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Maternal and Child Survival in Haor Region in Bangladesh. An Analysis of Fathers' Capabilities to Save the Future.

ABSTRACT: Maternal and child survival is a major public health problem in haor areas in Bangladesh. Fathers feel responsible as expressed by their capability "to save the future". Using the Capability Framework for Child Growth, we aimed to identify what contextual factors underlie a father's real opportunities to secure a safe delivery, including social norms and beliefs. Parents from households having children less than two years old were asked to participate in two rounds of qualitative research. In total, 25 focus group discussions and eight in-depth interviews were conducted. Late admission to health facilities emerged as the overarching disabling factor for fathers' capability to save the lives of mothers and children. Poor communication about the mother's health condition between spouses and fear for caesarean birth were underlying this late admission. In addition, inadequate advice by local doctors, underdeveloped infrastructure, and seasonal extremities contributed to late admission to health care facilities. The participants indicated that mother's autonomy in haor to seek health care is a constraint. This capability analysis points towards relevant interventions. In addition to the need for an improved health infrastructure, programs to improve maternal and child survival in haor could focus on the gendered household responsibilities and poor communication between spouses.

SUBMITTER: Chakraborty B

PROVIDER: S-EPMC7460361 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Maternal and Child Survival in Haor Region in Bangladesh. An Analysis of Fathers' Capabilities to Save the Future.

Chakraborty Barnali B Darak Shrinivas S Haisma Hinke H

International journal of environmental research and public health 20200810 16

Maternal and child survival is a major public health problem in haor areas in Bangladesh. Fathers feel responsible as expressed by their capability "to save the future". Using the Capability Framework for Child Growth, we aimed to identify what contextual factors underlie a father's real opportunities to secure a safe delivery, including social norms and beliefs. Parents from households having children less than two years old were asked to participate in two rounds of qualitative research. In to ...[more]

PMID: 32785170

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Project description:BACKGROUND:Childhood stunting is an important public health problem in the haor region of Bangladesh. Haor areas are located in the north-eastern part of the country and are vulnerable to seasonal flooding. The key objective of this study is to identify the capabilities of the parents and their children that shape multidimensional child growth outcomes in the haor region in the first thousand days of life. METHODS:A qualitative study was conducted in two sub-districts of the haor region, including in Derai in the Sunamganj district and Baniachang in the Habiganj district. We facilitated eight focus group discussions with the parents of children under age two. To allow us to explore individual stories, we conducted in-depth interviews with four fathers and four mothers. A capability framework to child growth was used in shaping the interview guides and analysing the data. RESULTS:The findings were categorised at four levels: a) capabilities for the child, b) capabilities for the mother, c) capabilities for the father, and d) capabilities at the household level. At the child's level, the parents discussed the capability to stay away from disease and to eat well, the capability to stay happy and playful, and the capability to be born with God's blessings and the hereditary traits needed to grow in size. The mothers frequently mentioned the capability to stay healthy and nourished, to stay away from violence, and to practice autonomy in allocating time for child care. The fathers stressed the earning opportunities that are affected by long-term flooding and the loss of agricultural productivity. At the household level, they discussed the capability to live in a safe shelter, to be mobile, to overcome their struggles with the earth, and to have a source of safe drinking water. CONCLUSIONS:The capability framework for child growth helped identify relevant capabilities in the haor region. These findings can guide discussions with communities and policy makers about developing programmes and interventions aimed at enhancing the identified capabilities for child growth in this vulnerable region.

Project description:BackgroundDuck viral enteritis, commonly known as duck plague (DP), is an acute and contagious fatal disease in ducks, geese, and swans caused by the DP virus (DPV). It poses a serious threat to the growth of duck farming in the Haor (wetland) areas of Bangladesh.AimThis study aimed to detect the circulating DPV by molecular characterization, followed by phylogenetic analysis, targeting the UL30 gene in infected ducks from five Haor districts in Bangladesh and to observe the variation in the genome sequence between the field virus and vaccine strain of DPV.MethodsA total of 150 samples (liver, 50; intestine, 50; and oropharyngeal tissue, 50) were collected from DP-suspected sick/dead ducks from 50 affected farms in Kishoreganj, Netrokona, B. Baria, Habiganj, and Sunamganj districts in Bangladesh. For the identification of DPV in collected samples, polymerase chain reaction (PCR) was utilized. Nucleotide sequences of the amplified UL30 gene were compared with those of other DPV strains available in GenBank.ResultsOf the 150 samples, 90 (60%) were found to be positive for DPV, as confirmed by PCR. Organ-wise prevalence was higher in the liver (72%), followed by the intestine (64%) and oropharyngeal tissue (44%). Regarding areas, the highest and lowest prevalence in the liver and intestine was observed in Habiganj and B. Baria, respectively, whereas the highest and lowest prevalence in the oropharyngeal tissue was observed in B. Baria and Habiganj, respectively. Two isolates, BAU/KA/DPV(B1)/2014 from Kishoreganj and BAU/KA/DPV(B4)/2014 from Sunamganj were sequenced, and phylogenetic analysis revealed that these isolates are evolutionarily closely related to Chinese isolates of DPV. Additionally, the isolates of DPV BAU/KA/DPV(B1)/2014 and BAU/KA/DPV(B4)/2014 showed the highest (98%) similarity to each other. The nucleotide sequence of the isolate BAU/KA/DPV(B1)/2014 exhibited higher nucleotide variability (246 nucleotides) than that of the vaccine strain (accession no. EU082088), which may affect protein function and additional drug sensitivity.ConclusionBased on the findings of the molecular study, it can be assumed that the Bangladeshi isolates and all Chinese isolates of DPV may have a common ancestry.

Project description:BackgroundYoung children require high-quality care for healthy growth and development. We defined "maternal capabilities" as factors that influence mothers' caregiving ability (physical and mental health, social support, time, decision-making autonomy, gender norm attitudes, and mothering self-efficacy), and developed survey tools to assess them.ObjectivesWe hypothesized that mothers with stronger capabilities during pregnancy would be more likely to practice improved care behaviors after their child was born.MethodsWe assessed maternal capabilities among 4667 pregnant women newly enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial. Several improved child-care practices were promoted until 18 mo postpartum, the trial endpoint. Care practices were assessed by survey, direct observation, or transcription from health records during postpartum research visits. We used logistic regression to determine the predictive association between maternal capabilities during pregnancy and child-care practices.ResultsMothers with more egalitarian gender norm attitudes were more likely to have an institutional delivery [adjusted OR (AOR), 2.06; 95% CI, 1.57-2.69], initiate breastfeeding within 1 h of delivery (AOR, 1.38; 95% CI, 1.03-1.84), exclusively breastfeed (EBF) from birth to 3 mo (AOR, 2.55; 95% CI, 1.95-3.35) and 3-6 mo (AOR, 1.75; 95% CI, 1.36-2.25), and, among households randomized to receive extra modules on sanitation and hygiene, have soap and water at a handwashing station (AOR, 1.76; 95% CI, 1.29-2.39). Mothers experiencing time stress were less likely to EBF from birth to 3 mo (AOR, 0.79; 95% CI, 0.66-0.93). Greater social support was associated with institutional delivery (AOR, 1.53; 95% CI, 1.37-1.98) and, among mothers randomized to receive extra complementary feeding modules, feeding children a minimally diverse diet (AOR, 1.18; 95% CI, 1.01-1.37). Depressed mothers were 37% and 33%, respectively, less likely to have an institutional delivery (AOR, 0.63; 95% CI, 0.44-0.88) and a fully immunized child (AOR, 0.67; 95% CI, 0.50-0.90).ConclusionsInterventions to reduce maternal depression, time stress, inadequate social support, and inequitable gender norms may improve maternal child caregiving.

Project description:OBJECTIVES:We evaluated the impact of the Improving Maternal, Neonatal, and Child Survival (IMNCS) project, which is being implemented by BRAC in rural communities in Bangladesh. METHODS:Four districts received program intervention i.e. trained community health workers to deliver essential maternal, neonatal, and child healthcare and nutrition services while two districts were treated as comparison group. A quasi-experimental study design (compared before-and-after) was undertaken. Baseline survey was conducted in 2008 among 7200 women followed by end line in 2012 among 4800 women with similar characteristics in the same villages. We evaluated maternal antenatal and post natal checkup, birth plans and delivery, complication and referred cases during antenatal checkup and post natal period, and child health indicators such as birth asphyxia, neonatal sepsis, and its management by the medically trained provider. FINDINGS:Increased number (four or more) antenatal visits, skill-birth attended delivery and postnatal visits (three or more) in the intervention group preceding four-year intervention period were observed compare to their counterpart. We noted negative difference-in-difference estimator (-5.0%, P = 0.159) regarding to the all major birth plans i.e. delivery place, birth attendant, and saved money in the comparison areas. Significant reduction of ante-partum and intra-partum complications occurred in the intervention group, contrary complications of such event increased in the comparison areas (-6.3%, P<0.05 and -20.5%, P<0.001 respectively). Referral case to the health centers due to these complications boosted significantly in intervention group than comparison group (2.3%, P<0.01 and 6.6%, P<0.001 respectively). Mother's knowledge of breastfeeding initiation and the practice of initiating breastfeeding within an hour of birth amplified significantly (14.6%, P<0.001 and 8.3%, P<0.001 respectively). We did not find any significant difference regards to the management of low birth weight by the medically trained health care provider and complete vaccination between the intervention and comparison arm. CONCLUSION:Medically trained health care provider assisted community based public health intervention could increase number of antenatal and postnatal visit, thereby could decrease pregnancy associated complications. These interventions may be considered for further up scaling when resources are limited.

Project description:Improving maternal nutrition practices during pregnancy is essential to save lives and improve health outcomes for both mothers and babies. This paper examines the maternal, household, and health service factors influencing maternal nutrition practices in the context of a large scale maternal, newborn, and child health (MNCH) program in Bangladesh. Data were from a household survey of pregnant (n = 600) and recently delivered women (n = 2,000). Multivariate linear and logistic regression analyses were used to examine the determinants of three outcomes: consumption of iron and folic acid (IFA) tablets, calcium tablets, and diverse diets. Women consumed 94 ± 68 IFA and 82 ± 66 calcium tablets (out of 180 as recommended) during pregnancy, and only half of them consumed an adequately diverse diet. Good nutrition knowledge was the key maternal factor associated with higher consumption of IFA (β = 32.5, 95% CI: 19.5, 45.6) and calcium tablets (β ~31.9, 95% CI: 20.9, 43.0) and diverse diet (OR = 1.8, 95% CI: 1.0-3.1), compared to poor knowledge. Women's self-efficacy in achieving the recommended practices and perception of enabling social norms were significantly associated with dietary diversity. At the household level, women who reported a high level of husband's support were more likely to consume IFA (β = 25.0, 95% CI: 18.0, 32.1) and calcium (β = 26.6, 95% CI: 19.4, 33.7) tablets and diverse diet (OR = 1.9, 95% CI: 1.2, 3.3), compared to those who received low support. Health service factors associated with higher intakes of IFA and calcium tablets were early and more prenatal care visits and receipt of free supplements. Combined exposure to several of these factors was attributed to the consumption of an additional 46 IFA and 53 calcium tablets and 17% higher proportions of women consuming diverse diets. Our study shows that improving knowledge, self-efficacy and perceptions of social norms among pregnant women, and increasing husbands' support, early registration in prenatal care, and provision of free supplements will largely improve maternal nutrition practices.

Dataset Information

Maternal and Child Survival in Haor Region in Bangladesh. An Analysis of Fathers' Capabilities to Save the Future.

Publications

Maternal and Child Survival in Haor Region in Bangladesh. An Analysis of Fathers' Capabilities to Save the Future.

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