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241.While there has been progress in disease prevention and control, and a decline in childhood communicable diseases, new and old infectious diseases, such as newer drug resistant tuberculosis, malaria, Dengue and HIV& AIDS are threats to health. The trend of noncommunicable disease such as cancer, diabetes, cardiovascular diseases and injuries are likely to rise in the future.

242.The malaria threat in Bangladesh is deepening in some parts of the country although aggregate statistics suggest a progressive lowering over the last four years to around 1 percent. While 13 of the 64 districts in the country are particularly affected, marginalized community living in remote hill tracts and adjacent districts of East and 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 and poor community mobilization.

Situation by disease and fields of health

243.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 and 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 and Traditional Birth Attendants-TBA). MICS 2006 reveals that overall about 66 percent births were delivered by TBA, 11 percent by relatives and friends, and remainder in hospital by skilled personnel.

244.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 and lowest level of antenatal care was found in the tribal areas. The coverage decreases with the increase of the age of woman and it is strongly co-related to educational background and socio economic status of the household. In 2004, the post natal care (PNC) coverage was 17.8 percent only.

245.The health seeking behaviour of women during pregnancy and childbirth is still not up to the expectation, with uneducated and less educated and poorer women being less likely to seek qualified care. Maternal malnutrition, infections during pregnancy, anaemia, and repeated pregnancies, contribute to a high rate of maternal mortality. Poor medical facilities at local level and 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 and absenteeism are major concerns.

246.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 and addressing violence against women; training has been conducted for medical officers and nurses from 31 health facilities. Safe Motherhood Day is observed regularly.

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