The effect of maternal and child health and family planning services on mortality: is prevention enough?
OBJECTIVE
To examine the impact on mortality of a child survival strategy, mostly based on preventive interventions.


METHODS
Cross sectional comparison of cause specific mortality in two communities differing in the type, coverage, and quality of maternal and child health and family planning services. In the intervention area the services were mainly preventive, community based, and home delivered.


METHODS
Neonates, infants, children, and mothers in two contiguous areas of rural Bangladesh.


METHODS
In the intervention area community health workers provided advice on contraception and on feeding and weaning babies; distributed oral rehydration solution, vitamin A tablets for children under 5, and ferrous fumarate and folic acid during pregnancy; immunised children; trained birth attendants in safe delivery and when to refer; treated minor ailments; and referred seriously ill people and malnourished children to a central clinic.


METHODS
Overall and age and cause specific death rates, obtained by a multiple step "verbal autopsy" process.


RESULTS
During the two years covered by the study overall mortality was 17% lower among neonates, 9% lower among infants aged 1-5 months, 30% lower among children aged 6-35 months, and 19% lower among women living in the study area than in those living in the control area. These differences were mainly due to fewer deaths from neonatal tetanus, measles, persistent diarrhoea with severe malnutrition among children, and fewer abortions among women.


CONCLUSIONS
The programme was effective in preventing some deaths. In addition to preventive components such as tetanus and measles immunisation, health and nutrition education, and family planning, curative services are needed to reduce mortality further.
Fauveau
V
V
International Centre for Diarrhoeal Disease Research, Bangladesh.
Wojtyniak
B
B
Chakraborty
J
J
Sarder
A M
AM
Briend
A
A
D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D002662:Child Health Services; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005193:Family Planning Services; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services; D009026:Mortality; D011247:Pregnancy; D011320:Primary Health Care; D011322:Primary Prevention / Q000706:statistics & numerical data*