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How does progress towards the MDG 4 affect inequalities between different subpopulations? Evidence from Nepal.
MedLine Citation:
PMID:  23322853     Owner:  NLM     Status:  Publisher    
BACKGROUND: Few previous studies have examined non-wealth-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.
Kim-Huong Nguyen; Eliana Jimenez-Soto; Alison Morgan; Chris Morgan; Andrew Hodge
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-15
Journal Detail:
Title:  Journal of epidemiology and community health     Volume:  -     ISSN:  1470-2738     ISO Abbreviation:  J Epidemiol Community Health     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7909766     Medline TA:  J Epidemiol Community Health     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
The University of Queensland, , Brisbane, Queensland, Australia.
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