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2017 ; 75
(ä): 58
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A comprehensive analysis on child mortality and its determinants in Bangladesh
using frailty models
#MMPMID28912949
Khan JR
; Awan N
Arch Public Health
2017[]; 75
(ä): 58
PMID28912949
show ga
BACKGROUND: Bangladesh has experienced a significant reduction of child mortality
over the past decades which helped achieve the Millennium Development Goal 4 (MDG
4) target. But the mortality among under-5 aged children is still relatively high
and it needs a substantial effort to achieve the Sustainable Development Goal
(SDG) target and decelerate the current rate of under-5 mortality. At this stage,
it is hence important to explore the trend and determinants of under-5 mortality
in order to reduce the vulnerability of child's survival. The aim of this study
is to explore the trends and identify the factors associated with mortality in
children aged less than 5 years in Bangladesh. METHODS: Data from three
repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) for
the year 2007, 2011 and 2014 were used. A stratified two-stage sampling method
was used to collect information on child and maternal health in these surveys.
Cox's proportional hazards models with community and mother level random effects
(or frailty models) were fitted to identify the associated factors with
under-five mortality. RESULTS: Our study reveals that urban-rural disparity in
child mortality has decreased over the time. The frailty models revealed that the
combined effect of birth order and preceding birth interval length, sex of the
child, maternal age at birth, mother's working status, parental education were
the important determinants associated with risk of child mortality. The risk of
mortality also varied across divisions with Sylhet division being the most
vulnerable one. Moreover, significant and sizable frailty effects were found
which indicates that the estimations of the unmeasured and unobserved mother and
community level factors on the risk of death were substantively important.
CONCLUSION: Our study suggests that community-based educational programs and
public health interventions focused on birth spacing may turn out to be the most
effective. Moreover, unobserved community and familial effects need to be
considered along with significant programmable determinants while planning for
the child survival program.
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