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

Abstract

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.

Analytical Study For Cases with Neonatal Emergencies Admitted in Al-Azhar Assuit Neonatal Intensive Care Unit

“…provide life support to neonates; however, admission to an NICU entails risks for both families and their admitted infants, including high costs. [1,2].…”

“…The efficient health care services of a country are categorized from neonatal morbidity and mortality [1,2]. Studies reported around 3 million mortality in neonates observed during this period, amounting to total of 45% of under-five deaths worldwide [1,3]. According to World Health Organization (WHO), 2015 nearly 2.7 million children died globally in the neonatal period, contributing to 45% of the total (under five mortality).…”

“…Neonatal deaths are due to infections, prematurity and perinatal asphyxia but recrudescence of these deaths differ between NICUs [8]. In a recently published study reporting the national demographic health survey it was reported that the annual rates of reduction for child mortality among neonates was -0.33% per annum, 3.13% per annum among post-neonatal, 0.9% per annum for infant, 2.47% per annum for child, and 1.19% per annum for under five [1].…”

Impact of High-Risk Fertility Behaviour on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

“…Though many studies have identified a wide array of risk factors of child mortality such as size of child at birth [23] and women empowerment [24], antenatal care visit [25], our criterion for including the confounding variables was that they should be associated with both the HRFB and child mortality. As only those confounding factors can be appropriate for this study which occurred before the HRFB and, by implication, before the birth of the index child, size of child at birth, antenatal care visits and women's empowerment are, therefore, not included in the list of confounding factors.…”

Impact of High-Risk Fertility Behaviour on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

“…Though many studies have identified a wide array of risk factors of child mortality such as size of child at birth [23] and women empowerment [24], antenatal care visit [25], our criterion for including the confounding variables was that they should be associated with both the HRFB and child mortality. As only those confounding factors can be appropriate for this study which occurred before the HRFB and, by implication, before the birth of the index child, size of child at birth, antenatal care visits and women's empowerment are, therefore, not included in the list of confounding factors.…”