Mukhtiar Hussain Ibupoto, Hamadullah Kakepoto
Rural children experience substantially higher mortality even after adjustment for compositional factors. These findings underscore the urgency of equity-focused health and education investments in Pakistan and carry broad implications for low- and middle-income countries facing similar structural disadvantages.
INTRODUCTION: Child mortality remains a critical public health challenge in Pakistan, where rates persistently exceed regional and global averages.
METHODS: Using data from the Pakistan Demographic and Health Survey (PDHS) 2017-18 (n = 13 558 live births in the 5 years preceding the survey), this study examines how socioeconomic inequalities, measured through maternal education, household wealth, place of residence, and paternal occupation, shape under-five, infant, and neonatal mortality. Discrete-time event-history models and concentration indices are applied to assess both the magnitude of mortality risk and the degree of socioeconomic inequality in its distribution.
RESULTS: Results reveal that children born to mothers with no education face more than three times the under-five mortality risk compared with children of mothers with secondary or higher education (OR = 3.42; 95% CI: 2.61-4.49). Household wealth quintile gradients are steep and consistent across all mortality indicators. Concentration indices confirm significant pro-rich inequality in child survival (C = -0.142, p = 0.001).
CONCLUSION: Rural children experience substantially higher mortality even after adjustment for compositional factors. These findings underscore the urgency of equity-focused health and education investments in Pakistan and carry broad implications for low- and middle-income countries facing similar structural disadvantages.