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Rahman MM, Alam K, Khanam R. Socio-economic factors affecting high infant and child mortality rates in selected African countries: does globalisation play any role? Global Health 2022; 18:69. [PMID: 35799303 PMCID: PMC9261177 DOI: 10.1186/s12992-022-00855-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/08/2022] [Indexed: 11/14/2022] Open
Abstract
Background Despite the declining trends worldwide, infant and child mortality rates are still high in many African countries. These high rates are problematic; therefore, this study attempts to explore the contributing factors that cause high infant and child mortality rates in 14 African countries using panel data for the period of 2000–2018. In particular, the role globalisation is explored. Methods The panel corrected standard error (PCSE), the Feasible generalized least square (FGLS) models, and the pair-wise Granger causality test have been applied as methodological approaches. Results The public health expenditure, numbers of physicians, globalization, economic development, education, good governance, and HIV prevalence rate have been revealed as the determinants of infant and child mortality in these countries. All these variables except the HIV prevalence rate negatively affect the infant and child mortality rates, while the HIV prevalence rate is found to be positive. Bidirectional and unidirectional causal relationships between the variables are also attained. Conclusions Effective socio-economic policy priority with due consideration of globalization should be emphasized to reduce infant and child mortality rates in these countries.
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Affiliation(s)
- Mohammad Mafizur Rahman
- School of Business, Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Khosrul Alam
- Department of Economics, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, 8100, Bangladesh.
| | - Rasheda Khanam
- School of Business, Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
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Abstract
This paper investigates the extent to which armed conflict influences the weight of young children in the Democratic Republic of the Congo. Exploiting the variation across districts in exposure to armed conflict and the within-district variation in the timing of whether the child was exposed to armed conflict due to birth timing within a difference-in-differences framework, we detect adverse impacts of conflict exposure to child weight. Specifically, experiencing armed conflict makes children weigh less for their age and weigh less for their height by 0.20 and 0.24 standard deviations, respectively. Armed conflict also increases the probability of children being underweight and wasted by 4.7 and 2.7 percentage points, respectively. Our heterogeneity analyses reveal that children of disadvantaged backgrounds, i.e., those born to low-educated mothers, poor mothers, and rural mothers, tend to be disproportionately affected. Our study calls for effective measures to mitigate the detrimental repercussions of armed conflict.
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Lay MJ, Norling J. The Consequences of the 1959-1961 Chinese Famine for Educational Attainment. THE B.E. JOURNAL OF ECONOMIC ANALYSIS & POLICY 2020; 20:20190043. [PMID: 33343788 PMCID: PMC7743912 DOI: 10.1515/bejeap-2019-0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper finds that the Great Chinese Famine of 1959-1961 reduced lifetime educational attainment by up to 3.8 years for people who lived in areas most severely hit by the famine. Using geographical variation in famine intensity, information about place of residence during the famine, and educational attainment recorded in the China Health and Retirement Longitudinal Study, the paper demonstrates that the decline in educational attainment was particularly sharp for women. This decline interrupted substantial gains in schooling achieved in China during the middle part of the twentieth century.
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Weitzman A, Smith-Greenaway E. The Marital Implications of Bereavement: Child Death and Intimate Partner Violence in West and Central Africa. Demography 2020; 57:347-371. [PMID: 31989537 PMCID: PMC10704395 DOI: 10.1007/s13524-019-00846-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In high-mortality contexts, research examining the effects of child mortality has focused almost exclusively on couples' fertility responses while overlooking other potential family consequences. Using nationally representative survey data from 13 West and Central African countries, we estimate multilevel discrete-time hazard models to determine how women's risk of intimate partner violence (IPV) varies with the death of children. We assess heterogeneity in this association across two surrounding circumstances: children's age at death and regional prevalence of child bereavement. Findings indicate that the risk of IPV initiation rises with the death of children under age 5-for whom women are most intensely responsible-but not with the death of older children. The effect of young child bereavement is most pronounced in regions where it is least prevalent among mothers-a finding not explained by concomitant regional variation in gender inequality, family norms, and infrastructural development. These findings highlight the importance of child mortality for family outcomes beyond fertility in the African context and demonstrate the prominent role of the broader mortality context in shaping these implications.
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Affiliation(s)
- Abigail Weitzman
- Department of Sociology, University of Texas at Austin, 305 East 23rd Street, A1700, RLP 3.306, Austin, TX, 78712-1086, USA.
| | - Emily Smith-Greenaway
- Department of Sociology, University of Southern California, 851 Downey Way, Hazel & Stanley Hall 314, Los Angeles, CA, 90089-1059, USA
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Bawah AA, Phillips JF, Asuming PO, Jackson EF, Walega P, Kanmiki EW, Sheff MC, Oduro A. Does the provision of community health services offset the effects of poverty and low maternal educational attainment on childhood mortality? An analysis of the equity effect of the Navrongo experiment in Northern Ghana. SSM Popul Health 2018; 7:100335. [PMID: 30623010 PMCID: PMC6304464 DOI: 10.1016/j.ssmph.2018.100335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022] Open
Abstract
The Government of Ghana has instituted a National Poverty Reduction Program with an initiative known as the Community-based Health Planning and Services (CHPS) as its core health development strategy. CHPS was derived from a plausibility trial of the Navrongo Health Research Centre testing four contrasting primary health care strategies: i) Training unpaid volunteers to promote health in communities, ii) placing nurses in communities with training and supplies for treating childhood illnesses, iii) combining the nurse and volunteer approaches, and iv) sustaining a comparison condition whereby clinic services were provided without community resident workers. This paper presents an age-conditional proportional hazard analysis of the long term impact of community health worker exposure among 94,599 children who were ever under age five over the January 1, 1995 to December 2010 period, adjusting for age conditional effects of shifts in exposure type as CHPS was scaled up in Navrongo project area over the 1995-2000 period. Results show that children whose parents are uneducated and relatively poor experience significantly higher mortality risks than children of the educated and less poor. Conditional hazard regression models assess the impact of CHPS on health equity by estimating the interaction of equity indicators with household exposure to CHPS service operations, adjusting for age conditional exposure to original Community Health and Family Planning Project (CHFP) service strategies as scale-up progressed. The association of mortality risk among children with uneducated and relatively impoverished mothers is offset by exposure to community health nursing services. If exposure is limited to volunteer-provided services alone, survival benefits arise only among children of relatively advantaged households. Findings lend support to policies that promote the CHPS nurse approach to community-based services as a core health component of poverty reduction programs.
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Affiliation(s)
- Ayaga A Bawah
- Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon, Accra, Ghana
| | - James F Phillips
- Heilbrunn Department of Population and Family Health, Columbia University, 60 Haven Ave, B-2, New York, NY 10032, USA
| | | | - Elizabeth F Jackson
- Heilbrunn Department of Population and Family Health, Columbia University, 60 Haven Ave, B-2, New York, NY 10032, USA
| | - Paul Walega
- Navrongo Health Research Centre, Ghana Health Service, P. O. Box 114, Navrongo, Ghana
| | - Edmund W Kanmiki
- Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon, Accra, Ghana
| | - Mallory C Sheff
- Heilbrunn Department of Population and Family Health, Columbia University, 60 Haven Ave, B-2, New York, NY 10032, USA
| | - Abraham Oduro
- Navrongo Health Research Centre, Ghana Health Service, P. O. Box 114, Navrongo, Ghana
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Moise IK. Causes of Morbidity and Mortality among Neonates and Children in Post-Conflict Burundi: A Cross-Sectional Retrospective Study. CHILDREN-BASEL 2018; 5:children5090125. [PMID: 30205549 PMCID: PMC6162533 DOI: 10.3390/children5090125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/09/2018] [Accepted: 09/03/2018] [Indexed: 11/16/2022]
Abstract
The risk of a child dying before age five in Burundi is almost 1.6 times higher than that in the World Health Organization (WHO) African region. However, variations in the all-cause mortality rates across Burundi have not yet been measured directly at subnational levels, age group and by gender. The objective of this study was to describe the main causes of hospitalization and mortality in children during the neonatal period and at ages 1 to 59 months, for boys and girls, and to assess the total annual (2010) burden of under-five morbidity and mortality in hospitals using hospitalization records from 21 district hospitals. We found variation in the gender and regional distribution of the five leading causes of hospitalization and death of children under five. Although the five causes accounted for 89% (468/523) of all neonatal hospitalizations, three causes accounted for 93% (10,851/11,632) of all-cause hospitalizations for children ages 1 to 59 months (malaria, lung disease, and acute diarrhea), malaria accounted for 69% (1086/1566) of all deaths at ages 1 to 59 months. In Burundi, human malarial infections continue to be the main cause of hospitalization and mortality among under-five children.
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Affiliation(s)
- Imelda K Moise
- Department of Geography and Regional Studies, College of Arts and Sciences, University of Miami, Coral Gables, FL 33124, USA.
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Dagnelie O, Luca GDD, Maystadt JF. Violence, selection and infant mortality in Congo. JOURNAL OF HEALTH ECONOMICS 2018; 59:153-177. [PMID: 29753197 DOI: 10.1016/j.jhealeco.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/12/2017] [Accepted: 02/04/2018] [Indexed: 06/08/2023]
Abstract
This paper documents the effects of the recent civil war in the Democratic Republic of Congo on mortality both in utero and during the first year of life. It instruments for conflict intensity using a mineral price index, which exploits the exogenous variation in the potential value of mineral resources generated by changes in world mineral prices to predict the geographic distribution of the conflict. Using estimates of civil war exposure on mortality across male and female newborn to assess their relative health, it provides evidence of culling effect (in utero selection) as a consequence of in utero shocks.
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Affiliation(s)
| | - Giacomo Davide De Luca
- Department of Economics, University of York, YO10 5DD Heslington, UK; LICOS KU Leuven, Belgium.
| | - Jean-François Maystadt
- Department of Economics, Lancaster University Management School, Lancaster LA1 4YX, UK; LICOS KU Leuven, Belgium.
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Mugo NS, Agho KE, Zwi AB, Damundu EY, Dibley MJ. Determinants of neonatal, infant and under-five mortality in a war-affected country: analysis of the 2010 Household Health Survey in South Sudan. BMJ Glob Health 2018. [PMID: 29527340 PMCID: PMC5841513 DOI: 10.1136/bmjgh-2017-000510] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Under-five children born in a fragile and war-affected setting of South Sudan are faced with a high risk of death as reflecting in high under-five mortality. In South Sudan health inequities and inequitable condition of daily living play a significant role in childhood mortality. This study examines factors associated with under-five mortality in South Sudan. Methods The study population includes 8125 singleton, live birth, under-five children born in South Sudan within 5 years prior to the 2010 South Sudan Household Survey. Factors associated with neonatal, infant and under-five deaths were examined using generalised linear latent and mixed models with the logit link and binomial family that adjusted for cluster and survey weights. Results The multivariate analysis showed that mothers who reported a previous death of a child reported significantly higher risk of neonatal (adjusted OR (AOR)=3.74, 95% confidence interval (CI 2.88 to 4.87), P<0.001), infant (AOR=3.19, 95% CI (2.62 to 3.88), P<0.001) and under-five deaths (AOR=3.07, 95% CI (2.58 to 3.64), P<0.001). Other associated factors included urban dwellers (AOR=1.37, 95% CI (1.01 to 1.87), P=0.045) for neonatal, (AOR=1.35, 95% CI (1.08 to 1.69), P=0.009) for infants and (AOR=1.39, 95% CI (1.13 to 1.71), P=0.002) for under-five death. Unimproved sources of drinking water were significantly associated with neonatal mortality (AOR=1.91, 95% CI (1.11 to 3.31), P=0.02). Conclusions This study suggested that the condition and circumstances in which the child is born into, and lives with, play a role in under-five mortality, such as higher mortality among children born to teenage mothers. Ensuring equitable healthcare service delivery to all disadvantaged populations of children in both urban and rural areas is essential but remains a challenge, while violence continues in South Sudan.
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Affiliation(s)
- Ngatho Samuel Mugo
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kingsley E Agho
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Anthony B Zwi
- School of Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Michael J Dibley
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Lindskog EE. The effect of war on infant mortality in the Democratic Republic of Congo. BMC Public Health 2016; 16:1059. [PMID: 27716146 PMCID: PMC5053205 DOI: 10.1186/s12889-016-3685-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 09/19/2016] [Indexed: 12/03/2022] Open
Abstract
Background The Democratic Republic of Congo (DRC) has suffered from war and lingering conflicts in East DRC and has one of the highest infant mortality rates in the world. Prior research has documented increases in infant and child mortality associated with war, but the empirical evidence is limited in several respects. Measures of conflict are quite crude or conflict is not tightly linked to periods of exposure to infant death. Few studies have distinguished between the effects of war on neonatal versus post-neonatal infants. No study has considered possible differences between women who give birth during wartime and those who do not that may be related to greater infant mortality. Methods The analysis used the nationally representative sample of 15,103 mothers and 53,768 children from the 2007 and 2013/2014 Demographic Health Survey in the DRC and indicators of conflict events and conflict deaths from the 2013 Uppsala Conflict Data. To account for unobserved heterogeneity across women, a multi-level modeling approach was followed by grouping all births for each woman and estimating random intercepts in discrete time event history models. Results Post-neonatal mortality increased during the Congolese wars, and was highest where conflict events and deaths were extreme. Neonatal mortality was not associated with conflict levels. Infant mortality was not higher in East DRC, where conflicts continued during the post Congolese war period. Models specifying unobserved differences between mothers who give birth during war and those who have children in peacetime did not reduce the estimated effect of war, i.e., no support was found for selectivity in the sample of births during war. Conclusion Differences in effects of the Congolese war on neonatal versus post-neonatal mortality suggest that conflict influences the conditions of infants’ lives more than the aspects of mothers’ pregnancy conditions and delivery that are relevant for infant mortality. These differences may, however, be specific to the nature of conflict and prior conditions in the DRC. Because of continued political instability, violent conflict may be expected to continue in contexts such as the DRC; we must therefore continue to document, analyze and monitor the mechanisms through which war influences infant mortality.
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Joshi M. Comprehensive peace agreement implementation and reduction in neonatal, infant and under-5 mortality rates in post-armed conflict states, 1989-2012. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2015; 15:27. [PMID: 26450696 PMCID: PMC4598964 DOI: 10.1186/s12914-015-0066-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 09/28/2015] [Indexed: 11/20/2022]
Abstract
Background Previous studies suggest that countries with a higher child mortality rate are more susceptible to armed conflict onset as well as recurrence. Studies do not explain conditions under which child mortality declines among post-armed conflict states. This article argues that where armed conflict is terminated through negotiation and implementation of comprehensive peace agreements (CPAs), the child mortality rate declines. This is due to the implementation of provisions in CPAs, which addresses underlying grievances of the poor, underserved and marginalized segments of the population, as well as the successful reconstruction of the health sector. CPA implementation resolves hostilities between armed rivals and facilitates the return process for internally displaced persons and refugees. The CPA implementation may also encourage the return of aid workers and health professionals to conflict-affected zones. Method This study utilizes new data on CPA implementation and examines neonatal, infant and under-5 mortality rates among 73 post-armed conflict countries between 1989 and 2012. Multivariate cross-sectional time series correlation (fixed effect) methods are used to analyze the data. Results Within post-armed conflict states, a decline in neonatal, infant and under-5 mortality rates is associated with higher CPA implementation rates. Additionally, this study shows that higher GDP per capita, higher levels of democracy, and more primary school enrollment are also associated with lower child mortality rates. On the other hand, child mortality rates increase following a rebel victory in armed conflict. Conclusion Ongoing armed conflicts are responsible for massive displacements and the destruction of economic, healthcare and human infrastructure, thus hindering improvements in child survival. For better health outcomes in post-armed conflict countries, ongoing armed conflict must cease through the signing and implementation of a CPA. Short-term and long-term public health issues are discussed in concluding comments. Electronic supplementary material The online version of this article (doi:10.1186/s12914-015-0066-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Madhav Joshi
- Kroc Institute for International Peace Studies, University of Notre Dame, 331 Hesburgh Center, Notre Dame, IN, 46556-5677, USA.
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Singh R, Tripathi V. Under-five mortality among mothers employed in agriculture: findings from a nationally representative sample. PeerJ 2015; 3:e710. [PMID: 25653900 PMCID: PMC4304864 DOI: 10.7717/peerj.710] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/06/2014] [Indexed: 11/25/2022] Open
Abstract
Background. India accounts for 24% to all under-five mortality in the world. Residence in rural area, poverty and low levels of mother’s education are known confounders of under-five mortality. Since two-thirds of India’s population lives in rural areas, mothers employed in agriculture present a particularly vulnerable population in the Indian context and it is imperative that concerns of this sizeable population are addressed in order to achieve MDG4 targets of reducing U5MR to fewer than 41 per 1,000 by 2015. This study was conducted to examine factors associated with under-five mortality among mothers employed in agriculture. Methods. Data was retrieved from National Family Household Survey-3 in India (2008). The study population is comprised of a national representative sample of single children aged 0 to 59 months and born to mothers aged 15 to 49 years employed in agriculture from all 29 states of India. Univariate and Multivariate Cox PH regression analysis was used to analyse the Hazard Rates of mortality. The predictive power of child mortality among mothers employed in agriculture was assessed by calculating the area under the receiver operating characteristic (ROC) curve. Results. An increase in mothers’ ages corresponds with a decrease in child mortality. Breastfeeding reduces child mortality by 70% (HR 0.30, 0.25–0.35, p = 0.001). Standard of Living reduces child mortality by 32% with high standard of living (HR 0.68, 0.52–0.89, 0.001) in comparison to low standard of living. Prenatal care (HR 0.40, 0.34–0.48, p = 0.001) and breastfeeding health nutrition education (HR 0.45, 0.31–0.66, p = 0.001) are associated significant factors for child mortality. Birth Order five is a risk factor for mortality (HR 1.49, 1.05–2.10, p = 0.04) in comparison to Birth Order one among women engaged in agriculture while the household size (6–10 members and ≥ 11 members) is significant in reducing child mortality in comparison to ≤5 members in the house. Under-five mortality among mothers employed in agriculture in India discriminated well between death and survival (Area Under ROC was 0.75, 95% CI [0.73–0.77]) indicating that the model is good for appropriate prediction of child mortality. Conclusion. In a nationally representative sample of households in India, mother’s age, breastfeeding, standard of living, prenatal care and breastfeeding health nutrition education are associated with reduction in child mortality.
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Affiliation(s)
- Rajvir Singh
- Cardiology Research Centre, Heart Hospital, Hamad Medical Corporation (HMC) , Doha , Qatar
| | - Vrijesh Tripathi
- The Faculty of Science and Technology, The University of the West Indies, St. Augustine Campus , Trinidad and Tobago , West Indies
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Bennett CM, Friel S. Impacts of Climate Change on Inequities in Child Health. CHILDREN-BASEL 2014; 1:461-73. [PMID: 27417491 PMCID: PMC4928733 DOI: 10.3390/children1030461] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/20/2014] [Accepted: 11/07/2014] [Indexed: 11/16/2022]
Abstract
This paper addresses an often overlooked aspect of climate change impacts on child health: the amplification of existing child health inequities by climate change. Although the effects of climate change on child health will likely be negative, the distribution of these impacts across populations will be uneven. The burden of climate change-related ill-health will fall heavily on the world's poorest and socially-disadvantaged children, who already have poor survival rates and low life expectancies due to issues including poverty, endemic disease, undernutrition, inadequate living conditions and socio-economic disadvantage. Climate change will exacerbate these existing inequities to disproportionately affect disadvantaged children. We discuss heat stress, extreme weather events, vector-borne diseases and undernutrition as exemplars of the complex interactions between climate change and inequities in child health.
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Affiliation(s)
- Charmian M Bennett
- National Centre for Epidemiology and Population Health, Australian National University, Acton ACT 0200, Australia.
| | - Sharon Friel
- Regulatory Institutions Network, Australian National University, Acton ACT 0200, Australia.
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Two year mortality and associated factors in a cohort of children from rural Uganda. BMC Public Health 2014; 14:314. [PMID: 24708689 PMCID: PMC4234345 DOI: 10.1186/1471-2458-14-314] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 03/31/2014] [Indexed: 11/10/2022] Open
Abstract
Background As part of site development for clinical trials in novel TB vaccines, a cohort of infants was enrolled in eastern Uganda to estimate the incidence of tuberculosis. The study introduced several mortality reduction strategies, and evaluated the mortality among study participants at two years. The specific of objective of this sub-study was to estimate 2 year mortality and associated factors in this community-based cohort. Methods A community based cohort of 2500 infants was enrolled from birth up to 8 weeks of age and followed for 1–2 years. During follow up, several mortality reduction activities were implemented to enhance cohort survival and retention. The verbal autopsy process was used to assign causes of death. Results A total of 152 children died over a median follow up period of 2.0 years. The overall crude mortality rate was 60.8/1000 or 32.9/1000 person years with 40 deaths per 1000 for children who died in their first year of life. Anaemia, malaria, diarrhoeal diseases and pneumonia were the top causes of death. There was no death directly attributed to tuberculosis. Significant factors associated with mortality were young age of a mother and child’s birth place not being a health facility. Conclusion The overall two year mortality in the study cohort was unacceptably high and tuberculosis disease was not identified as a cause of death. Interventions to reduce mortality of children enrolled in the cohort study did not have a significant impact. Clinical trials involving infants and young children in this setting will have to strengthen local maternal and child health services to reduce infant and child mortality.
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Haar RJ, Rubenstein LS. Health in fragile and post-conflict states: a review of current understanding and challenges ahead. Med Confl Surviv 2013; 28:289-316. [PMID: 23421305 DOI: 10.1080/13623699.2012.743311] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Health systems face enormous challenges in fragile and post-conflict states. This paper will review recent literature to better understand how, within a context of economic volatility, political instability, infrastructural collapse and human resource scarcity, population health deteriorates and requires significant attention and resources to rebuild. Classifications of fragile and post-conflict states differ among organizations and reviewing the basic consensus as well as differences will assist in clarifying how organizations use these terms and how statistics on these nations come about. Of particular interest is the increase in local conflicts within states that may not affect national mortality and morbidity but pose heavy burdens on regional populations. Recent research on sexual and reproductive health, children's health and mental health within fragile and post-conflict states highlights the effects of healthcare systems and their breakdown on communities. We propose a research agenda to further explore knowledge gaps concerning health in fragile and post-conflict states.
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Affiliation(s)
- Rohini J Haar
- St Luke's-Roosevelt Hospital, Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, USA.
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Adebowale AS, Yusuf BO, Fagbamigbe AF. Survival probability and predictors for woman experience childhood death in Nigeria: "analysis of North-South differentials". BMC Public Health 2012; 12:430. [PMID: 22691616 PMCID: PMC3432604 DOI: 10.1186/1471-2458-12-430] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 06/12/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Childhood mortality rate is high in Nigeria. There is dearth of information on the comparison of childhood mortality probability and its causal factors in the Northern and Southern Nigeria. This study was designed to fill these gaps. METHODS Nigeria Demographic and Health Survey, 2008 data was used. The first part of this study focused on women aged 15-49 who ever given birth to a child (n = 23,404), irrespective of the survival status of the child and the second part utilized all women aged 15-49 (N = 33,385). The outcome variable was experienced childhood mortality. Data was analyzed using Chi-square, logistic regression and Brass logit model. RESULTS Results showed that similar patterns of children's death were observed in the two regions, but variation existed. Childhood mortality experienced was more pronounced in the North than the South, even when the potential confounding variables were used as control. Levels of education and wealth index showed an inverse relationship with childhood death in the regions (p < 0.05). The gap in childhood mortality experienced between the poorest and richest was wider in the North than the South. There was no significant difference in the risk of childhood mortality experienced by women in the urban and rural areas in the North (p > 0.05), but the difference was significant in the South (p < 0.05). The life-table mortality levels were lower in the North than the South, an indication of higher previous childhood mortality experience in the North than in the South. Across all childhood ages, the smoothed childhood mortality probabilities were consistently higher in the North than the South. CONCLUSION Childhood mortality is higher in the Northern than Southern Nigeria. Improving women's education, particularly in the North will alleviate childhood mortality in Nigeria.
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Affiliation(s)
- Ayo S Adebowale
- Department of Epidemiology, Medical Statistics and Environmental health, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bidemi O Yusuf
- Department of Epidemiology, Medical Statistics and Environmental health, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adeniyi F Fagbamigbe
- Department of Epidemiology, Medical Statistics and Environmental health, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Uraguchi ZB. Rural income transfer programs and rural household food security in Ethiopia. JOURNAL OF ASIAN AND AFRICAN STUDIES 2012; 47:33-51. [PMID: 22451986 DOI: 10.1177/0021909611407151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Based on household food security surveys conducted in Ethiopia, this study seeks to understand the roles and limitations of income transfer projects as determinants of households’ food security. By covering the Food-For-Work Programs (FFWPs) and the Productive Safety Net Programs (PSNPs), the study shows that these programs served as temporary safety nets for food availability, but they were limited in boosting the dietary diversity of households and their coping strategies. Households which participated in the programs increased their supply of food as a temporary buffer to seasonal asset depletion. However, participation in the programs was marred by inclusion error (food-secure households were included) and exclusion error (food-insecure households were excluded). Income transfer projects alone were not robust determinants of household food security. Rather, socio-demographic variables of education and family size as well as agricultural input of land size were found to be significant in accounting for changes in households’ food security. The programs in the research sites were funded through foreign aid, and the findings of the study imply the need to reexamine the approaches adopted by bilateral donors in allocating aid to Ethiopia. At the same time the study underscores the need to improve domestic policy framework in terms of engendering rural local institutional participation in project management.
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Gakidou E, Cowling K, Lozano R, Murray CJL. Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysis. Lancet 2010; 376:959-74. [PMID: 20851260 DOI: 10.1016/s0140-6736(10)61257-3] [Citation(s) in RCA: 370] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In addition to the inherent importance of education and its essential role in economic growth, education and health are strongly related. We updated previous systematic assessments of educational attainment, and estimated the contribution of improvements in women's education to reductions in child mortality in the past 40 years. METHODS We compiled 915 censuses and nationally representative surveys, and estimated mean number of years of education by age and sex. By use of a first-differences model, we investigated the association between child mortality and women's educational attainment, controlling for income per person and HIV seroprevalence. We then computed counterfactual estimates of child mortality for every country year between 1970 and 2009. FINDINGS The global mean number of years of education increased from 4·7 years (95% uncertainty interval 4·4-5·1) to 8·3 years (8·0-8·6) for men (aged ≥25 years) and from 3·5 years (3·2-3·9) to 7·1 years (6·7 -7·5) for women (aged ≥25 years). For women of reproductive age (15-44 years) in developing countries, the years of schooling increased from 2·2 years (2·0-2·4) to 7·2 years (6·8-7·6). By 2009, in 87 countries, women (aged 25-34 years) had higher educational attainment than had men (aged 25-34 years). Of 8·2 million fewer deaths in children younger than 5 years between 1970 and 2009, we estimated that 4·2 million (51·2%) could be attributed to increased educational attainment in women of reproductive age. INTERPRETATION The substantial increase in education, especially of women, and the reversal of the gender gap have important implications not only for health but also for the status and roles of women in society. The continued increase in educational attainment even in some of the poorest countries suggests that rapid progress in terms of Millennium Development Goal 4 might be possible. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA.
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Bawah AA, Phillips JF, Adjuik M, Vaughan-Smith M, Macleod B, Binka FN. The impact of immunization on the association between poverty and child survival: Evidence from Kassena-Nankana District of northern Ghana. Scand J Public Health 2009; 38:95-103. [DOI: 10.1177/1403494809352532] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Research conducted in Africa has consistently demonstrated that parental poverty and low educational attainment adversely affect child survival. Research conducted elsewhere has demonstrated that low-cost vaccines against preventable diseases reduce childhood mortality. Therefore, the extension of vaccination to impoverished populations is widely assumed to diminish equity effects. Recent evidence that childhood mortality is increasing in many countries where vaccination programmes are active challenges this assumption. Data and methods: This paper marshals data from accurate and complete immunization records and survival histories for 18,368 children younger than five years in a rural northern Ghanaian population that is generally impoverished, but where family wealth and parental educational differentials exist nonetheless. Time-conditional Weibull hazard models are estimated to test the hypothesis that childhood immunization offsets the detrimental effects of poverty and low educational attainment. Conclusions: Findings show that the adverse effects of poverty disappear and that the effects of educational attainment are reduced in survival models that control for immunization status. This finding lends empirical support to policies that promote immunization as a strategic component of poverty-reduction programmes.
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Affiliation(s)
| | | | - Martin Adjuik
- Navrongo Health Research Centre, PO Box 114, Navrongo, Ghana
| | | | - Bruce Macleod
- Department of Computer Science, University of Southern Maine, Portland, USA
| | - Fred N. Binka
- School of Public Health, University of Ghana, Legon, Accra, Ghana
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Antai D, Ghilagaber G, Wedrén S, Macassa G, Moradi T. Inequities in under-five mortality in Nigeria: differentials by religious affiliation of the mother. JOURNAL OF RELIGION AND HEALTH 2009; 48:290-304. [PMID: 19639418 DOI: 10.1007/s10943-008-9197-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 07/08/2008] [Indexed: 05/28/2023]
Abstract
Observations in Nigeria have indicated polio vaccination refusal related to religion that ultimately affected child morbidity and mortality. This study assessed the role of religion in under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 7,620 women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey and included 6,029 children. Results show that mother's affiliation to Traditional indigenous religion is significantly associated with increased under-five mortality. Multivariable modelling demonstrated that this association is explained by differential use of maternal and child health services, specifically attendance to prenatal care. To reduce child health inequity, these results need to be incorporated in the formulation of child health policies geared towards achieving a high degree of attendance to prenatal care, irrespective of religious affiliation.
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Affiliation(s)
- Diddy Antai
- Division of Social Medicine (Unit of Epidemiology), Department of Public Health Sciences, Karolinska Institute, 171 76, Stockholm, Sweden.
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Alene GD, Worku A. Differentials of fertility in North and South Gondar zones, northwest Ethiopia: a comparative cross-sectional study. BMC Public Health 2008; 8:397. [PMID: 19055705 PMCID: PMC2610031 DOI: 10.1186/1471-2458-8-397] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 12/02/2008] [Indexed: 11/28/2022] Open
Abstract
Background Ethiopia is one of the most densely populated countries in Africa with an estimated population of 77.1 million in mid-2007. Uncontrolled fertility has adversely influenced the socio-economic, demographic and environmental situations of the country. It is one of the largest and poorest countries that, even in the midst of crisis, has maintained high levels of fertility. This study was aimed at investigating the most important factors influencing fertility behavior in Northwest Ethiopia. Methods A comparative cross-sectional study which included 2424 women aged 25 years and above was undertaken in the Amhara region of Northwest Ethiopia. The study subjects were grouped into high fertile and low fertile categories. There were 1011 and 1413 women in the high and low fertile groups, respectively. A multi-stage cluster sampling stratified by place of residence was employed to select the required study subjects. Both bivariate and multivariate logistic regression techniques were used to analyze the data. Results Among the 25 variables considered in this study, only 9 of them were found significantly and independently associated with the level of fertility. Women with at least secondary education were at a lower risk of high fertility with OR = 0.37 (95% CI: 0.21 to 0.64) compared to those with no formal education. However, women with primary education did not show any significant difference when compared with the same baseline group. Age at first marriage was inversely associated with the number of children ever born alive. Place of residence, household expenditure, number of children who have died, attitude towards using contraceptives, women's knowledge on the safe period, and current marital status were the other variables that showed significant associations with the level of fertility. Conclusion Female education beyond the primary level, reduced infant and child mortality, delayed marriage and correct knowledge on the safe period during the menstrual cycle were amongst the main factors that had a bearing on high fertility.
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Affiliation(s)
- Getu Degu Alene
- School of Public Health, Faculty of Medicine, Addis Ababa University, Ethiopia.
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Abstract
AIM To determine the association between maternal HIV infection and infant mortality in Malawi. METHODS A synthetic cohort life table based on the birth history of 2618 childbirths during 1999 and 2004, from the subsample of 2020 mothers who completed interview and were tested for HIV virus in the 2004 Malawi Demographic and Health Survey was used. The survey collected socio-demographic and health data of a natural representative sample of women aged 15 to 49; and obtained voluntary counselling tests for HIV infection from one-third of the representatives of the sample. Associations of maternal HIV status and other factors with infant mortality were estimated using survival regression analysis and the results are presented as hazard ratios (HR) with level of statistical significance (P-value). RESULTS Children born to HIV-infected mothers were more than two times as likely to die during infancy as those born to uninfected mothers (HR = 2.21; P < 0.01). Controlling for other risk factors and confounding factors for infant mortality further sharpened this relationship (HR = 2.70; P < 0.01). Boys are more likely to die in infancy than girls. Young mothers and mothers not receiving prenatal care, and low-birthweight children and children living in rural areas, particular so in the northern region, were associated with a higher risk of infant mortality. CONCLUSION Maternal HIV infection is strongly associated with infant mortality in Malawi independent of many other factors. Results from this study suggest that the HIV/AIDS epidemic has had an enormous impact on child well-being, child survival and infant mortality. The impact increases as the HIV/AIDS epidemic matures and infection in mothers and adults increases.
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Affiliation(s)
- Rathavuth Hong
- Department of Global Health, School of Public Health and Health Services, George Washington University, Washington, DC 20037, USA.
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Abstract
Despite improvements in child survival in recent decades, levels of infant and child mortality remain unacceptably high, particularly among the poor in developing countries recovering from recent wars and civil unrests. Using information on 8498 childbirths in five years preceding the 2000 Cambodia Demographic and Health Survey, this study measured the association between economic disparity and infant mortality using multivariate Weibull regression. Results indicate that children born in the poorest 40% households were more than twice as likely to die during infancy as those born in the richest 20% households, even after controlling for pregnancy care, birth weight, household living conditions, and other factors. Children born in the middle-income households also had significantly higher mortality risks. Not receiving antenatal care and low birth weight were associated with an increased risk. Also, boys had a higher risk than girls. The study concludes that poverty is strongly negatively associated with infant survival in Cambodia.
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Affiliation(s)
- R Hong
- School of Public Health and Health Services, George Washington University, USA.
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Abstract
The purpose of this study was to measure the association between maternal HIV infection and infant mortality in Ghana. Using a censored synthetic cohort life table based on the birth history of 3639 childbirths during 1999-2003 obtained from the interviews of a nationally representative sample of 5691 women age 15-49 in 6251 households in the 2003 Ghana Demographic and Health Survey. The survey collected demographic, socioeconomic, and health data of the respondents as well as obtained voluntary counseling test for HIV infection from all eligible women. The effects of maternal HIV status and other factors on infant mortality were estimated using multivariate survival regression analysis and the results are presented as Hazard Ratios (HR) with 95% confident interval (95% CI). Children born to HIV infected mothers were three times as likely to die during infancy as those born to uninfected mothers (HR = 3.01; 95% CI: 1.64, 5.50). Controlling for other factors affecting infant mortality further sharpens this relationship (HR = 3.51; 95% CI: 1.87, 6.61). Not receiving antenatal care, low birth weight, and living in households that use high pollution cooking fuels were associated with a higher risk of infant mortality. Maternal HIV status is a strong predictor of infant mortality in Ghana, independent of several other factors. The results of this study suggest that HIV/AIDS epidemic has had great impact on child well-being and child survival. This impact tends to increase as the HIV/AIDS epidemic matures and infection in adults increases.
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Affiliation(s)
- Rathavuth Hong
- Department of Global Health, School of Public Health and Health Services, George Washington University, 2175 K Street NW, Washington, DC 20037, USA
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Hong R, Ruiz-Beltran M. Impact of Prenatal Care on Infant Survival in Bangladesh. Matern Child Health J 2006; 11:199-206. [PMID: 17136460 DOI: 10.1007/s10995-006-0147-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Accepted: 09/19/2006] [Indexed: 11/28/2022]
Abstract
Despite improvements in public health in recent decades, levels of infant and child mortality remain unacceptably high, particularly in developing countries where primary healthcare services including prenatal care services are not universally available. Using information on 7,001 childbirths in five years preceding the 2004 Bangladesh Demographic and Health Survey, this study examined the relationship between receiving prenatal care during pregnancy and infant mortality using multivariate survival analysis. The results are presented in hazard ratios (HR) with 95% confidence intervals (95% CI). Results indicate that children of mothers who did not receive prenatal care during pregnancy were more than twice as likely to die during infancy as children whose mothers received prenatal care during pregnancy (HR=2.40, 95% CI: 1.74, 3.31) independent of child's sex, delivery assistance, birth order; mother's age at child birth, nutritional status, education level; household living conditions, and other factors. Children born to older mothers living in households without safe drinking water were at an increased risk. The study concludes that prenatal care is strongly negatively associated with infant mortality in Bangladesh independent of other risk factors. The results suggest that improving prenatal care services at the community level is key to improving child survival in Bangladesh.
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Affiliation(s)
- Rathavuth Hong
- Department of Global Health, School of Public Health and Health services, The George Washington University, Washington, DC 20037, USA.
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Nielsen J, Jensen H, Andersen PK, Aaby P. Mortality patterns during a war in Guinea-Bissau 1998–99: changes in risk factors? Int J Epidemiol 2005; 35:438-46. [PMID: 16326824 DOI: 10.1093/ije/dyi246] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The crude mortality rate of the whole population and the mortality of children <5 years of age are the common indicators of the severity of a complex emergency situation. However, these indicators rarely take account of differences in socioeconomic conditions and vulnerability. METHODS We followed a population in Guinea-Bissau, which fled when fighting took place in the capital during the war in 1998-99. The population stayed close to the area of conflict and returned as soon as a cease-fire was negotiated. A peace treaty was signed after half-a-year. The following 6 months was a period of returning and re-settlement, even though two outbreaks of fighting occurred. RESULTS In the first half-year the mortality rate was 78% [mortality ratio (MR) = 1.78; 95% CI 1.61-1.97] increased and mortality for children <5 years of age doubled (MR = 2.07; 95% CI 1.79-2.38). In the last 6 months of the war, mortality was slightly increased for children and not at all for the total population. In the first half-year, households living in better houses and having members with schooling were less affected. In the 're-settlement' period two inequalities emerged; the largest ethnic group, Pepel, continued to have high mortality when the mortality of other groups declined; likewise girls continued to have an elevated mortality whereas mortality of boys declined. CONCLUSION Whereas specific 'free' interventions reduced social inequalities for the groups affected, for the total population health-inequalities were slightly amplified during the war. Once the population returned to their urban homes, mortality fell to pre-war levels even though some fighting continued, limited humanitarian aid was available and the pre-war infra-structure had not been re-established.
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Affiliation(s)
- Jens Nielsen
- Bandim Health Project, Guinea-Bissau, West Africa.
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van Egmond K, Naeem AJ, Verstraelen H, Bosmans M, Claeys P, Temmerman M. Reproductive health in Afghanistan: results of a knowledge, attitudes and practices survey among Afghan women in Kabul. DISASTERS 2004; 28:269-282. [PMID: 15344941 DOI: 10.1111/j.0361-3666.2004.00258.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A reproductive-health knowledge, attitudes and practices (KAP) survey was carried out among 468 Afghan women of reproductive age. A convenience sample of women was selected from attendees in the outpatient departments of four health facilities in Kabul. Seventy-nine per cent of respondents had attended at least one antenatal consultation during their last pregnancy. Two-thirds (67 per cent) delivered their first child between 13 and 19 years. The Caesarean-section rate was low (1.6 per cent). Two-thirds (67 per cent) of deliveries occurred in the home. The contraceptive prevalence rate was 23 per cent (16 per cent modern and 7 per cent natural methods). Twenty-four per cent had knowledge of any STIs, although most of these women did not know correctly how to prevent them. Most of the women (93 per cent) needed authorization from their husband or a male relative before seeking professional health-care. In multivariate analysis, women's schooling was significantly associated with antenatal-care attendance (AOR 4.78), institutional delivery (AOR 2.29), skilled attendance at birth (AOR 2.07) and use of family planning (AOR 4.59). Reproductive-health indicators were noted to be poor even among these women living in Kabul, a group often considered to be the most privileged. To meet the reproductive-health needs of Afghan women, the socio-cultural aspects of their situation--especially their decision-making abilities -- will need to be addressed. A long-standing commitment from agencies and donors is required, in which the education of women should be placed as a cornerstone of the reconstruction process of Afghanistan.
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Affiliation(s)
- Kathia van Egmond
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 P3, B-9000 Ghent, Belgium.
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Garfield R. Commentary: War, famine and excess child mortality in Africa. Int J Epidemiol 2001. [DOI: 10.1093/ije/30.3.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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