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Causes of neonatal and maternal deaths in Dhaka slums: Implications for service delivery
Fatema Khatun1*, Sabrina Rasheed1, Allisyn C Moran1, Ashraful M Alam1, Mohammad S Shomik1, Munira Sultana2, Nuzhat Choudhury1,2, Mohammad Iqbal1 and Abbas Bhuiya1
* *Corresponding author: Fatema Khatun kfatema@icddrb.org
Author Affiliations
1ICDDR,B, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka1212, Bangladesh
2BRAC, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh
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BMC Public Health 2012, 12:84 doi:10.1186/1471-2458-12-84

The electronic version of this article is the complete one and can be found online at:http://www.biomedcentral.com/1471-2458/12/84

Received: | 7 August 2011 |
Accepted: | 26 January 2012 |
Published: | 26 January 2012|

© 2011 Khatun et al; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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AbstractBackground
Bangladesh has about 5.7 million people living in urban slums that are characterized by adverse living conditions, poor access to healthcare services and health outcomes. In an attempt to ensure safe maternal, neonatal and child health services in the slums BRAC started a programme, MANOSHI, in 2007. This paper reports the causes of maternal and neonatal deaths in slums and discusses theimplications of those deaths for Maternal Neonatal and Child Health service delivery.
Methods
Slums in three areas of Dhaka city were selected purposively. Data on causes of deaths were collected during 2008-2009 using verbal autopsy form. Two trained physicians independently assigned the cause of deaths.
Results
A total of 260 newborn and 38 maternal deaths were identified between 2008 and 2009.The majority (75%) of neonatal deaths occurred during 0-7 days. The main causes of deaths were birth asphyxia (42%), sepsis (20%) and birth trauma (7%). Post partum hemorrhage (37%) and eclampsia (16%) were the major direct causes and hepatic failure due to viral hepatitis was the most prevalent indirect cause (11%) of maternal deaths.
Conclusion
Delivery at a health facility with childassessment within a day of delivery and appropriate treatment could reduce neonatal deaths. Maternal mortality is unlikely to reduce without delivering at facilities with basic Emergency Obstetric Care (EOC) and arrangements for timely referral to EOC. There is a need for a comprehensive package of services that includes control of infectious diseases during pregnancy, EOC and adequate after deliverycare.
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Background
High maternal and neonatal mortality rates are still major challenges facing Bangladesh. Despite significant reduction over the last two decades, the maternal mortality ratio and neonatal mortality rate are high at 194 per 100,000 live births and 37 per 1000 live births [1,2] respectively. The situation is worse in the country'surban slums with neonatal mortality rate of 43.7 per 1000 live births [3]. The main causes of maternal deaths are hemorrhage (31%), eclampsia (20%) according to 2010 National survey [1]. There is no information available related to maternal cause of death in the urban slums. There are no national surveys of exploring the causes of neonatal deaths in Bangladesh. However, a study conducted selectedrural area reported birth asphyxia (45%), low birth weight/pre maturity (15%) and neonatal sepsis (12%) as the main causes of neonatal deaths [4].
Urban slums deserve special attention as they host over 5.7 million people, roughly 3.8% of the total national population [3]. Recent data show that most of the global urban growth is occurring in the low income countries of Asian cities such as...