title: Causes of adult female deaths in Bangladesh: findings from two National Surveys.
abstract: BACKGROUND
  Assessment of causes of death and changes in pattern of causes of death over time are needed for programmatic purposes. Limited national level data exist on the adult female causes of death in Bangladesh.
  
  
  METHODS
  Using data from two nationally representation surveys, the 2001 and 2010 Bangladesh Maternal Mortality Surveys (BMMS), the paper examines the causes of adult female death, aged 15-49 years, and changes in the patterns of these deaths. In both surveys, all household deaths three years prior to the survey were identified. Adult female deaths 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 made an independent review and assigned a cause of death.
  
  
  RESULTS
  The overall mortality rates for women aged 15-49 in 2001 and 2010 were 182 per 100,000 and 120 per 100,000 respectively. There is a shift in the pattern of causes of death during the period covered by the two surveys. In the 2001 survey, the main causes of death were maternal (20 %), followed by diseases of the circulatory system (15 %), malignancy (14 %) and infectious diseases (13 %). However, in the 2010 survey, malignancies were the leading cause (21 %), followed by diseases of the 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 both surveys, unnatural deaths were the main cause for teenage deaths, and malignancies were the main cause of death for older women. Although there is an increasing trend in the proportion of women who died in hospitals, in both surveys most women died at home (74 % in 2001 and 62 % in 2010).
  
  
  CONCLUSIONS
  The shift in the pattern of causes of adult female deaths is in agreement with the overall change in the disease pattern from communicable to non-communicable diseases in Bangladesh. Suicide and other violent deaths as the primary cause of deaths among teenage girls demands specific interventions to prevent such premature deaths. Prevention of deaths due to non-communicable diseases should also be a priority.
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. quamrun@icddrb.org.
authors.forename: Quamrun
authors.initials: Q
authors.lastname: Nahar
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. shams@icddrb.org.
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.affiliation: United States Agency for International Development (USAID)/Bangladesh, Madani Avenue Baridhara, Dhaka, 1212, Bangladesh. kjamil@usaid.gov.
authors.forename: Kanta
authors.initials: K
authors.lastname: Jamil
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh. pkstreatfield@icddrb.org.
authors.forename: Peter Kim
authors.initials: PK
authors.lastname: Streatfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001344:Autopsy; D001459:Bangladesh / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death / Q000639:trends*; D003141:Communicable Diseases / Q000401:mortality*; D003643:Death; D005260:Female; D006760:Hospitalization; D006801:Humans; D038801:International Classification of Diseases; D063130:Maternal Death; D008428:Maternal Mortality; D008875:Middle Aged; D061213:Mortality, Premature; D009369:Neoplasms / Q000401:mortality*; D013405:Suicide; D011795:Surveys and Questionnaires; D014754:Violence; D055815:Young Adult