Non-communicable diseases account for half of adult female deaths in rural Bangladesh

While global attention has for decades been focused on reducing maternal mortality, population-based data on other causes of death among women of reproductive age has been virtually non-existent. A study conducted by researchers at the Johns Hopkins Bloomberg School of Public Health found that non-communicable diseases accounted for 48 percent of 1,107 investigated female deaths in rural Bangladesh between 2002 and 2007. The findings lend urgency to review global health priorities to address neglected and potentially fatal non-communicable diseases affecting rural women in South Asia. The study is published in the May 2013 edition of the British Journal of Obstetrics & Gynecology.

For the study, researchers surveyed a population of more than 130,000 women of reproductive age in Bangladesh using a pregnancy surveillance system established during the JiVitA-1 community-based maternal vitamin A or beta-carotene supplementation trial. The researchers prospectively recorded deaths among enrolled women. Employing a modified World Health Organization verbal autopsy method, physicians interviewed families at home about the events and circumstances leading up to the death of each woman. A separate set of physicians independently reviewed the verbal autopsies to ascertain the primary cause of death: 22 percent were related to pregnancy, 17 percent due to infection and 9 percent attributable to injuries (both unrelated to pregnancy), while 48 percent of the fatalities were assigned to non-communicable diseases, among which circulatory system diseases and cancer were the top causes.

"While reducing mortality from pregnancy remains a high priority, these findings highlight the need to address and reduce the risk of death unrelated to pregnancy among women of reproductive age. The causes and risk factors need to be better understood to design interventions to reduce risk, likely focusing on nutrition, health education, early screening and health care for rural women in their prime of life," said Alain Labrique, PhD, assistant professor in the Bloomberg School's Department of International Health and lead author of the study.

"Beyond pregnancy - the neglected burden of female mortality in young women of reproductive age in Bangladesh: a prospective cohort study" was written by Alain B. Labrique, Shegufta S. Sikder, Lee Wu, Mahbubur Rashid, Hasmot Ali, Barkat Ullah, Abu A. Shamim, Sucheta Mehra, Rolf Klemm, Hashina Banu, Keith P. West, Jr., and Parul Christian. The manuscript can be accessed at: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12245/abstract.

Financial support for the research was provided by the Bill & Melinda Gates Foundation to the Center for Human Nutrition in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. Original trial support came from the U.S. Agency for International Development, with additional support from the Sight and Life Research Institute. Partial support for this data analysis was provided by the Johns Hopkins Bloomberg School of Public Health through a Global Field Experience Fund, a Framework Award in Global Health (Center for Global Health), and a Delta Omega Scholarship (Delta Omega Honor Society).