Preventable and treatable causes of infant death : examining neonatal and post neonatal mortality in rural Bangladesh

Background: Neonatal mortality is a major burden in developing countries. Most neonatal deaths in Bangladesh can be prevented by simple interventions or by preventive measures before birth, better delivery practices or basic treatments after birth. Researchers over the years have focused on upgrading health care options to combat particular causes of disease but simple preventive measures before birth are often ignored. The outcome of neonatal illnesses depends on how it is managed and when. An illness that is addressed before the actual occurrence will have a better outcome especially when it involves newly-born neonates who have limited immunity. Thus, understanding the neonatal causes of deaths is an effective way to improve neonatal outcomes at low cost. Study Design: This study used primary data from two ICDDR,B surveillance sites, Abhoynagar and Mirsarai from the period 1997-2006 and analysed the major 'preventable causes' that can be prevented before the birth of the baby. It also identified the 'treatable causes' that are not amenable to prevention before the birth of the baby. This categorization is based on context of a developing country as Bangladesh where advanced techniques to treat severe conditions is unavailable or expensive. A particular cause of death can potentially be prevented or treated but consideration needs to be given to what is feasible in terms of available resources. The study compares deaths between the two surveillance sites and observes some of the biological, social and health care variables associated with preventable and treatable causes of deaths. Result of Neonatal death causes: Preventable causes of neonatal deaths comprised 75 percent of all neonatal deaths signifying the importance of targeted interventions before birth .Major identified preventable causes were prematurity (48.9%), birth asphyxia(30.2%), maternal and pregnancy-related complications (16.5%)),and neonatal tetanus (4.4%). Pneumonia (66.4%) and sepsis (33.6%) were the two treatable causes identified. Preventable deaths comprised 79.5% (163/205) of deaths in Abhoynagar and 69.2% (144/208) of deaths in Mirsarai. Result of Post-neonatal causes of death: The study grouped preventable (Diarrhoea and malnutrition, composed 30%) and treatable (Pneumonia, sepsis and SIDS, comprise 70%) causes of post-neonatal deaths. Except for sepsis, all causes of deaths were found in greater proportion in Mirsarai. Conclusion: The study found that preventable causes constitute the majority of neonatal deaths in Bangladesh. To address the majority of causes of neonatal deaths, interventions are needed to focus on the period before birth of the baby