Bangladesh has yet to ensure the necessary number of Emergency Obstetric and Newborn Care (EmONC) for the treatment and management of birth-related complications in the district level health facilities, a recent study has found.
According to United Nation guidelines, there should be at least five EmONC facilities for every five lakh people, where Bangladesh only has 2.5 EmONC facilities.
The observations were revealed yesterday at the ICDDRB’s Sasakawa auditorium in a dissemination seminar titled “A Needs Assessment Study for EmONC Services in Selected 24 districts in Bangladesh,” conducted by the Center for Equity and Health System of the ICDDRB.
Although the country had the necessary infrastructure, service could not be made available in the upazila and remote areas because of the unavailability of doctors and trained nurses.
The study also found that because of shortage of skilled health officials, unskilled assistants often stitched the patient after Caesarean section, provided episiotomy, checked fetus position, delivered babies, managed newborns’ breathing, cleaning, weighing, while nurses managed PPH and eclampsia patients.
Addressing the programme, Niru Shamshunahar, a joint secretary (planning) of health ministry, said although new findings and recommendations are expected from the ICDDRB, the new study made no new recommendation.
However, Health Secretary MM Niazuddin termed the study unique and said they will look into the recommendations, while they will do the midterm review of a different operation plan.
The EmONC needs assessment study was conduct at medical college hospitals, district and upazila hospitals and some private health facilities in 24 districts during May-October 2012.
It is learnt that each year in Bangladesh 11,000 to 12,000 women die during delivery with 85% death resulting from complications of childbirth such as hemorrhage and eclampsia and newborn deaths result from infections , asphyxia, prematurity/low birth and other causes associated with unsafe delivery practices.
Overall, in the 24 studied districts, about 31% deliveries were conducted in health facilities, out of which about 19% were normal vaginal delivery, 12% were C-section and only 0.2% was assisted vaginal delivery.
The study found overall 40% met need for obstetric complications.
The overall stillbirth rate in the study districts was around 3%, while the neonatal death rate was above 2% of all facility births.
Proportion of maternal deaths because of indirect obstetric care causes was below 9%, but in two districts in Bhola and Sirajgonj was 40%.
The country had only one fifth (22%) of the required number of the maternity beds as per WHO requirement (24 beds per 1000 annual delivery)
In terms of availability of consultants in district hospital the study found though 90% sanctioned post of obstetricians, gynecologists and pediatrics were occupied, but in case of anesthesia, the post occupancy was only about 65%.
Around 80% of senior staff nurse and staff nurse found vacant and overall 50% of assistant nurse found vacant.
However, the situation was worsening in upazila level where a substantial proportion of post of medical doctors was vacant. The study found that in upazila health centre more than 60% of sanctioned post of consultant of obstetrician/gynecologist and more than 70% posts for anesthesia and pediatrics consultants were vacant.
