Newborn survival in Bangladesh: a decade of change and future implications

Abstract

Remarkable progress over the last decade has put Bangladesh on track for Millennium Development Goal (MDG) 4 for child survival and achieved a 40% decline in maternal mortality. However, since neonatal deaths make up 57% of under-five mortality in the country, increased scale up and equity in programmes for neonatal survival are critical to sustain progress. We examined change for newborn survival from 2000 to 2010 considering mortality, coverage and funding indicators, as well as contextual factors. The national neonatal mortality rate has undergone an annual decline of 4.0% since 2000, reflecting greater progress than both the regional and global averages, but the mortality reduction for children 1-59 months was double this rate, at 8.6%. Examining policy and programme change, and national and donor funding for health, we identified various factors which contributed to an environment favourable to newborn survival. Locally-generated evidence combined with re-packaged global evidence, notably The Lancet Neonatal Series, has played a role, although pathways between research and policies and programme change are often complex. Several high-profile champions have had major influence. Attention for community initiatives and considerable donor funding also appear to have contributed. There have been some increases in coverage of key interventions, such as skilled attendance at birth and postnatal care, however these are low and reach less than one-third of families. Major reductions in total fertility, some change in gross national income and other contextual factors are likely to also have had an influence in mortality reduction. However, other factors such as socio-economic and geographic inequalities, frequent changes in government and pluralistic implementation structures have provided challenges. As coverage of health services increases, a notable gap remains in quality of facility-based care. Future gains for newborn survival in Bangladesh rest upon increased implementation at scale and greater consistency in content and quality of programmes and services.

The correlation of health spending and infant mortality rate in Asian countries

“…Adults and older children benefit more from health investment and health infrastructure for example, in the Indian subcontinent, in Bangladesh, the national neonatal mortality rate has undergone an annual decline of 4.0% since 2000, reflecting greater progress than both the regional and global averages, but the mortality reduction for children 1-59 months was double this rate, at 8.6%. 10 Bangladesh spent 19 $ per capita or 3.5% of its GDP on health. Similarly in Nepal, neonatal mortality rate reduced by 3.6% per year, which was faster than the regional average (2.0%) but slower than national annual progress for mortality of children aged 1-59 months (7.7%) and maternal mortality (7.5%).…”

Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia

“…The World Health Organization (WHO) has published guidelines for Essential Newborn Care (ENC) including protective practices before, during, and after birth [3]. Several South Asian countries have increased the number of women giving birth in institutions or at home with a skilled birth attendant (SBA) [4-6]. Increasing access to skilled attendance at birth can reduce both maternal and neonatal mortality, but in resource-poor areas, having a skilled birth attendant or an institutional delivery may not guarantee full provision of WHO-recommended essential newborn care [7-12].…”

“…Increasing access to skilled attendance at birth can reduce both maternal and neonatal mortality, but in resource-poor areas, having a skilled birth attendant or an institutional delivery may not guarantee full provision of WHO-recommended essential newborn care [7-12]. Increased access to some components of newborn care for women giving birth at home without a SBA can also be an effective strategy to reduce neonatal morbidity and mortality [5,6,13], for instance through the use of clean delivery kits [14,15]. Both strategies are based on the knowledge that increasing the coverage of essential newborn care practices in South Asia is essential to achieving the millennium development goals for child survival [16-18].…”

Neonatal Sepsis – A Review

“…In another study conducted in Dhaka slums showed sepsis as a direct cause of neonatal deaths in 20% cases 8 . In another study in Bangladesh, estimated causes of mortality around the year 2010 for 102,000 neonatal deaths showed that severe infections (sepsis, meningitis, pneumonia and tetanus) contributed 20% of neonatal deaths 9,10 .…”