Mohammad Rifat Haider

Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh.

Background Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children’s Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Method Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Results Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Conclusions Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups. Maternal health programs, if properly designed and implemented, can improve access, partially overcoming the negative effects of socioeconomic disparities.

Systematic review and meta-analysis of global birth prevalence of clubfoot: a study protocol

Introduction Clubfoot is a common congenital birth defect, with an average prevalence of approximately 1 per 1000 live births, although this rate is reported to vary among different countries around the world. If it remains untreated, clubfoot causes permanent disability, limits educational and employment opportunities, and personal growth. The aim of this systematic review and meta-analysis is to estimate the global birth prevalence of congenital clubfoot. Methods and analysis Electronic databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Global Health, Latin American & Caribben Health Science Literature (LILACS), Maternity and Infant Care, Web of Science, Scopus and Google Scholar will be searched for observational studies based on predefined criteria and only in English language from inception of database in 1946 to 10 November 2017. A standard data extraction form will be used to extract relevant information from included studies. The Joanna Briggs Institute appraisal checklist will be used to assess the overall quality of studies reporting prevalence. All included studies will be assessed for risk of bias using a tool developed specifically for prevalence studies. Forest plots will be created to understand the overall random effects of pooled estimates with 95% CIs. An I2 test will be done for heterogeneity of the results (P>0.05), and to identify the source of heterogeneity across studies, subgroup or meta-regression will be used to assess the contribution of each variable to the overall heterogeneity. A funnel plot will be used to identify reporting bias, and sensitivity analysis will be used to assess the impact of methodological quality, study design, sample size and the impact of missing data. Ethics and dissemination This review will be conducted completely based on published data, so approval from an ethics committee or written consent will not be required. The results will be disseminated through a peer-reviewed publication and relevant conference presentations. PROSPERO registration number CRD42016041922.

Prevalence and determinants of hypertension among adult population in Nepal: Data from Nepal Demographic and Health Survey 2016

Like other developing countries, Nepal is currently going through epidemiological transition along with rising burden of Non-communicable Diseases. However, since 2013, no study investigated the prevalence and determinants of hypertension in Nepal involving nationally representative sample. Therefore, this study aimed to find out the current prevalence of hypertension in Nepal and its determinants using the latest nationally representative data obtained from Nepal Demographic and Health Survey (NDHS) 2016. The NDHS 2016 collected data on hypertension from 13,304 men and women aged 18 years and above from 5,520 urban and 5,970 rural households covering seven administrative provinces and three ecological zones. Participants were considered as hypertensive when their systolic blood pressure was ≥140 mmHg and/or diastolic blood pressure was ≥90 mmHg and/or they reported taking antihypertensive medication. A total of 19.9% study participants were diagnosed as hypertensive of which majority were male (male-24.3%, female-16.9%), ever married (ever married-21.7%, unmarried-6.1%) and residents of urban area (urban-20.9%, rural-18.3%). Hypertension prevalence has shown growing trend with the increase of age. This prevalence was also higher among rich and overweight/obese individuals. In multivariable logistic regression analysis, older age, male gender, better education, residence at urban area and province 4 and 5 and being overweight/obese were found positive association with having hypertension. When the determinants of hypertension were stratified by sex of the participants, difference was observed in case of age group, education and place of residence. As one out of every five individuals in Nepal are hypertensive, public health initiatives are immediately required for prevention and control of hypertension to reduce mortality and morbidity associated with this progressive disease.

Birth preparedness and complication readiness among women and couples and its association with skilled birth attendance in rural Bangladesh

Introduction Despite remarkable progress in maternal and neonatal health over past two decades, maternal and neonatal mortality in Bangladesh remain high, which is partially attributable to low use of skilled maternal and newborn health (MNH) services. Birth preparedness and complications readiness (BCPR) is recommended by the World Health Organization and by the Government of Bangladesh as a key intervention to increasing appropriate MNH services. This study aims to explore the status of BPCR in a hard-to-reach area of rural Bangladesh and to demonstrate how BPCR practices is associated with birth in the presence of a skilled birth attendant. Methods Data was collected using multistage cluster sampling-based household survey in two sub-districts of Netrokona, Bangladesh in 2014. Interviews were conducted among women with a recent birth history in 12-months and their husbands. Univariate, bivariate, and multivariable analysis using Stata 14.0 were performed from 317 couples. Results Mean age of respondents was 26.1 (SD ± 5.3) years. There was a significant difference in BPCR practice between women and couples for identification of the place of birth (84% vs. 75%), identification of a birth attendant (89% vs.72%), arranging transport for birth or emergencies (20% vs. 13%), and identification of a blood donor (15% vs. 8%). In multivariable analysis, odds of giving birth in presence of a skilled birth attendant consistently increased with higher completeness of preparedness (OR 3.3 for 3–5 BPCR components, OR 5.5 for 4–5 BPCR components, OR 10.4 for all 5 BPCR components). For different levels of completeness of BPCR practice, the adjusted odds ratios were higher for couple preparedness comparatively. Conclusions BPCR is associated with birth in the presence of a skilled attendant and this effect is magnified when planning is carried out by the couple. Interventions aiming to increase BPCR practices should not focus on women only, as involving the couple is most likely lead to positive care-seeking practices.

Determinants of caesarean section in Bangladesh: Cross-sectional analysis of Bangladesh Demographic and Health Survey 2014 Data

Background Caesarean section (CS) has been on the rise worldwide and Bangladesh is no exception. In Bangladesh, the CS rate, which includes both institutional and community-based deliveries, has increased from about 3% in 2000 to about 24% in 2014. This study examines the association of reported complications around delivery and socio-demographic, healthcare and spatial characteristics of mothers with CS, using data from the latest Bangladesh Demographic and Health Survey (BDHS). Methods The study is based on data from the 2014 BDHS. BDHS is a nationally representative survey which is conducted periodically and 2014 is the latest of the BDHS conducted. Data collected from 4,627 mothers who gave birth in health care institutions in three years preceding the survey were used in this study. Results Average age of the mothers was 24.6 years, while their average years of schooling were 3.2. Factors like mother being older, obese, residing in urban areas, first birth, maternal perception of large newborn size, husband being a professional, had higher number of antenatal care (ANC) visits, seeking ANC from private providers, and delivering in a private facility were statistically associated with higher rates of CS. Conclusions Bangladesh health system urgently needs policy guideline with monitoring of clinical indications of CS deliveries to avoid unnecessary CS. Strict adherence to this guideline, along with enhance knowledge on the unsafe nature of the unnecessary CS can achieve increased institutional normal delivery in future; otherwise, an emergency procedure may end up being a lucrative practice.

Ethnic predisposition of diabetes mellitus in the patients with previous history of gestational diabetes mellitus: a review

ABSTRACT Introduction: The worldwide prevalence of Gestational Diabetes Mellitus (GDM) is increasing day by day. However, there is a knowledge gap regarding the effect of ethnic and geographical distribution on the risk of developing Diabetes Mellitus (DM) in women with history of GDM. This review was conducted to find out the role of ethnic and geographical distribution on the risk of developing DM is women with GDM. Areas covered: In this review we conducted a comprehensive search of published studies through different electronic databases (PubMed, Google Scholar, CINAHL, CINAHL plus and EMBASE) published between 1990 and 2017. The studies which were published in English investigated the risk of development of DM in women with previous history of GDM, reported outcome according to ethnicity with specific criteria of reporting DM and GDM, reported development of diabetes after 6 month of delivery in women with GDM during pregnancy were included. Initially, 350 articles were identified, among which 16 articles were included in the final review. Expert commentary: Studies showed the increased risk of developing subsequent DM is associated with precedent GDM. Around 7-84% women developed diabetes after GDM in five years follow up, where some studies reported the risk continues to increase with increasing age. Risk of DM was found higher for some specific ethnicities, irrespective of the location of the study conducted. East Indian women showed the highest risk of postpartum DM after GDM and the crude prevalence remained almost similar in all form of study worldwide. Public health programme should focus more on women belonging to high-risk ethnicity of GDM for the prevention of postpartum DM.

A Cross-sectional study to explore the challenges faced by Myanmar women in accessing antenatal care services

Background : Myanmar has one of the highest maternal mortality rates in the Southeast Asian region, with most maternal deaths occuring at the time of delivery. The aim of this research was to identify the relationship between socio-demographic characteristics of Myanmar women and utilisation of antenatal care services. Methods : This is a descriptive cross-sectional study utilising the Myanmar Demographic and Health Survey Data 2015-16. A total of 13,454 women agedbetween 15-49 years were surveyed. This study sampled married women only (n=7870). Results : The mean age of the respondents was 35 years and the majority of respondents (50.7%) belonged to the 35-49 age group. Approximately 46.3% of respondents reported more than four antenatal care service (ANC) visits and almost 54% respondents attended ANC during their second and third trimesters. This study found that women with no education, poorer socioeconomic status, less access to mass media, living in rural areas and with more children were not utilising ANC services adequately. Conclusion : Strategies should be introduced to encourage pregnant women to attend a minimum of four antenatal check-ups and there should be adequate monitoring in place of the timing of ANC visits during pregnancy.