Global infant mortality trends and attributable determinants – an ecological study using data from 192 countries for the period 1990–2011

Abstract

Background: Infant mortality rate (IMR) is regarded as an important indicator of population health. IMR rates vary substantially with the highest found in sub-Saharan Africa (SSA) compared to the lowest in Europe. Identifying spatial disparities in IMR and quantifying attributable risk factors is essential for policymakers when tailoring time-appropriate interventions at a global, regional, and country level.Methods: Data for 192 countries were extracted from the World Bank Development Indicator database for the period 1990-2011. Spatial clustering was used to identify significant higher-risk IMR countries. A robust ecological generalized linear negative binomial regression model was used to quantify risk factors and associated decomposition values (Shapley). Results: Significant reductions were observed in IMR for all of the World Health Organization regions for the period 1990-2011 except for SSA, which indicated a reversal of this trend in the 1990s due to HIV. Significant high-risk clustering of IMR is also indicated in SSA countries and parts of Asia. Maternal mortality (survival), lack of water and sanitation and female education were confirmed as prominent and high attributable risk factors for IMR. Distinct temporal changes in the attributability of these factors were observed, as well as significant heterogeneity with regards to the most attributable factor by region and country. Conclusions: Our study suggests that maternal mortality is the most prominent attributable risk factor for infant mortality, followed by lack of access to sanitation, lack of access to water, and lower female education. Variation exists across regions and countries with regards to the most attributable factor. Our study also suggests significant underestimation of IMR in regions known for poorer data quality. The results will aid policymakers in re-tailoring time-appropriate interventions to more effectively reduce IMR in line with Millennium Development Goal 4.

Stunting in children (0–59 months): what is the current trend in South Africa?

“…To quantify the contribution (attributability) of each of the different factors to stunting, we used a Shapley regression-based decomposition approach for distributional analysis (Shorrocks, 2013). This approach has been increasingly applied in public health research in recent times due to advantages over the more classical attributable fraction approach and inherent problems with the latter (Rockhill, Newman, & Weinberg, 1998;Sartorius & Sartorius, 2014;Wang et al, 2014).…”

Factors associated with infant mortality in Nepal: a comparative analysis of Nepal demographic and health surveys (NDHS) 2006 and 2011

“…Another study reported an insignificant association between regional variation and infant mortality [26]. Some other studies have identified that eco-developmental region was significantly associated with infant mortality [4, 7, 18]. …”

“…Despite the reduction in infant mortality by two thirds by many countries indicating a progress towards achieving the millennium development goal (MDG)-4 by the year 2015, this has not been evident in sub-Saharan Africa and some Asian countries including Nepal [5, 6]. Hence, disparities and inter-country variations still exist around the world in terms of IMR [7]. Recent trends of childhood deaths in African and Asian countries show that one out of every 12 infants does not survive until adulthood [8].…”

The Differential Mortality of Undesired Infants in Sub-Saharan Africa

“…With high rates of infant mortality in sub-Saharan Africa, investments in infant and child health are subject to tough prioritizations of time and resources within the household, in which maternal preferences for a desired number and gender composition of children may play a part (Jones 2014;Mosley & Chen 1984;Sartorius & Sartorius 2014). Partly for that reason, reducing unwanted childbearing has been regarded as important for improving child health and survival (Günther & Harttgen 2016;Joshi & Schultz 2013;Lloyd & Montgomery 1996).…”