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Bake JF, Musubao MB, Cairo S. Neonatal surgical mortality at a low resource setting, HEAL Africa tertiary hospital, Eastern Democratic Republic of the Congo. Pediatr Surg Int 2024; 40:243. [PMID: 39190039 DOI: 10.1007/s00383-024-05829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE This study describes the experience with common neonatal surgical conditions and their outcomes at a single center in the Eastern Democratic Republic of the Congo (DRC) over a period of 7 years (2016-2022). METHODS A retrospective review of neonatal surgical admissions and their outcomes was performed for patient admitted between January 2016 and December 2022 at HEAL Africa teaching hospital. Data were collected from the neonatal admission and discharge registry for all patients with a potential surgical condition. RESULTS 107 neonates potentially requiring surgery were identified. 81.3% were referred from facilities within 10 km of HEAL Africa. The most common diagnosis was myelomeningocele/meningocele (27.1%). 68.2% of patients had an operation. The overall mortality was 29% for all patients and mean length of stay 9.9 days. Operated patients had a lower mortality at 16.4% (p-value < 0.001, OR 0.155, CI 0.062-0.389) while patients with a birth weight of less than 2500 g were more likely to die (p-value < 0.001, OR 5.333, CI 2.062-13.79). CONCLUSION The neonatal mortality rate for patients presenting with a potential surgical condition is extremely high. This is multifactorial and largely related to patient selection inherent to resource limitations.
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Affiliation(s)
- Jacques Fadhili Bake
- HEAL Africa Hospital, Goma, Democratic Republic of Congo.
- Institut Supérieur des Techniques Médicales, Goma, Democratic Republic of Congo.
| | | | - Sarah Cairo
- Division of Pediatric Surgery, University of California, San Francisco, USA
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Dey R, Kundu S, Ajayi KV, Kabir H, Banna MHA. Trends and inequalities in neonatal mortality rate in Bangladesh: Evidence from cross-sectional surveys. Health Sci Rep 2024; 7:e2298. [PMID: 39131597 PMCID: PMC11310099 DOI: 10.1002/hsr2.2298] [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: 01/05/2024] [Revised: 07/25/2024] [Accepted: 07/27/2024] [Indexed: 08/13/2024] Open
Abstract
Background and Aims Given the significance of addressing neonatal mortality in pursuing the 2030 Sustainable Development Goal on child health, research focus on this area is crucial. Despite the persistent high rates of neonatal mortality rate (NMR) in Bangladesh, there remains a notable lack of robust evidence addressing inequalities in NMR in the country. Therefore, this study aims to fill the knowledge gap by comprehensively investigating inequalities in NMR in Bangladesh. Methods The Bangladesh Demographic and Health Survey (BDHS) data from 2000 to 2017 were analyzed. The equity stratifiers used to measure the inequalities were wealth status, mother's education, place of residence, and subnational region. Difference (D) and population attributable fraction (PAF) were absolute measures, whereas population attributable risk (PAR) and ratio (R) were relative measures of inequality. Statistical significance was considered by estimating 95% confidence intervals (CIs) for each estimate. Results A declining trend in NMR was found in Bangladesh, from 50.2 in 2000 to 31.9 deaths per 1000 live births in 2017. This study detected significant wealth-driven (PAF: -20.6, 95% CI: -24.9, -16.3; PAR: -6.6, 95% CI: -7.9, -5.2), education-related (PAF: -11.6, 95% CI: -13.4, -9.7; PAR: -3.7, 95% CI: -4.3, -3.1), and regional (PAF: -20.6, 95% CI: -27.0, -14.3; PAR: -6.6, 95% CI: -8.6, -4.6) disparities in NMR in all survey points. We also found a significant urban-rural inequality from 2000 to 2014, except in 2017. Both absolute and relative inequalities in NMR were observed; however, these inequalities decreased over time. Conclusion Significant variations in NMR across subgroups in Bangladesh highlight the need for comprehensive, and targeted interventions. Empowering women through improved access to economic resources and education may help address disparities in NMR in Bangladesh. Future research and policies should focus on developing strategies to address these disparities and promote equitable health outcomes for all newborns.
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Affiliation(s)
- Rakhi Dey
- Statistics DisciplineKhulna UniversityKhulnaBangladesh
| | - Satyajit Kundu
- School of Medicine and DentistryGriffith UniversityGold CoastQLDAustralia
| | - Kobi V. Ajayi
- Department of Health Behavior, School of Public HealthTexas A&M University College StationCollege StationTexasUSA
| | - Humayun Kabir
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Md. Hasan Al Banna
- Faculty of Nutrition and Food SciencePatuakhali Science and Technology UniversityPatuakhaliBangladesh
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Wessells KR, Manger MS, Tsang BL, Brown KH, McDonald CM. Mandatory large-scale food fortification programmes can reduce the estimated prevalence of inadequate zinc intake by up to 50% globally. NATURE FOOD 2024; 5:625-637. [PMID: 38898330 PMCID: PMC11272573 DOI: 10.1038/s43016-024-00997-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/13/2024] [Indexed: 06/21/2024]
Abstract
Large-scale food fortification (LSFF) can increase dietary micronutrient intake and improve micronutrient status. Here we used food balance sheet data from the Food and Agriculture Organization of the United Nations to estimate current country-specific prevalences of inadequate zinc intake. We assessed the potential effects of improving existing LSFF programmes for cereal grains or implementing new programmes in 40 countries where zinc deficiency is a potential public health problem. Accounting for LSFF programmes as currently implemented, 15% of the global population (1.13 billion individuals) is estimated to have inadequate zinc intake. In countries where zinc deficiency is a potential public health problem, the implementation of high-quality mandatory LSFF programmes that include zinc as a fortificant would substantially increase the availability of zinc in the national food supply, reducing the estimated prevalence of inadequate zinc intake by up to 50% globally. Investments in strong LSFF programmes could have a substantial impact on population zinc status.
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Affiliation(s)
- K Ryan Wessells
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA.
| | - Mari S Manger
- International Zinc Nutrition Consultative Group, San Francisco, CA, USA
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Christine M McDonald
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
- International Zinc Nutrition Consultative Group, San Francisco, CA, USA
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Ventura MWS, Lima GA, da Silva VM, Lopes MVDO, Lima FET. Concept analysis of Neonatal Near Miss. J Pediatr Nurs 2024; 77:e411-e419. [PMID: 38760301 DOI: 10.1016/j.pedn.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE To analyze the concept of Neonatal Near Miss (NNM) using Walker and Avant's method. METHOD This study employs conceptual analysis following Walker and Avant's model, involving concept selection, objective definition, identification of potential uses, determination of attributes, model case creation, additional case consideration, antecedent identification, consequent analysis, and empirical reference examination. To elucidate the concept, a scoping review was conducted across journals indexed in scientific databases such as Web of Science, EMBASE, SCOPUS, and MEDLINE/PubMed. RESULTS The analysis encompassed 43 articles, revealing diverse definitions of neonatal near miss across different contexts. A comprehensive definition emerged from identified antecedents: risk of death, susceptibility to adverse outcomes, and potential adverse events. These antecedents were categorized into maternal conditions, neonatal conditions, and healthcare assistance. CONCLUSION The analysis and definition of the NNM concept was successful, and its antecedents, attributes, and consequences were delineated. IMPLICATIONS Identifying the risk factors associated with NNM cases may contribute to reducing infant morbidity and mortality and improving the quality of care, facilitating future research and improving the use of the NNM concept.
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Thamby A, Bajaj A, L M, G SK, Gr G, K T, Ts J. Impaired mother-infant bonding: a community study from India. J Reprod Infant Psychol 2024; 42:528-539. [PMID: 36138562 DOI: 10.1080/02646838.2022.2125938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Impaired mother-infant bonding (MIB) is associated with inadequate maternal skills and pose a higher risk for impaired learning, child abuse, and psychiatric disorders in children. There are approximately 24 million births annually in India; however, community data on MIB from India is lacking. METHODS The study reports the findings of a cross-sectional survey of 8189 mothers with children of age between 13 and 15 months from the state of Kerala, India. Bonding was assessed using the Mother-infant bonding scale (MIBS). Other correlates assessed include obstetric and birth history, chronic pain, postpartum depression and temperamental issues in the infant. RESULTS The prevalence of impaired MIB in our sample was 12.3%. Those in extended/joint family, experiencing postpartum complications, supplementary breastfeeding in the first 6 months, postpartum depression and temperamental issues in infant were found to be associated with increased MIBS scores in a multivariate mixed-effect zero-inflated poisson model. CONCLUSION Experience of impaired MIB is not uncommon among mothers in India. More needs to be done to explore these issues, especially among those with higher risk to ensure appropriate interventions to mitigate long-term consequences.
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Affiliation(s)
- Abel Thamby
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Aakash Bajaj
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Manoj L
- National Health Mission (Kerala), Thiruvananthapuram, India
| | - Sunil Kumar G
- National Health Mission (Kerala), Thiruvananthapuram, India
| | - Gokul Gr
- National Health Mission (Kerala), Thiruvananthapuram, India
| | - Thennarasu K
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jaisoorya Ts
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Vlachadis N, Loukas N, Antonakopoulos N, Vrachnis D, Zikopoulos A, Stavros S, Machairiotis N, Siori M, Drakakis P, Vrachnis N. Infant, Neonatal, and Post-neonatal Mortality in Greece: A Nationwide Time-Trend Analysis. Cureus 2024; 16:e61418. [PMID: 38947716 PMCID: PMC11214723 DOI: 10.7759/cureus.61418] [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] [Accepted: 05/31/2024] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION Infant mortality is a crucial perinatal measure and is also regarded as an important public health indicator. This study aimed to comprehensively present time trends in infant, neonatal, and post-neonatal mortality in Greece. METHODS The annual infant mortality rate (IMR), the neonatal mortality rate (NMR), and the post-neonatal mortality rate (PNMR) were calculated based on official national data obtained from the Hellenic Statistical Authority, spanning 67 years from 1956 to 2022. The time trends of the mortality rates were evaluated using joinpoint regression analysis, and the annual percent changes (APC) and the overall average annual percent change (AAPC) were calculated with a 95% confidence interval (95% CI). RESULTS The IMR exhibited accelerating declines over more than 50 years, with an APC of -1.9 (-2.8 to -1.0) from 1956 to 1968, -5.4 (-5.6 to -5.2) from 1968 to 1999, and -7.3 (-8.9 to -5.7) between 1999 and 2008. In 2008, IMR reached its all-time low of 2.7 per 1,000 live births, down 16.6-fold from its peak at 44.1 per 1,000 live births in 1957. This improving trend was reversed following the onset of the economic crisis in the country, leading to a 57% increase in IMR from 2008 to 2016, with an upward trend APC of 3.4 (1.2 to 5.5). In the recent period 2016-2022, there was an improvement with an APC of -3.7 (-6.2 to -1.1), resulting in an IMR of 3.1 per 1,000 live births in 2022. The decrease in IMR was estimated to have prevented 209,109 infant deaths in the country from 1958 to 2022. From 1956 to 2022, the IMR decreased with an AAPC of -3.9 (-4.3 to -3.4), while the PNMR saw a decline with an AAPC of -4.5 (-5.1 to -3.9) and the NMR with an AAPC of -3.2 (-3.7 to -2.6). CONCLUSION Greece achieved an impressive decrease in infant mortality rates, but this progress was halted and completely reversed during the economic crisis. Although there have been some recent improvements after the country's economic recovery, the rates have yet to reach pre-crisis levels.
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Affiliation(s)
- Nikolaos Vlachadis
- Department of Obstetrics and Gynecology, General Hospital of Messinia, Kalamata, GRC
| | - Nikolaos Loukas
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Attiko Hospital, Athens, GRC
| | | | - Dionysios Vrachnis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Attiko Hospital, Athens, GRC
| | - Athanasios Zikopoulos
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Attiko Hospital, Athens, GRC
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Attiko Hospital, Athens, GRC
| | - Nikolaos Machairiotis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Attiko Hospital, Athens, GRC
| | - Maria Siori
- Primary Health Center of Byron, National Health System of Greece, Athens, GRC
| | - Petros Drakakis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Attiko Hospital, Athens, GRC
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Attiko Hospital, Athens, GRC
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Azmat SK, Thom EM, Arshad M, Hamza HB, Aabroo A, Balal A, Awan MA, Rifaq F, Hemachandra N, Qudsia U. A study protocol for integrating outpatient services at the primary health care level as part of the universal health coverage benefit package within the national health insurance program of Pakistan through private health facilities. Front Public Health 2024; 12:1293278. [PMID: 38532967 PMCID: PMC10964903 DOI: 10.3389/fpubh.2024.1293278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction and aim Pakistan has a mixed-health system where up to 60% of health expenditures are out of pocket. Almost 80% of primary healthcare (PHC) facilities are in the private sector, which is deeply embedded within the country's health system and may account for the unaffordability of healthcare. Since 2016, the existing national health insurance program or Sehat Sahulat Program (SSP), has provided invaluable coverage and financial protection to the millions of low-income families living in Pakistan by providing inpatient services at secondary and tertiary levels. However, a key gap is the non-inclusion of outpatient services at the PHC in the insurance scheme. This study aims to engage a private provider network of general practitioners in select union councils of Islamabad Capital Authority (ICT) of Pakistan to improve access, uptake, and satisfaction and reduce out-of-pocket expenditure on quality outpatient services at the PHC level, including family planning and reproductive health services. Methods and analysis A 24-month research study is proposed with a 12-month intervention period using a mixed method, two-arm, prospective, quasi-experimental controlled before and after design with a sample of 863 beneficiary families from each study arm, i.e., intervention and control groups (N = 1726) will be selected through randomization at the selected beneficiary family/household level from four peri-urban Union Councils of ICT where no public sector PHC-level facility exists. All ethical considerations will be assured, along with quality assurance strategies. Quantitative pre/post surveys and third-party monitoring are proposed to measure the intervention outcomes. Qualitative inquiry with beneficiaries, general practitioners and policymakers will assess their knowledge and practices. Conclusion and knowledge contribution PHC should be the first point of contact for accessing health services and appears to serve as a programmatic engine for universal health coverage (UHC). The research aims to study a service delivery model which harnesses the private sector to deliver an essential package of health services as outpatient services under SSP, ultimately facilitating UHC. Findings will provide a blueprint referral system to reduce unnecessary hospital admissions and improve timely access to healthcare. A robust PHC system can improve population health, lower healthcare expenditure, strengthen the healthcare system, and ultimately make UHC a reality.
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Affiliation(s)
- Syed Khurram Azmat
- Marie Stopes Society, Karachi, Pakistan
- AIPH - AAPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Hasan Bin Hamza
- Ministry of National Health Services, Regulations, and Coordination, Islamabad, Pakistan
| | - Atiya Aabroo
- Ministry of National Health Services, Regulations, and Coordination, Islamabad, Pakistan
| | | | - Muhammad Ali Awan
- Marie Stopes Society, Karachi, Pakistan
- AIPH - AAPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Faisal Rifaq
- Federal Sehat Sahulat Program, Islamabad, Pakistan
| | | | - Uzma Qudsia
- World Health Organization, Islamabad, Pakistan
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Hazlett C, Ramos AP, Smith S. Better individual-level risk models can improve the targeting and life-saving potential of early-mortality interventions. Sci Rep 2023; 13:21706. [PMID: 38066048 PMCID: PMC10709389 DOI: 10.1038/s41598-023-48888-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Infant mortality remains high and uneven in much of sub-Saharan Africa. Even low-cost, highly effective therapies can only save lives in proportion to how successfully they can be targeted to those children who, absent the treatment, would have died. This places great value on maximizing the accuracy of any targeting or means-testing algorithm. Yet, the interventions that countries deploy in hopes of reducing mortality are often targeted based on simple models of wealth or income or a few additional variables. Examining 22 countries in sub-Saharan Africa, we illustrate the use of flexible (machine learning) risk models employing up to 25 generally available pre-birth variables from the Demographic and Health Surveys. Using these models, we construct risk scores such that the 10 percent of the population at highest risk account for 15-30 percent of infant mortality, depending on the country. Successful targeting in these models turned on several variables other than wealth, while models that employ only wealth data perform little or no better than chance. Consequently, employing such data and models to predict high-risk births in the countries studied flexibly could substantially improve the targeting and thus the life-saving potential of existing interventions.
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Affiliation(s)
- Chad Hazlett
- Professor, Department of Political Science and Department of Statistics and Data Science, University of California Los Angeles, Los Angeles, USA
- PhD Candidate, Department of Statistics and Data Science, University of California Los Angeles, Los Angeles, USA
| | - Antonio P Ramos
- Research Scientist, Califonia Center for Population Research, University of California, Los Angeles, USA.
- Principal Research Scientist, José Luiz Egydio Setúbal Foundation, São Paulo, Brazil.
| | - Stephen Smith
- PhD Candidate, Department of Statistics and Data Science, University of California Los Angeles, Los Angeles, USA
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Barro M, Ouattara CA, Sanogo B, Baby AA, Ouattara ABI, Nacro FS, Traoré IT, Kalmogho A, Ouermi AS, Ouoba RS, Cessouma KR, Nacro B. Risk factors for mortality in an African pediatric emergency department: case of Sourô Sanou Hospital, a prospective, cross-sectional study. J Trop Pediatr 2023; 70:fmad044. [PMID: 38099863 DOI: 10.1093/tropej/fmad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Childhood mortality rates remain high in sub-Saharan Africa. This study aimed to assess the causes and associated factors of pediatric emergency mortality at the Sourô Sanou University Hospital of Bobo-Dioulasso. METHODOLOGY This was a cross-sectional study with prospective collection from June to August 2020. We documented and analyzed demographic and clinical characteristics by means or proportions. Logistic regression was performed to identify the factors associated with childhood mortality. RESULTS From 618 pediatric patients admitted to pediatric emergency unit, 80 (12.9%) were documented as death outcomes. The mean age was 34.10 ± 36.38 months. The male sex represented 51.25%. The main diagnoses were severe malaria (61.25%), acute gastroenteritis (11.25%) and pneumonia (10%); 48.75% of the patients were malnourished and only 55% were fully immunized. The average length of hospitalization was 2.73 ± 3.03 days. Mortality was a strongly significant association with late come to the emergency unit (AOR = 1.11, CI = 1.04-1.18), young maternal age (AOR = 0.95, CI = 0.92-0.99) and incomplete vaccination (AOR = 1.94, CI = 1.13-3.31). CONCLUSION The in-hospital mortality rate was 12.94%; younger maternal age, delay in consultation, unimmunized or incompletely immunized status and shorter hospital stays were significantly associated with death.
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Affiliation(s)
- Makoura Barro
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | - Cheick Ahmed Ouattara
- Department of Public Health, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | - Bintou Sanogo
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | - Abdel Aziz Baby
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
- Emergency Reception, Service for Adults and Paediatrics, Niono Reference Health Center, Niono 45036, Mali
| | - Ad Bafa Ibrahim Ouattara
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | - Fatimata Sahoura Nacro
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | | | - Angèle Kalmogho
- Pediatric Department, Yalgado Ouédraogo University Hospital, 03 BP 7022 Ouagadougou 03, Burkina Faso
| | - Alain Saga Ouermi
- Pediatric Department, Ouahigouya Regional Hospital, Secteur 01 Ouahigouya, Burkina Faso
| | - Réné Souanguimpari Ouoba
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
| | | | - Boubacar Nacro
- Department of Pediatrics, Sourô Sanou University Hospital, 01 BP 676 Bobo-Dioulasso 01, Burkina Faso
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Yoo JY, Oh S, Shalish W, Maeng WY, Cerier E, Jeanne E, Chung MK, Lv S, Wu Y, Yoo S, Tzavelis A, Trueb J, Park M, Jeong H, Okunzuwa E, Smilkova S, Kim G, Kim J, Chung G, Park Y, Banks A, Xu S, Sant'Anna GM, Weese-Mayer DE, Bharat A, Rogers JA. Wireless broadband acousto-mechanical sensing system for continuous physiological monitoring. Nat Med 2023; 29:3137-3148. [PMID: 37973946 DOI: 10.1038/s41591-023-02637-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023]
Abstract
The human body generates various forms of subtle, broadband acousto-mechanical signals that contain information on cardiorespiratory and gastrointestinal health with potential application for continuous physiological monitoring. Existing device options, ranging from digital stethoscopes to inertial measurement units, offer useful capabilities but have disadvantages such as restricted measurement locations that prevent continuous, longitudinal tracking and that constrain their use to controlled environments. Here we present a wireless, broadband acousto-mechanical sensing network that circumvents these limitations and provides information on processes including slow movements within the body, digestive activity, respiratory sounds and cardiac cycles, all with clinical grade accuracy and independent of artifacts from ambient sounds. This system can also perform spatiotemporal mapping of the dynamics of gastrointestinal processes and airflow into and out of the lungs. To demonstrate the capabilities of this system we used it to monitor constrained respiratory airflow and intestinal motility in neonates in the neonatal intensive care unit (n = 15), and to assess regional lung function in patients undergoing thoracic surgery (n = 55). This broadband acousto-mechanical sensing system holds the potential to help mitigate cardiorespiratory instability and manage disease progression in patients through continuous monitoring of physiological signals, in both the clinical and nonclinical setting.
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Affiliation(s)
- Jae-Young Yoo
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Seyong Oh
- Division of Electrical Engineering, Hanyang University ERICA, Ansan, Republic of Korea
| | - Wissam Shalish
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Woo-Youl Maeng
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Emily Cerier
- Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Jeanne
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Myung-Kun Chung
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Shasha Lv
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Yunyun Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Seonggwang Yoo
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Andreas Tzavelis
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Jacob Trueb
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Minsu Park
- Department of Polymer Science and Engineering, Dankook University, Yongin, Republic of Korea
| | - Hyoyoung Jeong
- Department of Electrical and Computer Engineering, University of California, Davis, CA, USA
| | - Efe Okunzuwa
- Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Slobodanka Smilkova
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA
| | - Gyeongwu Kim
- Adlai E. Stevenson High School, Lincolnshire, IL, USA
| | - Junha Kim
- Department of Advanced Materials Engineering for Information and Electronics, Kyung Hee University, Gyeonggi-do, Republic of Korea
| | - Gooyoon Chung
- Department of Advanced Materials Engineering for Information and Electronics, Kyung Hee University, Gyeonggi-do, Republic of Korea
| | - Yoonseok Park
- Department of Advanced Materials Engineering for Information and Electronics, Kyung Hee University, Gyeonggi-do, Republic of Korea
| | - Anthony Banks
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Sibel Health, Niles, IL, USA
| | - Guilherme M Sant'Anna
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Debra E Weese-Mayer
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.
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11
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Tsegaye H, Demelash A, Aklilu D, Girma B. Determinants of pediatrics emergency mortality at comprehensive specialized hospitals of South nation nationalities and people region, Ethiopia, 2022: unmatched case-control study. BMC Pediatr 2023; 23:192. [PMID: 37085755 PMCID: PMC10120093 DOI: 10.1186/s12887-023-04011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Globally, child mortality is remaining high, especially in sub-Saharan African countries like Ethiopia. Mortality which happens within 24 hours of admission is preventable. However, in Ethiopia little is known regarding pediatric emergency mortality. Therefore, this study was aimed to identify determinants of pediatric emergency mortality at compressive specialized hospitals found in South Nation Nationalities and people region, Southern Ethiopia. METHODS A facility-based unmatched case-control study was conducted on 344 children (115 cases and 229 controls) at comprehensive specialized hospitals of South Nation Nationalities and people region, Ethiopia. The data collection checklist was checked for its consistency. Data were entered and cleaned for missed values by using Epi Data3.1, then exported to Stata version 14.1 for analysis. Logistic regression was done to identify the significant determinants for pediatric emergency mortality. Finally, AORs at 95% CI and P-value < 0.05 were used to declare statistical significance. RESULT A total of 344 charts were reviewed, of which 333 (97%) (112 cases and 221 controls) charts fulfilled the inclusion criteria.. In multivariable analysis, delayed diagnosis and treatment [AOR = 2.088, 95% of CI (1.128, 3.864)], acute respiratory distress syndrome [AOR = 2.804, 95% of CI (1.487, 5.250)], dehydration [AOR = 3.323, 95% of CI (1.260, 8.761)], meningitis [AOR = 5.282, 95% of CI (2.707, 10.310)], sepsis [AOR = 4.224, 95% of CI (2.220, 8.040)], accidental injury [AOR = 3.603, 95% of CI (1.877, 6.916)] and duration of sign/symptoms [AOR = 5.481, 95% of CI (2.457, 12.230)] were significantly associated with pediatric emergency mortality. CONCLUSION In the current study, delayed diagnosis and treatment, acute respiratory distress syndrome, dehydration, sepsis, meningitis, accidental injury and duration of signs/symptoms were significantly associated with pediatric emergency mortality. Healthcare professionals should identify and treat patients early at an emergency department and provide attention to patients with the above diseases. Furthermore, quality care should be provided.
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Affiliation(s)
| | - Alebachew Demelash
- Department of Pediatrics and Child Health Nursing, School of Midwifery and Nursing, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Dawit Aklilu
- Department of Pediatrics and Child Health Nursing, School of Midwifery and Nursing, College of Medicine and Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Bekahegn Girma
- Department of Nursing, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia.
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12
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Ren B, He Q, Ma J, Zhang G. A preliminary analysis of global neonatal disorders burden attributable to PM 2.5 from 1990 to 2019. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 870:161608. [PMID: 36649767 DOI: 10.1016/j.scitotenv.2023.161608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/21/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Prenatal fine particulate matter (PM2.5) exposure is related to various neonatal diseases (ND). However, data and studies assessing the neonatal disease burden caused by PM2.5 at the global level are limited, especially comparing countries with various socioeconomic development levels. We, therefore, assessed three-decades spatiotemporal changes in neonatal disease burden from 1990 at a national level, combined with the socio-demographic index (SDI). METHODS We extracted statistics from the Global Burden of Disease Study database for this retrospective study, and analyzed differences in the age-standardized mortality rate (ASMR) of ND and five sub-causes related to PM2.5 by gender, nationality, and SDI. To describe the trend of ASMR, the Joinpoint model was adopted to predict the annual percentage change (APC) and the average annual percentage changes (AAPCs). We executed the Gaussian process regression model to predict the relevance between SDI and ASMR. RESULTS The ND burden associated with PM2.5 kept rising since 1990, especially in low-middle SDI regions, South Asia, and Sub-Saharan Africa, and the sex ratio of ASMR was >1 at the global level and all five SDI regions. The leading cause of death was neonatal preterm birth. The global ASMR level of ND was 2.09 per 100,000 population in 2019 and AAPCs was 0.91 (98 % CI: 0.28, 1.55) meanwhile AAPCs decreased with rising SDI levels. The decreasing trend of ASMR in ND was detected in regions with higher SDI, such as North America, Europe, and Australasia. CONCLUSIONS In the past three decades, the global burden of ND related to PM2.5 has ascended considerably in lower SDI regions hence PM2.5 is still considered a notable environmental hazard factor for newborn diseases.
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Affiliation(s)
- Bingbing Ren
- Institute of Nutrition and Food Hygiene, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Qin He
- Institute of Nutrition and Food Hygiene, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Jianhua Ma
- Institute of Nutrition and Food Hygiene, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Gexiang Zhang
- Institute of Nutrition and Food Hygiene, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China.
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13
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Sahile A, Bekele D, Ayele H. Determining factors of neonatal mortality in Ethiopia: An investigation from the 2019 Ethiopia Mini Demographic and Health Survey. PLoS One 2022; 17:e0267999. [PMID: 36584102 PMCID: PMC9803101 DOI: 10.1371/journal.pone.0267999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Neonatal mortality is the probability of dying during the first 28 days of life. Of approximately 5 million children who die in the first year of life in the world, about 3 million are within their first 28 days of birth. In Ethiopia, the neonatal mortality rate is high about 37 per 1000 live births, and the factors are not well documented. Then, this study aimed to determine the key factors that have a significant influence on neonatal mortality. METHODS A total of 5753 neonatal mortality-related data were obtained from Ethiopia Mini Demographic and Health Survey (2019) data. A frequency distribution to summarize the overall data and Binary Logistic Regression to identify the subset of significant risk factors for neonatal mortality were applied to analyze the data. RESULTS An estimated 36 per 1000 live children had died before the first 28 days, with the highest in the Benishangul Gumuz region (15.9%) and the lowest in Addis Ababa (2.4%). From the Binary logistic regression analysis, the odds ratio and 95% CI of age 25-34 (OR = 0.263, 95% CI: 0.106-0.653), Afar (OR = 0.384, 95% CI: 0.167-0.884), SNNPR (OR = 0.265, 95% CI: 0.098-0.720), Addis Ababa (OR = 5.741, 95% CI: 1.115-29.566), Urban (OR = 0.253, 95% CI: 0.090, 0.709), toilet facility (OR = 0.603, 95% CI: 0.404-0.900), single birth (OR = 0.261, 95% CI: 0.138-0.495), poorest (OR = 10.573, 95% CI: 2.166-51.615), poorer (OR = 19.573, 95% CI: 4.171-91.848), never breastfed (OR = 35.939, 95% CI: 25.193-51.268), public health delivery (OR = 0.302, 95% CI: 0.106-0.859), private health facility (OR = 0.269, 95% CI: 0.095-0.760). CONCLUSION All regional states of Ethiopia, specially Benishangul Gumuz, and the Somali region must take remedial actions on public health policy, design strategies to improve facilities, and improve the capacities of stakeholders living in their region toward those major factors affecting neonatal mortality in the country.
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Affiliation(s)
- Abay Sahile
- Department of Statistics, Madda Walabu University, Robe, Oromia, Ethiopia
- * E-mail:
| | - Dereje Bekele
- Department of Statistics, Madda Walabu University, Robe, Oromia, Ethiopia
| | - Habtamu Ayele
- Department of Statistics, Madda Walabu University, Robe, Oromia, Ethiopia
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14
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Jain Y, Chaudhary T, Joshi CS, Chotiya M, Sinha B, Nair TS, Srivastava A, SV VK, Agrawal A, Srivastava V, Baswal D, Lalchandani K, Shah H, Usmanova G, Sood B, Yadav V, Kumar S. Improving quality of intrapartum and immediate postpartum care in public facilities: experiences and lessons learned from Rajasthan state, India. BMC Pregnancy Childbirth 2022; 22:586. [PMID: 35870874 PMCID: PMC9308226 DOI: 10.1186/s12884-022-04888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background In spite of considerable improvement in maternal and neonatal outcomes over the past decade in India, the current maternal mortality ratio and neonatal mortality rate are far from the Sustainable Development Goal targets due to suboptimal quality of maternity care. A package of interventions for improving quality of intrapartum and immediate postpartum care was co-designed with the Ministry of Health as the Dakshata program and implemented in public sector health facilities in selected districts in the state of Rajasthan of India since June 2015. This article describes the key strategies, interventions, results and challenges from four years of Dakshata program implementation. Methods We have conducted secondary analysis of program data (government data) collected from 202 public facilities across 20 districts of Rajasthan state. The data collected between June–August 2015 (baseline) and the data collected between May-August 2019 (latest) were analyzed. The data sources included: facility assessments, service statistics, monthly progress reports. Results During the period of program implementation, there were 17,94,249 deliveries accounting for 70% of institutional deliveries in intervention districts. As a result of the intervention, there was a notable increase in competency of health care providers, availability of essential resources, achievement of labour room standards and adherence to evidence-based clinical standards. We also observed reductions in the proportion of referrals for pre-eclampsia/eclampsia, postpartum hemorrhage and neonatal asphyxia by 11, 8 and 3 percentage points respectively. Similarly, data revealed a reduction in stillbirth rates in Dakshata intervention facilities (19.3 vs 15.3) compared to non-Dakshata facilities (21.8 vs 18). Conclusions Our experience and findings indicate that the quality of intrapartum and immediate postpartum care can be improved in low- and middle-income countries with the approach presented in this paper. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04888-5.
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Reeves A, Sochas L. When do democratic transitions reduce or increase child mortality? Exploring the role of non-violent resistance. Soc Sci Med 2022; 314:115459. [PMID: 36302297 PMCID: PMC10926273 DOI: 10.1016/j.socscimed.2022.115459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
What explains variation across countries in the effect of democratization on child mortality rates? Democratic transitions, on average, improve health outcomes but there is substantial variation across countries in whether democratization leads to lower-than-expected child mortality post-transition. As yet, there is no convincing quantitative explanation for this variation. In this paper, we argue that whether you have a protest-led or violence-led democratic transition alters the trajectory of child mortality post-transition. Our paper makes two contributions. First, we offer a more detailed account of how the type of resistance movement promoting regime change affects health post-transition. We also draw on novel data to categorise the movements producing democratic transitions as violent or peaceful, moving beyond earlier work which operationalised peaceful democratizations in terms of battle-related deaths. Second, we extend earlier research by examining whether the nature of the democratization movement constitutes a necessary cause of higher or lower-than-expected child mortality following democratization. Across 51 transitions, countries that have a protest-led transition have lower-than-expected child mortality rates after the transition to democracy than countries with other kinds of movements (β = -0.17, p = 0.003). Countries with violence-led transitions, meanwhile, have, on average, higher-than-expected child mortality rates after their transition (β = 0.20, p = 0.001). These associations hold when we adjust for covariates (including all possible combinations of various confounding variables). We also find evidence that protest-led transitions may be a necessary condition for avoiding increased child mortality post-transition. Finally, we conduct a deviant case analysis of transitions that appear to be contrary to our theory, finding that these cases are likely instances of measurement error. Democratization may not always improve health, but such health improvements are more likely when regime change is protest-led. This is because such movements are more likely to build broad coalitions committed to consensual politics post-transition, a critical feature of successful democracies.
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Affiliation(s)
- Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, United Kingdom.
| | - Laura Sochas
- Department of Social Policy and Intervention, University of Oxford, United Kingdom.
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16
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Jo M, Oh I, Moon D, Kim S, Jung-Choi K, Chung H. Maternal socioeconomic position and inequity in child deaths: An analysis of 2012 South Korean birth cohort of 466,636 children. SSM Popul Health 2022; 21:101304. [PMID: 36544546 PMCID: PMC9762189 DOI: 10.1016/j.ssmph.2022.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/29/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Inequalities in child mortality occur via interactions between socio-environmental factors and their constituents. Through childhood developmental stages, we can observe changing patterns of mortality. By investigating these patterns and social inequalities by cause and developmental stage, we aim to gain insights into health policies to reduce and equalize childhood mortality. Methods Using vital statistics, we examined the Korean birth cohort of 2012, including all children born in 2012 up to five years of age (N = 466,636). The dependent variables were all-cause and cause-specific mortality by developmental stage (i.e., neonatal, post-neonatal, and childhood). A Cox proportional hazard regression model was built to compare child mortality according to maternal education. The distribution of inequalities in cause-specific mortality by child age was calculated using the slope index of inequality (SII). Results Inequalities in child mortality due to maternal education occur during the neonatal period and increase over time. After adjusting for covariates, the Cox proportional hazard models showed that "injury and external causes" (HR = 2.178; 95% CI = [1.283-3.697]) and "unknown causes" (HR = 2.299; 95% CI = [1.572-3.363]) in the post-neonatal period, and "injury and external causes" (HR = 2.153; 95% CI = [1.347-3.440]) in the childhood period significantly contributed to socioeconomic inequalities in child mortality. For each period, the leading causes of inequality were identified as follows: "congenital" (96.7%) for the neonatal period, "unknown causes" (58.2%) and "injury and external causes" (28.4%) for the post-neonatal period, and "injury and external causes" (56.5%) for the childhood period. Conclusion We confirmed that the main causes of death in mortality inequality vary according to child age, in accordance with the distinctive context of child development. Strengthening the health system and multisectoral efforts that consider families' and children's needs according to spatial contexts (e.g., home, community) may be necessary to address the social inequalities in child health.
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Affiliation(s)
- Minjin Jo
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea,BK21FOUR R&E Center for Learning Health Systems, Graduate School, Korea University, Seoul, Republic of Korea
| | - Inseong Oh
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea
| | - Daseul Moon
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea,People's Health Institute, Seoul, Republic of Korea
| | - Sodam Kim
- Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea,Health Insurance Research Institute, National Health Insurance Service, Wonju, Republic of Korea
| | - Kyunghee Jung-Choi
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Haejoo Chung
- BK21FOUR R&E Center for Learning Health Systems, Graduate School, Korea University, Seoul, Republic of Korea,Division of Health Policy & Management, College of Health Science, Korea University, Seoul, Republic of Korea,Corresponding author. B-365 Hana Science Hall, 145 Anam-ro, Seongbuk-gu, Seoul, 20841, Republic of Korea.
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17
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Mean Platelet Volume in Neonatal Sepsis: Meta-Analysis of Observational Studies. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121821. [PMID: 36553264 PMCID: PMC9776520 DOI: 10.3390/children9121821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022]
Abstract
Introduction: Early onset neonatal sepsis (EONS), particularly in preterm sepsis, is a potentially fatal issue. Evaluation of mean platelet volume (MPV) as an EONS predictor was the goal. Methods: Four databases were used to conduct a systematic evaluation of cohort and case−control studies. Up till the end of October 2022, 137 articles were found utilizing the search method. Following the review, 12 studies were included. Leukocytes, MPV, platelets, gender, birth weight, gestational age, mortality, and C-reactive protein (CRP) were all taken into account while analyzing the prediction of EONS. Inverse-variance methodology and the random-effects model were used. Using GRADE, the evidence’s quality was evaluated. Results: Neonatal patients with sepsis had significantly higher MPV levels than do neonates without sepsis (MD 1.26; 95% CI 0.89−1.63; p < 0.001). An increased MPV during the first 24 h postpartum was associated with high CRP values and high risk of neonatal mortality. In the investigations, the MPV cutoff for sepsis patients was 9.95 (SD 0.843). Overall certainty of the evidence was very low. Conclusions: The increased MPV during the first 24 h postpartum may be predictive of EONS and mortality. Future studies are warranted.
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Sintayehu Y, Abera L, Sema A, Belay Y, Guta A, Amsalu B, Dejene T, Kassie N, Mulatu T, Tiruye G. Factors associated with neonatal near miss among neonates admitted to public hospitals in dire Dawa administration, Eastern Ethiopia: A case-control study. PLoS One 2022; 17:e0273665. [PMID: 36037193 PMCID: PMC9423664 DOI: 10.1371/journal.pone.0273665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
The neonatal near-miss cases are subject to factors that are major causes of early neonatal deaths. For every death, more newborns suffer a life-threatening complication. Nearly 98% of neonatal death unduly existed in developing countries. Though there were few prior studies in other regions, they failed in identifying the factors of NNM. Besides, there has been no prior study in the study area. Therefore, this study aimed to assess factors associated with neonatal near-miss.
Methods
A case-control study was employed on a total of 252 cases and 756 controls using a systematic random sampling technique. Data were collected using pre-tested and interview administered questionnaires adapted from similar studies and medical records from December 2020 –March 2021. Pragmatic and management criteria definition of neonatal near miss were utilized. Epi-Data version 3.1 and SPSS version 23 were used for data entry and analysis respectively. Bivariable and multivariable analyses were done to identify factors associated with a neonatal near-miss by using COR and AOR with a 95% confidence interval. Finally, the statistical significance was declared at a p-value < 0.05.
Results
There were a response rate of 100% for both cases, and controls. Factors that affects neonatal near miss were non-governmental/private employee (AOR, 1.72[95%CI: 1.037, 2.859]), referral in (AOR, 1.51[95%CI: 1.079, 2.108]), multiple birth (AOR, 2.50[95%CI: 1.387, 4.501]), instrumental assisted delivery (AOR, 4.11[95%CI: 1.681, 10.034]), hypertensive during pregnancy (AOR, 3.32[95%CI: 1.987, 5.530]), and male neonates (AOR, 1.71[95%CI: 1.230, 2.373]), paternal education of secondary school (AOR, 0.43[95%CI: 0.210, 0.868]) and college/above (AOR, 0.25[95%CI: 0.109, 0.578]), monthly income (1500–3500 birr) (AOR, 0.29[95%CI: 0.105, 0.809]) and >3500 birr (AOR, 0.34[95%CI: 0.124, 0.906]).
Conclusion
Maternal occupation, paternal education, income, referral, multiple births, mode of delivery, hypertension during pregnancy, and sex of the neonate have identified factors with neonatal near-miss. Better to create job opportunities, improving education, and income generation. Counseling on multiple birth and hypertension, and minimizing instrumental delivery should be done at the health facility level.
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Affiliation(s)
- Yitagesu Sintayehu
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
- * E-mail:
| | - Legesse Abera
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alekaw Sema
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Yalelet Belay
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Alemu Guta
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Bezabih Amsalu
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Tafese Dejene
- School of Medicine, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Nigus Kassie
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Teshale Mulatu
- Department of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getahun Tiruye
- Department of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Bossman E, Johansen MA, Zanaboni P. mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review. Front Glob Womens Health 2022; 3:942146. [PMID: 36090599 PMCID: PMC9453039 DOI: 10.3389/fgwh.2022.942146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Reducing maternal mortality, neonatal mortality and under 5-year mortality are important targets addressed by the United Nations' Sustainable Development Goals. Despite studies reported an improvement in maternal and child health indicators, the progress achieved is not uniform across regions. Due to the increasing availability of mobile phones in low and middle-income countries, mHealth could impact considerably on reducing maternal and child mortality and maximizing women's access to quality care, from the antenatal stage to the post-natal period. Methods A systematic literature review of mHealth interventions aimed at reducing maternal and child mortality in Sub-Saharan Africa and Southern Asia. Primary outcomes were maternal mortality, neonatal mortality, and under-five mortality. Secondary outcomes were skilled birth attendance, antenatal care (ANC) and post-natal care (PNC) attendance, and vaccination/immunization coverage. We searched for articles published from January 2010 to December 2020 in Embase, Medline and Web of Science. Quantitative comparative studies were included. The protocol was developed according to the PRISMA Checklist and published in PROSPERO [CRD42019109434]. The Quality Assessment Tool for Quantitative Studies was used to assess the quality of the eligible studies. Results 23 studies were included in the review, 16 undertaken in Sub-Saharan Africa and 7 in Southern Asia. Most studies used SMS or voice message reminders for education purposes. Only two studies reported outcomes on neonatal mortality, with positive results. None of the studies reported results on maternal mortality or under-five mortality. Outcomes on skilled birth attendance, ANC attendance, PNC attendance, and vaccination coverage were reported in six, six, five, and eleven studies, respectively. Most of these studies showed a positive impact of mHealth interventions on the secondary outcomes. Conclusion Simple mHealth educational interventions based on SMS and voice message reminders are effective at supporting behavior change of pregnant women and training of health workers, thus improving ANC and PNC attendance, vaccination coverage and skilled birth attendance. Higher quality studies addressing the role of mHealth in reducing maternal and child mortality in resource-limited settings are needed, especially in Southern Asia. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019109434, identifier CRD42019109434.
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Affiliation(s)
- Elvis Bossman
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Monika A. Johansen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Paolo Zanaboni
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
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Tesema GA, Seifu BL, Tessema ZT, Worku MG, Teshale AB. Incidence of infant mortality and its predictors in East Africa using Gompertz gamma shared frailty model. Arch Public Health 2022; 80:195. [PMID: 35999606 PMCID: PMC9400328 DOI: 10.1186/s13690-022-00955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Globally, infant mortality is a major public health concern and a sensitive indicator of countries' socio-economic and health status. Despite the substantial reduction of under-five mortality in sub-Saharan African countries specifically in East Africa, the infant mortality rate remains highest and too far below to achieve the WHO target. As to our search of the literature is concerned, there is a dearth of evidence on the incidence and predictors of infant mortality in East Africa. Therefore, this study investigated the incidence of infant mortality and its predictors in East Africa.
Methods
The present study has utilized 138,803 weighted samples from Demographic and Health Surveys (DHSs) of 12 East African countries. Considering the hierarchical nature of DHS data shared frailty parametric survival models were fitted and compared based on deviance (-2LLR), AIC, and BIC. Gompertz gamma shared frailty model was the best-fitted model for the data since it had the lowest deviance, AIC, and BIC values. Variables with a p-value < 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable Gompertz gamma shared analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of infant mortality.
Results
The infant mortality rate in East Africa was 41.41 per 1000 live births. Mothers aged 25–34 years, wanted birth, health facility delivery, 1–3 ANC visit, being 2nd- 4th birth order, 5th and above, the birth interval of 24–48 months, and birth interval of 49 months and above were significantly associated with lower risk of infant mortality. Whereas women who didn’t have formal education, women who didn't participate in making health care decisions making, being male children, cesarean delivery, small size at birth, and large size at birth were significantly associated with a higher risk of infant mortality.
Conclusion
Despite the substantial progress in improving maternal and child health, this study showed that infant mortality is still a major public health concern in East Africa. Maternal age, place of delivery, maternal education, birth size, sex of the child, mode of delivery, women's autonomy, birth order, birth interval, and ANC visit were found to be significant predictors of infant mortality. Therefore, public health interventions enhancing health facility delivery, ANC visit, maternal education, birth spacing, and empowering women are crucial for reducing the incidence of infant mortality in East Africa.
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Otayto K, Godana W, Feleke T, Hussen S, Alemu M. Prevalence of Milk Teeth Extraction and Enabling Community Factors Among Under Five-Year-Old Children in Alle Special Woreda, SNNPR, Ethiopia, 2022: Community-Based Cross-Sectional Study; Based on Theory of Planned Behavior Model. Pediatric Health Med Ther 2022; 13:257-269. [PMID: 35800712 PMCID: PMC9255413 DOI: 10.2147/phmt.s365768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Milk tooth extraction (MTE) is one of the most common harmful traditional practices performed by traditional healers without anesthesia and unsterile materials. The acute and chronic complications of this practice greatly affect the health of children. In order to develop effective preventive measures towards this harmful practice, the extent of the problem and factors contributing to the practice should be verified. The objective of this study was to assess the prevalence and associated factors of MTE among under five-years-old children in Alle special Woreda. Methods A community-based cross-sectional survey was undertaken at Alle Special Woreda among 363 women using a multi-stage stratified sampling method. Data was collected using semi-structured questionnaires and data entry was done with Epi-data version 4.4.3.1, while data management and analysis were done with STATA version 14.0. Univariate and multivariate binary logistic regression models were used while model’s fitness was checked by Hosmer and Lemeshow test. Variables having a p-value of less than 0.05 were declared statistically significant in the final model. Result Milk teeth extraction was practiced on 58.68% (95% CI:0.5,0.6) of children. Age of the child less than 12 months, AOR:1.27 (95% CI:1.02,1.6), maternal occupation (housewife) AOR:1.3 (95% CI:1.04,65), paternaleducational, level (illiterate) AOR:1.4 (95% CI:1.2,1.9), residence (rural) AOR:3.6 (95% CI:1.08,12.4), positive attitude AOR:1.65 (95% CI:1.01,2.8) and intentions AOR: 1.82 (95% CI:1.1,3.3) towards MTE practice showed statistically significant association with MTE practice. Conclusions and Recommendations It was found that milk teeth extraction practice was the most common practice in the study area, with a prevalence of 58.68%. Age of the child, maternal occupation, paternal educational level, residence, having a positive attitude and intentions toward MTE practice all had a statistically significant (P value less than 0.05) association with MTE practice. Society’s barriers, such as knowledge, attitude, and practice (KAP) related, health facility related, and peer and social pressure-related factors, were identified. All stakeholders should put great emphasis on the elimination of this harmful practice.
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Affiliation(s)
- Kusse Otayto
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- Correspondence: Kusse Otayto, Email ;
| | - Wanzahun Godana
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tesfaye Feleke
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Sultan Hussen
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Mathewos Alemu
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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22
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Saha P. Understanding Differences in Behaviour Patterns of Healthcare Service Elements Among Regions Applying Data Mining. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221105331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Maternal and child healthcare (MCH) has always been regarded as one of the important issues globally. The aim of this article is to find out all frequently occurring healthcare service elements along with their availability conditions and their interactions with other health system (HS) elements, when coverage of priority MCH intervention was either poor or moderate or good in any region. Association rule mining technique has been used to understand the probability of occurrences of different healthcare service elements among regions. Along with the proposed analytical framework, an interactive decision support system (DSS) has also been developed on a web platform, which would help healthcare policymakers to integrate the analytical framework easily in their processes of decision-making. The system has been developed by using Shiny package on R software. Data for all variables are collected for 584 Indian districts from the third phase of district-level household and facility survey. From results, it is observed that community healthcare services, sub-centre (SC)-level healthcare services and PHC-level healthcare services of a region are very much interlinked with each other, and their relationships define the healthcare condition of that region.
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Affiliation(s)
- Partha Saha
- Symbiosis Institute of Media and Communication, Pune, Maharashtra, India
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23
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Mehdipour P, Mohammadi E, Sepanlou SG, Ahmadvand A, Peykari N, Djalalinia S, Rezaei-Darzi E, Mohebi F, Moradi Y, Samaei M, Khosravi A, Jamshidi H, Farzadfar F. Level and trend of total plasma cholesterol in national and subnational of Iran: a systematic review and age-spatio-temporal analysis from 1990 to 2016. J Diabetes Metab Disord 2022; 21:1301-1315. [PMID: 35668771 PMCID: PMC9150051 DOI: 10.1007/s40200-022-01052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/28/2022] [Indexed: 11/27/2022]
Abstract
Purpose We aimed to estimate the level and trend of plasma cholesterol and raised total cholesterol (TC > 200 mg/dl) prevalence at national and subnational level of Iran. Methods Nine national surveys and 27 studies, encompassing 3,505 unique points on over 500,000 adults, aged > 25 years with a report of laboratory measurement of TC were found. Age-spatio-temporal model and Gaussian Process Regression were used to estimate mean TC for each sex, 5-year age groups, and 31 provinces from 1990 to 2016. Results At national level, age-standardized prevalence of TC > 200 mg/dL has decreased from 57·2%(53·3-61·1) to 22·4%(20·5-24·3) in women and 53·2%(49·1-57·3) to 18·0%(16·4-19·6) in men. TC distribution presented a condensation between 170-200 mg/dL. At subnational level, decreasing and converging patterns of raised TC prevalence were detected. Conclusion The decrease in raised TC is likely the result of statin widespread use, food industry improvements, and the expanded primary health care. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01052-w.
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Affiliation(s)
- Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713137 Iran.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713137 Iran
| | - Sadaf G Sepanlou
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Ahmadvand
- School of Medicine, Griffith University, Gold Coast, Queensland Australia
| | - Niloofar Peykari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713137 Iran.,Ministry of Health and Medical Education, Tehran, Iran
| | - Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713137 Iran.,Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Ehsan Rezaei-Darzi
- Monash University Accident Research Centre, Monash University, Clayton, Victoria Australia
| | - Farnam Mohebi
- Haas School of Business, University of Berkeley, Berkeley, CA USA
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mehrnoosh Samaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713137 Iran
| | - Ardeshir Khosravi
- Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Hamidreza Jamshidi
- School of Medicine, Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, 1411713137 Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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24
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Schmidt L, Elkasabi M. Accumulating Birth Histories Across Surveys for Improved Estimates of Child Mortality. POPULATION RESEARCH AND POLICY REVIEW 2022. [DOI: 10.1007/s11113-022-09721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractProducing reliable estimates for childhood mortality rates is essential to monitor progress towards the United Nations Sustainable Development Goals (UN SDGs) and correctly evaluate policies designed to reduce childhood mortality rates. Different model-based approaches have been proposed to assess levels and trends in childhood mortality indicators. In this paper, we propose a design-based complement that accumulates birth histories across different household surveys to increase the precision of childhood mortality rates estimates. We accumulate birth histories across different cross-sectional Demographic Health Surveys/Multiple Cluster Indicator Surveys collected in Senegal and Malawi and estimate pooled childhood mortality rates based on calendar years. We show that accumulating birth histories smoothens fluctuations in time series for national and sub-national mortality rates, establishes more stable and reliable time trends, and results in estimated standard errors of the cumulated rates that are about 50–60% lower than their counterparts from separate surveys.
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25
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Lou H, Liu H, Chen Z, Zhen Z, Dong B, Xu J. Bio-process inspired characterization of pregnancy evolution using entropy and its application in preterm birth detection. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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26
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Abdollahpour S, Heidarian Miri H, Khademol Khamse F, Khadivzadeh T. The relationship between global gender equality with maternal and neonatal health indicators: an ecological study. J Matern Fetal Neonatal Med 2022; 35:1093-1099. [PMID: 32290738 DOI: 10.1080/14767058.2020.1743655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Achieving the millennium development goals (MDGs) and sustainable development goals (SDGs) including gender equality, reducing maternal, neonatal, and under 5 mortality rates are still considered a major global challenge. This study was performed with the aim of investigating the relationship between global gender equality and maternal as well as neonatal, and under 5 children health indicators. MATERIALS AND METHODS The present study is an ecological study performed through credible secondary data published in 2017 for each country. Then, the Gender Equality Index along with its four areas, maternal mortality, neonatal mortality, and under 5 mortality rates were extracted. Data analysis was performed by SPSS 24 via descriptive-analytical statistics and linear regression. RESULTS There was a significant and direct correlation between all of the three variables of maternal mortality, neonatal, as well as under 5 mortality and Gender Equality Index. Correlation analysis between the above-mentioned indicators and the areas of Gender Equality Index showed that there is no significant correlation between the "economic opportunities and participation" index and none of the maternal, neonatal, and under 5 mortality indicators. The "educational attainment" index had an inverse significant correlation with the above-mentioned variables. The "survival and health" index had only an inverse significant correlation with neonatal mortality, and "political empowerment" had such a correlation with neonatal and under 5 mortality rates. CONCLUSIONS Panning and policymaking for reducing gender equality barriers should be among the top priorities of primary healthcare in order to achieve maternal, neonatal, and under 5 health universally.
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Affiliation(s)
- Sedigheh Abdollahpour
- PhD Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hamid Heidarian Miri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Khademol Khamse
- PhD Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Reproductive Health, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- Reproductive Health, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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27
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Global trends in incidence and death of neonatal disorders and its specific causes in 204 countries/territories during 1990–2019. BMC Public Health 2022; 22:360. [PMID: 35183143 PMCID: PMC8858498 DOI: 10.1186/s12889-022-12765-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/09/2022] [Indexed: 12/11/2022] Open
Abstract
Background Neonatal disorders (ND) are a significant global health issue. This article aimed to track the global trends of neonatal disorders in 204 countries/territories from 1990 to 2019. Methods Data was explored from the Global Burden of Disease study 2019. Estimated annual percentage change (EAPC) and age-standardized rate (ASR) were calculated to quantify the trends of neonatal disorders and their specific causes, mainly included neonatal preterm birth (NPB), neonatal encephalopathy due to birth asphyxia and trauma (NE), neonatal sepsis and other neonatal infections (NS), and hemolytic disease and other neonatal jaundice (HD). Results In 2019, there were 23,532.23 × 103 incident cases of ND, and caused 1882.44 × 103 death worldwide. During 1990–2019, trends in the overall age-standardized incidence rate (ASIR) of ND was relatively stable, but that of age-standardized death rate (ASDR) declined (EAPC = -1.51, 95% confidence interval [CI]: -1.66 to -1.36). Meanwhile, decreasing trends of ASDR were observed in most regions and countries, particularly Cook Islands and Estonia, in which the respective EAPCs were -9.04 (95%CI: -9.69 to -8.38) and -8.12 (95%CI: -8.46 to -7.77). Among the specific four causes, only the NPB showed decreasing trends in the ASIR globally (EAPC = -0.19, 95%CI: -0.26 to -0.11). Decreasing trends of ASDR caused by ND underlying specific causes were observed in most regions, particularly the HD in Armenia, with the EAPC was -13.08 (95%CI: -14.04 to -12.11). Conclusions Decreasing trends of death caused by neonatal disorders were observed worldwide from 1990 to 2019. However, the burden of neonatal disorders is still a considerable challenge, especially in low-resource settings, which need more effective health strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12765-1.
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28
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Ponnusamy S. Natural disasters and missing children. HEALTH ECONOMICS 2022; 31:399-416. [PMID: 34820935 DOI: 10.1002/hec.4458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
Using an exogenous measure of natural disasters based on physical intensities, I examine their impact on child mortality. I find that children, mostly, in poor countries are affected - a one standard deviation increase in the natural disaster index leads to an additional 6.77 deaths per 1000 live births in the disaster year. The impact is long lasting, extending beyond the disaster year. I provide suggestive evidence of the potential mechanisms driving these effects, namely, lower GDP and vaccination rates among children, along with an increased maternal mortality and disease incidence in low-income countries due to disasters. Using an endogenous measure of disasters based on damage records from insurance data leads to severe underestimation of the disaster impact. The results are robust to the use of mortality rates from multiple sources, different functional forms, and an extensive dynamic panel specification as well as various other tests.
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Affiliation(s)
- Sundar Ponnusamy
- School of Economics, University of Adelaide, Adelaide, South Australia, Australia
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29
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Koné S, Bonfoh B, Probst-Hensch N, Utzinger J, N'Goran EK, Fink G. Impact of newly constructed primary healthcare centres on antenatal care attendance, facility delivery and all-cause mortality: quasi-experimental evidence from Taabo health and demographic surveillance system, Côte d'Ivoire. BMJ Open 2022; 12:e054355. [PMID: 35105634 PMCID: PMC8808407 DOI: 10.1136/bmjopen-2021-054355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Access to quality care remains limited, particularly in low-income and middle-income countries. Although better health outcomes for families living in close proximity to healthcare facilities have been documented in cross-sectional studies, evidence on the extent to which additional health facilities can contribute to improved population health remains scanty. We aimed to estimate the causal impact of newly constructed primary healthcare facilities within a health and demographic surveillance (HDSS) site in Côte d'Ivoire. DESIGN We conducted a quasi-experimental study. Logistic and Cox proportional hazards regression models were used to estimate the impact of new healthcare facilities on healthcare-seeking behaviour and all-cause mortality. SETTING Data were collected prospectively through the Taabo HDSS located in south-central Côte d'Ivoire between 2010 and 2018. PARTICIPANTS We analysed 2957 deaths across 440 973 person-year observations as well as 14 132 live births. PRIMARY OUTCOME MEASURES The primary outcomes were antenatal care (ANC) attendance, facility delivery and mortality. Logistic and Cox proportional hazards models were employed to estimate the impact of the new health facilities on ANC attendance, facility delivery and child as well as adult mortality. RESULTS Average distance to the nearest healthcare facility declined from 5.5 km before to 2.8 km after opening of four new healthcare facilities in targeted villages. No improvement was observed for ANC attendance, institutional deliveries and adult mortality. New facilities reduced the risk of post-neonatal infant mortality by 46% (HR 0.54, 95% CI 0.31 to 0.94, p<0.05), suggesting a mortality gradient of 2 deaths per 1000 for each additional km (Coef=0.002, 95% CI 0.000 to 0.004, p<0.05). CONCLUSIONS Our results suggest that new facilities do not necessarily improve healthcare utilisation and health outcomes. Further research is needed to identify the best ways to ensure access to quality care in resource-constrained settings.
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Affiliation(s)
- Siaka Koné
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Eliézer K N'Goran
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Chaka EE. Multilevel analysis of continuation of maternal healthcare services utilization and its associated factors in Ethiopia: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000517. [PMID: 36962425 PMCID: PMC10022002 DOI: 10.1371/journal.pgph.0000517] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/03/2022] [Indexed: 12/25/2022]
Abstract
Continuum of care (CoC) has been recognized as a crucial strategy for minimizing maternal, neonatal, and child mortality. CoC promotes integrated Maternal Neonatal and Child Health (MNCH) services by linking together three aspects of maternal health care antenatal care, skilled birth attendance, and postnatal care. The study aimed to assess continuation of maternal healthcare services utilization and its associated factors among reproductive age women at pregnancy, delivery and postnatal stages in Ethiopia. Cross-sectional study design conducted using Ethiopian 2016 Demographic and Health Survey data. All women with the most recent live birth in the last five years preceding the 2016 survey were the study population. The sample size was 7590, 2415, and 1342 at service entry (ANC use), COC at a delivery level, and CoC at Postpartum level respectively. COC was measured at three levels of maternal health care (during pregnancy, delivery, and postpartum). The CoC is constructed from four or more antenatal care visits (ANC4+), skilled birth attendance (SBA), and postnatal care (PNC). About 9.1% of women received all components of CoC. Educational attainment, wealth quintile, and media exposure were associated with four or more antenatal care visits and COC at the delivery level. Perception of getting money for healthcare, having blood pressure measured and urine sample taken during ANC was associated with continuity of care at the delivery level and continuity of care at a postpartum level. Birth order, residence, and region were common factors associated with each outcome of interest. The proportion of women who received all ANC4+, SBA, and PNC across the CoC was low in Ethiopia. Effort needed to increase CoC at each stage. The study shows that focusing on place of residence and regional state variation is necessary to improve CoC at each level. Thus, contextualizing the strategies and further research are critical.
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Affiliation(s)
- Eshetu E Chaka
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Lokken EM, Mathur A, Bunge KE, Fairlie L, Makanani B, Beigi R, Noguchi L, Balkus JE. Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3. [PMID: 35187529 PMCID: PMC8856667 DOI: 10.3389/frph.2021.672446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Robust data summarizing the prevalence of pregnancy and neonatal outcomes in low- and middle-income countries are critically important for studies evaluating investigational products for HIV prevention and treatment in pregnant and breastfeeding women. In preparation for studies evaluating the safety of the dapivirine vaginal ring for HIV prevention in pregnancy, we conducted a systematic literature review and meta-analyses to summarize the prevalence of pregnancy and neonatal outcomes in Malawi, South Africa, Uganda, and Zimbabwe. Methods: Ten individual systematic literature reviews were conducted to identify manuscripts presenting prevalence data for 12 pregnancy and neonatal outcomes [pregnancy loss, stillbirth, preterm birth, low birthweight (LBW), neonatal mortality, congenital anomaly, chorioamnionitis, postpartum endometritis, postpartum hemorrhage, gestational hypertension, preeclampsia/eclampsia, and preterm premature rupture of membranes (PPROM)]. Studies included in the meta-analyses were published between January 1, 1998, and July 11, 2018, provided numerator and denominator data to support prevalence estimation, and included women of any HIV serostatus. Random-effects meta-analyses were conducted to estimate the pooled prevalence and 95% confidence interval (CI) for each outcome overall, by country, and by HIV status. Results: A total of 152 manuscripts were included across the 12 outcomes. Overall, the frequency of stillbirth (n = 75 estimates), LBW (n = 68), and preterm birth (n = 67) were the most often reported. However, fewer than 10 total manuscripts reported prevalence estimates for chorioamnionitis, endometritis, or PPROM. The outcomes with the highest pooled prevalence were preterm birth (12.7%, 95%CI 11.2–14.3), LBW (11.7%, 95%CI 10.6–12.9), and gestational hypertension (11.4%, 95%CI 7.8–15.7). Among the outcomes with the lowest pooled prevalence estimates were neonatal mortality (1.7%, 95%CI 1.4–2.1), pregnancy loss [1.9%, 95%CI 1.1–2.8, predominately studies (23/29) assessing losses occurring after the first trimester], PPROM (2.2%, 95%CI 1.5–3.2), and stillbirth (2.5%, 95%CI 2.2–2.7). Conclusions: Although this review identified numerous prevalence estimates for some outcomes, data were lacking for other important pregnancy-related conditions. Additional research in pregnant populations is needed for a thorough evaluation of investigational products, including for HIV prevention and treatment, and to inform better estimates of the burden of adverse pregnancy outcomes globally.
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Affiliation(s)
- Erica M. Lokken
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anya Mathur
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Katherine E. Bunge
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bonus Makanani
- Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Richard Beigi
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lisa Noguchi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jennifer E. Balkus
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- *Correspondence: Jennifer E. Balkus
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Saha P. Design of decision support system incorporating data mining algorithms for strengthening maternal and child health systems: Inclusion of systems-thinking approach. CARDIOMETRY 2021. [DOI: 10.18137/cardiometry.2021.20.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Reduction of maternal and infant mortality rates has been recognisedas one of the important goals of this century. Both coverageimprovement and inequity reduction have been set up asmillennium targets. Despite the availability of effective interventions,maternal and child healthcare conditions are not improvingin developing countries because of inefficiently functioninghealth systems. Knowledge generation about behaviors ofhealth system building blocks on the implementation of severalhealthcare interventions will help policymakers to design situation-specific and strategic interventions. A decision supportsystem has been devised incorporating data mining algorithmswhich would help to understand the condition of maternal andchild healthcare indicators; educational, socio, and economicsituations; healthcare status; and healthcare service blocksand their relationships with each other. In this paper, the designof the DSS has been discussed elaborately. To enhance a system-wide understanding of the healthcare system, all healthcare-related factors have been incorporated into this system.Three knowledge generation modules have been prepared byutilizing different visualization and data mining algorithms.
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Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter? PLoS One 2021; 16:e0259250. [PMID: 34735506 PMCID: PMC8568178 DOI: 10.1371/journal.pone.0259250] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 10/16/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND High maternal mortality ratio in sub-Saharan Africa (SSA) has been linked to inadequate medical care for pregnant women due to limited health facility delivery utilization. Thus, this study, examined the association between age at first childbirth and health facility delivery among women of reproductive age in Nigeria. METHODS The study used the most recent secondary dataset from Nigeria's Demographic and Health Survey (NDHS) conducted in 2018. Only women aged15-49 were considered for the study (N = 34,193). Bi-variate and multivariable logistic regression models were used to examine the association between age at first birth and place of delivery. The results were presented as crude odds ratios and adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p<0.05. RESULTS The results showed that the prevalence of health facility deliveries was 41% in Nigeria. Women who had their first birth below age 20 [aOR = 0.82; 95%(CI = 0.74-0.90)] were less likely to give birth at health facilities compared to those who had their first birth at age 20 and above. CONCLUSION Our findings suggest the need to design interventions that will encourage women of reproductive age in Nigeria who are younger than 20 years to give birth in health facilities to avoid the risks of maternal complications associated with home delivery. Such interventions should include male involvement in antenatal care visits and the education of both partners and young women on the importance of health facility delivery.
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Li Z, Kapoor M, Kim R, Subramanian SV. Association of maternal history of neonatal death with subsequent neonatal death across 56 low- and middle-income countries. Sci Rep 2021; 11:19919. [PMID: 34620895 PMCID: PMC8497561 DOI: 10.1038/s41598-021-97481-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/24/2021] [Indexed: 12/25/2022] Open
Abstract
Early identification of high-risk pregnancies can reduce global neonatal mortality rate. Using the most recent Demographic and Health Surveys from 56 low- and middle-income countries, we examined the proportion of mothers with history of neonatal deaths. Logistic regression models were used to assess the association between maternal history of neonatal death and subsequent neonatal mortality. The adjusted models controlled for socioeconomic, child, and pregnancy-related factors. Country-specific analyses were performed to assess heterogeneity in this association across countries. Among the 437,049 live births included in the study, 6910 resulted in neonatal deaths. In general, 22.4% (1549) occurred to mothers with previous history of neonatal death; at the country-level, this proportion ranged from 1.2% (95% confidence interval [CI] 0.0, 2.6) in Dominican Republic to 38.1% (95% CI 26.0, 50.1) in Niger. Maternal history of neonatal death was significantly associated with subsequent neonatal death in both the pooled and the subgroup analyses. In the fully adjusted model, history of neonatal death was associated with 2.1 (95% CI 1.9, 2.4) times higher odds of subsequent neonatal mortality in the pooled analysis. We observed large variation in the associations across countries ranging from fully adjusted odds ratio (FAOR) of 0.4 (95% CI 0.0, 4.0) in Dominican Republic to 16.1 (95% CI 3.6, 42.0) in South Africa. Our study suggests that maternal history of neonatal death could be an effective early identifier of high-risk pregnancies in resource-poor countries. However, country-specific contexts must be considered in national policy discussions.
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Affiliation(s)
- Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Mudit Kapoor
- Economics and Planning Unit, Indian Statistical Institute (ISI), New Delhi, India
| | - Rockli Kim
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul, 02841, South Korea. .,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea. .,Harvard Center for Population & Development Studies, 9 Bow Street, Cambridge, MA, USA.
| | - S V Subramanian
- Harvard Center for Population & Development Studies, 9 Bow Street, Cambridge, MA, USA. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Fan Y, Ullah I, Rehman A, Hussain A, Zeeshan M. Does tourism increase CO 2 emissions and health spending in Mexico? New evidence from nonlinear ARDL approach. Int J Health Plann Manage 2021; 37:242-257. [PMID: 34536240 DOI: 10.1002/hpm.3322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 07/02/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022] Open
Abstract
This study investigates the nexus between tourism, CO2 emissions and health spending in Mexico. We applied a nonlinear ARDL approach for the empirical analysis for the time period 1996-2018. Mexico receives a large number of tourists each year, tourism improves foreign exchange earnings and contributes positively to the economic growth. However, tourist activities impose a serious environmental cost in terms of CO2 emissions which increase health spending. The empirical findings suggest that tourism leads to CO2 emissions which resultantly causes a high level of health spending in Mexico. Both short-run and long-run findings reported a significant positive association between tourism, CO2 emissions, and health expenditures. Therefore, the government needs legislation to reduce CO2 emissions, besides the use of renewable energy could also help to reduce the CO2 emissions and health expenditures in society. This study does not support to reduce the health expenditure, rather it suggests optimal utilization of the funds allocated to the health sector.
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Affiliation(s)
- Yongxian Fan
- School of Economics, Yunnan University, Kunming, Yunnan, China.,School of Fiscal and Public Management, Yunnan University of Finance and Economics, Kunming, Yunnan, China
| | - Irfan Ullah
- Reading Academy, Nanjing University of Information Science and Technology, Nanjing, China
| | - Alam Rehman
- Faculty of Management Sciences, National University of Modern Languages, Islamabad, Pakistan
| | - Arif Hussain
- Institute of Business Studies and Leadership, Abdul Wali Khan University, Mardan, Pakistan
| | - Muhammad Zeeshan
- College of Business Administration, Liaoning Technical University, XingCheng, China
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Martínez-Osorio J, García-García JJ, Moraga-Llop F, Díaz A, Hernández S, Solé-Ribalta A, González-Peris S, Izquierdo C, Esteva C, Codina G, Planes AM, Uriona S, Campins M, Ciruela P, Salleras L, Domínguez Á, Muñoz-Almagro C, de Sevilla MF. Invasive pneumococcal disease in children under 60 months before and after availability of 13-valent conjugate vaccine. An Pediatr (Barc) 2021; 96:501-510. [PMID: 34238710 DOI: 10.1016/j.anpede.2021.06.005] [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: 02/18/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is the most important bacterial infection in young children, and the introduction of pneumococcal conjugate vaccines has changed its presentation. This study compared the incidence, characteristics and serotype distribution of IPD before and after the introduction of the pneumococcal conjugate vaccine (PCV13). METHODS Prospective enrolment of patients with IPD aged less than 60 months and admitted to either of 2 tertiary care hospitals between January 2007 and December 2009 (pre-PCV13 period) and January 2012 and June-2016 (PCV13 period). RESULTS We identified 493 cases, 319 in the pre-PCV13 period and 174 in the PCV13 period. The incidence of IPD decreased from 89.7 to 34.4 casos per 100 000 habitantes ( -62%; P < .001). This decrease was observed in all forms of disease except necrotising pneumonia (increase from 0.8 to 3.7 casos/100 000 population). There was a significant reduction in all serotypes included in the PCV13 and not included in the PCV7. We did not find significant differences in length of stay, mortality or the frequency of sequelae between both periods, but in the PCV13 period, the length of stay in the paediatric intensive care unit and the duration of mechanical ventilation were longer (P = .00). The incidence of serotype 3 decreased from 10.4 to 6.9 casos per 100 000 population, although it was the serotype involved most frequently in patients with severe disease. CONCLUSIONS After the introduction of the PCV13, there has been a significant decrease in IPD cases. Serotype 3 continues to be an important cause of severe IPD.
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Affiliation(s)
| | - Juan José García-García
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | - Sergi Hernández
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Anna Solé-Ribalta
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | | | - Conchita Izquierdo
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Cristina Esteva
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gemma Codina
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana María Planes
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sonia Uriona
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Magda Campins
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
| | - Luis Salleras
- Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Ángela Domínguez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mariona F de Sevilla
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Martínez-Osorio J, García-García JJ, Moraga-Llop F, Díaz A, Hernández S, Solé-Ribalta A, González-Peris S, Izquierdo C, Esteva C, Codina G, Planes AM, Uriona S, Campins M, Ciruela P, Salleras L, Domínguez Á, Muñoz-Almagro C, de Sevilla MF. [Invasive pneumococcal disease in children under 60 months before and after availability of 13-valent conjugate vaccine]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00206-X. [PMID: 34217675 DOI: 10.1016/j.anpedi.2021.05.018] [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: 02/18/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is the most important bacterial infection in young children, and the introduction of pneumococcal conjugate vaccines has changed its presentation. This study compared the incidence, characteristics and serotype distribution of IPD before and after the introduction of the pneumococcal conjugate vaccine (PCV13). METHODS Prospective enrolment of patients with IPD aged less than 60 months and admitted to either of 2 tertiary care hospitals between January 2007 and December 2009 (pre-PCV13 period) and January 2012 and June-2016 (PCV13 period). RESULTS We identified 493 cases, 319 in the pre-PCV13 period and 174 in the PCV13 period. The incidence of IPD decreased from 89.7 to 34.4 cases per 100,000 population (-62%; P<.001). This decrease was observed in all forms of disease except necrotising pneumonia (increase from 0.8 to 3.7 cases/100,000 population). There was a significant reduction in all serotypes included in the PCV13 and not included in the PCV7. We did not find significant differences in length of stay, mortality or the frequency of sequelae between both periods, but in the PCV13 period, the length of stay in the paediatric intensive care unit and the duration of mechanical ventilation were longer (P=.00). The incidence of serotype 3 decreased from 10.4 to 6.9 cases per 100,000 population, although it was the serotype involved most frequently in patients with severe disease. CONCLUSIONS After the introduction of the PCV13, there has been a significant decrease in IPD cases. Serotype 3 continues to be an important cause of severe IPD.
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Affiliation(s)
| | - Juan José García-García
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
| | | | | | - Sergi Hernández
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, España
| | | | | | - Conchita Izquierdo
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, España
| | - Cristina Esteva
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
| | - Gemma Codina
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Ana María Planes
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Sonia Uriona
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Magda Campins
- Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Pilar Ciruela
- Agència de Salut Pública de Catalunya, Generalitat de Catalunya, Barcelona, España
| | - Luis Salleras
- Departament de Medicina, Universitat de Barcelona, Barcelona, España
| | - Ángela Domínguez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España; Departament de Medicina, Universitat de Barcelona, Barcelona, España
| | - Carmen Muñoz-Almagro
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España; Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, España
| | - Mariona F de Sevilla
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, España
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Genowska A, Strukcinskiene B, Villerusa A, Konstantynowicz J. Converging or diverging trajectories of mortality under one year of age in the Baltic States: a comparison with the European Union. ACTA ACUST UNITED AC 2021; 79:76. [PMID: 33985577 PMCID: PMC8117592 DOI: 10.1186/s13690-021-00598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Information about trends in perinatal and child health inequalities is scarce, especially in the Eastern Europe. We analyzed how mortality under 1 year of age has been changing in the Baltic States and the European Union (EU) over 25 years, and what associations occurred between changes in macroeconomic factors and mortality. METHODS Data on fetal, neonatal, infant mortality, and macroeconomic factors were extracted from WHO database. Joinpoint regression analysis was performed to analyze time trajectories of mortality over 1990-2014. We also investigated how the changes in health expenditures and Gross Domestic Product (GDP) contributed to the changes in mortality. RESULTS The reduction of fetal, neonatal and infant mortality in the Baltic countries led to convergence with the EU. In Estonia this process was the fastest, and then the rates tended to diverge. The strongest effect in reduction of neonatal mortality was related to the annual increase in health expenditure and GDP which had occurred in the same year, and a decrease in fetal mortality associated with an increase in health expenditure and GDP in the 4th and 5th year, respectively, following the initial change. CONCLUSIONS These findings outlined convergences and divergences in mortality under 1 year of age in the Baltic States compared with the patterns of the EU. Our data highlighted a need to define health policy directions aimed at the implementation of effective intervention modalities addressing reduction of risks in prenatal and early life.
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Affiliation(s)
- Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, Bialystok, Poland
| | | | - Anita Villerusa
- Department of Public Health and Epidemiology, Institute of Public Health, Rīga Stradinš University, Rīga, Latvia
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children's Hospital, Bialystok, Poland.
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Tesema GA, Seretew WS, Worku MG, Angaw DA. Trends of infant mortality and its determinants in Ethiopia: mixed-effect binary logistic regression and multivariate decomposition analysis. BMC Pregnancy Childbirth 2021; 21:362. [PMID: 33952208 PMCID: PMC8097868 DOI: 10.1186/s12884-021-03835-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Infant mortality remains a serious global public health problem. The global infant mortality rate has decreased significantly over time, but the rate of decline in most African countries, including Ethiopia, is far below the rate expected to meet the SDG targets. Therefore, this study aimed to investigate the trends of infant mortality and its determinants in Ethiopia based on the four consecutive Ethiopian Demographic and Health Surveys (EDHSs). METHODS This analysis was based on the data from four EDHSs (EDHS 2000, 2005, 2011, and 2016). A total weighted sample of 46,317 live births was included for the final analysis. The logit-based multivariate decomposition analysis was used to identify significantly contributing factors for the decrease in infant mortality in Ethiopia over the last 16 years. To identify determinants, a mixed-effect logistic regression model was fitted. The Intra-class Correlation Coefficient (ICC) and Likelihood Ratio (LR) test were used to assess the presence of a significant clustering effect. Deviance, Akaike Information Criteria (AIC), and Bayesian Information Criteria (BIC) were used for model comparison. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to identify the statistically significant determinants of infant mortality. RESULTS Infant mortality rate has decreased from 96.9 per 1000 births in 2000 to 48 per 1000 births in 2016, with an annual rate of reduction of 4.2%. According to the logit based multivariate decomposition analysis, about 18.1% of the overall decrease in infant mortality was due to the difference in composition of the respondents with respect to residence, maternal age, type of birth, and parity across the surveys, while the remaining 81.9% was due to the difference in the effect of residence, parity, type of birth and parity across the surveys. In the mixed-effect binary logistic regression analysis; preceding interval < 24 months (AOR = 1.79, 95% CI; 1.46, 2.19), small size at birth (AOR = 1.55, 95% CI; 1.25, 1.92), large size at birth (AOR = 1.26, 95% CI; 1.01, 1.57), BMI < 18.5 kg/m2 (AOR = 1.22, 95% CI; 1.05, 1.50), and twins (AOR = 4.25, 95% CI; 3.01, 6.01), parity> 6 (1.51, 95% CI; 1.01, 2.26), maternal age and male sex (AOR = 1.50, 95% CI: 1.25, 1.79) were significantly associated with increased odds of infant mortality. CONCLUSION This study found that the infant mortality rate has declined over time in Ethiopia since 2000. Preceding birth interval, child-size at birth, BMI, type of birth, parity, maternal age, and sex of child were significant predictors of infant mortality. Public health programs aimed at rural communities, and multiparous mothers through enhancing health facility delivery would help maintain Ethiopia's declining infant mortality rate. Furthermore, improving the use of ANC services and maternal nutrition is crucial to reducing infant mortality and achieving the SDG targets in Ethiopia.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia
| | - Wullo Sisay Seretew
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia.
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia
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Li Z, Karlsson O, Kim R, Subramanian SV. Distribution of under-5 deaths in the neonatal, postneonatal, and childhood periods: a multicountry analysis in 64 low- and middle-income countries. Int J Equity Health 2021; 20:109. [PMID: 33902593 PMCID: PMC8077916 DOI: 10.1186/s12939-021-01449-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background As under-5 mortality rates declined all over the world, the relative distribution of under-5 deaths during different periods of life changed. To provide information for policymakers to plan for multi-layer health strategies targeting child health, it is essential to quantify the distribution of under-5 deaths by age groups. Methods Using 245 Demographic and Health Surveys from 64 low- and middle-income countries conducted between 1986 and 2018, we compiled a database of 2,437,718 children under-5 years old with 173,493 deaths. We examined the share of deaths that occurred in the neonatal (< 1 month), postneonatal (1 month to 1 year old), and childhood (1 to 5 years old) periods to the total number of under-5 deaths at both aggregate- and country-level. We estimated the annual change in share of deaths to track the changes over time. We also assessed the association between share of deaths and Gross Domestic Product (GDP) per capita. Results Neonatal deaths accounted for 53.1% (95% confidence interval [CI]: 52.7, 53.4) of the total under-5 deaths. The neonatal share of deaths was lower in low-income countries at 44.0% (43.5, 44.5), and higher in lower-middle-income and upper-middle income countries at 57.2% (56.8, 57.6) and 54.7% (53.8, 55.5) respectively. There was substantial heterogeneity in share of deaths across countries; for example, the share of neonatal to total under-5 deaths ranged from 20.9% (14.1, 27.6) in Eswatini to 82.8% (73.0, 92.6) in Dominican Republic. The shares of deaths in all three periods were significantly associated with GDP per capita, but in different directions—as GDP per capita increased by 10%, the neonatal share of deaths would significantly increase by 0.78 percentage points [PPs] (0.43, 1.13), and the postneonatal and childhood shares of deaths would significantly decrease by 0.29 PPs (0.04, 0.54) and 0.49 PPs (0.24, 0.74) respectively. Conclusions Along with the countries’ economic development, an increasing proportion of under-5 deaths occurs in the neonatal period, suggesting a need for multi-layer health strategies with potentially heavier investment in newborn health. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01449-8.
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Affiliation(s)
- Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Omar Karlsson
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.,Department of Economic History, School of Economics and Management, Lund University, P.O. Box 7083, 220 07, Lund, Sweden
| | - Rockli Kim
- Division of Health Policy & Management, College of Health Science, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, South Korea.,Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, 02841, South Korea.,Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. .,Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA.
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Macharia PM, Joseph NK, Sartorius B, Snow RW, Okiro EA. Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993-2014. BMJ Glob Health 2021; 6:e004544. [PMID: 33858833 PMCID: PMC8054106 DOI: 10.1136/bmjgh-2020-004544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To 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. METHODS Twenty 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. RESULTS Nationally, 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. CONCLUSION The 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.
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Affiliation(s)
- Peter M Macharia
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K Joseph
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Robert W Snow
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Allel K, Abou Jaoude G, Poupakis S, Batura N, Skordis J, Haghparast-Bidgoli H. Exploring the Associations between Early Childhood Development Outcomes and Ecological Country-Level Factors across Low- and Middle-Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3340. [PMID: 33804888 PMCID: PMC8037361 DOI: 10.3390/ijerph18073340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 12/03/2022]
Abstract
A poor start in life shapes children's development over the life-course. Children from low- and middle-income countries (LMICs) are exposed to low levels of early stimulation, greater socioeconomic deprivation and persistent environmental and health challenges. Nevertheless, little is known about country-specific factors affecting early childhood development (ECD) in LMICs. Using data from 68 LMICs collected as part of the Multiple Indicator Cluster Surveys between 2010 and 2018, along with other publicly available data sources, we employed a multivariate linear regression analysis at a national level to assess the association between the average Early Childhood Development Index (ECDI) in children aged 3-5 and country-level ecological characteristics: early learning and nurturing care and socioeconomic and health indicators. Our results show that upper-middle-income country status, attendance at early childhood education (ECE) programs and the availability of books at home are positively associated with a higher ECDI. Conversely, the prevalence of low birthweight and high under-5 and maternal mortality are negatively associated with ECDI nationally. On average, LMICs with inadequate stimulation at home, higher mortality rates and without mandatory ECE programs are at greater risks of poorer ECDI. Investment in early-year interventions to improve nurturing care and ECD outcomes is essential for achieving Sustainable Development Goals.
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Affiliation(s)
- Kasim Allel
- Institute for Global Health, University College London, London WC1E 6BT, UK; (G.A.J.); (S.P.); (N.B.); (J.S.); (H.H.-B.)
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Kassaw MW, Abebe AM, Abate BB, Masresha SA, Kassie AM, Adisu MA. Evidence from 2016 Ethiopian demographic and health survey data: association between post health education maternal knowledge and neonatal danger signs. BMC Pregnancy Childbirth 2021; 21:195. [PMID: 33750345 PMCID: PMC7941894 DOI: 10.1186/s12884-021-03681-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background Globally, 4 million infants die in their first 4weeks of life every year; above 8 million infants died before their first year of birthday, and nearly 10 million children died before their 5th birthday. Majority of the deaths were occurred at home because of not receiving health care. In Ethiopia, 120,000 infants died during their first 4 weeks of life. The aim of this study was to assess maternal knowledge about neonatal danger signs and its associations after they had been thought by health professionals in Ethiopia. Methods This study used the 2016 Ethiopian Demographic and Health Survey data (EDHS) as a data source. The 2016 EDHS data were collected using a two stage sampling method. All the regions were stratified into urban and rural areas. The study sample taken from the 2016 EDHS data and used in this further analysis was 325. A logistic regression model was used to assess the associations with post health education maternal knowledge on neonatal danger signs. Results In this study, mothers who had poor knowledge about neonatal danger signs (NDS) were 69.8 % (227) (95 %CI (64.8, 74.8 %). In the final logistic model, wanted no more child ((AOR = 4.15), (95 %CI = 1.12, 15.41)), female child ((AOR = 0.58), (95 %CI = 0.34, 0.98)), primary level maternal education ((AOR = 0.42), (95 %CI = 0.19, 0.92)), secondary level maternal education ((AOR = 0.37), (95 %CI = 0.16, 0.91)), and average size of child ((AOR = 2.64), (95 %CI = 1.26, 5.53)), and small size child ((AOR = 4.53), (95 %CI = 1.52, 13.51)) associated with post health education maternal knowledge about NDS. Conclusion The mothers’ knowledge about NDS is poor even they were gave a birth in health facilities. Wanting of additional child, child sex, maternal education and size of child were associated with NDS knowledge. This indicates that the mode of health education provided for mother might not be appropriate and needs protocol changes.
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Affiliation(s)
- Mesfin Wudu Kassaw
- Department of nursing, college of health science, Woldia University, P.O Box 400, Woldia, Ethiopia.
| | - Ayele Mamo Abebe
- Department of nursing, college of health science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Biruk Beletew Abate
- Department of nursing, college of health science, Woldia University, P.O Box 400, Woldia, Ethiopia
| | | | - Ayelign Mengesha Kassie
- Department of nursing, college of health science, Woldia University, P.O Box 400, Woldia, Ethiopia
| | - Molalign Aligaz Adisu
- Department of nursing, college of health science, Woldia University, P.O Box 400, Woldia, Ethiopia
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Evaluating equality in prescribing Novel Oral Anticoagulants (NOACs) in England: The protocol of a Bayesian small area analysis. PLoS One 2021; 16:e0246253. [PMID: 33539391 PMCID: PMC7861433 DOI: 10.1371/journal.pone.0246253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 01/18/2021] [Indexed: 12/05/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting about 1.6% of the population in England. Novel oral anticoagulants (NOACs) are approved AF treatments that reduce stroke risk. In this study, we estimate the equality in individual NOAC prescriptions with high spatial resolution in Clinical Commissioning Groups (CCGs) across England from 2014 to 2019. Methods A Bayesian spatio-temporal model will be used to estimate and predict the individual NOAC prescription trend on ‘prescription data’ as an indicator of health services utilisation, using a small area analysis methodology. The main dataset in this study is the “Practice Level Prescribing in England,” which contains four individual NOACs prescribed by all registered GP practices in England. We will use the defined daily dose (DDD) equivalent methodology, as recommended by the World Health Organization (WHO), to compare across space and time. Four licensed NOACs datasets will be summed per 1,000 patients at the CCG-level over time. We will also adjust for CCG-level covariates, such as demographic data, Multiple Deprivation Index, and rural-urban classification. We aim to employ the extended BYM2 model (space-time model) using the RStan package. Discussion This study suggests a new statistical modelling approach to link prescription and socioeconomic data to model pharmacoepidemiologic data. Quantifying space and time differences will allow for the evaluation of inequalities in the prescription of NOACs. The methodology will help develop geographically targeted public health interventions, campaigns, audits, or guidelines to improve areas of low prescription. This approach can be used for other medications, especially those used for chronic diseases that must be monitored over time.
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Tesema GA, Teshale AB. Residential inequality and spatial patterns of infant mortality in Ethiopia: evidence from Ethiopian Demographic and Health Surveys. Trop Med Health 2021; 49:8. [PMID: 33499956 PMCID: PMC7839209 DOI: 10.1186/s41182-021-00299-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background Despite the remarkable decrease in infant mortality rate in most countries, the rate of decline is slow and it remains unacceptably high in Sub-Saharan Africa. The progress in infant mortality in Ethiopia is far below the rate needed to achieve the Sustainable Development Goal. Understanding the residential inequality and spatiotemporal clusters of infant mortality is essential to prioritize areas and guide public health interventions. Therefore, this study aimed to investigate the residential inequality and spatial patterns of infant mortality in Ethiopia. Methods A secondary data analysis was done based on the Ethiopian demographic and health surveys conducted in 2000, 2005, 2011, and 2016. A total weighted sample of 46,317 live births was included for the final analysis. The residential inequality was assessed by calculating the risk difference in infant mortality rates between urban and rural live births and presented using a forest plot. For the spatial patterns of infant mortality, the SaTScan version 9.6 and ArcGIS version 10.6 statistical software were used to identify the spatial patterns of infant mortality. Results The study revealed that the infant mortality rate significantly declined from 96.9 per 1000 live births [95% CI 93.6, 104.2] in 2000 to 48.0 per 1000 live births [95% CI 44.2, 52.2] in 2016 with an annual rate of reduction of 3.2%. The infant mortality rate has substantial residential inequality over time, which is concentrated in the rural area. The spatial distribution of infant mortality was significantly clustered at the national level in survey periods (global Moran’s I, 0.04–0.081, p value < 0.05). In 2000, the most likely clusters were found in east Afar and at the border areas of south Amhara and north Oromia regions (LLR = 7.61, p value < 0.05); in 2005, at the border areas of Southern Nations Nationalities and People and in the entire Amhara region (LLR = 10.78, p value< 0.05); in 2011, at Southern Nations Nationalities and People and Gambella regions (LLR = 6.63, p value< 0.05); and in 2016, at east Oromia and northeast Somali regions (LLR = 8.38, p value < 0.05). Conclusion In this study, though infant mortality has shown remarkable reduction, infant mortality remains a major health care concern and had significant spatial variation across regions. Besides, the study found that infant mortality was highly concentrated in rural areas. Identifying the hotspot areas of infant mortality would help in designing effective interventions to reduce the incidence of infant mortality in these areas. Therefore, the findings highlighted that public health interventions should target rural areas and identified hotspot areas to reduce the incidence of infant mortality.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Botchway MT, Kruger D, Manful CA, Grieve A. The scope of operative general paediatric surgical diseases in South Africa—the Chris Hani Baragwanath experience. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-020-00052-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
Background
Infectious diseases have always been the lime light of global health with very little focus on childhood surgical conditions despite the fact that children constitute about half of the population in LMICs. A significant proportion of the burden of global disease can be reduced by surgical intervention. South Africa is one of the pioneers of the practice of paediatric surgery in Africa with a great burden of paediatric surgical conditions.
Few studies, if any, have investigated the burden of operative paediatric surgical procedures in South Africa. Therefore, this retrospective study aimed to look at the scope of operative paediatric surgical procedures at the Chris Hani Baragwanath Academic Hospital (CHBAH) based in Johannesburg, South Africa, and reports on the numbers of elective and emergency procedures over a 12-month study period.
Results
There were 1699 operative general paediatric surgical procedures of which 61.7% were electives and 38.3% were emergencies. The scope of general paediatric surgical conditions operated on fell under the categories of congenital anomalies, infections and tumours. Of these, surgeries for congenital anomalies were performed in almost all the subspecialties.
Conclusion
There is a high operative paediatric surgical burden at the CHBAH. The role of paediatric surgical care as an essential component of global health cannot be underrated.
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Abe Y, Ochiai D, Sato Y, Otani T, Fukutake M, Ikenoue S, Kasuga Y, Tanaka M. Amniotic fluid stem cells as a novel strategy for the treatment of fetal and neonatal neurological diseases. Placenta 2021; 104:247-252. [PMID: 33461069 DOI: 10.1016/j.placenta.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/26/2020] [Accepted: 01/08/2021] [Indexed: 01/26/2023]
Abstract
Even in the context of modern medicine, infants with fetal and neonatal neurological diseases such as cerebral palsy and myelomeningocele suffer serious long-lasting impairment due to the irreversible neuronal damage. The promotion of neurologically intact survival in patients with perinatal intractable neurological diseases requires the development of novel strategies. One promising strategy involves the use of human amniotic fluid stem cells (hAFSCs), which have attracted much attention in recent years and are known to exert anti-inflammatory and neuroprotective effects. In recent years, the therapeutic effects of hAFSCs on fetal-neonatal neurological diseases have become evident as per intense research efforts by our group and others. Specifically, hAFSCs administered into the nasal cavity migrated to the brain and controlled local inflammation in a rodent model of neonatal hypoxic-ischemic encephalopathy. In contrast, hAFSCs administered intraperitoneally did not migrate to the brain; they rather formed spheroids in the abdominal cavity, resulting in the suppression of systemic inflammation (including in the brain) via the secretion of anti-inflammatory cytokines in concert with peritoneal macrophages in a rodent model of periventricular leukomalacia. Moreover, studies in a rat model of myelomeningocele suggested that hAFSCs administered in utero secreted hepatocyte growth factor and protected the exposed spinal cord during pregnancy. Importantly, autologous hAFSCs, whose use for fetal-neonatal treatment does not raise ethical issues, can be collected during pregnancy and prepared in sufficient numbers for therapeutic use. This article outlines the results of preclinical research on fetal stem cell therapy, mainly involving hAFSCs, in the context of perinatal neurological diseases.
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Affiliation(s)
- Yushi Abe
- Department of Obstetrics & Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daigo Ochiai
- Department of Obstetrics & Gynecology, Keio University School of Medicine, Tokyo, Japan.
| | - Yu Sato
- Department of Obstetrics & Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Toshimitsu Otani
- Department of Obstetrics & Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Marie Fukutake
- Department of Obstetrics & Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Satoru Ikenoue
- Department of Obstetrics & Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Kasuga
- Department of Obstetrics & Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Tanaka
- Department of Obstetrics & Gynecology, Keio University School of Medicine, Tokyo, Japan
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Abstract
Sickle hepatopathy is an umbrella term describing various pattern of liver injury seen in patients with sickle cell disease. The disease is not uncommon in India; in terms of prevalence, India is second only to Sub-Saharan Africa where sickle cell disease is most prevalent. Hepatic involvement in sickle cell disease is not uncommon. Liver disease may result from viral hepatitis and iron overload due to multiple transfusions of blood products or due to disease activity causing varying changes in vasculature. The clinical spectrum of disease ranges from ischemic injury due to sickling of red blood cells in hepatic sinusoids, pigment gall stones, and acute/chronic sequestration syndromes. The sequestration syndromes are usually episodic and self-limiting requiring conservative management such as antibiotics and intravenous fluids or packed red cell transfusions. However, rarely these episodes may present with coagulopathy and encephalopathy like acute liver failure, which are life-threatening, requiring exchange transfusions or even liver transplantation. However, evidence for their benefits, optimal indications, and threshold to start exchange transfusion is limited. Similarly, there is paucity of the literature regarding the end point of exchange transfusion in this scenario. Liver transplantation may also be beneficial in end-stage liver disease. Hydroxyurea, the antitumor agent, which is popularly used to prevent life-threatening complications such as acute chest syndrome or stroke in these patients, has been used only sparingly in hepatic sequestrations. The purpose of this review is to provide insights into epidemiology of sickle cell disease in India and pathogenesis and classification of hepatobiliary involvement in sickle cell disease. Finally, various management options including exchange transfusion, liver transplantation, and hydroxyurea in hepatic sequestration syndromes will be discussed in brief.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- ACLF, Acute on chronic liver failure
- ALF, Acute liver failure
- ALT, Alanine transaminase
- AST, Aspartate transaminase
- FFP, Fresh frozen plasma
- GIT, Gastrointestinal tract
- HAV, Hepatitis A virus
- HBV, Hepatitis B virus
- HCV, Hepatitis C virus
- HEV, Hepatitis E virus
- HIC, Hepatic iron content
- HbS, Sickle hemoglobin
- HbSS, Sickle cell disease homozygous
- INR, International normalized ratio
- PT, Prothrombin time
- RUQ, Right upper quadrant
- SC, Scheduled caste
- SCD, Sickle cell disease
- SCIC, Sickle cell intrahepatic cholestasis
- ST, Scheduled tribe
- TJLB, Transjugular liver biopsy
- UDCA, Ursodeoxycholic acid
- cholelithiasis
- intrahepatic cholestasis
- sickle cell hepatopathy
- sickle cholangiopathy
- sickle hepatic crisis
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Affiliation(s)
| | - Anil C. Anand
- Address for correspondence. Anil C Anand, Professor and Head, Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences, Bhubneshwar, India.
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Philip M, Ramu R, Prasannan RV, Thomas M, James N, V. KB. Mothers' Knowledge of Childhood Neurodevelopmental Disorders: Indian Perspective. J Neurosci Rural Pract 2021; 12:165-170. [PMID: 33531777 PMCID: PMC7846324 DOI: 10.1055/s-0040-1722094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives This study aims to assess the knowledge of childhood neurodevelopmental disorders (CNDDs) among mothers of children younger than 5 years and to promote awareness through health education to promote early identification. Methods Quantitative approach, a descriptive survey in nature research design, was used. A total of 173 mothers who contented the inclusion conditions were chosen as sample on the basis of purposive sampling. The research study was done at the selected Primary Health Centre, Bengaluru, Karnataka. The tabulations were measured and construed based on the objectives of the study by using descriptive and inferential statistics. Results The findings showed that most of the mothers have insufficient knowledge (mean and standard deviation: 3.02 ± 2.75) and there is no substantial relationship found between mothers' knowledge on CNDD and their demographic variables except their occupation and majority of the mothers communicated that they needed further facts toward CNDD. Conclusion The government and nongovernmental organizations can take initiations to conduct health education programs toward childhood developmental delays and disorders for the general public including mothers and community health workers.
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Affiliation(s)
- Maria Philip
- College of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rajalakshmi Ramu
- College of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Rakhi V. Prasannan
- College of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Merin Thomas
- College of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Ninitha James
- College of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Kathyayani B. V.
- College of Nursing, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Ahinkorah BO, Seidu AA, Budu E, Armah-Ansah EK, Agbaglo E, Adu C, Hagan JE, Yaya S. Proximate, intermediate, and distal predictors of under-five mortality in Chad: analysis of the 2014-15 Chad demographic and health survey data. BMC Public Health 2020; 20:1873. [PMID: 33287797 PMCID: PMC7720533 DOI: 10.1186/s12889-020-09869-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Under-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972. Despite this decline in the mortality trend, for every six children in Chad, one dies before the age of five. This study, therefore, investigated the proximate, intermediate, and distal determinants of under-five mortality in Chad. METHODS We used data from the 2014-15 Chad's Demographic and Health Survey. Data of 7782 children below 5 years were used for the study. Both descriptive and multivariable hierarchical logistic regression analyses were performed. Statistical significance was declared at p < 0.05. RESULTS Under-five mortality was found to be 130 deaths per 1000 live births in Chad, with variations across the various population sub-groups. For distal predictors, the likelihood of death was higher in children born in the FChari Baguirmi region (AOR = 3.83, 95% CI: 1.81-8.14). Children whose mothers belonged to the Baguirmi/Barma ethnic group (AOR = 8.04, 95% CI: 1.75-36.99) were more likely to die before the age of five. On the contrary, the likelihood of under-five mortality was low among children born in rural areas (AOR = 0.73, 95% CI: 0.55-0.97). With the intermediate predictors, the likelihood of under-five deaths was higher among children whose mothers had no formal education (AOR = 1.72, 95% CI: 1.06-2.77). Regarding the proximate predictors, the odds of under-five deaths was higher among male children (AOR = 1.03, 95% CI: 1.05-1.63) and first rank children (AOR = 1.58, 95% CI: 1.13-2.21). CONCLUSION The study found that the determinants of under-five mortality in Chad are region of residence, place of residence, ethnicity, education, sex of child, and birth rank. These findings show that both socio-economic and proximate factors explain the disparities in under-five mortality in Chad. The identification of these factors can be pivotal towards the design of evidence-based interventions intended to improve child survival. Therefore, improving maternal education while refocusing and re-packaging existing strategies to target selected sub-regional populations with high under-five mortality is urgently required.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, UK
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