Abstract
BackgroundInfant mortality is one of the priority public health issues in developing countries like Nepal. The infant mortality rate (IMR) was 48 and 46 per 1000 live births for the year 2006 and 2011, respectively, a slight reduction during the 5 years’ period. A comprehensive analysis that has identified and compared key factors associated with infant mortality is limited in Nepal, and, therefore, this study aims to fill the gap.MethodsDatasets from Nepal Demographic and Health Surveys (NDHS) 2006 and 2011 were used to identify and compare the major factors associated with infant mortality. Both surveys used multistage stratified cluster sampling techniques. A total of 8707 and 10,826 households were interviewed in 2006 and 2011, with more than 99% response rate in both studies. The survival information of singleton live-born infants born 5 years preceding the two surveys were extracted from the ‘childbirth’ dataset. Multiple logistic regression analysis using a hierarchical modelling approach with the backward elimination method was conducted. Complex Samples Analysis was used to adjust for unequal selection probability due to the multistage stratified cluster-sampling procedure used in both NDHS.ResultsBased on NDHS 2006, ecological region, succeeding birth interval, breastfeeding status and type of delivery assistance were found to be significant predictors of infant mortality. Infants born in hilly region (AOR = 0.43, p = 0.013) and with professional assistance (AOR = 0.27, p = 0.039) had a lower risk of mortality. On the other hand, infants with succeeding birth interval less than 24 months (AOR = 6.66, p = 0.001) and those who were never breastfed (AOR = 1.62, p = 0.044) had a higher risk of mortality.Based on NDHS 2011, birth interval (preceding and succeeding) and baby’s size at birth were identified to be significantly associated with infant mortality. Infants born with preceding birth interval (AOR = 1.94, p = 0.022) or succeeding birth interval (AOR = 3.22, p = 0.002) shorter than 24 months had higher odds of mortality while those born with a very large or larger than average size had significantly lowered odds (AOR = 0.17, p = 0.008) of mortality.ConclusionIMR and associated risk factors differ between NDHS 2006 and 2011 except ‘succeeding birth interval’ which attained significant status in the both study periods. This study identified the ecological region, birth interval, delivery assistant type, baby’s birth size and breastfeeding status as significant predictors of infant mortality.
Highlights
Infant mortality is one of the priority public health issues in developing countries like Nepal
Despite the reduction in infant mortality by two thirds by many countries indicating a progress towards achieving the millennium development goal (MDG)-4 by the year 2015, this has not been evident in sub-Saharan Africa and some Asian countries including Nepal [5, 6]
This study found four factors in Nepal Demographic and Health Surveys (NDHS) 2006 and three factors in NDHS 2011 that were significantly associated with infant mortality based on the final overall model
Summary
Infant mortality is one of the priority public health issues in developing countries like Nepal. The infant mortality rate (IMR) was 48 and 46 per 1000 live births for the year 2006 and 2011, respectively, a slight reduction during the 5 years’ period. Infant mortality remains a major public health priority in many developing countries, and strategies aimed at addressing this challenge are of paramount importance. The infant mortality rate (IMR) has been declining steadily over the last century around the world; some developing countries like Nepal are still far behind. Despite the reduction in infant mortality by two thirds by many countries indicating a progress towards achieving the millennium development goal (MDG)-4 by the year 2015, this has not been evident in sub-Saharan Africa and some Asian countries including Nepal [5, 6]. Global decline of child mortality is dominated by the slow decline in sub-Saharan Africa [9]
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