Patterns and determinants of care seeking for obstetric complications in rural northwest Bangladesh: analysis from a prospective cohort study

Shegufta S Sikder, Alain B Labrique, Ian M Craig, Mohammad Abdul Wakil, Abu Ahmed Shamim, Hasmot Ali, Sucheta Mehra, Lee Wu, Saijuddin Shaikh, Keith P West Jr, Parul Christian, Shegufta S Sikder, Alain B Labrique, Ian M Craig, Mohammad Abdul Wakil, Abu Ahmed Shamim, Hasmot Ali, Sucheta Mehra, Lee Wu, Saijuddin Shaikh, Keith P West Jr, Parul Christian

Abstract

Background: In communities with low rates of institutional delivery, little data exist on care-seeking behavior for potentially life-threatening obstetric complications. In this analysis, we sought to describe care-seeking patterns for self-reported complications and near misses in rural Bangladesh and to identify factors associated with care seeking for these conditions.

Methods: Utilizing data from a community-randomized controlled trial enrolling 42,214 pregnant women between 2007 and 2011, we used multivariable multinomial logistic regression to explore the association of demographic and socioeconomic factors, perceived need, and service availability with care seeking for obstetric complications or near misses. We also used multivariable multinomial logistic regression to analyze the factors associated with care seeking by type of obstetric complication (eclampsia, sepsis, hemorrhage, and obstructed labor).

Results: Out of 9,576 women with data on care seeking for obstetric complications, 77% sought any care, with 29% (n = 2,150) visiting at least one formal provider and 70% (n = 5,149) visiting informal providers only. The proportion of women seeking at least one formal provider was highest among women reporting eclampsia (57%), followed by hemorrhage (28%), obstructed labor (22%), and sepsis (17%) (p < 0.001). In multivariable analyses, socioeconomic factors such as living in a household from the highest wealth quartile (Relative Risk Ratio of 1.49; 95% CI of [1.33-1.73]), women's literacy (RRR of 1.21; 95% CI of [1.05-1.42]), and women's employment (RRR of 1.10; 95% CI of [1.01-1.18]) were significantly associated with care seeking from formal providers. Service factors including living less than 10 kilometers from a health facility (RRR of 1.16; 95% CI of [1.05-1.28]) and facility availability of comprehensive obstetric services (RRR of 1.25; 95% CI of 1.04-1.36) were also significantly associated with seeking care from formal providers.

Conclusions: While the majority of women reporting obstetric complications sought care, less than a third visited health facilities. Improvements in socioeconomic factors such as maternal literacy, coupled with improved geographic access and service availability, may increase care seeking from formal facilities. Enhancing community awareness on symptoms of hemorrhage, sepsis, and obstructed labor and their consequences may promote care seeking for obstetric complications in rural Bangladesh.

Trial registration number: NCT00860470 .

Figures

Figure 1
Figure 1
Ecological framework of factors associated with care seeking for emergency obstetric care. The framework shown in Figure 1 is adapted from the Three Delays Model [12] and Andersen’s Care-Seeking Framework [35]. Figure 1 shows the demographic, socioeconomic, perceived need, and service availability factors that are hypothesized to affect care seeking behavior for obstetric complications.
Figure 2
Figure 2
Analytic cohort (n = 10,580) between 2007 and 2011, by type of pregnancy outcome. Figure 2 shows the cohort for this analysis, comprised of married women of reproductive age with data on care seeking for reported obstetric complications or near misses between December 2007 and June 2011.
Figure 3
Figure 3
Care-seeking patterns among 1,004 women of reproductive age reporting near misses between 2007 to 2011. Data on up to four providers sought for care were available for women reporting near misses. Figure 3 shows the percentage and number of women seeking formal or informal care at initial stages and at later stages of care seeking. This figure illustrates the complex number and type of providers sought for care by women with life-threatening obstetric conditions.

References

    1. Paxton A, Bailey P, Lobis S, Fry D. Global patterns in availability of emergency obstetric care. Int J Gynaecol Obstet. 2006;93(3):300–7. doi: 10.1016/j.ijgo.2006.01.030.
    1. Lee AC, Lawn JE, Cousens S, Kumar V, Osrin D, Bhutta ZA. Linking families and facilities for care at birth: what works to avert intrapartum-related deaths? Int J Gynaecol Obstet. 2009;107(Suppl1):S65–8. doi: 10.1016/j.ijgo.2009.07.012.
    1. World Health Organization . Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: World Health Organization; 2010.
    1. Koenig MA, Jamil K, Streatfield PK, Saha T, Al Sabir A, El Arifeen S. Maternal health and care-seeking behavior in Bangladesh: findings from a national survey. Int Fam Plan Perspect. 2007;33(2):75–82. doi: 10.1363/3307507.
    1. Armitage CJ, Conner M. Efficacy of the Theory of Planned Behaviour: a meta-analytic review. Br J Soc Psychol. 2001;40(Pt 4):471–99. doi: 10.1348/014466601164939.
    1. Armitage CJ, Norman P, Conner M. Can the Theory of Planned Behaviour mediate the effects of age, gender and multidimensional health locus of control? Br J Health Psychol. 2002;7(Part 3):299–316. doi: 10.1348/135910702760213698.
    1. Gabrysch S, Campbell OM. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth. 2009;9:34. doi: 10.1186/1471-2393-9-34.
    1. Magadi M, Diamond I, Rodrigues RN. The determinants of delivery care in Kenya. Soc Biol. 2000;47(3-4):164–88.
    1. Bell J, Curtis SL, Alayon S. Trends in delivery care in six countries. Maryland: Calverton; 2003.
    1. Glei DA, Goldman N, Rodriguez G. Utilization of care during pregnancy in rural Guatemala: does obstetrical need matter? Soc Sci Med. 2003;57(12):2447–63. doi: 10.1016/S0277-9536(03)00140-0.
    1. Burgard S. Race and pregnancy-related care in Brazil and South Africa. Soc Sci Med. 2004;59(6):1127–46. doi: 10.1016/j.socscimed.2004.01.006.
    1. Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Newsl Womens Glob Netw Reprod Rights. 1991;36:22–4.
    1. Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ. 2007;85(10):812–9. doi: 10.2471/BLT.06.035659.
    1. Stephenson R, Tsui AO. Contextual influences on reproductive health service use in Uttar Pradesh. India Stud Fam Plann. 2002;33(4):309–20. doi: 10.1111/j.1728-4465.2002.00309.x.
    1. Navaneetham K, Dharmalingam A. Utilization of maternal health care services in Southern India. Soc Sci Med. 2002;55(10):1849–69. doi: 10.1016/S0277-9536(01)00313-6.
    1. Paul BK, Rumsey DJ. Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study. Soc Sci Med. 2002;54(12):1755–65. doi: 10.1016/S0277-9536(01)00148-4.
    1. Gage AJ, Guirlene CM. Effects of the physical accessibility of maternal health services on their use in rural Haiti. Popul Stud (Camb) 2006;60(3):271–88. doi: 10.1080/00324720600895934.
    1. Sharma SK, Sawangdee Y, Sirirassamee B. Access to health: women’s status and utilization of maternal health services in Nepal. J Biosoc Sci. 2007;39(5):671–92. doi: 10.1017/S0021932007001952.
    1. Elo IT. Utilization of maternal health-care services in Peru: the role of women’s education. Health Transit Rev. 1992;2(1):49–69.
    1. Kost K, Landry DJ, Darroch JE. Predicting maternal behaviors during pregnancy: does intention status matter? Fam Plann Perspect. 1998;30(2):79–88. doi: 10.2307/2991664.
    1. Marston C, Cleland J. Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Popul Stud (Camb ) 2003;57(1):77–93. doi: 10.1080/0032472032000061749.
    1. Eggleston E. Unintended pregnancy and women’s use of prenatal care in Ecuador. Soc Sci Med. 2000;51(7):1011–8. doi: 10.1016/S0277-9536(00)00010-1.
    1. Gabrysch S, Cousens S, Cox J, Campbell OM. The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med. 2011;8(1) doi: 10.1371/journal.pmed.1000394.
    1. Chowdhury ME, Ahmed A, Kalim N, Koblinsky M. Causes of maternal mortality decline in Matlab, Bangladesh. J Health Popul Nutr. 2009;27(2):108–23. doi: 10.3329/jhpn.v27i2.3325.
    1. Sikder SS, Labrique AB, Ullah B, Ali H, Rashid M, Mehra S, et al. Accounts of severe acute obstetric complications in rural Bangladesh. BMC Pregnancy Childbirth. 2011;11:76. doi: 10.1186/1471-2393-11-76.
    1. Parkhurst JO, Penn-Kekana L, Blaauw D, Balabanova D, Danishevski K, Rahman SA, et al. Health systems factors influencing maternal health services: a four-country comparison. Health Policy. 2005;73(2):127–38. doi: 10.1016/j.healthpol.2004.11.001.
    1. Afsana K. Disciplining birth: power, knowledge, and childbirth practices in Bangladesh. Dhaka: University Press Limited; 2005.
    1. Goodburn EA, Gazi R, Chowdhury M. Beliefs and practices regarding delivery and postpartum maternal morbidity in rural Bangladesh. Stud Fam Plann. 1995;26(1):22–32. doi: 10.2307/2138048.
    1. Afsana K, Rashid SF. The challenges of meeting rural Bangladeshi women’s needs in delivery care. Reprod Health Matters. 2001;9(18):79–89. doi: 10.1016/S0968-8080(01)90094-1.
    1. Moran AC, Winch PJ, Sultana N, Kalim N, Afzal KM, Koblinsky M. Patterns of maternal care seeking behaviours in rural Bangladesh. Trop Med Int Health. 2007;12(7):823–32. doi: 10.1111/j.1365-3156.2007.01852.x.
    1. National Institute of Population Research and Training (NIPORT), Mitra and Associates, Macro International . Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland: NIPORT; 2012.
    1. Chowdhury ME, Akhter HH, Chongsuvivatwong V. Community-based self-reported symptoms of antepartum morbidities; the health burden and care-seeking patterns of rural Bangladeshi women. Southeast Asian J Trop Med Public Health. 2000;31(3):598–605.
    1. Anwar I, Sami M, Akhtar N, Chowdhury ME, Salma U, Rahman M, et al. Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programmes in Bangladesh. Bull World Health Organ. 2008;86(4):252–9. doi: 10.2471/BLT.07.042754.
    1. Afsana K. The tremendous cost of seeking hospital obstetric care in Bangladesh. Reprod Health Matters. 2004;12(24):171–80. doi: 10.1016/S0968-8080(04)24142-8.
    1. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10. doi: 10.2307/2137284.
    1. West KP, Jr, Shamim AA, Labrique AB, Ali H, Shaikh S, Mehra S. Efficacy of antenatal multiple micronutrient vs iron-folic acid supplementation in improving gestational and postnatal viability in rural Bangladesh: the JiVitA-3 trial. FASEB J. 2013;27:358.
    1. Labrique AB, Christian P, Klemm RD, Rashid M, Shamim AA, Massie A. A cluster-randomized, placebo-controlled, maternal vitamin A or beta-carotene supplementation trial in Bangladesh: design and methods. Trials. 2011;12:102. doi: 10.1186/1745-6215-12-102.
    1. Bangladesh Bureau of Statistics . 2011 Population & Housing Census: Preliminary Results. Dhaka: Statistics Division; 2011.
    1. Berendes S, Heywood P, Oliver S, Garner P. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. PLoS Med. 2011;8(4) doi: 10.1371/journal.pmed.1000433.
    1. Management Information Systems, Directorate General of Health Services. Health Bulletin 2012. Ministry of Health and Family Welfare, editor. Directorate General of Health Services: Dhaka, Bangladesh; 2013.
    1. Moran AC: Maternal morbidity in rural Bangladesh: Women’s perceptions and care seeking behaviors. PhD thesis. Johns Hopkins Bloomberg School of Public Health; 2006.
    1. Gunnsteinsson S, Labrique AB, West KP, Jr, Christian P, Mehra S, Shamim AA. Constructing indices of rural living standards in Northwestern Bangladesh. J Health Popul Nutr. 2010;28(5):509–19.
    1. World Health Organization . Service Availability and Readiness Assessment: an annual monitoring system for service delivery: Reference Manual. Geneva: World Health Organization; 2013.
    1. Sikder SS, Labrique AB, Ali H, Hanif AA, Klemm R, Mehra S, West KP, Jr, Christian P: Ready to provide care? Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh. BMC Public Health, in Press.
    1. Environmental Systems Research Institute . ArcGIS Desktop: Release 10. Redlands, CA: Environmental Systems Research Institute; 2011.
    1. R Core Team. R . A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, editor; 2012.
    1. Stata Corp LP . Stata Statistical Software: Release 11. College Station, TX: StataCorp LP; 2009.
    1. Akaike H. A new look at the statistical model identification. Automatic Control, IEEE Trans. 1974;19(6):716–23. doi: 10.1109/TAC.1974.1100705.
    1. AbouZahr C. Global burden of maternal death and disability. Br Med Bull. 2003;67:1–11. doi: 10.1093/bmb/ldg015.
    1. Filippi V, Ronsmans C, Gandaho T, Graham W, Alihonou E, Santos P. Women’s reports of severe (near miss) obstetric complications in Benin. Stud Family Plann. 2000;31:309–24. doi: 10.1111/j.1728-4465.2000.00309.x.
    1. Stewart MK, Festin M. Validation study of women’s reporting and recall of major obstetric complications treated at the Philippine General Hospital. Int J Gynaecol Obstet. 1995;48(Suppl):S53–66. doi: 10.1016/0020-7292(95)02320-C.
    1. Ronsmans C, Achadi E, Cohen S, Zazri A. Women’s recall of obstetric complications in South Kalimantan, Indonesia. Stud Fam Plann. 1997;28:203–14. doi: 10.2307/2137888.
    1. Seoane G, Castrillo M, O’Rourke K. A validation study of maternal self reports of obstetrical complications: implications for health surveys. Int J Gynecol Obstet. 1998;62:229–36. doi: 10.1016/S0020-7292(98)00104-0.
    1. Sibley L, Caleb-Varkey L, Upadhyay J, Prasad R, Saroha E, Bhatla N. Recognition of and response to postpartum hemorrhage in rural northern India. J Midwifery Womens Health. 2005;50(4):301–8. doi: 10.1016/j.jmwh.2005.03.006.
    1. Thaddeus S, Nangalia R, Vivio D. Perceptions matter: barriers to treatment of postpartum hemorrhage. J Midwifery Womens Health. 2004;49(4):293–7. doi: 10.1016/j.jmwh.2004.04.010.
    1. Reynolds HW, Wong EL, Tucker H. Adolescents’ use of maternal and child health services in developing countries. Int Fam Plan Perspect. 2006;32(1):6–16. doi: 10.1363/3200606.
    1. Nove A, Matthews Z, Neal S, Camacho AV. Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries. The Lancet. 2014;2(3):e155–64.
    1. Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121(1):40–8. doi: 10.1111/1471-0528.12630.
    1. Speizer IS, Santelli JS, Afable-Munsuz A, Kendall C. Measuring factors underlying intendedness of women’s first and later pregnancies. Perspect Sex Reprod Health. 2004;36(5):198–205. doi: 10.1363/3619804.
    1. Islam MM, Rob U, Chakroborty N. Menstrual regulation practices in Bangladesh: an unrecognized form of contraception. Asia-Pacific Popul J. 2004;19:75–99.
    1. Nashid T, Olsson P. Perceptions of Women about Menstrual Regulation Services: Qualitative Interviews from Selected Urban Areas of Dhaka. J Health Popul Nutr. 2007;25(4):392–8.
    1. Koblinsky MA. Beyond maternal mortality - magnitude, interrelationship, and consequences of women’s health, pregnancy-related complications and nutrition status on pregnancy outcomes. Int J Gynecol Obstet. 1995;48:S21–32. doi: 10.1016/0020-7292(95)02322-4.
    1. World Health Organization . Integrated Management of Pregnancy and Childbirth: A guide for essential practice. Geneva: WHO Press; 2009.
    1. Sikder SS, Labrique AB, Shamim AA, Ali H, Mehra S, Wu L, et al. Risk factors for reported obstetric complications and near misses in rural northwest Bangladesh: analysis from a prospective cohort study. BMC Pregnancy Childbirth. 2014;14:347. doi: 10.1186/1471-2393-14-347.
    1. Ahmed S, Hill K. Maternal mortality estimation at the subnational level: a model-based method with an application to Bangladesh. Bull World Health Organ. 2011;89(1):12–21. doi: 10.2471/BLT.10.076851.
    1. Rahman MH, Mosley WH, Ahmed S, Akhter HH. Does service accessibility reduce socioeconomic differentials in maternity care seeking? Evidence from rural Bangladesh. J Biosoc Sci. 2008;40(1):19–33. doi: 10.1017/S0021932007002258.
    1. Marmot M, Friel S, Bell R, Houweling TA, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661–9. doi: 10.1016/S0140-6736(08)61690-6.
    1. Senarath U, Gunawardena NS. Women’s autonomy in decision making for health care in South Asia. Asia Pac J Public Health. 2009;21(2):137–43. doi: 10.1177/1010539509331590.
    1. Bhuiya A: Health for the Rural Masses: Insights from Chakaria. ICDDR,B: Monograph No 8. Dhaka, 2009.
    1. Sikder SS, Labrique AB, Ullah B, Mehra S, Rashid M, Ali H, Jahan N, Shamim AA, KP West, Jr., P Christian: Care-seeking patterns for fatal non-communicable diseases among women of reproductive age in rural northwest Bangladesh (2012). BMC Women’s Health 12(23).

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться