Search

Objective: Several studies dealt with factors associated with childhood mortality, especially in developing countries, but less is known about former communistic countries. We therefore analyzed the factors affecting mortality rates among children in the Central Asian countries Kyrgyzstan, Kazakhstan and Uzbekistan. We focused on the impact of living place (rural versus urban) and age dependency (neonatal versus under-three mortality) on the mortality risk. Methods: We used the Demographic and Health Surveys data (DHS) for the three Central Asian countries. The combined data set included information about 2867 children under the age of three, 135 of whom died. We studied three multiple logistic regression models: for the mortality under the age of three, for neonatal mortality (1st month of life) and for mortality in 2nd-36th month of life. Results: Under-three mortality was independently associated with living in a rural versus urban area (OR 1.69 (CI 1.11-2.56)), birth order and mother not being currently married vs. married (OR 0.52 (CI 0.25-1.08)). There was a lower risk of mortality for children living in larger families (six or more household members vs. less than six, OR 0.45 (CI 0.30-0.65)). Living in a rural area was more strongly associated with mortality in 2-36 month of life than with neonatal mortality. Differences between countries were greater in neonatal mortality than in mortality between 2nd-36th month of life. Conclusions: This study suggests that urban-rural differences with respect to childhood mortality in these countries persist after adjusting for several socioeconomic factors.

Objective: To study time trends of weight, body mass index, overweight and obesity of children at school entry and to analyze potential effects of changes in the structure of consecutive cohorts of children at school entry over time on these weight-related measures. Design: We studied height, weight and body mass index (BMI) in 6 consecutive cohorts (1997-2002) of children at school entry (N=6,420). Overweight and obesity were defined by internationally valid sex and age specific cut-off points. In addition to descriptive statistics for time trends we applied an analysis of covariance to estimate the impact of covariates on weight and BMI and logistic regression models for the impact of covariates on overweight and obesity. Results: Although we found an overall decrease of mean body weight (minus 9%), BMI (minus 9.5%), overweight (minus 7.4%) and obesity (minus 6.8%) between 1997 and 2002, there was a considerable variation in these measures between single years. The analysis of covariance showed significant impact of age, gender and year of examination on weight and BMI. Whereas there were significant differences in the proportion of overweight children between different age groups, the effect of age was not significant for the proportion of obesity. Multiple logistic regression models showed that age (OR, 2.8; 95% CI, 2.3-3.5) and female gender (OR, 1.3; 95% CI, 1.2-1.5) were significantly associated with overweight and significantly with obesity (age: OR, 1.8; 95% CI, 1.2-2.9; female gender: OR, 1.4; 95% CI, 1.0-1.99), respectively. In these models the years of examination of 1998 (OR, 1.9; 95 %CI, 1.5-2.5) and 1999 (OR, 2.5; 95% CI, 1.97-3.3) were significantly associated with overweight, and the year 1999 (OR, 2.9; 95% CI, 1.6-5.2) with obesity. Conclusions: Our study showed that changes in age and gender distribution have to be taken into account when time trends of weight, BMI, overweight and obesity are derived from investigations of children at school entry.

BackgroundOnly about one-third of women in Palestine (West Bank and Gaza) obtain postpartum care. Therefore, the goal of this study was to assess factors associated with lack of postnatal care, women's reasons for not obtaining postnatal care, and their attitudes towards its importance.MethodsIn early 2006, a cross-sectional survey was conducted at three clinics run by the Ministry of Health providing Mother and Child Health Care in West Bank, Palestine. A total of 264 postpartum women attending the clinics were interviewed face-to-face, using a structured questionnaire.ResultsAlthough the majority of women considered postnatal care necessary (66.1%), only 36.6% of women obtained postnatal care. The most frequent reason for not obtaining postnatal care was that women did not feel sick and therefore did not need postnatal care (85%), followed by not having been told by their doctor to come back for postnatal care (15.5%). Based on a multivariable analysis, use of postnatal care was higher among women who had experienced problems during their delivery, had a cesarean section, or had an instrumental vaginal delivery than among women who had a spontaneous vaginal delivery. Use of postnatal care was also higher among women who delivered in a private hospital as compared to those who delivered in a public hospital. In addition, we found regional differences.ConclusionThe higher use of postnatal care among high-risk women is appropriate, but some clinically dangerous conditions can also occur in low-risk women. Future efforts should therefore focus on providing postnatal care to a larger number of low-risk women.