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Stagnant Neonatal Mortality and Persistent Health Inequality in Middle-Income Countries: A Case Study of the Philippines

Author

Listed:
  • Aleli D Kraft
  • Kim-Huong Nguyen
  • Eliana Jimenez-Soto
  • Andrew Hodge

Abstract

Background: The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country’s socioeconomic-related child health inequality. Methodology: Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. Findings: Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery. Conclusion: The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality – that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system – to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health.

Suggested Citation

  • Aleli D Kraft & Kim-Huong Nguyen & Eliana Jimenez-Soto & Andrew Hodge, 2013. "Stagnant Neonatal Mortality and Persistent Health Inequality in Middle-Income Countries: A Case Study of the Philippines," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-12, January.
    • Handle: RePEc:plo:pone00:0053696
    DOI: 10.1371/journal.pone.0053696
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    2. World Bank, 2012. "World Development Indicators 2012," World Bank Publications - Books, The World Bank Group, number 6014, December.
    3. Anna E Bauze & Linda N Tran & Kim-Huong Nguyen & Sonja Firth & Eliana Jimenez-Soto & Laura Dwyer-Lindgren & Andrew Hodge & Alan D Lopez, 2012. "Equity and Geography: The Case of Child Mortality in Papua New Guinea," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-9, May.
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    1. Joseph J. Capuno & Aleli D. Kraft & Stella A. Quimbo & Carlos Antonio, 2013. "Shocks to Philippine Households: incidence, idiosyncrasy, and impact," Philippine Review of Economics, University of the Philippines School of Economics and Philippine Economic Society, vol. 50(2), pages 1-27, December.
    2. Abrham Wondimu & Jurjen van der Schans & Marinus van Hulst & Maarten J. Postma, 2020. "Inequalities in Rotavirus Vaccine Uptake in Ethiopia: A Decomposition Analysis," IJERPH, MDPI, vol. 17(8), pages 1-14, April.
    3. Chandrashekhar T Sreeramareddy & H N Harsha Kumar & Brijesh Sathian, 2013. "Time Trends and Inequalities of Under-Five Mortality in Nepal: A Secondary Data Analysis of Four Demographic and Health Surveys between 1996 and 2011," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-1, November.
    4. Raoul Bermejo III & Sonja Firth & Andrew Hodge & Eliana Jimenez-Soto & Willibald Zeck, 2015. "Overcoming Stagnation in the Levels and Distribution of Child Mortality: The Case of the Philippines," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-13, October.

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