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Infant mortality trends in the State of Rio Grande do Sul, Brazil, 1994-2004: a multilevel analysis of individual and community risk factors
Zanini, Roselaine Ruviaro;Moraes, Anaelena Bragan?a de;Giugliani, Elsa Regina Justo;Riboldi, Jo?o;
Cadernos de Saúde Pública , 2009, DOI: 10.1590/S0102-311X2009000500010
Abstract: the aim of this study was to analyze the trend in infant mortality rates in the state of rio grande do sul, brazil, from 1994 to 2004, in a longitudinal ecological study, by means of panel data analysis and multilevel linear regression (two levels: microregion and time) to estimate factors associated with infant mortality. the infant mortality rate decreased from 19.2‰ (1994) to 13.7‰ (2004) live births, and the principal causes of death in the last five years were perinatal conditions (54.1%). approximately 47% of the variation in mortality occurred in the microregions, and a 10% increase in coverage by the family health program was associated with a 1‰ reduction in infant mortality. a 10% increase in the poverty rate was associated with a 2.1‰ increase in infant deaths. infant mortality was positively associated with the proportion of low birthweight newborns and the number of hospital beds per thousand inhabitants and negatively associated with the cesarean rate and number of hospitals per 100 thousand inhabitants. the findings suggest that individual and community variables display significant effects on the reduction of infant mortality rates.
Residential Segregation and Infant Mortality: A Multilevel Study Using Iranian Census Data
SS Hashemi Nazari,M Mahmoodi,MA Mansournia,K Holakouie Naieni
Iranian Journal of Public Health , 2012,
Abstract: Background: There is a great amount of literature concerning the effect of racial segregation on health outcomes but few papers have discussed the effect of segregation on the basis of social, demographic and economic characteristics on health. We estimated the independent effect of segregation of determinants of socioeconomic status on infant mortality in Iranian population.Methods: For measuring segregation, we used generalized dissimilarity index for two group and multi group nominal variables and ordinal information theory index for ordinal variables. Sample data was obtained from Iranian latest national census and multilevel modeling with individual variables at level one and segregation indices measured at province level for socioeconomic status variables at level two were used to assess the effect of segregation on infant mortality.Results: Among individual factors, mother activity was a risk factor for infant mortality. Segregated provinces in regard to size of the house, ownership of a house and motorcycle, number of literate individual in the family and use of natural gas for cooking and heating had higher infant mortality. Segregation indices measured for education level, migration history, activity, marital status and existence of bathroom were negatively associated with infant mortality.Conclusion: Segregation of different contextual characteristics of neighborhood had different effects on health outcomes. Studying segregation of social, economic, and demographic factors, especially in communities, which are racially homogenous, might reveal new insights into dissimilarities in health.
Determinants of infant and child mortality in Zimbabwe: Results of multivariate hazard analysis  [cached]
Joshua Kembo,Jeroen K. van Ginneken
Demographic Research , 2009,
Abstract: This study addresses important issues in infant and child mortality in Zimbabwe. The objective of the paper is to determine the impact of maternal, socioeconomic and sanitation variables on infant and child mortality. Results show that births of order 6+ with a short preceding interval had the highest risk of infant mortality. The infant mortality risk associated with multiple births was 2.08 times higher relative to singleton births (p<0.001). Socioeconomic variables did not have a distinct impact on infant mortality. Determinants of child mortality were different in relative importance from those of infant mortality. This study supports health policy initiatives to stimulate use of family planning methods to increase birth spacing. These and other results are expected to assist policy makers and programme managers in the child health sector to formulate appropriate strategies to improve the situation of children under 5 in Zimbabwe.
Infant and Child Mortality in India in the Last Two Decades: A Geospatial Analysis  [PDF]
Abhishek Singh, Praveen Kumar Pathak, Rajesh Kumar Chauhan, William Pan
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0026856
Abstract: Background Studies examining the intricate interplay between poverty, female literacy, child malnutrition, and child mortality are rare in demographic literature. Given the recent focus on Millennium Development Goals 4 (child survival) and 5 (maternal health), we explored whether the geographic regions that were underprivileged in terms of wealth, female literacy, child nutrition, or safe delivery were also grappling with the elevated risk of child mortality; whether there were any spatial outliers; whether these relationships have undergone any significant change over historical time periods. Methodology The present paper attempted to investigate these critical questions using data from household surveys like NFHS 1992–1993, NFHS 1998–1999 and DLHS 2002–2004. For the first time, we employed geo-spatial techniques like Moran's-I, univariate LISA, bivariate LISA, spatial error regression, and spatiotemporal regression to address the research problem. For carrying out the geospatial analysis, we classified India into 76 natural regions based on the agro-climatic scheme proposed by Bhat and Zavier (1999) following the Census of India Study and all estimates were generated for each of the geographic regions. Result/Conclusions This study brings out the stark intra-state and inter-regional disparities in infant and under-five mortality in India over the past two decades. It further reveals, for the first time, that geographic regions that were underprivileged in child nutrition or wealth or female literacy were also likely to be disadvantaged in terms of infant and child survival irrespective of the state to which they belong. While the role of economic status in explaining child malnutrition and child survival has weakened, the effect of mother's education has actually become stronger over time.
Infant mortality in South Africa - distribution, associations and policy implications, 2007: an ecological spatial analysis
Benn KD Sartorius, Kurt Sartorius, Tobias F Chirwa, Sharon Fonn
International Journal of Health Geographics , 2011, DOI: 10.1186/1476-072x-10-61
Abstract: Infant mortality remains high in South Africa with seemingly little reduction since previous estimates in the early 2000's. Results showed marked geographical differences in infant mortality risk between provinces as well as within provinces as well as significantly higher risk in specific sub-districts and provinces. A number of determinants were found to have a significant adverse influence on infant mortality at the sub-district level. Following multivariable adjustment increasing maternal mortality, antenatal HIV prevalence, previous sibling mortality and male infant gender remained significantly associated with increased infant mortality risk. Of these antenatal HIV sero-prevalence, previous sibling mortality and maternal mortality were found to be the most attributable respectively.This study demonstrates the usefulness of advanced spatial analysis to both quantify excess infant mortality risk at the lowest administrative unit, as well as the use of Bayesian modelling to quantify determinant significance given spatial correlation. The "novel" integration of determinant prevalence at the sub-district and coefficient estimates to estimate attributable fractions further elucidates the "high impact" factors in particular areas and has considerable potential to be applied in other locations. The usefulness of the paper, therefore, not only suggests where to intervene geographically, but also what specific interventions policy makers should prioritize in order to reduce the infant mortality burden in specific administration areas.Despite the Millennium Development Project's aims to reduce infant and child mortality, this problem remains a challenge in sub-Saharan Africa. The infant mortality rate (IMR), moreover, has worsened in many of these countries reversing the gains achieved in the previous century [1][2][3][4][5]. In 1990, for example, there was a 20-fold difference (180 versus 9 deaths per 1000 live births) in IMR between sub-Saharan African and industrializ
Analysis of the spatial distribution of infant mortality by cause of death in Austria in 1984 to 2006
Thomas Waldhoer, Martin Wald, Harald Heinzl
International Journal of Health Geographics , 2008, DOI: 10.1186/1476-072x-7-21
Abstract: This present study includes four additional years and now covers about 1.9 million individual birth certificates. It aimes to elucidate the observed non-random spatial distribution in more detail. We split up infant mortality into six groups according to the underlying cause of death. The underlying spatial distribution of standardized mortality ratios (SMR) is estimated by univariate models as well as by two models incorporating all six groups simultaneously.We observe strong correlations between the individual spatial patterns of SMR's except for "Sudden Infant Death Syndrome" and to some extent for "Peripartal Problems". The spatial distribution of SMR's is non-random with an area of decreased risk in the South-East of Austria. The group "Sudden Infant Death Syndrome" clearly and the group "Peripartal Problems" slightly show deviations from the common pattern. When comparing univariate and multivariate SMR estimates we observe that the resulting spatial distributions are very similar.We observe different non-random spatial distributions of infant mortality rates when grouped by cause of death. The models applied were based on individual data thereby avoiding ecological regression bias. The estimated spatial distributions do not substantially depend on the employed estimation method. The observed non-random spatial patterns of Austrian infant mortality remain to appear ambiguous.Infant mortality rate in Austria was higher than average in the European Union until 1987 but now has reached the European Union means [1,2] (Figure 1). Despite this very welcome temporal trend, in a recent study [3] including the years 1984–2002, we observed an explicit non-uniform spatial distribution indicating lower risks in the South-East of Austria. This study was based on about 1.6 million individual birth certificates allowing the adjustment of the infant mortality rates for a large number of covariates. The then observed non-uniform spatial distribution was surprising because the
Infant Mortality Rate Statistic Method and Difference Analysis in China  [PDF]
Benfeng Du, Yu Zhang
Open Journal of Statistics (OJS) , 2011, DOI: 10.4236/ojs.2011.13027
Abstract: Infant mortality rate (IMR) has been viewed as the vital index which can be used to measure the health level of a country or a district, and also can indirectly illustrate the economic development level of the country or district. In this paper, the authors 1) introduce three calculation methods of IMR and compare the differences among them; 2) calculate the IMR using one method above, and find the IMRs recorded in China Population Statistic Yearbook (CPSY) from National Statistics Institute and in China Health Statistic Yearbook from Ministry of National Hygiene are both overestimated; 3) point out three main reasons for this overestimation: firstly, confusion of methods of calculation and concepts, secondly, inconsistent statistical caliber among different yearbooks, thirdly, flaws within the registration system.
Infant and child mortality in Ethiopia: A statistical analysis approach
PP Kumar, G File
Ethiopian Journal of Education and Sciences , 2010,
Abstract: This study uses data from the Ethiopia Demographic and Health Survey [2005 EDHS] conducted in 2005 to investigate the predictors of child [0-5 years] mortality in developing country like Ethiopia. The specific objectives of this study are to identify the factors which are affecting child mortality and to suggest viable strategies to increase health service and reduce child mortality in Ethiopia. The crosstabulation technique has been used to estimate the predictors of child mortality. The cross-tabulation analysis shows that Birth Interval with Previous child and mother standard of living index is the vital factor associated wi th child mortal ity. Furthermore, Mother’s education, birth order has substantial impact on child mortality in E t h i o p i a . Finally these findings specified that an increase in Mothers’ education, improve health care services which should in turn raise child survival and should decrease child mortality in Ethiopia.
Infant mortality in the Flemish Region of Belgium 1999-2008: a time-to-event analysis
Edwin Pelfrene, Heidi Cloots, Erik Hendrickx
Archives of Public Health , 2012, DOI: 10.1186/0778-7367-70-6
Abstract: The Flemish unified death and birth certificates database for all calendar years between 1999 and 2008 was used. A Kaplan-Meier survival analysis on a yearly basis was performed to assess the mean time-to-event and to compare survival curves between both genders.Over the last years, a slight though not steady decrease of the infant mortality rate is observed. In 2008, the probability among live births of dying before their first anniversary is 4.6‰ in boys and 3.5‰ in girls. The large majority (about 85%) of these have died in their year of birth. The mean survival time of deaths in their year of birth was found to centre around 1 month (about 30 days), which results in a 'mean proportion of the calendar year lived' (k1) close to 0.09. Among those who died in the year after their year of birth yet before their first anniversary, no such concentration in time of the deaths is observed. Differences between the gender groups are small and generally not statistically significant.Statistics Belgium, the federal statistics office, imputes a value for k1 equal to 0.1 for infant deaths in their year of birth when calculating life expectancy. Our data fully support this value. We think such refinement is generally feasible in calculating life expectancy.When calculating life expectancy, it is assumed that deaths are uniformly distributed within each of the age intervals, which translates into the imputation of an additional 0.5 years of life for the deceased in their year of death. This generally holds for all ages, except for the youngest age group, and probably for the oldest age group as well (above 80) [1-3].Looking at infant mortality, the striking feature is indeed that most of the deaths among live births are concentrated in the very first days. This fact urges us to adopt some factor k notably inferior to 0.5 for the mean proportion of the calendar year lived by infants who die in their first year of life.Our aim is to assess this factor k by analyzing data for the F
A Study Of Infant Mortality In Field Practice Area Of Kasturba Medical College, Manipal - A Preliminary Analysis  [cached]
Chakladar B.K,Udaya Kiran N,Krishnan Lalitha,Phaneendra Rao R.S
Indian Journal of Community Medicine , 1987,
Abstract: A retrospective study was carried out during 1983-84 in the field practice area of Kasturba Medical College, Manipal to determine the infant mortality rate and the factors influencing it. The population covered was 29,519 and infant mortality rate was found to be 24.54. As the sample size was small, a separate study was carried out through Anganwadi workers which covered a larger population of 1,30,906 in the same taluka and the infant mortality rate was found to be 37.8. Searching for the causes of this low infant mortality rate the probable factors were found to be high female literacy health care facilities and its utilization by the people. The age and causes of infant support of the survey findings. Two thirds of the deaths occurred in the neonatal period. The majority of infant deaths were primarily due to infections resulting from environmental influence. The results of the hospital based data indirectly support the finding of low infant mortality rate.
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