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Cha S, Jung S, Abera T, Beyene ET, Schmidt WP, Ross I, Jin Y, Bizuneh DB. Performance of Pit Latrines and Their Herd Protection Against Diarrhea: A Longitudinal Cohort Study in Rural Ethiopia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200541. [PMID: 38834532 PMCID: PMC11216697 DOI: 10.9745/ghsp-d-22-00541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/30/2024] [Indexed: 06/06/2024]
Abstract
In sanitation policies, "improved sanitation" is often broadly described as a goal with little rationale for the minimum standard required. We conducted a secondary analysis of data collected as part of a cluster randomized controlled trial in rural Ethiopia. We compared the performance of well-constructed and poorly constructed pit latrines in reducing child diarrhea. In addition, we explored whether having a well-constructed household latrine provides indirect protection to neighbors if cluster-level coverage reaches a certain threshold. We followed up children aged younger than 5 years (U5C) of 906 households in rural areas of the Gurage zone, Ethiopia, for 10 months after community-led total sanitation interventions. A study-improved latrine was defined as having all the following: pit of ≥2 m depth, slab of any material, drop-hole cover, wall, roof, door, and handwashing facilities (water and soap observed). U5C in households with a study-improved latrine had 54% lower odds of contracting diarrhea than those living in households with a latrine missing 1 or more of the characteristics (adjusted odds ratio [aOR]=0.46; 95% confidence interval [CI]=0.27, 0.81; P=.006). Analyses were adjusted for child age and sex, presence of improved water for drinking, and self-reported handwashing at 4 critical times. The odds of having diarrhea among those with an improved latrine based on the World Health Organization/UNICEF Joint Monitoring Program (JMP) definition (i.e., pit latrines with slabs) were not substantially different from those with a JMP-unimproved latrine (aOR=0.99; 95% CI=0.56, 1.79; P=.99). Of U5C living in households without a latrine or with a study-unimproved latrine, those in the high-coverage villages were less likely to contract diarrhea than those in low-coverage villages (aOR=0.55; 95% CI=0.35, 0.86; P=.008). We recommend that academic studies and routine program monitoring and evaluation should measure more latrine characteristics and evaluate multiple latrine categories instead of making binary comparisons only.
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Affiliation(s)
- Seungman Cha
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom.
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, South Korea
| | - Sunghoon Jung
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Ermias Tadesse Beyene
- Department of Human Ecology and Technology, Graduate School of Advanced Convergence, Handong Global University, Pohang, South Korea
| | - Wolf-Peter Schmidt
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ian Ross
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yan Jin
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju, Korea
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Shirakura Y, Shobugawa Y, Saito R. Geographic variation in inpatient medical expenditure among older adults aged 75 years and above in Japan: a three-level multilevel analysis of nationwide data. Front Public Health 2024; 12:1306013. [PMID: 38481853 PMCID: PMC10933056 DOI: 10.3389/fpubh.2024.1306013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/18/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction In Japan, a country at the forefront of population ageing, significant geographic variation has been observed in inpatient medical expenditures for older adults aged 75 and above (IMEP75), both at the small- and large-area levels. However, our understanding of how different levels of administrative (geographic) units contribute to the overall geographic disparities remains incomplete. Thus, this study aimed to assess the degree to which geographic variation in IMEP75 can be attributed to municipality-, secondary medical area (SMA)-, and prefecture-level characteristics, and identify key factors associated with IMEP75. Methods Using nationwide aggregate health insurance claims data of municipalities for the period of April 2018 to March 2019, we conducted a multilevel linear regression analysis with three levels: municipalities, SMA, and prefectures. The contribution of municipality-, SMA-, and prefecture-level correlates to the overall geographic variation in IMEP75 was evaluated using the proportional change in variance across six constructed models. The effects of individual factors on IMEP75 in the multilevel models were assessed by estimating beta coefficients with their 95% confidence intervals. Results We analysed data of 1,888 municipalities, 344 SMAs, and 47 prefectures. The availability of healthcare resources at the SMA-level and broader regions to which prefectures belonged together explained 57.3% of the overall geographic variance in IMEP75, whereas the effects of factors influencing healthcare demands at the municipality-level were relatively minor, contributing an additional explanatory power of 2.5%. Factors related to long-term and end-of-life care needs and provision such as the proportion of older adults certified as needing long-term care, long-term care benefit expenditure per recipient, and the availability of hospital beds for psychiatric and chronic care and end-of-life care support at home were associated with IMEP75. Conclusion To ameliorate the geographic variation in IMEP75 in Japan, the reallocation of healthcare resources across SMAs should be considered, and drivers of broader regional disparities need to be further explored. Moreover, healthcare systems for older adults must integrate an infrastructure of efficient long-term care and end-of-life care delivery outside hospitals to alleviate the burden on inpatient care.
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Affiliation(s)
- Yuki Shirakura
- Division of International Health (Public Health), Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Department of Active Ageing, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yugo Shobugawa
- Department of Active Ageing, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Reiko Saito
- Division of International Health (Public Health), Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Omisakin OA, Adedini SA. A Longitudinal Multilevel Analysis of the Effects of Contraceptive Failures on Unintended Pregnancies among Women in Urban Nigeria. J Urban Health 2024; 101:193-204. [PMID: 38286904 PMCID: PMC10897120 DOI: 10.1007/s11524-023-00819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/31/2024]
Abstract
Unintended pregnancy is a global public health concern. However, the effect of contraceptive failure on unintended pregnancy remains unclear in Nigeria. We undertook a longitudinal analysis to examine the effect of contraceptive failure on unintended pregnancy among urban women in Nigeria. We used panel data from the Nigerian Urban Reproductive Health Initiative. The Measurement, Learning and Evaluation program conducted the surveys among a cohort of women aged 15-49 who were first interviewed at baseline in 2010/2011 and followed up at endline in 2014/2015. Analytic sample was 4140 women aged 15-49 who ever used contraceptives. We fitted three-level multilevel binary logistic regression models estimated with GLLAMM. The study established evidence that there is a significant effect of contraceptive failure on unintended pregnancy among urban women in Nigeria. The positive effect of between-person contraceptive failure indicates that respondents who experienced more contraceptive failure than the average in the sample had 5.26 times higher odds of unintended pregnancy (OR = 5.26; p-value < 0.001). Results also established a significant effect of within-person contraceptive failures among the respondents. Findings suggest there is evidence of a significant longitudinal effect of contraceptive failure on unintended pregnancy in urban Nigeria. Efforts to reduce unintended pregnancy must include interventions to address the problem of contraceptive failure among urban women in Nigeria.
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Affiliation(s)
- Olusola A Omisakin
- Center for Safe & Healthy Children, College of Health and Human Development, The Pennsylvania State University, 201 Henderson Building University Park, State College, PA, 16802, USA.
| | - Sunday A Adedini
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University, Oye-Ekiti, Nigeria
- Programme in Demography and Population Studies, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nwanze LD, Siuliman A, Ibrahim N. Factors associated with infant mortality in Nigeria: A scoping review. PLoS One 2023; 18:e0294434. [PMID: 37967113 PMCID: PMC10650982 DOI: 10.1371/journal.pone.0294434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Infant mortality persists as a global public health concern, particularly in lower-middle-income countries (LIMCs) such as Nigeria. The risk of an infant dying before one year of age is estimated to be six times higher in Africa than in Europe. Nigeria recorded an infant mortality rate of 72.2 deaths per 1,000 live births in 2020, in contrast to the global estimate of 27.4 per 1,000 live births. Several studies have been undertaken to determine the factors influencing infant mortality. OBJECTIVE This scoping review sought to identify and summarise the breadth of evidence available on factors associated with infant mortality in Nigeria. METHODS This review followed the five-stage principles of Arksey and O'Malley's framework. Four electronic databases were searched with no limit to publication date or study type: Ovid MEDLINE, PubMed, CINAHL Complete, and Web of Science. Selected studies were imported into Endnote software and then exported to Rayyan software where duplicates were removed. Included articles were thematically analysed and synthesised using the socioecological model. RESULTS A total of 8,139 references were compiled and screened. Forty-eight articles were included in the final review. At the individual level, maternal- and child-related factors were revealed to influence infant mortality; socioeconomic and sociocultural factors at the interpersonal level; provision and utilisation of health services, health workforce, hospital resources and access to health services at the organisational level; housing/neighbourhood and environmental factors at the community level; and lastly, governmental factors were found to affect infant mortality at the public policy level. CONCLUSION Factors related to the individual, interpersonal, organisational, community and public policy levels were associated with infant mortality in Nigeria.
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Affiliation(s)
- Loveth Dumebi Nwanze
- Department of Public Health, School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Alaa Siuliman
- Department of Public Health, School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Nuha Ibrahim
- Department of Public Health, School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Argawu AS, Mekebo GG. Zero-inflated Poisson regression analysis of factors associated with under-five mortality in Ethiopia using 2019 Ethiopian mini demographic and health survey data. PLoS One 2023; 18:e0291426. [PMID: 37948385 PMCID: PMC10637676 DOI: 10.1371/journal.pone.0291426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Remarkable reduction in global under-five mortality has been seen over the past two decades. However, Ethiopia is among the five countries which account for about half (49%) of all under-five mortality worldwide. This study aimed at identifying factors associated with under-five children mortality in Ethiopia using the 2019 Ethiopia mini demography and health survey data. METHODS The most recent national representative demography and health survey data of Ethiopia, 2019 Ethiopia mini demography and health survey data, were used for this study. Count data regression models were applied to identify the factors associated with under-five children mortality. Statistical significance was declared at P-value less than 0.05. RESULTS Zero-Inflated Poisson (ZIP) regression model was found to be the best model compared to other count regression models based on models comparison Criteria. The ZIP model revealed that decreased risk of under-five mortality was associated with mothers aged 25-34 years, unmarried mothers, mothers delivered in health facility, mothers used Pill/IUD, mothers who had larger number of children at home whereas increased risk of under-five mortality was associated with older mothers at their first births, mothers from rural areas, mothers travel for 1-30 min and >30 min to get drinking water, mothers used charcoal and wood, children with higher birth order and multiple births. CONCLUSIONS In this study, place of residence, region, place of delivery, religion, age of mother, mother's age at first birth, marital status, birth order, birth type, current contraceptive type used, type of cooking fuel, time to get drinking water, and number of children at home were statistically significant factors associated with under-five mortality in Ethiopia. Thus, the Ethiopian Ministry of Health and other concerned bodies are recommended to encourage mothers to deliver at health institutions, give awareness for mothers to use Pill/IUD contraceptive type, and facilitate rural areas to have electricity and drinking water near to homes so as to minimize the under-five mortality to achieve the sustainable development goal.
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Adelekan B, Goldson E, Ntoimo LFC, Adonri O, Aliyu Y, Onoja M, Araoyinbo I, Anakhuekha E, Mueller U, Ekwere EO, Inedu M, Moruf O, Swomen G, Igboin B, Okonofua FE. Clients' perspectives on the utilization of reproductive, maternal, neonatal, and child health services in primary health centers during COVID-19 pandemic in 10 States of Nigeria: A cross-sectional study. PLoS One 2023; 18:e0288714. [PMID: 37471429 PMCID: PMC10359015 DOI: 10.1371/journal.pone.0288714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Reports from various parts of the world suggest that the COVID-19 pandemic may have severe adverse effects on the delivery and uptake of reproductive health, maternal, neonatal, and child health (RMNCH) services. The objective of the study was to explore women's experiences with utilization of RMNCH services during the COVID-19 pandemic in Nigeria, and to elicit their perceptions on ways to sustain effective service delivery during the pandemic. METHODS A cross-sectional survey of 2930 women using primary health care facilities for antenatal, delivery, postnatal, and child care services before and after the onset of the pandemic in 10 States of Nigeria were interviewed with a semi-structured questionnaire. Data were collected on women's socio-demographic characteristics and pregnancy histories, the services they sought before and after the pandemic, the challenges they faced in accessing the services, their use of alternative sources of health care, and their recommendations on ways to sustain RMNCH service delivery during the pandemic. The data were analyzed with descriptive statistics, and multivariable logistic regression using SPSS 20.0. All the statistical analyses were two-tailed with a 95% confidence interval, and the p-value was set at 0.05. RESULTS The logistic regression results showed that women were at least 56% more likely to report that they used family planning, antenatal, and delivery services before the pandemic than after the pandemic started, but 38% less likely to report use of postnatal services. The experience of difficulty accessing RMNCH services was 23% more likely after the pandemic started than before the pandemic. Three categories of recommendations made by the respondents on measures to sustain RMNCH delivery during the pandemic included 1) facility improvement, and staff recruitment and re-training; 2) free and readily accessible PHC services, and 3) the provision of social safety nets including transportation and palliatives. CONCLUSION We conclude that the COVID-19 pandemic limited women's access to antenatal, delivery, and childcare services offered in PHCs in Nigeria. Addressing the recommendations and the concerns raised by women will help to sustain the delivery of RMNCH services during the COVID-19 pandemic and future epidemics or health emergencies in Nigeria.
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Affiliation(s)
| | | | - Lorretta Favour C. Ntoimo
- Department of Demography and Social Statistics, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
- Women’s Health and Action Research Centre, Benin City, Nigeria
| | | | | | | | | | | | | | | | | | - Olayinka Moruf
- Planned Parenthood Federation of Nigeria, Abuja, Nigeria
| | - George Swomen
- Planned Parenthood Federation of Nigeria, Abuja, Nigeria
| | - Brian Igboin
- Women’s Health and Action Research Centre, Benin City, Nigeria
| | - Friday E. Okonofua
- Women’s Health and Action Research Centre, Benin City, Nigeria
- Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Nigeria
- Department of Obstetrics and Gynecology, University of Benin, Benin City, Nigeria
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Odimegwu C, Muchemwa M, Akinyemi JO. Systematic review of multilevel models involving contextual characteristics in African demographic research. JOURNAL OF POPULATION RESEARCH 2023. [DOI: 10.1007/s12546-023-09305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
AbstractMultilevel modelling has become a popular analytical approach for many demographic and health outcomes. The objective of this paper is to systematically review studies which used multilevel modelling in demographic research in Africa in terms of the outcomes analysed, common findings, theoretical rationale, questions addressed, methodological approaches, study design and data sources. The review was conducted by searching electronic databases such as Ebsco hosts, Science Direct, ProQuest, Scopus, PubMed and Google scholar for articles published between 2010 and 2021. Search terms such as neighbourhood, social, ecological and environmental context were used. The systematic review consisted of 35 articles, with 34 being peer-reviewed journal articles and 1 technical report. Based on the systematic review community-level factors are important in explaining various demographic outcomes. The community-level factors such as distance to the health facility, geographical region, place of residence, high illiteracy rates and the availability of maternal antenatal care services influenced several child health outcomes. The interpretation of results in the reviewed studies mainly focused on fixed effects rather than random effects. It is observed that data on cultural practices, values and beliefs, are needed to enrich the robust evidence generated from multilevel models.
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Rojas-Botero ML, Borrero-Ramírez YE, Cáceres-Manrique FDM. [Social inequalities in under-five mortality: a systematic review]. Rev Salud Publica (Bogota) 2023; 22:220-237. [PMID: 36753114 DOI: 10.15446/rsap.v22n2.86964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify the characteristics of the published studies on social inequalities in under-five mortality, their theoretical perspectives, axes of inequality, methods and results. METHOD We carried out a systematic literature review. We consulted four electronic databases and Google Scholar, for studies published between 2010 and 2018. RESULTS We analyzed 126 articles. In 62.7%, territory was studied as the axis of inequality, followed by socioeconomic determinants (27.8%). Neonatal, infant and under-five mortality was analyzed as an output in health in 19.0%, 49.2% and 32.3%, respectively. It predominated ecological (62.7%) and longitudinal (50.0%) studies. Significant reductions in mortality rates were found, however, the decline was not homogeneous among subpopulations. CONCLUSIONS The literature reports a marked decrease in under-five mortality; however, the gaps between different axes of inequality continue and in some cases they have increased. Gaps varied according to time, place, axis of inequality and type of mortality analyzed.
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Affiliation(s)
- Maylen L Rojas-Botero
- MR: Profesional en Gerencia de Sistemas de Información en Salud, M.Sc. Epidemiología. Ph.D.(c) Epidemiología. Universidad de Antioquia, Facultad Nacional de Salud Pública. Medellín, Colombia.
| | - Yadira E Borrero-Ramírez
- YB: MD. Esp. Teoría Métodos de Investigación. M.Sc. Sociología. Ph.D. Salud Pública. Posdoctorado en Salud Colectiva. Universidad de Antioquia, Facultad Nacional de Salud Pública.
| | - Flor de María Cáceres-Manrique
- FC: Enfermera. Esp.; M.Sc. Epidemiología. Esp. Docencia Universitaria. Ph.D. Salud Pública. Universidad Industrial de Santander, Facultad de Salud, Escuela de Medicina, Departamento de Salud Pública. Bucaramanga, Colombia.
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Bhusal MK, Khanal SP. A Systematic Review of Factors Associated with Under-Five Child Mortality. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1181409. [PMID: 36518629 PMCID: PMC9744612 DOI: 10.1155/2022/1181409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 08/24/2023]
Abstract
BACKGROUND Preventing the life of the newborn and reducing the entrenched disparity of childhood mortality across different levels is one of the crucial public health problems, especially in underdeveloped and developing countries in the world. Sustainable development goals (SDGs)-3.2 is aimed at terminating all preventable under-five child mortality and shrinking it to 25 per 1000 live births or lower than this by 2030. Several factors have been shown to be linked with childhood mortality. OBJECTIVE This review is aimed at pointing out the significant determinants related to under-five child mortality by a systematic review of the literature. METHODS EMBASE, PubMed, Scopus database, and Google Scholar search engine were used for the systematic search of the literature. Special keywords and Boolean operators were used to point out the relevant studies for the review. Original research articles and peer-reviewed papers published in the English language till August 10, 2022, were included in the analysis and synthesis of the results. As per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, out of 299 studies identified from different sources, only 22 articles were ascertained for this study. Eligible articles were appraised in detail, and relevant information was extracted and then integrated into the systematic review. RESULTS Mother's education, size of child at birth, age of mother at childbirth, place of residence, birth interval, sex of child, type of birth (single or multiple), and birth order, along with other socioeconomic, maternal, child, health facility utilization, and community level variables, were observed as important covariates of under-five mortality. CONCLUSION Women's education and easy access to quality healthcare facilities should be the apex priority to lessen childhood mortality.
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Affiliation(s)
- Madhav Kumar Bhusal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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Jamee AR, Sen KK, Bari W. Examining the influence of correlates on different quantile survival times: infant mortality in Bangladesh. BMC Public Health 2022; 22:1980. [PMID: 36307785 PMCID: PMC9617317 DOI: 10.1186/s12889-022-14396-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have identified factors influencing infant mortality, but, to the best of knowledge, no studies assessed the factors considering unequal effects on different survival times of infant mortality in Bangladesh. In this study, it was examined how a set of covariates behaves on different quantile survival times related with the infant mortality. METHODS Data obtained from Bangladesh multiple indicator cluster survey (BMICS), 2019 have been used for purpose of the study. A total of 9,183 reproductive women were included in the study who gave their most recent live births within two years preceding the survey. Kaplan-Meier product limit approach has been applied to find the survival probabilities for the infant mortality, and the log-rank test has also been used to observe the unadjusted association between infant mortality and selected covariates. To examine the unequal effects of the covariates on different quantile survival time of infant mortality, the Laplace survival regression model has been fitted. The results obtained from this model have also been compared with the results obtained from the classical accelerated failure time (AFT) and Cox proportional hazard (Cox PH) models. RESULTS The infant mortality in Bangladesh is still high which is around 28 per 1000 live births. In all the selected survival regression models, the directions of regression coefficients were similar, but the heterogenous effects of covariates on survival time were observed in quantile survival model. Several correlates such as maternal age, education, gender of index child, previous birth interval, skilled antenatal care provider, immediate breastfeeding etc. were identified as potential factors having higher impact on initial survival times. CONCLUSION Infant mortality was significantly influenced by the factors more in the beginning of the infant's life period than at later stages, suggesting that receiving proper care at an early age will raise the likelihood of survival. Policy-making interventions are required to reduce the infant deaths, and the study findings may assist policy makers to revise the programs so that the sustainable development goal 3.2 can be achieved in Bangladesh.
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Affiliation(s)
| | - Kanchan Kumar Sen
- Department of Statistics, University of Dhaka, Dhaka, 1000 Bangladesh
| | - Wasimul Bari
- Department of Statistics, University of Dhaka, Dhaka, 1000 Bangladesh
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Argawu AS, Mekebo GG. Risk factors of under-five mortality in Ethiopia using count data regression models, 2021. Ann Med Surg (Lond) 2022; 82:104764. [PMID: 36268401 PMCID: PMC9577841 DOI: 10.1016/j.amsu.2022.104764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Despite the global reduction in under-five mortality, still many children die before their fifth birthday in Ethiopia. The main aim of this study was to identify determinants of under-five mortality using count data regression models based on 2019 Ethiopia mini demography and health survey data. Methods The data source for this study was the 2019 Ethiopia mini demography and health survey data. Various count data regression models were applied to identify the determinants of under-five mortality. Results A total of 5,535 mothers with children aged 0–59 months were included in the study. Of the total, 1,277 (23.07%) women had lost at least one child by death before celebrating fifth birthday. Zero-Inflated Poisson model was found to be the best model, and it revealed that mother's age, marital status, mother's age at 1st birth, place of delivery, current contraceptive type used, type of cooking fuel, residence, region, religion, time to get drinking water, number of children at home, birth order, and birth type were significant factors that determine U5 mortality in Ethiopia. Mothers aged 15–24 years (IRR = 1.24, p = 0.007) and above 24 years (IRR = 1.66, p = 0.000) at their 1st births, mothers from rural area (IRR = 1.27, p = 0.000), mothers traveled for 1–30 min (IRR = 1.62, p = 0.000) and >30 min (IRR = 1.82, p = 0.000) to get drinking water, mothers used charcoal (IRR = 1.86, p = 0.009) and wood (IRR = 1.64, p = 0.033), children with birth order of 2nd-3rd (IRR = 3.91, p = 0.000), 4th -5th (IRR = 13.14, p = 0.000), 5th and above (IRR = 38.17, p = 0.000), and multiple born children (IRR = 1.5, p = 0.000) had higher risk of under-five mortality while mothers aged 25–34 years (IRR = 0.73, p = 0.000), unmarried mothers (IRR = 0.68, p = 0.004), mothers delivered in public health sectors (IRR = 0.59, p = 0.000), mothers used Pill/IUD (IRR = 0.64, p = 0.018), mothers who had 3 to 5 (IRR = 0.51, p = 0.000) and more than 5 (IRR = 0.27, p = 0.000) children at home had lower risk of under-five mortality. Conclusions Mothers should be encouraged to deliver at health institutions. Mothers also should be given awareness to use Pill/IUD contraceptive type. Moreover, facilitating rural areas to get electricity and drinking water near to homes helps to reduce the burden of U5M and to be in line with sustainable development goal. Our study was an attempt to identify the risk factors for under-five mortality in Ethiopia. We used 2019 Ethiopian Mini Demographic and health Survey data. Analyses were done using Statistical sofwares R, Stata, and SPSS. Count Data Regression Models were employed to identify the risk factors of under-five mortality. The best model that fits the data well was selected using selection criterion like AIC, BIC. Zero-Inflated Poisson model was found to fit the data well. The study found that mother's age, marital status of mother, age of mother's at first birth, place of delivery, place of residence, time to get drinking water, number of children at home, birth order, type of birth were statistically significant determinants for under-five mortality in Ethiopia.
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Kawakatsu Y, Adolph C, Mosser JF, Baffoe P, Cheshi F, Aiga H, Watkins D, Sherr KH. Factors consistently associated with utilisation of essential maternal and child health services in Nigeria: analysis of the five Nigerian national household surveys (2003-2018). BMJ Open 2022; 12:e061747. [PMID: 36115678 PMCID: PMC9486329 DOI: 10.1136/bmjopen-2022-061747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE This study aims to identify the individual and contextual factors consistently associated with utilisation of essential maternal and child health services in Nigeria across time and household geolocation. DESIGN, SETTING AND PARTICIPANTS Secondary data from five nationally representative household surveys conducted in Nigeria from 2003 to 2018 were used in this study. The study participants are women and children depending on essential maternal and child health (MCH) services. OUTCOME MEASURES The outcome measures were indicators of whether participants used each of the following essential MCH services: antenatal care, facility-based delivery, modern contraceptive use, childhood immunisations (BCG, diphtheria, tetanus, pertussis/Pentavalent and measles) and treatments of childhood illnesses (fever, cough and diarrhoea). METHODS We estimated generalised additive models with logit links and smoothing terms for households' geolocation and survey years. RESULTS Higher maternal education and households' wealth were significantly associated with utilisation of all types of essential MCH services (p<0.05). On the other hand, households with more children under 5 years of age and in poor communities were significantly less likely to use essential MCH services (p<0.05). Except for childhood immunisations, greater access to transport was positively associated with utilisation (p<0.05). Households with longer travel times to the most accessible health facility were less likely to use all types of essential MCH services (p<0.05), except modern contraceptive use and treatment of childhood fever and/or cough. CONCLUSION This study adds to the evidence that maternal education and household wealth status are consistently associated with utilisation of essential MCH services across time and space. To increase utilisation of essential MCH services across different geolocations, interventions targeting poor communities and households with more children under 5 years of age should be appropriately designed. Moreover, additional interventions should prioritise to reduce inequities of essential MCH service utilisation between the wealth quantiles and between education status.
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Affiliation(s)
- Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Community-based Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Christopher Adolph
- Department of Political Science, University of Washington, Seattle, Washington, USA
- Center for Statistics and the Social Sciences, University of Washington, Seattle, Washington, USA
| | - Jonathan F Mosser
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA
| | | | | | - Hirotsugu Aiga
- Department of Health System Development, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - David Watkins
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Kenneth H Sherr
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, Washington, USA
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Islam MZ, Billah A, Islam MM, Rahman M, Khan N. Negative effects of short birth interval on child mortality in low- and middle-income countries: A systematic review and meta-analysis. J Glob Health 2022; 12:04070. [PMID: 36057919 PMCID: PMC9441110 DOI: 10.7189/jogh.12.04070] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Methods Eight databases, PubMed, CINAHL, Web of Science, Embase, PsycINFO, Cochrane Library, Popline, and Maternity and Infant Care, were searched, covering the period of January 2000 to January 2022. Studies that had examined the association between SBI and any form of child mortality were included. The findings of the included studies were summarized through fixed-effects or random-effects meta-analysis and the model was selected based on the heterogeneity index. Results A total of 51 studies were included. Of them, 19 were conducted in Ethiopia, 10 in Nigeria and 7 in Bangladesh. Significant higher likelihoods of stillbirth (odds ratio (OR) = 2.11; 95% confidence interval (CI) = 1.32-3.38), early neonatal mortality (OR = 1.58; 95% CI = 1.04-2.41), perinatal mortality (OR = 1.71; 95% CI = 1.32-2.21), neonatal mortality (OR = 1.85; 95% CI = 1.68-2.04), post-neonatal mortality (OR = 3.01; 95% CI = 1.43-6.33), infant mortality (OR = 1.92; 95% CI = 1.77-2.07), child mortality (OR = 1.67; 95% CI = 1.27-2.19) and under-five mortality (OR = 1.95; 95% CI = 1.56-2.44) were found among babies born in short birth intervals than those who born in normal intervals. Conclusions SBI significantly increases the risk of child mortality in LMICs. Programmes to reduce pregnancies in short intervals need to be expanded and strengthened. Reproductive health interventions aimed at reducing child mortality should include proper counselling on family planning, distribution of appropriate contraceptives and increased awareness of the adverse effects of SBI on maternal and child health.
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Affiliation(s)
- Mohammad Zahidul Islam
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh.,Department of Population Science and Human Resource Development, University of Rajshahi, Bangladesh
| | - Arif Billah
- Department of Social Work and Counselling, Faculty of Business, Economics and Social Development, Universiti Malaysia Terengganu, Malaysia
| | - M Mofizul Islam
- Department of Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Mostafizur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Bangladesh
| | - Nuruzzaman Khan
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
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Pattnaik A, Mohan D, Zeger S, Kanyuka M, Kachale F, Marx MA. From raw data to a score: comparing quantitative methods that construct multi-level composite implementation strength scores of family planning programs in Malawi. Popul Health Metr 2022; 20:18. [PMID: 36050721 PMCID: PMC9438221 DOI: 10.1186/s12963-022-00295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 03/27/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Data that capture implementation strength can be combined in multiple ways across content and health system levels to create a summary measure that can help us to explore and compare program implementation across facility catchment areas. Summary indices can make it easier for national policymakers to understand and address variation in strength of program implementation across jurisdictions. In this paper, we describe the development of an index that we used to describe the district-level strength of implementation of Malawi's national family planning program. METHODS To develop the index, we used data collected during a 2017 national, health facility and community health worker Implementation Strength Assessment survey in Malawi to test different methods to combine indicators within and then across domains (4 methods-simple additive, weighted additive, principal components analysis, exploratory factor analysis) and combine scores across health facility and community health worker levels (2 methods-simple average and mixed effects model) to create a catchment area-level summary score for each health facility in Malawi. We explored how well each model captures variation and predicts couple-years protection and how feasible it is to conduct each type of analysis and the resulting interpretability. RESULTS We found little difference in how the four methods combined indicator data at the individual and combined levels of the health system. However, there were major differences when combining scores across health system levels to obtain a score at the health facility catchment area level. The scores resulting from the mixed effects model were able to better discriminate differences between catchment area scores compared to the simple average method. The scores using the mixed effects combination method also demonstrated more of a dose-response relationship with couple-years protection. CONCLUSIONS The summary measure that was calculated from the mixed effects combination method captured the variation of strength of implementation of Malawi's national family planning program at the health facility catchment area level. However, the best method for creating an index should be based on the pros and cons listed, not least, analyst capacity and ease of interpretability of findings. Ultimately, the resulting summary measure can aid decision-makers in understanding the combined effect of multiple aspects of programs being implemented in their health system and comparing the strengths of programs across geographies.
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Affiliation(s)
- Anooj Pattnaik
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
| | - Diwakar Mohan
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
| | - Scott Zeger
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
| | | | - Fannie Kachale
- grid.415722.70000 0004 0598 3405Reproductive Health Directorate, Ministry of Health, Lilongwe, Malawi
| | - Melissa A. Marx
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
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Shobiye DM, Omotola A, Zhao Y, Zhang J, Ekawati FM, Shobiye HO. Infant mortality and risk factors in Nigeria in 2013-2017: A population-level study. EClinicalMedicine 2022; 51:101622. [PMID: 36176313 PMCID: PMC9513538 DOI: 10.1016/j.eclinm.2022.101622] [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: 04/07/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Globally, over the past two decades, many countries have significantly reduced the rate of infant mortality. Yet, in Africa, Nigeria remains one of the countries with the highest infant mortality rate (IMR). METHODS We conducted a population-level study using the 2018 Nigeria Demographic Health Survey (NDHS). A total of 41,668 household data were analyzed retrospectively. The association between each exposure and infant mortality was analyzed in logistic regression models (independently adjusted by demographic and socioeconomic status variables) and confirmed by the multiple comparisons analysis. FINDINGS The overall IMR of 2013-2017 was 61.5 (95% CI 58.0, 65.3) per 1000 live births. In general, the North-West and North-East regions had the highest IMR, whereas the South-West, South-East and South-South regions had the lowest IMR. The regression analysis found women who delivered their babies at the age <=18 years old (odds ratio (OR): 1.37 [1.17, 1.62]), had religion of Islam (OR: 1.35 [1.10, 1.65]), no ANC visit (OR: 1.69 [1.21, 2.35]), >4 ANC visits (OR: 1.70 [1.23, 2.34]), ANC not at home or skilled provider (0.40 [0.35, 0.46]) and the babies as the first child (OR: 1.23 [1.07, 1.42]) to be associated with higher IMR. INTERPRETATION Our findings imply that Nigeria is not on track to achieving the SDG target of reducing child mortality by 2030. Sustainable interventions are urgently needed to address the challenges for women of reproductive age, particularly those that are living in the rural areas and Northern regions, having limited/no access to health care/skilled providers, and delivered their first child. FUNDING None.
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Affiliation(s)
- Damilola M. Shobiye
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, USA
- Corresponding author.
| | - Ayomide Omotola
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yueming Zhao
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Jianrong Zhang
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Fitriana M. Ekawati
- Department of Family and Community Medicine Universitas Gadjah Mada, Indonesia
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Rachmawati PD, Kurnia ID, Asih MN, Kurniawati TW, Krisnana I, Arief YS, Mani S, Dewi YS, Arifin H. Determinants of under-five mortality in Indonesia: A nationwide study. J Pediatr Nurs 2022; 65:e43-e48. [PMID: 35216837 DOI: 10.1016/j.pedn.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mortality rate for infants and children under five in Indonesia is an ongoing challenge for the government, with figures exceeding the targets set for the country by the Sustainable Development Goals (SDGs). OBJECTIVES This study aims to discover the factors causing under-five mortality in Indonesia. METHODS This study will employ a cross-sectional study design with data sourced from the 2017 Indonesian Demographic and Health Survey (IDHS) between July and September 2017. The sample included 10,014 women who had given birth in the five years prior to the survey. The data was analyzed using Binary logistic regression with a significance level of p < 0.05. RESULTS The significant factors relating to under-five mortality in Indonesia are: mother's age at birth (AOR = 2.04; 95% CI 95% = 1.11-3.77); birth weight (AOR = 7.60; 95% CI 95% = 5.17-11.19); the sex of the child (AOR = 1.80; 95% CI 95% = 1.28-2.52); frequency of using the internet (AOR = 1.13; 95% CI 95% = 0.02-0.95); residence (AOR = 0.64; 95% CI 95% = 0.33-0.94); and birth interval (AOR = 0.52; 95% CI 95% = 0.29-0.92). Birth weight is the more likely cause for under-five mortality in Indonesia. CONCLUSIONS This study revealed that the characteristics of mothers, children, the area of residence, and the behavior of the mother affect the under-five mortality. PRACTICE IMPLICATIONS Pediatric nurses can have a role to play in developing knowledge about health for both mothers and families. Additionally, accessible health education on issues from planning a pregnancy to childcare should be promoted in both rural and urban areas as well as a campaign on proper hygiene practices.
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Affiliation(s)
| | | | | | | | - Ilya Krisnana
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia.
| | | | - Smriti Mani
- Govt College of Nursing, Medical College and Hospital, Kolkata, India; OSD, Nursing Directorate, Govt of West Bengal, India.
| | | | - Hidayat Arifin
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Bandung, Indonesia.
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Meitei WB, Singh A, Ladusingh L. The effects of community clustering on under-five mortality in India: a parametric shared frailty modelling approach. GENUS 2022. [DOI: 10.1186/s41118-022-00165-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe study of the effect of community clustering of under-five mortality has its implications in both research and policy. Studies have shown the contribution of community factors on under-five mortality. However, these studies did not account for censoring. We examine the presence of community dependencies and determine the risk factors of under-five mortality in India and its six state-regions by employing a Weibull hazard model with gamma shared frailty. We considered every possible way to ensure that the frailty models used in the study are not merely a consequence of how the data are organized rather than representing a substantive assumption about the source of the frailty. Data from the fourth round of the National Family Health Survey has been used. The study found that except for south India, children born in the same community in India and the other five state-regions shared similar characteristics of under-five mortality. The risk of under-five mortality decreased with an increase in mother’s schooling. Except for northern region, female births were less likely to die within first five years of life. We found a U-shaped relationship between preceding birth interval and under-five mortality. History of sibling’s death, multiple births and low-birthweight significantly increases the risk of under-five mortality in all the six state-regions. The Hindu–Muslim mortality gaps and Scheduled Caste or Tribe’s mortality disadvantage is diminishing. Since the factors associated with under-five mortality were not necessarily the same across the six state-regions of India, adopting a uniform approach in dealing with under-five mortality in India may not benefit all the regions equally.
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Rashmi R, Paul R. Determinants of multimorbidity of infectious diseases among under-five children in Bangladesh: role of community context. BMC Pediatr 2022; 22:159. [PMID: 35346126 PMCID: PMC8958815 DOI: 10.1186/s12887-022-03217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The presence of more than one morbid condition among children has become a global public health concern. Studies carried out in Bangladesh have primarily focused on diarrhoea and acute respiratory tract infections independently without considering their co-occurrence effect. The present study examines the multimorbid conditions of infectious diseases in under-five Bangladeshi children. It explores multimorbidity determinants and the role of community context, which are often overlooked in previous literature.
Methods
Utilizing the most recent Demographic and Health Survey of Bangladesh (2017–18), we used mixed-effects random-intercept Poisson regression models to understand the determinants of multimorbidity of infectious diseases in under-five Bangladeshi children considering the community-level characteristics.
Results
The present study found that 28% of the children experienced multimorbidity two weeks prior to the survey. Community-level variability across all the statistical models was statistically significant at the 5% level. On average, the incidence rate of multimorbidity was 1.34 times higher among children from high-risk communities than children from low-risk communities. Moreover, children residing in rural areas and other urban areas involved 1.29 [CI: 1.11, 1.51] and 1.28 [CI: 1.11, 1.47] times greater risk of multimorbidity respectively compared to children from city corporations. Additionally, the multimorbidity incidence was 1.16 times [CI: 1.03, 1.30] higher among children from high-altitude communities than children living in low-altitude communities.
Conclusion
The significant effect of public handwashing places suggests community-based interventions among individuals to learn hygiene habits among themselves, thus, the severity of coexistence nature of infectious diseases. A higher incidence of coexistence of such infectious diseases in the poor and semi-urban populace further recommends a targeted awareness of a clean environment and primary healthcare programmes.
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Adedini SA, Abatan SM, Ogunsakin AD, Alex-Ojei CA, Babalola BI, Shittu SB, Odusina EK, Ntoimo LFC. Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries. PLoS One 2022; 17:e0262688. [PMID: 35025949 PMCID: PMC8758032 DOI: 10.1371/journal.pone.0262688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/02/2022] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20-24 years) who married before age 18 and those who married at age 18 or above. METHOD Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20-24 (n = 33,630). RESULTS Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57-0.67, p<0.001), and women who married at ages 15-17 (OR: 0.81, CI: 0.75-0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics. CONCLUSION Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.
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Affiliation(s)
- Sunday A. Adedini
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
- Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa
- * E-mail:
| | - Sunday Matthew Abatan
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Adesoji Dunsin Ogunsakin
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Christiana Alake Alex-Ojei
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Blessing Iretioluwa Babalola
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Sarafa Babatunde Shittu
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Emmanuel Kolawole Odusina
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Lorretta Favour C. Ntoimo
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
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Adeomi AA, Fatusi A, Klipstein-Grobusch K. Individual and contextual factors associated with under- and over-nutrition among school-aged children and adolescents in two Nigerian states: a multi-level analysis. Public Health Nutr 2022; 25:1-13. [PMID: 35067272 PMCID: PMC9991795 DOI: 10.1017/s1368980022000258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/22/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to identify individual and contextual factors that are associated with under- and over-nutrition among school-aged children and adolescents in two Nigerian states. DESIGN Community-based cross-sectional study. SETTING The study was carried out in rural and urban communities of Osun and Gombe States in Nigeria. PARTICIPANTS A total of 1200 school-aged children and adolescents. RESULTS Multi-level analysis showed that the full models accounted for about 82 % and 39 % of the odds of thinness or overweight/obese across the communities, respectively. Household size (adjusted OR (aOR) 1·10; P = 0·001; 95 % CI (1·04, 1·16)) increased the odds, while the upper wealth index (aOR 0·43; P = 0·016; 95 % CI (0·22, 0·86)) decreased the odds of thinness. Age (aOR 0·86; P < 0·001; 95 % CI (1·26, 8·70)), exclusive breastfeeding (aOR 0·46; P = 0·010; 95 % CI (0·25, 0·83)), physical activity (aOR 0·55; P = 0·001; 95 % CI (0·39, 0·78)) and the upper wealth index (aOR 0·47; P = 0·018; 95 % CI (0·25, 0·88)) were inversely related with overweight/obesity, while residing in Osun State (aOR 3·32; P = 0·015; 95 % CI (1·26, 1·70)), female gender (aOR 1·73; P = 0·015; 95 % CI (1·11, 2·69)) and screen time > 2 h/d (aOR 2·33; P = 0·005; 95 % CI (1·29, 4·19)) were positively associated with overweight/obesity. CONCLUSIONS The study shows that selected community and individual-level factors are strongly associated with thinness and overweight/obesity among school-aged children and adolescents.
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Affiliation(s)
- Adeleye Abiodun Adeomi
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adesegun Fatusi
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
- Centre for Adolescent Health and Development, School of Public Health, University of Medical Sciences, Ondo, Nigeria
| | - Kerstin Klipstein-Grobusch
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
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Mayer MM, Xhinti N, Mashao L, Mlisana Z, Bobotyana L, Lowman C, Patterson J, Perlman JM, Velaphi S. Effect of Training Healthcare Providers in Helping Babies Breathe Program on Neonatal Mortality Rates. Front Pediatr 2022; 10:872694. [PMID: 35664883 PMCID: PMC9158330 DOI: 10.3389/fped.2022.872694] [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: 02/09/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Training in the Helping Babies Breathe (HBB) Program has been associated with a reduction in early neonatal mortality rate (ENMR), the neonatal mortality rate (NMR), and fresh stillbirth rate (FSBR) in low- and middle-income countries (LMICs). This program was implemented in five different healthcare facilities in the Oliver Reginald Tambo (ORT) District, South Africa from September 2015 to December 2020. OBJECTIVE To determine and compare the FSBR, ENMR, and NMR between 2015 before initiation of the program (baseline) and subsequent years up to 2020 following the implementation of facility-based training of HBB in five hospitals in ORT District. METHODS Records of perinatal statistics from January 2015 to December 2020 were reviewed to calculate FSBR, ENMR, and NMR. Data were collected from the five healthcare facilities which included two district hospitals (Hospital A&B), two regional hospitals (Hospital C&D), and one tertiary hospital (Hospital E). Comparisons were made between pre- (2015) and post- (2016-2020) HBB implementation periods. Differences in changes over time were also assessed using linear regression analysis. RESULTS There were 19,275 births in 2015, increasing to 22,192 in 2020 with the majority (55.3%) of births occurring in regional hospitals. There were significant reductions in ENMR (OR-0.78, 95% CI 0.70-0.87) and NMR (OR-0.81, 95% CI 0.73-0.90), but not in FSBR, in the five hospitals combined when comparing the two time periods. Significant reduction was also noted in trends over time in ENMR (r 2 = 0.45, p = 0.001) and NMR (r 2 = 0.23, p = 0.026), but not in FSBR (r 2 = 0.0, p = 0.984) with all hospitals combined. In looking at individual hospitals, Hospital A (r 2 = 0.61, p < 0.001) and Hospital E (r 2 = 0.19, p = 0.048) showed a significant reduction in ENMR over time, but there were no significant changes in all mortality rates for Hospitals B, C, and D, and for the district or regional hospitals combined. CONCLUSION There was an overall reduction of 22% and 19% in ENMR and NMR, respectively, from pre- to post-HBB implementation periods, although there were variations from year to year over the 5-year period and, across hospitals. These differences suggest that there were other factors that affected the perinatal/neonatal outcomes in the hospital sites in addition to the implementation of training in HBB.
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Affiliation(s)
- Maria M Mayer
- Department of Paediatrics, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Nomvuyo Xhinti
- Division of Education and Training, Helping Babies Breathe Programme, Resuscitation Council of Southern Africa, Johannesburg, South Africa
| | - Lolly Mashao
- Division of Education and Training, Helping Babies Breathe Programme, Resuscitation Council of Southern Africa, Johannesburg, South Africa
| | - Zolile Mlisana
- Department of Paediatrics, Mthatha Regional Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Luzuko Bobotyana
- Department of Paediatrics, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | - Casey Lowman
- Department of Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
| | - Janna Patterson
- Department of Global Child Health and Life Support, American Academy of Pediatrics, Itasca, IL, United States
| | - Jeffrey M Perlman
- Division of Newborn Medicine, Weil-Cornell University, New York, NY, United States
| | - Sithembiso Velaphi
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Daniel K, Onyango NO, Sarguta RJ. A Spatial Survival Model for Risk Factors of Under-Five Child Mortality in Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:399. [PMID: 35010659 PMCID: PMC8744899 DOI: 10.3390/ijerph19010399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 06/14/2023]
Abstract
Child mortality is high in Sub-Saharan Africa compared to other regions in the world. In Kenya, the risk of mortality is assumed to vary from county to county due to diversity in socio-economic and even climatic factors. Recently, the country was split into 47 different administrative regions called counties, and health care was delegated to those county governments, further aggravating the spatial differences in health care from county to county. The goal of this study is to evaluate the effects of spatial variation in under-five mortality in Kenya. Data from the Kenya Demographic Health Survey (KDHS-2014) consisting the newly introduced counties was used to analyze this risk. Using a spatial Cox Proportional Hazard model, an Intrinsic Conditional Autoregressive Model (ICAR) was fitted to account for the spatial variation among the counties in the country while the Cox model was used to model the risk factors associated with the time to death of a child. Inference regarding the risk factors and the spatial variation was made in a Bayesian setup based on the Markov Chain Monte Carlo (MCMC) technique to provide posterior estimates. The paper indicate the spatial disparities that exist in the country regarding child mortality in Kenya. The specific counties have mortality rates that are county-specific, although neighboring counties have similar hazards for death of a child. Counties in the central Kenya region were shown to have the highest hazard of death, while those from the western region had the lowest hazard of death. Demographic factors such as the sex of the child and sex of the household head, as well as social economic factors, such as the level of education, accounted for the most variation when spatial differences were factored in. The spatial Cox proportional hazard frailty model performed better compared to the non-spatial non-frailty model. These findings can help the country to plan health care interventions at a subnational level and guide social and health policies by ensuring that counties with a higher risk of Under Five Child Mortality (U5CM) are considered differently from counties experiencing a lower risk of death.
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Ezeh OK, Ogbo FA, Odumegwu AO, Oforkansi GH, Abada UD, Goson PC, Ishaya T, Agho KE. Under-5 Mortality and Its Associated Factors in Northern Nigeria: Evidence from 22,455 Singleton Live Births (2013-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9899. [PMID: 34574825 PMCID: PMC8469194 DOI: 10.3390/ijerph18189899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/23/2022]
Abstract
The northern geopolitical zones (NGZs) continue to report the highest under-5 mortality rates (U5MRs) among Nigeria's six geopolitical zones. This study was designed to identify factors related to under-5 mortality (U5M) in the NGZs. The NGZ populations extracted from the 2018 Nigeria Demographic and Health Survey were explored to assess the factors associated with U5M using logistic regression, generalised linear latent, and mixed models. Between 2013 and 2018, the northwest geopolitical zone reported the highest U5MR (179 deaths per 1000 live births; 95% confidence interval [CI]: 163-194). The adjusted model showed that geopolitical zone, poor household, paternal occupation, perceived children's body size at birth, caesarean delivery, and mothers and fathers' education were highly associated with increased odds of U5M. Other significant factors that influenced U5M included children of fourth or higher birth order with shorter interval ≤ 2 years (adjusted odds ratio [aOR] = 1.68; CI: 1.42-1.90) and mothers who did not use contraceptives (aOR = 1.41, CI: 1.13-1.70). Interventions are needed and should primarily spotlight children residing in low-socioeconomic households. Educating mothers on the benefits of contraceptive use, child spacing, timely and safe caesarean delivery and adequate care for small-sized babies may also reduce U5M in Nigeria, particularly in the NGZs.
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Affiliation(s)
- Osita K. Ezeh
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2750, Australia;
| | - Felix A. Ogbo
- Barmera Medical Clinic (Lake Bonney Private Medical Clinic), Barmera, SA 5345, Australia;
- Translational Health Research Institute (THRI), Campbelltown Campus, Western Sydney University, Penrith, NSW 2571, Australia
| | | | | | - Uchechukwu D. Abada
- Department of Banking and Finance, Okija Campus, Madonna University, Okija 431121, Nigeria;
| | - Piwuna C. Goson
- Department of Psychiatry, College of Health Sciences, University of Jos, Jos 930003, Nigeria;
| | - Tanko Ishaya
- Department of Computer Science, University of Jos, Jos 930003, Nigeria;
| | - Kingsley E. Agho
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2750, Australia;
- Translational Health Research Institute (THRI), Campbelltown Campus, Western Sydney University, Penrith, NSW 2571, Australia
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Ariyo T, Jiang Q. Trends in the association between educational assortative mating, infant and child mortality in Nigeria. BMC Public Health 2021; 21:1493. [PMID: 34340670 PMCID: PMC8330029 DOI: 10.1186/s12889-021-11568-0] [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: 02/26/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Existing knowledge has established the connection between maternal education and child survival, but little is known about how educational assortative mating (EAM), relates to childhood mortality. We attempt to examine this association in the context of Nigeria. METHODS Data was obtained from the 2008, 2013, and 2018 waves of the Nigeria Demographic and Health Survey, which is a cross-sectional study. The sample includes the analysis of 72,527 newborns within the 5 years preceding each survey. The dependent variables include the risk of a newborn dying before 12 months of age (infant mortality), or between the age of 12-59 months (child mortality). From the perspective of the mother, the independent variable, EAM, includes four categories (high-education homogamy, low-education homogamy, hypergamy, and hypogamy). The Cox proportional hazard regression was employed for multivariate analyses, while the estimation of mortality rates across the spectrum of EAM was obtained through the synthetic cohort technique. RESULTS The risk of childhood mortality varied across the spectrum of EAM and was particularly lowest among those with high-education homogamy. Compared to children of mothers in low-education homogamy, children of mothers in high-education homogamy had 25, 31 to 19% significantly less likelihood of infant mortality, and 34, 41, and 57% significantly less likelihood of child mortality in 2008, 2013 and 2018 survey data, respectively. Also, compared to children of mothers in hypergamy, children of mothers in hypogamous unions had 20, 12, and 11% less likelihood of infant mortality, and 27, 36, and 1% less likelihood of child mortality across 2008, 2013 and 2018 surveys, respectively, although not significant at p < 0.05. Both infant and child mortality rates were highest in low-education homogamy, as expected, lowest in high-education homogamy, and lower in hypogamy than in hypergamy. Furthermore, the trends in the rate declined between 2008 and 2018, and were higher in 2018 than in 2013. CONCLUSION This indicates that, beyond the absolute level of education, the similarities or dissimilarities in partners' education may have consequences for child survival, alluding to the family system theory. Future studies could investigate how this association varies when marital status is put into consideration.
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Affiliation(s)
- Tolulope Ariyo
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Quanbao Jiang
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
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Fagbamigbe AF, Salawu MM, Abatan SM, Ajumobi O. Approximation of the Cox survival regression model by MCMC Bayesian Hierarchical Poisson modelling of factors associated with childhood mortality in Nigeria. Sci Rep 2021; 11:13497. [PMID: 34188083 PMCID: PMC8241837 DOI: 10.1038/s41598-021-92606-0] [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: 07/26/2020] [Accepted: 06/07/2021] [Indexed: 11/26/2022] Open
Abstract
The need for more pragmatic approaches to achieve sustainable development goal on childhood mortality reduction necessitated this study. Simultaneous study of the influence of where the children live and the censoring nature of children survival data is scarce. We identified the compositional and contextual factors associated with under-five (U5M) and infant (INM) mortality in Nigeria from 5 MCMC Bayesian hierarchical Poisson regression models as approximations of the Cox survival regression model. The 2018 DHS data of 33,924 under-five children were used. Life table techniques and the Mlwin 3.05 module for the analysis of hierarchical data were implemented in Stata Version 16. The overall INM rate (INMR) was 70 per 1000 livebirths compared with U5M rate (U5MR) of 131 per 1000 livebirth. The INMR was lowest in Ogun (17 per 1000 live births) and highest in Kaduna (106), Gombe (112) and Kebbi (116) while the lowest U5MR was found in Ogun (29) and highest in Jigawa (212) and Kebbi (248). The risks of INM and U5M were highest among children with none/low maternal education, multiple births, low birthweight, short birth interval, poorer households, when spouses decide on healthcare access, having a big problem getting to a healthcare facility, high community illiteracy level, and from states with a high proportion of the rural population in the fully adjusted model. Compared with the null model, 81% vs 13% and 59% vs 35% of the total variation in INM and U5M were explained by the state- and neighbourhood-level factors respectively. Infant- and under-five mortality in Nigeria is influenced by compositional and contextual factors. The Bayesian hierarchical Poisson regression model used in estimating the factors associated with childhood deaths in Nigeria fitted the survival data.
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Affiliation(s)
- A F Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Health Data Science Group, Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK.
| | - M M Salawu
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Health Data Science Group, Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - S M Abatan
- Health Data Science Group, Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Demography and Social Statistics, Federal University Oye, Oye, Ekiti, Nigeria
| | - O Ajumobi
- Health Data Science Group, Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- School of Community Health Sciences, University of Nevada, Reno, USA
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Kiross GT, Chojenta C, Barker D, Loxton D. Individual-, household- and community-level determinants of infant mortality in Ethiopia. PLoS One 2021; 16:e0248501. [PMID: 33711062 PMCID: PMC7954351 DOI: 10.1371/journal.pone.0248501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION People living in the same area share similar determinants of infant mortality, such as access to healthcare. The community's prevailing norms and attitudes about health behaviours could also influence the health care decisions made by individuals. In diversified communities like Ethiopia, differences in child health outcomes might not be due to variation in individual and family characteristics alone, but also due to differences in the socioeconomic characteristics of the community where the child lives. While individual level characteristics have been examined to some extent, almost all studies into infant mortality conducted in Ethiopia have failed to consider the impact of community-level characteristics. Therefore, this study aims to identify individual and community level determinants of infant mortality in Ethiopia. METHOD Data from the Ethiopian Demographic and Health Survey in 2016 were used for this study. A total of 10641 live births were included in this analysis. A multi-level logistic regression analysis was used to examine both individual and community level determinants while accounting for the hierarchal structure of the data. RESULTS Individual-level characteristics such as infant sex have a statistically significant association with infant mortality. The odds of infant death before one year was 50% higher for males than females (AOR = 1.66; 95% CI: 1.25-2.20; p-value <0.001). At the community level, infants from pastoralist areas (Somali and Afar regions) were 1.4 more likely die compared with infants living in the Agrarian area such as Amhara, Tigray, and Oromia regions; AOR = 1.44; 95% CI; 1.02-2.06; p-value = 0.039). CONCLUSION Individual, household and community level characteristics have a statistically significant association with infant mortality. In addition to the individual based interventions already in place, household and community-based interventions such as focusing on socially and economically disadvantaged regions in Ethiopia could help to reduce infant mortality.
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Affiliation(s)
- Girmay Tsegay Kiross
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Daniel Barker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Woldeamanuel BT, Aga MA. Count Models Analysis of Factors Associated with Under-Five Mortality in Ethiopia. Glob Pediatr Health 2021; 8:2333794X21989538. [PMID: 33623812 PMCID: PMC7878955 DOI: 10.1177/2333794x21989538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/05/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background. Under-five mortality has continued a key challenge to public health in Ethiopia, and other sub-Saharan Africa countries. The threat of under-five mortality is incessant and more studies are needed to generate new scientific evidence. This study aimed to model the number of under-five deaths a mother has experienced in her lifetime and factors associated with it in Ethiopia. Method. A retrospective cross-sectional study based on data obtained from the Ethiopian Demographic and Health Survey (DHS), 2016 was used. The response variable was the total number of under-five children died per mother in her lifetime. Variables such as maternal socioeconomic and demographic characteristics, health, and environmental factors were considered as risk factors of under-five mortality. Hurdle negative binomial (HNB) regression analysis was employed to determine the factors associated with under-five mortality. Results. The data showed that 27.2% (95%CI: 0263, 0.282) of women experienced under-five deaths. The study revealed the age of mother at first birth, the age of mother at the time of under-five mortality occurred, number of household members, household access to electricity, region, educational level of the mother, sex of household head, wealth index, mother residing with husband/partner at the time of under-five mortality occurred as factors associated with under-five mortality. Age of mother at first birth 18 to 24 (IRR = .663; 95%CI: 0.587, 0.749), 25 or higher years old (IRR = 0.424; 95%CI: 0.306, 0.588), access to electricity (IRR = 0.758; 95%CI: 0.588, 0.976), primary education level of the mother (IRR = 0.715; 95%CI: 0.584, 0.875) and the richer wealth index (IRR = 0.785; 95%CI: 0.624, 0.988) were associated with reduced incidence of under-five mortality controlling for other variables in the model. Whereas older age of mother 35 to 39 (IRR = 5.252; 95%CI: 2.992, 9.218), 40 to 44 (IRR = 7.429; 95%CI: 4.188, 13.177), 45 to 49 (IRR = 8.697; 95%CI: 4.853, 15.585), being a resident of the Benishangul-gumuz region (IRR = 1.781; 95%CI: 1.303, 2.434), female household head (IRR = 1.256; 95%CI: 1.034, 1.525) were associated with an increased incidence of under-five mortality. Conclusion. The findings suggested that early age of mothers’ at first birth and old ages of mothers’, female household head and being uneducated were found to increase the incidence of the under-five mortality, whereas access to electricity and living with husband was statistically associated with reduced incidence of under-five mortality. The implication of this study is that policymakers and stakeholders should provide health education for mothers not to give birth at an earlier age and improve living standards to achieve sustainable development goals.
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Modelling determinants of geographical Patterns in the Marital Statuses of Women in Nigeria. SPATIAL DEMOGRAPHY 2021. [DOI: 10.1007/s40980-020-00072-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Simelane MS, Vermaak K, Zwane E, Masango S. Individual and community-level factors associated with lifetime number of sexual partners among women aged 15-49 in Eswatini. PLoS One 2021; 16:e0246100. [PMID: 33497398 PMCID: PMC7837491 DOI: 10.1371/journal.pone.0246100] [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: 08/05/2019] [Accepted: 01/13/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Understanding the risk factors for behavioral patterns in sexual relationships play a significant role in the reduction of the transmission of HIV/AIDS and other sexually transmitted infections. OBJECTIVE To investigate individual and community level factors on the lifetime number of sexual partners of women in Eswatini. MATERIAL AND METHODS The study was a secondary cross-sectional analysis of the 2014 Eswatini Multiple Indicator Cluster Survey (MICS). A total of 2,832 women aged 15-49 years were asked in total, how many different people have you had sexual intercourse in your lifetime. The multilevel negative binomial regression model was used to analyze the data. RESULTS The overall mean number of lifetime sexual partners was 2.78 (95% CI: 2.66, 2.91) in 2014. Compared to women aged 15-19, those aged 20 years and older, formerly married or never married reported more lifetime sexual partners compared to currently married women. Those that were aged 15 years and older at sexual debut reported fewer lifetime sexual partners compared to those that were aged less than 15 years. Compared to women that used a condom at last sexual intercourse, those that did not use a condom at last sexual encounter reported fewer lifetime sexual partners. Relative to women that lived with their sons and daughters, those that did not live with their sons and daughters reported more lifetime sexual partners. Women that lived in the Shiselweni and Lubombo regions reported fewer lifetime sexual partners compared to those residents in the Hhohho region. CONCLUSION Overall, lifetime sexual partners in Eswatini was significantly associated with individual characteristics and is unique across regions. Programs that aim to elucidate the factors associated with incident HIV infections among women in Eswatini should focus on individual and community-level factors that are associated with multiple sexual partnerships, which in turn might increase the risk of HIV exposure.
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Affiliation(s)
- Maswati S. Simelane
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni, Eswatini
| | - Kerry Vermaak
- The School of Built Environment and Development Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Eugene Zwane
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni, Eswatini
| | - Sdumo Masango
- Department of Statistics and Demography, Faculty of Social Sciences, University of Eswatini, Kwaluseni, Eswatini
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Adjei G, Darteh EKM, Nettey OEA, Doku DT. Neonatal mortality in the central districts of Ghana: analysis of community and composition factors. BMC Public Health 2021; 21:173. [PMID: 33478435 PMCID: PMC7819257 DOI: 10.1186/s12889-021-10156-6] [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: 05/19/2020] [Accepted: 01/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Communities and their composition have an impact on neonatal mortality. However, considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. Therefore, this study aimed to investigate the effect of community-, household- and individual-level factors on the risk of neonatal mortality in two districts in Ghana. METHODS This was a longitudinal study that used the Kintampo Health and Demographic Surveillance System as a platform to select 30,132 neonatal singletons with 634 deaths. Multilevel cox frailty model was used to examine the effect of community-, household- and individual-level factors on the risk of neonatal mortality. RESULTS Regarding individual-level factors, neonates born to mothers with previous adverse pregnancy (aHR = 1.38, 95% CI: 1.05-1.83), neonates whose mothers did not receive tetanus toxoid vaccine (aHR = 1.32, 95% CI: 1.08-1.60) and neonates of mothers with Middle, Junior High School or Junior Secondary School education (aHR = 1.30, 95% CI: 1.02-1.65) compared to mothers without formal education, had a higher risk of neonatal mortality. However, female neonates (aHR = 0.61, 95% CI: 0.51-0.73) and neonates whose mother had secondary education or higher (aHR = 0.37, 95% CI: 0.18-0.75) compared to those with no formal education had a lower risk of mortality. Neonates with longer gestation period (aHR = 0.95, 95% CI: 0.94-0.97) and those who were delivered at home (aHR = 0.56, 95% CI: 0.45-0.70), private maternity home (aHR = 0.45, 95% CI: 0.30-0.68) or health centre/clinic (aHR = 0.40, 95% CI: 0.26-0.60) compared to hospital delivery had lower risk of mortality. Regarding the household-level, neonates belonging to third quintile of the household wealth (aHR = 0.70, 95% CI: 0.52-0.94) and neonates belonging to households with crowded sleeping rooms (aHR = 0.91, 95% CI: 0.85-0.97) had lower risk of mortality. CONCLUSION The findings of the study suggest the risk of neonatal mortality at the individual- and household-levels in the Kintampo Districts. Interventions and strategies should be tailored towards the high-risk groups identified in the study.
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Affiliation(s)
- George Adjei
- Department of Community Medicine, University of Cape Coast, Cape Coast, Ghana
| | - Eugene K. M. Darteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Obed Ernest A. Nettey
- University of Ghana, Regional Institute for Population Studies, Accra, Ghana
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Ghana
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Geremew BM, Gelaye KA, Melesse AW, Akalu TY, Baraki AG. Factors Affecting Under-Five Mortality in Ethiopia: A Multilevel Negative Binomial Model. Pediatric Health Med Ther 2021; 11:525-534. [PMID: 33408551 PMCID: PMC7781031 DOI: 10.2147/phmt.s290715] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/18/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Even though remarkable declines in under-five mortality rates noticed globally, nearly 5.6 million children still die annually before celebrating their fifth birthday. The 2016 Ethiopian Demographic and Health Survey (EDHS) report revealed that 67 children per 1000 live births died before the fifth birthday. This study aimed at determining factors affecting under-five mortality in Ethiopia using EDHS, 2016. Materials and Methods The data were retrieved from the EDHS 2016, and a total weighted number of 11,023 under-five children were included. Descriptive statistics were reported using tables, graphs, and texts. A multilevel negative binomial regression model was fitted, and adjusted incidence rate (ARR) with a 95% confidence interval (CI) and a p-value <0.05 were reported. The deviance test was used to check the goodness of fit. Results Mother attained higher education (ARR=0.25, 95% CI: 0.10–0.66), female-headed household (ARR=1.32, 95% CI: 1.05–1.66), age of household head (AIRR=1.07, 95% CI: 1.03,1.11), preceding birth interval ≥48 months (ARR=0.51, 95% CI: 0.42–0.61), child who had history of diarrhea (ARR=1.23, 95% CI: 1.08–1.41), multiple birth type (ARR=1.80, 95% CI: 1.34–2.42), mothers who delivered in health facility (ARR=0.86, 95% CI: 0.73,0.94), residents of Addis Ababa (ARR=0.52, 95% CI: 0.28–0.98), and Amhara region (ARR=1.43, 95% CI: 1.09, 1.88) were statistically significant with the number of under-five mortality. Conclusion In this study, under-five mortality remains a public health problem in Ethiopia. Educational status of the mother, women delivered at health institution, preceding birth interval 24–35 and ≥48, and residents of Addis Ababa reduced the incidence of under-five mortality. On the other hand, being a female household head, age of mother at first giving birth, being employed, having multiple births, and childhood diarrhea were associated with a higher incidence of under-five mortality. This finding suggests that enhancing opportunities to female education, addressing regional disparities, and encouraging mothers to deliver at health institutions will help to reduce the burden of under-five mortality.
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Affiliation(s)
- Bisrat Misganew Geremew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemakef Wagnew Melesse
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adhanom Gebreegziabher Baraki
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hirose A, Kajungu D, Tusubira V, Waiswa P, Alfven T, Hanson C. Postneonatal under-5 mortality in peri-urban and rural Eastern Uganda, 2005-2015. BMJ Glob Health 2020; 5:e003762. [PMID: 33334903 PMCID: PMC7747610 DOI: 10.1136/bmjgh-2020-003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/29/2020] [Accepted: 11/17/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Community and individual sociodemographic characteristics play an important role in child survival. However, a question remains how urbanisation and demographic changes in sub-Saharan Africa affect community-level determinants for child survival. METHODS Longitudinal data from the Iganga/Mayuge Health and Demographic Surveillance Site was used to obtain postneonatal under-5 mortality rates between March 2005 and February 2015 in periurban and rural areas separately. Multilevel survival analysis models were used to identify factors associated with mortality. RESULTS There were 43 043 postneonatal under-5 children contributing to 116 385 person years of observation, among whom 1737 died. Average annual crude mortality incidence rate (IR) differed significantly between periurban and rural areas (9.0 (8.1 to 10.0) per 1000 person-years vs 18.1 (17.1 to 19.0), respectively). In periurban areas, there was evidence for decreasing mortality from IR=11.3 (7.7 to 16.6) in 2006 to IR=4.5 (3.0 to 6.9) in 2015. The mortality fluctuated with no evidence for reduction in rural areas (IR=19.0 (15.8 to 22.8) in 2006; IR=15.5 (13.0 to 18.6) in 2015). BCG vaccination was associated with reduced mortality in periurban and rural areas (adjusted rate ratio (aRR)=0.45; 95% CI 0.30 to 0.67 and aRR=0.56; 95% CI 0.41 to 0.76, respectively). Maternal education level within the community was associated with reduced mortality in both periurban and rural sites (aRR=0.83; 95% CI 0.70 to 0.99; aRR=0.90; 95% CI 0.81 to 0.99). The proportion of households in the poorest quintile within the community was associated with mortality in rural areas only (aRR=1.08; 95% CI 1.00 to 1.18). In rural areas, a large disparity existed between the least poor and the poorest (aRR=0.50; 95% CI 0.27 to 0.92). CONCLUSION We found evidence for a mortality decline in peri-urban but not rural areas. Investments in the known key health (eg, vaccination) and socio-economic interventions (education, and economic development) continue to be crucial for mortality declines. Focused strategies to eliminate the disparity between wealth quintiles are also warranted. There may be equitable access to health services in peri-urban areas but improved metrics of socioeconomic position suitable for peri-urban residents may be needed.
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Affiliation(s)
- Atsumi Hirose
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- School of Public Health, Imperial College London, London, UK
| | - Dan Kajungu
- Makerere University Centre for Health and Population Research, Kampala, Uganda
| | - Valerie Tusubira
- Makerere University Centre for Health and Population Research, Kampala, Uganda
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Tobias Alfven
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
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Naz L, Patel KK, Uzoma IE. Crucial predicting factors of under-five mortality in Sierra Leone. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Trends in and determinants of neonatal and infant mortality in Nigeria based on Demographic and Health Survey data. J Biosoc Sci 2020; 53:924-934. [PMID: 33118890 DOI: 10.1017/s0021932020000619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study aimed to assess the changes in neonatal and infant mortality rates in Nigeria over the period 1990 to 2018 using Nigerian Demographic and Health Survey (NDHS) data, and assess their socio-demographic determinants using data from the most recent survey conducted in 2018. The infant mortality rate was 87 per 1000 live births in 1990, and this increased to 100 per 1000 live births in 2003 - an increase of around 15% over 13 years. Neonatal and infant mortality rates started to decline steadily thereafter and continued to do so until 2013. After 2013, neonatal morality rose slightly by the year 2018. Information for 27,465 infants under 1 year of age from the NDHS-2018 was analysed using bivariate and multivariate analysis and the Cox proportional hazard technique. In 2018, infant deaths decreased as wealth increased, and the incidence of infant deaths was greater among those of Islam religion than among those of other religions. A negative association was found between infant deaths and the size of a child at birth. Infant mortality was higher in rural than in urban areas, and was higher among male than female children. Both neonatal and infant death rates varied by region and were found to be highest in the North West region and lowest in the South region. An increasing trend was observed in neonatal mortality in the 5-year period from 2013 to 2018. Policy interventions should be focused on the poor classes, women with a birth interval of less than 2 years and those living in the North West region of the country.
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Shibre G. Social inequality in infant mortality in Angola: Evidence from a population based study. PLoS One 2020; 15:e0241049. [PMID: 33091077 PMCID: PMC7580929 DOI: 10.1371/journal.pone.0241049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Within country inequality in infant mortality poses a big challenge for countries moving towards the internationally agreed upon targets on child mortality by 2030. There is a lack of high-quality evidence on infant mortality measured through different dimensions of social inequality in Angola. Thus, this paper was carried out to address the knowledge gap by conducting in-depth examination of infant mortality rate (IMR) inequality among population subgroups to provide more nuanced evidence to help end IMR disparity in the country. METHODS The World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) was used to analyze IMR inequality. HEAT is a software application that facilitates examination of disparities in reproductive, maternal, neonatal and child health indicators using the WHO Health Equity Monitor (HEM) database. Inequality of IMR was analyzed through disaggregation by five equity stratifiers: education, wealth, gender, subnational region and residence. These were analyzed through three inequality measures: Population Attributable Risk, Ratio and Slope Index of Inequality. A 95% confidence Interval (CI) was built around point estimates to determine statistical significance. RESULTS A notable disadvantage was found for children born to poor (Population Attributable Risk (PAR): -27.0; -28.4, -26.0) and uneducated (PAR: -17.0; -17.9, -16.0), women who live in rural areas (PAR: -7.3;-7.8, -6.7) and those residing in certain regions of the country (PAR: -43.0; 45.3, -4). Male infants had a higher risk of death than female infants (PAR: -6.8;-7.5, -6.2). The subnational regional variation of IMR had been the most evident when compared with the disparities in the other equity stratifers. CONCLUSIONS Policymakers and planners need to address the disproportionately higher clustering of IMR among infants born to disadvantaged subpopulations through interventions that benefit such subgroups.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
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Alotaibi RM, Rezk HR, Guure C. Bayesian frailty modeling of correlated survival data with application to under-five mortality. BMC Public Health 2020; 20:1429. [PMID: 32957954 PMCID: PMC7504601 DOI: 10.1186/s12889-020-09328-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background There is high rate of under-five mortality in West Africa with little effort made to study determinants that significantly increase or decrease its risk across the West African sub-region. This is important since it will help in the design of effective intervention programs for each country or the entire region. The overall objective of this research evaluates the determinants of under-five mortality prior to the end of the 2015 Millennium Development Goals, to guide West African countries implement strategies that will aid them achieve the Sustainable Development Goal 3 by 2030. Method This study used the Demographic and Health Survey (DHS) data from twelve (12) out of the eighteen West African countries; Ghana, Benin, Cote d’ Ivoire, Guinea, Liberia, Mali, Niger, Nigeria, Sierra Leone, Burkina Faso, Gambia and Togo. Data were extracted from the children and women of reproductive age files as provided in the DHS report. The response or outcome variable of interest is under-five mortality rate. A Bayesian exponential, Weibull and Gompertz regression models via a gamma shared frailty model were used for the analysis. The deviance information criteria and Bayes factors were used to discriminate between models. These analyses were carried out using Stata version 15 software. Results The study recorded 101 (95% CI: 98.6–103.5) deaths per 1000 live births occurring among the twelve countries. Burkina Faso (124.4), Cote D’lvoire (110.1), Guinea (116.4), Nigeria (120.6) and Niger (118.3) recorded the highest child under-5 mortality rate. Gambia (48.1), Ghana (60.1) and Benin (70.4) recorded the least unde-5 mortality rate per 1000 livebirths. Multiple birth children were about two times more likely to die compared to singleton birth, in all except Gambia, Nigeria and Sierra Leone. We observed significantly higher hazard rates for male compared to female children in the combined data analysis (HR: 1.14, 95% CI: [1.10–1.18]). The country specific analysis in Benin, Cote D’lvoire, Guinea, Liberia, Mali and Nigeria showed higher under-5 mortality hazard rates among male children compared to female children whilst Niger was the only country to report significantly lower hazard rate of males compared to females. Conclusion There is still quite a substantial amount of work to be done in order to meet the Sustainable Development Goal 3 in 2030 in West Africa. There exist variant differences among some of the countries with respect to mortality rates and determinants which require different interventions and policy decisions.
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Affiliation(s)
- Refah M Alotaibi
- Mathematical Sciences Department, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Hoda Ragab Rezk
- Mathematical Sciences Department, College of Science, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.,Department of statistics, Al-Azhar University, Cairo, Egypt
| | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
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Bora JK. Factors explaining regional variation in under-five mortality in India: An evidence from NFHS-4. Health Place 2020; 64:102363. [PMID: 32838888 DOI: 10.1016/j.healthplace.2020.102363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/25/2022]
Abstract
Although child mortality has declined in India, pronounced regional and socioeconomic inequality exists. The study examines the effects of individual- and community-level characteristics on under-five mortality and investigates the extent to which they affect regional variation. The study is based on Indian National Family and Health Survey 4, 2015-16 data. A two-level logistic regression model was performed to examine the effects of the socio-economic characteristics, and multivariate decomposition analysis was done to assess the contribution of factors in the inter-regional under-five mortality differentials. Regional variation in the selected variables is observed. For instance, the percentage of children with small childbirth size varied from 9.7% in the southern to 21.6% in the northeastern region. The percentage of poor households, low educated mothers, and childbirths delivered at home facility were higher in the central and eastern region compared to the southern region. The multilevel analysis shows that the region of residence explained 15.8% variance, and community-level characteristics alone could explain 25.3% variation in the risk of under-five deaths. The decomposition analysis indicates that the average number of excess deaths in the central and eastern regions is higher compared to the other regions. The compositional differences account for 50.9% of the under-five mortality gaps between the south and north region, 80.9% of the gap between the south and east, and 42.9% of the gap between the south and central region of India. Special attention and targeted action are needed to address the underlying causes of low birth weight of children in all the regions of India. Region-specific interventions might be priorities; for example, north, and central regions, need an economic and educational uplift, while infrastructural and economic policies should be prioritized for the northeastern region. Also, region-specific community-level interventions are needed to improve child survival in India.
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Affiliation(s)
- Jayanta Kumar Bora
- Indian Institute of Dalit Studies, New Delhi, 110049, India; International Institute for Applied Systems Analysis, Schlossplatz 1, A-2361, Laxenburg, Austria; Wittgenstein Centre for Demography and Global Human Capital (Univ. Vienna, IIASA, VID/ÖAW), Vienna, Austria.
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Yaya S, Ahinkorah BO, Ameyaw EK, Seidu AA, Darteh EKM, Adjei NK. Proximate and socio-economic determinants of under-five mortality in Benin, 2017/2018. BMJ Glob Health 2020; 5:e002761. [PMID: 32843572 PMCID: PMC7449341 DOI: 10.1136/bmjgh-2020-002761] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Globally, under-five mortality has declined significantly, but still remains a critical public health problem in sub-Saharan African countries such as Benin. Yet, there is no empirical information in the country using a nationally representative data to explain this phenomenon. The aim of this study was to examine how proximate and socio-economic factors are associated with mortality in under-five children in Benin. METHODS We analysed data of 5977 under-five children using the 2017 to 2018 Benin Demographic and Health Surveys. Multivariable hierarchical logistic regression modelling technique was applied to investigate the factors associated with under-five mortality. The fit of the models were assessed using variance inflation factor and Pseudo R2. Results were reported as adjusted odds ratios (aORs). All comparisons were considered to be statistically significant at p<0.05. RESULTS The study revealed an under-five mortality rate of 96 deaths per 1000 live births in Benin. Regarding the socio-economic determinants, the risk of death was found to be higher in children born in the Plateau region (aOR=3.05; 95% CI: 1.29 to 7.64), in rural areas (aOR=1.45; 95% CI: 1.07 to 1.98) and children with ≥4 birth rank and >2 years of birth interval (aOR=1.52; 95% CI: 1.07 to 2.17). Among the proximate determinants, we found the probability of death to be higher in children whose mothers had no postnatal check-up (PNC) visits after delivery (aOR=1.79; 95% CI: 1.22 to 2.63), but there was no significant association between individual-level/household-level factors and under-five mortality. CONCLUSION This study has established that socio-economic and proximate factors are important determinants of under-five mortality in Benin. Our findings have shown the need to implement both socio-economic and proximate interventions, particularly those related to PNC visits when planning on under-five mortality. To achieve this, a comprehensive, long-term public health interventions, which consider the disparity in the access and utilisation of healthcare services in Benin are key.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, UK
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | - Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Bremen, Germany
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Vijay J, Patel KK. Risk factors of infant mortality in Bangladesh. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Akinyemi JO, Odimegwu CO, Banjo OO, Gbadebo BM. Clustering of infant deaths among Nigerian women: investigation of temporal patterns using dynamic random effects model. GENUS 2019. [DOI: 10.1186/s41118-019-0058-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Harttgen K, Lang S, Seiler J. Selective mortality and the anthropometric status of children in low- and middle-income countries. ECONOMICS AND HUMAN BIOLOGY 2019; 34:257-273. [PMID: 31047818 DOI: 10.1016/j.ehb.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 02/11/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
Despite a close relationship between the childrens' anthropometric status and mortality rates, the highest mortality rates are concentrated in sub-Saharan Africa, while the lowest anthropometric indicators, in particular the height-for-age z-scores, are concentrated in South Asia. This discrepancy should, however, be expected to decrease when one accounts for the survivorship bias, i.e. selective mortality. We analyse whether the survivorship bias can explain these observed differences in three standard anthropometric indicators (stunting, underweight and wasting) by using individual data of children from six waves of Demographic and Health Surveys for a large cross-section of 37 low- and middle-income countries between 1991 and 2016. We use both a matching approach and semi-parametric regression to estimate the values for the anthropometric status of deceased children. The results are twofold: first, both methods reveal that the imputed values for the anthropometric indicators are, on average, between 0.10 and 0.25 standard deviations lower than the observed anthropometric indicators. Second, since the share of deceased children in our sample is below ten per cent, the contribution of the anthropometric status of deceased children to overall anthropometric indicators is small and therefore only influences it marginally.
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Affiliation(s)
- Kenneth Harttgen
- Department of Humanities, Social and Political Sciences, ETH Zurich, Clausiusstr. 37, 8092 Zurich, Switzerland.
| | - Stefan Lang
- Department of Statistics, University of Innsbruck, Universitätsstr. 15, 6020 Innsbruck, Austria.
| | - Johannes Seiler
- Department of Statistics, University of Innsbruck, Universitätsstr. 15, 6020 Innsbruck, Austria.
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Early Marriage, Cohabitation, and Childbearing in West Africa. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2019; 2019:9731756. [PMID: 31312221 PMCID: PMC6595391 DOI: 10.1155/2019/9731756] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/05/2019] [Accepted: 04/26/2019] [Indexed: 11/18/2022]
Abstract
The prevalence of child marriage in West Africa is one of the highest in the global south. Yet, much of what we know about the harmful effects of early marriage and why it persists comes from research on South Asia. Adopting life course family development perspectives on adolescent sexuality, we examine the linkages between the timing of union formation and childbearing across multiple countries with high rates of child marriage. Using the latest round of data from the Demographic and Health Surveys (DHS), we find that by age 18, 28 percent of adolescents in Nigeria, 25 percent in Burkina Faso, and as high as 60 percent in Niger are in a union, whilst 13 percent of Nigerian adolescents, 12 percent in Burkina Faso, and 27 percent in Niger have had a first birth. The results demonstrate that, net of individual characteristics, community variables are strong predictors of union formation and childbearing. Individual characteristics such as women's education, economic status of households, and residing in female-headed households and rural areas are other salient determinants of adolescent family transitions. We discuss the findings in the context of revamping stalled fertility transitions and the post-2015 framework for development in sub-Saharan Africa.
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Adanikin AI, Padmadas SS, McGrath N. Recurrent child mortality risks and parity transition in Nigeria. Reprod Health 2019; 16:79. [PMID: 31174553 PMCID: PMC6556041 DOI: 10.1186/s12978-019-0733-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fertility rates remain persistently high in Nigeria, with little difference across socioeconomic groups. While the desire for large family size is culturally rooted, there is little understanding of how repeated child mortality experiences influence fertility behaviour and parity transition in Nigeria. METHODS Using birth history data from the 2013 Nigeria Demographic and Health Survey (NDHS), we applied life table techniques and proportional-hazard regression model to explore the effect of child survival experience on parity transitions. We hypothesize that a woman with one or more child death experience is at elevated risk of progressing towards higher parities. RESULTS Our findings show that child mortality is concentrated among mothers living in deprived conditions especially in rural areas of the northern part of Nigeria and among those with little or no education and, among those belonging to Hausa/Fulani ethnicity and Islam religion. Mothers with repeated experience of child deaths were significantly at a higher rate of progressing to higher parities than their counterparts (HR: 1.45; 95% CI: 1.31-1.61), when adjusted for relevant biological and socio-demographic characteristics. CONCLUSION Recurrent experience of child deaths exacerbates the risks to higher parity transition. Interventions aimed at reducing fertility in Nigeria should target promoting child survival and family planning concurrently.
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Affiliation(s)
- Abiodun Idowu Adanikin
- Department of Social Statistics and Demography and Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sabu S. Padmadas
- Department of Social Statistics and Demography and Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
| | - Nuala McGrath
- Department of Social Statistics and Demography and Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
- Primary Care and Population Studies Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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Biradar R, Patel KK, Prasad JB. Effect of birth interval and wealth on under-5 child mortality in Nigeria. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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The effects of household and community context on mortality among children under five in Sierra Leone: Evidence from the 2013 Demographic and Health Survey. DEMOGRAPHIC RESEARCH 2019. [DOI: 10.4054/demres.2019.40.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Akinyemi JO, Bolajoko I, Gbadebo BM. Death of preceding child and maternal healthcare services utilisation in Nigeria: investigation using lagged logit models. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:23. [PMID: 30404661 PMCID: PMC6222986 DOI: 10.1186/s41043-018-0154-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/23/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND One of the factors responsible for high level of childhood mortality in Nigeria is poor utilization of maternal healthcare (MHC) services. Another important perspective which has been rarely explored is the influence of childhood death on MHC service utilization. In this study, we examined the relationship between death of preceding child and MHC services utilization [antenatal care (ANC), skilled attendant at birth (SAB), and postnatal care (PNC)] among Nigerian women and across the six geo-political zones of the country. METHODOLOGY We analyzed reproductive history dataset for 16,747 index births extracted from the 2013 Nigeria Demographic and Health Survey. The main explanatory variable was survival status of preceding child; therefore, only second or higher order births were considered. Analysis involved the use of descriptive statistics and lagged logit models fitted for each measure of MHC utilization. Association and statistical significance were expressed as adjusted odds ratio (AOR) with 95% confidence interval. RESULTS The use of MCH services for most recent births in the 2013 Nigeria DHS were ANC (56.0%), SAB (34.7%), and PNC (27.3%). Univariate models revealed that the death of preceding child was associated with lesser likelihood of ANC (OR = 0.64, CI 0.57-0.71), SAB (OR = 0.56, CI 0.50-0.63), and PNC (OR = 0.65, CI 0.55-0.69). Following adjustment for maternal socio-economic and bio-demographic variables, statistical significance in the relationship disappeared for the three MHC indicators: ANC (AOR = 1.00, CI 0.88-1.14), SAB (AOR = 0.97, CI 0.81-1.15), and PNC (AOR = 0.95, CI 0.83-1.11). There were no significant variations across the six geo-political regions in Nigeria. The likelihood of ANC utilization was higher when the preceding child died in Northcentral (AOR = 1.19, CI 0.84-1.70), Northeast (AOR = 1.26, CI 0.99-1.59), and South-south (AOR = 1.19, CI 0.72-1.99) regions while the reverse is the case in Southeast (AOR = 0.39, CI 0.23-0.60). For the Southeast, similar result was obtained for ANC, SAB, and PNC. CONCLUSION Death of a preceding child does not predict MHC services use in Nigeria especially when maternal socio-economic characteristics are controlled. Variations across the Northern and Southern regions did not attain statistical significance. Interventions are needed to reverse the pattern such that greater MHC utilization is recorded among women who have experienced child death.
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Affiliation(s)
- Joshua O. Akinyemi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State Nigeria
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Izzatullah Bolajoko
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State Nigeria
| | - Babatunde M. Gbadebo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State Nigeria
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Starnes JR, Chamberlain L, Sutermaster S, Owuor M, Okoth V, Edman W, Moon TD. Under-five mortality in the Rongo Sub-County of Migori County, Kenya: Experience of the Lwala Community Alliance 2007-2017 with evidence from a cross-sectional survey. PLoS One 2018; 13:e0203690. [PMID: 30192880 PMCID: PMC6128651 DOI: 10.1371/journal.pone.0203690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 08/24/2018] [Indexed: 01/27/2023] Open
Abstract
Introduction Childhood mortality remains a pressing problem in rural Kenya, and reducing under-five deaths is a key target of the Sustainable Development Goals. We aim to describe the reduction in under-five mortality in a rural Kenyan community served by the Lwala Community Alliance and factors associated with under-five mortality in this community. Methods A cross-sectional survey containing a complete birth history was administered to a representative sample of the catchment area of the Lwala Community Alliance. Survival analysis techniques were used to describe temporal trends and risk factors related to under-five mortality. Results 1,362 children were included in the study, and 91 children died before the fifth birthday. The most common causes of death among children under five were malaria (19%), respiratory infection (13%), and anemia (11%). The under-five mortality rate was 104.8 per 1,000 live births from 1999 to 2006 and 53.0 per 1,000 after the founding of the Lwala Community Alliance in 2007. Factors associated with under-five mortality included year of birth (HR 0.931; 95% CI: 0.877, 0.988; p = 0.019), multiple-gestation pregnancy (HR 6.201; 95% CI: 2.073, 18.555; p < 0.001), and birth in the long rain season (HR 1.981; 95% CI: 1.350, 2.907; p < 0.001). Birth spacing greater than 18 months was negatively associated with under-five mortality (HR 0.345; 95% CI: 0.203, 0.587; p < 0.001). Conclusions There was a significant decrease in under-five mortality before and after the presence of the Lwala Community Alliance. Multiple-gestation pregnancies, birth season, and short birth spacing were associated with under-five mortality and provide possible targets to further reduce mortality in the region. This provides both hyper-local data necessary for implementation efforts and generalizable data and sampling methods that may be useful for other implementing organizations in sub-Saharan Africa.
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Affiliation(s)
- Joseph R. Starnes
- School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
- Lwala Community Alliance, Lwala, Migori County, Kenya
- * E-mail:
| | | | | | - Mercy Owuor
- Lwala Community Alliance, Lwala, Migori County, Kenya
| | - Vincent Okoth
- Lwala Community Alliance, Lwala, Migori County, Kenya
| | - William Edman
- Lwala Community Alliance, Lwala, Migori County, Kenya
| | - Troy D. Moon
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
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Farley E, Lenglet A, Ariti C, Jiya NM, Adetunji AS, van der Kam S, Bil K. Risk factors for diagnosed noma in northwest Nigeria: A case-control study, 2017. PLoS Negl Trop Dis 2018; 12:e0006631. [PMID: 30138374 PMCID: PMC6107110 DOI: 10.1371/journal.pntd.0006631] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/22/2018] [Indexed: 01/22/2023] Open
Abstract
Background Noma (cancrum oris), a neglected tropical disease, rapidly disintegrates the hard and soft tissue of the face and leads to severe disfiguration and high mortality. The disease is poorly understood. We aimed to estimate risk factors for diagnosed noma to better guide existing prevention and treatment strategies using a case-control study design. Methods Cases were patients admitted between May 2015 and June 2016, who were under 15 years of age at reported onset of the disease. Controls were individuals matched to cases by village, age and sex. Caretakers answered the questionnaires. Risk factors for diagnosed noma were estimated by calculating unadjusted and adjusted odds ratios (ORs) and respective 95% confidence intervals (CI) using conditional logistic regression. Findings We included 74 cases and 222 controls (both median age 5 (IQR 3, 15)). Five cases (6.5%) and 36 (16.2%) controls had a vaccination card (p = 0.03). Vaccination coverage for polio and measles was below 7% in both groups. The two main reported water sources were a bore hole in the village (cases n = 27, 35.1%; controls n = 63, 28.4%; p = 0.08), and a well in the compound (cases n = 24, 31.2%; controls n = 102, 45.9%; p = 0.08). The adjusted analysis identified potential risk and protective factors for diagnosed noma which need further exploration. These include the potential risk factor of the child being fed pap every day (OR 9.8; CI 1.5, 62.7); and potential protective factors including the mother being the primary caretaker (OR 0.08; CI 0.01, 0.5); the caretaker being married (OR 0.006; CI 0.0006, 0.5) and colostrum being given to the baby (OR 0.4; CI 0.09, 2.09). Interpretation This study suggests that social conditions and infant feeding practices are potentially associated with being a diagnosed noma case in northwest Nigeria; these findings warrant further investigation into these factors. Noma or cancrum oris is an orofacial gangrene that rapidly disintegrates the hard and soft tissue of the face. Little is known about noma as most cases live in underserved, difficult to reach locations. There is a dearth of literature on the risk factors for the development of noma. Médecins Sans Frontières (MSF) in collaboration with the Nigerian Ministry of Health runs projects at the Noma Children’s Hospital in Sokoto. A case control study was conducted in northwest Nigeria to explore exposures associated with diagnosed noma using unadjusted and adjusted conditional logistic regression models. Potential risk and protective factors for diagnosed noma were identified and these findings need further exploration. The study identified that feeding pap to the child every day was a potential risk factor for diagnosed noma (possibly a proxy for poor variety in the diet). The following potential protective factors for diagnosed noma were identified: the mother being the primary caretaker, the caretaker being married, and colostrum being given to the baby. Noma is a neglected disease, and current risk factors suggest that intervention efforts could be more effective by focussing on access to health care, the benefits of breastfeeding and a varied diet. However, more research is needed in order to better understand the pathogenesis of this disease in order to improve prevention, early detection and treatment.
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Affiliation(s)
- Elise Farley
- Public Health Department, Médecins Sans Frontières, Operation Centre Amsterdam, Amsterdam, The Netherlands
- Department of Public Health Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Annick Lenglet
- Public Health Department, Médecins Sans Frontières, Operation Centre Amsterdam, Amsterdam, The Netherlands
| | - Cono Ariti
- Centre for Medical Education, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Nma M. Jiya
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Adeniyi Semiyu Adetunji
- Department of Plastic Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
- Department of Clinical Services, Noma Children’s Hospital, Sokoto, Nigeria
| | - Saskia van der Kam
- Public Health Department, Médecins Sans Frontières, Operation Centre Amsterdam, Amsterdam, The Netherlands
| | - Karla Bil
- Public Health Department, Médecins Sans Frontières, Operation Centre Amsterdam, Amsterdam, The Netherlands
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Akinyemi JO, Solanke BL, Odimegwu CO. Maternal Employment and Child Survival During the Era of Sustainable Development Goals: Insights from Proportional Hazards Modelling of Nigeria Birth History Data. Ann Glob Health 2018; 84:15-30. [PMID: 30873781 PMCID: PMC6748258 DOI: 10.29024/aogh.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: One of the targets for the third and fifth Sustainable Development Goals (SDGs) borders on children survival and women economic empowerment, respectively. A robust investigation of the relationship between maternal employment and childhood mortality will provide information useful for programs aimed at ensuring the complementarity of SDG 3 (healthy life for all) and SDG 5 (gender equality, girls and women empowerment). Objective: We addressed the following questions: (1) What is the independent relationship between maternal employment and infant (0–11 months) and child (12–59 months) mortality in Nigeria? (2) How does father’s occupation, type of residence, and geopolitical region modify the relationship? Methods: We retrospectively analysed cross-sectional data on weighted sample of 31,828 under-five children extracted from the birth history in the 2013 round of Nigeria Demographic and Health Survey, using Cox proportional hazards models. The outcomes of interest were infant (0–11 months) and child (12–59 months) mortality, and the main explanatory variables include maternal employment, involvement in decision making on work earnings, and father’s occupation. Other confounding variables were also controlled. Findings: Results showed that about two-third (68.7%) of under-five children had mothers who were working, with the majority engaged in self-employed occupations such as sales or small businesses, agriculture, and other manual labour. Infant mortality rate amongst children of employed mothers (65 per 1000 live births) was slightly less than the unemployed (70 per 1000 live births). A similar pattern was observed for child mortality. Hazards regression models revealed that the risk of both infant and child mortality was higher amongst unemployed women. Sales and agriculture/manual occupation constituted a higher risk for infant and child mortality. Analysis of interaction effects also revealed variations by father’s occupation, type of residence, and geopolitical region. Conclusion: The role of maternal employment in child survival is dynamic and depends on the type of occupation, family, and residential and regional context.
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Affiliation(s)
- Joshua O Akinyemi
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, ZA.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, NG
| | - Bola L Solanke
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, ZA.,Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, NG
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, ZA
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Silva JVD, Oliveira AGRDC. Individual and contextual factors associated to the self-perception of oral health in Brazilian adults. Rev Saude Publica 2018; 52:29. [PMID: 29641654 PMCID: PMC5893273 DOI: 10.11606/s1518-8787.2018052000361] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/08/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze how individual characteristics and the social context, together, are associated with self-perception of the oral health. METHODS A multilevel cross-sectional study with data from the Brazilian National Health Survey 2013, the United Nations Development Program, and the National Registry of Health Establishments. The explanatory variables for the “oral health perception” outcome were grouped, according to the study framework, into biological characteristics (sex, color, age), proximal social determinants (literacy, household crowding, and socioeconomic stratification), and distal (years of schooling expectancy at age 18, GINI, Human Development Index, and per capita income). The described analysis was performed, along with bivariate Poisson analysis and multilevel Poisson analysis for the construction of the explanatory model of oral health perception. All analyzes considered the sample weights. RESULTS Both the biological characteristics and the proximal and distal social determinants were associated with the perception of oral health in the bivariate analysis. A higher prevalence of bad oral health was associated to lower years of schooling expectancy (PR = 1.31), lower per capita income (PR = 1.45), higher income concentration (PR = 1.41), and worse human development (PR = 1.45). Inversely, oral health services in both primary and secondary care were negatively associated with oral health perception. All the biological and individual social characteristics, except reading and writing, made up the final explanatory model along with the distal social determinants of the Human Development Index and coverage of basic care in the multilevel analysis. CONCLUSIONS Biological factors, individual and contextual social determinants were associate synergistically with the population’s perception of oral health. It is necessary to improve individual living conditions and the implementation of public social policies to improve the oral health of the population.
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Affiliation(s)
- Janmille Valdivino da Silva
- Universidade Federal do Rio Grande do Norte. Faculdade de Odontologia. Programa de Pós-Graduação em Saúde Coletiva. Natal, RN, Brasil
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