| dc.description.abstract | University of Washington Abstract Topographical Differences of Infant Mortality in Nepal: Demographic and Health Survey 2011 Rubee Dev Chair of the Supervisory Committee: Marcia F. Williams, PhD, MPH Epidemiology Objective: Infant mortality is a major problem in Nepal, particularly for residents in remote rural areas. Lack of roads and absence of hospitals and health facilities in remote areas contribute to the problem. The objectives of this study were to assess infant mortality rate (IMR) in the three ecological zones of Nepal (Mountain, Hill and Terai) and to examine the effect of distance to health facility on the association between ecological zone and infant mortality. Methods: The Nepal Demographic and Health Survey (NDHS) conducted in 2011 was used to calculate infant mortality rates for the Mountain, Hill and Terai zones of Nepal. Infant mortality was compared across three ecological zones in a sample of 5,306 live births in the five years preceding the survey. Logistic regression was used to assess the association between ecological zones and infant mortality focusing on distance to health facility and adjusting for potential confounders including maternal age at first birth, education level, total children ever born, birth interval and infant size at birth. Results: The weighted IMR in each ecological zone was calculated to be 59 (95% CI: 36-81), 44 (35-53), and 40 (33-47) infant deaths per 1000 live births for the Mountain, Hill and Terai zones, respectively. Residing in the Mountain zone was associated with a greater risk of infant mortality compared to those in the Terai zone (OR=1.42, 95% CI: 1.01-2.02, p=0.04). The risk of infant mortality in the Hill zone did not differ significantly from risk in the Terai zone (OR=1.17, 95% CI: 0.86-1.57, p=0.30). The elevated risk of infant mortality in the Mountain Zone compared to the Terai zone was observed only among mothers who perceived distance to health facility as a major problem (OR=1.55, 95% CI: 1.01-2.40, p=0.04). There was no significant difference in IMRs in the three ecologic zones among births to women who did not perceive distance as a big problem. In addition, a greater percent of women in the Mountain zone reported that distance to health facilities was a big problem (70.8%) compared to 60.0% in the Hill zone and 45.6% in the Terai zone. Conclusions: The excess risk of infant mortality in the Mountain zone of Nepal is due to both 1) the higher risk of infant mortality in the Mountain zone vs. the Hill and Terai zones among births to women who perceived distance to health facilities as a big problem; and 2) the higher proportion of births in the Mountain zone where distance to health facilities is perceived to be a big problem. These findings highlight the importance of accessibility of health services, particularly in the Mountain zone of Nepal. Going forward it will be important to develop intervention strategies and programs that will target remote populations. Keywords: Infant mortality, ecological, region, developing country | en_US |
