Social determinants of under-five mortality in urban Bangladesh

Rapid urbanization and persistent health inequity are two significant phenomena in contemporary developing world. Urban population, albeit with more modern facilities and amenities at their proximity, are subject to extreme variation depending on economic abilities and living conditions. This results in disparate health status among population sub-groups. Achieving equity in health and reduction in under-five mortality rate (U5MR) are two important agenda of sustainable development goals (SDGs). Hence this paper examines the trends in socioeconomic differentials of under-five mortality rate in urban Bangladesh for two decades since early 1990s. Data on urban samples of seven Bangladesh Demographic and Health Surveys conducted during 1994–2014 were used. Cross-tabular and Cox’s Proportional Hazard Regression analysis were done. Under-five mortality rate decreased from 91.4/1000 in 1994 to 37.3 in 2014 and was 20% higher in towns than cities. Children of illiterate mothers had 2.5 times higher mortality than those of mothers with 6 + years schooling. Mortality in households with the lowest socioeconomic status (SES) was 2.2 times higher than that of children from highest SES households. Inequality in U5MR at various levels of mother’s education and household SES were observed in seven surveys except for 2014 and 2007. For children with birth order of 2 or below and preceding birth interval of 3 + years, U5MR were found lower than their respective counterparts. Steady linear decline in U5MR with increased household SES and birth order of 2 or below observed among children of mothers with 6 + years education and all education category respectively. No significant sex differential in U5MR was observed. No under five mortality were reported among urban under five children who received all basic vaccination. Reduction in U5MR and its socioeconomic inequality will help Bangladesh to achieve SDG targets. Equity focused policies and programmes complemented with monitoring of progress can be of help.