Differences In Child Mortality Research Articles

Modelling Factors that Predict Differences in Childhood Mortality in Lagos Communities Using Prognostic Logistic and Poisson Regression Models

Lagos State is a city with one of the largest concentration of people in the world with heterogenous behaviour and cultural beliefs. There are different prognostic models in the medical sciences, yet their real life application, especially to childhood mortality is limited. There are variations in childhood mortality rate across different communities in Lagos State. Childhood mortality is a subject of interest to World Health Organization (WHO) and one of the major Millennium Development Goals. In 2014, the Special Adviser to the Lagos State Governor on Public Health, Dr. Yewande Adeshina said that under-5 and infant mortality rates in Lagos state have reduced due to various health interventions being implemented in the State. However, the truth of the matter is that childhood mortality is still high and this is an indication that we still have lots of work to do in this regard. In this paper, prognostic models were used in modelling factors that predict the differences in childhood mortality in Lagos communities. Six models, two each from logistic regression, linear regression and Poisson regression models were used. Primary data were collected from mothers that fall in the age bracket (15-49), who reside in any of the 5 divisions of Lagos State, namely Ikorodu, Badagry, Lagos Mainland/Ikeja, Lagos Island and Epe. Five variables were identified as covariates. The prognostic multi-variable models were employed. The binary logistic regression model with 5 covariates was selected as the best model for the binary response variable, while the Poisson regression model with 4 covariates was selected as the best model for the count response variable. At the end of the research, Ikorodu, Badagry and Epe communities have higher than expected childhood mortality rates. Also, we estimated childhood mortality rate in Lagos State and measured the variations in childhood mortality across Lagos communities. The factors that predict these variations were detected and control measures were recommended to reduce the difference in childhood mortality rate in Lagos State.

Interferon-beta exposure in-utero and the risk of infections in early childhood.

Knowledge within the field of multiple sclerosis treatment during pregnancy is vital to ensure the most optimal clinical practice. Immunomodulatory treatment in pregnancy could in theory affect the normal development and maturation of the immune system of the fetus with a potential increased risk of infections, consequently. We therefore set out to investigate whether exposure to interferon-beta in utero affected the risk of acquiring infections in early childhood. This retrospective matched cohort study utilized data from the Danish Multiple Sclerosis Registry linked with national Danish registries to identify all children born of mothers with MS in Denmark from 1998 to 2018. The study included 510 children exposed to interferon-beta in utero. The children were matched 1:1 on various of demographic characteristics with children born to mothers with untreated MS and 1:3 with children born to mothers without MS. Each child was followed for up to five years. Using individual-level data, we investigated all-cause mortality, rate of hospital admissions due to infections, and redeemed prescriptions of antibiotics. The primary statistical model applied was a negative binomial regression analysis. We found no differences in childhood mortality, for hospital admissions the rate ratio compared to healthy controls was 0.79 (0.62-1.00). Regarding antibiotic prescriptions, the results were similar (RR 1.00 (0.90-1.11). Furthermore, we found no certain dose-response relationship between interferon-beta exposure duration and hospital admission rate (P=0.47) or redeemed antibiotic prescription (P=0.71). Exposure to interferon-beta during gestation has little to no impact on the risk of acquiring significant infections during the first five years of childhood.

Spatiotemporal analysis of the effect of global development indicators on child mortality

BackgroundChild mortality continue to be a major public health issue in most developing countries; albeit there has been a decline in global under-five deaths. The differences in child mortality can best be explained by socioeconomic and environmental inequalities among countries. In this study, we explore the effect of country-level development indicators on under-five mortality rates. Specifically, we examine potential spatio-temporal heterogeneity in the association between major world development indicators on under-five mortality, as well as, visualize the global differential time trend of under-five mortality rates.MethodsThe data from 195 countries were curated from the World Bank’s World Development Indicators (WDI) spanning from 2000 to 2017 and national estimates for under-five mortality from the UN Inter-agency Group for Child Mortality Estimation (UN IGME).We built parametric and non-parametric Bayesian space-time interaction models to examine the effect of development indicators on under-five mortality rates. We also used employed Bayesian spatio-temporal varying coefficient models to assess the spatial and temporal variations in the effect of development indicators on under-five mortality rates.ResultsIn both parametric and non-parametric models, the results show indicators of good socioeconomic development were associated with a reduction in under-five mortality rates while poor indicators were associated with an increase in under-five mortality rates. For instance, the parametric model shows that gross domestic product (GDP) (β = − 1.26, [CI − 1.51; − 1.01]), current healthcare expenditure (β = − 0.40, [CI − 0.55; − 0.26]) and access to basic sanitation (β = − 0.03, [CI − 0.05; − 0.01]) were associated with a reduction under-five mortality. An increase in the proportion practising open defecation (β = 0.14, [CI 0.08; 0.20]) an increase under-five mortality rate. The result of the spatial components spatial variation in the effect of the development indicators on under-five mortality rates. The spatial patterns of the effect also change over time for some indicators, such as PM2.5.ConclusionThe findings show that the burden of under-five mortality rates was considerably higher among sub-Saharan African countries and some southern Asian countries. The findings also reveal the trend in reduction in the sub-Saharan African region has been slower than the global trend.

Inequality in early life: Social class differences in childhood mortality in southern Sweden, 1815–1967

AbstractThis article analyses the long‐term development of social class differences in infant and child mortality in an area of southern Sweden, spanning from the early stages of the mortality transition at the beginning of the nineteenth century, to the late 1960s when both infant and child mortality had reached very low levels. Our findings show that infant and child mortality was fairly equal at the beginning of the study period. We find no clear pattern of class differentials in childhood mortality in the first half of the nineteenth century when both infant and child mortality declined. Later in the nineteenth century, class differences started to emerge. This is clear for both post‐neonatal mortality and child mortality, while we do not find any class differences in neonatal mortality. Over time, a more or less full gradient emerged for post‐neonatal mortality, and a weak gradient also emerged for child mortality. Strikingly, the disadvantaged position for unskilled and lower‐skilled workers remained throughout the 1960s, also at a time when mortality levels were very low, and living standards had increased dramatically for all classes in the population.

Are human natal sex ratio differences across the world adaptive? A test of Fisher's principle

Fisher's principle states that natural selection favours an equal number of male and female births at the population level, unless there are sex differences in rearing costs or sex differences in mortality before the end of the period of parental investment. Sex differences in rearing costs should be more pronounced in low- than in high-resource settings. We, therefore, examined whether human development index and sex differences in child mortality contribute to the natural variation in human sex ratio at birth across the globe. As predicted by Fisher's principle, the proportion of male births increased with both increasing male-biased childhood mortality and level of development of each country. However, these relationships were absent after accounting for spatial autocorrelation in the residuals, which our inference is conditioned on. This work shows how the failure to account for residual spatial autocorrelation can lead to incorrect conclusions regarding support for predictions from sex allocation theory.

A scoping review of methods for assessment of sex differentials in early childhood mortality

BackgroundWhile assessment of sex differentials in child mortality is straightforward, their interpretation must consider that, in the absence of gender bias, boys are more likely to die than girls. The expected differences are also influenced by levels and causes of death. However, there is no standard approach for determining expected sex differences.MethodsWe performed a scoping review of studies on sex differentials in under-five mortality, using PubMed, Web of Science, and Scopus databases. Publication characteristics were described, and studies were grouped according to their methodology.ResultsFrom the 17,693 references initially retrieved we included 154 studies published since 1929. Indian, Bangladeshi, and Chinese populations were the focus of 44% of the works, and most studies addressed infant mortality. Fourteen publications were classified as reference studies, as these aimed to estimate expected sex differentials based upon the demographic experience of selected populations, either considered as gender-neutral or not. These studies used a variety of methods – from simple averages to sophisticated modeling – to define values against which observed estimates could be compared. The 21 comparative studies mostly used life tables from European populations as standard for expected values, but also relied on groups without assuming those values as expected, otherwise, just as comparison parameters. The remaining 119 studies were categorized as narrative and did not use reference values, being limited to reporting observed sex-specific estimates or used a variety of statistical models, and in general, did not account for mortality levels.ConclusionStudies aimed at identifying sex differentials in child mortality should consider overall mortality levels, and report on more than one age group. The comparison of results with one or more reference values, and the use of statistical testing, are strongly recommended. Time trends analyses will help understand changes in population characteristics and interpret findings from a historical perspective.

Is son preference disappearing from Bangladesh?

• Using a survey of women born between 1975 and 1994, we assess how son preference is evolving in Bangladesh. • We find that, among women of childbearing age, son preference is giving way to a desire for gender balance. • We explore factors behind the trend: increased female education and employment, and decline in joint family living. • In contrast to stated fertility preferences, actual fertility decisions are still shaped by son preference. Historically, son preference has been widely prevalent in South Asia, manifested in the form of skewed sex ratios, gender differentials in child mortality, and worse educational investments in daughters versus sons. In the present study, we show, using data from a purposefully designed nationally representative survey for Bangladesh, that among women of childbearing age, son bias in stated fertility preferences has weakened and there is an emerging preference for gender balance. We examine a number of different hypotheses for the decline in son preference, including the increasing availability of female employment in the manufacturing sector, increased female education, and the decline of joint family living. Using survival analysis, we show that in contrast to stated fertility preferences, actual fertility decisions are still shaped by son preference.

Is Son Preference Disappearing from Bangladesh?

Historically, son preference has been widely prevalent in South Asia, manifested in the form of skewed sex ratios, gender differentials in child mortality, and worse educational investments in daughters versus sons. In the present study, we show, using data from a purposefully designed nationally representative survey for Bangladesh that, among women of childbearing age, son bias in stated fertility preferences has weakened and there is an emerging preference for gender balance. We examine a number of different hypotheses for the decline in son preference, including the increasing availability of female employment in the manufacturing sector, increased female education, and the decline of joint family living. Using survival analysis, we show that, in contrast to stated fertility preferences, actual fertility decisions are still shaped by son preference.

Utilizing "Positive deviance inquiry" to explore factors influencing child health: A qualitative study.

BACKGROUND:India is a lower middle-income country with one of the fastest growing economies in the world. Despite improvements in its economy, it has a high child mortality rate, with significant differences in child mortality both between and within different states. In this research, we tend to explore factors as to how a particular child's growth is optimal. With this aim, we utilized positive deviance inquiry to study the factors influencing under five child's health.MATERIALS AND METHODS:This qualitative study was carried out in Naigoan, an urban health setting of metropolitan city with 37 sample size between July 2020 and September 2020. It consisted of total 16 in-depth interviews (IDIs), 3 focus group Discussion (FGDs), and 7 key informant interviews (KIIs) which were performed by predesigned guides.RESULTS:Various themes evolved with the interviews; however, triangulation of the concept (from FGDs, IDIs, and KIIs) occurred with the following themes: satisfaction among mothers for health-care services, community participation, family support, and new interventions.CONCLUSION:Mothers’ satisfaction to health-care services, community participation, family support, and innovations by the health-care providers are the influencing factors in promoting child's health. Further research can be conducted to understand the in-depth understanding of each factor.

Road Traffic Accidents and Disparities in Child Mortality.

Road traffic accidents are a leading cause of child deaths in the United States. Although this has been examined at the national and state levels, there is more value in acquiring information at the county level to guide local policies. We aimed to estimate county-specific child mortality from road traffic accidents in the United States. We queried the Fatality Analysis Reporting System database, 2010-2017, for road traffic accidents that resulted in a death within 30 days of the auto crash. We included all children <15 years old who were fatally injured. We estimated county-specific age- and sex-standardized mortality. We evaluated the impact of the availability of trauma centers and urban-rural classification of counties on mortality. We included 9271 child deaths. Among those, 45% died at the scene. The median age was 7 years. The overall mortality was 1.87 deaths per 100 000 children. County-specific mortality ranged between 0.25 and 21.91 deaths per 100 000 children. The availability of a trauma center in a county was associated with decreased mortality (adult trauma center [odds ratio (OR): 0.59; 95% credibility interval (CI), 0.52-0.66]; pediatric trauma center [OR: 0.56; 95% CI, 0.46-0.67]). Less urbanized counties were associated with higher mortality, compared with large central metropolitan counties (noncore counties [OR: 2.33; 95% CI, 1.85-2.91]). There are marked differences in child mortality from road traffic accidents among US counties. Our findings can guide targeted public health interventions in high-risk counties with excessive child mortality and limited access to trauma care.

Maternal Education and Child Mortality Differentials: An Upshot From the National Family Health Survey 2015-2016, India.

Child mortality is a sociodemographical problem in India. Although nationally representative survey (National Family Health Survey) showed child mortality was gradually declining, that was not satisfactory, and child mortality differentials prevailed all over India. The study intended to identify the effect of maternal educational level along with some sociodemographical determinants on the mortality of their children. The study was run through bivariate association and logistic regression using the data from National Family Health Survey-4 (2015-2016). Findings declared that maternal education had significantly high influence (odds ratio: no education 3.9, primary 2.9, secondary 1.8; adjusted odds ratio: no education 2.9, primary 2.3, secondary 1.6) on child mortality in the Indian context.

Immigration and Child Mortality: Lessons from the United States at the turn of the Twentieth Century.

The societal integration of immigrants is a great concern in many of today's Western societies, and has been so for a long time. Whether we look at Europe in 2015 or the United States at the turn of the twentieth century, large flows of immigrants pose challenges to receiving societies. While much research has focused on the socioeconomic integration of immigrants there has been less interest in their demographic integration, even though this can tell us as much about the way immigrants fare in their new home country. In this paper we study the disparities in infant and child mortality across nativity groups and generations, using new, high-density census data. In addition to describing differentials and trends in child mortality among 14 immigrant groups relative to the native-born white population of native parentage, we focus special attention on the association between child mortality, immigrant assimilation, and the community-level context of where immigrants lived. Our findings indicate substantial nativity differences in child mortality, but also that factors related to the societal integration of immigrants explains a substantial part of these differentials. Our results also point to the importance of spatial patterns and contextual variables in understanding nativity differentials in child mortality.

Is Son Preference Disappearing from Bangladesh?

Historically, son preference has been widely prevalent in South Asia, manifested in the form of skewed sex ratios, gender differentials in child mortality, and worse educational investments in daughters versus sons. In the present study, we show, using data from a purposefully designed nationally representative survey for Bangladesh that, among women of childbearing age, son bias in stated fertility preferences has weakened and there is an emerging preference for gender balance. We examine a number of different hypotheses for the decline in son preference, including the increasing availability of female employment in the manufacturing sector, increased female education, and the decline of joint family living. Using survival analysis, we show that, in contrast to stated fertility preferences, actual fertility decisions are still shaped by son preference.

Type 1 Diabetes in 2017 - Global Estimates of Incident and Prevalent Cases in Children and Adults

Background: Data on type 1 diabetes incidence and prevalence are limited, particularly for adults. This study aims to estimate global numbers of incident and prevalent cases of type 1 diabetes in 2017 for all age groups by country and areas defined by income and region. Methods: Incidence rates of type 1 diabetes in children from existing literature were used and extrapolated to adults using available data on adult to child incidence ratios. Age-specific incidence rates were applied to population estimates to obtain incident case numbers. Duration of diabetes was estimated from available data and adjusted using differences in childhood mortality between countries. Prevalent case numbers were derived by modelling the relationship between prevalence, incidence, and disease duration. Findings: Global numbers of incident and prevalent cases were estimated to be 234,710 and 9,004,610, respectively. High income countries, with 17% of the global population, account for 49% of global incident cases and 52% of prevalent cases. Asia has the largest number of incident (32%) and prevalent (31%) cases and the largest proportion of the population (60%). Globally, the prevalent cases were 6%, 35%, 43%, and 6% in the age groups 0-14, 15-39, 40-64, and 65+ years, respectively. Interpretation: Globally type 1 diabetes represents about 2% of the estimated total cases of diabetes, ranging from less than 1% in certain Pacific countries to more than 15% in Northern European populations. This study provides information for development of health care and policy approaches to manage type 1 diabetes. Funding Statement: The study was funded by the US Centers for Disease Control and Prevention, through grant 5NU2GGH001235-05-00 of the WHO-CDC Cooperative Agreement, and by The Leona M. and Harry B. Helmsley Charitable Trust as part of the ACCISS Study. Declaration of Interests: AG and SMH report grants from the Institute of Applied Economics and Health Research, Copenhagen, Denmark outside the submitted work. SW reports non-financial support from Novo Nordisk, outside the submitted work. All other authors declare no competing interests.

Maternal Education, Fertility, and Child Survival in Comoros.

Reduction in child mortality is a demographic progress of significant socioeconomic development relevance in Africa. This paper analyzed the effect of maternal education and fertility on child survival in the Islands of Comoros. The 2012 Demographic and Health Survey (DHS) data were used. A two-stage probit regression method was used for data analysis. The results showed that about 75% of the children’s mothers had given birth to between one and five children, while more than half did not have any form of formal education. The results of the two-stage probit regression showed that while child survival reduced significantly (p < 0.05) with the age of the heads of households, residence in the Ngazidja region, being born as twins, mother’s number of business trips, and number of marital unions, it increased with maternal education, fertility, male household headship, and the child being breastfed immediately after birth. It was concluded that efforts to enhance maternal education would reduce child mortality. It is also critical to promote child breastfeeding among women, while regional characteristics promoting differences in child mortality in Comoros Islands should be properly addressed with keen focus on the Ngazidja region.

Changes in child mortality in Korea during the mid-twentieth century: gender, birth order and sibling composition

ABSTRACTThis study examines the changes in child mortality in Korea during the mid-twentieth century by focusing on gender, birth order and sibling composition. We hypothesize that social practices and biological factors play an important role, but this might differ by gender: while girls enjoyed genetic advantages, boys received more social care. Hence, sex differences in child mortality could reflect the relative strength of these two competing forces. Analyses of individual-level longitudinal data drawn from family registrations in a rural Korean village revealed the following results. First, maternal death increased child mortality substantially, and the association was stronger among boys than girls. Secondly, birth order was positively associated with child mortality, and this association was stronger among boys than girls. Thirdly, sibling size had a non-linear relationship with child mortality, and this association was slightly stronger among girls than boys. Finally, the implications of sibling composition differed by sex: having young siblings increased child mortality among boys and having old siblings reduced it among girls. These findings suggest that the relative strength of social and biological factors depended on the historical context and that Korean families actively responded to their circumstances under these constraints.

The color of child survival in Colombia, 1955–2005

ABSTRACTObjective(s): Colombia has the third largest black population in the Americas after Brazil and the USA. In 2005 mortality rate under 5 in Colombia was 21.5 per 1000, with a reduction of 82% between 2005 and 1955. That rate is not in line with rates for Cuba (6.8), Chile (9.1) or Costa Rica (10.4). Here we aim to provide evidence that a further reduction of child mortality relates to the unspoken racial gap in a pioneering country in family planning and praised in the 2000 WHO report as having the world’s fairest health care reform in terms of coverage and financial access.Design: The lack of nationally representative data to estimate black/white differences in child mortality is overcome by using the ratio of children born and alive as the measure of mortality and the 2005 census data from IPUMS-I, which provides racial categories based on self-identification. The working sample contains 617,985 mothers between 15 and 49 years of age, of whom 7.7% have experienced the death of at least one child. Using individual weights, a logistic regression is regressed on race, individual and community socio-economic status (SES), and demographic variables. Second, a model by cohort is regressed to capture the evolution of the racial gap over time. Third, interactions are run to examine the racial gap across SES groups.Results: The chances of losing a child are over 25% higher among black mothers relative to white mothers after controlling for individual and community SES characteristics. The racial gap remains stagnant and high for the period 1955–2005. The racial gap also is robust to changes in education and income levels.Conclusion: Failing to account for race slows down the improvement of child survival in Colombia relative to other countries of the region.

Kin and birth order effects on male child mortality: three East Asian populations, 1716–1945

Human child survival depends on adult investment, typically from parents. However, in spite of recent research advances on kin influence and birth order effects on human infant and child mortality, studies that directly examine the interaction of kin context and birth order on sibling differences in child mortality are still rare. Our study supplements this literature with new findings from large-scale individual-level panel data for three East Asian historical populations from northeast China (1789–1909), northeast Japan (1716–1870), and north Taiwan (1906–1945), where preference for sons and first-borns is common. We examine and compare male child mortality risks by presence/absence of co-resident parents, grandparents, and other kin, as well as their interaction effects with birth order. We apply discrete-time event-history analysis on over 172,000 observations of 69,125 boys aged 1–9 years old. We find that in all three populations, while the presence of parents is important for child survival, it is more beneficial to first/early-borns than to later-borns. Effects of other co-resident kin are however null or inconsistent between populations. Our findings underscore the importance of birth order in understanding how differential parental investment may produce child survival differentials between siblings.

Region of Birth and Child Mortality among Black Migrants to South Africa: Is there a foreign-born advantage?

Much of the existing evidence for the healthy immigrant advantage comes from developed countries. We investigate whether an immigrant health advantage exists in South Africa, an important emerging economy. Using the 2001 South African Census, this study examines differences in child mortality between native-born South African and immigrant blacks. We find that accounting for region of origin is critical: immigrants from southern Africa are more likely to experience higher lifetime child mortality compared to the native-born population. Further, immigrants from outside of southern Africa are less likely than both groups to experience child deaths. Finally, in contrast to patterns observed in developed countries, we detect a strong relationship between schooling and child mortality among black immigrants.

The Role of Wealth and Mother’s Education in Infant and Child Mortality in 26 Sub-Saharan African Countries: Evidence from Pooled Demographic and Health Survey (DHS) Data 2003–2011 and African Development Indicators (ADI), 2012

This study examined the regional differences in the role of wealth and mothers’ educational attainment in explaining infant and child mortality in sub-Saharan Africa (SSA). Specifically, this study investigates the role of wealth and mothers’ educational attainment in urban–rural and regional differences of SSA. We use data from Demographic and Health Surveys and the World Bank African Development Indicators to document these regional differences in infant and child mortality rates in SSA. Our findings show small variability in the risk of infant and child mortality attributable to regional differences in SSA. There is a statistically negative significant difference in infant and child mortality with urban dwellers compared to rural dwellers in SSA. Also, we found the risk of infant and child mortality to be correlated with per capita gross domestic product equal to or greater than five hundred US dollars ($500). Our findings show mother’s education to be negatively correlated with infant and child mortality in SSA. These findings give credence to previous studies which highlighted the significance of wealth, education of the mother, and location in explaining infant and child mortality differences in SSA. Our study finds no evidence of a statistically significant difference in the risk of infant and child mortality between the urban poorest and poorer wealth quintile households and their rural counterparts in SSA.