title: Maternal health care seeking behavior: the case of Haor (wetland) in Bangladesh.
abstract: The state of maternal healthcare (MHC) in Bangladesh is a grave concern especially in the remote haor areas. In this study, we aimed to determine the factors affecting the utilization of MHC services in the haor areas, to discover mothers' knowledge of MHC, and explore their attitudes toward MHC as well as practices in seeking MHC services.
  
  
  
  In this cross-sectional survey (n = 400), we randomly selected mothers (aged 15-49 years) from haor areas of the Habiganj district of Bangladesh. The study participants' socio demographic information as well as the extent of their knowledge about MHC, their attitudes, and practices in seeking MHC services were ascertained. The degree of association between the respondents' socio-demographic characteristics and their health-seeking behavior (before, during, and after childbirth) was assessed by the odds ratio (OR) with 95 % confidence intervals (CI) estimated from the bivariate and multivariable logistic regression analyses.
  
  
  
  The mean age of the study participants was 27.26 years. Respondents had an average of 2.64 children, and 88.6 % had at best a primary education or less. Among the study participants, 61 % of mothers had no knowledge about the availability of MHC in the study area, and only 36 % received any antenatal care (ANC). Also, 47 % sought ANC from government healthcare institutions. Irrespective of complications and potential danger signs, 95 % of births were delivered at home with the assistance of untrained birth attendants. Only 19.75 % of mothers and 12.3 % of infants received postnatal care (PNC). Moreover, mothers who had a secondary or tertiary education level had a higher likelihood of receiving ANC (OR: 3.48, 95 % C.I: 1.49-7.63) compared to mothers with no education. Also, mothers aged 25 years or older were less likely (OR: 0.24, 95 % C.I: 0.06-0.095) to give birth in a health facility than mothers who were younger than 25. The low utilization of MHC services can be attributed to many factors such as a lack of communication, a lack of knowledge about MHC services, low income, decision making, and the lack of a companion with whom to visit health services.
  
  
  
  To improve MHC utilization, to reach national targets and to save the lives of mothers and newborns, boat or ship-based special healthcare and educational programs should be implemented in the haor areas.
authors.affiliation: Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh. aminul.haque@du.ac.bd.
authors.forename: Md Aminul
authors.initials: MA
authors.lastname: Haque
authors.affiliation: Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh.
authors.forename: Surjya Kanta
authors.initials: SK
authors.lastname: Dash
authors.affiliation: Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, 33199, USA.
authors.forename: Muhammad Abdul Baker
authors.initials: MA
authors.lastname: Chowdhury
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001459:Bangladesh; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011181:Postnatal Care / Q000706:statistics & numerical data*; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D053833:Wetlands; D055815:Young Adult
keywords: Antenatal care (ANC) services; Bangladesh; Hoar areas; Maternal health care (MHC); Postnatal care (PNC)