Abstract
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 24 months 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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bhutta, Z. A., Gupta, I., de’Silva, H., Manandhar, D., Awasthi, S., Hossain, S. M., et al. (2004). Maternal and child health: Is South Asia ready for change? BMJ, 328(7443), 816–819. doi:10.1136/bmj.328.7443.816.
Black, R. E., Levin, C., Walker, N., Chou, D., Liu, L., & Temmerman, M. (2016). Reproductive, maternal, newborn, and child health: Key messages from disease control priorities 3rd edition. Lancet,. doi:10.1016/s0140-6736(16)00738-8.
Boco, A. G. (2010). Individual and community-level effects on child mortality: An analysis of 28 demographic and health surveys in Sub-Saharan Africa. DHS Working Papers. No. 73.
Budhwani, H., Hearld, K. R., & Harbison, H. (2015). Individual and area level factors associated with prenatal, delivery, and postnatal care in Pakistan. Maternal and Child Health Journal. doi:10.1007/s10995-015-1726-x.
Cleland, J., Conde-Agudelo, A., Peterson, H., Ross, J., & Tsui, A. (2012). Contraception and health. Lancet, 380(9837), 149–156. doi:10.1016/s0140-6736(12)60609-6.
Demographic and Health Surveys Program. (2013). Pakistan demographic and health survey 2012–2013. DHS final report. Retrieved from http://dhsprogram.com/publications/publication-fr290-dhs-final-reports.cfm.
Demographic and Health Surveys Program. (2016). DHS methodology. Retrieved from http://dhsprogram.com/What-We-Do/Survey-Types/DHS-Methodology.cfm.
Filippi, V., Chou, D., Ronsmans, C., Graham, W., & Say, L. (2016). Levels and causes of maternal mortality and morbidity. In R. E. Black, R. Laxminarayan, M. Temmerman, & N. Walker (Eds.), Reproductive, maternal, newborn, and child health: Disease control priorities (3rd ed., Vol. 2). Washington, DC: The International Bank for Reconstruction and Development/The World Bank.
Government of Pakistan. Ministry of Finance. (2016). Pakistan economic survey 2015–2016. Retrieved from http://www.finance.gov.pk/survey_1516.html.
Levine, R. A., Levine, S., Schnell-Anzola, B., Rowe, M. L., & Dexter, E. (2012). Literacy and mothering. How women’s schooling changes the lives of the world’s children. Oxford: Oxford University Press.
Levine, R. A., & Rowe, M. L. (2009). Maternal literacy and child health in less-developed countries: Evidence, processes, and limitations. Journal of Developmental & Behavioral Pediatrics, 30(4), 340–349. doi:10.1097/DBP.0b013e3181b0eeff.
Liu, L., Oza, S., Hogan, D., Perin, J., Rudan, I., Lawn, J. E., et al. (2015). Global, regional, and national causes of child mortality in 2000–2013, with projections to inform post-2015 priorities: An updated systematic analysis. Lancet, 385(9966), 430–440. doi:10.1016/s0140-6736(14)61698-6.
Memon, Z. A., Khan, G. N., Soofi, S. B., Baig, I. Y., & Bhutta, Z. A. (2015). Impact of a community-based perinatal and newborn preventive care package on perinatal and neonatal mortality in a remote mountainous district in Northern Pakistan. BMC Pregnancy Childbirth, 15, 106. doi:10.1186/s12884-015-0538-8.
Mosley, W. H., & Chen, L. C. (2003). An analytical framework for the study of child survival in developing countries. 1984. Bulletin of the World Health Organization, 81(2), 140–145.
Mwale, M. W. (2004). Infant and child mortality. The demographic and health surveys program. Retrieved from http://dhsprogram.com/pubs/pdf/fr175/08chapter08.pdf.
Nishtar, S., Bhutta, Z. A., Jafar, T. H., Ghaffar, A., Akhtar, T., Bengali, K., et al. (2013). Health reform in Pakistan: A call to action. Lancet, 381(9885), 2291–2297. doi:10.1016/s0140-6736(13)60813-2.
Smith-Greenaway, E. (2013). Mothers’ reading skills and child survival in Nigeria: Examining the relevance of mothers’ decision-making power. Social Science & Medicine, 97, 152–160. doi:10.1016/j.socscimed.2013.08.011.
Stoltenberg, C., Magnus, P., Skrondal, A., & Lie, R. T. (1999). Consanguinity and recurrence risk of stillbirth and infant death. American Journal of Public Health, 89(4), 517–523.
Teeuw, M. E., Henneman, L., Bochdanovits, Z., Heutink, P., Kuik, D. J., Cornel, M. C., et al. (2010). Do consanguineous parents of a child affected by an autosomal recessive disease have more DNA identical-by-descent than similarly-related parents with healthy offspring? Design of a case-control study. BMC Medical Genetics, 11, 113. doi:10.1186/1471-2350-11-113.
The Asia Foundation. 2015 LEAD Pakistan. (2015). Translating sustainable development goals at the country level. Retrieved from http://www.lead.org.pk/lead/Uploaded_images/Events/Policy%20Note%20-%20Translating%20Sustainable%20Development%20Goals%20(SDGs)%20at%20the%20National%20Level.pdf.
Tsui, A. O., Casterline, J., Singh, S., Bankole, A., Moore, A. M., Omideyi, A. K., et al. (2011). Managing unplanned pregnancies in five countries: Perspectives on contraception and abortion decisions. Global Public Health, 6(Suppl 1), S1–S24. doi:10.1080/17441692.2011.597413.
United Nations Development Programme in Pakistan. (2013). Pakistan millennium development goals report 2013. Retrieved from http://www.pk.undp.org/content/pakistan/en/home/library/mdg/pakistan-mdgs-report-2013/.
United Nations. (2016). Sustainable development goals. 17 goals to transform our world. Retrieved from http://www.un.org/sustainabledevelopment/health/.
United Nations. (2015). We can end poverty. Millenium development goals and beyond 2015. Retrieved from http://www.un.org/millenniumgoals/.
Wang, H., Liddell, C. A., Coates, M. M., Mooney, M. D., Levitz, C. E., Schumacher, A. E., et al. (2014). Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9947), 957–979. doi:10.1016/s0140-6736(14)60497-9.
World Bank. (2016). Pakistan. Retrieved from http://data.worldbank.org/country/pakistan.
World Health Organization. (2012). World health statistics 2012. Retrieved from http://www.who.int/gho/publications/world_health_statistics/EN_WHS2012_Full.pdf.
World Health Organization. (2014). WHO global health workforce statistics. The 2014 update. Retrieved from http://www.who.int/hrh/statistics/hwfstats/en/.
World Health Organization. UNICEF. The World Bank. United Nations. (2013). Levels & trends in child mortality. Estimates developed by the UN Inter-agency Group for child mortality estimation 2013. Retrieved from http://www.who.int/maternal_child_adolescent/documents/levels_trends_child_mortality_2013.pdf?ua=1.
You, D., Hug, L., Ejdemyr, S., Idele, P., Hogan, D., Mathers, C., et al. (2015). Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet,. doi:10.1016/s0140-6736(15)00120-8.
Acknowledgments
The authors would like to thank the [University of Alabama at Birmingham Sparkman Center for Global Health] for its ongoing support of international research endeavors and the United States Agency for International Development Demographic and Health Surveys Program.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Helova, A., Hearld, K.R. & Budhwani, H. Associates of Neonatal, Infant and Child Mortality in the Islamic Republic of Pakistan: A Multilevel Analysis Using the 2012–2013 Demographic and Health Surveys. Matern Child Health J 21, 367–375 (2017). https://doi.org/10.1007/s10995-016-2121-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-016-2121-y