Background predictors of time to death in infancy: evidence from a survival analysis of the 2018 Nigeria DHS data

Background Nigeria’s child health profile is quite concerning with an infant mortality rate of 67 deaths per 1000 live births and a significant slowing down in progress towards improving child health outcomes. Nigeria’s 2018 Demographic and Health Survey (DHS) suggests several bio-demographic risk factors for child death, including mother’s poor education, poverty, sex of child, age of mother, and location (rural vs urban) but studies are yet to explore the predictive power of these variables on infant survival in Nigeria. Methods The study extracted data for all births in the last 12 months preceding the 2018 Nigeria DHS and used the Cox proportional hazard model to predict infant survival in Nigeria. Failure in this analysis is death with two possible outcomes – dead/alive – while the survival time variable is age at death. We censored infants who were alive at the time of the study on the day of the interview. Covariates in the analysis were: age of mother, education of mother, wealth quintile, sex of child, location, region, place of delivery, and age of pregnancy. Results The study found that a higher education of a mother compared to no education (β = .429; p-value < 0.05); belonging to a household in the richer wealth quintile (β = .618; p-value < 0.05) or the highest quintile (β = .553; p-value < 0.05), compared to the lowest wealth quintile; and living in North West (β = 1.418; p-value < 0.05) or South East zone (β = 1.711; p-value < 0.05), significantly predict infant survival. Conclusion Addressing Nigeria’s infant survival problem requires interventions that give attention to the key drivers – education, socio-economic status, and socio-cultural contextual issues. We therefore recommend full implementation of the universal basic education policy, and child health education programs targeted at mothers as long- and short-term solutions to the problem of poor child health outcomes in Nigeria. We also argue in favor of better use of evidence in policy and program development in Nigeria.

Revisit the correlates of infant mortality in Bangladesh: findings from two nationwide cross-sectional studies

ObjectiveThe main objective of this study is to investigate how the direction and strength of the association between infant mortality and its predictors are changing over time in Bangladesh using a nationally representative sample for the period 2011–2014.Design, setting and participantsData from two repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) for the years 2011 and 2014 were used. A total of 7664 (with 312 infant death) and 7048 (with 264 infant death) complete cases, respectively, from BDHS 2011 and 2014 datasets were included in the study.MethodsCox’s proportional hazard model with robust standard error (SE) that adjusts for the complex survey design characteristics was implemented to assess how the risk factors associated with infant mortality change their paths.ResultsResults reflected that administrative division remained as a potential risk factor of infant death for both periods. Household’s socioeconomic status, father’s employment status, age difference between parents turned out to be potential risk factors in 2014, though they did not show any significant association with infant death in the year 2011. In contrast to 2011, mothers’ individual-level characteristics such as age at childbirth, education, media exposure, employment status did not remain as significant risk factors for infant death in 2014. Younger fathers increased the burden of death among infants of adolescent mothers. At higher order births, the burden of infant death significantly shifted from rural to urban areas. From the year 2011 to 2014, urban areas achieved socioeconomic equity in infant survival, while the extent of inequity was increased in rural areas.ConclusionCommunity-based programmes should be designed for urban mothers who are expecting higher order births. To eradicate the socioeconomic inequity in infant survival, the government should design strong and sustainable maternal and child healthcare facilities, especially for rural areas.

SOCIODEMOGRAPHIC FACTOR RELATIONSHIP WITH INFANT SURVIVAL IN INDONESIA

Child survival can be reflected in the presence of the Infant Mortality Rate (IMR). Indonesia has an Infant Mortality Rate (IMR) according to the 2017 IDHS, which reaches 24 deaths per 1000 live births. This figure has decreased compared to a survey conducted by the 2012 IDHS, where infant mortality reached 32 deaths per 1000 live births. Even though it experienced a decrease, the IMR in Indonesia was higher when compared to the IMR in other Southeast Asian countries. Socioeconomic factors for individuals, families, and communities, including the influence of infant mortality. Not only that, but infant mortality can also be due to the absence of awareness of maternal health. Thus, this study aims to determine several variables related to survival in infants in Indonesia. This type of research is a non-reactive study. This study uses quantitative analysis and a methodical approach with a cross-sectional approach that takes data from the 2017 IDHS. This study took a sample following the 2017 IDHS with the criteria that mothers who had babies still drank breast milk, were born single, and were still alive after the first three days in Indonesia. The number of respondents in this study was 7,599 mothers with babies. Analysis of the research data using Chi-Square analysis. Bivariable analysis shows that infants' survival has a relationship with the mother's education, type of area, and welfare level. However, infant survival also has no association with the age of the mother and birth attendants. Counseling pregnant women regarding risks, causes,

Intertwin differences in umbilical artery pulsatility index are associated with infant survival in twin-to-twin transfusion syndrome

Objectives To evaluate the association of intertwin differences in umbilical artery pulsatility index (DUAPI) and infant survival in twin-to-twin transfusion syndrome (TTTS). Methods Absolute DUAPI was calculated prior to laser surgery. Receiver-operating characteristics (ROC) curve analysis provided an intertwin DUAPI cutoff of 0.4 for the prediction of double twin survival to 30 days of life. Infant survival was compared between women with an intertwin DUAPI <0.4 and ≥0.4 in the whole cohort, in TTTS cases with Quintero stages I/II and in those with Quintero stages III/IV. Regression analyses were performed to evaluate the association of intertwin DUAPI <0.4 and infant survival adjusted for confounders. Results In total, 349 TTTS cases were included. Double twin survival to 30 days was observed in 67% (234/349) of cases. Significant differences in double twin survival was seen between intertwin DUAPI groups in the whole cohort (76.8 vs. 52.2%; p<0.001), in women with TTTS Quintero stage I or II (77.8 vs. 58.5%; p=0.015) as well as in women with TTTS Quintero stage III or IV (75 vs. 49.5%; p=0.001). Intertwin DUAPI <0.4 conferred a threefold increased chance for double twin survival. Conclusions Small intertwin DUAPI is associated with increased double infant survival in early and advanced TTTS stages.

Preventable multiple high-risk birth behaviour and infant survival in Nigeria

Background Globally, infant mortality has declined considerably but has remained unacceptably high in sub-Saharan Africa, especially Nigeria where infant mortality rate is 67/1000 live births. To facilitate infant mortality reduction in Nigeria, an understanding of the synergistic effect of bio-demographic characteristics of mothers known as High Risk Birth Behaviours (HrBBs) is important. We therefore investigated the influence of HrBBs on infant survival in Nigeria. Methods This cross-sectional study design utilized data from the 2018 round of Nigerian Demographic Health Survey. The study participants were a representative sample of women of reproductive age (n = 21,350) who had given birth within the 5 years preceding the survey. HrBBs was measured through integration of information on maternal age at child’s birth, parity, and preceding birth interval with respect to the most recent child. The HrBBs was categorized as none, single and multiple. Data were analysed using descriptive statistics, Log-rank test and Cox proportional hazard model (α =0.05). Results The mean age of the women was 29.7 ± 7.2 and 4.1% had experienced infant death. Infant mortality was highest among women with multiple HrBBs (5.1%). Being a male, having small size at birth, failure to receive tetanus injection, non-use of contraceptives and living in the core-north (North West and North East) predisposed children to higher risk of dying before 12 months of age. The hazard ratio of infant mortality was significantly higher among infants of mothers in multiple HrBBs category (aHR = 1.66; CI: 1.33–2.06) compared to their counterparts with no HrBBs. Conclusion Multiple HrBBs increase the chances of dying among infants in Nigeria. Screening women for HrBBs for special health attention during pregnancy, birth and postnatal period will alleviate infant death in Nigeria.

Infant Survival Among Free-Living Bonnet Macaques (Macaca radiata) in South India

Female reproductive success depends to a large extent on infants’ ability to survive to maturity. While most studies of female reproductive success have focused on the effects of individuals’ sociodemographic factors (e.g., age/parity, dominance rank) on offspring survival among wild primates living in less disturbed habitats, little research has focused on offspring survival in urban or periurban animals. Here we investigated sociodemographic and anthropogenic determinants of infant survival (up to 1 yr of age) in free-ranging bonnet macaques (Macaca radiata) living in a periurban environment in Southern India. We conducted the study from November 2016 to May 2018, on two groups of bonnet macaques at the Thenmala tourist site in the state of Kerala. Fifty infants were born across two birth seasons. Of these infants, 29.2% died or disappeared in 2017 and 26.9% died or disappeared in 2018. We found that infant survival was strongly influenced by the mother’s parity: infants of experienced mothers had a better chance of survival than those of first-time mothers. We also found that male infants were more likely to die than female infants. However, we found no effects of mothers’ dominance rank, or of frequency of mothers’ interactions with humans and time spent foraging on anthropogenic food, on infant survival. Our results, consistent with findings from other wild primate species, show that even in challenging human-impacted environments, experienced bonnet macaque mothers have greater success than inexperienced ones.

Human uniqueness? Life history diversity among small-scale societies and chimpanzees

Background Humans life histories have been described as “slow”, patterned by slow growth, delayed maturity, and long life span. While it is known that human life history diverged from that of a recent common chimpanzee-human ancestor some ~4–8 mya, it is unclear how selection pressures led to these distinct traits. To provide insight, we compare wild chimpanzees and human subsistence societies in order to identify the age-specific vital rates that best explain fitness variation, selection pressures and species divergence. Methods We employ Life Table Response Experiments to quantify vital rate contributions to population growth rate differences. Although widespread in ecology, these methods have not been applied to human populations or to inform differences between humans and chimpanzees. We also estimate correlations between vital rate elasticities and life history traits to investigate differences in selection pressures and test several predictions based on life history theory. Results Chimpanzees’ earlier maturity and higher adult mortality drive species differences in population growth, whereas infant mortality and fertility variation explain differences between human populations. Human fitness is decoupled from longevity by postreproductive survival, while chimpanzees forfeit higher potential lifetime fertility due to adult mortality attrition. Infant survival is often lower among humans, but lost fitness is recouped via short birth spacing and high peak fertility, thereby reducing selection on infant survival. Lastly, longevity and delayed maturity reduce selection on child survival, but among humans, recruitment selection is unexpectedly highest in longer-lived populations, which are also faster-growing due to high fertility. Conclusion Humans differ from chimpanzees more because of delayed maturity and lower adult mortality than from differences in juvenile mortality or fertility. In both species, high child mortality reflects bet-hedging costs of quality/quantity tradeoffs borne by offspring, with high and variable child mortality likely regulating human population growth over evolutionary history. Positive correlations between survival and fertility among human subsistence populations leads to selection pressures in human subsistence societies that differ from those in modern populations undergoing demographic transition.