Assessing sex differences in childhood mortality

Much of the research in recent times have focused on the changes in diets of people of developed as well as developing nations. This study tries to explain the changing food preferences of people in Indian context using data from a couple of secondary sources, and the health outcome of these changes on adult and young children. Further the study tries to examine the association of feeding practices on nutritional outcome during early childhood considering that these two are not mutually exclusive. We also examine the clustering of some quantitative measures of nutrition and the transmission of height, weight and other health outcomes from parents to children. The results confirm the westernisation of traditional diet in India particularly in urban areas, and its influence on nutritional status distribution of children from more underweight towards coexistence of overweight and underweight. Along with westernisation, differential feeding practices is another determinant of change in health outcome of children, but less improvement have been noticed in percentage of children getting a diverse diet. The results further indicate significant correlation between health status of parents and children and propose that children inherit a prominent fraction of their health status from their parents.

Despite profound distributional concerns, studies on undernutrition in India (or elsewhere) have exclusively focused on inter-personal inequalities whereas estimates regarding the magnitude of intersecting inequalities are unavailable. As such, an explicit concern for horizontal intersecting inequalities not only substantiates the intrinsic concern for equity but also offers vital policy insights that are evidently lost while engaging with a thoroughgoing individualistic approach. With this motivation, we apply the group analogues of Atkinson’s index and Gini coefficient to unravel the disproportionate burden of undernourishment borne by rural and historically vulnerable caste groups. Furthermore, the prominent determinants of inter-group disparities are identified through Blinder-Oaxaca decomposition analysis. In concluding, the paper calls for explicit targeting of backward castes across the country and improved inter-sectoral collaboration to ensure equitable access to education, healthcare, water and sanitation, particularly across underdeveloped regions.

There is no consensus in the literature on male-female differentials in childhood mortality. Moreover, most of the relevant studies on this subject are now outdated. This gives credence to the need to examine the current data on sex differentials in childhood mortality. This study examines male-female differentials in under-five mortality in sub-Saharan Africa. Data for this study came from the latest Demographic and Health Surveys in eight sub-Saharan African countries. Analysis was restricted to births in the five years preceding the survey. Descriptive and inferential statistics were employed in data analysis. Cox proportional hazard regression was employed at the multivariate level. Results showed that risks of under-five death were significantly higher among males in Ethiopia (Hazard Ratio (HR): 1.36, confidence interval (CI):1.09-1.68, p<0.05), Nigeria (HR: 1.15, CI: 1.06-1.24, p<0.05), Zambia (HR:1.29, CI:1.07-1.56, p<0.05) and Zimbabwe (HR:1.37, CI: 1.08-1.73, p<0.05). Adjusted HR indicates a narrowed gender gap in childhood mortality in Congo DR and Zambia. Findings suggest that sex discrimination in childcare in favour of boys may be a key factor in these countries. Elimination of discrimination against female children is likely to lead to further reduction in childhood mortality in these countries

Immunization has revolutionized child health throughout the world and stands out as one of the greatest public health achievements of 20th century. But the scenario of child immunization in India, especially among Muslims, is far from satisfactory. The paper brings out differentials and inequality in immunization coverage among Muslim children as compared to other religions using nationally representative District Level Household and Facility Survey-3(2007-08) data. Methodologies adopted are concentration index, gender ratio, bivariate and multivariate analysis. Muslim children in India have substantially low immunization coverage as compared to children from other religions and are less likely to be fully immunized and more likely to be not immunized. Among Muslim children, poor and girls are at disadvantageous position. Dropout from immunization schedule is a major problem. Drop out in Polio doses is highest among Muslims due to misconceptions about side effects of vaccine. Special efforts like improving accessibility of services, follow up for drop outs, educating parents especially mothers about need for vaccinating child, and removing myths and misconceptions about immunization is required to improve immunization among Muslims. Government, community organizations, religious leaders and NGOs can play an important role.

A long standing priority in global health has been meeting the health needs of the youngest population, children under the age of 5. Efforts to improve the wellbeing of the population under 5 years of age requires accurate and timely assessment of the current levels and trends of mortality risk in children under the age of 5. Here we present an updated methodological strategy using Spatio-temporal and Gaussian process regressions to synthesize disparate mortality data sources into a coherent time series of 5q0 estimates with 95% uncertainty bounds. We anticipate that in rigorous predictive validity tests this updated modeling strategy will again outperform other synthesis modeling options including LOESS and spline-regression.

Sub-Saharan Africa has the highest levels of both twining and under-five mortality in the world. It also had high excess mortality among twins. Surprisingly little is known about the infant and child mortality pattern among African twins. We examine which factors are associated with excess twin mortality and to what extent these factors are ‘universal’ or vary in weight by regions in Sub-Saharan Africa. We pool over 60 Demographic and Health Surveys from 32 Sub-Saharan African countries to obtain data on more than 45,000 twins. We include factors associated with under-five mortality on the child, mother and household level (e.g. maternal age & education, birth-interval) and the regional and national level (e.g. health-care facilities and development). We examine differences in these factors between twins and singletons and test interaction-effects between each determinant of mortality and twin/singleton status. Finally, we examine variations in the determinants across regions of Sub-Saharan Africa.

Studies in health sector have revealed socioeconomic inequalities between indigenous and non indigenous population. India is not an exception to this “health divide”, but there is dearth of studies exploring this divide between indigenous and non indigenous child health. The present study aims at decomposing socioeconomic inequalities among underweight, stunting and wasting child population under five years of age using kids file from National Family Health Survey-3 data. The study has used Blinder-Oaxaca decomposition which enables to quantify the part of the health gap due to selected predictors. Children belonging to Schedule Caste/ Schedule Tribe (SC/ST) groups are considered as indigenous and non SC/ST as non indigenous population. Findings demonstrate the health gap among indigenous and non indigenous child population. The selected predictors explained 69%,49% and 62% inequalities among underweight, stunted and wasted children respectively with the highest contribution of poor economic status (52%,49% and 56%) and mother’s illiteracy(25%, 29% and 21%) in the considered indicators. Considering religion as a factor for inequality is not significantly justified by the study. The study prioritizes the need for targeted intervention to enhance economic status and mother’s education to narrow down the health divide.

The childhood mortality may be vulnerable as many biological, environmental, social, cultural and behavioral factors have been responsible for structuring the patterns of mortality. The relation between first birth order and risk of child mortality is not well understood. Under the assumption there may be socio-demographic, behavioral, environment, etc factors behind this higher risk of mortality this study examines under-five aged child survival at first birth of the mother to identify the factors influence on child survival for policy suggestions. Using four rounds data set of the Bangladesh Demographic and Health Surveys (BDHS 1993-94, 1996-97, 1999-00 and 2004) binary logistic regression model shows that tetanus injection of mother before birth of the child is the most dominant determinant for the under-five aged first child survival; whereas educational attainment, antenatal visit for pregnancy before birth and tubewell as source of drinking water have had also impact with some variations. As higher education, access to antenatal visit and ensuring tetanus injection before pregnancy have had significant impact these should be taken into high consideration to accelerate further for child survival which will contribute to reduce mortality reduction as well. There are more scopes to examine other variables to understand child

In recent decades there has been a significant progress in child mortality decline around the world and this has been accompanied by important changes in the profile of causes of death. On one hand the levels of infant mortality rate (IMR) have fallen to 100 per thousand or less, and in some others cases these figures are similar to those observed in the developed world. On the other hand, there have been changes in the profile of causes: intestinal and respiratory infections have lost ground to perinatal conditions and congenital anomalies.
Despite these important advances there are still some outstanding issues in the effort to consolidate the decline in infant mortality. In particular, there are three points of interest:

1. Is infant mortality measured accurately?
2. Are vital statistics (VS) a reliable source for estimating IMR, or there is still a need to use the Brass technique to have reliable estimates?
3. How useful are the VS to ascertain the epidemiological profile of infant mortality?

This paper analyzes the situation (level and epidemiological profile) of infant mortality in several countries around the world using data from vital statistics and census information from the Integrated Public Use Microdata Series (IPUMS).

Although academic investigation into sex mortality differentials dates back to the 17th century with pioneering work by John Grant, a fundamental unresolved question in demographic and public health research is the underlying causes of the higher mortality of boys in early ages. In this study, we address this question by estimating the distinct contributions of biology and unobserved preconception environmental factors to sex differences in infant mortality across institutional settings. We use a large sample of twins from sub-Saharan African countries. These countries are grouped into four main institutional regions, and each region is further divided into urban and rural areas. We find that regions with better institutions have lower levels of infant mortality and smaller sex differences in survival rates. Sex differences in biology and unobserved preconception factors contribute to excess male mortality in most institutions, but the effect of biology becomes small and statistically insignificant with improved institutions.The role played by these factors tends to be more important in settings with better institutions, which suggests that more research should be done in order to address each of them.