Differentials in neonatal mortality in two adjacent rural areas of Bangladesh: Lessons for neonatal health interventions

Abstract

A household survey, conducted in three rural sub-districts of northeastern Bangladesh, revealed a markedly lower neonatal mortality rate (NMR) in one sub-district compared to two adjacent sub-districts. This study examines the degree to which the differential in NMR can be explained by factors that could be improved by maternal and newborn health programmes, such as knowledge of danger signs and use of antenatal, delivery, and postnatal care. Use of a skilled birth attendant in uncomplicated deliveries, mothers’ knowledge of newborn complications, and use of health care for sick newborns accounted for 32% of the differential in NMR. Pregnancy and delivery complications were associated with increased risk of neonatal mortality, and distance to nearest emergency obstetric care facility was significantly associated with lower risk of neonatal mortality. Therefore, health programmes to improve mothers’ knowledge of newborn complications, to increase access to emergency obstetric care, and to promote appropriate use of health care could significantly reduce neonatal mortality in impoverished communities.

Keywords:

• Neonatal mortality
• determinants
• Bangladesh
• community-based trials
• maternal health

Acknowledgements

This research was funded by the United Stages Agency for International Development (USAID), through cooperative agreements with the Johns Hopkins University Bloomberg School of Public Health and ICDDR,B, and by the Saving Newborn Lives Initiative (SNL) of Save the Children Federation-USA, through a grant from the Bill and Melinda Gates Foundation. We thank the many individuals in Sylhet district who gave their time generously and the field and data management staff of Projahnmo. We thank the members of the Projahnmo Technical Review Committee, the Bangladesh Ministry of Health and Family Welfare colleagues at the subdistrict, district, and central levels, and the members of the Shimantik executive committee for their valuable help and advice. The critical innovative inputs of Projahnmo study group members are acknowledged. Projahnmo Study Group (in alphabatical order): Jahiruddin Ahmed, Munir Ahmed, S.M. Alauddin, Nabeel Ashraf Ali, Arif Billah Al-Mahmud, Ahmed Al-Sabir, Tariq Anwar, Nazma Begum, Sameena Chowdhury, Mohiuddin Chowdhury, A.K.M. Fazlul Haque, Quamrul Hasan, Sahela Khatun, Paul Law, Qazi Sadequr Rahman, Syed Moshfiqur Rahman, Samir K Saha, Rasheduzzaman Shah, Ashrafuddin Siddik, Uzma Syed, Hugh Waters, K. Zaman.