A multilevel model of the impact of health services on infant and child mortality in Bangladesh

Ashton, Michael Dennis (1999) A multilevel model of the impact of health services on infant and child mortality in Bangladesh. University of Southampton, Doctoral Thesis.

Abstract

Of all health services in Bangladesh, the effects of family planning (FP) services far outweigh the effects of estimated distances of communities from health facilities or the presence of health service personnel. Multilevel models produced from the 1996/97 survey data show that postneonates living within 2 miles of a hospital/Thana Health Centre have one half of the odds of mortality compared with those at 3+ miles distant. At ages 1-4 years, the odds of mortality at 1 mile from the Family Welfare Centre are 33.2% and 63.8% respectively compared with children living at 2+ miles distant. At ages 2-4 years, children living 7+ miles from the Thana HQ have more than double the odds of mortality compared with those living 2-6 miles distant.

Recently diarrhoeic children aged 3 years have the lowest odds of receiving external or medical treatment of all children aged under 5 years. Results suggest that oral rehydration solutions may not be given sufficiently early in a child's live. Of all cases of recent childhood fever or cough, 42.3% receive external treatment, 18.4% receive medical treatment, but treatments at government health facilities comprise only 12.6% of all external treatments. Children aged 1-3 years have only one half the odds of receiving medical treatment, and 4-year olds only one quarter the odds, compared with infants. Women with higher education (6+ years) seek medical treatment for their child in 36.4% of cases and use private facilities in 27.3% of cases compared with 13.7% and 1.1% respectively for women with no education. Mothers working for cash prefer to utilize more distant private pharmacies for the symptoms of childhood fever and cough 'free' government health services are bypassed. Children of mothers working for cash have only two thirds the odds of receiving medical treatment as other children. Children of mothers who have not received a second tetanus toxoid vaccination during pregnancy have more than 4 times the odds of receiving no vaccinations themselves. Children of mothers who have received any formal education or have ever recommended FP have only two thirds the odds of non-vaccination compared with other children. Mother's recommendation of FP is a significant random effect at the community level. Children in Khulna and Rajshahi Divisions have one third and two thirds the odds of non-vaccination respectively compared with children residing in Dhaka Division.

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