Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Abstract Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

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Associations of women’s empowerment with neonatal, infant and under-5 mortality in low- and /middle-income countries: meta-analysis of individual participant data from 59 countries

BMJ Global Health ◽

10.1136/bmjgh-2019-001558 ◽

2020 ◽

Vol 5 (1) ◽

pp. e001558 ◽

Cited By ~ 2

Author(s):

David T Doku ◽

Zulfiqar A Bhutta ◽

Subas Neupane

Keyword(s):

Meta Analysis ◽

Child Survival ◽

Women's Empowerment ◽

Women’S Empowerment ◽

Individual Participant Data ◽

Middle Income ◽

Live Births ◽

Middle Income Countries ◽

Individual Participant ◽

Low And Middle Income

BackgroundChild survival and women’s empowerment are global public health concerns and important sustainable development goals (SDGs). Low- and middle-income countries (LMICs) have the largest burden of both phenomena. The aim of this study is to investigate a measure of women’s empowerment at individual and population levels and its potential associations with neonatal, infant and under-5 mortality at national and regional levels in 59 LMICs.MethodsWe used pooled population-based cross-sectional surveys from 59 LMICs (n=6 12 529) conducted from 2000 to 2015 using standardised protocols. We constructed individual-level women’s empowerment index (ILWEI) and population-level women’s empowerment index (PLWEI) for LMICs and investigated the potential associations of these measures with neonatal, infant and under-5 mortality using two-stage random-effect individual participant data (IPD) meta-analysis.ResultsThe pooled neonatal mortality rate was 24 per 1000 live births. Infant and under-5 mortality rates were 43 and 55/1000 live births, respectively. In the pooled sample, 61.6% and 19.9% of women had autonomy regarding their healthcare and household decision-making, respectively, whereas 56.0% rejected domestic violence against women for any reason. IPD meta-analysis showed that children of women with low ILWEI had a higher risk of neonatal (OR: 1.18, 95% CI 1.14 to 1.22), infant (OR: 1.12, 95% CI 1.08 to 1.17) and under-5 (OR: 1.12, 95% CI 1.07 to 1.18) mortality compared with children of high ILWEI. Similar relationships were found across most of the regions as well as between PLWEI and all the three outcomes.ConclusionsWomen’s empowerment at individual and population levels is associated with neonatal, infant and under-5 mortality in LMICs. Our study underscores the importance of women’s empowerment in accelerating progress towards the attainment of the SDG targets for child survival in LMICs. Multi-sectoral and concerted efforts are necessary to eliminate preventable child mortality in these countries.

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Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends

Reproductive Health ◽

10.1186/s12978-020-00990-z ◽

2020 ◽

Vol 17 (S3) ◽

Author(s):

Melissa Bauserman ◽

Vanessa R. Thorsten ◽

Tracy L. Nolen ◽

Jackie Patterson ◽

Adrien Lokangaka ◽

...

Keyword(s):

Risk Factors ◽

Maternal Mortality ◽

Maternal Deaths ◽

Middle Income ◽

Maternal Risk ◽

Live Births ◽

Middle Income Countries ◽

Risk Of Death ◽

Increased Risk ◽

Over Time

Abstract Background Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. Methods We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. Results We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. Conclusions The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. Trial registration The MNHR is registered at NCT01073475.

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Population-Level Behavior Change to Enhance Child Survival and Development in Low- and Middle-Income Countries

Journal of Health Communication ◽

10.1080/10810730.2014.934937 ◽

2014 ◽

Vol 19 (sup1) ◽

pp. 3-9 ◽

Cited By ~ 13

Author(s):

Elizabeth Fox ◽

Rafael Obregón

Keyword(s):

Behavior Change ◽

Child Survival ◽

Population Level ◽

Middle Income ◽

Middle Income Countries ◽

Survival And Development ◽

Low And Middle Income

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Understanding the effect of indoor air pollution on pneumonia in children under 5 in low- and middle-income countries: a systematic review of evidence

Environmental Science and Pollution Research ◽

10.1007/s11356-018-3769-1 ◽

2018 ◽

Vol 26 (4) ◽

pp. 3208-3225 ◽

Cited By ~ 11

Author(s):

Enemona Emmanuel Adaji ◽

Winifred Ekezie ◽

Michael Clifford ◽

Revati Phalkey

Keyword(s):

Systematic Review ◽

Air Pollution ◽

Indoor Air ◽

Indoor Air Pollution ◽

Middle Income ◽

Middle Income Countries ◽

Children Under 5 ◽

Low And Middle Income

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Lysine Genetically Enriched Cereals for Improving Nutrition in Children Under 5 Years in Low- And Middle- Income Countries

Journal of Nutritional Health & Food Engineering ◽

10.15406/jnhfe.2016.05.00164 ◽

2016 ◽

Vol 5 (2) ◽

Cited By ~ 1

Author(s):

Manuel Moya

Keyword(s):

Middle Income ◽

Middle Income Countries ◽

Children Under 5 ◽

Low And Middle Income

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Intrapartum-related events affecting the newborn

Oxford Textbook of Global Health of Women, Newborns, Children, and Adolescents ◽

10.1093/med/9780198794684.003.0030 ◽

2018 ◽

pp. 150-154

Author(s):

Saima Aftab ◽

Lauren Schaeffer ◽

Lian Folger ◽

Anne CC Lee

Keyword(s):

High Risk ◽

Secondary Prevention ◽

Neonatal Resuscitation ◽

Birth Asphyxia ◽

Obstetric Care ◽

Middle Income ◽

Neonatal Deaths ◽

Under Five ◽

Middle Income Countries ◽

Child Deaths

This chapter addresses the causes, burden, and interventions for intrapartum-related events, or ‘birth asphyxia’. Intrapartum-related neonatal deaths are among the leading causes of under-five child deaths, and account for 26% of all newborn deaths. An estimated one in ten babies will need some help to start breathing at birth. Approximately 98% of intrapartum deaths occur in low- and middle-income countries, as high rates of home births and unattended deliveries remain challenges. High-risk pregnancies should be monitored closely and deliver in facilities with capacity for obstetric and neonatal management. Here we present the evidence for interventions for primary and secondary prevention (including obstetric care, neonatal resuscitation), and tertiary prevention for infants with acute complications.

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Under-Five Mortality and Associated Factors: Evidence from the Nepal Demographic and Health Survey (2001–2016)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16071241 ◽

2019 ◽

Vol 16 (7) ◽

pp. 1241

Author(s):

Pramesh Ghimire ◽

Kingsley Agho ◽

Osita Ezeh ◽

Andre Renzaho ◽

Michael Dibley ◽

...

Keyword(s):

Sustainable Development ◽

Health Survey ◽

Child Survival ◽

Common Factors ◽

Demographic And Health Survey ◽

Sustainable Development Goal ◽

Development Goal ◽

Live Births ◽

Under Five ◽

Factors Associated

Child mortality in Nepal has reduced, but the rate is still above the Sustainable Development Goal target of 20 deaths per 1000 live births. This study aimed to identify common factors associated with under-five mortality in Nepal. Survival information of 16,802 most recent singleton live births from the Nepal Demographic and Health Survey for the period (2001–2016) were utilized. Survey-based Cox proportional hazard models were used to examine factors associated with under-five mortality. Multivariable analyses revealed the most common factors associated with mortality across all age subgroups included: mothers who reported previous death of a child [adjusted hazard ratio (aHR) 17.33, 95% confidence interval (CI) 11.44, 26.26 for neonatal; aHR 13.05, 95% CI 7.19, 23.67 for post-neonatal; aHR 15.90, 95% CI 11.38, 22.22 for infant; aHR 16.98, 95% CI 6.19, 46.58 for child; and aHR 15.97, 95% CI 11.64, 21.92 for under-five mortality]; nonuse of tetanus toxoids (TT) vaccinations during pregnancy (aHR 2.28, 95% CI 1.68, 3.09 for neonatal; aHR 1.86, 95% CI 1.24, 2.79 for post-neonatal; aHR 2.44, 95% CI 1.89, 3.15 for infant; aHR 2.93, 95% CI 1.51, 5.69 for child; and aHR 2.39, 95% CI 1.89, 3.01 for under-five mortality); and nonuse of contraceptives among mothers (aHR 1.69, 95% CI 1.21, 2.37 for neonatal; aHR 2.69, 95% CI 1.67, 4.32 for post-neonatal; aHR 2.01, 95% CI 1.53, 2.64 for infant; aHR 2.47, 95% CI 1.30, 4.71 for child; and aHR 2.03, 95% CI 1.57, 2.62 for under-five mortality). Family planning intervention as well as promotion of universal coverage of at least two doses of TT vaccine are essential to help achieve child survival Sustainable Development Goal (SDG) targets of <20 under-five deaths and <12 neonatal deaths per 1000 births by the year 2030.

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