ABSTRACT Objective: To analyze the temporal trend in infant mortality and in populational coverage by the Family Health Strategy and associated factors with infant mortality in the municipalities of the 3rd Health Regional of Paraná, Southern Brazil. Methods: Ecological time series study, with data from the Mortality Information System (Sistema de Informação Sobre Mortalidade - SIM), the Live Birth Information System (Sistema de Informação Sobre Nascidos Vivos - SINASC) and the Support Room for Strategic Management (Sala de Apoio à Gestão Estratégica - SAGE), from 2005 to 2016. Trends were calculated using polynomial regression. The associated factors with infant mortality were maternal, perinatal and obstetric variables. The significance level adopted was 5%. Results: Between 2005 and 2016, there were 115,796 births and 1,575 deaths of children under 1 year of age. Considering the municipalities together, the populational coverage by the Family Health Strategy went from 43.8% in 2005 to 66.4% in 2016 and the infant mortality from 17.1/1,000 live births in 2005 to 10.7/1,000 live births in 2016. The trend over time of populational coverage by the Family Health Strategy was crescent and of infant mortality was decrescent, for most municipalities. The factors associated with greater chances of death in children under 1 year of age were preterm gestational age (Odds Ratio - OR=15.05; 95% confidence interval - 95CI% 13.54-16.72), low birth weight (OR=15.14; 95%CI 13.61-16.84), multiple gestation (OR=4.51; 95%CI 3.74-5.45) and mother with up to 7 years of study (OR=1.93; 95%CI 1.74-2.14). Conclusions: Crescent trend in coverage by the Family Health Strategy was accompanied by a decrescent trend in infant mortality. The results can be a source of information for the strengthening of mother-child health actions, considering local and regional specificities.

This dataset is about diseases in China. It has 1 row. It features 5 columns: names, country, virus family, and mortality rate.

ABSTRACT It was aimed to evaluate the impact of the social programs: Bolsa Família Program and Family Health Strategy and fertility on child mortality in the brazilian Semiarid, during the period 2005-2010. The multivariate linear regression model of panel data with fixed effects was applied, using the Infant Mortality Rate as the dependent variable; and, as independents, the coverage of Bolsa Família and its conditionalities, coverage of the Family Health Strategy and the Fertility Rate. The public actions of the Programs, as well as the reduction of fertility levels, have greatly contributed to the decrease in infant mortality rates in the Semiarid.

Datasets for relationship between family income in the United States and child mortality

To determine the impact of prenatal and infant/toddler nurse home visiting on maternal and child mortality over 20 years following program enrollment. Three randomized controlled trials (Elmira, NY; Memphis, TN; Denver, CO) designed originally to assess program impacts on pregnancy outcomes and maternal and child health through child age 2. Each trial included a control group, a group that received the full intervention (nurse visitation through child age 2), and an alternative treatment group (nurse home visitation through pregnancy only or visitation by paraprofessionals through child age 2). Due to sample size considerations, the Elmira and Denver samples were combined for all mortality analyses. For determining mortality, background information used for determining mortality status was available for all 1138 mothers randomized to a Memphis treatment condition and all but 13 of the live-born children (n=1076). For the combined Elmira and Denver group, background information was available for all 1135 mothers randomized to any one of the treatment conditions and all but 10 of the live born children (n=1087). Pregnant women and their first-born children who were enrolled in one of three trials of the Nurse-Family Partnership (Elmira, Memphis, Denver) were included in the current study. The Elmira sample (N = 400) was enrolled between April 1978 and September 1980 with an 80% recruitment rate. At enrollment, 47% of the participating women were younger than 19 years of age, 62% were unmarried, and 61% came from families in Hollingshead’s social classes IV and V (semi-skilled and unskilled laborers). In the Memphis trial, a total of 1138 out of 1289 eligible women (88.3%) completed informed consent and were randomized from June 1, 1990, through August 31, 1991. We enrolled primarily African American women at less than 29 weeks of gestation, with no previous live births, and with at least 2 of the following socio-demographic risk characteristics: unmarried, less than 12 years of education, and unemployed. Of the women enrolled, 92.1% were African American, 98.1% were unmarried, 64.1% were 18 years or younger at registration, and 85.1% came from households with annual incomes below the US federal poverty guidelines. Denver trial enrollment took place between March 1994 and June 1995 with a total of 735 out of 1178 consecutive pregnant women with no previous live births who were eligible for Medicaid or who had no private health insurance enrolled in the trial and were randomized to control, paraprofessional, or nurse-visited conditions. 86% of participating women were unmarried, 42% were under 19 years of age, 45% were Latino, and on average participants lived in census tracts where 20% of the population was below the poverty line. The current study was approved by the University of Rochester Institutional Review Board and the Combined Institutional Review Board of the University of Colorado.

This dataset is about diseases. It has 2 rows. It features 5 columns: first founded year, country, virus family, and mortality rate. It is 100% filled with non-null values.

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Child mortality is often described as the best barometer of social and economic progress. Despite being one of the fastest growing economies, there has been no visible pattern between per capita income growth and the rate of reduction of child mortality rates. The Child Mortality (less than 5 years) in India constitutes about 18% to total deaths in the country. The decline in child mortality over the last nearly two decades masks a dangerous expansion of the child mortality gap between the richest and poorest families in India. Under the National Rural Health Mission (NRHM) and within its umbrella the Reproductive and Child Health Programme Phase II, several interventions have been taken to accelerate the pace of reduction of child mortality. The Under five mortality Millennium Development Goal for 2015 for India is 38 (Reduce by two-thirds, between 1990 and 2015) per 1000 live births which have reached to the level of 59 per 1000 live births in 2010. The under-five mortality is the probability (5q0) that a child born in a specific year or time period will die before reaching the age of five, subject to current age specific mortality rates. It is expressed as a rate per 1,000 live births. Office of Registrar General, India provides estimates of under five mortality India annually since 2008.

This dataset compromises all country data included in the UN Inter-agency Group for Child Mortality Estimation (IGME) database (https://childmortality.org/data, downloaded June 2019).

It includes:

Reference area: name of the country

Indicator: child mortality indicator (neonatal mortality, infant mortality, under-5 mortality and mortality rate age 5 to 14)

Sex: sex of the child (male, female and total)

Series name: name of survey/census/VR [note: UN IGME estimates, i.e. not source data, are identified as "UN IGME estimate" in this field]

Series year: year of survey/census/VR series

Observation value: value of indicator from survey/census/VR

Observation status: indicates whether the data point is included or excluded for estimation [status of "normal" indicates UN IGME estimate, i.e. not source data]

Series Category: category of survey/census/VR, and can be:

DHS [Demographic and Health Survey]

MIS [Malaria Indicator Survey]

AIS [AIDS Indicator Survey]

Interim DHS

Special DHS

NDHS [National DHS]

WFS [World Fertility Survey]

MICS [Multiple Indicator Cluster Survey]

NMICS [National MICS]

RHS [Reproductive Health Survey]

PAP [Pan Arab Project for Child or Pan Arab Project for Family Health or Gulf Famly Health Survey]

LSMS [Living Standard Measurement Survey]

Panel [Dual record, multiround/follow-up survey and longitudinal/panel survey]

Census

VR [Vital Registration]

SVR [Sample Vital Registration]

Others [e.g. Life Tables]

Series type: the type of calculation method used to derive the indicator value (direct, indirect, household deaths, life table and vital records)

Standard error: sampling standard error of the observation value

Series method: data collection method, and can be:

Survey/census with Full Birth Histories

Survey/census with Summary Birth Histories

Survey/census with Household death

Vital Registration

Other

Lower and upper bound: the lower and upper bounds of 90% uncertainty interval of UN IGME estimates (for estimates only, i.e., not source data).

The dataset is used in the following paper:

Ezbakhe, F. and Pérez-Foguet, A. (2019) Levels and trends in child mortality: a compositional approach. Demographic Research (Under Review)

The second National Family Health Survey (NFHS-2), conducted in 1998-99, provides information on fertility, mortality, family planning, and important aspects of nutrition, health, and health care. The International Institute for Population Sciences (IIPS) coordinated the survey, which collected information from a nationally representative sample of more than 90,000 ever-married women age 15-49. The NFHS-2 sample covers 99 percent of India's population living in all 26 states. This report is based on the survey data for 25 of the 26 states, however, since data collection in Tripura was delayed due to local problems in the state. IIPS also coordinated the first National Family Health Survey (NFHS-1) in 1992-93. Most of the types of information collected in NFHS-2 were also collected in the earlier survey, making it possible to identify trends over the intervening period of six and one-half years. In addition, the NFHS-2 questionnaire covered a number of new or expanded topics with important policy implications, such as reproductive health, women's autonomy, domestic violence, women's nutrition, anaemia, and salt iodization. The NFHS-2 survey was carried out in two phases. Ten states were surveyed in the first phase which began in November 1998 and the remaining states (except Tripura) were surveyed in the second phase which began in March 1999. The field staff collected information from 91,196 households in these 25 states and interviewed 89,199 eligible women in these households. In addition, the survey collected information on 32,393 children born in the three years preceding the survey. One health investigator on each survey team measured the height and weight of eligible women and children and took blood samples to assess the prevalence of anaemia. SUMMARY OF FINDINGS POPULATION CHARACTERISTICS Three-quarters (73 percent) of the population lives in rural areas. The age distribution is typical of populations that have recently experienced a fertility decline, with relatively low proportions in the younger and older age groups. Thirty-six percent of the population is below age 15, and 5 percent is age 65 and above. The sex ratio is 957 females for every 1,000 males in rural areas but only 928 females for every 1,000 males in urban areas, suggesting that more men than women have migrated to urban areas. The survey provides a variety of demographic and socioeconomic background information. In the country as a whole, 82 percent of household heads are Hindu, 12 percent are Muslim, 3 percent are Christian, and 2 percent are Sikh. Muslims live disproportionately in urban areas, where they comprise 15 percent of household heads. Nineteen percent of household heads belong to scheduled castes, 9 percent belong to scheduled tribes, and 32 percent belong to other backward classes (OBCs). Two-fifths of household heads do not belong to any of these groups. Questions about housing conditions and the standard of living of households indicate some improvements since the time of NFHS-1. Sixty percent of households in India now have electricity and 39 percent have piped drinking water compared with 51 percent and 33 percent, respectively, at the time of NFHS-1. Sixty-four percent of households have no toilet facility compared with 70 percent at the time of NFHS-1. About three-fourths (75 percent) of males and half (51 percent) of females age six and above are literate, an increase of 6-8 percentage points from literacy rates at the time of NFHS-1. The percentage of illiterate males varies from 6-7 percent in Mizoram and Kerala to 37 percent in Bihar and the percentage of illiterate females varies from 11 percent in Mizoram and 15 percent in Kerala to 65 percent in Bihar. Seventy-nine percent of children age 6-14 are attending school, up from 68 percent in NFHS-1. The proportion of children attending school has increased for all ages, particularly for girls, but girls continue to lag behind boys in school attendance. Moreover, the disparity in school attendance by sex grows with increasing age of children. At age 6-10, 85 percent of boys attend school compared with 78 percent of girls. By age 15-17, 58 percent of boys attend school compared with 40 percent of girls. The percentage of girls 6-17 attending school varies from 51 percent in Bihar and 56 percent in Rajasthan to over 90 percent in Himachal Pradesh and Kerala. Women in India tend to marry at an early age. Thirty-four percent of women age 15-19 are already married including 4 percent who are married but gauna has yet to be performed. These proportions are even higher in the rural areas. Older women are more likely than younger women to have married at an early age: 39 percent of women currently age 45-49 married before age 15 compared with 14 percent of women currently age 15-19. Although this indicates that the proportion of women who marry young is declining rapidly, half the women even in the age group 20-24 have married before reaching the legal minimum age of 18 years. On average, women are five years younger than the men they marry. The median age at marriage varies from about 15 years in Madhya Pradesh, Bihar, Uttar Pradesh, Rajasthan, and Andhra Pradesh to 23 years in Goa. As part of an increasing emphasis on gender issues, NFHS-2 asked women about their participation in household decisionmaking. In India, 91 percent of women are involved in decision-making on at least one of four selected topics. A much lower proportion (52 percent), however, are involved in making decisions about their own health care. There are large variations among states in India with regard to women's involvement in household decisionmaking. More than three out of four women are involved in decisions about their own health care in Himachal Pradesh, Meghalaya, and Punjab compared with about two out of five or less in Madhya Pradesh, Orissa, and Rajasthan. Thirty-nine percent of women do work other than housework, and more than two-thirds of these women work for cash. Only 41 percent of women who earn cash can decide independently how to spend the money that they earn. Forty-three percent of working women report that their earnings constitute at least half of total family earnings, including 18 percent who report that the family is entirely dependent on their earnings. Women's work-participation rates vary from 9 percent in Punjab and 13 percent in Haryana to 60-70 percent in Manipur, Nagaland, and Arunachal Pradesh. FERTILITY AND FAMILY PLANNING Fertility continues to decline in India. At current fertility levels, women will have an average of 2.9 children each throughout their childbearing years. The total fertility rate (TFR) is down from 3.4 children per woman at the time of NFHS-1, but is still well above the replacement level of just over two children per woman. There are large variations in fertility among the states in India. Goa and Kerala have attained below replacement level fertility and Karnataka, Himachal Pradesh, Tamil Nadu, and Punjab are at or close to replacement level fertility. By contrast, fertility is 3.3 or more children per woman in Meghalaya, Uttar Pradesh, Rajasthan, Nagaland, Bihar, and Madhya Pradesh. More than one-third to less than half of all births in these latter states are fourth or higher-order births compared with 7-9 percent of births in Kerala, Goa, and Tamil Nadu. Efforts to encourage the trend towards lower fertility might usefully focus on groups within the population that have higher fertility than average. In India, rural women and women from scheduled tribes and scheduled castes have somewhat higher fertility than other women, but fertility is particularly high for illiterate women, poor women, and Muslim women. Another striking feature is the high level of childbearing among young women. More than half of women age 20-49 had their first birth before reaching age 20, and women age 15-19 account for almost one-fifth of total fertility. Studies in India and elsewhere have shown that health and mortality risks increase when women give birth at such young ages?both for the women themselves and for their children. Family planning programmes focusing on women in this age group could make a significant impact on maternal and child health and help to reduce fertility. INFANT AND CHILD MORTALITY NFHS-2 provides estimates of infant and child mortality and examines factors associated with the survival of young children. During the five years preceding the survey, the infant mortality rate was 68 deaths at age 0-11 months per 1,000 live births, substantially lower than 79 per 1,000 in the five years preceding the NFHS-1 survey. The child mortality rate, 29 deaths at age 1-4 years per 1,000 children reaching age one, also declined from the corresponding rate of 33 per 1,000 in NFHS-1. Ninety-five children out of 1,000 born do not live to age five years. Expressed differently, 1 in 15 children die in the first year of life, and 1 in 11 die before reaching age five. Child-survival programmes might usefully focus on specific groups of children with particularly high infant and child mortality rates, such as children who live in rural areas, children whose mothers are illiterate, children belonging to scheduled castes or scheduled tribes, and children from poor households. Infant mortality rates are more than two and one-half times as high for women who did not receive any of the recommended types of maternity related medical care than for mothers who did receive all recommended types of care. HEALTH, HEALTH CARE, AND NUTRITION Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme of the Government of India. One goal is for each pregnant woman to receive at least three antenatal check-ups plus two tetanus toxoid injections and a full course of iron and folic acid supplementation. In India, mothers of 65 percent of the children born in the three years preceding NFHS-2 received at least one antenatal

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Abstract

The 2003 Turkey Demographic and Health Survey (TDHS-2003) is a nationally representative sample survey designed to provide information on levels and trends on fertility, infant and child mortality, family planning and maternal and child health. Survey results are presented at the national level, by urban and rural residence, and for each of the five regions in the country. The TDHS2003 sample also allows analyses for some of the survey topics for the 12 geographical regions (NUTS1) which were adopted at the second half of 2002 within the context of Turkey's move to join the European Union.

Funding for the TDHS-2003 was provided initially by the Government of Turkey, as a project in the annual investment program of the State Planning Organization, and further funding was obtained from the European Union through the Turkey Reproductive Health Program implemented by the Ministry of Health.

The survey was fielded between December 2003 and May 2004. Interviews were completed with 10,836 households and with 8,075 ever-married women at reproductive ages (15-49). Ever-married women at ages 15-49 who were present in the household on the night before the interview or who usually live in that household were eligible for the survey.

The 2003 Turkish Demographic and Health Survey (TDHS-2003) is the latest in a series of national-level population and health surveys that have been conducted by the Hacettepe University Institute of Population Studies (HUIPS), in the last four decades. The primary objective of the TDHS-2003 is to provide data on socioeconomic characteristics of households and women, fertility, mortality, marriage patterns, family planning, maternal and child health, nutritional status of women and children, and reproductive health. The survey obtained detailed information on these issues from a sample of ever-married women in the reproductive ages (15-49). The TDHS-2003 was designed to produce information in the field of demography and health that to a large extent can not be obtained from other sources.

Specifically, the objectives of the TDHS-2003 included: - Collecting data at the national level that allows the calculation of demographic rates, particularly fertility and childhood mortality rates; - Obtaining information on direct and indirect factors that determine levels and trends in fertility and childhood mortality; - Measuring the level of contraceptive knowledge and practice by method, region, and urban-rural residence; - Collecting data relative to mother and child health, including immunizations, prevalence and treatment of acute respiratory tract infections among children under five, antenatal care, assistance at delivery, and breastfeeding; - Measuring the nutritional status of children under five and of their mothers; and - Collecting data at the national level on elderly welfare, knowledge of sexually transmitted diseases (STDs) and AIDS, and usage of iodide salt.

The TDHS-2003 information is intended to contribute data to assist policy makers and administrators to evaluate existing programs and to design new strategies for improving demographic, social and health policies in Turkey. Another important purpose of the TDHS2003 is to sustain the flow of information for the interested organizations in Turkey and abroad on the Turkish population structure in the absence of reliable and sufficient vital registration system.

SUMMARY OF FINDINGS

The results show that there have been important changes in various demographic and health indicators in a more positive direction than expected. The fertility data indicate that Turkey is achieving “replacement” fertility. The survey findings also document improvements in infant and child mortality and progress in mother and child health services.

Geographic coverage

The sample was designed to provide estimates for: - Turkey as a whole; - Urban and rural areas (each as a separate domain); - Each of the conventional major five regions of the country, namely the West, South, Central, North, and East regions - The 12 NUTS 13 regions, for selected indicators which are based on sufficient number of observations

Analysis unit

• Household
• Women age 15-49
• Children under five

Universe

The population covered by the 1998 DHS is defined as the universe of all ever-married women age 15-49 in the household who were identified as eligible in the household schedule were interviewed. In addition, some information was collected for households and women in a sub-sample of one-half of all households.

Kind of data

Sample survey data

Sampling procedure

A weighted, multistage, stratified cluster sampling approach was used in the selection of the TDHS-2003 sample. The sample was designed in this fashion because of the need to provide estimates for a variety of characteristics for various domains. These domains, which are frequently employed in the tabulation of major indicators from the survey, are: - Turkey as a whole; - Urban and rural areas (each as a separate domain); - Each of the conventional major five regions of the country, namely the West, South, Central, North, and East regions - The 12 NUTS 13 regions, for selected indicators which are based on sufficient number of observations

The major objective of the TDHS-2003 sample design was to ensure that the survey would provide estimates with acceptable precision for these domains for most of the important demographic characteristics, such as fertility, infant and child mortality, and contraceptive prevalence, as well as for the health indicators.

SAMPLE FRAME

Different criteria have been used to describe "urban" and "rural" settlements in Turkey. In the demographic surveys of the 1970s, a population size of 2,000 was used to differentiate between urban and rural settlements. In the 1980s, the cut-off point was increased to 10,000 and, in some surveys in the 1990s, to 20,000. A number of surveys used information on the administrative status of settlements in combination with population size for the purpose of differentiation. The urban frame of the TDHS-2003 consisted of a list of provincial centers, district centers, and other settlements with populations larger than 10,000, regardless of administrative status. The rural frame consisted of all district centers, sub-districts and villages not included in the urban frame. The urban-rural definitions of the TDHS-2003 are identical with those in the TDHS-1998.

Initial information on all settlements in Turkey was obtained from the 2000 General Population Census. The results of 2000 General Population Census provided a computerized list of all settlements (provincial and district centers, sub-districts and villages), their populations and the numbers of households.

STRATIFICATION

Currently Turkey is divided administratively into 81 provinces. For purposes of selection in prior surveys in Turkey, these provinces have been grouped into five regions. This regional breakdown has been popularized as a powerful variable for understanding the demographic, social, cultural, and economic differences between different parts of the country. The five regions, West, South, Central, North, and East regions, include varying numbers of provinces.

In addition to the conventional five geographic regions, a new system of regional breakdown was adopted in late 2002. In accordance with the accession process of Turkey to the European Union, the State Planning Office and the State Institute of Statistics constructed three levels of NUTS regions, which have since become official (Law No. 2002/4720). "NUTS" stands for "The Nomenclature of Territorial Units for Statistics". NUTS is a statistical region classification that is used by member countries of European Union (EU). The 81 provinces were designated as regions of NUTS 3 level; these were further aggregated into 26 regions to form the NUTS 2 regions. NUTS 1 regions were formed by aggregating NUTS 2 regions into 12 regions. Two of the NUTS 1 regions, Istanbul and the Southeastern Anatolia, were given special attention in the sample design process and a comparatively larger share of the total sample was allocated to these regions to ensure that statistically sound estimates for a larger number of indicators would be obtained than would be the case for the remaining 10 NUTS 1 regions. Policymakers, researchers and other concerned circles had voiced interest in information on demographic and health indicators for Istanbul and the Southeastern Anatolian regions in the past. Furthermore, as an add-on study, the Istanbul metropolitan area was designated by UN-Habitat as one of the mega-cities in their International Slum Survey series. In co-operation with UN-Habitat, HUIPS wished to be able to produce estimates for slum4 and non-slum areas within Istanbul; for this reason, the total sample size for Istanbul was kept at a relatively high magnitude.

One of the priorities of the TDHS-2003 was to produce a sample design that was methodologically and conceptually consistent with the designs of previous demographic surveys carried out by the Hacettepe Institute of Population Studies. In surveys prior to the TDHS-1993, the five-region breakdown of the country was used for stratification. In TDHS-1993, a more detailed stratification taking into account subregions was employed to obtain a better dispersion of the sample. The criteria for subdividing the five major regions into subregions were the infant mortality rates of each province, estimated from the 1990 Population Census using indirect techniques.5 Using the infant mortality estimates as well as geographic proximity, the provinces in each region were grouped into 14 subregions at the time of the TDHS-1993. The sub-regional division

The Jordan Population and Family Health Survey (JPFHS) is part of the worldwide Demographic and Health Surveys Program, which is designed to collect data on fertility, family planning, and maternal and child health. The primary objective of the 2012 Jordan Population and Family Health Survey (JPFHS) is to provide reliable estimates of demographic parameters, such as fertility, mortality, family planning, and fertility preferences, as well as maternal and child health and nutrition, that can be used by program managers and policymakers to evaluate and improve existing programs. The JPFHS data will be useful to researchers and scholars interested in analyzing demographic trends in Jordan, as well as those conducting comparative, regional, or cross-national studies.

Abstract

The Sudan Demographic and Health Survey (SDHS) was conducted in two phases between November 15, 1989 and May 21, 1990 by the Department of Statistics of the Ministry of Economic and National Planning. The survey collected information on fertility levels, marriage patterns, reproductive intentions, knowledge and use of contraception, maternal and child health, maternal mortality, and female circumcision. The survey findings provide the National Population Committee and the Ministry of Health with valuable information for use in evaluating population policy and planning public health programmes.

A total of 5860 ever-married women age 15-49 were interviewed in six regions in northern Sudan; three regions in southern Sudan could not be included in the survey because of civil unrest in that part of the country. The SDHS provides data on fertility and mortality comparable to the 1978-79 Sudan Fertility Survey (SFS) and complements the information collected in the 1983 census.

The primary objective of the SDHS was to provide data on fertility, nuptiality, family planning, fertility preferences, childhood mortality, indicators of maternal health care, and utilization of child health services. Additional information was coUected on educational level, literacy, source of household water, and other housing conditions.

The SDHS is intended to serve as a source of demographic data for comparison with the 1983 census and the Sudan Fertility Survey (SFS) 1978-79, and to provide population and health data for policymakers and researchers. The objectives of the survey are to: - assess the overall demographic situation in Sudan, - assist in the evaluation of population and health programmes, - assist the Department of Statistics in strengthening and improving its technical skills for conducting demographic and health surveys, - enable the National Population Committee (NPC) to develop a population policy for the country, and - measure changes in fertility and contraceptive prevalence, and study the factors which affect these changes, and - examine the basic indicators of maternal and child health in Sudan.

MAIN RESULTS

Fertility levels and trends

Fertility has declined sharply in Sudan, from an average of six children per women in the Sudan Fertility Survey (TFR 6.0) to five children in the Sudan DHS survey flTR 5.0). Women living in urban areas have lower fertility (TFR 4.1) than those in rural areas (5.6), and fertility is lower in the Khartoum and Northern regions than in other regions. The difference in fertility by education is particularly striking; at current rates, women who have attained secondary school education will have an average of 3.3 children compared with 5.9 children for women with no education, a difference of almost three children.

Although fertility in Sudan is low compared with most sub-Saharan countries, the desire for children is strong. One in three currently married women wants to have another child within two years and the same proportion want another child in two or more years; only one in four married women wants to stop childbearing. The proportion of women who want no more children increases with family size and age. The average ideal family size, 5.9 children, exceeds the total fertility rate (5.0) by approximately one child. Older women are more likely to want large families than younger women, and women just beginning their families say they want to have about five children.

Marriage

Almost all Sudanese women marry during their lifetime. At the time of the survey, 55 percent of women 15-49 were currently married and 5 percent were widowed or divorced. Nearly one in five currently married women lives in a polygynous union (i.e., is married to a man who has more than one wife). The prevalence of polygyny is about the same in the SDHS as it was in the Sudan Fertility Survey.

Marriage occurs at a fairly young age, although there is a trend toward later marriage among younger women (especially those with junior secondary or higher level of schooling). The proportion of women 15-49 who have never married is 12 percentage points higher in the SDHS than in the Sudan Fertiliy Survey.

There has been a substantial increase in the average age at first marriage in Sudan. Among SDHS. Since age at first marriage is closely associated with fertility, it is likely that fertility will decrease in the future. With marriages occurring later, women am having their first birth at a later age. While one in three women age 45-49 had her first birth before age 18, only one in six women age 20-24 began childbearing prior to age 18. The women most likely to postpone marriage and childbearing are those who live in urban areas ur in the Khartoum and Northern regions, and women with pest-primary education.

Breastfeeding and postpartum abstinence

Breastfeeding and postpartum abstinence provide substantial protection from pregnancy after the birth uf a child. In addition to the health benefits to the child, breastfeeding prolongs the length of postpartum amenorrhea. In Sudan, almost all women breastfeed their children; 93 percent of children are still being breastfed 10-11 months after birth, and 41 percent continue breastfeeding for 20-21 months. Postpartum abstinence is traditional in Sudan and in the first two months following the birth of a child 90 percent of women were abstaining; this decreases to 32 percent after two months, and to 5 percent at~er one year. The survey results indicate that the combined effects of breastfeeding and postpartum abstinence protect women from pregnancy for an average of 15 months after the birth of a child.

Knowledge and use of contraception

Most currently married women (71 percent) know at least one method of family planning, and 59 percent know a source for a method. The pill (70 percent) is the most widely known method, followed by injection, female sterilisation, and the IUD. Only 39 percent of women knew a traditional method of family planning.

Despite widespread knowledge of family planning, only about one-fourth of ever-married women have ever used a contraceptive method, and among currently married women, only 9 percent were using a method at the time of the survey (6 percent modem methods and 3 percent traditional methods). The level of contraceptive use while still low, has increased from less than 5 percent reported in the Sudan Fertility Survey.

Use of family planning varies by age, residence, and level of education. Current use is less than 4 percent among women 15-19, increases to 10 percent for women 30-44, then decreases to 6 percent for women 45-49. Seventeen percent of urban women practice family planning compared with only 4 percent of rural women; and women with senior secondary education are more likely to practice family planning (26 percent) than women with no education (3 percent).

There is widespread approval of family planning in Sudan. Almost two-thirds of currently married women who know a family planning method approve of the use of contraception. Husbands generally share their wives's views on family planning. Three-fourths of married women who were not using a contraceptive method at the time of the survey said they did not intend to use a method in the future.

Communication between husbands and wives is important for successful family planning. Less than half of currently married women who know a contraceptive method said they had talked about family planning with their husbands in the year before the survey; one in four women discussed it once or twice; and one in five discussed it more than twice. Younger women and older women were less likely to discuss family planning than those age 20 to 39.

Mortality among children

The neonatal mortality rate in Sudan remained virtually unchanged in the decade between the SDHS and the SFS (44 deaths per 1000 births), but under-five mortality decreased by 14 percent (from 143 deaths per 1000 births to 123 per thousand). Under-five mortality is 19 percent lower in urban areas (117 per 1000 births) than in rural areas (144 per 10(30 births).

The level of mother's education and the length of the preceding birth interval play important roles in child survival. Children of mothers with no education experience nearly twice the level of under-five mortality as children whose mother had attained senior secondary or nigher education. Mortality among children under five is 2.7 times higher among children born after an interval of less than 24 months than among children born after interval of 48 months or more.

Maternal mortality

The maternal mortality rate (maternal deaths per 1000 women years of exposure) has remained nearly constant over the twenty years preceding the survey, while the maternal mortality ratio (number of maternal deaths per 100,000 births), has increased (despite declining fertility). Using the direct method of estimation, the maternal mortality ratio is 352 maternal deaths per 100,000 births for the period 1976-82, and 552 per 100,000 births for the period 1983-89. The indirect estimate for the maternal mortality ratio is 537. The latter estimate is an average of women's experience over an extended period before the survey centred on 1977.

Maternal health care

The health care mothers receive during pregnancy and delivery is important to the survival and well-being of both children and mothers. The SDHS results indicate that most women in Sudan made at least one antenatal visit to a doctor or trained health worker/midwife. Eighty-seven percent of births benefitted from professional antenatal care in urban areas compared with 62 percent in rural areas. Although the proportion of pregnant mothers seen by trained health workers/midwives are similar in urban and rural areas, doctors provided antenatal care for 42 percent and 19 percent of births in urban and rural areas, respectively.

Neonatal tetanus, a major

This survey was designed primarily to obtain information on the smoking habits of decedents by examining death certificates and questionnaires mailed to death record informants. Smoking variables in this data collection include number of cigarettes smoked when the decedent smoked most, number smoked the year before death, number smoked three years before death, and cigar and pipe smoking occurrence three years before death. Demographic variables include marital status, family type, number of children, living arrangements, size of family, birth and death of the decedent, family income and family debt, and cause of death.

Comparison of models for prediction of CVD mortality without and with addition of CVD family history.

Abstract

The 1993 Turkish Demographic and Health Survey (TDHS) is a nationally representative survey of ever-married women less than 50 years old. The survey was designed to provide information on fertility levels and trends, infant and child mortality, family planning, and maternal and child health. The TDHS was conducted by the Hacettepe University Institute of Population Studies under a subcontract through an agreement between the General Directorate of Mother and Child Health and Family Planning, Ministry of Health and Macro International Inc. of Calverton, Maryland. Fieldwork was conducted from August to October 1993. Interviews were carried out in 8,619 households and with 6,519 women.

The Turkish Demographic and Health Survey (TDHS) is a national sample survey of ever-married women of reproductive ages, designed to collect data on fertility, marriage patterns, family planning, early age mortality, socioeconomic characteristics, breastfeeding, immunisation of children, treatment of children during episodes of illness, and nutritional status of women and children. The TDHS, as part of the international DHS project, is also the latest survey in a series of national-level population and health surveys in Turkey, which have been conducted by the Institute of Population Studies, Haeettepe University (HIPS).

More specifically, the objectives of the TDHS are to:

Collect data at the national level that will allow the calculation of demographic rates, particularly fertility and childhood mortality rates; Analyse the direct and indirect factors that determine levels and trends in fertility and childhood mortality; Measure the level of contraceptive knowledge and practice by method, region, and urban- rural residence; Collect data on mother and child health, including immunisations, prevalence and treatment of diarrhoea, acute respiratory infections among children under five, antenatal care, assistance at delivery, and breastfeeding; Measure the nutritional status of children under five and of their mothers using anthropometric measurements.

The TDHS information is intended to assist policy makers and administrators in evaluating existing programs and in designing new strategies for improving family planning and health services in Turkey.

MAIN RESULTS

Fertility in Turkey is continuing to decline. If Turkish women maintain current fertility rates during their reproductive years, they can expect to have all average of 2.7 children by the end of their reproductive years. The highest fertility rate is observed for the age group 20-24. There are marked regional differences in fertility rates, ranging from 4.4 children per woman in the East to 2.0 children per woman in the West. Fertility also varies widely by urban-rural residence and by education level. A woman living in rural areas will have almost one child more than a woman living in an urban area. Women who have no education have almost one child more than women who have a primary-level education and 2.5 children more than women with secondary-level education.

The first requirement of success ill family planning is the knowledge of family planning methods. Knowledge of any method is almost universal among Turkish women and almost all those who know a method also know the source of the method. Eighty percent of currently married women have used a method sometime in their life. One third of currently married women report ever using the IUD. Overall, 63 percent of currently married women are currently using a method. The majority of these women are modern method users (35 percent), but a very substantial proportion use traditional methods (28 percent). the IUD is the most commonly used modern method (I 9 percent), allowed by the condom (7 percent) and the pill (5 percent). Regional differences are substantial. The level of current use is 42 percent in tile East, 72 percent in tile West and more than 60 percent in tile other three regions. "File common complaints about tile methods are side effects and health concerns; these are especially prevalent for the pill and IUD.

One of the major child health indicators is immunisation coverage. Among children age 12-23 months, the coverage rates for BCG and the first two doses of DPT and polio were about 90 percent, with most of the children receiving those vaccines before age one. The results indicate that 65 percent of the children had received all vaccinations at some time before the survey. On a regional basis, coverage is significantly lower in the Eastern region (41 percent), followed by the Northern and Central regions (61 percent and 65 percent, respectively). Acute respiratory infections (ARI) and diarrhea are the two most prevalent diseases of children under age five in Turkey. In the two weeks preceding the survey, the prevalence of ARI was 12 percent and the prevalence of diarrhea was 25 percent for children under age five. Among children with diarrhea 56 percent were given more fluids than usual.

Breastfeeding in Turkey is widespread. Almost all Turkish children (95 percent) are breastfed for some period of time. The median duration of breastfeeding is 12 months, but supplementary foods and liquids are introduced at an early age. One-third of children are being given supplementary food as early as one month of age and by the age of 2-3 months, half of the children are already being given supplementary foods or liquids.

By age five, almost one-filth of children arc stunted (short for their age), compared to an international reference population. Stunting is more prevalent in rural areas, in the East, among children of mothers with little or no education, among children who are of higher birth order, and among those born less than 24 months after a prior birth. Overall, wasting is not a problem. Two percent of children are wasted (thin for their height), and I I percent of children under five are underweight for their age. The survey results show that obesity is d problem among mothers. According to Body Mass Index (BMI) calculations, 51 percent of mothers are overweight, of which 19 percent are obese.

Geographic coverage

The Turkish Demographic and Health Survey (TDHS) is a national sample survey.

Analysis unit

• Household
• Women age 12-49
• Children under five

Universe

The population covered by the 1993 DHS is defined as the universe of all ever-married women age 12-49 who were present in the household on the night before the interview were eligible for the survey.

Kind of data

Sample survey data

Sampling procedure

The sample for the TDHS was designed to provide estimates of population and health indicators, including fertility and mortality rates for the nation as a whole, fOr urban and rural areas, and for the five major regions of the country. A weighted, multistage, stratified cluster sampling approach was used in the selection of the TDHS sample.

Sample selection was undertaken in three stages. The sampling units at the first stage were settlements that differed in population size. The frame for the selection of the primary sampling units (PSUs) was prepared using the results of the 1990 Population Census. The urban frame included provinces and district centres and settlements with populations of more than 10,000; the rural frame included subdistricts and villages with populations of less than 10,000. Adjustments were made to consider the growth in some areas right up to survey time. In addition to the rural-urban and regional stratifications, settlements were classified in seven groups according to population size.

The second stage of selection involved the list of quarters (administrative divisions of varying size) for each urban settlement, provided by the State Institute of Statistics (SIS). Every selected quarter was subdivided according tothe number of divisions(approximately 100 households)assigned to it. In rural areas, a selected village was taken as a single quarter, and wherever necessary, it was divided into subdivisions of approximately 100 households. In cases where the number of households in a selected village was less than 100 households, the nearest village was selected to complete the 100 households during the listing activity, which is described below.

After the selection of the secondary sampling units (SSUs), a household listing was obtained for each by the TDHS listing teams. The listing activity was carried out in May and June. From the household lists, a systematic random sample of households was chosen for the TDHS. All ever-married women age 12-49 who were present in the household on the night before the interview were eligible for the survey.

Mode of data collection

Face-to-face

Research instrument

Two questionnaires were used in the main fieldwork for the TDHS: the Household Questionnaire and the Individual Questionnaire for ever-married women of reproductive age. The questionnaires were based on the model survey instruments developed in the DHS program and on the questionnaires that had been employed in previous Turkish population and health surveys. The questionnaires were adapted to obtain data needed for program planning in Turkey during consultations with population and health agencies. Both questionnaires were developed in English and translated into Turkish.

a) The Household Questionnaire was used to enumerate all usual members of and visitors to the selected households and to collect information relating to the socioeconomic position of the households. In the first part of the Household Questionnaire, basic information was collected on the age, sex, educational attainment, marital status and relationship to the head of household for each person listed as a household member

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Motivated by the cooperative breeding hypothesis, we investigate the effect of having kin on the mortality of reproductive women based on family reconstitutions for the Krummhörn region (East Frisia, Germany, 1720–1874). We rely on a combination of Cox clustered hazard models and hazard models stratified at the family level. In order to study behavior-related effects, we run a series of models in which only kin who lived in the same parish are considered. To investigate structural, non-behavior-related effects, we run a different model series that include all living kin, regardless their spatial proximity. We find that women of reproductive age who had a living mother had a reduced mortality risk. It appears that having living sisters had an ambivalent impact on women’s mortality: i.e., depending on the socioeconomic status of the family, the effect of having living sisters ranged between representing a source of competition and representing a source of support. Models which are clustered at the family level suggest that the presence of a living mother-in-law was associated with reduced mortality among her daughters-in-law especially among larger-scale farm families. We interpret this finding as a consequence of augmented consanguineous marriages among individuals of higher social strata. For instance, in first cousin marriages, the mother-in-law could also be a biological aunt. Thus, it appears that among the wealthy elite, the genetic in-law conflict was neutralized to some extent by family solidarity. This result further suggests that the tipping point of the female trade-off between staying with the natal family and leaving the natal family to join an economically well-established in-law family might have been reached very quickly among women living under the socioeconomic conditions of the Krummhörn region.

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