Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study

Abstract

While knowledge of causes of deaths is important for health sector planning, little is known from conventional sources about the causes of deaths in Bangladesh. This is partly due to deficiencies in the registration system and partly because few deaths are attended by qualified physicians. The present study was undertaken to update the information available on causes of deaths among under-5-year-olds, taking advantage of advances in verbal autopsy methodology and of the national Bangladesh Demographic and Health Survey conducted in 1993-94. About 25% of the deaths were associated with acute lower respiratory infections (ALRI) and about 20% with diarrhoea. Neonatal tetanus and measles remained important causes of death, and drowning was a major cause for 1-4-year-olds. Research and programmes to enable mothers to identify ALRI cases, particularly pneumonia, and to encourage timely and appropriate care-seeking and strengthening of ALRI case management at the primary care facilities are important priorities. While promotion of oral rehydration for watery diarrhoea and antibiotic treatment for dysentery should continue, broader preventive interventions including provision of safe water and sanitation, and improvements in personal hygiene require more attention. Further intensification of immunization programmes and innovative experimental interventions to reduce childhood from drowning should be designed and tested.

PIP: Advances in verbal autopsy methodology and the availability of the 1993-94 Bangladesh Demographic and Health Survey data enabled an analysis of causes of childhood deaths in Bangladesh. Few deaths in Bangladesh are attended by qualified physicians and the registration system is deficient, making mortality analyses difficult with conventional sources. A follow-up survey of the 828 deaths of children under 5 years occurring in the 5 years preceding the 1993-94 survey was conducted in 1995. 311 deaths involved neonates, 232 occurred in the 1-11 month age group, and 285 were among children 12-59 months of age. 24.2% of deaths (40% of the infant deaths) were associated with acute lower respiratory infection (ALRI), 19.0% with diarrhea, 8.8% were due to accidents, and 5.4% were related to neonatal tetanus. Drowning accounted for 18.9% of deaths among 1-4 year olds. Malnutrition was associated with a third of the respiratory infections and half the diarrhea deaths. Urban deaths represented less than 10% of the total, but maternal educational status was not associated with different patterns of child mortality. Girls were less likely than boys to die from ALRI and more likely to die from malnutrition, measles, and diarrhea. Early recognition of pneumonia cases and appropriate care-seeking by parents, use of properly prepared oral rehydration solution in diarrhea, and measures to improve the general nutritional status of children would help improve child survival. Verbal autopsy instruments could be made more accurate if adapted based on mothers' recognition of signs and symptoms and the terms they use to describe them.