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Background
The United Nations Interagency Group for Child Mortality Estimation (UNIGME) indicates that child mortality is the death rate of children between age zero to five. The importance of this area of research is high where worldwide a number of studies have been led on infant and child mortality, despite limited research discoveries with rega...
Context in source publication
Citations
... But, only a scarce number of literatures talked about contextual level effect on under-five mortality. For instance, studies examined that factors such as low level of education, unimproved drinking water and sanitation, low family income, short birth interval, and birth delivery place continue to put children at risk [13][14][15][16]. Besides, there are some demographic determinants associated with under five mortality such as maternal age at birth, birth spacing pattern, parity, and size of the children at birth [17,18]. ...
Background
Many studies have been conducted on under-five mortality in India and most of them focused on the associations between individual-level factors and under-five mortality risks. On the contrary, only a scarce number of literatures talked about contextual level effect on under-five mortality. Hence, it is very important to have thorough study of under-five mortality at various levels. This can be done by applying multilevel analysis, a method that assesses both fixed and random effects in a single model. The multilevel analysis allows extracting the influence of individual and community characteristics on under-five mortality. Hence, this study would contribute substantially in understanding the under-five mortality from a different perspective.
Method
The study used data from the Demographic and Health Survey (DHS) acquired in India, i.e., the fourth round of National Family and Health Survey (2015–16). It is a nationally representative repeated cross-sectional data. Multilevel Parametric Survival Model (MPSM) was employed to assess the influence of contextual correlates on the outcome. The assumption behind this study is that ‘individuals’ (i.e., level-1) are nested within ‘districts’ (i.e., level-2), and districts are enclosed within ‘states’ (i.e., level-3). This suggests that people have varying health conditions, residing in dissimilar communities with different characteristics.
Results
Highest under-five mortality i.e., 3.85% are happening among those women whose birth interval is less than two years. In case of parity, around 4% under-five mortality is among women with Third and above order parity. Further, findings from the full model is that ICC values of 1.17 and 0.65% are the correlation of the likelihood of having under-five mortality risk among people residing in the state and district communities, respectively. Besides, the risk of dying was increased alarmingly in the first year of life and slowly to aged 3 years and then it remains steady.
Conclusion
This study has revealed that both aspects viz. individual and contextual effect of the community are necessary to address the importance variations in under-five mortality in India. In order to ensure substantial reduction in under-five mortality, findings of the study support some policy initiatives that involves the need to think beyond individual level effects and considering contextual characteristics.
... Additionally, the trends and features of the population have changed over time, due to changes in factors such as population size, density, age distribution, natality, mortality, growth, and fertility [24]. A 2021 study on child mortality in Sri Lanka only considered household characteristics and did not take into account the delivery method, type of birth, gender of the child, or the mother's characteristics, such as seeking antenatal care (ANC) and taking antenatal supplements [25]. The study results showed that place of residence, education level of the household head, sources of drinking water, and ethnicity were significantly associated with U5M. ...
Under-five mortality (U5M) is considered a major public health issue directly impacts a country's development. This study analyzed the prognostic factors of U5M in Sri Lanka using data from the 2016 Demographic and Health Survey (DHS) of 8123 children. The study employed both a binary logistic regression model (BLRM) and a binary logistic random intercept multilevel model (BLRIMM) and compared the accuracy of each model's prediction percentage. The results showed that the BLRIMM had a higher correct prediction percentage (98.67%) compared to the BLRM (98.31%). The study found that children who were not breastfed (Odds Ratio (OR) = 116.74, 95% Confidence Interval (CI) = 62.97-216.41), were part of multiple births (OR = 3.73, 95% CI = 1.21-11.51), did not have a normal delivery (OR = 1.86, 95% CI = 1.11-3.12), were born to mothers who had experienced previous miscarriages or child loss (OR = 2.27, 95% CI = 1.26-4.11), and were born to mothers with a higher Body Mass Index (BMI) (OR = 1.05, 95% CI = 1.003-1.10) had higher odds of U5M. The odds of U5M were found to be lower among Buddhists (OR = 0.06, 95% CI = 0.01-0.50), Hindus (OR = 0.05, 95% CI = 0.01-0.46), and Roman Catholics (OR = 0.032, 95% CI = 0.003-0.307) compared to the "Other Religions" category in the dataset. The estimated covariance parameter of the random intercept (0.8231, p-value = 0.0405) indicated significant unobserved cluster-level variation in U5M. The study's results emphasize the importance of addressing religion related differences of U5M and improving maternal education regarding healthy lifestyle, proper food intake, the significance of breastfeeding, safe delivery methods, safety measures during pregnancy and childbirth in cases of multiple births, and proper child care after birth.
... Noor & Udddin (2021) also found out that mother's education, higher birth order, and size of child at birth had a significant effect on child mortality in Bangladesh. Jayathilaka et al. (2021) explored socioeconomic and demographic factors associated with child mortality in Sri Lanka, and the improved source of drinking water had a lower risk of child mortality. In Afghanistan, place of residence, wealth index, age at first birth, and household size were found to be key determinants of child mortality (Shonazarova & Eshchanov, 2020). ...
Ethiopia is among the five countries which account for half of the global under-five deaths, with the under-five mortality rate of 67 deaths/1000 live births in 2016. Ethiopia had significant inequalities in child mortality between rural and urban areas where the risk of child mortality is largely higher in rural than urban areas. Inequalities in the distribution of factors influencing child mortality need to explain the gap between and within urban-rural areas. The study used the risk of child mortality as an outcome variable. Multilevel logistic regression was used as a standard model for assessing the effect of socioeconomic and contextual factors on child mortality. Furthermore, the Blinder-Oaxaca decomposition technique was used to explain the urban-rural, intra-rural, and intra-urban inequalities in child mortality. The birth order and sanitation type seem to be the most important explanatory factors, followed by wealth status in explaining the rural-urban inequality of 39 deaths/1000 children. Mean proportion indicates that there would be 47 deaths/1000 children for urban poor and 21 deaths/1000 children for urban non-poor, resulting in 26 deaths/1000 children change in urban poor when applying the urban non-poor coefficient and characteristics to urban poor behavior. The findings showed that some residential inequalities in child mortality occur at a level that could be addressed by targeting children, households, and some occurs at a community level that could be addressed by targeting regions. Therefore, any residential sensitive and specific interventions should consider child’s and household’s characteristics, and geographical location.
... ВСТУП. До основних критеріїв, що відображають стан соціально-економічного благополуччя населення країни, належать дитяча захворюваність і смертність [1]. Плацентарна дисфункція є причиною цієї соціальної проблеми [2,3]. ...
Вступ. Плацентарна дисфункція спричиняє перинатальну захворюваність і смертність. Одним з основних методів, що дозволяють їх знизити, є своєчасна діагностика патологічних станів, які впливають на життя та здоров’я дитини. Порушення росту і розвитку плода – це ускладнення пренатального періоду, яке може призвести до вкрай несприятливих наслідків. Вивчення ролі активації процесів пероксидного окиснення ліпідів (ПОЛ) у патогенезі ушкодження плаценти при дисфункції є важливим у сучасній медицині. Також розробка нових методів лікування плацентарної дисфункції дозволить знизити перинатальні втрати й ускладнення. Мета дослідження – дослідити зміни ПОЛ і показників системи антиоксидантного захисту (АОЗ), оцінити роль цих процесів у патогенезі плацентарної дисфункції, розробити комплексний метод терапії плацентарної дисфункції та оцінити його вплив на зміни в системі ПОЛ і АОЗ, внутрішньоутробний стан плода, ефективність для зменшення перинатальних втрат. Методи дослідження. Досліджували зміни ПОЛ і показників системи АОЗ у вагітних із плацентарною дисфункцією. Жінок, залежно від методу лікування, поділили на 2 групи: 1-ша – 25 вагітних, які отримували загальноприйняту терапію; 2-га – 25 вагітних, які одержували розроблену терапію і в яких у термін гестації 32–36 тижнів під час ультразвукового дослідження виявлили плацентарну дисфункцію. Контрольну групу становили 30 жінок з фізіологічним перебігом вагітності, які народили живих доношених дітей із масо-ростовими характеристиками відповідно до гестації. Здійснено клініко-статистичний аналіз перебігу вагітності, пологів і стану новонароджених у вагітних із плацентарною дисфункцією після проведеного комплексного лікування з використанням препарату “Тіворель” (1 мл 42 мг аргініну гідрохлориду та 20 мг левокарнітину) в формі розчину для інфузій по 100 мл 1 раз на добу курсом 7 днів внутрішньовенно. Результати й обговорення. За результатами проведеного дослідження встановлено, що в патогенезі плацентарної дисфункції зростала активність ПОЛ і знижувалися показники системи АОЗ. Запропонована терапія корегувала дисбаланс ПОЛ та системи АОЗ, позитивно впливала на стан внутрішньоутробного плода за даними кардіотокографії, ультразвукового дослідження. Висновки. Дисрегуляція співвідношення ПОЛ та показників системи АОЗ призводить до накопичення активних форм кисневих метаболітів, які на молекулярному рівні є патогенетичним ланками плацентарної дисфункції у вагітних. Активація ПОЛ не тільки впливає на молекулярний механізм ушкодження клітин, але одночасно направлена на формування компенсаторно-пристосувальних реакцій. Залежно від вираження оксидативного стресу відбуваються зміни у фетоплацентарному комплексі вагітних у фазу компенсації чи декомпенсації. Результати проведених досліджень вказують на те, що плацентарна дисфункція у вагітних супроводжується значними гемодинамічними змінами у фетоплацентарному комплексі. Застосування аргініну гідрохлориду та левокарнітину в терапії плацентарної дисфункції у вагітних ефективно стабілізує функціональний стан плода.
... Fertility and mortality are the indicators of population growth and are essential for social and national development (Centers For Disease Control and Prevention, 2013;Population Council, 2009;Vollset et al., 2020). The reproductive performance of women is influenced by the socioeconomic status of the population (Jayathilaka et al., 2021). Socioeconomic and environmental disparities have been observed to be higher among particularly vulnerable groups than in the general population (Damodar et al., 2015;WSR, 2020). ...
An attempt has been made to understand the reproductive behaviour of the Gond (146), Birhor (151) and Kawar (78) tribes of Bilaspur, Chhattisgarh. The study focuses on the role of socioeconomic and cultural factors responsible for the variation and continuum in woman’s fertility and from live births to child mortality. It involves a mixed-method approach to assess the measures of fertility and mortality by using the standard formula after Barclay (1958) and Bogue (1969). Despite the child–woman ratio being high among Kawar (1857.14) followed by Birhor (833.33) and Gond (766.66), it is observed that the total fertility rate is high among Birhor (11.8) followed by Gond (9.8) and Kawar (8.5) indicating women experiencing a greater number of live births, especially among Birhor. Further, the mortality rates indicate that neonatal deaths (93.75) among the Kawar tribe, and under five mortality (148.14) among Birhor are high. This can be attributed to the influence of socioeconomic and cultural factors. It reveals that fertility is high among the study population(s) to substantiate the prenatal and postnatal loss.
... Many studies have been conducted on under-ve mortality in developing countries like India and most of them focused on the associations between individual-level factors and under-ve mortality risks. But, only a scarce number of literatures talked about contextual level effect on under-ve mortality [13,14,15,16,17,18,19]. A notable increase in the coverage of interventions relevant to child survival, such as births in a health facility, skilled birth attendance, antenatal care visit, coverage of breastfeeding within 1 hour of birth and exclusive breastfeeding for children etc. have a signi cant contribution in reducing child mortality [21]. ...
... Our ndings go in line with the earlier studies where authors have tried to look into under-ve mortality and its predictors. For instance, studies examined that factors such as low level of education, unimproved drinking water, and low family income, short birth interval, and birth delivery place continue to put children at risk [13,14,15,16]. Besides, there are some demographic determinants associated with under ve mortality such as maternal age at birth, birth spacing pattern, parity, and size of the children at birth [17,18]. ...
Background
Many studies have been conducted on under-five mortality in India and most of them focused on the associations between individual-level factors and under-five mortality risks. On the contrary, only a scarce number of literatures talked about contextual level effect on under-five mortality. Hence, it is very important to have thorough study of under-five mortality at various levels. This can be done by applying multilevel analysis, a method that assesses both fixed and random effects in a single model. The multilevel analysis allows extracting the influence of individual and community characteristics on under-five mortality. Hence, this study would contribute substantially in understanding the under-five mortality from a different perspective.
Method
The study used data from the Demographic and Health Survey (DHS) acquired in India, i.e., the fourth round of National Family and Health Survey (2015-16). It is a nationally representative repeated cross-sectional data. Multilevel Parametric Survival Model (MPSM) was employed to assess the influence of contextual correlates on the outcome. The assumption behind this study is that ‘individuals’ (i.e., level-1) are nested within ‘districts’ (i.e., level-2), and districts are enclosed within ‘states’ (i.e., level-3). This suggests that people have varying health conditions, residing in dissimilar communities with different characteristics.
Results
Highest under-five mortality i.e., 3.85% are happening among those women whose birth interval is less than two years. In case of parity, around 4% under-five mortality is among women with Third and above order parity. Further, findings from the full model is that ICC values of 1.17% and 0.65% are the correlation of the likelihood of having under-five mortality risk among people residing in the state and district communities, respectively. Besides, the risk of dying was increased alarmingly in the first year of life and slowly to aged 3 years and then it remains steady.
Conclusion
This study has revealed that both aspects viz. individual and contextual effect of the community are necessary to address the importance variations in under-five mortality in India. In order to ensure substantial reduction in under-five mortality, findings of the study support some policy initiatives that involves the need to think beyond individual level effects and considering contextual characteristics.
