Effects of the health service and environmental factors on infant mortality: the case of Sri Lanka.

Abstract

SUMMARY One of the findings of this study is that regional variations in the infant mortality rates of Sri Lanka are large, ranging from 26 per 1000 live births in Jaffna to 91 per 1000 in Nuwara Eliya, a tea estate district. These differences are more strongly associated with regional variations in environmental determinants of mortality than with regional variations in public health expenditure. The most significant environmental factor associated with interregional infant mortality rates was found to be the nature of the water supply (r = -0X82, significant at the 99% level). Regional government expenditure on health had only a weak association with infant mortality rates (r = 0.08).There is increasing and justifiable concern in developing countries about the social and environmental determinants of health. These conditions could be expected to improve as development proceeds and it might be argued that there is no need to consider such factors within a health policy framework. This is emphatically not the case. An understanding of areas in which a concentration of efforts will achieve the greatest improvement is an essential prerequisite for decisions on resource allocation.In this study the associations between specific health service and environmental variables and the infant mortality rates of Sri Lanka are examined both across regions and through time. Thomas McKeown has argued that most of the improvement in the health of the population of developed countries occurred in conjunction with socioeconomic improvements and before the establishment of extensive curative medical care services.' It has also been noted that the necessary return-of infants who have been helped by curative medical care services to a hostile environment decreases the ability of these services to have as significant an impact on the health of the population as they otherwise could.2The major factors considered by demographers to have had a significant environmental effect on infant mortality are access to food, medical care, sanitation, and housing.3 In this study the association between the last two and the infant mortality rates of different regions of Sri Lanka is quantitatively examined. The relationship between the primarily curative medical care services and the infant mortality rates is also examined. It is suggested that particular environmental improvements might significantly increase the impact of the medical care services of Sri Lanka on the health of the population and particularly on the infant mortality rates. MethodsFour methods of analysis are used in determining the relative influences on infant mortality rates (IMRs) of different health service and environmental factors in Sri Lanka. The first two utilise time series data and the last two cross-sectional data. The initial mode of analysis is a simple graphical comparison of government health expenditure per caput over time and the national IMR over time. This has been done both in money terms (current rupees) and at constant (1955) prices (Figs. 1 and 2).The IMR i...

Housing quality and child mortality in the rural philippines

“…The present study of a rural Filipino province augments recent research findings in Sri Lanka (Patel, 1980), Guatemala (Haines et ai, 1983), Costa Rica (Haines & Avery, 1982), and the Philippines as a whole (Martin et ah, 1982) that identify housing quality as a significant factor in child survival. This result implies that policies to improve housing conditions on rural Filipino farms can reduce child mortality more quickly than can policies to raise maternal education or to decrease birth rates among women aged 30+.…”

“…Little published work has examined housing effects on child mortality in lesser developed countries. Patel (1980) found that regional infant mortality rates in Sri Lanka were inversely related to the percentage of homes with cement floors or with asbestos or tiled roofs. In Costa Rica, Haines & Avery (1982) found that a child's risk of death before exact age 2 years was lower if the mother's dwelling had a latrine and lower still if the home had a sewer or a septic tank.…”

Latrine Promotion for Trachoma: Assessment of Mortality from a Cluster-Randomized Trial in Ethiopia

“…Analyses that were adjusted for age group, individual azithromycin coverage, and sex also failed to show an association. Despite numerous observational studies that have shown that the presence of latrines is associated with reduced diarrheal morbidity 7,8,[18][19][20][21][22][23][24] and mortality, [25][26][27][28] this cluster-randomized trial was unable to demonstrate a mortality benefit of community latrine promotion. There are several reasons why we may have failed to find an association.…”

Behavioral convergence and institutional separation: An analysis of plural medicine in Sri Lanka

“…But, before doing that, a brief picture of the current status of the curative systems will be useful (Economic Review 1976Review , 1980. For example, in 1968 two-thirds of all births occurred in hospitals or were supervised at home by a trained midwife (Patel 1980). Any Sri Lankan has available to him, essentially t~ree 1, some sort of government health facility within, on the average, three miles of his home.…”