Survival Probabilities Of Children Research Articles

Sensory and demographic characteristics of deafblindness rehabilitation clients in Montréal, Canada

Demographic changes are increasing the number of older adults with combined age-related vision and hearing loss, while medical advances increase the survival probability of children with congenital dual (or multiple) impairments due to pre-maturity or rare hereditary diseases. Rehabilitation services for these populations are highly in demand since traditional uni-sensory rehabilitation approaches using the other sense to compensate are not always utilizable. Very little is currently known about the client population characteristics with dual sensory impairment. The present study provides information about demographic and sensory variables of persons in the Montreal region that were receiving rehabilitation for dual impairment in December 2010. This information can inform researchers, clinicians, educators, as well as administrators about potential research and service delivery priorities. A chart review of all client files across the three rehabilitation agencies that offer integrated dual sensory rehabilitation services in Montreal provided data on visual acuity, visual field, hearing detection thresholds, and demographic variables. The 209 males and 355 females ranged in age from 4months to 105years (M=71.9, S.D.=24.6), indicating a prevalence estimate for dual sensory impairment at 15/100000. Only 5.7% were under 18years of age, while 69.1% were over the age of 65years, with 43.1% over the age of 85years. The diagnostic combination that accounted for 31% of the entire sample was age-related macular degeneration with presbycusis. Their visual and auditory measures indicated that older adults were likely to fall into moderate to severe levels of impairment on both measures. Individuals with Usher Syndrome comprised 20.9% (n=118) of the sample. The age distribution in this sample of persons with dual sensory impairment indicates that service delivery planning will need to strongly consider the growing presence of older adults as the baby-boomers approach retirement age. The distribution of their visual and auditory limits indicates that the large majority of this client group has residual vision and hearing that can be maximized in the rehabilitation process in order to restore functional abilities and social participation. Future research in this area should identify the specific priorities in both rehabilitation and research in individuals affected with combined vision and hearing loss.

The Effects of Kin on Child Mortality in Rural Gambia

We analyzed data that were collected continuously between 1950 and 1974 from a rural area of the Gambia to determine the effects of kin on child mortality. Multilevel event-history models were used to demonstrate that having a living mother, maternal grandmother, or elder sisters had a significant positive effect on the survival probabilities of children, whereas having a living father, paternal grandmother, grandfather, or elder brothers had no effect. The mother’s remarriage to a new husband had a detrimental effect on child survival, but there was little difference in the mortality rates of children who were born to monogamous or polygynous fathers. The implications of these results for understanding the evolution of human life-history are discussed.

Relationship between subsistence and age at weaning in "preindustrial" societies.

Cross-cultural studies have revealed broad quantitative associations between subsistence practice and demographic parameters for preindustrial populations. One explanation is that variationin the availability of suitable weaning foods influenced the frequency and duration of breastfeeding and thus the length of interbirth intervals and the probability of child survival (the "weaning food availability" hypothesis). We examine the available data on weaning age variation in preindustrial populations and report results of a cross-cultural test of the predictions that weaning occurred earlier in agricultural and pastoral populations because dairy and cereal production increased the availability of easily digestible, nutrientrich foods appropriate for weaning. We found that, contrary to predictions, supplementation with liquid foods other than breast milk was delayed in agricultural populations relative to less agriculturally dependent ones and complementary feeding with solid foods was delayed in pastoral populations relative to those less dependent on herding. Although the duration of breastfeeding was longer in populations dependent on hunting, there was no qualitative evidence that such populations lacked foods appropriate for weaning. The patterns observed suggest that the relationships between demography and subsistence observed among preindustrial societies cannot be explained by the "weaning food availability" hypothesis. We discuss the implications for understanding the mechanisms underlying prehistoric human demography, subsistence shifts, allocation to parenting and mating effort, and the evolutionary implications of tradeoffs between diet and disease.

Childhood mortality in Amara region: A case study of Misrak Gojjam and Wag Hemra zone

Background : Mortality levels and differentials have shown variations not only among countries but also among areas in an administrative region within a country. Objective : To examine variations in childhood mortality between food secure and insecure areas in the Amhara Nation Regional State, Misrak Gojjam and Wag Hemra Zones, respectively. Methods : This is a study based on the 1994 population and Housing Census data. Ordinary Least Square regression is fitted using Trussell and Preston index of childhood mortality (the ratio of observed to expected deaths) as a dependent variable. The explanatory variables were: zonal and urban-rural residence, education level, migration status, age, parity and marital status of the mother, and household size, possession of a radio in the household, economic and sanitation status of the household size, population density and percent adult literate of the wereda. Findings : Controlling for potential confounding variables, childhood mortality was 11 percent higher in food insecure Wag Hemra Zone compared to Misrak Gojjam Zone that is better food producing. Conclusion : Effort must be strengthened in drought prone areas to introduce interventions likely to increase survival probabilities of children. (Ethiopian Journal of Health Development, 2001, 15(2): 75-88)

Seasonality of births in Homo sapiens in pre‐industrial Finland: maximisation of offspring survivorship?

AbstractWe examined the seasonal variation in human birth and infant survival rates in pre‐modern Finland. If survival probabilities of children born during different seasons of the year differ and if timing of reproduction has been affected by natural selection, periodic variation in environment could have led to reproduction during the season of best infant survival expectations. Significant seasonal variation in both birth rate and survival probability was found, but the monthly birth and survival rates of newborn were uncorrelated. Hence, if there was any tendency to maximise the reproductive success, increase in some other component of fitness than the infant survival was probably targeted. The effect of major holidays on the birth rate was proved to be notable, suggesting that although the basis for seasonal variation in birth rate was biological, sociocultural factors had an impact on the timing of reproduction in humans. The overall mortality of infant boys exceeded that of infant girls in all seasons. This difference was smallest during the time of best food supplies, indicating that the development of males was less buffered against environmental disturbances than that of females.

Health inputs and child mortality: Malaysia

This paper is concerned with the relationship between child mortality and the use of health care. We develop a simultaneous model of fetal and postnatal mortality risks and input demand equations for prenatal medical care and institutional delivery. This model is applied to retrospective data from Peninsular Malaysia covering 1950–1988. The results show that prenatal medical care and institutional delivery have strong beneficial effects on child survival probabilities, and that these effects are substantially underestimated when adverse self-selection among users of health care is ignored. The effectiveness of prenatal health care in Malaysia improved until 1980, and then deteriorated. We find that the risk of infant and child mortality is not independent of fetal survival, but show that ignoring selective fetal survival introduces only mild biases in infant and child mortality estimation. Higher infant and child mortality rates among young mothers are partly explained by their lower likelihood of purchasing health care.

Racial Inequality and Child Mortality in Brazil

This paper addresses the issue of racial inequality in Brazil. The authors apply demographic techniques to sample data from the 1980 census to estimate survival probabilities of children born to white and nonwhite mothers in metropolitan areas. Because mortality bears a direct and obvious relationship to human welfare estimates of the probability of death are useful for comparing living standards of whites and nonwhites in Brazil. The results of applying the Brass method to 1950 and 1980 census data indicate the magnitude and the persistence of racial inequalities in length of life in Brazil. In 1940/1950 the mortality experience of children born to white mothers was equivalent to an average expectation of life at birth of 47.5 years. The comparable figure for nonwhite children was 40 years. By 1970/1980 whites reached an average expectation of life of 66.1 years. The rate for nonwhites rose to 59.4 years. Because both groups experienced about the same rate of improvement over the 30-year period the gap between the 2 remained high. The findings of this study only imply the presence of exclusionary practices that deprive nonwhite children of health services that are otherwise available to white children. Still the discrimination hypothesis--which is admittedly speculative--is indirectly strengthened by 3 observations: 1) the interpretation is consistent with the conclusions of earlier studies that document the presence of other forms of racial discrimination in Brazil; 2) there is no evidence that nonwhite mothers endorse sharply different ideas about nutrition child rearing or about modern medical care; and 3) residential segregation by race in Brazil is not nearly as pronounced as 2 of the alternative explanations necessarily imply. The authors conclude that discrimination is a plausible interpretation of the observed racial differences in child mortality in metropolitan Brazil. Yet additional data are required to document whether discrimination exists and to identify the precise mechanisms through which exclusionary practices differentially affect the proximate determinants of child mortality among whites and nonwhites in urban areas.

Women's status and childhood mortality in two contrasting areas in south-western Nigeria: a preliminary analysis.

"The purpose of this paper is to examine the relationship between some women's status factors and differentials in probability of child survival in the south-western part of Nigeria. The present analysis is based on the results of the study of children of some 4,677 women in two towns contrasting geographical zones. The results of the study indicate the significant role of age of mother at first marriage and BCG vaccination while the influence of maternal education was inconsistent at both household and regional levels. Likewise, the possession of certain household items such as dustbin [and] dining table seem to enhance the survival of children in the urban centres."

Intra-Household Resource Allocation: An Inferential Approach

If household income is pooled and then allocated to maximize welfare then income under the control of mothers and fathers should have the same impact on demand. With survey data on family health and nutrition in Brazil, the equality of parental income effects is rejected. Unearned income in the hands of a mother has a bigger effect on her family's health than income under the control of a father; for child survival probabilities the effect is almost twenty times bigger. The common preference (or neoclassical) model of the household is rejected. If unearned income is measured with error and income is pooled then the ratio of maternal to paternal income effects should be the same; equality of the ratios cannot be rejected. There is also evidence for gender preference: mothers prefer to devote resources to improving the nutritional status of their daughters, fathers to sons.

A study group on brain tumors in childhood. Introduction, establishment and aims

Tumors of the central nervous system account for 15.7% of all malignancies registered at the documentation center for childhood malignancies in Western Germany. This group constitutes the largest entity of solid tumors. With the exception of medulloblastoma the five-year survival probability of children with cns tumors in only 54%. Prognosis can only be improved by a interdisziplinary and multicentric approach. Recently, the "Gesellschaft für Pädiatrische Onkologie (GPO)" has set up a special Brain Tumor Study Group. Members of this group will come from several fields such as neuropediatrics, neurosurgery, radiotherapy, pediatric endocrinology, neuroradiology, neuro-/paidopathology, experimental neurooncology, medical statistics, and pediatric oncology. The major aims are standardization of current strategies for diagnosis and therapy including concepts for early diagnosis, aftercare, and rehabilitation. Moreover, it is planned to develop clinical and experimental research facilities and to establish a brain tumor research data bank.

The impact of expected child survival on husbands' and wives' desired fertility in Malaysia: A log-linear probability model

The Malaysian Family Life Survey (MFLS) conducted in 1976-77 provides an opportunity to explore quantitatively the relationship between expected child survival on husbands and wives desired fertility. A valuable feature of the MFLS is that several questions were addressed to both husbands and wives. This study incorporates both sets of answers into the analysis. The hoarding hypothesis suggests that parents who expect a small fraction of children to survive would be more likely to desire additional births than their counterparts with more optimistic expectations. The results presented were obtained using the log linear probability model. In view of the fact that the desire to have at least 1 child is almost universal in Malaysia couples with no children at time of the interview were excluded from the analysis. The figures under in the table measure the impact of the various exogenous variables on the probability that H equals 1 i.e. that the husband wants to have additional children. If an exogenous variable say x has a positive sign in the H column this means that other factors held constant a rise in x increases the odds that H will equal 1. The figures under are the corresponding estimates for wives. The interaction term captures the influence of husbands desired fertility on the wifes and vice versa. Aside from the child mortality variables several other covariates are included in the analysis as controls. As expected the interaction term was positive and highly significant; the fertility desires of husbands and wives were positively associated. Other factors held constant if the husband wanted more children this makes it more likely that the wife will want more children and vice versa. The constant term was significantly larger for husbands than wives. Ceteris paribus husbands had preferences for larger family sizes than wives. Son preference was confirmed only for fathers and did not seem to be prevalent among women. Results showed an insignificant impact of female education on desired future fertility. For male education there was both a negative and a postive sign; the former for wives and the latter for husbands. The 2 coefficients associated with death were positive as expected but significance was low. The t ratio was 0.14 in the H column and 1.2 in the W column. Holding constant actual child deaths in the family and the control variables fathers perceptions of child survival probabilities affected desired fertility but mothers perceptions did not. The husbands perceptions had no influence on W; the wifes perceptions had no influence on H.

Modeling Resource Allocation for Child Survival

A framework is presented to provide a direct assessment of health interventions designed to raise the probability of child survival in a hypothetical community. The underlying belief is that direct interventions are a practicable means of improving the rate of child survival in developing countries. In spite of technical feasibility resource constraints restrict the adoption of projects; health programs must thus also be examined with respect to economic feasibility. Questions that arise include the cost-effectiveness of curative vs. preventive care; acess to vs. direct health services; the choice of appropriate population targets; the relative importance of nutrition interventions and identifying constraining resources as well as estimating the benefits to be derived from additional resources. Salient features of the proposed model include the use of interactive simultaneous equations to model the causes of death in a setting of multiple diseases the clear distinction between preventive activities affecting morbidity and curative activities affecting case fatality rates and the separation of the early childhood period into age subgroups with distinct morbidity characteristics. The optimization model also distinguishes between program use and program availability and operates in such a manner as to set intervention levels that tend to equilibrate use and availability. The 3 types of structural equations in the model generate the rates for 1) intervention use 2) marginal disease incidence and 3) fatality. The interventions selected for a hypothetical resource-poor community are promotion breastfeeding latrines water well-baby clinics tetanus immunization iron fortification tablets for all women and outpatient services for infants in the 1st 28 days. The parameters are specified through the use of a set of survey questions administered to medical and professional practitioners. Results indicate that inpatient care and hospital deliveries are not cost-effective and are not adopted by the optimization program until community resources reach high levels. Promotion is given strong emphasis by the allocation model. Nutrition interventions emerge as deserving special emphasis and timing as crucial to the cost-effectiveness of prenatal care. The optimization results indicate the importance of early detection of pregnancy to reduce low birth weight deliveries. The reduction in child mortality with the optimum use of resources is dramatic at low resource levels and diminshes as resources become more abundant. Similarly the value of the constraining resources falls as the general level of resources increases.

Post-neonatal mortality in Rural India: Implications of an economic model

In this paper we develop and test a theory of childhood mortality after the first month of life. Parents are assumed to have well-defined family size and sex composition objectives and to face severe budget constraints. In this set of circumstances, it is understandable that they will make allocative decisions that will affect the survival probabilities of children. These decisions and the environmental influences on mortality are the basic forces which determine whether a child will survive through the post-neonatal period. The model is tested with survey data from rural Uttar Pradesh, India. The results are consistent with the hypothetical framework discussed above. The burden of this pattern of choice is felt particularly strongly by female births.

Breast-feeding and child survival in Egypt.

SummaryIn a retrospective study, the impact of breast-feeding on the survival probabilities of children born to women in hospitals in Cairo, Egypt, is estimated. The analysis shows that early cessation of breastfeeding is associated with higher mortality and the effects are more severe the lower the education level of the mother.

Population and Nutrition: A Case for Integration

In operational terms effective nutrition services can increase health worker credibility with mothers and increase their receptivity toward family planning. Among other synergistic program relationships high IUD removal rates are related to nutritional anemia in women which could be corrected by nutritional supplementation. Finally operating efficiencies might be attainable in some instances through the use of common personnel and facilities. Integration although desirable in many cases faces several barriers: attempts to maintain separate programs in order to preserve independent institutional prestige and power; unequal priority assignment to the different programs; the lack of integrated approaches by international funding agencies. Additional information would be useful on attitudes in the parental procreation decision making process managerial requisites of integrated delivery systems biological and physiological linkages between fertility and nutrition and impact assessment of integrated programs. Two of the most critical problems facing low income countries today are wide spread malnutrition and burgeoning populations. Programs have been mounted to attack both of these interrelated problems but little has been done to coordinate and integrate these efforts. In many situations there appears to be strong rationale for such integration. Both are new programs trying to establish their places on the national development agenda. Population control is more readily justified by economic criteria while nutrition is more socially and politically acceptable. Their fusion can achieve a mutually reinforcing complementarity. There also exists a series of relationships (with varying degrees of evidential strength) among fertility family size and malnutrition: smaller families result in better nutrition which reduces malnutrition related mortality thus improving child survival probabilities and in turn enhancing family planning motivation. (authors)