Academic journal article Journal of Health Population and Nutrition

Neonatal Mortality in Rural Bangladesh: An Exploratory Study

Academic journal article Journal of Health Population and Nutrition

Neonatal Mortality in Rural Bangladesh: An Exploratory Study

Article excerpt


Every year, over 10 million children, aged less than five years, die globally before their first birthday, and about 40% of these deaths take place within the first 28 days of life, i.e. the neonatal period (1,2). Neonatal mortality rates vary from five in developed countries to 34 per 1,000 livebirths in the less-developed regions of the world (3). Although there has been a remarkable worldwide decline in child mortality in the last quarter of the 20th century, this reduction in death rate has occurred mainly among older children, mostly due to the effects of immunization and infectious disease-control programmes. According to the World Health Report, infant mortality declined by about 25% in developing countries during 1983-1995, whereas during the same period neonatal mortality fell by no more than 10% (4). To achieve further reductions in infant and child mortality rates, a substantial reduction in neonatal death is of major public-health importance (5). Updated knowledge on the cause of death in neonates is needed from a country perspective, both for policy-making and for monitoring and evaluating the existing health programmes.

In developing countries, 63% of deliveries take place at home (6). In rural Bangladesh, this proportion is about 94% (7). Hospitals with facilities for neonatal care are not accessible to the rural population. Most neo-natal deaths take place at home, and the cause of death is not recorded owing to a deficient death-registration system. Lay reporting or verbal autopsy data from home visits remain the only sources of information for identifying causes of neonatal deaths in developing countries.

In general, neonatal deaths are the consequence of events usually associated with poor maternal health and non-availability of care during delivery or immediately after birth. Death usually originates from a cause that triggers a sequence of morbidities that ultimately precipitates death. It is, therefore, important from an epidemiological point of view to distinguish the originating causes from the direct causes, so as to apply interventions to remove the originating causes, thereby preventing the direct cause from operating. According to ICD-10 (8), an originating cause is defined as "the disease or injury which precipitated a train of morbid events leading directly to death." We defined a direct cause as "the apparent morbid condition occurring immediately before death, that might have arisen due to another disease or injury or consequences of some circumstances."

In Bangladesh, very few studies have reported the causes of early and late neonatal deaths in the community (9,10), and there is a dearth of recent published data on this issue. Baqui et al., while documenting the causes of childhood mortality using data from the Demographic and Health Survey 1993-1994, reported the causes of late neonatal deaths (11) but did not classify the causes of early neonatal deaths owing to a deficiency of data. None of the above studies objectively addressed the originating and the direct causes of neonatal mortality.

To fill the knowledge gap, we conducted a follow-up study of pregnant women in rural Bangladesh to obtain verbal autopsy data in the cases of early or late neonatal deaths, from which originating and direct causes were assigned. We also examined the variability of early and late neonatal deaths with sociodemographic and reproductive characteristics of mothers, their delivery complications, and use of health services.


Study sites and subjects

We observed a cohort of pregnant women for their pregnancy-and childbirth-related complications, including the health outcome of their neonates among a population of 145,000 in selected rural areas of all the four former administrative divisions (Dhaka, Chittagong, Rajshahi, and Khulna) in Bangladesh. We randomly selected one district from each division, one upazila (sub-district) from each selected district, and two unions (the lowest administrative unit) from each of the four selected upazilas. …

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