Exploring causal pathways for factors associated with neonatal, infant and under-five mortality, analysis of 2015-2016 Myanmar Demographic Health Survey

Abstract

Background Background This study explores the intermediate and proximate causal factors associated with under-five mortality in Myanmar in order to help policymakers to assess and formulate appropriate interventions to prevent neonatal, infant and under-five deaths. Methods Methods We examined the data from the 2015-2016 Myanmar Demographic and Health Survey. The study population consisted of 4198 live born singleton children born within five years prior to the survey. We used logistic binomial regression and multivariate models adjusted for cluster and survey weights to examine the potential factors associated with neonatal, infant and under-five mortality. Results Results There were 162 under-five deaths with an estimated neonatal mortality rate of 20 per 1000 live births, an infant mortality rate of 35 per 1000 live births and an under-five mortality rate of 45 per 1000 live births. In the multivariate analysis never breastfeed (adjusted odds ratio (AOR)=36.34, 95% confidence interval (CI)=17.58 to 75.12), unweighed at birth (AOR=4.16, 95% CI=1.58 to 11.00), smaller than average size children (AOR=3.33, 95% CI=1.44 to 7.68), and natural wall material (AOR= 4.22, 95% CI=1.36, 13.09) were risks for neonatal mortality. Children born to the lowest wealth quintile households were more likely to die during the infant (AOR= 2.82, 95% CI=1.28, 6.20) and under five period (AOR= 3.83, 95% CI=1.76, 8.32) compared to those born to the richest wealth quintile households. Preceding birth interval < 3 years was associated with infant death (AOR= 2.26, 95% CI=1.31, 3.89) and under five death (AOR= 2.02, 95% CI=1.10, 3.70). Maternal education, age working status, and non-caesarean births were risk factors for infant and under-five mortality. Conclusions Conclusions Improving survival of under-five children in Myanmar will require implementing evidence-based interventions that target population subgroups such as poor households, neonates with low birth weight and size; improving women's access to family planning services and enhancing women and adolescent girl's education attainment. Globally, about 5.6 million under-five children die annually, and of these deaths, approximately 2.6 million, or 46% die in the first month of life, the neonatal period. 1 This translates to approximately 7,000 newborns dying every day. 1 Most of these deaths are preventable or treatable with access to proven, cost-effective interventions. The burden of neonatal and under-five deaths is unevenly distributed across regions and countries. For instance, almost 80% of global neonatal deaths occur in sub-Saharan Africa (37%) and the Southern Asian regions (39%). 2 This distribution is mostly due to inequities in development. 3 Reducing inequities that affect the most vulnerable under-five children are essential to achieving the Sustainable Development Goals target of reducing the under-five mortality rate to 25 or fewer deaths per 1000 live births by 2030. 4 Myanmar is an ethnically diverse country in Southeast Asia, with a population of approximately 5...

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