Transcript Centre for International Health

Care seeking for fatal neonatal
illness episodes: a population-based
study in rural Bangladesh
Md.Hafizur Rahman Chowdhury
8th October 2007
Conversation Series- Doctoral Forum
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Supervisors
• Principal supervisor
• Sandra Thompson
• Associate Supervisors
• Kieran McCall
• Kim Peter Steatfield
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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
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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
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Methodology
• Study was approved by Ethics Committees both at
ICDDR,B and Curtin University
• Neonatal deaths were identified through a populationbased 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
Matlab Study Site
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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Data collection
Verbal Autopsy questionnaire
-structured
-open-ended
Data management
Routine quality assurance
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Medical assistant VA review
Data entry
RESULTS
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Timing of death, Matlab 2003-2004
150
136
Frequency
37%
100
57
50
56
16%
15%
0
s
s
Le
an
th
1
y
da
1
y
da
d
2n
y
da
d
3r
30
8%
y
da
32
26
h
4t
8
y
da
6
h
5t
y
da
8
6
h
6t
y
da
h
7t
7%
y
da
1
8-
4
ys
da
15
28
9%
y
da
s
Age at death (day)
Deaths=365
Neonatal deaths by age at death
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Type of provider during consultation
Health care provider
No treatment
Medically qualified
N
(365)
Percent
137
37.5
37.2
MBBS
87
23.8
Health Centre
33
9.0
Paramedic
16
4.4
25.4
Traditional/unqualified
Quack/village doctor
29
8.0
Kabiraj/herbalist
29
8.0
Homeopath
21
5.8
Spiritual healer
11
3.0
2
0.6
Pharmacy (drug seller)
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Provider type by Service Area
Service area
ICDDR,B
(173)
Government
(192)
%
%
No treatment
28.9
45.3
Medically qualified
54.9
21.4
Traditional/unqualified
16.2
33.3
Health Care provider
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Provider Type by Sex of Neonate
Sex of newborn
Male
(200)
Female
(165)
%
%
No treatment
30.0
46.7
Medically qualified
45.0
27.8
Traditional/unqualified
25.0
25.5
Health care provider
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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)
%
%
No treatment
41.7
15.5
Medically qualified
37.2
38.0
Traditional/unqualified
21.1
46.5
Health care provider
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Consultation by sex of the neonate
Sex of newborn
N=365
No of Consultations
0
1
2
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Male
(n=200)
Female
(n=165)
%
%
30.0
44.0
25.0
46.7
34.6
18.8
Consultation by timing of death
Age at death (days)
N=365
0-7 days
(n=307)
8-28 days
(n=58)
%
%
0
41.7
15.5
1
41.0
36.2
2
17.3
48.3
No of Consultations
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Consultation by service area
Service area
N=365
ICDDR,B
Government
(n=173)
(n=192)
No of Consultations
0
1
2
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%
%
28.9
48.0
23.1
45.3
33.3
21.4
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
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Acknowledgements
 International Postgraduate Research
Scholarship (IPRS)
 Curtin University Postgraduate
Scholarship (CUPS)
 International Centre for Diarrhoeal Disease
Research, Bangladesh (ICDDR,B)
 Centre for International Health
Curtin University of Technology
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