gms | German Medical Science

Child mortality is a measure of the nation’s health and worldwide indicator of social well-being. There are numerous studies that recognized maternal, socioeconomic, environmental and behavioural factors as important determinants of child mortality.

Compared with some developing countries, child mortality rates in the Central Asian countries are substantially lower, but still remain relatively high. According to the Soviet definition of child mortality the Under-5-Mortality rates in 2002 were 29 for Kyrgyzstan, 21.7 for Kazakhstan and 24.3 for Uzbekistan per 1000 living births [Ref. 1].

The aim of this study is to determine which factors affect the high mortality rates among children in the Central Asian countries: Kyrgyzstan, Kazakhstan and Uzbekistan.

This study is a secondary analysis of existing data sources from the Demographic and Health Surveys (DHS), Macro International [Ref. 2]. Data from 3 Central Asian countries are used in the analysis:

The surveys collected birth history data from 12,034 women aged 15-49, focusing on births that occurred in the last 3 years preceding the surveys. The total number of children ever born to these women was 2,867.

The binary outcome variable is whether the child was alive or died in the 36 months after birth. The independent variables used in the analysis are place of residence, marital status, religion, maternal and paternal occupation, maternal education, access to safe water, maternal age at first marriage, maternal age at first birth, place of delivery, the number of household members, sex of a child, birth order. To avoid problems with clustering of the data we included in the analysis only one child per household.

A multivariate logistic regression analysis was used to establish the association between childhood mortality and a wide set of sociodemographic risk factors. A country-specific variable was used in the analysis as a categorial variable for comparing child mortality among countries. Data analysis was conducted using statistical package SAS version 8.02.

The results of a univariate analysis showed that living in a rural area and birth order are significantly associated with an increased risk of child mortality (Table 1 [Tab. 1]). When no other variables were controlled for there was a significant difference between countries in child mortality. Child mortality was higher in Kyrgyzstan and Uzbekistan compared to Kazakhstan. The results of a multivariate logistic regression analysis showed that living in a rural area was associated with increased risk of childhood mortality. The risks were much higher among children who were high order births. After adjusting for covariables in a multivariate analysis, childhood mortality was lower among children whose mothers were currently married. A large number of household members significantly reduce child mortality.

In this study child mortality was studied in relation to the major socioeconomic variables. We developed a regional model under the assumptions that the Central Asian countries have similar political, demographical and socioeconomic situations. The data used in the analysis are from DHS surveys which have the same methodology to estimate health and other socioeconomic indicators and are comparable across countries and over time.

This study suggests that more vulnerable children are rural residents and children whose mothers are formerly or never married. The association between child mortality and maternal education was not consistent with the expected pattern. The association with child birth order was described in the literature as an important predictor of child mortality [Ref. 3]. As family size increases, the resources have to be shared among more children in the family. This is incompatible with our findings which indicate that a large number of household members decrease childhood mortality.