Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines

Kraft, Aleli D., Nguyen, Kim-Huong, Jimenez-Soto, Eliana and Hodge, Andrew (2013) Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines. PLoS ONE, 8 1: e53696.1-e53696.12. doi:10.1371/journal.pone.0053696

Author Kraft, Aleli D.
Nguyen, Kim-Huong
Jimenez-Soto, Eliana
Hodge, Andrew
Title Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines
Journal name PLoS ONE   Check publisher's open access policy
ISSN 1932-6203
Publication date 2013-01-07
Sub-type Article (original research)
DOI 10.1371/journal.pone.0053696
Open Access Status DOI
Volume 8
Issue 1
Start page e53696.1
End page e53696.12
Total pages 12
Place of publication San Francisco, CA, United States
Publisher Public Library of Science
Collection year 2014
Language eng
Formatted abstract
Background: The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country’s socioeconomic-related child health inequality.

Methodology: Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality.

Findings: Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery.

Conclusion: The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality – that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system – to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health.
Keyword Child mortality
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article e53696

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 9 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 12 times in Scopus Article | Citations
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Created: Tue, 08 Jan 2013, 09:38:28 EST by Dr Andrew Hodge on behalf of School of Economics