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Objective: Recent meta-analyses demonstrate that small-quantity lipid-based nutrient supplements (SQ-LNS) for young children significantly reduce child mortality, stunting, wasting, anaemia and adverse developmental outcomes. Cost considerations should inform policy decisions. We developed a modelling framework to estimate the cost and cost-effectiveness of SQ-LNS and applied the framework in the context of rural Uganda. Design: We adapted costs from a costing study of micronutrient powder (MNP) in Uganda, and based effectiveness estimates on recent meta-analyses and Uganda-specific estimates of baseline mortality and the prevalence of stunting, wasting, anaemia and developmental disability. Setting: Rural Uganda. Participants: Not applicable. Results: Providing SQ-LNS daily to all children in rural Uganda (> 1 million) for 12 months (from 6 to 18 months of age) via the existing Village Health Team system would cost ∼$52 per child (2020 US dollars) or ∼$58·7 million annually. SQ-LNS could avert an average of > 242 000 disability-adjusted life years (DALYs) annually as a result of preventing 3689 deaths, > 160 000 cases of moderate or severe anaemia and ∼6000 cases of developmental disability. The estimated cost per DALY averted is $242. Conclusions: In this context, SQ-LNS may be more cost-effective than other options such as MNP or the provision of complementary food, although the total cost for a programme including all age-eligible children would be high. Strategies to reduce costs, such as targeting to the most vulnerable populations and the elimination of taxes on SQ-LNS, may enhance financial feasibility. [ABSTRACT FROM AUTHOR]

In this paper, we study differential infant and child mortality according to the origin of the mothers, natives of Madrid or immigrants, between 1916 and 1926. From 1880 to 1939, Madrid experienced spectacular demographic growth, with a massive influx of immigrants, mainly from the Castilian Plateau. Using the city's records of births and deaths, which we linked for the study period, we demonstrate an important spatial heterogeneity in infant and child mortality across the city. Although the development of the town was planned in the 1860s, the infrastructure and the real estate market were overwhelmed by the continuous arrival of new inhabitants. Moreover, major investments in public health increased the gap between the wealthy districts and peripheral areas. These improvements deepened inequality. During years marked by the waves of the influenza pandemic, we isolate the impact of poverty, which threatened the survival of newborns through poor nutrition, deficient hygienic infrastructures and deplorable housing conditions. Such features explain the impressive association between summer and the risk of dying from enteritis, diarrhea and other diseases of the same type among weaned children. However, the mortality differentials between the offspring of native and migrant mothers were surprisingly small, which we explained in terms of behavioral adaptation to the large city and its mass society. [ABSTRACT FROM AUTHOR]

2021 marked the 30-year anniversary of the publication Fatal Years: Child Mortality in the late Nineteenth-Century United States , a pioneering work in historical demography by Samuel H. Preston and Michael R. Haines. This special issue showcases the current state of historical mortality studies through a collection of articles originally presented at two commemorative sessions at the 2021 meeting of the Social Science History Association. It provides new and more nuanced evidence on several of the major themes of Fatal Years in terms of the mortality experience and includes studies of a wide range of contexts, from North America, to Ireland, England and Wales, and continental Europe. They all bring new evidence and leverage the dramatic development that has taken place in availability of large-scale micro-level data in the 30 years since Fatal Years was published. This introduction first provides some background to the collection and then summarizes the main findings from the different articles included. Preston and Haines provide a coda to this collection with a short reflection article on researching and writing Fatal Years. [ABSTRACT FROM AUTHOR]

This article appraises kin availability and migration timing on French-Canadian child mortality in an early twentieth-century North American industrial city. The analysis is based on the exploitation of an original dataset constructed by linking the 1910 census data (IPUMS-Full Count) for Manchester, New Hampshire to Quebec Catholic marriage records (BALSAC) and geocoding census data at the household level (Sanborn Fire Insurance Maps). Our results suggest that the presence of maternal and paternal grandmothers in the city living in different households were associated with reduced child mortality and that French-Canadian women who arrived in the United States as children or young adults experienced higher child mortality compared to second-generation French Canadians and those who migrated at a later age. [ABSTRACT FROM AUTHOR]

This is a history of the creation of the book Fatal Years: Child Mortality in late-Nineteenth-Century America (1991) by the authors. The data were a sample of households from the 1900 United States Census manuscripts. The primary method used was indirect estimation of child mortality (approximately ages 0–4) using information on the age and marriage duration of women. Among the findings were overall lower overall mortality than in the 1900/1902 Glover life tables for the Death Registration Area, and very large variations in mortality by race and size of place of residence. [ABSTRACT FROM AUTHOR]

With only a few exceptions, the historical study of individual-level correlates of child mortality in the United States has been limited to the period surrounding the turn of the twentieth century, when children ever born and children surviving data collected by the 1900 and 1910 censuses allow indirect estimation of child mortality. The recent release of linked census data, such as the IPUMS MLP datasets, allows a different type of indirect estimation over a longer period. By following couples across subsequent decennial censuses, it is possible to infer child mortality by measuring whether couples' own children in the first census were still present in the second census. We focus our analysis on children aged 1–3 in the first of two linked censuses, who were less likely to be undercounted by the census than infants, and unlikely to be living apart from their parents in the second census. We estimate child mortality over the intervening decade and use OLS regression to correlate that mortality to the residence location and socioeconomic characteristics of their parents' households. We limit our analysis to three panel datasets for married couples linked between the 1850–60, 1860–70, and 1870–80 censuses, when real estate and personal estate wealth data were collected. Our results indicate a significant negative relationship between wealth and child mortality across all regions of the United States and over the entire period examined. [ABSTRACT FROM AUTHOR]

This paper shows the effect that the medical expertise of medical practitioners had on the life chances of their children. We focus on infant and early childhood mortality. We reconstructed the life histories of the offspring of a group of around 2800 medical practitioners who were practicing in a high-mortality region in the Netherlands between 1850 and 1922, the period during which infant and child mortality in the Netherlands underwent the largest changes. The survival of their offspring is compared with that of a random sample of children from the Historical Sample of the Netherlands. Multilevel hazard analysis, using Cox proportional hazards models with shared frailty, is applied to study the effect of belonging to the medical profession on survival, in relation to the level of infant mortality in the regions where children were born. Within the group of medical practitioners, attention is paid to differences in children's survival according to the level of medical knowledge of the fathers. Our statistical analyses show that the offspring of medical practitioners as a whole did have better survival prospects than children born to families without a father with a medical background. When medical practitioners had effective medical knowledge, measured by the period of graduation and the highest level of medical training reached, the positive effects on the survival of their children were even stronger. [ABSTRACT FROM AUTHOR]

This paper takes, as its starting point, Preston and Haines' observation in Fatal Years that social class was the most important influence on infant and child mortality in England and Wales in the early twentieth century. A subsequent study suggested that this could in part be due to the spatial distribution of the different classes across different types of place, and that some of the mortality differences by social class might actually reflect the contextual effects of healthy and unhealthy places. Although this line of argument has received a considerable amount of attention in health geography literature, it has rarely been examined for a specific historic period, and then only within particular urban areas. In this paper, we apply multi-level models to a complete count individual-level dataset of the 1911 census of England and Wales, comparing influences on infant and child mortality at the level of the individual couple and for two spatial levels. We find that although most variation in infant and child mortality operates at the individual level, there is also important variation at the two spatial levels and part of the mortality differences between social classes is better explained by the areas in which people lived rather than by their social class. A consideration of independent variables at all three levels suggests that different spatial scales capture different sorts of influences on early age mortality. [ABSTRACT FROM AUTHOR]

In the first half of the twentieth century, deaths from infectious disease, especially among the very young, fell dramatically in American cities. However, as infant mortality fell and life expectancy rose, racial inequality in urban infectious disease mortality grew. In this paper, we show that the fall in mortality and the rise in racial inequality in mortality reflected two countervailing processes. The dramatic decline in infant mortality from waterborne diseases drastically reduced the total urban infectious disease mortality rate of both Black and white Americans while having a comparatively small effect on the total racial disparity in urban infectious disease mortality. In contrast, the unequal fall in tuberculosis mortality, particularly in the prime of life, widened racial inequality in infectious disease mortality in US cities. [ABSTRACT FROM AUTHOR]

Ireland is often seen as an outlier within the western world in terms of demographic behavior. As a society it has also been noted for its religious fervor, including religious division, at least until fairly recently. Might there be connections historically between these two spheres? One intriguing area of enquiry relates to possible links between religious denomination and child mortality. We explore this possibility using individual-level data from the household schedules of the Irish Census of 1911. The study area is Belfast, Ireland's leading industrial city, which allows for a wide range of occupational and social class differences. Combining regression techniques and the mortality index proposed by Preston and Haines (1991), we seek to tease out the relationship between child mortality and religious affiliation while controlling for a range of other explanatory variables. We show that religious identity is clearly associated with different infant and child mortality outcomes. Of the three major religious denominations, Catholics suffered the most from high infant mortality, Church of Ireland (Anglican) families were only a little better off, while the largest Protestant denomination, the Presbyterians, had the best infant mortality outcomes. These differences were related, in the main, to the varying socioeconomic composition of the three major religious denominations but religious affiliation also mattered in its own right. [ABSTRACT FROM AUTHOR]

Objective: To compare the prognostic value of mid-upper arm circumference (MUAC), weight-for-height Z -score (WHZ) and weight-for-age Z -score (WAZ) for predicting death over periods of 1, 3 and 6 months follow-up in children. Design: Pooled analysis of twelve prospective studies examining survival after anthropometric assessment. Sensitivity and false-positive ratios to predict death within 1, 3 and 6 months were compared for three individual anthropometric indices and their combinations. Setting: Community-based, prospective studies from twelve countries in Africa and Asia. Participants: Children aged 6–59 months living in the study areas. Results: For all anthropometric indices, the receiver operating characteristic curves were higher for shorter than for longer durations of follow-up. Sensitivity was higher for death with 1-month follow-up compared with 6 months by 49 % (95 % CI (30, 69)) for MUAC < 115 mm (P < 0·001), 48 % (95 % CI (9·4, 87)) for WHZ < -3 (P < 0·01) and 28 % (95 % CI (7·6, 42)) for WAZ < -3 (P < 0·005). This was accompanied by an increase in false positives of only 3 % or less. For all durations of follow-up, WAZ < -3 identified more children who died and were not identified by WHZ < -3 or by MUAC < 115 mm, 120 mm or 125 mm, but the use of WAZ < -3 led to an increased false-positive ratio up to 16·4 % (95 % CI (12·0, 20·9)) compared with 3·5 % (95 % CI (0·4, 6·5)) for MUAC < 115 mm alone. Conclusions: Frequent anthropometric measurements significantly improve the identification of malnourished children with a high risk of death without markedly increasing false positives. Combining two indices increases sensitivity but also increases false positives among children meeting case definitions. [ABSTRACT FROM AUTHOR]

Nigeria accounts for a quarter of malaria cases worldwide, which can be prevented with the use of insecticide treated nets (ITN). While studies have documented mother-related characteristics influencing use of ITN, regional variations in the influence of those factors are not well known. This study investigated nine factors (age, place of residence, education, religion, wealth, number of children in the household, sex of child, age of child and previous experience of child mortality) as possible predictors of use of ITN for children and how the associations vary across northern and southern parts of the country. The study utilised the 2015 Nigeria Malaria Indicator Survey, which comprised 6524 mothers (4009 from the north and 2151 from the south) aged 15-49. Bivariate and multivariate logistic regression models were fitted. It was found that, less than half (47.9%) of the respondents reported no access to a mosquito net in the north compared to 70.8% in the south. More than half (51.4%) of the northern respondents used insecticide treated net (ITN) for the child compared to 27.1% of southern mothers. When the variables are fitted together in the same model, place of residence, mother's age, mother's education, wealth, religion, number of children in the household and previous experience of child mortality were associated with the use of ITN. Regional variations exist in the influence of mother's age, number of children in the household and previous experience of child mortality. It was submitted that mother's characteristics are more important than the child's factors in the use of ITN, and that, contrary to the theory of poor utilisation of health-related facilities in the north compared to the south, residents in the former have access to and use ITN more than their counterparts from the latter. [ABSTRACT FROM AUTHOR]

The 2002 Dutch Euthanasia law applies to patients aged 12 years and older. Developments in end-of-life care and decision-making in the last decade have sparked the debate about usefulness and necessity to extend euthanasia to include children under 12 years of age. This paper describes two opposite positions: the affirmative position of a pediatrician and expert in pediatric palliative care and the negative position of a jurist and specialist in health law. [ABSTRACT FROM AUTHOR]

Objective: Infant and under-five mortality rates in low- and middle-income countries (LMIC) can be reduced by encouraging behaviours such as sleeping under insecticide-treated bed nets, exclusive breast-feeding for the first 6 months, regular handwashing, etc. Community-based volunteer or peer-to-peer mechanisms are cost-effective ways of promoting these lifesaving practices. However, the sustainability and reach of community-based behaviour change promotion remains a challenge. Our inquiry focuses on the utilisation, by non-governmental organisations (NGO), of Care Groups, a peer-to-peer behaviour change intervention. We asked: What are the mechanisms and contexts by which Care Groups achieve social and behavioural change in nutrition, health and other sectors? Design: Realist synthesis reviewing forty-two texts that contained empirical evidence about Care Group interventions. Setting: LMIC. Participants: We held consultations with a research reference group, which included Care Group and nutrition experts, and Care Group – implementing NGO staff in Malawi. Results: Different types of motivation drive the establishment and the sustainability of peer group interventions. A certain amount of motivation was derived from the resources provided by the NGO establishing the Care Groups. Subsequently, both volunteers and neighbourhood group members were motivated by the group dynamics and mutual support, as well as support from the wider community. Finally, volunteers and group members alike became self-motivated by their experience of being involved in group activities. Conclusions: When designing and implementing community-based behaviour change interventions, awareness of the multi-directional nature of the motivating drivers that are experienced by peer- or community group members is important, to optimise these groups' reach and sustainability. [ABSTRACT FROM AUTHOR]

Basic vaccination is important to protect children from infectious diseases and illnesses. Adequate levels of vaccination coverage reduce the morbidity and mortality burden among children and promote their physical and mental development. This study aimed to assess the association between basic childhood vaccination and the cognitive and learning ability of school children in India. Nationally representative follow-up data on 6183 children from the Indian Human Development Surveys conducted in 2004–05 and 2011–12 (IHDS I & II) were analysed. Children aged 8–10 years who had received all basic vaccines by the age 12 months performed better in a maths test than partially vaccinated or unvaccinated children (OR: 1.87, 95% CI: 1.48, 2.35). Similarly, fully vaccinated children performed better in writing tasks than partially vaccinated or unvaccinated children (OR: 1.77, 95% CI: 1.44, 2.18). Likewise, fully vaccinated children had better reading skills than fully unvaccinated children (OR: 1.60, 95% CI: 1.23, 2.09). The results suggest that enhancing child vaccination coverage can have significant benefits beyond health and can potentially improve the long-term educational outcomes of children. [ABSTRACT FROM AUTHOR]

Extant humans are currently increasing their genetic load, which is informing present and future human microevolution. This has been a gradual process that has been rising over the last centuries as a consequence of improved sanitation, nutritional improvements, advancements in microbiology and medical interventions, which have relaxed natural selection. Moreover, a reduction in infant and child mortality and changing societal attitudes towards fertility have led to a decrease in total fertility rates (TFRs) since the 19th century. Generally speaking, decreases in differential fertility and mortality have meant that there is less opportunity for natural selection to eliminate deleterious mutations from the human gene pool. It has been argued that the average human may carry ~250-300 mutations that are mostly deleterious, as well as several hundred less-deleterious variants. These deleterious alleles in extant humans mean that our fitness is being constrained. While such alleles are viewed as reducing human fitness, they may also have had an adaptive function in the past, such as assisting in genetic complexity, sexual recombination and diploidy. Saying this, our current knowledge on these fitness compromising alleles is still lacking. [ABSTRACT FROM AUTHOR]

The key recommendation of the Child Survival and Safe Motherhood programme was the provision of Emergency Obstetric Care (EmOC) for the prevention of maternal mortality, especially in developing countries like India. The objectives of this paper were three-fold: to examine the socioeconomic differentials in mean out-of-pocket expenditure on EmOC in public and private health care facilities in India; to evaluate the catastrophic health expenditure of households at the threshold levels of 5% and 10%; and finally, to assess the effects of various socioeconomic and demographic covariates on the levels of catastrophic health expenditure on EmOC. Data were extracted from the 71st round of the National Sample Survey Office (NSSO) survey conducted in India between January and June 2014. A stratified multi-stage sampling design was followed to conduct the survey. The information was collected from 65,932 households (rural: 36,480; urban: 29,452) and 33,104 individuals across various states and union territories in India. However, the present study had taken only 1653 sample women who availed EmOC care during the last one year preceding the survey date. Binary logistic regression was applied. Large differences in out-of-pocket expenditure on EmOC were found between private and public health care facilities. Mean annual out-of-pocket expenditure by women in private hospitals was INR 23,309 (US$367), which was about 6 times higher than in public hospitals, where mean spending was INR 3651 (US$58). Furthermore, logistic regression analysis showed a significant association between household socioeconomic status and level of catastrophic health expenditure on EmOC. The odds of catastrophic health expenditure in public health facilities among women from the North region were higher than among those from the Central, South and West regions. Age and level of education significantly influenced the mean level of catastrophic health expenditure. Access to good-quality obstetric care is key to reducing the maternal mortality rate and child deaths, and thus achieving Sustainable Development Goal 3. There is an urgent need for policy interventions to reduce the financial burden of households in accessing obstetric care in India. [ABSTRACT FROM AUTHOR]

Improving knowledge about African historical demography is essential to addressing current population trends and achieving deeper understanding of social, economic, and political change in the past and present. I use census and parish register data from Tanganyika to address the origins of twentieth-century population growth, to describe how major changes in fertility and child mortality began in the 1940s, and to emphasise the significance of the large rise in fertility between the 1940s and 1970s. Through this work and my wider survey of parish registers in Malawi, Uganda, Tanzania, and Zambia, I consider the relationships between power, evidence, and meaning in these data sources. Alongside the macro gaps in Africa's population history are significant microsilences — lacunae in the sources and data which reflect the hegemonic structures within which they were produced. I suggest a moral demography approach to their analysis, borrowing from the reflexive and dialectic method found in studies of moral economy. [ABSTRACT FROM AUTHOR]

The key challenges of global health policy are not limited to improving average health status, with a need for greater focus on reducing regional inequalities in health outcomes. This study aimed to assess health inequalities across the major Indian states used data from the Sample Registration System (SRS, 1981-2015), National Family Health Survey (NFHS, 1992-2015) and other Indian government official statistics. Catching-up plots, absolute and conditional β-convergence models, sigma (σ) plots and Kernel Density plots were used to test the Convergence Hypothesis, Dispersion Measure of Mortality (DMM) and the Gini index to measure progress in absolute and relative health inequalities across the major Indian states. The findings from the absolute β-convergence measure showed convergence in life expectancy at birth among the states. The results from the β- and σ-convergences showed convergence replacing divergence post-2000 for child and maternal mortality indicators. Furthermore, the estimates suggested a continued divergence for child underweight, but slow improvements in child full immunization. The trends in inter-state inequality suggest a decline in absolute inequality, but a significant increase or stationary trend in relative health inequality during 1981-2015. The application of different convergence metrics worked as robustness checks in the assessment of the convergence process in the selected health indicators for India over the study period. [ABSTRACT FROM AUTHOR]

Diarrhoeal disease is one of the major causes of morbidity and mortality in children and is usually measured at individual level. Shared household attributes, such as improved water supply and sanitation, expose those living in the same household to these same risk factors for diarrhoea. The occurrence of diarrhoea in two or more children in the same household is termed 'diarrhoea clustering'. The aim of this study was to examine the role of improved water supply and sanitation in the occurrence of diarrhoea, and the clustering of diarrhoea in households, among under-five children in India. Data were taken from the fourth round of the National Family and Health Survey (NFHS-4), a nationally representative survey which interviewed 699,686 women from 601,509 households in the country. If any child was reported to have diarrhoea in a household in the 2 weeks preceding the survey, the household was designated a diarrhoeal household. Household clustering of diarrhoea was defined the occurrence of diarrhoea in more than one child in households with two or more children. The analysis was done at the household level separately for diarrhoeal households and clustering of diarrhoea in households. The presence of clustering was tested using a chi-squared test. The overall prevalences of diarrhoea and clustering of diarrhoea were examined using exogenous variables. Odds ratios, standardized to allow comparison across categories, were computed. The household prevalence of diarrhoea was 12% and that of clustering of diarrhoea was 2.4%. About 6.5% of households contributed 12.6% of the total diarrhoeal cases. Access to safe water and sanitation was shown to have a great impact on reducing diarrhoeal prevalence and clustering across different household groups. Safe water alone had a greater impact on reducing the prevalence in the absence of improved sanitation when compared with the presence of improved sanitation. It may be possible to reduce the prevalence of diarrhoea in households by targeting those households with more than one child in the under-five age group with the provision of safe water and improved sanitation. [ABSTRACT FROM AUTHOR]

We present English translations of two French documents to show that the main reason for the rejection of Semmelweis's theory of the cause of childbed (puerperal) fever was because his proof relied on the post hoc ergo propter hoc fallacy, and not because Joseph Skoda referred only to cadaveric particles as the cause in his lecture to the Academy of Science on Semmelweis's discovery. Friedrich Wieger (1821–1890), an obstetrician from Strasbourg, published an accurate account of Semmelweis's theory six months before Skoda's lecture, and reported a case in which the causative agent originated from a source other than cadavers. Wieger also presented data showing that chlorine hand disinfection reduced the annual maternal mortality rate from childbed fever (MMR) from more than 7 per cent for the years 1840–1846 to 1.27 per cent in 1848, the first full year in which chlorine hand disinfection was practised. But an editorial in the Gazette médicale de Paris rejected the data as proof of the effectiveness of chlorine hand disinfection, stating that the fact that the MMR fell after chlorine hand disinfection was implemented did not mean that this innovation had caused the MMR to fall. This previously unrecognized objection to Semmelweis's proof was also the reason why Semmelweis's chief rejected Semmelweis's evidence. [ABSTRACT FROM AUTHOR]

This study proposes a measure of reproductive losses starting from conception to age 15 as an assessment of childbearing 'efficiency'. It is suggested that losses are due to miscarriages, abortions, stillbirths and deaths to age 15. Data were drawn from various sources for seven regions embracing 129 developing countries. Mortality is an important loss in severely disadvantaged regions, especially in sub-Saharan Africa, but the abortion rates are lower there. This is reversed in the more advanced regions, where mortality is low but abortion rates are higher. Total losses numerically depend upon the rates in combination with the numbers of conceptions. The general 'efficiency' in moving from conception to a surviving child aged 15 was estimated. The abortion component of wastage has apparently not improved over time, but the mortality component has done so. Abortion rates are found to drive reproductive efficiency downwards; but efficiency is positively correlated with contraceptive use once abortion is controlled for. This implies that as efficiency is improved more couples gain confidence to turn to contraceptive use to avoid unplanned pregnancies and births. [ABSTRACT FROM AUTHOR]

Studies have focused on the effect of short birth spacing on childhood mortality, yet very little attention has been paid to the possibility of an inverse relationship such that child mortality might also positively or negatively affect birth spacing. In Nigeria, where both fertility and child mortality are high, this inverse relationship is a possible reason for the country's high fertility. The objective of this study was to examine the effect of child death on time to birth of the next child. Data were drawn from the 2013 Nigerian Demographic Health Survey. The study sample comprised 188,986 live births born to women aged 15-49 years within the five years preceding the survey. A multivariate Cox proportional hazard regression model was fitted to the data, and hazard ratios with 95% confidence intervals calculated. More than half of the mothers (68%) already had a next birth by 36 months after the death of the index child. Controlling for other covariates, the Cox regression model showed that the likelihood of next birth was higher when the index child had died compared with when the index child survived (HR: 2.21; CI: 2.03-2.41). Sub-group analysis by geo-political regions in Nigeria showed that in all regions there was a higher likelihood of having a next birth following the death of a preceding child. Death of the index child was found to be a major factor that shortens the length of birth intervals in Nigeria. It is therefore important that the Government of Nigeria intensifies efforts aimed at reducing infant mortality and encouraging adequate birth spacing. [ABSTRACT FROM AUTHOR]

Objective: Over half of pregnant women in India are affected by anaemia, which can lead to premature birth, low birth weight and maternal and child mortality. Using formative research, we aimed to understand social and cultural factors around iron and folic acid (IFA) supplement provision and adherence to identify potential strategies for improving adherence and behaviours to prevent and treat anaemia among pregnant and lactating Indian women.Design: In-depth interviews and focus group discussions with women and key informant interviews with health officials and workers.Setting: Four districts in two Indian states: Allahabad and Bara Banki districts in Uttar Pradesh and Chikkballapura and Mandya districts in Karnataka.Participants: Pregnant and lactating women (n 65) and district officials and community health workers (n 14).Results: Most women were aware of anaemia but did not understand its seriousness and consequences. All women received IFA supplements (predominantly for free), but many were not adherent because of side effects; lack of information from healthcare providers on the causes of anaemia, its seriousness and solutions and low social support. To address anaemia, women were most confident in their ability to prepare and eat healthier foods but lacked control over resources such as appropriate food availability.Conclusions: Based on the findings, we recommend multicomponent interventions to train healthcare providers, address systemic barriers and involve family members to support IFA supplement adherence and dietary changes. Future research will determine which strategies are most effective to reduce the burden of anaemia in India among pregnant and lactating women. [ABSTRACT FROM AUTHOR]

The societal integration of immigrants is a great concern in many of today's Western societies, and has been so for a long time. Whether we look at Europe in 2015 or the United States at the turn of the twentieth century, large flows of immigrants pose challenges to receiving societies. While much research has focused on the socioeconomic integration of immigrants there has been less interest in their demographic integration, even though this can tell us as much about the way immigrants fare in their new home country. In this article we study the disparities in infant and child mortality across nativity groups and generations, using new, high-density census data. In addition to describing differentials and trends in child mortality among 14 immigrant groups relative to the native-born white population of native parentage, we focus special attention on the association between child mortality, immigrant assimilation, and the community-level context of where immigrants lived. Our findings indicate substantial nativity differences in child mortality, but also that factors related to the societal integration of immigrants explains a substantial part of these differentials. Our results also point to the importance of spatial patterns and contextual variables in understanding nativity differentials in child mortality. [ABSTRACT FROM AUTHOR]

Objective: In the present study, we aimed to compare anthropometric indicators as predictors of mortality in a community-based setting.Design: We conducted a population-based longitudinal study nested in a cluster-randomized trial. We assessed weight, height and mid-upper arm circumference (MUAC) on children 12 months after the trial began and used the trial's annual census and monitoring visits to assess mortality over 2 years.Setting: Niger.Participants: Children aged 6-60 months during the study.Results: Of 1023 children included in the study at baseline, height-for-age Z-score, weight-for-age Z-score, weight-for-height Z-score and MUAC classified 777 (76·0 %), 630 (61·6 %), 131 (12·9 %) and eighty (7·8 %) children as moderately to severely malnourished, respectively. Over the 2-year study period, fifty-eight children (5·7 %) died. MUAC had the greatest AUC (0·68, 95 % CI 0·61, 0·75) and had the strongest association with mortality in this sample (hazard ratio = 2·21, 95 % CI 1·26, 3·89, P = 0·006).Conclusions: MUAC appears to be a better predictor of mortality than other anthropometric indicators in this community-based, high-malnutrition setting in Niger. [ABSTRACT FROM AUTHOR]

In Afghanistan, acute respiratory infection (ARI) is a leading cause of under-five mortality. Previous studies on the effects of cooking fuel on ARI have only looked at the types of cooking fuel, and not the effects of the location of the cooking place. The present study aimed to assess the effects of fuel type and place of cooking on the prevalence of ARI among under-five children in Afghanistan. Descriptive statistics and multilevel logistic regression analysis were performed for 31,063 children using data from the first round of the Afghanistan Demographic and Health Survey conducted in 2015. Overall, 13% of the children suffered from ARI symptoms in the 2 weeks before the survey, but this varied widely across the country. The multilevel analysis showed that, compared with households using clean cooking fuel in a separate building or outside, households using clean cooking fuel within the house and without a separate kitchen had a 32% lower risk [95% confidence interval (CI)=0.51-0.91] of having under-five children with ARI, and those using clean fuel in a separate kitchen in the house had a 17% lower risk (95% CI=0.67-1.03). On the other hand, households using polluting cooking fuel in the house without a kitchen had a 14% (95% CI=0.91-1.44) higher risk of having under-five children with ARI, and those using polluting cooking fuel in the house with a separate kitchen had a 5% (95% CI=0.85-1.30) higher risk, after adjusting for other covariates. The findings indicate that type of cooking fuel is not the only issue affecting ARI in children. Place of cooking (in a house with or without a separate kitchen versus outside) also affects the risk of ARI among under-five children. The study also found that mother's education and occupational status, community poverty and ethnicity are other important factors affecting the prevalence of ARI in under-five children in Afghanistan. [ABSTRACT FROM AUTHOR]

Despite an overall downward trend in child sex ratios in India, some of the most imbalanced districts in 2001 (fewer girls than boys) showed signs of becoming more balanced in 2011. This analysis looked in depth at these districts to better understand the nature of the improvement in the child sex ratio using two rounds of data from the Census of India from 2001 and 2011. Data were used from the 153 districts that showed improvement in their child sex ratio between 2001 and 2011. The improvement was decomposed into: (1) less sex-selective abortion and (2) improved girl compared with boy mortality. Most of the improvement in child sex ratios were shown to be due to reductions in sex-selective abortion, although this still made up the majority of the cause of imbalanced sex ratios in 2011. Child sex ratio improvement has been happening in both rural and urban areas of India, and there is evidence of stagnation in mortality decline for urban girls. [ABSTRACT FROM AUTHOR]

Research on twinning in developed countries is well documented, but little is known about twinning in less-developed countries due to a lack of data or data limitations. This study examined the level of, trends in and determinants of twin births and their survival under age five in Jordan, using the 2012 Jordan Population and Family Health Survey (JPFHS) data. The birth history of 11,352 women included in the JPFHS provided information on 9859 live births that occurred within five years of the survey date, and these constituted the study subjects. Descriptive statistics, and bivariate and multivariate multilevel logistic regression models were used for data analysis. About 3.5% of the total live births were twins, which is one of the highest rates in developing countries. The twinning rate showed an increasing trend in Jordan, increasing by 45% from 2.4% in 1990 to 3.5% in 2012. Higher maternal age at child birth, higher parity, poor and richer economic status, contraceptive use status, secondary and above level of education of mothers and non-consanguinity were found to be associated with a higher rate of twin births in Jordan. Twins were observed to have a higher risk of low birth weight, being smaller in physical size at birth and at more than four times higher risk of neonatal death compared with singletons. To reduce the risk adverse outcomes of twin pregnancies and further improve maternal and child health, antenatal, delivery and postnatal care should be tailored towards the special needs of twin pregnancies and twin births in Jordan Twin pregnancies should be detected at the early stage of pregnancy so that perinatal outcomes can be improved by frequent prenatal visits, health education, counselling and proper management of peripartum complications. [ABSTRACT FROM AUTHOR]

Acute respiratory infection (ARI) is a major cause of mortality among children under the age of five in developing countries. This paper examines Demographic and Health Survey (DHS) data on maternal recall of episodes of ARI in the contrasting settings of Bangladesh and Nigeria, where about 11.1% and 3.3% of under-5 children, respectively, are reported to have symptoms of ARI. The surveys found that about 25.6% of married Bangladeshi women and 15.4% of married Nigerian women reported experiencing spousal violence in the past year. To test the proposition that women's experience of intimate partner violence (IPV) is associated with adversity in their children, the study examined the relationship between spousal violence in the past year and childhood ARI in the past 2 weeks among children under the age of five in Bangladesh and Nigeria. Data were taken from a nationally representative sample of mothers aged 15-49 years obtained from the 2007 Bangladesh DHS and 2008 Nigeria DHS. Random-effects multiple logistic regression models were estimated to assess the association of maternal exposure to IPV with the incidence of ARI in the past 2 weeks among under-5 children after controlling for the potentially confounding effects of maternal social and demographic characteristics. Results from Nigeria suggest that the odds of ARI incidence among children of mothers who were IPV victims were almost two times higher than among their counterparts whose mothers had not experienced IPV (OR = 1.78; 95% CI: 1.45-2.19; p <0.001). Similarly, the odds for the children of Bangladeshi IPV victims were elevated one and half times (OR = 1.61; 95% CI: 1.21-2.14; p <0.001). The findings suggest that under-5 children suffer indirect health consequences of gender-based violence. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether children with concurrent wasting and stunting require therapeutic feeding and to better understand whether multiple diagnostic criteria are needed to identify children with a high risk of death and in need of treatment.Design: Community-based cohort study, following 5751 children through time. Each child was visited up to four times at 6-month intervals. Anthropometric measurements were taken at each visit. Survival was monitored using a demographic surveillance system operating in the study villages.Setting: Niakhar, a rural area of the Fatick region of central Senegal.ParticipantsChildren aged 6-59 months living in thirty villages in the study area.Results: Weight-for-age Z-score (WAZ) and mid-upper arm circumference (MUAC) were independently associated with near-term mortality. The lowest WAZ threshold that, in combination with MUAC, detected all deaths associated with severe wasting or concurrent wasting and stunting was WAZ <-2·8. Performance for detecting deaths was best when only WAZ and MUAC were used. Additional criteria did not improve performance. Risk ratios for near-term death in children identified using WAZ and MUAC suggest that children identified by WAZ <-2·8 but with MUAC≥115 mm may require lower-intensity treatment than children identified using MUAC <115 mm.Conclusions: A combination of MUAC and WAZ detected all near-term deaths associated with severe anthropometric deficits including concurrent wasting and stunting. Therapeutic feeding programmes may achieve higher impact if WAZ and MUAC admission criteria are used. [ABSTRACT FROM AUTHOR]

Objective: To assess trends of mortality attributable to child and maternal undernutrition (CMU), overweight/obesity and dietary risks of non-communicable diseases (NCD) in sub-Saharan Africa (SSA) using data from the Global Burden of Disease (GBD) Study 2015.Design: For each risk factor, a systematic review of data was used to compute the exposure level and the effect size. A Bayesian hierarchical meta-regression analysis was used to estimate the exposure level of the risk factors by age, sex, geography and year. The burden of all-cause mortality attributable to CMU, fourteen dietary risk factors (eight diets, five nutrients and fibre intake) and overweight/obesity was estimated.Setting: Sub-Saharan Africa.ParticipantsAll age groups and both sexes.Results: In 2015, CMU, overweight/obesity and dietary risks of NCD accounted for 826204 (95 % uncertainty interval (UI) 737346, 923789), 266768 (95 % UI 189051, 353096) and 558578 (95 % UI 453433, 680197) deaths, respectively, representing 10·3 % (95 % UI 9·1, 11·6 %), 3·3 % (95 % UI 2·4, 4·4 %) and 7·0 % (95 % UI 5·8, 8·3 %) of all-cause mortality. While the age-standardized proportion of all-cause mortality accounted for by CMU decreased by 55·2 % between 1990 and 2015 in SSA, it increased by 63·3 and 17·2 % for overweight/obesity and dietary risks of NCD, respectively.Conclusions: The increasing burden of diet- and obesity-related diseases and the reduction of mortality attributable to CMU indicate that SSA is undergoing a rapid nutritional transition. To tackle the impact in SSA, interventions and international development agendas should also target dietary risks associated with NCD and overweight/obesity. [ABSTRACT FROM AUTHOR]

There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women's education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner's education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women's education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner's education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over-generalization of the association between women's education and maternal health service utilization can be misleading. Efforts to improve maternal health service utilization in Africa must adopt an 'equity' approach, taking into account the specific needs of sub-populations. [ABSTRACT FROM AUTHOR]

Objective: To assess ethnicity- and age-modified associations between mid-upper arm circumference (MUAC) and mortality in Nepalese children and whether sociodemographic factors explain these associations.Design: Secondary data analysis of children followed until 3 years of age. Estimated mortality hazard ratios (HR) for MUAC<11·5cm (recommended cut-off for identifying severe acute malnutrition among children ≥6 months old) compared with ≥11·5cm in younger (<6 months) and older children (≥6 months) of Pahadi and Madhesi ethnicity, adjusting for sex, socio-economic status (SES) and mother's education using Cox proportional hazard models.Setting: Sarlahi, Nepal (21 October 2001-2 February 2006).Subjects: Children (n 48 492) enrolled in the Nepal Nutrition Intervention Project, Sarlahi-4.Results: Among children aged ≥6 months, MUAC<11·5 cm was associated with increased risk of mortality in both Pahadis (HR=4·01; 95 % CI 1·42, 11·76) and Madhesis (HR=5·60; 95 % CI 3·87, 8·11) compared with those with MUAC≥11·5 cm, after adjusting for sex, SES and maternal literacy. Among children <6 months old, MUAC<11·5 cm was not associated with mortality in Pahadis with (HR=1·12; 95 % CI 0·72, 1·73) or without adjusting (HR=1·17; 95 % CI 0·75, 1·18) as compared with Madeshis (adjusted HR=1·76; 95 % CI 1·35, 2·28).Conclusions: Among older children, MUAC<11·5 cm is associated with subsequent mortality in both ethnicities regardless of other characteristics. However, among children aged <6 months, it predicted mortality only among Madhesis, while sociodemographic factors were more strongly associated with mortality than MUAC<11·5cm among Pahadis. [ABSTRACT FROM AUTHOR]

Objective: Despite progress, levels of malnutrition among children in Bangladesh are among the highest in the world and this is one of the major causes of death in children. The pace of reduction in the prevalence of undernutrition among children is still relatively low. The present study aimed to examine the association between parental education and childhood undernutrition among Bangladeshi children under 5 years of age when adjusting for potential risk factors.Design: The data set was extracted from a nationally representative survey based on a cross-sectional study, the Bangladesh Demographic and Health Survey (BDHS) 2014.Setting: The base survey was conducted using a two-stage stratified sample of households. In the first stage, 600 enumeration areas (EA) were selected with probability proportional to EA size (207 EA from urban areas, 393 EA from rural areas).Subjects: A total of 7173 children under 5 years from 17 863 households were considered for the analysis. A modified Poisson regression model was implemented to the data for assessing the relationship between parental education and childhood undernutrition when demographic and socio-economic covariates for the child, parents, households and clustering were adjusted.Results: Higher parental education level was associated with lower levels of stunting and underweight, but not with wasting. Maternal and paternal education were both significantly associated with the reduction in prevalence of childhood undernutrition in Bangladesh.Conclusions: Paternal education appears equally as important as maternal education in reducing undernutrition prevalence among children under 5 years in Bangladesh. [ABSTRACT FROM AUTHOR]

This study examined the effect of reproductive and child health (RCH) services on fertility and child mortality in the districts of Uttar Pradesh. It specifically measured the effect of antenatal care, medical assistance at birth, child immunization and use of modern methods of contraception on Total Fertility Rate (TFR), Infant Mortality Rate (IMR) and Under-five Morality Rate (U5MR) before and after the National Rural Health Mission (NRHM) period. Data from the 2002–04 District Level Household Survey (DLHS-2), 2012–13 Annual Health Survey (AHS) and the 2001 and 2011 Censuses of India were used. The TFR and U5MR were estimated from the Census of India with district as the unit of analysis. Descriptive statistics, composite indices, random- and fixed-effects models and difference-in-difference models were used to understand the effect of RCH services on the reduction in TFR, IMR and the U5MR. The results suggest large inter-district variations in the coverage of RCH services in the state. During the post-NRHM period, improvement was highest in safe delivery followed by immunization coverage and antenatal care and least for contraceptive use in most districts. The relative ranking of districts has not changed much over time. In 2002–04, the RCH Index was highest in Lucknow (0.442) followed by Ballia and least in Kaushambi (0.115). By 2012–13, it was highest in Jhansi (0.741) and lowest in Shrawasti (0.241). The districts of Kaushambi, Unnao, Mahoba, Banda and Hardoi performed better in the RCH Index over time, while Ballia, Gautam Buddha Nagar, Kanpur Nagar, Pratapgarh and Sonbhadra remained poor. The RCH service coverage and demographic outcomes were poor in seven districts, particularly those in eastern and western Uttar Pradesh. The regression analyses suggest that the RCH Index exerts greater influence on the reduction in IMR and U5MR, while female literacy exerts greater influence on the reduction in TFR. The results of the hybrid model suggest that a 10% change in RCH Index would lead to a 3 point decline in IMR, and a 10% increase in female literacy would lead to a 0.2 point decline in TFR. The study suggests continuing investment in female education and RCH services with a greater focus on poor-performing districts to realize demographic and health targets. [ABSTRACT FROM PUBLISHER]

Under-five mortality remains a major public health challenge in sub-Saharan Africa. Zimbabwe is one of the countries in the region that failed to achieve Millennium Developmental Goal 4 in 2015. The objective of this study was to examine the extent to which maternal health-seeking behaviour prior to and during pregnancy and post-delivery influences the likelihood of under-five mortality among Zimbabwean children. The study was cross-sectional and data were extracted from the 2010/11 Zimbabwe Demographic and Health Survey (ZDHS). The study sample comprised 5155 children who were born five years preceding the 2010/11 ZDHS to a sample of 4128 women of reproductive age (15–49 years). Cox Proportional Hazard regression modelling was used to examine the relationship between maternal health-seeking behaviour and under-five mortality. The results showed that maternal health-seeking behaviour factors are associated with the risk of dying during childhood. Children born to mothers who had ever used contraceptives (HR: 0.38, CI 0.28–0.51) had a lower risk of dying during childhood compared with children born to mothers who had never used any contraceptive method. The risk of under-five mortality among children who had a postnatal check-up within two months after birth (HR: 0.36, CI 0.23–0.56) was lower than that of children who did not receive postnatal care. Small birth size (HR: 1.70, CI 1.20–2.41) and higher birth order (2+) increased the risk of under-five mortality. Good maternal health-seeking behaviour practices at the three critical stages around childbirth have the potential to reduce under-five mortality. Therefore, public health programmes should focus on influencing health-seeking behaviour among women and removing obstacles to effective maternal health-seeking behaviour in Zimbabwe. [ABSTRACT FROM PUBLISHER]

Since 2001 a decentralization policy has increased the responsibility placed on local government for improving child health in Indonesia. This paper explores local government and community leaders’ perspectives on child health in a rural district in Indonesia, using a qualitative approach. Focus group discussions were held in May 2013. The issues probed relate to health personnel skills and motivation, service availability, the influence of traditional beliefs, and health care and gender inequity. The participants identify weak leadership, inefficient health management and inadequate child health budgets as important issues. The lack of health staff in rural areas is seen as the reason for promoting the use of traditional birth attendants. Midwifery graduates and village midwives are perceived as lacking motivation to work in rural areas. Some local traditions are seen as detrimental to child health. Husbands provide little support to their wives. These results highlight the need for a harmonization and alignment of the efforts of local government agencies and local community leaders to address child health care and gender inequity issues. [ABSTRACT FROM PUBLISHER]

Objective: To compare the performance of mid-upper arm circumference (MUAC) against weight-for-height Z-score (WHZ) for predicting inpatient deaths in children under 5 years of age.Design: Diagnostic test accuracy study.Setting: Paediatric emergency department of a tertiary care hospital catering to semi-urban and rural population in Delhi, India.Subjects: Hospitalized children (n 1663) aged 6 months to 5 years, for whom discharge outcome was available, were consecutively recruited over 14 months. MUAC (cm), weight (kg) height (cm), clinical details and the outcome were recorded. MUAC (index test) was compared with WHZ based on the WHO growth standards (reference test) for predicting the outcome.Results: One hundred and twenty-four (7 %) children died during hospital stay. Both MUAC < 11·5 cm (adjusted OR (95 % CI): 3·7 (2·43, 5·60), P<0·001) and WHZ<-3 (2·0 (1·37, 2·99), P<0·001) served as independent predictors of inpatient mortality. However, MUAC was a significantly better predictor of mortality compared with WHZ in terms of area under the receiver-operating characteristic curve (MUAC=0·698, WHZ=0·541, P<0·001). MUAC<11·5 cm had the best trade-off of sensitivity and specificity for predicting inpatient mortality. A combination of WHZ<-3 and/or MUAC<11·5 cm did not significantly improve the predictive value over that of MUAC/WHZ, assessed individually.Conclusion: MUAC<11·5 cm is a better predictor of mortality in hospitalized under-5 children, as compared with WHZ<-3. It should be measured in all emergency settings to identify the children at higher risk of death. [ABSTRACT FROM AUTHOR]

Objective: The present study was performed to describe the operational implications of using mid-upper arm circumference (MUAC) as a single admission criterion for treatment of severe acute malnutrition in South Sudan.Design: We performed a retrospective analysis of routine programme data of children with severe acute malnutrition aged 6-59 months admitted to a therapeutic feeding programme using weight-for-height Z-score (WHZ) and/or MUAC. To understand the implications of using MUAC as a single admission criterion, we compared patient characteristics and treatment outcomes for children admitted with MUAC<115 mm (irrespective of WHZ) v. children admitted with WHZ<-3 and MUAC≥115 mm.Results: Of 2205 children included for analysis, 719 (32·6 %) were admitted to the programme with MUAC<115 mm and 1486 (67·4 %) with WHZ<-3 and MUAC≥115 mm. Children who would have been admitted using a single MUAC<115 mm criterion were more severely malnourished and more likely to be female and younger. Compared with children admitted with WHZ<-3 and MUAC≥115 mm, children who would have been admitted using MUAC<115 mm were less likely to recover (54 % v. 69 %) and had higher risk of death (4 % v. 1 %), but responded to treatment with greater weight and MUAC gains. MUAC<115 mm would have failed to identify 33 % of deaths, while 98 % were identified by WHZ<-3 alone and 100 % by MUAC<130 mm.Conclusions: The study shows that MUAC<115 mm identified more severely malnourished children with a higher risk of mortality but failed to identify a third of the children who died. Admission criteria for therapeutic feeding should be adapted to the programmatic context with consideration for both operational and public health implications. [ABSTRACT FROM AUTHOR]

Analyses of historical or modern populations indicate a strong relationship between mortality level and standard of living, measured, among other factors, by degree of urbanization. The aim of this study was to assess mortality rates in children of up to 5 years of age in two populations living under different conditions in central modern Poland at the end of the 19th century: the rural parish of Kowal, under Russian partition, and Toruń, an industrial and urbanized centre under Prussian partition. Data on births and deaths were taken from birth certificate registries and from the Prussian statistics yearbooks for 1876–1894. Death rates of children aged 0–5 years were calculated, and also for annual age ranges. The urban population had lower birth rates (37.19‰), natural increase rates (8.0‰), population dynamics rates (1.26‰), which provide information about the relation between two components of a natural increase, i.e. births and deaths, and an over-mortality of boys in relation to girls. In the rural population these values were all higher: 53.67‰, 18.11‰ and 1.59‰ respectively. No impact was found of social stratification on child mortality in the wide age group of 0–5 years. However, for subsequent one-year age groups significant relationships between mortality level and size and industrialization level of the population centres were noted. The living conditions of infants in Toruń, although being in a better position as an area annexed by Prussia, were markedly worse than those of rural Kowal Parish. In the urban centre infant mortality was slightly over 269 for 1000 live born, and in Kowal Parish it was 163 for 1000 live born. The high infant mortality was balanced in Toruń by the higher mortality levels of children aged 2–5 years compared with Kowal Parish. Natural selection in the city had the greatest impact on infants, who did not have the protective influence of breast-feeding because women had to return to work shortly after giving birth. The lower infant mortality of mothers in the countryside due to longer breast-feeding led to larger family sizes. In 1871–1890 in the villages the number of children per women was about 7.42, whereas in Toruń it ranged from 4.4 to 5.2. The probability of death among children who survived the first year of life was higher in the countryside than the town. In the rural parish, perhaps because of cultural factors such as breast-feeding or working practices making full-time baby-sitting possible, children who did not reach the age of 1 year were not subjected to such intensive natural selection. Overall, differences in child mortality in the two centres in 19th central Poland resulted from ecological and cultural conditions, rather than from social and economical reasons (living under different partitions). [ABSTRACT FROM AUTHOR]

There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p<0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p<0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria. [ABSTRACT FROM PUBLISHER]

Identification of modifiable factors and mediators linked to low and heavy birth weight is crucial in reducing infant mortality and health care expenditure. The present paper explores the associations of socio-demographic factors and immigrant status of parents with adverse pregnancy outcomes in Hong Kong. The analysis compares very low birth weight (VLBW: <1500 g), low birth weight (LBW: ≥1500 g and <2500 g) and heavy birth weight births (HBW: ≥4500 g) with births of normal weight (≥2500 g and <4500 g) using multinomial regression modelling of a large dataset of 828,975 births of singletons occurring between 1995 and 2009. The findings indicate the expected significant adverse associations between teenage and advanced age of the mother with compromised birth outcomes; teenage motherhood, however, has a protective effect against HBW births. A strong socioeconomic gradient is apparent, more marked among LBW births; low educational attainment of the father, low occupational class, public housing and single motherhood are strongly related to adverse pregnancy outcomes. Regarding immigrant status, women born in South and South-East Asia exhibit consistently higher odds of a compromised outcome. Women born in Hong Kong have significantly higher chances of LBW births while Mainland Chinese and parents from developed countries face higher odds of HBW births. The study identifies high-risk groups such as teenage, older and single mothers, South-East Asians and couples of low socioeconomic profile. Implementation of policies supporting these groups would be beneficial. [ABSTRACT FROM PUBLISHER]

As a leading indicator of child health, under-five mortality was incorporated in the United Nations Millennium Development Goals with the aim of reducing the rate by two-thirds between 1990 and 2015. Under-five mortality in Nigeria is alarmingly high, and many of the diseases that result in mortality are vaccine preventable. This study evaluates the uptake of childhood immunization in Nigeria from 1990 to 2008. A multi-year trend analysis was carried out using Alternating Logistic Regression on 46,130 children nested within 17,380 mothers in 1938 communities from the Nigerian Demographic and Health Surveys from 1990 to 2008. The findings reveal that mother-level and community-level variability are significantly associated with immunization uptake in Nigeria. The model also indicates that children delivered at private hospitals have a higher chance of being immunized than children who are delivered at home. Children from the poorest families (who are more likely to be delivered at home) have a lower chance of being immunized than those from the richest families (OR=0.712; 95% CI, 0.641–0.792). Similarly, the chance of children with a mother with no education being immunized is decreased by 17% compared with children whose mother has at least a primary education. In the same way, children of mothers who are gainfully employed and those of older mothers have statistically significantly higher odds of being immunized. Children of households with a female head are less likely to be immunized than those from male-headed households. The statistical significance of the community–survey year interaction term suggests an increase in the odds of a child being immunized over the years and spread over communities. Evidence-based policy should lay more emphasis on mother- and community-level risk factors in order to increase immunization coverage among Nigerian children. [ABSTRACT FROM PUBLISHER]

The majority of studies of the birth spacing–child survival relationship rely on retrospective data, which are vulnerable to errors that might bias results. The relationship is re-assessed using prospective data on 13,502 children born in two Nairobi slums between 2003 and 2009. Nearly 48% were first births. Among the remainder, short preceding intervals are common: 20% of second and higher order births were delivered within 24 months of an elder sibling, including 9% with a very short preceding interval of less than 18 months. After adjustment for potential confounders, the length of the preceding birth interval is a major determinant of infant and early childhood mortality. In infancy, a preceding birth interval of less than 18 months is associated with a two-fold increase in mortality risks (compared with lengthened intervals of 36 months or longer), while an interval of 18–23 months is associated with an increase of 18%. During the early childhood period, children born within 18 months of an elder sibling are more than twice as likely to die as those born after an interval of 36 months or more. Only 592 children experienced the birth of a younger sibling within 20 months; their second-year mortality was about twice as high as that of other children. These results support the findings based on retrospective data. [ABSTRACT FROM AUTHOR]

The influence of religion on health remains a subject of considerable debate both in developed and developing settings. This study examines the connection between the religious affiliation of the mother and under-five mortality in Mozambique. It uses unique retrospective survey data collected in a predominantly Christian area in Mozambique to compare under-five mortality between children of women affiliated to organized religion and children of non-affiliated women. It finds that mother's affiliation to any religious organization, as compared with non-affiliation, has a significant positive effect on child survival net of education and other socio-demographic factors. When the effects of affiliation to specific denominational groups are examined, only affiliation to the Catholic or mainstream Protestant churches and affiliation to Apostolic churches are significantly associated with improved child survival. It is argued that the advantages of these groups may be achieved through different mechanisms: the favourable effect on child survival of having mothers affiliated to the Catholic or mainstream Protestant churches is probably due to these churches' stronger connections to the health sector, while the beneficial effect of having an Apostolic mother is probably related to strong social ties and mutual support in Apostolic congregations. The findings thus shed light on multiple pathways through which organized religion can affect child health and survival in sub-Saharan Africa and similar developing settings. [ABSTRACT FROM AUTHOR]

BackgroundThere is compelling evidence that children of mothers with postnatal depression (PD) experience poor developmental outcomes. However, no studies have specifically ascertained the risk of mortality for offspring during preschool years, the most catastrophic outcome in the vulnerable period. This nationwide population-based study aimed to investigate whether maternal depression in the first year after giving birth was associated with increased mortality risk among their preschool children aged up to 5 years.MethodThree nationwide population-based datasets [the National Health Insurance Research Database (NHIRD), birth certificate registry and death certificate registry] were linked in this study. A total of 10 236 offspring of mothers with PD were recruited, together with a comparison cohort of 81 888 births matched with the affected women in terms of maternal age and year of delivery. Each child was traced for 5 years from delivery between 2001 and 2003 until the end of 2008 to determine mortality during preschool years.ResultsDuring preschool years, 98 (0.96%) deaths were identified among the offspring of mothers with PD and 470 (0.57%) children in the comparison cohort died. For children up to 5 years old, exposure to maternal PD was independently associated with a 1.47-fold [95% confidence interval (CI) 1.16–1.87] increased mortality risk, after adjusting for family income, urbanization level and the characteristics of mother, father and infant. The risk of death by unnatural causes was even higher (about 2.23 times the risk, 95% CI 1.34–3.70) among exposed offspring.ConclusionsPD places preschool children at significantly increased risk of mortality, especially from unnatural causes of death. [ABSTRACT FROM PUBLISHER]

Now that racism has been officially recognized in Brazil, and some universities have adopted affirmative-action admission policies, measures of the magnitude of racial inequality and analyses that identify the factors associated with changes in racial disparities over time assume particular relevance to the conduct of public debate. This study uses census data from 1950 to 2000 to estimate the probability of death in the early years of life, a robust indicator of the standard of living among the white and Afro-Brazilian populations. Associated estimates of the average number of years of life expectancy at birth show that the 6.6-year advantage that the white population enjoyed in the 1950s remained virtually unchanged throughout the second half of the twentieth century, despite the significant improvements that accrued to both racial groups. The application of multivariate techniques to samples selected from the 1960, 1980, and 2000 census enumerations further shows that, controlling for key determinants of child survival, the white mortality advantage persisted and even increased somewhat in 2000. The article discusses evidence of continued racial inequality during an era of deep transformation in social structure, with reference to the challenges of skin color classification in a multiracial society and the evolution of debates about color, class, and discrimination in Brazil. [ABSTRACT FROM AUTHOR]