Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 925
Filtrar
2.
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
3.
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
4.
Biodemography Soc Biol ; 65(3): 214-226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32727278

RESUMO

Reducing the mortality of children under-5 (U5) is an essential part of the Sustainable Development Goal (SDG). Although Bangladesh has made progress in reducing child mortality, there remain inequalities among different sociodemographic groups. Education is one particular key factor with a multidimensional impact on child health and survival. This study assessed the association between parental education and U5 mortality using repeated cross-sectional Bangladesh Demographic and Health Survey data. The risk of child death was substantially low among educated parents. Children of secondary or higher educated mother and father were about 30% (hazard ratio [HR] = 0.697, 95% confidence interval [CI] 0.596 to 0.815, p< .001) and 26% (HR = 0.738, 95% CI 0.635 to 0.858, p < .001), respectively, less likely to die early. Children from wealthier households and born to mothers with long birth spacings were less likely to face an early death. The study findings emphasize on imparting education to parents as an intervention strategy to continue the reduction of child mortality rate in Bangladesh, which could be a policy direction toward achieving the SDGs.


Assuntos
Mortalidade da Criança/tendências , Escolaridade , Pais/educação , Adolescente , Adulto , Bangladesh , Criança , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Modelos de Riscos Proporcionais
6.
BMC Public Health ; 20(1): 1117, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32678015

RESUMO

BACKGROUND: This study analyzed the trends and seasonality in mortality among children aged 0-14 years in Guangzhou, China during 2008-2018. Understanding the epidemiology of this public health problem can guide policy development for children mortality prevention. METHODS: A population-based epidemiological retrospective study was conducted. Seven thousand two hundred sixty-five individual data of children mortality were obtained from the Guangzhou Center for Disease Control and Prevention (CDC). The Poisson regression was used to quantify the annual average reduction rate and the difference in mortality rate between sex and age groups. Incidence ratio with 95% confidence interval (CI) was estimated to determine the temperaol variations in mortality by month, season, school term, day of the week and between holidays and other days. RESULTS: Between 2008 and 2018, the children mortality rate in Guangzhou decreased from 54.0 to 34.3 per 100,000 children, with an annual reduction rate of 4.6% (95% CI: 1.1%-8.1%), especially the under-5 mortality rate decreased by 8.3% (95% CI: 4.8%-11.6%) per year. Decline trends varied by causes of death, even with an upward trend for the mortality of asphyxia and neurological diseases. The risk of death among males children was 1.33 times (95% CI: 1.20-1.47) of that of females. The distribution of causes of death differed by age group. Maternal and perinatal, congenital and pneumonia were the top three causes of death in infants and cancer accounted for 17% of deaths in children aged 1-14 years. Moreover, the injury-related mortality showed significant temporal variations with higher risk during the weekend. And there was a summer peak for drowning and a winter peak for asphyxia. CONCLUSIONS: Guangzhou has made considerable progress in reducing mortality over the last decade. The findings of characteristics of children mortality would provide important information for the development and implementation of integrated interventions targeted specific age groups and causes of death.


Assuntos
Causas de Morte/tendências , Mortalidade da Criança/tendências , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Estações do Ano
7.
Pan Afr Med J ; 35(Suppl 1): 13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32373264

RESUMO

Introduction: Measles is a highly infectious vaccine-preventable viral disease that mostly affects children less than five years old. Jigawa located in the north-west zone has the highest burden of measles in Nigeria. We reviewed Jigawa State measles surveillance data to identify measles trend and factors associated with mortality. Methods: We conducted a secondary data analysis of measles specific integrated disease surveillance and response data for Jigawa State from January 2013 to December 2017. We extracted relevant variables and analyzed data using descriptive statistics and logistic regression model (α = 0.05). We estimated seasonal variation using an additive time series model. Results: A total of 6,214 cases were recorded with 1038 (16.7%) confirmed by laboratory investigation. Only 1,185 (19.7%) had at least one dose of measles vaccine. Age specific attack and fatality rates were highest among children under the age of five years (503/100,000 and 1.8% respectively). The trend showed a decrease in number of cases across all the years. Seasonal variation existed with cases peaking in the first quarter. The likelihood of mortality associated with measles was higher among cases who had no vaccination (AOR = 4.7, 95% CI: 2.9-7.5) than those who had at least one dose of measles vaccine. Conclusion: There was a decrease in the trend of measles cases, however, the vaccination coverage was very low in Jigawa State. Receiving at least one dose of measles vaccine reduces mortality among the cases. Strengthening routine immunization will reduce number of cases and mortality associated with the disease.


Assuntos
Vacina contra Sarampo/uso terapêutico , Sarampo/epidemiologia , Sarampo/mortalidade , Sarampo/prevenção & controle , Vacinação/tendências , Adolescente , Criança , Mortalidade da Criança/tendências , Pré-Escolar , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/tendências , Estudos Transversais , Surtos de Doenças , Feminino , Humanos , Incidência , Lactente , Masculino , Nigéria/epidemiologia , Vigilância da População/métodos , Estudos Retrospectivos , Fatores de Tempo , Vacinação/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Cobertura Vacinal/tendências , Adulto Jovem
8.
BMC Public Health ; 20(1): 707, 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32423476

RESUMO

BACKGROUND: Child mortality has been reduced by more than 50 % over the past 30 years. A range of secular economic and social developments have been considered to explain this phenomenon. In this paper, we examine the association between ratification of the Convention on the Rights of the Child (CRC), which was specifically put in place to ensure the well-being of children, and declines in child mortality. METHODS: Data come from three sources: the United Nations Treaty Series Database, the World Bank World Development Indicators database and, the Polity IV database. Because CRC was widely ratified, leaving few control cases, we used interrupted times series analyses, which uses the trend in the health outcome before policy exposure to mathematically determine what the trend in the health outcome would have been after the policy exposure, if it had continued 'as is' - meaning, if the policy exposure had not occurred. RESULTS: CRC ratification was associated with declining child mortality. CRC ratification was associated with a significant change in shorter-term child mortality trends in all groups except high-income, non-democratic countries and low-imcome democratic countries. CRC ratification was associated with long-term child mortality trends in all groups except middle-income, non-democratic countries. CONCLUSIONS: Child mortality rates would likely have declined even in the absence of CRC ratification, but CRC is associated with a larger decline. Our findings provide a way to assess the effects of widely-held societal norms on health and demonstrate the moderating effects of democracy and income level.


Assuntos
Defesa da Criança e do Adolescente/estatística & dados numéricos , Mortalidade da Criança/tendências , Normas Sociais , Serviço Social/organização & administração , Criança , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Nível de Saúde , Humanos , Lactente , Cooperação Internacional , Análise de Séries Temporais Interrompida , Política , Nações Unidas
10.
Lancet ; 395(10237): 1640-1658, 2020 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-32413293

RESUMO

BACKGROUND: India has made substantial progress in improving child survival over the past few decades, but a comprehensive understanding of child mortality trends at disaggregated geographical levels is not available. We present a detailed analysis of subnational trends of child mortality to inform efforts aimed at meeting the India National Health Policy (NHP) and Sustainable Development Goal (SDG) targets for child mortality. METHODS: We assessed the under-5 mortality rate (U5MR) and neonatal mortality rate (NMR) from 2000 to 2017 in 5 × 5 km grids across India, and for the districts and states of India, using all accessible data from various sources including surveys with subnational geographical information. The 31 states and groups of union territories were categorised into three groups using their Socio-demographic Index (SDI) level, calculated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study on the basis of per-capita income, mean education, and total fertility rate in women younger than 25 years. Inequality between districts within the states was assessed using the coefficient of variation. We projected U5MR and NMR for the states and districts up to 2025 and 2030 on the basis of the trends from 2000 to 2017 and compared these projections with the NHP 2025 and SDG 2030 targets for U5MR (23 deaths and 25 deaths per 1000 livebirths, respectively) and NMR (16 deaths and 12 deaths per 1000 livebirths, respectively). We assessed the causes of child death and the contribution of risk factors to child deaths at the state level. FINDINGS: U5MR in India decreased from 83·1 (95% uncertainty interval [UI] 76·7-90·1) in 2000 to 42·4 (36·5-50·0) per 1000 livebirths in 2017, and NMR from 38·0 (34·2-41·6) to 23·5 (20·1-27·8) per 1000 livebirths. U5MR varied 5·7 times between the states of India and 10·5 times between the 723 districts of India in 2017, whereas NMR varied 4·5 times and 8·0 times, respectively. In the low SDI states, 275 (88%) districts had a U5MR of 40 or more per 1000 livebirths and 291 (93%) districts had an NMR of 20 or more per 1000 livebirths in 2017. The annual rate of change from 2010 to 2017 varied among the districts from a 9·02% (95% UI 6·30-11·63) reduction to no significant change for U5MR and from an 8·05% (95% UI 5·34-10·74) reduction to no significant change for NMR. Inequality between districts within the states increased from 2000 to 2017 in 23 of the 31 states for U5MR and in 24 states for NMR, with the largest increases in Odisha and Assam among the low SDI states. If the trends observed up to 2017 were to continue, India would meet the SDG 2030 U5MR target but not the SDG 2030 NMR target or either of the NHP 2025 targets. To reach the SDG 2030 targets individually, 246 (34%) districts for U5MR and 430 (59%) districts for NMR would need a higher rate of improvement than they had up to 2017. For all major causes of under-5 death in India, the death rate decreased between 2000 and 2017, with the highest decline for infectious diseases, intermediate decline for neonatal disorders, and the smallest decline for congenital birth defects, although the magnitude of decline varied widely between the states. Child and maternal malnutrition was the predominant risk factor, to which 68·2% (65·8-70·7) of under-5 deaths and 83·0% (80·6-85·0) of neonatal deaths in India could be attributed in 2017; 10·8% (9·1-12·4) of under-5 deaths could be attributed to unsafe water and sanitation and 8·8% (7·0-10·3) to air pollution. INTERPRETATION: India has made gains in child survival, but there are substantial variations between the states in the magnitude and rate of decline in mortality, and even higher variations between the districts of India. Inequality between districts within states has increased for the majority of the states. The district-level trends presented here can provide crucial guidance for targeted efforts needed in India to reduce child mortality to meet the Indian and global child survival targets. District-level mortality trends along with state-level trends in causes of under-5 and neonatal death and the risk factors in this Article provide a comprehensive reference for further planning of child mortality reduction in India. FUNDING: Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.


Assuntos
Mortalidade da Criança/tendências , Carga Global da Doença/estatística & dados numéricos , Mortalidade Infantil/tendências , Causas de Morte , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Fatores de Risco
13.
BMC Health Serv Res ; 20(1): 313, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293429

RESUMO

BACKGROUND: Since 2009, the Chinese government has been reforming the healthcare system and has committed to reinforcing increased use of primary care. To date, however, the Chinese healthcare system is still heavily reliant on hospital-based specialty care. Studies consistently show an association between primary care and improved health outcomes, and the same association is also found among the disadvantaged population. Due to the "hukou" system, interprovincial migrants in the urban districts are put in a weak position and become the disadvantaged. Therefore, the aim of this study is to investigate whether greater supply and utilization of primary care was associated with reduced child mortality among the entire population and the interprovincial migrants in urban districts of Guangdong province, China. METHODS: An ecological study was conducted using a 3-year panel data with repeated measurements within urban districts in Guangdong province from 2014 to 2016, with 178 observations in total. Multilevel linear mixed effects models were applied to explore the associations. RESULTS: Higher visit proportion to primary care was associated with reductions in the infant mortality rate and the under-five mortality rate in both the entire population and the interprovincial migrants (p < 0.05) in the full models. The association between visit proportion to primary care and reduced neonatal mortality rate was significant among the entire population (p < 0.05) while it was insignificant among the interprovincial migrants (p > 0.05). CONCLUSIONS: Our ecological study based in urban districts of Guangdong province found consistent associations between higher visit proportion to primary care and improvements in child health among the entire population and the interprovincial migrants, suggesting that China should continue to strengthen and develop the primary care system. The findings from China adds to the previously reported evidence on the association between primary care and improved health, especially that of the disadvantaged.


Assuntos
Saúde da Criança/estatística & dados numéricos , Serviços de Saúde Comunitária/provisão & distribução , Serviços de Saúde Comunitária/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Mortalidade da Criança/tendências , Pré-Escolar , China/epidemiologia , Conjuntos de Dados como Assunto , Assistência à Saúde/organização & administração , Hospitais , Humanos , Lactente , Mortalidade Infantil/tendências , Migrantes/estatística & dados numéricos , População Urbana/estatística & dados numéricos
14.
Trop Med Int Health ; 25(6): 732-739, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32155683

RESUMO

BACKGROUND: There has been a global rise in interest and efforts to improve under-five mortality rates, especially in low- and middle-income countries. Ghana has made some progress in improving this outcome; however, the extent of such progress and its equity implications remains understudied. METHODS: This study used a joinpoint regression analysis to assess the significance of changes in trends of under-five mortality rates in Ghana between 1988 and 2017 using data from seven rounds of the Ghana Demographic and Health Survey. Annual percentage change (APC) was estimated. The APCs of different dimensions of equity (residence, administrative region, maternal education and wealth quintile) were compared by coincidence test - to determine similarity in joinpoint regression functions via 10 000 Monte Carlo resampling. RESULTS: There has been progress in reduction of under-five mortality in Ghana between 1988 and 2017 with an annual percentage change of -3.49%. Disaggregation of the trends showed that the most rapid improvement in under-five mortality rates occurred in the Upper East Region (APC = -5.0%). The closing of under-five mortality equity gaps in the study period has been uneven in the country. The gap between rural and urban rates has closed the most, followed by regional gaps (between Upper East and Ashanti Region), while the most persistent gaps remain in maternal education and wealth quintile. CONCLUSION: The findings suggest that programmatic interventions have been more successful in reducing geographic (rural-urban and by administrative region) than non-geographic (maternal education and wealth quintile) inequities in under-five mortality in Ghana. To accelerate reduction and bridge the inequities in under-five mortality, Ghana may need to pursue more social policies aimed at redistribution.


Assuntos
Mortalidade da Criança/tendências , Mortalidade Infantil/tendências , Pré-Escolar , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Lactente , Masculino , Análise de Regressão , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos
15.
East Mediterr Health J ; 26(2): 161-169, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32141593

RESUMO

Background: Child mortality rates are considered to be one of the key indicators of child health. Aims: The main objective of this research was to calculate child mortality rates (CMRs) indirectly, using census data, and to investigate using spatial pattern analysis the presence of any clustering patterns among provincial regions. Methods: The Trussell version of the Brass method and Coale-Demeny West model were used to estimate CMRs and life expectancy (LE) at birth. The analyses were performed using the QFive program of MORTPAK 4 software. For cluster analysis, local and global Moran's I indexes were measured. Results: Infant mortality rate, under-5 mortality rate, 1-4 mortality rate and LE at birth were estimated as 21.9, 26, 4.1 (deaths per 1000 live births) and 72.1 years, respectively. Global Moran's I index was calculated as 0.09, 0.09, 0.08 and 0.12, respectively. Conclusion: Special attention must be paid in provinces with high clusters regarding the evaluation of public health programmes, and the cause of failure of these programmes in reduction of childhood mortality indices.


Assuntos
Censos , Mortalidade da Criança , Expectativa de Vida , Mortalidade/tendências , Distribuição por Idade , Criança , Mortalidade da Criança/tendências , Pré-Escolar , Análise por Conglomerados , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Irã (Geográfico)/epidemiologia , Expectativa de Vida/tendências , Masculino , Análise Espacial
17.
PLoS Med ; 17(3): e1003054, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32176692

RESUMO

BACKGROUND: Education and health are both constituents of human capital that enable people to earn higher wages and enhance people's capabilities. Human capabilities may lead to fulfilling lives by enabling people to achieve a valuable combination of human functionings-i.e., what people are able to do or be as a result of their capabilities. A better understanding of how these different human capabilities are produced together could point to opportunities to help jointly reduce the wide disparities in health and education across populations. METHODS AND FINDINGS: We use nationally and regionally representative individual-level data from Demographic and Health Surveys (DHS) for 55 low- and middle-income countries (LMICs) to examine patterns in human capabilities at the national and regional levels, between 2000 and 2017 (N = 1,657,194 children under age 5). We graphically analyze human capabilities, separately for each country, and propose a novel child-based Human Development Index (HDI) based on under-five survival, maternal educational attainment, and measures of a child's household wealth. We normalize the range of each component using data on the minimum and maximum values across countries (for national comparisons) or first-level administrative units within countries (for subnational comparisons). The scores that can be generated by the child-based HDI range from 0 to 1. We find considerable heterogeneity in child health across countries as well as within countries. At the national level, the child-based HDI ranged from 0.140 in Niger (with mean across first-level administrative units = 0.277 and standard deviation [SD] 0.114) to 0.755 in Albania (with mean across first-level administrative units = 0.603 and SD 0.089). There are improvements over time overall between the 2000s and 2010s, although this is not the case for all countries included in our study. In Cambodia, Malawi, and Nigeria, for instance, under-five survival improved over time at most levels of maternal education and wealth. In contrast, in the Philippines, we found relatively few changes in under-five survival across the development spectrum and over time. In these countries, the persistent location of geographical areas of poor child health across both the development spectrum and time may indicate within-country poverty traps. Limitations of our study include its descriptive nature, lack of information beyond first- and second-level administrative units, and limited generalizability beyond the countries analyzed. CONCLUSIONS: This study maps patterns and trends in human capabilities and is among the first, to our knowledge, to introduce a child-based HDI at the national and subnational level. Areas of chronic deprivation may indicate within-country poverty traps and require alternative policy approaches to improving child health in low-resource settings.


Assuntos
Desenvolvimento Infantil , Saúde da Criança/tendências , Países em Desenvolvimento , Escolaridade , Disparidades nos Níveis de Saúde , Indicadores Básicos de Saúde , Determinantes Sociais da Saúde/tendências , Fatores Etários , Saúde da Criança/economia , Mortalidade da Criança/tendências , Pré-Escolar , Estudos Transversais , Países em Desenvolvimento/economia , Feminino , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde/tendências , Pobreza/tendências , Estudos Retrospectivos , Determinantes Sociais da Saúde/economia
18.
Glob Health Action ; 13(1): 1732668, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32114967

RESUMO

Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries - Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Saúde da Criança/estatística & dados numéricos , Mortalidade da Criança/tendências , Objetivos Organizacionais , Desenvolvimento Sustentável , Criança , Pré-Escolar , Feminino , Grupos Focais , Previsões , Saúde Global/estatística & dados numéricos , Humanos , Quênia , Libéria , Gravidez , Zâmbia , Zimbábue
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA