Abstract
BackgroundDelivery by skilled birth attendants (SBAs) is strongly recommended to reduce maternal and neonatal mortality. The percentage of births attended by SBAs is low in Bangladesh (42% in 2014), though this rate varies widely by divisions, with the highest 58% in Khulna and only 27% in Sylhet. Comparing and critically analyzing the practices, distributions and determinants of delivery attendance in two divisions with the highest and lowest SBA attendance could help to understand the differences and to employ the findings of the high-performing division to the low-performing division.MethodsThe 7th Bangladesh Demographic and Health Survey (BDHS 2014) data were analyzed. After reporting the types of delivery attendants, logistic regression analyses were applied to calculate the odds ratios of determinants of deliveries attended by SBAs.ResultsSBAs attended 225 (58.6%) and 128 (27.4%) deliveries in Khulna and Sylhet, respectively. Khulna had higher birth attendance by qualified doctors (42.5%, n = 163) than Sylhet (15.8%, n = 74). Sylhet had higher attendance by traditional attendants (60.8%, n = 285) than Khulna (33.7%, n = 129). In both regions, attendance by community skilled birth attendants (CSBAs) was very low (< 1%). Khulna had higher percentages of women with higher education level, husbands’ higher education, antenatal care (ANC) visits by SBAs, and higher wealth quintiles than Sylhet.In multivariable analyses, higher education level (adjusted odds ratio (AOR): 8.4; 95% confidence interval (CI): 1.9–36.7), ANC visits (AOR: 3.6; 95% CI: 2.0–6.5), family planning workers’ visit (AOR: 3.0; 95% CI: 1.6–5.4), and belonging to richer (AOR: 2.6; 95% CI: 1.4–5.1) or richest (AOR: 3.8; 95% CI: 1.9–7.6) household wealth quintiles had significant positive associations with deliveries by SBAs in Sylhet. Similarly, ANC visits (AOR: 2.5; 95% CI: 1.4–4.6) and higher wealth quintile (AOR: 4.7; 95% CI: 1.9–11.5) were positive predictors in Khulna.ConclusionsThe higher proportion of educated women and their husbands, wealth status and ANC visits were associated with higher SBA utilization in Khulna compared to Sylhet. Improvement of socioeconomic status, increasing birth attendant awareness programs, providing ANC services, and family-planning workers’ visits could increase the proportion of SBA-attended deliveries in Sylhet Division. CSBA program should be re-evaluated for both divisions.
Highlights
Delivery by skilled birth attendants (SBAs) is strongly recommended to reduce maternal and neonatal mortality
We found that Khulna had higher birth attendance by qualified doctors than Sylhet, and low community skilled birth attendant (CSBA) usage in both divisions
Only antenatal care by skilled providers and higher wealth quintile were significantly associated with SBA delivery in Khulna
Summary
Delivery by skilled birth attendants (SBAs) is strongly recommended to reduce maternal and neonatal mortality. From 1990 to 2015, Bangladesh experienced a substantial reduction in maternal and neonatal mortality In this period, the estimated maternal mortality ratio (MMR) declined from 550 to 176 per 100,000 live births (LB) [1], and the neonatal mortality rate (NMR) decreased from 63 to 23 per 1000 LB [2]. The United Nations’ (UN) Millennium Development Goals (MDGs) targeted to reduce the MMR by three-fourths and child mortality by two-thirds within the year 2015 compared to their 1990 levels. In 2015, the healthrelated goal (Goal 3) of the UN’s Sustainable Development Goals (SDGs) set targets to reduce MMR and NMR to less than 70 per 100,000 LB and 12 per 1000 LB, respectively, by the year 2030 [3]. From 1990 to 2015, the estimated annual rate of reduction (ARR) of MMR and NMR were 4.5% and 3.9%, respectively in Bangladesh [1, 2]; these ARRs need to be increased to 6.0% and 4.5%, respectively to achieve the targets of SDGs
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