The Effects of Social Value on Child Mortality: the Case of El Sagrario Parish, Zacatecas, México, 1835-1845

BackgroundChild and neonatal mortality is a serious problem in Bangladesh. The main objective of this study was to determine the most significant socio-economic factors (covariates) between the years 2011 and 2014 that influences on neonatal and child mortality and to further suggest the plausible policy proposals.MethodsWe modeled the neonatal and child mortality as categorical dependent variable (alive vs death of the child) while 16 covariates are used as independent variables using χ2 statistic and multiple logistic regression (MLR) based on maximum likelihood estimate.FindingsUsing the MLR, for neonatal mortality, diarrhea showed the highest positive coefficient (β = 1.130; P < 0.010) leading to most significant covariate for both 2011 and 2014. The corresponding odds ratios were: 0.323 for both the years. The second most significant covariate in 2011 was birth order between 2-6 years (β = 0.744; P < 0.001), while father’s education was negative correlation (β = -0.910; P < 0.050). In general, 10 covariates in 2011 and 5 covariates in 2014 were significant, so there was an improvement in socio-economic conditions for neonatal mortality. For child mortality, birth order between 2-6 years and 7 and above years showed the highest positive coefficients (β = 1.042; P < 0.010) and (β = 1.285; P < 0.050) for 2011. The corresponding odds ratios were: 2.835 and 3.614, respectively. Father's education showed the highest coefficient (β = 0.770; P < 0.050) indicating the significant covariate for 2014 and the corresponding odds ratio was 2.160. In general, 6 covariates in 2011 and 4 covariates in 2014 were also significant, so there was also an improvement in socio-economic conditions for child mortality. This study allows policy makers to make appropriate decisions to reduce neonatal and child mortality in Bangladesh.ConclusionsIn 2014, mother’s age and father’s education were also still significant covariates for child mortality. This study allows policy makers to make appropriate decisions to reduce neonatal and child mortality in Bangladesh.

BackgroundIn India, excess female under-5 mortality is well documented. Under-5 mortality is also known to be patterned by socioeconomic factors. This study examines sex differentials and sex-specific wealth gradients in...

Post-2015 health goals: could country-specific targets supplement global ones?

The present review was intended to explore the effectiveness of perinatal services such as antenatal care (ANC) and post-natal care (PNC) on the health indicators such as maternal, child and neonatal mortality. Globally, indicators are considered very important in determining the health status and the overall performance of a country's healthcare system. A literature search was conducted using maternal mortality, child mortality, neonatal mortality, ANC and PNC in the PubMed, Google, Academia, The Lancet and Journal of the American Medical Association databases. Globally, implementing integrated perinatal care services has brought positive changes in the maternal, child and neonatal mortality indices. The United Nations (UN) is committed to improving the overall living conditions in all countries, significantly improving the population's health status. The UN came up with eight Millennium Development Goals in 2000, aiming to eliminate poverty and increase development in member states. The World Health Organization was a partner in implementing these goals. Later, the UN introduced 17-fold Sustainable Development Goals in 2015 as a blueprint for peace and prosperity for all citizens towards a better future by 2030. As a result, many countries have experienced positive changes in most indicator areas, including service utilisation, maternal mortality and child mortality. Some Sub-Saharan African and South Asian countries are progressing, however, slowly.

Maternal ethnic group, socioeconomic status, and neonatal and child mortality: a nationwide cohort study in England and Wales.

Child mortality remains a significant public health challenge particularly in developing countries of sub-Saharan Africa where around 50% of the global 6.3 million children die before their fifth birth day. Additionally, all the 16 countries with under-5 mortality rate of more than 100 per 1000 live births are located in sub-Saharan Africa and the region experienced one of the slowest annual rates of reduction in child mortality of 2.7% between 1990 and 2012 [1]. Of the 6.3 million child death estimated to have occurred worldwide in 2032, around 44% of these deaths took place during the neonatal period (i.e. within the first 28 days of life) and a further 75% of these neonatal deaths occurred during the first week of life (i.e. the early neonatal period) [2,3]. It follows that around 33% (or 2.1 million) of the global child death took place during the early neonatal period while the remaining 67% takes place in the remaining 1818 days. These deaths are substantial and targeting their determinants in the form of programmatic interventions will lead to significant reduction in child mortality overall. Therefore, strategies that promote better survival during the early neonatal period will have the greatest impact to reduce the overall child mortality as well as sustaining the progress made in reducing child mortality thus far. In Nigeria, child mortality continues to be a public health challenge despite adopting the various international health agendas aimed at reducing child mortality such as millennium development goals (MDGs), partnerships for maternal, neonatal and child health (PMNCH) and the Countdown Strategy. Despite keying into these programs, neonatal, infant, child and under-5 mortality rates remain high at 37, 69, 64 and 128 per 1000 live births respectively and Nigeria’s contribution to the global burden of child mortalityis immensely huge at around 13% (or 804,000 child deaths) in 2013 [4,5]. Nigeria’s contribution to global pool of child mortality has marginally decreased from 849,000 in 1990 to 827,000 in 2012 while there is a reversal in the expected decline as neonatal deaths increasing from 207, 000 to 267,000 during the same period [4]. Past literature on the subject matter have continued to give more emphasis on either under-five mortality [6-11] or on neonatal mortality [12,13] ignoring the significant proportion of early neonatal deaths as an important component of both Research Article Abstract

Addressing Gaps in Maternal, Neonatal, and Child Health for Achieving SDG 2030 in West Africa.

Background: Iraq has experienced decades of devastating wars and conflicts, which profoundly affected health including higher child mortality during 1990s. We examined the recent trends for child mortality and maternal, neonatal, child health and family planning (MNCH-FP) services since early 2000s during which Iraq also experienced war, invasions and conflicts. Methods: We conducted in-depth secondary data analyses using Multiple Indicator Cluster Surveys from 2006, 2011, and 2018. We examined national and subnational rates and trends for neonatal and under-five child mortality and 27 MNCH-FP indicators at national, regional and governorate levels. We used Lives Saved Tool (LiST) to model the impact of expanding coverage for child mortality reduction. Findings: From 2006 to 2018, under-five child mortality (U5MR) dropped from 40.9 to 27.1 deaths per 1,000 livebirths; neonatal mortality (NMR) declined from 21.6 to 13.3 deaths per 1,000 livebirths, with overall annual rate reductions (ARR) of 3.4% and 4.1%, respectively. ARRs were greater in Kurdistan (U5MR: 8.3%; NMR: 10.6%) compared to South/Central region (U5MR: 2.7%; NMR: 3.2%). Child mortality increased during post-2003 war and ISIS invasion periods. Analysis of governorates shows heterogeneity with limited progress in several governorates. LiST modeling suggests that universal scale up of MNCH interventions by 2030 could reduce 39% of child deaths in Iraq. Interpretation: Despite wars, conflicts, and invasions, Iraq demonstrated significant resilience and is poised to reach SDG-3.1 goals in upcoming years. However, significant inequity persists by regions, governorates, and socioeconomic variables. Addressing this is critical to strategically accelerate child mortality reduction in Iraq. Funding: UNICEF Iraq Office through contributions from the Government of Canada and Czech Republic. Declaration of Interest: All authors declare no competing interests.

Background:We aimed to measure changes in socioeconomic inequality in child mortality in Iran.Methods:A secondary data analysis of two Demographic and Health Surveys (DHS 2000 and 2010) was undertaken. Neonatal, infant and under-5 mortality rates were estimated directly from complete birth history. Economic quintiles were constructed using principal component analysis. Changes in inequality were measured using odds ratios, mortality rates, and concentration curves and indices.Results:Based on the compared measures, inequalities in neonatal, infant, and under-5 mortality declined between the two surveys. The poorest-to-richest neonatal, infant and under-5 mortality odds ratios in 2000 were 1.69 (95% CI= 1.3–2.07), 2.85 (95% CI= 1.96–4.1) and 1.98 (95% CI= 1.64–2.3), respectively. Whereas these mortality odds ratios in 2010 had fallen to 1.65 (95% CI= 0.95–2.9), 1.47 (95% CI=0.5–4) and 1.85 (95% CI=1.13–3), respectively. Moreover, mortality rates in all economic quintiles experienced a decreasing trend. Neonatal, infant, and under-5 mortality concentration indices in 2000 were −0.15, −0.26, and −0.17 respectively. Whereas concentration indices in 2010 had dropped to −0.13, −0.11, and −0.14, respectively. Concentration curves dominance test revealed that there was a statistically significant reduction in inequality in infant and under-5 mortalities.Conclusion:Despite substantial reduction in child mortality rates and narrowing of the gap between poor and rich people, socioeconomic inequality in child mortalities disfavoring worse-off groups still exists. Combination of child health-related efforts that aim to reach to those children born in poor households alongside with pro-equity programs in other sectors of society may further reduce infant, under-5, and particularly neonatal mortality across economic quintiles in Iran.

BackgroundSexual autonomy empowers women to set boundaries, take control of their bodies, prevent sexually transmitted diseases and avoid unplanned pregnancy. A woman’s ability to negotiate safer sex is crucial for her survival and that of her child. Sexual autonomy among East African women is vital to the elimination of the deaths of neonates, infants, and children. The aim of our study was to explore the association of sexual autonomy on neonatal, infant, and child mortality.MethodologyThis was a secondary analysis of demographic health survey (DHS) data on women of reproductive age (15–49 years) in five East African countries: Burundi, Kenya, Rwanda, Tanzania, and Uganda. Data on our outcome variables neonatal, infant, and under-five mortality which were in binary form was extracted from the database. Sexual autonomy was classified as a composite variable of “respondent can refuse sex,” “respondent can ask partner to use condom,” and “if spouse is justified in asking husband to use condom.” Other sociodemographic, maternal, health system and paternal variables were included in the analysis. STATA version 14 was used for analysis. Proportions and frequencies were used to describe the three outcome variables and sociodemographic characteristics. Chi-square tests were used to compare associations between sexual autonomy and categorical variables. Adjusted hazard ratios were used to determine the association between sexual autonomy and independent variables.ResultsThe sampled women were predominantly urban (75%; n = 5758) and poor (48.7%; n = 3702). A majority of those that experienced mortality (neonatal mortality 53.5%, infant mortality 54.3%, under-five mortality 55.7%) were young (under 20) at the time of their first child’s birth while their male partners were older. The multivariate analysis supports the beneficial effects of women’s sexual autonomy in East Africa. Women who exercised sexual autonomy experienced significantly lower rates of child mortality at all three stages: neonatal (NHR = 0.80, 95% CI: 0.68–0.94, p = 0.006), infant (IHR = 0.82, 95% CI: 0.72–0.93, p = 0.003), and under-five (UHR = 0.84, 95% CI: 0.75–0.94, p = 0.002), net of all other factors. Receiving antenatal care and using contraceptives also contributed significantly to lower child mortality rates.ConclusionOur findings suggest that sexual autonomy among East African women is an urgent priority that is crucial to the survival of neonates, infants, and children in East Africa. Women should be informed, empowered, and autonomous concerning their reproductive and sexual health.

Every newborn, every mother, every adolescent girl

Association of Undernutrition and Neonatal, Infant and Under-5 Mortality: Evidence from 62 Low-Income and Middle-Income Countries

SummaryBackgroundDuring the Millennium Development Goal (MDG) era, many countries in Africa achieved marked reductions in under-5 and neonatal mortality. Yet the pace of progress toward these goals substantially varied at the national level, demonstrating an essential need for tracking even more local trends in child mortality. With the adoption of the Sustainable Development Goals (SDGs) in 2015, which established ambitious targets for improving child survival by 2030, optimal intervention planning and targeting will require understanding of trends and rates of progress at a higher spatial resolution. In this study, we aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa.MethodsWe assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. We used a Bayesian geostatistical analytical framework to generate these estimates, and implemented predictive validity tests. In addition to reporting 5 × 5 km estimates, we also aggregated results obtained from these estimates into three different levels—national, and subnational administrative levels 1 and 2—to provide the full range of geospatial resolution that local, national, and global decision makers might require.FindingsAmid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8·8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030.InterpretationIn the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5 × 5 km estimates of child mortality in Africa provide a baseline against which local, national, and global stakeholders can map the pathways for ending preventable child deaths by 2030.FundingBill & Melinda Gates Foundation.

Child mortality is an important indicator of child health and overall national development. Under-five mortality is unacceptably high in Low- and Middle-Income Countries (LMICs) including Bangladesh. Increased availability and access to the healthcare services can play a significant role to reduce under-five mortality. The aim of this study was to explore the associations of several forms of child mortality with health facility level factors. Data were extracted from the 2017-18 Bangladesh Demographic and Health Survey data and 2017 Bangladesh Health Facility Survey data. Three outcome variables were considered: neonatal mortality, infant mortality, and under-five mortality in this study. Health facility level factors were considered as major explanatory variables. They were the availability of the child healthcare services at the nearest healthcare facility, readiness of the nearest healthcare facility to provide child healthcare services and the average distance of the nearest healthcare facility providing child healthcare services. Multilevel mixed-effect logistic regression model was used to determine the associations between the outcome variables and explanatory variables adjusted for covariates. We reported under-five, infant and neonatal mortality were 40, 37, and 30 per 1000 live births, respectively. The likelihood of neonatal and infant mortality was found to be declined for one-unit increase on the availability and readiness of the mothers’ homes nearest healthcare facilities to provide child healthcare services. On contrary, for every kilometre increased distance between mothers’ homes and their nearest healthcare facility was found to be associated with increased in the likelihoods of neonatal, infant and under-five mortality. The availability of health facilities providing child healthcare services close to residence and their improved management, infrastructure, and readiness to provide child healthcare services play a significant role in reducing under-five mortality in Bangladesh. Policies and programs should prioritize to increase the availability and accessibility of health facilities that provide child healthcare services.

In India, most child deaths now occur within the first 28 days of birth. Trends in socioeconomic disparities in death during these early and late neonatal stages over the past few decades have been understudied. This paper elucidates these trends in early neonatal and late neonatal mortality by household wealth and maternal education. We also examined these trends for post neonatal and child mortality, thereby examining the risk of death by socioeconomic status from birth until 59 months. Using data from five rounds of India's National Family Health Survey, we examined how the early neonatal, late neonatal, post neonatal and child mortality rates changed between 1993 and 2021 by household wealth and maternal education. We also examined how the absolute (difference in rates) and relative (ratio of rates) inequality between the highest and lowest socioeconomic groups changed for each outcome, and which children are on track to meet the Sustainable Development Goal targets. Despite large absolute reductions in early neonatal, late neonatal, post neonatal and child mortality, India's most vulnerable children remain at the highest risk of death as of 2021. Between 1993 and 2021, the absolute and relative socioeconomic inequality for early neonatal deaths increased. Now, most child deaths are among India's most vulnerable children in terms of household wealth and maternal education, and these children are not on track to meet the Sustainable Development Goal targets for early neonatal and post neonatal mortality. Our study highlights persistent socioeconomic inequalities in child death, and that these inequalities exist regardless of mortality stage. More pro poor policies and interventions are required to close these gaps. Doing so is essential for India to meet global targets.