A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991–2004)

<p>Abstract</p> <p>Background</p> <p>Bangladesh is committed to the fifth Millennium Development Goal (MDG-5) target of reducing its maternal mortality ratio by three-quarters between 1990 and 2015. Since the early 1990s, Bangladesh has followed a strategy of improving access to facilities equipped and staffed to provide emergency obstetric care (EmOC).</p> <p>Methods</p> <p>We used data from four Demographic and Health Surveys conducted between 1993 and 2004 to examine trends in the proportions of live births preceded by antenatal consultation, attended by a health professional, and delivered by caesarean section, according to key socio-demographic characteristics.</p> <p>Results</p> <p>Utilization of antenatal care increased substantially, from 24% in 1991 to 60% in 2004. Despite a relatively greater increase in rural than urban areas, utilization remained much lower among the poorest rural women without formal education (18%) compared with the richest urban women with secondary or higher education (99%). Professional attendance at delivery increased by 50% (from 9% to 14%, more rapidly in rural than urban areas), and caesarean sections trebled (from 2% to 6%), but these indicators remained low even by developing country standards. Within these trends there were huge inequalities; 86% of live births among the richest urban women with secondary or higher education were attended by a health professional, and 35% were delivered by caesarean section, compared with 2% and 0.1% respectively of live births among the poorest rural women without formal education. The trend in professional attendance was entirely confounded by socioeconomic and demographic changes, but education of the woman and her husband remained important determinants of utilization of obstetric services.</p> <p>Conclusion</p> <p>Despite commendable progress in improving uptake of antenatal care, and in equipping health facilities to provide emergency obstetric care, the very low utilization of these facilities, especially by poor women, is a major impediment to meeting MDG-5 in Bangladesh.</p

Belgian senior medical students and disaster medicine: a real disaster?

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Duration and magnitude of mortality after pregnancy in rural Bangladesh

BACKGROUND: Women remain at increased risk of mortality for some time after pregnancy although the length of this period is unclear. The aim of this study is to examine mortality after pregnancy in rural Bangladesh using data from a unique demographic surveillance system. METHODS: We included all person-time in women aged 15-50 between 1983 and 2001 and compared mortality rates by time since pregnancy outcome (live birth, stillbirth, induced and spontaneous abortion) using Poisson regression, adjusting for socio-demographic factors. RESULTS: Mortality was highest on the first day after pregnancy (adjusted RR compared with third to fourth year post-partum 105.74, 95% CI: 76.08, 146.95) and remained elevated until 180 days (adjusted RR 1.55, 95% CI: 1.13, 2.11). Pregnancies ending in abortions and stillbirths accounted for 50% of deaths in women within 6 weeks of the end of pregnancy, and mortality after these outcomes was between two and four times as high as mortality after a livebirth. CONCLUSION: The high mortality rates immediately after birth provide strong support for a skilled attendance strategy. After abortions or stillbirths, women should be under surveillance for up to 1 week. Further work on the cause of deaths in the late post-partum period is required to understand the mechanisms behind increased mortality risks at these times

Are tertiary paediatricians prepared for disaster situations?

INTRODUCTION: Children, with their specific vulnerabilities and needs, make up to more than 20% of society, so they are at risk of getting involved in disasters. Are the specialists treating them for medical problems in daily life also capable to deal with them in disaster situations? HYPOTHESIS/PROBLEM: The goals of this study were to evaluate perceived knowledge and capability of tertiary pediatricians to deal with disasters, to identify promoting factors, and to evaluate education need and willingness to work. METHODS: A survey looking for demographics, hospital disaster planning, estimated risk and capability for disasters, training, and willingness to work, and a set of six content assessment questions to evaluate knowledge, were presented to emergency pediatricians and pediatric emergency physicians in specialized tertiary centers. RESULTS: The response rate was 51%. Thirty-five percent had disaster training and 53% felt that disaster education should be obligatory in their curriculum. Risk for disasters was estimated from 2.4/10 for nuclear incidents to 7.6/10 for major trauma. Self-estimated capability for these situations ranged from 1.8/10 in nuclear incidents to 7.6/10 in major trauma. Unconditional willingness to work ranged from 37% in nuclear situations to 68% in pandemics. Mean score on the questions was 2.06/6. Training, knowledge of antidote and personal protective equipment (PPE) use, self-estimated capability, and exposure were significant predictors for higher scores. Willingness to work correlated significantly with age, self-estimated capability, and risk estimation. In case of chemical and nuclear incidents, there was correlation with knowledge on the use of decontamination, PPE, and radio-detection devices. CONCLUSION: Despite a clear perception of the risks and a high willingness to work, preparedness is limited. The major conclusion is that basics of disaster management should be included in pediatric training.status: publishe