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PubMed2003

Inequalities in child mortality in Mozambique: differentials by parental socio-economic position.

This study investigates the relation between socio-economic parental position (education and occupation) and child death in Mozambique using data from the Mozambican Demographic and Health Survey carried out between March and July 1997. The analysis included 9142 children born within 10 years before the survey. In spite of the Western system of classification used in the study, the results partly showed a parental socio-economic gradient of infant and child mortality in Mozambique. Father's education seemed to reflect the family's social standing in the Mozambique context, showing a strong statistical association with postneonatal and child mortality. However, maternal education as a measure of socio-economic position was not statistically significantly associated with child mortality. This finding may partly be explained by the extreme hardships experienced by the country (civil war and natural disasters) and the implementation of the Economic Structural Adjustment Programme that have also affected the health of women and their children during the years covered by this study. Other measures of socio-economic position applicable to the rural African setting should be investigated.

Adolescent↗
PubMed1977

Measuring the impact of child mortality on fertility: a methodological note.

Recent studies of the impact of child mortality on children ever born have used the "replacement factor" to measure mortality. When microlevel data are used, however, use of the replacement factor (or other variables which are nonlinear in the family's experienced child mortality rate) yields biased coefficients. An alternative model suggests a sequential, rather than a static, decision-making process to relate the decision to have an additional child to the reproductive experience to date. In this case, unbiased coefficients are obtained if the functional form is correctly specified. In the abscence of a priori knowledge of the functional form, it is difficult to untangle true effects from spurious ones.

Child↗
PubMed2005

Common causes of child mortality in Sana'a, Yemen.

OBJECTIVE: To study the common causes of child mortality at Al-Thawrah Hospital, Sana'a, Yemen. METHODS: A retrospective study of 639 children aged 0-14 years, who died in the hospital within a 4 year period. This study was carried out at the Al-Thawrah Hospital, Sana'a, Yemen, between January 2000 and December 2003. Children who were admitted to the pediatric/nursery unit and died in the hospital were included in this study. Data were collected from patient's files, hospital register and death certificate to ascertain the cause of death and their percentage. RESULTS: Out of 4575 admissions to the pediatric unit, there were 639 children deaths (13.96%). Deaths were higher among those <2 years of age. The most common causes of deaths in the pediatric unit were infections (18.1%) followed by respiratory problems (17.7%), central nervous system diseases (12%), renal (9.7%), malignancy (9.5%), shock (7.9%) and cardiac diseases(7.3%). While in the nursery, out of 4182 admissions in the same period, 823 died (19.67%), among these were pre-maturity (47%), birth asphyxia (23.7%), infections (10.9%), congenital anomalies (8.4%), central nervous system diseases (5.3%) and others (4.7%). Postmortem examination was not carried out in any of the cases. CONCLUSION: The percentage of deaths on admission among children is less than it was previously, but remains high. The majority of the causes of death are preventable. Efforts to further reduce the mortality should be directed at prevention and early treatment.

Adolescent↗
PubMed2005

Effects of vitamin A supplementation on child mortality: evidence from Nepal's 2001 Demographic and Health Survey.

OBJECTIVE: To assess the effect of Nepal's vitamin A supplementation programme on child mortality at age 12-59 months. MATERIALS AND METHODS: Logistic regression, applied to retrospective data from Nepal's 2001 Demographic and Health Survey. RESULTS: After a number of potentially confounding variables are controlled, the effect of 100% community-level vitamin A coverage since the child's birth, relative to no coverage, is to reduce the odds of dying at age 12-59 months by slightly more than half (OR = 0.47, P = 0.03). CONCLUSIONS: The estimated beneficial effect of vitamin A supplementation on child mortality is larger than that found in most earlier clinical studies. This larger effect may be due mainly to the other health-related activities undertaken by the female community health volunteers who distribute vitamin A capsules.

Child Mortality↗
PubMed2000

The 1999 annual report of the Regional Infant and Child Mortality Review Committee.

The 1999 Annual Report of the Regional Infant and Child Mortality Review Committee (RICMRC) is presented. Our Regional (Minnehaha, Lincoln, and Turner Counties) incidence for Sudden Infant Death (SIDS) continues to significantly exceed the national rate. In this study, SIDS is strongly associated with prone sleeping and sleeping on soft surfaces or bedding. The Back-to-Sleep campaign that has been an important part of lowering the national SIDS rate appears to have been less successful in our region. The Regional Infant Child Mortality Review Committee therefore has elected to serve not only as a data collection committee, but has also actively engaged in community education programs directed towards providing a safer environment for our children.

Accident Prevention↗
PubMed2003

Relative or absolute standards for child poverty: a state-level analysis of infant and child mortality.

OBJECTIVES: The purpose of the present study was to compare the associations of state-referenced and federal poverty measures with states' infant and child mortality rates. METHODS: Compressed mortality and Current Population Survey data were used to examine relationships between mortality and (1) state-referenced poverty (percentage of children below half the state median income) and (2) percentage of children below the federal poverty line. RESULTS: State-referenced poverty was not associated with mortality among infants or children, whereas poverty as defined by national standards was strongly related to mortality. CONCLUSIONS: Infant and child mortality is more closely tied to families' capacity for meeting basic needs than to relative position within a state's economic hierarchy.

Adolescent↗
PubMed1994

[Infant and child mortality in the Nordic countries before 1900].

The mortality decline in the Nordic countries started at the end of the 18th century with a decrease in infant and child mortality. It was not until the middle of the 19th century that adult mortality started to fall. Recent research shows that improvements in nutrient supply, medical care, sanitation and nursing, did not take place until the beginning of the 19th century, i.e. considerably later than the start of the decline in infant and child mortality. One possible explanation to the initial decline is that a change in virulence of pathogens did occur at the end of the 18th century, i.e. that the decline was caused by factors beyond human control. There is a general agreement that the decline that followed during the 19th century had multli-factoral causes. The importance of different factors is, however, still debated. To proceed with this debate there is an obvious need to construct more data series of age-specific mortality at the macro level and to make full use of family reconstitution data. The use of advanced statistical methods, such as life event analysis, will also be of crucial importance. Equally important is the quality of the data. Since the Nordic data are said to be very good, which they generally are, too little attention has been paid to the examination of its quality. One such problem is the under-reporting of infant deaths in the church books. It is vital to research on infant and child mortality, as well as on fertility, that those periods and parishes with good data are identified.

Child↗
PubMed2005

Impact on child mortality of removing user fees: simulation model.

OBJECTIVE: To estimate how many child deaths might be prevented if user fees were removed in 20 African countries DESIGN: Simulation model combining evidence on key health interventions' impacts on reducing child mortality with analysis of the effect of fee abolition on access to healthcare services. RESULTS: Elimination of user fees could prevent approximately 233,000 (estimate range 153,000-305,000) deaths annually in children aged under 5 in 20 African countries. CONCLUSION: Given the relatively low cost of abolition, replacing user fees with alternative financing mechanisms should be seen as an effective first step towards improving households' access to health care and achieving the millennium development goals for health.

Africa↗
PubMed1997

The AIDS epidemic and infant and child mortality in six districts of Uganda.

Several studies in sub-Saharan Africa have associated infant and child mortality with the AIDS epidemic in the region. The paper uses retrospective survey data of six districts in the east, south and west of Uganda to study infant and child mortality, which increased in the 1980s probably because of the AIDS epidemic and started declining in the early 1990s, a period when the epidemic was reported to be subsiding. Deeper analysis of data indicates that children whose parents are polygamous, educated, formally employed and in business are at a higher risk of death from AIDS and related illness. Although AIDS as a direct cause of death is the fourth leading killer of children, other serious diseases such as diarrhoea, respiratory infection and measles are associated with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Do insecticide-treated curtains reduce all-cause child mortality in Burkina Faso?

To evaluate whether insecticide-treated netting (ITN) reduces child mortality in different epidemiological settings, 4 large, randomized, controlled trials were conducted in Africa. Here we report the findings from the trial in Burkina Faso, in an area of hyperendemic and markedly seasonal malaria transmission. The trial involved 158 villages, with a total population of some 90,000, grouped into 16 geographical clusters. Ascertainment of mortality among children aged 6-59 months began in early 1993. In June/July 1994, 8 of the clusters, randomly selected, received permethrin-treated curtains. Follow-up of children and ascertainment of mortality continued until May 1996. A 15% reduction in all-cause mortality among children aged 6-59 months was observed over the 2-year period following the installation of the curtains (95% c.i. -4% to 30%). In the first year, post-intervention mortality was substantially lower in the clusters receiving curtains compared with the control clusters (rate ratio = 0.74; 95% c.i. 0.57, 0.95) but in the second year, there was no difference between mortality in the two groups (rate ratio = 0.99). The overall two-year impact of the intervention is consistent with the impacts observed in other trials which have demonstrated reductions in child mortality of from 17% to 33%. However, the year-by-year analysis raises some concerns about the long-term effect of ITN. Further follow-up of this population is warranted.

Burkina Faso↗
PubMed2000

Inequality of child mortality among ethnic groups in sub-Saharan Africa.

Accounts by journalists of wars in several countries of sub-Saharan Africa in the 1990s have raised concern that ethnic cleavages and overlapping religious and racial affiliations may widen the inequalities in health and survival among ethnic groups throughout the region, particularly among children. Paradoxically, there has been no systematic examination of ethnic inequality in child survival chances across countries in the region. This paper uses survey data collected in the 1990s in 11 countries (Central African Republic, Côte d'Ivoire, Ghana, Kenya, Mali, Namibia, Niger, Rwanda, Senegal, Uganda, and Zambia) to examine whether ethnic inequality in child mortality has been present and spreading in sub-Saharan Africa since the 1980s. The focus was on one or two groups in each country which may have experienced distinct child health and survival chances, compared to the rest of the national population, as a result of their geographical location. The factors examined to explain potential child survival inequalities among ethnic groups included residence in the largest city, household economic conditions, educational attainment and nutritional status of the mothers, use of modern maternal and child health services including immunization, and patterns of fertility and migration. The results show remarkable consistency. In all 11 countries there were significant differentials between ethnic groups in the odds of dying during infancy or before the age of 5 years. Multivariate analysis shows that ethnic child mortality differences are closely linked with economic inequality in many countries, and perhaps with differential use of child health services in countries of the Sahel region. Strong and consistent results in this study support placing the notion of ethnicity at the forefront of theories and analyses of child mortality in Africa which incorporate social, and not purely epidemiological, considerations. Moreover, the typical advantage of relatively small, clearly defined ethnic groups, as compared to the majority in the national population, according to fundamental indicators of wellbeing--child survival, education, housing, and so forth--suggests that many countries in sub-Saharan Africa, despite their widespread poverty, are as marked by social inequality as are countries in other regions in the world.

Africa South of the Sahara↗
PubMed2001

Influences of ethnicity on perinatal and child mortality in the Netherlands.

AIMS: To investigate the differences in perinatal death and child mortality between different ethnic groups in the Netherlands. METHODS: Retrospective analysis of data collected between 1990 and 1993 in the national obstetric registry comprising 569 743 births. Retrospective analysis of all death certificates of 0 to 15 year old children routinely collected between 1979 and 1993, comprising 20 211 deaths. RESULTS: Black mothers had the highest perinatal death rate compared with indigenous Dutch mothers (odds ratio 2.2). Hindustanis (West Indian Asians) had an odds ratio of 1.4 and Mediterraneans 1.3. The increased rate for black and Hindustani women could be fully explained by preterm birth. In the Mediterranean group the differences were explained by teenage pregnancy, grand multiparity, and socioeconomic status rather than prematurity. The death rate of Turkish and Moroccan children was twice as high as that of native Dutch children. For the different diagnostic categories this was: infectious diseases, relative risk (RR) 2.2; hereditary (metabolic) disorders, RR 2.0; accidents and drowning, RR 1.9. One quarter of the Turkish and Moroccan children died while on holiday in their country of origin. Sudden infant death syndrome was twice as high for Turkish infants as for Dutch children and four times higher than for Moroccan infants. CONCLUSION: Ethnic minorities in the Netherlands have a higher perinatal and child mortality rate than the indigenous Dutch. Apart from socioeconomic differences, sociocultural and lifestyle factors play an important role.

Adolescent↗
PubMed1983

A hazards-model analysis of the covariates of infant and child mortality in Sri Lanka.

The purpose of this paper is twofold: (a) to provide a complete self-contained exposition of estimating life tables with covariates through the use of hazards models, and (b) to illustrate this technique with a substantive analysis of child mortality in Sri Lanka, thereby demonstrating that World Fertility Survey data are a valuable source for the study of child mortality. We show that life tables with covariates can be easily estimated with standard computer packages designed for analysis of contingency tables. The substantive analysis confirms and supplements an earlier study of infant and child mortality in Sri Lanka by Meegama. Those factors found to be strongly associated with mortality are mother's and father's education, time period of birth, urban/rural/estate residence, ethnicity, sex, birth order, age of the mother at the birth, and type of toilet facility.

Actuarial Analysis↗
PubMed2000

Intra-ethnic diversity in Hispanic child mortality, 1890-1910.

Using a representative sample of the Hispanic population of the United States based on the manuscripts of the 1910 census, we estimate childhood mortality for the period from approximately 1890 to 1910. We find high child mortality in the Hispanic population, higher than for non-Hispanic whites but not significantly different than among nonwhite non-Hispanics (mostly African Americans). Hispanic rural farm populations in California, Texas, and Arizona experienced high mortality, but not as high as other Hispanic populations. Child mortality was very high among Hispanic residents of New Mexico and those in Florida outside Tampa; it was especially low in the Hispanic population in Tampa.

Black or African American↗
PubMed1993

Estimating child mortality in Zimbabwe: results of a pilot study using the preceding births technique.

Using the preceding birth technique, 2,229 mothers were interviewed at four antenatal centres (two of which were urban) over a three month period during a pilot study in Zimbabwe. Results of the study showed that there was a small difference between the under two and under five mortality. The smaller than expected difference could have been due to some degree of urbanisation being experienced at two of the centres, and to a systematic selection bias of the method. Other findings of the study showed that younger mothers (under 20 years of age) and older mothers (over 40 years) experienced higher proportions of mortality, than mothers in the age group between. The higher proportion of male mortality compared to that for females reflected the expected trend, but the size of the difference was somewhat surprising, and could have been due to recall bias. The mean birth interval was 36 months, rather than the expected 30 months, and analysis of mortality in relation to birth interval and maternal age showed that a birth interval of less than 18 months was associated with higher child mortality, significantly so with the second last child, independent of mother's age. Longer birth intervals (more than three years) among older mothers were associated with higher changes of child survival. It is concluded that the Brass-Macrae method is a useful technique to analyse levels and trends of child mortality.

Adult↗
PubMed1984

The impact of child mortality on spacing by parity: a Cox-regression analysis.

Child mortality may affect spacing through biological and behavioral channels. The death of a child may elicit a desire to have another one soon; further, it may interrupt breastfeeding and shorten the sterile period following childbirth. The hypothesis that the child mortality-spacing linkage varies across parities, being strongest in the middle parities, is examined using microdata from Malaysia and the Cox-regression technique. The empirical results lend support to the hypothesis.

Adult↗
PubMed2000

Infant and child mortality rates among Palestinian refugee populations.

We estimated infant and early child mortality rates among Palestinian refugees using maternal and child services in Jordan, Gaza, Lebanon, and Syria. Early childhood mortality per 1000 live births was 35 in Jordan, 36 in Gaza, 37 in Lebanon, and 32 in Syria. Infant mortality rates were 32 in Jordan, 33 in Gaza, 35 in Lebanon, and 29 in Syria.

Arabs↗
PubMedDate not supplied

Weaning practices of the Makushi of Guyana and their relationship to infant and child mortality: a preliminary assessment of international recommendations.

The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life, primarily because of potential immunological benefits which are deemed to outweigh nutritive costs for infants. This recommendation is controversial, as studies of the relationship between the term of EBF and infant and child health have produced conflicting results. The purpose of this paper is to evaluate the relationship between the term of EBF and infant and child mortality among a group of swidden-horticulturalists in lowland South America. Consistent with the WHO, we hypothesized that EBF <6 months will compromise the survival of the infant or child. This relationship was assessed via recall data generated in 2001 in structured interviews with 60 Makushi Amerindian women in Guyana's North Rupununi region. The data were analyzed with t-tests, Fisher's exact test, and logistic regression. The results do not support our hypothesis; the term of EBF is not found to be related to infant or child mortality. This is surprising given the potential for contamination in nonbreast-milk foods in this environment. Notably, this is occurring among mothers who are not energetically stressed. We propose that the apparent lack of benefit of EBF >or=6 months is due to insufficient energy supply from breast milk alone, which may predispose the child to morbidity when subsequently stressed. This study concurs with others which revealed no significant benefits to the infant of EBF >6 months, and the recognition that universal recommendations must be situated within local ecological contexts.

Adult↗