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Levano SR, Kraemer J, Dabla D, Miziou EA, Haughton J, Jones HE, Teasdale C, Ekouevi D, Hirschhorn LR, Fiori KP. Identifying determinants of under-five child mortality in northern Togo. J Glob Health 2024; 14:04019. [PMID: 38299779 PMCID: PMC10832555 DOI: 10.7189/jogh.14.04019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
Background Although global rates of under-five mortality have declined, many low- and middle-income countries (LMICs), including Togo, have not achieved sufficient progress. We aimed to identify the structural and intermediary determinants associated with under-five mortality in northern Togo. Methods We collected population-representative cross-sectional household surveys adapted from the Demographic Household Survey (DHS) and Multiple Indicator Cluster Survey from women of reproductive age in northern Togo in 2018. The primary outcome was under-five mortality for children born to respondents in the 10-year period prior to the survey. We selected structural and intermediary determinants of health from the World Health Organization Conceptual Framework for Action on the Social Determinants of Health. We estimated associations between determinants and under-five mortality for births in the last 10 years (model 1 and 2) and two years (model 3) using Cox proportional hazards models. Results Of the 20 121 live births in the last 10 years, 982 (4.80%) children died prior to five years of age. Prior death of a sibling (adjusted hazard ratio (aHR) = 5.02; 95% confidence interval (CI) = 4.23-5.97), maternal ethnicity (i.e. Konkomba, Temberma, Lamba, Losso, or Peul), multiple birth status (aHR = 2.27; 95% CI = 1.78-2.90), maternal age under 25 years (women <19 years: aHR = 2.05; 95% CI = 1.75-2.39; women 20-24 years: aHR = 1.48; 95% CI = 1.29-1.68), lower birth interval (aHR = 1.51; 95% CI = 1.31-1.74), and higher birth order (second or third born: aHR = 1.45; 95% CI = 1.32-1.60; third or later born: aHR = 2.14; 95% CI = 1.74-2.63) were associated with higher hazard of under-five mortality. Female children had lower hazards of under-five mortality (aHR = 0.80; 95% CI = 0.73-0.89). Under-five mortality was also lower for children born in the last two years (n = 4852) whose mothers received any (aHR = 0.48; 95% CI = 0.30-0.78) or high quality (aHR = 0.51; 95% CI = 0.29-0.88) prenatal care. Conclusion Compared to previous DHS estimates, under-five mortality has decreased in Togo, but remains higher than other LMICs. Prior death of a sibling and several intermediary determinants were associated with a higher risk of mortality, while receipt of prenatal care reduced that risk. These findings have significant implications on reducing disparities related to mortality through strengthening maternal and child health care delivery.
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Affiliation(s)
- Samantha R Levano
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John Kraemer
- Department of Health Management and Policy, Georgetown University School of Health, Washington D.C., USA
| | - Désiré Dabla
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
| | - Essodinam Agnes Miziou
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
| | - Jessica Haughton
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Heidi E Jones
- Department of Epidemiology and Biostatistics, City University of New York Graduate School of Public Health and Health Policy, New York, USA
- CUNY Institute of Implementation Science in Population Health, New York, USA
| | - Chloe Teasdale
- Department of Epidemiology and Biostatistics, City University of New York Graduate School of Public Health and Health Policy, New York, USA
| | - Didier Ekouevi
- Department of Public Health, Health Sciences Faculty, University of Lomé, Lomé, Togo
- African Research Center in Epidemiology and Public Health, Lomé, Togo
| | - Lisa R Hirschhorn
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Kevin P Fiori
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
- Community Health Systems Lab, Integrate Health/Santé Intégrée, Bronx, New York, USA/Kara, Togo
- Department of Family & Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
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Poulin D, Nimo G, Royal D, Joseph PV, Nimo T, Nimo T, Sarkodee K, Attipoe-Dorcoo S. Infant mortality in Ghana: investing in health care infrastructure and systems. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae005. [PMID: 38756556 PMCID: PMC10986301 DOI: 10.1093/haschl/qxae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 05/18/2024]
Abstract
Child and infant mortality is a global problem. Almost half of deaths of children under age 5 years occur in the neonatal period, the first 28 days of life, with 2.4 million neonatal deaths globally in 2020. Sub-Saharan Africa has disproportionately high numbers of neonatal deaths. Ghana's neonatal mortality rate is 22.8 per 1000 live births and remains behind targets set by the United Nations Sustainable Development Goals. Quality antenatal care, postnatal monitoring, breastfeeding support, and postnatal family planning are important in preventing neonatal deaths. While Ghana has made progress in making care more financially accessible, it has not been matched with the improvements in the critical infrastructure required to ensure quality health care. The improvements have also not eliminated out-of-pocket costs for care, which have hindered progress in decreasing infant mortality. Policymakers should consider investments in health care infrastructure, including expanding public-private partnerships. Policies that improve workforce development programs, transportation infrastructure, and health insurance systems improvements are needed.
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Affiliation(s)
| | - Gloria Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Dorian Royal
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | | | - Tiffany Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Tyra Nimo
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Kofi Sarkodee
- Amazing Grace Children's Charity, Dansoman Accra GA-542-8377, Ghana
| | - Sharon Attipoe-Dorcoo
- TERSHA LLC, Alpharetta, GA 30005, United States
- Healthcare Administration Program, College of Business, Texas Woman's University, Denton, TX 76204, United States
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Gebrerufael GG, Hagos BT. Predictors of mortality among under-five children in rural Ethiopia: a cross sectional study. BMC Pediatr 2023; 23:633. [PMID: 38102580 PMCID: PMC10722689 DOI: 10.1186/s12887-023-04440-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Under-five child mortality (UFCM) is one of the major significant and sensitive indicators of the health status of the public. Although the world has seen a remarkable and substantial decrease in UFCM since 1990, its progression rate still remains alarmingly high in Sub-Saharan African (SSA) countries, particularly in Ethiopia. Therefore, this study aimed to assess associations between mortality and under-five children in rural Ethiopia. METHODS This study used a secondary data analysis of the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) report. A total of 4,425 under-five children were included in the final analysis. The Kaplan-Meier (K-M) and Cox proportional hazard (PH) model analyses were utilized to estimate survival time and investigate the major predictors of mortality in under-five children, respectively. An adjusted hazard ratio (AHR) along with a 95% confidence interval (CI) was employed to measure the association size and direction of the association (STATA 12). RESULTS The study showed that 6.2% (95% CI: 5.43, 6.86) of children died beforehand celebrating their fifth birthday in rural Ethiopia. The multivariable Cox PH regression model analysis revealed associations of large spacing preceding birth interval (16-26 months) (AHR = 0.61; 95% CI: (0.402-0.920)), 27-38 months (AHR = 0.72; 95% CI: (0.496-1.03)), and ≥ 39 months, multiple births (AHR = 3.9; 95% CI: (2.77-5.62)), being breastfeeding (AHR = 0.13; 95% CI: (0.099-0.162)), and unvaccinated child (AHR = 11.6; 95% CI: (1.62-83.1)) were significant associations of under-five children mortality. CONCLUSIONS In this study, the UFCM rate was present, with 6.2% in the rural areas of Ethiopia. The birth type, preceding birth interval, vaccination of the child, and breastfeeding are identified as significant associations with under-five child mortality in rural Ethiopia. Therefore, public health interventions should be given attention to multiple births, unvaccinated, and non-breastfeeding children, as well as mothers' better encouragement to have a large spacing preceding the birth interval. Moreover, investigators should conduct continuous research on UFCM, which is imperative to provide current information and inform interventions in a timely manner.
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Affiliation(s)
- Gebru Gebremeskel Gebrerufael
- Department of Statistics, College of Natural and Computational Science, Adigrat University, P.O. Box 50, Adigrat, Ethiopia.
| | - Bsrat Tesfay Hagos
- Department of Statistics, College of Natural and Computational Science, Mekelle University, P.O. Box.231, Mekelle, Ethiopia
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Oyato B, Zakir H, Hussein D, Lemma T, Awol M. Time to Death and Its Predictors Among Infants in Ethiopia: Multilevel Mixed-Effects Parametric Survival Analysis Using the 2019 Ethiopian Mini Demographic Health Survey. Pediatric Health Med Ther 2023; 14:169-183. [PMID: 37250232 PMCID: PMC10224721 DOI: 10.2147/phmt.s402154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Three years ahead of the plan, Ethiopia has met Millennium Development Goal 4 of reducing under-five mortality. Additionally, the nation is on track to achieve the Sustainable Development Goal of putting an end to preventable child mortality. Despite this, recent data from the nation showed that there were 43 infant deaths for every 1000 live births. Moreover, the country has fallen short of the 2015 Health Sector Transformation Plan goal, with an anticipated infant mortality rate of 35 deaths per 1000 live births in 2020. Thus, this study aims to identify the time to death and its predictors among Ethiopian infants. Methods This study used the 2019 Mini-Ethiopian Demographic and Health Survey data set to conduct a retrospective study. The analysis used survival curves and descriptive statistics. Multilevel mixed-effects parametric survival analysis was applied to identify the predictors of infant mortality. Results The estimated mean survival time of infants was 11.3 months (95% CI: 11.1, 11.4). Women's current pregnancy status, family size, age of women, previous birth interval, place of delivery, and mode of delivery were significant individual-level predictors of infant mortality. Infants born with less than 24 months' birth interval had a 2.29 times higher estimated risk of death (AHR = 2.29, 95% CI: 1.05, 5.02). Infants born at home were 2.48 times more likely to die than those born in a health facility (AHR = 2.48, 95% CI: 1.03, 5.98). At the community level, women's education was the only statistically significant predictor of infant death. Conclusion The risk of infant death was higher before the first month of life, typically shortly after birth. Healthcare programs should put a strong emphasis on efforts to space out births and make institutional delivery services more readily accessible to mothers in Ethiopia to address the infant mortality challenges.
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Affiliation(s)
- Befekadu Oyato
- Department of Midwifery, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Husen Zakir
- Department of Midwifery, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Dursa Hussein
- Department of Public Health, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Tasfaye Lemma
- Department of Nursing, College of Health Sciences, Salale University, Fitche, Ethiopia
| | - Mukemil Awol
- Department of Midwifery, College of Health Sciences, Salale University, Fitche, Ethiopia
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Sachdeva A, Verma R, Agrawal G, Vinay, Satija J. Epidemiological Profile and Spatio-Temporal Pattern of Infant Deaths in a District of North India during 2016-2019. Indian J Community Med 2023; 48:346-350. [PMID: 37323726 PMCID: PMC10263054 DOI: 10.4103/ijcm.ijcm_608_22] [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: 07/13/2022] [Accepted: 02/13/2023] [Indexed: 11/02/2023] Open
Abstract
Background Infant mortality is an important health indicator of a population given its strong link to socioeconomic status, health service access, and quality and maternal health. The declining trend of Infant Mortality Rate has been observed in India where it reduced from 89 deaths per 1000 live births in 1990 to 28 deaths per 1000d live births in 2019. Most of the studies regarding the trend of infant mortality are state-based, however, state-level infant mortality has masked the intradistrict clustering of individual infant deaths. Hence, this study was planned with an objective to study the trend of infant mortality at the district level. Material and Methods A retrospective study was conducted in the district Rohtak of Haryana using the data collected regarding infant deaths. The collected data regarding addresses were geocoded. The resulting layer was then analyzed using QGIS v3.10. The descriptive data was analyzed using SPSS v20.0. Result In total, 1336 infant deaths during the study period were included. A declining trend of infant mortality was observed over the study period. The number of grids (25 km2) reduced from 18 in 2016 to 10 in 2019 depicting a reduction in the areas with more than expected count. Conclusion This study emphasizes on the importance of using the geographic information science technique in identifying local hotspots within the district so as to find areas that need more support and observation.
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Affiliation(s)
- Aman Sachdeva
- Department of Community Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Ramesh Verma
- Department of Community Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Ginni Agrawal
- Department of Community Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Vinay
- Department of Community Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - Jitesh Satija
- Department of Community Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
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