Using Partial Least Squares Regression and Artificial eural etwork Methods To Study Risk Factors Affecting Worldwide Infant Mortality Rates

The infant mortality rate (IMR) commonly serves as a marker to evaluate how well a geographic area is equipped with suitable living and health conditions and additionally, its economic prosperity. The IMR in the United States has been on the decline since the 1950s in lieu of a globally high IMR. Lower IMR globally can be attributed to increases in education about the importance of prenatal care and breastfeeding, along with changing socioeconomic climates across the world. The objective of this study was to uncover the significant and important risk factors that contribute to infant mortality rates globally. This study used Partial Least Squares (PLS) Regression and Artificial eural etwork (A ) analysis to assess how these factors: Gross Domestic Product (GDP), adolescent fertility rate, country development status, health care expenditure per capita, and adult literacy rate, contributed to infant mortality rate in 134 countries for which data was accessible through the United ation’s data bank. It was shown that the findings of PLS were consistent with the finding in A model and that adolescent fertility rate was the most important variable contributed to infant mortality rates in the countries studied. Though less important, country development status, GDP, and health care expenditure per capita, also are important in varying IMRs. The study confirms what was found in the literature that high fertility rates and high infant mortality rates are linked, and that the lower a country’s development status (1 st , 2 nd , or 3 rd world) the higher infant mortality rates will be. Introduction Infant mortality is defined as the death of a live-born infant before age one. The rate of infant mortality is calculated as the number of newborns dying within the first year of life divided by the number of live births European International Journal of Science and Technology ISS : 2304-9693 www.cekinfo. org.uk/EIJST 18 during a set time period (i.e. normally one year)-most research statistics present infant mortality rate (IMR) as the number of deaths per 1,000 live births. The IMR commonly serves as a marker to evaluate how well a geographic area is equipped with suitable living and health conditions and additionally, its economic prosperity. Background & Previous Findings Infant Mortality in the U.S. Infant mortality in the US dropped to its lowest rate in history at 6.06 in 2010 (Central Intelligence Agency, 2011) down from 6.42 in 2009, 6.58 in 2008 (Kochanek, Xu, Murphy, Miniño, & Kung, 2011), and 30.46 in the early 1950's (United Nations World Population Prospectus Report, 2011). Multiple infant lives were lost in the past; however the rates have dramatically dropped due to technological advances, healthcare improvements, healthy pregnancy education, and specialized birth assistance. International Infant Mortality In 2010 the infant mortality rate of the United States was approximately seven times lower than the world's average rate of 44.13. World IMR estimates for 2011 range as low as 1.79 in Monaco to a devastating 175.90 in Angola (Central Intelligence Agency, 2011). U.S. National Vital Statistics reported that the ranking of factors remained constant within the top 10 causes of infant mortality between 2008 and 2009; birth defects and low birth weight were in the top two slots-which are the same for Iran (Sharifzadeh, Namakin, Mehrjoofard, 2008)-and neonatal hemorrhage in the last position. In both countries, a large portion of infant deaths were attributed to low birth weight resulting from maternal smoking during gestation, yet a difference lies in the popular agent of consumption-tobacco for the U.S. versus opiates for Iran. Research also shows that implementation of policies influencing health and behavior changes, such as reducing barriers to smoking cessation and prenatal care, can reduce infant mortality rates overall (Singh &Kogan, 2007). However, these changes are likely to increase disparities between socioeconomic groups as those from higher socioeconomic strata implement and access the changes quicker than those from lower socioeconomic strata--for example, pregnant women who were not college-educated were initially 7.1 times more likely to smoke versus college educated-women, and over a 8 year span that disparity grew to 11.8 times more likely. A study of data from multiple nations found that the higher one's education, the better 1) access one has to resources that comprise prosperity (i.e. financial support, quality healthcare, etc), and 2) one is able to use critical thinking and deductive reasoning to identify health complications leading to early intervention and a resulting probability of positive resolution (eg. recognizing risks for premature or low birth weight infants)( Khamis&Hanoon, 2010). The longer one waits to solve a potential medical problem, the likelihood of mortality or permanent injury increase. European International Journal of Science and Technology Vol. 2 o. 3 April 2013 19 In Nepal, education that leads to prevention of medical problems has been an important factor in the lower average IMR in female-headed households-likely attributed to the women's ability to save a portion of household income for prenatal and healthcare services (Adhikari&Podhisita, 2010). Their ability to visit healthcare facilities (i.e. for preventive services and/or treatment) gives them additional opportunities (through pamphlets and/ or dialogue with their healthcare provider) to learn about family planning (which assists with birth spacing, and consequently lowered infant mortality rates), life saving immunizations, nutrition, and postpartum care. In contrast to Nepal, in developing countries like Bangladesh, the father's education level as head of the household is important. The father's education is inversely proportionate to the risk of infant mortality due to the father's heightened ability to understand and provide the proper nutrition and immunizations to their wives and infants (Uddin and Hossain, 2008). Additionally, findings support existing theory that extending breastfeeding and increasing birth spacing increases infant survival rates-30 months or more between births proved to be optimal spacing. In Zimbabwe urban couples and those with higher education were more likely to use birth control methods (Kembo& Van Ginneken, 2009). This implementation of family planning resulted in birth spacing, which, in turn, decreased the urban infant mortality rate. The researchers also noted an inverse relationship between multiple births and infant survival. Thus testing for and referring high-risk pregnancies to specialists as well as improving overall maternal and child health services, especially in rural populations, would improve infant survival. In Denizli, Turkey strengthening prenatal health through nutrition, pregnancy education, and screening for fetal abnormalities may improve infant mortality rates. Findings indicate the present rate is largely due to congenital defects and premature births (Karabulut, Istanbullu, Karahan, Ozdemir, 2009). Results also show a wide variability in infant mortality even amongst the wealthy who are thought to be able to afford proper healthcare (Anyamele, 2011). With socioeconomic factors being equal, the differences were evident in geographical location and subsequently access to implemented policy initiatives, largely urbantargeted, which left rural inhabitants having a much higher infant mortality rate than urban inhabitants. Another investigation found that rural girls in Bangladesh are more likely to marry at ages where their bodies lack the maturity to safely harbour a child (Quamrul, Islam, &Hossian, 2010). Breastfeeding is a strong component of infant nutrition and immunity which both play a massive role in determining infant survival. Birth spacing often has a direct relationship to breastfeeding-the smaller the interval between births the shorter the amount of time the elder infant is allowed to suckle before s/he is replaced by the new infant, which may leave the elder child undernourished. Malnutrition is also a pressing issue in Liberia-which is in the world's top five countries with the highest rate of infant mortality with 15% of children the nation's children dying under the age of 1. This crippling rate is due to the systemic and educational devastation from the 14-year civil war ending in 2003, and the nation’s efforts to resume operations with its broken pieces. The return of many citizens to continue their European International Journal of Science and Technology ISS : 2304-9693 www.cekinfo. org.uk/EIJST 20 education, especially young, uneducated mothers, has unfortunately left many infants home alone daily for long hours to perish from malnutrition (Mason, 2010). Additionally, the maternal mortality rates are destructively high with less than half of all births supervised by a healthcare professional. Studies in Ethiopia found adolescent motherhood, birth spacing, and birth order, were the largest triggers of infant mortality (Sathiyasusuman, 2011). The suggested remedies to these issues include issuing education and warnings about teenage pregnancy and early marriage, making contraceptives available and easily accessible to increase birth spacing, and encouraging breastfeeding amongst women who inhabit areas with poor sanitation and limited access to clean water. Poor sanitation is also a major factor causing Mozambique to hold the 13th highest infant mortality rate (Central Intelligence Agency, 2011). According to studies, the variables that contribute most to their high rate are viruses/ bacteria, sanitation, and access to specialized birth & pediatric guidance. "Significant risk factors for all-cause infant mortality were mother’s death in first year (most commonly due to HIV), death of previous sibling, and an increasing number of household deaths. Being born to a Mozambican mother posed a significant risk for infectious and parasitic deaths,