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Hill Tracts communities working to ensure the survival of mothers and newborns

© UNICEF Bangladesh/2009/Naser Siddique
Muisaching Marma, Community Nurse, discusses health issues with community members in Monjaipara, Bandarban sadar, Chittagong Hill Tracts, Bangladesh.

By Casey McCarthy

BANDARBAN, Bangladesh 4 May 2009:  Minu Prue was a 26 year-old widow when she died of post-delivery complications in February this year. Her village, Monji, in Bandarban district of the Chittagong Hill Tracts, south east Bangladesh is six hours by foot from the Bandarban District Hospital.

Until recently there was no road connecting Monji and Bandarban and with only one bus making the trip to town once each morning, villagers are forced to create a ‘human ambulance’ and walk six hours to Bandarban to receive medical attention.

Unable to afford her medication, Minu Prue husband’s family forbade her from visiting the Bandarban District Hospital to receive the treatment she needed after her son was born.

Sadly, Minu Prue’s story is not uncommon. More than 30 Bangladeshi women die every day due to pregnancy or childbirth-related complications and an estimated 120,000 newborns die every year. High maternal and child mortality rates are underpinned by the fact that 85 per cent of women give birth at home, most with unskilled attendants or relatives assisting. The low status of women, poor quality and low uptake of services are some of the reasons for this situation.

Cultural barriers and traditions as well as poverty and lack of information prevent women from accessing maternal and newborn health services. There is also little understanding about the need for rest and additional nutritious food during pregnancy. Also, the low status of women within the family means one in every two women will have her health care decided by her husband.

Delays are often experienced in recognizing a case of emergency, deciding to seek treatment, traveling to treatment facilities, and receiving treatment at the facility. The cost of treatment is another deterrent for many people in a country where 41 per cent of the population live on less than US $1 a day.

© UNICEF Bangladesh/2009/Naser Siddique
Misaching Marma, Community Nurse, performs antenatal checks and other health services and information for women and community members at the Monjaipara Health Clinic, Bandarban sadar, Chittagong Hill Tracts, Bangladesh.

Helping communities help themselves
A new UNICEF-supported project hopes to address these issues by improving maternal and neonatal mortality and morbidity, particularly among the poor and socially excluded, with the hope that it can be replicated on a national scale.

The project is currently working on a community level in six upazilas of three districts (Bandarban, Sherpur and Sunamganj) providing an integrated package of maternal, neonatal, and child survival interventions. The initiative will expand to 106 upazilas of 14 districts by 2011.

Under the project, trained community health workers visit households to provide antenatal information, nutrition supplements, delivery kits and counseling, conduct postnatal care visits (within 24 and 72 hours of birth) to ensure essential neonatal care, assist with birth registration, counsel on child care and caring practices and refer for immunization.

By training community members as health workers and establishing local support groups who meet once a month to receive health education and liaise with government to create a demand for services, the project aims to build the capacity of communities and implement sustainable solutions to the health crisis in remote parts of Bangladesh.

Making progress
Only a few months after Minu Prue’s death, this community has rallied together to ensure no other mothers or newborn babies die when they can help to prevent it.

The 167 households of Monji now rely on community nurse, Misa Ching, 22, community mobilizer Dolly Pru, 20, and the nine-member Health Forum to improve the health situation in their community.

Misa visits expectant mothers and their families to educate them on simple health practices,

The project aims to benefit 3.8 million children under five (including 680,000 neonates and 700,000 infants), 3.83 million women of child-bearing age (15-49 years), and approximately 25 million community groups, local government and non-government partners.

The situation in Bangladesh
UNICEF Health Specialist Dr Shehlina Ahmed said families often ignore very simple healthy practices or do not accept them because it is against tradition or common belief.

“Most people are not able to recognize when it is necessary to seek care for the mother or the baby. The knowledge of caregivers is crucial to avoid unnecessary maternal and newborn death,” Dr Shehlina said.

Focusing on the importance of newborn care practices, she said, “This project addresses the need for better understanding of essential newborn care practices such as clean and safe delivery, drying and wrapping for thermal protection, early initiation of exclusive breastfeeding, tactile stimulation and resuscitation, care of eyes, skin and cord for infection prevention.”

This project is supported by the Australian Government.



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