Infant and Child Mortality in Yemen [Archives:1999/01/Health]

There has been a substantial improvement in the area of mortality, compared with the conditions that prevailed in the first round of the Yemen Demographic and Maternal and Child Health Survey (YDMCHS) in 1991-92. However, this improvement is still below the desired levels targeted by the national health programs and policies. This is especially so because the current mortality levels are among the highest, compared with other countries.
In Yemen, health services in general and maternal and child medical services in particular have improved during the past six years. Nevertheless, there is a need for a strategy to expand these services throughout the administrative units of the country, taking into consideration climate, environmental conditions, the occurrence of epidemic diseases, as well as the population size and density of each unit.

Prevalence of Child Mortality:
The mean number of children ever born to ever-married women age 15-49 is 4.9; for urban women the mean is 4.7 while for rural women it is 5.0 children.
The mean number of children ever born increases with women’s age to 8.9 for women in the age group 45-49. The differentials in the proportion of the dead among children ever born by urban/rural residence is also high. Overall, 16% of children (1 in 6) do not survive (16% in rural areas and 13% in urban areas). Results also indicate that the proportion of the dead increases steadily with the age of the mother and the duration since first marriage. The proportion of the dead among children ever born to ever-married women aged 45-49 is 0.20, compared with 0.13 for women aged 15-19. This difference is due to the fact that children of older mothers were, on average, born further in the past than children of younger mothers and, as a consequence, have higher levels of mortality than the children of younger mothers.

Infant and Child Mortality Levels:
Direct Measures of Mortality:
The infant mortality levels have declined from 138 deaths per 1,000 live births during the period 15-19 years preceding the survey of 1998 to 75 per 1,000 live births during the five years prior to the survey. Similarly, under-five child mortality has dropped from 203 deaths per 1,000 live births during the period 15-19 years preceding the survey to 105 deaths during the five years prior to the survey.
Differentials in mortality in the period 0-4 years before the survey by sex show higher mortality among males than females both before the first birthday and during the first five years of life. However, female mortality is higher than male mortality among children aged 1 to 4 years. This may indicate a preference for male children, particularly in the provision of medical care. The estimates indicate that all mortality rates have dropped during the 25 years preceding the survey. As expected, despite of overall drop in infant mortality, there is a slower drop in neonatal mortality (less than one month of age) compared with post neonatal mortality (between 1-11 months of age). The neonatal mortality rate dropped from 67 deaths per 1,000 live births during the period 20-24 years preceding the survey to 34 deaths pre 1,000 live births during the period 0-4 years prior the survey. While the post neonatal mortality rate dropped from 119 deaths per 1,000 live births to 42 deaths for the same periods. In other words, neonatal mortality dropped by 49 and post neonatal by 65%.
Infant mortality has dropped from 186 deaths per 1,000 live births to 75 deaths per 1,000 live births, while child mortality (1-4 years) has dropped from 91 deaths per 1,000 live births during the period 20-24 years preceding the survey to 32 deaths per 1,000 live births during the five years preceding the survey.

Differentials in Infant and Child Mortality
a. Residence
Mortality rates are higher in rural areas than in urban areas. The infant mortality rate is 94 deaths per 1,000 live births in rural areas, compared with 75 deaths per 1,000 live births in urban areas. The child mortality rate in rural areas is 38 deaths per 1,000 live births, compared with 22 deaths per 1,000 live births in urban areas. The under-five mortality rate in rural areas is 128 deaths per 1,000 live births, compared with 96 deaths per 1,000 in urban areas.
Under-five mortality rates in Coastal, Mountainous, and Plateau and Desert regions are 137, 122, and 113 deaths per 1,000 live births, respectively.

b. Mother’s Level of Education
The infant mortality rate for children born to illiterate mothers – 93 per 1,000 live births-drops to 62 deaths per 1,000 for children born to mothers who completed primary education. Infant mortality continues to drop to 52 deaths per 1,000 births for children born to mothers with secondary or higher education. The same pattern can be observed in under-five mortality by mothers education.

c. Medical Maternal Care
The infant mortality rate for children born to mothers who received no medical maternal care during pregnancy and/or delivery is 78 deaths per 1,000 live births. The rate drops to 61 deaths per 1,000 for children born to mothers who received medial maternal care both during pregnancy and delivery.
Similarly, the under-five mortality rate dropped from 113 deaths per 1,000 live births for children born to mothers who received no medical maternal care to 101 deaths per 1,000 per children born to mothers who received medical maternal care during either pregnancy or delivery.

d. Qat Chewing and Tobacco Smoking
Estimates indicate that 79-84 deaths per 1,000 live births compared with 70 death per 1,000 live births occur among mothers who neither chew qat nor smoke tobacco.

Biodemographic Characteristics and Child Mortality

a. Sex of Child
Infant mortality is higher for boys than for girls (98 versus 80 deaths per 1,000 live births, respectively).
The pattern reverses slightly in child mortality and shows higher mortality for girls than boys (36 versus 33 deaths per 1,000 live births respectively). This reversal suggests there may be preference for boys and some tendency to provide greater care for boys than for girls during ages 1 to 4.

b. Maternal Age of Birth
The higher infant mortality risk occurs among children born to very young mothers, under 20 years age (128 deaths per 1,000 live births). However, mortality rates for children born to women aged 40-49 are not substantially different from those for children born to women aged 20-39 (79-84 deaths per 1,000 births)
Mortality under-five is higher for children born to women in the youngest age group (161 deaths per 1,000 live births) compared with 112 to 116 death per 1,000 for children born to other women.

c. Birth Order
The infant mortality rate is 110 deaths per 1,000 live births for first births, and decreased to 76 per 1,000 for fourth to sixth order births, then increases for birth order 7 or higher. A similar pattern is observed for neonatal mortality and under-five mortality.

d. Previous Birth Interval
Infant mortality decreases from 124 deaths per 1,000 live births for birth intervals less than two years to 36-55 deaths per 1,000 for birth intervals of two years more. The corresponding figures for under-five mortality are 166 and 54-79 deaths per 1,000 live births, respectively.

Environmental Factors and Child Mortality:
Estimates indicate that mortality rates among all groups of children under five are higher in rural areas, according to environmental factors. Mortality rates are also higher among children under-five than among younger children. Type of toilet or sewerage facilities of the dwelling is one of the most influential environmental factors affecting child health. Neonatal, infant, and under-five mortality artesian dwellings with no toilet are 47, 108, and 157 deaths per 1,000 live births, respectively. These rates drop to 34, 65, and 81 deaths per 1,000, respectively, in dwellings with modern toilets.
Better flooring material is associated with lower rates of infant and non-infant child mortality. Neonatal, post neonatal and under-five mortality rates are 43, 99, and 142 deaths per 1,000 live births, respectively. While these rates decrease to 38, 79, and 99 deaths per 1,000, respectively, in dwellings with cement or wooden floors.
The cleanliness of the area around the house is the last influential environmental factors on the child’s life. Neonatal, post neonatal and under-five mortality rates are 26, 63, and 105 deaths per 1,000 live births, respectively, when the area around the house has stagnant water. Surprisingly, these rates increase to 44, 89, and 121 deaths per 1,000, respectively, when the area around the house is clean.
In rural areas, the under-five mortality rate in dwellings where farm animals and household members live together is 129 per 1,000 births, the rate decreases to 125 deaths per 1,000 in dwellings with no farm animals.

Causes of Death
The results presented in the YDMCHS indicate that fever (25%), vomiting (20%), and difficult breathing and convulsions (18-19%) are the most common symptoms during the neonatal period. During the post neonatal period, the probable causes of child death are fever (69%), diarrhea (58%), vomiting (56%), and cough/difficult breathing (42%). For children one year of age and older, fever was again the most common symptom, associated with 74% of all deaths in that age group.

High-Risk Fertility Behavior
The data reveal that 31% of currently married women have the potential to give birth to a child with a single elevated risk category, while 46% of women have the potential to give birth to a child with multiple high-risk factors. In all, 76% of married women have the potential to give birth to children at elevated risk of dieing.

By: Ahmed N. Al-Barakani
and Ahmed Abdul-Rub,
Center for Population Studies & Research at the Central Organization for Statistics.

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