Maternal Health Care Practices among Mothers of a Selected Slum in Dhaka City Original Article

Background: Bangladesh is a small South Asian country which became independent in 1971 after a bloody war. Rapid urbanisation in Bangladesh (26% of the 147.1 million inhabitants live in urban areas) is fuelling a growth in urban poverty, particularly in the urban slums where the quality of life is extremely poor. The average population density in slums was reported in 2005 as 831 persons per acre or 205,415 people per square kilometre.1 Early commencement of antenatal care by pregnant women as well as regular visits has the potential to affect maternal and foetal outcome. Objective: To assess the status of ANC service used by the pregnant mothers and their socio-demographic characteristics. Materials and Methods: A community-based cross-sectional study was conducted at Moghbazar slum area in Dhaka district of Bangladesh, during January to June 2014. A total of 161 slum dwellers were enrolled in the study. Information regarding education, occupation, monthly family income, antenatal care was gathered using a pretested structured questionnnare and data were analysed. Results: The majority respondents had knowledge about antenatal care and of them 89 (55.2%) completed > 3 visits. Forty five (47.8%) pregnant women received ANC from government hospitals. Nearly 72% mothers received ANC service from doctors and 16.9% received from family welfare visitors (FWV). Half of mothers were satisfied with the overall care provided to them. About 86.2% mothers said that they had to wait for more than two hours for check-ups. More than 50% received information about exercise and 36% were reassured about discussing fear and anxiety about pregnancy. Conclusion: This study reveals that antenatal care provided was not up to the mark of standard care and measures should be taken to improve it.

In South Asia, the percentage of the population living in urban areas is increasing and urbanisation is also progressing in Bangladesh at a rapid pace. 2 Bangladesh has experienced one of the highest urban population growth rates (>6% per year) in the last three decades compared to the national population growth rate of about 1.5% per year.Slum dwellers are likely to be among the most deprived people in urban areas. 3The World Health Organization (WHO) defines women of reproductive age as those who are aged 15-49 years.They constitute more than one-fifth of the world's population and are repeatedly exposed to the risk of pregnancy and childbearing. 4Maternal health refers to the health of the mother during pregnancy, childbirth, and the postpartum period.The use of maternal healthcare services is important for the early detection of mothers who are at a high risk of morbidity and mortality during pregnancy. 5According to the WHO Introduction 166

Maternal Health Care Practices among Mothers of a Selected Slum in Dhaka City
current socioeconomic conditions and inaccessibility to health facilities. 6The Bangladesh Demographic and Health Survey (BDHS) 2011 showed that 55% of women with a birth in the three years preceding the survey received ANC at least once from any provider. 7regnancy and childbirth are normal physiological phenomena.Moreover, many cases terminate with the complications such as abortion, maternal or foetal disability and even maternal death or foetal loss or both. 8,9Global evidence shows that all pregnancies are at risk and complications during pregnancy, childbirth and the postnatal period are difficult to predict. 10 ANC which includes care during pregnancy should begin from the early stages of pregnancy.Women can access ANC services either by visiting a health centre where such services are available or from health workers during their domiciliary visits.One of the most important components of ANC is to offer information and advice to women about pregnancy-related complications and possible curative measures for the early detection and management of complications. 11his study was therefore conducted to assess the status of antenatal care services in selected urban slums in Dhaka.

Materials and Methods
This community based cross-sectional study was conducted at Moghbazar slum area in Dhaka district of Bangladesh during January to June 2014.A house-tohouse survey was conducted through a semi-structured pre-tested questionnaire and a standard checklist of antenatal care based on WHO protocol for antenatal care was used.A total 161 respondents were enrolled for the study by using purposive sampling technique.
Only interested slum dwellers who were either pregnant or had previous deliveries were interviewed face-toface.Information regarding age, education, occupation, monthly family income, marital status, number of living children and antenatal care related questions like number of antenatal visits, place of antenatal care, care providers, family planning counselling was collected.Women's views were explored in the other sections to assess their overall satisfaction with the quality of antenatal care, satisfaction with overall care, the time spent in the waiting room/area, getting medicine and tetanus vaccination by the care providers.Informed consent was taken by explaining the purpose of the study.Assurance had been given that the confidentiality concerning their information would be maintained strictly.Collected data were checked, verified and then entered into the computer.Only the fully completed questionnaire was entered into the computer for final analysis.The analysis was carried out with the help of SPSS (Statistical Package of Social Science, version 16.0) windows software programme.

Results
Table I  Table II shows the satisfaction levels among mothers in some selected slums of Dhaka city.Half of them were satisfied with the overall care provided.About 86.2% mothers said that they had to wait for more than two hours for check-ups.Regarding satisfaction with getting medicine 63% were found dissatisfied, 75% of mothers did not have complete tetanus vaccine.Nearly 50% received information about exercise and 36% were reassured about discussing fear and anxiety about pregnancy.
Table II

Discussion
Motherhood is the most important position a woman can have in her life but can be a life threatening event as well.During pregnancy any woman can develop serious, life-threatening complications that require medical care.The health of the urban poor is considerably worse than the urban middle and high income groups and may be even worse than the rural population. 12Out of 161 respondents, 70.6% mothers had knowledge about antenatal care.Among the respondents, 94 (58.5%) received ANC visit and 89 (55.2%) completed >3 visits.The BDHS conducted in 2011 showed that about 55% of the mothers received at least one ANC during their entire period of pregnancy. 7This is also consistent with the report done by Nigussie et al 13  Regarding satisfaction level among respondents half of them were satisfied with the overall care provided to them.About 86.2% mothers said that they had to wait for more than two hours for check-ups.Regarding getting medicine, 63% were found dissatisfied and 75% mothers did not have complete tetanus vaccine.More than 50% received information about exercise and 36% were reassured about discussing fear and anxiety about pregnancy.These observations are close to that of Nisar et al 14 who identified the prolonged waiting time, inadequate information about obstetric care, exercise, assurance of anxiety and fear in pregnancy and inadequate supply of drugs.
This study reveals that antenatal care provided was not up to the mark of standard care.Measures should be taken to improve public sector hospital obstetric services through increasing resources, adequate medicine supply, assurance of staff on duty and reducing waiting time.Furthermore, awareness among women should be created to properly utilize services.
The role of mass media should be enhanced to reduce the overall pregnancy related morbidity and mortality in Bangladesh.