Bangladesh 1993-1994 Demographic and Health ... - Measure DHS

immediately after the B DHS. Preliminary results indicate a remarkable level of consistency between the twosources in the total fertility rates for recent years (Bairagi et al., 1995).C.3 Childhood MortalityAs mentioned in Chapter 7, the estimates of childhood mortality are based on information from thebirth history section of the questionnaire administered to individual women. The reliability of mortalityestimates calculated from retrospective birth histories depends on the completeness with which deaths arereported and the extent to which birth dates and ages at death are accurately reported and recorded. Omissionof births and deaths directly affects the level and often the age pattern of mortality estimates, misreportingof the age at death may distort the age pattem of mortality, and displacement of dates has an impact onmortality trends.Omission of infant deaths is usually most severe for deaths which occur early in infancy. If earlydeaths are selectively underreported, the result would be an abnormally low ratio of deaths under seven daysto all neonatal deaths and an abnormally low ratio of neonatal to infant mortality. Underreporting of earlyinfant deaths is usually more common for births that occurred longer before the survey; hence it is useful toexamine the ratios over time.It does not appear that early infant deaths have been severely underreported in the 1993-94 BDHS,at least not for the most recent period. The proportion of neonatal deaths that occur in the first week of lifeis reasonably high, about 64 percent ~ (see Table C.6). However, the ratio is higher for the period 0-4 yearsprior to the survey than for earlier periods, suggesting that some early infant deaths were not reported by olderwomen. Alternatively, the increase in the proportion of early to total neonatal deaths could be due to overalldeclines in infant mortality; generally, early infant deaths are the most difficult to prevent and countries wilhlow mortality have relatively high ratios of early infant to total neonatal rates. Another indication that earlyinfant deaths were not underreported in the BDHS is that fact that the proportions of infant deaths that occurduring the first month of life are plausible (62-67 percent--see Table C.7).The quality of the reporting of age at death is also important. Misreporting of age at death will biasestimates of the age pattern of mortality if the net result of the misreporting is transference of deaths betweenage segments for which rates are calculated; for example, an overestimate of child mortality relative to infantmortality may result if children who died during the first year of life are reported as having died at age oneyear or older. In an effort to minimize error in the reporting of age at death, BDHS interviewers wereinstructed to record the age at death in days for deaths under one month, and in months for deaths under 2years. They were specifically asked to probe for deaths reported at one year of age to ensure that they hadactually occurred at 12 months. Nevertheless, there is evidence of some "heaping" on age 12 months in thereporting of age at death (see Table C.7).With regard to the issue of displacement of the dates of events, there is no evidence of systematicmisreporting of birth dates for children born in the five-year period immediately prior to the survey. Unlikethe pattern found in some DHS surveys, in which it appears that interviewers might have deliberatelytransferred the dates of births so as to put them out of the age range for eligibility for questions in the healthsection of the questionnaire, the BDHS data on births by year are quite uniform (see Section C.2 above).There are no model mortality patterns for the neonatal period. However, one review of data from several developingcountries concluded that, at levels of neonatal mortality of 20 per 1,000 or higher, approximately 70 percent of neonataldeaths occur within the first six days of life (Boerma, 1988, cited in Sullivan et al., 1990).171