Demography and Population Studies Programme, Schools of Social Sciences and Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
J Biosoc Sci. 2020 May;52(3):330-337. doi: 10.1017/S0021932019000464. Epub 2019 Jul 11.
Studies have focused on the effect of short birth spacing on childhood mortality, yet very little attention has been paid to the possibility of an inverse relationship such that child mortality might also positively or negatively affect birth spacing. In Nigeria, where both fertility and child mortality are high, this inverse relationship is a possible reason for the country's high fertility. The objective of this study was to examine the effect of child death on time to birth of the next child. Data were drawn from the 2013 Nigerian Demographic Health Survey. The study sample comprised 188,986 live births born to women aged 15-49 years within the five years preceding the survey. A multivariate Cox proportional hazard regression model was fitted to the data, and hazard ratios with 95% confidence intervals calculated. More than half of the mothers (68%) already had a next birth by 36 months after the death of the index child. Controlling for other covariates, the Cox regression model showed that the likelihood of next birth was higher when the index child had died compared with when the index child survived (HR: 2.21; CI: 2.03-2.41). Sub-group analysis by geo-political regions in Nigeria showed that in all regions there was a higher likelihood of having a next birth following the death of a preceding child. Death of the index child was found to be a major factor that shortens the length of birth intervals in Nigeria. It is therefore important that the Government of Nigeria intensifies efforts aimed at reducing infant mortality and encouraging adequate birth spacing.
研究集中在生育间隔过短对儿童死亡率的影响上，但很少关注到相反的可能性，即儿童死亡率也可能对生育间隔产生积极或消极的影响。在尼日利亚，生育率和儿童死亡率都很高，这种相反的关系可能是该国高生育率的一个原因。本研究的目的是检验儿童死亡对下一胎出生时间的影响。数据来自 2013 年尼日利亚人口与健康调查。研究样本包括在调查前五年内 15-49 岁的妇女所生的 188986 例活产。对数据进行了多变量 Cox 比例风险回归模型拟合，并计算了 95%置信区间的风险比。超过一半的母亲（68%）在指数儿童死亡后 36 个月内已经有了下一个孩子。在控制了其他协变量后，Cox 回归模型显示，与指数儿童存活相比，指数儿童死亡时下一胎的可能性更高（HR：2.21；CI：2.03-2.41）。按尼日利亚地理政治区域进行的亚组分析表明，在所有区域，在前一个孩子死亡后，下一胎的可能性更高。指数儿童的死亡被发现是缩短尼日利亚生育间隔的一个主要因素。因此，尼日利亚政府应加强努力，降低婴儿死亡率，并鼓励适当的生育间隔。
