Trends in stillbirths, early and late neonatal mortality in rural Bangladesh: The role of public health interventions

Carine Ronsmans, Mahbub Elahi Chowdhury, Nurul Alam, Marge Koblinsky, Shams El Arifeen

Research output: Contribution to journalArticle

Abstract

Trends were examined in a cohort study of stillbirths and early and late neonatal deaths in Matlab, a rural area of Bangladesh between 1975 and 2002, using routinely collected demographic surveillance data. Main outcome measures were stillbirths per 1000 births, early neonatal deaths per 1000 livebirths, and late neonatal deaths per 1000 children surviving after 1 week. We performed a logistic regression examining trends over time and between two areas in the three outcome measures, controlling for the effects of parental education, religion, time, geography, parity, maternal age and birth spacing. There was a marked decline in stillbirths, early and late neonatal mortality over time in both areas, though the pace of decline was somewhat faster in the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) service area. Stillbirths declined by 24% overall in the ICDDR,B service area (crude OR comparing 1996-2002 with 1975-81: 0.76 [95% CI 0.68, 0.84]), compared with 15% in the Government service area (crude OR comparing 1996-2002 with 1975-81: 0.85 [0.76, 0.94]). The overall reduction in early and late neonatal mortality comparing the same periods was 39% and 73%, respectively, in the ICDDR,B area, compared with 30% and 63%, respectively, in the Government service area. Adjusting for socio-economic or demographic factors did not substantially alter the time or area differentials. The dramatic decline in neonatal mortality was, in large part, due to a fall in deaths from neonatal tetanus. The pace of decline was faster in the area receiving intense maternal and child health and family planning interventions, but stillbirths, early and late neonatal deaths also declined in the area not receiving such intense attention, suggesting that factors outside the formal health sector play an important role.

Original languageEnglish (US)
Pages (from-to)269-279
Number of pages11
JournalPaediatric and Perinatal Epidemiology
Volume22
Issue number3
DOIs
StatePublished - May 2008
Externally publishedYes

Fingerprint

Bangladesh
Stillbirth
Infant Mortality
Public Health
Research
Demography
Outcome Assessment (Health Care)
Birth Intervals
Health Planning
Geography
Maternal Age
Tetanus
Family Planning Services
Religion
Parity
Cohort Studies
Logistic Models
Economics
Perinatal Death
Parturition

Keywords

  • Developing country
  • Health care
  • Neonatal mortality
  • Stillbirth rate
  • Tetanus immunisation
  • Time trends

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health

Cite this

Trends in stillbirths, early and late neonatal mortality in rural Bangladesh : The role of public health interventions. / Ronsmans, Carine; Chowdhury, Mahbub Elahi; Alam, Nurul; Koblinsky, Marge; Arifeen, Shams El.

In: Paediatric and Perinatal Epidemiology, Vol. 22, No. 3, 05.2008, p. 269-279.

Research output: Contribution to journalArticle

Ronsmans, Carine ; Chowdhury, Mahbub Elahi ; Alam, Nurul ; Koblinsky, Marge ; Arifeen, Shams El. / Trends in stillbirths, early and late neonatal mortality in rural Bangladesh : The role of public health interventions. In: Paediatric and Perinatal Epidemiology. 2008 ; Vol. 22, No. 3. pp. 269-279.
@article{0c732a352263400c89e485fdcc032e3f,
title = "Trends in stillbirths, early and late neonatal mortality in rural Bangladesh: The role of public health interventions",
abstract = "Trends were examined in a cohort study of stillbirths and early and late neonatal deaths in Matlab, a rural area of Bangladesh between 1975 and 2002, using routinely collected demographic surveillance data. Main outcome measures were stillbirths per 1000 births, early neonatal deaths per 1000 livebirths, and late neonatal deaths per 1000 children surviving after 1 week. We performed a logistic regression examining trends over time and between two areas in the three outcome measures, controlling for the effects of parental education, religion, time, geography, parity, maternal age and birth spacing. There was a marked decline in stillbirths, early and late neonatal mortality over time in both areas, though the pace of decline was somewhat faster in the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) service area. Stillbirths declined by 24{\%} overall in the ICDDR,B service area (crude OR comparing 1996-2002 with 1975-81: 0.76 [95{\%} CI 0.68, 0.84]), compared with 15{\%} in the Government service area (crude OR comparing 1996-2002 with 1975-81: 0.85 [0.76, 0.94]). The overall reduction in early and late neonatal mortality comparing the same periods was 39{\%} and 73{\%}, respectively, in the ICDDR,B area, compared with 30{\%} and 63{\%}, respectively, in the Government service area. Adjusting for socio-economic or demographic factors did not substantially alter the time or area differentials. The dramatic decline in neonatal mortality was, in large part, due to a fall in deaths from neonatal tetanus. The pace of decline was faster in the area receiving intense maternal and child health and family planning interventions, but stillbirths, early and late neonatal deaths also declined in the area not receiving such intense attention, suggesting that factors outside the formal health sector play an important role.",
keywords = "Developing country, Health care, Neonatal mortality, Stillbirth rate, Tetanus immunisation, Time trends",
author = "Carine Ronsmans and Chowdhury, {Mahbub Elahi} and Nurul Alam and Marge Koblinsky and Arifeen, {Shams El}",
year = "2008",
month = "5",
doi = "10.1111/j.1365-3016.2008.00939.x",
language = "English (US)",
volume = "22",
pages = "269--279",
journal = "Paediatric and Perinatal Epidemiology",
issn = "0269-5022",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Trends in stillbirths, early and late neonatal mortality in rural Bangladesh

T2 - The role of public health interventions

AU - Ronsmans, Carine

AU - Chowdhury, Mahbub Elahi

AU - Alam, Nurul

AU - Koblinsky, Marge

AU - Arifeen, Shams El

PY - 2008/5

Y1 - 2008/5

N2 - Trends were examined in a cohort study of stillbirths and early and late neonatal deaths in Matlab, a rural area of Bangladesh between 1975 and 2002, using routinely collected demographic surveillance data. Main outcome measures were stillbirths per 1000 births, early neonatal deaths per 1000 livebirths, and late neonatal deaths per 1000 children surviving after 1 week. We performed a logistic regression examining trends over time and between two areas in the three outcome measures, controlling for the effects of parental education, religion, time, geography, parity, maternal age and birth spacing. There was a marked decline in stillbirths, early and late neonatal mortality over time in both areas, though the pace of decline was somewhat faster in the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) service area. Stillbirths declined by 24% overall in the ICDDR,B service area (crude OR comparing 1996-2002 with 1975-81: 0.76 [95% CI 0.68, 0.84]), compared with 15% in the Government service area (crude OR comparing 1996-2002 with 1975-81: 0.85 [0.76, 0.94]). The overall reduction in early and late neonatal mortality comparing the same periods was 39% and 73%, respectively, in the ICDDR,B area, compared with 30% and 63%, respectively, in the Government service area. Adjusting for socio-economic or demographic factors did not substantially alter the time or area differentials. The dramatic decline in neonatal mortality was, in large part, due to a fall in deaths from neonatal tetanus. The pace of decline was faster in the area receiving intense maternal and child health and family planning interventions, but stillbirths, early and late neonatal deaths also declined in the area not receiving such intense attention, suggesting that factors outside the formal health sector play an important role.

AB - Trends were examined in a cohort study of stillbirths and early and late neonatal deaths in Matlab, a rural area of Bangladesh between 1975 and 2002, using routinely collected demographic surveillance data. Main outcome measures were stillbirths per 1000 births, early neonatal deaths per 1000 livebirths, and late neonatal deaths per 1000 children surviving after 1 week. We performed a logistic regression examining trends over time and between two areas in the three outcome measures, controlling for the effects of parental education, religion, time, geography, parity, maternal age and birth spacing. There was a marked decline in stillbirths, early and late neonatal mortality over time in both areas, though the pace of decline was somewhat faster in the ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh) service area. Stillbirths declined by 24% overall in the ICDDR,B service area (crude OR comparing 1996-2002 with 1975-81: 0.76 [95% CI 0.68, 0.84]), compared with 15% in the Government service area (crude OR comparing 1996-2002 with 1975-81: 0.85 [0.76, 0.94]). The overall reduction in early and late neonatal mortality comparing the same periods was 39% and 73%, respectively, in the ICDDR,B area, compared with 30% and 63%, respectively, in the Government service area. Adjusting for socio-economic or demographic factors did not substantially alter the time or area differentials. The dramatic decline in neonatal mortality was, in large part, due to a fall in deaths from neonatal tetanus. The pace of decline was faster in the area receiving intense maternal and child health and family planning interventions, but stillbirths, early and late neonatal deaths also declined in the area not receiving such intense attention, suggesting that factors outside the formal health sector play an important role.

KW - Developing country

KW - Health care

KW - Neonatal mortality

KW - Stillbirth rate

KW - Tetanus immunisation

KW - Time trends

UR - http://www.scopus.com/inward/record.url?scp=42249093871&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=42249093871&partnerID=8YFLogxK

U2 - 10.1111/j.1365-3016.2008.00939.x

DO - 10.1111/j.1365-3016.2008.00939.x

M3 - Article

C2 - 18426522

AN - SCOPUS:42249093871

VL - 22

SP - 269

EP - 279

JO - Paediatric and Perinatal Epidemiology

JF - Paediatric and Perinatal Epidemiology

SN - 0269-5022

IS - 3

ER -