Neonatal mortality in developing countries: an analysis of trends and determinants

Abstract

There is limited understanding of how both trends and determinants of neonatal mortality vary from post-neonatal mortality, and more specifically how health care variables are associated with deaths in the first month of life. In particular the association between care at delivery and neonatal mortality is difficult to determine: in developing countries many women only seek skilled care once complications arise, making poor outcomes more probable. It is therefore inappropriate to directly compare outcomes from those who did and did not receive care at delivery due to this heterogeneity between the groups.This three-paper PHD thesis attempts to address some of these issues. Chapter 1 provides an overview of what is known about the determinants of neonatal and child mortality, before developing a conceptual framework for the analysis of neonatal and post-neonatal deaths.Chapter 2 (paper 1) provides a comprehensive analysis of the quality of Demographic & Household Surveys (DHS) data, before describing how trends in neonatal mortality differ from post-neonatal mortality over the short- and medium- term. It then examines how the associations between gross domestic product and neonatal, post-neonatal and early childhood mortality at national level differ using both cross-sectional and longitudinal data.Chapter 3 (paper 2) uses DHS data from Bangladesh to carry out bivariate and multivariate analysis to determine how the determinants of neonatal mortality vary from those of postneonatal mortality. It also tries to identify groups of women who are at ‘high’ or ‘low’ risk from institutional deliveries and compares rates of neonatal mortality. The risk categories are based on socio-economic, maternal health and health care utilisation factors that influence whether or not they are likely to have planned their delivery care or sought hospital care only in the event of complications.Chapter 4 (paper 3) furthers this work using Indian DHS data by examining how the association between health care determinants and neonatal mortality differ by asset quintile, mother’s education and state-level access to professional attendant at delivery. In this chapter I also use instrumental variable methodology to overcome the problem of endogeneity between delivery care variables and neonatal mortality. This technique enables me to examine the association between professional assistance at delivery while adjusting for the heterogeneity between women who do and do not seek such care. Chapter 5 concludes with a summary of key findings, as well as outlining areas for further research in this area