Spatial Modeling of Risk Factors for Gender-Specific Child Mortality

The global reduction of child mortality has been a priority of international and national organizations for the last few decades. Despite widespread global efforts to improve child survival, the latest UNICEF report on the State of the World’s Children 2000 (UNICEF, 2000) indicates that child mortality rates continue to remain higher in lesser developed countries (LDCs), and in some areas, girls continue to die at a greater rate than boys.

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Refocusing vitamin A supplementation programmes to reach the most vulnerable

BMJ Global Health ◽

10.1136/bmjgh-2019-001997 ◽

2020 ◽

Vol 5 (7) ◽

pp. e001997

Author(s):

Erin McLean ◽

Rolf Klemm ◽

Hamsa Subramaniam ◽

Alison Greig

Keyword(s):

Vitamin A ◽

Child Mortality ◽

Vitamin A Deficiency ◽

Child Survival ◽

Public Health Problem ◽

Mortality Rates ◽

Vitamin A Supplementation ◽

Use Of Resources ◽

Year 2000 ◽

Programme Coverage

WHO recommends vitamin A supplementation (VAS) programmes for children 6–59 months where vitamin A deficiency is a public health problem. However, resources for VAS are falling short of current needs and programme coverage is suffering. The authors present the case for considering the options for shifting efforts and resources from a generalised approach, to prioritising resources to reach populations with continued high child mortality rates and high vitamin A deficiency prevalence to maximise child survival benefits . This includes evaluating where child mortality and/or vitamin A deficiency has dropped, as well as using under 5 mortality rates as a proxy for vitamin A deficiency, in the absence of recent data. The analysis supports that fewer countries may now need to prioritise VAS than in the year 2000, but that there are still a large number of countries that do. The authors also outline next steps for analysing options for improved targeting and cost-effectiveness of programmes. Focusing VAS resources to reach the most vulnerable is an efficient use of resources and will continue to promote young child survival.

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Urban Slums and Children's Health in Less-Developed Countries

Journal of World-Systems Research ◽

10.5195/jwsr.2012.483 ◽

2012 ◽

pp. 103-115 ◽

Cited By ~ 2

Author(s):

Andrew K. Jorgenson ◽

James Rice

Keyword(s):

Regression Analysis ◽

Child Mortality ◽

National Level ◽

Urban Slum ◽

Developed Countries ◽

Mortality Rates ◽

Panel Regression ◽

Less Developed Countries ◽

Cross Sectional ◽

Per Capita

We utilize first-difference panel regression analysis to assess the direct effect of urban slumprevalence on national level measures of under-5 mortality rates over the period 1990 to 2005.Utilizing data on 80 less developed countries, the results illustrate increasing urban slumprevalence over the period is a robust predictor of increasing child mortality rates. This effectobtains net the statistically significant influence of gross domestic product per capita, fertilityrate, and educational enrollment. Cross-sectional analyses for 2005 that include additionalcontrols provide further evidence of the mortality / urban slum relationship. The results confirmurban slum prevalence growth is an important contextual dynamic whereby the socialproduction of child mortality is enacted in the less developed countries.

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Linking the timing of a mother’s and child’s death: Comparative evidence from two rural South African population-based surveillance studies, 2000–2015

PLoS ONE ◽

10.1371/journal.pone.0246671 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246671

Author(s):

Brian Houle ◽

Chodziwadziwa W. Kabudula ◽

Alan Stein ◽

Dickman Gareta ◽

Kobus Herbst ◽

...

Keyword(s):

Risk Factors ◽

Child Mortality ◽

Mortality Risk ◽

Child Survival ◽

Population Based ◽

Population Surveillance ◽

Comparative Investigation ◽

Rural South ◽

Increased Risk ◽

Before And After

Background The effect of the period before a mother’s death on child survival has been assessed in only a few studies. We conducted a comparative investigation of the effect of the timing of a mother’s death on child survival up to age five years in rural South Africa. Methods We used discrete time survival analysis on data from two HIV-endemic population surveillance sites (2000–2015) to estimate a child’s risk of dying before and after their mother’s death. We tested if this relationship varied between sites and by availability of antiretroviral therapy (ART). We assessed if related adults in the household altered the effect of a mother’s death on child survival. Findings 3,618 children died from 2000–2015. The probability of a child dying began to increase in the 7–11 months prior to the mother’s death and increased markedly in the 3 months before (2000–2003 relative risk = 22.2, 95% CI = 14.2–34.6) and 3 months following her death (2000–2003 RR = 20.1; CI = 10.3–39.4). This increased risk pattern was evident at both sites. The pattern attenuated with ART availability but remained even with availability at both sites. The father and maternal grandmother in the household lowered children’s mortality risk independent of the association between timing of mother and child mortality. Conclusions The persistence of elevated mortality risk both before and after the mother’s death for children of different ages suggests that absence of maternal care and abrupt breastfeeding cessation might be crucial risk factors. Formative research is needed to understand the circumstances for children when a mother is very ill or dies, and behavioral and other risk factors that increase both the mother and child’s risk of dying. Identifying families when a mother is very ill and implementing training and support strategies for other members of the household are urgently needed to reduce preventable child mortality.

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Determinants of Neonatal and Post-neonatal Mortality in Pakistan

The Pakistan Development Review ◽

10.30541/v41i4iipp.723-744 ◽

2002 ◽

Vol 41 (4II) ◽

pp. 723-744 ◽

Cited By ~ 8

Author(s):

M. Arshad Mahmood

Keyword(s):

Child Mortality ◽

Parental Education ◽

Child Survival ◽

Well Being ◽

Developed Countries ◽

Economic Conditions ◽

Medical Attention ◽

Infant And Child Mortality ◽

Socio Economic Variables ◽

Independent Effects

Ensuring the survival and well being of children is a concern of families, communities and nations throughout the world. Since the turn of the 20th century infant and child mortality in more developed countries has steadily declined and, currently, has been reduced to almost minimal levels. In contrast, although infant and child mortality has declined in the past three decades in most less developed countries, the pace of change and the magnitude of improvement vary considerably from one country to another. The inverse relationship between socio-economic variables of the parents and infant and child mortality is well established by several studies [Muhuri (1995); Forste (1994); Hobcraft, et al. (1984); Caldwell (1979); Sathar (1985, 1987)] and it holds true irrespective of the overall level of mortality in the national populations [Ruzicka (1989)]. The influence of parental education on infant and child health and mortality has proved to be universally significant [Bicego and Boerma (1993); Caldwell, et al. (1990)]. The father’s education, mother’s education and their work status each have independent effects upon child survival in developing countries [Sandiford, et al. (1995); Forste (1994); Caldwell, et al. (1983)]. Economic conditions of the household also help in explaining the variation in infant and child mortality. The nature of housing, diet, access to and availability of water and sanitary conditions as well as medical attention all depend on the economic conditions of the household. For example, poor families may reside in crowded, unhygienic housing and, thus, suffer from infectious disease associated with inadequate and contaminated water supplies and with poor sanitation [Esrey and Habicht (1986)].

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Risk Factors for Child Mortality in the Kassena-Nankana District of Northern Ghana: A Cross-Sectional Study Using Population-Based Data

Scientifica ◽

10.1155/2018/7692379 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Michael N. K. Babayara ◽

Bright Addo

Keyword(s):

Risk Factors ◽

Child Mortality ◽

Child Survival ◽

Survival Rates ◽

Public Health Problem ◽

Population Based ◽

Survival Strategies ◽

Northern Ghana ◽

Major Public Health Problem ◽

Cross Sectional

Child mortality continues to be a major public health problem in Ghana, especially in northern Ghana where child survival rates are among the lowest. Though strategies are in place to address it, progress made is unsatisfactory and the Sustainable Development Goal 3 risks being missed. This makes the reexamination of the risk factors for child mortality crucial as results will aid in the modification of existing strategies aimed at addressing the problem. This study was a population-based case control study utilizing data (2007–2011) from the Demographic Surveillance System database of the Navrongo Health Research Center. Cases and controls were selected from the database and analysed unmatched. Cases were children who died before age five and controls were live children within the same year group. Univariate and bivariate analyses were performed using STATA (v13). The results revealed the main causes of death in the area to include malaria, diarrhoeal diseases, respiratory infections, and malnutrition. Mother’s age at birth, mother’s educational level, and mother’s household socioeconomic status were significantly related to child mortality. On the basis of these results, we conclude that the known risk factors for child mortality in the Kassena-Nankana district have not changed much over the years. Current child survival strategies therefore need to be evaluated and modified where necessary to yield desired results.

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Trends in the association between educational assortative mating, infant and child mortality in Nigeria

BMC Public Health ◽

10.1186/s12889-021-11568-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tolulope Ariyo ◽

Quanbao Jiang

Keyword(s):

High Education ◽

Infant Mortality ◽

Assortative Mating ◽

Child Mortality ◽

Child Survival ◽

Mortality Rates ◽

Childhood Mortality ◽

Low Education ◽

Infant And Child Mortality ◽

Educational Assortative Mating

Abstract Background Existing knowledge has established the connection between maternal education and child survival, but little is known about how educational assortative mating (EAM), relates to childhood mortality. We attempt to examine this association in the context of Nigeria. Methods Data was obtained from the 2008, 2013, and 2018 waves of the Nigeria Demographic and Health Survey, which is a cross-sectional study. The sample includes the analysis of 72,527 newborns within the 5 years preceding each survey. The dependent variables include the risk of a newborn dying before 12 months of age (infant mortality), or between the age of 12–59 months (child mortality). From the perspective of the mother, the independent variable, EAM, includes four categories (high-education homogamy, low-education homogamy, hypergamy, and hypogamy). The Cox proportional hazard regression was employed for multivariate analyses, while the estimation of mortality rates across the spectrum of EAM was obtained through the synthetic cohort technique. Results The risk of childhood mortality varied across the spectrum of EAM and was particularly lowest among those with high-education homogamy. Compared to children of mothers in low-education homogamy, children of mothers in high-education homogamy had 25, 31 to 19% significantly less likelihood of infant mortality, and 34, 41, and 57% significantly less likelihood of child mortality in 2008, 2013 and 2018 survey data, respectively. Also, compared to children of mothers in hypergamy, children of mothers in hypogamous unions had 20, 12, and 11% less likelihood of infant mortality, and 27, 36, and 1% less likelihood of child mortality across 2008, 2013 and 2018 surveys, respectively, although not significant at p < 0.05. Both infant and child mortality rates were highest in low-education homogamy, as expected, lowest in high-education homogamy, and lower in hypogamy than in hypergamy. Furthermore, the trends in the rate declined between 2008 and 2018, and were higher in 2018 than in 2013. Conclusion This indicates that, beyond the absolute level of education, the similarities or dissimilarities in partners’ education may have consequences for child survival, alluding to the family system theory. Future studies could investigate how this association varies when marital status is put into consideration.

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Comparison of child mortality by characteristics at birth in England and in Sweden using linked administrative data

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.138 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Anna Zylbersztejn ◽

Ruth Gilbert ◽

Anders Hjern ◽

Pia Hardelid

Keyword(s):

Risk Factors ◽

Early Childhood ◽

Child Mortality ◽

Early Life ◽

Congenital Malformations ◽

Mortality Rates ◽

Birth Cohorts ◽

Policy Makers ◽

Live Births ◽

Administrative Health Databases

ABSTRACT ObjectivesEngland has one of the highest child mortality rates in Western Europe, while Sweden has one of the lowest. These differences suggest that improvements in early life mortality should be achievable in England. However, policy makers need to know when in the life course to target interventions to prevent the largest number of deaths in early life, e.g. by addressing the prevalence of risk factors at birth (such as preterm birth or low birthweight), or improving the care of babies after birth. This study aims to compare child mortality in England and in Sweden using whole country birth cohorts based on linked administrative health databases in order to determine whether the disparities are driven by risk factors operating before or after birth. ApproachWe created birth cohorts from a national birth register (Sweden) and a hospital admission database (England). These were linked to longitudinal hospital data and death registration data. All singleton live births for 2003-2012 were included and followed from birth up to five years. We compared mortality in England and in Sweden using Cox proportional hazard model with characteristics at birth (gestation, birthweight, gender, maternal age, congenital malformations), socio-economic status and country as covariates. ResultsThe study cohort comprised 1,047,192 children in Sweden and 6,117,693 children in England. 2,820 of cohort children died in Sweden (0.3%) and 28,434 in England (0.5%). Preliminary results showed that under-5 mortality was almost twice as high in England as in Sweden (5.1 deaths per 1000 live births, 95% confidence interval (CI): 5.0/1000-5.2/1000 vs 3.0/1000, 95% CI: 2.9/1000-3.2/1000). Mortality rates were 45% higher in England during infancy, but only 15% higher in early-childhood (1-4 years). Children with congenital malformations were at similar risk of death in England (33.9/1000, 95% CI: 32.9/1000-34.8/1000) as in Sweden (32.7/1000, 95% CI: 29.5/1000-35.8/1000). The prevalence of congenital malformations, however, was twice as high in England (5.1% vs 2.6%). ConclusionsOur preliminary results suggest that the disparities in early-childhood mortality were partly driven by increased prevalence of congenital malformations in England relative to Sweden, as mortality rates within this group were comparable. Individual-level data from birth cohorts constructed using linked administrative health databases enable comparing mortality among children with the same combinations of risk factors at birth. Such analyses can inform policy makers whether resources to prevent early-life mortality are most effectively targeted at improving the health of pregnant women, neonatal care, or supporting families with young children.

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Understanding the determinants of infant and under-five mortality rates: a multivariate decomposition analysis of Demographic and Health Surveys in Ghana, 2003, 2008 and 2014

BMJ Global Health ◽

10.1136/bmjgh-2019-001658 ◽

2019 ◽

Vol 4 (4) ◽

pp. e001658 ◽

Cited By ~ 4

Author(s):

Duah Dwomoh ◽

Susan Amuasi ◽

Kofi Agyabeng ◽

Gabriel Incoom ◽

Yakubu Alhassan ◽

...

Keyword(s):

Child Mortality ◽

Health Surveys ◽

Child Survival ◽

Mortality Rates ◽

Multiple Births ◽

Demographic And Health Surveys ◽

Adjusted Relative Risk ◽

Decomposition Approach ◽

Development Goal ◽

Under Five

IntroductionDespite the decline in infant and under-five mortality rates since the last decade, Ghana did not meet the millennium development goal (MDG) 4 target. To implement effective interventions that could fast-track progress towards achieving the sustainable development goal 3 in 2030, factors contributing to the decline in child mortality throughout the MDG period and which factor(s) has/have been consistent in affecting child survival in the last decade need to be understood.MethodsThis study used Demographic and Health Surveys (DHS) from 2003, 2008 and 2014 and data from World Bank Development Indicators (2000–2018). We employed modified Poisson with robust SE and multivariate decomposition approach to assess risk factors of child mortality using DHS data from 2003, 2008 and 2014. Penalised regression was used assess the effect of 25 country-level contextual factors on child survival.ResultsThe risk of infant mortality is approximately five times higher among mothers who had multiple births compared with mothers who had single birth over the last decade (adjusted relative risk 4.6, 95% CI 3.2 to 6.6, p<0.001). An increase in the annual percentage of female labour force participation (FLFP) is associated with the reduction of approximately 10 and 18 infant and under-five annual deaths per 1000 live births, respectively.ConclusionsThis study found that multiple births and shorter birth spacing are associated with increased risk of infant and under-five deaths over the last decade. Increased in FLFP, and the proportion of children sleeping under bed-net are associated with reduced risk of both infants and under-five deaths.

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The Prospects of Survival

A Shot of Justice ◽

10.1093/oso/9780199490592.003.0003 ◽

2019 ◽

pp. 86-143

Author(s):

Ali Mehdi

Keyword(s):

Child Mortality ◽

Child Survival ◽

Social Groups ◽

State Level ◽

The State ◽

Important Lesson ◽

Under Five ◽

The World ◽

Relative Standing ◽

Inter State

This chapter presents data on child mortality from the earliest time available. It begins with an overview of India’s performance vis-à-vis the top five contributors to under-five deaths in the world and then looks at both inter-state, intra-group, intra-state, and inter-group inequalities among social groups by gender, tribe, caste, and religion. It also analyses intra-group differentials at the inter-state level, looking at how a particular group is doing or has done in different states. This not only shows their relative standing at the state level, but also their given maximal (if not the optimal) achievement in the country, and the shortfall in other states from their respective maximal. One important lesson from this chapter is that child survival in India is, first and foremost, a manifestation of systemic injustice, reflected in the country’s poor aggregate performance over the decades. A narrow focus on inter-group inequalities is, therefore, not enough.

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