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Care seeking for fatal neonatal illness episodes: a population-based
study in rural Bangladesh
Centre for International Health
Md.Hafizur Rahman Chowdhury
8th October 2007Conversation Series- Doctoral Forum
Centre for International Health
Supervisors
• Principal supervisor• Sandra Thompson
• Associate Supervisors• Kieran McCall• Kim Peter Steatfield
Centre for International Health
Background
• 40-50% of under-five deaths occur in the first four weeks (neonatal period)
• 98% of deaths occur in developing countries and most of these occur at home
• One in three child deaths occurs in South-East Asia
• Poor or delayed care seeking contributes to up to 70% of child deaths
• Community level information on cause of death and health care seeking during the fatal episode is often unavailable
Centre for International Health
Objectives
• To investigate the consultation patterns of care seeking during fatal illness in the rural Matlab sub-district of eastern Bangladesh
• To assess the differentials of consultation by– Sex of deceased– Time period at death – Service area
Centre for International Health
Methodology
• Study was approved by Ethics Committees both at ICDDR,B and Curtin University
• Neonatal deaths were identified through a population-based demographic surveillance system
• Trained staff administered a structured questionnaire on care seeking practice to mothers at home along with a verbal autopsy tool
• All data entered into Visual Fox-Pro
• Descriptive statistics used for analysis
• Stata software 9 version used for analysis
Bangladesh at a glance• 141 million people• Density: 900/km2• GNI: US$ 470
• IMR:65 /1,000 live births
• NMR:41 /1,000 LB
• MMR:320 /100,000 LB
• Home delivery: 90%
• Life exp: 62 years
220,000 population under regular demographic surveillance
• Vital registration
• Monthly home visit
• Identification number
• Two service areas
• ICDDR,B area-110,000 pop (MCH-FP services)
• Government area-110,000 pop (Government services)
• Quality assurance for data
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Matlab Study Site
Data collection
Verbal Autopsy questionnaire -structured -open-ended
Data management
Routine quality assuranceMedical assistant VA review
Data entry Centre for International Health
RESULTS
Centre for International Health
Timing of death, Matlab 2003-2004
136
57 56
30
8 6 6 8
2632
0
50
100
150
Fre
quen
cy
Less
than
1 d
ay1
day
2nd
day
3rd
day
4th
day
5th
day
6th
day
7th
day
8-14
day
s
15-2
8 da
ys
Age at death (day)
Neonatal deaths by age at death
Deaths=365
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37%
16%15% 9%8% 7%
Type of provider during consultation
Health care provider N(365)
Percent
No treatment 137 37.5
Medically qualified 37.2
MBBS 87 23.8
Health Centre 33 9.0
Paramedic 16 4.4
Traditional/unqualified 25.4
Quack/village doctor 29 8.0
Kabiraj/herbalist 29 8.0
Homeopath 21 5.8
Spiritual healer 11 3.0
Pharmacy (drug seller) 2 0.6
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Service area
ICDDR,B(173)
Government(192)
Health Care provider % %
No treatment 28.9 45.3
Medically qualified 54.9 21.4
Traditional/unqualified 16.2 33.3
Provider type by Service Area
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Provider Type by Sex of Neonate
Sex of newborn
Male(200)
Female(165)
Health care provider % %
No treatment 30.0 46.7
Medically qualified 45.0 27.8
Traditional/unqualified 25.0 25.5
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Provider Type by Time of Neonatal Death
Age at death (days)N=365
0-7 days(n=307)
8-28 days(n=58)
Health care provider % %
No treatment 41.7 15.5
Medically qualified 37.2 38.0
Traditional/unqualified 21.1 46.5
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Consultation by sex of the neonate
Sex of newborn N=365
Male(n=200)
Female(n=165)
No of Consultations % %
0 30.0 46.7
1 44.0 34.6
2 25.0 18.8
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Consultation by timing of death
Age at death (days)N=365
0-7 days(n=307)
8-28 days(n=58)
No of Consultations % %
0 41.7 15.5
1 41.0 36.2
2 17.3 48.3
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Consultation by service area
Service area N=365
ICDDR,B(n=173)
Government(n=192)
No of Consultations % %
0 28.9 45.3
1 48.0 33.3
2 23.1 21.4
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Conclusions• 84% died in the early (0-7days) neonatal period,
with 37% in first 24 hours
• Overall, 63% of the neonates received care either from traditional/unqualified provider or no care at all
• About 22% sought more than one consultation, including 6% received three or more.
• Multiple consultations for care, as well as consultations with a medically qualified provider, were more likely among male newborns, with late neonatal deaths, and in the ICDDR,B project area
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Recommendations• Increase community awareness about prompt
early care seeking
• Greater emphasis on gender equality and female education
• Skilled attendance at delivery and postnatal checkup for appropriate neonatal care
• Integrating traditional care providers into mainstream health programs may be an approach to reducing neonatal mortality in the study setting
Centre for International Health
International Postgraduate Research Scholarship (IPRS)
Curtin University Postgraduate Scholarship (CUPS)
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B)
Centre for International HealthCurtin University of Technology
Acknowledgements
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