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Shifting disease burden in low and middle-income countries: a 14-year survival analysis of childhood mortality in Bangladesh
  1. Olakunle Alonge1,
  2. Siran He1,
  3. Dewan Emdadul Hoque2,
  4. Shumona Sharmin Salam2,
  5. Irteja Islam2,
  6. Shams El-Arifeen2,
  7. Adnan A Hyder1
  1. 1 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2 Center for Child and Adolescent Health, International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
  1. Correspondence to Dr Olakunle Alonge, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Suite E8622, Baltimore, MD 21205, USA; oalonge1{at}


Background The objective of this study is to compare all-cause mortality and drowning-specific mortality rates and survival times among birth cohorts of children from rural Bangladesh over a 14-year period.

Method Seven birth cohorts of children aged 12–59 months were created using data from the Matlab Health and Demographic Surveillance System in Bangladesh. Each cohort represents children born within a 2-year interval between 1 July 1995 and 30 June 2009, who were then evaluated over a 2-year snapshot. All-cause and drowning-specific mortality rates were compared for each cohort using the oldest cohort (cohort 1) as reference. A Cox proportional model was used to estimate hazard rate ratios (HRR) comparing the cohorts, and adjusted for key independent variables. Kaplan-Meier survivor function was estimated for each birth cohort and compared with cohort 1 using log-rank test.

Results The adjusted HRR for all-cause mortality showed that children in cohorts 4, 5, 6 and 7 had significantly lower hazard rate compared with cohort 1 with a dose–response relationship, the adjusted HRRs were 0.51 (95% CI 0.31, 0.84), 0.53 (95% CI 0.32, 0.87), 0.44 (95% CI 0.26, 0.76) and 0.42 (95% CI 0.24, 0.74), respectively. For drowning, none of the adjusted HRR was statistically significant. Mother's primary education and being married were protective of risk of death from all causes.

Conclusion Whereas child mortality rates from all causes declined remarkably between 1998 and 2012 in rural Bangladesh, drowning-specific mortality rates remained unchanged. This shifting burden of disease underscores the epidemiological transition in the childhood causes of death in Bangladesh and the need for urgent action to review child health interventions.

  • Mortality
  • Injuries
  • Child health

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  • Contributors OA conceived the paper, contributed to the data analysis and result interpretation and wrote the first draft and subsequent drafts of manuscript. SH contributed to the data analysis and result interpretation and wrote the first draft of the manuscript. DEH, SSS, II, SEA and AAH contributed to the result interpretation and revised the manuscript for intellectual content.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from Institutional Review Board of the Johns Hopkins Bloomberg School of Public Health (JHSPH) and Ethics Review Committee of the International Center for Diarrheal Disease Research, Bangladesh (icddr,b).

  • Provenance and peer review Not commissioned; externally peer reviewed.