Researchers have characterised subgroups of children with high mortality in Bissau, the capital of Guinea-Bissau. Children from polygamous families born during the dry season have a significantly increased risk of dying, as do children born to mothers with no prenatal consultations and children in a specific urban area of the capital.
Child mortality is high in western Africa, with more than 5% of children dying before school age. However, the children with the highest and lowest risk of dying early in life differ in various ways. Now researchers have examined health data to identify which children have a high risk of dying early.
The research shows that children born in the dry season to mothers from polygamous families have a significantly increased risk of dying before the age of three years.
Using a very methodical approach for examining child mortality in Guinea-Bissau, the researchers hope that they can bring new knowledge to the table and help to identify high-risk groups to which social and health workers in the field may need to pay particular attention.
“Family finances are associated with child mortality in Guinea-Bissau. However, much of the research on child mortality in low-income countries uses the same methods and the same types of data, which does not necessarily improve knowledge. Here we took a very inquisitive approach to examining child mortality and which combinations of causes can explain why some children have higher mortality. To achieve this, we used data collected through repeated home visits and in great detail. Such an approach can provide new empirical findings and indicate some of the real-world high-risk groups to which we may not have paid enough attention,” explains a researcher behind the study, Ane Fisker, Professor, Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense.
Andreas Rieckmann, Postdoctoral Fellow, Department of Public Health, University of Copenhagen, Denmark is the first author of the article published in JMIR Public Health and Surveillance.
No data on child mortality in Guinea-Bissau
Child mortality is high in Guinea-Bissau, but determining how high it really is and which children have the highest risk of dying early is difficult because children are not registered in national databases until they reach the age of five years and start school.
The country’s routinely collected statistics do not identify how many children die before the age of five years.
In 2016, some of the researchers involved in the new study published research showing that only 16% of children younger than two years in the capital of Guinea-Bissau were registered in the country’s population register and that less than 2% of child deaths were recorded.
Data on 270,000 children
Nevertheless, some registration of children takes place in Guinea-Bissau, such as through the Bandim Health Project, which has existed since 1978 as both a health and research project in Guinea-Bissau. This has become the core of a health demographic surveillance system.
Within the Bandim Health Project’s data collection, project employees have given more than 270,000 pregnancies or newborn children an ID number, which has enabled the children to be monitored over time to determine how they are doing.
In the new study, the researchers used these data to identify subgroups of children with a particularly high risk of child death in data from the Bandim Health Project for children born in the capital between 2003 and 2016.
The researchers first investigated data from the first eight years for factors that were strongly associated with increased child mortality. They then verified the findings in the rest of the data set.
The researchers also investigated whether interactions between many factors affect the risk of child mortality between the ages of six weeks and three years.
Identified special high-risk groups
The results show that well-known risk factors are associated with increased child mortality. These include the mothers having less education, low financial resources and other socioeconomic factors. The researchers also identified additional factors that were not known in advance.
Children born in the dry season to mothers from polygamous families had an increased risk of dying before the age of three years: 1.7 percentage points higher than the already high risk of 5.2% from 2003 to 2011 and 2.9% from 2012 to 2016.
Correspondingly, the risk increased by 3.4 percentage points for children born in specific areas in large cities and 5.8 percentage points for children born to mothers who had not had prenatal consultations with healthcare personnel before birth.
Although the groups are relatively small, children were consistently at greater risk of dying before the age of three years during the study period.
“We thus carried out new types of analysis and found some subgroups of children on whom we have not previously focused and that we would not have otherwise discovered. We also found some subgroups of children with specific combinations of risk factors that we would otherwise never have considered. This applies to children born in the dry season to mothers from polygamous families,” says Ane Fisker.
Knowledge required for targeting interventions
According to Ane Fisker, the study brings new data to the table, but ascertaining what the data can be used for right now is difficult – apart from paying special attention to mothers from polygamous families who are about to give birth in the dry season or to children from specific urban areas.
The next area the researchers would like to investigate is identifying child mortality even closer to birth.
“This means identifying risk factors and interventions to reduce child mortality in low-income countries. And here, especially children in the first four weeks of life have not benefitted from the same progress in child mortality as the older ones. Before we can develop interventions, we need to know about the specific risk groups, and we can help to identify these through this exploratory approach, leveraging unique data from the Bandim Health Project and collaborating with people in the field,” concludes Ane Fisker.
