Trends and Sociodemographic Differentials in Neonatal, Infant, and Under-5 Mortality in Bangladesh, 1993-2022.

Abstract

Despite substantial national progress in reducing child mortality, disparities persist across sociodemographic groups in Bangladesh. A comprehensive understanding of how mortality rates vary by key risk factors is essential to guide equitable health interventions. This study analyzes trends in neonatal, infant, and under-5 mortality rates in Bangladesh from 1993 to 2022, focusing on the influence of socioeconomic, demographic, and maternal factors. Using data from nine rounds of the Bangladesh Demographic and Health Survey (1993-2022), we estimated mortality rates across categories of factors, such as maternal age, education, household wealth, fertility practices, and region. The findings show a substantial decline in all three mortality indicators over time, although some disparities remain. The neonatal mortality rate decreased across all groups, with the sharpest reduction among mothers under 20 years (from 67 to 23 per 1000 live births) and those with one child (from 44 to 10). Infant mortality rate (IMR) also declined significantly, particularly among wealthier, more educated, and rural mothers. Despite overall improvement, regional disparities persisted, with Khulna reporting the lowest IMR (40 in 2022). Under-5 mortality rate saw the largest decline among mothers having their first birth before age 20 (from 144 to 34 per 1000) and families with one child (from 98 to 17). Persistent relative risks of around twofold among the poorest households and children of less educated mothers indicate that mortality reductions have disproportionately benefited advantaged groups. These patterns call for prioritizing maternal education, poverty-targeted service delivery, and geographically focused interventions in high-risk regions, such as Sylhet and Rangpur, where excess risks remain consistently elevated.