The perspectives of clients and unqualified allopathic practitioners on the management of delivery care in urban slums, Dhaka, Bangladesh - a mixed method study.
BACKGROUND
BRAC is implementing a program to improve maternal and newborn health among the urban poor in the slums of Bangladesh (Mansohi), funded by the Bill & Melinda Gates Foundation. Formative research has demonstrated that unqualified allopathic practitioners (UAPs) are commonly assisting home-delivery. The objective of this study was to explore the role of unqualified allopathic practitioners during home delivery in urban slums of Dhaka.


METHODS
This cross-sectional study was conducted between September 2008 and June 2009 in Kamrangirchar slum in Dhaka, Bangladesh, using both qualitative and quantitative research methods. Through a door-to-door household survey, quantitative data were collected from 463 women with a home birth and/or trial of labor at home. We also conducted seven in-depth interviews with the UAPs to explore their practices.


RESULTS
About one-third (32%) of the 463 women interviewed sought delivery care from a UAP. We did not find an association between socio-demographic characteristics and care-seeking from a UAP, except for education of women. Compared to women with three or more pregnancies, the highest odds ratio was found in the primi-gravidity group [odds ratio (OR): 3.46; 95% confidence interval (CI): 1.65-7.25)], followed by women with two pregnancies (OR: 2.54; 95% CI: 1.36-4.77) to use a UAP. Of women who reported at least one delivery-related complication, 45.2% received care from the UAPs. Of 149 cases where the UAP was involved with delivery care, 133 (89.3%) received medicine to start or increase labor with only 6% (9 of 149) referred by a UAP to any health facility. The qualitative findings showed that UAPs provided a variety of medicines to manage excessive bleeding immediately after childbirth.


CONCLUSIONS
There is demand among slum women for delivery-related care from UAPs during home births in Bangladesh. Some UAPs' practices are contrary to current World Health Organization recommendations and could be harmful. Programs need to develop interventions to address these practices to improve perinatal care outcomes.
Wahed
Tasnuva
T
Reproductive Health Unit, Public Health Sciences Division, ICDDR, B, GPO Box 128, Dhaka 1000, Bangladesh. tasnuva@icddrb.org
Moran
Allisyn C
AC
Iqbal
Mohammad
M
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001459:Bangladesh; D003150:Community Health Workers / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D005260:Female; D006700:Home Childbirth; D006801:Humans; D007231:Infant, Newborn; D011204:Poverty Areas; D011247:Pregnancy
Hum Resour Health. 2004 Sep 17;2(1):13
15377382
J Health Popul Nutr. 2006 Dec;24(4):438-45
17591340
Int J Gynaecol Obstet. 2005 Sep;90(3):251-7
16023648
Aust J Rural Health. 2002 Apr;10(2):129-35
12047509
Multivariate Behav Res. 1991 Jul 1;26(3):499-510
26776715
BMC Pregnancy Childbirth. 2006 Aug 23;6:27
16928269
Health Policy Plan. 2009 Nov;24(6):467-78
19720721
Soc Sci Med. 1999 Feb;48(3):313-20
10077279
BMJ. 2004 Apr 24;328(7446):975
15105316
J Health Popul Nutr. 2009 Apr;27(2):303-12
19489423
BJOG. 2010 Dec;117(13):1608-15
21078056
Health Res Policy Syst. 2007 Feb 26;5:1
17324263
Health Promot Int. 2004 Mar;19(1):95-103
14976177
J Perinatol. 2008 Dec;28 Suppl 2:S9-13
19057572
Bull World Health Organ. 2007 Apr;85(4):322-3
17546315
Reprod Health Matters. 2007 Nov;15(30):172-8
17938082
Health Policy. 2007 Dec;84(2-3):332-43
17618702
Lancet. 2004 Sep 11-17;364(9438):970-9
15364188
J Health Popul Nutr. 2006 Dec;24(4):403-12
17591337
Health Policy Plan. 2007 May;22(3):149-55
17400575
J Fam Plann Reprod Health Care. 2005 Jan;31(1):40-3
15720849
J Health Popul Nutr. 2006 Dec;24(4):380-93
17591335
Trials. 2008 Feb 10;9:7
18261242