Causes of death among women aged 10-50 years in Bangladesh, 1996-1997.

Limited information is available at the national and district levels on causes of death among women of reproductive age in Bangladesh. During 1996-1997, health-service functionaries in facilities providing obstetric and maternal and child-heath services were interviewed on their knowledge of deaths of women aged 10-50 years in the past 12 months. In addition, case reports were abstracted from medical records in facilities with in-patient services. The study covered 4,751 health facilities in Bangladesh. Of 28,998 deaths reported, 13,502 (46.6%) occurred due to medical causes, 8,562 (29.5%) due to pregnancy-related causes, 6,168 (21.3%) due to injuries, and 425 (1.5%) and 259 (0.9%) due to injuries and medical causes during pregnancy respectively. Cardiac problems (11.7%), infectious diseases (11.3%), and system disorders (9.1%) were the major medical causes of deaths. Pregnancy-associated causes included direct maternal deaths (20.1%), abortion (5.1%), and indirect maternal deaths (4.3%). The highest proportion of deaths among women aged 10-19 years was due to injuries (39.3%) with suicides accounting for 21.7%. The largest proportion of direct obstetric deaths occurred among women aged 20-29 years (30.5%). At least one quarter (24.3%) of women (n = 28,998) did not receive any treatment prior to death, and 47.8% received treatment either from a registered physician or in a facility. More focus is needed on all causes of deaths among women of reproductive age in Bangladesh.

Neonatal mortality in rural Bangladesh: an exploratory study.

Bangladesh has a neonatal death rate that is substantially high and demands urgent attention. To assess the causes of neonatal mortality, 1,019 pregnant women were followed up in eight randomly-selected rural areas of the country. Trained female interviewers visited the households of the subjects at four-week intervals to record neonatal deaths (within 28 days after birth). For each death, they administered a structured verbal autopsy questionnaire to the mother and/or a close family member. Based on these field data, three neonatologists arrived at a consensus to assign two causes of death--an originating cause and a direct cause. The neonatal mortality rate was 53.5 per 1,000 livebirths. The originating causes of death were pre-maturity/low birth-weight (30%), difficult labour (16%), unhygienic birth practices (16%), others (4%), and unknown (34%). The direct causes were sepsis (32%), asphyxia (26%), tetanus (15%), respiratory distress (6%), others (6%), and unknown (14%). According to the prevailing causes of neonatal deaths, implementation of intervention programmes, often in the community, that do not depend on highly-technical training or sophisticated equipment should be implemented.