Adolescent
Self Reported Reproductive Morbidity and Health Care Seeking Behaviour
M. Mizanur Rahman,
M. Kabir, M. Shahidullah*
Department of Statistics, Jahangirnagar
University, Savar, Dhaka and *Department of Population Dynamics, National
Institute of Preventive and Social Medicine, Mohakhali,
Background: Addressing reproductive
health issues of women is now on the global social agenda in the new
millennium. Maternal mortality has long been the only indicator of women’s
health even though reproductive morbidity occurs far more frequently and
seriously affects women’s lives. In this paper, an attempt was made to assess
the magnitude of self reported gynaecological morbidity unrelated to
childbearing among the adolescents irrespective of their marital status. The
paper also explored the determinants of health care seeking behaviour of the
adolescents for their reproductive ailments. Methods: Both quantitative and qualitative data were collected for
this study. Cross sectional study was conducted both in rural and urban areas
using a multistage cluster sampling technique. A nationally representative data
on 2883 adolescents irrespective of their marital status were analysed. Results:
Analysis revealed that a large proportion of the adolescents (64.5%) reportedly has been
suffering from gynaecological morbidity. The most frequent form of morbidity
was menstrual disorders (63.9%) followed by lower abdominal
pain (58.6%), burning sensation during
urination(46.1%), genital itching (15.5%), vaginal discharge (3.4%) etc. Multivariate logistic
regression analysis revealed that older adolescents aged 15-19 years, family
income, type of family, type of residence and hygienic practice during
menstruation appeared to be influencing factors for adolescents reproductive
morbidity. The results also revealed that about one fifth (18.0%) sought health care for
their gynaecological ailments indicating that adolescents were unaware about
their reproductive morbidity (p<0.05). For assessing the factors
influencing their health care seeking for reproductive morbidity, multivariate
logistic regression analysis found significant positive association with adolescents aged 15-19 years, having autonomy
in treatment, working status, adolescents of joint or extended family (p<0.05). Discussion: Adolescent reproductive health in Bangladesh indicates
high incidence of maternal morbidity. The incidence of these health problems
varied by socio-economic and demographic characteristics of the adolescents.
Recommendations to address these problems include encouragement of female
education, introduction of family life education in school curricula, creating
community awareness for seeking health care and empowerment of women in
household decision making process.
Key Words: Adolescents, reproductive
morbidity, care seeking behaviour, Bangladesh.
Introduction
In developing countries, reproductive morbidity
commonly affects the quality of women’s lives. This form of ill health has
largely been ignored by the policy makers, health planners as well as
researchers. The reproductive morbidity includes the obstetric and
gynaecological conditions of ill health related to the reproductive process
during and outside the childbearing episodes. The obstetric morbidity
encompasses the conditions during pregnancy, delivery and post partum period
and gynaecological morbidity includes the conditions outside pregnancy related
events1. In this part, the reproductive morbidity refers to
gynaecological morbidity of ill health unrelated to pregnancy.
There are three methods for
the diagnosis of gynaecological morbidity such as self reported symptoms,
clinical examination and laboratory tests. Appropriate laboratory testing is
considered as the “Gold standard” for the precise detection of reproductive
morbidity and accurate measurement of prevalence of diseases. However, such
tests have limited applicability in developing countries because they are
expensive and present logistical difficulties2. Health facilities at
the community level are poorly equipped to deal with reproductive morbidity,
since they do not have diagnostic facilities, drugs, supply of blood or
surgical equipment to treat the diseases. Even, service providers are not well
acquainted to detect the morbidity or to provide counselling.
Information about
reproductive morbidity in developing countries is scanty. Although a few
studies have been conducted in this field, but most of them are based on
information obtained from clinics or hospitals. Large proportion of women does
not visit health facilities unless the disease becomes serious. So, the results
from hospitals or clinics do not reflect the magnitude of the disease burden.
The statistics provided by the hospitals are based on biomedical causes only,
but information on social, economic, demographic and behavioural determinants
are rare. In fact, a search of literature reveals that knowledge about
reproductive morbidity and its determinants in Bangladesh and also in the
sub-continent are almost non-existent. A few studies in this area showed a
varying prevalence of reproductive morbidity3-6 and these mainly
considered the adult women of reproductive age. Adolescent reproductive health
has been ignored. Concerted efforts are needed to provide useful information
for health planners and policy makers. So, the appropriate strategies to be
designed to bring about improvement in the reproductive health of women5.
With these objectives in view, the present study on self reported reproductive
morbidity among adolescents was undertaken.
Materials and Methods
This was a cross sectional study conducted in both
rural and urban areas of Bangladesh. The female adolescents aged 10-19 years
irrespective of their marital status constituted the study population. A
multistage cluster sampling technique was adopted to select the sample. Both
quantitative and qualitative data on reproductive morbidity were collected. A total of 2883 adolescents were selected.
They were also inquired about their health care seeking behaviour for their
problems. Both uni-variate and bi-variate analyses were performed. Multivariate
logistic regression analysis was used to identify the socio-economic and
demographic factors which were significantly related to reproductive morbidity
and care seeking behaviour. Data analysis was performed using Statistical
Package for Social Science (SPSS, version 11.0). To substantiate the results of
quantitative study, a series of focus group discussions were also conducted
among the adolescents. In the present study, the analysis on quantitative data
was presented.
Results
Socio-demographic
characteristics
The mean age of the respondents was 16.3±1.8 years
with a range of 10 to 19 years. Among the respondents, 34.9% were unmarried and 65.1% were married. The mean years of schooling
was 4.7±3.3 years. Among them 23.6% were illiterate, 33.1% had 1-5 years of schooling and the rest had
6 and above years of schooling. Regarding parental education, more than two
fifths (43.7%) of the adolescents’ fathers
were illiterate as against more than two thirds (69.9%) of mothers were illiterate
indicating that mothers were more illiterate than fathers. The mean family size was 5.2 persons. About one
third (29.6%) of the adolescents were currently engaged in different income
generating activities other than household work. Overwhelmingly majority of the
respondents were Muslims (89.0%) and only 11.0% were non-Muslims. About three
fifths of the adolescents (57.3%) were from nuclear families
and the rest from joint/ or extended families (42.7%). The median family income
was Tk.2500.0 and about three fifths (58.1%) of the families had income
less than Tk. 3000.0 (Table 1).
Table –1: Socio-demographic
characteristics of the adolescents (N=2883)
|
Characteristics |
Frequency |
% |
Mean ± SD |
|
Age in years |
|
|
|
|
10-14 |
567 |
19.7 |
16.3±1.8 |
|
15-19 |
2316 |
80.3 |
|
|
Marital status |
|||
|
Unmarried |
1005 |
34.9 |
|
|
Married |
1878 |
65.1 |
|
|
Residence |
|||
|
Rural |
1743 |
60.5 |
|
|
Urban |
1140 |
39.5 |
|
|
Years of schooling (Res) |
|||
|
0 |
680 |
23.6 |
4.7±3.3 |
|
1-5 |
955 |
33.1 |
|
|
≥6 |
1248 |
43.3 |
|
|
Religion |
|||
|
Non-Muslim |
317 |
11.0 |
|
|
Muslim |
2566 |
89.0 |
|
|
Level of education (F) |
|||
|
Illiterate |
1260 |
43.7 |
|
|
Literate |
1623 |
56.3 |
|
|
Level of education (M) |
|||
|
Illiterate |
2016 |
69.9 |
|
|
Literate |
867 |
30.1 |
|
|
Work status |
|||
|
No |
2030 |
70.4 |
|
|
Yes |
853 |
29.6 |
|
|
Type of family |
|||
|
Nuclear |
1651 |
57.3 |
|
|
Joint |
1232 |
42.7 |
|
|
Family size |
|||
|
2-3 |
862 |
23.7 |
5.2±2.1 |
|
4-5 |
1050 |
36.4 |
|
|
≥6 |
1151 |
39.9 |
|
|
Monthly family income (Tk.) |
|||
|
<2000
|
569 |
23.0 |
Median income= |
|
2000-3000 |
871 |
35.1 |
Tk. 2500.0 |
|
3000-4000 |
609 |
24.6 |
|
|
≥4000 |
430 |
17.3 |
|
Overall
reproductive morbidity and frequency
Married adolescents with current pregnancy and
unmarried adolescents not menstruating (that
is who did not attain the age of menarche) were excluded from the
analysis. So, a total of 2883 adolescents were studied. The adolescents were
inquired about symptoms of gynaecological morbidity for the last six months.
Among them 35.5% had no gynaecological
problem and the rest 64.5% had one or more gynaecological morbidities. The
average number of problems was 1.9 ranging from 1-6. Two-fifths (40.0%) had one problem followed by
36.4% who had two, 18.6% have had three and 5.0% had four and more problems. The most
frequent problem was menstrual disorders (63.9%) followed by lower abdominal
pain (58.6%), burning urination (46.1%), genital itching (15.5%), vaginal discharge with
fever (3.4%), genital ulcer (1.6%). More than one-fourth of
the married adolescents (26.4%) had complain of pain during
sexual intercourse and 1.9% had complain of bleeding
after sexual intercourse (Married adolescents only) (Fig-1).
Figure-1:
Frequency of self reporting morbidity
Variation of self reported reproductive morbidity by marital status and
age
Analysis revealed that the reproductive morbidities
were found significantly higher among married than unmarried adolescents such
as genital itching was 2.8 times, vaginal discharge 2.4 times, burning urination
1.6 times and lower abdominal pain 1.5 times higher among the married
adolescents whereas the menstrual disorders were less among the married
adolescents (p<0.05). On the other hand, the
reproductive morbidities were significantly high among the older adolescents
aged 15-19 years except pain during sexual intercourse among the married
adolescents (p<0.05). Genital itching was 3.1
times, vaginal discharges 2.4 times, lower abdominal pain 1.9 times, burning
urination 1.8 times and menstrual disorders 1.4 times higher among the older
adolescents. But older married adolescents were less likely to complain of
painful sexual intercourse. (This might be due to
immaturity of physical development of younger adolescents). On the other hand, the reproductive morbidities
were higher among older and married adolescents. This might be due to their
longer exposure to sexual environment.
Correlates of self reported symptoms of morbidity: Multivariate
analysis
The present study found that 64.5% of the adolescents reported about one or
more gynaecological problems. This indicates a high rate of reproductive
morbidity among the adolescents. To examine the socio-demographic and
behavioural factors associated with reproductive morbidity, the variables which
were found to be significantly associated in bi-variate analysis were
considered in the logistic regression analysis. The dependent variable was
dichotomous i.e. whether the adolescents reported any gynaecological problem in
the last six months. Adolescents’ current age was found to be significantly
associated with reported morbidities. Older adolescents reported 1.8 times more
gynaecological morbidity than younger adolescents. Similarly, adolescents
having monthly family income Tk. 4000.0 and above 1.6 times and having monthly
income Tk. 2000.0-3000.0 1.3 times reported about the symptoms of morbidity.
The adolescents of joint or extended families were 1.4 times likely to report
symptoms of morbidity. But adolescents of urban background and hygienic
practice during menstruation were less likely to report about gynaecological
morbidity.
Care Seeking Behaviour for
reported morbidity
Type of health facilities attended by adolescents:
Adolescents attended institutional as well as
non-institutional health care facilities for their gynaecological morbidities.
About sixty five per cent of the adolescents who had complain of gynaecological
problems, only 18.0% attended health care
facilities for treatment.
Although majority of the
adolescents attended institutional health care facilities, a large proportion
of them preferred to take treatment from quacks (25.4%). More than one tenth of the
adolescents (11.9%) received treatment from
traditional healers such as Homeopaths or Kabirajes (practitioners of indigenous
medicine). About institutional health care receivers, most of them received
treatment from Thana Health Complexes ( 26.5%) followed by Family Welfare
Centres (16.7%) and from other government
hospitals1(2.8%).
Reasons for not receiving
treatment:
The major reasons, as mentioned by adolescents for not receiving any health
care for gynaecological problems were personal grounds which include, 41.0% mentioned ‘no need of treatment’ followed by
‘lack of knowledge’ 19.8%, ‘economic hardship’ 18.4% and ‘shyness to expose to doctor’ 14.8%. In addition 6.1% of the adolescents reasoned related to
inadequate service facilities such as ‘no female doctor available in the
hospital’.
Determinants of care seeking behaviour for reproductive morbidity:
Multi-variate analysis
In order to examine the contribution of each of the
factors and health care seeking behaviour, a multivariate logistic regression
analysis was performed with dichotomous dependent variable “whether received
health care or not”. Analysis revealed that older adolescents aged 15-19 years
were 3.4 times more likely to seek health care than their younger counterparts.
Most importantly, adolescents having autonomy for their treatment that is
having control over other members of the family were 1.4 times more likely to
seek health care for their reproductive problems. Analysis also revealed that
working adolescents and members of joint or extended families were 1.3 times
more likely to seek health care.
Discussion
Most of the previous studies ignored the
reproductive morbidities of unmarried adolescents, but unmarried adolescents
are also exposed to similar environment as of married adolescents with the
exception of marital sex. Older women were included in the study of Bhatia et
al.,5 and Wasscrheit et al3.
Table 2: Type
of self reported reproductive morbidity by marital status
|
Reproductive morbidity |
N=2883 |
Marital status |
Odds ratio |
95% CI |
|
|
Married n=1878 |
|
||||
|
Unmarried n=1005 |
|
|
|
|
|
|
Menstrual disorders |
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes |
41.2 |
38.3 |
46.5 |
0.716*** |
0.613-0.836 |
|
No |
58.8 |
61.7 |
53.5 |
|
|
|
Lower
abdominal pain |
|
|
|
|
|
|
Yes |
37.8 |
40.9 |
31.8 |
1.484*** |
1.263-1.744
|
|
No |
|
|
|
|
|
|
62.2 |
59.1 |
68.2 |
|
|
|
|
Burning urination |
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes |
29.7 |
33.0 |
23.7 |
1.584*** |
1.331-1886
|
|
No |
|
|
|
|
|
|
70.3 |
67.0 |
76.3 |
|
|
|
|
Genital itching |
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes |
10.0 |
12.7 |
5.0 |
2.785*** |
2.032-3.817
|
|
No |
|
|
|
|
|
|
90.0 |
87.3 |
95.0 |
|
|
|
|
Vaginal discharge |
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes |
2.2 |
2.8 |
1.2 |
2.357*** |
1.252-4.435
|
|
No |
|
|
|
|
|
|
97.8 |
97.2 |
98.8 |
|
|
|
|
Genital ulcer |
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes |
1.0 |
1.2 |
0.7 |
1.768 |
0.756-4.134
|
|
No |
|
|
|
|
|
|
99.0 |
98.8 |
99.3 |
|
|
|
|
*Pain during sexual
intercourse |
|
|
|
|
|
|
|
|
|
- |
- |
|
|
Yes |
17.2 |
26.4 |
|
|
|
|
No |
|
|
|
|
|
|
82.8 |
73.6 |
100.0 |
|
|
|
|
*Bleeding after sexual
intercourse |
|
|
|
|
|
|
|
|
|
- |
- |
|
|
Yes |
1.2 |
1.9 |
0.0 |
|
|
|
No |
|
|
|
|
|
|
98.8 |
98.1 |
100.0 |
|
|
|
***p<0.001, Reference category = Unmarried
adolescents, *Married adolescents
Table 3: Type of self reported reproductive morbidity by age
|
Reproductive morbidity |
Total N=2883 |
Age in years |
Odds ratio |
95% CI |
|
|
10-14 (n=567) |
|
||||
|
15-19 (n=2316) |
|
|
|
|
|
|
Menstrual disorders |
|
|
|
|
|
|
Yes |
41.2 |
34.9 |
42.7 |
1.3889*** |
1.471-1.6817 |
|
No |
|
|
|
|
|
|
58.8 |
65.1 |
57.3 |
|
|
|
|
Burning urination |
|
|
|
|
|
|
Yes |
29.7 |
21.0 |
31.9 |
1.7607*** |
1.412-2.1944 |
|
No |
|
|
|
|
|
|
70.3 |
79.0 |
68.1 |
|
|
|
|
Lower abdominal pain |
|
|
|
|
|
|
|
|
|
|
|
|
|
Yes |
37.8 |
26.1 |
40.6 |
1.9375*** |
1.5785-2.3782 |
|
No |
|
|
|
|
|
|
62.2 |
73.9 |
59.4 |
|
|
|
|
Genital itching |
|
|
|
|
|
|
Yes |
10.0 |
4.1 |
11.5 |
3.0690*** |
1.9838-4.7478 |
|
No |
|
|
|
|
|
|
90.0 |
95.9 |
88.5 |
|
|
|
|
Vaginal discharge |
|
|
|
|
|
|
Yes |
2.2 |
1.1 |
2.5 |
2.4013** |
1.0309-5.5931 |
|
No |
|
|
|
|
|
|
97.8 |
98.9 |
97.5 |
|
|
|
|
Genital ulcer |
|
|
|
|
|
|
Yes |
1.0 |
0.4 |
1.2 |
3.4560 |
0.8211-14.5470 |
|
No |
|
|
|
|
|
|
99.0 |
99.6 |
98.8 |
|
|
|
|
*Pain during sexual
intercourse (n=1878) |
|
|
|
|
|
|
Yes |
26.4 |
24.5 |
53.3 |
0.2842*** |
0.1954-0.4134 |
|
No |
73.6 |
46.7 |
75.5 |
|
|
|
*Bleeding after sexual
intercourse (n=1878) |
|
|
|
- |
- |
|
Yes |
1.9 |
3.3 |
1.8 |
0.5377 |
0.1870-1.561 |
|
No |
98.1 |
98.2 |
96.7 |
|
|
***p<0.001; **p<0.01
Reference category = 10-14 years, *Married adolescents
Table 4: Adolescent self reported reproductive morbidity: Multi-variate
analysis
|
Attributes |
b |
p value |
Odds ratio |
95% CI |
|
Age in years |
|
|
|
|
|
10-14 (RC) |
- |
- |
- |
- |
|
15-19 |
0.6062 |
0.0000 |
1.8335 |
1.4341-2.3441 |
|
Marital status |
|
|
|
|
|
Unmarried (RC) |
- |
- |
- |
- |
|
Married |
-0.1390 |
0.2316 |
0.8702 |
0.6930-1.0928 |
|
Residence |
|
|
|
|
|
Rural (RC) |
- |
- |
- |
- |
|
Urban |
-0.2882 |
0.0024 |
0.7496 |
0.6224-.9029 |
|
Level of education (M) |
|
|
|
|
|
Illiterate (RC) |
- |
- |
- |
- |
|
Literate |
-0.1813 |
0.0739 |
0.8342 |
0.6838-1.0176 |
|
Monthly family income (Tk.) |
|
|
|
|
|
<2000 (RC) |
- |
- |
- |
- |
|
2000-3000 |
0.2400 |
0.0380 |
1.2712 |
1.0134-1.5948 |
|
3000-4000 |
0.1519 |
0.2274 |
1.1641 |
0.9096-1.4897 |
|
≥4000 |
0.5002 |
0.0007 |
1.6490 |
1.2351-2.2017 |
|
Work status |
|
|
|
|
|
No (RC) |
- |
- |
- |
- |
|
Yes |
0.1553 |
0.1068 |
1.1681 |
0.9671-1.4108 |
|
Type of family |
|
|
|
|
|
Nuclear (RC) |
- |
- |
- |
- |
|
Joint/extended |
0.3676 |
0.0001 |
1.4443 |
1.2077-1.7273 |
|
Practice of personal hygiene |
|
|
|
|
|
Non
sanitary (RC) |
- |
- |
- |
- |
|
Sanitary
|
-0.8530 |
0.0000 |
0.4261 |
0.3020-.6014 |
|
Model chi square |
104.672 |
|
||
|
Df |
10 |
|
||
|
Significance |
0.0000 |
|
||
|
N |
2479 |
|
||
|
Constant |
0.638 |
|
||
*RC= Reference
category
**Variables not
included in the regression model are: religion, years of schooling, father’s
level of education and family size, i.e. these are not statistically
significant in bi-variate analysis
Table 5: Adolescent care seeking behaviour for reproductive morbidity: Multi-variate analysis
|
Attributes |
b |
p value |
Odds ratio |
95% CI |
|
Age in years |
|
|
|
|
|
10-14 (RC) |
- |
- |
- |
- |
|
15-19 |
1.2331 |
0.0000 |
3.4318 |
2.0694-5.6910 |
|
Marital status |
|
|
|
|
|
Unmarried (RC) |
- |
- |
- |
- |
|
Married |
-0.0943 |
0.5300 |
0.9100 |
.6780-1.2214 |
|
Working status |
|
|
|
|
|
No (RC) |
- |
- |
- |
- |
|
Yes |
0.2904 |
0.0246 |
1.3370 |
1.0379-1.7224 |
|
Type of family |
|
|
|
|
|
Nuclear (RC) |
- |
- |
- |
- |
|
Joint/extended |
0.2782 |
0.0259 |
1.3208 |
1.0340-1.6871 |
|
Autonomy for treatment |
|
|
|
|
|
No (RC) |
- |
- |
- |
- |
|
Yes |
0.3581 |
0.0170 |
1.4307 |
1.0661-1.9199 |
|
Model chi square |
57.008 |
|
||
|
df |
5 |
|
||
|
Significance |
0.0000 |
|
||
|
N |
1859 |
|
||
|
Constant |
-2.8569 |
|
||
*RC= Reference
category, **Variables not included in the regression model are: residence,
religion, years of schooling, father’s and mother’s level of education, monthly
family income and family size, i.e. these are not statistically significant in
bi-variate analysis
Therefore in this study, unmarried adolescents were
also included to find out the variation of their reproductive morbidity. In
recent years, attention has focused on the problem of high level of maternal
mortality in developing countries. Little is known about the prevalence of
reproductive morbidity. Dixon-Mueller et al.,7 opined of “culture of
silence” surrounding women’s health that typifies these countries and the
constraints of living conditions particularly for poor women that prevent the
use of health services.
Varying proportion of
reproductive morbidity was reported by different studies ranging from 22.0% to 92.0%3,4,8. The study revealed a heavy
disease burden of reproductive morbidity. The vast majority of the adolescents
have been suffering from at least one reproductive morbidity. This high
prevalence of reproductive morbidity is certainly disabling women in the
community under study, who are mostly illiterate having low socio-economic
status. This high prevalence of morbidity raises great concern about women’s
physical and social well being which causes physical discomfort, personal
embarrassment, marital discord and also problems of women’s ability to achieve
a sustained marital satisfaction3. Bang et al4., in rural
India surprisingly found a high prevalence of gynaecological morbidity of 92
per cent. Both men and women in developing countries with low level of
education and lack of health information, especially about personal hygiene
could promote misconceptions about many illnesses and limit preventive
practices that lead to increased reproductive morbidity. Women of these areas
tend to internalize their health problems because of their status in the
family, they may not be allowed to seek health care, or they may feel
shy about reporting such sort of reproductive problems causing them to be
stigmatized by the community9,10. Another important factor might
hinder them from seeking health care due to inadequate facilities under the
government health infrastructure and or inaccessibility of public hospitals.
Most of the public hospitals run with inadequate logistics and manpower in the
relevant areas of maternal health care.
Analysis of the study
revealed an important programme aspect of reproductive health. The older
adolescents with rural background, joint or extended family and non-hygienic
practice during menstruation are the causes of high prevalence of reproductive
morbidity. Similarly, older adolescents having earnings and autonomy in
treatment encouraged them to seek health care from any source. This is
consistent with South Indian women5. So, the programme of health
education should be designed in the line of women status in the family.
In conclusion, the study recommends for
creating community awareness about health care facilities and instil self
concern in adolescents for their own health needs. The first referral units at
the grass root levels are Thana Health Complexes and Family Welfare Centres are
required to be equipped infrastructurally as well as with skilled manpower for
addressing reproductive health problems of women and to provide appropriate
referral services. Built in service component and confidentiality may improve
self reporting of reproductive morbidity in rapid health surveys. Studies have
shown that self reporting is close to clinical diagnosis when diagnostic
criterion is clear11. Thus such surveys could be an inexpensive way
for generating continuous information on reproductive health issues for health
mangers. The improved and clear diagnostic algorithm for reproductive morbidity
help in treating the women with reproductive ailments that will be more
fruitful and cost effective in the context of socio-cultural milieu of
Bangladesh.
Acknowledgement
The research was funded by a grant from Social
Science Research Council (SSRC), Ministry of Planning,
Government of the Peoples Republic of Bangladesh. We acknowledge Director, SSRC
for financial assistance.
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Address for
Correspondence:
Dr. M. Mizanur
Rahman,
58/K, West Raza Bazar, Indira Road, Tejgaon, Dhaka-1215, BANGLADESH.
Email: aniq@citechco.net