Modelling perinatal and child mortality in Nepal

Abstract

South Asia has the second largest burden of perinatal and childhood mortality in the world and Nepal has been reported as a significant contributor to this burden within the region. The main aim of this thesis was to statistically model perinatal and childhood mortality in Nepal. Specifically, this thesis will first conduct a systematic review of factors associated with perinatal mortality in South Asia including Nepal. Second, socioeconomic predictors of stillbirths in Nepal will be examined. Third, Factors associated with perinatal mortality in Nepal will be identified. Finally, this thesis will examine factors associated with under-5 mortality in Nepal. Chapter 2 identifies the factors associated with perinatal and childhood mortality through literature review. The systematic literature review revealed the most common factors associated with perinatal mortality were: low socioeconomic status, lack of quality health care services, pregnancy/obstetric complications and lack of antenatal care. Similarly, poor socio economic status, rural residence, higher birth order and lower birth interval, use of contraceptives, polluted fuel for cooking at home, and antenatal care were found to be associated with under-5 mortality. Chapter 4 examined the socio-economic predictors of stillbirth in Nepal. Multivariable analysis and found maternal age (>25years), ecological zone (mountains or hills), religion (Hindu, Muslim, Christian and others), low maternal education, mother's occupation (farming) and the use of open defecation system are associated with stillbirth. Chapter 5 presents the factors associated with Perinatal Mortality (PM) and Extended Perinatal Mortality (EPM) in Nepal. In this study, PM rate was 42 [95% Confidence Interval (CI): 39, 44] per 1000 births and the corresponding EPM rate was 49 [95% CI: 46, 51] for the five-year prior each survey (2001-2016). Multivariable analysis revealed that ecological zone, household wealth index, birth order and birth interval; maternal age, use of contraceptives, and types of cooking fuel were associated with PM and EPM. Chapter 6 assesses the common factors associated with neonatal, post-neonatal, infant, child, and under-5 mortality in Nepal, and the study found that the death of the previous child, non usage of contraceptives and non-receipt of TT vaccination during pregnancy were associated with inder-5 mortality. In summary, household with poor socio-economic status, and non-use of contraceptives among mothers were strongly associated with perinatal, and under-5 mortality in Nepal. Hence, future intervention to reduce perinatal and under-5 mortality should focus on family planning and these intervention should target mothers from socioeconomically disadvantaged groups.

Date of Award	2019
Original language	English