Factors influencing delivery-related complications and their consequences in hard-to-reach areas of Bangladesh.

BACKGROUND AND OBJECTIVES: Bangladesh's high maternal mortality ratio is exacerbated by delivery-related complications, particularly in hard-to-reach (HtR) areas with limited healthcare access. Despite this, few studies have explored delivery-related complications and factors contributing to these complications among the disadvantaged population. This study aimed to investigate the factors contributing to delivery-related complications and their consequences among the mothers residing in the HtR areas of Bangladesh. METHODS: Data were collected using a cross-sectional study design from 13 HtR sub-districts of Bangladesh between September 2019 and October 2019. Data from 1,290 recently delivered mothers were analysed. RESULTS: Around 32% (95% CI: 29.7-34.8) of the mothers reported at least one delivery-related complication. Prolonged labour pain (21%) was the highest reported complication during the delivery, followed by obstructive labour (20%), fever (14%), severe headache (14%). Mothers with higher education, a higher number of antenatal care (ANC) visits, complications during ANC, employed, and first-time mothers had higher odds of reporting delivery-related complications. More than one-half (51%) of these mothers had normal vaginal delivery. Nearly one-fifth (20%) of mothers who reported delivery-related complications were delivered by unskilled health workers at homes. On the other hand, about one-fifth (19%) of the mothers without any complications during delivery had a caesarean delivery. Nine out of ten of these caesarean deliveries were done at the private facilities. CONCLUSION: Delivery-related complications are significantly related to a woman's reproductive history and other background characteristics. Unnecessary caesarean delivery is prominent at private facilities.

Community-based integrated intervention for skilled maternal health care utilization in riverine remote areas, Bangladesh.

INTRODUCTION: Despite the decrease in maternal mortality ratio, many women in Bangladesh are still at high-risk of death due to pregnancy-related morbidities. Increasing the rate of skilled maternal healthcare service utilization is effective to reduce maternal mortality rate. This paper examines the intervention effect of an integrated community-based maternal healthcare project implemented by a non-government organization, Friendship, aiming to provide maternal health services to women living in the remote riverine regions of Bangladesh. METHODS: We examined the skilled maternal healthcare service utilization before and after project implementation of the mothers with birth experience of 0-6 months from the intervention (N = 1,304) and comparison areas (N = 1,304). A difference-in-differences logistic model measured the effect of the intervention. RESULTS: After the intervention, mothers were three times more likely to receive ≥ 4 ANC visits from skilled providers (AOR: 2.9; 95 % CI: 2.1-4.2), 1.5 times more likely to have skilled birth attendants during deliveries (AOR: 1.5; 95 % CI: 1.1-2.1) and 1.5 times more likely to seek at least one PNC within 42 days after delivery (AOR: 1.5; 95 % CI: 1.1-2.2) as compared to the comparison group. CONCLUSION: The intervention showed positive effect on improving the ANC coverage, skilled delivery, and PNC among the mothers residing the remote riverine areas. Therefore, it opens up the opportunity for adaptation of such integrated community and facility-based interventions by other LMICs.