scholarly journals The impact of child health interventions and risk factors on child survival in Kenya, 1993–2014: a Bayesian spatio-temporal analysis with counterfactual scenarios

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Peter M. Macharia ◽  
Noel K. Joseph ◽  
Robert W. Snow ◽  
Benn Sartorius ◽  
Emelda A. Okiro
Keyword(s):  
Risk Factors ◽  
Child Health ◽  
Child Survival ◽  
Ecological Factors ◽  
Temporal Analysis ◽  
Infection Prevalence ◽  
Intervention Coverage ◽  
Under Five ◽  
Maternal Autonomy ◽  
The Impact

Abstract Background During the millennium development goals period, reduction in under-five mortality (U5M) and increases in child health intervention coverage were characterised by sub-national disparities and inequities across Kenya. The contribution of changing risk factors and intervention coverage on the sub-national changes in U5M remains poorly defined. Methods Sub-national county-level data on U5M and 43 factors known to be associated with U5M spanning 1993 and 2014 were assembled. Using a Bayesian ecological mixed-effects regression model, the relationships between U5M and significant intervention and infection risk ecological factors were quantified across 47 sub-national counties. The coefficients generated were used within a counterfactual framework to estimate U5M and under-five deaths averted (U5-DA) for every county and year (1993–2014) associated with changes in the coverage of interventions and disease infection prevalence relative to 1993. Results Nationally, the stagnation and increase in U5M in the 1990s were associated with rising human immunodeficiency virus (HIV) prevalence and reduced maternal autonomy while improvements after 2006 were associated with a decline in the prevalence of HIV and malaria, increase in access to better sanitation, fever treatment-seeking rates and maternal autonomy. Reduced stunting and increased coverage of early breastfeeding and institutional deliveries were associated with a smaller number of U5-DA compared to other factors while a reduction in high parity and fully immunised children were associated with under-five lives lost. Most of the U5-DA occurred after 2006 and varied spatially across counties. The highest number of U5-DA was recorded in western and coastal Kenya while northern Kenya recorded a lower number of U5-DA than western. Central Kenya had the lowest U5-DA. The deaths averted across the different regions were associated with a unique set of factors. Conclusion Contributions of interventions and risk factors to changing U5M vary sub-nationally. This has important implications for targeting future interventions within decentralised health systems such as those operated in Kenya. Targeting specific factors where U5M has been high and intervention coverage poor would lead to the highest likelihood of sub-national attainment of sustainable development goal (SDG) 3.2 on U5M in Kenya.

scholarly journals The impact of antenatal care on under‐five mortality in Ethiopia: a difference‐in‐differences analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Samuel Oduse ◽  
Temesgen Zewotir ◽  
Delia North
Keyword(s):  
Antenatal Care ◽  
Child Survival ◽  
First Trimester ◽  
Sub Saharan Africa ◽  
P Value ◽  
Difference In Differences ◽  
Under Five ◽  
Care Services ◽  
Sub Saharan ◽  
The Impact

Abstract Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

The Impact of Maternal Health Care Utilization on Probability of Child Survival in India

2020 ◽  
Vol 11 (7) ◽  
pp. 1006-1014
Author(s):  
Ajit Kumar Jaiswal
Keyword(s):  
Health Care ◽  
Child Health ◽  
Maternal And Child Health ◽  
Child Survival ◽  
Nutrient Deficiency ◽  
Household Wealth ◽  
Care Utilization ◽  
The Government ◽  
The Impact ◽  
And Child Health

Maternal and child health programmes plays a key role in reducing infant and child mortality in any population. The Government of India started maternal and child health care services in the first five year plan (1951-56). This study uses data from the fourth round of the National Family Health Survey (NFHS, 2015-16). We are interested to examine the effect of child delivery at a healthcare facility, on child survival. We are followed by Mosley and Chen’s framework (1884), according to the framework, several socioeconomic determinants are grouped into some categories, namely, maternal, environmental contamination, nutrient deficiency, and personal illness control. Consequently, we reduced the number of independent variables to women’s age at birth and education, birth order, low child birth weight, household wealth, and healthcare.

scholarly journals Factors influencing rapid progress in child health in post-conflict Liberia: a mixed methods country case study on progress in child survival, 2000–2013

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e021879 ◽  
Author(s):  
Marie A Brault ◽  
Stephen B Kennedy ◽  
Connie A Haley ◽  
Adolphus T Clarke ◽  
Musu C Duworko ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Civil War ◽  
Child Health ◽  
Child Survival ◽  
Rapid Progress ◽  
African Region ◽  
Under Five ◽  
Post Conflict ◽  
Mdg 4

ObjectivesOnly 12 countries in the WHO’s African region met Millennium Development Goal 4 (MDG 4) to reduce under-five mortality by two-thirds by 2015. Given the variability across the African region, a four-country mixed methods study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia was selected for an in-depth case study due to its success in reducing under-five mortality by 73% and thus successfully meeting MDG 4. Liberia’s success was particularly notable given the civil war that ended in 2003. We examined some factors contributing to their reductions in under-five mortality.DesignA case study mixed methods approach drawing on data from quantitative indicators, national documents and qualitative interviews was used to describe factors that enabled Liberia to rebuild their maternal, neonatal and child health (MNCH) programmes and reduce under-five mortality following the country’s civil war.SettingThe interviews were conducted in Monrovia (Montserrado County) and the areas in and around Gbarnga, Liberia (Bong County, North Central region).ParticipantsKey informant interviews were conducted with Ministry of Health officials, donor organisations, community-based organisations involved in MNCH and healthcare workers. Focus group discussions were conducted with women who have experience accessing MNCH services.ResultsThree prominent factors contributed to the reduction in under-five mortality: national prioritisation of MNCH after the civil war; implementation of integrated packages of services that expanded access to key interventions and promoted intersectoral collaborations; and use of outreach campaigns, community health workers and trained traditional midwives to expand access to care and improve referrals.ConclusionsAlthough Liberia experiences continued challenges related to limited resources, Liberia’s effective strategies and rapid progress may provide insights for reducing under-five mortality in other post-conflict settings.

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 The impact of antenatal care on child mortality in Ethiopia: a difference-in-differences analysis

2020 ◽  
Author(s):  
Samuel Oduse ◽  
Temesgen Zewotir ◽  
Delia North
Keyword(s):  
Antenatal Care ◽  
Child Survival ◽  
Control Group ◽  
Antenatal Visit ◽  
Difference In Differences ◽  
Under Five ◽  
Antenatal Care Visit ◽  
Care Services ◽  
Care Visit ◽  
The Impact

Abstract Background This article examines the impact of antenatal care on child health outcome. We specifically investigated if women visits to antenatal care services has a positive effect in the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14-49 years who have at least one antenatal care visit before delivery (treatment group) or had no antenatal care visit before delivery (control group). Results The study revealed 1 481 cases of reported under-five mortality. 83.7% of that is by women who never had any antenatal care visit while the remaining 16.3% are by women who had at least one antenatal visit during their pregnancy. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 29% (CI = 1.3-56%, P= 0.04). Conclusions To achieve significant reduction in under-five mortality rate, Intervention programs that encourages antenatal care visits should be considered. This will improve child survival and help in attaining sustainable Development Goal target.

scholarly journals Health Interventions and Child Health in Sub-Saharan Africa: Assessing the Impact of the Millennium Development Goal

2016 ◽  
Vol 9 (1) ◽  
pp. 187 ◽  
Author(s):  
Oluwatomisin M. Ogundipe ◽  
Oluranti I. Olurinola ◽  
Adeyemi A. Ogundipe
Keyword(s):  
Child Health ◽  
Health Outcomes ◽  
Basic Education ◽  
Immunization Coverage ◽  
Health Interventions ◽  
Sub Saharan Africa ◽  
Intervention Programme ◽  
Under Five ◽  
Child Health Outcomes ◽  
The Impact

The study investigates the role of health interventions on child health in developing Africa for the period 1990-2013 using a dynamic panel approach. Among others, the study examines the effect of millennium development intervention programme on child health outcomes. Our analysis reveals MDG intervention as extremely pertinent in reducing the incidence of child mortality in Africa. It implies that introduction of MDGs culminates into increasing the rate of child survival in Africa. Similarly, maternal literacy, maternal health and other child protective measures adopted were found to be statistically significant in improving child health outcomes. The proportion of under-five mortality (proxy for child health) responds more strongly and negatively to immunization coverage, exclusive breastfeeding and DPT vaccines. On the other hand, the quality of institution contributively impact under-five mortality in Africa. Finally, there is need to strengthen institutional arrangement, ensure compulsory basic education for women and strengthen the health system to achieve full packages of intervention, curtain the rising incidence of child deaths and attain the MDGs.

scholarly journals Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993–2014

2021 ◽  
Vol 6 (4) ◽  
pp. e004544
Author(s):  
Peter M Macharia ◽  
Noel K Joseph ◽  
Benn Sartorius ◽  
Robert W Snow ◽  
Emelda A Okiro
Keyword(s):  
Health Planning ◽  
Child Survival ◽  
Gaussian Process Regression ◽  
Temporal Analysis ◽  
Spatial And Temporal Variation ◽  
Infection Prevalence ◽  
County Level ◽  
Factors Associated ◽  
Inadequate Sample Size ◽  
Spatio Temporal

BackgroundTo improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya.MethodsTwenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014.ResultsNationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993–2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria.ConclusionThe heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.

scholarly journals Simultaneous quantile regression and determinants of under-five severe chronic malnutrition in Ghana.

2020 ◽  
Author(s):  
Justice Moses K. Aheto
Keyword(s):  
Risk Factors ◽  
Quantile Regression ◽  
Significant Risk ◽  
Household Wealth ◽  
Public Health Issue ◽  
Wealth Status ◽  
Chronic Malnutrition ◽  
Severe Stunting ◽  
Under Five ◽  
The Impact

Abstract Background Under-five malnutrition is a major public health issue contributing to mortality and morbidity, especially in developing countries like Ghana where the rates remain unacceptably high. Identification of critical risk factors of under-five malnutrition using appropriate and advanced statistical methods can help formulate appropriate health programmes and policies aimed at achieving the United Nations SDG Goal 2 target 2. This study attempts to develop a simultaneous quantile regression, an in-depth statistical model to identify critical risk factors of under-five severe chronic malnutrition (severe stunting). Methods Based on the nationally representative data from the 2014 Ghana Demographic and Health Survey, height-for-age z-score (HAZ) was estimated. Multivariable simultaneous quantile regression modelling was employed to identify critical risk factors for severe stunting based on HAZ (a measure of chronic malnutrition in populations). Quantiles of HAZ with focus on severe stunting were modelled and the impact of the risk factors determined. Significant test of the difference between slopes at different selected quantiles of severe stunting and other quantiles were performed. A quantile regression plots of slopes were developed to visually examine the impact of the risk factors across these quantiles. Results Data on a total of 2716 children were analysed out of which 144 (5.3%) were severely stunted. The models identified child level factors such as type of birth, sex, age, place of delivery and size at birth as significant risk factors of under-five severe stunting. Maternal and household level factors identified as significant predictors of under-five severe stunting were maternal age and education, maternal national health insurance status, household wealth status, and number of children under-five in households. Highly significant differences exist in the slopes between 0.1 and 0.9 quantiles. The quantile regression plots for the selected quantiles from 0.1 to 0.9 showed substantial differences in the impact of the covariates across the quantiles of HAZ considered. Conclusion Critical risk factors that can aid formulation of child nutrition and health policies and interventions that will improve child nutritional outcomes and survival were identified. Modelling under-five severe stunting using multivariable simultaneous quantile regression models could be beneficial to addressing the under-five severe stunting.

scholarly journals The Epidemiology of Hepatitis D Virus in North Africa: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Mohamed A. Daw ◽  
Amina M. Daw ◽  
Nadia E. M. Sifennasr ◽  
Aisha M. Draha ◽  
Ahmed M. Daw ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis B ◽  
North Africa ◽  
Severe Disease ◽  
Diagnostic Testing ◽  
Infection Prevalence ◽  
Hepatitis D ◽  
Hepatitis D Virus ◽  
Hdv Infection ◽  
The Impact

Background. Hepatitis D virus (HDV) infection has been considered a serious neglected pandemic, particularly in developing countries. The virus causes a more severe disease than mono infection with hepatitis B virus (HBV). The epidemiology of HDV is not well documented in North Africa, which is known to be endemic for HBV. In this study, we explored the prevalence of HDV infection and also attempted to identify factors associated with hepatitis D positive status among chronic hepatitis B patients in North Africa.Methods. The electronic databases PubMed, Embase, Scopus, Science Direct, Web of Science, and Google Scholar were comprehensively searched for all papers published between January 1, 1998, and December 31, 2017, using appropriate strategies containing all related keywords, including North Africa, names of countries in the region, and all permutations of hepatitis D virus. The estimated prevalence of HDV in North Africa was calculated as an average of the pooled infection prevalence in each country weighted by the ratio of the country’s hepatitis D virus population to the study’s sample size in the survey data analysis.Findings. A total of 312 studies were identified and 32 were included in this study, with a total sample of 4907 individuals screened for HDV. There was considerable variability in the prevalence estimates of HDV within the countries of the region. The overall prevalence of HDV in the general population of North Africa was 5·01% (95% CI: 1·25–8·27) and in liver disease patients it was 20.7% (95% CI:9.87–44.53). Genotype-1 was the most prominent genotype reported in five published studies. Ten studies reported on HDV RNA in participants who were seropositive for HDV, and four studies highlighted the impact of demographic factors (sex and age). No study showed the impact of risk factors on the prevalence of HDV in North Africa.Interpretation. This review provides a comprehensive assessment of the burden of HDV in Northern Africa. There were significant differences in seroprevalence, study population, and diagnostic testing between the countries in the region. The results presented here will alert health professionals to implement clear policies based on evidence to diminish the burden of HDV infection. Such measures may include but are not restricted to improving the laboratory diagnostic tests and initiating patient data registries and blood screening. Further epidemiological and research studies are needed to explore the risk factors, coinfections, and approaches to increase testing for HDV, particularly in high-risk subpopulations, such as intravenous drug users and immigrants, and to define the consequences of HDV infection in North Africa.

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