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  • Title: [Urbanization, schooling and infant and child mortality].
    Author: Antoine P, Diouf PD.
    Journal: Ann IFORD; 1988 Jun; 12(1):9-24. PubMed ID: 12178521.
    Abstract:
    Socioeconomic factors are the important of the various factors implicated in infant and child mortality differentials between population groups. Infant and child mortality rates are especially sensitive to rural or urban residence and maternal educational level. The 2 variables are however closely related in Africa, where most educated persons live in urban areas and where the rural/urban differentials in mortality occur because urban residents are better educated, have more regular incomes, and benefit from more accessible health facilities than rural dwellers. Infant mortality rates in particular are usually lower in urban areas, as demonstrated by data for a number of African countries around 1977-82. The differences were great in Benin, Cameroon, and Senegal, and less in Kenya and Senegal, and less in Kenya and Ghana. Early childhood mortality is more sensitive to the influence of socioeconomic factors, and rural-urban comparisons occasionally reveal higher urban mortality rates. This is not the case in Senegal, where an overwhelming proportion of modern facilities are located in Dakar. A case study of mortality in Senegal concluded that urban residence explained 58-72% of the variance in mortality rates. Nevertheless, mortality differentials between socioeconomic strata and areas of residence within African cities may be very great and should not be overlooked. The maternal educational level similarly appears to be an influential factor in determining infant and early childhood mortality rates. All the data of the World Fertility Survey indicated that early childhood mortality declined as maternal education increased. Although the influence itself may not be unexpected, the extent of the effect is startling. A case study in the new city of Pikine near Dakar provided insight into the interrelations. 2807 women in 1855 households were interviewed in early 1986 to provide data among other topics on living conditions at the time of 8141 births and 987 deaths. 72% of the women were housewives and 69% were illiterate. 26% were from Pikine, 24% spent their childhoods in Dakar, and 30% were from rural areas. The population was relatively impoverished, but the infant mortality rate was lower than that of most of Senegal. Rates in Pikine, Dakar, and rural areas respectively were 52, 57, and 114/1000 for infant mortality and 55, 62, and 156 for early childhood mortality. The Pikine data illustrate the difficulty of distinguishing between the influence of maternal education, social level of the household, and health and sanitary conditions. Use of health services was a strong infant mortality differential in Pikine, but maternal education influenced early child mortality more strongly than infant mortality. Illiteracy appears to be a determining factor in differential infant mortality, but there is a risk of imputing to simple lack of education some other effects of the change from rural to urban residence.
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