Determinants of neonatal mortality in Pakistan: secondary analysis of Pakistan Demographic and Health Survey 2006–07

Abstract

BackgroundGlobally 7.6 million children died in 2010 before reaching their fifth birthday and 40% of these deaths occur in the neonatal period. Pakistan has the third highest rate of neonatal mortality globally. To implement evidence-based interventions for the reduction of neonatal mortality, it is important to investigate factors associated with neonatal mortality. The aim of the current study was to identify determinants of neonatal mortality in Pakistan.MethodsData was derived from the Pakistan Demographic and Health Survey 2006–07. All singleton live births between 2002 and 2006 were selected for the current analyses. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Multivariate Cox proportional hazard models were performed using step-wise backward elimination procedures to identify the determinants of neonatal mortality.ResultsA total of 5,702 singleton live births in the last five years preceding the survey were selected. Multivariate analyses showed that living in Punjab province (Adj HR = 2.10, p = 0.015), belonging to the poorest household wealth index quintile (Adj HR = 1.95, p = 0.035), male infants (Adj HR = 1.57, p = 0.014), first rank baby (Adj HR = 1.59, p = 0.049), smaller than average birth size (Adj HR = 1.61, p = 0.023) and mothers with delivery complications (Adj HR = 1.93, p = 0.001) had significantly higher hazards of neonatal death in Pakistan.ConclusionsTo reduce neonatal mortality, there is a need to implement interventions focusing on antenatal care, effective referral system and retraining of healthcare providers to manage delivery complications and smaller than average birth size babies in resource poor communities of Pakistan.

Social determinants and causes of child mortality in Pakistan: Analysis of national demographic health surveys from 1990 to 2013

“…Based on our analyses, neonatal death in Pakistan is associated with low maternal education, wealth quintile, previous birth interval of <2 years, birth order of 1 or ≥7, and very small birth size. Similar findings were reported by 2006–2007 survey analysis conducted to identify determinants of neonatal mortality in Pakistan . Taken together, with 55 deaths per 1000 live births, it seems clear that Pakistan has failed to achieve the MDGs.…”

“…Similar findings were reported by 2006-2007 survey analysis conducted to identify determinants of neonatal mortality in Pakistan. 13 Taken together, with 55 deaths per 1000 live births, it seems clear that Pakistan has failed to achieve the MDGs.…”

Antenatal iron–folic acid supplementation reduces risk of low birthweight in Pakistan: secondary analysis of Demographic and Health Survey 2006–2007

“…). Our previous secondary analyses of PDHS 2006–2007 showed an association between smaller than average birth size (a surrogate for LBW) and neonatal mortality in Pakistan (Nisar & Dibley ). The aim of the current study was to examine the impact of antenatal IFA supplementation on perceived birth size and birthweight in Pakistan over a 5‐year period from 2002 to 2006.…”

In-depth Validation of CHERG’S Verbal Autopsy-Social Autopsy (VASA) Tool for Ascertaining Determinants and Causes of Under-Five Child Mortalities in Karachi, Pakistan.

“…However, no attempts have been made in validating the SA, as well as the integrated VASA tool. Keeping in view of the current status of child mortality estimates in Pakistan (which stresses upon the fact that the country is among the top ten countries which hold signi cant burden of child mortality across the globe (20)(21)(22)), a VASA ICMI study has been undertaken in Karachi. The primary aim of VASA ICMI study was to gather evidence on a comprehensive list of determinants related to under-ve mortality in the underserved locations where there is a high chance that the child mortality cases might be missed to be registered under national CRVS and HMIS.…”