Clustering of infant deaths among Nigerian women: investigation of temporal patterns using dynamic random effects model

Factors associated with under-five mortality in Rwanda: An analysis of the Rwanda Demographic and Health Survey 2020

Despite global and Rwandan progress in reducing under-five mortality, the risk of children dying before their fifth birthday persists, necessitating intensified research on determinants. Thus, this study analyzed the birth history data to shed light on the underlying causes of under-five mortality in Rwanda. The study is a secondary analysis of data sourced from the 2020 Rwanda Demographic and Health Survey (RDHS) cross-sectional design. Using SPSS, the data was cleaned, recoded, and weighted, with descriptive and inferential statistics applied. The dependent variable was the child's living status, while independent variables included socio-demographic, media exposure status of mothers, child, and environmental factors. A total of 10267 under-five children of all interviewed mothers were included in the final analysis, of which 12.3% (1260) died. Maternal age (25-34 years: AOR = 1.514, 95% CI = 1.130-2.029, p = 0.005; 45+: AOR = 13.226, 95% CI = 9.253-18.905, p<0.001), occupational status (agricultural workers and other services), and three or more births within five years (AOR = 1.895, 95% CI = 1.433-2.508, p<0.001) significantly increase the risk of under-five mortality. Conversely, maternal education (primary: AOR = 0.821, p = 0.023; secondary: AOR = 0.533, p<0.001; higher: AOR = 0.365, p = 0.010) and higher wealth indexes (middle: AOR = 0.743, p = 0.001; rich: AOR = 0.612, p<0.001), as well as current breastfeeding (AOR = 0.524, 95% CI = 0.455-0.603, p-value <0.001), are associated with lower under-five mortality. Child sex significantly impacts under-five mortality (AOR = 0.873, 95% CI = 0.770-0.991, p = 0.035), favoring females over males. Conversely, multiple birth type children face higher under-five mortality (AOR = 3.541, 95% CI = 2.727-4.599, p<0.001) compared to singletons. Children in the northern (AOR = 1.478, 95% CI = 1.086-2.011, p = 0.013) and eastern (AOR = 1.470, 95% CI = 1.097-1.971, p = 0.010) regions are more susceptible to mortality compared to those in the central (Kigali) region. Additionally, under-five mortality is higher when using water from tanks and other sources (AOR = 2.240, 95% CI = 1.471-3.411, p<0.001) than piped water. This study identifies crucial factors linked to under-five mortality, underscoring the importance of prioritizing them in interventions to enhance Rwandan under-five survival rates.

Identifying determinants of under-five child mortality in northern Togo

Background

Although global rates of under-five mortality have declined, many low- and middle-income countries (LMICs), including Togo, have not achieved sufficient progress. We aimed to identify the structural and intermediary determinants associated with under-five mortality in northern Togo.

Methods

We collected population-representative cross-sectional household surveys adapted from the Demographic Household Survey (DHS) and Multiple Indicator Cluster Survey from women of reproductive age in northern Togo in 2018. The primary outcome was under-five mortality for children born to respondents in the 10-year period prior to the survey. We selected structural and intermediary determinants of health from the World Health Organization Conceptual Framework for Action on the Social Determinants of Health. We estimated associations between determinants and under-five mortality for births in the last 10 years (model 1 and 2) and two years (model 3) using Cox proportional hazards models.

Results

Of the 20 121 live births in the last 10 years, 982 (4.80%) children died prior to five years of age. Prior death of a sibling (adjusted hazard ratio (aHR) = 5.02; 95% confidence interval (CI) = 4.23-5.97), maternal ethnicity (i.e. Konkomba, Temberma, Lamba, Losso, or Peul), multiple birth status (aHR = 2.27; 95% CI = 1.78-2.90), maternal age under 25 years (women <19 years: aHR = 2.05; 95% CI = 1.75-2.39; women 20-24 years: aHR = 1.48; 95% CI = 1.29-1.68), lower birth interval (aHR = 1.51; 95% CI = 1.31-1.74), and higher birth order (second or third born: aHR = 1.45; 95% CI = 1.32-1.60; third or later born: aHR = 2.14; 95% CI = 1.74-2.63) were associated with higher hazard of under-five mortality. Female children had lower hazards of under-five mortality (aHR = 0.80; 95% CI = 0.73-0.89). Under-five mortality was also lower for children born in the last two years (n = 4852) whose mothers received any (aHR = 0.48; 95% CI = 0.30-0.78) or high quality (aHR = 0.51; 95% CI = 0.29-0.88) prenatal care.

Conclusion

Compared to previous DHS estimates, under-five mortality has decreased in Togo, but remains higher than other LMICs. Prior death of a sibling and several intermediary determinants were associated with a higher risk of mortality, while receipt of prenatal care reduced that risk. These findings have significant implications on reducing disparities related to mortality through strengthening maternal and child health care delivery.

Clustering of child deaths among families in low and middle-income countries: A meta-analysis

Background and Aims

Several studies have examined the phenomenon of "death clustering," in which two or more children born to the same mother or from the same family die at an early age. Therefore, a scientific examination of the results is essential to understand how the survival status of the older siblings affects the survival of the younger siblings. By using meta-analysis, this study aims to provide a quantitative synthesis of the results of studies on "child death clustering" in low- and middle-income countries (LMICs).

Methods

This study followed the PRISMA-P 2015 guidelines. We used four electronic databases-PubMed, Medline, Scopus, and Google Scholar with search and citation analysis capabilities. Initially, 140 studies were identified, but only 27 met the eligibility criteria eventually. These were studies that had used the death of a previous child as a covariate to determine the survival status of the index child. The heterogeneity and the publication bias of the studies were examined using the Cochran test, I ² statistic, and Egger's meta-regression test.

Results

The pooled estimate of 114 study estimates for LMICs contains some bias. India's 37 study estimates were distributed more or less equally along the middle line, indicating no publication bias, while there was a slight bias in the estimates for Africa, Latin America, and Bangladesh. The odds of experiencing the death of the index child in the selected LMICs were 2.3 times higher for mothers who had lost any prior child as compared to those mothers who had not had any prior child loss. For African mothers, the odds were five times higher, whereas for Indian mothers, the odds were 1.66 times higher. Mothers' characteristics, such as education, occupation, health-seeking behavior, and maternal competence, significantly affect the child's survival status.

Conclusion

Achieving the sustainable development goals would not be possible if mothers in countries experiencing high levels of under-five mortality are not provided with better health and nutrition facilities. Mothers who have lost multiple children should be targeted for assistance.

Infant Death Clustering in the Quarter of a Century in India: A Decomposition Analysis

The study aims to examine the clustering of infant deaths in India and the relative contribution of infant death clustering after accounting for the socio-economic and biodemographic factors that explain the decline in infant deaths. The study utilized 10 years of birth history data from three rounds of the National Family Health Survey (NFHS). The random effects dynamic probit model was used to decompose the decline in infant deaths into the contributions by the socio-economic and demographic factors, including the lagged independent variable, the previous infant death measuring the clustering of infant deaths in families. The study found that there has been a decline in the clustering of infant deaths among families during the past two and half decades. The simulation result shows that if the clustering of infant deaths in families in India was completely removed, there would be a decline of nearly 30 percent in the infant mortality rate (IMR). A decomposition analysis based on the dynamic probit model shows that for NFHS-1 and NFHS-3, in the total change of the probability of infant deaths, the rate of change for a given population composition contributed around 45 percent, and about 44 percent was explained by a compositional shift. Between NFHS-3 and NFHS-4, the rate of change for a given population composition contributed 86%, and the population composition for a given rate contributed 10% to the total change in the probability of infant deaths. Within this rate, the contribution of a previous infant was 0.8% and the mother's age was 10%; nearly 31% was contributed by the region of residence, 69% by the mother's education, and around 20% was contributed by the wealth index and around 8.7% by the sex of the child. The mother's unobserved factors contributed more than 50 percent to the variability of infant deaths in all the survey rounds and was also statistically significant (p < 0.01). Bivariate analysis suggests that women with two or more infant losses were much less likely to have full immunization (10%) than women with no infant loss (62%), although institutional delivery was high among both groups of women.

Determinant factors of under-five mortality in rural Ethiopia

Background

Methods

Results

Conclusion

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Ethiopia's under-five mortality rate is still high in the nation's rural areas despite a slight drop.

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A total of 4414 weighted under-five children from the EMDHS 2019 dataset were included from nine geographical regions and two administrative cities of Ethiopia.

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Out of 4414 total under-five children, 267(6%) of them were dead before the age of five years.

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From the current study the researcher Conclude that under-five mortality was very high in rural Ethiopia.

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This research suggests that encouraging women to birth in health facilities and expanding possibilities for mothers' education for rural residents will assist to lessen the burden of under-five mortality.

The factors associated with under-five mortality in Ethiopia

Background

Under-five mortality refers to the likelihood of dying between the ages of birth and five. The number of children under the age of five who die each year continues to climb worldwide. Over the previous few decades, the industry has made great progress in reducing mortality among children under the age of five. The study aims to identify the factors associated with under-five mortality in Ethiopia.

Subject and method

Community-based Cross-sectional data came from Ethiopia's Mini Demographic and Health Survey 2019. In two stages, the 2019 EMDHS sample was stratified and selected. 8855 women of reproductive age were interviewed using a nationally representative Woman (ages 15 to 49) and 5753 children were included. Ethiopia's under-five mortality served as the study's dependent (response) or outcome variable. Binary logistic regression was used to see if there is an association between the dependent and independent variables. All variables with a p-value of less than 0.25 in the bivariate analysis were chosen for the multivariable logistic regression to compensate for putative confounders. Significant predictors were defined as factors with a p-value of less than 0.05.

Results

A total of 5753 under-5 mortality were enrolled in this study. 339 (5.9%) of under-five Mortality have been declared lifeless before reaching the age of five. There were 1328(23.1%) and 4425(76.1%) with 72 (5.42%) and 267 (6.02%) of under-five mortality occurring in urban and rural respectively. Under-five mortality in the Afar region was 2.280 times more likely Compared to Children born in Tigray Region (AOR = 2.280 95% CI = 1.137–4.568, P = .020). Under-five Mortality in Rural residences was 1.908 times more likely as Compared to Urban Residence (AOR = 1.908, 95% CI = 1.257–4.539, P = .035). Under-five mortality in Poorer index Households was 0.343 times Less likely as compared to children born in the poorest index Household (AOR = 0.343,95% CI = 0.128–0.910, P = ). Under-five mortality in the public sector was 1.763 times less likely than among children born at Home (AOR = 1.763, 95% CI = 1.252–2.482, P = .033). Under-five Mortality of second multiple births was 2.389 times more likely Compared to Single birth (AOR = 2.389, 95% CI = 1.257–4.539, P = .008).

Conclusion

This study found that the prevalence of under-five mortality, is 5.9% (59/1000) or 59 death per one thousand live children in Ethiopia. The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving. Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been statistically significant factors of under-five mortality in Ethiopia. The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality.

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The global number of under-five mortality remains high including in Ethiopia.

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The prevalence of under-five mortality was 5.9% of live children in Ethiopia.

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Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been found to be statistically significant factors of under-five mortality in Ethiopia.

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The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving.

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The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality.

Examining infant and child death clustering among families in the cross-sectional and nationally representative Bangladesh Demographic and Health Survey 2017-2018

OBJECTIVES

We aim to examine the phenomenon of infant and child death clustering while considering the unobserved heterogeneity (frailty) at the family level.

DESIGN, SETTING, AND PARTICIPANTS

We analysed Bangladesh Demographic and Health Survey 2017-2018 data, including the birth history information for 47 828 children born to 18 134 women. We used Gompertz shared frailty model to control the correlation between event times at the mother level and capture the unobserved risks in infant and child deaths.

OUTCOME MEASURES

We estimated two sets of survival regression models where the failure event is the survival status of the index child during the infancy period, that is, from birth to 11 months, and childhood period, that is, between 12 and 59 months, respectively. All children who died during infancy and childhood were coded as 'yes'; otherwise, they were coded as 'no'.

RESULTS

About 2% of mothers experienced two or more infant deaths, and cumulatively these mothers account for 20% of all infant deaths in the sample. Children whose previous sibling was not alive at the time of their conception had 1.86 times (95% CI 1.59 to 2.17) more risk of dying as an infant. However, we did not find a statistically significant effect of death scarring on the risk of child mortality among siblings. Statistically significant frailty effect with a variance of 0.33 (95% CI CI 0.17 to 0.65) and 0.54 (95% CI 0.14 to 2.03)] in infancy and childhood, respectively, indicates the clustering of survival risks within families due to unobserved family-level characteristics shared by the siblings.

CONCLUSION

This study suggests that preceding birth interval, mother's age at first birth and mother's education are the most critical factors which can help in reducing scaring effect on infant mortality. Additionally, women from poor socioeconomic strata should be focused on as still an infant, and child mortality is concentrated among poor households.

Differential in infant, childhood and under-five death clustering among the empowered and non-empowered action group regions in India

Background

With 8,82,000 deaths in the under-five period, India observed varied intra-state and inter-regional differences across infant and child mortality in 2018. However, scarce literature is present to capture this unusual concentration of mortality in certain families by examining the association of the mortality risks among the siblings of those families along with various unobserved characteristics of the mother. Looking towards the regional and age differential in mortality, this paper attempts to provide evidence for the differential in mortality clustering among infants (aged 0–11 months), children (12–59 months) and under-five (0–59 months) period among mothers from the Empowered Action Group (EAG) and non-EAG regions of India.

Methods

The study used data from the National Family Health Survey (2015–16) which includes all the birth histories of 475,457 women aged 15–49 years. Bivariate and multivariate analyses were used to fulfil the objectives of the study. A two-level random intercept Weibull regression model was used to account for the unexplained mother (family) level heterogeneity.

Results

About 3.3% and 5.9% of infant deaths and 0.8% and 1.6% of childhood deaths were observed in non-EAG and EAG regions respectively. Among them, a higher percentage of infant and child death was observed due to the death of a previous sibling. There were 1.67 times [95% CI: 1.55–1.80] and 1.46 times [CI: 1.37–1.56] higher odds of infant and under-five mortality of index child respectively when the previous sibling at the time of conception of the index child was dead in the non-EAG regions. In contrast, the odds of death scarring (death of previous sibling scars the survival of index child) were 1.38 times [CI: 1.32–1.44] and 1.24 times [CI: 1.20–1.29] higher for infant and under-five mortality respectively in the EAG regions.

Conclusion

The extent of infant and child mortality clustering and unobserved heterogeneity was higher among mothers in the non-EAG regions in comparison to their EAG region counterparts. With the growing situation of under-five mortality clustering in non-EAG states, region-wise interventions are recommended. Additionally, proper care is needed to ameliorate the inter-family variation in mortality risk among the children of both EAG and non-EAG regions throughout their childhood.