Background A growing literature highlights the increased risk of stunting among children growing up in informal or slum settlements. Despite relatively high rates of female labor force participation in slums, there is limited evidence on relationship between mother’s work participation and nutritional outcomes of children in these settings. Methods We conducted a cross-sectional study in two large slums (Korail and Tongi) of Dhaka and Gazipur, Bangladesh to assess the association between maternal work and childhood stunting in a low-income urban context. Logistic regression models estimated unconditional and conditional associations between maternal work status and 1) child stunting, 2) child morbidity and dietary intake, and 3) health and hygiene behaviors. Subgroup analyses were done by type of child care support available. Results After adjusting for variations in individual and household level characteristics, we found that children of working mothers had nearly twice the odds of being stunted than children of non-working mothers (OR 1.84, 95%CI 1.05-3.23). Large differences in stunting were found by available care support: compared to children of non-working mothers, children of working mothers with nuclear-type family support had 4.5 times increased odds of stunting (OR 4.49, 95%CI 1.81-11.12), while no odds differential was found for children of working mothers with an extended-type family support (OR 0.69, 95%CI 0.30-1.59). Conclusions Maternal employment is associated with a substantial increase in the odds of child stunting in the slum areas studied. Given that these effects only appear to arise in the absence of adequate family support, integrating appropriate childcare support measures for low-income urban working mothers might be an effective strategy to help reduce the prevalence of chronic undernutrition among slum children.

Background and Objective: With the growing concern over treatment cost in health care and the desire to improve the effectiveness and equality of healthcare financing and the quality of the care, policy-makers have turned their attention to health insurance, especially, for the poor. This study attempted to determine the willingness to pay for health insurance among the mothers who utilized the urban primary health care clinic (UPHCC) for maternal and child health. Methods: This cross-sectional study was carried out in the working areas of UPHC Project in Bangladesh following two-stage cluster sampling technique to select the participants. Data were collected from 3949 women aged 15-49 years having at least one child aged two years or less. The data on willingness to pay for health insurance was collected using the contingent valuation method with bidding style. Data analysis was done by SPSS 22.0 version. Two generalized linear models with binary logit link function and normal identity link function were developed to identify the potential predictors for willingness to pay for monthly health insurance. Results: Three-fifths (67.5%) of the respondents agreed to pay for monthly health insurance. The median monthly premium for health insurance was BDT 15.5. Multivariate analysis revealed that utilization of UPHC clinic, quality of life, family size, age, wealth index, level of education, husband and respondent’s occupation, ownership status of the house, religion and family income appeared to be potential predictors for health insurance (p<0.05). However, utilization of UPHC clinic and quality of life appeared to be important predictors across all the models. Conclusion: A large proportion of the community agreed to pay premium for health insurance. Based on the finding of the current study the policy makers might consider introducing a scheme for health insurance especially among the urban poor. Bangladesh Journal of Medical Science Vol.19(3) 2020 p.433-443

Background: Although Bangladesh substantially reduced 40% maternal death in the last decades, it is still challenging, especially among the urban poor. The achievements are not equitable between different economic quintiles and between the rich and the urban poor. This study aims to examine the extent to which the entitlement card affects the utilization of maternal and child health care and identifies other factors that influence MCH services. Subjects and Method: This cross-sectional study was carried out in the working areas of the Urban Primary Healthcare Project (UPHCP) in Bangladesh. A two-stage cluster sampling technique was used to select the participants. A total of 3,949 women aged 15-49 years, having at least one child aged two years or less were selected for this study. The data were collected through faceto-face interviews. The data were analyzed using multinomial logistic regression. Results: The proportion of utilization of UPHCC was 49.9%. One-fourth (26.6%) of them fully utilized it and another 23.3% utilized it partially.Stepwise multinomial logistic regression analysis revealed that those who had an Entitlement Card from the UPHC project were 11.75 times (95% CI= 9.481, 14.549; p= 0.001) more likely to fully Utilized and 3.64 times (95% CI= 3.643, 2.911; p= 0.001) likely be utilized partially compared to non-utilizer. Respondents having no formal education utilized UPHCC fully (AOR=2.32; 95% CI= 1.46, 3.68; p= 0.001) and partially (AOR= 1.76; 95% CI= 1.12, 2.77; p= 0.014) used UPHCC. It was 3.08 (95% CI= 2.03, 4.67; p= 0.001) times for fully and 2.71 (95% CI= 1.82, 4.04; p= 0.001) times for partially utilized UPHCC compared to non-users among the primary level of education. Small family size (≤4) and monthly family income in the range of BDT 10,000 above were likely to utilise UPHCC. However, non-Muslims were less likely to Utilized UPHCC. Conclusion: Apart from the entitlement card, other factors such as monthly income BDT> 10,000, small family size, no formal educated mother appeared to be potential predictors for utilization of the Urban Primary Health care clinic.

Background. Patient's satisfaction with health care facilities and services is one of the indicators to assess quality health care. Objectives. This study was intended to assess the level of satisfaction with delivery care and its associated factors among the mothers who delivered their child at health facilities in the urban areas of Bangladesh. Material and methods. This was a cross-sectional study conducted among women aged 15-49 years having at least one child aged two years living in an Urban Primary Health Care Project area. A total of 3949 women were interviewed. A two-stage cluster sampling technique was adopted to select the participants. Multinomial regression analysis was carried out to identify the potential predictors of level of satisfaction with delivery care. Results. The analysis revealed that the women were least satisfied with accessibility and quality of services provided during delivery care. They were satisfied with availability, support services and interpersonal communication of the health facility. Multinomial regression analysis revealed that the satisfaction level among women who received post-delivery counseling from the non-poor catchment area was 6.98 times higher, compared to 5.88 times who received such counseling from the poor catchment area. However, women from poor families appeared to be highly satisfied with delivery care in the poor catchment area (p < 0.001). Conclusions.Although the study revealed that the women were satisfied overall with the delivery of care, there is still much work needed to be done in the area of providers' work quality, interpersonal communication such as behavioral issues, and accessibility to the health services.

Maternal mortality and its associated complications can be avoided by ensuring safe and supervised delivery. In this paper, the authors examined the factors associated with the utilisation of institutional delivery care at the Urban Primary Health Care Project (UPHCP) clinic in Bangladesh. A two-stage cluster sampling was used in selecting the ever-married women aged 15-49 years in the catchment areas of the UPHCP in Bangladesh. A total of 3,949 women’s data were analysed. The authors collected data through face-to-face interviews using a structured questionnaire. A multinomial logistic regression analysis was done to determine the potential factors associated with the utilisation of delivery care, in which ‘place of delivery care’ was considered as a dependent variable. Data entry and analysis were done in Statistical Package for the Social Sciences version 22.0. This study found that 30% of the women delivered their most recent child at the UPHCP clinic, and 45.9% of the women delivered their most recent child at other institutions. However, one-fifth of the women delivered at home. Doctors attended two-thirds of the deliveries. A small proportion of women were tended to by nurses, paramedics, FWV, and FWA. Traditional birth attendants attended one-fifth (20%) of deliveries. The multinomial logistic regression analysis found that respondents from poor catchment areas were 33.677 times more likely to utilise delivery care at the UPHCP when compared to 12.052 times by the respondents who took previous antenatal care from the non-poor catchment area. This study also found that women who had entitlement cards were 6.840 times more likely to utilise delivery care at the UPHCP in the poor catchment area, which was almost twice the women from the non-poor catchment area. Although the maternal mortality rate in Bangladesh has notably reduced,Bangladesh still needs to address the issue of safe delivery for marginalised women in order to attain the Sustainable Development Goals (SDGs) by 2030. A red card approach might increase access to the UPHCP for marginalised women to have safe deliveries.Keywords: poor, urban, red card, delivery care, Urban Primary Health Care Project, Bangladesh