Changes in neonatal mortality and newborn healthcare practices: descriptive data from the Bangladesh Demographic and Health Surveys 2011 and 2014
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World Health Organization. Regional Office for South-East Asia
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Background Bangladesh has made major improvements in health outcomes over the past twodecades, with falls in mortality rates in mothers and in infants and young children aged under 5 years.Despite these improvements, neonatal mortality rates (NMRs) are high in Bangladesh. This paperdescribes recent changes in NMRs and health-care practices, disaggregated by demographic andsocioeconomic characteristics.Methods Summary statistics from the reports of the Bangladesh Demographic and Health Survey(BDHS) were examined. The BDHS is a nationally representative cross-sectional survey and thetwo most recent rounds of surveys, 2007–2011 and 2010–2014, were included in the analysis. Thevariables considered in this study were neonatal deaths and related health-care practices, includingantenatal care visits, facility-based delivery, assistance from a medically trained provider duringdelivery, postnatal care from a trained provider and essential newborn care.Results Between the two survey periods, NMRs increased in Chittagong (average increase 4.5% peryear) and Khulna (8.3% per year), remained unchanged in Rangpur, and decreased in Barisal (averagedecrease 19.8% per year), Dhaka (12.2% per year), Rajshahi (7.7% per year) and Sylhet (4.8% peryear). A larger average annual reduction in the NMR was observed in urban areas than in rural areas(14.0% versus 2.1%). There was also a large average annual reduction in NMR in the fourth and fifthrichest quintiles for socioeconomic status (SES quintiles; 12.0% and 16.5% per year, respectively).Differences according to neonatal sex were also noted: the NMR for female neonates remainedunchanged and that for male neonates reduced by an annual average of 7.7%. General improvementswere observed in all health-care practices across all demographic and socioeconomic groups. However,the urban–rural gap in the uptake of antenatal care services, facility-based delivery, assistance from amedically trained provider during delivery, and postnatal care from a trained provider was roughly similarin both surveys. A similar unchanging gap was also seen between the poorest and richest SES quintiles.Conclusion The study analysis indicates that improvements in NMRs between the two surveyperiods are mixed. Further attention is required to improve the rate of reduction of neonatal mortalityin some divisions in Bangladesh, and it may be useful to investigate whether the higher NMR in ruralareas and for households with lower socioeconomic status can be reduced by strengthening theuptake of antenatal care services, facility-based delivery, assistance from a medically trained providerduring delivery, and postnatal care from a trained provider. The static NMR for female neonates mayencourage policy-makers to focus not only on ensuring standard essential newborn care practices forboth sexes but also on ensuring adequate and appropriate care-seeking for illness in female neonates
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