Infant Mortality Determinants In Pakistan Health And Social Care Essay

The research reported in this thesis was on “Socioeconomic Determinants of Infant Mortality in Pakistan”. The purpose of research was to study the socio-economic factors that affect the infant mortality and to suggest measures to accomplish it on better lines. The secondary data was collected by consultation of literature in the libraries and Internet and also from the material printed by UNICEF. The data was secondary and gathered from the already made researches and publications. Statgraphics Plus software was used to run multiple regression of the variables with the infant mortality and find out their relationship. The findings suggested that literacy rate of female, household income share, vaccination financing by government have significant impact in determining the infant mortality. Government policies and programs and the allocation of economic resources are the contributing factors. Thus, the reason behind was also determined and suggestions were made to improve the health and education sector in country.

Infant mortality is one of the essential indicators of social development including child health, mother’s health and mother’s education. In fact infant mortality rate depends on different factors like environment, socioeconomic conditions, geographic location and certain demographics.

After 1950’s, researches and developments have been made in controlling health issues worldwide and reducing the trend of mortality and increasing life expectancy and average lifespan and till today, science has been very much successful in controlling all issues. Health is the major factor which determines the economic position of a country worldwide.

Usually the lower developing countries have very high infant mortality rate compared to developed countries and the situation is bad for the poorer countries like middle Africans. Infant mortality actually means the death of an infant during first year of life and usually calculated per 1000 born.

The level of socioeconomic development of the nation determines the variable effects of socioeconomic factors on infant mortality (Uzma and Butt, 2000). Socioeconomically disadvantaged are indirectly at higher risk for increased infant mortality via health resources (Moon Fai Chan, 2010). It shows how much the government spends on health sector and the factors responsible for the low development. Over the years with the passage of time, improved policies and regulations are made and refined more and more for the betterment of the society considering mainly the health and education sectors.

The study focuses on the socioeconomic determinants of infant mortality in Pakistan and approaches a range of effecting factors.

Background

Pakistan since its independence in 1947 has been facing political instability thus keeping the country’s growth rate at low level current at 2% (Jan 2010). So, low growth rate means poor socioeconomic conditions thus a high Infant Mortality Rate (IMR). But the governments did focus on controlling the health issues and make the health sector as better as they could and provide its people with the best of resources and facilities.

During early period of 1950’s-60, the IMR declined rapidly from estimated 154 to 121 deaths per 1000 births (UN data) as new policies and programs were started in both East and West Pakistan and people were being educated and made aware of the facilities they could avail.

During 70’s – 80’s, the rate further decreased to estimated 104 (UN data). Though the political conditions were unstable but still people were facilitated with more resources even after losing East Pakistan, the health programs kept on working.

But due to the political riots, the IMR stagnated during late 80’s and early 90 keeping it to almost 101 deaths (Agha, 2000) and ended at near 84 deaths per 1000 at the start of 2000.

Since 1990’s the rate has been decreasing at a constant level which in year 2007 estimated to be 78 deaths per 1000 births. So, overall the trend has been downwards but still became constant in 90’s and for now it cannot be said that Pakistan doing good compared to other developing countries.

Importance of the study with respect to the world

As already mentioned, health sector determines the economic position of a country and shows how well or bad the country is working to reduce related issues and how much it should spend for them. Infant mortality is a major element in health sector and mostly the countries are ranked in this field based on the mortality rate. European countries like Norway, Denmark and Sweden have as low as 0-1 infant and child mortality rate and for their advanced researches in the betterment of their people; these are ranked among the top 5 countries worldwide.

The study here will help determine the world’s organization like UNO, World Bank and other international and welfare organizations that what are the major factors affecting the infant mortality in Pakistan and how effective are the federal and provincial governments doing in such issues thus determining where the country stands. Other than that they can also determine whether these actors are found in other countries or not.

Importance of the study with respect to Pakistan

Purpose of the study to increase knowledge about the infant mortality and to identify the importance of the socioeconomic factors related to infant mortality. It is a serious concern for Pakistan as it shows that the country lacks health related facilities and cannot counter such problems. The study will determine the main reasons and factors that are affecting the mortality rate and it can be used to create new programs and policies keeping in mind all the factors. Pakistan’s IMR in 2008 was estimated to be 78 deaths per 1000, which relatively is considered very low.

The study determines the basic socioeconomic factors and how much is the significance of each individual factor. It can be seen then where the government lacks in adhering to such issues and what steps and policies it should revise to further control the rate and in the same time reallocate the resources and make access to the health facilities much easier for all social, ethnic and income groups of the country.

Research Question

The research question would be that what the socioeconomic determinants of infant mortality in Pakistan are. It will analyze the significance and importance of each factor and thus results will be concluded.

CHAPTER 2

LITERATURE REVIEW

Sohail Agha (2000) conducted work on the determinants of infant mortality in Pakistan. He used the proximate determinants framework developed by Mosely and Chen (1984) as the analytical model for analysis. The data was collected for the period of ten years (1982-1991) and econometric model was the in-sample method using data from Pakistan Integrated Household Survey (1991). The socioeconomic determinants were died into three categories i.e. at The Community Level, The Household Level and The Individual Level. The statistical methods used were Hazard Logistic Regression, Generalized Estimation Equation and Model Building Strategy considering the outcome of the interest in the study as infant death. He concluded that infant mortality levels had stagnated in Pakistan in early 80’s and that the major determinants were the lack of access to health and educational units for the lower socioeconomic group and the low status and health of the mother.

Uzma Iram and Muhammad S. Butt (2000) conducted research on the socioeconomic determinants of child mortality in Pakistan. The purpose of the study was to verify and quantify the importance of various socioeconomic factors affecting child mortality at different child ages. They examined the role of household, demographic and environment factors as the determinants and used Sequential Probit Model based on sequence of binary choice model for their study to get a higher response category. The data from Pakistan Integrated Household Survey (2001) was used to estimate the sequential model and different variables were taken under consideration as the factors that significantly affect the mortality of child. They discussed that the level of socioeconomic development of the nation determines the variable effects of socioeconomic factors on infant mortality and concluded that mother’s feeding and mother’s education is strongly related to the neonatal mortality, infant mortality as well as child mortality through improved child care practices as well as other proximate determinants as parental care, income and environmental contamination.

Moon Fai Chan (2010) worked on finding the factors affecting the infant mortality rates in Singapore. The main idea behind his research was to study the impact of demographic changes, socioeconomic inequality and availability of health resources on infant mortality rate (IMR) in Singapore. The data collected was from year 1969 to 2008 (40 years); a retrospective study design having IMR as the dependent variable and three main determinants were demographics, socioeconomic status and health resources. The statistical analysis was done by using the Structural Equation Model (SEM) which included the independent variable and the three main determinants. He concluded that providing more health facilities reduces the risk of infant mortality and that the socioeconomically disadvantaged are indirectly at higher risk for high infant mortality via health resources especially during recession when unemployment occurs and the access to health units becomes difficult for them.

Nasra Shah, Makhdoom Shah, Abdul Aziz Khalaf, Mustafa, Mohammad Mustafa and Ali Al-Syed (2000) conducted a research on searching the socioeconomic risk factors in perinatal mortality in Kuwait. Their study purpose was to investigate whether socioeconomic factors such as parent’s education, occupation and income play as any risk factors in perinatal mortality. They conducted a case control study covering all perinatal deaths in Kuwait for 1 year i.e. October 1997 to September 1998. The case as perinatal death and control as live birth were considered. Information from 463 matched pairs was conducted in which 274 were Kuwaitis and 189 were non-Kuwaitis. The statistical methods used were Bivariate and Multivariate analysis methods. The bivariate analysis showed that factors like lower education and lower income increased the risk of perinatal mortality but due to government policies and programs aimed at reducing social inequality in Kuwait, the IMR is low and reducing.

John Stoeckel (1970) conducted a survey on the infant mortality trends in rural East Pakistan. The study aimed at the impacts of the rural development programs by the Pakistan Government on the infant mortality trend which actually started declining amidst the government regulations for mother’s education development programs. The data was taken by interviewing 1600 married women and Bogue pregnancy history technique was utilized for the study.

Hafsa Habib, Maheen Lohani, Habibullah Khan and Muhammad Hussain Khan (2007) conducted a research on the issue of infant morbidity leading to infant mortality exploring the causes and risk factors affecting infant morbidity and mortality in their study. They observed 150 infants; 51 in neonatal period and 99 in post-neonatal period. The study was cross-sectional and concluded that males were more at risk for infant morbidity and that exposure to diseases like diarrhea, birth asphyxia and others contribute majorly to mortality and breast feeding decreases both infant morbidity and mortality.

Hisham Elmahdi Mustafa and Clifford Odimegwu (2008) conducted research survey on the socioeconomic determinants of infant mortality in Kenya with the purpose of finding the relative importance of bio-social, demographic and economic factors related with infant mortality in Kenya. The study is well organized and also based on historical data and articles. It was an analytical cross-sectional study through the data analysis of 2003 Kenyan Demographic and Health Survey and the variables include socioeconomic, demographic and health outcome predictors and infant mortality as dependent variable. The statistical models of analysis were Univariate, Bivariate and Multivariate. They concluded that in urban areas the child survival depends on mother’s education and maternal awareness while in rural it depends whether they are in occupation and giving time to child or not, also the fertility factor and most importantly breast feeding is found as major determinant of child health leading to mortality along with family planning programs in Kenya.

Lisbeth B. Knudsen A and.J. Bengt Ka¨lle´n (1997) worked on a data based comparison between infant mortality in Denmark and Sweden and the aim was to study the differences in the infant mortality between the two nations. The data in the study had been retrieved from national health registers on infant death rates from both the countries with a time span from 1980-1988. The analysis was made on Odd Ratios comparing Demark with Sweden. The factors considered were birth weight, age, parity and socioeconomic level. It was concluded that even after stratification for these factors a difference between the countries remain and the IMR in Denmark was relatively higher than that of Sweden.

Edward G. Stockwell, Franklin W. Goza and Kelly S. Balistreri (2005) conducted research on infant mortality and socioeconomic status in the Ohio state of USA. The main purpose of study was the ecological analysis of the relationship between infant mortality and economic status in metropolitan Ohio. The data was taken for time period of 1960-2000. An ecological framework was utilized with primary analytical unit being the consensus tract of mother’s usual residence. The dependent variable, being infant mortality and independent were taken as low income families. The study concluded that thought infant mortality had decreased rapidly in this time span, yet a strong inverse relation between income status and infant mortality and that there are strong socioeconomic determinants relating to infant mortality.

CHAPTER 3

METHODOLOGY

Research Type

The variables including the factors affecting the “infant mortality” are measurable so the research type is quantitative. The variables thus should be more factual with trend analysis.

Data type and research period

The data being used under this research is secondary as researches on infant mortality have already been conducted several times and easily available. The research would be focusing on the data of 10 years mainly up to 2008 available thus showing historic trend. It would be a time series data research.

Sources of data

The major sources of data are websites and available publishing of following.

World Development Indicator

UNICEF

WHO

Statpak.gov.pk

World Bank

Pakistan Census Report

Theoretical Framework

Variables from theoretical framework

Dependent Variable

Infant Mortality

Infant means a child of age 1-12 months. Mortality means deaths within a population based on official death certificate based on age, sex and gender. So, infant mortality means the death of an infant during 1st year of life.

Independent Variables

Female Literacy

In Pakistan, people of age 15 and above who can read and write are said to be literate. Female literacy means the ratio of literate females within the population.

Vaccination Financing

Inoculation of a particular medicine to protect against diseases like malaria, polio, hepatitis, etc. and how much the government is spending on it.

Access to safe sanitation

The percentage of total population which has access to safe water and sanitation system.

Share of Household Income

The average combined gross income of all members of a household who are above 15 years of age.

Research Hypothesis

Ho: Female literacy has strong effect on the infant mortality.

H1: Female literacy does not affect the infant mortality.

Ho: Vaccination financing has impact on the infant mortality.

H1: Vaccination financing does not affect the infant mortality

Ho: Household income has strong impact on the infant mortality.

H1: Household income does not have strong impact on the infant mortality.

Ho: Accessibility to safe water and sanitation system affects the infant mortality.

H1: Accessibility to safe water and sanitation does not affect the infant mortality.

Techniques

The technique for carrying out the research will be multiple regression analysis. The technique will be useful as the data is already present and the trend can be shown making it a time series data. It will help in accepting or rejecting the null hypothesis. If p-value exceeds 0.1, then null hypothesis will be rejected.

Data Analysis

Data will be computed by running through the Stat graphics or Minitab software for analyzing the multiple regression and trend created.

Data Interpretation

The result from the software in form of graphs, charts and tables will be compiled and analyzed for final data interpretation. In this way it can be easily seen either the trend is rising or stagnated or decreasing and thus the strength of the variable can be seen.

CHAPTER 4

RESULTS AND ANALYSIS

Results

Analysis

The output shows the results of fitting a multiple linear regression model to describe the relationship between infant mortality and 3 independent variables. The equation of the fitted model is infant mortality = 123.345 – 0.466095*female literacy -0.797809*household share – 0889038*safe sanitation access.

Since the P-value in the ANOVA table is less than 0.10, there is a statistically significant relationship between the variables at the 90% confidence level.

The R-Squared statistic indicates that the model as fitted explains 63.8236% of the variability in infant mortality. The adjusted R-squared statistic, which is more suitable for comparing models with different numbers of independent variables, is 45.7354%. The standard error of the estimate shows the standard deviation of the residuals to be 4.44775. This value can be used to construct prediction limits for new observations by selecting the Reports option from the text menu. The mean absolute error (MAE) of 3.3209 is the average value of the residuals. The Durbin-Watson (DW) statistic tests the residuals to determine if there is any significant correlation based on the order in which they occur in your data file. Since the DW value is greater than 1.4, there is probably not any serious autocorrelation in the residuals.

Conclusion

From the table it can be seen that the p-value of female literacy is less than 0.1 which means there is a significant relationship between infant mortality and female literacy. So, Ho is accepted and it can be concluded that female literacy does has an impact on infant mortality. More the female literacy rate, lesser will be the chance of an infant’s death as educated mothers will be well aware of maintaining a child’s health.

The Vaccination has been taken as constant as it has been the same for all the time period as 100%. The p-value is less than 0.1, Ho is accepted and hence it is concluded that vaccination processes has significant impact on the infant mortality. Over the years the government has been successful in providing proper vaccination facilities to people all over.

The percentage of household share has a p-value a little greater than 0.1. It is somehow in relationship with infant mortality but not as much impact as other factors but still Ho is accepted and it is concluded that household income division does affect the infant mortality.

The access to safe sanitation is not showing a significant relationship as it has a p-value greater than 0.1.So, it is concluded that infant mortality is not affected by the access to safe sanitation, so Ho is rejected.