Patterns and causes of neonatal and postneonatal mortality in rural Bangladesh

Community-level research data from a Maternal-Child Health and Family Planning (MCH/FP) program and comparison areas in rural Bangladesh indicate that 60 percent of infant deaths occurred in the neonatal period in both areas. Since the inception of the MCH/FP program, mortality rates declined relative to those in the comparison area. This decline, however, was confined to the neonatal period death rates only, with mortality rates in the postneonatal period remaining similar in the two areas. Prematurity accounted for approximately 40 percent of deaths in the neonatal period. Cause-of-death data indicated that the differences in the neonatal mortality rates between the two areas was mainly due to a marked decline in tetanus neonatorum deaths in the MCH/FP program area, because of the tetanus toxoid immunization of pregnant women there. The interventions in the MCH/FP area, however, did not significantly influence mortality due to any other cause. This study provides an explanation for the limited impact on infant mortality of health interventions that focus on diarrheal diseases and immunizations of children.