COVARIATES OF CHILD MORTALITY IN MALI: DOES THE HEALTH-SEEKING BEHAVIOUR OF THE MOTHER MATTER?

2001 ◽  
Vol 33 (1) ◽  
pp. 33-54 ◽  
Author(s):  
JOSEPH MASUDI UCHUDI
Keyword(s):  
Child Mortality ◽  
Rural Areas ◽  
Socioeconomic Development ◽  
Maternal Education ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Special Focus ◽  
Health Seeking Behaviour ◽  
Health Seeking ◽  
Wide Range

This paper uses data from the 1995/96 Mali DHS survey to examine the importance of a wide range of socioeconomic, behavioural and biodemographic factors in the determination of child mortality in Mali, with a special focus on maternal education and behaviour. The central hypothesis of the study is that advances in maternal education would contribute little to child survival in settings such as Mali’s urban and rural communities where progress in educational attainment is not matched with improvements in other aspects of socioeconomic development such as economic growth, job creation, financial security and public health and medical resources. Units of analysis are children born in the past 5 years to DHS respondents (women aged 15–45) who were married at the time of the survey. The Cox proportional hazards regression technique has been used to estimate the net effects of variables included as covariates. The findings indicate that the health-seeking behaviour of the mother matters more than maternal education in explaining the observed differences in infant and child mortality in Mali’s urban and rural areas.

ROLE OF HEALTH-SEEKING BEHAVIOUR IN CHILD MORTALITY IN THE SLUMS OF KARACHI, PAKISTAN

2002 ◽  
Vol 35 (1) ◽  
pp. 131-144 ◽  
Author(s):  
RENNIE M. D’SOUZA
Keyword(s):  
Child Mortality ◽  
Maternal Education ◽  
Family Health ◽  
Respiratory Illness ◽  
Population Based ◽  
Health Seeking Behaviour ◽  
Health Seeking ◽  
Under Five ◽  
Life Threatening

The role of family health-seeking behaviour in under-five-year child mortality was explored through the combined approach of examining health-seeking behaviour regarding treatment generally, and in specific in relation to illness before death. A population-based case control study was carried out during the period 1993–1994 using 222 deaths from diarrhoea and acute respiratory illness (ARI) in children under five years of age in six slums of Karachi as cases, and 419 controls matched on age, disease (diarrhoea and ARI) and slum. Factors significantly associated (p<0·05) with child mortality in the multivariate analysis were: mothers changing healers quickly, using a traditional healer or an unqualified doctor and mothers to whom doctors did not explain the treatment, even when maternal education was controlled for. Seeking effective medical services is highly influential on whether the child survives or succumbs to ARI or diarrhoea. As mothers are the first providers of care, an attempt should be made to try and improve their skills through health education so that they can use simple and effective treatments for minor illnesses. They should also be taught to recognize potentially life-threatening conditions, to seek care early and to persist with treatment.

Correlates of Child Mortality in Pakistan: A Hazards Model Analysis

1999 ◽  
Vol 38 (1) ◽  
pp. 85-118 ◽  
Author(s):  
Jennifer Benneti
Keyword(s):  
Child Mortality ◽  
Proportional Hazards ◽  
Contraceptive Use ◽  
Proportional Hazards Model ◽  
Economic Status ◽  
Model Analysis ◽  
Health Seeking ◽  
Large Cities ◽  
Number Of Children ◽  
Hazards Model

This study investigated factors associated with child mortality in an area in Rawalpindi, one of the large cities of Pakistan. Using both demographic and anthropological methods, the research was conducted to specifically examine the processes and mechanisms whereby a link is established between child mortality and its covariates. Controlling for the socio-economic status as a determinant of child mortality, the study population was limited to a lower income stratum living in a homogeneous environment where all households had equal access to health-related and other facilities. Results of the proportional hazards model analysis on 130I index children suggest that non-economic factors like maternal health-seeking behaviour were related to high child mortality. The cultural norm of bearing a large number of children was the most significant correlate. In order of significance, this was followed by contraceptive use, current age of the mother, age at marriage and the hygienic conditions of the household. The study provides strong evidence of familial clustering of mortality by order of the household.

scholarly journals How long does it take patients to find a new primary care physician when theirs retires: a population-based, longitudinal study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lindsay Hedden ◽  
Megan A. Ahuja ◽  
M. Ruth Lavergne ◽  
Kimberlyn M. McGrail ◽  
Michael R. Law ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Rural Areas ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Care Physician ◽  
Potential Threat ◽  
Patient Age ◽  
Patient Âgé

Abstract Background The retirement of a family physician can represent a challenge in accessibility and continuity of care for patients. In this population-based, longitudinal cohort study, we assess whether and how long it takes for patients to find a new majority source of primary care (MSOC) when theirs retires, and we investigate the effect of demographic and clinical characteristics on this process. Methods We used provincial health insurance records to identify the complete cohort of patients whose majority source of care left clinical practice in either 2007/2008 or 2008/2009 and then calculated the number of days between their last visit with their original MSOC and their first visit with their new one. We compared the clinical and sociodemographic characteristics of patients who did and did not find a new MSOC in the three years following their original physician’s retirement using Chi-square and Fisher’s exact test. We also used Cox proportional hazards models to determine the adjusted association between patient age, sex, socioeconomic status, location and morbidity level (measured using Johns Hopkins’ Aggregated Diagnostic Groupings), and time to finding a new primary care physician. We produce survival curves stratified by patient age, sex, income and morbidity. Results Fifty-four percent of patients found a new MSOC within the first 12 months following their physician’s retirement. Six percent of patients still had not found a new physician after 36 months. Patients who were older and had higher levels of morbidity were more likely to find a new MSOC and found one faster than younger, healthier patients. Patients located in more urban regional health authorities also took longer to find a new MSOC compared to those in rural areas. Conclusions Primary care physician retirements represent a potential threat to accessibility; patients followed in this study took more than a year on average to find a new MSOC after their physician retired. Providing programmatic support to retiring physicians and their patients, as well as addressing shortages of longitudinal primary care more broadly could help to ensure smoother retirement transitions.

scholarly journals Maternal Education, Fertility, and Child Survival in Comoros

2018 ◽  
Vol 15 (12) ◽  
pp. 2814 ◽  
Author(s):  
Abayomi Samuel Oyekale ◽  
Thonaeng Charity Maselwa
Keyword(s):  
Child Mortality ◽  
Socioeconomic Development ◽  
Formal Education ◽  
Maternal Education ◽  
Child Survival ◽  
Regression Method ◽  
Probit Regression ◽  
Two Stage ◽  
Reduce Child Mortality ◽  
Household Headship

Reduction in child mortality is a demographic progress of significant socioeconomic development relevance in Africa. This paper analyzed the effect of maternal education and fertility on child survival in the Islands of Comoros. The 2012 Demographic and Health Survey (DHS) data were used. A two-stage probit regression method was used for data analysis. The results showed that about 75% of the children’s mothers had given birth to between one and five children, while more than half did not have any form of formal education. The results of the two-stage probit regression showed that while child survival reduced significantly (p < 0.05) with the age of the heads of households, residence in the Ngazidja region, being born as twins, mother’s number of business trips, and number of marital unions, it increased with maternal education, fertility, male household headship, and the child being breastfed immediately after birth. It was concluded that efforts to enhance maternal education would reduce child mortality. It is also critical to promote child breastfeeding among women, while regional characteristics promoting differences in child mortality in Comoros Islands should be properly addressed with keen focus on the Ngazidja region.

MODELLING THE DETERMINANTS OF UNDER-FIVE CHILD MORTALITY RATES USING COX PROPORTIONAL HAZARDS REGRESSION MODEL

2021 ◽  
Vol 4 (4) ◽  
pp. 401-408
Author(s):  
M. C. Musa ◽  
O. E. Asiribo ◽  
H. G. Dikko ◽  
M. Usman ◽  
S. S. Sani
Keyword(s):  
Regression Model ◽  
Child Mortality ◽  
Proportional Hazards ◽  
Mortality Rates ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Predictor Variables ◽  
Under Five ◽  
Cox Proportional Hazards Regression ◽  
Proportional Hazards Regression

An under-five childhood mortality rates in Nigeria is still high, despite efforts of government at all levels to combat the menace. This study examined some factors that significantly affect under-five child mortality. A sample of mothers with children under the age of five from Nigeria Demographic and Health Survey data (NDHS, 2013 & 2018) was used to assess the effect of some selected predictor variables (or covariates) on childhood survival. Cox proportional hazards model is essentially a regression model popularly used for investigating the association between the survival time and one or more predictor variables. The results from final fitted Cox proportional hazards regression model that the covariates, contraceptive used by the mother, state of residence, birth weight of child and type of toilet facility used by the h-ousehold were found to be significantly associated with under-five survival in the North Central Region of Nigeria. All the calculations are performed using the R software for statistical analysis.

scholarly journals Out-of-sequence DTP and measles vaccinations and child mortality in Guinea-Bissau: a reanalysis

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e024893 ◽  
Author(s):  
Sanne M Thysen ◽  
Amabelia Rodrigues ◽  
Peter Aaby ◽  
Ane B Fisker
Keyword(s):  
Mortality Rate ◽  
Child Mortality ◽  
Proportional Hazards ◽  
Child Survival ◽  
Secondary Analysis ◽  
Oral Polio Vaccine ◽  
Vaccination Schedule ◽  
Cox Proportional Hazards ◽  
Vaccination Status ◽  
Guinea Bissau

ObjectivesTo assess whether the sequence of diphtheria-tetanus-pertussis vaccine (DTP) and measles vaccine (MV) was associated with child survival in a dataset previously used to assess non-specific effects of vaccines with no consideration of vaccination sequence.DesignProspective cohort study analysed using the landmark approach.SettingBandim Health Project’s Health and Demographic Surveillance System covering 100 village clusters in rural Guinea-Bissau. The recommended vaccination schedule was BCG and oral polio vaccine (OPV) at birth, DTP and OPV at 6, 10 and 14 weeks, MV at 9 months and booster DTP and OPV at 18 months of age.ParticipantsChildren aged 9–17 months (main analysis) and 18–35 months (secondary analysis: age of booster DTP) with vaccination status assessed between April 1991 and April 1996.MethodsSurvival during the 6 months after assessing vaccination status was compared by vaccination sequence in Cox-proportional hazards models with age as underlying time. Analyses were stratified by sex and village cluster.Main outcome measureMortality rate ratio (MRR) for out-of-sequence vaccinations compared with in-sequence vaccinations.ResultsAmong children aged 9–17 months, 60% of observations (3574/5937) were from children who had received both MV and DTP. Among these, 1590 observations were classified as in-sequence vaccinations (last DTP before MV), and 1984 observations were out-of-sequence vaccinations (1491: MV with DTP and 493: MV before DTP). Out-of-sequence vaccinations were associated with higher mortality than in-sequence vaccinations (MRR 2.10, 95% CI 1.07 to 4.11); the MRR was 2.30 (95% CI 1.15 to 4.58) for MV with DTP and 1.45 (95% CI 0.50 to 4.22) for DTP after MV. Associations were similar for boys and girls (p=0.77). Between 18 and 35 months the mortality rate increased among children vaccinated in-sequence and the differential effect of out-of-sequence vaccinations disappeared.ConclusionOut-of-sequence vaccinations may increase child mortality. Hence, sequence of vaccinations should be considered when planning vaccination programmes or introducing new vaccines into the current vaccination schedule.

Multimorbidity and Polypharmacy Are Independently Associated With Mortality in Older People With Intellectual Disabilities: A 5-Year Follow-Up From the HA-ID Study

2018 ◽  
Vol 123 (1) ◽  
pp. 72-82 ◽  
Author(s):  
Josje D. Schoufour ◽  
Alyt Oppewal ◽  
Hanne J.K. van der Maarl ◽  
Heidi Hermans ◽  
Heleen M. Evenhuis ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Older People ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Survival Models ◽  
Future Research ◽  
Mortality Data ◽  
Chronic Medication ◽  
Wide Range

Abstract We studied the association between multimorbidity, polypharmacy, and mortality in 1,050 older adults (50+) with intellectual disability (ID). Multimorbidity (presence of ≥ 4 chronic health conditions) and polypharmacy (presence ≥ 5 chronic medication prescriptions) were collected at baseline. Multimorbidity included a wide range of disorders, including hearing impairment, thyroid dysfunction, autism, and cancer. Mortality data were collected during a 5-year follow-up period. Cox proportional hazards models were used to determine the independent association between multimorbidity and polypharmacy with survival. Models were adjusted for age, sex, level of ID, and the presence of Down syndrome. We observed that people classified as having multimorbidity or polypharmacy at baseline were 2.60 (95% CI = 1.86–3.66) and 2.32 (95% CI = 1.70–3.16) times more likely to decease during the follow-up period, respectively, independent of age, sex, level of ID, and the presence of Down syndrome. Although slightly attenuated, we found similar hazard ratios if the model for multimorbidity was adjusted for polypharmacy and vice versa. We showed for the first time that multimorbidity and polypharmacy are strong predictors for mortality in people with ID. Awareness and screening of these conditions is important to start existing treatments as soon as possible. Future research is required to develop interventions for older people with ID, aiming to reduce the incidence of polypharmacy and multimorbidity.

scholarly journals Individual-, maternal- and household-level factors associated with stunting among children aged 0–23 months in Bangladesh

2018 ◽  
Vol 22 (1) ◽  
pp. 85-94 ◽  
Author(s):  
Sabuj Kanti Mistry ◽  
Md. Belal Hossain ◽  
Fouzia Khanam ◽  
Fahmida Akter ◽  
Mahmood Parvez ◽  
...  
Keyword(s):  
Rural Areas ◽  
Random Sampling ◽  
Maternal Education ◽  
Reduction Rate ◽  
Urban Slums ◽  
Health Concern ◽  
Special Focus ◽  
Cross Sectional Survey ◽  
Household Level ◽  
Factors Associated

AbstractObjectiveChildhood stunting remains a major public health concern in Bangladesh. To accelerate the reduction rate of stunting, special focus is required during the first 23 months of a child’s life when the bulk of growth takes place. Therefore the present study explored individual-, maternal- and household-level factors associated with stunting among children under 2 years of age in Bangladesh.DesignData were collected through a nationwide cross-sectional survey conducted between October 2015 and January 2016. A two-stage cluster random sampling procedure was applied to select 11 428 households. In the first stage, 210 enumerations areas (EA) were selected with probability proportional to EA size (180 EA from rural areas, thirty EA from urban slums). In the second stage, an average of fifty-four households were selected from each EA through systematic random sampling.SettingRural areas and urban slums of Bangladesh.ParticipantsA total of 6539 children aged 0–23 months.ResultsOverall, 29·9 % of the children were stunted. After adjusting for all potential confounders in the modified Poisson regression model, child’s gender, birth weight (individual level), maternal education, age at first pregnancy, nutrition (maternal level), administrative division, place of residence, socio-economic status, food security status, access to sanitary latrine and toilet hygiene condition (household level) were significantly associated with stunting.ConclusionsThe study identified a number of potentially addressable multilevel risk factors for stunting among young children in Bangladesh that should be addressed through comprehensive multicomponent interventions.

Gender, socioeconomic development and health-seeking behaviour in Bangladesh

2000 ◽  
Vol 51 (3) ◽  
pp. 361-371 ◽  
Author(s):  
Syed Masud Ahmed ◽  
Alayne M Adams ◽  
Mushtaque Chowdhury ◽  
Abbas Bhuiya
Keyword(s):  
Socioeconomic Development ◽  
Health Seeking Behaviour ◽  
Health Seeking

Parental education and child mortality in Burundi

1991 ◽  
Vol 23 (3) ◽  
pp. 255-262 ◽  
Author(s):  
Josephine O'Toole ◽  
Robert E. Wright
Keyword(s):  
Child Mortality ◽  
Health Survey ◽  
Parental Education ◽  
Maternal Education ◽  
Proportional Hazards ◽  
Demographic And Health Survey ◽  
Proportional Hazards Models ◽  
Key Factor ◽  
Using Data ◽  
The Relationship

SummaryThis paper examines the relationship between parental education and child mortality in Burundi using data collected in the 1987 Demographic and Health Survey. Proportional hazards models are estimated to examine this relationship, while holding constant other known child mortality determinants. Parental education proves to be a key factor in explaining differences in child mortality, the effect of maternal education being particularly strong compared to paternal education.

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