title: Geographical disparities in child mortality in the rural areas of Iran: 16-years trend.
abstract: OBJECTIVE
  We performed this study to assess the trend of geographical disparities between rural areas located in the catchment areas of 41 medical universities in Iran from 1993 to 2008. We evaluated four indicators including rates for neonatal mortality (NMR), infant mortality (IMR), under-5 mortality (U5MR) and crude death (CDR).
  
  
  METHODS
  We got about 656 university-year data points for each of the indicators (missing data <0.5%). The people under assessment were between 16.7 (in 1993) to 20.1 million (in 2008). We measured disparities through the calculation of index of disparities (IDisp) and assessed the trends using the Cuzick non-parametric test for trend.
  
  
  RESULTS
  Except for the increasing trend of CDR (Z=+2.83, p=0.005), the others had decreasing trends: NMR (Z=-3.23, p=0.001), IMR (Z=-3.84, p<0.001) and U5MR (Z=-3.84, p<0.001). The IDisp trends of IMR (Z=-2.2, p=0.027) and U5MR (Z=-2.84, p=0.005) were decreasing, while the IDisp trends for NMR (Z=+2.19, p=0.028) and CDR (Z=+2.39, p=0.017) were increasing.
  
  
  CONCLUSIONS
  The results show that at least for IMR and U5MR, in addition to improvement in average national levels, the geographical disparities have decreased. In the cases of NMR and CDR, inspite of the improvements in national levels, the trends of health disparities are not as good. We need to use strategies to provide more specialised care fairly in addition to primary healthcare to reduce disparities in CDR and NMR and influence them more.
authors: Department of Community Medicine, Knowledge Utilization Research Center (KURC), Tehran University of Medical Sciences, Tehran, Iran. m_moradi@tums.ac.ir
authors: Maziar
authors: M
authors: Moradi-Lakeh
authors: Bita
authors: B
authors: Bijari
authors: Nasim
authors: N
authors: Namiranian
authors: Ali-Reza
authors: AR
authors: Olyaeemanesh
authors: Ardeshir
authors: A
authors: Khosravi
mesh_terms: D002391:Catchment Area, Health / Q000706:statistics & numerical data; D002423:Cause of Death; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D005843:Geography; D054624:Health Status Disparities; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007492:Iran / Q000453:epidemiology; D008137:Longitudinal Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D012923:Social Class; D018709:Statistics, Nonparametric; D014495:Universities