Recurrent child mortality risks and parity transition in Nigeria

The Impact of Childhood Mortality on Fertility in Rural Tanzania: Evidence From the Ifakara and Rufiji Health and Demographic Surveillance Systems

This manuscript examines the relationship between child mortality and subsequent fertility using longitudinal data on births and childhood deaths occurring among 15,291 Tanzanian mothers between 2000 and 2015. Generalized hazard regression analyses assess the effect of child loss on the hazard of conception, adjusting for child-level, mother-level, and contextual covariates. Results show that time to conception is most reduced if an index child dies during the subsequent birth interval, representing the combined effect of biological and volitional replacement. Deaths occurring during prior birth intervals were associated with accelerated time to conception during future intervals, consistent with hypothesized insurance effects of anticipating future child loss, but this effect is smaller than replacement effects. The analysis reveals that residence in areas of relatively high child mortality is associated with hastened parity progression, again consistent with the insurance hypothesis. Investigation of high-order interactions suggests that insurance effects tend to be greater in low-mortality communities, replacement effects tend to be stronger in high-mortality community contexts, and wealthier families tend to exhibit a weaker insurance response but a stronger replacement response to childhood mortality relative to poorer families.

Exploring and modeling recurrent birth events in Ethiopia: EMDHS 2019

Background

Globally, the estimated recurrent childbirth of one forth of women happens every two years or fewer. Next to Nigeria, Ethiopia is the second populist country in Africa and the first populist country in sub-Saharan Africa which consists of over 114 million population. There are prevalent short successive birth intervals problems in underdeveloped nations such as Ethiopia that contributes to adverse effects on mother and child health. However, studies that explore recurrent birth events and associated factors are very limited. Thus, this study aimed to explore and model the recurrent birth event by considering its subsequent within a mother and identifying its important determinants. As a result, the research findings of this study will be one of the preliminary research papers on the recurrent birth events that take into account the subsequent event and enable to be input for the policymakers, health institutions, and future researchers.

Methods

A total of 4676 mothers with their 16833 corresponding children were involved in this study. The data was obtained from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). In this study, extended cox regression models such as Andersen-Gill (AG), Prentice, Williams, and Peterson total time (PWP-TT) model, PWP-gap time (PWP-GT) model, and Frailty model were employed. These all models are used to consider recurrent events within mothers and determine the potential determinants. AG, PWP-TT, and PWP-GT estimate the effect of covariates by considering the correlation between event times for a person can be explained by past events given the covariates, k^th event since the entry time, k^th event since the time from the previous event, respectively.

Results

Among mothers who have first and ninth recurrent birth events, 75.5% and 80.1% of them respectively were rural residents while 57.6% and 70.6% of them respectively were a place of delivery in the health sector. The highest prevalence of first recurrent births (44.3%) was obtained from Muslim mothers. Mothers' education level (HR: 1.210; 95%CI: 1.010, 1.460), mothers' age at first birth (HR: 0.713; 95% CI: 0.614, 0.828), household wealth index (HR: 0.776; 95% CI: 0.625, 0.965), child mortality (HR: 0.673; 95%CI: 0.514, 0.881), household size (HR: 1.914; 95%CI:1.539,2.381) and sex of child (HR:0.836; 95%CI = 0.755,0.926) were important determinants of recurrent birth event. This indicates mothers’ education level and household size were positively associated with recurrent birth events. Whereas mothers’ age at first birth, household wealth index, child mortality, and sex of the child was negatively associated with recurrent birth events.

Conclusion

The WHO recommends a minimum of 33 months between two consecutive births, which is longer than the Ethiopian recurrent birth intervals observed in this study. The highest recurrent birth occurred during the age of fewer than twenty years old of mothers at first birth as compared to mothers whose age was older at first birth. Mothers, children, and household characteristics had significant effects on recurrent birth events. We authors would like to recommend communities, governmental and non-governmental stakeholders consider the associated factors of frequent recurrence of birth noticed in this study. Besides, we would also like to recommend women start birth while they got mature in age to reduce frequent recurrent birth and its corresponding adverse effects.