Comparing trends of perinatal mortality in two rural areas of Matlab, Bangladesh

2020 ◽  
Vol 35 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Aminur Rahman ◽  
Anne Austin ◽  
Iqbal Anwar ◽  
Surasak Taneepanichskul
Keyword(s):  
Adolescent Pregnancy ◽  
Adolescent Mothers ◽  
Rural Areas ◽  
Maternal Education ◽  
Perinatal Death ◽  
Diarrhoeal Disease ◽  
Adolescent Mother ◽  
Age At First Birth ◽  
Content Type ◽  
Service Areas

PurposeSixteen million adolescents give birth each year, constituting 11% of all births worldwide. Adverse adolescent pregnancy outcomes are well-documented. Available data on adolescent pregnancies have mainly relied on self-reported age and retrospective survey data, which might not capture adolescent births accurately. This paper reports on trends in adolescent pregnancy and associated adverse birth outcomes in Matlab, Bangladesh, using data from the Matlab Heath and Demographic System (HDSS) which precisely documents maternal age.Design/methodology/approachThe study was conducted in the rural subdistrict of Matlab in Bangladesh. HDSS data were used to examine trends in adolescent motherhood (10–19 years) in the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b) service areas (ISA) and government service areas (GSA) between 2007 and 2015. A total of 4,996 adolescent mothers were included in the analysis. Chi-square testing and binary logistic regression were used to document adolescent pregnancy trends and the differences in and causes of perinatal death.FindingsThe fertility rate was 27 per 1000 adolescent mothers in ISA and 20 per 1000 adolescent mothers in GSA, during the 9 years of the study period. The adjusted odd of an adolescent mother having a perinatal death in ISA, relative to GSA was 0.69. Significant determinants of perinatal death among adolescent mothers included maternal education, paternal education, mother’s age at first birth, asset score and distance from the nearest health facility.Originality/valueThis paper documents the real trend of adolescent pregnancy by capturing the accurate age at pregnancy for the first time in Bangladesh.

scholarly journals Comparing trends of perinatal mortality in two rural areas of Matlab, Bangladesh

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Rahman ◽  
I Anwar ◽  
A Austin
Keyword(s):  
Adolescent Mothers ◽  
Rural Areas ◽  
Maternal Education ◽  
Perinatal Death ◽  
Binary Logistic Regression ◽  
Diarrhoeal Disease ◽  
Adolescent Mother ◽  
P Value ◽  
Age At First Birth ◽  
Chi Square

Abstract The study conducted in a rural sub-district, Matlab, Bangladesh among adolescent motherhood (10-19 years) in the International Centre for Diarrhoeal Disease Research, Bangladesh included total of 4,996 adolescent mothers in the analysis. Chi-square tests and binary logistic regression were used to document adolescent pregnancy trends and the differences in and causes of perinatal death. The fertility rate was 27 per 1000 adolescent mothers in ISA and 20 per 1000 adolescent mothers in GSA, during the 9 year of study period. The adjusted odds of an adolescent mother having a perinatal death in ISA, relative to GSA was 0.69 (95% CI: 0.52 - 0.91, p-value<0.05). Significant determinants of perinatal death among adolescent mothers were: maternal education, paternal education, mothers' age at first birth, asset score and distance from nearest facility. Dr. Rahman will raise the importance of addressing these determinants in designing health policy interventions targeting this specifically vulnerable group.

scholarly journals Why Are Adolescent Mothers More iikely to Have Stunted and Underweight Children Than Adult Mothers? A Path Analysis Using Data from 30,000 Bangladeshi Mothers, 1996–2014

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1463-1463
Author(s):  
Phuong Nguyen ◽  
Samuel Scott ◽  
Long Khuong ◽  
Priyanjana Pramanik ◽  
Akhter Ahmed ◽  
...  
Keyword(s):  
Adolescent Pregnancy ◽  
Adolescent Mothers ◽  
Structural Equation ◽  
Service Use ◽  
Structural Equation Models ◽  
Complementary Feeding ◽  
Feeding Practices ◽  
Age At First Birth ◽  
Child Feeding ◽  
Poor Growth

Abstract Objectives Adolescent pregnancy is a major global concern due to its adverse effects on maternal and child health and wellbeing. Bangladesh has one of the highest rates of adolescent pregnancy globally. We sought to examine trends in adolescent pregnancy and associated factors in Bangladesh in the last two decades, and to understand why children of adolescent mothers are at high risk of poor growth. Methods Data were from 6 rounds of Bangladesh Demographic and Health Survey (1996–2014). Women aged 15–49 years who gave birth in the 5 years preceding each survey (n = 30,331) were classified based on age at first birth: ≤19 years (adolescence), 20–24 years (young adulthood), and ≥25 years (adulthood). Trend analysis was used to assess the progress over time. Multivariable regression and structural equation models were used to understand how adolescent pregnancy is linked to child undernutrition through maternal nutritional status, education and bargaining power, health service use, child feeding and living conditions. Results Adolescent pregnancy has declined slowly, from 84% in 1996 to 73% in 2014. Children born to adolescent mothers had lower z-scores for height-for-age (mean difference: −0·64 SD), weight-for-age (−0·45 SD), and higher prevalence of stunting (18 percentage points [pp]) and underweight (12pp) than children born to adult mothers. Compared to adult mothers, adolescent mothers were shorter (−0·8 cm), lighter (−6.9 kg), more likely to be underweight (+14pp), had lower education (−4·3 years), less decision-making power (−9pp), and lived in poorer households (−0·79 SD) with poorer sanitation (−23pp) (all P < 0.05). Adolescent mothers were less likely to access ANC (−20pp), institutional delivery (−42pp), postnatal care services (−24pp) and had poorer complementary feeding practices (−15pp). In path analyses, these intermediate factors explained 66% of the association between adolescent pregnancy and child anthropometry, with the strongest links being through women's weight, education, socioeconomic status and complementary feeding practices. Conclusions Adolescent pregnancy is still the norm in Bangladesh. Policies and programs to address poverty and improve women's education can help to improve women's health, reduce early childbearing and break the intergenerational cycle of poverty and undernutrition. Funding Sources A4NH at IFPRI.

Contributing factors to perinatal mortality among women who gave birth at the Jimma University Medical Centre, southwest Ethiopia

2021 ◽  
Vol 15 (3) ◽  
pp. 1-10
Author(s):  
Tekle Wakjira ◽  
Dejene Asefa ◽  
Geremew Muleta ◽  
Dessalegn Tamiru
Keyword(s):  
Perinatal Mortality ◽  
Rural Areas ◽  
Maternal Education ◽  
Perinatal Death ◽  
Statistical Significance ◽  
Study Participant ◽  
Medical Centre ◽  
Contributing Factors ◽  
Neonatal Deaths ◽  
Jimma University

Background Perinatal mortality remains a challenge worldwide, particularly in developing countries. Although significant achievements have been made to reduce neonatal mortality worldwide, in the last two decades there was a total of 5.3 million neonatal deaths and stillbirths each year. This study aims to assess the magnitude of perinatal mortality and its contributing factors among births at the Jimma University Medical Centre in Ethiopia. Method A facility-based cross-sectional study was conducted between January and April 2017. Convenience sampling was used to select study participants and data were collected using interviewer-administered pretested structured questionnaires. Descriptive statistics were used to analyse the data, with the chi-square test used to assess the relationship between each factor and outcome. Statistical significance was set at P<0.05. Results The rate of perinatal death was 107 per 1000 births, of which 39.2%, 25.9% and 34.9% were fresh stillbirths, macerated stillbirths and early neonatal deaths respectively. The majority (77.8%) of stillbirths occurred before the study participant reached the hospital and 64.3% of stillbirths had low birth weight. Hyaline membrane disease (27.6%) and meconium aspiration syndrome (20.7%) were the two most common causes of early perinatal death. Obstetric complications contributed to 89.6% of perinatal deaths. Stillbirth was significantly associated with a lack of education (P=0.036). The rate of perinatal mortality was high among women with their first pregnancy (53.0%) and those who had no previous pregnancy-related problems (79.5%), and was significantly associated with mechanical causes and antepartum haemorrhage (P=0.015). Conclusions The findings indicated that the rate of perinatal mortality was high at the Himma University Medical Centre. Improving maternal education and health services in rural areas are important steps to prevent poor perinatal outcomes. Facilitating transport and improving referral procedures may help to prevent mechanical complications, which are the most common cause of perinatal death, particularly fresh stillbirths which, in the present study, often occurred before a participant arrived at the hospital.

scholarly journals Can programmatic inputs improve adolescent mothers’ access to care in rural Bangladesh? Nine-years of evidence from a cohort study

2020 ◽  
Author(s):  
Aminur Rahman ◽  
Tahmina Begum ◽  
Anne Austin ◽  
Md. Hasan ◽  
Nurul Alam ◽  
...  
Keyword(s):  
Adolescent Mothers ◽  
Quality Care ◽  
Binary Logistic Regression ◽  
Newborn Health ◽  
Final Analysis ◽  
Adolescent Mother ◽  
Maternal And Newborn Health ◽  
P Value ◽  
Service Areas ◽  
Maternal And Newborn

Abstract Background Adolescent mothers (Girls aged 15-19) constitute 8% of annual global births, but account for 10% of annual maternal deaths. WHO recommended 4-8 Antenatal Care (ANC) visits, in addition to quality care and facility-based deliveries, are well-documented interventions to reduce maternal and child morbidity and mortality. Determinants of maternal and child health care in Bangladesh have received considerable attention, but less attention has been focused on adolescent mothers. This study explores the factors associated with 4 or more (4+) ANC visits and facility-based delivery among adolescent mothers in one rural area of Bangladesh, Methods This study uses Health and Demographic Surveillance System (HDSS) data. We conducted a comparative study on trends in 4+ ANC visits and facility-based deliveries among adolescent mothers (10-19 years) residing in an intervention area (icddr,b service area, ISA) against a comparison area (government service areas, GSA) of HDSS between 2007 and 2015. 4,996 adolescent mothers were included in the final analysis. Binary logistic regression was used to document the statistical difference on outcome indicators in the two study areas. Results Trends in 4+ANC visits and facility-based deliveries were higher in the ISA relative to the GSA. The adjusted odds of an adolescent mother accessing 4+ ANC visits in the GSA, relative to ISA was 0.57 (95% CI: 0.49 – 0.66, p-value <0.05); the adjusted odds of an adolescent mother accessing facility-based delivery in the ISA, relative to GSA was 6.63 (95% CI: 5.85 – 7.52, p-value <0.05). Increasing numbers of ANC visits were associated with increases in facility-based births in both the ISA and GSA. Conclusion This study documented that both 4+ ANC visits and facility delivery rates among adolescent mothers are much higher in the ISA than GSA. Increasing 4+ ANC visits and facility deliveries over the years, particularly in the ISA, coincide with programmatic efforts to improve the quality and availability of maternal and newborn health services. Learning from existing interventions in ISA and applying them to other areas will strengthen Bangladesh’s efforts to improve maternal and newborn health outcomes and achieve the sustainable development goal 3 (SDG 3).

scholarly journals Adolescent Pregnancy Outcomes Among Sisters and Mothers: A Population-Based Retrospective Cohort Study Using Linkable Administrative Data

2017 ◽  
Vol 133 (1) ◽  
pp. 100-108 ◽  
Author(s):  
Elizabeth Wall-Wieler ◽  
Leslie L. Roos ◽  
Nathan C. Nickel
Keyword(s):  
Adolescent Pregnancy ◽  
Adolescent Girls ◽  
Adolescent Mothers ◽  
Pregnancy Outcomes ◽  
Population Based ◽  
Adolescent Mother ◽  
Administrative Databases ◽  
Logistic Regression Models ◽  
Targeted Interventions ◽  
Adolescent Pregnancies

Objectives: Female family members affect both the likelihood of adolescent pregnancy and the outcome of that pregnancy. We examined the degree to which an older sister’s adolescent reproductive outcomes affect her younger sister’s reproductive behavior, and whether relationships in adolescent pregnancy among sisters born to adolescent mothers differ from those born to nonadolescent mothers. Methods: We followed a birth cohort in Manitoba, Ontario, Canada, to age 20 using linkable administrative databases housed at the Manitoba Centre for Health Policy. The cohort consisted of 12 391 girls born in Manitoba between April 1, 1984, and March 31, 1996, who had 1 older sister. We used logistic regression models to examine the relationships among familial adolescent pregnancy outcomes. Results: Compared with adolescent girls whose older sister did not have an adolescent pregnancy, adolescent girls whose older sister had an adolescent pregnancy were more likely to have a pregnancy (adjusted odds ratio [aOR] = 2.57), regardless of whether that pregnancy was completed (aOR = 2.56) or terminated (aOR = 2.59). Relationships in adolescent pregnancy among sisters were much stronger for those born to nonadolescent mothers (aOR = 3.16 [older sister completed adolescent pregnancy] and 3.18 [older sister terminated adolescent pregnancy]) than to adolescent mothers (aOR = 1.65 [older sister completed adolescent pregnancy] and 1.77 [older sister terminated adolescent pregnancy]). For younger sisters having an adolescent pregnancy, the odds of her completing the pregnancy were reduced if her older sister had terminated an adolescent pregnancy and her mother had not been an adolescent mother (aOR = 0.38). Conclusions: Younger sisters of adolescents who had a pregnancy may benefit from targeted interventions to reduce their likelihood of adolescent pregnancies.

scholarly journals Adolescent pregnancy and its outcomes: a cross-sectional study

2018 ◽  
Vol 5 (10) ◽  
pp. 4408
Author(s):  
Radha Kumari Paladugu ◽  
Pavan Chand Donipudi ◽  
Divya Chimata ◽  
Manasa Jasti
Keyword(s):  
Adolescent Pregnancy ◽  
Adolescent Mothers ◽  
Rural Areas ◽  
Teenage Pregnancy ◽  
Public Health Problem ◽  
Teenage Mothers ◽  
Major Public Health Problem ◽  
Cross Sectional ◽  
Demographic Profile ◽  
Under Nutrition

Background: Teenage or adolescent pregnancy is a major public health problem worldwide. Studies show that teenage mothers are more likely to experience pregnancy-related complications and maternal death compared to adult mothers. Hence, this study was conducted to study the socio-demographic profile and the maternal and fetal outcomes associated with teenage pregnancy and compare it with those of mothers aged 20-30 years.Methods: A cross-sectional comparative study was conducted in Government General Hospital, Guntur from April 2016 to October 2016. 50 adolescent mothers aged <19 years and 50 mothers aged 20-30 years were respectively selected as cases and controls. Data on socio-demographic profile, obstetric complications and fetal outcome was collected using a pre-designed, pre-tested, semi-structured questionnaire by face-to-face interview. Data was analysed by entering it in MS Excel worksheet.Results: Mean age was 18.2 years in adolescent mothers and 23.2 years in controls. Mean age at marriage was 17.3 years in adolescent mothers and 19.9 years in adults. Among teenage mothers 48% were Hindus, 72% upper lower socio-economic class, 88% from rural areas, 32% illiterates, 72% housewives and 32% had consanguineous marriages. Prevalence of under-nutrition (36% vs 14%, p<0.05), PROM (20% vs 4%, p<0.05), PPH (20% vs 4%, p<0.05) was significantly higher in adolescent mothers compared to adults. Prevalence of PIH was significantly lower in adolescent mothers compared to adults (8% vs 28%, p<0.05).Conclusions: Complications like maternal under-nutrition, PROM, PPH, preterm delivery and low birth weight babies were higher in teenage mothers compared to adult mothers. PIH was higher in adult mothers compared to adolescent mothers.

scholarly journals Evidence from 2016 Ethiopian demographic and health survey data: association between post health education maternal knowledge and neonatal danger signs

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mesfin Wudu Kassaw ◽  
Ayele Mamo Abebe ◽  
Biruk Beletew Abate ◽  
Seteamlak Adane Masresha ◽  
Ayelign Mengesha Kassie ◽  
...  
Keyword(s):  
Health Education ◽  
Survey Data ◽  
Health Survey ◽  
Rural Areas ◽  
Maternal Education ◽  
Female Child ◽  
Demographic And Health Survey ◽  
Maternal Knowledge ◽  
Danger Signs ◽  
Health Survey Data

Abstract Background Globally, 4 million infants die in their first 4weeks of life every year; above 8 million infants died before their first year of birthday, and nearly 10 million children died before their 5th birthday. Majority of the deaths were occurred at home because of not receiving health care. In Ethiopia, 120,000 infants died during their first 4 weeks of life. The aim of this study was to assess maternal knowledge about neonatal danger signs and its associations after they had been thought by health professionals in Ethiopia. Methods This study used the 2016 Ethiopian Demographic and Health Survey data (EDHS) as a data source. The 2016 EDHS data were collected using a two stage sampling method. All the regions were stratified into urban and rural areas. The study sample taken from the 2016 EDHS data and used in this further analysis was 325. A logistic regression model was used to assess the associations with post health education maternal knowledge on neonatal danger signs. Results In this study, mothers who had poor knowledge about neonatal danger signs (NDS) were 69.8 % (227) (95 %CI (64.8, 74.8 %). In the final logistic model, wanted no more child ((AOR = 4.15), (95 %CI = 1.12, 15.41)), female child ((AOR = 0.58), (95 %CI = 0.34, 0.98)), primary level maternal education ((AOR = 0.42), (95 %CI = 0.19, 0.92)), secondary level maternal education ((AOR = 0.37), (95 %CI = 0.16, 0.91)), and average size of child ((AOR = 2.64), (95 %CI = 1.26, 5.53)), and small size child ((AOR = 4.53), (95 %CI = 1.52, 13.51)) associated with post health education maternal knowledge about NDS. Conclusion The mothers’ knowledge about NDS is poor even they were gave a birth in health facilities. Wanting of additional child, child sex, maternal education and size of child were associated with NDS knowledge. This indicates that the mode of health education provided for mother might not be appropriate and needs protocol changes.

scholarly journals Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

2020 ◽  
Vol 5 (12) ◽  
pp. e002169
Author(s):  
Ngatho Samuel Mugo ◽  
Kyaw Swa Mya ◽  
Camille Raynes-Greenow
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Adolescent Mothers ◽  
Health Survey ◽  
Rural Areas ◽  
Urban Areas ◽  
Multinomial Logistic Regression ◽  
Wealth Quintile ◽  
Adjusted Risk ◽  
Factors Associated

IntroductionEarly access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of the new WHO ANC guidelines including the recommended number, on time initiation and adequate components of ANC contacts in Myanmar.MethodsWe examined data from 2943 mothers aged 15–49 years whose most recent birth occurred in the last 5 years prior to the 2015–2016 Myanmar Demographic and Health Survey. Factors associated with utilisation of the new WHO recommended ANC were explored using multinomial logistic regression and multivariate models. We used marginal standardisation methods to estimate the predicted probabilities of the factors significantly associated with the three measures of ANC.ResultsApproximately 18% of mothers met the new WHO recommended number of eight ANC contacts. About 58% of the mothers received adequate ANC components, and 47% initiated ANC within the first trimester of pregnancy. The predicted model shows that Myanmar could achieve 70% coverage of adequate components of ANC if all women were living in urban areas. Similarly, if ANC was through private health facilities, 63% would achieve adequate components of ANC. Pregnant women from urban areas (adjusted risk ratio (aRR): 4.86, 95% CI 2.44 to 9.68) were more than four times more likely to have adequate ANC components compared with women from rural areas. Pregnant women in the highest wealth quintile were three times more likely to receive eight or more ANC contacts (aRR: 3.20, 95% CI 1.61 to 6.36) relative to mothers from the lowest wealth quintile. On time initiation of the first ANC contact was fourfold for mothers aged 30–39 years relative to adolescent mothers (aRR: 4.07, 95% CI 1.53 to 10.84).ConclusionThe 2016 WHO ANC target is not yet being met by the majority of women in Myanmar. Our results highlight the need to address health access inequity for women who are from lower socioeconomic groups, or are younger, and those living in rural areas.

scholarly journals Characteristics and adverse outcomes of Chinese adolescent pregnancies between 2012 and 2019

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yanxia Xie ◽  
Xiaodong Wang ◽  
Yi Mu ◽  
Zheng Liu ◽  
Yanping Wang ◽  
...  
Keyword(s):  
Adolescent Pregnancy ◽  
Gestational Age ◽  
Rural Areas ◽  
Reference Group ◽  
Perinatal Outcomes ◽  
Severe Anaemia ◽  
Adverse Outcomes ◽  
Near Miss ◽  
Adolescent Women ◽  
Adolescent Pregnancies

AbstractWe aimed to describe the characteristics of adolescent pregnancy, determine its effect on adverse maternal and perinatal outcomes and explore whether that association varies with gestational age with the goal of proposing specific recommendations for adolescent health in China. This study included 2,366,559 women aged 10–24 years who had singleton pregnancies between 2012 and 2019 at 438 hospitals. Adolescent pregnancy was defined as younger than 20 years of age. We used multivariable logistic regression to estimate the effects. Women aged 20–24 years served as the reference group in all analyses. The proportion of rural girls with adolescent pregnancies rebounded after 2015 even though common-law marriage in rural areas decreased. Higher risks of eclampsia (adjusted odds ratio (aOR) 1.87, 95% confidence interval (CI) 1.57 ~ 2.23), severe anaemia (aOR 1.18, 95% CI 1.09 ~ 1.28), maternal near miss (MNM; aOR 1.24, 95% CI 1.12 ~ 1.37), and small for gestational age (SGA; aOR 1.30, 95% CI 1.28 ~ 1.33) were observed when gestational age was > 37 weeks. Adolescent pregnancy was independently associated with increased risks of other perinatal outcomes. Further implementation of pregnancy prevention strategies and improved health care interventions are needed to reduce adolescent pregnancies and prevent adverse fertility outcomes among adolescent women in China at a time when adolescent fertility rate is rebounding.

Loan officer rotation and credit access: evidence from Madagascar

2019 ◽  
Vol 80 (1) ◽  
pp. 51-67
Author(s):  
Yaw Sarfo ◽  
Oliver Musshoff ◽  
Ron Weber
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Frequency Effect ◽  
Content Type ◽  
Credit Access ◽  
Loan Officer ◽  
Microfinance Institution ◽  
Lending Decisions ◽  
Loan Officers ◽  
Loan Approval

Purpose With exclusive data from a commercial microfinance institution (MFI) in Madagascar, the purpose of this paper is to investigate if loan officer rotation (change of loan officer) has an effect on credit access (loan approval) in rural and in urban areas. The authors further analyze how the frequency of loan officer rotation affects credit access in rural and in urban areas. Design/methodology/approach The authors apply propensity score matching to compare credit access between loan applicants who experienced loan officer rotation and loan applicants who experienced no loan officer rotation in rural and in urban areas. Findings Results show that loan officer rotation has a positive and statistically significant effect on credit access. The authors observe further that loan officer rotation has a different effect on credit access in rural and in urban areas. Whilst rural loan applicants who experienced loan officer rotation are more likely to have credit access, urban loan applicants show no statistically significant effect of loan officer rotation on credit access. For the frequency effect on credit access, the authors observe that one loan officer rotation has a positive and statistically significant effect on credit access whereas results are mixed for two loan officer rotations. Research limitations/implications Even though the authors can show that loan officer rotation can improve credit access to loan applicants, especially in rural areas, the conditions in Madagascar are unique. Therefore, results need to be verified in other countries and institutional contexts. Practical implications From the perspective of MFI, the authors recommend that the management of MFI needs to provide better tools to loan officers to improve on the evaluation of agricultural loan products or standardize the assessment of agricultural loan products to improve on lending decisions. Further, if applicable, the authors recommend that MFI should consider using credit worthiness assessment procedures which rely less on loan officer’s judgment for loan evaluation, such as automated systems. From the perspective of loan applicants, the authors recommend that loan applicants should request for a change of loan officer if they experience successive loan applications rejection. Originality/value To the authors’ knowledge, this paper is the first to provide empirical evidence on the effect and frequency of loan officer rotation on credit access in Sub-Sahara Africa, and Madagascar, in particular.

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