Levels Of Child Mortality Research Articles

Child mortality levels and trends by HIV status in Blantyre, Malawi: 1989-2009.

Continuous evaluation of child survival is needed in sub-Saharan Africa where HIV prevalence among women of reproductive age continues to be high. We examined mortality levels and trends over a period of ∼20 years among HIV-unexposed and -exposed children in Blantyre, Malawi. Data from 5 prospective cohort studies conducted at a single research site from 1989 to 2009 were analyzed. In these studies, children born to HIV-infected and -uninfected mothers were enrolled at birth and followed longitudinally for at least 2 years. Information on sociodemographic, HIV infection status, survival, and associated risk factors was collected in all studies. Mortality rates were estimated using birth-cohort analyses stratified by maternal and infant HIV status. Multivariate Cox regression models were used to determine risk factors associated with mortality. The analysis included 8286 children. From 1989 to 1995, overall mortality rates (per 100 person-years) in these clinic-based cohorts remained comparable among HIV-uninfected children born to HIV-uninfected mothers (range 3.3-6.9) or to HIV-infected mothers (range 2.5-7.5). From 1989 to 2009, overall mortality remained high among all children born to HIV-infected mothers (range 6.3-19.3) and among children who themselves became infected (range 15.6-57.4, 1994-2009). Only lower birth weight was consistently and significantly (P < 0.05) associated with higher child mortality. HIV infection among mothers and children contributed to high levels of child mortality in the African setting in the pretreatment era. In addition to services that prevent mother-to-child transmission of HIV, other programs are needed to improve child survival by lowering HIV-unrelated mortality through innovative interventions that strengthen health infrastructure.

Does Context Matter? Factors influencing Neonatal Deaths in Rural North Indian (EAG) States: Hierarchical Linear Modeling Approach

United Nations Millennium Development Goal (MDG) for 2015 aims at reducing child mortality level from its level in 1990 by two-thirds. India has disproportionate burden of infant and child deaths. In India approximately two thirds of all the infant deaths are neonatal deaths. India achieves the MDG target of reduction in child mortality levels or not hinges largely on the progress made in the demographically poor performing states of undivided Bihar, Madhya Pradesh, Uttar Pradesh, Rajasthan and Odisha. Finding shows that neonatal deaths in pregnant mothers receiving Tetanus Toxid injections during the antenatal care visits is way less compared those who did not receive the TT injections. High levels of intra-class correlation indicate clustering of deaths. Fifty percent of the variations in neonatal deaths are due to between community differences. These community level differences are not captured well in the available dataset. The community distance to primary health facility used to study the variations at the community level do not have significant impact in explaining the differences in neo natal deaths at community level in the selected States.

Determinants of Childhood Mortality in South Africa: Using Categorical Data Modeling

KEYWO RDS Socio-economic Development. Environmental Ha zards. Sensitive Index.Health-related. Anti-natal Check-ups. Maximum Likelihood Estimation ABSTRACT Childhood mortality is of great interest to social scientists and policy makers concerned about the quality of life in less developed countries. Thus, the importance of the study of childhood mortalit y cannot be exaggerated. The levels of infant and child mortality are the two sensitive and widely used indicators of socio- economic development. The childhood mortality rate is a refined and sensitive index of the total cultural milieu of a community or a country. It reflects among other things, the state of public health and hygiene, the environmental sanitation, cultural mores about feeding and clothing, socio-economic development, and above all, the people's attitude towards the dignity and value of human life itself. It is the simple statistical index which conveys the idea of whether environmental hazards are controlled effectively or not, in developing countries, especially in Africa. The childhood mortality situation in South Africa has been investigated in this research using South African Demographic and Health Survey II data. About ten socio-economic, demographic, environmental and heal th- related variables were analyzed using categorical data modeling (catmod) analysis. On the basis of the analysis, the study concludes that education of parents, marital status as well as the occupation of mother, the survival of the penultimate child, duration of breastfeeding, anti-natal check-ups and availability of toilets in the residence are the determinants of childhood mortality in South Africa.

The challenge of improving neonatal mortality in India: Key to global achievement of MDG 4

In Millennium Development Goal four (MDG4), national leaders committed to reduce 1990 levels of child mortality in their countries by two-thirds by 2015. Between 1990 and 2009, child mortality has reduced globally from 89 to 60 per 1000 live births [1]; however, this trajectory is not sufficient to achieve MDG4. India has the highest number of births in the world and also accounts for over 20% of all child deaths. Achieving MDG4 globally depends on the progress and success in India, more than in any other single nation [2].

2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis

WHO recommends routine use of rotavirus vaccines in all countries, particularly in those with high mortality attributable to diarrhoeal diseases. To establish the burden of life-threatening rotavirus disease before the introduction of a rotavirus vaccine, we aimed to update the estimated number of deaths worldwide in children younger than 5 years due to diarrhoea attributable to rotavirus infection. We used PubMed to identify studies of at least 100 children younger than 5 years who had been admitted to hospital with diarrhoea. Additionally, we required the studies to have a data collection midpoint of the year 2000 or later, to be done in full-year increments, and to assesses diarrhoea attributable to rotavirus with EIAs or polyacrylamide gel electrophoresis. We also included data from countries that participated in the WHO-coordinated Global Rotavirus Surveillance Network (consisting of participating member states during 2009) and that met study criteria. For countries that have introduced a rotavirus vaccine into their national immunisation programmes, we excluded data subsequent to the introduction. We classified studies into one of five groups on the basis of region and the level of child mortality in the country in which the study was done. For each group, to obtain estimates of rotavirus-associated mortality, we multiplied the random-effect mean rotavirus detection rate by the 2008 diarrhoea-related mortality figures for countries in that group. We derived the worldwide mortality estimate by summing our regional estimates. Worldwide in 2008, diarrhoea attributable to rotavirus infection resulted in 453,000 deaths (95% CI 420,000-494,000) in children younger than 5 years-37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted for more than half of all deaths attributable to rotavirus infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan; India alone accounted for 22% of deaths (98,621 deaths). Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced.

Temporal trends (1977-2007) and ethnic inequity in child mortality in rural villages of southern Guinea Bissau.

BackgroundGuinea Bissau is one of the poorest countries in the world, with one of the highest under-5 mortality rate. Despite its importance for policy planning, data on child mortality are often not available or of poor quality in low-income countries like Guinea Bissau. Our aim in this study was to use the baseline survey to estimate child mortality in rural villages in southern Guinea Bissau for a 30 years period prior to a planned cluster randomised intervention. We aimed to investigate temporal trends with emphasis on historical events and the effect of ethnicity, polygyny and distance to the health centre on child mortality.MethodsA baseline survey was conducted prior to a planned cluster randomised intervention to estimate child mortality in 241 rural villages in southern Guinea Bissau between 1977 and 2007. Crude child mortality rates were estimated by Kaplan-Meier method from birth history of 7854 women. Cox regression models were used to investigate the effects of birth periods with emphasis on historical events, ethnicity, polygyny and distance to the health centre on child mortality.ResultsHigh levels of child mortality were found at all ages under five with a significant reduction in child mortality over the time periods of birth except for 1997-2001. That period comprises the 1998/99 civil war interval, when child mortality was 1.5% higher than in the previous period. Children of Balanta ethnic group had higher hazard of dying under five years of age than children from other groups until 2001. Between 2002 and 2007, Fula children showed the highest mortality. Increasing walking distance to the nearest health centre increased the hazard, though not substantially, and polygyny had a negligible and statistically not significant effect on the hazard.ConclusionChild mortality is strongly associated with ethnicity and it should be considered in health policy planning. Child mortality, though considerably decreased during the past 30 years, remains high in rural Guinea Bissau. Temporal trends also suggest that civil wars have detrimental effects on child mortality.Trial RegistrationCurrent Controlled Trials ISRCTN52433336

Performance-Based Financing Experiment Improved Health Care In The Democratic Republic Of Congo

In some low-income countries such as Cambodia and Rwanda, experimental performance-based payment systems have led to rapid improvements in access to health care and the quality of that care. Under this type of payment scheme, funders--including foreign governments and international aid programs--subsidize local health care providers for achieving certain benchmarks. The benchmarks can include such measures as child immunizations or childbirth in a health facility. In this article we report the results of a performance-based payment experiment conducted in the Democratic Republic of Congo, which is one of the poorest countries in the world and has an extremely high level of child and maternal mortality. We found that providing performance-based subsidies resulted in lower direct payments to health facilities for patients, who received comparable or better services and quality of care than those provided at a control group of facilities that were not financed in this way. The disparity occurred despite the fact that the districts receiving performance-based subsidies received external foreign assistance of approximately $2 per capita per year, compared to the $9-$12 in external assistance received by the control districts. The experiment also revealed that performance-based financing mechanisms can be effective even in a troubled nation such as the Democratic Republic of Congo.

The Effect of Handwashing at Recommended Times with Water Alone and With Soap on Child Diarrhea in Rural Bangladesh: An Observational Study

Standard public health interventions to improve hand hygiene in communities with high levels of child mortality encourage community residents to wash their hands with soap at five separate key times, a recommendation that would require mothers living in impoverished households to typically wash hands with soap more than ten times per day. We analyzed data from households that received no intervention in a large prospective project evaluation to assess the relationship between observed handwashing behavior and subsequent diarrhea. Fieldworkers conducted a 5-hour structured observation and a cross-sectional survey in 347 households from 50 villages across rural Bangladesh in 2007. For the subsequent 2 years, a trained community resident visited each of the enrolled households every month and collected information on the occurrence of diarrhea in the preceding 48 hours among household residents under the age of 5 years. Compared with children living in households where persons prepared food without washing their hands, children living in households where the food preparer washed at least one hand with water only (odds ratio [OR]=0.78; 95% confidence interval [CI]=0.57-1.05), washed both hands with water only (OR=0.67; 95% CI=0.51-0.89), or washed at least one hand with soap (OR=0.30; 95% CI=0.19-0.47) had less diarrhea. In households where residents washed at least one hand with soap after defecation, children had less diarrhea (OR=0.45; 95% CI=0.26-0.77). There was no significant association between handwashing with or without soap before feeding a child, before eating, or after cleaning a child's anus who defecated and subsequent child diarrhea. These observations suggest that handwashing before preparing food is a particularly important opportunity to prevent childhood diarrhea, and that handwashing with water alone can significantly reduce childhood diarrhea.

World Bank Structural Adjustment, Water, and Sanitation: A Cross-National Analysis of Child Mortality in Sub-Saharan Africa

The authors conduct a cross-national analysis that seeks to accomplish two important goals. First, they test dependency theory’s hypotheses that World Bank structural adjustment adversely affects child mortality in Sub-Saharan Africa. Second, they empirically evaluate the effect of access to clean water and basic sanitation on child mortality. In doing so, they use two-way fixed effects regression models to analyze child mortality using data on 31 nations and four time points (1990, 1995, 2000, and 2005). They find substantial support for their first goal relating to dependency theory that when a Sub-Saharan African nation is under a World Bank structural adjustment loan, then it tends to have higher levels of child mortality. They also find support for their second goal concerning the importance of including environmental variables in cross-national research on health. Specifically, they find that higher levels of access to an improved water source and an improved sanitation facility are associated with lower levels of child mortality within Sub-Saharan African nations. The authors conclude by discussing the findings, theoretical implications, methodological implications, policy suggestions, and possible directions for future research.

Do Family Policy Regimes Matter for Children's Well-Being?

Researchers have studied the impact of different welfare state regimes, and particularly family policy regimes, on gender equality. Very little research has been conducted, however, on the association between different family policy regimes and children's well-being. This article explores how the different family policy regimes of twenty OECD countries relate to children's well-being in the areas of child poverty, child mortality, and educational attainment and achievement. We focus specifically on three family policies: family cash and tax benefits, paid parenting leaves, and public child care support. Using panel data for the years 1995, 2000, and 2005, we test the association between these policies and child well-being while holding constant for a number of structural and policy variables. Our analysis shows that the dual-earner regimes, combining high levels of support for paid parenting leaves and public child care, are strongly associated with low levels of child poverty and child mortality. We find little long-term effect of family policies on educational achievement, but a significant positive correlation between high family policy support and higher educational attainment. We conclude that family policies have a significant impact on improving children's well-being, and that dual-earner regimes represent the best practice for promoting children's health and development.

Japan's new global health policy and ASEM initiative

At the United Nations Millennium Development Goals Summit in September this year, Japan launched a new global health policy, which makes maternal, newborn, and child health (MNCH) as one of its main pillars. Under this policy, Japan will provide assistance totaling five billion US dollars over a five-year period, beginning in 2011, and will make the utmost effort, in cooperation with other countries, to save the lives of 11.3 million children and 680,000 mothers. Today, many children continue to die within the first month of their birth due to preventable and treatable causes, and many pregnant women lose their lives without receiving quality preventive and clinical services at facilities. Many developing countries still have high levels of child and maternal mortality. Against this background, it is timely that the Asia Europe Journal (AEJ) focuses on “Public health and vulnerable groups” in this edition. It is unacceptable that women and children are excluded from the benefits that economic development has brought, just because they are vulnerable. MNCH is a key for success in reducing poverty and fostering economic growth. Securing a healthy future for mothers and children is therefore a diplomatic objective of critical importance, and it is also a valuable investment. In order to save the lives of mothers and children, it is essential to deliver a sequence of health services, including anteand post-neonatal care at facilities with adequate equipment and human resources and necessary immunizations. As part of the new global health policy, Japan proposed for MNCH an assistance model called “EMBRACE,” an acronym for “Ensure Mothers and Babies Regular Access to Care,” to ensure the continuum of care from pre-pregnancy to after Asia Eur J (2011) 8:453–455 DOI 10.1007/s10308-010-0285-4

“Modernization” increases parental investment and sibling resource competition: evidence from a rural development initiative in Ethiopia

Evolutionary models of parental investment often assume that negative effects of competition between offspring (i.e., quantity-quality trade-off effects) will be most apparent under conditions of resource scarcity. However, improvements in resource access associated with “modernization” may reduce levels of extrinsic environmental risk, creating a stronger association between parental investment and offspring success. Here we provide evidence that a rural development initiative in Ethiopia is associated with increased levels of parental investment in offspring status and increased levels of competition for this investment between siblings. Villages with access to an improved water supply, which have reduced levels of childhood mortality, are associated with higher investments in education, and the likelihood of offspring education is more determined by position within the family, compared to neighboring villages without access to water taps. However, there is no evidence of higher parental investment of base-level resources directly related to child health (indicated by childhood vaccination rates). Educational investment may be more sensitive to mortality changes, despite being costly and “surplus” to essential functions, because it has the potential to introduce the greatest economic payoffs for children, e.g., from jobs in an emerging wage-labour market. While tap villages are currently associated with a higher birth rate, we anticipate that in time, and with improved access to family planning, fertility will drop in response to shifts in environmental risk and improved pay-offs to strategies of high parental investment. These villages may be experiencing the initial stages of a demographic transition to small family sizes.

Health and wealth in Uzbekistan and sub-Saharan Africa in comparative perspective

The study investigates the magnitude of differences in child and adult mortality by wealth in Uzbekistan, a former soviet country of Central Asia, and compares it with similar indicators from sub-Saharan Africa. Data were derived from Demographic and Health Surveys. An “Absolute Wealth Index” was built from data on goods owned by households and quality of housing, and scaled from 0 to 12. Wealth was distributed evenly in Uzbekistan, with a symmetric distribution around a mean of 5.5 modern goods. In sub-Saharan Africa, on the contrary, the wealth distribution had a lower mean (2.5) and was highly skewed towards the left, revealing a high proportion of very poor people. Adult and child mortality levels were lower in Uzbekistan. Despite these major differences, the relationships between mortality indicators and the wealth index were similar in the two cases. The magnitude of mortality differentials by wealth was of the same order in both cases, with gradients ranging from 2.5 to 1 for child mortality and 1.5 to 1 for adult mortality (poorest versus richest). However, mortality levels remained lower in Uzbekistan than in sub-Saharan Africa at the same level of wealth for both children and adults. A similar relationship was found between nutritional status and wealth index in both cases. On the contrary, there were no differences by wealth in use of health services and level of education in Uzbekistan, whereas wealth gradients were steep for the same variables in sub-Saharan Africa. The study suggests that mortality differentials were primarily due to nutritional status, and not to access and use of health services or to education. The discussion focuses on health and social policies during the colonial and post-colonial period that have produced these patterns.

Idade materna e mortalidade infantil: efeitos nulos, biológicos ou socioeconômicos?

Há controvérsias se os extremos da idade reprodutiva feminina agregam o maior conjunto de fatores associados à mortalidade infantil, e se para filhos de mães abaixo dos 20 anos e a partir dos 35 anos de idade há evidências de maiores chances de ocorrência do óbito infantil. Para as mães adolescentes, há um importante debate se os resultados obstétricos adversos alcançados devem-se à imaturidade biológica, às condições socioeconômicas desfavoráveis, ou se há nulidade do efeito da jovem idade sobre as chances de ocorrência da mortalidade infantil. Para mães em idades avançadas, discute-se se o aumento na idade materna, a despeito dos avanços no campo da medicina, está associado ao crescimento da vulnerabilidade ao óbito infantil, se as melhores condições socioeconômicas atenuam o efeito das comorbidades maternas comuns à idade de 35 anos ou mais, ou ainda se a maternidade tardia não exerce qualquer efeito sobre a ocorrência da mortalidade infantil. Com base em evidências contrastantes acerca das chances de ocorrência da mortalidade infantil por idade materna, este trabalho objetiva apresentar e discutir os principais argumentos evocados pela literatura. No caso das maternidades precoce e tardia, há evidências que corroboram ambas as hipóteses da plausibilidade biológica e socioeconômica e da nulidade do efeito da idade materna. A variedade de metodologias empregadas para o estudo da associação entre idade da mãe ao ter o filho e a mortalidade infantil, além da não uniformidade na definição dos grupos etários entre os diversos estudos, dificulta uma identificação mais precisa acerca desta vulnerabilidade.

Millennium Development Goals and Infant Mortality in India: A Distant Dream or a Reality

Child mortality and more particularly infant mortality is often used as an indicator of the socioeconomic development of a country since children (infants), more than any other age-group of a population, depend heavily on the socioeconomic conditions of their environment for survival. Thus, the level of child mortality would present a measure of how well a society meets the needs of its people (Bicego and Ahmad, 1996). Looking into the history of the decline in mortality in India, it can be noted that in the country as a whole the level of infant mortality which was very high before 1951, fell substantially during the later half of the last century, although its level is still very high. As per the recent SRS estimates, the infant mortality rate (IMR) is 58 per 1000 live `births in 2005. It has also been a cause of concern that the pace of decline in infant mortality in the country has slowed during the last decade, particularly during its later half. Yet, there is surprisingly little evidence to suggest that planners and policy makers feel seriously concerned about this problem. In India, the programmes to reduce infant mortality had been guided by health professionals who were convinced that available low-cost technology was adequate to achieve the set goals.

The Concentration of Disadvantage and the Rise of an Urban Penalty: Urban Slum Prevalence and the Social Production of Health Inequalities in the Developing Countries

Urban slums are proliferating in the developing countries. A corollary of this structural transformation is the increasing recognition of an urban penalty wherein slum populations exhibit notable inequalities in health relative to non-slum urban residents and even rural populations. The built urban environment, in turn, is a crucial context within which the social production of disproportionate morbidity and mortality is enacted. The authors develop this assertion and use bivariate and partial correlation analysis to highlight the association of urban slum prevalence, or proportion of the total population living in urban slum conditions, with indicators of mortality and gender parity, measured at the national level. Data for 99 developing countries show that greater urban slum prevalence is strongly correlated with higher levels of infant, child, and maternal mortality. Further, urban slum prevalence exhibits strong, deleterious correlations with gender parity (measured by the gender development index) and fertility rate, factors that have a crucial direct impact in shaping variant mortality levels. Future research is warranted on the social inequalities in health and illness derived from the expansion of urban slum conditions in the developing countries.

Factors Influencing Infant and Child Mortality: A Case Study of Rajshahi District, Bangladesh

The main purpose of this study is to observe the influencing factors on infant and child mortality of suburban and rural areas of Rajshahi District, Bangladesh. Primary data have been used to examine the differential patterns of infant and child mortality. A multivariate technique is employed to investigate the effects of those variables both socioeconomic and demographic on infant and child mortality. The study results reveal that several socioeconomic, demographic and health related variables affect on infant and child mortality. Multivariate analysis results indicate that the most significant predictors of neonatal, post-neonatal, and child mortality levels are immunization, ever breastfeeding, mother’s age at birth and birth interval. Again, the risk of child mortality is 78.20% lower among the immunized child than never immunized child and also the risk of neonatal mortality is 57.70% lower after a birth interval of 36 months and above than under 18 months. Parents’ education, toilet facilities and treatment places are significant predictors during neonatal and childhood period but father’s occupation is significant at post-neonatal periods. For instance, risk of neonatal mortality is 31.40% lower among the women having primary education and 52.30% lower among the women having secondary and higher education than those having no education. It is observed that the risk of child mortality 32.00% lower among the household having hygienic toilet facility than those who have not such facilities. Similarly, risk of child mortality decreased with increased female education and wider access to safe treatment places. So, attention should be given to female education and expansion of public health system for reducing the risk of infant and child mortality.

Social Security as a Developmental Institution? Extending the Solar Case for the Relative Efficacy of Poor Relief Provisions under the English Old Poor Law

This paper assesses various issues concerning the operation of the English Old Poor from 1600 to 1834 that are presented as facilitating economic growth. It identifies those factors contributing to the efficacy of welfare provisioning by reference to problems that are frequently identified in the operation of such systems: the free-rider problem, risk covariance, adverse selection and information elicitation. The entitlement to relief through an individual's possession of a legal settlement in a parish thereby guaranteeing poor relief is seen as a key factor enabling risk-reduced labour migration and especially migration from the rural to urban sector, as well as minimisation of the free-rider problem as far as taxpayer willingness to furnish welfare funds were concerned. The extent to which welfare was generated in the agrarian sector and provided in the households of rural communities, and the minimal use of townbased 'indoor institutions' for welfare delivery, are seen as a key factors supporting rural household economies. These factors limited refugee flows from country to town, with positive epidemiological advantages, and enabled, by pre-industrial standards, modest levels of infant and child mortality, which also made it possible for fertility change to be the major force driving demographic change.

Editorial: The social and political basis for citizen action on urban poverty reduction

The diverse papers in this issue share one concern – the means by which low-income urban dwellers can get their needs addressed. But for most authors, the focus is not on the role of governments or aid agencies and development banks or international NGOs but on the role of the urban poor groups themselves. The main reason for this is that conventional approaches to poverty reduction – state-managed, professionally directed and sometimes funded by international donors – have not met the needs of large sections of the urban population. This can be seen in the very large number of urban dwellers who live in poverty. For instance, there are few cities in lowand middle-income nations that do not have large sections of their population living in informal settlements lacking good quality infrastructure and services. It is also evident in the very large defi cit in provision for, for instance, water and sanitation(1) and in the high levels of infant and child mortality among urban populations in many nations.(2) More than a third of the urban population in lowand middle-income nations live in poor quality, overcrowded and usually insecure housing,(3) lacking adequate provision for basic services. Most of this housing is built by urban poor households, outside formal rules and regulations, usually without legal tenure and without fi nancial support from formal organizations. In effect, in most lowand middle-income nations, state policies – whether or not supported by aid agencies and development banks – have had little or no success in addressing this. This is the case even in well-established democracies, where democratic pressures might have been expected to address these issues. It is also the case in cities and nations with rapidly growing economies.(4) While the proportion of the urban population living in poverty and lacking basic services varies considerably from nation to nation, as does the extent of the defi cit in services, even in successful middle-income nations, urban poverty is still a serious problem affecting large numbers of individuals and households.(5) Thus, most of these papers are interested in direct attempts by the urban poor to address their needs through collective processes and activities. For some papers, the focus is on citizen

Collective Familial Decision-Making In Times Of Trouble: Intergenerational Solidarity in Ghana

In post-colonial populations the retention of the nuclear family concept of collectivism as the basis for decision-making is associated with familial and cultural survival. Collectivism within familial contexts provides intergenerational access to experience, information, resources, and sound decision making during times of conflict or dealing with the consequences of poverty. In contemporary Ghana inter-ethnic wars and conflict have marginalized minority groups, causing substantial internal displacement of people. Poverty and cultural issues have caused a persistently high level of child malnutrition and mortality in all areas of Ghana, including urban centers where appropriate food is in abundance. In each of these circumstances the senior women, particularly the grandmothers, have been found to be essential for child survival, protecting the family from dissolution, and ensuring intergenerational cultural transmission. This paper discusses the place of collective decision-making processes of older African women in two studies in Ghana that assessed the: (1) indigenous methods used for understanding and arresting violent ethnic conflict by internally displaced women who survived the 1994/95 Guinea Fowl War; and (2) parenting and grandparenting strategies from families who insured the survival of children suffering from kwashiorkor, a severe form of childhood malnutrition. In this paper, findings from qualitative interview data will include narratives and illustrative cases.