Why do the children of the poor die in Dhaka, Bangladesh?

Mortality data from much of the developing world show that the health advantage of urban over rural areas is being eroded. The single most important factor is the very high mortality of the slum populations, mostly rural-urban migrants in the large cities. This has been shown to be true of Dhaka, Bangladesh, where much of the mortality differential between the poor and other residents can be explained by higher mortality in the slums among young children, especially infants. This paper reports on a collaborative project, Access to Health and Reproductive Health Services in the Dhaka Slums, which confirmed this situation in a 1999 survey and employed an in-depth approach in 2000 to investigate the circumstances of child deaths. It is shown that these deaths mostly occur among illiterate rural-urban migrants who have brought pre-Islamic folk beliefs about illness and its treatment with them. This and cost in most cases preclude modern medical treatment. These disadvantages are reinforced by treatment decisions being made in a purdah society almost entirely by women, especially old women, with husbands and other male relatives often being beyond contact. Suggestions are advanced for improving the situation.