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.     

Breast-feeding in Bangladesh

In this paper the duration of breastfeeding is examined in relation to demographic and socioeconomic characteristics of women and households. 98% of Bangladesh mothers breastfeed their children from birth. In data from the Bangladesh Fertility Survey conducted in 1975-1976 on 4998 live births, the mean duration of breastfeeding was 27.3 months. Duration of breastfeeding was positively related with the age of women. Female children were breastfed for periods about 5 months shorter than male children. Children born to urban mothers were breastfed for shorter durations than children born to rural mothers of all age groups. The duration of breastfeeding decreased with the increase of education of the mother. Promotion of breastfeeding should be a primary responsibility of family planning clinics. Further decline in the duration of breastfeeding would increase levels of fertility and infant and child mortality.     

Socioeconomic, demographic and environmental determinants of infant mortality in Nepal

The Nepal Fertility and Family Planning Survey of 1986 demonstrated that demographic variables, previous birth interval and survival of preceding child, still predominated as determinants of infant mortality, particularly in rural areas of Nepal. However, in urban Nepal, where the level of socioeconomic development is higher, an environmental variable, along with previous birth interval and survival of preceding child emerges as important in determining infant mortality. Separate policy measures for child survival prospects in rural and urban Nepal are suggested.     

Place of Residence Moderates the Risk of Infant Death in Kenya: Evidence from the Most Recent Census 2009

Background

Substantial progress has been made in reducing childhood mortality worldwide from 1990–2015 (Millennium Development Goal, target 4). Achieving target goals on this however remains a challenge in Sub-Saharan Africa. Kenya’s infant mortality rates are higher than the global average and are more pronounced in urban areas as compared to rural areas. Only limited knowledge exists about the differences in individual level risk factors for infant death among rural, non-slum urban, and slum areas in Kenya. Therefore, this paper aims at 1) assess individual and socio-ecological risk factors for infant death in Kenya, and at 2) identify whether living in rural, non-slum urban, or slum areas moderated individual or socio-ecological risk factors for infant death in Kenya.

Methodology

We used a cross-sectional study design based on the most recent Kenya Population and Housing Census of 2009 and extracted the records of all females who had their last child born in 12 months preceding the survey (N = 1,120,960). Multivariable regression analyses were used to identify risk factors that accounted for the risk of dying before the age of one at the individual level in Kenya. Place of residence (rural, non-slum urban, slum) was used as an interaction term to account for moderating effects in individual and socio-ecological risk factors.

Results

Individual characteristics of mothers and children (older age, less previously born children that died, better education, girl infants) and household contexts (better structural quality of housing, improved water and sanitation, married household head) were associated with lower risk for infant death in Kenya. Living in non-slum urban areas was associated with significantly lower infant death as compared to living in rural or slum areas, when all predictors were held at their reference levels. Moreover, place of residence was significantly moderating individual level predictors: As compared to rural areas, living in urban areas was a protective factor for mothers who had previous born children who died, and who were better educated. However, living in urban areas also reduced the health promoting effects of better structural quality of housing (i.e. poor or good versus non-durable). Furthermore, durable housing quality in urban areas turned out to be a risk factor for infant death as compared to rural areas. Living in slum areas was also a protective factor for mothers with previous child death, however it also reduced the promoting effects of older ages in mothers.

Conclusions

While urbanization and slum development continues in Kenya, public health interventions should invest in healthy environments that ideally would include improvements to access to safe water and sanitation, better structural quality of housing, and to access to education, health care, and family planning services, especially in urban slums and rural areas. In non-slum urban areas however, health education programs that target healthy diets and promote physical exercise may be an important adjunct to these structural interventions.     

Infant mortality in Zambia: socioeconomic and demographic correlates

Trends in infant mortality in Zambia suggest a reversal of the decline experienced between the 1960s and the late 1970s. From a high of about 140, infant mortality rate declined to about 90 in the late 1970s only to rise again to 100 by 1996. Data on 5,600 births born between 1987 and 1992, and 6,630 births between 1991 and 1996 from the Zambian DHS are analyzed to identify socioeconomic and demographic correlates of infant mortality. Demographic factors such as small size at birth and short birth intervals are associated with higher neonatal mortality. In the post-neonatal period, urban children from poorer households had the highest mortality between 1991-1996. Also, differences in infant mortality rates between provinces narrowed. Children born in the most developed province of Lusaka had as high of risk of dying as those from Luapula, a province with a history of extremely high mortality rates in Zambia.     

Covariates of child mortality in Mali: does the health-seeking behaviour of the mother matter?

This paper uses data from the 1995/96 Mali DHS survey to examine the importance of a wide range of socioeconomic, behavioural and biodemographic factors in the determination of child mortality in Mali, with a special focus on maternal education and behaviour. The central hypothesis of the study is that advances in maternal education would contribute little to child survival in settings such as Mali's urban and rural communities where progress in educational attainment is not matched with improvements in other aspects of socioeconomic development such as economic growth, job creation, financial security and public health and medical resources. Units of analysis are children born in the past 5 years to DHS respondents (women aged 15-45) who were married at the time of the survey. The Cox proportional hazards regression technique has been used to estimate the net effects of variables included as covariates. The findings indicate that the health-seeking behaviour of the mother matters more than maternal education in explaining the observed differences in infant and child mortality in Mali's urban and rural areas.     

Infant and child mortality in Pakistan--some trends and differentials

Data from reproductive histories collected in the Population, Labor Force and Migration Survey (PLM) of 1979 are used to analyze trends and differentials in infant and child mortality in Pakistan. Comparisons with the Pakistan Fertility Survey (PFS) findings are also presented. The main concern is to provide from the latest national data, the PLM, direct measures of infant and child mortality and to demonstrate the relatively static and low chances of survival for children in Pakistan. The apparent trends from the PLM and the PFS are similar and seem to confirm that infant and childhood mortality has ceased to decline, at least rapidly, since 1965-69. Neonatal mortality is higher at levels of 70-85 deaths/1000 compared to postneonatal mortality of 40-60 deaths/1000. Improvements in neonatal rates from 1950 until 1975 are only approximately 1/2 of those for postneonatal rates for that period. The relationship between maternal age and mortality in the PLM data confirms that children of youngest mothers experienced the highest rates of infant mortality; mortality is again higher for children of oldest mothers aged 35 and above. The pattern of mortality in the 2 surveys is similar except that in the PFS there was little variation among births higher than 5th order. Sex differentials in mortality are very clear in both surveys. Boys have higher chances of dying in the 1st month of life but then the probability of their surviving from age 1 to 5 years is higher, reflecting the behavioral preference for the male sex in this society. The data also demonstrate an almost monotonic decline in infant and child mortality associated with longer birth intervals. Childhood mortality shows a less clear association with preceding birth interval than does infant mortality. While neonatal mortality is much higher in rural than in urban areas, there are negligible differences in the postneonatal rate. The urban-rural differential continues into childhood, reflecting lower health care and nutrition of children in rural areas. The data confirm the importance of parental education, particularly that of mothers, as a contributor to the health and mortality of infants. Mortality between age 1 and 5 years for children of the rural educated group is lower than that for the urban uneducated indicating the strong influence that education of mothers can have in preventing child loss. The combined evidence from the PFS and PLM data stresses the importance of improving health facilities in the rural areas, in aneffort to reduce the differences in mortality by area of residence. The data from both surveys also suggest the need to restrict motherhood to between the ages of 20 and 34, when obstetrical and health risks are minimal, and indicate the definite advantages of increasing the spacing between children.     

Effect of infant mortality on subsequent fertility in Pakistan and Sri Lanka

This study used data from the 1975 World Fertility Surveys in Pakistan and Sri Lanka to examine the association between fertility and infant mortality. A positive association between the mean number of children ever born and the number of child deaths was found in both rural and urban areas of each country. In Pakistan, women with no child loss had 3.3 children ever born while those who lost 1 child had 4.7 children; in Sri Lanka the figures were 3.5 and 5.4 children, respectively. However, child replacement was much less marked when controls were introduced for demographic and socioeconomic factors. When deaths at specific parities were examined, and age and time since previous birth were controlled, child replacement at the 1st parity was reduced to .3 in Pakistan and .2 in Sri Lanka. Further control for a series of socioeconomic factors (e.g. husband's level of education, husband's occupation, household structure, religion, standard of living) reduced the child replacement ratio to .2 children in Pakistan and zero in Sri Lanka. Replacement was slightly more pronounced when there were fewer surviving male children. This analysis suggests that the relationship between infant mortality and fertility is complex. A possibility that could not be explored in this study is that variation in fertilitty may itself be responsible for some of the variation in infant mortality.     

Rural-urban differences in maternal responses to childhood fever in South East Nigeria

Background

Childhood fevers due to malaria remain a major cause of morbidity and mortality among under-five children in Nigeria. The degree of vulnerability perceived by mothers will affect their perception of the severity and threat of their child''s fever and the patterns of health care use. This study was undertaken to compare maternal responses to childhood fever in urban and rural areas of Enugu, south east Nigeria.

Methodology/Principal Findings

Data was collected with pre-tested interviewer-administered questionnaires from 276 and 124 urban and rural households respectively. In each household, only one woman aged 15–49 years who had lived in each of the urban and rural communities for at least one year and had at least one child less than 5 years old was interviewed. Malaria was mentioned as the commonest cause of childhood fevers. Rural mothers were more likely to recognize danger signs and symptoms than urban mothers. Rural mothers use more of informal than formal health services, and there is more home management of the fever with urban than rural mothers. Chloroquine, ACT, SP and Paracetamol are the main drugs given at home for childhood fevers, but the rural mothers were more likely to use leftover drugs from previous treatment to treat the fevers than urban mothers. The urban respondents were also more likely to use a preventive measure. Urban mothers sought actions faster than rural mothers and the total cost of treatment was also higher in urban areas.

Conclusions/Significance

Both urban and rural mothers are aware that malaria is the major cause of childhood fevers. Although rural mothers recognize childhood fever and danger signs better than urban mothers, the urban mothers'' responses to fever seem to be better than that for rural mothers. These responses and differences may be important for geographical targeting by policy makers for malaria interventions.     

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.     

Rural-urban migration and child survival in urban Bangladesh: are the urban migrants and poor disadvantaged?

This paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children's survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999-2000 Bangladesh Demographic and Health Survey. The results indicate that, although the indices of infant and child mortality are consistently better in urban areas, the urban-rural differentials in childhood mortality have diminished in recent years. The study identifies two distinct child morality regimes in urban Bangladesh: one for urban natives and one for rural-urban migrants. Under-five mortality is higher among children born to urban migrants compared with children born to life-long urban natives (102 and 62 per 1000 live births, respectively). The migrant-native mortality differentials more-or-less correspond with the differences in socioeconomic status. Like childhood mortality rates, rural-urban migrants seem to be moderately disadvantaged by economic status compared with their urban native counterparts. Within the urban areas, the child survival status is even worse among the migrant poor than among the average urban poor, especially recent migrants. This poor-non-poor differential in childhood mortality is higher in urban areas than in rural areas. The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant's children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban-rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.     

Rural-Urban Differences in Household Treatment-Seeking Behaviour for Suspected Malaria in Children at Bata District,Equatorial Guinea

BackgroundMalaria remains a major cause of morbidity and mortality among children under five years old in Equatorial Guinea. However, little is known about the community management of malaria and treatment-seeking patterns. We aimed to assess symptoms of children with reported malaria and treatment-seeking behaviour of their caretakers in rural and urban areas in the Bata District.MethodologyA cross-sectional study was conducted in the district of Bata and 440 houses were selected from 18 rural villages and 26 urban neighbourhoods. Differences between rural and urban caregivers and children with reported malaria were assessed through the chi-squared test for independence of categorical variables and the t-Student or the non-parametric Mann-Whitney test for normally or not-normally distributed continuous variables, respectively.ResultsDifferences between rural and urban households were observed in caregiver treatment-seeking patterns. Fever was the main symptom associated with malaria in both areas. Malaria was treated first at home, particularly in rural areas. The second step was to seek treatment outside the home, mainly at hospital and Health Centre for rural households and at hospital and private clinic for urban ones. Artemether monotherapy was the antimalarial treatment prescribed most often. Households waited for more than 24 hours before seeking treatment outside and delays were longest in rural areas. The total cost of treatment was higher in urban than in rural areas in Bata.ConclusionsThe delays in seeking treatment, the type of malaria therapy received and the cost of treatment are the principal problems found in Bata District. Important steps for reducing malaria morbidity and mortality in this area are to provide sufficient supplies of effective antimalarial drugs and to improve malaria treatment skills in households and in both public and private sectors.     

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.     

Characterizing Rural Household Differentiation from the Perspective of Farmland Transfer in Eastern China Using an Agent Based Model

Over the past several decades in China there has been a large amount of rural labor flow to non-farm industries as well as an increase in farmland transfers that have resulted in significant differentiation of farmer households and changes in agricultural land use pattern. For this study we developed an agent-based model to explore this process and the resulting concentration of agricultural production by characterizing the households’ decision-making behavior with respect to farmland transfer in Jinze Town, located in the developed eastern region in China. The model simulated the household agents’ farmland transfer behavior, reproduced the evolution and differentiation of household agents, and explored changes of farm area distribution across household types from 2005 to 2020. Small households, the dominant demographic as well the main agricultural producers at the beginning of the simulation, decreased radically and cultivated the smallest area of farmland by the end. In contrast, large-scale farming households increased rapidly and became the main agricultural producers. The majority of households entirely exited farming in favor of urban employment. We examine how farm households’ attributes influence their farmland transfer behavior and subsequent livelihood choices in the specific socioeconomic and political context in the research region. We conclude with policy suggestions for the provision of a favorable environment for both large-scale farm households and those who leave farming altogether. Our findings can provide references for land use policies in other transitional rural areas.     

Infant and child mortality in Bangladesh

Socioeconomic differences and trends in infant and child mortality in Bangladesh are examined using data from the 1975 World Fertility Survey and 1979 Contraceptive Prevalence Survery. There is evidence of some recent decline in infant mortality and child mortality. Logit analysis of infant and child mortality indicates that sociodemographic variables such as mother's education, recent period, or higher birth orders, has significant independent effects upon the reduction of infant and child mortality. Other variables such as fetal loss, father's education, or land ownership had no consistent significant effect. On the other hand the effect of urban residence on infant and child mortality was positive after the control of sociodemographic variables. Mere concentration on the supply of modern medical services may bring limited returns unless they are reinforced by appropriate social changes, in particular those affecting the socioeconomic status of women. Educated mothers are likely to belong to higher income households, have better knowledge of how to care for children, and can bring more resources to the care of a sick child.     

Household and community socioeconomic influences on early childhood malnutrition in Africa

This paper uses multilevel modelling and Demographic and Health Survey data from five African countries to investigate the relative contributions of compositional and contextual effects of socioeconomic status and place of residence in perpetuating differences in the prevalence of malnutrition among children in Africa. It finds that community clustering of childhood malnutrition is accounted for by contextual effects over and above likely compositional effects, that urban-rural differentials are mainly explained by the socioeconomic status of communities and households, that childhood malnutrition occurs more frequently among children from poorer households and/or poorer communities and that living in deprived communities has an independent effect in some instances. This study also reveals that socioeconomic inequalities in childhood malnutrition are more pronounced in urban centres than in rural areas.     

Urban Sheep Keeping in West Africa: Can Socioeconomic Household Profiles Explain Management and Productivity?

Rapid urbanization in Africa leads to a spatial concentration of people with different cultural origins and socioeconomic backgrounds resulting in a great diversity of life styles and livelihood strategies. One common strategy in Maroua/Cameroon and Bobo-Dioulasso/Burkina Faso is urban sheep keeping. Cluster analyses identified distinct socioeconomic groups with similarities between the towns: traditional livestock keepers, households headed by well educated government employees or traders, and more vulnerable groups formed of households headed by females, retired people or people with limited formal education. The household types in Bobo varied in their perception of the importance and the development of urban sheep keeping and their future plans. Those in Maroua differed in management intensity and in the potential to adapt their practices to the urban environment. Development interventions to reduce environmental pollution and risks for human health associated with urban sheep keeping need to account for these differences in the target group.     

The impact of rural-urban migration on under-two mortality in India

This paper examines the impact of rural-urban migration on under-two mortality in India, using data from the 1992/93 Indian National Family Health Survey. Multilevel logistic models are fitted for mortality in three age groups: neonatal, early post-neonatal, and late post-neonatal and toddler. Migration status was not a significant determinant of mortality in any of the three age groups. Further analysis shows that a relationship between migration status and mortality exists when socioeconomic and health utilization variables are omitted from the models. The relationship between migration and mortality is thus explained by differences in socioeconomic status and use of health services between rural-urban migrant and nonmigrant groups. The selectivity of rural-urban migrants on socioeconomic characteristics creates mortality differentials between rural-urban migrants and rural non-migrants. Problems faced by migrants in assimilating into urban societies create mortality differentials between rural-urban migrants and urban non-migrants. These results highlight the need to target migrants in the provision of health services, and demonstrate that rural areas continue to have the highest levels of infant-child mortality. Further research is needed to understand the health care needs of rural-urban migrants in order to inform the provision of appropriate health care.     

Neonatal abandonment in Japanese macaques

This study analyzed long-term demographic data relative to a captive colony of Japanese macaques (Macaca fuscata) in order to evaluate factors predicting increased probability of infant neonatal abandonment. Overall, 7.7% of liveborn infants were abandoned at birth. Probability of abandonment was significantly increased in primiparous and, to a lesser extent, low-ranking mothers. Primiparous mothers abandoned about 40% of their infants at birth. Mother age and infant sex had no independent effects on the probability of neonatal abandonment. Primiparous mothers that did not abandon their infants suffered increased infant mortality and showed longer interbirth intervals compared to same-age multiparous mothers. These results are partially consistent with adaptive hypotheses predicting maternal divestment under unfavorable conditions, and with proximate explanations linking abandonment to inexperience and stress.