00 | 1.00 | ||||
Non adolescence (20–49 years) | 0.42 | 0.37, 0.49 | <0.001 | 0.44 | 0.37, 0.51 | <0.001 |
Marital status | ||||||
Currently married | 1.00 | 1.00 | ||||
Formerly married † | 1.42 | 1.16, 1.73 | 0.001 | 1.31 | 1.05, 1.64 | 0.017 |
Contraceptive use | ||||||
Using | 1.00 | 1.00 | ||||
Not using | 1.19 | 1.07, 1.33 | 0.001 | 1.17 | 1.04, 1.32 | 0.008 |
Division | ||||||
Barishal | 1.00 | 1.00 | ||||
Chattogram | 0.77 | 0.58, 1.02 | 0.068 | 1.00 | 0.76, 1.31 | 0.973 |
Dhaka | 0.92 | 0.70, 1.22 | 0.575 | 1.42 | 1.08, 1.88 | 0.013 |
Khulna | 1.08 | 0.83, 1.42 | 0.558 | 1.41 | 1.08, 1.84 | 0.013 |
Mymensingh | 1.83 | 1.40, 2.41 | <0.001 | 1.86 | 1.44, 2.41 | <0.001 |
Rajshahi | 1.27 | 0.98, 1.65 | 0.074 | 1.50 | 1.17, 1.93 | 0.002 |
Rangpur | 1.37 | 1.03, 1.81 | 0.032 | 1.33 | 1.01, 1.75 | 0.045 |
Sylhet | 2.38 | 1.83, 3.09 | <0.001 | 2.67 | 2.07, 3.45 | <0.001 |
Wealth Index | ||||||
Richest | 1.00 | 1.00 | ||||
Richer | 2.11 | 1.63, 2.73 | <0.001 | 1.89 | 1.46, 2.46 | <0.001 |
Middle | 2.60 | 2.00, 3.37 | <0.001 | 2.28 | 1.74, 2.97 | <0.001 |
Poorer | 3.94 | 3.11, 4.99 | <0.001 | 3.11 | 2.40, 4.04 | <0.001 |
Poorest | 5.25 | 4.12, 6.69 | <0.001 | 3.86 | 2.94, 5.07 | <0.001 |
Characteristic | Overweight (n = 5164) | |||||
---|---|---|---|---|---|---|
Unadjusted | Adjusted | |||||
OR | 95% CI | p-Value | AOR | 95% CI | p-Value | |
Maternal education | ||||||
No education | 1.00 | 1.00 | ||||
Primary | 1.22 | 1.09, 1.38 | 0.001 | 1.19 | 1.06, 1.34 | 0.004 |
Secondary and above | 1.43 | 1.27, 1.60 | <0.001 | 1.18 | 1.05, 1.33 | 0.006 |
Watches television | ||||||
At least once a week | 1.00 | 1.00 | ||||
Less than once a week | 0.67 | 0.59, 0.77 | <0.001 | 0.89 | 0.77, 1.02 | 0.106 |
Never | 0.58 | 0.53, 0.63 | <0.001 | 0.90 | 0.81, 0.99 | 0.031 |
Currently breastfeeding | ||||||
No | 1.00 | 1.00 | ||||
Yes | 2.05 | 1.85, 2.26 | <0.001 | 1.91 | 1.72, 2.12 | <0.001 |
Women status | ||||||
Adolescence (15–19 years) | 1.00 | 1.00 | ||||
Non adolescence (20–49 years) | 3.29 | 2.79, 3.87 | <0.001 | 3.14 | 2.64, 3.72 | <0.001 |
Marital status | ||||||
Currently married | 1.00 | 1.00 | ||||
Formerly married † | 0.73 | 0.62, 0.86 | <0.001 | 0.76 | 0.63, 0.92 | <0.001 |
Power over earnings | ||||||
Husband alone | 1.00 | 1.00 | ||||
Woman alone or joint decision | 1.25 | 1.16, 1.35 | <0.001 | 1.16 | 1.06, 1.26 | 0.001 |
Division | ||||||
Barishal | 1.00 | 1.00 | ||||
Chattogram | 1.17 | 1.00, 1.36 | 0.048 | 0.89 | 0.78, 1.03 | 0.111 |
Dhaka | 1.09 | 0.93, 1.28 | 0.274 | 0.74 | 0.64, 0.86 | <0.001 |
Khulna | 1.04 | 0.88, 1.22 | 0.658 | 0.85 | 0.74, 0.99 | 0.033 |
Mymensingh | 0.66 | 0.55, 0.80 | 0.000 | 0.65 | 0.55, 0.76 | <0.001 |
Rajshahi | 0.87 | 0.73, 1.02 | 0.091 | 0.77 | 0.66, 0.89 | <0.001 |
Rangpur | 0.69 | 0.58, 0.82 | <0.001 | 0.73 | 0.62, 0.86 | <0.001 |
Sylhet | 0.62 | 0.50, 0.76 | <0.001 | 0.53 | 0.44, 0.63 | <0.001 |
Wealth Index | ||||||
Richest | 1.00 | 1.00 | ||||
Richer | 0.67 | 0.60, 075 | <0.001 | 0.73 | 0.65, 0.81 | <0.001 |
Middle | 0.54 | 0.49, 0.61 | <0.001 | 0.59 | 0.52, 0.67 | <0.001 |
Poorer | 0.38 | 0.33, 0.43 | <0.001 | 0.45 | 0.39, 0.52 | <0.001 |
Poorest | 0.27 | 0.24, 0.31 | <0.001 | 0.34 | 0.29, 0.40 | <0.001 |
Characteristic | Obesity (n = 1362) | |||||
---|---|---|---|---|---|---|
Unadjusted | Adjusted | |||||
OR | 95% CI | p-Value | AOR | 95% CI | p-Value | |
Maternal education | ||||||
No education | 1.00 | 1.00 | ||||
Primary | 1.53 | 1.22, 1.91 | <0.001 | 1.58 | 1.25, 1.99 | <0.001 |
Secondary and above | 1.99 | 1.61, 2.46 | <0.001 | 1.50 | 1.16, 1.94 | <0.001 |
Watches television | ||||||
At least once a week | 1.00 | 1.00 | ||||
Less than once a week | 0.45 | 0.34, 0.61 | <0.001 | 0.72 | 0.54, 0.97 | 0.029 |
Never | 0.31 | 0.26, 0.37 | <0.001 | 0.63 | 0.51, 0.77 | <0.001 |
Currently breastfeeding | ||||||
No | 1.00 | 1.00 | ||||
Yes | 1.94 | 1.61, 2.35 | <0.001 | 1.33 | 1.09, 1.63 | <0.001 |
Women status | ||||||
Adolescence(15–19 years) | 1.00 | 1.00 | ||||
Non adolescence (20–49 years) | 7.02 | 4.40, 11.19 | <0.001 | 3.26 | 1.93, 5.49 | <0.001 |
Age | ||||||
15–24 years | 1.00 | 1.00 | ||||
25–34 years | 2.76 | 2.19, 3.48 | <0.001 | 1.94 | 1.49, 2.52 | <0.001 |
35–49 years | 3.57 | 2.85, 4.48 | <0.001 | 2.73 | 2.10, 3.56 | <0.001 |
Autonomy Health Care | ||||||
Husband alone | 1.00 | 1.00 | ||||
Woman alone or joint decision | 1.50 | 1.29, 1.73 | <0.001 | 1.25 | 1.08, 1.45 | 0.003 |
Working status | ||||||
Non-working | 1.00 | 1.00 | ||||
Working (past 12 months) | 0.64 | 0.56, 0.73 | <0.001 | 0.74 | 0.64, 0.85 | <0.001 |
Reads newspaper or magazine | ||||||
At least once a week | 1.00 | 1.00 | ||||
Less than once a week | 0.61 | 0.46, 0.82 | 0.001 | 0.89 | 0.66, 1.19 | 0.439 |
Never | 0.32 | 0.25, 0.40 | <0.001 | 0.75 | 0.59, 0.95 | 0.017 |
Division | ||||||
Barishal | 1.00 | 1.00 | ||||
Chattogram | 1.77 | 1.31, 2.39 | <0.001 | 1.14 | 0.87, 1.49 | 0.332 |
Dhaka | 1.91 | 1.41, 2.59 | <0.001 | 1.03 | 0.79, 1.35 | 0.813 |
Khulna | 1.59 | 1.16, 2.17 | 0.004 | 1.15 | 0.88, 1.51 | 0.308 |
Mymensingh | 0.77 | 0.49, 1.20 | 0.248 | 0.74 | 0.50, 1.08 | 0.121 |
Rajshahi | 1.20 | 0.87, 1.67 | 0.266 | 1.00 | 1.75, 1.33 | 0.992 |
Rangpur | 0.96 | 0.67, 1.37 | 0.805 | 1.07 | 0.78, 1.47 | 0.679 |
Sylhet | 0.69 | 0.45, 1.05 | 0.082 | 0.51 | 0.37, 0.71 | <0.001 |
Wealth Index | ||||||
Richest | 1.00 | 1.00 | ||||
Richer | 0.43 | 0.36, 0.51 | <0.001 | 0.52 | 0.44, 0.62 | <0.001 |
Middle | 0.29 | 0.24, 0.34 | <0.001 | 0.37 | 0.30, 0.46 | <0.001 |
Poorer | 0.17 | 0.13, 0.21 | <0.001 | 0.26 | 0.20, 0.35 | <0.001 |
Poorest | 0.10 | 0.07, 0.13 | <0.001 | 0.19 | 0.13, 0.27 | <0.001 |
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Share and Cite
Khanam, M.; Osuagwu, U.L.; Sanin, K.I.; Haque, M.A.; Rita, R.S.; Agho, K.E.; Ahmed, T. Underweight, Overweight and Obesity among Reproductive Bangladeshi Women: A Nationwide Survey. Nutrients 2021, 13, 4408. https://doi.org/10.3390/nu13124408
Khanam M, Osuagwu UL, Sanin KI, Haque MA, Rita RS, Agho KE, Ahmed T. Underweight, Overweight and Obesity among Reproductive Bangladeshi Women: A Nationwide Survey. Nutrients. 2021; 13(12):4408. https://doi.org/10.3390/nu13124408
Chicago/Turabian StyleKhanam, Mansura, Uchechukwu Levi Osuagwu, Kazi Istiaque Sanin, Md. Ahshanul Haque, Razia Sultana Rita, Kingsley Emwinyore Agho, and Tahmeed Ahmed. 2021. "Underweight, Overweight and Obesity among Reproductive Bangladeshi Women: A Nationwide Survey" Nutrients 13, no. 12: 4408. https://doi.org/10.3390/nu13124408