voice of mis-health - নীড় পাতা€¦ · bangladesh maternal and child mortality...
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Newsletter, MIS-Health, DGHS, Dhaka, Bangladesh
Emergency Obstetric Care (EmOC) Performance Report January-June 2011
Issue 10 October 2011
Contents
Introduction-1
Information covered in the newsletter-1
Messages-2
Method-3
Results-3
Performance-measuring indicators-5
Division-wise status of EmOC services-5
Comparison of EmOC service status between year 2009 to 2011-6
Key findings-7
Limitation about the data source-7
Recommendation-7
Conclusion-7
Annexure-8
Voice of MIS-Health
Introduction Maternal Mortality Ratio (MMR) and Infant Mortality Rate
(IMR) have decreased significantly over the past years.
Bangladesh could reduce its MMR by 66% from 1990 to
2010 (in 20 years). In 1990, MMR in Bangladesh was 574
per 100,000 livebirths. According to Bangladesh Maternal
Mortality Survey 2010 (BMMS 2010), it was to be 194 per
100,000 livebirths in 2010. The Millennium Development
Goal 5 has set target for reduction of MMR by three-fourths
between 1990 and 2015 (25 years), which means a 75%
reduction. This reduction in MMR in the country is
attributable to the Government's strong commitment
through national policies and programs. The Government is
committed to improving the health services of the common
people, particularly of the mothers and children. Various
programs have been undertaken on Reproductive Health,
which include strengthening of Comprehensive Emergency
Obstetric Care (EmOC) services, amongst others, at
various medical college hospitals, district hospitals, upazila
health complexes, and at community levels. This newsletter
provides information on the status of EmOC facilities in
Bangladesh from January to June 2011 and compares with
the status in 2009 to 2011.
Information covered in the newsletter
• Status of EmOC services provided from
January to June 2011 in public, private and
NGO facilities with division-wise and health
facility-wise distribution
• Comparison of EmOC service status
between year 2009 and 2011
Director, Primary Health Care (Additional Charge)
and Line-Director, ESD
Directorate General of Health Services Mohakhali, Dhaka
I am happy to know that MIS-Health of DGHS is publishing the 10th issue of "Voice of MIS-Health" with support from UNICEF Bangladesh
focusing on the EmOC performances. We may have a good level of satisfaction that we could make a remarkable success in reducing maternal
mortality rate. It is now 194 per 100,000 livebirths, i.e. 40% reduction from 2001 figure and 66% reduction from 1990 figure. In the next sector
program, we are providing much more emphasis to enhance the maternal health program. Therefore, we may believe that we would be able to
achieve the targets of MDG 5 by 2015.
This newsletter will definitely help us understand different parameters of EmOC performances. If we learn from the lessons, we would be
benefited towards achieving our goal.
I thank the MIS-Health, DGHS, for their valuable efforts. I would like to thank everyone who worked hard to publish this newsletter.
(Dr. Md. Shamsul Haque)
Message
Message
Additional Director General (Planning & Development)
and Line-Director, Management Information System
Directorate General of Health Services
Mohakhali, Dhaka
Bangladesh has made a remarkable progress in maternal and child healthcare services in the recent time. Bangladesh Maternal and Child Mortality Survey
2010 (BMMS 2010) shows 194 maternal deaths per 100,000 livebirths. Maternal Mortality Ratio (MMR) is now used as a global indicator of overall health status
of women in any given country, where Bangladesh certainly has shown success. Emergency Obstetric Care (EmOC) has been recognized as an accepted
intervention for reducing the maternal mortality. When we have greater confidence about achievement of MDG 5, we should have greater effort to enhance the
intervention too for Emergency Obstetric Care (EmOC).
It is my great pleasure that the 10th issue of the newsletter "Voice of MIS-Health" is going to be published. The newsletter reports the EmOC performances and
their analysis based on the UN process indicators, which would enable comparison of data with other countries. However, the data presented here were not
collected in a research setting; rather were extracted from the facility registers and records filled in by staff nurses. We reported selected process indicators as
relevant to our context.
The UNICEF (Bangladesh) deserves special thanks for funding EmOC programs as well as for providing technical assistance and funding support for printing
this newsletter. I gratefully acknowledge the efforts made by members of the Editorial Board, who provided their time to review inputs of this newsletter.
(Professor Dr. Abul Kalam Azad)
Message
Director General
Directorate General of Health Services
Mohakhali, Dhaka
Our country made a significant progress in achieving MDG 5. This progress has been made in the past decade. Maternal mortality rate in
Bangladesh was 574 per 100,000 livebirths in 1990. It was 322 per 100,000 livebirths in 2001. The current rate is 194 per 100,000 livebirths.
This trend indicates that we will achieve our target of 143.5 per 100,000 livebirths by 2015. However, there is no room for complacence. As the
target is nearing, difficulty may also be much more to achieve more progress. Therefore, we would need to strengthen our efforts so that we can
reach the MDG 5 target by 2015.
It is, indeed, a great pleasure for me to know that the 10th Issue of "Voice of MIS-Health" on EmOC performances is going to be published by
MIS-Health. I am pleased to see that UNICEF is continuing its support to publish the newsletter. I thank UNICEF for this assistance.
I hope that the persons concerned with EmOC interventions, the planners and the managers of different levels will find this report useful in
improving the existing EmOC program. Finally, I would like to thank everyone who worked hard directly and behind the screen for publishing
this newsletter successfully.
(Professor Dr. Khondhaker Md. Shefyetullah)
MethodData from 649 health facilities, consisting of 14 medical
college hospitals, 62 district and general hospitals, 417
upazila health complexes, 57 maternal and child welfare
centers (MCWCs), 35 NGOs and 62 private hospitals in 62
districts, and 2 other types of hospitals, have been used for
analysis. Census 2011 data covering the current
population, expected births, and expected complications of
pregnancies have been used. Crude birth rate (CBR) was
calculated as constant of 19.4 births per thousand
populations (SVRS 2009, Bangladesh Bureau of
Statistics). Finally, the CBR and the census population of
year 2011 by division and district were used in generating
the expected number of births in each area. These
numbers of births were used in calculating the process
indicators.
ResultsTable 2 shows the division-wise distribution of admitted
patients, total deliveries, caesarean sections, livebirths,
stillbirths, maternal deaths and neonatal deaths. Data
show that there were 278,312 reported deliveries at EmOC
facilities in the country during January to June 2011 and,
out of them, 272,981 yielded livebirths and 8,344 resulted
in stillbirths. Among the total deliveries, caesarean sections
were 117,198. There were 668 maternal deaths and 1,335
neonatal deaths.
Table 3. Number of populations, expected births, and obstetric complications estimated for January to June
2011 by division
Category Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Total
Population
(Census 2011) 8,147,000 28,079,000 46,729,000 15,563,000 18,329,000 15,665,000 9,808,000 142,319,000
Expected births
(Jan-June 2011) 79,026 272,366 453,271 150,961 177,791 151,951 95,138 1,380,494
Estimated
complications
(Jan-June 2011)
11,854 40,855 67,991 22,644 26,669 22,793 14,271 207,074
Table 4. Division-wise distribution of status of process indicators translated from summary of EmOC data
received from health facilities (January-June 2011)
Category Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Total
Visit for ANC service (No.) 35,468 145,966 293,920 135,731 78,367 96,668 37,754 823,874
Admitted patients (No.) 21,707 56,772 124,446 53,811 57,725 51,997 24,234 390,692
Complication treated (No.) 7,783 16,244 45,639 16,588 13,601 9,837 8,464 118,156
Normal delivery (No.) 7,040 26,561 42,170 20,683 27,571 23,746 9,503 157,274
Forceps/Vacuum/Destructive
operation (No.) 9
450
382
117
139
365
283
1,745
Vaginal breech/Face
presentation delivery (No.)
27
570
588
148
152
391
219
2,095
Caesarean section (No.) 7,746 16,782 46,684 15,989 11,738 12,429 5,830 117,198
Total delivery (No.) 14,822 44,363 89,824 36,937 39,600 36,931 15,835 278,312
Livebirth (No.) 14,397 43,075 88,111 36,277 38,966 37,159 14,996 272,981
Stillbirth (No.) 537 1,726 2,338 856 831 1,126 930 8,344
Name of
division
Admitted
patients
Total
delivery
Caesarean
section Livebirth Stillbirth
Maternal
death
Neonatal
death
Barisal 21,707 14,822 7,746 14,397 537 61 249
Chittagong 56,772 44,363 16,782 43,075 1,726 110 330
Dhaka 124,446 89,824 46,684 88,111 2,338 190 259
Khulna 53,811 36,937 15,989 36,277 856 58 80
Rajshahi 57,725 39,600 11,738 38,966 831 89 92
Rangpur 51,997 36,931 12,429 37,159 1,126 94 204
Sylhet 24,234 15,835 5,830 14,996 930 66 121
Bangladesh 390,692 278,312 11,7198 27,2981 8,344 668 1,335
Table 2. Division-wise distribution of EmOC services
and status in number (January-June 2011)
Type of Institutions No.
Medical college hospitals 14
District and general hospitals 62
Upazila health complexes 417
Districts from where NGO providers sent data 35
Districts from where private providers sent data 62
Maternal and Child Welfare Centers (MCWCs) 57
Other sources 2
Total 649
03
Table 4. Division-wise distribution of status of process indicators translated from summary of EmOC data
received from health facilities (January-June 2011) (Continued...)
Table 5. Distribution of status of EmOC data received from type of health facilities (January to June 2011)
Category Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Total
Other surgery (No.) 514 3,319 5,783 1,977 2,333 1,917 1,594 17,437
Referred in (No.) 453 5,980 3,951 939 769 748 1,021 13,861
Referred out (No.) 1,108 2,938 6,621 1,915 2,841 3,385 1,747 20,555
Visit for PNC service (No.) 11,332 40,546 126,358 35,261 36,021 38,115 16,869 304,502
Maternal death (No.) 61 110 190 58 89 94 66 668
Neonatal death (No.) 249 330 259 80 92 204 121 1,335
Proportion (%) of all births in
EmOC facilities 18.76 16.29 19.82 24.47 22.27 24.30 16.64 20.16
Met need (%) for EmOC 65.66 39.76 67.13 73.26 51.00 43.16 59.31 57.06
Caesarean section as % of all
births 9.80 6.16 10.30 10.59 6.60 8.18 6.13 8.49
Case Fatality Rate (CFR) (%) 0.78 0.68 0.42 0.35 0.65 0.96 0.78 0.57
Medical
college
hospital
District and
general
hospital
Upazila
health
complex
Maternal
and child
welfare
center
Private
clinic/
hospital
NGO Other
sources Total
Visit for ANC service No. 59,328 91,862 267,170 131,412 175,684 98,244 174 823,874
% 7.2 11.2 32.4 16.0 21.3 11.9 0.0 100.0
Admitted patients No. 63,353 73,821 111,820 22,345 99,791 18,930 632 390,692
% 16.2 18.9 28.6 5.7 25.5 4.8 0.2 100.0
Complication No. 21,812 30,552 28,698 2,853 31,639 2,459 143 118,156
% 18.5 25.9 24.3 2.4 26.8 2.1 0.1 100.0
Normal delivery No. 18,980 24,091 62,034 15,299 26,683 9,728 459 157,274
% 12.1 15.3 39.4 9.7 17.0 6.2 0.3 100.0
Forceps/Vacuum/
Destructive
operation
No. 452 116 650 36 315 176 0 1,745
% 25.9 6.6 37.2 2.1 18.1 10.1 0.0 100.0
Vaginal breech/
Face delivery
No. 435 413 300 241 557 149 0 2,095
% 20.8 19.7 14.3 11.5 26.6 7.1 0.0 100.0
Caesarean section No. 21,635 14,810 9,907 4,213 60,834 5,799 0 117,198
% 18.5 12.6 8.5 3.6 51.9 4.9 0.0 100.0
Total delivery No. 41,502 39,430 72,891 19,789 88,389 15,852 459 278,312
% 14.9 14.2 26.2 7.1 31.8 5.7 0.2 100.0
Livebirth No. 39,255 37,643 71,143 19,721 89,012 15,775 432 272,981
% 14.4 13.8 26.1 7.2 32.6 5.8 0.2 100.0
Stillbirth No. 2,530 2,101 2,174 400 883 229 27 8,344
% 30.3 25.2 26.1 4.8 10.6 2.7 0.3 100.0
Other surgeries No. 5,764 5,747 3,856 214 1,678 178 0 17,437
% 33.1 33.0 22.1 1.2 9.6 1.0 0.0 100.0
Referred in No. 4,467 3,820 987 769 3,441 377 0 13,861
% 32.2 27.6 7.1 5.5 24.8 2.7 0.0 100.0
Referred out No. 168 3,340 13,404 985 1,610 904 144 20,555
% 0.8 16.2 65.2 4.8 7.8 4.4 0.7 100.0
PNC service No. 26,154 45,194 102,881 30,474 80,750 18,384 665 304,502
% 8.6 14.8 33.8 10.0 26.5 6.0 0.2 100.0
Maternal death No. 411 158 50 0 31 18 0 668
% 61.5 23.7 7.5 0.0 4.6 2.7 0.0 100.0
Neonatal death No. 932 81 91 1 133 97 0 1,335
% 69.8 6.1 6.8 0.1 10.0 7.3 0.0 100.0
Category
04
Performance-measuring indicatorsThe United Nations launched a guideline on EOC performance called United Nations (UN) Process Indicators in 1997 to
measure the status of emergency obstetric care in developed and developing countries. These UN Process Indicators
measure (i) the number of hospitals that can provide care for emergency obstetric conditions per 500,000 populations; (ii)
distribution of hospitals in the catchment area (iii) proportion of births in the hospitals; (iv) proportion of women with
obstetric complications treated in the hospitals; (v) caesarean section rate; and (vi) case fatality rate.
Division-wise status of EmOC Services (January-June 2011)
Process Indicator Acceptable level
1) Coverage by Essential Obstetric Care
(EOC):
Basic EOC facilities
Comprehensive EOC facilities
For every 500,000 population, there should be:
At least 4 Basic EOC facilities
At least 1 Comprehensive EOC facility
2) Geographical distribution of EOC facilities Minimum level for the coverage by EOC services is met in sub-
national areas
3) Proportion of all births in Basic and
Comprehensive EOC facilities
At least 15% of all births in the population take place in either Basic
or Comprehensive EOC facilities
4) Met need for EmOC:
Proportion of women estimated to
have complications who are treated
in EOC facilities
100% of women estimated to have obstetric complications are
treated in EOC facilities
5) Caesarean sections as percentage of all
births
As a proportion of all births in the population , caesarean sections
account for not less than 5% but not more than 15%
6) Case Fatality Rate (CFR) The case fatality rate among women with obstetric complications
in EOC facilities is less than 1%
Table 6. Indicators and acceptable levels
Figure 1. Division-wise distribution of institutional
delivery rates (% of all births in the EmOC facilities)
Figure 2. Division-wise distribution of the met need
(%) of obstetric care in the EmOC facilities (January
to June 2011)
18.76%
16.29%
19.82%
24.47%22.27%
24.30%
16.64%
20.16%
Ba
risa
l
Ch
itta
go
ng
Dh
ak
a
Kh
uln
a
Ra
jsh
ah
i
Ra
ng
pu
r
Sy
lhet
Ba
ng
lad
esh
65.66%
39.76%
67.13% 73.26%
51.00%
43.16%
59.31% 57.06%
Ba
risa
l
Ch
itta
go
ng
Dh
ak
a
Kh
uln
a
Ra
jsh
ah
i
Ra
ng
pu
r
Sy
lhet
Ba
ng
lad
esh
Proportion (%) of all births in EmOC facilitiesFigure 1 shows the division-wise distribution of the
proportion of all births which took place in EmOC facilities
during January to June 2011. It reveals that the proportion
(%) was the highest in Khulna division (24.47%) and the
lowest in Chittagong division (16.29%). It appears that the
institutional delivery rates stand high in the UN process
indicator norm in all divisions. The institutional delivery
rates in Rangpur, Rajshahi, Dhaka, Barisal, and Sylhet
divisions were between 16.64% and 24.30%. The average
for Bangladesh was 20.16%.
Met need (%) for EmOCFigure 2 shows the division-wise distribution of obstetric
complications treatment rate (% of need met) in different
EmOC facilities during January to June 2011. The rate was
the highest in Khulna division (73.26%) and the lowest in
Chittagong division (39.76%). The position of Dhaka
division (67.13%) and Barisal division (65.66%) was
second and third respectively with respect to performance.
Other divisions met between 59.31% and 43.16% of the
need respectively. The Bangladesh average was 57.06%.
05
Comparison of EmOC service status between year 2009 to 2011
Figure 5. Comparison of proportion of all births in
EmOC facilities from year 2009 to year 2011
Figure 6. Comparison of met need (%) of EmOC
facilities between year 2009, 2010, and 2011
9.80%
6.16%
10.30% 10.59%
6.60%
8.18%
6.13%
8.49%
Ba
risa
l
Ch
itta
go
ng
Dh
ak
a
Kh
uln
a
Ra
jsh
ah
i
Ra
ng
pu
r
Sy
lhet
Ba
ng
lad
esh
0.78%
0.68%
0.42%0.35%
0.65%
0.96%
0.78%
0.57%
Bari
sal
Ch
itta
gon
g
Dh
ak
a
Kh
uln
a
Rajs
hah
i
Ran
gp
ur
Sylh
et
Ban
gla
des
h
9.7611.01
14.9415.7 16.44 16.12
10.63
13.9812.1 12.08
16.34
18.4820.19 20.01
16.29
16.44
18.76
16.29
19.82
24.47
22.27
24.30
16.64
20.16
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh
2009 2010 2011
40.8135.66
52.62
45.21 50.49
30.25
54.98
45.05
46.3
37.11
60.41
49.7446.78
37.9
59.62
49.36
65.66
39.76
67.13
73.26
51.00
43.16
59.3157.06
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh
2009 2010 2011
Proportion (%) of all births in EmOC facilitiesFigure 5 compares the proportion (%) of all births that took
place in EmOC facilities in different divisions of Bangladesh
between year 2009, 2010, and 2011. Performance in January
to June 2011 clearly shows substantial improvement over the
previous two years, because the number of births in EmOC
facilities has increased in all divisions (Table-6, point 3).
Met need (%) for EmOCFigure 6 compares the met need (%) of EmOC in different
divisions of Bangladesh between year 2009, 2010, and
2011. The country average of performance in January to
June 2011 was better compared to the previous two
years.
Figure 3. Division-wise distribution of caesarean
section rate (%) in the EmOC facilities (January to
June 2011)
Figure 4. Division-wise distribution of Case Fatality
Rate (%) in the EmOC facilities (January to June
2011)
Caesarean section as % of all births Figure 3 shows the division-wise distribution of the
caesarean section rates as percentage of all births that
took place in the EmOC facilities during January to June
2011. It is one of the important indicators for monitoring
access to critical EmOC services. It is revealed that the
highest rate of caesarean births was in Khulna division
(10.59%), followed by Dhaka division (10.30%). The lowest
rate was in Sylhet division (6.13%). The caesarean section
rates varied from division to division. In other divisions, the
rates were as follows: Barisal (9.80%), Rangpur (8.18%),
Rajshahi (6.60%) and Chittagong (6.16%). The country
average was 8.49%, UN process indicator, point 5 in Table-
6, is thus been achieved.
Case Fatality RateThe direct obstetric case fatality rate is the proportion of
women who die before discharge, after being admitted to an
EmOC facility with major direct obstetric complications or who
develop such complications after admission. Case Fatality
Rate (CFR) gives rough indication of quality of EmOC
services. CFR, among women in Bangladesh, who came with
obstetric complications to EmOC facilities, was 0.57 in January
to June 2011 (Figure 4). It is within the acceptable limit of <1%
as per UN process indicators. CFR was the highest in Rangpur
division (0.96%), which was in the acceptable limit. The lowest
CFR was found in Khulna division (0.35%). CFRs in other
divisions were as follows: Barisal (0.78%), Sylhet (0.78%),
Chittagong (0.68%), Rajshahi (0.65%), and Dhaka (0.42%).
06
Figure 8. Comparison of cesarean sections as
percentage of all births in EmOC facilities between
year 2009, 2010, and 2011
Figure 7. Comparison of caesarean sections as
percentage of all births in EmOC facilities between
year 2009, 2010, and 2011
4.99
4.25
7.86
6.74
5.41
5.82
3.49
6.01
6.22
4.39
8.78
8.06
5.51
6.73
5.72
6.83
9.80
6.16
10.30 10.59
6.60
8.18
6.13
8.49
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh
1.00
0.64 0.5000.38 0.55
1.02
0.78
0.6
1.01
0.69
0.38
0.41
0.68
1.38
0.83
0.630.78 0.68
0.420.35
0.65
0.96
0.78
0.57
Barisal Chittagong Dhaka Khulna Rajshahi Rangpur Sylhet Bangladesh
2009 2010 2011
Key findingsIn all divisions, the proportion of all births that took place in
2011 was above the acceptable norm of UN process
indicators (Table-6). This means that the women who
needed life-saving obstetric care came to the health
facilities to receive the services (Figure 1).
In Chittagong, Rajshahi and Rangpur divisions, the
met need (%) indicates lack of utilization of the
facilities/less referral by the community during the
pregnancy-related complications (Figure 2).
Nationally-visible increase in institutional delivery rates
was found in 2011 compared to 2010 (Figure 5).
The country average of performance during January to
June 2011 was better with respect to met need (%) for
EmOC compared to the previous two years, although
in Sylhet division, the performance went a bit lower
compared to that in year 2010 (Figure 6).
The rates of caesarean sections during January to
June 2011 were more in all divisions compared to year
2009 and 2010 rates (Figure 7).
In some divisions, namely Barisal, Khulna, Rangpur,
and Sylhet, the case fatality rate was seen to improve,
whereas in Dhaka division, the situation deteriorated in
2011 than in 2010. The reason should be investigated
by the EmOC program (Figure 8).
Limitation about the data sourceThe MIS-Health receives data from inadequate number of
private sources (NGOs and private hospitals or clinics),
although the coverage by public facilities is satisfactory.
This limitation needs to be considered during evaluation of
the report.
RecommendationThe reproductive health program and others concerned
should explore the reasons for and solutions to the key
findings mentioned in this report.
ConclusionObstetric care-seeking behavior of women in Bangladesh
is improving as revealed from the increasing rate of
institutional deliveries in the EmOC facilities. There is
uneven distribution of service qualities in EmOC facilities
among divisions of Bangladesh. The country average of
case fatality rates in the EmOC facilities has been found to
decrease in 2011 compared to 2010, which indicates
substantial progress in EmOC.
Caesarean section as % of all births in EmOC facilities Figure 7 compares the caesarean sections as % of all
births in EmOC facilities in different divisions of
Bangladesh in 2009, 2010, and 2011. The rates of
caesarean sections in January to June 2011 were more in
all divisions compared to same period in 2009 and 2010.
Case Fatality Rate (%) in EmOC facilities Figure 8 compares the case fatality rates in EmOC
facilities in different divisions of Bangladesh between year
2009, 2010, and 2011. The country average of case fatality
rate appears to be a little higher in January to June 2011
than in same period of 2009. In some divisions, namely
Khulna and Rajshahi, the situation showed improvement,
whereas in other divisions, namely Chittagong, Dhaka,
Rangpur, and Sylhet, the situation deteriorated in 2010
than in 2009. In Barisal division, the situation remained
unchanged in 2010 compared to 2009. The reason should
be investigated by the EmOC program.
2009 2010 2011
Government of Bangladesh has introduced mobile phone health service in every District
Hospitals and Upazila Health Complexes for 24 hours a day and 7 days a week
•
•
•
•
•
07
08
Sl.
No
.
District
Pro
po
rtio
n (
%)
of
all
Bir
ths
in E
mO
C f
aci
liti
es
Me
t n
ee
d (
%)
for
Em
OC
CS
as
% o
f a
ll B
irth
s
Ca
se F
ata
lity
Ra
te (
CF
R)
1 Barguna 7.60 56.96 3.11 0.14
2 Barisal 30.12 100.68 19.46 1.25
3 Bhola 11.18 31.67 2.30 1.48
4 Jhalakhati 13.51 9.57 7.32 0.00
5 Patuakhali 15.50 93.06 8.64 0.19
6 Pirojpur 23.46 46.67 9.99 0.27
Barisal Division 18.76 65.66 9.80 0.78
7 Bandarban 10.26 11.48 0.78 14.06
8 Brahmanbaria 5.42 15.84 1.97 1.08
9 Chandpur 15.17 44.75 6.37 0.19
10 Chittagong 24.17 40.19 8.18 0.98
11 Comilla 10.61 24.88 3.72 0.78
12 Cox's Bazar 18.50 45.50 5.97 0.13
13 Feni 26.12 140.26 11.97 0.14
14 Khagrachari 13.70 39.22 2.32 1.44
15 Lakshmipur 12.44 59.97 6.64 0.27
16 Noakhali 14.03 26.33 7.64 1.36
17 Rangamati 20.53 28.02 6.54 0.82
Chittagong Division 16.29 39.76 6.16 0.68
18 Dhaka 16.58 49.07 9.08 0.81
19 Faridpur 33.22 194.59 18.37 0.30
20 Gazipur 18.23 73.64 9.70 0.03
21 Gopalganj 19.69 76.56 10.15 0.08
22 Jamalpur 15.76 72.31 6.92 0.34
23 Kishoreganj 25.22 117.70 14.87 0.33
24 Madaripur 25.79 83.50 15.92 0.14
25 Manikganj 15.90 35.73 6.93 0.14
26 Munshiganj 14.90 35.04 7.52 0.00
27 Mymensingh 18.82 43.01 7.07 1.68
28 Narayanganj 35.07 49.84 24.30 0.00
29 Narsingdi 22.96 87.21 10.78 0.07
30 Netrokona 12.01 61.47 3.96 0.10
31 Rajbari 10.69 37.40 3.77 0.53
32 Shariatpur 23.08 95.72 9.18 0.13
33 Sherpur 12.87 21.43 4.34 0.48
34 Tangail 21.03 83.05 11.13 0.28
Dhaka Division 19.82 67.13 10.30 0.42
35 Bagerhat 9.77 34.39 3.41 0.14
36 Chuadanga 19.41 39.11 3.68 0.31
37 Jessore 29.12 88.88 14.86 0.34
38 Jhenaidah 26.50 111.00 11.87 0.07
Sl.
No
.
District
Pro
po
rtio
n (
%)
of
all
Bir
ths
in E
mO
C f
aci
liti
es
Me
t n
ee
d (
%)
for
Em
OC
CS
as
% o
f a
ll B
irth
s
Ca
se F
ata
lity
Ra
te (
CF
R)
39 Khulna 19.81 60.19 9.48 1.00
40 Kushtia 31.15 91.06 13.93 0.51
41 Magura 18.64 56.53 5.01 0.27
42 Meherpur 66.79 74.42 23.54 0.14
43 Narail 21.24 101.99 12.30 0.09
44 Satkhira 18.72 60.89 8.48 0.23
Khulna Division 24.47 73.26 10.59 0.35
45 Bogra 17.05 32.46 7.65 0.88
46 Chapai Nababganj 25.18 77.51 7.93 0.05
47 Joypurhat 24.77 119.76 6.25 0.38
48 Naogaon 20.02 41.22 3.08 0.58
49 Natore 13.97 65.37 3.80 0.12
50 Pabna 21.91 52.87 7.52 0.31
51 Rajshahi 37.09 56.90 13.25 2.16
52 Serajganj 20.08 30.70 3.04 0.36
Rajshahi Division 22.27 51.00 6.60 0.65
53 Dinajpur 29.98 41.84 10.60 0.88
54 Gaibandha 24.89 61.68 6.91 0.14
55 Kurigram 18.79 32.02 4.98 0.73
56 Lalmonirhat 14.08 47.76 6.78 0.58
57 Nilphamari 23.69 49.54 4.54 0.15
58 Panchagarh 22.18 58.36 6.38 0.36
59 Rangpur 24.45 26.93 8.93 4.63
60 Thakurgaon 30.53 41.34 15.67 0.72
Rangpur Division 24.30 43.16 8.18 0.96
61 Habiganj 14.15 32.14 4.51 0.42
62 Moulvibazar 24.99 56.98 11.07 0.95
63 Sunamganj 8.06 14.63 1.48 0.58
64 Sylhet 19.65 109.11 7.68 0.81
Sylhet Division 16.64 59.31 6.13 0.78
Bangladesh Total 20.16 57.06 8.49 0.57
AnnexTable A. Distribution EmOC process indicators according to district (January to June 2011)
Editorial Board
Advisors
1. Professor Dr. Khondhaker Md. Shefyetullah
Director General of Health Services (DGHS)
2. Dr. Md. Shamsul Haque
Director, Primary Health Care (Additional Charge)
and Line Director, ESD, DGHS
Chief Editor
Professor Dr. Abul Kalam Azad
Additional Director General (Planning and
Development) and Line Director, MIS-Health, DGHS
Associate Editor
Md. Ashraful Islam Babul
Deputy Chief, MIS-Health, DGHS
Assistant Editor and Designer
Nayeem Al Mifthah
GIS Consultant, MIS-Health, DGHS
Members
1. Dr. Mamun Parvez
Chief (HIU), MIS-Health, DGHS
2. Dr. Md. Syedur Rahman
Program Manager (RH) and Deputy Director, ESD,
DGHS
3. Dr. Ashis Kumar Saha
Assistant Director, MIS-Health, DGHS
4. Mr. Sukhendu Shekhor Roy
System Analyst, MIS-Health, DGHS
5. Dr. Sultan Shamiul Bashar
OSD, MIS-Health, DGHS
6. Dr. Mohammad Khairul Hassan
Health Officer, UNICEF, Bangladesh
Data Analysis and Composer
S. M. Rezaul Hoque
Assistant Statistician, MIS-Health, DGHS
Correspondence should be addressd to:
From, ....................................................................................................
....................................................................................................
....................................................................................................
To,DirectorManagement Information System (MIS)Directorate General of Health Services (DGHS) Mohakhali, Dhaka -1212, BangladeshPhone:88-02-8816459; Fax: 88-02-8813875 E-mail: [email protected]
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