Peer-reviewed article
Rates and causes of neonatal and under-five mortality: insights from a national household survey in Pakistan.
Malik AA, Ariff S, Umer M, Nooruddin S, Habib MA et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study reports mortality rates and causes of death for newborns and children under five in Pakistan using data from a national household survey of over 115,000 households. Neonatal mortality was 39.8 deaths per 1,000 live births, with higher rates in rural areas than urban areas. The leading causes of neonatal death were complications from premature birth, birth asphyxia, and infections, while post-neonatal child deaths were mainly caused by infectious diseases, diarrhea, and pneumonia. The findings show significant disparities between rural and urban areas, indicating that preventable deaths remain a major public health challenge.
Key points
- Neonatal mortality rate was 39.8 per 1,000 live births (95% CI = 39.3-40.3), higher in rural areas (40.8) than urban areas (37.3)
- Post-neonatal under-five mortality was 35.9 per 1,000 live births, also higher in rural (36.8) than urban areas (33.6)
- Major causes of neonatal death: preterm birth complications, birth asphyxia, and infectious diseases
- Leading causes of post-neonatal under-five mortality: infectious diseases, diarrheal disorders, and pneumonia
- Survey covered 115,600 households with 3,880 deaths identified and analyzed using verbal and social autopsy procedures
Limitations
This is a descriptive epidemiological study reporting mortality rates and causes; it does not evaluate any intervention or test solutions to reduce mortality. The document identifies the problem and its distribution but cannot demonstrate what strategies or programs would be effective in preventing these deaths.
Abstract
Background Neonatal and under-five mortality rates are critical indicators of a country's health status and progress toward Sustainable Development Goals. Despite a decline in mortality rates globally, preventable child deaths continue to occur, particularly in Pakistan, which has one of the highest child mortality rates in the world. In this analysis, we present the latest cause-specific neonatal and under-five mortality estimates determined through verbal and social autopsy (VASA) procedures in a population-based household survey across Pakistan. Methods We used a household survey based on the Pakistan National Nutrition Survey sampling frame, which covered 115 600 households in both urban and rural areas. We identified 3880 neonatal and post-neonatal under-five deaths within the three years prior to the survey. The VASA interviews were conducted in households where deaths were reported. We determined the causes of death using the computerised InterVA-5, InSilicoVA, and Expert Algorithm VA methods and the physician-certified VASA method, utilising thorough reviews by verbal autopsy-trained paediatric and obstetric physicians. Results Neonatal mortality was estimated at 39.8 per 1000 live births (95% confidence interval (CI) = 39.3-40.3), with higher rates in rural (40.8; 95% CI = 40.2-41.4) compared to urban areas (37.3; 95% CI = 36.5-38.1). Post-neonatal under-five mortality was 35.9 per 1000 live births (95% CI = 35.4-36.4) and was also higher in rural (36.8; 95% CI = 36.2-37.4) than in urban areas (33.6; 95% CI = 32.6-34.5). The major causes of neonatal death included preterm birth complications, birth asphyxia, and infectious diseases. For post-neonatal under-five mortality, the leading causes were infectious diseases, diarrheal disorders, and pneumonia. Conclusions Our findings highlight the persistent burden and disparities in neonatal and under-five mortality across urban and rural areas in Pakistan. Targeted interventions are essential to address these preventable deaths and reduce mortality rates in high-risk populations.