Save the Children, Dhaka, Bangladesh.
Health Policy Plan. 2012 Jul;27 Suppl 3:iii40-56. doi: 10.1093/heapol/czs044.
Remarkable progress over the last decade has put Bangladesh on track for Millennium Development Goal (MDG) 4 for child survival and achieved a 40% decline in maternal mortality. However, since neonatal deaths make up 57% of under-five mortality in the country, increased scale up and equity in programmes for neonatal survival are critical to sustain progress. We examined change for newborn survival from 2000 to 2010 considering mortality, coverage and funding indicators, as well as contextual factors. The national neonatal mortality rate has undergone an annual decline of 4.0% since 2000, reflecting greater progress than both the regional and global averages, but the mortality reduction for children 1-59 months was double this rate, at 8.6%. Examining policy and programme change, and national and donor funding for health, we identified various factors which contributed to an environment favourable to newborn survival. Locally-generated evidence combined with re-packaged global evidence, notably The Lancet Neonatal Series, has played a role, although pathways between research and policies and programme change are often complex. Several high-profile champions have had major influence. Attention for community initiatives and considerable donor funding also appear to have contributed. There have been some increases in coverage of key interventions, such as skilled attendance at birth and postnatal care, however these are low and reach less than one-third of families. Major reductions in total fertility, some change in gross national income and other contextual factors are likely to also have had an influence in mortality reduction. However, other factors such as socio-economic and geographic inequalities, frequent changes in government and pluralistic implementation structures have provided challenges. As coverage of health services increases, a notable gap remains in quality of facility-based care. Future gains for newborn survival in Bangladesh rest upon increased implementation at scale and greater consistency in content and quality of programmes and services.
过去十年取得了显著进展，使孟加拉国有望实现千年发展目标 4 关于儿童生存，并使产妇死亡率降低了 40%。然而，由于新生儿死亡占该国五岁以下儿童死亡的 57%，因此扩大新生儿生存方案的规模并实现公平性对于维持进展至关重要。我们考虑了死亡率、覆盖范围和资金指标以及背景因素，考察了 2000 年至 2010 年期间新生儿生存状况的变化。自 2000 年以来，全国新生儿死亡率每年下降 4.0%，反映出比区域和全球平均水平都有更大的进展，但 1-59 个月儿童的死亡率下降速度是这一速度的两倍，为 8.6%。在审查政策和方案变化以及国家和捐助者对卫生的供资情况时，我们发现了有利于新生儿生存的各种因素。本地产生的证据与重新包装的全球证据（特别是《柳叶刀新生儿系列》）相结合发挥了作用，尽管研究与政策和方案变化之间的途径往往很复杂。一些备受瞩目的倡导者产生了重大影响。对社区倡议的关注以及大量捐助者的供资似乎也做出了贡献。一些关键干预措施的覆盖率有所提高，例如熟练接生和产后护理，但覆盖率仍然很低，不到三分之一的家庭能够享受到这些服务。总生育率的大幅下降、国民总收入的一些变化以及其他背景因素也可能对死亡率的降低产生了影响。然而，其他因素，如社会经济和地理不平等、政府频繁更迭以及多元化的实施结构，也带来了挑战。随着卫生服务覆盖率的提高，在机构护理质量方面仍存在明显差距。未来，孟加拉国新生儿生存状况的改善取决于更大规模的实施和服务内容与质量的一致性。
