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Zhang J, Li H, Wei B, He R, Zhu B, Zhang N, Mao Y. Association between maternal health service utilization and under-five mortality rate in China and its provinces, 1990-2017. BMC Pregnancy Childbirth 2024; 24:326. [PMID: 38671364 PMCID: PMC11055253 DOI: 10.1186/s12884-024-06437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The United Nations (UN) Sustainable Development Goal - 3.2 aims to eliminate all preventable under-five mortality rate (U5MR). In China, government have made efforts to provide maternal health services and reduce U5MR. Hence, we aimed to explore maternal health service utilization in relation to U5MR in China and its provinces in 1990-2017. METHODS We obtained data from Global Burden of Disease 2017, China Health Statistics Yearbook, China Statistical Yearbook, and Human Development Report China Special Edition. The trend of U5MR in each province of China from 1990 to 2017 was analyzed using Joinpoint Regression model. We measured the inequities in maternal health services using HEAT Plus, a health inequity measurement tool developed by the UN. The generalized estimating equation model was used to explore the association between maternal health service utilization (including prenatal screening, hospital delivery and postpartum visits) and U5MR. RESULTS First, in China, the U5MR per 1000 live births decreased from 50 in 1990 to 12 in 2017 and the average annual percentage change (AAPC) was - 5.2 (p < 0.05). Secondly, China had a high maternal health service utilization in 2017, with 96.5% for prenatal visits, 99.9% for hospital delivery, and 94% for postnatal visits. Inequity in maternal health services between provinces is declining, with hospital delivery rate showing the greatest decrease (SII, 14.01 to 1.87, 2010 to 2017). Third, an increase in the rate of hospital delivery rate can significantly reduce U5MR (OR 0.991, 95%CI 0.987 to 0.995). Postpartum visits rate with a one-year lag can reduce U5MR (OR 0.993, 95%CI 0.987 to 0.999). However, prenatal screening rate did not have a significant effect on U5MR. CONCLUSION The decline in U5MR in China was associated with hospital delivery and postpartum visits. The design and implementation of maternal health services may provide references to other low-income and middle-income countries.
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Affiliation(s)
- Jingya Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi , 710049, China
| | - Haoran Li
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi , 710049, China
| | - Bincai Wei
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, 518055, China
| | - Rongxin He
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Bin Zhu
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, Guangdong, 518055, China
| | - Ning Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
| | - Ying Mao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi , 710049, China.
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Tsegaye AT, Sherry C, Oduol C, Otieno J, Rwigi D, Masheti M, Machura I, Liru M, Akuka J, Omedo D, Symekher S, Khamadi SA, Isaaka L, Ogero M, Mumelo L, Berkley JA, Agweyu A, Walson JL, Singa BO, Tickell KD. Clinical epidemiology of COVID-19 among hospitalized children in rural western Kenya. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002011. [PMID: 37315023 PMCID: PMC10266603 DOI: 10.1371/journal.pgph.0002011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
The epidemiology of pediatric COVID-19 in sub-Saharan Africa and the role of fecal-oral transmission in SARS-CoV-2 are poorly understood. Among children and adolescents in Kenya, we identify correlates of COVID-19 infection, document the clinical outcomes of infection, and evaluate the prevalence and viability of SARS-CoV-2 in stool. We recruited a prospective cohort of hospitalized children aged two months to 15 years in western Kenya between March 1 and June 30 2021. Children with SARS-CoV-2 were followed monthly for 180-days after hospital discharge. Bivariable logistic regression analysis was used to identify the clinical and sociodemographics correlates of SARS-CoV-2 infection. We also calculated the prevalence of SARS-CoV-2 detection in stool of confirmed cases. Of 355 systematically tested children, 55 (15.5%) were positive and were included in the cohort. The commonest clinical features among COVID-19 cases were fever (42/55, 76%), cough (19/55, 35%), nausea and vomiting (19/55, 35%), and lethargy (19/55, 35%). There were no statistically significant difference in baseline sociodemographic and clinical characteristics between SARS-CoV-2 positive and negative participants. Among positive participants, 8/55 (14.5%, 95%CI: 5.3%-23.9%) died; seven during the inpatient period. Forty-nine children with COVID-19 had stool samples or rectal swabs available at baseline, 9 (17%) had PCR-positive stool or rectal swabs, but none had SARS-CoV-2 detected by culture. Syndromic identification of COVID-19 is particularly challenging among children as the presenting symptoms and signs mirror other common pediatric diseases. Mortality among children hospitalized with COVID-19 was high in this cohort but was comparable to mortality seen with other common illnesses in this setting. Among this small set of children with COVID-19 we detected SARS-CoV-2 DNA, but were not able to culture viable SARs-CoV-2 virus, in stool. This suggests that fecal transmission may not be a substantial risk in children recently diagnosed and hospitalized with COVID-19 infection.
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Affiliation(s)
- Adino Tesfahun Tsegaye
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Christina Sherry
- Departments of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Chrisantus Oduol
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joyce Otieno
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Doreen Rwigi
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mary Masheti
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Meshack Liru
- Homa Bay County Referral Hospital, Homa Bay, Kenya
| | - Joyce Akuka
- Migori County Referral Hospital, Migori, Kenya
| | | | - Samwel Symekher
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Samoel A. Khamadi
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lynda Isaaka
- KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Morris Ogero
- KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - James A. Berkley
- KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
- Centre for Tropical Medicine & Global Health Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ambrose Agweyu
- KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Judd L. Walson
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
- Departments of Global Health, Medicine (Infectious Disease), Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Benson O. Singa
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kirkby D. Tickell
- Departments of Global Health, University of Washington, Seattle, Washington, United States of America
- The Childhood Acute Illness and Nutrition Network (CHAIN), Nairobi, Kenya
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Kaforau LS, Tessema GA, Jancey J, Bugoro H, Pereira G. Prevalence and risk factors associated with under-five mortality in the Solomon Islands: an investigation from the 2015 Solomon Islands demographic and health survey data. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100691. [PMID: 37181533 PMCID: PMC10166993 DOI: 10.1016/j.lanwpc.2023.100691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/07/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023]
Abstract
Background Annually, over five million children die before their fifth birthday worldwide, with 98% of these deaths occurring in low-and middle-income countries. The prevalence and risks for under-five mortality are not well-established for the Solomon Islands. Methods We used the Solomon Islands Demographic and Health Survey 2015 data (SIDHS 2015) to estimate the prevalence and risk factors associated with under-five mortality. Findings Neonatal, infant, child and under-five mortality prevalence were 8/1000, 17/1000, 12/1000 and 21/1000 live births, respectively. After adjustment for potential confounders, neonatal mortality was associated with no breastfeeding [aRR 34.80 (13.60, 89.03)], no postnatal check [aRR 11.36 (1.22, 106.16)], and Roman Catholic [aRR 3.99 (1.34, 11.88)] and Anglican [aRR 2.78 (0.89, 8.65); infant mortality to no breastfeeding [aRR 11.85 (6.15, 22.83)], Micronesian [aRR 5.54 (1.67, 18.35)], and higher birth order [aRR 2.00 (1.03, 3.88)]; child mortality to multiple gestation [aRR 6.15 (2.08, 18.18)], Polynesian [aRR 5.80 (2.48, 13.53)], and Micronesian [aRR 3.65 (1.46, 9.10)], cigarette and tobacco [aRR 1.77 (0.79, 3.96)] and marijuana use [aRR 1.94 (0.43, 8.73)] and rural residence [aRR 1.85 (0.88, 3.92)]; under-five mortality to no breastfeeding [aRR 8.65 (4.97, 15.05)], Polynesian [aRR 3.23 (1.09, 9.54)], Micronesian [aRR 5.60 (2.52, 12.46)], and multiple gestation [aRR 3.34 (1.26, 8.88)]. Proportions of 9% for neonatal and 8% of under-five mortality were attributable to no maternal tetanus vaccination. Interpretation Under-five mortality in the Solomon Islands from the SIDHS 2015 data was attributable to maternal health, behavioural, and sociodemographic risk factors. We recommended future studies to confirm these associations. Funding No funding was declared to support this study directly.
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Affiliation(s)
- Lydia S. Kaforau
- Department of Paediatrics and Neonatal Care, National Referral Hospital, Solomon Islands
- Curtin School of Population Health, Curtin University, Perth, Australia
- Faculty of Nursing, Medicine and Health Sciences, Solomon Islands National University, Solomon Islands
| | - Gizachew A. Tessema
- Curtin School of Population Health, Curtin University, Perth, Australia
- School of Public Health, The University of Adelaide, South Australia, Australia
| | - Jonine Jancey
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Hugo Bugoro
- Faculty of Nursing, Medicine and Health Sciences, Solomon Islands National University, Solomon Islands
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Australia
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Koroma MM, Kabba JA, Wanda J, Yu J, Zhou F, Liang Z, Tarawally AB, Chigoneka K, Dai YC. Under-Five Mortality in Sierra Leone and Possible Associated Factors: Evidence from the 2019 Demographic and Health Survey. Health Policy Plan 2022; 37:1210-1220. [PMID: 36052949 DOI: 10.1093/heapol/czac070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 07/20/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
High under-five mortality rate remains one of the public health challenges, especially in sub-Saharans Africa, accounting for more than half of all global cases. Sierra Leone was and still one of the countries with the highest under-five mortality rate. Using the latest 2019 SLDHS data, we investigated factors associated with under-five mortality in Sierra Leone. A total of 9771 mothers aged 15-49 years in the country were interviewed and included in the analysis. The dependent variable is child status (dead=1; alive=0). A total of 871 (9%) children died before their fifth birthday. Maternal age of 20-24 years (AOR=0.46; CI=0.33-0.64; P<0.001) up to 40-44 years (AOR=0.43; CI=0.27-0.7; P=0.001), currently breastfeeding (AOR=0.20; CI=0.17-0.24; P<0.001), maternal media exposure and usage of reading newspapers/magazines less than once a week (AOR=0.48; CI=0.28-0.85; P=0.011) were more likely to enhance child survivability through their fifth birthday. Also, the child sex being female (AOR=0.68; CI=0.59-0.79) was more likely to survive under-five mortality compared to their male counterpart. On the other hand, mothers who listened to radio at least once a week (AOR=1.31; CI=1.08-1.59; P=0.007) watched television less than once a week (AOR=1.48; CI=1.16-1.90), had two (AOR=3.4, CI=2.78-4.16; P<0.001) or three and above birth (AOR=8.11; CI=6.07-10.83; P<0.001) in five years, had multiple birth children (AOR=1.41; CI=1.08-1.86) and very small-sized child at birth (AOR= 1.95; CI=1.41-2.70) were more likely to lose their children below the age of five years. The factors contributing to under-five mortality in Sierra Leone are critical to ensuring child survival and improving maternal health. Breastfeeding, maternal age, media exposure, child's sex, multiple birth type, very small-sized child and the total number of births in five years were significant drivers of under-five mortality. The result affirms the need for attention to be focused on enhancing the survival rate of under-five children in Sierra Leone.
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Affiliation(s)
- Mark Momoh Koroma
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | - John Alimamy Kabba
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Jessicah Wanda
- Department of Nursing, Southern Medical University, Guangzhou 510515, Guangdong, China
| | - Jingrong Yu
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | - Feiyuan Zhou
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | - Zhiyan Liang
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | | | - Kuleza Chigoneka
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Ying-Chun Dai
- Department of Epidemiology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
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Yemane GD. The factors associated with under-five mortality in Ethiopia. Ann Med Surg (Lond) 2022; 79:104063. [PMID: 35860052 PMCID: PMC9289410 DOI: 10.1016/j.amsu.2022.104063] [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: 05/06/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Under-five mortality refers to the likelihood of dying between the ages of birth and five. The number of children under the age of five who die each year continues to climb worldwide. Over the previous few decades, the industry has made great progress in reducing mortality among children under the age of five. The study aims to identify the factors associated with under-five mortality in Ethiopia. Subject and method Community-based Cross-sectional data came from Ethiopia's Mini Demographic and Health Survey 2019. In two stages, the 2019 EMDHS sample was stratified and selected. 8855 women of reproductive age were interviewed using a nationally representative Woman (ages 15 to 49) and 5753 children were included. Ethiopia's under-five mortality served as the study's dependent (response) or outcome variable. Binary logistic regression was used to see if there is an association between the dependent and independent variables. All variables with a p-value of less than 0.25 in the bivariate analysis were chosen for the multivariable logistic regression to compensate for putative confounders. Significant predictors were defined as factors with a p-value of less than 0.05. Results A total of 5753 under-5 mortality were enrolled in this study. 339 (5.9%) of under-five Mortality have been declared lifeless before reaching the age of five. There were 1328(23.1%) and 4425(76.1%) with 72 (5.42%) and 267 (6.02%) of under-five mortality occurring in urban and rural respectively. Under-five mortality in the Afar region was 2.280 times more likely Compared to Children born in Tigray Region (AOR = 2.280 95% CI = 1.137–4.568, P = .020). Under-five Mortality in Rural residences was 1.908 times more likely as Compared to Urban Residence (AOR = 1.908, 95% CI = 1.257–4.539, P = .035). Under-five mortality in Poorer index Households was 0.343 times Less likely as compared to children born in the poorest index Household (AOR = 0.343,95% CI = 0.128–0.910, P = ). Under-five mortality in the public sector was 1.763 times less likely than among children born at Home (AOR = 1.763, 95% CI = 1.252–2.482, P = .033). Under-five Mortality of second multiple births was 2.389 times more likely Compared to Single birth (AOR = 2.389, 95% CI = 1.257–4.539, P = .008). Conclusion This study found that the prevalence of under-five mortality, is 5.9% (59/1000) or 59 death per one thousand live children in Ethiopia. The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving. Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been statistically significant factors of under-five mortality in Ethiopia. The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality. The global number of under-five mortality remains high including in Ethiopia. The prevalence of under-five mortality was 5.9% of live children in Ethiopia. Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been found to be statistically significant factors of under-five mortality in Ethiopia. The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving. The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality.
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