Survival Probabilities Of Children Research Articles

Incidence of loss to follow-up and its predictors among HIV-infected under-five children after initiation of antiretroviral therapy in West Amhara Comprehensive Specialized Referral Hospitals, Northwest Ethiopia: a multicenter retrospective follow-up study

BackgroundLoss to follow-up (LTFU) among under-five children from HIV care profoundly affects the treatment outcomes of this vulnerable population. It is a major factor that negatively affects the benefits of antiretroviral therapy (ART). Current information about LTFU among HIV-positive under-five children on ART is essential for effective treatments. To far, nevertheless, limited research has been done in Ethiopia to address this issue. Thus, this study aimed to assess the incidence and predictors of LTFU among HIV-infected under-five children receiving ART in West Amhara Comprehensive Specialized Referral Hospitals.MethodsA multicenter institution-based retrospective follow-up study was conducted among 435 HIV-infected under-five children on ART selected by simple random sampling from January 1, 2010 to December 31, 2019, and data were collected between December 1, 2021, and January 31, 2022. A standardized data extraction tool adapted from the ART entry and follow-up forms was used. The event of interest for this study was LTFU, whereas the absence of LTFU was censored. Before being transferred to STATA version 14 for analysis, the data were entered into Epi-Data version 3.1. The Kaplan‒Meier curve was used to estimate an individual's survival-free probability at each specific point in time. The Cox proportional hazards model was used to identify predictors of LTFU.ResultsAmong the 420 records included in the final analysis, 30 (7.14%) of the individuals were LTFUs. The incidence rate of LTFU was 3.4 per 1000 person-months of observation (95% CI: 2.43–4.87). The survival probabilities of children after 12, 24, 36, and 48 months were 0.97, 0.92, 0.88, and 0.77, respectively. The independent predictors of LTFU were HIV infection in under-five children who lived in rural areas (AHR = 3.64; 95% CI: 1.41, 9.37), poor adherence to ART (AHR = 4.37; 95% CI: 1.59, 12.02), not receiving cotrimoxazole preventive therapy (AHR = 3.75; 95% CI: 1.39, 10.08), not receiving isoniazid prophylaxis (AHR = 3.4; 95% CI: 1.29, 9.01), and having a severe WHO clinical stage (AHR = 5.43; 95% CI: 1.38, 11.43).Conclusion and recommendationThe incidence of loss to follow-up was high, especially in the first two years after ART initiation. The risk of LTFU was greater for those who were rural residents, had poor adherence, lacked cotrimoxazole preventive therapy, not given isoniazid prophylaxis, and presented with WHO clinical stages III and IV. Therefore, clinicians should emphasize for cotrimoxazole preventive therapy and isoniazid prophylaxis, for those living in rural areas, who present with poor adherence and WHO clinical stages III and IV.

Incidence of anaemia and its predictors among HIV-infected children receiving highly active antiretroviral treatment in North-West Ethiopia: a multicentre retrospective follow-up study

BackgroundAnaemia is one of the most common problems in HIV-infected patients associated with increased HIV progression, decreased functional capacity, survival and quality of life. For better interventions, up-to-date information concerning...

Long-Term Outcomes of Childhood Acute Lymphocytic Leukemia Treated with Adapted Berlin-Frankfurt-Münster (BFM) Protocols: A Multicentric Analysis from a Developing Country.

The objective of the current study was to determine the survival probabilities of children and adolescents with acute lymphocytic leukemia treated with adapted Berlin-Frankfurt-Münster (BFM) protocols and compare our results with the original BFM reports. This retrospective study included 695 patients up to 19 years old treated with adapted BFM protocols between 1997 and 2018 in four hospitals in Rio de Janeiro. The 1997-2007 and 2008-2018 cohorts were analyzed separately. More than half of the patients were stratified into the high-risk BFM classification. Overall and event-free survivals were, in the 1997-2007 period, respectively, 88% and 80% (BFM standard risk group-SRG), 75% and 67% (intermediate risk group-IRG), and 48% and 33% (high-risk group-HRG). The corresponding numbers for the 2008-2018 period were 93% and 84% (SRG), 75% and 63% (IRG), and 64% and 57% (HRG). In the second period, both the OS (HR = 0.71, p = 0.011) and EFS (HR = 0.62, p < 0.001) were higher. Except for the intermediate-risk group, the latter results are comparable to the BFM. The BFM protocol adaptations can be safely implemented in developing countries, accounting for local specificities.

Modelling Child Survival at Birth Data Using Logistic Regression Model: A Case Study of Yobe State Specialist Hospital Damaturu, Nigeria

This research examines factors influencing the survival of child at birth in Yobe State Specialist Hospital using a well-known logistics regression model. A total of 150 data points were collected through transcription from the maternity record of the Hospital to test significant factors that affect survival of child at birth. Analysis of logistic regression model was applied to the data using the Generalized Linear Model (GLM) package in R programming software. The results indicate that Type of delivery and weight at birth have the most significant influence on the probability of child survival at birth at 0.001 level of significance. Correlation analysis results show that all the five variables (age, parity, apgar, birth weight, and type of delivery) have a weak relationship, which implies that there is no multicollinearity in the data. Therefore, these results may help policy makers and health personnel to educate pregnant women on the effect of overweight baby at birth to reduce the incidence of deaths at birth. This study recommend that pregnant women should be educated about the effect of baby weight in a worm as that may increases the chance of caesarean section which in turn may affect the likelihood of child survival at birth. Further studies are suggested to consider factors like educational level, income of level of the family, antennal status, and blood pressure. A more advance community-based survey is recommended since not pregnant women attain formal health care facilities for antennal and postnatal services, which may expose more factors that influence child survival at birth.

Survival status and predictors of mortality from severe community-acquired pneumonia among under-five children admitted at Debre Tabor comprehensive specialized hospital: a prospective cohort study.

Globally, Pneumonia continues to be the leading cause of mortality among under-five children. Ethiopia ranks fourth out of 15 countries worldwide in terms of the highest death rate of under-five children due to severe community-acquired pneumonia (SCAP). However, to date, there is no recent study that shows survival status and predictors of mortality from SCAP. Therefore, this study aimed to determine survival status and predictors of mortality from this dangerous disease among under-five children. A facility-based prospective cohort study was conducted from 1 November 2021 to 31 October 2022 at Debre Tabor comprehensive specialized hospital. All under-five children with SCAP admitted during the study period were included. Participants were selected using a systematic sampling technique. The collected data were coded, edited, and entered into epi-data version 4.2 and then exported to STATA version 17 for further analysis. The Kaplan Meier failure estimate with log-rank test was employed to determine the survival estimates. A cox-proportional hazard regression model was fitted to identify significant variables. The overall incidence density rate of mortality was 5.7 /1000 children with a median hospital stay of 8.2 days. Heart disease (AHR: 4.37; 95%CI: 1.68-11.32), previous admission of SCAP (AHR: 3.87; 95% CI: 1.31-11.43), WFL < -3Z score (AHR: 3.57; 95% CI: 1.02-12.42), impaired consciousness level at admission 3.41(1.14-10.19), and pleural effusion (AHR: 3.42; 95%CI: 1.18-9.93) were significant predictors of mortality. In this study, the survival probability of children with SCAP was low. Children with heart disease, previous admission of SCAP, WFL < -3Z score, impaired consciousness level at admission, and pleural effusion had low survival. Therefore, much emphasis is needed on children with SCAP, particularly those with identified predictors.

Seasonal Migration and Child’s Schooling: A Survival Approach

The article opts to investigate the long-term effects of parental seasonal migration on a child’s access to school education. The phenomenon of seasonal migration ‘leaving child at home’ or ‘accompanied by’ is a very common feature in the Purulia district where migration is the only viable option to sustain livelihood in lean-agricultural season. Although parents’ migration in such areas seems to be essential for the family economy, lack of parental care is found to be responsible for academic and psychological non-adjustment that affects a child’s education to a great extent. The Cox Regression Hazard Model and the Kaplan–Meier Estimator analysis of school participation have been employed to explore the survival probability of children at varying contexts, viz. migration status, gender, caste and age. The result shows the negative impact of parental migration on school participation of left-behind children leading to early dropout before the completion of the school education cycle.

Survival time and predictors of death among HIV infected under five children after initiation of anti -retroviral therapy in West Amhara Referral Hospitals, Northwest Ethiopia

BackgroundAcquired immune deficiency syndrome is an infectious disease caused by the human immunodeficiency virus (HIV) that primarily targets an individual's immune system. In Ethiopia, nearly 24% of HIV-related deaths occur in children under the age of five. However, studies regarding the survival time of HIV-positive under-five children after anti-retroviral therapy initiation are limited with poor evidence of predictors of death.ObjectiveTo assess survival time and predictors of death among HIV infected under-five children after initiation of anti-retroviral therapy in West Amhara Referral Hospitals, Northwest Ethiopia, 2021.MethodsA multicenter institution-based retrospective follow-up study was conducted among 432 HIV-positive under-five children on anti-retroviral therapy selected by simple random sampling from January 2010 to December 2019. A standardized data extraction tool was employed, which was adapted from anti-retroviral therapy entry and follow-up forms. The event of interest for this study is death, whereas the absence of experience of death is censored. Data were entered into Epi-Data version 3.1 and exported to STATA version 14. The Kaplan–Meier curve was used to estimate the survival probability. The Cox regression model was used to identify independent predictors of death.ResultsAmong the 415 records included in the final analysis, 25 (6.02%) of the individuals were died. The incidence rate of death was found to be 2.87 per 1000 child-months (95%CI: 1.94–4.25). The cumulative survival probabilities of children after 6, 12, 24, and 36 months were 0.97, 0.95, 0.92, and 0.85 respectively. HIV-infected under-five children who lived in rural areas (AHR 3.32:-95% CI 1.17–9.39), with poor adherence to anti-retroviral therapy (AHR = 3.36; CI: 1.06, 10.69), without Isoniazide prophylaxis (AHR = 3.15; CI: 1.11, 8.94) and with anemia (AHR: 3.05, 95% CI: 1.16, 8.03) were at higher risk of death.Conclusion and recommendationDeath of HIV-infected under-five children on anti-retroviral therapy is high within the first one year after enrolment. Living in rural area, had poor adherence, lacked Isoniazide prophylaxis, and anemia were predictors of death. Therefore, clinicians shall emphasize for those specific risk factors of death and take action accordingly.

Explaining the diminishing of Muslim advantage in child survival in India

AbstractReligion is one of the key instrumental social institutions in determining child health and mortality. Muslim advantage in child survival in India has been widely reported. Recent India’s National Family Health Survey (NFHS) shows that the gap between Hindu–Muslim childhood mortality rates is shrinking—reversing decades of child survival advantage for Muslims. This study examines the factors linked to the diminishing of Muslim advantage in childhood survival and attempts to uncover the mechanisms accounting for the convergence using the characteristics hypothesis of Goldscheider (Population, modernization, and social structure Little, Brown &amp; Co; 1971) and the analytical framework of Guillot and Allendorf (Genus 66(2), 2010). We have analyzed a pooled sample of 23,47,245 all live births and 428,541 of last live births from four rounds of NFHS (1992–2016). Kaplan–Meier survival plots over time by religion confirm convergence in Hindu–Muslim child survival probabilities. The Pyatt decomposition model reveals that the gap in Hindu–Muslim childhood mortality is diminishing due to a decline in within-Hindu inequality. Cox proportional hazard regression model shows that improvement in household and maternal socioeconomic factors has contributed to Hindu children catching up with Muslims—leading to a convergence in Hindu–Muslim childhood survival probabilities. Conditional β-convergence regression model also suggests the convergence in socio-economic status and maternal health care is driving the convergence in child survival of Hindus and Muslims across Indian states.

Time to death among HIV-infected under-five children after initiation of anti-retroviral therapy and its predictors in Oromiya liyu zone, Amhara region, Ethiopia: a retrospective cohort study

BackgroundHuman Immunodeficiency Virus (HIV) is infection which mainly attacks immune system of an individual. Its disease progress is rapid in children and if treatment is not initiated nearly half of infected children will die by the second year of infection. In Ethiopia, nearly twenty four percent of HIV related death is happen to under-five children; however studies done in this specific age group are limited are with poor evidence of predictors.ObjectivesTo determine time to death and identify predictors of death in HIV infected under- five children on antiretroviral therapy in Amhara regional state, Oromia ‘liyu’ zone, Northeast Ethiopia, from 2014 to 2019.MethodsInstitution based retrospective follow up study was conducted in 376 under-five HIV- infected children on antiretroviral therapy from January 2014 to December 2019 in health institutions in Oromia Liyu Zone, Amhara region, Ethiopia. Multivariable Cox-proportional hazard regression model was used to identify independent predictors of mortality in HIV- infected under-five children on antiretroviral therapy.ResultAt the end of follow up, 304 (80.85%) of HIV-infected children were alive, 39 (10.95%) were lost to follow up, 12 (3.19%) were transferred out and 21 (5.59%) were reported dead due to HIV/AIDS. The cumulative survival probabilities of children after 3, 6, 12, 24 and 36 months were 0.99, 0.98, 0.97, 0.89 and 0.87 respectively. The overall mean time to death was 19.7 months (95%CI = 18.74–20.67) with incidence of 5.9 deaths per 100 child-months (95%CI: 3.89–9.09). Children with severe malnutrition at baseline (AHR = 4.9; 95 CI: 1.04, 23.50), advanced WHO clinical stage at enrolment (AHR = 3.9; CI: 1.37, 10.88), poor adherence to ART (AHR = 6.56; CI: 3.33, 10.14) and with no history of Isoniazide prophylaxis were significantly associated to higher mortality events (AHR = 3.6; CI: 1.24, 10.18).ConclusionDeath of HIV-infected under-five children on ART is high within the first one year after enrolment. The risk of death increased if the child was malnourished at beginning of treatment, had poor ART adherence, with advanced WHO clinical stages and lack of Isoniazide prophylaxis during their age of infancy.

One but not two grandmothers increased child survival in poorer families in west Bohemian population, 1708–1834

Abstract Human childrearing is characterized by cooperative care and grandmothers are usually the most prominent alloparents. Nevertheless, it has been argued that limited resources may intensify competition among kin. The effect of grandmothers’ presence on child survival may thus crucially depend on the family’s socioeconomic status. We evaluate the impact of grandmothers’ presence on child survival using a large historical dataset from eighteenth to nineteenth-century western Bohemia (N = 6880) and assess the effects of socioeconomic status. We employed a varying effects model conditioned on relatedness between individuals because of possible genetically transmitted benefits. Proportional hazards showed that grandmothers had little or no impact on child survival in families of high and medium socioeconomic status (farmers and cottagers, respectively), whereas in families with the lowest socioeconomic status (lodgers), grandmothers’ presence increased the survival probability of children up to five years of age. The beneficial effect of grandmaternal care was strongest between the first and second years of life. Importantly, though, in families with low socioeconomic status, we also observed lower survival chances of children when both grandmothers lived in the same village. These findings suggest that the balance between kin cooperation in childrearing and competition over resources may depend on resource availability.

The Impact of Maternal Health Care Utilization on Probability of Child Survival in India

Maternal and child health programmes plays a key role in reducing infant and child mortality in any population. The Government of India started maternal and child health care services in the first five year plan (1951-56). This study uses data from the fourth round of the National Family Health Survey (NFHS, 2015-16). We are interested to examine the effect of child delivery at a healthcare facility, on child survival. We are followed by Mosley and Chen’s framework (1884), according to the framework, several socioeconomic determinants are grouped into some categories, namely, maternal, environmental contamination, nutrient deficiency, and personal illness control. Consequently, we reduced the number of independent variables to women’s age at birth and education, birth order, low child birth weight, household wealth, and healthcare.

Determinants of change in CD4 count and relationship with survival among children with HIV in Ethiopia

ABSTRACT We identify the determinants of the change in CD4 cell count and survival time of children living with HIV taking antiretroviral therapy. In a retrospective study, a cohort of 201 children living with HIV/AIDS aged less than 15 years were followed from October 2013 to March 2017. Separate linear effect models were done for the longitudinal outcome of CD4 cell count. The Cox PH model was conducted for the time-to-event outcome. Joint modeling was performed both for the longitudinal and survival outcomes, results were compared with the separate analysis. However, with the specific interest in identifying the determinants and characterizing the relationship between longitudinal CD4 cell count and time-to-event outcomes, the study focused on joint modeling. The finding from the joint model indicated that the estimated association parameter was −0.10, this shows lower values of CD4 cells associated with higher death. Seemingly; observation time, age, WHO clinical stages, history of Tuberculosis (assuming that Tuberculosis is active), and functional status were determinants for the mean change in the square root of CD4 cell count. Furthermore, WHO clinical stages, functional status, history of TB, and Body Mass Index have a significant negative impact on the survival probabilities of children living with HIV.

Survival and HIV-Free Survival Among Children Aged ≤3 Years - Eight Sub-Saharan African Countries, 2015-2017.

Although mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) is preventable through antiretroviral treatment (ART) during pregnancy and postpartum, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 160,000 new HIV infections occurred among children in 2018 (1). Child survival and HIV-free survival rates* are standard measures of progress toward eliminating MTCT† (2). Nationally representative Population-based HIV Impact Assessment (PHIA)§ survey data, pooled from eight sub-Saharan African countries¶ were used to calculate survival probability among children aged ≤3 years by maternal HIV status during pregnancy and HIV-free survival probability among children aged ≤3 years born to women with HIV infection, stratified by maternal ART** status during pregnancy. Survival probability was significantly lower among children born to women with HIV infection (94.7%) than among those born to women without HIV infection (97.6%). HIV-free survival probability of children born to women with HIV infection differed significantly by the timing of initiation of maternal ART: 93.0% among children whose mothers received ART before pregnancy, 87.8% among those whose mothers initiated ART during pregnancy, and 53.4% among children whose mothers did not receive ART during pregnancy. Focusing on prevention of HIV acquisition and, among women of reproductive age with HIV infection, on early diagnosis of HIV infection and ART initiation when applicable, especially before pregnancy, can improve child survival and HIV-free survival.

Mortality Among Children with Down syndrome in Hong Kong: A Population-Based Cohort Study from Birth

To describe the mortality patterns, comorbidities, and attendance at accident and emergency departments among children with Down syndrome in Hong Kong. This is a population-based, retrospective cohort study of live births of children with Down syndrome delivered between 1995 and 2014, as identified from territory-wide hospitalization data in Hong Kong. The Kaplan-Meier product limit method was adopted to estimate the survival probabilities of children with Down syndrome by selected demographic and clinical characteristics. Cox regression analyses were conducted to examine associations of comorbidities and accident and emergency department accident and emergency departments attendances with mortality patterns. There were 1010 live births of children with Down syndrome in Hong Kong within the study period and the average rate of live births with Down syndrome was 8.0 per 10 000 live births (95% CI, 6.8-9.30). The rate of live births with Down syndrome over the past 2decades decreased from 11.8 per 10 000 live births in 1995 to 3.4 per 10 000 in 2014. Eighty-three patients with Down syndrome died during this period. The overall 6-month and 1- and 5-year survival probabilities were 95.8%, 94.4%, and 92.6%, respectively. There was a significant decrease in mortality rates over the study period, particularly among those born between 2000-2004 and 2005-2009 compared with those born between 1995 and 1999 (P<.05). Patients with Down syndrome without congenital cardiovascular anomalies and without low birth weight had lower mortality rates than those with these diagnoses. Over the past 2decades, the early life mortality of children with Down syndrome in Hong Kong has improved significantly along with a reduction in Down syndrome live births.

The Effect of Exclusive Breastfeeding on Child Survival Using Modified Kaplan Meier Model (MKMM)

Background: In Survival analysis, Kaplan-Meier estimator serves as a tool for measuring the frequency or the number of patients surviving medical treatment. Kaplan Meier estimates of survival data have become a better way of analyzing data in cohort study. Kaplan- Meier (K-M) is a non-parametric estimates of survival function that is commonly used to describe survivorship of a study population and to compare two study populations.&#x0D; Aims: This research study is aimed at reducing the morbidity and mortality rate of children less than 6 months.&#x0D; Methodology: 58,609 children less than six months were Exclusive Breastfed from the database. The analysis is done using both K-M and the modified K-M model to examine the effects of Exclusive Breastfeeding. The AIC and BIC was also used as the information criteria.&#x0D; Results: Our results revealed that the K-M model 0.998566822 as the estimated survival probability of children under the ages of six months. Also showing, Exclusively Breastfed children stand the chance of 99% survival.&#x0D; The modified K-M model also revealed 6.98276443909739 as the estimated survival probability, due to initiation of milk substitute and food supplement into the breastfeeding pattern. Showing about 70% chances of survival. Implying about 30% of the existence in one disease or the other or the risk of dying before the age of 5 years.&#x0D; From the information criteria, the AIC (2.3119452169420) and BIC (7.8478797677756) in the Modified K-M are both lower compared to Existing Kaplan Meier (4.0012457354876) and (9.5371847322969) respectively. Modified K-M stand as the best model in knowing the types/amount of food to be added to breastfeeding pattern.&#x0D; Conclusion: So far, the Modified Kaplan Meier Model has been verified and the findings agree that the life expectation will be improved by 99% if children are fed exclusively with breast milk while the life span is been reduced that can lead to death by 30% if the children have a mix feeding which agrees with why Exclusive Breastfeeding should be done.

Modern contraceptive use and intention to use: implication for under-five mortality in Ethiopia

ObjectiveHigh under-five mortality has been identified as a major problem in many developing countries including Ethiopia. The main purpose of this study is to examine the effect of modern contraceptive use on under-five mortality in Ethiopia. MethodsThe study draws on data from the 2011 and 2016 Ethiopia Demographic and Health Surveys. The Kaplan-Meier survival function was used to demonstrate the survival probabilities of children while a multivariate analysis using the Cox proportional hazards model was used to estimate the under-five mortality risks for various predictors. ResultsThe results show consistently higher survival probabilities for children of mothers who use modern contraceptives for all survival periods. Significant predictors of under-five mortality include modern contraceptive use, tetanus vaccinations, mother's age, child's sex, parity, postnatal checkup, marital status, and source of drinking water. ConclusionModern contraceptive use has a notable implication for the chances of under-five survival in Ethiopia. This underscores the importance of modern contraceptive use in the pursuit of a substantial reduction in under-five mortality in the country.

On The Empirics of User-Fees, Maternal Health-Seeking Behavior and Child Survival in Ghana

This study examines the impact of the elimination of health user-fees on a variety of maternal and child health outcomes, under the Free Maternal Healthcare Program in Ghana using data from a nationally-representative sample survey. By employing a battery of linear and binomial logit and probit estimations, we find that the elimination of user fees significantly increases the probability of using the services of a skilled birth attendant (midwife or nurse) at delivery, whilst simultaneously reducing the probability of using a traditional attendant. We also find evidence that the program increases the number of antenatal care visits as well as the probability of going for post-natal baby check-ups. On family planning, even though we do not find a positive impact on the probability that a couple will not use family planning methods or on the ideal number of children a couple wishes to have in our Schultz(1969) family planning model, we find that it significantly increases the probability that a couple will keep an initially unwanted pregnancy. Additionally and perhaps most importantly, we find that the program is more significant in increasing the probability of child survival than any other variable in our Chen and Mosley (1984) child survival model. Our findings remain robust and consistent across specifications and after controlling for regional fixed effects, as well as rural and urban disparities in health facility endowments and non-facility costs.

Factors Explaining Child Survival in Ethiopia: Application of Two‐Stage Probit Model

AbstractPolicymakers in many developing countries had been mandated to pursue the goal of reducing child mortality as one of the Millennium Development Goals (MDGs). This paper analyses the factors influencing child survival in Ethiopia using a 2011 Demographic and Health Survey (DHS) dataset. Descriptive statistics and two‐stage least square probit regression were employed for data analyses. Results showed that the majority of the children (82.19 per cent) were born to households in rural areas, while average household heads' age was 42.78 years. Using combined children data, fertility, age of household heads, residence in urban areas, drinking of alcohol and smoking significantly reduced probability of child survival, while altitude, education, male household headship, age at first birth and rendering of assistance on domestic chores by the husband increased it (p &lt; 0.05). It was concluded that efforts at reducing maternal fertility by promoting education of female children will go a long way in reducing child mortality in Ethiopia.

The effect of maternal healthcare on the probability of child survival in Azerbaijan.

This study assesses the effects of maternal healthcare on child survival by using nonrandomized data from a cross-sectional survey in Azerbaijan. Using 2SLS and simultaneous equation bivariate probit models, we estimate the effects of delivering in healthcare facility on probability of child survival taking into account self-selection into the treatment. For women who delivered at healthcare facilities, the probability of child survival increases by approximately 18%. Furthermore, if every woman had the opportunity to deliver in healthcare facility, then the probability of child survival in Azerbaijan as a whole would have increased by approximately 16%.

The Optimal Trade-Off Between Quality and Quantity with Unknown Number of Survivors

In a model of endogenous fertility where individuals know the probability of child survival but not the final number of survivors, parents do not always formulate a precautionary demand for children. For some utility functions, parents have fewer children than what they would have in a situation in which the number of survivors is known earlier. The properties of the optimal economic policy depend on the degree to which the social welfare function takes ignorance into account. If social welfare is evaluated after parents know how many children survived, the parental response to uncertainty is socially inefficient. Individual decisions then should be corrected through tax or transfer on both births and education. This property helps determine the optimal public response to mortality crisis in the presence of educational externalities.