Prevalence, characteristics, quality of life, and health seeking behaviours of women with maternal morbidities in a rural community of Bangladesh

The maternal morbidity study is a mixed method study funded by Nagasaki University and being conducted in three sub districts (Gazipur Sadar, Shreepur and Kaliakoir) in Gazipur, Bangladesh. The objectives of the study are as follows:

• To identify the prevalence of selected major maternal morbidities, namely obstetric fistula, uterine prolapse, and urinary incontinence.

• To examine the characteristics and the quality of life of women with obstetric fistula, uterine prolapse, and urinary incontinence.

• To explore experiences and perceptions pertaining to these conditions, including indigenous etiology and care seeking behaviours of women with obstetric fistula, uterine prolapse, and urinary incontinence.

The quantitative components of this study primarily examined the magnitude of the health problems of obstetric fistula, uterine prolapse, and urinary incontinence, while the qualitative components conducted an in-depth analysis of the consequences of having these health problems.

The participants - women who were ever-married/married and/or experienced pregnancy - were targeted for the prevalence of fistula survey in the three upazilas in Gazipur. The target area for uterine prolapse and urinary incontinence was the Sadar upazila in Gazipur. The study commenced in March 2015 and is expected to be completed by March 2016.

• An orientation programme for district managers, branch managers, and programme organisers were done by Engender Health.
• One-day training for BRAC’s shasthyo shebikas (SSs) and shasthyo kormis (SKs) were done by the maternal morbidity research group.
• A clinical training on obstetric fistula and uterine prolapse was conducted by Dr Sayeba Akther.
• The SSs identified the suspected cases through three simple questionnaires during their household visits..
• SKs provided health education to women with urinary incontinence.
• The BRAC physician examined and diagnosed the patients, and referred them to tertiary care facilities if patients were found to have obstetric fistula and/or third degree prolapsed.

Our development partners include the following:
• Nagasaki University School of International Health Development,
• Health, Nutrition and Population Programme, BRAC
• Engender Health


• A total of 1,155 shasthyo shebikas (SSs) and 144 shasthyo kormis (SKs) from BRAC’s MANOSHI and essential health care programme are providing assistance with the study.
• The SKs provide a referral card to suspected patients.
• The suspected patients were referred to the BRAC clinics in batches from the second month onwards of the screening process.
• A maximum of 20 suspected fistula and prolapse patients visited the Gazipur BRAC clinic twice in a week.
• Two trained BRAC physicians conduct the diagnosis at the Gazipur clinic.
• The referrals are limited to 2,000 clients.
• The BRAC physicians can refer up to 200 confirmed fistula and third degree prolapse cases to tertiary care facilities for surgery.