Infant and child mortality determinants in Bangladesh: are they changing?

From the data of the 1989 Bangladesh Fertility Survey, aggregate deaths reported at ages 0-12 and 13-60 months are used to estimate infant and child mortality. Multivariate analysis shows that preceding birth interval length, followed by survival status of the immediately preceding child, are the most important factors associated with differential infant and child mortality risks; sex of the index child and mother's and father's education are also significant. Demographic factors are influential during infancy as well as childhood, but social factors, particularly mother's and father's education, now emerge as significant predictors of infant mortality risks. This indicates a change in the role of socioeconomic factors, since the earlier Bangladesh Fertility Survey in 1975.

PIP: This study identifies the risk factors associated with infant and child mortality in Bangladesh. The data are obtained from the 1989 Bangladesh Fertility Survey. Since 1975, infant and child mortality declined. In 1975, the determinants of child survival were sex of the child, maternal age at birth, birth order, preceding birth interval, and survival of preceding sibling: all demographic factors. This study finds that both mothers' and fathers' educational status were negatively related to mortality. The lowest rates of mortality occurred among births to either parent who had a secondary level of education. Mothers' education had a greater impact than fathers' education. Infant mortality was higher among births to teenage mothers and to mothers older than 35. Infants with parents living in rural areas had higher rates. Child mortality showed similar relationships, with the exception that females had higher child mortality rates and children following a sibling death had lower child mortality rates. Multivariate analyses indicate that child survival was highly significantly affected by both demographic and socioeconomic factors. The effects of birth interval and survival of the preceding child were stronger than the effects of fathers' or mothers' education. The determinants of infant and child mortality in 1989 differed from the determinants in 1975. The influence of educational status increased to include fathers' educational status. Both parents' educational status in 1989 influenced infant mortality. Findings suggest the greater influence of social factors in explaining differential mortality risks. The influence could be due to reduced mortality levels or changes in educational status or both. Policy should be directed to spacing births, special care to women with a previous history of pregnancy loss, and increased educational status.

Socioeconomic and environmental determinants of child survival in Bangladesh.

Differentials in child survival in Bangladesh have been examined using a number of socioeconomic and environmental factors on data from the 1989 Bangladesh Fertility Survey. Multivariate analysis reveals that both wife's and husband's education and household electricity show a significant positive association with child survival. The respondent's working status exerts a significant negative influence. Wife's education has a greater influence on child survival in Bangladesh than that of husband's education.

PIP: Statisticians used number of living children and total number of children ever born for each respondent of the 1989 Bangladesh Fertility Survey who had at least one live birth to determine the child survival index. They then controlled for the age of the mother to examine the differentials in child survival by using socioeconomic and environmental factors. The child survival index increased with parents' education. Mother's education had a greater positive effect than did father's education (among 20- 29 year old mothers, 79.9% for no education, 85.2% for primary education, and 90.4% for at least secondary education vs. 79.5%, 81.3%, and 87.8%, respectively, among same age fathers). Multivariate analysis showed that mother's and father's education and the presence of household electricity had a significant positive effect on child survival (T .0001). Enhanced knowledge about prevention, recognition, and treatment of childhood diseases probably explained the positive effect of mother's education. The positive effect of father's education and household electricity was mainly through higher socioeconomic status, indicating perhaps the ability to obtain child health care. On the other hand, mother's paid work had a significant negative effect on child survival (T .0001). Just 11% of all mothers worked. Working mothers tended to be from the lowest socioeconomic group. The multivariate analysis also indicated that the child survival index increased more between educational status levels for the mother than for the father (2.9 vs 1.6%). All the variables in the analysis accounted for only 5.6% of the total variation in the child survival index. These results indicated that an increase in male and female education, which should in turn increase socioeconomic status, and electrification, especially in rural areas, would improve child survival in Bangladesh.

Socioeconomic, demographic and environmental determinants of infant mortality in Nepal.

The Nepal Fertility and Family Planning Survey of 1986 demonstrated that demographic variables, previous birth interval and survival of preceding child, still predominated as determinants of infant mortality, particularly in rural areas of Nepal. However, in urban Nepal, where the level of socioeconomic development is higher, an environmental variable, along with previous birth interval and survival of preceding child emerges as important in determining infant mortality. Separate policy measures for child survival prospects in rural and urban Nepal are suggested.

PIP: The analysis of the 1986 Nepal Fertility and Family Planning Survey, based on a representative sample of 5-29 married women 15-50 years, was consistent with the hypothesis that demographic factors are more important in early stages of development, with socioeconomic and environmental factors gaining importance as development proceeds. The 1976 Nepal Fertility Survey also reveals the pattern of high infant mortality rates as a reflection of maternal age, parity, previous birth interval, and survival of preceding child. The infant mortality rates fell between 1976-86 from 150 to 100/1000. Urban areas are beginning to show environmental variables as determinants of infant mortality. In urban Nepal, the logit linear model of the effect of socioeconomic, environmental, and demographic factors show maternal age and birth order as significant determinants of infant mortality, regardless of whether demographic or socioeconomic variables are controlled. Mothers 20 years experience a risk of infant death 51% greater than mothers 20-29 years, and 50% higher than mothers 30 years. 1st born children have the lowest risk of dying during infancy and risk increases with birth order. Drinking water and toilet facilities were also significant factors. The probability of dying is 44% higher for those drinking lake or river water than those using piped or tube well water. Those without a toilet have a 64% higher probability of dying than those with their own toilet facility. These 2 variables are significant and enhanced even after controlling for maternal age and birth order. When a logit linear model is run with only 2 nd and higher order birth with birth interval and preceding child as control variables, only toilet facility has a significant effect. Birth interval and survival of preceding child become the significant demographic variables. The joint model of birth interval, survival of preceding child, and toilet facility has significant effects on infant mortality. Children born after a short interval (19 months) with the preceding child dead have a lower mortality due to lack of competition. The policy implications are to increase the use of contraception, to reduce births of young mothers, and insure adequate birth intervals. High risk households need special attention from family planning and health services.

Breast-feeding, birth interval and child mortality in Bangladesh.

The 1975-76 Bangladesh Fertility Survey data show little evidence that breast-feeding is the intermediate factor through which birth intervals influence child survival in Bangladesh. Preceding birth interval, subsequent pregnancy and breast-feeding duration each have an independent influence on early mortality risk. Within a specific interval the risk of dying decreases with increase in duration of breast-feeding, and also with an increase in the time between the index birth and the next pregnancy. The death of the immediately preceding child in infancy has a significant negative effect on the survival chance of the index child at ages 1-5 months. However, death of the preceding child appears to have a significantly positive effect on the survival chance of the index child between ages 9 months and 5 years; this may be related to competition between siblings.

PIP: Between December 1975-march 1976, interviewers gathered data on 6513 ever married women 50 years old for the Bangladesh Fertility Survey. Researchers from the University of Chittagong analyzed the data to learn the extent breast feeding has on birth intervals and the extent both breast feeding and birth intervals have on early mortality. Breast feeding had the strongest effect on reducing mortality for ages 1-4, 5-8, and 9-15 months (p.01), but after 15 months it did not have a significant effect. In fact, it surpassed the influence of timing of the next conception and the preceding birth interval. The detrimental effects of non-breast feeding contributed more to child mortality than did maternal depletion and competition with a sibling. Further, negligible differences occurred in the estimates of next conception with and without controlling breast feeding. These results did not support the theory that breast feeding is the intermediate factor through which birth intervals, especially next conception, influence child survival. Indeed they indicated that preceding birth interval, timing of next conception, and breast feeding each separately influence mortality at an early age. The child mortality risk at ages 1-4 months was lower for the group with an alive preceding sibling than those from the group with a dead preceding sibling. Yet there was no difference in the risk of dying at 5-8 months between these 2 groups. Furthermore, the group with a preceding sibling alive had a higher risk of dying at 9-59 months, than the group with no preceding sibling alive. Therefore competition is the more plausible mechanism of the influence of the survival status of the preceding child on mortality in childhood or late infancy.

Child survival and its effect on mortality of siblings in Bangladesh.

This study of the relationship between mortality risks of siblings born to the same mother shows that, in Bangladesh, the death of the immediately preceding sibling in its infancy has a negative influence on the survival chance of the child in question in its infancy; however, death of the preceding sibling appears to have a positive influence on the index child's survival at ages 1-5 years. Similar results are found for the survival status of the two preceding siblings. Preceding birth interval length and survival status and sex of the immediately preceding sibling are also significant predictors of child mortality between ages 1 and 5 years. Possible explanations may be that the index child faces stronger competition from its immediately preceding brother than from its immediately preceding sister, or that the index child is likely to be looked after more by its preceding sister than by its preceding brother.

Maternal factors and infant and child mortality in Bangladesh.

PIP: Using data from The World Fertility Survey, this study shows that the length of the preceding birth interval was the most important maternal factor influencing infant and child mortality risks in Bangladesh. This was such a crucial factor that its effects remain unaltered whether or not the influences of mother's age at birth and birth order are controlled. Infant and child mortality in Bangladesh can be expected to decline considerably if successive births can be spaced by an interval of at least 1.5 years. Child spacing seems to be the major factor requiring program attention. The effects of mother's education and place of residence on infant and child mortality are independent of the effects of maternal age at birth, birth order, and the preceding birth interval. The higher survival chances of children of educated mothers resulted neither through the age at which childbearing started nor through birth spacing but are likely to be related to their smaller family size and to other non-maternal proximate determinants of early mortality.^ieng

Physiology and bio - chemistry of germination of different types of seeds - v protein and sugar contents of seeds under the influence of different spectral bands of light.

The estimation of total protein and total sugars of cucumber, mango, paddy, radish and tomato seeds in dry, wet and germinating conditions were studied. Also the results are discussed in the light of possible physiological and bio - chemical change taking place inside the seeds during the process of absorption and germination.

Frequency analysis of adventitious lung sounds.

Adventitious lung sounds from twenty patients with respiratory diseases have been recorded and analysed by analogue methods. The results obtained are compared with those from five normal subjects. The difference in the frequency components of lung sounds from patients with pulmonary obstruction in the airways and those from normal subjects are pointed out. This technique may well prove to be an objective method of diagnosis in pulmonary medicine.

Iron and hemoglobin status of the offspring of guinea pigs whose mother received large doses of vitamin C during pregnancy and lactation.

1. Lower level of serum and liver iron were noted in the offspring of experimental group quinea pigs who received 1, 2 and 3 mg ascorbic acid per 100 g body weight per day. 2. Similar results were obtained in the hemoglobin content of same animals. 3. Normal values were observed for hemoglobin and the content of iron in serum and liver in the same group of offsprings when they were fed 4 mg ascorbic acid per 100 g body weight per day.

Effects of high intake of vitamin C by the guinea pigs in pregnancy and lactation on the tissue levels of the vitamin in their offspring.

1. Though the growth-rate of the guinea pigs of both the groups - control and experimental were almost same, the gain in body weight in the offspring of experimental group animals were observed to be less when they were fed 1, 2 and 3 mg ascorbic acid per 100 g body weight per day. 2. Ascorbic acid content in the tissues of the offspring maintained on 1, 2 and 3 mg ascorbic acid belonging to the experimental group were low. 3. The rate of growth and the tissue content of ascorbic acid were found to be normal in the same group of animals when they were supplemented with 4 mg ascorbic acid per 100 g body weight daily.

Effect of ascorbic acid on histamine metabolism in scorbutic guinea-pigs.

1. In guinea-pigs fed an ascorbic-acid-free diet, as the ascorbic acid levels decreased the histamine levels in blood and urine rose steadily to maxima in about 10-12 days. The elevated histamine levels persisted in the blood and urine of scorbutic guinea-pigs and the histamine levels in lung, gastric mucosa and spleen also increased. The increased histamine content of the urine, blood and other tissues in the ascorbic-acid-depleted condition could be brought back to normal levels by administration of a single dose of ascorbic acid 5 mg/100 g body wt. guinea-pig. 3. The drop in the elevated histamine level was not due to an indirect effect of ascorbic acid on histamine forming capacity, histaminase activity or histamine release.

Growth and ascorbic acid metabolism in rats and guinea pigs fed cereal diets.

The nutritional values of the whole grain principal cereals, namely, wheat, rice, corn, and a millet bajra, were investigated by growth studies and studies on ascorbic acid metabolism in rats and guinea pigs. Growth was markedly retarded by feeding the rats unfortified whole grain cereals. Among the whole grain cereals, rice provided the lowest nutritional value, and the cooking of rice affected the nutritional value further. In weanling rats, ascorbic acid synthesis at the subcellular level was inhibited, and tissue storage of ascorbic acid was decreased in rats fed whole grain cereals. In guinea pigs fed whole grain cereals, the utilization of ascorbic acid was increased. Ascorbic acid supplementation at various levels indicated that the requirement for ascorbic acid increased five times in guinea pigs fed whole grain cereals. The increased intake of the vitamin was not needed when the whole grain cereals were enriched with 15% casein.

Nutrient interrelationship of ascorbic acid and iron in rats and guinea pigs fed cereal diets.

Iron at a daily dose of 5 mg per animal was toxic to rats and guinea pigs fed unfortified whole wheat flour and whole rice flour diets. In rats, a species capable of synthesizing ascorbic acid, iron supplementation resulted only in decreased growth. In guinea pigs, iron administration resulted not only in decreased growth but also in high mortality. The apparent toxicity of iron was not observed when wheat flour was fortified with 15% casein. In guinea pigs, administration of ascorbic acid (k mg per 100 g body weight per day) along with iron not only counteracted the toxic effect of iron, but also led to a greater utilization of iron as revealed by increased hemoglobin and serum iron levels accompanied by decreased spleen iron content. Iron administration, however, resulted in decreased ascorbic acid synthesis (in rats only) and increased ascorbic acid utilization as revealed by lowered urinary, blood, and other tissue levels of the vitamin.