Academic journal article Bulletin of the World Health Organization

Factors Associated with Trends in Infant and Child Mortality in Developing Countries during the 1990s

Academic journal article Bulletin of the World Health Organization

Factors Associated with Trends in Infant and Child Mortality in Developing Countries during the 1990s

Article excerpt

Voir page 1268 le resume en francais. En la pagina 1269 figura un resumen en espanol.

Introduction

Mortality among infants and children has been declining in most developing countries from the mid-1980s and throughout the 1990s. However, this decline has recently slowed, stopped, or reversed itself in some countries of sub-Saharan Africa. The purpose of this paper is to examine some of the factors that may be involved in these trends in mortality and to measure the strength of the relations. The analysis is based on data gathered through the Demographic and Health Survey programme.

Data and methods

The Demographic and Health Surveys

The Demographic and Health Survey (DHS) programme is the world's largest survey, collecting information on mortality among infants and children and on health status and health service indicators. Now in its 16th year, the programme has conducted 104 comparable surveys in 62 developing countries comprising over 1 million interviews with women of reproductive age. Twenty-one additional surveys are being conducted. The United States Agency for International Development has provided most of the funds required to carry out the surveys. Because of priorities within the agency and the level of country representation, not all developing countries have been able to participate. Almost all of the surveys are representative at both the national level and at the level of populations living in households. Many countries have conducted more than one survey at intervals of 3 to 6 years. The data are gathered in face-to-face interviews. The infant and child mortality rates and demographic factors are derived from birth histories obtained from the mothers interviewed. Nutritional status indicators are based on anthropometric measurements, and vaccination rates are derived from inspection of immunization cards (or mothers' reports for children whose cards are not seen). Calculations for other health indicators are based on questions asked of mothers for each child.

The data used in this study come from the 89 surveys in 56 countries that had data available for analysis at the time of writing (a summary of the countries and surveys is available on the web at http://www.who.int/bulletin/tableofcontents/ 2000/vol.78no.10.html). The programme recommends that data are not released for analysis until the main survey report is published, usually about a year after the fieldwork is concluded. A few countries restrict when data can be released; this may delay the release of the data for these countries by an additional 2-4 years. In this analysis, trends in mortality and factors that might explain these trends are calculated from the differences between surveys conducted at various times in the same country. The earliest surveys took place in 1986 and the latest in 1998. While many countries have had two or three national surveys in the course of the programme, some have had only one. The intervals between two surveys in the same country range from 35 to 117 months with an average interval of 63.5 months. The data allow 33 comparisons. To increase the number of cases for multivariate analysis, each country was divided into urban and rural areas and the comparisons within each these areas were used, producing 66 cases.

The data pertain only to less developed countries and, because of funding agencies' priorities, tend to represent the larger countries. Sub-Saharan Africa had the most completed surveys (28). Of the comparisons between surveys from the same country, the greatest number come from sub-Saharan Africa (16) and Latin America (8). Given that the comparisons are concentrated by region, and even by country within a region, the results of the analysis may not fully represent the changes that have taken place in all developing countries. The results of this study will not identify factors that will affect changes in infant and child mortality in developed countries. …

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