Continuities and changes in spatial patterns of under-five mortality at the district level in India (1991-2011)

Reproductive and child health transition among selected empowered action groups states of India: A district-level analysis

BACKGROUND

Health is an inseparable part of life and central to all life supporting systems. The reproductive and child health shares a major portion of public health cases that is crucial for socio-economic development. Studies on reproductive and child health have traditionally been focused on demographic aspects using socio-economic parameters. Given the emphasis of Sustainable Development Goal (SDG)-3 on health and well-being, it is imperative to understand the geo-spatial dimension with the visible transition of key health indicators of fertility, maternal and infant/child health in the high burdened districts within these high focus Empowered Action Group (EAG) states of Rajasthan, Madhya Pradesh, Uttar Pradesh and Bihar that make up nearly 40% of India's population with relatively laggard health status.

METHODOLOGY

This paper aims to understand the status and trend of key reproductive and child health indicators and vital statistics based on the recent representative demographic surveys. We intend to undertake a district level spatio-temporal analysis by developing District Composite Health Profile (DCHP) using Composite Index Method on selected 13 equally weighted key reproductive and child health indicators. The study has been carried out using data from National Family Health Survey-4 (2015-16) and National Family Health Survey-5 (2019-21) survey rounds. We employed geo-spatial techniques i.e. Moran's-I, and univariate LISA to comprehend the geographical clustering of high and low health burden districts and their heterogeneities at the district level.

RESULTS/CONCLUSIONS

The study highlights emerging inter-districts, and inter-state disparities over survey periods. With consistent improvement in the selected EAG states over time, the overall reproductive and child health status through DCHP along with each indicator was relatively better in the states of Rajasthan and worse in Bihar. Districts along the Terai belt in Uttar Pradesh and Bihar consistently performed sluggish during survey rounds. The geo-spatial clustering follows the political boundary of states, albeit with intra-state variations. Monitoring of key health indicators using composite index method provides a useful leverage for identifying priority districts/regions for universal health access that should also consider geographical space as an important policy dimension.

Spatio-temporal modelling of under-five mortality in Lesotho using demographic and health survey data

Background

Lesotho is in the Sustainable Development Goal (SDG) region which aims to reduce the under-five mortality (U5M) to the average of 25 deaths per 1000 live births by the end of 2030 under the sustainable development goals (SDGs) initiative by the United Nations.

Methodology

This paper makes use of the Lesotho Demographic and Health Survey (LDHS dataset, which focuses on female reproductive ages 15-49 and male reproductive ages 15-54 The spatio-temporal models were used in this study to investigate how the proposed covariates change over time.

Results

The results showed that children who were breastfed had a lower odd of death compared to children who were not breastfed, children from more educated mothers had significantly lower odds of U5M compared to those from less educated mothers. Having a larger number of children under the age of five also contributed significantly to an increased risk of U5M. The likelihood of U5M increased with age.

Conclusion

The study recommends that mothers of under-five children be educated about breastfeeding and encouraged to use contraception in order to postpone birth and reduce parity. Rural development should be prioritized through improved primary health care; and public health services should be made more accessible to rural residents.

Geographic variation and factors associated with under-five mortality in Ethiopia. A spatial and multilevel analysis of Ethiopian mini demographic and health survey 2019

BACKGROUND

The distribution of under-five mortality (U5M) worldwide is uneven and the burden is higher in Sub-Saharan African countries, which account for more than 53% of the global under-five mortality. In Ethiopia, though U5M decreased substantially between 1990 and 2019, it remains excessively high and unevenly distributed. Therefore, this study aimed to assess geographic variation and factors associated with under-five mortality (U5M) in Ethiopia.

METHODS

We sourced data from the most recent nationally representative 2019 Ethiopian Mini-Demographic and Health Survey for this study. A sample size of 5,695 total births was considered. Descriptive, analytical analysis and spatial analysis were conducted using STATA version 16. Both multilevel and spatial analyses were employed to ascertain the factors associated with U5M in Ethiopia.

RESULTS

The U5M was 5.9% with a 95% CI 5.4% to 6.6%. Based on the multivariable multilevel logistic regression model results, the following characteristics were associated with under-five mortality: family size (AOR = 0.92, 95% CI: 0.84,0.99), number of under-five children in the family (AOR = 0.17, 95% CI: 0.14, 0.21), multiple birth (AOR = 14.4, 95% CI: 8.5, 24.3), children who were breastfed for less than 6 months (AOR = 5.04, 95% CI: 3.81, 6.67), people whose main roof is palm (AOR = 0.57, 95% CI: 0.34, 0.96), under-five children who are the sixth or more child to be born (AOR = 2.46, 95% CI: 1.49, 4.06), institutional delivery (AOR = 0.57, 95% CI: 0.41, 0.81), resident of Somali and Afar region (AOR = 3.46, 95% CI: 1.58, 7.55) and (AOR = 2.54, 95% CI: 1.10, 5.85), respectively. Spatial analysis revealed that hot spot areas of under-five mortality were located in the Dire Dawa and Somali regions.

CONCLUSION

Under-five mortality in Ethiopia is high and unacceptable when compared to the 2030 sustainable development target, which aims for 25 per 1000 live births. Breastfeeding for less than 6 months, twin births, institutional delivery and high-risk areas of under-five mortality (Somali and Dire Dawa) are modifiable risk factors. Therefore, maternal and community education on the advantages of breastfeeding and institutional delivery is highly recommended. Women who deliver twins should be given special attention. An effective strategy should be designed for intervention in under-five mortality hot spot areas such as Somali and Dire Dawa.

Sex inequality in under-five deaths and associated factors in low and middle-income countries: a Fairlie decomposition analysis

Background

There exist sex disparities in the burden of Under-five deaths (U5D) with a higher prevalence among male children. Factors explaining this inequality remain unexplored in Low-and Medium-Income Countries (LMIC). This study quantified the contributions of the individual- and neighborhood-level factors to sex inequalities in U5D in LMIC.

Methods

Demographic and Health Survey datasets (2010-2018) of 856,987 under-five children nested in 66,495 neighborhoods across 59 LMIC were analyzed. The outcome variable was U5D. The main group variable was the sex of the child while individual-level and neighborhood-level factors were the explanatory variables. Fairlie decomposition analysis was used to quantify the contributions of explanatory factors to the male-female inequalities in U5D at p<0.05.

Results

Overall weighted prevalence of U5D was 51/1000 children, 55 among males and 48 among females (p<0.001). Higher prevalence of U5D was recorded among male children in all countries except Liberia, Kyrgyz Republic, Bangladesh, Nepal, Armenia, Turkey and Papua New Guinea. Pro-female inequality was however not significant in any country. Of the 59 countries, 25 had statistically significant pro-male inequality. Different factors contributed to the sex inequality in U5D in different countries including birth order, birth weight, birth interval and multiple births.

Conclusions

There were sex inequalities in the U5D in LMIC with prominent pro-male-inequality in many countries. Interventions targeted towards the improvement of the health system that will, in turn, prevent preterm delivery and improve management of prematurity and early childhood infection (which are selective threats to the male child survival) are urgently required to address this inequality.

Health Inequalities in Under-Five Mortality: An Assessment of Empowered Action Group (EAG) States of India

Background: The effect of childhood well-being programs is commonly interconnected with a change in mortality trends. The proportion of disparity shows that inequality in child mortality is more collective in the similarly evolved states than the poorer states in India. Objective: To estimate and compare the health inequality of under-five mortality in Empowered Action groups (EAG) states of India. Methods: Data from the National Family Health Survey (NFHS-4) was used only for the EAG States of India. Under-five mortality rates (U5MR) were calculated for associated background characteristics by using the life table method. Wealth inequality was assessed separately for all EAG states by calculating measures of concentration index (CI). Concentration curves (CC) were also plotted to see the difference in inequality. Results: Higher U5MR was observed in all EAG states compared with estimates for overall India. On comparing estimates of inequality, CI values show the substantial burden of U5MR among EAG states of India. The CC shows the lowest inequality in EAG states of India. Conclusion: The results suggested the need to receive various health strategy intercessions in agreement with the instance of ever-changing commitments of economic components to child health disparities in EAG states. Measuring the impact of determinants to wealth-related inequality in U5MR helps in lining up the interventions targeted at improving child survival.