title: Factors associated with infant mortality in Nepal: a comparative analysis of Nepal demographic and health surveys (NDHS) 2006 and 2011.
abstract: Infant mortality is one of the priority public health issues in developing countries like Nepal. The infant mortality rate (IMR) was 48 and 46 per 1000 live births for the year 2006 and 2011, respectively, a slight reduction during the 5 years' period. A comprehensive analysis that has identified and compared key factors associated with infant mortality is limited in Nepal, and, therefore, this study aims to fill the gap.
  
  
  
  Datasets from Nepal Demographic and Health Surveys (NDHS) 2006 and 2011 were used to identify and compare the major factors associated with infant mortality. Both surveys used multistage stratified cluster sampling techniques. A total of 8707 and 10,826 households were interviewed in 2006 and 2011, with more than 99% response rate in both studies. The survival information of singleton live-born infants born 5 years preceding the two surveys were extracted from the 'childbirth' dataset. Multiple logistic regression analysis using a hierarchical modelling approach with the backward elimination method was conducted. Complex Samples Analysis was used to adjust for unequal selection probability due to the multistage stratified cluster-sampling procedure used in both NDHS.
  
  
  
  Based on NDHS 2006, ecological region, succeeding birth interval, breastfeeding status and type of delivery assistance were found to be significant predictors of infant mortality. Infants born in hilly region (AOR = 0.43, p = 0.013) and with professional assistance (AOR = 0.27, p = 0.039) had a lower risk of mortality. On the other hand, infants with succeeding birth interval less than 24 months (AOR = 6.66, p = 0.001) and those who were never breastfed (AOR = 1.62, p = 0.044) had a higher risk of mortality. Based on NDHS 2011, birth interval (preceding and succeeding) and baby's size at birth were identified to be significantly associated with infant mortality. Infants born with preceding birth interval (AOR = 1.94, p = 0.022) or succeeding birth interval (AOR = 3.22, p = 0.002) shorter than 24 months had higher odds of mortality while those born with a very large or larger than average size had significantly lowered odds (AOR = 0.17, p = 0.008) of mortality.
  
  
  
  IMR and associated risk factors differ between NDHS 2006 and 2011 except 'succeeding birth interval' which attained significant status in the both study periods. This study identified the ecological region, birth interval, delivery assistant type, baby's birth size and breastfeeding status as significant predictors of infant mortality.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Australia. rcsindhu@gmail.com.|Malteser International, Pulchowk, Laliltpur, Nepal. rcsindhu@gmail.com.
authors.forename: Reeta
authors.identifier: 0000-0002-7104-0224
authors.initials: R
authors.lastname: Lamichhane
authors.affiliation: School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia.
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: School of Public Health, Curtin University, Perth, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Paudel
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Perth, Australia.
authors.forename: Emmanuel O
authors.initials: EO
authors.lastname: Adewuyi
mesh_terms: D000293:Adolescent; D000328:Adult; D001721:Birth Intervals / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000706:statistics & numerical data; D016000:Cluster Analysis; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D003710:Demography / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Birth interval; Birth size; Breastfeeding; Infant mortality; Nepal; Region