Child mortality in Bangladesh – why, when, where and how? A national survey-based analysis

Abstract

Background Updated information on the cause of childhood mortality is essential for developing policies and designing programmes targeting the major burden of disease. There is a paucity of evidence regarding the current estimates of the cause of death in Bangladesh, which is essential for reinvigorating the current policies and reshaping existing strategies to avert preventable deaths. This paper aims to address this critical evidence gap and report the cause, timing and place of death among children under-five years of age using a nationally representative sample. Methods The present study was undertaken to provide updated estimates of causes of death among children under-five years of age using data from the 2017-18 round of the Bangladesh Demographic and Health Survey (BDHS). The verbal autopsy (VA) questionnaire of the 2017-18 BDHS was adapted from the standardised WHO 2016 instruments. Specially trained physicians reviewed the responses of the VA questionnaire and assigned the cause of death based on the online-2016-version of the International Classification of Diseases (ICD-10). We included 456 deaths among children under-five years of age in our analysis. Descriptive statistics were used to present the causes, timing and places of death with uncertainty ranges (UR). Results Pneumonia is the major killer (19%), accounting for approximately 24 268 (UR = 21 626-26 695) under-five deaths per-year. It is followed by birth asphyxia (16%), prematurity and low-birth-weight (11%), serious infections including sepsis (8%) causing 20 882 (UR = 18 608-22 970), 14 956 (UR = 13 327-16,452), and 10 723 (UR = 9555-11,795) deaths per-year, respectively. Drowning (8%) caused 10 441 (UR = 9304-11 485) deaths and congenital anomaly (7%) resulted in d 8748 (UR = 7795-9623) deaths per-year. Around 29% of all deaths occurred on the first day, 52% within the first week, and 66% within the first month of life. Around 70% of birth asphyxia, prematurity, and low birth weight-related deaths happen on the day of birth. Approximately 43% of pneumonia-related deaths occur in age 1-11 months, and around 51% of drowning-related deaths happen in age 12-23 months. Conclusions Pneumonia with other serious infections, birth asphyxia, prematurity and low-birth-weight are responsible for more than half of all deaths among children under-five years of age. Strengthening the existing maternal, neonatal and child health programmes may be helpful in averting the majority of these preventable deaths. A multisectoral approach is required for the prevention of childhood deaths, especially drowning-related fatalities. Special measures need to be taken to prevent and control emerging public health challenges like birth defects and congenital anomalies.

Success and time implications of SpO2 measurement through pulse oximetry among hospitalised children in rural Bangladesh: Variability by various device-, provider- and patient-related factors

“…It is important considering the context of Bangladesh, where most of the IMCI service providers are nurses and paramedics and do not have any prior exposure to performing pulse oximetry in outpatient or emergency settings. The short training package is also programmatically more implementable and scalable in a resource-constrained high pneumonia-burden setting like Bangladesh [ 1 , 3 , 23 ]. Since more than 90% of the assessments were completed within 60 seconds, recommending pulse oximetry while assessing the respiratory rate for one minute will add minimum additional workload on the IMCI services providers even in high-volume facilities.…”

“…Each year, approximately 24 000 children under-five years of age die due to pneumonia in Bangladesh, making it the major killer among this age group [ 1 , 2 ]. In addition to mortality, the morbidity-burden associated with childhood pneumonia is also remarkably high in Bangladesh as it causes around 4 million episodes of illness every year, of which around one million are severe episodes, and approximately half a million require hospitalisations [ 3 , 4 ].…”

Household Air Pollution from Cooking Fuels and its Association with Under-Five Mortality in Bangladesh

“…Bangladesh has achieved significant progress in reducing under-five mortality during the Millennium Development Goals period of 2000 to 2015 [13]. However, the rate is still very high at 45 and 30 per 1000 live births for under-five mortality and neonatal mortality, respectively [13, 14].…”

“…Bangladesh has achieved significant progress in reducing under-five mortality during the Millennium Development Goals period of 2000 to 2015 [13]. However, the rate is still very high at 45 and 30 per 1000 live births for under-five mortality and neonatal mortality, respectively [13, 14]. This presents a challenge in achieving the Sustainable Development Goal 3 (health and wellbeing for all), in particular, its targets to reduce under-five (25 per 1000 live births) and neonatal (12 per 1000 live births) mortality rates by 2030 [13, 14].…”

Introducing pulse oximetry in routine IMCI services in Bangladesh: A context-driven approach to influence policy and programme through stakeholder engagement

“…Moreover, most of these deaths and morbidities occur in low- and middle-income countries (LMICs) [ 1 , 2 ]. In Bangladesh, childhood pneumonia causes approximately 24 300 deaths per year, making it the leading cause of death in children younger than five years [ 6 , 7 ].…”