Impact of high-risk fertility behaviours on underfive mortality in Asia and Africa: evidence from Demographic and Health Surveys

Background Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries. Methods This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women’s age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child’s birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results Mother’s age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child’s birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04–1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36–1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88–2.28). Conclusion Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing.

What factors influence the choice of first healthcare provider for childhood fever or cough in Ghana?

Malaria and Pneumonia are major killers of children underfive. However, fever and cough are major signs of Malaria and Pneumonia respectively and hence making proper management of fever and cough indispensable in the fight against underfive mortality. This study therefore investigated the factors that influence the choice of first healthcare provider for children with fever or cough in Ghana. The study used the 2014 Ghana Demographic and Health Survey (GDHS) as the main source of data. By employing the multinomial probit model, the study found that urban children, children with higher birth rank, older children, children from the Ga/Dangme, Akan, Mole-Dagbani, Ewe, Mande and Gurma ethnicity and children of mothers with big problems with regards to permission and distance to seek self-medical care were more likely to be given self-medication or to be sent to a traditional practitioner initially for fever or cough. Contrary, mothers with health insurance, aging mothers and wealthy households were less likely to first resort to self-medication or a traditional practitioner in order to seek care for children with fever or cough. The study therefore concludes that ethnicity, residence, permission and distance to seek medical care by mother, mother’s health insurance, household wealth, child’s age, mother’s age and birth order are the factors that influence the choice of first healthcare provider for children with fever or cough in Ghana.