Determinants of infant and child mortality in rural Bangladesh(abstract)

Abstract

Objective: Examine the trends in and covariates of infant and child mortality in several rural areas of Bangladesh. Methodology: Data on a cohort of 21,268 children born between 1983 and 1991 in three rural project sites were obtained from the longitudinal Sample Registration System (SRS) of the MCH-FP Extension Project (Rural) of ICDDR.B—now called Operations Research Project (ORP). The analysis followed the model specified in the extended analysis of the 1993-94 Bangladesh Demographic and Health Survey (BDHS) and was divided into three components: neonatal mortality, postneonatal mortality, and mortality between 12 and 23 months. Estimates of mortality differentials by sociodemographic characteristics were derived, using a life-table technique. Multivariate logistic regression procedures were also applied separately to include fixed and temporal characteristics of the newbom cohort. The mortality estimates were compared with those of the national-level (BDHS) extended analysis. Results: Reduction in the rates of mortality of children aged less than five years was slightly more rapid at the ORP sites than in the country as a whole. Childhood mortality has been declining in the ORP areas since 1983, compared to the national average. Part of the decline can be attributed to increasing educational levels among parents, and changes in the length of birth interval associated with fertility decline. Conclusion: The results of the study confirm the findings of other research work, showing that longer preceding birth intervals play a significant roie in reducing child mortality. Of course, provision of primary health care services are associated with reduced risk. The data from the SRS in the ORP sites show a significant relationship between childhood immunization and reduced child mortality. Access to tubewell water was also associated with reduced mortality risk for young children.