Bangladesh 1993-1994 Demographic and Health ... - Measure DHS

should be organized on a priority basis. Maternal and child health performance reporting should alsohighlight indicators for such conditions, the absence of which is inhibiting the improvement of MCH servicesin general.A similarly unsatisfactory situation holds for child birth. The BDHS data show that even in the1990s, virtually all births (96 percent) take place at home (see Table 8.4). Six of every ten births are assistedby traditional birth attendants (trained or untrained), but less than one in ten by medically trained personnel(see Table 8.5). Although the proportion of deliveries attended by traditional birth attendants (TBAs) hasbeen increasing, it is still below the Govemment's goal of 60 percent by trained TBAs. Thus, efforts shouldbe made to further increase the delivery of births by trained personnel--at least by paramedics or trainedTBAs.In the earlier discussion of breastfeeding, mention was made of the undesirably early introductionof supplementary liquids in the first few months of breastfeeding (section 11.2). It is somewhat surprisingthen that even by the first birthday less than half of all children are being fed any solid or mushy food (seeTable 8.14). This implies severe undemutrition among infants in Bangladesh. Promotion of additionalfeedings for growing babies within existing available resources should be emphasized by maternal and childhealth programs. Provision of feeding services in Family Welfare Centers, Mother and Child WelfareCenters, or the Maternal and Child Health Units of the Thana Health Complexes should be explored, ifnecessary, with assistance from UNICEF, the Vulnerable Group Feeding Project, or other internationalagencies. The Matlab experience of providing feeding services should be examined for possible replications.The final area of interest is much more positive. The Govemment's immunization program, theExpanded Programme on Immunization(EPI),madedramatic strides in the late 1980s. Until 1987,1ess thanone in ten children was fully immunized, but within six years, UNICEF data (1995) indicated that aboutthree-quarters of one-year-old children were fully protected. The BDHS data do not fully support this claim,indicating that slightly less than half of children were immunized by their first birthday (see Table 8.6). Ifchildren aged between the first and second birthday are considered, then the proportion protected increasesto three in five, closer to the UNICEF level. Some differences in coverage would be expected due to thedifferent survey methodologies used by the BDHS and UNICEF; however, what is most important is theencouragingly high levels of coverage for all vaccines, which have been achieved in just a few years. Thereis much to be learned about health service delivery in Bangladesh from the success of the immunizationprogram.Immunization pattems of concern to health professionals are the lower levels of full coverage amonggirls; among large families; among less educated groups; and in rural areas. Although urban coverage isexpected to be higher than rural coverage and favor families in Dhaka, not quite half of children in DhakaDivision were fully immunized, compared with three-quarters or more in Barisal and Khulna Divisions. Thisemphasizes the urgency of continuing to promote urban immunization programs, especially among floatingand slum populations, in which the prevalence of immunizable diseases such as tuberculosis is likely to berelatively high.Somewhat unexpectedly the Divisional pattem is not the same for women as for children. Morewomen receive tetanus toxoid vaccination in Dhaka Division than in all other divisions except Kbulna.Presumably, this is a result of women in Dhaka being more likely to receive some antenatal care, particularlyfrom a doctor (see Table 8.1).140