|Changes in neonatal mortality and newborn health-care practices: descriptive data from the Bangladesh Demographic and Health Surveys 2011 and 2014|
||Tasnima Akter, Angela Dawson, and David Sibbritt
||WHO South-East Asia Journal of Public Health, 7(1): 43-50; DOI: 10.4103/2224-3151.228427
Health care utilization
Bangladesh has made major improvements in health outcomes over the past two decades, with falls in mortality rates in mothers and in infants and young children aged under 5 years. Despite these improvements, neonatal mortality rates (NMRs) are high in Bangladesh. This paper describes recent changes in NMRs and health-care practices, disaggregated by demographic and socioeconomic characteristics.
Summary statistics from the reports of the Bangladesh Demographic and Health Survey (BDHS) were examined. The BDHS is a nationally representative cross-sectional survey and the two most recent rounds of surveys, 2007-2011 and 2010-2014, were included in the analysis. The variables considered in this study were neonatal deaths and related health-care practices, including antenatal care visits, facility-based delivery, assistance from a medically trained provider during delivery, postnatal care from a trained provider and essential newborn care.
Between the two survey periods, NMRs increased in Chittagong (average increase 4.5% per year) and Khulna (8.3% per year), remained unchanged in Rangpur, and decreased in Barisal (average decrease 19.8% per year), Dhaka (12.2% per year), Rajshahi (7.7% per year) and Sylhet (4.8% per year). A larger average annual reduction in the NMR was observed in urban areas than in rural areas (14.0% versus 2.1%). There was also a large average annual reduction in NMR in the fourth and fifth richest quintiles for socioeconomic status (SES quintiles; 12.0% and 16.5% per year, respectively). Differences according to neonatal sex were also noted: the NMR for female neonates remained unchanged and that for male neonates reduced by an annual average of 7.7%. General improvements were observed in all health-care practices across all demographic and socioeconomic groups. However, the urban-rural gap in the uptake of antenatal care services, facility-based delivery, assistance from a medically trained provider during delivery, and postnatal care from a trained provider was roughly similar in both surveys. A similar unchanging gap was also seen between the poorest and richest SES quintiles.
The study analysis indicates that improvements in NMRs between the two survey periods are mixed. Further attention is required to improve the rate of reduction of neonatal mortality in some divisions in Bangladesh, and it may be useful to investigate whether the higher NMR in rural areas and for households with lower socioeconomic status can be reduced by strengthening the uptake of antenatal care services, facility-based delivery, assistance from a medically trained provider during delivery, and postnatal care from a trained provider. The static NMR for female neonates may encourage policy-makers to focus not only on ensuring standard essential newborn care practices for both sexes but also on ensuring adequate and appropriate care-seeking for illness in female neonates.
Bangladesh; antenatal care; essential newborn care; facility-based delivery; health-care practices; neonatal mortality; postnatal care