Risk of Child Mortality Due to Environmental Hazards in Rural Bangladesh

Md. Kapil Ahmed, ICDDR,B: Centre for Health and Population Research
Peter K. Streatfield, ICDDR,B: Centre for Health and Population Research

Context: It is an important achievement of the late 20th century for the children of Bangladesh that more than 90 percent of them now attain their fifth birthday safely. In earlier times, the major individual causes of deaths of children were diarrhoeal disease, followed by acute respiratory infections (ARI). In the late 70s, diarrhoeal accounted for about 32 percent and ARI for 8 percent of deaths of children aged 1-4 year(s) in Matlab. While the death rate due to infectious diseases have fallen impressively, drowning is now the single major cause of child mortality in Matlab and possibly, elsewhere in Bangladesh. It is not surprising that deaths from drowning of children are a significant problem in Bangladesh, given the geographical features of the country. While the absolute death rate due to drowning has remained unchanged at around 2.2 per 1,000 children aged 1-4 year(s), drowning (as a proportion) has risen from less than one in ten deaths in the early 1980s to over one in three in the late 1990s. In our country we have health policies and interventions to reduce most causes of infant and child deaths, but yet we have no policies or public education programs anywhere in the country to try to reduce drowning deaths, particularly among children. So, additional research is needed to evaluate the risk of death in relation to drowning among children. Objectives: The present study is to determine risk factors for incidents of drowning with an emphasized to examine the effect of childbearing patterns on the risk of child deaths due to drowning. Data and Methods: The data in this study came from the Health Demographic Surveillance System (HDSS) operated by the ICDDR,B: Center for Health and Population Research. The HDSS is a longitudinal surveillance system in which data has been collected in Matlab for nearly 35 years. Matlab is situated about 50 km southeast of Dhaka, the capital of Bangladesh. The area is entirely rural and surrounded by rivers and canals. An embankment was built with a flood control earthen which covers almost half of the villages of the surveillance area areas. Death registration, besides other events, includes in the surveillance area for collection of information on cause of death by means of forms filled out by a community health workers who are visiting every household once a month. Deaths from drowning are probably reported fairly accurately in the surveillance area due to the fact that in case of the death of child under five, the Medical Assistant who has formal paramedical training interviewed the mother or guardian during a home visit and determined the circumstances leading to the death. The data analyzed in this study are from calendar year 1991 through 2000. A case-control study was carried out where the death due to drowning (464) was compared with a sample of surviving children (928) born during 1996-1987. Proportions of drowning deaths in various categories of different independent variables with those of surviving children were compared. The independent variables were used: maternal age, parent's education, dwelling space (a proxy for income), sex of siblings (elder and younger), previous and subsequent birth interval of siblings, residential area (within vs outside embankment) and a nutrition indicator mid-upper-arm circumference (MUAC) of the children. The net effect of particular factors is evaluated by means of logistic regression models. Results: The result shows that there is a significant effect of childbearing pattern on the risk of child deaths due to drowning. If a particular (index) child has a younger sibling relatively close in age, the risk of drowning and death is higher for that index child. The closer in age the younger sibling is to the index child, the higher the risk of death. When a mother has two young children close in age, with the burden of household chores, she is likely to have less time to supervise the activities of the older (index) child. Even if there is sibling older than the index child, who could potentially supervise the index child, s/he does not appear to afford significant protection. Sex of both the elder and younger sibling is not related to risk of drowning and death. The results have also demonstrated that the risk of dying from drowning increases with the age of the mother, while parent education and dwelling space are not associated with drowning deaths. The contribution of drowning to total child death was significantly lower inside the flood control embankment. Child death due to drowning did not differ significantly among the different age groups of malnourished (MUAC <120 mm) and well-nourished children, suggesting that factors other than health status influence child mortality due to drowning. Conclusions: The findings suggest that while there are wide spread activities to promote child spacing through family planning, there should be emphasis on the potential benefits for parents to care for and supervise their children in the context of competing demands. It is desirable to develop interventions and target parents with children in vulnerable age group and to formulate policies with respect to drowning deaths since death due to drowning is in-principle avoidable.