Global implementation survey of Integrated Management of Childhood Illness (IMCI): 20 years on

ObjectiveTo assess the extent to which Integrated Management of Childhood Illness (IMCI) has been adopted and scaled up in countries.SettingThe 95 countries that participated in the survey are home to 82% of the global under-five population and account for 95% of the 5.9 million deaths that occurred among children less than 5 years of age in 2015; 93 of them are low-income and middle-income countries (LMICs).MethodsWe conducted a cross-sectional self-administered survey. Questionnaires and data analysis focused on (1) giving a general overview of current organisation and financing of IMCI at country level, (2) describing implementation of IMCI’s three original components and (3) reporting on innovations, barriers and opportunities for expanding access to care for children. A single data file was created using all information collected. Analysis was performed using STATA V.11.ParticipantsIn-country teams consisting of representatives of the ministry of health and country offices of WHO and Unicef.ResultsEighty-one per cent of countries reported that IMCI implementation encompassed all three components. Almost half (46%; 44 countries) reported implementation in 90% or more districts as well as all three components in place (full implementation). These full-implementer countries were 3.6 (95% CI 1.5 to 8.9) times more likely to achieve Millennium Development Goal 4 than other (not full implementer) countries. Despite these high reported implementation rates, the strategy is not reaching the children who need it most, as implementation is lowest in high mortality countries (39%; 7/18).ConclusionThis survey provides a unique opportunity to better understand how implementation of IMCI has evolved in the 20 years since its inception. Results can be used to assist in formulating strategies, policies and activities to support improvements in the health and survival of children and to help achieve the health-related, post-2015 Sustainable Development Goals.

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Association of Undernutrition and Neonatal, Infant and Under-5 Mortality: Evidence from 62 Low-Income and Middle-Income Countries

Current Developments in Nutrition ◽

10.1093/cdn/nzaa053_116 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 911-911

Author(s):

Paddy Ssentongo ◽

Joseph Lewcun ◽

Anna Ssentongo ◽

Djibril Ba ◽

Claudio Fronterre ◽

...

Keyword(s):

Infant Mortality ◽

Neonatal Mortality ◽

Child Mortality ◽

Low Income ◽

Household Survey ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries ◽

Country Level ◽

Nationally Representative

Abstract Objectives During the Millennium Development Goals (MDG) era, many low- and middle-income countries (LMICs) failed to achieve the MDG 4 of reducing neonatal, infant, and under-5 mortality. In this study, we aimed to assess whether reductions in early childhood undernutrition is associated with a reduction in neonatal, infant and under-5 mortality rate in LMICs. Methods We analyzed demographic and health household survey data from 62 LMICs collected between 2006 and 2018. The sample consisted of nationally representative cross-sectional surveys of children aged 0–59 months (n = 600,390). We examined country-level prevalence of stunting, wasting and underweight (based on z scores < −2 per the WHO Growth Standard) each as predictors of neonatal, infant and under-5 mortality incidence using multivariate Poisson regression models adjusted for country-level mean duration of breastfeeding and gross domestic product per capita. We also examined the association between breastfeeding and mortality. Results Overall, 28.4% (95% CI: 26.3%, 30.7%) of young children were stunted, 5.4% (95% CI: 4.5%, 6.6%) were wasted, 12.3% (95% CI: 10.4%, 14.6%) were underweight. Per 1000 live births, neonatal mortality was 23.6 (95% CI: 19.3–27.1), infant mortality was 43.4 (95% CI: 30.2–50.1) and under-5 mortality was 61.6 (95% CI: 55.3- 68.3). At the country level, a 10-fold decrease in stunting was associated with a relative risk (RR) of 0.81 (95% CI 0.66–0.98; P < 0.001) for neonatal mortality, 0.66 (95% CI 0.55–0.80; P < 0.001) for infant mortality, and 0.63 (95% CI 0.52–0.76; P < 0.001) for under-5 mortality. No association was seen between wasting or underweight and child mortality. Breastfeeding was associated with lower rates of child mortality. A one standard deviation (16 months) increase in breastfeeding was associated with a RR of 0.86 (95% CI 0.76–0.97; P = 0.015) for neonatal mortality, 0.79 (95% CI 0.70–0.89; P < 0.001) for infant mortality, and 0.75 (95% CI 0.67–0.85; P < 0.001) for under-5 mortality. Conclusions In a very large, multi-country sample of nationally-representative surveys in LMICs, stunting was strongly associated with child mortality from birth to 5 years. Stunting should be a focus in the effort to achieve the Sustainable Development Goal 3.2 target to reduce neonatal and under-5 mortality in all countries by 2030. Funding Sources National Institute of Health.

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Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey

BMJ Global Health ◽

10.1136/bmjgh-2020-003564 ◽

2020 ◽

Vol 5 (Suppl 2) ◽

pp. e003564

Author(s):

Mamadou Dioulde Balde ◽

Khalidha Nasiri ◽

Hedieh Mehrtash ◽

Anne-Marie Soumah ◽

Meghan A Bohren ◽

...

Keyword(s):

Physical Abuse ◽

Low Income ◽

Descriptive Analysis ◽

Secondary Analysis ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries ◽

Country Level ◽

Context Specific ◽

The Relationship

BackgroundEvidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool.MethodsWe conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment.ResultsOf 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9–6.9) and non-consented vaginal examinations (AOR 3.2, 1.6–6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7–3.1) and poor communication (AOR 2.0, 1.3–3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3–0.9).ConclusionLabour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women’s choices and autonomy.

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Inpatients’ experience and the associated factors: A cross-sectional study at Lung hospital, Son La, in 2020

Journal of Health and Development Studies ◽

10.38148/jhds.0504skpt21-007 ◽

2021 ◽

Vol 05 (04) ◽

pp. 110-116

Author(s):

Huu Thang Nguyen ◽

◽

Thi Nguyet Minh Doan ◽

Thanh Huong Tran ◽

Hai Thanh Pham

Keyword(s):

Low Income ◽

Associated Factors ◽

Income Group ◽

Cross Sectional Study ◽

Sectional Study ◽

Related Factors ◽

Cross Sectional ◽

Middle Income ◽

Medical Facilities ◽

Middle Income Group

Objectives: Medical facilities with an autonomous tendency always try to serve positive and pleasant experiences to improve the brand name, increase patient satisfaction and loyalty. A descriptive cross-sectional study was conducted on 245 inpatients at Lung Hospital in Son La province in 2020. To describe the current situation of the inpatient's experience at Lung Hospital in Son La province by 2020 and its related factors. Methods: This was a cross-sectional study conducted on 245 inpatients at Son La Lung Hospital Results: The study showed that the total score of inpatients’ experience ranged from 22 points to 57 points and the mean of it was 39.7 (6.13) points. Subject's experience scores were divided into 2 groups, the satisfied group accounted for 32.7% and the percentage of the unsatisfied group was 67.3%. As compared to men, a higher total score of women was (OR: 1.134; 95% CI: 0.284-0.997). The urban area group’s score was 1,190 times higher than that of those who live in rural and mountainous areas (95% CI: 1,010 - 1,400). The middle-income group had more positive experience than the low-income group (OR: 1.180; 95% CI: 1.010 - 1.370). Conclusions: Our research showed that gender, living area and economic condition affected the total score of inpatients’ experience at the Lung hospital. Keywords: Patient experiences, inpatient treatment, hospital, associated factors

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Long and short Integrated Management of Childhood Illness (IMCI) training courses in Afghanistan: a cross-sectional cohort comparison of post-course knowledge and performance

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2015.17 ◽

2015 ◽

Vol 4 (3) ◽

pp. 143-152 ◽

Cited By ~ 5

Author(s):

Maureen Mayhew ◽

Paul Ickx ◽

William Newbrander ◽

Hedayatullah Stanekzai ◽

Sayed Alisha Alawi

Keyword(s):

Integrated Management ◽

Childhood Illness ◽

Cross Sectional ◽

Cohort Comparison ◽

Training Courses ◽

And Performance

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

BMJ Open ◽

10.1136/bmjopen-2019-034524 ◽

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.

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PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents

BMJ Global Health ◽

10.1136/bmjgh-2018-000957 ◽

2018 ◽

Vol 3 (Suppl 5) ◽

pp. e000957 ◽

Cited By ~ 7

Author(s):

Sandy Picken ◽

Juliet Hannington ◽

Lara Fairall ◽

Tanya Doherty ◽

Eric Bateman ◽

...

Keyword(s):

Primary Care ◽

Quality Of Care ◽

Low Income ◽

Integrated Management ◽

Decision Support Tool ◽

Clinical Decision ◽

Childhood Mortality ◽

Middle Income ◽

Support Tool

Pioneering strategies like WHO’s Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults, that expands the scope and reach of integrated management and training programmes for paediatric primary care. This paper describes the development and key features of the PACK Child clinical decision support tool for the care of children up to 13 years, and lessons learnt during its development.

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The burden of serious health-related suffering among cancer decedents: Global projections study to 2060

Palliative Medicine ◽

10.1177/0269216320957561 ◽

2020 ◽

pp. 026921632095756

Author(s):

Katherine E Sleeman ◽

Barbara Gomes ◽

Maja de Brito ◽

Omar Shamieh ◽

Richard Harding

Keyword(s):

Palliative Care ◽

Low Income ◽

Population Based ◽

World Health ◽

Low Income Countries ◽

Cancer Type ◽

Middle Income ◽

Middle Income Countries ◽

Health Related ◽

Health Organization

Background: Palliative care improves outcomes for people with cancer, but in many countries access remains poor. Understanding future needs is essential for effective health system planning in response to global policy. Aim: To project the burden of serious health-related suffering associated with death from cancer to 2060 by age, gender, cancer type and World Bank income region. Design: Population-based projections study. Global projections of palliative care need were derived by combining World Health Organization cancer mortality projections (2016–2060) with estimates of serious health-related suffering among cancer decedents. Results: By 2060, serious health-related suffering will be experienced by 16.3 million people dying with cancer each year (compared to 7.8 million in 2016). Serious health-related suffering among cancer decedents will increase more quickly in low income countries (407% increase 2016–2060) compared to lower-middle, upper-middle and high income countries (168%, 96% and 39% increase 2016-2060, respectively). By 2060, 67% of people who die with cancer and experience serious health-related suffering will be over 70 years old, compared to 47% in 2016. In high and upper-middle income countries, lung cancer will be the single greatest contributor to the burden of serious health-related suffering among cancer decedents. In low and lower-middle income countries, breast cancer will be the single greatest contributor. Conclusions: Many people with cancer will die with unnecessary suffering unless there is expansion of palliative care integration into cancer programmes. Failure to do this will be damaging for the individuals affected and the health systems within which they are treated.

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