Individual and Community-level Determinants of Neonatal Mortality in Pakistan: indication from Pakistan Demographic and Health Survey (2017-18).

To evaluate individual and community-level factors influencing neonatal mortality in Pakistan. The retrospective, secondary-data, quantitative study was done from July 2021 to January 2022 after approval from the ethics review committee of the International Islamic University, Islamabad, Pakistan, and comprised data of live births from November 22, 2017, to April 30, 2018, which was the period covered by the Pakistan Demographic and Health Survey 2017-18. Significant community-level, maternal and proximate determinants of neonatal mortality were identified. Data was analysed using STATA 13. Among the 12,708 live births covered, the neonatal mortality rate within the first month of birth was 5337(42%), and 3939(31%) neonatal deaths occurred in the first week of life, while 3431(27%) deaths occurred on the first day. Distance to health facility (adjusted hazard ratio: 1.1; 95% confidence interval: 0.8-1.6), unimproved toilet facility (adjusted hazard ratio: 2.0; 95% confidence interval: 0.7-2.1), caesarean section deliveries (adjusted hazard ratio: 1.6; 95% confidence interval: 0.6-1.9) and child's birth size smaller than average (adjusted hazard ratio: 1.7; 95% confidence interval: 1.1-2.7) carried significantly higher risk of neonatal deaths. Compared to women aged 15-19 years, older women's child (adjusted hazard ratio: 0.6; 95% confidence interval: 0.2-1.6) and neonates having birth order 3 compared to birth order 1 (adjusted hazard ratio: 0.5; 95% confidence interval: 0.2-0.9) and female gender of child (adjusted hazard ratio: 0.3; 95% confidence interval: 0.2-0.9) were less likely to die. There was a markedly high prevalence of neonatal mortality rate in Pakistan. Unimproved toilet facility, distance to health facility, caesarean mode of delivery and small size of the child at birth were found linked with increased risk of neonatal mortality.