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. 2025 Jun 21;44(1):219.
doi: 10.1186/s41043-025-00971-7.

The nexus between healthcare provider distribution and neonatal mortality based on the context of maternal and child healthcare services in Pakistan

Rashed Nawaz  1 , Neelum Khalid  2 , Fatima Ajmal  3 , Mohammad Fazel Akbary  2 , Shaoqing Gong  4 , Zhongliang Zhou  2
Affiliations

The nexus between healthcare provider distribution and neonatal mortality based on the context of maternal and child healthcare services in Pakistan

Rashed Nawaz et al. J Health Popul Nutr. .

Abstract

Background: Healthcare provider dearth, particularly in Low and Middle-income countries (LMICs), reduces the development towards improved healthcare outcomes and accomplish the Sustainable Development Goals (SDGs-3). This study aims to investigate the association between Professional and Non-professional healthcare provider distribution and neonatal mortality through the mediating role of maternal and child healthcare (MCH) services in Pakistan.

Methods: The present research used data from the 2018 Pakistan Demographic and Health Survey (PDHS) total sample that comprises (N = 8022). The dependent variable includes the risk of neonatal mortality 0-30 days. Bivariate and Multivariate analyses were conducted by utilizing the Cox proportional hazards and regression models. The estimation of mortality rates was achieved through generalized structural equation modelling (GSEM) and the 5000 bootstrap technique. All the investigations were carried out in STATA v. 16.1.

Results: Our results revealed that around 2.46% of neonatal deaths occur. The average healthcare provider distribution type was professional, 83.45%, non-professional, 1.45%, and no care, 15.11%. 0.88% of females are less likely to die within the first thirty days of their birth compared to males. The regression outcomes demonstrate that the healthcare providers were positive and significantly linked to neonatal mortality. Additionally, a unit increase in healthcare providers has a 1.20% Higher likelihood of increasing the MCH and overall reducing neonatal mortality (HR = 0.60).

Conclusion: The outcomes illustrate that healthcare provider distribution and MCH play a vital role in minimizing neonatal mortality. To ensure well-distributed healthcare provider distribution, promoting maternal education, empowering women's decision-making in acquiring MCH services utilization, and expanding access to free MCH services are the essentials for better maternal and healthcare outcomes.

Keywords: Child health services; Developing countries; Generalized structural equation modelling; Healthcare workforce; Maternal health services; Mortality.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study involves human participants and procedures, and questionnaires for standard DHS surveys have been reviewed and approved by the ICF Institutional Review Board (IRB). Additionally, country-specific DHS survey protocols are reviewed by the ICF IRB and typically by an IRB in the host country. ICF IRB ensures that the survey complies with the US Department of Health and Human Services regulations for protecting human subjects (45 CFR 46), while the host country IRB ensures that the survey complies with the laws and norms of the nation. Participants gave informed consent to participate in the study before taking part. Consent for publication: Not applicable. Patient and public involvement: Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the sample selection
Fig. 2
Fig. 2
Test of proportional hazards assumption for the independent variable
Fig. 3
Fig. 3
illustrates the conceptual framework of the mediation association between healthcare providers and neonatal mortality
Fig. 4
Fig. 4
Effect of healthcare providers relative to neonatal mortality
Fig. 5
Fig. 5
Goodness of fit statistics for Model comparison (AIC, BIC, Log-likelihood
Fig. 6
Fig. 6
Estimated path coefficient from 5000 bootstrap repetitions in the mediation association between healthcare provider distribution and neonatal mortality. Note: ***p > 0.001
See this image and copyright information in PMC

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