Impact of Maternal Education and Health Related Behaviors on Infant and Child Survival in Pakistan

1
Impact of Maternal Education and Health Related
Behaviors on Infant and Child Survival in Pakistan

• G. Mustafa Zahid
• University of Western Ontario
• London, Ontario

2
Research Question

• What is the nature of the association between
  mothers schooling and child mortality on the one
  hand, and between the health seeking behavior of
  the mother and child mortality on the other hand?

3
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. Mothers 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.

4
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 mothers behavior in seeking health either
  as a preventive or curative treatment is an
  important factor in determining child
  survivorship through the childs health and
  nutritional status, as well as through her own
  health.

5
Introduction (contd. ii)

• 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.

6
What is Health Seeking behavior

• Health seeking behavior includes consulting a
  physician during the prenatal (for mothers
  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.

7
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 DSouza and Bhuiya, 1982
  Streatfield, 1992.

8
Theoretical Framework
Socio-economic determinants
Maternal factors
Environmental Contamination
Nutrient deficiency
Injury
Healthy
Sick
Treatment
Personal Illness Control
Growth Faltering
Mortality
Prevention
Source Mosley and Chen 1984, PDR Supplement 10
25-45
9
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.

10
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).

11
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. Coxs
  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.

12
1) Summary Results Neonatal
Covariates Regression Coefficients Exp (ß)
Age of mother at Birth
15-19 0.000 1.000
20-29 -0.104 0.901
30-49 -0.092 0.912
Birth Order
1 0.000 1.000
2-3 0.436 1.547
4 0.381 1.464
Immunization
No 0.000 1.000
Incomplete -1.863 0.155
Complete -3.906 0.020
Ever-breastfed
Yes 0.000 1.000
No 2.302 10.045
Antenatal Care
Doctor/ LHV / Nurse 0.000 1.000
Traditional 0.351 1.421
13
Continued Neonatal
Covariates Regression Coefficients Exp (ß)
Education of mother
No Education 0.000 1.000
Primary/ Middle -0.161 0.851
Secondary/ Higher -0.152 0.859
Sex of Child
Male 0.000 1.000
Female -0.208 0.812
Type of Toilet Facility
Flush 0.000 1.000
Others 0.455 1.576
Place of Residence
Urban 0.000 1.000
Rural 0.152 1.164
Tetanus Injection in Pregnancy
Yes 0.000 1.000
No 0.508 1.662
Significant at level lt0.10, lt 0.05, and
lt0.001
14
2 Summary Results Infants
Covariates Regression Coefficients Exp (ß)
Age of mother at Birth
15-19 0.000 1.000
20-29 -0.085 0.918
30-49 -0.723 0.485
Birth Order
1 0.000 1.000
2-3 0.227 1.255
4 0.299 1.349
Immunization
No 0.000 1.000
Incomplete -1.547 0.213
Complete -1.208 0.299
Ever-breastfed
Yes 0.000 1.000
No 1.519 4.566
Antenatal Care
Doctor/ LHV / Nurse 0.000 1.000
Traditional 1.076 2.932
15
Continued Infants
Covariates Regression Coefficients Exp (ß)
Education of mother
No Education 0.000 1.000
Primary/ Middle -0.457 0.633
Secondary/ Higher -0.398 0.672
Sex of Child
Male 0.000 1.000
Female -0.161 0.851
Type of Toilet Facility
Flush 0.000 1.000
Others 0.113 1.120
Place of Residence
Urban 0.000 1.000
Rural 0.147 1.158
Tetanus Injection in Pregnancy
Yes 0.000 1.000
No 0.498 1.645
16
3 Summary Results Children
Covariates Regression Coefficients Exp (ß)
Age of mother at Birth
15-19 0.000 1.000
20-29 -0.503 0.650
30-49 -0.643 0.526
Birth Order
1 0.000 1.000
2-3 0.605 1.831
4 1.118 3.059
Immunization
No 0.000 1.000
Incomplete -0.659 0.517
Complete -0.755 0.470
Ever-breastfed
Yes 0.000 1.000
No 1.015 2.760
Antenatal Care
Doctor/ LHV / Nurse 0.000 1.000
Traditional 1.042 2.835
17
Continued Children
Covariates Regression Coefficients Exp (ß)
Education of mother
No Education 0.000 1.000
Primary/ Middle -0.102 0.903
Secondary/ Higher -0.491 0.612
Sex of Child
Male 0.000 1.000
Female 0.072 1.075
Type of Toilet Facility
Flush 0.000 1.000
Others 0.687 1.988
Place of Residence
Urban 0.000 1.000
Rural 0.127 1.136
Tetanus Injection in Pregnancy
Yes 0.000 1.000
No 0.009 1.009
18
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
  childs birth which is termed as high risk births
  for very young and older mothers.

19
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.

20
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.

21
Conclusion (continued)

• The important conclusion from this analysis of
  differentials in infant and child mortality is
  that mothers education and age at birth are
  strongly correlated with lower neonatal and
  infant mortality.