Determinants of infant and child mortality in Kenya: an analysis controlling for frailty effects

In this paper, Weibull unobserved heterogeneity (frailty) survival models are utilized to analyze the determinants of infant and child mortality in Kenya. The results of these models are compared to those of standard Weibull survival models. The study particularly examines the extent to which child survival risks continue to vary net of observed factors and the extent to which nonfrailty models are biased due to the violation of the statistical assumption of independence. The data came from the 1998 Kenya Demographic and Health Survey. The results of the standard Weibull survival models clearly show that biodemographic factors are more important in explaining infant mortality, while socioeconomic, sociocultural and hygienic factors are more important in explaining child mortality. Frailty effects are substantial and highly significant both in infancy and in childhood, but the conclusions remain the same as in the nonfrailty models.     

The Impact of Social and Economic Indicators on Maternal and Child Health

As early as 1985, Rosenfield and Maine began to look at what is called the maternal child field (MCH). More than two decades later, maternal and infant mortality is still among the worst performing health indicator in resource-poor countries and regions, and it has barely changed since 1990. Although three of the eight United Nations Millennium Development Goals aim at reducing child mortality, maternal mortality, and promoting gender equality, most literature in the field is either clinical or exclusively deals with women’s health problems. In this study, I proposed an empirical model that tests the impact of gender equality, women’s human rights, and maternity care on MCH with economic and political development as background factors. The proposed model was tested by using structural equation analysis. Data were obtained from 137 developing countries. The proposed model is partially supported by the data. Empirical findings demonstrate that gender equality has a pivotal role to play in the promotion of MCH. The relationship between MCH and maternity care is found to be strong and statistically significant. This finding may permit a probable verification given the current social conditions in some developing countries, particularly the neglect of many of women’s health needs and the assignment of their primary responsibilities in childrearing. The women’s human rights hypothesis is not supported by the data. It is perhaps that human rights instruments provide a legal discourse for political functions and social welfare issues, but that the legal approach alone does not necessarily provide a moral and social foundation to ensure the implementation of social welfare and human well-being, particularly maternal and child health in developing countries. The findings also indicate the importance of economic development in predicting maternity care. Finally, a positive and statistically significant relationship is found between economic development and gender equality. Implications and limitations of the study are discussed.     

Polygynous Contexts,Family Structure,and Infant Mortality in Sub-Saharan Africa

Contextual characteristics influence infant mortality above and beyond family-level factors. The widespread practice of polygyny is one feature of many sub-Saharan African contexts that may be relevant to understanding patterns of infant mortality. Building on evidence that the prevalence of polygyny reflects broader economic, social, and cultural features and that it has implications for how families engage in the practice, we investigate whether and how the prevalence of polygyny (1) spills over to elevate infant mortality for all families, and (2) conditions the survival disadvantage for children living in polygynous families (i.e., compared with monogamous families). We use data from Demographic and Health Surveys to estimate multilevel hazard models that identify associations between infant mortality and region-level prevalence of polygyny for 236,336 children in 260 subnational regions across 29 sub-Saharan African countries. We find little evidence that the prevalence of polygyny influences mortality for infants in nonpolygynous households net of region-level socioeconomic factors and gender inequality. However, the prevalence of polygyny significantly amplifies the survival disadvantage for infants in polygynous families. Our findings demonstrate that considering the broader marital context reveals important insights into the relationship between family structure and child well-being.     

Measuring socioeconomic status in health research in developing countries: Should we be focusing on households,communities or both?

Research on the effects of socioeconomic well-being on health is important for policy makers in developing countries, where limited resources make it crucial to use existing health care resources to the best advantage. This paper develops and tests a set of measures of socioeconomic status indicators for predicting health status in developing countries. We construct socioeconomic indexes that capture both household and community attributes so as to allow us to separate the social from the purely economic dimensions of the socioeconomic status within a cross-national perspective, with applications to data from Demographic and Health Surveys (DHS) fielded in five African countries in the 1990s. This study demonstrates the distinctive contributions of socioeconomic indexes measured at the household vs. community level in understanding inequalities in health and survival and underlines the importance of going beyond the purely economic view of socioeconomic status to cover the multidimensional as well as multilevel concept of economic and social inequality.     

就业状况、社会保障与农民工城市间再流动意愿

本文基于浙江省2513个进城农民工样本,应用描述性统计方法对农民工的就业状况和社会保障进行分析,并建立有序Probit模型对新老两代农民工及不同性别农民工的城市间再流动意愿的影响因素进行了探讨。研究发现,就业状况、社会保障对农民工的城市间再流动意愿产生了重要的影响。此外,家庭结构、流动状况、受教育程度等因素也是影响农民工的城市间再流动意愿的重要因素。这些因素的影响存在着一定的性别差异与代别差异。     

隔代照顾的生物社会学动因及影响分析

当前社会环境下,儿童照顾给工作和家庭平衡带来压力和挑战。隔代照顾成为缓解这一压力的流行方式而得到了广泛的关注,学术界产生了许多研究成果。其中,生物社会学视角在国外隔代照顾研究中有较多的应用。但是在国内采用这一视角进行的实证研究非常少。本研究以中国健康与养老追踪调查(CHARLS)2015年的数据为资料,通过生物社会学的视角并使用广义Logistic模型和广义线性模型对四类儿女双全的祖辈的隔代照顾的积极性进行分析。结果表明亲缘选择假设不能完全解释四类祖辈照顾孙辈的积极性的差异。虽然从整体上看女性祖辈比男性祖辈更积极地照顾孙辈,但是父系女性祖辈照顾孙辈的积极性并没有像亲缘选择假设所推断的那样显著低于母系女性祖辈。同时,分城乡的回归结果表明城镇地区四类祖辈的积极性没有显著差异,而在乡村地区父系女性祖辈的照顾强度显著高于其他三类祖辈。因此,亲缘选择理论可以解释照顾者性别差异的部分原因,而无法阐明父系和母系的宗族差异。此外,照顾者的工作状态、婚姻状态、受教育水平、子女的经济支持、子女的数量和子女的年龄都是影响隔代照顾积极性的显著因素。需要注意的是虽然生物社会学理论有其独特的价值,但是将它用于社会研究也有明显的局限性。因此,这一理论仍然有许多亟待探索和完善的空间。     

新生代农民工市民化意愿的影响因素分析——基于广东省三市的调查

通过对广州、深圳、东莞三市外出务工人员的调查数据,运用理性选择理论,分析了新生代农民工市民化意愿及其影响因素。结果发现,年龄、性别、受教育程度和月收入都对新生代农民工的市民化意愿产生了影响;是否在城市购买住房、城市融入感和自我身份认同也影响了新生代农民工的市民化决策;购买城市社会保险显著提高市民化意愿。而务农经历、婚姻状况和是否获得技术等级证书则未对其市民化意愿产生影响。     

The Associations Between Parental Socio-Economic Conditions,Childhood Intelligence,Adult Personality Traits,Social Status and Mental Well-Being

This study explored a longitudinal data set of 5,090 adults examining the associations between parental social status indicators (measured at birth), childhood intelligence (measured at age 11), personality traits, educational achievement and occupational prestige in relation to mental well-being (all measured at age 50). Correlational analysis showed that parental social status indicators and childhood intelligence were significantly associated with all of the big five personality traits (extraversion, emotional stability, agreeableness, conscientiousness, and intellect). Parental social status indicators, childhood intelligence, personality traits, education and occupation were all significant correlates of mental well-being. Structural equation modelling showed childhood intelligence was significantly associated with all the five personality traits, and family social status (indicated by parental social class, and paternal and maternal education) was significantly associated with traits intellect, extraversion, and agreeableness. All the five personality traits were significant predictors of mental well-being after taking into account the effects of family social status, childhood intelligence, own education achievement and current occupational prestige. Implications and limitations are discussed.     

Fathers and infant health and survival in Ende,a rural district of Eastern Indonesia

Studies have shown that child survival can be greater when fathers are more highly involved in infant care than when they are less involved. This paper investigates fathers’ and paternal grandmothers’ knowledge and experiences relating to infants’ survival in a rural district of Eastern Indonesia, a context for which such information is lacking. Twenty fathers or replacement relatives participated in in-depth interviews. Most had very limited knowledge of the danger signs of childhood illness. None of participants had received child health-related information from local health personnel. Male-dominated forms of decision-making in relation to infant health care are the norm. Inadequacies in the child health services, such as difficulties in accessing health facilities, health personnel unavailability and discomfort during delivery, remain as challenges. Fathers appear to rely largely on their wives for their infant health and survival knowledge and have little involvement with their infants. They see their roles in terms of providing economic support and basic care for their infants. Grandmothers are seen as a major source of health information by fathers, but have limited knowledge of infant survival. The findings demonstrate a need for child health promotion programs and campaigns, including the safe motherhood program, to include fathers as well as mothers, in order to increase their awareness of infant survival and involvement in infant raising, and to persuade them to allow mothers greater scope to make child health-seeking decisions, especially when children require emergency treatment.     

新生代农民工市民化意愿影响因素的实证研究--基于人力资本、社会资本和心理资本的考察

本文基于全国198个城市的样本数据,运用二元logistic回归模型,从人力资本、社会资本、心理资本三个维度对新生代农民工市民化意愿影响因素进行了实证分析。结果发现,人力资本中是否参加过培训、培训次数、拥有的技能数以及技术等级四个变量对新生代农民工市民化意愿有显著的影响。而学历水平没能通过显著性检验。社会资本中的外地同学亲戚数和参加社会活动的数量对新生代农民工市民化意愿有显著影响,而当地同学亲戚数没有通过显著性检验。心理资本中城市归属感、本地人态度、对城市同龄人看法三个变量对新生代农民工市民化意愿有显著影响,而对未来变化的预期及生活满意度没有通过显著性检验。因此,在新型城镇化进程中,对新生代农民工人力资本的培育要切合其市民化发展的需要,增加农民工与市民之间的互动,加强对农民工的心理引导,促进农民工实现市民化的心理转变。     

老年人医疗保健支出水平及其影响因素分析——慢性病高发背景下的老年人医疗保健制度改革

选取年内绝对和相对医疗支出两个指标,采用Tobit模型,检验影响老年人医疗保健支出的因素。研究发现慢性病、收入、居住地、社会保障对老年人医疗保健支出的影响突出,其中慢性病的影响尤为显著,在此基础上提出调整城乡医疗资源配置结构,健全社会保障政策,在医疗保健制度中增加预防性保险与服务的政策性建议。     

Erosion of Advantage: Decomposing Differences in Infant Mortality Rates Among Older Non-Hispanic White and Mexican-Origin Mothers

We build on findings from recent research showing an erosion of infant survival advantage in the Mexican-origin population relative to non-Hispanic whites at older maternal ages, with patterns that differ by nativity. This runs counter to the well-documented Hispanic infant mortality paradox and suggests that weathering and/or other negative health selection mechanisms may contribute to increasing disadvantage at older maternal ages. Using the National Center for Health Statistics (NCHS) cohort-linked birth and infant death files, we decompose the difference in Mexican-origin non-Hispanic white infant mortality at older maternal ages to better understand the contribution of selected medical and social risk factors to components of the difference. We find differences in the distribution and effects of risk factors across the three populations of interest. The infant mortality rate (IMR) gap between Mexican-origin women and non-Hispanic whites can be attributed to numerous offsetting factors, with inadequate prenatal care standing out as a major contributor to the IMR difference. Equalizing access to and utilization of prenatal care may provide one possible route to closing the IMR gap at older maternal ages.     

Polygyny and child survival in Nigeria: Age-dependent effects

Mortality risks under age five are estimated using data from the 1990 Nigerian Demographic and Health Survey for children in monogamous and polygynous families. Integrating existing theories on polygyny’s relationship with infant and child mortality and some demographic concepts, the study shows that polygyny has different effects on infant and child mortality at different ages. The results indicate that polygyny does not have a significant effect on neonatal mortality (age less than one month). In contrast to the results of previous research, polygyny is significantly associated with lower child mortality during the post-neonatal period (1–11 months), but not during childhood (12–59 months). The study found socio-economic factors to be important confounders of the relationship between polygyny and mortality during the neonatal and post-neonatal periods. The protective effect of polygyny during the post-neonatal period suggests the need to further investigate circumstances that may favour post-neonatal child survival in polygynous families including availability of childcare.     

Rural–Urban Migration and Cross-National Variation in Infant Mortality in Less Developed Countries

The relationship between migration and child health in individual countries is well known, but the cross-national variation in this relationship is largely untested. Using Demographic and Health Survey (DHS) data from 52 medium and low income countries, this study examines the effect of rural–urban migration on infant mortality and whether its effect varies cross-nationally. A secondary objective is to determine whether there is a relationship between the time a child is born in the migration process and infant mortality. Hypotheses are developed on the basis of competing theories on the relationship between migration and health. There are modest, but significant cross-national effects of rural–urban migration on infant mortality, which were better revealed in the presence of family- and child-level variables. The results also show that the unadjusted effects of rural–urban migration are quite substantial, but were largely accounted for by family- and child-level factors including education, socioeconomic status (SES), marital status, birth order, maternal age at child’s birth, and inter-births intervals. The results largely point to a selection process, which is further confirmed by results showing that the hazards of infant death increase with length of urban residence. Programs that target increasing maternal education, improving household SES, and lengthening interbirth intervals would therefore greatly benefit child survival in less developed countries.     

“白发相亲”——上海相亲角的择偶行为分析

相亲角和＂白发相亲＂是2005年以来城市青年择偶领域内出现的新现象。本文考察了＂白发相亲＂者的阶层构成及其特征,重点分析了＂知青一代＂父母代替子女相亲所采取的择偶步骤和择偶策略。研究发现相亲角和＂白发相亲＂现象具有城市性;从＂自发相亲＂到＂白发相亲＂,在一定程度上是一种路径依赖。＂白发相亲＂的实质是＂毛的孩子们＂试图帮助＂邓的一代＂解决婚恋难题。     

The influence of network mortality experience on nonnumeric response concerning expected family size: Evidence from a Nepalese mountain village

This article investigates the effects of sociometric network members' self-reported experiences with infant mortality on nonnumeric responses regarding expected family size among women in a small Nepalese community. The hypotheses tested include (1) that uncertainty about child survival, measured as average infant mortality across social networks, increases the likelihood of a nonnumeric response and (2) that this effect will be stronger when there is less variance in infant mortality experience within women a networks. The results suggest that nonnumeric response may be related to uncertainty about mortality derived through social learning.     

Son preference, use of maternal health care, and infant mortality in rural China, 1989-2000

This study assesses the effects of socio-economic conditions and the interaction between son preference and China's one-child family planning policy on the use of maternal health care services and their effects on infant mortality in rural China, using nationally representative data from the 2001 National Family Planning and Reproductive Health Survey. The results show that while the use of maternal health care services has continued to increase over time, large gaps still exist in the use of these services and in infant survival by mother's education, community income, and parity. Further improvements in the reproductive health of all women and in infant survival will require effective reduction of the obstacles to the use of maternal health care among those women in rural China who are less educated, poor, and of higher parity.     

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

A long literature in demography has debated the importance of place for health, especially children’s health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.     

Socioeconomic Inequalities in Infant Mortality in Egypt: Analyzing Trends Between 1995 and 2014

This paper analyses the trend of the socioeconomic inequalities in infant mortality rates in Egypt over the period 1995–2014, using repeated cross-sectional data from the National Demographic and Health Survey. A multivariate logistic regression and concentration indices are used to examine the demographic and socioeconomic correlates of infant mortality, and how the degree of socioeconomic disparities in child mortality rates has evolved over time. We find a significant drop in infant mortality rates from 63 deaths per 1000 live births in 1995 to 22 deaths per 1000 live births in 2014. However, analyzing trends over the study period reveals no corresponding progress in narrowing the socioeconomic disparities in childhood mortality. Infant mortality rates remain higher in rural areas and among low-income families than the national average. Results show an inverse association between infant mortality rates and living standard measures, with the poor bearing the largest burden of early child mortality. Though the estimated concentration indices show a decline in the degree of socioeconomic inequality in child mortality rates over time, infant mortality rate among the poor remains twice the rate of the richest wealth quintile. Nonetheless, this decline in the degree of socioeconomic inequality in child mortality is not supported by the results of the multivariate logistic regression model. Results of the logistic model show higher odds of infant mortality among rural households, children who are twins, households with risky birth intervals. We find no statistically significant association between infant mortality and child’s sex, access to safe water, mothers’ work, and mothers’ nutritional status. Infant mortality is negatively associated with household wealth and regular health care during pregnancy. Concerted effort and targeting intervention measures are still needed to reduce the degree of socioeconomic and regional inequalities in child health, including infant mortality, in Egypt.     

Factors influencing Aboriginal and Torres Strait Islander women’s breastfeeding practice: A scoping narrative review

BackgroundThe nutritional and health benefits of breastfeeding for infants and young children are well-established however rates of breastfeeding initiation and duration for Aboriginal and Torres Strait Islander children are lower than non-Indigenous children.AimTo describe factors influencing breastfeeding practice amongst Aboriginal and Torres Strait Islander women.MethodsA scoping narrative review was conducted using the Joanna Briggs Institute framework. A search was conducted in four online databases (PubMed, Scopus, ANU SuperSearch, and Science Direct). Findings were analysed using [30] narrative synthesis.FindingsThis review included 9 journal articles, a conference summary and a book. This review identified four factors influencing women’s breastfeeding practice; sources of support, culturally appropriate care, intention to breastfeed and social determinants.ConclusionMultiple social determinants resulting from colonization have interrupted traditional infant feeding practices and women’s sources of support. Although Aboriginal and Torres Strait Islander women have strong intention to breastfeed, their breastfeeding outcomes are impacted by lack of pro-breastfeeding support when encountering breastfeeding challenges as well as norms surrounding the use of infant formula milk. Culturally appropriate care is essential for identifying women’s needs and avoiding stereotyping. Further research is needed to investigate the effectiveness of breastfeeding interventions for this group of women.