Maternal factors contributing to under-five mortality at birth order 1 to 5 in India: a comprehensive multivariate study

Abstract

The objective of the study is to assess maternal factors contributing to under-five mortality at birth order 1 to 5 in India. Data for this study was derived from the children’s record of the 2007 India National Family Health Survey, which is a nationally representative cross-sectional household survey. Data is segregated according to birth order 1 to 5 to assess mother’s occupation, Mother’s education, child’s gender, Mother’s age, place of residence, wealth index, mother’s anaemia level, prenatal care, assistance at delivery , antenatal care, place of delivery and other maternal factors contributing to under-five mortality. Out of total 51555 births, analysis is restricted to 16567 children of first birth order, 14409 of second birth order, 8318 of third birth order, 5021 of fourth birth order and 3034 of fifth birth order covering 92% of the total births taken place 0–59 months prior to survey. Mother’s average age in years for birth orders 1 to 5 are 23.7, 25.8, 27.4, 29 and 31 years, respectively. Most mothers whose children died are Hindu, with no formal education, severely anaemic and working in the agricultural sector. In multivariate logistic models, maternal education, wealth index and breastfeeding are protective factors across all birth orders. In birth order model 1 and 2, mother’s occupation is a significant risk factor. In birth order models 2 to 5, previous birth interval of lesser than 24 months is a risk factor. Child’s gender is a risk factor in birth order 1 and 5. Information regarding complications in pregnancy and prenatal care act as protective factors in birth order 1, place of delivery and immunization in birth order 2, and child size at birth in birth order 4. Prediction models demonstrate high discrimination that indicates that our models fit the data. The study has policy implications such as enhancing the Information, Education and Communication network for mothers, especially at higher birth orders, in order to reduce under-five mortality. The study emphasises the need of developing interventions to address the issues of anaemia, mothers working in the agricultural sector and improving relevant literacy among mothers.

Consequences of household air pollution on child survival: evidence from demographic and health surveys in 47 countries

“…21,[27][28][29] Being the firstborn child was protective for child mortality while it was a risk factor for neonatal mortality in our study. Urban versus rural status was not predictive of mortality for either age group.…”

Determinantes sociales de la mortalidad infantil por causas reducibles en la Argentina, 2009-2011

“…En los últimos años, diversos estudios han incorporado el análisis de otros factores como el bajo grado de escolaridad materna, la baja renta familiar y la ausencia de apoyo social (Behm, 2014;Fonseca, 2005;Hossain et al, 2015;Chowdhury et al, 2010). El acceso a los servicios de salud y las características del área donde ocurren estas muertes también vienen siendo investigados con mayor frecuencia en los estudios sobre los determinantes sociales que, en sus diferentes niveles (esto es, individual, así como micro y macro-social) influyen en la mortalidad infantil (Andrade et al, 2004;Augsburger et al, 2013;Behm, 2014;Singh y Tripathi, 2013;Kashima et al, 2012). Si bien el hallazgo del incremento de la mortalidad infantil en contextos de mayores desigualdades ha sido ampliamente documentado, los resultados de este estudio proponen contribuir con evidencia que permita dar visibilidad e identificar estas desigualdades e inequidades en esta población en estudio en pos de la planificación sanitaria para la reducción de las muertes infantiles y en particular aquellas que pueden ser efectivamente evitadas.…”

“…Se halló que ambos fueron capaces de evidenciar las desigualdades en salud, aunque la asociación con el nivel de renta, el bajo peso al nacer y la mortalidad infantil fue mayor (Andrade et al, 2004). Esto es coincidente con diversos estudios que han demostrado la importancia de la interrelación entre la educación de la madre, el nivel de ingresos del hogar y de la población y los resultados en salud por tratarse de indicadores de la disponibilidad de recursos y del conocimiento o el comportamiento en relación con la salud de los niños (Andrade et al, 2004;Victora et al, 1992;Kim y Saada, 2013;Chowdhury et al, 2010;Singh y Tripathi, 2013;Islam et al, 2013;Chomba et al, 2008;Adhikari y Sawangdee, 2011;Maitra, 2004). En este sentido, siguiendo a Behm (2014) la baja o nula instrucción de la madre es un indicador de las restricciones en el acceso a la educación (y a otros beneficios) que existen diferencialmente en las diversas clases sociales o sus fracciones.…”

Public health strategies to fasten the achievement of the millennium development goal -4A related to under-five mortality

“…However, the crucial step is to ensure continuous political and financial support so that the existing strategies can be regularly modified based on the trends and available resources 11,21 . In addition, special emphasis should be given to parameters like establishing a sound health information system within the community / hospital settings 22 ; developing strategies to guarantee the holistic development of the population by reducing social inequality / poverty 1,8,20 ; improving education status of the girl child 2,5,7,9 ; strengthening of the existing health care delivery system 2 ; filling-up all vacant posts of health care personnel 20 ; training outreach workers and utilizing them optimally to clear the myths associated with child care (i.e. pertaining to breastfeeding / dietary habits / health care practices) 19,22 ; implementing strategies to ensure availability of quality assured / integrated health care services 5,10,11 ; sensitizing physicians to be compliant with the recommended treatment protocol for childhood morbidities 18 ; advocating home-based management of diseases of childhood 14 ; ensuring maximum involvement of the mother in the process of early recognition of danger signs and rehabilitation of the child by imparting health education 14,19,22 ; increasing healthcare-seeking behavior among all sections of society 18,22 ; fostering linkages with the nongovernmental / international organizations 1 ; and developing a strong monitoring & supervision mechanism 1,3 ; so that the coverage of existing strategies can be expanded.…”

“…A wide range of potential determinants such as maternal age 4,5 ; sex of child 5,6 ; birth order 2,5 ; short birth intervals 2,7 ; socio-economic status & lowest wealth quintile 5,8,9 ; rural-urban disparity accessibility to health care services 10 ; social inequality 2,5 ; quality of antenatal / intra-natal / postnatal care services 5,11 ; low birth weight 2 ; under-nutrition 12,13 ; breastfeeding (exclusivity and duration) 8 ; socio-cultural practices 5 ; political commitment 11 ; economic growth of the country 11 ; infectious diseases (i.e. measles, malaria, pneumonia, diarrhea) 14 ; hazardous environmental effects on childhood illness 13 ; and religious attitude of the mother 15 ; have been attributed in the causation of under-five mortality.…”