Abstract
BackgroundInequalities in progress towards achievement of Millennium Development Goal four (MDG-4) reflect unequal access to child health services.ObjectiveTo examine the time trends, socio-economic and regional inequalities of under-five mortality rate (U5MR) in Nepal.MethodsWe analyzed the data from complete birth histories of four Nepal Demographic and Health Surveys (NDHS) done in the years 1996, 2001, 2006 and 2011. For each livebirth, we computed survival period from birth until either fifth birthday or the survey date. Using direct methods i.e. by constructing life tables, we calculated yearly U5MRs from 1991 to 2010. Projections were made for the years 2011 to 2015. For each NDHS, U5MRs were calculated according to child's sex, mother’s education, household wealth index, rural/urban residence, development regions and ecological zones. Inequalities were calculated as rate difference, rate ratio, population attributable risk and hazard ratio.ResultsYearly U5MR (per 1000 live births) had decreased from 157.3 (95% CIs 178.0-138.9) in 1991 to 43.2 (95% CIs 59.1-31.5) in 2010 i.e. 114.1 reduction in absolute risk. Projected U5MR for the year 2015 was 54.33. U5MRs had decreased in absolute terms in all sub groups but relative inequalities had reduced for gender and rural/urban residence only. Wide inequalities existed by wealth and education and increased between 1996 and 2011. For lowest wealth quintile (as compared to highest quintile) hazard ratio (HR) increased from 1.37 (95% CIs 1.27, 1.49) to 2.54 ( 95% CIs 2.25, 2.86) and for mothers having no education (as compared to higher education) HR increased from 2.55 (95% CIs 1.95, 3.33) to 3.75 (95% CIs 3.17, 4.44). Changes in regional inequities were marginal and irregular.ConclusionsNepal is most likely to achieve MDG-4 but eductional and wealth inequalities may widen further. National health policies should address to reduce inequalities in U5MR through ‘inclusive policies'.
Highlights
9-10 million children die each year before reaching their fifth birthday[1]
U5MR in 1994 was 85.6 whereas U5MR in 2008 was 61.6corrresponding to a change of 22.6 in absolute risk or 36.7% decline in U5MR between NDHS1996 and Nepal Demographic and Health Surveys (NDHS) 2011
Inequalities in U5MR according to various sub groups Number of births and under-five child deaths in each survey revealed that inequalities were present according to sub groups
Summary
9-10 million children die each year before reaching their fifth birthday[1]. Despite a steady progress made towards achieving MDG-4 in many countries[4,5], decline of U5MR in sub-Saharan Africa and some Asian countries has been slow[6] and socio-economic inequalities exist in terms mortality as well as coverage indicators of child survival interventions[4,7,8,9]. Nepal's success towards likely achievement of MDG-4 can be attributed to several child survival interventions implemented by the Government of Nepal(GoN). Methods: We analyzed the data from complete birth histories of four Nepal Demographic and Health Surveys (NDHS) done in the years 1996, 2001, 2006 and 2011.
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