Abstract
ObjectivesA community based approach before, during and after child birth has been proven effective address the burden of maternal, neonatal and child morbidity and mortality in the low and middle income countries. We aimed to examine the overall change in maternal and newborn health outcomes due the “Improved Maternal Newborn and Child Survival” (IMNCS) project, which was implemented by BRAC in rural communities of Bangladesh.MethodsThe intervention was implemented in four districts for duration of 5-years, while two districts served as comparison areas. The intervention was delivered by community health workers who were trained on essential maternal, neonatal and child health care services. A baseline survey was conducted in 2008 among 7, 200 women with pregnancy outcome in last year or having a currently alive child of 12–59 months. A follow-up survey was administered in 2012–13 among 4, 800 women of similar characteristics in the same villages.FindingsWe observed significant improvements in maternal and essential newborn care in intervention areas over time, especially in health care seeking behaviors. The proportion of births taking place at home declined in the intervention districts from 84.3% at baseline to 71.2% at end line (P<0.001). Proportion of deliveries with skilled attendant was higher in intervention districts (28%) compared to comparison districts (27.4%). The number of deliveries was almost doubled at public sector facility comparing with baseline (P<0.001). Significant improvement was also observed in healthy cord care practice, delayed bathing of the new-born and reduction of infant mortality in intervention districts compared to that of comparison districts.ConclusionsThis study demonstrates that community-based efforts offer encouraging evidence and value for combining maternal, neonatal and child health care package. This approach might be considered at larger scale in similar settings with limited resources.
Highlights
Bangladesh is the 8th populous country in the word [1]
This study demonstrates that community-based efforts offer encouraging evidence and value for combining maternal, neonatal and child health care package
This approach might be considered at larger scale in similar settings with limited resources
Summary
Bangladesh is the 8th populous country in the word [1]. The country has made significant progress in improving the health of its population, and has become one of the few countries to be on track to achieve the primary target of Millennium Development Goal (MDG) 5 by 2015 [2]. According to the first MDG progress report, the maternal mortality ratio (MMR) in 1990 was 574 per 100,000 live births in Bangladesh [3, 4]. The maternal mortality has declined to 322 in 2001 and 194 in 2010, a 40% decline in nine years as found in Bangladesh Maternal Mortality and Health Care Survey [5]. Health indicators currently reflect 33.1 infant deaths per 1,000 live births in Bangladesh [4]
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