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Jabeen S, Chandrima RM, Hasan M, Rahman MM, Rahman QSU, AKM TH, Dewan F, Alim A, Nadia N, Mahmud M, Sarker MH, Islam J, Islam MS, Ashrafee S, Haider MS, Chisti MJ, Sheikh MZH, Miah MS, Al-Mahmud M, Ameen S, Ahmed A, El Arifeen S, Rahman AE. A context-driven approach through stakeholder engagement to introduce a digital emergency obstetric and newborn care register into routine obstetric health care services in Bangladesh. J Glob Health 2024; 14:04098. [PMID: 38721686 PMCID: PMC11079701 DOI: 10.7189/jogh.14.04098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Emergency obstetric and newborn care (EmONC) in Bangladesh focusses on maternal health, whereby it addresses childbirth and postpartum complications to ensure women's health and well-being. It was transitioned to a digital platform to overcome challenges with the paper-based EmONC register and we conducted implementation research to assess the outcome. Here we outline the stakeholder engagement process integral to the implementation research process. Methods We adopted a four-step stakeholder engagement model based on the identification, sensitisation, involvement, and engagement of stakeholders. The approach was informed by previous experience, desk reviews, and expert consultations to ensure comprehensive engagement with stakeholders at multiple levels. Led by the Maternal Health Programme of the Government of Bangladesh, we involved high-power and high-interest stakeholders in developing a joint action plan for digitisation of the paper-based EmONC register. Finally, we demonstrated this digital EmONC register in real-life settings to stakeholders at different levels. Results The successful demonstration process fostered government ownership and collaboration with multiple stakeholders, while laying the foundation for scalability and sustainability. Nevertheless, our experience highlighted that the stakeholder engagement process is context-driven, time-consuming, resource-intensive, iterative, and dynamic, and it requires involving stakeholders with varied expertise. Effective strategic planning, facilitation, and the allocation of sufficient time and resources are essential components for successful stakeholder engagement. Conclusions Our experience demonstrates the potential of adopting the 'identification, sensitisation, involvement, and engagement' stakeholder engagement model. Success in implementing this model in diverse settings depends on leveraging knowledge gained during implementation, maintaining robust communication with stakeholders, and harnessing the patience and determination of the facilitating organisation.
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Affiliation(s)
- Sabrina Jabeen
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Mehedi Hasan
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Mahiur Rahman
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Tanvir Hossain AKM
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Farhana Dewan
- Obstetrical and Gynaecological Society of Bangladesh (OGSB), Dhaka, Bangladesh
| | - Azizul Alim
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Nuzhat Nadia
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Mustufa Mahmud
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Moazzem Hossain Sarker
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Jahurul Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Sabina Ashrafee
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Mohammad Sabbir Haider
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Md Al-Mahmud
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shafiqul Ameen
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shams El Arifeen
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- icddr,b (International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Jabeen S, Rahman M, Siddique AB, Hasan M, Matin R, Rahman QSU, AKM TH, Alim A, Nadia N, Mahmud M, Islam J, Islam MS, Haider MS, Dewan F, Begum F, Barua U, Anam MT, Islam A, Razzak KSB, Ameen S, Hossain AT, Nahar Q, Ahmed A, El Arifeen S, Rahman AE. Introducing a digital emergency obstetric and newborn care register for indoor obstetric patient management: An implementation research in selected public health care facilities of Bangladesh. J Glob Health 2024; 14:04075. [PMID: 38722093 PMCID: PMC11082830 DOI: 10.7189/jogh.14.04075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Digital health records have emerged as vital tools for improving health care delivery and patient data management. Acknowledging the gaps in data recording by a paper-based register, the emergency obstetric and newborn care (EmONC) register used in the labour ward was digitised. In this study, we aimed to assess the implementation outcome of the digital register in selected public health care facilities in Bangladesh. Methods Extensive collaboration with stakeholders facilitated the development of an android-based electronic register from the paper-based register in the labour rooms of the selected district and sub-district level public health facilities of Bangladesh. We conducted a study to assess the implementation outcome of introducing the digital EmONC register in the labour ward. Results The digital register demonstrated high usability with a score of 83.7 according to the system usability scale, and health care providers found it highly acceptable, with an average score exceeding 95% using the technology acceptance model. The adoption rate reached an impressive 98% (95% confidence interval (CI) = 98-99), and fidelity stood at 90% (95% CI = 88-91) in the digital register, encompassing more than 80% of data elements. Notably, fidelity increased significantly over the implementation period of six months. The digital system proved a high utility rate of 89% (95% CI = 88-91), and all outcome variables exceeded the predefined benchmark. Conclusions The implementation outcome assessment underscores the potential of the digital register to enhance maternal and newborn health care in Bangladesh. Its user-friendliness, improved data completeness, and high adoption rates indicate its capacity to streamline health care data management and improve the quality of care.
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Affiliation(s)
- Sabrina Jabeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahiur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Mehedi Hasan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rubaiya Matin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Azizul Alim
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Nuzhat Nadia
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Mustufa Mahmud
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Jahurul Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Mohammad Sabbir Haider
- Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Farhana Dewan
- Obstetrical and Gynaecological Society of Bangladesh, Dhaka, Bangladesh
| | - Ferdousi Begum
- Obstetrical and Gynaecological Society of Bangladesh, Dhaka, Bangladesh
| | - Uchchash Barua
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Abirul Islam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Shafiqul Ameen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Khan MN, Alam MB, Chowdhury AR, Kabir MA, Khan MMA. Availability and readiness of healthcare facilities and their effects on antenatal care services uptake in Bangladesh. BMC Health Serv Res 2024; 24:431. [PMID: 38575980 PMCID: PMC10996239 DOI: 10.1186/s12913-024-10824-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Sustainable Development Goal (SDG) 3.7 aims to ensure universal access to sexual and reproductive healthcare services, where antenatal care (ANC) is a core component. This study aimed to examine the influence of health facility availability and readiness on the uptake of four or more ANC visits in Bangladesh. METHODS The 2017/18 Bangladesh Demographic and Health Survey data were linked with the 2017 Health Facility Survey and analyzed in this study. The associations of health facility-level factors with the recommended number of ANC uptakes were determined. A multilevel mixed-effect logistic regression model was used to determine the association, adjusting for potential confounders. RESULTS Nearly 44% of mothers reported four or more ANC uptakes, with significant variations across several areas in Bangladesh. The average distance of mothers' homes from the nearest health facilities was 6.36 km, higher in Sylhet division (8.25 km) and lower in Dhaka division (4.45 km). The overall uptake of the recommended number of ANC visits was positively associated with higher scores for the management (adjusted odds ratio (aOR) 1.85; 95% CI, 1.16-2.82) and infrastructure (aOR, 1.59; 95% CI, 1.09-2.19) of health facilities closest to mothers' homes. The odds of using the recommended number of ANC in mothers increased by 3.02 (95% CI, 2.01-4.19) and 2.36 (95% CI, 2.09-3.16) folds for each unit increase in the availability and readiness scores to provide ANC services at the closest health facilities, respectively. Every kilometer increase in the average regional-level distance between mothers' homes and the nearest health facilities reduced the likelihood of receiving the recommended number of ANC visits by nearly 42% (aOR, 0.58, 95% CI, 0.42-0.74). CONCLUSION The availability of healthcare facilities close to residence, as well as their improved management, infrastructure, and readiness to provide ANC, plays a crucial role in increasing ANC services uptake. Policies and programs should prioritize increasing the availability, accessibility, and readiness of health facilities to provide ANC services.
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Affiliation(s)
- Md Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Namapara, Mymensingh, 2220, Bangladesh
- School of Medicine and Public Health, College of Health, Medicine and Well-Being, The University of Newcastle, NSW 2308, Callaghan, Australia
| | - Md Badsha Alam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Namapara, Mymensingh, 2220, Bangladesh
| | - Atika Rahman Chowdhury
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Namapara, Mymensingh, 2220, Bangladesh
| | - Md Awal Kabir
- Department of Social Work, Pabna University of Science and Technology, Pabna, 6600, Bangladesh
| | - Md Mostaured Ali Khan
- Maternal and Child Health Division (MCHD), icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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Afaya A, Nesa M, Akter J, Lee T. Institutional delivery rate and associated factors among women in rural communities: analysis of the 2017-2018 Bangladesh Demographic and Health Survey. BMJ Open 2024; 14:e079851. [PMID: 38531583 DOI: 10.1136/bmjopen-2023-079851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Institutional delivery rate among women in rural communities in Bangladesh remains low after several governmental interventions. A recent analysis of maternal mortality in Bangladesh revealed that women in rural communities were more likely to die from maternal complications than those in urban areas. OBJECTIVE This study assessed the institutional delivery rate and associated factors among women in rural communities in Bangladesh. DESIGN This was a cross-sectional study that used the 2017-2018 Bangladesh Demographic and Health Survey for analysis. To determine the factors associated with institutional delivery, multivariate logistic regression analysis was performed. SETTING AND PARTICIPANTS The study was conducted in Bangladesh and among 3245 women who delivered live births 3 years before the survey. MAIN OUTCOME MEASURE The outcome variable was the place of delivery which was dichotomised into institutional and home delivery/other non-professional places. RESULTS The institutional delivery rate was 44.82% (95% CI 42.02% to 47.65%). We found that women between the ages of 30 and 49 years (aOR=1.51, 95% CI 1.05 to 2.18), women whose partners attained higher education (aOR=2.02, 95% CI 1.39 to 2.94), women who had antenatal visits of 1-3 (aOR=2.54, 95% CI 1.65 to 3.90), 4-7 (aOR=4.79, 95% CI 3.04 to 7.53), and ≥8 (aOR=6.13, 95% CI 3.71 to 10.42), women who watched television (aOR=1.35, 95% CI 1.09 to 1.67) and women in the middle (aOR=1.38, 95% CI 1.05 to 1.82), rich (aOR=1.84, 95% CI 1.34 to 2.54) and richest (aOR=2.67, 95% CI 1.82 to 3.91) households were more likely to use institutional delivery. On the other hand, women who were working (aOR=0.73, 95% CI 0.60 to 0.89), women who were Muslims (aOR=0.62, 95% CI 0.44 to 0.89) and women who gave birth to two (aOR=0.61, 95% CI 0.48 to 0.77) or ≥3 children (aOR=0.46, 95% CI 0.35 to 0.60) were less likely to use institutional delivery. CONCLUSION The study revealed that a low proportion of women in rural communities in Bangladesh used institutional delivery. The results of this study should be taken into account by policy-makers and governmental efforts when creating interventions or programmes aimed at increasing institutional delivery in Bangladesh.
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Affiliation(s)
- Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Meherun Nesa
- College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
- National Institute of Advanced Nursing Education and Research, Mugda, Dhaka-1214, Bangladesh
| | - Jotsna Akter
- College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
- National Institute of Advanced Nursing Education and Research, Mugda, Dhaka-1214, Bangladesh
| | - Taewha Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, 03722, Seoul, South Korea
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Ahsan KZ, Angeles G, Curtis SL, Streatfield PK, Chakraborty N, Rahman M, Jamil K. Stagnation of maternal mortality decline in Bangladesh between 2010 and 2016 in spite of an increase in health services utilisation: Examining data from three large cross-sectional surveys. J Glob Health 2024; 14:04027. [PMID: 38273774 PMCID: PMC10811435 DOI: 10.7189/jogh.14.04027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Background After a 40% reduction in maternal mortality ratio (MMR) during 2001-2010 in Bangladesh, the MMR level stagnated between 2010 and 2016 despite a steady increase in maternal health services use and improvements in overall socioeconomic status. We revisited the factors that contributed to MMR decline during 2001-2010 and examined the changes in these factors between 2010 and 2016 to explain the MMR stagnation in Bangladesh. Methods We used data from the 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys, which sampled 566 115 households in total, to estimate the changes in the risk of dying of maternal causes associated with a pregnancy or birth between 2001-2010 and 2010-2016. We carried out Poisson regression analyses with random effects at the sub-district level to explore the relationship between the change in risk of maternal death from 2001 to 2016 and a range of demographic, socioeconomic, and health care factors. Results Between 2001 and 2016, the proportion of high-risk pregnancies decreased, except for teenage pregnancies. Meanwhile, there were notable improvements in socioeconomic status, access to health services, and the utilisation of maternal health services. A comparison of factors affecting the risk of maternal death between 2001-2010 and 2010-2016 indicated that first pregnancies continued to offer significant protection against maternal deaths. However, subsequent pregnancies among girls under 20 years became a significant risk factor during 2010-2016, increasing the risk of maternal deaths by nearly 3-fold. Among the key maternal health services, only skilled birth attendants (SBA) were identified as a key contributor to MMR reduction during 2001-2010. However, SBA is no longer significantly associated with reducing mortality risk during 2010-2016. Conclusions Despite continued improvements in the overall socioeconomic status and access to maternal health services in Bangladesh, the stagnation of MMR decline between 2010 and 2016 is associated with multiple teenage pregnancies and the lack of capacity in health facilities to provide quality delivery services, as SBA has been primarily driven by facility delivery. The findings provide a strong rationale for targeting at-risk mothers and strengthening reproductive health services, including family planning, to further reduce maternal mortality in Bangladesh.
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Affiliation(s)
- Karar Zunaid Ahsan
- Department of Public Health Leadership and Practice, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gustavo Angeles
- Data for Impact (D4I) and Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Siân L Curtis
- Data for Impact (D4I) and Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Peter Kim Streatfield
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nitai Chakraborty
- D4I, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mizanur Rahman
- D4I, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kanta Jamil
- Independent public health researcher, Melbourne, Australia
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Budu E, Ahinkorah BO, Okyere J, Seidu AA, Aboagye RG, Yaya S. High risk fertility behaviour and health facility delivery in West Africa. BMC Pregnancy Childbirth 2023; 23:842. [PMID: 38062455 PMCID: PMC10704621 DOI: 10.1186/s12884-023-06107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/03/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Evidence suggests that women who give birth in a health facility have lower odds of experiencing pregnancy complications and significantly reduced risk of death from pregnancy-related causes compared to women who deliver at home. Establishing the association between high-risk fertility behaviour (HRFB) and health facility delivery is imperative to inform intervention to help reduce maternal mortality. This study examined the association between HRFB and health facility delivery in West Africa. METHODS Data for the study were extracted from the most recent Demographic and Health Surveys of twelve countries in West Africa conducted from 2010 to 2020. A total of 69,479 women of reproductive age (15-49 years) were included in the study. Place of delivery was the outcome variable in this study. Three parameters were used as indicators of HRFB based on previous studies. These were age at first birth, short birth interval, and high parity. Multivariable binary logistic regression analysis was performed to examine the association between HRFB and place of delivery and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective 95% confidence interval (CI). RESULTS More than half (67.64%) of the women delivered in a health facility. Women who had their first birth after 34 years (aOR = 0.52; 95% CI = 0.46-0.59), those with short birth interval (aOR = 0.91; 95% CI = 0.87-0.96), and those with high parity (aOR = 0.58; 95% CI = 0.55-0.60) were less likely to deliver in a health compared to those whose age at first delivery was 18-34 years, those without short birth interval, and those with no history of high parity, respectively. The odds of health facility delivery was higher among women whose first birth occurred at an age less than 18 years compared to those whose age at first birth was 18-34 years (aOR = 1.17; 95% CI = 1.07-1.28). CONCLUSION HRFB significantly predicts women's likelihood of delivering in a health facility in West Africa. Older age at first birth, shorter birth interval, and high parity lowered women's likelihood of delivering in a health facility. To promote health facility delivery among women in West Africa, it is imperative for policies and interventions on health facility delivery to target at risk sub-populations (i.e., multiparous women, those with shorter birth intervals and women whose first birth occurs at older maternal age). Contraceptive use and awareness creation on the importance of birth spacing should be encouraged among women of reproductive age in West Africa.
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Affiliation(s)
- Eugene Budu
- Korle Bu Teaching Hospital, P.O. Box 77, Accra, Ghana
| | - Bright Opoku Ahinkorah
- REMS Consult Limited, Sekondi-Takoradi, Western Region, Ghana
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abdul-Aziz Seidu
- REMS Consult Limited, Sekondi-Takoradi, Western Region, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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Nahar Q, Alam A, Mahmud K, Sathi SS, Chakraborty N, Siddique AB, Rahman AE, Streatfield PK, Jamil K, El Arifeen S. Levels and trends in mortality and causes of death among women of reproductive age in Bangladesh: Findings from three national surveys. J Glob Health 2023; 13:07005. [PMID: 37616128 PMCID: PMC10449030 DOI: 10.7189/jogh.13.07005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Background Information on the mortality rate and proportional cause-specific mortality is essential for identifying diseases of public health importance, design programmes, and formulating policies, but such data on women of reproductive age in Bangladesh is limited. Methods We analysed secondary data from the 2001, 2010, and 2016 rounds of the nationally representative Bangladesh Maternal Mortality and Health Care Survey (BMMS) to estimate mortality rates and causes of death among women aged 15-49 years. We collected information on causes of death three years prior to each survey using a country-adapted version of the World Health Organization (WHO) verbal autopsy (VA) questionnaire. Trained physicians independently reviewed the VA questionnaire and assigned a cause of death using the International Classification of Diseases (ICD) codes. The analysis included mortality rates and proportional mortality showing overall and age-specific causes of death. Results The overall mortality rates for women aged 15-49 years decreased over time, from 190 per 100 000 years of observation in the 2001 BMMS, to 121 per 100 000 in the 2010 BMMS, to 116 per 100 000 in the 2016 BMMS. Age-specific mortality showed a similar downward pattern. The three diseases contributing the most to mortality were maternal causes (13-20%), circulatory system diseases (15-23%), and malignancy (14-24%). The relative position of these three diseases changed between the three surveys. From the 2001 BMMS to the 2010 BMMS and subsequently to the 2016 BMMS, the number of deaths from non-communicable diseases (e.g. cardiovascular diseases and malignancies) increased from 29% to 38% to 48%. Maternal causes led to the highest proportion of deaths among 20-34-year-olds in all three surveys (25-32%), while suicide was the number one cause of death for teenagers (19-22%). Circulatory system diseases and malignancy were the two leading causes of death for older women aged 35-49 years (40%-67%). Conclusions There was a gradual shift in the causes of death from communicable to non-communicable diseases among women of reproductive age in Bangladesh. Suicide as the primary cause of death among teenage girls demands urgent attention for prevention.
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Affiliation(s)
- Quamrun Nahar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anadil Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Nitai Chakraborty
- Data for Impact, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | | | - Kanta Jamil
- Independent Consultant, Melbourne, Australia
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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