Neo-natal mortality in South Asia: The special role of tetanus

First-year mortality in rural Uttar Pradesh is characterized by a predominance (60 per cent) of deaths during the first month of life, of which 66 per cent are reported to be due to tetanus. This pattern is not typical of the historical experience of many developed countries and the current experience of some less developed countries where post-neo-natal mortality predominates. To examine this phenomenon, two causal models of neo-natal mortality (one for tetanus and one for all other diseases) are developed and tested using retrospective survey data from 2000 couples living in rural Uttar Pradesh.

Neo-natal tetanus mortality is found to be primarily a function of opportunities for exposure to the disease (e.g. lack of antiseptic birth practices, ownership of large animals) rather than of socio-economic status or demographic variables. The importance of examining neo-natal mortality by cause, and the shortcomings inherent in making inferences from the historical experiences of Western nations are emphasized.     

Post-neonatal mortality in Rural India: Implications of an economic model

In this paper we develop and test a theory of childhood mortality after the first month of life. Parents are assumed to have well-defined family size and sex composition objectives and to face severe budget constraints. In this set of circumstances, it is understandable that they will make allocative decisions that will affect the survival probabilities of children. These decisions and the environmental influences on mortality are the basic forces which determine whether a child will survive through the post-neonatal period. The model is tested with survey data from rural Uttar Pradesh, India. The results are consistent with the hypothetical framework discussed above. The burden of this pattern of choice is felt particularly strongly by female births.     

New survey finds fertility decline in India

A brief indication was provided of demography, fertility, and contraceptive usage and knowledge based on the recent 1992/93 Indian National Family Health Survey. The sample included 88,562 households and 89,777 ever married women aged 13-49 years in 24 states and the National Capital Territory of Delhi. About 38% of household members were aged under 15 years. The sex ratio was 944 females to 100 males. 54% aged over 5 years were currently married; 10% were widowed, divorced, or separated. 43% were literate and 9% had secondary or higher education: 67% for females in cities and 34% in rural areas. Female literacy was 82% in Kerala but under 30% in Rajasthan, Bihar, Uttar Pradesh, and Madhya Pradesh. During 1990-92, the crude birth rate was 28.9 per 1000 population. Total fertility was 3.4 for women aged 15-49 years: 3.7 in rural and 2.7 in urban areas. 31% of parents had been sterilized. 26% desired no more children. Only 6% of women with four or more children desired another child. 99% of urban and 95% of rural respondents had knowledge of at least one modern or traditional method. Female and male sterilization were the most well-known modern methods. 47% of women had ever used contraception: 42% with a modern method and 12% with a traditional method. 41% were current users of family planning: 36% with a modern and 4% with a traditional method (45% in urban and 33% in rural areas with a modern method). The highest contraceptive use was in Kerala, Himachal Pradesh, Maharashtra, and Punjab states and Delhi (over 50%). The two most populous states, Uttar Pradesh and Bihar, had the lowest rates, which were under 25%; other low usage was in Assam and several small northeastern states. 75% of all female modern contraceptive use was female sterilization. 12% in urban and 3% in rural areas used a modern spacing method. Use increased with increased educational level. Rural sources of supply emphasized public facilities: sterilization and IUDs.     

Neo-natal and post-neo-natal mortality in a rural area of Bangladesh

Abstract An analysis of neo-natal and post-neo-natal mortality in 132 villages (population of 117,000) of Matlab thana indicates the following: (i) Neo-natal deaths accounted for 60% of the infant mortality rate of 125. This proportion was unexpectedly high since previous research had maintained that in countries with infant mortality rates over 100, neo-natal deaths account for less than one-third of all infant deaths. Since the present findings on the proportions of neo-natal deaths correspond exactly with results from an earlier registration system in East Pakistan, it is suggested that the long-accepted proposition, 'less developed' areas are characterized by lower proportions of neo-natal deaths than 'more developed' areas, be re-examined. (2) The infant death rate accounts for 36% of all deaths in the population. If the infant death rate were reduced by half the result would be a decrease in the current crude death rate from 16 to 13. Although this reduction would appear to be small, in the context of a current high growth rate of 3% (from 1966-67 to 1968-69) it exerts a sizeable impact. For example, it would take a reduction of eight points in the crude birth rate of 46 just to achieve a growth rate 2·5% under these circumstances. Obviously, continued efforts in death control without an effective birth control programme will perpetuate high rates of growth. (3) Neo-natal and post-neo-natal mortality exhibited the -expected 'U' shaped pattern with parity, and generally varied as expected with age and family size, except in the oldest age group and largest family size where the risk was smaller than in the preceding groups. An explanation for these findings is presented, based on the effect that births to high-parity women with low child mortality have upon the total neo-natal and post-neo-natal mortality rates. It was found that these births exhibit a much lower mortality risk than births to women of comparable parities and higher child mortality, and that their numbers account for the lower risk to the births in the oldest age group and largest family size. It was concluded that women with a combination of high parity and low child mortality most probably represent a group with superior socio-economic and or health conditions which contribute to the lower risk of neo-natal and post-neo-natal death.     

The end of population growth in Asia

This paper presents probabilistic population projections for five regions of Asia (South Asia, Central Asia, China region, Pacific OECD and Pacific Asia) and Asia as a whole. Over this century, Asia will experience very heterogeneous demographic development: Central Asia is expected to almost double in population and South Asia will become by far the world’s most populous region, rapidly surpassing the China region. Simultaneously, the Pacific OECD countries are likely to shrink in population size and experience extreme population ageing. The proportion of the population aged 60 and above in these countries (with Japan having the greatest weight) is expected to reach 50 per cent of the total population (with the 95 per cent uncertainty interval ranging from 35 to 61 per cent). The China region will experience a more rapid speed of ageing, with the proportion aged 60 and above expected to increase by a factor of four from 10 per cent in 2000 to 39 per cent in 2100.     

Culture influences demographic behavior: evidence from India

Delhi migrants from low socioeconomic classes were compared based on their home origins in north or south India. The two groups differed in cultural beliefs, attitudes, and practices, but they lived in the same resettlement colony and had the same physical access to services and opportunities. Retrospective data was collected from a sample of ever-married women and household heads. Longitudinal data was collected on households with at least two living children younger than 12 in visits once every two weeks over a six-month period. Information was obtained on children's eating patterns, activities, illnesses, and the treatment of their illnesses. Households from Tamil Nadu in the south were more modern, had greater female autonomy, and were open to new ideas. Uttar Pradesh women from the north were more traditional, secluded, and restricted in economic activities. The results showed lower fertility, higher levels of contraceptive use, and earlier ends to childbearing among Tamil Nadu women, who had had more exposure to ideas about smaller family size, healthful childrearing practices, and positive attitudes about contraceptive use. For every 100 Tamil Nadu children who died, 111 Uttar Pradesh children died. Health care practices differed between groups; the urban slum environment was conducive to the spread of gastrointestinal infections among Uttar Pradesh girls discouraged from using the public water taps and toilet facilities. Among the Tamil Nadu migrants, girls actually had lower childhood mortality rates than boys. 115 girls died for every 100 boys among the Uttar Pradesh. The reason may be due to the avoidance or delay of outside medical attention until too late. The conclusion was that the status of women, and their exposure to and interaction with the outside world and control over decision making at home, explained the differences between the two groups. Policy implications are to make programs culturally sensitive for example, providing at-home care for women traditionally sheltered from contact with strangers.     

Reply to Wachter

Although twins constitute only about 2.4 per cent of total births in less developed countries, they account for about 12 per cent of neonatal deaths and about nine per cent of infant deaths. Twin mortality in less developed countries has almost never been analysed systematically. We examine survival among twins as contrasted with that among singleton births by using 2692 twin observations pooled from 26 standardized Demographic and Health Surveys. Weakened by gestational and other biological complications, twins seem to be more vulnerable to detrimental demographic and household socio-economic influences than singletons. Twinning tends to amplify, or at least retain, whatever group differences exist among singleton births.     

Model life tables: An empirical test of their applicability to less developed countries

Model life tables are commonly used for estimating various parameters of mortality of populations in developing countries with limited data. The application of the models is based on the assumption that the agemortality pattern of the population under consideration resembles one of the life tables in the models. The analysis in this paper tests the validity of this assumption for developing countries with data usable for the purpose. The major conclusion is that infant mortality in the populations analyzed is higher than predicted by the models corresponding to the levels of adult mortality of these populations. The observed discrepancy is ascribed to the selectivity involved in the construction of model life tables, which are primarily derived from the historical experience of Western countries. Populations in the currently developing countries apparently differ in the process of mortality change from those used in the models. Though the analysis is limited to a few countries and may not necessarily be true for all the less developed countries, it suggests the need for caution in the use of conventional model life tables.     

Older adults in sub-Saharan Africa living with children and grandchildren

Using data from Demographic and Health Surveys, we examine the composition of households containing older adults in 24 countries of sub-Saharan Africa, with a focus on those living with children and grandchildren. Overall, 59 per cent live with a child and 46 per cent with a grandchild. Men are more likely to live in nuclear households and women in extended households and alone. Regression analyses show that individual-level determinants of household composition differ by sex. For example, living with children and grandchildren is tied to living with a spouse for men, but for women the effect is either not significant or in the opposite direction. Households with an older adult and a grandchild, but no adult children, are common. Usually the adult child lives elsewhere, though about 8 per cent of older adults live with a grandchild who has at least one deceased parent. Older adults are more likely to be living with double-orphans in countries with high AIDS-related mortality.     

Using survey data to assess neonatal tetanus mortality levels and trends in developing countries

Demographic and health surveys are a useful source of information on the levels and trends of neonatal mortality in developing countries. Such surveys provide data on mortality occurring at 4–14 days of life, which is a sensitive indicator of neonatal tetanus mortality. We analyze birth history data from 37 national surveys in developing countries to assess the quality of neonatal mortality data and to estimate levels and trends in mortality occurring at 4–14 days. It is shown that mortality at 4-14 days has declined considerably during the last decade in most developing countries, concomitant with development and expansion of programs to reduce neonatal tetanus. These declines show that reductions in neonatal tetanus mortality probably have been an important contributor to the decline of neonatal and infant mortality during the 1980s.     

Deadly Cities? Spatial Inequalities in Mortality in sub‐Saharan Africa

We investigate whether sub‐Saharan African countries are affected by an “urban mortality penalty” repeating the history of industrialized countries during the nineteenth century. We analyze Demographic and Health Surveys from several sub‐Saharan African countries for differences in child and adult mortality between rural and urban areas. For the first decade of the 2000s, our findings indicate that child mortality is higher in rural than in urban areas for all countries. On average, child mortality rates are 13.6 percent in rural areas and 10.8 percent in urban areas. In contrast, average urban adult mortality rates (14.1 percent) have exceeded rural adult mortality rates (12.4 percent). Child mortality rates are on average 65 percent higher in urban slums than in formal settlements. Child mortality rates in slum areas are, however, still lower than or equal to those in rural areas for most countries in our sample.     

General growth balance method: A reformulation for populations open to migration

This paper proposes a reformulation of the general growth balance method for estimating census and registration completeness so as to make it applicable even to populations that are affected by migration. It also discusses a new procedure of line fitting that could be useful in countries where the input data are severely affected by age misreporting. The method is applicable to countries where data on age distribution of the population are available for two points in time from either censuses or surveys. Following closely the original proposal of Brass, it involves adjusting the 'partial' birth rates for age-specific disturbances from growth and migration rates. Beyond correcting the death rates, the method is useful in inferring the relative completeness of the censuses, and in deriving a robust estimate of birth rate under certain conditions. The application of the method is illustrated using the example of the male population of the Indian state of Uttar Pradesh for the period 1981 to 1991.     

General growth balance method: A reformulation for populations open to migration

This paper proposes a reformulation of the general growth balance method for estimating census and registration completeness so as to make it applicable even to populations that are affected by migration. It also discusses a new procedure of line fitting that could be useful in countries where the input data are severely affected by age misreporting. The method is applicable to countries where data on age distribution of the population are available for two points in time from either censuses or surveys. Following closely the original proposal of Brass, it involves adjusting the ‘partial’ birth rates for age-specific disturbances from growth and migration rates. Beyond correcting the death rates, the method is useful in inferring the relative completeness of the censuses, and in deriving a robust estimate of birth rate under certain conditions. The application of the method is illustrated using the example of the male population of the Indian state of Uttar Pradesh for the period 1981 to 1991.     

Purposive concealment of death in household surveys in Misamis Oriental Province

Summary The randomized response technique was used in a household survey of approximately 2,000 rural and 2,000 urban households in Misamis Oriental Province in the southern Philippines in order to determine the extent of purposive concealment of death. The estimated number of deaths deliberately not revealed to the interviewers was 50 per cent or higher. Adjusted crude death rates of 11.5 and 13.4 per 1,000 population were computed for urban and rural areas, respectively, by adding estimated concealed deaths to deaths reported to the interviewers. Application of stable population techniques and of model life tables suitable to the Philippine setting, while not permitting definite conclusions, provided reasons for believing that these adjusted death rates are close to the true mortality situation in the study areas. Randomized response data further indicate that approximately 75 per cent of urban deaths and 47 per cent of rural deaths of the population studied were not registered with municipal authorities. The authors postulate that failure to register deaths with municipal authorities, together with fear of legal involvement if this failure becomes known outside the immediate neighbourhood, is a major reason for the purposive concealment of death in household surveys.     

Determinants of Regional Variations in Infant Mortality in Rural India

An analytical framework is specified for understanding the determinants of infant mortality. It distinguishes between factors at three levels – village, household and individual – and arranges them in ascending order with respect to their proximity to infant mortality. Village and household-level factors are assumed to influence infant mortality indirectly by influencing at least one of the six individual-level factors. The present analysis of the data aggregated at the state level clearly demonstrates the importance of both medical and non-medical factors for explaining the observed regional differences in infant mortality in rural India. The percentage of births attended by trained medical personnel and poverty, are the two important determinants of regional variations in neo-natal mortality; and the village-level availability of medical facilities and the extent of triple vaccination are the two important determinants of post-neo-natal mortality. The influence of adult women's literacy on infant mortality is explained by better medical care at birth, and preventive and curative medical care during the post-neo-natal period. Medical factors have been shown to be slightly more important than non-medical factors. This suggests that it might be possible to reduce the high level of infant mortality currently prevalent in many states in India by simple preventive medical interventions.     

Changing Residence: Comparative Perspectives on its Relationship to Age,Sex, and Marital Status

Change of usual dwelling unit (house, flat, etc.) during a fixed period of time is the common denominator to measuring the amount of spatial mobility within different countries. Around 1980 or 1981, the percentage of population who moved from one dwelling unit to another in one year was over 19 per cent in New Zealand, 17–18 per cent in the United States, Canada, and Australia, 9–10 per cent in Great Britain, Sweden, Japan and France, 7–8 per cent in the Netherlands and Belgium, and 6 per cent in Ireland. Evaluation of ‘age schedules’ of local and non-local movement reveals especially high mobility among U.S. children, and a narrowing of mobility differences for older people between countries, particularly over local distances. Life-table techniques help to quantify the amount of mobility associated with different marital statuses, and bring into focus some of the sequelae of these statuses for men and women in different countries.     

Rural-urban mortality in developing countries: An index for detecting rural underregistration

This study begins with a brief analysis of past and present urban-rural mortality in those countries which are presently considered to be developed. The same analysis centers in developing countries, for it is thought that their rural mortality should be greater than their urban mortality. Since available statistics generally show the contrary, a way is presented for constructing possible means of sub-registering vital statistics in some areas of these countries. The index would vary to agree with the system of the registry of vital statistics in a given area. Mexico is used as an example-the result of constructing and analyzing the index is to show in which areas there should be a subregistry of deaths. Finally, the cases of India and Taiwan are analyzed in order to confirm the hypothesis that in developing countries there will be a higher mortality rate in. rural than in urban areas.     

Demographic transitions: analyzing the effects of mortality on fertility

The effect of mortality reductions on fertility is one of the main mechanisms stressed by the recent growth literature in order to explain demographic transitions. We analyze the empirical relevance of this mechanism based on the experience of developed and developing countries since 1960. We distinguish between the effects on gross and net fertility, take into account the dynamic nature of the relationship, and control for alternative explanatory factors and for endogeneity. Our results show that mortality plays a large role in fertility reductions, that the change in fertility behavior comes with a lag of about 10 years and that both net and gross fertility are affected. We find comparatively little support for explanations of the demographic transition based on changes in GDP per capita.     

Children’s educational attainment,occupation, and income and their parents’ mortality

Using data from Finland, this paper contributes to a small but growing body of research regarding adult children's education, occupation, and income and their parents' mortality at ages 50+ in 1970–2007. Higher levels of children's education are associated with 30–36 per cent lower parental mortality at ages 50–75, controlling for parents' education, occupation, and income. This association is fully mediated by children's occupation and income, except for cancer mortality. Having at least one child educated in healthcare is associated with 11–16 per cent lower all-cause mortality at ages 50–75, an association that is largely driven by mortality from cardiovascular diseases. Children's higher white-collar occupation and higher income is associated with 39–46 per cent lower mortality in the fully adjusted models. At ages 75+, these associations are much smaller overall and children's schooling remains more strongly associated with mortality than children's occupation or income.     

Demographic crisis: The impact of the Bangladesh civil war (1971) on births and deaths in a rural area of Bangladesh

Summary In Matlab Bazaar Thana the Cholera Research Laboratory has registered the births, deaths and migrations in a population of approximately 125,000 since 1966. Although this rural area was not the scene of any significant armed encounters, striking changes in birth and death rates were registered during and after the conflict. Birth rates did not change during the relatively brief period of the civil war, but a small decline was registered for one year after the war. Fertility rates which had been declining slightly and irregularly in the pre-war baseline period may have increased slightly during the war and fell substantially in all age groups in the year following the war. The crude death rate, which rose by 37 per cent during the war, was a very sensitive reflection of the administrative and economic problems. Overall infant mortality rose by only 15 per cent over pre-war levels because all of the increase was observed in the post-neo-natal component, which traditionally accounts for less than one-third of the total infant mortality in Bangladesh. Children and older adults accounted for the majority of excess deaths which were largely attributed to acute diarrhoeas and other gastro-intestinal causes. The death rate at ages 1-4 rose by 43 per cent and at ages 5-9 soared to 208 per cent above pre-war baseline rates. All increases in age-specific mortality rates fell to baseline levels during the year following the war, except the 5-9-year age group, in which rates continued to be high largely because of deaths due to dysentery.