Date Published: September 27, 2018
Publisher: Public Library of Science
Author(s): Suman Kanti Chowdhury, Sk Masum Billah, Shams El Arifeen, Dewan Md Emdadul Hoque, Kelli K. Ryckman.
Neonatal deaths account for 45% of all under-five deaths globally and 60% in Bangladesh. This study aimed to investigate the most common symptoms and complications in neonates, care-seeking practices of the mothers for their sick neonates, and factors associated with the care-seeking practices.
This cross-sectional study analysed data from an Endline Household Survey (as part of an evaluation of a paired cluster-randomised controlled trial study in 14 rural sub-districts in Bangladesh) of 2,931 women who gave birth recently. Descriptive analysis and logistic regressions were conducted to identify the care-seeking practices of mothers of sick neonates and the factors associated with the care-seeking from trained providers.
Of the 2868 neonates, 886 (30.9%) were reported ill during first 28 days after birth. For those with reported symptoms, 748 (84.4%) of their mothers sought care. Of those who sought care, 65.2% sought care from untrained providers. Multiple logistic regression analysis showed significantly higher odds of care-seeking from trained providers when neonates had 3 or more concurrent symptoms (OR: 1.82; 95% CI: 1.07–3.08); when mothers perceived their neonates’ symptoms as severe (OR: 4.08; 95% CI: 2.92–5.70); when mothers received skilled care during pregnancy (OR: 1.95; 95% CI: 1.34–2.84); and when mothers had their delivery in a facility (OR: 3.50; 95% CI: 2.18–5.62). Mothers who delivered their babies at a facility, 43.1% of them sought care for their sick neonates at the same type of public hospital and 34.9% from same type of private hospitals where their deliveries took place.
Skilled care for mothers during pregnancy and delivery, and mothers’ perceptions of the severity of symptoms are the key associated factors of care-seeking for sick neonates from trained providers. Interventions should be tailored to increase care from trained providers during pregnancy and delivery at facilities to improve care-seeking for neonates from trained providers and for the survival of neonates.
Under-five mortality rates have halved globally since the Millennium Development Goal (MDG) baseline in 1990. However, the pace of this improvement varies between age groups within this age classification. The slowest improvement has been observed among neonates (infants below 1 month of age) . More than 90% of neonates die in low and middle income countries (LMICs) ; six times higher than neonates die in high-income countries . Neonatal mortality also varies greatly between regions  and in-country geographical locations [4, 5]. Although Bangladesh has achieved MDG 4 (reducing under-five mortality to 46 per 1000 live births by 2015), neonatal mortality remains high and is increasingly concentrated especially in the earliest days of neonatal period. Currently, neonatal deaths contribute to more than 60% of all under-five deaths in Bangladesh .
Of 2,868 mothers, 48.2% were aged between 25–34 years, and 41.6% were under 25 years of age. 38.4% mothers had no education, and only 13.6% mothers had deliveries in a facility. Participant background characteristics are presented in more detail in Table 1.
The objective of this study was to explore the distribution of reported neonatal symptoms and pattern of mothers’ care-seeking practices, and to identify the factors associated with care-seeking from trained providers.
Raised temperature and breathing difficulty remain the most common symptoms among neonates. Although care-seeking practices are high for sick neonates, most of them receive care from untrained providers, particularly from the village doctor. However, medical doctors are the most commonly chosen service provider when care is sought from trained providers. Mother’s perceptions of the severity of symptoms, whether they received antenatal care from trained providers during pregnancy and management during delivery at a facility or not are the key associated factors of care-seeking from trained providers. Interventions should be designed to increase the coverage of care from trained providers during pregnancy and facility delivery to improve care-seeking for sick neonates from trained providers, and ultimately the survival of neonates. Adequate and appropriate health education programmes at the family and community levels to ensure skilled maternal care and early recognition of newborn danger signs should be intensified. Further studies are needed to understand the specific predictors of care-seeking from trained providers and its trends at the community and facility levels.