Infant and Child health status ahead of implementation of an integrated intervention to improve nutrition and survival: A difference-in-difference quasi-experimental baseline assessment

Abstract Background Burundi has one of the poorest child health outcomes in the world. With an acute malnutrition rate of 5% and a chronic malnutrition rate of 56%, under five death is 78 per 1000 live births and 47 children in every 1000 children will not celebrate their first birthday. In response, Village Health Works, a Burundian-American organisation has invested in an integrated clinical and community intervention model. Ahead of implementation of this initiative, we conduct a baseline assessment using a difference-in-difference design in an effort to measure incremental effects. Methods A quasi-experimental evaluation design (difference-in-difference) was employed. Adopting the methodology of the DHS, a sample of 952 and 990 households comprising of 2675 and 3311 birth histories respectively in the treatment and control areas were reached. Mortality data were analysed with R package for mortality computation, Complex Samples Module of IBM – SPSS for other outcomes and Emergency Nutrition Assessment software for nutrition data. Logistic regression was used to assess strength of associations and cox regression model for assessing risk of mortality Results The incidence of low birth weight (LBW) was 5.7% at the program area compared to 7.2% at the controlled area with the strongest predictor being malnourished women (OR 1.4 95%CI 1.2 – 7.2 p=0.043). Fever incidence was higher in the program area (50.5%) in comparison to 48.4% in the control. Non-consumption of minimum acceptable diet was significantly associated with fever (OR 1.67 95%CI 1.07 – 2.61). Acute and chronic malnutrition was 7.6% and 45.8% respectively with non-receipt of Vitamin A was significantly associated with chronic malnutrition. Under-five mortality rate was 32.1 per 1000 live births in the program area and 33.6 in the control. Infant mortality rate was 25.7 in program area and 20.4 in the control. Risk of under-five mortality was higher in the neonatal period (HR 20.72 95% 8.64 – 49.65 p=0.001). Conclusion Improving child health status is complex and therefore investing into an integrated intervention yields best results. Given that the risk of all under-five was higher at the neonatal period, strengthening the health system to provide quality care is crucial.

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Spending on Health is a Complex Phenomenon in our Country

Annals of King Edward Medical University ◽

10.21649/akemu.v24is.2503 ◽

2018 ◽

Vol 24 (S) ◽

pp. 829-830

Author(s):

Sumair Anwar

Keyword(s):

Mortality Rate ◽

Neonatal Period ◽

Health Indicators ◽

Complex Phenomenon ◽

Live Births ◽

Under Five ◽

Under Five Children ◽

The Past

According to WHO statistics 2017, amongst health indicators of countries worldwide, Pakistan’s under five children mortality rate has been recorded up to 81.1 per 1000 live births, which is second highest in the list of SAARC countries.1 In Pakistan, over 57% of deaths under 5 years occur during the neonatal period (42 per 1000 live births) and have not changed over the past 6 years.2

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Infant and child health status ahead of implementation of an integrated intervention to improve nutrition and survival: a cross-sectional baseline assessment

BMC Nutrition ◽

10.1186/s40795-020-00372-5 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Emmanuel Nene Odjidja ◽

Sonia Hakizimana ◽

Ghislaine Gatasi ◽

Jean-Berchmans Masabo ◽

Gildas Irakoze ◽

...

Keyword(s):

Health Status ◽

Child Health ◽

Health Outcomes ◽

Acute Malnutrition ◽

Cross Sectional ◽

Live Births ◽

Under Five ◽

Child Health Outcomes ◽

Integrated Intervention ◽

Child Health Status

Abstract Background Burundi has one of the poorest child health outcomes in the world. With an acute malnutrition rate of 5% and a chronic malnutrition rate of 56%, under five death is 78 per 1000 live births and 47 children for every 1000 children will live until their first birthday. In response to this grim statistics, Village Health Works, a Burundian-American organisation has invested in an integrated clinical and community intervention model to improve child health outcomes. The aim of this study is to measure and report on child health indicator ahead of implementing this model. Methods A cross sectional design was employed, adopting the Demographic Health Survey methodology. We reached out to a sample of 952 households comprising of 2675 birth, in our study area. Mortality data was analysed with R package for mortality computation and other outcomes using SPSS. Principal component analysis was used to classify households into wealth quintiles. Logistic regression was used to assess strength of associations and significance of association was considered at 95% confidence level. Results The incidence of low birth weight (LBW) was 6.4% at the study area compared to 10% at the national level with the strongest predictor being malnourished women (OR 1.4 95%CI 1.2–7.2 p = 0.043). Fever incidence was higher in the study area (50.5%) in comparison to 39.5% nationally. Consumption of minimum acceptable diet was showed a significant protection against fever (OR 0.64 95%CI 0.41–0.94 p = 0.042). Global Acute Malnutrition rate was 7.6% and this significantly reduced with increasing age of child. Under-five mortality rate was 32.1 per 1000 live births and infant mortality was 25.7 per 1000 in the catchment with most deaths happening within the first 28 days of life (57.3%). Conclusion Improving child health status is complex, therefore, investing into an integrated intervention for both mother and child could yield best results. Given that most under-five deaths occurred in the neonatal period, implementing integrated clinical and community newborn care interventions are critical.

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Neonatal mortality and child health in a remote rural area in Nepal: a mixed methods study

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000519 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000519

Author(s):

Bindu Kumari Karki ◽

Guenter Kittel

Keyword(s):

Mixed Methods ◽

Mortality Rate ◽

Health Services ◽

Neonatal Mortality ◽

Rural Area ◽

Acute Lower Respiratory Infection ◽

Cultural Perceptions ◽

Live Births ◽

Under Five ◽

Remote Rural Area

ObjectiveTo assess neonatal and under-five mortality and the health situation for children in Dolpa, a remote rural area of Nepal.Study designMixed methods: quantitative (retrospective cross sectional) and qualitative (semistructured interviews).RationaleProgress in reducing child and newborn mortality in Nepal has reached the remote areas to a limited extent. Furthermore, there may be substantial under-reporting and data may be unreliable.Setting and participantsThe population of Dolpa district is approximately 35 000. We visited 10 randomly selected villages (plus one settlement) with approximately 12 000 inhabitants.MethodologyRecords of the number of deliveries, neonatal and under-five deaths were collected. 100 children (10 different villages) were evaluated for common diseases present during the month prior to the investigation. 20 interviews were conducted about the cultural perceptions of neonatal death and morbidity; in each village at least one interview was undertaken.ResultsThe population of the 10 villages (plus one settlement) under investigation was 12 287. 300 deliveries have taken place during the last 12 months before the study. There were 30 children reported to have died; out of those 20 were in the neonatal period. This reflects an estimated neonatal mortality rate in Dolpa district of 67/1000 live births (95% CI 41-101/1000) and an estimated under-five mortality rate of 100/1000 (95% CI 70-140/1000). In the previous month, out of 100 children surveyed there had been 11 cases of acute lower respiratory infection (ALRI), 7 cases of diarrhoea, 3 cases of isolated malnutrition and 5 cases of malnutrition combined with ALRI or diarrhoea.Based on qualitative interviews traditional beliefs still play a major role, and are partly a hindrance to progress in health. There is also mistrust in the health services and misconceptions about ‘modern’ medicine and treatment facilities.ConclusionDespite progress in child morbidity and mortality in Nepal, some areas remain underserved by health services and neonatal mortality is far above the Nepalese average, which is 29/1000 live births. There is a substantial need to increase and train health staff. Health promotion should be encouraged but cultural perceptions have to be understood if positive behavioural change is to be achieved.

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Child malnutrition and mortality in Swaziland: Situation analaysis of the immediate, underlying and basic causes

African Journal of Food, Agriculture, Nutrition and Development ◽

10.18697/ajfand.50.11710 ◽

2012 ◽

Vol 12 (50) ◽

pp. 5994-6006

Author(s):

SKS Masuku-Maseko ◽

◽

EE Owaga ◽

Keyword(s):

Health Care ◽

Mortality Rate ◽

Urban Areas ◽

Child Nutrition ◽

Child Malnutrition ◽

Live Births ◽

Under Five ◽

Childhood Malnutrition ◽

Under Five Children ◽

Depth Analysis

Malnutrition is a major confounding factor for child morbidity and mortality in developing countries. In Swaziland, about 31% of the under-five children are stunted in growth, where-as 1% and 6% are wasted and underweight, respectively. Hhohho region has the highest prevalence of underweight children (8.2%) relative to other regions such as Shiselweni (7.3%), Lubombo (6.7%) and Manzini (6.4%). The prevalence of infant and under-five children mortality rate (per 1,000 live births) are 85 and 102 deaths, respectively. Lubombo region has the highest cases of under-five mortality rate (deaths per 1,000 live births) of 115 when compared to rates in other regions, namely; Manzini (112), Shiselweni (100) and Hhohho (96). Despite the several child healthcare programmes, the problem of high child malnutrition places a significant hindrance towards the attainment of the Millennium Development Goals (MDG) 4 on reduction of child mortality. Potential determinants of childhood malnutrition and mortality in Swaziland can be categorized into three levels, namely: (a) immediate causes (inadequate dietary intake of protein, energy and micronutrients; diseases such as pneumonia, diarrhoeal diseases and HIV/AIDS, (b) underlying causes (inadequate access to food due to poverty and decline in food production; inadequate care of children and women, insufficient health services and unhealthy environment), and (c) basic causes (inadequate mother’s education and nutrition knowledge, insufficient human resources in child health care; inadequate policies on child nutrition and health care; inequitable distribution of household and national socioeconomic resources). This paper presents an in-depth analysis of the causal factors of childhood malnutrition and mortality in Swaziland, and further explores opportunities that could be adopted to address the malnutrition and mortality problem. It also aims to reinforce that in order to ensure effectiveness and sustainability of intervention programmes, there is need for multi-dimensional strategies and collaboration between all the stakeholders concerned with child nutrition, health and socio-economic development. However, the interventions must recognize the existing socio-economic differentials between the rural and urban areas, and the administrative regions.

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Association of maternal and child health related variables with decline in infant mortality rate in Punjab, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20175330 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4558

Author(s):

Harjot Kaur ◽

Tarundeep Singh ◽

PVM Lakshmi

Keyword(s):

Mortality Rate ◽

Child Health ◽

Infant Mortality ◽

Maternal And Child Health ◽

Health Indicators ◽

Infant Mortality Rate ◽

Rapid Decline ◽

Live Births ◽

Children Ever Born ◽

And Child Health

Background: Infant mortality rate (IMR) is a sensitive indicator for monitoring child health and survival. Punjab state in North India is performing better than most of the other states in various health indicators. Punjab’s IMR has shown a rapid decline from 38/1000 live births in 2008 (Sample registration system (SRS) 2008) to 24/1000 live births in 2014 (SRS 2014). This study was planned to assess which of the maternal and child health services is associated with rapid decline in infant mortality rate. Methods: Association between various components of prenatal care, intranatal care and postnatal care, and child healthcare and socio demographic variables (taken from secondary data of District Level Household Surveys) and Infant Mortality Rate (taken from SRS) of Punjab was studied. Spearman correlation coefficient was calculated to measure the association between the variables. Results: Total fertility rate (TFR), women who had institutional deliveries, safe deliveries and mean children ever born are statistically significantly associated with decline in infant mortality rate. Conclusions: In Punjab, maternal and child health indicators are directly or indirectly associated with decline in infant mortality rate. Findings of the study demonstrate that the recent rapid decline in IMR of Punjab is strongly associated with increase in institutional deliveries and decline in TFR and the mean number of children ever born.

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Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil

PLoS Medicine ◽

10.1371/journal.pmed.1003791 ◽

2021 ◽

Vol 18 (10) ◽

pp. e1003791

Author(s):

Enny S. Paixao ◽

Christian Bottomley ◽

Julia M. Pescarini ◽

Kerry L. M. Wong ◽

Luciana L. Cardim ◽

...

Keyword(s):

Mortality Rate ◽

Cesarean Delivery ◽

Child Mortality ◽

Neonatal Period ◽

Relative Rate ◽

Child Survival ◽

Routine Data ◽

Live Births ◽

Medical Indication ◽

Vaginal Deliveries

Background There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. Methods and findings We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. Conclusions In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.

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Statement on Infant Mortality

PEDIATRICS ◽

10.1542/peds.78.6.1155 ◽

1986 ◽

Vol 78 (6) ◽

pp. 1155-1160

Author(s):

Keyword(s):

Mortality Rate ◽

Child Health ◽

Infant Mortality ◽

Neonatal Mortality ◽

Mortality Rates ◽

First Year ◽

Postneonatal Mortality ◽

Factors Affecting ◽

Live Births ◽

First Year Of Life

Why Is Infant Mortality Important? Rates of infant mortality are sensitive indicators of a broad range of factors affecting children's health. As such, infant mortality is the "tip of the iceberg" of child health problems, and changes in infant mortality are a signal of factors affecting child health more broadly. In addition to its role as a general gauge of child health, infant mortality itself represents an important health problem. It is well to remember that infant death rates are the highest of any age group less than 65 years. The message conveyed by infant mortality rates if better understood in terms of the causes of mortality at different times during the first year of life. Neonatal Mortality Neonatal mortality rate is defined as the number of infants dying between 0 and 27 days of life per 1,000 live births. These deaths in the first month of life reflect primarily factors associated with health of the mother before and during pregnancy and the special problems of the newborn. Deaths in this age range result chiefly from inadequate intruterine growth (prematurity, intrauterine growth retardation) and congenital anomalies. As a result, neonatal mortality rates provide an indicator of the factors affecting pregnancy, delivery, and the neonate and the adequacy of services in the prenatal, intrapartum, and neonatal periods. Postneonatal Mortality Postneonatal mortality rate is defined as the number of infants dying between 28 days and 11 months of life per 1,000 live births, ie, deaths occurring during the remainder of the first year of life.

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Household factors and under-five mortality in Bankass, Mali: results from a cross-sectional survey

BMC Public Health ◽

10.1186/s12889-021-10242-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

David C. Boettiger ◽

Emily Treleaven ◽

Kassoum Kayentao ◽

Mahamadou Guindo ◽

Mama Coumaré ◽

...

Keyword(s):

Mortality Rate ◽

Reading Ability ◽

Cox Regression ◽

Household Wealth ◽

Reproductive Age ◽

Male Mortality ◽

Live Births ◽

Under Five ◽

Factors Associated ◽

Household Factors

Abstract Background Rural parts of Mali carry a disproportionate burden of the country’s high under-five mortality rate. A range of household factors are associated with poor under-five health in resource-limited settings. However, it is unknown which most influence the under-five mortality rate in rural Mali. We aimed to describe household factors associated with under-five mortality in Bankass, a remote region in central Mali. Methods We analysed baseline household survey data from a trial being conducted in Bankass. The survey was administered to households between December 2016 and January 2017. Under-five deaths in the five years prior to baseline were documented along with detailed information on household factors and women’s birth histories. Factors associated with under-five mortality were analysed using Cox regression. Results Our study population comprised of 17,408 under-five children from 8322 households. In the five years prior to baseline, the under-five mortality rate was 152.6 per 1000 live births (158.8 and 146.0 per 1000 live births for males and females, respectively). Living a greater distance from a primary health center was associated with a higher probability of under-five mortality for both males (adjusted hazard ratio [aHR] 1.53 for ≥10 km versus < 2 km, 95% confidence interval [CI] 1.25–1.88) and females (aHR 1.59 for ≥10 km versus < 2 km, 95% CI 1.27–1.99). Under-five male mortality was additionally associated with lower household wealth quintile (aHR 1.47 for poorest versus wealthiest, 95%CI 1.21–1.78), lower reading ability among women of reproductive age in the household (aHR 1.73 for cannot read versus can read, 95%CI 1.04–2.86), and living in a household with access to electricity (aHR 1.16 for access versus no access, 95%CI 1.00–1.34). Conclusions U5 mortality is very high in Bankass and is associated with living a greater distance from healthcare and several other household factors that may be amenable to intervention or facilitate program targeting.

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Under-five Mortality and Associated Factors among Children Born from 15-49 Years Old Mothers in Haramaya Town, Eastern Ethiopia

10.21203/rs.3.rs-799138/v2 ◽

2021 ◽

Author(s):

Mohammed Ahmed ◽

Melake Demena ◽

Zelalem Teklemariam ◽

Assefa Desalew ◽

Nega Assefa

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Mortality Rate ◽

Logistic Regression Analysis ◽

Associated Factors ◽

Household Size ◽

P Value ◽

Live Births ◽

Under Five ◽

Colostrum Feeding

Abstract Background: The global under-five mortality rate has dropped from almost 90 deaths per 1,000 live births in 1990 to 43 in 2015. The Ethiopian Mini Demographic Health Survey, 2019 shows 55 under-five deaths per 1,000 live births. In the eastern part of Ethiopia, evidence from the Kersa Health and Demographic Surveillance System in Kersa district of East Hararghe Zone, Oromia Region suggested the decline of under-five mortality rate from 131.8 per 1000 live births in 2008 to 77.4 per 1000 live births in 2013. The death rates still remain far from the Sustainable Development Goals’ target reduction to 25 or less per 1000 live births by 2030. However, the magnitude and determinants of under-five mortality is not studied in Haramaya town. Objective: To assess the under-five mortality rate and associated factors among children born during August 07, 2015- August 06, 2020 in Haramaya town, east Ethiopia by August 07–31/2020. Methodology: Quantitative cross-sectional population-based study was conducted on 391 pairs of 15-49 years old mothers and their live-born under-five children selected using systematic random sampling technique from Haramaya town to cmpare mortality between <=24 and >=25 mother’s age groups. Data were collected using interview-based questionnaire; double entered into EpiData 3.1; and then exported to statistical package for social sciences program version 20.0 for analysis. Binary logistic regression analysis (p-value <0.20) was performed to examine crude association of predictors with under-five mortality, and then multiple logistic regression analysis (p-value <0.05) to measure the statistical association. Results: The death of 28 out of 372 live births gave an under-five mortality rate of 75 per 1000 live births. Children born in households with less than 6 members had 7. 98 times higher odds of dying than those born in households with at least 6 members (AOR =7.98, 95% CI =1.59-40.17). Those children who did not feed colostrum were associated with 17.45 times increased risk of under-five deaths compared to colostrum-fed ones (AOR =17.45, 95% CI =6.54-46.55). Conclusion: The study suggests that 75 per 1000 live births die before celebrating their fifth birth day. Household size and colostrum feeding are the significantly associated factors.Recommendation: All concerned should inform the mothers the role of identified factors like household size and colostrum feeding in child survival.

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