Geographical Variation of the Effects of Child, Maternal and Household Health Interventions on Under-Five Mortality in Burkina Faso

Abstract

Background: Over the past 15 years, scaling up of cost effective interventions resulted in a remarkable decline of under-five mortality rates (U5MR) in sub-Saharan Africa. However, the reduction shows considerable heterogeneity. We assessed the effects of child, maternal, and household interventions on U5MR in Burkina Faso at national and subnational levels and identified the regions with least effective interventions. Methods: Data on health-related interventions and U5MR were extracted from the Burkina Faso Demographic and Health Survey (DHS) 2010. Bayesian geostatistical proportional hazards models with a Weibull baseline hazard were fitted on the mortality outcome. Spatially varying coefficients were considered to assess the geographical variation of the intervention effects. The analyses were adjusted for child, maternal, and household characteristics, as well as climatic and environmental factors. Findings: The average U5MR was as high as 128 per 1000 ranging from 81 (region of Centre-Est) to 223 (region of Sahel). At national level, DPT3, immunization, and baby postnatal check within 24 hours after birth had the most important effect on U5MR (hazard ratio (HR)=0·89, 95% Bayesian credible interval (BCI): 0·86-0·98 and HR=0·89, 95% BCI: 0·86-0·92, respectively). At sub-national level, the most effective interventions are the skilled birth attendance, and improved drinking water, followed by baby post-natal check within 24 hours after birth, vitamin A supplementation, antenatal care visit, and all-antigens immunization (including BCG, Polio3, DPT3, and measles immunization). Centre-Est, Sahel, and Sud-Ouest were the regions with the highest number of effective interventions. There was no intervention with statistically important effect on child survival in the Hauts Bassins region. Interpretation: The spatial variation of health interventions having the strongest effect on changes of U5MR raises the need to deliver and reinforce health interventions at a more granular level. Priority interventions are DPT3 immunization, skilled birth attendance, baby post-natal visits in the regions of Sud-Ouest, Sahel, and Hauts Bassins, respectively. Our methodology could be applied to other national surveys, as it allows an incisive, data-driven and specific decision-making approach to optimize the allocation of health interventions at subnational level. Funding: Swiss National Science Foundation (SNSF; Bern, Switzerland) and Swiss Development Cooperation (SDC; Bern, Switzerland). Declaration of Interest: We declare no competing interests.