scholarly journals Accelerating Kenya’s progress to 2030: understanding the determinants of under-five mortality from 1990 to 2015

2018 ◽  
Vol 3 (3) ◽  
pp. e000655 ◽  
Author(s):  
Emily C Keats ◽  
William Macharia ◽  
Neha S Singh ◽  
Nadia Akseer ◽  
Nirmala Ravishankar ◽  
...  
Keyword(s):  
Child Health ◽  
Reproductive Health ◽  
Linear Regression Analysis ◽  
Multivariable Analysis ◽  
Household Wealth ◽  
User Fees ◽  
Demographic And Health Surveys ◽  
Dramatic Improvement ◽  
Development Goal ◽  
Under Five

IntroductionDespite recent gains, Kenya did not achieve its Millennium Development Goal (MDG) target for reducing under-five mortality. To accelerate progress to 2030, we must understand what impacted mortality throughout the MDG period.MethodsTrends in the under-five mortality rate (U5MR) were analysed using data from nationally representative Demographic and Health Surveys (1989–2014). Comprehensive, mixed-methods analyses of health policies and systems, workforce and health financing were conducted using relevant surveys, government documents and key informant interviews with country experts. A hierarchical multivariable linear regression analysis was undertaken to better understand the proximal determinants of change in U5MR over the MDG period.ResultsU5MR declined by 50% from 1993 to 2014. However, mortality increased between 1990 and 2000, following the introduction of facility user fees and declining coverage of essential interventions. The MDGs, together with Kenya’s political changes in 2003, ushered in a new era of policymaking with a strong focus on children under 5 years of age. External aid for child health quadrupled from 40 million in 2002 to 180 million in 2012, contributing to the dramatic improvement in U5MR throughout the latter half of the MDG period. Our multivariable analysis explained 44% of the decline in U5MR from 2003 to 2014, highlighting maternal literacy, household wealth, sexual and reproductive health and maternal and infant nutrition as important contributing factors. Children living in Nairobi had higher odds of child mortality relative to children living in other regions of Kenya.ConclusionsTo attain the Sustainable Development Goal targets for child health, Kenya must uphold its current momentum. For equitable access to health services, user fees must not be reintroduced in public facilities. Support for maternal nutrition and reproductive health should be prioritised, and Kenya should acknowledge its changing demographics in order to effectively manage the escalating burden of poor health among the urban poor.

scholarly journals Distribution of wealth-stratified inequalities on maternal and child health parameters and influences of maternal-related factors on improvements in child health survival rate in Bangladesh

2020 ◽  
pp. 136749352090966
Author(s):  
Rashidul Alam Mahumud ◽  
Jeff Gow ◽  
Abdur Razzaque Sarker ◽  
Marufa Sultana ◽  
Golam Hossain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Child Health ◽  
Maternal And Child Health ◽  
Health Care Service ◽  
Demographic And Health Surveys ◽  
Maternal Risk ◽  
Under Five ◽  
And Child Health ◽  
Health Parameters

This study investigates the influence of household socioeconomic status and maternal risk factors and health-care service availability on changes in the under-five mortality rate (U5MR) in Bangladesh. Potential risk factors that influence U5MRs were investigated using multilevel logistic regression analysis and 29,697 data points from the Bangladesh Demographic and Health Surveys, 2004–2014. Maternal and child health parameters such as childhood morbidity, low vaccination coverage, poor utilization of perinatal care, and malnutrition were found to be more concentrated in poorer households. Pooled estimates indicated that the aggregate odds of U5MR risk declined by 18% to 2007 to 38% to 2014 compared to 2004. However, inadequate antenatal care, short birth interval, primiparity, illiteracy, delayed conception, and low socioeconomic status were significantly associated with a higher risk of under-five mortality. The magnitude of inequality using these measures were significantly associated with large variations in U5MR changes. Although a significant reduction in U5MR in Bangladesh was found in this study, substantial socioeconomic variations still persist. The analysis suggests that decreasing inequality in society is required for further reductions in child mortality. This will help to achieve a more equitable distribution of child and neonatal outcomes and assist the achievement of Sustainable Development Goals 3.2 by 2030.

scholarly journals MASALAH GIZI BALITA DAN HUBUNGANNYA DENGAN INDEKS PEMBANGUNAN KESEHATAN MASYARAKAT

2019 ◽  
Vol 42 (1) ◽  
pp. 1-10
Author(s):  
Nur Handayani Utami ◽  
Rofingatul Mubasyiroh
Keyword(s):  
Public Health ◽  
Regression Analysis ◽  
Reproductive Health ◽  
Linear Regression ◽  
Linear Regression Analysis ◽  
Communicable Diseases ◽  
Under Five ◽  
Prevalence Of Obesity ◽  
Public Health Development ◽  
One Way Anova

ABSTRACT The problem of undernutrition and overnutrition among underfive children is still a challenge in improving public health in Indonesia. Public Health Development Index (PHDI) has been developed based on the results of the Basic Health Research (Riskesdas) 2013. This analysis was carried out to determine the role of PHDI and its constituent components with the nutritional problems of children under five in Indonesia. The 2013 PHDI consists of 7 indexes, namely underfive children health, reproductive health, health services, health behavior, non-communicable diseases, communicable diseases, and environmental health. One-way ANOVA analysis was carried out to analyze the mean differences between the prevalence of undernutrition based on the category of PHDI values, while the analysis of overweight with the PHDI value category was analyzed by Kruskal-Wallis. Analysis of the association between the prevalence of undernutrition and overweight with the PHDI was done using linear regression. Mean analysis of the prevalence of undernutrition according to the PHDI  group shows a tendency with the higher PHDI, the lower the prevalence of undernutrition. Linear regression analysis shows that there is a significant relationship between the indices in the PHDI and the prevalence of undernutrition, where the reproductive health index has the highest contribution to the decreament of the prevalence of child undernutrition. In contrary, the analysis of the prevalence of obesity according to the PHDI group shows no difference in the prevalence of obesity with the PHDI group. Linear regression analysis also shows a weak relationship between the PHDI indices and the prevalence of obesity. Keywords: malnutrition; public health development index; under five children   ABSTRAK Masalah gizi kurang dan gizi lebih pada balita masih menjadi tantangan dalam perbaikan kesehatan masyarakat di Indonesia. Berdasarkan hasil Riset Kesehatan Dasar (Riskesdas) 2013 telah dikembangkan Indeks Pembangunan Kesehatan Masyarakat (IPKM) yang dapat menjadi arah dalam menentukan prioritas pembangunan di bidang kesehatan.  Analisis ini dilakukan untuk mengetahui peran dari IPKM dan komponen-komponen penyusunnya dengan masalah gizi balita (gizi buruk-kurang, pendek dan gemuk) di Indonesia. IPKM 2013 terdiri dari 7 indeks, yaitu kesehatan balita, kesehatan reproduksi, pelayanan kesehatan, perilaku kesehatan, penyakit tidak menular, penyakit menular, serta kesehatan lingkungan. Analisis one way anova dilakukan untuk menganalisis perbedaan rerata antara prevalensi kurang gizi berdasarkan kategori nilai IPKM, sedangkan pada analisis kegemukan dengan kategori nilai IPKM dilakukan analisis Kruskal-Wallis. Analisis hubungan antara prevalensi gizi kurang dan gizi lebih dengan IPKM dilakukan dengan menggunakan analisis regresi linear. Analisis rerata prevalensi kurang gizi menurut kelompok IPKM menunjukkan kecenderungan semakin tinggi IPKM suatu daerah semakin rendah prevalensi kurang gizi pada balita. Analisis regresi linear menunjukkan bahwa terdapat hubungan yang siknifikan antara indeks-indeks dalam IPKM dengan prevalensi gizi kurang, dimana indeks kesehatan reproduksi memberikan kontribusi yang paling besar terhadap penurunan prevalensi gizi kurang balita. Sementara analisis prevalensi kegemukan menurut kelompok IPKM menunjukkan tidak adanya perbedaan prevalensi kegemukan dengan kelompok IPKM. Analisis regresi linear juga menunjukkan hubungan yang lemah antara indeks-indeks IPKM dengan prevalensi kegemukan pada balita. [Penel Gizi Makan 2019, 42(1):1-10] Kata kunci: masalah gizi; indeks pembangunan kesehatan masyarakat; bawah lima tahun

scholarly journals SickKids Centre for Global Child Health - Chronic Child Malnutrition Project Placement

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Zahra Hussain
Keyword(s):  
Child Health ◽  
Motor Development ◽  
Maternal Education ◽  
Multivariable Analysis ◽  
Household Wealth ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Global Health Research ◽  
Access To Health Services ◽  
Mortality And Morbidity

I completed a 16-week practicum at the SickKids Centre for Global Child Health where I was a part of the stunting team led by Dr. Nadia Akseer under the research portfolio of Dr. Zulfiqar A. Bhutta. Linear growth stunting, or low height-for-age, is a visible and easily measurable physical manifestation of chronic malnutrition. Children who are stunted have higher rates of mortality and morbidity, as well as experience suboptimal cognitive and motor development. At the time of my placement, one of the team's main projects was a mixed-methods study involving an in-depth evaluation of policies, programs, and factors that have contributed to the decline of under-5 stunting in Ethiopia from 2000-2016. I worked on a variety of components of the manuscript for this study. These included narratives for country demographics, background statistics as well as migration and remittance trends. I also contributed to a literature review on factors that have contributed to a reduction in stunting in Ethiopia in relation to an adapted version of UNICEF's conceptual framework for malnutrition. In addition to the manuscript, I conducted a multivariable analysis of the 2016 determinants of under-5 wasting in Ethiopia. Wasting, or low weight for height, is a form of acute malnutrition and is also a risk factor for mortality. I applied a hierarchical analysis to wasting indicators such as disease, household wealth, maternal education and access to health services. I used Ethiopia's 2016 Demographic and Health Survey data and additional data sources provided through various Ethiopian government ministries. Overall my practicum was a rich interdisciplinary learning experience which allowed me to develop my quantitative and qualitative research skills. I also gained a deeper understanding of global health research processes and the multi-sectoral nature of combating child malnutrition.

scholarly journals Trends in the Prevalence and Associated Contributing Factors of Stunting in Children Under Five Years of Age. Secondary Data Analysis of 2005, 2010 and 2014-2015 Rwanda Demographic and Health Surveys

2020 ◽  
Vol 3 (1) ◽  
pp. 71-85
Author(s):  
Révérien Rutayisire ◽  
Clémentine Kanazayire ◽  
Germaine Tuyisenge ◽  
Cyprien Munyanshongore
Keyword(s):  
Health Survey ◽  
Household Wealth ◽  
Demographic And Health Survey ◽  
Demographic And Health Surveys ◽  
Prevalence Rates ◽  
Cross Sectional ◽  
Children Under Five ◽  
Under Five ◽  
Significant Difference ◽  
Chi Squared

Background Stunting affects more than 161 million children under five years of age worldwide. Rwanda has a high prevalence of stunted children under five years of age (~38%) according to the 2014-2015 Rwanda Demographic and Health Survey. Objectives The aim of this study is to compare the prevalence rates of stunting in Rwanda using the Rwanda Demographic and Health Survey data of 2005, 2010 and 2014-2015. Methods The three Rwanda Demographic and Health Survey cross-sectional studies into consideration were conducted in 2005, 2010 and in 2014-2015. Stunting prevalence rates from those surveys were compared using Pearson's chi-squared tests and Marascuilo procedure using STATA (StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.). Results The Pearson's chi-squared tests and Marascuilo procedure used in this research confirmed a significant difference between the reported three RDHS stunting prevalence rates. The trends in the stunting prevalence rates among children under five years of age showed a decrease of 13% in stunting prevalence rate, falling from 51%in 2005 to 38%in 2014-15. Conclusion A statistical analysis based on2005, 2010 and 2014-15 RDHS surveys datasets confirmed that there is a statistically significant reduction in stunting prevalence rates  over that decade(from 51% in 2005 to 38%in 2014-2015). The main persistent associated factors with stunting were the age, sex, size at birth, residence place of the child, and the mother’s educational level and household wealth index. Keywords: Stunting; children under five years; demographic and health survey; nutrition; Rwanda

scholarly journals Trends and Predictors of underweight among under-five children in Ethiopia, based on Ethiopian Demographic and Health Survey 2005 -2016. Multivariable Decomposition analysis

2020 ◽  
Author(s):  
Tilahun Yemanu Birhan ◽  
Dessie Abebaw Angaw
Keyword(s):  
Parental Education ◽  
Research Question ◽  
Decomposition Analysis ◽  
Wealth Index ◽  
Household Wealth ◽  
Demographic And Health Surveys ◽  
Data Set ◽  
Under Five ◽  
Under Five Children ◽  
Duration Of Breastfeeding

Abstract Background Underweight is one of the paramount major worldwide health problems, and it touches a large number of population from infancy to old age. This study aimed to analyze the trends and predictors of change in underweight among under-five children in Ethiopia Method The data for this study were accessed from three Ethiopian Demographic and Health Surveys data set 2005, 2011 and 2016. The trend was examined separately for the periods 2005–2011, 2005-2016, and 2011-2016. Multivariate decomposition analysis of change in underweight was employed to answer the major research question of this study. The technique employed the output from the logistic regression model to parcel out the observed difference in underweight into components, and STATA 14 was utilized for data management and analysis. Result Among children in Ethiopia the prevalence of underweight declined from 38% in 2005 to 25% in 2016. The decomposition analysis indicated that almost half of the overall change in underweight was due to difference in characteristics. Change in the composition of parental education, wealth index, duration of breastfeeding, respondents’ occupation, was the major contributor for the decline of underweight, while the age of child and presence of diarrhea were contributors for the rise of underweight in Ethiopia. Conclusion underweight shows a remarkable decline over the last decades in Ethiopia. Change in composition of Birth size, duration of breastfeeding, household wealth quantile (richer) and husband/partner primary education are attributable to the decline of underweight.

Examining inequality of opportunity in the use of maternal and reproductive health interventions in Sierra Leone

2019 ◽  
Vol 42 (2) ◽  
pp. 254-261 ◽  
Author(s):  
Mluleki Tsawe ◽  
A Sathiya Susuman
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Antenatal Care ◽  
Sierra Leone ◽  
Health Indicators ◽  
Household Wealth ◽  
Demographic And Health Surveys ◽  
Reproductive Health Services ◽  
Dissimilarity Index ◽  
Over Time

Abstract Background Poor countries, such as Sierra Leone, often have poor health outcomes, whereby the majority of the population cannot access lifesaving health services. Access to, and use of, maternal and reproductive health services is crucial for human development, especially in developing regions. However, inequality remains a persistent problem for many developing countries. Moreover, we have not found empirical studies, which have examined inequalities in maternal and reproductive health in Sierra Leone. Method We used data collected from the Sierra Leone Demographic and Health Surveys (DHS) conducted in 2008 and 2013. Five maternal and reproductive health indicators were selected for this study, including four or more antenatal care visits, skilled antenatal care provider, births delivered in a facility, births assisted by a skilled birth attendant, and any method of contraception. To measure inequalities, we adopted the Human Opportunity Index (HOI). Using this measure, we measured differentials over the two periods, and decomposed it to measure the contribution of the selected circumstance variables to inequality. Results Inequalities declined over time, as shown by the decrease in the dissimilarity index. Due to the drop in the dissimilarity index, the HOI increased for all the selected maternal and reproductive health indicators. Moreover, antenatal services were closer to equality compared to the other selected services. Overall, we found that household wealth status, maternal education and place of residence, are the most important factors contributing to the inequality in the use of maternal and reproductive health services. Conclusions Even though there are improvements in inequalities over time, there are variations in the way in which inequality within the different indicators has improved. In order to improve the use of maternal and reproductive health services, and to reduce inequalities in these services, the government will have to invest in: (i) increasing the educational levels of women, (ii) improving the standard of living, as well as (iii) bringing maternal and reproductive health services closer to rural populations.

scholarly journals Water and sanitation influence on child health in Namibia: using demographic and health surveys

2021 ◽  
Author(s):  
Mona Abdelhady ◽  
Anna Alfeus ◽  
Ndinomholo Hamatui
Keyword(s):  
Child Health ◽  
Health Surveys ◽  
Child Death ◽  
Healthcare Services ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Under Five ◽  
Sub Saharan ◽  
Child's Death ◽  
The Impact

Abstract Important milestones in reducing child mortality rates have been achieved internationally and in Africa. With 76 deaths per 1,000 live births, sub-Saharan Africa (SSA) continues to have the world's highest under-five mortality (U5M) rate. In SSA, one child in every 13 dies from preventable causes before reaching their fifth birthday. This study sought to determine the impact of demographic, socio-economic, and environmental determinants on child health in Namibia, using the Namibian demographic and health surveys (NDHS) from 2006 and 2013. A logistic regression model was used to determine the association between improved sanitary facilities and water sources and U5M in Namibia. Improved access to sanitation facilities in Namibia is associated with less U5M rate, according to the 2013 survey. No significant association was observed between improved access to safe water and child's death. In 2013, the greater the mother's level of education, the lower the chance of child death. Finally, the findings demonstrate that mothers with HIV-positive are more likely to experience under-five death. Hence, the Namibian government should increase sanitation facilities and promote maternal healthcare services for less fortunate households to lower the U5M rate.

scholarly journals Decomposition of Factors Associated With Housing Material Inequality in Under-Five Deaths in Low and Middle-Income Countries

2021 ◽  
Author(s):  
Oyewale Mayowa Morakinyo ◽  
Adeniyi Francis Fagbamigbe ◽  
Ayo Stephen Adebowale
Keyword(s):  
Decomposition Analysis ◽  
Household Wealth ◽  
Outcome Variable ◽  
Demographic And Health Surveys ◽  
Wealth Status ◽  
Middle Income ◽  
Under Five ◽  
Neighbourhood Level ◽  
Housing Materials ◽  
The Individual

Abstract Background: Low-and Medium-Income Countries (LMIC) continue to record high burden of under-five deaths (U5D). There is a gap in knowledge of the factors contributing to housing materials inequalities in U5D. This study examined the contributions of the individual- and neighbourhood-level factors to housing materials inequalities in influencing U5D in LMIC.Methods: We pooled data from the most recent Demographic and Health Surveys for 56 LMIC conducted between 2010 and 2018. In all, we analysed the data of 798,796 children living in 59,791 neighbourhoods. The outcome variable was U5D among live births within 0 to 59 months of birth. The main determinate variable was housing material types, categorised as unimproved housing materials (UHM) and improved housing materials (IHM) while the individual-level and neighbourhood-level factors are the independent variables. Data were analysed using Fairlie decomposition analysis at α=0.05. Results: The overall U5D rate was 53 per 1000 children, 61 among children from houses built with UHM, and 41 among children from houses built with IHM (p<0.001). This rate was higher among children from houses that were built with UHM in all countries except in Malawi, Zambia, Lesotho, Gambia, Liberia, Sierra Leone, Indonesia, Maldives, Jordan, and Albania. None of these countries had significant pro-IHM inequality. The factors explaining housing inequalities in U5D include household wealth status, residence location, source of drinking water, media access, paternal employment, birth interval, and toilet type.Conclusions: There are variations in individual- and neighbourhood-level factors driving housing materials inequalities as it influences U5D in LMIC. Interventions focusing on reducing the burden of U5D in households built with UHM are urgently needed.

scholarly journals Adolescent sexual and reproductive health in sub-Saharan Africa: who is left behind?

2020 ◽  
Vol 5 (1) ◽  
pp. e002231 ◽  
Author(s):  
Dessalegn Y Melesse ◽  
Martin K Mutua ◽  
Allysha Choudhury ◽  
Yohannes D Wado ◽  
Cheikh M Faye ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Sexual And Reproductive Health ◽  
Sexual Debut ◽  
Household Wealth ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Rural Residence ◽  
Modern Contraceptives ◽  
Urban Rural ◽  
Sub Saharan

Adolescent sexual and reproductive health (ASRH) continues to be a major public health challenge in sub-Saharan Africa where child marriage, adolescent childbearing, HIV transmission and low coverage of modern contraceptives are common in many countries. The evidence is still limited on inequalities in ASRH by gender, education, urban–rural residence and household wealth for many critical areas of sexual initiation, fertility, marriage, HIV, condom use and use of modern contraceptives for family planning. We conducted a review of published literature, a synthesis of national representative Demographic and Health Surveys data for 33 countries in sub-Saharan Africa, and analyses of recent trends of 10 countries with surveys in around 2004, 2010 and 2015. Our analysis demonstrates major inequalities and uneven progress in many key ASRH indicators within sub-Saharan Africa. Gender gaps are large with little evidence of change in gaps in age at sexual debut and first marriage, resulting in adolescent girls remaining particularly vulnerable to poor sexual health outcomes. There are also major and persistent inequalities in ASRH indicators by education, urban–rural residence and economic status of the household which need to be addressed to make progress towards the goal of equity as part of the sustainable development goals and universal health coverage. These persistent inequalities suggest the need for multisectoral approaches, which address the structural issues underlying poor ASRH, such as education, poverty, gender-based violence and lack of economic opportunity.

scholarly journals Burden of Acute Respiratory Infections Among Under-Five Children in Relation to Household Wealth and Socioeconomic Status in Bangladesh

2019 ◽  
Vol 4 (1) ◽  
pp. 36 ◽  
Author(s):  
Sanni Yaya ◽  
Ghose Bishwajit
Keyword(s):  
Socioeconomic Status ◽  
Respiratory Infections ◽  
Household Wealth ◽  
Outcome Variable ◽  
Demographic And Health Surveys ◽  
Special Focus ◽  
Acute Respiratory Infections ◽  
Water And Sanitation ◽  
Under Five ◽  
Under Five Children

Acute respiratory infections (ARIs), as a group of diseases and symptoms, are a leading cause of morbidity and mortality among under-five children in tropical countries like Bangladesh. Currently, no clear evidence has been published on the prevalence and socioeconomic correlates of ARIs in Bangladesh. In this regard, we carried out this study with the aim of assessing the prevalence and the socioeconomic predictors of ARIs among children aged 0–59 months, with a special focus on socioeconomic status and wealth-related indicators. Cross-sectional data on 32,998 mother-child (singleton) pairs were collected from six rounds of Bangladesh Demographic and Health Surveys (BDHS 1997–2014). The outcome variable were presence of the common symptoms of ARIs, fever and dyspnea, during the previous two weeks, which were measured based on mothers’ reports about the symptoms of these conditions. Explanatory variables included maternal demographic and socioeconomic factors such as age, education, occupation, wealth quintile, and child’s age and sex. The prevalence and predictors of ARIs were measured using descriptive and multivariate regression methods. The prevalence of both fever (31.00% in 1997 vs. 36.76% in 2014) and dyspnea (39.27% in 1997 vs. 43.27% in 2014) has increased gradually since 1997, and tended to be higher in households in the lower wealth quintiles. Multivariable analysis revealed that higher maternal educational status, access to improved water and sanitation facilities, and living in households in higher wealth quintiles had protective effects against both fever and dyspnea. Findings suggested a significantly negative association between lacking access to improved water and sanitation and use of biomass fuel with ARI symptoms. However, no sex difference was observed in these associations. Based on the findings, childhood ARI prevention strategies should address the risk factors stemming from parental socioeconomic marginalisation, household water and sanitation poverty, and use of unclean fuel.

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