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

Akter, Shahinoor; Davies, Kate; Rich, Jane; Inder, Kerry

doi:10.1371/journal.pone.0237002

Cited by 27 publications

(50 citation statements)

References 44 publications

(78 reference statements)

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“…Other factors range from the scarcity of skilled providers, poor health-system infrastructure, substandard quality of care to women’s reluctance to use maternity care where high cost is involved [ 6 ]. Further, lack of transportation, distance from Maternal and Child Health (MCH) centers, unavailability of doctors at the MCH centers are considered to be major obstacles to reach health facilities in hilly areas [ 75 , 76 ].…”

Section: Discussionmentioning

confidence: 99%

Spatial inequalities in skilled birth attendance in India: a spatial-regional model approach

et al. 2022

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Background Despite a significant increase in the skilled birth assisted (SBA) deliveries in India, there are huge gaps in availing maternity care services across social gradients - particularly across states and regions. Therefore, this study applies the spatial-regression model to examine the spatial distribution of SBA across districts of India. Furthermore, the study tries to understand the spatially associated population characteristics that influence the low coverage of SBA across districts of India and its regions. Methods The study used national representative cross-sectional survey data obtained from the fourth round of National Family Health Survey, conducted in 2015-16. The effective sample size was 259,469 for the analysis. Moran’s I statistics and bivariate Local Indicator for Spatial Association maps were used to understand spatial dependence and clustering of deliveries conducted by SBA coverage in districts of India. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of deliveries conducted by SBA. Results Moran’s I value for SBA among women was 0.54, which represents a high spatial auto-correlation of deliveries conducted by SBA over 640 districts of India. There were 145 hotspots for deliveries conducted by SBA among women in India, which includes almost the entire southern part of India. The spatial error model revealed that with a 10% increase in exposure to mass media in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Interestingly, also with the 10% increase in the four or more antenatal care (ANC) in a particular district, the deliveries conducted by SBA increased significantly by 2.5%. Again, if there was a 10% increase of women with first birth order in a particular district, then the deliveries conducted by SBA significantly increased by 6.1%. If the district experienced an increase of 10% household as female-headed, then the deliveries conducted by SBA significantly increased by 1.4%. Conclusion The present study highlights the important role of ANC visits, mass media exposure, education, female household headship that augment the use of an SBA for delivery. Attention should be given in promoting regular ANC visits and strengthening women’s education.

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Section: Discussionmentioning

confidence: 99%

Spatial inequalities in skilled birth attendance in India: a spatial-regional model approach

et al. 2022

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“…Our study focused on the residents of hilly areas, where it was difficult for locals to access health services. Furthermore, since health services are relatively away from residence and transport costs within these hilly regions are comparatively high, it was difficult to access health services among indigenous people who mostly rely on agriculture, cattle farming, and day labour [ 47 , 54 ]. Considering all these factors, indigenous people might prefer to self-medicate unless the medical condition was serious [ 47 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with self-medication among the indigenous communities of Chittagong Hill Tracts, Bangladesh

et al. 2022

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Background In developing countries like Bangladesh, self-medication has become a predicament associated with health risks and clinical complications. To date, no studies have been conducted on the practice of self-medication among the indigenous population living in Chittagong Hill Tract (CHT). Objectives This study was aimed to determine the prevalence of self-medication and analyzing the factors associated with it among the indigenous population in CHT. Methods This cross-sectional study was conducted from late October to early December 2020; among different indigenous group populations residing in the three districts of CHT aged 18 or more. A pre-tested and semi-structured questionnaire was developed to collect data on socio-demographic characteristics, health status, frequency of self-medication, reasons for self-medication in last one year, as well as other variables. Multivariate logistic regression was performed to assess associated factors with self-medication. Results A total of 1350 people from different indigenous populations were interviewed, among whom 49.9% practiced self-medication. The rate of self-prescribed antibiotics usage (80.9%) was significantly higher compared to other drugs. Self-prescribed medications were mostly used for diarrhea and food poisoning (60.6%), cough, cold and fever (51.4%), and headache (51.4%). A common source of self-prescribed medicines was community or retail pharmacy and the most reported reason for self-prescribed medication was the long-distance of healthcare facilities from home. Conclusion The prevalence of self-medication is substantially high among indigenous people and the effect is alarming. Particular concern is the misuse of antibiotics and analgesic drugs. Increasing awareness among the population of the negative effect of self-medication and implementation of proper policies and actions are urgently needed to prevent self-medication among indigenous population in Bangladesh.

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“…Acceptability of services: long queues were a common occurrence in the facilities of both districts, with the problem reported more in Ngabwe. This highlights the imbalance between service provision and the number of women seeking maternal related services, which inevitably results in overcrowding and long waiting times in facilities [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Access barriers to maternal healthcare services in selected hard-to-reach areas of Zambia: a mixed methods design

et al. 2021

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Introduction poor access to maternal health services is a one of the major contributing factors to maternal deaths in low-resource settings, and understanding access barriers to maternal services is an important step for targeting interventions aimed at promoting institutional delivery and improving maternal health. This study explored access barriers to maternal and antenatal services in Kaputa and Ngabwe; two of Zambia´s rural and hard-to-reach districts. Methods a concurrent mixed methods approach was therefore, undertaken to exploring three access dimensions, namely availability, affordability and acceptability, in the two districts. Structured interviews were conducted among 190 eligible women in both districts, while key informant interviews, in-depth interviews and focus group discussions were conducted for the qualitative component. Results the study found that respondents were happy with facilities´ opening and closing times in both districts. By comparison, however, women in Ngabwe spent significantly more time traveling to facilities than those in Kaputa, with bad roads and transport challenges cited as factors affecting service use. The requirement to have a traditional birth attendant (TBA) accompany a woman when going to deliver from the facility, and paying these TBAs, was a notable access barrier. Generally, services seemed to be more acceptable in Kaputa than in Ngabwe, though both districts complained about long queues, being delivered by male health workers and having delivery rooms next to male wards. Conclusion based on the indicators of access used in this study, maternal health services seemed to be more accessible in Kaputa compared to Ngabwe.

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

Cited by 27 publications

References 44 publications

Spatial inequalities in skilled birth attendance in India: a spatial-regional model approach

Spatial inequalities in skilled birth attendance in India: a spatial-regional model approach

Risk factors associated with self-medication among the indigenous communities of Chittagong Hill Tracts, Bangladesh

Access barriers to maternal healthcare services in selected hard-to-reach areas of Zambia: a mixed methods design

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