Affect Infant Mortality Research Articles

Effectiveness of Health Care Services for Pregnant Women and Infants

The authors of this paper focus on the health care services received by pregnant women and infants, and consider the ways in which these services affect child health outcomes. They examine the impact of prenatal, obstetrical, and neonatal care on two measures of infant health: the rate of low birth weight births and the rate of infant mortality. There is strong evidence that these two outcomes respond favorably to the application of appropriate health services, particularly prenatal care and neonatal intensive care. The delivery of prenatal care in the United States needs improvement: slightly more than 76% of women received early care in 1989, and discrepancies in prompt receipt of care among different ethnic and economic groups are large and persistent. Improved distribution of prenatal care services could have a significant impact on the rate of low birth weight births and infant deaths. In addition, expanded regionalization of prenatal, obstetric, and neonatal care in a coordinated approach to the entire continuum of gestation, labor, delivery, and early development holds out the promise of continued improvement in infant health. Health care initiatives need to focus more on the needs of poor families and of mothers and infants with special problems, especially high-risk pregnancies resulting from maternal substance abuse and pregnancies complicated by HIV infection. The authors describe advances in obstetrical technology and neonatology, and conclude that efforts to identify programs and activities which offer the greatest potential for improving newborn survival with the least investment should have high priority. C hildren are developing organisms. They continually grow and differentiate from one physical and psychological state to the next. An understanding of childhood health status, therefore, begins with an understanding of the conditions out of which children emerge. Intrauterine and neonatal environments are crucial determinants of a child’s well-being. A mother’s health throughout pregnancy, the process of labor and delivery, and a child’s experiences during the first critical hours and days of life will influence health status for months and years afterward. Moreover, poor birth outcomes have been associated with impeded cognitive development, reductions in years of formal schooling completed, and lower levels of lifetime earnings and other measures of economic well-being. Recognition of these principles has led policy analysts to give increasing attention to prenatal and neonatal health care services. In this paper we focus on health care services received by pregnant women and infants, and consider the ways in which these services affect child health outcomes. For our purposes, these services include prenatal medical care received by women during the course of their pregnancies, obstetrical care received at the time of delivery, and medical care received by newborn infants during the first 28 days of life (the neonatal period). We consider trends in these services over time, differentials in the receipt of these services among various groups in the population, and the impact utilization of these services has on child health outcomes. Two population outcome measures to which we devote particular attention are rates of low birth weight (LBW) and infant mortality. A low birth weight baby is one born weighing less than 2,500 grams (about 51⁄2 pounds). The LBW rate is the number of such births per 1,000 live births in the population in a given year. The infant mortality rate is measured by the annual number of deaths among children in the first year of life per 1,000 live births. Because LBW babies have a higher risk of death than normal weight babies, these two rates are closely related. Though birth weight and infant mortality each have a genetic component, birth weight depends very much upon the length and quality of the fetal experience during pregnancy while infant mortality depends also upon the type of care, medical and otherwise, that a child receives after birth. Therefore, these two measures may tell us much about the effectiveness of prenatal and neonatal care. We begin with a discussion of prenatal care and its relationship to low birth weight and then proceed to a consideration of obstetrical and neonatal care and how they affect infant mortality. We shall also mention some promising new technologies being applied in the field of

Determinants of Infant Mortality in Rural Nepal

Infant Mortality in Nepal is among the highest in the world. Since the 1950s a number of studies have examined the causes of infant mortality in Nepal. This study attempts to identify the causes of infant mortality using a comprehensive approach. In other words, this study incorporates biological, socio‐economic, behavioral, psychological, environmental, and health care factors to provide a thorough understanding of the underlying causes of infant mortality.Data for the study was collected in the Fall of 1987 and were based on interviews with 621 mothers who gave birth between April 15,1984 and April 14,1986 in twenty‐six randomly selected villages in Deokhari Valley, Western Nepal.The results indicate that biological factors are the intermediate or proximate variables through which all other variables operate to affect infant mortality. The study concludes by stressing the need for a comprehensive approach in health care services that emphasize both the curative as well as preventive aspects.

Theoretical perspectives for explaining infant mortality in the third world.

The authors analyze differentials in infant mortality rates in developing countries and attempt to go beyond the usual economic interpretations of these differences and identify some of the relevant social and political factors affecting infant mortality. In particular, they apply "a 'political economy of health' perspective to infant mortality and seek to account for discrepancies between economic progress and progress against infant mortality. [The paper] traces out a four-fold comparison--between countries with high/low economic development and countries with high/low infant mortality--for testing hypotheses in the political economy of health."

Factors Affecting Infant Mortality in Rural Bangladesh: Results from a Retrospective Sample Survey1

Abstract The primary objective of this paper is to assess the relative contribution of different socioeconomic and environmental factors affecting infant mortality in a rural area of Bangladesh. Data from detailed interviews with 1,787 women of reproductive ages were collected and analyzed. A multivariate approach was employed to examine the relative importance of different correlates of infant mortality. Birth interval and contraceptive use emerged as the strongest correlates of infant mortality. In addition, landholding size, birth of preferred sex, mother's age, and prior pregnancy loss had significant effects on infant mortality. The analysis suggests that some aspects of childbearing result in higher risks of infant mortality. Infant mortality could be reduced by altering the spacing of births and avoiding births at early reproductive ages. A positive impact on infant mortality could also result from improvements in economic conditions.

Demographic and socioeconomic factors affecting infant mortality in Egypt

This paper analyses the relative importance of demographic and socioeconomic factors with respect to their role in reducing infant mortality in Egypt. Logit analyses of data from a nationally representative sample of Egyptian households, and for urban and rural households separately, indicate that demographic factors have more effect on infant mortality than socioeconomic factors. The results also show the need to improve housing in urban areas and sewerage systems in rural areas in order to reduce infant mortality. One of the most important policy conclusions, however, concerns the importance of providing a vigorous educational campaign to enlighten mothers and prospective mothers in both rural and urban areas on the positive effects of breast-feeding, longer birth intervals, and fewer children on the survival of infants.

The determinants of infant mortality in regional India

Abstract Factor analysis is used to estimate a model in which infant mortality across Indian states is explained by socioeconomic variables. Twelve such variables are condensed into four factors which are statistically significant. The resulting model implies that all but one of these variables affect infant mortality in the way one would normally expect. We also test for sex bias in infant mortality as well as regional biases. The statistical performance of linear and logistical models is compared.

Socioeconomic, Medical Care, and Public Health Contexts Affecting Infant Mortality: A Study of Community-Level Differentials in Peru

Socioeconomic, medical care, and public health contexts are examined in Peruvian communities for their relationship to infant mortality. A deviant case analysis is used to uncover characteristics important in the social structure of Peruvian communities. Results from fieldwork in two "deviant" communities suggest that economic diversity, income disparity, social class fluidity, and women's autonomy, along with refined measures of medical care and public health resources, are important in understanding differentials in mortality. Attention is drawn to the community context and to the interplay of socioeconomic determinants affecting infant mortality.

Determinants of temporal and areal variation in infant mortality in Germany, 1871–1933

This article investigates how sociodemographic, economic, medical, and public health factors influence infant mortality by using data about German administrative areas from 1871 to 1933. Marital fertility has the largest impact on infant mortality, followed by illegitimacy, medical care, urbanization, and infant welfare centers. The variables considered here account for most of the variation in infant mortality. Some of the unexplained variance is due to factors associated with regions, such as breastfeeding patterns, and with time periods, such as national health insurance. The analyses found no evidence that advances in medical technology affected infant mortality or that the influence of economic development changed over time.

Farm Structure and Infant Mortality: An Analysis of Nonmetropolitan Counties

Community development practitioners long have been concerned with the effects of farm structure on community socioeconomic conditions. Most studies examining the impacts of farming have focused on economic outcomes, with little research directed toward noneconomic outcomes, such as health. This study examines the effects of three patterns of farm structure—smaller family, larger family and corporate/commercial farming—on a key indicator of health status, infant mortality. These farming patterns are hypothesized to affect infant mortality directly as well as indirectly, through effects on community socioeconomic status (income and education) and mortality-related factors (teenage fertility and per capita physicians). A model of the relationships is tested using path analysis and data for 840 nonmetropolitan counties. Counties with a greater extent of smaller family farming have significantly higher education, lower teenage fertility, and lower neonatal and infant mortality. Counties with a greater extent o...

Changing determinants of infant and child mortality: on the basis of the Korean experience, 1955-73.

SummaryFrom analysis of the 1974 Korean National Fertility Survey data, the changing patterns of demographic and socioeconomic determinants of infant and child mortality are generalized. The pattern for infant mortality is: (1) in a traditional society demographic factors affect infant mortality more than socioeconomic factors; (2) at the early stage of development, demographic factors are replaced by socioeconomic factors as the main determinants; (3) when the difference in living standards between social classes narrows, the socioeconomic differentials in mortality also diminish; and (4) at the stage of high development the effects of demographic factors remain although the absolute differences are very small. But the pattern of changing determinants of child mortality is nearly the reverse of that of infant mortality.

"Effect of Birth Spacing on Infant and Child Mortality in Rural Nepal"

This examination of the effect of birth spacing on infant and child mortality in rural Nepal is based on data from the Nepal Fertility Survey 1976 carried out by the Nepal Family Planning and Maternal Child Health Project in collaboration with the World Fertility Survey. The study confirms that the higher risk of infant death to 1st born children is mainly due to the higher proportion of younger women having 1st births rather than due to their being 1st order births per se. The effect of maternal age on infant and child mortality is largely associated with birth interval. Previous birth interval therefore stands out as the most important factor affecting infant mortality; the next most important factor is the survival of the preceding child. A child born after an interval of less than 18 months since the previous live birth has a 31% higher risk of dying during infancy than 1 born after an interval of 1 1/2 to 2 years. The risk of the index childs dying is only 50% of that when its preceding sibling is dead. Neither education of mother nor education of father has a significant effect on infant mortality in rural Nepal. (authors modified)

"The place of child-spacing as a factor in infant mortality: A recursive model"

This study investigates the role of a preceding birth interval in infant mortality by considering a causal ordering of seven variables. Data are from the 1974 World Fertility Survey for Korea and cover the survival of 6,161 index children. A two-stage logit model was used. The analysis suggests that infant mortality is directly influenced by the preceding birth interval which, in turn, is influenced by five other explanatory variables: maternal age, birth order, immediately preceding infant's death, education of mother, and place of residence. Maternal age and prior infant death also exert direct effects on mortality. In terms of relative risk, prior infant death has the strongest effect of all the explanatory variables. A longer birth interval increases the odds of an infant's survival by 25 per cent, whereas the death of a preceding child decreases the odds by 45 per cent. However, infant deaths in Korea occur infrequently in comparison with short birth intervals. Thus, the two factors present comparable attributable risks in unadjusted measurements. The first-stage causal structure affecting a birth interval is more complicated than the second-stage structure affecting infant mortality.

The place of child-spacing as a factor in infant mortality: a recursive model.

This study investigates the role of a preceding birth interval in infant mortality by considering a causal ordering of seven variables. Data are from the 1974 World Fertility Survey for Korea and cover the survival of 6,161 index children. A two-stage logit model was used. The analysis suggests that infant mortality is directly influenced by the preceding birth interval which, in turn, is influenced by five other explanatory variables: maternal age, birth order, immediately preceding infant's death, education of mother, and place of residence. Maternal age and prior infant death also exert direct effects on mortality. In terms of relative risk, prior infant death has the strongest effect of all the explanatory variables. A longer birth interval increases the odds of an infant's survival by 25 per cent, whereas the death of a preceding child decreases the odds by 45 per cent. However, infant deaths in Korea occur infrequently in comparison with short birth intervals. Thus, the two factors present comparable attributable risks in unadjusted measurements. The first-stage causal structure affecting a birth interval is more complicated than the second-stage structure affecting infant mortality.

'A time to die'?

In both the newborn and the elderly, medical care is increasingly able to prolong or curtail life. It is difficult to assess what effect this may have on the population as a whole and what implication it may have for the interpretation of both short-term and longer-term changes in mortality. The definition of cut-off points for age groups is critical to the interpretation of the way changes in medical care could affect infant mortality rates.

The impact of class, education, and health care on infant mortality in a developing society: The case of rural Thailand

Demographic and social factors affecting infant mortality in rural northern Thailand are examined using log-linear modified multiple regression models and data drawn from a representative sample of married couples in Chiang Mai and Chiang Rai provinces. Demographic factors do not account for the effects of variations in parental ability or willingness to provide adequate infant care. The final model estimated incorporated both these social dimensions of child care. Parental ability, measured by father's social class, mother's health information, and local community development levels, continued to have significant independent effects upon infant survival. Parental willingness, measured by parent's beliefs about intergenerational wealth transfers, no longer had a significant effect net of other social variables, but infant survival was still affected by whether both parents wanted a birth.

Education and infant survival in rural Bangladesh

This paper explores the mechanism through which socioeconomic status affects infant deaths. The data used here come from a prospective study in rural Bangladesh. Both neonatal deaths and postneonatal deaths were found to be higher in number among those whose mothers have no schooling. Again, education of the mother has been found to be related to gestational month at termination and this gestational month at termination (which is the maturity of the newborn) determines the neonatal death. The other factors affecting infant mortality were the height of the mother and the weight of the infant. The taller the mother, the fewer the neonatal and post-natal deaths. The weight of the infant has a direct relationship to its survival during infancy.

Socio-demographic correlates of infant mortality in Australia.

Abstract Correlations of infant mortality rates with other available characteristics of statistical divisions of Australia have been analysed. The analysis has been done in three segments (i) all statistical divisions (AUSTRALIA-I), (ii) divisions excluding large Aboriginal populations (AUSTRALIA-II), and (iii) divisions containing only major urban and metropolitan areas (AUSTRALIA-III). Neonatal mortality rate forms respectively 63%, 70% and 73% of infant mortality rate in the three sections. Proportion of Aboriginal population, percent ex-nuptial births, and index of heat discomfort are three of the most important variables in the variation of infant mortality among the statistical divisions. Path analysis has been used to decompose the correlations of each variable with neonatal and postneonatal mortality rates respectively, into direct and indirect effects. In AUSTRALIA-I, the variables considered are found to affect infant mortality rates more through postneonatal mortality than through neonatal mortality. In the other two segments, the variables appear to exert their influence on infant mortality more through neonatal mortality.

Paths of association in epidemiological analysis: application to health effects of environmental exposures.

Conventional regression analysis is based on assumptions of bidirectional associations between pairs of independent variables. In a number of circumstances these assumptions are not plausible. Structural representation in conventional regression is based on a set of parallel paths between independent and dependent variables; when the implausible assumptions are excluded, a different structrual relation between the independent and dependent variables is found. It permits a series associative path between independent variables. Two criteria for modification of conventional multivariate analysis are presented. They are when bilateral symmetry among independent variables is implausible on the basis of a priori information, and when there are significant differences between zero order and first order partial correlation coefficients. When these criteria are applied, there may result a series-parallel matrix of associations. For analysis of such a matrix, the procedures of path analysis are appropriate. The concepts are illustrated with environmental examples, and path analytical computations are worked out for a set of data on social and environmental factors which affected infant mortality in England and Wales between 1928-1938.

Effects of social and cultural processes on health∗

Future advances in the planning and evaluation of health service systems are highly dependent upon the development of a methodology that permits the empirical validation of hypotheses concerning the effects of social and cultural processes on health. In this paper such a methodology has been proposed. A structural model has been developed and analyzed, using the causal modeling technique of path analysis, in which social, economic, and demographic characteristics of New Mexico counties have been related to the infant mortality rate as an index of health. Path coefficients have been estimated from census data and vital statistics. Dynamic programming has been utilized to predict the combined direct and indirect effects on the health of New Mexico's population that would result from changes in the composition of the population. Analysis of the model suggests that these structural characteristics are causally interrelated, with economic factors a major determinant of infant mortality. While urbanization and migration also significantly affect infant mortality rates, education surprisingly is not important causally when compared to other variables, nor is proportion nonwhite when other social and economic factors are taken into account. In contrast, the proportion of Spanish-Americans residing in a county has a rather unexpected effect in that infant mortality rates decline as the proportion of this ethnic group rises. This finding suggests that it is important in health planning to consider cultural factors that may be unique to particular ethnic groups. In general the model building techniques and the algorithms presented here provide a valuable means of generating and testing hypotheses regarding the effects of social and cultural processes on health.

How Much does Improved Medical Service Affect Infant Mortality?

The meaning of the article by Dr. Chabot in Pediatrics, June 1971 concerning improved infant mortality between 1964 and 1968 in Denver puzzled me. I wonder whether there is any relation between the improved community health programs described and the happy results presented. Surely, many factors other than medical care affect infant mortality. For example, I wonder whether the author would suggest that the startling (to me) rise in infant mortality noted in Table II for Boston, Buffalo, Phoenix, Pittsburgh and Seattle, resulted from poorer delivery of medical care.