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Quality of care during childbirth at public health facilities in Bangladesh: a cross-sectional study using WHO/UNICEF ‘Every Mother Every Newborn (EMEN)’ standards

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Billah, Sk Masum, Chowdhury, Mohiuddin Ahsanul Kabir, Khan, Abdullah Nurus Salam, Karim, Farhana, Hassan, Aniqa, Zaka, Nabila, Arifeen, Shams El and Manu, Alexander ORCID: https://orcid.org/0000-0001-5230-6413 (2019) 'Quality of care during childbirth at public health facilities in Bangladesh: a cross-sectional study using WHO/UNICEF ‘Every Mother Every Newborn (EMEN)’ standards'. BMJ Open Quality, Vol 8, Issue 3, e000596.

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Abstract

Background This manuscript presents findings from a
baseline assessment of health facilities in Bangladesh
prior to the implementation of the ‘Every Mother Every
Newborn Quality Improvement’ initiative.
Methodology A cross-sectional survey was conducted
between June and August 2016 in 15 government health
facilities. Structural readiness was assessed by observing
the physical environment, the availability of essential drugs
and equipment, and the functionality of the referral system.
Structured interviews were conducted with care providers
and facility managers on human resource availability and
training in the maternal and newborn care. Observation of
births, reviews of patient records and exit interviews with
women who were discharged from the selected health
facilities were used to assess the provision and experience
of care.
Results Only six (40%) facilities assessed had designated
maternity wards and 11 had newborn care corners. There
were stock-outs of emergency drugs including magnesium
sulfate and oxytocin in nearly all facilities. Two-thirds of
the positions for medical officers was vacant in district
hospitals and half of the positions for nurses was vacant
in subdistrict facilities. Only 60 (45%) healthcare providers
interviewed received training on newborn complication
management. No health facility used partograph for labour
monitoring. Blood pressure was not measured in half
(48%) and urine protein in 99% of pregnant women. Only
27% of babies were placed skin to skin with their mothers.
Most mothers (97%) said that they were satisfied with the
care received, however, only 46% intended on returning to
the same facility for future deliveries.
Conclusions Systematic implementation of quality
standards to mitigate these gaps in service readiness,
provision and experience of care is the next step to
accelerate the country’s progress in reducing the maternal
and neonatal deaths.

Item Type: Article
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WQ Obstetrics > WQ 100 General works
WQ Obstetrics > WQ 20 Research (General)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjoq-2018-000596
Depositing User: Rachel Dominguez
Date Deposited: 07 Oct 2019 10:42
Last Modified: 07 Oct 2019 10:42
URI: https://archive.lstmed.ac.uk/id/eprint/12663

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