Department of Public Health, North South University, Dhaka, 1229, Bangladesh.
Global Health Institute, North South University, Dhaka, 1229, Bangladesh.
BMC Pregnancy Childbirth. 2023 Jun 9;23(1):430. doi: 10.1186/s12884-023-05754-8.
Maternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across socioeconomic and geographic regions. Therefore, we aim to estimate the trends and magnitude of inequality in SBA use in Bangladesh over the last two decades.
Data from the last 5 rounds of Bangladesh Demographic and Health Surveys (BDHS; 2017-18, 2014, 2011, 2007, and 2004) were used to measure the inequalities in the SBA use utilizing the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequality was assessed by four summary measures, namely, Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) based on the four equity dimensions: wealth status, education level, place of residence, and subnational regions (divisions). Point estimates and a 95% confidence interval (CI) were reported for each measure.
An increasing trend in the overall prevalence of SBA use was observed (From 15.6% in 2004 to 52.9% in 2017). We found significant inequalities in SBA use in every wave of BDHS (from 2004 to 2017), with the result concentrating on the rich (in 2017, PAF: 57.1; 95% CI: 52.5-61.7), educated (in 2017, PAR: 9.9; 95% CI: 5.2-14.5), and people from urban areas (in 2017, PAF: 28.0; 95% CI: 26.4-29.5). We also identified geographic disparities in SBA use favoring Khulna and Dhaka divisions (in 2017, PAR: 10.2; 95% CI: 5.7-14.7). Our study also observed inequality in using SBA among Bangladeshi women decreased over time.
To increase SBA use and to decrease inequality in all four equity dimensions, disadvantaged sub-groups should be prioritized in policies and planning for program implementation.
孕产妇和新生儿死亡率是全球主要的公共卫生关注点。有证据表明，熟练的接生员（SBA）可以显著降低孕产妇和新生儿死亡率。尽管 SBA 的使用有所改善，但孟加拉国在社会经济和地理区域之间 SBA 使用的平等方面缺乏证据。因此，我们旨在评估过去二十年中孟加拉国 SBA 使用不平等的趋势和程度。
利用世界卫生组织（WHO）的卫生公平评估工具包（HEAT）软件，使用最近五轮孟加拉国人口与健康调查（BDHS；2017-18 年、2014 年、2011 年、2007 年和 2004 年）的数据，衡量 SBA 使用中的不平等情况。使用四个综合指标来评估不平等情况，即基于四个公平维度（财富状况、教育水平、居住地点和次国家区域（分区））的人口归因风险（PAR）、人口归因分数（PAF）、差异（D）和比率（R）。报告了每个措施的点估计值和 95%置信区间（CI）。
我们发现，SBA 使用的总体流行率呈上升趋势（从 2004 年的 15.6%上升到 2017 年的 52.9%）。我们发现，在每一轮 BDHS 中，SBA 使用都存在显著的不平等（从 2004 年到 2017 年），结果集中在富人身上（2017 年，PAF：57.1%；95%CI：52.5-61.7）、受教育程度较高的人（2017 年，PAR：9.9%；95%CI：5.2-14.5）和城市地区的人（2017 年，PAF：28.0%；95%CI：26.4-29.5）。我们还发现，在 SBA 使用方面存在地理差异，有利于库尔纳和达卡分区（2017 年，PAR：10.2%；95%CI：5.7-14.7）。我们的研究还观察到，随着时间的推移，孟加拉国妇女使用 SBA 的不平等现象有所减少。
为了增加 SBA 的使用，并减少所有四个公平维度的不平等，应在政策和规划中优先考虑弱势亚群体，以实施方案。
