Abstract
BackgroundAppropriate antenatal care (ANC) is an important preventive public health intervention to ensure women’s and newborn health outcomes. The study aimed to investigate the impact of ANC, iron–folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh.MethodA cross-sectional study of three datasets from the Bangladesh Demographic and Health Surveys for the years 2004, 2007 and 2011 were pooled and used for the analyses. A total weighted sample of 16,721 maternal responses (5,364 for 2004; 4,872 for 2007 and 6,485 for 2011) was used. Multivariate logistic models that adjusted for cluster and sampling weights were used to examine the impact of ANC, IFA supplementation and TT vaccination during pregnancy on the death of a child aged 0–28 days (neonatal), 1–11 months (post-neonatal) and 12–59 months (child).ResultsMultivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had ANC [Odds Ratio (OR) = 0.60, 95% confidence interval (95% CI): 0.43–0.85], IFA supplementation [OR = 0.66, 95% CI: (0.45–0.98)] and ≥2 TT vaccinations (OR = 0.43, 95% CI: 0.49–0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51–0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48–0.94) and ≥2 TT vaccinations (OR = 0.50, 95% CI: 0.36–0.69). When combined, TT vaccination with IFA supplementation, and TT vaccination without IFA supplementation were protective across all groups.ConclusionThe study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh. The findings suggest that considerable gains in improving child survival could be achieved through ensuring universal coverage of ANC, promoting TT vaccination during pregnancy and IFA supplementation among pregnant women in Bangladesh.
Highlights
Child mortality is an important public health issue worldwide, and often reflects a country’s developmental status because it serves as a good indicator for antenatal care, delivery and early postnatal care as well as the health status of children [1]
Multivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had antenatal care (ANC) [Odds Ratio (OR) = 0.60, 95% confidence interval: 0.43–0.85], iron–folic acid (IFA) supplementation [OR = 0.66, 95% CI: (0.45–0.98)] and !2 tetanus toxoid (TT) vaccinations (OR = 0.43, 95% CI: 0.49–0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51–0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48– 0.94) and !2 TT vaccinations (OR = 0.50, 95% CI: 0.36–0.69)
The study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh
Summary
Child mortality is an important public health issue worldwide, and often reflects a country’s developmental status because it serves as a good indicator for antenatal care, delivery and early postnatal care as well as the health status of children [1]. Global policy attention and scale up efforts such as the Millennium Development Goals (MDGs) that focused on key aspects of improving child survival and health have played a major role in the reduction of childhoodrelated diseases (including diarrhoea, tetanus and measles), with subsequent impact on child mortality [1, 2]. Despite this improvement, child mortality remains a major health issue in resource-constraint communities in sub-Saharan Africa and South Asia countries, including Bangladesh [1]. The study aimed to investigate the impact of ANC, iron–folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh
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