scholarly journals Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999–2016

2019 ◽  
Vol 4 (6) ◽  
pp. e001926
Author(s):  
Amiya Bhatia ◽  
Nancy Krieger ◽  
Jason Beckfield ◽  
Aluisio J D Barros ◽  
Cesar Victora
Keyword(s):  
Low Income ◽  
Maternal Education ◽  
Vital Statistics ◽  
Birth Registration ◽  
Middle Income ◽  
Children Under Five ◽  
Under Five ◽  
Rural Location ◽  
Middle Income Countries ◽  
Urban Rural

IntroductionAlthough global birth registration coverage has improved from 58% to 71% among children under five globally, inequities in birth registration coverage by wealth, urban/rural location, maternal education and access to a health facility persist. Few studies examine whether inequities in birth registration in low-income and middle-income countries have changed over time.MethodsWe combined information on caregiver reported birth registration of 1.6 million children in 173 publicly available, nationally representative Demographic Health Surveys and Multiple Indicator Cluster Surveys across 67 low-income and middle-income countries between 1999 and 2016. For each survey, we calculated point estimates and 95% CIs for the percentage of children under 5 years without birth registration on average and stratified by sex, urban/rural location and wealth. For each sociodemographic variable, we estimated absolute measures of inequality. We then examined changes in non-registration and inequities between surveys, and annually.Results14 out of 67 countries had achieved complete birth registration. Among the remaining 53 countries, 39 countries successfully decreased the percentage of children without birth registration. However, this reduction occurred alongside statistically significant increases in wealth inequities in 9 countries and statistically significant decreases in 10 countries. At the most recent survey, the percentage of children without birth registration was greater than 50% in 16 out of 67 countries.ConclusionAlthough birth registration improved on average, progress in reducing wealth inequities has been limited. Findings highlight the importance of monitoring changes in inequities to improve birth registration, to monitor Sustainable Development Goal 16.9 and to strengthen Civil Registration and Vital Statistics systems.

scholarly journals Efficacy of deep learning methods for predicting under-five mortality in 34 low-income and middle-income countries

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e034524
Author(s):  
Adeyinka Emmanuel Adegbosin ◽  
Bela Stantic ◽  
Jing Sun
Keyword(s):  
Neural Network ◽  
Deep Learning ◽  
Low Income ◽  
Maternal Education ◽  
Household Wealth ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Middle Income ◽  
Under Five ◽  
Middle Income Countries

ObjectivesTo explore the efficacy of machine learning (ML) techniques in predicting under-five mortality (U5M) in low-income and middle-income countries (LMICs) and to identify significant predictors of U5M.DesignThis is a cross-sectional, proof-of-concept study.Settings and participantsWe analysed data from the Demographic and Health Survey. The data were drawn from 34 LMICs, comprising a total of n=1 520 018 children drawn from 956 995 unique households.Primary and secondary outcome measuresThe primary outcome measure was U5M; secondary outcome was comparing the efficacy of deep learning algorithms: deep neural network (DNN); convolution neural network (CNN); hybrid CNN-DNN with logistic regression (LR) for the prediction of child’s survival.ResultsWe found that duration of breast feeding, number of antenatal visits, household wealth index, postnatal care and the level of maternal education are some of the most important predictors of U5M. We found that deep learning techniques are superior to LR for the classification of child survival: LR sensitivity=0.47, specificity=0.53; DNN sensitivity=0.69, specificity=0.83; CNN sensitivity=0.68, specificity=0.83; CNN-DNN sensitivity=0.71, specificity=0.83.ConclusionOur findings provide an understanding of determinants of U5M in LMICs. It also demonstrates that deep learning models are more efficacious than traditional analytical approach.

scholarly journals Risk Factors of Stunting in Children Under Five Years of Age: A Systematic Review

2020 ◽  
Author(s):  
Melly Nirma Syahriani ◽  
◽  
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Maternal Education ◽  
Education Level ◽  
Middle Income ◽  
Children Under Five ◽  
Under Five ◽  
Factors Associated ◽  
Middle Income Countries ◽  
Low Middle Income Countries

ABSTRACT Background: Stunting, a chronic malnutrition, remains a serious global health concern. In 2019, UNICEF announced that 21.3% of children under five years of age were stunted. This study aimed to analyze the factors associated with stunting to complement the evidence for stunting ongoing efforts. Subjects and Method: A systematic review was conducted by searching from Science Direct, Wiley, EBSCO, and PubMed databases. The studies were synthesized by PEOS (Population, Exposure, Objective, and Study design), then appraised by Joanna Briggs Institute Critical Appraisal tools. The keywords were (((determinant) OR (causal factor) OR (risk factor)) AND (stunting)) AND ((toddler) OR (child)) OR (fives)) OR (Baby under five years old)). The inclusion criteria were English-language and primary studied full-text articles published in peer-reviewed journals between 2009 and 2019. The exclusion criteria were opinion papers and review articles. Results: The prevalence of stunted children under five was 21.9% globally. A total of selected eleven articles examined the causes of stunting in Low Middle-Income Countries (LMIC). Nine articles stated that gender and socio-economic factors associated with stunting. Six articles discussed the relationship between maternal age and stunting. Four articles revealed that maternal education level was one of the determinants of stunting. Two articles stated that nutritional status is strongly related to stunting. One article connected overweight as a contributing factor to stunting. Conclusion: Stunting in Low Middle-Income Countries (LMIC) is associated with age, gender, socio-economy, maternal education level, nutritional status, and overweight children. Keywords: stunting, children under five years, risk factor Correspondence: Melly Nirma Syahriani. Master Program of Midwifery, Universitas ‘Aisyiyah Yogyakarta. Jl. Siliwangi (Ringroad Barat) No. 63, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: [email protected]. Mobile: +62895392131591. DOI: https://doi.org/10.26911/the7thicph.03.64

scholarly journals The quality of malaria care in 25 low-income and middle-income countries

2020 ◽  
Vol 5 (2) ◽  
pp. e002023 ◽  
Author(s):  
Erlyn Macarayan ◽  
Irene Papanicolas ◽  
Ashish Jha
Keyword(s):  
Quality Of Care ◽  
Low Income ◽  
Poor Quality ◽  
Care Quality ◽  
Middle Income ◽  
Children Under Five ◽  
Treatment Cascade ◽  
Under Five ◽  
Middle Income Countries

IntroductionEven with accessible and effective diagnostic tests and treatment, malaria remains a leading cause of death among children under five. Malaria case management requires prompt diagnosis and correct treatment but the degree to which this happens in low-income and middle-income countries (LMICs) remains largely unknown.MethodsCross-sectional study of 132 566 children under five, of which 25% reported fever in the last 2 weeks from 2006 to 2017 using the latest Malaria Indicators Survey data across 25 malaria-endemic countries. We calculated the per cent of patient encounters of febrile children under five that received poor quality of care (no blood testing, less or more than two antimalarial drugs and delayed treatment provision) across each treatment cascade and region.ResultsAcross the study countries, 48 316 (58%) of patient encounters of febrile children under five received poor quality of care for suspected malaria. When comparing by treatment cascade, 62% of cases were not blood tested despite reporting fever in the last 2 weeks, 82% did not receive any antimalarial drug, 17% received one drug and 72% received treatment more than 24 hours after onset of fever. Of the four countries where we had more detailed malaria testing data, we found that 35% of patients were incorrectly managed (26% were undertreated, while 9% were overtreated). Poor malaria care quality varies widely within and between countries.ConclusionQuality of malaria care remains poor and varies widely in endemic LMICs. Treatments are often prescribed regardless of malaria test results, suggesting that presumptive diagnosis is still commonly practiced among cases of suspected malaria, rather than the WHO recommendation of ‘test and treat’. To reach the 2030 global malaria goal of reducing mortality rates by at least 90%, focussing on improving the quality of malaria care is needed.

PP124 Health Technology Assessment And Feedback For Healthy Workplace Culture In Malaria Care In Low And Middle Income Countries

2018 ◽  
Vol 34 (S1) ◽  
pp. 114-114
Author(s):  
Patrick Okwen ◽  
Raphael Cheabum ◽  
Etienne Che ◽  
Joy Ngwemsi Mbunu ◽  
Miriam Nkangu
Keyword(s):  
Workplace Culture ◽  
Evidence Based ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Children Under Five ◽  
Under Five ◽  
Middle Income Countries ◽  
Percent Improvement ◽  
Evidence Based Care ◽  
Low And Middle Income

Introduction:Malaria is a leading cause of mortality and morbidity in children under five in low and middle income countries (LMICs). Management of malaria in children under five years of age is challenging. One challenge faced by clinical practice in LMICs is lack of evidence to guide practice. This challenge is further compounded by different training backgrounds of team members. In the management of malaria in Cameroon, conflicts usually arise between clinicians, lab technicians and pharmacists resulting in over diagnosis and treatment of malaria. The patient's view is usually not considered. This leads to over diagnosis and over prescriptions for malaria in children under five years of age.Methods:We used the Joanna Briggs Institute (JBI) approach of getting research into practice to organize stakeholder meetings, assess existing evidence in malaria care, develop evidence criteria for management based on levels of evidence, assess the gamut of care for malaria, provide feedback to clinicians and re-assess practice. We used the JBI practical application of clinical evidence system (PACES) and getting research into practice (GRiP) evidence implementation tools in the process to facilitate teamwork, collaboration on evidence and provide feedback.Results:A collaborative approach to assessments and feedback including all healthcare stakeholders significantly improved workplace culture of evidence-based care and staff-to-staff relationships as well as staff-to-patient relationships. Over a period of twelve months, we reported eighty-four percent fewer conflicts between staff and ninety-eight percent fewer conflicts between staff and patients. For malaria management, overall criteria showed a thirty-one percent improvement in compliance with best practice recommendations with evidence levels of Grade 1.Conclusions:The project demonstrated that local leadership and evidence-based care can significantly improve practice in resource limited settings.

scholarly journals Urbanisation and asthma in low-income and middle-income countries: a systematic review of the urban–rural differences in asthma prevalence

Thorax ◽  
2019 ◽  
Vol 74 (11) ◽  
pp. 1020-1030 ◽  
Author(s):  
Alejandro Rodriguez ◽  
Elizabeth Brickley ◽  
Laura Rodrigues ◽  
Rebecca Alice Normansell ◽  
Mauricio Barreto ◽  
...  
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Epidemiological Studies ◽  
Asthma Prevalence ◽  
Geographical Differences ◽  
Middle Income ◽  
Middle Income Countries ◽  
Urban Rural ◽  
Urban And Rural Areas ◽  
The Relationship

BackgroundUrbanisation has been associated with temporal and geographical differences in asthma prevalence in low-income and middle-income countries (LMICs). However, little is known of the mechanisms by which urbanisation and asthma are associated, perhaps explained by the methodological approaches used to assess the urbanisation-asthma relationship.ObjectiveThis review evaluated how epidemiological studies have assessed the relationship between asthma and urbanisation in LMICs, and explored urban/rural differences in asthma prevalence.MethodsAsthma studies comparing urban/rural areas, comparing cities and examining intraurban variation were assessed for eligibility. Included publications were evaluated for methodological quality and pooled OR were calculated to indicate the risk of asthma in urban over rural areas.ResultsSeventy articles were included in our analysis. Sixty-three compared asthma prevalence between urban and rural areas, five compared asthma prevalence between cities and two examined intraurban variation in asthma prevalence. Urban residence was associated with a higher prevalence of asthma, regardless of asthma definition: current-wheeze OR:1.46 (95% CI:1.22 to 1.74), doctor diagnosis OR:1.89 (95% CI:1.47 to 2.41), wheeze-ever OR:1.44 (95% CI:1.15 to 1.81), self-reported asthma OR:1.77 (95% CI:1.33 to 2.35), asthma questionnaire OR:1.52 (95% CI:1.06 to 2.16) and exercise challenge OR:1.96 (95% CI:1.32 to 2.91).ConclusionsMost evidence for the relationship between urbanisation and asthma in LMICs comes from studies comparing urban and rural areas. These studies tend to show a greater prevalence of asthma in urban compared to rural populations. However, these studies have been unable to identify which specific characteristics of the urbanisation process may be responsible. An approach to understand how different dimensions of urbanisation, using contextual household and individual indicators, is needed for a better understanding of how urbanisation affects asthma.PROSPERO registration numberCRD42017064470.

scholarly journals 40 years after Alma-Ata, is building new hospitals in low-income and lower-middle-income countries beneficial?

2019 ◽  
Vol 3 (Suppl 3) ◽  
pp. e001293 ◽  
Author(s):  
Fanny Chabrol ◽  
Lucien Albert ◽  
Valéry Ridde
Keyword(s):  
Low Income ◽  
Environmental Sustainability ◽  
Public Hospitals ◽  
Decision Makers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Geographical Inequalities ◽  
Urban Rural ◽  
Hospital Construction

Public hospitals in low-income and lower-middle-income countries face acute material and financial constraints, and there is a trend towards building new hospitals to contend with growing population health needs. Three cases of new hospital construction are used to explore issues in relation to their funding, maintenance and sustainability. While hospitals are recognised as a key component of healthcare systems, their role, organisation, funding and other aspects have been largely neglected in health policies and debates since the Alma Ata Declaration. Building new hospitals is politically more attractive for both national decision-makers and donors because they symbolise progress, better services and nation-building. To avoid the ‘white elephant’ syndrome, the deepening of within-country socioeconomic and geographical inequalities (especially urban–rural), and the exacerbation of hospital-centrism, there is an urgent need to investigate in greater depth how these hospitals are integrated into health systems and to discuss their long-term economic, social and environmental sustainability.

scholarly journals Incidence and etiology of clinically-attended, antibiotic-treated diarrhea among children under five years of age in low- and middle-income countries: evidence from the Global Enteric Multicenter Study

2020 ◽  
Author(s):  
Joseph A Lewnard ◽  
Elizabeth T Rogawski McQuade ◽  
James A Platts-Mills ◽  
Karen L Kotloff ◽  
Ramanan Laxminarayan
Keyword(s):  
Multicenter Study ◽  
Incidence Rates ◽  
Sub Saharan Africa ◽  
Molecular Diagnostic ◽  
Middle Income ◽  
Children Under Five ◽  
Under Five ◽  
Middle Income Countries ◽  
Stool Specimens ◽  
Low And Middle Income

Background: Diarrhea is a leading cause of antibiotic consumption among children in low- and middle-income countries. While vaccines may prevent diarrhea infections for which children often receive antibiotics, the contribution of individual enteropathogens to antibiotic use is minimally understood. We used data from the Global Enteric Multicenter Study (GEMS) to estimate pathogen-specific incidence of antibiotic-treated diarrhea among children under five years old residing in six countries of sub-Saharan Africa and South Asia before rotavirus vaccine implementation. Methods and findings: GEMS was an age-stratified, individually-matched case-control study. Stool specimens were obtained from children presenting to sentinel health clinics with newly-onset, acute diarrhea (including moderate-to-severe and less-severe diarrhea) as well as matched community controls without diarrhea. We used data from conventional and quantitative molecular diagnostic assays applied to stool specimens to estimate the proportion of antibiotic-treated diarrhea cases attributable to each pathogen. Antibiotics were administered or prescribed to 9,606 of 12,109 moderate-to-severe cases and 1,844 of 3,174 less-severe cases. Across all sites, incidence rates of clinically-attended, antibiotic-treated diarrhea were 12.2 (95% confidence interval: 9.0-17.8), 10.2 (7.4-13.9) and 1.9 (1.3-3.0) episodes per 100 child-years at risk at ages 6 weeks to 11 months, 12-23 months, and 24-59 months, respectively. Based on the recommendation for antibiotic treatment to be reserved for cases with dysentery, we estimated a ratio of 12.6 (8.6-20.8) inappropriately-treated diarrhea cases for each appropriately-treated case. Rotavirus, adenovirus serotypes 40/41, Shigella, sapovirus, Shiga toxin-producing Escherichia coli, and Cryptosporidium were the leading antibiotic-treated diarrhea etiologies. Rotavirus caused 29.2% (24.5-35.2%) of antibiotic-treated cases, including the largest share in both the first and second years of life. Shigella caused 14.9% (11.4-18.9%) of antibiotic-treated cases, and was the leading etiology at ages 24-59 months. Conclusions: Our findings should inform the prioritization of vaccines with the greatest potential to reduce antibiotic exposure among children.

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