Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N, Wolfe Street, Baltimore, MD 21205, USA.
Popul Health Metr. 2011 Aug 5;9:43. doi: 10.1186/1478-7954-9-43.
Trends in the causes of child mortality serve as important global health information to guide efforts to improve child survival. With child mortality declining in Bangladesh, the distribution of causes of death also changes. The three verbal autopsy (VA) studies conducted with the Bangladesh Demographic and Health Surveys provide a unique opportunity to study these changes in child causes of death.
To ensure comparability of these trends, we developed a standardized algorithm to assign causes of death using symptoms collected through the VA studies. The original algorithms applied were systematically reviewed and key differences in cause categorization, hierarchy, case definition, and the amount of data collected were compared to inform the development of the standardized algorithm. Based primarily on the 2004 cause categorization and hierarchy, the standardized algorithm guarantees comparability of the trends by only including symptom data commonly available across all three studies.
Between 1993 and 2004, pneumonia remained the leading cause of death in Bangladesh, contributing to 24% to 33% of deaths among children under 5. The proportion of neonatal mortality increased significantly from 36% (uncertainty range [UR]: 31%-41%) to 56% (49%-62%) during the same period. The cause-specific mortality fractions due to birth asphyxia/birth injury and prematurity/low birth weight (LBW) increased steadily, with both rising from 3% (2%-5%) to 13% (10%-17%) and 10% (7%-15%), respectively. The cause-specific mortality rates decreased significantly due to neonatal tetanus and several postneonatal causes (tetanus: from 7 [4-11] to 2 [0.4-4] per 1,000 live births (LB); pneumonia: from 26 [20-33] to 15 [11-20] per 1,000 LB; diarrhea: from 12 [8-17] to 4 [2-7] per 1,000 LB; measles: from 5 [2-8] to 0.2 [0-0.7] per 1,000 LB; injury: from 11 [7-17] to 3 [1-5] per 1,000 LB; and malnutrition: from 9 [6-13] to 5 [2-7]).
Pneumonia remained the top killer of children under 5 in Bangladesh between 1993 and 2004. The increasing importance of neonatal survival is highlighted by the growing contribution of neonatal deaths and several neonatal causes. Notwithstanding the limitations, standardized computer-based algorithms remain a promising tool to generate comparable causes of child death using VA data.
儿童死亡原因的趋势是重要的全球健康信息，可用于指导改善儿童生存的努力。随着孟加拉国儿童死亡率的下降，死亡原因的分布也发生了变化。三次与孟加拉国人口与健康调查相结合的口头尸检（VA）研究提供了一个独特的机会，可以研究儿童死亡原因的这些变化。
为了确保这些趋势的可比性，我们开发了一种标准化算法，通过 VA 研究中收集的症状来分配死因。系统地审查了最初应用的算法，并比较了病因分类、层次结构、病例定义和收集数据量方面的关键差异，以制定标准化算法。该算法主要基于 2004 年的病因分类和层次结构，通过仅包括所有三项研究中普遍可用的症状数据，保证了趋势的可比性。
1993 年至 2004 年间，肺炎仍然是孟加拉国 5 岁以下儿童死亡的主要原因，占死亡人数的 24%至 33%。同期，新生儿死亡率从 36%（不确定范围[UR]：31%-41%）显著上升至 56%（49%-62%）。由于出生窒息/出生损伤和早产/低出生体重（LBW）导致的特定病因死亡率稳步上升，两者均从 3%（2%-5%）上升至 13%（10%-17%）和 10%（7%-15%）。由于新生儿破伤风和一些新生儿后期病因，特定病因死亡率显著下降（破伤风：从每千例活产 7[4-11]例降至 2[0.4-4]例；肺炎：从每千例活产 26[20-33]例降至 15[11-20]例；腹泻：从每千例活产 12[8-17]例降至 4[2-7]例；麻疹：从每千例活产 5[2-8]例降至 0.2[0-0.7]例；伤害：从每千例活产 11[7-17]例降至 3[1-5]例；和营养不良：从每千例活产 9[6-13]例降至 5[2-7]例）。
1993 年至 2004 年间，肺炎仍然是孟加拉国 5 岁以下儿童的头号杀手。新生儿死亡率的增加突显了新生儿生存的重要性，因为新生儿死亡和一些新生儿病因的贡献越来越大。尽管存在局限性，但基于标准化计算机算法仍然是使用 VA 数据生成可比儿童死因的有前途的工具。
