Estimation of a Neonatal Health Production Function for Iran: Secondary Analysis of Iran’s Multiple Indicator Demographic and Health Survey 2010
Background: Despite constant decrease in rate of neonatal mortality, the rate is still higher than that of other under-five children. One of the first steps towards reduction of neonatal mortality is to identify its determinants using health production function. The aim of the present study was to estimate neonatal health production function for Iran.
Methods: In this cross-sectional study, Iranian Multiple Indicator Demographic and Health Survey (IrMIDHS) 2010 was used. Four categories of socioeconomic, mother, neonatal demographic and healthcare system factors were entered into the Binomial Logistic Regression model to estimate neonate health production function. Households’ economic status was constructed using principal component analysis.
Results: History of abortion/stillbirth had the highest significant positive impact on odds of neonatal mortality (odds ratio=1.98; 95 % CI=1.55-2.75), indicating that neonates of mothers with such a history had 1.98 times higher chance of death compared to other neonates. Moreover, odds ratio of neonatal death for the poorest quintiles was 1.70 (95 % CI=1.08-2.74), indicating that by moving from the poorest quintile to the richest one, the odds of being alive for neonates increased up to 70%. However, skilled birth attendant decreased the chance of death up to 58% (odds ratio=0.58; 95 % CI=0.36-0.93).
Conclusion: Considering the most significant inputs of neonatal health production function in Iran, improvement of economic status of households, provision of appropriate care services for mothers, and improvement of delivery care provided by trained personnel, could be priorities for health policymakers to act and reduce neonatal mortality in Iran.
2. Malekzadeh R (2014). Global Burden of Disease Study 2010: A Real Advance in Global Descriptive Epidemiology: Perspective For Developing Countries. Arch Iran Med, 17(5):302-3.
3. Nations U (2015). The Millennium Development Goals Report 2015. (ed)^(eds), United Nations, New York.
4. Rajaratnam JK, Marcus JR, Flaxman AD et al (2010). Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet, 375(9730):1988-2008.
5. Xi B, Zhou C, Zhang M et al (2014). Maternal and child mortality in China. Lancet, 383(9921):953-4.
6. WHO (2014). World health statistics 2014. ed. World Health Organization.
7. Reichman NE, Corman H, Noonan K, Dave D (2009). Infant health production functions: what a difference the data make. Health Econ, 18(7):761-82.
8. UNICEF, WHO, World Bank Group and United Nations (2017). Levels & Trends in Child Mortality: Report 2017, Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation.
9. McKinnon B, Harper S, Kaufman JS, Bergevin Y (2014). Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis. Lancet Glob Health, 2(3):e165-73.
10. Rarani MA, Rashidian A, Khosravi A et al (2016). Changes in socio-economic inequality in neonatal mortality in Iran between 1995-2000 and 2005-2010: an Oaxaca decomposition analysis. Int J Health Policy Manag, 6(4):219-218.
11. Debelew GT, Afework MF, Yalew AW (2014). Determinants and causes of neonatal mortality in Jimma zone, southwest Ethiopia: a multilevel analysis of prospective follow up study. PLoS One, 9(9):e107184.
12. Siddiqi A, Jones MK, Erwin PC (2015). Does higher income inequality adversely influence infant mortality rates? Reconciling descriptive patterns and recent research findings. Soc Sci Med, 131:82-88.
13. Mekonnen Y, Tensou B, Telake DS et al (2013). Neonatal mortality in Ethiopia: trends and determinants. BMC Public Health, 13:483.
14. Kayode GA, Ansah E, Agyepong IA et al (2014). Individual and community determinants of neonatal mortality in Ghana: a multilevel analysis. BMC Pregnancy Childbirth, 14:165.
15. Kassar SB, Melo AM, Coutinho SnB et al (2013). Determinants of neonatal death with emphasis on health care during pregnancy, childbirth and reproductive history. J Pediatr (Rio J), 89(3):269-77.
16. Singh A, Kumar A, Kumar A (2013). Determinants of neonatal mortality in rural India, 2007-2008. PeerJ, 1:e75.
17. Bayati M, Akbarian R, Kavosi Z (2013). Determinants of life expectancy in eastern mediterranean region: a health production function. Int J Health Policy Manag, 1(1):57-61.
18. Rashidian A, Karimi-Shahanjarini A, Khosravi A et al (2014). Iran's multiple indicator demographic and health survey-2010: Study protocol. Int J Prev Med, 5(5):632-42.
19. Mosley WH, Chen LC (2003). An analytical framework for the study of child survival in developing countries 1984. Bull World Health Organ, 81(2):140-5.
20. Nisar YB, Dibley MJ (2014). Determinants of neonatal mortality in Pakistan: secondary analysis of Pakistan Demographic and Health Survey 2006-07. BMC Public Health, 14:663.
21. Zanini RR, Moraes ABd, Giugliani ERJ, Riboldi J (2011). Contextual determinants of neonatal mortality using two analysis methods, Rio Grande do Sul, Brazil. Rev Saude Publica, 45:79-89.
22. Kraft AD, Nguyen K-H, Jimenez-Soto E, Hodge A (2013). Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines. PLoS One, 8(1):e53696.
23. O’donnell O, Van Doorslaer E, Wagstaff A, Lindelow M (2008). Analyzing health equity using household survey data. Washington, DC: World Bank.
24. Archer KJ, Lemeshow S (2006). Goodness-of-fit test for a logistic regression model fitted using survey sample data. Stata J, 6:97-105.
25. Corman H, Grossman M (1985). Determinants of neonatal mortality rates in the US: A reduced form model. J Health Econ, 4(3):213-36.
26. Onayade A, Sule S, Elusiyan J (2006). Determinants of neonatal mortality at Wesley Guild Hospital, Ilesa, Nigeria. Niger J Med, 15(3):271-6.
27. Titaley CR, Dibley MJ, Agho K et al (2008). Determinants of neonatal mortality in Indonesia. BMC Public Health, 8:232.
28. Rosenstock S, Katz J, Mullany LC et al (2013). Sex differences in neonatal mortality in Sarlahi, Nepal: the role of biology and environment. J Epidemiol Community Health, 67(12):986-91.
29. Taha TE, Gray RH, Abdelwahab MM (1993). Determinants of neonatal mortality in central Sudan. Ann Trop Paediatr, 13(4):359-64.
30. Upadhyay R, Dwivedi P, Rai S et al (2012). Determinants of neonatal mortality in rural Haryana: a retrospective population based study. Indian Pediatr, 49(4):291-4.