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PubMed1985

Child mortality and economic variation among rural Mexican households.

In two rural Mexican communities, rates of child mortality are significantly related to economic situations of households. Measured over the childbearing years of post-reproductive women, the rate of child mortality (ages 0-5 years) per mother is 163 per 1000 children in one village and 338 in the other. Significant economic correlates, which are defined ethnographically in each community, are housing quality, quality of farm land and marital status. Correlations of child mortality rates with economic variables range from -0.25 to -0.54, showing that poorer mothers lose significantly more children in the first 5 years of life. These results parallel those of urban, regional, national and international studies, but economic correlates of child mortality have not previously been found in rural Latin America. The methodological contributions of this study include a meld of ethnographic and survey techniques of data collection, the development of culturally appropriate variables to measure economic status, the use of child rather than infant mortality rates, and a household-related demographic measure, the rate of child mortality per mother.

Child, Preschool↗
PubMed2004

Child mortality in a West African population protected with insecticide-treated curtains for a period of up to 6 years.

OBJECTIVES: To determine the impact of insecticide-treated curtains (ITC) on all-cause child mortality (6-59 months) over a period of six years. To determine whether initial reductions in child mortality following the implementation of ITC are sustained over the longer term or whether "delayed" mortality occurs. METHODS: A rural population of ca 100 000 living in an area with high, seasonal Plasmodium falciparum transmission was studied in Burkina Faso. Annual censuses were conducted from 1993 to 2000 to measure child mortality. ITC to cover doors, windows, and eaves were provided to half the population in 1994 with the remainder receiving ITC in 1996. Curtains were re-treated or, if necessary, replaced annually. FINDINGS: Over six years of implementation of ITC, no evidence of the shift in child mortality from younger to older children was observed. Estimates of the reduction in child mortality associated with ITC ranged from 19% to 24%. CONCLUSIONS: In our population there was no evidence to suggest that initial reduction in child mortality associated with the introduction of insecticide-treated materials was subsequently compromised by a shift in child mortality to older-aged children. Estimates of the impact of ITC on child mortality in this population range from 19% to 24%.

Animals↗
PubMed1999

Correlates of child mortality in Pakistan: a hazards model analysis.

This study investigated factors associated with child mortality in an area in Rawalpindi, one of the large cities of Pakistan. Using both demographic and anthropological methods, the research was conducted to specifically examine the process and mechanisms whereby a link is established between child mortality and its covariates. Controlling for the socioeconomic status as a determinant of child mortality, the study population was limited to a lower income stratum living in a homogeneous environment where all households had equal access to health-related and other facilities. Results of the proportional hazards model analysis on 1301 index children suggest that non-economic factors like maternal health-seeking behavior were related to high child mortality. The cultural norm of bearing a large number of children was the most significant correlate. In order of significance, this was followed by contraceptive use, current age of the mother, age at marriage, and the hygienic conditions of the household. The study provides strong evidence of familial clustering of mortality by order of the household.

Asia↗
PubMed2003

Non-specific effect of measles vaccination on overall child mortality in an area of rural India with high vaccination coverage: a population-based case-control study.

OBJECTIVE: To determine whether vaccination against measles in a population with sustained high vaccination coverage and relatively low child mortality reduces overall child mortality. METHODS: In April and May 2000, a population-based, case-control study was conducted at Ballabgarh (an area in rural northern India). Eligible cases were 330 children born between 1 January 1991 and 31 December 1998 who died aged 12-59 months. A programme was used to match 320 controls for age, sex, family size, and area of residence from a birth cohort of 15 578 born during the same time period. FINDINGS: The analysis used 318 matched pairs and suggested that children aged 12-59 months who did not receive measles vaccination in infancy were three times more likely to die than those vaccinated against measles. Children from lower caste households who were not vaccinated in infancy had the highest risk of mortality (odds ratio, 8.9). A 27% increase in child mortality was attributable to failure to vaccinate against measles in the study population. CONCLUSION: Measles vaccine seems to have a non-specific reducing effect on overall child mortality in this population. If true, children in lower castes may reap the greatest gains in survival. The findings should be interpreted with caution because the nutritional status of the children was not recorded and may be a residual confounder. "All-cause mortality" is a potentially useful epidemiological endpoint for future vaccine trials.

Case-Control Studies↗
PubMed1997

Measuring excess risk of child mortality: an exploration of DHS I for Burundi, Uganda and Zimbabwe.

This paper proposes a new method of measuring excess risk of child mortality in cross-sectional surveys, which is applied to DHS I data for Burundi, Uganda and Zimbabwe. The expected child mortality experience is estimated for each mother on the basis of child's age, mother's age at child's birth and her parity, and compared with her observed experience. Mothers who exceed their expected child mortality experience and also had more than one child die are considered to have excess child mortality. Zimbabwe had the greatest concentration of child deaths as measured by a simple ratio of mothers to deaths, but when observed experience was compared with expected it had less than half as many excess deaths as Uganda and Burundi. In all three countries mother's education had a strong negative association with the risk of excess child mortality, and in Zimbabwe and Burundi there were significant regional differences.

Adolescent↗
PubMed1991

Socio-economic development and the dynamics of child mortality among sedentarizing Bedouin in Israel.

The authors analyze trends in child mortality among the Bedouin in Israel, who are in the process of changing from a nomadic to a sedentary way of life. "At early stages of sedentarization and development, child mortality rates decline, as expected, then rise, only to decline again. The positive relationship that is theoretically assumed to exist in general between declining child mortality and socio-economic development over time and space may thus possibly be refined, to accompany an earlier similar refinement regarding fertility decline. Demographic indicators may consequently respond late to development processes."

Asia↗
PubMed1991

Parental education and child mortality in Burundi.

This paper examines the relationship between parental education and child mortality in Burundi using data collected in the 1987 Demographic and Health Survey. Proportional hazards models are estimated to examine this relationship, while holding constant other known child mortality determinants. Parental education proves to be a key factor in explaining differences in child mortality, the effect of maternal education being particularly strong compared to paternal education.

Birth Order↗
PubMed2005

Vitamin A deficiency and child mortality in Mozambique.

BACKGROUND: In areas where vitamin A deficiency (VAD) is prevalent, vitamin A repletion reduces child mortality by 23% on average. OBJECTIVES: To estimate the potential child survival benefits of policies and programmes aimed at controlling VAD in Mozambique, and to make policy and programme recommendations. METHODS: The potential contribution of VAD to child mortality in Mozambique was estimated by combining the observed VAD prevalence in the under-5s (71.2%), the measured child mortality effects of VAD (risk of death in children with VAD=1.75 times higher than in children without VAD) and the observed under-5 mortality rate in the country (210 per 1000 live births). RESULTS: In Mozambique, an estimated 2.3 million children below the age of 5 years are vitamin-A-deficient. In the absence of appropriate policy and programme action, VAD will be the attributable cause of over 30,000 deaths annually in the under-5s. This represents 34.8% of all-cause mortality in this age group. DISCUSSION: Vitamin A supplementation (VAS) has been adopted as a short- to medium-term strategy to control VAD in children, and is integrated into routine child health services. However, the last VAS coverage survey showed that only 46% of children received a vitamin A supplement in the 6 months preceding the survey. If VAS coverage is to increase significantly in the foreseeable future, four areas appear to be of paramount importance: (1) reduce missed opportunities for VAS such as visits of sick children to child health services and community outreach activities; (2) take advantage of all potential opportunities for accelerating VAS coverage, such as additional vaccination campaigns and emergency response activities; (3) strengthen health workers' training, supervision and monitoring skills; and (4) increase community demand for VAS of children. Biannual VAS, as the primary component of an integrated strategy for VAD control in children, has the promise to be among the most cost-effective/high-impact child survival interventions in Mozambique.

Cause of Death↗
PubMedDate not supplied

Child mortality in Goa: a cross-sectional analysis.

This paper is a study of the determinants of child mortality in the relatively developed Indian state of Goa. Data from the National Family Health Survey (NFHS, 1992-93) conducted in the state of Goa have been used to examine the child mortality experiences of 1,331 women who were within a marriage lasting 15 years. An aggregated index of child mortality, which summarizes the mortality experiences of a woman with exposure adjustment, is the study variable. Maternal education and longer birth spacing were found to lower child mortality risks significantly.

Birth Intervals↗
PubMed2006

Rates and causes of child mortality in an area of high HIV prevalence in rural South Africa.

OBJECTIVE: To determine child mortality rates in a rural area of South Africa with high HIV prevalence. METHODS: A community-based survey was conducted between 1 January 2000 and 31 December 2002 on deaths in children under the age of 15 years. Children were followed up through four monthly home visits. Cause of death was ascertained by verbal autopsy. Rates were calculated using Poisson regression. RESULTS: Mortality ratios were 59.6 deaths per 1000 live births for infants and 97.1 for children under 5 years of age. Infant and under-5 mortality rates were, respectively, 67.5 and 21.1 deaths per 1000 person-years. HIV/AIDS was attributed to 41% of deaths in the under-5 age group, with a mortality rate of 8.6 per 1000 person-years. Lower respiratory infections caused an estimated 24.9 deaths per 1000 person-years in children under 1 year of age. CONCLUSIONS: In rural South Africa, infant and child mortality levels are high, with HIV/AIDS estimated as the single largest cause of death. Interventions to reduce child mortality are required urgently.

Adolescent↗
PubMedDate not supplied

Birth spacing, breastfeeding, and early child mortality in a traditional Indian society: a hazards model analysis.

There are few studies of the interrelationships among breastfeeding, child spacing, and child mortality in traditional societies that incorporate extensive controls for social and demographic characteristics of the mother and child. In this paper, we investigate the impact of breastfeeding and the length of the preceding birth interval on early child mortality (defined as a death in the first two years of life) using data from a traditional society of India. Multivariate hazards models are used to analyze the data. Most prior analyses related the impact of breastfeeding duration to the duration of child survivability by taking breastfeeding as a fixed covariate. The present study has a methodological focus in the sense that breastfeeding information from retrospective survey data is treated as a time-dependent covariate both as a status variate as well as a duration--with empirical findings compared across the two specifications. The effects of postpartum amenorrhoea and various other demographic and socioeconomic characteristics of mother and child are also studied. The results suggest that breastfeeding duration has a strong impact in reducing the relative risk of early child mortality; but it does not explain the effect of the length of the preceding birth interval on early child mortality.

Birth Intervals↗
PubMed1998

Child mortality patterns in rural areas of Anhui and Henan provinces in China, 1990.

County-based IMR and U5MR in Anhui and Henan provinces in China were estimated and analyzed by using the 1990 Census Data. Census was conducted on July 1, 1990, the number of deaths only occurred in the first half year of 1990 was collected. In order to obtain the total population and total number of deaths in the same year, the total number of deaths in each age-sex group for the whole 1990 was then estimated by taking the death number in the first half of 1990 as the base and multiplying a coefficient, which varied in different age-sex-region groups. Two major adjustments for some possible under-reporting cases in female birth and infant death were made. If the sex ratio at age 0 in some counties was beyond 1.2, then it was taken as 1.15 for rural counties and 1.10 for urban cities, which were the estimates of sex ratios for the children at age 5 in the national 1% Population Sampling Survey in 1995. The adjustment for IMR were made by comparing the segment of the county lift table from age 15 through 59 with that from the same age groups in the international and Chinese Model Life Tables. The IMR in the county life table would be substituted by the one in the closest Model Life Talbe, if it was less than in the latter. The findings of the analysis may be summarized as follows: (i) Total county-based IMR and U5MR were 33.4 per 1,000 and 41.4 per 1,000 respectively, with great variations between urban cities (25.4 per 1,000 for IMR and 31.4 per 1,000 for U5MR) and rural counties (35.1 per 1,000 for IMR and 43.6 per 1,000 for U5MR). There were also significant differences in child mortality between nationally identified poor counties and other counties in rural areas. In the poor counties the total IMR was 40.7 per 1,000 living births in average while in non-poor counties it was only 33.2 per 1,000 in average (P < 0.05). The U5MR in poor counties was 25 percent higher than in non-poor counties (51.5 vs 40.9 per 1,000 living births). (ii) Statistically significant correlation between child mortality and socio-economic variables was revealed from the data set, among which gross social economic products per capita was found to have the strongest relationship with child mortality. The negative correlation was found between child mortality and a set of so-called 'rich' variables including the gross social products, gross agricultural products, gross industrial products and the proportions of high-educated population at county level, whereas the positive correlation was found between child mortality and a set of 'poor' variables, such as proportions of residents with lower level of education and illiteracy rate. (iii) Differences in child mortality between these two provinces were found, which were identical to the trends of differences in socio-economic indicators between them. Lower child mortality proved to be associated with better socio-economic conditions (higher per capita products, higher proportions of residents with higher level of education, lower proportion of less educated people and illiteracy) in province Henan. (iv) A simple linear regression model was developed separately for Henan and Anhui to predict the IMR and U5MRs in each stage of economic development, where the dependent variables were the logarithm of IMR and U5MR, and the independent variables were the quintiles of the output value of gross products (GOP). It was found that at the first quintile, which was equivalent to 800 yuan of GOP in average, the predicted IMR and U5MR would reach 40 per 1,000 and 51 per 1,000 respectively. It would decline to 38 per 1,000 for IMR and 47 per 1,000 for U5MR in the second lowest quintile. Dramatic drop of child mortality was found between the second quintile and the third quintile, where 6 per 1,000 decline would occur for both IMR and U5MR. The decline would continue subsequently, but slower. The prediction of child mortality in rural counties could be used as a reference to assess counties at different stages of socio-

Adolescent↗
PubMed1989

Child mortality differentials in Ghana: a preliminary report.

The relationship is examined of child mortality in Ghana with six socioeconomic factors: mother's type of place of residence, education, occupation and work status, and current husband's education and occupation. Using data from the 1979-80 Ghana Fertility Survey, Trussell's marriage duration model was employed to estimate probabilities of dying at exact ages 2 and 5 in different population subgroups. The two education variables (mother's and husband's education) have the largest effect on child mortality, followed by husband's occupation and mother's occupation, in that order. In order to reduce child mortality to tolerable levels, expansion is urgently required of the medical and health services, balanced by an equal development of education, particularly of girls, help being given especially to the rural areas where the majority of the population live.

Child↗
PubMed2001

War, famine and excess child mortality in Africa: the role of parental education.

BACKGROUND: Civilian-targeted warfare and famine constitute two of the greatest public health challenges of our time. Both have devastated many countries in Africa. Social services, and in particular, health services, have been destroyed. Dictatorial and military governments have used the withholding of food as a political weapon to exacerbate human suffering. Under such circumstances, war and famine are expected to have catastrophic impacts on child survival. This study examines the role of parental education in reducing excess child mortality in Africa by considering Tigrai-Ethiopia, which was severely affected by famine and civil war during 1973--1991. METHODS: This study uses data from the 1994 Housing and Population Census of Ethiopia and on communities' vulnerability to food crises. Child mortality levels and trends by various subgroups are estimated using indirect methods of mortality estimation techniques. A Poisson regression model is used to examine the relationship between number of children dead and parental education. RESULTS: Although child mortality is excessively high (about 200 deaths per 1000 births), our results show enormous variations in child mortality by parental education. Child mortality is highest among children born to illiterate mothers and illiterate fathers. Our results also show that the role of parental education in reducing child mortality is great during famine periods. In the communities devastated by war, however, its impact was significant only when the father has above primary education. CONCLUSIONS Our findings suggest that both mother's and father's education are significantly and negatively associated with child mortality, although this effect diminishes over time if the crisis is severe and prolonged. The policy implications of our study include, obviously, reducing armed conflict, addressing food security in a timely manner, and expansion of educational opportunities.

Child↗
PubMed1989

Fertility and child mortality in rural Ethiopia: Gondar and Hararge regions.

This paper presents fertility and child mortality estimates for agricultural households of the Gondar and Hararge regions, based on the 1981 Rural Demographic Survey. The study shows that fertility and child mortality are quite high in both regions as in the rest of the country. However, Hararge has significantly higher mean parity and child mortality than Gondar.

Adolescent↗
PubMed1988

Child mortality in a Nigerian city: its levels and socioeconomic differentials.

Using the 'indirect' demographic estimation technique, levels of child mortality for some selected socioeconomic characteristics of mothers in Ilorin, an urban community in Nigeria, were derived. The adjusted effects of these variables on child mortality were assessed. The variables found to exert significant independent effects on child mortality included the husbands education, area of residence in the town, the parity of the mother, her use of modern contraception, availability of indoor pipe-borne water and the use of a refrigerator by the household. Reliable or useful information on child mortality in this part of Nigeria is hard to come by, hence, the estimates provided here can serve as useful baseline data for evaluating the impacts of child survival activities that are currently going on in that part of the country.

Child, Preschool↗
PubMed1993

New estimates of infant and child mortality for blacks in South Africa, 1968-1979.

This report is part of a project to evaluate and improve the quality of mortality data for blacks in South Africa. Infant and child mortality rates of 79/1,000 and 81/1,000 were estimated for 1968-1974 and 1975-1979 respectively. A child mortality rate of 43/1,000 was estimated for 1973-1977. Estimates of infant mortality rates for 1970-1974 and 1975-1979, and the child mortality rate for 1973-1977, are higher than the results reported earlier by other analysts.

Adolescent↗
PubMedDate not supplied

Structural determinants of child mortality in sub-Saharan Africa: A cross-national study of economic and social influences from 1970 to 1997.

This cross-national study seeks to understand the lagging child mortality declines in sub-Saharan Africa by using World Bank data to investigate social and economic factors at three points in time: 1970, 1985, and 1997. Women's education, foreign debt-to-export ratio, and GNP per capita are among the strongest correlates of under five mortality over time. Cross-sectional and longitudinal results suggest that female education is the best overall predictor of child mortality. Average national income does not emerge as a strong predictor, particularly since 1985. Increasing levels of foreign debt are associated with a substantial excess mortality burden. In 1997, the effect of adult HIV prevalence on child mortality was moderate and statistically significant. The study concludes that, although future gains in social factors such as female education will likely be beneficial, without simultaneously addressing high levels of foreign debt and high HIV prevalence, it may be difficult to improve child mortality rates across sub-Saharan Africa.

Acquired Immunodeficiency Syndrome↗