Academic journal article Journal of Health Population and Nutrition

Child Health and Mortality

Academic journal article Journal of Health Population and Nutrition

Child Health and Mortality

Article excerpt


Is Bangladesh on target for achieving the Millennium Development Goal 4 (MDG 4) of reducing child mortality? According to a recent analysis by the United Nations, of the 10 regions covering developing countries, five (North Africa, East Asia, Southeast Asia, Latin America/Caribbean, and the former Soviet Republics in Europe) were on track to achieve MDG 4 (1). South Asia is described as still having high mortality, and the MDG 4 target is not expected to be met by 2015. Sub-Saharan Africa still had very high mortality while the three regions (West Asia, Oceania, and former Soviet Republics in Asia) had moderate mortality and unlikely to meet the MDG 4 target if the current trends prevailed. In a recent analysis of 68 countries of the world, selected because they together account for 97% of maternal, newborn and child deaths worldwide each year, the United Nations Children's Fund (UNICEF) reports that only 16 were on track to achieve MDG 4, including Bangladesh (2).

An earlier joint report in February 2005 by the Government of Bangladesh and the United Nations Country Team in Bangladesh expressed concern at the slowing of the pace in the decline of under-five mortality, based on data available at that time (3). The target for Bangladesh is to reduce under-five mortality from 151 deaths per 1,000 livebirths in 1990 to 50 in 2015. The report estimated that, if this MDG is to be achieved, the country needs to achieve and maintain a reduction of three childhood deaths per 1,000 livebirths every year. The report highlighted the need to focus attention on neonatal and perinatal causes of death, deaths due to pneumonia, diarrhoea, injuries, poor care-seeking practices, malnutrition, and low birthweight (LBW).

What can we say about achieving MDG 4 of reducing child mortality in Bangladesh from the findings of the five Bangladesh Demographic and Health Surveys (BDHS) since 1993 (4). From 1991 to 2004 (mid-years of the BDHS 1993-1994 and 2007), under-five mortality in Bangladesh declined by almost half, i.e. at an average rate of 5.3% per year (Table), which exceeds the required annual decline of 4.3% needed to achieve the MDG of a two-third reduction in under-five mortality by 2015 from the 1990 levels. However, if this estimate is disaggregated, the decline was almost 10% among 1-4 year(s) old children and about 6% annually among post-neonates [1-11 month(s)]. However, the reduction was only 2.6% annually in neonates. Much (57%) of the under-five mortality is now in neonates, and it seems unlikely that the high rates of decline will be sustained among children aged over one month. We actually observed substantial slowing down between 1997 and 2001. It is obvious that, if substantial reductions in neonatal mortality is not achieved, Bangladesh may not achieve MDG 4 (Table 1). While the trends in mortality suggest that we need to 'work harder' in achieving MDG 4, it may be that we also need to 'work smarter' in identifying the remaining issues that are preventing further improvements.


We do not yet have any disaggregated data from the BDHS 2007, which could be included in this assessment. Mortality rates among female children aged 1-59 month(s) have been declining faster than among boys (Fig. 1). The overall under-five mortality rate in the BDHS 2004 (5) is almost 10 points higher for boys than for girls, largely due to much lower neonatal mortality among girls, which is the norm in low-mortality populations. In the age-group of 1-11 month(s), girls are dying less often than boys, which is a major shift from the rates seen in 1993-1994 and 1996-1997 when boys and girls were at par. The mortality gap has been narrowing between boys and girls aged 1-4 year(s), but death rates are still high for girls. These changes likely reflect the changing attitude towards girls and their economic and social values in the Bangladeshi society. …

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