SEARCHCOHORTepidemiology, public health

cohort·epidemiology, public health, pediatrics, obstetrics and gynecology, observational study·PMC10121045

Effects of short birth interval on different forms of child mortality in Bangladesh: Application of propensity score matching technique with inverse probability of treatment weighting

PLOS ONE · 8 authors, 3 centres

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TL;DR

Using propensity score matching with inverse probability weighting on 5,941 Bangladeshi mothers, short birth interval (<33 months) was associated with significantly higher neonatal, infant, and under-five mortality compared to normal birth intervals.

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This study analyzed nationally representative data from 5,941 mothers in the 2017/18 Bangladesh Demographic and Health Survey, combined with health facility data, to estimate the effects of short birth interval (SBI; <33 months) on neonatal, infant, and under-five mortality. Covariates were selected using directed acyclic graphs, and propensity score matching with inverse probability treatment weighting was applied to create comparable groups, followed by multilevel Poisson regression. Newborns of SBI mothers had 63% higher likelihood of neonatal mortality (aPR 1.63; 95% CI 1.08–2.46), infant mortality was 1.45 times higher (aPR 1.45; 95% CI 1.01–2.08), and under-five mortality was 2.82 times higher (aPR 2.82; 95% CI 2.16–3.70) compared to normal birth interval counterparts. Limitations include the cross-sectional design, which precludes causal inference, and the inability to fully account for unknown residual confounders despite propensity score-based adjustments. Nevertheless, findings suggest SBI is a significant predictor of child mortality in Bangladesh.

STUDY TYPE

cohort

SPECIALTY

epidemiology

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ORIGINAL PAPER

PMC10121045

Effects of short birth interval on different forms of child mortality in Bangladesh: Application of propensity score matching technique with inverse probability of treatment weighting

PLOS ONE

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ABSTRACT

Abstract Background The prevalence of Short Birth Interval (SBI) is higher in Low- and Middle-Income countries (LMICs), including Bangladesh. Previous studies in LMICs have estimated the effects of SBI on child mortality by comparing two unequal groups of mothers based on their socio-economic status. This approach may lead to overestimation or underestimation of the true effect of birth interval on child mortality, particularly when sample sizes are relatively small. Objective We determined the effects of SBI on several forms of child mortality in Bangladesh by comparing two equal groups created by applying the propensity score matching technique. Methods This study analyzed data from 5,941 mothers and 1,594 health facilities extracted from the 2017/18 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. The exposure variable was SBI (defined as the interval between two subsequent births <33 months: yes, no), while the outcome variables were neonatal mortality (defined as mortality within 28 days of birth: yes, no), infant mortality (defined as mortality within 1 year of birth: yes, no), and under-five mortality (defined as mortality within 5 years of birth: yes, no). Multilevel Poisson regression based on inverse probability treatment weights was used to determine the association between exposure and outcome variables. Results The prevalence rates of neonatal, infant, and under-five mortality were 48.8, 30.8, and 23.1 per 1000 live births, respectively. Newborns of SBI mothers were found to have a 63% higher likelihood of neonatal mortality (aPR, 1.63; 95% CI, 1.08–2.46) compared to newborns of non-SBI mothers. Furthermore, the prevalence of infant mortality and under-five mortality was 1.45 times higher (aPR, 1.45; 95% CI, 1.01–2.08) and 2.82 times higher (aPR, 2.82; 95% CI, 2.16–3.70), respectively, among babies born in a short interval of their immediately preceding sibling as compared to babies born in a normal interval of their immediately preceding sibling. Conclusions Findings of this study indicate that SBI is an important predictor of child mortality. Consequently, around 1 million children born in a short interval every year in Bangladesh are at risk of dying before reaching their fifth birthday. This indicates a challenge for Bangladesh to achieve the SDG 3 target to reduce neonatal and under-five mortality to 12 and 25 deaths per 1000 live births, respectively. Hence, awareness-building programs about the adverse effects of SBI and strengthening existing healthcare facilities are important.

CITATION EXPORT

Mohammad Zahidul Islam, Md Mostafizur Rahman, Md Nuruzzaman Khan et al.. Effects of short birth interval on different forms of child mortality in Bangladesh: Application of propensity score matching technique with inverse probability of treatment weighting. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0284776

AUTHORS

8 · 3 CENTRES

Mohammad Zahidul Islam, Md Mostafizur Rahman, Md Nuruzzaman Khan, Betregiorgis Hailu Zegeye, Betregiorgis Hailu Zegeye, Betregiorgis Hailu Zegeye, Betregiorgis Hailu Zegeye, Betregiorgis Hailu Zegeye

1Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Trishal, Mymensingh, Bangladesh
2Department of Population Science and Human Resource Development, Rajshahi University, Rajshahi, Bangladesh
3HaSET Maternal and Child Health Research Program, ETHIOPIA