Lubna Hossain

BACKGROUND AND OBJECTIVES: Bangladesh's high maternal mortality ratio is exacerbated by delivery-related complications, particularly in hard-to-reach (HtR) areas with limited healthcare access. Despite this, few studies have explored delivery-related complications and factors contributing to these complications among the disadvantaged population. This study aimed to investigate the factors contributing to delivery-related complications and their consequences among the mothers residing in the HtR areas of Bangladesh. METHODS: Data were collected using a cross-sectional study design from 13 HtR sub-districts of Bangladesh between September 2019 and October 2019. Data from 1,290 recently delivered mothers were analysed. RESULTS: Around 32% (95% CI: 29.7-34.8) of the mothers reported at least one delivery-related complication. Prolonged labour pain (21%) was the highest reported complication during the delivery, followed by obstructive labour (20%), fever (14%), severe headache (14%). Mothers with higher education, a higher number of antenatal care (ANC) visits, complications during ANC, employed, and first-time mothers had higher odds of reporting delivery-related complications. More than one-half (51%) of these mothers had normal vaginal delivery. Nearly one-fifth (20%) of mothers who reported delivery-related complications were delivered by unskilled health workers at homes. On the other hand, about one-fifth (19%) of the mothers without any complications during delivery had a caesarean delivery. Nine out of ten of these caesarean deliveries were done at the private facilities. CONCLUSION: Delivery-related complications are significantly related to a woman's reproductive history and other background characteristics. Unnecessary caesarean delivery is prominent at private facilities.

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted essential health care services worldwide, including those related to immunisation. National data from Bangladesh shows that child immunisation may have been adversely affected by the pandemic but regional evidence is limited. We therefore aimed to explore the regional differences in the indirect effects of COVID-19 on child immunisation in Bangladesh. Methods: We extracted data from the District Health Information Software (DHIS2) spanning the period from January 2017 to December 2021. We examined three essential immunisation indicators: Bacille Calmette-Guérin (BCG), pentavalent third dose, and measles vaccinations. We examined both the yearly and monthly trends to explore fluctuations in the number of immunisations to pinpoint specific periods of service utilisation regression. Segmented regression with Poisson distribution was implemented given the count-based outcome. We reported incidence rate ratios (IRRs) with 95% confidence intervals (CIs) in different regions in 2020 and 2021 compared to the reference period (2017-19). Results: We initially observed a notable decline in vaccine administration in April 2020 compared to the pre-pandemic period of 2017-19 with a drop of approximately 53% for BCG vaccines, 55% for pentavalent third doses, and 51% for measles vaccines followed by May 2020. The second half of 2020 saw an increase in vaccination numbers. There were noticeable regional disparities, with Sylhet (IRR = 0.75; 95% CI = 0.67-0.84 for pentavalent administration, IRR = 0.79; 95% CI = 0.71-0.88 for measles administration) and Chattogram (IRR = 0.77; 95% CI = 0.72-0.83 for BCG administration) experiencing the most significant reductions in 2020. In April 2020, Dhaka also experienced the largest decline of 67% in measles vaccination. In 2021, most divisions experienced a rebound in BCG and pentavalent administration, exceeding 2019 levels, except for Chittagong, where numbers continued to decline, falling below the 2019 figure. Conclusions: Our findings highlight the impact of the COVID-19 pandemic on childhood immunisation across regions in Bangladesh. Sylhet, Chattogram, and Dhaka divisions experienced the most significant reductions in immunisation services during 2020. This underscores the importance of targeted interventions and regional strategies to mitigate the indirect effects of future challenges on essential health care services, particularly childhood immunisation, in Bangladesh.

Background: Sexual and reproductive health and rights (SRHR) are essential for individuals' health, well-being, survival, and economic development. A stakeholder-led approach to research prioritisation was essential to guide SRHR-related research in Bangladesh. Accordingly, we conducted a research prioritisation exercise to identify health research priorities related to SRHR in Bangladesh. Methods: We adopted the Child Health and Nutrition Research Initiative (CHNRI) method for this study. Five themes - adolescent Health (AH), fertility, gynaecological issues (GI), maternal and neonatal health (MNH), and SRH of key populations (SRHKP) - were selected from the broader field of SRHR. Seventy-six experts submitted 454 research questions (RQs), which were then condensed into 197 unique RQs and distributed to all experts for scoring based on five pre-selected criteria. Weighted and unweighted research priority scores (RPS) and average expert agreement (AEA) were calculated to compile a list of top-ranked RQs. Results: The weighted RPSs for the 197 RQs ranged from 0.944 to 0.623, with a median of 0.848. Among the top 20 list, six RQs belonged to AH, one to Fertility, two to GI, six to MNH, and five to SRHKP. For AH, top ranked RQs included adolescent pregnancy, sexual health education, and mental health. Promoting proper birth spacing among newlywed and underaged married women were top RQs for fertility. GI priorities emphasised early detection of gynaecological cancers, including HPV testing for cervical cancer screening. The MNH research focused on Newborn Stabilizing Units at sub-district hospitals, PPH bundle approaches, and counselling on danger signs to prevent adverse birth outcomes. The top-ranked RQs in SRHKP addressed stigma and discrimination towards key populations (KPs) and their impact on SRH behaviours. There was significant overlap between the top 20 RQs ranked by RPS and AEA. Conclusions: The study emphasises the need for intervention research to address barriers, assess effectiveness, and enhance the uptake of evidence-based and innovative interventions for SRHR in Bangladesh.