Page 209 - GHES-3-3

Global Health Economics and
Sustainability
Neonatal mortality in Pakistan

status (employed vs. unemployed), and newborn death
(survived vs. not survived).
One of the main advantages of the binary logistic
regression model is that it does not assume a linear
relationship between dependent and independent
variables. Unlike standard regression models, which
require normally distributed variables and the assumption
of constant variance, logistic regression is more flexible. It
performs well with skewed or unbalanced datasets because
its error term follows a binomial distribution instead of
a normal distribution. In addition, logistic regression
allows for the inclusion of both categorical and continuous Figure 1. Neonatal mortality by place of delivery in urban regions of
independent variables, making it a powerful tool for Pakistan Note: 0: If delivery takes place outside facility; 1: If delivery takes
analyzing diverse datasets. For instance, in the context place within facility.
of NM, independent variables such as place of delivery, Abbreviations: KP: Khyber Pakhtunkhwa; ICT/AJK/GB: Islamabad
maternal education level, and household wealth status Capital Territory/Azad Jammu Kashmir/Gilgit Baltistan.
(categorical variables), as well as maternal age and birth
weight (continuous variables), can be included in a single
model without requiring complex transformations.

3. Results
Graphical representations of the relationship between the
place of delivery and NM at the provincial and residential
levels are shown in Figure 1 and 2. In these figures, the
place of delivery (within facilities labeled as “1” while
outside healthcare facilities labeled as “0”) is measured
on the x-axis, whereas NM is measured on the y-axis.
Figure 1 presents data for urban regions, including Punjab,
Sindh, Khyber Pakhtunkhwa (KP), Balochistan, and the Figure 2. Neonatal mortality by place of delivery in rural areas of Pakistan
combined impact of Islamabad Capital Territory/Azad Note: 0: If delivery takes place outside facility; 1: If delivery takes place
Jammu Kashmir/Gilgit Baltistan (ICT/AJK/GB), whereas within facility.
Figure 2 represents the rural regions of Pakistan. Abbreviations: KP: Khyber Pakhtunkhwa; ICT/AJK/GB: Islamabad
Capital Territory/Azad Jammu Kashmir/Gilgit Baltistan.
The most striking observation in Figure 1 is that in the
urban areas of Punjab and Sindh, the NMR was notably quality and accessibility of healthcare facilities in the rural
higher when deliveries took place at home but dropped areas of KP and Balochistan. Furthermore, the combined
markedly when deliveries took place in healthcare region of ICT/AJK/GB experienced lower NMR when
facilities. This indicates that medical professionals and deliveries took place in healthcare facilities rather than at
hospital infrastructure can greatly reduce NM. In contrast, home.
in KP and Balochistan, NMRs remained higher even when The impact of place of delivery on NM was analyzed
deliveries occurred within facilities. The combined ICT/ using a binary logistic model, with deliveries outside
AJK/GB region exhibited only a slight difference between health facilities serving as the reference/base category. The
home and facility delivery. results are presented in Table 2. To ensure robustness, the
In Figure 2, a noticeable reduction in NM was observed study estimated four models. In Model 1, the main variable
when deliveries took place at the healthcare facilities of of interest was estimated. Model 2 incorporated child
Punjab and Sindh compared to those that occurred outside and maternal indicators, whereas Model 3 incorporated
healthcare facilities (from 0.059 to 0.049 and 0.049 to 0.036, socioeconomic indicators. In Model 4, all indicators
respectively). In contrast, in KP and Balochistan, deliveries were included. The ORs in all four models indicate that
that occurred in healthcare facilities showed slightly higher mothers who delivered in health facilities were markedly
NMRs (0.049 when delivered in facilities and 0.041 when less likely to experience NM compared to those mothers
delivery took place at home in KP, and 0.052 vs. 0.049 in who delivered outside a facility (0.15, 0.016, 0.09, 0.01).
Balochistan). These findings highlight issues with the The analysis further revealed that a higher birth order was

Volume 3 Issue 3 (2025) 201 https://doi.org/10.36922/ghes.5089