Factors Affecting on Child Survival in Bangladesh: Cox Proportional Hazards Model Analysis

摘要

This paper focuses mainly on the impact of utilization of heath care services on child mortality, using data from the 2004 Bangladesh Demographic and Health survey (BDHS, 2004). The study elucidate that 1 in 11 children born in Bangladesh dies before reaching the fifth birthday, while 1 in 15 children dies before reaching the first birthday. A child’s risk of dying is highest during the first month of life. From relative hazards we found that child mortality is higher among mothers who do not take sufficient ANC and also not receive assistance from medically trained personnel. Mothers whose place of delivery is any hospital were reported less child mortality as against their opposite counterparts. The result suggests that certain socioeconomic factors like mothers and father’s education are related to reduce the child mortality risks. An increase of one moth in the duration of breastfeeding by mothers decreases the hazard risks of child mortality. The household infrastructure variables like household electricity and household assets index seems to have little insight relationship with child mortality. The mortality hazard is 1.32 times higher if there is no provision of electricity in the household. Child mortality was reported 0.72 and 0.53 times less among mothers whose household’s assets position is medium and higher than lower index. Introduction Infant and child mortality that is the mortality during the first year of life and the mortality during 1-4 years of life respectively has traditionally been considered an important indicator for describing mortality conditions, health progress and indeed the overall social and economic well-being of a country1. The rate of loss in the first year and in the 1-4 years of life has attracted particular attention because: i) mortality ifs relatively high in these periods, the contribution of the probability of dying in the 0-4 years of human life is substantial, ii) it has a considerable impact on the average expectation of life and the arte of population growth, iii) it is sensitive to environmental and sanitary conditions and iv) the level of infant and child mortality is a useful indicator of the state of health and standard of a society or a country. Child mortality is therefore needed to be investigated in addition to infant mortality. Infant and child mortality in Bangladesh has long been a topic of interest to population and health researchers because of its apparent relationship with fertility and indirectly with acceptance of modern contraception2. The children of Bangladesh are particularly more victimized than those in other parts of the world. Because of poverty, neither mothers have access to medical facilities available in the country nor do their children. Moreover, the nutritional status of mother and children are very poor, about a quarter of infants in Bangladesh had low birth weights 3. According to BDHS Report 2004 the infant mortality rate is about 65 deaths per 1000 live births and a child mortality rate is 24 per1000. Though the infant and child mortality rate has decreased but it is still a burning problem in Bangladesh. Despite or recent decline in infant and child mortality the level is one of the highest in the world. Again the situation of mother’s aggregated than the health condition of the total population. It is also noted that maternal mortality and morbidity is also highest in Bangladesh4. The children who constitute a large proportion of the total population of Bangladesh are a vulnerable or special risk group, deserving special health care as the child mortality and morbidity risks are much higher then at older ages. Child mortality is determined by an enormous no. of complex and interrelated factors5. This paper focuses mainly on the impact of utilization of heath care services on child mortality. Availability and utilization of health personnel and facilities directly affect the mortality and morbidity of the children through standard biological tr