Abstract
IntroductionNepal has made considerable progress on improving child survival during the Millennium Development Goal period, however, further progress will require accelerated reduction in neonatal mortality. Neonatal survival is one of the priorities for Sustainable Development Goals 2030. This paper examines the trends, equity gaps and factors associated with neonatal mortality between 2001 and 2016 to assess the likelihood of Every Newborn Action Plan (ENAP) target being reached in Nepal by 2030.MethodsThis study used data from the 2001, 2006, 2011 and 2016 Nepal Demographic and Health Surveys. We examined neonatal mortality rate (NMR) across the socioeconomic strata and the annual rate of reduction (ARR) between 2001 and 2016. We assessed association of socio-demographic, maternal, obstetric and neonatal factors associated with neonatal mortality. Based on the ARR among the wealth quintile between 2001 and 2016, we made projection of NMR to achieve the ENAP target. Using the Lorenz curve, we calculated the inequity distribution among the wealth quintiles between 2001 and 2016.ResultsIn NDHS of 2001, 2006, 2011 and 2016, a total of 8400, 8600, 13,485 and 13,089 women were interviewed respectively. There were significant disparities between wealth quintiles that widened over the 15 years. The ARR for NMR declined with an average of 4.0% between 2001 and 2016. Multivariate analysis of the 2016 data showed that women who had not been vaccinated against tetanus had the highest risk of neonatal mortality (adjusted odds ratio [AOR] 3.38; 95% confidence interval [CI] 1.20–9.55), followed by women who had no education (AOR 1.87; 95% CI 1.62–2.16). Further factors significantly associated with neonatal mortality were the mother giving birth before the age of 20 (AOR 1.76; CI 95% 1.17–2.59), household air pollution (AOR 1.37; CI 95% 1.59–1.62), belonging to a poorest quintile (AOR 1.37; CI 95% 1.21–1.54), residing in a rural area (AOR 1.28; CI 95% 1.13–1.44), and having no toilet at home (AOR 1.21; CI 95% 1.06–1.40). If the trend of neonatal mortality rate of 2016 continues, it is projected that the poorest family will reach the ENAP target in 2067.ConclusionsAlthough neonatal mortality is declining in Nepal, if the current trend continues it will take another 50 years for families in the poorest group to attain the 2030 ENAP target. There are different factors associated with neonatal mortality, reducing the disparities for maternal and neonatal care will reduce mortality among the poorest families.
Highlights
Nepal has made considerable progress on improving child survival during the Millennium Development Goal period, further progress will require accelerated reduction in neonatal mortality
The Millennium Development Goals (MDGs) placed maternal and child health at front and centre of the global health agenda resulting in unprecedented attention and investment in reproductive, maternal and child health (UNICEF 2019; United Nations 2001) Globally, the under-five mortality rate (MDG 4) reduced by 52% and the maternal mortality ratio (MDG 5) by 30% over the MDG period (1990–2015) (Kassebaum et al 2016; Wang et al 2016)
Towards the end of the MDG era in 2014, there was a global call for action for reducing neonatal mortality through the Every Newborn Action Plan (ENAP) (World Health Organisation 2014)
Summary
Nepal has made considerable progress on improving child survival during the Millennium Development Goal period, further progress will require accelerated reduction in neonatal mortality. This paper examines the trends, equity gaps and factors associated with neonatal mortality between 2001 and 2016 to assess the likelihood of Every Newborn Action Plan (ENAP) target being reached in Nepal by 2030. Conclusions neonatal mortality is declining in Nepal, if the current trend continues it will take another 50 years for families in the poorest group to attain the 2030 ENAP target. The Millennium Development Goals (MDGs) placed maternal and child health at front and centre of the global health agenda resulting in unprecedented attention and investment in reproductive, maternal and child health (UNICEF 2019; United Nations 2001) Globally, the under-five mortality rate (MDG 4) reduced by 52% and the maternal mortality ratio (MDG 5) by 30% over the MDG period (1990–2015) (Kassebaum et al 2016; Wang et al 2016). To further accelerate reduction in neonatal mortality, investment was pledged by the government and its development partners under Nepal’s Every Newborn Action Plan (NENAP) (Ministry of Health and Population 2016). The Government of Nepal has promoted newborn health in partnership with developmental partners, academia and professional associations (Ministry of Health and Population, Nepal 2016)
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