Factors affecting child survival in Matlab, Bangladesh
Date
1989
Authors
Bhuiya, Abbas Uddin
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Abstract
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.
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