No abstract

Bangladesh needs to increase the availability of EmOC services through innovative public-private partnerships. In the public sector, additional trained manpower supported by an incentivized package should be deployed.

BackgroundBangladesh achieved Millennium Development Goal 4, a two thirds reduction in under–five mortality from 1990 to 2015. However neonatal mortality remains high, and neonatal deaths now account for 62% of under–five deaths in Bangladesh. The objective of this paper is to understand which newborns in Bangladesh are receiving postnatal care (PNC), a set of interventions with the potential to reduce neonatal mortality.MethodsUsing data from the Bangladesh Maternal Mortality Survey (BMMS) 2010 we conducted logistic regression analysis to understand what socio–economic and health–related factors were associated with early postnatal care (PNC) by day 2 and PNC by day 7. Key variables studied were maternal complications (during pregnancy, delivery or after delivery) and contact with the health care system (receipt of any antenatal care, place of delivery and type of delivery attendant). Using data from the BMMS 2010 and an Emergency Obstetric and Neonatal Care (EmONC) 2012 needs assessment, we also presented descriptive maps of PNC coverage overlaid with neonatal mortality rates.ResultsThere were several significant findings from the regression analysis. Newborns of mothers having a skilled delivery were significantly more likely to receive PNC (Day 7: OR = 2.16, 95% confidence interval (CI) 1.81, 2.58; Day 2: OR = 2.11, 95% 95% CI 1.76). Newborns of mothers who reported a complication were also significantly more likely to receive PNC with odds ratios varying between 1.3 and 1.6 for complications at the different points along the continuum of care. Urban residence and greater wealth were also significantly associated with PNC. The maps provided visual images of wide variation in PNC coverage and indicated that districts with the highest PNC coverage, did not necessarily have the lowest neonatal mortality rates.ConclusionNewborns of mothers who had a skilled delivery or who experienced a complication were more likely to receive PNC than newborns of mothers with a home delivery or who did not report a complication. Given that the majority of women in Bangladesh have a home delivery, strategies are needed to reach their newborns with PNC. Greater focus is also needed to reach poor women in rural areas. Engaging community health workers to conduct home PNC visits may be an interim strategy as Bangladesh strives to increase skilled delivery coverage.

BackgroundSignal functions for emergency obstetric and newborn care (EmONC) are the major interventions for averting maternal and neonatal mortalities. Readiness of the facilities is essential to provide all the basic and comprehensive signal functions for EmONC to ensure emergency services from the designated facilities. The study assessed population coverage and availability of EmONC services in public and private facilities in Bangladesh.MethodsAn assessment was conducted in all the public and private facilities providing obstetric care in to in-patients 24 districts. Data were collected on the performance of signal functions for EmONC from the study facilities in the last three months prior to the date of assessment. Trained data-collectors interviewed the facility managers and key service providers, along with review of records, using contextualized tools. Population coverage of signal functions was assessed by estimating the number of facilities providing the signal functions for EmONC compared to the United Nations requirements. Availability was assessed in terms of the proportion of facilities providing the services by type of facilities and by district.ResultsCaesarean section (CS) delivery and blood transfusion (BT) services (the two major components of comprehensive EmONC) were respectively available in 6.4 (0.9 public and 5.5 private) and 5.6 (1.3 public and 4.3 private) facilities per 500,000 population. The signal functions for basic EmONC, except two (parental anticonvulsants and assisted vaginal delivery), were available in a minimum of 5 facilities (public and private sectors combined) per 500,000 population. A major inter-district variation in the availability of signal functions was observed in each public- and private-sector facility. Among the various types of facilities, only the public medical college hospitals had all the signal functions. The situation was poor in other public facilities at the district and sub-district levels as well as in private facilities.ConclusionsIn the public sector, CS delivery and BT services were available in the minimum required number of facilities. However, to ensure basic EmONC services, participation of the private sector is necessary. Public-private partnership should be promoted for nationwide coverage of signal functions for EmONC in Bangladesh.

Assessing only the number of EmONC facilities does not ensure universal coverage; accessibility should be assessed when planning health systems.