Academic journal article Journal of Health Population and Nutrition

Achieving the Millennium Development Goal for Under-Five Mortality in Bangladesh: Current Status and Lessons for Issues and Challenges for Further Improvements

Academic journal article Journal of Health Population and Nutrition

Achieving the Millennium Development Goal for Under-Five Mortality in Bangladesh: Current Status and Lessons for Issues and Challenges for Further Improvements

Article excerpt

INTRODUCTION

One hundred eighty-nine countries attending the United Nations Millennium Summit signed the United Nations Millennium Declaration in 2000 to eradicate extreme poverty, hunger, and diseases among one billion people in the world, who subsist barely on anything (1). This project set a deadline of 2015 to achieve eight goals, known as Millennium Development Goals (MDGs). One of the goals was to reduce child mortality by two-thirds by 2015 from 1990. Evidence suggests that, region-wise, East Asia, Southeast Asia, Latin America/Caribbean countries, and Europe are on track to achieve the MDG 4 but South Asia was described as still having high mortality, and the target of MDG 4 may not be met by 2015 (2). The Government of Bangladesh and the United Nations Country Team in Bangladesh expressed concerns at the slowing of the pace in the decline of mortality of children aged less than five years (under-five mortality) (3). The most recent nationally-representative data in Bangladesh indicate that Bangladesh has made significant improvements in reducing the child mortality rate, although it is far below the MDG target. Child mortality per 1,000 livebirths came down from 94 in 1990 to 52 in 2007 (4); however, the decline has been faster in urban areas than in rural areas (5).

A very successful family-planning programme and the remarkable progress in expanding child-immunization coverage are mainly responsible for the decline in child mortality in Bangladesh. Different NGOs and private clinic/hospitals, especially in urban areas, played a vital role for the higher decline in urban areas than in rural areas. However, challenges still remain as there are higher neonatal mortality rates, higher child malnutrition, and differences regarding mortality by sex, division, and residence in Bangladesh (4). With the right types of interventions, the child mortality-related MDG may not be very difficult to achieve.

This paper focused on the available evidence of current health status of children, causes and proximate determinants of child morality, health-related programmes, and financial challenges to achieve the MDGs relating to under-five mortality. The objectives of the study were to present the achievement status, provide a critical review of relevant issues, and put forward recommendations for achieving the target of MDG relating to under-five mortality within 2015.

CHILD MORTALITY IN BANGLADESH

Levels and trends

The decline of under-five mortality in some developing countries, including Bangladesh, was striking in recent years (6). Based on the indicators set for the attainment of MDG 4 (Table 1), Bangladesh is moving slowly towards the targets set in relation to the reduction of child mortality. Data showed that, in all three indicators, Bangladesh, to a greater extent, is on the track in achieving the MDG relating to child mortality (Table 1). For example, under-five mortality decreased from 151 in 1990 to 65 per 1,000 livebirths in 2006, with a rate of 5.38 per year against the required annual rate of 2.14 per year. The projection shows that, if the present rate sustains, it would have been achieved the target at the end of 2009. Almost a similar decrease was found in infant mortality which seems to achieve the target at the end of 2015. However, the immunization coverage is still lagging behind, to some extent, from the annual required rate of achievement. It increased from 54% in 1990 to 81.9% in 2006, with the yearly achieved rate of 1.74% against the yearly required rate of 1.84%. The projection suggests that Bangladesh may achieve the target of immunization coverage in 2017, if the current rate of increase can be sustained in the coming years. However, to achieve the MDG relating to under-five mortality within the time limit, consideration should be given on causes of child mortality and its proximate determinants. Although, statistically, Bangladesh is going to achieve its target for child health within the time limit, except immunization, further achievement depends on many challenging factors, including sociocultural, programmatic and financial barriers. …

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