Determinants of infant and early childhood mortality in Cameroon: the role of socioeconomic factors, housing characteristics, and immunization status

Soc Biol. Fall-Winter 1994;41(3-4):181-211. doi: 10.1080/19485565.1994.9988872.

Abstract

This study examines factors impinging on the survival of children in Cameroon using longitudinal data collected by the United Nations Demographic Training and Research Institute of Yaoundé, Cameroon. It deals especially with the role of socioeconomic factors (mother's education, employment, marital status, ethnicity, and household income), housing characteristics (construction materials, power source, source of water supply, extent of crowding), and immunization status on infant and child mortality. Two-state parametric and nonparametric hazards models for the risk of death at any time within the course of the study are used, with and without accounting for unmeasured heterogeneity. Overall, overcrowding has robust deleterious effects on infant and child survival. As regards the effects of socioeconomic variables, the robustness of the effects of household income and ethnic differentials are unchanged, even after controlling for unmeasured heterogeneity; the deleterious effects of marital status are also apparent, but these effects are largely explained by unmeasured covariates. The data also suggest that the protective effects of full immunization status are robust and not contaminated by confounding factors, at least in the first 16 months of life. These findings provide solid ground to support immunization programs and efforts as a means to reduce significantly infant and child mortality.

PIP: Data from a 1978-81 demographic survey in Yaounde, Cameroon, was used to examine the demographic, biomedical, cultural, and socioeconomic determinants of child mortality. Two stage hazards models were used to analyze data from interviews and registrations at maternity wards in hospitals at birth, 1-3 months, 4-7, 8-11, 12-15, and 16-23 months. The model assumed a piece-wise constant with nodes at each monthly period and a Weibull distribution. Descriptive findings showed that only 32% of infants received full immunization by the age of one year; 44% were fully immunized by two years of age. Housing quality varied, and overcrowding was high. At least 30% of families had children sharing a room with three other household members. Under 50% had income higher than 20,000 CFA francs. 33% had income between 20,000-50,000 CFA francs. Piece-wise hazard models showed that all socioeconomic factors influenced significantly infant and child mortality. Children of unmarried were disadvantaged at all ages. Household income was an important predictor and mediated the impact of maternal employment and marital status. The inclusion of ethnicity in the model decreased the impact of maternal education, particularly in the neonatal period. Household characteristics replaced the impact of household income after the first year of life. Childbearing patterns were useful in explaining the disadvantage of the ethnic groups in the North and East. Controls for breast feeding or health care utilization or immunization status did not change the socioeconomic differences in mortality, particularly income and ethnicity. The hazards of dying were affected positively by sanitation, clean water, and modern building materials and negatively by overcrowding. The model with controls for socioeconomic factors showed overcrowding as still significant and electricity became a disadvantage at 4-7 months; piped water became a disadvantage during the first month. Socioeconomic factors probably mediated the effects of housing construction materials and availability of clean water and electricity. The analysis of immunization status revealed a robust relationship without confounding factors. Models controlling for unmeasured nonparametric heterogeneity revealed ethnicity and income as robust factors in child survival, and modern housing with amenities was a great survival advantage. Overcrowding was a great disadvantage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cameroon / epidemiology
  • Housing
  • Humans
  • Immunization
  • Infant
  • Infant Mortality*
  • Proportional Hazards Models
  • Socioeconomic Factors