CS is a life-saving intervention for both the mother and unborn child. However, unneces- sary CS deliveries are harmful for health and wellbeing of both mothers and the children [ 4 , 5 ]. CS also increases the chance of having preterm or early term babies [ 6 ] and even newborn deaths [ 7 ]. In some settings it was found that maternal mortality can be as high as 2–4 times greater for CS than normal vaginal deliveries [ 8 ]. Comparison of health status of mothers using EuroQoL-5D indicates that health condition of mothers who had undergone CS deliver- ies was poorer than the health status of the mothers who had normal vaginal delivery [ 9 ]. Adoption of CS delivery is justifiable for a number of well-defined maternal indications including severe antepartum haemorrhage, major cephalo-pelvic disproportion, abnormal fetal presentation etc. [ 10 ]. Another approach to identify potential CS cases is to use Robson classification system. Robson classification proposed a system that categorized women into 10 groups based on their obstetric characteristics (parity, previous CS, gestational age, onset of labour, fetal presentation and number of fetuses). This classification, if successfully incorpo- rated in the routine clinical practice of any country can help to study rates in homogeneous groups of population and act as a tool to monitor CS rates. Hence, the Robson criteria can be used as a tool to help reduce CS rates. [ 11 – 13 ].
All three study countries have experienced substantial increases in institutional delivery rates over the past two decades: births in health facilities increased from 4% (1993) to 29% (2011) in Bangladesh; from 26% (1992 – 1993) to 47% (2007 – 2008) in India and from 8% (1996) to 35% (2011) in Nepal. 10–15 All three countries have implemented incentive schemes to promote institutional delivery, though these have varying coverage. In 2010, Bangladesh ’ s pilot maternity voucher scheme reached an estimated 10.4 million people across 31 subdistricts, around 7% of the country ’ s population. 27 28 Mothers receive a cash incentive for antenatal care and delivery in a public or private facility, or at home with a skilled birth attendant. Government as well as private facility staff also receive cash incentives, including 3000 Bangladeshi Taka (US$38.5) for a caesareansection and 300 Tk for a normal delivery. 28 This maternity incentive scheme was operational in two of the three districts (Faridpur and Maulvibazaar) covered by our study. All three districts had public facilities including District Hospitals, Maternal and Child Welfare Centres, and Upazilla Health Complexes. Private facilities included a number of small-to-medium size clinics, Bangladesh Rural Advancement Committee (BRAC; non-governmental organisation, NGO) facilities and larger private hospitals.
In India, the Janani Suraksha Yojana ( JSY) maternity incentive scheme entitles women in rural areas of high focus states, including those in this study, to 1400 (US $22.4) after delivering in a government or accredited private health facility. Local community health volun- teers called Accredited Social Health Activists (ASHAs) also receive 600 (US$9.6) for identifying pregnant women and helping them get to a health facility. 29 Although the rural Indian data included in this study were collected between 2005 and 2008, the JSY was only operational in the study areas from 2008 onwards and its impact is unlikely to be re ﬂected here. The Indian urban area included in our study spanned informal set- tlements (slums) with a wealth of public and private pro- viders. 30 Mothers with Below Poverty Line cards in such areas are eligible for JSY and can receive 500 towards the costs of delivering in a health facility. 31 Nepal began a safe delivery incentive scheme in 2005 and free deliver- ies have been available in government facilities since
Data for this cross-sectional study of anemia preva- lence among ever-married women in Bangladesh come from the 2011 BangladeshDemographic and HealthSurvey (BDHS), a nationally representative survey con- ducted from July 8, 2011 to December 27, 2011. The data set used in the analysis was obtained from NIPORT. The BDHS used a two-stage stratified cluster sampling method based on enumeration areas (EAs) and household samples. In the first stage, 600 EAs were selected with probability proportional to the size. In the second stage, a total of 18,000 residential house- holds were selected, with an average of 30 households per EA. Additionally, in a sub-sample of one-third of the households, all ever-married women of reproduct- ive age (15 to 49 years) were selected for the biomarker component of the survey, including anemia. Blood was taken from 5902 ever-married women of reproductive
When vaginal delivery is not possible, caesareansection (CS) is an alternative mode of giving birth, which en- sures the safety of mother and her child. CS delivery is a highly effective procedure with surgical intervention in obstetrical care for preventing birth complications of a mother. CS delivery causes various complications for mother and the birth could be traumatic for the baby with long term consequences. Some previous studies re- ported that deficiency of family bondage, disharmony and shock were associated with CS delivery [1, 2]. In 1985 WHO suggested that the optimal population range for CS delivery rates would be between 5 and 15% [3, 4], and WHO stated, in 2015 (BMG-2016) that for the cry- ing need of CS delivery to a woman all possible effort should be provided without endeavoring any kind of specific rate . During pregnancy maternal deaths are mainly caused by hemorrhage, unsafe abortion, hyper- tension, obstructed labour and infections. Though these types of complications are unpredictable, almost all could be prevented by ensuring institutional delivery ser- vices as timely management and treatment can make the difference between life and death [6, 7]. Lack of know- ledge on CS delivery and misinformation about natural childbirth is important reasons for women to choose de- livery by CS . Also fear, anxiety and pain can play an important role for mothers to choose CS delivery . Now a day in Bangladesh without any complications some women undergo CS delivery.
To do so, we accessed one of the largest and most recent cross-sectional surveys conducted in the country in 2011. While the sample size of the survey and the presence of a large set of explanatory variables make the data attractive for the intended analysis, use of such data for analysing childhood illnesses, however, is not without limitations. First, given the cross-sectional nature of the source data, no consideration was made to measure sea- sonal variations in disease episode or their potential impact on the results of this study. The seasonal effects are minimised as the data were collected over a 6-month period covering both wet and dry seasons in the country. Second, our estimates on incidence of morbidity are based on women ’ s self-report and not clinical examina- tions. However, given the short recall period, the bias is assumed to be minimal. We also assume that these biases are independent of the characteristics of women or of their children. In addition, although the 2011 data used in the study are the most recent data that the country has for such analysis, it is important to note that the current situation with respect to childhood morbid- ity may be different from what is reported in our study as situations may have changed in the past 4 years.
Methods: We used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self- care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs). Results: Eight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub- district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care. Conclusion: Our study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.
We used data collected from most of the referral hos- pitals in Senegal and Mali. All deliveries were prospect- ively recorded and data quality was regularly controlled. Both the very large sample size (almost 90 000 deliver- ies) and the high number of CS allowed us to assess nu- merous factors with sufficient statistical power. The 41 included hospitals were representative of the existing health system in both countries, taking into account the variety of contexts (urban vs. rural) and the levels of care (primary vs. secondary referral health facilities). Our findings may be extrapolated to other referral hospitals in West Africa with similar recruitments and character- istics. However, more data on practices related to CS in all African countries is needed.
The BangladeshDemographic and HealthSurvey (BDHS) collects data on demographics, fertility, mortality, nutri- tion, awareness and attitude towards HIV/AIDS, etc., although the collection of data is often subject to the objective and vision of the year of survey. To investi- gate the trends and determinants of the knowledge about HIV/AIDS among the women in Bangladesh, we pooled the last three surveydata of BDHSs (2007–2014) and focused on the ever married sample to investigate our hypothesis. The main variable of interest is the knowl- edge status of married women about HIV/AIDS, which is extracted by asking the women whether they have heard about HIV/AIDS or not. To determine the effects of associated factors on the knowledge about HIV/AIDS, the relevant covariates are analysed that are reported in the earlier studies [5, 19, 21, 25, 26], depending on their availability in the BDHSs data. For instance, respon- dent’s age (“15–19”, “20–24”, “25–29”, “30–49”), respon- dent’s and husband’s highest level of education (“No education”, “Primary”, “Secondary or Higher”), division (“Barisal”, “Chittagong”, “Dhaka”, “Khulna”, “Rajshahi”, “Syl- het”), residence (“Rural”, “Urban”), Religion (“Islam”, “Oth- ers”), socio-economic status (“Poor”, “Middle”, “Rich”). The variable on contraceptive use is categorized into two, “Yes” if any method (condom or others) and “No” for no method. Media use is also categorized as “Yes” for those respondents who either watch television or listen to radio or read newspaper. And, a variable on family planning knowledge is categorized as “Yes” for the respondents who heard about family planning through media and “No” otherwise. For BDHS 2011 and 2014, we have merged Rangpur and Rajshahi divisions as Rajshahi division for matching with BDHS 2007. There are some other impor- tant variables, e.g. information of HIV incidence, women’s knowledge about HIV programs and sources of informa- tion, etc. which could help explaining women’s knowledge about HIV/AIDS, however, due to unavailability of such information in BDHS data we could not investigate these variables. For details of the design and survey questions
This study was based on the secondary analysis of data from the BangladeshHealth Facility Survey (BHFS) 2014 carried out by the National Institute of Population Research and Training (NIPORT) with support from ICF International (USA) and the Associates for Commu- nity and Population Research (ACPR), Dhaka. 10 The 2014 BHFS was a cross-sectional study with a stratified random sample of 1596 health facilities representing all formal sector health facilities in Bangladesh. The aim of the survey was to ascertain the service availability and readiness of health facilities in the areas of maternal and child health, family planning, selected NCDs (diabetes and cardiovascular diseases (CVDs)) and tubercu- losis. The survey also assessed the availability of human resources, basic services, and logistics including equip- ment, essential drugs, laboratory services and infection control mechanisms following standard procedures in the health facilities. 10
Abstract: Women’s autonomy or empowerment is an important issue to achieve targets for the Sustainable Development Goals (SDGs) of Bangladesh. There are several indicators to measure the women empowerment. Health seeking information is one of the most important indicators in this view. This study aims at identifying women’s maternal and child health-care seeking in relation to women empowerment in Bangladesh. BangladeshDemographic and HealthSurvey (BDHS) 2014data was used for the study. A total of 1875 women of reproductive age with complete information on the selected predictors were identified for this analysis by multistage stratified cluster sampling design. Multiple logistic regression and X 2 statistic were used to study determinant factors. A p-value less than 0.05 was considered as statistically significant. Among 1875 women sampled, 87.7% and 88.5% were received antenatal care and postnatal care respectively. Out of women who resided in urban areas, 91.2% women got postnatal care and 93.7% women received antenatal care where as only 83.4% rural women’s get antenatal care and 86.6% women got postnatal care respectively. Division, type of residence, respondent’s education level, wealth index, decision maker for using contraception, partner's education level, respondent’s currently working status, beating justified if wife goes out without telling husband, neglects the children, argues with husband, refuses to have sex with husband, burns the food respectively, women’s body mass index and age of 1st birth were found to be statistically significant determinants of receiving antenatal care. Type of residence, wealth index, respondent’s currently working status, person who usually decides on visits to family or rela- tives, beating justified if wife argues with husband were found to be statistically significant determinants of receiving postnatal care. In summary, our analysis highlights concerning continuing healthcare-seeking challenges in Bangladesh. This study ex- plores the factors associated with women’s autonomy and reproductive healthcare-seeking behavior in Bangladesh.
Bangladesh has made substantial progress in drug manufacturing since the promulgation of ‘Drug Control Ordinance-1982’ but irrational use, inappropriate prescribing and unjustified self medication of antibiotics often increase the cost of therapy and the risk of emergence of resistant organisms. Many doctors in Bangladesh are prescribing antibiotics irrationally without taking consideration the clinical test in most cases. Subsequently, the patients are not completing the complete dosage regimen of antibiotics if it is given in cold and general fever or even in other complicated infectious diseases. So, it is very important to know the extent of antibiotic usages and thereafter their resistance patterns as well to develop adequate regulatory controls by the Drug regulatory authority of Bangladesh for the distribution and selling of most prescribed antibiotics.
A multi-stage cluster random sampling technique was used for this study. Three unions from a total of 13 and one ward from a total of 9 wards of Narail upazilla were randomly selected at level 1. Two to three villages or mohalla from each selected union or ward were ran- domly selected at the level 2. About 120 older adults and 150 adults were interviewed from each of the vil- lages. Recruitment strategy and quality assurance in data collection were described in details previously . In brief, all team members participated in an intensive 2- day training programme in Narail before the commence- ment of the survey. The purpose of the training was to outline the rationale of the study, and the procedures and potential difficulties associated with data collection. The interviewers were instructed to visit every house- hold within the randomly selected villages and to inter- view one household member of an older adult first. If none were available in this subgroup, the interviewers were approached an adult person of that household. If there was more than one male or female adult in the same household, one individual was selected, based on who was born closer to January. However, to maintain an approximately equal number of males and female participants, one female was interviewed immediately after a male participant. The recruitment started from a corner of a village and continued until the recruitment of a maximum of 250 participants was reached for a large village where the number of eligible participants were greater than 250. In case of fewer than 250 house- holds in a village, the requirement continued to the adja- cent village to reach the number to 250.
In general unlike many previous undertakings, this study assessed the differentials of CS rate based on com- munity based data and assessed the trend over a reason- able period of time. Conversely, some limitations need to be considered while interpreting the findings of the study. Differentials of CS rate were identified based on bi- variate analysis hence confounding cannot be excluded. The available sample size for each data point was adequate to estimate the CS rate with 3-5% margin of error; how- ever, smaller margin of error would have been more opti- mal for the study. Further, at times when mothers had more than two births in the reference period, only the re- cent one was considered for the analysis and this could have introduced selection bias in the study.
Consistent electricity was available almost universally among facilities providing caesareans (table 4); however, piped running water on delivery wards was lower, partic- ularly among private hospitals and health centres of all sectors (58% for both). Almost all caesareans in Tanzania were conducted in facilities with access to an ambulance and with blood transfusion services, despite lower avail- ability in health centres of all sectors. Overall, 43% of facilities had a surgical theatre dedicated to caesareans; this percentage was lowest among private hospitals. Less than half (44%; 41%–47%) of facilities performing caesar- eans had all equipment for general anaesthesia available, accounting for 46% (45%–47%) of caesareans nationally. Availability was higher in FBO and private hospitals than in public hospitals (34%) and health centres. Among the seven items assessed, availability was somewhat poorer for Magills forceps and intubating stylets (70%–71%) than for oxygen concentrators and oropharyngeal airways present in 88%–89% of facilities (online supplementary table 2). However, no single equipment item single-hand- edly explains the poor combined availability observed.
The surveys conducted by the national BangladeshDemographic and Health surveys (BDHS) in 1999, 2004, and 2007 10-12 reported that the prevalence of EBF (defined as giving only breast milk, not even water) among infants below six months of age has not increased in the past twelve years. These surveys showed that the rate of EBF remained quite alike at around 45% in 1993 and 1999. But the rate decreased slightly to 42% in the year of 2004 and thereafter it has not improved notably. BDHS 2007 reported that the mean duration of EBF to be 3.3 months. The median duration has remained the same in the three surveys: 1.8 months in 1999- 2000, 1.7 months in 2004, and 1.8 months in 2007 9 . There may be multiple factors influencing breastfeeding decisions and practices of mothers which include knowledge, attitudes and beliefs as well as socio-cultural and physiological factors 13,
household surveys (Chakraborty et al. 2003, Chowdhury et al. 2007, Halder et al. 2007, Kamal 2009). Indeed, the relevance of maternal education for health services uptake and child health outcomes has been described repeatedly since the early 1990s (e.g. Bicego & Boerma 1993). The same studies highlight the significance of socioeconomic status. Even if vaccination rates have improved since the time of the Matlab survey conducted in 1990 (Bishai et al. 2002), the social gradient of full immunization coverage is still apparent in Bangladesh. This study serves to reinforce the understanding that the mere increase in service uptake does not necessarily diminish socioeconomic disparities in uptake unless root causes are tackled. The proper
This study used data available through two recent RDHSs. With the cross-sectional nature of the data col- lection, it is impossible to ascertain the sequence of out- comes and exposures, specifically the length of HIV infection, whether or not a woman knew her infection status (either at the time of the survey or the time of pregnancy), and whether or not she was accessing HIV care. Our hypothesis that access to ART contributed to the non-significant difference in fertility rates between HIV infected and HIV uninfected women relies on the assumption that HIV infected women knew their status and accessed HIV care and treatment services. This is plausible in 2010 when an estimated 80% of eligible indi- viduals in need were on ART, but tenuous in the full 5 years under study as these map to years of scale-up of the ART program. The amount that ART is contributing to non-differential fertility rates can be further explored by repeating this analysis with the 2015 RDHS under- way at the time of this analysis, and the 2013 Rwanda AIDS indicator survey. The hypothesis that knowledge of HIV status decreases desire for more children (either through increased family planning knowledge or because of stigma/fear) hinges on the assumption that a woman knew her status at the time of the RDHS data collection. This is a plausible assumption given that in 2010, 77.2% of respondents had ever had an HIV test and 38.6% had a test
Limitations of this study include the inability to exam- ine factors that were not included in the Rwanda DHS, as well as the retrospective nature of the death reporting which could lead to recall bias and prevents comparison of individual characteristics such as anemia or stunting. In particular, nutrition likely plays a major contributing role in mortality but could not be examined with the existing data. In addition, though important, father’s data could not be included because men were only inter- viewed in one of every three households, resulting in large amounts of missing data among fathers. Because women were only asked antenatal care questions about the last birth, the higher rate of mortality in those births that were “not asked” about suggests interviewer or re- porter bias to avoid talking about the child who died, and/or underreporting or misreporting the timing of re- cent deaths. The inability to separately examine factors associated with neonatal mortality may miss critical im- provements needed for decreasing neonatal deaths. While the available DHS data did not allow this analysis, the authors are currently completing research on specific contexts and factors associated with neonatal death through verbal autopsy, which is expected to provide additional information to target neonatal death reduc- tion specifically, in the Rwandan context. Additional confounding factors may be present that were not con- trolled for through the selected RDHS data. Finally, cer- tain social characteristics such as the household wealth and urban/rural residence reflect the family situation at the time of the survey, and may have been different at the time of the child ’ s death .
Rates of population-based and facility-based caesarean sections have increased over the past two decades in Bangladesh among women of all ages. Although the rates of population-based caesarean sections among ado- lescents are still within the WHO recommended levels, there is a disproportionately higher increase in health facility-based caesarean sections in Bangladesh that cannot be explained only by a self-selection of adoles- cents with complication. Previous studies conducted in Bangladesh have shown that factors such as provider- driven and patient-driven decisions in favour of a caesar- ean section that are not necessarily based on a medical indication as well as increased ﬁnancial beneﬁt for per- forming caesarean sections could be an explanation for increasing rates. 38 Many factors may support the deci- sion to perform a caesareansection, including the rapid- ity and the possibility of planning the intervention, a perceived lower health risk, ﬁnancial beneﬁts for the practitioner and the institution, the fear of litigation or women ’s demand resulting in, protocols and evidence- based guidelines regarding indications not being fol- lowed by the health providers. 39–41