Determinants and pattern of care seeking for preterm newborns in a rural Bangladeshi cohort

The burden of preterm birth and its complications has been increasing, and it represents a significant issue in combating neonatal health risks and reducing neonatal mortality. Despite the increased burden, there is a dearth of care-seeking data for preterm newborns, which is a significant knowledge gap. A study conducted in Sylhet district of Bangladesh aimed to examine the patterns and determinants of care-seeking for preterm newborns and to conduct comparative risk analysis for care-seeking from qualified and unqualified providers of health care. The study analyzed prospectively collected data from a large community-based cluster-randomized trial conducted between June 2007 and September 2009. The trial evaluated the impact of single or multiple cleansing of the umbilical cord with 4.0% chlorhexidine solution on overall neonatal mortality and incidence of cord infections. The study found that only one-fifth (19.7%) of preterm newborns were taken to seek either preventive or curative health care. Among care-seeker preterm newborns, preferred providers included homeopathic practitioners (50.0%), and less than a third (30.9%) sought care from qualified providers. Care-seeking from either unqualified or qualified providers was significantly lower for female preterm babies compared to male babies. The study identified several determinants of care-seeking for preterm newborns, including recognition of symptoms of illness, signs of local infection, history of child death, any antenatal care visit, birth preparedness, and any antenatal care visit. These factors were associated with increased likelihood of care-seeking for preterm babies from qualified providers. The study also found that caregivers who recognized symptoms of illness or signs of local infection were more likely to seek care for their preterm babies. The study's findings have implications for improving care-seeking practices for preterm babies and referral of sick newborns to qualified providers/facilities. The researchers recommend involving community-preferred health care providers in community-based health education and awareness-raising programs, integrating postnatal care-seeking messages into antenatal counseling, and further research on care-seeking practices for preterm babies. The study's conceptual framework was based on Andersen's socio-behavioural model of health services, which posits that an individual's choice to seek health care is guided by predisposing and enabling factors. The study incorporated both predisposing and enabling factors, as well as need factors, in the model. The study's findings highlight the importance of understanding community-specific patterns and determinants of population-level neonatal care-seeking practices, especially for preterm newborns. The study was implemented in 22 unions of Sylhet district in north-eastern Bangladesh, where health care was available through first-level health centers and sub-district hospitals. However, these facilities were not equipped to provide emergency care to newborns, especially preterm babies. The study's findings have implications for improving care-seeking practices for preterm babies in similar settings.