The sex gap in neonatal mortality and the AIDS epidemic in sub-Saharan Africa
Bibliographic record
Abstract
The sex gap in early-age death is one of the most important sources of child inequality in all societies, and it carries negative social consequences in the long run. In the absence of gender discrimination in the allocation of foods and heath resources, mortality rates are higher in boys than in girls.1–3 Recent studies however suggest that in sub-Saharan Africa, the general improvement in state capacity and the quality of political and democratic institutions has had stronger health benefits for boys, reducing the male-female gap in early-age mortality.4 5 Democratic indicators such as political participation, competitiveness in the recruitment of the executive and constraints on executive power substantially improved after 1990. These positive developments led to an improvement in the quality of public health institutions. Mabeu and Pongou’s research implies that the health benefits of these positive institutional changes have mostly accrued to boys, in part because these changes have helped constrain the negative influences of the male biological make-up on mortality.5 But this pattern was likely to be specific to HIV-unexposed children. Among HIV-exposed children, it seems that other forces were at play. In this editorial, we analyse trends in the sex gap in neonatal death—death occurring within 1 month of birth-during the era of the AIDS epidemic, and argue that they were sensitive to the availability of antiretroviral medicines. Child exposure to HIV (during pregnancy, delivery and breast feeding) reduced the female survival advantage, but this situation was gradually reversed by the availability of antiretroviral treatment. Our argument is partly captured in figure 1, which shows unadjusted trends in the probability of neonatal death over the period 1960–2017 for both boys and girls in sub-Saharan Africa. Neonatal mortality declined substantially over this period for both sexes. However, as figure 2 shows, the decline was …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.007 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".