War, famine and excess child mortality in Africa: the role of parental education

Background Civilian-targeted warfare and famine constitute two of the great est public health challenges of our time. Both have devastated many countri es in Africa. Social services, and in particular, health services, have bee n destroyed. Dictatorial and military governments have used the withholding of food as a political weapon to exacerbate human suffering. Under such ci rcumstances, war and famine are expected to have catastrophic impacts on ch ild survival. This study examines the role of parental education in reducin g excess child mortality in Africa by considering Tigrai-Ethiopia, which wa s severely affected by famine and civil war during 1973-1991. Methods This study uses data from the 1994 Housing and Population Census of Ethiopia and on communities' vulnerability to food crises. Child mortality levels and trends by various subgroups are estimated using indirect method s of mortality estimation techniques. A Poisson regression model is used to examine the relationship between number of children dead and parental educ ation. Results Although child mortality is excessively high (about 200 deaths per 1000 births), our results show enormous variations in child mortality by pa rental education. Child mortality is highest among children born to illiter ate mothers and illiterate fathers. Our results also show that the role of parental education in reducing child mortality is great during famine perio ds. In the communities devastated by war, however, its impact was significa nt only when the father has above primary education. Conclusions Our findings suggest that both mother's and father's education are significantly and negatively associated with child mortality, although this effect diminishes over time if the crisis is severe and prolonged. The policy implications of our study include, obviously, reducing armed confli ct, addressing food security in a timely manner, and expansion of education al opportunities.