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Under-five-child mortality remains a major challenge for governments in the Arab world to achieve Sustainable Development Goals. Thus, further studies are needed to analyze the determinants of child mortality. The Multiple Indicators Cluster Surveys (MICS) datasets of six Arab countries (Algeria, Egypt, Iraq, Mauritania, Sudan, and Tunisia) have been used, which are consisting of 249.000 children nested within 54.644 mothers. The study was designed in a women-parity-covered one to six birth order. Binary multivariable logistic models were used to estimate the risk ratios of death by adjusting for child sex, birth outcome (twin vs. singleton), mother's education level, maternal age, previous birth interval, place of residence (rural vs. urban), and the family wealth index. The findings revealed that the under-five child mortality rates were 87, 70,66,35,36, and 21 per 1000 live births in Sudan, Mauritania, Egypt, Iraq, Algeria, and Tunisia, respectively). First-born infants in these six countries have a higher risk of mortality during their five years of life. Second, third-and fourth-born infants were at a decreased risk of death compared to first-born infants in all countries; in contrast, fifth-and-sixth-born infants were at an increased risk in all countries except Sudan and Mauritania. Twin children have a higher risk of death than singletons in all countries and across all birth orders. Children of mothers with higher educational levels living in urban areas are at lower risk of death than their peers across all birth orders. Regarding policy implications, decision-makers can target three main axes: first, enhancing women's educational levels; second, increasing birth intervals (birth spacing policies); and third, improving living standards and healthcare strategies, especially in rural areas to improve child and mother health. [ABSTRACT FROM AUTHOR]

The child mortality rate is an essential measurement of socioeconomic growth and the quality of life in Ethiopia which is one among the six countries that account for half of the global under-five deaths. Therefore, this study aimed to identify the potential risk factors for child mortality in Ethiopia. Data for the study was drawn from the Ethiopian Demographic and Health Survey data conducted in 2016. A two-part random effects regression model was employed to identify the associated predictors of child mortality. The study found that 53.3% of mothers did not face any child death, while 46.7% lost at least one. Vaccinated child (IRR = 0.735, 95%CI: 0.647, 0.834), were currently using contraceptive (IRR = 0.885, 95%CI: 0.814, 0.962), who had antenatal care visit four or more times visit (IRR = 0.841, 95%CI: 0.737,0.960), fathers whose level of education is secondary or above(IRR = 0.695, 95%CI: 0.594, 0.814), mothers who completed their primary school(IRR = 0.785, 95%CI: 0.713, 0.864), mothers who have birth interval greater than 36 months (IRR = 0.728, 95%CI: 0.676, 0.783), where the age of the mother at first birth is greater than 16 years(IRR = 0.711, 95%CI: 0.674, 0.750) associated with the small number of child death. While multiple births (IRR = 1.355, 95%CI: 1.249, 1.471, four and above birth order (IRR = 1.487, 95%CI: 1.373, 1.612) and had working father (IRR = 1.125, 95%CI: 1.049, 1.206) associated with a higher number of child death. The variance components for the random effects showed significant variation of child mortality between enumeration areas. Policies and programs aimed at addressing enumeration area variations in child mortality need to be formulated and their implementation must be strongly pursued. Efforts are also needed to extend educational programmers aimed at educating mothers on the benefits of the antenatal checkup before first birth, spacing their birth interval, having their child vaccinated, and selecting a safe place of delivery to reduce child mortality. [ABSTRACT FROM AUTHOR]

Background: Exclusive Breast Feeding is one of the most cost effective and simple ways to ensure child health and survival and is the single most instrumental intervention that leads to decreased child mortality and morbidity. This study was done to determine the frequency of exclusive breast feeding among mothers in rural Rawalpindi and to determine the frequency of factors affecting exclusive breast feeding among mothers in rural Rawalpindi. Methods: It was a descriptive cross- sectional study, conducted in 6 months in Union Council Mandra, from November 2014 to April 2015. A sample size of 245was selected through non-probability consecutive sampling. Data was collected on a structured questionnaire from mothers visiting the RHC Mandra facility after taking informed consent. Data was analyzed in the statistical software SPSS 10. Conclusion: Health education by health professionals during antenatal period to initiate and maintain exclusive breast feeding should be strengthened by focusing more on the nutritional aspects of the newborn babies and its benefits in the later life. Results: The frequency of Exclusive Breast Feeding (EBF) determined in the study was 52.2%. 29% mothers had primary level education, 52.7% had deliveries in the public hospitals and 46.5% were house wives. The birth order, age of the child, number of antenatal visits, birth wt. and mode of delivery (p<0.05) were significantly associated with EBF. The association of mother's and father's education level, monthly income, birth interval and mother's occupation with EBF were not statistically significant (p>0.05). Conclusion: Health education by health professionals during antenatal period to initiate and maintain exclusive breast feeding should be strengthened by focusing more on the nutritional aspects of the newborn babies and its benefits in the later life. [ABSTRACT FROM AUTHOR]

Background. Though Ethiopia has made impressive progress in reducing child mortality in the past two decades, the reduction of under-five mortalities is a major concern for the Sustainable Development Goals (SDGs) introduced in 2016 targeted to reduce under-5 mortality rate below 25 deaths of under-5 per 1,000 live births by 2030. This study aims to assess the risk factors attributed to under-five mortalities in Ethiopia region based on Ethiopian Demographic Health Survey 2016 dataset. Methods. The study was a secondary analysis of 2016, Ethiopian Demographic Health Survey and the information collected from 10,274 children born five years preceding the survey was considered in the study, and variables like maternal social and demographic characteristics, child demographic characteristics, and cultural and environmental factors were considered as determinants of under-five deaths. The study used descriptive statistics and logistic regression model to explore significant risk factors accredited to under-five deaths in Ethiopia. Results. Maternal education attainment, women age at first birth, women current age, child birth order, preceding birth interval, birth type, and occupation of mother were found significant predictors of under-five mortalities. Being born to mother with no education (OR=2.610, 95% CI: 1.598, 4.265), short birth spacing 1 to 18 months birth intervals (OR=2.164, 95% CI: 1.821, 2.570), birth order of five and above, and 11 to 17 years ages at birth (OR=1.556, 95% CI: 1.243, 1.949) were factors significantly associated with increased risk of under-five mortalities. Conclusion. The magnitude of under-five deaths in the study area was decreasing. However, under-five mortality rates have stayed higher in some regions. Therefore, interventions that focus on birth spacing, mothers living in Affar and Gambela, and uneducated mothers are required for improving child survival in Ethiopia. [ABSTRACT FROM AUTHOR]

There is still considerable uncertainty about how reproductive factors affect child mortality. This study, based on Demographic and Health Survey data from 28 countries in sub-Saharan Africa, shows that mortality is highest for firstborn children with very young mothers. Other children with young mothers, or of high birth order, also experience high mortality. Net of maternal age and birth order, a short preceding birth interval is associated with above average mortality. These patterns change, however, if time-invariant unobserved mother-level characteristics of importance for both mortality and fertility are controlled for in a multilevel-multiprocess model. Most importantly, there are smaller advantages associated with longer birth intervals and being older at first birth. The implications of alternative reproductive 'strategies' are discussed, taking into account that if the mother is older at birth, the child will also be born in a later calendar year, when mortality may be lower [ABSTRACT FROM AUTHOR]

Objectives Pakistan is one of five nations contributing to half of the world's child mortality and holds under-five mortality rates which are nearly double global targets. Reasons for this shortfall include civil conflicts, political uncertainty, low education, poverty, rural-urban disparities, and limited health care access. The aim of this study was to explore associations between individual characteristics, community factors, and child mortality in Pakistan. Methods Data were derived from the 2012 to 2013 Pakistan Demographic and Health Survey, and included 7399 live births and 380 child deaths. Multivariate, multilevel logistic regression was used to model risk of neonatal, infant and under-five child deaths. Results Seventy-one percent of child deaths occurred during the neonatal period. Significant factors ( p < 0.05) associated with lower odds of child mortality included adhering to recommended minimum of 24 months interpregnancy interval and higher household wealth. These were significant for neonatal (OR 0.448; 0.871), infancy (OR 0.465; 0.881), and under-five deaths (OR 0.465; 0.879). Employed mothers had higher odds of neonatal (OR 1.479), infant (OR 1.506), and child mortality (OR 1.459). Likewise, women living in consanguineous marriages had higher odds of infant (OR 1.454) and under-five deaths (OR 1.381). Children in Balochistan, Punjab, and Sindh, regions disproportionately poor, rural with low levels of education, were at highest risk of dying. Conclusions for Practice Findings may assist in designing targeted interventions, developing appropriate public health messaging, and implementing policies designed to lower child mortality. Focusing on lowering rates of maternal poverty, increasing opportunities for education, and improving access to health care could assist in reducing child mortality in Pakistan. [ABSTRACT FROM AUTHOR]

Background: This study used data from recent Demographic and Health Surveys (DHS) to examine the impact of short or long preceding birth intervals on neonatal and under-five mortality. In order to minimize the effect of selection issues, we examined child mortality outcomes of the same mother, comparing short or long interval births against births with what had previously been considered optimal intervals. Methods: We analyzed 47 DHS datasets from low- and middle-income countries. For each dataset, we compared neonatal and under-five mortality of short preceding interval births (<18 months, <24 months) to reference interval births (24-<60 months) of a mother, using conditional logistic regression matching on the mother. We also conducted the same matched analysis for long (⩾60 months, ⩾72 months) preceding interval births. These associations were then meta-analyzed. We also stratified the analyses by mothers' completed fertility (fertility at end of reproductive period) to assess whether maternal characteristics highly correlated with completed fertility modify the association between birth interval and child mortality. Results: Children with shorter preceding intervals had increased odds of both neonatal (<24 months, OR: 1.61, 95% CI: 1.52-1.70) and under-five mortality (<24 months, OR: 1.48, 95% CI: 1.40-1.56). When the associations were stratified by the mothers' completed fertility, the impact of short intervals was greatly reduced or eliminated for low fertility mothers. In contrast, mortality associations became stronger for children of high fertility mothers. However, when the births of high fertility mothers were limited to birth orders 2-4, the associations were comparable to those of low fertility mothers. Longer preceding birth intervals had lower odds of mortality than reference intervals (i.e. under-5 mortality for ⩾60 months, OR 0.59, 95% CI: 0.52-0.67). This effect was also mediated by mothers' completed fertility; there was a strong protective effect of longer birth intervals for the high fertility mothers but not for low fertility mothers. Conclusions: These analyses reproduced findings reported in previous literature that shorter birth intervals are associated with higher child mortality. However the negative impact of short birth intervals may only occur in high parity births. Reproductive health interventions that seek to lengthen birth intervals may have larger impact by targeting women with high parity. This finding is consistent with the concept of maternal depletion as the underlying cause of increased adverse child outcomes associated with shorter birth intervals. [ABSTRACT FROM AUTHOR]

The complex interrelationships between birth order, birth intervals, and sibling mortality clustering have been the source of much debate in historical demography and in the demography of the developing world. No clear resolution yet exists either about the relative importance of these factors in determining infant and child mortality or about the pathways through which they operate. This article re-examines the issue in the context of nineteenth-century Belgium through the use of population registers, which can go one step further than historical-demographic studies based on family-reconstitution data and contemporary studies based on birth-history data. The movements in and out of households that population registers record enable us to trace the presence or absence of siblings in a household at a particular point in time. Accommodating the number of siblings present in a household as a time-varying entity is important given that familial-mortality clustering may signal shared exposure to pathogens and competition for resources, both of which depend on the presence of co-resident siblings. This article therefore aims to understand child-mortality clustering though the medium of the household rather than the mother's birth history, permitting the de facto presence of siblings to be factored into the analysis. [ABSTRACT FROM AUTHOR]

Abstract: There has been long-standing interest in the effects of maternal age, birth rank, and birth spacing on infant and child mortality. Contradictory inferences about the role of these factors have arisen on occasion because of the absence of adequate controls, the use of cross-sectional or incomplete reproductive histories, and inattention to the effect of family size goals and birth limitation practices. This study analyzes completed reproductive histories for German village populations in the 18th and 19th centuries, a period when deliberate fertility control was largely absent. Our results confirm previous studies of the association of in[ant mortality with maternal age, although in the present data these differentials are largely limited to neonatal mortality. They also confirm the importance of birth interval as a factor in infant mortality. Sibship size is positively related to infant mortality even when birth rank is controlled. However. once sibship size is controlled, there are no systematic differences in infant and child mortality by birth order. The mechanisms relating sibship size and mortality are explored. [ABSTRACT FROM AUTHOR]

Brass's method for estimating child mortality is based on an ingeniously simplified model. However, it frequently leads to values of q(x) that are not consistent with each other. This is most obvious for estimates of q(1). This paper examines the extent to which such inconsistencies are caused by simplifications in the model. Three assumptions are relaxed by adjusting for differences in infant mortality by birth order, taking account of annual fluctuations in mortality, and using a different age pattern of fertility for each cohort. These adjustments are applied to data from the 1974 Bangladesh Retrospective Survey of Fertility and Mortality and the 1975 Bangladesh Fertility Survey in which additional data from the Cholera Research Laboratory are used. The resulting estimates are more consistent both internally and with estimates from other surveys and by other procedures. [ABSTRACT FROM AUTHOR]

This analysis uses data from Bangladesh and the Philippines to demonstrate that children who are born within 15 months of a preceding birth are 60 to 80% more likely than other children to die in the first two years of life, once the confounding effects of prematurity are removed. The risks associated with short conception intervals are confined to children who are also high birth order; they persist in the presence of controls for prior familial child mortality, breast-feeding, mother's age, and socioeconomic status. In Bangladesh but not in the Philippines, these effects are confined to the neonatal period. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the association of child mortality with maternal age, parity, birth spacing, and socioeconomic status, in a sample of Guatemalan children who were included in a public health intervention program. Our results indicate that maternal age, birth order, and the length of the previous and following birth intervals all have a significant impact on the risk of child mortality and that these associations cannot be accounted for by differences in breastfeeding, socioeconomic status, or the survival status of the previous child. [ABSTRACT FROM AUTHOR]