Abstract
A high infant mortality rate (IMR) indicates a failure to meet people’s healthcare needs. The IMR in Lao People’s Democratic Republic has been decreasing but still remains high. This study aimed to identify the factors involved in the high IMR by analyzing data from 53,727 live births and 2189 women from the 2017 Lao Social Indicator Survey. The estimated IMR decreased from 191 per 1000 live births in 1978–1987 to 39 in 2017. The difference between the IMR and the neonatal mortality rate had declined since 1978 but did not change after 2009. Factors associated with the high IMR in all three models (forced-entry, forward-selection, and backward-selection) of multivariate logistic regression analyses were auxiliary nurses as birth attendants compared to doctors, male infants, and small birth size compared to average in all 2189 women; and 1–3 antenatal care visits compared to four visits, auxiliary nurses as birth attendants compared to doctors, male infants, postnatal baby checks, and being pregnant at the interview in 1950 women whose infants’ birth size was average or large. Maternal and child healthcare and family planning should be strengthened including upgrading auxiliary nurses to mid-level nurses and improving antenatal care quality.
Highlights
Infant mortality is a major health problem around the world
Multivariable logistic regression analyses using all variables showed that not having a tetanus immunization during the last pregnancy (adjusted odds ratio (AOR) = 1.54), auxiliary nurses as birth attendants compared to doctors (AOR = 6.91), male babies (AOR = 1.64), and babies being small at birth compared to average (AOR = 3.16) were significantly associated with higher infant mortality (Tables 1, 2, 3)
Factors associated with high infant mortality in all three models were (1) having auxiliary nurses as birth attendants compared to doctors, male infants, and small infants in all women (Table 4); and (2) being pregnant at the time of interview, 1–3 antenatal care (ANC) visits compared to four or more, having auxiliary nurses as birth attendants compared to doctors, having male infants, and having a postnatal baby check in women whose babies were average or large at birth (Table 5)
Summary
Infant mortality is a major health problem around the world. Globally, the estimated infant mortality in 2018 was 4.0 million, accounting for 75.5% of all deaths of children under 5-years[1]. The infant mortality rate (IMR) can serve as a health indicator of whole populations and of countries’ socio-economic c onditions[4]. A high IMR indicates a failure to meet people’s healthcare needs and suggests the presence of environmental factors unfavorable for infants. Predictive factors for infant mortality fall into three main categories: distal (socio-economic and demographic) factors; intermediate (maternal, reproductive, and healthcare delivery) factors; and proximal (neonatal) factors[5]. As a result of expanding health service delivery and improving healthcare quality, the IMR of Lao PDR declined; the improvement was slow[8,11], and it remains the highest in Southeast Asia, except for Timor-Leste[12]. This study aimed to show the infant mortality trends and to identify factors associated with infant mortality by secondary analysis of the LSIS-II data
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