Disparities In Child Mortality Research Articles

Impact of rural-urban migration on indirect child mortality estimation in Kenya

When estimating child mortality rates using the indirect method, it is assumed that all reported births and deaths occurred in the place where the mothers resided at the time of the survey. However, the migration of women can result in transferring data about deceased children from one place to another. In many developing countries, substantial migration happens between rural and urban regions, where child mortality disparities are significant. This migration creates challenges as child mortality estimates for rural and urban areas computed under the assumption of non-migration are likely to be erroneous. Our study pooled data from six Kenya Demographic and Health Surveys between 1989 and 2014. The study aimed to establish statistical evidence of the impact of rural-urban migration on indirect child mortality estimates. Our findings indicate that the inclusion of deceased children born to women who migrated from rural to urban regions led to a significant overestimation of infant, one-to-four, and under-five mortality rates in urban areas. On average, the overestimation of infant mortality rates ranged from 2.5% to 21.7%, while one-to-four mortality rate overestimation ranged from 4.0% to 41.2%. The average overestimation of under five mortality rate was between 3.0% and 26.8%. Based on these results, future indirect estimates of child mortality for rural and urban regions should be adjusted to account for the impacts of migration between these areas. Furthermore, it is essential to consider re-estimating trends of child mortality for rural and urban regions in Kenya to better understand the timing of mortality convergence between these regions.

Understanding inequities in child mortality in Egypt: Socioeconomic and proximate factors

ABSTRACT While there have been notable advancements in child health in Egypt, disparities in child mortality still exist. Understanding these disparities is crucial to addressing them. The objective of this study is to explore the factors linked to child mortality in Egypt, providing a comprehensive understanding of the disparities in child mortality rates. The study utilises cross-sectional data from Egypt's Demographic and Health Survey (EDHS) in 2014 to examine child mortality. The dataset consists of 15,848 observations from mothers with children born within five years prior to the survey. The choice of explanatory variables was guided by the Mosely and Chen Framework and logistic multivariate regression was used to conduct the analyses. The study finds lower education, early childbearing, insufficient birth spacing, lack of breastfeeding, and absence of improved toilet facilities (proxy for living conditions) were all significantly linked to an increased likelihood of child loss. Additionally, poorer people in rural settings experienced the worst child mortality. The findings align with the World Health Organization's Conceptual Framework for Action on the Social Determinants of Health (CSDH). Recommended policy interventions include targeting women in rural areas, improving living conditions and removing financial/other barriers to accessing care.

Death Inequality During the First Year of Life in Morocco: A Macro Level Analysis

Disparities in child mortality are a reality in Morocco. These disparities coexist with inequalities in: (i) the availability of primary health care (PHCs); (ii) the socioeconomic status of the population as reflected by the prevalence of various forms of poverty; as well as (iii) fertility levels (TFRs) and the status of women in literacy and employment rates. Despite its limitations, this research provides a macro-level understanding of the link between infant mortality and a range of aggregates (political, economic, social and demographic).The metadata collected in the 2014 census (RGPH-2014) RGPH-2014 was used to construct a provincial proxy indicator of infant mortality by area of residence.This is considered as a dependent variable that we have tried to explain by the above-mentioned indicators. This is considered as a dependent variable that we have tried to explain by the above-mentioned indicators. The latter indicators reflect the socio-economic conditions prevailing in each of the provinces by area of residence. In addition, they give information on the availability of basic health services and on the woman's status. A key finding is that the level of current fertility as measured by the TFR negatively affects child survival. With a statistically significant regression coefficient of 2.912 (Pvalue =0.000), it can be argued that high fertility increases the risk of infant mortality. In turn, the prevalence of overall poverty also has a statistically significant effect on infant survival (β= -0.213 with a pvalue =0.029).

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.

Role of Parental Social Class in Preterm Births and Low Birth Weight in Association with Child Mortality: A National Retrospective Cohort Study in Korea.

PurposeWe explored the role of parental social class in preterm birth (PTB) and low birth weight (LBW) in association with child mortality in Korea.Materials and MethodsA total of 7,302,732 births in Korea between 1995 and 2007 were used for designing the national retrospective cohort study. Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the risk of child death after adjusting for covariates.ResultsParental social class was associated with adverse birth outcomes and child mortality in Korea. Parental social class increased the strength of the relationship of adverse birth outcomes with child mortality. Child mortality was higher among PTB and LBW infants from parents with a lower social class than normal births from parents with a higher social class. In particular, the disparity in child mortality according to parental social class was greater for LBW and PTB than intrauterine growth retardation births. When one of the parents had a middle-school education or lower, the disparity in child mortality due to adverse birth outcomes was large regardless of the other spouse's educational status. Inactive economic status for the father, as well as an occupation in manual labor by the mother, increased the risk of child mortality.ConclusionStrong relationships for social inequalities and adverse birth outcomes with inequalities in child mortality in South Korea were found in this study. Tackling social inequalities, as well as reducing adverse birth outcomes, are needed to reduce the disparities in child mortality in South Korea.

National, regional, and state-level all-cause and cause-specific under-5 mortality in India in 2000–15: a systematic analysis with implications for the Sustainable Development Goals

SummaryBackgroundIndia had the largest number of under-5 deaths of all countries in 2015, with substantial subnational disparities. We estimated national and subnational all-cause and cause-specific mortality among children younger than 5 years annually in 2000–15 in India to understand progress made and to consider implications for achieving the Sustainable Development Goal (SDG) child survival targets.MethodsWe used a multicause model to estimate cause-specific mortality proportions in neonates and children aged 1–59 months at the state level, with causes of death grouped into pneumonia, diarrhoea, meningitis, injury, measles, congenital abnormalities, preterm birth complications, intrapartum-related events, and other causes. AIDS and malaria were estimated separately. The model was based on verbal autopsy studies representing more than 100 000 neonatal deaths globally and 16 962 deaths among children aged 1–59 months at the subnational level in India. By applying these proportions to all-cause deaths by state, we estimated cause-specific numbers of deaths and mortality rates at the state, regional, and national levels.FindingsIn 2015, there were 25·121 million livebirths in India and 1·201 million under-5 deaths (under-5 mortality rate 47·81 per 1000 livebirths). 0·696 million (57·9%) of these deaths occurred in neonates. There were disparities in child mortality across states (from 9·7 deaths [Goa] to 73·1 deaths [Assam] per 1000 livebirths) and regions (from 29·7 deaths [the south] to 63·8 deaths [the northeast] per 1000 livebirths). Overall, the leading causes of under-5 deaths were preterm birth complications (0·330 million [95% uncertainty range 0·279–0·367]; 27·5% of under-5 deaths), pneumonia (0·191 million [0·168–0·219]; 15·9%), and intrapartum-related events (0·139 million [0·116–0·165]; 11·6%), with cause-of-death distributions varying across states and regions. In states with very high under-5 mortality, infectious-disease-related causes (pneumonia and diarrhoea) were among the three leading causes, whereas the three leading causes were all non-communicable in states with very low mortality. Most states had a slower decline in neonatal mortality than in mortality among children aged 1–59 months. Ten major states must accelerate progress to achieve the SDG under-5 mortality target, while 17 are not on track to meet the neonatal mortality target.InterpretationEfforts to reduce vaccine-preventable deaths and to reduce geographical disparities should continue to maintain progress achieved in 2000–15. Enhanced policies and programmes are needed to accelerate mortality reduction in high-burden states and among neonates to achieve the SDG child survival targets in India by 2030.FundingBill & Melinda Gates Foundation.

The Role of Inadequate Water and Sanitation on Economic and Social Determinants of Child Mortality: A Global Analysis Across 43 Countries

Background: Social, economic and environmental factors have been identified as causes of child mortality. No known research has tried to disentangle these factors and quantify the contribution of these diverse factors to child mortality across countries using the decomposition analysis of the concentration index. Decomposition analysis is one method that can be used to disentangle the relative contribution of multiple variables to child mortality. A concentration index is a tool to measure wealth-related health inequalities. Methods: This is the first study to decompose the concentration index to quantify the contribution of water and sanitation access to maternal educational inequality and household wealth inequality across all 43 low and middle-income countries (LMICs) with data available between 2009-2013 from the nationally representative Demographic and Health Surveys (DHS). Findings: On average, the largest disparities in child mortality were found to come from mothers who had the least education. Unimproved sanitation contributed to greater child mortality inequalities than other variables, in over two-thirds of the countries. Interpretation: To increase child survival in LMICs included in this analysis, policies and interventions, on average, should focus on improving girls' education and access to water, and, especially, sanitation in the poorest households. Benefits in South Asia and sub-Saharan Africa have the greatest potential to impact population health and health inequalities from these interventions. Funding Statement: This research was funded by Health Sciences and Family Medicine and Public Health in the School of Medicine at the University of California, San Diego. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The DHS data-collection procedures were approved by the ICF International institutional review board and by the relevant human subject committees in each country. Survey respondents provided oral informed consent.

A comprehensive analysis on child mortality and its determinants in Bangladesh using frailty models

BackgroundBangladesh has experienced a significant reduction of child mortality over the past decades which helped achieve the Millennium Development Goal 4 (MDG 4) target. But the mortality among under-5 aged children is still relatively high and it needs a substantial effort to achieve the Sustainable Development Goal (SDG) target and decelerate the current rate of under-5 mortality. At this stage, it is hence important to explore the trend and determinants of under-5 mortality in order to reduce the vulnerability of child’s survival. The aim of this study is to explore the trends and identify the factors associated with mortality in children aged less than 5 years in Bangladesh.MethodsData from three repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) for the year 2007, 2011 and 2014 were used. A stratified two-stage sampling method was used to collect information on child and maternal health in these surveys. Cox’s proportional hazards models with community and mother level random effects (or frailty models) were fitted to identify the associated factors with under-five mortality.ResultsOur study reveals that urban-rural disparity in child mortality has decreased over the time. The frailty models revealed that the combined effect of birth order and preceding birth interval length, sex of the child, maternal age at birth, mother’s working status, parental education were the important determinants associated with risk of child mortality. The risk of mortality also varied across divisions with Sylhet division being the most vulnerable one. Moreover, significant and sizable frailty effects were found which indicates that the estimations of the unmeasured and unobserved mother and community level factors on the risk of death were substantively important.ConclusionOur study suggests that community-based educational programs and public health interventions focused on birth spacing may turn out to be the most effective. Moreover, unobserved community and familial effects need to be considered along with significant programmable determinants while planning for the child survival program.

A Register-Based Study of Diseases With an Autosomal Recessive Origin in Small Children in Denmark According to Maternal Country of Origin.

Compared with children born of Danish mothers, the mortality of children, born and living in Denmark, is significantly increased in those with a mother from Afghanistan, Iraq, Pakistan, Somalia, and Turkey. Consanguinity has been suggested to account for part of this disparity. Since information on consanguinity is lacking, this suggestion is difficult to test. With an indirect approach, we addressed this question by comparing the risk of diseases with autosomal recessive inheritance in children born in Denmark of Danish-born women and of women born in these five countries, respectively. All children born in Denmark (1994-2010) were followed until 5 years of age or end-of-study period for the risk of hospitalisation with diseases of autosomal recessive aetiology, and therefore considered consanguinity-related. Diagnoses of autosomal recessive diseases were identified using two different methods: a literature review of consanguinity-associated diseases and a search in the Online Catalogue of Human Genes and Genetic Disorders. Risks were also calculated for diseases with known non-autosomal recessive aetiology (considered non-consanguinity-related). We estimated adjusted hazard ratios for the diseases in children of foreign-born women compared with children of Danish-born women. Compared with offspring of Danish-born women, the risk of a consanguinity-related disease was significantly increased in children of foreign-born women, although the absolute risk was low. The risk of non-consanguinity-related diseases did not differ between the groups compared. The findings support the hypothesis that consanguinity accounts for some, however a minor part, of the disparity in child mortality among migrants in Denmark.

Entrenched geographical and socioeconomic disparities in child mortality: trends in absolute and relative inequalities in Cambodia.

BackgroundCambodia has made considerable improvements in mortality rates for children under the age of five and neonates. These improvements may, however, mask considerable disparities between subnational populations. In this paper, we examine the extent of the country's child mortality inequalities.MethodsMortality rates for children under-five and neonates were directly estimated using the 2000, 2005 and 2010 waves of the Cambodian Demographic Health Survey. Disparities were measured on both absolute and relative scales using rate differences and ratios, and where applicable, slope and relative indices of inequality by levels of rural/urban location, regions and household wealth.FindingsSince 2000, considerable reductions in under-five and to a lesser extent in neonatal mortality rates have been observed. This mortality decline has, however, been accompanied by an increase in relative inequality in both rates of child mortality for geography-related stratifying markers. For absolute inequality amongst regions, most trends are increasing, particularly for neonatal mortality, but are not statistically significant. The only exception to this general pattern is the statistically significant positive trend in absolute inequality for under-five mortality in the Coastal region. For wealth, some evidence for increases in both relative and absolute inequality for neonates is observed.ConclusionDespite considerable gains in reducing under-five and neonatal mortality at a national level, entrenched and increased geographical and wealth-based inequality in mortality, at least on a relative scale, remain. As expected, national progress seems to be associated with the period of political and macroeconomic stability that started in the early 2000s. However, issues of quality of care and potential non-inclusive economic growth might explain remaining disparities, particularly across wealth and geography markers. A focus on further addressing key supply and demand side barriers to accessing maternal and child health care and on the social determinants of health will be essential in narrowing inequalities.

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

Geographical disparities in child mortality in the rural areas of Iran: 16-years trend

PurposeWe performed this study to assess the trend of geographical disparities between rural areas located in the catchment areas of 41 medical universities in Iran from 1993 to 2008. We...

Regional disparities in child mortality within China 1996-2004: epidemiological profile and health care coverage.

China was one of the 68 "countdown" countries prioritized to attain Millennium Development Goals (MDG 4). The aim of this study was to analyze data on child survival and health care coverage of proven cost-effective interventions in China, with a focus on national disparities. National maternal and child mortality surveillance data were used to estimate child mortality. Coverage for proven interventions was analyzed based on data from the National Health Services Survey, National Nutrition and Health Survey, and National Immunization Survey. Consultations and qualitative field observations by experts were used to complement the Survey data. Analysis of the data revealed a significant reduction in the overall under-5 (U5) child mortality rate in China from 1996 to 2007, but also great regional disparities, with the risk of child mortality in rural areas II-IV being two- to sixfold higher than that in urban areas. Rural areas II-IV also accounted for approximately 80% of the mortality burden. More than 60% of child mortality occurred during the neonatal period, with 70% of this occurring during the first week of life. The leading causes of neonatal mortality were asphyxia at birth and premature birth; during the post-neonatal period, these were diarrhea and pneumonia, especially in less developed rural areas. Utilization of health care services in terms of both quantity and quality was positively correlated with the region's development level. A large proportion of children were affected by inadequate feeding, and the lack of safe water and essential sanitary facilities are vital indirect factors contributing to the increase in child mortality. The simulation analysis revealed that increasing access to and the quality of the most effective interventions combined with relatively low costs in the context of a comprehensive approach has the potential to reduce U5 deaths by 34%. China is on track to meet MDG 4; however, great disparities in health care do exist within the country. It is therefore necessary to specifically target rural areas II-IV. Many causes of child mortality can be prevented or averted through the provision of basic health care. However, the leading predisposing factor contributing to child mortality in China is the insufficient coverage and poor quality of maternal and child health care services. Based on these data, we recommend that the government put more effort to ensure the health of the Chinese people, particularly in terms of providing the most vulnerable populations, i.e., children from the poorest areas and households, with access to good quality essential health care services.

Declining child mortality and continuing racial disparities in the era of the Medicaid and SCHIP insurance coverage expansions.

We investigated trends in national childhood mortality, racial disparities in child mortality, and the effect of Medicaid and State Children's Health Insurance Program (SCHIP) eligibility expansions on child mortality. We analyzed child mortality by state, race, and age using the National Center for Health Statistics' multiple cause of death files over 20 years, from 1985 to 2004. Child mortality continued to decline in the United States, but racial disparities in mortality remained. Declines in child mortality (ages 1-17 years) were substantial for both natural (disease-related) and external (injuries, homicide, and suicide) causes for children of all races/ethnicities, although Black-White mortality ratios remained unchanged during the study period. Expanded Medicaid and SCHIP eligibility was significantly related to the decline in external-cause mortality; the relationship between natural-cause mortality and Medicaid or SCHIP eligibility remains unclear. Eligibility expansions did not affect relative racial disparities in child mortality. Although the study provides some evidence that public insurance expansions reduce child mortality, future research is needed on the effect of new health insurance on child health and on factors causing relative racial disparities.

Does child gender determine household decision for health care in rural Thatta, Pakistan?

In South Asia, gender disparity in child mortality is highest in Pakistan. We examined the influence of child gender on household decision regarding health care. Prevalence ratios were calculated for 3740 children aged 1-59 months from 92 randomly selected villages of rural Pakistan using a cluster-adjusted log-binomial model. Level 1 variables included child and household characteristics and level 2 included village characteristics. There were 25 more girl deaths than boys per 1000 live births (95% CI: 13.9, 48.6) among post-neonates and 38 more among children aged 12-59 months (95% CI: 10.5, 65.5). However, in adjusted analysis, gender was not a significant predictor of illness reporting, visit to health facilities, choice of provider, hospitalization and health expenditure. Significant predictors of health care were child's age, illness characteristics, number of children in the family, household socio-economic status and absence of girls' school in the village. Differential care seeking for boys and girls is not seen in Thatta despite clear differences in mortality ratios. This calls for more creative research to identify pathways for gender differential in child mortality. Factors identified as influencing child health care and amenable to modification include poverty alleviation and girls' education.

Health inequality and deprivation

This paper looks at health inequality and deprivation, with a particular focus on developing countries. It is specifically concerned with relationships between health and income, especially the extent to which inequality and deprivation in the former is driven by changes in the latter. The paper reports increasing disparity in child mortality among country groups since the mid-1970s. It also reports decreased inequality in life expectancy among countries from the early 1960s until the late 1980s and increased inequality thereafter. Similar patterns in life expectancy deprivation are reported. The paper finds that this is partly due to a changing behavioural relationship between life expectancy and income per capita among countries with low achievement in the former variable. The paper also introduces and provides an overview of the papers that follow in this Supplement.

Determinants of social inequalities in child mortality in Mozambique: What do we know? What could be done?*

Health inequalities are no longer an issue only for developed countries. In recent years there is agreement that all countries present health inequalities regardless of their level of wealth. In low-income countries and especially in sub-Saharan Africa where the majority of the poor people live as well as their children, research on child health inequalities is still scarce. This review of evidence suggests that if Mozambique is to achieve the millennium development goals (MDGs) by 2015 further research on important determinants of disparities in child mortality is urgently needed.

Widening Socioeconomic Disparities in US Childhood Mortality, 1969–2000

We examined the extent to which area socioeconomic inequalities in overall and cause-specific mortality among US children aged 1-14 years changed between 1969 and 2000. We linked a census-based deprivation index to US county mortality data from 1969 to 2000. We used Poisson and log-linear regression and inequality indices to analyze temporal disparities. Despite marked declines in child mortality, socioeconomic gradients (relative mortality risks) in overall child mortality increased substantially during the study period. During 1969-1971, children in the most deprived socioeconomic quintile had 52%, 13%, 69%, and 76% higher risks of all-cause, birth defect, unintentional injury, and homicide mortality, respectively, than did children in the least deprived socioeconomic quintile. The corresponding relative risks increased to 86%, 44%, 177%, 159%, respectively from 1998-2000. Dramatic reductions in mortality among children in all socioeconomic quintiles represent a major public health success. However, children in higher socioeconomic quintiles experienced much larger declines in overall, injury, and natural-cause mortality than did those in more deprived socioeconomic quintiles, which contributed to the widening socioeconomic gap in mortality. Widening disparities in child mortality may reflect increasing polarization among deprivation quintiles in material and social conditions.

Determinants of social inequalities in child mortality in Mozambique: what do we know? What could be done?

Health inequalities are no longer an issue only for developed countries. In recent years there is agreement that all countries present health inequalities regardless of their level of wealth. In low-income countries and especially in sub-Saharan Africa where the majority of the poor people live as well as their children, research on child health inequalities is still scarce. This review of evidence suggests that if Mozambique is to achieve the millennium development goals (MDGs) by 2015 further research on important determinants of disparities in child mortality is urgently needed. African Journal of Health Sciences Vol. 12(3-4) 2005: 118-121