Donors' Interest in Water and Sanitation Subsectors

International efforts have taken place to alleviate poverty by adopting several obligations within the international society; one of these obligations is the provision of safe access to water and sanitation. The MDGs helped people around the world to gain improved water sources and better sanitation. Although the sectoral aid increased from 20% between 1990 and 1992 (only 4.9% distributed for water supply and sanitation (W&S)) to 35% between 2002 and 2004 (only 3.9% allocated for W&S), facts showed that the allocated aid was biased to social aims rather than infrastructural targets. In this study, I am focusing on the donors' commitment for W&S, whether their ODA for these two sub-sectors is aligned with the intentions of the SDGs. I find that donors allocated W&S aid by focusing on governments in general with higher governance indicators, and that poorer countries received a higher allocation of aid.

Assessment of capital expenditure in achieving sanitation-related MDG targets and the uncertainties of the SDG targets in Algeria

This paper studies sanitation policy in Algeria by conducting an assessment of the capital expenditure on sanitation improvements between 2000 and 2018. It focuses on the period of implementation of the Millennium Development Goals (MDGs) between 2000 and 2015 and the first years of the Sustainable Development Goals (SDGs) from 2016 to 2018. The paper aims also to assess the level of subsidies for sanitation services in Algeria and the lack of full cost recovery. We then emphasise the idle capacity for wastewater treatment plants (WWTPs) and the risks of wastewater discharge on public health and ecological integrity. Our methodological approach is multidimensional and based on a critical reading of reports by institutions responsible for the implementation of sanitation policy. We used water and sanitation data from the water authorities to evaluate the funding of the sanitation subsector and to analyse the strengths and weaknesses of this sub-sector. This study was also facilitated by semi-structured interviews with executive staff in water institutions responsible for the implementation of sanitation policy in Algeria. In the period studied (2000-2018) we find that the sanitation subsector benefited from a significant investment budget (or budgetary allocations) of nearly US$7.58 billion (in constant 1999 US$), representing 20.53% of the total budget allocated to the water sector. However, the low absorption capacity, estimated at 62.7% between 2000 and 2015, meant that the capital expenditure of achieving MDG target 7.C related to sanitation was US$4.38 billion (in constant 1999 US$) out of US$6.98 billion allocated for the same period. The study shows that the decline in real investment since 2009, with a funding gap that increased from 201.49% in 2015 to 385.56% in 2018, casts uncertainty on the fulfillment of SDG targets 6.2 and 6.3 related to sanitation. It is thus very difficult to meet the level of investment planned for 2030. It seems, therefore, that the SDGs will only be comfortably achieved if reforms towards the sustainable recovery of sanitation service costs are undertaken.

The moral and social narratives of sexual and reproductive health in Kenya: a case of adolescents and young people pre- and within the MDG era

BACKGROUND

The role of global initiatives in catalyzing change within national contexts is complex and less understood. Addressing adolescent sexual and reproductive health in Kenya requires concerted efforts of both state and non-state actors and more importantly, a supportive environment. This paper deconstructs the moral and social narratives of adolescents' and young people's sexual and reproductive health (AYSRH) in Kenya as driven by the powerful discourse and ideologies pre- and within the Millennium Development Goal (MDG) era.

METHODS

Literature was systematically searched in PubMed and Medline with policy documents obtained from government agencies from the pre-MDG period (2000 and earlier) and within the MDG period (2001-2015). Literature with a substantial focus on SRH were eligible if they captured the different facets of ASRH in Kenya and sub-Saharan Africa (SSA). The results were reviewed and synthesized to disentangle the moral and social narratives of AYSRH in Kenya with an MDG lens.

RESULTS

The evolution of AYSRH policies and programmes in Kenya was gradual and largely shaped by prevailing development threats and moral and social narratives. Pre-MDG period was dominated by issue-based policies of population growth and high fertility rates, with a focus on married population with strong cultural and religious barriers to AYSRH; early to mid-MDG was mainly influenced by the threat of HIV/AIDS, culminating in the first Adolescent Reproductive Health and Development Policy in 2003. However, the policies and subsequent programmes focused on abstinence only and medical narratives, with persistent religious and cultural opposition to AYSRH. Late-MDG saw more progressive policies (these are policies that refer to those that tends towards acceptance of liberal social reforms and which sometimes are contrary to entrenched social norms, beliefs and practices), high government commitment and a refocus on SRH issues due to sustained early childbearing, culminating in the revised Adolescent Sexual and Reproductive Health Policy of 2015.

CONCLUSION

Debates in the translation of global goals and commitments to policy and practice at country level need to account for national level realities in AYSRH reforms. The findings contribute to critical evidence for strategic policy and programming approaches for AYSRH in Kenya and in SSA and for the realization of their rights within the context of sustainable development goals.

Maternal health services utilisation among primigravidas in Uganda: what did the MDGs deliver?

BACKGROUND

Achieving maternal health outcomes in the SDGs requires the implementation of more targeted policies and strategies. While the MDGs may have deepened our understanding in this regard, we know little about the trends in maternal health services utilisation among primigravidas, and how age and geographical regions could have influenced these trends. In this study, we examined utilisation of antenatal and skilled delivery services among primigravidas in Uganda, a country with one of the highest maternal mortality ratios, and where early childbearing and its attendant challenges are common.

METHODS

Guided by Andersen's Behavioural Model, we fitted multivariate regression models to a pooled dataset of the 2006, 2011 and 2016 Ugandan Demographic and Health Survey (n = 3477) to understand the dynamics in Antenatal Care (ANC) and Skilled Birth Attendance (SBAs) utilisation among primigravidas. Post-estimation margins were employed to further highlight the effect of age and geographical regions.

RESULTS

The analyses show an improvement in access to maternal health services among primigravidas from 2006 to 2016. Compared to 2006, primigravidas in 2016 were 48%, 24% and 2.98 times more likely to have early ANC, four or more ANC visits, and SBAs, respectively. Altogether, a primigravida in 2016 relative to 2006 was 42% more likely to meet all three maternal health service indicators. Post-estimation margins analyses on age and geographical disparities revealed that younger primigravidas have lower probability, while primigravidas in Eastern Region, one of the most deprived in the country, have the lowest probability of accessing maternal health services. Also, the study found education, wealth, women's household decision-making power, place of residence as important determinants of ANC visits and SBAs.

CONCLUSIONS

Based on our findings, it is important to address the vulnerabilities of primigravidas, particularly younger individuals, in accessing early ANC. Uganda should scale-up decentralisation and integration of maternal health delivery in local communities as a strategy of addressing lingering geographical disparities, and ultimately improve maternal health outcomes in the SDGs period.

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development

Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH-adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day.

Association between the Human Development Index and Millennium Development Goals 6 Indicators in Sub-Saharan Africa from 2000 to 2014: Implications for the New Sustainable Development Goals

It is important to assess whether regional progress toward achieving the millennium development goals (MDGs) has contributed to human development and whether this has had an effect on the triple burden of disease in the continent. This analysis investigates the association between the human development index (HDI) and co-occurrence of HIV/AIDS, tuberculosis (TB), and malaria as measured by MDG 6 indicators in 35 selected sub-Saharan African countries from 2000 to 2014. The analysis used secondary data from the United Nations Development Programme data repository for HDI and disease data from WHO Global Health observatory data repository. Generalized Linear Regression Models were used to analyze relationships between HDI and MDG 6 indicators. HDI was observed to improve from 2001 to 2014, and this varied across the selected sub-regions. There was a significant positive relationship between HDI and HIV prevalence in East Africa (β = 0.048 [95% CI: 0.040–0.056], p < 0.001) and Southern Africa (β = 0.032 [95% CI: 0.002–0.062], p = 0.034). A significant positive relationship was observed with TB incidence (β = 0.009 [95% CI: 0.003–0.015], p = 0.002) and a significant negative relationship was observed with malaria incidence (β = −0.020 (95% CI: −0.029 to −0.010, p < 0.001) in East Africa. Observed improvements in HDI from the year 2000 to 2014 did not translate into commensurate progress in MDG 6 goals.

Health insurance enrolment in the Upper West Region of Ghana: Does food security matter?

Toward achieving universal health coverage, Ghana's national health insurance has been acclaimed as a pro-poor scheme, yet been criticized for leaving the poor behind. Arising from this is how poverty has been operationalized and how poor people are targeted for enrolment into the scheme. We examine the role of food insecurity (not currently considered) as a multidimensional vulnerability concept on enrolment into Ghana's health insurance using binary logistics regression on cross-sectional survey of household heads (n = 1438) in the Upper West Region of Ghana. Our analyses show that heads of severely food-insecure households were significantly less likely to enroll in national health insurance scheme (NHIS) relative to households who reported being food-secure (OR = 0.36, P < .05). We also found education, occupation, and religion as significant predictors of health insurance enrolment. Based on our findings, it is crucial to incorporate food security status in the identification of vulnerable people for free enrolment in Ghana's health insurance.

Awareness and Knowledge of the Sustainable Development Goals in a University Community in Southwestern Nigeria

Background

The Sustainable Development Goals (SDGs) is a globally accepted developmental agenda, and it is expected that everyone everywhere in the world would be aware, knowledgeable and be willing to contribute to its attainment. This study aims to assess the level of awareness, knowledge of, and attitudes towards the SDGs among members of a university community.

Methods

A cross-sectional survey was conducted on 450 students and staff of Osun State University, Southwestern Nigeria, selected from three of its six multi-campuses via multi-stage sampling. Data were collected by means of semi-structured questionnaire. Data were analysed using SPSS version 20.0.

Results

The mean age for the respondents was 26(10.2) years. Only 43% of the respondents were aware of the SDGs and only 4.2% had good knowledge of the SDGs. However, 56.3% had positive attitude towards it. More respondents with good knowledge of the SDGs were either acadenic staff or those have been enlightened via personal study of the SDGs or through other means. Similarly having a positive attitude was associated with being an academic staff/ high level of education as well as belonging to the middle age group. (p<0.05).

Conclusion

The awareness of and attitudes towards the SDGs was just fair. However, the level of knowledge was abysmally low, and this has serious negative implications for SDGs attainment. Pertinent individual and population-level methods of enlightening people about the SDGs must be put in place in educational settings; curricular changes are imperative.

Maternal health research outputs and gaps in Latin America: reflections from the mapping study

As part of the MASCOT/WOTRO multinational team conducting the maternal health literature mapping, four Latin American researchers were particularly interested in analysing information specific to their region. The mapping started with 45,959 papers uploaded from MEDLINE, CINAHL, Embase, LILACAS, PopLINE, PsycINFO and Web of Knowledge. From these, 4175 full texts were reviewed and 2295 papers were subsequently included. Latin America experienced an average maternal mortality decline of 40% between 1990 and 2013. Nevertheless, the region's performance was below the global average and short of the 75% reduction set in Millennium Development Goal 5 for 2015. The main outcomes show that research on maternal health in the countries where the most impoverished populations of the world are living is not always aligned with their compelling needs. From another perspective, the review made it possible to recognize that research funding as well as the amount of scientific literature produced concentrate on issues that are not necessarily among the main causes of maternal deaths. Even though research on maternal health in Latin America has grown from an average of 92.5 publications per year in 2000-2003 to 236.7 between 2008 and 2012, it's not satisfactorily keeping pace with other regions. In conclusion, it is critical to effectively orient research funding and production to respond to the health needs of the population. At the same time, there is a need for innovative mechanisms to strengthen the production and uptake of scientific evidence that can properly inform public health decision making.

The impact of the worldwide Millennium Development Goals campaign on maternal and under-five child mortality reduction: 'Where did the worldwide campaign work most effectively?'

BACKGROUND

As the Millennium Development Goals campaign (MDGs) came to a close, clear evidence was needed on the contribution of the worldwide MDG campaign.

OBJECTIVE

We seek to determine the degree of difference in the reduction rate between the pre-MDG and MDG campaign periods and its statistical significance by region.

DESIGN

Unlike the prevailing studies that measured progress in 1990-2010, this study explores by percentage how much MDG progress has been achieved during the MDG campaign period and quantifies the impact of the MDG campaign on the maternal and under-five child mortality reduction during the MDG era by comparing observed values with counterfactual values estimated on the basis of the historical trend.

RESULTS

The low accomplishment of sub-Saharan Africa toward the MDG target mainly resulted from the debilitated progress of mortality reduction during 1990-2000, which was not related to the worldwide MDG campaign. In contrast, the other regions had already achieved substantial progress before the Millennium Declaration was proclaimed. Sub-Saharan African countries have seen the most remarkable impact of the worldwide MDG campaign on maternal and child mortality reduction across all different measurements. In sub-Saharan Africa, the MDG campaign has advanced the progress of the declining maternal mortality ratio and under-five mortality rate, respectively, by 4.29 and 4.37 years.

CONCLUSIONS

Sub-Saharan African countries were frequently labeled as 'off-track', 'insufficient progress', or 'no progress' even though the greatest progress was achieved here during the worldwide MDG campaign period and the impact of the worldwide MDG campaign was most pronounced in this region in all respects. It is time to learn from the success stories of the sub-Saharan African countries. Erroneous and biased measurement should be avoided for the sustainable development goals to progress.

Using advocacy and data to strengthen political accountability in maternal and newborn health in Africa

Accountability mechanisms help governments and development partners fulfill the promises and commitments they make to global initiatives such as the Millennium Development Goals and the Global Strategy on Women's and Children's health, and regional or national strategies such as the Campaign for the Accelerated Reduction in Maternal Mortality in Africa (CARMMA). But without directed pressure, comparative data and tools to provide insight into successes, failures, and overall results, accountability fails. The analysis of accountability mechanisms in five countries supported by the Evidence for Action program shows that accountability is most effective when it is connected across global and national levels; civil society has a central and independent role; proactive, immediate and targeted implementation mechanisms are funded from the start; advocacy for accountability is combined with local outreach activities such as blood drives; local and national champions (Presidents, First Ladies, Ministers) help draw public attention to government performance; scorecards are developed to provide insight into performance and highlight necessary improvements; and politicians at subnational level are supported by national leaders to effect change. Under the Sustainable Development Goals, accountability and advocacy supported by global and regional intergovernmental organizations, constantly monitored and with commensurate retribution for nonperformance will remain essential.

Pakistan and the Millennium Development Goals for Maternal and Child Health: progress and the way forward

The world has made substantial progress in reducing maternal and child mortality, but many countries are projected to fall short of achieving their Millennium Development Goals (MDGs) 4 and 5 targets. The major objective of this paper is to examine progress in Pakistan in reducing maternal and child mortality and malnutrition over the last two decades. Data from recent national and international surveys suggest that Pakistan lags behind on all of its MDGs related to maternal and child health and, for some indicators especially related to nutrition, the situation has worsened from the baseline of 1990. Progress in addressing key social determinants such as poverty, female education and empowerment has also been slow and unregulated population growth has further compromised progress. There is a need to integrate the various different sectors and programmes to achieve the desired results effectively and efficiently as many of the determinants and influencing factors are outside the health sector.

Measuring progress towards MDGs in child health: Should base level sensitivity and inequity matter?

Measurement of achievement or progress towards the Millennium Development Goals (MDGs) should be suggestive of the issues involved in intertemporal comparison. Commonly, we observe that the measurement techniques such as simple differentials, rates and ratios are employed for comparisons and interpretations. But such chosen measures are insensitive to two very important and fundamental concerns. Firstly, such measures are not differentially sensitive to the base level of the indicator against which comparisons are made to comment on the progress or achievement. Secondly, it is observed that in most of the progress assessments and comparisons, without exception, the focus is on population averages thus ignoring the inherent inequalities therein. To incorporate these two concerns, a method is proposed and an illustrative application is provided to review the MDG achievements in child health across 32 developing countries. The adopted technique is effective for comparison and interpretation of progress and achievement as it augments the principles of equity as well as base-level sensitivity. More importantly, such an improved measure could help the policymakers to identify achievements in a more realistic manner and thus develop a comprehensive vision regarding social and economic achievements.

Ending preventable newborn deaths in a generation

The end of the Millennium Development Goal (MDG) era was marked in 2015, and while maternal and child mortality have been halved, MGD 4 and MDG 5 are off-track at the global level. Reductions in neonatal death rates (age <1 month) lag behind those for post-neonates (age 1-59 months), and stillbirth rates (omitted from the MDGs) have been virtually unchanged. Hence, almost half of under-five deaths are newborns, yet about 80% of these are preventable using cost-effective interventions. The Every Newborn Action Plan has been endorsed by the World Health Assembly and ratified by many stakeholders and donors to reduce neonatal deaths and stillbirths to 10 per 1000 births by 2035. The plan provides an evidence-based framework for scaling up of essential interventions across the continuum of care with the potential to prevent the deaths of approximately three million newborns, mothers, and stillbirths every year. Two million stillbirths and newborns could be saved by care at birth and care of small and sick newborns, giving a triple return on investment at this key time. Commitment, investment, and intentional leadership from global and national stakeholders, including all healthcare professionals, can make these ambitious goals attainable.

Poverty and inequality - but of what - as social determinants of health in Africa?

BACKGROUND

Many African economies have achieved substantial economic growth over the past recent years, yet several of the Millennium Development Goals (MDGs) including those concerned with health, remain considerably behind target. This paper examines whether progress towards these goals is being hampered by existing levels of poverty and income inequality. It also considers whether the inequality hypothesis of Wilkinson and Pickett1 applies to population health outcomes in African states.

METHODS

Correlation analysis and scatter plots were used to assess graphically the link between variations in health outcomes, level of poverty and income inequality in different countries. Health status outcomes were measured by using four indicators: infant and under-five (child) mortality rates; maternal mortality ratios; and life expectancy at birth. In each of the 52 African nations, the proportion of the population living below the poverty line is used as an indicator of the level of poverty and Gini coefficient as a measure of income inequality. The study used a comprehensive review of secondary and relevant literature that are pertinent in the subject area. The data datasets obtained online from UNICEF2 and UNDP3 (2009) used to test the research questions. World Health Organization the three broad dimensions to consider when moving towards better population health outcome through Universal Health Coverage and the Social Determinants of Health framework reviewed to establish the poverty and income inequality link in African countries population health outcomes.

RESULTS

The study shows that poverty is strongly associated with all health outcome differences in Africa (IMR, cc = 0.63; U5MR, cc = 0.64; MMR, cc = 0.49; life expectancy at birth, cc = -0.67); income inequality with only one of the four indicators (IMR, cc = 0.14; U5MR, cc = 0.07; MMR, cc = 0.22; life expectancy at birth, cc = -0.49), whereas income inequality is associated with one of the four indicators.

CONCLUSION

The study shows that tackling poverty should be the immediate concern in Africaas a means of promoting better health for all. There is a question mark over whether the findings of Wilkinson and Pickett1 on the relationship between income inequality and health apply to Africa. The reasons for this question mark are discussed. More research is needed to investigate whether the inequality results found in this study are replicated in other studies of African health.

The public health effects of water and sanitation in selected West African countries

OBJECTIVE

This paper examines access to water and improved sanitation target under the Millennium Development Goal 7c (MDG 7c) for six West African countries: Chad, Niger, Nigeria, Mauritania, Sierra Leone and Togo. The article outlines some possible causes for the slow progress in achieving the MDG 7c, examines the public health effects of missing the targets, and charts paths for policy makers to consider in bringing these targets to acceptable levels.

METHODS

The study is based on secondary data analysis of trends in water and sanitation indicators for the six countries from 2000 to 2014. The data are drawn from the World Development Indicators (WDI) of the World Bank, and the World Health Organisation Joint Monitoring Programme (WHO JMP) and WaterAid Africa Wash Map. The performance of each country in the two indicators is presented and judged against the target set under MDG 7c. Forecasts based on the expiry of the MDG's in 2015 and the time required to achieve the targets are carried out.

RESULTS

The study showes that while some progress has been made in improved water, sanitation showed slow progress for all the countries between 2000 and 2014. The goal of attaining acceptable sanitation shows that the six West African countries have lagged behind the MDG 7c target and the progress is equally slow.

CONCLUSION

At the current rate of progress if strong public and private sector intervention mechanisms are not instituted across the board, the six West African countries under study would continue to lag behind the rest of the world in terms of access to improved water and sanitation. This has consequences for poverty alleviation and the risk of the re-emergence of neglected tropical diseases.

Antenatal Care Services Utilization in Yobe State, Nigeria: Examining Predictors and Barriers

OBJECTIVE

In Nigeria, wide disparities exist between the different parts of the country, with the states in the North East zone having poor health resources. The objective of this study is to assess whether women's biological, sociocultural, and economic characteristics are associated with utilization of ante natal care services as measured by number of antenatal care (ANC) visits in Yobe State.

METHODS

This is a secondary data analysis of the 2008 Nigeria Demographic and Health Survey with records from 33,385 women between 15-49 years who had given birth between January 2003 and December 2008 in Yobe State. Bivariate Pearson's Chi square test and two stages of Multivariate regression analysis were conducted.

RESULTS

Women with at least primary level education (adjusted OR (AOR) = 2.40; CI 1.24 - 4.67), belonging to professional employment category (AOR = 12.07; CI 0.19 - 75.74) and those who had access to skilled health workers (AOR = 5.13; CI 2.50 - 10.52) are more likely to make the required number of ANC visits compared to those who are illiterates, unemployed and had no access to skilled health workers.

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

This study demonstrated that educational level, family wealth income, and availability of skilled health worker were consistently associated with the number of ANC visits even after controlling for covariates. These three covariates are in tandem with the Millenium Development Goals (MDG) 1 - eradication of extreme poverty and hunger; MDG 2 - universal basic education; MDG 3 - gender equality; and MDG 4 - maternal mortality. There is the need for inter-sectoral holistic intervention approach.

The challenges for global harmonisation of food safety norms and regulations: issues for India

Safe and adequate food is a human right, safety being a prime quality attribute without which food is unfit for consumption. Food safety regulations are framed to exercise control over all types of food produced, processed and sold so that the customer is assured that the food consumed will not cause any harm. From the Indian perspective, global harmonisation of food regulations is needed to improve food and nutrition security, the food trade and delivery of safe ready-to-eat (RTE) foods at all places and at all times. The Millennium Development Goals (MDGs) put forward to transform developing societies incorporate many food safety issues. The success of the MDGs, including that of poverty reduction, will in part depend on an effective reduction of food-borne diseases, particularly among the vulnerable group, which includes women and children. Food- and water-borne illnesses can be a serious health hazard, being responsible for high incidences of morbidity and mortality across all age groups of people. Global harmonisation of food regulations would assist in facilitating food trade within and outside India through better compliance, ensuring the safety of RTE catered foods, as well as addressing issues related to the environment. At the same time, regulations need to be optimum, as overregulation may have undue negative effects on the food trade.

Persistent inequalities in child undernutrition: evidence from 80 countries, from 1990 to today

BACKGROUND

Global progress in reducing the burden of undernutrition tends to be measured at the population level. It has been hypothesized that population-level improvements may mask widening socioeconomic inequalities, but little attempt has been made to assess whether this is true.

METHODS

Original data from 131 demographic health surveys and 48 multiple indicator cluster surveys from 1990 to 2011 were used to examine trends in socioeconomic inequalities in stunting and underweight, as well as the relationship between changes in prevalence and changes in inequality, in 80 countries. Socioeconomic inequality is measured using the corrected concentration index.

RESULTS

Countries with a higher prevalence of stunting tend to have larger socioeconomic inequalities in stunting (Spearman rank correlation = -0.27 P = 0.014). In most countries, there has been no change in inequality in stunting: in 31 out of 53, the 90% confidence intervals around the changes overlap the zero value. In the remaining 22, there was a reduction in inequality in 11 and an increase in 11. The distributional patterns underlying the summary inequality statistics vary considerably across countries, but in most there have been considerable gains to the poorest quintile.

CONCLUSIONS

Reductions in the prevalence of undernutrition have generally not been accompanied by widening inequalities. However, inequalities have also not been narrowing. Rather, the picture is one of a strong persistence of existing inequalities. In addition, there are different distributional patterns underlying changes in the summary indices of inequality which will need to be taken into consideration in designing programmes to reach the poor.

Where are the gaps in improving maternal and child health in Mauritania? the case for contextualised interventions: a cross sectional study

Introduction

It is estimated that any progress made towards improving maternal and child health in Mauritania has likely stalled. A lack of reliable and up-to-date data regarding maternal and child health indicators makes it difficult to identify current gaps and adapt international programmes to meet local needs.

Methods

Using secondary data collected as part of a baseline assessment for a maternal and child health programme being implemented in two health departments, we compared maternal and child health indicators across two different samples of pregnant women and children under-five in M'bagne and Guérou. Descriptive analyses were conducted using a Pearson's Chi-Squared test, assuming a binomial distribution and a confidence level of alpha=0.05.

Results

Our results indicated that there were marked regional differences in maternal and child health indicators between these two rural sites, with M'bagne generally performing better across a range of indicators including: immunisation rates, child registration, vitamin A supplementation, deworming, delivery in the presence of a skilled birth attendant, and post-natal care coverage. In Guérou we observed lower rates of fever, diarrhoea, and fast and difficult breathing among children under-five.

Conclusion

Though socio-cultural differences may play a part in explaining some of these observed differences, these alone do not account for the observed differences in maternal and child health indicators. Context-specific activities to overcome barriers to care must be designed to address such rural regional differences if we are to see an improvement across maternal and child health indicators and accelerate progress towards MDGs 4 & 5 in Mauritania.

Mortality pattern in children: a hospital based study in Nigeria

BACKGROUND

Hospital based data on mortality pattern is a reflection of what is obtainable in a community at large. Therefore, data obtained from such review is usually beneficial in re-evaluating existing services and in improving facilities and patient care. The aim of this study was to evaluate the mortality pattern of children admitted into the children medical wards of the University of Port-Harcourt Teaching Hospital from Jan 2007 to December 2008.

MATERIALS AND METHODS

This was a retrospective study. The case files of all patients aged one month to 16 years, admitted into the paediatric wards of University of Port-Harcourt Teaching Hospital, Port-Harcourt, Nigeria over a 2 year period were reviewed. Neonatal and surgical cases were excluded.

RESULTS

There were 2,174 admissions during the study period. Sixty one of the total number of admissions died in the children medical wards giving a mortality rate of 2.8%. The youngest child was 2 months and the oldest 10 years. Fifty two (80.3%) were under 5 years. There was male preponderance. Most of the deaths occurred between April and September. The commonest causes of death were HIV/AIDS and bronchopneumonia in the under five age group; while in those above 5 years of age malignancies and HIV/AIDS were the predominant causes.

CONCLUSION

Effective HIV/AIDS control measures will significantly reduce child mortality in our community. Also there is need to have a closer look at the potential risk for malignancies. Health intervention programmes such as integrated management of childhood illnesses and primary health care, which have been shown to reduce childhood deaths significantly, need to be intensified in order to achieve the MDG 4 by 2015.