Transcript Impact of Maternal Education and Health Related Behaviors

Impact of Maternal Education and
Health Related Behaviors on Infant
and Child Survival in Pakistan
G. Mustafa Zahid
University of Western Ontario
London, Ontario
Research Question

What is the nature of the
association between mother’s
schooling and child mortality on the
one hand, and between the health
seeking behavior of the mother and
child mortality on the other hand?
Introduction


The level of infant and child mortality is widely
used not only as a demographic measure, but
also as an important indicator of the level of the
health in a society and of its living standard.
Women are known and considered all over the
world as the first providers of health care in the
home. Mother’s behavior has a great impact on
health and survival of children through curative
means when the child is sick, whether the mother
uses modern medicine or traditional practices.
Introduction (contd. i)

Prenatal visits enable mothers to obtain
health information on prevention as well
as specific medical attention which
results in low morbidity and mortality in
developing countries. Therefore, the
mother’s behavior in seeking health
either as a preventive or curative
treatment is an important factor in
determining child survivorship through
the child’s health and nutritional status,
as well as through her own health.
Introduction (contd. ii)

1.
2.
3.
4.
Women are expected by policy makers and society in
general to implement the child survival revolution by:
Bringing children to be immunized four times
during the first year of life;
Procuring or producing oral re-hydration solutions
and administering them to a sick child many times
over the course of each day of every bout of
diarrhea;
Breastfeeding their babies on demand until the child
is six months to two years old and processing and
feeding proper weaning foods in frequent meals to
small children at the appropriate ages;
Bringing children under age five to a weight
surveillance program monthly.
What is Health Seeking behavior

Health seeking behavior includes
consulting a physician during the
prenatal (for mother’s immunization
against tetanus), ante-natal (place
of delivery and help at delivery) and
postnatal (immunization of the
child) period, especially when
disease symptoms are aparent.
Previous Studies

Bicego and Boerma, 1993; Rajna et
al., 1998; Caldwell, 1979 ,1987,
1990, 1994; Desai and Alva, 1998;
Hobcraft et al., 1984; Martin et al.,
1983; Sathar, 1985; D’Souza and
Bhuiya, 1982; Streatfield, 1992.
Theoretical Framework
Socio-economic determinants
Maternal
factors
Environmental
Contamination
Healthy
Personal
Illness
Control
Nutrient
deficiency
Injury
Sick
Treatment
Prevention
Growth
Faltering
Source: Mosley and Chen 1984, PDR Supplement 10: 25-45
Mortality
Objectives


To examine the pattern of health
seeking behavior of mothers and its
effects on childhood mortality.
To examine and compare the effects
of socio-economic factors through
demographic and health seeking
behavior especially education of
mother on childhood mortality.
Source of Data and Method of Analysis

Data derive all its variables under study
from the Pakistan Demographic and
Health Survey (PDHS) of 1990-91, a
nationally representative survey covering
all four provinces of the country, the first
and up till now the latest survey
undertaken by Macro International in
conjunction with the National Institute of
Population Studies (NIPS).
Continued (methods)

The dependent variable is the survival times of
the children during neonatal, infant and
childhood ages. Since many children have not
completed the event at the date of survey these
observations were considered as censored. Cox’s
proportional hazard model is appropriate for the
analysis of data that includes censored
observations. Unlike parametric models, the
proportional hazard model does not make any
assumption on the distribution of the timing
function and thus appropriate for events whose
empirical distribution of the timing function is
unknown.
1) Summary Results: Neonatal
Covariates
Regression Coefficients
Exp (β)
15-19
0.000
1.000
20-29
-0.104**
0.901
30-49
-0.092**
0.912
0.000
1.000
2-3
0.436***
1.547
4+
0.381**
1.464
0.000
1.000
-1.863**
0.155
-3.906***
0.020
Yes
0.000
1.000
No
2.302***
10.045
0.000
1.000
0.351***
1.421
Age of mother at Birth
Birth Order
1
Immunization
No
Incomplete
Complete
Ever-breastfed
Antenatal Care
Doctor/ LHV / Nurse
Traditional
Continued: Neonatal
Covariates
Regression Coefficients
Exp (β)
0.000
1.000
Primary/ Middle
-0.161**
0.851
Secondary/ Higher
-0.152**
0.859
Male
0.000
1.000
Female
-0.208
0.812
Flush
0.000
1.000
Others
0.455
1.576
Urban
0.000
1.000
Rural
0.152**
1.164
Yes
0.000
1.000
No
0.508***
1.662
Education of mother
No Education
Sex of Child
Type of Toilet Facility
Place of Residence
Tetanus Injection in Pregnancy
* Significant at level <0.10, ** < 0.05, and *** <0.001
2: Summary Results: Infants
Covariates
Regression Coefficients
Exp (β)
15-19
0.000
1.000
20-29
-0.085**
0.918
30-49
-0.723**
0.485
0.000
1.000
2-3
0.227***
1.255
4+
0.299**
1.349
0.000
1.000
-1.547**
0.213
-1.208***
0.299
Yes
0.000
1.000
No
1.519***
4.566
0.000
1.000
1.076***
2.932
Age of mother at Birth
Birth Order
1
Immunization
No
Incomplete
Complete
Ever-breastfed
Antenatal Care
Doctor/ LHV / Nurse
Traditional
Continued: Infants
Covariates
Regression Coefficients
Exp (β)
0.000
1.000
-0.457*
0.633
-0.398***
0.672
Male
0.000
1.000
Female
-0.161
0.851
0.000
1.000
0.113**
1.120
Urban
0.000
1.000
Rural
0.147**
1.158
Yes
0.000
1.000
No
0.498***
1.645
Education of mother
No Education
Primary/ Middle
Secondary/ Higher
Sex of Child
Type of Toilet Facility
Flush
Others
Place of Residence
Tetanus Injection in Pregnancy
3: Summary Results: Children
Covariates
Regression Coefficients
Exp (β)
15-19
0.000
1.000
20-29
-0.503***
0.650
30-49
-0.643*
0.526
0.000
1.000
2-3
0.605**
1.831
4+
1.118*
3.059
0.000
1.000
-0.659*
0.517
-0.755***
0.470
Yes
0.000
1.000
No
1.015**
2.760
0.000
1.000
1.042**
2.835
Age of mother at Birth
Birth Order
1
Immunization
No
Incomplete
Complete
Ever-breastfed
Antenatal Care
Doctor/ LHV / Nurse
Traditional
Continued: Children
Covariates
Regression Coefficients
Exp (β)
0.000
1.000
Primary/ Middle
-0.102***
0.903
Secondary/ Higher
-0.491***
0.612
0.000
1.000
0.072***
1.075
0.000
1.000
0.687**
1.988
Urban
0.000
1.000
Rural
0.127**
1.136
Yes
0.000
1.000
No
0.009
1.009
Education of mother
No Education
Sex of Child
Male
Female
Type of Toilet Facility
Flush
Others
Place of Residence
Tetanus Injection in Pregnancy
Conclusion



The highest mortality occurred among children
born to mothers aged less than 20 years.
Neonatal and infant mortality is higher for males
than for females; this relationship is then
reversed for child mortality. This shows that there
are some gender related differences in child
rearing practices that favor boys over girls.
The high mortality of first and high order births
may be related to the age of the mother at the
child’s birth which is termed as high risk births for
very young and older mothers.
Conclusion (continued)

The analysis identifies that the
mothers who have a better
perception of disease processes and
an excellent aptitude to utilize
modern health services are
qualitatively distinct from those who
do not.
Conclusion (continued)

Differences in infant and child mortality
have also been observed according to the
place of residence at the time of the
survey. Mortality is higher in rural areas
than in urban areas as expected. This
finding might be due to factors including
sanitation, water supply, and unequal
distribution of health facilities between
rural and urban areas of the country.
Conclusion (continued)

The important conclusion from this
analysis of differentials in infant and
child mortality is that mother’s
education and age at birth are
strongly correlated with lower
neonatal and infant mortality.