Neonatal mortality in Nepal: A multilevel analysis of a nationally representative

Objectives: This study investigated individual, community and district level factors associated with neonatal mortality among a national sample of Nepalese women. Methods: Data were drawn from the 2006 Nepalese Demographic and Health Survey on women aged 15–49 who delivered within three years prior to the survey (N = 4136). Multilevel logistic regression models with three levels were fitted to assess the influences of measured individual, community and district level variables on neonatal mortality. Results: The total neonatal mortality in three years preceding the survey was 4.5 deaths per 100 live births (N = 190), with neonatal mortality rate (NMR) = 46 per 1000 live births. Having a partner with no formal education, being in the middle on the wealth index and residing in less developed district were associated with neonatal death in bivariate analysis. Women who were assisted by skilled personnel during delivery were less likely to have neonatal death (adjusted OR for no assistance = 2.26, 95% CI = 1.19–4.26). Having prenatal care with skilled attendant was associated with less likelihood of neonatal death (adjusted OR for no care = 1.75, 95% CI = 1.17–2.62). Older women, mother’s education, parity and wealth index were associated with neonatal mortality. Considerable variations in neonatal mortality at community and district levels were found. Conclusions: These findings emphasize the need for interventions at the individual level with regard to access and utilization of healthcare in order to reduce the neonatal mortality in Nepal.