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Effect of education and household characteristics on infant and child mortality in urban Nepal.

Infant and child mortality differentials are analysed by education of parents and other family members, access to toilet, electricity and source of drinking water in urban Nepal, using data from the Nepal Fertility and Family Planning Survey, 1986. The analyses showed significant effects of education, access to toilet and electricity in lowering infant and child mortality. Access to toilet and electricity are proxies for household socioeconomic status which suggests that education and household resources are complementary in lowering the infant and child mortality.

Child, Preschool

Impact of the National Control of Diarrhoeal Diseases Project on infant and child mortality in Dakahlia, Egypt. National Control of Diarrheal Diseases Project.

The Egyptian National Control of Diarrheal Diseases Project (NCDDP) started in 1983. A field trial done in Dakahlia Governorate in 1980 to promote oral rehydration therapy showed that the mortality rate for the under-fives during the diarrhoea season was 18.1/1000 in control villages and 10.5/1000 in "outreach" villages (p less than 0.001). In 1986 mortality rates had become similar in the two areas and lower than in 1980 (6.5/1000 and 6.0/1000, respectively), even though there were no significant changes in diarrhoea incidence. Virtually all the reduction in mortality was due to a decline in diarrhoea-associated deaths. The principal differences between 1986 and 1980 were better case-management by mothers and doctors, in both outreach and control villages, and far greater television ownership. Village civil registers showed only slight changes in under-five mortality from all causes after 1980, but an accelerating decline from 1983. Governorate-wide civil registration data showed slowly falling infant death rates from 1970 onward, accelerating after 1982, with most of the decline corresponding to the seasonal pattern of diarrhoea-associated mortality throughout the year. Thus NCDDP promotion of better treatment seems to have been responsible for the decline in mortality.

Child, Preschool

Determinants of infant and child mortality in rural Haryana.

To identify the individual and household level variables associated with increased risk of mortality, 159 infant and 50 child deaths (cases) and equal number of age matched live infants and children (controls) and their families were studied in a rural area of Haryana. The social, economic, educational and environmental characteristics of the case and control families were similar. Increased risk of infant and child mortality was associated with maternal age less than 20 and more than 30 years, birth order 4th or higher, unclean cord care at the time of child birth, failure of breast feeding during the first 3 months of age, lack of immunizations, and previous infant or child death(s) in the family (Odds ratio greater than 2; P less than 0.05-0.01 by X2 test). An emphasis on the interventions directed at control of the above mentioned variables may prove most helpful in reducing infant and child mortality in a rural area.

Child, Preschool

Child mortality and economic variation among rural Mexican households.

In two rural Mexican communities, rates of child mortality are significantly related to economic situations of households. Measured over the childbearing years of post-reproductive women, the rate of child mortality (ages 0-5 years) per mother is 163 per 1000 children in one village and 338 in the other. Significant economic correlates, which are defined ethnographically in each community, are housing quality, quality of farm land and marital status. Correlations of child mortality rates with economic variables range from -0.25 to -0.54, showing that poorer mothers lose significantly more children in the first 5 years of life. These results parallel those of urban, regional, national and international studies, but economic correlates of child mortality have not previously been found in rural Latin America. The methodological contributions of this study include a meld of ethnographic and survey techniques of data collection, the development of culturally appropriate variables to measure economic status, the use of child rather than infant mortality rates, and a household-related demographic measure, the rate of child mortality per mother.

Child, Preschool

Parental education and child mortality in Burundi.

This paper examines the relationship between parental education and child mortality in Burundi using data collected in the 1987 Demographic and Health Survey. Proportional hazards models are estimated to examine this relationship, while holding constant other known child mortality determinants. Parental education proves to be a key factor in explaining differences in child mortality, the effect of maternal education being particularly strong compared to paternal education.

Birth Order

Child mortality differentials in Ghana: a preliminary report.

The relationship is examined of child mortality in Ghana with six socioeconomic factors: mother's type of place of residence, education, occupation and work status, and current husband's education and occupation. Using data from the 1979-80 Ghana Fertility Survey, Trussell's marriage duration model was employed to estimate probabilities of dying at exact ages 2 and 5 in different population subgroups. The two education variables (mother's and husband's education) have the largest effect on child mortality, followed by husband's occupation and mother's occupation, in that order. In order to reduce child mortality to tolerable levels, expansion is urgently required of the medical and health services, balanced by an equal development of education, particularly of girls, help being given especially to the rural areas where the majority of the population live.

Child

Fertility and child mortality in rural Ethiopia: Gondar and Hararge regions.

This paper presents fertility and child mortality estimates for agricultural households of the Gondar and Hararge regions, based on the 1981 Rural Demographic Survey. The study shows that fertility and child mortality are quite high in both regions as in the rest of the country. However, Hararge has significantly higher mean parity and child mortality than Gondar.

Adolescent

Child mortality in a Nigerian city: its levels and socioeconomic differentials.

Using the 'indirect' demographic estimation technique, levels of child mortality for some selected socioeconomic characteristics of mothers in Ilorin, an urban community in Nigeria, were derived. The adjusted effects of these variables on child mortality were assessed. The variables found to exert significant independent effects on child mortality included the husbands education, area of residence in the town, the parity of the mother, her use of modern contraception, availability of indoor pipe-borne water and the use of a refrigerator by the household. Reliable or useful information on child mortality in this part of Nigeria is hard to come by, hence, the estimates provided here can serve as useful baseline data for evaluating the impacts of child survival activities that are currently going on in that part of the country.

Child, Preschool

Levels and patterns of infant and child mortality in Ghana.

This paper attempts to measure infant and child mortality levels and also to determine their structure by utilizing the results of the 1968-1069 National Demographic Sample Survey which was conducted under the directorship of the author. Among the major problems encountered in the exercise are the adjustment of the current raw mortality data and the estimation of infant and child mortality from independent source material. The estimated infant mortality rates range from 56 per 1,000 live births in the Accra Capital District to 192 in the Upper Region during the late 1960's. The urban rate is lower than the rural rate, 98, as against 161 per 1,000 live births. A large proportion of the deaths among children aged 0-4 occur in the second year of life, and deaths in this age group account for the bulk of the deaths within the age group 1-4 years.

Age Factors

Comparison of linear and exponential multivariate models for explaining national infant and child mortality.

Product form multivariate regression models (multiplicative exponential) were developed with infant and child mortality as outcomes, and national economic, health, nutrition, education, and demographic statistics as predictor variables. The models were applied to data from 129 countries, resulting in R-square values for the product form models of infants and child mortality of 0.77 and 0.80. For comparison purposes, more conventional sum form models (additive linear) were also estimated, and yielded R-square values (0.22, 0.29) markedly lower than the product form models. The product form models also had a much more uniform distribution of residuals and provided improved model fit across the different categories of nations. An inherent advantage to the product form models is that they did not predict negative mortality rates, in contrast to the sum form models which did predict negative mortalities for some of the more developed nations. Using a product form model, the correlation between physicians per capita and infant mortality was shown to be negative rather than positive--thus correcting for an anomaly seen in previous studies which showed a positive correlation between physicians per capita and infant mortality.

Child

Measuring the impact of child mortality on fertility: a methodological note.

Recent studies of the impact of child mortality on children ever born have used the "replacement factor" to measure mortality. When microlevel data are used, however, use of the replacement factor (or other variables which are nonlinear in the family's experienced child mortality rate) yields biased coefficients. An alternative model suggests a sequential, rather than a static, decision-making process to relate the decision to have an additional child to the reproductive experience to date. In this case, unbiased coefficients are obtained if the functional form is correctly specified. In the abscence of a priori knowledge of the functional form, it is difficult to untangle true effects from spurious ones.

Child

Infant and child mortality in rural Egypt.

This research examines determinants of infant and child mortality in rural Egypt, primarily the effects of household economic status and the availability of health services. Certain features of the health service environment affect survival in the neonatal period. In early childhood, survival chances improve markedly as income increases and if the household depends almost exclusively on employment income. In infancy and in early childhood, mortality is strongly associated with region of residence and maternal demographic characteristics, and is weakly associated with parental schooling.

Child, Preschool

Persistent and acute diarrhoea as the leading causes of child mortality in urban Guinea Bissau.

An investigation of child mortality in a semi-urban community, Bandim II, in the capital of Guinea Bissau was carried out from April 1987 to March 1990. 153 deaths were recorded among 1426 live-born children who were followed for 2753 child-years. The under-five mortality risk was 215 per 1000 children (95% confidence interval [CI] 176-264), infant mortality 94 per 1000 (95% CI 73-115), and perinatal mortality 52 per 1000 (95% CI 41-63). By prospective registration of morbidity, post-mortem interviews, and examination of available hospital records, a presumptive cause of death was established in 86% of the deaths. Persistent and acute diarrhoea were the most frequent causes of death, accounting for 43 and 31 deaths per 1000 children, respectively. Fever deaths (possibly malaria), neonatal deaths, acute respiratory infections, and measles were other frequent causes. The access to health services was relatively easy: 75% of the children who died had attended for treatment at a hospital or a health centre. It is important to find ways of preventing and managing persistent diarrhoea, the major cause of death, and to improve the control of acute diarrhoea by a targeted approach.

Acute Disease

Determinants of child mortality in south-west Uganda.

Anthropometric and sociodemographic variables were taken from 4320 children in a baseline survey carried out in March-April 1988 in the district of Mbarara, south-west Uganda. After 12 months a follow-up survey assessed the mortality of the children during the preceding year. Lack of ownership of cattle, recent arrival in the village, using candles for lighting, being of birth order higher than 5 and having a father with less than 8 years of schooling were significantly associated with child mortality. The addition of mid-upper arm circumference significantly improved the logistic model of socioeconomic variables and mortality and did not diminish the predictive power of socioeconomic variables in relation to increased mortality. This suggests that nutritional status and specific socioeconomic factors are both, independently, important predictors of child mortality.

Anthropometry

Social class differences in child mortality, Sweden 1981-1986.

STUDY OBJECTIVE: The aim was to analyse social class differences in mortality among Swedish children, 1-19 years old, during the period 1981-86. In order to study the development of these differences, mortality differences during the study period were compared with those 20 years earlier, ie, 1961-66. DESIGN: The study used data from two census linked death registries (CDR80 and CDR60). These were constructed by linkages between the 1980 and 1960 population censuses, respectively, and the corresponding national cause of death registries. Age specific and age standardised death rates, for total and cause specific mortality, were calculated for each social class and for the genders separately. To compare the death rates of social classes, relative risks with approximately 95% confidence limits were calculated. STUDY POPULATION: The study included children younger than 16 years at the time of the censuses and all deaths in the age range 1-19 years. The children were followed up for a period of six years after the censuses with respect to mortality. MAIN RESULTS: During the period 1981-86, children in families of both manual workers and self employed persons had a significantly higher mortality than children in families of non-manual workers. CONCLUSIONS: Although there has been a marked decrease in child mortality during the last decades the study shows that social class differences in child mortality still exist and show little tendency to disappear.

Adolescent

Control of deaths from diarrheal disease in rural communities. I. Design of an intervention study and effects on child mortality.

From May through October 1980, the "Strengthening Rural Health Delivery" project (SRHD) under the Rural Health Department of the Ministry of Health of Egypt had conducted an investigation into prevention of child mortality from diarrheal disease through testing various modules of Oral Rehydration Therapy delivery mechanisms. In a six-cell design counting a total of almost 29,000 children, ORT was provided both as hypotonic sucrose/salt solution prepared and administered by mothers and normotonic, balanced electrolyte solution in the hands of both mothers and health care providers and the effects on child mortality during the peak season of diarrheal incidence were measured. In addition, utilization and effects of ORT when made readily available through commercial channels was similarly examined. A cost-benefit analysis was performed on the cost of the services as well as on the outcome for each of five study cells using the sixth, the control, as reference. Results showed that early rehydration with a sucrose/salt solution in the hands of mothers, backed by balanced oral rehydration solution in the hands of health care providers proved the most cost-effective means of reducing diarrhea-specific mortality as well as being as safe as prepackaged commercial preparations.

Administration, Oral

Community-based infant and child mortality rates for peri-urban Pietermaritzburg.

Infant and child mortality rates outside of hospital practice are not widely available for the black population of the RSA, since identification and recording of births and deaths within the community has not been widely established. This community-based study of peri-urban Pietermaritzburg is compared with similar studies covering other areas of the RSA. The recent literature is evaluated with a view to determining possible approaches to reducing mortality rates among infants and children under 5 years in the RSA.

Child, Preschool

Birth weight and other determinants of infant and child mortality in three provinces of China.

Information on levels, trends and determinants of infant and child mortality was available from the 1985 In-depth Fertility Survey which was conducted in three provinces of China. Mortality of children below age 5 varied from 49 per 1000 live births in Shaanxi to 20 in Shanghai in 1980-85 and has declined substantially since 1960, from 206 in Shaanxi and 66 in Shanghai. Male mortality was considerably higher than female mortality in the neonatal and post-neonatal period, and at ages 1-5 years. Birth weight, place of residence and mother's education were found to be important determinants of mortality; age of mother and parity were less important.

Adult