Neonatal mortality and leading causes of deaths: a descriptive study in China, 2014–2018

ObjectiveThe present study estimated the national and urban–rural levels and causes of neonatal deaths in China annually between 2014 and 2018 to provide data support for the further end of preventable neonatal deaths for China and other low-income and middle-income countries.MethodsThe study was based on data from the National Maternal and Child Health Surveillance System. All neonates of surveillance districts (gestational week: ≥28 weeks) who died after delivery have been involved in the study. The mortality rate and the leading causes of death for neonates were analysed.ResultsThe neonatal mortality rate (NMR) of China has steadily decreased from 5.9 deaths per 1000 live births in 2014 to 3.9 deaths per 1000 live births in 2018. The NMR in 2018 of urban and rural areas was 2.2 deaths per 1000 live births and 4.7 deaths per 1000 live births, respectively. The leading preventable causes of neonatal deaths are the same in the urban and rural areas were same, which were preterm birth, intrapartum complications and pneumonia. Mortality rates of these three causes fell significantly between 2014 and 2018 but contributed to a higher proportion of deaths in rural areas than urban areas. The proportion of preventable deaths accounted for 74.6% in 2018.ConclusionsThe NMR of China has decreased steadily from 2014 to 2018. However, the inequality between urban and rural areas still exists. The goal of government interventions should be to reduce the health inequality of neonates and further take targeted measures to eliminate preventable neonatal death.

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Retrospective analysis of neonatal deaths secondary to infections in England and Wales, 2013–2015

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-319093 ◽

2020 ◽

pp. fetalneonatal-2020-319093

Author(s):

Godwin Oligbu ◽

Leila Ahmed ◽

Laura Ferraras-Antolin ◽

Shamez Ladhani

Keyword(s):

Mortality Rate ◽

Retrospective Analysis ◽

Neonatal Mortality ◽

Mortality Rates ◽

Neonatal Mortality Rate ◽

England And Wales ◽

Neonatal Deaths ◽

Live Births ◽

Extremely Preterm ◽

Related Mortality

ObjectiveTo estimate the overall and infection-related neonatal mortality rate and the pathogens responsible using electronic death registrations.DesignRetrospective analysis of national electronic death registrations data.SettingEngland and Wales.PatientsNeonates aged <28 days.Main outcome measuresOverall and infection-related mortality rate per 1000 live births in term, preterm (28–36 weeks) and extremely preterm (<28 weeks) neonates; the contribution of infections and specific pathogens; comparison with mortality rates in 2003–2005.ResultsThe neonatal mortality rate during 2013–2015 (2.4/1000 live births; 5095 deaths) was 31% lower than in 2003–2005 (3.5/1000; 6700 deaths). Infection-related neonatal mortality rate in 2013–2015 (0.32/1000; n=669) was 20% lower compared with 2003–2015 (0.40/1000; n=768), respectively. Infections were responsible for 13.1% (669/5095) of neonatal deaths during 2013–2015 and 11.5% (768/6700) during 2003–2005. Of the infection-related deaths, 44.2% (296/669) were in term, 19.9% (133/669) preterm and 35.9% (240/669) extremely preterm neonates. Compared with term infants (0.15/1000 live births), infection-related mortality rate was 5.9-fold (95% CI 4.7 to 7.2) higher in preterm (0.90/1000) and 188-fold (95% CI 157 to 223) higher in extremely preterm infants (28.7/1000) during 2013–2015. A pathogen was recorded in 448 (67%) registrations: 400 (89.3%) were bacterial, 37 (8.3%) viral and 11 (2.4%) fungal. Group B streptococcus (GBS) was reported in 30.4% (49/161) of records that specified a bacterial infection and 7.3% (49/669) of infection-related deaths.ConclusionsOverall and infection-related neonatal mortality rates have declined, but the contribution of infection and of specific pathogens has not changed. Further preventive measures, including antenatal GBS vaccine may be required to prevent the single most common cause of infection-related deaths in neonates.

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Strategies used to establish palliative care in rural low- and middle-income countries: an integrative review

Health Policy and Planning ◽

10.1093/heapol/czaa051 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1110-1129

Author(s):

Atsede Aregay ◽

Margaret O’Connor ◽

Jill Stow ◽

Nicola Ayers ◽

Susan Lee

Keyword(s):

Palliative Care ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Care Home ◽

Sub Saharan Africa ◽

Integrative Review ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Abstract Globally, 40 million people need palliative care; about 69% are people over 60 years of age. The highest proportion (78%) of adults are from low- and middle-income countries (LMICs), where palliative care still developing and is primarily limited to urban areas. This integrative review describes strategies used by LMICs to establish palliative care in rural areas. A rigorous integrative review methodology was utilized using four electronic databases (Ovid MEDLINE, Ovid Emcare, Embase classic+Embase and CINAHL). The search terms were: ‘palliative care’, ‘hospice care’, ‘end of life care’, ‘home-based care’, ‘volunteer’, ‘rural’, ‘regional’, ‘remote’ and ‘developing countries’ identified by the United Nations (UN) as ‘Africa’, ‘Sub-Saharan Africa’, ‘low-income’ and ‘middle- income countries’. Thirty papers published in English from 1990 to 2019 were included. Papers were appraised for quality and extracted data subjected to analysis using a public health model (policy, drug availability, education and implementation) as a framework to describe strategies for establishing palliative care in rural areas. The methodological quality of the reviewed papers was low, with 7 of the 30 being simple programme descriptions. Despite the inclusion of palliative care in national health policy in some countries, implementation in the community was often reliant on advocacy and financial support from non-government organizations. Networking to coordinate care and medication availability near-patient homes were essential features of implementation. Training, role play, education and mentorship were strategies used to support health providers and volunteers. Home- and community-based palliative care services for rural LMICs communities may best be delivered using a networked service among health professionals, community volunteers, religious leaders and technology.

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Mapping poverty using mobile phone and satellite data

Journal of The Royal Society Interface ◽

10.1098/rsif.2016.0690 ◽

2017 ◽

Vol 14 (127) ◽

pp. 20160690 ◽

Cited By ~ 67

Author(s):

Jessica E. Steele ◽

Pål Roe Sundsøy ◽

Carla Pezzulo ◽

Victor A. Alegana ◽

Tomas J. Bird ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Census Data ◽

Data Sources ◽

Human Potential ◽

Public And Private ◽

Middle Income ◽

Mobile Data ◽

Poverty Measures ◽

Urban And Rural Areas

Poverty is one of the most important determinants of adverse health outcomes globally, a major cause of societal instability and one of the largest causes of lost human potential. Traditional approaches to measuring and targeting poverty rely heavily on census data, which in most low- and middle-income countries (LMICs) are unavailable or out-of-date. Alternate measures are needed to complement and update estimates between censuses. This study demonstrates how public and private data sources that are commonly available for LMICs can be used to provide novel insight into the spatial distribution of poverty. We evaluate the relative value of modelling three traditional poverty measures using aggregate data from mobile operators and widely available geospatial data. Taken together, models combining these data sources provide the best predictive power (highest r 2 = 0.78) and lowest error, but generally models employing mobile data only yield comparable results, offering the potential to measure poverty more frequently and at finer granularity. Stratifying models into urban and rural areas highlights the advantage of using mobile data in urban areas and different data in different contexts. The findings indicate the possibility to estimate and continually monitor poverty rates at high spatial resolution in countries with limited capacity to support traditional methods of data collection.

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Faecal sludge management in low income areas: a case study of three districts in the Ashanti region of Ghana

Journal of Water Sanitation and Hygiene for Development ◽

10.2166/washdev.2014.126 ◽

2014 ◽

Vol 4 (2) ◽

pp. 189-199 ◽

Cited By ~ 9

Author(s):

Eugene Appiah-Effah ◽

Kwabena Biritwum Nyarko ◽

Samuel Fosu Gyasi ◽

Esi Awuah

Keyword(s):

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Sludge Management ◽

The Public ◽

Ashanti Region ◽

Toilet Facility ◽

Urban And Rural Areas ◽

Public Toilets ◽

Faecal Sludge

The challenge of faecal sludge management (FSM) in most developing countries is acute, particularly in low income areas. This study examined the management of faecal sludge (FS) from household latrines and public toilets in three districts in the Ashanti region of Ghana based on household surveys, key informant interviews and field observations. Communities did not have designated locations for the disposal and treatment of FS. For household toilets, about 31 and 42% of peri-urban and rural respondents, respectively, with their toilets full reported that they did not consider manual or mechanical desludging as an immediate remedy, although pits were accessible. Households rather preferred to close and abandon their toilets and use public toilets at a fee or practise open defecation. For the public toilets, desludging was manually carried out at a fee of GHC 800–1,800 and the process usually lasted 8–14 days per toilet facility. The study showed that FSM has not been adequately catered for in both peri-urban and rural areas. However, respondents from the peri-urban areas relatively manage their FS better than their rural counterparts. To address the poor FSM in the study communities, a decentralized FS composting is a potential technology that could be used.

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A growing disadvantage of being born in an urban area? Analysing urban–rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania

BMJ Global Health ◽

10.1136/bmjgh-2021-007544 ◽

2022 ◽

Vol 7 (1) ◽

pp. e007544

Author(s):

Megan Norris ◽

Gonnie Klabbers ◽

Andrea B Pembe ◽

Claudia Hanson ◽

Ulrika Baker ◽

...

Keyword(s):

Neonatal Mortality ◽

Rural Areas ◽

Urban Areas ◽

Maternal Education ◽

Health Seeking ◽

African Countries ◽

Live Births ◽

Urban Rural ◽

Ssa Countries

IntroductionNeonatal mortality rate (NMR) has been declining in sub-Saharan African (SSA) countries, where historically rural areas had higher NMR compared with urban. The 2015–2016 Demographic and Health Survey (DHS) in Tanzania showed an exacerbation of an existing pattern with significantly higher NMR in urban areas. The objective of this study is to understand this disparity in SSA countries and examine the specific factors potentially underlying this association in Tanzania.MethodsWe assessed urban–rural NMR disparities among 21 SSA countries with four or more DHS, at least one of which was before 2000, using the DHS StatCompiler. For Tanzania DHS 2015–2016, descriptive statistics were carried out disaggregated by urban and rural areas, followed by bivariate and multivariable logistic regression modelling the association between urban/rural residence and neonatal mortality, adjusting for other risk factors.ResultsAmong 21 countries analysed, Tanzania was the only SSA country where urban NMR (38 per 1000 live births) was significantly higher than rural (20 per 1,000), with largest difference during first week of life. We analysed NMR on the 2015–2016 Tanzania DHS, including live births to 9736 women aged between 15 and 49 years. Several factors were significantly associated with higher NMR, including multiplicity of pregnancy, being the first child, higher maternal education, and male child sex. However, their inclusion did not attenuate the effect of urban–rural differences in NMR. In multivariable models, urban residence remained associated with double the odds of neonatal mortality compared with rural.ConclusionThere is an urgent need to understand the role of quality of facility-based care, including role of infections, and health-seeking behaviour in case of neonatal illness at home. However, additional factors might also be implicated and higher NMR within urban areas of Tanzania may signal a shift in the pattern of neonatal mortality across several other SSA countries.

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ANALISIS KONSUMSI PANGAN TINGKAT RUMAH TANGGA DI PROPINSI LAMPUNG

Agro Ekonomi ◽

10.22146/agroekonomi.17108 ◽

2006 ◽

Vol 13 (2) ◽

Author(s):

Meliyanah Meliyanah ◽

Suhatmini Hardyastuti ◽

Djuwari Djuwari

Keyword(s):

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Household Consumption ◽

Income Level ◽

High Income ◽

Middle Income ◽

Household Level ◽

Rural And Urban Areas ◽

Rural And Urban

This research diamed to: 1) knowing the selft-price elasticity, cross-price elasticity and income elasticity of consumption per food item on household level according to location and income level; and 2) knowing the reation between level of income and food consumption on household level according to location and income level.This research used data from SUSENAS of Lmapung Province in 2002 with number of sample of 2091 household, which being differed between rural and urban areas based on low, middle, and high level of income. The data analysis used tobit model and sensored regression.The result showed that: 1) the demand of rice and beeh for household consumption in every level of income in rural and urban areas were inelastic; 2) Coen only been consumed by low income level household in rural areas and the demand was inelastic; 3) the demand of cassava for household consumption on low income level in urban area was elastic, While in middle income level, high income level and every level of income in rural area, cassava demand was inelastic. Cassava was considered as inferior goods; 4) The demand of fish for household consumption an every level of income in rural and urban areas was elastic. Household in rural area on every level of income and in urban areas on middle and high income level consider fish as a main necessity. While on low income level household in urban areas, it was considered as classy/exclusive good; 5) the demand of chicken; for household in rural areas on middle and high income level was inelastic. When in rural low income level and urban middle and high income level, was inelastic chicken meat was considend as classy/exclusive good the rural low income level household; 6) egg demand for household consumption in rural areas on every level of income was inelastic, while in urban area it was elastic for every level income; 7) the rural and urban household on every level of income considered rice as the stpale food; 8) Household in rural and urban areas on middle and high level of income considered beef as main necessity; 9) On household with middle income level in rural areas, egg was considere as inferior good; while an low income level in urban areas, egg was considere as expensive good.

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Clinical Profile of Birth Asphyxia in Dhulikhel Hospital: A Retrospective Study

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v30i3.3916 ◽

1970 ◽

Vol 30 (3) ◽

pp. 141-146 ◽

Cited By ~ 3

Author(s):

S Dongol ◽

J Singh ◽

S Shrestha ◽

A Shakya

Keyword(s):

Risk Factors ◽

Low Income ◽

Birth Asphyxia ◽

Clinical Information ◽

World Health ◽

Middle Income ◽

Mortality And Morbidity ◽

Neonatal Deaths ◽

Live Births ◽

Infant Birth

Introduction: Birth asphyxia is defined by the World Health Organization "the failure to initiate and sustain breathing at birth." The WHO has estimated that 4 million babies die during the neonatal period every year and 99% of these deaths occur in low-income and middle income countries. Three major causes account for over three quarters of these deaths, serious infection (28%) complication of preterm birth (26%) and birth asphyxia (23%). This estimation implies that birth asphyxia is the cause of around one million neonatal deaths each year. One of the present challenges is the lack of a gold standard for accurately defining birth asphyxia. Because of same reason the incidence of birth asphyxia is difficult to quantify. Objective: The aim of this study was to assess the prevalence of birth asphyxia, identify the common obstetric and neonatal risk factors, and study the cause of death. Methodology: All babies born in Dhulikhel Hospital (DH) from Jan 2007 to Oct 2009 with a diagnosis of birth asphyxia (5 min Apgar < 7 and those with no spontaneous respirations after birth) were included in the study (n=102). Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications). The NICU records provided additional information about new born infant (birth asphyxia, stages of birth asphyxia, birth weight, sex and subsequent mortality). Results: Among the 3784 live births there were 102 babies with birth asphyxia prevalence of 26.9/1000 live births. Babies with Hypoxic ischemic encephalopathy (HIE) Stage 1 had a very good outcome but HIE III was associated with a poor outcome. Males, primipara and pregnancies with complications were associated with a higher rate of birth asphyxia. Septicaemia, necrotizing enterocolitis, preterm delivery, convulsion and, pneumothorax were associated with higher mortality and morbidity. Conclusion: Birth asphyxia was one of the commonest causes of admission and mortality in NICU. Babies with HIE Stage III had a very poor prognosis. Birth asphyxia combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of birth asphyxia. Maternal gravida, pregnancy complication with PROM, meconium, APH, emergency caesarean section, preterm and male sex were the risk factors for birth asphyxia. Key words: Birth asphyxia; HIE; Neonatal sepsisDOI: 10.3126/jnps.v30i3.3916J Nep Paedtr Soc 2010;30(3):141-146

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

Thorax ◽

10.1136/thoraxjnl-2018-211793 ◽

2019 ◽

Vol 74 (11) ◽

pp. 1020-1030 ◽

Cited By ~ 7

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.

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Open defecation free: where do we need to focus ?

Health Prospect ◽

10.3126/hprospect.v19i0.27394 ◽

2020 ◽

Vol 19 (1) ◽

pp. 1-6

Author(s):

Ramesh Adhikari ◽

Sudha Ghimire

Keyword(s):

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Economic Status ◽

Positive Association ◽

Bivariate Analysis ◽

Contributing Factors ◽

Open Defecation ◽

Chi Square ◽

Middle Income

BackgroundDespite major national and international efforts, many households in Nepal (as in other low-income and middle-income countries) still lack toilets. This paper assesses various determinants that act as main contributing factors because of which households in Nepal still do not have toilets. MethodsData from the Nepal Demographic and Health Survey (NDHS) 2016 was used for this study. Bivariate analysis was done to assess the association between dependent variables (toilet status- having and not having toilets in the household) and independent variables (demographic, socio-economic and geographical characteristics) using Chi-square test. Then, a multi variate logistic regression model was used to assess significant predictors for a household not having a toilet after controlling other variables. ResultsOut of the total number of sampled households (11040), nearly a fifth (18%) belonged to province no. 2, where nearly half of the households (49%) did not have toilet facilities. Similarly, households in rural areas were found to be less likely to have toilets than households in urban areas (aOR=1.56, CI1.35-1.80). In the Terai, households were almost ten times as likely not to have toilets (aOR=9.65, CI6.56-14.19) as compared to households in the mountain region. Furthermore, there is a strong positive association between households with toilets and their economic status. Poorest (aOR=15.19, CI11.26-20.47), poorer (aOR=8.75, CI6.89-11.11) and middle income (aOR=5.12, CI4.15-6.32) households were less likely to have a toilet than richer or richest households. ConclusionsDespite some real achievements and progress in Open Defecation Free (ODF) status, Nepal still has a large number of residences without a toilet. Thus, it is crucial to address all the multifaceted factors such as geographical, provincial and economic when considering sustainable ODF programming.

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ANALISIS KONSUMSI BERAS PADATINGKAT RUMAH TANGGA DI PROPINSI DAERAH ISTIMEWA YOGYAKARTA

Agro Ekonomi ◽

10.22146/agroekonomi.16734 ◽

2016 ◽

Vol 14 (1) ◽

pp. 50

Author(s):

Cristovao R ◽

Slamet Hartono ◽

Jangkung Handoyo Mulyo

Keyword(s):

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Income Elasticity ◽

Income Level ◽

Middle Income ◽

Household Level ◽

Rural And Urban Areas ◽

Rural And Urban ◽

Rice Consumption

The objectives of the study were (1) to determine thefactors influencing rice consumption in urban and rural areas of Yogyakarta Special Province and (2) to determine the own price, cross price and income elasticity of rice consumption at different income levels in rural and urban areas. National Socio-Economic Survey (SUSENAS) data of 2005 Yogyakarta Special Province on rice consumption was used Totalrespondents 1990 households. Regression model used in the analysis was OLS. The result showed that thefactors that influence the consumption of rice are the price of the rice itself, price of the related household goods, income level, education of the mother, number offamily members, and location. Thefactors that individually influence rice consumption vary by kinds of rice, location, and income level. Therefore, the demand of rice in DIY is inelastic, the change of price did not significantly influence rice demand. Generally, rice is normal good at low income household level in the rural and urban areas andfor middle income in the rural, and in middle income and high income in the urban, rice is a inferior good. In other side, rice is Substituted for cassava and sweet potato. Rice is complementary for catfish, fermented soybean cake, cassava, egg, and tofu.Keywords: rice consumption, elasticity, substitution, complementary.

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