|Year : 2018 | Volume
| Issue : 1 | Page : 1-7
A review on child and maternal health status of Bangladesh
A. H. M. Mahmudur Rahman
Department of Pharmaceutical Sciences, North South University, Bashundhara, Dhaka-1229, Bangladesh
|Date of Web Publication||12-Jan-2018|
A. H. M. Mahmudur Rahman
54/7, North Manikdi, Dhaka-Cantonment, Dhaka-1206, Dhaka
Source of Support: None, Conflict of Interest: None
Child and maternal nutritional and health status is a very much concerning issue of Bangladesh. To summarize the specific conditions of Bangladeshi child and maternal health and related issues. This is a descriptive review and overall analysis and description of the literature was done regarding child and maternal health of the general population living in Bangladesh. The evidence reflected that infant, child, and maternal mortality in Bangladesh have declined gradually at least over the past years. It is found that infant mortality 2 times, child mortality 6 times, and under five mortality rates 3 times declined comparatively than the last two decades but it is noted that maternal assassination circumstance has not declined. Knowledge on child and maternal health carries an important role in education. Health knowledge index significantly improve child and maternal health although differentially. It is obvious that poverty is one of the root causes that have led to a high child and maternal mortalities and morbidities faced by the people of Bangladesh. The requirement for socio economic relief for those living in rural Bangladesh remains one of the core issues. Recently, Bangladesh is successfully declining the total number of childhood and nutrition related mortalities despites various complexities, but maternal health status is not improving at the same pace. Nongovernment and government funded organizations and policymakers should come forward for running some effective programs to conquer the situation completely in Bangladesh.
Keywords: Bangladeshi population, child health, diet, health challenge, health system, maternal health, nutrition
|How to cite this article:|
Mahmudur Rahman A. A review on child and maternal health status of Bangladesh. CHRISMED J Health Res 2018;5:1-7
| Introduction|| |
Bangladesh is a developing country in Southeast Asia sharing borders with India and Myanmar, with a population of >142 million, a poverty level of 33% in addition to another one-third of the population just above poverty level and also having lots of health-related issues.,,,,, Bangladesh also has low per capita expenses on health care at Gross Domestic Product 3.35%, which places mainly vulnerable populations for example women and children at high risk for health as well as quality of life problems.,,,,,,,, Child and maternal health issue is a “multi-faceted complex phenomenon” and is both an outcome and trigger of health concerns for Bangladesh. There are some numerous causal factors that are intercorrelated, and thus make it complicated to empirically resolve the key driving factors and underlying pathways regarding these aspects. Nevertheless, in Bangladesh, it is seen that social, health, nutrition, and economic opportunities are severely lessened for many women and children. Besides that, household food insecurity, insufficient care and feeding practices, unhealthy family environment along with lack of access or inadequate health services can be enlisted as factors influencing child and maternal health in Bangladesh.,,,
There are some research-based evidences on the immediate, underlying, and basic determinants of child and maternal health status in accordance with the United Nations International Children's Emergency Fund (UNICEF) conceptual framework. To determine the specific health needs of children and mother, it is important to understand the medical needs and other related issues. The purpose of this literature review is to identify, review, and summarize existing research evidence on the determinants of child and maternal status of Bangladeshi population.
| Methodology|| |
As it is a descriptive review, every part of the relevant electronic records was searched with value to the fundamentals to the child and maternal health that related to Bangladesh. Data were also reviewed from different secondary sources such as World Food Programme, United Nations Development Programme (UNDP), and so on. All information was collected manually and highlighted in a simple way because of trouble-free understanding. The paper is based on an extensive evaluation of published data/information on the health system in Bangladesh.
| Results|| |
Bangladesh is one of the poorest countries of the world in the midst of the highest population density except that the country has achieved many health indicators for the past few years; notwithstanding extraordinary advances in public health during the current decades. Child and maternal health is one of the most important issues regarding improving Bangladeshi health sector, and a little outline of child health and maternal health status of Bangladesh is given below.
Child health status of Bangladesh
The underlying determinants of child health include income poverty which is concomitant with household food uncertainty. Water, sanitation, and health facilities determine the infection environment which children are exposed to and thus their risk of suffering from diseases. Infection and disease hinder with child health, and thus, it should be considered as a causal factor which underlies child mortality [Table 1]. It is also known that child undernutrition is widely attributed to a shortage of some key micronutrients obligatory for the physical and mental growth of a child. The key micronutrients are: iodine, zinc, Vitamin A, and iron.,,,
In the context of Bangladesh, the composition of corresponding feeding is often inadequate or inappropriate and initiated too early or too late, consequently causing low micronutrient ingestion among children. Dietary diversity is a way of conceptualizing best nutrient intake in addition to many studies; it has connected household dietary diversity indicators to improved nutrient intake in the country. Limitations in dietary diversity can increase micronutrient deficiencies which is a major cause of child health problems in Bangladesh. In Bangladesh, diarrhea and acute respiratory infections are the cause of two-thirds of all deaths of children <1 year of age. Even though breastfeeding initiation is approximately common in Bangladesh, approximately 70% of mothers do not exclusively breastfeed for the recommended first 6 months of life for various environmental, cultural, and economic reasons.,,
Maternal health status of Bangladesh
The determinants of child health can spiral out to have intergenerational effects as adolescent girls are likely to become unhealthy mothers, and this can have impacts spanning from the intrauterine development phase throughout to the health along with the nutritional status of birth outcomes.,, Maternal health is a major factor in formatting the nutritional status of children, particularly in the first stage of infancy. The findings reveal that maternal factors had noteworthy effects on both severe as well as moderate acute undernutrition in Bangladesh. It is to be noted that low maternal nutrition levels were associated with a higher risk of wasting, low birth weight with acute health problem in children. There are also reasons for maternal health [Figure 1]. The prevalence of malnourishment among adolescent girls and pregnant women is high in Bangladesh, and one-third of such women have low BMI and anemia.,,,
|Figure 1: Causes of maternal deaths. United Nations International Children's Emergency Fund, 1999|
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Some studies have illustrated that the health condition of mothers can affect the fetal growth and birth size of children. In urban Bangladesh, anemia and Vitamin A deficiency was found to be prevalent among most of the pregnant mothers, and child undernutrition was more prevalent among those born to mothers under the age of 18 or over 34 years. The children of well-nourished mothers were shown to have a lower risk of being underweight compared with children of unhealthy mothers. A research showed that children of adolescent mothers were shown to have a higher risk of health problems in this country.,,,
Diet and nutrition of mother and children
Food uncertainty has been defined as a condition that exists while people do not have adequate physical, social, or economic access to food. Food security has major impacts on hunger as well as undernutrition. A lack of nutrients can direct to a vicious cycle of illness as well as undernutrition.,, A strong positive involvement has been observed between household food timidity and poor infant feeding practices. In the Bangladeshi context, another factor to take into deliberation is how food security itself is prejudiced by seasonality. A previous study based in northern Bangladesh shows confirmation of a strong association observed between home food anxiety and child wasting along with maternal health. In [Figure 2], trends in nutritional status of a child under age 5 were discussed. There are widespread overlaps here by means of the basic socio-economic and gender-based factors of child and maternal undernutrition. Furthermore, recent studies have showed the relationship between food prices and undernutrition.,,,,
|Figure 2: Trends in nutritional status of child under age 5, 2004–2014. Source: BDHS 2004, 2007, 2011, and 2014|
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In Bangladesh, it is well known that the prices of rice are known to be certainly associated with the prevalence of underweight of mothers and children and inversely associated with household nongrain food expenditures, an indicator of dietary quality. Low dietary diversity throughout the period before major food price increases indicates a probable risk for intensified micronutrient deficiencies in addition to consequent child and maternal undernutrition in Bangladesh. One study based on women in the northwest region of Bangladesh where food insecurity is widespread identifies socio-economic variables which forecast food insecurity, such as level of education, gender of the head of the family and house ownership.,,,
Challenges for the health system in Bangladesh
Tertiary hospitals also include national level super specialty hospitals or centers that provide high-end medical care services, particular in only one particular area of healthcare. It is found that a total of 536 public hospitals with 37,387 beds provide inpatient care services in Bangladesh intended for a population of 160 million. Details about types of health facilities are in [Table 2]. There are also 413 Upazila (subdistrict) Health Complexes which have very limited inpatient care services. Most Upazila Health Complexes (UHC) have 20 beds first and foremost to cater the emergency needs of pregnant women.,,,
District hospitals are typically termed secondary care hospitals as unlike the medical college hospitals these have smaller amount specialty care facilities. The medical college hospitals are situated in the regional urban hubs casing several districts and provide specialty care in a broad range of disciplines. Over the last few decades, Bangladesh has experienced a rapid expansion of the secondary and tertiary care networks all over the country, but that is not up to the mark yet. Although compared with other developing countries, it becomes obvious that Bangladesh does not have adequate number of hospital beds to provide its large population. For example, as Bangladesh has only 0.4 bed per 1,000 people, Ghana has 0.9 bed for the same number of people and Kenya at the same level of economic growth as Bangladesh has 35% elevated number of hospital beds than Bangladesh. It should be noted that as basic health-care service is intented to be free in public hospitals and other facilities, patients end up bearing the costs of medicine as well as laboratory tests, on top of some additional hidden costs. Furthermore, in many public hospitals, the available ambulances are either inoperative or being used by the physicians along with other staff. It is very clear that Bangladesh has a chronic shortage of appropriately trained human resources of health including physicians, nurses, and midwives. In short, there is a gap between principle and practice in public health facilities seriously compromising the accessibility of general people.,,
Maternal and child health-care delivery system
Maternal and child health (MCH) services have been given highest priority in the health system of Bangladesh. At the society level, the services are provided by the Family Welfare Assistants and Health Assistants as of the Community Clinics. At the union level, a Family Welfare Visitor (FWV) along with a Sub-Assistant Community Medical Officer or Medical Assistants are mostly responsible for providing the services. It is known that around 250 Graduate Medical Officers were posted in 3275 Union Health and Family Welfare Centres for providing MCH services. At the Upazila level, the MCH unit of the UHC headed by a Graduate Medical Officer is responsible for providing MCH services. The activities of the MCH unit along with other maternal health-care services are overseen by the Upazila Health and Family Planning Officer in the UHC. Still, there are a lot of vacant positions in health sector [Table 3]. Trained support personnel such as FWV and “Ayas” (female ward assistants) help as well. There is also a position called junior Consultant (gynecological) who provides services in case of emergencies, mostly attending all deliveries at the UHC and all referred maternal patients.,,
|Table 3: Shortage of health service providers in public facilities in Bangladesh|
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The district hospitals in the district headquarters give maternal services through an outpatient consultation center and a labor ward. These facilities are likely to be equipped to provide basic emergency obstetric care and obstetric first aid.
History and policy regarding maternal and child healthcare
Since independence, the government's population policy was pedestaled on the need to curb population growth, and the program was treated as a model whereby development goals were attained through a self-sufficient MCH based family planning program. Nongovernmental organizations have played a vital role behind the success in the population subdivision as they provided specific policy recommendations on the basis of their research-based intervention programs related to child and maternal health. In 1953, with the initiative of professionals and social workers, an organization called Family Planning Association of Bangladesh (FPAB) was founded. The voluntary activities of FPAB received government recognition in 1958, and the first national FP program began in 1960 when the government established the Directorate of Family Planning. As a result of these efforts, the country has experienced an amazing demographic transition over the last 3 decades with a population growth speed of only 1.48% between the 1991 and 2001 censuses. It is also notable that the Health and Population Sector Programme consists of a series of interventions to be undertaken between 1998 and 2003, which are expected to decrease maternal mortality and morbidity.,,
Improvement, research, and development of maternal and child health
In Bangladesh, many institutions are involved in MCH improvement, research, and development. Apart from those agencies within the Ministry of Health and Family Welfare, there are many government and nongovernment organisations, which are involved in maternal health research and development and these organisations comprise the National Institute of Population Research and Training, the Bangladesh Institute for Promotion of Essential and Reproductive Health Technologies, Association for Prevention of Septic Abortion, and the International Centre for Diarrhoeal Disease Research, Bangladesh. It is to be noted that most of these carry out their activities with financial assistance from donors. International and bilateral organisations including the World Health Organization, United Nations Population Fund formerly the United Nations Fund for Population Activities, UNICEF, UNDP, United Nations High Commissioner for Refugees, World Bank, Asian Development Bank, and Department for International Development (DFID) are also playing a vital role providing policy guidelines, completion support in addition to infrastructure development for improvement of the health sector.,
Antenatal care in Bangladesh
The 1999–2000 Department of Human Services (DHS) indicates that many mothers in Bangladesh do not receive antenatal care (ANC). It is found in some researches that in the births that occurred in the last 5 years nearly two-thirds (63%) of mothers received no ANC during pregnancy. Those who do receive care tend to receive it from doctors (24%), or nurses, midwives other than family planning visitors (10%). There are also regional variations in use of ANC, as 59% of urban births had received ANC compared with only 28% in rural areas. Details are provided in [Figure 3]. The difference in antenatal coverage by Division is minimal. Mothers in Sylhet Division are least likely to receive ANC for only 27% of births in this Division. The mothers have at least one ANC visit.,,
|Figure 3: Antenatal care by division. National Institute of Population Research and Training, 2001|
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Refusal of referrals
Cultural and social norms have been shown to affect preference of location and attendant for delivery. They also may lead to needless delays in seeking care, particularly if danger signs are not recognized or understood. However, there have been additional examples of case in which such factors may have also led to women refusing referrals, even when potential difficulties have been professionally identified. A study has been conducted to specifically identify the factors that lead to refusal of referral among pregnant women in the Matlab region of Bangladesh [Table 4]. The study was done to purposely identify the factors that direct to the refusal of referral among pregnant women in Bangladesh. A number of open and closed questions were asked to 52 women who had refused referral, as well as of decision makers when the women could not answer. This table represents only those responses given while women were asked for the most important reason intended for their refusal.,
|Table 4: Primary reasons for refusing referral in Matlab, Bangladesh (distribution of pregnant women as per the reasons of refusing referral)|
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It is found in previous studies that responses of fear of “medical intervention,” “evil spirits,” “shame,” and “delivery at home” rooted in the specific cultural background of the women and children; even though they comment that the percentages of Muslim and Hindu women refusing referral are similar, which seems to corroborate.,
| Conclusion|| |
Bangladesh is one of the developing countries of the world where the child and maternal health- and nutrition-related indicators improved over the past few decades. Women living in Bangladesh are at a high risk for maternal mortality and morbidity and children health conditions are not up to the mark at all. Overall, there remains a need for evaluation of cultural barriers that negatively impact maternal health and socioeconomic relief in the form of policy changes and successfully declines the total number of childhood and maternal mortalities and nutrition-related mortalities and complexities. Various nongovernment and government-funded organizations should run some valuable programs to completely overcome the situation in Bangladesh. The government must arrange more awareness programs, and there must be specific funding and authority for performing this mission. More research should be done on these aspects.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]