Academic journal article Journal of Health Population and Nutrition

Review of Domiciliary Newborn-Care Practices in Bangladesh

Academic journal article Journal of Health Population and Nutrition

Review of Domiciliary Newborn-Care Practices in Bangladesh

Article excerpt


Each year, approximately four million babies die during the first 28 days of life (i.e. neonatal mortality), and another three million are stillborn (dying between 28 weeks of gestation and birth). Neonatal mortality now accounts for approximately two-thirds of all infant mortality and 38% of deaths of children aged less then five years (under-five mortality) (1). Ninety-nine percent of these deaths occur in middle- and low-income countries with half of deliveries occurring in home (2).

The neonatal mortality rate in Bangladesh is relatively high (41 per 1,000 livebirths in 2003), with most of the estimated 170,000 annual deaths occurring due to infections, birth asphyxia, and complications of prematurity and low birth-weight (LBW) (1,3). This figure has shown an extremely slow decline over the years. In the time period ranging from 1995 to 1999, the neonatal mortality rate in Bangladesh was 42 per 1,000 livebirths, from 1992 to 1996 it was 48 per 1,000 livebirths, and from 1989 to 1993 it was 52 per 1,000 livebirths (3).

More than 90% of births and neonatal deaths occur at home, generally with little-to-no involvement of the formal healthcare system. Traditional birth attendants (TBAs) attend 75.6%, relatives predominantly attend 10.8%, and medically-trained personnel attend 11.6% of deliveries (4).

Most neonatal deaths can be avoided through simple, affordable interventions, especially in areas with weak health systems and high rates of neonatal mortality. Outreach and family-community care, health education to improve home-care practices, recognition of danger signs, generation of demand for skilled care, and increased health-seeking behaviour can lead to significant reductions in neonatal mortality (5). A programme executed under the five-year Health and Population Sector Programme (HPSP) of the Government of Bangladesh which concentrated on reproductive and child-health services, limited curative care, and behaviour change communication showed a significant reduction in neonatal mortality from 36.8 per 1,000 livebirths in 1999 to 15.1 per 1,000 livebirths in 2002 (6). Given this context, understanding the domiciliary newborn-care practices and care-seeking for illness are of paramount importance for developing strategies, including behaviour change communications, to prevent these deaths.

Formative research on community newborn-care practices and care-seeking behaviour is required to provide the foundation on which behaviour change-communication programmes can be designed and implemented (7). Such research will need to address the practices of the mother, her nuclear family, TBAs, traditional healers, and formal health providers and facilities. It also must explore the various social, cultural, religious, and economic factors that influence such practices.

The Saving Newborn Lives Initiative (SNLI) of Save the Children-USA undertook a review of maternal and newborn-healthcare practices, specifically: (a) Domiciliary practices: Current maternal and newborn-care practices and behaviours at the community and household levels that directly affect newborn health; (b) Attitudes and beliefs: Behavioural determinants of newborn-care practices, including a review of socio-cultural and religious beliefs, and economic determinants behind particular practices; (c) Decision-making: Roles of various individuals (mother, father, mother-in-law, extended family members, neighbours) involved in decision-making about the care of a newborn, including decisions about routine care of a well newborn and decisions relating to the care of a sick newborn. The primary influences, which impact the decision-making process, were also delineated; and (d) Health-seeking behaviour: We sought information on characteristics of those families who elect to use the formal health sector and those who do not. The types of conditions or illnesses that would lead a family to seek care and the type of care they would seek (e. …

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