Tracking progress towards equitable child survival in a Nicaraguan community: neonatal mortality challenges to meet the MDG 4

Wilton Pérez,Carina Källestål,Lars-Åke Persson,Rodolfo Peña

doi:10.1186/1471-2458-11-455

Abstract

BackgroundNicaragua has made progress in the reduction of the under-five mortality since 1980s. Data for the national trends indicate that this poor Central American country is on track to reach the Millennium Development Goal-4 by 2015. Despite this progress, neonatal mortality has not showed same progress. The aim of this study is to analyse trends and social differentials in neonatal and under-five mortality in a Nicaraguan community from 1970 to 2005.MethodsTwo linked community-based reproductive surveys in 1993 and 2002 followed by a health and demographic surveillance system providing information on all births and child deaths in urban and rural areas of León municipality, Nicaragua. A total of 49 972 live births were registered.ResultsA rapid reduction in under-five mortality was observed during the late 1970s (from 103 deaths/1000 live births) and the 1980s, followed by a gradual decline to the level of 23 deaths/1000 live births in 2005. This community is on track for the Millennium Development Goal 4 for improved child survival. However, neonatal mortality increased lately in spite of a good coverage of skilled assistance at delivery. After some years in the 1990s with a very small gap in neonatal survival between children of mothers of different educational levels this divide is increasing.ConclusionsAfter the reduction of high under-five mortality that coincided with improved equity in survival in this Nicaraguan community, the current challenge is the neonatal mortality where questions of an equitable perinatal care of good quality must be addressed.

Highlights

Nicaragua has made progress in the reduction of the under-five mortality since 1980s
This study aims at analysing trends and social differentials in neonatal and under-five mortality in the municipality of León, Nicaragua, and to relate the findings to the forth Millennium Development Goal as well as to a health equity perspective
We have shown that under-five mortality in this Nicaraguan community rapidly dropped during the 1980s, mainly linked to a pro-poor provision of essential

Summary

Introduction

Nicaragua has made progress in the reduction of the under-five mortality since 1980s. Data for the national trends indicate that this poor Central American country is on track to reach the Millennium Development Goal-4 by 2015. Despite this progress, neonatal mortality has not showed same progress. Of the eight Millennium Development Goals (MDGs) that the world should meet by 2015, the MDG-4 calls for a two-third reduction of under-five mortality. 34% percent of countries in the world are on track to meet this goal [2]. Every year around four million newborns die during the first 28 days of life, three quarters of these deaths occur in the first week and 99 percent take place in developing countries [4]. A small number of affordable and evidence-based services and interventions could result in a substantial reduction of neonatal mortality [5]

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