Vietnamese infant and childhood mortality in relation to the Vietnam War

Trends in Viet Nams infant and child mortality in the prewar period (before 1965) the war period (1965-75) and the postwar period (1976 and later) were examined. Data were obtained on >13000 live births and 737 deaths of children >6 years from the first 1988 Viet Nam Demographic and Health Survey of reproductive health and behavior. Regions were designated as north and south and levels of war activity were assigned to the following provinces: high Nghe Tinh Binh Tri Tien) intermediate (Hanoi Ha Bac Ha Nan Ninh Phu Khahn) and low (Tien Giang Dong Nai Hai Hung Cao Bang Hau Giang Ho Chi Minh City). The stratified analysis and logistic regressions included confounding factors such as material age infants sex mothers education and birth orders. There was clearly a decreasing mortality rate between the prewar and postwar periods. The relative risk (RR) ratios were 1.3 and 1.8. Decreases were particularly prominent for postneonatal mortality. There was little or no decline between wartime and postwartime mortality (RRs of .9 to 1.0). Mortality risk was increased at all ages for males children born to mothers 21 years old children of less educated mothers and children of birth order 5 or higher. When these factors were adjusted for mortality was higher in the prewar period and declined during the war and remained stable. The south showed a greater reduction of mortality than the north particularly for infant mortality. Analysis of level of war activity showed low and intermediate war level provinces had declines in mortality. High war areas had lower prewar rates (RRs of .6 to .9) and infant mortality declined to levels 30% lower than wartime rates. THus the wartime effect on mortality was most intense in provinces with high levels of war activity. A data limitation affecting the conclusions was the availability of data only on longterm survivors of the war; mortality among orphans was excluded. Another limitation was data pertained to residence at the time of the survey and not at the time of the birth. Estimates may not be very accurate for the war period. The suggestion was that in a rural economy not relying on infrastructure such as manufacturing and transportation provision of essentials is decentralized and less harmful to survival. Caution is urged in applying the findings to other wars or other indices of child health.