Skip to main content
Top
Published in: Maternal and Child Health Journal 2/2017

01-02-2017

Associates of Neonatal, Infant and Child Mortality in the Islamic Republic of Pakistan: A Multilevel Analysis Using the 2012–2013 Demographic and Health Surveys

Authors: Anna Helova, Kristine R. Hearld, Henna Budhwani

Published in: Maternal and Child Health Journal | Issue 2/2017

Login to get access

Abstract

Objectives Pakistan is one of five nations contributing to half of the world’s child mortality and holds under-five mortality rates which are nearly double global targets. Reasons for this shortfall include civil conflicts, political uncertainty, low education, poverty, rural–urban disparities, and limited health care access. The aim of this study was to explore associations between individual characteristics, community factors, and child mortality in Pakistan. Methods Data were derived from the 2012 to 2013 Pakistan Demographic and Health Survey, and included 7399 live births and 380 child deaths. Multivariate, multilevel logistic regression was used to model risk of neonatal, infant and under-five child deaths. Results Seventy-one percent of child deaths occurred during the neonatal period. Significant factors (p < 0.05) associated with lower odds of child mortality included adhering to recommended minimum of 24 months interpregnancy interval and higher household wealth. These were significant for neonatal (OR 0.448; 0.871), infancy (OR 0.465; 0.881), and under-five deaths (OR 0.465; 0.879). Employed mothers had higher odds of neonatal (OR 1.479), infant (OR 1.506), and child mortality (OR 1.459). Likewise, women living in consanguineous marriages had higher odds of infant (OR 1.454) and under-five deaths (OR 1.381). Children in Balochistan, Punjab, and Sindh, regions disproportionately poor, rural with low levels of education, were at highest risk of dying. Conclusions for Practice Findings may assist in designing targeted interventions, developing appropriate public health messaging, and implementing policies designed to lower child mortality. Focusing on lowering rates of maternal poverty, increasing opportunities for education, and improving access to health care could assist in reducing child mortality in Pakistan.
Literature
go back to reference Black, R. E., Levin, C., Walker, N., Chou, D., Liu, L., & Temmerman, M. (2016). Reproductive, maternal, newborn, and child health: Key messages from disease control priorities 3rd edition. Lancet,. doi:10.1016/s0140-6736(16)00738-8. Black, R. E., Levin, C., Walker, N., Chou, D., Liu, L., & Temmerman, M. (2016). Reproductive, maternal, newborn, and child health: Key messages from disease control priorities 3rd edition. Lancet,. doi:10.​1016/​s0140-6736(16)00738-8.
go back to reference Boco, A. G. (2010). Individual and community-level effects on child mortality: An analysis of 28 demographic and health surveys in Sub-Saharan Africa. DHS Working Papers. No. 73. Boco, A. G. (2010). Individual and community-level effects on child mortality: An analysis of 28 demographic and health surveys in Sub-Saharan Africa. DHS Working Papers. No. 73.
go back to reference Budhwani, H., Hearld, K. R., & Harbison, H. (2015). Individual and area level factors associated with prenatal, delivery, and postnatal care in Pakistan. Maternal and Child Health Journal. doi:10.1007/s10995-015-1726-x.PubMed Budhwani, H., Hearld, K. R., & Harbison, H. (2015). Individual and area level factors associated with prenatal, delivery, and postnatal care in Pakistan. Maternal and Child Health Journal. doi:10.​1007/​s10995-015-1726-x.PubMed
go back to reference Filippi, V., Chou, D., Ronsmans, C., Graham, W., & Say, L. (2016). Levels and causes of maternal mortality and morbidity. In R. E. Black, R. Laxminarayan, M. Temmerman, & N. Walker (Eds.), Reproductive, maternal, newborn, and child health: Disease control priorities (3rd ed., Vol. 2). Washington, DC: The International Bank for Reconstruction and Development/The World Bank. Filippi, V., Chou, D., Ronsmans, C., Graham, W., & Say, L. (2016). Levels and causes of maternal mortality and morbidity. In R. E. Black, R. Laxminarayan, M. Temmerman, & N. Walker (Eds.), Reproductive, maternal, newborn, and child health: Disease control priorities (3rd ed., Vol. 2). Washington, DC: The International Bank for Reconstruction and Development/The World Bank.
go back to reference Levine, R. A., Levine, S., Schnell-Anzola, B., Rowe, M. L., & Dexter, E. (2012). Literacy and mothering. How women’s schooling changes the lives of the world’s children. Oxford: Oxford University Press.CrossRef Levine, R. A., Levine, S., Schnell-Anzola, B., Rowe, M. L., & Dexter, E. (2012). Literacy and mothering. How women’s schooling changes the lives of the world’s children. Oxford: Oxford University Press.CrossRef
go back to reference Levine, R. A., & Rowe, M. L. (2009). Maternal literacy and child health in less-developed countries: Evidence, processes, and limitations. Journal of Developmental & Behavioral Pediatrics, 30(4), 340–349. doi:10.1097/DBP.0b013e3181b0eeff.CrossRef Levine, R. A., & Rowe, M. L. (2009). Maternal literacy and child health in less-developed countries: Evidence, processes, and limitations. Journal of Developmental & Behavioral Pediatrics, 30(4), 340–349. doi:10.​1097/​DBP.​0b013e3181b0eeff​.CrossRef
go back to reference Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., et al. (2015). Global, regional, and national causes of child mortality in 2000–2013, with projections to inform post-2015 priorities: An updated systematic analysis. Lancet, 385(9966), 430–440. doi:10.1016/s0140-6736(14)61698-6.CrossRefPubMed Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., et al. (2015). Global, regional, and national causes of child mortality in 2000–2013, with projections to inform post-2015 priorities: An updated systematic analysis. Lancet, 385(9966), 430–440. doi:10.​1016/​s0140-6736(14)61698-6.CrossRefPubMed
go back to reference Memon, Z. A., Khan, G. N., Soofi, S. B., Baig, I. Y., & Bhutta, Z. A. (2015). Impact of a community-based perinatal and newborn preventive care package on perinatal and neonatal mortality in a remote mountainous district in Northern Pakistan. BMC Pregnancy Childbirth, 15, 106. doi:10.1186/s12884-015-0538-8.CrossRefPubMedPubMedCentral Memon, Z. A., Khan, G. N., Soofi, S. B., Baig, I. Y., & Bhutta, Z. A. (2015). Impact of a community-based perinatal and newborn preventive care package on perinatal and neonatal mortality in a remote mountainous district in Northern Pakistan. BMC Pregnancy Childbirth, 15, 106. doi:10.​1186/​s12884-015-0538-8.CrossRefPubMedPubMedCentral
go back to reference Mosley, W. H., & Chen, L. C. (2003). An analytical framework for the study of child survival in developing countries. 1984. Bulletin of the World Health Organization, 81(2), 140–145.PubMedPubMedCentral Mosley, W. H., & Chen, L. C. (2003). An analytical framework for the study of child survival in developing countries. 1984. Bulletin of the World Health Organization, 81(2), 140–145.PubMedPubMedCentral
go back to reference Stoltenberg, C., Magnus, P., Skrondal, A., & Lie, R. T. (1999). Consanguinity and recurrence risk of stillbirth and infant death. American Journal of Public Health, 89(4), 517–523.CrossRefPubMedPubMedCentral Stoltenberg, C., Magnus, P., Skrondal, A., & Lie, R. T. (1999). Consanguinity and recurrence risk of stillbirth and infant death. American Journal of Public Health, 89(4), 517–523.CrossRefPubMedPubMedCentral
go back to reference Teeuw, M. E., Henneman, L., Bochdanovits, Z., Heutink, P., Kuik, D. J., Cornel, M. C., et al. (2010). Do consanguineous parents of a child affected by an autosomal recessive disease have more DNA identical-by-descent than similarly-related parents with healthy offspring? Design of a case-control study. BMC Medical Genetics, 11, 113. doi:10.1186/1471-2350-11-113.CrossRefPubMedPubMedCentral Teeuw, M. E., Henneman, L., Bochdanovits, Z., Heutink, P., Kuik, D. J., Cornel, M. C., et al. (2010). Do consanguineous parents of a child affected by an autosomal recessive disease have more DNA identical-by-descent than similarly-related parents with healthy offspring? Design of a case-control study. BMC Medical Genetics, 11, 113. doi:10.​1186/​1471-2350-11-113.CrossRefPubMedPubMedCentral
go back to reference Tsui, A. O., Casterline, J., Singh, S., Bankole, A., Moore, A. M., Omideyi, A. K., et al. (2011). Managing unplanned pregnancies in five countries: Perspectives on contraception and abortion decisions. Global Public Health, 6(Suppl 1), S1–S24. doi:10.1080/17441692.2011.597413.CrossRefPubMed Tsui, A. O., Casterline, J., Singh, S., Bankole, A., Moore, A. M., Omideyi, A. K., et al. (2011). Managing unplanned pregnancies in five countries: Perspectives on contraception and abortion decisions. Global Public Health, 6(Suppl 1), S1–S24. doi:10.​1080/​17441692.​2011.​597413.CrossRefPubMed
go back to reference Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., et al. (2014). Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9947), 957–979. doi:10.1016/s0140-6736(14)60497-9.CrossRefPubMedPubMedCentral Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., et al. (2014). Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9947), 957–979. doi:10.​1016/​s0140-6736(14)60497-9.CrossRefPubMedPubMedCentral
go back to reference You, D., Hug, L., Ejdemyr, S., Idele, P., Hogan, D., Mathers, C., et al. (2015). Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet,. doi:10.1016/s0140-6736(15)00120-8. You, D., Hug, L., Ejdemyr, S., Idele, P., Hogan, D., Mathers, C., et al. (2015). Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet,. doi:10.​1016/​s0140-6736(15)00120-8.
Metadata
Title
Associates of Neonatal, Infant and Child Mortality in the Islamic Republic of Pakistan: A Multilevel Analysis Using the 2012–2013 Demographic and Health Surveys
Authors
Anna Helova
Kristine R. Hearld
Henna Budhwani
Publication date
01-02-2017
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 2/2017
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-016-2121-y

Other articles of this Issue 2/2017

Maternal and Child Health Journal 2/2017 Go to the issue