title: Associates of Neonatal, Infant and Child Mortality in the Islamic Republic of Pakistan: A Multilevel Analysis Using the 2012-2013 Demographic and Health Surveys.
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.
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 517D Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Helova
authors.affiliation: Department of Health Services Administration, 563 School of Health Professions, University of Alabama at Birmingham, 1705 University Boulevard, Birmingham, AL, 35233, USA.
authors.forename: Kristine R
authors.initials: KR
authors.lastname: Hearld
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 517D Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294, USA. budhwani@uab.edu.
authors.forename: Henna
authors.identifier: http://orcid.org/0000-0002-6716-9754
authors.initials: H
authors.lastname: Budhwani
mesh_terms: D000293:Adolescent; D000328:Adult; D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D062305:Geographic Mapping; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D055361:Multilevel Analysis; D010154:Pakistan; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data
keywords: Child mortality; Demographic and Health Surveys; Pakistan; Poverty