Nutrition Research Division (NRD), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya.
BMC Public Health. 2024 Nov 28;24(1):3324. doi: 10.1186/s12889-024-20426-8.
Child mortality remains remarkably high in many low- and middle-income countries (LMICs), including Bangladesh. This study aimed to identify the sociodemographic and maternal health-related factors associated with under three (U3) child mortality in Bangladesh.
We extracted data of 5299 U3 children from Bangladesh Demographic and Health Survey (BDHS) 2017-18. We used descriptive statistics to summarize the data. The chi-square (χ2) test, simple and multiple Firth logistic regression were performed to test the associations between priori-defined factors and U3 mortality.
In Bangladesh, the U3 child mortality rate was 35 deaths per 1,000 live births, with a median age at death of less than one month. The adjusted model revealed that the odds of U3 child mortality were higher among children born to mothers aged between 30 and 39 years [adjusted odds ratio (AOR) = 2.01, 95% confidence interval (CI): 1.30-3.11; p-value (p) = 0.002], those who did not use any contraceptive [AOR = 2.57, 95% CI: 1.90-3.47; p < 0.001], with first pregnancy [AOR = 14.91, CI: 4.60-48.30; p < 0.001], had birth interval less than 24 months [AOR = 2.10, CI: 1.23-3.60; p = 0.007], children born to mothers who delivered vaginally [AOR = 3.18, 95% CI: 2.07-4.87; p < 0.001]. However, lower odds of mortality were observed among children of mothers with higher education levels [AOR = 0.50, 95% CI: 0.28-0.90; p = 0.021] and families with more than five members [AOR = 0.61, 95% CI: 0.45-0.83; p < 0.01]. In addition, religion, birth attendant during delivery, and the child's birth order were significantly associated with U3 child mortality, whereas mortality did not vary significantly across the divisions.
Higher odds of U3 child mortality were associated with mothers who did not use contraceptives, delivered vaginally, and were aged 30-39 years in Bangladesh. Conversely, higher maternal education and larger family size were associated with lower odds of U3 child mortality. The findings suggest that community-based family planning awareness programs focused on contraceptive use, as it prevents childbirth and is also a marker of health service usage.
在许多低收入和中等收入国家（LMICs），包括孟加拉国，儿童死亡率仍然高得惊人。本研究旨在确定与孟加拉国三岁以下儿童（U3）死亡率相关的社会人口学和与产妇健康相关的因素。
我们从 2017-18 年孟加拉国人口与健康调查（BDHS）中提取了 5299 名 U3 儿童的数据。我们使用描述性统计来总结数据。使用卡方（χ2）检验、简单和多 Firth 逻辑回归来检验先验定义因素与 U3 死亡率之间的关联。
在孟加拉国，U3 儿童死亡率为每 1000 例活产 35 例死亡，死亡时的中位年龄不到一个月。调整后的模型显示，母亲年龄在 30 至 39 岁之间的儿童[调整后的优势比（AOR）= 2.01，95%置信区间（CI）：1.30-3.11；p 值（p）= 0.002]、未使用任何避孕措施的儿童[AOR = 2.57，95%CI：1.90-3.47；p < 0.001]、初次怀孕的儿童[AOR = 14.91，CI：4.60-48.30；p < 0.001]、出生间隔小于 24 个月的儿童[AOR = 2.10，CI：1.23-3.60；p = 0.007]、由阴道分娩的母亲分娩的儿童[AOR = 3.18，95%CI：2.07-4.87；p < 0.001]，其 U3 死亡率的几率更高。然而，母亲受教育程度较高的儿童[AOR = 0.50，95%CI：0.28-0.90；p = 0.021]和家庭人口超过五人的儿童[AOR = 0.61，95%CI：0.45-0.83；p < 0.01]的死亡率较低。此外，宗教、分娩时的接生员和孩子的出生顺序与 U3 儿童死亡率显著相关，而死亡率在各地区之间没有显著差异。
在孟加拉国，未使用避孕药具、经阴道分娩和 30-39 岁的母亲与 U3 儿童死亡率的几率较高有关。相反，较高的母亲教育水平和较大的家庭规模与 U3 儿童死亡率的几率较低有关。研究结果表明，以社区为基础的计划生育宣传活动应侧重于使用避孕药具，因为它可以预防分娩，也是卫生服务利用的标志。
