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J Child Health Care. 2020 Mar 24:1367493520909665. doi: 10.1177/1367493520909665. [Epub ahead of print]

Distribution of wealth-stratified inequalities on maternal and child health parameters and influences of maternal-related factors on improvements in child health survival rate in Bangladesh.

Mahumud RA1,2,3,4, Gow J1,2,5, Sarker AR3,6,7, Sultana M8,9, Hossain G4, Alam K1.

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Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia.
School of Commerce, University of Southern Queensland, Toowoomba, Queensland, Australia.
Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Department of Statistics, Health and Epidemiology Research, University of Rajshahi, Rajshahi, Bangladesh.
School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa.
Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh.
Department of Management Science, University of Strathclyde Business School, Glasgow, UK.
Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research Bangladesh, Dhaka, Bangladesh.
School of Health and Social Development, Health Economics Research, Deakin University, Melbourne, Victoria, Australia.


This study investigates the influence of household socioeconomic status and maternal risk factors and health-care service availability on changes in the under-five mortality rate (U5MR) in Bangladesh. Potential risk factors that influence U5MRs were investigated using multilevel logistic regression analysis and 29,697 data points from the Bangladesh Demographic and Health Surveys, 2004-2014. Maternal and child health parameters such as childhood morbidity, low vaccination coverage, poor utilization of perinatal care, and malnutrition were found to be more concentrated in poorer households. Pooled estimates indicated that the aggregate odds of U5MR risk declined by 18% to 2007 to 38% to 2014 compared to 2004. However, inadequate antenatal care, short birth interval, primiparity, illiteracy, delayed conception, and low socioeconomic status were significantly associated with a higher risk of under-five mortality. The magnitude of inequality using these measures were significantly associated with large variations in U5MR changes. Although a significant reduction in U5MR in Bangladesh was found in this study, substantial socioeconomic variations still persist. The analysis suggests that decreasing inequality in society is required for further reductions in child mortality. This will help to achieve a more equitable distribution of child and neonatal outcomes and assist the achievement of Sustainable Development Goals 3.2 by 2030.


Bangladesh; inequality; socioeconomic status; under-five mortality


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