Dey Rakhi, Kundu Satyajit, Ajayi Kobi V, Kabir Humayun, Banna Md Hasan Al
Statistics Discipline Khulna University Khulna Bangladesh.
School of Medicine and Dentistry Griffith University Gold Coast QLD Australia.
Health Sci Rep. 2024 Aug 8;7(8):e2298. doi: 10.1002/hsr2.2298. eCollection 2024 Aug.
Given the significance of addressing neonatal mortality in pursuing the 2030 Sustainable Development Goal on child health, research focus on this area is crucial. Despite the persistent high rates of neonatal mortality rate (NMR) in Bangladesh, there remains a notable lack of robust evidence addressing inequalities in NMR in the country. Therefore, this study aims to fill the knowledge gap by comprehensively investigating inequalities in NMR in Bangladesh.
The Bangladesh Demographic and Health Survey (BDHS) data from 2000 to 2017 were analyzed. The equity stratifiers used to measure the inequalities were wealth status, mother's education, place of residence, and subnational region. Difference () and population attributable fraction (PAF) were absolute measures, whereas population attributable risk (PAR) and ratio () were relative measures of inequality. Statistical significance was considered by estimating 95% confidence intervals (CIs) for each estimate.
A declining trend in NMR was found in Bangladesh, from 50.2 in 2000 to 31.9 deaths per 1000 live births in 2017. This study detected significant wealth-driven (PAF: -20.6, 95% CI: -24.9, -16.3; PAR: -6.6, 95% CI: -7.9, -5.2), education-related (PAF: -11.6, 95% CI: -13.4, -9.7; PAR: -3.7, 95% CI: -4.3, -3.1), and regional (PAF: -20.6, 95% CI: -27.0, -14.3; PAR: -6.6, 95% CI: -8.6, -4.6) disparities in NMR in all survey points. We also found a significant urban-rural inequality from 2000 to 2014, except in 2017. Both absolute and relative inequalities in NMR were observed; however, these inequalities decreased over time.
Significant variations in NMR across subgroups in Bangladesh highlight the need for comprehensive, and targeted interventions. Empowering women through improved access to economic resources and education may help address disparities in NMR in Bangladesh. Future research and policies should focus on developing strategies to address these disparities and promote equitable health outcomes for all newborns.
鉴于在实现2030年儿童健康可持续发展目标过程中解决新生儿死亡率问题的重要性，对该领域的研究至关重要。尽管孟加拉国新生儿死亡率（NMR）一直居高不下，但该国仍明显缺乏关于NMR不平等问题的有力证据。因此，本研究旨在通过全面调查孟加拉国NMR的不平等情况来填补这一知识空白。
分析了2000年至2017年孟加拉国人口与健康调查（BDHS）的数据。用于衡量不平等的公平分层因素包括财富状况、母亲教育程度、居住地点和次国家区域。差异（）和人群归因分数（PAF）是绝对指标，而人群归因风险（PAR）和比值（）是不平等的相对指标。通过估计每个估计值的95%置信区间（CI）来考虑统计显著性。
孟加拉国的NMR呈下降趋势，从2000年的50.2降至2017年的每1000例活产31.9例死亡。本研究发现，在所有调查点，NMR存在显著的财富驱动差异（PAF：-20.6，95%CI：-24.9，-16.3；PAR：-6.6，95%CI：-7.9，-5.2）、教育相关差异（PAF：-11.6，95%CI：-13.4，-9.7；PAR：-3.7，95%CI：-4.3，-3.1）和区域差异（PAF：-20.6，95%CI：-27.0，-14.3；PAR：-6.6，95%CI：-8.6，-4.6）。我们还发现，除2017年外，2000年至2014年存在显著的城乡不平等。NMR的绝对和相对不平等均有观察到；然而，这些不平等随着时间的推移而减少。
孟加拉国各亚组之间NMR的显著差异凸显了采取全面、有针对性干预措施的必要性。通过改善获得经济资源和教育的机会来增强妇女权能，可能有助于解决孟加拉国NMR的差异问题。未来的研究和政策应侧重于制定战略来解决这些差异，并促进所有新生儿的公平健康结果。
