Background
Methods
Results
National time trends of neonatal mortality
National neonatal mortality profiles by cause
District-level time trends of neonatal mortality
Department | Regiona
| 2001–2003 | 2004–2006 | 2007–2009 | 2010-2012 | % of reduction |
---|---|---|---|---|---|---|
Amazonas | Amazon | 14.26 | 13.34 | 11.05 | 13.99 | 1.8 |
Ancash | Andes | 13.91 | 12.02 | 7.07 | 6.65 | 52.2 |
Apurimac | Andes | 18.85 | 15.45 | 6.05 | 7.06 | 62.5 |
Arequipa | Andes | 2.76 | 12.71 | 9.83 | 6.28 | −128.0 |
Ayacucho | Andes | 15.65 | 10.91 | 5.08 | 17.33 | −10.8 |
Cajamarca | Andes | 17.23 | 12.68 | 13.26 | 12.56 | 27.1 |
Cusco | Andes | 15.12 | 15.49 | 9.09 | 14.73 | 2.6 |
Huancavelica | Andes | 18.25 | 16.20 | 9.54 | 13.67 | 25.1 |
Huanuco | Andes | 16.30 | 12.43 | 11.54 | 9.19 | 43.6 |
Ica | Coast | 8.84 | 10.99 | 15.47 | 6.64 | 24.9 |
Junin | Andes | 19.62 | 12.25 | 7.19 | 8.76 | 55.3 |
La Libertad | Coast | 7.50 | 12.17 | 8.22 | 10.28 | −37.0 |
Lambayeque | Coast | 11.21 | 8.12 | 13.80 | 6.14 | 45.3 |
Lima/Callao | Coast | 5.93 | 10.50 | 2.80 | 7.24 | −22.0 |
Loreto | Amazon | 24.28 | 19.25 | 13.68 | 18.70 | 23.0 |
Madre de Dios | Amazon | 14.87 | 10.64 | 19.79 | 10.35 | 30.4 |
Moquegua | Coast | 17.01 | 11.55 | 8.68 | 6.02 | 64.6 |
Pasco | Andes | 18.20 | 21.48 | 12.92 | 3.03 | 83.4 |
Piura | Coast | 14.61 | 13.80 | 12.59 | 7.09 | 51.5 |
Puno | Andes | 21.32 | 15.00 | 16.65 | 12.36 | 42.0 |
San Martin | Amazon | 16.78 | 15.57 | 14.54 | 23.74 | −41.4 |
Tacna | Coast | 12.53 | 9.51 | 8.81 | 0.00 | 100.0 |
Tumbes | Coast | 13.09 | 20.81 | 12.68 | 12.55 | 4.1 |
Ucayali | Amazon | 12.71 | 15.91 | 9.69 | 5.21 | 59.0 |
Department | Demographic and Health Survey (DHS)-based birth cohorts | Registered and corrected | Individual DHS | ||||||
---|---|---|---|---|---|---|---|---|---|
Ranking | Beta | SE | Ranking | Beta | SE | Ranking | Beta | SE | |
Amazonas | 21 | −0.04 | 0.13 | 1 | −1.57 | 0.74 | 13 | −0.73 | 0.36 |
Ancash | 7 | −0.74 | 0.13 | 9 | −0.91 | 0.19 | 7 | −1.19 | 0.56 |
Apurimac | 2 | −1.21 | 0.26 | 2 | −1.55 | 0.13 | 4 | −1.90 | 0.85 |
Arequipa | 20 | −0.07 | 0.33 | 12 | −0.70 | 0.15 | 10 | −0.89 | 0.49 |
Ayacucho | 23 | 0.21 | 0.50 | 7 | −1.03 | 0.20 | 6 | −1.34 | 0.38 |
Cajamarca | 14 | −0.28 | 0.10 | 19 | −0.25 | 0.14 | 11 | −0.80 | 0.60 |
Cusco | 18 | −0.18 | 0.28 | 6 | −1.16 | 0.20 | 1 | −2.44 | 0.77 |
Huancavelica | 11 | −0.51 | 0.25 | 3 | −1.44 | 0.35 | 2 | −2.44 | 0.68 |
Huanuco | 10 | −0.57 | 0.06 | 4 | −1.41 | 0.28 | 5 | −1.87 | 0.58 |
Ica | 16 | −0.20 | 0.35 | 17 | −0.31 | 0.24 | 12 | −0.77 | 0.96 |
Junin | 6 | −0.89 | 0.21 | 8 | −0.92 | 0.20 | 8 | −1.18 | 0.93 |
La Libertad | 22 | 0.02 | 0.18 | 21 | 0.33 | 0.12 | 3 | −1.91 | 0.83 |
Lambayeque | 15 | −0.27 | 0.31 | 18 | −0.28 | 0.09 | 14 | −0.67 | 0.56 |
Lima/Callao | 17 | −0.19 | 0.30 | 14 | −0.49 | 0.08 | 19 | −0.48 | 0.28 |
Loreto | 13 | −0.48 | 0.28 | 22 | 0.55 | 0.60 | 22 | −0.37 | 0.74 |
Madre de Dios | 19 | −0.10 | 0.43 | 20 | 0.24 | 0.34 | 23 | −0.12 | 0.62 |
Moquegua | 5 | −0.93 | 0.08 | 10 | −0.85 | 0.29 | 18 | −0.51 | 0.37 |
Pasco | 1 | −1.76 | 0.43 | 13 | −0.56 | 0.37 | 20 | −0.43 | 0.70 |
Piura | 8 | −0.72 | 0.17 | 16 | −0.37 | 0.14 | 21 | −0.37 | 0.38 |
Puno | 9 | −0.61 | 0.16 | 5 | −1.30 | 0.35 | 17 | −0.53 | 1.01 |
San Martin | 24 | 0.70 | 0.32 | 23 | 0.57 | 0.57 | 9 | −1.08 | 0.48 |
Tacna | 3 | −1.12 | 0.25 | 11 | −0.79 | 0.30 | 24 | 0.02 | 0.32 |
Tumbes | 12 | −0.49 | 0.34 | 15 | −0.40 | 0.23 | 16 | −0.57 | 0.60 |
Ucayali | 4 | −0.97 | 0.27 | 24 | 1.11 | 0.40 | 15 | −0.67 | 0.51 |
Equity analyses of mortality and coverage
Urban | 95 % CI |
P-value | Rural | 95 % CI |
P-value | Poorest quintile | 95 % CI |
P-value | Richest quintile | 95 % CI |
P-value | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Coverage in 2000 (%) | 90.9 | 90.1 | 91.8 | 81.6 | 79.9 | 83.3 | 75.4 | 73.0 | 77.7 | 93.1 | 91.6 | 94.7 | |||||
FPS | Annual rate of increase (%)a
| 0.04 | −0.06 | 0.14 | NS | 0.5 | 0.3 | 0.7 | <0.001 | 0.9 | 0.6 | 1.2 | <0.001 | 0.1 | −0.08 | 0.3 | NS |
Coverage in 2013 (%) | 89.7 | 88.6 | 90.6 | 88.2 | 87.0 | 89.3 | 85.5 | 83.9 | 87.0 | 92.2 | 89.6 | 94.2 | |||||
Coverage in 2000 (%) | 81.1 | 79.5 | 82.7 | 50.9 | 48.1 | 53.8 | 42.9 | 39.8 | 45.9 | 93.3 | 91.2 | 95.4 | |||||
ANC | Annual rate of increase (%)a
| 0.9 | 0.8 | 1.1 | <0.001 | 2.5 | 2.2 | 2.9 | <0.001 | 3.9 | 3.4 | 4.4 | <0.001 | 0.4 | 0.2 | 0.6 | <0.001 |
Coverage in 2013 (%) | 96.6 | 95.9 | 97.2 | 91.5 | 89.9 | 92.8 | 89.1 | 87.1 | 90.9 | 98.3 | 96.1 | 99.3 | |||||
Coverage in 2000 (%) | 85.0 | 83.3 | 86.8 | 28.7 | 26.1 | 31.3 | 20.1 | 17.9 | 22.3 | 98.4 | 97.4 | 99.4 | |||||
SBA | Annual rate of increase (%)a
| 0.8 | 0.7 | 1.0 | <0.001 | 6.9 | 6.0 | 7.8 | <0.001 | 9.6 | 8.5 | 10.7 | <0.001 | −0.05 | −0.01 | −0.08 | 0.002 |
Coverage in 2013 (%) | 97.3 | 96.4 | 96.4 | 71.3 | 67.1 | 75.3 | 65.6 | 61.1 | 69.9 | 99.7 | 99.0 | 99.9 | |||||
Rate in 2000 (deaths/1,000) | 15.1 | 12.4 | 17.9 | 31.0 | 27.6 | 34.4 | 30.9 | 26.7 | 35.2 | 9.8 | 4.0 | 15.5 | |||||
NMR | Annual rate of reduction (%)a
| 3.2 | 1.1 | 5.2 | 0.001 | 6.6 | 5.2 | 8.0 | <0.001 | 5.9 | 4.2 | 7.6 | <0.001 | 0.9 | −6.0 | 7.3 | NS |
Rate in 2013 (deaths/1,000) | 11.4 | 8.3 | 14.5 | 13.3 | 10.4 | 16.1 | 14.7 | 11.1 | 18.2 | 7.6 | 1.3 | 14.0 |
Urban vs. rural | Richest quintile vs. Poorest quintile | ||
---|---|---|---|
FPS | Annual rate of increase (%) | <0.001 | <0.001 |
ANC4 | Annual rate of increase (%) | <0.001 | <0.001 |
SBA | Annual rate of increase (%) | <0.001 | <0.001 |
NMR | Annual rate of reduction (%) | 0.002 | 0.09 |
Completeness of registered neonatal mortality at district-level
Expenditure on maternal and neonatal health interventions
Potential underlying factors
1970s | 1980s | 1990s | 2000s | 2010- to date | |
---|---|---|---|---|---|
Political background | Military dictatorships | Transition to democracy (1980) Social violence (Shining Path: 1982–1992) with rural areas most affected | Continued democratic period, followed by an auto-coup (1992) and political instability Shining Path defeat (1992) Weak public and civil society institutions | Consolidation of democratic system and decentralisation process with mixed results Strengthened participation of civil society in policymaking and accountability | Stable democracy with continued decentralisation process with mixed results Continued strengthened participation of civil society in policymaking and accountability |
Economic growth | Economic stagnation | Inflation and foreign debt crisis Economic stagnation and recession Poverty increase | Control of inflation, sustained economic growth and GDP increase Poverty reduction Persistence of social and economic inequities | Fast economic growth and GDP increase. Further poverty reduction. Persistence of social and economic inequities. | Fast economic growth and GDP increase. Further poverty reduction. Efforts to reduce the equity gaps. Social inclusion policies. Rural areas and indigenous populations still lagging behind. |
Cross-cutting contextual policies | Agricultural reform Nationalisation of main economic industries | Economic liberalisation Formal restoration of civil rights, but with crisis of governance | Re-insertion into the international financial community Anti-terrorist policies implemented | Consolidation of market economy | Market economy consolidated. Efforts to increase investment and exports and to reach economic diversification. Extension of road infrastructure Public sector reform (including education and health) for improving efficiency and equity |
Macro health policies & systems | Establishment of 3-tiered system: Ministry of health and charitable services for poor (“Beneficencias”), social security and private | Continued implementation of 3-tiered system: Ministry of health and charitable services for poor (“Beneficencias”), social security and private | Creation of Maternal-Infant Insurance programme (1998) Continued implementation of 3-tiered system Health system strengthening efforts | Creation of Comprehensive Health Insurance (SIS) (2002) Continued implementation of 3-tiered system Health system strengthening efforts | Universal Health Insurance (AUS) (2009–2010) Continued implementation of 3-tiered system Health system strengthening efforts |
Demographic factors | Slow urbanisation Decrease in fertility rate | Urbanisation Decrease in fertility rate | Urbanisation Decrease in fertility rate | Urbanisation Decrease in fertility rate | Urbanisation Decrease in fertility rate |
Maternal & neonatal health programmes | None | None | Maternal-Infant Health Insurance programme (1998) Family planning & contraceptive initiatives (government and NGOs) Debate about violation of women’s reproductive and sexual rights. | Expansion of SIS (2002), with focus on under-5 children and mothers Cross-cutting programmes: introduction of Strategic Maternal-Neonatal Programme (2007) Stagnation of sexual & reproductive programmes | Cross-cutting programmes: scaling-up of Strategic Maternal-Neonatal Programme (2010) Stagnation of sexual & reproductive programmes |
Child health programmes | Establishment of National Immunisation Programme (1972) | Consolidation of child health vertical programmes and national immunisation campaigns Focus on child survival with low visibility of mothers and newborns | Consolidation of child vertical programmes and national immunisation campaigns IMCI introduction (1996) Focus on child survival with low visibility of mothers and newborns | Expansion of SIS (2002), with focus on children under-5 and mothers Cross-cutting programmes: introduction of Articulate Nutritional Programme (2007) | Expansion to SIS, with focus on under-5 children and mothers Cross-cutting programmes: scaling-up of Articulate Nutritional Programmes (2010) |
Non-health sector programmes | Establishment of National Program of Food Support (ONAA) and Programme of Direct Aid (PAD) Limited expansion of water supply & sanitation | Continuity of food supplementation programmes (PRONAA) Expansion of water supply & sanitation, with rural areas lagging behind | Continuity of food supplementation programmes (PRONAA) Expansion of water supply & sanitation, with rural areas lagging behind Improvement of women’s education | Introduction of conditional cash transfer programme (JUNTOS) (2005) Cross-cutting programmes (results-based budgeting) Continuity of food supplementation programmes (PRONAA) Expansion of water supply & sanitation, with rural areas lagging behind Improvement of women’s education | Scaling-up of JUNTOS Integration of social assistance programmes (MIDIS) & further emphasis on social inclusion beyond anti-poverty programmes Improvement of women’s education Non-health sector cross-cutting programmes (results-based budgeting) |