Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades
Abstract Background Maternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across s...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-023-05754-8 |
| _version_ | 1797806441415835648 |
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| author | Syed Sharaf Ahmed Chowdhury Satyajit Kundu Azaz Bin Sharif |
| author_facet | Syed Sharaf Ahmed Chowdhury Satyajit Kundu Azaz Bin Sharif |
| author_sort | Syed Sharaf Ahmed Chowdhury |
| collection | DOAJ |
| description | Abstract Background Maternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across socioeconomic and geographic regions. Therefore, we aim to estimate the trends and magnitude of inequality in SBA use in Bangladesh over the last two decades. Methods Data from the last 5 rounds of Bangladesh Demographic and Health Surveys (BDHS; 2017-18, 2014, 2011, 2007, and 2004) were used to measure the inequalities in the SBA use utilizing the WHO’s Health Equity Assessment Toolkit (HEAT) software. Inequality was assessed by four summary measures, namely, Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) based on the four equity dimensions: wealth status, education level, place of residence, and subnational regions (divisions). Point estimates and a 95% confidence interval (CI) were reported for each measure. Results An increasing trend in the overall prevalence of SBA use was observed (From 15.6% in 2004 to 52.9% in 2017). We found significant inequalities in SBA use in every wave of BDHS (from 2004 to 2017), with the result concentrating on the rich (in 2017, PAF: 57.1; 95% CI: 52.5–61.7), educated (in 2017, PAR: 9.9; 95% CI: 5.2–14.5), and people from urban areas (in 2017, PAF: 28.0; 95% CI: 26.4–29.5). We also identified geographic disparities in SBA use favoring Khulna and Dhaka divisions (in 2017, PAR: 10.2; 95% CI: 5.7–14.7). Our study also observed inequality in using SBA among Bangladeshi women decreased over time. Conclusion To increase SBA use and to decrease inequality in all four equity dimensions, disadvantaged sub-groups should be prioritized in policies and planning for program implementation. |
| first_indexed | 2024-03-13T06:07:22Z |
| format | Article |
| id | doaj.art-77f47b7af5ad4669880047dc79ea4d7d |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-03-13T06:07:22Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-77f47b7af5ad4669880047dc79ea4d7d2023-06-11T11:28:07ZengBMCBMC Pregnancy and Childbirth1471-23932023-06-012311810.1186/s12884-023-05754-8Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decadesSyed Sharaf Ahmed Chowdhury0Satyajit Kundu1Azaz Bin Sharif2Department of Public Health, North South UniversityGlobal Health Institute, North South UniversityDepartment of Public Health, North South UniversityAbstract Background Maternal and neonatal mortality is a major public health concern globally. Evidence supports that skilled birth attendants (SBA) can significantly reduce maternal and neonatal mortality. Despite the improvement in SBA use, Bangladesh lacks evidence of equality in SBA use across socioeconomic and geographic regions. Therefore, we aim to estimate the trends and magnitude of inequality in SBA use in Bangladesh over the last two decades. Methods Data from the last 5 rounds of Bangladesh Demographic and Health Surveys (BDHS; 2017-18, 2014, 2011, 2007, and 2004) were used to measure the inequalities in the SBA use utilizing the WHO’s Health Equity Assessment Toolkit (HEAT) software. Inequality was assessed by four summary measures, namely, Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D), and Ratio (R) based on the four equity dimensions: wealth status, education level, place of residence, and subnational regions (divisions). Point estimates and a 95% confidence interval (CI) were reported for each measure. Results An increasing trend in the overall prevalence of SBA use was observed (From 15.6% in 2004 to 52.9% in 2017). We found significant inequalities in SBA use in every wave of BDHS (from 2004 to 2017), with the result concentrating on the rich (in 2017, PAF: 57.1; 95% CI: 52.5–61.7), educated (in 2017, PAR: 9.9; 95% CI: 5.2–14.5), and people from urban areas (in 2017, PAF: 28.0; 95% CI: 26.4–29.5). We also identified geographic disparities in SBA use favoring Khulna and Dhaka divisions (in 2017, PAR: 10.2; 95% CI: 5.7–14.7). Our study also observed inequality in using SBA among Bangladeshi women decreased over time. Conclusion To increase SBA use and to decrease inequality in all four equity dimensions, disadvantaged sub-groups should be prioritized in policies and planning for program implementation.https://doi.org/10.1186/s12884-023-05754-8Skilled birth attendantMaternal healthInequalitiesBangladeshBDHS |
| spellingShingle | Syed Sharaf Ahmed Chowdhury Satyajit Kundu Azaz Bin Sharif Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades BMC Pregnancy and Childbirth Skilled birth attendant Maternal health Inequalities Bangladesh BDHS |
| title | Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades |
| title_full | Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades |
| title_fullStr | Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades |
| title_full_unstemmed | Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades |
| title_short | Socioeconomic and geographical inequalities in using skilled birth attendants during delivery in Bangladesh over two decades |
| title_sort | socioeconomic and geographical inequalities in using skilled birth attendants during delivery in bangladesh over two decades |
| topic | Skilled birth attendant Maternal health Inequalities Bangladesh BDHS |
| url | https://doi.org/10.1186/s12884-023-05754-8 |
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