The socio-economic determinants of infant mortality in Nepal: analysis of Nepal Demographic Health Survey, 2011

Association between maternal experiences of intimate partner violence and child stunting: a secondary analysis of the Demographic Health Surveys of four South Asian countries

OBJECTIVES

To determine the association between maternal exposure to intimate partner violence (IPV) and child stunting using the Demographic Health Survey (DHS) data comparing four South Asian countries.

DESIGN

A secondary analysis.

SETTING

Data from the seventh round of the DHS data of four South Asian countries; Pakistan, Nepal, India and Maldives.

PARTICIPANTS

Married women of reproductive age (15-49 years) from each household were randomly selected, having at least one child less than 5 years of age for whom all anthropometric measures were available.

OUTCOME MEASURE

The exposure variable was maternal IPV including, sexual violence, physical violence or both. The outcome variable was moderate or severe stunting, measured based on the height-for-age Z-score of children aged 6-59 months old . Multiple Cox proportional regression analyses were used separately on each country's data to determine the association between maternal IPV and child stunting.

RESULTS

The prevalence of IPV among women ranged from 10.17% in the Maldives to 31% in India. The burden of child stunting was the lowest in the Maldives at 14.04% and the highest in Pakistan at 35.86%. The number of severely stunted children was the highest in Pakistan (16.60%), followed by India (14.79%). In India, children whose mothers were exposed to IPV showed a 7% increase in the prevalence of moderate to severe child stunting (OR 1.07; 95% CI 1.01 to 1.14). Additionally, in Nepal, severe stunting was strongly associated with the prevalence of physical IPV (OR 1.66; 95% CI 1.01 to 2.87).

CONCLUSION

Our study findings suggest that maternal exposure to IPV is associated with child stunting. Further research investigating the relationship between IPV and child outcomes using improved and advanced statistical analyses can provide substantial evidence to enhance public awareness and potentially reduce the burden of child stunting in South Asian countries.

Spatial spillover impact of determinants on child mortality in Pakistan: evidence from Spatial Durbin Model

BACKGROUND

Child mortality is a major challenge to public health in Pakistan and other developing countries. Reduction of the child mortality rate would improve public health and enhance human well-being and prosperity. This study recognizes the spatial clusters of child mortality across districts of Pakistan and identifies the direct and spatial spillover effects of determinants on the Child Mortality Rate (CMR).

METHOD

Data of the multiple indicators cluster survey (MICS) conducted by the United Nations International Children's Emergency Fund (UNICEF) was used to study the CMR. We used spatial univariate autocorrelation to test the spatial dependence between contiguous districts concerning CMR. We also applied the Spatial Durbin Model (SDM) to measure the spatial spillover effects of factors on CMR.

RESULTS

The study results showed 31% significant spatial association across the districts and identified a cluster of hot spots characterized by the high-high CMR in the districts of Punjab province. The empirical analysis of the SDM confirmed that the direct and spatial spillover effect of the poorest wealth quintile and MPI vulnerability on CMR is positive whereas access to postnatal care to the newly born child and improved drinking water has negatively (directly and indirectly) determined the CMR in Pakistan.

CONCLUSION

The instant results concluded that spatial dependence and significant spatial spillover effects concerning CMR exist across districts. Prioritization of the hot spot districts characterized by higher CMR can significantly reduce the CMR with improvement in financial statuses of households from the poorest quintile and MPI vulnerability as well as improvement in accessibility to postnatal care services and safe drinking water.

The Impact of Sociodemographic, Macroeconomic, and Health Status and Resources on Infant Mortality Rates in Oman: Evidence from 1980 to 2022

BACKGROUND

The infant mortality rate (IMR) is an important reflection of the well-being of infants and the overall health of the population. This study aims to examine the macroeconomic (ME), sociodemographic (SD), and health status and resources (HSR) effects on IMR, as well as how they may interact with each other.

METHODS

A retrospective time-series study using yearly data for Oman from 1980 to 2022. Partial Least Squares-Structural Equation Modelling (PLS-SEM) was utilized to develop the exploratory model of the determinants of IMR.

RESULTS

The model indicates that HSR determinants directly, but negatively, affect IMR (β = -0.617, p < 0.001). SD directly and positively affects IMR (β = 0.447, p < 0.001). ME only indirectly affects IMR (β = -0.854, p < 0.001). ME determinants also exert some direct influences on both HSR (β = 0.722, p < 0.001) and SD (β = -0.916, p < 0.001) determinants.

CONCLUSIONS

This study has indicated that IMR is a multi-faceted issue. It also highlighted the interplay of numerous variables and their influence on IMR, particularly the role that social status, the health sector, and the wealth of the country and its population play in reducing IMR. These findings indicate that an integrated policy that addresses socioeconomic and health-related factors and the overall ME environment is necessary for the health and well-being of the children and the population overall in Oman.

Geographical disparities and determinants of infant mortality in Ethiopia: mapping and spatial analysis using EDHS data

BACKGROUND

Infant mortality remains a public health challenge in Ethiopia. Exploring infant mortality will aid in tracking the progress toward achieving sustainable development goals.

OBJECTIVE

The study aimed to explore the geographical variations and associated factors of infant mortality in Ethiopia.

METHOD

A total of 11,023 infants from the 2016 Ethiopian Demographic and Health Survey (EDHS) data were extracted and included in the analysis. EDHS used a two-stage cluster sampling design with a census enumeration area as the primary sampling unit and households as the secondary sampling unit. Arc GIS software was used for spatial analysis using clusters for exploring geographical variations in infant mortality. A binary logistic regression was employed using R software to identify the significant determinants of infant mortality.

RESULTS

The study revealed that the spatial distribution of infant mortality was non-random in the country. Infants whose mothers not receiving ANC (AOR = 1.45; 95%CI: 1.17, 1.79), not breastfed status (AOR = 3.94; 95%CI: 3.19, 4.81), poor wealth index (AOR = 1.36; 95%CI: 1.04, 1.77), male infants (AOR = 1.59; 95%CI: 1.29, 1.95), birth order of six or above (AOR = 3.11; 95%CI: 2.08, 4.62), small birth size (AOR = 1.27; 95%CI: 1.26, 1.60), birth spacing [(≤ 24 months (AOR = 2.29; 95%CI: 1.79, 2.92), 25-36 months (AOR = 1.16; 95%CI: 1.12, 1.49)], multiple births (AOR = 6.82; 95%CI: 4.76, 10.81), rural residence (AOR = 1.63; 95%CI: 1.05, 2.77) and regions [Afar (AOR = 1.54; 95%CI: 1.01, 2.36), Harari (AOR = 1.56; 95%CI: 1.04, 2.56), and Somali (AOR = 1.52; 95%CI: 1.03, 2.39)] were the determinants of infant death in Ethiopia.

CONCLUSIONS

There is a great geographical disparity in infant mortality rates across regions. Afar, Harari, and Somali regions were verified as hot spot areas. ANC usage, breastfed status, wealth index, sex of the infant, birth order, birth size, birth spacing, birth type, residence, and region were the determinants of infant death in Ethiopia. Therefore, appropriate interventions need to be implemented in the hot spots to alleviate the risk factors for infant mortality.

2008 economic crisis impact on perinatal and infant mortality in Southern European countries

INTRODUCTION

The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession's impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems' response to the protection of the health of the most vulnerable groups.

OBJECTIVE

To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain.

METHODS

Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models.

RESULTS

IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018.

CONCLUSION

Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population's health from the earliest days.

A Systematic Review of Factors Associated with Under-Five Child Mortality

BACKGROUND

Preventing the life of the newborn and reducing the entrenched disparity of childhood mortality across different levels is one of the crucial public health problems, especially in underdeveloped and developing countries in the world. Sustainable development goals (SDGs)-3.2 is aimed at terminating all preventable under-five child mortality and shrinking it to 25 per 1000 live births or lower than this by 2030. Several factors have been shown to be linked with childhood mortality.

OBJECTIVE

This review is aimed at pointing out the significant determinants related to under-five child mortality by a systematic review of the literature.

METHODS

EMBASE, PubMed, Scopus database, and Google Scholar search engine were used for the systematic search of the literature. Special keywords and Boolean operators were used to point out the relevant studies for the review. Original research articles and peer-reviewed papers published in the English language till August 10, 2022, were included in the analysis and synthesis of the results. As per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, out of 299 studies identified from different sources, only 22 articles were ascertained for this study. Eligible articles were appraised in detail, and relevant information was extracted and then integrated into the systematic review.

RESULTS

Mother's education, size of child at birth, age of mother at childbirth, place of residence, birth interval, sex of child, type of birth (single or multiple), and birth order, along with other socioeconomic, maternal, child, health facility utilization, and community level variables, were observed as important covariates of under-five mortality.

CONCLUSION

Women's education and easy access to quality healthcare facilities should be the apex priority to lessen childhood mortality.

An assessment of random forest technique using simulation study: illustration with infant mortality in Bangladesh

We aimed to assess different machine learning techniques for predicting infant mortality (<1 year) in Bangladesh. The decision tree (DT), random forest (RF), support vector machine (SVM) and logistic regression (LR) approaches were evaluated through accuracy, sensitivity, specificity, precision, F1-score, receiver operating characteristics curve and k-fold cross-validation via simulations. The Boruta algorithm and chi-square ( χ 2 ) test were used for features selection of infant mortality. Overall, the RF technique (Boruta: accuracy = 0.8890, sensitivity = 0.0480, specificity = 0.9789, precision = 0.1960, F1-score = 0.0771, AUC = 0.6590; χ 2 : accuracy = 0.8856, sensitivity = 0.0536, specificity = 0.9745, precision = 0.1837, F1-score = 0.0828, AUC = 0.6480) showed higher predictive performance for infant mortality compared to other approaches. Age at first marriage and birth, body mass index (BMI), birth interval, place of residence, religion, administrative division, parents education, occupation of mother, media-exposure, wealth index, gender of child, birth order, children ever born, toilet facility and cooking fuel were potential determinants of infant mortality in Bangladesh. Study findings may help women, stakeholders and policy-makers to take necessary steps for reducing infant mortality by creating awareness, expanding educational programs at community levels and public health interventions.

Improved Yet Unsafe: At the Light of NFHS-V

Following UNICEF’s analysis of National Family Health Survey-III Data (NFHS-III), it was opined that households with access to better sanitation and better access to improved water sources have much better infant survival rates than the others. Sahu et al. (2015, The Indian journal of medical research, 141(5), 709), Arun et al. (2017, International Conference on Cognitive Computing and Information Processing (pp. 81–92), Springer) and Tripathy and Mishra (2017, Journal of Tropical Pediatrics, 63(6), 431–439) supported these findings. However, Banerjee (2020a , Journal of Health Management, 22(1), 57–66), analysing NFHS-IV data, has vehemently criticised such findings and showed using regression with robust standard errors that improved access to better water sources leads to higher infant mortality. In another article published in the same year, Banerjee (2020b , Journal of Health Management, 22(3), 466–471) explained this paradox. Now with NFHS-V data coming out, time is apt to test the robustness of Banerjee’s findings (2002a). However, owing to the incomplete NFHS-V data published so far, unlike Banerjee (2002a) that has used data of 29 states, the present analysis is based on only 17 states. The findings support that the findings of Banerjee (2002a) were robust.

Background predictors of time to death in infancy: evidence from a survival analysis of the 2018 Nigeria DHS data

Background

Nigeria’s child health profile is quite concerning with an infant mortality rate of 67 deaths per 1000 live births and a significant slowing down in progress towards improving child health outcomes. Nigeria’s 2018 Demographic and Health Survey (DHS) suggests several bio-demographic risk factors for child death, including mother’s poor education, poverty, sex of child, age of mother, and location (rural vs urban) but studies are yet to explore the predictive power of these variables on infant survival in Nigeria.

Methods

The study extracted data for all births in the last 12 months preceding the 2018 Nigeria DHS and used the Cox proportional hazard model to predict infant survival in Nigeria. Failure in this analysis is death with two possible outcomes – dead/alive – while the survival time variable is age at death. We censored infants who were alive at the time of the study on the day of the interview. Covariates in the analysis were: age of mother, education of mother, wealth quintile, sex of child, location, region, place of delivery, and age of pregnancy.

Results

The study found that a higher education of a mother compared to no education (β = .429; p-value < 0.05); belonging to a household in the richer wealth quintile (β = .618; p-value < 0.05) or the highest quintile (β = .553; p-value < 0.05), compared to the lowest wealth quintile; and living in North West (β = 1.418; p-value < 0.05) or South East zone (β = 1.711; p-value < 0.05), significantly predict infant survival.

Conclusion

Addressing Nigeria’s infant survival problem requires interventions that give attention to the key drivers – education, socio-economic status, and socio-cultural contextual issues. We therefore recommend full implementation of the universal basic education policy, and child health education programs targeted at mothers as long- and short-term solutions to the problem of poor child health outcomes in Nigeria. We also argue in favor of better use of evidence in policy and program development in Nigeria.

Individual-, household- and community-level determinants of infant mortality in Ethiopia

INTRODUCTION

People living in the same area share similar determinants of infant mortality, such as access to healthcare. The community's prevailing norms and attitudes about health behaviours could also influence the health care decisions made by individuals. In diversified communities like Ethiopia, differences in child health outcomes might not be due to variation in individual and family characteristics alone, but also due to differences in the socioeconomic characteristics of the community where the child lives. While individual level characteristics have been examined to some extent, almost all studies into infant mortality conducted in Ethiopia have failed to consider the impact of community-level characteristics. Therefore, this study aims to identify individual and community level determinants of infant mortality in Ethiopia.

METHOD

Data from the Ethiopian Demographic and Health Survey in 2016 were used for this study. A total of 10641 live births were included in this analysis. A multi-level logistic regression analysis was used to examine both individual and community level determinants while accounting for the hierarchal structure of the data.

RESULTS

Individual-level characteristics such as infant sex have a statistically significant association with infant mortality. The odds of infant death before one year was 50% higher for males than females (AOR = 1.66; 95% CI: 1.25-2.20; p-value <0.001). At the community level, infants from pastoralist areas (Somali and Afar regions) were 1.4 more likely die compared with infants living in the Agrarian area such as Amhara, Tigray, and Oromia regions; AOR = 1.44; 95% CI; 1.02-2.06; p-value = 0.039).

CONCLUSION

Individual, household and community level characteristics have a statistically significant association with infant mortality. In addition to the individual based interventions already in place, household and community-based interventions such as focusing on socially and economically disadvantaged regions in Ethiopia could help to reduce infant mortality.

Demystifying the Aquatic Paradox: The Infant Mortality in India

It is evident that better access to improved water sources will lead to the lessening of infant mortality rate (IMR). However, for India, such inference is ambiguous. There is a strong group of academicians such as Sahu et al. (2015) , Arun et al. (2017) and Tripathy and Mishra (2017) and organizations such as UNICEF that firmly believe that if access to the improved water sources can be improved, then there would be tremendous social welfare and much betterment to the IMR.

On the other hand, Banerjee et al. (2020) have refuted such claims and opined that access to improved water sources increases the IMR. The empirical validation of their claim has been flawless, but they are somewhat silent on why such a direct relationship between IMR and improved water source exists. They have made a comment based on assumptions that it might be complacency that develops with access to improved water sources that refrain the people to consider any type of water treatment before passing it to infants for drinking. Such a comment might be valid, but neither is it built upon a sound literature review nor does it stand on strong empirics. At this juncture, the present article tests the claim of Banerjee et al. (2020) based on pure empirics.

Factors affecting infant mortality in the general population: evidence from the 2016 Ethiopian demographic and health survey (EDHS); a multilevel analysis

Background

Infant mortality is one of the leading public health problems globally; the problem is even more staggering in low-income countries. In Ethiopia seven in ten child deaths occurred during infancy in 2016. Even though the problem is devastating, updated information about the major determinants of infant mortality which is done on a countrywide representative sample is lacking. Therefore, this study was aimed to identify factors affecting infant mortality among the general population of Ethiopia, 2016.

Methods

A Community-based cross-sectional study was conducted in all regions of Ethiopia from January 18 to June 27, 2016. A total of 10,641 live births were included in the analysis. Data were analyzed and reported with both descriptive and analytic statistics. Bivariable and multivariable multilevel logistic regression models were fitted by accounting correlation of individuals within a cluster. Adjusted odds ratio (AOR) with 95% confidence interval was reported to show the strength of the association and its significance.

Results

A total of 10,641 live-births from the Ethiopian demographic and health survey (EDHS) data were included in the analysis. Being male infant (AOR = 1.51; 1.25, 1.82), Multiple birth (AOR = 5.49; 95% CI, 3.88–7.78), Preterm (AOR = 8.47; 95% CI 5.71, 12.57), rural residents (AOR = 1.76; 95% CI; 1.16, 2.67), from Somali region (AOR = 2.07; 1.29, 3.33), Harari (AOR = 2.14; 1.22, 3.75) and Diredawa (AOR = 1.91; 1.04, 3.51) were found to be statistically significantly associated with infant mortality.

Conclusion

The study has assessed the determinants of infant mortality based on EDHS data. Sex of the child, multiple births, prematurity, and residence were notably associated with infant mortality. The risk of infant mortality has also shown differences across different regions. Since infant mortality is still major public health problem interventions shall be done giving more attention to infants who were delivered multiple and who are preterm.

Improved yet Unsafe: An Aquatic Perspective of Indian Infant Mortality

Infant mortality rate (IMR) is an important development indicator and a vital component of millennium development goals (MDGs) set by United Nations Development Programme (UNDP). According to UNDP, so far India has only fared moderately in reducing IMR (Goal 4 of MDGs). India (32) ranks 144th among 196 countries regarding IMR as per the 2017 data availed from World Development Indicators. Its adjacent countries such as Bhutan (25.6), Bangladesh (26.9) and Nepal (27.8) have fared much better regarding infant survival. Numbers within the parentheses indicate the IMR of the respective country. The United Nations Children’s Fund (UNICEF) has identified that IMR among families with better access to improved drinking water sources and toilet is much lower than those bereft of the same. This inference has been drawn from National Family Health Survey 3 data (NFHS III). The present study investigates into the aforementioned relation analysing NFHS IV data. The result depicts that contrary to UNICEF’s findings, IMR increases with better accessibility to improved water sources. Further to this, the article shows that an additional aqua-related practice together with improved drinking water sources might lead to the betterment of IMR for India.

Socio-economic, macroeconomic, demographic, and environmental variables as determinants of child mortality in South Asia

The study empirically examines the effects of socio-economic (human capital), macroeconomic (per capita GDP), demographic (fertility rate, urbanization), and environmental variables (carbon emissions) on child mortality in South Asia. For empirical analysis, panel cointegration technique is used by using data for five South Asian countries for the period 1973 to 2015. First, it is found that the variables have unit roots at levels but are stationary at first differences, which indicates the possibility of cointegration. Cointegration test results show that long-run cointegrating relationship holds among variables. Fully Modified OLS (FMOLS) and Dynamic OLS (DOLS) methods are applied to find the parameter estimates. The results of long-run estimates show that human capital, per capita income, and urbanization reduce child mortality while high fertility rate and environmental degradation increase child mortality in the region. It is also found that trade openness, immunization, food security, and high life expectancy also decrease child mortality and that population density increases child mortality.

The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: analysis from four recent demographic and health surveys in Nepal

BACKGROUND

Despite policy intention to reach disadvantaged populations, inequalities in health care resource use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.

METHODS

Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens: Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of full vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.

RESULTS

Full vaccination coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from - 32.3 [- 45.5,-19.1] in 2001 to an SII of-8.4 [- 18.6,-1.7] in 2016. Similarly, the SII for education decreased from - 61.8 [- 73.5,-50.1] in 2001 to an SII of - 30.5 [- 40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full vaccination coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (- 0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.

CONCLUSION

Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

Socioeconomic, Demographic, and Environmental Determinants of Under-5 Mortality in Ethiopia: Evidence from Ethiopian Demographic and Health Survey, 2016

Background. Though Ethiopia has made impressive progress in reducing child mortality in the past two decades, the reduction of under-five mortalities is a major concern for the Sustainable Development Goals (SDGs) introduced in 2016 targeted to reduce under-5 mortality rate below 25 deaths of under-5 per 1,000 live births by 2030. This study aims to assess the risk factors attributed to under-five mortalities in Ethiopia region based on Ethiopian Demographic Health Survey 2016 dataset. Methods. The study was a secondary analysis of 2016, Ethiopian Demographic Health Survey and the information collected from 10,274 children born five years preceding the survey was considered in the study, and variables like maternal social and demographic characteristics, child demographic characteristics, and cultural and environmental factors were considered as determinants of under-five deaths. The study used descriptive statistics and logistic regression model to explore significant risk factors accredited to under-five deaths in Ethiopia. Results. Maternal education attainment, women age at first birth, women current age, child birth order, preceding birth interval, birth type, and occupation of mother were found significant predictors of under-five mortalities. Being born to mother with no education (OR=2.610, 95% CI: 1.598, 4.265), short birth spacing 1 to 18 months birth intervals (OR=2.164, 95% CI: 1.821, 2.570), birth order of five and above, and 11 to 17 years ages at birth (OR=1.556, 95% CI: 1.243, 1.949) were factors significantly associated with increased risk of under-five mortalities. Conclusion. The magnitude of under-five deaths in the study area was decreasing. However, under-five mortality rates have stayed higher in some regions. Therefore, interventions that focus on birth spacing, mothers living in Affar and Gambela, and uneducated mothers are required for improving child survival in Ethiopia.

Under-Five Mortality and Associated Factors: Evidence from the Nepal Demographic and Health Survey (2001⁻2016)

Child mortality in Nepal has reduced, but the rate is still above the Sustainable Development Goal target of 20 deaths per 1000 live births. This study aimed to identify common factors associated with under-five mortality in Nepal. Survival information of 16,802 most recent singleton live births from the Nepal Demographic and Health Survey for the period (2001⁻2016) were utilized. Survey-based Cox proportional hazard models were used to examine factors associated with under-five mortality. Multivariable analyses revealed the most common factors associated with mortality across all age subgroups included: mothers who reported previous death of a child [adjusted hazard ratio (aHR) 17.33, 95% confidence interval (CI) 11.44, 26.26 for neonatal; aHR 13.05, 95% CI 7.19, 23.67 for post-neonatal; aHR 15.90, 95% CI 11.38, 22.22 for infant; aHR 16.98, 95% CI 6.19, 46.58 for child; and aHR 15.97, 95% CI 11.64, 21.92 for under-five mortality]; nonuse of tetanus toxoids (TT) vaccinations during pregnancy (aHR 2.28, 95% CI 1.68, 3.09 for neonatal; aHR 1.86, 95% CI 1.24, 2.79 for post-neonatal; aHR 2.44, 95% CI 1.89, 3.15 for infant; aHR 2.93, 95% CI 1.51, 5.69 for child; and aHR 2.39, 95% CI 1.89, 3.01 for under-five mortality); and nonuse of contraceptives among mothers (aHR 1.69, 95% CI 1.21, 2.37 for neonatal; aHR 2.69, 95% CI 1.67, 4.32 for post-neonatal; aHR 2.01, 95% CI 1.53, 2.64 for infant; aHR 2.47, 95% CI 1.30, 4.71 for child; and aHR 2.03, 95% CI 1.57, 2.62 for under-five mortality). Family planning intervention as well as promotion of universal coverage of at least two doses of TT vaccine are essential to help achieve child survival Sustainable Development Goal (SDG) targets of <20 under-five deaths and <12 neonatal deaths per 1000 births by the year 2030.

Female labor force participation, paid maternity, caste system and under-5 mortality in Nepal

Purpose

The under-5 mortality rate in Nepal remains high in comparison to neighboring countries and developed nations. The result of this problem on Nepal’s social, economic, political and cultural development makes it an urgent priority requiring the Nepalese Government to address this issue. The purpose of this paper is to find out if Nepal’s high female labor force participation (FLFP), the caste system and no paid maternity leave are contributing factors to under-5 deaths in Nepal.

Design/methodology/approach

Data for this study were taken from Nepal’s cross-sectional demographic health survey 2016–2017. The study sample included 5,060 children born to 3,074 mothers in the five years preceding the survey. Data were collected by interviewing respondents via a structured questionnaire selected through stratified random sampling methods.

Findings

The study found that the hazard ratio for FLFP, the caste of the mother and paid maternity were 1.145, 1.485 and 0.556, respectively, with a p-value <0.001. Therefore, the risk of death in children under-5 years for a working mother, a Terai caste mother and a mother who did not get paid maternity was 14, 45 and 48 percent, respectively, higher than for non-working mothers, mothers from other castes and mothers who got paid maternity.

Originality/value

This research demonstrated that FLFP, the caste of the mother and paid maternity leave are important factors for determining the risk of death in children under the age of 5.

Neonatal Mortality in Hospitalized Chinese Population: A Meta-Analysis

OBJECTIVE

In this meta-analysis, we aim to investigate the neonatal mortality in hospitalized Chinese population in the recent 20 years in China, which may provide basis for decreasing the neonatal mortality.

METHODS

The merged mortality was estimated based on the random effect model, and subgroup analysis was performed for the gender, publication year, gestational age, and birth weight. Sensitivity analysis was utilized to evaluate the effects of research type and research quality on the effects.

RESULTS

The neonatal mortality in eastern China was lower than that of the central and western China (2.3% versus 2.9; 2.3% versus 26.%). The mortality in neonates with a gestational age of 28-32 weeks (0.6%) was significantly higher than that of <28 weeks (0.1%), 32-37 weeks (0.3%), 37-42 weeks (0.4%), and >42 weeks (0.1%). The mortality in those with a body weight of 1.0-2.5 kg (0.3%) was significantly higher than that of 2.5-4.0 kg (0.2%) and >4.0 kg (0.0%). Sensitivity analysis revealed that the findings of meta-analysis were stable. The major causes for neonatal death included asphyxia, respiratory distress syndrome, and infection.

CONCLUSIONS

The hospitalized neonatal mortality showed a tendency of decrease, which differed based on gender, region, gestational age, and birth weight.

Inequalities on mortality due to acute respiratory infection in children: A Colombian analysis

INTRODUCTION

Acute respiratory infections (ARI) are a leading public health issue worldwide.

OBJECTIVE

To explore the inequalities in ARI mortality rates in under-5, according to socioeconomic characteristics.

MATERIALS AND METHODS

We conducted an ecological analysis to study inequalities at municipal level due to ARI mortality in children under 5 years. The data were obtained from official death records of the Departamento Administrativo Nacional de Estadística. The analysis of inequalities in the under-5 mortality rate (U5MR) included: 1) Classification of the population in different socio-economic strata, and 2) measurement of the degree of inequality. We used the ARI-U5MR as an outcome measurement.The mortality rates were estimated at national and municipal levels for the years 2000, 2005, 2010, and 2013. Rate ratios, rates differences, and concentration curves were calculated to observe the inequalities.

RESULTS

A total of 18,012 children under 5 years died by ARI in Colombia from 2000 to 2013. ARIU5MR was greater in boys than in girls. During this period, an increase in the infant mortality relative gap in both boys and girls was observed. In 2013, the U5MR evidenced that for boys from municipalities with the highest poverty had a 1.6-fold risk to die than those in municipalities with the lowest poverty (low tercile). In girls, the ARI-U5MR for 2005 and 2013 in the poorest tercile was 1.5 and 2 times greater than in the first tercile, respectively.

CONCLUSION

Colombian inequalities in the ARI mortality rate among the poorest municipalities compared to the richest ones continue to be a major challenge in public health.

Determinants of neonatal, infant and under-five mortality in a war-affected country: analysis of the 2010 Household Health Survey in South Sudan

Background

Under-five children born in a fragile and war-affected setting of South Sudan are faced with a high risk of death as reflecting in high under-five mortality. In South Sudan health inequities and inequitable condition of daily living play a significant role in childhood mortality. This study examines factors associated with under-five mortality in South Sudan.

Methods

The study population includes 8125 singleton, live birth, under-five children born in South Sudan within 5 years prior to the 2010 South Sudan Household Survey. Factors associated with neonatal, infant and under-five deaths were examined using generalised linear latent and mixed models with the logit link and binomial family that adjusted for cluster and survey weights.

Results

The multivariate analysis showed that mothers who reported a previous death of a child reported significantly higher risk of neonatal (adjusted OR (AOR)=3.74, 95% confidence interval (CI 2.88 to 4.87), P<0.001), infant (AOR=3.19, 95% CI (2.62 to 3.88), P<0.001) and under-five deaths (AOR=3.07, 95% CI (2.58 to 3.64), P<0.001). Other associated factors included urban dwellers (AOR=1.37, 95% CI (1.01 to 1.87), P=0.045) for neonatal, (AOR=1.35, 95% CI (1.08 to 1.69), P=0.009) for infants and (AOR=1.39, 95% CI (1.13 to 1.71), P=0.002) for under-five death. Unimproved sources of drinking water were significantly associated with neonatal mortality (AOR=1.91, 95% CI (1.11 to 3.31), P=0.02).

Conclusions

This study suggested that the condition and circumstances in which the child is born into, and lives with, play a role in under-five mortality, such as higher mortality among children born to teenage mothers. Ensuring equitable healthcare service delivery to all disadvantaged populations of children in both urban and rural areas is essential but remains a challenge, while violence continues in South Sudan.

Risk factors for infant mortality in rural and urban Nigeria: evidence from the national household survey

AIMS

This study investigates the rural-urban differences in infant mortality rates (IMRs) and the associated risk factors in Nigeria.

METHODS

The dataset from the 2013 Nigeria demographic and health survey (NDHS), disaggregated by rural-urban residence, was analyzed using complex samples statistics. A multivariable logistic regression analysis was computed to explore the adjusted relationship and identify risk factors for infant mortality.

RESULTS

In rural and urban Nigeria, IMRs were 70 and 49 deaths per 1000 live births, respectively. Risk factors in rural residence were past maternal marital union (adjusted odds ratio (AOR): 1.625, p = 0.020), small birth size (AOR: 1.550, p < 0.001), birth interval <24 months (AOR: 2.057, p < 0.001), residence in North-East (AOR: 1.346, p = 0.038) and North-West (AOR: 1.653, p < 0.001) regions, and cesarean delivery (AOR: 2.922, p = 0.001). Risk factors in urban residence were poor wealth index (AOR: 2.292, p < 0.001), small birth size (AOR: 2.276, p < 0.001), male gender (AOR: 1.416, p = 0.022), birth interval <24 months (AOR: 1.605, p = 0.002), maternal obesity (AOR: 1.641, p = 0.008), and cesarean delivery (AOR: 1.947, p = 0.032).

CONCLUSIONS

Infants in rural residence had higher rates of mortality than their urban counterparts and disparities in risk factors exist between the residences.

Factors associated with infant mortality in Nepal: a comparative analysis of Nepal demographic and health surveys (NDHS) 2006 and 2011

Background

Infant mortality is one of the priority public health issues in developing countries like Nepal. The infant mortality rate (IMR) was 48 and 46 per 1000 live births for the year 2006 and 2011, respectively, a slight reduction during the 5 years’ period. A comprehensive analysis that has identified and compared key factors associated with infant mortality is limited in Nepal, and, therefore, this study aims to fill the gap.

Methods

Datasets from Nepal Demographic and Health Surveys (NDHS) 2006 and 2011 were used to identify and compare the major factors associated with infant mortality. Both surveys used multistage stratified cluster sampling techniques. A total of 8707 and 10,826 households were interviewed in 2006 and 2011, with more than 99% response rate in both studies. The survival information of singleton live-born infants born 5 years preceding the two surveys were extracted from the ‘childbirth’ dataset. Multiple logistic regression analysis using a hierarchical modelling approach with the backward elimination method was conducted. Complex Samples Analysis was used to adjust for unequal selection probability due to the multistage stratified cluster-sampling procedure used in both NDHS.

Results

Based on NDHS 2006, ecological region, succeeding birth interval, breastfeeding status and type of delivery assistance were found to be significant predictors of infant mortality. Infants born in hilly region (AOR = 0.43, p = 0.013) and with professional assistance (AOR = 0.27, p = 0.039) had a lower risk of mortality. On the other hand, infants with succeeding birth interval less than 24 months (AOR = 6.66, p = 0.001) and those who were never breastfed (AOR = 1.62, p = 0.044) had a higher risk of mortality.

Based on NDHS 2011, birth interval (preceding and succeeding) and baby’s size at birth were identified to be significantly associated with infant mortality. Infants born with preceding birth interval (AOR = 1.94, p = 0.022) or succeeding birth interval (AOR = 3.22, p = 0.002) shorter than 24 months had higher odds of mortality while those born with a very large or larger than average size had significantly lowered odds (AOR = 0.17, p = 0.008) of mortality.

Conclusion

IMR and associated risk factors differ between NDHS 2006 and 2011 except ‘succeeding birth interval’ which attained significant status in the both study periods. This study identified the ecological region, birth interval, delivery assistant type, baby’s birth size and breastfeeding status as significant predictors of infant mortality.