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Thabrew KAS, Sooriyarachchi MR, Jayakody DNK. Determinants of under-five mortality in Sri Lanka: A multilevel analysis of 2016 Sri Lankan DHS data. PLoS One 2023; 18:e0291246. [PMID: 37682906 PMCID: PMC10490942 DOI: 10.1371/journal.pone.0291246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/14/2023] [Indexed: 09/10/2023] Open
Abstract
Under-five mortality (U5M) is considered a major public health issue directly impacts a country's development. This study analyzed the prognostic factors of U5M in Sri Lanka using data from the 2016 Demographic and Health Survey (DHS) of 8123 children. The study employed both a binary logistic regression model (BLRM) and a binary logistic random intercept multilevel model (BLRIMM) and compared the accuracy of each model's prediction percentage. The results showed that the BLRIMM had a higher correct prediction percentage (98.67%) compared to the BLRM (98.31%). The study found that children who were not breastfed (Odds Ratio (OR) = 116.74, 95% Confidence Interval (CI) = 62.97-216.41), were part of multiple births (OR = 3.73, 95% CI = 1.21-11.51), did not have a normal delivery (OR = 1.86, 95% CI = 1.11-3.12), were born to mothers who had experienced previous miscarriages or child loss (OR = 2.27, 95% CI = 1.26-4.11), and were born to mothers with a higher Body Mass Index (BMI) (OR = 1.05, 95% CI = 1.003-1.10) had higher odds of U5M. The odds of U5M were found to be lower among Buddhists (OR = 0.06, 95% CI = 0.01-0.50), Hindus (OR = 0.05, 95% CI = 0.01-0.46), and Roman Catholics (OR = 0.032, 95% CI = 0.003-0.307) compared to the "Other Religions" category in the dataset. The estimated covariance parameter of the random intercept (0.8231, p-value = 0.0405) indicated significant unobserved cluster-level variation in U5M. The study's results emphasize the importance of addressing religion related differences of U5M and improving maternal education regarding healthy lifestyle, proper food intake, the significance of breastfeeding, safe delivery methods, safety measures during pregnancy and childbirth in cases of multiple births, and proper child care after birth.
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Affiliation(s)
| | | | - Dushantha Nalin K. Jayakody
- School of Engineering, Sri Lanka Technological Campus, Padukka, Sri Lanka
- TECHLAB—Centro de Investigação em Tecnologias, Universidade Autónoma de Lisboa, Lisbon, Portugal
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Timilsina K, Sawangdee Y, Bhandari R, Tiwari S, Adhikari A. Breastfeeding and female labor force participation: the probability of survival of children in Nepal under 3 years old. Int Breastfeed J 2023; 18:24. [PMID: 37127653 PMCID: PMC10150337 DOI: 10.1186/s13006-023-00560-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/08/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The number of breastfeeding mothers participating in a labor force to generate income has been increasing in Nepal. In this regard, the study aims to assess the survival of Under 3 children in Nepal from the mother based on their labor force participation and breastfeeding status. METHODS Data for the study were obtained from the Nepal Demographic and Health Survey 2016. The sample size of the study was 2,994 live births children, born in the last three years prior to the day of the interview. The robust hazard ratio and cox proportional hazard regression were conducted between dependent and independent variables with 95% confidence intervals (CIs) to conclude. RESULTS From a total of 2,994 live births, 85 children died within 36 months of birth. More than 80% of the non-working mothers were breastfeeding their children. The findings shows that the survival of children under-3 is positively associated with the interaction with the mother's work and breastfeeding status (Hazard Ratio 0.428, 95% CI 0.24, 0.75), family structure (Hazard Ratio 1.511; 95% CI 1.37, 1.655), relationship with the household head (Hazard Ratio 0.452; 95% CI 0.311, 0.65), wealth quintiles (Hazard Ratio 0.390; 95% CI 0.33, 0.46), caste (Hazard Ratio 0.652; 95% CI 0.60, 0.69), and religion (Hazard Ratio 2.015; 95% CI 1.09, 3.70) with model CI 95%, Log pseudo likelihood = -521.39236, prob. χ2 = 0.005 and time at risk = 52,748. CONCLUSIONS The highest rate of child survival was from the working mothers as well as continuing breastfeeding their children followed by mothers breastfeeding the child but not working, compared to mothers working but not breastfeeding the child, and mothers who were neither working nor breastfeeding their children respectively. This study provides clear evidence that breastfeeding is very important for the probability of survival of the child aged below 36 months and work of mother also have some positive impact on child survival. Employers should be encouraged to have a breastfeeding policy in the workplace through the establishment of a breastfeeding facility, and a flexible work schedule. At the same time government should also regulate the paid maternity leave and encourage societal support for the breastfeeding mothers.
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Affiliation(s)
- Kailash Timilsina
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand.
- Gandaki University, Pokhara, Nepal.
| | - Yothin Sawangdee
- Institute for Population and Social Research, Mahidol University, Salaya, Thailand
| | | | - Sirjana Tiwari
- School of Health and Allied Sciences, Pokhara University, Pokhara, Nepal
| | - Ashmita Adhikari
- School of Environmental Science and Sustainable Development, Kathmandu, Nepal
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Ganguly D, Goli S, Rammohan A. Explaining the diminishing of Muslim advantage in child survival in India. GENUS 2022. [DOI: 10.1186/s41118-022-00177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractReligion is one of the key instrumental social institutions in determining child health and mortality. Muslim advantage in child survival in India has been widely reported. Recent India’s National Family Health Survey (NFHS) shows that the gap between Hindu–Muslim childhood mortality rates is shrinking—reversing decades of child survival advantage for Muslims. This study examines the factors linked to the diminishing of Muslim advantage in childhood survival and attempts to uncover the mechanisms accounting for the convergence using the characteristics hypothesis of Goldscheider (Population, modernization, and social structure Little, Brown & Co; 1971) and the analytical framework of Guillot and Allendorf (Genus 66(2), 2010). We have analyzed a pooled sample of 23,47,245 all live births and 428,541 of last live births from four rounds of NFHS (1992–2016). Kaplan–Meier survival plots over time by religion confirm convergence in Hindu–Muslim child survival probabilities. The Pyatt decomposition model reveals that the gap in Hindu–Muslim childhood mortality is diminishing due to a decline in within-Hindu inequality. Cox proportional hazard regression model shows that improvement in household and maternal socioeconomic factors has contributed to Hindu children catching up with Muslims—leading to a convergence in Hindu–Muslim childhood survival probabilities. Conditional β-convergence regression model also suggests the convergence in socio-economic status and maternal health care is driving the convergence in child survival of Hindus and Muslims across Indian states.
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Ahinkorah BO, Budu E, Seidu AA, Agbaglo E, Adu C, Osei D, Banke-Thomas A, Yaya S. Socio-economic and proximate determinants of under-five mortality in Guinea. PLoS One 2022; 17:e0267700. [PMID: 35511875 PMCID: PMC9070918 DOI: 10.1371/journal.pone.0267700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The death of children under-five years is one of the critical issues in public health and improving child survival continues to be a matter of urgent concern. In this paper, we assessed the proximate and socio-economics determinants of child mortality in Guinea. METHODS Using the 2018 Guinea Demographic and Health Survey (GDHS), we extracted demographic and mortality data of 4,400 children under-five years. Both descriptive and multivariable logistic regression analyses were conducted. RESULTS Under-five mortality was 111 deaths per 1,000 live births in Guinea. The likelihood of death was higher among children born to mothers who belong to other religions compared to Christians (aOR = 2.86, 95% CI: 1.10-7.41), smaller than average children compared to larger than average children (aOR = 1.97, 95% CI: 1.28-3.04) and those whose mothers had no postnatal check-up visits after delivery (aOR = 1.72, 95% CI: 1.13-2.63). Conversely, the odds of death in children with 2-3 birth rank & >2 years of birth interval compared to ≥4 birth rank and ≤2 years of birth interval were low (aOR = 0.53, 95% CI: 0.34-0.83). CONCLUSION We found that household/individual-level socioeconomic and proximate factors predict under-five mortality in Guinea. With just about a decade left to the 2030 deadline of the Sustainable Development Goals (SDGs), concerted efforts across all key stakeholders, including government and development partners, need to be geared towards implementing interventions that target these predictors.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | | | - Abdul-Aziz Seidu
- Department of Real Estate Management, Faculty of Built and Natural Environment, Takoradi Technical University, Takoradi, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion, Education and Disability, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dorothy Osei
- Department of Health Promotion, Education and Disability, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aduragbemi Banke-Thomas
- School of Human Sciences, University of Greenwich, London, United Kingdom
- LSE Health, London School of Economics and Political Science, London, United Kingdom
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
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Influence of sociodemographic factors on child mortality in Bangladesh: a multivariate analysis. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01378-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kabir R, Farag M, Lim HJ, Geda N, Feng C. Socio-demographic and environmental risk factors associated with multiple under-five child loss among mothers in Bangladesh. BMC Pediatr 2021; 21:576. [PMID: 34911492 PMCID: PMC8672494 DOI: 10.1186/s12887-021-03034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/14/2021] [Indexed: 08/24/2023] Open
Abstract
Background Despite the substantial decline in child mortality globally over the last decade, reducing neonatal and under-five mortality in Bangladesh remains a challenge. Mothers who experienced multiple child losses could have substantial adverse personal and public health consequences. Hence, prevention of child loss would be extremely desirable during women’s reproductive years. The main objective of this study was to determine the risk factors associated with multiple under-five child loss from the same mother in Bangladesh. Methods In this study, a total of 15,877 eligible women who had given birth at least once were identified from the 2014 Bangladesh Demographic and Health Survey. A variety of count regression models were considered for identifying socio-demographic and environmental factors associated with multiple child loss measured as the number of lifetime under-five child mortality (U5M) experienced per woman. Results Of the total sample, approximately one-fifth (18.9%, n = 3003) of mothers experienced at least one child’s death during their reproductive period. The regression analysis results revealed that women in non-Muslim families, with smaller household sizes, with lower education, who were more advanced in their childbearing years, and from an unhygienic environment were at significantly higher risk of experiencing offspring mortality. This study also identified the J-shaped effect of age at first birth on the risk of U5M. Conclusions This study documented that low education, poor socio-economic status, extremely young or old age at first birth, and an unhygienic environment significantly contributed to U5M per mother. Therefore, improving women’s educational attainment and socio-economic status, prompting appropriate timing of pregnancy during reproductive life span, and increasing access to healthy sanitation are recommended as possible interventions for reducing under-five child mortality from a mother. Our findings point to the need for health policy decision-makers to target interventions for socio-economically vulnerable women in Bangladesh.
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Affiliation(s)
- Rasel Kabir
- Collaborative Biostatistics Program, School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, Saskatoon, Canada.,School of Public Administration and Development Economics (SPADE), Doha Institute for Graduate Studies, Doha, Qatar
| | - Hyun Ja Lim
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Nigatu Geda
- Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Cindy Feng
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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Cau BM, Agadjanian V. Religion and Use of Institutional Child Delivery Services: Individual and Contextual Pathways in Mozambique. INTERNATIONAL PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 45:35-43. [PMID: 31639079 DOI: 10.1363/45e7719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Research on institutional child delivery in Sub-Saharan Africa typically focuses on availability and accessibility of health facilities. Cultural factors, including religion, that may facilitate or hinder the use of such services have not been well examined and remain poorly understood. METHODS The relationship between religious affiliation and delivery in a health facility was explored using data from a household survey of 1,297 women aged 18-50 and a census of 825 religious congregations, both conducted in a predominantly Christian district in Mozambique in 2008. Multilevel logistic regression analyses were conducted to predict the likelihood of recent institutional delivery according to both individual religious affiliation and the concentration of religious congregations of certain denominations in the community of residence. RESULTS Approximately 63% of deliveries occurred in a health facility. The odds of such deliveries were lower among women who belonged to Apostolic churches or had no religious affiliation than among members of Catholic or mainline Protestant churches, net of other factors (odds ratios, 0.5 and 0.6, respectively). In addition, regardless of a woman's religion, the odds that she had an institutional delivery increased by 9% for each additional Catholic or mainline Protestant congregation in her community of residence (1.1). CONCLUSIONS Organized religion is associated with critical health outcomes in Mozambique and, potentially, in other Sub-Saharan African contexts. Policymakers should consider designing programs and interventions that promote the use of institutional delivery services among members of religious groups characterized by low use of these services and in areas where such religious groups have a strong presence.
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Affiliation(s)
- Boaventura Manuel Cau
- Associate professor, Department of Geography, Eduardo Mondlane University, and the Center for Population and Health Research, Maputo, Mozambique,
| | - Victor Agadjanian
- Professor, Department of Sociology, University of California, Los Angeles, Los Angeles, CA, USA
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Agadjanian V, Jansen NA. Historical Legacies, Social Capital, and Women's Decision-Making Power: Religion and Child Nutrition in Mozambique. JOURNAL OF RELIGION AND HEALTH 2018; 57:1458-1472. [PMID: 29188545 DOI: 10.1007/s10943-017-0526-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In sub-Saharan settings, parental religion may have important implications for children's health and well-being. Using survey data from rural Mozambique, we examine the relationship between women's religion and the likelihood of their children being chronically malnourished (stunted). Multivariate analyses show that children of religiously affiliated women are significantly less likely to be stunted than children of non-affiliated women. We also find a strong advantage of mainline Protestants, especially compared to members of Pentecostal-type denominations, net of other factors. We relate this advantage to two historically rooted characteristics of mainline Protestantism: its connections to the public health sector and higher levels of women's autonomy that it fosters.
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Affiliation(s)
- Victor Agadjanian
- Department of Sociology, University of Kansas, 1415 Jayhawk Boulevard, Fraser Hall 716, Lawrence, KS, 66045, USA.
| | - Natalie A Jansen
- Department of Sociology, University of Kansas, 1415 Jayhawk Boulevard, Fraser Hall 716, Lawrence, KS, 66045, USA
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