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Requejo JH, Strong K, Aboud F, Agweyu A, Billah SM, Black M, Boschi-Pinto C, Horiuchi S, Jamaluddine Z, Lazzerini M, Maiga A, Munos M, Schellenberg J, Weigel R, Sacks E. Harmonizing Data Visualizations on Child Health and Well-Being to Strengthen Advocacy and Monitoring Efforts. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300183. [PMID: 38071584 PMCID: PMC10749642 DOI: 10.9745/ghsp-d-23-00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/15/2023] [Indexed: 12/24/2023]
Abstract
Data visualization tools on child health have improved data accessibility but caused confusion over indicator data sources and which tools to use for specific purposes. We propose principles for generating future tools that can effectively trigger action and accountability for children everywhere.
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Affiliation(s)
- Jennifer Harris Requejo
- The World Bank Group, Global Financing Facility, Washington, DC, USA.
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Ambrose Agweyu
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Sk Masum Billah
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Maureen Black
- Department of Pediatrics and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Triangle Park, NC, USA
| | | | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Zeina Jamaluddine
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- American University of Beirut, Beirut, Lebanon
| | - Marzia Lazzerini
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Abdoulaye Maiga
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melinda Munos
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Emma Sacks
- Consultant, Child Health Accountability Tracking Technical Advisory Group
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2
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Bhutta ZA, Boerma T, Black MM, Victora CG, Kruk ME, Black RE. Optimising child and adolescent health and development in the post-pandemic world. Lancet 2022; 399:1759-1761. [PMID: 35489362 DOI: 10.1016/s0140-6736(21)02789-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; Institute for Global Health and Development, The Aga Khan University, Karachi 74800, Pakistan.
| | - Ties Boerma
- Countdown to 2030 for Women's, Children's and Adolescents' Health and Institute for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Triangle Park, NC, USA
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Margaret E Kruk
- Department of Global Health and Populations, Harvard University TH Chan School of Public Health, Boston, MA, USA
| | - Robert E Black
- Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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3
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Prasad JB, Pezhhan A, Patil SH. Effect of wealth, social inequality, Mother's BMI, and education level on child malnutrition in India. Diabetes Metab Syndr 2021; 15:102304. [PMID: 34601344 DOI: 10.1016/j.dsx.2021.102304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The differences in prevalence of malnutrition are mostly on account of social factors. However, we did not find any published study that provided an estimate of proportion of stunting and underweight among under-5 children due to household economic conditions, social inequalities, mother's BMI and education level. Hence, study has taken to study the effect of household economic status, social inequality, mother's BMI and education on stunting and underweight among children under-5 years and its determinants. METHODS The study used Kids file of NFHS-4 (2015-16), which comprised 259,627 children aged less than five years. This data was analysed by bivariate and Forward Logistic Regression techniques using M.S. Excel and IBM SPSS-22 version. RESULTS The prevalence of stunting and underweight children was significantly higher among those born to underweight mothers, poor households, working women, and women had a home delivery. It was also high among children of 4th or higher birth order, those from scheduled castes and tribes, born to illiterate women and those residing in rural. The odds of stunting (OR = 2.67, 95% CI: 2.54-2.81) and underweight (OR = 2.74, 95% CI: 2.60-2.88) were more than two times higher among children living in poor households than among those from rich households. Poor households account for about 40% of stunted and underweight children. Fifteen percent of stunted children and 26.9% of underweight were born to underweight mothers. Overall, 60% of stunted and 56.6% of underweight children had illiterate mothers. CONCLUSIONS children of illiterate and underweight mothers, socially deprived and economically poor groups are at a higher risk of being stunted and underweight. Hence, necessary health programmes are needed for improving nutritional status by giving special attention to illiterate, underweight mothers, socially deprived and economically poor groups.
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Affiliation(s)
- Jang Bahadur Prasad
- Department of Epidemiology and Biostatistics, KLE University, Belgaum, Karnataka, India.
| | - Ali Pezhhan
- Faculty in Department of Demography, Islamic Azad University, Central Tehran, Iran.
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4
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Druetz T, Bila A, Bicaba F, Tiendrebeogo C, Bicaba A. Free healthcare for some, fee-paying for the rest: adaptive practices and ethical issues in rural communities in the district of Boulsa, Burkina Faso. Glob Bioeth 2021; 32:100-115. [PMID: 34408385 PMCID: PMC8366671 DOI: 10.1080/11287462.2021.1966974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 08/06/2021] [Indexed: 10/30/2022] Open
Abstract
In Burkina Faso, in July 2016, user fees were removed at all public healthcare facilities, but only for children under 60 months of age and for "mothers", i.e. for reproductive care. This study was conducted in five rural communities in Boulsa District (Burkina Faso) (1) to understand the perceptions and practices of stakeholders regarding compliance with eligibility criteria for free care and (2) to explore the ethical tensions that may have resulted from this policy. Semi-directed individual interviews (n = 20) were conducted with healthcare personnel and mothers of young children. Interviews were recorded and transcribed, and a thematic content analysis was conducted. The study reveals the presence of practices to circumvent strict compliance with the eligibility criteria for free access. These include hiding the exact age of children over 60 months and using eligible persons for the benefit of others. These practices result from ethical and economic tensions experienced by the beneficiaries. They also raise dilemmas among healthcare providers, who have to enforce compliance with the eligibility criteria while realizing the households' deprivation. Informal adjustments are introduced at the community level to reconcile the healthcare providers' dissonance. Local reinvention mechanisms help in overcoming ethical tensions and in implementing the policy.
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Affiliation(s)
- Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
- Centre de recherche en santé publique, Montreal, Canada
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Alice Bila
- Société d’Études et de Recherche en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Frank Bicaba
- Société d’Études et de Recherche en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Cheick Tiendrebeogo
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
| | - Abel Bicaba
- Société d’Études et de Recherche en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
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Rodrigues LDS, Rodrigues LDS, Costa LC, Fontoura GMG, Maciel MCG. Trend in infant mortality rate caused by sepsis in Brazil from 2009 to 2018. Rev Inst Med Trop Sao Paulo 2021; 63:e26. [PMID: 33852709 PMCID: PMC8046506 DOI: 10.1590/s1678-9946202163026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/11/2021] [Indexed: 12/29/2022] Open
Abstract
Sepsis is the organ dysfunction resulting from an infection associated with an
unregulated host inflammatory response, which generates high mortality rates in
Brazil. The aim of this stydy was to analyze the trend of early, late and
post-neonatal mortality rates due to sepsis in Brazilian regions, from 2009 to
2018. This is an ecological study of time series. The trend of infant mortality
from sepsis was analyzed using the International Classification of Diseases
(ICD10) according to the place of residence (North, Northeast, Southeast, South
and Midwest). Death Certificate data were collected from the Mortality
Information System database. The temporal trend was analyzed using the
Prais-Winsten estimate, interpreted as increasing, decreasing or stable, through
the dependent variable (logarithm of mortality rates) and interdependent
variables (years of the historical series). The Stata 14.0 statistical software
was used. There were 39,867 infant deaths due to sepsis (78.67% for unspecified
bacterial sepsis of the neonate ). Most of the children were male, had mixed
ethnicity (black and white) , were born preterm with low birth weight and most
mothers were 20-34 years old. There were decreasing trends in mortality rates
from 2009 to 2018: early neonatal, in the Southeast (-3.57%), North (-3.33%) and
South (-2.91%); late neonatal, in the South (-4.12%), Southeast (-4.53%), North
(-4.55%) and Midwest (-6.21%); and post-neonatal, in the Northeast (-1.84%),
North (-3.62%), Southeast (-3.83%) and Midwest (-5.81%). The Northeast showed a
stable trend in early and late neonatal mortality rates. It was concluded that
most regions showed a decreasing trend in mortality rates from sepsis in all age
components, despite regional differences.
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Affiliation(s)
- Liliane Dos Santos Rodrigues
- Universidade Federal do Maranhão, Programa de Pós-Graduação em Biodiversidade e Biotecnologia da Amazônia Legal (Rede Bionorte), São Luís, Maranhão, Brazil
| | - Livia Dos Santos Rodrigues
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Ribeirão Preto, São Paulo, Brazil
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Bila A, Bicaba F, Tiendrebeogo C, Bicaba A, Druetz T. Soins de santé gratuits pour les uns, payants pour les autres : perceptions et stratégies d’adaptation dans le district de Boulsa (Burkina Faso). CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1073784ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Contexte : Les preuves des bienfaits des politiques de gratuité des soins sont réunies, mais les enjeux éthiques que ces politiques soulèvent dans les pays à faibles revenus ont été peu examinés. Au Burkina Faso, la gratuité a été introduite en juillet 2016 pour les enfants de moins de 5 ans et les femmes enceintes, en ce qui concerne les soins en santé reproductive. Il a été rapporté que les critères d’éligibilité sont parfois difficiles à interpréter ou à mettre en application. L’objectif de cette étude est double : 1) comprendre les perceptions et les pratiques du personnel de santé et des bénéficiaires à l’égard du respect des critères d’éligibilité à la gratuité et 2) explorer les tensions éthiques qui en ont découlé et les éventuels modes de résolution. Méthodologie : En 2018, une étude qualitative transversale a été menée dans cinq communautés rurales de Boulsa, au Burkina Faso, Des entrevues individuelles semi-dirigées ont été réalisées auprès du personnel soignant (n=10) et de mères de jeunes enfants (n=10), qui ont été sélectionnées avec l’aide d’agents de santé à base communautaire. Les enregistrements audios ont été traduits et retranscrits. Une analyse thématique de contenu a été réalisée sur l’ensemble du matériel. Les thèmes qui sont ressortis de l’analyse thématique ont été identifiés par les membres de l’équipe, qui en ont discuté et les ont reformulés. Résultats : L’étude suggère que les critères d’éligibilité à la gratuité ne sont pas toujours bien connus des bénéficiaires, ce qui peut entraîner des débordements involontaires. Elle révèle aussi l’adoption de pratiques pour contourner le respect strict des critères d’éligibilité à la gratuité, notamment pour en faire bénéficier les enfants de 5 ans et plus. Ces débordements délibérés résultent de tensions éthiques vécues par les bénéficiaires, et en soulèvent d’autres chez le personnel soignant. Des mécanismes sont mis en oeuvre officieusement pour réconcilier les dissonances ressenties par les prestataires. Conclusion : La mise en oeuvre de la politique de gratuité au Burkina Faso s’opère grâce à des mécanismes de réinvention locale pour surmonter les tensions éthiques liées au respect des critères d’éligibilité.
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Affiliation(s)
- Alice Bila
- Société d’Études et de Recherches en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Frank Bicaba
- Société d’Études et de Recherches en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Cheick Tiendrebeogo
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Montréal, Canada
| | - Abel Bicaba
- Société d’Études et de Recherches en Santé Publique (SERSAP), Ouagadougou, Burkina Faso
| | - Thomas Druetz
- Département de médecine sociale et préventive, École de santé publique de l’Université de Montréal, Montréal, Canada
- Centre de recherche en santé publique, Montréal, Canada
- Center for Applied Malaria Research and Evaluation, Department of Tropical Medicine, Tulane University, New Orleans, USA
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7
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Twabi HS, Manda SO, Small DS. Assessing the effects of maternal HIV infection on pregnancy outcomes using cross-sectional data in Malawi. BMC Public Health 2020; 20:974. [PMID: 32571265 PMCID: PMC7310115 DOI: 10.1186/s12889-020-09046-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have shown that maternal HIV infection is associated with adverse pregnancy outcomes such as low birth weight and perinatal mortality. However, the association is conflicted with the effect of antiretroviral therapy (ART) on the pregnancy outcomes and it remains unexamined. If the association is confirmed then it would guide policy makers towards more effective prevention of mother to child HIV transmission interventions. Using methods for matching possible confounders, the objectives of the study were to assess the effect of maternal HIV infection on birth weight and perinatal mortality and to investigate the effect of ART on these two pregnancy outcomes in HIV-infected women. METHODS Data on 4111 and 4759 children, born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys (MDHS) respectively, whose mothers had an HIV test result, were analysed. A best balancing method was chosen from a set of covariate balance methods namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting on the PS. HIV and ART data were only available in the MDHS 2010, permitting an assessment of the moderating effect of ART on the association between maternal HIV infection and birth weight and perinatal mortality. RESULTS The overall average birth weight was 3227.9g (95% CI: 3206.4, 3249.5) in 2010 and 3226.4g (95%: 3205.6, 3247.2) in 2015-16 and perinatal mortality was 3.8% (95%: 3.2, 4.3) in 2010 and 3.5% (95%: 2.8, 3.8) in 2015-16. The prevalence of HIV among the mothers was 11.1% (95%: 10.1, 12.0) and 9.2% (95% CI: 8.4, 10.1) in 2010 and 2015-16, respectively. In 2010, maternal HIV infection was negatively associated with birth weight (mean= -25.3g, 95% CI:(-95.5, -7.4)) and in 2015-16 it was positively associated with birth weight (mean= 116.3g, 95% CI:(27.8, 204.7)). Perinatal mortality was higher in infants of HIV-infected mothers compared to infants of HIV-uninfected mothers (OR = 1.5, 95% CI:(1.1 - 3.1)) in 2010, while there was no difference in the rate in 2015-16 (OR = 1.0, 95% CI:(0.4, 1.6)). ART was not associated with birth weight, however, it was associated with perinatal mortality (OR=3.9, 95% CI:(1.1, 14.8)). CONCLUSION The study has found that maternal HIV infection had an adverse effect on birth weight and perinatal mortality in 2010. Birth weight was not dependent on ART uptake but perinatal mortality was higher among infants of HIV-infected mothers who were not on ART. The higher birth weight among HIV-infected mothers and similarity in perinatal mortality with HIV-uninfected mothers in 2015-16 may be indicative of successes of interventions within the PMTCT program in Malawi.
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Affiliation(s)
- Halima S Twabi
- Department of Mathematical Sciences, University of Malawi, Zomba, Malawi.
| | - Samuel O Manda
- Biostatistics Research Unit, South Africa Medical Research Council, Pretoria, South Africa.,School of Mathematics, Statistics and Computer Science, University of Kwazulu-Natal, Pietermaritzburg, South Africa.,Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Dylan S Small
- Department of Statistics, University of Pennyslvania, Pennyslvania, USA
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Black R, Fontaine O, Lamberti L, Bhan M, Huicho L, El Arifeen S, Masanja H, Walker CF, Mengestu TK, Pearson L, Young M, Orobaton N, Chu Y, Jackson B, Bateman M, Walker N, Merson M. Drivers of the reduction in childhood diarrhea mortality 1980-2015 and interventions to eliminate preventable diarrhea deaths by 2030. J Glob Health 2019; 9:020801. [PMID: 31673345 PMCID: PMC6815873 DOI: 10.7189/jogh.09.020801] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Childhood diarrhea deaths have declined more than 80% from 1980 to 2015, in spite of an increase in the number of children in low- and middle-income countries (LMIC). Possible drivers of this remarkable accomplishment can guide the further reduction of the half million annual child deaths from diarrhea that still occur. METHODS We used the Lives Saved Tool, which models effects on mortality due to changes in coverage of preventive or therapeutic interventions or risk factors, for 50 LMIC to determine the proximal drivers of the diarrhea mortality reduction. RESULTS Diarrhea treatment (oral rehydration solution [ORS], zinc, antibiotics for dysentery and management of persistent diarrhea) and use of rotavirus vaccine accounted for 49.7% of the diarrhea mortality reduction from 1980 to 2015. Improvements in nutrition (stunting, wasting, breastfeeding practices, vitamin A) accounted for 38.8% and improvements in water, sanitation and handwashing for 11.5%. The contribution of ORS was greater from 1980 to 2000 (58.0% of the reduction) than from 2000 to 2015 (30.7%); coverage of ORS increased from zero in 1980 to 29.5% in 2000 and more slowly to 44.1% by 2015. To eliminate the remaining childhood diarrhea deaths globally, all these interventions will be needed. Scaling up diarrhea treatment and rotavirus vaccine, to 90% coverage could reduce global child diarrhea mortality by 74.1% from 2015 levels by 2030. Adding improved nutrition could increase that to 89.1%. Finally, adding increased use of improved water sources, sanitation and handwashing could result in a 92.8% reduction from the 2015 level. CONCLUSIONS Employing the interventions that have resulted in such a large reduction in diarrhea mortality in the last 35 years can virtually eliminate remaining childhood diarrhea deaths by 2030.
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Affiliation(s)
- Robert Black
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Olivier Fontaine
- World Health Organization, Department of Maternal, Newborn, Child and Adolescent Health Child and Adolescent Health and Development, Geneva, Switzerland
| | - Laura Lamberti
- Bill & Melinda Gates Foundation, Enteric Diarrheal Diseases, Seattle, Washington, USA
| | - Maharaj Bhan
- Indian Institute of Technology, New Delhi, India
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Lima, Peru
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Christa Fischer Walker
- US Centers for Disease Control and Prevention, Maternal and Child Health, Windhoek, Namibia
| | | | - Luwei Pearson
- United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Mark Young
- United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Nosa Orobaton
- Bill & Melinda Gates Foundation, Maternal, Newborn and Child Health, Seattle, Washington, USA
| | - Yue Chu
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Bianca Jackson
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA
| | - Massee Bateman
- US Agency for International Development (USAID), Jakarta, Indonesia
| | - Neff Walker
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Institute for International Programs, Baltimore, Maryland, USA (deceased)
| | - Michael Merson
- Duke University, Duke Global Health Institute, Durham, North Carolina, USA
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9
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Haley CA, Brault MA, Mwinga K, Desta T, Ngure K, Kennedy SB, Maimbolwa M, Moyo P, Vermund SH, Kipp AM. Promoting progress in child survival across four African countries: the role of strong health governance and leadership in maternal, neonatal and child health. Health Policy Plan 2019; 34:24-36. [PMID: 30698696 PMCID: PMC6479825 DOI: 10.1093/heapol/czy105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2018] [Indexed: 11/12/2022] Open
Abstract
Despite numerous international and national efforts, only 12 countries in the World Health Organization's African Region met the Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across sub-Saharan Africa, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia and Zambia were chosen to represent countries making substantial progress towards MDG#4, while Kenya and Zimbabwe represented countries making less progress. Our individual case studies suggested that strong health governance and leadership (HGL) was a significant driver of the greater success in Liberia and Zambia compared with Kenya and Zimbabwe. To elucidate specific components of national HGL that may have substantially influenced the pace of reductions in child mortality, we conducted a cross-country analysis of national policies and strategies pertaining to maternal, neonatal and child health (MNCH) and qualitative interviews with individuals working in MNCH in each of the four study countries. The three aspects of HGL identified in this study which most consistently contributed to the different progress towards MDG#4 among the four study countries were (1) establishing child survival as a top national priority backed by a comprehensive policy and strategy framework and sufficient human, financial and material resources; (2) bringing together donors, strategic partners, health and non-health stakeholders and beneficiaries to collaborate in strategic planning, decision-making, resource-allocation and coordination of services; and (3) maintaining accountability through a 'monitor-review-act' approach to improve MNCH. Although child mortality in sub-Saharan Africa remains high, this comparative study suggests key health leadership and governance factors that can facilitate reduction of child mortality and may prove useful in tackling current Sustainable Development Goals.
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Affiliation(s)
- Connie A Haley
- Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA
| | - Marie A Brault
- Department of Anthropology, University of Connecticut, 354 Mansfield Road, Storrs, CT, USA
| | - Kasonde Mwinga
- World Health Organization, Regional Office for Africa, Cite du Djoue, Brazzaville, Congo
| | - Teshome Desta
- World Health Organization, Inter-country Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Stephen B Kennedy
- University of Liberia-Pacific Institute for Research & Evaluation (UL-PIRE) Africa Center, University of Liberia, Monrovia, Liberia
| | | | - Precious Moyo
- Collaborative Research Program, University of Zimbabwe/University of California, San Francisco, Harare, Zimbabwe
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN, USA
| | - Aaron M Kipp
- Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA.,Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, USA
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Bhutta ZA, Victora C, Boerma T, Kruk ME, Patton G, Black MM, Sawyer S, Horton S, Black RE, Horton R. Optimising the continuum of child and adolescent health and development. Lancet 2019; 393:1080-1082. [PMID: 30878221 DOI: 10.1016/s0140-6736(19)30488-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; University of Toronto, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Cesar Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Ties Boerma
- University of Manitoba, Winnipeg, MB, Canada
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - George Patton
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Maureen M Black
- RTI International, Research Triangle Park, NC, USA; University of Maryland School of Medicine, Baltimore, MD, USA
| | - Susan Sawyer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital Melbourne, VIC, Australia
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Robert E Black
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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11
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Naimoli JF, Saxena S, Hatt LE, Yarrow KM, White TM, Ifafore-Calfee T. Health system strengthening: prospects and threats for its sustainability on the global health policy agenda. Health Policy Plan 2017; 33:85-98. [DOI: 10.1093/heapol/czx147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 11/15/2022] Open
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12
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Stegmuller AR, Self A, Litvin K, Roberton T. How is the Lives Saved Tool (LiST) used in the global health community? Results of a mixed-methods LiST user study. BMC Public Health 2017; 17:773. [PMID: 29143640 PMCID: PMC5688436 DOI: 10.1186/s12889-017-4750-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Lives Saved Tool (LiST) is a computer-based model that estimates the impact of scaling up key interventions to improve maternal, newborn and child health. Initially developed to inform the Lancet Child Survival Series of 2003, the functionality and scope of LiST have been expanded greatly over the past 10 years. This study sought to "take stock" of how LiST is now being used and for what purposes. METHODS We conducted a quantitative survey of LiST users, qualitative interviews with a smaller sample of LiST users and members of the LiST team at Johns Hopkins University, and a literature review of studies involving LiST analyses. RESULTS LiST is being used by donors, international organizations, governments, NGOs and academic institutions to assist program evaluation, inform strategic planning and evidenced-based decision-making, and advocate for high-impact interventions. Some organizations have integrated LiST into internal workflows and built in-house capacity for using LiST, while other organizations rely on the LiST team for support and to outsource analyses. In addition to being a popular stand-alone software, LiST is used as a calculation engine for other applications. CONCLUSIONS The Lives Saved Tool has been reported to be a useful model in maternal, newborn, and child health. With continued commitment, LiST should remain as a part of the international health toolkit used to assess maternal, newborn and child health programs.
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Affiliation(s)
- Angela R Stegmuller
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Andrew Self
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kate Litvin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy Roberton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Das S, Sahoo H. An Investigation into Factors Affecting Child Undernutrition in Madhya Pradesh. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/09720073.2011.11891201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sibabrata Das
- Department of Applied Geography, School of Regional Studies and Earth Sciences, Ravenshaw University , Cuttack 753 003, Odisha, India
| | - Harihar Sahoo
- Department of Sociology, Dr. Babasaheb Ambedkar Marathwada University , Aurangabad 431 004, Maharashtra, India
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14
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Ngwira A, Munthali ECS, Vwalika KD. Analysis on the Association Among Stunting, Wasting and Underweight in Malawi: An Application of a Log-Linear Model for the Three-Way Table. J Public Health Afr 2017; 8:620. [PMID: 28748062 PMCID: PMC5510209 DOI: 10.4081/jphia.2017.620] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/11/2016] [Accepted: 03/06/2017] [Indexed: 11/23/2022] Open
Abstract
Childhood undernutrition is an important public health problem. Many studies have investigated the factors of childhood undernutrition, but not the association between the undernutrition indicators. This study aimed at investigating the association between the childhood undernutrition indicators. A loglinear model of cell counts of a three way table of stunting, wasting, and underweight was fitted based on the 2010 Malawi demographic health survey data. Interaction terms in the model depicted deviations from independence. A multiple correspondence analysis of undernutrition indicators was also plotted to have a visual impression of association of the undernutrition variables. A loglinear model showed that underweight was associated with both stunting (P<0.001), and wasting (P<0.001). There was no association between stunting and wasting (P=1). Furthermore there was no three way association of stunting, wasting and underweight (P=1). Lack of three way interaction of stunting, wasting and underweight means that childhood undernutrition multidimensional nature is still valid, and no each indicator can represent the other.
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Affiliation(s)
- Alfred Ngwira
- Department of Basic Sciences, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Eddons C S Munthali
- Department of Basic Sciences, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Kondwani D Vwalika
- Department of Mathematical Science, Chancellor College, University of Malawi, Zomba, Malawi
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15
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Rodríguez DC, Shearer J, Mariano ARE, Juma PA, Dalglish SL, Bennett S. Evidence-informed policymaking in practice: country-level examples of use of evidence for iCCM policy. Health Policy Plan 2017; 30 Suppl 2:ii36-ii45. [PMID: 26516149 PMCID: PMC4625759 DOI: 10.1093/heapol/czv033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. As countries move to adopt iCCM, it becomes important to understand how this growing evidence base is viewed and used by national stakeholders. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and uses Carol Weiss’ models of research utilization to further explain the use of evidence in these contexts. A documentary review and in-depth stakeholder interviews were conducted as part of retrospective case studies in each study country. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organization and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. In terms of country-specific findings, Niger demonstrated both Interactive and Political models of research utilization by using iCCM to capitalize on the existing health infrastructure. Both Mozambique and Kenya exhibit Problem-Solving research utilization with different outcomes. Furthermore, the persistent quest for additional evidence suggests a Tactical use of research in Kenya. Results presented here indicate that while evidence from research studies and other contexts can be critical to policy development, local evidence is often needed to answer key policymaker questions. In the end, evidence may not be enough to overcome resistance if the policy is viewed as incompatible with national goals.
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Affiliation(s)
- Daniela C Rodríguez
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA,
| | - Jessica Shearer
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Alda R E Mariano
- Universidade Eduardo Mondlane, Community Health Department, Maputo, Mozambique and
| | - Pamela A Juma
- African Population and Health Research Center, Nairobi, Kenya
| | - Sarah L Dalglish
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Sara Bennett
- Johns Hopkins Bloomberg School of Public Health, Dept. of International Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
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16
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Rodríguez DC, Banda H, Namakhoma I. Integrated community case management in Malawi: an analysis of innovation and institutional characteristics for policy adoption. Health Policy Plan 2017; 30 Suppl 2:ii74-ii83. [PMID: 26516153 DOI: 10.1093/heapol/czv063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2007, Malawi became an early adopter of integrated community case management for childhood illnesses (iCCM), a policy aimed at community-level treatment for malaria, diarrhoea and pneumonia for children below 5 years. Through a retrospective case study, this article explores critical issues in implementation that arose during policy formulation through the lens of the innovation (i.e. iCCM) and of the institutions involved in the policy process. Data analysis is founded on a documentary review and 21 in-depth stakeholder interviews across institutions in Malawi. Findings indicate that the characteristics of iCCM made it a suitable policy to address persistent challenges in child mortality, namely that ill children were not interacting with health workers on a timely basis and consequently were dying in their communities. Further, iCCM was compatible with the Malawian health system due to the ability to build on an existing community health worker cadre of health surveillance assistants (HSAs) and previous experiences with treatment provision at the community level. In terms of institutions, the Ministry of Health (MoH) demonstrated leadership in the overall policy process despite early challenges of co-ordination within the MoH. WHO, United Nations Children's Fund (UNICEF) and implementing organizations played a supportive role in their position as knowledge brokers. Greater challenges were faced in the organizational capacity of the MoH. Regulatory issues around HSA training as well as concerns around supervision and overburdening of HSAs were discussed, though not fully addressed during policy development. Similarly, the financial sustainability of iCCM, including the mechanisms for channelling funding flows, also remains an unresolved issue. This analysis highlights the role of implementation questions during policy development. Despite several outstanding concerns, the compatibility between iCCM as a policy alternative and the local context laid the foundation for Malawi's road to early adoption of iCCM.
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Affiliation(s)
- Daniela C Rodríguez
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA and
| | - Hastings Banda
- Replace with Research on Equity and Community Health Trust, Lilongwe, Malawi
| | - Ireen Namakhoma
- Replace with Research on Equity and Community Health Trust, Lilongwe, Malawi
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17
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Victora C, Requejo J, Boerma T, Amouzou A, Bhutta ZA, Black RE, Chopra M. Countdown to 2030 for reproductive, maternal, newborn, child, and adolescent health and nutrition. LANCET GLOBAL HEALTH 2016; 4:e775-e776. [PMID: 27650656 DOI: 10.1016/s2214-109x(16)30204-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022]
Affiliation(s)
| | - Jennifer Requejo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Ties Boerma
- World Health Organization, Geneva, Switzerland
| | | | - Zulfiqar A Bhutta
- SickKids Center for Global Child Health, Toronto, ON, Canada; Aga Khan University, Karachi, Pakistan
| | - Robert E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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18
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Berman P, Requejo J, Bhutta ZA, Singh NS, Owen H, Lawn JE. Countries’ progress for women’s and children’s health in the Millennium Development Goal era: the Countdown to 2015 experience. BMC Public Health 2016. [PMCID: PMC5025817 DOI: 10.1186/s12889-016-3398-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Awasthi A, Pandey CM, Chauhan RK, Singh U. Disparity in maternal, newborn and child health services in high focus states in India: a district-level cross-sectional analysis. BMJ Open 2016; 6:e009885. [PMID: 27496225 PMCID: PMC4985800 DOI: 10.1136/bmjopen-2015-009885] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine the level and trend in the coverage gap of a set of interventions of maternal and child health services using a summary index and to assess the disparity in usage of maternal and child health services in the districts of high focus states of India. DESIGN Data for the present study are taken from the Annual Health Survey (AHS), 2010-2013 and Census of India, 2011. SETTINGS This study used secondary data from states having higher mortality and fertility rates, termed as high focus states in India. PARTICIPANTS District-level information regarding children aged 12-23 months and ever married women aged 15-49 years has been extracted from the AHS (2010-2013), and household amenities, female literacy and main workforce information has been obtained from the Census of India 2011. MEASURES 2 summary indexes were calculated first for maternal and child health services and another for socioeconomic and development status, using data from AHS and Census. Cronbach's α was used to assess the internal consistency of the items used in the index. RESULTS The result shows that the coverage gap is highest in Uttar Pradesh (37%) and lowest in Madhya Pradesh (21%). Converge gap and socioeconomic development are negatively correlated (r=-0.49, p=0.01). The average coverage gap was highest in the lowest quintile of socioeconomic development. There was an absolute change of 1.5% per year in coverage gap during 2009-2013. In regression analysis, the coefficient of determination was 0.24, β=-30.05, p=0.01 for a negative relationship between socioeconomic development and coverage gap. CONCLUSIONS There is a significant disparity in the usage of maternal and child healthcare services in the districts of India. Resource-rich people (urban residents and richest quintile) are way ahead of marginalised people (rural residents and poorest quintile) in the usage of healthcare services.
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Affiliation(s)
- Ashish Awasthi
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - C M Pandey
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajesh K Chauhan
- Population Research Center, University of Lucknow, Lucknow, Uttar Pradesh, India
| | - Uttam Singh
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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20
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McDougall L. Discourse, ideas and power in global health policy networks: political attention for maternal and child health in the millennium development goal era. Global Health 2016; 12:21. [PMID: 27193449 PMCID: PMC4872357 DOI: 10.1186/s12992-016-0157-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 04/29/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Maternal and child health issues have gained global political attention and resources in the past 10 years, due in part to their prominence on the Millennium Development Goal agenda and the use of evidence-based advocacy by policy networks. This paper identifies key factors for this achievement, and raises questions about prospective challenges for sustaining attention in the transition to the post-2015 Sustainable Development Goals, far broader in scope than the Millennium Development Goals. METHODS This paper relies on participant observation methods and document analysis to develop a case study of the behaviours of global maternal and child health advocacy networks during 2005-2015. RESULTS The development of coordinated networks of heterogeneous actors facilitated the rise in attention to maternal and child health during the past 10 years. The strategic use of epidemiological and economic evidence by these networks enabled policy attention and promoted network cohesion. The time-bound opportunity of reaching the 2015 Millennium Development Goals created a window of opportunity for joint action. As the new post-2015 goals emerge, networks seek to sustain attention by repositioning their framing of issues, network structures, and external alliances, including with networks that lay both inside and outside of the health domain. CONCLUSIONS Issues rise on global policy agendas because of how ideas are constructed, portrayed and positioned by actors within given contexts. Policy networks play a critical role by uniting stakeholders to promote persuasive ideas about policy problems and solutions. The behaviours of networks in issue-framing, member-alignment, and strategic outreach can force open windows of opportunity for political attention -- or prevent them from closing.
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Affiliation(s)
- Lori McDougall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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21
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Victora CG, Requejo JH, Barros AJD, Berman P, Bhutta Z, Boerma T, Chopra M, de Francisco A, Daelmans B, Hazel E, Lawn J, Maliqi B, Newby H, Bryce J. Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival. Lancet 2016; 387:2049-59. [PMID: 26477328 PMCID: PMC7613171 DOI: 10.1016/s0140-6736(15)00519-x] [Citation(s) in RCA: 277] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Conceived in 2003 and born in 2005 with the launch of its first report and country profiles, the Countdown to 2015 for Maternal, Newborn, and Child Survival has reached its originally proposed lifespan. Major reductions in the deaths of mothers and children have occurred since Countdown's inception, even though most of the 75 priority countries failed to achieve Millennium Development Goals 4 and 5. The coverage of life-saving interventions tracked in Countdown increased steadily over time, but wide inequalities persist between and within countries. Key drivers of coverage such as financing, human resources, commodities, and conducive health policies also showed important, yet insufficient increases. As a multistakeholder initiative of more than 40 academic, international, bilateral, and civil society institutions, Countdown was successful in monitoring progress and raising the visibility of the health of mothers, newborns, and children. Lessons learned from this initiative have direct bearing on monitoring progress during the Sustainable Development Goals era.
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Affiliation(s)
| | | | | | - Peter Berman
- Harvard School of Public Health, Boston, MA, USA
| | - Zulfiqar Bhutta
- Robert Harding Chair in Global Child Health and Policy, Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ties Boerma
- World Health Organization, Geneva, Switzerland
| | | | | | | | - Elizabeth Hazel
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joy Lawn
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Holly Newby
- United Nations Children's Fund, New York, NY, USA
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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22
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Kanyuka M, Ndawala J, Mleme T, Chisesa L, Makwemba M, Amouzou A, Borghi J, Daire J, Ferrabee R, Hazel E, Heidkamp R, Hill K, Martínez Álvarez M, Mgalula L, Munthali S, Nambiar B, Nsona H, Park L, Walker N, Daelmans B, Bryce J, Colbourn T. Malawi and Millennium Development Goal 4: a Countdown to 2015 country case study. LANCET GLOBAL HEALTH 2016; 4:e201-14. [PMID: 26805586 DOI: 10.1016/s2214-109x(15)00294-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/26/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Several years in advance of the 2015 endpoint for the Millennium Development Goals (MDGs), Malawi was already thought to be one of the few countries in sub-Saharan Africa likely to meet the MDG 4 target of reducing under-5 mortality by two-thirds between 1990 and 2015. Countdown to 2015 therefore selected the Malawi National Statistical Office to lead an in-depth country case study, aimed mainly at explaining the country's success in improving child survival. METHODS We estimated child and neonatal mortality for the years 2000-14 using five district-representative household surveys. The study included recalculation of coverage indicators for that period, and used the Lives Saved Tool (LiST) to attribute the child lives saved in the years from 2000 to 2013 to various interventions. We documented the adoption and implementation of policies and programmes affecting the health of women and children, and developed estimates of financing. FINDINGS The estimated mortality rate in children younger than 5 years declined substantially in the study period, from 247 deaths (90% CI 234-262) per 1000 livebirths in 1990 to 71 deaths (58-83) in 2013, with an annual rate of decline of 5·4%. The most rapid mortality decline occurred in the 1-59 months age group; neonatal mortality declined more slowly (from 50 to 23 deaths per 1000 livebirths), representing an annual rate of decline of 3·3%. Nearly half of the coverage indicators have increased by more than 20 percentage points between 2000 and 2014. Results from the LiST analysis show that about 280,000 children's lives were saved between 2000 and 2013, attributable to interventions including treatment for diarrhoea, pneumonia, and malaria (23%), insecticide-treated bednets (20%), vaccines (17%), reductions in wasting (11%) and stunting (9%), facility birth care (7%), and prevention and treatment of HIV (7%). The amount of funding allocated to the health sector has increased substantially, particularly to child health and HIV and from external sources, but remains below internationally agreed targets. Key policies to address the major causes of child mortality and deliver high-impact interventions at scale throughout Malawi began in the late 1990s and intensified in the latter half of the 2000s and into the 2010s, backed by health-sector-wide policies to improve women's and children's health. INTERPRETATION This case study confirmed that Malawi had achieved MDG 4 for child survival by 2013. Our findings suggest that this was achieved mainly through the scale-up of interventions that are effective against the major causes of child deaths (malaria, pneumonia, and diarrhoea), programmes to reduce child undernutrition and mother-to-child transmission of HIV, and some improvements in the quality of care provided around birth. The Government of Malawi was among the first in sub-Saharan Africa to adopt evidence-based policies and implement programmes at scale to prevent unnecessary child deaths. Much remains to be done, building on this success and extending it to higher proportions of the population and targeting continued high neonatal mortality rates. FUNDING Bill & Melinda Gates Foundation, WHO, The World Bank, Government of Australia, Government of Canada, Government of Norway, Government of Sweden, Government of the UK, and UNICEF.
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Affiliation(s)
| | | | - Tiope Mleme
- Malawi National Statistics Office, Zomba, Malawi
| | | | | | | | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rufus Ferrabee
- University College London, Institute for Global Health, London, UK; Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Elizabeth Hazel
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rebecca Heidkamp
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kenneth Hill
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melisa Martínez Álvarez
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Leslie Mgalula
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Spy Munthali
- Chancellor College, University of Malawi, Zomba, Malawi
| | - Bejoy Nambiar
- University College London, Institute for Global Health, London, UK
| | | | - Lois Park
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neff Walker
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tim Colbourn
- University College London, Institute for Global Health, London, UK.
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Kipp AM, Blevins M, Haley CA, Mwinga K, Habimana P, Shepherd BE, Aliyu MH, Ketsela T, Vermund SH. Factors associated with declining under-five mortality rates from 2000 to 2013: an ecological analysis of 46 African countries. BMJ Open 2016; 6:e007675. [PMID: 26747029 PMCID: PMC4716228 DOI: 10.1136/bmjopen-2015-007675] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Inadequate overall progress has been made towards the 4th Millennium Development Goal of reducing under-five mortality rates by two-thirds between 1990 and 2015. Progress has been variable across African countries. We examined health, economic and social factors potentially associated with reductions in under-five mortality (U5M) from 2000 to 2013. SETTING Ecological analysis using publicly available data from the 46 nations within the WHO African Region. OUTCOME MEASURES We assessed the annual rate of change (ARC) of 70 different factors and their association with the annual rate of reduction (ARR) of U5M rates using robust linear regression models. RESULTS Most factors improved over the study period for most countries, with the largest increases seen for economic or technological development and external financing factors. The median (IQR) U5M ARR was 3.6% (2.8 to 5.1%). Only 4 of 70 factors demonstrated a strong and significant association with U5M ARRs, adjusting for potential confounders. Higher ARRs were associated with more rapidly increasing coverage of seeking treatment for acute respiratory infection (β=0.22 (ie, a 1% increase in the ARC was associated with a 0.22% increase in ARR); 90% CI 0.09 to 0.35; p=0.01), increasing health expenditure relative to gross domestic product (β=0.26; 95% CI 0.11 to 0.41; p=0.02), increasing fertility rate (β=0.54; 95% CI 0.07 to 1.02; p=0.07) and decreasing maternal mortality ratio (β=-0.47; 95% CI -0.69 to -0.24; p<0.01). The majority of factors showed no association or raised validity concerns due to missing data from a large number of countries. CONCLUSIONS Improvements in sociodemographic, maternal health and governance and financing factors were more likely associated with U5M ARR. These underscore the essential role of contextual factors facilitating child health interventions and services. Surveillance of these factors could help monitor which countries need additional support in reducing U5M.
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Affiliation(s)
- Aaron M Kipp
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Meridith Blevins
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Connie A Haley
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kasonde Mwinga
- World Health Organization/Regional Office for Africa, Brazzaville, Congo
| | - Phanuel Habimana
- World Health Organization/Regional Office for Africa, Brazzaville, Congo
| | - Bryan E Shepherd
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Tigest Ketsela
- World Health Organization/Regional Office for Africa, Brazzaville, Congo
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Nashville, Tennessee, USA
- Pediatrics Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Quantifying the impact of accessibility on preventive healthcare in sub-Saharan Africa using mobile phone data. Epidemiology 2015; 26:223-8. [PMID: 25643101 PMCID: PMC4323566 DOI: 10.1097/ede.0000000000000239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor physical access to health facilities has been identified as an important contributor to reduced uptake of preventive health services and is likely to be most critical in low-income settings. However, the relation among physical access, travel behavior, and the uptake of healthcare is difficult to quantify. METHODS Using anonymized mobile phone data from 2008 to 2009, we analyze individual and spatially aggregated travel patterns of 14,816,521 subscribers across Kenya and compare these measures to (1) estimated travel times to health facilities and (2) data on the uptake of 2 preventive healthcare interventions in an area of western Kenya: childhood immunizations and antenatal care. RESULTS We document that long travel times to health facilities are strongly correlated with increased mobility in geographically isolated areas. Furthermore, we found that in areas with equal physical access to healthcare, mobile phone-derived measures of mobility predict which regions are lacking preventive care. CONCLUSIONS Routinely collected mobile phone data provide a simple and low-cost approach to mapping the uptake of preventive healthcare in low-income settings.
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Guanais FC. The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998-2010. Am J Public Health 2015; 105 Suppl 4:S593-9, S585-92. [PMID: 26313048 PMCID: PMC4561609 DOI: 10.2105/ajph.2013.301452r] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES I examined the combined effects of access to primary care through the Family Health Program (FHP) and conditional cash transfers from the Bolsa Familia Program (BFP) on postneonatal infant mortality (PNIM) in Brazil. METHODS I employed longitudinal ecological analysis using panel data from 4583 Brazilian municipalities from 1998 to 2010, totaling 54 253 observations. I estimated fixed-effects ordinary least squares regressions models with PNIM rate as the dependent variable and FHP, BFP, and their interactions as the main independent variables of interest. RESULTS The association of higher FHP coverage with lower PNIM became stronger as BFP coverage increased. At the means of all other variables, when BFP coverage was 25%, predicted PNIM was 5.24 (95% confidence interval [CI] = 4.95, 5.53) for FHP coverage = 0% and 3.54 (95% CI = 2.77, 4.31) for FHP coverage = 100%. When BFP coverage was 60%, predicted PNIM was 4.65 (95% CI = 4.36, 4.94) when FHP coverage = 0% and 1.38 (95% CI = 0.88, 1.89) when FHP coverage = 100%. CONCLUSIONS The effect of the FHP depends on the expansion of the BFP. For impoverished, underserved populations, combining supply- and demand-side interventions may be necessary to improve health outcomes.
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Affiliation(s)
- Frederico C Guanais
- Frederico C. Guanais is with the Social Protection and Health Division, Inter-American Development Bank, Washington, DC
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Guanais FC. Efectos combinados de la ampliación de la atención primaria de salud y de las transferencias condicionadas de dinero en efectivo sobre la mortalidad infantil en Brasil, 1998–2010. Am J Public Health 2015. [DOI: 10.2105/ajph.2013.301452s] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objetivos. Examiné los efectos combinados del acceso a la atención primaria mediante el Programa de Salud Familiar (PSF) y las transferencias condicionadas de dinero en efectivo del Programa Bolsa Familia (PBF) sobre la mortalidad infantil posneonatal (MIPN) en Brasil. Métodos. Empleé un análisis ecológico longitudinal usando datos en panel de 4 583 municipios brasileños de 1998 al 2010, con 54 253 observaciones en total. Estimé modelos de regresión de efectos fijos por mínimos cuadrados ordinarios, con la tasa de MIPN como la variable dependiente y el PSF, el PBF y sus interacciones como las principales variables independientes de interés. Resultados. La asociación de una mayor cobertura del PSF con una menor tasa de MIPN se volvió más fuerte conforme aumentaba la cobertura del PBF. En los promedios de todas las demás variables, cuando la cobertura de PBF era 25%, la MIPN predicha fue 5,24 (intervalo de confianza [IC] de 95% = 4,95, 5,53) para una cobertura del PSF de 0%, y de 3,54 (IC de 95% = 2,77, 4,31) para una cobertura del PSF de 100%. Cuando la cobertura del PBF era de 60%, la MIPN predicha fue 4,65 (IC de 95% = 4,36, 4,94) para una cobertura del PSF de 0%, y de 1,38 (IC de 95% = 0,88, 1,89) para una cobertura del PSF de 100%. Conclusiones. El efecto del PSF depende de la ampliación del PBF. Para las poblaciones empobrecidas y subatendidas, la combinación de intervenciones tanto del lado de la oferta como del lado de la demanda podría ser necesaria para mejorar los resultados en salud.
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Affiliation(s)
- Frederico C. Guanais
- Frederico C. Guanais, PhD, División de Protección Social y Salud, Banco In-teramericano de Desarrollo, Washington, D.C., Estados Unidos de América. La correspondencia deberá enviarse a
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New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH): A Controlled Non-Inferiority Study on Clinical Outcome and Antibiotic Use in Tanzania. PLoS One 2015; 10:e0132316. [PMID: 26161535 PMCID: PMC4498627 DOI: 10.1371/journal.pone.0132316] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 02/24/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction The decline of malaria and scale-up of rapid diagnostic tests calls for a revision of IMCI. A new algorithm (ALMANACH) running on mobile technology was developed based on the latest evidence. The objective was to ensure that ALMANACH was safe, while keeping a low rate of antibiotic prescription. Methods Consecutive children aged 2–59 months with acute illness were managed using ALMANACH (2 intervention facilities), or standard practice (2 control facilities) in Tanzania. Primary outcomes were proportion of children cured at day 7 and who received antibiotics on day 0. Results 130/842 (15∙4%) in ALMANACH and 241/623 (38∙7%) in control arm were diagnosed with an infection in need for antibiotic, while 3∙8% and 9∙6% had malaria. 815/838 (97∙3%;96∙1–98.4%) were cured at D7 using ALMANACH versus 573/623 (92∙0%;89∙8–94∙1%) using standard practice (p<0∙001). Of 23 children not cured at D7 using ALMANACH, 44% had skin problems, 30% pneumonia, 26% upper respiratory infection and 13% likely viral infection at D0. Secondary hospitalization occurred for one child using ALMANACH and one who eventually died using standard practice. At D0, antibiotics were prescribed to 15∙4% (12∙9–17∙9%) using ALMANACH versus 84∙3% (81∙4–87∙1%) using standard practice (p<0∙001). 2∙3% (1∙3–3.3) versus 3∙2% (1∙8–4∙6%) received an antibiotic secondarily. Conclusion Management of children using ALMANACH improve clinical outcome and reduce antibiotic prescription by 80%. This was achieved through more accurate diagnoses and hence better identification of children in need of antibiotic treatment or not. The building on mobile technology allows easy access and rapid update of the decision chart. Trial Registration Pan African Clinical Trials Registry PACTR201011000262218
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Sobrino Toro M, Riaño Galan I, Bassat Q, Perez-Lescure Picarzo J, de Aranzabal Agudo M, Krauel Vidal X, Rivera Cuello M. Child health and international cooperation: A paediatric approach. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ordóñez JE, Orozco JJ. Cost-effectiveness analysis of the available pneumococcal conjugated vaccines for children under five years in Colombia. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2015; 13:6. [PMID: 25878563 PMCID: PMC4397735 DOI: 10.1186/s12962-015-0032-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 03/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Pneumococcal diseases in children under five years are common and preventable. In Colombia there are two pneumococcal conjugate vaccines (PCV) that have proved clinical efficacy. The aim was to estimate the cost-effectiveness of 13-valent PCV (PCV13) and 10-valent PCV (PCV10) in terms of prevention of Invasive Pneumococcal Diseases (IPD), radiologically-confirmed pneumonia, and their related mortality, as well as, acute otitis media (AOM) in a cohort of newborns in Colombia. Methods We developed an analytical decision tree model with national data including the distribution of pneumococcal serotypes in Colombia between 2009 and 2013. A simulation of vaccination of 90% of newborns in Colombia took place with a time horizon of 5 years. The analysis was done from the Colombian health system perspective. Vaccines efficacy parameters were measured as life-years gained (LYG) and avoided morbidity by pneumococcal diseases; they were determined by a systematic review of literature. A health insurance company provided the costs. A probabilistic and a univariate sensitivity analysis for epidemiological, efficacy and cost parameters were done. Results After 5 years projection, PCV13 would prevent 437 deaths due to pneumococcal infections versus 321 that would be prevented by PCV10, compared to no vaccination. PCV13 would generate 25 396 LYG, and PCV10 would generate 18 708 LYG. Medical costs avoided would be US$ 19 479 395 for PCV13 and US$ 13 703 271 for PCV10. Compared to no vaccination, PCV13 and PCV10 were cost-effective, with an incremental cost-effectiveness ratio (ICER) of US$ 489.26 and US$ 813.41 per additional LYG, respectively; besides, PCV13 was dominant over PCV10 due to lower costs and better outcomes. Conclusion PCV13 is a cost-saving strategy compared with PCV10, as part of a universal coverage vaccination program in Colombian children under one year. PCV13 is expected to lead to a greater decrement in infant mortality from pneumococcal diseases, and a higher cost saving by preventing more pneumococcal diseases compared with PCV10 in a 5 years projection.
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Affiliation(s)
- Jaime E Ordóñez
- HEMO Group Carrera 25A N° 1A Sur-45, piso 5.Torre Médica El Tesoro Medellín, Medellín, Colombia
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Katepa-Bwalya M, Mukonka V, Kankasa C, Masaninga F, Babaniyi O, Siziya S. Infants and young children feeding practices and nutritional status in two districts of Zambia. Int Breastfeed J 2015; 10:5. [PMID: 25750656 PMCID: PMC4351847 DOI: 10.1186/s13006-015-0033-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 01/25/2015] [Indexed: 11/23/2022] Open
Abstract
Background Appropriate feeding is important in improving nutrition and child survival. Documentation of knowledge of caregiver on infant feeding is scanty in Zambia. The aim of this study was to describe feeding practices and nutritional status among infants and young children (IYC) in two districts in Zambia: Kafue and Mazabuka. Methods A cross-sectional study was conducted between January and March 2006 using both quantitative and qualitative methods. A questionnaire was administered to caregiver of children aged under24 months. Lengths and weights of all children were measured. Focused group discussions were conducted in selected communities to assess parents or guardian knowledge, attitude and practice related to infant feeding. Results A total of 634 caregivers (361 from Kafue and 273 from Mazabuka) participated in the study. About 311/618 (54.0%) of the caregiver knew the definition and recommended duration of exclusive breastfeeding (EBF) and when to introduce complementary feeds. Two hundred and fifty-one (81.2%) out of 310 respondents had acquired this knowledge from the health workers. Only 145/481 (30.1%) of the respondents practiced exclusive breastfeeding up to six months with 56/626 (8.9%) of the mothers giving prelacteal feeds. Although 596/629 (94.8%) of the respondents reported that the child does not need anything other than breast milk in the first three days of life, only 318/630 (50.5%) of them considered colostrum to be good. Complementary feeds were introduced early before six months of age and were usually not of adequate quality and quantity. Three hundred and ninety-one (64%) out of 603 caregivers knew that there would be no harm to the child if exclusively breastfed up to six months. Most of the children’s nutritional status was normal with 25/594 (4.2%) severely stunted, 10/596 (1.7%) severely underweight and 3/594 (0.5%) severely wasted. Conclusions The caregiver in the communities knew about the recommended feeding practices, but this knowledge did not translate into good practice. Knowing that most of the mothers will breastfeed and have heard about appropriate breastfeeding, is important in the development of sustainable strategies required to improve feeding practices and, thus, nutritional status of children.
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Affiliation(s)
| | - Victor Mukonka
- Public Health Unit, Clinical Sciences Department, School of Medicine, Copperbelt University, Ndola, Zambia
| | - Chipepo Kankasa
- Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
| | | | | | - Seter Siziya
- Public Health Unit, Clinical Sciences Department, School of Medicine, Copperbelt University, Ndola, Zambia
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Requejo JH, Bryce J, Barros AJD, Berman P, Bhutta Z, Chopra M, Daelmans B, de Francisco A, Lawn J, Maliqi B, Mason E, Newby H, Presern C, Starrs A, Victora CG. Countdown to 2015 and beyond: fulfilling the health agenda for women and children. Lancet 2015; 385:466-76. [PMID: 24990815 PMCID: PMC7613194 DOI: 10.1016/s0140-6736(14)60925-9] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The end of 2015 will signal the end of the Millennium Development Goal era, when the world can take stock of what has been achieved. The Countdown to 2015 for Maternal, Newborn, and Child Survival (Countdown) has focused its 2014 report on how much has been achieved in intervention coverage in these groups, and on how best to sustain, focus, and intensify efforts to progress for this and future generations. Our 2014 results show unfinished business in achievement of high, sustained, and equitable coverage of essential interventions. Progress has accelerated in the past decade in most Countdown countries, suggesting that further gains are possible with intensified actions. Some of the greatest coverage gaps are in family planning, interventions addressing newborn mortality, and case management of childhood diseases. Although inequities are pervasive, country successes in reaching of the poorest populations provide lessons for other countries to follow. As we transition to the next set of global goals, we must remember the centrality of data to accountability, and the importance of support of country capacity to collect and use high-quality data on intervention coverage and inequities for decision making. To fulfill the health agenda for women and children both now and beyond 2015 requires continued monitoring of country and global progress; Countdown is committed to playing its part in this effort.
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Affiliation(s)
- Jennifer Harris Requejo
- Partnership for Maternal, Newborn and Child Health, World Health Organization, 1211 Geneva 27, Switzerland.
| | - Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Peter Berman
- Harvard School of Public Health, Boston, MA, USA
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi 74800, Pakistan
| | | | - Bernadette Daelmans
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Andres de Francisco
- Partnership for Maternal, Newborn and Child Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Joy Lawn
- London School of Hygiene and Tropical Medicine, London, UK
| | - Blerta Maliqi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Elizabeth Mason
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Holly Newby
- United Nations Children's Fund, New York, NY, USA
| | - Carole Presern
- Partnership for Maternal, Newborn and Child Health, World Health Organization, 1211 Geneva 27, Switzerland
| | - Ann Starrs
- Family Care International, New York, NY, USA
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Sobrino Toro M, Riaño Galan I, Bassat Q, Perez-Lescure Picarzo J, de Aranzabal Agudo M, Krauel Vidal X, Rivera Cuello M. [Child health and international cooperation: A paediatric approach]. An Pediatr (Barc) 2014; 82:367.e1-6. [PMID: 25529375 DOI: 10.1016/j.anpedi.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/08/2014] [Indexed: 12/01/2022] Open
Abstract
The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters.
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Affiliation(s)
- M Sobrino Toro
- Área de Pediatría, Departamento de Farmacología, Pediatría y Radiología, Facultad de Medicina, Universidad de Sevilla, Sevilla, España.
| | - I Riaño Galan
- Servicio de Pediatría, Hospital San Agustín, Avilés, Asturias, España
| | - Q Bassat
- Centre for International Health Research Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | | | | | | | - M Rivera Cuello
- Unidad de Gestión Clínica del Área Sanitaria Este Málaga, Servicio Andaluz de Salud, Málaga, España
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Ahmad S, Seebacher W, Wolkinger V, Presser A, Faist J, Kaiser M, Brun R, Saf R, Weis R. Synthesis and antiprotozoal activities of new 3-azabicyclo[3.2.2]nonanes. Arch Pharm Res 2014; 38:1455-67. [PMID: 25433423 DOI: 10.1007/s12272-014-0523-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/24/2014] [Indexed: 11/30/2022]
Abstract
Some antimalarial agents in use typically bear basic side chains as ligands. Such ligands were attached to the amino substituent of a bridgehead atom of already antiprotozoal active 3-azabicyclo[3.2.2]nonanes. Structure verification was done by NMR measurements. The new compounds were tested for their antiplasmodial and antitrypanosomal activities against Plasmodium falciparum K 1 (multiresistant) and Trypanosoma brucei rhodesiense as well as for their cytotoxicity against L6 cells. Their activities are compared to those of already prepared compounds and structure-activity relationships are discussed.
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Affiliation(s)
- Sarfraz Ahmad
- Center for Research in Molecular Medicine, The University of Lahore, Lahore, Pakistan
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Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, Apfel H, Iannarone M, Phillips B, Lofgren KT, Sandar L, Dorrington RE, Rakovac I, Jacobs TA, Liang X, Zhou M, Zhu J, Yang G, Wang Y, Liu S, Li Y, Ozgoren AA, Abera SF, Abubakar I, Achoki T, Adelekan A, Ademi Z, Alemu ZA, Allen PJ, AlMazroa MA, Alvarez E, Amankwaa AA, Amare AT, Ammar W, Anwari P, Cunningham SA, Asad MM, Assadi R, Banerjee A, Basu S, Bedi N, Bekele T, Bell ML, Bhutta Z, Blore JD, Basara BB, Boufous S, Breitborde N, Bruce NG, Bui LN, Carapetis JR, Cárdenas R, Carpenter DO, Caso V, Castro RE, Catalá-Lopéz F, Cavlin A, Che X, Chiang PPC, Chowdhury R, Christophi CA, Chuang TW, Cirillo M, da Costa Leite I, Courville KJ, Dandona L, Dandona R, Davis A, Dayama A, Deribe K, Dharmaratne SD, Dherani MK, Dilmen U, Ding EL, Edmond KM, Ermakov SP, Farzadfar F, Fereshtehnejad SM, Fijabi DO, Foigt N, Forouzanfar MH, Garcia AC, Geleijnse JM, Gessner BD, Goginashvili K, Gona P, Goto A, Gouda HN, Green MA, Greenwell KF, Gugnani HC, Gupta R, Hamadeh RR, Hammami M, Harb HL, Hay S, Hedayati MT, Hosgood HD, Hoy DG, Idrisov BT, Islami F, Ismayilova S, Jha V, Jiang G, Jonas JB, Juel K, Kabagambe EK, Kazi DS, Kengne AP, Kereselidze M, Khader YS, Khalifa SEAH, Khang YH, Kim D, Kinfu Y, Kinge JM, Kokubo Y, Kosen S, Defo BK, Kumar GA, Kumar K, Kumar RB, Lai T, Lan Q, Larsson A, Lee JT, Leinsalu M, Lim SS, Lipshultz SE, Logroscino G, Lotufo PA, Lunevicius R, Lyons RA, Ma S, Mahdi AA, Marzan MB, Mashal MT, Mazorodze TT, McGrath JJ, Memish ZA, Mendoza W, Mensah GA, Meretoja A, Miller TR, Mills EJ, Mohammad KA, Mokdad AH, Monasta L, Montico M, Moore AR, Moschandreas J, Msemburi WT, Mueller UO, Muszynska MM, Naghavi M, Naidoo KS, Narayan KMV, Nejjari C, Ng M, de Dieu Ngirabega J, Nieuwenhuijsen MJ, Nyakarahuka L, Ohkubo T, Omer SB, Caicedo AJP, Pillay-van Wyk V, Pope D, Pourmalek F, Prabhakaran D, Rahman SUR, Rana SM, Reilly RQ, Rojas-Rueda D, Ronfani L, Rushton L, Saeedi MY, Salomon JA, Sampson U, Santos IS, Sawhney M, Schmidt JC, Shakh-Nazarova M, She J, Sheikhbahaei S, Shibuya K, Shin HH, Shishani K, Shiue I, Sigfusdottir ID, Singh JA, Skirbekk V, Sliwa K, Soshnikov SS, Sposato LA, Stathopoulou VK, Stroumpoulis K, Tabb KM, Talongwa RT, Teixeira CM, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Toyoshima H, Dimbuene ZT, Uwaliraye P, Uzun SB, Vasankari TJ, Vasconcelos AMN, Vlassov VV, Vollset SE, Waller S, Wan X, Weichenthal S, Weiderpass E, Weintraub RG, Westerman R, Wilkinson JD, Williams HC, Yang YC, Yentur GK, Yip P, Yonemoto N, Younis M, Yu C, Jin KY, El Sayed Zaki M, Zhu S, Vos T, Lopez AD, Murray CJL. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384:957-79. [PMID: 24797572 PMCID: PMC4165626 DOI: 10.1016/s0140-6736(14)60497-9] [Citation(s) in RCA: 512] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. METHODS We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. FINDINGS We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. INTERPRETATION Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. FUNDING Bill & Melinda Gates Foundation, US Agency for International Development.
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Affiliation(s)
- Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Chelsea A Liddell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Matthew M Coates
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Meghan D Mooney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Carly E Levitz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Austin E Schumacher
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Henry Apfel
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marissa Iannarone
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Bryan Phillips
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Katherine T Lofgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Logan Sandar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Ivo Rakovac
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - Troy A Jacobs
- MCH Division, USAID - Global Health Bureau, HIDN, Washington, DC, USA
| | - Xiaofeng Liang
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jun Zhu
- National Office for Maternal and Child's Health Surveillance, Chengdu, China
| | - Gonghuan Yang
- Peking Union Medical College, Beijing, China; Peking Union Medical College, Beijing, China
| | - Yanping Wang
- National Office for Maternal and Child's Health Surveillance, Chengdu, China
| | - Shiwei Liu
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yichong Li
- National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | | | | | - Tom Achoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Ministry of Health, Gaborone, Botswana
| | | | | | | | | | | | | | | | - Azmeraw T Amare
- Department of Epidemiology, University of Groningen, Groningen, Netherlands
| | | | | | | | | | - Reza Assadi
- Mashhad University of Medical Sciences, Mashhad, Khorasan, Iran
| | - Amitava Banerjee
- University of Birmingham, Birmingham, West Midlands, United Kingdom
| | | | - Neeraj Bedi
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
| | | | | | | | - Jed D Blore
- University of Melbourne, Melbourne, VIC, Australia
| | - Berrak Bora Basara
- Ministry of Health, General Directorate of Health Research, Ankara, Turkey
| | - Soufiane Boufous
- Transport and Road Safety (TARS) Research, University of New South Wales, Sydney, NSW, Australia
| | | | | | | | | | | | | | - Valeria Caso
- Stroke Unit, University of Perugia, Perugia, Italy
| | | | - Ferrán Catalá-Lopéz
- Division of Pharmacology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Ministry of Health, Madrid, Spain
| | - Alanur Cavlin
- Hacettepe University Institute of Population Studies, Ankara, Turkey
| | - Xuan Che
- National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | | | | | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India
| | | | | | | | | | | | | | - Uğur Dilmen
- Ministry of Health, General Directorate of Health Research, Ankara, Turkey
| | - Eric L Ding
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | | | - Sergei Petrovich Ermakov
- The Institute of Social and Economic Studies of Population at the Russian Academy of Sciences, Moscow, Russia
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrine and Metabolic Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Nataliya Foigt
- Institute of Gerontology, Academy of Medical Sciences, Kyiv, Ukraine
| | | | - Ana C Garcia
- Public Health Unit of Primary Health Care Group of Almada-Seixal (region of Lisbon), Almada, Portugal
| | - Johanna M Geleijnse
- Wageningen University, Division of Human Nutrition, Wageningen, the Netherlands
| | | | | | - Philimon Gona
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Atsushi Goto
- Department of Diabetes Research, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hebe N Gouda
- University of Queensland, Brisbane, QLD, Australia
| | - Mark A Green
- University of Sheffield, Sheffield, South York, United Kingdom
| | | | | | - Rahul Gupta
- Kanawha Charleston Health Department, Charleston, WV, USA
| | | | - Mouhanad Hammami
- Wayne County Department of Health and Human Services, Detroit, MI, USA
| | | | - Simon Hay
- University of Oxford, Oxford, United Kingdom
| | | | | | - Damian G Hoy
- School of Population Health, Brisbane, QLD, Australia; Public Health Division, Secretariat of the Pacific Community, Noumea, New Caledonia
| | | | | | | | - Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Guohong Jiang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Mannheim, Germany
| | - Knud Juel
- The National Institute of Public Health, Copenhagen, Denmark
| | | | - Dhruv S Kazi
- University of California San Francisco, San Francisco, CA, USA
| | - Andre Pascal Kengne
- South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Maia Kereselidze
- National Centre for Diseases Control and Public Health, Tbilisi, Georgia
| | | | | | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Daniel Kim
- Northeastern University, Boston, MA, USA
| | | | - Jonas M Kinge
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Soewarta Kosen
- Center for Community Empowerment, Health Policy & Humanities, NIHRD, Jakarta, Indonesia
| | | | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | | | - Ravi B Kumar
- Public Health Foundation of India, New Delhi, India
| | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | - Qing Lan
- National Cancer Institute, Bethesda, MD, USA
| | | | | | - Mall Leinsalu
- The National Institute for Health Development, Tallinn, Estonia
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Stefan Ma
- Ministry of Health Singapore, Singapore
| | - Abbas Ali Mahdi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | | | | | | | - Ziad A Memish
- Saudi Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | | | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | | | - Ted R Miller
- Pacific Institute for Research & Evaluation, Calverton, MD, USA
| | | | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lorenzo Monasta
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | - Marcella Montico
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | | | | | - William T Msemburi
- South African Medical Research Council, Cape Town, Western Cape, South Africa
| | | | | | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kovin S Naidoo
- University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | | | - Chakib Nejjari
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, University sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Marie Ng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | | | | | - Dan Pope
- University of Liverpool, Merseyside, United Kingdom
| | | | | | | | - Saleem M Rana
- Department of Public Health, University of the Punjab, Lahore, Punjab, Pakistan
| | | | - David Rojas-Rueda
- Centre of Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Luca Ronfani
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo," Trieste, Italy
| | | | | | - Joshua A Salomon
- Harvard School of Public Health, Harvard University, Boston, MA, USA
| | | | | | | | | | | | - Jun She
- Zhongshan Hospital, Fudan, University, Shanghai, China
| | - Sara Sheikhbahaei
- Non-Communicable Diseases Research Center, Endocrine and Metabolic Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Ivy Shiue
- Heriot-Watt University, Edinburgh, Scotland, United Kingdom
| | | | | | | | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Sergey S Soshnikov
- Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow, Russia
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | | | - Konstantinos Stroumpoulis
- KEELPNO (Center for Disease Control, Greece, dispatched to "Alexandra" General Hospital of Athens), Athens, Greece
| | | | | | | | - Abdullah Sulieman Terkawi
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | | | - Hideaki Toyoshima
- Health Care Center of Anjo Kosei Hospital, Anjo City, Aichi Prefecture, Japan
| | - Zacharie Tsala Dimbuene
- Department of Population Sciences and Development, Faculty of Economics and Management, University of Kinshasa, Kinshasa, Democratic Republic of the Congo, Rwanda, Kigali City, Rwanda
| | | | - Selen Begüm Uzun
- Ministry of Health, General Directorate of Health Research, Ankara, Turkey
| | | | | | | | | | - Stephen Waller
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | | | | | - Robert G Weintraub
- University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | | | | | | | - Yang C Yang
- University of North Carolina at Chapel Hill, Chapel Hill, NC. USA
| | | | - Paul Yip
- The University of Hong Kong, Hong Kong
| | - Naohiro Yonemoto
- National Center of Neurology and Psychiatry, Kodira, Tokyo, Japan
| | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, and Global Health Institute, Wuhan University, Wuhan, Hubei, China
| | - Kim Yun Jin
- TCM MEDICAL TK SDN BHD, Nusajaya, Johor Bahru, Malaysia
| | | | - Shankuan Zhu
- Zhejiang University School of Public Health, Hangzhou, Zhejiang, China
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- University of Melbourne, Melbourne, VIC, Australia
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Abstract
Nearly a decade ago, The Lancet published the Neonatal Survival Series, with an ambitious call for integration of newborn care across the continuum of reproductive, maternal, newborn, and child health and nutrition (RMNCH). In this first of five papers in the Every Newborn Series, we consider what has changed during this decade, assessing progress on the basis of a systematic policy heuristic including agenda-setting, policy formulation and adoption, leadership and partnership, implementation, and evaluation of effect. Substantial progress has been made in agenda setting and policy formulation for newborn health, as witnessed by the shift from maternal and child health to maternal, newborn, and child health as a standard. However, investment and large-scale implementation have been disappointingly small, especially in view of the size of the burden and potential for rapid change and synergies throughout the RMNCH continuum. Moreover, stillbirths remain invisible on the global health agenda. Hence that progress in improvement of newborn survival and reduction of stillbirths lags behind that of maternal mortality and deaths for children aged 1-59 months is not surprising. Faster progress is possible, but with several requirements: clear communication of the interventions with the greatest effect and how to overcome bottlenecks for scale-up; national leadership, and technical capacity to integrate and implement these interventions; global coordination of partners, especially within countries, in provision of technical assistance and increased funding; increased domestic investment in newborn health, and access to specific commodities and equipment where needed; better data to monitor progress, with local data used for programme improvement; and accountability for results at all levels, including demand from communities and mortality targets in the post-2015 framework. Who will step up during the next decade to ensure decision making in countries leads to implementation of stillbirth and newborn health interventions within RMNCH programmes?
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Affiliation(s)
- Gary L Darmstadt
- Global Development Division, Bill & Melinda Gates Foundation, Seattle, WA, USA.
| | - Mary V Kinney
- Saving Newborn Lives/Save the Children, Cape Town, South Africa
| | | | - Simon Cousens
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Maternal Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lily Kak
- United States Agency for International Development, Washington, DC, USA
| | - Vinod K Paul
- All India Institute of Medical Sciences, New Delhi, India
| | - Jose Martines
- Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland; Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Joy E Lawn
- Saving Newborn Lives/Save the Children, Cape Town, South Africa; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Maternal Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, UK; Research and Evidence Division, Department for International Development, London, UK
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Requejo J, Victora C, Bryce J. Data resource profile: countdown to 2015: maternal, newborn and child survival. Int J Epidemiol 2014; 43:586-96. [PMID: 24639449 PMCID: PMC3997378 DOI: 10.1093/ije/dyu034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Countdown to 2015 country profiles present, in one place, comprehensive evidence to enable an assessment of a country’s progress in improving reproductive, maternal, newborn and child health. Profiles are available for each of the 75 countries that together account for more than 95% of all maternal and child deaths. The two-page profiles are updated approximately every 2 years with new data and analyses. Profile data include demographics, mortality, nutritional status, coverage of evidence-based interventions, within-countries inequalities in coverage, measures of health system functionality, supportive policies and financing indicators. The main sources of data for the coverage, nutritional status and equity indicators are the US Agency for Internal Development (USAID)-supported demographic and health surveys and the United Nations Children’s Fund (UNICEF)-supported multiple indicator cluster surveys. Data on coverage are first summarized and checked for quality by UNICEF, and data on equity in intervention coverage are summarized and checked by the Federal University of Pelotas. The mortality estimates are developed by the Inter-agency Group for Child Mortality Estimation and the Maternal Mortality Estimation Inter-Agency Group. The financing data are abstracted from datasets maintained by the Organization for Economic Co-operation and Development Assistance Committee, and the policies and health systems data are derived from a special compilation prepared by the World Health Organization. Associated country profiles include equity-specific profiles and one-page profiles prepared annually that report on the 11 indicators selected by the Commission on Information and Accountability for Women’s and Children’s Health.
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Affiliation(s)
- Jennifer Requejo
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland, International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil and Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Abstract
The burden of social inequality falls disproportionately on child health and survival. This inequality raises the question of how wide this gap is, or what its relation is with the level of child mortality. Whether these disparities are increasing or declining with the development and how they differ from region to region or from state to state within the country needs to be looked into. As a measure of inequality and to compare the disparities between different states of India, concentration curves and indices are constructed from infant and under five mortality data classified under different quintiles of wealth index from the National Family Health Survey (NFHS-3) data of India. Inequality measures indicate that inequality in child mortality is more concentrated in the comparatively developed states than the poorer states in India.
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Nguyen PH, Kim SS, Keithly SC, Hajeebhoy N, Tran LM, Ruel MT, Rawat R, Menon P. Incorporating elements of social franchising in government health services improves the quality of infant and young child feeding counselling services at commune health centres in Vietnam. Health Policy Plan 2013; 29:1008-20. [PMID: 24234074 DOI: 10.1093/heapol/czt083] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although social franchising has been shown to enhance the quality of reproductive health services in developing countries, its effect on nutrition services remains unexamined. This study assessed the effects of incorporating elements of social franchising on shaping the quality of infant and young child feeding (IYCF) counselling facilities and services in Vietnam. METHODS Process-related data collected 12 months after the launch of the first franchises were used to compare randomly assigned Alive & Thrive-supported health facilities (AT-F, n = 20) with standard facilities (SF, n = 12) across three dimensions of service quality: 'structure', 'process' and 'outcome' that capture the quality of facilities, service delivery, and client perceptions and use, respectively. Data collection included facility assessments (n = 32), staff surveys (n = 96), counselling observations (n = 137), client exit interviews (n = 137) and in-depth interviews with mothers (n = 48). RESULTS Structure: AT-F were more likely to have an unshared, well-equipped room for nutrition counselling than SF (65.0% vs 10.0%). PROCESS Compared with SF providers, AT-F staff had better IYCF knowledge (mean score 9.9 vs 8.8, range 0-11 for breastfeeding; mean score 3.6 vs 3.2, range 0-4 for complementary feeding). AT-F providers also demonstrated significantly better interpersonal communication skills (score 9.6 vs 5.1, range 0-13) and offered more comprehensive counselling sessions. OUTCOME Overall utilization of franchises was low (10%). A higher proportion of pregnant women utilized franchise services (48.9%), compared with mothers with children 6-23.9 months (1.4%). There was no quantitative difference in client satisfaction with counselling services between AT-F and SF, but franchise users praised the AT-F for problem solving related to child feeding. CONCLUSIONS Incorporating elements of social franchising significantly enhances the quality of IYCF counselling services within government primary healthcare facilities, particularly their structural and process attributes. Provided that service utilization is improved through demand generation, this model has the potential to impact IYCF practices and child nutrition.
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Affiliation(s)
- Phuong H Nguyen
- International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India
| | - Sunny S Kim
- International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India
| | - Sarah C Keithly
- International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India
| | - Nemat Hajeebhoy
- International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India
| | - Lan M Tran
- International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India
| | - Marie T Ruel
- International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India
| | - Rahul Rawat
- International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India
| | - Purnima Menon
- International Food Policy Research Institute, Hanoi, Vietnam, International Food Policy Research Institute, Washington, DC 20006, USA, Institute of Social and Medical Studies, Hanoi, Vietnam, FHI360, Hanoi, Vietnam and International Food Policy Research Institute, New Delhi 110012, India
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Guanais FC. The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998-2010. Am J Public Health 2013; 103:2000-6. [PMID: 24028257 PMCID: PMC3828713 DOI: 10.2105/ajph.2013.301452] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES I examined the combined effects of access to primary care through the Family Health Program (FHP) and conditional cash transfers from the Bolsa Familia Program (BFP) on postneonatal infant mortality (PNIM) in Brazil. METHODS I employed longitudinal ecological analysis using panel data from 4583 Brazilian municipalities from 1998 to 2010, totaling 54,253 observations. I estimated fixed-effects ordinary least squares regressions models with PNIM rate as the dependent variable and FHP, BFP, and their interactions as the main independent variables of interest. RESULTS The association of higher FHP coverage with lower PNIM became stronger as BFP coverage increased. At the means of all other variables, when BFP coverage was 25%, predicted PNIM was 5.24 (95% confidence interval [CI] = 4.95, 5.53) for FHP coverage = 0% and 3.54 (95% CI = 2.77, 4.31) for FHP coverage = 100%. When BFP coverage was 60%, predicted PNIM was 4.65 (95% CI = 4.36, 4.94) when FHP coverage = 0% and 1.38 (95% CI = 0.88, 1.89) when FHP coverage = 100%. CONCLUSIONS The effect of the FHP depends on the expansion of the BFP. For impoverished, underserved populations, combining supply- and demand-side interventions may be necessary to improve health outcomes.
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Affiliation(s)
- Frederico C Guanais
- Frederico C. Guanais is with the Social Protection and Health Division, Inter-American Development Bank, Washington, DC
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Abstract
10 years ago, The Lancet published a Series about child survival. In this Review, we examine progress in the past decade in child survival, with a focus on epidemiology, interventions and intervention coverage, strategies of health programmes, equity, evidence, accountability, and global leadership. Knowledge of child health epidemiology has greatly increased, and although more and better interventions are available, they still do not reach large numbers of mothers and children. Child survival should remain at the heart of global goals in the post-2015 era. Many countries are now making good progress and need the time and support required to finish the task. The global health community should show its steadfast commitment to child survival by amassing knowledge and experience as a basis for ever more effective programmes. Leadership and accountability for child survival should be strengthened and shared among the UN system; governments in high-income, middle-income, and low-income countries; and non-governmental organisations.
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Affiliation(s)
- Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Barsanti S, Nuti S. The equity lens in the health care performance evaluation system. Int J Health Plann Manage 2013; 29:e233-46. [PMID: 23722829 DOI: 10.1002/hpm.2195] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 04/21/2013] [Indexed: 11/10/2022] Open
Abstract
The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the 'equity process' by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups.
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Affiliation(s)
- Sara Barsanti
- Istituto di Management, Laboratorio Management e Sanità, Scuola Superiore Sant'Anna Pisa, Pisa, Italy
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Requejo JH, Newby H, Bryce J. Measuring coverage in MNCH: challenges and opportunities in the selection of coverage indicators for global monitoring. PLoS Med 2013; 10:e1001416. [PMID: 23667336 PMCID: PMC3646210 DOI: 10.1371/journal.pmed.1001416] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Global monitoring of intervention coverage is a cornerstone of international efforts to improve reproductive, maternal, newborn, and child health. In this review, we examine the process and implications of selecting a core set of coverage indicators for global monitoring, using as examples the processes used by the Countdown to 2015 for Maternal, Newborn and Child Survival and the Commission on Accountability for Women's and Children's Health. We describe how the generation of data for global monitoring involves five iterative steps: development of standard indicator definitions and measurement approaches to ensure comparability across countries; collection of high-quality data at the country level; compilation of country data at the global level; organization of global databases; and rounds of data quality checking. Regular and rigorous technical review processes that involve high-level decision makers and experts familiar with indicator measurement are needed to maximize uptake and to ensure that indicators used for global monitoring are selected on the basis of available evidence of intervention effectiveness, feasibility of measurement, and data availability as well as programmatic relevance. Experience from recent initiatives illustrates the challenges of striking this balance as well as strategies for reducing the tensions inherent in the indicator selection process. We conclude that more attention and continued investment need to be directed to global monitoring, to support both the process of global database development and the selection of sets of coverage indicators to promote accountability. The stakes are high, because these indicators can drive policy and program development at the country and global level, and ultimately impact the health of women and children and the communities where they live.
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Affiliation(s)
- Jennifer Harris Requejo
- Institute for International Programs, Department of International Health, The Johns Hopkins University, Baltimore, Maryland, United States of America.
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Agrawal S, Agrawal P. Vitamin A supplementation among children in India: Does their socioeconomic status and the economic and social development status of their State of residence make a difference? INTERNATIONAL JOURNAL OF MEDICINE AND PUBLIC HEALTH 2013; 3:48-54. [PMID: 25729705 PMCID: PMC4340548 DOI: 10.4103/2230-8598.109322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND India has the largest percentage/number of vitamin A deficient children in the world. However, the effectiveness of a program of vitamin A supplementation at the population level has been rarely examined. We aim to examine the status of vitamin A supplementation among preschool children in India and its association with their socioeconomic and demographic characteristics and the social and economic development level of the State in which they reside. MATERIALS AND METHODS Data are from a cross-sectional study of 20,802 children aged 12-35 months whose mothers participated in the National Family Health Survey 3 (NFHS-3) conducted during 2005-2006. The association between the socioeconomic and demographic characteristics of the children, the social and economic development status of the State in which they reside and vitamin A supplementation status was examined by means of unadjusted and adjusted logistic regression models. RESULTS Only 25% of the children in India received vitamin A supplementation, indicating a poor coverage, and the differences between the States were wide (<10% to >45%). Rural children (OR: 1.20; 95% CI: 1.10-1.30; P < 0.0001) and children of educated mothers (OR: 2.40; 95% CI: 2.04-2.83; P < 0.0001) were more likely to receive vitamin A supplementation than others. Children born in a higher birth order (6+) (OR: 0.54; 95% CI: 0.46-0.63; P < 0.0001) and those residing in states with low levels of social and economic development (OR: 0.51; 95% CI: 0.46-0.57; P < 0.0001) were only about half as likely to receive vitamin A supplementation as their counterparts. CONCLUSION The national vitamin A supplementation program in India did not reach a majority of preschool children in 2005. Greater maternal formal education, higher household wealth status and high social development status of their State of residence appears to be an important determinant for receipt of a vitamin A supplementation by preschool children in India.
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Affiliation(s)
- Sutapa Agrawal
- South Asia Network for Chronic Disease, Public Health Foundation of India, C-1/52, First Floor, Safdurjung Development Area, New Delhi, India
| | - Praween Agrawal
- Population Council, 42, Golf Links, First Floor, New Delhi, India
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McCord GC, Liu A, Singh P. Deployment of community health workers across rural sub-Saharan Africa: financial considerations and operational assumptions. Bull World Health Organ 2013; 91:244-53B. [PMID: 23599547 DOI: 10.2471/blt.12.109660] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 10/28/2012] [Accepted: 12/26/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To provide cost guidance for developing a locally adaptable and nationally scalable community health worker (CHW) system within primary-health-care systems in sub-Saharan Africa. METHODS The yearly costs of training, equipping and deploying CHWs throughout rural sub-Saharan Africa were calculated using data from the literature and from the Millennium Villages Project. Model assumptions were such as to allow national governments to adapt the CHW subsystem to national needs and to deploy an average of 1 CHW per 650 rural inhabitants by 2015. The CHW subsystem described was costed by employing geographic information system (GIS) data on population, urban extents, national and subnational disease prevalence, and unit costs (from the field for wages and commodities). The model is easily replicable and configurable. Countries can adapt it to local prices, wages, population density and disease burdens in different geographic areas. FINDINGS The average annual cost of deploying CHWs to service the entire sub-Saharan African rural population by 2015 would be approximately 2.6 billion (i.e. 2600 million) United States dollars (US$). This sum, to be covered both by national governments and by donor partners, translates into US$ 6.86 per year per inhabitant covered by the CHW subsystem and into US$ 2.72 per year per inhabitant. Alternatively, it would take an annual average of US$ 3750 to train, equip and support each CHW. CONCLUSION Comprehensive CHW subsystems can be deployed across sub-Saharan Africa at cost that is modest compared with the projected costs of the primary-health-care system. Given their documented successes, they offer a strong complement to facility-based care in rural African settings.
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Kumar C, Singh PK, Rai RK. Coverage gap in maternal and child health services in India: assessing trends and regional deprivation during 1992-2006. J Public Health (Oxf) 2013; 35:598-606. [PMID: 23359666 DOI: 10.1093/pubmed/fds108] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Increasing the coverage of key maternal, newborn and child health interventions is essential, if India has to attain Millennium Development Goals 4 and 5. This study assesses the coverage gap in maternal and child health services across states in India during 1992-2006 emphasizing the rural-urban disparities. Additionally, association between the coverage gap and under-5 mortality rate across states are illustrated. METHODS The three waves of National Family Health Survey (NFHS) conducted during 1992-1993 (NFHS-1), 1998-1999 (NFHS-2) and 2005-2006 (NFHS-3) were used to construct a composite index of coverage gap in four areas of health-care interventions: family planning, maternal and newborn care, immunization and treatment of sick children. RESULTS The central, eastern and northeastern regions of India reported a higher coverage gap in maternal and child health care services during 1992-2006, while the rural-urban difference in the coverage gap has increased in Gujarat, Haryana, Rajasthan and Kerala over the period. The analysis also shows a significant positive relationship between the coverage gap index and under-five mortality rate across states. CONCLUSION Region or area-specific focus in order to increase the coverage of maternal and child health care services in India should be the priority of the policy-makers and programme executors.
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Affiliation(s)
- Chandan Kumar
- Department of Humanities & Social Sciences, Indian Institute of Technology (IIT) Roorkee, Roorkee 247667, Uttarakhand, India
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Taha TE, Dadabhai SS, Sun J, Rahman MH, Kumwenda J, Kumwenda N. Child mortality levels and trends by HIV status in Blantyre, Malawi: 1989-2009. J Acquir Immune Defic Syndr 2012; 61:226-34. [PMID: 22692091 PMCID: PMC3458133 DOI: 10.1097/qai.0b013e3182618eea] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Continuous evaluation of child survival is needed in sub-Saharan Africa where HIV prevalence among women of reproductive age continues to be high. We examined mortality levels and trends over a period of ∼20 years among HIV-unexposed and -exposed children in Blantyre, Malawi. METHODS Data from 5 prospective cohort studies conducted at a single research site from 1989 to 2009 were analyzed. In these studies, children born to HIV-infected and -uninfected mothers were enrolled at birth and followed longitudinally for at least 2 years. Information on sociodemographic, HIV infection status, survival, and associated risk factors was collected in all studies. Mortality rates were estimated using birth-cohort analyses stratified by maternal and infant HIV status. Multivariate Cox regression models were used to determine risk factors associated with mortality. RESULTS The analysis included 8286 children. From 1989 to 1995, overall mortality rates (per 100 person-years) in these clinic-based cohorts remained comparable among HIV-uninfected children born to HIV-uninfected mothers (range 3.3-6.9) or to HIV-infected mothers (range 2.5-7.5). From 1989 to 2009, overall mortality remained high among all children born to HIV-infected mothers (range 6.3-19.3) and among children who themselves became infected (range 15.6-57.4, 1994-2009). Only lower birth weight was consistently and significantly (P < 0.05) associated with higher child mortality. CONCLUSIONS HIV infection among mothers and children contributed to high levels of child mortality in the African setting in the pretreatment era. In addition to services that prevent mother-to-child transmission of HIV, other programs are needed to improve child survival by lowering HIV-unrelated mortality through innovative interventions that strengthen health infrastructure.
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Affiliation(s)
- Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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The "Child Health Evidence Week" and GRADE grid may aid transparency in the deliberative process of guideline development. J Clin Epidemiol 2012; 65:962-9. [PMID: 22742914 PMCID: PMC3413881 DOI: 10.1016/j.jclinepi.2012.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 02/07/2012] [Accepted: 03/16/2012] [Indexed: 11/21/2022]
Abstract
Objective To explore the evidence translation process during a 1-week national guideline development workshop (“Child Health Evidence Week”) in Kenya. Study Design and Setting Nonparticipant observational study of the discussions of a multidisciplinary guideline development panel in Kenya. Discussions were aided by GRADE (Grading of Recommendations Assessment, Development, and Evaluation) grid. Results Three key thematic categories emerged: 1) “referral to other evidence to support or refute the proposed recommendations;” 2) “assessment of the presented research evidence;” and 3) “assessment of the local applicability of evidence.” The types of evidence cited included research evidence and anecdotal evidence based on clinician experiences. Assessment of the research evidence revealed important challenges in the translation of evidence into recommendations, including absence of evidence, low quality or inconclusive evidence, inadequate reporting of key features of the management under consideration, and differences in panelists’ interpretation of the research literature. A broad range of factors with potential to affect local applicability of evidence were discussed. Conclusion The process of the “Child Health Evidence Week” combined with the GRADE grid may aid transparency in the deliberative process of guideline development, and provide a mechanism for comprehensive assessment, documentation, and reporting of multiple factors that influence the quality and applicability of guideline recommendations.
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Barasa EW, Ayieko P, Cleary S, English M. A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis. PLoS Med 2012; 9:e1001238. [PMID: 22719233 PMCID: PMC3373608 DOI: 10.1371/journal.pmed.1001238] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 05/03/2012] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale. METHODS AND FINDINGS Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals) with a partial intervention (n = 4 hospitals). Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$). Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average) quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06) in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18) in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31) per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY) averted by scaling up would vary between US$39.8 and US$398.3. CONCLUSION Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be cost-effective when compared to incremental cost-effectiveness ratios of other priority child health interventions.
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Affiliation(s)
- Edwine W Barasa
- Kenya Medical Research Institute (KEMRI) Centre for Geographic Medicine Research - Coast, Nairobi, Kenya.
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