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What's Need for Maternal and Neonatal Health Service Delivery In Research Article iMedPub Journals Integrative Journal of Global Health 2018 www.imedpub.com Vol.2 No.1:2 ISSN 2576-3911 DOI: 10.4172/2576-3911.1000002 What’s Need for Maternal and Neonatal Health Service Delivery in the Marginalized Tea Garden Community of Bangladesh? – A Qualitative Study Biswas A1, Abdullah AS1, Ferdoush J1, Doraisyami S2 and Halim MA1 1Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh 2United Nations Population Fund (UNFPA), Bangladesh *Corresponding author: Biswas A, Centre for Injury Prevention and Research (CIPRB), Dhaka, Bangladesh, Tel: +88-02-58814988; E-mail: [email protected] Received date: April 03, 2018, Accepted date: April 05, 2018, Published date: April 07, 2018 Copyright: © 2018 Biswas A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Citation: Biswas A, Abdullah AS, Ferdoush J, Doraisyami S, Halim MA (2018) What’s Need for Maternal and Neonatal Health Service Delivery in the Marginalized Tea Garden Community of Bangladesh? – A Qualitative Study. Integr J Glob Health. Vol.2 No.1:2. marginalized communities, specifically in tea garden Abstract areas. Keywords: Maternal and neonatal health; Service Background: Maternal, newborn and child health (MNCH) delivery; Tea garden community status in tea garden communities of Bangladesh is neglected and poor compared to many other areas in Bangladesh. Community health need assessments of maternal and neonatal health (MNH) services are Introduction important to identify the necessary interventions to improve MNH services in a community. Identifying and Bangladesh has made significant progress in reducing prioritizing health needs are two of the most essential maternal and neonatal deaths in the last two decades as a community-centric activities where each community can push towards achieving the millennium developmental goal 4 set their own priorities and areas of focus. and 5 target. However, a number of challenges still persist in reaching new sustainable development goal. One major Objectives: The current need assessment is designed to challenge is the maternal and reproductive health coverage of identify all needs and gaps along with assessing program marginalized communities in remote areas [1]. Major effort in increasing the quality, coverage, and utilization of reduction of maternal, neonatal and child mortality and MNH services as well as insuring there is a critical support universal access to reproductive health services by 2030 are system placed at each of the referral levels. key points in achieving the sustainable development goals [2]. Globally, 99% of maternal deaths and 98% of neonatal Methods: A qualitative study was conducted in the Moulvibazar district of Bangladesh. 20 in-depth interviews deaths occur in developing countries [3]. One in six women die (IDIs) were conducted among different groups of people during delivery in these countries, where one in thirty including civil surgeons, the Deputy Commissioner of thousand do in developed countries. This inspired a challenge Moulvibazar, the General Secretary of the Bangladesh Tea to achieve the fifth MDG: reducing maternal mortality by 75% Labour Union of Sreemangal, the Finance Secretary of the between 1990 and 2015 [4,5]. Based on maternal mortality Bangladesh Tea Estate Staff Association of Sreemangal, ratio (MMR) estimates for the year 2015, the Sustainable the Coordinator of the Bangladesh Tea Board of Development Goal is to have less than 70 maternal deaths per Sreemangal, community leaders, pregnant mothers, 100,000 live births by 2030. Therefore, the country needs to Panchayat committee members, traditional birth reduce their MMR by at least 7.5% annually [5]. attendants and health care providers of the selected tea gardens. In Bangladesh, MMR fell from 322 deaths per 100,000 live births from 1998-2001 to 194 from 2007-2010, an annual Results: Tea garden communities have lack knowledge decrease. of 5.6% due to improved access to quality health and awareness of MNCH issues as well as a gap in utilizing care services from health care facilities and decreased rate of related services. Reasons for not seeking proper health fertility [6]. Approximately 85% of maternal deaths occur from care services were lower socio-economic status, obstetric complications annually in Bangladesh [7]. Quality traditional myth and superstitions, dependency on antenatal care and social practices including awareness, traditional birth attendants and negligence on seeking influence the outcome of pregnancy [8,9]. appropriate MNH services. Policy makers need to place more emphasis on MNH related interventions in © Copyright iMedPub | This article is available from: http://www.imedpub.com/integrative-journal-of-global-health/ 1 Integrative Journal of Global Health 2018 ISSN 2576-3911 Vol.2 No.1:2 Tea garden people are mostly tribal, poor and backward the services of family planning and increase female education Hindu by caste and colonial attitude and policy of the rich man resulting in social development and women empowerment made them marginalized class which is isolated from the main [17]. This study is designed to assess MNH service delivery in stream of the society [10]. Poor health and social outcomes tea gardens through need assessment. In this way, needs or are more common among the indigenous people than non- gaps between the current and expected progress of MNH care indigenous in relation to maternal and child mortality [11]. can be determined and addressed. Research shows that pregnant mothers lack knowledge and usually do not receive treatment for obstretric complications Methodology in tea garden areas of Moulvibazar [12]. Local Health Bulletin revealed in 2014 that 120 maternal A qualitative study was conducted in two purposively deaths occurred in Moulvibazar, 47 (39.1%) of which were selected sub-districts (Upazila) of Moulvibazar district in from tea gardens [13]. These findings suggest that the progress February 2017. Six tea gardens in the Moulvibazar district were regarding the strengthening of the maternal and neonatal randomly chosen out of a possible 92. Five of the selected health system and the quality of service delivery has been areas were from Sreemangal, Upazila (sub-district) and one disproportionate in tea gardens compared to other areas. from Kamalganj, Upazila. 20 IDIs were conducted among Achieving effective coverage on maternal and neonatal health different groups of people including civil surgeons, the Deputy depends on life saving technologies, clinical approaches using Commissioner of Moulvibazar, the General Secretary of the evidence-based interventions [14] and research that focuses Bangladesh Tea Labour Union of Sreemangal, the Finance on implementing these processes [15,16]. Secretary of the Bangladesh Tea Estate Staff Association of Sreemangal, the Coordinator of the Bangladesh Tea Board of The most vulnerable areas (i.e., rural, poor) require special Sreemangal, community leaders, pregnant mothers, Panchayat interventions to achieve these goals [4]. It is also essential to committee members, traditional birth attendants and health improve Comprehensive Emergency Obstetric Care, strengthen care providers of the selected tea gardens (Table 1). Table 1 IDI Participant Information. Participant Name of Area Number of IDIs conducted Type Moulvibazar 2 Civil Surgeon, Deputy Commissioner Bangladesh Tea Labour Union, Sreemangal 1 General Secretary Bangladesh Tea Estate Staff Association, Sreemangal 1 Finance Secretary Bangladesh Tea Board, Sreemangal 1 Coordinator Mirtinga Tea Garden, Kamalganj 3 Community Leader, Pregnant Mother, Health Care Provider (Midwife) Amrailchara tea garden, Sreemangal 2 Community Leader, Health Care Provider (Midwife) Varaora Tea Garden, Sreemangal 3 Health Care Provider (Midwife), Dresser, Health Supervisor General Secretary, Panchayat Committee Member, Panchayat 2 Khejurichara tea garden, Sreemangal Committee President of the Rajghat Panchayat Committee, General Secretary of 2 Rajghat tea garden, Sreemangal the Rajghat Panchayat Committee Pregnant Mother, Traditional Birth Attendant, Member of Panchayat 3 Phulchara tea garden, Sreemangal Committee A standard guideline was developed and used to conduct all community’s view and assess the need of maternal and IDIs, covering issues such as finding the deficiencies or gaps of neonatal health care services in tea garden communities. All existing MNH services, level of knowledge and awareness, IDIs were conducted following the standard guidelines of a negligence, traditional beliefs and practices, accessibility to face-to-face interview. health care services, disharmony in coordination and challenges to improve MNH care services in a tea garden (Table 2). Twenty IDIs were performed with stakeholders, service providers, community leaders and others to explore the Table 2 Prompt used for pre-assessment. 2 This article is available from: http://www.imedpub.com/integrative-journal-of-global-health/ Integrative Journal of Global Health 2018 ISSN 2576-3911 Vol.2 No.1:2 Point Prompt What are the deficiencies of maternal health care services in tea gardens? Deficiency/Gap Do you think programs to strengthen maternal health care services are necessary for tea garden women? Why or why not? What problems do the pregnant mothers face while working at tea gardens? What do you think about maternal
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