The unfinished health agenda: Neonatal mortality in Cambodia

Abstract

BackgroundReduction of neonatal and under-five mortality rates remains a primary target in the achievement of universal health goals, as evident in renewed investments of Sustainable Development Goals. Various studies attribute declines in mortality to the combined effects of improvements in health care practices and changes in socio-economic factors. Since the early nineties, Cambodia has managed to evolve from a country devastated by war to a nation soon to enter the group of middle income countries. Cambodia's development efforts are reflected in some remarkable health outcomes such as a significant decline in child mortality rates and the early achievement of related Millennium Development Goals. An achievement acknowledged through the inclusion of Cambodia as one of the ten fast-track countries in the Partnership for Maternal, Newborn and Child Health. This study aims to highlight findings from the field so to provide evidence for future programming and policy efforts. It will be argued that to foster further advances in health, Cambodia will need to keep neonatal survival and health high on the agenda and tackle exacerbating inequities that arise from a pluralistic health system with considerable regional differences and socio-economic disparities.Methods/FindingsData was drawn from Demographic Health Surveys (2000, 2005, 2010, 2014). Information on a series of demographic and socio-economic household characteristics and on child anthropometry, feeding practices and child health were collected from nationally representative samples. To reach the required sample size, live-births that occurred over the past 10 years before the date of the interview were included. Demographic variables included: gender of the child, living area (urban or rural; four ecological regions (constructed by merging provinces and the capital), mother’s age at birth (<20, 20–35, 35+), birth interval (long, short) and birth order (1st, 2–3, 4–6, 7+). Socio-economic variables included: mother education level (none, primary, secondary+) and household wealth (asset-based index). Data on antenatal care, tetanus injection and skilled assistance at birth were used for the mother's last child.Between 2000 and 2014, Cambodia achieved a considerable reduction in neonatal mortality (46% reduction rate). By 2014, gender inequities became almost non-existent (for all measures of equality); inequity related to mother’s education decreased for all time periods; improvements were observed for differences in neonatal mortality by preceding birth interval; and a reduction in neonatal mortality rates could be noted among all the regional subgroups. Inequities increased between mothers who had limited antenatal care and those who received more than four antenatal care visits. In most scale indicators, the Slope Index of Inequality and Relative Index of Inequality estimates for all four rounds of the survey suggest inequity exacerbated in deprived communities. Also, wealth and residence (urban/rural divide) continued to be major determinants in neonatal m...

Time trends, geographical, socio-economic, and gender disparities in neonatal mortality in Burundi: evidence from the demographic and health surveys, 2010–2016

“…It's worth noting that both the relative disparities were significantly reduced from 2010 to 2016 and the absolute education-related inequality could not be detected in 2016 altogether, a finding that might signal the country's commitment in providing good health care services for the entire population including the uneducated. Consistent with a previous study [28], our finding also shows lower NMR among newborns of educated mothers. This could be due to better birth spacing, better awareness and utilization of prenatal care and health services among educated mothers [29,30].…”

The Trends of Neonatal Mortality Rate Among South East Asia Countries from 2000-2017

“…Many pregnant women rarely visited healthcare services or clinic to get antenatal care (32). The occurrence of birth asphyxia in Cambodia was related to geographical area (urban and rural) and continuum care of maternal and wealth inequities (33). The declining of premature birth and asphyxia might be due to the successful policy of Health Strategic Plan 2008-2015, which comprised: optimization of primary healthcare; health services accessibility; empowering human resources to handle maternal, neonatal, child health, degenerative diseases; and the distribution for health care workers that focus on nine priority health sector reform (16,17).…”

Sociodemographic characteristics associated with the utilization of maternal health services in Cambodia

“…Since obtaining independence in 1953, the country has made significant improvements in terms of reducing the percentage of absolute poverty, malnutrition, and improving the key public health indicators such as maternal and child mortality rates. Between 2000 and 2014, Cambodia managed to cut the rate of neonatal mortality by 46% [1] in parallel with an equally impressive gain in reducing maternal mortality (488 in 2000 to 160 in 2017) [2]. Despite these major advancements, the country still ranks among the least developed countries and faces critical challenges for meeting the millennium and sustainable development goals.…”