Dataset Information

Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison.

ABSTRACT:

Background

This study used data from recent Demographic and Health Surveys (DHS) to examine the impact of short or long preceding birth intervals on neonatal and under-five mortality. In order to minimize the effect of selection issues, we examined child mortality outcomes of the same mother, comparing short or long interval births against births with what had previously been considered optimal intervals.

Methods

We analyzed 47 DHS datasets from low- and middle-income countries. For each dataset, we compared neonatal and under-five mortality of short preceding interval births (<18 months, <24 months) to reference interval births (24-<60 months) of a mother, using conditional logistic regression matching on the mother. We also conducted the same matched analysis for long (? 60 months, ? 72 months) preceding interval births. These associations were then meta-analyzed. We also stratified the analyses by mothers' completed fertility (fertility at end of reproductive period) to assess whether maternal characteristics highly correlated with completed fertility modify the association between birth interval and child mortality.

Results

Children with shorter preceding intervals had increased odds of both neonatal (<24 months, OR: 1.61, 95% CI: 1.52-1.70) and under-five mortality (<24 months, OR: 1.48, 95% CI: 1.40-1.56). When the associations were stratified by the mothers' completed fertility, the impact of short intervals was greatly reduced or eliminated for low fertility mothers. In contrast, mortality associations became stronger for children of high fertility mothers. However, when the births of high fertility mothers were limited to birth orders 2-4, the associations were comparable to those of low fertility mothers. Longer preceding birth intervals had lower odds of mortality than reference intervals (i.e. under-5 mortality for ? 60 months, OR 0.59, 95% CI: 0.52-0.67). This effect was also mediated by mothers' completed fertility; there was a strong protective effect of longer birth intervals for the high fertility mothers but not for low fertility mothers.

Conclusions

These analyses reproduced findings reported in previous literature that shorter birth intervals are associated with higher child mortality. However the negative impact of short birth intervals may only occur in high parity births. Reproductive health interventions that seek to lengthen birth intervals may have larger impact by targeting women with high parity. This finding is consistent with the concept of maternal depletion as the underlying cause of increased adverse child outcomes associated with shorter birth intervals.

SUBMITTER: Kozuki N

PROVIDER: S-EPMC3847658 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison.

Kozuki Naoko N Walker Neff N

BMC public health 20130917

<h4>Background</h4>This study used data from recent Demographic and Health Surveys (DHS) to examine the impact of short or long preceding birth intervals on neonatal and under-five mortality. In order to minimize the effect of selection issues, we examined child mortality outcomes of the same mother, comparing short or long interval births against births with what had previously been considered optimal intervals.<h4>Methods</h4>We analyzed 47 DHS datasets from low- and middle-income countries. F ...[more]

PMID: 24564713

Similar Datasets

Project description:ObjectiveTo re-evaluate the causal effect of interpregnancy interval on adverse birth outcomes, on the basis that previous studies relying on between mother comparisons may have inadequately adjusted for confounding by maternal risk factors.DesignRetrospective cohort study using conditional logistic regression (matching two intervals per mother so each mother acts as her own control) to model the incidence of adverse birth outcomes as a function of interpregnancy interval; additional unconditional logistic regression with adjustment for confounders enabled comparison with the unmatched design of previous studies.SettingPerth, Western Australia, 1980-2010.Participants40 441 mothers who each delivered three liveborn singleton neonates.Main outcome measuresPreterm birth (<37 weeks), small for gestational age birth (<10th centile of birth weight by sex and gestational age), and low birth weight (<2500 g).ResultsWithin mother analysis of interpregnancy intervals indicated a much weaker effect of short intervals on the odds of preterm birth and low birth weight compared with estimates generated using a traditional between mother analysis. The traditional unmatched design estimated an adjusted odds ratio for an interpregnancy interval of 0-5 months (relative to the reference category of 18-23 months) of 1.41 (95% confidence interval 1.31 to 1.51) for preterm birth, 1.26 (1.15 to 1.37) for low birth weight, and 0.98 (0.92 to 1.06) for small for gestational age birth. In comparison, the matched design showed a much weaker effect of short interpregnancy interval on preterm birth (odds ratio 1.07, 0.86 to 1.34) and low birth weight (1.03, 0.79 to 1.34), and the effect for small for gestational age birth remained small (1.08, 0.87 to 1.34). Both the unmatched and matched models estimated a high odds of small for gestational age birth and low birth weight for long interpregnancy intervals (longer than 59 months), but the estimated effect of long interpregnancy intervals on the odds of preterm birth was much weaker in the matched model than in the unmatched model.ConclusionThis study questions the causal effect of short interpregnancy intervals on adverse birth outcomes and points to the possibility of unmeasured or inadequately specified maternal factors in previous studies.

Dataset Information

Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison.

Background

Methods

Results

Conclusions

Publications

Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets