Factors affecting child survival in Matlab, Bangladesh

This study investigated the factors that might affect child survival in Matlab, a rural area in Bangladesh, using a ‘proximate determinants’ conceptual framework. The analysis involved three sets of data. Identification of the important covariates of childhood mortality was based on follow-up of the 1982 birth cohort of the whole Matlab population until December 1984. Their household and maternal characteristics were collected during the 1982 census of the area carried out by the International Centre for Diarrhoeal Disease Research, Bangladesh. A survey conducted in late 1986 collected information in seven purposively selected villages on some selected proximate determinants from the mothers of 1128 children bom between 1 October 1983 and 30 June 1986. A survey of 63 health care providers in the area was also conducted during the first half of 1987. The covariates represented various characteristics of the household, of the mother, and of the children; among them economic condition, health program status, maternal age and education, sex and birth order of the children were found, through a hazard logit model analysis, to have significant relationships with child mortality when the age of the children was controlled. The survey revealed widespread malnutrition and morbidity among the children, and the risk of death of the severely malnourished children was found to be very high in comparison to the less severely malnourished and normally nourished children. This pattern supports the argument that child death in this community is mostly preceded by growth faltering. Moreover, most of the previously identified independent variables (excepting birth order, information on which was not available in the survey) maintained a pattem of relationship with severe malnutrition similar to that with mortality. This implied that mortality differentials, as observed for those variables among the children in the study area, are largely due to differentials in malnutrition or growth faltering. A high incidence of morbidity and inappropriate feeding practices may be important causes of malnutrition among the children. Prevalence among mothers of unhygienic practices and lack of appropriate knowledge about disease may be responsible for higher incidences of diseases like diarrhoea among the children. Traditional beliefs prevailing in the community about causes and transmission of diseases may be an important factor deterring parents from approaching scientific or modem methods of treatment and prevention. The practice of food withholding during sickness may also play an important role in aggravating the poor nutritional situation of the study children