Date Published: December 3, 2009
Publisher: Public Library of Science
Author(s): Amal K. Halder, Emily S. Gurley, Aliya Naheed, Samir K. Saha, W. Abdullah Brooks, Shams El Arifeen, Hossain M. S. Sazzad, Eben Kenah, Stephen P. Luby, Laurent Rénia. http://doi.org/10.1371/journal.pone.0008145
Abstract: Data on causes of early childhood death from low-income urban areas are limited. The nationally representative Bangladesh Demographic and Health Survey 2007 estimates 65 children died per 1,000 live births. We investigated rates and causes of under-five deaths in an urban community near two large pediatric hospitals in Dhaka, Bangladesh and evaluated the impact of different recall periods. We conducted a survey in 2006 for 6971 households and a follow up survey in 2007 among eligible remaining households or replacement households. The initial survey collected information for all children under five years old who died in the previous year; the follow up survey on child deaths in the preceding five years. We compared mortality rates based on 1-year recall to the 4 years preceding the most recent 1 year. The initial survey identified 58 deaths among children <5 years in the preceding year. The follow up survey identified a mean 53 deaths per year in the preceding five years (SD±7.3). Under-five mortality rate was 34 and neonatal mortality was 15 per thousand live births during 2006–2007. The leading cause of under-five death was respiratory infections (22%). The mortality rates among children under 4 years old for the two time periods (most recent 1-year recall and the 4 years preceding the most recent 1 year) were similar (36 versus 32). The child mortality in urban Dhaka was substantially lower than the national rate. Mortality rates were not affected by recall periods between 1 and 5 years.
Partial Text: Approximately 9.7 million children die annually from preventable causes . Rapid urbanization has occurred throughout low income countries, where 80% of the world’s largest cities are now located . Moreover, a growing urban poor population in these countries is an increasing challenge for local health authorities . Knowledge of the causes of child death is essential for appropriate health sector interventions . In the South-Asian sub-continent, the decline in urban child mortality has been less than in rural areas –. The diversity and mobility of urban populations can make them harder to reach .
During the initial survey in 2006, from the 7000 identified households that met the enrolment criteria, field workers completed interviews in 6971 (99.6%). Conducting the follow up survey in 2007, we revisited all 6971 households but had to replace 51% (3521) of households. We replaced 492 households because their children were now all older than the five year age limit and 3029 households because residents had moved. We included an additional 49 households that were still within the cluster boundary and had a child under the age of 5 years during survey date; die in last 5 years even though they did not have a child under age 5 years living at the household at the time of the survey.
Neonatal mortality 15 deaths per 1000 live births and under five mortality 34 deaths per 1000 live births estimated were much lower in this study population in urban Dhaka compared to national estimates –. In addition the Government of Bangladesh commissioned an Urban Health Survey in 2006 which selected a representative sample of slum and non-slum communities in the six largest cities in Bangladesh. The rates of neonatal and under five mortality in our study community were again much lower compared to national urban data (2006) in which the district municipalities neonatal mortality rate was 43 and under five mortality rate was 61 per 1000 live births. Child mortality rates in this study community were similar to the national non-slum urban data (neonate 31 and under-five 31 deaths per thousand live births) but lower than the slum data (neonate 44 and under-five 81 per thousand) . Although we did not capture the information to explicitly classify communities, we estimate that approximately 30% of survey households were in slums. Therefore, we would expect a mortality rate between the national slum and non-slum rates, but instead we measured a rate closer to national non-slum urban data. A possible reason for a lower than expected mortality could be that either of the two large pediatric hospitals are within one hour traveling distance and therefore, available to children who have a life threatening but treatable illness. Other possible reasons include, the availability of better outpatient services from a range of providers in an urban environment, migration out after experiencing the death of a child, and higher levels of education  that may facilitate a healthier environment and more effective decisions when a child is ill.