No Excess Mortality Detected in Rural Bangladesh in 2020 From Repeated Surveys of a Population of 81,000

Abstract

Background: Excess mortality has demonstrated under-counting of COVID-19 deaths in many countries but cannot be measured in low-income countries where civil registration is incomplete.Methods: Enumerators conducted an in-person census of all 16,054 households in a sample of 135 villages within a 350 km2 region of Bangladesh followed by a census conducted again in May and November 2020 over the phone. The date and cause of any changes in household composition, as well as changes in income and food availability, were recorded. For analysis, we stratify the mortality data by month, age, gender, and household education. Mortality rates were modeled by Bayesian multilevel regression and the strata aggregated to the population by poststratification.Findings: A total of 276 deaths were reported between February and the end of October 2020 for the subset of the population that could be contacted twice over the phone, slightly below the 289 deaths reported for the same population over the same period in 2019. After adjustment for survey non-response and poststratification, 2020 mortality changed by -8\% (95\% CI, -21\% to 7\%) relative to an annualized mortality of 6.1 per thousand in 2019. However, salaried breadwinners reported a 40\% decline in income and businesses a 60\% decline in profits in May 2020. Interpretation: All-cause mortality in the surveyed portion of rural Bangladesh was if anything lower in 2020 compared to 2019. Our findings suggest various restrictions imposed by the government limited the scale of the pandemic, although they need to be accompanied by expanded welfare programs.Funding Statement: The study was supported by the U.S. National Science Foundation.Declaration of Interests: The authors have no competing interests to declare.Ethics Approval Statement: Institutional Review Boards at both Michigan State University and Columbia University, as well as the NGO Bureau of Bangladesh, approved the study.