Survival Chances Of Children Research Articles

Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil.

There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.

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.

When children have children: The effects of child marriages and teenage pregnancies on early childhood mortality in Bangladesh

This paper examines the adverse effects of adolescent childbearing on early childhood mortality in Bangladesh in mother-fixed-effects regressions using individual mortality outcomes of 300,000 children. Children born to young mothers (child brides in Bangladesh) suffer from higher mortality in the first year of life than their siblings born later. The survival chances of children born to mothers aged 15−49 years are 48–81 % higher in infant period as compared to their siblings born in mother’s early adolescence (10−14 years). In poor households, these survival effects extend up to the fifth birthday, especially in the poorest households or among uneducated mothers. This evidence points towards a biological channel, probably low birth weight, as the main contributing factor in the first year of life. In the post-infant period, favorable socio-economic factors (wealth, education) seem to compensate the biological disadvantage of adolescent births. Adolescent pregnancies lead annually to estimated 18,700 under-5 deaths in Bangladesh.

Bitter Fruits of “A Merry Life?” Survival Chances of Children Born Out of Wedlock in Nineteenth-century Rural Estonia

The article explores the survival chances of children born out of wedlock in the Russian Baltic province of Livland from 1834 to 1891 and is based on court records as well as individual-level vital events data. The absence of a consistent mortality penalty for illegitimate infants and the considerable proportion of single mothers who went on to marry point to the lack of a strong social stigma. Other indicators, such as rates of stillbirths and early childhood mortality, mother’s age and socioeconomic status, and the time span between the birth and marriage, give evidence of marginalization.

Addressing Corner Solution Effect for Child Mortality Status Measure: An Application of Tobit Model

Although various models regarding corner solution data have been suggested, it is known that corner solution data is too complicated to predict the model. A corner solution is a unique solution in the sense that it is characterized by a mass-point at zero and a long right tail. For the present study, the data was taken from MICS collected by Punjab Bureau of Statistics (BOS) during 2011-2012. However, this study is based on the particular data. The child mortality within five-year interval was taken as a response variable. In the data obtained, 65% of the response variable observed to be zero. Tobit model reveals that it is the most accurate and widely used technique in this regard. The implementation of Tobit model shows that the significant predictor of child mortality in a family within five year are women age, postnatal checkups, antenatal care, total children ever born, and wealth index score. Since the majority (i.e. 74.4%) of mother age in the data is between 20 to 35 years. The results indicate that the chances of child survival are relatively higher for the mothers of age group of 20-35 years. Furthermore, Child mortality is highest for the families with low wealth index score. In addition, child mortality percentage tends to decrease with the improvement in postnatal and antenatal care facilities. The specification of Tobit model also used to verify the result of the Tobit model.

Morbidity and mortality in newborns at the limit of viability in Spain: A population-based study

Abstract Introduction Perinatal care in extremely immature newborns is a clinical and ethical problem of great importance for professionals and families, and requires that the available information on the chances of child survival is of the highest quality. The aim of this study was to determine the specific rates of survival at hospital discharge, and survival without major morbidity in newborns with a gestation age (GA) ≤ 26 weeks in Spain. Patients and methods We included live newborns ≤ 26 weeks admitted to the collaborating centres of the SEN1500 network (2004-2010). Outborn patients, infants who died in delivery room, and those with congenital anomalies incompatible with life were excluded. Results A total of 3,236 patients were included. GA specific survival was 12.5, 13.1, 36.9, 55.7, and 71.9% at 22, 23, 24, 25, and 26 weeks of GA, respectively. Survival without severe intracranial haemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, and/or retinopathy of prematurity was 1.5, 9.5, 19.0, and 29.9% at 23, 24, 25 and 26 weeks GA, respectively. Conclusions Survival without major morbidity in infants less than 23 weeks GA is exceptional, and scarce in newborns with 23 and 24 weeks GA. Infants ≥ 25 weeks GA have reasonable chances of survival and, in the absence of major malformations or other relevant complications, they should be offered active resuscitation and intensive care. The continuous updating of the results of individual centres is of utmost importance, as well as their comparison with the reference population-based results.

Morbimortalidad en recién nacidos al límite de la viabilidad en España: estudio de base poblacional

IntroductionPerinatal care in extremely immature newborns is a clinical and ethical problem of great importance for professionals and families, and requires that the available information on the chances of child survival is of the highest quality. The aim of this study was to determine the specific rates of survival at hospital discharge, and survival without major morbidity in newborns with a gestation age (GA)≤26 weeks in Spain. Patients and methodsWe included live newborns≤26 weeks admitted to the collaborating centers of the SEN1500 network (2004-2010). Out born patients, infants who died in delivery room, and those with congenital anomalies incompatible with life were excluded. ResultsA total of 3,236 patients were included. GA specific survival was 12.5, 13.1, 36.9, 55.7, and 71.9% at 22, 23, 24, 25, and 26 weeks of GA, respectively. Survival without severe intracranial hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, and/or retinopathy of prematurity was 1.5, 9.5, 19.0, and 29.9% at 23, 24, 25 and 26 weeks GA, respectively. ConclusionsSurvival without major morbidity in infants less than 23 weeks GA is exceptional, and scarce in newborns with 23 and 24 weeks GA. Infants≥25 weeks GA have reasonable chances of survival and, in the absence of major malformations or other relevant complications, should be offered active resuscitation and intensive care. The continuous updating of the results of individual centers is of utmost importance, as well as their comparison with the reference population-based results.

Correlates of Low Birth Weight: A Hospital-Based Study From Gangtok, India.

Background. Low birth weight is the single most important factor that determines the chances of child survival. A recent annual estimation indicated that nearly 8 million infants are born with low birth weight in India. The infant mortality rate is about 20 times greater for all low birth weight babies. Methods. A matched case–control study was conducted on 130 low birth weight babies and 130 controls for 12 months (from August 1, 2007, to July 31, 2008) at the Central Referral Hospital, Tadong, East District of Sikkim, India. Data were analyzed using the Statistical Package for Social Sciences, version 10.0 for Windows. Chi-square test and multiple logistic regression were applied. A P value less than .05 was considered as significant. Results. In the first phase of this study, 711 newborn babies, borne by 680 mothers, were screened at the Central Referral Hospital of Sikkim during the 1-year study period, and the proportion of low birth weight babies was determined to be 130 (18.3%). Conclusion. Multiple logistic regression analysis, conducted in the second phase, revealed that low or middle socioeconomic status, maternal underweight, twin pregnancy, previous history of delivery of low birth weight babies, smoking and consumption of alcohol during pregnancy, and congenital anomalies had independent significant association with low birth weight in this study population.

English

IUGR is one of the most serious challenges in both developed and developing contraries. It is the single most important factor that determines in chances of child survival. In our country PGRF remain one of the commonest cause of neonates morbidity and mortality 30% of neonatal death are done to IUGR. Despite of all efforts by government 100% antenatal care is poor but women are seeking health facility for delivery at time ever more important to identify such high risk pregnancy and manage for better met and fetal examination (one step) in 3 rd trimester can be used as a screening procedure for detection of IUGR babies. MATERIAL AND METHODS: all pregnant women coming to the facility diagnosed to have IUGR by clinical method (SFH, AG, clinical assessment of liquor) were included in the study for duration of one year. Maternal and fetal outcome was noted in terms of mode of delivery and neonatal death, still birth, SGA, AGA. Apgar score of all the babies was noted to assess morbidity. OBSERVATION: Of the total antenatal women 200 were identify as IUGR by clinical method out of which most of were from age group 21-25 years comprising 72.4% of total cases. Maternal weight and height influence weight of the babies 75% IUGR babies were noted in height less than 145 cm. 78.5% were unbooked and 64 belong to rural population. various risk maternal factors like hypertensive disorder 26%, anemia 16.5%, previous history of IUGR 9%, antepartum haemorrhage 6%, diabetes 1%, rh negative 4.5%, heart disease 1%, recurrent abortion 5% in 17% no identified risk factors were found, 80% were delivered vaginal, 67.5% babies were SGA after birth as assessed by clinical method, 68%, had Apgar score less than 7. Perinatal mortality constituted 27.3% of the babies. DISCUSSION: Intrauterine growth restriction is one of the common abnormality encountered by the obstetrician, when present it increases perinatal morbidity and mortality. it is a multifactorial disease with varying degree of severity as in our study the noted 68% of babies with Apgar less than 7 and only 32 had Apgar more than 7 with perinatal mortality of 27.3%. IUGR per se is a major problem in India, nearly million low birth weight babies are born annually in India and it account for more than half of neonatal death. This is evidenced in our study that we were able to screen and detect 67.5% of babies who were SGA out of total screen as IUGR. This study also emphasizes the fact that IUGR as cause of neonatal morbidity and mortality can be reduced if proper antenatal care prompting early detection of high risk factor and IUGR is done. One step method of clinical assessment of IUGR can be included in maternal health programs focusing on early detection of IUGR and associated maternal risk during antenatal period and early referral to more complete health care centres where they can be benefited by more sophisticated diagnostic and therapeutic methodology such as colour doppler and ultrasound.

Child Mortality Transition among Children Born to Adolescent Mothers in India: A Study Based on National Family Health Survey (NFHS) Data

KEYWORDS Survival Chances of Children. Type of Residence. Birth Interval. Age at Marriage. Sex of the Children. Ever Born Children ABSTRACT Adolescent (15-19 years) marriages are still in practice in many parts of India. As a result, many conceptions lead to mortality . Hence the data has been taken from National Family Health Survey (NFHS), which represents all India data, for the analysis. The survival chances of children have been considered for analysis. The logistic analysis has been done for the last birth order and last but one birth order using different variables in three different models. The findings indicate a distinct change from NFHS II onwards. NFHS III data has shown marked decline in mortality of infants and children. A good proportion (90 per cent) of adolescent mothers belonging to NFHS-I and II have not used any contraception compared to 87 per cent belonging to NFHS-III. Female children had better survival chances than male children in recent surveys (NFHS-III). Number of children ever born and age of the mother at marriage have seems to have inverse relation with survival status of child.

Kin and Child Survival in Rural Malawi : Are Matrilineal Kin Always Beneficial in a Matrilineal Society?

This paper investigates the impact of kin on child survival in a matrilineal society in Malawi. Women usually live in close proximity to their matrilineal kin in this agricultural community, allowing opportunities for helping behavior between matrilineal relatives. However, there is little evidence that matrilineal kin are beneficial to children. On the contrary, child mortality rates appear to be higher in the presence of maternal grandmothers and maternal aunts. These effects are modified by the sex of child and resource ownership: female children and children in households where women, rather than men, own land suffer higher mortality rates in the presence of maternal kin. These modifiers suggest the detrimental effects of matrilineal kin may result from competition between such kin for resources. There are some positive effects of kin on child survival: the presence of elder siblings of both sexes is correlated with higher survival rates, and there is some weak evidence that paternal grandmothers may be beneficial to a child's survival chances. There is little evidence that any male kin, whether matrilineal or patrilineal, and including fathers, affect child mortality rates. This study highlights the importance of taking social and ecological context into account when investigating relationships between kin.

Environmental Factors, Neighbourhood Deprivation, And Under-Five Mortality In Nigeria: An Exploratory Spatial Data Analysis

Aim: to examine the impact of state-level access to basic environmental services and neighbourhood deprivation on under-five mortality rate Methods: Using data from most recent Nigeria Demographic and Health Survey for a sample of 6029 live births between 1999 and 2003 and exploratory spatial data analyses, the study analyzed the state-level association between environmental, neighbourhood deprivation and under-five mortality rate. Results: The spatial distribution of rates of under-five mortality rate was non-random and clustered with a Moran's I = 0.654 (p = .001). Spatial clustering suggested that North-east and North-west can be group as under-five mortality hot-spot, and Southwest, South-south, and South-east can be group as under-five mortality cold-spot. The results outlined seemingly consistent finding that access to safe water, proper sanitation, and low pollution cooking fuel are important factors that can increase the chances of child survival. Conclusion: The maps could be used by policy makers for targeting development efforts at a glance for resource allocation and scaling up preventive efforts to achieve Millennium Development Goal, MDG-4 to reduce by two-thirds, between 1990 and 2015, the under-five mortality and MDG-7 to halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. Multifaceted geographically differentiated intervention may represent a potentially effective approach for addressing issues related to child survival.

Drug treatment costs: projected impact of using the integrated management of childhood illnesses.

The strategy of integrated management of childhood illness (IMCI) aims at improving the skills of first level health workers and consequently, improving the survival chances of children. The guidelines have been shown to be cost-effective. We aimed to determine the potential impact of using IMCI guidelines on drug treatment cost. The cost of drugs prescribed for 129 sick children, by first level health workers, who were managed at three primary health facilities in Sabon Gari Local Government Area of Kaduna State, was calculated. The corresponding cost using the IMCI guidelines was also calculated. There were 74 males and 55 females (M:F=1.3:1). An average of 4.5 drugs per patient were prescribed by the health workers compared to 2.3 drugs per patient when using the IMCI guidelines. The total cost of drugs prescribed by the health workers was N15,279.39 with an average of N118.44 per child. The corresponding costs had the IMCI guidelines been used were N3,062.53 and N23.73, respectively. Treatment cost using the traditional method was 4.98 times more expensive than using methods advocated by the IMCI guidelines. The projected cost savings related to drugs when using IMCI guidelines were based on the assumption that inappropriate drugs would not be prescribed by health workers once they are introduced to and started using the IMCI guidelines.

Long-term results and risk profiles of patients in five consecutive trials (1979–1997) with stage 4 neuroblastoma over 1 year of age

During the last two decades new diagnostic and therapeutic tools have been utilized to improve the poor survival chances of children with stage 4 neuroblastoma. This study reviews the risk profiles and the long-term outcome of patients from five consecutive German neuroblastoma trials. A total of 96% of all German patients registered at the German childhood cancer registry with neuroblastoma stage 4 over 1 year of age at diagnosis entered one of the trials during 1979–2001. Eight hundred and twenty-eight consecutive children were analyzed retrospectively. In spite of having significantly improved diagnostic tools like bone marrow superstaging and mIBG scintigraphy the stage 4 incidence did not increase after reaching completeness of the registry (5.4 cases/100,000 children at 1–14 years of age; P=0.52). The distribution of the primary tumors and of metastases was constant over the periods. The amount of bone marrow infiltration did not change with time. The risk factors lactate dehydrogenase, ferritin and MYCN, and the clinical risk groups 4A, 4B, 4C also remained constant over the trials with a few exceptions for NB97. The 5-year event free survival increased from 0.01±0.01 (NB79) to 0.14±0.03 (NB85), 0.16±0.04 (NB82), 0.27±0.02 (NB90), and 0.33±0.04 (NB97). The overall survival rates improved similarly from 0.04 (NB79) to 0.44 (NB97). In conclusion, the improved survival was associated with better treatment and not caused by lower risk profiles in stage 4 neuroblastoma patients.

The effects of water supply and sanitation on childhood mortality in urban Eritrea.

Child mortality differentials according to water supply and sanitation in many urban areas of developing countries suggest that access to piped water and toilet facilities can improve the survival chances of children. The central question in this study is whether access to piped water and a flush toilet affects the survival chance of children under five in urban areas of Eritrea. The study uses data collected by the Demographic and Health Survey (DHS) project in Eritrea in 1995. The results show that while the unadjusted effect of household environment (water supply and toilet facility) is large and statistically significant during the post-neonatal and child periods, it is relatively small and statistically insignificant during the neonatal period. The effect of household environment remains substantial during the post-neonatal and child periods, even when other socioeconomic variables are held constant. However, the household environment effect totally disappears during the neonatal period when the socioeconomic factors are controlled for.

Inequality of child mortality among ethnic groups in sub-Saharan Africa.

Accounts by journalists of wars in several countries of sub-Saharan Africa in the 1990s have raised concern that ethnic cleavages and overlapping religious and racial affiliations may widen the inequalities in health and survival among ethnic groups throughout the region, particularly among children. Paradoxically, there has been no systematic examination of ethnic inequality in child survival chances across countries in the region. This paper uses survey data collected in the 1990s in 11 countries (Central African Republic, Côte d'Ivoire, Ghana, Kenya, Mali, Namibia, Niger, Rwanda, Senegal, Uganda, and Zambia) to examine whether ethnic inequality in child mortality has been present and spreading in sub-Saharan Africa since the 1980s. The focus was on one or two groups in each country which may have experienced distinct child health and survival chances, compared to the rest of the national population, as a result of their geographical location. The factors examined to explain potential child survival inequalities among ethnic groups included residence in the largest city, household economic conditions, educational attainment and nutritional status of the mothers, use of modern maternal and child health services including immunization, and patterns of fertility and migration. The results show remarkable consistency. In all 11 countries there were significant differentials between ethnic groups in the odds of dying during infancy or before the age of 5 years. Multivariate analysis shows that ethnic child mortality differences are closely linked with economic inequality in many countries, and perhaps with differential use of child health services in countries of the Sahel region. Strong and consistent results in this study support placing the notion of ethnicity at the forefront of theories and analyses of child mortality in Africa which incorporate social, and not purely epidemiological, considerations. Moreover, the typical advantage of relatively small, clearly defined ethnic groups, as compared to the majority in the national population, according to fundamental indicators of wellbeing--child survival, education, housing, and so forth--suggests that many countries in sub-Saharan Africa, despite their widespread poverty, are as marked by social inequality as are countries in other regions in the world.

Fertility and infant mortality trends in Nicaragua 1964-1993. The role of women's education.

OBJECTIVES: To assess trends in fertility and infant mortality rates (IMR) in León, Nicaragua, and to examine the effect of women's education on these trends during 1964-1993, a period of...

Community characteristics, individual and household attributes, and child survival in brazil

This paper presents an analysis of the relationship between community characteristics, household attributes, and child survival in Brazil. The principal objectives are to investigate how the social and environmental context in which a child is raised affects his or her survival chances, and to analyze how household variables modify the effects of community characteristics. The interaction effects we examine help to explain the effects of community characteristics on child survival chances by illuminating the most likely pathways through which these covariates operate. This information is also useful for predicting who is most likely to benefit from public policies to improve community infrastructure, education, and health care.

Gender Differences in Child Health-care Practices: Evidence from the Pakistan Demographic and Health Survey, 1990-91

Among other factors, health care utilisation is important in determining the health status and survival chances of children. The patterns of childhood mortality, in general, indicate that deaths of male children have consistently exceeded those of females, with a much greater difference in the first month of birth (NNR). This has largely been attributed to differences in the genetic and biological factors between the sexes [Lopez and Ruzika (1983)]. The mortality level, thereafter, is influenced more by the socio-economic, environmental, and health care factors, indicating a mortality disadvantage for females in some populations. It has therefore been postulated that gender-based differences in health care practices partly explain the sex differentials in child mortality in some countries of South Asia, where healthseeking behaviour of parents discriminates against female children [Chen, et al. (1981); Das Gupta (1987); Sathar (1987); Ahmed (1990)]. Using data from Bangladesh, Chen, Haq, and D’Souza (1981) found that girls’ mortality risk was nearly 60 percent higher than that for boys after the neonatal period, and that girl children suffered more malnutrition and received lesser treatment for various infections. Das Gupta (1987) and Muhuri and Preston (1991) also explained the excess mortality of girls with a surviving elder sister in terms of conscious, selective neglect of the second daughter. Waldron (1983) in her extensive review of child mortality patterns in developing countries concluded that besides relative contributions of specific causes of death with different impact by sex, the variability in discrimination by gender, primarily in nutrition and health care utilisation, also contributes to excess female child mortality (1–4 age group).

Health Care Determinants of Child Survival in Pakistan

The health and survival status of children which are important indicators of social well-being, have become a subject of great concern in Pakistan in recent years. The available literature suggests that infant and child death rates in Pakistan are high even in the context of the Asian region and progress in health and survival of children has been much less than the desired level [World Bank (1993)]. Although estimates of infant and child mortality rates as derived from various data sources in Pakistan show great variation, 1 the available evidence indicates· that nearly 58 percent of all deaths occur among children under five years of age, 36 percent die during infancy and more than half of all infant deaths occur within the first four weeks of their birth [Irfan (1986); Afzal et al. (1988); Rukanuddin and Parooqui (1988); Sathar (1994)]. Recognising the fact that most of these deaths could be prevented, it is important to study the processes that are likely to influence the survival chances of children, the health care factors in particular, which are important components of mortality change.