Variations In Infant Mortality Research Articles

Community-level determinants of infant mortality in Mexico.

SummaryData from pregnancy histories collected by the 1976–77 Mexican Fertility Survey show wide variations in infant mortality among a sample of 125 communities. There are also large infant mortality differentials by population size, economic status, access variables, utilities, medical facilities and schools. These community-level factors, which have been little used in previous studies, are highly correlated and do not appear to affect infant survival independently of population size. As such, community size serves as a summary measure of a locality's overall level of development and comparative risk of early death for its young inhabitants.

Intra-urban variations of neonatal and post-neonatal mortality in a developing city

Numerous surveys at the national and regional level have demonstrated that large inequalities in infant health status exist in Southern Africa. Few studies have assessed infant mortality at the intra-urban scale of geographic analysis. Comparisons between infant mortality rates from different areas are made even more meaningful if the data are divided into two primary categories based on period-of-death; these being the neonatal and post-neonatal components. This study presents the results of a survey undertaken in Metropolitan Cape Town (population 1.6 million) during 1982. The aim was to determine the spatial variation of neonatal and post-neonatal mortality at the suburb (or community) level within the city. Overall, a total of 36,789 live births and 928 infant deaths were recorded; 53.4% in the neonatal period and 46.6% in the post-neonatal period. The mean infant mortality rate was 25.2 per 1000 live births; the neonatal mortality rate and post-neonatal mortality rate being 13.5/1000 and 11.7/1000, respectively. A marked range in death rates was evident for both components. For the neonatal category it was 0.0–49.9/1000 and 0.0–40.0/1000 for the post-neonatal period. The generally low post-neonatal mortality rate among the 69 suburbs studied has made the neonatal component the dominant contributor to the infant mortality rate. However, in the lowest socio-economic areas the post-neonatal mortality rate was responsible for over 60% of infant deaths. The results from this study clearly support the assumption of an inverse relationship between socio-economic status and infant death rates, particularly for the most socially deprived areas where the post-neonatal mortality rates were four to five times higher than compared with higher socio-economic suburbs. Spatial analysis found that variations in infant mortality rates were significantly correlated with variations in the distribution of socio-economic status.

"Effect of Infant Mortality on Subsequent Fertility in Pakistan and Sri Lanka"

This study used data from the 1975 World Fertility Surveys in Pakistan and Sri Lanka to examine the association between fertility and infant mortality. A positive association between the mean number of children ever born and the number of child deaths was found in both rural and urban areas of each country. In Pakistan women with no child loss had 3.3 children ever born while those who lost 1 child had 4.7 children; in Sri Lanka the figures were 3.5 and 5.4 children respectively. However child replacement was much less marked when controls were introduced for demographic and socioeconomic factors. When deaths at specific parities were examined and age and time since previous birth were controlled child replacement at the 1st parity was reduced to .3 in Pakistan and .2 in Sri Lanka. Further control for a series of socioeconomic factors (e.g. husbands level of education husbands occupation household structure religion standard of living) reduced the child replacement ratio to .2 children in Pakistan and zero in Sri Lanka. Replacement was slightly more pronounced when there were fewer surviving male children. This analysis suggests that the relationship between infant mortality and fertility is complex. A possibility that could not be explored in this study is that variation in fertilitty may itself be responsible for some of the variation in infant mortality.

Determinants of Regional Variations in Infant Mortality in Rural India

An analytical framework is specified for understanding the determinants of infant mortality. It distinguishes between factors at three levels – village, household and individual – and arranges them in ascending order with respect to their proximity to infant mortality. Village and household-level factors are assumed to influence infant mortality indirectly by influencing at least one of the six individual-level factors. The present analysis of the data aggregated at the state level clearly demonstrates the importance of both medical and non-medical factors for explaining the observed regional differences in infant mortality in rural India. The percentage of births attended by trained medical personnel and poverty, are the two important determinants of regional variations in neo-natal mortality; and the village-level availability of medical facilities and the extent of triple vaccination are the two important determinants of post-neo-natal mortality. The influence of adult women's literacy on infant mortality is explained by better medical care at birth, and preventive and curative medical care during the post-neo-natal period. Medical factors have been shown to be slightly more important than non-medical factors. This suggests that it might be possible to reduce the high level of infant mortality currently prevalent in many states in India by simple preventive medical interventions.

Infant mortality in Sri Lankan households: A causal model

The infant mortality rate in Sri Lanka has fallen precipitiously since World War II, to 44 per 1000 births, a rate that is similar to a number of Western Countries. Yet the aggregated country rate masks wide variations across districts, from a low 21 per 1000 in Jaffina District to a high of 100 per 1000 in Nuwara Eliya District. Such regional variations in infant mortality rates have been shown to be related to a number of social, demographic and intitutional characteristics of each area. To specify such linkages we move, in this paper, from the aggregate level of analysis to the level of individual households in order to look for social, economic and other characteristics associated with infant deaths. Data are derived from a systematic interview of 480 household heads in 12 villages of Sri Lanka, collected in 1980. The most proximate factors, public health or medical variables, that predict infant death in particular households include quality of family nutrition, supervised childbirth, immunization of children and, most significant, whether the family has a sanitary latrine. Yet these medical variables are strongly associated with educational and economic characteristics of the family which, in turn, are predictive of infant mortality. Poor families and poorly educated mothers are less likely to go to hospital for childbirth, have a latrine, etc., and more likely to have had an infant die. Underlying the variations in education and economic status are variations in ethnic group; families with poor sanitation, least education and few economic resources are most likely to be members of the minority communities, Ceylon or Indian Tamils and Muslims. Minority group membership is significantly associated with infant mortality as well. When a set of medical, educational, economic and cultural variables are examined simultaneously within a path model we show that the best causal explanation of infant death in Sri Lankan households says, “Minority group status results in poverty which prevents families from having safe sanitary facilities which causes infant death”. Infant mortality in Sri Lanka is thus not simply a medical problem to be dealt with by public health programs, nor is it solely an economic problem that can be solved with creation of jobs, but it is better seen as a problem of the structure of the whole society.

Patterns and variations in the relationship between infant mortality and socioeconomic status.

This study utilizes an ecological approach based on census tracts of residence to examine the relationship between infant mortality and socioeconomic status in metropolitan Ohio, US, at 2 two points in time (1959-1961 and 1969-1971). The data presented clearly indicate that the infant mortality rate continues to exhibit a pronounced inverse association with a wide variety of socioeconomic variables. Although there were some notable exceptions and variations from the general patterns, a basic inverse relationship was characteristic of both neonatal and postneonatal components of infant mortality, for both males and females, and for both major exogenous and endogenous causes of death. Of all the variables examined, the 1 factor that emerged as the strongest and most consistent determinant of census tract variations in infant mortality was the proportion of low income families. Thus, the overriding conclusion suggested by this study is that in spite of such things as continued advances in medicine and public health, the expansion of social programs during the 1960s, and the recent resumption of a downward trend in the infant mortality rate, there has been little if any progress in achieving more equitable life chances for the economically deprived segments of our population.

The percentage of deaths under one year of age of all deaths in Finland in 1749-1865

The proportion of deaths under one year of age is examined in relation to all deaths occurring in Finland from 1749 to 1865. Data are from a sample of parish registers. The results show a steady decline from the late 1700s to the mid-1800s with the proportion dropping from 33.7 percent in 1749-1773 to 24.6 percent in 1841-1865. Regional variations in infant mortality are also considered. (ANNOTATION)

Seasonal variation in infant mortality : an approach with applications

La plupart des études de démographie historique relatives aux variations saisonnières de la mortalité infantile s'en tiennent aux fluctuations mensuelles du nombre des décès. Ceci n'est pas satisfaisant, à cause de l'incidence potentielle du mouvement saisonnier des naissances. Pourtant, avec la reconstitution des familles, on peut évaluer les fluctuations saisonnières en termes de risque actuel de mortalité (et non plus de nombre de décès), et éliminer ainsi complètement l'influence du mouvement des naissances. On trouvera ici une manière de procéder et des résultats, comparés avec ceux tirés du seul mouvement des décès. La divergence des deux séries est maximale quand les variations saisonnières des naissances sont fortes et celles des risques de mortalité infantile faibles. On a appliqué la méthode à 14 villages allemands aux XVIIIe et XIXe siècles. Il apparaît que la saisonnalité des risques a changé beaucoup selon les époques et les régions, probablement en fonction des pratiques d'allaitement.

Maternal and child health: use of health status indicators in coordinating and targeting federal programs.

The United States has achieved dramatic improvements in overall maternal and child health status, yet faces disturbingly wide variations in the health status of many population subgroups. The Surgeon General in 1980 published specific quantitative objectives to stimulate further improvements in the health of the American people by 1990. A critical step in meeting relevant objectives is the more effective use at national, state, and local levels of available data, particularly infant, perinatal, neonatal, and maternal mortality rates and the incidence of low weight births. This paper reviews variations in infant mortality rates and five current federal "categorical" programs that aim to improve maternal and child health: Supplemental Feeding Program for Women, Infants and Children; Head Start; Maternal and Child Health; Family Planning; and Community Health Centers. Several examples are cited of effective use of data in the coordination and targeting of resources from these large public programs. Recommendations are made for enhancement of federal maternal and child health programs within current funding levels. These recommendations will be all the more relevant if the Congress enacts block grants to the states with lower total funding.

Variations in Infant Mortality Rates Among Counties of the United States: The Roles of Public Policies and Programs

The purpose of this paper is to shed light on the causes of the rapid decline in the infant mortality rate in the United States in the period after 1963. The roles of four public policies are considered: Medicaid, subsidized family planning services for low-income women, maternal and infant care projects, and the legalization of abortion. The most striking finding is that the increase in the legal abortion rate is the single most important factor in reductions in both white and nonwhite neonatal mortality rates. Not only does the growth in abortion dominate the other public policies, but it also dominates schooling and poverty.

Living conditions in childhood and subsequent development of risk factors for arteriosclerotic heart disease. The cardiovascular survey in Finnmark 1974-75.

Several studies in Norway have shown large differences in risk factors for arteriosclerotic heart disease among municipalities. Today it is difficult to show specific differences in the standard of living between the various municipalities to explain these findings. However, such differences have previously existed, and were expressed by, for example, the variations in infant mortality from one municipality to another. In this work a significant positive correlation is shown between the cholesterol values among men and women aged 35-49 years and the infant mortality rate previously present in the municipalities for the same cohort. The findings indicate that poverty in childhood and adolescence, followed by later prosperity, results in high cholesterol values. The findings are related to previous work where a significant positive correlation was shown between infant mortality rates and later mortality rates from arteriosclerotic heart disease.

Are poor living conditions in childhood and adolescence an important risk factor for arteriosclerotic heart disease?

Norwegian counties show considerable variations in their rates of mortality from arteriosclerotic heart disease. These variations cannot be explained by present-day differences in standard of living. Such differences did exist in the past as was shown by large variations in infant mortality. A significant positive correlation has been found between the county age-adjusted mortality from arteriosclerotic heart disease in people aged between 40 and 69 years and county infant mortality relating to the early years in the same cohorts. The findings suggest that great poverty in childhood and adolescence followed by prosperity, is a risk factor for arteriosclerotic heart disease.

Father's age and infant mortality.

The role of the fathers age on infant mortality is examined through 1960 data gathered by the National Center for Health Statistics which linked 100000 death and birth certificates. The information on these matched certificates was used to obtain various distributions of infant deaths by mothers and fathers age. Causes were separated by race and by whether or not deaths were caused by congenital malformations. For each mothers age group among whites and nonwhites there was a distinct tendency for the death rate to fall and then rise again as the fathers age increased. The lowest rate generally occurred when the mothers and fathers age were about the same. For deaths from congenital malformations the sampe pattern is suggestively present among white death rates but not among nonwhite rates. Data from births registered in North Carolina in 1968 which included information on parents education were examined to see if variations in infant mortality rates with the fathers age result from irregular social circumstances such as the practice of less educated men to marry much younger women. The education level among both whites and nonwhites of older fathers and younger mothers were lower in every mothers age group than for couples roughly the same age. With these figures mortality associated with younger fathers tended to increase; with older fathers it tended to decrease. Deaths from congenital malformations showed no tendency toward this trend which contrasted sharpely with trends from the 1st study. The conclusion is reached that some support is found for the hypothesis that infant mortality increases as either the fathers age or the span between the mothers and fathers age increases and that except in the case of congenital malformations this results in part from socioeconomic factors.

Urban variation in infant mortality from birth injury and atelectasis in England and Wales in 1958-67.

Variations in mortality attributed to birth injury and atelectasis in the 10 years 1958-67 have been investigated for each county borough of England and Wales. It became evident that diagnostic difficulties in separating these two causes must have been such that for statistical purposes they should be combined in a single rate.Variables likely to affect the local rates such as the sex ratio of births, and rates of illegitimacy and immaturity as an ill-defined cause of death appeared to affect the mortality levels in certain towns but not sufficiently to account for the wide variations apparent in those levels. It is concluded that local surveys are necessary in the towns with highest rates to uncover differences in numbers of births in hospital, in obstetric techniques and in quality of medical care.

Intermediaries, innovation, and change.

IN DEMONSTRATING how the American health care system is failing to meet the needs of our citizens, critics and commentators cite an impressive-and shockingarray of statistics. One statistic often used is that the U. S. ranks thirteenth among nations in infant mortality, due to the 75,000 newborn deaths which occurred in our country last year. While this is a shameful condition, comparing our nation to England or West Germany in infant health is not nearly as important as examining the variation in infant mortality between Massachusetts and Mississippi, or between Chicago's inner city and its suburbs, or even within the city itself. Therein lies a much greater-and more pressing-indicator of what is wrong with our health care system. Further evidence of the inequity in our health delivery system is the fact that the death rate from tuberculosis or the inci-