Aim The aim of the study was to define social determinants, causes and trends in child mortality from 1990 to 2013 in Pakistan. Understanding social determinants, causes and temporal trends in child mortality can inform strategies aimed at improving child health in low and middle income countries. Methods We characterised temporal trends and social determinants of child mortality in Pakistan using national demographic health survey data (1990–1991, 2006–2007 and 2012–2013). We analysed national data to generate regional estimates of health programme effectiveness. Results The annual rates of reduction for child mortality between 1990 and 2013 were estimated as follows: neonatal (−0.33% per annum), post‐neonatal (3.13% per annum), infant (0.9% per annum), child (2.47% per annum) and under 5 (1.19% per annum). Bivariate analyses of 2013 data showed that living in Punjab or Balochistan province, belonging to lowest wealth quintile, lack of maternal education, previous birth interval < 2 years, first birth order and below average birth size were associated (p < 0.05) with greater risk of child mortality in Pakistan. Common factors associated with child mortality were fever, diarrhoea and pneumonia, while among stillbirths, intrapartum asphyxia, unexplained antepartum and antepartum maternal disorders were most frequent. Conclusion Child survival strategies should integrate leading biosocial indicators and causes of death. Further research is needed to define the role(s) of social factors in child health and survival. These data should inform the implementation of cost‐effective interventions for child survival and advance targeting of interventions to populations at increased risk of child mortality.

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Background Globally 3 million stillbirths occur per year, and Pakistan is ranked 3 rd among the countries having the highest burden. Despite being a major public health problem, efforts to reduce this figure are insufficient. Objective The aim of the study was to identify and measure the inequalities in stillbirth associated risk factors, causes and fertility risk behaviors. Methods Data were derived from the Pakistan Demographic and Health Surveys (PDHS) 1990–2013. Inequalities on determinants were evaluated using rate differences and rate ratios; time trends computed with annualized reduction rate (ARR). Results Overall ARR determined for stillbirth was −12.52 percent per annum. The high ARR were recorded for mothers age <20, urban areas, educated mothers and for highest wealth quintile. The relative inequalities were most pronounced for wealth quintiles, education and age of mothers. Stillbirth causes were unexplained antepartum (33%), unexplained intrapartum (21%), intrapartum asphyxia (21%) and antepartum maternal disorders (19%). The high fertility risk behavior was found in mothers with age >34 and birth order >3. Conclusion The study concluded that to achieve gain in child survival, there is need to promote antenatal care, birth spacing, and family planning programs in developing countries.

In this paper, we propose an exponential cum ratio-product type class of estimators for population median under simple random sampling scheme using the supplementary variable. Expressions for bias and mean square error (MS E) are obtained up to first order of approximation. The proposed class of estimators is more efficient as compared to all considered estimators under certain conditions. Four real data sets and simulation studies are carried out to observe the performances of the estimators. Both numerical and simulation studies show that the proposed class of estimators performs better as compared to all considered estimators.