1921
Volume 95, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.

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References

  1. de Zoysa I, , 2010. The Importance of Reducing Maternal Mortality for Women's Health in Africa. Available at: www.un.org/en/ecosoc/newfunct/pdf/DeZoysa.pdf. [Google Scholar]
  2. Ronsmans C, Graham WJ, Lancet Maternal Survival Series Steering Group, , 2006. Maternal mortality: who, when, where, and why. Lancet 368: 11891200.[Crossref] [Google Scholar]
  3. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, Child Health Epidemiology Reference Group of WHO and UNICEF, , 2012. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 21512161.[Crossref] [Google Scholar]
  4. Chowdhury HR, Thompson S, Ali M, Alam N, Yunus M, Streatfield PK, , 2010. Causes of neonatal deaths in a rural subdistrict of Bangladesh: implications for intervention. J Health Popul Nutr 28: 375382. [Google Scholar]
  5. Wall SN, Lee ACC, Carlo W, Goldenberg R, Niermeyer S, Darmstadt GL, Keenan W, Bhutta ZA, Perlman J, Lawn JE, , 2010. Reducing intrapartum-related neonatal deaths in low- and middle-income countries: what works? Semin Perinatol 34: 395407.[Crossref] [Google Scholar]
  6. Adegoke AA, van den Broek N, , 2009. Skilled birth attendance: lessons learnt. BJOG 116 (Suppl 1): 3340.[Crossref] [Google Scholar]
  7. Starrs A, , 1997. The Safe Motherhood Action Agenda: Priorities for the Next Decade. New York, NY: Inter-Agency Group for Safe Motherhood. [Google Scholar]
  8. Pattinson RC, , 2003. Challenges in saving babies: avoidable factors, missed opportunities and substandard care in perinatal deaths in South Africa. S Afr Med J 93: 450455. [Google Scholar]
  9. Velaphi S, Pattinson R, , 2007. Avoidable factors and causes of neonatal deaths from perinatal asphyxia-hypoxia in South Africa: national perinatal survey. Ann Trop Paediatr 27: 99106.[Crossref] [Google Scholar]
  10. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, Sankar MJ, Blencowe H, Rizvi A, Chou VB, Walker N, Lancet Newborn Interventions Review Group Lancet Every Newborn Study Group, ; , 2014. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet 384: 347370.[Crossref] [Google Scholar]
  11. UNICEF, 2014. The State of the World's Children 2015: Executive Summary. New York, NY: Division of Communication, UNICEF. Available at: http://www.unicef.org/publications/files/SOWC_2015_Summary_and_Tables.pdf. [Google Scholar]
  12. UNICEF, 2007. The State of the World's Children 2008: Child Survival. New York, NY: UNICEF, 156. [Google Scholar]
  13. UNICEF, 2013. The State of the World's Children 2013: Children with Disabilities. New York, NY: UNICEF. [Google Scholar]
  14. Anwar I, Nababan HY, Mostari S, Rahman A, Khan JAM, , 2015. Trends and inequities in use of maternal health care services in Bangladesh, 1991–2011. PLoS One 10: e0120309.[Crossref] [Google Scholar]
  15. Zafar Ullah AN, Huque R, Husain A, Akter S, Islam A, Newell JN, , 2012. Effectiveness of involving the private medical sector in the National TB Control Programme in Bangladesh: evidence from mixed methods. BMJ Open 2: e001534.[Crossref] [Google Scholar]
  16. Barkat A, Maksud AKM, , 2003. Private Sector Health Services in Bangladesh: An Exploratory Study, Prepared for Engender Health. Dhaka, Bangladesh: Human Development Research Centre (HDRC). Available at: http://www.hdrc-bd.com/admin_panel/images/notice/1386583983.15.%20private%20sector%20health%20services%20in%20bangladesh_%20an%20exploratory%20study.pdf. [Google Scholar]
  17. Siddiqui N, Khandaker SA, , 2007. Comparison of services of public, private and foreign hospitals from the perspective of Bangladeshi patients. J Health Popul Nutr 25: 221230. [Google Scholar]
  18. Rahman M, Rob U, Noor FR, Bellows B, , 2012. Out-of-pocket expenses for maternity care in rural Bangladesh: a public-private comparison. Int Q Community Health Educ 33: 143157.[Crossref] [Google Scholar]
  19. Begum F, Alam S, Hossain A, , 2014. Funds for treatment of hospitalized patients: evidence from Bangladesh. J Health Popul Nutr 32: 465470. [Google Scholar]
  20. icddr,b, WaterAid Bangladesh, Ministry of Local Government, Rural Development and Cooperative, 2014. Bangladesh National Hygiene Baseline Survey: Preliminary Report. Dhaka, Bangladesh: Ministry of Local Government, Rural Development and Cooperative, 66. Available at: www.wateraid.org/~/media/Publications/Bangladesh-national-hygiene-baseline-survey.pdf. [Google Scholar]
  21. Alam B, Mridha MK, Biswas TK, Roy L, Rahman M, Chowdhury ME, , 2015. Coverage of emergency obstetric care and availability of services in public and private health facilities in Bangladesh. Int J Gynaecol Obstet 131: 6369.[Crossref] [Google Scholar]
  22. World Health Organization, UNFPA, UNICEF, Mailman School of Public Health, 2009. Monitoring Emergency Obstetric Care: A Handbook. Available at: http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf?ua=1. [Google Scholar]
  23. Gabrysch S, Civitelli G, Edmond KM, Mathal M, Ali M, Bhutta ZA, Campbell OMR, , 2012. New signal functions to measure the ability of health facilities to provide routine and emergency newborn care. PLoS Med 9: e1001340.[Crossref] [Google Scholar]
  24. Nesbitt RC, Lohela TJ, Manu A, Vesel L, Okyere E, Edmond K, Owusu-Agyei S, Kirkwood BR, Gabrysch S, , 2013. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana. PLoS One 8: e81089.[Crossref] [Google Scholar]
  25. Azim T, Khan SI, Haseen F, Huq NL, Henning L, Pervez MM, Chowdhury ME, Sarafian I, , 2008. HIV and AIDS in Bangladesh. J Health Popul Nutr 26: 311324. [Google Scholar]
  26. National Institute of Population Research and Training (NIPORT), Mitra and Associates, MEASURE DHS ICF International, 2013. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland: NIPORT, Mitra and Associates, and ICF International, 430. Available at: http://dhsprogram.com/pubs/pdf/FR265/FR265.pdf. [Google Scholar]
  27. R Development Core Team, 2008. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing. Available at: http://www.R-project.org. [Google Scholar]
  28. Chongsuvivatwong V, , 2007. Analysis of Epidemiological Data Using R and Epicalc. Hat Yai, Thailand: Epidemiology Unit, Prince of Songkla University. [Google Scholar]
  29. Vesel L, Manu A, Lohela TJ, Gabrysch S, Okyere E, ten Asbroek AHA, Hill Z, Agyemang CT, Owusu-Agyei S, Kirkwood BR, , 2013. Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data. BMJ Open 3: e002326.[Crossref] [Google Scholar]
  30. Houweling TAJ, Ronsmans C, Campbell OMR, Kunst AE, , 2007. Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bull World Health Organ 85: 745754.[Crossref] [Google Scholar]
  31. Mony PK, Krishnamurthy J, Thomas A, Sankar K, Ramesh BM, Moses S, Blanchard J, Avery L, , 2013. Availability and distribution of emergency obstetric care services in Karnataka State, south India: access and equity considerations. PLoS One 8: e64126.[Crossref] [Google Scholar]
  32. Sikder S, Labrique A, Ali H, Hanif A, Klemm R, Mehra S, West K, Jr Christian P, , 2015. Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh. BMC Public Health 15: 114.[Crossref] [Google Scholar]
  33. Mirkuzie A, Sisay M, Reta A, Bedane M, , 2014. Current evidence on basic emergency obstetric and newborn care services in Addis Ababa, Ethiopia; a cross sectional study. BMC Pregnancy Childbirth 14: 354.[Crossref] [Google Scholar]
  34. SMGL, 2014. Saving Mothers, Giving Life Phase 1: Emergency Obstetric and Newborn Care Services: Access and Availability. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Available at: http://www.cdc.gov/reproductivehealth/global/publications/pdfs/smgl-emergencyobstetriccare-508.pdf. [Google Scholar]
  35. Makene C, Plotkin M, Currie S, Bishanga D, Ugwi P, Louis H, Winani K, Nelson B, , 2014. Improvements in newborn care and newborn resuscitation following a quality improvement program at scale: results from a before and after study in Tanzania. BMC Pregnancy Childbirth 14: 381.[Crossref] [Google Scholar]
  36. Park H, Choi BS, Lee SJ, Son I-A, Seol I-J, Lee HJ, , 2014. Practical application of kangaroo mother care in preterm infants: clinical characteristics and safety of kangaroo mother care. J Perinat Med 42: 239245.[Crossref] [Google Scholar]
  37. Lawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S, , 2010. “Kangaroo mother care” to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol 39 (Suppl 1): i144i154.[Crossref] [Google Scholar]
  38. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R, Adler A, Vera Garcia C, Rohde S, Say L, Lawn JE, , 2012. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 379: 21622172.[Crossref] [Google Scholar]
  39. icddr,b, 2011. Matlab's Kangaroo Mother Care: Saving Lives—icddr,b. Available at: http://www.icddrb.org/news-and-events/features?id=12&task=view. [Google Scholar]
  40. Maternal and Child Health Integrated Program, 2012. Kangaroo Mother Care Implementation Guide. Available at: www.mchip.net/sites/default/files/MCHIP%20KMC%20Guide_English.pdf. [Google Scholar]
  41. Blomqvist YT, Frolund L, Rubertsson C, Nyqvist KH, , 2013. Provision of kangaroo mother care: supportive factors and barriers perceived by parents. Scand J Caring Sci 27: 345353.[Crossref] [Google Scholar]
  42. Parikh S, Banker D, Shah U, Bala DV, , 2013. Barriers in implementing community based kangaroo mother care in low income community. NHL J Med Sci 2: 3638. [Google Scholar]
  43. Bergh A-M, Manu R, Davy K, Van Rooyen E, Quansah Asare G, Awoonor-Williams J, Dedzo M, Twumasi A, Nang-Beifubah A, , 2013. Progress with the implementation of kangaroo mother care in four regions in Ghana. Ghana Med J 47: 5763. [Google Scholar]
  44. Bergh A-M, van Rooyen E, Pattinson RC, , 2008. Scaling up kangaroo mother care in South Africa: “on-site” versus “off-site” educational facilitation. Hum Resour Health 6: 13.[Crossref] [Google Scholar]
  45. Sloan NL, Ahmed S, Mitra SN, Choudhury N, Chowdhury M, Rob U, Winikoff B, , 2008. Community-based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial. Pediatrics 121: e1047e1059.[Crossref] [Google Scholar]
  46. Ahmed S, Mitra SN, Chowdhury AM, Camacho LL, Winikoff B, Sloan NL, , 2011. Community kangaroo mother care: implementation and potential for neonatal survival and health in very low-income settings. J Perinatol 31: 361367.[Crossref] [Google Scholar]
  47. Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis JP, , 2009. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev 7: CD006614. [Google Scholar]
  48. Watterberg K, , 2012. Evidence-based neonatal pharmacotherapy: postnatal corticosteroids. Clin Perinatol 39: 4759.[Crossref] [Google Scholar]
  49. Jarreau P-H, Fayon M, Baud O, Autret-Leca E, Danan M, de Verdelhan A, Castot A, , 2010. Utilisation de la corticothérapie postnatale chez le nouveau-né prématuré dans la prévention et le traitement de la dysplasie bronchopulmonaire: état des lieux et conduite à tenir. Arch Pediatr 17: 14801487.[Crossref] [Google Scholar]
  50. World Bank, 2005. Comparative Advantages of Public and Private Health Care Providers in Bangladesh. Dhaka, Bangladesh: World Bank, 123. Available at: http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2006/03/22/000160016_20060322092725/Rendered/PDF/355530BDS40pub1vate0health01PUBLIC1.pdf. [Google Scholar]
  51. Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D, , 2012. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review. PLoS Med 9: e1001244.[Crossref] [Google Scholar]
  52. Larson CP, Saha UR, Islam R, Roy N, , 2006. Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care. Int J Epidemiol 35: 14301439.[Crossref] [Google Scholar]
  53. Ameh C, Msuya S, Hofman J, Raven J, Mathai M, van den Broek N, , 2012. Status of emergency obstetric care in six developing countries five years before the MDG targets for maternal and newborn health. PLoS One 7: e49938.[Crossref] [Google Scholar]
  54. Ali M, Hotta M, Kuroiwa C, Ushijima H, , 2005. Emergency obstetric care in Pakistan: potential for reduced maternal mortality through improved basic EmOC facilities, services, and access. Int J Gynaecol Obstet 91: 105112.[Crossref] [Google Scholar]
  55. Kim Y-M, Zainullah P, Mungia J, Tappis H, Bartlett L, Zaka N, , 2012. Availability and quality of emergency obstetric and neonatal care services in Afghanistan. Int J Gynaecol Obstet 116: 192196.[Crossref] [Google Scholar]
  56. Mony PK, Krishnamurthy J, Thomas A, Sankar K, Ramesh BM, Moses S, Blanchard J, Avery L, , 2013. Availability and distribution of emergency obstetric care services in Karnataka State, south India: access and equity considerations. PLoS One 8: e64126.[Crossref] [Google Scholar]
  57. Gao Y, Barclay L, , 2010. Availability and quality of emergency obstetric care in Shanxi Province, China. Int J Gynaecol Obstet 110: 181185.[Crossref] [Google Scholar]
  58. Chaturvedi S, Randive B, Mistry N, , 2013. Availability of treatment for eclampsia in public health institutions in Maharashtra, India. J Health Popul Nutr 31: 8695.[Crossref] [Google Scholar]
  59. Bigdeli M, Zafar S, Assad H, Ghaffar A, , 2013. Health system barriers to access and use of magnesium sulfate for women with severe pre-eclampsia and eclampsia in Pakistan: evidence for policy and practice. PLoS One 8: e59158.[Crossref] [Google Scholar]
  60. National Institute of Population Research and Training (NIPORT), MEASURE Evaluation, icddr,b, 2012. Bangladesh Maternal Mortality and Health Care Survey 2010. Dhaka, Bangladesh: NIPORT, MEASURE Evaluation, and icddr,b, 276. Available at: www.cpc.unc.edu/measure/publications/tr-12-87/at_download/document. [Google Scholar]
  61. McDonald SD, Lutsiv O, Dzaja N, Duley L, , 2012. A systematic review of maternal and infant outcomes following magnesium sulfate for pre-eclampsia/eclampsia in real-world use. Int J Gynaecol Obstet 118: 9096.[Crossref] [Google Scholar]
  62. Anwar I, Kalim N, Koblinsky M, , 2009. Quality of obstetric care in public-sector facilities and constraints to implementing emergency obstetric care services: evidence from high- and low-performing districts of Bangladesh. J Health Popul Nutr 27: 139155. [Google Scholar]
  63. Islam MT, Haque YA, Waxman R, Bhuiyan AB, , 2006. Implementation of emergency obstetric care training in Bangladesh: lessons learned. Reprod Health Matters 14: 6172.[Crossref] [Google Scholar]
  64. Upadhyay RP, Chinnakali P, Odukoya O, Yadav K, Sinha S, Rizwan SA, Daral S, Chellaiyan VG, Silan V, , 2012. High neonatal mortality rates in rural India: what options to explore? ISRN Pediatr 2012: 968921.[Crossref] [Google Scholar]
  65. Willis-Shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P, , 2008. Motivation and retention of health workers in developing countries: a systematic review. BMC Health Serv Res 8: 247.[Crossref] [Google Scholar]
  66. Alam K, Oliveras E, , 2014. Retention of female volunteer community health workers in Dhaka urban slums: a prospective cohort study. Hum Resour Health 12: 29.[Crossref] [Google Scholar]
  67. Rahman SM, Ali NA, Jennings L, Seraji MHR, Mannan I, Shah R, Al-Mahmud AB, Bari S, Hossain D, Das MK, Baqui AH, El Arifeen S, Winch PJ, , 2010. Factors affecting recruitment and retention of community health workers in a newborn care intervention in Bangladesh. Hum Resour Health 8: 12.[Crossref] [Google Scholar]
  68. Paxton A, Bailey P, Lobis S, , 2006. The United Nations process indicators for emergency obstetric care: reflections based on a decade of experience. Int J Gynaecol Obstet 95: 192208.[Crossref] [Google Scholar]
  69. Kamal SMM, , 2013. Preference for institutional delivery and caesarean sections in Bangladesh. J Health Popul Nutr 31: 96109.[Crossref] [Google Scholar]
  70. Levine A, Marsh R, Nelson S, Tyer-Viola L, Burke T, , 2008. Measuring access to emergency obstetric care in rural Zambia. Int J Emerg Med 1: 113119.[Crossref] [Google Scholar]
  71. Mridha MK, Anwar I, Koblinsky M, , 2009. Public-sector maternal health programmes and services for rural Bangladesh. J Health Popul Nutr 27: 124138.[Crossref] [Google Scholar]
  72. Duysburgh E, Temmerman M, M, Williams A, Massawe S, Williams J, Mpembeni R, Loukanova S, Haefeli WE, Blank A, , 2015. Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana, and Tanzania: an intervention study. Trop Med Int Health 21: 7083.[Crossref] [Google Scholar]
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  • Received : 12 May 2015
  • Accepted : 02 May 2016

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