scholarly journals Child deaths at National District Hospital, Free State: one a month is better than one a week

2017 ◽  
Vol 59 (3) ◽  
pp. 36
Author(s):  
H Brits
Keyword(s):  
Child Mortality ◽  
District Hospital ◽  
Integrated Management ◽  
Scale Up ◽  
Hiv Care ◽  
Treatment And Prevention ◽  
Child Deaths ◽  
Before And After ◽  
Development Goals ◽  
Mdg 4

Background: The United Nations set a two-thirds reduction in child mortality between 1990 and 2015 in the Millennium Development Goals (MDGs) of 2000. The National Department of Health (NDoH) introduced strategies to achieve these MDGs, which included new vaccines, better HIV care and training of healthcare workers. This study investigated whether the strategies implemented by the NDoH decreased child mortality (MDG 4) at National District Hospital (NDH). Method: A retrospective file review was done on all children that died in NDH from 2008 to 2015. Data were collected from patient files and ChildPIP data forms. Deaths before and after the implementation of the strategies were compared. Results: A total of 209 children died during the study period. The mortality rate decreased from 47 per thousand admissions and stabilised at 15 per thousand admissions for the past five years. Deaths due to acute gastroenteritis decreased from 67% of the total to less than 40%. Pneumonia as the main cause of death decreased from 44 during the 2008–2010 period to 19 during the 2011–2015 period. More than 90% of the children who died were malnourished. There was no statistically significant improvement in the malnutrition rates during the study periods (p = 0.85). Conclusion: Child deaths decreased from one a week to one a month at NDH. Strategies to meet the MDG 4 targets, like the introduction of the Rotavirus and Pneumococcal vaccine, the scale-up of anti-retroviral treatment and Prevention of Mother to Child transmission of HIV and better Integrated Management of Childhood Illness training all contributed to the better outcome. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1317991

Impact of mass distribution of long-lasting insecticidal nets (LLINs) in Mozambique, 2011 to 2025: Retrospective and prospective modeling of child mortality and lives saved

2020 ◽  
Author(s):  
Erica A Wetzler ◽  
Jorge A.H. Arroz ◽  
Chulwoo Park ◽  
Marta Chande ◽  
Figueiredo Mussambala ◽  
...  
Keyword(s):  
Child Mortality ◽  
Scale Up ◽  
Universal Coverage ◽  
Population Based ◽  
Distribution Model ◽  
Neonatal Deaths ◽  
Registration Data ◽  
Child Deaths ◽  
Llin Distribution ◽  
Long Lasting Insecticidal Nets

Abstract Background Malaria was the leading cause of post-neonatal deaths in Mozambique in 2017. The use of long-lasting insecticidal nets (LLINs) is recognized as one of the most effective ways to reduce malaria morbidity and mortality, especially in children. In 2015, Mozambique committed to the expansion of LLIN coverage nationwide, culminating in the first countrywide campaign in 2017, reaching 95% of registered households. Between 2012 and 2019, more than 34 million LLINs were distributed. No previous analyses have estimated changes in mortality attributable to the scale-up of LLINs, accounting for provincial differences in mortality rates and coverage of health interventions. Methods From 2012 to 2020, the population-based model NetCALC was used to predict provincial household LLIN coverage based upon the number of LLINs distributed annually. NetCALC also projected how many LLINs are needed to maintain universal coverage in 10 provinces from 2021 to 2025. Based upon the annual provincial coverage of LLINs, the Lives Saved Tool (LiST), a multi-cause mathematical model, estimated under-5 lives saved, and reductions in under-5 mortality attributable to LLIN expansion in 10 provinces of Mozambique between 2012 and 2020, and projected lives saved from 2021 to 2025 if universal coverage of LLINs is sustained. Results Results from the LiST models estimate that 64,470 child deaths were averted between 2012 and 2019. If currently planned quantities of LLINs are distributed in 2020, and universal coverage is maintained from 2021 to 2025, an additional 68,695 child deaths could be averted. From 2011 to 2020, the percent reduction in all-cause child mortality was 19.2%, from 114.5 per 1,000 to 93.2 per 1000 in the LLIN distribution model compared to 9.5% in the baseline model. If universal coverage continues through 2025, this reduction will be sustained. Conclusions LiST and NetCALC used together are useful in estimating lives saved and mortality in countries such as Mozambique where vital registration data to measure changes in mortality are not consistently available. Universal coverage of LLINs can save a substantial number of child lives and reduce child mortality in Mozambique but will require resource mobilization. Without continued investment, thousands of avoidable child deaths will occur.

Positive Strategies in Achieving Health for All Children: An Equity Framework and Its Effect on Research Design and Education

2018 ◽  
pp. 43-60
Author(s):  
Renee Sharma ◽  
Jai K. Das ◽  
Zulfiqar A. Bhutta
Keyword(s):  
Mortality Rate ◽  
Maternal Mortality ◽  
Child Mortality ◽  
Millennium Development Goals ◽  
Maternal Mortality Ratio ◽  
Effective Interventions ◽  
Mortality Ratio ◽  
Development Goals ◽  
Sub Saharan ◽  
Mdg 4

The United Nations Millennium Development Goals (MDGs) adopted by world leaders in 2000 aimed to address some of the most pressing global issues of our times: extreme poverty, unequal health, and inequities in development. The MDGs, a set of interrelated targets to be met by 2015, catalyzed political commitment toward improving child survival and maternal health. Millennium Development Goals 4 and 5 called for a two-thirds reduction in the younger-than-5 child mortality rate and a three-quarters reduction in the maternal mortality ratio, respectively, from 1990 base figures.1 Although concerted global efforts have led to substantial reductions in maternal and child mortality over the past 25 years, MDG 4 and 5 targets have not been fully realized. Only 62 of the 195 countries with available estimates achieved the MDG 4 target, of which 24 were low-income and lower-middle–income countries.2 Only 2 regions, East Asia and the Pacific (69% reduction) and Latin America and the Caribbean (67% reduction), met the target at a regional level.2 For MDG 5, of the 95 countries that had a maternal mortality ratio of more than 100 in 1990, only 9 achieved the target for reduction in maternal mortality: Bhutan, Cambodia, Cape Verde, Iran, Laos, Maldives, Mongolia, Rwanda, and Timor-Leste.3 As we celebrate the fact that the global younger-than-5 mortality rate and maternal mortality ratio have fallen by 53% and 43.9%, respectively, since 1990, we also face the sobering reality that high numbers of women and children are still dying every year, largely due to conditions that could have been prevented or treated if existing cost-effective interventions were universally available.2–4 The burden of mortality also remains unevenly distributed, with the largest numbers and highest rates of maternal and younger-than-5 deaths concentrated in countries of sub-Saharan Africa and South Asia, especially in lower-income countries and among fragile states, especially those with ongoing conflict.2,3,5 2015 marked the end of the MDG era and the beginning of a new global framework, the Sustainable Development Goals (SDGs). This new framework presents an opportunity to leverage the momentum built over recent decades to tackle global inequities in maternal and child health. Of these SDGs, goal 3 also calls for an end to preventable deaths of newborns and children younger than 5 years, as well as a reduction in maternal mortality to less than 70 per 100,000 live births, by 2030.6 Achieving this target would require overcoming barriers and inequities in access to quality health services and, thus, implementing strategies to reach all mothers and children, including those who are most vulnerable, remote, and at risk. In this chapter, we discuss the current burden of younger-than-5 and maternal mortality, barriers contributing to health inequities, and, finally, evidence-based strategies to bridge these gaps.

Region of Birth and Child Mortality among Black Migrants to South Africa: Is there a foreign-born advantage?

2016 ◽  
Vol 13 (3) ◽  
pp. 359-376 ◽  
Author(s):  
Tiffany L Green ◽  
Amos C Peters
Keyword(s):  
South Africa ◽  
South African ◽  
Child Mortality ◽  
Southern Africa ◽  
Strong Relationship ◽  
Developed Countries ◽  
Black Immigrants ◽  
Foreign Born ◽  
Region Of Origin ◽  
Child Deaths

Much of the existing evidence for the healthy immigrant advantage comes from developed countries. We investigate whether an immigrant health advantage exists in South Africa, an important emerging economy.  Using the 2001 South African Census, this study examines differences in child mortality between native-born South African and immigrant blacks.  We find that accounting for region of origin is critical: immigrants from southern Africa are more likely to experience higher lifetime child mortality compared to the native-born population.  Further, immigrants from outside of southern Africa are less likely than both groups to experience child deaths.  Finally, in contrast to patterns observed in developed countries, we detect a strong relationship between schooling and child mortality among black immigrants.

scholarly journals Integrated TB and HIV care for Mozambican children: temporal trends, site-level determinants of performance, and recommendations for improved TB preventive treatment

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
W. Chris Buck ◽  
Hanh Nguyen ◽  
Mariana Siapka ◽  
Lopa Basu ◽  
Jessica Greenberg Cowan ◽  
...  
Keyword(s):  
Temporal Trends ◽  
Scale Up ◽  
Preventive Treatment ◽  
Preventive Therapy ◽  
Pediatric Hiv ◽  
Hiv Care ◽  
Pediatric Care ◽  
P Value ◽  
Missed Opportunities ◽  
Art Initiation

Abstract Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. Methods A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0–14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. Results Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001). Conclusions Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed.

scholarly journals Newborns and Under-5 Mortality in Ethiopia: The Necessity to Revitalize Partnership in Post-COVID-19 Era to Meet the SDG Targets

2021 ◽  
Vol 12 ◽  
pp. 215013272199688
Author(s):  
Yonas Getaye Tefera ◽  
Asnakew Achaw Ayele
Keyword(s):  
Child Mortality ◽  
Millennium Development Goals ◽  
Sustainable Development Goals ◽  
National Plan ◽  
Health Targets ◽  
The Sustainable Development ◽  
Live Births ◽  
Mortality Estimation ◽  
Development Goals ◽  
Children Under 5

The Sustainable Development Goals (SDGs) were adopted during the United Nations meeting in 2015 to succeed Millennium Development Goals. Among the health targets, SDG 3.2 is to end preventable deaths of newborns and children under 5 years of age by 2030. These 2 targets aim to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. Ethiopia is demonstrating a great reduction in child mortality since 2000. In the 2019 child mortality estimation which is nearly 5 years after SDGs adoption, Ethiopia’s progress toward reducing the newborns and under-5 mortality lie at 27 and 50.7 per 1000 live births, respectively. The generous financial and technical support from the global partners have helped to achieve such a significant reduction. Nevertheless, the SDG targets for newborns and under-5 mortality reduction are neither attained yet nor met the national plan to achieve by the end of 2019/2020. The partnership dynamics during COVID-19 crisis and the pandemic itself may also be taken as an opportunity to draw lessons and spur efforts to achieve SDG targets. This urges the need to reaffirm a comprehensive partnership and realignment with other interconnected development goals. Therefore, collective efforts with strong partnerships are required to improve the determinants of child health and achieving SDG target reduction until 2030.

scholarly journals Oral rehydration therapies in Senegal, Mali, and Sierra Leone: a spatial analysis of changes over time and implications for policy

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Kirsten E. Wiens ◽  
Lauren E. Schaeffer ◽  
Samba O. Sow ◽  
Babacar Ndoye ◽  
Carrie Jo Cain ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Healthcare Access ◽  
Scale Up ◽  
National Policy ◽  
Geostatistical Model ◽  
Oral Rehydration ◽  
Severe Diarrhea ◽  
Before And After ◽  
Changes Over Time ◽  
Over Time

Abstract Background Oral rehydration solution (ORS) is a simple intervention that can prevent childhood deaths from severe diarrhea and dehydration. In a previous study, we mapped the use of ORS treatment subnationally and found that ORS coverage increased over time, while the use of home-made alternatives or recommended home fluids (RHF) decreased, in many countries. These patterns were particularly striking within Senegal, Mali, and Sierra Leone. It was unclear, however, whether ORS replaced RHF in these locations or if children were left untreated, and if these patterns were associated with health policy changes. Methods We used a Bayesian geostatistical model and data from household surveys to map the percentage of children with diarrhea that received (1) any ORS, (2) only RHF, or (3) no oral rehydration treatment between 2000 and 2018. This approach allowed examination of whether RHF was replaced with ORS before and after interventions, policies, and external events that may have impacted healthcare access. Results We found that RHF was replaced with ORS in most Sierra Leone districts, except those most impacted by the Ebola outbreak. In addition, RHF was replaced in northern but not in southern Mali, and RHF was not replaced anywhere in Senegal. In Senegal, there was no statistical evidence that a national policy promoting ORS use was associated with increases in coverage. In Sierra Leone, ORS coverage increased following a national policy change that abolished health costs for children. Conclusions Children in parts of Mali and Senegal have been left behind during ORS scale-up. Improved messaging on effective diarrhea treatment and/or increased ORS access such as through reducing treatment costs may be needed to prevent child deaths in these areas.

scholarly journals South–south collaboration in scale-up of HIV care: building human capacity for care

AIDS ◽  
2010 ◽  
Vol 24 (Suppl 1) ◽  
pp. S73-S78 ◽  
Author(s):  
Louise C Ivers ◽  
Joia S Mukherjee ◽  
Fernet R Leandre ◽  
Jonas Rigodon ◽  
Kimberly A Cullen ◽  
...  
Keyword(s):  
Scale Up ◽  
Hiv Care ◽  
Human Capacity

scholarly journals ‘Oh, she is just a nurse’ Re-imagining the role of the nursing workforce in Uganda after a decade of ART scale-up (2004-2014)

2020 ◽  
Author(s):  
Henry Zakumumpa
Keyword(s):  
Mixed Methods ◽  
Disease Management ◽  
Scale Up ◽  
Task Shifting ◽  
Health Facilities ◽  
Hiv Care ◽  
Scope Of Practice ◽  
Nursing Workforce ◽  
Hiv Disease

Abstract Background The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the international year of the nurse and midwife, we set out to describe how the role of nurses had expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up between 2004 and 2014.Methods A mixed-methods study was conducted in two phases. Phase One entailed a cross-sectional health facility survey (n=195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase Two entailed qualitative case-studies of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). We adopted a qualitatively-led mixed methods approach whereby core thematic analyses were supported by descriptive statistics.Results We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most of nurse-led HIV clinics were based in rural settings although this trend was fairly even across all settings (rural/urban/peri-urban). A number of health facilities in our sample (n=36) deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to doctors to nurses in which the latter handled patients who were stable on ART.Conclusion Overall, our study reveals a wide expansion in the scope-of-practice of nurses during the initial ART scale-up phase in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of medical doctors. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope of practice in Uganda such as the need for evolving a policy on task shifting which is currently lacking in Uganda.

scholarly journals Features of the course and treatment of chronic catarrhal gingivitis in dogs

2020 ◽  
Vol 22 (100) ◽  
pp. 71-77
Author(s):  
N. M. Khomyn ◽  
A. R. Mysak ◽  
S. V. Tsisinska ◽  
V. V. Pritsak ◽  
N. V. Nazaruk ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Periodontal Disease ◽  
Mucous Membrane ◽  
Inflammatory Process ◽  
Recovery Period ◽  
Control Group ◽  
Treatment And Prevention ◽  
Before And After ◽  
Medicinal Substances ◽  
Effective Treatment Regimen

Periodontal disease is known to be the most common and serious health problem in dogs today. Despite the rather large arsenal of medicinal substances, the problem of treatment and prevention of periodontal disease remains relevant. Based on this, the purpose of the work was to study the features of chronic catarrhal gingivitis and to develop an effective treatment regimen for dentistically ill dogs. For research, two groups of animals with chronic catarrhal gingivitis were formed in 5 dogs in each (control and experimental), selected on the principle of analogues in terms of age, character and localization of the inflammatory process. Animals of the control and experimental groups were performed tartar removal, irrigation of the oral cavity with water and drying of the mucosa with a sterile gauze swab. Dogs of the control group on the mucous membrane was applied 1 ml of septogel 2 times a day, and the experimental – argumentistin 2 times a day. Before and after the procedures on the mucous membrane was applied a 3 % solution of hydrogen peroxide. It was determined the prevalence of dental disease in dogs, the influence of microflora on the condition of the oral cavity of dogs with chronic catarrhal gingivitis, the clinical condition and the main indices and samples were studied, reflecting the intensity of the inflammatory process in the gums of sick dogs and was developed a method of treatment. The results of researches have shown that the use of argumentistin in the complex treatment of dogs with chronic catarrhal gingivitis helps to reduce the recovery period by 5 days.

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