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Socioeconomic Disparities in Accessing Early Newborn Care in Pakistan: Secondary Data Analysis of Nationally
Rakhshanda Ayub Khan1, Owais Raza2, Mansoor Ahmed1
1School of Public Health, Dow University of Health Sciences, Karachi, Pakistan.
Insights
Socioeconomic factors like wealth and access to institutional delivery, cesarean sections, skilled birth attendants, and frequent antenatal care visits are linked to better newborn care practices in Pakistan. Targeted interventions are needed for vulnerable mothers.
Area of Science:
- Public Health
- Maternal and Child Health
- Health Disparities
Background:
- Pakistan faces a high burden of newborn mortality, ranking third globally.
- Understanding socioeconomic disparities in essential newborn care practices is crucial for targeted interventions.
Purpose of the Study:
- To investigate socioeconomic disparities in 48-hour newborn care practices in Pakistan.
- To analyze the association between socioeconomic factors and the completion of at least two essential newborn care signal functions.
Main Methods:
- Secondary analysis of Pakistan Demographic and Health Survey 2017-2018 data from 3936 mothers.
- Newborn care practices assessed using six indicators: cord examination, temperature measurement, danger sign counseling, breastfeeding counseling, breastfeeding observation, and weight measurement.
- Multivariate logistic regression used to identify factors associated with completing at least two signal functions.
Main Results:
- Higher newborn care practice levels were associated with urban residence, higher wealth quintiles, institutional deliveries, cesarean sections, frequent antenatal care visits (≥4), and skilled birth attendants.
- Cesarean sections (OR=2.46) and frequent antenatal care visits (OR=2.41) significantly increased the likelihood of adequate newborn care.
- Institutional deliveries (OR=1.58), skilled birth attendants (OR=1.75), and higher wealth quintiles (OR=1.64) were also positively associated with better newborn care.
Conclusions:
- Wealth, cesarean sections, institutional births, skilled birth attendants, and frequent antenatal care visits are key determinants of higher newborn care levels in Pakistan.
- Significant socioeconomic disparities exist, highlighting the need for targeted public health strategies to improve newborn care in vulnerable populations.
- Addressing these disparities is essential to reduce Pakistan's high newborn mortality rate.
Abstract:
Objective: Pakistan ranks third in newborn mortality. The study aims to examine any socioeconomic disparities in 48-hour newborn care practices in Pakistan using 6 signal functions. Materials and Methods: Using R (version 4.3.1), a secondary analysis of 3936 mothers' Pakistan Demographic and Health Survey 2017-2018 data was performed. Newborn care practices in 48 hours of life were measured using 6 indicators: cord examination, temperature measurement, danger sign counseling, breastfeeding counseling, breastfeeding observation, and weight measurement. The outcome variable was defined as completing at least 2 signal functions. The frequencies of explanatory variables were estimated using descriptive analysis. Multivariate logistic regression was performed between independent variables and at least 2 signal functions. Results: Among mothers practicing the most newborn care, 71.8% were from urban areas, 81.9% were among the richest, 68.9% had institutional deliveries, 71.3% had 4 or more antenatal care (ANC) visits, 81.5% had cesarean sections (C-sections), and 68.1% were attended by skilled birth attendants. After adjusting for covariates, the likelihood of having at least 2 signal functions was 2.46 times greater for C-sections and 1.58 times greater for institutional deliveries, 2.41 times more probable for mothers with over 4 ANC visits, 1.75 times more likely for those with skilled birth attendants, and 1.64 times more common for the richest mothers. Conclusion: Wealth, C-sections, institutional births, skilled birth attendants, and frequent ANC visits were related to higher care levels, indicating the need for targeted measures in vulnerable populations.
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