Risk factors for under-5 mortality: evidence from Bangladesh Demographic and Health Survey, 2004-2011

Objective: The aim of this study was to identify factors associated with mortality in children under 5 years of age using a nationally representative sample of singleton births for the period of 2004-2011. Design, Setting and Participants: Pooled 2004, 2007 and 2011 cross-sectional data sets of the Bangladesh Demographic and Health Surveys were analysed. The surveys used a stratified two-stage cluster sample of 16 722 singleton live-born infants of the most recent birth of a mother within a 3-year period. Main Outcome Measures: Outcome measures were neonatal mortality (0-30 days), postneonatal mortality (1-11 months), infant mortality (0-11 months), child mortality (1-4 years) and under-5 mortality (0-4 years). Results: Survival information for 16 722 singleton live-born infants and 522 deaths of children <5 years of age included: 310 neonatal deaths, 154 postneonatal deaths, 464 infant deaths, 58 child deaths and 522 under-5 deaths. Multiple variable analysis showed that, over a 7-year period, mortality reduced significantly by 48% for postneonatal deaths, 33% for infant deaths and 29% for under-5 deaths, but there was no significant reduction in neonatal deaths (adjusted OR (AOR)=0.79, 95% CI 0.59 to 1.06) or child deaths (AOR=1.00, 95% CI 0.51 to 1.94). The odds of neonatal, postneonatal, infant, child and under-5 deaths decreased significantly among mothers who used contraceptive and mothers who had other children aged 3 years or older. The risk of neonatal, postneonatal, infant, child and under-5 deaths was significantly higher in mothers who reported a previous death of a sibling. Conclusions: Our study suggests that family planning is needed to further reduce the overall rate of under-5 deaths in Bangladesh. To reduce childhood mortality, public health interventions that focus on child spacing and contraceptive use by mothers may be most effective.