Analysis of risk factors for infant mortality in the 1992-3 and 2002-3 birth cohorts in rural Guinea-Bissau

Abstract

IntroductionThough still high, the infant mortality rate in Guinea-Bissau has declined. We aimed to identify risk factors including vaccination coverage, for infant mortality in the rural population of Guinea-Bissau and assess whether these risk factors changed from 1992–3 to 2002–3.MethodsThe Bandim Health Project (BHP) continuously surveys children in rural Guinea-Bissau. We investigated the association between maternal and infant factors (especially DTP and measles coverage) and infant mortality. Hazard ratios (HR) were calculated using Cox regression. We tested for interactions with sex, age groups (defined by current vaccination schedule) and cohort to assess whether the risk factors were the same for boys and girls, in different age groups in 1992–3 and in 2002–3.ResultsThe infant mortality rate declined from 148/1000 person years (PYRS) in 1992–3 to 124/1000 PYRS in 2002–3 (HR = 0.88;95%CI:0.77–0.99); this decline was significant for girls (0.77;0.64–0.94) but not for boys (0.97;0.82–1.15) (p = 0.10 for interaction). Risk factors did not differ significantly by cohort in either distribution or effect. Mortality decline was most marked among girls aged 9–11 months (0.56;0.37–0.83). There was no significant mortality decline for girls 1.5–8 months of age (0.93;0.68–1.28) (p = 0.05 for interaction). DTP and measles coverage increased from 1992–3 to 2002–3.ConclusionsRisk factors did not change with the decline in mortality. Due to beneficial non-specific effects for girls, the increased coverage of measles vaccination may have contributed to the disproportional decline in mortality by sex and age group.

Time to death and its associated factors among infants in sub-Saharan Africa using the recent demographic and health surveys: shared frailty survival analysis

“…This study evidenced that the risk of death among multiple-birth infants was higher by 2.68 times than singleton births. This finding was similar to previous studies conducted in Ethiopia [ 15 ], a birth cohort study at Guinea Bissau [ 18 ], and a study from the US National Center for Health Statistics [ 23 ]. The possible explanation for this evidence might be multi-fetal pregnancy and births lead to adverse fetal outcomes during pregnancy and childbirth [ 24 ].…”

Mortality Associated With Acute Respiratory Infections Among Children at Home

“…Dying infants with ARI may not be obviously sicker during their fatal illness or necessarily frailer than their neighbors before contracting disease. But they more often lack basic living conditions, and perhaps their families cannot master certain skills required for them to overcome disease [3, 5, 14, 15].…”

Seasonal variation in child mortality in rural Guinea‐Bissau

“…However, the increase in maternal schooling has been limited in rural Guinea‐Bissau. Among women giving birth in 1992–1993, 87% had not attended school, and in 2002–2003, this percentage was still 85% . Nevertheless, there has been little measurable improvement in the health care system, and during the same period, there has been no decline in mortality of women of fertile age ; hence, the explanation may be sought among interventions selectively affecting young children.…”