Abstract
BackgroundTo 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.MethodsSpatially 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.ResultsAt 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.ConclusionSub-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.
Highlights
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
The aim of the present study was to estimate geographically varying associations of health interventions (i.e., control interventions against malaria, water, sanitation and hygiene (WASH), reproductive health, breastfeeding, vaccinations, micronutrient supplementation and treatments) with Under-five mortality (U5M) at the national and sub-national scale to identify interventions associated with the largest reduction in mortality at a sub-national scale, and to estimate hotspots of the U5M in Uganda
The discrepancies in U5M across regions suggest that mortality rates may be influenced by region-specific factors
Summary
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. Under-five mortality (U5M) is an important indicator of the social and economic development of a specific country or a smaller administrative unit [1]. Over the same 5-year period, the coverage of health interventions improved country-wide. The percentage of children receiving vitamin A supplements in the past 6 months increased from 36 to 57%. The percentage of children with fever 2 weeks prior to a survey who were given artemisinin-based combination therapy (ACT) increased from a mere 3% in 2006 to 69% in 2011. Coverage of other health interventions improved as well [2, 3]
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