Causes of childhood deaths in Bangladesh: results of a nation-wide verbal autopsy study

Abstract

Knowledge of causes of death structure, so far it relates to major available interventions, is important for health sector planning. Very little is known from conventional sources about the cause of death structure in Bangladesh, partly because of deficiencies in the registration of deaths,and partly because relatively few deaths are attended by qualified physician. The present study was undertaken to update the information available on causes of death among children aged less than five years, taking advantage of advances in verbal autopsy methodology, and of the Bangladesh Demographic and Health Survey (BDHS) conducted in 1993-94. The study revealed that about one of the four deaths were associated with acute lower respiratory infections (ALRIs) and about one-fifth of the deaths were associated with diarrhoea. Neonatal tetanus and measles remained important causes of death. Drowning was a major cause of death in children aged 1-4-years. Research and programmatic actions that will enable mothers to identify different grades of acute respiratory infections (ARIs), particularly pneumonia cases, will encourage timely and appropriate care-seeking, and strengthening of ARI case management at the primary care facilities would be important priorities. While the promotion of oral rehydration thearapy for watery diarrhoea and the use of antibiotics for dysentery should continue, broader preventive interventions, including provision of safe water, sanitation, improvements in personal hygiene, and measures to improve general nutritional stutus of children, will require more attention. Further intensification of immunization programme, and innovative experimental interventions to reduce deaths from drowning should be designed and tested. A cause could not be assigned to about 15 persent of deaths. Further improvements of the verbal autopsy instrument are needed.