The effect of poverty, social inequity, and maternal education on infant mortality in Nicaragua, 1988-1993.
OBJECTIVE
This study assessed the effect of poverty and social inequity on infant mortality risks in Nicaragua from 1988 to 1993 and the preventive role of maternal education.


METHODS
A cohort analysis of infant survival, based on reproductive histories of a representative sample of 10,867 women aged 15 to 49 years in León, Nicaragua, was conducted. A total of 7073 infants were studied; 342 deaths occurred during 6394 infant-years of follow-up. Outcome measures were infant mortality rate (IMR) and relative mortality risks for different groups.


RESULTS
IMR was 50 per 1000 live births. Poverty, expressed as unsatisfied basic needs (UBN) of the household, increased the risk of infant death (adjusted relative risk [RR] = 1.49; 95% confidence interval [CI] = 1.15, 1.92). Social inequity, expressed as the contrast between the household UBN and the predominant UBN of the neighborhood, further increased the risk (adjusted RR = 1.74; 95% CI = 1.12, 2.71). A protective effect of the mother's educational level was seen only in poor households.


CONCLUSIONS
Apart from absolute level of poverty, social inequity may be an independent risk factor for infant mortality in a low-income country. In poor households, female education may contribute to preventing infant mortality.
Peña
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Department of Preventive Medicine, Universidad Nacional Autónoma, León, Nicaragua. rodolfo.pena@epiph.umu.se
Wall
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Persson
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D000293:Adolescent; D000328:Adult; D004493:Education; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D009527:Nicaragua / Q000453:epidemiology; D011203:Poverty; D011247:Pregnancy; D012111:Residence Characteristics; D012306:Risk; D017678:Sex Distribution; D012940:Social Problems