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Abstract

War, famine and excess child mortality in Africa: The role of parental education 
Kiros,Gebre-Egziabher; Hogan,Dennis P.
International Journal of Epidemiology 30(3): 447-445
Publication date: 2001


Background
Civilian-targeted warfare and famine constitute twoof the greatest public health challenges of our time. Both havedevastated many countries in Africa. Social services, and inparticular, health services, have been destroyed. Dictatorialand military governments have used the withholding of food asa political weapon to exacerbate human suffering. Under suchcircumstances, war and famine are expected to have catastrophicimpacts on child survival. This study examines the role of parentaleducation in reducing excess child mortality in Africa by consideringTigrai-Ethiopia, which was severely affected by famine and civilwar during 1973-1991.

Methods
This study uses data from the 1994 Housing and PopulationCensus of Ethiopia and on communities' vulnerability to foodcrises. Child mortality levels and trends by various subgroupsare estimated using indirect methods of mortality estimationtechniques. A Poisson regression model is used to examine therelationship between number of children dead and parental education.

Results
Although child mortality is excessively high (about200 deaths per 1000 births), our results show enormous variationsin child mortality by parental education. Child mortality ishighest among children born to illiterate mothers and illiteratefathers. Our results also show that the role of parental educationin reducing child mortality is great during famine periods.In the communities devastated by war, however, its impact wassignificant only when the father has above primary education.

Conclusions
Our findings suggest that both mother's and father'seducation are significantly and negatively associated with childmortality, although this effect diminishes over time if thecrisis is severe and prolonged. The policy implications of ourstudy include, obviously, reducing armed conflict, addressingfood security in a timely manner, and expansion of educationalopportunities.