title: Patterns and determinants of care seeking for obstetric complications in rural northwest Bangladesh: analysis from a prospective cohort study.
abstract: BACKGROUND
  In communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions.
  
  
  METHODS
  Utilizing data from a community-randomized controlled trial enrolling 42,214 pregnant women between 2007 and 2011, we used multivariable multinomial logistic regression to explore the association of demographic and socioeconomic factors, perceived need, and service availability with care seeking for obstetric complications or near misses. We also used multivariable multinomial logistic regression to analyze the factors associated with care seeking by type of obstetric complication (eclampsia, sepsis, hemorrhage, and obstructed labor).
  
  
  RESULTS
  Out of 9,576 women with data on care seeking for obstetric complications, 77% sought any care, with 29% (n = 2,150) visiting at least one formal provider and 70% (n = 5,149) visiting informal providers only. The proportion of women seeking at least one formal provider was highest among women reporting eclampsia (57%), followed by hemorrhage (28%), obstructed labor (22%), and sepsis (17%) (p < 0.001). In multivariable analyses, socioeconomic factors such as living in a household from the highest wealth quartile (Relative Risk Ratio of 1.49; 95% CI of [1.33-1.73]), women's literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women's employment (RRR of 1.10; 95% CI of [1.01-1.18]) were significantly associated with care seeking from formal providers. Service factors including living less than 10 kilometers from a health facility (RRR of 1.16; 95% CI of [1.05-1.28]) and facility availability of comprehensive obstetric services (RRR of 1.25; 95% CI of 1.04-1.36) were also significantly associated with seeking care from formal providers.
  
  
  CONCLUSIONS
  While the majority of women reporting obstetric complications sought care, less than a third visited health facilities. Improvements in socioeconomic factors such as maternal literacy, coupled with improved geographic access and service availability, may increase care seeking from formal facilities. Enhancing community awareness on symptoms of hemorrhage, sepsis, and obstructed labor and their consequences may promote care seeking for obstetric complications in rural Bangladesh.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  NCT00860470 .
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ssikder2@jhu.edu.
authors.forename: Shegufta S
authors.initials: SS
authors.lastname: Sikder
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. alabriq1@jhu.edu.
authors.forename: Alain B
authors.initials: AB
authors.lastname: Labrique
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. icraig3@jhu.edu.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Craig
authors.affiliation: The JiVitA Maternal and Child Health Research Project, Gaibandha, Bangladesh. wakil.jivita@gmail.com.
authors.forename: Mohammad Abdul
authors.initials: MA
authors.lastname: Wakil
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. shamim.jivita@gmail.com.
authors.forename: Abu Ahmed
authors.initials: AA
authors.lastname: Shamim
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. hasmot.jivita@gmail.com.
authors.forename: Hasmot
authors.initials: H
authors.lastname: Ali
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. smehra5@jhu.edu.
authors.forename: Sucheta
authors.initials: S
authors.lastname: Mehra
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. lwu2@jhu.edu.
authors.forename: Lee
authors.initials: L
authors.lastname: Wu
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. saiju.jivita@gmail.com.
authors.forename: Saijuddin
authors.initials: S
authors.lastname: Shaikh
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. kwest1@jhu.edu.
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. pchrist1@jhu.edu.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D036861:Delivery, Obstetric; D005190:Family; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies; D019035:Rural Health Services; D012959:Socioeconomic Factors; D055815:Young Adult