The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61377

Shyam Thapa, PhD¹, Minja K. Choe, PhD², and Robert D. Retherford, PhD². (1) YouthNet, Family Health International, 2101 Wilson Blvd., Arlington, VA 22201, (2) Population and Health Studies, East-West Center, 1601 East-West Road, Honolulu, HI 96848, 808-944-7475, mchoe@hawaii.edu

Impacts of Mother and Child Health Interventions on Under-five Mortality in Nepal

The purpose of this paper is to estimate impacts of selected health interventions on under-five mortality in Nepal using data from Nepal's 2001 Demographic and Health Survey. A problem is that much of the health utilization information is collected only for surviving children. Our study circumvents this problem by measuring intervention variables in terms of the extent of community-level service coverage. Communities defined as rural villages and urban blocks, which are the primary sampling units (PSUs). Individual births, however, are the units of analysis in our logistic regression analysis, which includes not only community-level variables but also individual (birth)-level variables. We use logistic regression instead of hazard regression in order to allow adjustments for clustering at the PSU level, which yields more accurate estimates of statistical significance. Measured effects are virtually the same whether logistic or hazard regression is used.

The data for the logistic regression analysis comprise information on 6,931 children born during the five-year period before the survey. Intervention variables include two antenatal care indicators, four childhood immunizations, and vitamin A supplementation. Controls include child's age and a number of community-, household-, and individual-level characteristics.

The results show that, net of the effects of control variables, each health intervention reduces under-five mortality. When these interventions are considered jointly, however, the effects of vitamin A supplementation and antenatal care are no longer statistically significant. The analysis suggests that the initially apparent effects of antenatal care and vitamin A supplementation result from their correlation with childhood immunization.

Learning Objectives:

• Learn about recent research directions and findings on maternal and child health, especially in developing countries.

Keywords: Immunizations, Child Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.