Third and Fourth Periodic Report on CRC - Unicef

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<strong>Third</strong> <strong>and</strong> <strong>Fourth</strong> <strong>Periodic</strong> <strong>Report</strong> country are particularly affected, marginalized community living in remote hill tracts <strong>and</strong> adjacent districts of East <strong>and</strong> North East border of the country are more vulnerable. National mechanism to combat malaria is weak due to insufficient resources, poor surveillance, rising drug resistance, prohibitive cost of insecticides <strong>and</strong> poor community mobilization. 6.4.4 Situation by disease <strong>and</strong> fields of health Maternal mortality: According to the Bangladesh Maternal Mortality Survey 2001, the maternal mortality ratio is in the range 320-400 per 100,000 live births reduced from 478 in 1990. In 2006, only 35 percent of urban births <strong>and</strong> 15 percent rural births are assisted by skilled health workers (BBS/UNICEF, 2006), that is of the total deliveries, 88 percent take place at home (by relatives <strong>and</strong> Traditional Birth Attendants-TBA). MICS 2006 reveals that overall about 66 percent births were delivered by TBA, 11 percent by relatives <strong>and</strong> friends, <strong>and</strong> remainder in hospital by skilled personnel. Coverage of antenatal care (by doctor, nurse or midwife) is relatively low in Bangladesh. With 47.7 percent of women receiving antenatal care at least once during pregnancy (MICS 2006). The care varies widely between areas, around 67 percent in urban against 41.2 percent in rural areas <strong>and</strong> lowest level of antenatal care was found in the tribal areas. The coverage decreases with the increase of the age of woman <strong>and</strong> it is strongly corelated to educational background <strong>and</strong> socio economic status of the household. In 2004, the post natal care (PNC) coverage was 17.8 percent only. The health seeking behaviour of women during pregnancy <strong>and</strong> childbirth is still not up to the expectation, with uneducated <strong>and</strong> less educated <strong>and</strong> poorer women being less likely to seek qualified care. Maternal malnutrition, infections during pregnancy, anaemia, <strong>and</strong> repeated pregnancies, contribute to a high rate of maternal mortality. Poor medical facilities at local level <strong>and</strong> poverty cause insufficient health seeking attitude in the country. Only about a third of the Union Health Centres are managed by qualified doctors. The frequent transfer of doctors <strong>and</strong> absenteeism are major concerns. A national strategy for maternal health was adopted in 2001. HNPSP has a separate component on maternal health. Under the Woman Friendly Hospital Initiative (WFHI); aimed at strengthening EmOC services <strong>and</strong> addressing violence against women; training has been conducted for medical officers <strong>and</strong> nurses from 31 health facilities. Safe Motherhood Day is observed regularly. Steady but considerable progress has been made in increasing the coverage of EmOC services with an estimated ratio of 1 for every 646,557 persons. A total of 132 EmOC facilities are providing Comprehensive EmOC <strong>and</strong> another 59 facilities are providing Basic. Met need for EmOC services increased to 13.7 percent in 2005 from 11.9 percent in 2004 <strong>and</strong> case fatality rate decreased to 1.18 percent in 2005 compared to 1.7 percent in 2004. Health professionals were trained on EmOC services. Family planning: Bangladesh achieved good progress in contraceptive adoption, awareness raising about <strong>and</strong> controlling of population growth rate. Contraceptive Prevalence Rate (CPR) stood at 57 percent in 2005. Total Fertility Rate (TFR) came down from 3.3 in 2001 to 2.5 in 2005. These two important factors, along with drop in infant mortality rate, increased the mean age of first marriage (16 years), increase in female literacy rate <strong>and</strong> higher female labour participation rate contributed to slower growth rate of population (1.52 percent), which in turn caused by drop in infant mortality. Significant differences exist in the use of Family Planning (FP) methods with CPR among Divisions, 32 to 68.3 percent. One major concern regarding FP methods is that nearly 50 percent of women, who use contraceptives, discontinue within the first year. There are other problems like inadequate addressing of the marginalized <strong>and</strong> poor people, ineffective policies <strong>and</strong> programmes such as more dependence on female. The other weaknesses in FP include: shortage of field staff <strong>and</strong> contraceptives, traditional beliefs <strong>and</strong> practices. 58
Convention on the Rights of the Child Adolescent reproductive health: Under aged mothers are more likely to suffer severe complications during delivery, resulting in higher mortality <strong>and</strong> morbidity among themselves <strong>and</strong> the children. Dowry still remains the core of marriage negotiations <strong>and</strong> major cause of violence, <strong>and</strong> early marriage of girl is still high. Early marriage, son-preference <strong>and</strong> low status of women in the society affect adolescent girls' nutrition, education <strong>and</strong> access to health. In Bangladesh indicated that a substantial portion of adolescent <strong>and</strong> young people are not aware of causes of menstruation, consequences of unprotected sexual activity, STD, HIV&AIDS <strong>and</strong> availability of treatment facilities. The State Party has therefore identified adolescent health <strong>and</strong> education both as a priority <strong>and</strong> challenge, <strong>and</strong> incorporated this issue in the HNPSP. Health <strong>and</strong> other related issues of adolescents will be further incorporated in curriculum of secondary education from 2008. Infant <strong>and</strong> child mortality: Infant <strong>and</strong> child mortality are key indicators of the care, health <strong>and</strong> nutrition status of children as well as the social, cultural <strong>and</strong> economic progress of country. There has been a steady decline in the infant mortality rate from 87 per thous<strong>and</strong> live births in 1993-94 to 65 per thous<strong>and</strong> in 2004 (BDHS, 2004). Under-five mortality rate has come down from 133 in 1993-94 to 94 in 2000, further down to 84 per thous<strong>and</strong> in 2003 (BBS, 2005). There continue to be urban-rural differences in under-five mortality rate (55 in urban areas compared 78 in rural areas per thous<strong>and</strong> in 2004). Neonatal death rate of 41 per thous<strong>and</strong> live births (BDHS 2004) is due to three main causes: infections (pneumonia, neonatal sepsis), birth asphyxia <strong>and</strong> low birth weight (LBW) <strong>and</strong> preterm delivery. There has been an epidemiological transition of mortality pattern in Bangladesh. Due to the relative decline in deaths caused by infectious diseases, non-infectious causes such as injuries <strong>and</strong> accidents now are considered to be important factors of child mortality. Study (ICMH <strong>and</strong> UNICEF, 2003) shows that injuries <strong>and</strong> accidents contribute to 29 percent of total deaths among children aged 1-4 years. Table 6.2: Trend in early childhood mortality in Bangladesh, 1993-2004 (per 1,000) Data Source Approximate Neonatal Post-neonatal Infant Child Under-five Reference period Mortality Mortality Mortality Mortality BDHS 2004 1999-2003 41 24 65 24 88 BDHS;1999-2000 1995-1999 42 24 66 30 94 BDHS;1996-1997 1992-1996 48 34 82 37 116 BDHS;1993-1994 1989-1993 52 35 87 50 133 In order to reduce deaths from diarrhoea, the oral rehydration therapy (ORT) campaign has been in effect for a long time. The ORT campaign is a regular activity in ORT corners in Government hospitals, EPI outreach sites, <strong>and</strong> home visits by health workers, throughout the country. Oral rehydration solution (ORS) use during diarrhoea increased from 62 percent in 2000 (BBS/UNICEF 2000) to 68 percent in 2003 (BBS/UNICEF, 2003) to 70 percent in 2006 (BBS/UNICEF, 2006). Immunization: Bangladesh contributes to have a record with regard to immunization coverage. The valid coverage of fully immunized children (all doses given at right intervals) increased from 52 percent in 2001 to 63 percent in 2003 <strong>and</strong> to 71 percent in 2006 (Coverage Evaluation Survey 2000, 2003 <strong>and</strong> 2006). Both hepatitis B vaccination <strong>and</strong> Auto Disposable (AD) syringes have been introduced in 2003. Facility Based Integrated Management of Childhood Illnesses (IMCI) activities that began in 2002 cover over 140 of sub-districts (Upazilas) in 2006. 59
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