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Dandona R, Kumar GA, Majumder M, Akbar M, Prasad Dora SS, Dandona L. Poor coverage of quality-adjusted antenatal care services: a population-level assessment by visit and source of antenatal care services in Bihar state of India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100332. [PMID: 39021484 PMCID: PMC467073 DOI: 10.1016/j.lansea.2023.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 07/20/2024]
Abstract
Background Despite the evidence on the poor quality of antenatal care (ANC) services, significant gap remains in the understanding of quality-adjusted coverage at the population-level for each ANC visit and by the source of ANC services, and in equity in this coverage. Methods All births between July 2020 and June 2021 were listed from 261,124 households (91.5% participation) representative of the Bihar state. Mothers of all stillbirths and neonatal deaths, and of 25% random sample of livebirths who survived the neonatal period provided data on each ANC visit up to a maximum of first 4 ANC visits, including the source of ANC services and the services received (weight measurement, blood pressure checked, abdomen checked, urine sample taken, and blood sample taken). An ANC visit was deemed of quality if all of these services were received in that visit. We report the coverage of quality-adjusted ANC services (Q-ANC) for ANC visits 1-4 disaggregated by source of ANC services and wealth index (WI). Weighted proportions are reported to take into account the sampling design. Findings A total of 30,412 births were reported by 29,517 women, and 7270 (82.1%) of the 8853 eligible women participated. Overall, 19,950 unique ANC visits from 6929 women were available for analysis, of which 41.7%, 13.8% and 44.5% were at Village Health and Nutrition Day (VNHD), public facility, and with a private provider, respectively. A total of 4409 (65.3%) of the 1st ANC visits were undertaken at VHND, with the proportion of private provider ANC visits increasing significantly from ANC visit 1 to ANC visit 4 (p < 0.001). Q-ANC coverage considering all ANC visits was 20.9% (95% CI 20.7-21.2); and was 0.9% (95% CI 0.8-1.0), 29.9% (95% CI 29.2-30.7) and 36.9% (95% CI 36.5-37.4) for ANC visits in VHND, public facilities, and with private provider, respectively. Q-ANC coverage in the public facility was significantly lower in the 4th ANC visit (25.1%; 95% CI 23.4-26.9) as compared with visits 1 to 3, whereas it was the highest for 1st ANC visit with private provider (50.2%; 95% CI 49.2-51.1) and then dropped for visits 2 to 4. Irrespective of the source of ANC services, Q-ANC coverage increased significantly with increasing WI quartile for ANC visits 1 and 2, with WI quartile 3 women having significantly less coverage for ANC visit 3 compared to the rest, and no significant difference seen in the coverage of ANC 4 visit. Varied pattern of Q-ANC coverage by WI for each ANC visit was seen for public facility and private provider visits. Interpretation With only 2 of 10 ANC visits deemed of adequate quality, sustainable delivery of quality ANC services are needed for every pregnant woman through-out the pregnancy irrespective of gestation period, number of ANC visit, and source of ANC services. Funding The funding was provided by the India office of the Bill & Melinda Gates Foundation, USA.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, Gurugram, National Capital Region, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - Moutushi Majumder
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - Md Akbar
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - S Siva Prasad Dora
- Public Health Foundation of India, Gurugram, National Capital Region, India
| | - Lalit Dandona
- Public Health Foundation of India, Gurugram, National Capital Region, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - ENHANCE 2020 team
- Public Health Foundation of India, Gurugram, National Capital Region, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
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Kumar J, Saini SS, Kumar P. Care During Labour, Childbirth, and Immediate Newborn Care in India: A Review. Indian J Pediatr 2023; 90:20-28. [PMID: 37380919 DOI: 10.1007/s12098-023-04721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023]
Abstract
India is committed to achieve a single-digit neonatal mortality rate (NMR) and stillbirth rate (SBR) by 2030 through India Newborn Action Plan (INAP) 2014. However, the current rate of decline is not enough to achieve the target neonatal mortality rate. Course correction and renewed efforts are required. This review outlines the current scenario and proposed scale-up of services included during labour, childbirth, and the immediate newborn period. The article summarises the challenges and bottlenecks in achieving a reduction in neonatal mortality rate and INAP targets. India has achieved over 80% coverage of three of the four ENAP coverage targets, but antenatal care coverage is still poor. There are concerns about the quality and completeness of antenatal care visits and other program interventions. The ongoing quality assurance should be strengthened through continuous supportive supervision by involving the medical colleges in a hub and spoke model and other key stakeholders. There is a need for effective and strategic engagement of the private sector in these initiatives. The states need to systematically assess the gaps as per population requirements and find effective solutions to overcome them quickly. The state and district-wise data maps show immense variations in coverage between states and within states, mirroring the variations in NMR. This indicates the need to ensure contextual micro-plans and provides an opportunity for the districts and states to learn from each other. The recent initiatives to strengthen primary healthcare should be used as a platform for all stillbirth and neonatal mortality prevention interventions in India.
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Affiliation(s)
- Jogender Kumar
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shiv Sajan Saini
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Dandona R, Kumar GA, Akbar M, Dora SSP, Dandona L. Substantial increase in stillbirth rate during the COVID-19 pandemic: results from a population-based study in the Indian state of Bihar. BMJ Glob Health 2023; 8:e013021. [PMID: 37491108 PMCID: PMC10373740 DOI: 10.1136/bmjgh-2023-013021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023] Open
Abstract
INTRODUCTION We report on the stillbirth rate (SBR) and associated risk factors for births during the COVID-19 pandemic, and change in SBR between prepandemic (2016) and pandemic periods in the Indian state of Bihar. METHODS Births between July 2020 and June 2021 (91.5% participation) representative of Bihar were listed. Stillbirth was defined as fetal death with gestation period of ≥7 months where the fetus did not show any sign of life. Detailed interviews were conducted for all stillbirths and neonatal deaths, and for 25% random sample of surviving live births. We estimated overall SBR, and during COVID-19 peak and non-peak periods per 1000 births. Multiple logistic regression models were run to assess risk factors for stillbirth. The change in SBR for Bihar from 2016 to 2020-2021 was estimated. RESULTS We identified 582 stillbirths in 30 412 births with an estimated SBR of 19.1 per 1000 births (95% CI 17.7 to 20.7); SBR was significantly higher in private facility (38.4; 95% CI 34.3 to 43.0) than in public facility (8.6; 95% CI 7.3 to 10.1) births, and for COVID-19 peak (21.2; 95% CI 19.2 to 23.4) than non-peak period (16.3; 95% CI 14.2 to 18.6) births. Pregnancies with the last pregnancy trimester during the COVID-19 peak period had 40.4% (95% CI 10.3% to 70.4%) higher SBR than those who did not. Risk factor associations for stillbirths were similar between the COVID-19 peak and non-peak periods, with gestation age of <8 months with the highest odds of stillbirth followed by referred deliveries and deliveries in private health facilities. A statistically significant increase of 24.3% and 68.9% in overall SBR and intrapartum SBR was seen between 2016 and 2020-2021, respectively. CONCLUSIONS This study documented an increase in SBR during the COVID-19 pandemic as compared with the prepandemic period, and the varied SBR based on the intensity of the COVID-19 pandemic and by the place of delivery.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - G Anil Kumar
- Public Health Foundation of India, New Delhi, India
| | - Md Akbar
- Public Health Foundation of India, New Delhi, India
| | | | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Dandona R, Majumder M, Akbar M, Bhattacharya D, Nanda P, Kumar GA, Dandona L. Assessment of quality of antenatal care services in public sector facilities in India. BMJ Open 2022; 12:e065200. [PMID: 36456027 PMCID: PMC9716787 DOI: 10.1136/bmjopen-2022-065200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES We undertook assessment of quality of antenatal care (ANC) services in public sector facilities in the Indian state of Bihar state delivered under the national ANC programme (Pradhan Mantri Surakshit Matritva Abhiyan, PMSMA). SETTING Three community health centres and one subdistrict hospital each in two randomly selected districts of Bihar. PARTICIPANTS Pregnant women who sought ANC services under PMSMA irrespective of the pregnancy trimester. PRIMARY AND SECONDARY MEASURES Quality ANC services were considered if a woman received all of these services in that visit-weight, blood pressure and abdomen check, urine and blood sample taken, and were given iron and folic acid and calcium tablets. The process of ANC service provision was documented. RESULTS Eight hundred and fourteen (94.5% participation) women participated. Coverage of quality ANC services was 30.4% (95% CI 27.3% to 33.7%) irrespective of pregnancy trimester, and was similar in both districts and ranged 3%-83.1% across the facilities. Quality ANC service coverage was significantly lower for women in the first trimester of pregnancy (6.8%, 95% CI 3.3% to 13.6%) as compared with those in the second (34.4%, 95% CI 29.9% to 39.1%) and third (32.9%, 95% CI 27.9% to 38.3%) trimester of pregnancy. Individually, the coverage of weight and blood pressure check-up, receipt of iron folic acid (IFA) and calcium tablets, and blood sample collection was >85%. The coverage of urine sample collection was 46.3% (95% CI 42.9% to 49.7%) and of abdomen check-up was 62% (95% CI 58.6% to 65.3%). Poor information sharing post check-up was done with the pregnant women. Varied implementation of ANC service provision was seen in the facilities as compared with the PMSMA guidelines, in particular with laboratory diagnostics and doctor consultation. Task shifting from doctors to ANMs was observed in all facilities. CONCLUSIONS Grossly inadequate quality ANC services under the PMSMA needs urgent attention to improve maternal and neonatal health outcomes.
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Affiliation(s)
- Rakhi Dandona
- Public Health Foundation of India, Gurugram, Haryana, India
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA
| | | | - Md Akbar
- Public Health Foundation of India, Gurugram, Haryana, India
| | | | - Priya Nanda
- Bill & Melinda Gates Foundation India, New Delhi, India
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, Haryana, India
| | - Lalit Dandona
- Public Health Foundation of India, Gurugram, Haryana, India
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, USA
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Obiero CW, Williams P, Murunga S, Thitiri J, Omollo R, Walker AS, Egondi T, Nyaoke B, Correia E, Kane Z, Gastine S, Kipper K, Standing JF, Ellis S, Sharland M, Berkley JA. Randomised controlled trial of fosfomycin in neonatal sepsis: pharmacokinetics and safety in relation to sodium overload. Arch Dis Child 2022; 107:802-810. [PMID: 35078765 PMCID: PMC9411916 DOI: 10.1136/archdischild-2021-322483] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/24/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess pharmacokinetics and changes to sodium levels in addition to adverse events (AEs) associated with fosfomycin among neonates with clinical sepsis. DESIGN A single-centre open-label randomised controlled trial. SETTING Kilifi County Hospital, Kenya. PATIENTS 120 neonates aged ≤28 days admitted being treated with standard-of-care (SOC) antibiotics for sepsis: ampicillin and gentamicin between March 2018 and February 2019. INTERVENTION We randomly assigned half the participants to receive additional intravenous then oral fosfomycin at 100 mg/kg two times per day for up to 7 days (SOC-F) and followed up for 28 days. MAIN OUTCOMES AND MEASURES Serum sodium, AEs and fosfomycin pharmacokinetics. RESULTS 61 and 59 infants aged 0-23 days were assigned to SOC-F and SOC, respectively. There was no evidence of impact of fosfomycin on serum sodium or gastrointestinal side effects. We observed 35 AEs among 25 SOC-F participants and 50 AEs among 34 SOC participants during 1560 and 1565 infant-days observation, respectively (2.2 vs 3.2 events/100 infant-days; incidence rate difference -0.95 events/100 infant-days (95% CI -2.1 to 0.20)). Four SOC-F and 3 SOC participants died. From 238 pharmacokinetic samples, modelling suggests an intravenous dose of 150 mg/kg two times per day is required for pharmacodynamic target attainment in most children, reduced to 100 mg/kg two times per day in neonates aged <7 days or weighing <1500 g. CONCLUSION AND RELEVANCE Fosfomycin offers potential as an affordable regimen with a simple dosing schedule for neonatal sepsis. Further research on its safety is needed in larger cohorts of hospitalised neonates, including very preterm neonates or those critically ill. Resistance suppression would only be achieved for the most sensitive of organisms so fosfomycin is recommended to be used in combination with another antimicrobial. TRIAL REGISTRATION NUMBER NCT03453177.
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Affiliation(s)
- Christina W Obiero
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Phoebe Williams
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sheila Murunga
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnstone Thitiri
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Raymond Omollo
- Global Antibiotic Research and Development Partnership, Nairobi, Kenya
| | | | - Thaddaeus Egondi
- Global Antibiotic Research and Development Partnership, Nairobi, Kenya
| | - Borna Nyaoke
- Global Antibiotic Research and Development Partnership, Nairobi, Kenya
| | - Erika Correia
- Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | - Zoe Kane
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Silke Gastine
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Karin Kipper
- Institute of Chemistry, University of Tartu, Tartu, Estonia.,Analytical Services International (ASI) Ltd, St George's - University of London, London, UK
| | - Joseph F Standing
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sally Ellis
- Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, University of London, London, UK
| | - James Alexander Berkley
- Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya .,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
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Kumar GA, George S, Akbar M, Bhattacharya D, Nanda P, Dandona L, Dandona R. Implications of the availability and distribution of birth weight on addressing neonatal mortality: population-based assessment from Bihar state of India. BMJ Open 2022; 12:e061934. [PMID: 35728896 PMCID: PMC9214371 DOI: 10.1136/bmjopen-2022-061934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE A large proportion of neonatal deaths in India are attributable to low birth weight (LBW). We report population-based distribution and determinants of birth weight in Bihar state, and on the perceptions about birth weight among carers. DESIGN A cross-sectional household survey in a state representative sample of 6007 live births born in 2018-2019. Mothers provided detailed interviews on sociodemographic characteristics and birth weight, and their perceptions on LBW (birth weight <2500 g). We report on birth weight availability, LBW prevalence, neonatal mortality rate (NMR) by birth weight and perceptions of mothers on LBW implications. SETTING Bihar state, India. PARTICIPANTS Women with live birth between October 2018 and September 2019. RESULTS A total of 5021 (83.5%) live births participated, and 3939 (78.4%) were weighed at birth. LBW prevalence among those with available birth weight was 18.4% (95% CI 17.1 to 19.7). Majority (87.5%) of the live births born at home were not weighed at birth. LBW prevalence decreased and birth weight ≥2500 g increased significantly with increasing wealth index quartile. NMR was significantly higher in live births weighing <1500 g (11.3%; 95% CI 5.1 to 23.1) and 1500-1999 g (8.0%; 95% CI 4.6 to 13.6) than those weighing ≥2500 g (1.3%, 95% CI 0.9 to 1.7). Assuming proportional correspondence of LBW and NMR in live births with and without birth weight, the estimated LBW among those without birth weight was 35.5% (95% CI 33.0 to 38.0) and among all live births irrespective of birth weight availability was 23.0% (95% CI 21.9 to 24.2). 70% of mothers considered LBW to be a sign of sickness, 59.5% perceived it as a risk of developing other illnesses and 8.6% as having an increased probability of death. CONCLUSIONS Missing birth weight is substantially compromising the planning of interventions to address LBW at the population-level. Variations of LBW by place of delivery and sociodemographic indicators, and the perceptions of carers about LBW can facilitate appropriate actions to address LBW and the associated neonatal mortality.
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Affiliation(s)
- G Anil Kumar
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Sibin George
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Md Akbar
- Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Priya Nanda
- Bill & Melinda Gates Foundation India, New Delhi, India
| | - Lalit Dandona
- Public Health Foundation of India, Gurgaon, Haryana, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Rakhi Dandona
- Public Health Foundation of India, Gurgaon, Haryana, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Yokobori Y, Matsuura J, Sugiura Y, Mutemba C, Julius P, Himwaze C, Nyahoda M, Mwango C, Kazhumbula L, Yuasa M, Munkombwe B, Mucheleng'anga L. Comparison of the Causes of Death Identified Using Automated Verbal Autopsy and Complete Autopsy among Brought-in-Dead Cases at a Tertiary Hospital in Sub-Sahara Africa. Appl Clin Inform 2022; 13:583-591. [PMID: 35705183 PMCID: PMC9200488 DOI: 10.1055/s-0042-1749118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Over one-third of deaths recorded at health facilities in Zambia are brought in dead (BID) and the causes of death (CODs) are not fully analyzed. The use of automated verbal autopsy (VA) has reportedly determined the CODs of more BID cases than the death notification form issued by the hospital. However, the validity of automated VA is yet to be fully investigated. OBJECTIVES To compare the CODs identified by automated VA with those by complete autopsy to examine the validity of a VA tool. METHODS The study site was the tertiary hospital in the capital city of Zambia. From September 2019 to January 2020, all BID cases aged 13 years and older brought to the hospital during the daytime on weekdays were enrolled in this study. External COD cases were excluded. The deceased's relatives were interviewed using the 2016 World Health Organization VA questionnaire. The data were analyzed using InterVA, an automated VA tool, to determine the CODs, which were compared with the results of complete autopsies. RESULTS A total of 63 cases were included. The CODs of 50 BID cases were determined by both InterVA and complete autopsies. The positive predictive value of InterVA was 22%. InterVA determined the CODs correctly in 100% cases of maternal CODs, 27.5% cases of noncommunicable disease CODs, and 5.3% cases of communicable disease CODs. Using the three broader disease groups, 56.0% cases were classified in the same groups by both methods. CONCLUSION While the positive predictive value was low, more than half of the cases were categorized into the same broader categories. However, there are several limitations in this study, including small sample size. More research is required to investigate the factors leading to discrepancies between the CODs determined by both methods to optimize the use of automated VA in Zambia.
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Affiliation(s)
- Yuta Yokobori
- National Center for Global Health and Medicine, Shinjuku-ku, Japan,Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan,Address for correspondence Yuta Yokobori, MD, MPH, MSc 1-21-1, Toyama, Shinjuku-ku, TokyoJapan
| | - Jun Matsuura
- National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Yasuo Sugiura
- National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Charles Mutemba
- Ministry of Health, Lusaka, Zambia,Adult Hospital, University Teaching Hospital, Lusaka, Zambia
| | - Peter Julius
- Ministry of Health, Lusaka, Zambia,Department of Pathology and Microbiology, School of Medicine, The University of Zambia, Lusaka, Zambia
| | - Cordelia Himwaze
- Ministry of Health, Lusaka, Zambia,Department of Pathology and Microbiology, School of Medicine, The University of Zambia, Lusaka, Zambia
| | - Martin Nyahoda
- Department of National Registration of Home Passport & Citizenship, Ministry Affairs, Lusaka, Zambia
| | - Chomba Mwango
- Bloomberg Data for Health Initiative, Lusaka, Zambia
| | | | - Motoyuki Yuasa
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Brian Munkombwe
- National Center for Health Statistics, Center for Disease Control and Prevention, Atlanta, United States
| | - Luchenga Mucheleng'anga
- Office of the State Forensic Pathologist, Ministry of Home Affairs and Internal Security, Lusaka, Zambia
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Odejimi A, Quinley J, Eluwa GI, Kunnuji M, Wammanda RD, Weiss W, James F, Bello M, Ogunlewe A, King R, Franca-Koh AC. Causes of deaths in neonates and children aged 1-59 months in Nigeria: verbal autopsy findings of 2019 Verbal and Social Autopsy study. BMC Public Health 2022; 22:1130. [PMID: 35668378 PMCID: PMC9172014 DOI: 10.1186/s12889-022-13507-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Nigeria has one of the highest under-five mortality rates in the world. Identifying the causes of these deaths is crucial to inform changes in policy documents, design and implementation of appropriate interventions to reduce these deaths. This study aimed to provide national and zonal-level estimates of the causes of under-five death in Nigeria in the 2013–2018 periods. Methods We conducted retrospective inquiries into the cause of deaths of 948 neonates and 2,127 children aged 1–59 months as identified in the 2018 Nigeria Demographic and Health Survey (NDHS). The verbal autopsy asked about signs and symptoms during the final illness. The Physician Coded Verbal Autopsy (PCVA) and Expert Algorithm Verbal Autopsy (EAVA) methods were employed to assign the immediate and underlying cause of deaths to all cases. Result For the analysis, sampling weights were applied to accommodate non-proportional allocation. Boys accounted for 56 percent of neonatal deaths and 51.5 percent of the 1–59-months old deaths. About one-quarter of under-5 mortality was attributed to neonatal deaths, and 50 percent of these neonatal deaths were recorded within 48 h of delivery. Overall, 84 percent of the under-5 deaths were in the northern geopolitical zones. Based on the two methods for case analysis, neonatal infections (sepsis, pneumonia, and meningitis) were responsible for 44 percent of the neonatal deaths, followed by intrapartum injury (PCVA: 21 percent vs. EAVA: 29 percent). The three main causes of death in children aged 1–59 months were malaria (PCVA: 23 percent vs. EAVA: 35 percent), diarrhoea (PCVA: 17 percent vs. EAVA: 23 percent), and pneumonia (PCVA: 10 percent vs. EAVA: 12 percent). In the North West, where the majority of under-5 (1–59 months) deaths were recorded, diarrhoea was the main cause of death (PCVA: 24.3 percent vs. EAVA: 30 percent). Conclusion The causes of neonatal and children aged 1–59 months deaths vary across the northern and southern regions. By homing on the specific causes of mortality by region, the study provides crucial information that may be useful in planning appropriately tailored interventions to significantly reduce under-five deaths in Nigeria. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13507-z.
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Affiliation(s)
- Adeyinka Odejimi
- Department of Health Planning, Research, and Statistics, Federal Ministry of Health, Abuja, Nigeria.
| | | | | | - Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | - Robinson Daniel Wammanda
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
| | - William Weiss
- Department of International Health, Johns Hopkins University, Baltimore, USA
| | - Femi James
- Department of Family Health, Child Health Division, Federal Ministry of Health, Abuja, Nigeria
| | - Mustapha Bello
- Department of Paediatrics, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria
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Kannaujiya AK, Kumar K, Upadhyay AK, McDougal L, Raj A, James KS, Singh A. Effect of preterm birth on early neonatal, late neonatal, and postneonatal mortality in India. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000205. [PMID: 36962696 PMCID: PMC10021707 DOI: 10.1371/journal.pgph.0000205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022]
Abstract
Despite India having a high burden of infant deaths and preterm birth, there is a clear lack of studies documenting association between preterm birth and infant mortality in India. Additionally, existing studies have failed to account for unobserved heterogeneity while linking preterm birth with infant mortality. Hence, the present study examines association of preterm birth with early neonatal death (ENND), late neonatal death (LNND), and postneonatal death (PNND) in India. We used the reproductive calendar canvassed in the cross-sectional National Family Health Survey 2015-16 (NFHS-4) to identify preterm births. We used multivariable logistic regression to examine the associations for all births, most-, second most-, and third most- recent births occurred in five years preceding NFHS-4. We use mother fixed-effect logistic regression to confirm the associations among all recent births. Among all births, preterm births were 4.2, 3.8, and 1.7 times as likely as full-term births to die during early neonatal, late neonatal, and postneonatal periods respectively. Among most recent births, preterm births were 4.4, 4.0, and 2.0 times as likely as full-term births to die during early neonatal, late neonatal, and postneonatal periods respectively. Preterm births were also associated with risk of only ENND, LNND, and PNND among the second most recent births. Preterm births were associated with risk of only ENND and LNND among the third most recent births. Preterm births were also associated with ENND, LNND, and PNND in the mother fixed-effects regressions. This study establishes associations of preterm birth with ENND, LNND, and PNND in India using over 0.2 million births that occurred in 5 years preceding one of the largest population-based representative household surveys conducted in any part of the world. Our findings call for programmatic and policy interventions to address the considerable burden of preterm birth in the country.
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Affiliation(s)
| | - Kaushalendra Kumar
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | | | - Lotus McDougal
- Center on Gender Equity and Health, University of California San Diego, San Diego, California, United States of America
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego, San Diego, California, United States of America
| | - K S James
- International Institute for Population Sciences, Mumbai, India
| | - Abhishek Singh
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
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Is newborn survival influenced by place of delivery? A comparison of home, public sector and private sector deliveries in India. J Biosoc Sci 2021; 54:184-198. [PMID: 33685536 DOI: 10.1017/s0021932021000080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In 2005 and again in 2011, the Government of India launched schemes to encourage institutional delivery among poor women, with the aim of improving maternal and newborn health outcomes. Partly as a result of these initiatives, the proportion of children born in a health facility rose steeply from 42% in 2000-2005 to 81% a decade later. In this context, the objective of this paper was to determine the association between place of delivery (public sector, private sector, home) and early neonatal mortality, defined as death in the first 7 days after birth. The focus was on early neonatal mortality because over half of all under-five deaths occur in his period and because the protective effect of an institutional place of birth should be strongest in those few early days. Both bivariate methods and multivariate logistic regression analysis were applied to data from the fourth round of the National Family Health Survey conducted in 2015-16. For the country as a whole, it was found that the adjusted odds of death in the early neonatal period were lower for deliveries in public health facilities than for home deliveries (OR 0.833 p<0.01), but no significant difference was found between deliveries in private health facilities and at home. Adjusted odds of death were higher for deliveries in private than public sector facilities (OR 1.41 p<0.01). On further investigation, for the poor in Bihar and Uttar Pradesh, it was found that the risks of dying in the early neonatal period were even higher for babies delivered in private health facilities than for home deliveries with adjusted odds of over 2.0. These results raise serious questions about quality of care in the private sector in India. In the context of increased emphasis on public-private partnerships in health services provision in the country, it becomes imperative to enforce better inspection, licensing and quality control of private sector facilities, especially in the states of Bihar and Uttar Pradesh.
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11
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Dandona R, Kumar GA, Henry NJ, Joshua V, Ramji S, Gupta SS, Agrawal D, Kumar R, Lodha R, Mathai M, Kassebaum NJ, Pandey A, Wang H, Sinha A, Hemalatha R, Abdulkader RS, Agarwal V, Albert S, Biswas A, Burstein R, Chakma JK, Christopher DJ, Collison M, Dash AP, Dey S, Dicker D, Gardner W, Glenn SD, Golechha MJ, He Y, Jerath SG, Kant R, Kar A, Khera AK, Kinra S, Koul PA, Krish V, Krishnankutty RP, Kurpad AV, Kyu HH, Laxmaiah A, Mahanta J, Mahesh PA, Malhotra R, Mamidi RS, Manguerra H, Mathew JL, Mathur MR, Mehrotra R, Mukhopadhyay S, Murthy GVS, Mutreja P, Nagalla B, Nguyen G, Oommen AM, Pati A, Pati S, Perkins S, Prakash S, Purwar M, Sagar R, Sankar MJ, Saraf DS, Shukla DK, Shukla SR, Singh NP, Sreenivas V, Tandale B, Thankappan KR, Tripathi M, Tripathi S, Tripathy S, Troeger C, Varghese CM, Varughese S, Watson S, Yadav G, Zodpey S, Reddy KS, Toteja GS, Naghavi M, Lim SS, Vos T, Bekedam HJ, Swaminathan S, Murray CJL, Hay SI, Sharma RS, Dandona L. Subnational mapping of under-5 and neonatal mortality trends in India: the Global Burden of Disease Study 2000-17. Lancet 2020; 395:1640-1658. [PMID: 32413293 PMCID: PMC7262604 DOI: 10.1016/s0140-6736(20)30471-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND India has made substantial progress in improving child survival over the past few decades, but a comprehensive understanding of child mortality trends at disaggregated geographical levels is not available. We present a detailed analysis of subnational trends of child mortality to inform efforts aimed at meeting the India National Health Policy (NHP) and Sustainable Development Goal (SDG) targets for child mortality. METHODS We assessed the under-5 mortality rate (U5MR) and neonatal mortality rate (NMR) from 2000 to 2017 in 5 × 5 km grids across India, and for the districts and states of India, using all accessible data from various sources including surveys with subnational geographical information. The 31 states and groups of union territories were categorised into three groups using their Socio-demographic Index (SDI) level, calculated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study on the basis of per-capita income, mean education, and total fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using the coefficient of variation. We projected U5MR and NMR for the states and districts up to 2025 and 2030 on the basis of the trends from 2000 to 2017 and compared these projections with the NHP 2025 and SDG 2030 targets for U5MR (23 deaths and 25 deaths per 1000 livebirths, respectively) and NMR (16 deaths and 12 deaths per 1000 livebirths, respectively). We assessed the causes of child death and the contribution of risk factors to child deaths at the state level. FINDINGS U5MR in India decreased from 83·1 (95% uncertainty interval [UI] 76·7-90·1) in 2000 to 42·4 (36·5-50·0) per 1000 livebirths in 2017, and NMR from 38·0 (34·2-41·6) to 23·5 (20·1-27·8) per 1000 livebirths. U5MR varied 5·7 times between the states of India and 10·5 times between the 723 districts of India in 2017, whereas NMR varied 4·5 times and 8·0 times, respectively. In the low SDI states, 275 (88%) districts had a U5MR of 40 or more per 1000 livebirths and 291 (93%) districts had an NMR of 20 or more per 1000 livebirths in 2017. The annual rate of change from 2010 to 2017 varied among the districts from a 9·02% (95% UI 6·30-11·63) reduction to no significant change for U5MR and from an 8·05% (95% UI 5·34-10·74) reduction to no significant change for NMR. Inequality between districts within the states increased from 2000 to 2017 in 23 of the 31 states for U5MR and in 24 states for NMR, with the largest increases in Odisha and Assam among the low SDI states. If the trends observed up to 2017 were to continue, India would meet the SDG 2030 U5MR target but not the SDG 2030 NMR target or either of the NHP 2025 targets. To reach the SDG 2030 targets individually, 246 (34%) districts for U5MR and 430 (59%) districts for NMR would need a higher rate of improvement than they had up to 2017. For all major causes of under-5 death in India, the death rate decreased between 2000 and 2017, with the highest decline for infectious diseases, intermediate decline for neonatal disorders, and the smallest decline for congenital birth defects, although the magnitude of decline varied widely between the states. Child and maternal malnutrition was the predominant risk factor, to which 68·2% (65·8-70·7) of under-5 deaths and 83·0% (80·6-85·0) of neonatal deaths in India could be attributed in 2017; 10·8% (9·1-12·4) of under-5 deaths could be attributed to unsafe water and sanitation and 8·8% (7·0-10·3) to air pollution. INTERPRETATION India has made gains in child survival, but there are substantial variations between the states in the magnitude and rate of decline in mortality, and even higher variations between the districts of India. Inequality between districts within states has increased for the majority of the states. The district-level trends presented here can provide crucial guidance for targeted efforts needed in India to reduce child mortality to meet the Indian and global child survival targets. District-level mortality trends along with state-level trends in causes of under-5 and neonatal death and the risk factors in this Article provide a comprehensive reference for further planning of child mortality reduction in India. FUNDING Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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