Implications of health care provision on acute lower respiratory infection mortality in Bangladeshi children

This study uses a geographic information system to evaluate the effects of health care provision on acute lower respiratory infection (ALRI) mortality in very young children in rural Bangladesh. Since 1988, an ALRI control program has been operating in a rural area of Bangladesh in an effort to decrease morbidity and mortality of children suffering from ALRI. ALRI-specific mortality data for very young children (<2 years of age) were obtained from a surveillance system of the area from 1988 to 1993. The ALRI mortality data were aggregated by clusters of households called baris. In order to avoid bias in the population size of baris, spatial moving averages of ALRI-specific death rates were calculated. The relationships between ALRI death rates and several environmental and health service provision variables were measured using regression analysis. The results show that the ALRI mortality rate was 54% lower in the community-based ALRI control program area than in a comparison area where there was no intervention. Greater access to allopathic practitioners was related to lower ALRI mortality rates while access to indigenous practitioners was related to higher mortality. In conclusion, the benefit of the community-based ALRI control program, using a simple case management strategy and improved access to allopathic practitioners, should be replicated in other rural areas of Bangladesh in an effort to reduce child ALRI mortality. Copyright (C) 2000 Elsevier Science Ltd.