The environment as a determinant of child mortality among migrants in frontier areas of Pará and RondÔnia, Brazil, 1980

This article examines child mortality as an indicator of the quality of life among migrants living in Brazilian Amazonia in 1980. I focus on migrants in the frontier states of Pará and RondÔnia, which experienced rapid settlement during the 1970s. The key question here is the effect of settlement location on child mortality rates. While RondÔnia had lower ratios of population per public health establishments and personnel than Pará, RondÔnia nonetheless exhibited a higher malaria prevalence in 1980. I therefore attribute locational differences in child mortality to environmental factors important to malaria transmission rather than to health care infrastructure. The findings from multivariate regression analysis show that net of the effects of human capital, migration history and migrant living standards, settling in Pará rather than RondÔnia resulted in significantly lower rates of child mortality. These findings suggest that environmental factors coinciding with location of frontier settlement had important consequences for the living standards of migrants in the Brazilian Amazon.     

Family size and child mental disorders in Bahia,Brazil

The relationship between family size and child mental disorders was assessed through a prevalence study conducted in an urban neighborhood of Salvador, Brazil. From a representative sample of 828 children aged between 5 and 14 years, 23.3% were diagnosed as exhibiting varying degrees of mental disorders. Diagnoses were based on psychiatric interviews, following screening using the QMPI (a Portuguese-language screening questionnaire). Results supported the hypotheses that: (1) children from smaller families would exhibit higher prevalence of mental disorders than those from larger families; and (2) prevalence of neurotic and psychosomatic disorders would be lower for children from larger families than from smaller ones. Significant associations were also found between family size and diagnosis and severity of child mental disorders. Controlled analyses indicated that these relationships were not confounded by age or sex of the child, family social class, or family type.     

The empowerment of women,fertility, and child mortality: Towards a theoretical analysis

This paper examines one avenue through which female autonomy impinges on fertility and child mortality in developing countries. A simple model is set out in which couples are motivated to have children for old age security purposes. The decisions of a couple regarding fertility and allocation of resources for the healthcare of their children are made within a bargaining framework. An increase in female autonomy translating into an increase in the relative bargaining power or the threat point utility of mothers is shown to reduce fertility and also to reduce child mortality rates. Paradoxically, the increase in female autonomy within a household may increase the disadvantage suffered by female children in that household with respect to survival. Received: 4 August 1999/Accepted: 7 September 2000     

Consanguinity and child mortality: The risk faced by families

Previous research reveals that the characteristics and practices of a child's family are important determinants of its chances of surviving beyond childhood. This study investigates the effects of consanguinity on a family's odds of experiencing the death of a child in Pakistan, a society in which marriage among close relatives is common. Analysis of data from the 1991 Pakistan Demographic and Health Survey reveals that first cousin marriages increase a couple's risk of enduring the death of one or more of their children. These couples are 1.18 times as likely to have a child die by its fifth birthday than couples not related by blood net of other factors associated with child mortality. Elimination of first cousin marriages would contribute to a modest decrease in the proportion of Pakistani families suffering the death of a child.     

A response to criticism of our estimates of under-5 mortality in Iraq, 1980-98

According to estimates published in this journal, the number of deaths of children under 5 in Iraq in the period 1991-98 resulting from the Gulf War of 1991 and the subsequent imposition of sanctions by the United Nations was between 400,000 and 500,000. These estimates have since been held to be implausibly high by a working group set up by an Independent Inquiry Committee appointed by the United Nations Secretary-General. We believe the working group's own estimates are seriously flawed and cannot be regarded as a credible challenge to our own. To obtain their estimates, they reject as unreliable the evidence of the 1999 Iraq Child and Maternal Mortality Survey--despite clear evidence of its internal coherence and supporting evidence from another, independent survey. They prefer to rely on the 1987 and 1997 censuses and on data obtained in a format that had elsewhere been rejected as unreliable 30 years earlier.     

Regional trends in fertility and mortality in Brazil

Abstract Questions asked in the 1970 Brazilian census allow the application of fertility and childhood mortality techniques developed by W. Brass. Using some propositions based on fertility estimates from the 1970 census data it was possible to extend the analysis to the 1940, 1950 and 1960 censuses. Estimates are also provided for ten Brazilian regions, for 1940, 1950 and 1970. These estimates show a slight decrease in the fertility level for the country as a whole, but two different trends at regional levels. Between 1940-50 and 1960-70 the poorer regions experienced constant or increasing fertility levels while developed regions experienced declining ones, with only one exception. The mortality estimates indicate a consistent decline in the mortality level of all regions, but also a divergent trend between poor and developed regions, in life expectancies at birth. This work is a summarized version of Chapters II, III and IV of my Ph.D. thesis written under the supervision of Professor D. V. Glass and Mr J. Hobcraft at the University of London. I am most grateful to my supervisors as well as to Professor W. Brass for valuable comments on several aspects of the thesis. While carrying out this study, the author was supported by grants from the Federal University of Minas Gerais, Brazil, and the Ford Foundation.     

The effect of piped water on early childhood mortality in Urban Brazil, 1970 to 1976

The effects of access to piped water on the trends in child mortality and on differentials by income class are analyzed using data on surviving children and other variables in samples of urban mothers aged 20–29 in 1970 and 1976. Path analytic regression techniques are used to test a recursive model linking the supply and demand for piped water to selected household and community level variables, and to examine their joint effect on child mortality. The model’s estimated parameters for 1970 and 1976 are used to analyze changes in mortality between the two dates. Increased maternal education accounts for a larger share of the mortality decline than any other single factor. Increased access to piped water also contributes to mortality decline, and such access helps to reduce the mortality differential between lower and higher income and education classes.     

Reproductive patterns and child mortality in guatemala

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.     

Contribution of mortality decline to longer working life: The case of indonesian males 1980–1995

The length of working life of Indonesian males has been estimated for 1980 and 1995. Data on age specific labour force participation rates are obtained from the 1980 census and the 1995 intercensal population survey. Data on agespecific mortality have been adopted from appropriate model life tables based on indirect estimates of child mortality in the absence of any direct information about mortality. The contribution of declining mortality to the lengthening of working life has been greater than the contribution of higher labour force participation rates. Reductions in mortality at ages before entry into the labour force have increased the potential for added and improved education and training needed for the work force, which is also a contribution of reduced mortality to human capital development. The findings have implications for policy and future employment plans.     

Estimating seasonality effects on child mortality in Matlab,Bangladesh

This paper estimates the net effect of seasonality on child mortality in Matlab. Results suggest that childhood mortality was well above the average monthly level in the hot, dry month of April and in November, the first harvest month of the aman crop. It was found to be remarkably low in the post harvest months of February and March. and also in August. During the hungry months of September and October, children were at a considerably increased risk of mortality. particularly from diarrheal diseases, if mothers had no schooling. but this was not the case if mothers had schooling. The protective effect of the Matlab interventions on childhood death from diarrheal diseases was also greater during the hungry months than during other months of the year.     

Differentials in infant and child mortality and their change over time: Guatemala, 1959–1973

This paper employs 5 percent samples of the Guatemalan censuses of 1964 and 1973 to estimate differential childhood mortality. For 1973, conventional indirect mortality estimation procedures were applied; for 1964, a modification of the Preston-Palloni technique was used. A major result is that differential child mortality widened appreciably between about 1959 and about 1968. Factors leading to mortality decline were possibly unequally spread by geographic region, rural-urban residence, ethnic groups, and educational groups. Guatemala City seems to have benefited most from the decline. Analysis of small geographic units supports these conclusions and suggests some role for public health. A by-product of the analysis was the finding that parity was understated in the 1964 census.     

New estimates of fertility and child mortality in Africa, south of the Sahara

Summary Earlier work by Page and Coale has estimated demographic indices of fertility and mortality for parts of Africa using the Sullivan modification of Brass's technique. The present paper presents modified and more accurate estimates of fertility and child mortality, not only for the sub-national units covered by Page and Coale but also for areas not covered by them. The present analysis which employs Trussell's refinement of Brass and Sullivan's techniques also includes improvements overlooked in earlier estimates. The salient finding that emerges is that while the Brass mortality technique is very powerful, his equally ingenious fertility technique is very weak and should not be relied on for estimating fertility parameters.     

Religious differentials in infant and child mortality in Holland, 1855-1912

At least three kinds of hypothesis may be invoked to interpret religious differentials in mortality. They are (i) hypotheses that refer to characteristics, (ii) those that refer to lifestyle, and (iii) those that refer to the social isolation of minorities. This paper tests all three kinds of hypothesis using data on urban child mortality from the Hague just before and during the demographic transition. A hazard analysis suggests that economic and demographic characteristics do not account for much of the variation by religion. An analysis of seasonal mortality suggests that some of the variation may be explained by differences in lifestyle. The third kind of hypothesis is presented here for the first time. We suggest that the social isolation of small religious groups lowered their exposure to certain kinds of infectious disease. We use a simulation study to show that this hypothesis could account for part of the variation.     

Levels and patterns of infant and child mortality in ghana

This paper attempts to measure infant and child mortality levels and also to determine their structure by utilizing the results of the 1968–1969 National Demographic Sample Survey which was conducted under the directorship of the author. Among the major problems encountered in the exercise are the adjustment of the current raw mortality data and the estimation of infant and child mortality from independent source material. The estimated infant mortality rates range from 56 per 1,000 live births in the Accra Capital District to 192 in the Upper Region during the late 1960’s. The urban rate is lower than the rural rate, 98 as against 161 per 1,000 live births. A large proportion of the deaths among children aged 0–4 occur in the second year of life, and deaths in this age group account for the bulk of the deaths within the age group 1–4 years.     

Birth interval and family effects on postneonatal mortality in Brazil

In this paper random-effects logistic models are used to analyze the effects of the preceding birth interval on postneonatal mortality in Brazil, controlling for the correlation of survival outcomes between siblings. The results are compared to those obtained by using ordinary logistic regression. Family effects are found to be highly significant in the random-effects model, but the substantive conclusions of the ordinary logistic model are preserved. In particular, birth interval effects remain highly significant.     

The effect of child mortality experience on subsequent fertility: in Pakistan and Bangladesh

Summary This paper presents an empirical analysis of the effects, behavioural and biological, of child mortality experience on subsequent fertility in two South Asian Islamic nations. Data for the investigation came from retrospective pregnancy histories of 2,910 currently married women interviewed in the Pakistan National Impact Survey (1968-69) and from longitudinal vital registration data (1966-2070) of 5,236 women residing in a rural area of Bangladesh collected by the Cholera Research Laboratory. The aim of this study was to assess the importance of the child-replacement motivational response to child death experience after biological effects have been controlled adequately. A common approach employed previously has been to examine cumulative fertility according to child death experience. In Pakistan and Bangladesh, a consistently positive relationship was demonstrated between the number of children ever born and the number of child deaths. This method, however, did not exclude the inverse relationship, the influence of fertility on mortality, nor did it dissect out behavioural from biological effects. Utilizing a measure of subsequent fertility, live-birth-to-live-birth intervals, the study further illustrated another common pitfall. Since the risk of infant death, which leads to shorter birth intervals, is associated with the mother's reproductive history, women with child mortality experience are more likely to experience shorter intervals because of the biological effect of subsequent infant death. Behavioural influences may, therefore, be observed by considering only those birth intervals in which the first-born child survives to the end of the interval. With these limitations controlled, very few, if any, behavioural influences were noted in the Pakistan and Bangladesh data. Median birth intervals in Pakistan varied between 35-43 and 41-42 months, increasing with parity. Within each parity group, no consistent difference was observed between women with and without previous child loss. In Bangladesh, the median birth interval for all women with a surviving infant was 37-2 months. This was shortened to 24-31 months by an infant death. When intervals with infant deaths were excluded, little or no behavioural influence was detected among women of the same parity, but with varying levels of previous child loss. Even without behavioural effects, elimination of infant mortality in Bangladesh would reduce fertility by prolonging the average period of post-partum sterility. In the Bangladesh setting, however, the size of the effect was only about four per cent. This modest effect, more-over, was counterbalanced by an overall increase of net reproduction by seven per cent due to better survivorship of infants.     

Infant and child mortality in India: trends in inequalities across economic groups

This paper examines the trends in economic inequalities with respect to infant and child mortality in India using three rounds of the Indian National Family Health Survey conducted in 1992–1993, 1998–1999, and 2005–2006. The paper uses concentration index, and pooled discrete-time survival regression model to examine the aforementioned trends and regional patterns. The findings suggest a decreasing trend in economic inequality in infant mortality but an upward trend in economic inequality in child mortality in India. Economic inequalities in infant mortality have narrowed in the southern region, whereas they have widened in the western region and risen in the northern region. However, mixed trends in concentration indices were found in the different regions of India in the case of child mortality.