Determinants and pattern of care seeking for preterm newborns in a rural Bangladeshi cohort

Abstract

BackgroundDespite the increased burden of preterm birth and its complications, the dearth of care seeking data for preterm newborns remains a significant knowledge gap. Among preterm babies in rural Bangladesh, we examined: 1) determinants and patterns of care seeking, and 2) risk analysis for care-seeking from qualified and unqualified providers.MethodTrained community health workers collected data prospectively from 27,460 mother-liveborn baby pairs, including 6,090 preterm babies, between June 2007 and September 2009. Statistical analyses included binomial and multinomial logistic regressions.ResultsOnly one-fifth (19.7%) of preterm newborns were taken to seek either preventive or curative health care. Among care-seeker preterm newborns, preferred providers included homeopathic practitioners (50.0%), and less than a third (30.9%) sought care from qualified providers. Care-seeking from either unqualified or qualified providers was significantly lower for female preterm babies, compared to male babies [Relative Risk Ratio (RRR) for unqualified care: 0.68; 95% Confidence Interval (CI): 0.58, 0.80; RRR for qualified care: 0.52; 95% CI: 0.41, 0.66]. Among preterm babies, care-seeking was significantly higher among caregivers who recognized symptoms of illness [RR: 2.14; 95% CI: 1.93, 2.38] or signs of local infection (RR: 2.53; 95% CI: 2.23, 2.87), had a history of child death [RR: 1.21; 95% CI: 1.07, 1.37], any antenatal care (ANC) visit [RR: 1.41; 95% CI: 1.25, 1.59]. Birth preparedness (RRR: 1.24; 95% CI: 1.09, 1.68) and any ANC visit (RRR: 1.73; 95% CI: 1.50, 2.49) were also associated with increased likelihood of care seeking for preterm babies from qualified providers.ConclusionTo improve care seeking practices for preterm babies and referral of sick newborns to qualified providers/facilities, we recommend: 1) involving community-preferred health care providers in community-based health education and awareness raising programs; 2) integrating postnatal care seeking messages into antenatal counselling; and 3) further research on care seeking practices for preterm babies.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-417) contains supplementary material, which is available to authorized users.

The Profile, Health Seeking Behavior, Referral Patterns, and Outcome of Outborn Neonates Admitted to a District and Regional Hospital in the Upper West Region of Ghana: A Cross-Sectional Study

“…It is reassuring to note that the majority of the patients sought care in a health facility and only a few patients sought care from an alternate source. This is in contrast to other studies which showed that most mothers preferred to visit untrained health providers [11,12,23]. A study in Ghana also showed that while 61% of caregivers sought care for sick neonates, only 39% sought the care of a doctor [29].…”

“…This ranges from the awareness of danger signs, essential newborn care practices, personal and communal beliefs, health and socio-cultural practices, as well as financial and physical access to health services [5,[7][8][9][10][11]. The level of service that is readily available close to them can also affect health [9,10,12]. Thus, the robustness of the referral system, the type of care that is available, and the providers at each level, from home to hospital, are important determinants of neonatal outcome [1,[11][12][13][14][15].…”

“…The level of service that is readily available close to them can also affect health [9,10,12]. Thus, the robustness of the referral system, the type of care that is available, and the providers at each level, from home to hospital, are important determinants of neonatal outcome [1,[11][12][13][14][15]. We examined the health practices, care seeking behavior, and selected aspects of the processes involved in the referral of outborn neonates to a district and a regional hospital in the Upper West Region of Ghana, the region with the most rural population during the last census in 2010, in order to identify care barriers in this and similar settings.…”

Caregiver acceptability of the guidelines for managing young infants with possible serious bacterial infections (PSBI) in primary care facilities in rural Bangladesh

“…When selecting caregivers for participation in the FGDs we originally tried to select caregivers of young infants (0-59 days) since this age group is the focus of the intervention. However, we had difficulty recruiting mothers with infants in this age group because many women in rural Bangladesh predominantly spend their time at home the first two months postpartum, which limits their ability to join a group discussion in the community [23,44]. We adjusted our inclusion criteria to allow mothers of infant under 6 months of age to participate in the FGDs.…”

“…In Bangladesh, healthcare services are sought from a mix of sources including public and private providers in both the formal and informal sector, as well as traditional medicine [19][20][21]. Rural and disadvantaged populations in Bangladesh commonly first seek care from a wide array of informal providers including village doctors, traditional healers, drug sellers, and homeopathic doctors [18,19,22,23]. Village doctors are prominent providers in rural communities-approximately 12.5 per 10,000 population.…”