Effect of an integrated maternal and neonatal health intervention on maternal healthcare utilisation addressing inequity in Rural Bangladesh

Anisuddin Ahmed; Fariya Rahman; Abu Sayeed; Tania Sultana Tanwi; Abu Bakkar Siddique; Aniqa Tasnim Hossain; Saraban Tahura Ether; Ema Akter; Tazeen Tahsina; Syed Moshfiqur Rahman; Shams El Arifeen; Ahmed Ehsanur Rahman

doi:10.1186/s13690-023-01155-7

Effect of an integrated maternal and neonatal health intervention on maternal healthcare utilisation addressing inequity in Rural Bangladesh

Arch Public Health. 2023 Aug 22;81(1):153. doi: 10.1186/s13690-023-01155-7.

Affiliations

¹ Department of Women's and Children's Health, Uppsala University, Uppsala, 75205, Sweden. anisuddin.ahmed@kbh.uu.se.
² International Centre for Diarrheal Disease Research, Bangladesh, Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh. anisuddin.ahmed@kbh.uu.se.
³ International Centre for Diarrheal Disease Research, Bangladesh, Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh.
⁴ Department of Women's and Children's Health, Uppsala University, Uppsala, 75205, Sweden.

Abstract

Background: Although Bangladesh has made significant improvements in maternal, neonatal, and child health, the disparity between rich and poor remains a matter of concern.

Objective: The study aimed to increase coverage of skilled maternal healthcare services while minimising the inequity gap among mothers in different socioeconomic groups.

Methods: We implemented an integrated maternal and neonatal health (MNH) intervention between 2009 and 2012, in Shahjadpur sub-district of Sirajganj district, Bangladesh. The study was quasi-experimental in design for the evaluation. Socioeconomic status was derived from household assets using principal component analysis. Inequity in maternal healthcare utilisation was calculated using rich-poor ratio and concentration index to determine the changes in inequity between the baseline and the endline time period.

Result: The baseline and endline surveys included 3,158 (mean age 23.5 years) and 3,540 (mean age 24.3 years) recently delivered mothers respectively. Reduction in the rich-poor ratio was observed in the utilisation of skilled 4+ antenatal care (ANC) (2.4:1 to 1.1:1) and related concentration index decreased from 0.220 to 0.013 (p < 0.001). The rich-poor ratio for skilled childbirth reduced from 1.7:1 to 1.0:1 and the related concentration index declined from 0.161 to -0.021 (p < 0.001). A similar reduction was also observed in the utilisation of skilled postnatal care (PNC); where the rich-poor gap decreased from 2.5:1 to 1.0:1 and the related concentration index declined from 0.197 to -0.004 (p < 0.001).

Conclusion: The MNH intervention was successful in reducing inequity in receiving skilled 4+ ANC, delivery, and PNC in rural Bangladesh.

Keywords: 4+ ANC check-up; Bangladesh; Maternal health; Neonatal Health; Skilled ANC visit; Skilled Healthcare Provider; Skilled PNC; Skilled delivery.