title: Evaluation of Maternal Health Service Indicators in Urban Slum of Bangladesh.
abstract: BACKGROUND
  A continuous influx of poor people to urban slums poses a challenge to Bangladesh's health system as it has failed to tackle maternal morbidity and mortality. BRAC is the largest non-governmental organisation in Bangladesh. BRAC has been working to reduce maternal, neonatal and under-five children morbidity and mortality of slum dwellers in cities. BRAC has been doing this work for a decade through a programme called MANOSHI. This programme provides door-to-door services to its beneficiaries through community health workers (CHWs) and normal delivery service through its delivery and maternity centres. BRAC started the 'MANOSHI' programme in Narayanganj City Corporation during 2011 to address maternal, neonatal and child health problems facing slum dwellers. We investigated the existing maternal health-service indicators in the slums of Narayanganj City Corporation and compared the findings with a non-intervention area.
  
  
  METHODS
  This cross-sectional study was conducted during 2012, in 47 slums of Narayanganj City Corporation as intervention and 10 slums of Narsingdi Sadar Municipality as comparison area. A total of 1206 married women, aged 15-49 years, with a pregnancy outcome in the previous year were included for interview. Data on socio-demographic characteristics, reproductive and maternal health-care practices like use of contraceptive methods, antenatal care (ANC), delivery care, postnatal care (PNC) were collected through a structured questionnaire. The chi-square test, Student t test, Mann Whitney U-test, factor analysis and log-binominal test were performed by using STATA statistical software for analysing data.
  
  
  RESULTS
  The activities of BRAC CHWs significantly improved four or more ANC (47% vs. 21%; p<0.000) and PNC (48% vs. 39%; p<0.01) coverage in the intervention slums compared to comparison slums. Still, about half of the deliveries in both areas were attended at home by unskilled birth attendants, of which a very few received PNC within 48 hours after delivery. The poorest and illiterate women received fewer maternal health services from medically trained providers (MTPs). The poorest had a lower likelihood of receiving services from MTPs during delivery complications.
  
  
  CONCLUSIONS
  The MANOSHI programme service coverage for delivery care and PNC-checkup for women who prefer home delivery needs to be improved. For sustainable improvement of maternal health outcomes in urban slums, the programme needs to facilitate access to services for poor and illiterate women.
authors.affiliation: Research and Evaluation Division, BRAC, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Saira Parveen
authors.initials: SP
authors.lastname: Jolly
authors.affiliation: Research and Evaluation Division, BRAC, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Mahfuzar
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Health, Nutrition and Population Program, BRAC, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Kaosar
authors.initials: K
authors.lastname: Afsana
authors.affiliation: Research and Evaluation Division, BRAC, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Fakir Md
authors.initials: FM
authors.lastname: Yunus
authors.affiliation: Corporate Office, BRAC, Mohakhali, Dhaka 1212, Bangladesh.
authors.forename: Ahmed M R
authors.initials: AM
authors.lastname: Chowdhury
mesh_terms: D000328:Adult; D001459:Bangladesh; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006700:Home Childbirth; D006801:Humans; D007407:Interviews as Topic; D000067010:Literacy; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011181:Postnatal Care; D011204:Poverty Areas; D011247:Pregnancy; D011295:Prenatal Care; D012923:Social Class; D011795:Surveys and Questionnaires; D055815:Young Adult