Mahmood Hassan Rushekh, Hossain Lubna, Azrin Farhia, Sajib Md Refat Uz Zaman, Hassan A K M Mahmudul, Mallick Trisha, Hayder Tanvir, Ahmed Anisuddin, Hasan Md Mehedi, Sayeed Abu, Jabeen Sabrina, Tonmon Tajrin Tahrin, Rahman Md Mahiur, Siddique Md Abu Bakkar, Zaman Shamsuz, Rasghuvanshi Vibhavendra S, Rahman Afruna, Murshid Haroon Bin, Nadia Nuzhat, Mahmud Mustufa, Alim Md Azizul, El Arifeen Shams, Hoque Dewan Md Emdadul, Hasan Abu Sayed Md, Rahman Ahmed Ehsanur
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Department of Health and Kinesiology, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.
J Glob Health. 2025 May 16;15:04128. doi: 10.7189/jogh.15.04128.
Maternal mortality remains critical in Bangladesh, driven by delays in accessing timely care at health care facilities. Globally, a woman dies every two minutes from pregnancy or childbirth, often due to systemic inefficiencies in health care. In Bangladesh, high maternal mortality rates are worsened by overcrowded facilities, limited resources, and complex procedures. The 'three delays' model identifies barriers to care, with the third delay - receiving timely treatment - being a major contributor to maternal deaths. This study aims to generate evidence on how the 'Welcome Person' can improve maternity care at the facility level in Bangladesh.
We conducted a cross-sectional study from April to December 2022 among pregnant women at three selected health care facilities in Gaibandha District, Bangladesh. We deployed 20 'Welcome Persons' to navigate and assist pregnant women, enhancing maternal health care. The Welcome Persons provided round-the-clock support, guiding mothers from the moment they entered the hospital through their admission, treatment, and any necessary referrals. The Welcome Persons maintained detailed time-stamped records, tracking patient movements and service timelines.
In this study of 5260 mothers, 47% presented with complications, with 52% arriving after office hours. The median time from entry to treatment was 15 minutes, with those without complications taking 14 minutes and those with complications 15 minutes. Entry-to-admission took a median of nine minutes, varying by age, with younger patients completing faster. Admission-to-treatment had a median time of six minutes, with severely complicated patients experiencing shorter times. Only 1% completed within five minutes, while 63% finished within 15 minutes. Upazila Health Complexes (UHCs) showed better performance in completing procedures within median times compared to the District Hospital (DH). Future study plans should include measuring maternal and neonatal outcomes as well.
This study demonstrates that timely maternal care is achievable by deploying a support person. Using the 'Welcome Person' model to address admission bottlenecks, health care facilities can enhance patient experiences and outcomes. Despite a few limitations, evidence generated from this study can be utilised for scaling up decisions and can contribute to the health policy.
在孟加拉国，由于在医疗机构获得及时护理存在延误，孕产妇死亡率仍然居高不下。在全球范围内，每两分钟就有一名妇女死于妊娠或分娩，这往往是由于医疗保健系统效率低下所致。在孟加拉国，设施拥挤、资源有限和程序复杂使孕产妇死亡率居高不下的情况更加恶化。“三个延误”模型确定了护理障碍，其中第三个延误——获得及时治疗——是孕产妇死亡的主要原因。本研究旨在提供证据，证明“迎宾员”如何能够在孟加拉国的医疗机构层面改善孕产妇护理。
2022年4月至12月，我们在孟加拉国盖班达区选定的三家医疗机构对孕妇进行了一项横断面研究。我们部署了20名“迎宾员”，为孕妇提供引导和帮助，以加强孕产妇保健。迎宾员提供全天候支持，从母亲进入医院的那一刻起，就指导她们办理入院、治疗以及任何必要的转诊手续。迎宾员保存了详细的带时间戳的记录，跟踪患者的行动和服务时间线。
在这项对5260名母亲的研究中，47%的母亲出现并发症，52%在办公时间之后到达。从入院到接受治疗的中位时间为15分钟，无并发症的母亲为14分钟，有并发症的母亲为15分钟。入院前的中位时间为9分钟，因年龄而异，年轻患者完成得更快。入院到治疗的中位时间为6分钟，病情严重复杂的患者所需时间较短。只有1%的患者在5分钟内完成，而63%的患者在15分钟内完成。与地区医院（DH）相比，乡级卫生中心（UHC）在中位时间内完成程序方面表现更好。未来的研究计划还应包括衡量孕产妇和新生儿结局。
本研究表明，通过部署一名支持人员可以实现及时的孕产妇护理。利用“迎宾员”模式解决入院瓶颈问题，医疗机构可以改善患者体验和结局。尽管存在一些局限性，但本研究产生的证据可用于扩大规模的决策，并可为卫生政策做出贡献。
