Care seeking for fatal neonatal illness episodes: a population-based study in rural Bangladesh Centre for International Health Md.Hafizur Rahman Chowdhury 8th October 2007 Conversation Series- Doctoral Forum Centre for International Health

Supervisors Principal supervisor Sandra Thompson Associate Supervisors Kieran McCall Kim Peter Steatfield Centre for International Health

Background 40-50% of under-five deaths occur in the first four weeks (neonatal period) 98% of deaths occur in developing countries and most of these occur at home One in three child deaths occurs in South-East Asia Poor or delayed care seeking contributes to up to 70% of child deaths Community level information on cause of death and health care seeking during the fatal episode is often unavailable Centre for International Health

Objectives To investigate the consultation patterns of care seeking during fatal illness in the rural Matlab sub-district of eastern Bangladesh To assess the differentials of consultation by –Sex of deceased –Time period at death –Service area Centre for International Health

Methodology Study was approved by Ethics Committees both at ICDDR,B and Curtin University Neonatal deaths were identified through a population- based demographic surveillance system Trained staff administered a structured questionnaire on care seeking practice to mothers at home along with a verbal autopsy tool All data entered into Visual Fox-Pro Descriptive statistics used for analysis Stata software 9 version used for analysis

Bangladesh at a glance 141 million people Density: 900/km2 GNI: US$ 470 IMR:65 /1,000 live births NMR:41 /1,000 LB MMR:320 /100,000 LB Home delivery: 90% Life exp: 62 years

220,000 population under regular demographic surveillance Vital registration Monthly home visit Identification number Two service areas ICDDR,B area-110,000 pop (MCH-FP services) Government area-110,000 pop (Government services) Quality assurance for data Centre for International Health Matlab Study Site

Data collection Verbal Autopsy questionnaire -structured -open-ended

Data management Routine quality assurance Medical assistant VA review Data entry Centre for International Health

RESULTS Centre for International Health

Timing of death, Matlab Neonatal deaths by age at death Deaths=365 Centre for International Health 37% 16% 15% 9% 8% 7%

Type of provider during consultation Health care provider N (365) Percent No treatment Medically qualified 37.2 MBBS Health Centre339.0 Paramedic164.4 Traditional/unqualified 25.4 Quack/village doctor298.0 Kabiraj/herbalist298.0 Homeopath215.8 Spiritual healer113.0 Pharmacy (drug seller)20.6 Centre for International Health

Service area ICDDR,B (173) Government (192) Health Care provider% No treatment Medically qualified Traditional/unqualified Provider type by Service Area Centre for International Health

Provider Type by Sex of Neonate Sex of newborn Male (200) Female (165) Health care provider% No treatment Medically qualified Traditional/unqualified Centre for International Health

Provider Type by Time of Neonatal Death Age at death (days) N= days (n=307) 8-28 days (n=58) Health care provider% No treatment Medically qualified Traditional/unqualified Centre for International Health

Consultation by sex of the neonate Sex of newborn N=365 Male (n=200) Female (n=165) No of Consultations% 2 Centre for International Health

Consultation by timing of death Age at death (days) N= days (n=307) 8-28 days (n=58) No of Consultations% 2 Centre for International Health

Consultation by service area Service area N=365 ICDDR,B (n=173) Government (n=192) No of Consultations% 2 Centre for International Health

Conclusions 84% died in the early (0-7days) neonatal period, with 37% in first 24 hours Overall, 63% of the neonates received care either from traditional/unqualified provider or no care at all About 22% sought more than one consultation, including 6% received three or more. Multiple consultations for care, as well as consultations with a medically qualified provider, were more likely among male newborns, with late neonatal deaths, and in the ICDDR,B project area Centre for International Health

Recommendations Increase community awareness about prompt early care seeking Greater emphasis on gender equality and female education Skilled attendance at delivery and postnatal checkup for appropriate neonatal care Integrating traditional care providers into mainstream health programs may be an approach to reducing neonatal mortality in the study setting Centre for International Health

 International Postgraduate Research Scholarship (IPRS)  Curtin University Postgraduate Scholarship (CUPS)  International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B)  Centre for International Health Curtin University of Technology Acknowledgements Centre for International Health