Correlations among the maternal healthcare services in Bangladesh: An application of joint modelling technique

Kakoli Rani Bhowmik; Sumonkanti Das; Unnati Rani Saha; Ruhul Amin; Md Atiqul Islam

doi:10.1016/j.heliyon.2023.e22453

Correlations among the maternal healthcare services in Bangladesh: An application of joint modelling technique

Heliyon. 2023 Nov 24;9(12):e22453. doi: 10.1016/j.heliyon.2023.e22453. eCollection 2023 Dec.

Authors

Kakoli Rani Bhowmik¹, Sumonkanti Das², Unnati Rani Saha³, Ruhul Amin⁴, Md Atiqul Islam⁵

Affiliations

¹ Department of Bio-Medical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.
² School of Demography, Australian National University, Canberra, Australia.
³ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
⁴ Bangladesh Institute of Governance and Management (BIGM), Dhaka, 1207, Bangladesh.
⁵ Department of Statistics, Jagannath University, Dhaka, Bangladesh.

Abstract

Background: Caesarean section (C-section) in Bangladesh have received great attention as the number has been amplified during the last two decades. The question arises whether this rise has a correlation with other maternal healthcare services and/or has been influenced by their predictors.

Objective: The main objectives of this study are to assess correlations among the maternal healthcare indicators-antenatal care use, childbirth in private facilities, and childbirth through C-section-and identify their associated predictors in Bangladesh through the development of an appropriate cluster-adjusted joint model that accounts for inter-correlation among the indicators in the same cluster.

Design: The 2019 Bangladesh Multiple Indicator Cluster Survey data have been utilized in this study. Separate generalized linear mixed models developed for the three outcome variables are combined into a joint model by letting cluster-specific random effects be in association.

Findings: The joint model shows that the number of antenatal cares is fairly positively correlated with delivery in private facilities and C-section, while the latter two are strongly positively correlated. Household socio-economic condition, women and their partners' education, women's exposure to mass media, place of residence, religion, and regional settings have significant influence on the joint likelihood of receiving antenatal care, choosing a private health facility for birth, and opting for C-section birth.

Key conclusions and implications: The rising rate of C-section delivery over time is alarming for Bangladesh to achieve the World Health Organization target of 10-15 %. The joint model reveals that the rising rate of C-sections may be correlated with the choice of a private health facility as the delivery place. The study findings also suggest that maternal childbirth care is private-dominant and predominantly utilized by urban women with better education and higher socio-economic status. The policy should focus on strengthening the public health sector while also keeping importance in increasing coverage of maternal care services among the less well-off.

Keywords: Antenatal care; Caesarean section; Delivery in private facilities; Inter-correlation; Joint model.