Factors associated with infant mortality in Nepal: a comparative analysis of Nepal demographic and health surveys (NDHS) 2006 and 2011

Background: Infant mortality is one of the priority public health issues in developing countries like Nepal. The infant mortality rate (IMR) was 48 and 46 per 1000 live births for the year 2006 and 2011, respectively, a slight reduction during the 5 years’ period. A comprehensive analysis that has identified and compared key factors associated with infant mortality is limited in Nepal, and, therefore, this study aims to fill the gap. Methods: Datasets from Nepal Demographic and Health Surveys (NDHS) 2006 and 2011 were used to identify and compare the major factors associated with infant mortality. Both surveys used multistage stratified cluster sampling techniques. A total of 8707 and 10,826 households were interviewed in 2006 and 2011, with more than 99% response rate in both studies. The survival information of singleton live-born infants born 5 years preceding the two surveys were extracted from the ‘childbirth’ dataset. Multiple logistic regression analysis using a hierarchical modelling approach with the backward elimination method was conducted. Complex Samples Analysis was used to adjust for unequal selection probability due to the multistage stratified cluster-sampling procedure used in both NDHS.Results: Based on NDHS 2006, ecological region, succeeding birth interval, breastfeeding status and type of delivery assistance were found to be significant predictors of infant mortality. Infants born in hilly region (AOR = 0.43, p = 0.013) and with professional assistance (AOR = 0.27, p = 0.039) had a lower risk of mortality. On the other hand, infants with succeeding birth interval less than 24 months (AOR = 6.66, p = 0.001) and those who were never breastfed (AOR = 1.62, p = 0.044) had a higher risk of mortality. Based on NDHS 2011, birth interval (preceding and succeeding) and baby’s size at birth were identified to be significantly associated with infant mortality. Infants born with preceding birth interval (AOR = 1.94, p = 0.022) or succeeding birth interval (AOR = 3.22, p = 0.002) shorter than 24 months had higher odds of mortality while those born with a very large or larger than average size had significantly lowered odds (AOR = 0.17, p = 0.008) of mortality. Conclusion: IMR and associated risk factors differ between NDHS 2006 and 2011 except ‘succeeding birth interval’ which attained significant status in the both study periods. This study identified the ecological region, birth interval, delivery assistant type, baby’s birth size and breastfeeding status as significant predictors of infant mortality

Antimicrobial Resistance and Virulence: a Successful or Deleterious Association in the Bacterial World?

SUMMARY: Hosts and bacteria have coevolved over millions of years, during which pathogenic bacteria have modified their virulence mechanisms to adapt to host defense systems. Although the spread of pathogens has been hindered by the discovery and widespread use of antimicrobial agents, antimicrobial resistance has increased globally. The emergence of resistant bacteria has accelerated in recent years, mainly as a result of increased selective pressure. However, although antimicrobial resistance and bacterial virulence have developed on different timescales, they share some common characteristics. This review considers how bacterial virulence and fitness are affected by antibiotic resistance and also how the relationship between virulence and resistance is affected by different genetic mechanisms (e.g., coselection and compensatory mutations) and by the most prevalent global responses. The interplay between these factors and the associated biological costs depend on four main factors: the bacterial species involved, virulence and resistance mechanisms, the ecological niche, and the host. The development of new strategies involving new antimicrobials or nonantimicrobial compounds and of novel diagnostic methods that focus on high-risk clones and rapid tests to detect virulence markers may help to resolve the increasing problem of the association between virulence and resistance, which is becoming more beneficial for pathogenic bacteria