Socioeconomic and health implications of adult deaths in families of rural Bangladesh.

Effects of adult deaths on subsequent health and socioeconomic well-being of rural families of Bangladesh were examined. Data for this study were drawn from the longitudinal Sample Registration System (SRS) operational in two rural areas of the then MCH-FP Extension Project (Rural) of ICDDR,B. In total, deaths of 327 married adults aged 15-59 years, during January 1983-December 1987, were reviewed. The families of the deceased were followed up for five years after death. Factors, such as survival status of children, educational status of children aged 6-12 years, and out-migration status among adolescents aged 12-20 years in those families, was observed and recorded. A control group of 3,350 families experiencing no adult deaths was also followed up for five years. The health and socioeconomic impacts on children in both the groups five years after death of the adult were compared. The findings of the study showed that negative impact was more pronounced among the children of poor families, and the female children were most severely affected. Death of a father or a mother was associated with a higher rate of out-migration (especially marriage) of adolescent daughters. An adult death was associated with a significantly higher mortality risk of children during the five years following death of the adult. These child-mortality risks were significantly higher when an adult female died, and when the index child was a female and/or aged less than five years at the time of death of an adult. The children, aged 6-12 years, in families where a parent had died were significantly more likely to be uneducated and out-of-school after the death of a father or a mother compared to the children in families where neither of the parents had died. This finding remained valid even after controlling for the educational status of the parents who died and of those who did not die. Since the study used a limited number of independent variables and since there is a need to understand the specific reasons why such significant differences occurred, it is recommended to conduct a more in-depth qualitative study to know more clearly the nature and mechanisms of the socioeconomic and health impacts of death of an adult on the family and the society.

Use of mid-upper arm circumference for evaluation of nutritional status of children and for identification of high-risk groups for malnutrition in rural Bangladesh.

Measurements of mid-upper arm circumference (MUAC) of 8,881 children were considered cross-sectionally to determine the effects of diarrhoea, breast-feeding, and birth-spacing on the nutritional status of children in rural Matlab, Bangladesh. It was observed that age was one of the most significant determinants of child nutrition. The younger children (< 2 years) had significantly higher levels of severe malnutrition than the children aged 2 years or older. Children who had diarrhoea during the last 12 months prior to the study had significantly (p < 0.001) higher severe malnutrition than the children who did not suffer from diarrhoea. Children born with a longer interval after birth of an elder sibling (24+ months) and who were breastfed for a longer duration (2-3 years) were less likely to be severely malnourished than those who were born with a shorter birth interval or who terminated breast-feeding prior to 2 years of age. Education of mothers, housing space, family size, religion, and sex of children had significant effects on the nutritional status of children. Results of the study suggest that MUAC is a potential anthropometric indicator of child nutrition.