HEALTH TRANSITION REVIEW

Australia (Canberra) 57

OCTOBER 1997 - VOLUME 7, NUMBER 2

98.57.30 - English - Frans VAN POPPEL, Netherlands Interdisciplinary Demographic Institute, PO Box 11650, 2502 AR The Hague (Netherlands), and Cor VAN DER HEIJDEN, Vooreind 7a, 5096 BC Hulsel (Netherlands)

The effects of water supply on infant and childhood mortality: A review of historical evidence (p. 113-148)

The provision of clean water is mentioned as an important factor in many studies dealing with the decline of mortality in Europe during the late 19th and early 20th centuries. In developing countries too, improved water supply is assumed to have a strong impact on mortality. When studying the effect of water supply on public health, researchers are confronted with many methodological problems. Most of these also apply to historical studies of the subject. We review the evidence from this historical research, taking into account the methodological problems observed in contemporary impact evaluation studies, and we use more refined data from the Dutch city of Tilburg, enabling us to overcome many of these shortcomings. Finally, we discuss some factors which may explain why we failed to discover an effect of the availability of piped water on the level of childhood mortality. (NETHERLANDS, CITIES, HISTORY, CHILD MORTALITY, MORTALITY DECLINE, WATER SUPPLY)

98.57.31 - English - Kathleen STUEBING, Theological College of Central Africa, PO Box 250100, Ndola (Zambia)

Maternal schooling and comprehension of child health information in urban Zambia: Is literacy a missing link in the maternal schooling-child health relationship? (p. 151-171)

This paper examines the relationship between literacy skills and comprehension of health information by studying mothers of young children in a high-density urban area in Zambia. Both decontextualized language and print literacy skills were assessed for each woman and the resulting scores were related to her comprehension of both broadcast and printed health information. The results indicate that fluency in a language is not sufficient for full comprehension of broadcast messages in the decontextualized type of language used in bureaucratic communication, and that a woman's ability to use decontextualized language is associated with greater comprehension of such messages. Skill in using this type of language increases with years of schooling, even in the poorly equipped schools in Zambia, as does print literacy, even though the levels of comprehension achieved are well below their grade level on average for these women. Some implications of these findings for both health care providers and educators are then considered. (ZAMBIA, MATERNAL AND CHILD HEALTH, HEALTH EDUCATION, LITERACY)

98.57.32 - English - Indrani PIERIS and Bruce CALDWELL, ICDDR,B, Dhaka (Bangladesh)

Gender and health in Sri Lanka (p. 173-186)

Sri Lanka has today easily the longest life-expectancy of any nation in South Asia. The country's achievements have been particularly impressive in the health of women and girls who have substantially lower mortality levels than males; this is unexceptional in the developed world where it is the norm but striking in South Asia where it is not. It has been suggested that low female mortality may reflect a high involvement of Sri Lankan women in decision-making over health care and feeding practices which has benefited their health and that of their children, especially their daughters. Yet census data indicate that until recent decades overall mortality levels were little lower than in other South Asian countries and female age-specific mortality rates were higher than male rates. The paper explores the issues involved concluding that the autonomy of women has contributed to the decline of overall mortality, once modern health services developed. However, women's autonomy has not in itself overcome the sex differential in care, given the economic dependence of women and their families on males: husbands while the women are raising children and ultimately sons for old-age support. (SRI LANKA, PUBLIC HEALTH, DIFFERENTIAL MORTALITY, SEX DIFFERENTIALS, MORTALITY DECLINE)

98.57.33 - English - Peter BERMAN, Jennifer ZEITLIN, Harvard University School of Public Health, 677 Huntington Ave., Boston, MA 02115 (U.S.A.), Prodipto ROY and Sarojini KHUMTAKAR, Council for Social Development, New Delhi (India)

Does maternal employment augment spending for children's health care? A test from Haryana, India (p. 187-204)

Evidence that women's employment and earnings foster increased allocations of household resources to children's well-being have led to advocacy of investment in women's employment as a method for targeting the social benefits of enhanced economic opportunity. Work and associated earnings are hypothesized to empower women, who can then exercise their individual preferences for spending on child well-being as well as influence household spending patterns. This paper presents results from a small detailed household and community study of maternal employment and child health in northern India (one of six studies in a research network), which sought to show that such effects did indeed occur and that they could be linked to work characteristics. Careful analysis of employment and earnings showed that they are multidimensional and highly variable over occupations and seasons. Contrary to expectations, spending on health care for children's illness episodes was negatively associated with maternal employment and earnings variables in econometric analysis. The expected individual effects on women of work and earnings, if they did occur, were not sufficient to alter the general spending pattern. We conclude that the attributes of work as well as the social and cultural environment are important mediators of such effects, suggesting a confluence of 'individual' and 'collective' behavioural determinants meeting in the locus of the household. (INDIA, MATERNAL AND CHILD HEALTH, FAMILY BUDGET, FEMALE EMPLOYMENT)

98.57.34 - English - Friday E. OKONOFUA, Women's Health and Action Research Centre, PO Box 10234, Ugbowo, Benin City (Nigeria), Diana HARRIS, Harvard School of Public Health, Boston, MA (U.S.A.), Adetanwa ODEBIYI, Obafemi Awolowo University, Ile-Ife (Nigeria), Thomas KANE, Johns Hopkins University School of Public Health, Baltimore, MD (U.S.A.), and Rachel C. SNOW, Harvard School of Public Health, Boston, MA (U.S.A.)

The social meaning of infertility in Southwest Nigeria (p. 205-220)

There has been very little documentation of the social meaning given to infertility in many developing countries, including Nigeria, where the prevalence of infertility is known to be high. We have conducted a number of qualitative studies aimed at exploring sociocultural issues associated with infertility in Ile-Ife, Southwestern Nigeria. Twenty-five focus-group discussions were held with knowledgeable persons in the rural and urban parts of the community to ascertain their attitudes towards infertility. The results show that community members accord great significance to childbearing, but, they have incorrect knowledge of the causes and appropriate treatment of infertility. Focus-group participants mentioned several traditional beliefs regarding the causes of infertility from which they derived a variety of traditional and religious methods for its treatment; many affected couples use these methods of treatment, sometimes singly but most often in combination. Orthodox treatments are less often used because of perceptions of the causes of infertility and lack of confidentiality at the treatment centres. Women are more likely to suffer the social consequences of infertility; they suffer physical and mental abuse, neglect, abandonment, economic deprivation and social ostracism as a result of their infertile status. These findings have profound implications for reproductive health and reproductive rights of women in the area. Measures recommended to ameliorate the adverse consequences of infertility in the community include provision of broad reproductive health education and appropriate services, integration of infertility treatment and prevention into primary health care and the traditional system of health care delivery, and programs aimed at the empowerment of women in the area. (NIGERIA, INFERTILITY, CULTURE, ATTITUDE, PUBLIC HEALTH, WOMEN'S STATUS)

98.57.35 - English - Bamikale J. FEYISETAN, Sola ASA and Joshua A. EBIGBOLA, Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife (Nigeria)

Mothers' management of childhood diseases in Yorubaland: The influence of cultural beliefs (p. 221-234)

The authors attempt to analyse the extent to which certain beliefs where illness is concerned ("abiku"), that is traditional in the Nigerian States of Ondo and Ekiti, has an impact on mothers' reactions to their sick children. The majority of Yoruba females are ignorant of the causes of any given infant disease, such as measles; however, this does not prevent them from often preferring modern medical treatment. But more than half the mothers believe in "abiku" and feel that an "abiku" child can only be treated by a traditional medicine-man, no matter the illness from which the child may be suffering. The probability that a sick child actually receives the appropriate care thus varies, depending on whether he or she is considered to be "abiku" or not. Here again, we have renewed proof of the interest which lies in considering people's traditional beliefs and practices when implementing a health policy. (NIGERIA, MATERNAL AND CHILD HEALTH, CULTURE)

98.57.36 - English - Bruce FETTER, Department of History, University of Wisconsin, Milwaukee (U.S.A.)

The epidemiologic transition: One, many or none? (p. 235-236)

98.57.37 - English - Philip R. P. COELHO

Epidemiology and the demographic transition in the New World (p. 237-240)

98.57.38 - English - John ROGERS and Marie C. NELSON

The epidemiologic transition revisited: Or what happens if we look beneath the surface? (p. 241-255)

Back to Home page