الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Rate and trend of infant mortality are frequently regarded as indicator , i jof country development. 1 mother, her parity. ! J as father factors has been } lpwlic health’studies. The association of maternal factors as age Of occupation. education and duration of marriage as well of long standing interest in stat:l.stical and The present work aimed at studying infant mortality in Kuwait in re lation to certain characteristics of the family. ages of mothers and fath ers, education and occupation of parents, birth order and status. and total foetal deaths from linkage of birth and death certificate. And alsQ to Wentify the high risk group of infants related to studied variabla~. To accomplish this aim. all the infant deaths which occurred amonij those born during the year 1982 in Kuwai t (1137) were included. The birth certificates of these infants were obtained and linkage of its data with t~t of their death certificate data had been done by using a transfer sheet designed to include all required data from both certificates. To recognise ! risk factors a’ matched control group (1137) of the same sample size were i , i obtained from births of the same year who celeberated their first year of age, The birth certificate of the control group were obtained. recorded, analysed and compared wi th the study group. Data collected were then tabulated and statistically analysed giving the following results. Results: 1. Analysis of birth and death certificate data and infant mortality rate according to different variables. 1.1 : Out of 1137 deaths 574 (50.5) were early neonatal deaths, leas than half (46.7) of the early neonatal mortalities occurred before they reached one day’s age 21. 4 died in their first day, and 12.0 in their second day. Late neonatal deaths (130) were 11.4 of total infant deaths. About half of these (46.2) died during their second week, 30.0 during the third week and 23.8 during their fourth week of life. Post-neonatal deaths constituted 38.1 of total infant deaths. One fourths (24.7) occurred in the first month, 22.4 in the second ~onth and the rest (52.9) occurred in the months from the third to the eleventh and less than one year. 1.2 : A majority of infant death occurred during January (12.1), Ma.l’c;h (10.6), November (9.8) and December ’10.8), while fewer deaths oCdurt~d during July (5.7), August (5.5), September (5.5) and October (6.5). The infant mortality rate is high in January 29.2,) February 24.6.)Match 27 .O~ and December 25.0.1.e. winter season and early spring. 1.3 : Infant deaths were analysed by age at death and season, and it was observed that rearly the same proportion of neonatal and post-neonatal deaths occurred during the Autumn (21. 6 compared to 22.2). The infant mortality rate is high in winter (26.4~ live births) and low in summer (16.3.live births). 1.4 : Studying month of delivery, it is observed that a majority of infants who died in infancy were delivered in January (11.2), October (9.4) and November (9.0) (i.e. late autumn & mid winter season) compared to fever deaths amongst those delivered in April (6.5) and July (6.3. Also infant mortality rate by month of birth showed a seasonal patterns. It is quite high in winter and early spring but singificantly low in April. 1.5: More infant deaths are encountered among males than females (56.2 vs 43.8 and there is also a great difference in the infant mortality rate Kcording to sex distribution. It is 23.1. live births in males and 18.7. live birth in females. 1.6 : Highest proportion of infant deaths were belongs to the nQn Kuwaitis (38.7) followed by Beduwins/persons without nationality (31.8) and lastly the Kuwaitis (29.5). However the infant mortality rate is increased in the Kuwaititis including Bedwins/persons without nationality (24.0.1ive birth) compared to non-Kuwaitis (17.4olive births). 1. 7: Regarding the nationalities and residence it is observed that the Kuwaiti nationality have more infant deaths in HawaIi Governorate (40.6), also the non-Kuwaitis (64.8) while Bedwins/persons without nationality were concent ra ted in J ahra Governora te (71.0). These differences are signific 2 ant (XQ = 426.1, P < 0.001). 1.8 : There is strong inverse correlation between infant mortality rata & mother’s level of education (rs = -0.94, p < 0.010), and level of father’s education (rs ... -0.9, p < 0.01). 1.9: Studying the infant mortality rate and mother’s occupation shows that the lowest rate was found for clerical and sales workers (12.9. live births) and also professional, technical, administrative and managerial workers (l4.7.live births).However studying the infant mortality rate and futher’s occupation shows that the highest infant mortality rate was found when the father’s had no occupation (24.7. live births) followed by service workers, production and labours (23.7.live births). 1.10: There is a strong inverse correlation between infant mortality ~te and mother’s age under 27.5 years (r = -0.96). On the other hand there is a strong direct correlation between infant mortality rate and mother’s age 27.5 years and over (r ... 0.95). Also studying age of father and infant mortality rate showed a strong inverse correlation under 32.5 years (r = -0.99), and strong direct correl . ation between infant mortality from fathers age 32.5 years and over (r ... p. 95) . 1.11 : There is a strong inverse correlation between infant mortality rate and duration of marriage from 1-4 years (r = -0.999), on the other hand, there is a strong direct correlation between infant mortality and duration of marriage if it is a 5 years and over (r ... 0.82). 1.12 : The present work shows that there is a strong inverse correl~t!on between infant mortality rate and infants birth order from the first ~o tha fifth (r = -0.94). On the other hand there is a strong direct correlation between infant mortality rate and infants birth order from the fifth and over (r = 0.96). 1.13 : Place of death: most of the infant deaths had occured in the governmental hospitals (81.7). Infant deaths at home constituted 13.0 of total infant deaths. 1.14 : Analysis of cause of death according to the ten most important causes of death (by the three digit level ICD - 9, 1975), the study reve1aad that more than one fourth deaths (26.7) belonged to immaturity. Pneumonia and bronchopneumonia was responsible for 11.0 of deaths, gastroenteritis . and diarrhoea for 8.9 and congenital heart for 7.3 of deaths. (2) Case control study of important risk factors. 2.1 :Parent’s education: There is a significant statistical difference between the mothers of the two groups related to the level of their edu ’cations (x(2) ”” 22.49, signifiCan~ as regards father’s education x(2) 2 P < 0.001) and the differences are found to be also ”” 15.93, P < 0.001). 2.2 :Parent’s occupation: Studying mother’s occupation shows that the differences are statistically significant (x(2) 3 ”” 8.79, P< 0.005). Howevet for father occupation the differences (2) antx3 = 3.38, P>0.05) found to be statistically insignific 2.3 :Parent’s Age: The mean age of mothers was nearly the same between those who lost their infants & their controls (27.6 + 6.80 and 27.8 + 6.31 years respectively) where (t = 0.79, P>0.05). While the mean age of fath~ra who lost their infants in the infancy period was 34.7 :t 9.2 years as compared to 34.8 + 8.7 years for the control (t = 0.27 , P > 0.05). 2.4 ~Infant Birth order: There was a statistical difference between the birth order of mother who lost their infants and their controls. The pro ~rtion is raised in the first and the second birth order of the first grDup, from the sixth birth order and more the proportion is increased in the ~fant deaths compared to their controls (x(2) = 27.63, P < 0.001) 9 ’ 1 1 2.5 : .ccured , :Plurality of Birth: The study showed that more infant deaths from multiple pregnancies (6.2 as compared to their controls (2.3) . The differences are significant x (2) = 21.8, P <0.001). 1 2.6 :Duration of marriage: The mean duration of marriage for couples losing their infants was 7.68 t 5.93 years while that of controls was 7.82 t 5.66 years. No significant difference is observed between the 2 means ( t a 0.57, P>0.005). from these findings it can be concluded that, in Kuwait, neonatal mortality is much more important than mortality occured during the rest of the first year of life. And the most important causes of death (with high percent in early neonatal period) is immaturity and congenital abnormal i ties. Also the study clearly showed that the infant mortality tate Was higher among Kuwaiti including Bedwin/persons without nationality than among Non-Kuwai tis. Paternal factors as education, age and occupation had a significant relation to infant mortality. Case - control study clearly portray the effect of social and biologic~l factors on infant mortality by the statistical significant difference between index cases and control groups as regards father and mother’s edu cation, mother’s occupation, birth order and plurality of birth.