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Risk factors for under-5 mortality: evidence from Bangladesh Demographic and Health Survey, 2004–2011
Authors: Tanvir Abir, Kingsley Emwinyore Agho, Andrew Nicolas Page, Abul Hasnat Milton, and Michael John Dibley
Source: BMJ Open, 5:e006722 doi:10.1136/bmjopen-2014-006722
Topic(s): Childhood mortality
Children under five
Country: Asia
Published: AUG 2015
Abstract: Objective The aim of this study was to identify factors associated with mortality in children under 5 years of age using a nationally representative sample of singleton births for the period of 2004–2011. Design, setting and participants Pooled 2004, 2007 and 2011 cross-sectional data sets of the Bangladesh Demographic and Health Surveys were analysed. The surveys used a stratified two-stage cluster sample of 16 722 singleton live-born infants of the most recent birth of a mother within a 3-year period. Main outcome measures Outcome measures were neonatal mortality (0–30 days), postneonatal mortality (1–11 months), infant mortality (0–11 months), child mortality (1–4 years) and under-5 mortality (0–4 years). Survival information for 16 722 singleton live-born infants and 522 deaths of children <5 years of age included: 310 neonatal deaths, 154 postneonatal deaths, 464 infant deaths, 58 child deaths and 522 under-5 deaths. Multiple variable analysis showed that, over a 7-year period, mortality reduced significantly by 48% for postneonatal deaths, 33% for infant deaths and 29% for under-5 deaths, but there was no significant reduction in neonatal deaths (adjusted OR (AOR)=0.79, 95% CI 0.59 to 1.06) or child deaths (AOR=1.00, 95% CI 0.51 to 1.94). The odds of neonatal, postneonatal, infant, child and under-5 deaths decreased significantly among mothers who used contraceptive and mothers who had other children aged 3 years or older. The risk of neonatal, postneonatal, infant, child and under-5 deaths was significantly higher in mothers who reported a previous death of a sibling. Conclusions Our study suggests that family planning is needed to further reduce the overall rate of under-5 deaths in Bangladesh. To reduce childhood mortality, public health interventions that focus on child spacing and contraceptive use by mothers may be most effective. Strengths and limitations of this study This is the first pooled analysis of 2004, 2007 and 2011 Bangladesh Demographic and Health Surveys with an average response rate of 98%. Our method used multilevel modelling, which took into account the effect of clustering to better estimate the level of association of the study factors with the outcome. The pooled method increases the study power, predicts which risk factors for child deaths persist over time, and the findings can be safely generalised to cover populations with similar characteristics. The survey interviewed surviving women only, and this may have led to an underestimation of mortality rates, because of the association between neonatal and maternal deaths. Several variables in the study were not infant-specific as they only reflected the most recent conditions or birth, such as mother's work status, which represented the employment status within the past 12 months preceding the survey.