Factors influencing delivery-related complications and their consequences in hard-to-reach areas of Bangladesh.

BACKGROUND AND OBJECTIVES: Bangladesh's high maternal mortality ratio is exacerbated by delivery-related complications, particularly in hard-to-reach (HtR) areas with limited healthcare access. Despite this, few studies have explored delivery-related complications and factors contributing to these complications among the disadvantaged population. This study aimed to investigate the factors contributing to delivery-related complications and their consequences among the mothers residing in the HtR areas of Bangladesh. METHODS: Data were collected using a cross-sectional study design from 13 HtR sub-districts of Bangladesh between September 2019 and October 2019. Data from 1,290 recently delivered mothers were analysed. RESULTS: Around 32% (95% CI: 29.7-34.8) of the mothers reported at least one delivery-related complication. Prolonged labour pain (21%) was the highest reported complication during the delivery, followed by obstructive labour (20%), fever (14%), severe headache (14%). Mothers with higher education, a higher number of antenatal care (ANC) visits, complications during ANC, employed, and first-time mothers had higher odds of reporting delivery-related complications. More than one-half (51%) of these mothers had normal vaginal delivery. Nearly one-fifth (20%) of mothers who reported delivery-related complications were delivered by unskilled health workers at homes. On the other hand, about one-fifth (19%) of the mothers without any complications during delivery had a caesarean delivery. Nine out of ten of these caesarean deliveries were done at the private facilities. CONCLUSION: Delivery-related complications are significantly related to a woman's reproductive history and other background characteristics. Unnecessary caesarean delivery is prominent at private facilities.

Trends and inequity in improved sanitation facility utilisation in Bangladesh: Evidence from Bangladesh Demographic and Health Surveys.

Improved sanitation is indispensable to human health. However, lack of access to improved sanitation remains one of the most daunting public health challenges of the twenty-first century in Bangladesh. The aim of the study was to describe the trends in access to improved sanitation facilities following the inequity gap among households in different socioeconomic groups in Bangladesh. Data from the Bangladesh Demographic and Health Survey (BDHS) 2007, 2011, 2014, and 2017-18 were extracted for this study. Inequity in access to improved sanitation was calculated using rich-poor ratio and concentration index to determine the changes in inequity across the time period. In Bangladesh, the proportion of households with access to improved sanitation increased steadily from 25.4% to 45.4% between 2007 and 2014, but slightly decreased to 44.0% in 2017-18. Age, educational status, marital status of household head, household wealth index, household size, place of residence, division, and survey year were significantly associated with the utilisation of improved sanitation. There is a pro-rich situation, which means that utilisation of improved sanitation was more concentrated among the rich across all survey years (Concentration Index ranges: 0.40 to 0.27). The government and other relevant stakeholders should take initiatives considering inequity among different socioeconomic groups to ensure the use of improved sanitation facilities for all, hence achieving universal health coverage.

Disparities in the maternal healthcare continuum among Bangladeshi women: evidence from nationally representative surveys.

INTRODUCTION: Utilisation of maternal healthcare is low, and it consistently decreases across antenatal to postnatal period in Bangladesh. However, there is paucity of knowledge in Bangladesh to understand gaps and associated factors in seeking continuum of maternal healthcare along the pathway. Therefore, we aimed to assess the trend in socioeconomic and demographic factors and wealth inequity in maternal CoC using the Bangladesh Multiple Indicator Cluster Survey (MICS). METHODS: We performed a secondary analysis on nationally representative data from the last two MICS survey, carried out in 2012-13 and 2019. The study included women of reproductive age (15-49 years) with a live birth within two years preceding the survey. Total of 7,950 and 9,183 respondents were identified from these two surveys, respectively. We used multivariable logistic regression and concentration index to examine the covariates and inequity, respectively, in the utilisation of CoC. RESULTS: Utilisation of ≥4 antenatal care, skilled delivery, and postnatal care for both mother and newborn increased from 13 percent in 2012-13 to 25 percent in 2019 survey. Moreover, wealth inequity persists favouring the rich in utilisation of CoC in Bangladesh. Women belonging to wealthier quintile, urban areas, and non-Muslim families, with higher education, a household head with higher education, media use, and fewer children were most likely to avail complete CoC in both the surveys. CONCLUSION: Overall utilisation of maternal CoC increased between 2012 and 13 and 2019, however, women in Bangladesh still lack the CoC with persistent wealth inequality. Integrated provision of ANC, delivery by SBA, and PNC should be introduced, comprising both private and public health facilities, and targeting women in poor and rural communities. Efforts should also focus on women's education, autonomy, fertility rate, and exposure to media.

Contribution of socio-economic and demographic factors to maternal and child malnutrition in Bangladesh: Insights from a nationwide survey.

Background: Malnutrition is a major global public health issue, especially for under five children and their mothers. Objective: This study examined the relationships between socio-economic and demographic characteristics and under- and over-nutrition in mothers and children of Bangladesh. Method: Using the Nationally representative Bangladesh Demographic and Health Survey (2017-18) data, we performed the multiple logistic regression analysis to assess the relationships between key outcome variables and predictors. The analysis included 8321 children aged 0-59 months and 7800 mothers aged 15-49 years. Findings: The prevalence of stunting, wasting, and overweight among children under five was 30.72%, 8.44%, and 2.21% respectively. About 2.74% of the children were both stunted and wasted, while 0.56% of the children were both stunted and overweight. The prevalence of underweight and overweight among mother was 14.09% and 26.35% respectively. Children who are stunted are significantly associated with the mother's BMI status, mothers' education, fathers' education, and wealth index, while children who are wasted are significantly associated with the mother's BMI status and the child's sex. A child's sex and birth order are significantly associated with children being overweight. Mother's age, mother's education, father's education, place of residence and wealth index are significant determinants for mothers being underweight, whereas mother's age, mother's occupation, father's education, father's occupation, place of residence and wealth index are significant determinants for mothers being overweight. Conclusion: In addition to essential nutrition interventions, it is vital to address the basic social-economic and demographic determinants.

Effect of an integrated maternal and neonatal health intervention on maternal healthcare utilisation addressing inequity in Rural Bangladesh.

BACKGROUND: Although Bangladesh has made significant improvements in maternal, neonatal, and child health, the disparity between rich and poor remains a matter of concern. OBJECTIVE: The study aimed to increase coverage of skilled maternal healthcare services while minimising the inequity gap among mothers in different socioeconomic groups. METHODS: We implemented an integrated maternal and neonatal health (MNH) intervention between 2009 and 2012, in Shahjadpur sub-district of Sirajganj district, Bangladesh. The study was quasi-experimental in design for the evaluation. Socioeconomic status was derived from household assets using principal component analysis. Inequity in maternal healthcare utilisation was calculated using rich-poor ratio and concentration index to determine the changes in inequity between the baseline and the endline time period. RESULT: The baseline and endline surveys included 3,158 (mean age 23.5 years) and 3,540 (mean age 24.3 years) recently delivered mothers respectively. Reduction in the rich-poor ratio was observed in the utilisation of skilled 4+ antenatal care (ANC) (2.4:1 to 1.1:1) and related concentration index decreased from 0.220 to 0.013 (p < 0.001). The rich-poor ratio for skilled childbirth reduced from 1.7:1 to 1.0:1 and the related concentration index declined from 0.161 to -0.021 (p < 0.001). A similar reduction was also observed in the utilisation of skilled postnatal care (PNC); where the rich-poor gap decreased from 2.5:1 to 1.0:1 and the related concentration index declined from 0.197 to -0.004 (p < 0.001). CONCLUSION: The MNH intervention was successful in reducing inequity in receiving skilled 4+ ANC, delivery, and PNC in rural Bangladesh.

Levels and determinants of quality antenatal care in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey.

BACKGROUND: Assessing the quality of antenatal care (ANC) is imperative for improving care provisions during pregnancy to ensure the health of mother and baby. In Bangladesh, there is a dearth of research on ANC quality using nationally representative data to understand its levels and determinants. Thus, the current study aimed to assess ANC quality and identify the sociodemographic factors associated with the usage of quality ANC services in Bangladesh. METHODS: Secondary data analysis was conducted using the last two Bangladesh Demographic and Health Surveys (BDHSs) from 2014 and 2017-18. A total of 8,277 ever-married women were included in the analysis (3,631 from 2014 and 4,646 from 2017-18). The quality ANC index was constructed using a principal component analysis on the following ANC components: weight and blood pressure measurements, blood and urine test results, counselling about pregnancy complications and completion of a minimum of four ANC visits, one of which was performed by a medically trained provider. Multinomial logistic regression was used to determine the strength of the association. RESULTS: The percentage of mothers who received all components of quality ANC increased from about 13% in 2014 to 18% in 2017-18 (p < 0.001). Women from the poorest group, those in rural areas, with no education, a high birth order and no media exposure were less likely to receive high-quality ANC than those from the richest group, those from urban areas, with a higher level of education, a low birth order and media exposure, respectively. CONCLUSION: Although the quality of ANC improved from 2014 to 2017-18, it remains poor in Bangladesh. Therefore, there is a need to develop targeted interventions for different socio-demographic groups to improve the overall quality of ANC. Future interventions should address both the demand and supply-side perspectives.

Prevalence and Risk Factors of Gestational Diabetes Mellitus in Bangladesh: Findings from Demographic Health Survey 2017-2018.

Gestational diabetes mellitus (GDM) has serious consequences for both maternal and neonatal health. The growing number of noncommunicable diseases and related risk factors as well as the introduction of new World Health Organization (WHO) diagnostic criteria for GDM are likely to impact the GDM prevalence in Bangladesh. Our study aimed to assess the national prevalence and identify the risk factors using the most recent WHO criteria. We used the secondary data of 272 pregnant women (weighted for sampling strategy) from the Bangladesh Demographic and Health Survey 2017-2018. Multivariate logistic regression was performed to determine the risk factors of GDM. The overall prevalence of GDM in Bangladesh was 35% (95/272). Increased odds of GDM were observed among women living in the urban areas (adjusted odds ratio (aOR) 2.74, 95% confidence interval (CI) 1.43-5.27) compared to rural areas and those aged ≥25 years (aOR 2.03, 95% CI 1.13-3.65). GDM rates were less prevalent in the later weeks of pregnancy compared to early weeks. Our study demonstrates that the national prevalence of GDM in Bangladesh is very high, which warrants immediate attention of policy makers, health practitioners, public health researchers, and the community. Context-specific and properly tailored interventions are needed for the prevention and early diagnosis of GDM.