Haque Md Aminul, Dash Surjya Kanta, Chowdhury Muhammad Abdul Baker
Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh.
Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, 33199, USA.
BMC Public Health. 2016 Jul 18;16:592. doi: 10.1186/s12889-016-3296-2.
The state of maternal healthcare (MHC) in Bangladesh is a grave concern especially in the remote haor areas. In this study, we aimed to determine the factors affecting the utilization of MHC services in the haor areas, to discover mothers' knowledge of MHC, and explore their attitudes toward MHC as well as practices in seeking MHC services.
In this cross-sectional survey (n = 400), we randomly selected mothers (aged 15-49 years) from haor areas of the Habiganj district of Bangladesh. The study participants' socio demographic information as well as the extent of their knowledge about MHC, their attitudes, and practices in seeking MHC services were ascertained. The degree of association between the respondents' socio-demographic characteristics and their health-seeking behavior (before, during, and after childbirth) was assessed by the odds ratio (OR) with 95 % confidence intervals (CI) estimated from the bivariate and multivariable logistic regression analyses.
The mean age of the study participants was 27.26 years. Respondents had an average of 2.64 children, and 88.6 % had at best a primary education or less. Among the study participants, 61 % of mothers had no knowledge about the availability of MHC in the study area, and only 36 % received any antenatal care (ANC). Also, 47 % sought ANC from government healthcare institutions. Irrespective of complications and potential danger signs, 95 % of births were delivered at home with the assistance of untrained birth attendants. Only 19.75 % of mothers and 12.3 % of infants received postnatal care (PNC). Moreover, mothers who had a secondary or tertiary education level had a higher likelihood of receiving ANC (OR: 3.48, 95 % C.I: 1.49-7.63) compared to mothers with no education. Also, mothers aged 25 years or older were less likely (OR: 0.24, 95 % C.I: 0.06-0.095) to give birth in a health facility than mothers who were younger than 25. The low utilization of MHC services can be attributed to many factors such as a lack of communication, a lack of knowledge about MHC services, low income, decision making, and the lack of a companion with whom to visit health services.
To improve MHC utilization, to reach national targets and to save the lives of mothers and newborns, boat or ship-based special healthcare and educational programs should be implemented in the haor areas.
孟加拉国的孕产妇保健状况令人严重关切，尤其是在偏远的豪尔地区。在本研究中，我们旨在确定影响豪尔地区孕产妇保健服务利用的因素，了解母亲们对孕产妇保健的认识，探索她们对孕产妇保健的态度以及寻求孕产妇保健服务的行为。
在这项横断面调查（n = 400）中，我们从孟加拉国哈比甘杰区的豪尔地区随机挑选了年龄在15至49岁之间的母亲。确定了研究参与者的社会人口统计学信息，以及她们对孕产妇保健的了解程度、态度和寻求孕产妇保健服务的行为。通过二元和多变量逻辑回归分析估计的比值比（OR）及其95%置信区间（CI），评估了受访者的社会人口统计学特征与她们（分娩前、分娩期间和分娩后）的就医行为之间的关联程度。
研究参与者的平均年龄为27.26岁。受访者平均育有2.64个孩子，88.6%的人最高只接受过小学或以下教育。在研究参与者中，61%的母亲不知道研究地区有孕产妇保健服务，只有36%的人接受过任何产前护理（ANC）。此外，47%的人从政府医疗机构寻求产前护理。无论有无并发症和潜在危险信号，95%的分娩是在未经培训的助产人员协助下在家中进行的。只有19.75%的母亲和12.3%的婴儿接受过产后护理（PNC）。此外，与未受过教育的母亲相比，受过中等或高等教育的母亲接受产前护理的可能性更高（OR：3.48，95%CI：1.49 - 7.63）。同样，25岁及以上的母亲在医疗机构分娩的可能性低于25岁以下的母亲（OR：0.24，95%CI：0.06 - 0.095）。孕产妇保健服务利用率低可归因于许多因素，如缺乏沟通、对孕产妇保健服务缺乏了解、收入低、决策以及缺乏陪同前往医疗服务机构的人。
为了提高孕产妇保健服务的利用率，实现国家目标并挽救母亲和新生儿的生命，应在豪尔地区实施以船只为基础的特殊医疗保健和教育项目。
