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Inequalities in early childhood mortality in Myanmar: Association between parents' socioeconomic status and early childhood mortality
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. a Department of Preventive and Social Medicine, University of Medicine Mandalay, Mandalay, Myanmar.
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, New Lambton Heights, NSW, Australia.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.ORCID iD: 0000-0002-8854-498x
2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1603516Article in journal (Refereed) Published
Abstract [en]

Background: Despite global achievements in reducing early childhood mortality, disparities remain. There have been empirical studies of inequalities conducted in low- and middle-income countries. However, there have been no epidemiological studies on socioeconomic inequalities and early childhood survival in Myanmar.

Objective: To estimate associations between two measures of parental socioeconomic status - household wealth and education - and age-specific early childhood mortality in Myanmar.

Methods: Using cross-sectional data obtained from the Myanmar Demographic Health Survey (2015-2016), univariate and multiple logistic regressions were performed to investigate associations between household wealth and highest attained parental education, and under-5, neonatal, post-neonatal and child mortality. Data for 10,081 children born to 5,932 married women (aged 15-49 years) 10 years prior to the survey, were analysed.

Results: Mortality during the first five years was associated with household wealth. In multiple logistic models, wealth was protective for post-neonatal mortality. After adjusting for individual proximate determinants, the odds of post-neonatal mortality in the richest households were 85% lower (95% CI: 50-96%) than in the poorest households. However, significant association was not found between wealth and neonatal mortality. Parental education was important for early childhood mortality; the highest benefit from parental education was for child mortality in the one- to five-year age bracket. After adjusting for proximate determinants, children with a higher educated parent had 95% (95% CI 77-99%) lower odds of death in this age group compared with children whose parents' highest educational attainment was at primary level. The association between parental education and neonatal mortality was not significant.

Conclusions: In Myanmar, household wealth and parental education are important for childhood survival before five years of age. This study identified nuanced age-related differences in associations. Health policy must take socioeconomic determinants into account in order to address unfair inequalities in early childhood mortality.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019. Vol. 12, no 1, article id 1603516
Keywords [en]
Household wealth, parental education, neonatal mortality, post-neonatal mortality, under-5 mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-159641DOI: 10.1080/16549716.2019.1603516ISI: 000467824000001PubMedID: 31066344OAI: oai:DiVA.org:umu-159641DiVA, id: diva2:1319705
Available from: 2019-06-03 Created: 2019-06-03 Last updated: 2019-06-12Bibliographically approved

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Stewart Williams, JenniferNilsson Sommar, Johan

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