Biblioteca Digital

A whole range of techniques have been developed for estimating infant and child mortality from the information routinely recorded in maternity registers on age and reproductive history of delivering mothers. Among them, the best-known and most widely applied indirect technique was developed by William Brass. Using the baseline nformation from a birth cohort (Generation XXI assembled in the period 2005-2006 in the metropolitan area of Porto, North of Portugal, we addressed in this paper the following objectives: (1) to estimate the child mortality rates based on information about previous births and their survivorship among women recruited for this birth cohort; (2) to compare these indirect estimates with direct values retrieved from Portuguese vital statistics; (3) to analyse the potential of this birth cohort to generate plausible estimates of lifetable indicators. We retrieved data on mother’s age, previous live births prior to the current one, and number of surviving and deceased children from a group of multiparous women (n=3521). The data was divided into seven 5-year groups by maternal age and survival and death probabilities were computed for each group. Through the Brass method,we obtained estimates of probability of dying before attaining certain exact childhood ages...

While most countries are committed to increasing access to safe water and thereby reducing child mortality, there is little consensus on how to actually improve water services. One important proposal under discussion is whether to privatize water provision. In the 1990s Argentina embarked on one of the largest privatization campaigns in the world including the privatization of local water companies covering approximately 30 percent of the country’s municipalities. Using the varia tion in ownership of water provision across time and space generated by the privatization process, we find that child mortality fell 8 percent in the areas that privatized their water services; and that the effect was largest (26 percent) in the poorest areas. We check the robustness of these estimates using cause specific mortality. While privatization is associated with significant reductions in deaths from infectious and parasitic diseases, it is uncorrelated with deaths from causes unrelated to water conditions.

This paper analyzes complementarities between different Millennium Development Goals, focusing on child mortality and how it is influenced by progress in the other goals, in particular two goals related to the expansion of female education: universal primary education and gender equality in education. The authors provide evidence from eight Sub-Saharan African countries using two rounds of Demographic and Health Surveys per country and applying a consistent micro-econometric methodology. In contrast to the mixed findings of previous studies, for most countries the findings reveal strong complementarities between mothers educational achievement and child mortality. Mothers schooling lifts important demand-side constraints impeding the use of health services. Children of mothers with primary education are much more likely to receive vaccines, a crucial proximate determinant of child survival. In addition, better educated mothers tend to have longer birth intervals, which again increase the chances of child survival. For the variables related to the other goals...

We use a competing risk model to analyze environmental determinants of child mortality using the 1992 China National Health Survey, which collects information on cause of death. Our primary question is whether taking into account of cause of death using a competing risk model, compared with a simple model of all-cause mortality, affects conclusions about the effectiveness of policy interventions. There are two potential analytical advantages in using cause of death information: (1) obtaining more accurate estimates and (2) validating causal relationships. Although, we do not find significant differences between estimates obtained from the competing risk model and those from simpler hazard models, we do find evidence supporting the causal interpretations of the effect of access to safe water on child mortality. Our analysis also suggests that a respondent-based health survey can be used to collect relatively reliable information on cause of death. Modifying future demographic and health survey (DHS) instruments to collect cause of death information inexpensively may be worthwhile for enhancing the analytical strength of the DHS.

The reduction of child mortality and the improvement of maternal health are two of the Millennium Development Goals. Child and maternal mortalities continue to represent severe burdens in many developing countries. Every year, 527,000 women in developing countries die of pregnancy-related complications and nearly 4 million children die during their first month (accounting for 40 percent of all deaths under 5 years of age) with nearly all (98 percent) of them in developing countries. The risks of dying from pregnancy-related complications and a child dying under the age of five are highest in Sub-Saharan Africa. The risk of a mother or an infant dying can be significantly reduced by a continuum of basic care, which should include preventive measures and a skilled attendant during childbirth with access to the necessary equipment, drugs, and other supplies for effective management of any pregnancy-related complications. Yet, many women spend excessive time trying to reach a health facility with the capacity to treat obstetric or infant complications. It is estimated that 75 percent of maternal deaths might be prevented through timely access to essential emergency childbirth-related care. This paper focuses on the ways in which transport and road infrastructure play key roles in the overall delivery of and access to health services...

Using a city-level database of global Urban Indicators, the author finds that: 1) Improved access to urban potable water and sewerage connections is consistently associated with low child mortality. 2) Government involvement in providing water services, especially locally, significantly reduces child mortality. 3) Private or parastatal participation in providing sewerage connections is associated with low child mortality. $) Rapid urban growth and high levels of poverty within the city are correlated with high child mortality.

Although child mortality rates have declined all across the developing world over the past 40 years, they have declined the most in the Middle East and North Africa region. This paper documents this remarkable experience and shows that it is broad based in the sense that all countries in the Middle East and North Africa experienced significant declines in child mortality over this period and each country did better than most of its comparators. In looking for the sources of the region s performance edge, the paper confirms the importance of such determinants of child mortality as income growth, education stock, public spending on health, urbanization, and food sufficiency. In addition, the paper establishes that the initial level of mortality has a substantial influence on the pace of subsequent child mortality decline. Of these factors, food sufficiency status is found to contribute to the region s performance edge over all developing regions, while the other factors are found to matter to varying degrees in selected pairwise regional comparisons.

As Asia becomes increasingly urbanized the effect of new industrial development on child mortality becomes of increasing interest. In India, considerable investment has been made in the social infrastructure of industrial new towns. This survey of Durgapur steel town in West Bengal shows that although the average level of child mortality in the working class population is favourable in comparison with other Indian cities, considerable differentials, that can be related to social, economic and environmental differences within the population, have arisen since the creation of the city in the late 1950s. The paper argues that the undertaking of selective sanitary interventions to improve access to drinking water (in particular) would be administratively feasible in these industrial new towns, of immediate impact, and indeed necessary if the differentials in mortality are to be eliminated.; no

The objective of this paper is to examine how child mortality changes with different levels of maternal education and to quantify the impact of maternal education and female labour force participation. Child mortality gradients, according to years of education, are rather steep at the primary education level for both male and female children. In post-primary stages of education incremental gains in mortality reduction are almost non-existent. Child mortality is inversely related to both maternal education and female labour force participation but disaggregated analysis showed that female labour force participation has no impact on child mortality among females with fewer than seven years of education. The relative impact of maternal education on child mortality is three times stronger than that of female labour force participation. Excess female child mortality prevailing in certain parts of India also has an inverse relationship with the length of mothers’ education, and female labour force participation. Female labour force participation has a stronger influence on excess female child mortality than on absolute child mortality. The evidence in the paper lends support to Bardhan’s hypothesis on excess female child mortality.; yes

Several studies in sub-Saharan Africa have associated infant and child mortality with the AIDS epidemic in the region. The paper uses retrospective survey data of six districts in the east, south and west of Uganda to study infant and child mortality, which increased in the 1980s probably because of the AIDS epidemic and started declining in the early 1990s, a period when the epidemic was reported to be subsiding. Deeper analysis of data indicates that children whose parents are polygamous, educated, formally employed and in business are at a higher risk of death from AIDS and related illness. Although AIDS as a direct cause of death is the fourth leading killer of children, other serious diseases such as diarrhoea, respiratory infection and measles are associated with AIDS.; no

This study examines differentials in infant and child mortality by socio-economic and demographic characteristics in Nepal. The study is mainly based on data from the Nepal Fertility Survey carried out by the Nepal Family Planning and Maternal child Health Project in 1976 in collaboration with the World Fertility Survey. This was the first major national representative demographic survey carried out in Nepal. This study examined the infant and child mortality differentials in rural areas of Nepal by regions, by socio-economic characteristics of the family and by demographic characteristics of the mothers. Taking into consideration variations by socio-economic and demographic factors, regional differentials in mortality are found to be important. The risk of infant and child death has been shown to be higher in the mountains compared to the Terai and hills. Education of the mother is found to be important in determining child mortality. With regard to demographic factors, it has been shown that the high risk of infant and child death to first order births is due to the fact that these births occur predominantly to younger women. The importance of the combined effect of maternal age and parity is also demonstrated in this study. High order births to younger women have an excessive risk of infant and child death. This synergistic effect of higher order births and young maternal age of infant and child mortality is obviously linked with short birth intervals. The length of preceding birth intervals and the survival of previous birth are important predictors of infant and child mortality among subsequent births. This study revealed that even at the shortest preceding birth interval (<18months) the probability of the later child of the interval dying during infancy is considerably higher among the children of mothers whose first child of the interval has died than if the first child of the interval is alive. This indicates that in addition to and...

Using household survey data, this paper estimates the mortality impact of improved water and sanitation access in order to evaluate the potential contribution of water and sanitation investment toward achieving the child mortality targets defined in Millennium Development Goal 4. The authors find that the average mortality reduction achievable by investment in water and sanitation infrastructure is 25 deaths per 1,000 children born across countries, a difference that accounts for about 40 percent of the gap between current child mortality rates and the 2015 target set in the Millennium Development Goals. According to the estimates, full household coverage with water and sanitation infrastructure could lead to a total reduction of 2.2 million child deaths per year in the developing world. Combining this analysis with cost data for water and sanitation infrastructure, the authors estimate that the average cost per life-year saved ranges between 65 and 80 percent of developing countries' annual gross domestic product per capita. The results suggest that investment in water and sanitation is a highly cost-effective policy option...

This report builds on the World Bank's earlier report on the Millennium Development Goals (MDGs) in India (2004 report number 30266), which highlighted the challenges India faces in meeting a number of the MDGs. The report focuses on the state of Orissa and is organized as follows: the second chapter provides a brief background on Orissa. This is followed by a review of recent trends with infant and child mortality in the state. Chapter 4 introduces a framework for assessing the multitude of factors which have a bearing on infant and child mortality, dividing them into four groups: the individual woman/mother; the family; the community and service provision. Chapter 5 applies the analytical framework to Orissa and this is followed by a chapter 6 which looks at district level patterns. The final chapter of the report pulls it altogether and attempts to answer three questions: what is needed to bring down child mortality rates in Orissa and achieve the 11" Five Year Plan and MDG goal; how well are existing interventions placed to do the job; and where are the gaps and how can they best be filled. The report ends with an outline of a possible multi-sectoral program designed to reduce child mortality in Orissa.

The authors focus on infant and child mortality in rural areas of India. They construct a flexible duration model framework that allows for frailty at multiple levels and interactions between the child's age and individual socioeconomic, and environmental characteristics. The model is estimated using the 1998-99 wave of the Indian National Family and Health Survey. The estimated results show that socioeconomic and environmental characteristics have significantly different effects on mortality rates at different ages. These are particularly important immediately after birth. The authors use the estimated model for policy experiments. These indicate that child mortality can be reduced substantially, particularly by improving the education of women and reducing indoor air pollution caused by cooking fuels. In addition, providing access to electricity and sanitation facilities can reduce under-five-years mortality rates significantly.

The authors use data from the National Family Health Survey 2005 to present age-specific patterns of child mortality among India's tribal (Adivasi) population. The analysis shows three clear findings. First, a disproportionately high number of child deaths are concentrated among Adivasis, especially in the 1-5 age group and in those states and districts where there is a high concentration of Adivasis. Any effort to reduce child morality in the aggregate will have to focus more squarely on lowering mortality among the Adivasis. Second, the gap in mortality between Adivasi children and the rest really appears after the age of one. In fact, before the age of one, tribal children face more or less similar odds of dying as other children. However, these odds significantly reverse later. This calls for a shift in attention from infant mortality or in general under-five mortality to factors that cause a wedge between tribal children and the rest between the ages of one and five. Third, the analysis goes contrary to the conventional narrative of poverty being the primary factor driving differences between mortality outcomes. Instead...

This report focuses on the attainment of five major human development-related Millennium Development Goals (MDGs) in Bangladesh - consumption poverty, infant and under-five mortality, child malnutrition, schooling enrollment and completion, gender disparities in schooling. The report stipulates that of these MDGs, Bangladesh has already attained (or nearly attained) the goal relating to elimination of gender disparity in schooling opportunities. Bangladesh is the only country in South Asia (other than Sri Lanka) to have achieved parity in male and female enrollments, not just at the primary level, but also at the secondary level. The analysis in this report suggests that attainment of two other MDGs - in particular, the reduction of consumption-poverty and under-five mortality - is also feasible with a combination of interventions, including sector-specific interventions (such as expanding immunization coverage and reducing pupil-teacher ratios), economic growth, improved coverage of infrastructure, and social safety-net programs (such as the District Education Stipends Program, and the Vulnerable Group Development programs). However, it will be challenging for Bangladesh to attain the child malnutrition-related MDG, as well as the education MDGs relating to universal net primary enrollment...

A whole range of techniques have been developed for estimating infant and child mortality from the information routinely recorded in maternity registers on age and reproductive history of delivering mothers. Among them, the best-known and most widely applied indirect technique was developed by William Brass. Using the baseline information from a birth cohort (Generation XXI) assembled in the period 2005-2006 in the metropolitan area of Porto, North of Portugal, we addressed in this paper the following objectives: (1) to estimate the child mortality rates based on information about previous births and their survivorship among women recruited for this birth cohort; (2) tocompare these indirect estimates with direct values retrieved from Portuguese vital statistics; (3) to analyse the potential of this birth cohort to generate plausible estimates of life-table indicators. We retrieved data on mother’s age, previous live births prior to the current one, and number of surviving and deceased children from a group of multiparous women (n=3521). The data was divided into seven 5-year groups by maternal age and survival and death probabilities were computed for each group. Through the Brass method, we obtained estimates of probability of dying before attaining certain exact childhood ages...

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women’s and Children’s Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula – fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society...

Objetivo: Analisar a evolução de mortalidade infantil. Método: Estudo ecológico e descritivo. Utilizaram-se os bancos de dados de óbitos fornecidos pelo Sistema de Informações sobre mortalidade, durante o período de 2006 a 2010. Selecionaram-se apenas os registros em que o município de residência e de ocorrência dos óbitos correspondiam ao município de Porto Velho e os que apresentavam idade menor de 12 meses no momento do óbito. Analisaram apenas os óbitos por causas evitáveis neonatal e pós-neonatal. Resultados: No município de Porto Velho, em período estudado há um predomínio de mães com idade entre 20 a 34 anos, cujos percentuais de óbitos infantis variaram entre 26,0% em 2006 a 29,0% em 2010, com oscilações percentuais nos demais anos. Houve uma tendência crescente de óbitos prematuros, exceto no ano de 2009, cujo percentual foi de 45,0%. Entre os anos de 2006 e 2007 esse percentual manteve-se em 50,0%, aumentou para 53% em 2008 e em 2010 representou 54,0% dos óbitos em menores de 1 ano. Conclusão: A estimativa de incidência de mortalidade infantil foi sempre mais elevada, ao longo do período estudado, do que o valor esperado para o Brasil até 2015.; Objective: To analyze the evolution of child mortality. Methods: A descriptive ecological study was conducted. The database of deaths provided by the Mortality Information System between 2006 and 2010 was used. Only records in which the city of residence and occurrence of deaths corresponded to the city of Porto Velho and whose children were younger than 12 months at the time of death were included in this study. In addition...

The increased attention to tracking progress towards the Millennium Development Goals (MDG), including Goal 4 of reducing child mortality, has drawn attention to a number of interrelated technical, operational and political challenges and to the underlying weaknesses of country health information systems upon which reliable monitoring depends. Assessments of child mortality published in 2005, for almost all low-income countries, are based on an extrapolation of the trends observed during the 1990s, rather than on the empirical data for more recent years. The validity of the extrapolation depends on the quality and quantity of the data used, and many countries lack suitable data. In the long run, it is hoped that vital registration or sample registration systems will be established to monitor vital events in a sustainable way. However, in the short run, tracking child mortality in high-mortality countries will continue to rely on household surveys and extrapolations of historical trends. This will require more collaborative efforts both to collect data through initiatives to strengthen health information systems at the country level, and to harmonize the estimation process. The latter objective requires the continued activity of a coordinating group of international agencies and academics that aims to produce transparent estimates- through the consistent application of an agreed-upon methodology- for monitoring at the international level.