Differences In Child Mortality Research Articles

Factors That Predict Differences in Childhood Mortality in Nigerian Communities: A Prognostic Model

To identify predictors of variations of childhood mortality between Nigerian communities and to identify high-risk communities where childhood mortality was higher than expected. Secondary analysis of the 2013 Nigeria Demographic and Health Survey data using prognostic univariable and multivariable mixed Poisson regression models. Likelihood ratio test, Hosmer-Lemeshow goodness-of-fit, and variance inflation factor were used to evaluate the fitness of the final model. The final adjusted model revealed that communities with high rating of multiple childhood deprivation (relative risk 1.14, 95% CI 1.09-1.19) and maternal socioeconomic deprivation (relative risk 1.22, 95% CI 1.14-1.29) were associated significantly with the risk of childhood mortality. Communities with enhanced maternal hospital-based health-seeking behaviors and more advantageous environmental conditions had reduced risks of childhood mortality. Similarly, children living in communities with high ethnic diversity were significantly less likely to die before their fifth birthday (relative risk 0.96, 95% CI 0.94-0.97). About 64% of the observed heterogeneity in childhood mortality in these communities was explained by the final model. Eleven of the 896 communities had higher than expected childhood mortality rates during the study period. Of the 31 482 children included in this survey, 2886 had died before their fifth birthday (128 deaths per 1000 live births). There are variations in childhood mortality across Nigerian communities that are not determined only by health system functions but also by factors beyond the scope of health authorities and healthcare delivery systems.

Childhood Mortality Differentials by Ecological Region in Nepal

AbstractDespite the rapid decline of childhood mortality in Nepal, there is considerable variation in the rate of progress by ecological region. Using the Nepal Demographic Health Survey 2011 data, we investigate two critical questions: first, whether the ecological differences in childhood mortality still remain independent of the factors known to influence mortality and second, what socio‐economic and demographic factors shape these differences in childhood mortality across the ecological regions? The results from the Cox proportional hazard regression analysis, which controls for established socio‐economic and demographic factors known to influence childhood mortality, suggest that children who live in the hill and the Terai regions have a lower probability of death than those from the mountainous areas. The results of the Blinder–Oaxaca decomposition model further reveal that father's education, household economic status, place of residence, higher‐order births with lower birth interval, and mother's employment status significantly contribute to differences in childhood mortality across the ecological regions. Our findings provide important insights on the issue of (ecological) regional disparities in childhood mortality and draw attention to critical challenges for socio‐economic, population, and health policy in Nepal. Copyright © 2015 John Wiley & Sons, Ltd.

Assessing sex differentials in under-five mortality in sub-Saharan Africa: A cross-national comparative analysis

This paper investigates and compares country-specific sex differentials in childhood mortality in thirty sub-Saharan African countries. Data from the demographic and Health Surveys (DHS) were analyzed to assess sex differentials in U5M rates before and after adjustment for individual, household, and community-level factors, using multilevel discrete-time hazard models. The findings show a systematically higher mortality for male children compared to female in all countries except Sierra Leone and Swaziland. The relationship is significant in nineteen of the thirty countries. Across the region, males have 17–54 per cent higher odds of dying before age five. These patterns remained when controls were added for individual and community-level factors, as well as unobserved community-level effects.

Trends and social differentials in child mortality in Rwanda 1990-2010: results from three demographic and health surveys.

BackgroundRwanda has embarked on ambitious programmes to provide equitable health services and reduce mortality in childhood. Evidence from other countries indicates that advances in child survival often have come at the expense of increasing inequity. Our aims were to analyse trends and social differentials in mortality before the age of 5 years in Rwanda from 1990 to 2010.MethodsWe performed secondary analyses of data from three Demographic and Health Surveys conducted in 2000, 2005 and 2010 in Rwanda. These surveys included 34 790 children born between 1990 and 2010 to women aged 15–49 years. The main outcome measures were neonatal mortality rates (NMR) and under-5 mortality rates (U5MR) over time, and in relation to mother's educational level, urban or rural residence and household wealth. Generalised linear mixed effects models and a mixed effects Cox model (frailty model) were used, with adjustments for confounders and cluster sampling method.ResultsMortality rates in Rwanda peaked in 1994 at the time of the genocide (NMR 60/1000 live births, 95% CI 51 to 65; U5MR 238/1000 live births, 95% CI 226 to 251). The 1990s and the first half of the 2000s were characterised by a marked rural/urban divide and inequity in child survival between maternal groups with different levels of education. Towards the end of the study period (2005–2010) NMR had been reduced to 26/1000 (95% CI 23 to 29) and U5MR to 65/1000 (95% CI 61 to 70), with little or no difference between urban and rural areas, and household wealth groups, while children of women with no education still had significantly higher U5MR.ConclusionsRecent reductions in child mortality in Rwanda have concurred with improved social equity in child survival. Current challenges include the prevention of newborn deaths.

Explaining Sex Differentials in Child Mortality in India: Trends and Determinants

This study has twofold objectives: (1) to investigate the progress in sex differentials in child mortality in India in terms of within and between group changes and (2) to identify the factors explaining the sex differentials in child mortality and quantify their relative contributions. We have used three rounds of the National Family Health Survey (NFHS) data, 1992 to 2006. Life table approach and Pyatt and Oaxaca decomposition models were used as methods of analyses. The results revealed that though sex differential in child mortality is still high in India, it declined during 1992 to 2006 (Gini index from 0.36 to 0.24). This decline was primarily led by a change in within inequality of female child mortality (Gini index from 0.18 to 0.14). Among the selected predictors, breastfeeding (40%), birth order (24%), antenatal care (9%), and mother’s age (7%) emerged as critical contributors for the excess female child mortality in India. From the findings of this study, we suggest that any efforts to do away with gender differences in child survival should focus more on within female child disparity across different population subgroups alongside male-female disparity. Implications are advanced.

A comparison of under 5 childhood mortality among Turks living in Turkey and Turkish migrants in Germany

Introduction Childhood mortality is considered to be a sensitive international indicator for population health, and health system performance, as it is largely avoidable. Migrant populations should be able to benefit from host country health system performance in the same way as the majority population. The indicator of childhood mortality can show whether this works or not. To address this question, we explored differences in childhood mortality in two population groups: migrants from Turkey, resident …

Socioeconomic differences in child mortality in central Poland at the end of the nineteenth century.

Analyses of historical or modern populations indicate a strong relationship between mortality level and standard of living, measured, among other factors, by degree of urbanization. The aim of this study was to assess mortality rates in children of up to 5 years of age in two populations living under different conditions in central modern Poland at the end of the 19th century: the rural parish of Kowal, under Russian partition, and Toruń, an industrial and urbanized centre under Prussian partition. Data on births and deaths were taken from birth certificate registries and from the Prussian statistics yearbooks for 1876-1894. Death rates of children aged 0-5 years were calculated, and also for annual age ranges. The urban population had lower birth rates (37.19‰), natural increase rates (8.0‰), population dynamics rates (1.26‰), which provide information about the relation between two components of a natural increase, i.e. births and deaths, and an over-mortality of boys in relation to girls. In the rural population these values were all higher: 53.67‰, 18.11‰ and 1.59‰ respectively. No impact was found of social stratification on child mortality in the wide age group of 0-5 years. However, for subsequent one-year age groups significant relationships between mortality level and size and industrialization level of the population centres were noted. The living conditions of infants in Toruń, although being in a better position as an area annexed by Prussia, were markedly worse than those of rural Kowal Parish. In the urban centre infant mortality was slightly over 269 for 1000 live born, and in Kowal Parish it was 163 for 1000 live born. The high infant mortality was balanced in Toruń by the higher mortality levels of children aged 2-5 years compared with Kowal Parish. Natural selection in the city had the greatest impact on infants, who did not have the protective influence of breast-feeding because women had to return to work shortly after giving birth. The lower infant mortality of mothers in the countryside due to longer breast-feeding led to larger family sizes. In 1871-1890 in the villages the number of children per women was about 7.42, whereas in Toruń it ranged from 4.4 to 5.2. The probability of death among children who survived the first year of life was higher in the countryside than the town. In the rural parish, perhaps because of cultural factors such as breast-feeding or working practices making full-time baby-sitting possible, children who did not reach the age of 1 year were not subjected to such intensive natural selection. Overall, differences in child mortality in the two centres in 19th central Poland resulted from ecological and cultural conditions, rather than from social and economical reasons (living under different partitions).

United Nations, Department of Economic and Social Affairs, Population Division, Sex Differentials in Childhood Mortality

United Nations, Department of Economic and Social Affairs, Population Division, <i>Sex Differentials in Childhood Mortality</i>

The elusive effect of water and sanitation on the global burden of disease

About 2.5 billion people lack access to improved sanitation, and 1 billion have no access to any form of sanitation (UNICEF 2013). About 780 million people lack access to an improved water source, a figure that is based on a fairly generous definition incorporating little with respect to reliability, proximity and convenience of access (UNICEF 2013). While the ancient Romans may already have been aware of it (Bradley 2012), water and sanitation came to be regarded as key to improve health in the growing cities of Europe and America in the late 19th and early 20th centuries. A number of notable observational studies were carried out that even with the limited epidemiological tools available at the time all but proved the direct link between water, sanitation and health (Snow 1860; Pringle 1910). By contrast, in the early days of development aid in the post-colonial era, water and sanitation were often not regarded as a health issue, but primarily provided with the aim of making people’s life easier and enable developmental activities. Whoever tried to argue for more investment on health grounds was faced by a lack of epidemiological studies conducted in low-income settings, which led to a renewed interest in research from the 1970s.

Wealthiest is Not Always Healthiest: What Explains Differences in Child Mortality in West Africa?

Ghana has the lowest under-five mortality rate in West Africa. Understanding why Ghana’s child mortality rate is lower than in neighboring countries may offer useful insights for other developing countries that are trying to improve child health. This paper explores whether Ghana’s lower mortality rate is mostly a result of greater household wealth, better implementation of national health policies, or more favorable geography. The paper uses micro level data for children under five to examine relative child mortality risk between Ghana and each of its three immediate neighbors — Burkina Faso, the Ivory Coast and Togo. A Cox proportional hazards model is used to test which of the three ‘contenders’ — health policy, wealth or geography — best explains Ghana’s mortality advantage. The results of the analysis indicate that wealth variables are not able to explain any of the child mortality variation between Ghana and its neighbors. Geography and health policy variables each explain about 40% of the mortality gap between Ghana and Burkina Faso. Health policy differences alone are able to explain about 70% of the child mortality gap between Ghana and the Ivory Coast. These results suggest that even poor countries that have been 'cursed' by bad geography can potentially improve development outcomes and save children’s lives.

Spatial Differentials in Childhood Mortality in South Africa: Evidence from the 2001 Census

This study examines spatial differentials in childhood mortality in South Africa using data from the 2001 population census. Of the complex routes of geographical area hierarchy maintained by South Africa, one route links provinces to Magisterial Districts (MDs). There are in all 354 MDs and nine provinces. Our analyses are conducted mainly at the level of MDs. The results show that provincial level indicators mask huge disparities in child health experienced by certain segments of the population. Children born in MDs such as Tabankulu, Lusikisiki, Bizana, Flagstaff, Libode and in the Eastern Cape Province in general are the most threatened early in life. Under prevailing mortality conditions, more than 10% of the children born in these districts are unlikely to celebrate their fifth anniversary. Most of the high mortality MDs form clusters that sometimes cut across provincial boundary. As it is to be expected, most of these high risk districts are among the poorest in the country as measured by average monthly expenditure. However, the worse-off districts, health-wise, are not necessarily the poorest and similarly, the best child health achievers are not necessarily the most economically well-off. On the basis of these findings, implementing policies targeting such high risk districts would seem a more rational way to help close the within country disparities in child mortality and thereby speed up progress toward the MDGs target

Child Mortality Estimation: Estimating Sex Differences in Childhood Mortality since the 1970s

Producing estimates of infant (under age 1 y), child (age 1-4 y), and under-five (under age 5 y) mortality rates disaggregated by sex is complicated by problems with data quality and availability. Interpretation of sex differences requires nuanced analysis: girls have a biological advantage against many causes of death that may be eroded if they are disadvantaged in access to resources. Earlier studies found that girls in some regions were not experiencing the survival advantage expected at given levels of mortality. In this paper I generate new estimates of sex differences for the 1970s to the 2000s. Simple fitting methods were applied to male-to-female ratios of infant and under-five mortality rates from vital registration, surveys, and censuses. The sex ratio estimates were used to disaggregate published series of both-sexes mortality rates that were based on a larger number of sources. In many developing countries, I found that sex ratios of mortality have changed in the same direction as historically occurred in developed countries, but typically had a lower degree of female advantage for a given level of mortality. Regional average sex ratios weighted by numbers of births were found to be highly influenced by China and India, the only countries where both infant mortality and overall under-five mortality were estimated to be higher for girls than for boys in the 2000s. For the less developed regions (comprising Africa, Asia excluding Japan, Latin America/Caribbean, and Oceania excluding Australia and New Zealand), on average, boys' under-five mortality in the 2000s was about 2% higher than girls'. A number of countries were found to still experience higher mortality for girls than boys in the 1-4-y age group, with concentrations in southern Asia, northern Africa/western Asia, and western Africa. In the more developed regions (comprising Europe, northern America, Japan, Australia, and New Zealand), I found that the sex ratio of infant mortality peaked in the 1970s or 1980s and declined thereafter. The methods developed here pinpoint regions and countries where sex differences in mortality merit closer examination to ensure that both sexes are sharing equally in access to health resources. Further study of the distribution of causes of death in different settings will aid the interpretation of differences in survival for boys and girls. Please see later in the article for the Editors' Summary.

Persistence Of Income Inequality: Does Child Mortality Matter?

Many developing countries are afflicted by persistent inequality in the distribution of income. While a growing body of literature emphasize differential fertility as a channel through which income inequality persists, this paper investigates differential child mortality - differences in the incidence of child mortality across socioeconomic groups - as a critical link in this regard. Using evidence from cross-country data to evaluate this linkage, we find that differential child mortality serves as a stronger channel than differential fertility in the transmission of income inequality over time. We use random effects and generalized estimating equations techniques to account for temporal correlation within countries. The results are robust to the use of an alternate definition of fertility that reflects parental preference for children instead of realized fertility.

Effect of mother’s migration on under-twomortality in Kenya

This study examines the effect of mothers’ migration status controlling for other proximate factors (socio-economic, environmental and bio-demographic characteristics) on under two mortality in Kenya. Data used were drawn from 2003 Kenya Demographic Health Survey with focus on infants and children below two years in age. A total of 5949 infants and children born five years before the survey are used in the analysis. Cox proportional hazard model is used to assess the relative effect of the migration status (migrant or non-migrant) of the mother on survival rates controlling for other explanatory variables. The general results shows that children of migrant mothers especially those of urban-rural migrants face a higher mortality risk compared to those of non-migrant mothers. The results show that failure to account for migration may alter the estimation of urban-rural differentials in childhood mortality.

Demografia de um povo indígena da Amazônia brasileira: os sateré-mawé

A participative sociodemographic census survey on the satere-mawe population, carried out in 2002 and 2003, in two indigenous territories and four cities west of the state of Amazonas revealed demographic, economic, social and cultural information about the indigenous people. In all, 7,502 people were interviewed in their lands and 998 in urban areas. The present study aimed to analyze the sociodemographic characteristics of the satere-mawe, including age and sex distribution, fertility, mortality, and migration. Most of the satere-mawe are young, because of their high fertility and reduced aged population. There are intense, relatively recent, migratory flows, both towards the land occupied by the satere-mawe and to nearby cities. Child mortality in the territory is high and uneven, higher in the head of one of the main rivers going through the satere-mawe territory. The socioeconomic, infrastructural and nutritional characteristics of the satere-mawe people also determine some elements of the levels and differentials in child mortality.

Wealthiest Is Not Always Healthiest: What Explains Differences in Child Mortality in West Africa?

Ghana has the lowest under-five mortality rate in West Africa. Understanding why Ghana’s child mortality rate is lower than in neighboring countries may offer useful insights for other developing countries that are trying to improve child health. This paper explores whether Ghana’s lower mortality rate is mostly a result of greater household wealth, better implementation of national health policies, or more favorable geography. The paper uses micro level data for children under five to examine relative child mortality risk between Ghana and each of its three immediate neighbors -- Burkina Faso, Cote d’Ivoire, and Togo. A Cox proportional hazards model is used to test which of the three ‘contenders’ – health policy, wealth, or geography – best explains Ghana’s mortality advantage. The results of the analysis indicate that wealth variables are not able to explain any of the child mortality variation between Ghana and its neighbors. Geography and health policy variables each explain about 40% of the mortality gap between Ghana and Burkina Faso. Health policy differences alone are able to explain about 70% of the child mortality gap between Ghana and Cote d’Ivoire. These results suggest that even poor countries that have been ‘cursed’ by bad geography can potentially improve development outcomes and save children’s lives.

P1-203 Social and gender differentials in childhood mortality in rural North India

IntroductionAchieving Millennium Development Goals on childhood mortality in developing countries requires that inequities be addressed. This study examined changing gender differentials as social and economic improvement occurred in a rural...

Achieving the millennium development goal for under-five mortality in Bangladesh: current status and lessons for issues and challenges for further improvements.

The study assessed the achievements in, critically reviewed the relevant issues of, and put forward recommendations for achieving the target of the Millennium Development Goal relating to mortality of children aged less than five years (under-five mortality) in Bangladesh within 2015. To materialize the study objectives, a thorough literature review was done. Mortality of under-five children and infants decreased respectively to 65 from 151 and to 52 from 94 per 1,000 livebirths during 1990-2006. The immunization coverage increased from 54% to 81.9% during the same period. The projection shows that Bangladesh will achieve targeted reduction in under-five mortality and infant mortality within the time limit, except immunization coverage. Neonatal mortality contributed to the majority of childhood deaths. Contribution of neonatal mortality to child mortality was the highest. There were remarkable differences in child mortality by sex, division, and residence. To progress further for achieving the target of MDG relating to child mortality, some issues, such as lower use of maternal healthcare services, hazardous environmental effects on childhood illness, high malnutrition among children, shorter duration of exclusive breastfeeding practices, various child injuries leading to death, low healthcare-use of children, probable future threat of financial shortage, and strategies lacking area-wise focus on child mortality, need to be considered. Without these, the achievement of MDG relating to child mortality may not be possible within 2015.

Does living in a female-headed household lower child mortality? The case of rural Nigeria

The high infant and child morbidity and mortality in most sub-Saharan African countries, and Nigeria in particular, is a prominent global concern. The objective of this study was to assess factors influencing, and the prevalence of, the experience of child death among rural Nigerian mothers, with the specific aim to investigate whether household headship had an impact on child death. Using data from the 2008 Nigeria Demographic and Health Survey, multivariate logistic regression methods were used to assess the influence of household headship and other associated variables among rural women who experienced child death (n=13 203) in the 5 years preceding the survey. A total of 5632 women (43%) whose most recent birth occurred in the 5 years preceding the survey had reported the death of a child. Women who utilized health services were less likely to report child death than those who never utilized health services. Women who delivered their most recent child at home were more likely (46%; n=4565) to report child death compared with those who delivered in a health facility (32%; n=997). The women who resided in male-headed households had a significantly higher (43%; n=5143) prevalence of child death than women from female-headed households (37%; n=489). After controlling for all covariates in the multivariate logistic regression models, women from female-headed households were 17% less likely to experience child death (odds ratio=0.83; 95% confidence interval 0.71, 0.98) than women from male-headed households. The occurrence of child death is not unusual in rural Nigeria. Multiple frameworks are needed to account for differentials in child mortality. After controlling for other explanatory variables such as age, wealth status, region and place of delivery of recent birth, this study found that household headship remained a strong predictor of child mortality. Recommendations are provided according to the complex interplay of socio-cultural, economic, and situational factors affecting the survival of children in rural Nigeria.

Gender inequity and age-appropriate immunization coverage in India from 1992 to 2006.

BackgroundA variety of studies have considered the affects of India's son preference on gender differences in child mortality, sex ratio at birth, and access to health services. Less research has focused on the affects of son preference on gender inequities in immunization coverage and how this may have varied with time, and across regions and with sibling compositions. We present a systematic examination of trends in immunization coverage in India, with a focus on inequities in coverage by gender, birth order, year of birth, and state.MethodsWe analyzed data from three consecutive rounds of the Indian National Family Health Survey undertaken between 1992 and 2006. All children below five years of age with complete immunization histories were included in the analysis. Age-appropriate immunization coverage was determined for the following antigens: bacille Calmette-Guérin (BCG), oral polio (OPV), diphtheria, pertussis (whooping cough) and tetanus (DPT), and measles.Results Immunization coverage in India has increased since the early 1990s, but complete, age-appropriate coverage is still under 50% nationally. Girls were found to have significantly lower immunization coverage (p<0.001) than boys for BCG, DPT, and measles across all three surveys. By contrast, improved coverage of OPV suggests a narrowing of the gender differences in recent years. Girls with a surviving older sister were less likely to be immunized compared to boys, and a large proportion of all children were found to be immunized considerably later than recommended.ConclusionsGender inequities in immunization coverage are prevalent in India. The low immunization coverage, the late immunization trends and the gender differences in coverage identified in our study suggest that risks of child mortality, especially for girls at higher birth orders, need to be addressed both socially and programmatically. in HindiSee the full article online for a translation of this abstract in Hindi.