Child loss and fertility behaviour in Ghana

Evidence shows a strong relationship between child mortality and fertility at the aggregate level but the relationship at the individual level is less clear. Data from the 1993 Ghana DHS are used to examine the impact of infant death on a woman's subsequent fertility behaviour. Birth interval analysis, parity progression ratios, and multilevel discrete-time hazard models are used. Child replacement after infant death is found to be taking place in Ghana. On average, birth intervals are shortened by about 15 months if a child dies in the neonatal stage, and by about 11 months for postneonatal death. Progression to the next parity is higher if an infant dies than if it survives; the probability of progression is about 32% higher if a male child dies than if a female dies. A sustained decline in child mortality in Ghana is likely to result in further reduction in fertility

Impact of estimation techniques on regression analysis: an application to survey data on child nutritional status in five African countries

This paper illustrates the impact of ignoring survey design and hierarchical structure of survey data when fitting regression models. Data on child nutritional status from Ghana, Malawi, Tanzania, Zambia, and Zimbabwe are analysed using four techniques: ordinary least squares; weighted regression using standard statistical software; regression using specialist software that accounts for the survey design; and multilevel modelling. The impact of ignoring survey design on logistic and linear regression models is examined. The results show bias in estimates averaging between five and 17 per cent in linear models and between five and 22 per cent in logistic regression models. The standard errors are also under-estimated by up to 49 per cent in some countries. Socio-economic variables and service utilisation variables are poorly estimated when the survey design is ignored

Pathways of the determinants of unfavourable birth outcomes in Kenya

This paper explores the pathways of the determinants of unfavourable birth outcomes, such as premature birth, the size of the baby at birth, and Caesarean section deliveries in Kenya, using graphical loglinear chain models. The results show that a number of factors which do not have direct associations with unfavourable birth outcomes contribute to these outcomes indirectly through intermediate factors. Marital status, the desirability of a pregnancy, the use of family planning, and access to health facilities have no direct associations with poor birth outcomes, such as premature births and the small size of the baby at birth, but are linked to these outcomes through antenatal care. Antenatal care is identified as a central link between various socio- demographic or reproductive factors and birth outcomes

Does living in a community with more educated mothers enhance children’s school attendance? Evidence from Sierra Leone

In Sierra Leone girls are 23.4% less likely to attend secondary education than boys. This difference between sexes increases the gender gap in educational attainment since women's education is positively associated with children's educational wellbeing. This paper investigates the relationship between children's school attendance, their mothers’ level of education, as well as the overall level of women's education at the community level in Sierra Leone using multilevel statistical modelling techniques and the country's 2008 Demographic and Health Survey data. The findings suggest that, regardless of a child's own mother's education, an increase in the proportion of mothers with secondary or higher education in a community by 10% improves the probability of attending junior secondary school significantly by 8%; a 50% increase improves the likelihood of attending school by 45%. There was no significant relationship between the proportion of better educated mothers in a community and primary school attendance. However, relative to children whose mothers had no formal education, children whose mothers had attained primary, secondary or higher education were 7%, 14% and 22% more likely to attend primary school respectively. Future policies should seek to promote girls’ education at post-primary education and develop community based programmes to enable the diffusion and transmission of educational messages

Examining the Urban advantage in maternal health care in developing countries

Although recent survey data make it possible to examine inequalities in maternal and newborn health care in developing countries, analyses have not tended to take into consideration the special nature of urban poverty. Using improved methods to measure urban poverty in 30 countries, we found substantial inequalities in maternal and newborn health, and in access to health care. The ‘‘urban advantage’’ is, for some, non-existent. The urban poor do not necessarily have better access to services than the rural poor, despite their proximity to services. There are two main patterns of urban inequality in developing countries: (1) massive exclusion, in which most of the population do not have access to services, and (2) urban marginalisation, in which only the poor are excluded. At a country level, these two types of inequality can be further subdivided on the basis of rural access levels. Inequity is not mandatory. Patterns of health inequality differ with context, and there are examples of countries with relatively small degrees of urban inequity. Women and their babies need to have access to care, especially around the time of birth. Different strategies to achieve universal coverage in urban areas are needed according to urban inequality typology, but the evidence for what works is restricted to a few case studies

Millennium development goal 6 and HIV infection in Zambia : what can we learn from successive household surveys?

Background: Geographic location represents an ecological measure of HIV status and is a strong predictor of HIV prevalence. Given the complex nature of location effects, there is limited understanding of their impact on policies to reduce HIV prevalence. Methods: Participants were 3949 and 10 874 respondents from two consecutive Zambia Demographic and Health Surveys from 2001/2007 (mean age for men and women: 30.3 and 27.7 years, HIV prevalence 14.3% in 2001/2002; 30.3 and 28.0 years, HIV prevalence of 14.7% in 2007). A Bayesian geo-additive mixed model based on Markov Chain Monte Carlo techniques was used to map the change in the spatial distribution of HIV/AIDS prevalence at the provincial level during the 6-year period, accounting for important risk factors. Results: Overall HIV/AIDS prevalence changed little over the 6-year period, but the mapping of residual spatial effects at the provincial level suggested different regional patterns. A pronounced change in odds ratios in Lusaka and Copperbelt provinces in 2001/2002 and in Lusaka and Central provinces in 2007 was observed following adjustment for spatial autocorrelation. Western province went from a lower prevalence area in 2001 (13.4%) to a higher prevalence area in 2007 (17.3%). Southern province went from the highest prevalence area in 2001 (17.3%) to a lower prevalence area in 2007 (15.9%). Conclusion: Findings from two consecutive surveys corroborate the Zambian government's effort to achieve Millennium Developing Goal (MDG) 6. The novel finding of increased prevalence in Western province warrants further investigation. Spatially adjusted provincial-level HIV/AIDS prevalence maps are a useful tool for informing policies to achieve MDG 6 in Zambia. (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkin

Use of Family Planning in Lesotho: The Importance of Quality of Care and Access

This paper aims to identify social and demographic factors affecting contraceptive use and methods choice and also explore whether, net of these factors, contraceptive behaviour of Basotho women is affected by the family planning environment in which they reside. The study uses multilevel models and data from three sources: 1995 Lesotho Safe Motherhood Initiative Women's Health Survey, information collected in 1997/98 on the facilities of family planning clinics in some areas of Lesotho, and focus group discussions of users of contraceptives. Women aged 20-29, with at least two living children, and those with secondary or higher education have the highest probability of using modern methods. Community differences in use of contraception are explained by provider bias, access to a facility, and the type of facility. Excerpts from focus group discussions indicate that the quality of care is also important in influencing the decision by women to use contraception.Dans cet article, l'auteur cherche \ue0 identifier les facteurs sociaux et d\ue9mographiques susceptibles d'influencer l'utilisation de la contraception et le choix des m\ue9thodes. Sur la base de ces r\ue9sultats, il cherche \ue0 \ue9tablir si le comportement des femmes basotho en mati\ue8re de contraception est influenc\ue9 par l'environnement de planification familiale dans lequel elles vivent. Pour ce faire, l'auteur utilise les mod\ue8les multiniveaux, ainsi que des donn\ue9es provenant de trois sources: le Lesotho Safe Motherhood Initiative Women's Health Survey de 1995, les donn\ue9es collect\ue9es en 1997/98 sur la disponibilit\ue9 des centres de planification familiale dans certaines r\ue9gions du Lesotho et les Focus Group d'utilisatrices des contraceptifs. Les femmes \ue2g\ue9es de 20 \ue0 29 ans ayant au moins deux enfants vivants ainsi que celles qui ont \ue9t\ue9 jusqu'1 l'enseignement secondaire ou sup\ue9rieur sont celles qui utiliseront les m\ue9thodes modernes le plus probablement. Les facteurs qui expliquent les diff\ue9rences constat\ue9es dans l'utilisation de la contraception sont l'influence du fournisseur, l'acc\ue8s \ue0 un centre et le type de centre. Des extraits de Focus Group montrent que la qualit\ue9 des soins est \ue9galement un facteur important dans la prise de d\ue9cision par les femmes d'utiliser la contraception

Halftime for SDGs: Maternal and Newborn Health—Best Investment Paper

Each year, 295,000 women die during and just after pregnancy, and 2.4 million babies die in the first month of their lives. In 2019, 2,160,000 neonatal deaths and 275,000 maternal deaths occurred in low- income and lower-middle income countries alone, translating to a welfare loss equivalent to $426 billion and$36 billion for neonatal and maternal deaths respectively. The total loss was $462 billion or almost 6$3.2 billion per year more investment and will deliver benefits worth $278 billion per year in avoided deaths and higher economic growth. It will also yield a demographic dividend benefit equivalent to$25bn annually. For every $1 invested, the social and economic benefits are estimated to be$87. The benefit-cost ratio (BCR) is 87

Intermediary and structural determinants of early childhood health in Colombia : exploring the role of communities

This study examines how structural determinants influence intermediary factors of child health inequities and how they operate through the communities where children live. In particular, we explore individual, family and community level characteristics associated with a composite indicator that quantitatively measures intermediary determinants of early childhood health in Colombia. We use data from the 2010 Colombian Demographic and Health Survey (DHS). Adopting the conceptual framework of the Commission on Social Determinants of Health (CSDH), three dimensions related to child health are represented in the index: behavioural factors, psychosocial factors and health system. In order to generate the weight of the variables and take into account the discrete nature of the data, principal component analysis (PCA) using polychoric correlations are employed in the index construction. Weighted multilevel models are used to examine community effects. The results show that the effect of household's SES is attenuated when community characteristics are included, indicating the importance that the level of community development may have in mediating individual and family characteristics. The findings indicate that there is a significant variance in intermediary determinants of child health between-community, especially for those determinants linked to the health system, even after controlling for individual, family and community characteristics. These results likely reflect that whilst the community context can exert a greater influence on intermediary factors linked directly to health, in the case of psychosocial factors and the parent's behaviours, the family context can be more important. This underlines the importance of distinguishing between community and family intervention programmes