Abstract
BackgroundBRAC is implementing a program to improve maternal and newborn health among the urban poor in the slums of Bangladesh (Mansohi), funded by the Bill & Melinda Gates Foundation. Formative research has demonstrated that unqualified allopathic practitioners (UAPs) are commonly assisting home-delivery. The objective of this study was to explore the role of unqualified allopathic practitioners during home delivery in urban slums of Dhaka.MethodsThis cross-sectional study was conducted between September 2008 and June 2009 in Kamrangirchar slum in Dhaka, Bangladesh, using both qualitative and quantitative research methods. Through a door-to-door household survey, quantitative data were collected from 463 women with a home birth and/or trial of labor at home. We also conducted seven in-depth interviews with the UAPs to explore their practices.ResultsAbout one-third (32%) of the 463 women interviewed sought delivery care from a UAP. We did not find an association between socio-demographic characteristics and care-seeking from a UAP, except for education of women. Compared to women with three or more pregnancies, the highest odds ratio was found in the primi-gravidity group [odds ratio (OR): 3.46; 95% confidence interval (CI): 1.65-7.25)], followed by women with two pregnancies (OR: 2.54; 95% CI: 1.36-4.77) to use a UAP. Of women who reported at least one delivery-related complication, 45.2% received care from the UAPs. Of 149 cases where the UAP was involved with delivery care, 133 (89.3%) received medicine to start or increase labor with only 6% (9 of 149) referred by a UAP to any health facility. The qualitative findings showed that UAPs provided a variety of medicines to manage excessive bleeding immediately after childbirth.ConclusionThere is demand among slum women for delivery-related care from UAPs during home births in Bangladesh. Some UAPs' practices are contrary to current World Health Organization recommendations and could be harmful. Programs need to develop interventions to address these practices to improve perinatal care outcomes.
Highlights
Another study in the urban slums of Bangladesh demonstrated that families preferred seeking care from unqualified allopathic practitioners for perceived postpartum complications compared to other sources [18]
The objective of this paper is to explore care-seeking from unqualified allopathic practitioners (UAPs) during labor and delivery and delivery care practices in urban slums in Dhaka, Bangladesh
We did not find an association between socio-demographic characteristics and health care-seeking from a UAP during delivery, except for education of women
Summary
There is a serious shortage of human resources to provide healthcare services in the South Asian region This shortage is exacerbated by an inequitable distribution of providers by geographic area (rural versus urban), skillmix (nurses/midwives versus specialists), level of health diarrhea, malaria, acute respiratory infection, Integrated Management of Childhood Illness, AIDS, tuberculosis, and safe motherhood. Another study in the urban slums of Bangladesh demonstrated that families preferred seeking care from unqualified allopathic practitioners for perceived postpartum complications compared to other sources [18]. One study found that UAPs incorrectly managed postpartum bleeding with ergometrine They play an important role in referring women to health facilities, even when traditional birth attendants (TBAs) prefer to manage the complications at home [12,20]
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