Assessing sex differences in childhood mortality

This paper aimed at investigating the influence of socioeconomic, demographic and household environmental factors on infant mortality in urban and rural areas of Kenya. Descriptive and logistic regression analyses were carried out on 2008/09 Kenya demographic and health survey child datasets in order to help in filling the gap on the factors that explain child survival in Kenya’s urban and rural areas respectively. Descriptive statistics show that majority (77 percent) of infant deaths were recorded in rural areas probably depicting the health inequalities that exist between urban and rural areas. Results of bivariate analysis show that sex of the birth, ever breastfed, region and source of drinking water were significantly related to infant mortality in rural areas while level of education, maternal age, birth order and ever breastfed factors were significantly related to infant mortality in urban areas. Multivariate analytical results show that region, sex of the birth, ever breastfed and source of drinking water were significantly related to rural infant mortality with solely ever breastfed factor being a significant explainer of urban infant mortality. There is need to advocate for compulsory exclusive breastfeeding for the first six month of a child’s life given the finding that children who are not breastfed are t

Background: Socio-economic determinants of health-seeking behaviour remain unexplored among poor families in middle-income countries.
Objective: To examine socio-economic determinants of health-seeking behaviour for children under 5-years with diarrhoea or cough from rural Egyptian families, by developing a comprehensive measurement of socio-economic position (SEP) encompassing parental education and occupation, dwelling characteristics and household assets.
Methods: Latent variable modelling to construct SEP. Multivariate logistic regression of SEP and progression in three consecutive steps of health-seeking behaviour for each disease, with attention to child gender and age.
Findings: A third of children had diarrhoea and two thirds cough in the preceding month. More than 80% of children with either symptom received care, of which more than half was from private providers. Male gender was associated with higher likelihood of seeking care for cough and with higher expenses for care in both illnesses. No single component of SEP determined progression in three steps of health-seeking behaviours. Further examination of association with latent SEP is required.
Conclusion: Understanding the association between SEP and health-seeking behaviours among poor families is crucial to designing policy to reduce socio-economic gradient.

Under natural circumstances, the ratio of the male to female under-five mortality rate is greater than one. However, deprivation of girls’ access to health care or proper nutrition could lead to distorted ratios of under-five mortality. Monitoring of mortality by sex is challenging because of issues with data availability and quality. Moreover, the sex ratio is expected to vary with under-five mortality, which makes it challenging to define "expected levels".
We present a Bayesian hierarchical model to estimate the sex ratio of under-five mortality for all countries. In addition, we estimate the relative difference between national sex ratios and expected sex ratios based on the global relation between under-five mortality and the sex ratio. All estimates include an uncertainty assessment to enable assessments of whether differences between countries or within countries over time are significant or highly uncertain. Preliminary results suggest that girls may be disadvantaged in several countries.

In most countries of the world, national levels of mortality in childhood have fallen substantially in recent decades. A large difference in the mortality of female children indicates gender discrimination in access to the right to live.
The study has the following specific objectives:
i) To estimate the under-five mortality by sex in India.
ii) To examine the pattern & factors that affect sex differential in under-five mortality across the region.
iii) To bring out the policy implications to reduce under-five mortality across the region.
The main purpose of this paper has been to analyze the effects of the biological and socio-economic on the survival of male and female U-5 children and its differences across the region in India. In all the six regions, the relative risk (F/M) of mortality is higher in rural areas than in urban areas and the relative risk decreases as the education level of mother increases. Significant factors causative to under-5 mortality in India are the place of residence, parent’s education and work status, wealth, social group, mother’s smoking/alcoholic habit and her health. Among all the above factor mother’s education, residence and religion are the most significant factors for sex differential in U-5 mortality.

The consequences of environmental tobacco smoke (especially maternal smoking) on child respiratory health are very severe. Moreover, high fertility rates in Africa mean rising rates of female smoking in Africa translate into increase of maternal smoking, with devastating consequences for fetus and child health. Besides, underlying sex differentials often are critical to better understanding of child health. Thus the research question: Does maternal smoking in Africa engender sex differentials among children as far as their respiratory health is concerned? The study addresses issues like determination of the net impact of maternal smoking on child respiratory health among several confounding factors and identification of tobacco products with severest impact on child respiratory health. The following hypothesis is tested: “there is no health risk variation between boys and girls as far as respiratory infections are concerned, unless the mother of the child is smoking”. The analysis uses a sample of 37 274 children less than 5 years of age from the most recent DHS surveys in Cameroon, Senegal and Malawi, including 328 born to 226 smoking mothers. The Poisson regression is used to model the number of symptoms suffered by children during survey period.

Morocco has significantly improved health conditions of its children. Child mortality decreased constantly and Morocco is on the track to achieve the fourth MDG. However, improvement was not equally shared by groups from different milieu, regions and/or level of education and wealth.
Rural children are more likely to suffer from stunting, wasting and underweight compared to urban children. Moreover, the gaps persisted and sometimes increased during the last two decades. For instance, the national percentage of stunted children decreased from 22.6% in 1992 to 14.9 % in 2011 but the rural-urban ratio increased from 2.1 to 2.4.
Between 1992 and 2011, neonatal, postnatal, infant and under five mortality rates decreased but rural-urban ratios remained of the same order.
Neonatal, post-neonatal, infant and child mortality all show differences by gender, mother’s education level and wealth quintile.
Children born to an illiterate woman are at least twice as likely to die as their counterparts born to a woman with secondary or higher level of education. The ratio reaches 3 for post-neonatal mortality.
A child born in the poorest wealth quintile is three times more likely to die before his or her fifth birthday compared to a child born in the richest quintile.

The present paper aims to assess the gender disparity in health expenditure among various age groups in different regions of India using Consumer Expenditure data collected in two rounds by National Sample Survey Organization (1999-2000 and 2007-08). Also the paper examines whether the change in the age and sex composition contributes to the change in health expenditure from the first survey period to the second survey period. Bivariate analysis is used to fulfil the first objective and to obtain the second objective Decomposition analysis is employed. Findings indicate that in India health expenditure has not increased over time and a huge disparity is seen between men and women of all age groups in getting health care facilities in different regions. Result from Decomposition analysis reveals that compositional shift in age contributes to increase in health expenditure, whereas compositional shift in female population contributes to decrease the health expenditure from the first to the second survey period. The study suggests that looking towards the gender disparity in health expenditure, Government should implement programmes addressing health care facilities in all the regions of India and emphasize should be given on women as they are the deprived group in getting health care services.

This paper evaluates the impact of a prenatal nutritional program on child health at birth in one of the Canadian provinces, Québec. The objective of the OLO ("oeuf-lait-orange") program is to reduce the incidence of prematurity and low birth weight by providing nutritional supplements to pregnant women in situations of poverty. We exploit the historical and geospatial progressive implementation of the program throughout the province between 1985 and 2005 to identify the causal impact of the program on infant health. Our preliminary results suggest a positive effect of the OLO program on birth weight. Since birth weight is associated with a number of adulthood outcomes such as educational attainment, the evaluation of this program contributes to the debates on which policies should be implemented in order to reduce socioeconomic inequalities.

Turkey is one of the countries distinguished with high level of infant mortalities and consanguineous marriages. According to the results of TDHS-2008, the infant mortality rate is 17 per thousand, and 24 percent of women has a consanguineous marriage. The aim of this study is to analyze the causal relationship between the consanguineous marriages and infant mortality in Turkey. To accomplish this goal, contrary to the previous studies using just one data set, four data sets of demographic surveys conducted by HUIPS were used by merging all of them. In the study, the survival analysis method was used to understand the impact of consanguienous marriages on infant mortality by controlling all possible variables. The results of the desriptive analysis reveals that infant mortality rate in consanguineous marriages is 34 percent higher than that of non-consanguienous marriages. Results of multivarite analysis are compatible with this finding, as well. The risk of infant mortality is two times higher among women with first-degree consanguineous marriages compared to women with non-consanguienous marriages. Results of this study will be helpful in determining the policy instruments to reduce infant mortality and will set an example for other countries having higher consanguineous marriages and infant mortality.

Although the literature finds adverse birth outcomes following exposure to ambient heat waves in utero, less work focuses on infant health following cold stress. We address this gap in the literature and employ rigorous methodology to test the relation between cold ambient temperature in utero and four perinatal outcomes. We examined 14,000 births in Uppsala, Sweden (1915 to 1929), a population that—unlike most societies today—experienced sub-standard indoor-heating and fewer amenities to provide shelter from ambient cold. Results, which control for season of birth, indicate that the risk of both stillbirth and preterm delivery rises as ambient temperature over gestation falls. Exploratory analyses by sex indicate that the increased risk of preterm appears confined only to male births. Infant birth length (but not birth weight) also declines with lower temperatures. In this historical population, cold stress adversely affects fetal development. Our work holds relevance to maternal-fetal biology as well as to contemporary societies (e.g., indigenous Arctic populations) with limited resources to mitigate the adverse consequences of cold.