Poverty and infant mortality in the Eastern Mediterranean region: a meta-analysis

Objectives: To test the hypothesis that poverty is associated with infant mortality in Eastern Mediterranean countries and to measure the strength of the association. Methods: A bibliographic search was conducted. The studies including data regarding deaths during the first year of life, socioeconomic status of the household and/or maternal literacy were selected. Nine studies, conducted in the Eastern Mediterranean region, fulfilled the inclusion criteria. These included seven cross-sectional surveys and two case-control studies. Maternal illiteracy and low socioeconomic status were used to show the level of poverty in each household. Risk estimates for low socioeconomic status and maternal illiteracy were extracted from each study. Meta-analysis was performed for the association between exposure groups of low socioeconomic status and maternal illiteracy and the outcome of death within the first year of life. Main results: Poverty was associated with an increased risk of infant death ( pooled OR 1.52, 95% CI 1.38 to 1.67), significant at p < 0.0001. There was a significantly increased risk of infant death among illiterate mothers ( OR 1.72, 95% CI 1.42 to 2.08) compared with literate mothers. The metaanalysis OR for an association between low socioeconomic status subgroup and infant death was 1.37 ( 95% CI 1.25 to 1.49), significant at p < 0.0001. Conclusions: This meta- analysis indicates that there is a significantly increased mortality risk in infants born in poor households. The results suggest that policies aimed at poverty alleviation and female literacy will substantially contribute to a decrease in infant mortality.