{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T21:05:32Z","timestamp":1793221532947,"version":"4.5.0"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec025\">\n<jats:title>Background<\/jats:title>\n<jats:p>Bangladesh faces one of the highest global burdens of maternal and newborn deaths, primarily caused by hemorrhage and eclampsia\/preeclampsia. Despite reducing maternal mortality by 40%, comprehensive medical interventions remain insufficient in health facilities.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec026\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>This study assessed the readiness of sub-district hospitals in Bangladesh to provide Emergency Obstetric and Newborn Care (EmONC) and analyzed the association between facility readiness and delivery rates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec027\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Using Health Facility Assessment Survey data from 140 hospitals in 2014 and 141 in 2017, facility readiness was measured based on nine signal functions: administering antibiotics, oxytocin, and anticonvulsants; providing blood transfusions; performing cesarean and assisted vaginal deliveries; managing retained placentas and products of conception; and neonatal resuscitation. Donabedian\u2019s model guided the analysis. Multiple linear regression examined associations between facility readiness and delivery rates using 2017 data.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec028\">\n<jats:title>Results<\/jats:title>\n<jats:p>Between 2014 and 2017, the availability of signal functions such as oxytocin (85% to 95%), anticonvulsants (58% to 63%), and blood transfusions (22% to 38%) improved. In 2014, 77% of facilities had at least 5 signal functions, 49% had 7, and 6% had all 9. By 2017, these increased to 83%, 56%, and 8%, respectively. Despite these improvements, the mean readiness index remained nearly unchanged (0.67 in 2014 vs. 0.69 in 2017). Only 8% of facilities performed fewer than 52 deliveries annually in 2017, while 26% conducted over 500. Regression analysis revealed a significant association between readiness scores and delivery rates (p =\u2009 0.009).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec029\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>While certain indicators improved, overall readiness stagnated due to shortages of anesthetists, gynecologists, and essential supplies. With 64% of surveyed sub-district hospitals classified as comprehensive care facilities, resource and staffing investments are crucial to enhance readiness and reduce maternal and newborn mortality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0297734","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T17:59:01Z","timestamp":1748368741000},"page":"e0297734","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Association between \u2018Emergency obstetric &amp; newborn care readiness\u2019 and delivery service utilization in Bangladesh: Evidence from national health facility assessment surveys"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2396-4999","authenticated-orcid":true,"given":"Kaji","family":"Keya-Korotki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4979-0317","authenticated-orcid":true,"given":"Nabil","family":"Natafgi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Macauda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3880-4317","authenticated-orcid":true,"given":"Syed Abdul","family":"Hamid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Mahmud","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"issue":"6","key":"pone.0297734.ref001","article-title":"Global causes of maternal death: a WHO systematic analysis","volume":"2","author":"L Say","year":"2014","journal-title":"Lancet Glob Health"},{"key":"pone.0297734.ref002","doi-asserted-by":"crossref","DOI":"10.1596\/978-92-4-151390-6","article-title":"Delivering quality health services: a global imperative for universal health coverage","author":"World Health Organization, Organization for Economic Co-operation and Development, The World Bank.","year":"2018"},{"key":"pone.0297734.ref003","volume-title":"MEASURE Evaluation, icddr,b. Bangladesh Maternal Mortality and Health Care Survey 2010","author":"National Institute of Population Research and Training (NIPORT)","year":"2012"},{"key":"pone.0297734.ref004","volume-title":"Bangladesh Maternal Mortality and Health Care Survey: Preliminary Report","author":"National Institute of Population Research and Training, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), and MEASURE Evaluation","year":"2016"},{"issue":"4","key":"pone.0297734.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0271867","article-title":"The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students","volume":"18","author":"NI Pappu","year":"2023","journal-title":"PLoS One"},{"key":"pone.0297734.ref006","doi-asserted-by":"crossref","first-page":"07002","DOI":"10.7189\/jogh.13.07002","article-title":"Maternal mortality in Bangladesh: Who, when, why, and where? A national survey-based analysis","volume":"13","author":"AT Hossain","year":"2023","journal-title":"J Glob Health"},{"key":"pone.0297734.ref007","volume-title":"Directorate General of Health Services. Ministry of Health and Family Welfare","author":"Management Information System (MIS). Health Bulletin 2018","year":"2018"},{"issue":"6","key":"pone.0297734.ref008","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1093\/ije\/dyv115","article-title":"Institutional deliveries weakly associated with improved neonatal survival in developing countries: evidence from 192 Demographic and Health Surveys","volume":"44","author":"G Fink","year":"2015","journal-title":"Int J Epidemiol"},{"issue":"9940","key":"pone.0297734.ref009","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S0140-6736(14)60792-3","article-title":"Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?","volume":"384","author":"ZA Bhutta","year":"2014","journal-title":"Lancet"},{"issue":"1","key":"pone.0297734.ref010","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12913-019-4871-x","article-title":"Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal","volume":"20","author":"TP Lama","year":"2020","journal-title":"BMC Health Serv Res"},{"issue":"9879","key":"pone.0297734.ref011","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1016\/S0140-6736(13)60686-8","article-title":"Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study","volume":"381","author":"JP Souza","year":"2013","journal-title":"Lancet"},{"issue":"9947","key":"pone.0297734.ref012","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1016\/S0140-6736(14)60696-6","article-title":"Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"NJ Kassebaum","year":"2014","journal-title":"Lancet"},{"issue":"2","key":"pone.0297734.ref013","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-020608","article-title":"Health facility service availability and readiness to provide basic emergency obstetric and newborn care in a low-resource setting: evidence from a Tanzania National Survey","volume":"9","author":"D Bintabara","year":"2019","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0297734.ref014","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1186\/s12884-019-2656-1","article-title":"Quality of maternal and newborn healthcare services in two public hospitals of Bangladesh: identifying gaps and provisions for improvement","volume":"19","author":"TK Biswas","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"issue":"11","key":"pone.0297734.ref015","article-title":"Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys","volume":"4","author":"ME Kruk","year":"2016","journal-title":"Lancet Glob Health"},{"issue":"3","key":"pone.0297734.ref016","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/AOG.0b013e31822a65e4","article-title":"Hospital volume, provider volume, and complications after childbirth in U.S. hospitals","volume":"118","author":"V Janakiraman","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"1","key":"pone.0297734.ref017","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajog.2012.05.010","article-title":"The association between hospital obstetrical volume and maternal postpartum complications","volume":"207","author":"KL Kyser","year":"2012","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"pone.0297734.ref018","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ijgo.2004.11.026","article-title":"The evidence for emergency obstetric care","volume":"88","author":"A Paxton","year":"2005","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0297734.ref019","volume-title":"Monitoring emergency obstetric care: a handbook","author":"World Health Organization, United Nations Population Fund, United Nations Children's Fund, Averting Maternal Death and Disability Program.","year":"2009"},{"key":"pone.0297734.ref020","unstructured":"United Nations Children\u2019s Fund, World Health Organization, United Nations Population Fund. Guidelines for monitoring the availability and use of obstetric services. 1997."},{"key":"pone.0297734.ref021","article-title":"Trends in maternal mortality: 1990 to 2015","author":"WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division","year":"2015"},{"key":"pone.0297734.ref022","volume-title":"Bangladesh Health Facility Survey 2017NIPORT, ACPR, and ICF","author":"National Institute of Population Research and Training (NIPORT) and ICF","year":"2019"},{"key":"pone.0297734.ref023","unstructured":"Management Information System (MIS). Local Health Bulletin. Directorate General of Health Services (DGHS). Ministry of Health & Family Welfare. People\u2019s Republic of Bangladesh. 2017. http:\/\/103.247.238.81\/webportal\/pages\/rtlhb_menu.php"},{"issue":"12","key":"pone.0297734.ref024","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1001\/jama.1988.03410120089033","article-title":"The quality of care. How can it be assessed?","volume":"260","author":"A Donabedian","year":"1988","journal-title":"JAMA"},{"issue":"13","key":"pone.0297734.ref025","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1001\/jama.2015.12470","article-title":"Facilitating quality improvement: Pushing the pendulum back toward process measures","volume":"314","author":"KY Bilimoria","year":"2015","journal-title":"JAMA"},{"issue":"4","key":"pone.0297734.ref026","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1111\/1471-0528.12507","article-title":"Determining obstetric patient safety indicators: the differences in neonatal outcome measures between different-sized delivery units","volume":"121","author":"A Pyyk\u00f6nen","year":"2014","journal-title":"BJOG"},{"key":"pone.0297734.ref027","article-title":"Mapping maternity care: the configuration of maternity care in England","author":"M Redshaw","year":"2011","journal-title":"Birthplace in England Research Programme"},{"issue":"4","key":"pone.0297734.ref028","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/j.1552-6909.2011.01262.x","article-title":"An overview of distribution of births in United States hospitals in 2008 with implications for small volume perinatal units in rural hospitals","volume":"40","author":"KR Simpson","year":"2011","journal-title":"J Obstet Gynecol Neonatal Nurs"},{"issue":"11","key":"pone.0297734.ref029","article-title":"Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh","volume":"12","author":"L Roy","year":"2017","journal-title":"PLoS One"},{"issue":"1","key":"pone.0297734.ref030","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ijgo.2015.04.041","article-title":"Coverage of emergency obstetric care and availability of services in public and private health facilities in Bangladesh","volume":"131","author":"B Alam","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"issue":"3","key":"pone.0297734.ref031","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/heapol\/czr023","article-title":"Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap","volume":"27","author":"RY Hsia","year":"2012","journal-title":"Health Policy Plan"},{"issue":"3","key":"pone.0297734.ref032","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.ijgo.2006.01.028","article-title":"The availability of life-saving obstetric services in developing countries: an in-depth look at the signal functions for emergency obstetric care","volume":"93","author":"P Bailey","year":"2006","journal-title":"Int J Gynaecol Obstet"},{"key":"pone.0297734.ref033","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1016\/S0140-6736(04)17229-2","article-title":"How to bridge the gap in human resources for health","volume":"364","author":"C Hongoro","year":"2004","journal-title":"Lancet"},{"issue":"9445","key":"pone.0297734.ref034","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/S0140-6736(04)17313-3","article-title":"Human resources and health outcomes: cross-country econometric study","volume":"364","author":"S Anand","year":"2004","journal-title":"Lancet"},{"key":"pone.0297734.ref035","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s12884-015-0435-1","article-title":"Determinants of delays in travelling to an emergency obstetric care facility in Herat, Afghanistan: an analysis of cross-sectional survey data and spatial modelling","volume":"15","author":"A Hirose","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"issue":"1","key":"pone.0297734.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0116675","article-title":"Determinants of maternal near-miss in Morocco: too late, too far, too sloppy?","volume":"10","author":"B Assarag","year":"2015","journal-title":"PLoS One"},{"issue":"9730","key":"pone.0297734.ref037","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1016\/S0140-6736(10)60744-1","article-title":"India\u2019s Janani Suraksha Yojana, a conditional cash transfer programme to increase births in health facilities: an impact evaluation","volume":"375","author":"SS Lim","year":"2010","journal-title":"Lancet"},{"issue":"6","key":"pone.0297734.ref038","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0067452","article-title":"India\u2019s conditional cash transfer programme (the JSY) to promote institutional birth: is there an association between institutional birth proportion and maternal mortality?","volume":"8","author":"B Randive","year":"2013","journal-title":"PLoS One"},{"key":"pone.0297734.ref039","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1016\/S0140-6736(10)60901-4","article-title":"India: conditional cash transfers for in-facility deliveries","volume":"375","author":"VK Paul","year":"2010","journal-title":"Lancet"},{"key":"pone.0297734.ref040","doi-asserted-by":"crossref","unstructured":"Talukder M, Rob U, Musa S, Bajracharya A, Keya K, Noor F, et al. Evaluation of the impact of the voucher program for improving maternal health behavior and status in Bangladesh. 2014.","DOI":"10.31899\/rh10.1000"},{"issue":"8","key":"pone.0297734.ref041","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.bpobgyn.2015.08.002","article-title":"Reducing maternal mortality on a countrywide scale: The role of emergency obstetric training","volume":"29","author":"NF Moran","year":"2015","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"pone.0297734.ref042","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1186\/s12884-014-0417-8","article-title":"Audit of a new model of birth care for women with low risk pregnancies in South Africa: the primary care onsite midwife-led birth unit (OMBU)","volume":"14","author":"GJ Hofmeyr","year":"2014","journal-title":"BMC Pregnancy Childbirth"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0297734","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T17:59:14Z","timestamp":1748368754000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0297734"}},"subtitle":[],"editor":[{"given":"Gizachew Tadele","family":"Tiruneh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0297734","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]}}}