Care seeking for fatal illness episodes in Neonates: a population-based study in rural Bangladesh

Sandra C Thompson,Mohammed Yunus,Nurul Alam,Peter K Streatfield,Mohammed Ali,Hafizur R Chowdhury

doi:10.1186/1471-2431-11-88

Abstract

BackgroundPoor neonatal health is a major contributor to under-five mortality in developing countries. A major constraint to effective neonatal survival programme has been the lack of population level data in developing countries. This study investigated the consultation patterns of caregivers during neonatal fatal illness episodes in the rural Matlab sub-district of eastern Bangladesh.MethodsNeonatal deaths were identified through a population-based demographic surveillance system in Matlab ICDDR,B maternal and child health (MCH) project area and an adjoining government service area. Trained project staff administered a structured questionnaire on care seeking to mothers at home who had experienced a neonatal death. Univariate, bivariate and binary multivariate logistic regressions were performed to describe care seeking during the fatal illness episode.ResultsOf the 365 deaths recorded during 2003 and 2004, 84% died in the early (0-7 days) neonatal period, with the remaining deaths occurring over the subsequent 8 to 28 days. The first resort of care by parents was a qualified doctor or paramedic in 37% of cases, followed by traditional and unqualified health care providers in 25%, while 38% sought no care. Thus, almost two thirds (63%) of neonates who died received only traditional and unqualified care or no care at all during their final illness episode. About 22% sought care from more than one provider, including 6% from 3 or more providers. Such plurality in care seeking was more likely among male infants, in the late neonatal period, and in the MCH project area.ConclusionsThe high proportion of neonatal deaths that had received traditional care or no medical care in a rural area of Bangladesh highlights the need to develop community awareness about prompt medical care seeking for neonatal illnesses and to improve access to effective health care. Integration of traditional care providers into mainstream health programs should also be considered.

Highlights

Poor neonatal health is a major contributor to under-five mortality in developing countries
In a cross-sectional survey in four rural sub districts of Bangladesh, 49% of the neonates were reported to have suffered from some kind of illnesses, for which homeopaths and unqualified village doctors comprised more than two thirds (68%) of the health provider care sought, with trained health care including government facilities sought in only 22% of such cases
The caesarian section rate was much higher in the ICDDR,B area compared to the government area (9.3% versus 1.6%)

Summary

Introduction

Poor neonatal health is a major contributor to under-five mortality in developing countries. A major constraint to effective neonatal survival programme has been the lack of population level data in developing countries. Understanding care seeking behaviour during serious illnesses is important in designing effective public health interventions for neonatal care. In this regard, information on care seeking during episodes of fatal illnesses would be helpful. The few published studies on care seeking for neonatal illnesses in Bangladesh, a densely populated country with a very high neonatal. These studies have revealed a number of common harmful behaviours/practices that have important implications for neonatal survival. Seeking care from a trained provider appeared to depend on factors such as male gender of the baby, higher birth order, father’s education and income, and antenatal care attendance by the mother [5]

Objectives

Methods

Results

Discussion

Conclusion