Mortality Reductions from Health Interventions: The Case of Immunization in Bangladesh

Researchers used data from rural Matlab Bangladesh to examine potential mortality reductions from immunization. 20.5% of all neonatal deaths were attributable to tetanus. These deaths were very high during days 1-2. Nevertheless the number of deaths attributable to tetanus compared to all causes of death showed no tetanus deaths during days 1-4 (the primary risk period) and tetanus deaths were clustered in days 7-8. Moreover tetanus deaths accounted for 45% of all deaths during days 4-14. Indeed about 50% of all neonatal deaths occurred before tetanus could even contribute to mortality. The analysis indicated that administration of tetanus toxoid would result in reductions of neonatal mortality between 16-19 deaths/1000. Pertussis and measles vaccinations did not affect neonatal mortality rates. Tetanus toxoid and pertussis vaccinations would contribute to a reduction of <2 deaths during the postneonatal period (1-11 months). Measles vaccinations would only cause a slight reduction in postneonatal mortality (1-5 deaths). The analysis showed that measles vaccinations hold the greatest promise for reduction in mortality in children 1-4 years old. For example the reductions ranged from 11-40.2. Tetanus and pertussis vaccinations in this age group contributed to only reductions of .4-1.2 deaths. The results demonstrated that immunizations do not significantly reduce deaths during the early months of life but measles vaccinations do reduce deaths in 1-4 year olds. Indeed the major causes of early infant mortality (low birth weight/prematurity acute respiratory infection dysentery and chronic diarrhea/ severe malnutrition) are not necessarily considered in primary health care strategies e.g. growth monitoring oral rehydration breast feeding and immunization (GOBI) strategy. Immunization programs should not be abandoned however.