Gender differentials in the impact of parental death: Adolescent's sexual behaviour and risk of HIV infection in rural South Africa

Using data from a longitudinal surveillance study from rural South Africa, we investigated the odds of sexual debut, pregnancy and HIV infection of 15- to 19-year-old adolescents by parental survival. Using descriptive statistics and logistic regressions, we examine the relative risk of orphans compared with non-orphans to have ever had sex, being pregnant and being HIV infected, adjusting for age, sex, socio-economic status, education, being employed and residency. Of 8274 adolescents, 42% were orphaned (one or both parents died). Over 80% of adolescents remained in school, but orphans were significantly more likely to lag behind in grade for age. Female adolescent maternal (aOR 1.32, 95% CI 1.071.62), paternal (aOR 1.26, 95% CI 1.061.49) and dual (aOR 1.37, 95% CI 1.051.78) orphans were significantly more likely than non-orphaned females to have ever had sex; among males it was only paternal (aOR 1.27, 95% CI 1.051.53) orphans. Maternal (aOR 1.49, 95% CI 1.032.15) and dual (aOR 1.74, 95% CI 1.112.73) female orphans relative to non-orphaned females were significantly more likely to be HIV infected; male paternal (aOR 3.41, 95% CI 1.378.46) and dual (aOR 3.54, 95% CI 1.0611.86) orphans had over three-fold the odds of being infected. There was strong evidence that death of mother for girls was associated with increased vulnerability to earlier sexual debut and HIV infection, while fathers appeared to play a significant role in both their son's and daughter's lives

Socio-economic factors in infant and child mortality: a cross-national comparison

Using results from the World Fertility Survey (WFS) for 28 countries, socioeconomic differences in neonatal, postneonatal, and child mortality were examined. To maintain some degree of comparability and to make presentation of the results feasible, focus was on 5 variables which are available for each survey. It can be argued that each of the 5 socioeconomic variables considered here--mother's education, mother's work status since marriage, current or most recent husband of mother's occupation and education, and current type of place of residence of mother--affects infant and child mortality, although often as surrogates for other variables which were usually not directly available. For over 24 countries, the neonatal mortality rate varied from 84 in Nepal to 15 in Malaysia. In Nepal the rate for children of the skilled and unskilled was high (124) but where the husband had received 7 or more years of education the rate of 54 was low. At the other extreme, rates in Malaysia varied from 5 when mother's had 7 or more years of education to 23 for offspring of the least educated husbands. The highest overall postneonatal rate of 89 was again found in Nepal and the lowest national rate in Trinidad and Tobago at 13. In 9 out of 24 countries the high values were over 3 times as great as the low values and the absolute difference exceeded 30/1000 in 13 countries. Differences on child mortality are substantial, reflecting the greater influence of socioeconomic factors on mortality in early childhood. Nationally, the values ranged from 186 in Senegal to a low of 8 in Trinidad and Tobago. In only Haiti, Guyana, and Pakistan did the ratio of the maximum to the minimum rates for sizeable groups fall below 2. At the other extreme, in 5 countries the ratio exceeded 10 and in a further 6 was above 4. Differences between the high and low groups within countries exceeded 30 in 18 out of 28 countries and were over 50 in 10 of these. In 9 countries the highest rates occurred among mothers with no education and in a further 6 among husbands with no education. Education of mother, followed by education of her husband and his occupation were generally the strongest explanatory variables. The work status of the mother was not likely to be an important explanatory variable in these analyses. Results of a multivariate analysis suggested intriguing differences in the relative roles of different socioeconomic variables. Mother's education seemed to play an important role in determining children's chances of surviving in several Latin American and South East Asian countries. In no country did husband's level of education appear in all 3 models. The occupation of the husband was possibly the purest indicator of socioeconomic status, and this factor appeared in the models for all 3 segments of infant and child mortality. Mother's work status appeared least often

Demographic determinants of infant and early child mortality

In this paper we examine the relative importance of a number of demographic determinants of infant and early child mortality using information from 39 World Fertility Survey countries. We include sex of the child, age of the mother at the time of the birth, birth order, mother's educational level and a number of indicators of spacing of adjacent births among the correlates of chances of survival for children below the age of five years.Mortality of firstborn children and of those born to teenage mothers is shown to be higher than average; that of later children and those of older mothers was not much higher than average, once other factors are controlled. Effects of poor birth-spacing persist even after other factors have been controlled, and are similar where a sib was born during the two years preceding the birth of the child, regardless of the survival status of that sib; however, mortality was higher when that sib had died, due to increased familial risks of mortality. Rapid subsequent births also raise mortality for their earlier sibs.The findings are generally remarkably consistent in a wide range of countries and associated mortality conditions, although attention is drawn to a few interesting geographically clustered exceptions which deserve further investigation. The study leaves little room for doubt that poor child-spacing is clearly linked to decreased survival chances