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This paper documents changes in infant mortality (IM) rates in São Paulo, Brazil, between 2003 and 2013 and examines the association among neighborhood characteristics and IM. We investigate the extent to which increased use of health care services and improvements in economic and social conditions are associated with reductions in IM. Using data from the Brazilian Census and the São Paulo Secretaria Municipal da Saúde/SMS, we conducted a longitudinal analysis of panel data in all 96 districts of São Paulo for every year between 2003 and 2013. Our regression model includes district level measures that reflect economic, health care and social determinants of IM. We find that investments in health care have contributed to lower IM rates in the city, but the direct effect of increased spending is most evident for people living in São Paulo's middle- and high-income neighborhoods. Improvements in social conditions were more strongly associated with IM declines than increases in the use of health care among São Paulo's low-income neighborhoods. To reduce health inequalities, policies should target benefits to lower-income neighborhoods. Subsequent research should document the consequences of recent changes in Brazil's economic capacity and commitment to public health spending for population health.
This chapter explores the consequences of patchwork forms of state authority on subnational development outcomes, primarily in India but also in Pakistan and Bangladesh. It presents two key mechanisms in state–society relations in the economy – commodification and investment – that have economic consequences for growth and human development. It then demonstrates the impact of the patchwork state on different measures of growth and human development, both between and within Indian states. It broadens this discussion out to consider South Asia in comparative perspective, explaining the starkly different trajectories of Pakistan and Bangladesh through the preponderance of different forms of governance. The chapter concludes with a discussion of the relationship among development, violence, and the patchwork state.
This chapter examines the effectiveness of Chinese development finance. At the recipient-country level, we test the impact of Chinese development finance on economic growth, infant mortality, and the spatial concentration of economic activity. We then move below the country level and investigate the economic development effects of China’s development finance at the subnational level using luminosity data at fine spatial resolution (in addition to infant mortality and spatial concentration). We disentangle differences between Chinese aid and debt and compare these effects to those of World Bank funding. In addition, this chapter analyzes whether the motivational forces that shape the provision of Chinese development finance affect downstream development outcomes in recipient countries and regions. The empirical evidence presented in the chapter shows that, irrespective of political bias, Chinese aid and debt improve socio- economic outcomes at both national and subnational scales. However, these impacts vary significantly across jurisdictions. We also find that socio-economic impacts of Chinese development projects are comparable, if not superior, to those generated by the World Bank.
Food insecurity (FI) affects approximately 11·1 % of US households and is related to worsened infant outcomes. Evidence in lower income countries links FI and infant mortality rates (IMR), but there are limited data in the USA. This study examines the relationship between FI and IMR in North Carolina (NC).
NC county-level health data were used from the 2019 Robert Woods Johnson Foundation County Health Rankings. The dependent variable was county-level IMR. Eighteen county-level independent variables were selected and a multivariable linear regression was performed. The independent variable, FI, was based on the United States Department of Agriculture’s Food Security Supplement to the Current Population Survey.
Residents of NC, county-level data.
The mean NC county-level IMR was 7·9 per 1000 live births compared with 5·8 nationally. The average percentage of county population reporting FI was 15·4 % in the state v. 11·8 % nationally. Three variables statistically significantly predicted county IMR: percent of county population reporting FI; county population and percent population with diabetes (P values, respectively, < 0·04; < 0·05; < 0·03). These variables explained 42·4 % of the variance of county-level IMR. With the largest standardised coefficient (0·247), FI was the strongest predictor of IMR.
FI, low birth weight and diabetes are positively correlated with infant mortality. While correlation is not causation, addressing FI as part of multifaceted social determinants of health might improve county-level IMR in NC.
The notion that a child has rights is longstanding: the 1924 Declaration of the Rights of the Child, adopted by the League of Nations, was the first international instrument explicitly acknowledging the existence of children’s rights. The formulation of the right to life under the Convention on the Rights of the Child—the most widely ratified human rights treaty in history – is distinct, referring to the duty to ensure to the maximum extent possible the survival and development of the child. Accordingly, the chapter considers infanticide and violence against children, including in domestic settings as well as against children in the streets. Also addressed are infant mortality, disease, illness, and substance abuse, and recruitment into armed forces, armed groups, and gangs.
This study aimed to assess the changes in neonatal and infant mortality rates in Nigeria over the period 1990 to 2018 using Nigerian Demographic and Health Survey (NDHS) data, and assess their socio-demographic determinants using data from the most recent survey conducted in 2018. The infant mortality rate was 87 per 1000 live births in 1990, and this increased to 100 per 1000 live births in 2003 – an increase of around 15% over 13 years. Neonatal and infant mortality rates started to decline steadily thereafter and continued to do so until 2013. After 2013, neonatal morality rose slightly by the year 2018. Information for 27,465 infants under 1 year of age from the NDHS-2018 was analysed using bivariate and multivariate analysis and the Cox proportional hazard technique. In 2018, infant deaths decreased as wealth increased, and the incidence of infant deaths was greater among those of Islam religion than among those of other religions. A negative association was found between infant deaths and the size of a child at birth. Infant mortality was higher in rural than in urban areas, and was higher among male than female children. Both neonatal and infant death rates varied by region and were found to be highest in the North West region and lowest in the South region. An increasing trend was observed in neonatal mortality in the 5-year period from 2013 to 2018. Policy interventions should be focused on the poor classes, women with a birth interval of less than 2 years and those living in the North West region of the country.
Reproductive justice refers to three primary principles: the right not to have a child, the right to have a child, and the right to parent children in safe and healthy environments. It depends upon the adoption and enactment of a human rights framework, including both negative rights (e.g., governments must not interfere with people’s autonomy) and positive rights (e.g., governments must ensure that people can exercise their rights and freedom and live with dignity). The term is preferred by many because it merges support for reproductive rights with broader movements for social justice. Lack of control over one’s body and an inability to make decisions about one’s destiny can have lasting impacts on women’s physical and mental health and well-being, and have been associated with shame, depression, anxiety, anger, trauma, poor body image, low self-esteem, and low self-worth. Reproductive injustice increases women’s morbidity and mortality risks, and it makes it difficult for them to provide a safe, healthy, and loving environment for their children. This chapter explores four themes based on psychological theory and research – poverty, access to education, access to health care services and supplies, culture – that impact reproductive health (e.g., preconception health, maternal care, maternal and infant mortality, abortion).
Access to quality healthcare varies across the national territory inside Latin American countries, with some subnational units enjoying higher-quality care than others. Such territorial inequality is consequential, as residents of particular regions face shorter life spans and an increased risk of preventable disease. This article analyzes trajectories of territorial healthcare inequality across time in Argentina, Brazil, and Mexico. The data reveal a large decline in Brazil, a moderate decline in Mexico, and low levels of change followed by a moderate decline in Argentina. The article argues that two factors account for these distinct trajectories: the nature of the coalition that pushed health decentralization forward and the existence of mechanisms for central government oversight and management.
This Element explores the association between political democracy and population health. It reviews the rise of scholarly interest in the association, evaluates alternative indicators of democracy and population health, assesses how particular dimensions of democracy have affected population health, and explores how population health has affected democracy. It finds that democracy - optimally defined as free, fair, inclusive, and decisive elections plus basic rights - is usually, but not invariably, beneficial for population health, even after good governance is taken into account. It argues that research on democracy and population health should take measurement challenges seriously; recognize that many aspects of democracy, not just competitive elections, can affect population health; acknowledge that democracy's impact on population health will be large or small, and beneficial or harmful, depending on circumstances; and identify the relevant circumstances by combining the quantitative analysis of many cases with the qualitative study of a few cases.
Using vital statistics in Japan (1995–2008), 154,578 live-born twin pairs (128,236 monozygotic [MZ] and 180,920 dizygotic [DZ]) were identified. The proportion of severe discordance among live-born twin births was twice as high in Japanese than Caucasian infants. There were 1858 MZ and 1620 DZ infant deaths. Computation of the relationship between infant mortality rate and birth weight discordance among the twins was performed. Discordance levels were classified into seven groups: <5%, five groups from 5–9% to 25–29%, and ≥30%.The mortality rate was significantly higher in MZ than DZ twins for discordances except at 5–9% and 10–14%. The lowest rate for MZ twins was at 5–9% (7.5 per 1000 live twins) and significantly increased from 10–14% (9.4) to ≥30% (83.4), while the lowest rate for DZ twins was at <5% (6.7), which significantly increased at 10–14% (8.0) and from 25–29% (12.1) to ≥30% (35.5). The relationship was also computed in two gestational age groups (<28 and ≥28 weeks). For births at <28 weeks, three discordances (after 20–24%) in MZ twins were associated with adverse mortality rate. For births at ≥28 weeks, the same relationship was obtained after 10–14% in MZ and after 20–24% in DZ twins. The relationship from 2002 to 2008 showed that the mortality rates significantly increased after 10–14% for both types of twins. In conclusion, five discordance levels in MZ and three levels in DZ twins were associated with adverse mortality rates.
Evidence on the impact of the quality of prenatal care on childhood mortality is limited in developing countries, including India. Therefore, using nationally representative data from the latest round of the National Family Health Survey (2015–16), this study examined the impact of the quality of prenatal care on neonatal and infant mortality in India using a multivariable binary logistic regression model. The effect of the essential components of prenatal care services on neonatal and infant mortality were also investigated. The results indicate that improvement in the quality of prenatal care is associated with a decrease in neonatal (OR: 0.93, 95% CI: 0.91–0.97) and infant (OR: 0.94, 95% CI: 0.92–0.96) mortality in India. Tetanus toxoid vaccination, consumption of iron–folic acid tablets during pregnancy and having been weighed during pregnancy were statistically associated with a lower risk of neonatal and infant mortality. Educating women on pregnancy complications was also associated with a lower risk of neonatal mortality. No effect of blood pressure examination, blood test and examination of the abdomen during pregnancy were found on either of the two indicators of childhood mortality. Although the coverage of prenatal care has increased dramatically in India, the quality of prenatal care is still an area of concern. There is therefore a need to ensure high-quality prenatal care in India.
Fetal echocardiography is the main modality of prenatal diagnosis of CHD. This study was done to describe the trends and benefits associated with prenatal diagnosis of complex CHD at a tertiary care centre.
Retrospective chart review of patients with complex CHD over an 18-year period was performed. Rates of prenatal detection along with early and late infant mortality outcomes were studied.
Of 381 complex CHD patients born during the study period, 68.8% were diagnosed prenatally. Prenatal detection rate increased during the study period from low-50s in the first quarter to mid-80s in the last quarter (p=0.001). Rate of detection of conotruncal anomalies increased over the study period. No infant mortality benefit was noted with prenatal detection.
Improved obstetrical screening indications and techniques have contributed to higher proportions of prenatal diagnosis of complex CHD. However, prenatal diagnosis did not confer survival benefits in infancy in our study.
Do neoliberal economic policies help or hinder human development? Many have argued that such policies promote economic stability and growth, which may have indirect positive effects on human welfare. Others claim that neoliberal policies retard human development. We argue that neoliberal economic policies may improve the human welfare in ways that are independent of their effects on economic performance. Specifically, this paper hypothesizes that open international trade policies, low-inflation macroeconomic environments, and market-oriented property rights regimes promote human development across the world. We test this argument by examining the impact of several measures of neoliberal policies on infant mortality rates across the world between 1960 and 1999. Results suggest that openness to imports, long-term membership in the GATT and WTO, low rates of inflation, and effective contract enforcement are each associated with lower rates of infant mortality across the world, even when controlling for countries' economic performance.
How does democratic politics affect infant mortality? The bulk of existing research has debated whether democracies have lower levels of infant mortality than non-democracies. Yet, infant mortality varies as much within countries as it does between countries, suggesting that the political processes affecting infant mortality operate at the subnational level. To shed new light on the debate, this paper examines how three core democratic attributes affect infant mortality within a single democracy: India. I argue that higher levels of political representation, citizens’ participation, and electoral competition provide political incentives for elected representatives to reduce infant mortality. The theory is tested on a times-series data set from 15 major Indian states between 1980 and 2011. Overall, the results demonstrate the significance of democratic politics, particularly political representation, in influencing infant mortality.
Mongolia experienced one of its most severe natural winter disasters (dzud) in 2009-2010. It is difficult to accurately assess the risk of the effects of dzud on human lives and public health. This study aimed to evaluate the Mongolian public health risks of dzud by assessing livestock loss.
We analyzed data from all 21 provinces and Ulaanbaatar in Mongolia and compared the changes in infant mortality (2009-2010) and the decline in the numbers of livestock (percentage change from the previous year), which included horses, cattle, camels, sheep, and goats (2009-2010) and/or meteorological data. We also evaluated the association among the trends in the infant mortality rate, the number of livestock, and foodstuff consumption throughout Mongolia (2001-2012).
The change in the infant mortality rate was positively correlated with the rate of decreasing numbers of each type of livestock in 2010. Average temperature and total precipitation were not related to the change in the infant mortality rate. In the trend from 2001 to 2012, there was a significant positive correlation between the infant mortality rate and the number of livestock and the consumption of milk products.
Loss of livestock and shortage of milk products leading to malnutrition might have affected public health as typified by infant mortality in Mongolia. (Disaster Med Public Health Preparedness. 2016;10:549–552)
Despite shared colonization histories between the United States and Latin America, research examining racial disparities in health in the United States has often neglected Latinos. Additionally, descendants from Latin America residing in the United States are often categorized under the pan-ethnic label of Hispanic or Latino. This categorization obscures the group's heterogeneity, which is illuminated by research showing consistent differences in health for the three largest segments of the Latino population—Mexicans, Puerto Ricans, and Cubans. We examine whether the patterns of infant mortality associated with race in the non-Latino population also follow for Latinos. We also examine whether we can attribute patterns of infant mortality between the three largest Latino sub-groups to a process we term segmented racialization. We find that race operates for Latinos the same way it does for the non-Latino population and that there seems to be some evidence to support our segmented racialization hypothesis. The results point to the need to abandon the practices of combining Latino sub-groups as well as ignoring the racial diversity within the Latino population in health research.
The infant mortality rate (IMR) among single and twin births from 1999 to 2008 was analyzed using Japanese Vital Statistics. The IMR was 5.3-fold higher in twins than in singletons in 1999 and decreased to 3.9-fold in 2008. The reduced risk of infant mortality in twins relative to singletons may be related, partially, to survival rates, which improved after fetoscopic laser photocoagulation for twin — twin transfusion syndrome. The proportion of neonatal deaths among total infant deaths was 54% for singletons and 74% for twins. Thus, intensive care of single and twin births may be very important during the first month of life to reduce the IMR. The IMR decreased as gestational age (GA) rose in singletons, whereas the IMR in twins decreased as GA rose until 37 weeks and increased thereafter. The IMR was significantly higher in twins than in singletons from the shortest GA (<24 weeks) to 28 weeks as well as ≥38 weeks, whereas the IMR was significantly higher in singletons than in twins from 30 to 36 weeks. As for maternal age, the early neonatal and neonatal mortality rates as well as the IMR in singletons were significantly higher in the youngest maternal age group than in the oldest one, whereas the opposite result was obtained in twins. The lowest IMR in singletons was 1.1 per 1,000 live births for ≥38 weeks of gestation and heaviest birth weight (≥2,000 g), while the lowest IMR in twins was 1.8 at 37 weeks and ≥2,000 g.
Vitamin A treatment reduces mortality during acute measles infection, and vitamin A supplementation (VAS) to children above 6 months of age may reduce the incidence of measles infection. The effect of VAS at birth on measles incidence is unknown. In a randomised placebo-controlled trial in Guinea-Bissau, normal-birth-weight newborns were randomised to 50 000 IU (15 mg) VAS or placebo. During the trial, a measles epidemic occurred. We linked data from the trial with data from the measles infection surveillance and studied the effect of VAS on the measles incidence before 12 months of age in both sexes. A total of 165 measles cases were identified among the 4183 children followed from 28 d of age. Up to 6 months of age, the incidence rate ratio of measles for VAS compared with placebo was 0·54 (95 % CI 0·25, 1·15) among boys and 1·57 (95 % CI 0·80, 3·08) among girls (test of interaction, P = 0·04). The corresponding figures at 12 months were 0·67 (95 % CI 0·43, 1·05) and 1·17 (95 % CI 0·76, 1·79) (test of interaction, P = 0·08). VAS compared with placebo tended to be associated with less measles hospitalisation or death during the first 6 months of life in boys (P = 0·06), but not in girls. VAS at birth may affect the susceptibility to measles infection during the first 6 months of life in a sex-differential manner.