title: Girl-child marriage and its association with morbidity and mortality of children under 5 years of age in a nationally-representative sample of Pakistan.
abstract: OBJECTIVE
  To determine the relationship between child marriage (before age 18 years) and morbidity and mortality of children under 5 years of age in Pakistan beyond those attributed to social vulnerabilities.
  
  
  METHODS
  Nationally-representative cross-sectional observational survey data from Pakistan Demographic and Health Survey, 2006-2007 was limited to children from the past 5 years, reported by ever-married women aged 15-24 years (n = 2630 births of n = 2138 mothers) to identify differences in infectious diseases in past 2 weeks (diarrhea, acute respiratory infection [ARI], ARI with fever), under 5 years of age and infant mortality, and low birth weight by early (<18) vs adult (≥ 18) age at marriage. Associations between child marriage and mortality and morbidity of children under 5 years of age were assessed by calculating adjusted OR using logistic regression models after controlling for maternal and child demographics.
  
  
  RESULTS
  Majority (74.5%) of births were from mothers aged <18 years. Marriage before age 18 years increased the likelihood of recent diarrhea among children born to young mothers (adjusted OR = 1.59; 95% CI: 1.18-2.14). Even though maternal child marriage was associated with infant mortality and mortality of children under 5 years of age in unadjusted models, association was lost in the adjusted models. We did not find a relation between girl-child marriage and low birth weight infants, and ARI.
  
  
  CONCLUSIONS
  Girl-child marriage increases the likelihood of recent diarrhea among children born to young mothers. Further qualitative and prospective quantitative studies are needed to understand the factors that may drive child morbidity and mortality among those married as children vs adults in Pakistan.
authors.affiliation: Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany; Rollins School of Public Health, Emory University, Atlanta, GA; Injury Control Research Center, West Virginia University, Morgantown, WV. Electronic address: muazzam.nasrullah@gmail.com.
authors.forename: Muazzam
authors.initials: M
authors.lastname: Nasrullah
authors.affiliation: Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.
authors.forename: Rubeena
authors.initials: R
authors.lastname: Zakar
authors.affiliation: Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan.
authors.forename: Muhammad Zakria
authors.initials: MZ
authors.lastname: Zakar
authors.affiliation: Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Krämer
mesh_terms: D000293:Adolescent; D046688:Child Mortality; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D005334:Fever / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008393:Marriage; D033242:Minors; D010154:Pakistan; D012141:Respiratory Tract Infections / Q000453:epidemiology; D055815:Young Adult