Did the Community Based Newborn Care Program (CB-NCP) Reduce Neonatal and Under-Five Child Mortality in Nepal?

Background: Goal 4 of the Millennium Development Goals (MDGs) was to reduce the under-five child mortality rate by two thirds between 1990 and 2015 (United Nations, 2014). Recent data show that the annual number of deaths in children under-five years of age has dropped globally by almost 50% from 12.6 million in 1990 to 6.6 million in 2012 (United Nations, 2014). While this is a huge progress, there is more to be done; nearly 18,000 children under age five die every day from preventable diseases (UNICEF, 2014). To reduce child mortality rate, many developing countries, including Nepal, have expanded their health infrastructures, trained a large number of health care providers and disseminated health education and nutritional information through mass media and community health social work professionals.  Several countries also introduced the Community-Based Newborn Care Package (CB-NCP) that involves a range of strategies aimed at improving the health and survival of infants and children. In 2007, Nepal piloted the Community-Based Newborn Care Package (CB-NCP) in 10 of its 75 districts.  In this paper, we asked the following question: Did the CB-NCP reduce women’s risks for experiencing neonatal and under-five-child deaths in Nepal controlling for empowerment measures, access to health services, and socio-demographic characteristics?

 Method:We analyzed data from 4,079 women who had given birth in the past five years using the 2011 Nepal Demographic and Health Survey data, a nationally representative comprehensive survey, that used a two-stage, stratified sample design to collect data from women between 15 and 49 years of age. We employed descriptive and logistic regression analyses using SAS version 9.2 to assess the relationships between child death and the CB-NCP controlling for other factors.

Results:About 10% and 17% of the women had ever experienced neonatal and under-five-child death respectively. In the districts with the CB-NCP, the women’s odds of experiencing neonatal mortality declined by 34% (OR=.66; CI=0.45-0.98) and under-five- child mortality declined by 26% (OR=73; CI=0.56-0.94) controlling for other factors. Also, women married by age 15 were 3.2 times more likely to experience neonatal death (OR=3.21; CI=1.94-5.32) and 5.6 times more likely to experience under-five-child death (OR=5.55; CI=3.50-8.81) compared to women married at age 20 and after.  Women without any formal education were twice as likely to experience both neonatal as well as under five child deaths as women with beyond primary education.  Finally, women who used institutional delivery for their most recent birth were significantly less likely to have experienced child death. 

Implications:Current evidence supports the expansion of the CB-NCP to reduce child mortality in Nepal. Also, we discuss different strategies health and social work professionals may use to work with local community to delay age at first marriage for girl children, improve their opportunity for formal education, and promote institutional delivery. 

UNICEF. (2014). The state of the world's children 2014 in numbers: Revealing disparities, advancing children’s rights. Retrieved from http://www.unicef.org/sowc2014/numbers/documents/english/SOWC2014_In%20Numbers_28%20Jan.pdf.

United Nations. (2014). The Millennium Development Goals Report 2014. Retrieved from http://www.un.org/millenniumgoals/2014%20MDG%20report/MDG%202014%20English%20web.pdf.