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PubMed2006

Why are infant and child mortality rates lower in the MCH-FP area of Matlab, Bangladesh?

Infant and child mortality rates are significantly lower in the Maternal and Child Health-Family Planning (MCH-FP) area of Matlab, Bangladesh, than in a comparison area. The two areas are similar in terms of socioeconomic characteristics, but the MCH-FP area provides better maternal and child health and family planning services, resulting in different reproductive patterns, including lower fertility rates and longer intervals between pregnancies. We use data from the Matlab Demographic Surveillance System for nearly 126,000 singleton live births that occurred between 1982 and 2002 to investigate the extent to which the different reproductive patterns in the MCH-FP area explain why infant and child mortality rates are lower there. Differences in reproductive patterns account for a small portion (up to 20 percent) of the variation in these rates between the MCH-FP and comparison areas, suggesting that the majority of the difference is due to the quality of MCH services.

Bangladesh↗
PubMed1984

[The structure for an analysis of the determinants of infant and child mortality].

An attempt is made to develop models that can explain the age patterns of infant and child mortality. The authors first review factors affecting infant and child mortality, identifying both the factors involving exposure to risk and those governing the individual's resistance to disease. Consideration is also given to the effect of therapeutic care. An indicator of the structure of child mortality is then developed to be "used as a dependent variable in a model of linear regression which includes mortality level, sex, climate, time and income as explanatory variables." The results indicate that the mortality level is the key factor affecting the age pattern of mortality during childhood and that the mortality of both sexes is very similar between one and five years of age. Of the other factors considered, only climate has a significant impact on mortality. (summary in ENG, SPA)

Age Factors↗
PubMed2003

Child mortality, socioeconomic position, and one-parent families: independent associations and variation by age and cause of death.

BACKGROUND: Although the association between child mortality and socioeconomic status is well established, it is unclear whether child mortality differences by socioeconomic position are present at all ages. The association of one-parent families with mortality, and whether any such association is due to associated low socioeconomic position, is also not clear. METHODS: In all, 480 of 693 (69%) 0-14 year old deaths during 1991-1994 were linked to 1991 census records. Analyses were weighted to adjust for potential linkage bias. RESULTS: There was approximately twofold higher mortality among the lowest compared with the highest socioeconomic categories of education, income, car access, and neighbourhood deprivation. Occupational class differences were weaker. These socioeconomic differences in mortality were strongest among infants (particularly sudden infant death syndrome [SIDS] mortality), but similar across other age groups (1-4, 5-9, and 10-14 years). The socioeconomic differences were of a similar magnitude for unintentional injury, cancer, congenital, and other deaths. Multivariable analyses demonstrated persistent independent associations of education, income, car access, and neighbourhood deprivation with mortality. Rate ratios (adjusted for age and ethnicity) for one-parent families compared with two-parent or other families were 1.2 (95% CI: 1.0, 1.5) and 1.8 (95% CI: 1.2, 2.5) for all-cause and unintentional injury mortality, respectively. Further adjustment for socioeconomic factors reduced these associations to 0.8 (95% CI: 0.6, 1.2) and 1.2 (95% CI: 0.7, 2.2), respectively. CONCLUSIONS: There does not appear to be notable variation in relative risk terms of socioeconomic differences in child mortality by age or cause of death. Any association of one-parent families with child mortality is due to associated low socioeconomic position.

Adolescent↗
PubMed2006

Tracking progress towards the Millennium Development Goals: reaching consensus on child mortality levels and trends.

The increased attention to tracking progress towards the Millennium Development Goals (MDG), including Goal 4 of reducing child mortality, has drawn attention to a number of interrelated technical, operational and political challenges and to the underlying weaknesses of country health information systems upon which reliable monitoring depends. Assessments of child mortality published in 2005, for almost all low-income countries, are based on an extrapolation of the trends observed during the 1990s, rather than on the empirical data for more recent years. The validity of the extrapolation depends on the quality and quantity of the data used, and many countries lack suitable data. In the long run, it is hoped that vital registration or sample registration systems will be established to monitor vital events in a sustainable way. However, in the short run, tracking child mortality in high-mortality countries will continue to rely on household surveys and extrapolations of historical trends. This will require more collaborative efforts both to collect data through initiatives to strengthen health information systems at the country level, and to harmonize the estimation process. The latter objective requires the continued activity of a coordinating group of international agencies and academics that aims to produce transparent estimates -- through the consistent application of an agreed-upon methodology --for monitoring at the international level.

Child Mortality↗
PubMed1991

[Levels, trends, and prospects concerning infant and child mortality in West Sumatra].

"This article investigates the levels, trends and differentials in infant and child mortality in West Sumatra [Indonesia]. The results of this study, based on the 1971, 1980 Population Censuses and the 1985 Intercensal Population Survey confirm a trend toward lower infant and child mortality in West Sumatra over the last two decades. The estimates also show that there are considerable urban-rural differentials in childhood mortality. In general, babies born in urban areas have a lower mortality rate than those born in rural areas. The study also shows that education, age at first marriage, occupation, and literacy level of the mother have significant effect on the child mortality differentials." (SUMMARY IN ENG)

Asia↗
PubMed2003

Child mortality associated with reasons for non-breastfeeding and weaning: is breastfeeding best for HIV-positive mothers?

OBJECTIVE: To estimate child mortality associated with reasons for the non-initiation of breastfeeding and weaning caused by preceding morbidity, compared with voluntary weaning as a result of maternal choice. METHODS: Demographic and Health Surveys were analysed from 14 developing countries. Women reported whether they initiated lactation or weaned, and if so, their reasons for non-initiation or stopping breastfeeding were classified as voluntary choice or as a result of preceding maternal/infant illness. Rates of child mortality and survival analyses were estimated, by reasons for non-breastfeeding or weaning. RESULTS: Mortality was highest among never-breastfed children. Child mortality among women who never initiated breastfeeding was significantly higher than among women who weaned. Preceding maternal/infant morbidity was the most common reason for not breastfeeding (63.9%), and the mortality of children never breastfed because of preceding morbidity was higher than in children not breastfed as a result of maternal choice; 326.8 per 1000 versus 34.8 per 1000, respectively. Mortality among breastfed children who were weaned because of preceding morbidity was higher than among those weaned voluntarily; 19.2 per 1000 versus 9.3 per 1000, respectively. Failure to initiate lactation was significantly more frequent among women reporting complications of delivery and with low birthweight infants. CONCLUSION: Child mortality as a result of the voluntary non-initiation of breastfeeding or voluntary weaning was lower than previously estimated, and this should be used as a benchmark when counselling HIV-positive mothers on the risks of non-breastfeeding or weaning to prevent mother-to-child transmission of HIV.

Breast Feeding↗
PubMed2001

Behavioural effects of infant and child mortality on fertility in Kenya.

This paper analyses the behavioural effects of infant and child mortality on birth intervals in Kenya. Analysing the behavioural effects of infant and child mortality on fertility independent of its biological effects has been considered a difficult task. In this paper, a procedure for analysing these effects separately is developed and applied to the 1989 Kenya Demographic and Health Survey (KDHS) data. The results of the analysis suggests that women in Kenya adopt various strategies such as curtailing the duration of breastfeeding, increasing frequency of coitus, and to a lesser extent use of contraception in order to replace infant or children who have died or to insure against those who are likely to die. These findings suggest the existence of behavioural effects of infant and child mortality on fertility in Kenya.

Adolescent↗
PubMed1995

The determinants of infant and child mortality in Tanzania.

This paper investigates the determinants of infant and child mortality in Tanzania using the 1991/92 Tanzania Demographic and Health Survey. A hazards model is used to assess the relative effect of the variables hypothesized to influence under-five mortality. Short birth intervals, teenage pregnancies and previous child deaths are associated with increased risk of death. The Government of the United Republic of Tanzania should therefore maintain its commitment to encouraging women to space their births at least two years apart and delay childbearing beyond the teenage years. Further, this study shows that there is a remarkable lack of infant and child mortality differentials by socioeconomic subgroups of the population, which may reflect post-independence health policy and development strategies. Whilst lack of socioeconomic differentials can be considered an achievement of government policies, mortality remains high so there is still a long way to go before Tanzania achieves its stated goal of 'Health for All'.

Birth Intervals↗
PubMed1986

[Child mortality in Nepal: an analysis of its socioeconomic determinants and a comparison with other developing countries].

The author studies child mortality in Nepal in this section of a large comparative project involving 15 developing countries. "Employing a method suggested by Trussell and Preston (1982) a child mortality index is computed for every woman by relating actual number of child deaths to the expected number of child deaths implied by marital duration, fertility, and the national mortality level. Based on the Nepal Fertility Survey of 1976 bi-, tri-, and multivariate analysis showed significant child mortality differentials according to mothers' and fathers' education, religion, and ecological region. The population of Nepal is still extremely homogeneous in that 96% of all ever-married women aged 15-49 can neither read or write, 95% live in rural areas, and 90% are Hindus. For women deviating from this pattern child mortality is in most cases substantially lower." (SUMMARY IN ENG)

Asia↗
PubMed1993

Socio-cultural determinants of child mortality in southern Peru: including some methodological considerations.

Among Amerindian children living at high altitude in the Andes in southern Peru, high child mortality rates have been reported in the literature, especially in the perinatal and neonatal period. We compared mortality rates in children calculated from retrospective survey data in 86 rural families from 2 Aymara and 3 Quechua peasant communities living at the same level of altitude (3825 m) in southern Peru. Relations between land tenure, socio-cultural factors and child mortality were studied, and methodological considerations in this field of interest are discussed. Checks on consistency of empirical data showed evidence for underreporting of neonatal female deaths with birth order 3 and more. Perinatal (124 vs 34 per 1000 births) and infant mortality (223 vs 111 per 1000 live births) was significantly higher in Aymara compared with Quechua children, but no difference was found after the first year of life. A short pregnancy interval was associated with an elevated perinatal and infant mortality rate, and a similar albeit insignificant association was found with increased maternal age. Amount of land owned and birth order were not related with child mortality. Although levels of maternal education are generally low in both cultures, a consistent decline in infant and child mortality was found with the amount of years mothers had attended school. However, the results suggest a U-shaped relationship between the amount of years of parental education and perinatal mortality in offspring. Late fetal and early neonatal mortality were particularly high in one Aymara community where mothers were found to have more years of education. Infanticide, a known phenomenon in the highlands of the Andes, is discussed in relation with the findings of the study. Although maternal and child health services are utilized by the majority of families in 4 of 5 study communities, 43 of 51 mothers under the age of 45 years reported that they delivered their last baby in the absence of traditional midwives or official medical supervision.

Adult↗
PubMed2002

Geography of child mortality clustering within African families.

After decades of sustained child mortality reductions, infant and early childhood mortality levels in Africa remain high. This can partly be ascribed to the concentration of child mortality within particular families, communities or geographic localities. Strong mortality clustering is indicative of marked social inequality and of an unequal distribution of health and health-related resources and infrastructures. It also signifies a concentration of nutritional and sanitary behaviors harmful to the good health and longevity of children. Finally, it likely points to the existence of particular genetic problems in certain families, or environmental problems within specific communities. Using nationally representative family level data from all sub-regions of Africa, two important findings emerge from this study. First, levels of mortality have generally declined in all countries over time, and as mortality decreases, mortality clustering tends to follow the same trend. Second, bio-demographic covariates have a more important effect on familial mortality clustering risks than socio-economic ones.

Africa↗
PubMed2004

Child mortality and HIV infection in Africa: a review.

OBJECTIVES: To review the available data relating to child mortality in Africa by the HIV infection status of mothers and children. RESULTS: Child survival is influenced by the HIV epidemic through several mechanisms. Mother-to-child transmission of HIV ranges from 15 to 45%, with up to 15-20% resulting from breastfeeding. HIV-infected children have high mortality rates. For example, a recent community-based study in Rakai, Uganda, showed 2-year mortality rates of 547, 166 and 128 per thousand among HIV-infected children, HIV-negative children of HIV-positive mothers, and HIV-negative children of HIV-negative women, respectively. Child mortality estimates from community-based cohorts demonstrate that the children of HIV-infected mothers have higher mortality rates than the children of uninfected mothers, and that child mortality is closely linked with maternal health status, but because the proportion of vertically infected children is unknown, the value of these studies is limited. Models that use HIV surveillance data together with a set of assumptions indicate that child mortality caused by HIV/AIDS has increased throughout the 1990s to reach close to 10% by 2002. CONCLUSION: Both disparate trends in HIV prevalence and varying levels of non-HIV-associated child mortality will ensure very different impacts in different countries. To improve the projections of the overall effect that the HIV epidemic will have on child mortality at the population level in countries with generalized epidemics, reliable age-specific mortality rates in infected and uninfected children are needed.

Africa↗
PubMed2004

Impact of child mortality and fertility preferences on fertility status in rural Ethiopia.

OBJECTIVES: To determine the effects of child mortality and fertility preference on fertility status in rural Ethiopia. DESIGN: Case-referent where the cases were women with number of children ever born alive was less than five and controls were women with number of children ever born alive greater or equal to five. SETTING: Butajira rural health project study base which is a field epidemiologic laboratory found 35 Kms south of the capital city of Ethiopia, Addis Ababa run by the Department of Community Health of Tikur Anbessa Medical Faculty. MAIN OUTCOME MEASURES: Fertility status measured by number of children ever born alive; death of a child or an infant is a predictor. SUBJECTS: A total of 219 women with number of children ever born alive less than five and 899 women with number of children ever born alive greater or equal to five were included in the study. RESULTS: Child mortality affected number of children ever born alive significantly (OR= 7.39, 95% CI: 4.62, 9.08). As the number of children died increased proportionally, there is a proportional increase in the risk of higher fertility (X2 for trend 4.92, d.f =4, p-value 0.02). Number of children desired before marriage, desire for more children and sex preference were not associated with increased fertility in this study. Of all the socio-demographic and reproductive variables, later age at first marriage and first birth showed lower number of children ever born alive with (OR= 1.82, 95 % CI: 1.24, 2.83) and (OR= 3.08, 95 % CI: 2.03, 4.68) respectively. Breast-feeding duration of more than six months showed association with less number of children ever born alive (OR= 1.92, 95% CI: 1.30,2.80). CONCLUSION: The study finding implies high fertility status is strongly associated with child death and hence measures that curb child mortality are believed to decrease fertility status besides promoting child survival.

Adult↗
PubMed1975

Levels and patterns of infant and child mortality in Ghana.

This paper attempts to measure infant and child mortality levels and also to determine their structure by utilizing the results of the 1968-1069 National Demographic Sample Survey which was conducted under the directorship of the author. Among the major problems encountered in the exercise are the adjustment of the current raw mortality data and the estimation of infant and child mortality from independent source material. The estimated infant mortality rates range from 56 per 1,000 live births in the Accra Capital District to 192 in the Upper Region during the late 1960's. The urban rate is lower than the rural rate, 98, as against 161 per 1,000 live births. A large proportion of the deaths among children aged 0-4 occur in the second year of life, and deaths in this age group account for the bulk of the deaths within the age group 1-4 years.

Age Factors↗
PubMed2001

Risk factors and child mortality among the Miao in Yunnan, Southwest China.

Environmental factors and the lifestyle of communities in developing countries as in the industrialized world have a great deal to do with their health status. This study carried out among the Miao people of southeastern Yunnan province in Southwest China has demonstrated important links between child mortality (one indicator of health status) and specific risk factors. These include lifestyle variables such as geographic mobility, the age of weaning and religious belief. In addition, the use of available health care facilities was another explanatory variable. Perhaps surprisingly, a history of tuberculosis seemed also to be empirically related to the presence or absence of child mortality. Although it was impossible to show a significant statistical relationship between traditional practices and child mortality from the study's database, the authors have observed qualitatively that birthing customs play an important role in explaining the perinatal component of child mortality. These various relationships shed some light on potential areas for intervention with a view to reducing the levels of child mortality among minority peoples in China and elsewhere.

China↗
PubMed2001

Social differentials in the decline of child mortality in nineteenth century Stockholm.

BACKGROUND: Mortality had declined dramatically by the end of the nineteenth century and the early twentieth century. Little is known about the development of social differentials in infant and child mortality in Stockholm at the turn of the century. This study investigates social differentials in child mortality during the years 1885, 1891 and 1910 in one parish in Stockholm. METHODS: Individual entries from computerised records originally collected for civil registration purposes in Stockholm for 1878-1925 (the Roteman Archives) were analysed with respect to social class of the head of household and marital status of the mother for 36,718 children aged 0-14 years. Age- and cause-specific mortality rates were calculated for each year of study. Cox' regression analysis was used to analyse the mortality risk (relative rates (RRs) of mortality) by socioeconomic group and by marital status of the mother. RESULTS: Child mortality rates were nearly halved between 1885 and 1910. Socioeconomic differentials in mortality between the four social classes emerged from 1891 as the overall mortality declined. The decline was sharpest in the upper and middle social classes. Children born out of wedlock had higher mortality rates than children of married mothers in all 3 years studied. CONCLUSION: The social differentials in child mortality risk were substantial and the gradient emerged sharper from 1891 to 1910. The results are in line with studies from England and Wales, Germany and the USA for the same time period. The differentials mostly increased because of a greater decline in mortality among higher socioeconomic groups.

Child, Preschool↗
PubMed1993

Factors influencing child mortality in Bangladesh and their implications for the national health programme.

"This study attempts to estimate by indirect estimation technique the levels of infant and child mortality in Bangladesh using the 1989 Bangladesh Fertility Survey (BFS). The levels of infant and child mortality obtained from the 1989 BFS indicate substantial improvements in child survival, although the fall in infant mortality has been faster than the fall in child mortality."

Asia↗