Carine Ronsmans
Birth Spacing and Child Survival in Rural Senegal
studies examining associations short birth spacing child mortality often concentrated strength associations whilst public health importance short spacing specific communities received less attention study reexamines association short birth intervals child mortality rural senegal discusses potential direct effects efforts delay births child mortality communitythe study uses longitudinal data cohort 4852 children born 1983 1989 associations birth spacing child mortality examined using logistic cox proportional hazards regression modelsthe probability dying age five 224 per 1000 livebirths median interval births 33 months 12 birth intervals less 24 months length odds dying neonatal postneonatal period 227 212 times higher respectively children born preceding birth intervals one year less compared children born longer intervals children born within two years subsequent birth 409 times higher risk dying second year life children whose mother gave birth 2 years index birthin community prolonged breastfeeding causes women space births long intervals short birth intervals consequence rather cause child mortality potential direct effects birth spacing efforts child mortality limited reduce high levels child mortality efforts made ensure effective preventive curative health services maintain traditional pattern breastfeedingthis study 1 describes distribution birth intervals 2 explores extent child mortality reduces birth interval 3 examines association short birth interval neonatal postneonatal mortality mortality age 1 year next birth study conducted among rural population living east dakar senegal annual data obtained demographic surveillance system 198387 prolonged breast feeding widespread four separate samples selected 4852 single births occurred 198387 among mothers 22 study villages standard life tables used construct mortality levels entire sample subsamples used establish nonparametric kaplanmeier survival probability next birth average length birth intervals effect short preceding birth interval subsequent neonatal infant mortality effect short birth interval subsequent mortality among children aged 1 year probability dying first year 10351000 live births 13431000 among children aged 15 years median birth interval 33 months neonatal death 50 women another birth within 15 months proportion short birth interval 14 months declined child survived infancy neonatal postneonatal deaths occurred estimated date next conception large proportion deaths among infants aged 12 years occurred date next conception preceding birth intervals 12 years affect neonatal postneonatal mortality child mortality second year attributed abrupt weaning children 258 times higher risk dying postneonatally rainy season mortality declined study period birth order maternal age sex literacy largely affect child mortality