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Razzaque A, Rahman A, Chowdhury R, Mustafa AHMG, Naima S, Begum F, Shafique S, Sarker BK, Islam MZ, Kim M, Jahangir MA, Matin Z, Ferdous J, Vandenent M, Reidpath DD. Preterm birth and neonatal mortality in selected slums in and around Dhaka City of Bangladesh: A cohort study. PLoS One 2024; 19:e0284005. [PMID: 38241263 PMCID: PMC10798464 DOI: 10.1371/journal.pone.0284005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Although under-five mortality has declined appreciably in Bangladesh over the last few decades, neonatal mortality still remains high. The objective of the study is to assess the level and determinants of preterm birth and the contribution of preterm birth to neonatal mortality. METHODS Data for this study came from selected slums in and around Dhaka city, where; since 2015, icddr,b has been maintaining the Health and Demographic Surveillance System (HDSS). The HDSS data were collected by female Field Workers by visiting each household every three months; however, during the visit, data on the Last Menstrual Period (LMP) were also collected by asking each eligible woman to ascertain the date of conception. Gestational age was estimated in complete weeks by subtracting LMP from the date of the pregnancy outcome. In this study, 6,989 livebirths were recorded by HDSS during 2016-2018, and these births were followed for neonatal survival; both bivariate and multivariate analyses were performed. RESULTS Out of total births, 21.7% were born preterm (before 37 weeks of gestation), and sub-categories were: 2.19% for very preterm (28 to 31 weeks), 3.81% for moderate preterm (32 to 33 weeks), and 15.71% for late preterm (34 to 36 weeks). The study revealed that preterm babies contributed to 39.6% of neonatal deaths; however, the probability of death was very high on the 1st day of birth (0.124 for very preterm, 0.048 for moderate preterm, 0.024 for late preterm, and 0.013 for term birth), and continued until the 3rd day. In the regression analysis, compared to the term neonates, the odds of neonatal mortality were 8.66 (CI: 5.63, 13.32, p<0.01), 4.13 (CI: 2.69, 6.34, p<0.01) and 1.48 (CI: 1.05, 2.08, p<0.05) respectively for very, moderate, and late preterm birth categories. The population attributable fraction for neonatal mortality was 23%, and sub-categories were 14% for very preterm, 10% for moderate preterm, and 6% for late preterm. CONCLUSIONS Although urban slums are in proximity to many health facilities, a substantial proportion of preterm births contribute to neonatal deaths. So, pregnant women should be targeted, to ensure timely care during pregnancy, delivery, and post-partum periods to improve the survival of new-borns in general and preterm birth in particular.
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Affiliation(s)
- Abdur Razzaque
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anisur Rahman
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Razib Chowdhury
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A. H. M. Golam Mustafa
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shakera Naima
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Begum
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sohana Shafique
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Bidhan Krishna Sarker
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Minjoon Kim
- Maternal Newborn Health, UNICEF New York, New York, New York, United States of America
| | | | - Ziaul Matin
- Health Section, UNICEF India, New Delhi, India
| | | | | | - Daniel D. Reidpath
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Curry D, Islam MA, Sarker BK, Laterra A, Khandaker I. A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh. Hum Resour Health 2023; 21:7. [PMID: 36750825 PMCID: PMC9906919 DOI: 10.1186/s12960-022-00773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/18/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Expanding the health workforce to increase the availability of skilled birth attendants (SBAs) presents an opportunity to expand the power and well-being of frontline health workers. The role of the SBA holds enormous potential to transform the relationship between women, birthing caregivers, and the broader health care delivery system. This paper will present a novel approach to the community-based skilled birth attendant (SBA) role, the Skilled Health Entrepreneur (SHE) program implemented in rural Sylhet District, Bangladesh. CASE PRESENTATION The SHE model developed a public-private approach to developing and supporting a cadre of SBAs. The program focused on economic empowerment, skills building, and formal linkage to the health system for self-employed SBAs among women residents. The SHEs comprise a cadre of frontline health workers in remote, underserved areas with a stable strategy to earn adequate income and are likely to remain in practice in the area. The program design included capacity-building for the SHEs covering traditional techno-managerial training and supervision in programmatic skills and for developing their entrepreneurial skills, professional confidence, and individual decision-making. The program supported women from the community who were social peers of their clients and long-term residents of the community in becoming recognized, respected health workers linked to the public system and securing their livelihood while improving quality and access to maternal health services. This paper will describe the SHE program's design elements to enhance SHE empowerment in the context of discourse on social power and FLHWs. CONCLUSION The SHE model successfully established a private SBA cadre that improved birth outcomes and enhanced their social power and technical skills in challenging settings through the mainstream health system. Strengthening the agency, voice, and well-being of the SHEs has transformative potential. Designing SBA interventions that increase their power in their social context could expand their economic independence and reinforce positive gender and power norms in the community, addressing long-standing issues of poor remuneration, overburdened workloads, and poor retention. Witnessing the introduction of peer or near-peer women with well-respected, well-compensated roles among their neighbors can significantly expand the effectiveness of frontline health workers and offer a model for other women in their own lives.
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Affiliation(s)
- Dora Curry
- CARE (formerly for Curry, Islam, and Laterra; current for Khandaker), Atlanta, USA.
- University of Georgia, Athens, Georgia.
| | - Md Ahsanul Islam
- CARE (formerly for Curry, Islam, and Laterra; current for Khandaker), Atlanta, USA
| | - Bidhan Krishna Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (formerly CARE-Bangladesh), Dhaka, Bangladesh
| | - Anne Laterra
- CARE (formerly for Curry, Islam, and Laterra; current for Khandaker), Atlanta, USA
| | - Ikhtiar Khandaker
- CARE (formerly for Curry, Islam, and Laterra; current for Khandaker), Atlanta, USA
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Dutta GK, Sarker BK, Ahmed HU, Bhattacharyya DS, Rahman MM, Majumder R, Biswas TK. Mental healthcare-seeking behavior during the perinatal period among women in rural Bangladesh. BMC Health Serv Res 2022; 22:310. [PMID: 35255914 PMCID: PMC8900444 DOI: 10.1186/s12913-022-07678-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Mental health conditions are of rising concern due to their increased contribution to the global burden of disease. Mental health issues are inextricably linked with other socio-cultural and health dimensions, especially in the rural areas in developing countries. The complex relationship between mental health issues and socio-cultural settings may largely toll upon healthcare-seeking behavior. So, it urges to document the current status of mental healthcare-seeking behavior during the perinatal period among rural women in Bangladesh to develop a context-specific intervention in the future. METHODS This study was carried out in one sub-district in Bangladesh from April 2017 to June 2018. We conducted 21 In-depth Interviews (IDIs) and seven Focus Group Discussions (FGDs) with different groups of purposively selected participants. After collecting the recorded interview and making the verbatim transcription, the data were coded through Atlasti 5.7.a. Data were analyzed thematically to interpret the findings. RESULTS Two-thirds of the total respondents did not seek mental healthcare during the perinatal period at the community level. They also did not know about the mental health service provider or the facility to get set these services. Only one respondent out of twenty-one sought maternal mental healthcare from a gynecologist from a private hospital. Socio-cultural factors such as social stigma, traditional beliefs and practices, social and religious taboos, and social capital negatively influence healthcare-seeking behaviors. Besides, the community-level service providers were not found to be adequately trained and did not have proper guidelines regarding its management. CONCLUSION The findings provide evidence that there is an urgent need to increase the awareness for service users and formulate a guideline for the community-level service provider to manage maternal mental problems during the perinatal period of women in rural Bangladesh.
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Affiliation(s)
- Goutam Kumar Dutta
- icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | | | | | | | - Md Musfikur Rahman
- icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Ratna Majumder
- Maternal and Child Health Training Institute, 1205, Dhaka, Bangladesh
| | - Taposh Kumar Biswas
- icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Abstract
OBJECTIVE This paper explored the factors that influence the timely initiation of antenatal care (ANC) in Bangladesh. DESIGN This was a cross-sectional survey. SETTING This study conducted in two rural subdistricts and one urban area from three Northern districts of Bangladesh from August to November 2016. PARTICIPANTS Women who had a live birth in the last 1 year prior to data collection were enrolled for this study. In each study area, around 900 women were interviewed, and finally, we completed 2731 interviews. PRIMARY OUTCOME MEASURES The primary outcome was timely first ANC from a Medically Trained Provider (MTP). RESULTS About 43% of pregnancies were detected at their earliest time. The majority of participants (82%) received at least one ANC from an MTP. Only 11% received timely first ANC from an MTP as per the WHO FANC model. The women who detected pregnancy earlier were more likely (adj.OR 1.99, 95% CI 1.31 to 3.01) to receive the timely first ANC. The urban women were more likely (adj.OR 1.78, 95% CI 1.13 to 2.80) to receive the timely first ANC from an MTP than those of the rural women. Besides, their husbands' educational status (adj.OR 1.61, 95% CI 1.0 to 2.60) was significantly associated with the timely first ANC. CONCLUSION Apart from sociodemographic factors, early pregnancy detection was strongly associated with the timely first ANC visit. Timely initiation of ANC is an opportunity to adhere to all the WHO recommended timely ANC visits for a pregnant woman. The findings suggest maternal, neonatal, and child health programmes to focus on the early detection of pregnancy to ensure universal ANC coverage and its timeliness.
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Affiliation(s)
- Bidhan Krishna Sarker
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tawhidur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tanjina Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Musfikur Rahman
- Alive & Thrive Bangladesh Program, FHI 360, Dhaka, Bangladesh
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Rahman A, Friberg IK, Dolphyne A, Fjeldheim I, Khatun F, O'Donnell B, Pervin J, Rahman M, Rahman AMQ, Nu UT, Sarker BK, Venkateswaran M, Frøen JF. An Electronic Registry for Improving the Quality of Antenatal Care in Rural Bangladesh (eRegMat): Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e26918. [PMID: 34255723 PMCID: PMC8292932 DOI: 10.2196/26918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Digital health interventions (DHIs) can alleviate several barriers to achieving better maternal and child health. The World Health Organization's guideline recommendations for DHIs emphasize the need to integrate multiple DHIs for maximizing impact. The complex health system of Bangladesh provides a unique setting for evaluating and understanding the role of an electronic registry (eRegistry) for antenatal care, with multiple integrated DHIs for strengthening the health system as well as improving the quality and utilization of the public health care system. OBJECTIVE The aim of this study is to assess the effect of an eRegistry with DHIs compared with a simple digital data entry tool without DHIs in the community and frontline health facilities. METHODS The eRegMat is a cluster-randomized controlled trial conducted in the Matlab North and Matlab South subdistricts in the Chandpur district, Bangladesh, where health facilities are currently using the eRegistry for digital tracking of the health status of pregnant women longitudinally. The intervention arm received 3 superimposed data-driven DHIs: health worker clinical decision support, health worker feedback dashboards with action items, and targeted client communication to pregnant women. The primary outcomes are appropriate screening as well as management of hypertension during pregnancy and timely antenatal care attendance. The secondary outcomes include morbidity and mortality in the perinatal period as well as timely first antenatal care visit; successful referrals for anemia, diabetes, or hypertension during pregnancy; and facility delivery. RESULTS The eRegistry and DHIs were co-designed with end users between 2016 and 2018. The eRegistry was implemented in the study area in July 2018. Recruitment for the trial started in October 2018 and ended in June 2020, followed by an 8-month follow-up period to capture outcome data until February 2021. Trial results will be available for publication in June 2021. CONCLUSIONS This trial allows the simultaneous assessment of multiple integrated DHIs for strengthening the health system and aims to provide evidence for its implementation. The study design and outcomes are geared toward informing the living review process of the guidelines for implementing DHIs. TRIAL REGISTRATION ISRCTN Registry ISRCTN69491836; https://www.isrctn.com/ISRCTN69491836. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/26918.
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Affiliation(s)
- Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Ingrid K Friberg
- Tacoma-Pierce County Health Department, Tacoma, WA, United States
| | - Akuba Dolphyne
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingvild Fjeldheim
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Fatema Khatun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian O'Donnell
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Monjur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - A M Qaiyum Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - U Tin Nu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Bidhan Krishna Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mahima Venkateswaran
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
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Pervin J, Sarker BK, Nu UT, Khatun F, Rahman AMQ, Venkateswaran M, Rahman A, Frøen JF, Friberg IK. Developing targeted client communication messages to pregnant women in Bangladesh: a qualitative study. BMC Public Health 2021; 21:759. [PMID: 33879108 PMCID: PMC8056650 DOI: 10.1186/s12889-021-10811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Timely and appropriate evidence-based practices during antenatal care improve maternal and neonatal health. There is a lack of information on how pregnant women and families perceive antenatal care in Bangladesh. The aim of our study was to develop targeted client communication via text messages for increasing antenatal care utilization, as part of an implementation of an electronic registry for maternal and child health. Methods Using a phenomenological approach, we conducted this qualitative study from May to June 2017 in two sub-districts of Chandpur district, Bangladesh. We selected study participants by purposive sampling. A total of 24 in-depth interviews were conducted with pregnant women (n = 10), lactating women (n = 5), husbands (n = 5), and mothers-in-law (n = 4). The Health Belief Model (HBM) was used to guide the data collection. Thematic analysis was carried out manually according to the HBM constructs. We used behavior change techniques to inform the development of targeted client communication based on the thematic results. Results Almost no respondents mentioned antenatal care as a preventive form of care, and only perceived it as necessary if any complications developed during pregnancy. Knowledge of the content of antenatal care (ANC) and pregnancy complications was low. Women reported a variety of reasons for not attending ANC, including the lack of information on the timing of ANC; lack of decision-making power; long-distance to access care; being busy with household chores, and not being satisfied with the treatment by health care providers. Study participants recommended phone calls as their preferred communication strategy when asked to choose between the phone call and text message, but saw text messages as a feasible option. Based on the findings, we developed a library of 43 automatically customizable text messages to increase ANC utilization. Conclusions Pregnant women and family members had limited knowledge about antenatal care and pregnancy complications. Effective health information through text messages could increase awareness of antenatal care among the pregnant women in Bangladesh. This study presents an example of designing targeted client communication to increase antenatal care utilization within formal scientific frameworks, including a taxonomy of behavior change techniques. Trial registration ISRCTN69491836. Registered on December 06, 2018. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10811-y.
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Affiliation(s)
- Jesmin Pervin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. .,University of Bergen, Bergen, Norway.
| | - Bidhan Krishna Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - U Tin Nu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fatema Khatun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Norwegian Institute of Public Health, Oslo, Norway
| | - A M Quaiyum Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahima Venkateswaran
- University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - J Frederik Frøen
- University of Bergen, Bergen, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Ingrid K Friberg
- Norwegian Institute of Public Health, Oslo, Norway.,Tacoma-Pierce County Health Department, Tacoma, WA, USA
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Sarker BR, Ghosh S, Chowdhury S, Dutta A, Chandra Deb L, Krishna Sarker B, Sultana T, Mozaffor Hossain KM. Prevalence and antimicrobial susceptibility profiles of non-typhoidal Salmonella isolated from chickens in Rajshahi, Bangladesh. Vet Med Sci 2021; 7:820-830. [PMID: 33527778 PMCID: PMC8136930 DOI: 10.1002/vms3.440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 11/04/2020] [Accepted: 01/16/2021] [Indexed: 02/02/2023] Open
Abstract
Salmonellosis in poultry is an important disease that seriously impedes the development of the poultry industry. The increased resistance to antimicrobials against Salmonella has been a major public health concern worldwide. We conducted a study from January to June 2016 in and around the Rajshahi district of Bangladesh on the commercial chicken to isolate, identify and characterize poultry-specific Salmonella, to assess the potential risk factors and to determine the antimicrobial resistance pattern of the isolates. The overall prevalence of Salmonella enterica was 41% (49/120) [95% CI: 31.95%-50.17%] with 41.7% in broiler chicken (25/60) [95% CI: 29.06%-55.12%] and 40% in layer chicken (24/60, 40%) [95% CI: 27.56%-53.46%]. Samples collected from Rajshahi city (OR = 1.37, 95% CI: 0.50-3.73) and Puthia Upazila (OR = 1.51, 95% CI: 0.56-4.12) were more likely to be positive for Salmonella than Charghat Upazila. Salmonella detection was 1.3 times higher in chicken, providing loose feed than those provided ready feed. All the isolates fermented dextrose, maltose and mannitol with the production of acid and gas, but did not ferment sucrose and lactose. The isolates showed catalase, MR, citrate utilization test and TSI agar test positive, but indole and V-P tests negative. Salmonella isolates were sensitive to ciprofloxacin (90%), gentamycin (80%), amoxicillin (75%), streptomycin (70%), ampicillin (45%) and sulfamethoxazole-trimethoprim (45%), whereas highly resistant to penicillin (100%) and nalidixic acid (100%) followed by sulfamethoxazole-trimethoprim (55%), ampicillin (40%) and amoxicillin (25%). Salmonella enterica is endemic in commercial chicken production in Bangladesh with high prevalence. A considerable proportion of Salmonella isolates was found to be resistant to the majority of the common antimicrobial drugs. A good biosecurity system could be effective for the reduction of Salmonella. It is necessary to obtain universal commitments to establish prudent antibiotic use policies.
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Affiliation(s)
- Bindu R Sarker
- Department of Veterinary and Animal Sciences, Faculty of Agriculture, University of Rajshahi, Rajshahi, Bangladesh
| | - Sumon Ghosh
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sukanta Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Avijit Dutta
- Chittagong Veterinary and Animal Sciences University, Chittagong, Bangladesh
| | - Liton Chandra Deb
- Department of Public Health, North Dakota State University, Fargo, ND, USA
| | - Bidhan Krishna Sarker
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tania Sultana
- Department of Veterinary and Animal Sciences, Faculty of Agriculture, University of Rajshahi, Rajshahi, Bangladesh
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Sarker BK, Rahman M, Rahman T, Rahman T, Rahman F, Khalil JJ, Hasan M, Mahfuz SN, Ahmmed F, Miah MS, Ahmed A, Mitra D, Mridha MK, Rahman A. Factors associated with calendar literacy and last menstrual period (LMP) recall: a prospective programmatic implication to maternal health in Bangladesh. BMJ Open 2020; 10:e036994. [PMID: 33318107 PMCID: PMC7737077 DOI: 10.1136/bmjopen-2020-036994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the prevalence and determinants of calendar literacy and last menstrual period (LMP) recall among women in Bangladesh. DESIGN Cross-sectional survey. SETTINGS Two rural subdistricts and one urban area from three Northern districts of Bangladesh. PARTICIPANTS We interviewed 2731 women who had a live birth in the last 1 year. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome variable was LMP recall and the secondary outcome was calendar literacy. RESULTS The majority of participants (65%) correctly mentioned the current date according to the English calendar while 12% mentioned according to the Bengali calendar. During the interview sessions, we used three different calendars: Bengali, English and Hijri to assess calendar literacy. We asked women to mark the current date using the calendar on the day of the interview. Almost 61% women marked the English calendar, 16% marked the Bengali calendar and 4% marked the Hijri calendar correctly. Sixty-three per cent women were found as calendar literate who marked any of the calendars. Among the participants, 58% had calendars available at their home and only 10% of women used calendars to track their LMPs. Overall, 53% women were able to recall their recent LMP. Among the calendar literate, 60% could recall their LMPs. Factors found associated with recalling LMP were: completed eight or more years of schooling (adj.OR 1.39), primigravida (adj.OR 1.88), the richest wealth quintile (adj.OR 1.55) and calendar literacy (adj.OR 1.59). CONCLUSIONS Despite having reasonable calendar literacy and availability, the use of calendars for tracking LMP found very low. Calendar literacy and sociodemographic characteristics were found as the key factors associated with LMP recall. Maternal, neonatal and child health programmes in low-resource settings can promote a simple tool like calendar and target the communities where ultrasound is not available to ensure accurate LMP recall for early pregnancy registration and timely antenatal care coverage.
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Affiliation(s)
| | - Musfikur Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Tanjina Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Tawhidur Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Fariya Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Mehedi Hasan
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Sadia Nishat Mahfuz
- School of Health Sciences, Western Sydney University, Greater Western Sydney, New South Wales, Australia
| | - Faisal Ahmmed
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Muhammad Salim Miah
- Department of Anthropology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Dipak Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Malay Kanti Mridha
- Centre of Excellence for Non-Communicable Diseases and Nutrition, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Anisur Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
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Sarker BK, Rahman M, Rahman T, Rahman T, Khalil JJ, Hasan M, Rahman F, Ahmed A, Mitra DK, Mridha MK, Rahman A. Status of the WHO recommended timing and frequency of antenatal care visits in Northern Bangladesh. PLoS One 2020; 15:e0241185. [PMID: 33151964 PMCID: PMC7644040 DOI: 10.1371/journal.pone.0241185] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 10/10/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE There is dearth of information on the timeliness of antenatal care (ANC) uptake. This study aimed to determine the timely ANC uptake by a medically trained provider (MTP) as per the World Health Organization (WHO) recommendations and the country guideline. METHODS Cross-sectional survey was done with 2,731 women having livebirth outcome in last one year in Dinajpur, Nilphamari and Rajshahi districts, Bangladesh from August-November,2016. RESULTS About 82%(2,232) women received at least one ANC from a MTP. Overall, 78%(2,142) women received 4 or more ANCs by any provider and 43%(1168) from a MTP. Only 14%(378) women received their first ANC at the 1st trimester by a MTP. As per 4 schedule visits by the WHO FANC model and the country guideline 8%(203) and 20%(543) women respectively received the first 2 timely ANC by a MTP; where only 1%(32) and 3%(72) received the first 3 visits timely and 0.6%(17) and 1%(29) received all the four timely visits. Factors significantly associated with the first two timely visits are: 10 or above years of schooling of women [adj. OR 2.13 (CI: 1.05, 4.30)] and their husbands [adj. OR 2.40 (CI: 1.31, 4.38)], women's employment [adj. OR 2.32 (CI: 1.43, 3.76)], urban residential status [adj. OR 3.49 (CI: 2.46, 4.95)] and exposure to mass media [adj. OR 1.58 (CI: 1.07, 2.34)] at 95% confidence interval. According to the 2016 WHO ANC model, only 1.5%(40) women could comply with the first two ANC contacts timely by a MTP and no one could comply with all the timely 8 contacts. CONCLUSION Despite high coverage of ANC utilization, timely ANC visit is low as per both the WHO recommendations and the country guideline. For better understanding, further studies on the timeliness of ANC coverage are required to design feasible intervention for improving maternal and child health.
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Affiliation(s)
| | - Musfikur Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Tanjina Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Tawhidur Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Mehedi Hasan
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Fariya Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Anisuddin Ahmed
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Dipak Kumar Mitra
- Department of Public Health, North South University, Dhaka, Bangladesh
| | - Malay Kanti Mridha
- Professor and Director of Centre of Excellence for Non-Communicable Disease, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Anisur Rahman
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
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Samandari G, Sarker BK, Grant C, Huq NL, Talukder A, Mahfuz SN, Brent L, Nitu SNA, Aziz H, Gullo S. Understanding individual, family and community perspectives on delaying early birth among adolescent girls: findings from a formative evaluation in rural Bangladesh. BMC Womens Health 2020; 20:169. [PMID: 32778096 PMCID: PMC7419185 DOI: 10.1186/s12905-020-01044-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/03/2020] [Indexed: 11/16/2023]
Abstract
BACKGROUND Pregnancy among adolescent girls in Bangladesh is high, with 66% of women under the age of 18 reporting a first birth; this issue is particularly acute in the northern region of Bangladesh, an area that is especially impoverished and where girls are at heightened risk. Using formative research, CARE USA examined the underlying social, individual and structural factors influencing married girls' early first birth and participation in alternative opportunities (such as education or economic pursuits) in Bangladesh. METHODS In July of 2017, researchers conducted in-depth interviews of community members in two sub-districts of northern Bangladesh (Kurigram Sadar and Rajarhat). Participants (n = 127) included adolescent girls (both married and unmarredi), husbands of adolescent girls, influential adults in the girls' lives, community leaders, and health providers. All interviews were transcribed, coded and organized using Dedoose software. RESULTS Participants recognize the health benefits of delaying first birth, but stigma around infertility and contraceptive use, pressure from mothers-in-law and health provider bias interfere with a girl's ability to delay childbearing. Girls' social isolation, lack of mobility or autonomy, and inability to envision alternatives to early motherhood compound the issue; provider bias may also prevent access to methods. While participants agree that pursuit of education and economic opportunities are important, better futures for girls do not necessarily supersede their marital obligations of childrearing and domestic chores. CONCLUSIONS Findings indicate the need for a multi-level approach to delaying early birth and stimulating girls' participation in economic and educational pursuits. Interventions must mitigate barriers to reproductive health care; train adolescent girls on viable economic activities; and provide educational opportunities for girls. Effective programs should also address contextual issues by including immediate members of the girls' families, particularly the husband and mother-in-law.
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Affiliation(s)
- Ghazaleh Samandari
- Public Health Leadership Program, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | | | | | - Nafisa Lira Huq
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Aloka Talukder
- Health System and Population Science Division, icddr,b, Dhaka, Bangladesh
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Pramanik P, Nguyen P, Avula R, Billah SM, Ferdous T, Sarker BK, Ireen S, Mahmud Z, Ash D, Menon P. Using Novel Scenario-Based Assessments to Examine Feasibility of Integrating Preventive Nutrition Services Through the Primary Healthcare System in Bangladesh. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa043_116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Bangladesh's National Nutrition Services aims to deliver nutrition services to pregnant women and children through the primary health care system. Previous research highlighted gaps in coverage of preventive nutrition intervention delivery through this system but little is known about feasibility of reshaping service delivery to close the gaps. Prior to designing new approaches, we used a novel scenario-based feasibility testing approach to assess potential to strengthen service delivery.
Methods
We interviewed 32 service providers and 16 policymakers and conducted 4 focus group discussions with potential beneficiaries, asking respondents about the feasibility of four hypothetical scenarios for preventive service delivery: community-based events (CBE) for pregnant women; well-child services integrated into immunization contacts; CBE for well-children and well-child visits at facilities. Transcribed interviews were systematically coded, synthesized and interpreted using a pre-defined framework.
Results
Opinions on the need for new platforms for preventive services were mixed; some recommended new platforms, but others suggested strengthening existing delivery points. CBE for pregnant women were perceived as feasible, but workforce shortages emerged as a key challenge. Challenges such as equipment portability, upset children, and a fast-moving service environment suggested low feasibility of integrating nutrition into immunization contacts. In contrast, CBE and facility-based well-child visits emerged as feasible options, conditional on having the necessary workforce, structural readiness and budget support. On the demand side, enabling factors include using interpersonal communication and involving community leaders to increase awareness, organizing events at a convenient time and place for both providers and beneficiaries, and incentives for beneficiaries to encourage participation.
Conclusions
A scenario-based approach is an efficient method to assess potential feasibility options for nutrition service delivery. Introducing preventive nutrition services requires addressing current challenges in the health system, including human resource and logistic gaps, and investing in creating demand for preventive services.
Funding Sources
Bill & Melinda Gates Foundation, through A&T, managed by FHI 360.
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Affiliation(s)
| | | | - Rasmi Avula
- International Food Policy Research Institute
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12
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Hossain J, Laterra A, Paul RR, Islam A, Ahmmed F, Sarker BK. Filling the human resource gap through public-private partnership: Can private, community-based skilled birth attendants improve maternal health service utilization and health outcomes in a remote region of Bangladesh? PLoS One 2020; 15:e0226923. [PMID: 31951620 PMCID: PMC6968857 DOI: 10.1371/journal.pone.0226923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background In Sunamganj there are fewer than four skilled providers per 10,000 population and just 27% of births are assisted by a skilled attendant. We evaluate a private community skilled birth attendant (P-CSBA) model, developed through the GSK-CARE Frontline Health Worker Programme, designed to address this gap and report on changes in service utilization and health outcomes from baseline to three years post-baseline. Methods This analysis presents the results of a pre-post cross sectional design. A baseline survey (n = 1800) was conducted using a multistage cluster sampling approach. Three years post-baseline a second cross-sectional survey (n = 1755) was conducted across the same project area. To describe demographic characteristics of the study participants descriptive statistical techniques were used as appropriate. Logistic and multiple logistic regression, controlling for a comprehensive set of covariates, were used to assess odds ratios for key maternal health behaviors and outcomes. Results Birth planning and the use of key maternal health services improved from baseline to follow-up. There was a dramatic increase in the proportion of respondents reporting skilled attendance at birth (aOR: 2.18, p = .001). Women also reported significantly fewer complications during the prenatal (aOR: .30, p<.001), labor and delivery (aOR: 0.41, p<.0001) and postnatal periods (aOR: 0.32, p<.0001). Conclusion Private-sector approaches, when coupled with robust efforts to strengthen and collaborate with the public sector, can work successfully to deliver services in underserved communities. The success of this model lends credence to the growing appreciation that reaching our development targets will require governments to work in partnership with private sector actors and highlights the potential of private-public partnerships as we drive towards universal health coverage.
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Affiliation(s)
| | - Anne Laterra
- Sexual Reproductive Health and Rights Team, CARE USA, Atlanta, Georgia, United States of America
- * E-mail:
| | - Rina Rani Paul
- Health and Nutrition Team, CARE Bangladesh, Dhaka, Bangladesh
| | - Ahsanul Islam
- Health and Nutrition Team, CARE Bangladesh, Dhaka, Bangladesh
| | - Faisal Ahmmed
- International Centre for Diaarrhoeal Disease Research, Dhaka, Bangladesh
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Huda FA, Mahmood HR, Alam A, Ahmmed F, Karim F, Sarker BK, Al Haque N, Ahmed A. Provision of menstrual regulation with medication among pharmacies in three municipal districts of Bangladesh: a situation analysis. Contraception 2017; 97:144-151. [PMID: 29175274 DOI: 10.1016/j.contraception.2017.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective was to assess the provision of the combination of mifepristone-misoprostol for menstrual regulation (MR) in randomly selected urban pharmacies in Bangladesh. STUDY DESIGN We conducted a cross-sectional survey among 553 pharmacy workers followed by 548 mystery client visits to the same pharmacies in 3 municipal districts during July 2014-December 2015. RESULTS The survey found that 99% of pharmacy workers visited had knowledge of MR procedures but only two-thirds (67%) could state the legal time limit correctly; they mentioned misoprostol (86%) over mifepristone-misoprostol combination (78%) as a procedure of MR with medication (MRM); 36% reported knowing the recommended dosage of mifepristone-misoprostol combination; 70% reported providing information on effectiveness of the medicines; 50% reported recommending at least one follow-up visit to them; 63% reported explaining possible complications of using the medications; and 47% reported offering any post-MR contraception to their clients. In contrast, mystery client visits found that the mifepristone-misoprostol combination (69%) was suggested over misoprostol (51%) by the pharmacy workers; 54% provided the recommended dosage of mifepristone-misoprostol combination; 42% provided information on its effectiveness; 12% recommended at least one follow-up visit; 11% counseled on possible complications; and only 5% offered post-MR contraceptives to the mystery clients. CONCLUSIONS We found knowledge gaps regarding recommended dosage for MRM and inconsistent practice in informing women on effectiveness, follow-up visits, possible complications and provision of post-MR contraceptives among the pharmacy workers, particularly during the mystery client visits. IMPLICATIONS Pharmacy workers in Bangladesh need to be trained on legal time limits for MR services provision, on providing accurate information on disbursed medicine, and on proper referral mechanisms. A strong monitoring and regulatory system for pharmacy provision of MRM in pharmacies should be established.
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Affiliation(s)
- Fauzia Akhter Huda
- icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh.
| | | | - Anadil Alam
- icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Faisal Ahmmed
- icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Farzana Karim
- The George Washington University, Washington, DC, USA
| | | | - Nafis Al Haque
- icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Anisuddin Ahmed
- icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh
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Huda FA, Robertson Y, Chowdhuri S, Sarker BK, Reichenbach L, Somrongthong R. Contraceptive practices among married women of reproductive age in Bangladesh: a review of the evidence. Reprod Health 2017; 14:69. [PMID: 28587619 PMCID: PMC5461624 DOI: 10.1186/s12978-017-0333-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 05/24/2017] [Indexed: 11/12/2022] Open
Abstract
Background Bangladesh has experienced a sevenfold increase in its contraceptive prevalence rate (CPR) in less than forty years from 8% in 1975 to 62% in 2014. However, despite this progress, almost one-third of pregnancies are still unintended which may be attributed to unmet need for family planning and discontinuation and switching of methods after initiation of their use. Methods We conducted an extensive literature review on contraceptive use among married women of reproductive age (MWRA) in Bangladesh. A total of 263 articles were identified through database search and after final screening ten articles were included in this synthesis. Results Findings showed that method discontinuation and switching, method failure, and method mix may offset achievements in the CPR. Most of the women know of at least one contraceptive method. Oral pill is the most widely used (27%) method, followed by injectables (12.4%), condoms (6.4%), female sterilization (4.6%), male sterilization (1.2%), implants (1.7%), and IUDs (0.6%). There has been a decline in the use of long acting and permanent methods over the last two decades. Within 12 months of initiation, the rate of method discontinuation particularly the short-acting methods remain high at 36%. It is important to recognize the trends as married Bangladeshi women, on average, wanted 1.6 children, but the rate of actual children was 2.3. Conclusions A renewed commitment from government bodies and independent organizations is needed to implement and monitor family planning strategies in order to ensure the adherence to and provision of the most appropriate contraceptive method for couples.
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Affiliation(s)
- Fauzia Akhter Huda
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh.,College of Public Health Sciences, Chulalongkorn University, Room 1012, Floor 10, Institute Building 3, Bangkok, Thailand
| | - Yolande Robertson
- Melbourne Academic Centre for Health, University of Melbourne, Melbourne, Australia
| | - Sabiha Chowdhuri
- The Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Ratana Somrongthong
- College of Public Health Sciences, Chulalongkorn University, Room 1012, Floor 10, Institute Building 3, Bangkok, Thailand.
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Sarker BK, Rahman M, Rahman T, Hossain J, Reichenbach L, Mitra DK. Reasons for Preference of Home Delivery with Traditional Birth Attendants (TBAs) in Rural Bangladesh: A Qualitative Exploration. PLoS One 2016; 11:e0146161. [PMID: 26731276 PMCID: PMC4701391 DOI: 10.1371/journal.pone.0146161] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives Although Bangladesh has made significant progress in reducing maternal and child mortality in the last decade, childbirth assisted by skilled attendants has not increased as much as expected. An objective of the Bangladesh National Strategy for Maternal Health 2014–2024 is to reduce maternal mortality to 50/100,000 live births. It also aims to increase deliveries with skilled birth attendants to more than 80% which remains a great challenge, especially in rural areas. This study explores the underlying factors for the major reliance on home delivery with Traditional Birth Attendants (TBA) in rural areas of Bangladesh. Methods This was a qualitative cross-sectional study. Data were collected between December 2012 and February 2013 in Sunamganj district of Sylhet division and data collection methods included key informant interviews (KII) with stakeholders; formal and informal health service providers and health managers; and in-depth interviews (IDI) with community women to capture a range of information. Key questions were asked of all the study participants to explore the question of why women and their families prefer home delivery by TBA and to identify the factors associated with this practice in the local community. Results The study shows that home delivery by TBAs remain the first preference for pregnant women. Poverty is the most frequently cited reason for preferring home delivery with a TBA. Other major reasons include; traditional views, religious fallacy, poor road conditions, limited access of women to decision making in the family, lack of transportation to reach the nearest health facility. Apart from these, community people also prefer home delivery due to lack of knowledge and awareness about service delivery points, fear of increased chance of having a caesarean delivery at hospital, and lack of female doctors in the health care facilities. Conclusions The study findings provide us a better understanding of the reasons for preference for home delivery with TBA among this population. These identified factors can inform policy makers and program implementers to adopt socially and culturally appropriate interventions that can improve deliveries with skilled attendants and thus contribute to the reduction of maternal and neonatal mortality and morbidity in rural Bangladesh.
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Affiliation(s)
- Bidhan Krishna Sarker
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box-1000, Dhaka, Bangladesh
- * E-mail: ;
| | - Musfikur Rahman
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box-1000, Dhaka, Bangladesh
| | - Tawhidur Rahman
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box-1000, Dhaka, Bangladesh
| | - Jahangir Hossain
- Care Bangladesh, Pragati Insurance Bhabhan, 20–21 Kawran Bazar, Level 9–13, Dhaka, 1215, Bangladesh
| | - Laura Reichenbach
- Senior Associate and Deputy Director for Research, The Evidence Project, Population Council, Washington, District of Columbia, United States of America
- Former Director and Social Scientist, Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), GPO Box-1000, Dhaka, Bangladesh
| | - Dipak Kumar Mitra
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Sarker BK, Ahmed S, Islam N, Khan JA. Cost of behavior change communication channels of Manoshi -a maternal, neonatal and child health (MNCH) program in urban slums of Dhaka, Bangladesh. Cost Eff Resour Alloc 2013; 11:28. [PMID: 24228844 PMCID: PMC3831249 DOI: 10.1186/1478-7547-11-28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 11/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cost of behavior change communication (BCC) interventions has not been rigorously studied in Bangladesh. This study was conducted to assess the implementation costs of a BCC intervention in a maternal, neonatal and child health program (Manoshi) run by BRAC, which has been operating in the urban slums of Dhaka since 2007. The study estimates the costs of BCC tools per exposure among the different types of BCC channels: face-to-face, group counseling, and mass media. METHODS The study was conducted from November 2010 to April 2011 in the Dhaka urban slum area. A micro-costing approach was applied using primary and secondary data sources to estimate the cost of BCC tools. Primary data were collected through interviews with service-providers and managers from the Manoshi program, observations of group counseling, and mass media events. RESULTS Per exposure, the cost of face-to-face counseling was found to be 3.08 BDT during pregnancy detection, 3.11 BDT during pregnancy confirmation, 12.42 BDT during antenatal care, 18.96 BDT during delivery care and 22.65 BDT during post-natal care. The cost per exposure of group counseling was 22.71 BDT (95% CI 21.30-24.87) for Expected Date of Delivery (EDD) meetings, 14.25 BDT (95% CI 12.37-16.12) for Women Support Group meetings, 17.83 BDT (95% CI 14.90-20.77) for MNCH committee meetings and 6.62 BDT (95% CI 5.99-7.26) for spouse forum meetings. We found the cost per exposure for mass media interventions was 9.54 BDT (95% CI 7.30-12.53) for folk songs, 26.39 BDT (95% CI 23.26-32.56) for street dramas, 0.39 BDT for TV-broadcasting and 7.87 BDT for billboards. Considering all components reaching the target audience under each broader type of channel, the total cost per exposure was found to be 60.22 BDT (0.82 USD) for face-to-face counseling, 61.40 BDT (0.82 USD) for group counseling and 44.19 BDT (0.61 USD) for mass media. CONCLUSIONS The total cost for group counseling was the highest per exposure, followed by face-to-face counseling and mass media. The cost per exposure varied substantially across BCC channels due to differences in cost drivers such as personnel, materials and refreshments. The cost per exposure can be valuable for planning and resource allocation related to the implementation of BCC interventions in low resource settings.
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