Abstract

BackgroundBangladesh has experienced a significant reduction of child mortality over the past decades which helped achieve the Millennium Development Goal 4 (MDG 4) target. But the mortality among under-5 aged children is still relatively high and it needs a substantial effort to achieve the Sustainable Development Goal (SDG) target and decelerate the current rate of under-5 mortality. At this stage, it is hence important to explore the trend and determinants of under-5 mortality in order to reduce the vulnerability of child’s survival. The aim of this study is to explore the trends and identify the factors associated with mortality in children aged less than 5 years in Bangladesh.MethodsData from three repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) for the year 2007, 2011 and 2014 were used. A stratified two-stage sampling method was used to collect information on child and maternal health in these surveys. Cox’s proportional hazards models with community and mother level random effects (or frailty models) were fitted to identify the associated factors with under-five mortality.ResultsOur study reveals that urban-rural disparity in child mortality has decreased over the time. The frailty models revealed that the combined effect of birth order and preceding birth interval length, sex of the child, maternal age at birth, mother’s working status, parental education were the important determinants associated with risk of child mortality. The risk of mortality also varied across divisions with Sylhet division being the most vulnerable one. Moreover, significant and sizable frailty effects were found which indicates that the estimations of the unmeasured and unobserved mother and community level factors on the risk of death were substantively important.ConclusionOur study suggests that community-based educational programs and public health interventions focused on birth spacing may turn out to be the most effective. Moreover, unobserved community and familial effects need to be considered along with significant programmable determinants while planning for the child survival program.

Highlights

  • Bangladesh has experienced a significant reduction of child mortality over the past decades which helped achieve the Millennium Development Goal 4 (MDG 4) target

  • Bangladesh has experienced a remarkable change in child mortality rates over the few decades, from 133 deaths to 46 deaths per 1000 live births

  • Child mortality rate is decreasing over time, Bangladesh has to further reduce child mortality to obtain the Sustainable Development Goals (SDGs) [3]

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Summary

Introduction

Bangladesh has experienced a significant reduction of child mortality over the past decades which helped achieve the Millennium Development Goal 4 (MDG 4) target. The mortality among under-5 aged children is still relatively high and it needs a substantial effort to achieve the Sustainable Development Goal (SDG) target and decelerate the current rate of under-5 mortality. At this stage, it is important to explore the trend and determinants of under-5 mortality in order to reduce the vulnerability of child’s survival. About 20% further reduction in infant mortality is needed to achieve the Health, Population, and Nutrition Sector Development Program (HPNSDP) target of 31 deaths per 1000 live births in 2016 [6]. With the growing emphasis on the implementation of family planning programs in recent time, finding out the determinants of child mortality and its trends is getting important [7]

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