Author:
ProCite
RefWorks
Reference Manager
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Zotero
EndNote
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Association between Maternal High-Risk Fertility Behavior and Childhood Morbidity in Bangladesh: A Nationally Representative Cross-Sectional Survey
Mosfequr Rahman
Mosfequr Rahman
Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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Alamgeer Hosen
Alamgeer Hosen
Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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Mostaured Ali Khan
Mostaured Ali Khan
Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
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In this cross-sectional study, we evaluated data from the 2014 Bangladesh Demographic and Health Survey (BDHS), which consisted of 7,707 married women aged 15–49 years who lived with at least one child younger than 5 years. This study’s primary aim was to examine the relationship between maternal high-risk fertility behavior and child morbidity. To define high-risk fertility behaviors, we considered three variables: maternal age at the time of delivery, birth order, and birth interval. The main outcome measures were mortality-related disease in the past 2 weeks (acute respiratory infection [ARI], diarrhea, and fever) and low birth weight (LBW). We used modified Poisson regression with generalized estimating equations to assess the relationships between the variables of interest. Results indicate that a substantial portion of women (34%) exhibited high-risk fertility patterns; 28.7% engaged in a single high-risk behavior and 5.4% engaged in multiple high-risk behaviors. After adjusting for relevant covariates, high-risk fertility behaviors were significantly associated with an increased likelihood of ARI (adjusted relative risk [ARR]: 1.22, 95% CI: 1.05–1.50), diarrhea (ARR: 1.18, 95% CI: 1.03–1.35), fever (ARR: 1.29, 95% CI: 1.11–1.58), and LBW (ARR: 1.27, 95% CI: 1.10–1.52). In addition, engaging in multiple high-risk fertility behaviors appeared to have far-reaching consequences on the outcomes measured. Maternal high-risk fertility behaviors are important predictors of morbidity in children younger than 5 years. Preventing high-risk fertility behavior may reduce childhood morbidity and mortality in Bangladesh.
Author Notes
Authors’ addresses: Mosfequr Rahman, Alamgeer Hosen, and Mostaured Ali Khan, Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh, E-mails: mosfeque@ru.ac.bd, md.alamgeer_hossen@yahoo.com, and mostaured.khan@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME), 2018. Levels & Trends in Child Mortality. Report 2018. Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation. New York, NY: United Nations Children’s Fund.
-
2.
UNICEF, 2018. Save Newborns: South Asia Headline Results-2017 Progress Report. Available at: http://www.unicefrosa-progressreport.org/savenewborns.html. Accessed March 10, 2019.
-
3.
UNDP Millenium, 2015, Development Goal 4. Available at: http://www.bd.undp.org/content/bangladesh/en/home/post-2015/millennium-development-goals/mdg4/. Accessed March 10, 2019.
-
4.
Balabanova D et al. 2013. Good health at low cost 25 years on: lessons for the future of health systems strengthening. Lancet 38: 2118–2133.
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5.
Ministry of Health and Family Welfare B, Partnership for maternal NCH, WHO, World Bank, Alliance for Health Policy and Systems Research, 2015. Success Factors for Women’s and Children’s Health: Bangladesh. Available at: http://www.who.int/pmnch/successfactors/en/. Accessed March 12, 2019.
-
6.
UNICEF, 2015. Committing to Child Survival: A Promise Renewed: Progress Report 2015. New York, NY: UNICEF.
-
7.
Kamal M, Richardson A, 2013. Factors influencing acute respiratory infection of children in Bangladesh. Int J Stat 8: 239–250.
-
8.
Kamal MM, Hasan MM, Davey R, 2015. Determinants of childhood morbidity in Bangladesh: evidence from the demographic and health survey 2011. BMJ Open 5: e007538.
-
9.
Kandala NB, Emina JB, Nzita PDK, Cappuccio FP, 2009. Diarrhoea, acute respiratory infection, and fever among children in the Democratic Republic of Congo. Soc Sci Med 68: 1728–1236.
-
10.
Rayhan MI, Khan MSH, Shahidullah M, 2007. Impacts of bio-social factors on morbidity among children aged under-5 in Bangladesh. Asia Pac Popul J 22: 65–75.
-
11.
Aremu O, Lawoko S, Moradi T, Dalal K, 2011. Socio-economic determinants in selecting childhood diarrhoea treatment options in sub-Saharan Africa: a multilevel model. Ital J Pediatr 37: 13.
-
12.
Di Cesare M, Bhatti Z, Soofi SB, Fortunato L, Ezzati M, Bhutta ZA, 2015. Geographical and socioeconomic inequalities in women and children’s nutritional status in Pakistan in 2011: an analysis of data from a nationally representative survey. Lancet Glob Health 3: e229–e39.
-
13.
Ferdous F, Das SK, Ahmed S, Farzana FD, Malek MA, Das J, Latham JR, Faruque AS, Chisti MJ, 2014. Diarrhoea in slum children: observation from a large diarrhoeal disease hospital in Dhaka, Bangladesh. Trop Med Int Health 19: 1170–1176.
-
14.
Fink G, Günther I, Hill K, 2011. The effect of water and sanitation on child health: evidence from the demographic and health surveys 1986–2007. Int J Epidemiol 40: 1196–1204.
-
15.
Kandala NB, Ji C, Stallard N, Stranges S, Cappuccio FP, 2007. Spatial analysis of risk factors for childhood morbidity in Nigeria. Am J Trop Med Hyg 77: 770–779.
-
16.
Prüss‐Ustün A et al. 2014. Burden of disease from inadequate water, sanitation and hygiene in low‐and middle‐income settings: a retrospective analysis of data from 145 countries. Trop Medint Health 19: 894–905.
-
17.
Abdullah K, Malek MA, Faruque AS, Salam MA, Ahmed T, 2007. Health and nutritional status of children of adolescent mothers: experience from a diarrhoeal disease hospital in Bangladesh. Acta Paediatr 96: 396–400.
-
18.
Adhikari RK, 2003. Early marriage and childbearing: risks and consequences. Bott S, Jejeebhoy S, Shah I, Puri C, eds. Towards Adulthood: Exploring the Sexual and Reproductive Health of Adolescents in South Asia. Geneva, Switzerland: World Health Organization, Department of Reproductive Health and Research, 62–66.
-
19.
Alam N, 2000. Teenage motherhood and infant mortality in Bangladesh: maternal age-dependent effect of parity one. J Biosoc Sci 32: 229–236.
-
20.
Awasthi S, Agarwal S, 2003. Determinants of childhood mortality and morbidity in urban slums in India. Ind Pediatr 40: 1145–1161.
-
21.
Finlay JE, Özaltin E, Canning D, 2011. The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low-and middle-income countries. BMJ Open 1: e000226.
-
22.
Jain S, Kurz K, 2007. New Insights on Preventing Child Marriage: A Global Analysis of Factors and Programs. Washington, DC: International Center for Research on Women (ICRW).
-
23.
Markovitz BP, Cook R, Flick LH, Leet TL, 2005. Socioeconomic factors and adolescent pregnancy outcomes: distinctions between neonatal and post-neonatal deaths? BMC Pub Health 5: 79.
-
24.
Taffa N, 2003. A comparison of pregnancy and child health outcomes between teenage and adult mothers in the slums of Nairobi, Kenya. Int J Adol Med Health 15: 321–330.
-
25.
Heffner LJ, 2004. Advanced maternal age–how old is too old? N Engl J Med 351: 1927–1929.
-
26.
Hoffman MC, Jeffers S, Carter J, Duthely L, Cotter A, González-Quintero VH, 2007. Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. Am J Obstet Gnecolo 196: e11–e3.
-
27.
Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A, 2010. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 203: 558.
-
28.
Raj A, Saggurti N, Balaiah D, Silverman JG, 2009. Prevalence of child marriage and its effect on fertility and fertility-control outcomes of young women in India: a cross-sectional, observational study. Lancet 373: 1883–1889.
-
29.
Fronczak N, Antelman G, Moran A, Caulfield L, Baqui A, 2005. Delivery‐related complications and early postpartum morbidity in Dhaka, Bangladesh. Int J Gynecol Obstet 91: 271–278.
-
30.
DaVanzo J, Hale L, Razzaque A, Rahman M, 2008. The effects of pregnancy spacing on infant and child mortality in Matlab, Bangladesh: how they vary by the type of pregnancy outcome that began the interval. Popul Stud 62: 131–154.
-
31.
Rasooly MH, Saeed KMI, Noormal B, Aman I, Arnold F, Govindasamy P, Rutstein S, Winter R, 2013. The Effect of Birth Intervals on Causes of Under-five Mortality in Afghanistan. DHS Working Papers. Calverton, MD: ICF International.
-
32.
Mishra S, Ram B, Singh A, Yadav A, 2018. Birth order, stage of infancy and infant mortality in India. J Biosoc Sci 50: 604–625.
-
33.
National Institute of Population Research and Training (NIPORT), Mitra and Associates, ICF International, 2016. Bangladesh Demographic and Health Survey 2014. Dhaka, Bangladesh and Rockville, Rockville, MD: NIPORT, Mitra and Associates, and ICF International.
-
34.
Ackerson LK, Subramanian S, 2009. Intimate partner violence and death among infants and children in India. Pediatr 124: e878–e89.
-
35.
Rutstein SO, 2000. Factors associated with trends in infant and child mortality in developing countries during the 1990s. Bull World Health Organ 78: 1256–1270.
-
36.
Rustein SO, Johnson K, 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, MD: ORC Macro.
-
37.
Ruel MT, Alderman H; Maternal, Group CNS, 2013. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet 382: 536–551.
-
38.
World Health Organization, 2002. WHO Antenatal Care Randomized Trial: Manual for the Implementation of the New Model. Geneva, Switzerland: WHO.
-
39.
Rustein SO, Staveteig S, 2014. Making the Demographic and Health Surveys Wealth Index Comparable. DHS Methodological Reports No. 9. Rockville, MD: ICF International.
-
40.
Chan Y, 2004. Biostatistics 201: linear regression analysis. Singapore Med J 45: 55–61.
-
41.
Barclay K, Myrskylä M, 2016. Advanced maternal age and offspring outcomes: reproductive aging and counterbalancing period trends. Popul Dev Rev 45: 69–94.
-
42.
Fall CH et al. 2015. Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). Lancet Glob Health 3: e366–e77.
-
43.
Hviid MM, Skovlund CW, Mørch LS, Lidegaard Ø, 2017. Maternal age and child morbidity: a Danish national cohort study. PLoS One 12: e0174770.
-
44.
Mihrete TS, Alemie GA, Teferra AS, 2014. Determinants of childhood diarrhea among underfive children in Benishangul Gumuz regional state, north west Ethiopia. BMC Pediatr 14: 102.
-
45.
Raj A, Saggurti N, Winter M, Labonte A, Decker MR, Balaiah D, Silverman JG, 2010. The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample. BMJ 340: b4258.
-
46.
Shinwell E, Blickstein I, Lusky A, Reichman B, 2004. Effect of birth order on neonatal morbidity and mortality among very low birthweight twins: a population based study. Arch Dis Child Fetal Neonatal Ed 89: F145–F8.
-
47.
Santhya K, Jejeebhoy SJ, 2007. Early marriage and HIV/AIDS: risk factors among young women in India. Econ Polit Wkly 42: 1291–1297.
-
48.
UNICEF, 2001. Early Marriage: Child Spouses. Innocenti Digest No. 7. Available at: https://www.unicef-irc.org/publications/pdf/digest7e.pdf. Accessed March 14, 2019.
-
49.
UNICEF, 2009. Child marriage. Progress for Children. Protecting Against Abuse, Exploitation and Violence. Available at: https://www.unicef.org/progressforchildren/2007n6/index_41848.htm. Accessed March 15, 2019.
-
50.
King JC, 2003. The risk of maternal nutritional depletion and poor outcomes increases in early or closely spaced pregnancies. J Nutr 133: 1732S–1736S.
-
51.
Lenders CM, McElrath TF, Scholl TO, 2000. Nutrition in adolescent pregnancy. Curr Opin Pediatr 12: 291–296.
-
52.
Arokiasamy P, Pradhan J, 2006. Gender Bias against Female Children in India: Regional Differences and Their Implications for MDGs [Unpublished]. Presented at the 2006 Annual Meeting of the Population Association of America, Los Angeles, CA.
-
53.
Osmani S, Sen A, 2003. The hidden penalties of gender inequality: fetal origins of ill-health. Econ Hum Biol 1: 105–121.
-
54.
Rah JH, Christian P, Shamim AA, Arju UT, Labrique AB, Rashid M, 2008. Pregnancy and lactation hinder growth and nutritional status of adolescent girls in rural Bangladesh. J Nutr 138: 1505–1511.
-
55.
Rahman M, Nasrin S, 2008. Mothers’ nutritional status in an impoverished nation: evidence from rural Bangladesh. Internet J Nutr Wellness 7.
-
56.
Rah J, 2013. Adolesent pregnancy, its impact on the growth and nutritional status of young mothers: what does evidence say. Sight and Life 27: 37–38.
-
57.
Abdalla HI, Burton G, Kirkland A, Johnson MR, Leonard T, Brooks AA, Studd JW, 1993. Pregnancy: age, pregnancy and miscarriage: uterine versus ovarian factors. Hum Reprod 8: 1512–1517.
-
58.
Carolan M, Frankowska D, 2011. Advanced maternal age and adverse perinatal outcome: a review of the evidence. Midwifery 27: 793–801.
-
59.
Jacobsson B, Ladfors L, Milsom I, 2004. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 104: 727–733.
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