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3.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1356-1362, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838804

RESUMO

Objective: To describe the trends and potential reasons responsible for injury mortality among children under 18 years old in different stages of the China Children's Development Outlines (CCDO) for children from 1990 to 2017, in China. Methods: Data derived from the Global Burden of Disease 2017 (GBD2017) were used to analyze the change of injury mortality, among children under 18 years old, by sex and provinces. Results: Since 1990, the Chinese government had formulated and implemented three CCDOs on Children. Each CCDO proposed corresponding main targets and strategic measures based on the development of children under current situation, in each area, accordingly. The first two CCDOs failed to set clear targets for child injury prevention and control, but the third one did propose a quantifiable target. The injury mortality rate of children under 18 years old showed a declining trend in all periods of the three CCDOs, by 26.07%, 40.68% and 26.48%, respectively. Both boys and girls showed significant downward trend in these three stages. Mortality rate on child injury differed in these three stages in all the 31 provinces. Conclusion: Thanks to the contribution of CCDO in different stages that providing important policies and impetus for the prevention and control of child injury, the number of deaths caused by child injury kept reducing, from 1990 to 2017, in China.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Mortalidade da Criança/tendências , Ferimentos e Lesões/mortalidade , Adolescente , Criança , Desenvolvimento Infantil , Pré-Escolar , China/epidemiologia , Feminino , Carga Global da Doença , Humanos , Masculino , Saúde Pública
6.
BMC Public Health ; 19(1): 1516, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718615

RESUMO

BACKGROUND: In populations that lack vital registration systems, under-5 mortality (U5M) is commonly estimated using survey-based approaches, including indirect methods. One assumption of indirect methods is that a mother's survival and her children's survival are not correlated, but in populations affected by HIV/AIDS this assumption is violated, and thus indirect estimates are biased. Our goal was to estimate the magnitude of the bias, and to create a predictive model to correct it. METHODS: We used an individual-level, discrete time-step simulation model to measure how the bias in indirect estimates of U5M changes under various fertility rates, mortality rates, HIV/AIDS rates, and levels of antiretroviral therapy. We simulated 4480 populations in total and measured the amount of bias in U5M due to HIV/AIDS. We also developed a generalized linear model via penalized maximum likelihood to correct this bias. RESULTS: We found that indirect methods can underestimate U5M by 0-41% in populations with HIV prevalence of 0-40%. Applying our model to 2010 survey data from Malawi and Tanzania, we show that indirect methods would underestimate U5M by up to 7.7% in those countries at that time. Our best fitting model to correct bias in U5M had a root median square error of 0.0012. CONCLUSIONS: Indirect estimates of U5M can be significantly biased in populations affected by HIV/AIDS. Our predictive model allows scholars and practitioners to correct that bias using commonly measured population characteristics. Policies and programs based on indirect estimates of U5M in populations with generalized HIV epidemics may need to be reevaluated after accounting for estimation bias.


Assuntos
Viés , Mortalidade da Criança , Métodos Epidemiológicos , Infecções por HIV/mortalidade , Mortalidade Infantil , Mães/estatística & dados numéricos , Inquéritos e Questionários/normas , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Coeficiente de Natalidade , Causas de Morte , Pré-Escolar , Epidemias , Feminino , HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Tanzânia/epidemiologia , Adulto Jovem
7.
Pan Afr Med J ; 33: 318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692720

RESUMO

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.


Assuntos
Autopsia/métodos , Mortalidade da Criança , Política de Saúde , África ao Sul do Saara , Causas de Morte , Criança , Humanos , Formulação de Políticas , Reprodutibilidade dos Testes
10.
BMC Public Health ; 19(1): 1330, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640635

RESUMO

BACKGROUND: To reduce the under-five mortality (U5M), fine-gained spatial assessment of the effects of health interventions is critical because national averages can obscure important sub-national disparities. In turn, sub-national estimates can guide control programmes for spatial targeting. The purpose of our study is to quantify associations of interventions with U5M rate at national and sub-national scales in Uganda and to identify interventions associated with the largest reductions in U5M rate at the sub-national scale. METHODS: Spatially explicit data on U5M, interventions and sociodemographic indicators were obtained from the 2011 Uganda Demographic and Health Survey (DHS). Climatic data were extracted from remote sensing sources. Bayesian geostatistical Weibull proportional hazards models with spatially varying effects at sub-national scales were utilized to quantify associations between all-cause U5M and interventions at national and regional levels. Bayesian variable selection was employed to select the most important determinants of U5M. RESULTS: At the national level, interventions associated with the highest reduction in U5M were artemisinin-based combination therapy (hazard rate ratio (HRR) = 0.60; 95% Bayesian credible interval (BCI): 0.11, 0.79), initiation of breastfeeding within 1 h of birth (HR = 0.70; 95% BCI: 0.51, 0.86), intermittent preventive treatment (IPTp) (HRR = 0.74; 95% BCI: 0.67, 0.97) and access to insecticide-treated nets (ITN) (HRR = 0.75; 95% BCI: 0.63, 0.84). In Central 2, Mid-Western and South-West, largest reduction in U5M was associated with access to ITNs. In Mid-North and West-Nile, improved source of drinking water explained most of the U5M reduction. In North-East, improved sanitation facilities were associated with the highest decline in U5M. In Kampala and Mid-Eastern, IPTp had the largest associated with U5M. In Central1 and East-Central, oral rehydration solution and postnatal care were associated with highest decreases in U5M respectively. CONCLUSION: Sub-national estimates of the associations between U5M and interventions can guide control programmes for spatial targeting and accelerate progress towards mortality-related Sustainable Development Goals.


Assuntos
Serviços de Saúde da Criança/organização & administração , Mortalidade da Criança/tendências , Bem-Estar da Criança/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Antimaláricos/uso terapêutico , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Inseticidas/uso terapêutico , Modelos de Riscos Proporcionais , Fatores de Risco , Uganda
12.
BMC Public Health ; 19(1): 1281, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601205

RESUMO

BACKGROUND: Death of a mother at an early age of the child may result in an increased risk of childhood mortality, especially in low-and-middle-income countries. This study aims to synthesize estimates of the association between a mother's death and the risk of childhood mortality at different age ranges from birth to 18 years in these settings. METHODS: Various MEDLINE databases, EMBASE, and Global Health databases were searched for population-based cohort and case-control studies published from 1980 to 2017. Studies were included if they reported the risk of childhood mortality for children whose mother had died relative to those whose mothers were alive. Random-effects meta-analyses were used to pool effect estimates, stratified by various exposures (child's age when mother died, time since mother's death) and outcomes (child's age at risk of child death). RESULTS: A total of 62 stratified risk estimates were extracted from 12 original studies. Childhood mortality was associated with child's age at time of death of a mother and time since a mother's death. For children whose mother died when they were ≤ 42 days, the relative risk (RR) of dying within the first 1-6 months of the child's life was 35.5(95%CI:9.7-130.5, p [het] = 0.05) compared to children whose mother did not die; by 6-12 months this risk dropped to 2.8(95%CI:0.7-10.7). For children whose mother died when they were ≤ 1 year, the subsequent RR of dying in that year was 15.9(95%CI:2.2-116.1,p [het] = 0.02), compared to children whose mother lived. For children whose mother died when they were ≤ 5 years of age, the RR of dying before aged 12 was 4.1(95%CI:3.0-5.7),p [het] = 0.83. Mortality was also elevated in specific analysis  among children whose mother died when child was older than 42 days. Overall, for children whose mother died < 6 and 6+ months ago, RRs of dying before reaching adulthood (≤18 years) were 4.7(95%CI:2.6-8.7,p [het] = 0.2) and 2.1(95%CI:1.3-3.4,p [het] = 0.7), respectively, compared to children whose mother lived. CONCLUSIONS: There is evidence of an association between the death of a mother and childhood mortality in lower resource settings. These findings emphasize the critical importance of women in family outcomes and the importance of health care for women during the intrapartum and postpartum periods and throughout their child rearing years.


Assuntos
Mortalidade da Criança/tendências , Países em Desenvolvimento , Morte Materna/estatística & dados numéricos , Criança , Humanos , Fatores de Risco
13.
14.
Int Health ; 11(5): 344-348, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31529108

RESUMO

The decline in child mortality over the past two decades has been described as the greatest story in global public health. Indeed, using modern tools and interventions, there has been remarkable progress, reducing deaths in children <5 y of age by nearly half from 2000 to 2017. However, as a consequence of persistent geographic inequalities, we fall short of the United Nations Sustainable Development Goal to end all preventable child deaths by 2030, with an estimated 44.6 million preventable deaths expected to occur by the target year. This article discusses how we might further improve the downward trend in child mortality over the next decade to end preventable child deaths.


Assuntos
Mortalidade da Criança/tendências , Saúde Global , Pré-Escolar , Humanos , Lactente , Fatores Socioeconômicos , Desenvolvimento Sustentável , Nações Unidas
15.
BMC Public Health ; 19(1): 1243, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500599

RESUMO

BACKGROUND: Under-five mortality is still a major health issue in many developing countries like Tanzania. To achieve the Sustainable Development Goal target of ending preventable child deaths in Tanzania, a detailed understanding of the risk factors for under-five deaths is essential to guide targeted interventions. This study aimed to investigate trends and determinants of neonatal, post-neonatal, infant, child and under-five mortalities in Tanzania from 2004 to 2016. METHODS: The study used combined data from the 2004-2005, 2010 and 2015-2016 Tanzania Demographic and Health Surveys, with a sample of 25,951 singletons live births and 1585 under-five deaths. We calculated age-specific mortality rates, followed by an assessment of trends and determinants (community, socioeconomic, individual and health service) of neonatal, postneonatal, infant, child and under-five mortalities in Cox regression models. The models adjusted for potential confounders, clustering and sampling weights. RESULTS: Between 2004 and 2016, we found that neonatal mortality rate remained unchanged, while postneonatal mortality and child mortality rates have halved in Tanzania. Infant mortality and under-five mortality rates have also declined. Mothers who gave births through caesarean section, younger mothers (< 20 years), mothers who perceived their babies to be small or very small and those with fourth or higher birth rank and a short preceding birth interval (≤2 years) reported higher risk of neonatal, postneonatal and infant mortalities. CONCLUSION: Our study suggests that there was increased survival of children under-5 years in Tanzania driven by significant improvements in postneonatal, infant and child survival rates. However, there remains unfinished work in ending preventable child deaths in Tanzania.


Assuntos
Mortalidade da Criança/tendências , Mortalidade Infantil/tendências , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Fatores de Risco , Tanzânia/epidemiologia
17.
Nat Med ; 25(9): 1370-1376, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31406349

RESUMO

The MORDOR I trial1, conducted in Niger, Malawi and Tanzania, demonstrated that mass azithromycin distribution to preschool children reduced childhood mortality1. However, the large but simple trial design precluded determination of the mechanisms involved. Here we examined the gut microbiome of preschool children from 30 Nigerien communities randomized to either biannual azithromycin or placebo. Gut microbiome γ-diversity was not significantly altered (P = 0.08), but the relative abundances of two Campylobacter species, along with another 33 gut bacteria, were significantly reduced in children treated with azithromycin at the 24-month follow-up. Metagenomic analysis revealed functional differences in gut bacteria between treatment groups. Resistome analysis showed an increase in macrolide resistance gene expression in gut microbiota in communities treated with azithromycin (P = 0.004). These results suggest that prolonged mass azithromycin distribution to reduce childhood mortality reduces certain gut bacteria, including known pathogens, while selecting for antibiotic resistance.


Assuntos
Azitromicina/administração & dosagem , Infecções por Campylobacter/tratamento farmacológico , Microbioma Gastrointestinal/efeitos dos fármacos , Metagenômica , Campylobacter/efeitos dos fármacos , Campylobacter/patogenicidade , Infecções por Campylobacter/genética , Infecções por Campylobacter/mortalidade , Criança , Mortalidade da Criança , Pré-Escolar , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/genética , Regulação Bacteriana da Expressão Gênica/efeitos dos fármacos , Humanos , Macrolídeos/administração & dosagem , Masculino , Nigéria/epidemiologia , Análise de Sequência de RNA
18.
Artigo em Inglês | MEDLINE | ID: mdl-31416153

RESUMO

Despite worldwide efforts, maternal and child mortality remains a major health problem in many developing countries. Cambodia's maternal mortality rate has decreased over recent years through government efforts and support from various international development cooperation agencies. The purpose of this study was to investigate the factors that affected the accessibility of Cambodia's maternal healthcare services. Data from maternal health service surveys conducted in Battambang, Cambodia in 2012 and 2015 were compared and analyzed. Multiple regression analysis was conducted to identify factors related to the accessibility of integrated maternal healthcare service. The travel time to health centers was found to be related to distance from the health center (ß = 0.031, p < 0.001), travel time during the rainy season (ß = 0.166, p < 0.001), and travel cost (ß = 0.001, p < 0.001), with an explanatory power of 27% (R2 = 0.274). Based on these findings, future research and policy should focus on improving accessibility to effective maternal and child healthcare services, to reduce maternal and child mortality. This study is intended to contribute to developing a multi-directional and integrated strategy for access to maternal health services in developing countries.


Assuntos
Mortalidade da Criança , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Mortalidade Materna , Viagem/estatística & dados numéricos , Adulto , Camboja , Pré-Escolar , Países em Desenvolvimento , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Inquéritos e Questionários
19.
BMC Public Health ; 19(1): 1132, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420035

RESUMO

BACKGROUND: The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections. METHODS: Mortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates. RESULTS: Our research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953-0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984-0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea. CONCLUSIONS: A conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections. The coverage should be maintained -or increased in a period of economic crisis- and its implementation strengthened.


Assuntos
Saúde da Criança/economia , Mortalidade da Criança/tendências , Pobreza/economia , Assistência Pública/economia , Transtornos da Nutrição Infantil/economia , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Diarreia/economia , Diarreia/mortalidade , Equador/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Análise de Regressão , Infecções Respiratórias/economia , Infecções Respiratórias/mortalidade
20.
Genetica ; 147(3-4): 249-258, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31392547

RESUMO

Throughout the world, there is a male-bias in the sex ratio at birth (SRB). It is not known whether this phenomenon has a genetic basis, though there is tentative evidence from genealogical and genomic studies that it may have. It has been proposed that the higher rate of male childhood mortality in humans is linked to the male-bias in SRB through parental investment, but this may only apply to facultative not genetic sex ratio adjustment. In previous population genetic models, elevated mortality in one sex (prior to breeding) has been shown not to affect the SRB, but these models did not consider the role of replacement births (i.e. births that only occur because a sibling died prematurely). In a set of population genetic modelling simulations, in which sex ratio is controlled by an autosomal gene expressed in the male line, this study shows that when there is replacement of dead offspring, this leads to a sustained bias in the SRB in the direction of the sex suffering the highest mortality. In the example of higher male mortality, this occurs, because replacement offspring are disproportionately drawn from fathers who were genetically predisposed to have initially had sons (because sons were more likely to die prematurely), and more likely to pass on male-biasing alleles to replacement offspring. To test the empirical basis for replacement births, an analysis of birth data from the Demographic and Health Survey program was conducted, which shows that parents do indeed tend to replace children who die prematurely.


Assuntos
Razão de Masculinidade , Criança , Mortalidade da Criança , Demografia , Características da Família , Feminino , Genótipo , Humanos , Lactente , Mortalidade Infantil , Masculino
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