Levels, trends and socio-demographic determinants of infant and under-five mortalities in and around slum areas of Dhaka city, Bangladesh.

ABSTRACT

Infant and child mortality are often used to monitor the progress of national population health programs. The data for this study was collected from selected urban slums where icddr,b has maintained the Health and Demographic Surveillance System (HDSS). Using the HDSS database, 6,666 married women were selected and interviewed in 2018 to collect data on socioeconomic status, pregnancy history and safe motherhood practices. The study examined levels and trends of infant and under-five mortality for three periods 1990-1999 (Period 1), 2000-2009 (Period 2), and 2010-2018 (Period 3) and examined socio-demographic differentials of infant and under-five mortality for Period 3. From Period 1 to Period 3, under-five mortality declined by 68.2%, with child mortality (1-4 years) declining more than infant mortality (84% vs. 65%). In the regression models for Period 3, infant and under-five mortality were higher for working than non-working mothers (infant OR = 1.35*, CI 0.98, 1.86; under-five OR = 1.34*, CI 0.99, 1.82), lower for girls than boys (infant OR = 0.77*, CI 0.57, 1.03; under-five OR = 0.77*, CI 0.58, 1.03), higher for small-size than normal/big-size babies (infant OR = 4.11***, CI 3.00, 5.64; under-five OR = 3.68***, CI 2.70, 5.02), higher for babies delivered vaginally than by caesarean section (infant OR = 1.79**, CI 1.14, 2.97; under-five OR = 1.87***, CI 1.21, 2.88), higher for babies delivered with complications than no complication (infant OR = 2.16***, CI 1.48, 3.15; under-five OR = 2.21***, CI 1.55, 3.18), and higher for babies born after a short (<24 months) birth interval (infant OR = 1.71*, CI 0.96, 3.05; under-five OR = 1.63*, CI 0.93, 2.86) than firstborns. While substantial progress has been made in reducing under-five and infant mortality, neonatal mortality have declined less slowly. Targeted population health interventions addressing the socio-demographic drivers of infant mortality, with a focus on the urban poor, will help Bangladesh achieve Sustainable Development Goal 3.