Access to maternal healthcare services among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study

Abstract

ObjectivesThis study aimed to estimate the prevalence of, and factors associated with, accessing maternal healthcare services (MHC) by Indigenous women in the Chittagong Hill Tracts (CHT), Bangladesh.DesignThis was a cross-sectional survey among Indigenous women of reproductive age.SettingTwo upazillas (subdistricts) of Khagrachhari hill district of the CHT.ParticipantsIndigenous women (15–49 years) within 36 months of delivery were surveyed about accessing MHC services (antenatal care, delivery and postnatal care) for their last pregnancy and delivery.Primary outcome measuresThe primary outcome for this analysis is the prevalence of accessing any MHC service and secondary outcome is factors associated with access to MHC services for Indigenous women during their last pregnancy and childbirth.ResultsOf 438 Indigenous women (220 Chakma, 100 Marma, 118 Tripura) who participated, 75% were aged 16–30 years. With an 89% response rate, a total of 258 (59%) women reported accessing at least one MHC service (Chakma 51.6%, Marma 28%, Tripura 20.5%; p=<0.001). Independent factors associated with accessing MHC after adjusting for clustering were attending secondary school and above (OR 2.4; 95% CI 1.2 to 4.9); knowledge about nearest health facilities (OR 3.8, 95% CI 1.8 to 7.8) and knowledge of pregnancy-related complications (OR 3.0, 95% CI 1.5 to 5.8).ConclusionFindings suggest that the prevalence of accessing MHC services is lower among Indigenous women in the CHT compared with national average. MHC access may be improved through better education and awareness raising of local services.

Barriers to accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh: A qualitative descriptive study of Indigenous women’s experiences

“…Unlike previous literature, this study found neither travel time nor distance were major barriers to accessing MHC services [52]. This could be because Indigenous women had limited knowledge about existing facility services within their communities and therefore, had not considered the distance [29].…”

“…This was a qualitative study involving in-depth interviews with Indigenous women within 36 months of delivery in Khagrachhari district, Bangladesh. This study was conducted as a part of a mixed-method study [29].…”

“…Indigenous women lack knowledge regarding MHC services [27]. National estimates for accessing antenatal, facility delivery and postnatal care services are 78%, 37% and 36% respectively [28] compared to 53%, 33% and 10% respectively for Indigenous women in the CHT [29]. Only 6.4% of Indigenous women accessed all three MHC services (antenatal, facility delivery and postnatal care) for their last pregnancy [29], significantly lower than the national average of 43% [4].…”

“…The study was undertaken between September 2017 and February 2018 in the Khagrachhari district, CHT, Bangladesh. A detailed description of the larger study has previously been reported [29]. The Khagrachhari district is hilly with a significant proportion of forested land [41].…”

Wide range of G6PD activities found among ethnic groups of the Chittagong Hill Tracts, Bangladesh

“…Anecdotal reports from the CHT estimate the G6PDd prevalence between 20% and 40% (Khan, personal communication), however in hospital based surveys in the same region only 0.6% to 1.4% of patients were G6PDd [25,26]. The significant differences in these estimates may reflect study populations with different ethnic backgrounds, and associated differences in G6PD genetic profiles, or an underlying difference in G6PD activity in patients with and without malaria [15,27]. Understanding whether the prevalence of G6PDd differs significantly between different ethnicities living in the same area is essential in informing decision-makers on whether and how to introduce routine testing for G6PDd into national malaria treatment guidelines.…”