How Bangladesh is faring
Child mortality reduction was a crucial aspect of the Millennium Development Goals (MDGs). It is considered to be an important indicator of socioeconomic advancement under the Sustainable Development Goals (SDGs). Target 3.2 under Goal 3 of the SDGs calls for ending preventable deaths of newborns and children under five years of age.
Bangladesh has fared well with respect to reduction of child mortality which is measured by under-five mortality rate (U-5MR) and infant (children under one year of age) mortality rate (IMR). The U-5MR has gone down from 146 per 1,000 live births in 1990 to 84 in 2000 and further reduced to 46 per 1,000 live births in 2014 (Bangladesh Demographic and Health Survey (BDHS) 2014). The infant mortality rate (IMR) likewise came down from 92 per 1,000 live births in 1990 to 58 in 2000 and 38 in 2014 (BDHS 2014).
Bangladesh met the MDG target with respect to child mortality reduction. The socioeconomic improvements in the country in the past decades have contributed to this success. The country's GDP has grown at a rate of about six percent on average and the GDP per capita increased from USD 206 in 1980 to USD 1,044 in 2014.
The reduction of population living below the poverty line from 56.7 percent in 1990 to 24.8 percent in 2015 has also had a positive impact on child mortality reduction and this led to Bangladesh achieving the MDG target of poverty reduction as well. As an SDG target for 2030, we need to now strive to achieve an under-five mortality rate of 25 per 1,000 live births.
It is important to note that the highest number of deaths of children occurs in the early months of life which is caused by complications largely associated with conditions of pregnancy and safe delivery. Low birth weight, one of the most important factors in neo-natal mortality, is an outcome of several conditions in pregnancy including infections, maternal malnutrition, malaria, hepatitis and anemia. Complications in delivery can endanger both the lives of the mother and the newborn.
As the child grows, diarrhoea, acute respiratory infections, malaria, and vaccine preventable diseases continue to cause under-five morbidity and mortality. These diseases can even accelerate deaths of children if they are suffering from malnutrition. About 45 percent under-five mortality is attributable to malnutrition.
To understand the child malnutrition situation in the country, one important indicator we need to consider is the rate of underweight children which decreased from 57 percent in 2000 to 32.6 percent in 2014 (BDHS 2014). Again, the percentage of stunted children declined from 51 in 2004 to 36 in 2014 (BDHS 2014). The slow improvement of exclusive breastfeeding rate since 2007 which rose from 43 percent to 55 percent in 2014, is a cause for concern. About 26 percent of babies born with low birth weight (less than 2,500 grams) in the country are more prone to diseases.
Micronutrient deficiencies remain high which has been demonstrated by low iodised salt intake. About 46 percent households are not adequately consuming iodised salt (Bangladesh Multiple Indicators Cluster Survey, 2013). There is significant deficiency in Vitamin A among children—about 20 percent of children are not receiving Vitamin A. It is clear that child malnutrition is still high and needs to be addressed to further reduce under-five mortality in the country.
The Expanded Programme on Immunization (EPI) is being implemented for the past several decades now and it is an important way to deal with vaccine preventable diseases. About 84 percent of children aged 12-23 months are fully immunised in the country, as per data obtained in 2014, which is a major achievement. However, efforts should be made to fully immunise 100 percent of children in the country.
The incidence of diarrhoea among under-five children in 2014 was reported at 3.9 percent. The prevalence of malaria per 100,000 population was 777 in 2008 which came down to 434 in 2014. Nationwide, 43.5 percent of births are assisted by a skilled person and some 31 percent deliveries take place in a health facility. The water supply situation has improved greatly and 97.9 percent of the people had access to an improved water source in 2014. The percentage of households with access to sanitary facilities stood at 76.8 percent in 2014 (BDHS 2014).
It is to be noted that considerable inequality persists in the performance of child mortality reduction among different economic groups. The under-five mortality rates are as high as 79 per 1,000 live births for the poorest compared to 35 for the richest quintile of the population.
In 2013, the government committed itself to reducing child mortality under an international initiative called "A Promise Renewed" and in 2014 it developed "Bangladesh Every Newborn Action Plan." This is a comprehensive plan to deal with both the supply and demand sides of the child and maternal mortality issue.
Although Bangladesh has made progress in delivering primary healthcare to the people, the country has only 2.2 nurses and midwives per 10,000 population. In 2012-2013, the government allocation to the health sector was 4.1 percent of the total budget which needs to be increased.
In order to bring down child mortality further, several areas are recommended for improvement. These are: (a) stronger communication/social mobilisation campaigns using appropriate messages with special focus on diarrhoea, malaria, immunisation, and feeding practices; (b) energising the EPI to reach 100 percent coverage of children; (c) making available widely oral rehydration salts (ORS); (d) comprehensive coverage with micronutrient supplements such as vitamins A, D, iodised salt, de-worming tablets, and iron supplements for women; (e) making impregnated bed nets universally available including in all malaria endemic areas, and supporting communities with re-impregnation logistics; (f) empowerment of women and development of their socioeconomic status; and (g) making efforts to end child marriage: child marriage has many negative consequences including early pregnancy, birth complications and babies born with low birth weight.
Dr Nawshad Ahmed holds a PhD in economics. He worked as a UN official for the last 18 years in Bangladesh and outside the country.
Comments