Child mortality on the rise, SDG efforts suffer setback

In a rather grim development, the child mortality rate in Bangladesh saw a rise in 2022 compared to the previous four years, as per the latest data available.

This means the government will have to drastically scale up its efforts to bring down preventable deaths of newborns and children under five as per the 2030 Sustainable Development Goals (SDGs). 

A summary of Bangladesh Sample Vital Statistics 2022, prepared by Bangladesh Bureau of Statistics, published last June, shows the number of infants dying before turning one has risen to 24 per 1,000 live births.

It was 22 in 2021, 21 in 2020 and 2019, and 22 in 2018.

"We've noticed an increase in neonatal deaths due to factors such as prematurity, low birth weight, intrauterine growth restriction, infections, and perinatal asphyxia."

— Professor Dr Jahangir Alam Director of Bangladesh Shishu Hospital and Institute

Meanwhile, the number of children under five dying for every 1,000 live births has also gone up to 31 in 2022 from 28 in 2021, 2020, and 2019, and 29 in 2018.

Bangladesh Demographic and Health Survey (2022) prepared by National Institute of Population Research and Training also showed similar data regarding the mortality rate of children under five.

According to the SDG 3.2 indicators, the government has a target to cut the under-5 mortality rate down to 25 per 1,000 live births.

BBS's detailed report was released on January 31 this year. According to it, the number of neonates dying before turning one month has remained 16 in 2022, like in 2021. It was 15 in 2019 and 2020.

As per the SDG, the target is to reduce neonatal mortality to as low as 12 per 1,000 live births.

Further analysis also revealed that the number of infants dying between one to 11 months has increased to eight per 1,000 births. It was six in the previous four years.

Simultaneously, the death rate for children aged 1-4, against every 1,000 children in that age group, has also risen to 1.8 in 2022 from 1.6 in 2021.

The BBS report also shows that male children face greater health risks and vulnerabilities compared to female children, resulting in a higher mortality rate among them.

No analysis of the reasons behind the rise in mortality rate was done.

However, in 2021, the major causes for child mortality were reported to be pneumonia, jaundice, fever, diarrhoea, malnutrition, acute respiratory infection and drowning.

Dr Md Muniruzzaman Siddiqui, director of the Directorate General of Family Planning (DGFP)'s maternal and child health (MCH) services, said they have not pinpointed the exact cause, but they suspect that the disruption of services during the Covid-19 pandemic could be a contributing factor to the rise in child mortality.

"It might be an aftereffect of the pandemic."

Dr Md Manjur Hossain, programme manager of DGFP's MCH services, echoed the same.

"Covid-19 emerged in 2020, reached its peak in 2021, and showed some improvement in 2022 -- all of which contributed to the increased death rate among children under five. The disruption to services hindered our ability to effectively manage conditions like pneumonia and diarrhea.

"During the pandemic, antenatal checkups were reduced, and appointments were postponed until the later stages of pregnancy. Institutional deliveries also decreased, which we believe was a direct impact of the pandemic."

Dr Manjur further said, "Moreover, from my perspective, the decline in the quantity of service providers within our facilities is worrisome. The irregular recruitment practices have led to a decrease in their numbers, which I perceive as a potential contributing factor."

Data provided by DGFP in 2022 highlighted the alarming vacancy rates of critical positions for maternal and child health services.

According to it, the vacancy rate was 99 percent of 175 medical technologists; 98 percent of 464 assistant family welfare officers; 81 percent of 140 senior staff nurses; 53 percent of 517 family planning officers; 75 percent of 495 assistant family planning officers; and 39 percent of 636 family welfare visitors.

Prof Dr Gulshan Ara, former secretary-general of Obstetric and Gynecological Society of Bangladesh, pointed that dengue was another factor behind the spike.

According to the Directorate General of Health Services, 10 percent of all dengue deaths in 2022 were of children.

Professor Dr Jahangir Alam, director of Bangladesh Shishu Hospital and Institute and secretary-general of Bangladesh Paediatric Association, on the other hand, said, "We've noticed an increase in neonatal deaths due to factors such as prematurity, low birth weight, intrauterine growth restriction, infections, and perinatal asphyxia.

"Disruption in maternal nutrition intake during the pandemic could be another reason."

He commended the government's initiative to establish 60 Sheikh Rasel Special Care Newborn Unit in district-level hospitals. "If these units could be made more dynamic with adequate resources and manpower, it could truly make a significant difference."