Multilevel Analysis of Factors Associated with Child Mortality in Uganda.
DOI:
https://doi.org/10.61538/ajer.v3i2.476Abstract
The purpose of this paper is to examine the effect of factors associated with child mortality in Uganda. The Demographic and Health Survey data set (2006) is used to investigate these factors. A random effects regression model and logistic regression model were fitted to establish the significant factors affecting child mortality. The paper considers two types of factors which are maternal Factors (Education level, age of mother, wealth of household) and child factors (birth order, weight of child, Sex of a child, and duration of breastfeeding). Sex, birth weight, Education level, age of mother and household wealth were found to be important predictors of child mortality. However, controlling for mother level factors in model II, the within childhood characteristics were highly correlated. From an explicit multilevel analytic framework, the study therefore demonstrates that individual (child) and mother level characteristics are independent predictors of child mortality; and that there is significant variation in odds of reporting child mortality, even after controlling for effects of both child and mother-level characteristics. The p - values in the random effects model were small compared to the p – values of a standard logistic model. The results of random effects model are more statistically significant than those of a standard logistic regression model. Therefore, the random effects regression model is recommended as an appropriate alternative to standard logistic regression in order to account for variations due to a hierarchical structure.References
Ahimbisibwe, F.E., (1997). “Environmental sanitation and maternal factors as the determinants of infant mortality in Ankoleâ€. MA Dissertation, Makerere University, Kampala.
Ahonsi B, A (1995) “Age Variations in the Proximate Determinants of Child Mortality in South-West Nigeria†Journal of Biosocial Science. Vol 27 (01) Pp 19 – 30
Aizenman DE. (1988) “Impact of Family Planning ob Maternal-child Health: The future of humanity depends on our children†Profamilia: planificación, población y desarollo, Vol 4(13): Pp. 28-33.
Balk, D., T. Pullum, A. Storeygard, F. Greenwell, and M. Neuman. (2004). “A Spatial Analysis of Childhood Mortality in West Africa†Population, Space and Place Vol 10: Pp 175-216.
Barrera, A. (1990). “The role of maternal schooling and its interaction with public healthprograms in child health production†Journal of Development Economics,Vol 32(1), Pp 69-91.
Basu, A., & Stephenson, R. (2005). “Low Levels of Maternal Education and the proximate determinants of childhood mortality: a little learning is not a dangerous thing.†Social Science & Medicine, Vol 60; Pp 2011-2023.
Bhuiya A, Streatfield K & Meyer P (1990) “Mother’s hygienic awareness, behavior, and Knowledge of major childhood diseases in Matlab Bangladesh.†In J Caldwell, S Findley, P Caldwell, G Santow, W Cosford, J Braid & D Broers-Freeman (Eds) What we know about health transition: The cultural, social, and behavioural determinants of health Canberra: The Australian National University Printing Service
Binka FN, et al. (2007) “Rapid achievement of the child survival millennium development goal: evidence from the Navrongo experiment in Northern Ghana.†Tropical Medicine & International Health. Vol 12: Pp 578–583
Caldwell J C. (1993) “Health transition: The cultural, Social and behavioral determinants of health in the Third World.†Social Science and Medicine. Vol 35: Pp 125-135
Caldwell, J. (1979). “Education as a factor in mortality decline: An examination of Nigerian data.†Population Studies, Vol 33, Pp 395-413.
Carvajal, M. and Burgress, P. (1978), “Socio-Economic Determinants of Fetal and Child deaths in Latin America: A Comparative Study of Bogota, Caracas and Rio de Janeiro,†Social Science and Medicine, Vol 12: Pp 89-98.
Castro Martin T & Juarez F (1995) “The impact of women’s education on fertility in Latin America: Searching for explanations,†International Family Planning Perspectives; Vol.27; Pp 1357-1368
Cleland, J.G. and Van Ginneken, J.K. (1988). “Maternal education and child survival in developing countries: The search for pathways of influence.†Social Science and Medicine; Vol. 27(12): Pp 1357-1368
Frost, M. B., Forste, R., & Haas, D. W. (2005). “Maternal education and child nutritional status in Bolivia: Finding the links†Social Science and Medicine, Vol 60; Pp 395407.
Gakidou, E. and G. King. (2002). “Measuring Total Health Inequality: Adding Individual Variation to Group-Level Differences†International Journal for Equity in Health; Vol. 1(3)
Gibbons, R.D. and D. Hedeker. 1997. “Random Effects Probit and Logistic Regression Models for Three-Level Data.†Biometrics Vol 53: Pp 1527-1537.
Hobcraft, J.N, McDonald, J.W., and Rutstein, S.O. (1984). “Socio-economic factors in infant and child mortality: A cross national comparison.†Population Studies; Vol. 38(2): Pp 193-223
Jason, J, Nieburg, P, Marks, J. (1984). “Mortality and infectious disease associated with infant feeding practices in developing countries†Paediatrics. Vol. 74: Pp 702-727
Kaharuza F, Sabroe S, Scheutz, F (2001) “Determinants of child mortality in a rural Ugandan communityâ€. East African Medical Journal; Vol. 78(12): Pp 630-5.
Koenig M. A, Phillips J. F, Campbell O. M and S. D’Souza, (1990) “Birth Intervals and Childhood Mortality in Rural Bangladesh†Demography, Vol. 27 (2): Pp. 251-265
Manda, S.O.M. (1998). “Unobserved Family and Community Effects on Infant Mortality in
Malawi†Genus Vol 47: Pp 1841-1854.
McElroy, P.D., F.O. Ter Kuile, A.W. Hightower, W.A. Hawlley, P.A. Phillips-Howard, A.J. Oloo, A.A. Lal, and B.L. Nahlen. (2001): “All-cause mortality among young children in western Kenyaâ€. American Journal of Tropical Medicine and Hygiene. Vol. 64: Pp 18-27
McCullagh, P., and Nelder, J.(1989): Generalised linear models (2nd edition). London: Chapman and Hall.
Mosley, W, H., Chen, C. (1984) “An analytical Frame work for the study of child survival in developing countries†Population and Development Review, Vol. 10: Pp 25-45.
Mott, F. (1979). Infant Mortality in Kenya: Evidence from the Kenya Fertility Survey. Scientific Report 32. London: World Fertility Survey.
Nazrul M, Kamal H and Korban A (2009) “Factors influencing infant and child mortality: A case study of Rajshahi District, Bangladesh.†Journal of Human Ecology Vol. 26: Pp
–39.
Norman, P., Gregory, I., Dorling, D., & Baker, A. (2008) Geographical trends in infant mortality:England and Wales, 1970-2006. Office for National Statistics, Health Statistics Quarterly, winter; Vol 40: Pp 8-29.
Poffenberger, T (1981) “Child rearing and social structure in rural India: Toward a crosscultural definition of child abuse and neglect.†In J.E. Korbin (Ed.), Child abuse and neglect: Cross-cultural perspectives, pp. 71-95. Berkeley: University of California Press.
Reichman, N., Pagnini, D. (1997) “Maternal Age and Birth Outcomes: Data from New Jersey,†Family Planning Perspectives, Vol. 29: Pp 268-272 & 295.
Scrimshaw, Susan C. M. (1978) "Infant mortality and behavior in the regulation of family size," Population and Development Review 4, Vol. 3: Pp383-403.
Simmons, George B., C. Smucker, S. Bernstein, and E. Jensen (1982) "Postneonatal mortality in rural India: Implications of an economic model," Demography 19, Vol. 3: Pp 371389.
Ssewanyana, S and Stephen D. Younge (2005) “Infant Mortality in Uganda: Determinants,
Trends, and the Millennium Development Goals†SAGA Working Paper.
Uganda Bureau of Statistics (UBOS) and ORC Macro (2001), Uganda Demographic and Health Survey 2000-2001. Calverton, Maryland, USA: UBOS and ORC Macro.
UBOS (2007). Demographic and Health Survey, 2006. Calverton, Maryland USA
Uganda Bureau of Statistics (UBOS) and Macro International Inc. (2007). Uganda Demographic and Health Survey 2006. Kampala, Uganda and Calverton, Maryland,
USA: Uganda Bureau of Statistics and Macro International Inc
UNICEF (1999) Duration of Breastfeeding and Diarrhoea; Breastfeeding Foundation for a Healthy Future. New York.
UNICEF, State of the World’s Children 2003 Report UNICEF, UNICEF House, 2 UN Plaza, New York, NY10017, USA Wadsworth Publishing Company USA UNICEF, (2006) Under five deaths by Cause report.
UNICEF, (2006) Facts on Children report
UNICEF, WHO (2007), The World Bank and UN Population Division, ‘Levels and Trends of Child Mortality in 2006: Estimates developed by the Inter-agency Group for Child
Mortality Estimation’, New York.
UNICEF (2008). Global child mortality rates continue to drop, UNICEF reports.
United Nations Manual X, (1983) Indirect Techniques for Demographic Estimation, Series A, Population Studies, Vol No. 81 UNICEF, UNICEF House, 2 UN Plaza, New York, NY10017, USA Wadsworth Publishing Company USA
United Nations (1994), The Health Rationale for Family Planning: Timing of Births and Child Survival. Population Division, New York.
World Bank (2008), The Growth Report: Strategies for Sustained Growth and Inclusive Development, Washington D.C., Commission on Growth and Development, World Bank.
World Development Indicators 2006 report, Washington, DC.
WHO, UNFA and UNICEF (1999) Reduction of maternal mortality. Geneva:
World Health Organization. (2001). Global Strategy for Infant and Young Child Feeding, The Optimal Duration of Exclusive Breastfeeding, Geneva.
WHO (2005) The World Health Report 2005 - Make Every Mother and Child Count. World Health Organization.
Zere, E. and McIntyre, D. (2003), “Inequalities in under-five child malnutrition in South Africaâ€, International Journal for Equity in Health, Vol. 2 (7).
