Child survival in Beirut during wartime: time trends and socio-religious differentials.

BACKGROUND Child mortality estimates in Beirut are presented for the late 1970s and the mid 1980s, and changes in socio-religious differentials of mortality across time are investigated. METHODS Baseline information was obtained from maternity registries in Beirut in 1984 and 1991. Age of mother, number of children ever born and number of children alive, hospitalization class (1, 2 or 3 within each hospital, depending on the room rate, the services and the doctor's fees), and religion of newborn was recorded. Brass and Macrae's technique was used to convert the proportion dead among children ever born to mothers in age group 30-34 into 5q0 estimates for the reference periods 1978 (1984 data) and 1985 (1991 data). Using hospitalization class as a proxy for social class, religious differentials in child mortality were explored by logistic regression analysis within each period. RESULTS Overall, 5q0 is estimated at 46 per 1000 in the late 1970s, and at 36 per 1000 in the mid 1980s. The religious differentials in 5q0 mortality estimates were quite large in the former period, with a risk for Muslims relative to Christians of 1.53, which declined to 1.35 in the latter period. The regression analysis of the proportion dead among children ever born; (1) confirmed the magnitude of the religious differentials in child mortality, and their reduction over time; (2) demonstrated the existence of an interaction between religion and social class, as the religious differentials in child mortality were found to be highly prevalent in the lower social classes, and almost insignificant in the middle and upper ones; (3) highlighted the decisive role of differential fertility in generating differential child mortality, with higher fertility and higher child mortality in Muslims, and with the disappearance of religious differentials in child mortality after adjustment for fertility. CONCLUSION The findings confirm the hypothesis of a reduction over time of religious-based child mortality differences in the capital city of Lebanon, in agreement with the pattern found for religious-based fertility differences. Comparisons with other countries in the region indicate that the war in Lebanon has slowed down the decline in child mortality, causing the country to loose its priviledged position among Arab countries.