Mortality in the first two years of life was studied in a cohort of 510 children born in a rural Javanese village. Lower risk of death was associated with younger maternal age, maternal schooling, ownership of a well, smaller sibship, longer gap between child and next oldest sibling and, in particular, with good nutritional status. Diarrhoea, pneumonia and immunizable diseases accounted for over half the deaths, with malnutrition contributing to most. A primary health care programme focusing on malnutrition, immunization and early treatment for diarrhoea and pneumonia could reduce mortality by half or more in this population.
PIP: A study, initiated in May 1976, was conducted in the rural village of Ngaglik located 15 km north of Yogyakarta city, Indonesia in an attempt to provide definitive information on child mortality. 510 mothers who gave birth between January 1, 1976 and March 31, 1977 were followed. Each woman was interviewed monthly in her home from May 1976 through July 1978 when information on women's activities, diet, illness, and fertility was obtained. Once in every 35 days each neighborhood was visited by a specially trained anthropometric team who carried out body measurements on each woman and her child with accurate and standardized instruments. Measurements included body weight; height, head, arm, and chest circumferences; and skinfold thickness. A detailed history of illness during the past month and treatment response was recorded for each child and mother. Each death was reported and a visit was made immediately to the family of the deceased child. An open-ended interview was conducted, covering the terminal illness, preceding symptoms, treatment efforts, and presumed cause of death. Data on each deceased child were hand tabulated and compared with the entire cohort of 458 survivors. A comparison group of children or "controls" was established. 2 age matched surviving children were chosen and matched for village, economic indicators, maternal education level, and maternal age. Analysis of these 104 survivors was carried out as a control group for comparison with the 52 deceased children. There was a significant relationship between maternal age and mortality, the mortality rate more than doubling for births to mothers over age 30, i.e., 6.8% in those mothers aged 15-29 and 14.7% for children with mothers aged 30 and older. Educational level of the mother indicated a higher mortality among children whose mothers had never attended school, i.e., 13.8% compared to 8.4% for those with some education. This relationship was not statistically significant. Absence of a drinking water well, close child spacing, and size of sibship were also associated with increased risk of dying. Family economic status failed to demonstrate the expected direct correlation with risk of death, the highest rates being found in the middle income and medium land holding groups. The causes of death found were preventable infections, readily treated infections, and undernutrition. Some 90% of the postneonatal deaths need not have occurred had even the most basic of primary health services been provided for these families. Effective family planning programs aimed at higher parity, older mothers, and increased child spacing could reduce some of the risk factors.