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Recurrent child mortality risks and parity transition in Nigeria.

ABSTRACT: BACKGROUND:Fertility rates remain persistently high in Nigeria, with little difference across socioeconomic groups. While the desire for large family size is culturally rooted, there is little understanding of how repeated child mortality experiences influence fertility behaviour and parity transition in Nigeria. METHODS:Using birth history data from the 2013 Nigeria Demographic and Health Survey (NDHS), we applied life table techniques and proportional-hazard regression model to explore the effect of child survival experience on parity transitions. We hypothesize that a woman with one or more child death experience is at elevated risk of progressing towards higher parities. RESULTS:Our findings show that child mortality is concentrated among mothers living in deprived conditions especially in rural areas of the northern part of Nigeria and among those with little or no education and, among those belonging to Hausa/Fulani ethnicity and Islam religion. Mothers with repeated experience of child deaths were significantly at a higher rate of progressing to higher parities than their counterparts (HR: 1.45; 95% CI: 1.31-1.61), when adjusted for relevant biological and socio-demographic characteristics. CONCLUSION:Recurrent experience of child deaths exacerbates the risks to higher parity transition. Interventions aimed at reducing fertility in Nigeria should target promoting child survival and family planning concurrently.

SUBMITTER: Adanikin AI

PROVIDER: S-EPMC6556041 | biostudies-other | 2019 Jun

REPOSITORIES: biostudies-other

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Recurrent child mortality risks and parity transition in Nigeria.

Adanikin Abiodun Idowu AI Padmadas Sabu S SS McGrath Nuala N

Reproductive health 20190607 1

<h4>Background</h4>Fertility rates remain persistently high in Nigeria, with little difference across socioeconomic groups. While the desire for large family size is culturally rooted, there is little understanding of how repeated child mortality experiences influence fertility behaviour and parity transition in Nigeria.<h4>Methods</h4>Using birth history data from the 2013 Nigeria Demographic and Health Survey (NDHS), we applied life table techniques and proportional-hazard regression model to ...[more]

PMID: 31174553

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Project description:BackgroundThis study used data from recent Demographic and Health Surveys (DHS) to examine the impact of high parity on under-five and neonatal mortality. The analyses used various techniques to attempt eliminating selection issues, including stratification of analyses by mothers' completed fertility.MethodsWe analyzed DHS datasets from 47 low- and middle-income countries. We only used data from women who were age 35 or older at the time of survey to have a measure of their completed fertility. We ran log-binominal regression by country to calculate relative risk between parity and both under-five and neonatal mortality, controlled for wealth quintile, maternal education, urban versus rural residence, maternal age at first birth, calendar year (to control for possible time trends), and birth interval. We then controlled for maternal background characteristics even further by using mothers' completed fertility as a proxy measure.ResultsWe found a statistically significant association between high parity and child mortality. However, this association is most likely not physiological, and can be largely attributed to the difference in background characteristics of mothers who complete reproduction with high fertility versus low fertility. Children of high completed fertility mothers have statistically significantly increased risk of death compared to children of low completed fertility mothers at every birth order, even after controlling for available confounders (i.e. among children of birth order 1, adjusted RR of under-five mortality 1.58, 95% CI: 1.42, 1.76). There appears to be residual confounders that put children of high completed fertility mothers at higher risk, regardless of birth order. When we examined the association between parity and under-five mortality among mothers with high completed fertility, it remained statistically significant, but negligible in magnitude (i.e. adjusted RR of under-five mortality 1.03, 95% CI: 1.02-1.05).ConclusionsOur analyses strongly suggest that the observed increased risk of mortality associated with high parity births is not driven by a physiological link between parity and mortality. We found that at each birth order, children born to women who have high fertility at the end of their reproductive period are at significantly higher mortality risk than children of mothers who have low fertility, even after adjusting for available confounders. With each unit increase in birth order, a larger proportion of births at the population level belongs to mothers with these adverse characteristics correlated with high fertility. Hence it appears as if mortality rates go up with increasing parity, but not for physiological reasons.

Project description:BackgroundExisting knowledge has established the connection between maternal education and child survival, but little is known about how educational assortative mating (EAM), relates to childhood mortality. We attempt to examine this association in the context of Nigeria.MethodsData was obtained from the 2008, 2013, and 2018 waves of the Nigeria Demographic and Health Survey, which is a cross-sectional study. The sample includes the analysis of 72,527 newborns within the 5 years preceding each survey. The dependent variables include the risk of a newborn dying before 12 months of age (infant mortality), or between the age of 12-59 months (child mortality). From the perspective of the mother, the independent variable, EAM, includes four categories (high-education homogamy, low-education homogamy, hypergamy, and hypogamy). The Cox proportional hazard regression was employed for multivariate analyses, while the estimation of mortality rates across the spectrum of EAM was obtained through the synthetic cohort technique.ResultsThe risk of childhood mortality varied across the spectrum of EAM and was particularly lowest among those with high-education homogamy. Compared to children of mothers in low-education homogamy, children of mothers in high-education homogamy had 25, 31 to 19% significantly less likelihood of infant mortality, and 34, 41, and 57% significantly less likelihood of child mortality in 2008, 2013 and 2018 survey data, respectively. Also, compared to children of mothers in hypergamy, children of mothers in hypogamous unions had 20, 12, and 11% less likelihood of infant mortality, and 27, 36, and 1% less likelihood of child mortality across 2008, 2013 and 2018 surveys, respectively, although not significant at p < 0.05. Both infant and child mortality rates were highest in low-education homogamy, as expected, lowest in high-education homogamy, and lower in hypogamy than in hypergamy. Furthermore, the trends in the rate declined between 2008 and 2018, and were higher in 2018 than in 2013.ConclusionThis indicates that, beyond the absolute level of education, the similarities or dissimilarities in partners' education may have consequences for child survival, alluding to the family system theory. Future studies could investigate how this association varies when marital status is put into consideration.

Project description:BackgroundNulliparity is considered to be a risk factor of preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). With the new two-child policy launched in 2016, more Chinese women have delivered their 2nd baby. Yet few studies have assessed the impact of parity on adverse birth outcomes in China. This study aimed to examine the association between parity and risks of PTB, LBW and SGA in a Chinese population. The combined effects of maternal age and parity on adverse birth outcomes were also assessed.MethodsThis retrospective study included all non-malformed live births born during January 1, 2014 and December 31, 2018 in Chengdu, China. A total of 746,410 eligible live singletons with complete information were included in the analysis. Parity was classified into nulliparity (i.e. has never delivered a newborn before) and multiparity (i.e. has delivered at least one newborn before). Log-binomial regression analyses were applied to evaluate the association between parity and PTB, LBW and SGA. We further divided maternal age into different groups (< 25 years, 25-29 years, 30-34 years and ≥ 35 years) to assess the combined effects of maternal age and parity on adverse birth outcomes.ResultsMultiparity was associated with reduced risks of PTB (aRR = 0.91, 95% CI: 0.89-0.93), LBW (aRR = 0.74, 95% CI: 0.72-0.77) and SGA (aRR = 0.67, 95% CI: 0.66-0.69) compared with nulliparity. In each age group, we observed that multiparity was associated with lower risks of adverse birth outcomes. Compared to nulliparous women aged between 25 and 29 years, women aged ≥35 years had greater risks of PTB and LBW, regardless of their parity status. In contrast, multiparous women aged ≥35 years (aRR = 0.73, 95% CI: 0.70-0.77) and those aged < 25 years (aRR = 0.88, 95% CI: 0.84-0.93) were at lower risk of SGA compared with nulliparous women aged between 25 and 29 years.ConclusionMultiparity was associated with lower risks of all adverse birth outcomes. Special attention should be paid to nulliparous mothers and those with advanced age during antenatal care, in order to reduce the risks of adverse birth outcomes.

Project description:Data from the 2016-17 Multiple Indicator Cluster Survey from Nigeria are used to study the relationship between child stature, mother's years of education, and indicators of early childhood development (ECD). The relationships are contrasted between two empirical approaches: the conventional approach whereby control variables are selected in an ad-hoc manner, and the double machine-learning (DML) approach that employs data-driven methods to select controls from a much wider set of variables and thus reducing potential omitted variable bias. Overall, the analysis confirms that maternal education and the incidence of chronic malnutrition have a significant direct effect on measures of early childhood development. The point estimates based on the ad-hoc specification tend to be larger in absolute value than those based on the DML specification. Frequently, the point estimates based on the ad-hoc specification fall inside the confidence interval of the DML point estimates, suggesting that in these cases the omitted variable bias is not serious enough to prevent making causal inferences based on the ad-hoc specification. However, there are instances where the omitted variable bias is sufficiently large for the ad hoc specification to yield a statistically significant relationship when in fact the more robust DML specification suggests there is none. The DML approach also reveals a more complex picture that highlights the role of context. In rural areas, mother's education affects early childhood development both directly and indirectly through its impact on the nutritional status of both older and younger children. In contrast, in urban areas, where the average level of maternal education is much higher, increases in a mother's education have only a direct effect on child ECD measures but no indirect effect through child nutrition. Thus, DML provides a practical and feasible approach to reducing threats to internal validity for robust inferences and policy design based on observational data.

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Recurrent child mortality risks and parity transition in Nigeria.

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Recurrent child mortality risks and parity transition in Nigeria.

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