BIRTH SPACING AND CHILD MORTALITY: AN ANALYSIS OF PROSPECTIVE DATA FROM THE NAIROBI URBAN HEALTH AND DEMOGRAPHIC SURVEILLANCE SYSTEM

SummaryThe majority of studies of the birth spacing–child survival relationship rely on retrospective data, which are vulnerable to errors that might bias results. The relationship is re-assessed using prospective data on 13,502 children born in two Nairobi slums between 2003 and 2009. Nearly 48% were first births. Among the remainder, short preceding intervals are common: 20% of second and higher order births were delivered within 24 months of an elder sibling, including 9% with a very short preceding interval of less than 18 months. After adjustment for potential confounders, the length of the preceding birth interval is a major determinant of infant and early childhood mortality. In infancy, a preceding birth interval of less than 18 months is associated with a two-fold increase in mortality risks (compared with lengthened intervals of 36 months or longer), while an interval of 18–23 months is associated with an increase of 18%. During the early childhood period, children born within 18 months of an elder sibling are more than twice as likely to die as those born after an interval of 36 months or more. Only 592 children experienced the birth of a younger sibling within 20 months; their second-year mortality was about twice as high as that of other children. These results support the findings based on retrospective data.

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Birth spacing and infant and early childhood mortality in a high fertility area of Bangladesh: age-dependent and interactive effects

Journal of Biosocial Science ◽

10.1017/s0021932000023002 ◽

1995 ◽

Vol 27 (4) ◽

pp. 393-404 ◽

Cited By ~ 35

Author(s):

Nurul Alam

Keyword(s):

Early Childhood ◽

Birth Interval ◽

Neonatal Period ◽

Birth Spacing ◽

Childhood Mortality ◽

High Fertility ◽

Birth Intervals ◽

Risk Of Death ◽

Older Siblings ◽

Older Sibling

SummaryTo examine the effects of birth spacing on early childhood mortality, 3729 singleton births in 1983–84 were followed for 3 years in rural Bangladesh. Logistic regression analyses were used to assess whether the survival of older siblings modifies the effect of preceding birth intervals and to see if the effects of preceding and succeeding birth intervals are inter-related, controlling for the effects of sex of the child, mother's age and household economic status. With the exception of the neonatal period, birth spacing effects were highly significant. A preceding birth interval of <15 months was associated with a greater mortality risk in the post-neonatal period for children with an older sibling who survived infancy. However, a short preceding birth interval did not adversely affect post-neonatal mortality if the older sibling died in infancy. Neonatal and post-neonatal deaths were higher if older siblings had died in respective age intervals. A pregnancy interval of <12 months after childbirth raised the risk of death at ages 1–2 years considerably if the child was born after a short birth interval (<15 months). The results suggest that the high mortality risks of closely spaced children are due to sibling competition for parental resources.

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EFFECTS OF INFANT FEEDING PRACTICES AND BIRTH SPACING ON INFANT AND CHILD SURVIVAL: A REASSESSMENT FROM RETROSPECTIVE AND PROSPECTIVE DATA

Journal of Biosocial Science ◽

10.1017/s0021932097003039 ◽

1997 ◽

Vol 29 (3) ◽

pp. 303-326 ◽

Cited By ~ 9

Author(s):

BARTHELEMY KUATE DEFO

Keyword(s):

Breast Feeding ◽

Health Care Services ◽

Child Survival ◽

Birth Spacing ◽

Childhood Mortality ◽

Protective Effects ◽

Design Data ◽

Prospective Data ◽

Care Services ◽

Immunisation Status

Retrospective and prospective data collected in Cameroon were used to reassess hypotheses about how infant and early childhood mortality is affected by birth spacing and breast-feeding. These data show that: (a) a short preceding birth interval is detrimental for child survival in the first 4 months of life; (b) full and partial breast-feeding have direct protective effects on child survival in the first 4-6 months of life, with the effects of the former stronger than those of the latter; (c) early subsequent conception significantly increases mortality risks in the first 16 months of life of the index child. These findings are robust to various controls, e.g. study design, data defects, child's health conditions at/around birth, postnatal maternal and child recurrent illnesses, patterns of utilisation of health care services, and immunisation status of the child.

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Breast-feeding and child survival in Matlab, Bangladesh

Journal of Biosocial Science ◽

10.1017/s0021932000021180 ◽

1994 ◽

Vol 26 (2) ◽

pp. 143-154 ◽

Cited By ~ 7

Author(s):

M. Shahidullah

Keyword(s):

Early Childhood ◽

Longitudinal Data ◽

Socioeconomic Factors ◽

Breast Feeding ◽

Birth Interval ◽

Child Survival ◽

Hazard Model ◽

Childhood Mortality ◽

Previous Birth ◽

Model Approach

SummaryThis study investigates the effect of both total and unsupplemented breast-feeding in conjunction with birth interval on early childhood mortality, using longitudinal data from Matlab, Bangladesh. A discrete hazard model approach shows that it is not the duration of total breast-feeding but the duration of unsupplemented breast-feeding which increases child survival. Unsupplemented breast-feeding appears as such a crucial determinant of early childhood mortality that its effect could not be substantially attenuated even when important demographic and socioeconomic factors were controlled. Each of the covariates—supplementation, previous birth interval and onset of a subsequent conception—has an independent influence on early childhood mortality.

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Domestic violence and early childhood mortality in rural India: evidence from prospective data

International Journal of Epidemiology ◽

10.1093/ije/dyq066 ◽

2010 ◽

Vol 39 (3) ◽

pp. 825-833 ◽

Cited By ~ 28

Author(s):

M. A. Koenig ◽

R. Stephenson ◽

R. Acharya ◽

L. Barrick ◽

S. Ahmed ◽

...

Keyword(s):

Domestic Violence ◽

Early Childhood ◽

Childhood Mortality ◽

Rural India ◽

Prospective Data

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To What Extent Does Breastfeeding Explain Birth-Interval Effects on Early Childhood Mortality?

Demography ◽

10.2307/2061603 ◽

1989 ◽

Vol 26 (3) ◽

pp. 439 ◽

Cited By ~ 24

Author(s):

Robert D. Retherford ◽

Minja Kim Choe ◽

Shyam Thapa ◽

Bhakta B. Gubhaju

Keyword(s):

Early Childhood ◽

Birth Interval ◽

Childhood Mortality

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A hazard logit model analysis of covariates of childhood mortality in Matlab, Bangladesh

Journal of Biosocial Science ◽

10.1017/s0021932000020010 ◽

1992 ◽

Vol 24 (4) ◽

pp. 447-462 ◽

Cited By ~ 15

Author(s):

Abbas Bhuiya ◽

Kim Streatfield

Keyword(s):

Birth Order ◽

Logit Model ◽

Economic Status ◽

Child Survival ◽

Childhood Mortality ◽

Children Health ◽

A Prospective Study ◽

The Relationship ◽

Effect Of Age ◽

Health Programmes

SummaryIn a prospective study in Matlab, a rural area in Bangladesh, the relationship between a variety of covariates and childhood mortality was examined. Economic status of household, education of mother, sex of the children, health intervention programmes, age of mother, and live birth order of the children were identified as having a statistically significant impact on child survival when the effect of age was controlled. The effects of sex of the children, health programmes, age of mother, and birth order were found to be dependent on the age of the children, but the effect of mother's education was dependent on sex of the children.

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Immunotherapy to treat malignancy in patients with pre-existing autoimmunity

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2019-000356 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000356 ◽

Cited By ~ 3

Author(s):

Patrick Boland ◽

Anna C Pavlick ◽

Jeffrey Weber ◽

Sabina Sandigursky

Keyword(s):

Autoimmune Disease ◽

Autoimmune Diseases ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Retrospective Data ◽

Prospective Data ◽

The Past ◽

Increased Risk ◽

Autoimmune Conditions ◽

The Relationship

In the past 10 years, immune checkpoint inhibitors (ICIs) have become an additional pillar of cancer therapy by activating the immune system to treat a number of different malignancies. Many patients receiving ICIs develop immune-related adverse events (irAEs) that mimic some features of classical autoimmune diseases. Unfortunately, patients with underlying autoimmune conditions, many of whom have an increased risk for malignancy, have been excluded from clinical trials of ICIs due to a concern that they will have an increased risk of irAEs. Retrospective data from patients with autoimmune diseases and concomitant malignancy treated with ICIs are encouraging and suggest that ICIs may be tolerated safely in patients with specific autoimmune diseases, but there are no prospective data to guide management. In this manuscript, we review the relationship between pre-existing autoimmune disease and irAEs from checkpoint inhibitors. In addition, we assess the likelihood of autoimmune disease exacerbations in patients with pre-existing autoimmunity receiving ICI.

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"To What Extent Does Breastfeeding Explain Birth-Interval Effects on Early Childhood Mortality?"

Studies in Family Planning ◽

10.2307/1966441 ◽

1989 ◽

Vol 20 (6) ◽

pp. 365

Author(s):

Robert D. Retherford ◽

Minja Kim Choe ◽

Shyam Thapa ◽

Bhakta B. Gubhaju

Keyword(s):

Early Childhood ◽

Birth Interval ◽

Childhood Mortality

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Child survival and its effect on mortality of siblings in Bangladesh

Journal of Biosocial Science ◽

10.1017/s0021932000018708 ◽

1990 ◽

Vol 22 (3) ◽

pp. 333-347 ◽

Cited By ~ 2

Author(s):

A. K. Majumder

Keyword(s):

Child Mortality ◽

Birth Interval ◽

Child Survival ◽

Negative Influence ◽

Positive Influence ◽

Interval Length ◽

Index Child ◽

Mortality Risks ◽

Survival Status ◽

The Relationship

SummaryThis study of the relationship between mortality risks of siblings born to the same mother shows that, in Bangladesh, the death of the immediately preceding sibling in its infancy has a negative influence on the survival chance of the child in question in its infancy; however, death of the preceding sibling appears to have a positive influence on the index child's survival at ages 1–5 years. Similar results are found for the survival status of the two preceding siblings. Preceding birth interval length and survival status and sex of the immediately preceding sibling are also significant predictors of child mortality between ages 1 and 5 years. Possible explanations may be that the index child faces stronger competition from its immediately preceding brother than from its immediately preceding sister, or that the index child is likely to be looked after more by its preceding sister than by its preceding brother.

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