Akter Tasnima, Dawson Angela, Sibbritt David
Faculty of Health, University of Technology, Sydney, Australia.
WHO South East Asia J Public Health. 2018 Apr;7(1):43-50. doi: 10.4103/2224-3151.228427.
Bangladesh has made major improvements in health outcomes over the past two decades, with falls in mortality rates in mothers and in infants and young children aged under 5 years. Despite these improvements, neonatal mortality rates (NMRs) are high in Bangladesh. This paper describes recent changes in NMRs and health-care practices, disaggregated by demographic and socioeconomic characteristics.
Summary statistics from the reports of the Bangladesh Demographic and Health Survey (BDHS) were examined. The BDHS is a nationally representative cross-sectional survey and the two most recent rounds of surveys, 2007-2011 and 2010-2014, were included in the analysis. The variables considered in this study were neonatal deaths and related health-care practices, including antenatal care visits, facility-based delivery, assistance from a medically trained provider during delivery, postnatal care from a trained provider and essential newborn care.
Between the two survey periods, NMRs increased in Chittagong (average increase 4.5% per year) and Khulna (8.3% per year), remained unchanged in Rangpur, and decreased in Barisal (average decrease 19.8% per year), Dhaka (12.2% per year), Rajshahi (7.7% per year) and Sylhet (4.8% per year). A larger average annual reduction in the NMR was observed in urban areas than in rural areas (14.0% versus 2.1%). There was also a large average annual reduction in NMR in the fourth and fifth richest quintiles for socioeconomic status (SES quintiles; 12.0% and 16.5% per year, respectively). Differences according to neonatal sex were also noted: the NMR for female neonates remained unchanged and that for male neonates reduced by an annual average of 7.7%. General improvements were observed in all health-care practices across all demographic and socioeconomic groups. However, the urban-rural gap in the uptake of antenatal care services, facility-based delivery, assistance from a medically trained provider during delivery, and postnatal care from a trained provider was roughly similar in both surveys. A similar unchanging gap was also seen between the poorest and richest SES quintiles.
The study analysis indicates that improvements in NMRs between the two survey periods are mixed. Further attention is required to improve the rate of reduction of neonatal mortality in some divisions in Bangladesh, and it may be useful to investigate whether the higher NMR in rural areas and for households with lower socioeconomic status can be reduced by strengthening the uptake of antenatal care services, facility-based delivery, assistance from a medically trained provider during delivery, and postnatal care from a trained provider. The static NMR for female neonates may encourage policy-makers to focus not only on ensuring standard essential newborn care practices for both sexes but also on ensuring adequate and appropriate care-seeking for illness in female neonates.
在过去二十年中，孟加拉国在健康成果方面取得了重大进展，孕产妇、婴儿及5岁以下幼儿的死亡率均有所下降。尽管有这些改善，但孟加拉国的新生儿死亡率仍然很高。本文描述了按人口和社会经济特征分类的新生儿死亡率及医疗保健实践的近期变化。
研究了孟加拉国人口与健康调查（BDHS）报告中的汇总统计数据。BDHS是一项具有全国代表性的横断面调查，分析纳入了最近两轮调查，即2007 - 2011年和2010 - 2014年的调查。本研究考虑的变量包括新生儿死亡及相关医疗保健实践，如产前检查次数、设施分娩、分娩时接受医学专业人员协助、接受专业人员的产后护理以及基本新生儿护理。
在两个调查期之间，吉大港的新生儿死亡率上升（平均每年上升4.5%），库尔纳上升（每年8.3%），朗布尔保持不变，巴里萨尔下降（平均每年下降19.8%），达卡下降（每年12.2%），拉杰沙希下降（每年7.7%），锡尔赫特下降（每年4.8%）。城市地区新生儿死亡率的年均降幅大于农村地区（分别为14.0%和2.1%）。社会经济地位处于最富有五分之一和次富有五分之一的人群中，新生儿死亡率也有较大幅度的年均下降（分别为每年12.0%和16.5%）。还注意到新生儿性别差异：女婴的新生儿死亡率保持不变，男婴的新生儿死亡率平均每年下降7.7%。所有人口和社会经济群体的所有医疗保健实践均有普遍改善。然而，在两次调查中，城乡在产前护理服务、设施分娩、分娩时接受医学专业人员协助以及接受专业人员产后护理方面的差距大致相似。最贫困和最富有的社会经济五分之一人群之间也存在类似的不变差距。
研究分析表明，两个调查期之间新生儿死亡率的改善情况不一。需要进一步关注以提高孟加拉国某些地区新生儿死亡率的下降速度，研究通过加强产前护理服务利用、设施分娩、分娩时接受医学专业人员协助以及接受专业人员产后护理，是否能够降低农村地区和社会经济地位较低家庭的较高新生儿死亡率可能会有所帮助。女婴不变的新生儿死亡率可能会促使政策制定者不仅关注确保为男女新生儿提供标准的基本新生儿护理实践，还要关注确保女婴患病时能够获得充分和适当的就医服务。
