Plos One manuscript data

<b>Background</b>:
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.

<b>Objectives</b>:
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.<b></b>

<b>Methods:</b> 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’s model guided the analysis.
Multiple linear regression examined associations between facility readiness and
delivery rates using 2017 data.

<b>Results:</b> 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 = 0.009).

<b>Conclusion: </b>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.