COVID-19 brings harsh challenges and unique opportunities to improve health services in remote parts of Bangladesh
Noor Jahan, 35, gave birth to a baby boy on 28 February 2021 in the remote district of Bhola. It was her fifth child and she was not expecting any difficulties, so she opted for a home birth with support from her village midwife.
Shortly after giving birth, Noor Jahan’s baby boy was suffering from cold and respiratory problems. The family were advised to go to Bhola District Hospital immediately, a three-hour drive from their home. Noor Jahan and her husband Abdul faced two major problems. COVID-19’s impact on the family business meant they didn’t have any money for transport, and Noor Jahan was extremely weak having suffered a haemorrhage during the birth.
“I was afraid because my child was facing trouble breathing. He was suffering from cold. I knew it could be something serious like pneumonia,” said Noor Jahan.
As the situation grew more critical, Noor’s husband borrowed money to cover their transport and Noor Jahan summoned up energy for the long journey knowing her baby’s life was in danger.
COVID-19 exposes gaps in maternal and child services
Over the past decade, progress on child mortality has stalled in Bangladesh with no significant decrease in neonatal and infant mortality rates.[i]
The onset of COVID-19 led to a 50 per cent plummet in maternal and child health (MCH) service uptake nationwide. Deliveries in health facilities, usually over 350,000 per month, dropped to 160,000 in April 2020. The Lancet medical journal issued a stark warning that a 45 per cent reduction in MCH coverage for 6 months could result in 30 per cent more maternal deaths.[ii]
“At the time, there was fear on both sides of contracting COVID-19. Patients were afraid to come to the health clinic and health workers hadn’t yet received sufficient Personal Protective Equipment to protect themselves while working,” says Dr Sanjana Bhardwaj, Chief of Health, UNICEF Bangladesh.
An assessment of 200 health facilities in Bangladesh in July 2020 revealed that 70 per cent did not have adequate oxygen infrastructure and essential oxygen equipment to respond to both COVID and non-COVID cases.
Targeted approach for better results
In response, UNICEF teamed up with the United Kingdom Foreign, Commonwealth and Development Office (FCDO) to strengthen maternal and child health services in eight priority districts including Bhola, working in close collaboration with the Government of Bangladesh.
As one of the five poorest districts in Bangladesh, Bhola faces distinct challenges. It is an island district, frequently impacted by flooding, tidal surges and cyclones. There is no road or rail connection, the mainland can only be reached by boat.
“If patients need to be transferred from Bhola to Barishal or Dhaka for emergency treatment, we can lose a lot of time because the logistics are so complex. If we don’t have the required health services and human resources available here in this district, patients can die,” said Ani Lucia Baroi, Senior Staff Nurse, Special Care Newborn Unit (SCANU), Bhola District Hospital.
With UNICEF-FCDO support, the SCANU in Bhola District Hospital was upgraded with essential equipment and supplies including oxygen concentrators, cylinders, flowmeters, radiant warmers and resuscitators. Infection Prevention Control measures were institutionalized through training, and triage points were established to separate suspected COVID-19 patients from other patients prior to hospital admission.
“We also trained healthcare staff on “kangaroo mother care”, newborn quality of care standards and use of oxygen therapy, as well as data management,” said Dr Bhardwaj.
The upgraded facilities and trainings had an immediate impact for healthcare workers in Bhola District Hospital.
“We have many newborns with low birth weight, who are delivered pre-term and who suffer severe pneumonia – these newborns need oxygen. Before, we could not guarantee the oxygen supply using cylinders, and a shortage could be the difference between life or death. Now with oxygen concentrators, we are relieved because we can supply oxygen 24/7,” said Nurse Baroi. “We feel more confident and better equipped to respond to complicated cases requiring oxygen therapy,” she added.
In the nick of time
Upon reaching Bhola District Hospital, both Noor Jahan and her baby required immediate treatment. Noor Jahan received a blood transfusion, while her baby was quickly admitted to the SCANU.
“I remember Noor Jahan’s baby. He had severe postnatal aspiration and respiratory problems. We quickly provided him with oxygen support and placed him on a special warmer until his body temperature returned to normal,” said Baroi.
“Babies are usually admitted to the SCANU for 2-3 days. Noor Jahan’s baby received treatment for four days until his condition stabilized. After he recovered and could breastfeed, we were able to discharge them both from hospital. Without oxygen support, the outcome could have been very different,” shared Baroi.
Turning the tide against preventable deaths
COVID-19 has shone a spotlight on critical gaps in health services. The renewed focus on health system strengthening offers a unique opportunity to build back better.
“We continue to work closely with the Government focusing on COVID-19 prevention, safety and adaptation measures, as well as sustained community outreach to restore all essential maternal and child health services. We must focus on the quality of care to bring down maternal and child mortality rates further. Our target is zero preventable deaths,” said Dr Bhardwaj.
“This critical investment in oxygen support, human resources, data management and quality assurance facilitates the revitalization of maternal and child health services at a critical time. We believe this is a turning point, as we continue to work towards saving mothers and vulnerable newborns in the future,” Dr Bhardwaj added.
UNICEF wishes to express its sincere gratitude to United Kingdom Foreign, Commonwealth and Development Office, for their generous contributions towards supporting Special Care Newborn Units throughout Bangladesh.
[i] UNICEF (2019) Bangladesh Multiple Indicator Cluster Survey (MICS) 2019 <https://mics.unicef.org/news_entries/152/BANGLADESH-MICS-2019-REPORT:-KEY-FINDINGS> accessed on 9 March 2021
[ii] Roberton, Timothy et al., (2020) ‘Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study’, The Lancet, vol. 8, July 2020, pp. 901–08.
accessed on 10 March 2021