Potential reductions in infant and child mortality through immunisation programmes: evidence from Matlab Bangladesh.

The authors examine potential mortality reductions from immunization in rural Bangladesh using data from the Matlab Demographic Surveillance System on both the age distribution of mortality and specific cause of death during infancy and early childhood. Estimates of potential reductions in mortality which could be achieved through the Expanded Programme on Immunisation in Bangladesh are subsequently derived. The study focuses on 3 infectious diseases which are preventable by immunization - tetanus measles and pertussis. Data come from the Demographic Surveillance System in Matlab. Findings underscore the need to consider a simple but frequently overlooked explanation - the failure of health technologies to address adequately the causes of death during the early months of life which have been shown to be a principle component of overall childhood mortality in settings such as rural Bangladesh. Equally significantly the results identify a number of important causes of childhood death - low birth weight/prematurity acute respiratory infection dysentery and chronic diarrhea - which remain largely outside of strategies such as Growth monitoring Oral rehydration Breast feeding and Immunization (GOBI) and are less amenable to intervention with simple health technologies. These findings should not be interpreted as questioning the rationale behind the inclusion of immunization as a key component of programs to improve child health and survival in developing countries. Instead results indicate that while the Expanded Programme on Immunisation has the potential to exert a major impact upon mortality from ages 1-4 its impact upon infant mortality is likely to be much more modest. Levels of infant mortality in settings such as rural Bangladesh are thus likely to remain high even after the successful implementation of the program. Rather than being reviewed as a failure of the Expanded Programme on Immunisation these results are instead consistent with the growing recognition that individual health interventions even those as efficacious as immunization programs are alone unlikely to lead to marked improvements in child survival. Strategies such as GOBI are therefore most appropriately viewed as starting points rather than comprehensive solutions to the problem of improving child health and survival in the developing world.