Document Detail

Birth spacing and child survival in rural Senegal.
MedLine Citation:
PMID:  8921485     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Studies examining the associations between short birth spacing and child mortality have often concentrated on the strength of the associations whilst the public health importance of short spacing in specific communities has received less attention. This study re-examines the association between short birth intervals and child mortality in rural Senegal and discusses the potential direct effects of efforts to delay births on child mortality in this community. METHODS: The study uses longitudinal data in a cohort of 4852 children born between 1983 and 1989. The associations between birth spacing and child mortality are examined using logistic and Cox proportional hazards regression models. RESULTS: The probability of dying before age five is 224 per 1000 livebirths. The median interval between births is 33 months and only 12% of the birth intervals are less than 24 months in length. The odds of dying in the neonatal and post-neonatal period is 2.27 and 2.12 times higher respectively for children born after preceding birth intervals of one year or less compared to children born after longer intervals. Children born within two years of a subsequent birth are at 4.09 times higher risk of dying in the second year of life than children whose mother gave birth more than 2 years after the index birth. CONCLUSIONS: In this community where prolonged breastfeeding causes women to space their births at long intervals, short birth intervals are a consequence rather than a cause of child mortality and the potential direct effects of birth spacing efforts on child mortality are limited. To reduce the high levels of child mortality, efforts will have to be made to ensure effective preventive and curative health services, and to maintain the traditional pattern of breastfeeding.
This study 1) describes the distribution of birth intervals, 2) explores the extent to which child mortality reduces the birth interval, and 3) examines the association between a short birth interval and neonatal and postneonatal mortality and mortality over the age of 1 year in the next birth. The study was conducted among a rural population living east of Dakar, Senegal. Annual data were obtained from the demographic surveillance system during 1983-87. Prolonged breast feeding was widespread. Four separate samples were selected from the 4852 single births that occurred during 1983-87 among the mothers in the 22 study villages. Standard life tables were used to construct mortality levels for the entire sample. Subsamples were used to establish the nonparametric Kaplan-Meier survival probability of a next birth, the average length of birth intervals, the effect of a short preceding birth interval on subsequent neonatal and infant mortality, and the effect of a short birth interval on subsequent mortality among children aged over 1 year. The probability of dying in the first year was 103.5/1000 live births, and 134.3/1000 among children aged 1-5 years. The median birth interval was 33 months. After a neonatal death, 50% of women had another birth within 15 months. The proportion with a short birth interval under 14 months declined if a child survived infancy. Most neonatal and postneonatal deaths occurred before the estimated date of the next conception. A large proportion of deaths among infants aged 1-2 years occurred after the date of next conception. Preceding birth intervals of 1-2 years did not affect neonatal and postneonatal mortality. Child mortality in the second year is attributed to abrupt weaning. Children had a 2.58 times higher risk of dying postneonatally during the rainy season. Mortality declined over the study period. Birth order, maternal age, sex, or literacy did not largely affect child mortality.
C Ronsmans
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  International journal of epidemiology     Volume:  25     ISSN:  0300-5771     ISO Abbreviation:  Int J Epidemiol     Publication Date:  1996 Oct 
Date Detail:
Created Date:  1997-02-07     Completed Date:  1997-02-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7802871     Medline TA:  Int J Epidemiol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  989-97     Citation Subset:  IM; J    
Maternal and Child Epidemiology Unit, London School of Hygiene and Tropical Medicine, UK.
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MeSH Terms
Birth Intervals*
Child, Preschool
Cohort Studies
Developing Countries
Infant Mortality / trends*
Infant, Newborn
Mortality / trends
Multivariate Analysis
Proportional Hazards Models
Risk Factors
Rural Population / statistics & numerical data
Senegal / epidemiology
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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