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![Page 1: Care seeking for fatal neonatal illness episodes: a population-based study in rural Bangladesh Centre for International Health Md.Hafizur Rahman Chowdhury.](https://reader030.fdocuments.in/reader030/viewer/2022032702/56649ced5503460f949b99a0/html5/thumbnails/1.jpg)
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
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Supervisors
• Principal supervisor• Sandra Thompson
• Associate Supervisors• Kieran McCall• Kim Peter Steatfield
Centre for International Health
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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
Centre for International Health
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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
Centre for International Health
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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
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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
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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
Centre for International Health
Matlab Study Site
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Data collection
Verbal Autopsy questionnaire -structured -open-ended
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Data management
Routine quality assuranceMedical assistant VA review
Data entry Centre for International Health
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RESULTS
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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
Centre for International Health
37%
16%15% 9%8% 7%
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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
Centre for International Health
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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
Centre for International Health
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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
Centre for International Health
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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
Centre for International Health
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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
Centre for International Health
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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
Centre for International Health
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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
Centre for International Health
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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
Centre for International Health
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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
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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
Centre for International Health
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Centre for International Health