Inequality in Under-Five Mortality in Iran: A National and Subnational Survey Data Analysis

Rarani, Mostafa Amini; Rashidian, Arash; Arab, Mohammad; Khosravi, Ardeshir; Abbasian, Ezatollah

doi:10.5539/gjhs.v9n3p215

Cited by 4 publications

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“…Simultaneously, national U5M (=19.4) is below the current study observation of 22 and this may show the level of disparity in this indicator in rural Khuzestan as compared to the whole of Iran. Similarly, subnational reports indicating that there are significant differences in mortality rate, for instance, U5M rate for Mazandaran and Zanjan (two of the wealthiest provinces) was 14.6 and 16.4 9 .…”

Section: Discussionmentioning

confidence: 82%

“…This province was the most affected during the eight-year war between Iran and Iraq. Previous studies have shown a high level of disparity in U5M within the province as compared to other provinces 8,9 . Therefore, this study evaluated the prevalence, socio-demographic, and health-related causes of U5M in the rural areas of Khuzestan province, Iran.…”

Section: Introductionmentioning

confidence: 85%

“…Like many other countries, Iran witnessed a steady decline in U5M from 281 cases per 1000 live births in the year 1956 to 16.8 cases per 1000 live births in the year 2013 7 . However, a wide gap has been reported in U5M among rural and urban areas and among different provinces of Iran 8,9 .…”

Section: Introductionmentioning

confidence: 99%

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Temporal and spatial distribution of under-five mortality and factors associated with multiple cases of under-five deaths within a family in the rural area of Khuzestan, Southern Iran

Anafcheh

Doust

Mirkazemi³

et al. 2018

Sci Rep

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Under-five mortality (U5M) is an important indicator of the overall health and development of society. There is a wide gap in U5M among different countries and also within the countries. This study was carried out to assess the prevalence, as well as the socio-demographic, and health-related causes of U5M in the region of study. A cross-sectional study was conducted among all registered cases of U5M in rural areas of Khuzestan province, Iran, during the years 2011 to 2015. To assess the socio-demographic determinants of U5M, the sample surveyed consists of 320 families with at least one under-five death using a multistage random sampling method. Also, this study evaluated the number of variables, which may increase the chance of families to have more than one U5M. U5M was 26 per 1000 live births in 2011, but decreased to 22 per 1000 live births in 2015. With the highest cumulative incidence of 43 in Masjed Soleyman and the lowest of 15 in Dehdez, infant mortality constitutes 76% of all U5M. Prematurity and congenital anomalies were responsible for 46% of all causes of mortality (that is, U5). Maternal age at delivery <18 years or >35 years (OR = 3.5; 95% CI, 1.29–6.22), marriage duration >9 years (1.85, 1.06–3.21), spouse age gap >5 years (2.32, 1.20–4.50), cesarean section (3.85, 1.19–5.74), delivery interval <3 years (2.83, 1.22–5.58), non-Arab ethnicity (2.58, 1.50–4.44), and mother working in agriculture or animal husbandry (3.93, 1.41–6.94) were the most important determinants associated with more than one child death per family. Spatially, there was a great disparity in U5M with different reduction rate during the 5 years of the study. Marriage age, cesarean delivery, delivery interval, and mother field activity were associated with U5M. This may have implications for the preventive health program.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 85%

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Temporal and spatial distribution of under-five mortality and factors associated with multiple cases of under-five deaths within a family in the rural area of Khuzestan, Southern Iran

Anafcheh

Doust

Mirkazemi³

et al. 2018

Sci Rep

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National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment

Chao

You

Pedersen

et al. 2018

The Lancet Global Health

137

116

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SummaryBackgroundThe progress to achieve the fourth Millennium Development Goal in reducing mortality rate in children younger than 5 years since 1990 has been remarkable. However, work remains to be done in the Sustainable Development Goal era. Estimates of under-5 mortality rates at the national level can hide disparities within countries. We assessed disparities in under-5 mortality rates by household economic status in low-income and middle-income countries (LMICs).MethodWe estimated country-year-specific under-5 mortality rates by wealth quintile on the basis of household wealth indices for 137 LMICs from 1990 to 2016, using a Bayesian statistical model. We estimated the association between quintile-specific and national-level under-5 mortality rates. We assessed the levels and trends of absolute and relative disparity in under-5 mortality rate between the poorest and richest quintiles, and among all quintiles.FindingsIn 2016, for all LMICs (excluding China), the aggregated under-5 mortality rate was 64·6 (90% uncertainty interval [UI] 61·1–70·1) deaths per 1000 livebirths in the poorest households (first quintile), 31·3 (29·5–34·2) deaths per 1000 livebirths in the richest households (fifth quintile), and in between those outcomes for the middle quintiles. Between 1990 and 2016, the largest absolute decline in under-5 mortality rate occurred in the two poorest quintiles: 77·6 (90% UI 71·2–82·6) deaths per 1000 livebirths in the poorest quintile and 77·9 (72·0–82·2) deaths per 1000 livebirths in the second poorest quintile. The difference in under-5 mortality rate between the poorest and richest quintiles decreased significantly by 38·8 (90% UI 32·9–43·8) deaths per 1000 livebirths between 1990 and 2016. The poorest to richest under-5 mortality rate ratio, however, remained similar (2·03 [90% UI 1·94–2·11] in 1990, 1·99 [1·91–2·08] in 2000, and 2·06 [1·92–2·20] in 2016). During 1990–2016, around half of the total under-5 deaths occurred in the poorest two quintiles (48·5% in 1990 and 2000, 49·5% in 2016) and less than a third were in the richest two quintiles (30·4% in 1990, 30·5% in 2000, 29·9% in 2016). For all regions, differences in the under-5 mortality rate between the first and fifth quintiles decreased significantly, ranging from 20·6 (90% UI 15·9–25·1) deaths per 1000 livebirths in eastern Europe and central Asia to 59·5 (48·5–70·4) deaths per 1000 livebirths in south Asia. In 2016, the ratios of under-5 mortality rate in the first quintile to under-5 mortality rate in the fifth quintile were significantly above 2·00 in two regions, with 2·49 (90% UI 2·15–2·87) in east Asia and Pacific (excluding China) and 2·41 (2·05–2·80) in south Asia. Eastern and southern Africa had the smallest ratio in 2016 at 1·62 (90% UI 1·48–1·76). Our model suggested that the expected ratio of under-5 mortality rate in the first quintile to under-5 mortality rate in the fifth quintile increases as national-level under-5 mortality rate decreases.InterpretationFor all LMICs (excluding China) combined, the absolute disparitie...

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Socioeconomic Inequality in Malnutrition in Under-5 Children in Iran: Evidence From the Multiple Indicator Demographic and Health Survey, 2010

Kia

Rezapour

Khosravi

et al. 2017

J Prev Med Public Health

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ObjectivesThe aim of this study was to assess the socioeconomic inequality in malnutrition in under-5 children in Iran in order to help policymakers reduce such inequality.MethodsData on 8443 under-5 children were extracted from the Iran Multiple Indicator Demographic and Health Survey. The wealth index was used as proxy for socioeconomic status. Socioeconomic inequality in stunting, underweight, and wasting was calculated using the concentration index. The concentration index was calculated for the whole sample, as well as for subcategories defined in terms of categories such as area of residence (urban and rural) and the sex of children.ResultsStunting was observed to be more prevalent than underweight or wasting. The results of the concentration index at the national level, as well as in rural and urban areas and in terms of children’s sex, showed that inequality in stunting and underweight was statistically significant and that children in the lower quintiles were more malnourished. The wasting index was not sensitive to socioeconomic status, and its concentration index value was not statistically significant.ConclusionsThis study showed that it can be misleading to assess the mean levels of malnutrition at the national level without knowledge of the distribution of malnutrition among socioeconomic groups. Significant socioeconomic inequalities in stunting and underweight were observed at the national level and in both urban and rural areas. Regarding the influence of nutrition on the health and economic well-being of preschool-aged children, it is necessary for the government to focus on taking targeted measures to reduce malnutrition and to focus on poorer groups within society who bear a greater burden of malnutrition.

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Inequality in Under-Five Mortality in Iran: A National and Subnational Survey Data Analysis

Cited by 4 publications

References 0 publications

Temporal and spatial distribution of under-five mortality and factors associated with multiple cases of under-five deaths within a family in the rural area of Khuzestan, Southern Iran

Temporal and spatial distribution of under-five mortality and factors associated with multiple cases of under-five deaths within a family in the rural area of Khuzestan, Southern Iran

National and regional under-5 mortality rate by economic status for low-income and middle-income countries: a systematic assessment

Socioeconomic Inequality in Malnutrition in Under-5 Children in Iran: Evidence From the Multiple Indicator Demographic and Health Survey, 2010

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