Child Mortality In Pakistan Research Articles

Polygyny, Infant, and Child Mortality in Pakistan: Moderating Effect of Household Wealth Status.

The United Nations report in 2021 ranks Pakistan 21st among countries with the highest infant and child mortality rate in the world. It is the fifth most populous country in the world with a growth rate of 2% annually. Therefore, understanding child mortality is crucial to reducing the child mortality burden. The research utilized two waves of the Pakistan Demographic and Health Survey (PDHS), 2012-13 and 2017-18. The data are analyzed using logistic regression with interaction effects of household wealth status and propensity score matching techniques. The study reveals a positive link between polygyny and infant and child mortality. The odd ratios higher than "1" indicate increased mortality risk for infants and children belonging to polygynous families taking monogamous families as a reference category. Mortality risk is higher among children (OR 1.50 CI 0.18-12.63) as compared with infants (OR 1.28 CI 0.37-4.45). The main effect of household shows a negative association with infant and child mortality while after interacting with polygyny it turns out to be positive. The mortality risks increase with increasing wealth status. It can be translated as a positive link between household wealth status, and infant and child mortality in the context of polygyny. Infants and children belonging to polygynous families experience increased mortality risk as compared with monogamous families. The household wealth status may not help improve child mortality.

Losing the female survival advantage: Sex differentials in infant and child mortality in Pakistan

Losing the female survival advantage: Sex differentials in infant and child mortality in Pakistan

Validation of CHERG'S Verbal Autopsy-Social Autopsy (VASA) tool for ascertaining determinants and causes of under-five child mortality in Pakistan.

The majority (40%) of the world's under-five mortality burden is concentrated in nations like Nigeria (16.5%), India (16%), Pakistan (8%), and the Democratic Republic of the Congo (6%), where an undetermined number of under-five deaths go unrecorded. In low-resource settings throughout the world, the Verbal Autopsy-Social Autopsy (VASA) technique may assist assess under-five mortality estimates, assigning medical and social causes of death, and identifying relevant determinants. Uncertainty regarding missing data in high-burden nations like Pakistan necessitates a valid and reliable VASA instrument. This is the first study to validate Child Health Epidemiology Reference Group-CHERG's VASA tool globally. In Pakistan, data from such a valid and reliable tool is vital for policy. This paper reports on the VASA tool in Karachi, Pakistan. Validity and reliability of the CHERG VASA tool were tested using face, content, discriminant validation, and reliability tests on one hundred randomly selected mothers who had recently experienced an under-five child death event. Data were computed on SPSS (version-21) and R software. Testing revealed high Item-content Validity Index (I-CVI) (>81.43%); high Cronbach's Alpha (0.843); the accuracy of between 75-100% of the discriminants classifying births to live and stillbirths; and I-CVI (>82.07% and 88.98% respectively) with high accuracy (92% and 97% respectively) for assigning biological and social causes of child deaths, respectively. The CHERG VASA questionnaire was found relevant to the conceptual framework and valid in Pakistan. This valid tool can assign accurate medical and non-medical causes of child mortality cases occurring in Pakistan.

Spatial spillover impact of determinants on child mortality in Pakistan: evidence from Spatial Durbin Model

BackgroundChild mortality is a major challenge to public health in Pakistan and other developing countries. Reduction of the child mortality rate would improve public health and enhance human well-being and prosperity. This study recognizes the spatial clusters of child mortality across districts of Pakistan and identifies the direct and spatial spillover effects of determinants on the Child Mortality Rate (CMR).MethodData of the multiple indicators cluster survey (MICS) conducted by the United Nations International Children’s Emergency Fund (UNICEF) was used to study the CMR. We used spatial univariate autocorrelation to test the spatial dependence between contiguous districts concerning CMR. We also applied the Spatial Durbin Model (SDM) to measure the spatial spillover effects of factors on CMR.ResultsThe study results showed 31% significant spatial association across the districts and identified a cluster of hot spots characterized by the high-high CMR in the districts of Punjab province. The empirical analysis of the SDM confirmed that the direct and spatial spillover effect of the poorest wealth quintile and MPI vulnerability on CMR is positive whereas access to postnatal care to the newly born child and improved drinking water has negatively (directly and indirectly) determined the CMR in Pakistan.ConclusionThe instant results concluded that spatial dependence and significant spatial spillover effects concerning CMR exist across districts. Prioritization of the hot spot districts characterized by higher CMR can significantly reduce the CMR with improvement in financial statuses of households from the poorest quintile and MPI vulnerability as well as improvement in accessibility to postnatal care services and safe drinking water.

The Interaction Effect of Birth Spacing and Maternal Healthcare Services on Child Mortality in Pakistan.

There is widespread agreement that improved health should be regarded as a means and an end in the context of the development process. The health of the populace and the equitable provision of healthcare are two indicators of a society's level of development. A variety of factors influences child mortality. This study investigated the causes of child death and the interaction effect of birth spacing (B.S.) and maternal health care services (MHCS) on child mortality. Using SPSS version 20, we used the Pakistan Demographic and Health Survey (PDHS) 2017-2018 data set to investigate the associated factors of child mortality and the moderating influence of birth spacing using binary logistic regression. The outcome variable is categorical with two categories. The findings indicated that the risk of infant death decreased with adequate B.S. between two pregnancies and access to maternal health care services. Birth spacing was found to moderate the link between access to maternal health care services (MHCS) and child mortality. Our research leads us to conclude that the amount of time between children's births significantly reduces infant mortality. When the birth spacing is at least 33 months, the relationship between maternal health care services and child mortality becomes more evident and negative.

Is government spending in the education and health sector necessary for human capital development?

This study intends to examine the impact of current health expenditure, domestic government health expenditure, government education expenditure, social protection, population growth, and foreign direct investment (FDI) on human capital formation in the context of Pakistan. This study utilized skill and health to measure human capital. The study utilized annual data for the period of 1990–2020 and data has been extracted from World Development Indicators (WDI) and World Bank. The study utilized auto-regressive distributed lag (ARDL) bound test to examine long-run co-integration among defined variables. Furthermore, the study employed ARDL Model to obtain long-run and short-run empirical estimates for modeled variables. The results of this study indicated that current health expenditure (CHE), domestic government health expenditure (DGHE), government education expenditures (GEE), foreign direct expenditure (FDI), and social protection program (SP) have a positive and significant association with human capital in term of primary, secondary, and tertiary education attainment and life expectancy at birth. Moreover, domestic government spending on health and education, and social protection program significantly decreases child mortality in Pakistan. Furthermore, this study found that population growth has a negative and significant association with primary attainment. The findings of this study suggest that the Government of Pakistan should allocate more of its budget for health, education, and social protection programs to uplift its human capital.

Infant & Child Mortality in Pakistan and its Determinants: A Review.

Over the years, several developing countries have been suffering from high infant and child mortality rates, however, according to the recent statistics, Pakistan falls high on the list. Our narrative review of copious research on this topic highlights that several factors, such as complications associated with premature births, high prevalence of birth defects, lack of vaccination, unsafe deliveries, poor breastfeeding practices, complications during delivery, sudden infant death syndrome (SIDS), poor socioeconomic conditions, and a struggling healthcare system, have influenced these rates. Bearing in mind the urgency of addressing the increased infant and child mortality rate in Pakistan, multiple steps must be taken in order to prevent unnecessary deaths. An effective initiative could be spreading awareness and education among women, as a lack of education among women has been indirectly linked to increased child mortality in Pakistan across many researches conducted on the issue. Furthermore, the government should invest in healthcare by hiring more physicians and providing better supplies and improving infrastructure, especially in underdeveloped areas, to decrease child mortality due to lack of clean water and poor hygiene. Lastly, telemedicine should be made common in order to provide easy access to women who cannot visit the hospital.

Impact of Socioeconomic Determinants on Infant Mortality in Pakistan

The recent study was carried out to estimate the impact of socioeconomic, demographic and the aspect of health status on child mortality in Pakistan. The data for the study was collected from the PSLM (Pakistan Social and Living Standard measurement survey) for the year 2011-12. The data were analyzed through cross-tabulation and binary logistic model using MLE (Maximum likelihood estimation) technique. Overall, 13216 households were selected for the analysis. The result of the study of the cross-tabulation shows that the overall child mortality was low in Baluchistan province, the maximum number of children survived in Punjab province further, and the child mortality was low in an urban area where 290 children died out of 3984 houses as compared to rural area household in Pakistan. Child mortality was high among females than males in Pakistan. The result of binary logistics shows that out of the total independent variable, nine variables significantly affect child mortality in Pakistan, location of the household, gender, education of father, education of mother, income and mother feeding, positively associated the infant mortality; all these aspects reduce the chance of child mortality, while there was a less likely chance that child survives in Punjab, Sindh as compared to KPK in Pakistan. In the case of Baluchistan, there was also the same situation as KPK in terms of child mortality. Infant mortality was high in female children compared to male children, which means there is a less likely chance of surviving among the female child than the male child. All other variables were insignificant in Pakistan. It is suggested that the central authority provide basic children and mothers health facilities at minimum cost to the rural areas of Pakistan.

Correlates of Child Mortality in Pakistan: A Hazards Model Analysis

This study investigated factors associated with child mortality in an area in Rawalpindi, one of the large cities of Pakistan. Using both demographic and anthropological methods, the research was conducted to specifically examine the process and mechanisms whereby a link is established between child mortality and its covariates. Controlling for the socioeconomic status as a determinant of child mortality, the study population was limited to a lower income stratum living in a homogeneous environment where all households had equal access to health-related and other facilities. Results of the proportional hazards model analysis on 1301 index children suggest that non-economic factors like maternal health-seeking behavior were related to high child mortality. The cultural norm of bearing a large number of children was the most significant correlate. In order of significance, this was followed by contraceptive use, current age of the mother, age at marriage, and the hygienic conditions of the household. The study provides strong evidence of familial clustering of mortality by order of the household.

Status of Maternal, Neonatal and Child Health Services in Primary and Secondary Health Facilities of Public Sector in Pakistan: A Cross-Sectional Case Study

The case study aimed to assess the efforts being carried out by the public sector to decrease Maternal, Neonatal, and Child mortality in Pakistan to establish an information base for future planning, and assessment of the Maternal, neonatal, and child health services being provided in primary and secondary health facilities to establish an information base for future planning. It was a descriptive/cross-sectional case study. A universal sample of the District Head Quarters Hospitals, Tehsil Head Quarters Hospitals, Rural Health Centers, and 20% Basic Health Units by using a stratified sampling technique surveys were conducted. Data was collected by using a questionnaire. The findings of the study showed the assessment of the availability of essential staff as per the required standard of the facility and availability was determined at 4,33, 53, and 86 percent in public sectors respectively. Preventive services are rendered at 86% of Basic Health Units, basic emergency obstetric and newborn care at 6% of Rural Health Centers, and comprehensive emergency obstetric and newborn care is being rendered at 4% and 33of by District Head Quarters Hospitals, Tehsil Head Quarters Hospitals respectively. Status of resuscitation with incubation is poor in Tehsil Head Quarters Hospitals (17%) and District Head Quarters Hospitals (51%), it is a very essential service to save the life of neonates if in the presence of staff at 4% of District Head Quarters Hospitals. The study recommended the expedited indefinite quantity of Maternal, neonatal, and child health services in primary and secondary health facilities of public sectors to drop off the mortality rate and to achieve targets regarding maternal and child mortality.

Socio-economic determinants of child mortality in Pakistan and the moderating role of household\u2019s wealth index

BackgroundChild mortality is an important social indicator that describes the health conditions of a country as well as determines the country’s overall socio-economic development. The Government of Pakistan has been struggling to reduce child mortality (67.2 per thousand live births in 2019). Pakistan could not achieve the target set for Millennium Development Goals to reduce child mortality and still working to meet the target set by the Sustainable Development Goals. This study has investigated the socio-economic determinants of child mortality in Pakistan by using household-level data. Socio-economic characteristics related to women (mothers) and households have been considered as possible determinants of child mortality. The moderating role of a household’s wealth index on the association between woman’s education and child mortality has also been investigated.MethodsThe comprehensive dataset of the Pakistan Demographic and Health Survey 2017–18 has been used to explore the determinants of child mortality by using multivariable logistic regression. The interaction term of women’s education and household wealth index has been used to investigate the moderating role of the household’s wealth index.ResultsThe results indicate that the likelihood of child mortality decreases with an increase in women’s education, their empowerment, their husband’s education, the wealth status of their households, access to clean drinking water, access to toilet facilities, and exposure to mass media. Whereas, an increase in unmet need for family planning increases the likelihood of child mortality. The study also identified the moderating role of a household’s wealth index on the association between woman’s education and child mortality.ConclusionsHousehold wealth status moderates the association between women’s education and child mortality. The absolute slope of the curve showing the association of women’s education and child mortality is higher (more negative) for richer households than poorer households. It implies that a household’s wealth status strengthens the relationship between women’s education and child mortality. With the increase in the household’s wealth status, the effect of a mother’s education on child mortality becomes more pronounced.

Association of breast feeding and birth interval with child mortality in Pakistan: a cross-sectional study using nationally representative Demographic and Health Survey data

ObjectivesThis study analysed the association between breast feeding (BF) and birth interval (BI) (both succeeding and preceding) with neonatal mortality (NM), infant mortality (IM) and under-5 mortality (U5M).DesignThis cross-sectional study...

Exposure of Air Pollution and its Relationship with Child Mortality in Pakistan

This study discovered the special effects of coal energy (a kind of non-renewable energy), Greenhouse gases, Industrialization, Population growth rate and renewable energy on human health, with key emphasis on Child Mortality rate in Pakistan. For profound practical insight, study established Auto-Regressive Distributed Lag (ARDL) model and study analyzed time series data of Pakistan for time period 1986 to 2017. The results reported that with an increase in use of coal energy mortality among children increase. In addition, results also underscored that by turning to renewable energy (energy by sun, wind and air) the health conditions could be improved as renewable energy type is environment friendly and does not produce Greenhouse gases. So, renewable energy serves as a helping factor to reduce mortality among children in Pakistan. On the other hand, coal energy is the cause of environmental degradation by increasing amount of Greenhouse gas emissions in atmosphere which in turn causes Child mortality in Islamic Republic of Pakistan.

Time Series Analysis of Child Mortality in Pakistan: An Application of Bootstrap ARDL

Time Series Analysis of Child Mortality in Pakistan: An Application of Bootstrap ARDL

Social determinants and causes of child mortality in Pakistan: Analysis of national demographic health surveys from 1990 to 2013.

The aim of the study was to define social determinants, causes and trends in child mortality from 1990 to 2013 in Pakistan. Understanding social determinants, causes and temporal trends in child mortality can inform strategies aimed at improving child health in low and middle income countries. We characterised temporal trends and social determinants of child mortality in Pakistan using national demographic health survey data (1990-1991, 2006-2007 and 2012-2013). We analysed national data to generate regional estimates of health programme effectiveness. The annual rates of reduction for child mortality between 1990 and 2013 were estimated as follows: neonatal (-0.33% per annum), post-neonatal (3.13% per annum), infant (0.9% per annum), child (2.47% per annum) and under 5 (1.19% per annum). Bivariate analyses of 2013 data showed that living in Punjab or Balochistan province, belonging to lowest wealth quintile, lack of maternal education, previous birth interval < 2 years, first birth order and below average birth size were associated (p < 0.05) with greater risk of child mortality in Pakistan. Common factors associated with child mortality were fever, diarrhoea and pneumonia, while among stillbirths, intrapartum asphyxia, unexplained antepartum and antepartum maternal disorders were most frequent. Child survival strategies should integrate leading biosocial indicators and causes of death. Further research is needed to define the role(s) of social factors in child health and survival. These data should inform the implementation of cost-effective interventions for child survival and advance targeting of interventions to populations at increased risk of child mortality.

Factors Determining Poverty and Child Mortality in Pakistan

The objective of the study was to check the factors determining poverty and child mortality in Pakistan. We used secondary data, collected from various economic surveys and the World Bank. OLS technique used to find the relationship between variables. Consumer Price Index (CPI), GDP growth, number of hospitals, and unemployment used as independent variables. For poverty, female literacy rate, male literacy rate, immunization, and GDP growth used as independent variables for child mortality. The study showed that CPI, GDP growth, and the unemployment rate have a positive relationship with poverty whereas the number of hospitals has a negative relationship with poverty. Furthermore, the study revealed that the female literacy rate has a negative impact on infant mortality while the male literacy rate has no significant impact on the infant mortality rate. Immunization has a negative and significant relationship with the infant mortality rate. GDP growth has a positive impact on the infant mortality rate due to high inequality in Pakistan. Authors recommended that parental education, water quality, and motivation to mothers to utilize health facilities can play an important role to reduce poverty and child mortality.

Socioeconomic determinants of child mortality: Evidence from Pakistan Demographic and Health Survey

This paper attempts to highlight socioeconomic determinants of child mortality in Pakistan. Binary logistic regression is applied to 7297 observations from the Pakistan Demographic and Health Survey 2012-13. The results reveal that probability of child mortality decreases with greater birth-interval, child’s large size at birth, more family members, mother’s education, mother’s ownership of assets and mother’s decision-making at the household level. Policy makers can work to improve mothers’ characteristics such as fertility behavior, education, empowerment and decision-making at the household level, to reduce child mortality.

Comparison of fractional splines with polynomial splines; An Application on under-five year’s child mortality data in Pakistan (1960-2012)

Cubic splines are commonly used for capturing the changes in economic analysis. This is because of the fact that traditional regression including polynomial regression fail to capture the underlying changes in the corresponding response variables. Moreover, these variables do not change monotonically, i.e. there are discontinuities in the trend of these variables over a period of time. The objective of this research is to explain the movement of under-five child mortality in Pakistan over the past few decades through a combination of statistical techniques. While cubic splines explain the movement of under-five child mortality to a large extent, we cannot deny the possibility that splines with fractional powers might better explain the underlying movement. . Hence, we estimated the value of fractional power by nonlinear regression method and used it to develop the fractional splines. Although, the fractional spline model may have the potential to improve upon the cubic spline model, it does not demonstrate a real improvement in results of this case, but, perhaps, with a different data set.

Associates of Neonatal, Infant and Child Mortality in the Islamic Republic of Pakistan: A Multilevel Analysis Using the 2012-2013 Demographic and Health Surveys.

Objectives Pakistan is one of five nations contributing to half of the world's child mortality and holds under-five mortality rates which are nearly double global targets. Reasons for this shortfall include civil conflicts, political uncertainty, low education, poverty, rural-urban disparities, and limited health care access. The aim of this study was to explore associations between individual characteristics, community factors, and child mortality in Pakistan. Methods Data were derived from the 2012 to 2013 Pakistan Demographic and Health Survey, and included 7399 live births and 380 child deaths. Multivariate, multilevel logistic regression was used to model risk of neonatal, infant and under-five child deaths. Results Seventy-one percent of child deaths occurred during the neonatal period. Significant factors (p<0.05) associated with lower odds of child mortality included adhering to recommended minimum of 24months interpregnancy interval and higher household wealth. These were significant for neonatal (OR 0.448; 0.871), infancy (OR 0.465; 0.881), and under-five deaths (OR 0.465; 0.879). Employed mothers had higher odds of neonatal (OR 1.479), infant (OR 1.506), and child mortality (OR 1.459). Likewise, women living in consanguineous marriages had higher odds of infant (OR 1.454) and under-five deaths (OR 1.381). Children in Balochistan, Punjab, and Sindh, regions disproportionately poor, rural with low levels of education, were at highest risk of dying. Conclusions for Practice Findings may assist in designing targeted interventions, developing appropriate public health messaging, and implementing policies designed to lower child mortality. Focusing on lowering rates of maternal poverty, increasing opportunities for education, and improving access to health care could assist in reducing child mortality in Pakistan.

Statistical Analysis of Factors Affecting Child Mortality in Pakistan.

Child mortality is a composite indicator reflecting economic, social, environmental, healthcare services, and their delivery situation in a country. Globally, Pakistan has the third highest burden of fetal, maternal, and child mortality. Factors affecting child mortality in Pakistan are investigated by using Binary Logistic Regression Analysis. Region, education of mother, birth order, preceding birth interval (the period between the previous child birth and the index child birth), size of child at birth, and breastfeeding and family size were found to be significantly important with child mortality in Pakistan. Child mortality decreased as level of mother's education, preceding birth interval, size of child at birth, and family size increased. Child mortality was found to be significantly higher in Balochistan as compared to other regions. Child mortality was low for low birth orders. Child survival was significantly higher for children who were breastfed as compared to those who were not.