Epidemiology and Causes of Adult Female Death in Bangladesh: Findings from Two National Surveys
Epidemiological assessment of causes of death and changes in pattern of causes of deaths over time are needed for programmatic purpose. Limited national level data exist on the adult female causes of death in Bangladesh. Using data from two nationally representation surveys, the 2001 and 2010 Bangladesh Maternal Mortality Surveys (BMMS), the paper examines the epidemiology and causes of adult female deaths and changes in the patterns of these death.
METHODS:
In both surveys, all household deaths three years prior to the survey were identified. Adult female deaths (15-49 years) were then followed by a verbal autopsy (VA) using the WHO structured questionnaire. Two physicians independently reviewed the VA forms to assign a cause of death using the ICD-10; in case of disagreement, a third physician was called to make an independent review.
RESULTS:
Overall, there is a shift in pattern of causes of death during the period covered by the two surveys. In the 2001 survey, the main cause of adult female deaths was maternal (20%), followed by diseases of circulatory system (15%), malignancy (14%) and infectious diseases (13%); however, in the 2010 survey, malignancy was the number one cause (21%), followed by diseases of circulatory system (16%), maternal causes (14%) and infectious diseases (8%).
While maternal deaths remained the number one cause of death among 20-34 years old in the both surveys, unnatural deaths (suicide and other violent deaths) were the main cause for teenage deaths. In 2001, 1 in 3 teenagers died due to these causes, the same figure increased in 2010 and every other teenager had unnatural deaths. In 2001, diseases of circulatory system were the primary cause of death for women aged 35 -49 years followed by malignancy whereas malignancy ranked as the main cause of death in 2010. Although there is an increasing trend in the proportion of women died in hospitals, most women died at home in both surveys (74% in 2001 and 62% in 2010). Care seeking before death varied widely by age and disease pattern.
CONCLUSIONS:
The shift in the pattern of causes of adult female death is in agreement with the overall shift in the disease pattern from communicable to non-communicable diseases in Bangladesh. Suicide and other violent deaths as the primary cause of death among teenagers highlights the need for specific intervention to prevent such premature deaths.