1,721,427 research outputs found
Child immunisation in Ghana: the effects of family, location and social disparity
No full textThe data from the Demographic and Health Survey conducted in Ghana in 1988 are used to identify determinants of immunisation uptake for children under 5 years. The logistic binomial analysis shows that socioeconomic factors are significant, especially women's education and region, and that the type of prenatal care received by the mother is also important. There is a strong familial correlation of vaccination behaviours, and there is also clustering of data within enumeration areas
Determinants of infant mortality in Malawi: an analysis to control for death clustering within families
No full textTwo logistic binomial models for neonatal mortality (under 1 month) and post-neonatal mortality were used to determine the probability of dying among families in Malawi. Data was obtained from 3043 women aged 15-54 years on 6258 births, which occurred 0-15 years before the survey, from the 1988 Malawi Traditional and Modern Methods of Child Spacing Survey. Mortality included 211 post-neonatal deaths, 147 toddler deaths, and 172 child deaths. Missing information or date of death missing information pertained to 182 reported deaths that were excluded from the analysis. Logistic models were run with the complete sample and the sub-sample and found to have similar results. Findings showed that children born in homes with electricity had 34% lower risk of dying than children born in homes without electricity. Preceding birth interval was unrelated to neonatal mortality. Neonatal mortality rates were significantly higher in Chiradzulu rural area, which was found to have a lower proportion of mothers with five or more years of education. The random term, which was high, suggested a high familial correlation with neonatal mortality risk. Findings showed that families with favorable characteristics living in the Chiradzulu area had a probability of 0.005 of a neonatal death. Low risk families in unfavorable circumstances had lower probabilities of child loss than high risk families with favorable conditions. Significant determinants of post-neonatal mortality were preceding birth interval, maternal education, father's occupation, and geographic area. Women with 9 or more years of education had lower infant mortality risks. Family effects were significant, even after controlling for socioeconomic conditions. The most favorable conditions for child survival were: no preceding child; a preceding birth interval of 19 months or longer; maternal education of 9 or more years; and paternal employment in non-manual work
The demographic impact of child immunisation programmes in developing countries: a strategy for assessment
No full textThe expanded Programme on Immunisation: mortality consequences and demographic impact in developing countries
No full textA multilevel analysis of the effects of rurality and social deprivation on premature limiting long term illness
No full textSTUDY OBJECTIVE---To examine the geographical variation in self perceived morbidity in the south west of England, and assess the associations with rurality and social deprivation.DESIGN---A geographically based cross sectional study using 1991 census data on premature Limiting Long Term Illness (LLTI). The urban-rural and intra-rural variation in standardised premature LLTI ratios is described, and correlation and regression analyses explore how well this is explained by generic deprivation indices. Multilevel Poisson modelling investigates whether Customised Deprivation Profiles (CDPs) and area characteristics improve upon the generic indices.SETTING---Nine counties in the south west of EnglandPARTICIPANTS---The population of the south west enumerated in the 1991 census.MAIN RESULTS---Intra-rural variation is apparent, with higher rates of premature LLTI in remoter areas. Together with high rates in urban areas and lower rates in the semi-rural areas this indicates the existence of a U shaped relation with rurality. The generic deprivation indices have strong positive relations with premature LLTI in urban areas, but these are a lot weaker in semi-rural and rural locations. CDPs improve upon the generic indices, especially in the rural settings. A substantial reduction in unexplained variation in rural areas is seen after controlling for the level of local isolation, with higher isolation, at the wider geographical scale, being related to higher levels of LLTI.CONCLUSIONS---This study highlights the need to treat rural areas as heterogeneous, although this has not been the tendency in health research. Generic deprivation indices are unlikely to be a true reflection of levels of deprivation in rural environments. The importance of CDPs that are specific to the area type and health outcome is emphasised. The significance of physical isolation suggests that accessibility to public and health services may be an important issue, and requires further research
The inter-relationships between three proxies of health care need at the small area level: an urban/rural comparison
No full textStudy objective: To examine the relations between geographical variations in mortality, morbidity, and deprivation at the small area level in the south west of England and to assess whether these relations vary between urban and rural areas. Design: A geographically based cross sectional study using 1991 census data on premature limiting long term illness (LLTI) and socioeconomic characteristics, and 1991–1996 data on all cause premature mortality. The interrelations between the three widely used proxies of health care need are examined using correlation coefficients and scatterplots. The distribution of standardised LLTI residuals from a regression analysis on mortality are mapped and compared with the distribution of urban and rural areas. Multilevel Poisson modelling investigates whether customised deprivation profiles improve upon a generic deprivation index in explaining the spatial variation in morbidity and mortality after controlling for age and sex. These relations are examined separately for urban, fringe, and rural areas. Setting: Nine counties in the south west of England. Participants: Those aged between 0–64 who reported having a LLTI in the 1991 census, and those who died during 1991–1996 aged 0–74. Main results: Relations between both health outcomes and generic deprivation indices are stronger in urban than rural areas. The replacement of generic with customised indices is an improvement in all area types, especially for LLTI in rural areas. The relation between mortality and morbidity is stronger in urban than rural areas, with levels of LLTI appearing to be greater in rural areas than would be predicted from mortality rates. Despite the weak direct relations between mortality and morbidity, there are strong relations between the customised deprivation indices computed to predict these outcomes in all area types. Conclusions: The improvement of the customised deprivation indices over the generic indices, and the similarity between the mortality and morbidity customised indices within area types highlights the importance of modelling urban and rural areas separately. Stronger relations between mortality and morbidity have been revealed at the local authority level in previous research providing empirical evidence that the inadequacy of mortality as a proxy for morbidity becomes more marked at lower levels of aggregation, especially in rural areas. Higher levels of LLTI than expected in rural areas may reflect different perceptions or differing patterns of illness. The stronger relations between the three proxies in urban than rural areas suggests that the choice of indicator will have less impact in urban than rural areas and strengthens the argument to develop better measures of health care need in rural areas
Child immunisation programmes in developing countries: a general impact assessment approach
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