Activity 13: Matlab Community Health Research

PI: Dr. Mohammad Yunus

The Matlab Health Research Centre (MHRC) is the oldest and the largest population-based field site of ICDDR,B. The Clinical Research Branch—which provides clinical services and research facilities; and, the Community Health Research Branch—which offers reproductive and child health services within communities and helps implement community-based research and interventions.

The Matlab site is a unique research and training facility targeting public-health issues relevant to developing countries like Bangladesh. At Matlab, clinical, epidemiological, nutritional, and environmental health research are linked to health services that the MHRC provides to the study population. In this way, the MHRC addresses a wide range of health problems, including diarrhoea, acute respiratory infections, malnutrition, illness caused by arsenic-contaminated drinking-water, and reproductive-health problems. It also addresses issues of basic maternity and newborn care.

Lessons learned from research in Matlab over the past 3 decades have contributed significantly to the policy and policy-related actions of international agencies and the governments of developing countries, including Bangladesh. The research structure of the MHRC includes a team of well-trained and committed village-based community health research workers, 4 sub-centre clinics (each serving around 28,000 people and run by paramedical staff), and a primary-care hospital that has basic laboratory facilities and deals with diarrhoea, acute respiratory infections, malnutrition, and other child and reproductive-health problems, including maternity care.

Number of patients treated

Over the past year, 10,466 patients with diarrhoea were treated at the Matlab Hospital. Of them, 15% had to be admitted. The overall case-fatality rate for this group was low (0.12%).

Collaborating Institutions:

• Upazilla Health Complex, Matlab South
• Upazilla Health Complex, Matlab North

Results:

1. In Matlab in 2006, 80,221 patients (includes women of child bearing age and children under 5 years of age) received treatment for variety of health conditions, in addition to another 13,670 diarrhoea patients. 1200 deliveries were conducted. In the first six months in 2007, 33,992 women and children (<5 years) and 6481 diarrhoea patients of all ages received treatment. 425 deliveries were conducted. Our activities are run from one hospital, 4 sub centres and 41 fixed site clinics (FSCs). Physicians run the hospital at Matlab, well trained paramedics run our sub centre clinics and skilled Community Health Research Workers (CHRWs) run our FSCs. We have established pregnancy identification in the community and established continuum of care. IHP funds have been used in these activities in addition to Centre’s core funds.

2. As a result of a recent evaluation we have standardized partography and assessed needs for skill development. We have developed data tools to be used for ante-partum, intrapartum and post-partum period to monitor quality of care.

3. One of the many objectives of the Maternal Neonatal and Child Health (MNCH) programme is to increase efforts to reduce mortality rate in Matlab. We have established evidence based intervention in sub-centres and Matlab Hospital and provide:

   • Essential newborn care

   • Infection prevention

   • Breast feeding promotion

   • Use of partograph,

   • Choice of birthing position

   • Quality care for severe maternal morbidity

   • Kangaroo Mother Care services for premature and low birth weight infants

4. Under the MNCH program extra efforts have been made to increase facility based delivery (in ICDDR,B Matlab Hospital and 4 sub-centre clinics). We have ensured 24 hour services for maternity care at our hospital and sub-centre clinics. Facility based delivery has been increasing significantly in Matlab and is currently about 46% (2006) compared to 35% in 2003.

5. We have established pregnancy identification in the community and established continuum of care by:

   • Identifying pregnant women by urine tests

   • Enrolling them into our data system

   • Antenatal home visit, identify support person

   • Birth preparedness

   • Developing home based life saving skills

   • Counseling

   • Ensuring antenatal care

   • Identifying complications

   • Referral to sub centre/ Matlab Hospital/ District Hospitals

   • Encouraging facility based delivery

   • Ensuring post natal care, etc.

6. With the support of IHP funds, Matlab Health Research Centre in collaboration with ICDDR,B Training Branch and NIPORT (GOB) had organized two 5-day courses for the Medical Officers from district and Upazilla level, family planning officers and officials from NIPORT sharing ICDDR,B experiences in reproductive health in 2006.

7. Series of other training have been conducted in the last 6 months to upgrade knowledge and skills of the ICDDR,B service providers in Matlab. We have also conducted the following training courses for our staff:

   • Home-based life saving skills (HBLSS) training for birth team

Essential newborn and safe motherhood training for health care providers in the facility and community level.