Effects of the health service and environmental factors on infant mortality: the case of Sri Lanka

How Does Deprivation Affect Early-Age Mortality? Patterns of Socioeconomic Determinants of Neonatal and Postneonatal Mortality in Bolivia

Three mechanisms related to household living standards might affect early-age mortality: the absolute level of deprivation, its level relative to the average of the community, and the inequality in the distribution of deprivation within communities. A large body of literature has explored the effect of the absolute level of deprivation, but little research has examined the association between relative deprivation and early-age mortality, and findings related to deprivation inequality are inconsistent. Using 2008 Bolivian Demographic and Health Survey data, this study explores patterns of association between the three factors and mortality occurring in the neonatal and postneonatal periods. Because household-level deprivation might capture some unmeasured characteristics at the community level, such as area-specific investments, this study decomposes household-level deprivation into its between- and within-community components. The results show that after possible confounders are controlled for, community-level absolute deprivation is a significant predictor of neonatal and postneonatal mortality. Relative deprivation and deprivation inequality are not associated with early-age mortality. These findings are specific to a context of widespread deprivation and low inequality within communities; the role of the distribution of deprivation might be more important in countries in which basic needs are met within a bigger proportion of the population. This study helps identify crucial sectors of development related to living standards and deprivation inequality in order to tackle neonatal and postneonatal mortality.

Latrine promotion for trachoma: assessment of mortality from a cluster-randomized trial in Ethiopia

Trachoma control strategies, including latrine construction and antibiotic distribution, are directed at reducing ocular chlamydia, but may have additional benefits. In a cluster-randomized clinical trial, 24 subkebeles (administrative geographic units) in Ethiopia were offered a single mass azithromycin treatment, and half were randomized to receive an intensive latrine promotion. At a follow-up census 26 months after the baseline treatment, 320 persons had died. The mortality rate of children 1-5 years of age was 3.87 (95% confidence interval [CI] = 2.19-6.82) per 1,000 person-years in the latrine promotion arm, and 2.72 (95% CI = 1.37-5.42) per 1,000 person-years in the control arm. In a multi-level mixed effects logistic regression model controlling for age, there was no difference in mortality in persons randomized into the latrine or control arms (odds ratio = 1.18, 95% CI = 0.89-1.58). Latrine promotion provided no additional effect on mortality in the context of an azithromycin distribution program (clinicaltrials.gov, #NCT00322972).

Socio-cultural determinants of child mortality in southern Peru: including some methodological considerations

Among Amerindian children living at high altitude in the Andes in southern Peru, high child mortality rates have been reported in the literature, especially in the perinatal and neonatal period. We compared mortality rates in children calculated from retrospective survey data in 86 rural families from 2 Aymara and 3 Quechua peasant communities living at the same level of altitude (3825 m) in southern Peru. Relations between land tenure, socio-cultural factors and child mortality were studied, and methodological considerations in this field of interest are discussed. Checks on consistency of empirical data showed evidence for underreporting of neonatal female deaths with birth order 3 and more. Perinatal (124 vs 34 per 1000 births) and infant mortality (223 vs 111 per 1000 live births) was significantly higher in Aymara compared with Quechua children, but no difference was found after the first year of life. A short pregnancy interval was associated with an elevated perinatal and infant mortality rate, and a similar albeit insignificant association was found with increased maternal age. Amount of land owned and birth order were not related with child mortality. Although levels of maternal education are generally low in both cultures, a consistent decline in infant and child mortality was found with the amount of years mothers had attended school. However, the results suggest a U-shaped relationship between the amount of years of parental education and perinatal mortality in offspring. Late fetal and early neonatal mortality were particularly high in one Aymara community where mothers were found to have more years of education. Infanticide, a known phenomenon in the highlands of the Andes, is discussed in relation with the findings of the study. Although maternal and child health services are utilized by the majority of families in 4 of 5 study communities, 43 of 51 mothers under the age of 45 years reported that they delivered their last baby in the absence of traditional midwives or official medical supervision.

Infant mortality and socioeconomic development: evidence from Malaysian household data

Household data from Malaysia are used to assess the roles of a number of mortality correlates in explaining the inverse relationship between the infant mortality rate (IMR) and socioeconomic development. Increases in mothers' education and improvements in water and sanitation are the most important household-level changes that accompany regional and temporal development and contribute to the inverse relationship between the IMR and development. One concomitant of development--reduced reduced breastfeeding--has kept the relationship from being even stronger. Continued prevalence of extended breastfeeding in the poorer states of Peninsular Malaysia and a narrowing of educational and sanitation differentials helped close the IMR gap between the richer and the poorer states.

Infant mortality and socioeconomic development: Evidence from Malaysian household data

Household data from Malaysia are used to assess the roles of a number of mortality correlates in explaining the inverse relationship between the infant mortality rate (IMR) and socioeconomic development. Increases in mothers’ education and improvements in water and sanitation are the most important household-level changes that accompany regional and temporal development and contribute to the inverse relationship between the IMR and development. One concomitant of development—reduced breastfeeding—has kept the relationship from being even stronger. Continued prevalence of extended breastfeeding in the poorer states of Peninsular Malaysia and a narrowing of educational and sanitation differentials helped close the IMR gap between the richer and the poorer states.

[Health status of children of the municipality of São Paulo (Brazil), 1984/1985. IX. Coverage and quality of maternal-child care]

Como parte de investigação epidemiológica sobre condições de saúde na infância, foram estudadas a cobertura e a qualidade da assistência materno-infantil prestada à população do Município de São Paulo. Todas as estimativas do estudo baseiam-se em dados obtidos através de inquérito recordatório aplicado a uma amostra representativa de crianças menores de cinco anos residentes no Município (n = 1.016). A cobertura da assistência pré-natal foi estimada em 92,9%, sendo que em cerca de 70% dos casos a assistência foi iniciada no primeiro trimestre de gestação e o número de consultas realizadas foi de seis ou mais. A cobertura da assistência hospitalar ao parto foi estimada em 99,0%, observando-se que 47,1% das crianças nasceram através de cesareanas. A cobertura da assistência de puericultura foi estimada em 98,0%, sendo que em dois terços das vezes a assistência foi iniciada nos primeiros dois meses de vida. Ainda com relação à puericultura, pôde-se observar: grande concentração de consultas no primeiro ano de vida (em média 7,7 consultas), percentagem relativamente alta de crianças vacinadas (Sabin = 86,7%, Tríplice = 85,1%, BCG = 89,0%, Anti-sarampo = 85,9%), decréscimo expressivo de consultas após a idade de doze meses e pequena proporção de crianças com assistência odontológica (19,5%). A estratificação social da população revelou diferenciais sócio-econômicos mínimos quanto à cobertura geral da assistência materno-infantil, observando-se, entretanto, diferenças expressivas quanto a aspectos qualitativos da assistência. Comparando-se o presente inquérito com outros realizados no país, observa-se que a situação de São Paulo apresenta-se mais favorável do que a observada no conjunto das áreas urbanas brasileiras. Verifica-se também que tem sido positiva a evolução recente da assistência materno-infantil no Município. As principais deficiências ainda encontradas dizem respeito a características relacionadas à qualidade da assistência, sendo imprescindível, sobretudo nos estratos populacionais de pior nível sócio-econômico, elevar a cobertura da assistência pré-natal precoce e a cobertura de puericultura após o primeiro ano de vida. Um item especialmente preocupante relacionado à assistência ao parto foi a alta incidência de cesareanas, uma das maiores já registrada em uma população.

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.

Housing quality and child mortality in the rural Philippines

This study investigated factors influencing child survival to age 5 years for a rural farm sample in Iloilo Province, Philippines. Children from better quality housing were more likely to live to age 5 than were children from worse quality housing. The life expectancy at birth, indirectly estimated by the Brass method, was 63·4 years for children from worse quality housing and 69·9 years for children from better quality housing. The implications are explored.

Behavioral convergence and institutional separation: an analysis of plural medicine in Sri Lanka

In Sri Lanka, as in India, two formally structured systems of medical service exist side-by-side. While Western-style biomedicine is believed to be useful, Ayurvedic medicine is also well established and commonly used. Underlying one explanation for the existence of plural medical systems is the idea that traditional and Western systems of medicine provide unique treatments for distinct problems, and patients having certain characteristics select them accordingly. A brief review of several studies in Sri Lanka suggest, however, that Western and Ayurvedic physicians practice medicine in similar ways, are selected for treatment of very similar symptoms, and from the patient's point of view are often indistinguishable from each other. A second structural explanation rests on the fact that, as institutions, Western and Ayurvedic medicine have effectively divided up territory and jobs to the satisfaction of each; this division allows for upward mobility, through medicine, for young people from different segments of society. Thus these medical systems persist, not because each provides something unique for patients, but because they provide access to status and power for the physicians themselves.