scholarly journals Comparing socioeconomic inequalities between early neonatal mortality and facility delivery: Cross-sectional data from 72 low- and middle-income countries

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Terhi J. Lohela ◽  
Robin C. Nesbitt ◽  
Juha Pekkanen ◽  
Sabine Gabrysch
Keyword(s):  
Neonatal Mortality ◽  
Socioeconomic Inequalities ◽  
Facility Delivery ◽  
Cross Sectional ◽  
Middle Income ◽  
Early Neonatal Mortality ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Association of the quality of antenatal care with neonatal mortality: meta-analysis of individual participant data from 60 low- and middle-income countries

2019 ◽  
Vol 11 (6) ◽  
pp. 596-604 ◽  
Author(s):  
Subas Neupane ◽  
David Teye Doku
Keyword(s):  
Antenatal Care ◽  
Neonatal Mortality ◽  
Lower Risk ◽  
Meta Analysis ◽  
Cox Proportional Hazards ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractBackgroundWe investigated the quality of antenatal care (ANC) and its effect on neonatal mortality in 60 low- and middle-income countries (LMICs).MethodsWe used pooled comparable cross-sectional surveys from 60 LMICs (n=651 681). Cox proportional hazards multivariable regression models and meta-regression analysis were used to assess the effect of the quality of ANC on the risk of neonatal mortality. Kaplan–Meier survival curves were used to describe the time-to-event patterns of neonatal survival in each region.ResultsPooled estimates from meta-analysis showed a 34% lower risk of neonatal mortality for children of women who were attended to at ANC by skilled personnel. Sufficient ANC advice lowered the risk of neonatal mortality by 20%. Similarly, children of women who had adequate ANC had a 39% lower risk of neonatal mortality. The pooled multivariable model showed an association of neonatal mortality with the ANC quality index (HR 0.85, 95% CI 0.77 to 0.93).ConclusionsImprovement in the quality of ANC can reduce the risk of neonatal mortality substantially. Pursuing sustainable development goal 3, which aims to reduce neonatal mortality to 12 per 1000 live births by 2030, should improve the quality of ANC women receive in LMICs.

scholarly journals Survival analysis of the association between antenatal care attendance and neonatal mortality in 57 low- and middle-income countries

2017 ◽  
Vol 46 (5) ◽  
pp. 1668-1677 ◽  
Author(s):  
David T Doku ◽  
Subas Neupane
Keyword(s):  
Antenatal Care ◽  
Neonatal Mortality ◽  
Lower Risk ◽  
Proportional Hazards ◽  
First Trimester ◽  
Cox Proportional Hazards ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Abstract Background Neonatal mortality is unacceptably high in most low- and middle-income countries (LMICs). In these countries, where access to emergency obstetric services is limited, antenatal care (ANC) utilization offers improved maternal health and birth outcomes. However, evidence for this is scanty and mixed. We explored the association between attendance for ANC and survival of neonates in 57 LMICs. Methods Employing standardized protocols to ensure comparison across countries, we used nationally representative cross-sectional data from 57 LMICs (N = 464 728) to investigate the association between ANC visits and neonatal mortality. Cox proportional hazards multivariable regression models and meta-regression analysis were used to analyse pooled data from the countries. Kaplan-Meier survival curves were used to describe the patterns of neonatal survival in each region. Results After adjusting for potential confounding factors, we found 55% lower risk of neonatal mortality [hazard ratio (HR) 0.45, 95% confidence interval (CI) 0.42–0.48] among women who met both WHO recommendations for ANC (first visit within the first trimester and at least four visits during pregnancy) in pooled analysis. Furthermore, meta-analysis of country-level risk shows 32% lower risk of neonatal mortality (HR 0.68, 95% CI 0.61–0.75) among those who met at least one WHO recommendation. In addition, ANC attendance was associated with lower neonatal mortality in all the regions except in the Middle East and North Africa. Conclusions ANC attendance is protective against neonatal mortality in the LMICs studied, although differences exist across countries and regions. Increasing ANC visits, along with other known effective interventions, can improve neonatal survival in these countries.

scholarly journals Hierarchical disentanglement of contextual from compositional risk factors of diarrhoea among under-five children in low- and middle-income countries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Adeniyi Francis Fagbamigbe ◽  
A. Olalekan Uthman ◽  
Latifat Ibisomi
Keyword(s):  
Risk Factors ◽  
National Level ◽  
Cross Sectional ◽  
Middle Income ◽  
Contextual Risk ◽  
Under Five ◽  
Factors Associated ◽  
Under Five Children ◽  
Middle Income Countries ◽  
Low And Middle Income

AbstractSeveral studies have documented the burden and risk factors associated with diarrhoea in low and middle-income countries (LMIC). To the best of our knowledge, the contextual and compositional factors associated with diarrhoea across LMIC were poorly operationalized, explored and understood in these studies. We investigated multilevel risk factors associated with diarrhoea among under-five children in LMIC. We analysed diarrhoea-related information of 796,150 under-five children (Level 1) nested within 63,378 neighbourhoods (Level 2) from 57 LMIC (Level 3) using the latest data from cross-sectional and nationally representative Demographic Health Survey conducted between 2010 and 2018. We used multivariable hierarchical Bayesian logistic regression models for data analysis. The overall prevalence of diarrhoea was 14.4% (95% confidence interval 14.2–14.7) ranging from 3.8% in Armenia to 31.4% in Yemen. The odds of diarrhoea was highest among male children, infants, having small birth weights, households in poorer wealth quintiles, children whose mothers had only primary education, and children who had no access to media. Children from neighbourhoods with high illiteracy [adjusted odds ratio (aOR) = 1.07, 95% credible interval (CrI) 1.04–1.10] rates were more likely to have diarrhoea. At the country-level, the odds of diarrhoea nearly doubled (aOR = 1.88, 95% CrI 1.23–2.83) and tripled (aOR = 2.66, 95% CrI 1.65–3.89) among children from countries with middle and lowest human development index respectively. Diarrhoea remains a major health challenge among under-five children in most LMIC. We identified diverse individual-level, community-level and national-level factors associated with the development of diarrhoea among under-five children in these countries and disentangled the associated contextual risk factors from the compositional risk factors. Our findings underscore the need to revitalize existing policies on child and maternal health and implement interventions to prevent diarrhoea at the individual-, community- and societal-levels. The current study showed how the drive to the attainment of SDGs 1, 2, 4, 6 and 10 will enhance the attainment of SDG 3.

Socioeconomic inequalities in unhealthy lifestyles in low- and middle-income countries

2020 ◽  
Author(s):  
Charlotte Dieteren ◽  
Igna Bonfrer
Keyword(s):  
Alcohol Use ◽  
Tobacco Use ◽  
Socioeconomic Inequalities ◽  
Individual Characteristics ◽  
Middle Income ◽  
The Sustainable Development ◽  
Middle Income Countries ◽  
The Poor ◽  
Harmful Alcohol ◽  
Low And Middle Income

Abstract Background: The heavy and ever rising burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) warrants interventions to reduce unhealthy lifestyles. To effectively target these interventions, it is important to know how unhealthy lifestyles vary with socioeconomic characteristics. This study quantifies prevalence and socioeconomic inequalities in unhealthy lifestyles in LMICs, to identify policy priorities conducive to the Sustainable Development Goal of a one third reduction in deaths from NCDs by 2030.Methods: Data from 1,278,624 adult respondents to Demographic & Health Surveys across 22 LMICs between 2013 and 2018 are used to estimate crude prevalence rates and socioeconomic inequalities in tobacco use, overweight, harmful alcohol use and the clustering of these three in a household. Inequalities are measured by a concentration index and correlated with the percentage of GDP spent on health. We estimate a multilevel model to examine associations of individual characteristics with different unhealthy lifestyles.Results: The prevalence of tobacco use among men ranges from 59.6% (Armenia) to 6.6% (Nigeria). The highest level of overweight among women is 83.7% (Egypt) while this is less than 12% in Burundi, Chad and Timor-Leste. 82.5% of women in Burundi report that their partner is “often or sometimes drunk” compared to 1.3% in Gambia. Tobacco use is concentrated among the poor, except for the low share of men smoking in Nigeria. Overweight, however, is concentrated among the better off, especially in Tanzania and Zimbabwe (Erreygers Index (EI) 0.227 and 0.232). Harmful alcohol use is more concentrated among the better off in Nigeria (EI 0.127), while Chad, Rwanda and Togo show an unequal pro-poor distribution (EI respectively -0.147, -0.210, -0.266). Cambodia exhibits the largest socioeconomic inequality in unhealthy household behaviour (EI -0.253). The multilevel analyses confirm that in LMICs, tobacco and alcohol use are largely concentrated among the poor, while overweight is concentrated among the better-off.Conclusions: This study emphasizes the importance of unhealthy lifestyles in LMICs and the socioeconomic variation therein. Given the different socioeconomic patterns in unhealthy lifestyles - overweight patters in LMICs differ considerably from those in high income countries- tailored interventions towards specific high-risk populations are warranted.

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