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Biomedical subjects

A R Pebley

Publications and source records attributed to A R Pebley.

At least 19 recordsLinked to original sources
PubMed2001

Diffusion of ideas about personal hygiene and contamination in poor countries: evidence from Guatemala.

In this paper, we explore the diffusion of beliefs pertaining to the causes of childhood diarrhea in rural Guatemala. The analysis focuses on the importance of interpersonal and impersonal contacts as conduits for information and norms related to hygiene and contamination. Estimates from multivariate models reveal that there is evidence of a diffusion process through social contacts, primarily through interpersonal ones. The analysis also identifies striking differences between (1) the diffusion process related to hygiene (e.g. dirtiness) and that related to contamination (e.g. pathogens); and (2) beliefs about the causes of diarrheal illness among children in general and those among respondents' own children.

Adolescent↗
PubMed1998

The use of calendars to measure child illness in health interview surveys.

BACKGROUND: During the past two decades, health interview surveys have become an increasingly common source of information about current morbidity patterns and utilization of health services in developing countries. This study describes a recent effort to enhance the utility of these surveys by incorporating a calendar format. METHODS: A calendar of morbidity and treatment behaviour during the 2-week period prior to interview was implemented in the Guatemalan Survey of Family Health (EGSF), a large-scale sample survey that was fielded in 60 communities in rural Guatemala in 1995. A total of 2872 women aged 18-35 were interviewed and provided information on 3193 children born since 1990. RESULTS: The EGSF calendar data provide estimates of diarrhoeal illness that are consistent with those obtained from more conventional questionnaire designs. However, in contrast to conventional health survey questions, these calendar data: (1) permit a much more complete evaluation of the accuracy of reporting; and (2) offer a richer and more complex description of child illness and treatment behaviour. For example, the results demonstrate that even the preferred 2-week recall period suffers from underreporting of diarrhoeal illness, that the majority of children with diarrhoea experience at least one additional symptom, and that mothers assess severity of diarrhoea from the type and number of accompanying symptoms. CONCLUSIONS: The findings indicate that additional implementation and evaluation of calendar formats is warranted in order to provide the most useful and accurate data possible at relatively low cost.

Adolescent↗
PubMed1998

Demography and the environment.

Demographers' interest in the environment has generally been enmeshed in broader issues of population growth and economic development. Empirical research by demographers on environmental issues other than natural-resource constraints is limited. In this paper, I briefly review past demographic thinking about population and the environment and suggest reasons for the limited scope of demographic research in this area. Next, I describe more recent demographic research on the environment and suggest several newer areas for demographic research. Finally, I consider the future of research on the environment in the field of demography.

Demography↗
PubMed1996

Prenatal and delivery care and childhood immunization in Guatemala: do family and community matter?

In this paper we investigate family choices about pregnancy-related care and the use of childhood immunization. Estimates obtained from a multilevel logistic model indicate that use of formal (or "modern") health services differs substantially by ethnicity, by social and economic factors, and by availability of health services. The results also show that family and community membership are very important determinants of the use of health care, even in the presence of controls for a large number of observed characteristics of individuals, families, and communities.

Child, Preschool↗
PubMed1995

Social inequality and children's growth in Guatemala.

This paper is an investigation of the effects of social inequality in Guatemala on children's health and nutritional status as measured by attained height. Guatemala remains a highly stratified and poor society. We examine the association of land distribution, land tenure, occupation, and other aspects of family social and economic status with children's height between the ages of three months and 36 months, using data from a cross-sectional survey. An important consequence of the poverty and poor living conditions of the majority of the Guatemalan population is substantial deficits in children's growth. Our results suggest that children's growth is affected by ethnicity, their father's occupation, land distribution in the area where they live, and maternal education. Substantial growth deficits are observed among children living at altitudes above 1500 metres; we hypothesize that this is because, in Guatemala, higher altitude is associated with land scarcity, poorer agricultural conditions, and greater remoteness from transport networks and other public services.

Adolescent↗
PubMed1994

Health cards, maternal reports and the measurement of immunization coverage: the example of Guatemala.

Immunization against major childhood diseases has been an essential component of health policies in developing countries. However, despite its importance and the efforts invested by many organizations in promoting immunization programs, consistent and accurate measurement of immunization coverage has not yet been achieved. In this paper, we explore the implications of alternative methods of measuring immunization coverage rates in Guatemala, using data from the 1987 Encuesta Nacional de Salud Materno Infantil, and we consider the dangers of making inferences about levels and trends in coverage from cross-sectional data. The results indicate that (1) service statistics may well lead to overestimates of coverage; (2) survey estimates derived from health cards can also produce severely biased estimates; and (3) in spite of problems associated with maternal recall, mothers' reports of their children's vaccination status probably result in substantially improved estimates of immunization coverage.

Bias↗
PubMed1994

Childhood immunization and pregnancy-related services in Guatemala.

In this paper we examine the experience of one poor country, Guatemala, that provided childhood immunization partly through a major national campaign, and provided pregnancy-related services through government health facilities, during the 1980s. Specifically, we compare the breadth of coverage of these two types of services using national sample survey data collected in 1987. We then draw upon results of previous qualitative studies to explore the social, cultural, and organizational factors that may account for differences between the use of immunization and the use of pregnancy-related health services.

Child↗
PubMed1993

Mortality and use of health services surveys in rural Zaire.

The Combatting Childhood Communicable Disease (CCCD) project is a comprehensive public health programme designed to reduce child mortality by 25% through the use of the following strategies: vaccination, oral rehydration therapy, and prompt treatment for malaria. To evaluate this programme, cross-sectional surveys were conducted in neighbouring health zones in Zaire in 1984 to determine the use of selected medical services by the population and to estimate the child mortality rate before the CCCD programme began. A reinterview survey was conducted on a subsample of women previously interviewed to determine the reliability of the mortality estimates. In both health zones 84-85% of women used antenatal services, 45% of children under age 6 who had had fewer were treated with an anti-malarial drug, 19-22% of children age 12-23 months had been vaccinated against measles, and virtually no children who had had diarrhoea were treated with oral rehydration therapy. Women's underreporting of births and deaths resulted in low estimates of mortality in both surveys. The reinterview survey provided more accurate estimates of mortality and led to a better understanding of the factors influencing underreporting. The estimated infant mortality rate was 74 deaths per 1000 livebirths; and the probability of dying before age 5 was 191 per 1000. Because births and deaths reported with incomplete dates were excluded from analysis, the mortality rates from the reinterview survey are underestimates. Given the difficulty in obtaining accurate estimates of mortality, primary importance should be given to developing and improving routine health information systems that measure changes in health status and provide information to evaluate programmes.

Adolescent↗
PubMed1992

Birth spacing and child mortality in Bangladesh and the Philippines.

This analysis uses data from Bangladesh and the Philippines to demonstrate that children who are born within 15 months of a preceding birth are 60 to 80% more likely than other children to die in the first two years of life, once the confounding effects of prematurity are removed. The risks associated with short conception intervals are confined to children who are also high birth order; they persist in the presence of controls for prior familial child mortality, breast-feeding, mother's age, and socioeconomic status. In Bangladesh but not in the Philippines, these effects are confined to the neonatal period.

Bangladesh↗
PubMed1991

Birth spacing and infant mortality: evidence for eighteenth and nineteenth century German villages.

Data from an historical population in which fertility control was minimal and modern health services were mostly unavailable are used to show that there appears to have been a strong association between previous birth interval length and infant mortality, especially when the previous child survived. Although only imperfect proxies for breast-feeding practices and other potentially confounding factors are available for this population, the results suggest that the association between previous interval length and infant mortality in this population is not solely, or primarily, a function of differences in breast-feeding behaviour or socioeconomic status. Other factors, e.g. maternal depletion or sibling competition, are more likely to explain the observed association.

Birth Intervals↗
PubMed1991

The impact of a public-health intervention on sex differentials in childhood mortality in rural Punjab, India.

This paper examines the effects of a public-health intervention program on sex differentials in health and mortality during childhood. Among the different health-service packages offered as part of the experimental design, those including nutritional services seem to have been more successful in reducing excess female mortality. The reason for this success appears to have been careful follow-up of undernourished children by project workers. The results also indicate that, consistent with earlier research, girls with surviving older sisters had higher mortality rates after their first month of life. Contrary to earlier research, however, boys with surviving older brothers also have higher mortality rates, at least between the ages of one and three years. We conclude that these effects for boys and girls cannot be attributed to problems associated with larger family size, since the number of older siblings of the opposite sex (regardless of survival status) does not generally appear to be related to children's chances of survival.

Child↗
PubMed1984

Calculation of life tables from survey data: a technical note.

Life table calculations from survey data are frequently based on events for which exact dates are not available. When these dates are coded in monthly form (e.g., century months), estimates should take into account the fact that the first duration interval--the interval which captures events occurring in the first month of exposure--is half the length of all remaining intervals. Although failure to do so has a trivial effect on many demographic calculations, estimates which are based on events which occur with high frequency in the first few months of exposure can be substantially biased. Estimates of fecundability for four countries in the World Fertility Survey are used to illustrate this bias.

Actuarial Analysis↗
PubMed1982

Women's sex preferences in the United States: 1970 to 1975.

This analysis examines the potential effect of sex preselection technology in the United States. The results suggest that controlling the sex of offspring is not the desire of most American women; that if it were employed, there would be a significant increase in sons as first-born and daughters as second children; that the overall sex ratio would be little changed from that occurring naturally except at very low fertility levels with universal use of such technology; and that fertility is only minimally influenced by gender preferences.

Attitude↗