Report on Demographic profiling and needs assessment of maternal and child health (MCH) care for the Rohingya refugee population in Cox’s Bazar, Bangladesh
Introduction: The number of forcibly displaced people labelled as refugees across the world have grown rapidly since the last few decades. The most recent inclusion being the Rohingya diasporas of Myanmar who have been fleeing en masse from their homes since August 25, 2017. To date, more than 1.2 million Rohingya refugees have settled in designated Rohingya camps (expansion sites) located in Cox’s Bazar district of Bangladesh. This recent sudden massive influx of Rohingya refugees have overwhelmed scarce resources and posed a substantial strain to the ad hoc health systems set up at these camps. The exploration of the health needs including ascertainment of prevalence of pregnant women, lactating mothers and age-sex distribution of the population is a timely and judicious necessity to help the Government of Bangladesh working in collaboration with national and international organizations to deliver key services in a more organized and efficient way. In this circumstances, icddr,b, with active supervision and assistance of UNFPA, conducted a brief needs assessment of maternal and child health with special attention to pregnancy, lactation and family planning status of the women, and current health status of the under-5 children. Methods: The study employed a cross-sectional quantitative study design in 11 Rohingya camps located in Ukhia and Teknaf upazilas of Cox’s Bazar, Bangladesh. Four modules of data collection tools were administered in the field that included household listing form for household heads, structured questionnaire for women of reproductive age (13-49 years), caregivers of under-5 children, and for the household heads regarding their food support. Given the linguistic similarities between the Rohingya people and locals in Cox’s Bazar, the data collectors were recruited locally from Cox’s Bazar. They were extensively trained on the data collection methods with data collection tools that were pre-tested before final phase of training. We collected information from 3,050 households that accounted for 16,588 Rohingya population of which 16,243 Rohingya refugees are currently living in Bangladesh. Among the 16,243 Rohingyas, 14,220 entered Bangladesh after the recent influx since 25 August, 2017. About 3,701 women of reproductive age were approached for interview of whom 3,664 (99%) could complete the questionnaire. After quality assurance, the data were analysed for descriptive statistics of basic demographics, pregnancy rates, reported illness and the services received. The frequency distributions are reported using tables and graphs in this report. The study protocol was approved by the Institutional Review Board (IRB) of icddr,b. Analyses were carried out using Stata version 13.0 SE. Results: We reached 16,588 populations from 3,050 household with a mean household size of 5.3 ± 2.3. Among the study population, 45.8% were of 13-49 years of age. It is noteworthy to mention that the age-sex distribution in the cumulative Rohingya population residing in Cox’s Bazar (Old camps) and the newly arrived Rohingyas were almost similar. About 70% of the Rohingya women of reproductive age (13-49 years) were below 30 years. The proportion of ever married women was 72.2% and mean age at first marriage was 16.8 ± 2.2 years. The mean age at first pregnancy was 18.0± 2.4 years. We identified 370 pregnant women (14.0% of ever married women) among the study population. If we consider women of reproductive age, the pregnancy prevalence has been 10.1%. However, among the total population, the pregnant women constitute about 2.3%. When the pregnant women were asked for their plan for future delivery, 54.1% reported that they did not decide on their plan yet. However, only 10% of them were willing to deliver at facility level and the rest (35.9%) wanted to deliver at home. Among the ever married women (N=2,643), 568 (21.5%) delivered their babies within the last 12 months. About 53% of these recently delivered women delivered their babies in Myanmar and the rest delivered after entering Bangladesh. Lactating women constitute almost 6.0% of the total study population of 16,243. However, if we consider, this proportion rises to 26.4% among the women of reproductive age and to 36.6% among the ever married women. Family planning (FP) related questionnaire was administered to currently married women (N=2,227). About 86.3% of them heard at least one method of family planning and injection Depot-Provera and Oral Contraceptive Pill (OCP) have been the two most cited Family planning methods. About 48.9% of the currently married women reported that they knew the service delivery place for Family planning method and most of them mentioned about NGO hospitals/clinics (93.1%) and NGO workers (22.4%) respectively. The contraceptive prevalence rate (CPR) has been measured as 33.7%. Injection Depot-Provera (70.5%) and OCP (28.9%) were the two most common methods they were currently using. Regarding illnesses, frequently mentioned complaints were general weakness (23.7%), sore throat (18.4%), joint pain (18.3%), pain during menstruation (11.1%) and malnourishment (16%). Regarding the satisfaction level for shelter, clothing and health care services, the respondents clearly marked the services as satisfying except for a few indicators like safe water, hand washing material, waiting time during health care services, and the travel time to go to the health services centre. Regarding hand washing practices, 93.1% women of reproductive age claimed to have always washed their hands. About 96.7% reported to use soap as hand washing material, although 33.7% admitted that sometimes they washed their hands with water only. Some others reported to use ash (17.4%) and earth (11.6%). During the data collection period, about 2,937 children had illness complaints of which cough (69.5%), fever (41.1%), difficulty in breathing (12.4%), and passage of loose stools (9.8%) were the most common symptoms. Conclusion: Firstly, our report highlights the need for special attention and care required for the pregnant and lactating women. Second, we find that the Rohingya population in Bangladesh should be informed of the different family planning methods available and delivery points where they can procure family planning and other healthcare services. Finally, we have assessed the level of satisfaction and explored the need for shelter, food, clothing and health care services in this vulnerable population group. We expect our findings would help the Government of Bangladesh and other stakeholders to take effective steps to ensure the welfare and well-being of the Rohingya Diaspora.