ORCID Profile
0000-0002-5236-3597
Current Organisations
La Trobe University
,
University of Newcastle Australia
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Publisher: Public Library of Science (PLoS)
Date: 11-08-2020
Publisher: Elsevier BV
Date: 07-2022
Publisher: Springer Science and Business Media LLC
Date: 07-11-2020
DOI: 10.1186/S13006-020-00338-0
Abstract: In Bangladesh 65% of children under 6 months of age were exclusively breastfed with maternal employment being a risk factor that has jeopardized exclusive breastfeeding. As Ready Made Garment (RMG) factories have been the largest employer of low income women in Bangladesh, the objective of our study was to explore the barriers and facilitators of breastfeeding and perceptions about use of expressed breast milk among mothers who worked in the RMG sector. This formative research was conducted during July–September 2015 in two slums of Dhaka among RMG workers who were mothers and the caregivers of 0–12 month old infants. Qualitative data was obtained from purposively selected participants of 8 in-depth interviews and 4 focus group discussions (mothers and caregivers), and 2 key informant (RMG factory official) interviews. Mothers were from multiple RMG factories while factory officials were from a single factory. Thematic analysis was conducted. The main themes of qualitative exploration were knowledge and experience of breastfeeding structural barriers (home and workplace) consequences of inadequate breastfeeding and perception and experience of using expressed breast milk. Despite knowledge both of the benefits of breast milk and of the importance of breastfeeding for 6 months, most mothers introduced formula as early as 2 months to prepare for their return to work. Barriers such as excessive workload, inadequate crèche facilities at work, and lack of adequate caregivers at home impeded exclusive breastfeeding. Mothers and caregivers had very little knowledge about the use of expressed breast milk and were concerned about contamination. As RMG factories are the largest employer of low-income women in Bangladesh, facilitating RMG factory working mothers’ ability to use breast milk could help to promote infant health and help women remain in the workforce.
Publisher: Springer Science and Business Media LLC
Date: 25-05-2017
Publisher: Wiley
Date: 04-12-2020
Publisher: Elsevier BV
Date: 09-2023
Publisher: Springer Science and Business Media LLC
Date: 21-09-2022
DOI: 10.1186/S12913-022-08565-3
Abstract: Increasing access to long-acting modern contraceptives (LMAC) is one of the key factors in preventing unintended pregnancy and protecting women’s health rights. However, the availability and accessibility of health facilities and their impacts on LAMC utilisation (implant, intrauterine devices, sterilisation) in low- and middle-income countries is an understudied topic. This study aimed to examine the association between the availability and readiness of health facilities and the use of LAMC in Bangladesh. In this survey study, we linked the 2017/18 Bangladesh Demographic and Health Survey data with the 2017 Bangladesh Health Facility Survey data using the administrative-boundary linkage method. Mixed-effect multilevel logistic regressions were conducted. The s le comprised 10,938 married women of 15–49 years age range who were fertile but did not desire a child within 2 years of the date of survey. The outcome variable was the current use of LAMC (yes, no), and the explanatory variables were health facility-, in idual-, household- and community-level factors. Nearly 34% of participants used LAMCs with significant variations across areas in Bangladesh. The average scores of the health facility management and health facility infrastructure were 0.79 and 0.83, respectively. Of the facilities where LAMCs were available, 69% of them were functional and ready to provide LAMCs to the respondents. The increase in scores for the management (adjusted odds ratio (aOR), 1.59 95% CI, 1.21–2.42) and infrastructure (aOR, 1.44 95% CI, 1.01–1.69) of health facilities was positively associated with the overall uptake of LAMC. For per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities, the aORs for women to report using LAMC were 2.16 (95% CI, 1.18–3.21) and 1.74 (95% CI, 1.15–3.20), respectively. A nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometre increase in the average regional-level distance between women’s homes and the nearest health facilities. The proximity of health facilities and their improved management, infrastructure, and readiness to provide LAMCs to women significantly increase their uptake. Policies and programs should prioritise improving health facility readiness to increase LAMC uptake.
Publisher: Informa UK Limited
Date: 23-12-2020
DOI: 10.1080/13557858.2020.1862766
Abstract: Bangladesh has achieved notable success in improving maternal health by increasing women's access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities' perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities' perspectives on challenges and opportunities for improving MHC service access in the CHT. This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential.
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-033224
Abstract: This study aimed to estimate the prevalence of, and factors associated with, accessing maternal healthcare services (MHC) by Indigenous women in the Chittagong Hill Tracts (CHT), Bangladesh. This was a cross-sectional survey among Indigenous women of reproductive age. Two upazillas (subdistricts) of Khagrachhari hill district of the CHT. Indigenous women (15–49 years) within 36 months of delivery were surveyed about accessing MHC services (antenatal care, delivery and postnatal care) for their last pregnancy and delivery. The primary outcome for this analysis is the prevalence of accessing any MHC service and secondary outcome is factors associated with access to MHC services for Indigenous women during their last pregnancy and childbirth. Of 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) who participated, 75% were aged 16–30 years. With an 89% response rate, a total of 258 (59%) women reported accessing at least one MHC service (Chakma 51.6%, Marma 28%, Tripura 20.5% p= .001). Independent factors associated with accessing MHC after adjusting for clustering were attending secondary school and above (OR 2.4 95% CI 1.2 to 4.9) knowledge about nearest health facilities (OR 3.8, 95% CI 1.8 to 7.8) and knowledge of pregnancy-related complications (OR 3.0, 95% CI 1.5 to 5.8). Findings suggest that the prevalence of accessing MHC services is lower among Indigenous women in the CHT compared with national average. MHC access may be improved through better education and awareness raising of local services.
Publisher: Elsevier BV
Date: 11-2020
Publisher: OMICS Publishing Group
Date: 03-06-2014
Publisher: Springer Science and Business Media LLC
Date: 11-01-2023
DOI: 10.1186/S13012-022-01253-0
Abstract: Postpartum haemorrhage (PPH) is the leading cause of global maternal deaths, accounting for 30–50% of maternal deaths in sub-Saharan Africa. Most PPH-related deaths are preventable with timely detection and initiation of care, which may be facilitated by using a clinical care bundle. We explore influences on current PPH detection and management and on the future implementation of a new PPH bundle (E-MOTIVE) in low-resource, high-burden settings. Semi-structured qualitative interviews based on the Theoretical Domains Framework were conducted with 45 healthcare providers across nine hospitals in Nigeria, Kenya and South Africa, to identify barriers and enablers to current PPH detection and management and future implementation of a new PPH care bundle. Data were analysed using thematic and framework analysis. The Behaviour Change Wheel was used to identify potential interventions to address identified barriers and enablers. Influences on current PPH detection and management fell under 12 domains: Environmental Context and Resources (drug and staff shortages), Skills (limited in-service training), Knowledge (variable understanding of the recommended practice), Behaviour Regulation (limited quality improvement culture), Beliefs about Consequences (drawbacks from inaccurate detection), Emotion (stress from the unpredictability of PPH), Social Influence (teamwork), Memory, Attention and Decision-making (limited guideline use), Social/Professional Role and Identity (role clarity), Beliefs about Capabilities (confidence in managing PPH), Reinforcement (disciplinary procedures) and Goals (PPH as a priority). Influences on bundle uptake included: Beliefs about Consequences (perceived benefits of new blood loss measurement tool), Environmental Context and Resources (high cost of drugs and new tools), Memory, Attention and Decision-making (concerns about whether bundle fits current practice), Knowledge (not understanding ‘bundled’ approach), Social Influence (acceptance by women and staff) and Intention (limited acceptance of ‘bundled' approach over existing practice). These influences were consistent across countries. Proposed interventions included: Education, Training, Modelling (core and new skills), Enablement (monitoring uptake), Persuasion (leadership role) and Environmental Restructuring (PPH emergency trolley/kit). A wide range of in idual, socio-cultural and environmental barriers and enablers to improving PPH detection and management exist in these settings. We identified a range of interventions that could improve PPH care and the implementation of new care bundles in this context. ClinicalTrials.gov : NCT04341662
Publisher: Cold Spring Harbor Laboratory
Date: 29-09-2021
DOI: 10.1101/2021.09.27.21264197
Abstract: Evidence on the availability and accessibility of health facilities and their impacts on long-acting modern contraceptives (LAMC) use in low- and middle-Income countries are scarce. This study examined the influence of the availability and readiness of health facilities in determining the use of LAMC in Bangladesh. We linked data of the Bangladesh Demographic and Health Survey and the Health Facility Survey using the administrative-boundary linkage method. Mixed effect multilevel logistic regression was conducted. The s le comprised 10,938 married women of 15-49 years of age, who were fertile but did not desire a child within two years of the date of survey. The outcome variable was the current use of LAMC (yes, no) and the explanatory variables were health facility-, in idual-, household- and community-level factors. Nearly 34% of participants used LAMC with significant variations across areas in Bangladesh. The average distance between the nearest LAMC-providing health facilities and women’s homes was 6.36 km, higher in the Sylhet ision (8.34 km) and lower in the Dhaka ision (4.34 km). Increased scores for the management (adjusted odds ratio (AOR) 1.59 95% CI, 1.21-2.42) and infrastructure (AOR, 1.44 95% CI, 1.01-1.69) of health facilities were positively associated with the overall uptake of LAMC. AORs for women to report using LMAC were 2.16 (95% CI, 1.18-3.21) and 1.74 (95% CI, 1.15-3.20), respectively, for per unit increase in the availability and readiness scores to provide LAMC at the nearest health facilities. Nearly 27% decline in the likelihood of LAMC uptake was observed for every kilometer increase in the average regional-level distance between women’s homes and the nearest health facilities. The availability of health facilities close to residence and their improved management, infrastructure, and readiness to provide LAMC play a significant role in increasing LAMC uptake among women. Policies and programs should prioritize increasing the availability and accessibility of health facilities that provide LAMC services.
Publisher: Springer Science and Business Media LLC
Date: 20-03-2018
Publisher: Informa UK Limited
Date: 06-11-2022
DOI: 10.1080/13691058.2021.1998631
Abstract: There is limited evidence about the lives of queer Mongolian youth. This is despite mental health problems being a pressing concern among young Mongolians, and international evidence suggesting queer youth may experience more mental health challenges than their non-queer peers. We explored the experiences of queer youth in their immediate environments and navigation of their identities in Mongolian society. In this study, twelve young queer-identifying people aged 18-25 from Ulaanbaatar, Mongolia participated in photo-elicitation interviews. Visual research methods allowed participants to generate rich (visual, textual, and oral) data about their lived experiences. We analysed data using a thematic approach and identified three main themes, each with three sub-themes. Participants reported that peer bullying and gendered expectations at school, heteronormativity and gender role expectation in family settings, along with strong stereotypes about queerness in broader society, substantially impacted participants' mental and physical wellbeing. Mongolian queer youth need strong support from their immediate environments, such as school and family. Stigma and misconception around queerness remain persistent among the public but young people are continuously resisting the prejudice expressed towards them. Understanding these challenges is crucial to increasing inclusivity in policies and programmes to enhance the wellbeing of young queer Mongolians.
Publisher: Springer Science and Business Media LLC
Date: 30-11-2019
DOI: 10.1007/S00038-018-1177-4
Abstract: Globally, Indigenous people have lower-health status compared to non-Indigenous people due to unequal access to health care. Barriers or enablers to accessing maternal health services by Indigenous women are not well researched. This review aims to determine accessibility and utilisation of maternal primary healthcare services among Indigenous women in lower- and middle-income countries. We conducted a systematic integrative review of published and grey literature published between 2000 and 2017. Studies on maternal healthcare service utilisation by Indigenous women in lower- and middle-income countries were included. From 3092 articles identified, 10 met the eligibility criteria. The most prominent barrier to accessing maternal primary healthcare services was the top-down nature of intervention programmes, which made programmes culturally unfriendly for Indigenous women. Distance, cost, transport, accommodation, language barriers and lack of knowledge about existing services also impacted access. Findings provided insights into understanding the gaps in existing policies for Indigenous women and their access to maternal health services. Results suggested that efforts be made to ensure appropriate programmes for Indigenous women's maternal health right.
Publisher: Elsevier BV
Date: 09-2022
Publisher: Elsevier BV
Date: 2023
DOI: 10.2139/SSRN.4485711
Publisher: Public Library of Science (PLoS)
Date: 29-12-2020
DOI: 10.1371/JOURNAL.PONE.0244640
Abstract: Prevalence of accessing antenatal care (ANC) services among Indigenous women in the Chittagong Hill Tracts (CHT) is unknown. This study aims to estimate the prevalence of accessing ANC services by Indigenous women in the CHT and identify factors associated with knowledge of, and attendance at, ANC services. Using a cross-sectional design three Indigenous groups in Khagrachari district, CHT, Bangladesh were surveyed between September 2017 and February 2018. Indigenous women within 36 months of delivery were asked about attending ANC services and the number who attended was used to estimate prevalence. Socio-demographic and obstetric characteristics were used to determine factors associated with knowledge and attendance using multivariable logistic regression techniques adjusted for clustering by village results are presented as odds ratios (OR), adjusted OR, and 95% confidence intervals (CI). Of 494 indigenous women who met the inclusion criteria in two upazilas, 438 participated (89% response rate) in the study, 75% were aged 16–29 years. Sixty-nine percent were aware of ANC services and the prevalence of attending ANC services was 53% (n = 232, 95%CI 0.48–0.58). Half (52% n = 121) attended private facilities. Independent factors associated with knowledge about ANC were age ≥30 years (OR 2.2, 95%CI 1.1–4.6), monthly household income greater than 20,000 Bangladeshi Taka (OR 3.4, 95%CI 1.4–8.6) knowledge of pregnancy-related complications (OR 3.6, 95%CI 1.6–8.1), knowledge about nearest health facilities (OR 4.3, 95%CI 2.1–8.8) and attending secondary school or above (OR 4.8, 95%CI 2.1–11). Independent factors associated with attending ANC services were having prior knowledge of ANC benefits (OR 7.7, 95%CI 3.6–16), Indigenous women residing in Khagrachhari Sadar subdistrict (OR 6.5, 95%CI 1.7–25) and monthly household income of 20,000 Bangladeshi Taka or above (OR 2.8, 95%CI 1.1–7.4). Approximately half of Indigenous women from Chittagong Hill Tracts Bangladesh attended ANC services at least once. Better awareness and education may improve ANC attendance for Indigenous women. Cultural factors influencing attendance need to be explored.
Publisher: Public Library of Science (PLoS)
Date: 15-07-2020
Publisher: Elsevier BV
Date: 07-2023
Publisher: Springer Science and Business Media LLC
Date: 04-11-2020
DOI: 10.1186/S13012-020-01054-3
Abstract: Despite being one of the few evidence-based treatments for acute ischemic stroke, intravenous thrombolysis has low implementation rates—mainly due to a narrow therapeutic window and the health system changes required to deliver it within the recommended time. This systematic review and meta-analyses explores the differential effectiveness of intervention strategies aimed at improving the rates of intravenous thrombolysis based on the number and type of behaviour change wheel functions employed. The following databases were searched: MEDLINE, EMBASE, PsycINFO, CINAHL and SCOPUS. Multiple authors independently completed study selection and extraction of data. The review included studies that investigated the effects of intervention strategies aimed at improving the rates of intravenous thrombolysis and/or onset-to-needle, onset-to-door and door-to-needle time for thrombolysis in patients with acute ischemic stroke. Interventions were coded according to the behaviour change wheel nomenclature. Study quality was assessed using the QualSyst scoring system for quantitative research methodologies. Random effects meta-analyses were used to examine effectiveness of interventions based on the behaviour change wheel model in improving rates of thrombolysis, while meta-regression was used to examine the association between the number of behaviour change wheel intervention strategies and intervention effectiveness. Results from 77 studies were included. Five behaviour change wheel interventions, ‘Education’, ‘Persuasion’, ‘Training’, ‘Environmental restructuring’ and ‘Enablement’, were found to be employed among the included studies. Effects were similar across all intervention approaches regardless of type or number of behaviour change wheel-based strategies employed. High heterogeneity ( I 2 75%) was observed for all the pooled analyses. Publication bias was also identified. There was no evidence for preferring one type of behaviour change intervention strategy, nor for including multiple strategies in improving thrombolysis rates. However, the study results should be interpreted with caution, as they display high heterogeneity and publication bias.
Publisher: Massachusetts Medical Society
Date: 06-07-2023
Publisher: Elsevier BV
Date: 05-2022
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/16094069221107514
Abstract: Indigenous women’s health in low and middle-income countries continues to experience exclusions from the mainstream context and has remained underrepresented in health research, including qualitative research. Based on mixed methods research (comprising qualitative and quantitative methods) into Indigenous women in Bangladesh, this article addresses the reflexivity of a non-Indigenous researcher studying Indigenous women’s health issues in the Chittagong Hill Tracts of Bangladesh. As reflexivity is a crucial strategy to ensure rigor in qualitative research, understanding how the characteristics and experiences of the study may influence the research process is of paramount importance. For non-Indigenous researchers working in an Indigenous context, the imperative to understand one’s impact and position within the research becomes even more critical. Unfortunately, non-Indigenous researchers often avoid providing appropriate detail on reflexivity aspects in conducting research, particularly mixed-method research, among Indigenous communities in low- and middle-income countries like Bangladesh. In this reflexive evaluation, the researchers of this mixed method study evaluate the introspective reflexivity reflect on the pre-research stage in developing collaborative and negotiated design and reflect on positionality during fieldwork and data analysis to consider interpersonal and collective dynamics during the research process. Strategies are offered to harvest the benefits of the researcher’s familiarity with the subject and limit any unfavorable consequences. Directions for future research include integration of research methods, using qualified Indigenous researchers, engaging Indigenous community leaders, and collecting data using native language to respect and value the culture and voice of Indigenous communities.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Wiley
Date: 03-05-2023
DOI: 10.1002/RFC2.25
Abstract: Anaemia during pregnancy is a significant global health problem, disproportionately affecting women in low‐ and middle‐income countries (LMICs). Oral iron is the standard of care however, challenges exist regarding adherence and coverage. Increasingly, evidence demonstrates the superiority of intravenous (IV) iron over oral iron. Although clinical experience on IV iron for antenatal anaemia is growing, there remains little understanding regarding implementation. Our mixed‐method systematic review aims to identify barriers and facilitators to implementing an IV iron intervention for pregnant women with anaemia and implementation strategies. Five bibliographic databases and grey literature were searched for studies. Barriers and facilitators were identified and mapped to the Consolidated Framework for Implementation Research (CFIR) and then matched to Expert Recommendations for Implementing Change (ERIC) strategies using the CFIR‐ERIC matching tool. The search identified six studies. Most studies captured the perspective of healthcare providers, with some studies capturing the perspective of pregnant women. Barriers and facilitators were mapped to the following CFIR constructs: (1) intervention characteristics—cost, complexity, evidence strength and quality, and relative advantage (2) outer setting—patient needs and resources (3) inner setting—culture, available resources and access to knowledge and information (4) characteristics of in iduals—knowledge and beliefs about the intervention (5) process—ch ions. Matching ERIC strategies included identifying and preparing ch ions, conducting educational meetings and assessing for readiness and identifying barriers and facilitators. Once tailored to each context, our findings can be used to improve the adoption, implementation, and sustainability of an IV iron programme for pregnant women with anaemia.
Publisher: Frontiers Media SA
Date: 18-11-2022
DOI: 10.3389/FGWH.2022.1020163
Abstract: Postpartum haemorrhage (PPH) is the leading cause of maternal death globally. Most PPH deaths can be avoided with timely detection and management however, critical challenges persist. A multi-country cluster-randomised trial (E-MOTIVE) will introduce a clinical care bundle for early detection and first-response PPH management in hospital settings. This formative qualitative study aimed to explore healthcare providers' knowledge and practices of PPH detection and management after vaginal birth, to inform design and implementation of E-MOTIVE. Between July 2020–June 2021, semi-structured qualitative interviews were conducted with 45 maternity healthcare providers (midwives, nurses, doctors, managers) of nine hospitals in Kenya, Nigeria, and South Africa. A thematic analysis approach was used. Four key themes were identified, which varied across contexts: in-service training on emergency obstetric care limited knowledge about PPH current approaches to PPH detection and current PPH management and associated challenges. PPH was recognised as an emergency but understanding of PPH varied. Early PPH detection was limited by the subjective nature of visual estimation of blood loss. Lack of expertise on PPH detection and using visual estimation can result in delays in initiation of PPH management. Shortages of trained staff and essential resources, and late inter-hospital referrals were common barriers to PPH management. There are critical needs to address context-specific barriers to early and timely detection and management of PPH in hospital settings. These findings will be used to develop evidence-informed implementation strategies, such as improved in-service training, and objective measurement of blood loss, which are key components of the E-MOTIVE trial ( Trial registration: ClinicalTrials.gov: NCT04341662).
Publisher: Springer Science and Business Media LLC
Date: 14-07-2021
DOI: 10.1186/S12978-021-01162-3
Abstract: Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. When PPH occurs, early identification of bleeding and prompt management using evidence-based guidelines, can avert most PPH-related severe morbidities and deaths. However, adherence to the World Health Organization recommended practices remains a critical challenge. A potential solution to inefficient and inconsistent implementation of evidence-based practices is the application of a ‘clinical care bundle’ for PPH management. A clinical care bundle is a set of discrete, evidence-based interventions, administered concurrently, or in rapid succession, to every eligible person, along with teamwork, communication, and cooperation. Once triggered, all bundle components must be delivered. The E-MOTIVE project aims to improve the detection and first response management of PPH through the implementation of the “E-MOTIVE” bundle, which consists of (1) E arly PPH detection using a calibrated drape, (2) uterine M assage, (3) O xytocic drugs, (4) T ranexamic acid, (5) I ntra V enous fluids, and (6) genital tract E xamination and escalation when necessary. The objective of this paper is to describe the protocol for the formative phase of the E-MOTIVE project, which aims to design an implementation strategy to support the uptake of this bundle into practice. We will use behavior change and implementation science frameworks [e.g. capability, opportunity, motivation and behavior (COM-B) and theoretical domains framework (TDF)] to guide data collection and analysis, in Kenya, Nigeria, South Africa, Sri Lanka, and Tanzania. There are four methodological components: qualitative interviews surveys systematic reviews and design workshops. We will triangulate findings across data sources, participant groups, and countries to explore factors influencing current PPH detection and management, and potentially influencing E-MOTIVE bundle implementation. We will use these findings to develop potential strategies to improve implementation, which will be discussed and agreed with key stakeholders from each country in intervention design workshops. This formative protocol outlines our strategy for the systematic development of the E-MOTIVE implementation strategy. This focus on implementation considers what it would take to support roll-out and implementation of the E-MOTIVE bundle. Our approach therefore aims to maximize internal validity in the trial alongside future scalability, and implementation of the E-MOTIVE bundle in routine practice, if proven to be effective. Trial registration: ClinicalTrials.gov: NCT04341662
Location: Australia
Location: Bangladesh
No related grants have been discovered for SHAHINOOR AKTER.