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Macharia PM, Beňová L. Double burden of under-5 mortality in LMICs. Lancet Glob Health 2022; 10:e1535-e1536. [PMID: 36240809 DOI: 10.1016/s2214-109x(22)00357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, 43640-00100, Nairobi, Kenya; Center for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom.
| | - Lenka Beňová
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Verhulst A, Prieto JR, Alam N, Eilerts-Spinelli H, Erchick DJ, Gerland P, Katz J, Lankoande B, Liu L, Pison G, Reniers G, Subedi S, Villavicencio F, Guillot M. Divergent age patterns of under-5 mortality in south Asia and sub-Saharan Africa: a modelling study. Lancet Glob Health 2022; 10:e1566-e1574. [PMID: 36088913 PMCID: PMC9588693 DOI: 10.1016/s2214-109x(22)00337-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022]
Abstract
Background Understanding the age pattern of under-5 mortality is essential for identifying the most vulnerable ages and underlying causes of death, and for assessing why the decline in child mortality is slower in some countries and subnational areas than others. The aim of this study is to detect age patterns of under-5 mortality that are specific to low-income and middle-income countries (LMICs). Methods In this modelling study, we used data from 277 Demographic and Health Surveys (DHSs), 58 Health and Demographic Surveillance Systems (HDSSs), two cohort studies, and two sample-registration systems. From these sources, we collected child date of birth and date of death (or age at death) from LMICs between 1966 and 2020. We computed 22 deaths rates from each survey with the following age breakdowns: 0, 7, 14, 21, and 28 days; 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 15, 18, and 21 months; and 2, 3, 4, and 5 years. We assessed how probabilities of dying estimated for the 22 age groups deviated from predictions generated by a vital registration model that reflects the historical mortality of 25 high-income countries. Findings We calculated mortality rates of 81 LMICs between 1966 and 2020. In contrast with the other regions of the world, we found that under-5 mortality in south Asia and sub-Saharan Africa was characterised by increased mortality at both ends of the age range (ie, younger than 28 days and older than 6 months) at a given level of mortality. Observed mortality in these regions was up to 2 times higher than predicted by the vital registration model for the younger-than-28 days age bracket, and up to 10 times higher than predicted for the older-than-6 months age bracket. This age pattern of under-5 mortality is significant in 17 countries in south Asia and sub-Saharan Africa. Excess mortality in children older than 6 months without excess mortality in children younger than 28 days was found in 38 countries. In south Asia, results were consistent across data sources. In sub-Saharan Africa, excess mortality in children younger than 28 days was found mostly in DHSs; the majority of HDSSs did not show this excess mortality. We have attributed this difference in data sources mainly to omissions of early deaths in HDSSs. Interpretation In countries with age patterns of under-5 mortality that diverge from predictions, evidence-based public health interventions should focus on the causes of excess of mortality; notably, the effect of fetal growth restriction and infectious diseases. The age pattern of under-5 mortality will be instrumental in assessing progress towards the decline of under-5 mortality and the Sustainable Development Goals. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.
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Affiliation(s)
- Andrea Verhulst
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA.
| | - Julio Romero Prieto
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Nurul Alam
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Daniel J Erchick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruno Lankoande
- Institut Supérieur des Sciences de la Population, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Li Liu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gilles Pison
- Laboratoire d'Eco-anthropologie, French Museum of Natural History, Paris, France; French Institute for Demographic Studies (INED), Paris, France
| | - Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Seema Subedi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Francisco Villavicencio
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Centre for Demographic Studies, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Michel Guillot
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA; French Institute for Demographic Studies (INED), Paris, France
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Jasseh M, Rerimoi AJ, Reniers G, Timæus IM. Assessment of the consistency of health and demographic surveillance and household survey data: A demonstration at two HDSS sites in The Gambia. PLoS One 2022; 17:e0271464. [PMID: 35830461 PMCID: PMC9278757 DOI: 10.1371/journal.pone.0271464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To assess whether an adapted Demographic and Health Survey (DHS) like cross-sectional household survey with full pregnancy histories can demonstrate the validity of health and demographic surveillance (HDSS) data by producing similar population structural characteristics and childhood mortality indicators at two HDSS sites in The Gambia–Farafenni and Basse. Methods A DHS-type survey was conducted of 2,580 households in the Farafenni HDSS, and 2,907 in the Basse HDSS. Household members were listed and pregnancy histories obtained for all women aged 15–49. HDSS datasets were extracted for the same households including residency episodes for all current and former members and compared with the survey data. Neonatal (0–28 days), infant (<1 year), child (1–4 years) and under-5 (< 5 years) mortality rates were derived from each source by site and five-year periods from 2001–2015 and by calendar year between 2011 and 2015 using Kaplan–Meier failure probabilities. Survey-HDSS rate ratios were determined using the Mantel-Haenszel method. Results The selected households in Farafenni comprised a total population of 27,646 in the HDSS, compared to 26,109 captured in the household survey, implying higher coverage of 94.4% (95% CI: 94.1–94.7; p<0.0001) against a hypothesised proportion of 90% in the HDSS. All population subgroups were equally covered by the HDSS except for the Wollof ethnic group. In Basse, the total HDSS population was 49,287, compared to 43,538 enumerated in the survey, representing an undercount of the HDSS by the survey with a coverage of 88.3% (95% CI: 88.0–88.6; p = 1). All sub-population groups were also under-represented by the survey. Except for the neonatal mortality rate for Farafenni, the childhood mortality indicators derived from pregnancy histories and HDSS data compare reasonably well by 5-year periods from 2001–2015. Annual estimates from the two data sources for the most recent quinquennium, 2011–2015, were similar in both sites, except for an excessively high neonatal mortality rate for Farafenni in 2015. Conclusion Overall, the adapted DHS-type survey has reasonably represented the Farafenni HDSS database using population size and structure; and both databases using childhood mortality indicators. If the hypothetical proportion is lowered to 85%, the survey would adequately validate both HDSS databases in all considered aspects. The adapted DHS-type sample household survey therefore has potential for validation of HDSS data.
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Affiliation(s)
- Momodou Jasseh
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- * E-mail:
| | - Anne J. Rerimoi
- Department of Women and Children’s Health, King’s College, London, United Kingdom
| | - Georges Reniers
- Department of Epidemiology and Population Health, Population Studies Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ian M. Timæus
- Department of Epidemiology and Population Health, Population Studies Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre for Actuarial Research, University of Cape Town, Cape Town, South Africa
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Bocquier P, Ginsburg C, Menashe-Oren A, Compaoré Y, Collinson M. The Crucial Role of Mothers and Siblings in Child Survival: Evidence From 29 Health and Demographic Surveillance Systems in Sub-Saharan Africa. Demography 2021; 58:1687-1713. [PMID: 34499115 DOI: 10.1215/00703370-9429499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A considerable body of research has studied the effects of siblings on child mortality through birth intervals. This research has commonly focused on older siblings. We argue that birth intervals with younger siblings may have equal or stronger effects on child mortality, even during a mother's pregnancy. Moreover, we contend that birth interval effects need to be considered only when siblings are coresident. Using longitudinal data from 29 Health and Demographic Surveillance Systems across sub-Saharan Africa, covering more than 560,000 children, we examine the proximate role of siblings and mothers in child mortality. We find that a birth interval of 24 months or more is advantageous for both older and younger siblings. The effect of a younger sibling on child mortality is more pronounced than that of an older sibling and adds to the effect of an older sibling. Moreover, child mortality is particularly low during a mother's subsequent pregnancy, contrasting the shock resulting from a younger sibling's birth. Further, we find that a mother's or sibling's absence from the household results in a higher risk of mortality, and the death of either reduces child survival up to six months before the death.
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Affiliation(s)
- Philippe Bocquier
- Centre de Recherches en Démographie, Université Catholique de Louvain, Louvain-la-Neuve, Belgium; Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand (Education Campus), Johannesburg, South Africa
| | - Carren Ginsburg
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand (Education Campus), Johannesburg, South Africa
| | - Ashira Menashe-Oren
- Centre de Recherches en Démographie, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Yacouba Compaoré
- Institut Supérieur des Sciences de la Population (ISSP), Université de Ouagadougou, Burkina Faso; Centre de Recherches en Démographie, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Mark Collinson
- Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand (Education Campus), Johannesburg, South Africa; Department of Science and Innovation, South African Medical Research Council, South African Population Research Infrastructure Network (SAPRIN), SAMRC Durban Office, Durban, South Africa
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Berrueta M, Ciapponi A, Bardach A, Cairoli FR, Castellano FJ, Xiong X, Stergachis A, Zaraa S, Meulen AST, Buekens P. Maternal and neonatal data collection systems in low- and middle-income countries for maternal vaccines active safety surveillance systems: A scoping review. BMC Pregnancy Childbirth 2021; 21:217. [PMID: 33731029 PMCID: PMC7968860 DOI: 10.1186/s12884-021-03686-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most post-licensure vaccine pharmacovigilance in low- and middle-income countries (LMICs) are passive reporting systems. These have limited utility for maternal immunization pharmacovigilance in LMIC settings and need to be supplemented with active surveillance. Our study's main objective was to identify existing perinatal data collection systems in LMICs that collect individual information on maternal and neonatal health outcomes and could be developed to inform active safety surveillance of novel vaccines for use during pregnancy. METHODS A scoping review was performed following the Arksey and O'Malley six-stage approach. We included studies describing electronic or mixed paper-electronic data collection systems in LMICs, including research networks, electronic medical records, and custom software platforms for health information systems. Medline PubMed, EMBASE, Global Health, Cochrane Library, LILACS, Bibliography of Asian Studies (BAS), and CINAHL were searched through August 2019. We also searched grey literature including through Google and websites of existing relevant perinatal data collection systems, as well as contacted authors of key studies and experts in the field to validate the information and identify additional sources of relevant unpublished information. RESULTS A total of 11,817 records were identified. The full texts of 264 records describing 96 data collection systems were assessed for eligibility. Eight perinatal data collection systems met our inclusion criteria: Global Network's Maternal Newborn Health Registry, International Network for the Demographic Evaluation of Populations and their Health; Perinatal Informatic System; Pregnancy Exposure Registry & Birth Defects Surveillance; SmartCare; Open Medical Record System; Open Smart Register Platform and District Health Information Software 2. These selected systems were qualitatively characterized according to seven different domains: governance; system design; system management; data management; data sources, outcomes and data quality. CONCLUSION This review provides a list of active maternal and neonatal data collection systems in LMICs and their characteristics as well as their outreach, strengths, and limitations. Findings could potentially help further understand where to obtain population-based high-quality information on outcomes to inform the conduct of maternal immunization active vaccine safety surveillance activities and research in LMICs.
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Affiliation(s)
- Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Federico Rodriguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Fabricio J Castellano
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | | | - Sabra Zaraa
- University of Washington, Seattle, WA, 98195-7631, USA
| | | | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
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Age patterns of under-5 mortality in sub-Saharan Africa during 1990‒2018: A comparison of estimates from demographic surveillance with full birth histories and the historic record. DEMOGRAPHIC RESEARCH 2021; 44:415-442. [PMID: 35368427 PMCID: PMC8974662 DOI: 10.4054/demres.2021.44.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Estimates of under-5 mortality (U5M) for sub-Saharan African populations often rely heavily on full birth histories (FBHs) collected in surveys and model age patterns of mortality calibrated against vital statistics from other populations. Health and Demographic Surveillance Systems (HDSSs) are alternate sources of population-based data in much of sub-Saharan Africa, which are less formally utilized in estimation. OBJECTIVE In this study we compare the age pattern of U5M in different African data sources (HDSSs, Demographic and Health Surveys (DHS), and Multiple Indicator Cluster Surveys (MICS)), and contrast these with the historical record as summarized in the Human Mortality Database and model age patterns. METHODS We examined the relative levels of neonatal, postneonatal, infant, and child mortality across data sources. We directly compared estimates for DHS and MICS subnational regions with HDSS, and used linear regression to identify data and contextual attributes that correlated with the disparity between estimates. RESULTS HDSS and FBH data suggests that African populations have higher levels of child mortality and lower infant mortality than the historic record. This age pattern is most explicit for Western African populations, but also characterizes data for other subregions. The comparison between HDSS and FBH data suggests that FBH estimates of child mortality are biased downward. The comparison is less conclusive for neonatal and infant mortality. CONTRIBUTION This study questions the practice of using model age patterns derived from largely high-income settings for inferring or correcting U5M estimates for African populations. It also highlights the considerable uncertainty around the consistency of HDSS and FBH estimates of U5M.
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Wamai RG, Kengne AP, Levitt N. Non-communicable diseases surveillance: overview of magnitude and determinants in Kenya from STEPwise approach survey of 2015. BMC Public Health 2018; 18:1224. [PMID: 30400841 PMCID: PMC6218983 DOI: 10.1186/s12889-018-6051-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Richard G Wamai
- Integrated Initiative for Global Health, Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA USA
| | - Andre Pascal Kengne
- Non Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape South Africa
| | - Naomi Levitt
- Diabetic Medicine and Endocrinology, University of Cape Town, J47/86 Old Main Building Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Chronic Disease Initiative for Africa (CDIA), University of Capetown, J47/86 Old Main Building Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
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