The effect of poverty, social inequity, and maternal education on infant mortality in Nicaragua, 1988-1993

Abstract

Objectives: 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.