Maternal and Child Health Care Services at Kurigram District in Bangladesh

S.M. Shahid-Uz-Zaman Research Fellow Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh Md. Abdul Goni, Ph.D Associate Professor Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh J.A.M. Shoquilur Rahman Ph.D Associate Professor Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh

S.M. Shahid-Uz-Zaman E-mail: shahidpops@gmail.com Md. Abdul Goni, Ph.D E-mail: magoni_popsrubd@yahoo.com J.A.M. Shoquilur Rahman Ph.D E-mail: jamsrpshrd@yahoo.com

ABSTRACT The aim of this study is to identify factors related with the maternal and child health care services at Kurigram district, Bangladesh. For this purpose, we have used micro data obtained from field survey, around Fulbari sadar thana in Kurigram district and have analyzed these data by using well known statistical techniques like contingency and logistic regression analysis. Medical check up during pregnancy period, tetanus toxoid vaccination and giving sal-milk to the new born babies have been considered as the maternal and child health care services in this study. Our findings indicate that a good number of reproductive women are not health conscious. Significant associations are seen within the health care services and the socio-demographic variables. The probabilities of having a medical check up during the pregnancy period, tetanus toxoid vaccination as well as giving sal-milk to the new born babies of the women who are literate, age at marriage 18+ years and have access to mass media are significantly higher than those who are illiterate, age at marriage less than 18 years and having no access to mass media. To promote the use of health care services among the mothers, their socio-economical and demographical status should be improved. The policy makers need to take proper initiatives for the improvement of reproductive health of the rural women in Bangladesh. Key Words: Medical Check up, Tetanus Toxoid Vaccination, Sal-milk, Contingency and Logistic Regression Analysis, Bangladesh.

INTRODUCTION

In reproductive health, maternal and child health have traditionally been considered as an important indicator for describing health progress, and social and economic well being of a country. Since independence in 1971, the government of Bangladesh is investing substantially in the institution building and strengthening of health and family planning services in the country. The main thrust of these programs has been in the provision of primary health care services. The government has already initiated the institutionalization of maternal and child health and family planning services such as Health and Family Welfare Centre (HFWC), Rural Dispensary (RD), Satellite Clinic (SC) etc. have been established through the country (BDHS, 2004). The objective of maternal and child health care is the reduction in the maternal, prenatal, neonatal, infant and child mortality and the promotion of the health of mother and child in the family. Despite this initiative of the government, maternal and child health conditions have not improved as much as expected in the country.
Maternal and child health services indicate various facilities and programs organized for the purposes of providing medical and social services for mothers and children. Medical services include prenatal and postnatal services, family planning care and pediatric care in infancy (Maternal and Child Health Services, 2009). In this study, we have considered the maternal and child health care services as medical check up during pregnancy period, tetanus toxoid vaccination and giving sal-milk to new born babies.

Most of the country's health infrastructure and health service system are under the government's management and control. At the local level, 3,275 Union Health and Family Welfare Centres (UHFWCs) exist to serve the 4,470 unions. Additionally there are upazila health complexes, with 31 beds in 391 rural upazilas, 64 district hospitals, 13 government medical college (MC) hospitals, 6 postgraduate hospitals and 25 specialized hospitals. A further 64 Maternal and Child Welfare Centres (MCWCs) have been established to provide maternal services at the district level (MOHFW, 2000).

Although improving in terms of national averages, maternal health status for many Bangladeshi women remains poor. Around 50% of Bangladeshi women suffer from chronic energy deficiency. Over 43% of the pregnant women are iodine deficient and more than 2.7% develop night blindness during pregnancy (BDHS, 2001). Life expectancy at birth has increased from 44 in 1970, to the present 62 years (UNICEF, 2004).

The reproductive health care services that a mother receives during her pregnancy and at the time of delivery are important for the well-being of the mother and her child. A well-designed and implemented national antenatal care program facilitates, detection and treatment of complications during pregnancy, and it provides an opportunity to disseminate health messages to women and their families. In addition, this early contact with the health care system can improve the timely and appropriate use of delivery care services.

The Bangladesh Maternal Health Services and Maternal Mortality Survey 2001 evaluated women's awareness about specific life threatening complications during pregnancy, delivery and after delivery, and found it to be low. That survey also reported that 40% of the pregnancies are free of complications and 60% are reported with one or more problems. The most common complications (about 50%) reported are headache/blurry vision/high blood pressure/oedema. The other major complications (about 24%) are breach of delivery/prolonged or obstructed labor/ torn uterus. Other notable problems are abdominal pain (15%) and excessive bleeding (13%). Overall, 45% of all pregnancies with complications are perceived as dangerous or potentially life threatening.
To reduce the maternal mortality and improve the overall reproductive health status of women, the Bangladesh government has taken on an extensive program, The major activities aimed at maternal health focus on awareness about and access to contraceptive methods; antenatal care (Tetanus immunization, iron folic acid supplementation, nutrition education); promotion of safe delivery practices by skilled birth attendants, Emergency Obstetric Care (EOC) and post natal care (Safe Motherhood, 2002).

In the back drop of the above scenario, this paper focuses on the medical check up during pregnancy period, tetanus toxoid vaccination during pregnancy period and giving sal-milk for their new born babies and we will try to identify the factors that are affecting those maternal and child health care services.

The Ministry of Health and Family Welfare (MOHFW) has adopted the Health, Nutrition and Population Sector Program (HNPSP) to provide quality, affordable reproductive health services, including family planning, to contribute directly to the attainment of the Millennium Development Goals (MDGs). Although there has been considerable success in the health services, still more than 60% of the population does not have access to basic health care, despite the fact that many government health facilities at various levels are not being adequately utilized (MOHFW, 2003). This analysis aims to provide new ideas about ways of investigating levels of health care services that can be used by health service providers to target those women who don't receive professional health care services. Policy makers may also find the results helpful in developing policies targeting underserved women. In an overview of maternal health issues, data source and methods are discussed in section 2; section 3 discusses the results and concluding remarks are set out in section 4.

DATA AND METHODS

In this study, a total number of 900 female respondents have been questioned during the survey period in 2008 and this survey has been conducted under the authority of the Department of Population Science and Human Resource Development, University of Rajshahi. The respondents were interviewed by some selected questions from Fulbari Sadar Thana at Kurigram District in Bangladesh, by purposive sampling technique. In this study, the respondents are ever married women aged 13-49.

Various alternative statistical tools exist for analyzing the extent of maternal and child health care services over time. This study reports the results from percentage distribution, test of association, Yates Correction also make for 2×2 contingency analysis and multivariate logistic regression estimation. Logistic regression models are used to determine the relative effects of various characteristics on maternal and child health care services. The variables are presented in Table 1.


Table 1: List of variables used for logistics regression analysis:

RESULTS AND DISCUSSION

Women's low status in society, the poor quality of maternity care services, lack of trained providers, low uptake of services by women, and infrastructure and administrative difficulties all contribute to the high rate of maternal deaths (Haque et.al., 2007). Table 2 shows that the percentage distribution of some selected background characteristics of the respondents, more than fifty percent (55.6%) of respondents' age at marriage are under 18 years, a higher percentage (42.0%) of respondents are illiterate, 58.0% of women are literate but most of them know how to write their name only, 86.1% of respondents are housewives, about fifty percent (46.9%) respondents obtain their treatment in the traditional way (village doctor, kabiraj, traditional healer etc), 52.6% of respondents have not taken their medical check up during pregnancy period, 53.6% of respondents have not taken tetanus toxoid vaccination, and 40.6% have not given sal-milk to their new born babies and 98.0% of respondents are Muslims.


Table 2: Percentage distribution of women by some selected background characteristics

Table 2 also shows the socio-economic condition of the respondent's husbands; 40.2% respondents' husbands are illiterate, about 45.6% respondents' family monthly income are less than 2500 taka, 57.0% of families have no access to mass media and 31.2% of families consist of more than four members.

The above result reveals that the socio-demographic conditions of the rural people of Kurigram district are not so good. Therefore those peoples do not receive their maternal and health care services properly.



Table 3: Contingency analysis for medical check up during pregnancy period, tetanus toxoid vaccination and habit of giving sal-milk to the new born babies of the respondents

All the dependent variables (categorical) are significantly associated with the independent variables (categorical). The one exception is made in the case of respondents' occupation. However, we may say that these background characteristics of the respondents have significant effect on medical check up, tetanus toxoid vaccination during pregnancy period and giving sal-milk to new born babies.

To identify the contribution of the selected socio-demographic characteristics of the respondents on their medical check up, tetanus toxoid vaccination during pregnancy period and giving sal-milk to the new born babies, we make a multiple logistic regression analysis. The necessary findings are presented in Table 4.


Table 4: Results of logistic regression analysis on medical check up, tetanus toxoid vaccination during the pregnancy and habit of giving sal-milk to their new born babies of the respondents

From Table 4, it is observed that the selected socio-demographic variables are positively significantly associated with their medical check up, tetanus toxoid vaccination during pregnancy period and giving sal-milk to the new born babies of the respondents, but two exceptions have been found in the case of husbands' education and the nature of treatment of the respondents.
Firstly, the ever married women age at marriage 18 and above years have received medical check ups 1.96 times more, have received tetanus toxoid vaccination during pregnancy period 2.02 times more and had given sal-milk to their new born babies 2.09 times more than those of the age at marriage less than 18 years.

The literate women have received medical check up 1.8 times more, received tetanus toxoid vaccination during pregnancy period 1.6 times more and given sal-milk to their new born babies 1.5 times more than those of the illiterate women.

Family's monthly income indicates the economic condition of the respondent. We found that the respondents' family monthly income 2500-3500 taka and 3500+ taka have positively influenced medical check up, tetanus toxoid vaccination during pregnancy period and giving sal-milk to their new born babies. The respondents whose family monthly income 2500-3500 taka and more than 3500 taka have more likely received a medical check up, tetanus toxoid vaccination during pregnancy period and given sal-milk to their new born babies than those of the respondents whose monthly family income <2500 taka.

The non Muslim respondents 4.1, 4.2 and 4.0 times more receive medical check up, tetanus toxoid vaccination during pregnancy period and have the habit of giving sal-milk to their new born babies than those of the Muslim respondents.

Access to information is the determinant that raises women's awareness and helps to make decisions regarding medical check up during the pregnancy period, tetanus toxoid vaccination during pregnancy period and giving sal-milk to their new born babies. Radio and television are powerful media that play key roles in increasing the participation in medical check ups during pregnancy, tetanus toxoid vaccination during the pregnancy period and giving sal-milk to their new born babies. The women who have access to mass media such as radio or television are 1.58, 1.62 and 1.82 times more likely to receive medical check up, tetanus toxoid vaccination during pregnancy period and give sal-milk to their new born babies, respectively, than those of the women who have no access to the radio or television.

Again the respondents who have family members of 4 and above received medical check up, tetanus toxoid vaccination during pregnancy period and habit of giving sal-milk to their new born babies more than those of the respondents who have 2-3 family members.

CONCLUSION

In this study we consider that medical check up, tetanus toxoid vaccination during pregnancy period and the habit of giving sal-milk to new born babies, as maternal and child health care services. Different services of maternal and child health care are very poor at Kurigram district. A higher percentage of mothers have not had any medical check up, they have not received any tetanus toxoid vaccination during the pregnancy period as well as a good number of mothers have not been in the habit of giving Sal-milk to their newborn babies, which is very important for new born babies. This scenario focuses on the observation that a good number of respondents are not aware of the need for maternal and child health care. The socio-demographic and economic variables such as age at marriage, education, religion, family monthly income, access mass media and family member play important roles on maternal and child health care services. These identified variables are significantly associated with medical check up, tetanus toxic vaccination during pregnancy period and the habit of giving sal-milk to newborn babies. The probabilities of taking a medical check up during the pregnancy period, as well as tetanus toxoid vaccination and giving sal-milk to their new born babies of the women who are literate, age at marriage 18+ years and have access to mass media are significantly higher than those who are illiterate, age at marriage less than 18 years and have no access to mass media. To promote the use of health care services among the mothers, their socio-economical and demographical status should be improved. The policy makers need to take proper initiatives (or programs) for the improvement of reproductive health of the rural women in Bangladesh.

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