Comparing estimates of child mortality reduction modelled in LiST with pregnancy history survey data for a community-based NGO project in Mozambique

PubMed Central

2011-01-01

Background There is a growing body of evidence that integrated packages of community-based interventions, a form of programming often implemented by NGOs, can have substantial child mortality impact. More countries may be able to meet Millennium Development Goal (MDG) 4 targets by leveraging such programming. Analysis of the mortality effect of this type of programming is hampered by the cost and complexity of direct mortality measurement. The Lives Saved Tool (LiST) produces an estimate of mortality reduction by modelling the mortality effect of changes in population coverage of individual child health interventions. However, few studies to date have compared the LiST estimates of mortality reduction with those produced by direct measurement. Methods Using results of a recent review of evidence for community-based child health programming, a search was conducted for NGO child health projects implementing community-based interventions that had independently verified child mortality reduction estimates, as well as population coverage data for modelling in LiST. One child survival project fit inclusion criteria. Subsequent searches of the USAID Development Experience Clearinghouse and Child Survival Grants databases and interviews of staff from NGOs identified no additional projects. Eight coverage indicators, covering all the project’s technical interventions were modelled in LiST, along with indicator values for most other non-project interventions in LiST, mainly from DHS data from 1997 and 2003. Results The project studied was implemented by World Relief from 1999 to 2003 in Gaza Province, Mozambique. An independent evaluation collecting pregnancy history data estimated that under-five mortality declined 37% and infant mortality 48%. Using project-collected coverage data, LiST produced estimates of 39% and 34% decline, respectively. Conclusions LiST gives reasonably accurate estimates of infant and child mortality decline in an area where a package of community-based interventions was implemented. This and other validation exercises support use of LiST as an aid for program planning to tailor packages of community-based interventions to the epidemiological context and for project evaluation. Such targeted planning and assessments will be useful to accelerate progress in reaching MDG4 targets. PMID:21501454

Population‐based survey methods to quantify associations between human rights violations and health outcomes among internally displaced persons in eastern Burma

PubMed Central

Mullany, Luke C; Richards, Adam K; Lee, Catherine I; Suwanvanichkij, Voravit; Maung, Cynthia; Mahn; Beyrer, Chris; Lee, Thomas J

2007-01-01

Background Case reports of human rights violations have focused on individuals' experiences. Population‐based quantification of associations between rights indicators and health outcomes is rare and has not been documented in eastern Burma. Objective We describe the association between mortality and morbidity and the household‐level experience of human rights violations among internally displaced persons in eastern Burma. Methods Mobile health workers in conflict zones of eastern Burma conducted 1834 retrospective household surveys in 2004. Workers recorded data on vital events, mid‐upper arm circumference of young children, malaria parasitaemia status of respondents and household experience of various human rights violations during the previous 12 months. Results Under‐5 mortality was 218 (95% confidence interval 135 to 301) per 1000 live births. Almost one‐third of households reported forced labour (32.6%). Forced displacement (8.9% of households) was associated with increased child mortality (odds ratio = 2.80), child malnutrition (odds ratio = 3.22) and landmine injury (odds ratio = 3.89). Theft or destruction of the food supply (reported by 25.2% of households) was associated with increased crude mortality (odds ratio = 1.58), malaria parasitaemia (odds ratio = 1.82), child malnutrition (odds ratio = 1.94) and landmine injury (odds ratio = 4.55). Multiple rights violations (14.4% of households) increased the risk of child (incidence rate ratio = 2.18) and crude (incidence rate ratio = 1.75) mortality and the odds of landmine injury (odds ratio = 19.8). Child mortality risk was increased more than fivefold (incidence rate ratio = 5.23) among families reporting three or more rights violations. Conclusions Widespread human rights violations in conflict zones in eastern Burma are associated with significantly increased morbidity and mortality. Population‐level associations can be quantified using standard epidemiological methods. This approach requires further validation and refinement elsewhere. PMID:17873229

Consequences of household air pollution on child survival: evidence from demographic and health surveys in 47 countries

PubMed Central

Patel, Archana B.; Borkar, Jitesh A.; Hibberd, Patricia L.

2015-01-01

Background: Over one-third of the world’s population is exposed to household air pollution (HAP) but the separate effects of cooking with solid fuel and kerosene on childhood mortality are unclear. Objectives: To evaluate the effects of both solid fuels and kerosene on neonatal (0-28 days) and child (29 days-59 months) mortality. Methods: We used Demographic and Health Surveys from 47 countries and calculated adjusted relative risks (aRR) using Poisson regression models. Results: The aRR of neonatal and child mortality in households exposed to solid fuels were 1.24 (95% CI: 1.14, 1.34) and 1.21 (95% CI: 1.12, 1.30), respectively, and the aRR for neonatal and child mortality in households exposed to kerosene were 1.34 (95% CI: 1.18, 1.52) and 1.12 (95% CI: 0.99, 1.27), controlling for individual, household, and country-level predictors of mortality. Conclusions: Kerosene should not be classified as a clean fuel. Neonates are at risk for mortality from exposure to solid fuels and kerosene. PMID:25843087

Statistical Analysis of Factors Affecting Child Mortality in Pakistan.

PubMed

Ahmed, Zoya; Kamal, Asifa; Kamal, Asma

2016-06-01

Child mortality is a composite indicator reflecting economic, social, environmental, healthcare services, and their delivery situation in a country. Globally, Pakistan has the third highest burden of fetal, maternal, and child mortality. Factors affecting child mortality in Pakistan are investigated by using Binary Logistic Regression Analysis. Region, education of mother, birth order, preceding birth interval (the period between the previous child birth and the index child birth), size of child at birth, and breastfeeding and family size were found to be significantly important with child mortality in Pakistan. Child mortality decreased as level of mother's education, preceding birth interval, size of child at birth, and family size increased. Child mortality was found to be significantly higher in Balochistan as compared to other regions. Child mortality was low for low birth orders. Child survival was significantly higher for children who were breastfed as compared to those who were not.

Trends and determinants of infant and under-five childhood mortality in Vietnam, 1986-2011.

PubMed

Lee, Hwa-Young; Van Do, Dung; Choi, Sugy; Trinh, Oanh Thi Hoang; To, Kien Gia

2016-01-01

Although Vietnam has taken great efforts to reduce child mortality in recent years, a large number of children still die at early age. Only a few studies have been conducted to identify at-risk groups in order to provide baseline information for effective interventions. The study estimated the overall trends in infant mortality rate (IMR) and under-five mortality rate (U5MR) during 1986-2011 and identified demographic and socioeconomic determinants of child mortality. Data from the Vietnam Multiple Indicator Cluster Surveys (MICSs) in 2000 (MICS2), 2006 (MICS3) and 2011 (MICS4) were analysed. The IMR and U5MR were calculated using the indirect method developed by William Brass. Unadjusted and adjusted odds ratios were estimated to assess the association between child death and demographic and socioeconomic variables. Region-stratified stepwise logistic regression was conducted to test the sensitivity of the results. The IMR and U5MR significantly decreased for both male and female children between 1986 and 2010. Male children had higher IMR and U5MR compared with females in all 3 years. Women who were living in the Northern Midlands and Mountain areas were more likely to experience child deaths compared with women who were living in the Red River Delta. Women who were from minor ethnic groups, had low education, living in urban areas, and had multiple children were more likely to have experienced child deaths. Baby boys require more healthcare attention during the first year of their life. Comprehensive strategies are necessary for tackling child mortality problems in Vietnam. This study shows that child mortality is not just a problem of poverty but involves many other factors. Further studies are needed to investigate pathways underlying associations between demographic and socioeconomic conditions and childhood mortality.

Under-five mortality among mothers employed in agriculture: findings from a nationally representative sample.

PubMed

Singh, Rajvir; Tripathi, Vrijesh

2015-01-01

Background. India accounts for 24% to all under-five mortality in the world. Residence in rural area, poverty and low levels of mother's education are known confounders of under-five mortality. Since two-thirds of India's population lives in rural areas, mothers employed in agriculture present a particularly vulnerable population in the Indian context and it is imperative that concerns of this sizeable population are addressed in order to achieve MDG4 targets of reducing U5MR to fewer than 41 per 1,000 by 2015. This study was conducted to examine factors associated with under-five mortality among mothers employed in agriculture. Methods. Data was retrieved from National Family Household Survey-3 in India (2008). The study population is comprised of a national representative sample of single children aged 0 to 59 months and born to mothers aged 15 to 49 years employed in agriculture from all 29 states of India. Univariate and Multivariate Cox PH regression analysis was used to analyse the Hazard Rates of mortality. The predictive power of child mortality among mothers employed in agriculture was assessed by calculating the area under the receiver operating characteristic (ROC) curve. Results. An increase in mothers' ages corresponds with a decrease in child mortality. Breastfeeding reduces child mortality by 70% (HR 0.30, 0.25-0.35, p = 0.001). Standard of Living reduces child mortality by 32% with high standard of living (HR 0.68, 0.52-0.89, 0.001) in comparison to low standard of living. Prenatal care (HR 0.40, 0.34-0.48, p = 0.001) and breastfeeding health nutrition education (HR 0.45, 0.31-0.66, p = 0.001) are associated significant factors for child mortality. Birth Order five is a risk factor for mortality (HR 1.49, 1.05-2.10, p = 0.04) in comparison to Birth Order one among women engaged in agriculture while the household size (6-10 members and ≥ 11 members) is significant in reducing child mortality in comparison to ≤5 members in the house. Under-five mortality among mothers employed in agriculture in India discriminated well between death and survival (Area Under ROC was 0.75, 95% CI [0.73-0.77]) indicating that the model is good for appropriate prediction of child mortality. Conclusion. In a nationally representative sample of households in India, mother's age, breastfeeding, standard of living, prenatal care and breastfeeding health nutrition education are associated with reduction in child mortality.

South African child deaths 1990–2011: have HIV services reversed the trend enough to meet Millennium Development Goal 4?

PubMed Central

Kerber, Kate J.; Lawn, Joy E.; Johnson, Leigh F.; Mahy, Mary; Dorrington, Rob E.; Phillips, Heston; Bradshaw, Debbie; Nannan, Nadine; Msemburi, William; Oestergaard, Mikkel Z.; Walker, Neff P.; Sanders, David; Jackson, Debra

2013-01-01

Objective: To analyse trends in under-five mortality rate in South Africa (1990–2011), particularly the contribution of AIDS deaths. Methods: Three nationally used models for estimating AIDS deaths in children were systematically reviewed. The model outputs were compared with under-five mortality rate estimates for South Africa from two global estimation models. All estimates were compared with available empirical data. Results: Differences between the models resulted in varying point estimates for under-five mortality but the trends were similar, with mortality increasing to a peak around 2005. The three models showing the contribution of AIDS suggest a maximum of 37–39% of child deaths were due to AIDS in 2004–2005 which has since declined. Although the rate of progress from 1990 is not the 4.4% needed to meet Millennium Development Goal 4 for child survival, South Africa's average annual rate of under-five mortality decline between 2006 and 2011 was between 6.3 and 10.2%. Conclusion: In 2005, South Africa was one of only four countries globally with an under-five mortality rate higher than the 1990 Millennium Development Goal baseline. Over the past 5 years, the country has achieved a rate of child mortality reduction exceeded by only three other countries. This rapid turnaround is likely due to scale-up of prevention of mother-to-child transmission of HIV, and to a lesser degree, the expanded roll-out of antiretroviral therapy. Emphasis on these programmes must continue, but failure to address other aspects of care including integrated high-quality maternal and neonatal care means that the decline in child mortality could stall. PMID:23863402

Application of random survival forests in understanding the determinants of under-five child mortality in Uganda in the presence of covariates that satisfy the proportional and non-proportional hazards assumption.

PubMed

Nasejje, Justine B; Mwambi, Henry

2017-09-07

Uganda just like any other Sub-Saharan African country, has a high under-five child mortality rate. To inform policy on intervention strategies, sound statistical methods are required to critically identify factors strongly associated with under-five child mortality rates. The Cox proportional hazards model has been a common choice in analysing data to understand factors strongly associated with high child mortality rates taking age as the time-to-event variable. However, due to its restrictive proportional hazards (PH) assumption, some covariates of interest which do not satisfy the assumption are often excluded in the analysis to avoid mis-specifying the model. Otherwise using covariates that clearly violate the assumption would mean invalid results. Survival trees and random survival forests are increasingly becoming popular in analysing survival data particularly in the case of large survey data and could be attractive alternatives to models with the restrictive PH assumption. In this article, we adopt random survival forests which have never been used in understanding factors affecting under-five child mortality rates in Uganda using Demographic and Health Survey data. Thus the first part of the analysis is based on the use of the classical Cox PH model and the second part of the analysis is based on the use of random survival forests in the presence of covariates that do not necessarily satisfy the PH assumption. Random survival forests and the Cox proportional hazards model agree that the sex of the household head, sex of the child, number of births in the past 1 year are strongly associated to under-five child mortality in Uganda given all the three covariates satisfy the PH assumption. Random survival forests further demonstrated that covariates that were originally excluded from the earlier analysis due to violation of the PH assumption were important in explaining under-five child mortality rates. These covariates include the number of children under the age of five in a household, number of births in the past 5 years, wealth index, total number of children ever born and the child's birth order. The results further indicated that the predictive performance for random survival forests built using covariates including those that violate the PH assumption was higher than that for random survival forests built using only covariates that satisfy the PH assumption. Random survival forests are appealing methods in analysing public health data to understand factors strongly associated with under-five child mortality rates especially in the presence of covariates that violate the proportional hazards assumption.

[Estimation of infant and child mortality in the eastern provinces of Cuba].

PubMed

Gonzalez, G; Herrera, L

1986-01-01

An estimate of infant and child mortality in the eastern provinces of Cuba is presented using the Brass method as adapted by Trussell. "Estimations by urban and rural zones are also performed within the provinces studied, and results are compared with those possible to obtain by continuous statistics. Results obtained show that in the eastern [part] of the country Holguin and Guantanamo are the provinces with highest infantile mortality rates, and the lowest rates correspond to Granma, followed by Santiago de Cuba." (SUMMARY IN ENG AND FRE) excerpt

Progress towards the child mortality millennium development goal in urban sub-Saharan Africa: the dynamics of population growth, immunization, and access to clean water.

PubMed

Fotso, Jean-Christophe; Ezeh, Alex Chika; Madise, Nyovani Janet; Ciera, James

2007-08-28

Improvements in child survival have been very poor in sub-Saharan Africa (SSA). Since the 1990 s, declines in child mortality have reversed in many countries in the region, while in others, they have either slowed or stalled, making it improbable that the target of reducing child mortality by two thirds by 2015 will be reached. This paper highlights the implications of urban population growth and access to health and social services on progress in achieving MDG 4. Specifically, it examines trends in childhood mortality in SSA in relation to urban population growth, vaccination coverage and access to safe drinking water. Correlation methods are used to analyze national-level data from the Demographic and Health Surveys and from the United Nations. The analysis is complemented by case studies on intra-urban health differences in Kenya and Zambia. Only five of the 22 countries included in the study have recorded declines in urban child mortality that are in line with the MDG target of about 4% per year; five others have recorded an increase; and the 12 remaining countries witnessed only minimal decline. More rapid rate of urban population growth is associated with negative trend in access to safe drinking water and in vaccination coverage, and ultimately to increasing or timid declines in child mortality. There is evidence of intra-urban disparities in child health in some countries like Kenya and Zambia. Failing to appropriately target the growing sub-group of the urban poor and improve their living conditions and health status - which is an MDG target itself - may result in lack of improvement on national indicators of health. Sustained expansion of potable water supplies and vaccination coverage among the disadvantaged urban dwellers should be given priority in the efforts to achieve the child mortality MDG in SSA.

Trends and determinants of infant and under-five childhood mortality in Vietnam, 1986–2011

PubMed Central

Lee, Hwa-Young; Van Do, Dung; Choi, Sugy; Trinh, Oanh Thi Hoang; To, Kien Gia

2016-01-01

Background Although Vietnam has taken great efforts to reduce child mortality in recent years, a large number of children still die at early age. Only a few studies have been conducted to identify at-risk groups in order to provide baseline information for effective interventions. Objective The study estimated the overall trends in infant mortality rate (IMR) and under-five mortality rate (U5MR) during 1986–2011 and identified demographic and socioeconomic determinants of child mortality. Design Data from the Vietnam Multiple Indicator Cluster Surveys (MICSs) in 2000 (MICS2), 2006 (MICS3) and 2011 (MICS4) were analysed. The IMR and U5MR were calculated using the indirect method developed by William Brass. Unadjusted and adjusted odds ratios were estimated to assess the association between child death and demographic and socioeconomic variables. Region-stratified stepwise logistic regression was conducted to test the sensitivity of the results. Results The IMR and U5MR significantly decreased for both male and female children between 1986 and 2010. Male children had higher IMR and U5MR compared with females in all 3 years. Women who were living in the Northern Midlands and Mountain areas were more likely to experience child deaths compared with women who were living in the Red River Delta. Women who were from minor ethnic groups, had low education, living in urban areas, and had multiple children were more likely to have experienced child deaths. Conclusion Baby boys require more healthcare attention during the first year of their life. Comprehensive strategies are necessary for tackling child mortality problems in Vietnam. This study shows that child mortality is not just a problem of poverty but involves many other factors. Further studies are needed to investigate pathways underlying associations between demographic and socioeconomic conditions and childhood mortality. PMID:26950560

Effect of Governance Indicators on Under-Five Mortality in OECD Nations: Generalized Method of Moments.

PubMed

Emamgholipour, Sara; Asemane, Zahra

2016-01-01

Today, it is recognized that factors other than health services are involved in health improvement and decreased inequality so identifying them is the main concern of policy makers and health authorities. The aim of this study was to investigate the effect of governance indicators on health outcomes. A panel data study was conducted to investigate the effect of governance indicators on child mortality rate in 27 OECD countries from 1996 to 2012 using the Generalized Method of Moments (GMM) model and EVIEWS.8 software. According to the results obtained, under-five mortality rate was significantly related to all of the research variables (p < 0.05). One percent increase in under-five mortality in the previous period resulted in a 0.83% increase in the mortality rate in the next period, and a 1% increase in total fertility rate, increased the under-five mortality rate by 0.09%. In addition, a 1% increase in GDP per capita decreased the under-five mortality rate by 0.07%, and a 1% improvement in control of corruption and rule of law indicators decreased child mortality rate by 0.05 and 0.08%, respectively. Furthermore, 1% increase in public health expenditure per capita resulted in a 0.03% decrease in under-five mortality rate. The results of the study suggest that considering control variables, including GDP per capita, public health expenditure per capita, total fertility rate, and improvement of governance indicators (control of corruption and rule of law) would decrease the child mortality rate.

The Health Impact of Child Labor in Developing Countries: Evidence From Cross-Country Data

PubMed Central

Roggero, Paola; Mangiaterra, Viviana; Bustreo, Flavia; Rosati, Furio

2007-01-01

Objectives. Research on child labor and its effect on health has been limited. We sought to determine the impact of child labor on children’s health by correlating existing health indicators with the prevalence of child labor in selected developing countries. Methods. We analyzed the relationship between child labor (defined as the percentage of children aged 10 to14 years who were workers) and selected health indicators in 83 countries using multiple regression to determine the nature and strength of the relation. The regression included control variables such as the percentage of the population below the poverty line and the adult mortality rate. Results. Child labor was significantly and positively related to adolescent mortality, to a population’s nutrition level, and to the presence of infectious disease. Conclusions. Longitudinal studies are required to understand the short- and long-term health effects of child labor on the individual child. PMID:17194870

Indirect child mortality estimation technique to identify trends of under-five mortality in Ethiopia.

PubMed

Ayele, Dawit G; Zewotir, Temesgen; Mwambi, Henry

2016-03-01

In sub-Saharan African countries, the chance of a child dying before the age of five years is high. The problem is similar in Ethiopia, but it shows a decrease over years. The 2000; 2005 and 2011 Ethiopian Demographic and Health Survey results were used for this work. The purpose of the study is to detect the pattern of under-five child mortality overtime. Indirect child mortality estimation technique is adapted to examine the under-five child mortality trend in Ethiopia. From the result, it was possible to see the trend of under-five child mortality in Ethiopia. The under-five child mortality shows a decline in Ethiopia. From the study, it can be seen that there is a positive correlation between mother and child survival which is almost certain in any population. Therefore, this study shows the trend of under-five mortality in Ethiopia and decline over time.

Disparities in child health in the Arab region during the 1990s

PubMed Central

Khawaja, Marwan; Dawns, Jesse; Meyerson-Knox, Sonya; Yamout, Rouham

2008-01-01

Background While Arab countries showed an impressive decline in child mortality rates during the past few decades, gaps in mortality by gender and socioeconomic status persisted. However, large socioeconomic disparities in child health were evident in almost every country in the region. Methods Using available tabulations and reliable micro data from national household surveys, data for 18 Arab countries were available for analysis. In addition to infant and child mortality, child health was measured by nutritional status, vaccination, and Acute Respiratory Infection (ARI). Within-country disparities in child health by gender, residence (urban/rural) and maternal educational level were described. Child health was also analyzed by macro measures of development, including per capita GDP (PPP), female literacy rates, urban population and doctors per 100,000 people. Results Gender disparities in child health using the above indicators were less evident, with most showing clear female advantage. With the exception of infant and child survival, gender disparities demonstrated a female advantage, as well as a large urban advantage and an overall advantage for mothers with secondary education. Surprisingly, the countries' rankings with respect to disparities were not associated with various macro measures of development. Conclusion The tenacity of pervasive intra-country socioeconomic disparities in child health calls for attention by policy makers and health practitioners. PMID:19021903

Trends and social differentials in child mortality in Rwanda 1990–2010: results from three demographic and health surveys

PubMed Central

Musafili, Aimable; Essén, Birgitta; Baribwira, Cyprien; Binagwaho, Agnes; Persson, Lars-Åke; Selling, Katarina Ekholm

2015-01-01

Background Rwanda has embarked on ambitious programmes to provide equitable health services and reduce mortality in childhood. Evidence from other countries indicates that advances in child survival often have come at the expense of increasing inequity. Our aims were to analyse trends and social differentials in mortality before the age of 5 years in Rwanda from 1990 to 2010. Methods We performed secondary analyses of data from three Demographic and Health Surveys conducted in 2000, 2005 and 2010 in Rwanda. These surveys included 34 790 children born between 1990 and 2010 to women aged 15–49 years. The main outcome measures were neonatal mortality rates (NMR) and under-5 mortality rates (U5MR) over time, and in relation to mother's educational level, urban or rural residence and household wealth. Generalised linear mixed effects models and a mixed effects Cox model (frailty model) were used, with adjustments for confounders and cluster sampling method. Results Mortality rates in Rwanda peaked in 1994 at the time of the genocide (NMR 60/1000 live births, 95% CI 51 to 65; U5MR 238/1000 live births, 95% CI 226 to 251). The 1990s and the first half of the 2000s were characterised by a marked rural/urban divide and inequity in child survival between maternal groups with different levels of education. Towards the end of the study period (2005–2010) NMR had been reduced to 26/1000 (95% CI 23 to 29) and U5MR to 65/1000 (95% CI 61 to 70), with little or no difference between urban and rural areas, and household wealth groups, while children of women with no education still had significantly higher U5MR. Conclusions Recent reductions in child mortality in Rwanda have concurred with improved social equity in child survival. Current challenges include the prevention of newborn deaths. PMID:25870163

Direct estimates of national neonatal and child cause–specific mortality proportions in Niger by expert algorithm and physician–coded analysis of verbal autopsy interviews

PubMed Central

Kalter, Henry D.; Roubanatou, Abdoulaye–Mamadou; Koffi, Alain; Black, Robert E.

2015-01-01

Background This study was one of a set of verbal autopsy investigations undertaken by the WHO/UNCEF–supported Child Health Epidemiology Reference Group (CHERG) to derive direct estimates of the causes of neonatal and child deaths in high priority countries of sub–Saharan Africa. The objective of the study was to determine the cause distributions of neonatal (0–27 days) and child (1–59 months) mortality in Niger. Methods Verbal autopsy interviews were conducted of random samples of 453 neonatal deaths and 620 child deaths from 2007 to 2010 identified by the 2011 Niger National Mortality Survey. The cause of each death was assigned using two methods: computerized expert algorithms arranged in a hierarchy and physician completion of a death certificate for each child. The findings of the two methods were compared to each other, and plausibility checks were conducted to assess which is the preferred method. Comparison of some direct measures from this study with CHERG modeled cause of death estimates are discussed. Findings The cause distributions of neonatal deaths as determined by expert algorithms and the physician were similar, with the same top three causes by both methods and all but two other causes within one rank of each other. Although child causes of death differed more, the reasons often could be discerned by analyzing algorithmic criteria alongside the physician’s application of required minimal diagnostic criteria. Including all algorithmic (primary and co–morbid) and physician (direct, underlying and contributing) diagnoses in the comparison minimized the differences, with kappa coefficients greater than 0.40 for five of 11 neonatal diagnoses and nine of 13 child diagnoses. By algorithmic diagnosis, early onset neonatal infection was significantly associated (χ2 = 13.2, P < 0.001) with maternal infection, and the geographic distribution of child meningitis deaths closely corresponded with that for meningitis surveillance cases and deaths. Conclusions Verbal autopsy conducted in the context of a national mortality survey can provide useful estimates of the cause distributions of neonatal and child deaths. While the current study found reasonable agreement between the expert algorithm and physician analyses, it also demonstrated greater plausibility for two algorithmic diagnoses and validation work is needed to ascertain the findings. Direct, large–scale measurement of causes of death complement, can strengthen, and in some settings may be preferred over modeled estimates. PMID:25969734

Low infant mortality among Palestine refugees despite the odds

PubMed Central

Khader, Ali; Sabatinelli, Guido

2011-01-01

Abstract Objective To present data from a 2008 infant mortality survey conducted in Jordan, Lebanon, the Syrian Arab Republic, the Gaza Strip and the West Bank and analyse infant mortality trends among Palestine refugees in 1995–2005. Methods Following the preceding birth technique, mothers who were registering a new birth were asked if the preceding child was alive or dead, the day the child was born and the date of birth of the neonate whose birth was being registered. From this information, neonatal, infant and early child mortality rates were estimated. The age at death for early child mortality was determined by the mean interval between successive births and the mean age of neonates at registration. Findings In 2005–2006, infant mortality among Palestine refugees ranged from 28 deaths per 100 000 live births in the Syrian Arab Republic to 19 in Lebanon. Thus, infant mortality in Palestine refugees is among the lowest in the Near East. However, infant mortality has stopped decreasing in recent years, although it remains at a level compatible with the attainment of Millennium Development Goal 4. Conclusion Largely owing to the primary health care provided by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East and other entities, infant mortality among Palestine refugees had consistently decreased. However, it is no longer dropping. Measures to address the most likely reasons – early marriage and childbearing, poor socioeconomic conditions and limited access to good perinatal care – are needed. PMID:21479095

Causes of child mortality (1 to 4 years of age) from 1983 to 2012 in the Republic of Korea: national vital data.

PubMed

Choe, Seung Ah; Cho, Sung-Il

2014-11-01

Child mortality remains a critical problem even in developed countries due to low fertility. To plan effective interventions, investigation into the trends and causes of child mortality is necessary. Therefore, we analyzed these trends and causes of child deaths over the last 30 years in Korea. Causes of death data were obtained from a nationwide vital registration managed by the Korean Statistical Information Service. The mortality rate among all children aged between one and four years and the causes of deaths were reviewed. Data from 1983-2012 and 1993-2012 were analyzed separately because the proportion of unspecified causes of death during 1983-1992 varied substantially from that during 1993-2012. The child (1-4 years) mortality rates substantially decreased during the past three decades. The trend analysis revealed that all the five major causes of death (infectious, neoplastic, neurologic, congenital, and external origins) have decreased significantly. However, the sex ratio of child mortality (boys to girls) slightly increased during the last 30 years. External causes of death remain the most frequent origin of child mortality, and the proportion of mortality due to child assault has significantly increased (from 1.02 in 1983 to 1.38 in 2012). In Korea, the major causes and rate of child mortality have changed and the sex ratio of child mortality has slightly increased since the early 1980s. Child mortality, especially due to preventable causes, requires public health intervention.

Parental incarceration and child mortality in Denmark.

PubMed

Wildeman, Christopher; Andersen, Signe Hald; Lee, Hedwig; Karlson, Kristian Bernt

2014-03-01

We used Danish registry data to examine the association between parental incarceration and child mortality risk. We used a sample of all Danish children born in 1991 linked with parental information. We conducted discrete-time survival analysis separately for boys (n = 30 146) and girls (n = 28 702) to estimate the association of paternal and maternal incarceration with child mortality, controlling for parental sociodemographic characteristics. We followed the children until age 20 years or death, whichever came first. Results indicated a positive association between paternal and maternal imprisonment and male child mortality. Paternal imprisonment was associated with lower child mortality risks for girls. The relationship between maternal imprisonment and female child mortality changed directions depending on the model, suggesting no clear association. These results indicate that the incarceration of a parent may influence child mortality but that it is important to consider the gender of both the child and the incarcerated parent.

Impact of multisectoral health determinants on child mortality 1980-2010: An analysis by country baseline mortality.

PubMed

Cohen, Robert L; Murray, John; Jack, Susan; Arscott-Mills, Sharon; Verardi, Vincenzo

2017-01-01

Some health determinants require relatively stronger health system capacity and socioeconomic development than others to impact child mortality. Few quantitative analyses have analyzed how the impact of health determinants varies by mortality level. 149 low- and middle-income countries were stratified into high, moderate, low, and very low baseline levels of child mortality in 1990. Data for 52 health determinants were collected for these countries for 1980-2010. To quantify how changes in health determinants were associated with mortality decline, univariable and multivariable regression models were constructed. An advanced statistical technique that is new for child mortality analyses-MM-estimation with first differences and country clustering-controlled for outliers, fixed effects, and variation across decades. Some health determinants (immunizations, education) were consistently associated with child mortality reduction across all mortality levels. Others (staff availability, skilled birth attendance, fertility, water and sanitation) were associated with child mortality reduction mainly in low or very low mortality settings. The findings indicate that the impact of some health determinants on child mortality was only apparent with stronger health systems, public infrastructure and levels of socioeconomic development, whereas the impact of other determinants was apparent at all stages of development. Multisectoral progress was essential to mortality reduction at all baseline mortality levels. Policy-makers can use such analyses to direct investments in health and non-health sectors and to set five-year child mortality targets appropriate for their baseline mortality levels and local context.

Non-specific effect of measles vaccination on overall child mortality in an area of rural India with high vaccination coverage: a population-based case-control study.

PubMed Central

Kabir, Zubair; Long, Jean; Reddaiah, Vankadara P.; Kevany, John; Kapoor, Suresh K.

2003-01-01

OBJECTIVE: To determine whether vaccination against measles in a population with sustained high vaccination coverage and relatively low child mortality reduces overall child mortality. METHODS: In April and May 2000, a population-based, case-control study was conducted at Ballabgarh (an area in rural northern India). Eligible cases were 330 children born between 1 January 1991 and 31 December 1998 who died aged 12-59 months. A programme was used to match 320 controls for age, sex, family size, and area of residence from a birth cohort of 15 578 born during the same time period. FINDINGS: The analysis used 318 matched pairs and suggested that children aged 12-59 months who did not receive measles vaccination in infancy were three times more likely to die than those vaccinated against measles. Children from lower caste households who were not vaccinated in infancy had the highest risk of mortality (odds ratio, 8.9). A 27% increase in child mortality was attributable to failure to vaccinate against measles in the study population. CONCLUSION: Measles vaccine seems to have a non-specific reducing effect on overall child mortality in this population. If true, children in lower castes may reap the greatest gains in survival. The findings should be interpreted with caution because the nutritional status of the children was not recorded and may be a residual confounder. "All-cause mortality" is a potentially useful epidemiological endpoint for future vaccine trials. PMID:12764490

Level, trends and differentials of infant and child mortality in Yemen.

PubMed

Suchindran, C M; Adlakha, A L

1985-12-01

This study investigates the levels, trends and differentials of infant and child mortality in Yemen. The data used are from the 1979 Yemen Fertility Survey, part of the World Fertility Survey. Mortality rates for 4 age intervals of life are presented: neonatal, postnatal, infant and child. For the birth cohort immediately preceding the survey (1976 1978), the level of infant mortality was estimated as 157/1000 for both sexes and 163 for males and 145 for females. For the birth cohort 1971 1975, the level of child mortality was 95/1000 for both sexes, 78 for males and 112 for females. Analysis of time trends in mortality for the years from 1961 to 1978 indicated substantial declines in neonatal, postneonatal, infant and child mortality. Neonatal mortality declined by almost 33%, and postneonatal mortality by almost 43%. During 1961-1975, child mortality declined by about 39%. A persistent pattern of mortality differentials by sex was found in the data. For all birth cohorts between 1961 and 1978, male neonatal and postneonatal mortality exceeded female neonatal mortality, but male childhood mortality was less than corresponding female mortality. This pattern suggests preferential care and treatment of male offspring. Estimates of infant and child mortality showed considerable regional differences. The eastern region experienced considerably lower risk of infant and childhood mortality than other regions. Breastfeeders aged 1-5 experienced lower mortality rates than nonbreastfeeders. Multivariate analysis with a logistic regression model show the net effect of demographic and socioeconomic factors on mortality.

Potential confounding in the association between short birth intervals and increased neonatal, infant, and child mortality

PubMed Central

Perin, Jamie; Walker, Neff

2015-01-01

Background Recent steep declines in child mortality have been attributed in part to increased use of contraceptives and the resulting change in fertility behaviour, including an increase in the time between births. Previous observational studies have documented strong associations between short birth spacing and an increase in the risk of neonatal, infant, and under-five mortality, compared to births with longer preceding birth intervals. In this analysis, we compare two methods to estimate the association between short birth intervals and mortality risk to better inform modelling efforts linking family planning and mortality in children. Objectives Our goal was to estimate the mortality risk for neonates, infants, and young children by preceding birth space using household survey data, controlling for mother-level factors and to compare the results to those from previous analyses with survey data. Design We assessed the potential for confounding when estimating the relative mortality risk by preceding birth interval and estimated mortality risk by birth interval in four categories: less than 18 months, 18–23 months, 24–35 months, and 36 months or longer. We estimated the relative risks among women who were 35 and older at the time of the survey with two methods: in a Cox proportional hazards regression adjusting for potential confounders and also by stratifying Cox regression by mother, to control for all factors that remain constant over a woman's childbearing years. We estimated the overall effects for birth spacing in a meta-analysis with random survey effects. Results We identified several factors known for their associations with neonatal, infant, and child mortality that are also associated with preceding birth interval. When estimating the effect of birth spacing on mortality, we found that regression adjustment for these factors does not substantially change the risk ratio for short birth intervals compared to an unadjusted mortality ratio. For birth intervals less than 18 months, standard regression adjustment for confounding factors estimated a risk ratio for neonatal mortality of 2.28 (95% confidence interval: 2.18–2.37). This same effect estimated within mother is 1.57 (95% confidence interval: 1.52–1.63), a decline of almost one-third in the effect on neonatal mortality. Conclusions Neonatal, infant, and child mortality are strongly and significantly related to preceding birth interval, where births within a short interval of time after the previous birth have increased mortality. Previous analyses have demonstrated this relationship on average across all births; however, women who have short spaces between births are different from women with long spaces. Among women 35 years and older where a comparison of birth spaces within mother is possible, we find a much reduced although still significant effect of short birth spaces on child mortality. PMID:26562139

Potential confounding in the association between short birth intervals and increased neonatal, infant, and child mortality.

PubMed

Perin, Jamie; Walker, Neff

2015-01-01

Recent steep declines in child mortality have been attributed in part to increased use of contraceptives and the resulting change in fertility behaviour, including an increase in the time between births. Previous observational studies have documented strong associations between short birth spacing and an increase in the risk of neonatal, infant, and under-five mortality, compared to births with longer preceding birth intervals. In this analysis, we compare two methods to estimate the association between short birth intervals and mortality risk to better inform modelling efforts linking family planning and mortality in children. Our goal was to estimate the mortality risk for neonates, infants, and young children by preceding birth space using household survey data, controlling for mother-level factors and to compare the results to those from previous analyses with survey data. We assessed the potential for confounding when estimating the relative mortality risk by preceding birth interval and estimated mortality risk by birth interval in four categories: less than 18 months, 18-23 months, 24-35 months, and 36 months or longer. We estimated the relative risks among women who were 35 and older at the time of the survey with two methods: in a Cox proportional hazards regression adjusting for potential confounders and also by stratifying Cox regression by mother, to control for all factors that remain constant over a woman's childbearing years. We estimated the overall effects for birth spacing in a meta-analysis with random survey effects. We identified several factors known for their associations with neonatal, infant, and child mortality that are also associated with preceding birth interval. When estimating the effect of birth spacing on mortality, we found that regression adjustment for these factors does not substantially change the risk ratio for short birth intervals compared to an unadjusted mortality ratio. For birth intervals less than 18 months, standard regression adjustment for confounding factors estimated a risk ratio for neonatal mortality of 2.28 (95% confidence interval: 2.18-2.37). This same effect estimated within mother is 1.57 (95% confidence interval: 1.52-1.63), a decline of almost one-third in the effect on neonatal mortality. Neonatal, infant, and child mortality are strongly and significantly related to preceding birth interval, where births within a short interval of time after the previous birth have increased mortality. Previous analyses have demonstrated this relationship on average across all births; however, women who have short spaces between births are different from women with long spaces. Among women 35 years and older where a comparison of birth spaces within mother is possible, we find a much reduced although still significant effect of short birth spaces on child mortality.

Child mortality from solid-fuel use in India: a nationally-representative case-control study

PubMed Central

2010-01-01

Background Most households in low and middle income countries, including in India, use solid fuels (coal/coke/lignite, firewood, dung, and crop residue) for cooking and heating. Such fuels increase child mortality, chiefly from acute respiratory infection. There are, however, few direct estimates of the impact of solid fuel on child mortality in India. Methods We compared household solid fuel use in 1998 between 6790 child deaths, from all causes, in the previous year and 609 601 living children living in 1.1 million nationally-representative homes in India. Analyses were stratified by child's gender, age (neonatal, post-neonatal, 1-4 years) and colder versus warmer states. We also examined the association of solid fuel to non-fatal pneumonias. Results Solid fuel use was very common (87% in households with child deaths and 77% in households with living children). After adjustment for demographic factors and living conditions, solid-fuel use significantly increase child deaths at ages 1-4 (prevalence ratio (PR) boys: 1.30, 95%CI 1.08-1.56; girls: 1.33, 95%CI 1.12-1.58). More girls than boys died from exposure to solid fuels. Solid fuel use was also associated with non-fatal pneumonia (boys: PR 1.54 95%CI 1.01-2.35; girls: PR 1.94 95%CI 1.13-3.33). Conclusions Child mortality risks, from all causes, due to solid fuel exposure were lower than previously, but as exposure was common solid, fuel caused 6% of all deaths at ages 0-4, 20% of deaths at ages 1-4 or 128 000 child deaths in India in 2004. Solid fuel use has declined only modestly in the last decade. Aside from reducing exposure, complementary strategies such as immunization and treatment could also reduce child mortality from acute respiratory infections. PMID:20716354

Determinants of child mortality in LDCs: empirical findings from demographic and health surveys.

PubMed

Wang, Limin

2003-09-01

Empirical studies on child mortality at the disaggregated level-by social-economic group or geographic location-are more informative for designing health polices. Using Demographic and Health Survey data from over 60 low-income countries, this study (1) presents global patterns of the level and inequality in child mortality and (2) investigates the determinants of child mortality, both at the national level and separately for urban and rural areas. The global patterns of health outcomes reveal two interesting observations. First, as child mortality declines, the gap in mortality between the poor and the better-off widens. Second, while child mortality in rural areas is substantially higher than in urban areas, the reduction in child mortality is much slower in rural areas where the poor are concentrated. This suggests that health interventions implemented in the past decade may not have been as effective as intended in reaching the poor. The analysis on mortality determination shows that at the national level access to electricity, incomes, vaccination in the first year of birth, and public health expenditure significantly reduce child mortality. The electricity effect is large and independent of the income effect. While in urban areas, access to electricity is the only significant mortality determinant, in rural areas, vaccination in the first year of birth is the only significant factor.

Practical issues in the measurement of child survival in health systems trials: experience developing a digital community-based mortality surveillance programme in rural Nepal.

PubMed

Harsha Bangura, Alex; Ozonoff, Al; Citrin, David; Thapa, Poshan; Nirola, Isha; Maru, Sheela; Schwarz, Ryan; Raut, Anant; Belbase, Bishal; Halliday, Scott; Adhikari, Mukesh; Maru, Duncan

2016-01-01

Child mortality measurement is essential to the impact evaluation of maternal and child healthcare systems interventions. In the absence of vital statistics systems, however, assessment methodologies for locally relevant interventions are severely challenged. Methods for assessing the under-5 mortality rate for cross-country comparisons, often used in determining progress towards development targets, pose challenges to implementers and researchers trying to assess the population impact of targeted interventions at more local levels. Here, we discuss the programmatic approach we have taken to mortality measurement in the context of delivering healthcare via a public-private partnership in rural Nepal. Both government officials and the delivery organisation, Possible , felt it was important to understand child mortality at a fine-grain spatial and temporal level. We discuss both the short-term and the long-term approach. In the short term, the team chose to use the under-2 mortality rate as a metric for mortality measurement for the following reasons: (1) as overall childhood mortality declines, like it has in rural Nepal, deaths concentrate among children under the age of 2; (2) 2-year cohorts are shorter and thus may show an impact more readily in the short term of intervention trials; and (3) 2-year cohorts are smaller, making prospective census cohorts more feasible in small populations. In the long term, Possible developed a digital continuous surveillance system to capture deaths as they occur, at which point under-5 mortality assessment would be desirable, largely owing to its role as a global standard.

Social Sector Expenditure and Child Mortality in India: A State-Level Analysis from 1997 to 2009

PubMed Central

Makela, Susanna M.; Dandona, Rakhi; Dilip, T. R.; Dandona, Lalit

2013-01-01

Background India is unlikely to meet the Millennium Development Goal for child mortality. As public policy impacts child mortality, we assessed the association of social sector expenditure with child mortality in India. Methods and Findings Mixed-effects regression models were used to assess the relationship of state-level overall social sector expenditure and its major components (health, health-related, education, and other) with mortality by sex among infants and children aged 1–4 years from 1997 to 2009, adjusting for potential confounders. Counterfactual models were constructed to estimate deaths averted due to overall social sector increases since 1997. Increases in per capita overall social sector expenditure were slightly higher in less developed than in more developed states from 1997 to 2009 (2.4-fold versus 2-fold), but the level of expenditure remained 36% lower in the former in 2009. Increase in public expenditure on health was not significantly associated with mortality reduction in infants or at ages 1–4 years, but a 10% increase in health-related public expenditure was associated with a 3.6% mortality reduction (95% confidence interval 0.2–6.9%) in 1–4 years old boys. A 10% increase in overall social sector expenditure was associated with a mortality reduction in both boys (6.8%, 3.5–10.0%) and girls (4.1%, 0.8–7.5%) aged 1–4 years. We estimated 119,807 (95% uncertainty interval 53,409 – 214,662) averted deaths in boys aged 1–4 years and 94,037 (14,725 – 206,684) in girls in India in 2009 that could be attributed to increases in overall social sector expenditure since 1997. Conclusions Further reduction in child mortality in India would be facilitated if policymakers give high priority to the social sector as a whole for resource allocation in the country’s 5-year plan for 2012–2017, as public expenditure on health alone has not had major impact on reducing child mortality. PMID:23409166

Child mortality in the Netherlands in the past decades: an overview of external causes and the role of public health policy.

PubMed

Gijzen, Sandra; Boere-Boonekamp, Magda M; L'Hoir, Monique P; Need, Ariana

2014-02-01

Among European countries, the Netherlands has the second lowest child mortality rate from external causes. We present an overview, discuss possible explanations, and suggest prevention measures. We analyzed mortality data from all deceased children aged 0-19 years for the period 1969-2011. Child mortality declined in the past decades, largely from decreases in road traffic accidents that followed government action on traffic safety. Accidental drowning also showed a downward trend. Although intentional self-harm showed a significant increase, other external causes of mortality, including assault and fatal child abuse, remained constant. Securing existing preventive measures and analyzing the circumstances of each child's death systematically through Child Death Review may guide further reduction in child mortality.

Assessment of Malawi’s success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation

PubMed Central

Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

2015-01-01

Background Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. Methods We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007–2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. Results The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991–1995 to 119 deaths (95% CI 105 to 132) in the period 2006–2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide–treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Conclusions Malawi provides a strong example for countries in sub–Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community–based delivery platform, can lead to significant reductions in child mortality. PMID:26649176

Country-level economic disparity and child mortality related to housing and injuries: a study in 26 European countries.

PubMed

Sengoelge, Mathilde; Elling, Berty; Laflamme, Lucie; Hasselberg, Marie

2013-10-01

Adverse living standards are associated with poorer child health and safety. This study investigates whether adverse housing and neighbourhood conditions contribute to explain country-level associations between a country's economic level and income inequality and child mortality, specifically injury mortality. Ecological, cross-sectional study. Twenty-six European countries were grouped according to two country-level economic measures from Eurostat: gross domestic product (GDP) and income inequality. Adverse country-level housing and neighbourhood conditions were assessed using data from the 2006 European Union Income Social Inclusion and Living Conditions Database (n=203 000). Child mortality incidence rates were derived for children aged 1-14 years for all causes, all injuries, road traffic injuries and unintentional injuries excluding road traffic. Linear regression analysis was applied to measure whether housing or neighbourhood conditions have a significant association with child mortality and whether a strain modified the association between GDP/income inequality and mortality. Country-level income inequality and GDP demonstrated a significant association with child mortality for all outcomes. A significant association was also found between housing strain and all child mortality outcomes, but not for neighbourhood strain. Housing strain partially modified the relationship between income inequality and GDP and all child mortality outcomes, with the exception of income inequality and road traffic injury mortality showing full mediation by housing strain. Adverse housing conditions are a likely pathway in the country-level association between income inequality and economic GDP and child injury mortality.

Multidimensional poverty and child survival in India.

PubMed

Mohanty, Sanjay K

2011-01-01

Though the concept of multidimensional poverty has been acknowledged cutting across the disciplines (among economists, public health professionals, development thinkers, social scientists, policy makers and international organizations) and included in the development agenda, its measurement and application are still limited. OBJECTIVES AND METHODOLOGY: Using unit data from the National Family and Health Survey 3, India, this paper measures poverty in multidimensional space and examine the linkages of multidimensional poverty with child survival. The multidimensional poverty is measured in the dimension of knowledge, health and wealth and the child survival is measured with respect to infant mortality and under-five mortality. Descriptive statistics, principal component analyses and the life table methods are used in the analyses. The estimates of multidimensional poverty are robust and the inter-state differentials are large. While infant mortality rate and under-five mortality rate are disproportionately higher among the abject poor compared to the non-poor, there are no significant differences in child survival among educationally, economically and health poor at the national level. State pattern in child survival among the education, economical and health poor are mixed. Use of multidimensional poverty measures help to identify abject poor who are unlikely to come out of poverty trap. The child survival is significantly lower among abject poor compared to moderate poor and non-poor. We urge to popularize the concept of multiple deprivations in research and program so as to reduce poverty and inequality in the population.

Economic cycles and child mortality: A cross-national study of the least developed countries.

PubMed

Pérez-Moreno, Salvador; Blanco-Arana, María C; Bárcena-Martín, Elena

2016-09-01

This paper examines the effects of growth and recession periods on child mortality in the Least Developed Countries (LDCs) during the period 1990-2010. We provide empirical evidence of uneven effects of variations in Gross Domestic Product (GDP) per capita on the evolution of child mortality rate in periods of economic recession and expansion. A decrease in GDP per capita entails a significant rise in child mortality rates, whereas an increase does not affect child mortality significantly. In this context, official development assistance seems to play a crucial role in counteracting the increment in child mortality rates in recession periods, at least in those LDCs receiving greater aid. Copyright © 2016 Elsevier B.V. All rights reserved.

Decreasing child mortality, spatial clustering and decreasing disparity in North-Western Burkina Faso.

PubMed

Becher, Heiko; Müller, Olaf; Dambach, Peter; Gabrysch, Sabine; Niamba, Louis; Sankoh, Osman; Simboro, Seraphin; Schoeps, Anja; Stieglbauer, Gabriele; Yé, Yazoume; Sié, Ali

2016-04-01

Within relatively small areas, there exist high spatial variations of mortality between villages. In rural Burkina Faso, with data from 1993 to 1998, clusters of particularly high child mortality were identified in the population of the Nouna Health and Demographic Surveillance System (HDSS), a member of the INDEPTH Network. In this paper, we report child mortality with respect to temporal trends, spatial clustering and disparity in this HDSS from 1993 to 2012. Poisson regression was used to describe village-specific child mortality rates and time trends in mortality. The spatial scan statistic was used to identify villages or village clusters with higher child mortality. Clustering of mortality in the area is still present, but not as strong as before. The disparity of child mortality between villages has decreased. The decrease occurred in the context of an overall halving of child mortality in the rural area of Nouna HDSS between 1993 and 2012. Extrapolated to the Millennium Development Goals target period 1990-2015, this yields an estimated reduction of 54%, which is not too far off the aim of a two-thirds reduction. © 2016 John Wiley & Sons Ltd.

Child Deaths Due to Injury in the Four UK Countries: A Time Trends Study from 1980 to 2010

PubMed Central

Hardelid, Pia; Davey, Jonathan; Dattani, Nirupa; Gilbert, Ruth

2013-01-01

Background Injuries are an increasingly important cause of death in children worldwide, yet injury mortality is highly preventable. Determining patterns and trends in child injury mortality can identify groups at particularly high risk. We compare trends in child deaths due to injury in four UK countries, between 1980 and 2010. Methods We obtained information from death certificates on all deaths occurring between 1980 and 2010 in children aged 28 days to 18 years and resident in England, Scotland, Wales or Northern Ireland. Injury deaths were defined by an external cause code recorded as the underlying cause of death. Injury mortality rates were analysed by type of injury, country of residence, age group, sex and time period. Results Child mortality due to injury has declined in all countries of the UK. England consistently experienced the lowest mortality rate throughout the study period. For children aged 10 to 18 years, differences between countries in mortality rates increased during the study period. Inter-country differences were largest for boys aged 10 to 18 years with mortality rate ratios of 1.38 (95% confidence interval 1.16, 1.64) for Wales, 1.68 (1.48, 1.91) for Scotland and 1.81 (1.50, 2.18) for Northern Ireland compared with England (the baseline) in 2006–10. The decline in mortality due to injury was accounted for by a decline in unintentional injuries. For older children, no declines were observed for deaths caused by self-harm, by assault or from undetermined intent in any UK country. Conclusion Whilst child deaths from injury have declined in all four UK countries, substantial differences in mortality rates remain between countries, particularly for older boys. This group stands to gain most from policy interventions to reduce deaths from injury in children. PMID:23874585

Governance matters: an ecological association between governance and child mortality

PubMed Central

Lin, Ro-Ting; Chien, Lung-Chang; Chen, Ya-Mei; Chan, Chang-Chuan

2014-01-01

Background Governance of a country may have widespread effects on the health of its population, yet little is known about the effect of governance on child mortality in a country that is undergoing urbanization, economic development, and disease control. Methods We obtained indicators of six dimensions of governance (perceptions of voice and accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption) and national under-5 mortality rates for 149 countries between 1996 and 2010. We applied a semi-parametric generalized additive mixed model to examine associations after controlling for the effects of development factors (urbanization level and economy), disease control factors (hygienic conditions and vaccination rates), health expenditures, air quality, and time. Results Governance, development, and disease control showed clear inverse relations with the under-5 mortality rate (p<0.001). Per unit increases in governance, development, and disease control factors, the child mortality rate had a 0.901-, 0.823-, and 0.922-fold decrease, respectively, at fixed levels of the other two factors. Conclusions In the effort to reduce the global under-5 mortality rate, addressing a country's need for better governance is as important as improvements in development and disease control. PMID:24711600

Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru

PubMed Central

Bohra, Tasneem; Benmarhnia, Tarik; McKinnon, Britt; Kaufman, Jay S.

2017-01-01

Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population. PMID:27821698

Seeking explanations for high levels of infant mortality in Pakistan.

PubMed

Sathar, Z A

1987-01-01

Data from the Fertility Module of the 1979 Population, Labour Force and Migration (PLM) Survey of Pakistan were analyzed to determine which of 4 factors were primarily responsible for the high infant mortality rate. The factors examined were poverty, childbearing and childrearing practices, distribution of health care and lack of individual attention given to children due to ignorance. These items were presented in a discussion format. Infant mortality in Pakistan is high at about 125-140/1000, for a country with mid-level per capita income. Income was not a good indicator of child mortality, primarily because it was difficult to determine, particularly in rural areas where non-cash income predominates. Wealth and status were good indicators of child survival. Child-rearing practices were somewhat important, as judged by birth order, breastfeeding duration and gender. Childbearing practices as shown by spacing were important determinants of survival. Health care facilities were somewhat important, indicated by higher mortality in rural areas. Rural neonates die from tetanus due to lack of immunization, or later from diarrheal disease due to lack of potable water or poor weaning practices. Maternal education was a strong indicator of survival, much more so than paternal education. Similarly, female heads of households increased survival, probably because they control financial allocations. The study suggested that rather than attempting to eliminate poverty overall, improvements in maternal education, nutrition, health care facilities and their use, and childbearing and child-rearing methods would do more to improve child survival in Pakistan.

Factors influencing child mortality levels in rural Bangladesh: evidence from a micro study.

PubMed

Kabir, M; Uddin, M M; Hossain, M Z

1988-01-01

"This paper examines the factors that affect child mortality [in rural Bangladesh] by using a multivariate technique. The results suggest that mother's access to education and health care facilities are important determinants of child mortality. The access to maternal and child health programs and visit by the health workers were also related to low childhood mortality...." (SUMMARY IN FRE AND ITA) excerpt

Forced Suffocation of Infants with Baby Wipes: A Previously Undescribed Form of Child Abuse

ERIC Educational Resources Information Center

Krugman, Scott D.; Lantz, Patrick E.; Sinal, Sara; De Jong, Allan R.; Coffman, Kathryn

2007-01-01

Background: Foreign body aspiration in children is commonly seen in emergency departments and carries a significant mortality. Abusive foreign body suffocation is not well described. Methods: We present a case-series of four infants who presented with aspiration of a baby wipe. Results: Each child was found to be a victim of child physical abuse…

The US President’s Malaria Initiative and under-5 child mortality in sub-Saharan Africa: A difference-in-differences analysis

PubMed Central

Angeles, Gustavo; Thirumurthy, Harsha

2017-01-01

Background Despite substantial financial contributions by the United States President’s Malaria Initiative (PMI) since 2006, no studies have carefully assessed how this program may have affected important population-level health outcomes. We utilized multiple publicly available data sources to evaluate the association between introduction of PMI and child mortality rates in sub-Saharan Africa (SSA). Methods and findings We used difference-in-differences analyses to compare trends in the primary outcome of under-5 mortality rates and secondary outcomes reflecting population coverage of malaria interventions in 19 PMI-recipient and 13 non-recipient countries between 1995 and 2014. The analyses controlled for presence and intensity of other large funding sources, individual and household characteristics, and country and year fixed effects. PMI program implementation was associated with a significant reduction in the annual risk of under-5 child mortality (adjusted risk ratio [RR] 0.84, 95% CI 0.74–0.96). Each dollar of per-capita PMI expenditures in a country, a measure of PMI intensity, was also associated with a reduction in child mortality (RR 0.86, 95% CI 0.78–0.93). We estimated that the under-5 mortality rate in PMI countries was reduced from 28.9 to 24.3 per 1,000 person-years. Population coverage of insecticide-treated nets increased by 8.34 percentage points (95% CI 0.86–15.83) and coverage of indoor residual spraying increased by 6.63 percentage points (95% CI 0.79–12.47) after PMI implementation. Per-capita PMI spending was also associated with a modest increase in artemisinin-based combination therapy coverage (3.56 percentage point increase, 95% CI −0.07–7.19), though this association was only marginally significant (p = 0.054). Our results were robust to several sensitivity analyses. Because our study design leaves open the possibility of unmeasured confounding, we cannot definitively interpret these results as causal. Conclusions PMI may have significantly contributed to reducing the burden of malaria in SSA and reducing the number of child deaths in the region. Introduction of PMI was associated with increased coverage of malaria prevention technologies, which are important mechanisms through which child mortality can be reduced. To our knowledge, this study is the first to assess the association between PMI and all-cause child mortality in SSA with the use of appropriate comparison groups and adjustments for regional trends in child mortality. PMID:28609442

Setting priorities for zinc-related health research to reduce children's disease burden worldwide: an application of the Child Health and Nutrition Research Initiative's research priority-setting method.

PubMed

Brown, Kenneth H; Hess, Sonja Y; Boy, Erick; Gibson, Rosalind S; Horton, Susan; Osendarp, Saskia J; Sempertegui, Fernando; Shrimpton, Roger; Rudan, Igor

2009-03-01

To make the best use of limited resources for supporting health-related research to reduce child mortality, it is necessary to apply a suitable method to rank competing research options. The Child Health and Nutrition Research Initiative (CHNRI) developed a new methodology for setting health research priorities. To broaden experience with this priority-setting technique, we applied the method to rank possible research priorities concerning the control of Zn deficiency. Although Zn deficiency is not generally recognized as a direct cause of child mortality, recent research indicates that it predisposes children to an increased incidence and severity of several of the major direct causes of morbidity and mortality. Leading experts in the field of Zn research in child health were identified and invited to participate in a technical working group (TWG) to establish research priorities. The individuals were chosen to represent a wide range of expertise in Zn nutrition. The seven TWG members submitted a total of ninety research options, which were then consolidated into a final list of thirty-one research options categorized by the type of resulting intervention. The identified priorities were dominated by research investment options targeting Zn supplementation, and were followed by research on Zn fortification, general aspects of Zn nutrition, dietary modification and other new interventions. In general, research options that aim to improve the efficiency of an already existing intervention strategy received higher priority scores. Challenges identified during the implementation of the methodology and suggestions to modify the priority-setting procedures are discussed.

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 4. child health findings

PubMed Central

Freeman, Paul A; Schleiff, Meike; Sacks, Emma; Rassekh, Bahie M; Gupta, Sundeep; Perry, Henry B

2017-01-01

Background This paper assesses the effectiveness of community–based primary health care (CBPHC) in improving child health beyond the neonatal period. Although there has been an accelerated decline in global under–5 mortality since 2000, mortality rates remain high in much of sub–Saharan Africa and in some south Asian countries where under–5 mortality is also decreasing more slowly. Essential interventions for child health at the community level have been identified. Our review aims to contribute further to this knowledge by examining how strong the evidence is and exploring in greater detail what specific interventions and implementation strategies appear to be effective. Methods We reviewed relevant documents from 1950 onwards using a detailed protocol. Peer reviewed documents, reports and books assessing the impact of one or more CBPHC interventions on child health (defined as changes in population coverage of one or more key child survival interventions, nutritional status, serious morbidity or mortality) among children in a geographically defined population was examined for inclusion. Two separate reviews took place of each document followed by an independent consolidated summative review. Data from the latter review were transferred to electronic database for analysis. Results The findings provide strong evidence that the major causes of child mortality in resource–constrained settings can be addressed at the community level largely by engaging communities and supporting community–level workers. For all major categories of interventions (nutritional interventions; control of pneumonia, diarrheal disease and malaria; HIV prevention and treatment; immunizations; integrated management of childhood diseases; and comprehensive primary health care) we have presented randomized controlled trials that have consistently produced statistically significant and operationally important effects. Conclusions This review shows that there is strong evidence of effectiveness for CBPHC implementation of an extensive range of interventions to improve child health and that four major strategies for delivering these interventions are effective. PMID:28685042

Household resources as determinants of child mortality in Ghana.

PubMed

Nutor, Jerry John; Bell, Janice F; Slaughter-Acey, Jaime C; Joseph, Jill G; Apesoa-Varano, Ester Carolina; de Leon Siantz, Mary Lou

2017-01-01

Although the association between child mortality and socioeconomic status is well established, the role of household assets as predictors of child mortality, over and above other measures of socioeconomic status, is not well studied in developing nations. This study investigated the contribution of several household resources to child mortality, beyond the influence of maternal education as a measure of socioeconomic status. This secondary analysis used data from the 2007 Ghana Maternal Health Survey to explore the relationship of child mortality to household resources. The analysis of 7183 parous women aged 15-45 years examined household resources for their association with maternal reports of any child's death for children aged less than 5 years using a survey-weighted logistic regression model while controlling for sociodemographic and health covariates. The overall household resources index was significantly associated with the death of one or more child in the entire sample (adjusted odd ratios (OR)=0.95; 95% confidence interval (CI): 0.92, 0.98]. In stratified analysis, this finding held for women living in rural but not in urban areas. Having a refrigerator at the time of interview was associated with lower odds of reporting child mortality (OR=0.63; 95%CI: 0.48, 0.83). Having a kerosene lantern (OR=1.40; 95%CI: 1.06, 1.85) or flush toilet (OR=1.84; 95%CI: 1.23, 2.75) was associated with higher odds of reporting child mortality. Adjusted regression models showed only possession of a refrigerator retained significance. Possession of a refrigerator may play a role in child mortality. This finding may reflect unmeasured socioeconomic status or the importance of access to refrigeration in preventing diarrheal disease or other proximal causes of child mortality in sub-Saharan Africa.

Child spacing and child mortality among Nigerian Igbos.

PubMed

Ebigbo, P O; Chukudebelu, W O

1980-01-01

Until recently, a birth interval of at least two years was the norm in the Nigerian Igbo culture, a practice necessary for infant health and survival. A study of antenatal patients of the University of Nigeria Teaching Hospital, Enugu, Nigeria, shows that this cultural pattern has been disrupted by Westernization, urbanization and consumerism. The patients studied had an average of four pregnancies in five years. Roughly half of those conceived did not survive: 41% of the patients reported having lost at least one child. Modern family planning methods are urged as replacements for the abandoned traditional methods of child spacing.

Multidimensional Poverty and Child Survival in India

PubMed Central

Mohanty, Sanjay K.

2011-01-01

Background Though the concept of multidimensional poverty has been acknowledged cutting across the disciplines (among economists, public health professionals, development thinkers, social scientists, policy makers and international organizations) and included in the development agenda, its measurement and application are still limited. Objectives and Methodology Using unit data from the National Family and Health Survey 3, India, this paper measures poverty in multidimensional space and examine the linkages of multidimensional poverty with child survival. The multidimensional poverty is measured in the dimension of knowledge, health and wealth and the child survival is measured with respect to infant mortality and under-five mortality. Descriptive statistics, principal component analyses and the life table methods are used in the analyses. Results The estimates of multidimensional poverty are robust and the inter-state differentials are large. While infant mortality rate and under-five mortality rate are disproportionately higher among the abject poor compared to the non-poor, there are no significant differences in child survival among educationally, economically and health poor at the national level. State pattern in child survival among the education, economical and health poor are mixed. Conclusion Use of multidimensional poverty measures help to identify abject poor who are unlikely to come out of poverty trap. The child survival is significantly lower among abject poor compared to moderate poor and non-poor. We urge to popularize the concept of multiple deprivations in research and program so as to reduce poverty and inequality in the population. PMID:22046384

The impacts of health, education, family planning and electrification programs on fertility, mortality and child schooling in East Java, Indonesia.

PubMed

Wirakartakusumah, M D

1988-06-01

This paper examines the effects of public health, family planning, education, electrification, and water supply programs on fertility, child mortality, and school enrollment decisions of rural households in East Java, Indonesia. The theoretical model assumes that parents maximize a utility function, subject to 1) a budget constraint that equates income with expenditures on children (including schooling and health inputs), and 2) a production function that relates health inputs to child survival possibilities. Public programs affect prices of contraceptives, schooling and health inputs, and environmental conditions that in turn affect child survival. Data are taken from the 1980 East Java Population Survey, the Socio-economic Survey, and the Detailed Village Census. The final sample consists of 3170 rural households with married women of childbearing age. Ordinary least squares and logit regressions of recent fertility, child mortality, and school enrollment on program and household variables yielded the following findings. 1) The presence of maternal and child health clinics reduced fertility but not mortality. 2) The presence of public health centers strongly reduced mortality but not fertility. 3) The presence of contraceptive distribution centers had no effect on fertility. 4) School attendance rates were influenced positively by the availability of primary and secondary schools. 5) Health and family planning programs had no effects on schooling. 6) The availability of public latrines reduced fertility and mortality. 7) The water supply variable did not affect the dependent variables when ordinary least squares techniques were applied but had statistically significant impact when logit methods were used. 8) Electricity supply had little effect on the dependent variables. 9) The mother's schooling had a strong positive correlation with children's schooling but no effect on fertility or mortality. 10) Household expenditures were related positively to school attendance and negatively to mortality. 11) There was little or no interaction between household variables and presence of government programs. 12) Subprovincial area measures of service availability appeared more appropriate for public health and family planning services, while village-level measures appeared more appropriate for schooling.

Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru.

PubMed

Bohra, Tasneem; Benmarhnia, Tarik; McKinnon, Britt; Kaufman, Jay S

2017-01-11

Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population. © The American Society of Tropical Medicine and Hygiene.

Stagnant neonatal mortality and persistent health inequality in middle-income countries: a case study of the Philippines.

PubMed

Kraft, Aleli D; Nguyen, Kim-Huong; Jimenez-Soto, Eliana; Hodge, Andrew

2013-01-01

The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country's socioeconomic-related child health inequality. Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery. The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality--that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system--to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health.

Effects of economic downturns on child mortality: a global economic analysis, 1981-2010.

PubMed

Maruthappu, Mahiben; Watson, Robert A; Watkins, Johnathan; Zeltner, Thomas; Raine, Rosalind; Atun, Rifat

2017-01-01

To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels. Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation. Global. 204 countries between 1981 and 2010. Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors. 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0-21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1-5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001). Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries.

Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: a pooled cross-sectional analysis

PubMed Central

Ezeh, Osita Kingsley; Agho, Kingsley Emwinyore; Dibley, Michael John; Hall, John Joseph; Page, Andrew Nicolas

2015-01-01

Objectives To identify common factors associated with post-neonatal, infant, child and under-5 mortality in Nigeria. Design, setting and participants A cross-sectional data of three Nigeria Demographic and Health Surveys (NDHS) for the years 2003, 2008 and 2013 were used. A multistage, stratified, cluster random sampling method was used to gather information on 63 844 singleton live-born infants of the most recent birth of a mother within a 5-year period before each survey was examined using cox regression models. Main outcome measures Postneonatal mortality (death between 1 and 11 months), infant mortality (death between birth and 11 months), child mortality (death between 12 and 59 months) and under-5 mortality (death between birth and 59 months). Results Multivariable analyses indicated that children born to mothers with no formal education was significantly associated with mortality across all four age ranges (adjusted HR=1.30, 95% CI 1.01 to 1.66 for postneonatal; HR=1.38, 95% CI 1.11 to 1.84 for infant; HR=2.13, 95% CI 1.56 to 2.89 for child; HR=1.19, 95% CI 1.02 to 1.41 for under-5). Other significant factors included living in rural areas (HR=1.48, 95% CI 1.16 to 1.89 for postneonatal; HR=1.23, 95% CI 1.03 to 1.47 for infant; HR=1.52, 95% CI 1.16 to 1.99 for child; HR=1.29, 95% CI 1.11 to 1.50 for under-5), and poor households (HR=2.47, 95% CI 1.76 to 3.47 for postneonatal; HR=1.40, 95% CI 1.10 to 1.78 for infant; HR=1.72, 95% CI 1.19 to 2.49 for child; HR=1.43, 95% CI 1.17 to 1.76 for under-5). Conclusions This study found that no formal education, poor households and living in rural areas increased the risk of postneonatal, infant, child and under-5 mortality among Nigerian children. Community-based interventions for reducing under-5 deaths are needed and should target children born to mothers of low socioeconomic status. PMID:25818271

Risk factors for postneonatal, infant, child and under-5 mortality in Nigeria: a pooled cross-sectional analysis.

PubMed

Ezeh, Osita Kingsley; Agho, Kingsley Emwinyore; Dibley, Michael John; Hall, John Joseph; Page, Andrew Nicolas

2015-03-27

To identify common factors associated with post-neonatal, infant, child and under-5 mortality in Nigeria. A cross-sectional data of three Nigeria Demographic and Health Surveys (NDHS) for the years 2003, 2008 and 2013 were used. A multistage, stratified, cluster random sampling method was used to gather information on 63,844 singleton live-born infants of the most recent birth of a mother within a 5-year period before each survey was examined using cox regression models. Postneonatal mortality (death between 1 and 11 months), infant mortality (death between birth and 11 months), child mortality (death between 12 and 59 months) and under-5 mortality (death between birth and 59 months). Multivariable analyses indicated that children born to mothers with no formal education was significantly associated with mortality across all four age ranges (adjusted HR=1.30, 95% CI 1.01 to 1.66 for postneonatal; HR=1.38, 95% CI 1.11 to 1.84 for infant; HR=2.13, 95% CI 1.56 to 2.89 for child; HR=1.19, 95% CI 1.02 to 1.41 for under-5). Other significant factors included living in rural areas (HR=1.48, 95% CI 1.16 to 1.89 for postneonatal; HR=1.23, 95% CI 1.03 to 1.47 for infant; HR=1.52, 95% CI 1.16 to 1.99 for child; HR=1.29, 95% CI 1.11 to 1.50 for under-5), and poor households (HR=2.47, 95% CI 1.76 to 3.47 for postneonatal; HR=1.40, 95% CI 1.10 to 1.78 for infant; HR=1.72, 95% CI 1.19 to 2.49 for child; HR=1.43, 95% CI 1.17 to 1.76 for under-5). This study found that no formal education, poor households and living in rural areas increased the risk of postneonatal, infant, child and under-5 mortality among Nigerian children. Community-based interventions for reducing under-5 deaths are needed and should target children born to mothers of low socioeconomic status. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Child Mortality Estimation 2013: An Overview of Updates in Estimation Methods by the United Nations Inter-Agency Group for Child Mortality Estimation

PubMed Central

Alkema, Leontine; New, Jin Rou; Pedersen, Jon; You, Danzhen

2014-01-01

Background In September 2013, the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) published an update of the estimates of the under-five mortality rate (U5MR) and under-five deaths for all countries. Compared to the UN IGME estimates published in 2012, updated data inputs and a new method for estimating the U5MR were used. Methods We summarize the new U5MR estimation method, which is a Bayesian B-spline Bias-reduction model, and highlight differences with the previously used method. Differences in UN IGME U5MR estimates as published in 2012 and those published in 2013 are presented and decomposed into differences due to the updated database and differences due to the new estimation method to explain and motivate changes in estimates. Findings Compared to the previously used method, the new UN IGME estimation method is based on a different trend fitting method that can track (recent) changes in U5MR more closely. The new method provides U5MR estimates that account for data quality issues. Resulting differences in U5MR point estimates between the UN IGME 2012 and 2013 publications are small for the majority of countries but greater than 10 deaths per 1,000 live births for 33 countries in 2011 and 19 countries in 1990. These differences can be explained by the updated database used, the curve fitting method as well as accounting for data quality issues. Changes in the number of deaths were less than 10% on the global level and for the majority of MDG regions. Conclusions The 2013 UN IGME estimates provide the most recent assessment of levels and trends in U5MR based on all available data and an improved estimation method that allows for closer-to-real-time monitoring of changes in the U5MR and takes account of data quality issues. PMID:25013954

Testing survey-based methods for rapid monitoring of child mortality, with implications for summary birth history data.

PubMed

Brady, Eoghan; Hill, Kenneth

2017-01-01

Under-five mortality estimates are increasingly used in low and middle income countries to target interventions and measure performance against global development goals. Two new methods to rapidly estimate under-5 mortality based on Summary Birth Histories (SBH) were described in a previous paper and tested with data available. This analysis tests the methods using data appropriate to each method from 5 countries that lack vital registration systems. SBH data are collected across many countries through censuses and surveys, and indirect methods often rely upon their quality to estimate mortality rates. The Birth History Imputation method imputes data from a recent Full Birth History (FBH) onto the birth, death and age distribution of the SBH to produce estimates based on the resulting distribution of child mortality. DHS FBHs and MICS SBHs are used for all five countries. In the implementation, 43 of 70 estimates are within 20% of validation estimates (61%). Mean Absolute Relative Error is 17.7.%. 1 of 7 countries produces acceptable estimates. The Cohort Change method considers the differences in births and deaths between repeated Summary Birth Histories at 1 or 2-year intervals to estimate the mortality rate in that period. SBHs are taken from Brazil's PNAD Surveys 2004-2011 and validated against IGME estimates. 2 of 10 estimates are within 10% of validation estimates. Mean absolute relative error is greater than 100%. Appropriate testing of these new methods demonstrates that they do not produce sufficiently good estimates based on the data available. We conclude this is due to the poor quality of most SBH data included in the study. This has wider implications for the next round of censuses and future household surveys across many low- and middle- income countries.

Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015.

PubMed

Murray, Christopher J L; Laakso, Thomas; Shibuya, Kenji; Hill, Kenneth; Lopez, Alan D

2007-09-22

Global efforts have increased the accuracy and timeliness of estimates of under-5 mortality; however, these estimates fail to use all data available, do not use transparent and reproducible methods, do not distinguish predictions from measurements, and provide no indication of uncertainty around point estimates. We aimed to develop new reproducible methods and reanalyse existing data to elucidate detailed time trends. We merged available databases, added to them when possible, and then applied Loess regression to estimate past trends and forecast to 2015 for 172 countries. We developed uncertainty estimates based on different model specifications and estimated levels and trends in neonatal, post-neonatal, and childhood mortality. Global under-5 mortality has fallen from 110 (109-110) per 1000 in 1980 to 72 (70-74) per 1000 in 2005. Child deaths worldwide have decreased from 13.5 (13.4-13.6) million in 1980 to an estimated 9.7 (9.5-10.0) million in 2005. Global under-5 mortality is expected to decline by 27% from 1990 to 2015, substantially less than the target of Millennium Development Goal 4 (MDG4) of a 67% decrease. Several regions in Latin America, north Africa, the Middle East, Europe, and southeast Asia have had consistent annual rates of decline in excess of 4% over 35 years. Global progress on MDG4 is dominated by slow reductions in sub-Saharan Africa, which also has the slowest rates of decline in fertility. Globally, we are not doing a better job of reducing child mortality now than we were three decades ago. Further improvements in the quality and timeliness of child-mortality measurements should be possible by more fully using existing datasets and applying standard analytical strategies.

[Political crises in Africa and infant and child mortality].

PubMed

Garenne, M

1997-01-01

Many African countries experienced severe political crises after independence, and in a number of cases the crises had significant demographic consequences, especially for child mortality. Data based on maternity histories allowed the reconstruction of child mortality trends over the past 20-30 years in Uganda, Ghana, Rwanda, Madagascar, and Mozambique. The indicator used was the child mortality quotient (number of deaths of under-5 children per 1000 births). Uganda's child mortality declined from 227/1000 in 1960 to 154/1000 in 1970, but the trend was reversed in 1971, when Idi Amin Dada came to power, and the rate reached 204/1000 in 1982 before beginning to decline again. The level of mortality remained high, however, and was still 160/1000 in 1988. Ghana suffered a political and economic crisis during 1979-84. Child mortality rose from 130/1000 in 1978 to 175/1000 in 1983. Mortality rates began a rapid decline after structural adjustment programs were begun, possibly due to improved management of health services. The child mortality rate in Rwanda increased from around 220/1000 in 1960 to 240/1000 in 1975, before beginning a decline in the late 1970s that reached 140/1000 by 1990. The period of political stability and relative prosperity during the 15-year reign of Juvenal Habyarimana was associated with the decline. Political crises marked by student and peasant uprisings were associated with Madagascar's child mortality rate increase from about 145/1000 in 1960 to 185/1000 in 1985. Mozambique was beset by civil war after independence, in which destruction of the health infrastructure was a strategy. The child mortality rate increased from 270/1000 to 470/1000 between 1975 and 1986, a peak war year. The factors by which political crises affect mortality so profoundly remain to be explained, but particular attention should be given to studying the health sector.

Child mortality estimation 2013: an overview of updates in estimation methods by the United Nations Inter-agency Group for Child Mortality Estimation.

PubMed

Alkema, Leontine; New, Jin Rou; Pedersen, Jon; You, Danzhen

2014-01-01

In September 2013, the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) published an update of the estimates of the under-five mortality rate (U5MR) and under-five deaths for all countries. Compared to the UN IGME estimates published in 2012, updated data inputs and a new method for estimating the U5MR were used. We summarize the new U5MR estimation method, which is a Bayesian B-spline Bias-reduction model, and highlight differences with the previously used method. Differences in UN IGME U5MR estimates as published in 2012 and those published in 2013 are presented and decomposed into differences due to the updated database and differences due to the new estimation method to explain and motivate changes in estimates. Compared to the previously used method, the new UN IGME estimation method is based on a different trend fitting method that can track (recent) changes in U5MR more closely. The new method provides U5MR estimates that account for data quality issues. Resulting differences in U5MR point estimates between the UN IGME 2012 and 2013 publications are small for the majority of countries but greater than 10 deaths per 1,000 live births for 33 countries in 2011 and 19 countries in 1990. These differences can be explained by the updated database used, the curve fitting method as well as accounting for data quality issues. Changes in the number of deaths were less than 10% on the global level and for the majority of MDG regions. The 2013 UN IGME estimates provide the most recent assessment of levels and trends in U5MR based on all available data and an improved estimation method that allows for closer-to-real-time monitoring of changes in the U5MR and takes account of data quality issues.

Maternal and child mortality indicators across 187 countries of the world: converging or diverging.

PubMed

Goli, Srinivas; Arokiasamy, Perianayagam

2014-01-01

This study reassessed the progress achieved since 1990 in maternal and child mortality indicators to test whether the progress is converging or diverging across countries worldwide. The convergence process is examined using standard parametric and non-parametric econometric models of convergence. The results of absolute convergence estimates reveal that progress in maternal and child mortality indicators is diverging for the entire period of 1990-2010 [maternal mortality ratio (MMR) - β = .00033, p < .574; neonatal mortality rate (NNMR) - β = .04367, p < .000; post-neonatal mortality rate (PNMR) - β = .02677, p < .000; under-five mortality rate (U5MR) - β = .00828, p < .000)]. In the recent period, such divergence is replaced with convergence for MMR but diverged for all the child mortality indicators. The results of Kernel density estimate reveal considerable reduction in divergence of MMR for the recent period; however, the Kernel density distribution plots show more than one 'peak' which indicates the emergence of convergence clubs based on their mortality levels. For child mortality indicators, the Kernel estimates suggest that divergence is in progress across the countries worldwide but tended to converge for countries with low mortality levels. A mere progress in global averages of maternal and child mortality indicators among a global cross-section of countries does not warranty convergence unless there is a considerable reduction in variance, skewness and range of change.

Malaria ecology, child mortality & fertility.

PubMed

McCord, Gordon C; Conley, Dalton; Sachs, Jeffrey D

2017-02-01

The broad determinants of fertility are thought to be reasonably well identified by demographers, though the detailed quantitative drivers of fertility levels and changes are less well understood. This paper uses a novel ecological index of malaria transmission to study the effect of child mortality on fertility. We find that temporal variation in the ecology of the disease is well-correlated to mortality, and pernicious malaria conditions lead to higher fertility rates. We then argue that most of this effect occurs through child mortality, and estimate the effect of child mortality changes on fertility. Our findings add to the literature on disease and fertility, and contribute to the suggestive evidence that child mortality reductions have a causal effect on fertility changes. Copyright © 2016 Elsevier B.V. All rights reserved.

On hunger and child mortality in India.

PubMed

Gaiha, Raghav; Kulkarni, Vani S; Pandey, Manoj K; Imai, Katsushi S

2012-01-01

Despite accelerated growth there is pervasive hunger, child undernutrition and mortality in India. Our analysis focuses on their determinants. Raising living standards alone will not reduce hunger and undernutrition. Reduction of rural/urban disparities, income inequality, consumer price stabilization, and mothers’ literacy all have roles of varying importance in different nutrition indicators. Somewhat surprisingly, public distribution system (PDS) do not have a significant effect on any of them. Generally, child undernutrition and mortality rise with poverty. Our analysis confirms that media exposure triggers public action, and helps avert child undernutrition and mortality. Drastic reduction of economic inequality is in fact key to averting child mortality, conditional upon a drastic reordering of social and economic arrangements.

Perinatal Outcomes, Including Mother-to-Child Transmission of HIV, and Child Mortality and Their Association with Maternal Vitamin D Status in Tanzania

PubMed Central

Mehta, Saurabh; Hunter, David J.; Mugusi, Ferdinand M.; Spiegelman, Donna; Manji, Karim P.; Giovannucci, Edward L.; Hertzmark, Ellen; Msamanga, Gernard I.; Fawzi, Wafaie W.

2009-01-01

Background Vitamin D is a strong immunomodulator and may protect against adverse pregnancy outcomes, mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), and child mortality. Methods A total of 884 HIV-infected pregnant women who were participating in a vitamin supplementation trial in Tanzania were monitored to assess pregnancy outcomes and child mortality. The association of these outcomes with maternal vitamin D status at enrollment was examined in an observational analysis. Results No association was observed between maternal vitamin D status and adverse pregnancy outcomes, including low birth weight and preterm birth. In multivariate models, a low maternal vitamin D level (<32 ng/mL) was associated with a 50% higher risk (95% confidence interval [CI], 2%–120%) of MTCT of HIV at 6 weeks, a 2-fold higher risk of MTCT of HIV through breast-feeding among children who were HIV uninfected at 6 weeks (95% CI, 1.08–3.82), and a 46% higher overall risk of HIV infection (95% CI, 11%–91%). Children born to women with a low vitamin D level had a 61% higher risk of dying during follow-up (95% CI, 25%–107%). Conclusions If found to be efficacious in randomized trials, vitamin D supplementation could prove to be an inexpensive method of reducing the burden of HIV infection and death among children, particularly in resource-limited settings. PMID:19673647

Family Planning and Child Survival: The Role of Reproductive Factors in Infant and Child Mortality.

ERIC Educational Resources Information Center

Conly, Shanti R.

This report summarizes the evidence that family planning can reduce deaths of children under 5 years of age at a reasonable cost. The report also: (1) identifies the major reproductive factors associated with child mortality; (2) estimates the approximate reduction in child mortality that could be achieved through improved childbearing patterns;…

Achieving the Millennium Development Goal for Under-five Mortality in Bangladesh: Current Status and Lessons for Issues and Challenges for Further Improvements

PubMed Central

Nury, Abu Taher Md. Sanaullah; Hossain, Md. Delwar

2011-01-01

The study assessed the achievements in, critically reviewed the relevant issues of, and put forward recommendations for achieving the target of the Millennium Development Goal relating to mortality of children aged less than five years (under-five mortality) in Bangladesh within 2015. To materialize the study objectives, a thorough literature review was done. Mortality of under-five children and infants decreased respectively to 65 from 151 and to 52 from 94 per 1,000 livebirths during 1990-2006. The immunization coverage increased from 54% to 81.9% during the same period. The projection shows that Bangladesh will achieve targeted reduction in under-five mortality and infant mortality within the time limit, except immunization coverage. Neonatal mortality contributed to the majority of childhood deaths. Contribution of neonatal mortality to child mortality was the highest. There were remarkable differences in child mortality by sex, division, and residence. To progress further for achieving the target of MDG relating to child mortality, some issues, such as lower use of maternal healthcare services, hazardous environmental effects on childhood illness, high malnutrition among children, shorter duration of exclusive breastfeeding practices, various child injuries leading to death, low healthcare-use of children, probable future threat of financial shortage, and strategies lacking area-wise focus on child mortality, need to be considered. Without these, the achievement of MDG relating to child mortality may not be possible within 2015. PMID:21608418

Risk factors of neonatal mortality and child mortality in Bangladesh.

PubMed

Maniruzzaman, Md; Suri, Harman S; Kumar, Nishith; Abedin, Md Menhazul; Rahman, Md Jahanur; El-Baz, Ayman; Bhoot, Makrand; Teji, Jagjit S; Suri, Jasjit S

2018-06-01

Child and neonatal mortality is a serious problem in Bangladesh. The main objective of this study was to determine the most significant socio-economic factors (covariates) between the years 2011 and 2014 that influences on neonatal and child mortality and to further suggest the plausible policy proposals. We modeled the neonatal and child mortality as categorical dependent variable (alive vs death of the child) while 16 covariates are used as independent variables using χ 2 statistic and multiple logistic regression (MLR) based on maximum likelihood estimate. Using the MLR, for neonatal mortality, diarrhea showed the highest positive coefficient (β = 1.130; P  < 0.010) leading to most significant covariate for both 2011 and 2014. The corresponding odds ratios were: 0.323 for both the years. The second most significant covariate in 2011 was birth order between 2-6 years (β = 0.744; P  < 0.001), while father's education was negative correlation (β = -0.910; P  < 0.050). In general, 10 covariates in 2011 and 5 covariates in 2014 were significant, so there was an improvement in socio-economic conditions for neonatal mortality. For child mortality, birth order between 2-6 years and 7 and above years showed the highest positive coefficients (β = 1.042; P  < 0.010) and (β = 1.285; P  < 0.050) for 2011. The corresponding odds ratios were: 2.835 and 3.614, respectively. Father's education showed the highest coefficient (β = 0.770; P  < 0.050) indicating the significant covariate for 2014 and the corresponding odds ratio was 2.160. In general, 6 covariates in 2011 and 4 covariates in 2014 were also significant, so there was also an improvement in socio-economic conditions for child mortality. This study allows policy makers to make appropriate decisions to reduce neonatal and child mortality in Bangladesh. In 2014, mother's age and father's education were also still significant covariates for child mortality. This study allows policy makers to make appropriate decisions to reduce neonatal and child mortality in Bangladesh.

An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality

PubMed Central

2012-01-01

Background Water and sanitation access are known to be related to newborn, child, and maternal health. Our study attempts to quantify these relationships globally using country-level data: How much does improving access to water and sanitation influence infant, child, and maternal mortality? Methods Data for 193 countries were abstracted from global databases (World Bank, WHO, and UNICEF). Linear regression was used for the outcomes of under-five mortality rate and infant mortality rate (IMR). These results are presented as events per 1000 live births. Ordinal logistic regression was used to compute odds ratios for the outcome of maternal mortality ratio (MMR). Results Under-five mortality rate decreased by 1.17 (95%CI 1.08-1.26) deaths per 1000, p < 0.001, for every quartile increase in population water access after adjustments for confounders. There was a similar relationship between quartile increase of sanitation access and under-five mortality rate, with a decrease of 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. Improved water access was also related to IMR, with the IMR decreasing by 1.14 (95%CI 1.05-1.23) deaths per 1000, p < 0.001, with increasing quartile of access to improved water source. The significance of this relationship was retained with quartile improvement in sanitation access, where the decrease in IMR was 1.66 (95%CI 1.11-1.32) deaths per 1000, p < 0.001. The estimated odds ratio that increased quartile of water access was significantly associated with increased quartile of MMR was 0.58 (95%CI 0.39-0.86), p = 0.008. The corresponding odds ratio for sanitation was 0.52 (95%CI 0.32-0.85), p = 0.009, both suggesting that better water and sanitation were associated with decreased MMR. Conclusions Our analyses suggest that access to water and sanitation independently contribute to child and maternal mortality outcomes. If the world is to seriously address the Millennium Development Goals of reducing child and maternal mortality, then improved water and sanitation accesses are key strategies. PMID:22280473

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa

PubMed Central

Chola, Lumbwe; McGee, Shelley; Tugendhaft, Aviva; Buchmann, Eckhart; Hofman, Karen

2015-01-01

Introduction Family planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa. Methods The Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030. Results If CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers. Conclusion Maternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception. PMID:26076482

Parental mortality rates in a western country after the death of a child: assessment of the role of the child's sex.

PubMed

Werthmann, Jessica; Smits, Luc J M; Li, Jiong

2010-02-01

Loss of a child has been associated with elevated mortality rates in parents. Studies that focus on the influence of the child's sex on parental mortality are sparse. The main objective of the present study was to reevaluate the combined impact of the parents' and child's sex within a larger sample and focus on adverse health effects as an objective measure of possible long-term effects of maladaptive grief reactions. For the time period between 1980 and 1996, all children in Denmark who died before 18 years of age were identified. Parents who had lost a child were identified as the bereaved (exposed) group. Mortality rates of parents within the same-sex parent-child dyad were compared with mortality rates of parents within the opposite-sex parent-child dyad. Separate analyses were performed for bereaved fathers and for bereaved mothers, and additional analyses were conducted to examine the sole effect of the child's sex, irrespective of parental gender. A Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) with 95% CIs. The study population consisted of 21,062 parents (mean age at entry, 32 years; 11,221 mothers, 9841 fathers). Bereaved parents who had lost a child of the same sex had similar overall mortality as bereaved parents who had lost a child of the opposite sex (HR = 1.02; 95% CI, 0.85-1.22). Similar findings were observed for mortality due to natural death (HR = 0.96; 95% CI, 0.78-1.18) or mortality due to unnatural death (HR = 1.22; 95% CI, 0.84-1.77). Bereaved fathers who had lost a son had similar mortality as those bereaved by the death of a daughter (HR = 1.10; 95% CI, 0.86-1.40). Bereaved mothers who had lost a daughter had similar mortality as those bereaved by the death of a son (HR = 0.93; 95% CI, 0.70-1.22). Bereaved parents who had lost a son had mortality rates similar to those who had lost a daughter (HR = 1.09; 95% CI, 0.91-1.31). The interactions between grouping variable and sex of parents were not significant, indicating that the differential effect of losing a child based on sex of the child was not greater for fathers than for mothers. The results of this study revealed no significant effect of sex of the deceased child on mortality in these bereaved parents. The results might differ if this study was replicated in a population with a different grief culture and, more importantly, different gender schemas. Copyright 2010. Published by Elsevier Inc.

Effects of economic downturns on child mortality: a global economic analysis, 1981–2010

PubMed Central

Maruthappu, Mahiben; Watson, Robert A; Watkins, Johnathan; Zeltner, Thomas; Raine, Rosalind; Atun, Rifat

2017-01-01

Objectives To analyse how economic downturns affect child mortality both globally and among subgroups of countries of variable income levels. Design Retrospective observational study using economic data from the World Bank's Development Indicators and Global Development Finance (2013 edition). Child mortality data were sourced from the Institute for Health Metrics and Evaluation. Setting Global. Participants 204 countries between 1981 and 2010. Main outcome measures Child mortality, controlling for country-specific differences in political, healthcare, cultural, structural, educational and economic factors. Results 197 countries experienced at least 1 economic downturn between 1981 and 2010, with a mean of 7.97 downturns per country (range 0–21; SD 0.45). At the global level, downturns were associated with significant (p<0.0001) deteriorations in each child mortality measure, in comparison with non-downturn years: neonatal (coefficient: 1.11, 95% CI 0.855 to 1.37), postneonatal (2.00, 95% CI 1.61 to 2.38), child (2.93, 95% CI 2.26 to 3.60) and under 5 years of age (5.44, 95% CI 4.31 to 6.58) mortality rates. Stronger (larger falls in the growth rate of gross domestic product/capita) and longer (lasting 2 years rather than 1) downturns were associated with larger significant deteriorations (p<0.001). During economic downturns, countries in the poorest quartile experienced ∼1½ times greater deterioration in neonatal mortality, compared with their own baseline; a 3-fold deterioration in postneonatal mortality; a 9-fold deterioration in child mortality and a 3-fold deterioration in under-5 mortality, than countries in the wealthiest quartile (p<0.0005). For 1–5 years after downturns ended, each mortality measure continued to display significant deteriorations (p<0.0001). Conclusions Economic downturns occur frequently and are associated with significant deteriorations in child mortality, with worse declines in lower income countries. PMID:28589010

Paternal smoking and increased risk of infant and under-5 child mortality in Indonesia.

PubMed

Semba, Richard D; de Pee, Saskia; Sun, Kai; Best, Cora M; Sari, Mayang; Bloem, Martin W

2008-10-01

We examined the relationship between paternal smoking and child mortality. Among 361,021 rural and urban families in Indonesia, paternal smoking was associated with increased infant mortality (rural, odds ratio [OR] = 1.30; 95% confidence interval [CI] = 1.24, 1.35; urban, OR = 1.10; 95% CI = 1.01, 1.20), and under-5 child mortality (rural, OR = 1.32; 95% CI = 1.26, 1.37; urban, OR = 1.14; 95% CI = 1.05, 1.23). Paternal smoking diverts money from basic necessities to cigarettes and adversely affects child health; tobacco control should therefore be considered among strategies to improve child survival.

Is there an urban advantage in child survival in sub-saharan Africa? Evidence from 18 countries in the 1990s.

PubMed

Bocquier, Philippe; Madise, Nyovani Janet; Zulu, Eliya Msiyaphazi

2011-05-01

Evidence of higher child mortality of rural-to-urban migrants compared with urban nonmigrants is growing. However, less attention has been paid to comparing the situation of the same families before and after they migrate with the situation of urban-to-rural migrants. We use DHS data from 18 African countries to compare child mortality rates of six groups based on their mothers' migration status: rural nonmigrants; urban nonmigrants; rural-to-urban migrants before and after they migrate; and urban-to-rural migrants before and after they migrate. The results show that rural-to-urban migrants had, on average, lower child mortality before they migrated than rural nonmigrants, and that their mortality levels dropped further after they arrived in urban areas. We found no systematic evidence of higher child mortality for rural-to-urban migrants compared with urban nonmigrants. Urban-to-rural migrants had higher mortality in the urban areas, and their move to rural areas appeared advantageous because they experienced lower or similar child mortality after living in rural areas. After we control for known demographic and socioeconomic correlates of under-5 mortality, the urban advantage is greatly reduced and sometimes reversed. The results suggest that it may not be necessarily the place of residence that matters for child survival but, rather, access to services and economic opportunities.

The association between household bed net ownership and all-cause child mortality in Madagascar.

PubMed

Meekers, Dominique; Yukich, Joshua O

2016-09-17

Malaria continues to be an important cause of morbidity and mortality in Madagascar. It has been estimated that the malaria burden costs Madagascar over $52 million annually in terms of treatment costs, lost productivity and prevention expenses. One of the key malaria prevention strategies of the Government of Madagascar consists of large-scale mass distribution campaigns of long-lasting insecticide-treated bed nets (LLIN). Although there is ample evidence that child mortality has decreased in Madagascar, it is unclear whether increases in LLIN ownership have contributed to this decline. This study analyses multiple recent cross-sectional survey data sets to examine the association between household bed net ownership and all-cause child mortality. Data on household-level bed net ownership confirm that the percentage of households that own one or more bed nets increased substantially following the 2009 and 2010 mass LLIN distribution campaigns. Additionally, all-cause child mortality in Madagascar has declined during the period 2008-2013. Bed net ownership was associated with a 22 % reduction in the all-cause child mortality hazard in Madagascar. Mass bed net distributions contributed strongly to the overall decline in child mortality in Madagascar during the period 2008-2013. However, the decline was not solely attributable to increases in bed net coverage, and nets alone were not able to eliminate most of the child mortality hazard across the island.

Government health care spending and child mortality.

PubMed

Maruthappu, Mahiben; Ng, Ka Ying Bonnie; Williams, Callum; Atun, Rifat; Zeltner, Thomas

2015-04-01

Government health care spending (GHS) is of increasing importance to child health. Our study determined the relationship between reductions in GHS and child mortality rates in high- and low-income countries. The authors used comparative country-level data for 176 countries covering the years 1981 to 2010, obtained from the World Bank and the Institute for Health Metrics and Evaluation. Multivariate regression analysis was used to determine the association between changes in GHS and child mortality, controlling for differences in infrastructure and demographics. Data were available for 176 countries, equating to a population of ∼ 5.8 billion as of 2010. A 1% decrease in GHS was associated with a significant increase in 4 child mortality measures: neonatal (regression coefficient [R] 0.0899, P = .0001, 95% confidence interval [CI] 0.0440-0.1358), postneonatal (R = 0.1354, P = .0001, 95% CI 0.0678-0.2030), 1- to 5-year (R = 0.3501, P < .0001, 95% CI 0.2318-0.4685), and under 5-year (R = 0.5207, P < .0001, 95% CI 0.3168-0.7247) mortality rates. The effect was evident up to 5 years after the reduction in GHS (P < .0001). Compared with high-income countries, low-income countries experienced greater deteriorations of ∼ 1.31 times neonatal mortality, 2.81 times postneonatal mortality, 8.08 times 1- to 5-year child mortality, and 2.85 times under 5-year mortality. Reductions in GHS are associated with significant increases in child mortality, with the largest increases occurring in low-income countries. Copyright © 2015 by the American Academy of Pediatrics.

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

PubMed Central

Perry, Henry B; Rassekh, Bahie M; Gupta, Sundeep; Freeman, Paul A

2017-01-01

Background There is limited evidence about the long–term effectiveness of integrated community–based primary health care (CBPHC) in improving maternal, neonatal and child health. However, the interventions implemented and the approaches used by projects with such evidence can provide guidance for ending preventable child and maternal deaths by the year 2030. Methods A database of 700 assessments of the effectiveness of CBPHC in improving maternal, neonatal and child health has been assembled, as described elsewhere in this series. A search was undertaken of these assessments of research studies, field project and programs (hereafter referred to as projects) with more than a single intervention that had evidence of mortality impact for a period of at least 10 years. Four projects qualified for this analysis: the Matlab Maternal Child Health and Family Planning (MCH–FP) P in Bangladesh; the Hôpital Albert Schweitzer in Deschapelles, Haiti; the Comprehensive Rural Health Project (CRHP) in Jamkhed, India; and the Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, India. Results These four projects have all been operating for more than 30 years, and they all have demonstrated reductions in infant mortality, 1– to 4–year mortality, or under–5 mortality for at least 10 years. They share a number of characteristics. Among the most notable of these are: they provide comprehensive maternal, child health and family planning services, they have strong community–based programs that utilize community health workers who maintain regular contact with all households, they have develop strong collaborations with the communities they serve, and they all have strong referral capabilities and provide first–level hospital care. Conclusions The shared features of these projects provide guidance for how health systems around the world might improve their effectiveness in improving maternal, neonatal and child health. Strengthening these features will contribute to achieving the goal of ending preventable child and maternal deaths by the year 2030. PMID:28685045

Child Mortality: A Preventable Tragedy.

ERIC Educational Resources Information Center

Seipel, Michael M. O.

1996-01-01

Worldwide data reveal that child mortality (ages 1-5) accounts for about 10-15% of all deaths in developing countries, and less than 1% of all deaths in developed countries. Strategies for reducing child mortality include improving health services, improving environmental conditions, enhancing the social conditions of children, and protecting and…

Child Mortality in a Developing Country: A Statistical Analysis

ERIC Educational Resources Information Center

Uddin, Md. Jamal; Hossain, Md. Zakir; Ullah, Mohammad Ohid

2009-01-01

This study uses data from the "Bangladesh Demographic and Health Survey (BDHS] 1999-2000" to investigate the predictors of child (age 1-4 years) mortality in a developing country like Bangladesh. The cross-tabulation and multiple logistic regression techniques have been used to estimate the predictors of child mortality. The…

LiST modelling with monitoring data to estimate impact on child mortality of an ORS and zinc programme with public sector providers in Bihar, India.

PubMed

Ayyanat, Jayachandran A; Harbour, Catherine; Kumar, Sanjeev; Singh, Manjula

2018-01-05

Many interventions have attempted to increase vulnerable and remote populations' access to ORS and zinc to reduce child mortality from diarrhoea. However, the impact of these interventions is difficult to measure. From 2010 to 15, Micronutrient Initiative (MI), worked with the public sector in Bihar, India to enable community health workers to treat and report uncomplicated child diarrhoea with ORS and zinc. We describe how we estimated programme's impact on child mortality with Lives Saved Tool (LiST) modelling and data from MI's management information system (MIS). This study demonstrates that using LiST modelling and MIS data are viable options for evaluating programmes to reduce child mortality. We used MI's programme monitoring data to estimate coverage rates and LiST modelling software to estimate programme impact on child mortality. Four scenarios estimated the effects of different rates of programme scale-up and programme coverage on estimated child mortality by measuring children's lives saved. The programme saved an estimated 806-975 children under-5 who had diarrhoea during five-year project phase. Increasing ORS and zinc coverage rates to 19.8% & 18.3% respectively under public sector coverage with effective treatment would have increased the programme's impact on child mortality and could have achieved the project goal of saving 4200 children's lives during the five-year programme. Programme monitoring data can be used with LiST modelling software to estimate coverage rates and programme impact on child mortality. This modelling approach may cost less and yield estimates sooner than directly measuring programme impact with population-based surveys. However, users must be cautious about relying on modelled estimates of impact and ensure that the programme monitoring data used is complete and precise about the programme aspects that are modelled. Otherwise, LiST may mis-estimate impact on child mortality. Further, LiST software may require modifications to its built-in assumptions to capture programmatic inputs. LiST assumes that mortality rates and cause of death structure change only in response to changes in programme coverage. In Bihar, overall child mortality has decreased and diarrhoea seems to be less lethal than previously, but at present LiST does not adjust its estimates for these sorts of changes.

Survival of HIV-infected children: A cohort study from the Asia-Pacific region

PubMed Central

Lumbiganon, Pagakrong; Kariminia, Azar; Aurpibul, Linda; Hansudewechakul, Rawiwan; Puthanakit, Thanyawee; Kurniati, Nia; Kumarasamy, Nagalingeswaran; Chokephaibulkit, Kulkanya; Yusoff, Nik Khairulddin Nik; Vonthanak, Saphonn; Moy, Fong Siew; Razali, Kamarul Azahar Mohd; Nallusamy, Revathy; Sohn, Annette H.

2010-01-01

Background Combination antiretroviral therapy (ART) has been used for HIV-infected children in many Asian countries since 2002. This study describes survival outcomes among HIV-infected children in a multicenter regional cohort in Asia. Patients and Methods Retrospective and prospective data collected through March 2009 from children in five countries enrolled in TREAT Asia's Pediatric HIV Observational Database (TApHOD) were analysed. Multivariate Cox proportional hazard models were used to assess factors associated with mortality in children who received ART. Results Among 2280 children, 1752 (77%) had received ART. During a median follow up of 3.1 years after ART, 115 (6.6%) deaths occurred, giving a crude mortality rate of 1.9 per 100 child-years (95% CI, 1.6-2.4). The mortality rate was highest in the first three months of ART (10.2 per 100 child-years; 95% CI, 7.5-13.7) and declined after 12 months (0.9 per 100 child-years; 95% CI, 0.7-1.3). Those with a low recent CD4 percentage, who started ART with lower baseline weight-for-age z-score, or with WHO clinical stage 4 had an increased risk of death. Of 528 (23%) children who never received ART, 36 (6.8%) died after presenting to care, giving a crude mortality rate of 4.1 per 100 child-years (95% CI 3.0-5.7), with a lost-to-program rate of 31.5 per 100 child-years (95% CI, 28.0-35.5). Conclusion The high mortality during the first three months of ART and in those with low CD4 percentage support the implementation of early diagnosis and ART initiation. PMID:21160429

Levels, trends & predictors of infant & child mortality among Scheduled Tribes in rural India.

PubMed

Sahu, Damodar; Nair, Saritha; Singh, Lucky; Gulati, B K; Pandey, Arvind

2015-05-01

The level of infant and child mortality is high among Scheduled Tribes particularly those living in rural areas. This study examines levels, trends and socio-demographic factors associated with infant and child mortality among Scheduled Tribes in rural areas. Data from the three rounds of the National Family Health Survey (NFHS) of India from 1992 to 2006 were analysed to assess the levels and trends of infant and child mortality. Univariate and multivariate Cox proportional hazard model were used to understand the socio-economic and demographic factors associated with mortality during 1992-2006. Significant change was observed in infant and child mortality over the time period from 1992-2006 among Scheduled Tribes in rural areas. After controlling for other factors, birth interval, household wealth, and region were found to be significantly associated with infant and child mortality. Hazard of infant mortality was highest among births to mothers aged 30 yr or more (HR=1.3, 95% CI=1.1-1.7) as compared with births to the mother's aged 20-29 yr. Hazard of under-five mortality was 42 per cent (95% CI=1.3-1.6) higher among four or more birth order compared with the first birth order. The risk of infant dying was higher among male children (HR = 1.2, 95% CI=1.1-1.4) than among female children while male children were at 30 per cent (HR=0.7, 95% CI=0.6-0.7) less hazard of child mortality than female children. Literate women were at 40 per cent (HR=0.6, 95% CI=0.50-0.76) less hazard of child death than illiterate women. Mortality differentials by socio-demographic and economic factors were observed over the time period (1992-2006) among Scheduled Tribes (STs) in rural India. Findings support the need to focus on age at first birth and spacing between two births.

Remaining missed opportunities of child survival in Peru: modelling mortality impact of universal and equitable coverage of proven interventions.

PubMed

Tam, Yvonne; Huicho, Luis; Huayanay-Espinoza, Carlos A; Restrepo-Méndez, María Clara

2016-10-04

Peru has made great improvements in reducing stunting and child mortality in the past decade, and has reached the Millennium Development Goals 1 and 4. The remaining challenges or missed opportunities for child survival needs to be identified and quantified, in order to guide the next steps to further improve child survival in Peru. We used the Lives Saved Tool (LiST) to project the mortality impact of proven interventions reaching every women and child in need, and the mortality impact of eliminating inequalities in coverage distribution between wealth quintiles and urban-rural residence. Our analyses quantified the remaining missed opportunities in Peru, where prioritizing scale-up of facility-based case management for all small and sick babies will be most effective in mortality reduction, compared to other evidenced-based interventions that prevent maternal and child deaths. Eliminating coverage disparities between the poorest quintiles and the richest will reduce under-five and neonatal mortality by 22.0 and 40.6 %, while eliminating coverage disparities between those living in rural and urban areas will reduce under-five and neonatal mortality by 29.3 and 45.2 %. This projected neonatal mortality reduction achieved by eliminating coverage disparities is almost comparable to that already achieved by Peru over the past decade. Although Peru has made great strides in improving child survival, further improvement in child health, especially in newborn health can be achieved if there is universal and equitable coverage of proven, quality health facility-based interventions. The magnitude of reduction in mortality will be similar to what has been achieved in the past decade. Strengthening health system to identify, understand, and direct resources to the poor and rural areas will ensure that Peru achieve the Sustainable Development Goals by 2030.

Fine and Gray competing risk regression model to study the cause-specific under-five child mortality in Bangladesh.

PubMed

Mohammad, Khandoker Akib; Fatima-Tuz-Zahura, Most; Bari, Wasimul

2017-01-28

The cause-specific under-five mortality of Bangladesh has been studied by fitting cumulative incidence function (CIF) based Fine and Gray competing risk regression model (1999). For the purpose of analysis, Bangladesh Demographic and Health Survey (BDHS), 2011 data set was used. Three types of mode of mortality for the under-five children are considered. These are disease, non-disease and other causes. Product-Limit survival probabilities for the under-five child mortality with log-rank test were used to select a set of covariates for the regression model. The covariates found to have significant association in bivariate analysis were only considered in the regression analysis. Potential determinants of under-five child mortality due to disease is size of child at birth, while gender of child, NGO (non-government organization) membership of mother, mother's education level, and size of child at birth are due to non-disease and age of mother at birth, NGO membership of mother, and mother's education level are for the mortality due to other causes. Female participation in the education programs needs to be increased because of the improvement of child health and government should arrange family and social awareness programs as well as health related programs for women so that they are aware of their child health.

Development assistance for health in central and eastern European Region.

PubMed Central

Suhrcke, Marc; Rechel, Bernd; Michaud, Catherine

2005-01-01

OBJECTIVE: We aimed to quantify development assistance for health to countries of central and eastern Europe and the Commonwealth of Independent States (CEE-CIS). METHODS: We used the International Development Statistics database of the Organisation for Economic Co-operation and Development and the database on development assistance for health compiled for the Commission on Macroeconomics and Health to quantify health development assistance to the region, compared to global and overall development assistance. We based our analysis on standard health indicators, including child mortality, life expectancy at birth and health expenditures. FINDINGS: Although total development assistance per capita to CEE-CIS was higher than that for most other regions of the world, development assistance for health was very low compared to other countries with similar levels of child mortality, life expectancy at birth and national expenditures on health. CONCLUSION: The allocation of development assistance for health on a global scale seems to be related far more to child mortality rather than adult mortality. Countries of CEE-CIS have a high burden of adult morbidity and mortality from non-communicable diseases, which does not appear to attract proportionate development assistance. Levels of development assistance for health should be determined in consideration of the region's particular burden of disease. PMID:16462984

Monitoring child mortality through community health worker reporting of births and deaths in Malawi: validation against a household mortality survey.

PubMed

Amouzou, Agbessi; Banda, Benjamin; Kachaka, Willie; Joos, Olga; Kanyuka, Mercy; Hill, Kenneth; Bryce, Jennifer

2014-01-01

The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed where accurate vital registration data are lacking to help governments assess and report on progress in child survival. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially trained community health workers (CHWs) in Malawi. Government-employed community health workers in Malawi are responsible for maintaining a Village Health Register, in which they record births and deaths that occur in their catchment area. We expanded on this system to provide additional training, supervision and incentives. We tested the equivalence between child mortality rates obtained from data on births and deaths collected by 160 randomly-selected and trained CHWs over twenty months in two districts to those computed through a standard household mortality survey. CHW reports produced an under-five mortality rate that was 84% (95%CI: [0.71,1.00]) of the household survey mortality rate and statistically equivalent to it. However, CHW data consistently underestimated under-five mortality, with levels of under-estimation increasing over time. Under-five deaths were more likely to be missed than births. Neonatal and infant deaths were more likely to be missed than older deaths. This first test of the accuracy and completeness of vital events data reported by CHWs in Malawi as a strategy for monitoring child mortality shows promising results but underestimated child mortality and was not stable over the four periods assessed. Given the Malawi government's commitment to strengthen its vital registration system, we are working with the Ministry of Health to implement a revised version of the approach that provides increased support to CHWs.

Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

PubMed Central

Wang, Haidong; Liddell, Chelsea A; Coates, Matthew M; Mooney, Meghan D; Levitz, Carly E; Schumacher, Austin E; Apfel, Henry; Iannarone, Marissa; Phillips, Bryan; Lofgren, Katherine T; Sandar, Logan; Dorrington, Rob E; Rakovac, Ivo; Jacobs, Troy A; Liang, Xiaofeng; Zhou, Maigeng; Zhu, Jun; Yang, Gonghuan; Wang, Yanping; Liu, Shiwei; Li, Yichong; Ozgoren, Ayse Abbasoglu; Abera, Semaw Ferede; Abubakar, Ibrahim; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Alemu, Zewdie Aderaw; Allen, Peter J; AlMazroa, Mohammad AbdulAziz; Alvarez, Elena; Amankwaa, Adansi A; Amare, Azmeraw T; Ammar, Walid; Anwari, Palwasha; Cunningham, Solveig Argeseanu; Asad, Majed Masoud; Assadi, Reza; Banerjee, Amitava; Basu, Sanjay; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L; Bhutta, Zulfiqar; Blore, Jed; Basara, Berrak Bora; Boufous, Soufiane; Breitborde, Nicholas; Bruce, Nigel G; Bui, Linh Ngoc; Carapetis, Jonathan R; Cárdenas, Rosario; Carpenter, David O; Caso, Valeria; Castro, Ruben Estanislao; Catalá-Lopéz, Ferrán; Cavlin, Alanur; Che, Xuan; Chiang, Peggy Pei-Chia; Chowdhury, Rajiv; Christophi, Costas A; Chuang, Ting-Wu; Cirillo, Massimo; Leite, Iuri da Costa; Courville, Karen J; Dandona, Lalit; Dandona, Rakhi; Davis, Adrian; Dayama, Anand; Deribe, Kebede; Dharmaratne, Samath D; Dherani, Mukesh K; Dilmen, Uğur; Ding, Eric L; Edmond, Karen M; Ermakov, Sergei Petrovich; Farzadfar, Farshad; Fereshtehnejad, Seyed-Mohammad; Fijabi, Daniel Obadare; Foigt, Nataliya; Forouzanfar, Mohammad H; Garcia, Ana C; Geleijnse, Johanna M; Gessner, Bradford D; Goginashvili, Ketevan; Gona, Philimon; Goto, Atsushi; Gouda, Hebe N; Green, Mark A; Greenwell, Karen Fern; Gugnani, Harish Chander; Gupta, Rahul; Hamadeh, Randah Ribhi; Hammami, Mouhanad; Harb, Hilda L; Hay, Simon; Hedayati, Mohammad T; Hosgood, H Dean; Hoy, Damian G; Idrisov, Bulat T; Islami, Farhad; Ismayilova, Samaya; Jha, Vivekanand; Jiang, Guohong; Jonas, Jost B; Juel, Knud; Kabagambe, Edmond Kato; Kazi, Dhruv S; Kengne, Andre Pascal; Kereselidze, Maia; Khader, Yousef Saleh; Khalifa, Shams Eldin Ali Hassan; Khang, Young-Ho; Kim, Daniel; Kinfu, Yohannes; Kinge, Jonas M; Kokubo, Yoshihiro; Kosen, Soewarta; Defo, Barthelemy Kuate; Kumar, G Anil; Kumar, Kaushalendra; Kumar, Ravi B; Lai, Taavi; Lan, Qing; Larsson, Anders; Lee, Jong-Tae; Leinsalu, Mall; Lim, Stephen S; Lipshultz, Steven E; Logroscino, Giancarlo; Lotufo, Paulo A; Lunevicius, Raimundas; Lyons, Ronan Anthony; Ma, Stefan; Mahdi, Abbas Ali; Marzan, Melvin Barrientos; Mashal, Mohammad Taufiq; Mazorodze, Tasara T; McGrath, John J; Memish, Ziad A; Mendoza, Walter; Mensah, George A; Meretoja, Atte; Miller, Ted R; Mills, Edward J; Mohammad, Karzan Abdulmuhsin; Mokdad, Ali H; Monasta, Lorenzo; Montico, Marcella; Moore, Ami R; Moschandreas, Joanna; Msemburi, William T; Mueller, Ulrich O; Muszynska, Magdalena M; Naghavi, Mohsen; Naidoo, Kovin S; Narayan, KM Venkat; Nejjari, Chakib; Ng, Marie; Ngirabega, Jean de Dieu; Nieuwenhuijsen, Mark J; Nyakarahuka, Luke; Ohkubo, Takayoshi; Omer, Saad B; Caicedo, Angel J Paternina; Wyk, Victoria Pillay-van; Pope, Dan; Prabhakaran, Dorairaj; Rahman, Sajjad UR; Rana, Saleem M; Reilly, Robert Quentin; Rojas-Rueda, David; Ronfani, Luca; Rushton, Lesley; Saeedi, Mohammad Yahya; Salomon, Joshua; Sampson, Uchechukwu; Santos, Itamar S; Sawhney, Monika; Schmidt, Jürgen C; Nazarova, Marina Shakh; She, Jun; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin Hyun; Shishani, Kawkab; Shiue, Ivy; Sigfusdottir, Inga Dora; Singh, Jasvinder A; Skirbekk, Vegard; Sliwa, Karen; Soshnikov, Sergey S; Sposato, Luciano A; Stathopoulou, Vasiliki Kalliopi; Stroumpoulis, Konstantinos; Tabb, Karen M; Talongwa, Roberto Tchio; Teixeira, Carolina Maria; Terkawi, Abdullah Sulieman; Thomson, Alan J; Lyman, Andrew L Thorne; Toyoshima, Hideaki; Dimbuene, Zacharie Tsala; Uwaliraye, Parfait; Uzun, Selen Begüm; Vasankari, Tommi J; Vasconcelos, Ana Maria Nogales; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Vos, Theo; Waller, Stephen; Wan, Xia; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Westerman, Ronny; Wilkinson, James D; Williams, Hywel C; Yang, Yang C; Yentur, Gokalp Kadri; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa; Yu, Chuanhua; Jin, Kim Yun; Zaki, Maysaa El Sayed; Zhu, Shankuan; Lopez, Alan D; Murray, Christopher J L

2014-01-01

Summary Background Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. Methods We generated updated estimates of child mortality in early neonatal (age 0–6 days), late neonatal (7–28 days), postneonatal (29–364 days), childhood (1–4 years), and under-5 (0–4 years) age groups for 188 countries from 1970 to 2013, with more than 29 000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. Findings We estimated that 6·3 million (95% UI 6·0–6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1–18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6–177·4) in Guinea-Bissau to 2·3 (1·8–2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from −6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000–13 than during 1990–2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only −1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. Interpretation Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. Funding Bill & Melinda Gates Foundation, US Agency for International Development. PMID:24797572

Modeling the Impact of Breast-Feeding by HIV-Infected Women on Child Survival.

ERIC Educational Resources Information Center

Heymann, Sally Jody

1990-01-01

Models the survival outcomes of children in developing countries born to women infected with human immunodeficiency virus (HIV) who are breast-fed, bottle-fed, and wet-nursed. Uses decision analysis to assess the relative risk of child mortality from HIV transmission and non-HIV causes associated with different methods of feeding. (FMW)

Fertility response to child survival in Nigeria: an analysis of microdata from Bendel State.

PubMed

Okojie, C E

1991-01-01

A researcher used data on 2145 15-50 year old ever married women from a 1985 fertility survey in Bendel State, Nigeria to estimate fertility response to own child survival. For 35-50 year old women, fertility fell steadily with higher levels of education even when she controlled for the age education interaction. Education did not have a significant effect for younger women, however. Yet husband's education had a significant positive effect on fertility. Further the proportion of surviving children (the survival ratio) was negatively associated with fertility for all women and for all age groups, especially 25-34 year old women. The fact that the survival ratio was still negatively associated with fertility for women =or+ 35 years old suggested that women adjusted to their own experience of child mortality by the end of childbearing. Further it implied that a rise in child survival would inevitably lower fertility. The researcher then compared the fertility behavior of rural and urban women in terms of child survival. Since the survival rate was significant for rural women, it is suggested that own child survival had a considerable influence on fertility behavior. For urban women, however, it was significant perhaps because access to water did not differ much in the urban sample or account for child mortality. Own child mortality was 36.7% for rural women compared to 23.7% for urban women. The stronger reproductive response among older women and among rural women implied that behavior factors had a stronger role in the reproductive response than biological factors. These results suggested that own child mortality and community mortality may be more important than national average mortality. Further research on aggregate mortality trends and individual child survival experience and their link to individual reproductive behavior in Nigeria are needed.

[Fertility and health in Mexico].

PubMed

Urbina-Fuentes, M; Echánove-Fernández, E

1989-01-01

Fertility, health, and family planning are not independent factors, but rather involve a series of biological and social mechanisms in close interaction with one another. The impact that a high fertility rate has on health is reflected mainly in a rise in the rates of maternal and child mortality. Similarly, fertility has a greater negative effect upon the health of groups characterized by high reproductive risk, high parity, short intergenesic intervals, and unwanted pregnancies. On the other hand, family planning -and specifically the use of contraceptive methods-helps to achieve a lowering of the fertility rate and also has a positive effect on maternal-child health. This situation can be observed in the case of Mexico, where fertility rates and tendencies, as well as maternal and child mortality, have been reduced during the past decade.

Stagnant Neonatal Mortality and Persistent Health Inequality in Middle-Income Countries: A Case Study of the Philippines

PubMed Central

Kraft, Aleli D.; Nguyen, Kim-Huong; Jimenez-Soto, Eliana; Hodge, Andrew

2013-01-01

Background The probability of survival through childhood continues to be unequal in middle-income countries. This study uses data from the Philippines to assess trends in the prevalence and distribution of child mortality and to evaluate the country’s socioeconomic-related child health inequality. Methodology Using data from four Demographic and Health Surveys we estimated levels and trends of neonatal, infant, and under-five mortality from 1990 to 2007. Mortality estimates at national and subnational levels were produced using both direct and indirect methods. Concentration indices were computed to measure child health inequality by wealth status. Multivariate regression analyses were used to assess the contribution of interventions and socioeconomic factors to wealth-related inequality. Findings Despite substantial reductions in national under-five and infant mortality rates in the early 1990s, the rates of declines have slowed in recent years and neonatal mortality rates remain stubbornly high. Substantial variations across urban-rural, regional, and wealth equity-markers are evident, and suggest that the gaps between the best and worst performing sub-populations will either be maintained or widen in the future. Of the variables tested, recent wealth-related inequalities are found to be strongly associated with social factors (e.g. maternal education), regional location, and access to health services, such as facility-based delivery. Conclusion The Philippines has achieved substantial progress towards Millennium Development Goal 4, but this success masks substantial inequalities and stagnating neonatal mortality trends. This analysis supports a focus on health interventions of high quality – that is, not just facility-based delivery, but delivery by trained staff at well-functioning facilities and supported by a strong referral system – to re-start the long term decline in neonatal mortality and to reduce persistent within-country inequalities in child health. PMID:23308278

Space-Time Smoothing of Complex Survey Data: Small Area Estimation for Child Mortality.

PubMed

Mercer, Laina D; Wakefield, Jon; Pantazis, Athena; Lutambi, Angelina M; Masanja, Honorati; Clark, Samuel

2015-12-01

Many people living in low and middle-income countries are not covered by civil registration and vital statistics systems. Consequently, a wide variety of other types of data including many household sample surveys are used to estimate health and population indicators. In this paper we combine data from sample surveys and demographic surveillance systems to produce small area estimates of child mortality through time. Small area estimates are necessary to understand geographical heterogeneity in health indicators when full-coverage vital statistics are not available. For this endeavor spatio-temporal smoothing is beneficial to alleviate problems of data sparsity. The use of conventional hierarchical models requires careful thought since the survey weights may need to be considered to alleviate bias due to non-random sampling and non-response. The application that motivated this work is estimation of child mortality rates in five-year time intervals in regions of Tanzania. Data come from Demographic and Health Surveys conducted over the period 1991-2010 and two demographic surveillance system sites. We derive a variance estimator of under five years child mortality that accounts for the complex survey weighting. For our application, the hierarchical models we consider include random effects for area, time and survey and we compare models using a variety of measures including the conditional predictive ordinate (CPO). The method we propose is implemented via the fast and accurate integrated nested Laplace approximation (INLA).

Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages

PubMed Central

2012-01-01

Background Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. Methods We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. Results In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of −0.11 (maternal) and −0.12 (children) to a more equitable concentration index of −0,03 and −0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Conclusions Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs. PMID:23270489

The impact of antenatal care, iron–folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh

PubMed Central

Abir, Tanvir; Ogbo, Felix Akpojene; Stevens, Garry John; Page, Andrew Nicolas; Milton, Abul Hasnat; Agho, Kingsley Emwinyore

2017-01-01

Background Appropriate antenatal care (ANC) is an important preventive public health intervention to ensure women’s and newborn health outcomes. The study aimed to investigate the impact of ANC, iron–folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh. Method A cross-sectional study of three datasets from the Bangladesh Demographic and Health Surveys for the years 2004, 2007 and 2011 were pooled and used for the analyses. A total weighted sample of 16,721 maternal responses (5,364 for 2004; 4,872 for 2007 and 6,485 for 2011) was used. Multivariate logistic models that adjusted for cluster and sampling weights were used to examine the impact of ANC, IFA supplementation and TT vaccination during pregnancy on the death of a child aged 0–28 days (neonatal), 1–11 months (post-neonatal) and 12–59 months (child). Results Multivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had ANC [Odds Ratio (OR) = 0.60, 95% confidence interval (95% CI): 0.43–0.85], IFA supplementation [OR = 0.66, 95% CI: (0.45–0.98)] and ≥2 TT vaccinations (OR = 0.43, 95% CI: 0.49–0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51–0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48–0.94) and ≥2 TT vaccinations (OR = 0.50, 95% CI: 0.36–0.69). When combined, TT vaccination with IFA supplementation, and TT vaccination without IFA supplementation were protective across all groups. Conclusion The study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh. The findings suggest that considerable gains in improving child survival could be achieved through ensuring universal coverage of ANC, promoting TT vaccination during pregnancy and IFA supplementation among pregnant women in Bangladesh. PMID:29091923

Female circumcision and child mortality in urban Somalia.

PubMed

Mohamud, O A

1991-01-01

In Somalia, a demographer analyzed urban data obtained from the Family Health Survey to examine the effect female circumcision has on child mortality and the mechanism of that effect. Girls undergo female circumcision between 5-12 years old in Somalia. Since sunni circumcision (removal of the clitoral prepuce and tip of the clitoris) and clitoridectomy (removal of the entire clitoris) did not affect child mortality, he used them as the reference group. Infibulation (entire removal of the clitoris and of the labia minora and majora with the remains of the labia majora being sewn together allowing only a small opening for passage of urine) did affect child mortality. Female children who underwent infibulation and whose mothers most likely also underwent infibulation experienced higher mortality (13-72%) than those from other circumcised mothers. Female mortality exceeded male mortality indicating possible son preference. Mothers with clitoridectomy or infibulation had significantly higher infant mortality than those with sunni circumcision with the strongest effects during the neonatal period (95% and 42% higher mortality, respectively; p=.01). The effect of female circumcision on child mortality decreased with increased child's age. This higher than expected mortality among women with clitoridectomy may have been because women with infibulation had more stillbirths which were not counted as births. The exposed vagina of clitoridectomized women is more likely to be infected resulting in high risk of stillbirths and premature births than the closed vagina of infibulated women. The researcher suggested that the policies promoting education and consciousness raising may eventually eradicate female circumcision. This longterm campaign should use mass media, senior women of high status, and respected religious leaders. Legislation prohibiting this practice would only drive it underground under unsanitary conditions. Demographers should no longer ignore female circumcision's effect on mortality and other demographic variables.

Fertility and Child Mortality: Issues in the Demographic Transition of a Migrant Population.

ERIC Educational Resources Information Center

Ben-Porath, Yoram

This paper reviews issues pertaining to the relationship between child mortality and fertility and examines the fertility-mortality relationship of women who emigrated to Israel from various countries in Asia, Africa, and Europe and continued child bearing in Israel. Data from the 1961 Israel census of population is used. Among issues addressed in…

Tackling Health Inequities in Chile: Maternal, Newborn, Infant, and Child Mortality Between 1990 and 2004

PubMed Central

Requejo, Jennifer Harris; Nien, Jyh Kae; Merialdi, Mario; Bustreo, Flavia; Betran, Ana Pilar

2009-01-01

Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged > 28 days and < 1 year), and children aged 1 to 4 years. We also calculated these statistics by 5-year intervals for Chile's poorest to richest district quintiles. Results. During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100 000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions. During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. PMID:19443831

Modelling determinants of child mortality and poverty in the Comoros.

PubMed

Lachaud, Jean-Pierre

2004-03-01

Based on the Demographic and Health Survey of the Comoros of 1996, the analysis of the determinants of child mortality reaches three conclusions. Firstly, differentiated analytical options generate partially convergent results and provide different dimensions of child mortality. Secondly, the study shows that the low standard of living of households in terms of assets is associated with high child mortality. Thirdly, the determinants of infant and infanto-juvenile mortality are relatively comparable. On the one hand, some common factors to both analytical options affect negatively child health: (i) geographical location in rural zones and/or on the islands of Anjouan and Mohéli; (ii) the low standard of living of households in terms of assets; (iii) some community elements, in particular morbidity, the insufficiency of vaccination and the absence of childbirth assisted by qualified persons. On the other hand, characteristics of mothers and births have an impact on infant and infanto-juvenile survival.

Maternal Reading Skills and Child Mortality in Nigeria: A Reassessment of Why Education Matters

PubMed Central

Smith-Greenaway, Emily

2013-01-01

Mother’s formal schooling—even at the primary level—is associated with lower risk of child mortality. It remains unclear why this is the case. This study examines whether mother’s reading skills help to explain the association in the context of Nigeria. Using data from the Demographic and Health Survey, the analysis demonstrates that women’s reading skills increase linearly with years of primary school; however many women with several years of formal school are unable to read at all. The results further show that mother’s reading skills help to explain the relationship between mother’s formal schooling and child mortality, and that mother’s reading skills are highly associated with child mortality. The study highlights the need for more data on literacy and for more research on whether and how mother’s reading skills lower child mortality in additional contexts. PMID:23592326

Effect of Investment in Malaria Control on Child Mortality in Sub-Saharan Africa in 2002–2008

PubMed Central

Akachi, Yoko; Atun, Rifat

2011-01-01

Background Around 8.8 million children under-five die each year, mostly due to infectious diseases, including malaria that accounts for 16% of deaths in Africa, but the impact of international financing of malaria control on under-five mortality in sub-Saharan Africa has not been examined. Methods and Findings We combined multiple data sources and used panel data regression analysis to study the relationship among investment, service delivery/intervention coverage, and impact on child health by observing changes in 34 sub-Saharan African countries over 2002–2008. We used Lives Saved Tool to estimate the number of lives saved from coverage increase of insecticide-treated nets (ITNs)/indoor residual spraying (IRS). As an indicator of outcome, we also used under-five mortality rate. Global Fund investments comprised more than 70% of the Official Development Assistance (ODA) for malaria control in 34 countries. Each $1 million ODA for malaria enabled distribution of 50,478 ITNs [95%CI: 37,774–63,182] in the disbursement year. 1,000 additional ITNs distributed saved 0.625 lives [95%CI: 0.369–0.881]. Cumulatively Global Fund investments that increased ITN/IRS coverage in 2002–2008 prevented an estimated 240,000 deaths. Countries with higher malaria burden received less ODA disbursement per person-at-risk compared to lower-burden countries ($3.90 vs. $7.05). Increased ITN/IRS coverage in high-burden countries led to 3,575 lives saved per 1 million children, as compared with 914 lives in lower-burden countries. Impact of ITN/IRS coverage on under-five mortality was significant among major child health interventions such as immunisation showing that 10% increase in households with ITN/IRS would reduce 1.5 [95%CI: 0.3–2.8] child deaths per 1000 live births. Conclusions Along with other key child survival interventions, increased ITNs/IRS coverage has significantly contributed to child mortality reduction since 2002. ITN/IRS scale-up can be more efficiently prioritized to countries where malaria is a major cause of child deaths to save greater number of lives with available resources. PMID:21738633

Reduction in child mortality in Ethiopia: analysis of data from demographic and health surveys.

PubMed

Doherty, Tanya; Rohde, Sarah; Besada, Donela; Kerber, Kate; Manda, Samuel; Loveday, Marian; Nsibande, Duduzile; Daviaud, Emmanuelle; Kinney, Mary; Zembe, Wanga; Leon, Natalie; Rudan, Igor; Degefie, Tedbabe; Sanders, David

2016-12-01

To examine changes in under-5 mortality, coverage of child survival interventions and nutritional status of children in Ethiopia between 2000 and 2011. Using the Lives Saved Tool, the impact of changes in coverage of child survival interventions on under-5 lives saved was estimated. Estimates of child mortality were generated using three Ethiopia Demographic and Health Surveys undertaken between 2000 and 2011. Coverage indicators for high impact child health interventions were calculated and the Lives Saved Tool (LiST) was used to estimate child lives saved in 2011. The mortality rate in children younger than 5 years decreased rapidly from 218 child deaths per 1000 live births (95% confidence interval 183 to 252) in the period 1987-1991 to 88 child deaths per 1000 live births in the period 2007-2011 (78 to 98). The prevalence of moderate or severe stunting in children aged 6-35 months also declined significantly. Improvements in the coverage of interventions relevant to child survival in rural areas of Ethiopia between 2000 and 2011 were found for tetanus toxoid, DPT3 and measles vaccination, oral rehydration solution (ORS) and care-seeking for suspected pneumonia. The LiST analysis estimates that there were 60 700 child deaths averted in 2011, primarily attributable to decreases in wasting rates (18%), stunting rates (13%) and water, sanitation and hygiene (WASH) interventions (13%). Improvements in the nutritional status of children and increases in coverage of high impact interventions most notably WASH and ORS have contributed to the decline in under-5 mortality in Ethiopia. These proximal determinants however do not fully explain the mortality reduction which is plausibly also due to the synergistic effect of major child health and nutrition policies and delivery strategies.

Comparing progress toward the millennium development goal for under-five mortality in León and Cuatro Santos, Nicaragua, 1990–2008

PubMed Central

2014-01-01

Background Social inequality in child survival hampers the achievement of Millennium Development Goal 4 (MDG4). Monitoring under-five mortality in different social strata may contribute to public health policies that strive to reduce social inequalities. This population-based study examines the trends, causes, and social inequality of mortality before the age of five years in rural and urban areas in Nicaragua. Methods The study was conducted in one rural (Cuatro Santos) and one urban/rural area (León) based on data from Health and Demographic Surveillance Systems. We analyzed live births from 1990 to 2005 in the urban/rural area and from 1990 to 2008 in the rural area. The annual average rate reduction (AARR) and social under-five mortality inequality were calculated using the education level of the mother as a proxy for socio-economic position. Causes of child death were based on systematic interviews (verbal autopsy). Results Under-five mortality in all areas is declining at a rate sufficient to achieve MDG4 by 2015. Urban León showed greater reduction (AARR = 8.5%) in mortality and inequality than rural León (AARR = 4.5%) or Cuatro Santos (AARR = 5.4%). Social inequality in mortality had increased in rural León and no improvement in survival was observed among mothers who had not completed primary school. However, the poor and remote rural area Cuatro Santos was on track to reach MDG4 with equitable child survival. Most of the deaths in both areas were due to neonatal conditions and infectious diseases. Conclusions All rural and urban areas in Nicaragua included in this study were on track to reach MDG4, but social stratification in child survival showed different patterns; unfavorable patterns with increasing inequity in the peri-urban rural zone and a more equitable development in the urban as well as the poor and remote rural area. An equitable progress in child survival may also be accelerated in very poor settings. PMID:24428933

Trends and social differentials in child mortality in Rwanda 1990-2010: results from three demographic and health surveys.

PubMed

Musafili, Aimable; Essén, Birgitta; Baribwira, Cyprien; Binagwaho, Agnes; Persson, Lars-Åke; Selling, Katarina Ekholm

2015-09-01

Rwanda has embarked on ambitious programmes to provide equitable health services and reduce mortality in childhood. Evidence from other countries indicates that advances in child survival often have come at the expense of increasing inequity. Our aims were to analyse trends and social differentials in mortality before the age of 5 years in Rwanda from 1990 to 2010. We performed secondary analyses of data from three Demographic and Health Surveys conducted in 2000, 2005 and 2010 in Rwanda. These surveys included 34 790 children born between 1990 and 2010 to women aged 15-49 years. The main outcome measures were neonatal mortality rates (NMR) and under-5 mortality rates (U5MR) over time, and in relation to mother's educational level, urban or rural residence and household wealth. Generalised linear mixed effects models and a mixed effects Cox model (frailty model) were used, with adjustments for confounders and cluster sampling method. Mortality rates in Rwanda peaked in 1994 at the time of the genocide (NMR 60/1000 live births, 95% CI 51 to 65; U5MR 238/1000 live births, 95% CI 226 to 251). The 1990s and the first half of the 2000s were characterised by a marked rural/urban divide and inequity in child survival between maternal groups with different levels of education. Towards the end of the study period (2005-2010) NMR had been reduced to 26/1000 (95% CI 23 to 29) and U5MR to 65/1000 (95% CI 61 to 70), with little or no difference between urban and rural areas, and household wealth groups, while children of women with no education still had significantly higher U5MR. Recent reductions in child mortality in Rwanda have concurred with improved social equity in child survival. Current challenges include the prevention of newborn deaths. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Towards a capability approach to child growth: A theoretical framework.

PubMed

Haisma, Hinke; Yousefzadeh, Sepideh; Boele Van Hensbroek, Pieter

2018-04-01

Child malnutrition is an important cause of under-5 mortality and morbidity around the globe. Despite the partial success of (inter)national efforts to reduce child mortality, under-5 mortality rates continue to be high. The multidimensional approaches of the Sustainable Development Goals may suggest new directions for rethinking strategies for reducing child mortality and malnutrition. We propose a theoretical framework for developing a "capability" approach to child growth. The current child growth monitoring practices are based on 2 assumptions: (a) that anthropometric and motor development measures are the appropriate indicators; and (b) that child growth can be assessed using a single universal standard that is applicable around the world. These practices may be further advanced by applying a capability approach to child growth, whereby growth is redefined as the achievement of certain capabilities (of society, parents, and children). This framework is similar to the multidimensional approach to societal development presented in the seminal work of Amartya Sen. To identify the dimensions of healthy child growth, we draw upon theories from the social sciences and evolutionary biology. Conceptually, we consider growth as a plural space and propose assessing growth by means of a child growth matrix in which the context is embedded in the assessment. This approach will better address the diversities and the inequalities in child growth. Such a multidimensional measure will have implications for interventions and policy, including prevention and counselling, and could have an impact on child malnutrition and mortality. © 2017 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.

Impact Evaluation of Malaria Control Interventions on Morbidity and All-Cause Child Mortality in Rwanda, 2000-2010.

PubMed

Eckert, Erin; Florey, Lia S; Tongren, Jon Eric; Salgado, S René; Rukundo, Alphonse; Habimana, Jean Pierre; Hakizimana, Emmanuel; Munguti, Kaendi; Umulisa, Noella; Mulindahabi, Monique; Karema, Corine

2017-09-01

The impressive decline in child mortality that occurred in Rwanda from 1996-2000 to 2006-2010 coincided with a period of rapid increase of malaria control interventions such as indoor residual spraying (IRS); insecticide-treated net (ITN) distribution and use, and improved malaria case management. The impact of these interventions was examined through ecological correlation analysis, and robust decomposition analysis of contextual factors on all-cause child mortality. Child mortality fell 61% during the evaluation period and prevalence of severe anemia in children 6-23 months declined 71% between 2005 and 2010. These changes in malaria morbidity and mortality occurred concurrently with a substantial increase in vector control activities. ITN use increased among children under five, from 4% to 70%. The IRS program began in 2007 and covered 1.3 million people in the highest burden districts by 2010. At the same time, diagnosis and treatment with an effective antimalarial expanded nationally, and included making services available to children under the age of 5 at the community level. The percentage of children under 5 who sought care for a fever increased from 26% in 2000 to 48% in 2010. Multivariable models of the change in child mortality between 2000 and 2010 using nationally representative data reveal the importance of increasing ITN ownership in explaining the observed mortality declines. Taken as a whole, the evidence supports the conclusion that malaria control interventions contributed to the observed decline in child mortality in Rwanda from 2000 to 2010, even in a context of improving socioeconomic, maternal, and child health conditions.

Child mortality patterns in rural Tanzania: an observational study on the impact of malaria control interventions.

PubMed

Alba, Sandra; Nathan, Rose; Schulze, Alexander; Mshinda, Hassan; Lengeler, Christian

2014-02-01

Between 1997 and 2009, a number of key malaria control interventions were implemented in the Kilombero and Ulanga Districts in south central Tanzania to increase insecticide-treated nets (ITN) coverage and improve access to effective malaria treatment. In this study we estimated the contribution of these interventions to observed decreases in child mortality. The local Health and Demographic Surveillance Site (HDSS) provided monthly estimates of child mortality rates (age 1 to 5 years) expressed as cases per 1000 person-years (c/1000py) between 1997 and 2009. We conducted a time series analysis of child mortality rates and explored the contribution of rainfall and household food security. We used Poisson regression with linear and segmented effects to explore the impact of malaria control interventions on mortality. Child mortality rates decreased by 42.5% from 14.6 c/1000py in 1997 to 8.4 c/1000py in 2009. Analyses revealed the complexity of child mortality patterns and a strong association with rainfall and food security. All malaria control interventions were associated with decreases in child mortality, accounting for the effect of rainfall and food security. Reaching the fourth Millenium Development Goal will require the contribution of many health interventions, as well as more general improvements in socio-environmental and nutritional conditions. Distinguishing between the effects of these multiple factors is difficult and represents a major challenge in assessing the effect of routine interventions. However, this study suggests that credible estimates can be obtained when high-quality data on the most important factors are available over a sufficiently long time period.

Estimated disability-adjusted life years averted by long-term provision of long acting contraceptive methods in a Brazilian clinic.

PubMed

Bahamondes, Luis; Bottura, Bruna F; Bahamondes, M Valeria; Gonçalves, Mayara P; Correia, Vinicius M; Espejo-Arce, Ximena; Sousa, Maria H; Monteiro, Ilza; Fernandes, Arlete

2014-10-10

What is the contribution of the provision, at no cost for users, of long acting reversible contraceptive methods (LARC; copper intrauterine device [IUD], the levonorgestrel-releasing intrauterine system [LNG-IUS], contraceptive implants and depot-medroxyprogesterone [DMPA] injection) towards the disability-adjusted life years (DALY) averted through a Brazilian university-based clinic established over 30 years ago. Over the last 10 years of evaluation, provision of LARC methods and DMPA by the clinic are estimated to have contributed to DALY averted by between 37 and 60 maternal deaths, 315-424 child mortalities, 634-853 combined maternal morbidity and mortality and child mortality, and 1056-1412 unsafe abortions averted. LARC methods are associated with a high contraceptive effectiveness when compared with contraceptive methods which need frequent attention; perhaps because LARC methods are independent of individual or couple compliance. However, in general previous studies have evaluated contraceptive methods during clinical studies over a short period of time, or not more than 10 years. Furthermore, information regarding the estimation of the DALY averted is scarce. We reviewed 50 004 medical charts from women who consulted for the first time looking for a contraceptive method over the period from 2 January 1980 through 31 December 2012. Women who consulted at the Department of Obstetrics and Gynaecology, University of Campinas, Brazil were new users and users switching contraceptive, including the copper IUD (n = 13 826), the LNG-IUS (n = 1525), implants (n = 277) and DMPA (n = 9387). Estimation of the DALY averted included maternal morbidity and mortality, child mortality and unsafe abortions averted. We obtained 29 416 contraceptive segments of use including 25 009 contraceptive segments of use from 20 821 new users or switchers to any LARC method or DMPA with at least 1 year of follow-up. The mean (± SD) age of the women at first consultation ranged from 25.3 ± 5.7 (range 12-47) years in the 1980s, to 31.9 ± 7.4 (range 16-50) years in 2010-2011. The most common contraceptive chosen at the first consultation was copper IUD (48.3, 74.5 and 64.7% in the 1980s, 1990s and 2000s, respectively). For an evaluation over 20 years, the cumulative pregnancy rates (SEM) were 0.4 (0.2), 2.8 (2.1), 4.0 (0.4) and 1.3 (0.4) for the LNG-IUS, the implants, copper IUD and DMPA, respectively and cumulative continuation rates (SEM) were 15.1 (3.7), 3.9 (1.4), 14.1 (0.6) and 7.3 (1.7) for the LNG-IUS, implants, copper IUD and DMPA, respectively (P < 0.001). Over the last 10 years of evaluation, the estimation of the contribution of the clinic through the provision of LARC methods and DMPA to DALY averted was 37-60 maternal deaths; between 315 and 424 child mortalities; combined maternal morbidity and mortality and child mortality of between 634 and 853, and 1056-1412 unsafe abortions averted. The main limitations are the number of women who never returned to the clinic (overall 14% among the four methods under evaluation); consequently the pregnancy rate could be different. Other limitations include the analysis of two kinds of copper IUD and two kinds of contraceptive implants as the same IUD or implant, and the low number of users of implants. In addition, the DALY calculation relies on a number of estimates, which may vary in different parts of the world. LARC methods and DMPA are highly effective and women who were well-counselled used these methods for a long time. The benefit of averting maternal morbidity and mortality, child mortality, and unsafe abortions is an example to health policy makers to implement more family planning programmes and to offer contraceptive methods, mainly LARC and DMPA, at no cost or at affordable cost for the underprivileged population. This study received partial financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), grant # 2012/12810-4 and from the National Research Council (CNPq), grant #573747/2008-3. B.F.B., M.P.G., and V.M.C. were fellows from the scientific initiation programme from FAPESP. Since the year 2001, all the TCu380A IUD were donated by Injeflex, São Paulo, Brazil, and from the year 2006 all the LNG-IUS were donated by the International Contraceptive Access Foundation (ICA), Turku, Finland. Both donations are as unrestricted grants. The authors declare that there are no conflicts of interest associated with this study. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Associations between key intervention coverage and child mortality: an analysis of 241 sub-national regions of sub-Saharan Africa.

PubMed

Akachi, Yoko; Steenland, Maria; Fink, Günther

2017-12-21

Reducing child mortality remains a key objective in the Sustainable Development Goals. Although remarkable progress has been made with respect to under-5 mortality over the last 25 years, little is known regarding the relative contributions of public health interventions and general improvements in socioeconomic status during this time period. We combined all available data from the Demographic and Health Survey (DHS) to construct a longitudinal, multi-level dataset with information on subnational-level key intervention coverage, household socioeconomic status and child health outcomes in sub-Saharan Africa. The dataset covers 562 896 child records and 769 region-year observations across 24 countries. We used multi-level multivariable logistics regression models to assess the associations between child mortality and changes in the coverage of 17 key reproductive, maternal, newborn and child health interventions such as bednets, water and sanitation infrastructure, vaccination and breastfeeding practices, as well as concurrent improvements in social and economic development. Full vaccination coverage was associated with a 30% decrease in the odds of child mortality [odds ratio (OR) 0.698, 95% confidence interval (CI) 0.564, 0.864], and continued breastfeeding was associated with a 24% decrease in the odds of child mortality (OR 0.759, 95% CI 0.642, 0.898). Our results suggest that changes in vaccination coverage, as well as increases in female education and economic development, made the largest contributions to the positive mortality trends observed. Breastfeeding was associated with child survival but accounts for little of the observed declines in mortality due to declining coverage levels during our study period. Our findings suggest that a large amount of progress has been made with respect to coverage levels of key health interventions. Whereas all socioeconomic variables considered appear to strongly predict health outcomes, the same was true only for very few health coverage indicators. © The Author(s) 2017; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association

Economic and other determinants of infant and child mortality in small developing countries: the case of Central America and the Caribbean.

PubMed

Hojman, D E

1996-03-01

This analysis involves empirically testing a theoretical model among 22 Central American and Caribbean countries during the 1990s that explains differences in infant and child mortality. Explanatory measures capture demographic, economic, health care, and educational characteristics. The model is expected to allow for an assessment of the potential impact of structural adjustment and external debt. It is pointed out that birth rates and child mortality rates followed similar patterns over time and between countries. In this study's regression analyses all variables in the three models that explain infant mortality are exogenous: low birth weight, immunization, gross domestic product per capita, years of schooling for women, population/nurse, and debt as a proportion of gross national product. As nations became richer, infant mortality declined. Infant mortality was lower in countries with high external debt. In models for explaining the birth rate and the child mortality rate, the best fit included variables for debt, real public expenditure on health care, water supply, and malnutrition. Analysis in a simultaneous model for 10 countries revealed that the birth rate and the child mortality rate were more responsive to shocks in exogenous variables in Barbados than in the Dominican Republic, and more responsive in the Dominican Republic than in Guatemala. The impact of each exogenous variable varied by country. In Barbados education was four times more effective in explaining the birth rate than water. In Guatemala, the most effective exogenous variable was malnutrition. Child mortality rates were affected more by multiplier effects. In richer countries, the most important impact on child survival was improved access to safe water, and the most important impact on the birth rate was increased real public expenditure on education per capita. For the poorest countries, findings suggest first improvement in malnutrition and then improvement in safe water supplies. Structural adjustment variables were found to have small impacts on the birth rate or limited impacts on child survival in poorer countries.

Association between gender inequality index and child mortality rates: a cross-national study of 138 countries.

PubMed

Brinda, Ethel Mary; Rajkumar, Anto P; Enemark, Ulrika

2015-03-09

Gender inequality weakens maternal health and harms children through many direct and indirect pathways. Allied biological disadvantage and psychosocial adversities challenge the survival of children of both genders. United Nations Development Programme (UNDP) has recently developed a Gender Inequality Index to measure the multidimensional nature of gender inequality. The global impact of Gender Inequality Index on the child mortality rates remains uncertain. We employed an ecological study to investigate the association between child mortality rates and Gender Inequality Indices of 138 countries for which UNDP has published the Gender Inequality Index. Data on child mortality rates and on potential confounders, such as, per capita gross domestic product and immunization coverage, were obtained from the official World Health Organization and World Bank sources. We employed multivariate non-parametric robust regression models to study the relationship between these variables. Women in low and middle income countries (LMICs) suffer significantly more gender inequality (p < 0.001). Gender Inequality Index (GII) was positively associated with neonatal (β = 53.85; 95% CI 41.61-64.09), infant (β = 70.28; 95% CI 51.93-88.64) and under five mortality rates (β = 68.14; 95% CI 49.71-86.58), after adjusting for the effects of potential confounders (p < 0.001). We have documented statistically significant positive associations between GII and child mortality rates. Our results suggest that the initiatives to curtail child mortality rates should extend beyond medical interventions and should prioritize women's rights and autonomy. We discuss major pathways connecting gender inequality and child mortality. We present the socio-economic problems, which sustain higher gender inequality and child mortality in LMICs. We further discuss the potential solutions pertinent to LMICs. Dissipating gender barriers and focusing on social well-being of women may augment the survival of children of both genders.

Associations of gender inequality with child malnutrition and mortality across 96 countries.

PubMed

Marphatia, A A; Cole, T J; Grijalva-Eternod, C; Wells, J C K

2016-01-01

National efforts to reduce low birth weight (LBW) and child malnutrition and mortality prioritise economic growth. However, this may be ineffective, while rising gross domestic product (GDP) also imposes health costs, such as obesity and non-communicable disease. There is a need to identify other potential routes for improving child health. We investigated associations of the Gender Inequality Index (GII), a national marker of women's disadvantages in reproductive health, empowerment and labour market participation, with the prevalence of LBW, child malnutrition (stunting and wasting) and mortality under 5 years in 96 countries, adjusting for national GDP. The GII displaced GDP as a predictor of LBW, explaining 36% of the variance. Independent of GDP, the GII explained 10% of the variance in wasting and stunting and 41% of the variance in child mortality. Simulations indicated that reducing GII could lead to major reductions in LBW, child malnutrition and mortality in low- and middle-income countries. Independent of national wealth, reducing women's disempowerment relative to men may reduce LBW and promote child nutritional status and survival. Longitudinal studies are now needed to evaluate the impact of efforts to reduce societal gender inequality.

Income and child mortality in developing countries: a systematic review and meta-analysis.

PubMed

O'Hare, Bernadette; Makuta, Innocent; Chiwaula, Levison; Bar-Zeev, Naor

2013-10-01

We aimed to quantify the relationship between national income and infant and under-five mortality in developing countries. We conducted a systematic literature search of studies that examined the relationship between income and child mortality (infant and/or under-five mortality) and meta-analysed their results. Developing countries. Child mortality (infant and /or under-five mortality). The systematic literature search identified 24 studies, which produced 38 estimates that examined the impact of income on the mortality rates. Using meta-analysis, we produced pooled estimates of the relationship between income and mortality. The pooled estimate of the relationship between income and infant mortality before adjusting for covariates is -0.95 (95% CI -1.34 to -0.57) and that for under-five mortality is -0.45 (95% CI -0.79 to -0.11). After adjusting for covariates, pooled estimate of the relationship between income and infant mortality is -0.33 (-0.39 to -0.26) while the estimate for under-five mortality is -0.28 (-0.37 to -0.19). If a country has an infant mortality of 50 per 1000 live births and the gross domestic product per capita purchasing power parity increases by 10%, the infant mortality will decrease to 45 per 1000 live births. Income is an important determinant of child survival and this work provides a pooled estimate for the relationship.

Public health care funding modifies the effect of out-of-pocket spending on maternal, infant, and child mortality.

PubMed

Noel, Jonathan K

2017-03-01

Increased out-of-pocket (OOP) health care spending has been associated with increased maternal, infant, and child mortality, but the effect of public health care spending on mortality has not been studied. I identified a statistically significant interaction between public health care expenditure and OOP health care spending for maternal, infant, and child mortality. Generally, increases in public expenditure coincide with decreased rates of mortality, regardless of OOP spending levels. Specifically, higher levels of public expenditure with moderate levels of OOP spending may result in the lowest mortality rates. Increased public health care spending may improve health outcomes better than efforts to reduce OOP expenditure alone.

Comments on "Differentials on Child Mortality and Health Care in Pakistan".

PubMed

Manzoor, K

1992-01-01

Critical comments are provided on M. Framurz Kiani's examination of differentials in child mortality by parents' education, urban/rural status, work status, availability of maternal and child health services, immunization status, and diarrheal treatment and age of the mother. The findings emphasize the importance of literacy, particularly maternal education, as a major influence in child survival. There were 5 areas of discussion. The first pertained to the absence of factors for fertility, which had been shown to be interactive with mortality. Higher fertility was associated with higher mortality, and higher mortality was associated with higher fertility, and both were influenced by poverty and literacy. The second comment pertained to the lack of control variables for income and socioeconomic status in order to separate out the effects of educational status. It may well be that educational status was capturing the affordability and accessibility of health care, and increased consciousness due to education, even in an urban setting. Work status of the mother, rather than mothers working in a family business of working as housewives, may be representing women's mobility. Salaried fathers may enjoy lower mortality because of full or partial medical benefits that are included in their salary package, that those in agriculture would not have. The third point focused on the lack of specification of what "clinic" referred to, in the findings that urban and rural mothers with postnatal care had lower child mortality. The fourth point noted that the findings (maternal education was important in maternal and child health care and paternal education was important in immunization) reflected women's lack of decision making. Other findings were that education differences influenced child survival, but child immunization was not a significant factor. The policy implications are that health services and outreach are needed in rural areas in order to increase the level of awareness about the importance of immunization and complete immunization. Access to services must be assured as well. The last point noted the lack of specification of male vs. female mortality. The study was commended for identifying major factors in determining child mortality.

Child survival and changing fertility patterns in Pakistan.

PubMed

Sathar, Z A

1992-01-01

Pakistan is a country with high fertility and high infant and child mortality, and declines in total mortality and substantial development initiatives. The discussion considers whether fertility patterns in Pakistan can be related to changes in child mortality, and whether current and future changes in fertility influence child survival favorably. Omran's study linked large family size to child survival. Resources, which are divided, become more important deficits in households below the poverty line: a situation common in Pakistan. High fertility is associated with short birth intervals, which are related to higher infant and child mortality. In Pakistan, the spacing and mortality link was found among both poverty and higher socioeconomic households. There is some support for the notion that it is birth weight and general health that are linked to survival rather than competition for resources. Other studies link the maternal age at birth and birth order with child mortality (Alam and Cleland). Trussel argues for limiting births in high risk ages of under 20 years and over 35 years. The exact casual link is not well documented. Institutional and community factors are also considered important in influencing child survival: sanitation, potable water, access to roads, electricity, health and family planning services, and sewage. Young infants are more vulnerable to these factors. Bangladesh and some Indian states have shown that population programs and raising per captia incomes are necessary to fertility decline. In India, female autonomy, access to education, and more equal income distribution were considered more important than economic development to child survival. In Pakistan, Sathar and Kazi have linked at least 2 years of elementary, maternal education with reductions in child mortality. The pervasiveness of female illiteracy hinders the chances of child survival. Sex preferences also impact on female children. The probably impacts of declines in breast feeding, smaller family sizes, and delayed childbearing on child survival are discussed. Lessons to be learned from sub-Saharan Africa are that countries should not be caught in social cutbacks due to structural adjustment packages, and should use approaches, such as in Matlab in Bangladesh, to provide contraceptives and immunization. Policy must emphasize female education at least through the primary level for long lasting effects.

Mortality in parents following the death of a child: a nationwide follow-up study from Sweden.

PubMed

Rostila, Mikael; Saarela, Jan; Kawachi, Ichiro

2012-10-01

The death of a young child is so devastating that it can increase the risk of mortality in the grieving parent. Little is known about the impact of an adult child's death on the health of parents. The authors conducted a follow-up study between 1980 and 2002 based on a linked-registers database that contains the total Swedish population. The authors examined mortality from all causes, natural causes and unnatural causes among parents following the death of children aged 10-49 years. An increased mortality risk (RR 1.31, 95% CI 1.02 to 1.68) in mothers following the death of a minor child (10-17 years) was found and especially following unnatural deaths (primarily accidents and suicides). Mothers also experienced elevated mortality following the death of an adult child aged 18-25 years (RR 1.15, 95% CI 1.03 to 1.29). Bereavement effects among fathers were more attenuated and chiefly found after >8 years of follow-up. From a short-term perspective (1-3 years), the death of an adult child (>25 years) was somewhat protective for parents. However, over longer follow-up periods, it approached (4-8 years) and exceeded (>8 years) the death risk of the general population. These findings corroborate and extend earlier findings suggesting elevated mortality risks also following the death of an adult child.

A Reversal in Reductions of Child Mortality in Western Kenya, 2003–2009

PubMed Central

Hamel, Mary J.; Adazu, Kubaje; Obor, David; Sewe, Maquins; Vulule, John; Williamson, John M.; Slutsker, Laurence; Feikin, Daniel R.; Laserson, Kayla F.

2011-01-01

We report and explore changes in child mortality in a rural area of Kenya during 2003–2009, when major public health interventions were scaled-up. Mortality ratios and rates were calculated by using the Kenya Medical Research Institute/Centers for Disease Control and Prevention Demographic Surveillance System. Inpatient and outpatient morbidity and mortality, and verbal autopsy data were analyzed. Mortality ratios for children less than five years of age decreased from 241 to 137 deaths/1,000 live-births in 2003 and 2007 respectively. In 2008, they increased to 212 deaths/1,000 live-births. Mortality remained elevated during the first 8 months of 2009 compared with 2006 and 2007. Malaria and/or anemia accounted for the greatest increases in child mortality. Stock-outs of essential antimalarial drugs during a time of increased malaria transmission and disruption of services during civil unrest may have contributed to increased mortality in 2008–2009. To maintain gains in child survival, implementation of good policies and effective interventions must be complemented by reliable supply and access to clinical services and essential drugs. PMID:21976557

Urbanisation and child health in resource poor settings with special reference to under-five mortality in Africa.

PubMed

Garenne, Michel

2010-06-01

The health of children improved dramatically worldwide during the 20th century, although with major contrasts between developed and developing countries, and urban and rural areas. The quantitative evidence on urban child health from a broad historical and comparative perspective is briefly reviewed here. Before the sanitary revolution, urban mortality tended to be higher than rural mortality. However, after World War I, improvements in water, sanitation, hygiene, nutrition and child care resulted in lower urban child mortality in Europe. Despite a similar mortality decline, urban mortality in developing countries since World War II has been generally lower than rural mortality, probably because of better medical care, higher socio-economic status and better nutrition in urban areas. However, higher urban mortality has recently been seen in the slums of large cities in developing countries as a result of extreme poverty, family disintegration, lack of hygiene, sanitation and medical care, low nutritional status, emerging diseases (HIV/AIDS and tuberculosis) and other health hazards (environmental hazards, accidents, violence). These emerging threats need to be addressed by appropriate policies and programmes.

Space-Time Smoothing of Complex Survey Data: Small Area Estimation for Child Mortality

PubMed Central

Mercer, Laina D; Wakefield, Jon; Pantazis, Athena; Lutambi, Angelina M; Masanja, Honorati; Clark, Samuel

2016-01-01

Many people living in low and middle-income countries are not covered by civil registration and vital statistics systems. Consequently, a wide variety of other types of data including many household sample surveys are used to estimate health and population indicators. In this paper we combine data from sample surveys and demographic surveillance systems to produce small area estimates of child mortality through time. Small area estimates are necessary to understand geographical heterogeneity in health indicators when full-coverage vital statistics are not available. For this endeavor spatio-temporal smoothing is beneficial to alleviate problems of data sparsity. The use of conventional hierarchical models requires careful thought since the survey weights may need to be considered to alleviate bias due to non-random sampling and non-response. The application that motivated this work is estimation of child mortality rates in five-year time intervals in regions of Tanzania. Data come from Demographic and Health Surveys conducted over the period 1991–2010 and two demographic surveillance system sites. We derive a variance estimator of under five years child mortality that accounts for the complex survey weighting. For our application, the hierarchical models we consider include random effects for area, time and survey and we compare models using a variety of measures including the conditional predictive ordinate (CPO). The method we propose is implemented via the fast and accurate integrated nested Laplace approximation (INLA). PMID:27468328

Girl-child marriage and its association with morbidity and mortality of children under 5 years of age in a nationally-representative sample of Pakistan.

PubMed

Nasrullah, Muazzam; Zakar, Rubeena; Zakar, Muhammad Zakria; Krämer, Alexander

2014-03-01

To determine the relationship between child marriage (before age 18 years) and morbidity and mortality of children under 5 years of age in Pakistan beyond those attributed to social vulnerabilities. Nationally-representative cross-sectional observational survey data from Pakistan Demographic and Health Survey, 2006-2007 was limited to children from the past 5 years, reported by ever-married women aged 15-24 years (n = 2630 births of n = 2138 mothers) to identify differences in infectious diseases in past 2 weeks (diarrhea, acute respiratory infection [ARI], ARI with fever), under 5 years of age and infant mortality, and low birth weight by early (<18) vs adult (≥ 18) age at marriage. Associations between child marriage and mortality and morbidity of children under 5 years of age were assessed by calculating adjusted OR using logistic regression models after controlling for maternal and child demographics. Majority (74.5%) of births were from mothers aged <18 years. Marriage before age 18 years increased the likelihood of recent diarrhea among children born to young mothers (adjusted OR = 1.59; 95% CI: 1.18-2.14). Even though maternal child marriage was associated with infant mortality and mortality of children under 5 years of age in unadjusted models, association was lost in the adjusted models. We did not find a relation between girl-child marriage and low birth weight infants, and ARI. Girl-child marriage increases the likelihood of recent diarrhea among children born to young mothers. Further qualitative and prospective quantitative studies are needed to understand the factors that may drive child morbidity and mortality among those married as children vs adults in Pakistan. Copyright © 2014 Mosby, Inc. All rights reserved.

Impact Evaluation of Malaria Control Interventions on Morbidity and All-Cause Child Mortality in Rwanda, 2000–2010

PubMed Central

Eckert, Erin; Florey, Lia S.; Tongren, Jon Eric; Salgado, S. René; Rukundo, Alphonse; Habimana, Jean Pierre; Hakizimana, Emmanuel; Munguti, Kaendi; Umulisa, Noella; Mulindahabi, Monique; Karema, Corine

2017-01-01

Abstract. The impressive decline in child mortality that occurred in Rwanda from 1996–2000 to 2006–2010 coincided with a period of rapid increase of malaria control interventions such as indoor residual spraying (IRS); insecticide-treated net (ITN) distribution and use, and improved malaria case management. The impact of these interventions was examined through ecological correlation analysis, and robust decomposition analysis of contextual factors on all-cause child mortality. Child mortality fell 61% during the evaluation period and prevalence of severe anemia in children 6–23 months declined 71% between 2005 and 2010. These changes in malaria morbidity and mortality occurred concurrently with a substantial increase in vector control activities. ITN use increased among children under five, from 4% to 70%. The IRS program began in 2007 and covered 1.3 million people in the highest burden districts by 2010. At the same time, diagnosis and treatment with an effective antimalarial expanded nationally, and included making services available to children under the age of 5 at the community level. The percentage of children under 5 who sought care for a fever increased from 26% in 2000 to 48% in 2010. Multivariable models of the change in child mortality between 2000 and 2010 using nationally representative data reveal the importance of increasing ITN ownership in explaining the observed mortality declines. Taken as a whole, the evidence supports the conclusion that malaria control interventions contributed to the observed decline in child mortality in Rwanda from 2000 to 2010, even in a context of improving socioeconomic, maternal, and child health conditions. PMID:28990918

REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS.

PubMed

Adedini, Sunday A; Odimegwu, Clifford; Imasiku, Eunice N S; Ononokpono, Dorothy N; Ibisomi, Latifat

2015-03-01

There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.

Factors influencing infant/child mortality in Bangladesh: implication for family planning programs and policies.

PubMed

Miah, M M

1993-01-01

"This study examined a host of socio-economic and demographic factors (including their interactions) that determine infant/child mortality of married women at the different parity levels in Bangladesh [using data from] a multivariate analysis of the 1975-76 Bangladesh Fertility Survey.... The major hypothesis of this research is that the higher the level of fertility of a married woman, the higher will be her experience of infant/child mortality. However, a woman's family planning practice may interact with fertility and affect the total infant/child deaths...." excerpt

Prevalence and Determinants of the Gender Differentials Risk Factors of Child Deaths in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey, 2011

PubMed Central

Hossain, Md. Mosharaf; Mani, Kulanthayan K. C.; Islam, Md. Rafiqul

2015-01-01

Background The number of child deaths is a potential indicator to assess the health condition of a country, and represents a major health challenge in Bangladesh. Although the country has performed exceptionally well in decreasing the mortality rate among children under five over the last few decades, mortality still remains relatively high. The main objective of this study is to identify the prevalence and determinants of the risk factors of child mortality in Bangladesh. Methods The data were based on a cross-sectional study collected from the Bangladesh Demographic and Health Survey (BDHS), 2011. The women participants numbered 16,025 from seven divisions of Bangladesh – Rajshahi, Dhaka, Chittagong, Barisal, Khulna, Rangpur and Sylhet. The 𝟀2 test and logistic regression model were applied to determine the prevalence and factors associated with child deaths in Bangladesh. Results In 2011, the prevalence of child deaths in Bangladesh for boys and girls was 13.0% and 11.6%, respectively. The results showed that birth interval and birth order were the most important factors associated with child death risks; mothers’ education and socioeconomic status were also significant (males and females). The results also indicated that a higher birth order (7 & more) of child (OR=21.421 & 95%CI=16.879-27.186) with a short birth interval ≤ 2 years was more risky for child mortality, and lower birth order with longer birth interval >2 were significantly associated with child deaths. Other risk factors that affected child deaths in Bangladesh included young mothers of less than 25 years (mothers’ median age (26-36 years): OR=0.670, 95%CI=0.551-0.815), women without education compared to those with secondary and higher education (OR =0 .711 & .628, 95%CI=0.606-0.833 & 0.437-0.903), mothers who perceived their child body size to be larger than average and small size (OR= 1.525 & 1.068, 95%CI=1.221-1.905 & 0.913-1.249), and mothers who delivered their child by non-caesarean (OR= 1.687, 95%CI=1.253-2.272). Conclusion Community-based educational programs or awareness programs are required to reduce the child death in Bangladesh, especially for younger women should be increase the birth interval and decrease the birth order. The government should apply the strategies to enhance the socioeconomic conditions, especially in rural areas, increase the awareness program through media and expand schooling, particularly for girls. PMID:25747178

Underascertainment of Child Abuse Fatalities in France: Retrospective Analysis of Judicial Data to Assess Underreporting of Infant Homicides in Mortality Statistics

ERIC Educational Resources Information Center

Tursz, Anne; Crost, Monique; Gerbouin-Rerolle, Pascale; Cook, Jon M.

2010-01-01

Objectives: Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation. Methods: A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant…

Linking high parity and maternal and child mortality: what is the impact of lower health services coverage among higher order births?

PubMed

Sonneveldt, Emily; DeCormier Plosky, Willyanne; Stover, John

2013-01-01

A number of data sets show that high parity births are associated with higher child mortality than low parity births. The reasons for this relationship are not clear. In this paper we investigate whether high parity is associated with lower coverage of key health interventions that might lead to increased mortality. We used DHS data from 10 high fertility countries to examine the relationship between parity and coverage for 8 child health intervention and 9 maternal health interventions. We also used the LiST model to estimate the effect on maternal and child mortality of the lower coverage associated with high parity births. Our results show a significant relationship between coverage of maternal and child health services and birth order, even when controlling for poverty. The association between coverage and parity for maternal health interventions was more consistently significant across countries all countries, while for child health interventions there were fewer overall significant relationships and more variation both between and within countries. The differences in coverage between children of parity 3 and those of parity 6 are large enough to account for a 12% difference in the under-five mortality rate and a 22% difference in maternal mortality ratio in the countries studied. This study shows that coverage of key health interventions is lower for high parity children and the pattern is consistent across countries. This could be a partial explanation for the higher mortality rates associated with high parity. Actions to address this gap could help reduce the higher mortality experienced by high parity birth.

Accelerating Maternal and Child Health Gains in Papua New Guinea: Modelled Predictions from Closing the Equity Gap Using LiST.

PubMed

Byrne, Abbey; Hodge, Andrew; Jimenez-Soto, Eliana

2015-11-01

Many priority countries in the countdown to the millennium development goals deadline are lagging in progress towards maternal and child health (MCH) targets. Papua New Guinea (PNG) is one such country beset by challenges of geographical inaccessibility, inequity and health system weakness. Several countries, however, have made progress through focused initiatives which align with the burden of disease and overcome specific inequities. This study identifies the potential impact on maternal and child mortality through increased coverage of prioritised interventions within the PNG health system. The burden of disease and health system environment of PNG was documented to inform prioritised MCH interventions at community, outreach, and clinical levels. Potential reductions in maternal and child mortality through increased intervention coverage to close the geographical equity gap were estimated with the lives saved tool. A set community-level interventions, with highest feasibility, would yield significant reductions in newborn and child mortality. Adding the outreach group delivers gains for maternal mortality, particularly through family planning. The clinical services group of interventions demands greater investment but are essential to reach MCH targets. Cumulatively, the increased coverage is estimated to reduce the rates of under-five mortality by 19 %, neonatal mortality by 26 %, maternal mortality ratio by 10 % and maternal mortality by 33 %. Modest investments in health systems focused on disadvantaged populations can accelerate progress in maternal and child survival even in fragile health systems like PNG. The critical approach may be to target interventions and implementation appropriately to the sensitive context of lagging countries.

Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey

PubMed Central

Fledderjohann, Jasmine; Vellakkal, Sukumar; Khan, Zaky; Ebrahim, Shah; Stuckler, David

2016-01-01

Abstract Background: Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India’s slow progress in improving childhood survival. Methods : Using rounds 2 and 3 (2002—08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states (‘Empowered Action Groups’). Results : Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories. Conclusions: Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states. PMID:27063607

Poverty, health and satellite-derived vegetation indices: their inter-spatial relationship in West Africa

PubMed Central

Sedda, Luigi; Tatem, Andrew J.; Morley, David W.; Atkinson, Peter M.; Wardrop, Nicola A.; Pezzulo, Carla; Sorichetta, Alessandro; Kuleszo, Joanna; Rogers, David J.

2015-01-01

Background Previous analyses have shown the individual correlations between poverty, health and satellite-derived vegetation indices such as the normalized difference vegetation index (NDVI). However, generally these analyses did not explore the statistical interconnections between poverty, health outcomes and NDVI. Methods In this research aspatial methods (principal component analysis) and spatial models (variography, factorial kriging and cokriging) were applied to investigate the correlations and spatial relationships between intensity of poverty, health (expressed as child mortality and undernutrition), and NDVI for a large area of West Africa. Results This research showed that the intensity of poverty (and hence child mortality and nutrition) varies inversely with NDVI. From the spatial point-of-view, similarities in the spatial variation of intensity of poverty and NDVI were found. Conclusions These results highlight the utility of satellite-based metrics for poverty models including health and ecological components and, in general for large scale analysis, estimation and optimisation of multidimensional poverty metrics. However, it also stresses the need for further studies on the causes of the association between NDVI, health and poverty. Once these relationships are confirmed and better understood, the presence of this ecological component in poverty metrics has the potential to facilitate the analysis of the impacts of climate change on the rural populations afflicted by poverty and child mortality. PMID:25733559

Child mortality, commodity price volatility and the resource curse.

PubMed

Makhlouf, Yousef; Kellard, Neil M; Vinogradov, Dmitri

2017-04-01

Given many developing economies depend on primary commodities, the fluctuations of commodity prices may imply significant effects for the wellbeing of children. To investigate, this paper examines the relationship between child mortality and commodity price movements as reflected by country-specific commodity terms-of-trade. Employing a panel of 69 low and lower-middle income countries over the period 1970-2010, we show that commodity terms-of-trade volatility increases child mortality in highly commodity-dependent importers suggesting a type of 'scarce' resource curse. Strikingly however, good institutions appear able to mitigate the negative impact of volatility. The paper concludes by highlighting this tripartite relationship between child mortality, volatility and good institutions and posits that an effective approach to improving child wellbeing in low to lower-middle income countries will combine hedging, import diversification and improvement of institutional quality. Copyright © 2017. Published by Elsevier Ltd.

Nationwide implementation of integrated community case management of childhood illness in Rwanda

PubMed Central

Mugeni, Catherine; Levine, Adam C; Munyaneza, Richard M; Mulindahabi, Epiphanie; Cockrell, Hannah C; Glavis-Bloom, Justin; Nutt, Cameron T; Wagner, Claire M; Gaju, Erick; Rukundo, Alphonse; Habimana, Jean Pierre; Karema, Corine; Ngabo, Fidele; Binagwaho, Agnes

2014-01-01

ABSTRACT Background: Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive reporting and referral services. Methods: We used data from the Rwanda health management information system (HMIS) to calculate monthly all-cause under-5 mortality rates, health facility use rates, and community-based treatment rates for childhood illness in each district. We then compared a 3-month baseline period prior to iCCM implementation with a seasonally matched comparison period 1 year after iCCM implementation. Finally, we compared the actual changes in all-cause child mortality and health facility use over this time period with the changes that would have been expected based on baseline trends in Rwanda. Results: The number of children receiving community-based treatment for diarrhea and pneumonia increased significantly in the 1-year period after iCCM implementation, from 0.83 cases/1,000 child-months to 3.80 cases/1,000 child-months (P = .01) and 0.25 cases/1,000 child-months to 5.28 cases/1,000 child-months (P<.001), respectively. On average, total under-5 mortality rates declined significantly by 38% (P<.001), and health facility use declined significantly by 15% (P = .006). These decreases were significantly greater than would have been expected based on baseline trends. Conclusions: This is the first study to demonstrate decreases in both child mortality and health facility use after implementing iCCM of childhood illness at a national level. While our study design does not allow for direct attribution of these changes to implementation of iCCM, these results are in line with those of prior studies conducted at the sub-national level in other low-income countries. PMID:25276592

Household wealth and child health in India.

PubMed

Chalasani, Satvika; Rutstein, Shea

2014-03-01

Using data from the Indian National Family Health Surveys (1992-93, 1998-99, 2005-06), this study examined how the relationship between household wealth and child health evolved during a time of significant economic change in India. The main predictor was an innovative measure of household wealth that captures changes in wealth over time. Discrete-time logistic models (with community fixed effects) were used to examine mortality and malnutrition outcomes: infant, child, and under-5 mortality; stunting, wasting, and being underweight. Analysis was conducted at the national, urban/rural, and regional levels, separately for boys and girls. The results indicate that the relationship between household wealth and under-5 mortality weakened over time but this result was dominated by infant mortality. The relationship between wealth and child mortality stayed strong for girls. The relationship between household wealth and malnutrition became stronger over time for boys and particularly for girls, in urban and (especially) rural areas.

A hazards-model analysis of the covariates of infant and child mortality in Sri Lanka.

PubMed

Trussell, J; Hammerslough, C

1983-02-01

The purpose of this paper is twofold: (a) to provide a complete self-contained exposition of estimating life tables with covariates through the use of hazards models, and (b) to illustrate this technique with a substantive analysis of child mortality in Sri Lanka, thereby demonstrating that World Fertility Survey data are a valuable source for the study of child mortality. We show that life tables with covariates can be easily estimated with standard computer packages designed for analysis of contingency tables. The substantive analysis confirms and supplements an earlier study of infant and child mortality in Sri Lanka by Meegama. Those factors found to be strongly associated with mortality are mother's and father's education, time period of birth, urban/rural/estate residence, ethnicity, sex, birth order, age of the mother at the birth, and type of toilet facility.

Associations between maternal experiences of intimate partner violence and child nutrition and mortality: findings from Demographic and Health Surveys in Egypt, Honduras, Kenya, Malawi and Rwanda.

PubMed

Rico, Emily; Fenn, Bridget; Abramsky, Tanya; Watts, Charlotte

2011-04-01

If effective interventions are to be used to address child mortality and malnutrition, then it is important that we understand the different pathways operating within the framework of child health. More attention needs to be given to understanding the contribution of social influences such as intimate partner violence (IPV). To investigate the relationship between maternal exposure to IPV and child mortality and malnutrition using data from five developing countries. Population data from Egypt, Honduras, Kenya, Malawi and Rwanda were analysed. Logistic regression analysis was used to generate odds ratios of the associations between several categories of maternal exposure to IPV since the age of 15 and three child outcomes: under-2-year-old (U2) mortality and moderate and severe stunting (<-2 Z-score height-for-age and <-3 Z-score height-for-age) in 6-59-month-old children. Analyses were adjusted for potential confounders, and the role of mediating factors was explored. The prevalence of physical and/or sexual IPV since the age of 15 years ranged from 15.5% (Honduras) to 46.2% (Kenya). For child stunting, prevalence ranged from 25.4% (Egypt) to 58.0% (Malawi) and for U2 mortality from 3.6% (Honduras) to 15.2% (Rwanda). In Kenya, maternal exposure to IPV was associated with higher U2 mortality (adjusted odds ratio (OR)=1.42, 95% CI 1.18 to 1.71) and child stunting (adjusted OR=1.36, 95% CI 1.16 to 1.61). In Malawi and Honduras, marginal associations were observed between IPV and severe stunting and U2 mortality, respectively, with strength of associations varying by type of violence. The relationship between IPV and U2 mortality and stunting in Kenya, Honduras and Malawi suggests that, in these countries, IPV plays a role in child malnutrition and mortality. This contributes to a growing body of evidence that broader public health benefits may be incurred if efforts to address IPV are incorporated into a wider range of maternal and child health programmes; however, the authors highlight the need for more research that can establish temporality, use data collected on the basis of the study's objectives, and further explore the causal framework of this relationship using more advanced statistical analysis.

Housing, income inequality and child injury mortality in Europe: a cross-sectional study.

PubMed

Sengoelge, M; Hasselberg, M; Ormandy, D; Laflamme, L

2014-03-01

Child poverty rates are compared throughout Europe to monitor how countries are caring for their children. Child poverty reduction measures need to consider the importance of safe living environments for all children. In this study we investigate how European country-level economic disparity and housing conditions relate to one another, and whether they differentially correlate with child injury mortality. We used an ecological, cross-sectional study design of 26 European countries of which 20 high-income and 6 upper-middle-income. Compositional characteristics of the home and its surroundings were extracted from the 2006 European Union Income Social Inclusion and Living Conditions Database (n = 203,000). Mortality data of children aged 1-14 years were derived from the World Health Organization Mortality Database. The main outcome measure was age standardized cause-specific injury mortality rates analysed by income inequality and housing and neighbourhood conditions. Nine measures of housing and neighbourhood conditions highly differentiating European households at country level were clustered into three dimensions, labelled respectively housing, neighbourhood and economic household strain. Income inequality significantly and positively correlated with housing strain (r = 0.62, P = 0.001) and household economic strain (r = 0.42, P = 0.009) but not significantly with neighbourhood strain (r = 0.34, P = 0.087). Child injury mortality rates correlated strongly with both country-level income inequality and housing strain, with very small age-specific differences. In the European context housing, neighbourhood and household economic strains worsened with increasing levels of income inequality. Child injury mortality rates are strongly and positively associated with both income inequality and housing strain, suggesting that housing material conditions could play a role in the association between income inequality and child health. © 2013 John Wiley & Sons Ltd.

Income Inequality and Child Mortality in Wealthy Nations.

PubMed

Collison, David

2016-01-01

This chapter presents evidence of a relationship between child mortality data and socio-economic factors in relatively wealthy nations. The original study on child mortality that is reported here, which first appeared in a UK medical journal, was undertaken in a school of business by academics with accounting and finance backgrounds. The rationale explaining why academics from such disciplines were drawn to investigate these issues is given in the first part of the chapter. The findings related to child mortality data were identified as a special case of a wide range of social and health indicators that are systematically related to the different organisational approaches of capitalist societies. In particular, the so-called Anglo-American countries show consistently poor outcomes over a number of indicators, including child mortality. Considerable evidence has been adduced in the literature to show the importance of income inequality as an explanation for such findings. An important part of the chapter is the overview of a relatively recent publication in the epidemiological literature entitled The Spirit Level: Why Equality Is Better for Everyone, which was written by Wilkinson and Pickett. © 2016 S. Karger AG, Basel.

Social sector expenditure and child mortality in India: a state-level analysis from 1997 to 2009.

PubMed

Makela, Susanna M; Dandona, Rakhi; Dilip, T R; Dandona, Lalit

2013-01-01

India is unlikely to meet the Millennium Development Goal for child mortality. As public policy impacts child mortality, we assessed the association of social sector expenditure with child mortality in India. Mixed-effects regression models were used to assess the relationship of state-level overall social sector expenditure and its major components (health, health-related, education, and other) with mortality by sex among infants and children aged 1-4 years from 1997 to 2009, adjusting for potential confounders. Counterfactual models were constructed to estimate deaths averted due to overall social sector increases since 1997. Increases in per capita overall social sector expenditure were slightly higher in less developed than in more developed states from 1997 to 2009 (2.4-fold versus 2-fold), but the level of expenditure remained 36% lower in the former in 2009. Increase in public expenditure on health was not significantly associated with mortality reduction in infants or at ages 1-4 years, but a 10% increase in health-related public expenditure was associated with a 3.6% mortality reduction (95% confidence interval 0.2-6.9%) in 1-4 years old boys. A 10% increase in overall social sector expenditure was associated with a mortality reduction in both boys (6.8%, 3.5-10.0%) and girls (4.1%, 0.8-7.5%) aged 1-4 years. We estimated 119,807 (95% uncertainty interval 53,409-214,662) averted deaths in boys aged 1-4 years and 94,037 (14,725-206,684) in girls in India in 2009 that could be attributed to increases in overall social sector expenditure since 1997. Further reduction in child mortality in India would be facilitated if policymakers give high priority to the social sector as a whole for resource allocation in the country's 5-year plan for 2012-2017, as public expenditure on health alone has not had major impact on reducing child mortality.

Racial Inequality and Child Mortality in Brazil.

ERIC Educational Resources Information Center

Wood, Charles H.; Lovell, Peggy A.

1992-01-01

In 1980 urban Brazil, race of mother significantly affected child mortality after controlling for region, income, and parent education, with a mortality gap of 6.7 years between the whites and Afro-Brazilians. Parent education, indoor plumbing, access to public health care, and presence of adult females significantly reduced the probability of…

Disparities in Under-Five Child Injury Mortality between Developing and Developed Countries: 1990-2013.

PubMed

Huang, Yun; Wu, Yue; Schwebel, David C; Zhou, Liang; Hu, Guoqing

2016-07-07

Using estimates from the 2013 Global Burden of Disease (GBD) study, we update evidence on disparities in under-five child injury mortality between developing and developed countries from 1990 to 2013. Mortality rates were accessed through the online visualization tool by the GBD study 2013 group. We calculated percent change in child injury mortality rates between 1990 and 2013. Data analysis was conducted separately for <1 year and 1-4 years to specify age differences in rate changes. Between 1990 and 2013, over 3-fold mortality gaps were observed between developing countries and developed countries for both age groups in the study time period. Similar decreases in injury rates were observed for developed and developing countries (<1 year: -50% vs. -50% respectively; 1-4 years: -56% vs. -58%). Differences in injury mortality changes during 1990-2013 between developing and developed nations varied with injury cause. There were greater reductions in mortality from transport injury, falls, poisoning, adverse effects of medical treatment, exposure to forces of nature, and collective violence and legal intervention in developed countries, whereas there were larger decreases in mortality from drowning, exposure to mechanical forces, and animal contact in developing countries. Country-specific analysis showed large variations across countries for both injury mortality and changes in injury mortality between 1990 and 2013. Sustained higher child injury mortality during 1990-2013 for developing countries merits the attention of the global injury prevention community. Countries that have high injury mortality can benefit from the success of other countries.

The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample

PubMed Central

Saggurti, Niranjan; Winter, Michael; Labonte, Alan; Decker, Michele R; Balaiah, Donta; Silverman, Jay G

2010-01-01

Objective To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India. Design Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations. Adjusted models included maternal and child demographics and maternal body mass index as covariates. Setting India. Population Women aged 15-49 years (n=124 385); data collected in 2005-6 through National Family Health Survey-3. Data about child morbidity and mortality reported by participants. Analyses restricted to births in past five years reported by ever married women aged 15-24 years (n=19 302 births to 13 396 mothers). Main outcome measures In under 5s: mortality related infectious diseases in the past two weeks (acute respiratory infection, diarrhoea); malnutrition (stunting, wasting, underweight); infant (age <1 year) and child (1-5 years) mortality; low birth weight (<2500 kg). Results The majority of births (73%; 13 042/19 302) were to mothers married as minors. Although bivariate analyses showed significant associations between maternal child marriage and infant and child diarrhoea, malnutrition (stunted, wasted, underweight), low birth weight, and mortality, only stunting (adjusted odds ratio 1.22, 95% CI 1.12 to 1.33) and underweight (1.24, 1.14 to 1.36) remained significant in adjusted analyses. We noted no effect of maternal child marriage on health of boys versus girls. Conclusions The risk of malnutrition is higher in young children born to mothers married as minors than in those born to women married at a majority age. Further research should examine how early marriage affects food distribution and access for children in India. PMID:20093277

Maternal education and child mortality in Zimbabwe.

PubMed

Grépin, Karen A; Bharadwaj, Prashant

2015-12-01

In 1980, Zimbabwe rapidly expanded access to secondary schools, providing a natural experiment to estimate the impact of increased maternal secondary education on child mortality. Exploiting age specific exposure to these reforms, we find that children born to mothers most likely to have benefited from the policies were about 21% less likely to die than children born to slightly older mothers. We also find that increased education leads to delayed age at marriage, sexual debut, and first birth and that increased education leads to better economic opportunities for women. We find little evidence supporting other channels through which increased education might affect child mortality. Expanding access to secondary schools may greatly accelerate declines in child mortality in the developing world today. Copyright © 2015 Elsevier B.V. All rights reserved.

Effectiveness of an NGO primary health care programme in rural Bangladesh: evidence from the management information system.

PubMed

Mercer, Alec; Khan, Mobarak Hossain; Daulatuzzaman, Muhammad; Reid, Joanna

2004-07-01

This paper considers evidence of the effectiveness of a non-governmental organization (NGO) primary health care programme in rural Bangladesh. It is based on data from the programme's management information system reported by 27 partner NGOs from 1996-2002. The data indicate relatively high coverage has been achieved for reproductive and child health services, as well as lower infant and child mortality. On the basis of a crude indicator of socio-economic status, the programme is poverty-focused. There is good service coverage among the poorest one-third and others, and the infant and child mortality differential has been eliminated over recent years. A rapid decline in infant mortality among the poorest from 1999-2002 reflects a reduction in neonatal mortality of about 50%. Allowing for some under-reporting and possible misclassification of deaths to the stillbirths category, neonatal mortality is relatively low in the NGO areas. The lower child and maternal mortality for the NGO areas combined, compared with estimates for Bangladesh in recent years, may at least in part be due to high coverage of reproductive and child health services. Other development programmes implemented by many of the NGOs could also have contributed. Despite the limited resources available, and the lower infant and child mortality already achieved, there appears to be scope for further prevention of deaths, particularly those due to birth asphyxia, acute respiratory infection, diarrhoeal disease and accidents. Maternal mortality in the NGO areas was lower in 2000-02 than the most recent estimate for Bangladesh. Further reduction is likely to depend on improved access to qualified community midwives and essential obstetric care at government referral facilities.

Child Survival Strategies: Assessment of Knowledge and Practice of Rural Women of Reproductive Age in Cross River State, Nigeria.

PubMed

Etokidem, Aniekan Jumbo; Johnson, Ofonime

2016-01-01

Introduction . Nigeria is one of the five countries that account for about 50% of under-five mortality in the world. The objective of this study was to assess the knowledge and practice of child survival strategies among rural community caregivers in Cross River State of Nigeria. Materials and Methods . This descriptive cross-sectional survey used a pretested questionnaire to obtain information from 150 women of reproductive age. Data analysis was done using SPSS version 20. Results . The child survival strategy known to most of the respondents was oral rehydration therapy as indicated by 98% followed by female education by 73.3% and immunization by 67.3%. Only 20% of the respondents had adequate knowledge of frequency of weighing a child while only 32.7% knew that breastfeeding should be continued even if the child had diarrhea. More respondents with nonformal education (83.3%) practiced exclusive breastfeeding of their last children compared to respondents with primary education (77.3%), secondary education (74.2%), and tertiary education (72.2%). Conclusion . Although respondents demonstrated adequate knowledge and practice of most of the strategies, there was evidence of gaps, including myths and misconceptions that could mar efforts towards reducing child morbidity and mortality in the state.

Spatial-temporal dynamics and structural determinants of child and maternal mortality in a rural, high HIV burdened South African population, 2000-2014: a study protocol.

PubMed

Tlou, B; Sartorius, B; Tanser, F

2016-07-15

Child (infant and under-5) and maternal mortality rates are key indicators for assessing the health status of populations. South Africa's maternal and child mortality rates are high, and the country mirrors the continental trend of slow progress towards its Millennium Development Goals. Rural areas are often more affected regarding child and maternal mortalities, specifically in areas with a high HIV burden. This study aims to understand the factors affecting child and maternal mortality in the Africa Centre Demographic Surveillance Area (DSA) from 2003 to 2014 towards developing tailored interventions to reduce the deaths in resource poor settings. This will be done by identifying child and maternal mortality 'hotspots' and their associated risk factors. This retrospective study will use data for 2003-2014 from the Africa Centre Demographic Information System (ACDIS) in rural KwaZulu-Natal Province, South Africa. All homesteads in the study area have been mapped to an accuracy of <2 m, all deaths recorded and the assigned cause of death established using a verbal autopsy interview. Advanced spatial-temporal clustering techniques (both regular (Kulldorff) and irregular (FleXScan)) will be used to identify mortality 'hotspots'. Various advanced statistical modelling approaches will be tested and used to identify significant risk factors for child and maternal mortality. Differences in attributability and risk factors profiles in identified 'hotspots' will be assessed to enable tailored intervention guidance/development. This multicomponent study will enable a refined intervention model to be developed for typical rural populations with a high HIV burden. Ethical approval was received from the Biomedical Research Ethics Committee (BREC) of the University of KwaZulu-Natal (BE 169/15). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Taking the long view: a systematic review reporting long-term perspectives on child unintentional injury.

PubMed

Mytton, Julie A; Towner, Elizabeth M L; Powell, Jane; Pilkington, Paul A; Gray, Selena

2012-10-01

The relative significance of child injury as a cause of preventable death has increased as mortality from infectious diseases has declined. Unintentional child injuries are now a major cause of death and disability across the world with the greatest burden falling on those who are most disadvantaged. A review of long-term data on child injury mortality was conducted to explore trends and inequalities and consider how data were used to inform policy, practice and research. The authors systematically collated and quality appraised data from publications and documents reporting unintentional child injury mortality over periods of 20 years or more. A critical narrative synthesis explored trends by country income group, injury type, age, gender, ethnicity and socioeconomic group. 31 studies meeting the inclusion criteria were identified of which 30 were included in the synthesis. Only six were from middle income countries and none were from low income countries. An overall trend in falling child injury mortality masked rising road traffic injury deaths, evidence of increasing vulnerability of adolescents and widening disparities within countries when analysed by ethnic group and socioeconomic status. Child injury mortality trend data from high and middle income countries has illustrated inequalities within generally falling trends. There is scope for greater use of existing trend data to inform policy and practice. Similar evidence from low income countries where the burden of injury is greatest is needed.

Total prevention of folic acid-preventable spina bifida and anencephaly would reduce child mortality in India: Implications in achieving Target 3.2 of the Sustainable Development Goals.

PubMed

Kancherla, Vijaya; Oakley, Godfrey P

2018-03-15

The potential to reduce child mortality by preventing folic acid-preventable spina bifida and anencephaly (FAP SBA) is inadequately appreciated. To quantify possible reduction in FAP SBA-associated child mortality in low- and middle-income countries, we conducted an analysis to demonstrate in India, a country with more than 25 million births and 1.2 million under-five deaths each year, the decrease in neonatal, infant, and under-five mortality that would occur through total prevention of FAP SBA. We estimated the percent reductions in neonatal, infant, and under-five mortality that would have occurred in India in 2015 had all of FAP SBA been prevented. We also estimated the contributions of these reductions toward India's Sustainable Development Goals on child mortality indicators. We considered the overall prevalence of spina bifida and anencephaly in India as 5 per 1,000 live births, of which 90% were preventable with effective folic acid intervention. In the year 2015, folic acid interventions would have prevented about 116,070 cases of FAP SBA and 101,565 under-five deaths associated with FAP SBA. Prevention of FAP SBA would have reduced annually, neonatal, infant, and under-five mortality by 10.2%, 8.9%, and 8.3%, respectively. These reductions would have contributed 18.5% and 17.2% to the reductions in neonatal and under-five mortality, respectively, needed by India to achieve its 2030 Sustainable Developmental Goal Target 3.2 addressing preventable child mortality. Total prevention of FAP SBA clearly has a significant potential for immediate reductions in neonatal, infant, and under-five mortality in India, and similarly other countries. © 2017 Wiley Periodicals, Inc.

Labor migration and child mortality in Mozambique

PubMed Central

Yabiku, Scott T.; Agadjanian, Victor; Cau, Boaventura

2013-01-01

Male labor migration is widespread in many parts of the world, yet its consequences for child outcomes and especially childhood mortality remain unclear. Male labor migration could bring benefits, in the form of remittances, to the families that remain behind and thus help child survival. Alternatively, the absence of a male adult could imperil the household's well-being and its ability to care for its members, increasing child mortality risks. In this analysis, we use longitudinal survey data from Mozambique collected in 2006 and 2009 to examine the association between male labor migration and under-five mortality in families that remain behind. Using a simple migrant/non-migrant dichotomy, we find no difference in mortality rates across migrant and non-migrant men's children. When we separated successful from unsuccessful migration based on the wife's perception, however, stark contrasts emerge: children of successful migrants have the lowest mortality, followed by children of non-migrant men, followed by the children of unsuccessful migrants. Our results illustrate the need to account for the diversity of men's labor migration experience in examining the effects of migration on left-behind households. PMID:23121856

Consequences of household air pollution on child survival: evidence from demographic and health surveys in 47 countries.

PubMed

Kleimola, Lauren B; Patel, Archana B; Borkar, Jitesh A; Hibberd, Patricia L

2015-01-01

Over one-third of the world's population is exposed to household air pollution (HAP) but the separate effects of cooking with solid fuel and kerosene on childhood mortality are unclear. To evaluate the effects of both solid fuels and kerosene on neonatal (0-28 days) and child (29 days-59 months) mortality. We used Demographic and Health Surveys from 47 countries and calculated adjusted relative risks (aRR) using Poisson regression models. The aRR of neonatal and child mortality in households exposed to solid fuels were 1.24 (95% CI: 1.14, 1.34) and 1.21 (95% CI: 1.12, 1.30), respectively, and the aRR for neonatal and child mortality in households exposed to kerosene were 1.34 (95% CI: 1.18, 1.52) and 1.12 (95% CI: 0.99, 1.27), controlling for individual, household, and country-level predictors of mortality. Kerosene should not be classified as a clean fuel. Neonates are at risk for mortality from exposure to solid fuels and kerosene.

The effect of economic sanctions on the mortality of Iraqi children prior to the 1991 Persian Gulf War.

PubMed Central

Daponte, B O; Garfield, R

2000-01-01

OBJECTIVES: This study examined the effect of sanctions on mortality among Iraqi children. METHODS: The effects of economic sanctions on health are not well known. Past studies on the effect of economic sanctions on mortality have suffered from unreliable data sources and the collinearity of sanctions with other negative economic events. We overcame these weaknesses by using individual child records from a retrospective survey of mothers conducted after the 1991 Persian Gulf War to examine the effect of sanctions on mortality among Iraqi children. Multivariate proportional hazards analysis was used to assess the effect of economic sanctions prior to war (from August through December 1990). RESULTS: We found that after controlling for child and maternal characteristics, when economic sanctions were entered into the proportional hazards equation, the risk of dying increased dramatically. This increase was highly significant statistically. CONCLUSIONS: Innovative application of robust epidemiologic research tools can contribute to assessments of health and well-being even under the methodological and practical constraints of comprehensive economic sanctions, but more research is needed. PMID:10754968

Trends In State-Level Child Mortality, Maternal Mortality, And Fertility Rates In India.

PubMed

Munshi, Vidit; Yamey, Gavin; Verguet, Stéphane

2016-10-01

Trends in child mortality, maternal mortality, and fertility in India reveal wide variation across states. As a whole, India performs worse than many other low- and middle-income countries, although its rates of improvement have recently increased. Differences in health systems and adopted policies may account for some of the variation across Indian states. Published by Project HOPE—The People-to-People Health Foundation, Inc.

Does intelligence account for the link between maternal literacy and child survival?

PubMed

Sandiford, P; Cassel, J; Sanchez, G; Coldham, C

1997-10-01

The strong and consistent correlation between maternal education and child health is now well known, and numerous studies have shown that wealth and income cannot explain the link. Policy-makers have therefore assumed that the relationship is causal and explicitly advocate schooling as a child health intervention. However, there are other factors which could account for the apparent effect of maternal education on child morbidity and mortality, one of which is intelligence. This paper examines the effect of maternal intelligence on child health and looks at the degree to which it can explain the literacy associations with child survival and risk of malnutrition. The data are from a retrospective cohort study of 1294 mothers and their 7475 offspring, of whom 454 were women who had learned to read and write as adults in Nicaragua's literacy programme, 457 were illiterate, and 383 had become literate as young girls attending school. The women's intelligence was tested using Raven's Coloured Progressive Matrices. Acquisition of literacy was strongly related to intelligence. Statistically significant associations with maternal literacy were found for under five mortality, infant mortality, and the risk of low mid-upper-arm circumference (MUAC) for age, before and after controlling for a wide range of socio-economic factors. Under five, child (one to four years), infant and post-neonatal mortality plus the risk of low height for age were significantly correlated with intelligence, but only with infant and under mortality rates did the association remain significant after controlling for socio-economic factors. A significant interaction between intelligence and literacy for under five mortality was due to literacy having a strong effect in the women of low intelligence, and a negligible effect among those of high intelligence. This study provides evidence that intelligence is an important determinant of child health among the illiterate, and that education may have the greatest impact on child health for mothers of relatively low intelligence.

Drivers of Inequality in Millennium Development Goal Progress: A Statistical Analysis

PubMed Central

Stuckler, David; Basu, Sanjay; McKee, Martin

2010-01-01

Background Many low- and middle-income countries are not on track to reach the public health targets set out in the Millennium Development Goals (MDGs). We evaluated whether differential progress towards health MDGs was associated with economic development, public health funding (both overall and as percentage of available domestic funds), or health system infrastructure. We also examined the impact of joint epidemics of HIV/AIDS and noncommunicable diseases (NCDs), which may limit the ability of households to address child mortality and increase risks of infectious diseases. Methods and Findings We calculated each country's distance from its MDG goals for HIV/AIDS, tuberculosis, and infant and child mortality targets for the year 2005 using the United Nations MDG database for 227 countries from 1990 to the present. We studied the association of economic development (gross domestic product [GDP] per capita in purchasing-power-parity), the relative priority placed on health (health spending as a percentage of GDP), real health spending (health system expenditures in purchasing-power-parity), HIV/AIDS burden (prevalence rates among ages 15–49 y), and NCD burden (age-standardised chronic disease mortality rates), with measures of distance from attainment of health MDGs. To avoid spurious correlations that may exist simply because countries with high disease burdens would be expected to have low MDG progress, and to adjust for potential confounding arising from differences in countries' initial disease burdens, we analysed the variations in rates of change in MDG progress versus expected rates for each country. While economic development, health priority, health spending, and health infrastructure did not explain more than one-fifth of the differences in progress to health MDGs among countries, burdens of HIV and NCDs explained more than half of between-country inequalities in child mortality progress (R 2-infant mortality  = 0.57, R 2-under 5 mortality  = 0.54). HIV/AIDS and NCD burdens were also the strongest correlates of unequal progress towards tuberculosis goals (R 2 = 0.57), with NCDs having an effect independent of HIV/AIDS, consistent with micro-level studies of the influence of tobacco and diabetes on tuberculosis risks. Even after correcting for health system variables, initial child mortality, and tuberculosis diseases, we found that lower burdens of HIV/AIDS and NCDs were associated with much greater progress towards attainment of child mortality and tuberculosis MDGs than were gains in GDP. An estimated 1% lower HIV prevalence or 10% lower mortality rate from NCDs would have a similar impact on progress towards the tuberculosis MDG as an 80% or greater rise in GDP, corresponding to at least a decade of economic growth in low-income countries. Conclusions Unequal progress in health MDGs in low-income countries appears significantly related to burdens of HIV and NCDs in a population, after correcting for potentially confounding socioeconomic, disease burden, political, and health system variables. The common separation between NCDs, child mortality, and infectious syndromes among development programs may obscure interrelationships of illness affecting those living in poor households—whether economic (e.g., as money spent on tobacco is lost from child health expenditures) or biological (e.g., as diabetes or HIV enhance the risk of tuberculosis). Please see later in the article for the Editors' Summary PMID:20209000

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

PubMed Central

2017-01-01

Summary Background Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Methods Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1–4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980–2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age–sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, 5·8 million (95% uncertainty interval [UI] 5·7–6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7–53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3–43·6) to 2·6 million (2·6–2·7) neonatal deaths and 47·0% (35·1–57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6–3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Interpretation Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. PMID:27733285

Inequities in under-five mortality in Nigeria: differentials by religious affiliation of the mother.

PubMed

Antai, Diddy; Ghilagaber, Gebrenegus; Wedrén, Sara; Macassa, Gloria; Moradi, Tahereh

2009-09-01

Observations in Nigeria have indicated polio vaccination refusal related to religion that ultimately affected child morbidity and mortality. This study assessed the role of religion in under-five (0-59 months) mortality using a cross-sectional, nationally representative sample of 7,620 women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey and included 6,029 children. Results show that mother's affiliation to Traditional indigenous religion is significantly associated with increased under-five mortality. Multivariable modelling demonstrated that this association is explained by differential use of maternal and child health services, specifically attendance to prenatal care. To reduce child health inequity, these results need to be incorporated in the formulation of child health policies geared towards achieving a high degree of attendance to prenatal care, irrespective of religious affiliation.

Reducing the burden of maternal and child morbidity and mortality in the Eastern Mediterranean Region? Yes, we can.

PubMed

Fathalla, Mahmoud Fahmy

2014-02-11

Maternal and child morbidity and mortality are a major public health, development and human rights challenge globally and in the WHO Eastern Mediterranean Region. The Region is diverse, with high-, middle- and low- income countries, many suffering from political instability, conflicts and other complex development challenges. Although progress has been made towards Millennium Development Goals 4 and 5, it has been uneven both between and within countries. This paper makes an analysis of the strengths, weaknesses, opportunities and threats to improving maternal and child mortality and morbidity with a focus on the Region. In answer to the question whether we can reduce the burden of maternal and child morbidity and mortality in the Region: yes, we can. However, commitment and collaboration are needed at the country, regional and international levels.

Inequality in child mortality across different states of India: a comparative study.

PubMed

De, Partha; Dhar, Arpita

2013-12-01

The burden of social inequality falls disproportionately on child health and survival. This inequality raises the question of how wide this gap is, or what its relation is with the level of child mortality. Whether these disparities are increasing or declining with the development and how they differ from region to region or from state to state within the country needs to be looked into. As a measure of inequality and to compare the disparities between different states of India, concentration curves and indices are constructed from infant and under five mortality data classified under different quintiles of wealth index from the National Family Health Survey (NFHS-3) data of India. Inequality measures indicate that inequality in child mortality is more concentrated in the comparatively developed states than the poorer states in India.

Effects of food price inflation on infant and child mortality in developing countries.

PubMed

Lee, Hyun-Hoon; Lee, Suejin A; Lim, Jae-Young; Park, Cyn-Young

2016-06-01

After a historic low level in the early 2000s, global food prices surged upwards to bring about the global food crisis of 2008. High and increasing food prices can generate an immediate threat to the security of a household's food supply, thereby undermining population health. This paper aims to assess the precise effects of food price inflation on child health in developing countries. This paper employs a panel dataset covering 95 developing countries for the period 2001-2011 to make a comprehensive assessment of the effects of food price inflation on child health as measured in terms of infant mortality rate and child mortality rate. Focusing on any departure of health indicators from their respective trends, we find that rising food prices have a significant detrimental effect on nourishment and consequently lead to higher levels of both infant and child mortality in developing countries, and especially in least developed countries (LDCs). High food price inflation rates are also found to cause an increase in undernourishment only in LDCs and thus leading to an increase in infant and child mortality in these poorest countries. This result is consistent with the observation that, in lower-income countries, food has a higher share in household expenditures and LDCs are likely to be net food importing countries. Hence, there should be increased efforts by both LDC governments and the international community to alleviate the detrimental link between food price inflation and undernourishment and also the link between undernourishment and infant mortality.

[The health gap in Mexico, measured through child mortality].

PubMed

Gutiérrez, Juan Pablo; Bertozzi, Stefano M

2003-01-01

To estimate the health gap in Mexico, as evidenced by the difference between the observed 1998 mortality rate and the estimated rate and the estimated rate for the same year according to social and economic indicators, with rates from other countries. An econometric model was developed, using the 1998 child mortality rate (CMR) as the dependent variable, and macro-social and economic indicators as independent variables. The model included 70 countries for which complete data were available. The proposed model explained over 90% of the variability in CMR among countries. The expected CMR for Mexico was 22% lower that the observed rate, which represented nearly 20,000 excess deaths. After adjusting for differences in productivity, distribution of wealth, and investment in human capital, the excess child mortality rate suggested efficiency problems in the Mexican health system, at least in relation to services intended to reduce child mortality. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

The impact of the Brazilian family health on selected primary care sensitive conditions: A systematic review

PubMed Central

Menzies, Dick; Hone, Thomas; Dehghani, Kianoush; Trajman, Anete

2017-01-01

Background Brazil has the largest public health-system in the world, with 120 million people covered by its free primary care services. The Family Health Strategy (FHS) is the main primary care model, but there is no consensus on its impact on health outcomes. We systematically reviewed published evidence regarding the impact of the Brazilian FHS on selective primary care sensitive conditions (PCSC). Methods We searched Medline, Web of Science and Lilacs in May 2016 using key words in Portuguese and English, without language restriction. We included studies if intervention was the FHS; comparison was either different levels of FHS coverage or other primary health care service models; outcomes were the selected PCSC; and results were adjusted for relevant sanitary and socioeconomic variables, including the national conditional cash transfer program (Bolsa Familia). Due to differences in methods and outcomes reported, pooling of results was not possible. Results Of 1831 records found, 31 met our inclusion criteria. Of these, 25 were ecological studies. Twenty-one employed longitudinal quasi-experimental methods, 27 compared different levels the FHS coverage, whilst four compared the FHS versus other models of primary care. Fourteen studies found an association between higher FHS coverage and lower post-neonatal and child mortality. When the effect of Bolsa Familia was accounted for, the effect of the FHS on child mortality was greater. In 13 studies about hospitalizations due to PCSC, no clear pattern of association was found. In four studies, there was no effect on child and elderly vaccination or low-birth weight. No included studies addressed breast-feeding, dengue, HIV/AIDS and other neglected infectious diseases. Conclusions Among these ecological studies with limited quality evidence, increasing coverage by the FHS was consistently associated with improvements in child mortality. Scarce evidence on other health outcomes, hospitalization and synergies with cash transfer was found. PMID:28786997

Parental leave and child health.

PubMed

Ruhm, C J

2000-11-01

This study investigates whether rights to parental leave improve pediatric health. Aggregate data are used for 16 European countries over the 1969 through 1994 period. More generous paid leave is found to reduce deaths of infants and young children. The magnitudes of the estimated effects are substantial, especially where a causal effect of leave is most plausible. In particular, there is a much stronger negative relationship between leave durations and post-neonatal or child fatalities than for perinatal mortality, neonatal deaths, or low birth weight. The evidence further suggests that parental leave may be a cost-effective method of bettering child health.

Determinants and development of a web-based child mortality prediction model in resource-limited settings: A data mining approach.

PubMed

Tesfaye, Brook; Atique, Suleman; Elias, Noah; Dibaba, Legesse; Shabbir, Syed-Abdul; Kebede, Mihiretu

2017-03-01

Improving child health and reducing child mortality rate are key health priorities in developing countries. This study aimed to identify determinant sand develop, a web-based child mortality prediction model in Ethiopian local language using classification data mining algorithm. Decision tree (using J48 algorithm) and rule induction (using PART algorithm) techniques were applied on 11,654 records of Ethiopian demographic and health survey data. Waikato Environment for Knowledge Analysis (WEKA) for windows version 3.6.8 was used to develop optimal models. 8157 (70%) records were randomly allocated to training group for model building while; the remaining 3496 (30%) records were allocated as the test group for model validation. The validation of the model was assessed using accuracy, sensitivity, specificity and area under Receiver Operating Characteristics (ROC) curve. Using Statistical Package for Social Sciences (SPSS) version 20.0; logistic regressions and Odds Ratio (OR) with 95% Confidence Interval (CI) was used to identify determinants of child mortality. The child mortality rate was 72 deaths per 1000 live births. Breast-feeding (AOR= 1.46, (95% CI [1.22. 1.75]), maternal education (AOR= 1.40, 95% CI [1.11, 1.81]), family planning (AOR= 1.21, [1.08, 1.43]), preceding birth interval (AOR= 4.90, [2.94, 8.15]), presence of diarrhea (AOR= 1.54, 95% CI [1.32, 1.66]), father's education (AOR= 1.4, 95% CI [1.04, 1.78]), low birth weight (AOR= 1.2, 95% CI [0.98, 1.51]) and, age of the mother at first birth (AOR= 1.42, [1.01-1.89]) were found to be determinants for child mortality. The J48 model had better performance, accuracy (94.3%), sensitivity (93.8%), specificity (94.3%), Positive Predictive Value (PPV) (92.2%), Negative Predictive Value (NPV) (94.5%) and, the area under ROC (94.8%). Subsequent to developing an optimal prediction model, we relied on this model to develop a web-based application system for child mortality prediction. In this study, nearly accurate results were obtained by employing decision tree and rule induction techniques. Determinants are identified and a web-based child mortality prediction model in Ethiopian local language is developed. Thus, the result obtained could support child health intervention programs in Ethiopia where trained human resource for health is limited. Advanced classification algorithms need to be tested to come up with optimal models. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Child Mortality in the School Setting. Position Statement. Revised

ERIC Educational Resources Information Center

Bergren, Martha Dewey

2017-01-01

It is the position of the National Association of School Nurses (NASN) that data on children's deaths in school should be recorded, analyzed and reported at the local, state and national levels. The systematic review of data on child mortality is necessary to drive interventions and policies that will decrease mortality from injuries, violence,…

Leadership, infrastructure and capacity to support child injury prevention: can these concepts help explain differences in injury mortality rankings between 18 countries in Europe?

PubMed

MacKay, J Morag; Vincenten, Joanne A

2012-02-01

Mortality and morbidity rates, traditionally used indicators for child injury, are limited in their ability to explain differences in child injury between countries, are inadequate in capturing actions to address the problem of child injury and do not adequately identify progress made within countries. There is a need for a broader set of indicators to help better understand the success of countries with low rates of child injury, provide guidance and benchmarks for policy makers looking to make investments to reduce their rates of fatal and non-fatal child injury and allow monitoring of progress towards achieving these goals. This article describes an assessment of national leadership, infrastructure and capacity in the context of child injury prevention in 18 countries in Europe and explores the potential of these to be used as additional indicators to support child injury prevention practice. Partners in 18 countries coordinated data collection on 21 items relating to leadership, infrastructure and capacity. Responses were coded into an overall score and scores for each of the three areas and were compared with child injury mortality rankings using Spearman's rank correlation. Overall score and scores for leadership and capacity were significantly negatively correlated to child injury mortality ranking. Findings of this preliminary work suggest that these three policy areas may provide important guidance for the types of commitments that are needed in the policy arena to support advances in child safety and their assessment a way to measure progress.

A low muscle mass increases mortality in compensated cirrhotic patients with sepsis.

PubMed

Lucidi, Cristina; Lattanzi, Barbara; Di Gregorio, Vincenza; Incicco, Simone; D'Ambrosio, Daria; Venditti, Mario; Riggio, Oliviero; Merli, Manuela

2018-05-01

Severe infections and muscle wasting are both associated to poor outcome in cirrhosis. A possible synergic effect of these two entities in cirrhotic patients has not been previously investigated. We aimed at analysing if a low muscle mass may deteriorate the outcome of cirrhotic patients with sepsis. Consecutive cirrhotic patients hospitalized for sepsis were enrolled in the study. Patients were classified for the severity of liver impairment (Child-Pugh class) and for the presence of "low muscle mass" (mid-arm muscle circumference<5th percentile). The development of complication during hospitalization and survival was analysed. There were 74 consecutive cirrhotics with sepsis. Forty-three of these patients showed low muscle mass. In patients with and without low muscle mass, severity of liver disease and characteristics of infections were similar. Mortality tended to be higher in patients with low muscle mass (47% vs 26%, P = .06). A multivariate analysis selected low muscle mass (P < .01, HR: 3.2, IC: 1.4-4.8) and Child-Pugh C (P < .01, HR: 3.3, 95% IC: 1.5-4.9) as independent predictors of in-hospital mortality. In Child-Pugh A-B patients, mortality was higher in patients with low muscle mass compared with those without (50% vs 16%; P = .01). The mortality rate and the incidence of complications in malnourished patients classified in Child-Pugh A-B were similar to those Child-Pugh C. Low muscle mass worsen prognosis in cirrhotic patients with severe infections. This is particularly evident in patients with Child A-B cirrhosis in whom the coexistence of low muscle mass and sepsis caused a negative impact on mortality similar to that observable in all Child C patients with sepsis. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Influence of Infant Feeding Practices on Infant Mortality in Southern Africa.

PubMed

Motsa, Lungile F; Ibisomi, Latifat; Odimegwu, Clifford

2016-10-01

Objective To examine the adjusted and unadjusted effects of infant feeding practices on infant mortality in Southern Africa. Methods A merged dataset from the most recent Demographic and Health Surveys for Lesotho, Swaziland, Zambia and Zimbabwe was analysed using the Cox Proportional Hazard Model. A total number of 13,218 infants born in 5 years preceding all the surveys with information on infant feeding practices constituted the study population. Infant mortality was the outcome variable and infant feeding practices categorised into; no breastfeeding, partial breastfeeding and exclusive breastfeeding were the main explanatory variables. Maternal demographic and socio-economic characteristics and infants' bio-demographic characteristics were also studied. Results Although, exclusive breastfeeding was quite low (12 %), exclusively breastfed infants exhibited a 97 % lower risk of dying during infancy compared to infants not breastfed in the region. Variations existed by country in the levels and patterns of both infant mortality and infant feeding practices. Mother's country, highest level of education and marital status; child's sex, birth weight and preceding birth interval were the significant predictors of infant mortality in Southern Africa. Conclusions Any form of breastfeeding whether exclusive or partial breastfeeding greatly reduces the risk of infant mortality with the greatest mortality reduction effect observed among exclusively breastfed infants in Southern Africa. To reduce the upsurge of infant mortality, there is the need to step up the effectiveness of child nutrition programmes that promote breastfeeding and put emphasis on exclusive breastfeeding of infants in the region.

Accelerating reproductive and child health programme impact with community-based services: the Navrongo experiment in Ghana.

PubMed Central

Phillips, James F.; Bawah, Ayaga A.; Binka, Fred N.

2006-01-01

OBJECTIVE: To determine the demographic and health impact of deploying health service nurses and volunteers to village locations with a view to scaling up results. METHODS: A four-celled plausibility trial was used for testing the impact of aligning community health services with the traditional social institutions that organize village life. Data from the Navrongo Demographic Surveillance System that tracks fertility and mortality events over time were used to estimate impact on fertility and mortality. RESULTS: Assigning nurses to community locations reduced childhood mortality rates by over half in 3 years and accelerated the time taken for attainment of the child survival Millennium Development Goal (MDG) in the study areas to 8 years. Fertility was also reduced by 15%, representing a decline of one birth in the total fertility rate. Programme costs added 1.92 US Dollar per capita to the 6.80 US Dollar per capita primary health care budget. CONCLUSION: Assigning nurses to community locations where they provide basic curative and preventive care substantially reduces childhood mortality and accelerates progress towards attainment of the child survival MDG. Approaches using community volunteers, however, have no impact on mortality. The results also demonstrate that increasing access to contraceptive supplies alone fails to address the social costs of fertility regulation. Effective deployment of volunteers and community mobilization strategies offsets the social constraints on the adoption of contraception. The research in Navrongo thus demonstrates that affordable and sustainable means of combining nurse services with volunteer action can accelerate attainment of both the International Conference on Population and Development agenda and the MDGs. PMID:17242830

Effects of health intervention programs and arsenic exposure on child mortality from acute lower respiratory infections in rural Bangladesh.

PubMed

Jochem, Warren C; Razzaque, Abdur; Root, Elisabeth Dowling

2016-09-01

Respiratory infections continue to be a public health threat, particularly to young children in developing countries. Understanding the geographic patterns of diseases and the role of potential risk factors can help improve future mitigation efforts. Toward this goal, this paper applies a spatial scan statistic combined with a zero-inflated negative-binomial regression to re-examine the impacts of a community-based treatment program on the geographic patterns of acute lower respiratory infection (ALRI) mortality in an area of rural Bangladesh. Exposure to arsenic-contaminated drinking water is also a serious threat to the health of children in this area, and the variation in exposure to arsenic must be considered when evaluating the health interventions. ALRI mortality data were obtained for children under 2 years old from 1989 to 1996 in the Matlab Health and Demographic Surveillance System. This study period covers the years immediately following the implementation of an ALRI control program. A zero-inflated negative binomial (ZINB) regression model was first used to simultaneously estimate mortality rates and the likelihood of no deaths in groups of related households while controlling for socioeconomic status, potential arsenic exposure, and access to care. Next a spatial scan statistic was used to assess the location and magnitude of clusters of ALRI mortality. The ZINB model was used to adjust the scan statistic for multiple social and environmental risk factors. The results of the ZINB models and spatial scan statistic suggest that the ALRI control program was successful in reducing child mortality in the study area. Exposure to arsenic-contaminated drinking water was not associated with increased mortality. Higher socioeconomic status also significantly reduced mortality rates, even among households who were in the treatment program area. Community-based ALRI interventions can be effective at reducing child mortality, though socioeconomic factors may continue to influence mortality patterns. The combination of spatial and non-spatial methods used in this paper has not been applied previously in the literature, and this study demonstrates the importance of such approaches for evaluating and improving public health intervention programs.

Non-specific effect of measles vaccination on overall child mortality in an area of rural India with high vaccination coverage: a population-based case-control study.

PubMed

Kabir, Zubair; Long, Jean; Reddaiah, Vankadara P; Kevany, John; Kapoor, Suresh K

2003-01-01

To determine whether vaccination against measles in a population with sustained high vaccination coverage and relatively low child mortality reduces overall child mortality. In April and May 2000, a population-based, case-control study was conducted at Ballabgarh (an area in rural northern India). Eligible cases were 330 children born between 1 January 1991 and 31 December 1998 who died aged 12-59 months. A programme was used to match 320 controls for age, sex, family size, and area of residence from a birth cohort of 15 578 born during the same time period. The analysis used 318 matched pairs and suggested that children aged 12-59 months who did not receive measles vaccination in infancy were three times more likely to die than those vaccinated against measles. Children from lower caste households who were not vaccinated in infancy had the highest risk of mortality (odds ratio, 8.9). A 27% increase in child mortality was attributable to failure to vaccinate against measles in the study population. Measles vaccine seems to have a non-specific reducing effect on overall child mortality in this population. If true, children in lower castes may reap the greatest gains in survival. The findings should be interpreted with caution because the nutritional status of the children was not recorded and may be a residual confounder. "All-cause mortality" is a potentially useful epidemiological endpoint for future vaccine trials.

Some socio-economic factors affecting infant and child mortality with special reference to Indonesia.

PubMed

Kristanto, B

1983-06-01

A review of the literature on the socioeconomic factors affecting infant and child mortality is presented, with special reference to Indonesia. Four main factors are identified: parents' education, parents' occupation, urban-rural residence, and housing conditions. The author suggests that, in fact, problems related to health and sanitation are the main causes of infant and child mortality. Also important are problems related to poverty, income, and income distribution. It is suggested that the solution is to be found in general socioeconomic development.

Disparities in child mortality trends: what is the evidence from disadvantaged states in India? the case of Orissa and Madhya Pradesh.

PubMed

Nguyen, Kim-Huong; Jimenez-Soto, Eliana; Dayal, Prarthna; Hodge, Andrew

2013-06-27

The Millennium Development Goals prompted renewed international efforts to reduce under-five mortality and measure national progress. However, scant evidence exists about the distribution of child mortality at low sub-national levels, which in diverse and decentralized countries like India are required to inform policy-making. This study estimates changes in child mortality across a range of markers of inequalities in Orissa and Madhya Pradesh, two of India's largest, poorest, and most disadvantaged states. Estimates of under-five and neonatal mortality rates were computed using seven datasets from three available sources--sample registration system, summary birth histories in surveys, and complete birth histories. Inequalities were gauged by comparison of mortality rates within four sub-state populations defined by the following characteristics: rural-urban location, ethnicity, wealth, and district. Trend estimates suggest that progress has been made in mortality rates at the state levels. However, reduction rates have been modest, particularly for neonatal mortality. Different mortality rates are observed across all the equity markers, although there is a pattern of convergence between rural and urban areas, largely due to inadequate progress in urban settings. Inter-district disparities and differences between socioeconomic groups are also evident. Although child mortality rates continue to decline at the national level, our evidence shows that considerable disparities persist. While progress in reducing under-five and neonatal mortality rates in urban areas appears to be levelling off, policies targeting rural populations and scheduled caste and tribe groups appear to have achieved some success in reducing mortality differentials. The results of this study thus add weight to recent government initiatives targeting these groups. Equitable progress, particularly for neonatal mortality, requires continuing efforts to strengthen health systems and overcome barriers to identify and reach vulnerable groups.

Rural-urban migration and child survival in urban Bangladesh: are the urban migrants and poor disadvantaged?

PubMed

Islam, M Mazharul; Azad, Kazi Md Abul Kalam

2008-01-01

This paper analyses the levels and trends of childhood mortality in urban Bangladesh, and examines whether children's survival chances are poorer among the urban migrants and urban poor. It also examines the determinants of child survival in urban Bangladesh. Data come from the 1999-2000 Bangladesh Demographic and Health Survey. The results indicate that, although the indices of infant and child mortality are consistently better in urban areas, the urban-rural differentials in childhood mortality have diminished in recent years. The study identifies two distinct child morality regimes in urban Bangladesh: one for urban natives and one for rural-urban migrants. Under-five mortality is higher among children born to urban migrants compared with children born to life-long urban natives (102 and 62 per 1000 live births, respectively). The migrant-native mortality differentials more-or-less correspond with the differences in socioeconomic status. Like childhood mortality rates, rural-urban migrants seem to be moderately disadvantaged by economic status compared with their urban native counterparts. Within the urban areas, the child survival status is even worse among the migrant poor than among the average urban poor, especially recent migrants. This poor-non-poor differential in childhood mortality is higher in urban areas than in rural areas. The study findings indicate that rapid growth of the urban population in recent years due to rural-to-urban migration, coupled with higher risk of mortality among migrant's children, may be considered as one of the major explanations for slower decline in under-five mortality in urban Bangladesh, thus diminishing urban-rural differentials in childhood mortality in Bangladesh. The study demonstrates that housing conditions and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas, even after controlling for migration status. The findings of the study may have important policy implications for urban planning, highlighting the need to target migrant groups and the urban poor within urban areas in the provision of health care services.

Kin and birth order effects on male child mortality: three East Asian populations, 1716-1945.

PubMed

Dong, Hao; Manfredini, Matteo; Kurosu, Satomi; Yang, Wenshan; Lee, James Z

2017-03-01

Human child survival depends on adult investment, typically from parents. However, in spite of recent research advances on kin influence and birth order effects on human infant and child mortality, studies that directly examine the interaction of kin context and birth order on sibling differences in child mortality are still rare. Our study supplements this literature with new findings from large-scale individual-level panel data for three East Asian historical populations from northeast China (1789-1909), northeast Japan (1716-1870), and north Taiwan (1906-1945), where preference for sons and first-borns is common. We examine and compare male child mortality risks by presence/absence of co-resident parents, grandparents, and other kin, as well as their interaction effects with birth order. We apply discrete-time event-history analysis on over 172,000 observations of 69,125 boys aged 1-9 years old. We find that in all three populations, while the presence of parents is important for child survival, it is more beneficial to first/early-borns than to later-borns. Effects of other co-resident kin are however null or inconsistent between populations. Our findings underscore the importance of birth order in understanding how differential parental investment may produce child survival differentials between siblings.

Under-Five Child Mortality and Morbidity Associated with Consanguineous Child Marriage in Pakistan: Retrospective Analysis using Pakistan Demographic and Health Surveys, 1990-91, 2006-07, 2012-13.

PubMed

Mustafa, Mudasir; Zakar, Rubeena; Zakar, Muhammad Zakria; Chaudhry, Ashraf; Nasrullah, Muazzam

2017-05-01

Objective To assess the combined effect of consanguineous and child marriages (CCM) on children health, which has not previously been explored, either globally or locally. Methods We analyzed secondary data from a series of cross-sectional, nationally representative Pakistan Demographic and Health Surveys 1990-91, 2006-07, and 2012-13. A total of 5406 mothers with 10,164 children were included in the analysis. Child health was assessed by variables such as history of diarrhea, acute respiratory infection (ARI), ARI with fever, Under-5 child mortality (U5CM) and small-size birth (SSB). Associations among variables were assessed by calculating unadjusted Odd Ratios (OR) and adjusted OR (AOR). Results A majority (n = 6,247, 61%) of the births were to mothers having CCM as compare to non-CCM (3917, 39%). There was a significant association between CCM and U5CM during 1990-91 (AOR 1.24, 95% CI 1.03-1.49) and 2006-07 (AOR 1.25, 95% CI 1.05-1.51), and infant mortality in 1990-91 (AOR 1.39, 95% CI 1.05-1.85) and 2006-07 (AOR 1.61, 95% CI 1.17-2.21). A significant association was also found between CCM and SSB infants in the period 2006-07 (AOR 1.19, 95% CI 1.01-1.42) and 2012-13 (AOR 1.22, 95% CI 1.02-1.46). We noted no effect of CCM on diarrhea, ARI, and ARI with fever. Conclusion CCM increases the likelihood of U5CM, infant mortality and SSB infants. Further quantitative and qualitative research should be conducted to assess the effects of environmental, congenital and genetic factors on the health of children born to mothers in CCM.

Etiology of child mortality in Goroka, Papua New Guinea: a prospective two-year study.

PubMed Central

Duke, Trevor; Michael, Audrey; Mgone, Joyce; Frank, Dale; Wal, Tilda; Sehuko, Rebecca

2002-01-01

OBJECTIVE: To collect accurate data on disease- and microbial-specific causes and avoidable factors in child deaths in a developing country. METHODS: A systematic prospective audit of deaths of children seen at Goroka Hospital in the highlands of Papua New Guinea was carried out. Over a 24-month period, we studied 353 consecutive deaths of children: 126 neonates, 186 children aged 1-59 months, and 41 children aged 5-12 years. FINDINGS: The most frequent age-specific clinical diagnoses were as follows: for neonates--very low birth weight, septicaemia, birth asphyxia and congenital syphilis; for children aged 1-59 months--pneumonia, septicaemia, marasmus and meningitis; and for children aged 5-12 years--malignancies and septicaemia. At least one microbial cause of death was identified for 179 (50.7%) children and two or more were identified for 37 (10.5%). Nine microbial pathogens accounted for 41% of all childhood deaths and 76% of all deaths that had any infective component. Potentially avoidable factors were identified for 177 (50%) of deaths. The most frequently occurring factors were as follows: no antenatal care in high-risk pregnancies (8.8% of all deaths), very delayed presentation (7.9%), vaccine-preventable diseases (7.9%), informal adoption or child abandonment leading to severe malnutrition (5.7%), and lack of screening for maternal syphilis (5.4%). Sepsis due to enteric Gram-negative bacilli occurred in 87 (24.6%). The strongest associations with death from Gram- negative sepsis were adoption/abandonment leading to severe malnutrition, village births, and prolonged hospital stay. CONCLUSIONS: Reductions in child mortality will depend on addressing the commonest causes of death, which include disease states, microbial pathogens, adverse social circumstances and health service failures. Systematic mortality audits in selected regions where child mortality is high may be useful for setting priorities, estimating the potential benefit of specific and non-specific interventions, and providing continuous feedback on the quality of care provided and the outcome of health reforms. PMID:11884969

Democracy and growth in divided societies: A health-inequality trap?

PubMed

Powell-Jackson, Timothy; Basu, Sanjay; Balabanova, Dina; McKee, Martin; Stuckler, David

2011-07-01

Despite a tremendous increase in financial resources, many countries are not on track to achieve the child and maternal mortality targets set out in the Millennium Development Goals 4 and 5. It is commonly argued that two main social factors - improved democratic governance and aggregate income - will ultimately lead to progress in reducing child and maternal mortality. However, these two factors alone may be insufficient to achieve progress in settings where there is a high level of social division. To test the effects of growth and democratisation, and their interaction with social inequalities, we regressed data on child and maternal mortality rates for 192 countries against internationally used indexes of income, democracy, and population inequality (including income, ethnic, linguistic, and religious divisions) covering the period 1970-2007. We found that a higher degree of social division, especially ethnic and linguistic fractionalisation, was significantly associated with greater child and maternal mortality rates. We further found that, even in democratic states, greater social division was associated with lower overall population access to healthcare and lesser expansion of health system infrastructure. Perversely, while greater democratisation and aggregate income were associated with reduced maternal and child mortality overall, in regions with high levels of ethnic fragmentation the health benefits of democratisation and rising income were undermined and, at high levels of inequality reversed, so that democracy and growth were adversely related to child and maternal mortality. These findings are consistent with literature suggesting that high degrees of social division in the context of democratisation can strengthen the power of dominant elite and ethnic groups in political decision-making, resulting in health and welfare policies that deprive minority groups (a health-inequality trap). Thus, we show that improving economic growth and democratic governance are insufficient to achieve child and maternal health targets in communities with high levels of persistent social inequality. To reduce child and maternal mortality in highly divided societies, it will be necessary not only to increase growth and promote democratic elections, but also empower disenfranchised communities. Copyright © 2011 Elsevier Ltd. All rights reserved.

Women's economic roles and child survival: the case of India.

PubMed

Basu, A M; Basu, K

1991-04-01

This article provides evidence that women's employment, in spite of its other benefits, probably has one crucial adverse consequence: a higher level of child mortality than is found among women who do not work. We examine various intermediate mechanisms for this relationship and conclude that a shortage of time is one of the major reasons for this negative relation between maternal employment and child survival. However, even in the area of child survival, there is one aspect which is positively affected by female employment: the disadvantage to girls in survival which is characteristic of South Asia seems to be smaller among working mothers. This is in contrast to the effect of maternal education which may often have no clear relation to the sex ratio of childhood mortality even though absolute levels of child mortality are lower for educated mothers.

Risk factors for early infant mortality in Sarlahi district, Nepal.

PubMed Central

Katz, Joanne; West, Keith P.; Khatry, Subarna K.; Christian, Parul; LeClerq, Steven C.; Pradhan, Elizabeth Kimbrough; Shrestha, Sharada Ram

2003-01-01

OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies. METHODS: Over the period 1994-97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR = 1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). CONCLUSION: Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy. PMID:14758431

Assessing the Impact of U.S. Food Assistance Delivery Policies on Child Mortality in Northern Kenya.

PubMed

Nikulkov, Alex; Barrett, Christopher B; Mude, Andrew G; Wein, Lawrence M

2016-01-01

The U.S. is the main country in the world that delivers its food assistance primarily via transoceanic shipments of commodity-based in-kind food. This approach is costlier and less timely than cash-based assistance, which includes cash transfers, food vouchers, and local and regional procurement, where food is bought in or nearby the recipient country. The U.S.'s approach is exacerbated by a requirement that half of its transoceanic food shipments need to be sent on U.S.-flag vessels. We estimate the effect of these U.S. food assistance distribution policies on child mortality in northern Kenya by formulating and optimizing a supply chain model. In our model, monthly orders of transoceanic shipments and cash-based interventions are chosen to minimize child mortality subject to an annual budget constraint and to policy constraints on the allowable proportions of cash-based interventions and non-US-flag shipments. By varying the restrictiveness of these policy constraints, we assess the impact of possible changes in U.S. food aid policies on child mortality. The model includes an existing regression model that uses household survey data and geospatial data to forecast the mean mid-upper-arm circumference Z scores among children in a community, and allows food assistance to increase Z scores, and Z scores to influence mortality rates. We find that cash-based interventions are a much more powerful policy lever than the U.S.-flag vessel requirement: switching to cash-based interventions reduces child mortality from 4.4% to 3.7% (a 16.2% relative reduction) in our model, whereas eliminating the U.S.-flag vessel restriction without increasing the use of cash-based interventions generates a relative reduction in child mortality of only 1.1%. The great majority of the gains achieved by cash-based interventions are due to their reduced cost, not their reduced delivery lead times; i.e., the reduction of shipping expenses allows for more food to be delivered, which reduces child mortality.

Assessing the Impact of U.S. Food Assistance Delivery Policies on Child Mortality in Northern Kenya

PubMed Central

Nikulkov, Alex; Barrett, Christopher B.; Mude, Andrew G.; Wein, Lawrence M.

2016-01-01

The U.S. is the main country in the world that delivers its food assistance primarily via transoceanic shipments of commodity-based in-kind food. This approach is costlier and less timely than cash-based assistance, which includes cash transfers, food vouchers, and local and regional procurement, where food is bought in or nearby the recipient country. The U.S.’s approach is exacerbated by a requirement that half of its transoceanic food shipments need to be sent on U.S.-flag vessels. We estimate the effect of these U.S. food assistance distribution policies on child mortality in northern Kenya by formulating and optimizing a supply chain model. In our model, monthly orders of transoceanic shipments and cash-based interventions are chosen to minimize child mortality subject to an annual budget constraint and to policy constraints on the allowable proportions of cash-based interventions and non-US-flag shipments. By varying the restrictiveness of these policy constraints, we assess the impact of possible changes in U.S. food aid policies on child mortality. The model includes an existing regression model that uses household survey data and geospatial data to forecast the mean mid-upper-arm circumference Z scores among children in a community, and allows food assistance to increase Z scores, and Z scores to influence mortality rates. We find that cash-based interventions are a much more powerful policy lever than the U.S.-flag vessel requirement: switching to cash-based interventions reduces child mortality from 4.4% to 3.7% (a 16.2% relative reduction) in our model, whereas eliminating the U.S.-flag vessel restriction without increasing the use of cash-based interventions generates a relative reduction in child mortality of only 1.1%. The great majority of the gains achieved by cash-based interventions are due to their reduced cost, not their reduced delivery lead times; i.e., the reduction of shipping expenses allows for more food to be delivered, which reduces child mortality. PMID:27997571

Child mortality, hypothalamic-pituitary-adrenal axis activity and cellular aging in mothers.

PubMed

Barha, Cindy K; Salvante, Katrina G; Hanna, Courtney W; Wilson, Samantha L; Robinson, Wendy P; Altman, Rachel M; Nepomnaschy, Pablo A

2017-01-01

Psychological challenges, including traumatic events, have been hypothesized to increase the age-related pace of biological aging. Here we test the hypothesis that psychological challenges can affect the pace of telomere attrition, a marker of cellular aging, using data from an ongoing longitudinal-cohort study of Kaqchikel Mayan women living in a population with a high frequency of child mortality, a traumatic life event. Specifically, we evaluate the associations between child mortality, maternal telomere length and the mothers' hypothalamic-pituitary-adrenal axis (HPAA), or stress axis, activity. Child mortality data were collected in 2000 and 2013. HPAA activity was assessed by quantifying cortisol levels in first morning urinary specimens collected every other day for seven weeks in 2013. Telomere length (TL) was quantified using qPCR in 55 women from buccal specimens collected in 2013. Shorter TL with increasing age was only observed in women who experienced child mortality (p = 0.015). Women with higher average basal cortisol (p = 0.007) and greater within-individual variation (standard deviation) in basal cortisol (p = 0.053) presented shorter TL. Non-parametric bootstrapping to estimate mediation effects suggests that HPAA activity mediates the effect of child mortality on TL. Our results are, thus, consistent with the hypothesis that traumatic events can influence cellular aging and that HPAA activity may play a mediatory role. Future large-scale longitudinal studies are necessary to confirm our results and further explore the role of the HPAA in cellular aging, as well as to advance our understanding of the underlying mechanisms involved.

Child mortality, hypothalamic-pituitary-adrenal axis activity and cellular aging in mothers

PubMed Central

Barha, Cindy K.; Salvante, Katrina G.; Hanna, Courtney W.; Wilson, Samantha L.; Robinson, Wendy P.; Altman, Rachel M.

2017-01-01

Psychological challenges, including traumatic events, have been hypothesized to increase the age-related pace of biological aging. Here we test the hypothesis that psychological challenges can affect the pace of telomere attrition, a marker of cellular aging, using data from an ongoing longitudinal-cohort study of Kaqchikel Mayan women living in a population with a high frequency of child mortality, a traumatic life event. Specifically, we evaluate the associations between child mortality, maternal telomere length and the mothers’ hypothalamic-pituitary-adrenal axis (HPAA), or stress axis, activity. Child mortality data were collected in 2000 and 2013. HPAA activity was assessed by quantifying cortisol levels in first morning urinary specimens collected every other day for seven weeks in 2013. Telomere length (TL) was quantified using qPCR in 55 women from buccal specimens collected in 2013. Results: Shorter TL with increasing age was only observed in women who experienced child mortality (p = 0.015). Women with higher average basal cortisol (p = 0.007) and greater within-individual variation (standard deviation) in basal cortisol (p = 0.053) presented shorter TL. Non-parametric bootstrapping to estimate mediation effects suggests that HPAA activity mediates the effect of child mortality on TL. Our results are, thus, consistent with the hypothesis that traumatic events can influence cellular aging and that HPAA activity may play a mediatory role. Future large-scale longitudinal studies are necessary to confirm our results and further explore the role of the HPAA in cellular aging, as well as to advance our understanding of the underlying mechanisms involved. PMID:28542264

Exploring the relationship between cyberbullying and unnatural child death: an ecological study of twenty-four European countries

PubMed Central

2014-01-01

Background Internet risk has been recognised as a child safety problem, but evidence is insufficient to conclude that a child’s online risk exposure can lead to physical harm. This study aims to explore the ecological relationship between Internet risk exposure and unnatural child death. Methods Multiple secondary data sources were used: online exposure to content about self-harm, cyberbullying, and Internet addiction data (EU Kids Online survey, 2010); and mortality data (European Detailed Mortality Database, 2010 or the latest year if not available) of 24 European countries. Correlations were found using quasi-Poisson regression. Countries’ prevalence rates of psychiatric problems (European Social Survey Round 3 and 6, 2006 and 2012) were used to test for possible spuriousness. Results This study finds that countries with higher rates of cyberbullying were more likely to have a higher incidence of unnatural child death. A 1 percent rise in the prevalence of cyberbullying translated into a 28% increase in risk of unnatural child death (95% CI: 2%-57%). No evidence was found to substantiate confounding effect of the national prevalence of depressive symptoms or traditional bullying. Conclusions Explanations are given for the findings. We conclude that intervention programs designed to serve as precautionary measures for risk minimisation should be considered. PMID:25079144

Adjusted effects of domestic violence, tobacco use, and indoor air pollution from use of solid fuel on child mortality.

PubMed

Pandey, Shanta; Lin, Yuan

2013-10-01

Studies that have separately examined the consequences of gender based violence upon women, use of solid fuel for cooking, and mother and father's use of tobacco on child health have concluded that they serve as risk factors for maternal and child health. Some authors have implied that these studies may have run the risk of overestimating the burden of disease of one factor over another. In this paper, we included all four factors in the same model to estimate their adjusted effects on child mortality, controlling for the demographic factors. The data come from 2005 to 2006 National Family Health Survey of India that interviewed a nationally representative sample of 39,257 couples. Of the four factors, mothers' use of tobacco presented the highest risk for child mortality (OR = 1.42; CI = 1.27-1.60) followed by fathers' use of tobacco (OR = 1.23; CI = 1.12-1.36), households' use of solid fuel for cooking (OR = 1.23; CI = 1.06-1.43), and physical abuse upon mothers (OR = 1.20; CI = 1.10-1.32). Among the households that used solid fuel for cooking, improved cookstoves users experienced 28 % lower odds of child mortality (OR = 0.72; CI = 0.61-0.86) compared to nonusers of improved cookstoves. Additionally, increase in age of mothers at birth of first child, parents' education, and household wealth served as protective factors for child mortality. To prevent child death, programs should focus on reducing couple's use of tobacco, protecting women from physical abuse, and helping households switch from solid to liquid fuel. Moreover, a significant reduction in child death could be attained by improving girls' education, and delaying their age at marriage and first birth.

Low infant mortality among Palestine refugees despite the odds.

PubMed

Riccardo, Flavia; Khader, Ali; Sabatinelli, Guido

2011-04-01

To present data from a 2008 infant mortality survey conducted in Jordan, Lebanon, the Syrian Arab Republic, the Gaza Strip and the West Bank and analyse infant mortality trends among Palestine refugees in 1995-2005. Following the preceding birth technique, mothers who were registering a new birth were asked if the preceding child was alive or dead, the day the child was born and the date of birth of the neonate whose birth was being registered. From this information, neonatal, infant and early child mortality rates were estimated. The age at death for early child mortality was determined by the mean interval between successive births and the mean age of neonates at registration. In 2005-2006, infant mortality among Palestine refugees ranged from 28 deaths per 100 000 live births in the Syrian Arab Republic to 19 in Lebanon. Thus, infant mortality in Palestine refugees is among the lowest in the Near East. However, infant mortality has stopped decreasing in recent years, although it remains at a level compatible with the attainment of Millennium Development Goal 4. Largely owing to the primary health care provided by the United Nations Relief and Works Agency (UNRWA) for Palestine Refugees in the Near East and other entities, infant mortality among Palestine refugees had consistently decreased. However, it is no longer dropping. Measures to address the most likely reasons - early marriage and childbearing, poor socioeconomic conditions and limited access to good perinatal care - are needed.

Child Mortality Estimation: Estimating Sex Differences in Childhood Mortality since the 1970s

PubMed Central

Sawyer, Cheryl Chriss

2012-01-01

Introduction Producing estimates of infant (under age 1 y), child (age 1–4 y), and under-five (under age 5 y) mortality rates disaggregated by sex is complicated by problems with data quality and availability. Interpretation of sex differences requires nuanced analysis: girls have a biological advantage against many causes of death that may be eroded if they are disadvantaged in access to resources. Earlier studies found that girls in some regions were not experiencing the survival advantage expected at given levels of mortality. In this paper I generate new estimates of sex differences for the 1970s to the 2000s. Methods and Findings Simple fitting methods were applied to male-to-female ratios of infant and under-five mortality rates from vital registration, surveys, and censuses. The sex ratio estimates were used to disaggregate published series of both-sexes mortality rates that were based on a larger number of sources. In many developing countries, I found that sex ratios of mortality have changed in the same direction as historically occurred in developed countries, but typically had a lower degree of female advantage for a given level of mortality. Regional average sex ratios weighted by numbers of births were found to be highly influenced by China and India, the only countries where both infant mortality and overall under-five mortality were estimated to be higher for girls than for boys in the 2000s. For the less developed regions (comprising Africa, Asia excluding Japan, Latin America/Caribbean, and Oceania excluding Australia and New Zealand), on average, boys' under-five mortality in the 2000s was about 2% higher than girls'. A number of countries were found to still experience higher mortality for girls than boys in the 1–4-y age group, with concentrations in southern Asia, northern Africa/western Asia, and western Africa. In the more developed regions (comprising Europe, northern America, Japan, Australia, and New Zealand), I found that the sex ratio of infant mortality peaked in the 1970s or 1980s and declined thereafter. Conclusions The methods developed here pinpoint regions and countries where sex differences in mortality merit closer examination to ensure that both sexes are sharing equally in access to health resources. Further study of the distribution of causes of death in different settings will aid the interpretation of differences in survival for boys and girls. Please see later in the article for the Editors' Summary. PMID:22952433

Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality

PubMed Central

2013-01-01

Background Nepal has made substantial progress in reducing under-five mortality and is on track to achieve Millennium Development Goal 4, but advances in neonatal health are less encouraging. The objectives of this study were to assess relative and absolute inequalities in neonatal mortality over time, and to review experience with major programs to promote neonatal health. Methods Using four nationally representative surveys conducted in 1996, 2001, 2006 and 2011, we calculated neonatal mortality rates for Nepal and for population groups based on child sex, geographical and socio-economic variables using a true cohort log probability approach. Inequalities based on different variables and years were assessed using rate differences (rd) and rate ratios (rr); time trends in neonatal mortality were measured using the annual rate of reduction. Through literature searches and expert consultation, information on Nepalese policies and programs implemented since 1990 and directly or indirectly attempting to reduce neonatal mortality was compiled. Data on timeline, coverage and effectiveness were extracted for major programs. Results The annual rate of reduction for neonatal mortality between 1996 and 2011 (2.8 percent per annum) greatly lags behind the achievements in under-five and infant mortality, and varies across population groups. For the year 2011, stark absolute and relative inequalities in neonatal mortality exist in relation to wealth status (rd = 21.4, rr = 2.2); these are less pronounced for other measures of socio-economic status, child sex and urban–rural residence, ecological and development region. Among many efforts to promote child and maternal health, three established programs and two pilot programs emerged as particularly relevant to reducing neonatal mortality. While these were designed based on national and international evidence, information about coverage of different population groups and effectiveness is limited. Conclusion Neonatal mortality varies greatly by socio-demographic variables. This study clearly shows that much remains to be achieved in terms of reducing neonatal mortality across different socio-economic, ethnic and geographical population groups in Nepal. In moving forward it will be important to scale up programs of proven effectiveness, conduct in-depth evaluation of promising new approaches, target unreached and hard-to-reach populations, and maximize use of financial and personnel resources through integration across programs. PMID:24373558

Assessing development assistance for child survival between 2000 and 2014: A multi-sectoral perspective.

PubMed

Lu, Chunling; Chu, Annie; Li, Zhihui; Shen, Jian; Subramanian, S V; Hill, Kenneth

2017-01-01

The majority of Countdown countries did not reach the fourth Millennium Development Goal (MDG 4) on reducing child mortality, despite the fact that donor funding to the health sector has drastically increased. When tracking aid invested in child survival, previous studies have exclusively focused on aid targeting reproductive, maternal, newborn, and child health (RMNCH). We take a multi-sectoral approach and extend the estimation to the four sectors that determine child survival: health (RMNCH and non-RMNCH), education, water and sanitation, and food and humanitarian assistance (Food/HA). Using donor reported data, obtained mainly from the OECD Creditor Reporting System and Development Assistance Committee, we tracked the level and trends of aid (in grants or loans) disbursed to each of the four sectors at the global, regional, and country levels. We performed detailed analyses on missing data and conducted imputation with various methods. To identify aid projects for RMNCH, we developed an identification strategy that combined keyword searches and manual coding. To quantify aid for RMNCH in projects with multiple purposes, we adopted an integrated approach and produced the lower and upper bounds of estimates for RMNCH, so as to avoid making assumptions or using weak evidence for allocation. We checked the sensitivity of trends to the estimation methods and compared our estimates to that produced by other studies. Our study yielded time-series and recipient-specific annual estimates of aid disbursed to each sector, as well as their lower- and upper-bounds in 134 countries between 2000 and 2014, with a specific focus on Countdown countries. We found that the upper-bound estimates of total aid disbursed to the four sectors in 134 countries rose from US$ 22.62 billion in 2000 to US$ 59.29 billion in 2014, with the increase occurring in all income groups and regions with sub-Saharan Africa receiving the largest sum. Aid to RMNCH has experienced the fastest growth (12.4%), followed by aid to Food/HA (9.4%), education (5.1%), and water and sanitation (5.0%). With the exception of RMNCH, the average per capita aid disbursed to each sector in the 74 Countdown countries was smaller than in non-Countdown countries. While countries with a large number of child deaths tend to receive the largest amount of disbursements, non-Countdown countries with small populations usually received the highest level of per capita aid for child survival among all 134 countries. Compared to other Countdown countries, those that met MDG 4 with a high reliance on health aid received much higher per capita aid across all sectors. These findings are robust to estimation methods. The study suggests that to improve child survival, better targeted investments should be made in the four sectors, and aid to non-health sectors could be a possible contributor to child mortality reduction. We recommend that future studies on tracking aid for child survival go beyond the health sector and include other sectors that directly affect child survival. Investigation should also be made about the link between aid to each of the four sectors and child mortality reduction.

Newborn care in Indonesia, Lao People’s Democratic Republic and the Philippines: a comprehensive needs assessment

PubMed Central

2014-01-01

Background Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People’s Democratic Republic (PDR) and the Philippines. Methods We assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns’ health status, the health policy and the health system context for newborn care and the equity situation regarding newborn survival. Results Main findings: (1) In the three countries, decline of neonatal mortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable. Conclusions Similar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality of newborn care provided and inequities in newborn care. Child survival programmes focussed on children over four weeks of age have shown to have positive outcomes. Similar efforts as those used in these programmes should be considered in newborn care. PMID:24528519

Reducing child mortality in India in the new millennium.

PubMed Central

Claeson, M.; Bos, E. R.; Mawji, T.; Pathmanathan, I.

2000-01-01

Globally, child mortality rates have been halved over the last few decades, a developmental success story. Nevertheless, progress has been uneven and in recent years mortality rates have increased in some countries. The present study documents the slowing decline in infant mortality rates in india; a departure from the longer-term trends. The major causes of childhood mortality are also reviewed and strategic options for the different states of India are proposed that take into account current mortality rates and the level of progress in individual states. The slowing decline in childhood mortality rates in India calls for new approaches that go beyond disease-, programme- and sector-specific approaches. PMID:11100614

Extremes of maternal age and child mortality: analysis between 2000 and 2009☆

PubMed Central

Ribeiro, Fanciele Dinis; Ferrari, Rosângela Aparecida Pimenta; Sant'Anna, Flávia Lopes; Dalmas, José Carlos; Girotto, Edmarlon

2014-01-01

OBJECTIVE: To analyze the characteristics of infant mortality at the extremes of maternal age. METHOD: Retrospective, cross-sectional quantitative study using data from Live Birth Certificates, Death Certificates and from Child Death Investigation records in Londrina, Paraná, in the years of 2000-2009. RESULTS: During the 10-year study period , there were 176 infant deaths among mothers up to 19 years of age, and 113 deaths among mothers aged 35 years or more. The infant mortality rate among young mothers was 14.4 deaths per thousand births, compared to 12.9 deaths in the other age group. For adolescent mothers, the following conditions prevailed: lack of a stable partner (p<0.001), lack of a paid job (p<0.001), late start of prenatal care in the second trimester of pregnancy (p<0.001), fewer prenatal visits (p<0.001) and urinary tract infections (p<0.001). On the other hand, women aged 35 or more had a higher occurrence of hypertension during pregnancy (p<0.001), and of surgical delivery (p<0.001). Regarding the underlying cause of infant death, congenital anomalies prevailed in the group of older mothers (p=0.002), and external causes were predominant in the group of young mothers (p=0.019). CONCLUSION: Both age groups deserve the attention of social services for maternal and child health, especially adolescent mothers, who presented a higher combination of factors deemed hazardous to the child's health. PMID:25511003

The US President's Malaria Initiative and under-5 child mortality in sub-Saharan Africa: A difference-in-differences analysis.

PubMed

Jakubowski, Aleksandra; Stearns, Sally C; Kruk, Margaret E; Angeles, Gustavo; Thirumurthy, Harsha

2017-06-01

Despite substantial financial contributions by the United States President's Malaria Initiative (PMI) since 2006, no studies have carefully assessed how this program may have affected important population-level health outcomes. We utilized multiple publicly available data sources to evaluate the association between introduction of PMI and child mortality rates in sub-Saharan Africa (SSA). We used difference-in-differences analyses to compare trends in the primary outcome of under-5 mortality rates and secondary outcomes reflecting population coverage of malaria interventions in 19 PMI-recipient and 13 non-recipient countries between 1995 and 2014. The analyses controlled for presence and intensity of other large funding sources, individual and household characteristics, and country and year fixed effects. PMI program implementation was associated with a significant reduction in the annual risk of under-5 child mortality (adjusted risk ratio [RR] 0.84, 95% CI 0.74-0.96). Each dollar of per-capita PMI expenditures in a country, a measure of PMI intensity, was also associated with a reduction in child mortality (RR 0.86, 95% CI 0.78-0.93). We estimated that the under-5 mortality rate in PMI countries was reduced from 28.9 to 24.3 per 1,000 person-years. Population coverage of insecticide-treated nets increased by 8.34 percentage points (95% CI 0.86-15.83) and coverage of indoor residual spraying increased by 6.63 percentage points (95% CI 0.79-12.47) after PMI implementation. Per-capita PMI spending was also associated with a modest increase in artemisinin-based combination therapy coverage (3.56 percentage point increase, 95% CI -0.07-7.19), though this association was only marginally significant (p = 0.054). Our results were robust to several sensitivity analyses. Because our study design leaves open the possibility of unmeasured confounding, we cannot definitively interpret these results as causal. PMI may have significantly contributed to reducing the burden of malaria in SSA and reducing the number of child deaths in the region. Introduction of PMI was associated with increased coverage of malaria prevention technologies, which are important mechanisms through which child mortality can be reduced. To our knowledge, this study is the first to assess the association between PMI and all-cause child mortality in SSA with the use of appropriate comparison groups and adjustments for regional trends in child mortality.

Mortality after Parental Death in Childhood: A Nationwide Cohort Study from Three Nordic Countries

PubMed Central

Li, Jiong; Vestergaard, Mogens; Cnattingius, Sven; Gissler, Mika; Bech, Bodil Hammer; Obel, Carsten; Olsen, Jørn

2014-01-01

Background Bereavement by spousal death and child death in adulthood has been shown to lead to an increased risk of mortality. Maternal death in infancy or parental death in early childhood may have an impact on mortality but evidence has been limited to short-term or selected causes of death. Little is known about long-term or cause-specific mortality after parental death in childhood. Methods and Findings This cohort study included all persons born in Denmark from 1968 to 2008 (n = 2,789,807) and in Sweden from 1973 to 2006 (n = 3,380,301), and a random sample of 89.3% of all born in Finland from 1987 to 2007 (n = 1,131,905). A total of 189,094 persons were included in the exposed cohort when they lost a parent before 18 years old. Log-linear Poisson regression was used to estimate mortality rate ratio (MRR). Parental death was associated with a 50% increased all-cause mortality (MRR = 1.50, 95% CI 1.43–1.58). The risks were increased for most specific cause groups and the highest MRRs were observed when the cause of child death and the cause of parental death were in the same category. Parental unnatural death was associated with a higher mortality risk (MRR = 1.84, 95% CI 1.71–2.00) than parental natural death (MRR = 1.33, 95% CI 1.24–1.41). The magnitude of the associations varied according to type of death and age at bereavement over different follow-up periods. The main limitation of the study is the lack of data on post-bereavement information on the quality of the parent-child relationship, lifestyles, and common physical environment. Conclusions Parental death in childhood or adolescence is associated with increased all-cause mortality into early adulthood. Since an increased mortality reflects both genetic susceptibility and long-term impacts of parental death on health and social well-being, our findings have implications in clinical responses and public health strategies. Please see later in the article for the Editors' Summary PMID:25051501

Spatial variations and determinants of infant and under-five mortality in Bangladesh.

PubMed

Gruebner, Oliver; Khan, Mmh; Burkart, Katrin; Lautenbach, Sven; Lakes, Tobia; Krämer, Alexander; Subramanian, S V; Galea, Sandro

2017-09-01

Reducing child mortality is a Sustainable Development Goal yet to be achieved by many low-income countries. We applied a subnational and spatial approach based on publicly available datasets and identified permanent insolvency, urbanicity, and malaria endemicity as factors associated with child mortality. We further detected spatial clusters in the east of Bangladesh and noted Sylhet and Jamalpur as those districts that need immediate attention to reduce child mortality. Our approach is transferable to other regions in comparable settings worldwide and may guide future studies to identify subnational regions in need for public health attention. Our study adds to our understanding where we may intervene to more effectively improve health, particularly among disadvantaged populations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Using social autopsy to understand maternal, newborn, and child mortality in low-resource settings: a systematic review of the literature

PubMed Central

Moyer, Cheryl A.; Johnson, Cassidy; Kaselitz, Elizabeth; Aborigo, Raymond

2017-01-01

ABSTRACT Background: Social, cultural, and behavioral factors are often potent upstream contributors to maternal, neonatal, and child mortality, especially in low- and middle-income countries (LMICs). Social autopsy is one method of identifying the impact of such factors, yet it is unclear how social autopsy methods are being used in LMICs. Objective: This study aimed to identify the most common social autopsy instruments, describe overarching findings across populations and geography, and identify gaps in the existing social autopsy literature. Methods: A systematic search of the peer-reviewed literature from 2005 to 2016 was conducted. Studies were included if they were conducted in an LMIC, focused on maternal/neonatal/infant/child health, reported on the results of original research, and explicitly mentioned the use of a social autopsy tool. Results: Sixteen articles out of 1950 citations were included, representing research conducted in 11 countries. Five different tools were described, with two primary conceptual frameworks used to guide analysis: Pathway to Survival and Three Delays models. Studies varied in methods for identifying deaths, and recall periods for respondents ranged from 6 weeks to 5+ years. Across studies, recognition of danger signs appeared to be high, while subsequent care-seeking was inconsistent. Cost, distance to facility, and transportation issues were frequently cited barriers to care-seeking, however, additional barriers were reported that varied by location. Gaps in the social autopsy literature include the lack of: harmonized tools and analytical methods that allow for cross-study comparisons, discussion of complexity of decision making for care seeking, qualitative narratives that address inconsistencies in responses, and the explicit inclusion of perspectives from husbands and fathers. Conclusion: Despite the nascence of the field, research across 11 countries has included social autopsy methods, using a variety of tools, sampling methods, and analytical frameworks to determine how social factors impact maternal, neonatal, and child health outcomes. PMID:29261449

Factors associated with preventable infant death: a multiple logistic regression.

PubMed

Vidal E Silva, Sandra Maria Cunha; Tuon, Rogério Antonio; Probst, Livia Fernandes; Gondinho, Brunna Verna Castro; Pereira, Antonio Carlos; Meneghim, Marcelo de Castro; Cortellazzi, Karine Laura; Ambrosano, Glaucia Maria Bovi

2018-01-01

OBJECTIVE To identify and analyze factors associated with preventable child deaths. METHODS This analytical cross-sectional study had preventable child mortality as dependent variable. From a population of 34,284 live births, we have selected a systematic sample of 4,402 children who did not die compared to 272 children who died from preventable causes during the period studied. The independent variables were analyzed in four hierarchical blocks: sociodemographic factors, the characteristics of the mother, prenatal and delivery care, and health conditions of the patient and neonatal care. We performed a descriptive statistical analysis and estimated multiple hierarchical logistic regression models. RESULTS Approximatelly 35.3% of the deaths could have been prevented with the early diagnosis and treatment of diseases during pregnancy and 26.8% of them could have been prevented with better care conditions for pregnant women. CONCLUSIONS The following characteristics of the mother are determinant for the higher mortality of children before the first year of life: living in neighborhoods with an average family income lower than four minimum wages, being aged ≤ 19 years, having one or more alive children, having a child with low APGAR level at the fifth minute of life, and having a child with low birth weight.

Evaluation of Millennium Development Goals in Reduction of Maternal and Child Mortality in Narok County, Kenya

ERIC Educational Resources Information Center

Koini, Stellah Malaso

2017-01-01

Background: Millennium Development Goals are the 21st Century worlds' concern to improve human way of life by 2015. In Kenya the Millennium Development Goals for reduction of maternal and child mortality has been recently powered by the beyond zero initiative which started in the year 2014 with the aim of reducing mortality as well as contributing…

Equity and geography: the case of child mortality in Papua New Guinea.

PubMed

Bauze, Anna E; Tran, Linda N; Nguyen, Kim-Huong; Firth, Sonja; Jimenez-Soto, Eliana; Dwyer-Lindgren, Laura; Hodge, Andrew; Lopez, Alan D

2012-01-01

Recent assessments show continued decline in child mortality in Papua New Guinea (PNG), yet complete subnational analyses remain rare. This study aims to estimate under-five mortality in PNG at national and subnational levels to examine the importance of geographical inequities in health outcomes and track progress towards Millennium Development Goal (MDG) 4. We performed retrospective data validation of the Demographic and Health Survey (DHS) 2006 using 2000 Census data, then applied advanced indirect methods to estimate under-five mortality rates between 1976 and 2000. The DHS 2006 was found to be unreliable. Hence we used the 2000 Census to estimate under-five mortality rates at national and subnational levels. During the period under study, PNG experienced a slow reduction in national under-five mortality from approximately 103 to 78 deaths per 1,000 live births. Subnational analyses revealed significant disparities between rural and urban populations as well as inter- and intra-regional variations. Some of the provinces that performed the best (worst) in terms of under-five mortality included the districts that performed worst (best), with district-level under-five mortality rates correlating strongly with poverty levels and access to services. The evidence from PNG demonstrates substantial within-province heterogeneity, suggesting that under-five mortality needs to be addressed at subnational levels. This is especially relevant in countries, like PNG, where responsibility for health services is devolved to provinces and districts. This study presents the first comprehensive estimates of under-five mortality at the district level for PNG. The results demonstrate that for countries that rely on few data sources even greater importance must be given to the quality of future population surveys and to the exploration of alternative options of birth and death surveillance.

Child Marriage: A Silent Health and Human Rights Issue

PubMed Central

Nour, Nawal M

2009-01-01

Marriages in which a child under the age of 18 years is involved occur worldwide, but are mainly seen in South Asia, Africa, and Latin America. A human rights violation, child marriage directly impacts girls’ education, health, psychologic well-being, and the health of their offspring. It increases the risk for depression, sexually transmitted infection, cervical cancer, malaria, obstetric fistulas, and maternal mortality. Their offspring are at an increased risk for premature birth and, subsequently, neonatal or infant death. The tradition, driven by poverty, is perpetuated to ensure girls’ financial futures and to reinforce social ties. One of the most effective methods of reducing child marriage and its health consequences is mandating that girls stay in school. PMID:19399295

Closing the gaps in child health in the Pacific: An achievable goal in the next 20 years

PubMed Central

Duke, Trevor; Kado, Joseph H; Auto, James; Amini, James; Gilbert, Katherine

2015-01-01

It is not inconceivable that by 2035 the substantial gaps in child health across the Pacific can close significantly. Currently, Australia and New Zealand have child mortality rates of 5 and 6 per 1000 live births, respectively, while Pacific island developing nations have under 5 mortality rates ranging from 13 to 16 (Vanuatu, Fiji and Tonga) to 47 and 58 per 1000 live births (Kiribati and Papua New Guinea, respectively). However, these Pacific child mortality rates are falling, by an average of 1.4% per year since 1990, and more rapidly (1.9% per year) since 2000. Based on progress elsewhere, there is a need to (i) define the specific things needed to close the gaps in child health; (ii) be far more ambitious and hopeful than ever before; and (iii) form a new regional compact based on solidarity and interdependence. PMID:25586845

Integrated Strategies to Address Maternal and Child Health and Survival in Low-Income Settings: Implications for Haiti

PubMed Central

Bhutta, Zulfiqar A

2016-01-01

The Millennium Development Goals for improving maternal and child health globally were agreed on in 2000, and several monitoring and evaluation strategies were put in place, including “Countdown to 2015” for monitoring progress and intervention coverage to reach the goals. However, progress in achieving the goals has been slow, with only 13 of the 75 participating Countdown countries on track to reach the targets for reducing child mortality. An overview of child mortality rates in low-income countries is presented, followed by a discussion of evidenced-based interventions that can bridge the equity gaps in global health. Finally, comments are included on the companion article in this issue, “Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care” (page 59), and what is needed for that new project to succeed. PMID:27065474

Women's status and child well-being: a state-level analysis.

PubMed

Koenen, Karestan C; Lincoln, Alisa; Appleton, Allison

2006-12-01

We conducted an ecologic analysis of the relation between women's status and child well-being in the 50 United States. State-level women's status was assessed via four composite indices: women's political participation, economic autonomy, employment and earnings, and reproductive rights. Child well-being was measured via five outcomes: percentage of low birthweight babies, infant mortality, teen mortality, high school dropout rate, and teen birth rate. Higher state-level women's status on all indicators was associated with significantly better state-level child well-being in unadjusted analyses. Several associations remained significant after adjusting for income inequality and state racial composition. Women's political participation was associated with a significantly lower percentage of low birthweight babies (p<.001) and lower teen birth rates (p<.05). Women's employment and earnings was associated with lower infant mortality (p<.05) and teen birth rates (p<.05). More economic and social autonomy for women was associated with better child outcomes on all measures (p<.01 all). Greater reproductive rights were associated with significantly lower infant mortality (p<.01). We conclude that child well-being is worse in states where women have lower political, economic, and social status. Women's status is an important aspect of children's social context which may impact their well-being. Multi-level analyses of the association between state-level women's status and child well-being are needed.

Kin and birth order effects on male child mortality: three East Asian populations, 1716–1945☆,☆☆

PubMed Central

Dong, Hao; Manfredini, Matteo; Kurosu, Satomi; Yang, Wenshan; Lee, James Z.

2017-01-01

Human child survival depends on adult investment, typically from parents. However, in spite of recent research advances on kin influence and birth order effects on human infant and child mortality, studies that directly examine the interaction of kin context and birth order on sibling differences in child mortality are still rare. Our study supplements this literature with new findings from large-scale individual-level panel data for three East Asian historical populations from northeast China (1789–1909), northeast Japan (1716–1870), and north Taiwan (1906–1945), where preference for sons and first-borns is common. We examine and compare male child mortality risks by presence/absence of co-resident parents, grandparents, and other kin, as well as their interaction effects with birth order. We apply discrete-time event-history analysis on over 172,000 observations of 69,125 boys aged 1–9 years old. We find that in all three populations, while the presence of parents is important for child survival, it is more beneficial to first/early-borns than to later-borns. Effects of other co-resident kin are however null or inconsistent between populations. Our findings underscore the importance of birth order in understanding how differential parental investment may produce child survival differentials between siblings. PMID:28781514

Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review.

PubMed

Reilly, J J; Kelly, J

2011-07-01

The last systematic review on the health consequences of child and adolescent obesity found little evidence on consequences for adult health. The present study aimed to summarize evidence on the long-term impact of child and adolescent obesity for premature mortality and physical morbidity in adulthood. Systematic review with evidence searched from January 2002 to June 2010. Studies were included if they contained a measure of overweight and/or obesity between birth and 18 years (exposure measure) and premature mortality and physical morbidity (outcome) in adulthood. Five eligible studies examined associations between overweight and/or obesity, and premature mortality: 4/5 found significantly increased risk of premature mortality with child and adolescent overweight or obesity. All 11 studies with cardiometabolic morbidity as outcomes reported that overweight and obesity were associated with significantly increased risk of later cardiometabolic morbidity (diabetes, hypertension, ischaemic heart disease, and stroke) in adult life, with hazard ratios ranging from 1.1-5.1. Nine studies examined associations of child or adolescent overweight and obesity with other adult morbidity: studies of cancer morbidity were inconsistent; child and adolescent overweight and obesity were associated with significantly increased risk of later disability pension, asthma, and polycystic ovary syndrome symptoms. A relatively large and fairly consistent body of evidence now demonstrates that overweight and obesity in childhood and adolescence have adverse consequences on premature mortality and physical morbidity in adulthood.

Is the Urban Child Health Advantage Declining in Malawi?: Evidence from Demographic and Health Surveys and Multiple Indicator Cluster Surveys.

PubMed

Lungu, Edgar Arnold; Biesma, Regien; Chirwa, Maureen; Darker, Catherine

2018-06-01

In many developing countries including Malawi, health indicators are on average better in urban than in rural areas. This phenomenon has largely prompted Governments to prioritize rural areas in programs to improve access to health services. However, considerable evidence has emerged that some population groups in urban areas may be facing worse health than rural areas and that the urban advantage may be waning in some contexts. We used a descriptive study undertaking a comparative analysis of 13 child health indicators between urban and rural areas using seven data points provided by nationally representative population based surveys-the Malawi Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Rate differences between urban and rural values for selected child health indicators were calculated to denote whether urban-rural differentials showed a trend of declining urban advantage in Malawi. The results show that all forms of child mortality have significantly declined between 1992 and 2015/2016 reflecting successes in child health interventions. Rural-urban comparisons, using rate differences, largely indicate a picture of the narrowing gap between urban and rural areas albeit the extent and pattern vary among child health indicators. Of the 13 child health indicators, eight (neonatal mortality, infant mortality, under-five mortality rates, stunting rate, proportion of children treated for diarrhea and fever, proportion of children sleeping under insecticide-treated nets, and children fully immunized at 12 months) show clear patterns of a declining urban advantage particularly up to 2014. However, U-5MR shows reversal to a significant urban advantage in 2015/2016, and slight increases in urban advantage are noted for infant mortality rate, underweight, full childhood immunization, and stunting rate in 2015/2016. Our findings suggest the need to rethink the policy viewpoint of a disadvantaged rural and much better-off urban in child health programming. Efforts should be dedicated towards addressing determinants of child health in both urban and rural areas.

Spatial analysis of under-5 mortality and potential risk factors in the Basse Health and Demographic Surveillance System, the Gambia.

PubMed

Quattrochi, John; Jasseh, Momodou; Mackenzie, Grant; Castro, Marcia C

2015-07-01

To describe the spatial pattern in under-5 mortality rates in the Basse Health and Demographic Surveillance System (BHDSS) and to test for associations between under-5 deaths and biodemographic and socio-economic risk factors. Using data on child survival from 2007 to 2011 in the BHDSS, we mapped under-5 mortality by km(2) . We tested for spatial clustering of high or low death rates using Kulldorff's spatial scan statistic. Associations between child death and a variety of biodemographic and socio-economic factors were assessed with Cox proportional hazards models, and deviance residuals from the best-fitting model were tested for spatial clustering. The overall death rate among children under 5 was 0.0195 deaths per child-year. We found two spatial clusters of high death rates and one spatial cluster of low death rates; children in the two high clusters died at a rate of 0.0264 and 0.0292 deaths per child-year, while in the low cluster, the rate was 0.0144 deaths per child-year. We also found that children born to Fula mothers experienced, on average, a higher hazard of death, whereas children born in the households in the upper two quintiles of asset ownership experienced, on average, a lower hazard of death. After accounting for the spatial distribution of biodemographic and socio-economic characteristics, we found no residual spatial pattern in child mortality risk. This study demonstrates that significant inequality in under-5 death rates can occur within a relatively small area (1100 km(2) ). Risks of under-5 mortality were associated with mother's ethnicity and household wealth. If high mortality clusters persist, then equity concerns may require additional public health efforts in those areas. © 2015 John Wiley & Sons Ltd.

Population attributable risks of patient, child and organizational risk factors for perinatal mortality in hospital births.

PubMed

Poeran, Jashvant; Borsboom, Gerard J J M; de Graaf, Johanna P; Birnie, Erwin; Steegers, Eric A P; Bonsel, Gouke J

2015-04-01

The main objective of this study was to estimate the contributing role of maternal, child, and organizational risk factors in perinatal mortality by calculating their population attributable risks (PAR). The primary dataset comprised 1,020,749 singleton hospital births from ≥22 weeks' gestation (The Netherlands Perinatal Registry 2000-2008). PARs for single and grouped risk factors were estimated in four stages: (1) creating a duplicate dataset for each PAR analysis in which risk factors of interest were set to the most favorable value (e.g., all women assigned 'Western' for PAR calculation of ethnicity); (2) in the primary dataset an elaborate multilevel logistic regression model was fitted from which (3) the obtained coefficients were used to predict perinatal mortality in each duplicate dataset; (4) PARs were then estimated as the proportional change of predicted- compared to observed perinatal mortality. Additionally, PARs for grouped risk factors were estimated by using sequential values in two orders: after PAR estimation of grouped maternal risk factors, the resulting PARs for grouped child, and grouped organizational factors were estimated, and vice versa. The combined PAR of maternal, child and organizational factors is 94.4 %, i.e., when all factors are set to the most favorable value perinatal mortality is expected to be reduced with 94.4 %. Depending on the order of analysis, the PAR of maternal risk factors varies from 1.4 to 13.1 %, and for child- and organizational factors 58.7-74.0 and 7.3-34.3 %, respectively. In conclusion, the PAR of maternal-, child- and organizational factors combined is 94.4 %. Optimization of organizational factors may achieve a 34.3 % decrease in perinatal mortality.

Disparities in child mortality trends in two new states of India

PubMed Central

2013-01-01

Background India has the world’s highest total number of under-five deaths of any nation. While progress towards Millennium Development Goal 4 has been documented at the state level, little information is available for greater disaggregation of child health markers within states. In 2000, new states were created within the country as a partial response to political pressures. State-level information on child health trends in the new states of Chhattisgarh and Jharkhand is scarce. To fill this gap, this article examines under-five and neonatal mortality across various equity markers within these two new states, pre-and post-split. Methods Both direct and indirect estimation using pooled data from five available sources were undertaken. Inter-population disparities were evaluated by mortality data stratification of rural–urban location, ethnicity, wealth and districts. Results Both states experienced an overall reduction in under-five and neonatal mortality, however, this has stagnated post-2001 and various disparities persist. In cases where disparities have declined, such as between urban–rural populations and low- and high-income groups, this has been driven by modest declines within the disadvantaged groups (i.e. low-income rural households) and stagnation or worsening of outcomes within the advantaged groups. Indeed, rising trends in mortality are most prevalent in urban middle-income households. Conclusions The results suggest that rural health improvements may have come at the expense of urban areas, where poor performance may be attributed to factors such as lack of access to quality private health facilities. In addition, the disparities may in part be associated with geographical access, traditional practices and district-level health resource allocation. PMID:23978236

Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries

PubMed Central

Ademuyiwa, Adesoji O

2016-01-01

Background Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally. Methods Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression. Results This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed. Conclusions Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas. Trial registration number NCT02179112; Pre-results. PMID:28588977

Assessment of Malawi's success in child mortality reduction through the lens of the Catalytic Initiative Integrated Health Systems Strengthening programme: Retrospective evaluation.

PubMed

Doherty, Tanya; Zembe, Wanga; Ngandu, Nobubelo; Kinney, Mary; Manda, Samuel; Besada, Donela; Jackson, Debra; Daniels, Karen; Rohde, Sarah; van Damme, Wim; Kerber, Kate; Daviaud, Emmanuelle; Rudan, Igor; Muniz, Maria; Oliphant, Nicholas P; Zamasiya, Texas; Rohde, Jon; Sanders, David

2015-12-01

Malawi is estimated to have achieved its Millennium Development Goal (MDG) 4 target. This paper explores factors influencing progress in child survival in Malawi including coverage of interventions and the role of key national policies. We performed a retrospective evaluation of the Catalytic Initiative (CI) programme of support (2007-2013). We developed estimates of child mortality using four population household surveys undertaken between 2000 and 2010. We recalculated coverage indicators for high impact child health interventions and documented child health programmes and policies. The Lives Saved Tool (LiST) was used to estimate child lives saved in 2013. The mortality rate in children under 5 years decreased rapidly in the 10 CI districts from 219 deaths per 1000 live births (95% confidence interval (CI) 189 to 249) in the period 1991-1995 to 119 deaths (95% CI 105 to 132) in the period 2006-2010. Coverage for all indicators except vitamin A supplementation increased in the 10 CI districts across the time period 2000 to 2013. The LiST analysis estimates that there were 10 800 child deaths averted in the 10 CI districts in 2013, primarily attributable to the introduction of the pneumococcal vaccine (24%) and increased household coverage of insecticide-treated bednets (19%). These improvements have taken place within a context of investment in child health policies and scale up of integrated community case management of childhood illnesses. Malawi provides a strong example for countries in sub-Saharan Africa of how high impact child health interventions implemented within a decentralised health system with an established community-based delivery platform, can lead to significant reductions in child mortality.

Infant and Child Mortality in India in the Last Two Decades: A Geospatial Analysis

PubMed Central

Singh, Abhishek; Pathak, Praveen Kumar; Chauhan, Rajesh Kumar; Pan, William

2011-01-01

Background Studies examining the intricate interplay between poverty, female literacy, child malnutrition, and child mortality are rare in demographic literature. Given the recent focus on Millennium Development Goals 4 (child survival) and 5 (maternal health), we explored whether the geographic regions that were underprivileged in terms of wealth, female literacy, child nutrition, or safe delivery were also grappling with the elevated risk of child mortality; whether there were any spatial outliers; whether these relationships have undergone any significant change over historical time periods. Methodology The present paper attempted to investigate these critical questions using data from household surveys like NFHS 1992–1993, NFHS 1998–1999 and DLHS 2002–2004. For the first time, we employed geo-spatial techniques like Moran's-I, univariate LISA, bivariate LISA, spatial error regression, and spatiotemporal regression to address the research problem. For carrying out the geospatial analysis, we classified India into 76 natural regions based on the agro-climatic scheme proposed by Bhat and Zavier (1999) following the Census of India Study and all estimates were generated for each of the geographic regions. Result/Conclusions This study brings out the stark intra-state and inter-regional disparities in infant and under-five mortality in India over the past two decades. It further reveals, for the first time, that geographic regions that were underprivileged in child nutrition or wealth or female literacy were also likely to be disadvantaged in terms of infant and child survival irrespective of the state to which they belong. While the role of economic status in explaining child malnutrition and child survival has weakened, the effect of mother's education has actually become stronger over time. PMID:22073208

Seasonal variation in child and old-age mortality in rural Ghana.

PubMed

Engelaer, Frouke M; van Bodegom, David; Mangione, Julia N A; Eriksson, Ulrika K; Westendorp, Rudi G J

2014-03-01

Mortality in tropical countries varies considerably from season to season. As many of these countries have seen mortality moving from child to old-age mortality, we have studied seasonal variation in child and old-age mortality in a rural area in Ghana that currently undergoes an epidemiologic transition. In an annual survey from 2002 through to 2011, we followed 29 642 individuals and obtained the cause and month of death from 1406 deceased individuals by making use of verbal autopsies. When comparing the seasons, we observed a trend for higher mortality during the wet season. When comparing separate months, we observed 34% more deaths than expected in September (95% CI 1.04-1.69; p = 0.024) at the end of the wet season and 43% more deaths in April (95% CI 1.13-1.80; p = 0.004) at the end of the dry season, while there were 42% less deaths than expected in December (95% CI 0.52-0.70; p = 0.003), shortly after the wet season. Cause-specific analysis indicated that the peak at the end of the wet season was due to excess mortality from infectious diseases in children and older people alike, whereas the peak in old-age mortality at the end of the dry season was due to non-infectious causes in older people only. Taken together, our data suggest that during the epidemiologic transition, mortality not only shifts from child to old-age and from infectious to non-infectious, but also from the wet to the dry season.

Country level economic disparities in child injury mortality.

PubMed

Khan, Uzma Rahim; Sengoelge, Mathilde; Zia, Nukhba; Razzak, Junaid Abdul; Hasselberg, Marie; Laflamme, Lucie

2015-02-01

Injuries are a neglected cause of child mortality globally and the burden is unequally distributed in resource poor settings. The aim of this study is to explore the share and distribution of child injury mortality across country economic levels and the correlation between country economic level and injuries. All-cause and injury mortality rates per 100,000 were extracted for 187 countries for the 1-4 age group and under 5s from the Global Burden of Disease Study 2010. Countries were grouped into four economic levels. Gross domestic product (GDP) per capita was used to determine correlation with injury mortality. For all regions and country economic levels, the share of injuries in all-cause mortality was greater when considering the 1-4 age group than under 5s, ranging from 36.6% in Organization for Economic Cooperation and Development countries to 10.6% in Sub-Saharan Africa. Except for Sub-Saharan Africa, there is a graded association between country economic level and 1-4 injury mortality across regions, with all low-income countries having the highest rates. Except for the two regions with the highest overall injury mortality rates, there is a significant negative correlation between GDP and injury mortality in Latin America and the Caribbean, Eastern Europe/Central Asia, Asia East/South-East and Pacific and North Africa/ Middle East. Child injury mortality is unevenly distributed across regions and country economic level to the detriment of poorer countries. A significant negative correlation exists between GDP and injury in all regions, exception for the most resource poor where the burden of injuries is highest. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The unfinished health agenda: Neonatal mortality in Cambodia

PubMed Central

Hong, Rathmony; Ahn, Pauline Yongeun; Rathavy, Tung; Gauthier, Ludovic; Hong, Rathavuth; Laillou, Arnaud

2017-01-01

Background Reduction of neonatal and under-five mortality rates remains a primary target in the achievement of universal health goals, as evident in renewed investments of Sustainable Development Goals. Various studies attribute declines in mortality to the combined effects of improvements in health care practices and changes in socio-economic factors. Since the early nineties, Cambodia has managed to evolve from a country devastated by war to a nation soon to enter the group of middle income countries. Cambodia's development efforts are reflected in some remarkable health outcomes such as a significant decline in child mortality rates and the early achievement of related Millennium Development Goals. An achievement acknowledged through the inclusion of Cambodia as one of the ten fast-track countries in the Partnership for Maternal, Newborn and Child Health. This study aims to highlight findings from the field so to provide evidence for future programming and policy efforts. It will be argued that to foster further advances in health, Cambodia will need to keep neonatal survival and health high on the agenda and tackle exacerbating inequities that arise from a pluralistic health system with considerable regional differences and socio-economic disparities. Methods/Findings Data was drawn from Demographic Health Surveys (2000, 2005, 2010, 2014). Information on a series of demographic and socio-economic household characteristics and on child anthropometry, feeding practices and child health were collected from nationally representative samples. To reach the required sample size, live-births that occurred over the past 10 years before the date of the interview were included. Demographic variables included: gender of the child, living area (urban or rural; four ecological regions (constructed by merging provinces and the capital), mother’s age at birth (<20, 20–35, 35+), birth interval (long, short) and birth order (1st, 2–3, 4–6, 7+). Socio-economic variables included: mother education level (none, primary, secondary+) and household wealth (asset-based index). Data on antenatal care, tetanus injection and skilled assistance at birth were used for the mother's last child. Between 2000 and 2014, Cambodia achieved a considerable reduction in neonatal mortality (46% reduction rate). By 2014, gender inequities became almost non-existent (for all measures of equality); inequity related to mother’s education decreased for all time periods; improvements were observed for differences in neonatal mortality by preceding birth interval; and a reduction in neonatal mortality rates could be noted among all the regional subgroups. Inequities increased between mothers who had limited antenatal care and those who received more than four antenatal care visits. In most scale indicators, the Slope Index of Inequality and Relative Index of Inequality estimates for all four rounds of the survey suggest inequity exacerbated in deprived communities. Also, wealth and residence (urban/rural divide) continued to be major determinants in neonatal mortality rates and related inequity trends. Conclusion Analysis highlighted some of the complex patterns and determinants of neonatal mortality, in Cambodia. There has been a considerable decline in neonatal mortality which echoes global trends. Our analysis reveals that despite these advances, additional socio-economic and demographic characteristics considerably affected neonatal mortality rates and its inequities. There continue to be pockets of vulnerable groups that are lagging behind. This analysis highlights the determinants along the urban-rural and rich-poor divides in neonatal mortality inequities and how these affect access to and utilization of quality basic health services. This calls for future policy and programming efforts to be deliberate in their equity approach. Quality improvements in health services and targeted interventions for specific socio-economic groups will be required to further accelerate progress in reducing neonatal mortality and address Cambodia’s pressing unfinished agenda in health. PMID:28323854

Low levels of maternal education and the proximate determinants of childhood mortality: a little learning is not a dangerous thing.

PubMed

Basu, Alaka Malwade; Stephenson, Rob

2005-05-01

This paper examines the impact of 'low' levels of maternal education on the proximate determinants of child mortality using data from the 1992/93 Indian National Family Health Survey. Twenty-two outcomes are investigated, representing child mortality and morbidity, illness management, service utilization and health behaviours. Maternal education is a significant correlate of each of the outcomes, and even low levels of education increase child survival prospects and health-related behaviours, except for neonatal mortality and the effective management of diarrhoea. We speculate on some of the possible mechanisms behind such impressive findings and suggest that rather than female autonomy, it may be the 'hidden curriculum' values of discipline and obedience of authority that account for them.

Changes in fertility patterns can improve child survival in Southeast Asia.

PubMed

Greenspan, A

1993-12-01

This analysis of 1988 Philippine Demographic Survey data provides information on the direct and indirect effects of several major determinants of childhood mortality in the Philippines. Data are compared to rates in Indonesia and Thailand. The odds of infant mortality in the Philippines are reduced by 39% by spacing children more than two years apart. This finding is significant because infant mortality rates have not declined over the past 20 years. Child survival is related to the number of children in the family, the spacing of the children, the mother's age and education, and the risks of malnutrition and infection. Directs effects on child survival are related to infant survival status of the preceding child and the length of the preceding birth interval, while key indirect or background variables are maternal age and education, birth order, and place of residence. The two-stage causation model is tested with data on 13,716 ever married women aged 15-49 years and 20,015 index children born between January 1977 and February 1987. Results in the Philippine confirm that maternal age, birth order, mortality of the previous child, and maternal education are directly related to birth interval, while mortality of the previous child, birth order, and maternal educational status are directly related to infant mortality. Thailand, Indonesia, and the Philippines all show similar explanatory factors that directly influence infant mortality. The survival status of the preceding child is the most important predictor in all three countries and is particularly strong in Thailand. This factor acts through the limited time interval for rejuvenation of mother's body, nutritional deficiencies, and transmission of infectious disease among siblings. The conclusion is that poor environmental conditions increase vulnerability to illness and death. There are 133% greater odds of having a short birth interval among young urban women than among older rural women. There is a 29% increase in odds for second parity births compared to third or higher order parities. Maternal education is a strong predictor of infant survival only in the Philippines and Indonesia. Adolescent pregnancy is a risk only in Indonesia. Socioeconomic factors are not as important as birth interval, birth order, and maternal education in determining survival status.

Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries.

PubMed

Raj, Anita; Boehmer, Ulrike

2013-04-01

This study was designed to assess associations between national rates of girl child marriage and national rates of HIV and maternal and child health (MCH) concerns, using national indicator data from 2009 United Nations reports. Current analyses were limited to the N = 97 nations (of 188 nations) for which girl child marriage data were available. Regression analyses adjusted for development and world region demonstrate that nations with higher rates of girl child marriage are significantly more likely to contend with higher rates of maternal and infant mortality and nonutilization of maternal health services, but not HIV.

The impact of breastfeeding on the health of HIV-positive mothers and their children in sub-Saharan Africa.

PubMed Central

Taha, Taha E.; Kumwenda, Newton I.; Hoover, Donald R.; Kafulafula, George; Fiscus, Susan A.; Nkhoma, Chiwawa; Chen, Shu; Broadhead, Robin L.

2006-01-01

OBJECTIVE: We assessed the impact of breastfeeding by women infected with human immunodeficiency virus (HIV)-1 on their morbidity and risk of mortality and on the mortality of their children. METHODS: We analysed longitudinal data from two previous randomized clinical trials of mother-to-child transmission of HIV conducted between April 2000 and March 2003 in the Republic of Malawi, Africa. Mothers infected with HIV, and their newborns, were enrolled at the time of their child's birth; they then returned for follow-up visits when the child was aged 1 week, 6-8 weeks and then 3, 6, 9, 15, 18, 21 and 24 months. Patterns of breastfeeding (classified as exclusive, mixed or no breastfeeding), maternal morbidity and mortality, and mortality among their children were assessed at each visit. Descriptive and multivariate analyses were performed to determine the association between breastfeeding and maternal and infant outcomes. FINDINGS: A total of 2000 women infected with HIV were enrolled in the original studies. During the 2 years after birth, 44 (2.2%) mothers and 310 (15.5%) children died. (Multiple births were excluded.) The median duration of breastfeeding was 18 months (interquartile range (IQR)=9.0-22.5), exclusive breastfeeding 2 months (IQR=2-3) and mixed feeding 12 months (IQR=6-18). Breastfeeding patterns were not significantly associated with maternal mortality or morbidity after adjusting for maternal viral load and other covariates. Breastfeeding was associated with reduced mortality among infants and children: the adjusted hazard ratio for overall breastfeeding was 0.44 (95% confidence interval (CI)=0.28-0.70), for mixed feeding 0.45 (95% CI=0.28-0.71) and for exclusive breastfeeding 0.40 (95% CI=0.22-0.72). These protective effects were seen both in infants who were infected with HIV and those who were not. CONCLUSION: Breastfeeding by women infected with HIV was not associated with mortality or morbidity; it was associated with highly significant reductions in mortality among their children. PMID:16878228

Outcomes of human immunodeficiency virus-infected children after anti-retroviral therapy in Malaysia.

PubMed

Moy, Fong Siew; Fahey, Paul; Nik Yusoff, Nik K; Razali, Kamarul A; Nallusamy, Revathy

2015-02-01

To describe outcome and examine factors associated with mortality among human immunodeficiency virus (HIV)-infected children in Malaysia after anti-retroviral therapy (ART). Retrospective and prospective data collected through March 2009 from children in four different states in Malaysia enrolled in TREAT Asia's Pediatric HIV Observational Database were analysed. Of 347 children in the cohort, only 278 (80.1%) were commenced on ART. The median CD4 count and median age at baseline prior to ART was 272 cells/μL and 4.2 years (interquartile range (IQR): 1.4, 7.4 years), respectively. The median duration of follow-up was 3.7 years (IQR: 1.8, 6.0) with 32 deaths giving a crude mortality rate of 2.86 per 100 child-years. The mortality rate highest in the first 6 months of ART was 10.62 per 100 child-years and declined to 1.83 per 100 child-years thereafter. On univariate analyses, only baseline median CD4 percentage, weight for age z score, height for age z score and anaemia were significantly associated with mortality. Upon including all four of these predictors into a single multivariate model, only weight for age z score remained statistically significantly predictive of mortality. Children commenced on ART had high mortality in the first 6 months especially in those with low CD4 percentage, wasting and anaemia. Poor nutritional status is an important independent predictor of mortality in this study. Besides initiating ART therapy, nutritional support and intervention must receive the utmost attention. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Independent and combined effects of maternal smoking and solid fuel on infant and child mortality in sub-Saharan Africa.

PubMed

Akinyemi, Joshua O; Adedini, Sunday A; Wandera, Stephen O; Odimegwu, Clifford O

2016-12-01

To estimate the independent and combined risks of infant and child mortality associated with maternal smoking and use of solid fuel in sub-Saharan Africa. Pooled weighted data on 143 602 under-five children in the most recent demographic and health surveys for 15 sub-Saharan African countries were analysed. The synthetic cohort life table technique and Cox proportional hazard models were employed to investigate the effect of maternal smoking and solid cooking fuel on infant (age 0-11 months) and child (age 12-59 months) mortality. Socio-economic and other confounding variables were included as controls. The distribution of the main explanatory variable in households was as follows: smoking + solid fuel - 4.6%; smoking + non-solid fuel - 0.22%; no smoking + solid fuel - 86.9%; and no smoking + non-solid fuel - 8.2%. The highest infant mortality rate was recorded among children exposed to maternal smoking + solid fuel (72 per 1000 live births); the child mortality rate was estimated to be 54 per 1000 for this group. In full multivariate models, the risk of infant death was 71% higher among those exposed to maternal smoking + solid fuel (HR = 1.71, CI: 1.29-2.28). For ages 12 to 59 months, the risk of death was 99% higher (HR = 1.99, CI: 1.28-3.08). Combined exposures to cigarette smoke and solid fuel increase the risks of infant and child mortality. Mothers of under-five children need to be educated about the danger of smoking while innovative approaches are needed to reduce the mortality risks associated with solid cooking fuel. © 2016 John Wiley & Sons Ltd.

[Chile: mortality between 1 and 4 years of age. Trends and causes].

PubMed

Taucher, E

1981-08-01

The great decline in infant mortality in Chile in the last 2 decades provokes interest in the current situation in child mortality (for children 1-4 years of age). For the present analysis, central death rates and probabilities of dying are used, calculated with Greville's method from birth and death data. Mortality trends of the group between 1961-78, sex differentials, and causes of death are studied. The findings indicate that mortality in this age group has declined dramatically during the period of analysis, mainly due to the decrease in mortality from respiratory diseases, diarrhea, and diseases avoidable through vaccination. To attain the future approach of the Chilean rate to that of more developed countries, the reduction of mortality from respiratory diseases and diarrhea should continue together with the achievement of substantial reduction in mortality from violence and accidents. This, the primary cause of death in children, ages 1-4, has not varied during the period under study. (author's)

The Potential Impact of Changes in Fertility on Infant, Child, and Maternal Mortality. World Bank Staff Working Papers No. 698 and Population and Development Series No. 23.

ERIC Educational Resources Information Center

Trussell, James; Pebley, Anne R.

The relationship between changes in the timing and quantity of fertility, such as those that might result from an effective family planning program in developing countries, and changes in child and maternal mortality is examined. Results from five multivariate studies estimate the changes in mortality that might occur from altering maternal age,…

Scaling Up Family Planning to Reduce Maternal and Child Mortality: The Potential Costs and Benefits of Modern Contraceptive Use in South Africa.

PubMed

Chola, Lumbwe; McGee, Shelley; Tugendhaft, Aviva; Buchmann, Eckhart; Hofman, Karen

2015-01-01

Family planning contributes significantly to the prevention of maternal and child mortality. However, many women still do not use modern contraception and the numbers of unintended pregnancies, abortions and subsequent deaths are high. In this paper, we estimate the service delivery costs of scaling up modern contraception, and the potential impact on maternal, newborn and child survival in South Africa. The Family Planning model in Spectrum was used to project the impact of modern contraception on pregnancies, abortions and births in South Africa (2015-2030). The contraceptive prevalence rate (CPR) was increased annually by 0.68 percentage points. The Lives Saved Tool was used to estimate maternal and child deaths, with coverage of essential maternal and child health interventions increasing by 5% annually. A scenario analysis was done to test impacts when: the change in CPR was 0.1% annually; and intervention coverage increased linearly to 99% in 2030. If CPR increased by 0.68% annually, the number of pregnancies would reduce from 1.3 million in 2014 to one million in 2030. Unintended pregnancies, abortions and births decrease by approximately 20%. Family planning can avert approximately 7,000 newborn and child and 600 maternal deaths. The total annual costs of providing modern contraception in 2030 are estimated to be US$33 million and the cost per user of modern contraception is US$7 per year. The incremental cost per life year gained is US$40 for children and US$1,000 for mothers. Maternal and child mortality remain high in South Africa, and scaling up family planning together with optimal maternal, newborn and child care is crucial. A huge impact can be made on maternal and child mortality, with a minimal investment per user of modern contraception.

A comparative analysis of early child health and development services and outcomes in countries with different redistributive policies

PubMed Central

2013-01-01

Background The social environment is a fundamental determinant of early child development and, in turn, early child development is a determinant of health, well-being, and learning skills across the life course. Redistributive policies aimed at reducing social inequalities, such as a welfare state and labour market policies, have shown a positive association with selected health indicators. In this study, we investigated the influence of redistributive policies specifically on the social environment of early child development in five countries with different political traditions. The objective of this analysis was to highlight similarities and differences in social and health services between the countries and their associations with other health outcomes that can inform better global early child development policies and improve early child health and development. Methods Four social determinants of early child development were selected to provide a cross-section of key time periods in a child’s life from prenatal to kindergarten. They included: 1) prenatal care, 2) maternal leave, 3) child health care, and 4) child care and early childhood education. We searched international databases and reports (e.g. Organization for Economic Cooperation and Development, World Bank, and UNICEF) to obtain information about early child development policies, services and outcomes. Results Although a comparative analysis cannot claim causation, our analysis suggests that redistributive policies aimed at reducing social inequalities are associated with a positive influence on the social determinants of early child development. Generous redistributive policies are associated with a higher maternal leave allowance and pay and more preventive child healthcare visits. A decreasing trend in infant mortality, low birth weight rate, and under five mortality rate were observed with an increase in redistributive policies. No clear influence of redistributive policies was observed on breastfeeding and immunization rates. In the analysis of child care and early education, the lack of uniform measures of early child development outcomes was apparent. Conclusions This paper provides further support for an association between redistributive policies and early child health and development outcomes, along with the organization of early child health and development services. PMID:24195544

Associations between prenatal arsenic exposure with adverse pregnancy outcome and child mortality.

PubMed

Shih, Yu-Hsuan; Islam, Tariqul; Hore, Samar Kumar; Sarwar, Golam; Shahriar, Mohammad Hasan; Yunus, Mohammad; Graziano, Joseph H; Harjes, Judith; Baron, John A; Parvez, Faruque; Ahsan, Habibul; Argos, Maria

2017-10-01

Chronic arsenic exposure is a public health concern in many parts of the world, with elevated concentrations in groundwater posing a threat to millions of people. Arsenic is associated with various cancers and an array of chronic diseases; however, the relationship with adverse pregnancy outcomes and child mortality is less established. We evaluated associations between individual-level prenatal arsenic exposure with adverse pregnancy outcomes and child mortality in a pregnancy study among 498 women nested in a larger population-based cohort in rural Bangladesh. Creatinine-adjusted urinary total arsenic concentration, a comprehensive measure of exposure from water, food, and air sources, reflective of the prenatal period was available for participants. Self-reported pregnancy outcomes (livebirth, stillbirth, spontaneous/elective abortion) were ascertained. Generalized estimating equations, accounting for multiple pregnancies of participants, were used to estimate odds ratios and 95% confidence intervals in relation to adverse pregnancy outcomes. Vital status of livebirths was subsequently ascertained through November 2015. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals in relation to child mortality. We observed a significant association between prenatal arsenic exposure and the risk of stillbirth (greater than median; adjusted OR = 2.50; 95% CI = 1.04, 6.01). We also observed elevated risk of child mortality (greater than median; adjusted HR = 1.92; 95% CI = 0.78, 4.68) in relation to prenatal arsenic exposure. Prospective studies should continue to evaluate prenatal and early life health effects of arsenic exposure and arsenic remediation strategies for women of child-bearing age. Copyright © 2017 Elsevier Inc. All rights reserved.

Multinational Corporations, Democracy and Child Mortality: A Quantitative, Cross-National Analysis of Developing Countries

ERIC Educational Resources Information Center

Shandra, John M.; Nobles, Jenna E.; London, Bruce; Williamson, John B.

2005-01-01

This study presents quantitative, sociological models designed to account for cross-national variation in child mortality. We consider variables linked to five different theoretical perspectives that include the economic modernization, social modernization, political modernization, ecological-evolutionary, and dependency perspectives. The study is…

State Limitations, Self-Help Secondary Schooling, and Development in Kenya.

ERIC Educational Resources Information Center

Bradshaw, York W.

1993-01-01

Over 60% of Kenya's secondary schools are nongovernment community-run schools. Analysis of district-level data on adult literacy, secondary enrollment, child health and mortality, malaria prevalence, and rural development indicates that government schooling has few effects. Nongovernment schooling is associated with lower child mortality and other…

Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

PubMed

Wang, Haidong; Liddell, Chelsea A; Coates, Matthew M; Mooney, Meghan D; Levitz, Carly E; Schumacher, Austin E; Apfel, Henry; Iannarone, Marissa; Phillips, Bryan; Lofgren, Katherine T; Sandar, Logan; Dorrington, Rob E; Rakovac, Ivo; Jacobs, Troy A; Liang, Xiaofeng; Zhou, Maigeng; Zhu, Jun; Yang, Gonghuan; Wang, Yanping; Liu, Shiwei; Li, Yichong; Ozgoren, Ayse Abbasoglu; Abera, Semaw Ferede; Abubakar, Ibrahim; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Alemu, Zewdie Aderaw; Allen, Peter J; AlMazroa, Mohammad AbdulAziz; Alvarez, Elena; Amankwaa, Adansi A; Amare, Azmeraw T; Ammar, Walid; Anwari, Palwasha; Cunningham, Solveig Argeseanu; Asad, Majed Masoud; Assadi, Reza; Banerjee, Amitava; Basu, Sanjay; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L; Bhutta, Zulfiqar; Blore, Jed D; Basara, Berrak Bora; Boufous, Soufiane; Breitborde, Nicholas; Bruce, Nigel G; Bui, Linh Ngoc; Carapetis, Jonathan R; Cárdenas, Rosario; Carpenter, David O; Caso, Valeria; Castro, Ruben Estanislao; Catalá-Lopéz, Ferrán; Cavlin, Alanur; Che, Xuan; Chiang, Peggy Pei-Chia; Chowdhury, Rajiv; Christophi, Costas A; Chuang, Ting-Wu; Cirillo, Massimo; da Costa Leite, Iuri; Courville, Karen J; Dandona, Lalit; Dandona, Rakhi; Davis, Adrian; Dayama, Anand; Deribe, Kebede; Dharmaratne, Samath D; Dherani, Mukesh K; Dilmen, Uğur; Ding, Eric L; Edmond, Karen M; Ermakov, Sergei Petrovich; Farzadfar, Farshad; Fereshtehnejad, Seyed-Mohammad; Fijabi, Daniel Obadare; Foigt, Nataliya; Forouzanfar, Mohammad H; Garcia, Ana C; Geleijnse, Johanna M; Gessner, Bradford D; Goginashvili, Ketevan; Gona, Philimon; Goto, Atsushi; Gouda, Hebe N; Green, Mark A; Greenwell, Karen Fern; Gugnani, Harish Chander; Gupta, Rahul; Hamadeh, Randah Ribhi; Hammami, Mouhanad; Harb, Hilda L; Hay, Simon; Hedayati, Mohammad T; Hosgood, H Dean; Hoy, Damian G; Idrisov, Bulat T; Islami, Farhad; Ismayilova, Samaya; Jha, Vivekanand; Jiang, Guohong; Jonas, Jost B; Juel, Knud; Kabagambe, Edmond Kato; Kazi, Dhruv S; Kengne, Andre Pascal; Kereselidze, Maia; Khader, Yousef Saleh; Khalifa, Shams Eldin Ali Hassan; Khang, Young-Ho; Kim, Daniel; Kinfu, Yohannes; Kinge, Jonas M; Kokubo, Yoshihiro; Kosen, Soewarta; Defo, Barthelemy Kuate; Kumar, G Anil; Kumar, Kaushalendra; Kumar, Ravi B; Lai, Taavi; Lan, Qing; Larsson, Anders; Lee, Jong-Tae; Leinsalu, Mall; Lim, Stephen S; Lipshultz, Steven E; Logroscino, Giancarlo; Lotufo, Paulo A; Lunevicius, Raimundas; Lyons, Ronan Anthony; Ma, Stefan; Mahdi, Abbas Ali; Marzan, Melvin Barrientos; Mashal, Mohammad Taufiq; Mazorodze, Tasara T; McGrath, John J; Memish, Ziad A; Mendoza, Walter; Mensah, George A; Meretoja, Atte; Miller, Ted R; Mills, Edward J; Mohammad, Karzan Abdulmuhsin; Mokdad, Ali H; Monasta, Lorenzo; Montico, Marcella; Moore, Ami R; Moschandreas, Joanna; Msemburi, William T; Mueller, Ulrich O; Muszynska, Magdalena M; Naghavi, Mohsen; Naidoo, Kovin S; Narayan, K M Venkat; Nejjari, Chakib; Ng, Marie; de Dieu Ngirabega, Jean; Nieuwenhuijsen, Mark J; Nyakarahuka, Luke; Ohkubo, Takayoshi; Omer, Saad B; Caicedo, Angel J Paternina; Pillay-van Wyk, Victoria; Pope, Dan; Pourmalek, Farshad; Prabhakaran, Dorairaj; Rahman, Sajjad U R; Rana, Saleem M; Reilly, Robert Quentin; Rojas-Rueda, David; Ronfani, Luca; Rushton, Lesley; Saeedi, Mohammad Yahya; Salomon, Joshua A; Sampson, Uchechukwu; Santos, Itamar S; Sawhney, Monika; Schmidt, Jürgen C; Shakh-Nazarova, Marina; She, Jun; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin Hyun; Shishani, Kawkab; Shiue, Ivy; Sigfusdottir, Inga Dora; Singh, Jasvinder A; Skirbekk, Vegard; Sliwa, Karen; Soshnikov, Sergey S; Sposato, Luciano A; Stathopoulou, Vasiliki Kalliopi; Stroumpoulis, Konstantinos; Tabb, Karen M; Talongwa, Roberto Tchio; Teixeira, Carolina Maria; Terkawi, Abdullah Sulieman; Thomson, Alan J; Thorne-Lyman, Andrew L; Toyoshima, Hideaki; Dimbuene, Zacharie Tsala; Uwaliraye, Parfait; Uzun, Selen Begüm; Vasankari, Tommi J; Vasconcelos, Ana Maria Nogales; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Waller, Stephen; Wan, Xia; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G; Westerman, Ronny; Wilkinson, James D; Williams, Hywel C; Yang, Yang C; Yentur, Gokalp Kadri; Yip, Paul; Yonemoto, Naohiro; Younis, Mustafa; Yu, Chuanhua; Jin, Kim Yun; El Sayed Zaki, Maysaa; Zhu, Shankuan; Vos, Theo; Lopez, Alan D; Murray, Christopher J L

2014-09-13

Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. Bill & Melinda Gates Foundation, US Agency for International Development. Copyright © 2014 Elsevier Ltd. All rights reserved.

Unmasking inequalities: Sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story

PubMed Central

Adebayo Oluwakemi, Agnes; Abayomi, Oluwatosin

2017-01-01

Introduction Nigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos. Materials and methods The study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected. Results Data was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894–1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility. Discussion The maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in order to identify pockets of marginalization needing additional resources and tailored approaches to guarantee equitable treatment and timely access to quality health services for vulnerable groups. This study demonstrates the importance of sub-regional, disaggregated data to identify and redress inequities that exist among poor, remote, vulnerable populations—as in the urban slums of Lagos. PMID:28489890

Abolishing inequity, a necessity for poverty reduction and the realisation of child mortality targets.

PubMed

Målqvist, Mats

2015-02-01

The first Millennium Development Goal (MDG 1) due in 2015 concerns poverty reduction. It has been claimed to be fulfilled on a global level, but still more than 1 billion people are living in abject poverty. There is a strong link between the economy and child survival, and only a minority of countries will have reached the MDG target for child mortality reduction by 2015. This paper discusses the relationship between poverty and child survival. It argues that a focus on equity is necessary to further reduce child mortality, through poverty reduction in absolute terms and also through targeting interventions for increased child survival to disadvantaged populations. The political will to actually achieve real change for those in greatest need is crucial but not to be taken for granted, and the distribution rather than the generation of wealth needs to be made a priority in the post-MDG era. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 4. child health findings.

PubMed

Freeman, Paul A; Schleiff, Meike; Sacks, Emma; Rassekh, Bahie M; Gupta, Sundeep; Perry, Henry B

2017-06-01

This paper assesses the effectiveness of community-based primary health care (CBPHC) in improving child health beyond the neonatal period. Although there has been an accelerated decline in global under-5 mortality since 2000, mortality rates remain high in much of sub-Saharan Africa and in some south Asian countries where under-5 mortality is also decreasing more slowly. Essential interventions for child health at the community level have been identified. Our review aims to contribute further to this knowledge by examining how strong the evidence is and exploring in greater detail what specific interventions and implementation strategies appear to be effective. We reviewed relevant documents from 1950 onwards using a detailed protocol. Peer reviewed documents, reports and books assessing the impact of one or more CBPHC interventions on child health (defined as changes in population coverage of one or more key child survival interventions, nutritional status, serious morbidity or mortality) among children in a geographically defined population was examined for inclusion. Two separate reviews took place of each document followed by an independent consolidated summative review. Data from the latter review were transferred to electronic database for analysis. The findings provide strong evidence that the major causes of child mortality in resource-constrained settings can be addressed at the community level largely by engaging communities and supporting community-level workers. For all major categories of interventions (nutritional interventions; control of pneumonia, diarrheal disease and malaria; HIV prevention and treatment; immunizations; integrated management of childhood diseases; and comprehensive primary health care) we have presented randomized controlled trials that have consistently produced statistically significant and operationally important effects. This review shows that there is strong evidence of effectiveness for CBPHC implementation of an extensive range of interventions to improve child health and that four major strategies for delivering these interventions are effective.

Space-time variations in child mortality in a rural South African population with high HIV prevalence (2000-2014).

PubMed

Tlou, Boikhutso; Sartorius, Benn; Tanser, Frank

2017-01-01

The aim of the study was to identify the key determinants of child mortality 'hot-spots' in space and time. Comprehensive population-based mortality data collected between 2000 and 2014 by the Africa Centre Demographic Information System located in the UMkhanyakude District of KwaZulu-Natal Province, South Africa, was analysed. We assigned all mortality events and person-time of observation for children <5 years of age to an exact homestead of residence (mapped to <2m accuracy as part of the DSA platform). Using these exact locations, both the Kulldorff and Tango spatial scan statistics for regular and irregular shaped cluster detection were used to identify clusters of childhood mortality events in both space and time. Of the 49 986 children aged < 5 years who resided in the study area between 2000 and 2014, 2010 (4.0%) died. Childhood mortality decreased by 80% over the period from >20 per 1000 person-years in 2001-2003 to 4 per 1000 person-years in 2014. The two scanning spatial techniques identified two high-risk clusters for child mortality along the eastern border of the study site near the national highway, with a relative risk of 2.10 and 1.91 respectively. The high-risk communities detected in this work, and the differential risk factor profile of these communities, can assist public health professionals to identify similar populations in other parts of rural South Africa. Identifying child mortality hot-spots will potentially guide policy interventions in rural, resource-limited settings.

Classification of maltreatment-related mortality by Child Death Review teams: How reliable are they?

PubMed

Parrish, Jared W; Schnitzer, Patricia G; Lanier, Paul; Shanahan, Meghan E; Daniels, Julie L; Marshall, Stephen W

2017-05-01

Accurate estimation of the incidence of maltreatment-related child mortality depends on reliable child fatality review. We examined the inter-rater reliability of maltreatment designation for two Alaskan Child Death Review (CDR) panels. Two different multidisciplinary CDR panels each reviewed a series of 101 infant and child deaths (ages 0-4 years) in Alaska. Both panels independently reviewed identical medical, autopsy, law enforcement, child welfare, and administrative records for each death utilizing the same maltreatment criteria. Percent agreement for maltreatment was 64.7% with a weighted Kappa of 0.61 (95% CI 0.51, 0.70). Across maltreatment subtypes, agreement was highest for abuse (69.3%) and lowest for negligence (60.4%). Discordance was higher if the mother was unmarried or a smoker, if residence was rural, or if there was a family history of child protective services report(s). Incidence estimates did not depend on which panel's data were used. There is substantial room for improvement in the reliability of CDR panel assessment of maltreatment related mortality. Standardized decision guidance for CDR panels may improve the reliability of their data. Copyright © 2017 Elsevier Ltd. All rights reserved.

C-reactive protein-to-albumin ratio is a predictor of hepatitis B virus related decompensated cirrhosis: time-dependent receiver operating characteristics and decision curve analysis.

PubMed

Huang, Si-Si; Xie, Dong-Mei; Cai, Yi-Jing; Wu, Jian-Min; Chen, Rui-Chong; Wang, Xiao-Dong; Song, Mei; Zheng, Ming-Hua; Wang, Yu-Qun; Lin, Zhuo; Shi, Ke-Qing

2017-04-01

Hepatitis B virus (HBV) infection remains a major health problem and HBV-related-decompensated cirrhosis (HBV-DC) usually leads to a poor prognosis. Our aim was to determine the utility of inflammatory biomarkers in predicting mortality of HBV-DC. A total of 329 HBV-DC patients were enrolled. Survival estimates for the entire study population were generated using the Kaplan-Meier method. The prognostic values for model for end-stage liver disease (MELD) score, Child-Pugh score, and inflammatory biomarkers neutrophil/lymphocyte ratio, C-reactive protein-to-albumin ratio (CAR), and lymphocyte-to-monocyte ratio (LMR) for HBV-DC were compared using time-dependent receiver operating characteristic curves and time-dependent decision curves. The survival time was 23.1±15.8 months. Multivariate analysis identified age, CAR, LMR, and platelet count as prognostic independent risk factors. Kaplan-Meier analysis indicated that CAR of at least 1.0 (hazard ratio, 7.19; 95% confidence interval, 4.69-11.03), and LMR less than 1.9 (hazard ratio, 2.40; 95% confidence interval, 1.69-3.41) were independently associated with mortality of HBV-DC. The time-dependent receiver operating characteristic indicated that CAR showed the best performance in predicting mortality of HBV-DC compared with LMR, MELD score, and Child-Pugh score. The results were also confirmed by time-dependent decision curves. CAR and LMR were associated with the prognosis of HBV-DC. CAR was superior to LMR, MELD score, and Child-Pugh score in HBV-DC mortality prediction.

Child mortality in new industrial localities and opportunities for change: a survey in an Indian steel town.

PubMed

Crook, N; Malaker, C R

1992-10-01

As Asia becomes increasingly urbanized the effect of new industrial development on child mortality becomes of increasing interest. In India, considerable investment has been made in the social infrastructure of industrial new towns. This survey of Durgapur steel town in West Bengal shows that although the average level of child mortality in the working class population is favourable in comparison with other Indian cities, considerable differentials, that can be related to social, economic and environmental differences within the population, have arisen since the creation of the city in the late 1950s. The paper argues that the undertaking of selective sanitary interventions to improve access to drinking water (in particular) would be administratively feasible in these industrial new towns, of immediate impact, and indeed necessary if the differentials in mortality are to be eliminated.

Impact of consanguineous marriages and degrees of inbreeding on fertility, child mortality, secondary sex ratio, selection intensity, and genetic load: a cross-sectional study from Northern India.

PubMed

Fareed, Mohd; Kaisar Ahmad, Mir; Azeem Anwar, Malik; Afzal, Mohammad

2017-01-01

The aim of our study was to understand the relationship between consanguineous marriages and reproductive outcomes. A total of 999 families were recruited from five Muslim populations of Jammu region. Family pedigrees were drawn to access the family history and inbreeding status in terms of coefficient of inbreeding (F). Fertility, mortality, secondary sex ratio, selection intensity, and lethal equivalents were measured using standard methods. The significant differences for gross fertility was found to be higher among inbred groups as compared to the unrelated families (P < 0.05) and higher mortality rates were observed among consanguineous families of all populations in comparison with the non-consanguineous family groups. Moreover, the prenatal and postnatal child mortality rates (i.e., U5MR and U18MR) have presented a persuasive increase with an upsurge in the homozygosity level. The mortality rate was found to be maximum among families with the highest value of coefficient of inbreeding (F). The selection intensity (SI) also showed inflations among families with respect to their increasing inbreeding coefficients. The greater values of lethal equivalents per gamete (LEs/gamete) were observed for autosomal inheritance in comparison with sex-linked inheritance. Our conclusive assessment brings out the deleterious consequence of consanguineous marriages on reproductive outcomes.

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries.

PubMed

Hathi, Payal; Haque, Sabrina; Pant, Lovey; Coffey, Diane; Spears, Dean

2017-02-01

A long literature in demography has debated the importance of place for health, especially children's health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.

National and subnational all-cause and cause-specific child mortality in China, 1996-2015: a systematic analysis with implications for the Sustainable Development Goals.

PubMed

He, Chunhua; Liu, Li; Chu, Yue; Perin, Jamie; Dai, Li; Li, Xiaohong; Miao, Lei; Kang, Leni; Li, Qi; Scherpbier, Robert; Guo, Sufang; Rudan, Igor; Song, Peige; Chan, Kit Yee; Guo, Yan; Black, Robert E; Wang, Yanping; Zhu, Jun

2017-02-01

China has achieved Millennium Development Goal 4 to reduce under-5 mortality rate by two-thirds between 1990 and 2015. In this study, we estimated the national and subnational levels and causes of child mortality in China annually from 1996 to 2015 to draw implications for achievement of the SDGs for China and other low-income and middle-income countries. In this systematic analysis, we adjusted empirical data on levels and causes of child mortality collected in the China Maternal and Child Health Surveillance System to generate representative estimates at the national and subnational levels. In adjusting the data, we considered the sampling design and probability, applied smoothing techniques to produce stable trends, fitted livebirth and age-specific death estimates to natvional estimates produced by the UN for international comparison, and partitioned national estimates of infrequent causes produced by independent sources to the subnational level. Between 1996 and 2015, the under-5 mortality rate in China declined from 50·8 per 1000 livebirths to 10·7 per 1000 livebirths, at an average annual rate of reduction of 8·2%. However, 181 600 children still died before their fifth birthday, with 93 400 (51·5%) deaths occurring in neonates. Great inequity exists in child mortality across regions and in urban versus rural areas. The leading causes of under-5 mortality in 2015 were congenital abnormalities (35 700 deaths, 95% uncertainty range [UR] 28 400-45 200), preterm birth complications (30 900 deaths, 24 200-40 800), and injuries (26 600 deaths, 21 000-33 400). Pneumonia contributed to a higher proportion of deaths in the western region of China than in the eastern and central regions, and injury was a main cause of death in rural areas. Variations in cause-of-death composition by age were also examined. The contribution of preterm birth complications to mortality decreased after the neonatal period; congenital abnormalities remained an important cause of mortality throughout infancy, whereas the contribution of injuries to mortality increased after the first year of life. China has achieved a rapid reduction in child mortality in 1996-2015. The decline has been widespread across regions, urban and rural areas, age groups, and cause-of-death categories, but great disparities remain. The western region and rural areas and especially western rural areas should receive most attention in improving child survival through enhanced policy and programmes in the Sustainable Development Goals era. Continued investment is crucial in primary and secondary prevention of deaths due to congenital abnormalities, preterm birth complications, and injuries nationally, and of deaths due to pneumonia in western rural areas. The study also has implications for improving child survival and civil registration and vital statistics in other low-income and middle-income countries. Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Addressing maternal and child health in post-conflict Afghanistan: the way forward.

PubMed

Singh, P K; Rai, R K; Alagarajan, M

2013-09-01

Afghanistan's maternal and child mortality rates are among the highest in the world. The country faces challenges to meet the Millennium Development Goals set for 2015 which can be attributed to multiple causes related to accessibility, affordability and availability of health-care services. This report addresses the challenges in strengthening maternal and child health care in Afghanistan, as well discussing the areas to be prioritized. In order to ensure sound maternal and child health care in Afghanistan, policy-makers must prioritize monitoring and surveillance systems, integrating maternal and child health care with rights-based family planning methods, building human resources, offering incentives (such as the provision of a conditional cash transfer to women) and promoting action-oriented, community-based interventions. On a wider scale, the focus must be to improve the health infrastructure, organizing international collaboration and expanding sources of funding.

Entrenched geographical and socioeconomic disparities in child mortality: trends in absolute and relative inequalities in Cambodia.

PubMed

Jimenez-Soto, Eliana; Durham, Jo; Hodge, Andrew

2014-01-01

Cambodia has made considerable improvements in mortality rates for children under the age of five and neonates. These improvements may, however, mask considerable disparities between subnational populations. In this paper, we examine the extent of the country's child mortality inequalities. Mortality rates for children under-five and neonates were directly estimated using the 2000, 2005 and 2010 waves of the Cambodian Demographic Health Survey. Disparities were measured on both absolute and relative scales using rate differences and ratios, and where applicable, slope and relative indices of inequality by levels of rural/urban location, regions and household wealth. Since 2000, considerable reductions in under-five and to a lesser extent in neonatal mortality rates have been observed. This mortality decline has, however, been accompanied by an increase in relative inequality in both rates of child mortality for geography-related stratifying markers. For absolute inequality amongst regions, most trends are increasing, particularly for neonatal mortality, but are not statistically significant. The only exception to this general pattern is the statistically significant positive trend in absolute inequality for under-five mortality in the Coastal region. For wealth, some evidence for increases in both relative and absolute inequality for neonates is observed. Despite considerable gains in reducing under-five and neonatal mortality at a national level, entrenched and increased geographical and wealth-based inequality in mortality, at least on a relative scale, remain. As expected, national progress seems to be associated with the period of political and macroeconomic stability that started in the early 2000s. However, issues of quality of care and potential non-inclusive economic growth might explain remaining disparities, particularly across wealth and geography markers. A focus on further addressing key supply and demand side barriers to accessing maternal and child health care and on the social determinants of health will be essential in narrowing inequalities.

Child Health and Mortality

PubMed Central

Arifeen, Shams El

2008-01-01

Bangladesh is currently one of the very few countries in the world, which is on target for achieving the Millennium Development Goal (MDG) 4 relating to child mortality. There have been very rapid reductions in mortality, especially in recent years and among children aged over one month. However, this rate of reduction may be difficult to sustain and may impede the achievement of MDG 4. Neonatal deaths now contribute substantially (57%) to overall mortality of children aged less than five years, and reductions in neonatal mortality are difficult to achieve and have been slow in Bangladesh. There are some interesting attributes of the mortality decline in Bangladesh. Mortality has declined faster among girls than among boys, but the poorest have not benefited from the reduction in mortality. There has also been a relative absence of a decline in mortality in urban areas. The age and cause of death pattern of under-five mortality indicate certain interventions that need to be scaled up rapidly and reach high coverage to achieve MDG 4 in Bangladesh. These include skilled attendance at delivery, postnatal care for the newborn, appropriate feeding of the young infant and child, and prevention and management of childhood infections. The latest (2007) Bangladesh Demographic and Health Survey shows that Bangladesh has made sustained and remarkable progress in many areas of child health. More than 80% of children are receiving all vaccines. The use of oral rehydration solution for diarrhoea is high, and the coverage of vitamin A among children aged 9-59 months has been consistently increasing. However, poor quality of care, misperceptions regarding the need for care, and other social barriers contribute to low levels of care-seeking for illnesses of the newborns and children. Improvements in the health system are essential for removing these barriers, as are effective strategies to reach families and communities with targeted messages and information. Finally, there are substantial health-system challenges relating to the design and implementation, at scale, of interventions to reduce neonatal mortality. PMID:18831224

Cyclicality, Mortality, and the Value of Time: The Case of Coffee Price Fluctuations and Child Survival in Colombia

PubMed Central

Miller, Grant; Urdinola, B. Piedad

2011-01-01

Recent studies demonstrate procyclical mortality in wealthy countries, but there are reasons to expect a countercyclical relationship in developing nations. We investigate how child survival in Colombia responds to fluctuations in world Arabica coffee prices – and document starkly procyclical child deaths. In studying this result’s behavioral underpinnings, we highlight that: (1) The leading determinants of child health are inexpensive but require considerable time, and (2) As the value of time declines with falling coffee prices, so does the relative price of health. We find a variety of direct evidence consistent with the primacy of time in child health production. PMID:22090662

Status and drivers of maternal, newborn, child and adolescent health in the Islamic world: a comparative analysis.

PubMed

Akseer, Nadia; Kamali, Mahdis; Bakhache, Nour; Mirza, Maaz; Mehta, Seema; Al-Gashm, Sara; Bhutta, Zulfiqar A

2018-04-14

The Millennium Development Goal (MDG) period saw dramatic gains in health goals MDG 4 and MDG 5 for improving child and maternal health. However, many Muslim countries in the south Asian, Middle Eastern, and African regions lagged behind. In this study, we aimed to evaluate the status of, progress in, and key determinants of reproductive, maternal, newborn, child, and adolescent health in Muslim majority countries (MMCs). The specific objectives were to understand the current status and progress in reproductive, maternal, newborn, child, and adolescent health in MMCs, and the determinants of child survival among the least developed countries among the MMCs; to explore differences in outcomes and the key contextual determinants of health between MMCs and non-MMCs; and to understand the health service coverage and contextual determinants that differ between best and poor or moderate performing MMCs. In this country-level ecological study, we examined data from between 1990 and 2015 from multiple publicly available data repositories. We examined 47 MMCs, of which 26 were among the 75 high-burden Countdown to 2015 countries. These 26 MMCs were compared with 48 non-Muslim Countdown countries. We also examined characteristics of the eight best performing MMCs that had accelerated improvement in child survival (ie, that reached their MDG 4 targets). We estimated adolescent, maternal, under-5, and newborn mortality, and stillbirths, and the causes of death, essential interventions coverage, and contextual determinants for all MMCs and comparative groups using standardised methods. We also did a hierarchical multivariable analysis of determinants of under-5 mortality and newborn mortality in low-income and middle-income MMCs. Despite notable reductions between 1990 and 2015, MMCs compared with a global esimate of all countries including MMCs had higher mortality rates, and MMCs relative to non-MMCs within Countdown countries also performed worse. Coverage of essential interventions across the continuum of care was on average lower among MMCs, especially for indicators of reproductive health, prenatal care, delivery, and labour, and childhood vaccines. Outcomes within MMCs for mortality and many reproductive, maternal, newborn, child, and adolescent health indicators varied considerably. Structural and contextual factors, especially state governance, conflict, and women and girl's empowerment indicators, were significantly worse in MMCs compared with non-MMCs within the high-burden Countdown countries, and were shown to be strongly associated with child and newborn mortality within low-income and middle-income MMCs. In adjusted hierarchical models, among other factors, under-5 mortality in MMCs increased with more refugees originating from a country (β=23·67, p=0·0116), and decreased with better political stability or absence of terrorism (β=-0·99, p=0·0285), greater political rights or government effectiveness (β=-1·17, p<0·0001), improvements in log gross national income per capita (β=-4·44, p<0·0001), higher total adult literacy (β=-1·69, p<0·0001), higher female adult literacy (β=-0·97, p<0·0001), and greater female to male enrolment in secondary school (β=-16·1, p<0·0001). The best performing MMCs were Azerbaijan, Bangladesh, Egypt, Indonesia, Kyrgyzstan, Morocco, Niger, and Senegal, which had higher coverage of family planning interventions and newborn or child vaccinations, and excelled in many of the above contextual determinants when compared with moderate or poorly performing MMCs. The status and progress in reproductive, maternal, newborn, child, and adolescent health is heterogeneous among MMCs, with little indication that religion and its practice affects outcomes systemically. Some Islamic countries such as Niger and Bangladesh have made great progress, despite poverty. Key findings from this study have policy and programmatic implications that could be prioritised by national heads of state and policy makers, development partners, funders, and the Organization of the Islamic Cooperation to scale up and improve these health outcomes in Muslim countries in the post-2015 era. US Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn, and Child Survival, the Centre for Global Child Health, Hospital for Sick Children, and the Aga Khan University. Copyright © 2018 Elsevier Ltd. All rights reserved.

Increasing Neonatal Mortality among Palestine Refugees in the Gaza Strip

PubMed Central

van den Berg, Maartje M.; Madi, Haifa H.; Khader, Ali; Hababeh, Majed; Zeidan, Wafa’a; Wesley, Hannah; Abd El-Kader, Mariam; Maqadma, Mohamed; Seita, Akihiro

2015-01-01

Background The United Nations Relief and Works Agency for Palestine refugees in the Near East (UNRWA) has periodically estimated infant mortality rates among Palestine refugees in Gaza. These surveys have recorded a decline from 127 per 1000 live births in 1960 to 20.2 in 2008. Methods We used the same preceding-birth technique as in previous surveys. All multiparous mothers who came to the 22 UNRWA health centres to register their last-born child for immunization were asked if their preceding child was alive or dead. We based our target sample size on the infant mortality rate in 2008 and included 3128 mothers from August until October 2013. We used multiple logistic regression analyses to identify predictors of infant mortality. Findings Infant mortality in 2013 was 22.4 per 1000 live births compared with 20.2 in 2008 (p = 0.61), and this change reflected a statistically significant increase in neonatal mortality (from 12.0 to 20.3 per 1000 live births, p = 0.01). The main causes of the 65 infant deaths were preterm birth (n = 25, 39%), congenital anomalies (n = 19, 29%), and infections (n = 12, 19%). Risk factors for infant death were preterm birth (OR 9.88, 3.98–24.85), consanguinity (2.41, 1.35–4.30) and high-risk pregnancies (3.09, 1.46–6.53). Conclusion For the first time in five decades, mortality rates have increased among Palestine refugee newborns in Gaza. The possible causes of this trend may include inadequate neonatal care. We will estimate infant and neonatal mortality rates again in 2015 to see if this trend continues and, if so, to assess how it can be reversed. PMID:26241479

Working toward decreasing infant mortality in developing countries through change in the medical curriculum

PubMed Central

2011-01-01

Background High infant and maternal mortality rates are one of the biggest health issues in Pakistan. Although these rates are given high priority at the national level (Millennium Development Goals 4 and 5, respectively), there has been no significant decrease in them so far. We hypothesize that this lack of success is because the undergraduate curriculum in Pakistan does not match local needs. Currently, the Pakistani medical curriculum deals with issues in maternal and child morbidity and mortality according to Western textbooks. Moreover, these are taught disjointedly through various departments. We undertook curriculum revision to sensitize medical students to maternal and infant mortality issues important in the Pakistani context and educate them about ways to reduce the same through an integrated teaching approach. Methods The major determinants of infant mortality in underdeveloped countries were identified through a literature review covering international research produced over the last 10 years and the Pakistan Demographic Health Survey 2006-07. An interdisciplinary maternal and child health module team was created by the Medical Education Department at Shifa College of Medicine. The curriculum was developed based on the role of identified determinants in infant and maternal mortality. It was delivered by an integrated team without any subject boundaries. Students' knowledge, skills, and attitudes were assessed by multiple modalities and the module itself by student feedback using questionnaires and focus group discussions. Results Assessment and feedback demonstrated that the students had developed a thorough understanding of the complexity of factors that contribute to infant mortality. Students also demonstrated knowledge and skill in counseling, antenatal care, and care of newborns and infants. Conclusions A carefully designed integrated curriculum can help sensitize undergraduate medical students and equip them to identify and address complex issues related to maternal and infant mortality in underdeveloped countries. PMID:21871130

Factors associated with preventable infant death: a multiple logistic regression

PubMed Central

Vidal e Silva, Sandra Maria Cunha; Tuon, Rogério Antonio; Probst, Livia Fernandes; Gondinho, Brunna Verna Castro; Pereira, Antonio Carlos; Meneghim, Marcelo de Castro; Cortellazzi, Karine Laura; Ambrosano, Glaucia Maria Bovi

2018-01-01

ABSTRACT OBJECTIVE To identify and analyze factors associated with preventable child deaths. METHODS This analytical cross-sectional study had preventable child mortality as dependent variable. From a population of 34,284 live births, we have selected a systematic sample of 4,402 children who did not die compared to 272 children who died from preventable causes during the period studied. The independent variables were analyzed in four hierarchical blocks: sociodemographic factors, the characteristics of the mother, prenatal and delivery care, and health conditions of the patient and neonatal care. We performed a descriptive statistical analysis and estimated multiple hierarchical logistic regression models. RESULTS Approximatelly 35.3% of the deaths could have been prevented with the early diagnosis and treatment of diseases during pregnancy and 26.8% of them could have been prevented with better care conditions for pregnant women. CONCLUSIONS The following characteristics of the mother are determinant for the higher mortality of children before the first year of life: living in neighborhoods with an average family income lower than four minimum wages, being aged ≤ 19 years, having one or more alive children, having a child with low APGAR level at the fifth minute of life, and having a child with low birth weight. PMID:29723389

The relationships between income inequality, welfare regimes and aggregate health: a systematic review.

PubMed

Kim, Ki-Tae

2017-06-01

: When analysing the relationships between income inequality, welfare regimes and aggregate health at the cross-national level, previous primary articles and systematic reviews reach inconsistent conclusions. Contrary to theoretical expectations, equal societies or the Social Democratic welfare regime do not always have the best aggregate health when compared with those of other relatively unequal societies or other welfare regimes. This article will shed light on the controversial subjects with a new decomposition systematic review method. The decomposition systematic review method breaks down an individual empirical article, if necessary, into multiple findings based on an article's use of the following four components: independent variable, dependent variable, method and dataset. This decomposition method extracts 107 findings from the selected 48 articles, demonstrating the dynamics between the four components. 'The age threshold effect' is recognized over which the hypothesized relations between income inequality, welfare regimes and aggregate health reverse. The hypothesis is supported mainly for younger infant and child health indicators, but not for adult health or general health indicators such as life expectancy. Further three threshold effects (income, gender and period) have also been put forward. The negative relationship between income inequality and aggregate health, often termed as the Wilkinson Hypothesis, was not generally observed in all health indicators except for infant and child mortality. The Scandinavian welfare regime reveals worse-than-expected outcomes in all health indicators except infant and child mortality. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Child Mortality in the School Setting. Position Statement

ERIC Educational Resources Information Center

Bergren, Martha Dewey

2012-01-01

It is the position of the National Association of School Nurses (NASN) that data on children's deaths in school should be recorded, analyzed and reported at the local, state and national level. The systematic review of data on child deaths is necessary to drive interventions and policies that will decrease mortality from injuries, violence, acute…

Association of Selected Risk Factors with Variation in Child and Adolescent Firearm Mortality by State

ERIC Educational Resources Information Center

Murnan, Judy; Dake, Joseph A.; Price, James H.

2004-01-01

This study examined relationships between variation in child and adolescent firearm mortality by state and the following variables: childhood poverty rate, percent single parent families, percent population that is African American, percent population that is Hispanic. percent students carrying a gun, percent students carrying a weapon, percent…

Regional inequalities of child mortality in peninsular Malaysia with special reference to the differentials between Perlis and Kuala Terengganu.

PubMed

Brehm, U

1993-05-01

In Peninsular Malaysia child mortality rates (5q0) vary from 13 to 63 per thousand at district level. The spatial pattern is closely associated with the regional distribution of socio-economic factors. But due to multicollinearity it is difficult to isolate the influence of socio-economic variables from other variables by employing aggregated data. However, individual data collected in a case-control-study that was conducted in Perlis and Kuala Terengganu confirm the important role of socio-economic factors. So it should be possible to achieve a further reduction of child mortality by raising the income and educational level of the under-privileged groups. Apart from that, as the case of Perlis shows, the provision of family planning and preventive medical services may also contribute to lower child mortality independent from socio-economic changes. But, as the comparison with Kuala Terengganu shows, the utilization of family planning and preventive medical services is not only influenced by the accessibility to, but also by the socio-culturally determined acceptability of such services.

Interventions to Improve Neonatal Health and Later Survival: An Overview of Systematic Reviews.

PubMed

Lassi, Zohra S; Middleton, Philippa F; Crowther, Caroline; Bhutta, Zulfiqar A

2015-08-01

Evidence-based interventions and strategies are needed to improve child survival in countries with a high burden of neonatal and child mortality. An overview of systematic reviews can focus implementation on the most effective ways to increase child survival. In this overview we included published Cochrane and other systematic reviews of experimental and observational studies on antenatal, childbirth, postnatal and child health interventions aiming to prevent perinatal/neonatal and child mortality using the WHO list of essential interventions. We assessed the methodological quality of the reviews using the AMSTAR criteria and assessed the quality of the outcomes using the GRADE approach. Based on the findings from GRADE criteria, interventions were summarized as effective, promising or ineffective. The overview identified 148 Cochrane and other systematic reviews on 61 reproductive, maternal, newborn and child health interventions. Of these, only 57 reviews reported mortality outcomes. Using the GRADE approach, antenatal corticosteroids for preventing neonatal respiratory distress syndrome in preterm infants; early initiation of breastfeeding; hygienic cord care; kangaroo care for preterm infants; provision and promotion of use of insecticide treated bed nets (ITNs) for children; and vitamin A supplementation for infants from six months of age, were identified as clearly effective interventions for reducing neonatal, infant or child mortality. Antenatal care, tetanus immunization in pregnancy, prophylactic antimalarials during pregnancy, induction of labour for prolonged pregnancy, case management of neonatal sepsis, meningitis and pneumonia, prophylactic and therapeutic use of surfactant, continuous positive airway pressure for neonatal resuscitation, case management of childhood malaria and pneumonia, vitamin A as part of treatment for measles associated pneumonia for children above 6 months, and home visits across the continuum of care, were identified as promising interventions for reducing neonatal, infant, child or perinatal mortality. Comprehensive adoption of the above six effective and 11 promising interventions can improve neonatal and child survival around the world. Choice of intervention and degree of implementation currently depends on resources available and policies in individual countries and geographical settings. This review was part of doctoral thesis which was funded by University of Adelaide, Australia.

Mapping under-5 and neonatal mortality in Africa, 2000-15: a baseline analysis for the Sustainable Development Goals.

PubMed

Golding, Nick; Burstein, Roy; Longbottom, Joshua; Browne, Annie J; Fullman, Nancy; Osgood-Zimmerman, Aaron; Earl, Lucas; Bhatt, Samir; Cameron, Ewan; Casey, Daniel C; Dwyer-Lindgren, Laura; Farag, Tamer H; Flaxman, Abraham D; Fraser, Maya S; Gething, Peter W; Gibson, Harry S; Graetz, Nicholas; Krause, L Kendall; Kulikoff, Xie Rachel; Lim, Stephen S; Mappin, Bonnie; Morozoff, Chloe; Reiner, Robert C; Sligar, Amber; Smith, David L; Wang, Haidong; Weiss, Daniel J; Murray, Christopher J L; Moyes, Catherine L; Hay, Simon I

2017-11-11

During the Millennium Development Goal (MDG) era, many countries in Africa achieved marked reductions in under-5 and neonatal mortality. Yet the pace of progress toward these goals substantially varied at the national level, demonstrating an essential need for tracking even more local trends in child mortality. With the adoption of the Sustainable Development Goals (SDGs) in 2015, which established ambitious targets for improving child survival by 2030, optimal intervention planning and targeting will require understanding of trends and rates of progress at a higher spatial resolution. In this study, we aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa. We assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. We used a Bayesian geostatistical analytical framework to generate these estimates, and implemented predictive validity tests. In addition to reporting 5 × 5 km estimates, we also aggregated results obtained from these estimates into three different levels-national, and subnational administrative levels 1 and 2-to provide the full range of geospatial resolution that local, national, and global decision makers might require. Amid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8·8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030. In the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5 × 5 km estimates of child mortality in Africa provide a baseline against which local, national, and global stakeholders can map the pathways for ending preventable child deaths by 2030. Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Comparing Inference Approaches for RD Designs: A Reexamination of the Effect of Head Start on Child Mortality

ERIC Educational Resources Information Center

Cattaneo, Matias D.; Titiunik, Rocío; Vazquez-Bare, Gonzalo

2017-01-01

The regression discontinuity (RD) design is a popular quasi-experimental design for causal inference and policy evaluation. The most common inference approaches in RD designs employ "flexible" parametric and nonparametric local polynomial methods, which rely on extrapolation and large-sample approximations of conditional expectations…

Monitoring Child Abuse and Neglect at a Population Level: Patterns of Hospital Admissions for Maltreatment and Assault

ERIC Educational Resources Information Center

O'Donnell, Melissa; Nassar, Natasha; Leonard, Helen; Mathews, Richard; Patterson, Yvonne; Stanley, Fiona

2010-01-01

Objectives: To investigate the prevalence, trends, and characteristics of maltreatment and assault related hospital admissions and deaths among children; and identify common injuries and conditions associated with these admissions using routinely collected morbidity and mortality data. Methods: A retrospective cohort study of all children aged…

Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana.

PubMed

Helleringer, Stephane; Arhinful, Daniel; Abuaku, Benjamin; Humes, Michael; Wilson, Emily; Marsh, Andrew; Clermont, Adrienne; Black, Robert E; Bryce, Jennifer; Amouzou, Agbessi

2018-01-01

Reducing neonatal and child mortality is a key component of the health-related sustainable development goal (SDG), but most low and middle income countries lack data to monitor child mortality on an annual basis. We tested a mortality monitoring system based on the continuous recording of pregnancies, births and deaths by trained community-based volunteers (CBV). This project was implemented in 96 clusters located in three districts of the Northern Region of Ghana. Community-based volunteers (CBVs) were selected from these clusters and were trained in recording all pregnancies, births, and deaths among children under 5 in their catchment areas. Data collection lasted from January 2012 through September 2013. All CBVs transmitted tallies of recorded births and deaths to the Ghana Birth and deaths registry each month, except in one of the study districts (approximately 80% reporting). Some events were reported only several months after they had occurred. We assessed the completeness and accuracy of CBV data by comparing them to retrospective full pregnancy histories (FPH) collected during a census of the same clusters conducted in October-December 2013. We conducted all analyses separately by district, as well as for the combined sample of all districts. During the 21-month implementation period, the CBVs reported a total of 2,819 births and 137 under-five deaths. Among the latter, there were 84 infant deaths (55 neonatal deaths and 29 post-neonatal deaths). Comparison of the CBV data with FPH data suggested that CBVs significantly under-estimated child mortality: the estimated under-5 mortality rate according to CBV data was only 2/3 of the rate estimated from FPH data (95% Confidence Interval for the ratio of the two rates = 51.7 to 81.4). The discrepancies between the CBV and FPH estimates of infant and neonatal mortality were more limited, but varied significantly across districts. In northern Ghana, a community-based data collection systems relying on volunteers did not yield accurate estimates of child mortality rates. Additional implementation research is needed to improve the timeliness, completeness and accuracy of such systems. Enhancing pregnancy monitoring, in particular, may be an essential step to improve the measurement of neonatal mortality.

Post-natal anaemia and iron deficiency in HIV-infected women and the health and survival of their children.

PubMed

Isanaka, Sheila; Spiegelman, Donna; Aboud, Said; Manji, Karim P; Msamanga, Gernard I; Willet, Walter C; Duggan, Christopher; Fawzi, Wafaie W

2012-07-01

Prenatal iron supplementation may improve pregnancy outcomes and decrease the risk of child mortality. However, little is known about the importance of post-natal maternal iron status for child health and survival, particularly in the context of HIV infection. We examined the association of maternal anaemia and hypochromic microcytosis, an erythrocyte morphology consistent with iron deficiency, with child health and survival in the first two to five years of life. Repeated measures of maternal anaemia and hypochromic microcytosis from 840 HIV-positive women enrolled in a clinical trial of vitamin supplementation were prospectively related to child mortality, HIV infection and CD4 T-cell count. Median duration of follow-up for the endpoints of child mortality, HIV infection and CD4 cell count was 58, 17 and 23 months, respectively. Maternal anaemia and hypochromic microcytosis were associated with greater risk of child mortality [hazard ratio (HR) for severe anaemia = 2.58, 95% confidence interval (CI): 1.66-4.01, P trend < 0.0001; HR for severe hypochromic microcytosis = 2.36, 95% CI: 1.27-4.38, P trend = 0.001]. Maternal anaemia was not significantly associated with greater risk of child HIV infection (HR for severe anaemia = 1.46, 95% CI: 0.91, 2.33, P trend = 0.08) but predicted lower CD4 T-cell counts among HIV-uninfected children (difference in CD4 T-cell count/µL for severe anaemia: -93, 95% CI: -204-17, P trend = 0.02). The potential child health risks associated with maternal anaemia and iron deficiency may not be limited to the prenatal period. Efforts to reduce maternal anaemia and iron deficiency during pregnancy may need to be expanded to include the post-partum period. © 2012 Blackwell Publishing Ltd.

Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia.

PubMed

Semba, Richard D; de Pee, Saskia; Kraemer, Klaus; Sun, Kai; Thorne-Lyman, Andrew; Moench-Pfanner, Regina; Sari, Mayang; Akhter, Nasima; Bloem, Martin W

2009-07-01

In developing countries, poor families in urban slums often do not receive municipal services including water. The objectives of our study were to characterize families who purchased drinking water and to examine the relation between purchasing drinking water and child morbidity and mortality in urban slums of Indonesia, using data collected between 1999 and 2003. Of 143,126 families, 46.8% purchased inexpensive drinking water from street vendors, 47.4% did not purchase water, i.e., had running or spring/well water within household, and 5.8% purchased more expensive water in the previous 7 days. Families that purchased inexpensive drinking water had less educated parents, a more crowded household, a father who smoked, and lower socioeconomic level compared with the other families. Among children of families that purchased inexpensive drinking water, did not purchase drinking water, or purchased more expensive water, the prevalence was, respectively, for diarrhea in last 7 days (11.2%, 8.1%, 7.7%), underweight (28.9%, 24.1%, 24.1%), stunting (35.6%, 30.5%, 30.5%), wasting (12.0%, 10.5%, 10.9%), family history of infant mortality (8.0%, 5.6%, 5.1%), and of under-five child mortality (10.4%, 7.1%, 6.4%) (all P<0.0001). Use of inexpensive drinking water was associated with under-five child mortality (Odds Ratio [O.R.] 1.32, 95% Confidence Interval [C.I.] 1.20-1.45, P<0.0001) and diarrhea (O.R. 1.43, 95% C.I. 1.29-1.60, P<0.0001) in multivariate logistic regression models, adjusting for potential confounders. Purchase of inexpensive drinking water was common and associated with greater child malnutrition, diarrhea, and infant and under-five child mortality in the family. Greater efforts must be made to ensure access to safe drinking water, a basic human right and target of the Millennium Development Goals, in urban slums.

The impact of antenatal care, iron-folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh.

PubMed

Abir, Tanvir; Ogbo, Felix Akpojene; Stevens, Garry John; Page, Andrew Nicolas; Milton, Abul Hasnat; Agho, Kingsley Emwinyore

2017-01-01

Appropriate antenatal care (ANC) is an important preventive public health intervention to ensure women's and newborn health outcomes. The study aimed to investigate the impact of ANC, iron-folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh. A cross-sectional study of three datasets from the Bangladesh Demographic and Health Surveys for the years 2004, 2007 and 2011 were pooled and used for the analyses. A total weighted sample of 16,721 maternal responses (5,364 for 2004; 4,872 for 2007 and 6,485 for 2011) was used. Multivariate logistic models that adjusted for cluster and sampling weights were used to examine the impact of ANC, IFA supplementation and TT vaccination during pregnancy on the death of a child aged 0-28 days (neonatal), 1-11 months (post-neonatal) and 12-59 months (child). Multivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had ANC [Odds Ratio (OR) = 0.60, 95% confidence interval (95% CI): 0.43-0.85], IFA supplementation [OR = 0.66, 95% CI: (0.45-0.98)] and ≥2 TT vaccinations (OR = 0.43, 95% CI: 0.49-0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51-0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48-0.94) and ≥2 TT vaccinations (OR = 0.50, 95% CI: 0.36-0.69). When combined, TT vaccination with IFA supplementation, and TT vaccination without IFA supplementation were protective across all groups. The study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh. The findings suggest that considerable gains in improving child survival could be achieved through ensuring universal coverage of ANC, promoting TT vaccination during pregnancy and IFA supplementation among pregnant women in Bangladesh.

Adult education and child mortality in India: the influence of caste, household wealth, and urbanization.

PubMed

Singh-Manoux, Archana; Dugravot, Aline; Smith, George Davey; Subramanyam, Malavika; Subramanian, S V

2008-03-01

Although socioeconomic position is generally found to be related to health, the associations can be different for different measures of socioeconomic position. We examined the association between adult education and child mortality, and the influence of other socioeconomic markers (caste, household wealth, and urbanization) on this association. Data were drawn from the 1998-1999 Indian National Family Health Survey, conducted in 26 states and comprising 66,367 children age 5 years or under. Adult education, for the head of household and spouse, was categorized into 0, 1-8, and 9 or more years of schooling. We used logistic regression to estimate associations between education and child mortality in analysis adjusted for other socioeconomic markers. Effect modification by caste, household wealth, and urbanization was assessed by fitting an interaction term with education. Compared with those who had no education, 9 or more years of education for the head of household and for the spouse were associated with lower child mortality (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.48-0.62 and OR = 0.44; 95% CI = 0.36-0.54, respectively) in analyses adjusted for age, sex, and state of residence. Further adjustments for caste and urbanization attenuated these associations slightly; when adjustments were made for household wealth the associations were attenuated more substantially. Nevertheless, in fully adjusted models, 9 or more years of education for the head of household (OR = 0.81; 95% CI = 0.70-0.93) and the spouse (OR = 0.75; 95% CI = 0.60-0.94) remained associated with lower child mortality. There was no effect modification of this association by caste, household wealth, and urbanization. Adult education has a protective association with child mortality in India. Caste, household wealth, and urbanization do not modify or completely attenuate this association.

Maternal education is associated with reduced female disadvantages in under-five mortality in sub-Saharan Africa and southern Asia.

PubMed

Monden, Christiaan W S; Smits, Jeroen

2013-02-01

The male:female (M:F) mortality ratio for under-five mortality varies considerably across and within societies. Maternal education has been linked to better outcomes for girls, but the evidence is mixed. We examined how the M:F ratio for under-five mortality varies by maternal education in sub-Saharan Africa and southern Asia. We used recent Demographic and Health Surveys from 31 sub-Saharan African and 4 southern Asian countries. M:F mortality ratios were determined using information on 49 769 deaths among 521 551 children. We estimate M:F ratios for under-five (month 0-59), neonatal (month 0), post-neonatal (month 1-11) and child mortality (month 12-59) by maternal education while controlling for demographic and household characteristics. M:F ratios for under-five mortality and child mortality are compared with more 'gender neutral' thresholds (of 1.25 and 1.17, respectively) estimated on the basis of the Human Mortality Database. In sub-Saharan Africa, the M:F ratio for under-five mortality is 1.09 [95% confidence interval (CI) 1.06-1.13] among non-educated mothers, 1.14 (95% CI 1.09-1.19) among mothers with some primary education and 1.25 (95% CI 1.16-1.34) among mothers with some secondary or more education. For southern Asia, the ratios are 0.88 (95% CI 0.82-0.95), 1.10 (95% CI 0.97-1.25) and 1.13 (95% CI 1.02-1.26), respectively. The M:F ratio for child mortality also shows an educational gradient in both regions, with the M:F ratio being lower among non-educated mothers. In southern Asia, the M:F ratio for child mortality is particularly low among mothers with no education, M:F ratio = 0.54 (95% CI 0.41-0.72). Among mothers with more education, the difference in the mortality chances of boys and girls more closely resembles a 'gender neutral' situation than among women with no or little education. Girls benefit both in absolute and relative terms from having a more educated mother.

Association of Urban Slum Residency with Infant Mortality and Child Stunting in Low and Middle Income Countries

PubMed Central

Kyu, Hmwe Hmwe; Shannon, Harry S.; Georgiades, Katholiki; Boyle, Michael H.

2013-01-01

This study aimed to (i) examine the contextual influences of urban slum residency on infant mortality and child stunting over and above individual and household characteristics and (ii) identify factors that might modify any adverse effects. We obtained data from Demographic and Health Surveys conducted in 45 countries between 2000 and 2009. The respondents were women (15–49 years) and their children (0–59 months). Results showed that living in a slum neighborhood was associated with infant mortality (OR = 1.34, 95% CI = 1.15–1.57) irrespective of individual and household characteristics and this risk was attenuated among children born to women who had received antenatal care from a health professional (OR = 0.79, 95% CI = 0.63–0.99). Results also indicated that increasing child age exacerbated the risk for stunting associated with slum residency (OR = 1.19, 95% CI = 1.16–1.23). The findings suggest that improving material circumstances in urban slums at the neighborhood level as well as increasing antenatal care coverage among women living in these neighborhoods could help reduce infant mortality and stunted child growth. The cumulative impact of long-term exposure to slum neighborhoods on child stunting should be corroborated by future studies. PMID:24151612

Association of urban slum residency with infant mortality and child stunting in low and middle income countries.

PubMed

Kyu, Hmwe Hmwe; Shannon, Harry S; Georgiades, Katholiki; Boyle, Michael H

2013-01-01

This study aimed to (i) examine the contextual influences of urban slum residency on infant mortality and child stunting over and above individual and household characteristics and (ii) identify factors that might modify any adverse effects. We obtained data from Demographic and Health Surveys conducted in 45 countries between 2000 and 2009. The respondents were women (15-49 years) and their children (0-59 months). Results showed that living in a slum neighborhood was associated with infant mortality (OR = 1.34, 95% CI = 1.15-1.57) irrespective of individual and household characteristics and this risk was attenuated among children born to women who had received antenatal care from a health professional (OR = 0.79, 95% CI = 0.63-0.99). Results also indicated that increasing child age exacerbated the risk for stunting associated with slum residency (OR = 1.19, 95% CI = 1.16-1.23). The findings suggest that improving material circumstances in urban slums at the neighborhood level as well as increasing antenatal care coverage among women living in these neighborhoods could help reduce infant mortality and stunted child growth. The cumulative impact of long-term exposure to slum neighborhoods on child stunting should be corroborated by future studies.

Social, economic, and political factors in progress towards improving child survival in developing nations.

PubMed

Lykens, Kristine; Singh, Karan P; Ndukwe, Elewichi; Bae, Sejong

2009-01-01

Child mortality is a persistent health problem faced by developing nations. In 2000 the United Nations (UN) established a set of high priority goals to address global problems of poverty and health, the Millennium Development Goals, which address extreme poverty, hunger, primary education, child mortality, maternal health, infectious diseases, environmental sustainability, and partnerships for development. Goal 4 aims to reduce by two thirds, between 2000 and 2015, the under-five mortality rate in developing countries. In sub-Saharan Africa from 2000 to 2006 these rates have only been reduced from 167 per 1,000 live births to 157, and 27 nations in this region have made no progress towards the goal. A country-specific database was developed from the UN Millennium Development Goal tracking project and other international sources which include age distribution, under-nutrition, per capita income, government expenditures on health, external resources for health, civil liberties, and political rights. A multiple regression analysis examined the extent to which these factors explain the variance in child mortality rates in developing countries. Nutrition, external resources, and per capita income were shown to be significant factors in child survivability. Policy options include developed countries' renewed commitment of resources, and developing nations' commitments towards governance, development, equity, and transparency.

Report examines links among women's equality, smaller families, healthier children.

PubMed

1997-06-01

This article reports on a new study by Nancy Riley about the relationship between gender equality and fertility and mortality declines in developing countries. Findings indicate that mortality and fertility has declined in countries without gender equality. Fertility and child mortality decline is related to women's educational status and employment. Riley argues that women's power to make decisions about health care, contraception, and the timing and number of children, if affected by education and paid employment, is more likely to lower mortality and fertility. Women's power may decline in countries where women's education and employment are advanced, but their role in society remains that of mothers. All developing countries showed a relationship between the amount of education and family size and child health. Fertility tends to be lowest among highly educated women. However, women's education has a stronger effect on child health and mortality. Maternal education also affects child nutritional status. Women's education offers women the option of job opportunities and new values or ideas. Women's employment may result in increased resources and status or in poverty and heavy physical labor. Societal views of women's work may reflect an increased self-worth for working women or lower status or the failure of a husband to adequately provide for family welfare. The key to the impact of women's employment is whether work becomes a way to achieve greater power for women in decision making about child welfare and family planning. Employment outside the home educates. In most countries, women who worked for cash had fewer children, but differences in fertility between working and nonworking women range from small to large. Higher income for Nigerian women means more children. Women's work also has inconsistent effects on child health.

Gender-Based Disparities in Infant and Child Mortality Based on Maternal Exposure to Spousal Violence

PubMed Central

Silverman, Jay G.; Decker, Michele R.; Cheng, Debbie M.; Wirth, Kathleen; Saggurti, Niranjan; McCauley, Heather L.; Falb, Kathryn L.; Donta, Balaiah; Raj, Anita

2014-01-01

Objectives To examine associations between intimate partner violence (IPV) against Indian women and risk of death among their infants and children, as well as related gender-based disparities. Design Analyses of nationally representative data to estimate adjusted hazard ratios (aHRs) and attributable risks for infant and child mortality based on child gender and on IPV against mothers. Setting India. Participants Women aged 15 to 49 years (n=59 467) across all 29 Indian states participating in the Indian National Family Health Survey 3 provided information about 158 439 births and about infant and child mortality occurring during the 20 years before the survey. Main Outcome Measures Maternal IPV and infant and child (<5 years) mortality among boy vs girl children. Results Infant mortality was greater among infants whose mothers experienced IPV (79.2 of 1000 births) vs those whose mothers did not experience IPV (59.1 of 1000 births) (aHR, 1.09; 95% confidence interval [CI], 1.03–1.15); this effect was significant only for girls (1.15; 1.07–1.24; for boys, 1.04; 0.97–1.11). Child mortality was also greater among children whose mothers experienced IPV (103.6 of 1000 births) vs those whose mothers did not experience IPV (74.8 per 1000 births) (aHR, 1.10; 95% CI, 1.05–1.15); again, this effect was significant only for girls (1.14; 1.07–1.21; for boys, 1.05; 0.99–1.12). An estimated 58 021 infant girl deaths and 89 264 girl child deaths were related to spousal violence against wives annually, or approximately 1.2 million female infant deaths and 1.8 million girl deaths in India between December 1985 and August 2005. Conclusion Intimate partner violence against women should be considered an urgent priority within programs and policies aimed at maximizing survival of children in India, particularly those attempting to increase the survival of girls 5 years and younger. PMID:21199976

Child Mortality Estimation: Accelerated Progress in Reducing Global Child Mortality, 1990–2010

PubMed Central

Hill, Kenneth; You, Danzhen; Inoue, Mie; Oestergaard, Mikkel Z.; Hill, Kenneth; Alkema, Leontine; Cousens, Simon; Croft, Trevor; Guillot, Michel; Pedersen, Jon; Walker, Neff; Wilmoth, John; Jones, Gareth

2012-01-01

Monitoring development indicators has become a central interest of international agencies and countries for tracking progress towards the Millennium Development Goals. In this review, which also provides an introduction to a collection of articles, we describe the methodology used by the United Nations Inter-agency Group for Child Mortality Estimation to track country-specific changes in the key indicator for Millennium Development Goal 4 (MDG 4), the decline of the under-five mortality rate (the probability of dying between birth and age five, also denoted in the literature as U5MR and 5 q 0). We review how relevant data from civil registration, sample registration, population censuses, and household surveys are compiled and assessed for United Nations member states, and how time series regression models are fitted to all points of acceptable quality to establish the trends in U5MR from which infant and neonatal mortality rates are generally derived. The application of this methodology indicates that, between 1990 and 2010, the global U5MR fell from 88 to 57 deaths per 1,000 live births, and the annual number of under-five deaths fell from 12.0 to 7.6 million. Although the annual rate of reduction in the U5MR accelerated from 1.9% for the period 1990–2000 to 2.5% for the period 2000–2010, it remains well below the 4.4% annual rate of reduction required to achieve the MDG 4 goal of a two-thirds reduction in U5MR from its 1990 value by 2015. Thus, despite progress in reducing child mortality worldwide, and an encouraging increase in the pace of decline over the last two decades, MDG 4 will not be met without greatly increasing efforts to reduce child deaths. PMID:22952441

Child mortality inequalities across Rwanda districts: a geoadditive continuous-time survival analysis.

PubMed

Niragire, François; Achia, Thomas N O; Lyambabaje, Alexandre; Ntaganira, Joseph

2017-05-11

Child survival programmes are efficient when they target the most significant and area-specific factors. This study aimed to assess the key determinants and spatial variation of child mortality at the district level in Rwanda. Data from the 2010 Rwanda Demographic and Health Survey were analysed for 8817 live births that occurred during five years preceding the survey. Out of the children born, 433 had died before survey interviews were carried out. A full Bayesian geo-additive continuous-time hazard model enabled us to maximise data utilisation and hence improve the accuracy of our estimates. The results showed substantial district- level spatial variation in childhood mortality in Rwanda. District-specific spatial characteristics were particularly associated with higher death hazards in two districts: Musanze and Nyabihu. The model estimates showed that there were lower death rates among children from households of medium and high economic status compared to those from low-economic status households. Factors, such as four antenatal care visits, delivery at a health facility, prolonged breastfeeding and mothers younger than 31 years were associated with lower child death rates. Long preceding birth intervals were also associated with fewer hazards. For these reasons, programmes aimed at reducing child mortality gaps between districts in Rwanda should target maternal factors and take into consideration district-specific spatial characteristics. Further, child survival gains require strengthening or scaling-up of existing programmes pertaining to access to, and utilisation of maternal and child health care services as well as reduction of the household gap in the economic status.

Poverty and child (0-14 years) mortality in the USA and other Western countries as an indicator of "how well a country meets the needs of its children" (UNICEF).

PubMed

Pritchard, Colin; Williams, Richard

2011-01-01

Children's (0-14 years) mortality rates in the USA and 19 Western countries (WCs) were examined in the context of a nation-specific measure of relative poverty and the Gross Domestic Product Health Expenditure (GDPHE) of countries to compare the effectiveness and efficiency of health care systems "to meet the needs of its children" (UNICEF). World Health Organisation child mortality rates per million were analysed for 1979-1981 and 2003-2005 to determine any significant differences between the USA and the other WCs over these periods. Child mortality rates are correlated with all countries GDPHE and 'relative poverty', defined by 'Income Inequalities', i.e., the gap between top and bottom 20% of incomes. Outputs: The mortality rate of every country fell substantially ranging from falls of 46% in the USA to 78% in Portugal. The highest current mortality rates are: USA, 2436 per million (pm), New Zealand 2105 pm, Portugal 1929 pm, Canada 1877 pm and the UK 1834 pm; the lowest are: Japan 1073 pm and Sweden 1075 pm, Finland 1193 pm and Norway 1200 pm. A total of 16 countries rates fell significantly more than the USA over these periods. Inputs: The USA had the greatest GDPHE and widest Income Inequality gap. There was no significant correlation between GDPHE and mortality but highly significant correlations with children's deaths and income inequalities. The five widest income inequality countries had the six worst rates, the narrowest four had the lowest. Despite major improvements in every WC, based upon financial inputs and child mortality outputs, the USA health care system appears the least efficient and effective in "meeting the needs of its children".

The decline in child mortality: a reappraisal.

PubMed Central

Ahmad, O. B.; Lopez, A. D.; Inoue, M.

2000-01-01

The present paper examines, describes and documents country-specific trends in under-five mortality rates (i.e., mortality among children under five years of age) in the 1990s. Our analysis updates previous studies by UNICEF, the World Bank and the United Nations. It identifies countries and WHO regions where sustained improvement has occurred and those where setbacks are evident. A consistent series of estimates of under-five mortality rate is provided and an indication is given of historical trends during the period 1950-2000 for both developed and developing countries. It is estimated that 10.5 million children aged 0-4 years died in 1999, about 2.2 million or 17.5% fewer than a decade earlier. On average about 15% of newborn children in Africa are expected to die before reaching their fifth birthday. The corresponding figures for many other parts of the developing world are in the range 3-8% and that for Europe is under 2%. During the 1990s the decline in child mortality decelerated in all the WHO regions except the Western Pacific but there is no widespread evidence of rising child mortality rates. At the country level there are exceptions in southern Africa where the prevalence of HIV is extremely high and in Asia where a few countries are beset by economic difficulties. The slowdown in the rate of decline is of particular concern in Africa and South-East Asia because it is occurring at relatively high levels of mortality, and in countries experiencing severe economic dislocation. As the HIV/AIDS epidemic continues in Africa, particularly southern Africa, and in parts of Asia, further reductions in child mortality become increasingly unlikely until substantial progress in controlling the spread of HIV is achieved. PMID:11100613

Mortality of children under five and prevalence of newborn congenital anomalies in relation to macroeconomic and socioeconomic factors in Latvia.

PubMed

Ebela, Inguna; Zile, Irisa; Zakis, Aleksandrs; Folkmanis, Valdis; Rumba-Rozenfelde, Ingrida

2011-01-01

Mortality of infants and children younger than 5 years is a globally recognized and broad national welfare indicator. Scientific literature has data on the correlation of mortality indicators with macroeconomic indicators. It is important to study the associations between prevalence and mortality indicators and socioeconomic factors, since deaths from congenital anomalies account for approximately 25%-30% of all deaths in infancy. The aim of the study was to analyze the overall trend in mortality of infants and young children aged 0 to 4 years in relation to macroeconomic factors in Latvia and prevalence of congenital anomalies in newborns in relation to socioeconomic factors. The Newborns' Register and Causes of Death Register were used as data sources; data on specific socioeconomic factors were retrieved from the Central Statistics Office. The results of the study show a strong correlation between mortality in children younger than 5 years and gross domestic product, as well as health budget in LVL per capita and the national unemployment level. The average decrease in infant mortality from congenital anomalies in Latvia was found to be 6.8 cases per 100,000 live births. There is a strong correlation between child mortality and socioeconomic situation in the country. There is a need to analyze the data on child mortality in a transnational context on a regular basis and studying the correlations between child mortality indicators and socioeconomic indicators and health care management parameters.

Social Factors Influencing Child Health in Ghana

PubMed Central

Quansah, Emmanuel; Ohene, Lilian Akorfa; Norman, Linda; Mireku, Michael Osei; Karikari, Thomas K.

2016-01-01

Objectives Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals’ target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal. Methods ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review. Results Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence), family income (wealth/poverty) and high dependency (multiparousity). These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices. Conclusions Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother’s health knowledge is emphasised. PMID:26745277

Socioeconomic Determinants of the Utilization of Antenatal Care and Child Vaccination in India.

PubMed

Zuhair, Mohd; Roy, Ram Babu

2017-11-01

Antenatal care and child vaccination services are adopted worldwide to reduce the risk of child mortality, maternal mortality, and burden of infectious diseases. This article examines the effect of socioeconomic factors on the utilization of antenatal care and child vaccination services in India. The generalized linear model has been used along with the Indian National Family Health Survey data for the period 2005-2006. The analysis shows that the health insurance plan has a significant effect on the use of antenatal care but not in the child vaccination. Furthermore, there is inequality in the utilization of antenatal care as well as child vaccination services and it is positively related to the wealth. The study suggests that there is a need to improve the socioeconomic status of the financially weaker section of the society for improving the use of child and maternal care services.

Risk of Bacterial Infection in Patients With Cirrhosis and Acute Variceal Hemorrhage, Based on Child-Pugh Class, and Effects of Antibiotics.

PubMed

Tandon, Puneeta; Abraldes, Juan G; Keough, Adam; Bastiampillai, Ravin; Jayakumar, Saumya; Carbonneau, Michelle; Wong, Eric; Kao, Dina; Bain, Vince G; Ma, Mang

2015-06-01

Antibiotics frequently are overused and are associated with serious adverse events in patients with cirrhosis. However, these drugs are recommended for all patients presenting with acute variceal hemorrhage (AVH). We investigated whether patients should be stratified for antibiotic prophylaxis based on Child-Pugh scores, to estimate risks of bacterial infection, rebleeding, and mortality, and whether antibiotics have equal effects on patients of all Child-Pugh classes. We performed a sensitivity analysis using model for end-stage liver disease (MELD) scores. In a retrospective study, we analyzed data from 381 adult patients with cirrhosis and AVH (70% men; mean age, 56 y), admitted from 2000 through 2009 to 2 tertiary care hospitals in Edmonton, Alberta, Canada. We excluded patients with bacterial infection on the day of AVH. The association between antibiotic prophylaxis and outcomes was adjusted by liver disease severity and by a propensity score. The patients included in the study had mean MELD scores of 16, and 54% received antibiotic prophylaxis. Overall, antibiotic therapy was associated with lower risks of infection (adjusted odds ratio, 0.37; 95% confidence interval, 0.91-0.74) and mortality (adjusted odds ratio, 0.63; 95% confidence interval, 0.31-1.29). Among patients categorized as Child-Pugh class A given antibiotics, only 2% developed infections and the mortality rate was 0.4%. Among patients categorized as Child-Pugh class B given antibiotics, 6% developed infections, compared with 14% of patients who did not receive antibiotics; antibiotics did not affect mortality. Administration of antibiotics to patients categorized as Child-Pugh class C reduced infections and mortality by approximately 50%, compared with patients who did not receive antibiotics. MELD scores were not as useful as Child-Pugh class in identifying patients at risk for infection. Based on a retrospective analysis of patients with cirrhosis and AVH, those categorized as Child-Pugh class A had lower rates of bacterial infection and lower mortality rates in the absence of antibiotic prophylaxis than patients categorized as classes B or C. The recommendation for routine antibiotic prophylaxis for this subgroup requires further evaluation. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Fertility transition and adverse child sex ratio in districts of India.

PubMed

Mohanty, Sanjay K; Rajbhar, Mamta

2014-11-01

Demographic research in India over the last two decades has focused extensively on fertility change and gender bias at the micro-level, and less has been done at the district level. Using data from the Census of India 1991-2011 and other sources, this paper shows the broad pattern of fertility transition and trends in the child sex ratio in India, and examines the determinants of the child sex ratio at the district level. During 1991-2011, while the Total Fertility Rate (TFR) declined by 1.2 children per woman, the child sex ratio fell by 30 points in the districts of India. However, the reduction in fertility was slower in the high-fertility compared with the low-fertility districts. The gender differential in under-five mortality increased in many districts of India over the study period. The decline in the child sex ratio was higher in the transitional compared with the low-fertility districts. The transitional districts are at higher risk of a low child sex ratio due to an increased gender differential in mortality and increase in the practice of sex-selective abortions. The sex ratio at birth and gender differential in mortality explains one-third of the variation, while region alone explains a quarter of the variation in the child sex ratio in the districts of India.

Effect of home visiting by nurses on maternal and child mortality: results of a 2-decade follow-up of a randomized clinical trial.

PubMed

Olds, David L; Kitzman, Harriet; Knudtson, Michael D; Anson, Elizabeth; Smith, Joyce A; Cole, Robert

2014-09-01

Mothers and children living in adverse contexts are at risk of premature death. To determine the effect of prenatal and infant/toddler nurse home visiting on maternal and child mortality during a 2-decade period (1990-2011). A randomized clinical trial was designed originally to assess the home visiting program's effect on pregnancy outcomes and maternal and child health through child age 2 years. The study was conducted in a public system of obstetric and pediatric care in Memphis, Tennessee. Participants included primarily African American women and their first live-born children living in highly disadvantaged urban neighborhoods, who were assigned to 1 of 4 treatment groups: treatment 1 (transportation for prenatal care [n = 166]), treatment 2 (transportation plus developmental screening for infants and toddlers [n = 514]), treatment 3 (transportation plus prenatal/postpartum home visiting [n = 230]), and treatment 4 (transportation, screening, and prenatal, postpartum, and infant/toddler home visiting [n = 228]). Treatments 1 and 3 were included originally to increase statistical power for testing pregnancy outcomes. For determining mortality, background information was available for all 1138 mothers assigned to all 4 treatments and all but 2 live-born children in treatments 2 and 4 (n = 704). Inclusion of children in treatments 1 and 3 was not possible because background information was missing on too many children. Nurses sought to improve the outcomes of pregnancy, children's health and development, and mothers' health and life-course with home visits beginning during pregnancy and continuing through child age 2 years. All-cause mortality in mothers and preventable-cause mortality in children (sudden infant death syndrome, unintentional injury, and homicide) derived from the National Death Index. The mean (SE) 21-year maternal all-cause mortality rate was 3.7% (0.74%) in the combined control group (treatments 1 and 2), 0.4% (0.43%) in treatment 3, and 2.2% (0.97%) in treatment 4. The survival contrast of treatments 1 and 2 combined with treatment 3 was significant (P = .007); the contrast of treatments 1 and 2 combined with treatment 4 was not significant (P = .19), and the contrast of treatments 1 and 2 combined with treatments 3 and 4 combined was significant (post hoc P = .008). At child age 20 years, the preventable-cause child mortality rate was 1.6% (0.57%) in treatment 2 and 0.0% (SE not calculable) in treatment 4; the survival contrast was significant (P = .04). Prenatal and infant/toddler home visitation by nurses is a promising means of reducing all-cause mortality among mothers and preventable-cause mortality in their first-born children living in highly disadvantaged settings. clinicaltrials.gov Identifier: NCT00708695.

Infant mortality in the Marshall Islands.

PubMed

Levy, S J; Booth, H

1988-12-01

Levy and Booth present previously unpublished infant mortality rates for the Marshall Islands. They use an indirect method to estimate infant mortality from the 1973 and 1980 censuses, then apply indirect and direct methods of estimation to data from the Marshall Islands Women's Health Survey of 1985. Comparing the results with estimates of infant mortality obtained from vital registration data enables them to estimate the extent of underregistration of infant deaths. The authors conclude that 1973 census appears to be the most valid information source. Direct estimates from the Women's Health Survey data suggest that infant mortality has increased since 1970-1974, whereas the indirect estimates indicate a decreasing trend in infant mortality rates, converging with the direct estimates in more recent years. In view of increased efforts to improve maternal and child health in the mid-1970s, the decreasing trend is plausible. It is impossible to estimate accurately infant mortality in the Marshall Islands during 1980-1984 from the available data. Estimates based on registration data for 1975-1979 are at least 40% too low. The authors speculate that the estimate of 33 deaths per 1000 live births obtained from registration data for 1984 is 40-50% too low. In round figures, a value of 60 deaths per 1000 may be taken as the final estimate for 1980-1984.

Child Mortality, Women's Status, Economic Dependency, and State Strength: A Cross-National Study of Less Developed Countries.

ERIC Educational Resources Information Center

Shen, Ce; Williamson, John B.

1997-01-01

Data from 86 developing countries suggest that foreign investment and debt dependency have adverse indirect effects on child mortality--effects mediated by variables linked to industrialism theory and gender stratification theory: women's education, health, and reproductive autonomy and rate of economic growth. State strength was related to lower…

Family Structure and Child Mortality in Sub-Saharan Africa: Cross-National Effects of Polygyny

ERIC Educational Resources Information Center

Omariba, D. Walter Rasugu; Boyle, Michael H.

2007-01-01

This study applies multilevel logistic regression to Demographic and Health Survey data from 22 sub-Saharan African countries to examine whether the relationship between child mortality and family structure, with a specific emphasis on polygyny, varies cross-nationally and over time. Hypotheses were developed on the basis of competing theories on…

Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: a Countdown to 2015 country case study.

PubMed

Keats, Emily C; Ngugi, Anthony; Macharia, William; Akseer, Nadia; Khaemba, Emma Nelima; Bhatti, Zaid; Rizvi, Arjumand; Tole, John; Bhutta, Zulfiqar A

2017-08-01

Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015. We did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 to 2015, using data from nationally representative Demographic Health Surveys done between 1989 and 2014. For comparison, we used modelled mortality estimates from the UN Inter-Agency Groups for Child and Maternal Mortality Estimation. We estimated time trends for key RMNCH indicators, as defined by Countdown to 2015, at both the national and the subnational level, and used linear regression methods to understand the determinants of change in intervention coverage during the past decade. Finally, we used the Lives Saved Tool (LiST) to model the effect of intervention scale-up by 2030. After an increase in mortality between 1990 and 2003, there was a reversal in all mortality trends from 2003 onwards, although progress was not substantial enough for Kenya to achieve Millennium Development Goal targets 4 or 5. Between 1990 and 2015, maternal mortality declined at half the rate of under-5 mortality, and changes in neonatal mortality were even slower. National-level trends in intervention coverage have improved, although some geographical inequities remain, especially for counties comprising the northeastern, eastern, and northern Rift Valley regions. Disaggregation of intervention coverage by wealth quintile also revealed wide inequities for several health-systems-based interventions, such as skilled birth assistance. Multivariable analyses of predictors of change in family planning, skilled birth assistance, and full vaccination suggested that maternal literacy and family size are important drivers of positive change in key interventions across the continuum of care. LiST analyses clearly showed the importance of quality of care around birth for maternal and newborn survival. Intensified and focused efforts are needed for Kenya to achieve the RMNCH targets for 2030. Kenya must build on its previous progress to further reduce mortality through the widespread implementation of key preventive and curative interventions, especially those pertaining to labour, delivery, and the first day of life. Deliberate targeting of the poor, least educated, and rural women, through the scale-up of community-level interventions, is needed to improve equity and accelerate progress. US Fund for UNICEF, Bill & Melinda Gates Foundation. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC-BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Trends and patterns of modern contraceptive use and relationships with high-risk births and child mortality in Burkina Faso.

PubMed

Maïga, Abdoulaye; Hounton, Sennen; Amouzou, Agbessi; Akinyemi, Akanni; Shiferaw, Solomon; Baya, Banza; Bahan, Dalomi; Barros, Aluisio J D; Walker, Neff; Friedman, Howard

2015-01-01

In sub-Saharan Africa, few studies have stressed the importance of spatial heterogeneity analysis in modern contraceptive use and the relationships with high-risk births. This paper aims to analyse the association between modern contraceptive use, distribution of birth risk, and under-five child mortality at both national and regional levels in Burkina Faso. The last three Demographic and Health Surveys - conducted in Burkina Faso in 1998, 2003, and 2010 - enabled descriptions of differentials, trends, and associations between modern contraceptive use, total fertility rates (TFR), and factors associated with high-risk births and under-five child mortality. Multivariate models, adjusted by covariates of cultural and socio-economic background and contact with health system, were used to investigate the relationship between birth risk factors and modern contraceptive prevalence rates (mCPR). Overall, Burkina Faso's modern contraception level remains low (15.4% in 2010), despite significant increases during the last decade. However, there are substantial variations in mCPR by region, and health facility contact was positively associated with mCPR increase. Women's fertility history and cultural and socio-economic background were also significant factors in predicting use of modern contraception. Low modern contraceptive use is associated with higher birth risks and increased child mortality. This association is stronger in the Sahel, Est, and Sud-Ouest regions. Even though all factors in high-risk births were associated with under-five mortality, it should be stressed that short birth spacing ranked as the highest risk in relation to mortality of children. Programmes that target sub-national differentials and leverage women's health system contacts to inform women about family planning opportunities may be effective in improving coverage, quality, and equity of modern contraceptive use. Improving the demand satisfied for modern contraception may result in a reduction in the percentage of women experiencing high-risk births and may also reduce child mortality.

Trends and patterns of modern contraceptive use and relationships with high-risk births and child mortality in Burkina Faso

PubMed Central

Maïga, Abdoulaye; Hounton, Sennen; Amouzou, Agbessi; Akinyemi, Akanni; Shiferaw, Solomon; Baya, Banza; Bahan, Dalomi; Barros, Aluisio J. D.; Walker, Neff; Friedman, Howard

2015-01-01

Background In sub-Saharan Africa, few studies have stressed the importance of spatial heterogeneity analysis in modern contraceptive use and the relationships with high-risk births. Objective This paper aims to analyse the association between modern contraceptive use, distribution of birth risk, and under-five child mortality at both national and regional levels in Burkina Faso. Design The last three Demographic and Health Surveys – conducted in Burkina Faso in 1998, 2003, and 2010 – enabled descriptions of differentials, trends, and associations between modern contraceptive use, total fertility rates (TFR), and factors associated with high-risk births and under-five child mortality. Multivariate models, adjusted by covariates of cultural and socio-economic background and contact with health system, were used to investigate the relationship between birth risk factors and modern contraceptive prevalence rates (mCPR). Results Overall, Burkina Faso's modern contraception level remains low (15.4% in 2010), despite significant increases during the last decade. However, there are substantial variations in mCPR by region, and health facility contact was positively associated with mCPR increase. Women's fertility history and cultural and socio-economic background were also significant factors in predicting use of modern contraception. Low modern contraceptive use is associated with higher birth risks and increased child mortality. This association is stronger in the Sahel, Est, and Sud-Ouest regions. Even though all factors in high-risk births were associated with under-five mortality, it should be stressed that short birth spacing ranked as the highest risk in relation to mortality of children. Conclusions Programmes that target sub-national differentials and leverage women's health system contacts to inform women about family planning opportunities may be effective in improving coverage, quality, and equity of modern contraceptive use. Improving the demand satisfied for modern contraception may result in a reduction in the percentage of women experiencing high-risk births and may also reduce child mortality. PMID:26562142

Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010.

PubMed

Bishai, David M; Cohen, Robert; Alfonso, Y Natalia; Adam, Taghreed; Kuruvilla, Shyama; Schweitzer, Julian

2016-01-01

From 1990-2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.

Violence against women increases the risk of infant and child mortality: a case-referent study in Nicaragua.

PubMed Central

Asling-Monemi, Kajsa; Peña, Rodolfo; Ellsberg, Mary Carroll; Persson, Lars Ake

2003-01-01

OBJECTIVE: To investigate the impact of violence against mothers on mortality risks for their offspring before 5 years of age in Nicaragua. METHODS: From a demographic database covering a random sample of urban and rural households in Le n, Nicaragua, we identified all live births among women aged 15-49 years. Cases were defined as those who had died before the age of 5 years, between January 1993 and June 1996. For each case, two referents, matched for sex and age at death, were selected from the database. A total of 110 mothers of the cases and 203 mothers of the referents were interviewed using a standard questionnaire covering mothers' experience of physical and sexual violence. The data were analysed for the risk associated with maternal experience of violence of infant and under-5 mortality. FINDINGS: A total of 61% of mothers of cases had a lifetime experience of physical and/or sexual violence compared with 37% of mothers of referents, with a significant association being found between such experiences and mortality among their offspring. Other factors associated with higher infant and under-5 mortality were mother's education (no formal education), age (older), and parity (multiparity). CONCLUSIONS: The results suggest an association between physical and sexual violence against mothers, either before or during pregnancy, and an increased risk of under-5 mortality of their offspring. The type and severity of violence was probably more relevant to the risk than the timing, and violence may impact child health through maternal stress or care-giving behaviours rather than through direct trauma itself. PMID:12640470

Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countries

PubMed Central

2011-01-01

Objective Few studies have examined the link between health system strength and important public health outcomes across nations. We examined the association between health system indicators and mortality rates. Methods We used mixed effects linear regression models to investigate the strength of association between outcome and explanatory variables, while accounting for geographic clustering of countries. We modelled infant mortality rate (IMR), child mortality rate (CMR), and maternal mortality rate (MMR) using 13 explanatory variables as outlined by the World Health Organization. Results Significant protective health system determinants related to IMR included higher physician density (adjusted rate ratio [aRR] 0.81; 95% Confidence Interval [CI] 0.71-0.91), higher sustainable access to water and sanitation (aRR 0.85; 95% CI 0.78-0.93), and having a less corrupt government (aRR 0.57; 95% CI 0.40-0.80). Out-of-pocket expenditures on health (aRR 1.29; 95% CI 1.03-1.62) were a risk factor. The same four variables were significantly related to CMR after controlling for other variables. Protective determinants of MMR included access to water and sanitation (aRR 0.88; 95% CI 0.82-0.94), having a less corrupt government (aRR 0.49; 95%; CI 0.36-0.66), and higher total expenditures on health per capita (aRR 0.84; 95% CI 0.77-0.92). Higher fertility rates (aRR 2.85; 95% CI: 2.02-4.00) were found to be a significant risk factor for MMR. Conclusion Several key measures of a health system predict mortality in infants, children, and maternal mortality rates at the national level. Improving access to water and sanitation and reducing corruption within the health sector should become priorities. PMID:22023970

Sex of First Child and Breast Cancer Survival in Young Women.

PubMed

Olson, Jon C; Bogdan, Gregory F; Tuthill, Robert W; Nasca, Philip C

2015-08-14

Two studies have reported that young women with breast cancer face increased risk of early mortality if their first child was male rather than female. An immunological mechanism has been suggested. We sought to confirm these results in a larger, historical cohort study of 223 parous women who were aged <45 years at breast cancer diagnosis during 1983-1987. Subjects were identified through the Maine Cancer Registry. Follow-up data were obtained from hospitals, physicians, and death certificates. Reproductive history data were obtained from the next of kin of the deceased women, birth certificates, physicians, hospitals, and lastly, subjects. With a 7-year follow-up, multivariate modeling found a lower mortality risk in women with a male first child (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.32-0.81, log-rank comparison). The survival advantage remained for at least 13 years in women with a male firstborn. Thus, previous studies were not confirmed. Mortality risk in young women with breast cancer is not increased by having borne a male first child rather than a female first child.

Maryland's Kids Count Factbook 1996.

ERIC Educational Resources Information Center

Advocates for Children and Youth, Baltimore, MD.

This Kids Count report details statewide trends in the well-being of Maryland's children. The statistical portrait is based on 14 indicators of child well being: (1) child poverty; (2) child support; (3) births to teens; (4) low birthweight infants; (5) infant mortality; (6) lead screening; (7) child abuse and neglect; (8) child death rate; (9)…

Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long-term mortality impact.

PubMed

Perry, Henry B; Rassekh, Bahie M; Gupta, Sundeep; Freeman, Paul A

2017-06-01

There is limited evidence about the long-term effectiveness of integrated community-based primary health care (CBPHC) in improving maternal, neonatal and child health. However, the interventions implemented and the approaches used by projects with such evidence can provide guidance for ending preventable child and maternal deaths by the year 2030. A database of 700 assessments of the effectiveness of CBPHC in improving maternal, neonatal and child health has been assembled, as described elsewhere in this series. A search was undertaken of these assessments of research studies, field project and programs (hereafter referred to as projects) with more than a single intervention that had evidence of mortality impact for a period of at least 10 years. Four projects qualified for this analysis: the Matlab Maternal Child Health and Family Planning (MCH-FP) P in Bangladesh; the Hôpital Albert Schweitzer in Deschapelles, Haiti; the Comprehensive Rural Health Project (CRHP) in Jamkhed, India; and the Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, India. These four projects have all been operating for more than 30 years, and they all have demonstrated reductions in infant mortality, 1- to 4-year mortality, or under-5 mortality for at least 10 years. They share a number of characteristics. Among the most notable of these are: they provide comprehensive maternal, child health and family planning services, they have strong community-based programs that utilize community health workers who maintain regular contact with all households, they have develop strong collaborations with the communities they serve, and they all have strong referral capabilities and provide first-level hospital care. The shared features of these projects provide guidance for how health systems around the world might improve their effectiveness in improving maternal, neonatal and child health. Strengthening these features will contribute to achieving the goal of ending preventable child and maternal deaths by the year 2030.

A Service evaluation of a hospital child death review process to elucidate understanding of contributory factors to child mortality and inform practice in the English National Health Service.

PubMed

Magnus, Daniel S; Schindler, Margrid B; Marlow, Robin D; Fraser, James I

2018-03-16

To describe a novel approach to hospital mortality meetings to elucidate understanding of contributory factors to child death and inform practice in the National Health Service. All child deaths were separately reviewed at a meeting attended by professionals across the healthcare pathway, and an assessment was made of contributory factors to death across domains intrinsic to the child, family and environment, parenting capacity and service delivery. Data were analysed from a centrally held database of records. All child deaths in a tertiary children's hospital between 1 April 2010 and 1 April 2013. Descriptive data summarising contributory factors to child deaths. 95 deaths were reviewed. In 85% cases, factors intrinsic to the child provided complete explanation for death. In 11% cases, factors in the family and environment and, in 5% cases, factors in parenting capacity, contributed to patient vulnerability. In 33% cases, factors in service provision contributed to patient vulnerability and in two patients provided complete explanation for death. 26% deaths were classified as potentially preventable and in those cases factors in service provision were more commonly identified than factors across other domains (OR: 4.89; 95% CI 1.26 to 18.9). Hospital child death review meetings attended by professionals involved in patient management across the healthcare pathway inform understanding of events leading to a child's death. Using a bioecological approach to scrutinise contributory factors the multidisciplinary team concluded most deaths occurred as a consequence of underlying illness. Although factors relating to service provision were commonly identified, they rarely provided a complete explanation for death. Efforts to reduce child mortality should be driven by an understanding of modifiable risk factors. Systematic data collection arising from a standardised approach to hospital reviews should be the basis for national mortality review processes and database development. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015.

PubMed

2016-10-08

Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Bill & Melinda Gates Foundation. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Measles Vaccination in the Presence or Absence of Maternal Measles Antibody: Impact on Child Survival

PubMed Central

Aaby, Peter; Martins, Cesário L.; Garly, May-Lill; Andersen, Andreas; Fisker, Ane B.; Claesson, Mogens H.; Ravn, Henrik; Rodrigues, Amabelia; Whittle, Hilton C.; Benn, Christine S.

2014-01-01

Background. Measles vaccine (MV) has a greater effect on child survival when administered in early infancy, when maternal antibody may still be present. Methods. To test whether MV has a greater effect on overall survival if given in the presence of maternal measles antibody, we reanalyzed data from 2 previously published randomized trials of a 2-dose schedule with MV given at 4–6 months and at 9 months of age. In both trials antibody levels had been measured before early measles vaccination. Results. In trial I (1993–1995), the mortality rate was 0.0 per 1000 person-years among children vaccinated with MV in the presence of maternal antibody and 32.3 per 1000 person-years without maternal antibody (mortality rate ratio [MRR], 0.0; 95% confidence interval [CI], 0–.52). In trial II (2003–2007), the mortality rate was 4.2 per 1000 person-years among children vaccinated in presence of maternal measles antibody and 14.5 per 1000 person-years without measles antibody (MRR, 0.29; 95% CI, .09–.91). Possible confounding factors did not explain the difference. In a combined analysis, children who had measles antibody detected when they received their first dose of MV at 4–6 months of age had lower mortality than children with no maternal antibody, the MRR being 0.22 (95% CI, .07–.64) between 4–6 months and 5 years. Conclusions. Child mortality in low-income countries may be reduced by vaccinating against measles in the presence of maternal antibody, using a 2-dose schedule with the first dose at 4–6 months (earlier than currently recommended) and a booster dose at 9–12 months of age. Clinical Trials Registration. NCT00168558. PMID:24829213

How Effective Are Public Health Education Programs, Unfettered Farm Markets and Single Sex Schools?

ERIC Educational Resources Information Center

Fox, Jonathan Franklin

2010-01-01

My dissertation examines the effectiveness of three policy choices in meeting socio-economic goals. The first analyzes the impact of public health education and poverty relief on child mortality in the early twentieth century, when infant and child mortality rates in the United States were startlingly high. During the 1920s, the rates dropped…

Water for Life: The Impact of the Privatization of Water Services on Child Mortality.

ERIC Educational Resources Information Center

Galiani, Sebastian; Gertler, Paul; Schargrodsky, Ernesto

2005-01-01

While most countries are committed to increasing access to safe water and thereby reducing child mortality, there is little consensus on how to actually improve water services. One important proposal under discussion is whether to privatize water provision. In the 1990s Argentina embarked on one of the largest privatization campaigns in the world,…

Determinants of childhood mortality in slums of Karachi, Pakistan.

PubMed

D'souza, R M; Bryant, J H

1999-01-01

Pakistan has an infant mortality rate (IMR) of 90.5/1000 live births, and the country's child mortality level of 117.5 is worse than in other South Asian countries. Rapid population growth combined with rural-to-urban migration has led to the creation of urban slums in which morbidity levels are usually higher than in rural populations. A study was conducted in January 1993 in 6 slums of Karachi where the Aga Khan University has operated primary health care programs since 1985. Researchers recorded the deaths of 347 children under age 5 years old due to diarrhea and acute respiratory infections (ARI) during 1989-93. 235 mothers of these children were interviewed. The following are discussed as risk factors for under-5 child mortality: the use of traditional healers, poor nutritional status, incomplete or no immunization, the quick change of healers, inappropriate child care arrangements, mother's literacy, who decides about outside treatment, short birth interval, bottle feeding, and nuclear family structure. Maternal autonomy, appropriate health-seeking behavior, and child-rearing processes identified in the study point to the need for intervention strategies which go beyond the usual primary health care initiatives and involve communities in developing social support systems for mothers.

Maternal, neonatal, and child health in southeast Asia: towards greater regional collaboration.

PubMed

Acuin, Cecilia S; Khor, Geok Lin; Liabsuetrakul, Tippawan; Achadi, Endang L; Htay, Thein Thein; Firestone, Rebecca; Bhutta, Zulfiqar A

2011-02-05

Although maternal and child mortality are on the decline in southeast Asia, there are still major disparities, and greater equity is key to achieve the Millennium Development Goals. We used comparable cross-national data sources to document mortality trends from 1990 to 2008 and to assess major causes of maternal and child deaths. We present inequalities in intervention coverage by two common measures of wealth quintiles and rural or urban status. Case studies of reduction in mortality in Thailand and Indonesia indicate the varying extents of success and point to some factors that accelerate progress. We developed a Lives Saved Tool analysis for the region and for country subgroups to estimate deaths averted by cause and intervention. We identified three major patterns of maternal and child mortality reduction: early, rapid downward trends (Brunei, Singapore, Malaysia, and Thailand); initially high declines (sustained by Vietnam but faltering in the Philippines and Indonesia); and high initial rates with a downward trend (Laos, Cambodia, and Myanmar). Economic development seems to provide an important context that should be coupled with broader health-system interventions. Increasing coverage and consideration of the health-system context is needed, and regional support from the Association of Southeast Asian Nations can provide increased policy support to achieve maternal, neonatal, and child health goals. Copyright © 2011 Elsevier Ltd. All rights reserved.

Water and sanitation infrastructure for health: The impact of foreign aid

PubMed Central

2010-01-01

Background The accessibility to improved water and sanitation has been understood as a crucial mechanism to save infants and children from the adverse health outcomes associated with diarrheal disease. This knowledge stimulated the worldwide donor community to develop a specific category of aid aimed at the water and sanitation sector. The actual impact of this assistance on increasing population access to improved water and sanitation and reducing child mortality has not been examined. Methods We performed a country-level analysis of the relationship between water and sanitation designated official development assistance (WSS-ODA) per capita, water and sanitation coverage, and infant and child mortality in low-income countries as defined by the World Bank. We focused our inquiry to aid effectiveness since the establishment of the Millennium Development Goals (MDGs). Results Access to improved water has consistently improved since 2002. Countries receiving the most WSS-ODA ranged from odds ratios of 4 to 18 times more likely than countries in the lowest tertile of assistance to achieve greater gains in population access to improved water supply. However, while there were modestly increased odds of sanitation access, these were largely non-significant. The countries with greatest gains in sanitation were 8-9 times more likely to have greater reductions in infant and child mortality. Conclusions Official development assistance is importantly impacting access to safe water, yet access to improved sanitation remains poor. This highlights the need for decision-makers to be more intentional with allocating WSS-ODA towards sanitation projects. PMID:20670447

Non-specific sex-differential effect of DTP vaccination may partially explain the excess girl child mortality in Ballabgarh, India.

PubMed

Krishnan, A; Srivastava, R; Dwivedi, P; Ng, N; Byass, P; Pandav, C S

2013-11-01

To test the hypothesis that a gender differential exists in the effect on child mortality of BCG, DTP, measles vaccine as administered under programme conditions in Ballabgarh HDSS area. All live births in 28 villages of Ballabgarh block in North India from 2006 to 2011 were followed until 31 December 2011 or 36 months of age whichever was earlier. The period of analysis was divided into four time periods based on eligibility for vaccines under the national immunisation schedule (BCG for tuberculosis, primary and booster doses of diphtheria-tetanus-pertussis and measles). Cox proportional hazards regression was used to assess the association between sex and risk of mortality by vaccination status using age as the timescale in survival analysis and adjusting for wealth index, access to health care, the presence of a health facility in the village, parental education, type of family, birth order of the child and year of birth. 702 deaths (332 boys and 370 girls) occurred among 12,142 children in the cohort in the 3 years of follow-up giving a cumulative mortality rate of 57.5 per 1000 live births with 35% excess girl child mortality. Age at vaccination for the four vaccines did not differ by sex. There was significant excess mortality among girls after immunisation with DTP, for both primary (HR 1.65; 95% CI:1.17-2.32) and DTPb (2.21; 1.24-3.93) vaccinations. No significant excess morality among girls was noted after exposure to BCG 1.06 (0.67-1.67) or measles 1.34 (0.85-2.12) vaccine. This study supports the contention that DTP vaccination is partially responsible for higher mortality among girls in this study population. © 2013 John Wiley & Sons Ltd.

Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China

PubMed Central

Wang, Yanping; Li, Xiaohong; Zhou, Maigeng; Luo, Shusheng; Liang, Juan; Liddell, Chelsea A; Coates, Matthew M; Gao, Yanqiu; Wang, Linhong; He, Chunhua; Kang, Chuyun; Liu, Shiwei; Dai, Li; Schumacher, Austin E; Fraser, Maya S; Wolock, Timothy M; Pain, Amanda; Levitz, Carly E; Singh, Lavanya; Coggeshall, Megan; Lind, Margaret; Li, Yichong; Li, Qi; Deng, Kui; Mu, Yi; Deng, Changfei; Yi, Ling; Liu, Zheng; Ma, Xia; Li, Hongtian; Mu, Dezhi; Zhu, Jun; Murray, Christopher J L; Wang, Haidong

2017-01-01

Summary Background In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012. Methods We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties. Findings In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates significantly faster than expected. Fast reduction in under-5 mortality rates have been recorded not only in the Han population, the dominant ethnic majority in China, but also in the minority populations. All top ten minority groups in terms of population sizes have experienced annual reductions in under-5 mortality rates faster than the MDG 4 target at 4·4%. Interpretation The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8·8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates. Funding National “Twelfth Five-Year” Plan for Science and Technology Support, National Health and Family Planning Commission of The People’s Republic of China, Program for Changjiang Scholars and Innovative Research Team in University, the National Institute on Aging, and the Bill & Melinda Gates Foundation. PMID:26510780

What can Pakistan do to address maternal and child health over the next decade?

PubMed

Bhutta, Zulfiqar A; Hafeez, Assad

2015-11-25

Pakistan faces huge challenges in meeting its international obligations and agreed Millennium Development Goal targets for reducing maternal and child mortality. While there have been reductions in maternal and under-5 child mortality, overall rates are barely above secular trends and neonatal mortality has not reduced much. Progress in addressing basic determinants, such as poverty, undernutrition, safe water, and sound sanitary conditions as well as female education, is unsatisfactory and, not surprisingly, population growth hampers economic growth and development across the country. The devolution of health to the provinces has created challenges as well as opportunities for action. This paper presents a range of actions needed for change within the health and social sectors, including primary care, social determinants, strategies to reach the unreached, and accountability.

Utility of local health registers in measuring perinatal mortality: A case study in rural Indonesia

PubMed Central

2011-01-01

Background Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. Methods A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Results Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Conclusions Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control, in conjunction with computerisation to strengthen register maintenance can provide routine local area measures of perinatal mortality for health policy, and monitoring of newborn care interventions. Similar efforts are required to strengthen routine health data in all developing countries, to guide planned progress towards reduction in the local, national and international burden from perinatal mortality. PMID:21410993

The resource curse and child mortality, 1961-2011.

PubMed

Wigley, Simon

2017-03-01

There is now an extensive literature on the adverse effect of petroleum wealth on the political, economic and social well-being of a country. In this study we examine whether the so-called resource curse extends to the health of children, as measured by under-five mortality. We argue that the type of revenue available to governments in petroleum-rich countries reduces their incentive to improve child health. Whereas the type of revenue available to governments in petroleum-poor countries encourages policies designed to improve child health. In order to test that line of argument we employ a panel of 167 countries (all countries with populations above 250,000) for the years 1961-2011. We find robust evidence that petroleum-poor countries outperform petroleum-rich countries when it comes to reducing under-five mortality. This suggests that governments in oil abundant countries often fail to effectively use the resource windfall at their disposal to improve child health. Copyright © 2017 Elsevier Ltd. All rights reserved.

Child Protection, Care and Education in Vietnam from Now up to the Year 2000.

ERIC Educational Resources Information Center

Son, Ngo Quang

1994-01-01

Provides an overview of child welfare and early childhood education programs in Vietnam, including statistics on infant mortality, child survival, vaccination ratios, birth weight trends, and rates of disease and disability. Describes government programs to promote child welfare; early childhood (creche) education; kindergarten; programs for…

Seasonal variation in child mortality in rural Guinea-Bissau.

PubMed

Nielsen, Bibi Uhre; Byberg, Stine; Aaby, Peter; Rodrigues, Amabelia; Benn, Christine Stabell; Fisker, Ane Baerent

2017-07-01

In many African countries, child mortality is higher in the rainy season than in the dry season. We investigated the effect of season on child mortality by time periods, sex and age in rural Guinea-Bissau. Bandim health project follows children under-five in a health and demographic surveillance system in rural Guinea-Bissau. We compared the mortality in the rainy season (June to November) between 1990 and 2013 with the mortality in the dry season (December to May) in Cox proportional hazards models providing rainy vs. dry season mortality rate ratios (r/d-mrr). Seasonal effects were estimated in strata defined by time periods with different frequency of vaccination campaigns, sex and age (<1 month, 1-11 months, 12-59 months). Verbal autopsies were interpreted using InterVa-4 software. From 1990 to 2013, overall mortality was declined by almost two-thirds among 81 292 children (10 588 deaths). Mortality was 51% (95% ci: 45-58%) higher in the rainy season than in the dry season throughout the study period. The seasonal difference increased significantly with age, the r/d-mrr being 0.94 (0.86-1.03) among neonates, 1.57 (1.46-1.69) in post-neonatal infants and 1.83 (1.72-1.95) in under-five children (P for same effect <0.001). According to the InterVa, malaria deaths were the main reason for the seasonal mortality difference, causing 50% of all deaths in the rainy season, but only if the InterVa included season of death, making the argument self-confirmatory. The mortality declined throughout the study, yet rainy season continued to be associated with 51% higher overall mortality. © 2017 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Fertility, infertility and child survival of Somali women.

PubMed

Omar, M M; Högberg, U; Bergström, B

1994-09-01

The relationship of reproductive patterns, some socio-economic factors and child survival was studied in 766 rural Somali women. A structured questionnaire was the method of data collection. Teenage marriage was the norm for the women, and divorce was very common. The mean number of live births was 5.2, and the mean number of surviving children was 3.7. 2/3 of the women aged 45+ had a parity of 6 or more, about one third had had at least one miscarriage and one fifth had experienced one stillbirth. Primary infertility was observed in 7% of the women aged 45+, while 20% were considered subfertile. Verbal autopsy showed that mortality was highest among infants and accounted for 63% of the child deaths. Major causes of death were neonatal tetanus, diarrhoea and respiratory diseases. Child survival and reproductive outcome ratios were found to be negatively related to the increasing age of the mother and parity. Divorce and widowhood were also found to be associated with low child survival.

Inequality of child mortality among ethnic groups in sub-Saharan Africa.

PubMed Central

Brockerhoff, M.; Hewett, P.

2000-01-01

Accounts by journalists of wars in several countries of sub-Saharan Africa in the 1990s have raised concern that ethnic cleavages and overlapping religious and racial affiliations may widen the inequalities in health and survival among ethnic groups throughout the region, particularly among children. Paradoxically, there has been no systematic examination of ethnic inequality in child survival chances across countries in the region. This paper uses survey data collected in the 1990s in 11 countries (Central African Republic, Côte d'Ivoire, Ghana, Kenya, Mali, Namibia, Niger, Rwanda, Senegal, Uganda, and Zambia) to examine whether ethnic inequality in child mortality has been present and spreading in sub-Saharan Africa since the 1980s. The focus was on one or two groups in each country which may have experienced distinct child health and survival chances, compared to the rest of the national population, as a result of their geographical location. The factors examined to explain potential child survival inequalities among ethnic groups included residence in the largest city, household economic conditions, educational attainment and nutritional status of the mothers, use of modern maternal and child health services including immunization, and patterns of fertility and migration. The results show remarkable consistency. In all 11 countries there were significant differentials between ethnic groups in the odds of dying during infancy or before the age of 5 years. Multivariate analysis shows that ethnic child mortality differences are closely linked with economic inequality in many countries, and perhaps with differential use of child health services in countries of the Sahel region. Strong and consistent results in this study support placing the notion of ethnicity at the forefront of theories and analyses of child mortality in Africa which incorporate social, and not purely epidemiological, considerations. Moreover, the typical advantage of relatively small, clearly defined ethnic groups, as compared to the majority in the national population, according to fundamental indicators of wellbeing--child survival, education, housing, and so forth--suggests that many countries in sub-Saharan Africa, despite their widespread poverty, are as marked by social inequality as are countries in other regions in the world. PMID:10686731

Mothers continuing bonds and ambivalence to personal mortality after the death of their child--an interpretative phenomenological analysis.

PubMed

Harper, Mairi; O'Connor, Rory; Dickson, Adele; O'Carroll, Ronan

2011-03-01

The main objective of this study was to identify how bereaved mothers describe their coping strategies in their own words. The literature on parental bereavement is sparse, and the present study aims to add to existing knowledge by eliciting the mothers' experiences covering a wide range of child ages including infants, younger children and adults. Semi-structured interviews were held with 13 bereaved mothers in the UK. Causes of death include accident, illness and suicide. The methodological approach was interpretative phenomenological analysis (IPA). This article reports two inter-related recurrent themes: (1) Continuing the bond with the deceased child and (2) Ambivalence to personal mortality. Participants reported that the relationship with their child was continued in a variety of ways, from tending to the grave and the child's remains, through linking objects or by establishing a symbolic representation of the child within their daily lives. All mothers talked openly about their own mortality, either demonstrating ambivalence about their own death, or expressing clear suicidal ideation. Death was seen as a release from living with the pain of loss. The presence of surviving siblings appeared to moderate suicidal ideation, but mothers expressed concerns about their ability to care adequately for other family members during times of intense grief.

Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries.

PubMed Central

Rice, A. L.; Sacco, L.; Hyder, A.; Black, R. E.

2000-01-01

INTRODUCTION: Recent estimates suggest that malnutrition (measured as poor anthropometric status) is associated with about 50% of all deaths among children. Although the association between malnutrition and all-cause mortality is well documented, the malnutrition-related risk of death associated with specific diseases is less well described. We reviewed published literature to examine the evidence for a relation between malnutrition and child mortality from diarrhoea, acute respiratory illness, malaria and measles, conditions that account for over 50% of deaths in children worldwide. METHODS: MEDLINE was searched for suitable review articles and original reports of community-based and hospital-based studies. Findings from cohort studies and case-control studies were reviewed and summarized. RESULTS: The strongest and most consistent relation between malnutrition and an increased risk of death was observed for diarrhoea and acute respiratory infection. The evidence, although limited, also suggests a potentially increased risk for death from malaria. A less consistent association was observed between nutritional status and death from measles. Although some hospital-based studies and case-control studies reported an increased risk of mortality from measles, few community-based studies reported any association. DISCUSSION: The risk of malnutrition-related mortality seems to vary for different diseases. These findings have important implications for the evaluation of nutritional intervention programmes and child survival programmes being implemented in settings with different disease profiles. PMID:11100616

Early Initiation of ARV During Pregnancy to Move towards Virtual Elimination of Mother-to-Child-Transmission of HIV-1 in Yunnan, China.

PubMed

Meyers, Kathrine; Qian, Haoyu; Wu, Yingfeng; Lao, Yunfei; Chen, Qingling; Dong, Xingqi; Li, Huiqin; Yang, Yiqing; Jiang, Chengqin; Zhou, Zengquan

2015-01-01

To identify factors associated with mother-to-child-transmission and late access to prevention of maternal to child transmission (PMTCT) services among HIV-infected women; and risk factors for infant mortality among HIV-exposed infants in order to assess the feasibility of virtual elimination of vertical transmission and pediatric HIV in this setting. Observational study evaluating the impact of a provincial PMTCT program. The intervention was implemented in 26 counties of Yunnan Province, China at municipal and tertiary health care settings. Log linear regression models with generalized estimating equations were used to identify unadjusted and adjusted correlates for late ARV intervention and MTCT. Cox proportional hazard models with robust sandwich estimation were applied to examine correlates of infant mortality. Mother-to-child- transmission rate of HIV was controlled to 2%, with late initiation of maternal ARV showing a strong association with vertical transmission and infant mortality. Risk factors for late initiation of maternal ARV were age, ethnicity, education, and having a husband not tested for HIV. Mortality rate among HIV-exposed infants was 2.9/100 person-years. In addition to late initiation of maternal ARV, ethnicity, low birth weight and preterm birth were associated with infant mortality. This PMTCT program in Yunnan achieved low rates of MTCT. However the infant mortality rate in this cohort of HIV-exposed children was almost three times the provincial rate. Virtual elimination of MTCT of HIV is an achievable goal in China, but more attention needs to be paid to HIV-free survival.

Impact of Insecticide-Treated Net Ownership on All-Cause Child Mortality in Malawi, 2006-2010.

PubMed

Florey, Lia S; Bennett, Adam; Hershey, Christine L; Bhattarai, Achuyt; Nielsen, Carrie F; Ali, Doreen; Luhanga, Misheck; Taylor, Cameron; Eisele, Thomas P; Yé, Yazoume

2017-09-01

Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis. To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62-90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60-0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006-2010 in Malawi and represent a novel use of district-level data from nationally representative surveys.

The impact of prenatal care quality on neonatal, infant and child mortality in Zimbabwe: evidence from the demographic and health surveys.

PubMed

Makate, Marshall; Makate, Clifton

2017-04-01

The impact of the quality of prenatal care on child mortality outcomes has received less attention in sub-Saharan Africa. This study endeavoured to explore the effect of the quality of prenatal care and its individual components on neonatal, infant and under-five mortality. The empirical analysis uses data from the three most recent waves of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 1999, 2005/06 and 2010/11. The results indicate that a one-unit increase in the quality of prenatal care lowers the prospect of neonatal, infant and under-five mortality by approximately 42.33, 30.86 and 28.65%, respectively. These findings remained roughly the same even after adjusting for potential mediating factors. Examining the effect of individual prenatal care components on child mortality revealed that women who receive information on possible complications arising during pregnancy are less liable to experience a neonatal death. Similarly, women who had blood pressure checks and tetanus immunizations were less likely to experience an infant or under-five death. We did not find any statistically meaningful impact on child mortality outcomes of blood and urine sample checks, iron tablet consumption, and the receipt of malarial tablets. Overall, our results suggest the need for public health policymakers to focus on ensuring high-quality prenatal care to enhance the survival prospects of Zimbabwe's infants. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Childhood Problem Behaviors and Death by Midlife: The British National Child Development Study

ERIC Educational Resources Information Center

Jokela, Markus; Ferrie, Jane; Kivimaki, Mika

2009-01-01

The childhood behavior problem as assessed by teachers of over 11,000 boys and girls who were born in 1958 and were part of the British National Child Development Study is reviewed to determine a link between these behaviors and mortality by the age of 46. It is found that childhood behavior problem is linked to long-term mortality beyond…

Upper gastrointestinal bleeding in patients with hepatic cirrhosis: clinical course and mortality prediction.

PubMed

Afessa, B; Kubilis, P S

2000-02-01

We conducted this study to describe the complications and validate the accuracy of previously reported prognostic indices in predicting the mortality of cirrhotic patients hospitalized for upper GI bleeding. This prospective, observational study included 111 consecutive hospitalizations of 85 cirrhotic patients admitted for GI bleeding. Data obtained included intensive care unit (ICU) admission status, Child-Pugh score, the development of systemic inflammatory response syndrome (SIRS), organ failure, and inhospital mortality. The performances of Garden's, Gatta's, and Acute Physiology and Chronic Health Evaluation (APACHE) II prognostic systems in predicting mortality were assessed. Patients' mean age was 48.7 yr, and the median APACHE II and Child-Pugh scores were 17 and 9, respectively. Their ICU admission rate was 71%. Organ failure developed in 57%, and SIRS in 46% of the patients. Nine patients had acute respiratory distress syndrome, and three patients had hepatorenal syndrome. The inhospital mortality was 21%. The APACHE II, Garden's, and Gatta' s predicted mortality rates were 39%, 24%, and 20%, respectively, and their areas under the receiver operating characteristic curve (AUC) were 0.78, 0.70, and 0.71, respectively. The AUC for Child-Pugh score was 0.76. SIRS and organ failure develop in many patients with hepatic cirrhosis hospitalized for upper GI bleeding, and are associated with increased mortality. Although the APACHE II prognostic system overestimated the mortality of these patients, the receiver operating characteristic curves did not show significant differences between the various prognostic systems.

Governance matters: an ecological association between governance and child mortality.

PubMed

Lin, Ro-Ting; Chien, Lung-Chang; Chen, Ya-Mei; Chan, Chang-Chuan

2014-09-01

Governance of a country may have widespread effects on the health of its population, yet little is known about the effect of governance on child mortality in a country that is undergoing urbanization, economic development, and disease control. We obtained indicators of six dimensions of governance (perceptions of voice and accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption) and national under-5 mortality rates for 149 countries between 1996 and 2010. We applied a semi-parametric generalized additive mixed model to examine associations after controlling for the effects of development factors (urbanization level and economy), disease control factors (hygienic conditions and vaccination rates), health expenditures, air quality, and time. Governance, development, and disease control showed clear inverse relations with the under-5 mortality rate (p<0.001). Per unit increases in governance, development, and disease control factors, the child mortality rate had a 0.901-, 0.823-, and 0.922-fold decrease, respectively, at fixed levels of the other two factors. In the effort to reduce the global under-5 mortality rate, addressing a country's need for better governance is as important as improvements in development and disease control. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Infant mortality in Bangladesh: a review of recent evidence.

PubMed

Ahmed, M F

1991-07-01

Estimates of child mortality are mainly based on reports by mothers on the survival status of their children. Infant mortality estimates from such data do not seem to have declined in recent years. The Bangladesh Bureau of Statistics sample registration infant mortality estimates appear to be suspiciously low.

Drivers of inequality in Millennium Development Goal progress: a statistical analysis.

PubMed

Stuckler, David; Basu, Sanjay; McKee, Martin

2010-03-02

Many low- and middle-income countries are not on track to reach the public health targets set out in the Millennium Development Goals (MDGs). We evaluated whether differential progress towards health MDGs was associated with economic development, public health funding (both overall and as percentage of available domestic funds), or health system infrastructure. We also examined the impact of joint epidemics of HIV/AIDS and noncommunicable diseases (NCDs), which may limit the ability of households to address child mortality and increase risks of infectious diseases. We calculated each country's distance from its MDG goals for HIV/AIDS, tuberculosis, and infant and child mortality targets for the year 2005 using the United Nations MDG database for 227 countries from 1990 to the present. We studied the association of economic development (gross domestic product [GDP] per capita in purchasing-power-parity), the relative priority placed on health (health spending as a percentage of GDP), real health spending (health system expenditures in purchasing-power-parity), HIV/AIDS burden (prevalence rates among ages 15-49 y), and NCD burden (age-standardised chronic disease mortality rates), with measures of distance from attainment of health MDGs. To avoid spurious correlations that may exist simply because countries with high disease burdens would be expected to have low MDG progress, and to adjust for potential confounding arising from differences in countries' initial disease burdens, we analysed the variations in rates of change in MDG progress versus expected rates for each country. While economic development, health priority, health spending, and health infrastructure did not explain more than one-fifth of the differences in progress to health MDGs among countries, burdens of HIV and NCDs explained more than half of between-country inequalities in child mortality progress (R(2)-infant mortality = 0.57, R(2)-under 5 mortality = 0.54). HIV/AIDS and NCD burdens were also the strongest correlates of unequal progress towards tuberculosis goals (R(2) = 0.57), with NCDs having an effect independent of HIV/AIDS, consistent with micro-level studies of the influence of tobacco and diabetes on tuberculosis risks. Even after correcting for health system variables, initial child mortality, and tuberculosis diseases, we found that lower burdens of HIV/AIDS and NCDs were associated with much greater progress towards attainment of child mortality and tuberculosis MDGs than were gains in GDP. An estimated 1% lower HIV prevalence or 10% lower mortality rate from NCDs would have a similar impact on progress towards the tuberculosis MDG as an 80% or greater rise in GDP, corresponding to at least a decade of economic growth in low-income countries. Unequal progress in health MDGs in low-income countries appears significantly related to burdens of HIV and NCDs in a population, after correcting for potentially confounding socioeconomic, disease burden, political, and health system variables. The common separation between NCDs, child mortality, and infectious syndromes among development programs may obscure interrelationships of illness affecting those living in poor households--whether economic (e.g., as money spent on tobacco is lost from child health expenditures) or biological (e.g., as diabetes or HIV enhance the risk of tuberculosis).

The State of the Child in Pennsylvania: A 1997 Guide to Child Well-Being in Pennsylvania Counties. State of the Child in Pennsylvania Fact Book Series.

ERIC Educational Resources Information Center

Steketee, Martha Wade; Bergsten, Martha C.

This Kids Count data book examines statewide trends in the status of Pennsylvania's children. The statistical portrait is based on 18 indicators of child well-being: (1) low birth weight; (2) lack of early prenatal care; (3) births to single teens; (4) infant mortality; (5) child deaths; (6) child violent deaths; (7) substantiated child abuse; (8)…

Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status

PubMed Central

Houle, Brian; Stein, Alan; Kahn, Kathleen; Madhavan, Sangeetha; Collinson, Mark; Tollman, Stephen M; Clark, Samuel J

2013-01-01

Background Household characteristics are important influences on the risk of child death. However, little is known about this influence in HIV-endemic areas. We describe the effects of household characteristics on children’s risk of dying in rural South Africa. Methods We use data describing the mortality of children younger than 5 years living in the Agincourt health and socio-demographic surveillance system study population in rural northeast South Africa during the period 1994–2008. Using discrete time event history analysis we estimate children’s probability of dying by child characteristics and household composition (other children and adults other than parents) (N = 924 818 child-months), and household socio-economic status (N = 501 732 child-months). Results Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying (OR 2.5; 95% CI 1.1–5.7). Children also experience increased odds of dying in the period 6 months (OR 2.1; 95% CI 1.2–3.6), 3–5 months (OR 3.0; 95% CI 1.5–5.9), and 2 months (OR 11.8; 95% CI 7.6–18.3) before another household child dies. The odds of dying remain high at the time of another child’s death (OR 11.7; 95% CI 6.3–21.7) and for the 2 months following (OR 4.0; 95% CI 1.9–8.6). Having a related but non-parent adult aged 20–59 years in the household reduces the odds (OR 0.6; 95% CI 0.5–0.8). There is an inverse relationship between a child’s odds of dying and household socio-economic status. Conclusions This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying when another child is very ill or has recently died. Short birth intervals and additional children in the household are further risk factors. Presence of a related adult is protective, as is higher socio-economic status. Such evidence can inform primary health care practice and facilitate targeting of community health worker efforts, especially when covering defined catchment areas. PMID:23912808

Child mortality in the Democratic Republic of Congo: cross-sectional evidence of the effect of geographic location and prolonged conflict from a national household survey

PubMed Central

2014-01-01

Background The child mortality rate is a good indicator of development. High levels of infectious diseases and high child mortality make the Democratic Republic of Congo (DRC) one of the most challenging environments for health development in Sub-Saharan Africa (SSA). Recent conflicts in the eastern part of the country and bad governance have compounded the problem. This study aimed to examine province-level geographic variation in under-five mortality (U5M), accounting for individual- and household-level risk factors including environmental factors such as conflict. Methods Our analysis used the nationally representative cross-sectional household sample of 8,992 children under five in the 2007 DRC Demographic and Health Survey. In the survey year, 1,005 deaths among this group were observed. Information on U5M was aggregated to the 11 provinces, and a Bayesian geo-additive discrete-time survival mixed model was used to map the geographic distribution of under-five mortality rates (U5MRs) at the province level, accounting for observable and unobservable risk factors. Results The overall U5MR was 159 per 1,000 live births. Significant associations with risk of U5M were found for < 24 month birth interval [posterior odds ratio and 95% credible region: 1.14 (1.04, 1.26)], home birth [1.13 (1.01, 1.27)] and living with a single mother [1.16 (1.03, 1.33)]. Striking variation was also noted in the risk of U5M by province of residence, with the highest risk in Kasaï-Oriental, a non-conflict area of the DRC, and the lowest in the conflict area of North Kivu. Conclusion This study reveals clear geographic patterns in rates of U5M in the DRC and shows the potential role of individual child, household and environmental factors, which are unexplained by the ongoing conflict. The displacement of mothers to safer areas may explain the lower U5MR observed at the epicentre of the conflict in North Kivu, compared with rates in conflict-free areas. Overall, the U5M maps point to a lack of progress towards the Millennium Development Goal of reducing U5M by half by 2015. PMID:24649944

Diffuse Lung Disease in Biopsied Children 2 to 18 Years of Age. Application of the chILD Classification Scheme.

PubMed

Fan, Leland L; Dishop, Megan K; Galambos, Csaba; Askin, Frederic B; White, Frances V; Langston, Claire; Liptzin, Deborah R; Kroehl, Miranda E; Deutsch, Gail H; Young, Lisa R; Kurland, Geoffrey; Hagood, James; Dell, Sharon; Trapnell, Bruce C; Deterding, Robin R

2015-10-01

Children's Interstitial and Diffuse Lung Disease (chILD) is a heterogeneous group of disorders that is challenging to categorize. In previous study, a classification scheme was successfully applied to children 0 to 2 years of age who underwent lung biopsies for chILD. This classification scheme has not been evaluated in children 2 to 18 years of age. This multicenter interdisciplinary study sought to describe the spectrum of biopsy-proven chILD in North America and to apply a previously reported classification scheme in children 2 to 18 years of age. Mortality and risk factors for mortality were also assessed. Patients 2 to 18 years of age who underwent lung biopsies for diffuse lung disease from 12 North American institutions were included. Demographic and clinical data were collected and described. The lung biopsies were reviewed by pediatric lung pathologists with expertise in diffuse lung disease and were classified by the chILD classification scheme. Logistic regression was used to determine risk factors for mortality. A total of 191 cases were included in the final analysis. Number of biopsies varied by center (5-49 biopsies; mean, 15.8) and by age (2-18 yr; mean, 10.6 yr). The most common classification category in this cohort was Disorders of the Immunocompromised Host (40.8%), and the least common was Disorders of Infancy (4.7%). Immunocompromised patients suffered the highest mortality (52.8%). Additional associations with mortality included mechanical ventilation, worse clinical status at time of biopsy, tachypnea, hemoptysis, and crackles. Pulmonary hypertension was found to be a risk factor for mortality but only in the immunocompetent patients. In patients 2 to 18 years of age who underwent lung biopsies for diffuse lung disease, there were far fewer diagnoses prevalent in infancy and more overlap with adult diagnoses. Immunocompromised patients with diffuse lung disease who underwent lung biopsies had less than 50% survival at time of last follow-up.

Community-based intervention packages facilitated by NGOs demonstrate plausible evidence for child mortality impact.

PubMed

Ricca, Jim; Kureshy, Nazo; LeBan, Karen; Prosnitz, Debra; Ryan, Leo

2014-03-01

Evidence exists that community-based intervention packages can have substantial child and newborn mortality impact, and may help more countries meet Millennium Development Goal 4 (MDG 4) targets. A non-governmental organization (NGO) project using such programming in Mozambique documented an annual decline in under-five mortality rate (U5MR) of 9.3% in a province in which Demographic and Health Survey (DHS) data showed a 4.2% U5MR decline during the same period. To test the generalizability of this finding, the same analysis was applied to a group of projects funded by the US Agency for International Development. Projects supported implementation of community-based intervention packages aimed at increasing use of health services while improving preventive and home-care practices for children under five. All projects collect baseline and endline population coverage data for key child health interventions. Twelve projects fitted the inclusion criteria. U5MR decline was estimated by modelling these coverage changes in the Lives Saved Tool (LiST) and comparing with concurrent measured DHS mortality data. Average coverage changes for all interventions exceeded average concurrent trends. When population coverage changes were modelled in LiST, they were estimated to give a child mortality improvement in the project area that exceeded concurrent secular trend in the subnational DHS region in 11 of 12 cases. The average improvement in modelled U5MR (5.8%) was more than twice the concurrent directly measured average decline (2.5%). NGO projects implementing community-based intervention packages appear to be effective in reducing child mortality in diverse settings. There is plausible evidence that they raised coverage for a variety of high-impact interventions and improved U5MR by more than twice the concurrent secular trend. All projects used community-based strategies that achieved frequent interpersonal contact for health behaviour change. Further study of the effectiveness and scalability of similar packages should be part of the effort to accelerate progress towards MDG 4.

Kids Count in Indiana 2001 Data Book: County Profiles of Child Well-Being.

ERIC Educational Resources Information Center

Erickson, Judith; King, Mindy Hightower

This Kids Count data book examines statewide trends in the well-being of Indiana's children. The statistical portrait is based on indicators in 10 general areas: (1) child and family demographics; (2) economic well-being; (3) poverty; (4) child safety; (5) child abuse and neglect; (6) education; (7) child health; (8) mortality; (9) high risk…

The value of the girl child in Singapore.

PubMed

Thein, M M; Goh, L G

1991-01-01

Son preference exists in many countries in Asia. In countries like Pakistan, Bangladesh and Nepal, such preference has been shown to result in excess female mortality. In Singapore, there is also son preference but excess female mortality is not seen because of several factors: Government's policy of equal educational opportunities for boys and girls since World War II, the protection of women's rights through the Women's Charter, the family planning message that "Boy or Girl, two is enough", urbanisation and industrialisation. Singapore is seeing increasing participation of women in the workforce, not only as clerks and factory operators but also as decision makers in middle and senior management positions. In this modern age, the girl child should be given as much value as the boy child. Only when such an egalitarian attitude towards the girl child exists would she be able to develop into her full potential to be an asset to her country. Government policies to promote the well-being, protect the rights, and to improve the lot of the girl child appear necessary in countries where son preference leads to excess mortality of girls from sex discrimination in nutrition and/or health care.

Long-Term Mortality Consequences of Childhood Family Context in Liaoning, China, 1749-1909

PubMed Central

Campbell, Cameron Dougall; Lee, James Z

2009-01-01

We examine the effects on adult and old age mortality of childhood living arrangements and other aspects of family context in early life. We focus on features of family context that have already been shown to be associated with infant or child mortality in historical and developing country populations. We apply discrete-time event-history analysis to longitudinal, individual-level household register data for a rural population in northeast China from the eighteenth and nineteenth centuries. Loss of a mother in childhood, a short preceding birth interval, and high maternal age were all associated with elevated mortality risks later in life. Such effects persist in a model with fixed effects that account for unobserved characteristics of the community and household. An important implication of these results is that in high mortality populations, features of early life family context that are associated with elevated infant and child mortality may also predict adverse mortality outcomes in adulthood. PMID:19278765

Treating HIV infected mothers reduces mortality in children under 5 years of age to levels seen in children of HIV uninfected mothers: evidence from rural South Africa

PubMed Central

Ndirangu, James; Newell, Marie-Louise; Thorne, Claire; Bland, Ruth

2012-01-01

Background Maternal and child survival are highly correlated, but the contribution of HIV infection on this relationship, and in particular the impact of HIV treatment has not been quantified. We estimate the association between maternal HIV and treatment and under-5 child mortality in a rural population in South Africa. Methods All children born between January 2000-January 2007 in the Africa Centre Demographic Surveillance Area were included. Maternal HIV status information was available from HIV surveillance; maternal antiretroviral treatment (ART) from the HIV Treatment Programme database and linked to surveillance data. Mortality rates were computed as deaths per 1000 person-years observed. Time-varying maternal HIV effect (positive, negative, ART) on U5MR was assessed in Cox regression, adjusting for other factors associated with under-5 mortality. Results 9,068 mothers delivered 12,052 children, of whom 947 (7.9%) died before age 5. Infant mortality rate (IMR) declined by 49% from 69.0 in 2000 to 35.5 in 2006 deaths per 1000 person-years observed; a significantly decline was observed post-ART (2004-2006). The estimated proportion of deaths across all age groups were higher among the children born to the HIV-positive and HIV-not reported status women than among children of HIV-negative women. Multivariably, mortality in children of mothers on ART was not significantly different from children of HIV-negative mothers (aHR 1.29, 0.53-3.17; p=0.572). Conclusions These findings highlight the importance of maternal HIV treatment with direct benefits of improved survival among all children under-5. Timely HIV treatment for eligible women is required to benefit both mothers and children. PMID:22267472

Child contact management in high tuberculosis burden countries: A mixed-methods systematic review.

PubMed

Szkwarko, Daria; Hirsch-Moverman, Yael; Du Plessis, Lienki; Du Preez, Karen; Carr, Catherine; Mandalakas, Anna M

2017-01-01

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996-2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children.

Child contact management in high tuberculosis burden countries: A mixed-methods systematic review

PubMed Central

Du Plessis, Lienki; Du Preez, Karen; Carr, Catherine; Mandalakas, Anna M.

2017-01-01

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996–2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children. PMID:28763500

Success in reducing maternal and child mortality in Afghanistan.

PubMed

Rasooly, Mohammad Hafiz; Govindasamy, Pav; Aqil, Anwer; Rutstein, Shea; Arnold, Fred; Noormal, Bashiruddin; Way, Ann; Brock, Susan; Shadoul, Ahmed

2014-01-01

After the collapse of the Taliban regime in 2002, Afghanistan adopted a new development path and billions of dollars were invested in rebuilding the country's economy and health systems with the help of donors. These investments have led to substantial improvements in maternal and child health in recent years and ultimately to a decrease in maternal and child mortality. The 2010 Afghanistan Mortality Survey (AMS) provides important new information on the levels and trends in these indicators. The AMS estimated that there are 327 maternal deaths for every 100,000 live births (95% confidence interval = 260-394) and 97 deaths before the age of five years for every 1000 children born. Decreases in these mortality rates are consistent with changes in key determinants of mortality, including an increasing age at marriage, higher contraceptive use, lower fertility, better immunisation coverage, improvements in the percentage of women delivering in health facilities and receiving antenatal and postnatal care, involvement of community health workers and increasing access to the Basic Package of Health Services. Despite the impressive gains in these areas, many challenges remain. Further improvements in health services in Afghanistan will require sustained efforts on the part of both the Government of Afghanistan and international donors.

Development assistance for health in central and eastern European Region.

PubMed

Suhrcke, Marc; Rechel, Bernd; Michaud, Catherine

2005-12-01

We aimed to quantify development assistance for health to countries of central and eastern Europe and the Commonwealth of Independent States (CEE-CIS). We used the International Development Statistics database of the Organisation for Economic Co-operation and Development and the database on development assistance for health compiled for the Commission on Macroeconomics and Health to quantify health development assistance to the region, compared to global and overall development assistance. We based our analysis on standard health indicators, including child mortality, life expectancy at birth and health expenditures. Although total development assistance per capita to CEE-CIS was higher than that for most other regions of the world, development assistance for health was very low compared to other countries with similar levels of child mortality, life expectancy at birth and national expenditures on health. The allocation of development assistance for health on a global scale seems to be related far more to child mortality rather than adult mortality. Countries of CEE-CIS have a high burden of adult morbidity and mortality from non-communicable diseases, which does not appear to attract proportionate development assistance. Levels of development assistance for health should be determined in consideration of the region's particular burden of disease.

How Ethiopia achieved Millennium Development Goal 4 through multisectoral interventions: a Countdown to 2015 case study.

PubMed

Ruducha, Jenny; Mann, Carlyn; Singh, Neha S; Gemebo, Tsegaye D; Tessema, Negussie S; Baschieri, Angela; Friberg, Ingrid; Zerfu, Taddese A; Yassin, Mohammed; Franca, Giovanny A; Berman, Peter

2017-11-01

3 years before the 2015 deadline, Ethiopia achieved Millennium Development Goal 4. The under-5 mortality decreased 69%, from 205 deaths per 1000 livebirths in 1990 to 64 deaths per 1000 livebirths in 2013. To understand the underlying factors that contributed to the success in achieving MDG4, Ethiopia was selected as a Countdown to 2015 case study. We used a set of complementary methods to analyse progress in child health in Ethiopia between 1990 and 2014. We used Demographic Health Surveys to analyse trends in coverage and equity of key reproductive, maternal health, and child health indicators. Standardised tools developed by the Countdown Health Systems and Policies working group were used to understand the timing and content of health and non-health policies. We assessed longitudinal trends in health-system investment through a financial analysis of National Health Accounts, and we used the Lives Saved Tool (LiST) to assess the contribution of interventions towards reducing under-5 mortality. The annual rate of reduction in under-5 mortality increased from 3·3% in 1990-2005 to 7·8% in 2005-13. The prevalence of stunting decreased from 60% in 2000 to 40% in 2014. Overall levels of coverage of reproductive, maternal health, and child health indicators remained low, with disparities between the lowest and highest wealth quintiles despite improvement in coverage for essential health interventions. Coverage of child immunisation increased the most (21% of children in 2000 vs 80% of children in 2014), followed by coverage of satisfied demand for family planning by women of reproductive age (19% vs 63%). Provision of antenatal care increased from 10% of women in 2000 to 32% of women in 2014, but only 15% of women delivered with a skilled birth attendant by 2014. A large upturn occurred after 2005, bolstered by a rapid increase in health funding that facilitated the accelerated expansion of health infrastructure and workforce through an innovative community-based delivery system. The LiST model could explain almost 50% of the observed reduction in child mortality between 2000 and 2011; and changes in nutritional status were responsible for about 50% of the 469 000 lives saved between 2000 and 2011. These developments occurred within a multisectoral policy platform, integrating child survival and stunting goals within macro-level policies and programmes for reducing poverty and improving agricultural productivity, food security, water supply, and sanitation. The reduction of under-5 mortality in Ethiopia was the result of combined activities in health, nutrition, and non-health sectors. However, Ethiopia still has high neonatal and maternal morbidity and mortality from preventable causes and an unfinished agenda in reducing inequalities, improving coverage of effective interventions, and strengthening multisectoral partnerships for further progress. Bill & Melinda Gates Foundation and Government of Canada. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

The Impact of Education On Fertility and Child Mortality: Do Fathers Really Matter Less than Mothers? OECD Development Centre Working Paper, No. 217 (Formerly Webdoc No. 5)

ERIC Educational Resources Information Center

Breierova, Lucia; Duflo, Esther

2003-01-01

This paper takes advantage of a massive school construction program that took place in Indonesia between 1973 and 1978 to estimate the effect of education on fertility and child mortality. Time and region varying exposure to the school construction program generates instrumental variables for the average education in the household, and the…

The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá – Colombia: an ecological analysis

PubMed Central

2012-01-01

Background Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá. Methods An ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007. Results In both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20% to inequality in DPT coverage, favoring the poorer localities. Conclusion The PHC strategy developed in Bogotá appears to be contributing to reductions of the inequality associated with socioeconomic and living conditions in child health outcomes. PMID:23145972

Impact of the economic crisis and increase in food prices on child mortality: exploring nutritional pathways.

PubMed

Christian, Parul

2010-01-01

The current economic crisis and food price increase may have a widespread impact on the nutritional and health status of populations, especially in the developing world. Gains in child survival over the past few decades are likely to be threatened and millennium development goals will be harder to achieve. Beyond starvation, which is one of the causes of death in famine situations, there are numerous nutritional pathways by which childhood mortality can increase. These include increases in childhood wasting and stunting, intrauterine growth restriction, and micronutrient deficiencies such as that of vitamin A, iron, and zinc when faced with a food crisis and decreased food availability. These pathways are elucidated and described. Although estimates of the impact of the current crisis on child mortality are yet to be made, data from previous economic crises provide evidence of an increase in childhood mortality that we review. The current situation also emphasizes that there are vast segments of the world's population living in a situation of chronic food insecurity that are likely to be disproportionately affected by an economic crisis. Nutritional and health surveillance data are urgently needed in such populations to monitor both the impacts of a crisis and of interventions. Addressing the nutritional needs of children and women in response to the present crisis is urgent. But, ensuring that vulnerable populations are also targeted with known nutritional interventions at all times is likely to have a substantial impact on child mortality.

Death and suicide among former child and adolescent psychiatric patients

PubMed Central

Engqvist, Ulf; Rydelius, Per-Anders

2006-01-01

Background Increased mortality rates among previous child and adolescent psychiatry (CAP) patients have been found in Scandinavian studies up to the 1980s. The suicide risk in this group has been estimated to be almost five times higher than expected. This article addresses two questions: Do Swedish CAP patients continue to risk premature death and what kind of information related to psychiatric symptoms and/or behavior problems can predict later suicide? Methods Hospital files, Sweden's census databases (including immigration and emigration) and administrative databases (including the Swedish Hospital Discharge register and the Persons Convicted of Offences register), and the Cause of Death register were examined to determine the mortality rate in a group of 1,400 former CAP inpatients and outpatients over a period of 12–33 years. Observed and expected numbers of deceased were calculated with the prospective method and the standardized mortality ratio (SMR) method. The relative risk or the risk ratio (RR) is presented with 95% confidence intervals (CIs). Significance level tests were made using two-by-two tables and chi-square tests. The Cox proportional-hazards regression model was used for survival analysis. Results Twenty-four males and 14 females died. Compared with the general population, the standardized mortality ratio in this group of CAP patients was significantly higher in both sexes. Behavioral problems, school problems, and co-morbid alcohol or drug abuse and criminality (including alcohol-related crimes) were found to be important predictors. Thirty-two deaths were attributed to suicide, intoxication, drug overdose, or accident; one patient died of an alcohol abuse-related disorder, and five patients died of natural causes. Suicide was the most common cause of death, but only 2 of these 19 cases were initially admitted for attempted suicide. Conclusion We suggest that suicide and death prevention among CAP patients may not be a psychiatric issue per se but a future function of society's juvenile social-welfare investments and juvenile-delinquency prevention programs. PMID:17081290

Counting the cost of child mortality in the World Health Organization African region.

PubMed

Kirigia, Joses M; Muthuri, Rosenabi Deborah Karimi; Nabyonga-Orem, Juliet; Kirigia, Doris Gatwiri

2015-11-06

Worldwide, a total of 6.282 million deaths occurred among children aged less than 5 years in 2013. About 47.4 % of those were borne by the 47 Member States of the World Health Organization (WHO) African Region. Sadly, even as we approach the end date for the 2015 Millennium Development Goals (MDGs), only eight African countries are on track to achieve the MDG 4 target 4A of reducing under-five mortality by two thirds between 1990 and 2015. The post-2015 Sustainable Development Goal (SDG) 3 target is "by 2030, end preventable deaths of new-borns and children under 5 years of age". There is urgent need for increased advocacy among governments, the private sector and development partners to provide the resources needed to build resilient national health systems to deliver an integrated package of people-centred interventions to end preventable child morbidity and mortality and other structures to address all the basic needs for a healthy population. The specific objective of this study was to estimate expected/future productivity losses from child deaths in the WHO African Region in 2013 for use in advocacy for increased investments in child health services and other basic services that address children's welfare. A cost-of-illness method was used to estimate future non-health GDP losses related to child deaths. Future non-health GDP losses were discounted at 3 %. The analysis was undertaken with the countries categorized under three income groups: Group 1 consisted of nine high and upper middle income countries, Group 2 of 13 lower middle income countries, and Group 3 of 25 low income countries. One-way sensitivity analysis at 5 % and 10 % discount rates assessed the impact of the expected non-health GDP loss. The discounted value of future non-health GDP loss due to the deaths of children under 5 years old in 2013 will be in the order of Int$ 150.3 billion. Approximately 27.3 % of the loss will be borne by Group 1 countries, 47.1 % by Group 2 and 25.7 % by Group 3. The average non-health GDP lost per child death will be Int$ 174 310 for Group 1, Int$ 57 584 for Group 2 and Int$ 25 508 for Group 3. It is estimated that the African Region will incur a loss of approximately 6 % of its non-health GDP from the future years of life lost among the 2 976 000 child deaths that occurred in 2013. Therefore, countries and development partners should in solidarity sustainably provide the resources essential to build resilient national health systems and systems to address the determinants of health and meet the other basic needs such as for clothing, education, food, shelter, sanitation and clean water to end preventable child morbidity and mortality.

Pregnancy termination in Matlab, Bangladesh: maternal mortality risks associated with menstrual regulation and abortion.

PubMed

Rahman, Mizanur; DaVanzo, Julie; Razzaque, Abdur

2014-09-01

In Bangladesh, both menstrual regulation (MR), which is thought to be a relatively safe method, and abortion, which in this setting is often performed using unsafe methods, are used to terminate pregnancies (known or suspected). However, little is known about changes over time in the use of these methods or their relative mortality risks. Data from the Demographic Surveillance System in Matlab, Bangladesh, on 110,152 pregnancy outcomes between 1989 and 2008 were used to assess changes in mortality risks associated with MR (and a small number of dilation and curettage procedures), abortion and live birth. Tabulation and logistic regression analyses were used to compare outcomes in two areas of Matlab--the comparison area, which receives standard government health and family planning services, and the Maternal and Child Health-Family Planning (MCH-FP) area, which receives enhanced health and family planning services. In Matlab as a whole, the proportion of pregnancies ending in MR increased from 1.9% in 1989-1999 to 4.2% in 2000-2008, while the proportion ending in abortion decreased from 1.6% to 1.1%. The odds of mortality from MR were 4.1 times those from live birth in 1989-1999, but were no longer elevated in 2000-2008. The odds of mortality from abortion were 12.0 and 4.9 times those of live birth in 1989-1999 and 2000-2008, respectively. Reduction in mortality risk was greater in the MCH-FP area than the comparison area (90% vs. 75%). MR is no longer associated with higher mortality risk than live birth in Bangladesh, but abortion is.

Child maltreatment in Taiwan for 2004-2013: A shift in age group and forms of maltreatment.

PubMed

Chen, Chih-Tsai; Yang, Nan-Ping; Chou, Pesus

2016-02-01

Cases of child maltreatment are being increasingly reported in Taiwan. However, the trend or changes of child maltreatment in Taiwan are fragmentary and lack empirical evidence. This study analyzed the epidemiological characteristics of substantiated child maltreatment cases from the previous decade, using mortality as an indicator to investigate the care of children who experienced substantiated maltreatment in the past to determine any new developments. Data for analysis and estimates were retrieved from the Department of Statistics in the Ministry of the Interior from 2004 to 2013. Trend analyses were conducted using the Joinpoint Regression Program. The child maltreatment rate in Taiwan was found to have nearly tripled from 2004 to 2013. A greater increase in the maltreatment of girls than boys and the maltreatment of aboriginal children than non-aboriginal children was noted from 2004 to 2013. When stratified by age group, the increase in maltreatment was most pronounced in children aged 12-17 years, and girls aged 12-17 years experienced the greatest increase in maltreatment. In terms of the proportional changes of different maltreatment forms among substantiated child maltreatment cases, child neglect was decreasing. The increase in sexual abuse was higher than for any other form of maltreatment and surpassed neglect by the end of 2013. Furthermore, the mortality rate of children with substantiated maltreatment record is increasing in Taiwan, whereas the mortality rate among children without any substantiated maltreatment record is decreasing. The results of this study highlight the need for policy reform in Taiwan regarding child maltreatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

Child Mortality Estimation: A Global Overview of Infant and Child Mortality Age Patterns in Light of New Empirical Data

PubMed Central

Guillot, Michel; Gerland, Patrick; Pelletier, François; Saabneh, Ameed

2012-01-01

Background The under-five mortality rate (the probability of dying between birth and age 5 y, also denoted in the literature as U5MR and 5 q 0) is a key indicator of child health, but it conceals important information about how this mortality is distributed by age. One important distinction is what amount of the under-five mortality occurs below age 1 y (1 q 0) versus at age 1 y and above (4 q 1). However, in many country settings, this distinction is often difficult to establish because of various types of data errors. As a result, it is common practice to resort to model age patterns to estimate 1 q 0 and 4 q 1 on the basis of an observed value of 5 q 0. The most commonly used model age patterns for this purpose are the Coale and Demeny and the United Nations systems. Since the development of these models, many additional sources of data for under-five mortality have become available, making possible a general evaluation of age patterns of infant and child mortality. In this paper, we do a systematic comparison of empirical values of 1 q 0 and 4 q 1 against model age patterns, and discuss whether observed deviations are due to data errors, or whether they reflect true epidemiological patterns not addressed in existing model life tables. Methods and Findings We used vital registration data from the Human Mortality Database, sample survey data from the World Fertility Survey and Demographic and Health Surveys programs, and data from Demographic Surveillance Systems. For each of these data sources, we compared empirical combinations of 1 q 0 and 4 q 1 against combinations provided by Coale and Demeny and United Nations model age patterns. We found that, on the whole, empirical values fall relatively well within the range provided by these models, but we also found important exceptions. Sub-Saharan African countries have a tendency to exhibit high values of 4 q 1 relative to 1 q 0, a pattern that appears to arise for the most part from true epidemiological causes. While this pattern is well known in the case of western Africa, we observed that it is more widespread than commonly thought. We also found that the emergence of HIV/AIDS, while perhaps contributing to high relative values of 4 q 1, does not appear to have substantially modified preexisting patterns. We also identified a small number of countries scattered in different parts of the world that exhibit unusually low values of 4 q 1 relative to 1 q 0, a pattern that is not likely to arise merely from data errors. Finally, we illustrate that it is relatively common for populations to experience changes in age patterns of infant and child mortality as they experience a decline in mortality. Conclusions Existing models do not appear to cover the entire range of epidemiological situations and trajectories. Therefore, model life tables should be used with caution for estimating 1 q 0 and 4 q 1 on the basis of 5 q 0. Moreover, this model-based estimation procedure assumes that the input value of 5 q 0 is correct, which may not always be warranted, especially in the case of survey data. A systematic evaluation of data errors in sample surveys and their impact on age patterns of 1 q 0 and 4 q 1 is urgently needed, along with the development of model age patterns of under-five mortality that would cover a wider range of epidemiological situations and trajectories. Please see later in the article for the Editors' Summary. PMID:22952438

The State of the Child in Pennsylvania: A 2002 Guide to Child Well-Being in Pennsylvania.

ERIC Educational Resources Information Center

Ollivier, Diane J.

This Kids Count report examines statewide trends in the well-being of Pennsylvanias children. The statistical portrait is based on trends in 19 indicators of child well being: (1) early prenatal care; (2) low birth weight; (3) infant mortality; (4) child deaths; (5) child violent deaths; (6) births to single mothers under age 20; (7) mothers with…

Prevalence and determinants of the gender differentials risk factors of child deaths in Bangladesh: evidence from the Bangladesh demographic and health survey, 2011.

PubMed

Hossain, Md Mosharaf; Mani, Kulanthayan K C; Islam, Md Rafiqul

2015-03-01

The number of child deaths is a potential indicator to assess the health condition of a country, and represents a major health challenge in Bangladesh. Although the country has performed exceptionally well in decreasing the mortality rate among children under five over the last few decades, mortality still remains relatively high. The main objective of this study is to identify the prevalence and determinants of the risk factors of child mortality in Bangladesh. The data were based on a cross-sectional study collected from the Bangladesh Demographic and Health Survey (BDHS), 2011. The women participants numbered 16,025 from seven divisions of Bangladesh - Rajshahi, Dhaka, Chittagong, Barisal, Khulna, Rangpur and Sylhet. The 2 test and logistic regression model were applied to determine the prevalence and factors associated with child deaths in Bangladesh. In 2011, the prevalence of child deaths in Bangladesh for boys and girls was 13.0% and 11.6%, respectively. The results showed that birth interval and birth order were the most important factors associated with child death risks; mothers' education and socioeconomic status were also significant (males and females). The results also indicated that a higher birth order (7 & more) of child (OR=21.421 & 95%CI=16.879-27.186) with a short birth interval ≤ 2 years was more risky for child mortality, and lower birth order with longer birth interval >2 were significantly associated with child deaths. Other risk factors that affected child deaths in Bangladesh included young mothers of less than 25 years (mothers' median age (26-36 years): OR=0.670, 95%CI=0.551-0.815), women without education compared to those with secondary and higher education (OR =0 .711 & .628, 95%CI=0.606-0.833 & 0.437-0.903), mothers who perceived their child body size to be larger than average and small size (OR= 1.525 & 1.068, 95%CI=1.221-1.905 & 0.913-1.249), and mothers who delivered their child by non-caesarean (OR= 1.687, 95%CI=1.253-2.272). Community-based educational programs or awareness programs are required to reduce the child death in Bangladesh, especially for younger women should be increase the birth interval and decrease the birth order. The government should apply the strategies to enhance the socioeconomic conditions, especially in rural areas, increase the awareness program through media and expand schooling, particularly for girls.

Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages.

PubMed

Ruhago, George M; Ngalesoni, Frida N; Norheim, Ole F

2012-12-27

Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. We used the Lives Saved Tool (LiST) to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of -0.11 (maternal) and -0.12 (children) to a more equitable concentration index of -0,03 and -0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.

Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990-2013: findings from the Global Burden of Disease Study 2013.

PubMed

Deribew, Amare; Tessema, Gizachew Assefa; Deribe, Kebede; Melaku, Yohannes Adama; Lakew, Yihunie; Amare, Azmeraw T; Abera, Semaw F; Mohammed, Mesoud; Hiruye, Abiy; Teklay, Efrem; Misganaw, Awoke; Kassebaum, Nicholas

2016-01-01

Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990-2013. We used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used. Between 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1-4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013. Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths ( n  = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap. LRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.

Impact of Insecticide-Treated Net Ownership on All-Cause Child Mortality in Malawi, 2006–2010

PubMed Central

Florey, Lia S.; Bennett, Adam; Hershey, Christine L.; Bhattarai, Achuyt; Nielsen, Carrie F.; Ali, Doreen; Luhanga, Misheck; Taylor, Cameron; Eisele, Thomas P.; Yé, Yazoume

2017-01-01

Abstract. Insecticide-treated nets (ITNs) have been shown to be highly effective at reducing malaria morbidity and mortality in children. However, there are limited studies that assess the association between increasing ITN coverage and child mortality over time, at the national level, and under programmatic conditions. Two analytic approaches were used to examine this association: a retrospective cohort analysis of individual children and a district-level ecologic analysis. To evaluate the association between household ITN ownership and all-cause child mortality (ACCM) at the individual level, data from the 2010 Demographic and Health Survey (DHS) were modeled in a Cox proportional hazards framework while controlling for numerous environmental, household, and individual confounders through the use of exact matching. To evaluate population-level association between ITN ownership and ACCM between 2006 and 2010, program ITN distribution data and mortality data from the 2006 Multiple Indicator Cluster Survey and the 2010 DHS were aggregated at the district level and modeled using negative binomial regression. In the Cox model controlling for household, child and maternal health factors, children between 1 and 59 months in households owning an ITN had significantly lower mortality compared with those without an ITN (hazard ratio = 0.75, 95% confidence interval [CI] = 0.62–90). In the district-level model, higher ITN ownership was significantly associated with lower ACCM (incidence rate ratio = 0.77; 95% CI = 0.60–0.98). These findings suggest that increasing ITN ownership may have contributed to the decline in ACCM during 2006–2010 in Malawi and represent a novel use of district-level data from nationally representative surveys. PMID:28990922

Child health and nutrition in Peru within an antipoverty political agenda: a Countdown to 2015 country case study.

PubMed

Huicho, Luis; Segura, Eddy R; Huayanay-Espinoza, Carlos A; de Guzman, Jessica Niño; Restrepo-Méndez, Maria Clara; Tam, Yvonne; Barros, Aluisio J D; Victora, Cesar G

2016-06-01

Peru is an upper-middle-income country with wide social and regional disparities. In recent years, sustained multisectoral antipoverty programmes involving governments, political parties, and civil society have included explicit health and nutrition goals and spending increased sharply. We did a country case study with the aim of documenting Peru's progress in reproductive, maternal, neonatal, and child health from 2000-13, and explored the potential determinants. We examined the outcomes of health interventions coverage, under-5 mortality, neonatal mortality, and prevalence of under-5 stunting. We obtained data from interviews with key informants, a literature review of published and unpublished data, national censuses, and governmental reports. We obtained information on social determinants of health, including economic growth, poverty, unmet basic needs, urbanisation, women's education, water supply, fertility rates, and child nutrition from the annual national households surveys and the Peruvian Demographic and Health Surveys. We obtained national mortality data from the Interagency Group for Child Mortality Estimation, and calculated subnational rates from 11 surveys. Analyses were stratified by region, wealth quintiles, and urban or rural residence. We calculated coverage indicators for the years 2000-13, and we used the Lives Saved Tool (LiST) to estimate the effect of changes in intervention coverage and in nutritional status on mortality. From 2000 to 2013, under-5 mortality fell by 58% from 39·8 deaths per 1000 livebirths to 16·7. LiST, which was used to predict the decline in mortality arising from changes in fertility rates, water and sanitation, undernutrition, and coverage of indicators of reproductive, maternal, neonatal, and child health predicted that the under-5 mortality rate would fall from 39·8 to 28·4 per 1000 livebirths, accounting for 49·2% of the reported reduction. Neonatal mortality fell by 51% from 16·2 deaths per 1000 livebirths to 8·0. Stunting prevalence remained stable at around 30% until 2007, decreasing to 17·5% by 2013, and the composite coverage index for essential health interventions increased from 75·1% to 82·6%, with faster increases among the poor, in rural areas, and in the Andean region. Socioeconomic, urban-rural, and regional inequalities in coverage, mortality, and stunting were substantially reduced. The proportion of the population living below the poverty line reduced from 47·8% to 23·9%, women with fewer than 4 years of schooling reduced from 11·5% to 6·9%, urbanisation increased from 68·1% to 75·6%, and the total fertility rate decreased from 3·0 children per woman to 2·4. We interviewed 175 key informants and they raised the following issues: economic growth, improvement of social determinants, civil society empowerment and advocacy, out-of-health and within-health-sector changes, and sustained implementation of evidence-based, pro-poor reproductive, maternal, neonatal, and child health interventions. Peru has made substantial progress in reducing neonatal and under-5 mortality, and child stunting. This country is a good example of how a combination of political will, economic growth, broad societal participation, strategies focused on poor people, and increased spending in health and related sectors can achieve significant progress in reproductive, maternal, neonatal, and child health. The remaining challenges include continuing to address inequalities in wealth distribution, poverty, and access to basic services, especially in the Amazon and Andean rural areas. Bill & Melinda Gates Foundation. Copyright © 2016 Huicho et al. Open Access article distributed under the terms of CC BY 4.0. Published by Elsevier Ltd.. All rights reserved.

The Health Rationale for Family Planning: Timing of Births and Child Survival.

ERIC Educational Resources Information Center

United Nations, New York, NY. Population Div.

Among the most influential findings from the World Fertility Survey (WFS) were those linking fertility patterns to child survival, in particular the findings concerning the high infant and child mortality for children born after a short birth interval. This study examined the relations between fertility and child survival based on more recent data…

Measures of Child Well-Being in Utah, 2000. How Are the Children?

ERIC Educational Resources Information Center

Haven, Terry, Ed.

This Kids Count report details statewide trends in the well-being of Utah's children. The statistical portrait is based on 22 indicators of children's well-being, including: (1) prenatal care; (2) low birth weight infants; (3) infant mortality; (4) child death rates; (5) child injury deaths; (6) child abuse; (7) injury hospital discharges; (8)…

Children in Africa: Key Statistics on Child Survival, Protection and Development

ERIC Educational Resources Information Center

UNICEF, 2014

2014-01-01

This report presents key statistics relating to: (1) child malnutrition in Africa; (2) HIV/AIDS and Malaria in Africa; (3) child marriage, birth registration and Female Genital Mutilation/Cutting (FGM/C); (4) education in Africa; (5) child mortality in Africa; (6) Drinking water and sanitation in Africa; and (7) maternal health in Africa.…

The Knowledge of Staff in Day Nurseries about Some Basic Measures Which Promote Child Health

ERIC Educational Resources Information Center

Cavalcante, Suzy S.; Nunes de Melo, Maria Clotildes; Carneiro, Nadya Bustani; Silva, Luciana Rodrigues

2005-01-01

Purpose: This paper aims to determine the knowledge that staff in day nurseries in Brazil had of basic measures to promote child health which are connected with high child mortality. These measures included breastfeeding, oral rehydration therapy, child growth follow-up, immunization and the identification of signs that indicate that the child…

Leadership for child health in the developing countries of the Western Pacific

PubMed Central

Subhi, Rami; Duke, Trevor

2011-01-01

The content and landscape of global child health is increasingly complex. There is strong evidence for the effectiveness of local, national and institutional leadership in reducing child mortality, but this has not been a focus of global health initiatives. Interventions to strengthen health systems should include support for local leadership: building-up institutions of training, empowering national paediatric professional associations, creating opportunities for contribution and leadership at national, provincial and local level, and networks of support for staff working in child health in remote areas. In the poorer high mortality burden countries of the Pacific, to meet the clinical and public health gaps, there is a need for increases in the education of child health nurse practitioners, and development of systems of continuing professional development for paediatric doctors and nurses. Involvement in local research, especially that which contributes directly to critical issues in child health policy or strengthening national data systems builds capacity for leadership. PMID:23198107

Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000.

PubMed

Liu, Li; Johnson, Hope L; Cousens, Simon; Perin, Jamie; Scott, Susana; Lawn, Joy E; Rudan, Igor; Campbell, Harry; Cibulskis, Richard; Li, Mengying; Mathers, Colin; Black, Robert E

2012-06-09

Information about the distribution of causes of and time trends for child mortality should be periodically updated. We report the latest estimates of causes of child mortality in 2010 with time trends since 2000. Updated total numbers of deaths in children aged 0-27 days and 1-59 months were applied to the corresponding country-specific distribution of deaths by cause. We did the following to derive the number of deaths in children aged 1-59 months: we used vital registration data for countries with an adequate vital registration system; we applied a multinomial logistic regression model to vital registration data for low-mortality countries without adequate vital registration; we used a similar multinomial logistic regression with verbal autopsy data for high-mortality countries; for India and China, we developed national models. We aggregated country results to generate regional and global estimates. Of 7·6 million deaths in children younger than 5 years in 2010, 64·0% (4·879 million) were attributable to infectious causes and 40·3% (3·072 million) occurred in neonates. Preterm birth complications (14·1%; 1·078 million, uncertainty range [UR] 0·916-1·325), intrapartum-related complications (9·4%; 0·717 million, 0·610-0·876), and sepsis or meningitis (5·2%; 0·393 million, 0·252-0·552) were the leading causes of neonatal death. In older children, pneumonia (14·1%; 1·071 million, 0·977-1·176), diarrhoea (9·9%; 0·751 million, 0·538-1·031), and malaria (7·4%; 0·564 million, 0·432-0·709) claimed the most lives. Despite tremendous efforts to identify relevant data, the causes of only 2·7% (0·205 million) of deaths in children younger than 5 years were medically certified in 2010. Between 2000 and 2010, the global burden of deaths in children younger than 5 years decreased by 2 million, of which pneumonia, measles, and diarrhoea contributed the most to the overall reduction (0·451 million [0·339-0·547], 0·363 million [0·283-0·419], and 0·359 million [0·215-0·476], respectively). However, only tetanus, measles, AIDS, and malaria (in Africa) decreased at an annual rate sufficient to attain the Millennium Development Goal 4. Child survival strategies should direct resources toward the leading causes of child mortality, with attention focusing on infectious and neonatal causes. More rapid decreases from 2010-15 will need accelerated reduction for the most common causes of death, notably pneumonia and preterm birth complications. Continued efforts to gather high-quality data and enhance estimation methods are essential for the improvement of future estimates. The Bill & Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.

Reducing infant mortality.

PubMed

Johnson, T R

1994-01-01

Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.

Sex differences in child and adolescent mortality by parental education in the Nordic countries.

PubMed

Gissler, Mika; Rahkonen, Ossi; Mortensen, Laust; Arntzen, Annett; Cnattingius, Sven; Nybo Andersen, Anne-Marie; Hemminki, Elina

2012-01-01

Socioeconomic position inequalities in infant mortality are well known, but there is less information on how child mortality is socially patterned by sex and age. To assess maternal and paternal socioeconomic inequalities in mortality by sex, whether these differences vary by age and country, and how much of the sex differences can be explained by external causes of death. Data on all live-born children were received from national birth registries for 1981-2000 (Denmark: n=1,184,926; Norway: n=1,090,127; and Sweden n=1,961,911) and for 1987-2000 (Finland: n=841,470). Data on the highest level of education in 2000 were obtained from national education registers, and data on mortality and causes of death were received from the national cause-of-death registers until the end of follow-up (20 years or 2003). Boys had a higher child and adolescent mortality than girls. The children of mothers and fathers who had had the shortest education time had the highest mortality for both sexes and for all ages and countries. The differences between the groups with longer than basic education were smaller, particularly among older children and girls. The gradient in mortality was mostly similar for boys and girls. Among 1-19-year-olds, 32% of boys' deaths and 27% of girls' deaths were due to external causes. Boys' excess mortality was only partly explained by educational inequalities or by deaths from external causes. A more detailed analysis is needed to study whether the share of avoidable deaths is higher among children whose parents have had a shorter education time.

Childhood mortality impact and costs of integrating vitamin A supplementation into immunization campaigns.

PubMed Central

Ching, P; Birmingham, M; Goodman, T; Sutter, R; Loevinsohn, B

2000-01-01

Country-specific activity and coverage data were used to estimate the childhood mortality impact (deaths averted) and costs of integrating vitamin A supplements into immunization campaigns conducted in 1998 and 1999. More than 94 million doses of vitamin A were administered in 41 countries in 1998, helping to avert nearly 169,000 deaths. During 1999, delivery of more than 97 million doses in 50 countries helped avert an estimated 242,000 deaths. The estimated incremental cost per death averted was US$72 (range: 36-142) in 1998 and US$64 (range: 32-126) in 1999. The estimated average total cost of providing supplementation per death averted was US$310 (range: 157-609) in 1998 and US$276 (range: 139-540) in 1999. Costs per death averted varied by campaign, depending on the number and proportion of the child population reached, number of doses received per child, and child mortality rates. PMID:11029982

Vaccination and All-Cause Child Mortality From 1985 to 2011: Global Evidence From the Demographic and Health Surveys

PubMed Central

McGovern, Mark E.; Canning, David

2015-01-01

Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimated the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determined the relationship between vaccination coverage and the probability of dying between birth and 5 years of age at the survey cluster level. Our data included approximately 1 million children in 68,490 clusters from 62 countries. We considered the childhood measles, bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjusted for selection bias that resulted from the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimated that children in clusters with complete vaccination coverage have a relative risk of mortality that is 0.73 (95% confidence interval: 0.68, 0.77) times that of children in a cluster with no vaccinations. Although widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing coverage rates in order to reduce child mortality. PMID:26453618

Improving access to child health services at the community level in Zambia: a country case study on progress in child survival, 2000–2013

PubMed Central

Kipp, Aaron M; Maimbolwa, Margaret; Brault, Marie A; Kalesha-Masumbu, Penelope; Katepa-Bwalya, Mary; Habimana, Phanuel; Vermund, Sten H; Mwinga, Kasonde; Haley, Connie A

2017-01-01

Abstract Reductions in under-five mortality in Africa have not been sufficient to meet the Millennium Development Goal #4 (MDG#4) of reducing under-five mortality by two-thirds by 2015. Nevertheless, 12 African countries have met MDG#4. We undertook a four country study to examine barriers and facilitators of child survival prior to 2015, seeking to better understand variability in success across countries. The current analysis presents indicator, national document, and qualitative data from key informants and community women describing the factors that have enabled Zambia to successfully reduce under-five mortality over the last 15 years and achieve MDG#4. Results identified a Zambian national commitment to ongoing reform of national health strategic plans and efforts to ensure universal access to effective maternal, neonatal and child health (MNCH) interventions, creating an environment that has promoted child health. Zambia has also focused on bringing health services as close to the family as possible through specific community health strategies. This includes actively involving community health workers to provide health education, basic MNCH services, and linking women to health facilities, while supplementing community and health facility work with twice-yearly Child Health Weeks. External partners have contributed greatly to Zambia’s MNCH services, and their relationships with the government are generally positive. As government funding increases to sustain MNCH services, national health strategies/plans are being used to specify how partners can fill gaps in resources. Zambia’s continuing MNCH challenges include basic transportation, access-to-care, workforce shortages, and financing limitations. We highlight policies, programs, and implementation that facilitated reductions in under-five mortality in Zambia. These findings may inform how other countries in the African Region can increase progress in child survival in the post-MDG period. PMID:28453711

Arsenic

MedlinePlus

... its development. Arsenic is also associated with adverse pregnancy outcomes and infant mortality, with impacts on child health (1) , and exposure in utero and in early childhood has been linked to increases in mortality ...

Effect of political decentralization and female leadership on institutional births and child mortality in rural Bihar, India.

PubMed

Kumar, Santosh; Prakash, Nishith

2017-07-01

In this paper, we investigate the impacts of political decentralization and women reservation in local governance on institutional births and child mortality in the state of Bihar, India. Using the difference-in-differences methodology, we find a significant positive association between political decentralization and institutional births. We also find that the increased participation of women at local governance led to an increased survival rate of children belonging to richer households. We argue that our results are consistent with female leaders having policy preference for women and child well-being. Copyright © 2017 Elsevier Ltd. All rights reserved.

Air Pollution and Infant Mortality in Mexico City

EPA Science Inventory

Historic air pollution episodes of the 1950s led to acute increases in infant mortality, and some recent epidemiologic studies suggest that infant or child mortality may still result from air pollution at current levels. To investigate the evidence for such an association, we con...

Fertile lifespan characteristics and all-cause and cause-specific mortality among postmenopausal women: the Rotterdam Study.

PubMed

Jaspers, Loes; Kavousi, Maryam; Erler, Nicole S; Hofman, Albert; Laven, Joop S E; Franco, Oscar H

2017-02-01

To characterize the relation between established and previously unexplored characteristics of the fertile life with all-cause and cause-specific mortality. Prospective cohort study. Not applicable. A total of 4,076 postmenopausal women. Women's fertile lifespan (age at menarche to menopause), number of children, maternal age at first and last child, maternal lifespan (interval between maternal age at first and last child), postmaternal fertile lifespan (interval between age at last child and menopause), lifetime cumulative number of menstrual cycles, and unopposed cumulative endogenous estrogen (E) exposure. Registry-based all-cause and cause-specific mortality. A total of 2,754 women died during 14.8 years of follow-up. Compared with women with 2-3 children, a 12% higher hazard of dying was found for women having 1 child (hazard ratio [HR], 1.12; 95% confidence interval [CI] 1.01-1.24), which became nonsignificant in models adjusted for confounders (HR, 1.08; 95% CI 0.96-1.21). Late age at first and last birth were associated with a 1% lower hazard of dying (HR, 0.99; 95% CI 0.98-1.00). Longer maternal and postmaternal fertile lifespan (HR 1.01; 95% CI 1.00-1.02), longer fertile lifespan (HR 1.02; 95% CI 1.00-1.05), and unopposed cumulative E exposure (HR, 1.02; 95% CI 1.00-1.04) were significantly harmful for all-cause mortality. Findings differed with regard to direction, size, and statistical significance when stratifying for cardiovascular disease, cancer, and other mortality. Overall, we found that late first and last reproduction were protective for all-cause mortality, whereas a longer maternal lifespan, postmaternal fertile lifespan, and E exposure were harmful for all-cause mortality. More research is needed in contemporary cohorts with larger sample sizes and more extreme ages of birth. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

The State of the Child in Pennsylvania: A 1999 Guide to Child Well-Being in Pennsylvania. State of the Child in Pennsylvania Fact Book Series.

ERIC Educational Resources Information Center

Bergsten, Martha C.; Steketee, Martha Wade

This Kids Count report examines statewide trends in the well-being of Pennsylvania's children. The statistical portrait is based on trends in 17 indicators of child well being: (1) birth weight; (2) early prenatal care; (3) infant mortality; (4) substantiated cases of child abuse or neglect; (5) out-of-home placements; (6) delinquent children…

Developing child mental health services in resource-poor countries.

PubMed

Omigbodun, Olayinka

2008-06-01

Despite significant gains in tackling the major causes of child mortality and evidence of an urgent need for child mental health services, resource-poor countries continue to lag behind in child and adolescent mental health service development. This paper analyses possible barriers to the development of child mental health services in resource-poor countries and attempts to proffer solutions. Obstacles identified are the magnitude of child mental health problems that remain invisible to policy makers, an absence of child mental policies to guide the process of service development, and overburdened child mental health professionals. The belief systems about mental illness also prompt help seeking in alternative health systems, thereby reducing the evidence for the burden associated with health seeking. Solutions that may support child mental health service development are the provision of adequate advocacy tools to reveal the burden, poverty alleviation, health awareness programmes, enforcing legislation, training centred within the region, and partnerships with professionals in developed countries. These solutions require simultaneous approaches to encourage service development and utilization. Reductions in child mortality in resource-poor countries will be even more dramatic in the years to come and preparations need to be made to take care of the mental health needs of the children who will survive.

The life-history trade-off between fertility and child survival

PubMed Central

Lawson, David W.; Alvergne, Alexandra; Gibson, Mhairi A.

2012-01-01

Evolutionary models of human reproduction argue that variation in fertility can be understood as the local optimization of a life-history trade-off between offspring quantity and ‘quality’. Child survival is a fundamental dimension of quality in these models as early-life mortality represents a crucial selective bottleneck in human evolution. This perspective is well-rehearsed, but current literature presents mixed evidence for a trade-off between fertility and child survival, and little empirical ground to evaluate how socioecological and individual characteristics influence the benefits of fertility limitation. By compiling demographic survey data, we demonstrate robust negative relationships between fertility and child survival across 27 sub-Saharan African countries. Our analyses suggest this relationship is primarily accounted for by offspring competition for parental investment, rather than by reverse causal mechanisms. We also find that the trade-off increases in relative magnitude as national mortality declines and maternal somatic (height) and extrasomatic (education) capital increase. This supports the idea that socioeconomic development, and associated reductions in extrinsic child mortality, favour reduced fertility by increasing the relative returns to parental investment. Observed fertility, however, falls considerably short of predicted optima for maximizing total offspring survivorship, strongly suggesting that additional unmeasured costs of reproduction ultimately constrain the evolution of human family size. PMID:23034700

Strengthening the primary care workforce to deliver community case management for child health in rural Indonesia.

PubMed

Setiawan, Agus; Dawson, Angela

2017-10-02

Objectives The aim of the present study was to report on the implementation of community case management (CCM) to reduce infant mortality in a rural district, namely Kutai Timur, Kalimantan Indonesia. Methods An interpretive qualitative methodology was used. In-depth interviews were conducted with 18 primary healthcare workers (PHCWs), and PHCWs were observed during a consultation with mothers to gain insight into the delivery of the new protocol and workforce issues. The field notes and interview transcripts were analysed thematically. Results PHCWs reported that their performance had improved as a result of increased knowledge and confidence. The implementation of CCM had also reportedly enhanced the PHCWs' clinical reasoning. However, the participants noted confusion surrounding their role in prescribing medication. Conclusions CCM is viewed as a useful model of care in terms of enhancing the capacity of rural PHCWs to provide child health care and improve the uptake of life-saving interventions. However, work is needed to strengthen the workforce and to fully integrate CCM into maternal and child health service delivery across Indonesia. What is known about the topic? Indonesia has successfully reduced infant mortality in the past 10 years. However, concerns remain regarding issues related to disparities between districts. The number of infant deaths in rural areas tends to be staggeringly high compared with that in the cities. One of the causes is inadequate access to child health care. What does this paper add? CCM is a model of care that is designed to address childhood illnesses in limited-resource settings. In CCM, PHCWs are trained to deliver life-saving interventions to sick children in rural communities. In the present study, CCM improved the capacity of PHCWs to treat childhood illnesses. What are the implications for practitioners? CCM can be considered to strengthen PHCWs' competence in addressing infant mortality in areas where access to child health care is challenging. Policy regarding task shifting needs to be examined further so that CCM can be integrated into current health service delivery in Indonesia.

Measures of Child Well-Being in Utah, 2003: Counting on a Better Future for Utah's Kids.

ERIC Educational Resources Information Center

Haven, Terry, Ed.

This Kids Count report examines statewide trends in the well-being of Utah's children. The statistical portrait is based on 28 indicators of children's well-being in five areas: (1) child health (prenatal care, low birth-weight births, infant mortality, child injury deaths, injury-related hospital discharges, child abuse, childhood immunizations,…

Measures of Child Well-Being in Utah, 2002: Counting the Kids Who Count on Us. Utah KIDS COUNT.

ERIC Educational Resources Information Center

Haven, Terry, Ed.

This Kids Count report details statewide trends in the well-being of Utah's children. The statistical portrait is based on 29 indicators of children's well-being in five areas: (1) child health and safety (prenatal care, low birthweight, infant mortality, child injury deaths, injury-related hospital discharges, child abuse, childhood…

Unmasking inequalities: Sub-national maternal and child mortality data from two urban slums in Lagos, Nigeria tells the story.

PubMed

Anastasi, Erin; Ekanem, Ekanem; Hill, Olivia; Adebayo Oluwakemi, Agnes; Abayomi, Oluwatosin; Bernasconi, Andrea

2017-01-01

Nigeria has one of the highest maternal mortality ratios in the world as well as high perinatal mortality. Unfortunately, the country does not have the resources to assess this critical indicator with the conventional health information system and measuring its progress toward the goal of ending preventable maternal deaths is almost impossible. Médecins Sans Frontières (MSF) conducted a cross-sectional study to assess maternal and perinatal mortality in Makoko Riverine and Badia East, two of the most vulnerable slums of Lagos. The study was a cross-sectional, community-based household survey. Nearly 4,000 households were surveyed. The sisterhood method was utilized to estimate maternal mortality and the preceding births technique was used to estimate newborn and child mortality. Questions regarding health seeking behavior were posed to female interviewees and self-reported data were collected. Data was collected from 3963 respondents for a total of 7018 sisters ever married. The maternal mortality ratio was calculated at 1,050/100,000 live births (95% CI: 894-1215), and the lifetime risk of maternal death at 1:18. The neonatal mortality rate was extracted from 1967 pregnancies reported and was estimated at 28.4/1,000; infant mortality at 43.8/1,000 and under-five mortality at 103/1,000. Living in Badia, giving birth at home and belonging to the Egun ethnic group were associated with higher perinatal mortality. Half of the last pregnancies were reportedly delivered in private health facilities. Proximity to home was the main influencing factor (32.4%) associated with delivery at the health facility. The maternal mortality ratio found in these urban slum populations within Lagos is extremely high, compared to the figure estimated for Lagos State of 545 per 100,000 live births. Urgent attention is required to address these neglected and vulnerable neighborhoods. Efforts should be invested in obtaining data from poor, marginalized, and hard-to-reach populations in order to identify pockets of marginalization needing additional resources and tailored approaches to guarantee equitable treatment and timely access to quality health services for vulnerable groups. This study demonstrates the importance of sub-regional, disaggregated data to identify and redress inequities that exist among poor, remote, vulnerable populations-as in the urban slums of Lagos.

Exploring Child Mortality Risks Associated with Diverse Patterns of Maternal Migration in Haiti

PubMed Central

Smith-Greenaway, Emily; Thomas, Kevin

2014-01-01

Internal migration is a salient dimension of adulthood in Haiti, particularly among women. Despite the prevalence of migration in Haiti, it remains unknown whether Haitian women’s diverse patterns of migration influence their children’s health and survival. In this paper, we introduce the concept of lateral (i.e., rural-to-rural, urban-to-urban) versus nonlateral (i.e., rural-to-urban, urban-to-rural) migration to describe how some patterns of mothers’ internal migration may be associated with particularly high mortality among children. We use the 2006 Haitian Demographic and Health Survey to estimate a series of discrete-time hazard models among 7,409 rural children and 3,864 urban children. We find that, compared with their peers with nonmigrant mothers, children born to lateral migrants generally experience lower mortality whereas those born to nonlateral migrants generally experience higher mortality. Although there are important distinctions across Haiti’s rural and urban contexts, these associations remain net of socioeconomic factors, suggesting they are not entirely attributable to migrant selection. Considering the timing of maternal migration uncovers even more variation in the child health implications of maternal migration; however, the results counter the standard disruption and adaptation perspective. Although future work is needed to identify the processes underlying the differential risk of child mortality across lateral versus nonlateral migrants, the study demonstrates that looking beyond rural-to-urban migration and considering the timing of maternal migration can provide a fuller, more complex understanding of migration’s association with child health. PMID:25506111

Impact of implementation of NRHM program on NMR in Tamil Nadu (TN): a case study.

PubMed

Kumutha, J; Chitra, N; Vidyasagar, Dharmapuri

2014-12-01

The Government of India had set up the National Rural Health Mission (NRHM) in 2005 in an effort towards providing quality healthcare to the underserved rural areas and also to achieve the Millennium Development Goals (MDGs) by 2015. While the trends in child and maternal mortality show great progress by India since 1990 with steady decline in Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR), a comparison of the predicted trend and target of MDGs show that India would fall short by a few points. In contrast, Tamil Nadu has reached its MDGs and is ensuring sustained progress in reducing child and maternal mortality with an effective implementation of the various schemes of NRHM. Tamil Nadu leads the way in ensuring universal health coverage leveraging the expertise and funds of NRHM by providing round the clock services, introducing new and innovative programs to improve outcomes and regular monitoring of the functional operation and outcomes to ensure effective implementation. Adopting the features of the Tamil Nadu model of healthcare system that caters to their particular state and effectively implementing the initiatives of NRHM would help the other states in considerably reducing the child and maternal mortality and also ensure early achievement of MDGs by the nation.

Validating hierarchical verbal autopsy expert algorithms in a large data set with known causes of death.

PubMed

Kalter, Henry D; Perin, Jamie; Black, Robert E

2016-06-01

Physician assessment historically has been the most common method of analyzing verbal autopsy (VA) data. Recently, the World Health Organization endorsed two automated methods, Tariff 2.0 and InterVA-4, which promise greater objectivity and lower cost. A disadvantage of the Tariff method is that it requires a training data set from a prior validation study, while InterVA relies on clinically specified conditional probabilities. We undertook to validate the hierarchical expert algorithm analysis of VA data, an automated, intuitive, deterministic method that does not require a training data set. Using Population Health Metrics Research Consortium study hospital source data, we compared the primary causes of 1629 neonatal and 1456 1-59 month-old child deaths from VA expert algorithms arranged in a hierarchy to their reference standard causes. The expert algorithms were held constant, while five prior and one new "compromise" neonatal hierarchy, and three former child hierarchies were tested. For each comparison, the reference standard data were resampled 1000 times within the range of cause-specific mortality fractions (CSMF) for one of three approximated community scenarios in the 2013 WHO global causes of death, plus one random mortality cause proportions scenario. We utilized CSMF accuracy to assess overall population-level validity, and the absolute difference between VA and reference standard CSMFs to examine particular causes. Chance-corrected concordance (CCC) and Cohen's kappa were used to evaluate individual-level cause assignment. Overall CSMF accuracy for the best-performing expert algorithm hierarchy was 0.80 (range 0.57-0.96) for neonatal deaths and 0.76 (0.50-0.97) for child deaths. Performance for particular causes of death varied, with fairly flat estimated CSMF over a range of reference values for several causes. Performance at the individual diagnosis level was also less favorable than that for overall CSMF (neonatal: best CCC = 0.23, range 0.16-0.33; best kappa = 0.29, 0.23-0.35; child: best CCC = 0.40, 0.19-0.45; best kappa = 0.29, 0.07-0.35). Expert algorithms in a hierarchy offer an accessible, automated method for assigning VA causes of death. Overall population-level accuracy is similar to that of more complex machine learning methods, but without need for a training data set from a prior validation study.

Health transitions in sub-Saharan Africa: overview of mortality trends in children under 5 years old (1950-2000).

PubMed Central

Garenne, Michel; Gakusi, Enéas

2006-01-01

OBJECTIVE: To reconstruct and analyse mortality trends in children younger than 5 years in sub-Saharan Africa between 1950 and 2000. METHODS: We selected 66 Demographic and Health Surveys and World Fertility Surveys from 32 African countries for analysis. Death rates were calculated by yearly periods for each survey. When several surveys were available for the same country, overlapping years were combined. Country-specific time series were analysed to identify periods of monotonic trends, whether declining, steady or increasing. We tested changes in trends using a linear logistic model. FINDINGS: A quarter of the countries studied had monotonic declining mortality trends: i.e. a smooth health transition. Another quarter had long-term declines with some minor rises over short periods of time. Eight countries had periods of major increases in mortality due to political or economic crises, and in seven countries mortality stopped declining for several years. In eight other countries mortality has risen in recent years as a result of paediatric AIDS. Reconstructed levels and trends were compared with other estimates made by international organizations, usually based on indirect methods. CONCLUSION: Overall, major progress in child survival was achieved in sub-Saharan Africa during the second half of the twentieth century. However, transition has occurred more slowly than expected, with an average decline of 1.8% per year. Additionally, transition was chaotic in many countries. The main causes of mortality increase were political instability, serious economic downturns, and emerging diseases. PMID:16799731

Mortality in the Year Following Antiretroviral Therapy Initiation in HIV-Infected Adults and Children in Uganda and Zimbabwe

PubMed Central

Walker, A. Sarah; Prendergast, Andrew J.; Mugyenyi, Peter; Munderi, Paula; Hakim, James; Kekitiinwa, Addy; Katabira, Elly; Gilks, Charles F.; Kityo, Cissy; Nahirya-Ntege, Patricia; Nathoo, Kusum; Gibb, Diana M.

2012-01-01

Background. Adult mortality in the first 3 months on antiretroviral therapy (ART) is higher in low-income than in high-income countries, with more similar mortality after 6 months. However, the specific patterns of changing risk and causes of death have rarely been investigated in adults, nor compared with children in low-income countries. Methods. We used flexible parametric hazard models to investigate how mortality risks varied over the first year on ART in human immunodeficiency virus–infected adults (aged 18–73 years) and children (aged 4 months to 15 years) in 2 trials in Zimbabwe and Uganda. Results. One hundred seventy-nine of 3316 (5.4%) adults and 39 of 1199 (3.3%) children died; half of adult/pediatric deaths occurred in the first 3 months. Mortality variation over year 1 was similar; at all CD4 counts/CD4%, mortality risk was greatest between days 30 and 50, declined rapidly to day 180, then declined more slowly. One-year mortality after initiating ART with 0–49, 50–99 or ≥100 CD4 cells/μL was 9.4%, 4.5%, and 2.9%, respectively, in adults, and 10.1%, 4.4%, and 1.3%, respectively, in children aged 4–15 years. Mortality in children aged 4 months to 3 years initiating ART in equivalent CD4% strata was also similar (0%–4%: 9.1%; 5%–9%: 4.5%; ≥10%: 2.8%). Only 10 of 179 (6%) adult deaths and 1 of 39 (3%) child deaths were probably medication-related. The most common cause of death was septicemia/meningitis in adults (20%, median 76 days) and children (36%, median 79 days); pneumonia also commonly caused child deaths (28%, median 41 days). Conclusions. Children ≥4 years and adults with low CD4 values have remarkably similar, and high, mortality risks in the first 3 months after ART initiation in low-income countries, similar to cohorts of untreated individuals. Bacterial infections are a major cause of death in both adults and children; targeted interventions could have important benefits. PMID:22972859

Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care

PubMed Central

Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

2016-01-01

The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries. To create a major change in Haiti’s health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic “community care grids” to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis. We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti’s health care system will be among the leaders in that region. PMID:26934625

Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

PubMed

Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

2016-01-01

The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.

Use of new World Health Organization child growth standards to assess how infant malnutrition relates to breastfeeding and mortality

PubMed Central

Vesel, Linda; Martines, Jose; Penny, Mary; Bhandari, Nita; Kirkwood, Betty R

2010-01-01

Abstract Objective To compare the estimated prevalence of malnutrition using the World Health Organization’s (WHO) child growth standards versus the National Center for Health Statistics’ (NCHS) growth reference, to examine the relationship between exclusive breastfeeding and malnutrition, and to determine the sensitivity and specificity of nutritional status indicators for predicting death during infancy. Methods A secondary analysis of data on 9424 mother–infant pairs in Ghana, India and Peru was conducted. Mothers and infants were enrolled in a trial of vitamin A supplementation during which the infants’ weight, length and feeding practices were assessed regularly. Malnutrition indicators were determined using WHO and NCHS growth standards. Findings The prevalence of stunting, wasting and underweight in infants aged < 6 months was higher with WHO than NCHS standards. However, the prevalence of underweight in infants aged 6–12 months was much lower with WHO standards. The duration of exclusive breastfeeding was not associated with malnutrition in the first 6 months of life. In infants aged < 6 months, severe underweight at the first immunization visit as determined using WHO standards had the highest sensitivity (70.2%) and specificity (85.8%) for predicting mortality in India. No indicator was a good predictor in Ghana or Peru. In infants aged 6–12 months, underweight at 6 months had the highest sensitivity and specificity for predicting mortality in Ghana (37.0% and 82.2%, respectively) and Peru (33.3% and 97.9% respectively), while wasting was the best predictor in India (sensitivity: 54.6%; specificity: 85.5%). Conclusion Malnutrition indicators determined using WHO standards were better predictors of mortality than those determined using NCHS standards. No association was found between breastfeeding duration and malnutrition at 6 months. Use of WHO child growth standards highlighted the importance of malnutrition in the first 6 months of life. PMID:20428352

Formative research methods for designing culturally appropriate, integrated child nutrition and development interventions: An overview

PubMed Central

Bentley, Margaret E.; Johnson, Susan L.; Wasser, Heather; Creed-Kanashiro, Hilary; Shroff, Monal; Fernandez-Rao, Sylvia; Cunningham, Melissa

2014-01-01

Nutritional and developmental insults in the first few years of life have profound public health implications, including substantial contributions to neonatal, infant, and early childhood morbidity and mortality, as well as longer term impacts on cognitive development, school achievement, and worker productivity. Optimal development that can lead to the attainment of the individual's fullest potential therefore requires a combination of genetic capacity, adequate nutrition, psychosocial stimulation, and safe, clean physical environments. Researchers and policymakers have called for integrated child nutrition and development interventions for more than twenty years, yet there are only a handful of efficacy trials and even fewer examples of integrated interventions that have been taken to scale. While a critical component to the design of such interventions is formative research, there is a dearth of information in both the literature and policy arenas to guide this phase of the process. To move the field forward, this paper first provides an overview of formative research methods with a focus on qualitative inquiry, a description of the critical domains to be assessed (infant and young child feeding, responsive feeding, and child development), and currently available resources. Application of these methods is provided through a real-world case study—the design of an integrated nutrition and child development efficacy trial in Andhra Pradesh, India. Recommendations for next steps are discussed, the most important of which is the need for a comprehensive set of formative guidelines for designing locally tailored, culturally appropriate integrated interventions. PMID:24673167

Community health worker interventions are key to optimal infant immunization coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya

PubMed Central

Nzioki, Japheth Mativo; Ouma, James; Ombaka, James Hebert; Onyango, Rosebella Ongutu

2017-01-01

Introduction Immunization is a powerful and cost-effective health intervention which averts an estimated 2 to 3 million deaths every year. Kenya has a high infant and under five mortality and morbidity rates. Increasing routine child immunization coverage is one way of reducing child morbidity and mortality rates in Kenya. Community Health Workers (CHWs) have emerged as critical human resources for health in developing countries. The Community Strategy (CS) is one of the CHW led interventions promoting Maternal and Child Health (MCH) in Kenya. This study sought to establish the effect of CS on infant vaccination Coverage (IVC) in Mwingi west sub-county; Kenya. Methods This was a pretest - posttest experimental study design with 1 pretest and 2 post-test surveys conducted in intervention and control sites. Mwingi west and Mwingi north sub-counties where intervention and control sites respectively. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents. Results Intervention site end-term evaluation indicated that; the CS increased IVC by 10.1% (Z =6.0241, P <0.0001), from a suboptimal level of 88.7% at baseline survey to optimal level of 98.8% at end term survey. Infants in intervention site were 2.5 times more likely to receive all recommended immunizations within their first year of life [(crude OR= 2.475, P<0.0001; 95%CI: 1.794-3.414) (adj. OR=2.516, P<0.0001; 95%CI: 1.796-3.5240)]. Conclusion CS increased IVC in intervention site to optimal level (98.8%). To improve child health outcomes through immunization coverage, Kenya needs to fast-track nationwide implementation of the CS intervention. PMID:29138657

Maternal and child health in China.

PubMed Central

Hesketh, T.; Zhu, W. X.

1997-01-01

China has made great progress in improving the health of women and children over the past two generations. The success has been attributed to improved living standards, public health measures, and good access to health services. Although overall infant and maternal mortality rates are relatively low there are large differences in patterns of mortality between urban and rural areas. The Chinese have developed a hierarchical network of maternal and child health services, with each level taking a supervisory and teaching role for the level below it. Maternal and child health in China came to international attention in 1995 with the promulgation of the maternal and child health law. In China this was seen as a means of prioritising resources and improving the quality of services, but in the West it was widely described as a law on eugenics. PMID:9224139

Ramadan, Pregnancy, Nutrition, and Epidemiology.

PubMed

Stein, Aryeh D

2018-05-05

Ramadan is observed by 1.6 billion Muslims. In a paper published this month that uses data from the Nouna Health and Demographic Surveillance System site in Burkina Faso, it is found that experiencing Ramadan in early pregnancy is associated with an increased risk of child mortality. Ramadan exposes observant individuals to a specific pattern of nutrition and other behaviors, including changes in sleep patterns. How these behaviors might result in child mortality is not yet understood, and the findings reported in the paper should be replicated in other settings.

Oklahoma Kids Count Factbook, 2002.

ERIC Educational Resources Information Center

Ingraham, Sandy

This Kids Count Factbook details county and statewide trends in the well-being of children in Oklahoma. The statistical portrait is based on seven indicators or benchmarks of child well-being: (1) low birthweight infants; (2) infant mortality; (3) births to young teens; (4) child abuse and neglect; (5) child and teen death; (6) high school…

Child survival in big cities: the disadvantages of migrants.

PubMed

Brockerhoff, M

1995-05-01

Data from 15 Demographic and Health Surveys are used to examine whether rural-urban migrants in developing countries experience higher child mortality after settling in towns and cities than do lifelong urban residents, and if so, what individual or household characteristics account for this. Findings indicate that children of female migrants from the countryside generally have much poorer survival chances than other urban children. This survival disadvantage is more pronounced in big cities than in smaller urban areas, among migrants who have lived in the city for many years than among recent migrants, and in urban Latin America than in urban North Africa and sub-Saharan Africa. Within big cities, higher child mortality among migrant women is clearly related to their concentration in low-quality housing, and in part to fertility patterns at early ages of children and mother's educational attainment at later ages. Excess child mortality among urban migrants may also result from factors associated with the migration process, that are outlined in this study but not included in the analysis. Evidence of moderately high levels of residential segregation of migrant women in big cities suggests that opportunities exist for urban health programs to direct interventions to this disadvantaged segment of city populations.

Adding interventions to mass measles vaccinations in India

PubMed Central

Verguet, Stéphane; Morris, Shaun K; Sharma, Jitendar K; Ram, Usha; Gauvreau, Cindy; Jones, Edward; Jha, Prabhat; Jit, Mark

2016-01-01

Abstract Objective To quantify the impact on mortality of offering a hypothetical set of technically feasible, high-impact interventions for maternal and child survival during India’s 2010–2013 measles supplementary immunization activity. Methods We developed Lives Saved Tool models for 12 Indian states participating in the supplementary immunization, based on state- and sex-specific data on mortality from India’s Million Deaths Study and on health services coverage from Indian household surveys. Potential add-on interventions were identified through a literature review and expert consultations. We quantified the number of lives saved for a campaign offering measles vaccine alone versus a campaign offering measles vaccine with six add-on interventions (nutritional screening and complementary feeding for children, vitamin A and zinc supplementation for children, multiple micronutrient and calcium supplementation in pregnancy, and free distribution of insecticide-treated bednets). Findings The measles vaccination campaign saved an estimated 19 016 lives of children younger than 5 years. A hypothetical campaign including measles vaccine with add-on interventions was projected to save around 73 900 lives (range: 70 200–79 300), preventing 73 700 child deaths (range: 70 000–79 000) and 300 maternal deaths (range: 200–400). The most effective interventions in the whole package were insecticide-treated bednets, measles vaccine and preventive zinc supplementation. Girls accounted for 66% of expected lives saved (12 712/19 346) for the measles vaccine campaign, and 62% of lives saved (45 721/74 367) for the hypothetical campaign including add-on interventions. Conclusion In India, a measles vaccination campaign including feasible, high-impact interventions could substantially increase the number of lives saved and mitigate gender-related inequities in child mortality. PMID:27843161

Big Earthquakes and Little Children.

ERIC Educational Resources Information Center

Cottle, Thomas J.

1990-01-01

A children's social health index calculated from six aspects of social health indicates that the social health of children is deteriorating in the areas of infant mortality, child abuse, child poverty, teenage suicide, and high school dropouts. (SH)

Global Impact of Rotavirus Vaccination on Childhood Hospitalizations and Mortality From Diarrhea.

PubMed

Burnett, Eleanor; Jonesteller, Christine L; Tate, Jacqueline E; Yen, Catherine; Parashar, Umesh D

2017-06-01

In 2006, 2 rotavirus vaccines were licensed. We summarize the impact of rotavirus vaccination on hospitalizations and deaths from rotavirus and all-cause acute gastroenteritis (AGE) during the first 10 years since vaccine licensure, including recent evidence from countries with high child mortality. We used standardized guidelines (PRISMA) to identify observational evaluations of rotavirus vaccine impact among children <5 years of age that presented at least 12 months of pre- and post-vaccine introduction surveillance data. We identified 57 articles from 27 countries. Among children <5 years of age, the median percentage reduction in AGE hospitalizations was 38% overall and 41%, 30%, and 46% in countries with low, medium, and high child mortality, respectively. Hospitalizations and emergency department visits due to rotavirus AGE were reduced by a median of 67% overall and 71%, 59%, and 60% in countries with low, medium, and high child mortality, respectively. Implementation of rotavirus vaccines has substantially decreased hospitalizations from rotavirus and all-cause AGE. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Population-based study on infant mortality.

PubMed

Lima, Jaqueline Costa; Mingarelli, Alexandre Marchezoni; Segri, Neuber José; Zavala, Arturo Alejandro Zavala; Takano, Olga Akiko

2017-03-01

Although Brazil has reduced social, economic and health indicators disparities in the last decade, intra- and inter-regional differences in child mortality rates (CMR) persist in regions such as the state capital of Mato Grosso. This population-based study aimed to investigate factors associated with child mortality in five cohorts of live births (LB) of mothers living in Cuiabá (MT), Brazil, 2006-2010, through probabilistic linkage in 47,018 LB. We used hierarchical logistic regression analysis. Of the 617 child deaths, 48% occurred in the early neonatal period. CMR ranged from 14.6 to 12.0 deaths per thousand LB. The following remained independently associated with death: mothers without companion (OR = 1.32); low number of prenatal consultations (OR = 1.65); low birthweight (OR = 4.83); prematurity (OR = 3.05); Apgar ≤ 7 at the first minute (OR = 3.19); Apgar ≤ 7 at the fifth minute (OR = 4.95); congenital malformations (OR = 14.91) and male gender (OR = 1.26). CMR has declined in Cuiabá, however, there is need to guide public healthcare policies in the prenatal and perinatal period to reduce early neonatal mortality and further studies to identify the causes of preventable deaths.

Spatial cluster for clustering the influence factor of birth and death child in Bogor Regency, West Java

NASA Astrophysics Data System (ADS)

Bekti, Rokhana Dwi; Rachmawati, Ro'fah

2014-03-01

The number of birth and death child is the benchmarks to determine and monitor the health and welfare in Indonesia. It can be used to identify groups of people who have a high mortality risk. Identifying group is important to compare the characteristics of human that have high and low risk. These characteristics can be seen from the factors that influenced it. Furthermore, there are factors which influence of birth and death child, such us economic, health facility, education, and others. The influence factors of every individual are different, but there are similarities some individuals which live close together or in the close locations. It means there was spatial effect. To identify group in this research, clustering is done by spatial cluster method, which is view to considering the influence of the location or the relationship between locations. One of spatial cluster method is Spatial 'K'luster Analysis by Tree Edge Removal (SKATER). The research was conducted in Bogor Regency, West Java. The goal was to get a cluster of districts based on the factors that influence birth and death child. SKATER build four number of cluster respectively consists of 26, 7, 2, and 5 districts. SKATER has good performance for clustering which include spatial effect. If it compare by other cluster method, Kmeans has good performance by MANOVA test.

Contraceptive prevalence, reproductive health and our common future. The C. Donald Christian Memorial Lecture.

PubMed

Diczfalusy, E

1993-05-01

Worldwide, female sterilization is the most common contraceptive method, followed by IUDs and oral contraceptives. As unwanted pregnancy for women in developing countries can mean life or death, which may explain why modern contraceptive methods with low failure rates (e.g., sterilization, IUDs. and hormonal methods) predominate in developing countries. Conventional methods with relatively high failure rates (e.g., natural family planning, barrier methods, and withdrawal) predominate in developed countries. Developing-country governments first supported family planning programs for demographic reasons. They now embrace them because they save the lives of women and children. The four fundamental pillars of reproductive health policy are family planning, maternal care, infant and child care, and control of sexually transmitted diseases (STDs). Indicators of reproductive health include, rates of maternal mortality and morbidity; induced abortion; infertility; perinatal, infant, and child mortality; and STDs (including AIDS). Governments in the poorest countries invest only US$5 per capita for health, compared to US$400 per capita for developed countries. If the poorest countries increased that $5 figure by just $2 per capita, they could immunize all children, eradicate polio, and provide the drugs to cure the most common diseases. Further, if humans were to use resources more reasonably, we could greatly decrease the number of people living in poverty. Three UN population projections show that the population will continue to grow well within the next century. With strong commitment from governments and individuals, we can increase contraceptive use and reduce total fertility rates. Barriers to achieving those goals are few funds allocated to family planning methods and services; politicians; religious and community leaders; culture; low women's status; limited accessibility to information, methods, and quality services; and limited contraceptive choice.

Livestock Ownership among Rural Households and Child Morbidity and Mortality: An Analysis of Demographic Health Survey Data from 30 Sub-Saharan African Countries (2005–2015)

PubMed Central

Kaur, Maneet; Graham, Jay P.; Eisenberg, Joseph N. S.

2017-01-01

Children living in homes with livestock may have both an increased risk of enteric infections and improved access to food, and therefore improved nutritional status. Few studies, however, have characterized these relationships in tandem. This study investigated the association between child health and household ownership of livestock. A cross-sectional study was performed using data from Demographic and Health Surveys conducted in 30 sub-Saharan African countries with 215,971 rural children under 5 years of age from 2005 to 2015. Logistic regression was performed for each country to estimate the relationship between a log2 increase in the number of livestock owned by the household and three child-health outcomes: 2-week prevalence of diarrhea, stunting, and all-cause mortality. Results for each country were combined using meta-analyses. Most countries (22 of 30) displayed an odds ratio (OR) less than 1 for child stunting associated with livestock (pooled OR = 0.97; 95% confidence interval [CI] = 0.95, 0.99). The results for diarrhea were more even with 14 countries displaying ORs greater than 1 and 10 displaying ORs less than 1. Most countries (22 of 30) displayed an OR greater than 1 for child mortality (pooled OR = 1.04; 95% CI = 1.02, 1.06). All meta-analyses displayed significant heterogeneity by country. Our analysis is consistent with the theory that livestock may have a dual role as protective against stunting, an indicator of chronic malnutrition, and a risk factor for all-cause mortality in children, which may be linked to acute infections. The heterogeneity by country, however, indicates more data are needed on specific household livestock management practices. PMID:28044044

Livestock Ownership Among Rural Households and Child Morbidity and Mortality: An Analysis of Demographic Health Survey Data from 30 Sub-Saharan African Countries (2005-2015).

PubMed

Kaur, Maneet; Graham, Jay P; Eisenberg, Joseph N S

2017-03-01

AbstractChildren living in homes with livestock may have both an increased risk of enteric infections and improved access to food, and therefore improved nutritional status. Few studies, however, have characterized these relationships in tandem. This study investigated the association between child health and household ownership of livestock. A cross-sectional study was performed using data from Demographic and Health Surveys conducted in 30 sub-Saharan African countries with 215,971 rural children under 5 years of age from 2005 to 2015. Logistic regression was performed for each country to estimate the relationship between a log 2 increase in the number of livestock owned by the household and three child-health outcomes: 2-week prevalence of diarrhea, stunting, and all-cause mortality. Results for each country were combined using meta-analyses. Most countries (22 of 30) displayed an odds ratio (OR) less than 1 for child stunting associated with livestock (pooled OR = 0.97; 95% confidence interval [CI] = 0.95, 0.99). The results for diarrhea were more even with 14 countries displaying ORs greater than 1 and 10 displaying ORs less than 1. Most countries (22 of 30) displayed an OR greater than 1 for child mortality (pooled OR = 1.04; 95% CI = 1.02, 1.06). All meta-analyses displayed significant heterogeneity by country. Our analysis is consistent with the theory that livestock may have a dual role as protective against stunting, an indicator of chronic malnutrition, and a risk factor for all-cause mortality in children, which may be linked to acute infections. The heterogeneity by country, however, indicates more data are needed on specific household livestock management practices.

The impact of internal displacement on child mortality in post-earthquake Haiti: a difference-in-differences analysis.

PubMed

Chen, Bradley; Halliday, Timothy J; Fan, Victoria Y

2016-07-19

The Haiti earthquake in 2010 resulted in 1.5 million internally displaced people (IDP), yet little is known about the impact of displacement on health. In this study, we estimate the impact of displacement on infant and child mortality and key health-behavior mechanisms. We employ a difference-in-differences (DID) design with coarsened exact matching (CEM) to ensure comparability among groups with different displacement status using the 2012 Haiti Demographic and Health Survey (DHS). The participants are 21,417 births reported by a nationally representative sample of 14,287 women aged 15-49. The main independent variables are household displacement status which includes households living in camps, IDP households (not in camps), and households not displaced. The main outcomes are infant and child mortality; health status (height-for-age, anemia); uptake of public health interventions (bed net use, spraying against mosquitoes, and vaccinations); and other conditions (hunger; cholera). Births from the camp households have higher infant mortality (OR = 2.34, 95 % CI 1.15 to 4.75) and child mortality (OR = 2.34, 95 % CI 1.10 to 5.00) than those in non-camp IDP households following the earthquake. These odds are higher despite better access to food, water, bed net use, mosquito spraying, and vaccines among camp households. IDP populations are heterogeneous and households that are displaced outside of camps may be self-selected or self-insured. Meanwhile, even households not displaced by a disaster may face challenges in access to basic necessities and health services. Efforts are needed to identify vulnerable populations to provide targeted assistance in post-disaster relief.

The Effects of an Integrated Community Case Management Strategy on the Appropriate Treatment of Children and Child Mortality in Kono District, Sierra Leone: A Program Evaluation.

PubMed

Ratnayake, Ruwan; Ratto, Jeffrey; Hardy, Colleen; Blanton, Curtis; Miller, Laura; Choi, Mary; Kpaleyea, John; Momoh, Pheabean; Barbera, Yolanda

2017-09-01

Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM's impact and effects on child health using cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 [95% confidence interval [CI]: 3.47-5.60] to 3.95 [95% CI: 3.06-4.83] deaths per 1,000 per month ( P = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2-52.0] to 58.2% [95% CI: 50.5-65.5] ( P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM's role in Kono district.

Cost and impact of scaling up interventions to save lives of mothers and children: taking South Africa closer to MDGs 4 and 5

PubMed Central

Chola, Lumbwe; Pillay, Yogan; Barron, Peter; Tugendhaft, Aviva; Kerber, Kate; Hofman, Karen

2015-01-01

Background South Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved. Design We modelled the impact of maternal, newborn and child interventions using the Lives Saved Tools Projections to 2015 and used realistic coverage increases based on expert opinion considering recent policy change, financial and resource inputs, and observed coverage change. A scenario analysis was undertaken to test the impact of increasing intervention coverage to 95%. Results By 2015, with realistic coverage, the maternal mortality ratio (MMR) can reduce to 153 deaths per 100,000 and child mortality to 34 deaths per 1,000 live births. Fifteen interventions, including labour and delivery management, early HIV treatment in pregnancy, prevention of mother-to-child transmission and handwashing with soap, will save an additional 9,000 newborns and children and 1,000 mothers annually. An additional US$370 million (US$7 per capita) will be required annually to scale up these interventions. When intervention coverage is increased to 95%, breastfeeding promotion becomes the top intervention, the MMR reduces to 116 and the child mortality ratio to 23. Conclusions The 15 interventions identified were adopted by the National Department of Health, and the Health Minister launched a campaign to encourage Provincial Health Departments to scale up coverage. It is hoped that by focusing on implementing these 15 interventions at high quality, South Africa will reach Millennium Development Goal (MDG) 4 soon after 2015 and MDG 5 several years later. Focus on HIV and TB during early antenatal care is essential. Strategic gains could be realised by targeting vulnerable populations and districts with the worst health outcomes. The analysis demonstrates the usefulness of priority setting tools and the potential for evidence-based decision making in the health sector. PMID:25906769

Mothers' reading skills and child survival in Nigeria: examining the relevance of mothers' decision-making power.

PubMed

Smith-Greenaway, Emily

2013-11-01

Mothers' literacy skills are emerging as a key determinant of children's health and survival in low-income contexts, with emphasis on the cognitive and psychological agency that literacy skills provide. This work has clearly established a strong association between mothers' reading skills--a key subcomponent of broader literacy and language skills--and child mortality. However, this relatively nascent literature has not yet considered how broader social structures condition the process. In Nigeria and in sub-Saharan Africa more broadly, gender-based social inequality constrains many mothers' decision-making power over children's health matters; this structural feature may condition the association between mothers' reading skills and child mortality. This paper uses data from the 2003 Nigerian Demographic and Health Survey (N = 12,076) to test the conditionality of the relationship between mothers' reading skills and child survival on mothers' decision-making power, highlighting how structural realities should factor more heavily into this individual-action-oriented literature. Among Nigerian children whose mothers have decision-making power, mothers' reading skills convey a 27 percent lower risk of child mortality; however, for children whose mothers lack decision-making power, mothers' reading skills do not yield a significant survival advantage. Overall, these findings support the need for future work to further analyze how broader social structures condition the benefits of mothers' reading skills for children's health. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mothers’ Reading Skills and Child Survival in Nigeria: Examining the Relevance of Mothers’ Decision-Making Power

PubMed Central

Smith-Greenaway, Emily

2013-01-01

Mothers’ literacy skills are emerging as a key determinant of children’s health and survival in low-income contexts, with emphasis on the cognitive and psychological agency that literacy skills provide. This work has clearly established a strong association between mothers’ reading skills—a key subcomponent of broader literacy and language skills—and child mortality. However, this relatively nascent literature has not yet considered how broader social structures condition the process. In Nigeria and in sub-Saharan Africa more broadly, gender-based social inequality constrains many mothers’ decision-making power over children’s health matters; this structural feature may condition the association between mothers’ reading skills and child mortality. This paper uses data from the 2003 Nigerian Demographic and Health Survey (N = 12,076) to test the conditionality of the relationship between mothers’ reading skills and child survival on mothers’ decision-making power, highlighting how structural realities should factor more heavily into this individual-action-oriented literature. Among Nigerian children whose mothers have decision-making power, mothers’ reading skills convey a 27 percent lower risk of child mortality; however, for children whose mothers lack decision-making power, mothers’ reading skills do not yield a significant survival advantage. Overall, these findings support the need for future work to further analyze how broader social structures condition the benefits of mothers’ reading skills for children’s health. PMID:24161100

Quantifying the indirect effects of key child survival interventions for pneumonia, diarrhoea, and measles.

PubMed

Fischer Walker, C L; Munos, M K; Black, R E

2013-01-01

To date many studies have measured the effect of key child survival interventions on the main cause of mortality while anecdotally reporting effects on all-cause mortality. We conducted a systematic literature review and abstracted cause-specific and all-cause mortality data from included studies. We then estimated the effect of the intervention on the disease of primary interest and calculated the additional deaths prevented (i.e. the indirect effect). We calculated that insecticide-treated nets have been shown to result in a 12% reduction [95% confidence interval (CI) 0·0-23] among non-malaria deaths. We found pneumonia case management to reduce non-pneumonia mortality by 20% (95% CI 8-22). For measles vaccine, seven of the 10 studies reporting an effect on all-cause mortality demonstrated an additional benefit of vaccine on all-cause mortality. These interventions may have benefits on causes of death beyond the specific cause of death they are targeted to prevent and this should be considered when evaluating the effects of implementation of interventions.

Burden of climate change on malaria mortality.

PubMed

Dasgupta, Shouro

2018-06-01

In 2016, an estimated 445,000 deaths and 216 million cases of malaria occurred worldwide, while 70% of the deaths occurred in children under five years old. Changes in climatic exposures such as temperature and precipitation make malaria one of the most climate sensitive outcomes. Using a global malaria mortality dataset for 105 countries between 1980 and 2010, we find a non-linear relationship between temperature and malaria mortality and estimate that the global optimal temperature threshold beyond which all-age malaria mortality increases is 20.8 °C, while in the case of child mortality; a significantly lower optimum temperature of 19.3° is estimated. Our results also suggest that this optimal temperature is 28.4 °C and 26.3 °C in Africa and Asia, respectively - the continents where malaria is most prevalent. Furthermore, we estimate that child mortality (ages 0-4) is likely to increase by up to 20% in some areas due to climate change by the end of the 21st century. Copyright © 2018 Elsevier GmbH. All rights reserved.

Advancing the application of systems thinking in health: understanding the dynamics of neonatal mortality in Uganda

PubMed Central

2014-01-01

Background Of the three million newborns that die each year, Uganda ranks fifth highest in neonatal mortality rates, with 43,000 neonatal deaths each year. Despite child survival and safe motherhood programmes towards reducing child mortality, insufficient attention has been given to this critical first month of life. There is urgent need to innovatively employ alternative solutions that take into account the intricate complexities of neonatal health and the health systems. In this paper, we set out to empirically contribute to understanding the causes of the stagnating neonatal mortality by applying a systems thinking approach to explore the dynamics arising from the neonatal health complexity and non-linearity and its interplay with health systems factors, using Uganda as a case study. Methods Literature reviews and interviews were conducted in two divisions of Kampala district with high neonatal mortality rates with mothers at antenatal clinics and at home, village health workers, community leaders, healthcare decision and policy makers, and frontline health workers from both public and private health facilities. Data analysis and brainstorming sessions were used to develop causal loop diagrams (CLDs) depicting the causes of neonatal mortality, which were validated by local and international stakeholders. Results We developed two CLDs for demand and supply side issues, depicting the range of factors associated with neonatal mortality such as maternal health, level of awareness of maternal and newborn health, and availability and quality of health services, among others. Further, the reinforcing and balancing feedback loops that resulted from this complexity were also examined. The potential high leverage points include special gender considerations to ensure that girls receive essential education, thereby increasing maternal literacy rates, improved socioeconomic status enabling mothers to keep healthy and utilise health services, improved supervision, and internal audits at the health facilities as well as addressing the gaps in resources (human, logistics, and drugs). Conclusions Synthesis of theoretical concepts through CLDs facilitated our understanding and interpretation of the interactions and feedback loops that contributed to the stagnant neonatal mortality rates in Uganda, which is the first step towards discussing and exploring the potential strategies and their likely impact. PMID:25104047

Socioeconomic position, health behaviors, and racial disparities in cause-specific infant mortality in Michigan, USA

PubMed Central

El-Sayed, Abdulrahman M.; Finkton, Darryl W.; Paczkowski, Magdalena; Keyes, Katherine M.; Galea, Sandro

2015-01-01

Objectives Studies about racial disparities in infant mortality suggest that racial differences in socioeconomic position (SEP) and maternal risk behaviors explain some, but not all, excess infant mortality among Blacks relative to non-Hispanic Whites. We examined the contribution of these to disparities in specific causes of infant mortality. Methods We analyzed data about 2,087,191 mother–child dyads in Michigan between 1989 and 2005. First, we calculated crude Black–White infant mortality ratios independently and by specific cause of death. Second, we fit multivariable Poisson regression models of infant mortality, overall and by cause, adjusting for SEP and maternal risk behaviors. Third, Crude Black–White mortality ratios were compared to adjusted predicted probability ratios, overall and by specific cause. Results SEP and maternal risk behaviors explained nearly a third of the disparity in infant mortality overall, and over 25% of disparities in several specific causes including homicide, accident, sudden infant death syndrome, and respiratory distress syndrome. However, SEP and maternal risk behaviors had little influence on disparities in other specific causes, such as septicemia and congenital anomalies. Conclusions These findings help focus policy attention toward disparities in those specific causes of infant mortality most amenable to social and behavioral intervention, as well as research attention to disparities in specific causes unexplained by SEP and behavioral differences. PMID:25849882

Somalia: supporting the child survival agenda when routine health service is broken.

PubMed

Mirza, Imran Raza; Kamadjeu, Raoul; Assegid, Kebede; Mulugeta, Abraham

2012-03-01

Somalia, one of the most unstable countries in the world, has been without a permanent government for nearly 2 decades. With a health system in total disarray, coverage of basic health interventions remains low and, maternal and child mortality is among the highest in the world. Health partners jointly outlined an integrated package of critical child survival interventions to be delivered through a population-based delivery strategy known as Child Health Days (CHDs), to reduce child mortality. Using this strategy, key child survival interventions are delivered to the community with an objective of reaching children <5 years and women of childbearing age in all districts of Somalia every 6 months. Through this strategy, immunization services were reached in remote areas, and coverage disparity between the urban and rural areas was reduced from 17% (42% urban and 25% rural) to 10% (50% urban and 60% rural). In addition, infants were reached with a third dose of diphtheria-pertussis-tetanus vaccine, achieving 51% coverage during 2009 and 66% in 2010. This paper summarizes the challenges of scaling up child interventions in the troubled context of Somalia by reviewing the planning, implementation, and achievements of CHDs as well as reflecting on challenges for the future of child survival in Somalia.

Are urban children really healthier? Evidence from 47 developing countries.

PubMed

Van de Poel, Ellen; O'Donnell, Owen; Van Doorslaer, Eddy

2007-11-01

On average, child health outcomes are better in urban than in rural areas of developing countries. Understanding the nature and the causes of this rural-urban disparity is essential in contemplating the health consequences of the rapid urbanization taking place throughout the developing world and in targeting resources appropriately to raise population health. Using micro-data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries, the purpose of this paper is threefold. First, we document the magnitude of rural-urban disparities in child nutritional status and under-5 mortality across all 47 developing countries. Second, we adjust these disparities for differences in population characteristics across urban and rural settings. Third, we examine rural-urban differences in the degree of socioeconomic inequality in these health outcomes. The results demonstrate that there are considerable rural-urban differences in mean child health outcomes in the entire developing world. The rural-urban gap in stunting does not entirely mirror the gap in under-5 mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in growth stunting is more than 1.5 times higher than that in mortality. On average, the rural-urban risk ratios of stunting and under-5 mortality fall by, respectively, 53% and 59% after controlling for household wealth. Controlling thereafter for socio-demographic factors reduces the risk ratios by another 22% and 25%. We confirm earlier findings of higher socioeconomic inequality in stunting in urban areas and demonstrate that this also holds for under-5 mortality. In a considerable number of countries, the urban poor actually have higher rates of stunting and mortality than their rural counterparts. The findings imply that there is a need for programs that target the urban poor, and that this is becoming more necessary as the size of the urban population grows.

Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals.

PubMed

Liu, Li; Oza, Shefali; Hogan, Dan; Chu, Yue; Perin, Jamie; Zhu, Jun; Lawn, Joy E; Cousens, Simon; Mathers, Colin; Black, Robert E

2016-12-17

Despite remarkable progress in the improvement of child survival between 1990 and 2015, the Millennium Development Goal (MDG) 4 target of a two-thirds reduction of under-5 mortality rate (U5MR) was not achieved globally. In this paper, we updated our annual estimates of child mortality by cause to 2000-15 to reflect on progress toward the MDG 4 and consider implications for the Sustainable Development Goals (SDG) target for child survival. We increased the estimation input data for causes of deaths by 43% among neonates and 23% among 1-59-month-olds, respectively. We used adequate vital registration (VR) data where available, and modelled cause-specific mortality fractions applying multinomial logistic regressions using adequate VR for low U5MR countries and verbal autopsy data for high U5MR countries. We updated the estimation to use Plasmodium falciparum parasite rate in place of malaria index in the modelling of malaria deaths; to use adjusted empirical estimates instead of modelled estimates for China; and to consider the effects of pneumococcal conjugate vaccine and rotavirus vaccine in the estimation. In 2015, among the 5·9 million under-5 deaths, 2·7 million occurred in the neonatal period. The leading under-5 causes were preterm birth complications (1·055 million [95% uncertainty range (UR) 0·935-1·179]), pneumonia (0·921 million [0·812 -1·117]), and intrapartum-related events (0·691 million [0·598 -0·778]). In the two MDG regions with the most under-5 deaths, the leading cause was pneumonia in sub-Saharan Africa and preterm birth complications in southern Asia. Reductions in mortality rates for pneumonia, diarrhoea, neonatal intrapartum-related events, malaria, and measles were responsible for 61% of the total reduction of 35 per 1000 livebirths in U5MR in 2000-15. Stratified by U5MR, pneumonia was the leading cause in countries with very high U5MR. Preterm birth complications and pneumonia were both important in high, medium high, and medium child mortality countries; whereas congenital abnormalities was the most important cause in countries with low and very low U5MR. In the SDG era, countries are advised to prioritise child survival policy and programmes based on their child cause-of-death composition. Continued and enhanced efforts to scale up proven life-saving interventions are needed to achieve the SDG child survival target. Bill & Melinda Gates Foundation, WHO. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Determinants of Performance of Health Systems Concerning Maternal and Child Health: A Global Approach

PubMed Central

Pinzón-Flórez, Carlos Eduardo; Fernández-Niño, Julián Alfredo; Ruiz-Rodríguez, Myriam; Idrovo, Álvaro J.; Arredondo López, Abel Armando

2015-01-01

Aims To assess the association of social determinants on the performance of health systems around the world. Methods A transnational ecological study was conducted with an observation level focused on the country. In order to research on the strength of the association between the annual maternal and child mortality in 154 countries and social determinants: corruption, democratization, income inequality and cultural fragmentation, we used a mixed linear regression model for repeated measures with random intercepts and a conglomerate-based geographical analysis, between 2000 and 2010. Results Health determinants with a significant association on child mortality(<1year): higher access to water (βa Quartile 4(Q4) vs Quartile 1(Q1) = -6,14; 95%CI: -11,63 to -0,73), sanitation systems, (Q4 vs Q1 = -25,58; 95%CI: -31,91 to -19,25), % measles vaccination coverage (Q4 vs Q1 = -7.35; 95%CI: -10,18 to -4,52), % of births attended by a healthcare professional (Q4 vs Q1 = -7,91; 95%CI: -11,36 to -4,52) and a % of the total health expenditure (Q3 vs Q1 = -2,85; 95%CI: -4,93 to -0,7). Ethnic fragmentation (Q4 vs Q1 = 9,93; 95%CI: -0.03 to 19.89) had a marginal effect. For child mortality<5 years, an association was found for these variables and democratization (not free vs free = 11,23; 95%CI: -0,82 to 23,29), out-of-pocket expenditure (Q1 vs Q4 = 17,71; 95%CI: 5,86 to 29,56). For MMR (Maternal mortality ratio), % of access to water for all the quartiles, % of access to sanitation systems, (Q3 vs Q1 = -171,15; 95%CI: -281,29 to -61), birth attention by a healthcare professional (Q4 vs Q1 = -231,23; 95%CI: -349,32 to -113,15), and having corrupt government (Q3 vs Q1 = 83,05; 95%CI: 33,10 to 133). Conclusions Improving access to water and sanitation systems, decreasing corruption in the health sector must become priorities in health systems. The ethno-linguistic cultural fragmentation and the detriment of democracy turn out to be two factors related to health results. PMID:25822246

Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5?

PubMed

Moucheraud, Corrina; Owen, Helen; Singh, Neha S; Ng, Courtney Kuonin; Requejo, Jennifer; Lawn, Joy E; Berman, Peter

2016-09-12

Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi, Niger, Pakistan, Peru, and Tanzania. This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress. Applying a standard evaluation framework, analyses of impact, coverage and equity were undertaken, including a mixed methods analysis of how these were influenced by national context and coverage determinants (including health systems, policies and financing). The majority (7/10) of case study countries met MDG-4 with over two-thirds reduction in child mortality, but none met MDG-5a for 75 % reduction in maternal mortality, although six countries achieved >75 % of this target. None achieved MDG-5b regarding reproductive health. Rates of reduction in neonatal mortality were half or less that for post-neonatal child mortality. Coverage increased most for interventions administered at lower levels of the health system (e.g., immunisation, insecticide treated nets), and these experienced substantial political and financial support. These interventions were associated with ~30-40 % of child lives saved in 2012 compared to 2000, in Ethiopia, Malawi, Peru and Tanzania. Intrapartum care for mothers and newborns -- which require higher-level health workers, more infrastructure, and increased community engagement -- showed variable increases in coverage, and persistent equity gaps. Countries have explored different approaches to address these problems, including shifting interventions to the community setting and tasks to lower-level health workers. These Countdown case studies underline the importance of consistent national investment and global attention for achieving improvements in RMNCH. Interventions with major global investments achieved higher levels of coverage, reduced equity gaps and improvements in associated health outcomes. Given many competing priorities for the Sustainable Development Goals era, it is essential to maintain attention to the unfinished RMNCH agenda, particularly health systems improvements for maternal and neonatal outcomes where progress has been slower, and to invest in data collection for monitoring progress and for rigorous analyses of how progress is achieved in different contexts.

Modelling determinants, impact, and space-time risk of age-specific mortality in rural South Africa: integrating methods to enhance policy relevance.

PubMed

Sartorius, Benn

2013-01-24

There is a lack of reliable data in developing countries to inform policy and optimise resource allocation. Health and socio-demographic surveillance sites (HDSS) have the potential to address this gap. Mortality levels and trends have previously been documented in rural South Africa. However, complex space-time clustering of mortality, determinants, and their impact has not been fully examined. To integrate advanced methods enhance the understanding of the dynamics of mortality in space-time, to identify mortality risk factors and population attributable impact, to relate disparities in risk factor distributions to spatial mortality risk, and thus, to improve policy planning and resource allocation. Agincourt HDSS supplied data for the period 1992-2008. Advanced spatial techniques were used to identify significant age-specific mortality 'hotspots' in space-time. Multivariable Bayesian models were used to assess the effects of the most significant covariates on mortality. Disparities in risk factor profiles in identified hotspots were assessed. Increasing HIV-related mortality and a subsequent decrease possibly attributable to antiretroviral therapy introduction are evident in this rural population. Distinct space-time clustering and variation (even in a small geographic area) of mortality were observed. Several known and novel risk factors were identified, and population impact was quantified. Significant differences in the risk factor profiles of the identified 'hotspots' included ethnicity; maternal, partner, and household deaths; household head demographics; migrancy; education; and poverty. A complex interaction of highly attributable multilevel factors continues to demonstrate differential space-time influences on mortality risk (especially for HIV). High-risk households and villages displayed differential risk factor profiles. This integrated approach could prove valuable to decision makers. Tailored interventions for specific child and adult high-risk mortality areas are needed, such as preventing vertical transmission, ensuring maternal survival, and improving water and sanitation infrastructure. This framework can be applied in other settings within the region.

Success factors for reducing maternal and child mortality

PubMed Central

Schweitzer, Julian; Bishai, David; Chowdhury, Sadia; Caramani, Daniele; Frost, Laura; Cortez, Rafael; Daelmans, Bernadette; de Francisco, Andres; Adam, Taghreed; Cohen, Robert; Alfonso, Y Natalia; Franz-Vasdeki, Jennifer; Saadat, Seemeen; Pratt, Beth Anne; Eugster, Beatrice; Bandali, Sarah; Venkatachalam, Pritha; Hinton, Rachael; Murray, John; Arscott-Mills, Sharon; Axelson, Henrik; Maliqi, Blerta; Sarker, Intissar; Lakshminarayanan, Rama; Jacobs, Troy; Jacks, Susan; Mason, Elizabeth; Ghaffar, Abdul; Mays, Nicholas; Presern, Carole; Bustreo, Flavia

2014-01-01

Abstract Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women’s and Children’s Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula – fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women’s and children’s health towards 2015 and beyond. PMID:25110379

Success factors for reducing maternal and child mortality.

PubMed

Kuruvilla, Shyama; Schweitzer, Julian; Bishai, David; Chowdhury, Sadia; Caramani, Daniele; Frost, Laura; Cortez, Rafael; Daelmans, Bernadette; de Francisco, Andres; Adam, Taghreed; Cohen, Robert; Alfonso, Y Natalia; Franz-Vasdeki, Jennifer; Saadat, Seemeen; Pratt, Beth Anne; Eugster, Beatrice; Bandali, Sarah; Venkatachalam, Pritha; Hinton, Rachael; Murray, John; Arscott-Mills, Sharon; Axelson, Henrik; Maliqi, Blerta; Sarker, Intissar; Lakshminarayanan, Rama; Jacobs, Troy; Jack, Susan; Jacks, Susan; Mason, Elizabeth; Ghaffar, Abdul; Mays, Nicholas; Presern, Carole; Bustreo, Flavia

2014-07-01

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women's and Children's Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula--fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women's and children's health towards 2015 and beyond.

Birth spacing, sibling rivalry and child mortality in India.

PubMed

Whitworth, Alison; Stephenson, Rob

2002-12-01

The detrimental impact of short preceding birth intervals on infant and early childhood mortality is well documented in demographic literature, although the pathways of influence within the relationship remain an area of debate. This paper examines the impact of the length of the preceding birth interval on under-two mortality in India, and examines the pathways through which short preceding birth intervals may lead to an increased risk of mortality. Three mortality periods are examined: neonatal, early post neonatal and late post-neonatal and toddler, using the 1992 Indian National Family Health Survey. A multilevel modelling approach is used to account for the hierarchical nature of the data. The determinants of infants following a short or long birth interval are also examined. The results show that short preceding birth intervals (< 18 months) are associated with an increased risk of mortality in all three age groups, and the effect is particularly marked in the early post-neonatal period. Significant interactions were found between the length of the preceding birth interval and maternal education, gender and the survival status of the previous child. The significance of these interactions varied with the age of the child. The results highlight the diluting effect that a higher level of maternal education has on the relationship between short preceding birth intervals and mortality risk. There is evidence to suggest that sibling rivalry is a pathway through which short birth intervals influence mortality, with the death of the previous sibling removing the competition for scarce resources, and resulting in lower risks of mortality than if the previous sibling was still alive. The greatest risks of an infant following a short birth interval are among those whose previous sibling died, high parities, those with young mothers, and those whose previous sibling was breastfed for a short duration. Copyright 2002 Elsevier Science Ltd.

The unfinished health agenda: Neonatal mortality in Cambodia.

PubMed

Hong, Rathmony; Ahn, Pauline Yongeun; Wieringa, Frank; Rathavy, Tung; Gauthier, Ludovic; Hong, Rathavuth; Laillou, Arnaud; Van Geystelen, Judit; Berger, Jacques; Poirot, Etienne

2017-01-01

Reduction of neonatal and under-five mortality rates remains a primary target in the achievement of universal health goals, as evident in renewed investments of Sustainable Development Goals. Various studies attribute declines in mortality to the combined effects of improvements in health care practices and changes in socio-economic factors. Since the early nineties, Cambodia has managed to evolve from a country devastated by war to a nation soon to enter the group of middle income countries. Cambodia's development efforts are reflected in some remarkable health outcomes such as a significant decline in child mortality rates and the early achievement of related Millennium Development Goals. An achievement acknowledged through the inclusion of Cambodia as one of the ten fast-track countries in the Partnership for Maternal, Newborn and Child Health. This study aims to highlight findings from the field so to provide evidence for future programming and policy efforts. It will be argued that to foster further advances in health, Cambodia will need to keep neonatal survival and health high on the agenda and tackle exacerbating inequities that arise from a pluralistic health system with considerable regional differences and socio-economic disparities. Data was drawn from Demographic Health Surveys (2000, 2005, 2010, 2014). Information on a series of demographic and socio-economic household characteristics and on child anthropometry, feeding practices and child health were collected from nationally representative samples. To reach the required sample size, live-births that occurred over the past 10 years before the date of the interview were included. Demographic variables included: gender of the child, living area (urban or rural; four ecological regions (constructed by merging provinces and the capital), mother's age at birth (<20, 20-35, 35+), birth interval (long, short) and birth order (1st, 2-3, 4-6, 7+). Socio-economic variables included: mother education level (none, primary, secondary+) and household wealth (asset-based index). Data on antenatal care, tetanus injection and skilled assistance at birth were used for the mother's last child. Between 2000 and 2014, Cambodia achieved a considerable reduction in neonatal mortality (46% reduction rate). By 2014, gender inequities became almost non-existent (for all measures of equality); inequity related to mother's education decreased for all time periods; improvements were observed for differences in neonatal mortality by preceding birth interval; and a reduction in neonatal mortality rates could be noted among all the regional subgroups. Inequities increased between mothers who had limited antenatal care and those who received more than four antenatal care visits. In most scale indicators, the Slope Index of Inequality and Relative Index of Inequality estimates for all four rounds of the survey suggest inequity exacerbated in deprived communities. Also, wealth and residence (urban/rural divide) continued to be major determinants in neonatal mortality rates and related inequity trends. Analysis highlighted some of the complex patterns and determinants of neonatal mortality, in Cambodia. There has been a considerable decline in neonatal mortality which echoes global trends. Our analysis reveals that despite these advances, additional socio-economic and demographic characteristics considerably affected neonatal mortality rates and its inequities. There continue to be pockets of vulnerable groups that are lagging behind. This analysis highlights the determinants along the urban-rural and rich-poor divides in neonatal mortality inequities and how these affect access to and utilization of quality basic health services. This calls for future policy and programming efforts to be deliberate in their equity approach. Quality improvements in health services and targeted interventions for specific socio-economic groups will be required to further accelerate progress in reducing neonatal mortality and address Cambodia's pressing unfinished agenda in health.

Socioeconomic Inequality and Its Determinants Regarding Infant Mortality in Iran

PubMed Central

Damghanian, Maryam; Shariati, Mohammad; Mirzaiinajmabadi, Khadigeh; Yunesian, Masud; Emamian, Mohammad Hassan

2014-01-01

Background: Infant mortality rate is a useful indicator of health conditions in the society, the racial and socioeconomic inequality of which is from the most important measures of social inequality. Objectives: The aim of this study was to determine the socioeconomic inequality and its determinants regarding infant mortality in an Iranian population. Patients and Methods: This cross-sectional study was performed on 3794 children born during 2010-2011 in Shahroud, Iran. Based on children’s addresses and phone numbers, 3412 were available and finally 3297 participated in the study. A data collection form was filled out through interviewing the mothers as well as using health records. Using principal component analysis, the study population was divided to high and low socioeconomic groups based on the case’s home asset, education and job of the household’s head, marital status, and composition of the household members. Inequality between the groups with regard to infant mortality was investigated by Blinder-Oaxaca decomposition method. Results: The mortality rate was 15.1 per 1000 live births in the high socioeconomic group and 42.3 per 1000 in the low socioeconomic group. Mother's education, consanguinity of parents, and infant's nutrition type and birth weight constituted 44% of the gap contributing factors. Child's gender, high-risk pregnancy, and living area had no impact on the gap. Conclusions: There was considerable socioeconomic inequality regarding infant mortality in Shahroud. Mother's education was the most contributing factor in this inequality. PMID:25068048

Trends in childhood mortality in Kenya: The urban advantage has seemingly been wiped out

PubMed Central

Kimani-Murage, E.W.; Fotso, J.C.; Egondi, T.; Abuya, B.; Elungata, P.; Ziraba, A.K.; Kabiru, C.W.; Madise, N.

2014-01-01

Background We describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials. Methods We use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR). Results Between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya. Conclusions The narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums. PMID:25024120

Changes in mortality in Pakistan 1960-88.

PubMed

Sathar, Z A

1991-01-01

General trends in Pakistan infant/child mortality, adult mortality, differentials in mortality, and prospects for future declines in mortality are presented. Future mortality declines are desired and recognized by government policy. Paucity of data and quality control issues cloud an accurate presentation of trends. The crude death rate (CDR) has nonetheless declined in 4 decades form 40-50/1000 in 1900 to 10-12/1000 in the late 1970s and early 1980s. The 1984-88 Pakistan Demographic Survey (PDS) reports a CDR of 10.8/1000. Life expectancy is expected to improve. The majority of deaths are infant/child related. Government policy aims to have 1 trained traditional birth attendant/village in order to improve maternal and child care. Although official statistics are in dispute, there is general agreement that infant mortality has declined particularly in neonatal mortality, i.e., infant mortality is now at 56-62/1000 and neonatal mortality 48/1000 in 1988. Data are derived from the Pakistan Fertility Survey (PFS), and Population Labor Force and Migration Survey (PLM) in the 1960-70s, the 1976-79 Population Growth Surveys (PGS), and the 1984-88 PDS. Lower death rates have also occurred among adults. Sex differentials in mortality have reversed, although the sex ratio still favors males; the improvement may be due to better reporting of female mortality. Life expectancy has improved for women, and there are gains over males. The disadvantage at 15-40 years has been eliminated. Differential mortality is expressed geographically, where urban mortality is much lower than in rural areas. There is a relationship between mothers who have some education and lower infant mortality. Labor force participation effects on mortality are dependent on the reasons for work: economic necessity or in pursuance of a career and supplemental income. Findings on the relationship between income or social class and mortality are equivocal. Improvements are dependent on further fertility declines through birth spacing, educational attainment increases, contraceptive use increases, and the declining trend in length of breast feeding. The Population Program needs to achieve its targets of reducing family size norms and greater spacing between children. Improvements in combating communicable disease, including infective and parasitic diseases, are integral to decline in death rates. Better sanitation, particularly in slums, and availability of potable water are government objectives and will contribute to mortality decline. Access and availability of health care are crucial to improvements, particularly in rural areas.

Creating and Using New Data Sources to Analyze the Relationship Between Social Policy and Global Health: The Case of Maternal Leave

PubMed Central

Heymann, Jody; Raub, Amy; Earle, Alison

2011-01-01

Objectives Operating at a societal level, public policy is often one of our best approaches to addressing social determinants of health (SDH). Yet, limited data availability has constrained past research on how national social policy choices affect health outcomes. We developed a new data infrastructure to illustrate how globally comparative data on labor policy might be used to examine the impact of social policy on health. Methods We used multivariate ordinary least squares regression models to examine the relationship between the duration of paid maternal leave and neonatal, infant, and child mortality rates in 141 countries when controlling for overall resources available to meet basic needs measured by per capita gross domestic product, total and government health expenditures, female literacy, and basic health care and public health provision. Results An increase of 10 full-time-equivalent weeks of paid maternal leave was associated with a 10% lower neonatal and infant mortality rate (p≤0.001) and a 9% lower rate of mortality in children younger than 5 years of age (p≤0.001). Paid maternal leave is associated with significantly lower neonatal, infant, and child mortality in non-Organisation for Economic Co-operation and Development (OECD) countries and OECD countries. Conclusions This preliminary study, using newly available worldwide policy data, demonstrates the potential strength of using globally comparative data to examine SDH. Further data development to make multilevel modeling of the impact of labor conditions possible and to broaden which social policies can be examined is a critical next step. PMID:21836745

Validity and Psychometric Properties of the Early Development Instrument in Canada, Australia, United States, and Jamaica

ERIC Educational Resources Information Center

Janus, Magdalena; Brinkman, Sally A.; Duku, Eric K.

2011-01-01

There is an increasing support from international organizations and the research community for stepping beyond infant or child mortality as the most common child level social indicator and progressing towards an international measure of child development. The Early Development Instrument (EDI) is a teacher-completed measure of children's…

Can We Measure Success in Preventing Child Abuse? Issues in Policy, Programming and Research.

ERIC Educational Resources Information Center

Garbarino, James

1986-01-01

The article reviews efforts to set child abuse prevention goals in the U.S., noting research on program effectiveness and the role of maltreatment in child mortality. Alternative models for assessing the impact of prevention are described and the need to clarify and specify goals in prevention is stressed. (CL)

The IDEFICS (Identification and prevention of Dietary and lifestyle-induced health EFfects In Children and infantS) trial outcomes and process evaluations

USDA-ARS?s Scientific Manuscript database

Child obesity is a serious problem because it tracks and accumulates throughout childhood and into adult years. Child obesity predicts child cardiovascular disease risks, which also track into the adult years causing adult cardiovascular disease-related morbidity and mortality. As a result, arrestin...

Relation between increased numbers of safe playing areas and decreased vehicle related child mortality rates in Japan from 1970 to 1985: a trend analysis

PubMed Central

Nakahara, S.; Nakamura, Y.; Ichikawa, M.; Wakai, S.

2004-01-01

Objectives: To examine vehicle related mortality trends of children in Japan; and to investigate how environmental modifications such as the installation of public parks and pavements are associated with these trends. Design: Poisson regression was used for trend analysis, and multiple regression modelling was used to investigate the associations between trends in environmental modifications and trends in motor vehicle related child mortality rates. Setting: Mortality data of Japan from 1970 to 1994, defined as E-code 810–23 from 1970 to 1978 and E810–25 from 1979 to 1994, were obtained from vital statistics. Multiple regression modelling was confined to the 1970–1985 data. Data concerning public parks and other facilities were obtained from the Ministry of Land, Infrastructure, and Transport. Subjects: Children aged 0–14 years old were examined in this study and divided into two groups: 0–4 and 5–14 years. Main results: An increased number of public parks was associated with decreased vehicle related mortality rates among children aged 0–4 years, but not among children aged 5–14. In contrast, there was no association between trends in pavements and mortality rates. Conclusions: An increased number of public parks might reduce vehicle related preschooler deaths, in particular those involving pedestrians. Safe play areas in residential areas might reduce the risk of vehicle related child death by lessening the journey both to and from such areas as well as reducing the number of children playing on the street. However, such measures might not be effective in reducing the vehicle related mortalities of school age children who have an expanded range of activities and walk longer distances. PMID:15547055

Quantifying the impact of rising food prices on child mortality in India: a cross-district statistical analysis of the District Level Household Survey.

PubMed

Fledderjohann, Jasmine; Vellakkal, Sukumar; Khan, Zaky; Ebrahim, Shah; Stuckler, David

2016-04-01

Rates of child malnutrition and mortality in India remain high. We tested the hypothesis that rising food prices are contributing to India's slow progress in improving childhood survival. Using rounds 2 and 3 (2002-08) of the Indian District Level Household Survey, we calculated neonatal, infant and under-five mortality rates in 364 districts, and merged these with district-level food price data from the National Sample Survey Office. Multivariate models were estimated, stratified into 27 less deprived states and territories and 8 deprived states ('Empowered Action Groups'). Between 2002 and 2008, the real price of food in India rose by 11.7%. A 1% increase in total food prices was associated with a 0.49% increase in neonatal (95% confidence interval (CI): 0.13% to 0.85%), but not infant or under-five mortality rates. Disaggregating by type of food and level of deprivation, in the eight deprived states, we found an elevation in neonatal mortality rates of 0.33% for each 1% increase in the price of meat (95% CI: 0.06% to 0.60%) and 0.10% for a 1% increase in dairy (95% CI: 0.01% to 0.20%). We also detected an adverse association of the price of dairy with infant (b = 0.09%; 95% CI: 0.01% to 0.16%) and under-five mortality rates (b = 0.10%; 95% CI: 0.03% to 0.17%). These associations were not detected in less deprived states and territories. Rising food prices, particularly of high-protein meat and dairy products, were associated with worse child mortality outcomes. These adverse associations were concentrated in the most deprived states. © The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological Association.

Reducing under-five mortality through Hôpital Albert Schweitzer's integrated system in Haiti.

PubMed

Perry, Henry; Cayemittes, Michel; Philippe, Francois; Dowell, Duane; Dortonne, Jean Richard; Menager, Henri; Bottex, Erve; Berggren, Warren; Berggren, Gretchen

2006-05-01

The degree to which local health systems contribute to reductions in under-five mortality in severely impoverished settings has not been well documented. The current study compares the under-five mortality in the Hôpital Albert Schweitzer (HAS) Primary Health Care Service Area with that for Haiti in general. HAS provides an integrated system of community-based primary health care services, hospital care and community development. A sample of 10% of the women of reproductive age in the HAS service area was interviewed, and 2390 live births and 149 child deaths were documented for the period 1995-99. Under-five mortality rates were computed and compared with rates for Haiti. In addition, available data regarding inputs, processes and outputs for the HAS service area and for Haiti were assembled and compared. Under-five mortality was 58% less in the HAS service area, and mortality for children 12-59 months of age was 76% less. These results were achieved with an input of fewer physicians and hospital beds per capita than is available for Haiti nationwide, but with twice as many graduate nurses and auxiliary nurses per capita than are available nationwide, and with three cadres of health workers that do not exist nationwide: Physician Extenders, Health Agents and Community Health Volunteers. The population coverage of targeted child survival services was generally 1.5-2 times higher in the HAS service area than in rural Haiti. These findings support the conclusion that a well-developed system of primary health care, with outreach services to the household level, integrated with hospital referral care and community development programmes, can make a strong contribution to reducing infant and child mortality in severely impoverished settings.

Death and suicide among former child and adolescent psychiatric patients.

PubMed

Engqvist, Ulf; Rydelius, Per-Anders

2006-11-02

Increased mortality rates among previous child and adolescent psychiatry (CAP) patients have been found in Scandinavian studies up to the 1980s. The suicide risk in this group has been estimated to be almost five times higher than expected. This article addresses two questions: Do Swedish CAP patients continue to risk premature death and what kind of information related to psychiatric symptoms and/or behavior problems can predict later suicide? Hospital files, Sweden's census databases (including immigration and emigration) and administrative databases (including the Swedish Hospital Discharge register and the Persons Convicted of Offences register), and the Cause of Death register were examined to determine the mortality rate in a group of 1,400 former CAP inpatients and outpatients over a period of 12-33 years. Observed and expected numbers of deceased were calculated with the prospective method and the standardized mortality ratio (SMR) method. The relative risk or the risk ratio (RR) is presented with 95% confidence intervals (CIs). Significance level tests were made using two-by-two tables and chi-square tests. The Cox proportional-hazards regression model was used for survival analysis. Twenty-four males and 14 females died. Compared with the general population, the standardized mortality ratio in this group of CAP patients was significantly higher in both sexes. Behavioral problems, school problems, and co-morbid alcohol or drug abuse and criminality (including alcohol-related crimes) were found to be important predictors. Thirty-two deaths were attributed to suicide, intoxication, drug overdose, or accident; one patient died of an alcohol abuse-related disorder, and five patients died of natural causes. Suicide was the most common cause of death, but only 2 of these 19 cases were initially admitted for attempted suicide. We suggest that suicide and death prevention among CAP patients may not be a psychiatric issue per se but a future function of society's juvenile social-welfare investments and juvenile-delinquency prevention programs.

Ethnicity and infant mortality in Malaysia.

PubMed

Dixon, G

1993-06-01

Malaysian infant mortality differentials are a worthwhile subject for study, because socioeconomic development has very clearly had a differential impact by ethnic group. The Chinese rates of infant mortality are significantly lower than the Malay or Indian rates. Instead of examining the obvious access to care issues, this study considered factors related to the culture of infant care. Practices include the Chinese confinement of the mother in the first month after childbirth ("pe'i yue") and Pillsbury's 12 normative rules for Malaysian Chinese care. Malay practices vary widely by region and history. Indian mothers are restricted by diet. Data-recording flaws do not permit analysis of Sarawak or Sabah. The general assumption that Western medicine favors better health for mothers and infants is substantiated among peninsular communities, however, there are also negative impacts which affect infant mortality. The complex interaction of factors impacting on infant mortality reported in seven previous studies is discussed. A review of these studies reveals that immediate causes are infections, injuries, and dehydration. Indirect causes are birth weight or social and behavioral factors such as household income or maternal education. Indirect factors, which are amenable to planned change and influence the biological proximate determinants of infant mortality, are identified as birth weight, maternal age at birth, short pregnancy intervals or prior reproductive loss, sex of the child, birth order, duration of breast feeding and conditions of supplementation, types of household water and sanitation, year of child's birth, maternal education, household income and composition, institution of birth, ethnicity, and rural residence. Nine factors are identified empirically as not significant: maternal hours of work in the child's first year, maternal occupation, distance from home to workplace, presence of other children or servants, incidence of epidemics in the child's first year of life, community types of sanitation, prices and availability of infant foods, and access to various types of medical care. Future empirical study should consider factors such as class differences, place of residence, or extent of illiteracy as underlying or related to ethnicity. Policy-makers should be aware that future decline in infant mortality rates may depend on the blending of traditional with modern practices.

Geographical Detector-Based Risk Assessment of the Under-Five Mortality in the 2008 Wenchuan Earthquake, China

PubMed Central

Hu, Yi; Wang, Jinfeng; Li, Xiaohong; Ren, Dan; Zhu, Jun

2011-01-01

On 12 May, 2008, a devastating earthquake registering 8.0 on the Richter scale occurred in Sichuan Province, China, taking tens of thousands of lives and destroying the homes of millions of people. Many of the deceased were children, particular children less than five years old who were more vulnerable to such a huge disaster than the adult. In order to obtain information specifically relevant to further researches and future preventive measures, potential risk factors associated with earthquake-related child mortality need to be identified. We used four geographical detectors (risk detector, factor detector, ecological detector, and interaction detector) based on spatial variation analysis of some potential factors to assess their effects on the under-five mortality. It was found that three factors are responsible for child mortality: earthquake intensity, collapsed house, and slope. The study, despite some limitations, has important implications for both researchers and policy makers. PMID:21738660

Geographical detector-based risk assessment of the under-five mortality in the 2008 Wenchuan earthquake, China.

PubMed

Hu, Yi; Wang, Jinfeng; Li, Xiaohong; Ren, Dan; Zhu, Jun

2011-01-01

On 12 May, 2008, a devastating earthquake registering 8.0 on the Richter scale occurred in Sichuan Province, China, taking tens of thousands of lives and destroying the homes of millions of people. Many of the deceased were children, particular children less than five years old who were more vulnerable to such a huge disaster than the adult. In order to obtain information specifically relevant to further researches and future preventive measures, potential risk factors associated with earthquake-related child mortality need to be identified. We used four geographical detectors (risk detector, factor detector, ecological detector, and interaction detector) based on spatial variation analysis of some potential factors to assess their effects on the under-five mortality. It was found that three factors are responsible for child mortality: earthquake intensity, collapsed house, and slope. The study, despite some limitations, has important implications for both researchers and policy makers.

Child Health: Reaching the Poor

PubMed Central

Wagstaff, Adam; Bustreo, Flavia; Bryce, Jennifer; Claeson, Mariam

2004-01-01

In most countries, rates of mortality and malnutrition among children continue to decline, but large inequalities between poor and better-off children exist, both between and within countries. These inequalities, which appear to be widening, call into question the strategies for child mortality reduction relied upon to date. We review (1) what is known about the causes of socioeconomic inequalities in child health and where programs aimed at reducing inequalities may be most effectively focused and (2) what is known about the success of actual programs in narrowing these inequalities. We end with lessons learned: the need for better evidence, but most of all for a new approach to improving the health of all children that is evidence based, broad, and multifaceted. PMID:15117689

A Comparison of Willingness to Pay to Prevent Child Maltreatment Deaths in Ecuador and the United States

PubMed Central

Corso, Phaedra S.; Ingels, Justin B.; Roldos, M. Isabel

2013-01-01

Estimating the benefits of preventing child maltreatment (CM) is essential for policy makers to determine whether there are significant returns on investment from interventions to prevent CM. The aim of this study was to estimate the benefits of preventing CM deaths in an Ecuadorian population, and to compare the results to a similar study in a US population. The study used the contingent valuation method to elicit respondents’ willingness to pay (WTP) for a 1 in 100,000 reduction in the risk of CM mortality. After adjusting for differences in purchasing power, the WTP to prevent the CM mortality risk reduction in the Ecuador population was $237 and the WTP for the same risk reduction in the US population was $175. In the pooled analysis, WTP for a reduction in CM mortality was significantly impacted by country (p = 0.03), history of CM (p = 0.007), payment mechanism (p < 0.001), confidence in response (p = 0.014), and appropriateness of the payment mechanism (p < 0.001). These findings suggest that estimating benefits from one culture may not be transferable to another, and that low- and middle-income countries, such as Ecuador, may be better served by developing their own benefits estimates for use in future benefit-cost analyses of interventions designed to prevent CM. PMID:23538730

The total cost of father desertion.

PubMed

Winking, Jeffrey; Gurven, Michael

2011-01-01

The benefits of paternal investment have long been explored by assessing the impact of father's presence on child wellbeing. Previous studies, however, have only examined the average effect of father's presence on child survivorship. Here we assess the total fitness cost to men of deserting (or the benefit of staying), by considering effects on the entire progeny. We estimate the total number of children that a deserting father can expect to lose due to reduced survivorship over the life course in five populations, and compare this loss to the benefit gains from remarrying a younger wife. We compiled the observed impacts of father's absence, as well as mortality and fertility schedules, for five foraging or foraging/horticultural populations. We calculate how many additional children a man can expect to lose due to father's absence throughout a marriage. We then calculate the minimum age difference between a first and second spouse that would be necessary to overcome this cost. Because child mortality rates drop so rapidly, the costs that men experience from desertion due to augmented child mortality are modest throughout marriage. Even hypothetically inflated father effects can be overcome with modest age differences between first and second spouses. Returns to paternal investment in terms of increased child survival are not substantial compared to those received by successfully practicing a serial mating strategy. This suggests that factors other than the ability to enhance child survival, such as female choice, are important to the evolutionary history and continued adaptive functioning of men's unique reproductive strategies. Copyright © 2011 Wiley-Liss, Inc.

Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis: A retrospective study.

PubMed

Zou, Deli; Qi, Xingshun; Zhu, Cuihong; Ning, Zheng; Hou, Feifei; Zhao, Jiancheng; Peng, Ying; Li, Jing; Deng, Han; Guo, Xiaozhong

2016-03-01

The albumin-bilirubin (ALBI) score is a new model for assessing the severity of liver dysfunction. In the present study, we aimed to retrospectively compare the performance of ALBI with Child-Pugh and the model for end-stage liver disease (MELD) scores for predicting the in-hospital mortality of acute gastrointestinal bleeding (AUGIB) in liver cirrhosis. All cirrhotic patients with AUGIB were eligible, provided they had the data needed to determine the ALBI score. Areas under the receiving-operator characteristics curve (AUC) are reported. Overall, 631 patients were included. In all the included patients, the AUC of the ALBI, Child-Pugh, and MELD scores were 0.808, 0.785 (p=0.5831), and 0.787 (p=0.7033), respectively. In patients with only hepatitis B virus-related liver cirrhosis, the AUC of the ALBI, Child-Pugh, and MELD scores were 0.865, 0.836 (p=0.6064), and 0.818 (p=0.6399), respectively. In patients with only alcohol-related liver cirrhosis, the AUC of the ALBI, Child-Pugh, and MELD scores were 0.869, 0.860 (p=0.9003), and 0.801 (p=0.5548), respectively. In patients treated with endoscopic therapy for AUGIB, the AUC of the ALBI, Child-Pugh, and MELD scores were 0.873, 0.884 (p=0.7898), and 0.834 (p=0.5531), respectively. The prognostic performance of the ALBI score was comparable with that of the Child-Pugh and MELD scores for predicting the in-hospital mortality of AUGIB in liver cirrhosis.

Formative research methods for designing culturally appropriate, integrated child nutrition and development interventions: an overview.

PubMed

Bentley, Margaret E; Johnson, Susan L; Wasser, Heather; Creed-Kanashiro, Hilary; Shroff, Monal; Fernandez Rao, Sylvia; Cunningham, Melissa

2014-01-01

Nutritional and developmental insults in the first few years of life have profound public health implications, including substantial contributions to neonatal, infant, and early childhood morbidity and mortality, as well as longer term effects on cognitive development, school achievement, and worker productivity. Optimal development that can lead to the attainment of an individual's fullest potential, therefore, requires a combination of genetic capacity, adequate nutrition, psychosocial stimulation, and safe, clean physical environments. Researchers and policymakers have called for integrated child nutrition and development interventions for more than 20 years, yet there are only a handful of efficacy trials and even fewer examples of integrated interventions that have been taken to scale. While a critical component in the design of such interventions is formative research, there is a dearth of information in both the literature and policy arenas to guide this phase of the process. To move the field forward, this paper first provides an overview of formative research methods with a focus on qualitative inquiry, a description of the critical domains to be assessed (infant and young child feeding, responsive feeding, and child development), and currently available resources. Application of these methods is provided through a real-world case study--the design of an integrated nutrition and child development efficacy trial in Andhra Pradesh, India. Recommendations for next steps are discussed, the most important of which is the need for a comprehensive set of formative guidelines for designing locally tailored, culturally appropriate, integrated interventions. © 2013 New York Academy of Sciences.

Global, regional, and national causes of child mortality in 2008: a systematic analysis.

PubMed

Black, Robert E; Cousens, Simon; Johnson, Hope L; Lawn, Joy E; Rudan, Igor; Bassani, Diego G; Jha, Prabhat; Campbell, Harry; Walker, Christa Fischer; Cibulskis, Richard; Eisele, Thomas; Liu, Li; Mathers, Colin

2010-06-05

Up-to-date information on the causes of child deaths is crucial to guide global efforts to improve child survival. We report new estimates for 2008 of the major causes of death in children younger than 5 years. We used multicause proportionate mortality models to estimate deaths in neonates aged 0-27 days and children aged 1-59 months, and selected single-cause disease models and analysis of vital registration data when available to estimate causes of child deaths. New data from China and India permitted national data to be used for these countries instead of predictions based on global statistical models, as was done previously. We estimated proportional causes of death for 193 countries, and by application of these proportions to the country-specific mortality rates in children younger than 5 years and birth rates, the numbers of deaths by cause were calculated for countries, regions, and the world. Of the estimated 8.795 million deaths in children younger than 5 years worldwide in 2008, infectious diseases caused 68% (5.970 million), with the largest percentages due to pneumonia (18%, 1.575 million, uncertainty range [UR] 1.046 million-1.874 million), diarrhoea (15%, 1.336 million, 0.822 million-2.004 million), and malaria (8%, 0.732 million, 0.601 million-0.851 million). 41% (3.575 million) of deaths occurred in neonates, and the most important single causes were preterm birth complications (12%, 1.033 million, UR 0.717 million-1.216 million), birth asphyxia (9%, 0.814 million, 0.563 million-0.997 million), sepsis (6%, 0.521 million, 0.356 million-0.735 million), and pneumonia (4%, 0.386 million, 0.264 million-0.545 million). 49% (4.294 million) of child deaths occurred in five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan, and China. These country-specific estimates of the major causes of child deaths should help to focus national programmes and donor assistance. Achievement of Millennium Development Goal 4, to reduce child mortality by two-thirds, is only possible if the high numbers of deaths are addressed by maternal, newborn, and child health interventions. WHO, UNICEF, and Bill & Melinda Gates Foundation. Copyright 2010 Elsevier Ltd. All rights reserved.

Non-specific effects of diphtheria tetanus pertussis vaccination on child mortality in Cebu, The Philippines.

PubMed

Chan, Grace J; Moulton, Lawrence H; Becker, Stan; Muñoz, Alvaro; Black, Robert E

2007-10-01

To determine the non-specific effects of diphtheria, tetanus and pertussis (DTP) vaccination and sex on mortality before 30 months of age among those who received Bacille Calmette Guerin (BCG) vaccine in a high mortality area. This analysis used a longitudinal study of child survival monitoring the use of primary care services, morbidity and mortality in Metro Cebu, The Philippines. Participants included 14 537 children under 30 months of age who received a BCG vaccination from July 1988 to January 1991. The main outcome measure was all-cause mortality. Mortality before 30 months of age was 57% lower among BCG-vaccinated children who received DTP vaccination than BCG-vaccinated children who did not receive DTP vaccination {hazard ratio (HR) for vaccinated vs unvaccinated 0.43 [95% confidence interval (CI) 0.21-0.88]}. Females had lower mortality rates [HR = 0.19 (0.04-0.86), P = 0.03] than males among DTP-unvaccinated children. The protective effect of DTP vaccination was more pronounced in males [HR 0.32 (0.14-0.73)] than in females [HR 0.86 (0.18-4.23)]. DTP vaccination increased (interaction term P = 0.08) the female-to-male mortality ratio to 0.76 (0.52-1.12). Among BCG-vaccinated children under 30 months of age, DTP vaccination is associated with improved survival. The increased female-male mortality ratio is associated with reduced mortality among males following DTP vaccination rather than increased mortality among female children.

26 CFR 25.7520-3 - Limitation on the application of section 7520.

Code of Federal Regulations, 2010 CFR

2010-04-01

... beneficial interests. If, under the provisions of this paragraph (b), the interest rate and mortality... trust, the trust property is to be distributed to the donor's child. The section 7520 rate for the month.... [Reserved] For further guidance, see § 25.7520-3T(b)(2)(v) Example 5. (3) Mortality component. The mortality...

26 CFR 25.7520-3 - Limitation on the application of section 7520.

Code of Federal Regulations, 2011 CFR

2011-04-01

... beneficial interests. If, under the provisions of this paragraph (b), the interest rate and mortality... trust, the trust property is to be distributed to the donor's child. The section 7520 rate for the month.... [Reserved] For further guidance, see § 25.7520-3T(b)(2)(v) Example 5. (3) Mortality component. The mortality...

Vaccination and all-cause child mortality from 1985 to 2011: global evidence from the Demographic and Health Surveys.

PubMed

McGovern, Mark E; Canning, David

2015-11-01

Based on models with calibrated parameters for infection, case fatality rates, and vaccine efficacy, basic childhood vaccinations have been estimated to be highly cost effective. We estimated the association of vaccination with mortality directly from survey data. Using 149 cross-sectional Demographic and Health Surveys, we determined the relationship between vaccination coverage and the probability of dying between birth and 5 years of age at the survey cluster level. Our data included approximately 1 million children in 68,490 clusters from 62 countries. We considered the childhood measles, bacillus Calmette-Guérin, diphtheria-pertussis-tetanus, polio, and maternal tetanus vaccinations. Using modified Poisson regression to estimate the relative risk of child mortality in each cluster, we also adjusted for selection bias that resulted from the vaccination status of dead children not being reported. Childhood vaccination, and in particular measles and tetanus vaccination, is associated with substantial reductions in childhood mortality. We estimated that children in clusters with complete vaccination coverage have a relative risk of mortality that is 0.73 (95% confidence interval: 0.68, 0.77) times that of children in a cluster with no vaccinations. Although widely used, basic vaccines still have coverage rates well below 100% in many countries, and our results emphasize the effectiveness of increasing coverage rates in order to reduce child mortality. © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[HIV/AIDS spread and influence on other health-related Millennium Development Goals].

PubMed

Alban, Anita; Andersen, Nina Bjerglund

2006-09-04

HIV/AIDS is threatening the development of countries with high HIV prevalence. This article analyses the impact of HIV/AIDS on the Millennium Development Goals for Health. The analysis is based on a literature survey on the impact of HIV on child health, maternal mortality, tuberculosis and malaria. We find a strong correlation between HIV and child mortality and HIV and TB. We conclude that, in order to reach the Millennium Development Goals, health strategies must include a comprehensive and coordinated approach to fight major health problems including improved resource allocation.

Cross-National Systematic Review of Neonatal Mortality and Postnatal Newborn Care: Special Focus on Pakistan.

PubMed

Ahmed, Mansoor; Won, Youngjoon

2017-11-23

The latest nationwide survey of Pakistan showed that considerable progress has been made toward reducing all child mortality indicators except neonatal mortality. The aim of this study is to compare Pakistan's under-five mortality, neonatal mortality, and postnatal newborn care rates with those of other countries. Neonatal mortality rates and postnatal newborn care rates from the Demographic and Health Surveys (DHSs) of nine low- and middle-income countries (LMIC) from Asia and Africa were analyzed. Pakistan's maternal, newborn, and child health (MNCH) policies and programs, which have been implemented in the country since 1990, were also analyzed. The results highlighted that postnatal newborn care in Pakistan was higher compared with the rest of countries, yet its neonatal mortality remained the worst. In Zimbabwe, both mortality rates have been increasing, whereas the neonatal mortality rates in Nepal and Afghanistan remained unchanged. An analysis of Pakistan's MNCH programs showed that there is no nationwide policy on neonatal health. There were only a few programs concerning the health of newborns, and those were limited in scale. Pakistan's example shows that increased coverage of neonatal care without ensuring quality is unlikely to improve neonatal survival rates. It is suggested that Pakistan needs a comprehensive policy on neonatal health similar to other countries, and its effective programs need to be scaled up, in order to obtain better neonatal health outcomes.

The comparative cost-effectiveness of an equity-focused approach to child survival, health, and nutrition: a modelling approach.

PubMed

Carrera, Carlos; Azrack, Adeline; Begkoyian, Genevieve; Pfaffmann, Jerome; Ribaira, Eric; O'Connell, Thomas; Doughty, Patricia; Aung, Kyaw Myint; Prieto, Lorena; Rasanathan, Kumanan; Sharkey, Alyssa; Chopra, Mickey; Knippenberg, Rudolf

2012-10-13

Progress on child mortality and undernutrition has seen widening inequities and a concentration of child deaths and undernutrition in the most deprived communities, threatening the achievement of the Millennium Development Goals. Conversely, a series of recent process and technological innovations have provided effective and efficient options to reach the most deprived populations. These trends raise the possibility that the perceived trade-off between equity and efficiency no longer applies for child health--that prioritising services for the poorest and most marginalised is now more effective and cost effective than mainstream approaches. We tested this hypothesis with a mathematical-modelling approach by comparing the cost-effectiveness in terms of child deaths and stunting events averted between two approaches (from 2011-15 in 14 countries and one province): an equity-focused approach that prioritises the most deprived communities, and a mainstream approach that is representative of current strategies. We combined some existing models, notably the Marginal Budgeting for Bottlenecks Toolkit and the Lives Saved Tool, to do our analysis. We showed that, with the same level of investment, disproportionately higher effects are possible by prioritising the poorest and most marginalised populations, for averting both child mortality and stunting. Our results suggest that an equity-focused approach could result in sharper decreases in child mortality and stunting and higher cost-effectiveness than mainstream approaches, while reducing inequities in effective intervention coverage, health outcomes, and out-of-pocket spending between the most and least deprived groups and geographic areas within countries. Our findings should be interpreted with caution due to uncertainties around some of the model parameters and baseline data. Further research is needed to address some of these gaps in the evidence base. Strategies for improving child nutrition and survival, however, should account for an increasing prioritisation of the most deprived communities and the increased use of community-based interventions. Copyright © 2012 Elsevier Ltd. All rights reserved.

Stratifying risk in the prevention of recurrent variceal hemorrhage: Results of an individual patient meta-analysis.

PubMed

Albillos, Agustín; Zamora, Javier; Martínez, Javier; Arroyo, David; Ahmad, Irfan; De-la-Peña, Joaquin; Garcia-Pagán, Juan-Carlos; Lo, Gin-Ho; Sarin, Shiv; Sharma, Barjesh; Abraldes, Juan G; Bosch, Jaime; Garcia-Tsao, Guadalupe

2017-10-01

Endoscopic variceal ligation plus beta-blockers (EVL+BB) is currently recommended for variceal rebleeding prophylaxis, a recommendation that extends to all patients with cirrhosis with previous variceal bleeding irrespective of prognostic stage. Individualizing patient care is relevant, and in published studies on variceal rebleeding prophylaxis, there is a lack of information regarding response to therapy by prognostic stage. This study aimed at comparing EVL plus BB with monotherapy (EVL or BB) on all-source rebleeding and mortality in patients with cirrhosis and previous variceal bleeding stratified by cirrhosis severity (Child A versus B/C) by means of individual time-to-event patient data meta-analysis from randomized controlled trials. The study used individual data on 389 patients from three trials comparing EVL plus BB versus BB and 416 patients from four trials comparing EVL plus BB versus EVL. Compared with BB alone, EVL plus BB reduced overall rebleeding in Child A (incidence rate ratio 0.40; 95% confidence interval, 0.18-0.89; P = 0.025) but not in Child B/C, without differences in mortality. The effect of EVL on rebleeding was different according to Child (P for interaction <0.001). Conversely, compared with EVL, EVL plus BB reduced rebleeding in both Child A and B/C, with a significant reduction in mortality in Child B/C (incidence rate ratio 0.46; 95% confidence interval, 0.25-0.85; P = 0.013). Outcomes of therapies to prevent variceal rebleeding differ depending on cirrhosis severity: in patients with preserved liver function (Child A), combination therapy is recommended because it is more effective in preventing rebleeding, without modifying survival, while in patients with advanced liver failure (Child B/C), EVL alone carries an increased risk of rebleeding and death compared with combination therapy, underlining that BB is the key element of combination therapy. (Hepatology 2017;66:1219-1231). © 2017 by the American Association for the Study of Liver Diseases.

Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.

PubMed

Allareddy, Veerajalandhar; Asad, Rahimullah; Lee, Min Kyeong; Nalliah, Romesh P; Rampa, Sankeerth; Speicher, David G; Rotta, Alexandre T; Allareddy, Veerasathpurush

2014-01-01

To describe nationally representative outcomes of physical abuse injuries in children necessitating Emergency Department (ED) visits in United States. The impact of various injuries on mortality is examined. We hypothesize that physical abuse resulting in intracranial injuries are associated with worse outcome. We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS), the largest all payer hospital based ED database, for the years 2008-2010. All ED visits and subsequent hospitalizations with a diagnosis of "Child physical abuse" (Battered baby or child syndrome) due to various injuries were identified using ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) codes. In addition, we also examined the prevalence of sexual abuse in this cohort. A multivariable logistic regression model was used to examine the association between mortality and types of injuries after adjusting for a multitude of patient and hospital level factors. Of the 16897 ED visits that were attributed to child physical abuse, 5182 (30.7%) required hospitalization. Hospitalized children were younger than those released treated and released from the ED (1.9 years vs. 6.4 years). Male or female partner of the child's parent/guardian accounted for >45% of perpetrators. Common injuries in hospitalized children include- any fractures (63.5%), intracranial injuries (32.3%) and crushing/internal injuries (9.1%). Death occurred in 246 patients (13 in ED and 233 following hospitalization). Amongst the 16897 ED visits, 1.3% also had sexual abuse. Multivariable analyses revealed each 1 year increase in age was associated with a lower odds of mortality (OR = 0.88, 95% CI = 0.81-0.96, p < 0.0001). Females (OR = 2.39, 1.07-5.34, p = 0.03), those with intracranial injuries (OR = 65.24, 27.57-154.41, p<0.0001), or crushing/internal injury (OR = 4.98, 2.24-11.07, p<0.0001) had higher odds of mortality compared to their male counterparts. In this large cohort of physically abused children, younger age, females and intracranial or crushing/internal injuries were independent predictors of mortality. Identification of high risk cohorts in the ED may enable strengthening of existing screening programs and optimization of outcomes.

A Child Survival and Development Revolution?

ERIC Educational Resources Information Center

Halpern, Robert

1986-01-01

Addresses the problems of child survival and development in developing countries by discussing the biomedical causes and the concomitant social determinants of high infant mortality rates. Describes four intervention strategies recommended by UNICEF: growth monitoring, oral rehydration therapy, breast feeding, and immunization. (HOD)

Reducing the Child Death Rate. KIDS COUNT Indicator Brief

ERIC Educational Resources Information Center

Shore, Rima; Shore, Barbara

2009-01-01

In the 20th century's final decades, advances in the prevention and treatment of infectious diseases sharply reduced the child death rate. Despite this progress, the child death rate in the U.S. remains higher than in many other wealthy nations. The under-five mortality rate in the U.S. is almost three times higher than that of Iceland and Sweden…

Kids Count Data Book. State Profiles of Child Well-Being.

ERIC Educational Resources Information Center

Center for the Study of Social Policy, Washington, DC.

Statistics are presented for eight measures of child and adolescent health, education, and social and economic well-being in each of the 50 states and the District of Columbia. Indicators measured were: (1) percent low birth weight babies; (2) infant mortality rate (per 1,000 live births); (3) child death rate ages 1-14 (per 100,000 children); (4)…

Religious affiliation and under-five mortality in Mozambique.

PubMed

Cau, Boaventura M; Sevoyan, Arusyak; Agadjanian, Victor

2013-05-01

The influence of religion on health remains a subject of considerable debate both in developed and developing settings. This study examines the connection between the religious affiliation of the mother and under-five mortality in Mozambique. It uses unique retrospective survey data collected in a predominantly Christian area in Mozambique to compare under-five mortality between children of women affiliated to organized religion and children of non-affiliated women. It finds that mother's affiliation to any religious organization, as compared with non-affiliation, has a significant positive effect on child survival net of education and other socio-demographic factors. When the effects of affiliation to specific denominational groups are examined, only affiliation to the Catholic or mainstream Protestant churches and affiliation to Apostolic churches are significantly associated with improved child survival. It is argued that the advantages of these groups may be achieved through different mechanisms: the favourable effect on child survival of having mothers affiliated to the Catholic or mainstream Protestant churches is probably due to these churches' stronger connections to the health sector, while the beneficial effect of having an Apostolic mother is probably related to strong social ties and mutual support in Apostolic congregations. The findings thus shed light on multiple pathways through which organized religion can affect child health and survival in sub-Saharan Africa and similar developing settings.

Do family policy regimes matter for children's well-being?

PubMed

Engster, Daniel; Stensöta, Helena Olofsdotter

2011-01-01

Researchers have studied the impact of different welfare state regimes, and particularly family policy regimes, on gender equality. Very little research has been conducted, however, on the association between different family policy regimes and children's well-being. This article explores how the different family policy regimes of twenty OECD countries relate to children's well-being in the areas of child poverty, child mortality, and educational attainment and achievement. We focus specifically on three family policies: family cash and tax benefits, paid parenting leaves, and public child care support. Using panel data for the years 1995, 2000, and 2005, we test the association between these policies and child well-being while holding constant for a number of structural and policy variables. Our analysis shows that the dual-earner regimes, combining high levels of support for paid parenting leaves and public child care, are strongly associated with low levels of child poverty and child mortality. We find little long-term effect of family policies on educational achievement, but a significant positive correlation between high family policy support and higher educational attainment. We conclude that family policies have a significant impact on improving children's well-being, and that dual-earner regimes represent the best practice for promoting children's health and development.

A Sibling Death in the Family: Common and Consequential

PubMed Central

Fletcher, Jason; Mailick, Marsha; Song, Jieun

2015-01-01

Although a large literature analyzes the determinants of child mortality and suggests policy and medical interventions aimed at its reduction, there is little existing analysis illuminating the consequences of child mortality for other family members. In particular, there is little evidence exploring the consequences of experiencing the death of a sibling on one’s own development and transition to adulthood. This article examines the prevalence and consequences of experiencing a sibling death during one’s childhood using two U.S. data sets. We show that even in a rich developed country, these experiences are quite common, affecting between 5 % and 8 % of the children with one or more siblings in our two data sets. We then show that these experiences are associated with important reductions in years of schooling as well as a broad range of adult socioeconomic outcomes. Our findings also suggest that sisters are far more affected than brothers and that the cause of death is an important factor in sibling effects. Overall, our findings point to important previously unexamined consequences of child mortality, adding to the societal costs associated with childhood mortality as well as suggesting additional benefits from policy and medical innovations aimed at curbing both such deaths and subsequent effects on family members. PMID:23073753

State gun safe storage laws and child mortality due to firearms.

PubMed

Cummings, P; Grossman, D C; Rivara, F P; Koepsell, T D

1997-10-01

Since 1989, several states have passed laws that make gun owners criminally liable if someone is injured because a child gains unsupervised access to a gun. These laws are controversial, and their effect on firearm-related injuries is unknown. To determine if state laws that require safe storage of firearms are associated with a reduction in child mortality due to firearms. An ecological study of firearm mortality from 1979 through 1994. All 50 states and the District of Columbia. All children younger than 15 years. Unintentional deaths, suicides, and homicides due to firearms. Laws that make gun owners responsible for storing firearms in a manner that makes them inaccessible to children were in effect for at least 1 year in 12 states from 1990 through 1994. Among children younger than 15 years, unintentional shooting deaths were reduced by 23% (95% confidence interval, 6%-37%) during the years covered by these laws. This estimate was based on within-state comparisons adjusted for national trends in unintentional firearm-related mortality. Gun-related homicide and suicide showed modest declines, but these were not statistically significant. State safe storage laws intended to make firearms less accessible to children appear to prevent unintentional shooting deaths among children younger than 15 years.

Control of deaths from diarrheal disease in rural communities. I. Design of an intervention study and effects on child mortality.

PubMed

Kielmann, A A; Mobarak, A B; Hammamy, M T; Gomaa, A I; Abou-el-Saad, S; Lotfi, R K; Mazen, I; Nagaty, A

1985-12-01

From May through October 1980, the "Strengthening Rural Health Delivery" project (SRHD) under the Rural Health Department of the Ministry of Health of Egypt had conducted an investigation into prevention of child mortality from diarrheal disease through testing various modules of Oral Rehydration Therapy delivery mechanisms. In a six-cell design counting a total of almost 29,000 children, ORT was provided both as hypotonic sucrose/salt solution prepared and administered by mothers and normotonic, balanced electrolyte solution in the hands of both mothers and health care providers and the effects on child mortality during the peak season of diarrheal incidence were measured. In addition, utilization and effects of ORT when made readily available through commercial channels was similarly examined. A cost-benefit analysis was performed on the cost of the services as well as on the outcome for each of five study cells using the sixth, the control, as reference. Results showed that early rehydration with a sucrose/salt solution in the hands of mothers, backed by balanced oral rehydration solution in the hands of health care providers proved the most cost-effective means of reducing diarrhea-specific mortality as well as being as safe as prepackaged commercial preparations.

Increasing the minimum age of marriage program to improve maternal and child health in Indonesia

NASA Astrophysics Data System (ADS)

Anjarwati

2017-08-01

The objective of the article is to review the importance of understanding the adolescent reproductive health, especially the impact of early marriage to have commitment for health maintenance by increasing the minimum age of marriage. There are countless studies describing the impact of pregnancy at a very young age, the risk that young people must understand to support the program of increasing minimum age of marriage in Indonesia. Increasing the minimum age of marriage is as one of the government programs in improving maternal and child health. It also supports the Indonesian government's program about a thousand days of life. It is required that teens understand the impact of early marriage to prepare for optimal health for future generations. The maternal mortality rate and infant mortality rate in Indonesia is still high because health is not optimal since the early period of pregnancy. These studies reveal that the increased number of early marriages leads to rising divorce rate, maternal mortality rate, and infant mortality and intensifies the risk of cervical cancer. The increase in early marriage is mostly attributed to unwanted pregnancy. It is revealed that early marriage increases the rate of pregnancy at too young an age with the risk of maternal and child health in Indonesia.

Socio-economic and demographic determinants of under-five mortality in rural northern Ghana

PubMed Central

2014-01-01

Background In spite of global decline in under-five mortality, the goal of achieving MDG 4 still remains largely unattained in low and middle income countries as the year 2015 closes-in. To accelerate the pace of mortality decline, proven interventions with high impact need to be implemented to help achieve the goal of drastically reducing childhood mortality. This paper explores the association between socio-economic and demographic factors and under-five mortality in an impoverished region in rural northern Ghana. Methods We used survey data on 3975 women aged 15–49 who have ever given birth. First, chi-square test was used to test the association of social, economic and demographic characteristics of mothers with the experience of under-five death. Subsequently, we ran a logistic regression model to estimate the relative association of factors that influence childhood mortality after excluding variables that were not significant at the bivariate level. Results Factors that significantly predict under-five mortality included mothers’ educational level, presence of co-wives, age and marital status. Mothers who have achieved primary or junior high school education were 45% less likely to experience under-five death than mothers with no formal education at all (OR = 0.55, p < 0.001). Monogamous women were 22% less likely to experience under-five deaths than mothers in polygamous marriages (OR = 0.78, p = 0.01). Similarly, mothers who were between the ages of 35 and 49 were about eleven times more likely to experience under-five deaths than those below the age of 20 years (OR = 11.44, p < 0.001). Also, women who were married had a 27% less likelihood (OR = 0.73, p = 0.01) of experiencing an under-five death than those who were single, divorced or widowed. Conclusion Taken independently, maternal education, age, marital status and presence of co-wives are associated with childhood mortality. The relationship of these indicators with women’s autonomy, health seeking behavior, and other factors that affect child survival merit further investigation so that interventions could be designed to foster reductions in child mortality by considering the needs and welfare of women including the need for female education, autonomy and socioeconomic well-being. PMID:25145383

Socioeconomic inequalities in under-five mortality in rural Bangladesh: evidence from seven national surveys spreading over 20 years.

PubMed

Chowdhury, Asiful Haidar; Hanifi, Syed Manzoor Ahmed; Mia, Mohammad Nahid; Bhuiya, Abbas

2017-11-13

Socioeconomic inequality in health and mortality remains a disturbing reality across nations including Bangladesh. Inequality drew renewed attention globally. Bangladesh though made impressive progress in health, it makes an interesting case for learning. This paper examined the trends and changing pattern of socioeconomic inequalities in under-five mortality in rural Bangladesh. It also examined whether mother's education had any effect in reducing socioeconomic inequalities. Data from rural samples of seven Bangladesh Demographic Health Surveys, carried out so far, were used. Children born alive during 5 years preceding the surveys were included in the analysis. Univariate, bivariate and multivariate analyses were carried out. Under-five mortality rate steadily declined over the years from 128/1000 in 1994 to 48 in 2014. Females had 8% lower mortality rates than males. Children of mothers with no schooling had 1.88 times higher mortality than those whose mother had six or more years of schooling. Similarly, children from low asset category households had on an average 1.17 times higher mortality rate than those from high asset category households. Inequality by mother's education disappeared in the recent years, and inequality by household socioeconomic condition persisted all through. The pattern of inequality by sex, mother's education, and household socioeconomic status was not changed statistically significantly over the years, and mothers' education did not reduce socioeconomic inequalities. The reduction in mortality was consistent with changes in the proximate determinants of child survival in the country. Proximate determinants included maternal factors, environmental contamination, nutrient deficiency, personal illness control, and injury. Health and population programmes have been effective in increasing immunization coverage, use of ORS for managing diarrhoeal diseases, and increasing contraceptive use. Development activities on the other hand raised the literacy, especially among females, demand for modern health services, and reduction of poverty. However, socioeconomic inequality still exists in both under-five mortality and proximate determinants of child survival. The socioeconomic inequality in under-five mortality is showing resistance against further reduction. An assessment of the adequacy of the existing programmes taking the proximate determinants of child survival into consideration will be useful for further improvement.

Health and wealth in Uzbekistan and sub-Saharan Africa in comparative perspective.

PubMed

Hohmann, Sophie; Garenne, Michel

2010-12-01

The study investigates the magnitude of differences in child and adult mortality by wealth in Uzbekistan, a former soviet country of Central Asia, and compares it with similar indicators from sub-Saharan Africa. Data were derived from Demographic and Health Surveys. An "Absolute Wealth Index" was built from data on goods owned by households and quality of housing, and scaled from 0 to 12. Wealth was distributed evenly in Uzbekistan, with a symmetric distribution around a mean of 5.5 modern goods. In sub-Saharan Africa, on the contrary, the wealth distribution had a lower mean (2.5) and was highly skewed towards the left, revealing a high proportion of very poor people. Adult and child mortality levels were lower in Uzbekistan. Despite these major differences, the relationships between mortality indicators and the wealth index were similar in the two cases. The magnitude of mortality differentials by wealth was of the same order in both cases, with gradients ranging from 2.5 to 1 for child mortality and 1.5 to 1 for adult mortality (poorest versus richest). However, mortality levels remained lower in Uzbekistan than in sub-Saharan Africa at the same level of wealth for both children and adults. A similar relationship was found between nutritional status and wealth index in both cases. On the contrary, there were no differences by wealth in use of health services and level of education in Uzbekistan, whereas wealth gradients were steep for the same variables in sub-Saharan Africa. The study suggests that mortality differentials were primarily due to nutritional status, and not to access and use of health services or to education. The discussion focuses on health and social policies during the colonial and post-colonial period that have produced these patterns. Copyright © 2010 Elsevier B.V. All rights reserved.

Child-resistant and tamper-resistant packaging: A systematic review to inform tobacco packaging regulation

PubMed Central

Jo, Catherine L.; Ambs, Anita; Dresler, Carolyn M.; Backinger, Cathy L.

2017-01-01

Objective We aimed to investigate the effects of special packaging (child-resistant, adult-friendly) and tamper-resistant packaging on health and behavioral outcomes in order to identify research gaps and implications for packaging standards for tobacco products. Methods We searched seven databases for keywords related to special and tamper-resistant packaging, consulted experts, and reviewed citations of potentially relevant studies. 733 unique papers were identified. Two coders independently screened each title and abstract for eligibility. They then reviewed the full text of the remaining papers for a second round of eligibility screening. Included studies investigated a causal relationship between type of packaging or packaging regulation and behavioral or health outcomes and had a study population composed of consumers. Studies were excluded on the basis of publication type, if they were not peer-reviewed, and if they had low external validity. Two reviewers independently coded each paper for study and methodological characteristics and limitations. Discrepancies were discussed and resolved. Results The review included eight studies: four assessing people’s ability to access the contents of different packaging types and four evaluating the impact of packaging requirements on health-related outcomes. Child-resistant packaging was generally more difficult to open than non-child-resistant packaging. Child-resistant packaging requirements have been associated with reductions in child mortality. Conclusions Child-resistant packaging holds the expectation to reduce tobacco product poisonings among children under six. PMID:27939602

The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh.

PubMed

Huda, Tanvir M; Tahsina, Tazeen; El Arifeen, Shams; Dibley, Michael J

2016-01-01

Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions). We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.

77 FR 7594 - Advisory Committee on Infant Mortality; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

... Infant Mortality (ACIM). Dates and Times: March 8, 2012, 8:30 a.m.-6 p.m.; March 9, 2012, 8:30 a.m.-3 p.m... mortality and improving the health status of infants and pregnant women; and factors affecting the continuum...; a Maternal and Child Health Bureau (MCHB) update; an update from the Committee's four workgroups...

NGO-promoted women's credit program, immunization coverage, and child mortality in rural Bangladesh.

PubMed

Amin, R; Li, Y

1997-01-01

A growing number of non-governmental organizations (NGOs) are adopting the collateral-free credit programs by anchoring them with their social development programs aimed at improved program effectiveness and sustainability. Drawing upon a sample of 3,564 targeted poor households covered by five small NGOs in rural Bangladesh, this study finds that the NGO credit-members as well as those who reside in the NGO program area are higher adopters of child immunization than those in the non-program area. Similarly, the study found that infant and child mortality is lower among the NGO credit members than among the non-members and that under five-year deaths of children progressively decline with the increase in the doses of vaccines. Implications of these findings are discussed in the study.

[Infant and child mortality in Latin America].

PubMed

Behm, H; Primante, D A

1978-04-01

High mortality rates persist in Latin America, and data collection is made very difficult because of the lack of reliable statistics. A study was initiated in 1976 to measure the probability of mortality from birth to 2 years of age in 12 Latin American countries. The Brass method was used and applied to population censuses. Probability of mortality is extremely heterogeneous and regularly very high, varying between a maximum of 202/1000 in Bolivia, to a minimum of 112/1000 in Uruguay. In comparison, the same probability is 21/1000 in the U.S., and 11/1000 in sweden. Mortality in rural areas is much higher than in urban ones, and varies according to the degree of education of the mother, children being born to mothers who had 10 years of formal education having the lowest risk of death. Children born to the indigenous population, largely illiterate and living in the poorest of conditions, have the highest probability of death, a probability reaching 67% of all deaths under 2 years. National health services in Latin America, although vastly improved and improving, still do not meet the needs of the population, especially rural, and structural and historical conditions hamper a wider application of existing medical knowledge.

Child health and education in Kenyan schools programmes.

PubMed

Fleming, J

1991-03-01

Jane Fleming describes the health education in schools programme launched by the Aga Khan Health Services in Kisumu, Kenya. The project has brought major improvements in child health and mortality rates as well as better health awareness to the community as a whole.

Causes and differentials of childhood mortality in Iraq

PubMed Central

Awqati, Naira A; Ali, Mohamed M; Al-Ward, Nada J; Majeed, Faiza A; Salman, Khawla; Al-Alak, Mahdi; Al-Gasseer, Naeema

2009-01-01

Background Limited information is available in Iraq regarding the causes of under-five mortality. The vital registration system is deficient in its coverage, particularly from rural areas where access to health services is limited and most deaths occur at home, i.e. outside the health system, and hence the cause of death goes unreported. Knowledge of patterns and trends in causes of under-five mortality is essential for decision-makers in assessing programmatic needs, prioritizing interventions, and monitoring progress. The aim of this study was to identify causes of under-five children deaths using a simplified verbal autopsy questionnaire. The objective was to define the leading symptoms and cause of death among Iraqi children from all regions of Iraq during 1994–1999. Methods To determine the cause structure of child deaths, a simplified verbal autopsy questionnaire was used in interviews conducted in the Iraqi Child & Maternal Mortality Survey (ICMMS) 1999 national sample. All the mothers/caregivers of the deceased children were asked open-ended questions about the symptoms within the two weeks preceding death; they could mention more than one symptom. Results The leading cause of death among under-five children was found to be childhood illnesses in 81.2%, followed by sudden death in 8.9% and accidents in 3.3%. Among under-five children dying of illnesses, cough and difficulty in breathing were the main symptoms preceding death in 34.0%, followed by diarrhea in 24.4%. Among neonates the leading cause was cough/and or difficulty in breathing in 42.3%, followed by sudden death in 11.9%, congenital abnormalities in 10.3% and prematurity in 10.2%. Diarrhea was the leading cause of death among infants in 49.8%, followed by cough and/or difficulty in breathing in 26.6%. Among children 12–59 months diarrhea was the leading cause of death in 43.4%, followed by accidents, injuries, and poisoning in 19.3%, then cough/difficulty in breathing in 14.8%. Conclusion In Iraq Under-five child mortality is one of the highest in the Middle East region; deaths during the neonatal period accounted for more than half of under-five children deaths highlighting an urgent need to introduce health interventions to improve essential neonatal care. Priority needs to be given to the prevention, early and effective treatment of neonatal conditions, diarrheal diseases, acute respiratory infections, and accidents. This study points to the need for further standardized assessments of under-5 mortality in Iraq. PMID:19545410

Non-specific effects of diphtheria-tetanus-pertussis and measles vaccinations? An analysis of surveillance data from Navrongo, Ghana.

PubMed

Welaga, Paul; Nielsen, Jens; Adjuik, Martin; Debpuur, Cornelius; Ross, David A; Ravn, Henrik; Benn, Christine S; Aaby, Peter

2012-12-01

Studies from low-income countries have suggested that routine vaccinations may have non-specific effects on child mortality; measles vaccine (MV) is associated with lower mortality and diphtheria-tetanus-pertussis (DTP) with relatively higher mortality. We used data from Navrongo, Ghana, to examine the impact of vaccinations on child mortality. Vaccination status was assessed at the initiation of a trial of vitamin A supplementation and after 12 and 24 months of follow-up. Within the placebo group, we compared the mortality over the first 4 months and the full 2 years of follow-up for different vaccination status groups with different likelihoods of additional vaccinations during follow-up. The frequency of additional vaccinations was assessed among children whose vaccination card was seen at 12 and 24 months of follow-up. Among children with a vaccination card, more than 75% received missing DTP or MV during the first 12 months of follow-up, whereas only 25% received these vaccines among children with no vaccination card at enrollment. Children without a card at enrollment had a significant threefold higher mortality over the 2-year follow-up period than those fully vaccinated. The small group of children with DTP3-4 but no MV at enrollment had lower mortality than children without a card and had the same mortality as fully vaccinated children. In contrast, children with 1-2 DTP doses but no MV had a higher mortality during the first 4 months than children without a card [MRR = 1.65 (0.95, 2.87)]; compared with the fully vaccinated children, they had significantly higher mortality after 4 months [MRR = 2.38 (1.07, 5.30)] and after 2 years [MRR = 2.41 (1.41, 4.15)]. Children with 0-2 DTP doses at enrollment had higher mortality after 4 months (MRR = 1.67 (0.82, 3.43) and after 2 years [MRR = 1.85 (1.16, 2.95)] than children who had all three doses of DTP at enrollment. As hypothesised, DTP vaccination was associated with higher child mortality than measles vaccination. To optimise vaccination policies, routine vaccinations need to be evaluated in randomised trials measuring the impact on survival. © 2012 Blackwell Publishing Ltd.

Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality.

PubMed

Paudel, Deepak; Shrestha, Ishwar B; Siebeck, Matthias; Rehfuess, Eva A

2013-12-28

Nepal has made substantial progress in reducing under-five mortality and is on track to achieve Millennium Development Goal 4, but advances in neonatal health are less encouraging. The objectives of this study were to assess relative and absolute inequalities in neonatal mortality over time, and to review experience with major programs to promote neonatal health. Using four nationally representative surveys conducted in 1996, 2001, 2006 and 2011, we calculated neonatal mortality rates for Nepal and for population groups based on child sex, geographical and socio-economic variables using a true cohort log probability approach. Inequalities based on different variables and years were assessed using rate differences (rd) and rate ratios (rr); time trends in neonatal mortality were measured using the annual rate of reduction. Through literature searches and expert consultation, information on Nepalese policies and programs implemented since 1990 and directly or indirectly attempting to reduce neonatal mortality was compiled. Data on timeline, coverage and effectiveness were extracted for major programs. The annual rate of reduction for neonatal mortality between 1996 and 2011 (2.8 percent per annum) greatly lags behind the achievements in under-five and infant mortality, and varies across population groups. For the year 2011, stark absolute and relative inequalities in neonatal mortality exist in relation to wealth status (rd = 21.4, rr = 2.2); these are less pronounced for other measures of socio-economic status, child sex and urban-rural residence, ecological and development region. Among many efforts to promote child and maternal health, three established programs and two pilot programs emerged as particularly relevant to reducing neonatal mortality. While these were designed based on national and international evidence, information about coverage of different population groups and effectiveness is limited. Neonatal mortality varies greatly by socio-demographic variables. This study clearly shows that much remains to be achieved in terms of reducing neonatal mortality across different socio-economic, ethnic and geographical population groups in Nepal. In moving forward it will be important to scale up programs of proven effectiveness, conduct in-depth evaluation of promising new approaches, target unreached and hard-to-reach populations, and maximize use of financial and personnel resources through integration across programs.

Broader health coverage is good for the nation's health: evidence from country level panel data.

PubMed

Moreno-Serra, Rodrigo; Smith, Peter C

2015-01-01

Progress towards universal health coverage involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. The paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. We use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. We employ various proxies for the coverage level in a health system. Our results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries.

Broader health coverage is good for the nation's health: evidence from country level panel data

PubMed Central

Moreno-Serra, Rodrigo; Smith, Peter C

2015-01-01

Progress towards universal health coverage involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. The paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. We use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. We employ various proxies for the coverage level in a health system. Our results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries. PMID:25598588

Important Risk Factors of Mortality Among Children Aged 1-59 Months in Rural Areas of Shahroud, Iran: A Community-based Nested Case-Control Study.

PubMed

Chaman, Reza; Alami, Ali; Emamian, Mohammad Hassan; Naieni, Kourosh Holakouie; Mirmohammadkhani, Majid; Ahmadnezhad, Elham; Entezarmahdi, Rasool; Shati, Mohsen; Shariati, Mohammad

2012-12-01

The aim of the study was to evaluate potential risk factors of children mortality between 1-59 months of age. This nested case-control study was conducted among children born from June 1999 to March 2009 in rural areas of Shahroud, located in the central region of Iran using health care visit reports and follow-up data available in household health records. MORTALITY WAS SIGNIFICANTLY ASSOCIATED WITH BREASTFEEDING DURATION (OR: 0.87, 95% CI: 0.81-0.93), total health care visits (OR: 0.90, 95% CI: 0.83-0.98) and low birth weight (LBW) (OR: 7.38, 95% CI: 1.37-39.67). In our study, a longer breastfeeding period and more frequent health care visits were two important protective factors, while LBW was an important risk factor for 1-59 month child mortality. It seems, that complex and multiple factors may be involved in mortality of under 5-year-old children, so combined efforts would be necessary to improve child health indicators.

Precisely Tracking Childhood Death.

PubMed

Farag, Tamer H; Koplan, Jeffrey P; Breiman, Robert F; Madhi, Shabir A; Heaton, Penny M; Mundel, Trevor; Ordi, Jaume; Bassat, Quique; Menendez, Clara; Dowell, Scott F

2017-07-01

Little is known about the specific causes of neonatal and under-five childhood death in high-mortality geographic regions due to a lack of primary data and dependence on inaccurate tools, such as verbal autopsy. To meet the ambitious new Sustainable Development Goal 3.2 to eliminate preventable child mortality in every country, better approaches are needed to precisely determine specific causes of death so that prevention and treatment interventions can be strengthened and focused. Minimally invasive tissue sampling (MITS) is a technique that uses needle-based postmortem sampling, followed by advanced histopathology and microbiology to definitely determine cause of death. The Bill & Melinda Gates Foundation is supporting a new surveillance system called the Child Health and Mortality Prevention Surveillance network, which will determine cause of death using MITS in combination with other information, and yield cause-specific population-based mortality rates, eventually in up to 12-15 sites in sub-Saharan Africa and south Asia. However, the Gates Foundation funding alone is not enough. We call on governments, other funders, and international stakeholders to expand the use of pathology-based cause of death determination to provide the information needed to end preventable childhood mortality.

Absolute or relative? A comparative analysis of the relationship between poverty and mortality.

PubMed

Fritzell, Johan; Rehnberg, Johan; Bacchus Hertzman, Jennie; Blomgren, Jenni

2015-01-01

We aimed to examine the cross-national and cross-temporal association between poverty and mortality, in particular differentiating the impact of absolute and relative poverty. We employed pooled cross-sectional time series analysis. Our measure of relative poverty was based upon the standard 60% of median income. The measure of absolute, or fixed, poverty was based upon the US poverty threshold. Our analyses were conducted on data for 30 countries between 1978 and 2010, a total of 149 data points. We separately studied infant, child, and adult mortality. Our findings highlight the importance of relative poverty for mortality. Especially for infant and child mortality, we found that our estimates of fixed poverty is close to zero either in the crude models, or when adjusting for gross domestic product. Conversely, the relative poverty estimates increased when adjusting for confounders. Our results seemed robust to a number of sensitivity tests. If we agree that risk of death is important, the public policy implication of our findings is that relative poverty, which has close associations to overall inequality, should be a major concern also among rich countries.

Impact of the level of state tax code progressivity on children's health outcomes.

PubMed

Granruth, Laura Brierton; Shields, Joseph J

2011-08-01

This research study examines the impact of the level of state tax code progressivity on selected children's health outcomes. Specifically, it examines the degree to which a state's tax code ranking along the progressive-regressive continuum relates to percentage of low birthweight babies, infant and child mortality rates, and percentage of uninsured children. Using data merged from a number of public data sets, the authors find that the level of state tax code progressivity is a factor in state rates of infant and child mortality. States with lower median incomes and regressive tax policies have the highest rates of infant and child mortality.With regard to the percentage of children 17 years of age and below who lack health insurance, it is found that larger states with regressive tax policies have the largest percentage of uninsured children. In general, more heavily populated states with more progressive tax codes have healthier children. The implications of these findings are discussed in terms of tax policy and the well-being of children as well as for social work education, social work practice, and social work research.

The impact of violence against women on reproductive health and child mortality in Timor-Leste.

PubMed

Taft, Angela J; Powell, Rhonda L; Watson, Lyndsey F

2015-04-01

To determine differences in reproductive health and infant and child mortality and health between abused and non-abused ever-married women in Timor-Leste. Secondary data analysis of Timor-Leste Demographic Health Survey (1,959 ever-married women aged 15-49 years). Associations with violence estimated using multinomial logistic regression adjusted for sociodemographic variables and age of first intercourse. Overall, 45% of ever-married women experienced violence: 34% reported physical only and 11% reported combined physical, sexual and/or emotional violence. Compared to non-abused women, women reporting physical violence only were more likely to use traditional contraception (AdjOR 2.35, 95%CI 1.05-5.26) or report: a sexually transmitted infection (AdjOR 4.46, 95%CI 3.27-6.08); a pregnancy termination (AdjOR 1.42, 95%CI 1.03-1.96); a child who had died (AdjOR 1.30, 95%CI 1.05-1.60), a low birth weight infant (AdjOR 2.08, 95%CI 1.64-2.64); and partially vaccinated children (AdjOR 1.35, 95%CI 1.05-1.74). Women who reported combined abuse were more likely to report: a sexually transmitted infection (AdjOR 3.51, 95%CI 2.26-5.44); a pregnancy termination (AdjOR 1.95, 95%CI 1.27-3.01); few antenatal visits (AdjOR 1.76 95%CI 1.21-2.55); and a child who had died (AdjOR 1.45, 95%CI 1.06-2.00). Violence exposes women to poor reproductive health, infant and child mortality and poor infant and child health. Preventing and reducing violence against women should improve women and children's health outcomes in Timor-Leste. © 2015 Public Health Association of Australia.

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects

PubMed Central

Perry, Henry B; Sacks, Emma; Schleiff, Meike; Kumapley, Richard; Gupta, Sundeep; Rassekh, Bahie M; Freeman, Paul A

2017-01-01

Background As part of our review of the evidence of the effectiveness of community–based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH), we summarize here the common delivery strategies of projects, programs and field research studies (collectively referred to as projects) that have demonstrated effectiveness in improving child mortality. Other articles in this series address specifically the effects of CBPHC on improving MNCH, while this paper explores the specific strategies used. Methods We screened 12 166 published reports in PubMed of community–based approaches to improving maternal, neonatal and child health in high–mortality, resource–constrained settings from 1950–2015. A total of 700 assessments, including 148 reports from other publicly available sources (mostly unpublished evaluation reports and books) met the criteria for inclusion and were reviewed using a data extraction form. Here we identify and categorize key strategies used in project implementation. Results Six categories of strategies for program implementation were identified, all of which required working in partnership with communities and health systems: (a) program design and evaluation, (b) community collaboration, (c) education for community–level staff, volunteers, beneficiaries and community members, (d) health systems strengthening, (e) use of community–level workers, and (f) intervention delivery. Four specific strategies for intervention delivery were identified: (a) recognition, referral, and (when possible) treatment of serious childhood illness by mothers and/or trained community agents, (b) routine systematic visitation of all homes, (c) facilitator–led participatory women’s groups, and (d) health service provision at outreach sites by mobile health teams. Conclusions The strategies identified here provide useful starting points for program design in strengthening the effectiveness of CBPHC for improving MNCH. PMID:28685044

Household context and child mortality in rural South Africa: the effects of birth spacing, shared mortality, household composition and socio-economic status.

PubMed

Houle, Brian; Stein, Alan; Kahn, Kathleen; Madhavan, Sangeetha; Collinson, Mark; Tollman, Stephen M; Clark, Samuel J

2013-10-01

Household characteristics are important influences on the risk of child death. However, little is known about this influence in HIV-endemic areas. We describe the effects of household characteristics on children's risk of dying in rural South Africa. We use data describing the mortality of children younger than 5 years living in the Agincourt health and socio-demographic surveillance system study population in rural northeast South Africa during the period 1994-2008. Using discrete time event history analysis we estimate children's probability of dying by child characteristics and household composition (other children and adults other than parents) (N=924,818 child-months), and household socio-economic status (N=501,732 child-months). Children under 24 months of age whose subsequent sibling was born within 11 months experience increased odds of dying (OR 2.5; 95% CI 1.1-5.7). Children also experience increased odds of dying in the period 6 months (OR 2.1; 95% CI 1.2-3.6), 3-5 months (OR 3.0; 95% CI 1.5-5.9), and 2 months (OR 11.8; 95% CI 7.6-18.3) before another household child dies. The odds of dying remain high at the time of another child's death (OR 11.7; 95% CI 6.3-21.7) and for the 2 months following (OR 4.0; 95% CI 1.9-8.6). Having a related but non-parent adult aged 20-59 years in the household reduces the odds (OR 0.6; 95% CI 0.5-0.8). There is an inverse relationship between a child's odds of dying and household socio-economic status. This detailed household profile from a poor rural setting where HIV infection is endemic indicates that children are at high risk of dying when another child is very ill or has recently died. Short birth intervals and additional children in the household are further risk factors. Presence of a related adult is protective, as is higher socio-economic status. Such evidence can inform primary health care practice and facilitate targeting of community health worker efforts, especially when covering defined catchment areas.

Pakistan and the Millennium Development Goals for Maternal and Child Health: progress and the way forward.

PubMed

Rizvi, Arjumand; Bhatti, Zaid; Das, Jai K; Bhutta, Zulfiqar A

2015-01-01

The world has made substantial progress in reducing maternal and child mortality, but many countries are projected to fall short of achieving their Millennium Development Goals (MDGs) 4 and 5 targets. The major objective of this paper is to examine progress in Pakistan in reducing maternal and child mortality and malnutrition over the last two decades. Data from recent national and international surveys suggest that Pakistan lags behind on all of its MDGs related to maternal and child health and, for some indicators especially related to nutrition, the situation has worsened from the baseline of 1990. Progress in addressing key social determinants such as poverty, female education and empowerment has also been slow and unregulated population growth has further compromised progress. There is a need to integrate the various different sectors and programmes to achieve the desired results effectively and efficiently as many of the determinants and influencing factors are outside the health sector.

Why are women so intelligent? The effect of maternal IQ on childhood mortality may be a relevant evolutionary factor.

PubMed

Charlton, Bruce G

2010-03-01

Humans are an unusual species because they exhibit an economic division of labour. Most theories concerning the evolution of specifically human intelligence have focused either on economic problems or sexual selection mechanisms, both of which apply more to men than women. Yet while there is evidence for men having a slightly higher average IQ, the sexual dimorphism of intelligence is not obvious (except at unusually high and low levels). However, a more female-specific selection mechanism concerns the distinctive maternal role in child care during the offspring's early years. It has been reported that increasing maternal intelligence is associated with reducing child mortality. This would lead to a greater level of reproductive success for intelligent women, and since intelligence is substantially heritable, this is a plausible mechanism by which natural selection might tend to increase female intelligence in humans. Any effect of maternal intelligence on improving child survival would likely be amplified by assortative mating for IQ by which people tend to marry others of similar intelligence - combining female maternal and male economic or sexual selection factors. Furthermore, since general intelligence seems to have the functional attribute of general purpose problem-solving and more rapid learning, the advantages of maternal IQ are likely to be greater as the environment for child-rearing is more different from the African hunter-gatherer society and savannah environment in which ancestral humans probably evolved. However, the effect of maternal IQ on child mortality would probably only be of major evolutionary significance in environments where childhood mortality rates were high. The modern situation is that population growth is determined mostly by birth rates; so in modern conditions, maternal intelligence may no longer have a significant effect on reproductive success; the effect of female IQ on reproductive success is often negative. Nonetheless, in the past it is plausible that the link between maternal IQ and child survival constituted a strong selection pressure acting specifically on women. Copyright (c) 2009. Published by Elsevier Ltd.

Women's autonomy and child survival: a comparison of Muslims and non-Muslims in four Asian countries.

PubMed

Ghuman, Sharon J

2003-08-01

In this article, I evaluate the hypothesis that higher infant and child mortality among Muslim populations is related to the lower autonomy of Muslim women using data from 15 pairs of Muslim and non-Muslim communities in India, Malaysia, the Philippines, and Thailand. Women's autonomy in various spheres is not consistently lower in Muslim than in non-Muslim settings. Both across and within communities, the association between women's autonomy and mortality is weak, and measures of autonomy or socioeconomic status are generally of limited import for understanding the Muslim disadvantage in children's survival.

Drug-Drug Interactions, Effectiveness, and Safety of Hormonal Contraceptives in Women Living with HIV.

PubMed

Scarsi, Kimberly K; Darin, Kristin M; Chappell, Catherine A; Nitz, Stephanie M; Lamorde, Mohammed

2016-11-01

Family planning options, including hormonal contraceptives, are essential for improving reproductive health among the more than 17 million women living with HIV worldwide. For these women, prevention of unintended pregnancy decreases maternal and child mortality, as well as reduces the risk of perinatal HIV transmission. Similarly, treatment of HIV with antiretroviral therapy (ART) is essential for reducing morbidity and mortality among HIV-positive individuals, as well as preventing HIV transmission between sexual partners or from mother to child. Importantly, despite the benefits of hormonal contraceptives, barriers to effective family planning methods exist for HIV-positive women. Specifically, drug-drug interactions can occur between some antiretroviral medications and some hormonal contraceptives, which may influence both contraceptive efficacy and tolerability. In addition, safety concerns have been raised about the impact of hormonal contraceptives on HIV disease progression, tolerability, and the risk of female-to-male HIV transmission. This review article summarizes the potential for drug-drug interactions, tolerability, and contraceptive effectiveness when hormonal contraceptives are combined with ART. In addition, the evidence surrounding the influence of hormonal contraceptives on HIV transmission and HIV disease progression in women living with HIV are summarized.

Commentary: Gaze Aversion and Unnoticed Phenomena.

PubMed

Runyan, Desmond K

2018-03-28

Child abuse is a social phenomenon that has been under-researched and under-supported. The scale of the problem is large with over 3 million US children reported for abuse or neglect each year. An estimated 15% of confirmed victims may be placed in out-of-home care to ensure their safety. Studies have not previously examined the impact of losing a child into foster care on maternal health and mortality. Family and maternal risk factors, such as teen pregnancy, intimate partner violence or drug and alcohol abuse, have been well documented as risk factors for maltreatment. The findings of Wall-Wieler, et al. are not so much unexpected as they are surprising in that the impact of foster care on maternal health has heretofore been largely unexamined. The innovative use of maternal sisters with children not in foster care as controls provides a powerful control for family genetics, and family environment with likely common early life experiences, in the mortality of the mothers whose children were removed. With over 3 million children reported for suspected maltreatment each year, the related health and social outcomes for both children and their families require more careful examination using public health methods.

Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation.

PubMed

You, Danzhen; Hug, Lucia; Ejdemyr, Simon; Idele, Priscila; Hogan, Daniel; Mathers, Colin; Gerland, Patrick; New, Jin Rou; Alkema, Leontine

2015-12-05

In 2000, world leaders agreed on the Millennium Development Goals (MDGs). MDG 4 called for a two-thirds reduction in the under-5 mortality rate between 1990 and 2015. We aimed to estimate levels and trends in under-5 mortality for 195 countries from 1990 to 2015 to assess MDG 4 achievement and then intended to project how various post-2015 targets and observed rates of change will affect the burden of under-5 deaths from 2016 to 2030. We updated the UN Inter-agency Group for Child Mortality Estimation (UN IGME) database with 5700 country-year datapoints. As of July, 2015, the database contains about 17 000 country-year datapoints for mortality of children younger than 5 years for 195 countries, and includes all available nationally-representative data from vital registration systems, population censuses, household surveys, and sample registration systems. We used these data to generate estimates, with uncertainty intervals, of under-5 (age 0-4 years) mortality using a Bayesian B-spline bias-reduction model (B3 model). This model includes a data model to adjust for systematic biases associated with different types of data sources. To provide insights into the global and regional burden of under-5 deaths associated with post-2015 targets, we constructed five scenario-based projections for under-5 mortality from 2016 to 2030 and estimated national, regional, and global under-5 mortality rates up to 2030 for each scenario. The global under-5 mortality rate has fallen from 90·6 deaths per 1000 livebirths (90% uncertainty interval 89·3-92·2) in 1990 to 42·5 (40·9-45·6) in 2015. During the same period, the annual number of under-5 deaths worldwide dropped from 12·7 million (12·6 million-13·0 million) to 5·9 million (5·7 million-6·4 million). The global under-5 mortality rate reduced by 53% (50-55%) in the past 25 years and therefore missed the MDG 4 target. Based on point estimates, two regions-east Asia and the Pacific, and Latin America and the Caribbean-achieved the MDG 4 target. 62 countries achieved the MDG 4 target, of which 24 were low-income and lower-middle income countries. Between 2016 and 2030, 94·4 million children are projected to die before the age of 5 years if the 2015 mortality rate remains constant in each country, and 68·8 million would die if each country continues to reduce its mortality rate at the pace estimated from 2000 to 2015. If all countries achieve the Sustainable Development Goal of an under-5 mortality rate of 25 or fewer deaths per 1000 livebirths by 2030, we project 56·0 million deaths by 2030. About two-thirds of all sub-Saharan African countries need to accelerate progress to achieve this target. Despite substantial progress in reducing child mortality, concerted efforts remain necessary to avoid preventable under-5 deaths in the coming years and to accelerate progress in improving child survival further. Urgent actions are needed most in the regions and countries with high under-5 mortality rates, particularly those in sub-Saharan Africa and south Asia. None. Copyright © 2015 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.

Newborn care in Indonesia, Lao People's Democratic Republic and the Philippines: a comprehensive needs assessment.

PubMed

Duysburgh, Els; Kerstens, Birgit; Diaz, Melissa; Fardhdiani, Vini; Reyes, Katherine Ann V; Phommachanh, Khamphong; Temmerman, Marleen; Rodriques, Basil; Zaka, Nabila

2014-02-15

Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People's Democratic Republic (PDR) and the Philippines. We assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns' health status, the health policy and the health system context for newborn care and the equity situation regarding newborn survival. (1) In the three countries, decline of neonatal mortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable. Similar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality of newborn care provided and inequities in newborn care. Child survival programmes focussed on children over four weeks of age have shown to have positive outcomes. Similar efforts as those used in these programmes should be considered in newborn care.

Tanzania's countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015.

PubMed

Afnan-Holmes, Hoviyeh; Magoma, Moke; John, Theopista; Levira, Francis; Msemo, Georgina; Armstrong, Corinne E; Martínez-Álvarez, Melisa; Kerber, Kate; Kihinga, Clement; Makuwani, Ahmad; Rusibamayila, Neema; Hussein, Asia; Lawn, Joy E

2015-07-01

Tanzania is on track to meet Millennium Development Goal (MDG) 4 for child survival, but is making insufficient progress for newborn survival and maternal health (MDG 5) and family planning. To understand this mixed progress and to identify priorities for the post-2015 era, Tanzania was selected as a Countdown to 2015 case study. We analysed progress made in Tanzania between 1990 and 2014 in maternal, newborn, and child mortality, and unmet need for family planning, in which we used a health systems evaluation framework to assess coverage and equity of interventions along the continuum of care, health systems, policies and investments, while also considering contextual change (eg, economic and educational). We had five objectives, which assessed each level of the health systems evaluation framework. We used the Lives Saved Tool (LiST) and did multiple linear regression analyses to explain the reduction in child mortality in Tanzania. We analysed the reasons for the slower changes in maternal and newborn survival and family planning, to inform priorities to end preventable maternal, newborn, and child deaths by 2030. In the past two decades, Tanzania's population has doubled in size, necessitating a doubling of health and social services to maintain coverage. Total health-care financing also doubled, with donor funding for child health and HIV/AIDS more than tripling. Trends along the continuum of care varied, with preventive child health services reaching high coverage (≥85%) and equity (socioeconomic status difference 13-14%), but lower coverage and wider inequities for child curative services (71% coverage, socioeconomic status difference 36%), facility delivery (52% coverage, socioeconomic status difference 56%), and family planning (46% coverage, socioeconomic status difference 22%). The LiST analysis suggested that around 39% of child mortality reduction was linked to increases in coverage of interventions, especially of immunisation and insecticide-treated bednets. Economic growth was also associated with reductions in child mortality. Child health programmes focused on selected high-impact interventions at lower levels of the health system (eg, the community and dispensary levels). Despite its high priority, implementation of maternal health care has been intermittent. Newborn survival has gained attention only since 2005, but high-impact interventions are already being implemented. Family planning had consistent policies but only recent reinvestment in implementation. Mixed progress in reproductive, maternal, newborn, and child health in Tanzania indicates a complex interplay of political prioritisation, health financing, and consistent implementation. Post-2015 priorities for Tanzania should focus on the unmet need for family planning, especially in the Western and Lake regions; addressing gaps for coverage and quality of care at birth, especially in rural areas; and continuation of progress for child health. Government of Canada, Foreign Affairs, Trade, and Development; US Fund for UNICEF; and the Bill & Melinda Gates Foundation. Copyright © 2015 Afnan-Holmes et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Birth rates among male cancer survivors and mortality rates among their offspring: a population-based study from Sweden.

PubMed

Tang, Siau-Wei; Liu, Jenny; Juay, Lester; Czene, Kamila; Miao, Hui; Salim, Agus; Verkooijen, Helena M; Hartman, Mikael

2016-03-08

With improvements in treatment of cancer, more men of fertile age are survivors of cancer. This study evaluates trends in birth rates among male cancer survivors and mortality rates of their offspring. From the Swedish Multi-generation Register and Cancer Register, we identified 84,752 men ≤70 years with a history of cancer, for which we calculated relative birth rates as compared to the background population(Standardized Birth Ratios, SBRs). We also identified 126,696 offspring of men who had cancer, and compared their risks of death to the background population(Standardized Mortality Ratio, SMRs). Independent factors associated with reduced birth rates and mortality rates were estimated with Poisson modelling. Men with a history of cancer were 23 % less likely to father a child compared to the background population(SBR 0.77, 95 % Confidence Interval[CI] 0.75-0.79). Nulliparous men were significantly more likely to father a child after diagnosis (SBR 0.81, 95 % CI 0.79-0.83) compared to parous men (SBR 0.68, 95 % CI 0.66-0.74). Cancer site(prostate), onset of cancer during childhood or adolescence, parity status at diagnosis(parous), current age(>40 years) and a recent diagnosis were significant and independent predictors of a reduced probability of fathering a child after diagnosis. Of the 126,696 children born to men who have had a diagnosis of cancer, 2604(2.06 %) died during follow up. The overall mortality rate was similar to the background population(SMR of 1.00, 95 %CI 0.96-1.04) and was not affected by the timing of their birth in relation to father's cancer diagnosis. Male cancer survivors are less likely to father a child compared to the background population. This is influenced by cancer site, age of onset and parity status at diagnosis. However, their offspring are not at an increased risk of death.

77 FR 64524 - Advisory Committee on Infant Mortality; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... the Healthy Start Program and Healthy People 2020 infant mortality objectives. Agenda: Topics that will be discussed include the following: HRSA Update; Maternal and Child Health Bureau Update; Healthy Start Program Update; Updates from Partnering Agencies and Organizations; and ACIM's recommendations for...

Missed cases of multiple forms of child abuse and neglect.

PubMed

Koc, Feyza; Oral, Resmiye; Butteris, Regina

2014-01-01

Child abuse and neglect is a public health problem and usually associated with family dysfunction due to multiple psychosocial, individual, and environmental factors. The diagnosis of child abuse may be difficult and require a high index of suspicion on the part of the practitioners encountering the child and the family. System-related factors may also enable abuse or prevent the early recognition of abuse. Child abuse and neglect that goes undiagnosed may give rise to chronic abuse and increased morbidity-mortality. In this report, we present two siblings who missed early diagnosis and we emphasize the importance of systems issues to allow early recognition of child abuse and neglect.

The introduction of new policies and strategies to reduce inequities and improve child health in Kenya: A country case study on progress in child survival, 2000-2013.

PubMed

Brault, Marie A; Ngure, Kenneth; Haley, Connie A; Kabaka, Stewart; Sergon, Kibet; Desta, Teshome; Mwinga, Kasonde; Vermund, Sten H; Kipp, Aaron M

2017-01-01

As of 2015, only 12 countries in the World Health Organization's AFRO region had met Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Kenya was one of the countries selected for an in-depth case study due to its insufficient progress in reducing under-five mortality, with only a 28% reduction between 1990 and 2013. This paper presents indicators, national documents, and qualitative data describing the factors that have both facilitated and hindered Kenya's efforts in reducing child mortality. Key barriers identified in the data were widespread socioeconomic and geographic inequities in access and utilization of maternal, neonatal, and child health (MNCH) care. To reduce these inequities, Kenya implemented three major policies/strategies during the study period: removal of user fees, the Kenya Essential Package for Health, and the Community Health Strategy. This paper uses qualitative data and a policy review to explore the early impacts of these efforts. The removal of user fees has been unevenly implemented as patients still face hidden expenses. The Kenya Essential Package for Health has enabled construction and/or expansion of healthcare facilities in many areas, but facilities struggle to provide Emergency Obstetric and Neonatal Care (EmONC), neonatal care, and many essential medicines and commodities. The Community Health Strategy appears to have had the most impact, improving referrals from the community and provision of immunizations, malaria prevention, and Prevention of Mother-to-Child Transmission of HIV. However, the Community Health Strategy is limited by resources and thus also unevenly implemented in many areas. Although insufficient progress was made pre-2015, with additional resources and further scale-up of new policies and strategies Kenya can make further progress in child survival.

The introduction of new policies and strategies to reduce inequities and improve child health in Kenya: A country case study on progress in child survival, 2000-2013

PubMed Central

Brault, Marie A.; Ngure, Kenneth; Haley, Connie A.; Kabaka, Stewart; Sergon, Kibet; Desta, Teshome; Mwinga, Kasonde; Vermund, Sten H.; Kipp, Aaron M.

2017-01-01

As of 2015, only 12 countries in the World Health Organization’s AFRO region had met Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Kenya was one of the countries selected for an in-depth case study due to its insufficient progress in reducing under-five mortality, with only a 28% reduction between 1990 and 2013. This paper presents indicators, national documents, and qualitative data describing the factors that have both facilitated and hindered Kenya’s efforts in reducing child mortality. Key barriers identified in the data were widespread socioeconomic and geographic inequities in access and utilization of maternal, neonatal, and child health (MNCH) care. To reduce these inequities, Kenya implemented three major policies/strategies during the study period: removal of user fees, the Kenya Essential Package for Health, and the Community Health Strategy. This paper uses qualitative data and a policy review to explore the early impacts of these efforts. The removal of user fees has been unevenly implemented as patients still face hidden expenses. The Kenya Essential Package for Health has enabled construction and/or expansion of healthcare facilities in many areas, but facilities struggle to provide Emergency Obstetric and Neonatal Care (EmONC), neonatal care, and many essential medicines and commodities. The Community Health Strategy appears to have had the most impact, improving referrals from the community and provision of immunizations, malaria prevention, and Prevention of Mother-to-Child Transmission of HIV. However, the Community Health Strategy is limited by resources and thus also unevenly implemented in many areas. Although insufficient progress was made pre-2015, with additional resources and further scale-up of new policies and strategies Kenya can make further progress in child survival. PMID:28763454

Consumer knowledge and availability of maternal and child health services: a challenge for achieving MDG 4 and 5 in Southeast Nigeria

PubMed Central

2013-01-01

Background Reducing child mortality and improving maternal health occupies a prominent space in the Millennium Development Goals (MDGs), and it has been noted that some reductions have taken place, but not enough. If consumers know what and where services are available, they may be motivated to use them. This study therefore evaluated consumers’ knowledge about available maternal and child health services and where these services can be obtained in the study area. Although knowledge of available health services does not translate to utilization of these services, this study is important as knowledge of available health services can prompt the informed use of services. The study determined the consumers’ knowledge about available Maternal and Child Health services and where these services are available. Methods The study was a cross-sectional research design. The sample for the study consisted of a total of 450 women of child bearing age selected from the 20 political wards that make up Ezeagu Local Government Area. The 20 political wards constituted 20 clusters (cluster sampling technique) i.e. one cluster per political ward. Simple random sampling method by balloting was used to select five (5) wards out of the 20 political wards. Finally, a total of 90 women of childbearing age were selected from each of the five wards (clusters) using simple random method. Results The study showed that majority of the women (37.3%) were between 36-45 years, married [49.5%], had more than five children [21.6%], hold at least SSCE [23.7%], and were farmers and Christians [32.3% and 81.8%] respectively. Maternal health services available are mainly antenatal [57%] and delivery services [54.3%]. Other available services are described at the results section. In the same vein, immunization [63.8%] was the most available child health service in the area. Both Maternal and Child Health services were available mainly at public and private hospitals [53.6% and 52.3% for maternal services; 56.1% and 53.9% respectively for child health services] respectively [see result section for details]. Conclusions Available Maternal and Child Health services known to mothers in the study area were not encouraging, and these are structurally contextual. ANC and delivery services for mothers, and immunization for children were found to be available as indicated by at least more than half of the respondents. The women knew that these services were available mostly in public and private hospitals which should constitute referral points instead of the health centers that offer primary care at community level. Knowledge of available services is important for consumers to make use of the services. Awareness programmes should be targeted more on the consumers if the MDG 4 and 5 must be reached by 2015. This suggests that the women in the study area do not use primary health care services adequately, and may be incurring huge indirect costs and at the same time travel too far to obtain primary care. This is therefore quite challenging for reducing child mortality and improving maternal health in southeast Nigeria. Knowledge of available services is important for consumers to make use of the services. Awareness programmes should be targeted more on the consumers if the MDG 4 and 5 must be reached by 2015. PMID:23394481

Intergenerational impacts of maternal mortality: Qualitative findings from rural Malawi

PubMed Central

2015-01-01

Background Maternal mortality, although largely preventable, remains unacceptably high in developing countries such as Malawi and creates a number of intergenerational impacts. Few studies have investigated the far-reaching impacts of maternal death beyond infant survival. This study demonstrates the short- and long-term impacts of maternal death on children, families, and the community in order to raise awareness of the true costs of maternal mortality and poor maternal health care in Neno, a rural and remote district in Malawi. Methods Qualitative in-depth interviews were conducted to assess the impact of maternal mortality on child, family, and community well-being. We conducted 20 key informant interviews, 20 stakeholder interviews, and six sex-stratified focus group discussions in the seven health centers that cover the district. Transcripts were translated, coded, and analyzed in NVivo 10. Results Participants noted a number of far-reaching impacts on orphaned children, their new caretakers, and extended families following a maternal death. Female relatives typically took on caregiving responsibilities for orphaned children, regardless of the accompanying financial hardship and frequent lack of familial or governmental support. Maternal death exacerbated children’s vulnerabilities to long-term health and social impacts related to nutrition, education, employment, early partnership, pregnancy, and caretaking. Impacts were particularly salient for female children who were often forced to take on the majority of the household responsibilities. Participants cited a number of barriers to accessing quality child health care or support services, and many were unaware of programming available to assist them in raising orphaned children or how to access these services. Conclusions In order to both reduce preventable maternal mortality and diminish the impacts on children, extended families, and communities, our findings highlight the importance of financing and implementing universal access to emergency obstetric and neonatal care, and contraception, as well as social protection programs, including among remote populations. PMID:26000733

"Girl Power!": The Relationship between Women's Autonomy and Children's Immunization Coverage in Ethiopia.

PubMed

Ebot, Jane O

2015-09-18

Although immunizations are efficient and cost effective methods of reducing child mortality, worldwide, approximately 2 million children die yearly of vaccine-preventable diseases. Researchers and health organizations have detailed information on the positive relationship between women's autonomy and children's health outcomes in developing countries. This study investigates the links between women's household autonomy and children's immunization status using data from a nationally representative sample of children aged 12-30 months (N = 2941) from the 2011 Ethiopia Demographic and Health Survey. The results showed that women's socioeconomic status and household autonomy were significantly associated with children's immunization status. Overall, the implications of this study align with those of the Millennium Development Goal #3: improvements in women's household autonomy are linked to more positive child health outcomes.

The value and use of different contraceptive methods.

PubMed

Kumar, T C

1994-04-01

Reductions in the rates of maternal and child mortality as well as in demographic growth are directly linked to contraceptive usage. The development and availability of safer, improved contraceptives which are convenient to use could be expected to be used by a larger group of individuals and thus make an impact on reproductive health as well as on population growth rates. Such arguments have been used to support contraceptive research. This article deals with some of the developments that have occurred as a consequence of such efforts.

Globalization, democracy, and child health in developing countries.

PubMed

Welander, Anna; Lyttkens, Carl Hampus; Nilsson, Therese

2015-07-01

Good health is crucial for human and economic development. In particular poor health in childhood is of utmost concern since it causes irreversible damage and has implications later in life. Recent research suggests globalization is a strong force affecting adult and child health outcomes. Yet, there is much unexplained variation with respect to the globalization effect on child health, in particular in low- and middle-income countries. One factor that could explain such variation across countries is the quality of democracy. Using panel data for 70 developing countries between 1970 and 2009 this paper disentangles the relationship between globalization, democracy, and child health. Specifically the paper examines how globalization and a country's democratic status and historical experience with democracy, respectively, affect infant mortality. In line with previous research, results suggest that globalization reduces infant mortality and that the level of democracy in a country generally improves child health outcomes. Additionally, democracy matters for the size of the globalization effect on child health. If for example Côte d'Ivoire had been a democracy in the 2000-2009 period, this effect would translate into 1200 fewer infant deaths in an average year compared to the situation without democracy. We also find that nutrition is the most important mediator in the relationship. To conclude, globalization and democracy together associate with better child health in developing countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

Foreign body aspiration in a child detected through emergency department radiology reporting: a case report.

PubMed

Crawford, Nigel W

2007-08-01

Foreign-body aspiration remains a leading cause of mortality in children under 3 years despite child-safety initiatives. This case report describes a classic history of peanut aspiration in a young child. Unfortunately, the diagnosis was delayed and only detected the next day through radiology review. The clinical history is paramount and this case highlights how emergency radiology reporting can minimize morbidity.

North Carolina Children's Index, 2000: A Profile of Leading Indicators of the Health and Well-Being of North Carolina's Children.

ERIC Educational Resources Information Center

Haggerty, Joann H.

This Kids Count report examines statewide trends in the well-being of North Carolina's children. The statistical portrait is based on 20 key indicators of child well-being: (1) infant mortality; (2) low birth weight infants; (3) births to teens; (4) births to mothers with early prenatal care; (5) child deaths; (6) regulated child care enrollment;…