Factors affecting deliveries attended by skilled birth attendants in Bangladesh.
BACKGROUND
The presence of skilled birth attendants (SBAs) is crucial in childbirth to reduce the maternal mortality ratio (MMR) and to achieve the maternal mortality target of the United Nations' Sustainable Development Goals (SDGs). The aim of this study was to investigate the factors related to childbirths attended by SBAs in Bangladesh.


METHODS
Data from the Bangladesh Demographic and Health Survey (2014 BDHS) were analyzed. Logistic regression was applied to calculate crude odds ratios (CORs), adjusted odds ratios (AORs), 95% confidence intervals (CIs), and p-values.


RESULTS
In Bangladesh, 35.9% of deliveries were attended by SBAs, and 44.2% of those women received at least one antenatal check-up by a skilled provider. The deliveries by SBAs were less than 50% of the total deliveries in all divisions, excluding Khulna. Known pregnancy complications (AOR: 1.2; 95% CI: 1.1-1.4), higher level of education in both women (AOR: 1.7; 95% CI: 1.2-2.3) and their husbands (AOR: 1.8; 95% CI: 1.3-2.4), receiving antenatal care (ANC) by a skilled provider during the pregnancy period (AOR: 1.5; 95% CI: 1.1-2.1), and higher wealth quintiles (AOR: 3.4; 95% CI: 2.5-4.7) were all significantly associated with an increased likelihood of a delivery by SBAs (p<0.05). In contrast, women living in rural areas (AOR: 0.7; 95% CI: 0.6-0.8) and the Sylhet Division (AOR: 0.4; 95% CI: 0.3-0.5) were less likely to be delivered by SBAs.


CONCLUSIONS
To achieve the target of the Government of Bangladesh - 50% of deliveries to be attended by SBAs - it is important to increase ANC services and awareness programs in all seven divisions of Bangladesh. Special focus in rural areas is also required to meet this target. A new study should be conducted to explore the unexamined factors associated with the presence of SBAs during childbirth.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA.
Gulam Muhammed Al
GMA
Kibria
School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan Canada.
Swagata
S
Ghosh
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA.
Shakir
S
Hossen
Department of Pediatrics, Sylhet M. A. G. Osmani Medical College Hospital, ProjAHNMo- Johns Hopkins University-Bangladesh, Sylhet, Bangladesh.
Rifath Ara Alam
RAA
Barsha
Shimantik, Sylhet, Bangladesh.
Atia
A
Sharmeen
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205 USA.
S M Iftekhar
SMI
Uddin
Bangladesh; Childbirth; Delivery; Factors; Maternal mortality ratio; Skilled birth attendants