Trends and projections of under-5 mortality in Bangladesh including the effects of maternal high-risk fertility behaviours and use of healthcare services

Abstract

Objective This study examines trends and puts forward projections of under-5 mortality (U5M) in Bangladesh and identifies the effects of maternal high-risk fertility behaviours and use of healthcare services. Methods Data from seven waves of the Bangladesh Demographic and Health Survey (1994–2014) were analyzed for trends and projections of U5M and a Chi-square (χ2) test was used to identify if there was any association with maternal high-risk fertility behaviours and use of healthcare services. A multivariate logistic regression model was used to determine the effects of fertility behaviors and healthcare usage on the occurrence of U5M adjusting with confounders. Results U5M declined from 82.5 to 41.0 per 1000 livebirths during 1994–2014 and is projected to further reduce to 17.6 per 1000 livebirths by 2030. The study identified a noticeable regional variation in U5M with maternal high-risk fertility behaviours including age at birth <18 years (aOR: 1.84, 95% CI: 1.23–2.76) and birth interval <24 months (aOR: 1.56, 95% CI: 1.02–2.37) found to be significant determinants. There was a 39–53% decline in this rate of mortality among women that had used antenatal care services at least four times (aOR, 0.51, 95% CI: 0.27–0.97), delivery care (aOR, 0.47, 95% CI: 0.24–0.95), and had received postnatal care (aOR, 0.61, 95% CI: 0.41–0.91) in their last birth. Cesarean section was found to be associated with a 51% reduction in U5M (aOR, 0.49, 95% CI: 0.29–0.82) compared to its non-use. Conclusion The Sustainable Development Goals require a U5M rate of 25 per 1000 livebirths to be achieved by 2030. This study suggests that with the current trend of reduction, Bangladesh will achieve this target before the deadline. This study also found that maternal high-risk fertility behaviours and non-use of maternal healthcare services are very prevalent in some regions of Bangladesh and have increased the occurrence of U5M in those areas. This suggests therefore, that policies and programmes designed to reduce the pregnancy rates of women that are at risk and to encourage an increase in the use of maternal healthcare services are needed.

Determinants associated with high-risk fertility behaviours among reproductive aged women in Bangladesh: a cross-sectional study

“…HRFB in mothers also associated with the neonatal mortality; while a study in India identified causal effect of birth spacing on neonatal mortality [14], and also childbearing at teenage was also found to be linked to neonatal mortality [15]. Some previous studies established a relationship between numerous HRFB-related parameters and their detrimental effects on maternal and infant health [7,8,16,17]. Women who start having children at an early age often have more children [18] and this is also associated with adverse maternal, infant and child health outcomes [19].…”

“…Maternal HRFB is a bio-demographic risk factor that impedes the achievement of lower maternal and child morbidity and mortality [3][4][5][6][7]. Some demographic variables, such as women's age, parity, and birth spacing are the crucial parameters of measuring HRBF including too-early (< 18 years) or too-late (> 34 years) childbearing, short birth intervals (< 24 months) and a higher number of live births (4 or higher) [3,4,7,8]. Although the total fertility rate (TFR) of Bangladesh declined from 3.7 in 1995 to 2.04 in 2020 [9].…”

Household Air Pollution from Cooking Fuels and its Association with Under-Five Mortality in Bangladesh

“…Bangladesh has achieved significant progress in reducing under-five mortality during the Millennium Development Goals period of 2000 to 2015 [13]. However, the rate is still very high at 45 and 30 per 1000 live births for under-five mortality and neonatal mortality, respectively [13, 14]. This presents a challenge in achieving the Sustainable Development Goal 3 (health and wellbeing for all), in particular, its targets to reduce under-five (25 per 1000 live births) and neonatal (12 per 1000 live births) mortality rates by 2030 [13, 14].…”

Determinants associated high-risk fertility behaviours among reproductive aged women in Bangladesh: a cross-sectional study

“…Maternal HRFB is a bio-demographic risk factor that impedes the achievement of lower maternal and child morbidity and mortality [4][5][6][7][8]. Some demographic variables, such as women's age, parity, and birth spacing are the crucial parameters of measuring HRBF including too-early (<18 years) or too-late (>34 years) childbearing, short birth intervals (<24 months) and a higher number of live births (4 or higher) [4,5,[8][9][10]. Although the total fertility rate (TFR) of Bangladesh declined from 3.7 in 1995 to 2.04 in 2020 [1].…”

“…Several studies identi ed the linkage between various factors of HRFB and its adverse impacts on the mother and child health [8,10,18,19]; however, there is a dearth of literature that assessed the risk factors of HRFB in Bangladesh using the latest round BDHS dataset. Therefore, the present study was undertaken to identify the determinants associated with high-risk fertility behaviour of reproductive aged women (15-49 years) in Bangladesh.…”