Abstract
BackgroundThe probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country’s socioeconomic-related child health inequality.MethodologyUsing data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality.FindingsDespite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery.ConclusionThe Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality – that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system – to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health.
Highlights
The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality – that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system – to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health
Data The data utilised for this analysis was derived from the Philippines Demographic and Health Surveys (DHS) conducted in 1993, 1998, 2003, and 2008
Trends and Disparities in Child Mortality Consistent with many large developing countries, our results illustrate that the Philippines has experienced a decline in underfive and infant mortality at the national level
Summary
Socioeconomic inequalities are gathering momentum as a significant issue beyond the Millennium Development Goal (MDG) deadline in 2015.[1,2,3] There is increasing evidence that substantial inequalities in health across a number of dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries.[4,5,6,7,8] it has been suggested that inequalities may have widened in recent times. [9,10] Persistent inequalities represent a major policy challenge [11] and have prompted a renewed interest in the topic, especially in developing countries.[12,13,14,15].The Philippines provides an opportune context to investigate such issues. Socioeconomic inequalities are gathering momentum as a significant issue beyond the Millennium Development Goal (MDG) deadline in 2015.[1,2,3] There is increasing evidence that substantial inequalities in health across a number of dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries.[4,5,6,7,8] it has been suggested that inequalities may have widened in recent times. [20] On the other hand, in recent years there have been limited improvements in maternal and reproductive health and increasing out-of-pocket expenditure. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country’s socioeconomic-related child health inequality
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