Child Health and Mortality in Sub-Saharan Africa: Trends, Causes, and Forecasts

2019 ◽  
Vol 69 (Supplement_4) ◽  
pp. S262-S273 ◽  
Author(s):  
Navit T Salzberg ◽  
Kasthuri Sivalogan ◽  
Quique Bassat ◽  
Allan W Taylor ◽  
Sunday Adedini ◽  
...  

Abstract Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through comprehensive mortality surveillance, utilizing minimally invasive tissue sampling (MITS), postmortem laboratory and pathology testing, verbal autopsy, and clinical and demographic data. CHAMPS sites have established facility- and community-based mortality notification systems, which aim to report potentially eligible deaths, defined as under-5 deaths and stillbirths within a defined catchment area, within 24–36 hours so that MITS can be conducted quickly after death. Where MITS has been conducted, a final cause of death is determined by an expert review panel. Data on cause of death will be provided to local, national, and global stakeholders to inform strategies to reduce perinatal and childhood mortality in sub-Saharan Africa and South Asia.


2016 ◽  
Vol 3 (2) ◽  
pp. 150460 ◽  
Author(s):  
Caroline Uggla ◽  
Ruth Mace

Parents face trade-offs between investing in child health and other fitness enhancing activities. In humans, parental investment theory has mostly been examined through the analysis of differential child outcomes, with less emphasis on the actions parents take to further a particular offspring’s condition. Here, we make use of household data on health-seeking for children in a high mortality context where such behaviours are crucial for offspring survival. Using Demographic and Health Survey (DHS) data from 17 sub-Saharan African countries, we examine whether maternal factors (age, health, marital status) and child factors (birth order, health, sex, age) independently influence parental investment in health-seeking behaviours: two preventative behaviours (malaria net use and immunization) and two curative ones (treating fever and diarrhoea). Results indicate that children with lower birth order, older mothers and mothers with better health status have higher odds of investment. The effects of a child’s sex and health status and whether the mother is polygynously married vary depending on the type of health-seeking behaviour (preventative versus curative). We discuss how these results square with predictions from parental investment theory pertaining to the state of mothers and children, and reflect on some potential mechanisms and directions for future research.


2005 ◽  
Vol 3 (1) ◽  
Author(s):  
George H Swingler ◽  
James H Irlam ◽  
William M Macharia ◽  
Félix Tietche ◽  
Martin M Meremikwu

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Daniella Watson ◽  
Sarah H Kehoe ◽  
Agnes Erzse ◽  
Adélaïde Compaoré ◽  
Cornelius Debpuur ◽  
...  

Abstract Objective: To explore community perceptions on maternal and child nutrition issues in Sub-Saharan Africa. Design: Thirty focus groups with men and women from three communities facilitated by local researchers. Setting: One urban (Soweto, South Africa) and two rural settings (Navrongo, Ghana and Nanoro, Burkina Faso) at different stages of economic transition. Participants: Two hundred thirty-seven men and women aged 18–55 years, mostly subsistence farmers in Navrongo and Nanoro and low income in Soweto. Results: Differences in community concerns about maternal and child health and nutrition reflected the transitional stage of the country. Community priorities revolved around poor nutrition and hunger caused by poverty, lack of economic opportunity and traditional gender roles. Men and women felt they had limited control over food and other resources. Women wanted men to take more responsibility for domestic chores, including food provision, while men wanted more involvement in their families but felt unable to provide for them. Solutions suggested focusing on ways of increasing control over economic production, family life and domestic food supplies. Rural communities sought agricultural support, while the urban community wanted regulation of the food environment. Conclusions: To be acceptable and effective, interventions to improve maternal and child nutrition need to take account of communities’ perceptions of their needs and address wider determinants of nutritional status and differences in access to food reflecting the stage of the country’s economic transition. Findings suggest that education and knowledge are necessary but not sufficient to support improvements in women’s and children’s nutritional status.


Parasitology ◽  
2008 ◽  
Vol 135 (12) ◽  
pp. 1447-1455 ◽  
Author(s):  
J. R. STOTHARD ◽  
E. IMISON ◽  
M. D. FRENCH ◽  
J. C. SOUSA-FIGUEIREDO ◽  
I. S. KHAMIS ◽  
...  

SUMMARYSoil-transmitted helminthiasis (STH) is a scourge to the health and well-being of infants and pre-schoolchildren throughout many parts of sub-Saharan Africa. To improve maternal and child health, regular de-worming is recommended and often delivered from mother and child health (MCH) clinics, yet there have been few studies monitoring the progress and impact of interventions on local levels of disease. A cross-sectional parasitological survey, supplemented with questionnaires, was therefore conducted across 10 Ungujan villages examining mothers (n=322) and their pre-school children (n=359). Within children, mean prevalence of ascariasis, trichuriasis and hookworm was 8·6% (95% CI 5·5–11·8), 18·9% (95% CI 14·5–23·4) and 1·7% (95% CI 0·2–3·5) while in mothers mean prevalence was 6·7% (95% CI 3·7–9·7), 11·9% (95% CI 8·0–15·8) and 1·9% (95% CI 0·2–3·5), respectively. There was, however, significant spatial heterogeneity of STH by village, 2 villages having much elevated levels of infection, although general access to anthelminthics and utilization of village MCH clinics was good. Levels of parasite aggregation (k) were determined and a multilevel logistic regression model identified access to a household latrine [OR=0·56 (95% CI 0·32–0·99)] and having an infected household member [OR=3·72 (95% CI 2·22–6·26)] as observed risk factors. To further investigate worm burdens of Ascaris lumbricoides, adult worms were expelled using Combantrin® and measured. A negative relationship between mean worm burden and mean worm mass was found. Villages in the north of Unguja represent locations where there is elevated prevalence of both ascariasis and trichuriasis and it appears that local factors are particularly favourable for transmission of these helminths. From a perspective of control, in such locations, intervention efforts should be stepped up and greater efforts placed upon improving household sanitation.


2020 ◽  
Vol 17 (S1) ◽  
Author(s):  
Meriel Flint-O’Kane ◽  
◽  
Peter von Dadelszen ◽  
Prestige Tatenda Makanga ◽  
Esperança Sevene ◽  
...  

PLoS Medicine ◽  
2020 ◽  
Vol 17 (3) ◽  
pp. e1003055 ◽  
Author(s):  
Lucy S. Tusting ◽  
Peter W. Gething ◽  
Harry S. Gibson ◽  
Brian Greenwood ◽  
Jakob Knudsen ◽  
...  

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035580
Author(s):  
Christmal Dela Christmals ◽  
Susan J Armstrong

ObjectivesThe implementation of advanced practice nursing (APN) programmes in sub-Saharan Africa (SSA) has been difficult due to lack of SSA-specific curriculum frameworks or benchmarks to guide institutions in developing and implementing APN programmes. A few APN programmes in SSA were benchmarked on western philosophy and materials, making local ownership and sustainability challenging. This paper presents an SSA-specific concept-based APN (Child Health Nurse Practitioner, CHNP) curriculum framework developed to guide institutions in developing relevant and responsive APN curricula in order to qualify CHNP and contribute to a decreased incidence of preventable deaths of children in the SSA region.DesignA sequential multimethod study design consisting of a scoping review, Delphi study, development of a framework by a curriculum team, and evaluation of the curriculum framework by faculty from 15 universities in SSA.SettingThis study included universities from East, West, Central and Southern Africa.ParticipantsThe study included international multidisciplinary health professionals and curriculum development experts from 15 universities in 10 SSA countries.ResultsA concept-based Advanced CHNP curriculum framework was developed. The faculty who evaluated the curriculum framework for applicability within their institutions and the SSA context unanimously stated that the framework is detailed, evidenced-based and could be adapted for other APN specialty areas.ConclusionThe Child Health Nurse Practitioner curriculum framework is comprehensive, context-specific and has the potential to respond to the special child healthcare needs of SSA. It is adaptable for other APN specialty programmes in SSA. Nursing leaders should lobby for funding and advocate for the introduction of the CHNP programme as a collaborative process between government, clinical services, communities and educational institutions.


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