Proximate determinants of child mortality in Liberia

Risk factors and a predictive model for under-five mortality in Nigeria: evidence from Nigeria demographic and health survey

Background

Under-5 mortality is a major public health challenge in developing countries. It is essential to identify determinants of under-five mortality (U5M) childhood mortality because these will assist in formulating appropriate health programmes and policies in order to meet the United Nations MDG goal. The objective of this study was to develop a predictive model and identify maternal, child, family and other risk factors associated U5M in Nigeria.

Methods

Population-based cross-sectional study which explored 2008 demographic and health survey of Nigeria (NDHS) with multivariable logistic regression. Likelihood Ratio Test, Hosmer-Lemeshow Goodness-of-Fit and Variance Inflation Factor were used to check the fit of the model and the predictive power of the model was assessed with Receiver Operating Curve (ROC curve).

Results

This study yielded an excellent predictive model which revealed that the likelihood of U5M among the children of mothers that had their first marriage at age 20-24 years and ≥ 25 years declined by 20% and 30% respectively compared to children of those that married before the age of 15 years. Also, the following factors reduced odds of U5M: health seeking behaviour, breastfeeding children for > 18 months, use of contraception, small family size, having one wife, low birth order, normal birth weight, child spacing, living in urban areas, and good sanitation.

Conclusions

This study has revealed that maternal, child, family and other factors were important risk factors of U5M in Nigeria. This study has identified important risk factors that will assist in formulating policies that will improve child survival.

Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war

The aim of this study was to describe and analyse hospital mortality patterns after the Liberian war. Data were collected retrospectively from January to July 2005 in a referral hospital in Monrovia, Liberia. The overall fatality rate was 17.2% (438/2543) of medical admissions. One-third of deaths occurred in the first 24h. The adult fatality rate was 23.3% (241/1034). Non-infectious diseases accounted for 56% of the adult deaths. The main causes of death were meningitis (16%), stroke (14%) and heart failure (10%). Associated fatality rates were 48%, 54% and 31% respectively. The paediatric fatality rate was 13.1% (197/1509). Infectious diseases caused 66% of paediatric deaths. In infants <1 month old, the fatality rate was 18% and main causes of death were neonatal sepsis (47%), respiratory distress (24%) and prematurity (18%). The main causes of death in infants > or =1 month old were respiratory infections (27%), malaria (23%) and severe malnutrition (16%). Associated fatality rates were 12%, 10% and 19%. Fatality rates were similar to those found in other sub-Saharan countries without a previous conflict. Early deaths could decrease through recognition and early referral of severe cases from health centres to the hospital and through assessment and priority treatment of these patients at arrival.

Can we achieve Millennium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015

BACKGROUND

Global efforts have increased the accuracy and timeliness of estimates of under-5 mortality; however, these estimates fail to use all data available, do not use transparent and reproducible methods, do not distinguish predictions from measurements, and provide no indication of uncertainty around point estimates. We aimed to develop new reproducible methods and reanalyse existing data to elucidate detailed time trends.

METHODS

We merged available databases, added to them when possible, and then applied Loess regression to estimate past trends and forecast to 2015 for 172 countries. We developed uncertainty estimates based on different model specifications and estimated levels and trends in neonatal, post-neonatal, and childhood mortality.

FINDINGS

Global under-5 mortality has fallen from 110 (109-110) per 1000 in 1980 to 72 (70-74) per 1000 in 2005. Child deaths worldwide have decreased from 13.5 (13.4-13.6) million in 1980 to an estimated 9.7 (9.5-10.0) million in 2005. Global under-5 mortality is expected to decline by 27% from 1990 to 2015, substantially less than the target of Millennium Development Goal 4 (MDG4) of a 67% decrease. Several regions in Latin America, north Africa, the Middle East, Europe, and southeast Asia have had consistent annual rates of decline in excess of 4% over 35 years. Global progress on MDG4 is dominated by slow reductions in sub-Saharan Africa, which also has the slowest rates of decline in fertility.

INTERPRETATION

Globally, we are not doing a better job of reducing child mortality now than we were three decades ago. Further improvements in the quality and timeliness of child-mortality measurements should be possible by more fully using existing datasets and applying standard analytical strategies.

Inequality and changes in women's use of maternal health-care services in Tajikistan

Using recently available survey data for Tajikistan, this study explores changes in the pattern of maternal health care during the last decade and the extent to which inequalities in access to that care have emerged. In particular, the links between poverty and women's educational status and the use of maternal health-care services are investigated. The survey findings demonstrate a significant decline in the use of maternal health-care services in Tajikistan since the country gained independence from the Soviet Union in 1991. They show changes in the location of delivery and the person providing assistance, with a clear shift away from giving birth in a medical facility toward giving birth at home. More than two-fifths of all women who gave birth in the year prior to the survey delivered their baby at home. Women from the poorest quintile are three times more likely than women from the richest quintile to undergo a home delivery without a trained assistant.

Path analysis and multi-criteria decision making: an approach for multivariate model selection and analysis in health

PURPOSE

This paper introduces an approach that includes non-quantitative factors for the selection and assessment of multivariate complex models in health.

METHODS

A goodness-of-fit based methodology combined with fuzzy multi-criteria decision-making approach is proposed for model selection. Models were obtained using the Path Analysis (PA) methodology in order to explain the interrelationship between health determinants and the post-neonatal component of infant mortality in 59 municipalities of Brazil in the year 1991. Socioeconomic and demographic factors were used as exogenous variables, and environmental, health service and agglomeration as endogenous variables. Five PA models were developed and accepted by statistical criteria of goodness-of fit. These models were then submitted to a group of experts, seeking to characterize their preferences, according to predefined criteria that tried to evaluate model relevance and plausibility. Fuzzy set techniques were used to rank the alternative models according to the number of times a model was superior to ("dominated") the others.

RESULTS

The best-ranked model explained above 90% of the endogenous variables variation, and showed the favorable influences of income and education levels on post-neonatal mortality. It also showed the unfavorable effect on mortality of fast population growth, through precarious dwelling conditions and decreased access to sanitation.

CONCLUSIONS

It was possible to aggregate expert opinions in model evaluation. The proposed procedure for model selection allowed the inclusion of subjective information in a clear and systematic manner.

Infant death rates and animal-shed delivery in remote rural areas of Nepal

This article outlines a community-based retrospective study in a remote area of Nepal and describes local birth practices and their impact on infant mortality. Data collection was carried out in two steps, a household survey from September to October 1996 and a qualitative research phase. Data collected include socio-economic background, reproductive history, birth practices and child survival. Among 3007 live-born children, 660 (22%) died before their first birthday. In keeping with local customs, approximately half of the children were delivered in an animal shed and the other half in the home. Children born in an animal shed were at significantly higher risk of dying than were those born in the home even after adjusting for socio-economic status and biological variables. The association was stronger in the neonatal period (OR = 2.8, 95% CI 1.9-4.1) than during the post-neonatal period (OR= 1.3, 95% CI 1.02-1.6). The preparation of the delivery place was inadequate and thereby facilitated infection of both the newborn and the mother. Traditional norms and animal-shed delivery practices are common in the Jumla community. The reasons addressed for giving birth in the animal shed included (1) Household Deity's anger if delivery takes place in the home and (2) easy to clean the shed following the birth.

The socio-economic determinants of maternal health care utilization in Turkey

The purpose of this study is to investigate the individual-, household- and community-level factors that affect women's use of maternal health care services in Turkey. The data used for the study come from the 1993 Turkey Demographic and Health Survey (TDHS), a nationally representative survey of ever married women 15 to 49 years of age. In order to assess the impact of socio-economic factors on maternal health care utilization, we use logistical regression techniques to estimate models of the prenatal care use and birth delivery assistance among women who have had at least one birth in the three years prior to the survey. Separate models are also estimated for urban and rural women. The results indicate that educational attainment, parity level, health insurance coverage, ethnicity, household wealth and geographic region are statistically significant factors that affect the use of health care services thought essential to reduce infant and child mortality rates. The results of the model are used to provide insights for both micro- and macro-level planning of maternal health service delivery.

Prior and proximate causes of infant survival in Ghana, with special attention to polygyny

This study examines the role of marriage form in infant mortality and tests the relative effects and mechanisms through which polygyny affects infant survival. A sample of infants born in the 5 years preceding the 1988 Ghana Demographic and Health Survey was used. A causal model was constructed and polygyny was found to be an important mediating factor in understanding infant survival. The findings highlight the relevance of family structure (polygyny) as an intervening factor, but also reveal the complex role of ethnicity, dietary supplement and birth interval in accounting for infant survival.

The Butajira Rural Health Project in Ethiopia: a nested case-referent (control) study of under-5 mortality and its health and behavioural determinants

The associations between under-5 mortality and its health and behavioural determinants were investigated in a rural district of Ethiopia, by means of a concurrent case-referent technique nested within a study-base population established in 1987. Three-hundred and six infant and child deaths registered over a period of 1 year, were contrasted with 612 controls, matched for age, sex and study area. Data were collected by trained non-medical workers using a structured questionnaire. Breastfeeding and supplementary feeding came out as strongly protective against under-5 mortality, even when controlling for parental and environmental determinants. Early termination of breastfeeding was demonstrated to have a substantial impact on mortality, particularly on that caused by diarrhoea. Late introduction of supplementary feeding, particularly of protein origin, was also associated with increased under-5 mortality. When the relative impacts of parental, environmental and behavioural determinants are compared, the greater impact of parental factors can be demonstrated, especially among infants.

Age at breast feeding start and postneonatal growth and survival

Colostrum has important anti-infective properties. It may also somehow promote the development of the child's immunological system. Discarding colostrum, as practised in some cultures, could thus have adverse health consequences beyond the neonatal period. To test this hypothesis, the age at breast feeding start of 734 healthy newborns in urban Guinea-Bissau was ascertained. The children were then prospectively followed up to 3 years of age. Eighty nine deaths occurred during the study. The probability of death in the age interval 28 days to 3 years was about 20%. The child's age at breast feeding start had no statistical impact on postneonatal growth or survival. As a single measure, early breast feeding start is not likely to make much difference for the long term growth or survival of children living under material poverty conditions.