Improvement of coverage and utilization of EmOC services in southwestern Bangladesh.

OBJECTIVE: The Government of Bangladesh has implemented safe motherhood programs throughout the country supported by the United Nations Children's Fund (UNICEF) and United Nations Population Fund (UNFPA) aimed at reducing maternal morbidity and mortality. The objective of this study is to assess the effect of the interventions on the UN emergency obstetric care (EmOC) process indicators in Khulna division, Bangladesh. METHODS: Of the 71 government health facilities in Khulna division, 32 were providing comprehensive and 20 were providing basic EmOC services. Another 4 facilities were providing comprehensive or basic EmOC services during the first three-quarters but became non-functional during the last quarter. EmOC data, from January to December 2002, were collected from all these 56 facilities to determine the levels of EmOC process indicators relative to the UN guidelines and compared with baseline data from 1998 to 1999. RESULTS: There were 1.04 and 0.64 comprehensive and basic EmOC facilities respectively per 500,000 population. When compared with the baseline data, the coverage of comprehensive EmOC services was substantially increased from 0.23 to 1.04 per 500,000 population, which achieves the minimum UN standards but the coverage of basic EmOC services remained the same. The data also showed that, compared with the baseline survey, the proportion of births at the EmOC facilities increased 119% from 5.3% to 11.7% (p<0.001), met need increased 141% from 11.1% to 26.6% (p<0.001), and cesarean section as a proportion of all expected births, increased 151% from 0.5% to 1.3% (p<0.001), while the overall case fatality rate (CFR) decreased by 51% (p<0.001). CONCLUSION: With the exception of coverage of basic EmOC after the interventions, there was significant improvement in all the EmOC process indicators in Khulna division. However, most of the process indicators are still far from the minimum recommended UN standards. RECOMMENDATIONS: Efforts should continue to keep the EmOC facilities functional 24/7 while increasing the number of basic EmOC facilities, and improving utilization of services to reach the minimum UN standards. Community mobilization should be directed to understand the danger signs and utilization of services at functional facilities when necessary. Further research to identify the factors influencing utilization of EmOC services and continuous monitoring and periodical assessment of the process indicators are recommended to evaluate the overall situation from time to time.

The Woman Friendly Hospital Initiative in Bangladesh setting: standards for the care of women subject to violence.

The Woman Friendly Hospital Initiative is part of the overall strategy aimed at overcoming a situation of high maternal mortality in Bangladesh. It has evolved from the reality of 14% of maternal deaths being associated with violence. A key of the initiative is the management of violence against women. Training courses for doctors developed through a process of multi-sectoral consultation. The focus is on effecting a change in the perceptions, emotions, attitude, knowledge and skills of providers and nurturing leadership.

Verbal autopsy for maternal death.

This cross sectional study was done in Gopalganj district from September 1997 to August 1998. To ascertain the magnitude and causes of maternal deaths and perinatal and neonatal outcome of the babies. Two hundred five in maternal deaths occurring from 1994 to 1997 were investigated by verbal autopsy. Teenager mothers had more deaths in first pregnancy. Maternal deaths increased with gravidity above 30 years. Haemorrhage and eclampsia were common causes of death. Eclampsia was prominent in primigravids <20 years while haemorrhage occurred more in multigravidas between 25-35 years of age (P = 0.029 for age, P = <0.001 for gravidity). Nearly 64% of maternal deaths occurred in postpartum period. Among live births, 45.6% babies died before their first birth day. The findings support the need of increasing the age of marriage and first childbirth, through strengthened family planning programme and ensuring skilled birth attendance during delivery. It also stresses need for communication on danger signs of pregnancy and childbirth.