Kiros G E, Hogan D P
Policy Research Division, The Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, USA.
Int J Epidemiol. 2001 Jun;30(3):447-55; discussion 456. doi: 10.1093/ije/30.3.447.
Civilian-targeted warfare and famine constitute two of the greatest public health challenges of our time. Both have devastated many countries in Africa. Social services, and in particular, health services, have been destroyed. Dictatorial and military governments have used the withholding of food as a political weapon to exacerbate human suffering. Under such circumstances, war and famine are expected to have catastrophic impacts on child survival. This study examines the role of parental education in reducing excess child mortality in Africa by considering Tigrai-Ethiopia, which was severely affected by famine and civil war during 1973--1991.
This study uses data from the 1994 Housing and Population Census of Ethiopia and on communities' vulnerability to food crises. Child mortality levels and trends by various subgroups are estimated using indirect methods of mortality estimation techniques. A Poisson regression model is used to examine the relationship between number of children dead and parental education.
Although child mortality is excessively high (about 200 deaths per 1000 births), our results show enormous variations in child mortality by parental education. Child mortality is highest among children born to illiterate mothers and illiterate fathers. Our results also show that the role of parental education in reducing child mortality is great during famine periods. In the communities devastated by war, however, its impact was significant only when the father has above primary education. CONCLUSIONS Our findings suggest that both mother's and father's education are significantly and negatively associated with child mortality, although this effect diminishes over time if the crisis is severe and prolonged. The policy implications of our study include, obviously, reducing armed conflict, addressing food security in a timely manner, and expansion of educational opportunities.
针对平民的战争和饥荒是我们这个时代最大的两个公共卫生挑战。这两者都给非洲许多国家带来了巨大破坏。社会服务，尤其是卫生服务遭到了破坏。独裁和军事政府将扣留粮食作为政治武器，加剧了人类的苦难。在这种情况下，战争和饥荒预计会对儿童生存产生灾难性影响。本研究通过考察1973年至1991年期间受饥荒和内战严重影响的埃塞俄比亚提格雷地区，来探讨父母教育在降低非洲儿童超额死亡率方面的作用。
本研究使用了1994年埃塞俄比亚住房和人口普查数据以及社区对粮食危机的脆弱性数据。使用间接死亡率估计技术来估计各亚组的儿童死亡率水平和趋势。采用泊松回归模型来检验儿童死亡数量与父母教育之间的关系。
尽管儿童死亡率极高（每1000例出生约有200例死亡），但我们的结果显示，儿童死亡率因父母教育程度不同而有巨大差异。文盲母亲和文盲父亲所生孩子的死亡率最高。我们的结果还表明，在饥荒时期，父母教育在降低儿童死亡率方面的作用很大。然而，在受战争破坏的社区，只有当父亲受过小学以上教育时，其影响才显著。结论我们的研究结果表明，母亲和父亲的教育都与儿童死亡率显著负相关，不过，如果危机严重且持续时间长，这种影响会随着时间推移而减弱。我们研究的政策含义显然包括减少武装冲突、及时解决粮食安全问题以及扩大教育机会。
