Introduction

Bangladesh is considered a developing country with more than 75% of the total (142 million) population living in rural areas. About 36% of the population continue to live below the national poverty line (<US$1/day). Basic needs of living particularly health and education remain largely unmet and only less than 40% of the population has access to basic healthcare.₁,₂ Most (97.6%) rural households have access to clean drinking water but only 33.9% households have access to improved latrine system. More than half (56%) of the rural population are landless.₃ Maternal mortality ratio is still very high (380/100,000 live births) with a lifetime risk of 1 in 59. Infant mortality rate (per 1000 live birth) and neonatal mortality rate (per 1000 live birth) are 56 and 36 respectively. In spite of government's policy of free healthcare, the average cost for uncomplicated vaginal delivery or emergency cesarean section beyond the monthly income of most of the population.₄

Rural Health Care Services Infrastructures in Bangladesh

Materials And Methods

Subjects and Settings

Study Design

Data Collection and Analysis

Results

Forty percent of the households were landless while 44.5% did not have any regular income. Only 1.7% families had a monthly income of more than Taka 5000 (USD 70), while 23.8% had from Taka 1000 (US$ 14) to Taka 2000 (US$ 28) per month. About 9% of the women had any income at all to support their families. All the respondents mentioned that tubewell (hand pump for safe drinking water) as main drinking water source but many of them washed utensils in pond water. Nearly half of the households did not have any latrine at all and used bush or open places for defecation. Seventy two percent of the women used soap to wash hands after defecation but hand-washing was often inappropriate. Sometimes they also used soil or ash when soap was not available.

About 20% women arranged some polythene sheets on which to give birth, and 42.1% gave birth on soil while 36.1% gave birth on a piece of mat. Only 7% of women had the opportunity to visit nearby satellite clinics or FWCs (Family Welfare Centers) accompanied by untrained TBA (Traditional Birth Attendants) or FWA (Family Welfare Assistants). Self-motivated sterilization was almost absent among all the women. Many of the participants disclosed that sterilizations were attended with financial allurement or sometimes forcibly, even under the threat of police. A summary of the socio-demographic and health status characteristics has been depicted in the following table:

Figure 1

Table 1: Socio-demographic and maternal health statistics (Total subjects: N=357)

Most of the respondents attended quacks or kabiraz (traditional healers) for general illnesses. Diarrhea was the most common disease experienced by participants. Of those affected by diarrhea, only 13.4% took ORS (Oral Rehydration Saline). Approximately, 75.1% women consumed fish once a week, 88.2% took meat once a month during any special occasion and 8.1% women reported that they ate meat only during the Eid-ul-Adha (a religious festival of the Muslims).

Discussion

The study results showed that women living in the two villages suffered from various general and maternal health complications mainly due to little access to healthcare facilities, inadequate nutritional status, lack of significant financial activities and lack of proper sanitation systems. Except tetanus toxoid immunization and contraceptive use, all other health indicators were found below satisfactory level in this study. Total formalized perinatal care services appeared to be of primitive level among the study population. Ill health, low income, lack of access to health education, proper sanitary systems, lack of clean water, and lack of other essential health care services were found predominant in this study. On a positive note significant portion of the population had adequate access to clean drinking water in the study areas.

It is evident that about 12,000 women die from maternal causes each year in Bangladesh.₇ Moreover, nearly 37% of rural women in the country are considered as thin or malnourished (body mass index <18.5 kg/m²).₈ Previous study showed that only a small percentage of households regularly consume animal foods, vegetables and other good sources of micronutrients in Bangladesh.₉ The present study further showed that women in these two villages also took inadequate food stuffs during the study period. Available reports suggested that nearly half (49.1%) of the rural women did not receive any type of ANC during pregnancy for the most recent birth in Bangladesh. The proportion of pregnant women receiving tetanus toxoid immunization has risen substantially to 84.2% in Bangladesh.₅ Results of the presents study also showed similar rates of tetanus immunization among women.

In Bangladesh, most (93.2%) of the deliveries in rural areas took place at home and the remainder at public health facilities.₆ Recent data showed that around 75.5% care services were attended by untrained TBA and friends or other relatives. The present study also showed nearly equal incidents of pregnancy care services. Only 13.1% children and 13.5% mothers are said to receive postnatal care (PNC) from a trained provider within 42 days of delivery in the country. Contraceptive prevalence rate in rural Bangladesh is 52.3%, whereas the present study showed about 55% of contraceptive uses among rural women. Many (78.7%) of the rural women are not involved in any type of income-generating activities.₅ Truly, this fact was revealed in the present study where only 9% women had self income capabilities.

Limitations Of The Study

Acknowledgements