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Levano SR, Kraemer J, Dabla D, Miziou EA, Haughton J, Jones HE, Teasdale C, Ekouevi D, Hirschhorn LR, Fiori KP. Identifying determinants of under-five child mortality in northern Togo. J Glob Health 2024; 14:04019. [PMID: 38299779 PMCID: PMC10832555 DOI: 10.7189/jogh.14.04019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background Although global rates of under-five mortality have declined, many low- and middle-income countries (LMICs), including Togo, have not achieved sufficient progress. We aimed to identify the structural and intermediary determinants associated with under-five mortality in northern Togo. Methods We collected population-representative cross-sectional household surveys adapted from the Demographic Household Survey (DHS) and Multiple Indicator Cluster Survey from women of reproductive age in northern Togo in 2018. The primary outcome was under-five mortality for children born to respondents in the 10-year period prior to the survey. We selected structural and intermediary determinants of health from the World Health Organization Conceptual Framework for Action on the Social Determinants of Health. We estimated associations between determinants and under-five mortality for births in the last 10 years (model 1 and 2) and two years (model 3) using Cox proportional hazards models. Results Of the 20 121 live births in the last 10 years, 982 (4.80%) children died prior to five years of age. Prior death of a sibling (adjusted hazard ratio (aHR) = 5.02; 95% confidence interval (CI) = 4.23-5.97), maternal ethnicity (i.e. Konkomba, Temberma, Lamba, Losso, or Peul), multiple birth status (aHR = 2.27; 95% CI = 1.78-2.90), maternal age under 25 years (women <19 years: aHR = 2.05; 95% CI = 1.75-2.39; women 20-24 years: aHR = 1.48; 95% CI = 1.29-1.68), lower birth interval (aHR = 1.51; 95% CI = 1.31-1.74), and higher birth order (second or third born: aHR = 1.45; 95% CI = 1.32-1.60; third or later born: aHR = 2.14; 95% CI = 1.74-2.63) were associated with higher hazard of under-five mortality. Female children had lower hazards of under-five mortality (aHR = 0.80; 95% CI = 0.73-0.89). Under-five mortality was also lower for children born in the last two years (n = 4852) whose mothers received any (aHR = 0.48; 95% CI = 0.30-0.78) or high quality (aHR = 0.51; 95% CI = 0.29-0.88) prenatal care. Conclusion Compared to previous DHS estimates, under-five mortality has decreased in Togo, but remains higher than other LMICs. Prior death of a sibling and several intermediary determinants were associated with a higher risk of mortality, while receipt of prenatal care reduced that risk. These findings have significant implications on reducing disparities related to mortality through strengthening maternal and child health care delivery.
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Affiliation(s)
- Samantha R Levano
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John Kraemer
- Department of Health Management and Policy, Georgetown University School of Health, Washington D.C., USA
| | - Désiré Dabla
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
| | - Essodinam Agnes Miziou
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
| | - Jessica Haughton
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Heidi E Jones
- Department of Epidemiology and Biostatistics, City University of New York Graduate School of Public Health and Health Policy, New York, USA
- CUNY Institute of Implementation Science in Population Health, New York, USA
| | - Chloe Teasdale
- Department of Epidemiology and Biostatistics, City University of New York Graduate School of Public Health and Health Policy, New York, USA
| | - Didier Ekouevi
- Department of Public Health, Health Sciences Faculty, University of Lomé, Lomé, Togo
- African Research Center in Epidemiology and Public Health, Lomé, Togo
| | - Lisa R Hirschhorn
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kevin P Fiori
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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Isaacson A, Diseko M, Mayondi G, Mabuta J, Davey S, Mmalane M, Makhema J, Jacobson DL, Luckett R, Shapiro RL, Zash R. Prevalence and outcomes of twin pregnancies in Botswana: a national birth outcomes surveillance study. BMJ Open 2021; 11:e047553. [PMID: 34675010 PMCID: PMC8532549 DOI: 10.1136/bmjopen-2020-047553] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the prevalence and outcome of twin pregnancies in Botswana. SETTING The Tsepamo Study conducted birth outcomes surveillance at 8 government-run hospitals (~45% of all births in Botswana) from August 2014 to June 2018 and expanded to 18 hospitals (~70% of all births in Botswana) from July 2018 to March 2019. PARTICIPANTS Data were collected for all live-born and stillborn in-hospital deliveries with a gestational age (GA) greater than 24 weeks. This analysis included 117 593 singleton and 3718 twin infants (1859 sets (1.6%)) born to 119 477 women between August 2014 and March 2019 and excluded 73 higher order multiples (23 sets of triplets and 1 set of quadruplets). OUTCOMES MEASURED Our primary outcomes were preterm delivery (<37 weeks GA), very preterm delivery (<32 weeks GA) and stillbirth (APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score of 0, 0, 0). RESULTS Women with twin pregnancies had a similar median number of antenatal care visits (9 vs 10), but were more likely to deliver in a tertiary centre (54.8% vs 45.1%, p<0.001) and more likely to have a cesarean-section (54.6% vs 22.0%, p<0.001) than women with singletons. Compared with singletons, twin pregnancies had a higher risk of preterm delivery (<37 weeks GA) (47.6% vs 16.7%, adjusted risk ratio (aRR) 2.8, 95% CI 2.7 to 2.9) and very preterm delivery (<32 weeks) (11.8% vs 4.0%, aRR 3.0 95% CI 2.6 to 3.4). Among all twin pregnancies, 128 (6.9%) had at least one stillborn infant compared with 2845 (2.4%) stillbirths among singletons (aRR 2.8, 95% CI 2.3 to 3.3). CONCLUSION Adverse birth outcomes are common among twins in Botswana, and are often severe. Interventions that allow for earlier identification of twin gestation and improved antenatal management of twin pregnancies may improve infant and child survival.
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Affiliation(s)
- Arielle Isaacson
- Harvard Medical School, Boston, Massachusetts, USA
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Modiegi Diseko
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Gloria Mayondi
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Judith Mabuta
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Sonya Davey
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mompati Mmalane
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Denise L Jacobson
- Center for Biostatistics and AIDS Research, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Luckett
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Roger L Shapiro
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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The Guinea-Bissau Twin Registry Update: A Platform for Studying Twin Mortality and Metabolic Disease. Twin Res Hum Genet 2019; 22:554-560. [PMID: 31317858 DOI: 10.1017/thg.2019.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sub-Saharan Africa has the highest natural twinning rate in the world. Unfortunately, due to lack of adequate care during pregnancy, labor and postnatally, twin mortality in Sub-Saharan Africa also remains very high. Thus, it has been estimated that one in five twins dies during the childhood years. In spite of this, surprisingly few twin studies have been conducted in the region, making additional epidemiological data much needed. In 2009, we established one of the first twin registries in Sub-Saharan Africa at the Bandim Health Project in Guinea-Bissau. The registry had two main objectives. First, we wanted to describe the twinning rate and mortality patterns among newborn twins, including mortality risk factors and hospitalization patterns. Such studies can help the local clinicians improve twin health by identifying the most vulnerable children. Second, and in light of the rapidly increasing diabetes rates in Africa, we wanted to use the registry to particularly focus on metabolic disorders. Twins are often born with low birth weight, which according to the 'thrifty phenotype hypothesis' could predispose them to metabolic disorders later in life. Yet, no such 'fetal programming' data have previously been available from African twins despite the fact that nutritional patterns and influences from other factors (e.g., infections) could be markedly different here compared to high-income settings. In this article, we summarize the findings and current status of the Guinea-Bissau twin registry.
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