title: Low child survival index in a multi-dimensionally poor Amerindian population in Venezuela.
abstract: BACKGROUND
  Warao Amerindians, who inhabit the Orinoco Delta, are the second largest indigenous group in Venezuela.  High Warao general mortality rates were mentioned in a limited study 21 years ago. However, there have been no comprehensive studies addressing child survival across the entire population.
  
  
  OBJECTIVE
  To determine the Child Survival-Index (CSI) (ratio: still-living children/total-live births) in the Warao population, the principal causes of childhood death and the socio-demographic factors associated with childhood deaths.
  
  
  METHODS
  We conducted a cross-sectional epidemiological survey of 688 women from 97 communities in 7 different subregions of the Orinoco Delta. Data collected included socio-demographic characteristics and the reproductive history of each woman surveyed. The multidimensional poverty index (MPI) was used to classify the households as deprived across the three dimensions of the Human Development Index. Multivariable linear regression and Generalized Linear Model Procedures were used to identify socioeconomic and environmental characteristics statistically associated with the CSI.
  
  
  RESULTS
  The average CSI was 73.8% ±26. The two most common causes of death were gastroenteritis/diarrhea (63%) and acute respiratory tract Infection/pneumonia (18%).  Deaths in children under five years accounted for 97.3% of childhood deaths, with 54% occurring in the neonatal period or first year of life.  Most of the women (95.5%) were classified as multidimensionally poor.  The general MPI in the sample was 0.56.   CSI was negatively correlated with MPI, maternal age, residence in a traditional dwelling and profession of the head of household other than nurse or teacher.
  
  
  CONCLUSIONS
  The Warao have a low CSI which is correlated with MPI and maternal age.  Infectious diseases are responsible for 85% of childhood deaths.  The low socioeconomic development, lack of infrastructure and geographic and cultural isolation suggest that an integrated approach is urgently needed to improve the child survival and overall health of the Warao Amerindians.
authors.affiliation: Dirección Regional de Salud Estado Delta Amacuro, Tucupita, Venezuela ; Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela ; Lovelace Respiratory Research Institute, Albuquerque, New Mexico, United States of America.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Villalba
authors.affiliation: Lovelace Respiratory Research Institute, Albuquerque, New Mexico, United States of America.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Escuela de Medicina José María Vargas, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Mauyuri K
authors.initials: MK
authors.lastname: Alvarez
authors.affiliation: Escuela de Medicina José María Vargas, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Luisana
authors.initials: L
authors.lastname: Calderon
authors.affiliation: Escuela de Medicina José María Vargas, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Merari
authors.initials: M
authors.lastname: Canache
authors.affiliation: Escuela de Medicina José María Vargas, Universidad Central de Venezuela, Caracas, Venezuela.
authors.forename: Gaudymar
authors.initials: G
authors.lastname: Cardenas
authors.affiliation: Escuela de Medicina José María Vargas, Universidad Central de Venezuela, Caracas, Venezuela ; Departamento de Pediatría, Hospital de Niños "J.M. de los Ríos", Caracas, Venezuela.
authors.forename: Berenice
authors.initials: B
authors.lastname: Del Nogal
authors.affiliation: Laboratorio de Genética Molecular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela.
authors.forename: Howard E
authors.initials: HE
authors.lastname: Takiff
authors.affiliation: Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela.
authors.forename: Jacobus H
authors.initials: JH
authors.lastname: De Waard
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D003710:Demography; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data; D016019:Survival Analysis; D014687:Venezuela / Q000453:epidemiology / Q000208:ethnology; D055815:Young Adult