School of Economics, Bahauddin Zakariya University, Multan, Pakistan.
Department of Economics, Gomal University, Dera Ismail Khan, KP, Pakistan.
BMC Public Health. 2023 Aug 24;23(1):1612. doi: 10.1186/s12889-023-16526-6.
Child mortality is a major challenge to public health in Pakistan and other developing countries. Reduction of the child mortality rate would improve public health and enhance human well-being and prosperity. This study recognizes the spatial clusters of child mortality across districts of Pakistan and identifies the direct and spatial spillover effects of determinants on the Child Mortality Rate (CMR).
Data of the multiple indicators cluster survey (MICS) conducted by the United Nations International Children's Emergency Fund (UNICEF) was used to study the CMR. We used spatial univariate autocorrelation to test the spatial dependence between contiguous districts concerning CMR. We also applied the Spatial Durbin Model (SDM) to measure the spatial spillover effects of factors on CMR.
The study results showed 31% significant spatial association across the districts and identified a cluster of hot spots characterized by the high-high CMR in the districts of Punjab province. The empirical analysis of the SDM confirmed that the direct and spatial spillover effect of the poorest wealth quintile and MPI vulnerability on CMR is positive whereas access to postnatal care to the newly born child and improved drinking water has negatively (directly and indirectly) determined the CMR in Pakistan.
The instant results concluded that spatial dependence and significant spatial spillover effects concerning CMR exist across districts. Prioritization of the hot spot districts characterized by higher CMR can significantly reduce the CMR with improvement in financial statuses of households from the poorest quintile and MPI vulnerability as well as improvement in accessibility to postnatal care services and safe drinking water.
儿童死亡率是巴基斯坦和其他发展中国家公共卫生面临的主要挑战。降低儿童死亡率将改善公共卫生状况，提高人类福祉和繁荣水平。本研究认识到巴基斯坦各地区儿童死亡率的空间聚集，并确定了决定因素对儿童死亡率（CMR）的直接和空间溢出效应。
本研究使用联合国儿童基金会（UNICEF）开展的多指标类集调查（MICS）的数据来研究儿童死亡率。我们使用空间单变量自相关来检验CMR 方面相邻地区之间的空间依赖性。我们还应用空间杜宾模型（SDM）来衡量因素对 CMR 的空间溢出效应。
研究结果表明，31%的地区之间存在显著的空间关联，并确定了一个以旁遮普省各地区高-高 CMR 为特征的热点集群。SDM 的实证分析证实，最贫困五分之一人口和多维贫困指数脆弱性对 CMR 的直接和空间溢出效应为正，而为新生儿提供产后护理以及改善饮用水供应则对 CMR 具有负向（直接和间接）影响。
即时结果表明，CMR 在各地区之间存在空间依赖性和显著的空间溢出效应。对高 CMR 特征的热点地区进行优先排序，可以通过改善最贫困五分之一人口和多维贫困指数脆弱性的家庭的财务状况以及提高获得产后护理服务和安全饮用水的机会，显著降低 CMR。
