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Social determinants and causes of child mortality in Pakistan: Analysis of national demographic health surveys from 1990 to 2013
Author(s) -
Afshan Kiran,
Narjis Ghulam,
Qureshi Irfan Z,
Cappello Michael
Publication year - 2020
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.14670
Subject(s) - medicine , child mortality , psychological intervention , infant mortality , demography , environmental health , social determinants of health , pediatrics , public health , population , nursing , psychiatry , sociology
Aim 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. Methods 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. Results 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. Conclusion 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.