Factors influencing maternal mortality in Cumilla city corporation, Bangladesh

INTRODUCTION

Bangladesh is one of the fast economically growing countries in South Asia. Bangladesh is situated in the northern part of the Bay of Bengal. The total area of Bangladesh is 1,48,460 square kilometers and the total population is about 16.4 billion. Most of the people in Bangladesh live in rural areas and involve in agricultural activities. The migration from rural to urban is largely increased in this country.¹ The rate of urbanization in Bangladesh in 2018 was 36.63% which is continuously increasing. The two basic needs including education and health care facilities have a low level of efficiency to improve the socio-economic conditions in Bangladesh to improve the socio-economic conditions.^2-4 It is positive that the major macroeconomic variables are growing rapidly in Bangladesh since the last decade.⁵ The education system has an immense contribution to raise awareness of health care facilities among individuals.⁶ Maternal education enriches our knowledge about maternal and mother care and maternal education depends on the availability and accessibility of healthcare information and facilities which people can easily accept, understand and utilize.

Maternal health is the part of the demographic measure which is discussed as a macroeconomic variable.⁷ Maternal health can be defined by the health conditions of women during their pregnancy, childbirth and postnatal period. It also depends on the availability and use of contraceptive prevalence and coverage of tetanus injection services. Antenatal and postnatal care increases the safety of mother life. The unwanted pregnancy creates vulnerability of the mother health.^8-10 Maternal health also depends on the health care service providers like nurses, doctors' positions and others.

The People's Republic of Bangladesh is constitutionally committed to the supply of basic medical requirements to all levels of people in society and to improve the nutrition status and public health status.¹¹ In the aspect of juvenile motherhood (giving birth in a priori stage of life), Bangladesh is one of the highest vulnerable in the world. 25% of the teenage girls in Bangladesh have already become a mother due to socio-economic factors including poverty and inequality and lack of education, knowledge, government restrictions and rules. The factors are liable to increase the number of teenage mothers in Bangladesh. Each and every year mothers are dying in case of pregnancy and childbirth. In 2010 the maternal mortality rate was 574 per 100000 live births; in 2018 maternal mortality rate was 194 deaths per 100000 live births which is continuously decreasing.¹²

Moreover, the general objective of the study was to explore the scenario of maternal health in Cumilla city corporation, focusing on antenatal care (ANC), delivery, and postnatal care (PNC) services. The specific objectives of the study presented were to find out believes and practices concerning maternal health, to explore each ANC, delivery and PNC services seeking pattern, to search the reasons for seeking ANC, delivery and PNC, to estimate the way of communication (who, when, whom and how) to the service providers regarding the birth of newborn and pre and post care of mother and to find out the way of better health service for mothers.

Questionnaire and interview surveys were conducted to analyze the influencing factors of maternal mortality.

METHODS

Study type

Current study conducted a primary data based analysis. Through questionnaires and interviews, we collected information about the danger signs, symptoms during pregnancy, antenatal care, child delivery, TT vaccination to women and postnatal care.

Study place and period

The population of the current study had consisted of male and female respondents in Comilla city. The study was conducted in Cumilla city and ward numbers 3, 5, 8, 10, 11, 18, 24 and 27 were selected to collect data and information. The sample size of this study was about 150 respondents. The fieldwork was commenced in mid-2019 to late 2019.

Statistical analysis

The data was collected through interviews and questionnaire surveys with a structured and unstructured questionnaire and checklist. That kind of methodology was also used to collect data.^13,14 The purpose of this study was based on socio-economic, socio-demographic knowledge, practice and attitude with respect to maternal health. The collected data have analyzed by using SPSS software and this study conducted a descriptive analysis to determine the impact of maternal mortality factors.

RESULTS

Socio-economic factors

Information was collected from married women for reproductive age. The distribution of respondents according to age is presented in Table 1. Findings indicate that 28% of respondents are aged between 16-25 years, 39.33% of respondents are aged between 26-35 years, 19.33% of respondents are aged between 36-45 years, 13.33% of respondents are aged between 46-55 years. Findings indicate that about 12% of the respondents are illiterate, 11.33% of respondents have education level between class 1 and class 7, 10% of respondents are between class 8-10, 36.67% of the respondents have completed SSC, 19.33% of the respondents have completed HSC and 10% of the respondents have completed graduation and above which is shown in Figure 1.

Table 2 demonstrates that 33.33% of the respondents are housewife and 6.67% of the respondents are farmers. About 26.67% of respondents are involved in small businesses, 10% of the respondents are involved in big business, 16.67% of the respondents are involved in services and 3.33% of the respondents are engaged as a professional worker. About 3.33% of the respondents are unskilled laborers. This survey also found that the number of children for the female respondent. About 74% of the respondents are using septic tank/modern toilet, 21% are using slab latrine and 5% are using the hanging latrine. The economic statuses of the respondent’s households are also presented in Table 2. Respondents were asked whether they thought their household was a surplus or deficit in terms of food consumption. Only 32.67% indicated that they have a surplus of food, while 42.67% of respondents mentioned that they have neither a deficit nor a surplus of food and 14.67% of respondents face a deficit sometimes in a year.

Socio-demographic factors

Knowledge about the birth control method is presented in Table 3. Findings show that most of the respondents are not using the method before birth. Only 30% of the respondents used the method before birth while 70% of the respondents did not use any method before birth.

Respondents first heard about the method are also presented in Table 3. 49.33% of the respondents mentioned they HAVE heard about this method first from their relatives or friends. Only 13.33% of the respondents have heard about this method from radio or TV.

Only 45 out of 150 respondents used this method before birth. 48.89% of the respondents followed by pill, 17.78% of the respondents followed by IUD and 2.22% of the respondents used another method before birth. Distribution of respondent’s on the basis of currently using methods to avoid pregnancy is presented in Table 4. The table shows that currently 69.33% of the respondents are using the method to avoid pregnancy and 30.67% of the respondents are not using a method to avoid pregnancy. The names of currently using methods to avoid pregnancy are also presented in Table 4. About 48.08% of the respondents follow pill to avoid pregnancy, 21.15% of the respondents follow injection, 7.14% follow implant, 12.5% of the respondents used female sterilization and 2.88% of the respondents used male sterilization and 5.79% of the respondents follow condom to avoid pregnancy at currently do not require. The frequency and percentage of abortion or miscarriage is about 69% of the respondents aborted or miscarriage their child while 31% of the respondents did not abort or miscarriage their child.

Respondents were asked whether they went for ANC in their last pregnancy and it is found that 121 women out of 150 took ANC. Among them, 48.76% visited two or three times and 25.62 % visited more than three times. 46.28% of the respondents visited ANC before their six months of pregnancy. Among them, 70.25% had gone to a qualified doctor and 8.26% had gone to homeopathic and untrained TBA (dai). Due to the religious binding, lack of knowledge about this, a portion of respondents did not take ANC. Besides, most of them did not perceive it, as necessary. These are presented in Table 5.

Table 6 depicts the services received by the respondents during ANC. Findings suggest that 28.01% of respondents measured weight, 20.67% measured height. During ANC, blood pressure check, urine test was done by 9.09 % and 8.26% of respondents, respectively. An ultrasonogram was conducted (19.83%) of the conducted respondent. An important factor for determining mother health is testing blood, which is 5.78% only. Table 6 also shows that almost 70% of the respondents received TT injection and 16.67% do not receive any TT injection. 90.67% of the respondents mentioned that they have taken iron tablets or iron syrup during ANC and 9.33% do not take any iron tablet or iron syrup.

Table 7 presents who assisted during delivery. 32.67 % of respondents chose qualified doctors to deliver babies, however, the major portion of delivery (56.67%) was conducted by TBA. 10.67% of respondents took assistance of FWA. TBA is frequently used not only in this study area but also in the entire county. Table 6 demonstrate knowledge about PNC services. Findings show that 78% of the respondents received medical checkups on the baby’s health after delivery while 22% of the respondents do not receive any medical checkups on the baby’s health after delivery. In the first two months after delivery 88.67%, women took vitamin A capsule and 11.33% did not take vitamin A capsule.

Table 8 shows that 26% of the respondents breastfeed their children between 1-10 months, 60.67% of the respondents breastfeed their children between 11-20 months; 13.33% of the respondents breastfeed their children between 21-30 months.

Breastfeed methods for child care are an important issue where nutrient food helps to accumulate mother health in antenatal and postnatal situations. The breastfeed durations for the child are presented in Figure 2.

Table 10 shows the opinion of the respondents about ANC, delivery and PNC. Most of the respondents (86.67%) think that women should have a medical checkup during their pregnancy. They think at the time of delivery they need some arrangements. Among them, 50.67% of the respondents believe it is required to arrange money and 27.33% think it is necessary to visit a trained provider and 22% of the respondents think it is required in order to organize the vehicle for an emergency. Most of the respondents think when women face a problem ANC delivery, PNC, at that time, she goes to a qualified doctor.

DISCUSSION

On the basis of our findings the study presents the following discussion with recommendations. It is about 13.33% of respondents have no medical check-up during their pregnancy time. So, it should be necessary to increase skilled manpower in field visits and need to increase the efficiency of the community clinic. The government needs to take initiatives to improve the socio-economic conditions in this study area. The current study found that about 11.33% of respondents have no maternal education, 26% of respondents lack toilet facilities and 10% of respondents face income deficit in the entire year where necessary information’s about maternal education needed.^17,18 Ensure the probable check-up by doctors however the 28% of respondents still check-up by unskilled nurse and midwife. About 17.36% respondent doesn’t take any ANC and only 25.62% respondent takes ANC more than three times in this study region. Whatever the ANC services should be increases during pregnancy time. Increase the facilities of community clinic services because of 22% respondent still doesn’t include PNC Services in the study area. A productive home visit by government or non-government medical services providers can guide mothers about delivery care and complexity. Moreover, the delivery assisted by qualified doctors only 32.67%, family relatives assist 10.67% and 56.67% assist by untrained TBA (in the local language it’s called dai) in the current study area. The government campaign for health improvement must maintain a sequential time frame. Safe motherhood, family planning, uses of contraceptive (condom) should be increased and use of pill should be reduced. Whatever 48.08% of respondents used pill and uses condom only 5.79% to avoid pregnancy. The use of pill creates complexity in mother health and consequences are deeply hampered reproduction ability of mothers.^15,16 Ensure the inter-link among the mid-wives (FWVs/nurses), TBAs and FWAs must be improved to ensure the quality of services and effective referral systems.

Limitations

To complete this study we faced some limitation. Due to time constraints, the fieldwork was limited to only eight wards out of 27 wards, some of the respondents were illiterate. For illiterate respondents, the interview survey was conducted instead of questionnaire. Sometimes few respondents were not interested to respond to our questions due to shyness. Therefore, the sample size was not large.

CONCLUSION

The purpose of this study was on socio-economic, socio-demographic knowledge, practice and attitude to determine maternal health. The current study was focused on socio-economic factors and found that 33.33% of the respondents are involved in household activities and 10% of respondents face poverty in the whole year, 14.67% of respondents face temporary poverty due to seasonal unemployment. Moreover, 11.33% of respondents have no educations. The analysis of socio-demographic factors illustrated that 22% of the respondent had been completed the motherhood up to 16 years or not more 25 years which is create more vulnerability in mother heath and increase the maternal mortality rate. Almost 70% of mother did not adopt any birth control method during the gap between the first and second baby which is the vital reason of unwanted pregnancy and abortion Whatever the 69% of the mother was willing to do abortion for an unwanted pregnancy. In this study area, 9.33% of respondents had no ANC knowledge and 22% had no PNC knowledge. The current study gives the importance of reductions of early marriage, unwanted pregnancy, improve the skills of unorganized service providers, home visits, family planning and the effective gap between first and next pregnancy. To reduce the mortality, family care and self-care must need which is created by educations and training. Educated women feel safe during pregnancy and delivery time, they have effective child care knowledge than uneducated. The contributions of the current study will add a great value in existing literature and practices in health and social well-being in the study area as well as in Bangladesh. Stakeholders of this study would be beneficiaries with knowledge and importance of maternal care, PNC and ANC to reduce maternal mortality.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

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