Repeated neonatal deaths in families with special reference to causes of death

Abstract

It is recognized that one infant death in a family indicates an increased risk of death of a subsequent sibling. This study examines which cause of death of a sibling is related to the mortality of the younger sibling and when. Longitudinal vital events data from the maternal and child health and family planning (MCH-FP) project and the comparison areas in Matlab, Bangladesh, were used. Primary causes of 868 neonatal deaths and 624 post-neonatal deaths resulting from 18,865 singleton live births in 1989-92 and those (967 as neonates and 708 as post-neonates) of their immediate elder siblings were categorised into infectious and non-infectious diseases. Multinomial logistic regression was used to estimate the risk of younger siblings dying in each age period from infectious and non-infectious diseases given the age and cause of deaths of older siblings and controlling for other biosocial correlates of infant mortality. A neonatal death of non-infectious causes in a family was twice as likely to be followed by another one occurring at the same age from similar causes compared with a surviving infant followed by a neonatal death from non-infectious causes. The MCH-FP project, though successful in reducing the risk of neonatal and post-neonatal mortality from infectious diseases, did not reduce the risk of dying from non-infectious diseases.

PIP: This study examines what cause of death repeats among families in Bangladesh and whether accessibility to maternal-child health and family planning (MCH-FP) services plays a role in weakening the shared mortality risks of siblings in families. Longitudinal vital event data from the MCH-FP project and the comparison areas in Matlab, Bangladesh were used. Multinomial logistic regression was used to estimate the risk of younger siblings dying in each age period from infectious and noninfectious diseases given the age and cause of deaths of older siblings and controlling for other biosocial correlates of infant mortality. The primary causes of the 868 neonatal deaths and 624 postneonatal deaths resulting from 18,865 singleton live births in 1989-92 and those (967 as neonates and 708 as postneonates) of their immediate elder siblings were categorized into infectious and noninfectious diseases. This study revealed that the odds were twice as high for a sibling to die in the neonatal period from noninfectious causes if the older sibling had died at the same age from similar causes. Deaths caused by noninfectious diseases may have their origins in the mother's intrinsic biological or obstetric conditions. It further showed that the mortality risks of the sibling were not associated for infectious disease deaths in any period. Rather, infectious disease mortality of older siblings dying as neonates due to their cause. No associations of infectious disease mortality of siblings in families suggests that parents in Matlab somehow managed to cope with family hazards indicated by earlier infectious disease death