Birth Spacing and Child Mortality: An Analysis of Prospective Data From the Nairobi Urban Health and Demographic Surveillance System

Abstract

SummaryThe majority of studies of the birth spacing–child survival relationship rely on retrospective data, which are vulnerable to errors that might bias results. The relationship is re-assessed using prospective data on 13,502 children born in two Nairobi slums between 2003 and 2009. Nearly 48% were first births. Among the remainder, short preceding intervals are common: 20% of second and higher order births were delivered within 24 months of an elder sibling, including 9% with a very short preceding interval of less than 18 months. After adjustment for potential confounders, the length of the preceding birth interval is a major determinant of infant and early childhood mortality. In infancy, a preceding birth interval of less than 18 months is associated with a two-fold increase in mortality risks (compared with lengthened intervals of 36 months or longer), while an interval of 18–23 months is associated with an increase of 18%. During the early childhood period, children born within 18 months of an elder sibling are more than twice as likely to die as those born after an interval of 36 months or more. Only 592 children experienced the birth of a younger sibling within 20 months; their second-year mortality was about twice as high as that of other children. These results support the findings based on retrospective data.

Intra-demographic birth risk assessment scheme and infant mortality in Nigeria

“…Consequently, diverse quantitative and qualitative research has been conducted to investigate factors influencing mortality among children in Nigeria [14,15,17,19,29]. Despite the existing interesting findings from these studies and their impact on mortality and its associated causes through policies, a more scholarly approach is obligatory to enhance the survival chances of newborn babies.…”

“…The view that age of the mother at childbirth, birth interval and birth order are linked to infant mortality has been consistently reported in the literature [17,19–21]. In most of these studies, a higher risk of infant mortality was found to be associated with short and too long birth interval, births to women less than 19 years and above 35 years of age, first birth and parity four and higher births [17,19–21].…”

“…In most of these studies, a higher risk of infant mortality was found to be associated with short and too long birth interval, births to women less than 19 years and above 35 years of age, first birth and parity four and higher births [17,19–21]. It is therefore expected that the combined effect of these factors should increase the risk of infant mortality.…”

“…Persistent high levels of fertility (TFR = 5.5), infant mortality (68 per 1000 live births) and maternal mortality (550 per 100,000 women) have been reported in the country in recent times [19,26]. The country has six geo-political zones in which there are 36 states and local government areas.…”

“…Findings from scientific studies have also established a strong relationship between infant mortality and specific demographic factors like maternal age at childbirth, birth order and preceding birth interval [18]. Typically, the early childhood probability of dying is higher for children born to too young or too old mothers, children born after a short birth interval and children born to women who have had more than three births [17,19–21]. This is obviously because a very young mother is likely to experience poor pregnancy outcome because of her physical and physiological immaturity.…”