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Subramanian SV, Kumar A, Pullum TW, Ambade M, Rajpal S, Kim R. Early-Neonatal, Late-Neonatal, Postneonatal, and Child Mortality Rates Across India, 1993-2021. JAMA Netw Open 2024; 7:e2410046. [PMID: 38728034 PMCID: PMC11087840 DOI: 10.1001/jamanetworkopen.2024.10046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/06/2024] [Indexed: 05/12/2024] Open
Abstract
Importance The global success of the child survival agenda depends on how rapidly mortality at early ages after birth declines in India, and changes need to be monitored to evaluate the status. Objective To understand the disaggregated patterns of decrease in early-life mortality across states and union territories (UTs) of India. Design, Setting, and Participants Repeated cross-sectional data from the 5 rounds of the National Family Health Survey conducted in 1992-1993, 1998-1999, 2005-2006, 2015-2016, and 2019-2021 were used in a representative population-based study. The study was based on data of children born in the past 5 years with complete information on date of birth and age at death. The analysis was conducted in February 2024. Exposure Time and geographic units. Main Outcomes and Measures Mortality rates were computed for 4 early-life periods: early-neonatal (first 7 days), late-neonatal (8-28 days), postneonatal (29 days to 11 months), and child (12-59 months). For early and late neonatal periods, the rates are expressed as deaths per 1000 live births, for postneonatal, as deaths per 1000 children aged at least 29 days and for child, deaths per 1000 children aged at least 1 year. These are collectively mentioned as deaths per 1000 for all mortalities. The relative burden of each of the age-specific mortalities to total mortality in children younger than 5 years was also computed. Results The final analytical sample included 33 667 (1993), 29 549 (1999), 23 020 (2006), 82 294 (2016), and 64 242 (2021) children who died before their fifth birthday in the past 5 years of each survey. Mortality rates were lowest for the late-neonatal and child periods; early-neonatal was the highest in 2021. Child mortality experienced the most substantial decrease between 1993 and 2021, from 33.5 to 6.9 deaths per 1000, accompanied by a substantial reduction in interstate inequalities. While early-neonatal (from 33.5 to 20.3 deaths per 1000), late-neonatal (from 14.1 to 4.1 deaths per 1000), and postneonatal (from 31.0 to 10.8 deaths per 1000) mortality also decreased, interstate inequalities remained notable. The mortality burden shifted over time and is now concentrated during the early-neonatal (48.3% of total deaths in children younger than 5 years) and postneonatal (25.6%) periods. A stagnation or worsening for certain states and UTs was observed from 2016 to 2021 for early-neonatal, late-neonatal, and postneonatal mortality. If this pattern continues, these states and UTs will not meet the United Nations Sustainable Development Goal targets related to child survival. Conclusions and Relevance In this repeated cross-sectional study of 5 time periods, the decrease in mortality during early-neonatal and postneonatal phases of mortality was relatively slower, with notable variations across states and UTs. The findings suggest that policies pertaining to early-neonatal and postneonatal mortalities need to be prioritized and targeting of policies and interventions needs to be context-specific.
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Affiliation(s)
- S. V. Subramanian
- Harvard Center for Population and Development Studies, Boston, Massachusetts
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Akhil Kumar
- Faculty of Arts and Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Thomas W. Pullum
- The Demographic and Health Surveys Program, ICF
- Department of Sociology, University of Texas, Austin
| | - Mayanka Ambade
- Indian Institute of Technology, Mandi, Himachal Pradesh, India
| | - Sunil Rajpal
- Department of Economics, FLAME University, Pune, India
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, South Korea
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea
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Chiumia FK, Chithope-Mwale C, Abikoloni F, Matchaya V, Gaviyawo T, Khuluza F. Availability, pricing, and affordability of essential medicines for pediatric population in Malawi. Front Pharmacol 2024; 15:1379250. [PMID: 38666031 PMCID: PMC11043549 DOI: 10.3389/fphar.2024.1379250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Objective Lack of access to essential medicines negatively impacts on the quality of healthcare delivery and increases morbidity and mortality, especially to the vulnerable pediatric population. We assessed the availability, pricing, and affordability of pediatric formulations in Malawi. Methodology The study was conducted in 76 health facilities (public, faith-based and private pharmacies, and clinics) from the northern and southern regions of Malawi from March to May 2023. We adapted the WHO/HAI method for the assessment of both availability and pricing of medicines. Data on availability were collected from stock card records using a WHO/HAI template and medicine prices were provided by the pharmacy personnel who were managing the facilities. Availability of medicines was calculated as the percentage of facilities which had a stock of the respective medicine at the time of data collection while medicine prices was assessed by calculating the median prices of each medicine. To assess the affordability of the medicines, we calculated the number of days it takes for a person who is receiving the government-set minimum wage to work to pay for a treatment course of common indications. The study was approved by the KUHES ethics committee under the numbers U.12/22/3900 and U.12/22/3903. Results and conclusion The overall availability of pediatric medicines was 38.1% for public health facilities, 53.7% for private retail pharmacies and drug stores, 49.5% for private clinics and 48.3% for Christian Health Association of Malawi (CHAM) facilities. We found the illegal availability of prescription-only medicines of up to 54% in medicine stores. Medicine median prices were higher in the private clinics followed by retail pharmacies and drugs stores. CHAM had the lowest median prices for medicines of all the sectors. More than 50% of medicines were found to be affordable as less than a day's wage was required to purchase the treatment. We found poor availability of pediatric formulation among public, CHAM, and private sectors in Malawi. This may affect the quality of care among pediatric patients and therefore contribute to morbidity and mortality in Malawi. The supply of medicines and health commodities needs to consider needs of special populations such as children to achieve universal health coverage.
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Affiliation(s)
| | | | | | | | | | - Felix Khuluza
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
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Zein MM, Arafa N, El-Shabrawi MHF, El-Koofy NM. Effect of nutrition-related infodemics and social media on maternal experience: A nationwide survey in a low/middle income country. World J Clin Pediatr 2024; 13:89139. [PMID: 38596445 PMCID: PMC11000056 DOI: 10.5409/wjcp.v13.i1.89139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/29/2023] [Accepted: 02/18/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Undernutrition is a crucial cause of morbidity and mortality among children in low- or middle-income countries (LMICs). A better understanding of maternal general healthy nutrition knowledge, as well as misbeliefs, is highly essential, especially in such settings. In the current era of infodemics, it is very strenuous for mothers to select not only the right source for maternal nutrition information but the correct information as well. AIM To assess maternal healthy nutritional knowledge and nutrition-related misbeliefs and misinformation in an LMIC, and to determine the sources of such information and their assessment methods. METHODS This cross-sectional analytical observational study enrolled 5148 randomly selected Egyptian mothers who had one or more children less than 15 years old. The data were collected through online questionnaire forms: One was for the general nutrition knowledge assessment, and the other was for the nutritional myth score. Sources of information and ways of evaluating internet sources using the Currency, Relevance, Authority, Accuracy, and Purpose test were additionally analyzed. RESULTS The mean general nutrition knowledge score was 29 ± 9, with a percent score of 70.8% ± 12.1% (total score: 41). The median myth score was 9 (interquartile range: 6, 12; total score: 18). The primary sources of nutrition knowledge for the enrolled mothers were social media platforms (55%). Half of the mothers managed information for currency and authority, except for considering the author's contact information. More than 60% regularly checked information for accuracy and purpose. The mothers with significant nutrition knowledge checked periodically for the author's contact information (P = 0.012). The nutrition myth score was significantly lower among mothers who periodically checked the evidence of the information (P = 0.016). Mothers dependent on their healthcare providers as the primary source of their general nutritional knowledge were less likely to hold myths by 13% (P = 0.044). However, using social media increased the likelihood of having myths among mothers by approximately 1.2 (P = 0.001). CONCLUSION Social media platforms were found to be the primary source of maternal nutrition information in the current era of infodemics. However, healthcare providers were the only source for decreasing the incidence of maternal myths among the surveyed mothers.
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Affiliation(s)
- Marwa M Zein
- Department of Public Health and Community Medicine, Cairo University, Cairo 515211, Egypt
| | - Noha Arafa
- Department of Pediatric Endocrinology and Diabetes, Children's Hospital, Kasralainy Medical School, Cairo University, Cairo 515211, Egypt
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Laillou A, Nanama S, Hussen A, Ntambi J, Baye K. Should we prioritise children 6-23 months of age for vitamin A supplementation? Case study of West and Central Africa. BMJ Nutr Prev Health 2024; 7:88-94. [PMID: 38966108 PMCID: PMC11221273 DOI: 10.1136/bmjnph-2023-000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/23/2024] [Indexed: 07/06/2024] Open
Abstract
Background Vitamin A (VA) supplementation has been associated with reductions of all-cause child mortality. Child mortality amenable to VA, particularly related to infectious diseases, may be age dependent; hence, the beneficial effect of VA supplementation may differ between younger and older children. We aimed to estimate the all-cause child mortality disaggregated by younger and older than 2 years of age and estimate the contribution of VA supplementation in preventing child death in West and Central Africa. Methods Using the most recent (post-2010) cross-sectional Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we analysed child-level data (n=187 651) from 20 West and Central African countries. Age-specific (all-cause) mortality rates were estimated using survival analyses. Age-specific VA supplementation coverage was linked with the age-specific all-cause child mortality to estimate the contribution of the supplementation in averting child death. Results The cost per averted child death was also estimated using an average cost of US$1.2/child and VA supplementation coverage which ranged from 14% in Cote d'Ivoire to 81% in the Gambia. About 75% of the under-5 mortality occurred in the first 2 years of life. The share of excess (all-cause) mortality averted by VA supplementation was significantly higher in the first 2 years of life. A mean reduction of 7.1 deaths/1000 live births was estimated for children 6-23 months, compared to a reduction of 2.5 deaths/1000 live births for older children (24-59 months). The mean cost/averted child death for the 20 countries was 2.8 times lower for the 6-23 than the 24-59 months age group. Conclusion Prioritising VA supplementation for children in the first 2 years of life could be more cost-effective than when implemented among 6-59 months of age.
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Affiliation(s)
- Arnaud Laillou
- Nutrition Section, UNICEF West and Central Africa Region, Dakar, Senegal
| | - Simeon Nanama
- Nutrition Section, UNICEF West and Central Africa Region, Dakar, Senegal
| | - Alemayehu Hussen
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - John Ntambi
- Nutrition Section, UNICEF West and Central Africa Region, Dakar, Senegal
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Research Center for Inclusive Development in Africa, Addis Ababa, Ethiopia
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Karlsson O, Kim R, Moloney GM, Hasman A, Subramanian SV. Patterns in child stunting by age: A cross-sectional study of 94 low- and middle-income countries. MATERNAL & CHILD NUTRITION 2023; 19:e13537. [PMID: 37276243 PMCID: PMC10483943 DOI: 10.1111/mcn.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Abstract
Child stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidity and cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0-59 months old in 94 low- and middle-income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age-presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months-presumably mostly due to further adverse exposures being less detrimental for older children, and catch-up growth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standards and sex. Poorer countries and households had a higher prevalence at all ages and a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch-up growth may be achieved after age 2, screening around this time can be beneficial.
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Affiliation(s)
- Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMassachusettsUSA
- Department of Economic History, School of Economics and ManagementLund UniversityLundSweden
| | - Rockli Kim
- Division of Health Policy & Management, College of Health ScienceKorea UniversitySeoulKorea
- Harvard Center for Population and Development StudiesCambridgeMassachusettsUSA
| | - Grainne M. Moloney
- Nutrition Section, United Nations Children's Fund (UNICEF), Kenya Country OfficeUN Complex GigiriNairobiKenya
| | | | - S. V. Subramanian
- Harvard Center for Population and Development StudiesCambridgeMassachusettsUSA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public HealthHarvard UniversityBostonMassachusettsUSA
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Bolarinwa OA, Hajjar JM, Alawode OA, Ajayi KV, Roberts AT, Yaya S. Multiple high-risk fertility behaviours and children under five mortality survivors among ever-married women of reproductive age in Nigeria. Arch Public Health 2023; 81:175. [PMID: 37759256 PMCID: PMC10523755 DOI: 10.1186/s13690-023-01192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Multiple high-risk fertility behaviours (MHRFBs), including maternal age < 18 or > 34 years old, a birth order 4+, and birth spacing < 24 months, can directly or indirectly affect survival outcomes among under-five children. There is a dearth of available information and data about these two phenomena in Nigeria. Thus, this study evaluates the prevalence of MHRFBs and examines the association between MHRFBs and under-five mortality survival (U5M) outcomes among ever-married women of reproductive age in Nigeria. METHODS This study used the recent secondary datasets from the Nigerian Demographic Health Surveys conducted in 2018, with a total sample size of 10,304 women of reproductive age. The outcome variable was MHRFBs. Multivariable logistic regression analysis was employed to examine the association between U5M and MHRFBs. Odds ratios with a p-value of less than 0.05 were considered significant. RESULTS It was found that among women who had MHRFBs, U5M was prevalent, particularly in young maternal age (< 18 years) and within short birth intervals (< 24 months). The adjusted odds ratio of the association between MHRFBs and U5M shows the experience of MHRFBs, in addition to other factors such as household wealth index, type of marriage, and sex of child, to be significant predictors for U5M. The odds were higher for U5M to occur among women who had experienced MHRFBs compared to those who have not had an experience of MHRFBs [aOR = 1.48; 95%CI: 1.02-2.17 ]. Similarly, the odds of U5M occurrence among women in polygamous marriages are higher compared to those in monogamous unions [aOR = 1.35; 95% CI: 1.10-1.65]. While under-five children born in the richest households (wealth quintiles) are less likely to die compared to those born in the poorest households [aOR = 0.64; 95% CI: 0.41-1.01]. CONCLUSION This study concludes that women in Nigeria who engaged in MHRFBs, particularly maternal ages < 18 years and short birth intervals (< 24 months), were more likely to experience U5M. Furthermore, children born to women who received post-natal care after delivery were more likely to survive U5M, as were children born to women with educated partners. We recommend strengthening educational opportunities and creating adaptive reproductive health education programs for ever-married women of reproductive age in Nigeria.
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Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health, York St. John University, London, UK.
- Department of Demography and Population Studies, University of Witwatersrand, Johannesburg, South Africa.
| | - Julia Marie Hajjar
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Oluwatobi Abel Alawode
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL, 32611, USA
| | - Kobi V Ajayi
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | | | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Bastos-Amador P, Duarte EL, Torres J, Caldeira AT, Silva I, Salvador C, Assunção R, Alvito P, Ferreira M. Maternal dietary exposure to mycotoxin aflatoxin B 1 promotes intestinal immune alterations and microbiota modifications increasing infection susceptibility in mouse offspring. Food Chem Toxicol 2023; 173:113596. [PMID: 36603704 DOI: 10.1016/j.fct.2022.113596] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
Mycotoxins are secondary metabolites produced by fungi occurring in food that are toxic to animals and humans. Early-life mycotoxins exposure has been linked to diverse pathologies. However, how maternal exposure to mycotoxins impacts on the intestinal barrier function of progeny has not been explored. Here, exposure of pregnant and lactating C57Bl/6J female mice to aflatoxin B1 (AFB1; 400 μg/kg body weight/day; 3 times a week) in gelatine pellets, from embryonic day (E)11.5 until weaning (postnatal day 21), led to gut immunological changes in progeny. The results showed an overall increase of lymphocyte number in intestine, a reduction of expression of epithelial genes related to microbial defence, as well as a decrease in cytokine production by intestinal type 2 innate lymphoid cells (ILC2). While susceptibility to chemically induced colitis was not worsened, immune alterations were associated with changes in gut microbiota and with a higher vulnerability to infection by the protozoan Eimeria vermiformis at early-life. Together these results show that maternal dietary exposure to AFB1 can dampen intestinal barrier homeostasis in offspring decreasing their capability to tackle intestinal pathogens. These data provide insights to understand AFB1 potential harmfulness in early-life health in the context of intestinal infections.
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Affiliation(s)
- Patricia Bastos-Amador
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, 1649-016, Lisbon, Portugal; Champalimaud Foundation, Champalimaud Centre for the Unknown, 1400-038, Lisbon, Portugal
| | - Elsa Leclerc Duarte
- University of Évora, School of Science and Technology, 7000-671, Évora, Portugal; MED-Mediterranean Institute for Agriculture, Environment and Development, 7006-554, Évora, Portugal
| | - Júlio Torres
- University of Coimbra, Center for Innovative Biomedicine and Biotechnology, Center for Neuroscience and Cell Biology, 3004-504, Coimbra, Portugal
| | | | - Inês Silva
- University of Évora, School of Science and Technology, 7000-671, Évora, Portugal; MED-Mediterranean Institute for Agriculture, Environment and Development, 7006-554, Évora, Portugal; HERCULES Laboratory, Universidade de Évora, 7000-809, Évora, Portugal
| | - Cátia Salvador
- HERCULES Laboratory, Universidade de Évora, 7000-809, Évora, Portugal
| | - Ricardo Assunção
- IUEM, Instituto Universitário Egas Moniz, Egas Moniz-Cooperativa de Ensino Superior, CRL, 2829 - 511, Caparica, Portugal; University of Aveiro, CESAM - Centre for Environmental and Marine Studies, 3810-193, Aveiro, Portugal
| | - Paula Alvito
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, 1649-016, Lisbon, Portugal; University of Aveiro, CESAM - Centre for Environmental and Marine Studies, 3810-193, Aveiro, Portugal
| | - Manuela Ferreira
- Champalimaud Foundation, Champalimaud Centre for the Unknown, 1400-038, Lisbon, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology, Center for Neuroscience and Cell Biology, 3004-504, Coimbra, Portugal.
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Verhulst A, Prieto JR, Alam N, Eilerts-Spinelli H, Erchick DJ, Gerland P, Katz J, Lankoande B, Liu L, Pison G, Reniers G, Subedi S, Villavicencio F, Guillot M. Divergent age patterns of under-5 mortality in south Asia and sub-Saharan Africa: a modelling study. Lancet Glob Health 2022; 10:e1566-e1574. [PMID: 36088913 PMCID: PMC9588693 DOI: 10.1016/s2214-109x(22)00337-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022]
Abstract
Background Understanding the age pattern of under-5 mortality is essential for identifying the most vulnerable ages and underlying causes of death, and for assessing why the decline in child mortality is slower in some countries and subnational areas than others. The aim of this study is to detect age patterns of under-5 mortality that are specific to low-income and middle-income countries (LMICs). Methods In this modelling study, we used data from 277 Demographic and Health Surveys (DHSs), 58 Health and Demographic Surveillance Systems (HDSSs), two cohort studies, and two sample-registration systems. From these sources, we collected child date of birth and date of death (or age at death) from LMICs between 1966 and 2020. We computed 22 deaths rates from each survey with the following age breakdowns: 0, 7, 14, 21, and 28 days; 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 15, 18, and 21 months; and 2, 3, 4, and 5 years. We assessed how probabilities of dying estimated for the 22 age groups deviated from predictions generated by a vital registration model that reflects the historical mortality of 25 high-income countries. Findings We calculated mortality rates of 81 LMICs between 1966 and 2020. In contrast with the other regions of the world, we found that under-5 mortality in south Asia and sub-Saharan Africa was characterised by increased mortality at both ends of the age range (ie, younger than 28 days and older than 6 months) at a given level of mortality. Observed mortality in these regions was up to 2 times higher than predicted by the vital registration model for the younger-than-28 days age bracket, and up to 10 times higher than predicted for the older-than-6 months age bracket. This age pattern of under-5 mortality is significant in 17 countries in south Asia and sub-Saharan Africa. Excess mortality in children older than 6 months without excess mortality in children younger than 28 days was found in 38 countries. In south Asia, results were consistent across data sources. In sub-Saharan Africa, excess mortality in children younger than 28 days was found mostly in DHSs; the majority of HDSSs did not show this excess mortality. We have attributed this difference in data sources mainly to omissions of early deaths in HDSSs. Interpretation In countries with age patterns of under-5 mortality that diverge from predictions, evidence-based public health interventions should focus on the causes of excess of mortality; notably, the effect of fetal growth restriction and infectious diseases. The age pattern of under-5 mortality will be instrumental in assessing progress towards the decline of under-5 mortality and the Sustainable Development Goals. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.
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Affiliation(s)
- Andrea Verhulst
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA.
| | - Julio Romero Prieto
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Nurul Alam
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruno Lankoande
- Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Li Liu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gilles Pison
- Laboratoire d'Eco-anthropologie, French Museum of Natural History, Paris, France; French Institute for Demographic Studies (INED), Paris, France
| | - Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Seema Subedi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Francisco Villavicencio
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Centre for Demographic Studies, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Michel Guillot
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA; French Institute for Demographic Studies (INED), Paris, France
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