Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh.
Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.
Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York. witwicha@buffalo.edu.
Wit
W
Wichaidit
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Mahbub-Ul
MU
Alam
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Amal K
AK
Halder
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Leanne
L
Unicomb
Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts. Department of Global Health, Boston University School of Public Health, Boston, Massachusetts. Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts.
Davidson H
DH
Hamer
Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York.
Pavani K
PK
Ram
D001459:Bangladesh; D004632:Emergency Medical Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008428:Maternal Mortality / Q000639:trends; D009774:Obstetrics / Q000706:statistics & numerical data*; D018743:Perinatal Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D011247:Pregnancy; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population; D014505:Urban Population; D000078329:Workforce