Abstract / Summary
Abstract Objective To examine national and provincial trends in neonatal mortality in Pakistan and identify key socioeconomic and biological determinants using nationally representative data. Study design: This is a secondary analysis of cross-sectional survey data. Place and duration: This study utilized data from the National Institute of Population Studies Pakistan Maternal Mortality Survey (PMMS) 2019, conducted nationwide across all provinces and regions of Pakistan. The original survey was implemented in 2019. Methodology: Data were derived from the Pakistan Maternal Mortality Survey 2019. Neonatal mortality was defined as death within 28 days of birth. Descriptive statistics estimated neonatal mortality rates (NMR) nationally and provincially. Bivariate associations were assessed using chi-square tests. Multivariable binary logistic regression was performed to estimate adjusted odds ratios (AORs) with 95% confidence intervals (CI) for socioeconomic and biological risk factors, controlling for maternal age, parity, wealth quintile, residence, antenatal care, place of delivery, and postnatal care. Results Marked provincial disparities were observed, with Sindh demonstrating the highest NMR (58.9 per 1,000 live births), while Gilgit-Baltistan reported the lowest (27.5 per 1,000). High parity significantly increased neonatal mortality risk: mothers with 3–5 prior births (AOR 1.54; 95% CI 1.17–2.02) and ≥ 6 births (AOR 2.16; 95% CI 1.48–3.15). Younger maternal age (< 25 years) was also associated with higher odds (AOR 1.83; 95% CI 1.26–2.65). The lowest wealth quintile showed significantly elevated risk (AOR 1.80; 95% CI 1.18–2.76). Prematurity and maternal complications were strongly associated with increased neonatal mortality. Conclusions Neonatal mortality in Pakistan remains disproportionately high, with significant provincial inequities and strong associations with high parity, young maternal age, and poverty. Strengthening family planning services, expanding comprehensive antenatal care, and addressing socioeconomic disparities are critical to accelerating progress toward national and global child survival targets.