Maternal demographic and socioeconomic correlates of child mortality in Papua New Guinea: Evidence from the integrated Health and Demographic Surveillance System

Background: Papua New Guinea (PNG) continues to struggle with high child U5MRs, with data from the PNG Census reporting 63.9 deaths per 1000 live births. Addressing high child U5MRs remains a health priority for PNG in line with the UN SDG3. This study aimed to examine the socio-demographic correlates associated with U5MR in PNG. Methods: The 2015 Women of Reproductive Age (15-49 years) and Household Socio-Economic Status datasets from the PNG Institute of Medical Research (PNGIMR) integrated Health Demographic Surveillance System (iHDSS) were used to examine associations between surveillance site, maternal age, marital status and household wealth quintile and U5MR. The main outcome measure was under-5 mortality (death from between 0-59 months) determined by using data from women of reproductive age who had experienced under-five mortality in the lifetime. Sociodemographic factors were assessed using participant interviews. Chi-square and logistic regressions were used to test the strength of associations between factors and U5MR. Results: A total of 5,899 women were included in the study. Factorssignificantly associated with U5MR were maternal age group and marital status. Children born to mothers aged 15-19 [OR: 10.91 (95% CI: 3.70-32.15)] and children born to mothers aged 20-24 [OR: 3.11 (95% CI: 1.65 -5.85)] had higher likelihood of experiencing U5MR compared to children who were born to mothers aged 40-49. Children born to single mothers [OR: 1.91 (95% CI: 1.19-3.05) were more likely to experience U5MR compared to children born to married mothers. Compared with the Hiri surveillance site, U5MR was lower in Asaro [OR: 0.54 (95% CI: 0.32-0.90)] and Hides [OR: 0.25 (95% CI: 0.11-0.59)] surveillance sites. No associations were found between the U5MR and household wealth quintile. Conclusions: This study highlights the importance of re-evaluating existing maternal and child health intervention programs. Comprehensive approaches are needed to address associated maternal and household socio-economic factors to improve U5MR in PNG.