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.
Highlights
7.6 million children died in 2010 before reaching their fifth birthday and 40% of these deaths occur in the neonatal period
About one third of the mothers perceived that their babies were smaller than average birth size
Main findings The current study found that male infants, smaller than average birth size and delivery complications were significantly associated with higher risk of neonatal mortality in Pakistan
Summary
7.6 million children died in 2010 before reaching their fifth birthday and 40% of these deaths occur in the neonatal period. Despite having made significant progress in incorporating newborn care into national policies and programs and improvement in coverage of several interventions relevant to newborn survival during the last decade, neonatal mortality has declined slowly with an annualized decline of 0.9% during the same period [8]. This shows that the current rate of decline will be insufficient for the country to reach its child survival MDG. The latest Pakistan Demographic and Health survey (PDHS) 2012–13 reported a neonatal mortality of 55 per 1,000 live births [9]
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