The decline in child mortality: a reappraisal.

The present paper examines, describes and documents country-specific trends in under-five mortality rates (i.e., mortality among children under five years of age) in the 1990s. Our analysis updates previous studies by UNICEF, the World Bank and the United Nations. It identifies countries and WHO regions where sustained improvement has occurred and those where setbacks are evident. A consistent series of estimates of under-five mortality rate is provided and an indication is given of historical trends during the period 1950-2000 for both developed and developing countries. It is estimated that 10.5 million children aged 0-4 years died in 1999, about 2.2 million or 17.5% fewer than a decade earlier. On average about 15% of newborn children in Africa are expected to die before reaching their fifth birthday. The corresponding figures for many other parts of the developing world are in the range 3-8% and that for Europe is under 2%. During the 1990s the decline in child mortality decelerated in all the WHO regions except the Western Pacific but there is no widespread evidence of rising child mortality rates. At the country level there are exceptions in southern Africa where the prevalence of HIV is extremely high and in Asia where a few countries are beset by economic difficulties. The slowdown in the rate of decline is of particular concern in Africa and South-East Asia because it is occurring at relatively high levels of mortality, and in countries experiencing severe economic dislocation. As the HIV/AIDS epidemic continues in Africa, particularly southern Africa, and in parts of Asia, further reductions in child mortality become increasingly unlikely until substantial progress in controlling the spread of HIV is achieved.

Proximate determinants of child mortality in Liberia.

The study looks at the effects of maternal sociodemographic characteristics and the quality of the environment on child survival through two intervening variables, breast-feeding and prenatal care. A linear structural equation modelling approach was used to examine infant and child survival based on a weighted sample of 5180 Liberian children aged 0-5 years. The findings confirm previous studies, but also reveal complex relationships of the role of education, maternal age and breast-feeding in enhancing child survival.

PIP: The hypothesis that female education has a positive direct influence on child survival was investigated through the use of data from the 1986 Demographic and Health Survey of Liberia. Of the 5180 children born in the 5 years preceding the survey, 873 (17%) had died. Even when other socioeconomic variables were controlled, maternal education had a significant positive direct effect (0.167) on child survival at 5 years of age. The percentage of child loss was 17.9% among mothers with no education, 15.5% among those with a primary education, and 14.0% among mothers with an education above the primary level. This effect was weak, however, when compared to that of breastfeeding. The proportion of child mortality was 41.7% among non-breastfeeding mothers compared to only 8.9% among breastfeeding mothers. To the extent that high maternal educational decreased the propensity to breastfeed in this sample, education has a negative indirect effect on child survival--an effect that is counterbalanced somewhat by the tendency of education to increase the likelihood of obtaining prenatal care, the most important source of knowledge about child health. Moreover, prenatal care has the strongest direct effect on breastfeeding status. The excess risk of child mortality among teenage mothers in this survey (19.8%, compared to 14.9% among mothers 35 years of age and above) is believed to reflect to decreasing prevalence of breastfeeding in younger age groups. Overall, the risk of child death was greater in rural areas (17.75) than urban ones (15.6%), but, for breastfed children, the risk was lower in rural areas. These findings indicate a need for greater attention toward promoting breastfeeding as the central element of child survival campaigns.