Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh.
Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
BMJ Open. 2021 Aug 12;11(8):e045506. doi: 10.1136/bmjopen-2020-045506.
The main objective of this study is to investigate how the direction and strength of the association between infant mortality and its predictors are changing over time in Bangladesh using a nationally representative sample for the period 2011-2014.
DESIGN, SETTING AND PARTICIPANTS: Data from two repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) for the years 2011 and 2014 were used. A total of 7664 (with 312 infant death) and 7048 (with 264 infant death) complete cases, respectively, from BDHS 2011 and 2014 datasets were included in the study.
Cox's proportional hazard model with robust standard error (SE) that adjusts for the complex survey design characteristics was implemented to assess how the risk factors associated with infant mortality change their paths.
Results reflected that administrative division remained as a potential risk factor of infant death for both periods. Household's socioeconomic status, father's employment status, age difference between parents turned out to be potential risk factors in 2014, though they did not show any significant association with infant death in the year 2011. In contrast to 2011, mothers' individual-level characteristics such as age at childbirth, education, media exposure, employment status did not remain as significant risk factors for infant death in 2014. Younger fathers increased the burden of death among infants of adolescent mothers. At higher order births, the burden of infant death significantly shifted from rural to urban areas. From the year 2011 to 2014, urban areas achieved socioeconomic equity in infant survival, while the extent of inequity was increased in rural areas.
Community-based programmes should be designed for urban mothers who are expecting higher order births. To eradicate the socioeconomic inequity in infant survival, the government should design strong and sustainable maternal and child healthcare facilities, especially for rural areas.
本研究的主要目的是利用 2011 年至 2014 年期间具有代表性的全国样本，调查孟加拉国婴儿死亡率及其预测因素之间的关联方向和强度随时间的变化。
设计、地点和参与者：本研究使用了来自 2011 年和 2014 年两次孟加拉国人口与健康调查（BDHS）的重复横断面数据。分别从 2011 年和 2014 年的 BDHS 数据集共纳入了 7664 名（312 名婴儿死亡）和 7048 名（264 名婴儿死亡）完整病例。
采用 Cox 比例风险模型，采用稳健标准误差（SE）调整复杂调查设计特征，以评估与婴儿死亡率相关的风险因素如何改变其路径。
结果表明，行政区划分仍然是两个时期婴儿死亡的潜在风险因素。家庭的社会经济地位、父亲的就业状况、父母年龄差距在 2014 年成为潜在的风险因素，尽管它们在 2011 年与婴儿死亡没有任何显著关联。与 2011 年相比，母亲的个体特征，如生育年龄、教育程度、媒体接触、就业状况，在 2014 年不再是婴儿死亡的显著风险因素。年轻的父亲增加了青少年母亲所生孩子的死亡负担。在更高的生育顺序中，婴儿死亡的负担从农村地区转移到了城市地区。从 2011 年到 2014 年，城市地区在婴儿生存方面实现了社会经济公平，而农村地区的不公平程度有所增加。
应该为期望更高生育顺序的城市母亲设计基于社区的方案。为了消除婴儿生存的社会经济不公平，政府应该设计强大和可持续的母婴保健设施，特别是为农村地区。
