scholarly journals Impact of High-Risk Fertility Behavior on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

2020 ◽  
Author(s):  
Rafi Amir-ud-Din ◽  
Lubna Naz ◽  
Anila Rubi ◽  
Muhammad Usman ◽  
Umesh Ghimire
Keyword(s):  
High Risk ◽  
Birth Order ◽  
Child Mortality ◽  
South Asian ◽  
Birth Interval ◽  
Health Surveys ◽  
Demographic And Health Surveys ◽  
African Countries ◽  
Under Five ◽  
Increased Risk

Abstract Background High-risk fertility behaviors (HRFBs) are common in African and South Asian countries and can potentially affect child survival. This study examines the high-risk fertility behaviors concerning child mortality across the countries. Method Data from a series of Demographic and Health Surveys from the year 1987 to 2016 from 24 South Asian and African countries (N=1,224,832) were included in this study. Four HRFB parameters - women’s age <18 or >=34 years at childbirth, birth spacing <24 months, and child order of birth >3, were categorized into three exposure levels: i) exposure to any HRFBs category (exposure to any of four parameters); ii) exposure to single and multiple HRFB category (a combination of two or more parameters); and iii) the specific type of HRFB category (either single or multiple HRFB categories). Bivariate descriptive analysis and a multivariate logistic regression model were used to examine the association between under-five child mortality and various measures of HRFBs. Results Our pooled data analysis reported that HRFBs was associated with an increased risk of under-five child mortality in Asian and African countries. Children of women exposed to HRFBs were at increased risk of under-five mortality by 77% (Adjusted Odds Ratio (AOR) = 1.771, 95% confidence interval (CI): 1.722 - 1.821). Children born within 24 months’ birth interval were four times more likely to die (AOR = 4.995, 95% CI: 4.842-5.152) than their counterparts. However, a single high-risk category was not associated with under-five mortality, and birth order was found to be a protective factor against under-five mortality. Age of women (<18 or >=34 years) was found to be a risk factor of Under-five child mortality in 16 countries. The association between under-five mortality risk and birth interval of less than 24 months was highly significant in all countries. Conclusion Women’s age at childbirth, birth interval, and birth order were significantly associated with under-five mortality. Quality care for women and newborns need to be ensured through investment in the healthcare system, and by promoting health services with more focus given to the valuable populations through sexual and reproductive health education programs and empowering women.

scholarly journals Impact of High-Risk Fertility Behaviour on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

2020 ◽  
Author(s):  
Rafi Amir-ud-Din ◽  
Lubna Naz ◽  
Anila Rubi ◽  
Muhammad Usman ◽  
Umesh Ghimire
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Birth Order ◽  
Birth Interval ◽  
Health Surveys ◽  
Maternal Age ◽  
Demographic And Health Surveys ◽  
Index Child ◽  
Under Five ◽  
Fertility Behaviour

Abstract Background: Smaller or older maternal age, smaller inter-pregnancy birth interval, and higher birth order of the child are considered to be high-risk fertility behaviour (HRFB). Under-five mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and under-five mortality in selected Asian and African countries. Methods: This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in Sub-Saharan Africa, Middle East, North Africa, and South Asia from 1986 to 2017 (N=1,467,728). Previous evidence hints at four markers of HRFB: women's age at the birth of index child <18 years or >34 years, smaller preceding birth interval (PBI) <24 months, and child's birth order >3. Using logistic regression, we analysed the change in the odds of under-five mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results: Mother's age at the birth of index child <18 years and preceding birth interval (PBI) <24 months were significant risk factors of under-five mortality, while a child's birth order >3 was a protective factor against under-five mortality. Presence of any single HRFB was associated with 1.067 times higher risk of under-five mortality (OR = 1.067; 95% CI: 1.042 - 1.090; P < 0.001). Presence of multiple HRFBs was associated with 1.392 times higher risk of under-five mortality (OR = 1.392; 95% CI: 1.355 - 1.431; P < 0.001). Some specific combinations of risky fertility behaviour such as younger maternal age (<18 years) and smaller preceding birth interval (PBI <24) significantly increased the odds of under-five mortality.Conclusion: Younger maternal age and small preceding birth interval significantly increase the risk of under-five mortality. This highlights the need for effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for an optimal interpregnancy interval.

Impact of High-Risk Fertility Behaviour on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

2020 ◽  
Author(s):  
Rafi Amir-ud-Din ◽  
Lubna Naz ◽  
Anila Rubi ◽  
Muhammad Usman ◽  
Umesh Ghimire
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Birth Order ◽  
Birth Interval ◽  
Health Surveys ◽  
Maternal Age ◽  
Demographic And Health Surveys ◽  
Index Child ◽  
Under Five ◽  
Fertility Behaviour

Abstract Background: Younger or older maternal age, short inter-pregnancy birth interval, and higher birth order of the child are considered to be high-risk fertility behaviour (HRFB). Under-five mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and under-five mortality in selected Asian and African countries.Methods: This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in Sub-Saharan Africa, Middle East, North Africa, and South Asia from 1986 to 2017 (N=1,467,728). Previous evidence hints at four markers of HRFB: women’s age at the birth of index child <18 years or >34 years, short preceding birth interval (PBI) <24 months, and child’s birth order >3. Using logistic regression, we analysed the change in the odds of under-five mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results: Mother’s age at the birth of index child <18 years and preceding birth interval (PBI) <24 months were significant risk factors of under-five mortality, while a child’s birth order >3 was a protective factor against under-five mortality. Presence of any single HRFB was associated with 1.067 times higher risk of under-five mortality (OR = 1.067; 95% CI: 1.042 - 1.090; P < 0.001). Presence of multiple HRFBs was associated with 1.392 times higher risk of under-five mortality (OR = 1.392; 95% CI: 1.355 - 1.431; P < 0.001). Some specific combinations of risky fertility behaviour such as younger maternal age (<18 years) and short preceding birth interval (PBI <24) significantly increased the odds of under-five mortality.Conclusion: Younger maternal age and short preceding birth interval significantly increase the risk of under-five mortality. This highlights the need for effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for an optimal interpregnancy interval.

scholarly journals Impact of high-risk fertility behaviours on underfive mortality in Asia and Africa: evidence from Demographic and Health Surveys

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rafi Amir-ud-Din ◽  
Lubna Naz ◽  
Aneela Rubi ◽  
Muhammad Usman ◽  
Umesh Ghimire
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Birth Order ◽  
Birth Interval ◽  
Health Surveys ◽  
Maternal Age ◽  
Demographic And Health Surveys ◽  
Index Child ◽  
Underfive Mortality ◽  
Age At Birth

Abstract Background Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries. Methods This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women’s age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child’s birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results Mother’s age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child’s birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04–1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36–1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88–2.28). Conclusion Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing.

scholarly journals Determinants of Under-Five Child Mortality in Arab Countries. Are the Effects Homogeneous Across Birth Order and Among Countries?

2021 ◽  
Vol 14 (23) ◽  
pp. 34-49
Author(s):  
Chellai Fatih
Keyword(s):  
Birth Order ◽  
Child Mortality ◽  
Rural Areas ◽  
Urban Areas ◽  
Arab Countries ◽  
Policy Implications ◽  
Educational Levels ◽  
Under Five ◽  
Risk Of Death ◽  
Increased Risk

Abstract Under-five-child mortality remains a major challenge for governments in the Arab world to achieve Sustainable Development Goals. Thus, further studies are needed to analyze the determinants of child mortality. The Multiple Indicators Cluster Surveys (MICS) datasets of six Arab countries (Algeria, Egypt, Iraq, Mauritania, Sudan, and Tunisia) have been used, which are consisting of 249.000 children nested within 54.644 mothers. The study was designed in a women-parity-covered one to six birth order. Binary multivariable logistic models were used to estimate the risk ratios of death by adjusting for child sex, birth outcome (twin vs. singleton), mother’s education level, maternal age, previous birth interval, place of residence (rural vs. urban), and the family wealth index. The findings revealed that the under-five child mortality rates were 87, 70,66,35,36, and 21 per 1000 live births in Sudan, Mauritania, Egypt, Iraq, Algeria, and Tunisia, respectively). First-born infants in these six countries have a higher risk of mortality during their five years of life. Second, third-and fourth-born infants were at a decreased risk of death compared to first-born infants in all countries; in contrast, fifth-and-sixth-born infants were at an increased risk in all countries except Sudan and Mauritania. Twin children have a higher risk of death than singletons in all countries and across all birth orders. Children of mothers with higher educational levels living in urban areas are at lower risk of death than their peers across all birth orders. Regarding policy implications, decision-makers can target three main axes: first, enhancing women’s educational levels; second, increasing birth intervals (birth spacing policies); and third, improving living standards and healthcare strategies, especially in rural areas to improve child and mother health.

scholarly journals Does Birth Interval Matter in Under-Five Mortality? Evidence from Demographic and Health Surveys from Eight Countries in West Africa

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Eugene Budu ◽  
Bright Opoku Ahinkorah ◽  
Edward Kwabena Ameyaw ◽  
Abdul-Aziz Seidu ◽  
Betregiorgis Zegeye ◽  
...  
Keyword(s):  
West Africa ◽  
Birth Interval ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Age At First Birth ◽  
African Countries ◽  
Birth Intervals ◽  
Crude Odds Ratio ◽  
Under Five ◽  
Mother’S Age

In sub-Saharan Africa (SSA), every 1 in 12 children under five dies every year compared with 1 in 147 children in the high-income regions. Studies have shown an association between birth intervals and pregnancy outcomes such as low birth weight, preterm birth, and intrauterine growth restriction. In this study, we examined the association between birth interval and under-five mortality in eight countries in West Africa. A secondary analysis of the Demographic and Health Survey (DHS) data from eight West African countries was carried out. The sample size for this study comprised 52,877 childbearing women (15-49 years). A bivariate logistic regression analysis was carried out and the results were presented as crude odds ratio (cOR) and adjusted odds ratios (aOR) at 95% confidence interval (CI). Birth interval had a statistically significant independent association with under-five mortality, with children born to mothers who had >2 years birth interval less likely to die before their fifth birthday compared to mothers with ≤2 years birth interval [ cOR = 0.56 ; CI = 0.51 − 0.62 ], and this persisted after controlling for the covariates [ aOR = 0.55 ; CI = 0.50 − 0.61 ]. The country-specific results showed that children born to mothers who had >2 years birth interval were less likely to die before the age of five compared to mothers with ≤2 years birth interval in all the eight countries. In terms of the covariates, wealth quintile, mother’s age, mother’s age at first birth, partner’s age, employment status, current pregnancy intention, sex of child, size of child at birth, birth order, type of birth, and contraceptive use also had associations with under-five mortality. We conclude that shorter birth intervals are associated with higher under-five mortality. Other maternal and child characteristics also have associations with under-five mortality. Reproductive health interventions aimed at reducing under-five mortality should focus on lengthening birth intervals. Such interventions should be implemented, taking into consideration the characteristics of women and their children.

scholarly journals Exploring spatiotemporal distribution of under-five mortality in Ethiopia: further analysis of Ethiopian Demographic and Health Surveys 2000, 2005, 2011 and 2016

2021 ◽  
Vol 5 (1) ◽  
pp. e001047
Author(s):  
Alemneh Mekuriaw Liyew ◽  
Ayenew Kassie ◽  
Achamyeleh Birhanu Teshale ◽  
Adugnaw Zeleke Alem ◽  
Yigizie Yeshaw ◽  
...  
Keyword(s):  
High Risk ◽  
Health Surveys ◽  
Spatiotemporal Distribution ◽  
Scan Statistics ◽  
Demographic And Health Surveys ◽  
Hotspot Analysis ◽  
Under Five ◽  
Geographical Regions ◽  
Risk Areas ◽  
Benishangul Gumuz Region

ObjectiveThe aim of this study was to explore spatiotemporal distribution of under-five mortality in Ethiopia using data from four (2000, 2005, 2011 and 2016) consecutive demographic and health surveys.MethodsA total of 41 498 children were included from four consecutive Ethiopian Demographic and Health Surveys. The geospatial analysis was conducted by using ArcGIS V.10.7 and saTScan V.9.6. Thus, spatial autocorrelation, hotspot analysis, spatial interpolation and spatial scan statistics were carried out for each survey separately to show the temporal pattern of geographically risk areas of under-five mortality in Ethiopia. Finally, the most under-five mortality rate (U5MR) risk areas in each survey period were mapped.ResultsUnder-five mortality was spatially clustered in Ethiopia (Moran’s Index: 0.046–0.096, p<0.01). The Benishangul-Gumuz region was consistently at a higher risk in the last two decades. Additional hotspot areas were detected at Afar and Amhara (in 2000, 2005, 2016), at Gambala (in 2011) and the South Nation Nationality and People’s (SNNP) Region (in 2016). Moreover, 160 primary clusters were identified. Of these, 85 clusters (log-likelihood ratio (LLR)=13.10, p<0.01) were from Benishangul-Gumuz and Amhara regions (in 2000); 67 clusters (LLR=12.93, p<0.01) were from Afar and Amhara regions (in 2005); 4 clusters (LLR=10.54, p<0.01) were from Benishangul-Gumuz region (in 2011); and another 4 clusters (LLR=11.85, p<0.01) were from Afar region (in 2016).ConclusionHigh-risk areas were detected mainly in the Benishangul-Gumuz and Afar regions. As a result, designing under-five population targeted intervention programmes in those high-risk geographical regions was vital to reduce under-five mortality in Ethiopia.

scholarly journals Understanding the determinants of infant and under-five mortality rates: a multivariate decomposition analysis of Demographic and Health Surveys in Ghana, 2003, 2008 and 2014

2019 ◽  
Vol 4 (4) ◽  
pp. e001658 ◽  
Author(s):  
Duah Dwomoh ◽  
Susan Amuasi ◽  
Kofi Agyabeng ◽  
Gabriel Incoom ◽  
Yakubu Alhassan ◽  
...  
Keyword(s):  
Child Mortality ◽  
Health Surveys ◽  
Child Survival ◽  
Mortality Rates ◽  
Multiple Births ◽  
Demographic And Health Surveys ◽  
Adjusted Relative Risk ◽  
Decomposition Approach ◽  
Development Goal ◽  
Under Five

IntroductionDespite the decline in infant and under-five mortality rates since the last decade, Ghana did not meet the millennium development goal (MDG) 4 target. To implement effective interventions that could fast-track progress towards achieving the sustainable development goal 3 in 2030, factors contributing to the decline in child mortality throughout the MDG period and which factor(s) has/have been consistent in affecting child survival in the last decade need to be understood.MethodsThis study used Demographic and Health Surveys (DHS) from 2003, 2008 and 2014 and data from World Bank Development Indicators (2000–2018). We employed modified Poisson with robust SE and multivariate decomposition approach to assess risk factors of child mortality using DHS data from 2003, 2008 and 2014. Penalised regression was used assess the effect of 25 country-level contextual factors on child survival.ResultsThe risk of infant mortality is approximately five times higher among mothers who had multiple births compared with mothers who had single birth over the last decade (adjusted relative risk 4.6, 95% CI 3.2 to 6.6, p<0.001). An increase in the annual percentage of female labour force participation (FLFP) is associated with the reduction of approximately 10 and 18 infant and under-five annual deaths per 1000 live births, respectively.ConclusionsThis study found that multiple births and shorter birth spacing are associated with increased risk of infant and under-five deaths over the last decade. Increased in FLFP, and the proportion of children sleeping under bed-net are associated with reduced risk of both infants and under-five deaths.

scholarly journals Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014–2018): Analysis of Demographic Health Surveys

2021 ◽  
Vol 18 (9) ◽  
pp. 4578
Author(s):  
Nidhi Wali ◽  
Kingsley E. E. Agho ◽  
Andre M. N. Renzaho
Keyword(s):  
South Asia ◽  
South Asian ◽  
Health Surveys ◽  
Associated Factors ◽  
Common Factor ◽  
Household Wealth ◽  
Health Concern ◽  
Demographic And Health Surveys ◽  
Asian Countries ◽  
Sampling Weights

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.

scholarly journals Trends of inequalities in care seeking behavior for under-five children with suspected pneumonia in Ethiopia: evidence from Ethiopia demographic and health surveys (2005–2016)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gebretsadik Shibre ◽  
Betregiorgis Zegeye ◽  
Dina Idriss-Wheeler ◽  
Sanni Yaya
Keyword(s):  
Health Surveys ◽  
Demographic And Health Surveys ◽  
Care Seeking ◽  
Health Seeking ◽  
Under Five ◽  
Under Five Children ◽  
Care Seeking Behavior ◽  
Seeking Behavior ◽  
Index Of Inequality ◽  
Suspected Pneumonia

Abstract Background Pneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia. Methods Using cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance. Results The percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years. Conclusions Health care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).

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