DETERMINANTS OF CHILDHOOD MORTALITY IN BANGLADESH: EVIDENCE FROM 2011 BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY

Introduction: According to United Nations, Bangladesh is one of the 49 least developed countries that have managed to reduce their under-five mortality rates from 49 deaths per 1000 live births in 2004 to 46 deaths per 1000 live births in 2011. Despite this significant improvement, the rate of childhood mortality in Bangladesh is still higher than some South Asian countries. Hence this study aimed to identify potential risk factors associated with neonatal, infant and under-fives mortality in Bangladesh, using the 2011 Bangladesh Demographic and Health Survey.

Methods: Child deaths of all singleton live-born 2011 dataset was used, including survival information from 8634 singleton live born infants of the most recent birth of a mother within a 5-year period. In this analysis, three time periods for child mortality were examined, neonatal (0 to 28 days), infant (0 to 11months) and under-fives (0 to 4 years). The risk factors for neonatal, infant and under-fives deaths was examined against 20 potential risk factors covering individual, household and community level factors using Cox proportional hazards regression models.

Results: Multivariable analyses indicated that the common significant risk factors for neonatal, infant and under-fives deaths are: male child (adjusted Hazard ratio (aHR) =1.67, 95%CI:1.23-2.26 for neonatal, aHR=1.51,95%CI:1.17-1.94 for infant and aHR=1.40, 95%CI:1.11-1.77 for under-five), mothers employed for at least 12 months (aHR =1.64, 95%CI:1.14-2.35 for neonatal, aHR=1.74,95%CI:1.28-2.39 for infant and aHR=1.59, 95%CI:1.17-2.16 for under-five) and mothers who had 1 to 3 antenatal visits during pregnancy (aHR =2.45,95%CI:1.54-3.88 for neonatal, aHR=2.01, 95%CI:1.42-3.07 for infant and aHR=2.05, 95%CI:1.42-2.95 for under-five)

Conclusions: Considerable progress has been made in child survival rate in Bangladesh but the current rate of progress is well short of the Millennium Development Goals (MDGs) target of a two-thirds reduction by 2015. Community based interventions are also needed and these should focus on male child, working mothers and pregnant mothers who received at least one antenatal visit.