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.     

The Middle East population puzzle

An overview is provided of Middle Eastern countries on the following topics; population change, epidemiological transition theory and 4 patterns of transition in the middle East, transition in causes of death, infant mortality declines, war mortality, fertility, family planning, age and sex composition, ethnicity, educational status, urbanization, labor force, international labor migration, refugees, Jewish immigration, families, marriage patterns, and future growth. The Middle East is geographically defined as Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, United Arab Emirates, Yemen, Gaza and the West Bank, Iran, Turkey, and Israel. The Middle East's population grew very little until 1990 when the population was 43 million. Population was about doubled in the mid-1950s at 80 million. Rapid growth occurred after 1950 with declines in mortality due to widespread disease control and sanitation efforts. Countries are grouped in the following ways: persistent high fertility and declining mortality with low to medium socioeconomic conditions (Jordan, Oman, Syria, Yemen, and the West Bank and Gaza), declining fertility and mortality in intermediate socioeconomic development (Egypt, Lebanon, Turkey, and Iran), high fertility and declining mortality in high socioeconomic conditions (Bahrain, Iraq, Kuwait, Qatar, Saudi Arabia, and the United Arab Emirates), and low fertility and mortality in average socioeconomic conditions (Israel). As birth and death rates decline, there is an accompanying shift from communicable diseases to degenerative diseases and increases in life expectancy; this pattern is reflected in the available data from Egypt, Kuwait, and Israel. High infant and child mortality tends to remain a problem throughout the Middle East, with the exception of Israel and the Gulf States. War casualties are undetermined, yet have not impeded the fastest growing population growth rate in the world. The average fertility is 5 births/woman by the age of 45. Muslim countries tend to have larger families. Contraceptive use is low in the region, with the exception of Turkey and Egypt and among urban and educated populations. More than 40% of the population is under 15 years of age. The region is about 50% Arabic (140 million). Educational status has increased, particularly for men; the lowest literacy rates for women are in Yemen and Egypt. The largest countries are Iran, Turkey, and Egypt.     

Birth Intervals and Childhood Mortality in Rural Bangladesh

This study investigates the relationship between birth intervals and childhood mortality, using longitudinal data from rural Bangladesh known to be of exceptional accuracy and completeness. Results demonstrate significant but very distinctive effects of the previous and subsequent birth intervals on mortality, with the former concentrated in the neonatal period and the latter during early childhood. The impact of short birth intervals on mortality, however, is substantially less than that found in many previous studies of this issue, particularly for the previous birth interval. The findings are discussed in terms of the potential for family planning programs to contribute to improved child survival in settings such as Bangladesh.     

The Level and Age Pattern of Mortality in Bandafassi (Eastern Senegal): Results From a Small-Scale and Intensive Multi-Round Survey

The data collected in the Bandafassi demographic study in Eastern Senegal, a small-scale intensive and experimental follow-up survey of a population of about 7,000 in 1983, were analysed to derive an estimated life table. The use of multi-round surveys, combined with anthropological methods to estimate ages and collect genealogies, has resulted in unusually reliable data. Taking into account the uncertainty of the estimates due to the small size of the population, mortality was high, with life-expectancy at birth close to 31 years; a pattern of infant and child mortality close to that observed in other rural areas of Senegal, with a very high level or mortality between ages six months and three years; a seasonal pattern in child mortality with two high-risk periods, the rainy season and the end of the dry season; an adult mortality pattern similar to that described in model life tables for developed countries; no significant difference by sex or ethnic group. The Bandafassi population study and a few similar studies suggest that one possible way to improve demographic estimates in countries where vital registration systems are defective would be to set up a sample of population laboratories where intensive methods of data collection would continue for extended periods.     

A hazards-Model analysis of the covariates of infant and child mortality in Sri Lanka

The purpose of this paper is twofold: (a) to provide a complete self-contained exposition of estimating life tables with covariates through the use of hazards models, and (b) to illustrate this technique with a substan-tive analysis of child mortality in Sri Lanka, thereby demonstrating that World Fertility Survey data are a valuable source for the study of child mortality. We show that life tables with covariates can be easily estimated with standard computer packages designed for analysis of contingency tables. The substantive analysis confirms and supplements an earlier study of infant and child mortality in Sri Lanka by Meegama. Those factors found to be strongly associated with mortality are mother’s and father’s education, time period of birth, urban/rural/estate residence, ethnicity, sex, birth order, age of the mother at the birth, and type of toilet facility.     

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.     

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

Summary 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.     

Changes in fertility patterns can improve child survival in Southeast Asia

This analysis of 1988 Philippine Demographic Survey data provides information on the direct and indirect effects of several major determinants of childhood mortality in the Philippines. Data are compared to rates in Indonesia and Thailand. The odds of infant mortality in the Philippines are reduced by 39% by spacing children more than two years apart. This finding is significant because infant mortality rates have not declined over the past 20 years. Child survival is related to the number of children in the family, the spacing of the children, the mother's age and education, and the risks of malnutrition and infection. Directs effects on child survival are related to infant survival status of the preceding child and the length of the preceding birth interval, while key indirect or background variables are maternal age and education, birth order, and place of residence. The two-stage causation model is tested with data on 13,716 ever married women aged 15-49 years and 20,015 index children born between January 1977 and February 1987. Results in the Philippine confirm that maternal age, birth order, mortality of the previous child, and maternal education are directly related to birth interval, while mortality of the previous child, birth order, and maternal educational status are directly related to infant mortality. Thailand, Indonesia, and the Philippines all show similar explanatory factors that directly influence infant mortality. The survival status of the preceding child is the most important predictor in all three countries and is particularly strong in Thailand. This factor acts through the limited time interval for rejuvenation of mother's body, nutritional deficiencies, and transmission of infectious disease among siblings. The conclusion is that poor environmental conditions increase vulnerability to illness and death. There are 133% greater odds of having a short birth interval among young urban women than among older rural women. There is a 29% increase in odds for second parity births compared to third or higher order parities. Maternal education is a strong predictor of infant survival only in the Philippines and Indonesia. Adolescent pregnancy is a risk only in Indonesia. Socioeconomic factors are not as important as birth interval, birth order, and maternal education in determining survival status.     

Christian–Muslim differences in child survival in Egypt

Ethnic and religious inequalities in child survival have been documented in many countries. In Egypt, during the 1980s and 1990s, Christians had higher childhood mortality than Muslims despite their higher socio-economic status (SES) and concentration in urban areas. This paper explores reasons for this Christian–Muslim mortality gap. Data for this study are drawn from Egypt’s 1988, 1992, 1995, 2005 and 2008 Demographic and Health Surveys, which recorded the respondents’ religious affiliation. The main analysis compares children of Christian and Muslim mothers in survival to age five using proportional hazards Cox regression models. Results indicate that differences in the regional distributions of Christians and Muslims positively contributed to the mortality gap during the 1980s–1990s. The majority of Christians resided in Upper Egypt where childhood mortality rates were considerably higher than in other regions. However, only part of higher Christian mortality can be explained by their regional concentration. In Upper Egypt, despite their higher SES, as well as greater urban residence, Christians had higher mortality than Muslims. These findings are at odds with research demonstrating the significance of SES and urban concentration in explaining ethnic–religious mortality gaps.     

Further evidence on the decline in infant mortality in pre-industrial England: North Shropshire, 1561-1810

Summary There is growing evidence of a substantial decline in infant mortality in England from the late seventeenth century onwards. This trend is examined in detail using data from the parish registers of a group of rural parishes in North Shropshire. A major change in the whole pattern of first-year mortality during the period 1661-1810 is indicated, its main features being an increase in mortality between the ages of six and eleven months, and a marked fall in mortality during the first three months of life. Examination of the seasonal pattern of infant mortality shows very heavy mortality among young infants in the winter, presumably from respiratory causes, during the period before 1700. It is suggested that a fall in the number of deaths from these causes was the main reason for the decline in infant mortality since the late seventeenth century.     

A close look at the demography of Afghanistan

The first survey designed to allow estimates of the demographic characteristics of Afghanistan's sedentary population was conducted during the period 1972-1974. Our analysis of these data, based on recently developed techniques for handling imcomplete or inaccurate data, suggests that this population lives under conditions that are extreme when judged by modern standards. Marriage is early, especially for females, and universal. Marital fertility conforms to a pattern of natural fertility and total fertility is high. The birth rate is among the highest in the world today, and the expectation of life at birth is among the very lowest. Mortality is lower in urban areas than in rural areas, whereas total fertility is approximately the same in both. Our estimates of fertility and mortality imply stable populations which match closely the observed age distributions for both the rural and urban areas.     

Population statistics] as of July 1, 2000

This Mahidol Population Gazette presents Thailand's population and demographic estimates as of July 1, 2000, using the standard techniques of demographic analysis. The paper provides estimates of Thailand's total population, population by sex, population in urban and rural areas, population by region, and by age group. In addition, figures of crude birth and death are listed per 1000 population, natural growth rate, and infant mortality rate per 1000 live births, male and females' life expectancy at birth and at age 60, total fertility rate, contraceptive prevalence rate. The number of the aged population in 2020 is also presented. Presented in a bar graph is a population pyramid for Thailand in the year 2000, illustrating male and females' age and year of birth.     

Demographic Responses And Population Change

Most Western societies have gone through a process of population change during the past 100-150 years. One important aspect is the socalled demographic transition: the shift from high to low birth and death rates, and accelerated growth resulting from the lag between falling mortality and falling fertility, in national populations. Equally important has been the "rural-to-urban" transition, which involved the migration of millions of people from rural areas. It is hypothesized, following the suggestion of Davis (Theory of the Multi-Phasic Demographic Response), that the adjustment in reproductive behavior made by a community in response to a rising "strain," such as that resulting from higher natural increase, is likely to differ depending upon the ease with which the community can relieve the strain through out migration. Relationships among such characteristics of modernization as intensity of industrialization, speed of urbanization, structural changes in the agricultural system, and declining fertility are implied. Case studies of England and Sweden lend support to the hypothesis: more rapid urban-industrial development, larger-scale movement from rural areas, and a delayed decline in the rural birth rate distinguish the English transition.     

Child mortality in rural India

This paper focuses on infant and child mortality in rural areas of India. We construct a flexible duration model, which allows for frailty at multiple levels and interactions between the child’s age and individual, socioeconomic, and environmental characteristics. The model is estimated using the Indian National Family and Health Survey 1998/1999. The estimation results show that socioeconomic and environmental characteristics have significantly different impacts on mortality rates at different ages. These are particularly important immediately after birth. The parameter estimates indicate that child mortality can be reduced substantially, particularly by improving the education of women, providing safe water, and reducing indoor air pollution caused by dirty cooking fuels. Finally, we still found substantial differences in mortality rates between states, which are associated with differences in schooling expenditures, female immunization, and poverty rates.     

The seasonality of births in Canada: A comparison with the northern United States

This paper presents evidence that there are substantial differences in the seasonal birth patterns of Canada and the northern United States. The seasonal birth pattern in Canada is characterized by a birth peak in April–May, and a trough in December–January. The birth pattern in the northern U.S. is characterized by a trough in April–May, and a peak in August–September. The influence of climate on the birth patterns is explored in an attempt to explain the discrepancies. In both Canada and the United States, there is an inverse relationship between temperature and conceptions during the summer months. The study concludes that variation in temperature alone cannot explain the discrepancy between the birth patterns of southern Canada and the northern United States.     

Two Centuries of Mortality Change in Central Japan: The Evidence From a Temple Death Register

Temple registers in a remote area of central Japan are used to produce a portrait of mortality change over a period of nearly two centuries. This portrait is most remarkable in showing a near-stability in life expectancy at birth between 30 and 40 years until the middle of the twentieth century. This stability was to some extent a product of offsetting trends. Infant and child mortality declined sharply after 1885, coinciding with a major national effort to vaccinate against smallpox. At the same time, mortality was rising at ages 15–29 as industrialization brought increased exposure to tuberculosis. Both these trends are likely to have been shared throughout much of rural Japan.     

Famine,Disease, and Mortality Patterns in the Parish of Borshevka,Russia, 1830–1912

Scholars have projected a dismal image of nineteenth-century, rural Russia as a society repeatedly punctuated by crop failures, famine, starvation, and epidemics of famine-related diseases. But there has been no rigorous attempt, using appropriate methods, to assess the nature of demographic crises in Russia and their contribution to overall mortality and population growth. The pattern of mortality evident in the parish under examination is distinguished by an extremely high incidence of infant, diarrhoeal diseases and childhood, infectious diseases. This unfavourable disease environment and resulting high rates of infant and early childhood mortality were more closely related to fertility levels, household size, housing conditions, and weaning practices than to annual or seasonal food availability and the nutritional status of the population. In a disease-driven society, the susceptibility to infection and the force of infection can, to a considerable extent, be determined by demographic factors, familial norms, and climatic constraints.     

Famine, disease, and mortality patterns in the parish of Borshevka, Russia, 1830-1912

Scholars have projected a dismal image of nineteenth-century, rural Russia as a society repeatedly punctuated by crop failures, famine, starvation, and epidemics of famine-related diseases. But there has been no rigorous attempt, using appropriate methods, to assess the nature of demographic crises in Russia and their contribution to overall mortality and population growth. The pattern of mortality evident in the parish under examination is distinguished by an extremely high incidence of infant, diarrhoeal diseases and childhood, infectious diseases. This unfavourable disease environment and resulting high rates of infant and early childhood mortality were more closely related to fertility levels, household size, housing conditions, and weaning practices than to annual or seasonal food availablity and the nutritional status of the population. In a disease-driven society, the susceptibility to infection and the force of infection can, to a considerable extent, be determined by demographic factors, familial norms, and climatic constraints.     

Some aspects of socio-economic determinants of mortality in tropical Africa

Measurements of mortality levels and trends continue to be inadequate in Africa, largely because of the lack of reliable and adequate information on deaths. A series of estimates depicting mortality levels and trends has been prepared by demographers, different kinds of data and employing different estimation procedures, but knowledge of the "true" structure of mortality in tropical Africa is virtually nonexistent. Because of these problems only a "bird's eye view" of the prevailing situation in tropical Africa is presented. The discussion -- directed to mortality by sex and age, by residence, and by cause -- is based on secondary and fragmentary data. Socioeconomic and cultural determinants of mortality are also examined. Available information on male and female mortality indicates that the death rates for males are higher than they are for females. Early childhood mortality (1-4 years) in tropical Africa is relatively high compared with the other age groups, including infants. Mortality differentials have been noted among geographical and administrative units and subdivisions of populations within the various countries of tropical Africa. Also, urban dwellers enjoy a higher expectation of life at birth than do rural dwellers. Communicable diseases are the main killers in tropical Africa. Persistent poverty and malnutrition, poor housing, unhealthy conditions in the growing cities, nonexistence of health facilities in the rural areas, rapid population expansion, and low levels of education are among the factors impeding progress in reducing mortality in tropical Africa. The need exists to express development goals in terms of the progressive reduction and eventual elimination of malnutrition, disease, illiteracy, squalor, and inequalities. Future trends in mortality in tropical Africa may depend more than they have in the recent past on economic and social development.