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Borghesi A. Life-threatening infections in human newborns: Reconciling age-specific vulnerability and interindividual variability. Cell Immunol 2024; 397-398:104807. [PMID: 38232634 DOI: 10.1016/j.cellimm.2024.104807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Abstract
In humans, the interindividual variability of clinical outcome following exposure to a microorganism is immense, ranging from silent infection to life-threatening disease. Age-specific immune responses partially account for the high incidence of infection during the first 28 days of life and the related high mortality at population level. However, the occurrence of life-threatening disease in individual newborns remains unexplained. By contrast, inborn errors of immunity and their immune phenocopies are increasingly being discovered in children and adults with life-threatening viral, bacterial, mycobacterial and fungal infections. There is a need for convergence between the fields of neonatal immunology, with its in-depth population-wide characterization of newborn-specific immune responses, and clinical immunology, with its investigations of infections in patients at the cellular and molecular levels, to facilitate identification of the mechanisms of susceptibility to infection in individual newborns and the design of novel preventive and therapeutic strategies.
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Affiliation(s)
- Alessandro Borghesi
- Neonatal Intensive Care Unit, San Matteo Research Hospital, Pavia, EU, Italy; School of Life Sciences, Swiss Federal Institute of Technology, Lausanne, Switzerland.
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Okoroiwu HU, Edet UO, Uchendu IK, Echieh CP, Nneoyi-Egbe AF, Anyanwu SO, Umoh EA, Nwaiwu NP, Mbabuike IU. Causes of infant and under-five (under-5) morbidity and mortality among hospitalized patients in Southern Nigeria: A hospital based study. J Public Health Res 2024; 13:22799036241231787. [PMID: 38405688 PMCID: PMC10894548 DOI: 10.1177/22799036241231787] [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] [Received: 07/04/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Background Rate and pattern of under-five mortality is a reflection of a society's healthcare system and quality of life. This study is aimed at reviewing the causes of infants and under-five morbidity and mortality in Calabar, Southern Nigeria. Methods This study used retrospective descriptive cross-sectional design. We did a retrospective collation of data on under-five morbidity and mortality from 2012 to 2017 of under-five patients admitted or died while in admission in University of Calabar Teaching Hospital. The causes of morbidity and mortality were reported based on International Classification of Diseases 10 (ICD-10). The morbidity, mortality and fatality rates were computed. Results A total of 11,416 under-five admissions and 391 deaths were recorded within the study period giving a fatality rate of 3.4%. Age 1-4 years category represented 50.5% of the admissions while infants (<1 year) constitute majority of the deaths (64.7%). There were 5652 infant admissions and 253 infant deaths giving fatality rate of 4.5% within the study period. Males constituted majority (55.8%) of under-five morbidity whereas females constituted majority (51.2%) of the deaths. Conditions originating from perinatal period; and infectious and parasitic diseases were the leading broad cause of under-five mortality. Specific disease analysis showed sepsis/septicemia; congenital infectious and parasitic diseases; slow fetal growth, malnutrition and short gestation as the chief causes of both infant and under-five mortality. Conclusion The leading causes of under-five deaths in the studied population are amenable. Improved healthcare and antenatal will be of immense benefit.
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Affiliation(s)
- Henshaw Uchechi Okoroiwu
- Medical Laboratory Science Department, Faculty of Health Sciences and Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
- Haematology Unit, Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
| | - Uwem Okon Edet
- Department of Biological Science (Microbiology Unit), Faculty of Natural and Applied Sciences, Arthur Jarvis University, Akpabuyo, Cross River State, Nigeria
| | - Ikenna Kingsley Uchendu
- Clinical Chemistry Division, Department of Medical Laboratory Science, University of Nigeria, Enugu, Nigeria
| | - Chidiebere Peter Echieh
- Division of Cardiothoracic Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Stanley Obialor Anyanwu
- Department of Histopathology, Faculty of Medical Laboratory Science, University of Calabar, Calabar, Cross River State, Nigeria
| | | | - Ndidi Patience Nwaiwu
- Medical Laboratory Science Department, Imo State University, Owerri, Imo State, Nigeria
| | - Ikenna Uchechukwu Mbabuike
- Biomedical Engineering Department, Faculty of Health Sciences and Technology, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
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Kalter HD, Koffi AK, Perin J, Kamwe MA, Black RE. Maternal interventions to decrease stillbirths and neonatal mortality in Tanzania: evidence from the 2017-18 cross-sectional Tanzania verbal and social autopsy study. BMC Pregnancy Childbirth 2023; 23:849. [PMID: 38082404 PMCID: PMC10714492 DOI: 10.1186/s12884-023-06099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Reduction of Tanzania's neonatal mortality rate has lagged behind that for all under-fives, and perinatal mortality has remained stagnant over the past two decades. We conducted a national verbal and social autopsy (VASA) study to estimate the causes and social determinants of stillbirths and neonatal deaths with the aim of identifying relevant health care and social interventions. METHODS A VASA interview was conducted of all stillbirths and neonatal deaths in the prior 5 years identified by the 2015-16 Tanzania Demographic and Health Survey. We evaluated associations of maternal complications with antepartum and intrapartum stillbirth and leading causes of neonatal death; conducted descriptive analyses of antenatal (ANC) and delivery care and mothers' careseeking for complications; and developed logistic regression models to examine factors associated with delivery place and mode. RESULTS There were 204 stillbirths, with 185 able to be classified as antepartum (88 [47.5%]) or intrapartum (97 [52.5%]), and 228 neonatal deaths. Women with an intrapartum stillbirth were 6.5% (adjusted odds ratio (aOR) = 1.065, 95% confidence interval (CI) 1.002, 1.132) more likely to have a C-section for every additional hour before delivery after reaching the birth attendant. Antepartum hemorrhage (APH), maternal anemia, and premature rupture of membranes (PROM) were significantly positively associated with early neonatal mortality due to preterm delivery, intrapartum-related events and serious infection, respectively. While half to two-thirds of mothers made four or more ANC visits (ANC4+), a third or fewer received quality ANC (Q-ANC). Women with a complication were more likely to deliver at hospital only if they received Q-ANC (neonates: aOR = 4.5, 95% CI 1.6, 12.3) or ANC4+ (stillbirths: aOR = 11.8, 95% CI 3.6, 38.0). Nevertheless, urban residence was the strongest predictor of hospital delivery. CONCLUSIONS While Q-ANC and ANC4 + boosted hospital delivery among women with a complication, attendance was low and the quality of care is critical. Quality improvement efforts in urban and rural areas should focus on early detection and management of APH, maternal anemia, PROM, and prolonged labor, and on newborn resuscitation.
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Affiliation(s)
- Henry D Kalter
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Alain K Koffi
- Department of International Health, Health Systems, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Jamie Perin
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Mlemba A Kamwe
- National Bureau of Statistics, Dodoma, United Republic of Tanzania
| | - Robert E Black
- Department of International Health, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Wamyil-Mshelia T, Madaki S, Isiyaku S, Shu'aibu J, Olobio NP, Aliero AA, Abdulsalam M, Taiwo J, McDickoh VJ. Treatment coverage of mass administration of azithromycin among children aged 1-11 months in 21 districts of Kebbi state, Nigeria. Int Health 2023; 15:ii12-ii18. [PMID: 38048379 PMCID: PMC10695469 DOI: 10.1093/inthealth/ihad086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The WHO recommends mass drug administration (MDA) as a strategy to deliver safe and cost-effective medicines to prevent and treat diseases. The antibiotic, azithromycin, has been used during MDA for the treatment and prevention of trachoma in Nigeria. Azithromycin has recently been shown to reduce infant mortality in communities receiving it for trachoma-elimination purposes in sub-Saharan Africa. This article reports on the implementation strategies for the safety and antimicrobial resistance of mass administration of azithromycin to children aged 1-11 mo using the trachoma programme platform in Kebbi state. METHODS The mass administration of azithromycin among 1-11-mo-olds in Kebbi was implemented in three phases: (i) the preimplementation phase, during which specific activities were conducted to achieve government and community buy-in, ownership and capacity building; (ii) the implementation phase, which included the mass administration of azithromycin carried out by community volunteers (also known as community-directed distributors [CDDs]), monitoring (by health workers and independent monitors) and reporting of the distribution by all personnel; and (iii) the postimplementation phase, which included the validation of community data, where each item of community summary data is verified and checked for completeness and accuracy before uploading to the District Health Information System platform, where data are visualised, analysed and stored. RESULTS In total, 97% of the target population received treatment; the remaining 3% were not treated due to signs of ill health, history of allergy to antibiotics, parental refusal or absence at the time of MDA. Children aged 1-11 mo accounted for 17% of the under-5 population, with females constituting 56% of the target population. In communities that were monitored, reports showed that only 5% lacked distribution materials (scales, slings or registers), >80% correctly entered data into community registers and 5% of children were not treated due to inadequate azithromycin provided to the CDDs for distribution. CONCLUSION The implementation of azithromycin MDA for children aged 1-11 mo in Kebbi, utilising the trachoma platform, exhibited commendable coverage due to existing programme platform, healthcare and community structures, intensive advocacy and social mobilisation, real-time monitoring and progress-tracking strategies. It also demonstrated that the trachoma platform is suitable for implementing public health interventions, even after the elimination of trachoma in previously endemic districts.
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Affiliation(s)
| | - Suzie Madaki
- Sightsavers Nigeria Country Office, Abuja, Nigeria
| | | | - Joy Shu'aibu
- Sightsavers Nigeria Country Office, Abuja, Nigeria
| | - Nicholas P Olobio
- National Trachoma Elimination Programme, Neglected Tropical Diseases Division (NTDs), Department of Public Health Federal Ministry of Health, Abuja, Nigeria
| | - Attahiru A Aliero
- Neglected Tropical Disease Office, Department of Public Health, State Ministry of Health, Kebbi State, Nigeria
| | | | - Joshua Taiwo
- Sightsavers Nigeria Country Office, Abuja, Nigeria
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Adepoju VA, Oladimeji O. A Comparative Analysis of Patient Profiles and Health Service Utilization between Patent Medicine Vendors and Community Pharmacists in Nigeria. Healthcare (Basel) 2023; 11:2484. [PMID: 37761681 PMCID: PMC10530569 DOI: 10.3390/healthcare11182484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND This study examined Nigeria's socio-demographic profiles and health service utilization patterns of Patent Medicine Vendors (PMVs) and Community Pharmacists (CPs). METHOD A cross-sectional study using a structured self-administered questionnaire among 405 retail outlets (322 PMVs and 83 CPs) across 16 Lagos and Kebbi Local Government Areas (LGAs) between June 2020 and December 2020. RESULTS Results showed that 60.4% were male, 76.3% from Lagos, 58.3% had tertiary education, and 74.1% had medical training. Cough and fever were common symptoms. Significant differences were found in the utilization of STD services (PMVs: 9.2%, CPs: 12.3%, p = 0.03), services by age <15 (PMVs: 54.3, CPs: 61.2, p < 0.001), and utilization by males (PMVs: 50.8, CPs: 47.1, p = 0.013). The study revealed that men visited PMVs more, while CPs used more STI services and childhood visits. CONCLUSIONS The findings suggest that expanding health services among PMVs could target male-dominant diseases, and capacity building of CPs on syndromic STI management could reduce the STI burden.
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Affiliation(s)
- Victor Abiola Adepoju
- Department of HIV and Infectious Diseases, Jhpiego (An Affiliate of Johns Hopkins University), Abuja 190918, Nigeria
| | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5099, Eastern Cape, South Africa;
- Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
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Risk factors of mortality among children under age five in Awi Zone, northwest Ethiopia. PLoS One 2022; 17:e0275659. [PMID: 36197924 PMCID: PMC9534439 DOI: 10.1371/journal.pone.0275659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Globally, under-five mortality rates have dropped, but in Ethiopia, the under-five mortality rate is still high. In Amhara region, the death of children under the age of five is still a public health problem. This study assessed the risk factors of mortality among children under age five in Awi Zone. METHOD A community-based cross-sectional study was conducted from December 1, 2020, up to April 30, 2021. Data entry and analysis were conducted using SPSS version 26 and Stata version 16, respectively. A zero-inflated Poisson regression model was fitted to identify the risk factors of under-five mortality. RESULT Out of the 1,340 mothers in the Awi zone, 11.9% of women lost at least one child. Single births (IRR = 0.598, 95% CI: 0.395, 0.906), fathers whose level of education is secondary or above(IRR = 0.223, 95% CI: 0.064, 0.782), mothers who completed their secondary and above education level(IRR = 0.116, 95% CI: 0.014, 0.971), mothers who have birth interval greater than 24 months (IRR = 0.619,95% CI: 0.417, 0.917), 8 and above family size the households (IRR = 0.543, 95% CI: 0.302, 0.976), 31 and above mother age groups (IRR = 0.296, 95% CI: 0.093, 0.943), medium households of mothers (IRR = 0.540, 95% CI: 0.316, 0.920), working mothers (IRR = 1.691, 95% CI: 1.040, 2.748) and mothers who had not antenatal visits during pregnancy (IRR = 2.060, 95% CI: 1.259, 3.371) were significant factors of under-five mortality. CONCLUSION Mother's age group, preceding birth interval, family size, wealth index, duration of pregnancy, antenatal visits during pregnancy, types of birth, mother's education level, husband's education level, and place of delivery were significant factors of under-five mortality in Awi zone. So, Awi zone public health institute, Awi zone children's and youth office, and other relevant bodies should work to reduce under-five mortality by focusing on child mortality issues.
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King C, Siddle M, Adams O, Ahmar S, Ahmed T, Bakare AA, Bakare D, Burgess RA, Colbourn T, McCollum ED, Olowookere T, Salako J, Uchendu O, Graham HR, Falade AG. Prevalence of pneumonia and malnutrition among children in Jigawa state, Nigeria: a community-based clinical screening study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001640. [PMID: 36645778 PMCID: PMC9577914 DOI: 10.1136/bmjpo-2022-001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the point prevalence of pneumonia and malnutrition and explore associations with household socioeconomic factors. DESIGN Community-based cross-sectional study conducted in January-June 2021 among a random sample of households across all villages in the study area. SETTING Kiyawa Local Government Area, Jigawa state, Nigeria. PARTICIPANTS Children aged 0-59 months who were permanent residents in Kiyawa and present at home at the time of the survey. MAIN OUTCOME MEASURES Pneumonia (non-severe and severe) defined using WHO criteria (2014 revision) in children aged 0-59 months. Malnutrition (moderate and severe) defined using mid-upper arm circumference in children aged 6-59 months. RESULTS 9171 children were assessed, with a mean age of 24.8 months (SD=15.8); 48.7% were girls. Overall pneumonia (severe or non-severe) point prevalence was 1.3% (n=121/9171); 0.6% (n=55/9171) had severe pneumonia. Using an alternate definition that did not rely on caregiver-reported cough/difficult breathing revealed higher pneumonia prevalence (n=258, 2.8%, 0.6% severe, 2.2% non-severe). Access to any toilet facility was associated with lower odds of pneumonia (aOR: 0.56; 95% CI: 0.31 to 1.01). The prevalence of malnutrition (moderate or severe) was 15.6% (n=1239/7954) with 4.1% (n=329/7954) were severely malnourished. Being older (aOR: 0.22; 95% CI: 0.17 to 0.27), male (aOR: 0.77; 95% CI: 0.66 to 0.91) and having head of compound a business owner or professional (vs subsistence farmer, aOR 0.71; 95% CI: 0.56 to 0.90) were associated with lower odds of malnutrition. CONCLUSIONS In this large, representative community-based survey, there was a considerable pneumonia and malnutrition morbidity burden. We noted challenges in the diagnosis of Integrated Management of Childhood Illness-defined pneumonia in this context.
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Affiliation(s)
- Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Morgan Siddle
- Institute for Global Health, University College London, London, UK
| | - Osebi Adams
- Save the Children International, Abuja, Nigeria
| | | | | | - Ayobami Adebayo Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine, University College Hospital Ibadan, Ibadan, Nigeria
| | - Damola Bakare
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | | | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Julius Salako
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | - Obioma Uchendu
- Department of Community Medicine, University College Hospital Ibadan, Ibadan, Nigeria.,Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hamish R Graham
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria .,International Child Health, MCRI, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adegoke Gbadegesin Falade
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria.,College of Medicine, University of Ibadan, Ibadan, Nigeria
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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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Kunnuji M, Wammanda RD, Ojogun TO, Quinley J, Oguche S, Odejimi A, Weiss W, Abba BI, King R, Franca-Koh A. Health beliefs and (timely) use of facility-based care for under-five children: lessons from the qualitative component of Nigeria's 2019 VASA. BMC Public Health 2022; 22:850. [PMID: 35484514 PMCID: PMC9047270 DOI: 10.1186/s12889-022-13238-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background Nigeria’s under-five health outcomes have improved over the years, but the mortality rates remain unacceptably high. The qualitative component of Nigeria’s 2019 verbal and social autopsy (VASA) showed that caregivers’ health beliefs about causes of illnesses and efficacious treatment options contribute to non-use/delay in use of facility-based healthcare for under-five children. This study explored how these health beliefs vary across zones and how they shape how caregivers seek healthcare for their under-five children. Methods Data for this study come from the qualitative component of the 2019 Nigeria VASA, comprising 69 interviews with caregivers of under-five children who died in the five-year period preceding the 2018 Nigeria Demographic and Health Survey (NDHS); and 24 key informants and 48 focus group discussions (FGDs) in 12 states, two from each of the six geo-political zones. The transcripts were coded using predetermined themes on health beliefs from the 2019 VASA (qualitative component) using NVivo. Results The study documented zonal variation in belief in traditional medicine, biomedicine, spiritual causation of illnesses, syncretism, and fatalism, with greater prevalence of beliefs discouraging use of facility-based healthcare in the southern zones. Driven by these beliefs and factors such as availability, affordability, and access to and perceived quality of care in health facilities, caregivers often choose one or a combination of traditional medicines, care from medicine vendors, and faith healing. Most use facility-based care as the last option when other methods fail. Conclusion Caregivers’ health beliefs vary by zones, and these beliefs influence when and whether they will use facility-based healthcare services for their under-five children. In Nigeria’s northern zones, health beliefs are less likely to deter caregivers from using facility-based healthcare services, but they face other barriers to accessing facility-based care. Interventions seeking to reduce under-five deaths in Nigeria need to consider subnational differences in caregivers’ health beliefs and the healthcare options they choose based on those beliefs.
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Affiliation(s)
- Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria.
| | - Robinson Daniel Wammanda
- Department of Paediatrics, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - John Quinley
- Social Solution International, CIRCLE Project, Rockville, USA
| | - Stephen Oguche
- Department of Paediatrics, Faculty of Clinical Sciences, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Adeyinka Odejimi
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - William Weiss
- USAID Senior Monitoring & Evaluation Advisor, IPA Mobility Program/Johns Hopkins University, Baltimore, USA
| | | | - Rebekah King
- Social Solutions International (United States), Rockville, USA
| | - Ana Franca-Koh
- Social Solutions International (United States), Rockville, USA
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Common childhood illnesses: a cross-sectional study of commodity stocking patterns and management knowledge among patent and proprietary medicine vendors in Nigeria. Arch Public Health 2022; 80:88. [PMID: 35317867 PMCID: PMC8939160 DOI: 10.1186/s13690-022-00846-x] [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] [Received: 09/27/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background The trio of commonest illnesses and causes mortality among children under five (Malaria, Pneumonia and Diarrhea) are easily treatable through timely exposure to cost effective interventions at the community level. Patent and proprietary medicine vendors (PPMVs) are a leading source of care for illnesses among under-five children in Nigeria. This study was designed to explore child health services offering, particularly commodity stocking patterns and case management knowledge for common childhood illnesses among PPMVs in Ebonyi and Kaduna States. Methods A descriptive cross-sectional study was conducted among PPMVs in four local government areas across Ebonyi and Kaduna States. Data was collected using semi-structured interviewer-administered questionnaires. Information was obtained on medicine and supplies, knowledge of common childhood illnesses management and referral practices. Results A total of 374 PPMVs were interviewed; the mean age was 33.7 ± 9.8 years. Among the 132 health trained respondents, 59.0% offer treatment services for sick children while 83.5% of the non-health trained respondents offer the same service. At least, 88.0% of the respondents keep stock ACTs, Amoxycilin DT, ORS and Zinc. About 38.5% reported stock-out of ACTs in the month preceding the study, 55.1% reported stock out lasting only 0 to 6 days. Only 83 (22.2%) of respondents knew the correct diagnosis of fast breathing among children aged 2 to less than 12 months old. Education and health training background were associated with a good knowledge of common childhood illnesses management (X2 = 44.88, p < 0.001; X2 = 27.14, p < 0.001). Conclusion The relative constant availability of medicines and commodities for managing childhood illnesses positions PPMVs as a preferred source of care for these illnesses. There is a need to complement steady stock availability with provision of quality services by exposing PPMVs to trainings on integrated community case management of childhood illnesses and implementation of robust supervision mechanism to monitor them.
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Dasgupta RR, Mao W, Ogbuoji O. Addressing child health inequity through case management of under-five malaria in Nigeria: an extended cost-effectiveness analysis. Malar J 2022; 21:81. [PMID: 35264153 PMCID: PMC8905868 DOI: 10.1186/s12936-022-04113-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/02/2022] [Indexed: 11/27/2022] Open
Abstract
Background Under-five malaria in Nigeria is a leading cause of global child mortality, accounting for 95,000 annual child deaths. High out-of-pocket medical expenditure contributes to under-five malaria mortality by discouraging care-seeking and use of effective anti-malarials in the poorest households. The significant inequity in child health outcomes in Nigeria stresses the need to evaluate the outcomes of potential interventions across socioeconomic lines. Methods Using a decision tree model, an extended cost-effectiveness analysis was done to determine the effects of subsidies covering the direct and indirect costs of case management of under-five malaria in Nigeria. This analysis estimates the number of child deaths averted, out-of-pocket (OOP) expenditure averted, cases of catastrophic health expenditure (CHE) averted, and cost of implementation. An optimization analysis was also done to determine how to optimally allocate money across wealth groups using different combinations of interventions. Results Fully subsidizing direct medical, non-medical, and indirect costs could annually avert over 19,000 under-five deaths, 8600 cases of CHE, and US$187 million in OOP spending. Per US$1 million invested, this corresponds to an annual reduction of 76 under-five deaths, 34 cases of CHE, and over US$730,000 in OOP expenditure. Due to low initial treatment coverage in poorer socioeconomic groups, health and financial-risk protection benefits would be pro-poor, with the poorest 40% of Nigerians accounting for 72% of all deaths averted, 55% of all OOP expenditure averted, and 74% of all cases of CHE averted. Subsidies targeted to the poor would see greater benefits per dollar spent than broad, non-targeted subsidies. In an optimization scenario, the strategy of fully subsidizing direct medical costs would be dominated by a partial subsidy of direct medical costs as well as a full subsidy of direct medical, nonmedical, and indirect costs. Conclusion Subsidizing case management of under-five malaria for the poorest and most vulnerable would reduce illness-related impoverishment and child mortality in Nigeria while preserving limited financial resources. This study is an example of how focusing a targeted policy-intervention on a single, high-burden disease can yield large health and financial-risk protection benefits in a low and middle-income country context and address equity consideration in evidence-informed policymaking. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04113-w.
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Affiliation(s)
- Rishav Raj Dasgupta
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA. .,Center for Policy Impact in Global Health at Duke Global Health Institute, Durham, NC, USA.
| | - Wenhui Mao
- Center for Policy Impact in Global Health at Duke Global Health Institute, Durham, NC, USA
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health at Duke Global Health Institute, Durham, NC, USA. .,Duke Margolis Center for Health Policy, Durham, NC, USA.
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12
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Kunnuji M, Eshiet I, Ahinkorah BO, Omogbemi T, Yaya S. Background predictors of time to death in infancy: evidence from a survival analysis of the 2018 Nigeria DHS data. BMC Public Health 2022; 22:15. [PMID: 34991534 PMCID: PMC8734103 DOI: 10.1186/s12889-021-12424-x] [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] [Received: 10/23/2020] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Nigeria’s child health profile is quite concerning with an infant mortality rate of 67 deaths per 1000 live births and a significant slowing down in progress towards improving child health outcomes. Nigeria’s 2018 Demographic and Health Survey (DHS) suggests several bio-demographic risk factors for child death, including mother’s poor education, poverty, sex of child, age of mother, and location (rural vs urban) but studies are yet to explore the predictive power of these variables on infant survival in Nigeria. Methods The study extracted data for all births in the last 12 months preceding the 2018 Nigeria DHS and used the Cox proportional hazard model to predict infant survival in Nigeria. Failure in this analysis is death with two possible outcomes – dead/alive – while the survival time variable is age at death. We censored infants who were alive at the time of the study on the day of the interview. Covariates in the analysis were: age of mother, education of mother, wealth quintile, sex of child, location, region, place of delivery, and age of pregnancy. Results The study found that a higher education of a mother compared to no education (β = .429; p-value < 0.05); belonging to a household in the richer wealth quintile (β = .618; p-value < 0.05) or the highest quintile (β = .553; p-value < 0.05), compared to the lowest wealth quintile; and living in North West (β = 1.418; p-value < 0.05) or South East zone (β = 1.711; p-value < 0.05), significantly predict infant survival. Conclusion Addressing Nigeria’s infant survival problem requires interventions that give attention to the key drivers – education, socio-economic status, and socio-cultural contextual issues. We therefore recommend full implementation of the universal basic education policy, and child health education programs targeted at mothers as long- and short-term solutions to the problem of poor child health outcomes in Nigeria. We also argue in favor of better use of evidence in policy and program development in Nigeria.
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Affiliation(s)
- Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | | | | | | | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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13
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Onyango DO, Akelo V, van der Sande MAB, Ridzon R, Were JA, Agaya JA, Oele EA, Wandiga S, Igunza AK, Young PW, Blau DM, Joseph RH, Yuen CM, Zielinski-Gutierrez E, Tippett-Barr BA. Causes of death in HIV-infected and HIV-uninfected children aged under-five years in western Kenya. AIDS 2022; 36:59-68. [PMID: 34586084 DOI: 10.1097/qad.0000000000003086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Describe the causes of death among infants and children less than 5 years stratified by HIV status. DESIGN Cross-sectional analysis of causes of death ascertained through minimally invasive tissue sampling (MITS) in the Kenya Child Health and Mortality Prevention Surveillance site. METHODS We included decedents aged 28 days to less than 5 years, whose death was reported within 36 h, underwent MITS, and had HIV test results and causes of death determined. MITS specimens were tested using Taqman Array Cards, culture, cytology, histopathology and immunohistochemistry and HIV PCR. A panel evaluated epidemiologic, clinical, verbal autopsy and laboratory data to assign causes of death using ICD-10 guidelines. Causes of death and etiological agents were stratified by HIV status. RESULTS Of 176 included decedents, 14% (n = 25) were HIV-infected, median viral load was 112 205 copies/ml [interquartile range (IQR) = 9349-2 670 143). HIV-disease (96%; n = 24) and malnutrition (23%; n = 34) were the leading underlying causes of death in HIV-infected and HIV-uninfected decedents, respectively. Malnutrition was more frequent in the causal chain of HIV-infected (56%; n = 14) than HIV-uninfected decedents (31%; n = 49) (P value = 0.03). Viral pneumonia was twice as common in HIV-infected (50%; n = 9) than HIV-uninfected decedents (22%; n = 7) (P value = 0.04). CONCLUSION Nearly all HIV-infected decedents' underlying cause of death was HIV disease, which was associated with malnutrition. Our findings underscore the need for strengthening early identification and management of HIV-infected children. Prevention, early diagnosis and treatment of malnutrition could be instrumental in improving the survival of HIV-infected and HIV-uninfected children.
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Affiliation(s)
- Dickens O Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Victor Akelo
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Renee Ridzon
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Joyce A Were
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Janet A Agaya
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Steve Wandiga
- Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | | | - Peter W Young
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | - Dianna M Blau
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachael H Joseph
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
| | | | | | - Beth A Tippett-Barr
- Division of Global HIV & TB, US Centers for Disease Control and Prevention (CDC), Kisumu and Nairobi
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14
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Tesema GA, Teshale AB, Tessema ZT. Incidence and predictors of under-five mortality in East Africa using multilevel Weibull regression modeling. Arch Public Health 2021; 79:196. [PMID: 34772469 PMCID: PMC8588577 DOI: 10.1186/s13690-021-00727-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2017, an estimated 5.3 million under-five children died annually in Sub-Saharan African countries, more than half of those deaths occurred in East Africa. Though East African countries share the huge burden of global under-five mortality, there is limited evidence on the incidence and predictors of under-five mortality. Therefore, this study investigated the incidence and predictors of under-five mortality in East Africa. METHODS A community-based cross-sectional study was done based on the Demographic and Health Survey (DHS) data of 12 East African countries conducted from 2008 to 2019. A total weighted sample of 138,803 live births within 5 years preceding the survey were included for analysis. The Kaplan-Meier curve and Log-rank test were done to assess the children's survival experience across variable categories. The Global Schoenfeld residual test was employed for checking Proportional Hazard (PH) assumptions and it was violated (p-value< 0.05). Considering the hierarchical nature of DHS data, multilevel parametric survival models were fitted. Model comparison was made by AIC, deviance, and shape of the hazard function. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multilevel Weibull regression analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of under-five mortality. RESULTS Under-five mortality rate in East Africa was 51.318 (95% CI: 51.311, 51.323) per 1000 live births. Babies born to mothers attained secondary education and above (AHR = 0.83, 95% CI: 0.75, 0.91), being 2nd - 4th birth order (AHR = 0.62, 95% CI: 0.56, 0.67), ≥ 5th birth order (AHR = 0.68, 95% CI: 0.61, 0.76), health facility delivery (AHR = 0.87, 95% CI: 0.82, 0.93), 1-3 ANC visit (AHR = 0.61, 95% CI: 0.54, 0.68), births interval of 24-48 months (AHR = 0.53, 95% CI: 0.50, 0.57), wanted pregnancy (AHR = 0.72, 95% CI: 0.68, 0.76), middle wealth status (AHR = 0.90, 95% CI: 0.83, 0.97), and richest wealth status (AHR = 0.81, 95% CI:0.73, 0.90) were significantly associated with lower hazards of under-five mortality. Whereas, advanced maternal age (≥35 years) (AHR = 1.13, 95% CI: 1.04, 1.24),, babies born to household who did not have media exposure (AHR = 1.13, 95% CI: 1.07, 1.20), twin births (AHR = 3.81, 95% CI: 3.52, 4.12), being male child (AHR = 1.27, 95%CI: 1.21, 1.33), small birth size at birth (AHR = 1.73, 95% CI: 1.63, 1.84), and large size at birth (AHR = 1.11, 95% CI: 1.04, 1.11) were significantly associated with higher hazards of under-five mortality. CONCLUSION Under-five mortality is a major public health concern in East African countries. Health facility delivery, ANC visit, higher wealth status, adequate birth spacing, wanted pregnancy, and maternal education were significantly correlated with a lower risk of under-5 mortality. Whereas, higher birth order, small or large size at birth, male birth, twin birth, advanced maternal age and mothers who didn't have media exposure were significantly correlated with a higher risk of under-five mortality. This study highlights that public health programs should enhance health facility delivery, ANC visit, media exposure, maternal education, and adequate birth spacing to decrease the incidence of under-five mortality in East Africa.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, institute of public health, College of medicine and health science, University of Gondar, Gondar, Ethiopia.
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, institute of public health, College of medicine and health science, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, institute of public health, College of medicine and health science, University of Gondar, Gondar, Ethiopia
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15
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Koffi AK, Kalter HD, Kamwe MA, Black RE. Verbal/social autopsy analysis of causes and determinants of under-5 mortality in Tanzania from 2010 to 2016. J Glob Health 2021; 10:020901. [PMID: 33274067 PMCID: PMC7699006 DOI: 10.7189/jogh.10.020901] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Tanzania has decreased its child mortality rate by more than 70 percent in the last three decades and is striving to develop a nationally-representative sample registration system with verbal autopsy to help focus health policies and programs toward further reduction. As an interim measure, a verbal and social autopsy study was conducted to provide vital information on the causes and social determinants of neonatal and child deaths. Methods Causes of neonatal and 1-59 month-old deaths identified by the 2015-16 Tanzania Demographic and Health Survey were assessed using the expert algorithm verbal autopsy method. The social autopsy examined prevalence of key household, community and health system indicators of preventive and curative care provided along the continuum of care and Pathway to Survival models. Careseeking for neonates and 1-59 month-olds was compared, and tests of associations of age and cause of death to careseeking indicators and place of death were conducted. Results The most common causes of death of 228 neonates and 351 1-59 month-olds, respectively, were severe infection, intrapartum related events and preterm delivery, and pneumonia, diarrhea and malaria. Coverage of early initiation of breastfeeding (24%), hygienic cord care (29%), and full immunization of 12-59 month-olds (33%) was problematic. Most (88.8%) neonates died in the first week, including 44.3% in their birth facility before leaving. Formal care was sought for just 41.9% of newborns whose illness started at home and was delayed by 5.3 days for 1-59 month-olds who sought informal care. Care was less likely to be sought for the youngest neonates and infants and severely ill children. Although 70.3% of 233 under-5 year-olds were moderately or severely ill on discharge from their first provider, only 29.0%-31.2% were referred. Conclusions The study highlights needed actions to complete Tanzania’s child survival agenda. Low levels of some preventive interventions need to be addressed. The high rate of facility births and neonatal deaths requires strengthening of institutionally-based interventions targeting maternal labor and delivery complications and neonatal causes of death. Scale-up of Integrated Community Case Management should be considered to strengthen careseeking for the youngest newborns, infants and severely ill children and referral practices at first level facilities.
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Affiliation(s)
- Alain K Koffi
- Institute for International Programs, Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Henry D Kalter
- Institute for International Programs, Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Robert E Black
- Institute for International Programs, Department of International Health, Bloomberg School of Public Health, Baltimore, Maryland, USA
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16
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Makinde OA, Odimegwu CO, Udoh MO, Adedini SA, Akinyemi JO, Atobatele A, Fadeyibi O, Sule FA, Babalola S, Orobaton N. Death registration in Nigeria: a systematic literature review of its performance and challenges. Glob Health Action 2021; 13:1811476. [PMID: 32892738 PMCID: PMC7783065 DOI: 10.1080/16549716.2020.1811476] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Death registration provides an opportunity for the legal documentation of death of persons. Documentation of deaths has several implications including its use in the recovery of inheritance and insurance benefits. It is also an important input for construction of life tables which are crucial for national planning. However, the registration of deaths is poor in several countries including Nigeria. Objective This paper describes the performance of death registration in Nigeria and factors that may affect its performance. Methods We conducted a systematic literature review of death registration completeness in Nigeria to identify, characterize issues as well as challenges associated with realizing completeness in death registration. Results Only 13.5% of deaths in Nigeria were registered in 2007 which regressed to 10% in 2017. There was no data reported for Nigeria in the World Health Organization database between 2008 and 2017. The country scored less than 0.1 (out of a maximum of 1) on the Vital Statistics Performance Index. There are multiple institutions with parallel constitutional and legal responsibilities for death registration in Nigeria including the National Population Commission, National Identity Management Commission and Local Government Authorities, which may be contributing to its overall poor performance. Conclusions We offer proposals to substantially improve death registration completeness in Nigeria including the streamlining and merger of the National Population Commission and the National Identity Management Commission into one commission, the revision of the legal mandate of the new agency to mainly coordination and establishment of standards. We recommend that Local Government authorities maintain the local registries given their proximity to households. This arrangement will be enhanced by increased utilization of information and communications technology in Civil Registration and Vital Statistics processes that ensure records are properly archived.
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Affiliation(s)
- Olusesan Ayodeji Makinde
- Viable Helpers Development Organization , Abuja, Nigeria.,Viable Knowledge Masters , Abuja, Nigeria
| | - Clifford Obby Odimegwu
- Demography and Population Studies Program, Schools of Public Health and Social Sciences, University of the Witwatersrand , Johannesburg, South Africa
| | - Mojisola O Udoh
- Department of Pathology, University of Benin/University of Benin Teaching Hospital , Benin-City, Nigeria
| | - Sunday A Adedini
- Vaccine and Infectious Disease Analytics Research Unit, University of the Witwatersrand , Johannesburg, South Africa
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan , Ibadan, Nigeria
| | - Akinyemi Atobatele
- Monitoring and Evaluations Unit, United States Agency for International Development , Abuja, Nigeria
| | | | | | - Stella Babalola
- Bloomberg School of Public Health, Johns Hopkins University , Baltimore, MD, USA
| | - Nosakhare Orobaton
- MNCH Program Strategy Team, Bill and Melinda Gates Foundation , Seattle, WA, USA
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17
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Perin J, Koffi AK, Kalter HD, Monehin J, Adewemimo A, Quinley J, Black RE. Using propensity scores to estimate the effectiveness of maternal and newborn interventions to reduce neonatal mortality in Nigeria. BMC Pregnancy Childbirth 2020; 20:534. [PMID: 32928142 PMCID: PMC7488987 DOI: 10.1186/s12884-020-03220-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/28/2020] [Indexed: 11/11/2022] Open
Abstract
Background Nigeria is the largest country in sub-Saharan Africa, with one of the highest neonatal mortality rates and the second highest number of neonatal deaths in the world. There is broad international consensus on which interventions can most effectively reduce neonatal mortality, however, there is little direct evidence on what interventions are effective in the Nigerian setting. Methods We used the 2013 Nigeria Demographic and Health Survey (NDHS) and the follow-up 2014 Verbal and Social Autopsy study of neonatal deaths to estimate the association between neonatal survival and mothers’ and neonates’ receipt of 18 resources and interventions along the continuum of care with information available in the NDHS. We formed propensity scores to predict the probability of receiving the intervention or resource and then weighted the observations by the inverse of the propensity score to estimate the association with mortality. We examined all-cause mortality as well as mortality due to infectious causes and intrapartum related events. Results Among 19,685 livebirths and 538 neonatal deaths, we achieved adequate balance for population characteristics and maternal and neonatal health care received for 10 of 18 resources and interventions, although inference for most antenatal interventions was not possible. Of ten resources and interventions that met our criteria for balance of potential confounders, only early breastfeeding was related to decreased all-cause neonatal mortality (relative risk 0.42, 95% CI 0.32–0.52, p < 0.001). Maternal decision making and postnatal health care reduced mortality due to infectious causes, with relative risks of 0.29 (95% CI 0.09–0.88; 0.030) and 0.46 (0.22–0.95; 0.037), respectively. Early breastfeeding and delayed bathing were related to decreased mortality due to intrapartum events, although these are not likely to be causal associations. Conclusion Access to immediate postnatal care and women’s autonomous decision-making have been among the most effective interventions for reducing neonatal mortality in Nigeria. As neonatal mortality increases relative to overall child mortality, accessible interventions are necessary to make further progress for neonatal survival in Nigeria and other low resource settings.
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Affiliation(s)
- Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Alain K Koffi
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henry D Kalter
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Kalter HD, Perin J, Amouzou A, Kwamdera G, Adewemimo WA, Nguefack F, Roubanatou AM, Black RE. Using health facility deaths to estimate population causes of neonatal and child mortality in four African countries. BMC Med 2020; 18:183. [PMID: 32527253 PMCID: PMC7291588 DOI: 10.1186/s12916-020-01639-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Verbal autopsy is the main method used in countries with weak civil registration systems for estimating community causes of neonatal and 1-59-month-old deaths. However, validation studies of verbal autopsy methods are limited and assessment has been dependent on hospital-based studies, with uncertain implications for its validity in community settings. If the distribution of community deaths by cause was similar to that of facility deaths, or could be adjusted according to related demographic factors, then the causes of facility deaths could be used to estimate population causes. METHODS Causes of neonatal and 1-59-month-old deaths from verbal/social autopsy (VASA) surveys in four African countries were estimated using expert algorithms (EAVA) and physician coding (PCVA). Differences between facility and community deaths in individual causes and cause distributions were examined using chi-square and cause-specific mortality fractions (CSMF) accuracy, respectively. Multinomial logistic regression and random forest models including factors from the VASA studies that are commonly available in Demographic and Health Surveys were built to predict population causes from facility deaths. RESULTS Levels of facility and community deaths in the four countries differed for one to four of 10 EAVA or PCVA neonatal causes and zero to three of 12 child causes. CSMF accuracy for facility compared to community deaths in the four countries ranged from 0.74 to 0.87 for neonates and 0.85 to 0.95 for 1-59-month-olds. Crude CSMF accuracy in the prediction models averaged 0.86 to 0.88 for neonates and 0.93 for 1-59-month-olds. Adjusted random forest prediction models increased average CSMF accuracy for neonates to, at most, 0.90, based on small increases in all countries. CONCLUSIONS There were few differences in facility and community causes of neonatal and 1-59-month-old deaths in the four countries, and it was possible to project the population CSMF from facility deaths with accuracy greater than the validity of verbal autopsy diagnoses. Confirmation of these findings in additional settings would warrant research into how medical causes of deaths in a representative sample of health facilities can be utilized to estimate the population causes of child death.
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Affiliation(s)
- Henry D Kalter
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Agbessi Amouzou
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gift Kwamdera
- Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi
| | | | - Félicitée Nguefack
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Iuliano A, Aranda Z, Colbourn T, Agwai IC, Bahiru S, Bakare AA, Burgess RA, Cassar C, Shittu F, Graham H, Isah A, McCollum ED, Falade AG, King C, On Behalf Of The Inspiring Project Consortium. The burden and risks of pediatric pneumonia in Nigeria: A desk-based review of existing literature and data. Pediatr Pulmonol 2020; 55 Suppl 1:S10-S21. [PMID: 31985170 DOI: 10.1002/ppul.24626] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/22/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pneumonia is a leading killer of children under-5 years, with a high burden in Nigeria. We aimed to quantify the regional burden and risks of pediatric pneumonia in Nigeria, and specifically the states of Lagos and Jigawa. METHODS We conducted a scoping literature search for studies of pneumonia morbidity and mortality in under-5 children in Nigeria from 10th December 2018 to 26th April 2019, searching: Cochrane, PubMed, and Web of Science. We included grey literature from stakeholders' websites and information shared by organizations working in Nigeria. We conducted multivariable logistic regression using the 2016 to 2017 Multiple Cluster Indicators Survey data set to explore factors associated with pneumonia. Descriptive analyses of datasets from 2010 to 2019 was done to estimate trends in mortality, morbidity, and vaccination coverage. RESULTS We identified 25 relevant papers (10 from Jigawa, 8 from Lagos, and 14 national data). None included data on pneumonia or acute respiratory tract infection burden in the health system, inpatient case-fatality rates, severity, or age-specific pneumonia mortality rates at state level. Secondary data analysis found that no household or caregiver socioeconomic indicators were consistently associated with self-reported symptoms of cough and/or difficulty breathing, and seasonality was inconsistently associated, dependant on region. CONCLUSION There is a clear evidence gap around the burden of pediatric pneumonia in Nigeria, and challenges with the interpretation of existing household survey data. Improved survey approaches are needed to understand the risks of pediatric pneumonia in Nigeria, alongside the need for investment in reliable routine data systems to provide data on the clinical pneumonia burden in Nigeria.
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Affiliation(s)
- Agnese Iuliano
- Institute for Global Health, University College London, London, UK
| | - Zeus Aranda
- Institute for Global Health, University College London, London, UK
| | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Imaria C Agwai
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ayobami A Bakare
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | | | | | - Funmilayo Shittu
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Hamish Graham
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adamu Isah
- Save the Children International, Abuja, Nigeria
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Adegoke G Falade
- Department of Paediatrics, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Carina King
- Institute for Global Health, University College London, London, UK.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Dougherty L, Gilroy K, Olayemi A, Ogesanmola O, Ogaga F, Nweze C, Banerjee J, Oduenyi C, Pacqué M. Understanding factors influencing care seeking for sick children in Ebonyi and Kogi States, Nigeria. BMC Public Health 2020; 20:746. [PMID: 32448259 PMCID: PMC7245913 DOI: 10.1186/s12889-020-08536-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/16/2020] [Indexed: 03/18/2023] Open
Abstract
Background Nigeria has one of the highest child mortality rates in the world, with an estimated 750,000 deaths annually among children under age five. The majority of these deaths are due to pneumonia, malaria, or diarrhea. Many parents do not seek sick-child care from trained, biomedical providers, contributing to this high rate of mortality. Methods This qualitative study explores factors enabling or preventing parents from seeking care for sick under-five children in Nigeria’s Kogi and Ebonyi states, including gender-related roles and social norms. Interviews were conducted with parents of sick under-five children and service providers, and focus group discussions were held with community leaders to assess how care-seeking behavior was influenced by four modes from the Colvin et al. conceptual framework for household decision-making and pathways to care. These include (1) caregivers’ recognition and response to illness, (2) seeking advice and negotiating access within the family, (3) making use of community-based treatment options, and (4) accessing biomedical services. Results Parents were found to have a general understanding of illness symptoms but did not always attribute illness to biomedical causes. Intra-household decision-making processes were shaped by gender dynamics between men and women, and were found to have great effects on decisions to seek care. Use of traditional medicine and self-treatment were found to be common first steps in treatment before turning to the biomedical care system. Once the decision to seek biomedical care was taken, the route of seeking care varied between seeking care at chemists and then continuing to health facilities or starting with a health facility and then accessing prescriptions from a chemist. Conclusion We conclude that care-seeking decisions do not follow a linear process; that intra-household decision-making processes particularly among parents should not be underestimated in addressing sick-child care seeking; and that, given the role of mothers as primary caregivers, their knowledge in illness recognition and agency in care-seeking decision-making, and seeking biomedical care, is deserving of future study.
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Affiliation(s)
- Leanne Dougherty
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA.
| | - Kate Gilroy
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Abimbola Olayemi
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | | | - Felix Ogaga
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | - Chinwe Nweze
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
| | | | | | - Michel Pacqué
- Maternal and Child Survival Program (MCSP), John Snow, Inc. (JSI), 2733 Crystal Dr 4th Floor, Arlington, VA, 22202, USA
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Oshomah-Bello EO, Esezobor CI, Solarin AU, Njokanma FO. Acute Kidney Injury in Children with Severe Malaria Is Common and Associated with Adverse Hospital Outcomes. J Trop Pediatr 2020; 66:218-225. [PMID: 31505001 DOI: 10.1093/tropej/fmz057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The prevalence of acute kidney injury (AKI) in children with severe malaria in sub-Saharan African may have been underestimated. The study aimed to determine the prevalence of AKI in children with severe malaria and its association with adverse hospital outcomes. METHODS At presentation, we measured complete blood count, serum bilirubin, and serum electrolytes, urea and creatinine in children with severe malaria. At 24 h after hospitalization, we repeated serum creatinine measurement. Urine passed in the first 24 h of hospitalization was also measured. We defined AKI and its severity using the Kidney Disease: Improving Global Outcome AKI guidelines. RESULTS The study involved 244 children (53.3% males) with a median age of 3.5 (1.9-7.0) years. One hundred and forty-four (59%) children had AKI, and it reached maximum Stages 1, 2 and 3 in 56 (23%), 45 (18.4%) and 43 (17.6%) children, respectively. The majority (86.1%) with AKI had only elevated serum creatinine. Mortality increased with increasing severity of AKI on univariate analysis but weakened on multiple logistic regression. Mortality was also higher in those with both oliguria and elevated serum creatinine than in those with elevated serum creatinine only (50% vs. 4.8%, p < 0.001). Furthermore, children with AKI spent three days more in hospital than those without AKI (p < 0.001). CONCLUSIONS Acute kidney injury complicates severe malaria in 6 out of every 10 children and is commonly identified using elevated serum creatinine. It is also associated with adverse hospital outcome.
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Affiliation(s)
- Eunice O Oshomah-Bello
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | - Christopher I Esezobor
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Mushin, Lagos State, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Mushin, Lagos State, Nigeria
| | - Adaobi U Solarin
- Department of Paediatrics, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - Fidelis O Njokanma
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria.,Department of Paediatrics, Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
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Akinyemi JO, Odimegwu CO, Banjo OO, Gbadebo BM. Clustering of infant deaths among Nigerian women: investigation of temporal patterns using dynamic random effects model. GENUS 2019. [DOI: 10.1186/s41118-019-0058-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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23
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Uneke CJ, Sombie I, Uro-Chukwu HC, Johnson E. Developing equity-focused interventions for maternal and child health in Nigeria: an evidence synthesis for policy, based on equitable impact sensitive tool (EQUIST). Pan Afr Med J 2019; 34:158. [PMID: 32153698 PMCID: PMC7046112 DOI: 10.11604/pamj.2019.34.158.16622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/12/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Among the most critical health systems components that requires strengthening to improve maternal, newborn and child health (MNCH) outcomes in Nigeria is the concept of equity. UNICEF has designed the equitable impact sensitive tool (EQUIST) to enable policymakers improve equity in MNCH and reduce disparities between the most marginalized mothers and young children and the better-off. Methods Using the latest available DHS data sets, we conducted EQUIST situation and scenario analysis of MNCH outcomes in Nigeria by sub-national categorization, wealth and by residence. We then identified the intervention package, the bottlenecks and strategies to address them and the number of deaths avertible. Results EQUIST profile analysis showed that the number of under-five deaths was considerably higher among the poorest and rural population in Nigeria, and was highest in North-West region. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Highest maternal mortality was recorded in the North-West Nigeria. Ante-partum, intrapartum and postpartum haemorrhages and hypertensive disorder, were responsible for highest maternal deaths. EQUIST scenario analysis showed that an intervention package of insecticide treated net can avert more than 20,000 under-five deaths and delivery by skilled professionals can avert nearly 17,000 under-five deaths. While as many as 3,370 maternal deaths can be averted by deployment of skilled professionals. Conclusion Scaling up integrated packages of essential interventions across the continuum of care, addressing the human resource shortages in rural area and economic/social empowerment of women are policy recommendations that can improve MNCH outcomes in Nigeria.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | - Issiaka Sombie
- West African Health Organization, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo Dioulasso 01, Burkina Faso
| | | | - Ermel Johnson
- West African Health Organization, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo Dioulasso 01, Burkina Faso
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24
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Folayan MO, Arije O, El Tantawi M, Kolawole KA, Obiyan M, Arowolo O, Oziegbe EO. Association between early childhood caries and malnutrition in a sub-urban population in Nigeria. BMC Pediatr 2019; 19:433. [PMID: 31722683 PMCID: PMC6852898 DOI: 10.1186/s12887-019-1810-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/29/2019] [Indexed: 12/22/2022] Open
Abstract
Background To determine the association between malnutrition and early childhood caries (ECC) in children resident in sub-urban, Nigeria. Methods This study was a subset of a larger cross-sectional study the data of which was generated through a household survey conducted in Ile-Ife, Nigeria. The study’s explanatory variable was malnutrition (underweight, overweight, wasting and stunting) and the outcome variable was ECC. Poisson regression analysis was used to determine the association between ECC and malnutrition. Variables (sex, frequency of sugar consumption, maternal knowledge of oral hygiene, oral hygiene status) associated with ECC in the primary study were adjusted for to obtain the adjusted prevalence ratio (APR). Results Of the 370 children, 20 (5.41%) were underweight, 20 (5.41%) were overweight, 67 (18.11%) were wasting, 120 (32.43%) were stunted and 18 (4.86%) had ECC. Factors associated with ECC were being stunted, underweight, overweight and fair oral hygiene. The prevalence of ECC was lower in children who were stunted (APR: 0.14; 95% CI: 0.03–0.69; p = 0.02), almost seven times higher in children who were overweight (APR: 6.88; 95% CI: 1.83–25.85; p < 0.001), and predictively absent in children who were underweight (APR: 0; 95% CI: 0–0; p < 0.001) when compared with children who had normal weight. Non-significant risk indicators for ECC included consuming sugar between meals three times a day or more, having low socioeconomic status and being female. Conclusions For this study population, the indicators of malnutrition – being stunted, underweight, overweight - and fair oral hygiene were risk indicators for ECC. The frequency of sugar consumption was not a significant risk indicator when malnutrition was included as an explanatory variable for ECC in the study population.
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Affiliation(s)
| | - Olujide Arije
- Institute of Public Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Maha El Tantawi
- Department of Preventive Dental Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Mary Obiyan
- Department of Demography and Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olaniyi Arowolo
- Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals' Complex, Ile-Ife, Nigeria
| | - Elizabeth O Oziegbe
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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25
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Uneke CJ, Uro-Chukwu HC, Chukwu OE. Validation of verbal autopsy methods for assessment of child mortality in sub-Saharan Africa and the policy implication: a rapid review. Pan Afr Med J 2019; 33:318. [PMID: 31692720 PMCID: PMC6815483 DOI: 10.11604/pamj.2019.33.318.16405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/12/2019] [Indexed: 12/31/2022] Open
Abstract
Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and InterVA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | | | - Onyedikachi Echefu Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria
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26
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Koffi AK, Perin J, Kalter HD, Monehin J, Adewemimo A, Black RE. How fast did newborns die in Nigeria from 2009-2013: a time-to-death analysis using Verbal /Social Autopsy data. J Glob Health 2019; 9:020501. [PMID: 31360450 PMCID: PMC6657661 DOI: 10.7189/jogh.09.020501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The slow decline in neonatal mortality as compared to post-neonatal mortality in Nigeria calls for attention and efforts to reverse this trend. This paper examines how socioeconomic, cultural, behavioral, and contextual factors interact to influence survival time among deceased newborns in Nigeria. Methods Using the neonatal deaths data from the 2014 Nigeria Verbal/ Social Autopsy survey, we examined the temporal distribution of overall and cause-specific mortality of a sample of 723 neonatal deaths. We fitted an extended Cox regression model that also allowed a time-dependent set of risk factors on time-to-neonatal death from all causes, and then separately, from birth injury/birth asphyxia (BIBA) and neonatal infections, while adjusting for possible confounding variables. Results Approximately 26% of all neonatal deaths occurred during the first day, 52.8% during the first three days, and 73.9% during the first week of life. Almost all deaths (94.4%) due to BIBA and about 64% from neonatal infections occurred in the first week of life. The expected all-cause mortality hazard was 6.23 times higher on any particular illness day for the deceased newborns who had a severe illness at onset compared to those who did not. While the all-cause mortality hazard ratio of poor vs wealthier households was 0.77 (95% confidence interval (CI) = 0.648-0.922), the BIBA mortality hazard ratio of households with no electricity was 1.79 times higher compared to households with electricity (95% CI = 1.180-2.715). Conclusions The findings suggest the need for continued improvement of the coverage and quality of maternal and neonatal health interventions at birth and in the immediate postnatal period. They may also require confirmation in real-world cohorts with detailed, time-varying information on neonatal mortality.
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Affiliation(s)
- Alain K Koffi
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Henry D Kalter
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph Monehin
- Office of Population, Health, Nutrition and Education, USAID Dhaka/ Bangladesh
| | - Adeyinka Adewemimo
- Department of Health Planning, Research, and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Bazzano AN, Var C, Wilkosz D, Duggal R, Oberhelman RA. Neonatal deaths in Cambodia: findings from a community-based mortality review. BMC Res Notes 2019; 12:236. [PMID: 31014375 PMCID: PMC6480804 DOI: 10.1186/s13104-019-4265-5] [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: 02/11/2019] [Accepted: 04/11/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of this study was to describe potential factors contributing to neonatal mortality in Takeo, Cambodia through assessment of verbal autopsies collected following newborn deaths in the community. The mortality review was nested within a trial of a behavioral intervention to improve newborn survival, and was conducted after the close of the trial, within the study setting. The World Health Organization standardized definition of neonatal mortality was employed, and two pediatricians independently reviewed data collected from each event to assign a cause of death. Results Thirteen newborn deaths of infants born in health facilities participating in a community based, behavioral intervention were reported during February 2015–November 2016. Ten deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. Five out of 13 deaths (38.46%) occurred within the first day of life. The largest single contributor to mortality was neonatal sepsis; six of 13 deaths (46.15%) were attributed to some form of sepsis. Twenty-three percent of deaths were attributed to asphyxia. The study highlights the continuing need to improve quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.
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Affiliation(s)
- A N Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA.
| | - C Var
- National Institute of Public Health, #2 Kim Y Sung Blvd, Tuol Kork, P.O. Box 1300, Phnom Penh, Cambodia.,Reproductive Health Association of Cambodia (RHAC), #5, 150 St., Phnom Penh, Cambodia
| | - D Wilkosz
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
| | - R Duggal
- Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - R A Oberhelman
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
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Comparison of Micro-Census Results for Magarya Ward, Wurno Local Government Area of Sokoto State, Nigeria, with Other Sources of Denominator Data. DATA 2019; 4:20. [PMID: 30956970 PMCID: PMC6444184 DOI: 10.3390/data4010020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Routine immunization coverage in Nigeria is suboptimal. In the northwestern state of Sokoto, an independent population-based survey for 2016 found immunization coverage with the third dose of Pentavalent vaccine to be 3%, whereas administrative coverage in 2016 was reported to be 69%. One possibility driving this large discrepancy is that administrative coverage is calculated using an under-estimated target population. Official population projections from the 2006 Census are based on state-specific standard population growth rates. Immunization target population estimates from other sources have not been independently validated. We conducted a micro-census in Magarya ward, Wurno Local Government Area of Sokoto state to obtain an accurate count of the total population living in the ward, and to compare these results with other sources of denominator data. We developed a precise micro-plan using satellite imagery, and used the navigation tool EpiSample v1 in the field to guide teams to each building, without duplications or omissions. The particular characteristics of the selected ward underscore the importance of using standardized shape files to draw precise boundaries for enumeration micro-plans. While the use of this methodology did not resolve the discrepancy between independent and administrative vaccination coverage rates, a simplified application can better define the target population for routine immunization services and estimate the number of children still unprotected from vaccine-preventable diseases.
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Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1736-1788. [PMID: 30496103 PMCID: PMC6227606 DOI: 10.1016/s0140-6736(18)32203-7] [Citation(s) in RCA: 4223] [Impact Index Per Article: 703.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. FINDINGS At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. INTERPRETATION Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. FUNDING Bill & Melinda Gates Foundation.
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Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe HT, Abebe M, Abebe Z, Abejie AN, Abera SF, Abil OZ, Abraha HN, Abrham AR, Abu-Raddad LJ, Accrombessi MMK, Acharya D, Adamu AA, Adebayo OM, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adib MG, Admasie A, Afshin A, Agarwal G, Agesa KM, Agrawal A, Agrawal S, Ahmadi A, Ahmadi M, Ahmed MB, Ahmed S, Aichour AN, Aichour I, Aichour MTE, Akbari ME, Akinyemi RO, Akseer N, Al-Aly Z, Al-Eyadhy A, Al-Raddadi RM, Alahdab F, Alam K, Alam T, Alebel A, Alene KA, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Alonso J, Altirkawi K, Alvis-Guzman N, Amare AT, Aminde LN, Amini E, Ammar W, Amoako YA, Anber NH, Andrei CL, Androudi S, Animut MD, Anjomshoa M, Ansari H, Ansha MG, Antonio CAT, Anwari P, Aremu O, Ärnlöv J, Arora A, Arora M, Artaman A, Aryal KK, Asayesh H, Asfaw ET, Ataro Z, Atique S, Atre SR, Ausloos M, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Ayele Y, Ayer R, Azzopardi PS, Babazadeh A, Bacha U, Badali H, Badawi A, Bali AG, Ballesteros KE, Banach M, Banerjee K, Bannick MS, Banoub JAM, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barquera S, Barrero LH, Bassat Q, Basu S, Baune BT, Baynes HW, Bazargan-Hejazi S, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Béjot Y, Bekele BB, Belachew AB, Belay E, Belay YA, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berman AE, Bernabe E, Bernstein RS, Bertolacci GJ, Beuran M, Beyranvand T, Bhalla A, Bhattarai S, Bhaumik S, Bhutta ZA, Biadgo B, Biehl MH, Bijani A, Bikbov B, Bilano V, Bililign N, Bin Sayeed MS, Bisanzio D, Biswas T, Blacker BF, Basara BB, Borschmann R, Bosetti C, Bozorgmehr K, Brady OJ, Brant LC, Brayne C, Brazinova A, Breitborde NJK, Brenner H, Briant PS, Britton G, Brugha T, Busse R, Butt ZA, Callender CSKH, Campos-Nonato IR, Campuzano Rincon JC, Cano J, Car M, Cárdenas R, Carreras G, Carrero JJ, Carter A, Carvalho F, Castañeda-Orjuela CA, Castillo Rivas J, Castle CD, Castro C, Castro F, Catalá-López F, Cerin E, Chaiah Y, Chang JC, Charlson FJ, Chaturvedi P, Chiang PPC, Chimed-Ochir O, Chisumpa VH, Chitheer A, Chowdhury R, Christensen H, Christopher DJ, Chung SC, Cicuttini FM, Ciobanu LG, Cirillo M, Cohen AJ, Cooper LT, Cortesi PA, Cortinovis M, Cousin E, Cowie BC, Criqui MH, Cromwell EA, Crowe CS, Crump JA, Cunningham M, Daba AK, Dadi AF, Dandona L, Dandona R, Dang AK, Dargan PI, Daryani A, Das SK, Gupta RD, Neves JD, Dasa TT, Dash AP, Davis AC, Davis Weaver N, Davitoiu DV, Davletov K, De La Hoz FP, De Neve JW, Degefa MG, Degenhardt L, Degfie TT, Deiparine S, Demoz GT, Demtsu BB, Denova-Gutiérrez E, Deribe K, Dervenis N, Des Jarlais DC, Dessie GA, Dey S, Dharmaratne SD, Dicker D, Dinberu MT, Ding EL, Dirac MA, Djalalinia S, Dokova K, Doku DT, Donnelly CA, Dorsey ER, Doshi PP, Douwes-Schultz D, Doyle KE, Driscoll TR, Dubey M, Dubljanin E, Duken EE, Duncan BB, Duraes AR, Ebrahimi H, Ebrahimpour S, Edessa D, Edvardsson D, Eggen AE, El Bcheraoui C, El Sayed Zaki M, El-Khatib Z, Elkout H, Ellingsen CL, Endres M, Endries AY, Er B, Erskine HE, Eshrati B, Eskandarieh S, Esmaeili R, Esteghamati A, Fakhar M, Fakhim H, Faramarzi M, Fareed M, Farhadi F, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Farzaei MH, Feigin VL, Feigl AB, Fentahun N, Fereshtehnejad SM, Fernandes E, Fernandes JC, Ferrari AJ, Feyissa GT, Filip I, Finegold S, Fischer F, Fitzmaurice C, Foigt NA, Foreman KJ, Fornari C, Frank TD, Fukumoto T, Fuller JE, Fullman N, Fürst T, Furtado JM, Futran ND, Gallus S, Garcia-Basteiro AL, Garcia-Gordillo MA, Gardner WM, Gebre AK, Gebrehiwot TT, Gebremedhin AT, Gebremichael B, Gebremichael TG, Gelano TF, Geleijnse JM, Genova-Maleras R, Geramo YCD, Gething PW, Gezae KE, Ghadami MR, Ghadimi R, Ghasemi Falavarjani K, Ghasemi-Kasman M, Ghimire M, Gibney KB, Gill PS, Gill TK, Gillum RF, Ginawi IA, Giroud M, Giussani G, Goenka S, Goldberg EM, Goli S, Gómez-Dantés H, Gona PN, Gopalani SV, Gorman TM, Goto A, Goulart AC, Gnedovskaya EV, Grada A, Grosso G, Gugnani HC, Guimaraes ALS, Guo Y, Gupta PC, Gupta R, Gupta R, Gupta T, Gutiérrez RA, Gyawali B, Haagsma JA, Hafezi-Nejad N, Hagos TB, Hailegiyorgis TT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haro JM, Hasan M, Hassankhani H, Hassen HY, Havmoeller R, Hay RJ, Hay SI, He Y, Hedayatizadeh-Omran A, Hegazy MI, Heibati B, Heidari M, Hendrie D, Henok A, Henry NJ, Herteliu C, Heydarpour F, Heydarpour P, Heydarpour S, Hibstu DT, Hoek HW, Hole MK, Homaie Rad E, Hoogar P, Hosgood HD, Hosseini SM, Hosseinzadeh M, Hostiuc M, Hostiuc S, Hotez PJ, Hoy DG, Hsiao T, Hu G, Huang JJ, Husseini A, Hussen MM, Hutfless S, Idrisov B, Ilesanmi OS, Iqbal U, Irvani SSN, Irvine CMS, Islam N, Islam SMS, Islami F, Jacobsen KH, Jahangiry L, Jahanmehr N, Jain SK, Jakovljevic M, Jalu MT, James SL, Javanbakht M, Jayatilleke AU, Jeemon P, Jenkins KJ, Jha RP, Jha V, Johnson CO, Johnson SC, Jonas JB, Joshi A, Jozwiak JJ, Jungari SB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalani R, Karami M, Karami Matin B, Karch A, Karema C, Karimi-Sari H, Kasaeian A, Kassa DH, Kassa GM, Kassa TD, Kassebaum NJ, Katikireddi SV, Kaul A, Kazemi Z, Karyani AK, Kazi DS, Kefale AT, Keiyoro PN, Kemp GR, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khafaei B, Khafaie MA, Khajavi A, Khalid N, Khalil IA, Khan EA, Khan MS, Khan MA, Khang YH, Khater MM, Khoja AT, Khosravi A, Khosravi MH, Khubchandani J, Kiadaliri AA, Kibret GD, Kidanemariam ZT, Kiirithio DN, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek K, Kivimäki M, Knudsen AKS, Kocarnik JM, Kochhar S, Kokubo Y, Kolola T, Kopec JA, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Kuate Defo B, Kucuk Bicer B, Kumar GA, Kumar M, Kumar P, Kutz MJ, Kuzin I, Kyu HH, Lad DP, Lad SD, Lafranconi A, Lal DK, Lalloo R, Lallukka T, Lam JO, Lami FH, Lansingh VC, Lansky S, Larson HJ, Latifi A, Lau KMM, Lazarus JV, Lebedev G, Lee PH, Leigh J, Leili M, Leshargie CT, Li S, Li Y, Liang J, Lim LL, Lim SS, Limenih MA, Linn S, Liu S, Liu Y, Lodha R, Lonsdale C, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lunevicius R, Ma S, Macarayan ERK, Mackay MT, MacLachlan JH, Maddison ER, Madotto F, Magdy Abd El Razek H, Magdy Abd El Razek M, Maghavani DP, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malta DC, Manda AL, Mandarano-Filho LG, Manguerra H, Mansournia MA, Mapoma CC, Marami D, Maravilla JC, Marcenes W, Marczak L, Marks A, Marks GB, Martinez G, Martins-Melo FR, Martopullo I, März W, Marzan MB, Masci JR, Massenburg BB, Mathur MR, Mathur P, Matzopoulos R, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McKee M, McMahon BJ, Mehata S, Mehndiratta MM, Mehrotra R, Mehta KM, Mehta V, Mekonnen TC, Melese A, Melku M, Memiah PTN, Memish ZA, Mendoza W, Mengistu DT, Mengistu G, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mestrovic T, Mezgebe HB, Miazgowski B, Miazgowski T, Millear AI, Miller TR, Miller-Petrie MK, Mini GK, Mirabi P, Mirarefin M, Mirica A, Mirrakhimov EM, Misganaw AT, Mitiku H, Moazen B, Mohammad KA, Mohammadi M, Mohammadifard N, Mohammed MA, Mohammed S, Mohan V, Mokdad AH, Molokhia M, Monasta L, Moradi G, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Moreno Velásquez I, Morgado-Da-Costa J, Morrison SD, Moschos MM, Mouodi S, Mousavi SM, Muchie KF, Mueller UO, Mukhopadhyay S, Muller K, Mumford JE, Musa J, Musa KI, Mustafa G, Muthupandian S, Nachega JB, Nagel G, Naheed A, Nahvijou A, Naik G, Nair S, Najafi F, Naldi L, Nam HS, Nangia V, Nansseu JR, Nascimento BR, Natarajan G, Neamati N, Negoi I, Negoi RI, Neupane S, Newton CRJ, Ngalesoni FN, Ngunjiri JW, Nguyen AQ, Nguyen G, Nguyen HT, Nguyen HT, Nguyen LH, Nguyen M, Nguyen TH, Nichols E, Ningrum DNA, Nirayo YL, Nixon MR, Nolutshungu N, Nomura S, Norheim OF, Noroozi M, Norrving B, Noubiap JJ, Nouri HR, Nourollahpour Shiadeh M, Nowroozi MR, Nyasulu PS, Odell CM, Ofori-Asenso R, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Ong KL, Ong SKS, Oren E, Orpana HM, Ortiz A, Ortiz JR, Otstavnov SS, Øverland S, Owolabi MO, Özdemir R, P A M, Pacella R, Pakhale S, Pakhare AP, Pakpour AH, Pana A, Panda-Jonas S, Pandian JD, Parisi A, Park EK, Parry CDH, Parsian H, Patel S, Pati S, Patton GC, Paturi VR, Paulson KR, Pereira A, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pigott DM, Pillay JD, Pirsaheb M, Pishgar F, Polinder S, Postma MJ, Pourshams A, Poustchi H, Pujar A, Prakash S, Prasad N, Purcell CA, Qorbani M, Quintana H, Quistberg DA, Rade KW, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi K, Rahimi-Movaghar A, Rahman M, Rahman MHU, Rahman MA, Rai RK, Rajsic S, Ram U, Ranabhat CL, Ranjan P, Rao PC, Rawaf DL, Rawaf S, Razo-García C, Reddy KS, Reiner RC, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezaeian S, Rezai MS, Riahi SM, Ribeiro ALP, Rios-Blancas MJ, Roba KT, Roberts NLS, Robinson SR, Roever L, Ronfani L, Roshandel G, Rostami A, Rothenbacher D, Roy A, Rubagotti E, Sachdev PS, Saddik B, Sadeghi E, Safari H, Safdarian M, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Salam N, Salama JS, Salamati P, Saldanha RDF, Saleem Z, Salimi Y, Salvi SS, Salz I, Sambala EZ, Samy AM, Sanabria J, Sanchez-Niño MD, Santomauro DF, Santos IS, Santos JV, Milicevic MMS, Sao Jose BP, Sarker AR, Sarmiento-Suárez R, Sarrafzadegan N, Sartorius B, Sarvi S, Sathian B, Satpathy M, Sawant AR, Sawhney M, Saxena S, Sayyah M, Schaeffner E, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Scott JG, Sekerija M, Sepanlou SG, Serván-Mori E, Seyedmousavi S, Shabaninejad H, Shackelford KA, Shafieesabet A, Shahbazi M, Shaheen AA, Shaikh MA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharma R, She J, Sheikh A, Shi P, Shiferaw MS, Shigematsu M, Shiri R, Shirkoohi R, Shiue I, Shokraneh F, Shrime MG, Si S, Siabani S, Siddiqi TJ, Sigfusdottir ID, Sigurvinsdottir R, Silberberg DH, Silva DAS, Silva JP, Silva NTD, Silveira DGA, Singh JA, Singh NP, Singh PK, Singh V, Sinha DN, Sliwa K, Smith M, Sobaih BH, Sobhani S, Sobngwi E, Soneji SS, Soofi M, Sorensen RJD, Soriano JB, Soyiri IN, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Starodubov VI, Stathopoulou V, Stein DJ, Steiner C, Stewart LG, Stokes MA, Subart ML, Sudaryanto A, Sufiyan MB, Sur PJ, Sutradhar I, Sykes BL, Sylaja PN, Sylte DO, Szoeke CEI, Tabarés-Seisdedos R, Tabuchi T, Tadakamadla SK, Takahashi K, Tandon N, Tassew SG, Taveira N, Tehrani-Banihashemi A, Tekalign TG, Tekle MG, Temsah MH, Temsah O, Terkawi AS, Teshale MY, Tessema B, Tessema GA, Thankappan KR, Thirunavukkarasu S, Thomas N, Thrift AG, Thurston GD, Tilahun B, To QG, Tobe-Gai R, Tonelli M, Topor-Madry R, Torre AE, Tortajada-Girbés M, Touvier M, Tovani-Palone MR, Tran BX, Tran KB, Tripathi S, Troeger CE, Truelsen TC, Truong NT, Tsadik AG, Tsoi D, Tudor Car L, Tuzcu EM, Tyrovolas S, Ukwaja KN, Ullah I, Undurraga EA, Updike RL, Usman MS, Uthman OA, Uzun SB, Vaduganathan M, Vaezi A, Vaidya G, Valdez PR, Varavikova E, Vasankari TJ, Venketasubramanian N, Villafaina S, Violante FS, Vladimirov SK, Vlassov V, Vollset SE, Vos T, Wagner GR, Wagnew FS, Waheed Y, Wallin MT, Walson JL, Wang Y, Wang YP, Wassie MM, Weiderpass E, Weintraub RG, Weldegebreal F, Weldegwergs KG, Werdecker A, Werkneh AA, West TE, Westerman R, Whiteford HA, Widecka J, Wilner LB, Wilson S, Winkler AS, Wiysonge CS, Wolfe CDA, Wu S, Wu YC, Wyper GMA, Xavier D, Xu G, Yadgir S, Yadollahpour A, Yahyazadeh Jabbari SH, Yakob B, Yan LL, Yano Y, Yaseri M, Yasin YJ, Yentür GK, Yeshaneh A, Yimer EM, Yip P, Yirsaw BD, Yisma E, Yonemoto N, Yonga G, Yoon SJ, Yotebieng M, Younis MZ, Yousefifard M, Yu C, Zadnik V, Zaidi Z, Zaman SB, Zamani M, Zare Z, Zeleke AJ, Zenebe ZM, Zhang AL, Zhang K, Zhou M, Zodpey S, Zuhlke LJ, Naghavi M, Murray CJL. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:1736-1788. [PMID: 30496103 PMCID: PMC6227606 DOI: 10.1016/s0140-6736%2818%2932203-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 01/19/2024]
Abstract
BACKGROUND Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. FINDINGS At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. INTERPRETATION Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. FUNDING Bill & Melinda Gates Foundation.
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Uneke CJ, Sombie I, Uro-Chukwu HC, Johnson E. Using equitable impact sensitive tool (EQUIST) to promote implementation of evidence informed policymaking to improve maternal and child health outcomes: a focus on six West African Countries. Global Health 2018; 14:104. [PMID: 30400931 PMCID: PMC6219200 DOI: 10.1186/s12992-018-0422-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 10/12/2018] [Indexed: 01/05/2023] Open
Abstract
Background United Nations Children’s Fund (UNICEF) designed EQUitable Impact Sensitive Tool (EQUIST) to enable global health community address the issue of equity in maternal, newborn and child health (MNCH) and minimize health disparities between the most marginalized population and the better-off. The purpose of this study was to use EQUIST to provide reliable evidence, based on demographic health surveys (DHS) on cost–effectiveness and equitable impact of interventions that can be implemented to improve MNCH outcomes in Benin, Burkina Faso, Ghana, Mali, Nigeria and Senegal. Methods Using the latest available DHS data sets, we conducted EQUIST Situation Analysis of maternal and child health outcomes in the six countries by sub-national categorization, wealth and by residence. We then identified the poorest population class within each country with the highest maternal and child mortality and performed EQUIST Scenario Analysis of this population to identify intervention package, bottlenecks and strategies to address them, cost of the intervention and strategies as well as the number of deaths avertible. Results Under-five mortality was highest in Atlantique (Benin), Sahel (Burkina Faso), Northern (Ghana), Sikasso (Mali), North-West (Nigeria), and Diourbel (Senegal). The number of under-five deaths was considerably higher among the poorest and rural population. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Ante-partum, intra-partum, and post-partum haemorrhages, and hypertensive disorder, were responsible for highest maternal deaths. The national average for improved water source was highest in Ghana (82%). Insecticide treated nets ownership percentage national average was highest in Benin (73%). Delivery by skilled professional is capable of averting the highest number of under-five and maternal deaths in the six countries. Redeployment/relocation of existing staff was the strategy with highest costs in Burkina Faso, Nigeria and Senegal. Ghana recorded the least cost per capita ($0.39) while the highest cost per capita was recorded in Benin ($4.0). Conclusion EQUIST highlights the most vulnerable and deprived children and women needing urgent health interventions as a matter of priority. It will continue to serve as a tool for maximizing the number of lives saved; decreasing health disparities and improving overall cost effectiveness. Electronic supplementary material The online version of this article (10.1186/s12992-018-0422-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, PMB 053, Nigeria.
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01, 01 BP 153, Burkina Faso
| | - Henry Chukwuemeka Uro-Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, PMB 053, Nigeria
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01, 01 BP 153, Burkina Faso
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Ayoade MA. Spatio-temporal patterns of under 5 mortality in Nigeria. SSM Popul Health 2018; 6:116-124. [PMID: 30258970 PMCID: PMC6153387 DOI: 10.1016/j.ssmph.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 11/28/2022] Open
Abstract
Under 5 mortality rates in Nigeria are very high.
There are significant variations in under 5 mortality rates across states over time.
There is evidence of statistically significant spatial autocorrelation over time.
Significant reductions are achievable with both state and region specific measures.
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Affiliation(s)
- Modupe Alake Ayoade
- Department of Geography, University of Ibadan, P.O Box 22325, Ibadan 200005, Oyo State, Nigeria
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Yaya S, Hudani A, Udenigwe O, Shah V, Ekholuenetale M, Bishwajit G. Improving Water, Sanitation and Hygiene Practices, and Housing Quality to Prevent Diarrhea among Under-Five Children in Nigeria. Trop Med Infect Dis 2018; 3:tropicalmed3020041. [PMID: 30274437 PMCID: PMC6073794 DOI: 10.3390/tropicalmed3020041] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 11/16/2022] Open
Abstract
Sub-Saharan Africa as a region accounts for the bulk of the global under-five mortality rate, to which diarrhea is major contributor. Millions of children die from diarrheal diseases each year and those who survive often do so facing suboptimal growth. Preventing the common pathways of transmission for diarrhea-causing pathogens, including improved water, sanitation, and hygiene (WASH) are regarded as the most cost-effective measures for tackling this life-threatening disease. This study aimed to quantitatively assess the quality of living arrangement and access to WASH, and their impact on diarrheal outcomes among under-five children in Nigeria. Methods: Data were collected from the 2013 Nigeria Demographic and Health survey (NDHS). Study participants included 28,596 mother-child pairs. Household construction material for wall, floor, and ceiling, access to electricity, and improved water and toilet, were included as the main explanatory variables. Data were analyzed using descriptive and multivariable regression methods. Results: The prevalence of diarrhea was 11.3% (95% CI = 10.2⁻12.6), with the rate being markedly higher in rural (67.3%) as compared to urban areas (32.7%). In the regression analysis, lacking access to improved toilet and water facilities were associated with 14% and 16% higher odds, respectively, of suffering from diarrhea as compared to those who had improved access. Conclusion: There is evidence of a weak, but statistically significant, relationship between the quality of living environment, including water and sanitation facilities, and diarrhea among under-five children in Nigeria. The study concludes that investing in living conditions and WASH may have potential benefits for child mortality prevention programs in the country.
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Affiliation(s)
- Sanni Yaya
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Alzahra Hudani
- Population Health, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Ogochukwu Udenigwe
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Vaibhav Shah
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan 200284, Nigeria.
| | - Ghose Bishwajit
- Faculty of Social Sciences, School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
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Beyond causes of death: The social determinants of mortality among children aged 1-59 months in Nigeria from 2009 to 2013. PLoS One 2017; 12:e0177025. [PMID: 28562610 PMCID: PMC5451019 DOI: 10.1371/journal.pone.0177025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background Millions of children worldwide suffer and die from conditions for which effective interventions exist. While there is ample evidence regarding these diseases, there is a dearth of information on the social factors associated with child mortality. Methods The 2014 Verbal and Social Autopsy Study was conducted based on a nationally representative sample of 3,254 deaths that occurred in children under the age of five and were reported on the birth history component of the 2013 Nigerian Demographic and Health Survey. We conducted a descriptive analysis of the preventive and curative care sought and obtained for the 2,057 children aged 1–59 months who died in Nigeria and performed regional (North vs. South) comparisons. Results A total of 1,616 children died in the northern region, while 441 children died in the South. The majority (72.5%) of deceased children in the northern region were born to mothers who had no education, married at a young age, and lived in the poorest two quintiles of households. When caregivers first noticed that their child was ill, a median of 2 days passed before they sought or attempted to seek healthcare for their children. The proportion of children who reached and departed from their first formal healthcare provider alive was greater in the North (30.6%) than in the South (17.9%) (p<0.001). A total of 548 children were moderately or severely sick at discharge from the first healthcare provider, yet only 3.9%-18.1% were referred to a second healthcare provider. Cost, lack of transportation, and distance from healthcare facilities were the most commonly reported barriers to formal care-seeking behavior. Conclusions Maternal, household, and healthcare system factors contributed to child mortality in Nigeria. Information regarding modifiable social factors may be useful in planning intervention programs to promote child survival in Nigeria and other low-income countries in sub-Saharan Africa.
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