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Thank you for visiting nature. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. Despite remarkable success in the Millennium Development Goal era, Bangladesh experienced a sluggish reduction in the under-5 mortality rate U5MR between and — Our study aimed to explain this stagnancy by examining the variation in the key predictor-specific mortality risks over time, using the Bangladesh Demographic and Health Survey , and —18 data.
We applied multilevel mixed effects logistic regression to examine the extent to which the under-5 mortality U5M risks were associated with the key sociodemographic and health service-specific predictors. Poverty and low education aggravated the mortality risks. Compulsory use of ANC and PNC cards and strict monitoring of their use may improve the quality of these health services.
Leveraging committees like the Upazila Hospital Management Committee can bring harmony to implementing policies and programmes in the sectors related to U5M. It is influenced by a complex interplay of factors, including the health care delivery systems, socioeconomic and environmental conditions, and broader macro-political and structural contexts 2 , 3 , 4 , 5. As a result, the underperformance of any of these interrelated sectors can overtake the positive impact of the improvement in other sectors.
For example, educating all women may not effectively prevent U5M from severe pneumonia unless the health facilities are efficient enough to provide the required health care on time 6. Therefore, attaining sustained progress in U5M requires a collective and synchronised endeavour concurrently encompassing improvements across these interrelated sectors. However, the rate of reduction was slower during —19, and some regions shared remarkably higher U5M than others. Hence, Bangladesh is considered one of the exemplars of U5M reduction Some primary drivers in health services were interventions focused on maternal and neonatal health, immunisation, prevention of diarrhoeal diseases, and vitamin A supplementation 10 , Alongside these, the contribution of stable socioeconomic, structural, and technological advancement during the MDG period was highlighted Functional coordination between government and NGO sector was mentioned as the key driver in the leadership and governance domain Regardless of a sluggish reduction of U5MR between and —18, Bangladesh made prominent improvements post — Still, it would be unwise to remain assured by the recent decline in U5MR and overlook the prior stagnancies Instead, it is essential to understand this stagnancy and use that knowledge to prepare for possible future stagnancies.
