Hypertension Prevalence. Deaths Hospitalization Stroke Emergency Visits. Sunburn Sun Safety Behaviours. Injury Related Deaths. Using multilevel models in future research will help to decompose these rates and ratios by studying individuals nested within their environments. The sensitivity of zone designs on multilevel modeling results is an area for future research.
Another limitation in our study was that some zones, especially for deaths were very large and if the purpose of future studies is to explore underlying risk factors for infant deaths in small areas then a Bayesian method would be preferred.
Another limitation is that we used low birthweight as an outcome measure but future research should also study small for gestational age SGA. SGA is defined as a birth weight less than the 10th percentile for a given gestational age based on a reference population of all singleton live births in the United States [ 35 ] and may be conceptually helpful in studying adverse birth outcomes in diverse populations.
Finally, the Zip Code of mother's residence was used to map these spatial patterns of low birthweight and infant deaths but since a travel history was not available future research should also consider the movement of women and infants and their differential exposures during pregnancy up to death.
To correct this problem, researchers have used geographic methods such as probability mapping, spatial filters, also referred to as spatial smoothers, Bayesian smoothing techniques and cluster detection methods. This study demonstrates another technique called AZM tool for automated zone design to stabilize rates and ratios.
AZM inputs boundaries but reconstructs the geography in areas with low case counts in order to increase case numbers to stabilize rates and ratios for thematic mapping. Thematic maps are a useful tool to visualize and explore spatial patterns because they are relatively easy to read and interpret from a research and laymen's i.
AZM is therefore, a valuable tool that could be used for geo-surveillance in public health departments, including the reporting of disease and health conditions to the public.
From these spatial patterns specific zones of high risk can be identified from within which to study underlying mechanisms, target for monitoring and implementing public health intervention and prevention programs and evaluating the need for health care services. Researcher's who wish to proceed with AZM however, need to be aware that the protocol to evaluate optimal zone design is largely subjective and dependent upon the study question, conceptual design of the study and input modeling parameters.
Future research should continue to document conceptual frameworks of health studies in addition to the input modeling parameters to evaluate optimal zone design for different health outcomes. Only live singleton births were studied thus reducing the dataset to , births. The birth records were queried for low birthweight defined as infants born weighting less than 2, grams.
There were 2, infant deaths during this time period, excluding those infant deaths that occurred in to infants born in and those infants who died in but were born in Infant deaths were defined as those infants born alive that died within their first year of life. The infant death records were linked to the live birth files using the birth certificate as the common identifier.
The Zip Code of mother's residence at the time of her infant's birth was the geographic unit of analysis. The recoding of Zip Codes was validated with the geocoded address of the mother and did not affect the original location-geographic position of the birth.
Using the Zip Code as the unit of analysis also reduced potential bias associated with missing data. This potential bias would have been located largely in Upper Michigan. We recognize that Zip Codes may not reflect the local neighborhood environment in which mothers live and infants are born and that a finer resolution of geography is preferred to explore local hazards and potential exposures.
To visualize and explore spatial patterns and to generate mechanistic hypotheses at a finer geographic scale the birth and linked infant death records would need to be geocoded and aggregated to the census block, block group or census tract. The authors decided that from a surveillance perspective, the Zip Code level of analysis would be conduced first while the records are being geocoded and thereafter, surveillance at a finer geographic scale could follow.
This software incorporates the principles of automated zone design originally conceptualized by Oppenshaw [ 38 ]. In preparation for AZM analysis the ESRI Zip Code boundary file [ 36 ] was converted to an ArcInfo coverage and island polygons were removed and slivers and overshoots were removed and undershoots were corrected.
After the topology was check and corrected the arc and polygon attribute information was exported for use in the AZM software. The arc files were uploaded in AZM as intersection and contiguity files. These files comprised the Zip Code geography used in subsequent analyses. The minimum population threshold was 50 births. These TP parameters were held constant throughout the analysis. Where q k is the perimeter of zone k and A k is its area.
AZM functions to minimize the perimeter squared divided by area, which maximizes shape compactness on zones. As outlined in Martin [ 37 ] software documentation "irregular shapes may have longer perimeters in relation to their area; thus, squaring the perimeter makes highly irregular shapes less attractive when this constraint is in operation.
The third parameter selected was the homogeneity constraint. The homogeneity constraint promotes homogeneity within zones and heterogeneity between zones by encouraging the aggregation of similar values.
In this study we used mother's race i. Maternal race was added because of the high levels of racial residential segregation in Michigan's cities and the desire to capture spatial-racial disparities in low birthweight and infant mortality. An IAC of 0. An optional parameter that may be changed for user preferences was the "random number initialization value," which sets the seed value for the pseudorandom number generator prior to the IRA run.
Keeping this value constant during multiple restarts of AZM would result in the same zone designs. Changing this seed value would result in a different sequence of pseudorandom decisions, which would alter the zone designs. For the purposes of this surveillance research we kept this parameter constant to eliminate differences between zone designs.
With these model parameters the AZM analysis was conducted by running 50 program restarts with iterations each taking the run i. Following this reconstruction of zones the rates and ratios were calculated for each zone using SAS 9.
Where L 0. The standardized morbidity ratios were calculated by dividing the observed number of low birthweight cases O i by the expected number of cases E i for each zone. The expected numbers of cases were derived using the formula:. Ninety-five percent confidence intervals were also calculated for the standardized incidence and mortality rates. Following the calculation of the rates and ratios by zone these data were rejoined to the zone geography, input into ArcGIS 9.
SaTScan is cluster detection software developed by Dr. Martin Kulldorff. SaTScan has been used in many health studies as a surveillance tool to explore clusters of disease in space, time and space-time [ 41 ]. We used a Poisson-based model, where the number of low birthweight cases or infant deaths in each Zip Code was assumed to be Poisson distributed, according to the underlying births at risk.
The expected number of cases in each Zip Code was calculated as:. Where c was the observed number of cases and p was the number of births in the Zip Code of interest, while C and P were the total number of cases and births respectively. A relative risk was derived by dividing the observed number of cases by the expected number of cases.
The alternative hypothesis is that there was an elevated risk within the window as compared to the outside. Under the Poisson assumption, the likelihood function for a specific window was proportional to:. Where C was the total number of cases, c was the observed number of cases within the window and E [c] was the adjusted expected number of cases within the window under the null-hypothesis. C-E [c] was the expected number of cases outside the window.
I was an indicator function. When SaTScan scans for clusters with high rates, I was equal to 1 when the window had more cases than expected under the null-hypothesis, and 0 otherwise [ 41 ]. Hypothesis testing was conducted using Monte Carlo simulations. In this study we scanned for clusters of geographic sizes that would capture between zero and 6. We also scanned for clusters of geographic sizes that would capture between zero and 7. There was no geographic overlap in clusters.
Michigan Department of Community Health. Environment and Planning A. Article Google Scholar. Centers for Disease Control and Prevention. Google Scholar. Healthy People Statistical Note: Healthy people criteria for data suppression. US Census Bureau: Source and accuracy of the data for the March current population survey microdata file, National Vital Statistics Reports.
Cockings S, Martin D: Zone design for environment and health studies using pre-aggregated data. Social Science and Medicine. PubMed Article Google Scholar. Health and Place. Daras K: An information statistics approach to zone design in the geography of health outcomes and provision.
Modifiable neighbourhood units, zone design and residents' perceptions. Openshaw S, Rao L: Algorithms for reengineering census geography. Enviornment and Planning A. Martin D: Developing the automated zoning procedure to reconcile incompatible zoning systems. International Journal of Geographical Information Science. The Census Data System. Riva M, Apparicio P, Gauvin L, Brodeur J: Establishing the soundness of administrative spatial units for operationalising the active living potential of residential environments: An exemplar for designing optimal zones.
Given the potential high risk of death from untreated pneumonia, the World Health Organisation WHO recommends antibiotic treatment depending on the disease symptoms and its severity before the cause of disease is known.
Amoxicillin, ampicillin and gentamicin are the most commonly used antibiotics to treat pneumonia. During pneumonia, alveoli in the lungs get filled with pus and fluid, which prevents oxygen from being transferred to the blood. Consequently, a condition known as hypoxaemia — a lack of oxygen — can develop. When a child with pneumonia develops hypoxaemia the risk of dying increases five-fold. However, the need for a specialist equipment to diagnose and treat hypoxaemia still poses a substantial barrier in low-resource settings.
The section below only discusses diarrheal diseases in the context of child mortality. You can find a more in-depth look at the burden of diarrheal diseases, their causes and treatments in our diarrheal disease entry here. As the visualization shows, one-third of all who died from diarrheal diseases were children under five years old.
For most of the past three decades under-5s have accounted for the majority of deaths from diarrheal diseases — back in it killed 1. Diarrheal diseases are the third leading cause of child mortality globally, falling just behind pneumonia and preterm birth complications.
The death rate from diarrheal diseases in many of the poorest countries is higher than annual deaths per , children. In those countries with the worst health — including Madagascar, Chad and the Central African Republic — the rate is higher than per , In high-income countries the death rate is very low.
In many European countries, but also some rich Asian countries the rate is below 1 per , per year. At lower levels of income risk factors for diarrheal diseases such as lack of access to clean water , rotavirus vaccine availability , undernutrition , stunting and others are the most prevalent.
There are two main reasons why the number of children dying from diarrhea is still so large — the prevalence of diarrhea-associated risk factors and the lack of access to essential treatment. The figure shows the number of deaths associated with the major risks factors for diarrheal diseases: unsafe drinking water, poor sanitation and malnutrition are responsible for the largest portion of deaths.
Since we have made a lot of progress in reducing these major risks; you can read more in our research entries on Hunger and Undernourishment , Extreme Poverty and Water Use and Sanitation. But continued progress is still needed. In addition to reducing exposure to risks factors, increasing access to oral rehydration therapy ORT , therapeutic zinc use and the coverage of rotavirus vaccines were all shown to be essential for reducing the burden of diarrheal diseases in children.
The table below lists the range of interventions available for the treatment of diarrhea we have today. Some of these interventions, such as ORS, breastfeeding and improvements in sanitation broadly target all-causes of diarrhea, whereas, vaccination and antibiotic use are specifically directed against the causative agents of the disease.
Water, sanitation and hygiene WASH interventions are the best way to prevent diarrheal diseases. Educating mothers about the importance of breastfeeding is also important. Breastfeeding allows for the transfer of maternal immunity to the child — in developing countries infants that are not breastfed are six times more likely to die from infectious diseases, such as those causing to diarrhea, in the first 2 months of their lives.
Another way to prevent diarrheal diseases is vaccination. Until relatively recently, there were few vaccines available to prevent diarrheal diseases. Cholera vaccine has been licensed since but it is primarily given to travelers and used as an outbreak control measure. This is because targeted immunization combined with other sanitary measures is more cost-effective than immunizing every individual with a vaccine that only provides a few years of protection.
In , however, new vaccines against rotavirus — the leading cause of childhood diarrhea as the treemap above shows — have been introduced. The most recent studies show that, while the effectiveness of the new rotavirus vaccines vary across different countries, it works well in protecting children against rotavirus disease.
We will explore the success, potential and limitations of rotavirus vaccines in an upcoming post. When preventative measures fail, several options for the treatment of diarrheal diseases are available, including nutritional interventions and antibiotic use when necessary. But the single best treatment for diarrheal diseases is a surprisingly simple mixture of water, salt and sugar: otherwise known as the oral rehydration solution. The section below only discusses malaria in the context of child mortality.
You can find a more in-depth look at the global burden of malaria, its history and treatments in our entry on the topic here. At a global level, the most vulnerable age group to malaria deaths are children under five years old — in they accounted for 57 percent of total deaths.
The number of deaths from malaria tends to decrease with age; with those over 70 years old accounting for around five percent. When age categories are combined, children under 14 years old account for more than two-thirds of mortality.
Of the more than , deaths from malaria in children under-5 in , almost half of them have occurred in just two countries — Nigeria and the Democratic Republic of Congo. The highest mortality rates from the disease are in Burkina Faso and Sierra Leone, where and children per , died of the disease in Even after a century of progress against malaria, the disease remains devastating for millions. The World Health Organization estimates that million suffered from the disease in Fortunately only a small fraction of malaria victims die of the disease.
But those who die are the very weakest; three out of four malaria victims are children younger than 5 years old making it one of the leading causes of child mortality in the world today. In the history of improving population health, the most important progress is made in the prevention of disease; for infectious diseases this means interrupting its transmission.
However, very recent developments are encouraging; at the time of writing the WHO has rolled out a first large-scale trial of a vaccine. A second one is to prevent the transmission of the parasite where it is still prevalent. It is a surprisingly simple technology that stopped transmission and saved the lives of millions in the last few years alone. The years since the turn of the millennium were an extraordinarily successful era in the fight against malaria.
The two maps shows the change of malaria mortality for children in the region where the disease causes the highest death toll. From to the number of malaria deaths has almost halved , from , deaths per year to ,, according to the World Health Organization.
A recent publication in Nature 76 studied what made this success possible. The focus of the study was Africa, where — as the chart shows — most of the recent reduction was achieved. The researchers found that the single most important contributor to the decline was the increased distribution of insecticide-treated bed nets.
The bed nets protect those who sleep under them. The insecticide used on the bed nets kills the mosquitoes. So a community where a sufficiently high number of people sleep under bed nets the entire community is protected, regardless of whether they themselves use the bed nets. This is similar to the positive externality effect that vaccination has on communities. The authors of the Nature study estimate that bed nets alone were responsible for averting million cases of malaria in Africa between and The other two interventions that were important for the reduction in the disease burden of malaria were indoor residual spraying IRS and the treatment of malaria cases with artemisinin-based combination therapy ACT.
Progress never happens by itself. For millennia our ancestors were exposed to the malaria parasite without defense; the fact that this changed is the achievement of the scientific and political work of the last few generations.
Today we are in the fortunate situation that we have some decades of progress behind us: We can study what worked and use this knowledge to go further. To continue the improvement in global health more has to be done, and more can be done.
Some of the most important research in global development asks the question where donations can do the most good. Often it is unfortunately not possible to achieve much progress by donating money because funding is not the limiting constraint or the proposed solution does not actually work. But in some areas we can achieve extraordinary progress by making funding available. The diseases many children die from are preventable — we therefore know that we can continue this reduction of child mortality, if we choose to do so.
What is different from the past and what makes the deaths of children so appalling today is that we now know how to prevent them. The evidence shows that the fight against malaria is still underfunded; it will depend on this funding and work whether it is possible to continue our progress against it. It requires the commitment from governments around the world, but it is also something where each of us individually can contribute. Every one of us can contribute so that we continue to reduce the number of children that die in the world.
In children with HIV, transmission has typically occurred from the mother mother-to-child-transmission; MTCT either during pregnancy or childbirth, or through breastfeeding. The chart shows the total number of children aged 14 years old and under who are living with HIV. Globally the number of children living with HIV peaked in at approximately 2. This has since declined to 1. The chart shows the number of children aged 17 and under orphaned from AIDS deaths.
The map shows the total number of children newly infected with HIV each year. Globally — with similar trends at national levels — the number of new infections in children peaked around the early s globally at , new infections per year followed by a rapid decline over the last decade.
In an estimated , new children were infected with HIV. Given that majority of AIDS cases in children are due to the virus transmission from mother to child during pregnancy, stopping the mother-to-child transmission is key to preventing children from getting newly infected with HIV.
PMTCT services include preventative measures such as providing antiviral therapy for mother and newborn, correct breastfeeding practices, and early child testing for HIV infection. The visualization shows the number of child infections averted from coverage of ART in mothers. What children die from in the first few days or weeks of life is very different to the months and years that follow. So, too, are the interventions to prevent these deaths.
In the visualization we see the total number of child deaths by life stage. More than one-third — 1. This is a devastatingly large number: it means that, on average, 5, children younger than one week die every day. In fact, if we look at the probability of death is the highest in the first 24 hours of life. Newborns are four times more likely to die in the first 24 hours of life than in the next 24 and nine times more likely than on their 7th day of life.
While child mortality has fallen across all age groups, the rate of reduction has not been even. The world has been much more successfully in preventing deaths of older children than young infants. Since , mortality has fallen by:.
Older children tend to die from diseases such as diarrhea , pneumonia , measles , and meningitis. These can now be prevented through vaccination. Over the last decades, the world has made rapid progress in the fight against these vaccine-preventable diseases. But the causes of death in the youngest children are very different. Pre- and post- birth complications — which are the major cause of death in the early days of life — cannot be directly prevented by these types of interventions.
This means that as child mortality rates decline across the world, our attention must turn increasingly towards saving babies in the first days of life. We need to make much faster progress in addressing neonatal causes of death. Neonatal deaths can be prevented by provision of basic care for mothers and newborns. Over the past decades the coverage of many of these interventions has increased: more women receive antenatal care , more births are attended by a skilled healthcare worker , more newborns are exclusively breastfed.
But the coverage of these and other interventions is still far from sufficient. More than , neonates died in due to complications arising as a result of preterm birth. Premature birth is common globally, around 1 in 10 newborns is born prematurely every year.
Close to half a million newborns died due to this condition in In the map you see child mortality rates due to complications arising as a result of preterm birth. Globally, preterm birth mortality rates have been falling since In that number has halved to 0. Some countries have made impressive progress in recent decades: Brazil, Peru and Egypt, for example, now see close to five times fewer deaths from premature births compared to almost 30 years ago.
But huge disparities between countries still exist. The highest mortality rate due to preterm birth complications is in Sudan, where out of , preterm babies die. There are two ways to reduce preterm mortality rates: trying to reduce the prevalence of preterm births and providing better care for babies who are born prematurely.
A recent systemic review of the literature by the Cochrane Library has identified four interventions that had a positive effect on reducing preterm births: We should note that zinc supplementation was found to be effective in studies based on low-income populations. Therefore, the study authors suggest that this may be a consequence of a general maternal undernutrition. Indeed, multiple observational studies have indicated that maternal nutrition may have an impact on the length of pregnancies.
In the right settings, most premature babies can be taken care of with simple interventions. The key care required for preterms is provision of thermal insulation and feeding, both of which can usually be provided by the mother through kangaroo care.
Kangaroo care involves early breastfeeding and hour skin-to-skin contact between the mother and newborn. From life expectancy to mental health ; substance use to cancer rates ; there are important differences in health outcomes between the sexes. Here we focus on the youngest, asking, why do young boys die more often than girls?
Child mortality measures the share of newborns who die before reaching their 5th birthday. In the chart below we see the comparison of child mortality by sex. Here, the mortality rate for boys is shown on the y-axis, and the mortality rate for girls on the x-axis.
The grey line running diagonally across the chart marks where the mortality rate for both sexes is equal. In countries which lie above the grey line, the rate for boys is higher than for girls. This is also true for infant mortality , which is the share of newborns who die within their 1st year of life. We study why India and Tonga are outliers here. Over the past half-century in particular, child mortality has been falling rapidly across the world. This has been true for boys and girls alike.
It has been known for a long time that the mortality of boys is higher. Why is it the case that boys die more often than girls? In this chart we see global mortality rates in infants across different causes in Just like the charts above, causes which lie above the grey line are more common in boys.
The chart shows that for all major causes of death, mortality is higher in boys. The sex differences in the causes of infant deaths were already documented almost a century ago: in an impressive paper published in , Bawkin explores the mortality sex ratio of specific diseases from countries across the world. But overall, infant boys are more likely to die in childhood than girls. Boys are more vulnerable in two key ways: they are at higher risk of birth complications, and infectious disease.
We explore the possible reasons for this below. From comparison of mortality rates in infant boys and girls, it becomes clear that boys are at higher risk of complications in the first few days of life: preterm births, asphyxia, birth defects and heart anomalies. But why? First of all, boys are more likely to be born prematurely : the share of boys born before full-term pregnancy is higher than for girls.
Boys tend to have a higher birthweight than girls — which can increase the risk of waiting to term to deliver — meaning that more boys are induced before the end of the pregnancy term. The fact that preterm births are more common for boys contributes to this. Although boys are, on average, heavier than girls at birth, they are less physiologically mature at birth. This means they are at higher risk of having delayed physiological function such as lung function and adverse neurological outcomes.
The reason for this difference has been an important question for decades — the answer is still not clear. But there are some leading hypotheses: surfactant production for lung function has been observed earlier in female fetuses, leading to improved airway flow in the lungs; estrogen has been shown to affect lung development positively in females; males, on average, have a higher birthweight meaning they may trade-off increased size for functional development; and the uterus may be less hospitable to male fetuses — the introduction of a Y chromosome in females can create and immunoreactive response to the central nervous system.
This, combined with a higher risk of premature birth may explain why boys have higher rates of asphyxia, respiratory infections and birth defects. Boys are also at higher risk of infectious diseases such as syphilis, malaria , respiratory infections, tetanus and diarrheal diseases.
This is more generally true for a broad range of infections, spanning person-to-person, vector-borne, blood-borne, and food and water borne diseases. We see this clearly when we compare mortality rates for boys and girls in the earlier chart. But why are boys more susceptible to infection?
Overall, boys have weaker immune systems. There are two key hypotheses for why. The Y-chromosome in boys increases their vulnerability. Biologically, males and females are differentiated by chromosomes: females have two X chromosomes XX and males one X and one Y chromosome XY.
Having two X chromosomes means that the newborn has a stronger immune system because X chromosomes contain a larger number of immune-related genes. This makes males more vulnerable to many infectious diseases. Maps shaded white black signify significantly higher lower risks, while estimates for locations in grey colour are not significant.
Spatial effects for the crude analysis Fig. Inclusion of demographic variables and controlling for the unstructured spatial effects via a random effect component, a proxy for unmeasured risks factors, drastically changed the observed crude spatial pattern.
The results show significantly higher risks in all the regions of Sierra Leone; Faranah and Kankan regions of Guinea, which are neighbours to Sierra Leone; and Cascades and Sahel regions of Burkina Faso.
Results of the full equation reveal that when demographic, status and amenity variables are accounted for, the risks of mortality among children under five are only significantly higher in the Southern region of Sierra Leone but lower in Plateau, Benin, but not significant for all other regions. Significant risks are observed only in the results of the first equation.
As the demographic variables were included, the risks are not significant for any region. Therefore, we present only the outcomes of the first and last equations in Fig. Findings from the first equation show that of the 10 countries analysed, the risks of infant mortality are merely significantly higher in three regions: the Southern and Eastern regions of Sierra Leone and North Western region of Liberia. The map of the posterior means shows that some parts of Niger, Mali and Burkina Faso are places where risks of infant mortality are lower, albeit these are not significant.
This study aimed at disentangling the spatial variations of child mortality in West African countries in a manner that transcends regional boundaries and therefore offers some insights into the disparity in the experience in a region that contributes largely to children deaths in sub-Saharan Africa.
The method and strategy of analysis employed made it possible to discern regional specific effects and how different categories of variables exert influence leading to variations in chances of child survival across space. Though the differences in mortality in West African nations might have been shown using traditional parametric approaches, the Bayesian geo-additive method employed is able to uniquely discern subtle region-specific differences. Adopting methods that create dummies for the regions would unnecessarily upsurge the number of parameters to be estimated and could lead to unstable estimates.
A major finding from this study is that patterns of under-five mortality in West Africa have spatial structure that surpass geographical boundary where similar patterns were observed for neighbouring countries. This is however not the situation in the case of infants where the structure is uniform to some extent. For instances, in respect to other regions, under-five deaths are significantly higher in northwest and northeast Nigeria, a pattern that transcends to neighbouring southwest of Niger.
This spatial clustering in the part of Sahel persists even after controlling for some variables. Another clustering was obtained in Sierra Leone, parts of Guinea and neighbouring western regions of Liberia. On the other hand, significantly lower levels were obtained in the southern Nigerian and neighbouring regions of Benin. The findings may partly be explained by similar prevalence of shared childhood diseases, general healthcare practices and residual spatial variation swayed by variation in unexplained region-specific traits.
The Sahel region is typically dry, hot, sunny and somewhat windy all year long and is associated with some diseases, such as cerebrospinal meningitis characterized by high fever, skin rash stupor and sometimes coma, which affect humans particularly children which could account for the clustering in the portion of the region.
The Sahel region has also continued to face food insecurity leading to severe acute malnutrition among children European Commission ; West Africa Regional Health Working Group The fact that infants depend much on breast milk from their mothers makes them less vulnerable to strong food reduction, except if breastfeeding is not exclusive or malnutrition severely affects the mother.
Thus, the spatial structure does not show evidence of strong variation among infants, even when the crude data was fitted. It is noteworthy that the strong spatial structure of Sierra Leone and neighbouring Guinea could only be disentangled by accounting for amenity variables.
This underscores the importance of and state of social amenities in these countries. Already, pervasive poverty, high level of illiteracy among women, limited access to safe drinking water and adequate sanitation, poor feeding and hygienic practices, overcrowded housing and limited access to quality health services have been adduced as the causes of huge childhood morbidity and mortality in these regions Tomori ; WHO Interventions that could lead to behavioural change in addition to improving the available social amenities in these two countries in particular and other West African countries would go a long way to ameliorate the survival chance of the young children.
After controlling for spatial dependence in the data, the majority of the covariates in the fixed part of the models were found to have significant effects in the right direction. Findings on birth order, multiple births and gender for instance conform with existing literature on sub-Saharan Africa Magadi et al. Multi-foetal pregnancy and multiple births including twins and higher order multiples such as triplets and quadruplets are known to be high-risk pregnancies and births while first births are likely to have occurred to inexperienced mothers.
Biological hardiness and gender preference especially resulting from perceived bride price to be earned could account for differences in mortality between genders Fuse Our findings show higher chances of child mortality for children whose parents attained primary education against those whose parents had no education. This therefore reaffirms the need to raise maternal education to at least the secondary level in West African countries.
Children born to poor households are faced with challenges such as insufficient food intake and lack of access to basic healthcare. The results of the household wealth index are rather fascinating.
We found significantly lower risks for children from the richest quantum in the model without amenity variables, but this was no more statistically significant when these variables where included. The implication is that, with the prevailing level of social amenities in West Africa, the impact of family wealth on child mortality becomes weak. Similar to results from Nigeria Adebayo and Fahrmeir , Malawi Manda and Bolivia Forste , working women had higher child mortality than the non-working.
One would have expected the opposite. However, majority of the people who live in the major cities of sub-Saharan countries, where gainful employment could be found, live in sprawling settlements that are often overcrowding with poor sanitation Manda ; Mutunga The import of household electricity, improved toilet facilities and delivery at hospital facilities to child survival as indicated by this study cannot be overemphasized.
Electricity in households provides energy needed in boiling and preservation which prevents diarrhoeal diseases and respiratory infections in cold climate, but many households in West Africa are still without the essential commodity. The use of pit latrine and other surfaces for passing excreta has been shown to be higher risk morbidity and mortality among children because they are easy source of contamination Folasade The non-significance of water source might result from the fact that in most West African countries, pipes are often dry, leaving the people to source their water from other available sources.
On the place of delivery, some African countries including Equatorial Guinea, Morocco, Rwanda, Egypt, Angola and Niger have adopted the strategy of increasing the proportion of births attended to by skilled attendants as a way of reducing incidences of maternal and child mortality and this is yielding positive results MDG Report The patterns emphasized that risks are associated with late childbirth, while, as previously stated, children born to much older women compete for limited resources, and these women also rely on previous experiences and therefore refuse to seek for expert help during childbirth Babalola and Fatusi ; Onah et al.
Such experiences might also be relied upon in dealing with childhood diseases. The baseline effects demonstrate that risks of dying are highest in the first month of life and reduce thereafter. Cost-effective interventions, such as early post-natal home visits and case management of neonate infections, need to be intensified in all West African countries. The influences of different categories of demographic and socioeconomic variables on the spatial structure of infants and child mortality have been scrutinized.
The modelling approach was apparently able to discern imperceptible influences and identify region-specific clustering. However, in the case of infant mortality, the results do not present evidence of pronounced spatial variations. Cost-effective interventions would be required to save the lives of these children. Findings from this study, particularly from the maps generated, could help policymakers and international donors in their various intervention programmes aimed at saving the lives of young children.
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