title: Determinants and pattern of care seeking for preterm newborns in a rural Bangladeshi cohort.
abstract: BACKGROUND
  Despite the increased burden of preterm birth and its complications, the dearth of care seeking data for preterm newborns remains a significant knowledge gap. Among preterm babies in rural Bangladesh, we examined: 1) determinants and patterns of care seeking, and 2) risk analysis for care-seeking from qualified and unqualified providers.
  
  
  METHODS
  Trained community health workers collected data prospectively from 27,460 mother-liveborn baby pairs, including 6,090 preterm babies, between June 2007 and September 2009. Statistical analyses included binomial and multinomial logistic regressions.
  
  
  RESULTS
  Only one-fifth (19.7%) of preterm newborns were taken to seek either preventive or curative health care. Among care-seeker preterm newborns, preferred providers included homeopathic practitioners (50.0%), and less than a third (30.9%) sought care from qualified providers. Care-seeking from either unqualified or qualified providers was significantly lower for female preterm babies, compared to male babies [Relative Risk Ratio (RRR) for unqualified care: 0.68; 95% Confidence Interval (CI): 0.58, 0.80; RRR for qualified care: 0.52; 95% CI: 0.41, 0.66]. Among preterm babies, care-seeking was significantly higher among caregivers who recognized symptoms of illness [RR: 2.14; 95% CI: 1.93, 2.38] or signs of local infection (RR: 2.53; 95% CI: 2.23, 2.87), had a history of child death [RR: 1.21; 95% CI: 1.07, 1.37], any antenatal care (ANC) visit [RR: 1.41; 95% CI: 1.25, 1.59]. Birth preparedness (RRR: 1.24; 95% CI: 1.09, 1.68) and any ANC visit (RRR: 1.73; 95% CI: 1.50, 2.49) were also associated with increased likelihood of care seeking for preterm babies from qualified providers.
  
  
  CONCLUSIONS
  To improve care seeking practices for preterm babies and referral of sick newborns to qualified providers/facilities, we recommend: 1) involving community-preferred health care providers in community-based health education and awareness raising programs; 2) integrating postnatal care seeking messages into antenatal counselling; and 3) further research on care seeking practices for preterm babies.
authors.affiliation: Department of International Health, International Center for Maternal and Newborn Health (ICMNH), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. mshah@savechildren.org.
authors.forename: Rashed
authors.initials: R
authors.lastname: Shah
authors.forename: Luke C
authors.initials: LC
authors.lastname: Mullany
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Radwanur Rahman
authors.initials: RR
authors.lastname: Talukder
authors.forename: Syed Moshfiqur
authors.initials: SM
authors.lastname: Rahman
authors.forename: Ishtiaq
authors.initials: I
authors.lastname: Mannan
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D000328:Adult; D001459:Bangladesh; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007224:Infant Care; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012424:Rural Population; D055815:Young Adult