The role of maternal cognitive ability on child health

Little is known about the mechanisms through which mother's cognitive ability operates in enhancing her children's health. This paper analyzes how maternal returns to cognitive ability on children's height reflect contemporaneous endowments and childhood background of the mother. Results suggest that maternal returns to cognitive ability on child height are less likely to reflect observed mother's childhood endowments as measured by parental transmission of knowledge or school quality, but are more likely to be associated with learning to be a mother, and with a better capacity to take advantage of household and community available resources.     

Can mothers judge the size of their newborn? Assessing the determinants of a mother's perception of a baby's size at birth

Birth weight is known to be closely related to child health, although as many infants in developing countries are not weighed at birth and thus will not have a recorded birth weight it is difficult to use birth weight when analysing the determinants of child illness. It is common to use a proxy for birth weight instead, namely the mother's perception of the baby's size at birth. Using DHS surveys in Cambodia, Kazakhstan and Malawi the responses to this question were assessed to indicate the relationship between birth weight and mother's perception. The determinants of perception were investigated using multilevel ordinal regression to gauge if they are different for infants with and without a recorded birth weight, and to consider if there are societal or community influences on perception of size. The results indicate that mother's perception is closely linked to birth weight, although there are other influences on the classification of infants into size groups. On average, a girl of the same birth weight as a boy will be classified into a smaller size category. Likewise, infants who died by the time of the survey will be classified as smaller than similarly heavy infants who are still alive. There are significant variations in size perception between sampling districts and clusters, indicating that mothers mainly judge their child for size against a national norm. However, there is also evidence that the size of infants in the community around the newborn also has an effect on the final size perception classification. Overall the results indicate that mother's perception of size is a good proxy for birth weight in large nationally representative surveys, although care should be taken to control for societal influences on perception.     

Changing determinants of infant and child mortality: on the basis of the Korean experience, 1955-73

Data from the 1974 Korean National Fertility Survey were analyzed to learn more about the main determinants of infant and child mortality in the course of mortality decline and how they change. In the Korean survey, about 5000 eligible women were selected for the individual survey and the sample design aimed at a self-weighting nationally representative and probability sample. Preliminary analysis showed clear mortality differentials between different socioeconomic levels and between demographic subgroups in infant and child mortality during the period 1955-73 in Korea. To examine the net effect of each variable on mortality, the logit-linear model was used. A table shows the probability level of 4 variables -- maternal age, birth order, mother's education, and number of rooms used by household -- in Korea, when the effects of others were controlled. In the urban areas, only the socioeconomic factors were the main determinants of infant mortality on all the birth cohorts. Mother's education and number of rooms used strongly affected infant mortality in the 1955-59 and 1960-64 birth cohorts, but the effects became weaker in the 1965-69 and 1970-73 birth cohorts, and their statistical significance was reduced. In the rural areas, the effects of 3 variables -- the exception being number of rooms used -- on infant mortality were statistically significant. It is concluded that the main determinants of infant mortality in urban areas were socioeconomic factors. The main determinants of infant mortality in the rural areas were demographic in the earlier birth cohorts, but in the recent birth cohorts mother's education, a socioeconomic factor, became the main determinant while the effects of demographic variables became weaker and finally disappeared. The change in the determinants of child mortality appears to be the reverse of that for infant mortality. Prior to the introduction of the national development program, in the rural areas mother's education was the main determinant of child mortality (rural 1955-59 cohort), but with the socioeconomic development the determinants changed to give dominance to demographic factors (urban 1955-59) cohort and, in the recent period, even the effects of demographic factors on child mortality became weaker (urban 1960-69 cohort). When the differences in living status by maternal age were weaker and the competition among siblings less because of small family size, only the socioeconomic variables remained as main determinants affecting child mortality.     

Factors affecting infant and child mortality

This paper examines the determinants of infant and child mortality variations in Jordan, Yemen, Egypt, and Tunisia using data from WFS surveys. The analysis considers biological correlates of mortality--mother's age, birth order, birth interval, and previous infant loss--and several social factors--mother's and father's education, mother's residence, father's occupation, and mother's work experience since marriage. The estimates for the 4 countries show large variations in the mortality rates and an expected pattern of declining infant and child mortality during the period of 20 years prior to the survey. Further, the proportionate decline in child mortality in each country was generally greater than the proportionate decline in infant mortality. A persistent pattern of higher child mortality for females than for males is found, suggesting preferential care and treatment of male offspring. The higher mortality risk is found for infants born to very young and very old mothers, with short previous birth intervals, of higher birth orders, and where the previous infant had died. Among the socioeconomic characteristics, the education of the mother and rural-urban residence are found to affect infant survival. In childhood, among the demographic factors, only birth interval shows a significant effect on mortality. The risk of child mortality decreases considerably with the increase in the birth interval. The analysis of the effect of breastfeeding on mortality, although based on limited information, clearly shows the beneficial effect of breastfeeding on the infant's survival, especially during the early months of life. For all countries, the mortality rate for the non-breastfeeders is substantially higher than for the breastfeeders even when the effect of the other covariates is controlled.     

Role of education in reducing child labour: evidence from rural Bangladesh

This paper explores the hypothesis that the level of education of children and their parents plays a major role in reducing child labour. Data were generated from a sample survey of 3809 children aged 10-14 years living in 150 villages in two rural districts of Bangladesh. A significant inverse relationship was found between child labour and years of schooling. Age and education of children, parental education, land ownership of household and fathers' occupation were the determinants of child labour force participation. Child's years of schooling is the variable that has most influence on the probability of participation in the labour force, followed by father's and mother's education.     

Evidence on the impact of child labor on child health in Indonesia, 1993–2000

Despite an abundant literature on child labor in developing countries, few papers have attempted to investigate the consequences of child labor on health. This paper explores whether child labor affects child health using data from the Indonesian Socio-Economic Surveys during the 1990s. For our empirical analysis, we restrict our attention to children currently enrolled in school and we use several discrete indicators for health. Our results show that child labor is associated negatively with health. We obtain this result by introducing labor participation as an exogenous covariate in the different health equations. Similar results are found once the work decision is instrumented.     

Neonatal mortality and maternal health care in Nepal: searching for patterns of association

This study explores the factors associated with neonatal mortality and maternal health care in Nepal. The subjects were 4375 births reported in the 1996 Nepal Family Health Survey. Maternal and child health care was found to have a significant association with neonatal mortality, although preceding birth interval and sex of child had stronger effects. Four aspects of maternal care were found to be highly associated with region, household ownership of assets, mother's education and father's education. This indicates that accessibility, affordability and availability of maternal health care are important factors to consider in future research on neonatal mortality.     

Husband involvement in the treatment of child illness in Guatemala

The aim of this study is to test prevailing assumptions that Guatemalan men are authoritative or aloof husbands and, in turn, are either problematic or irrelevant to child health. Based on survey data collected in 1994-95 about 959 children, this research examines whether, how and why husbands were involved in recent episodes of young children's illness and sheds light on the potential effect of husband involvement on treatment. A relatively high percentage of women reported that they asked for advice or assistance from their husbands regarding child illness, and, contrary to popular notions, the multivariate analyses suggest that husbands' involvement was not driven by their household authority. Rather, key determinants of whether husbands gave advice or assistance included characteristics of the illness and child and the availability of sources of social support, while key determinants of what kind of support husbands gave (namely whether they gave/bought medicines, recommended a provider visit, or gave other advice or assistance) largely related to characteristics of the illness and child, as well as the availability of biomedical health care providers in the community and ethnicity.     

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.     

The public health implications of maternal care trade-offs

The socioeconomic and ethnic characteristics of parents are some of the most important correlates of adverse health outcomes in childhood. However, the relationships between ethnic, economic, and behavioral factors and the health outcomes responsible for this pervasive finding have not been specified in child health epidemiology. The general objective of this paper is to propose a theoretical approach to the study of maternal behaviors and child health in diverse ethnic and socioeconomic environments. The specific aims are: (a) to describe a causal pathway between the utility that women obtain through work outside the home and through child care and disease hazard rates in childhood using an optimization model; (b) to specify the influence of ethnic and socioeconomic factors on model constraints; (c) to use the model as a tool to learn about how different combinations of maternal wage labor and child care time might influence child health outcomes in diverse social contexts; (d) to identify parameters that will require measurement in future research; (e) to discuss research strategies that will enable us to obtain these measurements; and (f) to discuss the implications of the model for biostatistical modeling and public health intervention. Optimization models are powerful heuristic tools for understanding how ethnic, environmental, family, and personal characteristics can place important constraints on both the quality and quantity of care that women can provide to their children. They provide a quantitative appreciation for the difficult trade-offs that most women face between working in order to purchase basic goods that children cannot do without (e.g., food, clothing, shelter, health insurance), and increasing offspring well-being through child care (e.g., training in social skills, affection, protection from environmental hazards, help with homework). The research was funded by a Faculty Scholars Award from the William T. Grant Foundation to A. Magdalena Hurtado. A. Magdalena Hurtado, Ph.D., is an associate professor in the Department of Anthropology, University of New Mexico. Her research interests include the origins of the sexual division of labor, epidemiology of indigenous peoples, disease susceptibility, the development and intergenerational transmission of antigens and immune defense, immune function and allergic sensitization, and trauma. She also works on public health interventions, biological capital and poverty, and land tenure and human rights in native communities of South America. Carol Lambourne, M.Sc., is a doctoral candidate in the Department of Anthropology, University of New Mexico. Her research interests are evolutionary models of child and adolescent development, life history theory, family composition and investment patterns, pubertal timing and psychosexual maturation, juvenile stress, and infanticide. Kim Hill, Ph.D., is a professor in the Department of Anthropology, University of New Mexico. His research interests are modern hunter-gatherers, including extensive fieldwork in lowland South America. Current topics of interest include human evolution, economic strategies, life history theory, the evolution of cooperation, and the emergence of social norms enforced by punishment. He is also involved in economic development, health and education projects with lowland South American native populations. Karen Kessler received her M.S. in Anthropology from the University of New Mexico in 1996. Her research interests are the application of mathematical modeling to the prevention of diabetes and other causes of morbidity and mortality in historical populations.     

Factors influencing prereproductive mortality in the isolated and preindustrial western Mediterranean population of La Alpujarra, 1900-1950

We study the effects of several variables on the prereproductive mortality pattern in the isolated and rural population of La Alpujarra, located on the western Mediterranean coast (southeast Spain), in the first half of the 20th century. The study is a retrospective analysis from a total sample of 2,200 deliveries, 2,085 of which were born alive and 171 of which did not survive to the 20th birthday. The potential influences of birthdate of children, twinning, firstborn, parental inbreeding, and sex on Alpujarran mortality were analyzed through logistic regression. Parity, family size, and birth interval effects were estimated through the difference between observed and expected mortality rates. In every case four age groups of mortality were considered because of the large influence of child growth: neonatal (less than 1 month of life), postneonatal infant (between 1 month and 1 year old), childhood (1-5 years old), and youth (5-20 years old). The Alpujarran prereproductive mortality pattern can be summarized as the result of three main risk factors: biodemographic, biomechanical, and social and health determinants. In general, every factor showed a decreased effect as children grew. The most significant determinants were birthdate of children, which is more related to increased mother's awareness of child care than to health improvement, and family size associated with decreasing alimentary resources as the sibling number increased. Male mortality was higher than female mortality in children older than 1 year but not for infant mortality, possibly as a result of a reproductive behavior favorable to males. Although firstborn status and twinning appeared associated with high mortality, maternal age and birth interval were related to low risk, but these influences always ceased after the first month of life. Parental inbreeding did not show any effect on infant, childhood, or youth mortality.     

Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010

Introduction

From 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change.

Methods

This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data.

Findings

The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector.

Conclusions

Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.     

Child health in rural Colombia: determinants and policy interventions

We study the determinants of child anthropometrics on a sample of poor Colombian children living in small municipalities. We focus on the influence of household consumption, and public infrastructure, taking into account the endogeneity of household consumption using two different sets of instruments: household assets and municipality average wage. We find that both household consumption and public infrastructure are important determinants of child health. We have also found that the coverage of the piped water network positively influenced child health if the parents have some education.     

The socioeconomic gradient in child health and noncognitive skills: Evidence from the Czech Republic

We investigate the presence of a socioeconomic status (SES) gradient in children’s health and noncognitive skill development, and its evolution with child age using cohort data from the Czech Republic. We show that family SES are positively associated with better child health. These effects start to emerge at age 3 and are persistent for all subsequent ages. We find a modest strengthening of the gradient as the children grow older. Similarly, at the lowest distribution of average family income, children lag in their noncognitive skills. We find evidence that children enter school with substantial differences in noncognitive skill endowments based on family SES. This correlation persists when controlling for poor health at birth, the roles of specific and chronic health problems, housing conditions, and partner characteristics. Maternal health status explains some of the association between family income and child noncognitive skills. We account for the endogeniety of SES and non-linearities in measures.     

The “Long-arm” of chronic conditions in childhood: Evidence from Canada using linked survey-administrative data

The objective of this study was to investigate the relationship between health conditions in childhood (ages 4–11), and health and socioeconomic outcomes in adulthood (ages 21–33). This study takes advantage of a new linkage between the National Longitudinal Survey of Children and Youth (NLSCY) and administrative tax data from the T1 Family File (T1FF) from Statistics Canada. The NLSCY includes rich longitudinal information on child development, while the T1FF includes administrative tax information on each child in adulthood (e.g., income, social assistance). The primary measures of child health relate to the diagnosis of a chronic condition, affecting the child’s physical or mental/developmental health. The results suggest that mental/developmental health conditions in childhood more negatively influence adult health and socioeconomic conditions, compared to physical health conditions. Interaction models reveal modest heterogenous effects; for example, there is some evidence of a cushioning effect from higher household income in childhood, as well as an exacerbating negative effect from lower birth weight for mental/developmental health conditions. Using a covariate decomposition approach to explore underlying pathways, the results reveal that associations between health in early life and outcomes in adulthood are partially explained by differences in cognitive skills (i.e., mathematics test scores) in adolescence (ages 16–17). Results may encourage policy investments to mitigate the occurrence of health conditions in childhood and to ensure timely access to educational supports and health services for children with chronic conditions.     

Effects of land titling on child health

This paper examines the impact of urban land titling on child health. We hypothesize that land titling may translate into positive effects on health through its impact on housing investments and household structure. To address selection concerns, we take advantage of a natural experiment of land occupation in a suburban area of Buenos Aires, Argentina, that ensures that the allocation of property rights is exogenous to the characteristics of the squatters. Our results show that in the titled parcels children enjoy better weight-for-height scores (but similar height-for-age scores), and teenage girls have lower pregnancy rates than those in untitled parcels.     

Analyzing infant mortality with geoadditive categorical regression models: a case study for Nigeria

In this paper, we analyze infant mortality in Nigeria based on the data set from the 1999 Nigeria Demographic and Health Survey (NDHS). We investigate spatial patterns at a highly disaggregated level of Nigerian states and consider non-linear effects of mother's age at birth. Time to the occurrence of a child's death can intuitively be considered to be categorical in nature and the determinants of a child's death may differ in different age groups. Thus, it may be desirable to investigate separately the death of a child in the first month and in the remaining 11 months of the first year of life. To avoid selection bias, the data set used for this case study is based on information on children who were born 12 months preceding the survey. Inference is Bayesian and is based on Markov chain Monte Carlo (MCMC) techniques. We find that spatial variation and the determinants of death indeed differ considerably for the two age groups considered.     

Teenage motherhood and infant mortality in Bangladesh: maternal age-dependent effect of parity one

Nuptiality norms in rural Bangladesh favour birth during the teenage years. An appreciable proportion of teenage births are, in fact, second births. This study examines the relationship between teenage fertility and high infant mortality. It is hypothesized that if physiological immaturity is responsible, then the younger the mother, the higher would be the mortality risk, and the effect of mother's 'teenage' on mortality in infancy, particularly in the neonatal period, would be higher for the second than the first births. Vital events recorded by the longitudinal demographic surveillance system in Matlab, Bangladesh, in 1990-92 were used. Logistic regression was used to estimate the effects on early and late neonatal (0-3 days and 4-28 days respectively) and post-neonatal mortality of the following variables: mother's age at birth, parity, education and religion, sex of the child, household economic status and exposure to a health intervention programme. The younger the mother, the higher were the odds of her child dying as a neonate, and the odds were higher for second children than first children of teenage mothers. First-born children were at higher odds of dying in infancy than second births if mothers were in their twenties. Unfavourable mother's socioeconomic conditions were weakly, but significantly, associated with higher odds of dying during late neonatal and post-neonatal periods. The results suggest that physical immaturity may be of major importance in determining the relationship between teenage fertility and high neonatal mortality.     

Weaving carpets, weaving lives: Childhood and ethnicity in downtown Kathmandu

In the developing metropolis public perceptions about caste and ethnicity are influenced by historical trends in decisions about occupations; but what does this mean for children whose families decide they work? In Kathmandu's carpet industry, a large percentage of workers are Tamang, an ethnic group who represent a small percentage of the country's population. Organisations working with Tamang child labourers have predominantly used quantitative research data to construct their intervention strategies. This has left many factors unexamined. This paper discusses qualitative and quantitative research data generated by a team of Nepali practitioners striving to address child labour issues. The purpose of their study was to examine the social and cultural factors influencing child migration and the quality of life for children in the carpet industry. The methodology included participatory indicators of children's social, economic, physical and psychological well-being. The paper will draw on children's perspectives to highlight the role of ethnicity in opportunity and exploitation.     

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.