The aim of the study was to review the complications, management and outcome of pregnancy in carriers of haemophilia over a 10-year period following the introduction of a multidisciplinary management guideline. Comparison was made to a 10-year cohort prior to implementation of the guidelines. A retrospective review of case notes of carriers of haemophilia (41 haemophilia A, 12 haemophilia B) who had received obstetric care at the Royal Free Hospital between 1995 and 2005 was conducted. There were 90 pregnancies (65 live births, 13 miscarriages, 12 terminations). Prenatal testing was taken up in 97% (63/65) of pregnancies where the mother was known to be a carrier of haemophilia. The majority (71%; 46/65) chose only to have non-invasive fetal sex determination. Seventeen (26%) had invasive testing (13 primarily for haemophilia and four primarily for chromosomal abnormalities). Termination of pregnancy was opted for in 67% (6/9) of pregnancies affected with haemophilia. Pregnancy was accompanied by a marked rise in factor VIII levels compared to only a small rise in factor IX levels. Invasive intrapartum monitoring techniques and instrumental deliveries were avoided in all pregnancies known to be at risk of haemophilia. Regional block was performed in 25 pregnancies for labour/delivery with no complications. The caesarean section rate was 47%. The incidence of primary and secondary postpartum haemorrhage was 19% and 2%, respectively. There were two neonatal head bleeding complications associated with prolonged labour or instrumental delivery. Availability of management guideline and care provided in a multidisciplinary approach can help to minimize bleeding complications in carriers of haemophilia and their newborns.

BackgroundIn 2011, the Bangladesh Government introduced the National Nutrition Services (NNS) by leveraging the existing health infrastructure to deliver nutrition services to pregnant woman and children. This study examined the quality of nutrition services provided during antenatal care (ANC) and management of sick children younger than five years.MethodsService delivery quality was assessed across three dimensions; structural readiness, process and outcome. Structural readiness was assessed by observing the presence of equipment, guidelines and register/reporting forms in ANC rooms and consulting areas for sick children at 37 primary healthcare facilities in 12 sub-districts. In addition, the training and knowledge relevant to nutrition service delivery of 95 healthcare providers was determined. The process of nutrition service delivery was assessed by observing 381 ANC visits and 826 sick children consultations. Satisfaction with the service was the outcome and was determined by interviewing 541 mothers/caregivers of sick children.ResultsStructural readiness to provide nutrition services was higher for ANC compared to management of sick children; 73% of ANC rooms had >5 of the 13 essential items while only 13% of the designated areas for management of sick children had >5 of the 13 essential items. One in five (19%) healthcare providers had received nutrition training through the NNS. Delivery of the nutrition services was poor: <30% of women received all four key antenatal nutrition services, 25% of sick children had their weight checked against a growth-chart and <1% had their height measured. Nevertheless, most mothers/caregivers rated their satisfaction of the service above average.ConclusionsStrengthening the provision of equipment and increasing the coverage of training are imperative to improve nutrition services. Inherent barriers to implementing nutrition services in primary health care, especially high caseloads during the management of sick under-five children, should be considered to identify alternative and appropriate service delivery platforms before nationwide scale up.

BackgroundInitiation of breastfeeding within one hour of birth can avert 22% of newborn mortality. Several factors influence breastfeeding practice including mothers’ socio-demographic and obstetric characteristics, and factors related to time around child birth. This study explores breastfeeding initiation practices and associated influencing factors for initiating breastfeeding within one hour of birth in public health facilities of Bangladesh.MethodsIn this study, normal deliveries were observed in 15 public health facilities from 3 districts in Bangladesh. Study participants were selected by convenient sampling i.e. delivery cases attending health facilities during the study period were selected excluding caesarean section deliveries. Among 249 mothers, time of initiation of breastfeeding was observed and its association was measured with type of health facility, privacy in delivery room, presence of separate staff for newborn, spontaneous breathing, skin-to-skin contact and postnatal contact of mother or newborn with health care providers within one hour after delivery. Data was collected during August-September, 2016. Kruskal-Wallis test was used to measure equality of median duration of breastfeeding initiation time among two or more categories of independent variables. Series of simple logistic regressions were conducted followed by multiple logistic regression to identify the determinants for breastfeeding initiation within one hour.ResultsAmong 249 mothers observed, 67% initiated breastfeeding within one hour of birth at health facilities and median time to initiate breastfeeding was 38 minutes (Inter-quartile range: 20–56 minutes). After controlling for maternal age as potential confounder, the odds of initiating breastfeeding within one hour of birth was significantly higher if mothers gave birth in district hospitals (AOR 3.5: 95% CI 1.5, 6.4), visual privacy was well-maintained in delivery room (AOR 2.6: 95% CI 1.2, 4.8), newborns cried spontaneously (AOR 4.9: 95% CI 3.4, 17.2), were put to skin-to-skin contact with mothers (AOR 3.4: 95% CI 1.9, 10.4) or were examined by health care providers in the facilities (AOR 2.4: 95% CI 1.3, 12.9).ConclusionsIn health facilities, initiation of breastfeeding within one hour is associated with some critical practices and events around the time of birth. With the global push toward facility-based deliveries, it is very important to identify those key factors, within the landscape of maternal and newborn care, which significantly enable health care providers and parents to engage in the evidence-based newborn care activities including early initiation of breastfeeding that will, in turn, reduce global rates of newborn mortality.

Postpartum depression (PPD) is a serious pubic health concern and known to have the adverse effects on mother’s perinatal wellbeing; and child’s physical and cognitive development. There were limited literatures on PPD in Bangladesh, especially in urban slum context. The aim of this study was to assess the burden and risk factors of PPD among the urban slum women. A cross-sectional study was conducted between November-December 2017 in three urban slums on 376 women within first 12 months of postpartum. A validated Bangla version of Edinburgh Postnatal Depression Scale was used to measure the depression status. Respondent’s socio-economic characteristics and other risk factors were collected with structured validated questionaire by trained interviewers. Unadjusted Prevalence Ratio (PR) and Adjusted Prevalence Ratio (APR) were estimated with Generalized Linear Model (GLM) and Generalized Estimating Equation (GEE) respectively to identify the risk factors of PPD. The prevalence of PPD was 39.4% within first 12 months following the child birth. Job involvement after child delivery (APR = 1.9, 95% CI = 1.1, 3.3), job loss due to pregnancy (APR = 1.5, 95% CI = 1.0, 2.1), history of miscarriage or still birth or child death (APR = 1.4, 95% CI = 1.0, 2.0), unintended pregnancy (APR = 1.8, 95% CI = 1.3, 2.5), management of delivery cost by borrowing, selling or mortgaging assets (APR = 1.3, 95% CI = 0.9, 1.9), depressive symptom during pregnancy (APR = 2.5, 95% CI = 1.7, 3.8) and intimate partner violence (APR = 2.0, 95% CI = 1.2, 3.3), were identified as risk factors. PPD was not associated with poverty, mother in law and any child related factors. The burden of postpartum depression was high in the urban slum of Bangladesh. Maternal mental health services should be integrated with existing maternal health services. Research is required for the innovation of effective, low cost and culturally appropriate PPD case management and preventive intervention in urban slum of Bangladesh.

Background Breastfeeding within one hour of birth is a critical component of newborn care and is estimated to avert 22% of neonatal mortality globally. Understanding the determinants of early initiation of breastfeeding (EIBF) is essential for designing targeted and effective breastfeeding promotion programmes. The aim of this study was to determine the prevalence and determinants of early initiation of breastfeeding among Bangladeshi women. Methods This paper analyses the data from the Bangladesh Demographic and Health Survey, 2014. Analysis was based on responses of women who had at least one live birth in the two years preceding the survey (n = 3,162) collected using a structured questionnaire. The primary outcome was breastfeeding initiation within one hour of birth ascertained by women’s self-report. Explanatory variables included woman’s age, education, religion, household wealth, place of residence and place of delivery, birth order, child’s size, antenatal care (ANC), postnatal care (PNC) and skin-to-skin contact. Associations between variables were assessed by simple and multivariable logistic regressions. Results Of the 3,162 recently delivered mothers, 51% initiated breastfeeding within one hour of delivery. Prevalence of EIBF varied significantly between different types of mode of delivery, among different geographical regions and among women who had PNC with their newborn. Women who had caesarean section (C-section) were less likely to initiate breastfeeding early after birth than women who had normal vaginal delivery (NVD) (AOR: 0.32, 95% CI 0.23 0.43; p value < 0.001). Women who had received PNC with their newborns within one hour of delivery were more likely to breastfeed their babies within one hour of birth compared to those who did not (AOR: 1.61, 95% CI 1.26 2.07; p value < 0.001). Mother’s age, education, religion, household wealth index, place of residence and place of delivery, birth order, number of antenatal visits, child’s size and skin-to-skin contact were not significantly associated with EIBF. Conclusions Findings from this study suggest that investing more effort in ensuring immediate PNC of mother-newborn pair can increase EIBF. Solutions should be explored to increase EIBF among mothers who undergo C-section as C-section is rising rapidly in Bangladesh. Further research is needed to explore the regional differences in the country, including specific cultural practices that influence EIBF.