Infant mortality
Child mortality is a vital indicator of child health and overall national development. It denotes the number of death of children below one year. This death toll is measured by Infant Mortality Rate (IMR) which is the number of deaths of children under one year per 1000 live births every year.
Premature and malnourished birth is the biggest contributor to the IMR. Early marriage, sometimes aged marriage, maternal care during pregnancy, delivery practices of child, post-delivery activity, breast feeding aspects, working mother and adequate diet for children are some main factors of infant mortality.
Other leading causes of infant mortality are birth asphyxia, pneumonia, congenital malformations, term birth complications, neonatal infection, diarrhea, malaria, measles and malnutrition. Many factors contribute to infant mortality, such as the mother’s level of education, environmental conditions, and political-medical infrastructure.
By improving sanitation, access to clean drinking water, immunization against infectious diseases and other public health measures can help reduce high rates of infant mortality.
World perspective
Over the past 25 years, the world has made a significant progress in saving young children’s lives. The rate of child mortality fell 62% from 1990-2017, with under-five deaths dropping from 12.7 million to 5.6 million. In 2017, World Health Organization reported 4.1 million deaths occurred within the first year of life. The risk of a child dying before completing the first year of age was highest in the WHO African Region, over six times higher than that in the WHO European Region. Still there are 51 deaths per 1000 live births in African region and 8 deaths per 1000 live births in European region.
Globally, the infant mortality rate has decreased from an estimated rate of 65 deaths per 1000 live births in 1990 to 29 deaths per 1000 live births in 2017. Annual infant deaths have declined from 8.8 million in 1990 to 4.1 million in 2017. In 2018, it is expected that infant mortality would reduce worldwide.
State of Bangladesh
Bangladesh is a very small country in southern part of Asia. It has experienced a significant reduction of child mortality over the past decades which helped to achieve the Millennium Development Goal 4 (MDG 4) target. But still Bangladesh has 24.3 percent people are living less than national poverty line and half of them are living below extreme poverty line according to the official poverty statistics 2017.
The national poverty line fell in both urban and rural area but the speed of reduction is lower in urban area. But the mortality among under 5 age children must be further reduced for a substantial effort to achieve the Sustainable Development Goal (SDG) target in Bangladesh.
At this stage, it is hence important to explore the trend and determinants of under-5 mortality to reduce the vulnerability of child’s survival. 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 and parental education were the important determinants associated with risk of child mortality.
Reason of Infant Mortality
There are many reasons that drives higher infant mortality rate.
Premature, complications during labor and birth, and infections like sepsis, pneumonia, tetanus and diarrhea are among the leading causes, which can be treated or prevented with simple, affordable solutions. But these children are also dying because of who they are and the environment they were born into-be it an impoverished family, a marginalized community or a country consumed by conflict. 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.
Causes of Child Death or Infant Mortality in Bangladesh:
There are some major reasons for infant mortality rate in Bangladesh, those are pointed out in the below:
Neonatal Mortality (0-4 Weeks):
It includes-
- Low birth weight,
- Hemolytic disease of newborn,
- Birth injury and difficult labor,
- Acute respiratory infection (ARI),
- Measles,
- Congenital anomalies,
- Septicemia,
- Malnutrition,
- Conditions of placenta and cord,
- Diarrhea disease,
- Tetanus,
- A whooping cough,
- Vitamin deficiency
Post Neonatal Mortality (1-12 Months):
It includes-
- Acute respiratory infection (ARI),
- Diarrhea disease,
- Malnutrition,
- Another communicable disease,
- Accidents,
- Congenital anomalies.
Risk Factors of Infant Mortality and Morbidity in Bangladesh:
Factors associated with infant mortality and morbidity has discussed in the following:
a. Biological Factors:
It includes-
- Birth weight: Babies of low birth weight (under 2.5 kg) and high birth weight (over 4 kg) are at special risk.
- Age of mother: When the mother is either very young (below the age of 19 years) or relatively older (over 30 years) then the possibility of Infant mortality rates (IMR) is greater.
- Birth order: After the third birth, the risk of infant mortality escalates.
- Birth spacing,
- Multiple births,
- Family size,
- High fertility.
b. Economic Factors:
Poor economic status.
c. Cultural and Social Factors:
It includes-
- Early marriage: The newborn baby of the teenage mother has the maximum risk for neonatal and post-neonatal mortality.
- Broken families: Infant mortality tends to be high where the mother or father has died or separated.
- Breastfeeding,
- Sex of the child,
- Religion and caste,
- Quality of mothering,
- Brutal habits and customs,
- Maternal education,
- Bad environmental sanitation,
- Illegitimacy,
- Quality of health care,
- The indigenous aid.
Comparison over the years
Bangladesh has brought down the child mortality rate by 73% over the last 25 years along with achieving the target of reducing under-five mortality rates, according to a UNICEF report.
Nearly half of all under-five deaths are associated with malnutrition. The risk of mortality also varied across divisions with Sylhet division being the most vulnerable one. Most of these deaths are entirely preventable.
The data shows there is a steady decrease of infant mortality in Bangladesh over the decade. In 2007 the IMR was 45.6% which got down to 35% in 2012. As per the last available data it got reduced to 26.9% in 2017.
According to WHO, a substantial global progress has been made in reducing child deaths. Among these countries, Bangladesh has also registered a substantive acceleration, experiencing a remarkable change in child mortality rates over the last few decades. Although, according to the report, child mortality rate is decreasing over time, Bangladesh has to further reduce child’s death to obtain the Sustainable Development Goals (SDGs). The high fertility rate is boosted up by high infant and child mortality, because of the fear of death of the children at an early age. There are many factors which are closely related to the mortality experience among children such as maternal education and household income status. Generally, under-privileged mothers have more child deaths than others. Some demographic variables are associated with infant and child mortality such as maternal age at marriage and during child’s birth, birth spacing pattern, parity, maternal height and weight, and size of the children at birth. In addition to global estimates for under-five, infant and newborn mortality, the report for the first time contains estimates on mortality among children aged 5-14.
Conclusion
Bangladesh as a developing nation has shown a remarkable change in the IMR . The IMR rate has reduced over the years and the day is not far when Bangladesh will join itself with countries like Monaco, Japan, and Iceland who have the lowest infant mortality rates (around 2 infant deaths per 1000 infants).
Reference
https://www.adb.org/countries/bangladesh/poverty
http://povertydata.worldbank.org/poverty/country/BGD
https://data.worldbank.org/indicator/SI.POV.DDAY?end=2016&locations=1W-BD&start=1981&view=chart
https://knoema.com/atlas/ranks/Poverty-rate?baseRegion=BD
https://www.britannica.com/science/population-biology-and-anthropology/Mortality#ref366893
https://nursinghelpline.blogspot.com/2018/11/infant-mortality-rate-causes-bangladesh.html
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