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1.
J Prim Care Community Health ; 12: 2150132721996889, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33632030

RESUMO

The Sustainable Development Goals (SDGs) were adopted during the United Nations meeting in 2015 to succeed Millennium Development Goals. Among the health targets, SDG 3.2 is to end preventable deaths of newborns and children under 5 years of age by 2030. These 2 targets aim to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births. Ethiopia is demonstrating a great reduction in child mortality since 2000. In the 2019 child mortality estimation which is nearly 5 years after SDGs adoption, Ethiopia's progress toward reducing the newborns and under-5 mortality lie at 27 and 50.7 per 1000 live births, respectively. The generous financial and technical support from the global partners have helped to achieve such a significant reduction. Nevertheless, the SDG targets for newborns and under-5 mortality reduction are neither attained yet nor met the national plan to achieve by the end of 2019/2020. The partnership dynamics during COVID-19 crisis and the pandemic itself may also be taken as an opportunity to draw lessons and spur efforts to achieve SDG targets. This urges the need to reaffirm a comprehensive partnership and realignment with other interconnected development goals. Therefore, collective efforts with strong partnerships are required to improve the determinants of child health and achieving SDG target reduction until 2030.


Assuntos
Mortalidade da Criança/tendências , Mortalidade Infantil/tendências , Cooperação Internacional , Desenvolvimento Sustentável , /epidemiologia , Pré-Escolar , Etiópia/epidemiologia , Humanos , Lactente , Recém-Nascido , Nações Unidas
2.
Artigo em Inglês | MEDLINE | ID: mdl-33535688

RESUMO

Child Mortality (CM) is a worldwide concern, annually affecting as many as 6.81% children in low- and middle-income countries (LMIC). We used data of the Multiple Indicators Cluster Survey (MICS) (N = 275,160) from 27 LMIC and a machine-learning approach to rank 37 distal causes of CM and identify the top 10 causes in terms of predictive potency. Based on the top 10 causes, we identified households with improved conditions. We retrospectively validated the results by investigating the association between variations of CM and variations of the percentage of households with improved conditions at country-level, between the 2005-2007 and the 2013-2017 administrations of the MICS. A unique contribution of our approach is to identify lesser-known distal causes which likely account for better-known proximal causes: notably, the identified distal causes and preventable and treatable through social, educational, and physical interventions. We demonstrate how machine learning can be used to obtain operational information from big dataset to guide interventions and policy makers.


Assuntos
Mortalidade da Criança , Países em Desenvolvimento , Criança , Humanos , Renda , Aprendizado de Máquina , Estudos Retrospectivos
3.
Artigo em Inglês | MEDLINE | ID: mdl-33406601

RESUMO

Child survival and wellbeing remain a global health challenge despite vast development within the area and a significant decline in mortality rates of children under five years of age. This study investigates the perceived causes of ill health and childhood mortality in the context of five villages located in the Tonkolili district of Sierra Leone. Mixed method methodology was applied in this study consisting of both quantitative and qualitative data contribution. The quantitative part consisted of a household survey on child health, where 341 households, equivalent to 50.6% of the total number of households in the five villages, participated with a response rate of 100%. The qualitative part consisted of six semi structured interviews-one with a health care worker and five with mothers from each village. The main perceived reason for child morbidity was inadequate care of children related to personal hygiene of the child, hygiene and safety in the environment, in-sufficient nutrition, inadequate supervision and poor healthcare seeking behavior. Additionally, reasons given for disease included supernatural forces such as witchcraft. In relation to the survey, the perceived causes of child mortality for ill children in the villages were mainly malaria (33.6%), diarrhea (11.6%), pneumonia (8.6%), and unknown (26%). The observed symptoms of illness among children were fever (43.7%), cough and difficulty breathing (10.7%), frequent watery stool (10.3%) and no symptoms (20.3%). The perception of ill health in children was mainly associated with the parent's ability to cater for the child's physical needs, but also associated with external factors such as witchcraft and "God's will". In addition, biomedical causes for disease and supernatural causes for disease were seen to coexist.


Assuntos
Saúde da Criança , Mortalidade da Criança , Conhecimentos, Atitudes e Prática em Saúde , População Rural , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Higiene , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Serra Leoa/epidemiologia , Adulto Jovem
4.
Lancet Diabetes Endocrinol ; 9(3): 144-152, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33482107

RESUMO

BACKGROUND: There has been a considerable increase in thyroid cancer incidence among adults in several countries in the past three decades, attributed primarily to overdiagnosis. We aimed to assess global patterns and trends in incidence and mortality of thyroid cancer in children and adolescents, in view of the increased incidence among adults. METHODS: We did a population-based study of the observed incidence (in 49 countries and territories) and mortality (in 27 countries) of thyroid cancer in children and adolescents aged 0-19 years using data from the International Incidence of Childhood Cancer Volume 3 study database, the WHO mortality database, and the cancer incidence in five continents database (CI5plus; for adult data [age 20-74 years]). We analysed temporal trends in incidence rates, including absolute changes in rates, and the strength of the correlation between incidence rates in children and adolescents and in adults. We calculated the average annual number of thyroid cancer deaths and the age-standardised mortality rates for children and adolescents. FINDINGS: Age-standardised incidence rates of thyroid cancer among children and adolescents aged 0-19 years ranged from 0·4 (in Uganda and Kenya) to 13·4 (in Belarus) cancers per 1 million person-years in 2008-12. The variability in the incidence rates was mostly accounted for by the papillary tumour subtype. Incidence rates were almost always higher in girls than in boys and increased with age in both sexes. Rapid increases in incidence between 1998-2002 and 2008-12 were observed in almost all countries. Country-specific incidence rates in children and adolescents were strongly correlated (r>0·8) with rates in adults, as were the temporal changes in the respective incidence rates (r>0·6). Thyroid cancer deaths in those aged younger than 20 years were less than 0·1 per 10 million person-years in each country. INTERPRETATION: The pattern of thyroid cancer incidence in children and adolescents mirrors the pattern seen in adults, suggesting a major role for overdiagnosis, which, in turn, can lead to overtreatment, lifelong medical care, and side effects that can negatively affect quality of life. We suggest that the existing recommendation against screening for thyroid cancer in the asymptomatic adult population who are free from specific risk factors should be extended to explicitly recommend against screening for thyroid cancer in similar populations of children and adolescents. FUNDING: International Agency for Research on Cancer and the Union for International Cancer Control; French Institut National du Cancer; Italian Association of Cancer Research; and Italian Ministry of Health.


Assuntos
Saúde Global/tendências , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/mortalidade , Adolescente , Idade de Início , Causas de Morte/tendências , Criança , Mortalidade da Criança , Pré-Escolar , Feminino , Saúde Global/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Expectativa de Vida/tendências , Masculino , Sobremedicalização/estatística & dados numéricos , Fatores de Risco , Neoplasias da Glândula Tireoide/diagnóstico , Adulto Jovem
5.
BMC Med ; 18(1): 405, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33342436

RESUMO

BACKGROUND: Oral rehydration solution (ORS) is a simple intervention that can prevent childhood deaths from severe diarrhea and dehydration. In a previous study, we mapped the use of ORS treatment subnationally and found that ORS coverage increased over time, while the use of home-made alternatives or recommended home fluids (RHF) decreased, in many countries. These patterns were particularly striking within Senegal, Mali, and Sierra Leone. It was unclear, however, whether ORS replaced RHF in these locations or if children were left untreated, and if these patterns were associated with health policy changes. METHODS: We used a Bayesian geostatistical model and data from household surveys to map the percentage of children with diarrhea that received (1) any ORS, (2) only RHF, or (3) no oral rehydration treatment between 2000 and 2018. This approach allowed examination of whether RHF was replaced with ORS before and after interventions, policies, and external events that may have impacted healthcare access. RESULTS: We found that RHF was replaced with ORS in most Sierra Leone districts, except those most impacted by the Ebola outbreak. In addition, RHF was replaced in northern but not in southern Mali, and RHF was not replaced anywhere in Senegal. In Senegal, there was no statistical evidence that a national policy promoting ORS use was associated with increases in coverage. In Sierra Leone, ORS coverage increased following a national policy change that abolished health costs for children. CONCLUSIONS: Children in parts of Mali and Senegal have been left behind during ORS scale-up. Improved messaging on effective diarrhea treatment and/or increased ORS access such as through reducing treatment costs may be needed to prevent child deaths in these areas.


Assuntos
Diarreia/terapia , Hidratação , Política de Saúde/tendências , Administração Oral , Bicarbonatos/uso terapêutico , Criança , Mortalidade da Criança/história , Mortalidade da Criança/tendências , Pré-Escolar , Diarreia/epidemiologia , Feminino , Hidratação/história , Hidratação/métodos , Hidratação/estatística & dados numéricos , Hidratação/tendências , Glucose/uso terapêutico , Política de Saúde/história , História do Século XX , História do Século XXI , Humanos , Lactente , Masculino , Mali/epidemiologia , Cloreto de Potássio/uso terapêutico , Senegal/epidemiologia , Índice de Gravidade de Doença , Serra Leoa/epidemiologia , Cloreto de Sódio/uso terapêutico , Análise Espacial , Fatores de Tempo , Resultado do Tratamento
6.
Artigo em Russo | MEDLINE | ID: mdl-33338332

RESUMO

The article presents the analysis of results of the study of incidence and prevalence of children diseases in Russia in 2012-2018 including structure of diseases classes, regional characteristics in the Federal okrugs and regions and assessment of chronization coefficient. The significant changes are established in incidence cases rate by disease classes in the Federal districts and regions, in dynamics of chronization coefficient, and their absence in morbidity structure.


Assuntos
Mortalidade da Criança , Criança , Humanos , Morbidade , Prevalência , Federação Russa/epidemiologia
7.
N Engl J Med ; 383(20): 1941-1950, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33176084

RESUMO

BACKGROUND: Mass distribution of azithromycin to preschool children twice yearly for 2 years has been shown to reduce childhood mortality in sub-Saharan Africa but at the cost of amplifying macrolide resistance. The effects on the gut resistome, a reservoir of antimicrobial resistance genes in the body, of twice-yearly administration of azithromycin for a longer period are unclear. METHODS: We investigated the gut resistome of children after they received twice-yearly distributions of azithromycin for 4 years. In the Niger site of the MORDOR trial, we enrolled 30 villages in a concurrent trial in which they were randomly assigned to receive mass distribution of either azithromycin or placebo, offered to all children 1 to 59 months of age every 6 months for 4 years. Rectal swabs were collected at baseline, 36 months, and 48 months for analysis of the participants' gut resistome. The primary outcome was the ratio of macrolide-resistance determinants in the azithromycin group to those in the placebo group at 48 months. RESULTS: Over the entire 48-month period, the mean (±SD) coverage was 86.6±12% in the villages that received placebo and 83.2±16.4% in the villages that received azithromycin. A total of 3232 samples were collected during the entire trial period; of the samples obtained at the 48-month monitoring visit, 546 samples from 15 villages that received placebo and 504 from 14 villages that received azithromycin were analyzed. Determinants of macrolide resistance were higher in the azithromycin group than in the placebo group: 7.4 times as high (95% confidence interval [CI], 4.0 to 16.7) at 36 months and 7.5 times as high (95% CI, 3.8 to 23.1) at 48 months. Continued mass azithromycin distributions also selected for determinants of nonmacrolide resistance, including resistance to beta-lactam antibiotics, an antibiotic class prescribed frequently in this region of Africa. CONCLUSIONS: Among villages assigned to receive mass distributions of azithromycin or placebo twice yearly for 4 years, antibiotic resistance was more common in the villages that received azithromycin than in those that received placebo. This trial showed that mass azithromycin distributions may propagate antibiotic resistance. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02047981.).


Assuntos
Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Farmacorresistência Bacteriana/efeitos dos fármacos , Microbioma Gastrointestinal/efeitos dos fármacos , Macrolídeos/farmacologia , Administração Massiva de Medicamentos , Antibacterianos/farmacologia , Azitromicina/farmacologia , Mortalidade da Criança , Pré-Escolar , Farmacorresistência Bacteriana/genética , Feminino , Humanos , Lactente , Macrolídeos/uso terapêutico , Masculino , Metagenoma , Níger , Análise de Sequência de DNA
8.
Nursing (Säo Paulo) ; 23(270): 4816-4825, nov.2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1145451

RESUMO

Objetivo: Descrever as principais causas de óbitos evitáveis em crianças menores de cinco anos no município de Passos, Minas Gerais, entre os anos de 2010 a 2018, segundo a "Lista Brasileira de Causas de Mortes Evitáveis". Método: Pesquisa descritiva, retrospectiva, com abordagem quantitativa, por meio dos dados coletados pela base de dados do Sistema de Informação sobre Mortalidade (SIM), posteriormente digitados em planilhas do Excel 2010 e analisados por estatística descritiva simples. Resultados: Houve maior ocorrência de óbitos em crianças do sexo masculino, no período neonatal precoce. As causas mais prevalentes foram as reduzíveis por adequada atenção à mulher na gestação, seguida por adequada atenção ao recém-nascido. Conclusão: Há necessidade de maior envolvimento dos gestores em saúde quanto à assistência pré-natal, com implementação de ações que promovam a saúde e a prevenção de doenças e agravos, garantindo assim serviços de excelência para o atendimento destes grupos vulneráveis.(AU)


Objective: To describe the main causes of preventable deaths in children under five years of age in the municipality of Passos, Minas Gerais, between 2010 and 2018, according to the "Brazilian List of Causes of Avoidable Deaths". Method: Descriptive, retrospective research, with a quantitative approach, using data collected from the Mortality Information System (SIM) database, which were later entered into Excel 2010 spreadsheets and analyzed using simple descriptive statistics. Results: There was a higher occurrence of deaths in male children in the early neonatal period. The most prevalent causes were those that could be reduced by adequate care for women during pregnancy, followed by adequate care for the newborn. Conclusion: There is a need for greater involvement of health managers in terms of prenatal care, with the implementation of actions that promote health and the prevention of diseases and injuries, thus guaranteeing excellent services for the care of these vulnerable groups.(AU)


Objetivo: Describir las principales causas de muertes evitables en menores de cinco años en el municipio de Passos, Minas Gerais, entre 2010 y 2018, según la "Lista Brasileña de Causas de Muertes Evitables". Método: Investigación descriptiva, retrospectiva, con enfoque cuantitativo, utilizando datos recolectados de la base de datos del Sistema de Información de Mortalidad (SIM), que luego fueron ingresados en hojas de cálculo Excel 2010 y analizados mediante estadística descriptiva simple. Resultados: Hubo una mayor incidencia de muertes en niños varones en el período neonatal temprano. Las causas más prevalentes fueron las que podrían reducirse con una atención adecuada a la mujer durante el embarazo, seguida de una atención adecuada al recién nacido. Conclusión: Existe la necesidad de una mayor participación de los gestores de salud en materia de atención prenatal, con la implementación de acciones que promuevan la salud y la prevención de enfermedades y lesiones, garantizando así excelentes servicios para la atención de estos grupos vulnerables.(AU)


Assuntos
Humanos , Pré-Escolar , Saúde da Criança , Fatores de Risco , Causas de Morte , Mortalidade da Criança , Enfermagem Pediátrica , Causalidade
9.
Lakartidningen ; 1172020 10 12.
Artigo em Sueco | MEDLINE | ID: mdl-33051860

RESUMO

The 2030 Agenda for Sustainable Development and its seventeen Sustainable Development Goals were adopted by the United Nations General Assembly in 2015. It is a bold agenda for global social, environmental and economic development, with human health as a central theme. Even though substantial improvements in health have been achieved during the last decades, every year over 5 million children die, mostly from preventable causes, and 300 000 women die in conjunction with childbirth. Premature deaths from non-communicable diseases are increasing, and our ability to treat infections is under threat through widespread anti-microbial resistance. Climate change is recognized as the biggest threat to health in our time. When the world now starts to plan for how society and our health systems should be reorganized after the COVID-19 pandemic the 2030 Agenda could and should play a central role. In this context, Agenda 2030 provides an ambitious roadmap for development, with its emphasis on collaboration across borders and disciplines. The agenda is achievable but reaching its goals will require strong commitment at all levels and societal change on a large scale.


Assuntos
Infecções por Coronavirus , Saúde Global , Pandemias , Pneumonia Viral , Desenvolvimento Sustentável , Betacoronavirus , Criança , Mortalidade da Criança , Mudança Climática , Feminino , Humanos
10.
PLoS One ; 15(10): e0238847, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052926

RESUMO

BACKGROUND: Goal 3.2 from the Sustainable Development Goals (SDG) calls for reductions in national averages of Under-5 Mortality. However, it is well known that within countries these reductions can coexist with left behind populations that have mortality rates higher than national averages. To measure inequality in under-5 mortality and to identify left behind populations, mortality rates are often disaggregated by socioeconomic status within countries. While socioeconomic disparities are important, this approach does not quantify within group variability since births from the same socioeconomic group may have different mortality risks. This is the case because mortality risk depends on several risk factors and their interactions and births from the same socioeconomic group may have different risk factor combinations. Therefore mortality risk can be highly variable within socioeconomic groups. We develop a comprehensive approach using information from multiple risk factors simultaneously to measure inequality in mortality and to identify left behind populations. METHODS: We use Demographic and Health Surveys (DHS) data on 1,691,039 births from 182 different surveys from 67 low and middle income countries, 51 of which had at least two surveys. We estimate mortality risk for each child in the data using a Bayesian hierarchical logistic regression model. We include commonly used risk factors for monitoring inequality in early life mortality for the SDG as well as their interactions. We quantify variability in mortality risk within and between socioeconomic groups and describe the highest risk sub-populations. FINDINGS: For all countries there is more variability in mortality within socioeconomic groups than between them. Within countries, socioeconomic membership usually explains less than 20% of the total variation in mortality risk. In contrast, country of birth explains 19% of the total variance in mortality risk. Targeting the 20% highest risk children based on our model better identifies under-5 deaths than targeting the 20% poorest. For all surveys, we report efficiency gains from 26% in Mali to 578% in Guyana. High risk births tend to be births from mothers who are in the lowest socioeconomic group, live in rural areas and/or have already experienced a prior death of a child. INTERPRETATION: While important, differences in under-5 mortality across socioeconomic groups do not explain most of overall inequality in mortality risk because births from the same socioeconomic groups have different mortality risks. Similarly, policy makers can reach the highest risk children by targeting births based on several risk factors (socioeconomic status, residing in rural areas, having a previous death of a child and more) instead of using a single risk factor such as socioeconomic status. We suggest that researchers and policy makers monitor inequality in under-5 mortality using multiple risk factors simultaneously, quantifying inequality as a function of several risk factors to identify left behind populations in need of policy interventions and to help monitor progress toward the SDG.


Assuntos
Mortalidade da Criança , Países em Desenvolvimento , Mortalidade Infantil , Fatores Socioeconômicos , Pré-Escolar , Feminino , Saúde Global , Humanos , Lactente , Recém-Nascido , Masculino , Parto , Pobreza , Gravidez , Fatores de Risco , Inquéritos e Questionários , Desenvolvimento Sustentável
13.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33082284

RESUMO

BACKGROUND AND OBJECTIVES: Road traffic accidents are a leading cause of child deaths in the United States. Although this has been examined at the national and state levels, there is more value in acquiring information at the county level to guide local policies. We aimed to estimate county-specific child mortality from road traffic accidents in the United States. METHODS: We queried the Fatality Analysis Reporting System database, 2010-2017, for road traffic accidents that resulted in a death within 30 days of the auto crash. We included all children <15 years old who were fatally injured. We estimated county-specific age- and sex-standardized mortality. We evaluated the impact of the availability of trauma centers and urban-rural classification of counties on mortality. RESULTS: We included 9271 child deaths. Among those, 45% died at the scene. The median age was 7 years. The overall mortality was 1.87 deaths per 100 000 children. County-specific mortality ranged between 0.25 and 21.91 deaths per 100 000 children. The availability of a trauma center in a county was associated with decreased mortality (adult trauma center [odds ratio (OR): 0.59; 95% credibility interval (CI), 0.52-0.66]; pediatric trauma center [OR: 0.56; 95% CI, 0.46-0.67]). Less urbanized counties were associated with higher mortality, compared with large central metropolitan counties (noncore counties [OR: 2.33; 95% CI, 1.85-2.91]). CONCLUSIONS: There are marked differences in child mortality from road traffic accidents among US counties. Our findings can guide targeted public health interventions in high-risk counties with excessive child mortality and limited access to trauma care.


Assuntos
Acidentes de Trânsito/mortalidade , Mortalidade da Criança , Centros de Traumatologia/provisão & distribução , Adolescente , Teorema de Bayes , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Escolaridade , Feminino , Humanos , Renda , Governo Local , Masculino , Razão de Chances , Distribuição de Poisson , População Rural/estatística & dados numéricos , Distribuição por Sexo , Análise de Pequenas Áreas , Centros de Traumatologia/classificação , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos
14.
Yonsei Med J ; 61(9): 805-815, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32882765

RESUMO

PURPOSE: We explored the role of parental social class in preterm birth (PTB) and low birth weight (LBW) in association with child mortality in Korea. MATERIALS AND METHODS: A total of 7,302,732 births in Korea between 1995 and 2007 were used for designing the national retrospective cohort study. Kaplan-Meier survival curves and Cox proportional hazard models were used to determine the risk of child death after adjusting for covariates. RESULTS: Parental social class was associated with adverse birth outcomes and child mortality in Korea. Parental social class increased the strength of the relationship of adverse birth outcomes with child mortality. Child mortality was higher among PTB and LBW infants from parents with a lower social class than normal births from parents with a higher social class. In particular, the disparity in child mortality according to parental social class was greater for LBW and PTB than intrauterine growth retardation births. When one of the parents had a middle-school education or lower, the disparity in child mortality due to adverse birth outcomes was large regardless of the other spouse's educational status. Inactive economic status for the father, as well as an occupation in manual labor by the mother, increased the risk of child mortality. CONCLUSION: Strong relationships for social inequalities and adverse birth outcomes with inequalities in child mortality in South Korea were found in this study. Tackling social inequalities, as well as reducing adverse birth outcomes, are needed to reduce the disparities in child mortality in South Korea.


Assuntos
Mortalidade da Criança , Nascimento Prematuro/epidemiologia , Classe Social , Adulto , Criança , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Gravidez , Resultado da Gravidez/epidemiologia , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos
15.
PLoS Med ; 17(9): e1003285, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32931496

RESUMO

BACKGROUND: Biannual azithromycin distribution has been shown to reduce child mortality as well as increase antimicrobial resistance. Targeting distributions to vulnerable subgroups such as malnourished children is one approach to reaching those at the highest risk of mortality while limiting selection for resistance. The objective of this analysis was to assess whether the effect of azithromycin on mortality differs by nutritional status. METHODS AND FINDINGS: A large simple trial randomized communities in Niger to receive biannual distributions of azithromycin or placebo to children 1-59 months old over a 2-year timeframe. In exploratory subgroup analyses, the effect of azithromycin distribution on child mortality was assessed for underweight subgroups using weight-for-age Z-score (WAZ) thresholds of -2 and -3. Modification of the effect of azithromycin on mortality by underweight status was examined on the additive and multiplicative scale. Between December 2014 and August 2017, 27,222 children 1-11 months of age from 593 communities had weight measured at their first study visit. Overall, the average age among included children was 4.7 months (interquartile range [IQR] 3-6), 49.5% were female, 23% had a WAZ < -2, and 10% had a WAZ < -3. This analysis included 523 deaths in communities assigned to azithromycin and 661 deaths in communities assigned to placebo. The mortality rate was lower in communities assigned to azithromycin than placebo overall, with larger reductions among children with lower WAZ: -12.6 deaths per 1,000 person-years (95% CI -18.5 to -6.9, P < 0.001) overall, -17.0 (95% CI -28.0 to -7.0, P = 0.001) among children with WAZ < -2, and -25.6 (95% CI -42.6 to -9.6, P = 0.003) among children with WAZ < -3. No statistically significant evidence of effect modification was demonstrated by WAZ subgroup on either the additive or multiplicative scale (WAZ < -2, additive: 95% CI -6.4 to 16.8, P = 0.34; WAZ < -2, multiplicative: 95% CI 0.8 to 1.4, P = 0.50, WAZ < -3, additive: 95% CI -2.2 to 31.1, P = 0.14; WAZ < -3, multiplicative: 95% CI 0.9 to 1.7, P = 0.26). The estimated number of deaths averted with azithromycin was 388 (95% CI 214 to 574) overall, 116 (95% CI 48 to 192) among children with WAZ < -2, and 76 (95% CI 27 to 127) among children with WAZ < -3. Limitations include the availability of a single weight measurement on only the youngest children and the lack of power to detect small effect sizes with this rare outcome. Despite the trial's large size, formal tests for effect modification did not reach statistical significance at the 95% confidence level. CONCLUSIONS: Although mortality rates were higher in the underweight subgroups, this study was unable to demonstrate that nutritional status modified the effect of biannual azithromycin distribution on mortality. Even if the effect were greater among underweight children, a nontargeted intervention would result in the greatest absolute number of deaths averted. TRIAL REGISTRATION: The MORDOR trial is registered at clinicaltrials.gov NCT02047981.


Assuntos
Azitromicina/uso terapêutico , Transtornos da Nutrição Infantil/tratamento farmacológico , Transtornos da Nutrição Infantil/mortalidade , Antibacterianos/uso terapêutico , Peso Corporal , Mortalidade da Criança/tendências , Pré-Escolar , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Malária/tratamento farmacológico , Masculino , Administração Massiva de Medicamentos/métodos , Administração Massiva de Medicamentos/mortalidade , Níger/epidemiologia , Estado Nutricional , Magreza
16.
PLoS Med ; 17(9): e1003364, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32931499

RESUMO

In this Perspective, David Mabey and colleagues discuss a recent PLOS Medicine article on azithromycin as an intervention for reducing child mortality.


Assuntos
Azitromicina , Mortalidade da Criança , Criança , Humanos , Níger
17.
PLoS Med ; 17(9): e1003356, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32986711

RESUMO

BACKGROUND: Following a reduction in global child mortality due to communicable diseases, the relative contribution of congenital anomalies to child mortality is increasing. Although infant survival of children born with congenital anomalies has improved for many anomaly types in recent decades, there is less evidence on survival beyond infancy. We aimed to systematically review, summarise, and quantify the existing population-based data on long-term survival of individuals born with specific major congenital anomalies and examine the factors associated with survival. METHODS AND FINDINGS: Seven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, and citations of the included articles for studies published 1 January 1995 to 30 April 2020 were searched. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate. We included original population-based studies that reported long-term survival (beyond 1 year of life) of children born with a major congenital anomaly with the follow-up starting from birth that were published in the English language as peer-reviewed papers. Studies on congenital heart defects (CHDs) were excluded because of a recent systematic review of population-based studies of CHD survival. Meta-analysis was performed to pool survival estimates, accounting for trends over time. Of 10,888 identified articles, 55 (n = 367,801 live births) met the inclusion criteria and were summarised narratively, 41 studies (n = 54,676) investigating eight congenital anomaly types (spina bifida [n = 7,422], encephalocele [n = 1,562], oesophageal atresia [n = 6,303], biliary atresia [n = 3,877], diaphragmatic hernia [n = 6,176], gastroschisis [n = 4,845], Down syndrome by presence of CHD [n = 22,317], and trisomy 18 [n = 2,174]) were included in the meta-analysis. These studies covered birth years from 1970 to 2015. Survival for children with spina bifida, oesophageal atresia, biliary atresia, diaphragmatic hernia, gastroschisis, and Down syndrome with an associated CHD has significantly improved over time, with the pooled odds ratios (ORs) of surviving per 10-year increase in birth year being OR = 1.34 (95% confidence interval [95% CI] 1.24-1.46), OR = 1.50 (95% CI 1.38-1.62), OR = 1.62 (95% CI 1.28-2.05), OR = 1.57 (95% CI 1.37-1.81), OR = 1.24 (95% CI 1.02-1.5), and OR = 1.99 (95% CI 1.67-2.37), respectively (p < 0.001 for all, except for gastroschisis [p = 0.029]). There was no observed improvement for children with encephalocele (OR = 0.98, 95% CI 0.95-1.01, p = 0.19) and children with biliary atresia surviving with native liver (OR = 0.96, 95% CI 0.88-1.03, p = 0.26). The presence of additional structural anomalies, low birth weight, and earlier year of birth were the most commonly reported predictors of reduced survival for any congenital anomaly type. The main limitation of the meta-analysis was the small number of studies and the small size of the cohorts, which limited the predictive capabilities of the models resulting in wide confidence intervals. CONCLUSIONS: This systematic review and meta-analysis summarises estimates of long-term survival associated with major congenital anomalies. We report a significant improvement in survival of children with specific congenital anomalies over the last few decades and predict survival estimates up to 20 years of age for those born in 2020. This information is important for the planning and delivery of specialised medical, social, and education services and for counselling affected families. This trial was registered on the PROSPERO database (CRD42017074675).


Assuntos
Mortalidade da Criança/tendências , Anormalidades Congênitas/mortalidade , Nascimento Vivo , Adulto , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Parto/fisiologia , Gravidez , Sistema de Registros , Adulto Jovem
18.
PLoS One ; 15(8): e0237640, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804942

RESUMO

The child mortality rate is an essential measurement of socioeconomic growth and the quality of life in Ethiopia which is one among the six countries that account for half of the global under-five deaths. Therefore, this study aimed to identify the potential risk factors for child mortality in Ethiopia. Data for the study was drawn from the Ethiopian Demographic and Health Survey data conducted in 2016. A two-part random effects regression model was employed to identify the associated predictors of child mortality. The study found that 53.3% of mothers did not face any child death, while 46.7% lost at least one. Vaccinated child (IRR = 0.735, 95%CI: 0.647, 0.834), were currently using contraceptive (IRR = 0.885, 95%CI: 0.814, 0.962), who had antenatal care visit four or more times visit (IRR = 0.841, 95%CI: 0.737,0.960), fathers whose level of education is secondary or above(IRR = 0.695, 95%CI: 0.594, 0.814), mothers who completed their primary school(IRR = 0.785, 95%CI: 0.713, 0.864), mothers who have birth interval greater than 36 months (IRR = 0.728, 95%CI: 0.676, 0.783), where the age of the mother at first birth is greater than 16 years(IRR = 0.711, 95%CI: 0.674, 0.750) associated with the small number of child death. While multiple births (IRR = 1.355, 95%CI: 1.249, 1.471, four and above birth order (IRR = 1.487, 95%CI: 1.373, 1.612) and had working father (IRR = 1.125, 95%CI: 1.049, 1.206) associated with a higher number of child death. The variance components for the random effects showed significant variation of child mortality between enumeration areas. Policies and programs aimed at addressing enumeration area variations in child mortality need to be formulated and their implementation must be strongly pursued. Efforts are also needed to extend educational programmers aimed at educating mothers on the benefits of the antenatal checkup before first birth, spacing their birth interval, having their child vaccinated, and selecting a safe place of delivery to reduce child mortality.


Assuntos
Mortalidade da Criança , Análise Multinível/métodos , Criança , Estudos Transversais , Etiópia/epidemiologia , Pai/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Mães/estatística & dados numéricos , Análise de Regressão , Fatores de Risco , População Rural/estatística & dados numéricos , Vacinação/estatística & dados numéricos
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