Social factors,nutrition and child mortality in a rural subsistance economy

Data from the Zambia National Nutrition Status Survey was used to identify socioeconomic, health, and nutritional factors associated with child mortality among rural residents. In each sample village, all children, who were both under the age of 5 and the youngest child in the family, were given physical examinations and their mothers were interviewed about the socioeconomic characteristics of the family. Mothers were also asked to provide information on the number of live births they had and on the number of children they had who died. Physical disorders, revealed in the physical examinations, were analyzed in regard to their relationship to sibling death rates, and the socioeconomic characteristics of the family were analyzed in regard to their relationship to the child deaths reported by the mothers. Findings were 1) high sibling death rates were positively associated with the presence of malaria and with the presence of malnutrition in the youngest child in the family; 2) the role of malaria in sibling deaths was greater than the role of malnutrition; 3) social factors associated with high child deaths were parental residence in tribal areas, high maternal parity, and low parental educational attainment; 4) subsistence farm families lost 26.0% of their children compared to other occupational groups which lost an average of 20.9% of their children; 5) polygamously married women lost 28.7% of their children compared to monogamously married women. These findings will be used to help formulate policies aimed at reducing the high child mortality rates in rural Zambia. Only after this rate is reduced will rural residents be receptive to family planning.     

Non-specific and sex-differential effects of vaccinations on child survival in rural western India

Background

Studies from Africa have suggested marked non-specific effects (NSEs) of routine vaccinations with effects on child survival. There have been few studies from Asia. We re-analyzed a study from Maharashtra, India, which had collected information on vaccinations during infancy and survival until 5 years of age.

Design

4138 children born between 1987 and 1989 were visited at home every three months to collect information on nutritional status and vaccinations. Since nutritional status was a determinant of time to vaccinations, we adjusted for nutritional status in the analyzes of the association between vaccinations and mortality.

Setting

45 contiguous villages in Shirur Administrative Block in Pune District.

Main outcome measures

Mortality rate ratios (MRR) for different vaccination status groups.

Results

The study area has male preferential treatment, but the female–male mortality ratio varied between age groups with different pre-dominant vaccines; it was high in the age group in which diphtheria–tetanus–pertussis (DTP) vaccine predominates and low in the age group in which measles vaccine (MV) is given. Children who followed the WHO recommended schedule of first BCG and then DTP vaccination were vaccinated earlier than other children (p < 0.01). Two-thirds of the children had received BCG and DTP out-of-sequence, i.e. BCG and DTP simultaneously or BCG after DTP. Children who received BCG and DTP simultaneously or BCG as most recent vaccination had significantly lower mortality than children having DTP as the most recent vaccination, the mortality rate ratio being 0.15 (0.03–0.70).

Conclusions

BCG out-of-sequence may be associated with lower mortality than DTP as the most recent vaccination. Given the public health implications, this possibility should be tested in randomized trials. Excess female mortality may also be related to vaccination policy.     

Risk factors of infant and child mortality in rural Burkina Faso

OBJECTIVE: The aim of the study was to quantify the effect of risk factors for childhood mortality in a typical rural setting in sub-Saharan Africa. METHODS: We performed a survival analysis of births within a population under demographic surveillance from 1992 to 1999 based on data from a demographic surveillance system in 39 villages around Nouna, western Burkina Faso, with a total population of about 30000. All children born alive in the period 1 January 1993 to 31 December 1999 in the study area (n = 10 122) followed-up until 31 December 1999 were included. All-cause childhood mortality was used as outcome variable. FINDINGS: Within the observation time, 1340 deaths were recorded. In a Cox regression model a simultaneous estimation of hazard rate ratios showed death of the mother and being a twin as the strongest risk factors for mortality. For both, the risk was most pronounced in infancy. Further factors associated with mortality include age of the mother, birth spacing, season of birth, village, ethnic group, and distance to the nearest health centre. Finally, there was an overall decrease in childhood mortality over the years 1993-99. CONCLUSION: The study supports the multi-causation of childhood deaths in rural West Africa during the 1990s and supports the overall trend, as observed in other studies, of decreasing childhood mortality in these populations. The observed correlation between the factors highlights the need for multivariate analysis to disentangle the separate effects. These findings illustrate the need for more comprehensive improvement of prenatal and postnatal care in rural sub-Saharan Africa.     

Disability, psychosocial factors and mortality among the elderly in a rural French population

The purpose of this work is to identify risk markers of mortality in a cohort of 645 people aged 60 and over. The study was carried out in rural areas in south west France. Data were collected by questionnaire in 1982. Mortality was determined 4 years later; 111 deaths were registered. The analysis of age-adjusted odds ratios (OR) showed strong relationships between mortality and disability (OR = 7.75), compared health (OR = 3.94), self-rated health (OR = 2.47), home comfort (OR = 0.52), physical activity (OR = 0.32), sociability (OR = 0.43) and two subjective well-being items: the feeling of uselessness (OR = 3.51), and the lack of projects for the future (OR = 2.35). By contrast, no significant association was observed with reported morbidity and social support. Two multivariate analyses were performed: the first on longevity using Cox's regression model, the second on mortality using a linear discriminant analysis. The results of these analyses were translated into a simple set of 8 independent risk markers for the identification of a "high risk group" of mortality within 4 years. The sensitivity of this mortality risk indicator was 73% and its specificity 77%.     

Gender differences in body mass index in rural India are determined by socio-economic factors and lifestyle

A survey of the nutritional status of women in 6 villages of the Pune district of Maharashtra, India, found young women to have a significantly lower BMI than their male peers. The purpose of this study was to identify social and economic factors associated with this difference in thinness and to explore the behavior in men and women that might underlie these associations. We compared men and women in 90 families in this part of Maharashtra by taking measurements of the height and weight of the married couple of child-bearing age in each family and assessing their social and economic details, fasting practices, and oil consumption. In this agricultural community, women were thinner in joint land-owning families, where the main occupation was farming, than those in nonfarming families. This was not true of men in this type of family. Men in "cash-rich" families had higher BMI than men in families without this characteristic. There was no corresponding difference in women's BMI. We then examined the lifestyles of men and women in a subset of 45 of these families. Women were more likely to work full time in farming than men, to carry the burden of all household chores, to have less sleep, and to eat less food away from home than men. Women fasted more frequently and more strictly than men. Despite identifying significant differences in behavior between men and women in the same household, we did not find a direct link between behavior and BMI. We conclude that being married into a farming family is an important factor in determining the thinness of a woman in rural Maharashtra.     

The educational status of parents, and infant and child mortality in rural North India

The task of this discussion is to disentangle the various forces which influence the probability of death for children and, where possible, to identify the independent role of education. This discussion is one of a series of explorations of the mortality and fertility experiences of a sample of couples from North India. The analysis is based on interviews with a rural sample of husbands and wives living in 120 villages in Uttar Pradesh State in India. Information concerning fertility and mortality is based on the retrospective fertility histories collected in 1972. The population is heavily dependent upon agriculture, and it is poor and has little formal education. Per capita income at the time of the survey was less than $100/year, and 52% of the husbands and 87% of the wives had never been to school. The crude birth rate is over 50/1000 and the total fertility rate is 7.7. The overall level of infant mortality in the uncorrected data is on the order of 170/1000 births. For the 2nd and 3rd years of life the mortality rate is 74/1000 children surviving the 1st year. There are considerable differences in the mortality experience of children according to the educational attainment of their parents. In general, the mortality differentials between those with no education and those with a moderate amount of education are small, but for all 3 measures of education, children with the most educated parents experience substantially lower levels of mortality. Those households where the mother has had some education tend to have lower female than male mortality rates, i.e., children of both sexes born into those households experience lower levels of mortality than do children born into households where neither parent or only the father is educated, but female children do particularly well. A clear measure of association between education and mortality is shown, but these measures are suggestive. To examine further the role of education as a determinant of mortality, the multivariate correlates of mortality in the neonatal and postneonatal periods are examined separately. In each case the determinants of death are examined in the context of a complex model of behavior. The regressions show a reasonably high degree of explanation of mortality during the 1st month of life, but education is not a significant explanatory variable in any of the regressions. In the multivariate context the influence of education in the postneonatal period is restricted to female births. Those girls born to households where the mother has received some education are significantly less likely to die than are the counterparts born to families where neither parent is educated or just the father has attended school. In sum, education is not a statistically significant predictor for the mortality probability of males in either age group, but it is a significant and robust predictor of female mortality in the postneonatal period.     

Longitudinal study of heart disease in a Jamaican rural population. 2. Factors influencing mortality

The relationship between cardiovascular characteristics and mortality was investigated in an epidemiological study of heart disease in a representative adult rural community in Jamaica. Of 449 men and 469 women followed up for 5 years, 36 men and 28 women died and the data concerning their status as regards arterial pressure, electrocardiographic abnormalities, and histories of effort pain at the intial survey have been analysed. Cardiovascular disease, and heart disease in particular, was the major cause of death in this population. Blood pressure levels exceeding 160/95 mm Hg had been recorded in about one third of the men and half the women who died and a clear trend was found between overall mortality and arterial pressure. Symptoms of effort pain and ECG abnormalities compatible with myocardial ischaemia, both of which were unexpectedly common, appeared to have independent prognostic significance. The prognosis of each was worse when associated with hypertension; hypertension unaccompanied by either effort pain or ECG “ischaemic” abnormality, on the other hand, caused no excess mortality in either sex within the period of follow-up. Although classical myocardial infarction was confirmed to be relatively infrequent, myocardial disorders with many of the features of ischaemic heart disease are an important cause of death in rural Jamaicans.     

Reducing child mortality in India in the new millennium

Globally, child mortality rates have been halved over the last few decades, a developmental success story. Nevertheless, progress has been uneven and in recent years mortality rates have increased in some countries. The present study documents the slowing decline in infant mortality rates in india; a departure from the longer-term trends. The major causes of childhood mortality are also reviewed and strategic options for the different states of India are proposed that take into account current mortality rates and the level of progress in individual states. The slowing decline in childhood mortality rates in India calls for new approaches that go beyond disease-, programme- and sector-specific approaches.     

Socio-economic factors associated with malaria in a tribal area of Orissa, India

Study on the socio-economic factors and human behaviour in a cross-section of tribal communities in Sundargarh district, Orissa revealed that poor socioeconomic status and socio-cultural factors play important role in maintaining high degree of malaria transmission. Human behaviour such as location of hamlets, type of housing, sleeping habits, outdoor activities after dusk, poor knowledge about the disease and treatment seeking behaviour are of great significance as determinants of malaria transmission. All these factors need to be considered before planning community health programme. Estimation of economic loss due to malaria showed an average loss of 8.96 mandays per malaria patient with an average loss of 3.84 mandays to other family members. Mean total loss per malaria episode comes to Rs.334.91. The study showed that malaria is one of the major disease affecting the tribals to the greatest extent and putting a lot of burden on the economic upliftment of these communities.     

Diet and nutritional status of adolescent tribal population in nine states of India

Tribal population constitutes about 8% of the total population in India. They are particularly vulnerable to undernutrition, because of their geographical isolation, socio-economic disadvantage and inadequate health facilities. Recognizing the problem, Government of India launched different programmes for their welfare. Adolescence is a significant period of growth and maturation. The nutritional status of adolescent girls, the future mothers, contributes significantly to the nutritional status of the community. Therefore an attempt was made to assess the diet and nutritional status of adolescent population from the different tribal areas of India. The available database collected by National Nutrition Monitoring Bureau (1998-99) was utilized for this purpose. Data on a total of 12,789 adolescents (10-17 yrs) was included for the analysis. Four percent of the adolescent girls were married and less than 1% were either pregnant (0.4%) or lactating (0.7%) at the time of the survey. The mean intake of all the foodstuffs, especially the income elastic foods such as Pulses, Milk & Milk products, Oils & fats and Sugar & Jaggery were lower than the recommended levels of ICMR. The intake of all the foodstuffs except green leafy vegetables was lower than that of their rural counterparts. The intake of all the nutrients were below the recommended level, while that of micronutrients such as iron, vitamin A and riboflavin were grossly inadequate in all the age and sex groups. About 63% of adolescent boys and 42% of girls were undernourished (< 5th BMI age percentiles of NHANES). A significant association between undernutrition and socio-economic parameters like type of family, size of land holding and occupation of head of household was observed. Therefore, there is a need to evolve comprehensive programmes for the overall development of tribal population with special focus on adolescents.     

西部农村小学生视力不良影响因素分析

目的 探讨西部农村小学生视力不良发生率和配镜率与个体及学校间的关系,为制定有效干预措施提供依据。方法 在西部陕西省A市和甘肃省B市农村随机抽样251所小学,对学校的校长和19803名4~5年级小学生进行标准化问卷调查,并用ETDRS视力表对学生进行视力筛查。结果 4~5年级学生视力不良发生率为24.16%,视力不良学生配镜率为16.85%,其中女生、5年级、家庭富裕、学校每年组织视力筛查、每天播放眼保健操和榆林市的学生视力不良发生率相对更高,差异均有统计学意义(均P<0.05);5年级、家庭富裕、学校每年组织视力筛查、学校开展了视力保护宣传活动和榆林市的视力不良学生配镜率相对更高,差异均有统计学意义(均P<0.05);多因素logistic回归分析结果表明,视力不良发生率男生更低(OR=0.791),5年级(OR=1.432)、富裕家庭(OR=1.155)和A市(OR=1.960)发生率更高,5年级(OR=1.401)、富裕家庭(OR=1.459)和学校开展了视力保护宣传活动(OR=1.469)的视力不良学生配镜率更高。结论 西部农村4~5年级学生视力不良发生率高,配镜率低;性别、年级、家庭经济状况是影响学生视力不良发生率和配镜率的主要因素;2项主要的学校眼保健活动(视力筛查和眼保健操)与学生视力不良发生率和配镜率无关。     

Inequalities in child mortality in Mozambique: differentials by parental socio-economic position

This study investigates the relation between socio-economic parental position (education and occupation) and child death in Mozambique using data from the Mozambican Demographic and Health Survey carried out between March and July 1997. The analysis included 9142 children born within 10 years before the survey. In spite of the Western system of classification used in the study, the results partly showed a parental socio-economic gradient of infant and child mortality in Mozambique. Father's education seemed to reflect the family's social standing in the Mozambique context, showing a strong statistical association with postneonatal and child mortality. However, maternal education as a measure of socio-economic position was not statistically significantly associated with child mortality. This finding may partly be explained by the extreme hardships experienced by the country (civil war and natural disasters) and the implementation of the Economic Structural Adjustment Programme that have also affected the health of women and their children during the years covered by this study. Other measures of socio-economic position applicable to the rural African setting should be investigated.     

Heat exposure and socio-economic vulnerability as synergistic factors in heat-wave-related mortality

Heat waves may become a serious threat to the health and safety of people who currently live in temperate climates. It was therefore of interest to investigate whether more deprived populations are more vulnerable to heat waves. In order to address the question on a fine geographical scale, the spatial heterogeneity of the excess mortality in France associated with the European heat wave of August 2003 was analysed. A deprivation index and a heat exposure index were used jointly to describe the heterogeneity on the Canton scale (3,706 spatial units). During the heat wave period, the heat exposure index explained 68% of the extra-Poisson spatial variability of the heat wave mortality ratios. The heat exposure index was greater in the most urbanized areas. For the three upper quintiles of heat exposure in the densely populated Paris area, excess mortality rates were twofold higher in the most deprived Cantons (about 20 excess deaths/100,000 people/day) than in the least deprived Cantons (about 10 excess deaths/100,000 people/day). No such interaction was observed for the rest of France, which was less exposed to heat and less heterogeneous in terms of deprivation. Although a marked increase in mortality was associated with heat wave exposure for all degrees of deprivation, deprivation appears to be a vulnerability factor with respect to heat-wave-associated mortality.     

Risk factors for insomnia in a rural population

PURPOSE: This study compared in one data set the relative importance of most previously examined risk factors for different symptoms of insomnia. METHODS: Data were obtained from personal interviews of 1,588 adults in a rural area. Statistical methods evaluated the association of 42 risk factors with any insomnia and each of four insomnia subtypes: difficulty with initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and restless sleep (RS). RESULTS: Insomnia rates were greater in this rural population than most U.S. studies and greater in the United States than other countries. The correlations between insomnia subtype and energy level was highest for RS, -0.29, and lowest for EMA, -0.11. All sleep disturbances increased monotonically with depressive symptoms, but the increase was greatest for RS (r = 0.57) and weakest for EMA (r = 0.24). Anxiety and pain also were independently associated with each insomnia subtype. Insomnia problems of spouses were uncorrelated. Other risk factors were independently associated with some insomnia subtypes but not others. For example, the association of age with difficulty maintaining sleep was independent of health measures. CONCLUSION: The results suggest that different insomnias have different rates and risk factors and therefore possibly different etiologies and management strategies.     

The combined impact of rural residence and socio-economic status on premature mortality

The health of rural and urban populations differs, with rural areas appearing healthier. However, it is unknown whether the benefit of living in rural areas is felt by individuals in all levels of deprivation, or whether some suffer a disadvantage of rural residence. For England and Wales 2001–2003 premature mortality rates were calculated, subdivided by individual deprivation and gender, for areas with differing rurality characteristics. Premature mortality data (age 50-retirement) and a measure of the individual's deprivation (National Statistics Socio-economic Classification 1–7) was obtained from death certificates. Overall premature mortality was examined as well as premature mortality subdivided by major cause. Male premature mortality rates (age 50–64) fell with increasing rurality for individuals in all socio-economic status classifications. The most deprived individuals benefitted most from residence in increasingly rural areas. Similar trends were observed when premature mortality was subdivided by the major causes of death. Female premature mortality rates (age 50–59) demonstrated similar trends but the differences between urban and rural areas were less marked.     

Immunization coverage in tribal and rural areas of Visakhapatnam district of Andhra Pradesh,India

Objective  This paper aims to report and compare the immunization coverage of various vaccines among tribal and rural children in a distinct socio-economic environment in India. Methods  The study was conducted in two tribal and two rural developmental blocks of Visakhapatnam district of Andhra Pradesh, India, by employing both qualitative and quantitative data collection techniques. Data collected included the immunisation coverage and the associated socio-demographic factors. Results  The majority of mothers was aware of vaccination of children, and usually the primary heath centres and their health workers were the source of vaccination. Vaccination cards were received by 79.2% of tribal and 71.3% of rural children. Some of the socio-demographic characters of mothers, such as habitat, caste and occupation, were associated with the reception of a vaccination card. The coverage of various vaccines was higher among the tribal than among the rural population. Of the eligible children aged above 9 months, 63.3% of tribal children and only 14.5% of rural children were fully vaccinated [three doses of diphtheria, pertussis and tetanus (DPT), four doses of oral polio vaccine, Bacille Calmette Guerin (BCG) and measles vaccine]. The coverage of vaccination against measles and vitamin-A supplementation were very low among rural children (19.6% and 15.2%, respectively) when compared to tribal children (69.2% and 64.2%, respectively). The qualitative data indicated that the community was not satisfied with regard to vaccination services, particularly in the rural area. Conclusion  The coverage of various vaccines was moderate in tribal areas and poor in rural areas. The sole dependence on and demand for public health services was responsible for relatively better coverage of immunisation in tribal areas compared to rural areas where the private sector plays a major role. The existing strategies of health-care delivery including delivery of vaccination services need to be examined and improved. Improvements in physical access, infrastructure, quality of care and increased use of mass media and interpersonal communication are indispensable for improvement in the provision of services.