Causes of under-five mortality using verbal autopsies in urban slum areas in Bangladesh: a cross-sectional analysis of surveillance data

Abstract

Background Under-5 deaths in urban slum communities are often unnoticed in many cases. However, previous surveys reported a high burden of mortality. Therefore, we presented the distribution of the causes of death of under-5 children in selected urban slum areas in Bangladesh. Methods Since October 2020, the Urban Health and Demographic Surveillance System (Urban HDSS) has been collecting verbal autopsy information for neonates, children, and adults to report the causes of death. We used the data collected by the trained Field Workers- from all households (30,857) in the ongoing HDSS area, comprising 118,238 people. The causes of deaths were identified by using the WHO-standardized verbal autopsy (VA) questionnaire that was reviewed and coded by a trained physician. Later, the cause-specific fractions of the deaths were evaluated by the child’s age, sex, the mother’s education, occupation, household wealth quintile, slum locations, mode and place of delivery, and antenatal and postnatal care. Results A total of 155 deaths of children under-5 years were interviewed during October 2020–2021. Most of them were neonates (67.7%), boys (67.7%), belonged to poor households (43.9%), born at home (51%) and had vaginal delivered (77%). Most of the mothers of the deceased children took antenatal care services (80%), and a comparatively lower proportion received postnatal care (39.3% and 47.1% of mothers and children, respectively). In this slum area, birth asphyxia (25.2%) was the major leading cause of under-5 deaths occurred in the neonatal period (37.1%), followed by other infections (14.2%) and pneumonia (16.1%). Other important causes of death were cerebral ischemia (7.7%), prematurity and low birth weights (6.5%), congenital anomalies (5.2%), and other external causes (18.1%), contributed to the under-5 child deaths. The cause of mortality fraction varied by different socioeconomic and delivery-related attributes such as place, mode of delivery, and utilization of ANC and PNC visits. Conclusions Major causes of under-5 death are birth asphyxia, pneumonia, and infectious diseases. Adequate attention and additional safety measures, education and awareness about child’s health among mothers, and proper delivery care for pregnant slum women and children could prevent under-5 deaths in the slum area.