Has the reduction in child mortality in Iran been equitable? Two national surveys analysis

  • Mostafa Amini Rarani Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
  • Arash Rashidian Department of Health Management and Economics, School of Public Health, Tehran University of medical Sciences. Tehran, Iran.
  • Mohammad Arab Department of Health Management and Economics, School of Public Health, Tehran University of medical Sciences. Tehran, Iran.
  • Ardeshir Khosravi Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran.
  • Ezatollah Abbasian Department of Economics, Bu-Ali Sina University, Hamadan, Iran.
Keywords: Child mortality, Inequality change, Concentration index, Odds ratio, Iran.

Abstract

Background: To measure changes in socioeconomic inequality in child mortality in Iran. Methods: A secondary data analysis of two Demographic and Health Surveys (DHS 2000 and 2010) was undertaken. Neonatal, infant, and under-5 mortality rates were estimated directly from complete birth history. Economic quintiles were constructed using principal component analysis. Changes in inequality were measured using odds ratios, mortality rates, and concentration curves and indices. Results: Based on the compared measures, inequalities in neonatal, infant, and under-5 mortality declined between the two surveys. Odds ratio for poorest quintile compared to that of richest one in 2000 and 2010 were 1.69 (95 % CI= 1.3-2.07) and 1.65 (95% CI= 0.95-2.9); 2.85 (95 % CI= 1.96-4.1) and 1.47 (95 % CI=0.5-4); and 1.98 (95 % CI= 1.64-2.3) and 1.85 (95 % CI=1.13-3) for neonatal, infant, and under-5 mortality rates respectively. In fact, mortality rates in all economic quintiles experienced a decreasing trend. Neonatal, infant, and under-5 mortality concentration indices in 2000 were -0.15, -0.26, and -0.17 respectively. Whereas, concentration indices in 2010 had dropped to -0.13, -0.11, and -0.14, respectively. Concentration curves dominance test showed that there was a statistically significant reduction in inequality in infant and under-5 mortalities.  Conclusion: Despite substantial reduction in child mortality rates and narrowing of the gap between poor and rich people, socioeconomic inequality in child mortalities disfavoring worse-off groups still exists. It is suggested that focusing on new pro-poor child health interventions may further reduce infant, under-5, and particularly neonatal mortality across economic quintiles.
Published
2018-09-05
How to Cite
1.
Amini Rarani M, Rashidian A, Arab M, Khosravi A, Abbasian E. Has the reduction in child mortality in Iran been equitable? Two national surveys analysis. IJPH. 47(9):1378-86.
Section
Original Article(s)