Causes of childhood deaths in Bangladesh : results of a nation-wide verbal autopsy study

This study was undertaken to update the information available on causes of death among children aged less than 5 years, taking the advantage of advances in verbal autopsy methodology and of the Bangladesh Demographic and Health Survey (BDHS) conducted in 1993-1994. The study revealed that about one in four deaths were associated with acute lower respiratory infections (ALRIs) and about one in five with diarrhea. Neonatal tetanus and measles remained important causes of death. Drowning was a major cause of death in children aged 1-4 years. Research and programmatic actions that will enable mothers to identify different grades of acute respiratory infections (ARIs), particularly pneumonia cases, will encourage timely and appropriate care-seeking. Strengthening of ARI case management at the primary care facilities is also an important priority. While the promotion of oral rehydration therapy for watery diarrhea and the use of antibiotics for dysentery should continue, broader preventive interventions, including provision for safe water, sanitation, improvements in personal hygiene, and measures to improve general nutritional status of children, will require more attention. Further intensification of immunization programs, as well as innovative experimental interventions to reduce deaths from drowning, should be designed and tested. A cause could not be assigned to about 15% of the deaths. Further improvements of the verbal autopsy instrument are needed. (Author abstract, modified)