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Azevedo JP, Banerjee A, Wilmoth J, Fu H, You D. Hard truths about under-5 mortality: call for urgent global action. Lancet 2024; 404:506-508. [PMID: 38492579 DOI: 10.1016/s0140-6736(24)00501-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Affiliation(s)
- João Pedro Azevedo
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY 10017, USA
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Aging Department, World Health Organization, Geneva, Switzerland
| | - John Wilmoth
- Population Division, Department of Economic and Social Affairs, United Nations, New York, NY, USA
| | - Haishan Fu
- Development Data Group, World Bank Group, Washington, DC, USA
| | - Danzhen You
- Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY 10017, USA.
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Roberts JM, Abimbola S, Bale TL, Barros A, Bhutta ZA, Browne JL, Celi AC, Dube P, Graves CR, Hollestelle MJ, Hopkins S, Khashan A, Koi-Larbi K, Lackritz E, Myatt L, Redman CWG, Tunçalp Ö, Vermund SH, Gravett MG. Global inequities in adverse pregnancy outcomes: what can we do? AJOG GLOBAL REPORTS 2024; 4:100385. [PMID: 39253028 PMCID: PMC11381988 DOI: 10.1016/j.xagr.2024.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
The Health Equity Leadership & Exchange Network states that "health equity exists when all people, regardless of race, sex, sexual orientation, disability, socioeconomic status, geographic location, or other societal constructs, have fair and just access, opportunity, and resources to achieve their highest potential for health." It is clear from the wide discrepancies in maternal and infant mortalities, by race, ethnicity, location, and social and economic status, that health equity has not been achieved in pregnancy care. Although the most obvious evidence of inequities is in low-resource settings, inequities also exist in high-resource settings. In this presentation, based on the Global Pregnancy Collaboration Workshop, which addressed this issue, the bases for the differences in outcomes were explored. Several different settings in which inequities exist in high- and low-resource settings were reviewed. Apparent causes include social drivers of health, such as low income, inadequate housing, suboptimal access to clean water, structural racism, and growing maternal healthcare deserts globally. In addition, a question is asked whether maternal health inequities will extend to and be partially due to current research practices. Our overview of inequities provides approaches to resolve these inequities, which are relevant to low- and high-resource settings. Based on the evidence, recommendations have been provided to increase health equity in pregnancy care. Unfortunately, some of these inequities are more amenable to resolution than others. Therefore, continued attention to these inequities and innovative thinking and research to seek solutions to these inequities are encouraged.
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Affiliation(s)
- James M Roberts
- Departments of Obstetrics, Gynecology, and Reproductive Sciences, Epidemiology, and Clinical and Translational Research, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA (Roberts)
| | - Seye Abimbola
- The University of Sydney School of Public Health, Camperdown, Australia (Abimbola)
| | - Tracy L Bale
- Department of Psychiatry, The University of Colorado Anschutz Medical Campus, Aurora, CO (Bale)
| | - Aluisio Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil (Barros)
| | - Zulfiqar A Bhutta
- Departments of Paediatrics, Nutritional Sciences, and Public Health, University of Toronto, Toronto, Ontario, Canada (Bhutta)
| | - Joyce L Browne
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (Browne)
| | - Ann C Celi
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Celi)
| | - Polite Dube
- Cordaid Ethiopia Office, Addis Abada, Ethiopia (Dube)
| | - Cornelia R Graves
- Tennessee Maternal Fetal Medicine, University of Tennessee College of Medicine and Ascension Health, Nashville, TN (Graves)
| | - Marieke J Hollestelle
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (Hollestelle)
| | - Scarlett Hopkins
- Department of Obstetrics and Gynecology, Oregon Health & Science University School of Nursing, Portland, OR (Hopkins)
| | - Ali Khashan
- INFANT Research Centre, School of Public Health, University College Cork, Cork, Ireland (Khashan)
| | | | - Eve Lackritz
- Rosebud Indian Health Service Hospital, Rosebud, SD (Lackritz)
- Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis, MN (Lackritz)
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, Moore Institute of Nutrition and Wellness, Oregon Health & Science University, Portland, OR (Myatt)
| | - Christopher W G Redman
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom (Redman)
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland (Tunçalp)
| | - Sten H Vermund
- Department of Pediatrics, School of Public Health, Yale University, New Haven, CT (Vermund)
| | - Michael G Gravett
- Departments of Obstetrics and Gynecology and Global Health, University of Washington, Seattle, WA (Gravett)
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Laillou A, Nanama S, Hussen A, Ntambi J, Baye K. Should we prioritise children 6-23 months of age for vitamin A supplementation? Case study of West and Central Africa. BMJ Nutr Prev Health 2024; 7:88-94. [PMID: 38966108 PMCID: PMC11221273 DOI: 10.1136/bmjnph-2023-000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/23/2024] [Indexed: 07/06/2024] Open
Abstract
Background Vitamin A (VA) supplementation has been associated with reductions of all-cause child mortality. Child mortality amenable to VA, particularly related to infectious diseases, may be age dependent; hence, the beneficial effect of VA supplementation may differ between younger and older children. We aimed to estimate the all-cause child mortality disaggregated by younger and older than 2 years of age and estimate the contribution of VA supplementation in preventing child death in West and Central Africa. Methods Using the most recent (post-2010) cross-sectional Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we analysed child-level data (n=187 651) from 20 West and Central African countries. Age-specific (all-cause) mortality rates were estimated using survival analyses. Age-specific VA supplementation coverage was linked with the age-specific all-cause child mortality to estimate the contribution of the supplementation in averting child death. Results The cost per averted child death was also estimated using an average cost of US$1.2/child and VA supplementation coverage which ranged from 14% in Cote d'Ivoire to 81% in the Gambia. About 75% of the under-5 mortality occurred in the first 2 years of life. The share of excess (all-cause) mortality averted by VA supplementation was significantly higher in the first 2 years of life. A mean reduction of 7.1 deaths/1000 live births was estimated for children 6-23 months, compared to a reduction of 2.5 deaths/1000 live births for older children (24-59 months). The mean cost/averted child death for the 20 countries was 2.8 times lower for the 6-23 than the 24-59 months age group. Conclusion Prioritising VA supplementation for children in the first 2 years of life could be more cost-effective than when implemented among 6-59 months of age.
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Affiliation(s)
- Arnaud Laillou
- Nutrition Section, UNICEF West and Central Africa Region, Dakar, Senegal
| | - Simeon Nanama
- Nutrition Section, UNICEF West and Central Africa Region, Dakar, Senegal
| | - Alemayehu Hussen
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - John Ntambi
- Nutrition Section, UNICEF West and Central Africa Region, Dakar, Senegal
| | - Kaleab Baye
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Research Center for Inclusive Development in Africa, Addis Ababa, Ethiopia
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Qureshi Z. Medical education is still complicit in poor healthcare outcomes for ethnic minority patients. BMJ 2023; 383:2760. [PMID: 37996107 DOI: 10.1136/bmj.p2760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
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Vidaletti LP, Cata-Preta BO, Phillips DE, Shekhar S, Barros AJD, Victora CG. Time trends in ethnic inequalities in child health and nutrition: analysis of 59 low and middle-income countries. Int J Equity Health 2023; 22:76. [PMID: 37118789 PMCID: PMC10148503 DOI: 10.1186/s12939-023-01888-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/06/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Although ethnicity is a key social determinant of health, there are no global analyses aimed at identifying countries that succeeded in reducing ethnic gaps in child health and nutrition. METHODS We identified 59 low and middle-income countries with at least two surveys since 2010 providing information on ethnicity or language and on three outcomes: under-five mortality, child stunting prevalence and a composite index (CCI) based on coverage with eight maternal and child health interventions. Firstly, we calculated population-weighted and unweighted measures of inequality among ethnic or language groups within each country. These included the mean difference from the overall national mean (absolute inequality), mean ratio relative to the overall mean (relative inequality), and the difference and ratio between the best- and worst-performing ethnic groups. Second, we examined annual changes in these measures in terms of annual absolute and relative changes. Thirdly, we compared trends for each of the three outcome indicators and identified exemplar countries with marked progress in reducing inequalities. RESULTS For each outcome indicator, annual changes in summary measures tended to show moderate (Pearson correlation coefficients of 0.4 to 0.69) or strong correlations (0.7 or higher) among themselves, and we thus focused on four of the 12 measures: absolute and relative annual changes in mean differences and ratios from the overall national mean. On average, absolute ethnic or language group inequalities tended to decline slightly for the three outcomes, and relative inequality declined for stunting and CCI, but increased for mortality. Correlations for annual trends across the three outcomes were inconsistent, with several countries showing progress in terms of one outcome but not in others. Togo and Uganda showed with the most consistent progress in reducing inequality, whereas the worst performers were Nigeria, Moldova, Kyrgyzstan, Sao Tome and Principe, and Burkina Faso. CONCLUSIONS Although measures of annual changes in ethnic or language group inequalities in child health were consistently correlated within each outcome, analyses of such inequalities should rely upon multiple measures. Countries showing progress in one child health outcome did not necessarily show improvements in the remaining outcomes. In-depth analyses at country level are needed to understand the drivers of success in reducing ethnic gaps.
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Affiliation(s)
- Luis Paulo Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
| | - Bianca O Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
| | - David E Phillips
- Gates Ventures, 4110 Carillon Pt, Kirkland, Seattle, WA, 98033-7463, USA
| | - Sonya Shekhar
- Gates Ventures, 4110 Carillon Pt, Kirkland, Seattle, WA, 98033-7463, USA
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil.
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, Pelotas, RS, 96020-220, Brazil.
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Gwanzura C, Gavi S, Mangiza M, Moyo FV, Lohman MC, Nhemachena T, Chipato T. Effect of anesthesia administration method on apgar scores of infants born to women undergoing elective cesarean section. BMC Anesthesiol 2023; 23:142. [PMID: 37106343 PMCID: PMC10134612 DOI: 10.1186/s12871-023-02098-w] [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: 09/25/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Neonatal health at delivery as measured by apgar scores is an important outcome. This study was done to assess the impact of anesthesia on Apgar 1-minute and 5-minute scores of infants delivered through elective cesarean section in Zimbabwe. METHODS We carried out a secondary analysis of data from the Efficacy of Tranexamic Acid in Preventing Postpartum Hemorrhage (ETAPPH) clinical trial in Zimbabwe. Outcomes measured were infant Apgar scores at 1 and 5 min, exposure was the administration of either a general (intravenous propofol/ketamine/sodium thiopental) or spinal (hyperbaric bupivacaine 0.5%) anesthesia for anesthesia during the elective cesarean section procedure. Marginal Structural Logistic Modelling (MSM) using an unstabilized Inverse Probability Treatment Weight (IPTW) estimator was used to assess the relationship between anesthetic administration method and infant Apgar scores. RESULTS Four hundred and twenty-one (421) women who had an elective caesarean section in the ETAPPH study had their infants assessed for Apgar scores. Comparing general anesthesia to spinal anesthesia, spinal anesthesia was related to good Apgar scores at 1-minute (adjusted odds ratio [aOR] = 4.0, 95% Confidence Interval = 1.5-10.7, sensitivity analysis E-value = 3.41). Spinal anesthetic administration was also related to good Apgar scores at 5 min (adjusted odds ratio [aOR] = 6.2, 95% Confidence Interval = 1.6-23.1, sensitivity analysis E-value = 4.42). CONCLUSIONS When providing anesthesia for patients undergoing elective cesarean section, care should be taken on the method of administration of anesthetic agents. General anesthesia tends to depress Apgar scores at 1 min, although most neonates recover and have better scores at 5 min. Spinal anesthesia should be the first choice whenever possible. TRIAL REGISTRATION The clinical trial from which data of this study was abstracted was registered under clinical trials registration number NCT04733157.
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Affiliation(s)
- Chipo Gwanzura
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Samuel Gavi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Marcia Mangiza
- Department of Pediatrics, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Faith Vhenekai Moyo
- Department of Anesthesia and Critical Care Medicine, Sally Mugabe Central Hospital, PO Box ST14 Southerton, Harare, Zimbabwe
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Taazadza Nhemachena
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Tsungai Chipato
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
- Clinical Trials Research Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Devakumar D, Rajagopalan S, Strong KL, Requejo J, Diaz T, Gram L, Aldridge R, Dalglish SL. Racism, xenophobia, and discrimination: data disaggregation is a complex but crucial step to improving child health. Lancet 2023; 401:1321-1323. [PMID: 37004671 DOI: 10.1016/s0140-6736(23)00618-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Srivatsan Rajagopalan
- Children in All Policies 2030, Institute for Global Health, University College London, London, UK
| | - Kathleen L Strong
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Jennifer Requejo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Financing Facility, World Bank Group, Washington DC, USA
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Lu Gram
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, London WC1N 1EH, UK
| | - Sarah L Dalglish
- Children in All Policies 2030, Institute for Global Health, University College London, London, UK
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Sociodemographic determinants of child mortality based on mothers' attitudes toward partner violence: Evidence from Bangladesh. Heliyon 2023; 9:e13848. [PMID: 36923848 PMCID: PMC10009682 DOI: 10.1016/j.heliyon.2023.e13848] [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: 05/17/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/27/2023] Open
Abstract
Bangladesh, a lower-middle-income country in South Asia, has achieved a significant reduction in child mortality over the last three decades from 151 to 40 per 1000 live births. However, child mortality is still considered high, which may be attributed to a lack of awareness among mothers regarding the risk factors, particularly their perceptions of intimate partner violence (IPV). To investigate the effect of demographic and socioeconomic factors of women on child mortality, this study extracted data from the cross-sectional survey of Bangladesh Multiple Indicator Cluster Survey (MICS) 2019. The data were analyzed using a Poisson regression model to assess women's perceptions and exposure to physical violence in the last three years preceding the survey and their impact on the risk of child mortality. The results indicated that approximately 26% of the participants justified domestic violence under certain circumstances. Moreover, the prevalence of child mortality was higher among those who thought that IPV is acceptable than among those who considered such violence to be unjustified. Among women who are strongly averse to partner violence, the risk of child mortality was significantly lower in those who had higher levels of education, higher household income, internet usage experience, first child at 20 years or later, frequent access to mass media, and one or two children ever born. Moreover, child mortality rates also varied across geographical areas, with children from Sylhet and Mymenshing being the most vulnerable. The data indicates women's intolerable attitudes toward partner violence not only improve their status but also increase the survival chances of their young children.
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Yao Y, Cui Y, Zhang Y, Li H, Zeng W. Population mental health matters child health disparity: a national level analysis. BMC Public Health 2022; 22:2372. [PMID: 36528613 PMCID: PMC9759864 DOI: 10.1186/s12889-022-14530-w] [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: 05/24/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The association between social distress and child health is important and attracts research interest. This study aims to examine the trend of inequality in the mortality rate for children under five (U5MR) over time and decompose the population mental health (PMH)-gradient in U5MR into different drivers at the national level. METHODS Data from 1990 to 2019 on the U5MR, PMH, and potential risk factors, such as socioeconomic status, environmental exposures at the national level, health behavior, basic water and sanitation services, urbanization, healthcare level, and HIV prevalence, were collected from online databases. We described the trend of U5MR and broke down U5MR based on the countries' risk factor status and PMH. We constructed regression models and decomposed the drivers of change in U5MR disparity based on PMH-gradient. RESULTS The difference in U5MR between countries with different levels of air pollution and income status was narrowed since 1990 for the high PMH groups. Countries with a higher level of PMH had less significant differences in U5MR between low- and middle-income groups than those with a lower level of PMH. The development of PMH-related gradient in child health is not consistent thoroughly. Before 2000, boys experienced a sharper decline in PMH-related gradient in health than girls did. The decomposition shows that the changes in PMH-gradient in child health were mainly caused by changes in the return to risk factors. The mental health of female population matters more in child health outcomes. CONCLUSION Although the U5MR converges across countries, the reason varies. The PMH gradient in child mortality is mainly explained by the change in the return to risk factors. The PMH-gradient health disparity in boys is larger than that in girls in 2019, which indicates that boys' health may be more vulnerable to the development of PMH recently. The findings remind us that we need to pay attention to the hidden reasons for the growth of disparity. It also suggests that improving PMH has a great impact on reducing PMH-related health disparity, especially for boys. Our research contributes to the understanding of the transition of PMH-related health disparity in U5MR and provides policy implications for reducing gender disparity in child health.
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Affiliation(s)
- Yao Yao
- grid.16821.3c0000 0004 0368 8293Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Huangpu District, Shanghai, 200025 P.R. China ,grid.16821.3c0000 0004 0368 8293China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Yujie Cui
- grid.16821.3c0000 0004 0368 8293Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Huangpu District, Shanghai, 200025 P.R. China ,grid.16821.3c0000 0004 0368 8293China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Yanfeng Zhang
- grid.33764.350000 0001 0476 2430School of Economics and Management, Harbin Engineering University, 145, Nantong Street, Nangang District, Harbin, 150001 P.R. China
| | - Heng Li
- grid.443524.00000 0000 9001 9434Public Health Governance Research Center, East China University of Political Science and Law, 1575 Wandu Hang Road, Songjiang District, Shanghai, 200042 P.R. China
| | - Wu Zeng
- grid.213910.80000 0001 1955 1644Department of Global Health, School of Health, Georgetown University, 3700 Reservoir Rd NW, Washington, DC, USA
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Clark EC, Cranston E, Polin T, Ndumbe-Eyoh S, MacDonald D, Betker C, Dobbins M. Structural interventions that affect racial inequities and their impact on population health outcomes: a systematic review. BMC Public Health 2022; 22:2162. [PMID: 36424559 PMCID: PMC9685079 DOI: 10.1186/s12889-022-14603-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
Structural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 29 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that affect the structural determinants of health and health inequities and improve daily living conditions.
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Affiliation(s)
- Emily C Clark
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Emily Cranston
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Tionné Polin
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Sume Ndumbe-Eyoh
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Danielle MacDonald
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, 2400 Camden Hall, Antigonish, NS, B2G 2W5, Canada
| | - Claire Betker
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, 2400 Camden Hall, Antigonish, NS, B2G 2W5, Canada
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada.
- School of Nursing, McMaster University, Health Sciences Centre, 2J20, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
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Hone T, Gomez S, Rao M, Ferreira A, Barkley S, Swift Koller T. Primary health care as a platform for addressing racial discrimination to "leave no one behind" and reduce health inequities. Int J Equity Health 2022; 21:152. [PMID: 36324144 PMCID: PMC9628171 DOI: 10.1186/s12939-022-01779-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/21/2022] Open
Abstract
The health inequities faced by populations experiencing racial discrimination, including indigenous peoples and people of African descent, Roma, and other ethnic minorities, are an issue of global concern. Health systems have an important role to play in tackling these health inequities. Health systems based on comprehensive Primary Health Care (PHC) are best placed to tackle health inequities because PHC encompasses a whole-of-society approach to health. PHC includes actions to address the wider social determinants of health, multisectoral policy and action, intercultural and integrated healthcare services, community empowerment, and a focus on addressing health inequities. PHC can also serve as a platform for introducing specific actions to tackle racial discrimination and can act to drive wider societal change for tackling racial and ethnic health inequities.
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Affiliation(s)
- Thomas Hone
- grid.7445.20000 0001 2113 8111Department of Primary care and Public Health, Imperial College London, South Kensington, UK
| | - Susana Gomez
- grid.3575.40000000121633745Department for Gender, Equity and Human Rights, Director General’s Office, World Health Organisation Headquarters, Geneva, Switzerland
| | - Mala Rao
- grid.7445.20000 0001 2113 8111Department of Primary care and Public Health, Imperial College London, South Kensington, UK
| | - Andrêa Ferreira
- grid.418068.30000 0001 0723 0931Centre for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Bahia, Brazil ,grid.166341.70000 0001 2181 3113The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Shannon Barkley
- grid.3575.40000000121633745Primary Healthcare, World Health Organisation Headquarters, Geneva, Switzerland
| | - Theadora Swift Koller
- grid.3575.40000000121633745Department for Gender, Equity and Human Rights, Director General’s Office, World Health Organisation Headquarters, Geneva, Switzerland
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Rebouças P, Goes E, Pescarini J, Ramos D, Ichihara MY, Sena S, Veiga R, Rodrigues LC, Barreto ML, Paixão ES. Ethnoracial inequalities and child mortality in Brazil: a nationwide longitudinal study of 19 million newborn babies. Lancet Glob Health 2022; 10:e1453-e1462. [PMID: 36113530 PMCID: PMC9638038 DOI: 10.1016/s2214-109x(22)00333-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Racism is a social determinant of health inequities. In Brazil, racial injustices lead to poor outcomes in maternal and child health for Black and Indigenous populations, including greater risks of pregnancy-related complications; decreased access to antenatal, delivery, and postnatal care; and higher childhood mortality rates. In this study, we aimed to estimate inequalities in childhood mortality rates by maternal race and skin colour in a cohort of more than 19 million newborns in Brazil. METHODS We did a nationwide population-based, retrospective cohort study using linked data on all births and deaths in Brazil between Jan 1, 2012, and Dec 31, 2018. The data consisted of livebirths followed up to age 5 years, death, or Dec 31, 2018. Data for livebirths were extracted from the National Information System for livebirths, SINASC, and for deaths from the Mortality Information System, SIM. The final sample consisted of complete data for all cases regarding maternal race and skin colour, and no inconsistencies were present between date of birth and death after linkage. We fitted Cox proportional hazard regression models to calculate the crude and adjusted hazard ratios (HRs) and 95% CIs for the association between maternal race and skin colour and all-cause and cause-specific younger than age 5 mortality rates, by age subgroups. We calculated the trend of HRs (and 95% CI) by time of observation (calendar year) to indicate trends in inequalities. FINDINGS From the 20 526 714 livebirths registered in SINASC between Jan 1, 2012, and Dec 31, 2018, 238 436 were linked to death records identified from SIM. After linkage, 1 010 871 records were excluded due to missing data on maternal race or skin colour or inconsistent date of death. 19 515 843 livebirths were classified by mother's race, of which 224 213 died. Compared with children of White mothers, mortality risk for children younger than age 5 years was higher among children of Indigenous (HR 1·98 [95% CI 1·92-2·06]), Black (HR 1·39 [1·36-1·41]), and Brown or Mixed race (HR 1·19 [1·18-1·20]) mothers. The highest hazard ratios were observed during the post-neonatal period (Indigenous, HR 2·78 [95% CI 2·64-2·95], Black, HR 1·54 [1·48-1·59]), and Brown or Mixed race, HR 1·25 [1·23-1·27]) and between the ages of 1 year and 4 years (Indigenous, HR 3·82 [95% CI 3·52-4·15]), Black, HR 1·51 [1·42-1·60], and Brown or Mixed race, HR 1·30 [1·26-1·35]). Children of Indigenous (HR 16·39 [95% CI 12·88-20·85]), Black (HR 2·34 [1·78-3·06]), and Brown or Mixed race mothers (HR 2·05 [1·71-2·45]) had a higher risk of death from malnutrition than did children of White mothers. Similar patterns were observed for death from diarrhoea (Indigenous, HR 14·28 [95% CI 12·25-16·65]; Black, HR 1·72 [1·44-2·05]; and Brown or Mixed race mothers, HR 1·78 [1·61-1·98]) and influenza and pneumonia (Indigenous, HR 6·49 [95% CI 5·78-7·27]; Black, HR 1·78 [1·62-1·96]; and Brown or Mixed race mothers, HR 1·60 [1·51-1·69]). INTERPRETATION Substantial ethnoracial inequalities were observed in child mortality in Brazil, especially among the Indigenous and Black populations. These findings demonstrate the importance of regular racial inequality assessments and monitoring. We suggest implementing policies to promote ethnoracial equity to reduce the impact of racism on child health. FUNDING MCTI/CNPq/MS/SCTIE/Decit/Bill & Melinda Gates Foundation's Grandes Desafios Brasil, Desenvolvimento Saudável para Todas as Crianças, and Wellcome Trust core support grant awarded to CIDACS-Center for Data and Knowledge Integration for Health.
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Affiliation(s)
- Poliana Rebouças
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
| | - Emanuelle Goes
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Iyaleta Research Association-Research, Science and Humanities, Salvador, Bahia, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Instituto de Saude Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil; Iyaleta Research Association-Research, Science and Humanities, Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Samila Sena
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rafael Veiga
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maurício L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Instituto de Saude Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Enny S Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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13
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Ahinkorah BO, Seidu AA, Hagan JE, Budu E, Mohammed A, Adu C, Ameyaw EK, Adoboi F, Schack T. Barriers to healthcare access and healthcare seeking for childhood illnesses among childbearing women in Burundi. PLoS One 2022; 17:e0274547. [PMID: 36178926 PMCID: PMC9524664 DOI: 10.1371/journal.pone.0274547] [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: 11/03/2020] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Poor health seeking behaviour continues to be major challenge in accessing healthcare in sub-Saharan Africa despite the availability of effective treatment for most childhood illnesses. The current study investigated the barriers to healthcare access and health seeking for childhood illnesses in Burundi.
Methods
The study utilized data from the 2016–17 Burundi Demographic and Health Survey (BDHS). A total of 2173 children under five of childbearing women were included in our study. The outcome variable for the study was healthcare seeking for childhood illnesses (diarrhea and fever/cough). Barriers to healthcare access were the explanatory variables and maternal and child factors were the control variables. Chi-square test of independence and a binary logistic regression modelling were carried out to generate the results.
Results
Overall, less than 50% of children in Burundi who were ill two weeks before the survey obtained healthcare. We found that children of mothers who perceived getting money for medical care for self as a big problem [aOR = 0.75; CI = 0.60–0.93] and considered going for medical care alone as a big problem [aOR = 0.71; CI = 0.55–0.91] had lower odds of getting healthcare, compared to those of mothers who considered these indicators as not a big problem. The results also showed that children of mothers who had three [aOR = 1.48; 1.02–2.15] and four [aOR = 1.62; 1.10–2.39], children were more likely to get healthcare for childhood illnesses compared to those whose mothers had one child. Children of mothers with single birth children were less likely to get healthcare compared to those whose mothers had multiple births.
Conclusion
Findings of the low prevalence of healthcare for childhood illnesses in Burundi suggest the need for government and non-governmental health organizations to strengthen women’s healthcare accessibility for child healthcare services and health seeking behaviours. The Burundian government through multi-sectoral partnership should strengthen health systems for maternal health and address structural determinants of women’s health by creating favourable conditions to improve the status of women and foster their overall socioeconomic well-being. Free child healthcare policies in Burundi should be strengthened to enhance the utilization of child healthcare services in Burundi.
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Affiliation(s)
- Bright Opoku Ahinkorah
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, 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
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
- Faculty of Psychology and Sport Sciences, Neurocognition and Action-Biomechanics-Research Group, Bielefeld University, Bielefeld, Germany
- * E-mail:
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Aliu Mohammed
- Department of Health, Physical Education, and Recreation, 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
| | - Edward Kwabena Ameyaw
- Faculty of Health, School of Public Health, University of Technology Sydney, Ultimo, Australia
| | - Faustina Adoboi
- Cape Coast Nursing and Midwifery Training College, Cape Coast, Ghana
| | - Thomas Schack
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
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Goodarzi B, Seijmonsbergen‐Schermers A, van Rijn M, Shah N, Franx A, de Jonge A. Maternal characteristics as indications for routine induction of labor: A nationwide retrospective cohort study. Birth 2022; 49:569-581. [PMID: 35229355 PMCID: PMC9546001 DOI: 10.1111/birt.12628] [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: 11/08/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal characteristics, such as parity and age, are increasingly considered indications for routine induction of labor of otherwise healthy women to prevent fetal and neonatal mortality. To fully balance the risks and benefits of induction of labor, we examined the association of additional relevant maternal characteristics and gestational age with fetal and neonatal mortality. METHODS We conducted a nationwide retrospective cohort study among a healthy Dutch population consisting of all singleton pregnancies in midwife-led care after 37 weeks of gestation in the period 2000-2018. We examined the association of maternal ethnicity, age, parity, and socioeconomic status with fetal and neonatal mortality, stratified by gestational age. The association of single characteristics was examined using descriptive statistics, and univariable and multivariable logistics regression analyses. The associations of multiple characteristics were examined using inter-categorical analyses and using interaction terms in the multivariable logistic regression analyses. RESULTS The results showed that ethnicity, age, parity, socioeconomic status, and gestational age did not act as single determinant of fetal and neonatal mortality. The probability of fetal and neonatal mortality differed among subgroups of women depending on which determinants were considered and the number of determinants included. CONCLUSIONS Decision-making about induction of labor to prevent fetal and neonatal mortality based on a single determinant may lead to overuse or underuse of IOL. A value-based health care strategy, addressing social inequity, and investing in better screening and diagnostic methods that employ an individualized and multi-determinant approach may be more effective at preventing fetal and neonatal mortality.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery ScienceAmsterdam Public HealthAmsterdam UMCVrije Universiteit AmsterdamAVAGAmsterdamthe Netherlands
| | - Anna Seijmonsbergen‐Schermers
- Department of Midwifery ScienceAmsterdam Public HealthAmsterdam UMCVrije Universiteit AmsterdamAVAGAmsterdamthe Netherlands
| | - Maaike van Rijn
- Department of Obstetrics and GynaecologyHaga ZiekenhuisThe HagueThe Netherlands
| | - Neel Shah
- Department of Obstetrics, Gynaecology and Reproductive BiologyHarvard Medical SchoolBostonMassachusettsUSA
| | - Arie Franx
- Department of Obstetrics and GynaecologyErasmus MCRotterdamthe Netherlands
| | - Ank de Jonge
- Department of Midwifery ScienceAmsterdam Reproduction and DevelopmentAmsterdam UMCVrije Universiteit AmsterdamAVAGAmsterdamthe Netherlands
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Qureshi Z, Richards A, Kingdon CC, Sinha I, Lokulo-Sodipe O, Rose AM. Ethnicity, child health and paediatric services. Arch Dis Child 2022; 108:453-454. [PMID: 35760454 DOI: 10.1136/archdischild-2021-323599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/14/2022] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - Ian Sinha
- Respiratory Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Division of Child Health, University of Liverpool, Liverpool, UK
| | | | - Anna M Rose
- Paediatrics, John Radcliffe Hospital, Oxford, UK
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16
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Victora CG, Hartwig FP, Vidaletti LP, Martorell R, Osmond C, Richter LM, Stein AD, Barros AJD, Adair LS, Barros FC, Bhargava SK, Horta BL, Kroker-Lobos MF, Lee NR, Menezes AMB, Murray J, Norris SA, Sachdev HS, Stein A, Varghese JS, Bhutta ZA, Black RE. Effects of early-life poverty on health and human capital in children and adolescents: analyses of national surveys and birth cohort studies in LMICs. Lancet 2022; 399:1741-1752. [PMID: 35489358 PMCID: PMC9061872 DOI: 10.1016/s0140-6736(21)02716-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/14/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022]
Abstract
The survival and nutrition of children and, to a lesser extent, adolescents have improved substantially in the past two decades. Improvements have been linked to the delivery of effective biomedical, behavioural, and environmental interventions; however, large disparities exist between and within countries. Using data from 95 national surveys in low-income and middle-income countries (LMICs), we analyse how strongly the health, nutrition, and cognitive development of children and adolescents are related to early-life poverty. Additionally, using data from six large, long-running birth cohorts in LMICs, we show how early-life poverty can have a lasting effect on health and human capital throughout the life course. We emphasise the importance of implementing multisectoral anti-poverty policies and programmes to complement specific health and nutrition interventions delivered at an individual level, particularly at a time when COVID-19 continues to disrupt economic, health, and educational gains achieved in the recent past.
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Affiliation(s)
- Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
| | - Fernando P Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luis P Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Linda M Richter
- Department of Science and Innovation, National Research Foundation Centre of Excellence in Human Development, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Fernando C Barros
- Post-Graduate Program of Health in the Life Cycle, Catholic University of Pelotas, Pelotas, Brazil
| | | | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Maria F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Nanette R Lee
- USC Office of Population Studies Foundation, University of San Carlos, Cebu, Philippines
| | - Ana Maria B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | - Shane A Norris
- SAMRC Pathways for Health Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alan Stein
- MRC-Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Health Research Institute, Durban, South Africa
| | | | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
| | - Robert E Black
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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17
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Dirksen J, Pinilla-Roncancio M, Wehrmeister FC, Ferreira LZ, Vidaletti LP, Kirkby K, Koller TS, Schlotheuber A, Tapia H, Vidal Fuertes C, Alkire S, Barros AJD, Hosseinpoor AR. Exploring the potential for a new measure of socioeconomic deprivation status to monitor health inequality. Int J Equity Health 2022; 21:56. [PMID: 35461294 PMCID: PMC9034442 DOI: 10.1186/s12939-022-01661-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring health inequalities is an important task for health research and policy, to uncover who is being left behind - and where - and to inform effective and equitable policies and programmes to tackle existing inequities. The choice of which measure to use to monitor and analyse health inequalities is thereby not trivial. This article explores a new measure of socioeconomic deprivation status (SDS) to monitor health inequalities. METHODS The SDS measure was constructed using the Alkire-Foster method. It includes eight indicators across two equally weighted dimensions (education and living standards) and specifies a four-level gradient of socioeconomic deprivation at the household-level. We conducted four exercises to examine the value-added of the proposed SDS measure, using Demographic and Health Surveys data. First, we examined the discriminatory power of the new measure when applied to outcomes in four select reproductive, maternal, neonatal, and child health (RMNCH) indicators across six countries: skilled birth attendance, stunting, U5MR, and DTP3 immunisation. Then, we analysed the behaviour and association of the new SDS measure vis-à-vis the DHS Wealth Index, including chi-squared test and Pearson correlation coefficient. Third, we analysed the robustness of the SDS measure results to changes in its structure, using pairwise comparisons and Kendal Tau-b rank correlation. Finally, we illustrated some of the advantageous properties of the new measure, disaggregation and decomposition, on Haitian data. RESULTS 1) Higher levels of socioeconomic deprivation are generally consistently associated with lower levels of achievements in the RMNCH indicators across countries. 2) 87% of all pairwise rank comparisons across a range of SDS measure structures were robust. 3) SDS and DHS Wealth Index are associated, but with considerable cross-country variation, highlighting their complementarity. 4) Haitian households in rural areas experienced, on average, more severe socioeconomic deprivation as well as lower levels of RMNCH achievement than urban households. CONCLUSIONS The proposed SDS measure adds analytical possibilities to the health inequality monitoring literature, in line with ethically and conceptually well-founded notions of absolute, multidimensional disadvantage. In addition, it allows for breakdown by its dimensions and components, which may facilitate nuanced analyses of health inequality, its correlates, and determinants.
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Affiliation(s)
- Jakob Dirksen
- Oxford Poverty and Human Development Initiative, University of Oxford, Oxford, UK
| | - Monica Pinilla-Roncancio
- Oxford Poverty and Human Development Initiative, University of Oxford, Oxford, UK.,Universidad de los Andes, Bogotá, Colombia
| | - Fernando C Wehrmeister
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Leonardo Z Ferreira
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luis Paulo Vidaletti
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | - Heriberto Tapia
- Human Development Report Office, United Nations Development Programme, New York, USA
| | | | - Sabina Alkire
- Oxford Poverty and Human Development Initiative, University of Oxford, Oxford, UK
| | - Aluisio J D Barros
- International Center for Equity in Health, Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Clarke G, Chapman E, Crooks J, Koffman J, Ahmed S, Bennett MI. Does ethnicity affect pain management for people with advanced disease? A mixed methods cross-national systematic review of 'very high' Human Development Index English-speaking countries. BMC Palliat Care 2022; 21:46. [PMID: 35387640 PMCID: PMC8983802 DOI: 10.1186/s12904-022-00923-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Racial disparities in pain management have been observed in the USA since the 1990s in settings such as the emergency department and oncology. However, the palliative care context is not well described, and little research has focused outside of the USA or on advanced disease. This review takes a cross-national approach to exploring pain management in advanced disease for people of different racial and ethnic groups. METHODS Mixed methods systematic review. The primary outcome measure was differences in receiving pain medication between people from different racial and ethnic groups. Five electronic databases were searched. Two researchers independently assessed quality using JBI checklists, weighted evidence, and extracted data. The quantitative findings on the primary outcome measure were cross-tabulated, and a thematic analysis was undertaken on the mixed methods studies. Themes were formulated into a conceptual/thematic matrix. Patient representatives from UK ethnically diverse groups were consulted. PRISMA 2020 guidelines were followed. RESULTS Eighteen papers were included in the primary outcome analysis. Three papers were rated 'High' weight of evidence, and 17/18 (94%) were based in the USA. Ten of the eighteen (56%) found no significant difference in the pain medication received between people of different ethnic groups. Forty-six papers were included in the mixed methods synthesis; 41/46 (89%) were based in the USA. Key themes: Patients from different ethnically diverse groups had concerns about tolerance, addiction and side effects. The evidence also showed: cultural and social doctor-patient communication issues; many patients with unmet pain management needs; differences in pain assessment by racial group, and two studies found racial and ethnic stereotyping. CONCLUSIONS There was not enough high quality evidence to draw a conclusion on differences in receiving pain medication for people with advanced disease from different racial and ethnic groups. The mixed methods findings showed commonalities in fears about pain medication side effects, tolerance and addiction across diverse ethnic groups. However, these fears may have different foundations and are differently prioritised according to culture, faith, educational and social factors. There is a need to develop culturally competent pain management to address doctor-patient communication issues and patients' pain management concerns. TRIAL REGISTRATION PROSPERO- CRD42020167890 .
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Affiliation(s)
- Gemma Clarke
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jodie Crooks
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, England, UK
| | - Shenaz Ahmed
- Division of Psychological & Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK
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Menashe-Oren A, Masquelier B. The shifting rural-urban gap in mortality over the life course in low- and middle-income countries. Population Studies 2022; 76:37-61. [PMID: 35075983 DOI: 10.1080/00324728.2021.2020326] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Studies have shown that children in rural areas face excess risks of dying, but the little research on spatial inequalities in adult mortality has reached mixed conclusions. We examine rural-urban differences in mortality in 53 low- and middle-income countries. We consider how the rural-urban mortality gap evolves from birth to age 60 by estimating mortality based on birth and sibling histories from 138 Demographic and Health Surveys run between 1992 and 2018. We observe excess rural mortality until age 15, finding the largest differences between urban and rural sectors among 1-59-month-olds. While we cannot claim higher mortality among urban adults than those in rural areas, we find a reduced gap between the sectors over the life course and a diminishing urban advantage in adult mortality with age. This shift over the life course reflects a divergence in the epidemiologic transition between the rural and urban sectors.
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Marchant T, Boerma T, Diaz T, Huicho L, Kyobutungi C, Mershon CH, Schellenberg J, Somers K, Waiswa P. Measurement and accountability for maternal, newborn and child health: fit for 2030? BMJ Glob Health 2021; 5:bmjgh-2020-002697. [PMID: 32624502 PMCID: PMC7337616 DOI: 10.1136/bmjgh-2020-002697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- Tanya Marchant
- Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Ties Boerma
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Theresa Diaz
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization, Geneve, Switzerland
| | - Luis Huicho
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | | | - Kate Somers
- Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
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21
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Jayathilaka R, Adikari H, Liyanage R, Udalagama R, Wanigarathna N. Cherish your children: socio-economic and demographic characteristics associated with child mortality. BMC Public Health 2021; 21:1217. [PMID: 34167493 PMCID: PMC8224253 DOI: 10.1186/s12889-021-11276-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/10/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The United Nations Interagency Group for Child Mortality Estimation (UNIGME) indicates that child mortality is the death rate of children between age zero to five. The importance of this area of research is high where worldwide a number of studies have been led on infant and child mortality, despite limited research discoveries with regards to Sri Lanka. The aim of this study is to investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka. METHODS Using the context of Sri Lanka as a case study, this study carried out based on data gathered from the micro level national survey. Using the logit regression model through the step-wise technique, the study investigate the socio-economic and demographic characteristics associated with child mortality in Sri Lanka. RESULTS According to the generated results, place of residence province-wise, household head's education level and source of drinking water have negative effect (lower risk) on child mortality in Sri Lanka. Exceptionally, the Western province has the highest negative effect on child mortality which demonstrates it as the least harmful region in Sri Lanka in child endurance. Household heads who owns private entities and Sri Lankan Moors has a positive effect on child mortality as well. CONCLUSION This study is helpful to address the population health of local arena and results can be supportive to the government and policymakers to gain an overview of physical health status of the country and able to uplift their policies based on the new findings.
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Affiliation(s)
- Ruwan Jayathilaka
- Department of Information Management, SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka.
| | - Harindu Adikari
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Rangi Liyanage
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Rumesh Udalagama
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
| | - Nuwan Wanigarathna
- Department of Business Management, SLIIT Business School, Sri Lanka Institute of Information Technology, New Kandy Road, Malabe, Sri Lanka
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Wang M. Health indicators on adolescents reveal disparity and inequality on regional and national levels. BMC Public Health 2021; 21:1006. [PMID: 34049513 PMCID: PMC8161722 DOI: 10.1186/s12889-021-10989-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health status in adolescents is difficult to evaluate and compare horizontally, vertically and longitudinally among different regions and nations of the world. METHODS With repeated surveys conducted with relatively uniformed standards, the UNICEF Data warehouse compiles and publishes a wide spectrum of health indicators, of which data analysis and visualization would reveal the underlying statuses and trends on global, regional and national levels. RESULTS Apparent geographic disparity is present in that sub-Saharan African countries lag far behind their counterparts in other regions with regard to most health indicators on adolescents. Education attendance rates sequentially drop from primary to secondary school levels, and display correlation with youth literacy. Harmful practices of early marriage, early childbearing and female genital mutilation have decreased but the presences of peer violence and sexual violence are worthy of attentions. Although incidence and mortality rates of HIV/AIDS have dropped (most notably in sub-Saharan Africa), adolescents' HIV/AIDS awareness remains suboptimal in selected countries. Cumulative COVID-19 cases and deaths in the adolescents are comparable to the children but relatively lower than the adult and senior groups. CONCLUSIONS Findings on the health indicators of adolescents until 2019 reveal the most recent status quo for reference right before the hit of ongoing COVID-19 pandemic. Progresses made on the various health indicators as well as the associated disparity and inequality underlie the remaining gaps to fill for the achievement of the Sustainable Development Goals by 2030.
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Affiliation(s)
- Mengqiao Wang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Renmin South Road 16, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Khan MA, Khan N, Rahman O, Mustagir G, Hossain K, Islam R, Khan HTA. Trends and projections of under-5 mortality in Bangladesh including the effects of maternal high-risk fertility behaviours and use of healthcare services. PLoS One 2021; 16:e0246210. [PMID: 33539476 PMCID: PMC7861360 DOI: 10.1371/journal.pone.0246210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study examines trends and puts forward projections of under-5 mortality (U5M) in Bangladesh and identifies the effects of maternal high-risk fertility behaviours and use of healthcare services. METHODS Data from seven waves of the Bangladesh Demographic and Health Survey (1994-2014) were analyzed for trends and projections of U5M and a Chi-square (χ2) test was used to identify if there was any association with maternal high-risk fertility behaviours and use of healthcare services. A multivariate logistic regression model was used to determine the effects of fertility behaviors and healthcare usage on the occurrence of U5M adjusting with confounders. RESULTS U5M declined from 82.5 to 41.0 per 1000 livebirths during 1994-2014 and is projected to further reduce to 17.6 per 1000 livebirths by 2030. The study identified a noticeable regional variation in U5M with maternal high-risk fertility behaviours including age at birth <18 years (aOR: 1.84, 95% CI: 1.23-2.76) and birth interval <24 months (aOR: 1.56, 95% CI: 1.02-2.37) found to be significant determinants. There was a 39-53% decline in this rate of mortality among women that had used antenatal care services at least four times (aOR, 0.51, 95% CI: 0.27-0.97), delivery care (aOR, 0.47, 95% CI: 0.24-0.95), and had received postnatal care (aOR, 0.61, 95% CI: 0.41-0.91) in their last birth. Cesarean section was found to be associated with a 51% reduction in U5M (aOR, 0.49, 95% CI: 0.29-0.82) compared to its non-use. CONCLUSION The Sustainable Development Goals require a U5M rate of 25 per 1000 livebirths to be achieved by 2030. This study suggests that with the current trend of reduction, Bangladesh will achieve this target before the deadline. This study also found that maternal high-risk fertility behaviours and non-use of maternal healthcare services are very prevalent in some regions of Bangladesh and have increased the occurrence of U5M in those areas. This suggests therefore, that policies and programmes designed to reduce the pregnancy rates of women that are at risk and to encourage an increase in the use of maternal healthcare services are needed.
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Affiliation(s)
- Mostaured Ali Khan
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
- MEL and Research, Practical Action, Dhanmondi, Dhaka, Bangladesh
| | - Nuruzzaman Khan
- School of Public Health and Medicine, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Obaidur Rahman
- Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke’s International University, Tokyo, Japan
- Department of Global Health Policy, School of International Health, The University of Tokyo, Tokyo, Japan
| | - Golam Mustagir
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Kamal Hossain
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Rafiqul Islam
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Hafiz T. A. Khan
- Public Health & Statistics, College of Nursing, Midwifery and Healthcare, University of West London, Brentford, United Kingdom
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Schlüter BS, Masquelier B. Space-time smoothing of mortality estimates in children aged 5-14 in Sub-Saharan Africa. PLoS One 2021; 16:e0245596. [PMID: 33465127 PMCID: PMC7815126 DOI: 10.1371/journal.pone.0245596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022] Open
Abstract
To meet the SDG requirement of spatial disaggregation of indicators, several methods have been developed to generate estimates of under-five mortality at the sub-national level. The reliability of sub-national mortality estimates in children aged 5-14 with the available survey data has not been evaluated so far. We generate Admin-1 sub-national estimates of the risk of dying in children aged less than five (5q0) and those aged 5 to 14 years old (10q5). We use 96 Demographic and Health Surveys (DHS) in 20 Sub-Saharan countries having at least 3 surveys designed to be representative at a sub-national level. The estimates account for the complex sample design of DHS and HIV-related biases in young children. A Bayesian space-time model previously developed for under-five mortality is used to smooth estimates across space and time in both age groups to reduce problems associated with data sparsity. The posterior distributions of the probability 10q5 are used to compute coefficients of variation and assess precision. Sufficiently precise estimates are retained to study the sub-national relationship between age-specific mortality rates (5q0 and 10q5), accounting for uncertainty in sub-national levels. Out of 1,132 space-time estimates, 62.3% are considered sufficiently precise with high heterogeneity across countries. Across all periods, sub-national estimates of mortality in children aged 0-4 are highly correlated with those in older children and young adolescents but this correlation is largely driven by the mortality decline. Within specific periods of time, it is often impossible to assess the relationship between mortality rates in the two age groups at the sub-national level, except in Nigeria, Ethiopia, Cameroon, Senegal and Zambia. As increased attention is devoted to survival after age 5, more research is needed to ensure that sub-national areas with specific interventions required for older children can be correctly identified.
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Affiliation(s)
| | - Bruno Masquelier
- Université Catholique de Louvain-la-Neuve (UCLouvain), Louvain-la-Neuve, Belgium
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25
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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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26
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Major gaps in child survival by ethnic group. LANCET GLOBAL HEALTH 2020; 8:e308-e309. [PMID: 32087155 DOI: 10.1016/s2214-109x(20)30029-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/24/2022]
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27
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Wehrmeister FC, Fayé CM, da Silva ICM, Amouzou A, Ferreira LZ, Jiwani SS, Melesse DY, Mutua M, Maïga A, Ca T, Sidze E, Taylor C, Strong K, Carvajal-Aguirre L, Porth T, Hosseinpoor AR, Barros AJD, Boerma T. Wealth-related inequalities in the coverage of reproductive, maternal, newborn and child health interventions in 36 countries in the African Region. Bull World Health Organ 2020; 98:394-405. [PMID: 32514213 PMCID: PMC7265922 DOI: 10.2471/blt.19.249078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To investigate whether sub-Saharan African countries have succeeded in reducing wealth-related inequalities in the coverage of reproductive, maternal, newborn and child health interventions. METHODS We analysed survey data from 36 countries, grouped into Central, East, Southern and West Africa subregions, in which at least two surveys had been conducted since 1995. We calculated the composite coverage index, a function of essential maternal and child health intervention parameters. We adopted the wealth index, divided into quintiles from poorest to wealthiest, to investigate wealth-related inequalities in coverage. We quantified trends with time by calculating average annual change in index using a least-squares weighted regression. We calculated population attributable risk to measure the contribution of wealth to the coverage index. FINDINGS We noted large differences between the four regions, with a median composite coverage index ranging from 50.8% for West Africa to 75.3% for Southern Africa. Wealth-related inequalities were prevalent in all subregions, and were highest for West Africa and lowest for Southern Africa. Absolute income was not a predictor of coverage, as we observed a higher coverage in Southern (around 70%) compared with Central and West (around 40%) subregions for the same income. Wealth-related inequalities in coverage were reduced by the greatest amount in Southern Africa, and we found no evidence of inequality reduction in Central Africa. CONCLUSION Our data show that most countries in sub-Saharan Africa have succeeded in reducing wealth-related inequalities in the coverage of essential health services, even in the presence of conflict, economic hardship or political instability.
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Affiliation(s)
- Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
| | - Cheikh Mbacké Fayé
- African Population and Health Research Centre, West Africa Regional Office, Dakar, Senegal
| | - Inácio Crochemore M da Silva
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
| | - Agbessi Amouzou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
| | - Leonardo Z Ferreira
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
| | - Safia S Jiwani
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
| | | | - Martin Mutua
- African Population and Health Research Center, Central Office, Nairobi, Kenya
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
| | - Tome Ca
- Health Information System, West African Health Organization, Bobo-Dioulasso, Burkina Faso
| | - Estelle Sidze
- African Population and Health Research Center, Central Office, Nairobi, Kenya
| | - Chelsea Taylor
- Department of Data and Analytics, World Health Organization, Geneva, Switzerland
| | - Kathleen Strong
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Liliana Carvajal-Aguirre
- Division of Data, Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, USA
| | - Tyler Porth
- Division of Data, Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, USA
| | | | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
| | - Ties Boerma
- Centre for Global Public Health, University of Manitoba, Canada
| | - on the behalf of the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health regional collaboration in sub-Saharan Africa
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3 piso, Pelotas, Brazil
- African Population and Health Research Centre, West Africa Regional Office, Dakar, Senegal
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America (USA)
- Centre for Global Public Health, University of Manitoba, Canada
- African Population and Health Research Center, Central Office, Nairobi, Kenya
- Health Information System, West African Health Organization, Bobo-Dioulasso, Burkina Faso
- Department of Data and Analytics, World Health Organization, Geneva, Switzerland
- Department of Maternal, Newborn, Child, and Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
- Division of Data, Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, USA
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