Background Early initiation of breastfeeding within one hour of birth (EIBF) and no prelacteal feeding are WHO recommended practices for improving maternal and newborn health outcomes. Globally, EIBF can avert around 22% of newborn death. In recent years, Bangladesh has experienced increasing facility delivery coverage and cesarean section rates. However, the impact of these changes on early breastfeeding initiation in hard to reach areas (HtR) of the country is still poorly understood. Therefore, this study aimed to examine the independent associations between childbirth locations and mode of delivery with favorable early breastfeeding practices in four hard to reach areas of Bangladesh. Method We extracted data from a cross-sectional study conducted in four HtR areas of Bangladesh in 2017. A total of 2768 women, having birth outcomes in the past 12 months of the survey, were interviewed using structured questionnaires. EIBF and no prelacteal feeding were considered as favorable early breastfeeding practices. The categories of childbirth locations were defined by the place of birth (home vs. facility) and the delivery sector (public/NGO vs. private). The mode of delivery was categorized into vaginal delivery and cesarean section. Generalized linear models were used to test the independent associations while adjusting for potential confounders. Results The prevalence of EIBF practices were 69.6%(95% CI:67.8–71.3); 72.2%(95% CI:67.8–71.3) among home births Vs 63.0%(95% CI:59.5%-66.4%) among facility births. Around 73.9% (95% CI:72.3–75.6) mother’s in the study areas reported no-prelacteal feeding. Compared to home births, women delivering in the facilities had lower adjusted odds of EIBF (aOR = 0.51; 95%CI:0.35–0.75). Cesarean section was found to be negatively associated with EIBF (aOR = 0.20; 95%CI:0.12–0.35), after adjusting for potential confounders. We could not find any significant associations between the place of birth and mode of delivery with no prelacteal feeding. Discussions This study found that facility births and cesarean deliveries were negatively associated with EIBF. Although the implementation of "Baby-Friendly Hospital Initiatives" could be a potential solution for improving EIBF and no prelacteal feeding practices, the challenges of reduced service availability and accessibility in HtR areas must be considered while devising effective intervention strategies. Future studies can explore potential interventions to promote early breastfeeding for facility births and cesarean deliveries in HtR areas.

BACKGROUND Background: A health care delivery through estimating disease burden and cause of death. An effective system of Civil Registration and Vital Statistics (CRVS) is fundamental to the rational operation of health care services. ‘Notification’ of occurrence of the vital events can be a step for designing a comprehensive CRVS system for countries. OBJECTIVE Objectives: Our primary objective was to asses-i) the proportion of events identified by the notification systems (success rate) and contribution of different notifiers individually and in combination/s (completeness),ii) the proportion of events notified within specific time limits (timeliness of notifications) and iii) feasibility of domiciliary workers to conduct verbal autopsies. METHODS Methods: We conducted a pilot study in 2016 in two sub-districts of Bangladesh to understand whether accurate, timely and complete information on births and deaths can be collected and notified by facility based service providers, community health workers, local government authorities and key informants from community. Our primary objective was to assess the proportion of events identified by the notification systems (success rate) and contribution of different notifiers individually and in combination. For each notifier we designed a mobile technology-based platform; an application and a call centre through which the notification was provided. All notifications were verified through confirmation of events by family members during a visit to the concerned household. A household survey-based assessment was undertaken at the end of the notification period. RESULTS Results: A total of 13,377 notifications for births and deaths were received from all channels. Verification success rate was 92% for birth and 93% for death and the unique event rates were 57% for birth and 53% for deaths. The household survey conducted among a sub sample of project population identified 1,204 births and 341 deaths. Over 87% of births and 65% of deaths were captured through the notification system. 77% of home and 66% of facility births were captured by Health Assistants (HAs) alone. Family Welfare Assistants (FWAs) were able to notify around 26% of home birth and 17% among the facility births. This was followed by Community Health Care Providers (CHCPs) covering 14% of home and 15% of facility births.52% of facility deaths and 42% of home deaths were captured by HAs. Almost 18% of home and 21% of facility deaths were captured by FWAs while these were 22% and 20% respectively by CHCPs. 88% of births and 86% of deaths were covered by HAs, FWAs and CHCPs combined. CONCLUSIONS Conclusion: The global investment plan for CRVS scaling up 2015 to 2024 and the World Health Organization (WHO) reiterated the importance building evidence base for improving CRVS. Our pilot innovation revealed that it is possible to tap into the routine health information system for notification on births and deaths as a first step to ensure registration. HAs could capture more than half of the notifications as a standalone source