Mortality decline in India, 1951-1961: development vs public health program hypothesis

The main determinants of infant mortality in Nepal

Infant mortality has reached a low stable rate in developed countries while it is still high and on a slow decline in developing countries. There are many factors that contribute to the incidence of a high or low level of infant mortality. Although credit for contributing to the lowering of infant mortality has been given to health programs by public health personnel and to the improvement in socio-economic status by social scientists, in a traditional and agricultural country such as Nepal, both these factors are found to influence infant mortality. Data on infant mortality obtained by the 1991 Demographic Health Survey of Nepal are analyzed in this study. A logistic regression model is used for analyzing the data. Several hypotheses are tested to explain the incidence of infant mortality in Nepal. The various reasons for the persistence of high infant mortality and the difficulties in lowering it are discussed. The findings suggest that among all the variables analyzed in the study, parity, place of residence, immunization, and ethnicity influence infant mortality the most.

Sex preference and third birth intervals in a traditional Indian society

The traditional preference for sons may be the main hindrance to India's current population policy of two children per family. In this study, the effects of various sociodemographic covariates, particularly sex preference, on the length of the third birth interval are examined for the scheduled caste population in Assam, India. Life table and hazards regression techniques are applied to retrospective sample data. The analysis shows that couples having two surviving sons are less likely to have a third child than those without a surviving son and those with only one surviving son. Age at first marriage, length of preceding birth intervals, age of mother, and household income have strong effects on the length of the third birth interval.

Mortality in Pacific island countries around 1980: geopolitical, socioeconomic, demographic and health service factors

Inhabitants of Pacific island countries experience a wide range of levels and cause structures of mortality. Data on socioeconomic, geopolitical and demographic variables have been analysed here to identify correlates and determinants of mortality in Pacific island countries circa 1980. The mortality data used in the study were the best available for the period and are reasonably accurate; descriptive data were derived from recognised sources. Political status was a major correlate, with independence positively associated with mortality. However, the influence of political status was partly accounted for by economic and social variables. Economic indices, particularly imports per capita, were major inverse correlates of mortality. Disparities in life expectancy occurred between malarious and nonmalarious countries, and these were not explicable by other factors. Melanesians, especially women, experienced high mortality rates. Education and doctor availability were both associated with increased life expectancy. Intercorrelation and confounding need to be taken into account in the interpretation of this analysis. The results have ramifications for policy development in the Pacific island countries themselves, and for investment and aid programs from major donor nations and organisations.

Infant mortality in Sri Lankan households: a causal model

The infant mortality rate in Sri Lanka has fallen precipitiously since World War II, to 44 per 1000 births, a rate that is similar to a number of Western Countries. Yet the aggregated country rate masks wide variations across districts, from a low 21 per 1000 in Jaffna District to a high of 100 per 1000 in Nuwara Eliya District. Such regional variations in infant mortality rates have been shown to be related to a number of social, demographic and intitutional characteristics of each area. To specify such linkages we move, in this paper, from the aggregate level of analysis to the level of individual households in order to look for social, economic and other characteristics associated with infant deaths. Data are derived from a systematic interview of 480 household heads in 12 villages of Sri Lanka, collected in 1980. The most proximate factors, public health or medical variables, that predict infant death in particular households include quality of family nutrition, supervised childbirth, immunization of children and, most significant, whether the family has a sanitary latrine. Yet these medical variables are strongly associated with educational and economic characteristics of the family which, in turn, are predictive of infant mortality. Poor families and poorly educated mothers are less likely to go to hospital for childbirth, have a latrine, etc., and more likely to have had an infant die. Underlying the variations in education and economic status are variations in ethnic group; families with poor sanitation, least education and few economic resources are most likely to be members of the minority communities, Ceylon or Indian Tamils and Muslims. Minority group membership is significantly associated with infant mortality as well. When a set of medical, educational, economic and cultural variables are examined simultaneously within a path model we show that the best causal explanation of infant death in Sri Lankan households says, "Minority group status results in poverty which prevents families from having safe sanitary facilities which causes infant death". Infant mortality in Sri Lanka is thus not simply a medical problem to be dealt with by public health programs, nor is it solely an economic problem that can be solved with creation of jobs, but it is better seen as a problem of the structure of the whole society.

Correlates of life expectancy in less developed countries

Analyses were performed to investigate several hypotheses concerning the multiple determinants of levels of life expectancy in developing countries in recent decades and some possible explanation for the observed variations in amount of gain in life expectancy from the 1950's to the 1970's. The findings were significant. For level of life expectancy the results of this present work conform by and large to results of other scholars in this area, although the present work is unique in that only developing countries were included. From the 1960's to the 1970's there has been a shift in the relative importance of economic indicators and general social indicators in favor of the social indicators. In the period 1960-65 some 70% of the variation in levels of life expectancy was associated with per capita income and literacy rates in a ratio of about three to two in favor of the economic variable. By 1970-75 the ratio has become six to one in favor of literacy. In addition, the multivariate model showed that the sanitation variables began to appear as significant correlates of levels of life expectancy in the more recent time period, playing a larger role than level of income per capita. Work pursued as part of a separate but concurrent project explored explicitly this three-way interaction between literacy, life expectancy and sanitation.

The international transfer of medical technology--an analysis and a proposal for effective monitoring

The international transfer of medical technology to the developing countries occurs at four levels--medical education, research, and missions; multinational corporate transactions; technical assistance projects sponsored by the World Health Organization; and bilateral foreign aid programs. In this article, a proposal is made for effective monitoring of international medical technology transfer through political and legal means, including a specific code of conduct for corporations engaged in medical technology transfer. The development of "intermediate health technologies" along the lines suggested by E. F. Schumacher, and the advantages of such an innovation in terms of population issues and economic development are also discussed.