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Kolekang A, Sarfo B, Danso-Appiah A, Dwomoh D, Akweongo P. Contribution of child health interventions to under-five mortality decline in Ghana: A modeling study using lives saved and missed opportunity tools. PLoS One 2022; 17:e0267776. [PMID: 35913919 PMCID: PMC9342718 DOI: 10.1371/journal.pone.0267776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Increased coverage of interventions have been advocated to reduce under-five mortality. However, Ghana failed to achieve the Millennium Development Goal on child survival in 2015 despite improved coverage levels of some child health interventions. Therefore, there is the need to determine which interventions contributed the most to mortality reduction and those that can further rapidly reduce mortality to inform the prioritization of the scale-up of interventions. Materials and methods Deterministic mathematical modeling was done using Lives Saved and Missed Opportunity Tools. Secondary data was used, and the period of the evaluation was between 2008 and 2014. Some of the interventions assessed were complementary feeding, skilled delivery, and rotavirus vaccine. Results A total of 48,084 lives were saved from changes in coverage of interventions and a reduction in the prevalence of stunting and wasting. Reduction in wasting prevalence saved 10,372(21.6%) lives, insecticide-treated net/indoor residual spraying 6,437(13.4%) lives saved, reduction in stunting 4,315(9%) lives saved and artemisinin-based combination therapy (ACTs) 4,325(9.0%) lives saved. If coverage levels of interventions in 2014 were scaled up to 90% in 2015, among neonates, full supportive care for prematurity (5,435 lives saved), full supportive care for neonatal sepsis/pneumonia (3,002 lives saved), and assisted vaginal delivery (2,163 lives saved), would have saved the most lives among neonates, while ACTs (4,925 lives saved), oral rehydration salts (ORS) (2,056 lives saved), and antibiotics for the treatment of pneumonia (1,805 lives saved) would have made the most impact on lives saved among children 1–59 months. Lastly, if all the interventions were at 100% coverage in 2014, the under-five mortality rate would have been 40.1 deaths per 1,000 live births in 2014. Discussion The state of the package of interventions will likely not lead to rapid mortality reduction. Coverage and quality of childbirth-related interventions should be increased. Additionally, avenues to further reduce stunting and wasting, including increased breastfeeding and complementary feeding, will be beneficial.
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Affiliation(s)
- Augusta Kolekang
- School of Public Health, University for Development Studies, Tamale, Ghana
- * E-mail:
| | - Bismark Sarfo
- School of Public Health, University of Ghana, Legon, Accra, Ghana
| | | | - Duah Dwomoh
- School of Public Health, University of Ghana, Legon, Accra, Ghana
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Perin J, Chu Y, Villavicencio F, Schumacher A, McCormick T, Guillot M, Liu L. Adapting and validating the log quadratic model to derive under-five age- and cause-specific mortality (U5ACSM): a preliminary analysis. Popul Health Metr 2022; 20:3. [PMID: 35012587 PMCID: PMC8744238 DOI: 10.1186/s12963-021-00277-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The mortality pattern from birth to age five is known to vary by underlying cause of mortality, which has been documented in multiple instances. Many countries without high functioning vital registration systems could benefit from estimates of age- and cause-specific mortality to inform health programming, however, to date the causes of under-five death have only been described for broad age categories such as for neonates (0-27 days), infants (0-11 months), and children age 12-59 months. METHODS We adapt the log quadratic model to mortality patterns for children under five to all-cause child mortality and then to age- and cause-specific mortality (U5ACSM). We apply these methods to empirical sample registration system mortality data in China from 1996 to 2015. Based on these empirical data, we simulate probabilities of mortality in the case when the true relationships between age and mortality by cause are known. RESULTS We estimate U5ACSM within 0.1-0.7 deaths per 1000 livebirths in hold out strata for life tables constructed from the China sample registration system, representing considerable improvement compared to an error of 1.2 per 1000 livebirths using a standard approach. This improved prediction error for U5ACSM is consistently demonstrated for all-cause as well as pneumonia- and injury-specific mortality. We also consistently identified cause-specific mortality patterns in simulated mortality scenarios. CONCLUSION The log quadratic model is a significant improvement over the standard approach for deriving U5ACSM based on both simulation and empirical results.
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Affiliation(s)
- Jamie Perin
- Department of International Health, Johns Hopkins University, Baltimore, USA
| | - Yue Chu
- Department of International Health, Johns Hopkins University, Baltimore, USA
| | | | | | - Tyler McCormick
- Departments of Statistics and Sociology, University of Washington, Seattle, USA
| | - Michel Guillot
- Department of Sociology, University of Pennsylvania, Philadelphia, USA
| | - Li Liu
- Department of International Health, Johns Hopkins University, Baltimore, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, USA
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Baye K. Prioritizing the Scale-Up of Evidence-Based Nutrition and Health Interventions to Accelerate Stunting Reduction in Ethiopia. Nutrients 2019; 11:E3065. [PMID: 31888177 PMCID: PMC6950157 DOI: 10.3390/nu11123065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 01/19/2023] Open
Abstract
Despite some progress, stunting prevalence in many African countries including Ethiopia remains unacceptably high. This study aimed to identify key interventions that, if implemented at scale through the health sector in Ethiopia, can avert the highest number of stunting cases. Using the Lives Saved Tool (LiST), the number of stunting cases that would have been averted, if proven interventions were scaled-up to the highest wealth quintile or to an aspirational 90% coverage was considered. Stunting prevalence was highest among rural residents and households in the poorest wealth quintile. Coverage of breastfeeding promotion and vitamin A supplementation were relatively high (>50%), whereas interventions targeting women were limited in number and had particularly low coverage. Universal coverage (90%) of optimal complementary feeding, preventive zinc supplementation, and water connection in homes could have each averted 380,000-500,000 cases of stunting. Increasing coverage of water connection to homes to the level of the wealthiest quintile could have averted an estimated 168,000 cases of stunting. Increasing coverage of optimal complementary feeding, preventive zinc supplementation, and Water, Sanitation and Hygiene (WASH) services is critical. Innovations in program delivery and health systems governance are required to effectively reach women, remote areas, rural communities, and the poorest proportion of the population to accelerate stunting reduction.
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Affiliation(s)
- Kaleab Baye
- Center for Food Science and Nutrition, College of Natural and Computational Sciences, Addis Ababa University, P.O. Box 1176 Addis Ababa, Ethiopia
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Carter R, Xiong X, Lusamba-Dikassa PS, Kuburhanwa EC, Kimanuka F, Salumu F, Clarysse G, Tutu BK, Yuma S, Iyeti AM, Hernandez JH, Shaffer JG, Bertrand JT, Villeneuve S, Prual A, Pyne-Mercier L, Nigussie A, Buekens P. Facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care in 72 rural health facilities in the Democratic Republic of the Congo: A cross-sectional study. Gates Open Res 2019; 3:13. [PMID: 31410393 PMCID: PMC6676177 DOI: 10.12688/gatesopenres.12905.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Current facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care (EmONC) were assessed in the Kwango and Kwilu provinces of the Democratic Republic of the Congo (DRC). Methods: This is an analysis of the baseline survey data from an ongoing clinical mentoring program among 72 rural health facilities in the DRC. Data collectors visited each of the facilities and collected data through a pre-programmed smartphone. Frequencies of selected indicators were calculated by province and facility type-general referral hospital (GRH) and primary health centers (HC). Results: Facility conditions varied across province and facility type. Maternity wards and delivery rooms were available in the highest frequency of rooms assessed (>95% of all facilities). Drinking water was available in 25.0% of all facilities; electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms in all facilities. Antenatal, delivery, and postnatal care services were available but varied across facilities. While the proportion of blood pressure measured during antenatal care was high (94.9%), the antenatal screening rate for proteinuria was low (14.7%). The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility type (91.3% in GRH and 81.4% in HC). The provision of immediate postnatal care to mothers every 15 minutes was provided in less than 50% of all facilities. GRH facilities generally had higher frequencies of available equipment and more services available than HC. GRH facilities provided an average of 6 EmONC signal functions (range: 2-9). Conclusions: Despite poor facility conditions and a lack of supplies, GRH and HC facilities were able to provide EmONC care in rural DRC. These findings could guide the provision of essential needs to the health facilities for better delivery of maternal and neonatal care.
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Affiliation(s)
- Rebecca Carter
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Paul-Samson Lusamba-Dikassa
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Elvis C. Kuburhanwa
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Freddy Salumu
- UNICEF-DRC, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Guy Clarysse
- UNICEF-DRC, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Baudouin Kalume Tutu
- Ministère de la Santé, Secrétariat général, Kinshasa – Gombe, Democratic Republic of the Congo
| | - Sylvain Yuma
- Ministère de la Santé, Secrétariat général, Kinshasa – Gombe, Democratic Republic of the Congo
| | - Alain Mboko Iyeti
- Ministère de la Santé, Secrétariat général, Kinshasa – Gombe, Democratic Republic of the Congo
| | - Julie H. Hernandez
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Jeffrey G. Shaffer
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Jane T. Bertrand
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Susie Villeneuve
- UNICEF Western & Central Africa Regional Office, Dakar-Yoff, Senegal
| | - Alain Prual
- UNICEF Western & Central Africa Regional Office, Dakar-Yoff, Senegal
| | | | | | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
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Mishra NR, Mohanty SK, Mittra D, Shah M, Meitei WB. Projecting stunting and wasting under alternative scenarios in Odisha, India, 2015-2030: a Lives Saved Tool (LiST)-based approach. BMJ Open 2019; 9:e028681. [PMID: 31142537 PMCID: PMC6549738 DOI: 10.1136/bmjopen-2018-028681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Although nutrition-specific interventions are designed based on maternal, household and community-level correlates, no attempt has been made to project stunting and wasting and identify intervention priorities in India. The objective of this paper is to model the stunting and wasting in the state of Odisha, India by scaling up maternal and child health interventions under alternative scenarios. DESIGN This study primarily used data from National Family Health Survey 4, 2015-2016. MEASURES The LiST (Lives Saved Tool) software is used to model the nutritional outcomes and prioritise interventions. The projections were carried out under four alternative scenarios: scenario 1-if the coverage indicators continued based on past trends; scenario 2-scaled up to the level of the richest quintile; scenario 3-scaled up to that of Tamil Nadu; and scenario 4-scaled up to an aspirational coverage level. RESULTS In 2015, out of 3.52 million under-5 children in Odisha, around 1.20 million were stunted. By 2030, the numbers of stunted children will be 1.11 million under scenario 1, 1.07 million under scenario 2, 1.09 million under scenario 3 and 0.89 million under scenario 4. The projected stunting level will be 25% under scenario 4 and around 31% under all other scenarios. By 2030, the level of wasting will remain unchanged at 20% under the first three scenarios and 4.3% under scenario 4. Appropriate complementary feeding would avert about half of the total stunting cases under all four scenarios, followed by zinc supplementation. Water connection at home, washing hands with soap and improved sanitation are other effective interventions. CONCLUSION Sustaining the maternal and child health interventions, promoting evidence-based stunting and wasting reduction interventions, and a multisectoral approach can achieve the World Health Assembly targets and Sustainable Development Goals of undernutrition in Odisha.
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Affiliation(s)
| | - Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Devjit Mittra
- Azim Premji Philanthrophic Initiatives, Bhubaneswar, Odisha, India
| | - Mansi Shah
- Azim Premji Philanthropic Initiatives, Bengaluru, Karnataka, India
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Allen E, Schellenberg J, Berhanu D, Cousens S, Marchant T. Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia. PLoS One 2018; 13:e0199937. [PMID: 30071026 PMCID: PMC6071969 DOI: 10.1371/journal.pone.0199937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background Survival of mothers and newborns depends on life-saving interventions reaching those in need. Recent evidence suggests that indicators of contact with health services are poor proxies for measures of coverage of life saving care and attention has shifted towards the quality of care provided during contacts. Methods and findings Regression analysis using data from representative cluster-based household surveys and surveys of the frontline health workers and primary health facilities in four regions of Ethiopia in 2012 and 2015 was used to explore associations between increased numbers of contacts or improvements in quality and any change in the coverage of interventions (intervention coverage). In pregnancy, in multiple regression, an increase in the quality indicator ‘focused ANC behaviours’ was associated with a change in both the coverage of iron supplementation and syphilis prevention ((regression coefficients (95% CI)) 0·06 (0·01, 0·11); 0·07 (0·04, 0·10)). This equates to a 0.6% increase in the proportion of women taking iron supplementation and a 0.7% in women receiving syphilis prevention for a 10% increase in the quality indicator ‘focused ANC behaviours’. At delivery, in multiple regression the quality indicator ‘availability of uterotonic supplies amongst birth attendants’ was associated with improved coverage of prophylactic uterotonics (0·72 (0·50, 0·94)). No evidence of any relationships between contacts, quality and intervention coverage were observed within the early postnatal period. Conclusions Increases in both contacts and in quality of care are needed to increase the coverage of life saving interventions. For interventions that need to be delivered at multiple visits, such as antenatal vaccination, increasing the number of contacts had the strongest association with coverage. For those relying on a single point of contact, such as those delivered at birth, we found strong evidence to support current commitments to invest in both input and process quality.
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Affiliation(s)
- Elizabeth Allen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Della Berhanu
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon Cousens
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tanya Marchant
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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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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