Table 4.
Programmable Determinants and Background Variables of Under-five Mortality using Traditional Cox Proportional Hazards, Cox Variance-Corrected and Cox Frailty Models in Rural EAG States for Five Years Preceding the NFHS-3 (2005-06) Survey of India (n = 13,785)
| Programmable Determinants | Model 1 (Cox Proportional Hazards Model) | Model 2 (Cox Variance Corrected Model) | Model 3 (Cox Frailty Model) | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Unadjusted | Adjusteda | pb | Unadjusted | Adjusteda | pb | Unadjusted | Adjusteda | pb | ||
| Mother’s age at birth (y) | ||||||||||
| 12-19 y | 1.53 (1.33, 1.76) | 1.19 (1.00, 1.41) | 0.048 | 1.53 (1.33, 1.76) | 1.19 (0.98, 1.44) | 0.078 | 1.57 (1.36, 1.82) | 1.41 (1.14, 1.75) | 0.002 | |
| ≥ 31 y | 1.11 (0.92, 1.33) | 1.04 (0.85, 1.27) | 0.715 | 1.11 (0.91, 1.34) | 1.04 (0.84, 1.29) | 0.733 | 1.09 (0.90, 1.32) | 0.96 (0.75, 1.24) | 0.770 | |
| Place of Delivery | ||||||||||
| Non-institutional | 1.01 (0.86, 1.18) | 0.69 (0.52, 0.93) | 0.014 | 1.01 (0.85, 1.19) | 0.69 (0.51, 0.95) | 0.021 | 1.00 (0.84, 1.18) | 0.66 (0.46, 0.94) | 0.021 | |
| Delivery assistance by whom | ||||||||||
| DAI/TBA | 1.13 (0.97, 1.31) | 1.13 (0.87, 1.46) | 0.353 | 1.13 (0.96, 1.32) | 1.13 (0.86, 1.48) | 0.375 | 1.13 (0.97, 1.33) | 1.33 (0.97, 1.81) | 0.075 | |
| Relatives/no one | 1.21 (1.02, 1.43) | 1.25 (0.95, 1.65) | 0.115 | 1.21 (1.01, 1.44) | 1.25 (0.94, 1.67) | 0.130 | 1.20 (1.01, 1.44) | 1.38 (0.99, 1.93) | 0.061 | |
| Type of Delivery | ||||||||||
| Caesarian | 0.92 (0.62, 1.38) | 1.01 (0.66, 1.56) | 0.948 | 0.92 (0.60, 1.41) | 1.01 (0.65, 1.58) | 0.949 | 0.94 (0.62, 1.44) | 0.89 (0.51, 1.55) | 0.680 | |
| Sex of the baby | ||||||||||
| Female | 1.18 (1.05, 1.34) | 1.17 (1.03, 1.32) | 0.013 | 1.18 (1.05, 1.34) | 1.17 (1.02, 1.33) | 0.021 | 1.19 (1.05, 1.34) | 1.22 (1.05, 1.41) | 0.008 | |
| Birth Order (BO) & Birth Interval (BI) | ||||||||||
| First BO | 2.10 (1.74, 2.53) | 2.03 (1.58, 2.61) | < 0.001 | 2.10 (1.74, 2.53) | 2.03 (1.54, 2.68) | < 0.001 | 2.14 (1.77, 2.59) | 2.04 (1.52, 2.73) | <0.001 | |
| 2-3 BO & BI < 2y | 1.99 (1.61, 2.46) | 1.64 (1.31, 2.04) | < 0.001 | 1.99 (1.60, 2.47) | 1.64 (1.28, 2.09) | < 0.001 | 1.94 (1.56, 2.41) | 1.97 (1.52, 2.57) | < 0.001 | |
| ≥ 4 BO & BI ≥ 2y | 1.27 (1.04, 1.56) | 1.04 (0.82, 1.30) | 0.766 | 1.27 (1.04, 1.57) | 1.04 (0.82, 1.31) | 0.773 | 1.26 (1.02, 1.55) | 1.06 (0.80, 1.39) | 0.700 | |
| ≥ 4 BO & BI < 2 y | 3.04 (2.49, 3.72) | 2.31 (1.85, 2.89) | < 0.001 | 3.04 (2.47, 3.74) | 2.31 (1.82, 2.93) | < 0.001 | 2.93 (2.37, 3.61) | 2.42 (1.84, 3.18) | < 0.001 | |
| Size of the baby at birth | ||||||||||
| Very small & small | 1.58 (1.31, 1.89) | 1.39 (1.16, 1.68) | < 0.001 | 1.58 (1.31, 1.90) | 1.39 (1.14, 1.70) | 0.001 | 1.62 (1.34, 1.96) | 1.42 (1.12, 1.79) | 0.003 | |
| Average | 0.96 (0.82, 1.14) | 0.99 (0.83, 1.17) | 0.871 | 0.96 (0.81, 1.14) | 0.99 (0.82, 1.19) | 0.880 | 0.96 (0.80, 1.14) | 0.97 (0.78, 1.19) | 0.740 | |
| Survival status of previous child | ||||||||||
| Dead | 2.40 (2.02, 2.84) | 1.86 (1.56, 2.21) | < 0.001 | 2.40 (2.03, 2.83) | 1.86 (1.54, 2.24) | < 0.001 | 2.22 (1.86, 2.64) | 0.82 (0.67, 1.02) | 0.072 | |
| Breastfeeding | ||||||||||
| No | 16.6 (14.6, 18.8) | 18.2 (15.9, 20.9) | < 0.001 | 16.6 (14.3, 19.2) | 18.2 (15.5, 21.4) | < 0.001 | 116.0 (93, 146) | 102.0 (81, 128) | <0.001 | |
| Background Variables EAG States | ||||||||||
| Bihar | 1.37 (0.95, 1.95) | 1.55 (1.06, 2.26) | 0.022 | 1.37 (0.95, 1.96) | 1.55 (1.00, 2.41) | 0.049 | 1.39 (0.95, 2.02) | 1.63 (0.98, 2.74) | 0.063 | |
| Jharkhand | 1.52 (1.50, 2.20) | 1.77 (1.19, 2.63) | 0.005 | 1.52 (1.04, 2.23) | 1.77 (1.11, 2.81) | 0.016 | 1.52 (1.03, 2.24) | 1.49 (0.87, 2.56) | 0.140 | |
| Madhya Pradesh | 1.79 (1.27, 2.52) | 1.98 (1.38, 2.85) | <0.001 | 1.79 (1.27, 2.54) | 1.98 (1.29, 3.04) | 0.002 | 1.80 (1.26, 2.58) | 2.29 (1.39, 3.78) | 0.001 | |
| Chhattisgarh | 1.63 (1.13, 2.35) | 2.53 (1.71, 3.75) | <0.001 | 1.63 (1.13, 2.36) | 2.53 (1.62, 3.96) | <0.001 | 1.65 (1.13, 2.43) | 2.47 (1.46, 4.20) | <0.001 | |
| Rajasthan | 1.54 (1.08, 2.20) | 2.12 (1.47, 3.08) | <0.001 | 1.54 (1.08, 2.20) | 2.12 (1.39, 3.24) | <0.001 | 1.55 (1.07, 2.24) | 2.06 (1.24, 3.41) | 0.005 | |
| Orissa | 1.50 (1.04, 2.17) | 1.56 (1.05, 2.28) | 0.027 | 1.50 (1.06, 2.18) | 1.55 (0.99, 2.42) | 0.056 | 1.50 (1.02, 2.20) | 1.88 (1.10, 3.22) | 0.021 | |
| Uttar Pradesh | 1.81 (1.32, 2.50) | 2.51 (1.80, 3.51) | <0.001 | 1.82 (1.32, 2.50) | 2.51 (1.69, 3.72) | <0.001 | 1.82 (1.31, 2.54) | 2.41 (1.51, 3.85) | <0.001 | |
| Caste | ||||||||||
| Scheduled Caste | 1.28 (1.11, 1.48) | 1.09 (0.94, 1.27) | 0.251 | 1.28 (1.10, 1.49) | 1.09 (0.93, 1.29) | 0.293 | 1.28 (1.10, 1.49) | 1.18 (0.96, 1.44) | 0.110 | |
| Scheduled Tribe | 1.25 (1.06, 1.47) | 1.26 (1.04, 1.52) | 0.017 | 1.25 (1.05, 1.48) | 1.26 (1.02, 1.55) | 0.029 | 1.25 (1.05, 1.49) | 1.38 (1.08, 1.76) | 0.011 | |
| Religion | ||||||||||
| Others | 1.04 (0.88, 1.24) | 1.09 (0.90, 1.32) | 0.364 | 1.04 (0.87, 1.24) | 1.09 (0.88, 1.35) | 0.420 | 1.05 (0.87, 1.26) | 1.24 (0.97, 1.59) | 0.080 | |
| Mother’s education | ||||||||||
| Illiterate | 1.47 (1.28, 1.69) | 1.27 (1.09, 1.49) | 0.003 | 1.47 (1.27, 1.70) | 1.27 (1.06, 1.53) | 0.010 | 1.48 (1.28, 1.71) | 1.29 (1.05, 1.59) | 0.014 | |
| Mother’s occupation | ||||||||||
| Agri related/unskilled | 1.14 (0.68, 1.91) | 0.90 (0.53, 1.51) | 0.683 | 1.14 (0.64, 2.05) | 0.90 (0.47, 1.72) | 0.744 | 1.17 (0.68, 2.01) | 0.80 (0.41, 1.50) | 0.500 | |
| Not working | 1.11 (0.67, 1.86) | 0.89 (0.53, 1.50) | 0.670 | 1.11 (0.62, 1.99) | 0.89 (0.47, 1.71) | 0.733 | 1.13 (0.65, 1.94) | 0.80 (0.41, 1.54) | 0.500 | |
| Total number of children | ||||||||||
| > 2 | 1.11 (0.97, 1.25) | 1.27 (1.00, 1.53) | 0.047 | 1.11 (0.97, 1.26) | 1.24 (0.97, 1.59) | 0.086 | 1.08 (0.94, 1.23) | 1.40 (1.08, 1.81) | 0.009 | |
| Household Wealth Index | ||||||||||
| Poorer | 0.97 (0.84, 1.11) | 0.97 (0.84, 1.13) | 0.729 | 0.97 (0.83, 1.12) | 0.97 (0.83, 1.15) | 0.753 | 0.97 (0.83, 1.12) | 1.03 (0.85, 1.25) | 0.760 | |
| Middle | 0.80 (0.68, 0.95) | 0.84 (0.69, 1.02) | 0.077 | 0.80 (0.67, 0.96) | 1.84 (0.68, 1.04) | 0.104 | 0.80 (0.66, 0.96) | 0.81 (0.64, 1.05) | 0.110 | |
| Richer | 0.48 (0.37, 0.63) | 0.54 (0.40, 0.72) | <0.001 | 0.48 (0.37, 0.64) | 0.54 (0.39, 0.74) | <0.001 | 0.48 (0.37, 0.63) | 0.45 (0.31, 0.66) | <0.001 | |
| Richest | 0.42 (0.27, 0.67) | 0.53 (0.32, 0.86) | 0.011 | 0.42 (0.26, 0.69) | 0.53 (0.31, 0.90) | 0.018 | 0.42 (0.26, 0.71) | 0.40 (0.21, 0.75) | 0.005 | |
| Desire for pregnancy | ||||||||||
| Later | 0.96 (0.77, 1.19) | 0.88 (0.70, 1.10) | 0.25 | 0.96 (0.76, 1.21) | 0.88 (0.67, 1.15) | 0.348 | 0.98 (0.78, 1.23) | 1.17 (0.89, 1.53) | 0.270 | |
| No more | 1.17 (0.98, 1.38) | 1.17 (0.96, 1.42) | 0.113 | 1.17 (0.97, 1.41) | 1.17 (0.95, 1.45) | 0.147 | 1.19 (1.00, 1.43) | 1.22 (0.96, 1.56) | 0.100 | |
| Variance of frailty | 2.86 | <0.001 | ||||||||
| Log likelihood/I-likelihood | -9246.9 | -9246.9 | -9150.5 | |||||||
| R2 | 10.80% | 10.80% | 27.4% | |||||||
Reference categories: Mother’s age at birth 20-30 y, Institutional Delivery, Delivery assistance by Doctors/ANM/HP, Male children, 2-3 Birth Order & Birth Interval ≥ 2y, Very large & large size of the baby at birth, surviving previous sibling, breastfed children, Uttarakhand state, other caste, Hindu religion, literate mothers, Professional/Clerical/Sales, ≤ 2 children, poorest household wealth index and then for desire for pregnancy; aAdjusted for background factors such as EAG States, religion, caste, mother’s education, mother’s occupation, number of children, wealth index, desire time for pregnancy and other determinants; pb- p-value for multivariate analysis and p<0.05, statistically significant.