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Nwanze LD, Siuliman A, Ibrahim N. Factors associated with infant mortality in Nigeria: A scoping review. PLoS One 2023; 18:e0294434. [PMID: 37967113 PMCID: PMC10650982 DOI: 10.1371/journal.pone.0294434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Infant mortality persists as a global public health concern, particularly in lower-middle-income countries (LIMCs) such as Nigeria. The risk of an infant dying before one year of age is estimated to be six times higher in Africa than in Europe. Nigeria recorded an infant mortality rate of 72.2 deaths per 1,000 live births in 2020, in contrast to the global estimate of 27.4 per 1,000 live births. Several studies have been undertaken to determine the factors influencing infant mortality. OBJECTIVE This scoping review sought to identify and summarise the breadth of evidence available on factors associated with infant mortality in Nigeria. METHODS This review followed the five-stage principles of Arksey and O'Malley's framework. Four electronic databases were searched with no limit to publication date or study type: Ovid MEDLINE, PubMed, CINAHL Complete, and Web of Science. Selected studies were imported into Endnote software and then exported to Rayyan software where duplicates were removed. Included articles were thematically analysed and synthesised using the socioecological model. RESULTS A total of 8,139 references were compiled and screened. Forty-eight articles were included in the final review. At the individual level, maternal- and child-related factors were revealed to influence infant mortality; socioeconomic and sociocultural factors at the interpersonal level; provision and utilisation of health services, health workforce, hospital resources and access to health services at the organisational level; housing/neighbourhood and environmental factors at the community level; and lastly, governmental factors were found to affect infant mortality at the public policy level. CONCLUSION Factors related to the individual, interpersonal, organisational, community and public policy levels were associated with infant mortality in Nigeria.
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Affiliation(s)
- Loveth Dumebi Nwanze
- Department of Public Health, School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Alaa Siuliman
- Department of Public Health, School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Nuha Ibrahim
- Department of Public Health, School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Rojas-Botero ML, Borrero-Ramírez YE, Cáceres-Manrique FDM. [Social inequalities in under-five mortality: a systematic review]. Rev Salud Publica (Bogota) 2023; 22:220-237. [PMID: 36753114 DOI: 10.15446/rsap.v22n2.86964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify the characteristics of the published studies on social inequalities in under-five mortality, their theoretical perspectives, axes of inequality, methods and results. METHOD We carried out a systematic literature review. We consulted four electronic databases and Google Scholar, for studies published between 2010 and 2018. RESULTS We analyzed 126 articles. In 62.7%, territory was studied as the axis of inequality, followed by socioeconomic determinants (27.8%). Neonatal, infant and under-five mortality was analyzed as an output in health in 19.0%, 49.2% and 32.3%, respectively. It predominated ecological (62.7%) and longitudinal (50.0%) studies. Significant reductions in mortality rates were found, however, the decline was not homogeneous among subpopulations. CONCLUSIONS The literature reports a marked decrease in under-five mortality; however, the gaps between different axes of inequality continue and in some cases they have increased. Gaps varied according to time, place, axis of inequality and type of mortality analyzed.
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Affiliation(s)
- Maylen L Rojas-Botero
- MR: Profesional en Gerencia de Sistemas de Información en Salud, M.Sc. Epidemiología. Ph.D.(c) Epidemiología. Universidad de Antioquia, Facultad Nacional de Salud Pública. Medellín, Colombia.
| | - Yadira E Borrero-Ramírez
- YB: MD. Esp. Teoría Métodos de Investigación. M.Sc. Sociología. Ph.D. Salud Pública. Posdoctorado en Salud Colectiva. Universidad de Antioquia, Facultad Nacional de Salud Pública.
| | - Flor de María Cáceres-Manrique
- FC: Enfermera. Esp.; M.Sc. Epidemiología. Esp. Docencia Universitaria. Ph.D. Salud Pública. Universidad Industrial de Santander, Facultad de Salud, Escuela de Medicina, Departamento de Salud Pública. Bucaramanga, Colombia.
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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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Islam MA, Butt ZA, Sathi NJ. Prevalence of Neonatal Mortality and its Associated Factors: A Meta-analysis of Demographic and Health Survey Data from 21 Developing Countries. DR. SULAIMAN AL HABIB MEDICAL JOURNAL 2022. [DOI: 10.1007/s44229-022-00013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AbstractNeonatal mortality is high in developing countries, and reducing neonatal mortality is an indispensable part of the third Sustainable Development Goal. This study estimated the prevalence of neonatal mortality and the impact of maternal education, economic status, and utilization of antenatal care (ANC) services on neonatal mortality in developing countries. We used a cross-sectional study design to integrate data from 21 developing countries to acquire a wider perspective on neonatal mortality. A meta-analysis was conducted using the latest Demographic and Health Survey data from 21 developing countries. In addition, sensitivity analysis was adopted to assess the stability of the meta-analysis. The random-effects model indicated that women with higher education were less likely to experience neonatal death than mothers with up to primary education (odds ratio [OR] 0.820, 95% confidence interval [CI] 0.740–0.910). Women with higher socioeconomic status were less likely to experience neonatal death than mothers with lower socioeconomic status (OR 0.823, 95% CI 0.747–0.908). Mothers with ANC were less likely to experience neonatal death than those with no ANC (OR 0.374, 95% CI 0.323–0.433). Subgroup analysis showed that maternal education and ANC were more effective in Asian countries. In this study, mothers’ lower educational level, poor economic status, and lack of ANC were statistically significant factors associated with neonatal death in developing countries. The effect of these factors on neonatal death differed in different regions.
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Wardani Y, Huang YL, Chuang YC. Factors Associated with Infant Deaths in Indonesia: An Analysis of the 2012 and 2017 Indonesia Demographic and Health Surveys. J Trop Pediatr 2022; 68:6655516. [PMID: 35924318 DOI: 10.1093/tropej/fmac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND This exploratory study aimed to investigate factors related to infant deaths using a conceptual framework that explains the risk factors of infant deaths in developing countries. METHODS The study adopted a cross-sectional study design and used data from the 2012 and 2017 Indonesia Demographic and Health Surveys, with a sample of 3694 singleton live births in 2012 and 3413 in 2017. RESULTS Female infants had a lower chance of mortality compared to male infants [adjusted odds ratio (aOR) = 0.51; 95% confidence interval (CI) = 0.34-0.77]. Infants with a smaller birth size had a higher risk of infant death compared to those with an average size (aOR = 5.66; 95% CI = 3.66-8.77). The risk of infant death with a preceding birth interval of ≥24 months was lower than that with a preceding birth interval of <24 months (aOR = 0.48; 95% CI = 0.26-0.90). An older maternal age was a risk factor for infant death compared to younger mothers (aOR = 3.61; 95% CI = 1.42-9.23). Infants who were born in Sumatra (aOR = 0.38; 95% CI = 0.16-0.89) and Java and Bali (aOR = 0.33; 95% CI = 0.14-0.78) were less likely to die than infants who were born in Papua and Maluku. CONCLUSIONS A higher infant death risk was associated with male babies and a shorter birth interval (<24 months). Mothers who perceived their babies to be small and mothers who were older (35-49 years old) were high-risk factors for infant mortality. Mothers who lived in Java and Bali as well as Sumatera were less likely to experience infant mortality compared to those who lived in Papua and Maluku.
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Affiliation(s)
- Yuniar Wardani
- School of Public Health, Taipei Medical University, Taipei City 11031, Taiwan.,Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia
| | - Ya-Li Huang
- School of Medicine, Department of Public Health, Taipei Medical University, Taipei City 11031, Taiwan
| | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, Taipei City 11031, Taiwan
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Wuneh AD, Bezabih AM, Okwaraji YB, Persson LÅ, Medhanyie AA. Wealth and Education Inequities in Maternal and Child Health Services Utilization in Rural Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5421. [PMID: 35564817 PMCID: PMC9099508 DOI: 10.3390/ijerph19095421] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/04/2022]
Abstract
As part of the 2030 maternal and child health targets, Ethiopia strives for universal and equitable use of health services. We aimed to examine the association between household wealth, maternal education, and the interplay between these in utilization of maternal and child health services. Data emanating from the evaluation of the Optimizing of Health Extension Program intervention. Women in the reproductive age of 15 to 49 years and children aged 12-23 months were included in the study. We used logistic regression with marginal effects to examine the association between household wealth, women's educational level, four or more antenatal care visits, skilled assistance at delivery, and full immunization of children. Further, we analyzed the interactions between household wealth and education on these outcomes. Household wealth was positively associated with skilled assistance at delivery and full child immunization. Women's education had a positive association only with skilled assistance at delivery. Educated women had skilled attendance at delivery, especially in the better-off households. Our results show the importance of poverty alleviation and girls' education for universal health coverage.
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Affiliation(s)
- Alem Desta Wuneh
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia; (A.M.B.); (A.A.M.)
| | - Afework Mulugeta Bezabih
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia; (A.M.B.); (A.A.M.)
| | - Yemisrach Behailu Okwaraji
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (Y.B.O.); (L.Å.P.)
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Lars Åke Persson
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (Y.B.O.); (L.Å.P.)
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle P.O. Box 1871, Ethiopia; (A.M.B.); (A.A.M.)
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Woelile TA, Kibret GT, Workie HM, Amare AT, Tigabu A, Aynalem YA, Chanie ES, Birlie TA. Survival Status and Predictors of Mortality Among Low-Birth-Weight Neonates Admitted to the Neonatal Intensive Care Unit at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, 2020. Pediatric Health Med Ther 2021; 12:451-466. [PMID: 34512075 PMCID: PMC8427078 DOI: 10.2147/phmt.s323526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Low birth weight neonates are subjected to different comorbidities due to anatomical and physiological immaturity. Globally, 60-80% of neonatal mortality was due to low birth weight. Hence, this study aimed to assess the survival status and predictors of mortality among low birth weight neonates. METHODS An institutional-based retrospective cohort study design was conducted among 718 low birth weight neonates admitted to the neonatal intensive care unit from January 1, 2017, to December 30, 2019, at Felege Hiwot Comprehensive Specialized Hospital. Data were entered into Epi data version 3.1 and analyzed with STATA version 14. Kaplan-Meier curves together with a Log rank test were used to estimate the survival time and showed the presence of differences among groups. Cox proportional-hazard regression was used to estimate the hazard ratio at the 5% level of significance to determine the net effect of each explanatory variable on survival status. RESULTS The overall incidence density was 35.3 per 1000 person-day observations (CI: 30.8 -40.6) with 5715 follow-up days. Deliveries outside the health institution [AHR; 2.31 (95% CI: 1.20-4.42)], maternal age <18 years [AHR; 3.08 (95% CI: 1.64-5.81)] and maternal age >35 years [AHR; 3.83 (95% CI: 2.00-7.31)], neonatal sepsis [AHR; 2.33 (95% CI: 1.38-3.94)], neonatal respiratory distress syndrome [AHR; 1.92 (95% CI: 1.27-2.89)], necrotizing enterocolitis [AHR; 3.09 (95% CI: 1.69-5.64)] and birth weight <1000 gm [AHR; 3.61 (95% CI: 1.73-7.55)] were found to be significant predictors. CONCLUSION This study showed that two of the seven low birth weight neonates died during the follow-up period. Therefore, it is better for health care providers and other stakeholders to focus more on early diagnosis and management of low birth weight neonates with sepsis, respiratory distress syndrome, necrotizing enterocolitis and counseling mothers on the risk of having a child in early and old age.
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Affiliation(s)
- Tamiru Alene Woelile
- Department of Pediatrics and Neonatal Nursing, Wolaita Sodo University, Sodo, Southern Nation and Nationalities of Ethiopia, Ethiopia
| | - Getasew Tesfa Kibret
- Department of Pediatrics and Child Health Nursing, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
| | | | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, Debre Tabor University, Debra Tabor, Amhara, Ethiopia
| | - Agimasie Tigabu
- Department of Adult Health Nursing, Debre Tabor University, Debra Tabor, Amhara, Ethiopia
| | | | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | - Tekalign Amera Birlie
- Department of Adult Health Nursing, Debre Tabor University, Debra Tabor, Amhara, Ethiopia
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Rocha TAH, de Thomaz EBAF, de Almeida DG, da Silva NC, Queiroz RCDS, Andrade L, Facchini LA, Sartori MLL, Costa DB, Campos MAG, da Silva AAM, Staton C, Vissoci JRN. Data-driven risk stratification for preterm birth in Brazil: a population-based study to develop of a machine learning risk assessment approach. LANCET REGIONAL HEALTH. AMERICAS 2021; 3:100053. [PMID: 36777406 PMCID: PMC9904131 DOI: 10.1016/j.lana.2021.100053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Background Preterm birth (PTB) is a growing health issue worldwide, currently considered the leading cause of newborn deaths. To address this challenge, the present work aims to develop an algorithm capable of accurately predicting the week of delivery supporting the identification of a PTB in Brazil. Methods This a population-based study analyzing data from 3,876,666 mothers with live births distributed across the 3,929 Brazilian municipalities. Using indicators comprising delivery characteristics, primary care work processes, and physical infrastructure, and sociodemographic data we applied a machine learning-based approach to estimate the week of delivery at the point of care level. We tested six algorithms: eXtreme Gradient Boosting, Elastic Net, Quantile Ordinal Regression - LASSO, Linear Regression, Ridge Regression and Decision Tree. We used the root-mean-square error (RMSE) as a precision. Findings All models obtained RMSE indexes close to each other. The lower levels of RMSE were obtained using the eXtreme Gradient Boosting approach which was able to estimate the week of delivery within a 2.09 window 95%IC (2.090-2.097). The five most important variables to predict the week of delivery were: number of previous deliveries through Cesarean-Section, number of prenatal consultations, age of the mother, existence of ultrasound exam available in the care network, and proportion of primary care teams in the municipality registering the oral care consultation. Interpretation Using simple data describing the prenatal care offered, as well as minimal characteristics of the pregnant, our approach was capable of achieving a relevant predictive performance regarding the week of delivery. Funding Bill and Melinda Gates Foundation, and National Council for Scientific and Technological Development - Brazil, (Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPQ acronym in portuguese) Support of the research project named: Data-Driven Risk Stratification for Preterm Birth in Brazil: Development of a Machine Learning-Based Innovation for Health Care- Grant: OPP1202186.
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Affiliation(s)
- Thiago Augusto Hernandes Rocha
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America,Corresponding author: Thiago Augusto Hernandes Rocha, Duke University
| | | | | | - Núbia Cristina da Silva
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | - Luciano Andrade
- Department of Nursing, State University of the West of Parana, Foz do Iguaçu, Parana, Brazil
| | - Luiz Augusto Facchini
- Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | | | - Dalton Breno Costa
- The Federal University of Health Sciences of Porto Alegre. Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Catherine Staton
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC USA. Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - João Ricardo Nickenig Vissoci
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC USA. Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Rahman AE, Mhajabin S, Dockrell D, Nair H, El Arifeen S, Campbell H. Managing pneumonia through facility-based integrated management of childhood management (IMCI) services: an analysis of the service availability and readiness among public health facilities in Bangladesh. BMC Health Serv Res 2021; 21:667. [PMID: 34229679 PMCID: PMC8260350 DOI: 10.1186/s12913-021-06659-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With an estimated 24,000 deaths per year, pneumonia is the single largest cause of death among young children in Bangladesh, accounting for 18% of all under-5 deaths. The Government of Bangladesh adopted the WHO recommended Integrated Management of Childhood Illness (IMCI)-strategy in 1998 for outpatient management of pneumonia, which was scaled-up nationally by 2014. This paper reports the service availability and readiness related to IMCI-based pneumonia management in Bangladesh. We conducted a secondary analysis of the Bangladesh Health Facility Survey-2017, which was conducted with a nationally representative sample including all administrative divisions and types of health facilities. We limited our analysis to District Hospitals (DHs), Maternal and Child Welfare Centres (MCWCs), Upazila (sub-district) Health Complexes (UHCs), and Union Health and Family Welfare Centres (UH&FWCs), which are mandated to provide IMCI services. Readiness was reported based on 10 items identified by national experts as 'essential' for pneumonia management. RESULTS More than 90% of DHs and UHCs, and three-fourths of UH&FWCs and MCWCs provide IMCI-based pneumonia management services. Less than two-third of the staff had ever received IMCI-based pneumonia training. Only one-third of the facilities had a functional ARI timer or a watch able to record seconds on the day of the visit. Pulse oximetry was available in 27% of the district hospitals, 18% of the UHCs and none of the UH&FWCs. Although more than 80% of the facilities had amoxicillin syrup or dispersible tablets, only 16% had injectable gentamicin. IMCI service registers were not available in nearly one-third of the facilities and monthly reporting forms were not available in around 10% of the facilities. Only 18% of facilities had a high-readiness (score 8-10), whereas 20% had a low-readiness (score 0-4). The readiness was significantly poorer among rural and lower level facilities (p < 0.001). Seventy-two percent of the UHCs had availability of one of any of the four oxygen sources (oxygen concentrators, filled oxygen cylinder with flowmeter, filled oxygen cylinder without flowmeter, and oxygen distribution system) followed by DHs (66%) and MCWCs (59%). CONCLUSION There are substantial gaps in the readiness related to IMCI-based pneumonia management in public health facilities in Bangladesh. Since pneumonia remains a major cause of child death nationally, Bangladesh should make a substantial effort in programme planning, implementation and monitoring to address these critical gaps to ensure better provision of essential care for children suffering from pneumonia.
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Affiliation(s)
- Ahmed Ehsanur Rahman
- University of Edinburgh, Edinburgh, UK.
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
| | - Shema Mhajabin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Islam MA, Biswas B. Socio-economic factors associated with increased neonatal mortality: A mixed-method study of Bangladesh and 20 other developing countries based on demographic and health survey data. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Adjei G, Darteh EKM, Nettey OEA, Doku DT. Neonatal mortality in the central districts of Ghana: analysis of community and composition factors. BMC Public Health 2021; 21:173. [PMID: 33478435 PMCID: PMC7819257 DOI: 10.1186/s12889-021-10156-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Communities and their composition have an impact on neonatal mortality. However, considering the smallest health administrative units as communities and investigating the impact of these communities and their composition on neonatal mortality in Ghana have not been studied. Therefore, this study aimed to investigate the effect of community-, household- and individual-level factors on the risk of neonatal mortality in two districts in Ghana. METHODS This was a longitudinal study that used the Kintampo Health and Demographic Surveillance System as a platform to select 30,132 neonatal singletons with 634 deaths. Multilevel cox frailty model was used to examine the effect of community-, household- and individual-level factors on the risk of neonatal mortality. RESULTS Regarding individual-level factors, neonates born to mothers with previous adverse pregnancy (aHR = 1.38, 95% CI: 1.05-1.83), neonates whose mothers did not receive tetanus toxoid vaccine (aHR = 1.32, 95% CI: 1.08-1.60) and neonates of mothers with Middle, Junior High School or Junior Secondary School education (aHR = 1.30, 95% CI: 1.02-1.65) compared to mothers without formal education, had a higher risk of neonatal mortality. However, female neonates (aHR = 0.61, 95% CI: 0.51-0.73) and neonates whose mother had secondary education or higher (aHR = 0.37, 95% CI: 0.18-0.75) compared to those with no formal education had a lower risk of mortality. Neonates with longer gestation period (aHR = 0.95, 95% CI: 0.94-0.97) and those who were delivered at home (aHR = 0.56, 95% CI: 0.45-0.70), private maternity home (aHR = 0.45, 95% CI: 0.30-0.68) or health centre/clinic (aHR = 0.40, 95% CI: 0.26-0.60) compared to hospital delivery had lower risk of mortality. Regarding the household-level, neonates belonging to third quintile of the household wealth (aHR = 0.70, 95% CI: 0.52-0.94) and neonates belonging to households with crowded sleeping rooms (aHR = 0.91, 95% CI: 0.85-0.97) had lower risk of mortality. CONCLUSION The findings of the study suggest the risk of neonatal mortality at the individual- and household-levels in the Kintampo Districts. Interventions and strategies should be tailored towards the high-risk groups identified in the study.
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Affiliation(s)
- George Adjei
- Department of Community Medicine, University of Cape Coast, Cape Coast, Ghana
| | - Eugene K. M. Darteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Obed Ernest A. Nettey
- University of Ghana, Regional Institute for Population Studies, Accra, Ghana
- Kintampo Health Research Centre, P.O. Box 200, Kintampo, Ghana
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Bossio JC, Sanchis I, Herrero MB, Armando GA, Arias SJ. Mortalidad infantil y desigualdades sociales en Argentina, 1980-2017. Rev Panam Salud Publica 2020; 44:e127. [PMID: 33165396 PMCID: PMC7603357 DOI: 10.26633/rpsp.2020.127] [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: 12/16/2019] [Accepted: 05/01/2020] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Estimar la tendencia de la mortalidad infantil, de la desigualdad entre jurisdicciones y de la desigualdad asociada a las condiciones sociales en Argentina entre 1980 y 2017. Métodos. Estudio ecológico y de serie temporal de la mortalidad infantil y de su desigualdad. Se obtuvieron los datos oficiales de mortalidad infantil, de nacimientos y de necesidades básicas insatisfechas; se calculó la tasa de mortalidad infantil, el índice de Gini y el índice de concentración. También se analizó la tendencia con un modelo de regresión lineal y se calculó el coeficiente de regresión y su significación estadística. Resultados. La mortalidad infantil se redujo 71,2% (de 32,41 a 9,34 por 1 000 nacidos vivos). La desigualdad por jurisdicción también se redujo y el índice de Gini pasó de 0,163 a 0,09. La desigualdad asociada a las condiciones sociales también mostró una reducción, y el índice de concentración disminuyó de -0,153 a -0,079. Si bien la mortalidad infantil se redujo en todo el período, este descenso no siempre se acompañó de una reducción del índice de Gini y del índice de concentración. Conclusiones. La tendencia de la tasa de mortalidad infantil fue al descenso mientras que la desigualdad en su distribución por jurisdicción y la desigualdad asociada a las condiciones sociales no siempre acompañaron esa reducción.
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Affiliation(s)
- Juan Carlos Bossio
- Instituto Nacional de Enfermedades Respiratorias “Emilio Coni”, Santa Fe, Argentina
| | - Iván Sanchis
- Universidad Nacional del Litoral, Santa Fe, Argentina
| | - María Belén Herrero
- Facultad Latinoamericana de Ciencias Sociales (FLACSO), Buenos Aires, Argentina
| | | | - Sergio Javier Arias
- Instituto Nacional de Enfermedades Respiratorias “Emilio Coni”, Santa Fe, Argentina
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A Hybrid Decision-Making Approach for the Service and Financial-Based Measurement of Universal Health Coverage for the E7 Economies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183295. [PMID: 31500288 PMCID: PMC6765831 DOI: 10.3390/ijerph16183295] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 11/17/2022]
Abstract
The aim of this study is to measure universal health coverage in Emerging 7 (E7) economies. Within this framework, five different dimensions and 14 different criteria are selected by considering the explanations of World Health Organization and United Nations regarding universal health coverage. While weighting the dimensions and criteria, the Decision-making Trial and Evaluation Laboratory (DEMATEL) is considered with the triangular fuzzy numbers. Additionally, Multi-Objective Optimization on the basis of Ratio Analysis (MOORA) approach is used to rank E7 economies regarding Universal Health Coverage (UHC) performance. The novelty of this study is that both service and financial based factors are taken into consideration at the same time. Additionally, fuzzy DEMATEL and MOORA methodologies are firstly used in this study with respect to the evaluation of universal health coverage. The findings show that catastrophic out of pocket health spending, pushed below an international poverty line and annual growth rate of real Gross Domestic Product (GDP) per capita are the most significant criteria for universal health coverage performance. Moreover, it is also concluded that Russia is the country that has the highest universal health coverage performance whereas China, India and Brazil are in the last ranks. It can be understood that macroeconomic conditions play a very significant role on the performance of universal health coverage. Hence, economic conditions should be improved in these countries to have better universal health coverage performance. Furthermore, it is necessary to establish programs that provide exemptions or lower out-of-pocket expenditures which will not prevent the use of health services. This situation can protect people against the financial risks related to health expenditures. In addition to them, it is also obvious that high population has also negative influence on the countries such as, China and India. It indicates that it would be appropriate for these countries to make population planning for this purpose.
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Robin TA, Khan MA, Kabir N, Rahaman ST, Karim A, Mannan II, George J, Rashid I. Using spatial analysis and GIS to improve planning and resource allocation in a rural district of Bangladesh. BMJ Glob Health 2019; 4:e000832. [PMID: 31321091 PMCID: PMC6606075 DOI: 10.1136/bmjgh-2018-000832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 11/17/2022] Open
Abstract
The application of a geographic information system (GIS) in public health is relatively common in Bangladesh. However, the use of GIS for planning, monitoring and decision-making by local-level managers has not been well documented. This assessment explored how effectively local government health managers used maps with spatial data for planning, resource allocation and programme monitoring. The United States Agency for International Development-funded MaMoni Health Systems Strengthening project supported the introduction of the maps into district planning processes in 2015 and 2016. GIS maps were used to support the prioritisation of underserved unions (the lowest administrative units) and clusters of disadvantaged communities for the allocation of funds. Additional resources from local government budgets were allocated to the lowest performing unions for improving health facility service readiness and supervision. Using a mixed-methods approach, the project evaluated the outputs of this planning process. District planning reports, population-based surveys, local government annual expenditure reports and service availability and utilisation data were reviewed. The goal was to determine the degree to which district planning teams were able to use the maps for their intended purpose. Key informant interviews were conducted with upazila (subdistrict) managers, elected government representatives and service providers to understand how the maps were used, as well as to identify potential institutionalisation scopes. The project observed improvements in health service availability and utilisation in the highest priority unions in 2016. Quick processing of maps during planning sessions was challenging. Nevertheless, managers and participants expressed their satisfaction with the use of spatial analysis, and there was an expressed need for more web-based GIS both for improving community-level service delivery and for reviewing performance in monthly meetings. Despite some limitations, the use of GIS maps helped local health managers identify health service gaps, prioritise underserved unions and monitor results.
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Affiliation(s)
- T A Robin
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Marufa Aziz Khan
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Nazmul Kabir
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Sk Towhidur Rahaman
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Afsana Karim
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | | | - Joby George
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Iftekhar Rashid
- United States Agency for International Development (USAID), Dhaka, Bangladesh
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15
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Hilal FA, Herrero MB, Maciel EMGDS, Braga JU. Social determinants of pulmonary tuberculosis in Argentina. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190003. [PMID: 30892466 DOI: 10.1590/1980-549720190003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/25/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Argentina, approximately 9,000 new cases of tuberculosis (TB) are recorded every year, representing an incidence rate of 22 cases per 100,000 inhabitants. There are no reported studies in Argentina examining the factors that influence the unequal distribution of the disease. The aim of the study was to identify the relationship between the distribution of social and economic factors and TB in Argentina between 2008 and 2012. METHOD An ecologic study involving 525 departmental jurisdictions was conducted. Simple linear regression analysis was performed, followed by multiple linear regression for each group of determinants. A final model of determinants of TB's incidence was constructed from a model of multiple linear regression. RESULTS The following determinants explain 43% of the variability of TB's incidence rate among different jurisdictions: overcrowding, proportion of households with a sewage network, proportion of examined patients with respiratory symptoms and proportion of patients who discontinued treatment. DISCUSSION This study makes an important contribution to a better understanding of the factors influencing the TB occurrence in Argentina, which is the result of a multidimensional and complex process. Thesefactors make part of this disease's social determination. CONCLUSION TB incidence is associated with different determinants, from multiple levels. Inequalities in its distribution in Argentina are driven by the unequal distribution of key social determinants.
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Affiliation(s)
- Fernando Andrés Hilal
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde,Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - María Belén Herrero
- Departamento de Relaciones Internacionales, Facultad Latinoamericana de Ciencias Sociales - Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas - Buenos Aires, Argentina
| | - Elvira Maria Godinho de Seixas Maciel
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde,Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Jose Ueleres Braga
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde,Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil.,Departamento de Epidemiologia,Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
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16
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Dendup T, Zhao Y, Dema D. Factors associated with under-five mortality in Bhutan: an analysis of the Bhutan National Health Survey 2012. BMC Public Health 2018; 18:1375. [PMID: 30558601 PMCID: PMC6296032 DOI: 10.1186/s12889-018-6308-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As an important marker for health equity and access, under-five mortality (UFM) is a primary measure for socioeconomic development. The importance of reducing UFM has been further emphasized in an ambitious target under Sustainable Development Goals. The factors influencing UFM are not adequately understood in Bhutan. METHODS The most recent dataset of the Bhutan National Health Survey (BNHS) 2012 was used in this study. Multiple logistic regression analysis using a backwards elimination approach was performed to identify significant factors influencing UFM. All statistical analyses were adjusted for the complex study design due to the multistage stratified cluster sampling used in BNHS. RESULTS Bhutan's UFM rate was 37 per 1000 live births. The weighted mean age of the children was 7.3 years (SD: 1.53; range: 3-12). Mother's age, household size, access to electricity and sanitation, residential region, and parity were the key factors associated with UFM. The UFM risk was significantly lower in children born to mothers aged 36-40 years, 41-45 years, and > 45 years when compared to that in children born to mothers aged < 26 years. The likelihood of mortality was 66% lower (95% CI: 0.21-0.55) among children born in households with > 5 members. Children born in households without electricity and safe sanitation had a significantly higher risk of death, by 81 and 49% respectively. Relative to those born in the west, children born in the central and eastern regions were 1.72 (95% CI: 1.07-2.77) and 2.09 (95% CI: 1.46-2.99) times more likely to die, respectively. Children born to mothers who gave birth to > 2 children were significantly more likely to die than their counterparts. CONCLUSION These findings suggest that younger mother's age, the higher number of births and being born in the central and eastern regions are associated with a higher UFM risk, whereas a larger household size and access to electricity and safe sanitation are key factors associated with lower UFM risk in Bhutan. Women empowerment, health education and strategies promoting maternal and child health in rural areas need to be scaled-up. Additionally, socioeconomic development programs should seek to reduce regional disparities.
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Affiliation(s)
- Tashi Dendup
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102 Australia
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Yun Zhao
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102 Australia
| | - Deki Dema
- National Commission for Women and Children, Royal Government of Bhutan, Thimphu, Bhutan
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Pulok MH, Uddin J, Enemark U, Hossin MZ. Socioeconomic inequality in maternal healthcare: An analysis of regional variation in Bangladesh. Health Place 2018; 52:205-214. [PMID: 29960144 DOI: 10.1016/j.healthplace.2018.06.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/17/2018] [Accepted: 06/19/2018] [Indexed: 11/25/2022]
Abstract
Socioeconomic inequality in the utilisation of maternal healthcare services is well-documented in Bangladesh. However, the spatial dimension of this inequality is largely unexplored in the literature. This study examined the regional variation of wealth-related inequality in the utilisation of maternal healthcare services using data from Bangladesh Demographic and Health Survey, 2014. The highest extent of pro-wealthy inequality was found in Chittagong and Sylhet for ANC services compared to Khulna and Rangpur where inequality was the lowest. Pro-wealthy inequality was the lowest in Rangpur while Dhaka and Barisal tended to have the greatest degree of inequality for delivery care services. Policy efforts aiming to tackle socioeconomic inequality in maternal healthcare should consider this spatial dimension of inequality in Bangladesh.
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Affiliation(s)
- Mohammad Habibullah Pulok
- Centre for Health Economics Research and Evaluation (CHERE), UTS Business School, University of Technology, Sydney (UTS), PO Box 123, Broadway, NSW 2007, Australia; CMCRC Health Market Quality Research Program, GPO Box 970, Sydney, NSW 2001, Australia; The Canadian Centre for Health Economics (CCHE), the University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada M5T 3M6.
| | - Jalal Uddin
- Department of Sociology, University of Alabama at Birmingham, Heritage Hall 460E, 1401 University Blvd., Birmingham, AL 35233, USA.
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Bartholins Allé 2 - Building 1260, DK-8000 Aarhus C, Denmark.
| | - Muhammad Zakir Hossin
- Department of Public Health Sciences, Karolinska Institute, Tomtebodavägen 18B, Solna, 17165 Stockholm, Sweden.
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18
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Shafique S, Bhattacharyya DS, Anwar I, Adams A. Right to health and social justice in Bangladesh: ethical dilemmas and obligations of state and non-state actors to ensure health for urban poor. BMC Med Ethics 2018; 19:46. [PMID: 29945594 PMCID: PMC6019983 DOI: 10.1186/s12910-018-0285-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The world is urbanizing rapidly; more than half the world’s population now lives in urban areas, leading to significant transition in lifestyles and social behaviours globally. While offering many advantages, urban environments also concentrate health risks and introduce health hazards for the poor. In Bangladesh, although many public policies are directed towards equity and protecting people’s rights, these are not comprehensively and inclusively applied in ways that prioritize the health rights of citizens. The country is thus facing many issues that raise moral and ethical concerns. Methods A narrative literature review was conducted between October 2016 and November 2017 on issues related to social justice, health, and human rights in urban Bangladesh. The key questions discussed here are: i) ethical dilemmas and inclusion of the urban poor to pursue social justice; and ii) the ethical obligations and moral responsibilities of the state and non-state sectors in serving Bangladesh’s urban poor. Using a Rawlsian theory of equality of opportunity to ensure social justice, we identified key health-related ethical issues in the country’s rapidly changing urban landscape, especially among the poor. Results We examined ethical dilemmas in Bangladesh’s health system through the rural–urban divide and the lack of coordination among implementing agencies. The unregulated profusion of the private sector and immoral practices of service providers result in high out-of-pocket expenditures for urban poor, leading to debt and further impoverishment. We also highlight policy and programmatic gaps, as well as entry points for safeguarding the right to health for Bangladeshi citizens. Conclusions The urban health system in Bangladesh needs a reform in which state and non-state actors should work together, understanding and acknowledging their moral responsibilities for improving the health of the urban poor by engaging multiple sectors. The social determinants of health should be taken into account when formulating policies and programs to achieve universal health coverage and ensure social justice for the urban poor in Bangladesh.
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Affiliation(s)
- Sohana Shafique
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
| | | | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Alayne Adams
- Department of International Health, Georgetown University, Washington, DC, USA
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19
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Akinyemi JO, Solanke BL, Odimegwu CO. Maternal Employment and Child Survival During the Era of Sustainable Development Goals: Insights from Proportional Hazards Modelling of Nigeria Birth History Data. Ann Glob Health 2018; 84:15-30. [PMID: 30873781 PMCID: PMC6748258 DOI: 10.29024/aogh.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: One of the targets for the third and fifth Sustainable Development Goals (SDGs) borders on children survival and women economic empowerment, respectively. A robust investigation of the relationship between maternal employment and childhood mortality will provide information useful for programs aimed at ensuring the complementarity of SDG 3 (healthy life for all) and SDG 5 (gender equality, girls and women empowerment). Objective: We addressed the following questions: (1) What is the independent relationship between maternal employment and infant (0–11 months) and child (12–59 months) mortality in Nigeria? (2) How does father’s occupation, type of residence, and geopolitical region modify the relationship? Methods: We retrospectively analysed cross-sectional data on weighted sample of 31,828 under-five children extracted from the birth history in the 2013 round of Nigeria Demographic and Health Survey, using Cox proportional hazards models. The outcomes of interest were infant (0–11 months) and child (12–59 months) mortality, and the main explanatory variables include maternal employment, involvement in decision making on work earnings, and father’s occupation. Other confounding variables were also controlled. Findings: Results showed that about two-third (68.7%) of under-five children had mothers who were working, with the majority engaged in self-employed occupations such as sales or small businesses, agriculture, and other manual labour. Infant mortality rate amongst children of employed mothers (65 per 1000 live births) was slightly less than the unemployed (70 per 1000 live births). A similar pattern was observed for child mortality. Hazards regression models revealed that the risk of both infant and child mortality was higher amongst unemployed women. Sales and agriculture/manual occupation constituted a higher risk for infant and child mortality. Analysis of interaction effects also revealed variations by father’s occupation, type of residence, and geopolitical region. Conclusion: The role of maternal employment in child survival is dynamic and depends on the type of occupation, family, and residential and regional context.
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Affiliation(s)
- Joshua O Akinyemi
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, ZA.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, NG
| | - Bola L Solanke
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, ZA.,Department of Demography and Social Statistics, Obafemi Awolowo University, Ile Ife, NG
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, ZA
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20
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Gruebner O, Khan M, Burkart K, Lautenbach S, Lakes T, Krämer A, Subramanian SV, Galea S. Spatial variations and determinants of infant and under-five mortality in Bangladesh. Health Place 2017; 47:156-164. [PMID: 28888890 DOI: 10.1016/j.healthplace.2017.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/19/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022]
Abstract
Reducing child mortality is a Sustainable Development Goal yet to be achieved by many low-income countries. We applied a subnational and spatial approach based on publicly available datasets and identified permanent insolvency, urbanicity, and malaria endemicity as factors associated with child mortality. We further detected spatial clusters in the east of Bangladesh and noted Sylhet and Jamalpur as those districts that need immediate attention to reduce child mortality. Our approach is transferable to other regions in comparable settings worldwide and may guide future studies to identify subnational regions in need for public health attention. Our study adds to our understanding where we may intervene to more effectively improve health, particularly among disadvantaged populations.
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Affiliation(s)
- Oliver Gruebner
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany; University of Zurich, Epidemiology, Biostatistics, and Prevention Institute, Zurich, Switzerland.
| | - Mmh Khan
- King Faisal University, College of Applied Medical Sciences, Department of Public Health, Saudi Arabia; University of Bielefeld, School of Public Health, Department of Public Health Medicine, Bielefeld, Germany
| | - Katrin Burkart
- Columbia University, Mailman School of Public Health, Department of Environmental Health Sciences, New York City, NY, USA
| | - Sven Lautenbach
- University of Bonn, Institute of Geodesy and Geoinformation (IGG), Bonn, Germany
| | - Tobia Lakes
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany
| | - Alexander Krämer
- University of Bielefeld, School of Public Health, Department of Public Health Medicine, Bielefeld, Germany
| | - S V Subramanian
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
| | - Sandro Galea
- Boston University, School of Public Health, Boston, MA, USA
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Beyond causes of death: The social determinants of mortality among children aged 1-59 months in Nigeria from 2009 to 2013. PLoS One 2017; 12:e0177025. [PMID: 28562610 PMCID: PMC5451019 DOI: 10.1371/journal.pone.0177025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background Millions of children worldwide suffer and die from conditions for which effective interventions exist. While there is ample evidence regarding these diseases, there is a dearth of information on the social factors associated with child mortality. Methods The 2014 Verbal and Social Autopsy Study was conducted based on a nationally representative sample of 3,254 deaths that occurred in children under the age of five and were reported on the birth history component of the 2013 Nigerian Demographic and Health Survey. We conducted a descriptive analysis of the preventive and curative care sought and obtained for the 2,057 children aged 1–59 months who died in Nigeria and performed regional (North vs. South) comparisons. Results A total of 1,616 children died in the northern region, while 441 children died in the South. The majority (72.5%) of deceased children in the northern region were born to mothers who had no education, married at a young age, and lived in the poorest two quintiles of households. When caregivers first noticed that their child was ill, a median of 2 days passed before they sought or attempted to seek healthcare for their children. The proportion of children who reached and departed from their first formal healthcare provider alive was greater in the North (30.6%) than in the South (17.9%) (p<0.001). A total of 548 children were moderately or severely sick at discharge from the first healthcare provider, yet only 3.9%-18.1% were referred to a second healthcare provider. Cost, lack of transportation, and distance from healthcare facilities were the most commonly reported barriers to formal care-seeking behavior. Conclusions Maternal, household, and healthcare system factors contributed to child mortality in Nigeria. Information regarding modifiable social factors may be useful in planning intervention programs to promote child survival in Nigeria and other low-income countries in sub-Saharan Africa.
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