Exploring spatial variations in level and predictors of unskilled birth attendant delivery in Bangladesh using spatial analysis techniques: Findings from nationally representative survey data

Abstract

Background Bangladesh has failed to meet the United Nations goal for reducing maternal mortality in the last decade. The high prevalence of unskilled birth attendant (UBA) delivery (47%) has resulted in negative consequences for the health of mothers and newborn babies in the country. Spatial variations in UBA delivery and its predictors are yet to be explored in Bangladesh, which could be very helpful in formulating cost-effective policies for reducing that. This study examines the spatial variations in UBA delivery and its predictors in Bangladesh. Methods This study analyzed the characteristics of 672 clusters extracted from the 2017/18 Bangladesh Demographic and Health Survey, and healthcare facility data from the 2017 Bangladesh Health Facility Survey. These data were analyzed using descriptive and spatial analyses (hot spot analysis, Ordinary Least Squares Regression, and Geographically Weighted Regression) techniques. Results Statistically significant hot spots of UBA delivery were concentrated in parts of the Mymensingh, Sylhet, Barishal, and Rangpur regions, while Khulna was the safest region. Predictive strengths of the statistically significant predictors of spatial variation in UBA delivery were observed to vary considerably across the regions. Poorest household wealth status and less than four antenatal care contacts emerged as strong predictors of UBA delivery in all the aforementioned hot spot-stricken regions, except Barisal. Additionally, primiparity and all secondary education or higher were strong predictors of lower UBA delivery rates in Mymensingh and Sylhet, while poorer household wealth status was also a strong predictor of UBA delivery in Sylhet. Multiparity was an additional strong predictor of UBA delivery in Rangpur. In Barisal, only poorer household wealth status exerted a strong positive influence on UBA delivery. Conclusions The remarkable spatial variations in UBA delivery and its predictors’ strengths indicate that geographically-targeted interventions could be a cost-effective method for reducing the UBA delivery prevalence in Bangladesh, thereby improve maternal and child health.

Spatial Distribution and Determinants of Unskilled Birth Attendance in Ethiopia: Spatial and Multilevel Analysis

“…Based on the 2016 EDHS data, the prevalence of unskilled birth attendants (UBA) in Ethiopia was 66.93% with 95% CI (66.39, 69.12). This study nding was higher than studies conducted in Chad 61.5% [14], in Bangladesh 47.1% [23] and in Sub-Sharan African 44% [13]. The possible reason for this spatial variation might be due to women's cultural attitudes and social beliefs differences across the countries.…”

Projections of maternal mortality ratios in Bangladesh

“…The reference forecast and Scenario 3 are scenarios that consider regional differences by administrative division. This is because several reports on Bangladesh have found that community and regional characteristics are associated with decisions regarding the place of birth and birth attendants [24,25]. Bangladesh has eight administrative divisions, and the education level of women, wealth of households, and utilisation of maternal and child health services, such as ANC visits and facility delivery rates, vary by division.…”