Infant mortality and mother's education in Ondo State, Nigeria

Survival among children under-five in India: a parametric multilevel survival approach

BACKGROUND

Many studies have been conducted on under-five mortality in India and most of them focused on the associations between individual-level factors and under-five mortality risks. On the contrary, only a scarce number of literatures talked about contextual level effect on under-five mortality. Hence, it is very important to have thorough study of under-five mortality at various levels. This can be done by applying multilevel analysis, a method that assesses both fixed and random effects in a single model. The multilevel analysis allows extracting the influence of individual and community characteristics on under-five mortality. Hence, this study would contribute substantially in understanding the under-five mortality from a different perspective.

METHOD

The study used data from the Demographic and Health Survey (DHS) acquired in India, i.e., the fourth round of National Family and Health Survey (2015-16). It is a nationally representative repeated cross-sectional data. Multilevel Parametric Survival Model (MPSM) was employed to assess the influence of contextual correlates on the outcome. The assumption behind this study is that 'individuals' (i.e., level-1) are nested within 'districts' (i.e., level-2), and districts are enclosed within 'states' (i.e., level-3). This suggests that people have varying health conditions, residing in dissimilar communities with different characteristics.

RESULTS

Highest under-five mortality i.e., 3.85% are happening among those women whose birth interval is less than two years. In case of parity, around 4% under-five mortality is among women with Third and above order parity. Further, findings from the full model is that ICC values of 1.17 and 0.65% are the correlation of the likelihood of having under-five mortality risk among people residing in the state and district communities, respectively. Besides, the risk of dying was increased alarmingly in the first year of life and slowly to aged 3 years and then it remains steady.

CONCLUSION

This study has revealed that both aspects viz. individual and contextual effect of the community are necessary to address the importance variations in under-five mortality in India. In order to ensure substantial reduction in under-five mortality, findings of the study support some policy initiatives that involves the need to think beyond individual level effects and considering contextual characteristics.

Factors associated with infant mortality in Nigeria: A scoping review

BACKGROUND

Infant mortality persists as a global public health concern, particularly in lower-middle-income countries (LIMCs) such as Nigeria. The risk of an infant dying before one year of age is estimated to be six times higher in Africa than in Europe. Nigeria recorded an infant mortality rate of 72.2 deaths per 1,000 live births in 2020, in contrast to the global estimate of 27.4 per 1,000 live births. Several studies have been undertaken to determine the factors influencing infant mortality.

OBJECTIVE

This scoping review sought to identify and summarise the breadth of evidence available on factors associated with infant mortality in Nigeria.

METHODS

This review followed the five-stage principles of Arksey and O'Malley's framework. Four electronic databases were searched with no limit to publication date or study type: Ovid MEDLINE, PubMed, CINAHL Complete, and Web of Science. Selected studies were imported into Endnote software and then exported to Rayyan software where duplicates were removed. Included articles were thematically analysed and synthesised using the socioecological model.

RESULTS

A total of 8,139 references were compiled and screened. Forty-eight articles were included in the final review. At the individual level, maternal- and child-related factors were revealed to influence infant mortality; socioeconomic and sociocultural factors at the interpersonal level; provision and utilisation of health services, health workforce, hospital resources and access to health services at the organisational level; housing/neighbourhood and environmental factors at the community level; and lastly, governmental factors were found to affect infant mortality at the public policy level.

CONCLUSION

Factors related to the individual, interpersonal, organisational, community and public policy levels were associated with infant mortality in Nigeria.

The incidence of stunting, the frequency/duration of diarrhea and Acute Respiratory Infection in toddlers

Background: Infectious diseases such as diarrhea and Acute Respiratory Infection (ARI) lead to loss of appetite in children and stunting growth. This study analyzes the relationship between the incidence of stunting and the frequency/duration of diarrhea and ARI in children under five years.

Design and Methods: The stratified random sampling method was used to obtain data from 152 children in 4 villages in Surabaya, East Java, Indonesia.

Results: The results showed that children under the age of five, experience higher stunting duration and longer frequency of diarrhea. The Rho Spearmen Test showed differences in the incidence of stunting with the frequency of diarrhea P = 0.005 (P<α = 0.05), P = 0.003 (P<α = 0.05), with ARI of P =0.001 (P<α = 0.05).

Conclusions: In conclusion, stunting is related to the frequency and duration of diarrheal diseases and ARI, therefore, community- integrated health center need to carryout counseling activities on children less than five years to determine their health status.

Structured additive distributional zero augmented beta regression modeling of mortality in Nigeria

Child mortality has remained persistently high in most sub-Saharan African countries. Majority of the effort in analyzing the determinants, or covariables did not consider the duration of exposure to mortality risks. In addition, covariates are usually linked to the mean of the response variable, thereby neglecting the possible association with other higher moments. In this paper, we account for the duration of exposure via the child mortality index, defined as the ratio of observed to expected child death, for all women captured in the 2013 Nigeria Demographic and Health Survey. Based on this index, a structured additive distributional beta regression model was adopted to examine covariate effects on the probability of a woman experiencing no child mortality, the conditional expectation of mortality, and the mortality spread, controlling for latent spatial associations. Our inferential framework is Bayesian inference, powered by generic MCMC tools based on iterative weighted least squares. Results confirm the existence of significant variation in the likelihood of a woman experiencing no child mortality, and in the spread of mortality, across Nigerian states. Findings also show that although mortality is fairly spread among women aged ≥30 years, it is concentrated among the younger women.

Prevalence and determinants of childhood mortality in Nigeria

Background

Childhood mortality has remained a major challenge to public health amongst families in Nigeria and other developing countries. The menace of incessant childhood mortality has been a major concern and this calls for studies to generate new scientific evidence to determine its prevalence and explore predisposing factors associated with it in Nigeria.

Method

Data was obtained from Nigeria DHS, 2013. The study outcome variable was the total number of children lost by male partners and female partners respectively who were married. The difference between the numbers of child births and the number of living children was used to determine the number of children lost. Study variables were obtained for 8658 couples captured in the data set. Descriptive statistics were computed to examine the presence of over-dispersion and zero occurrences. Data were analysed using STATA Software version 12.0. Zero-inflated negative binomial (ZINB) regression analysis was carried out to determine the factors associated with childhood mortality. Results of ZINB were reported in terms of IRR and 95% confidence interval (CI).

Results

The age (mean ± std.) of male and female participants were 36.88 ± 7.37 and 28.59 ± 7.30 respectively. The data showed that 30.8% women reported loss of children and 37.3% men reported the same problem. The study revealed age (years), region, residence, education, wealth index, age at first birth and religion of father and mother as factors associated with childhood mortality. In terms of education, secondary and tertiary educated fathers exhibited 3.8% and 12.1% lower risk of childhood mortality respectively than non-educated fathers. The results showed that the risk of childhood mortality are 26.7%, 39.7 and 45.9% lower among the mothers having primary, secondary and tertiary education respectively than those with no formal education. The mothers living in rural areas experienced 28.3% increase in childhood mortality than those in urban areas, while the fathers in rural areas experienced 33.5% increase in childhood mortality than the urban areas. The risk of childhood mortality was significantly lower in middle, richer and richest (11.1%, 37.5 and 49%) economic quintiles respectively when compared to the risk of childhood mortality with female spouse who are poorest. Similar results were obtained for the fathers, with reduction in the incidence-rate ratio of 3.3%, 20.2 and 28.7% for middle, richer and richest economic quintiles respectively, compared to the poorest status. Furthermore, region and religion were found to be significant factors associated with childhood mortality in Nigeria.

Conclusion

The findings suggested that age, region, residence, education, wealth index, age at first birth and religion of fathers and mothers are key determinants associated with childhood mortality. The correlation between childhood mortality and fathers’ and mothers’ ages were found to increase the incidence of the outcome for every unit increase in age. The converse was however, true for age at first birth which was also statistically significant. The implication of this study is that policy makers and stakeholders in health care should provide for improved living standards to achieve good life expectancy meeting SDG3.

REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS

There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.

Social inequality in infant mortality: what explains variation across low and middle income countries?

Growing work demonstrates social gradients in infant mortality within countries. However, few studies have compared the magnitude of these inequalities cross-nationally. Even fewer have assessed the determinants of social inequalities in infant mortality across countries. This study provides a comprehensive and comparative analysis of social inequalities in infant mortality in 53 low-and-middle-income countries (LMICs). We used the most recent nationally representative household samples (n = 874,207) collected through the Demographic Health Surveys (DHS) to calculate rates of infant mortality. The relative and absolute concentration indices were used to quantify social inequalities in infant mortality. Additionally, we used meta-regression analyses to examine whether levels of inequality in proximate determinants of infant mortality were associated with social inequalities in infant mortality across countries. Estimates of both the relative and the absolute concentration indices showed a substantial variation in social inequalities in infant mortality among LMICs. Meta-regression analyses showed that, across countries, the relative concentration of teenage pregnancy among poorer households was positively associated with the relative concentration of infant mortality among these groups (beta = 0.333, 95% CI = 0.115 0.551). Our results demonstrate that the concentration of infant deaths among socioeconomically disadvantaged households in the majority of LMICs remains an important health and social policy concern. The findings suggest that policies designed to reduce the concentration of teenage pregnancy among mothers in lower socioeconomic groups may mitigate social inequalities in infant mortality.

Risk factors and a predictive model for under-five mortality in Nigeria: evidence from Nigeria demographic and health survey

Background

Under-5 mortality is a major public health challenge in developing countries. It is essential to identify determinants of under-five mortality (U5M) childhood mortality because these will assist in formulating appropriate health programmes and policies in order to meet the United Nations MDG goal. The objective of this study was to develop a predictive model and identify maternal, child, family and other risk factors associated U5M in Nigeria.

Methods

Population-based cross-sectional study which explored 2008 demographic and health survey of Nigeria (NDHS) with multivariable logistic regression. Likelihood Ratio Test, Hosmer-Lemeshow Goodness-of-Fit and Variance Inflation Factor were used to check the fit of the model and the predictive power of the model was assessed with Receiver Operating Curve (ROC curve).

Results

This study yielded an excellent predictive model which revealed that the likelihood of U5M among the children of mothers that had their first marriage at age 20-24 years and ≥ 25 years declined by 20% and 30% respectively compared to children of those that married before the age of 15 years. Also, the following factors reduced odds of U5M: health seeking behaviour, breastfeeding children for > 18 months, use of contraception, small family size, having one wife, low birth order, normal birth weight, child spacing, living in urban areas, and good sanitation.

Conclusions

This study has revealed that maternal, child, family and other factors were important risk factors of U5M in Nigeria. This study has identified important risk factors that will assist in formulating policies that will improve child survival.

Influence of maternal education on child immunization and stunting in Kenya

In 2003, the child mortality rate in Kenya was 115/1000 children compared to 88/1000 average for Sub-Saharan African countries. This study sought to determine the effect of maternal education on immunization (n=2,169) and nutritional status (n=5,949) on child's health. Cross-sectional data, Kenya Demographic Health Survey (KDHS)-2003 were used for data analyses. 80% of children were stunted and 49% were immunized. After controlling for confounding, overall, children born to mothers with only a primary education were 2.17 times more likely to be fully immunized compared to those whose mothers lacked any formal education, P<0.001. For nutrition, unadjusted results, children born to mothers with primary education were at 94% lower odds of having stunted growth compared to mothers with no primary education, P<0.01. Policy implications for child health in Kenya should focus on increasing health knowledge among women for better child health outcomes.

Mother's knowledge of sickle-cell anaemia in Nigeria

The study ascertains knowledge of mothers of sufferers of sickle-cell anaemia specifically regarding aetiology of the disorder and acceptable medical care. One hundred fifty-seven mothers of children suffering from sickle-cell anaemia (HbSS) attending a haematology clinic of a general hospital in Lagos were randomly sampled and asked about the aetiology and their understanding of the rules of care using a short open-ended questionnaire. The mean age of the mothers was 37.4 and a significant majority belong to the lower socio-economic strata. Thirty-four percent reported having been informed of the hereditary basis of anaemia but 48.4% received no explanation. Doctors, nurses, and lay literature were the main sources of information on the condition, as well as its medical care. The considerable gaps in appropriate knowledge on sickle-cell anaemia in Nigeria observed indicates that adequate and properly-presented information to parents or guardians of patients should be an essential part of a comprehensive care plan.

Structural determinants of child mortality in sub-Saharan Africa: A cross-national study of economic and social influences from 1970 to 1997

This cross-national study seeks to understand the lagging child mortality declines in sub-Saharan Africa by using World Bank data to investigate social and economic factors at three points in time: 1970, 1985, and 1997. Women's education, foreign debt-to-export ratio, and GNP per capita are among the strongest correlates of under five mortality over time. Cross-sectional and longitudinal results suggest that female education is the best overall predictor of child mortality. Average national income does not emerge as a strong predictor, particularly since 1985. Increasing levels of foreign debt are associated with a substantial excess mortality burden. In 1997, the effect of adult HIV prevalence on child mortality was moderate and statistically significant. The study concludes that, although future gains in social factors such as female education will likely be beneficial, without simultaneously addressing high levels of foreign debt and high HIV prevalence, it may be difficult to improve child mortality rates across sub-Saharan Africa.

Analysing child mortality in Nigeria with geoadditive discrete-time survival models

Child mortality reflects a country's level of socio-economic development and quality of life. In developing countries, mortality rates are not only influenced by socio-economic, demographic and health variables but they also vary considerably across regions and districts. In this paper, we analysed child mortality in Nigeria with flexible geoadditive discrete-time survival models. This class of models allows us to measure small-area district-specific spatial effects simultaneously with possibly non-linear or time-varying effects of other factors. Inference is fully Bayesian and uses computationally efficient Markov chain Monte Carlo (MCMC) simulation techniques. The application is based on the 1999 Nigeria Demographic and Health Survey. Our method assesses effects at a high level of temporal and spatial resolution not available with traditional parametric models, and the results provide some evidence on how to reduce child mortality by improving socio-economic and public health conditions.

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.

Risk factors for overall and persistent diarrhoea in infancy in Antalya, Turkey: a cohort study

The aim of this study was to identify factors that influence the incidence of diarrhoea in infancy. The study was a prospective cohort study conducted in two primary healthcare unit areas in Antalya, Turkey. A total of 204 infants were followed until they were aged 1 year. Morbidity surveillance and anthropometric measurements were carried out by home visits every 2 months. The average incidences were found to be 2.76 episodes per child-year for overall diarrhoea and 18.56 episodes per 100 child-years for persistent diarrhoea. Relative risks, confidence intervals and logistic regression analyses were used to assess the associations. For both overall diarrhoea and persistent episodes, increased risks were associated with having an uneducated mother (RR=1.89 and 5.33, respectively) and a self-employed father (RR=1.89 and 3.77, respectively). Among environmental factors, living in a slum was associated with both overall (RR=1.68) and persistent (RR=2.69) diarrhoea, whereas living in a crowded house (RR=1.70), having no kitchen (RR=2.27) or having an unhygienic toilet (RR=1.93) were found to be significant for overall episodes alone. Factors related to the infant were preterm birth (RR=1.64), low birth weight (RR=2.05), and first breastfeed given more than 1 h after birth (RR=1.64). Nutritional status was also associated with overall or persistent diarrhoea: underweight children (RR=2.15, persistent diarrhoea only), stunted children (RR=1.67 and 2.14, respectively) or wasted children (RR=1.54 and 3.20, respectively). By logistic regression analysis, both overall and persistent diarrhoea were found to be associated with mother's education.

Implications of women's work for child nutritional status in sub-Saharan Africa: a case study of Nigeria

The study examines the relationships between women's work and child nutritional status (stunting and wasting) of 5331 Nigerian children aged 0-59 months, using data from the 1990 Nigerian Demographic and Health Survey. In defining women's work, the study considers whether women earned cash from their work and carried their children to work in order to assess the importance of childcare and income, which are the principal pathways through which women's work affects child nutritional status. The study also examines infants and children differently in order to assess the influence of child's age on nutritional status. The results reveal that wasting among infants increased when mothers did not take them to work. Furthermore, mothers' work reduced stunting in their children, but the expected positive effect of earning cash from work on childhood nutrition was less visible from the results. Other results from the study revealed that during infancy, having recent episodes of diarrhea or shorter breast-feeding duration increased wasting. Additionally, wasting was lower during infancy for children in households with pit toilets and children with Christian mothers. For infants, immunization reduced stunting, but longer duration of breast-feeding, being a higher parity child, being in households with pit toilets increased stunting. During childhood, higher birth weight, immunization, and having a Christian mother reduced stunting and wasting. Children in wealthy households are less likely to be stunted, while mother's education and being a higher parity child increased stunting. Also during childhood, having a Christian mother reduced wasting while recent episodes of fever increased wasting.

Incidence of acute respiratory infections and the relationship with some factors in infancy in Antalya, Turkey

BACKGROUND

Acute respiratory infections (ARI) are one of the major problems of childhood in developing countries. The objective of the study was to obtain the incidence of ARI and its risk factors in Antalya, Turkey.

METHODS

We carried out a prospective cohort study on 204 infants who were born between 1 November and 31 December 1997, in the area of two primary health-care units in the Antalya city center. The research group was followed periodically every 2 months by home visits and the infants were investigated to determine their symptoms of ARI. The weight and length of children were measured in every home visit. Additional questions about socioeconomic status, some environmental characteristics, and nutrition practice were asked. Data were entered into the computer and the Z-scores were calculated by the Epi Info 5 package program. The incidence rates, relative risks and confidence intervals were calculated by Microsoft Excel version 5.0 program.

RESULTS

The incidence of ARI was 6.53 episodes per child per year among the children in the research group. The factors that influenced the incidence of ARI were lack of mother's and father's education, heating by wood stove, being a low-birthweight infant, not being completely breast-fed in the first 4 months of life and being stunted. There were no associations between the number of persons per room or smoking status of family members with ARI incidence.

CONCLUSION

Our results demonstrated that ARI were also associated with some socioeconomic, environmental and nutritional status characteristics such as paternal education, house ownership, breast-feeding, stunting, prematurity and burning of biomass fuels in Turkey.

Environmental factors, situation of women and child mortality in southwestern Nigeria

In an earlier paper, the author identified the role of maternal social characteristics on child mortality in Sub-Saharan Africa through statistical analysis (Iyun, 1992; GeoJournal, 26(1), 43-52). This follow-up analysis attempts to further analyze and determine the relative significance of environmental and maternal factors on childhood mortality in two contrasting towns in southwestern Nigeria. The research design takes advantage of the integration of the medical and social sciences. The results of the current analysis reveal interesting insights into child mortality and maternal factors on one hand and domestic environmental conditions on the other. They give credence to an ecological perspective as a way to understand the complexities behind child survival. Domestic environmental conditions were stronger predictors of child mortality in the more developed study town, Ota, than the more traditional town, Iseyin. However, in both sites maternal factors, in particular age of mother at marriage, age of mother at first childbirth and parity were statistically significant predictors of child mortality. Mother's education was only significant in the more urbanized center, and generally remains inconsistent in its relationship with child mortality. Furthermore, child mortality rates continued to be a function of an environmental factor, namely source of drinking water, and a child care behavior factor, where the child was kept when mother was at work, especially the market environment.

Indices and sociodemographic determinants of childhood mortality in rural Upper Egypt

There is a general agreement that childhood mortality in Egypt has substantially declined during the last two decades. The decline has been traditionally attributed to the impact of the National Control of Diarrhoeal Diseases Program (NCDDP). However, a controversy still exists over the magnitude of that decline and the claimed impact of the NCDDP on diarrhoea related mortality. This study was carried out in six sites in rural Upper Egypt to determine indices, leading causes, and sociodemographic determinants of childhood mortality. Verbal autopsy was conducted with mothers or caretakers who had reported the death of a child under the age of five (U5) before the study to determine the leading cause of death. Then, the association between childhood mortality and a wide set of sociodemographic risk factors was examined by comparing these children with 1025 living U5 children using a multivariate logistic regression analysis. Results showed that the average infant and U5 mortality rates are 97.2 and 130.8 per 1000 live births respectively. Verbal autopsy revealed that the leading causes of U5 mortality are: diarrhoeal diseases (39.4%), acute respiratory infection (26.8%), combined episode of both (5.1%), febrile illnesses including meningitis (10.6%), neonatal causes (12.6%), and accidents (2.5%). Diagnosis was not determined in 3.0% of the cases. Child age (< 12 month) and mother age at childbirth are the strongest determinants of childhood mortality. Other determinants include parental illiteracy, parental age difference, house ownership, child order and average household meat consumption.

Enhancing participation of women of child-bearing age in a literacy for health project in southeastern Nigeria

This paper summarizes the approach of a 'literacy for health project' in southeastern Nigeria to recruit and maintain participants. Literacy for health projects enhance and develop the educational abilities of women while at the same time acting as a vehicle to combat the problems associated with maternal and child health. We describe ways to foster and enhance the participation of women of child-bearing age in a literacy for health project operated in Igbo-speaking southeastern Nigeria. Findings reveal that of four literacy centres, participation rates ranged from 50.35% to 61.1%. We maintain that efforts designed to impart the transference of literacy and numeracy skills to such women in southeastern Nigeria must: (a) address the farming needs, practices and operations of the target community prior to programme implementation; (b) consider the inclusion of counsellors in addition to traditional village health workers and/or literacy instructors; (c) determine the impact of using other sites based on community activities; as opposed to traditional locations such as schools and churches; (d) use incentives to motivate participants; and (e) extend the current level of participation beyond focus groups to planning beyond curriculum development.

Socioeconomic status and use of family planning among Ghanaian government workers

The low utilization of family planning methods in Ghana, and by inference in much of Africa, is explained by reference to traditional sociocultural values held by males. A LISREL model is tested using data collected from educated males working in the Ghanaian government. Among the findings are that lack of couple communication, segregated conjugal role relationships, and male-dominated decision-making are all significant predictors of non-use of family planning methods (pronatalist attitude is not). Possession of knowledge of family planning among Ghanaian males alone is unlikely to initiate use of family planning methods. Additional sociodemographic and modernization findings are reported.