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The deaths of children aged 1-4 years were studied in a cohort of 5914 Brazilian liveborns. A total of 29 early childhood deaths were recorded (cumulative mortality risk of approximately 6 per 1000), 17 of which (59%) were due to infectious diseases. The death rate was highest in the second year. Deaths were highly concentrated in children from low income (< US $50/month) families, where the cumulative risk of early childhood death was about 10 per 1000; on the other hand, there were no deaths among the 616 children from families with a monthly income of US $300 or more. Birthweight was also associated with mortality: the cumulative risk of children weighing less than 2000 g at birth was 21 per 1000, compared to 4 per 1000 among those with birthweights of 3500 g or more. Simultaneous adjustment for income and birthweight did not substantially change these differentials. These findings confirm the strong association between early childhood mortality and socioeconomic conditions, but also make evident the long-term effects of low birthweight.
In 1985-86, 286 underfive deaths occurred among a population of 30,000 in a rural area of Haryana. Two hundred and eighty one were analysed for socio-biological factors related to under five mortality. Females had a higher mortality. About 2/3 of the deaths were in infants, and 90% in first 3 years. Most of the deaths (94%) occurred in the village itself, 58.4% did not seek any medical care during the terminal illness, 80-90% did not receive even a single dose of BCG, DPT or O.P.V., and 36.7% died in the first attack of illness. Though 68% had at least one episode earlier, 31.0% had been admitted in hospitals for an earlier episode of illness. In 42.8% of deaths, the birth order was IV or above. Deaths in socially and economically disadvantaged cases constituted 77.6%. The triad of diarrhea, ARI and malnutrition claimed 56% deaths. In 93% of the deaths, the mothers were illiterate and 96.4% were house wives. There was a sibling death earlier in the family in 78.3%, and 60.1% deaths were of those living in poor housing conditions. About 50% had radio for communication, 85.8% had bicycle for conveyance, and in 66.9% the family had piped water supply. All these findings have been discussed in the study.
Estimates of child mortality are mainly based on reports by mothers on the survival status of their children. Infant mortality estimates from such data do not seem to have declined in recent years. The Bangladesh Bureau of Statistics sample registration infant mortality estimates appear to be suspiciously low.
In a prospective study in Matlab, a rural area in Bangladesh, the relationship between a variety of covariates and childhood mortality was examined. Economic status of household, education of mother, sex of the children, health intervention programmes, age of mother, and live birth order of the children were identified as having a statistically significant impact on child survival when the effect of age was controlled. The effects of sex of the children, health programmes, age of mother, and birth order were found to be dependent on the age of the children, but the effect of mother's education was dependent on sex of the children.
Ten independent variables were used to predict death before the first birthday for 4411 births that took place from 1878 to 1976 to 978 women of native ancestry on the island of St. Barthélemy. Significant predictors of death include the death of the mother within a year, the birth year, multiple birth, whether the preceding child also died before 1 year of age, and whether the next child was conceived before the index child was 1 year old. Unlike most prior studies, birth-spacing variables were only weakly related to death in the first year. The relative absence of contraceptive techniques to control birth spacing in the study population and the use of vital records rather than survey data distinguish this project from others and may account at least partly for the unusual findings.
The objective of the present project is to evaluate the relative importance of different governmental social programmes for health development during the 1970's. National statistics available for the whole period and disaggregated to district level were analyzed with particular regard to three indicators of infant health status when the infant mortality rate was used, increased access to secondary care and improved socio-economic status were related to improvement in infant health status. When the percentage of neonatal deaths or the percentage of deceased live births per woman was used, neither the socio-economic improvement nor the assess to secondary did explain the improvement. Moreover, the primary health programme did not seem to be of importance in explaining the changes in the three indicators of infant health status. A second phase of the project, currently ongoing, is aimed at the evaluation of other factors such as the degree of efficiency of some of the health programmes. This study is based on directly collected information, quantitative as well as qualitative. Structured interviews have been used together with anthropological information from in-depth interviews with individuals and groups. The preliminary results of this second phase indicate that the contradictions observed in the first phase might be due to shortcomings in the national registers. In one of the study areas the coverage of PHC developed earlier than indicated by the official information. In other areas it was found that different obstacles as access problems, lack of health centers, socio-economical problems and lack of cultural knowledge reduced the effectiveness and impact of the primary health programmes.
The study looks at the effects of maternal sociodemographic characteristics and the quality of the environment on child survival through two intervening variables, breast-feeding and prenatal care. A linear structural equation modelling approach was used to examine infant and child survival based on a weighted sample of 5180 Liberian children aged 0-5 years. The findings confirm previous studies, but also reveal complex relationships of the role of education, maternal age and breast-feeding in enhancing child survival.
Based on the Third National Cancer Survey (1969 to 1971), the incidence of malignant neoplasms in the United States was 183.4 per million live births per year in infants younger than 1 year and 36.5 in newborns younger than 29 days. In both age groups, neuroblastoma was the most commonly diagnosed neoplasm. Overall, cancer incidence in infants younger than 1 year was almost 3.5 times greater than mortality determined from US death certificates from 1960 to 1969. For individual tumor types, the ratio between incidence and mortality varied between 159 for retinoblastoma and 1.5 for leukemia largely reflecting relative differences in survival due to treatment.
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.
Of a total of 755 neonates who died between 1972 and 1988, 331 (43.9%) were subjected to necropsy examination. The ranking of major primary causes of neonatal death was as follows: infections 27.2%, hyaline membrane disease 20.2%, congenital malformations 19.6%, perinatal anoxia 14.5%, immaturity 5.1% and birth trauma 2.7%. Over the years, the prevalence of infections as the cause of death has consistently declined. Compared with that in other contemporary Indian studies, the prevalence of hyaline membrane disease is higher and that of infections and perinatal anoxia relatively lower.
Analyses of vital data derived from a family record register for the native population of Guam reveal significant variations in births, deaths, and marriages over the period 1901-41. Although lacking marked photoperiod or temperature changes of temperate zones, the tropical island is subject to marked seasonal differences in rainfall characteristic of western Pacific islands. Marital patterns exhibit troughs associated respectively with the Lenten period and with Christmas celebrations. Infant and childhood deaths show close correspondence with rainfall patterns, consistently exceeding expected values during the rainy season (July-November) when conditions are optimal for the spread of communicable and gastrointestinal diseases. Births attain a peak in November, or at the beginning of the more advantageous season for infant health and survival. Seasonality in vital events, reported for many Euroamerican and some African and Asian populations of modern and historical periods, has rarely been documented for native populations of the tropical Pacific. Comparisons of differences in these patterns among different populations in varied environments provide unique opportunities to evaluate causal models of interactions among biological, sociocultural, and physioenvironmental factors.
In the US, black infants born near or at term experience higher mortality than white infants. To extend our understanding of black-white differences in the relative advantages of growth (measured by birthweight) for gestational age, we compared race-specific rates of perinatal mortality by deviation in grams from the median birthweight for four categories of gestation (35-36, 37-38, 39-41, and 42-43 weeks). We also used race-specific standards to examine the difference between the median birthweight and the optimum birthweight (i.e. birthweight with the lowest mortality). The data, which were derived from vital records for singletons delivered in the US from 1983-1984, comprised 24,626 fetal and neonatal deaths among 5,157,197 white infants and 5973 fetal and neonatal deaths among 926,678 black infants. At all deviations from the median birthweight, black infants had relatively better survival at 35-36 weeks of gestation. This advantage was reversed among infants with gestations of 39-41 and 42-43 weeks. The optimum birthweight for black infants with gestations greater than or equal to 37 weeks was closer to their median birthweight than was that for white infants. For black infants with gestations of 39-41 weeks, the optimum birthweight was 187g (95% confidence interval (CI): 150-234) greater than the median birthweight (3289g); for comparable white infants the optimum birthweight was 397g (95% CI: 366-431) greater than the median birthweight (3487g). To reduce the black-white gap in perinatal mortality, we need a better understanding of aetiological relations between gestation, growth, and mortality.
The incidence of, and risk factors associated with, perinatal mortality in Shanghai during 1986-1987 are examined using data from a multi-site study conducted in 29 hospitals. The overall perinatal mortality rate was 14.96 per 1000 births. The mortality rates of antepartum fetal death, intrapartum fetal death and early neonatal death were 5.97, 2.06 and 6.94 per 1000 births, respectively. The perinatal mortality rates increased in winter and late spring. Male neonates were 1.5 times more likely to die than females. Low birthweight and preterm infants had 15 to 80 times higher risk of perinatal death. Higher parity, multiple pregnancy, and maternal age greater than or equal to 35 years were the risk factors for perinatal mortality. Asphyxia, cord complications, and congenital malformations were found to be the major causes of perinatal deaths. Comparison of mortality rates between Shanghai and the US suggests that the shortage of advanced technology in perinatal care (e.g. neonatal intensive care units) is a major obstacle to the reduction of perinatal mortality in Shanghai.
Data derived from the Encuesta Nacional de Fecundidad y Salud (ENFES) confirm that overall levels of infant mortality in Mexico have been steadily declining. However, a more specific analysis furnishes evidence that this decline has occurred at varying rates within different social groups, reflecting an increase in social inequalities. The analytical strategy used in this article leads to three basic conclusions: (1) the impact of the economic crisis on infant mortality is reflected not in a reversal of the declining trend but an increase in social inequalities; (2) certain variables universally accepted as determinants of infant mortality, such as mother's education, seem nonsignificant for some social sectors; and (3) certain biodemographic characteristics assumed to have a uniform mortality-related behavior vary among sectors, suggesting that even these constants are determined by social factors.
An anthropometric survey of children aged 0-59 months in north-west Uganda in February-March 1987 indicated a high prevalence of stunting but little wasting. Use of unprotected water supplies in the dry season, prolonged breast-feeding, and age negatively affected nutrition; in contrast, parental education level improved nutrition. Mortality during the 12 months following the survey was higher among those who had low weight-for-age and weight-for-height, but children who had low height-for-age did not have higher mortality. Weight-for-age was the most sensitive predictor of mortality at specificities > 88%, while at lower specificity levels weight-for-height was the most sensitive. Children whose fathers' work was associated with the distillation of alcohol had a higher risk of mortality than other children. The lowest mortality was among children whose fathers were businessmen or who grew tobacco.
The evidence is provided of a close relationship between the features of women's reproductive behaviour, their health status and the health of their children: the lack of rational planning child-birth results in increasing maternal and infant mortality rates, prematurity, birth of unwanted children. The use of abortions as one of the basic means of birth control produces a negative effect, i.e. they are a frequent cause of sterility, gynaecological diseases, complicated future pregnancies and deliveries. There is a description of the priority tasks and conditions for the effective introduction of family planning into the everyday life--the necessity of taking into account sociopsychological, regional aspects of birth control within a family, demographic situation at the local level; identification of women populations which are in need of family planning activities.
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