Date of Award

12-2020

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Syed Shujaat Hussain

Second Advisor

Sarah Saleem

Third Advisor

Iqbal Azam)

Department

Community Health Sciences

Abstract

Background Pakistan has reported to have the highest neonatal mortality rate across the globe, 42/1000 live births.(1) An evidence based & policy driven substantial reduction in neonatal deaths is required in country to meet sustainable development Goal of ending preventable deaths of newborns to 12 per 1,000 live births by 2030. This study reports rates and predictors of neonatal mortality in Pakistan.
Methods The study encompasses analysis of secondary data obtained from fourth Demographic & Health Survey conducted in Pakistan (2017-18). The data on most recent singleton live births in period of 2013-2017 was selected for analysis. After adjusting for cluster sampling & survey weight, univariate & stepwise forward multivariable Cox proportional hazard model was built to identify the predictors of neonatal mortality.
Results Total number of most recent live births reported were 10,444 of which 313 died in neonatal period. The study founds those neonates who were not observed for the breast feeding within two days of birth had increase hazard of death by aHR1.99 times (95% CI 1.20, 3.0) more as compared to those neonates who were observed for the breast feeding. Neonates who were born with short preceding birth interval of less than two year and those who were born to mothers with no tetanus vaccination had increase hazard of death. Among neonates whose Father’s education attainment was up to secondary level (9-10 classes) had increase hazard of mortality aHR 2.17 (95% CI 1.06, 4.45). Among the regions neonates who were born in Sindh had highest hazard of neonatal mortality 7 aHR 3.45 (95% CI 1.39, 8.45) and those who born Punjab had hazard of neonatal mortality aHR 3.37 (95% CI 1.38, 8.21).
Conclusion To reduce neonatal mortality, universal health coverage must be ensured in all the provinces of Pakistan. The educational reforms are required with target to achieve national & subnational literacy rate above the 90%. There is an urgent need to enhance the coverage of quality antenatal and postnatal care. The digital registry for maternal tetanus vaccination status & coverage must be established to avoid missing of non-vaccinated pregnant women. The birth spacing of more than 2 years reduces the hazards of neonatal death therefore the prevalence of contraception must be increase through efficient and interactive family planning programs. The observation of breast[1]feeding practice of mother in first two days delivery must not be avoid in addition to counselling on early & exclusive breast.

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1

Last Page

115

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