How does progress towards the MDG 4 affect inequalities between different subpopulations? Evidence from Nepal

Nguyen, Kim-Huong, Jimenez-Soto, Eliana, Morgan, Alison, Morgan, Chris and Hodge, Andrew (2013) How does progress towards the MDG 4 affect inequalities between different subpopulations? Evidence from Nepal. Journal of Epidemiology and Community Health, 67 4: 311-319. doi:10.1136/jech-2012-201503

Author Nguyen, Kim-Huong
Jimenez-Soto, Eliana
Morgan, Alison
Morgan, Chris
Hodge, Andrew
Title How does progress towards the MDG 4 affect inequalities between different subpopulations? Evidence from Nepal
Journal name Journal of Epidemiology and Community Health   Check publisher's open access policy
ISSN 0143-005X
Publication date 2013-01-15
Sub-type Article (original research)
DOI 10.1136/jech-2012-201503
Volume 67
Issue 4
Start page 311
End page 319
Total pages 9
Place of publication London, United Kingdom
Publisher B M J
Collection year 2014
Language eng
Formatted abstract
Background: Few previous studies have examined nonwealth-based inequalities in child mortality within developing countries. This study estimates changes in under-5-year-olds and neonatal mortality in Nepal across a range of subnational levels, which allows us to assess the degree of equity in Nepal's progress towards Millennium Development Goal 4.

Methods: Direct estimates of under-5-year-olds and neonatal death rates were generated for 1990-2005 using three Demographic and Health Surveys and two Living Standards Surveys by the following levels: national, rural/urban location, ecological region, development region, ethnicity and wealth. Absolute and relative inequalities were measured by rate differences and rate ratios, respectively. Additionally, wealth-related inequality was calculated using slope and relative indexes of inequality and concentration indices.

Results: Estimates suggest that while most rates of under-5-year-olds and neonatal mortality have declined across the different equity markers, leading to a downward trend in absolute inequalities, relative inequalities appear to have remained stable over time. The decline in absolute inequalities is strongest for under-5-year-olds' mortality, with no statistically significant trend in either relative or absolute inequalities found for neonatal mortality. A possible increase in inequalities, at least in relative terms, was found across development regions, where death rates remain high in the mid-western region.

Conclusions: By 2015, our estimates suggest that more than 65% of deaths of under-5-year-olds will occur in the neonatal period, with stable trends in neonatal mortality inequalities. These findings along with the fact that health outcomes for neonates are more highly dependent on health systems, suggest further equitable reductions in under-5-year-olds mortality will require broad health-system strengthening, with a focus on the improvement of healthcare services provided for mothers and newborns. Other inequities suggest continued special attention for vulnerable subpopulations is warranted, particularly to overcome social exclusion and financial barriers to care in urban areas.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 8 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 8 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Thu, 07 Mar 2013, 13:00:02 EST by Dr Andrew Hodge on behalf of School of Public Health