Individual and Residential Level Effects on Child Mortality in Pakistan

Background: Pakistan has one of the highest rates of child mortality (CM) globally. Thus to better understand this grave global health concern, the aim of this study was to examine effects of individual and residential factors associated with risk of CM in Pakistan.  

Methods: Using multivariate multilevel logistic regression, we examined effects of individual-level factors (e.g. interval between births, birth order, mother’s age at first and last birth, blood relation between parents, prenatal, postnatal care), and residential factors (urban/rural, region, education and poverty tier) on neonatal, infant and under-five deaths in Pakistan. Data were derived from the 2012-2013 Pakistan Demographic and Health Survey. 7,399 most recent live births from the past five years prior to survey were included.

Results: 380 under-five child deaths occurred in the sample, 71% during neonatal period and 95% during infancy. Factors increasing the risk of death at p<0.05 included less than 24 month interval between births, multiple births, utilization of postnatal care in each of the three periods, mother’s employment in infant and under-five periods, and blood relation between parents in infancy. Children in Balochistan were at highest risk of dying during infancy and prior to reaching fifth birthday compared to the capital city of Islamabad. Odds of neonatal death were increased in Punjab region, odds of infant and under-five deaths were higher in Punjab, Sindh and Northern Areas.   

Conclusions: Results of this study could help determine priority areas to achieve targets related to the United National Millennium Development Goal 4 to reduce child mortality.