A Systematic Review of Factors Associated with Under-Five Child Mortality

Investigation of Factors Influencing Infant Mortality at Greater Accra Regional Hospital, Ghana

Background

Annually, 5.4 million children under five face mortality, with 2.5 million deaths in the first month, 1.6 million between one and eleven months, and 1.3 million aged one to four. Despite global strides, sub-Saharan Africa, including Ghana, grapples with persistent high child mortality. This study employs statistical methods to pinpoint factors driving under-five mortality in the Greater Accra Regional Hospital.

Methods

The data was acquired from Greater Accra Regional Hospital, Ghana, spanning January to December 2020. The data comprised all under-five deaths recorded in the hospital in 2020. The statistical tools employed were the chi-square test of association and the multinomial logistic regression model.

Results

In 2020, there were 238 cases of under-five mortality recorded in the hospital, with males constituting the majority (55%). About 85% of these cases occurred within the first month of birth, primarily attributed to respiratory distress, prematurity, and sepsis. Notably, meconium aspiration was the least common among grouped diagnoses. The test of association and multinomial logistic model emphasised the child's age, birth type, and weight at birth as significant factors influencing child mortality. Conversely, attributes like sex, marital status, and mother's age displayed no notable association with the diagnosis of death.

Conclusion

The study on child mortality at the Greater Accra Regional Hospital unveils key factors shaping child health outcomes, emphasising the role of age, birth type, and weight. While specific demographics show no significant association, identified predictors are vital for targeted interventions. Proposed strategies encompass education programs, improved care, birthing practices, and data-driven policies.

Identifying determinants of under-five child mortality in northern Togo

Background

Although global rates of under-five mortality have declined, many low- and middle-income countries (LMICs), including Togo, have not achieved sufficient progress. We aimed to identify the structural and intermediary determinants associated with under-five mortality in northern Togo.

Methods

We collected population-representative cross-sectional household surveys adapted from the Demographic Household Survey (DHS) and Multiple Indicator Cluster Survey from women of reproductive age in northern Togo in 2018. The primary outcome was under-five mortality for children born to respondents in the 10-year period prior to the survey. We selected structural and intermediary determinants of health from the World Health Organization Conceptual Framework for Action on the Social Determinants of Health. We estimated associations between determinants and under-five mortality for births in the last 10 years (model 1 and 2) and two years (model 3) using Cox proportional hazards models.

Results

Of the 20 121 live births in the last 10 years, 982 (4.80%) children died prior to five years of age. Prior death of a sibling (adjusted hazard ratio (aHR) = 5.02; 95% confidence interval (CI) = 4.23-5.97), maternal ethnicity (i.e. Konkomba, Temberma, Lamba, Losso, or Peul), multiple birth status (aHR = 2.27; 95% CI = 1.78-2.90), maternal age under 25 years (women <19 years: aHR = 2.05; 95% CI = 1.75-2.39; women 20-24 years: aHR = 1.48; 95% CI = 1.29-1.68), lower birth interval (aHR = 1.51; 95% CI = 1.31-1.74), and higher birth order (second or third born: aHR = 1.45; 95% CI = 1.32-1.60; third or later born: aHR = 2.14; 95% CI = 1.74-2.63) were associated with higher hazard of under-five mortality. Female children had lower hazards of under-five mortality (aHR = 0.80; 95% CI = 0.73-0.89). Under-five mortality was also lower for children born in the last two years (n = 4852) whose mothers received any (aHR = 0.48; 95% CI = 0.30-0.78) or high quality (aHR = 0.51; 95% CI = 0.29-0.88) prenatal care.

Conclusion

Compared to previous DHS estimates, under-five mortality has decreased in Togo, but remains higher than other LMICs. Prior death of a sibling and several intermediary determinants were associated with a higher risk of mortality, while receipt of prenatal care reduced that risk. These findings have significant implications on reducing disparities related to mortality through strengthening maternal and child health care delivery.

Factors Associated With Low Birth Weight Among the Tribal Population in India: A Narrative Review

Low birth weight (LBW) is defined by the WHO as a birth weighing less than 2500 g (5.5 lb). The highest burden of any nation is LBW infants. In countries where the frequency of neonate babies is high, short gestation is a major cause. LBW babies have an 11-13 times greater risk of delayed developmental milestones and other medical diagnoses. Greater than the global incidence, LBW prevalence is a severe public health problem in India. A comprehensive literature search was conducted using internet sources like PubMed, Web of Science, Cochrane Library, and Google Scholar. The words "birth weight," "abnormal birth weight," "LBWs," "neonates," "premature birth," "risks factors," "causes," "factors," "prevalence," and "frequency" were searched. In this review, we examine the causes of LBW, implementation of pre-birth prevention strategies, and post-birth multifaceted health promotion interventions. The mother's knowledge, dietary requirements, and prenatal services need to be addressed to decrease the prevalence of LBWs among tribal districts of India.

Determinants of Neonatal, Infant and Child Mortalities in Iran: A Systematic Review

Background

Children mortality is considered as one of the main indicators of population development and health, while most of the children's deaths are preventable. This study systematically reviewed the determinants of children mortality in Iran.

Methods

This systematic review was conducted to summarize all the factors associated with children mortality in three age groups; Neonate (0-28 d), Infant (28 d-1 yr old) and children (<5 yr old), based on the PRISMA guideline. Many of the electronic international and national databases, in addition to hand searching of reference of selected articles, grey literature, formal and informal reports and government documents were screened to identify potential records up to Jan 2022. We included all studies that identified determinants of child mortality in any province of Iran or the whole country, without any restriction.

Results

Overall, 32 studies were included, published between 2000 and 2022, of which 23 were cross-sectional and 15 published in Farsi language. The associations between several risk factors (n=69) and the child mortality were examined. Among the identified factors, 'birth weight', 'mother's literacy', 'socioeconomic status', 'delivery type', 'gestational age', 'pregnancy interval', 'immaturity', 'type of nutrition', and 'stillbirth' were the most important mentioned determinants of child mortality in Iran.

Conclusion

Appropriate interventions and policies should be developed and implemented in Iran, addressing the main identified associated factors, resulting from this review study, with the aim of minimizing preventable child deaths, based on their age categories.

Childhood mortality and associated factors in Migori County, Kenya: evidence from a cross-sectional survey

OBJECTIVES

The under-five mortality (U5M) rate in Kenya (41 per 1000 live births) remains significantly above international goals (25 per 1000 live births). This is further exacerbated by regional inequalities in mortality. We aimed to describe U5M in Migori County, Kenya, and identify associated factors that can serve as programming targets.

DESIGN

Cross-sectional observational survey.

SETTING

Areas served by the Lwala Community Alliance and control areas in Migori County, Kenya.

PARTICIPANTS

This study included 15 199 children born to respondents during the 18 years preceding the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was mortality in the first 5 years of life. The survey was powered to detect a 10% change in various health metrics over time with 80% power.

RESULTS

A total of 15 199 children were included in the primary analyses, and 230 (1.5%) were deceased before the fifth birthday. The U5M rate from 2016 to 2021 was 32.2 per 1000 live births. Factors associated with U5M included year of birth (HR 0.926, p<0.001), female sex (HR 0.702, p=0.01), parental marriage (HR 0.642, p=0.036), multiple gestation pregnancy (HR 2.776, p<0.001), birth spacing less than 18 months (HR 1.894, p=0.005), indoor smoke exposure (HR 1.916, p=0.027) and previous familial contribution to the National Hospital Insurance Fund (HR 0.553, p=0.009). The most common cause of death was malaria.

CONCLUSIONS

We describe factors associated with childhood mortality in a Kenyan community using survival analyses of complete birth histories. Mortality rates will serve as the baseline for future programme evaluation as a part of a 10-year study design. This provides both the hyperlocal information needed to improve programming and generalisable conclusions for other organisations working in similar environments.