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Care seeking for fatal illness episodes in neonates: a population-based study in rural Bangladesh
Hafizur R Chowdhury1, Sandra C Thompson, Mohammed Ali
1Matlab Health Research Centre, ICDDR,B, GPO Box 128, Dhaka 1000 Bangladesh. hafiz@icddrb.org
Insights
Many neonates in rural Bangladesh die without receiving proper medical care. Improving access to qualified healthcare and community awareness is crucial for neonatal survival.
Area of Science:
- Public Health
- Neonatal Health
- Demography
Background:
- Neonatal mortality remains a significant challenge in developing nations, contributing substantially to under-five mortality.
- A critical barrier to effective neonatal survival programs is the scarcity of population-level data.
- This study addresses this gap by examining caregiver consultation patterns during neonatal fatal illness episodes in rural Bangladesh.
Purpose of the Study:
- To investigate care-seeking behaviors of caregivers during neonatal fatal illness episodes.
- To identify patterns in healthcare provider consultation for neonatal deaths.
- To understand the role of qualified versus traditional/unqualified care in neonatal mortality.
Main Methods:
- Utilized a population-based demographic surveillance system to identify neonatal deaths.
- Employed structured questionnaires administered by trained project staff to mothers who experienced a neonatal death.
- Applied univariate, bivariate, and binary multivariate logistic regressions to analyze care-seeking patterns.
Main Results:
- 84% of 365 neonatal deaths occurred within the early neonatal period (0-7 days).
- Only 37% of caregivers initially sought care from qualified providers; 25% sought traditional/unqualified care, and 38% sought no care.
- A significant majority (63%) of deceased neonates received only traditional/unqualified care or no care during their fatal illness.
Conclusions:
- A high proportion of neonatal deaths involved traditional or no medical care, underscoring the need for enhanced community awareness regarding prompt medical attention.
- Improving access to effective healthcare services is essential for increasing neonatal survival rates.
- Consideration should be given to integrating traditional care providers into mainstream health programs to improve overall neonatal care delivery.
Background:
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. This study investigated the consultation patterns of caregivers during neonatal fatal illness episodes in the rural Matlab sub-district of eastern Bangladesh.
Methods:
Neonatal 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.
Results:
Of 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.
Conclusions:
The 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.
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