Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study.

ABSTRACT

PIP: Advances in verbal autopsy methodology and the availability of the 1993-94 Bangladesh Demographic and Health Survey data enabled an analysis of causes of childhood deaths in Bangladesh. Few deaths in Bangladesh are attended by qualified physicians and the registration system is deficient, making mortality analyses difficult with conventional sources. A follow-up survey of the 828 deaths of children under 5 years occurring in the 5 years preceding the 1993-94 survey was conducted in 1995. 311 deaths involved neonates, 232 occurred in the 1-11 month age group, and 285 were among children 12-59 months of age. 24.2% of deaths (40% of the infant deaths) were associated with acute lower respiratory infection (ALRI), 19.0% with diarrhea, 8.8% were due to accidents, and 5.4% were related to neonatal tetanus. Drowning accounted for 18.9% of deaths among 1-4 year olds. Malnutrition was associated with a third of the respiratory infections and half the diarrhea deaths. Urban deaths represented less than 10% of the total, but maternal educational status was not associated with different patterns of child mortality. Girls were less likely than boys to die from ALRI and more likely to die from malnutrition, measles, and diarrhea. Early recognition of pneumonia cases and appropriate care-seeking by parents, use of properly prepared oral rehydration solution in diarrhea, and measures to improve the general nutritional status of children would help improve child survival. Verbal autopsy instruments could be made more accurate if adapted based on mothers' recognition of signs and symptoms and the terms they use to describe them.