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Mahfuzur MR, Billah MA, Liebergreen N, Ghosh MK, Alam MS, Haque MA, Al-Maruf A. Exploring spatial variations in level and predictors of unskilled birth attendant delivery in Bangladesh using spatial analysis techniques: Findings from nationally representative survey data. PLoS One 2022; 17:e0275951. [PMID: 36282794 PMCID: PMC9595510 DOI: 10.1371/journal.pone.0275951] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Background Bangladesh has failed to meet the United Nations goal for reducing maternal mortality in the last decade. The high prevalence of unskilled birth attendant (UBA) delivery (47%) has resulted in negative consequences for the health of mothers and newborn babies in the country. Spatial variations in UBA delivery and its predictors are yet to be explored in Bangladesh, which could be very helpful in formulating cost-effective policies for reducing that. This study examines the spatial variations in UBA delivery and its predictors in Bangladesh. Methods This study analyzed the characteristics of 672 clusters extracted from the 2017/18 Bangladesh Demographic and Health Survey, and healthcare facility data from the 2017 Bangladesh Health Facility Survey. These data were analyzed using descriptive and spatial analyses (hot spot analysis, Ordinary Least Squares Regression, and Geographically Weighted Regression) techniques. Results Statistically significant hot spots of UBA delivery were concentrated in parts of the Mymensingh, Sylhet, Barishal, and Rangpur regions, while Khulna was the safest region. Predictive strengths of the statistically significant predictors of spatial variation in UBA delivery were observed to vary considerably across the regions. Poorest household wealth status and less than four antenatal care contacts emerged as strong predictors of UBA delivery in all the aforementioned hot spot-stricken regions, except Barisal. Additionally, primiparity and all secondary education or higher were strong predictors of lower UBA delivery rates in Mymensingh and Sylhet, while poorer household wealth status was also a strong predictor of UBA delivery in Sylhet. Multiparity was an additional strong predictor of UBA delivery in Rangpur. In Barisal, only poorer household wealth status exerted a strong positive influence on UBA delivery. Conclusions The remarkable spatial variations in UBA delivery and its predictors’ strengths indicate that geographically-targeted interventions could be a cost-effective method for reducing the UBA delivery prevalence in Bangladesh, thereby improve maternal and child health.
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Affiliation(s)
- Md. Rahman Mahfuzur
- Department of Population Science and Human Resource Development, Sir Jagadish Chandra Bose Academic Building, University of Rajshahi, Rajshahi, Bangladesh
- * E-mail:
| | - Md. Arif Billah
- Department of Social Work and Counselling, Faculty of Business, Economics and Social Development, Universiti Malaysia Terengganu, Kuala Nerus, Terengganu, Malaysia
| | | | - Manoj Kumer Ghosh
- Department of Geography and Environmental Studies, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Shafiul Alam
- Department of Geography and Environmental Studies, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Armanul Haque
- Information Science & Library Management, University of Rajshahi, Rajshahi, Bangladesh
| | - Abdullah Al-Maruf
- Department of Geography and Environmental Studies, University of Rajshahi, Rajshahi, Bangladesh
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Bhowmik J, Biswas RK, Ananna N. Women's education and coverage of skilled birth attendance: An assessment of Sustainable Development Goal 3.1 in the South and Southeast Asian Region. PLoS One 2020; 15:e0231489. [PMID: 32315328 PMCID: PMC7173780 DOI: 10.1371/journal.pone.0231489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/24/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of Sustainable Development Goal 3.1 is to reduce the global maternal mortality ratio (MMR) below 70 per 100,000 live births by 2030. One of the indicators for this objective is the proportion of births attended by skilled health attendants (SBA). This study assessed the progress of low- and middle-income countries from South and Southeast Asian (SSEA) region in SBA coverage and evaluated the contribution of women’s education in this progression. Methods The Demographic and Health Surveys were assessed, which included 38 nationally representative surveys on women aged between 15-49 years from 10 selected SSEA region countries in past 30 years. Binary Logistic regression models were fitted adjusting the survey clusters, strata and sampling weights. Meta-analyses were conducted by collapsing effect sizes and confidence intervals of education modeled on SBA coverage. Results Results indicated that Cambodia, Indonesia and Philippines had over 80% SBA coverage after 2010, whereas Bangladesh and Afghanistan had around 50% coverage. Women with primary, secondary and higher level of education were 1.65, 2.21 and 3.14 times significantly more likely to access SBA care during childbirth respectively as compared to women with no education, suggesting that education is a key factor to address skilled delivery cares in the SSEA region. Conclusion Evaluation of the existing skilled birth attendance policies at the national level could provide useful insight for the decision makers to improve access to skilled care at birth by investing on women’s education in remote and rural areas.
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Affiliation(s)
- Jahar Bhowmik
- Department of Health Science and Biostatistics, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Raaj Kishore Biswas
- Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, Sydney, Australia
- * E-mail:
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Adegbosin AE, Zhou H, Wang S, Stantic B, Sun J. Systematic review and meta-analysis of the association between dimensions of inequality and a selection of indicators of Reproductive, Maternal, Newborn and Child Health (RMNCH). J Glob Health 2019; 9:010429. [PMID: 31131102 PMCID: PMC6513502 DOI: 10.7189/jogh.09.010429] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Globally, progress in Maternal and Child Health (MCH) has been inconsistent, with several evidence showing both between and within country disparities in several RMNCH outcome measures. In this study, we aim to meta-analyse existing literature on association between three major equity stratifiers and a selection of RMNCH indicators. METHODS We searched PubMed, Embase, Scopus databases and grey literatures from the WHO, UNICEF and World Bank publications. Using the PRISMA guidelines, we identified and reviewed studies from low and middle-income countries, that explored the effects of inequalities on RMNCH, with focus on studies that utilised data from a nationally representative survey. The review protocol was registered at the PROSPERO international prospective register of systematic reviews. RESULTS A total of 28 studies were included in the meta-analysis. Results revealed the existence of marked inequality based on income levels, education and place of residence. The most significant level of disparity was with regards to unmet need for contraception and antenatal coverage. For both respective indicators, those with secondary or higher education were 6 times more likely to have better coverage, than those with lesser level of education; (odds ratio (OR) = 6.25 (95% confidence interval (CI) = 1.68-23.23; I2 = 98%, P = 0.006) and (OR = 6.17 (95% CI = 3.03-12.56; I2 = 97%, P < 0.00001) respectively. In contrast, the lowest inequality was in the completion of 3 doses of diphtheria, pertussis and tetanus vaccines (DPT3), those with primary or no education, were equally as likely as those with secondary or higher education to have received DPT3; (OR = 1.21, 95% CI = 0.34-4.27; I2 = 96%, P = 0.77). CONCLUSIONS In developing countries, maternal and child health coverage remains highly inequitable and assess to maternal and child health services are governed by factors such as income, level of education, and place of residence.
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Affiliation(s)
| | | | - Sen Wang
- School of Information and Communication Technology, Griffith University, Queensland, Australia
| | - Bela Stantic
- School of Information and Communication Technology, Griffith University, Queensland, Australia
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Ryan BL, Krishnan RJ, Terry A, Thind A. Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis. BMC Public Health 2019; 19:583. [PMID: 31096959 PMCID: PMC6521440 DOI: 10.1186/s12889-019-6945-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 05/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With Bangladesh's adoption of the third Sustainable Development Goal to reduce maternal mortality, the impetus for Bangladesh to continue to improve uptake of maternal healthcare is strong. METHODS Using a propensity-score matched analysis, the present study utilized data from the 2014 Bangladesh Demographic Health survey to examine the impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery. RESULTS The results revealed a significant and positive impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery after matching treated and untreated mothers on included socio-demographic characteristics. CONCLUSIONS Implementation of policies to provide at least four antenatal care visits may serve as an effective strategy to increase SBA use and institutional delivery in Bangladesh, which could contribute to the reduction of maternal mortality.
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Affiliation(s)
- Bridget L Ryan
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, ON, Canada.,Department of Family Medicine, Western University, London, ON, Canada
| | - Rohin J Krishnan
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, ON, Canada.,Department of Family Medicine, Western University, London, ON, Canada
| | - Amanda Terry
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, ON, Canada.,Department of Family Medicine, Western University, London, ON, Canada.,Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, ON, Canada. .,Department of Family Medicine, Western University, London, ON, Canada. .,Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada.
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Bhowmik J, Biswas RK, Woldegiorgis M. Antenatal care and skilled birth attendance in Bangladesh are influenced by female education and family affordability: BDHS 2014. Public Health 2019; 170:113-121. [PMID: 30991173 DOI: 10.1016/j.puhe.2019.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 02/11/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Antenatal care (ANC) during pregnancy and skilled birth attendance (SBA) during delivery are important policy concerns to reduce maternal deaths. Bangladesh is one of the developing countries which has made remarkable progress in both services during the last couple of decades by improving the SBA service rate from 16% in 2004 to 42.1% in 2014. However, this rate remains below the targeted level (50%) of the Health Population and Nutrition Sector Development Program set by the Ministry of the Health and Family Welfare of Bangladesh. This article explored the sociodemographic factors associated with the ANC and SBA service attainment. Furthermore, the possible implication of using ANC on SBA was also investigated. STUDY DESIGN The study followed a cross-sectional design using the Bangladesh demographic and health survey 2014, with a sample of size 4603 women with at least one live birth 3 years preceding the survey. METHODS Following a bivariate analysis, linear mixed-effect models were used to assess the relationship between sociodemographic factors and the outcome indicators (ANC and SBA). Finally, the association between SBA and ANC was evaluated through another mixed-effect model. RESULTS Wealth index, participation in household decisions, and partner's and respondent's education were significant predictors of ANC; whereas, residence, age at first birth, wealth index, working status, participation in household decisions, and partner and respondent's education were significant for SBA. Female education and household affordability were the strongest predictors for both ANC and SBA. ANC showed significant association with SBA as women accessing essential ANC during delivery seemed to be 4 times more likely (95% confidence interval: 3.05-5.93) to avail SBA services. CONCLUSIONS Overall, four factors were significant: residence, wealth index, education, and ANC access. Women residing in urban areas, having higher financial solvency, completing higher education, and accessing ANC by skilled personnel were more likely to receive SBA at delivery than their counterparts. Accessibility to skilled care during pregnancy leads to increased professional care during delivery. Thus, policies to encourage women and heads of families to seek skilled care during pregnancy would be beneficial to reach the maternal healthcare targets of Bangladesh.
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Affiliation(s)
- J Bhowmik
- Department of Statistics Data Science and Epidemiology, Swinburne University of Technology, Australia.
| | - R K Biswas
- Transport and Road Safety Research, University of New South Wales, Australia.
| | - M Woldegiorgis
- Department of Statistics Data Science and Epidemiology, Swinburne University of Technology, Australia.
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Santas F, Celik Y, Eryurt MA. Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years. Int J Health Plann Manage 2017; 33:e344-e356. [PMID: 29277916 DOI: 10.1002/hpm.2482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/12/2022] Open
Abstract
This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth.
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Affiliation(s)
- Fatih Santas
- Bozok University Faculty of Economics & Administrative Science, Department of Health Management, Yozgat, Turkey
| | - Yusuf Celik
- Hacettepe University Faculty of Economics & Administrative Science, Department of Health Management, Ankara, Turkey
| | - Mehmet Ali Eryurt
- Hacettepe University Institute of Population Studies, Ankara, Turkey
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Chamroonsawasdi K, Soe M, Charupoonphol P, Srisorrachatr S. Rate of Utilization of Skilled Birth Attendant and the Influencing Factors in an Urban Myanmar Population. Asia Pac J Public Health 2015; 27:521-30. [PMID: 25556218 DOI: 10.1177/1010539514565445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A survey study aimed at identifying rates and predictive factors on utilization of skilled birth attendant (SBA) among pregnant women. A stratified random sampling technique was used to select 200 Myanmar women aged 18 to 49 years in Kalay Township. Data were collected by interview questionnaire from March 1 to 15, 2012, and data were analyzed by frequency, percentage, mean and standard deviation, χ(2) test, and multiple logistic regression analysis. The utilization rate of SBA was 74%. Factors significantly predicting utilization of SBA (P < .05) were level of maternal and child health (MCH) knowledge, attitude toward SBA, and accessibility to MCH services. The women who had a moderate to good level of knowledge utilized SBA 2.7 times more than those who had a poor level of knowledge (odds ratio = 2.705, 95% confidence interval = 1.31-5.57). The women who had a positive attitude toward SBA utilized SBA 7.7 times more than those who had a negative attitude (odds ratio = 7.708, 95% confidence interval = 3.71-15.98). The women who had high accessibility to MCH services utilized SBA 1.4 times more than those who had low accessibility (odds ratio = 1.477, 95% confidence interval = 1.05-2.21). These factors were able to correctly predict utilization of SBA at 74.9%. MCH knowledge and information on utilization of SBA should be strengthened during every antenatal care visit to enhance positive attitude on utilization of SBA and to increase accessibility to MCH services by providing community antenatal care or home visits.
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Hajizadeh M, Alam N, Nandi A. Social inequalities in the utilization of maternal care in Bangladesh: Have they widened or narrowed in recent years? Int J Equity Health 2014; 13:120. [PMID: 25492512 PMCID: PMC4272805 DOI: 10.1186/s12939-014-0120-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/26/2014] [Indexed: 01/16/2023] Open
Abstract
Background Notwithstanding the significant progress in reducing maternal mortality in recent years, social inequalities in the utilization of maternal care continue to be a challenge in Bangladesh. In this study, we aim to provide a comprehensive analysis of trends in social inequalities in utilization of antenatal care (ANC), facility based delivery (FBD), and skilled birth attendance (SBA) in Bangladesh between 1995 and 2010. Methods Data were extracted from the five latest rounds of Bangladesh Demographic Health Surveys (BDHS). The Theil index (T) and between-group variance (BGV) were used to calculate relative and absolute disparities in the utilization of three measures (ANC, FBD, and SBA) of maternal care across six administrative regions. The relative and slope indices of inequality (RII and SII, respectively) were also used to calculate wealth- and education-based inequality in the utilization of maternal care. Results The results of the T-index suggest that relative inequality in SBA has declined by 0.2% per year. Nevertheless, the estimated BGV demonstrated that absolute inequalities in all three measures of maternal care have increased across administrative divisions. For all three measures of maternal care, the RII and SII indicated consistent socioeconomic inequalities favouring wealthier and more educated women. The adjusted RII suggested that wealth- and education-related inequalities for ANC declined by 9% and 6%, respectively, per year during the study period. The adjusted SII, however, showed that wealth- and education-related inequalities for FBD increased by 0.6% per year. Conclusions Although socially disadvantaged mothers increased their utilization of care relative to mothers of higher socioeconomic status, the absolute gap in utilization of care between socioeconomic groups has increased over time. Our findings indicate that wealthier and more educated women, as well as those living in urban areas, are the major users of ANC, FBD and SBA in Bangladesh. Thus, priority focus should be given to implementing and evaluating interventions that benefit women who are poorer, less educated and live in rural areas.
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Affiliation(s)
- Mohammad Hajizadeh
- School of Health Administration, Faculty of Health Professions, Dalhousie University, 5161 George Street, Suite 700, Halifax, NS, B3H 4R2, Canada.
| | - Nazmul Alam
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.
| | - Arijit Nandi
- Institute for Health and Social Policy & Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
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